Cornual or Interstitial Ectopic Pregnancy?

Min et al, mentioned in their published article that the cornual pregnancy is a rare ectopic pregnancy form which occurs in the upper lateral part portion of the uterus, and their studied cornual pregnancy cases were diagnosed at mean gestational age of 8 weeks and 6 days (7 cases of ruptured cornual pregnancies, and 41 cases of non-ruptured cornual pregnancies). The published Min et al, article may be confusing to the readers. William's textbook of Obstetrics defines cornual pregnancy as a pregnancy in a rudimentary horn of the uterus with Müllerian anomaly. Additionally, the cornual pregnancies are usually diagnosed at the mid-trimester of pregnancy 16 weeks for unruptured cornual pregnancies, and 20-21 weeks for ruptured cornual pregnancies.

The relationship between vitamin D and adolescents' parathyroid hormone and bone mineral density.

Introduction: To detect the relationship between 25-hydroxy vitamin D (25(OH)D) and adolescents' parathyroid hormone (PTH) and bone mineral density (BMD). Material and methods: Two hundred adolescent girls were recruited for this cross-sectional comparative study. After detailed evaluation, a pelvic sonography was performed for the studied adolescents to rule out any pelvic pathology. Adolescents' blood samples were collected to measure the thyroid stimulating hormone, prolactin, glycosylated haemoglobin (HbA1C), PTH, and 25(OH)D. The studied adolescents' BMD and the T-score were evaluated at 2 anatomical sites. The studied adolescents were classified according to their serum 25(OH)D into 2 groups: a 25(OH)D-deficient group (study group; 25(OH)D < 20 ng/ml) and normal controls (25(OH)D > 30 ng/ml). Student's t-test was used for analysis of the studied adolescents' variables, and correlation analysis (Pearson`s correlation) was used to detect the relationship between 25(OH)D and adolescents' PTH and BMD. Results: The parathyroid hormone was statistically higher in the 25(OH)D-deficient group than in the normal controls (41.3 ±3.4 pg/ml vs. 21.1 ±2.8) (p = 0.02), and the BMD was statistically lower in the 25(OH)D-deficient group than in the normal controls (-1.25 ±0.5 vs. 0.3 ±0.4) (p = 0.01). The 25(OH)D had a significant negative correlation with the adolescents' PTH (r = -0.9175; p < 0.00001) and a significant positive correlation with the adolescents' BMD (r = 0.756; p < 0.00001). The parathyroid hormone had a significant negative correlation with the adolescents' BMD (r = -0.7006; p < 0.00001). Conclusions: The parathyroid hormone in this study had significant negative correlations with both 25(OH)D and BMD. The 25(OH)D had a significant positive correlation with the studied adolescents' BMD.

Regarding cornual pregnancy as a rare entity of ectopic pregnancy: A case report.

The published Toumi et al's article is somewhat confusing to the readers. The cornual pregnancy (CP) defined as a pregnancy that occurs in a rudimentary horn of a uterus with a Müllerian anomaly according to William's textbook. The interstitial ectopic pregnancy (IEP) occurs in the interstitial part of the fallopian tube where it crosses the uterine muscular to enter the uterine cavity. The IEP sonographic findings include an empty uterus with an eccentrically placed gestational sac, located ≥1 cm from the endometrial margin and bordered by ≤ 5 mm myometrial rim.

Relation between Guillain-Barré syndrome and Covid-19: Case-Series.

Approximately two-thirds of the Guillain-Barré syndrome (GBS) cases are preceded by upper respiratory tract infection or enteritis. There has been previous documentation of a clear association between Covid-19 and GBS. Covid-19 can affect the nervous tissue either through direct damage or through triggering a host immune response with subsequent development of autoimmune diseases such as GBS. Covid-19 can affect the host`s immune system through the activation and interaction of the T-and B-lymphocytes with subsequent production of antibodies that cross-react with the gangliosides. Depending on the nature of the neuronal autoimmune destruction, the affected individual may have either a demyelinating or axonal subtype of GBS. These subtypes differ not only in symptoms but also in the likelihood of recovery. This report presents two cases of GBS that developed after the respiratory symptoms of Covid-19. Their neurological features indicated demyelination, axonal damage, irritation of spinal nerve roots, and impaired sensory and motor transmission with additional facial nerve palsy in the second-studied case. This case report highlights the relationship between GBS and Covid-19 infection.

The relation between serum uric acid and severity of preeclampsia in pregnant women: a cross-sectional study.

Introduction: There are conflicting data regarding the relation between serum uric acid (SUA) and severity of preeclampsia (PE). The aim of the study was to assess the relation between SUA and the severity of PE. Material and methods: A total of 110 pregnant women were studied; 55 with mild PE were compared to 55 women with severe PE in this cross-sectional study, which was conducted in Maternity Hospital. After thorough evaluation and renal function tests, spot urine samples were taken from participants for the protein/creatinine ratio. The urine proteins were measured by the Biuret colorimetric method. The urine creatinine was measured by the modified Jaffe test. The serum uric acid was measured by the enzymatic method. The collected participants' data were statistically analysed, and Pearson's coefficient was used to detect the relation between SUA and severity of PE. Results: The serum uric acid was significantly higher in the severe PE group (7.65 ±0.61 mg/dl) compared to the mild PE group (5.26 ±0.79 mg/dl), (p = 0.04). There were significant positive relations between the SUA and both the systolic and diastolic blood pressures [r = 0.27 (p = 0.045) and r = 0.483 (p < 0.001), respectively] in the severe PE group. There were also significant positive relations between the SUA and both the systolic and diastolic blood pressures [r = 0.359 (p = 0.007) and r = 0.429 (p = 0.001), respectively] in the mild PE group. Conclusions: There were significant positive relations between the SUA and both the systolic and dia-stolic blood pressures in the severe PE group. This study recommends the use of SUA as a reliable marker of the severity of PE.

Maternal and fetal outcomes after bariatric surgeries.

Introduction: Obesity is the most common medical problem affecting reproductive-age women. To detect the prevalence of obesity, and bariatric surgeries (BSs) in reproductive-age women, and the impact of obesity vs. BSs on the subsequent pregnancy outcomes. Material and methods: Obese-pregnant women, and women underwent BSs before the current pregnancy, with complete antenatal, and delivery records were included in the current study. Collected data were analyzed using MedCalc 20.106 to calculate the odd ratio (OR), and relative risk (RR) of adverse maternal, and fetal outcomes in relation to maternal obesity vs. BSs. Results: Data of 14,474 pregnant women were collected during this study; 33.94% (4912/14474) of them were obese, and 3.8% (546/14474) of them had previous BSs before the current pregnancy. The obese group has significantly higher odds, and RR of gestational diabetes mellitus (GDM) [OR 1.9 (p = 0.0001), and RR 1.79 (p = 0.0001)], gestational hypertension [OR 1.7 (p = 0.0002), and RR 1.6 (p = 0.0003)], and preeclampsia (PE) [OR 1.7 (p = 0.0001), and RR 1.6 (p = 0.0001)] compared to BSs group. The obese group has also significantly higher odds, and RR of cesarean sections (CSs) [OR 1.3 (p = 0.008), and RR 1.25 (p = 0.01)], and large for gestational age [OR 1.39 (p = 0.01), and RR 1.3 (p = 0.02)] compared to BSs group. Conclusions: About 33.94% of the reproductive-age women in Kuwait are obese, and 3.8% of them had previous BSs. Obese-pregnant women are at increased risks of GDM, gestational hypertension, PE, and CSs. Bariatric surgeries reduced the rates of GDM, gestational hypertension, PE, and CSs significantly.

The relation between primary dysmenorrhea in adolescents and body mass index.

Introduction: The aim was to assess the relation between primary dysmenorrhea in adolescents and body mass index (BMI). Material and methods: Two-hundred and ten adolescents were recruited for this cross-sectional research. After detailed evaluation, pelvic sonography was performed for the studied adolescents to rule out any pelvic abnormalities and/or lesion(s). The severity of the studied adolescents' dysmenorrhea was assessed by the visual analogue scale (VAS). The studied adolescents were divided into underweight, normal-weight, overweight, and obese adolescent groups based on their BMI (kg/m2). Collected data were analyzed using the ANOVA test, and correlation analysis (Pearson's correlation) to assess the relation between primary dysmenorrhea in adolescents and BMI. Results: The visual analogue scale of dysmenorrhea was statistically higher in the underweight adolescent group (8.7 ±0.8) compared to normal-weight (6.5 ±0.5) (p = 0.000001), and overweight (6.3 ±0.6) (p = 0.000001) adolescent groups. The visual analogue scale of dysmenorrhea was also statistically higher in the obese adolescent group (9.4 ±0.6) compared to underweight (8.7 ±0.8) (p = 0.000001), normal-weight (6.5 ±0.5) (p = 0.000001), and overweight (6.3 ±0.6) (p = 0.000001) adolescent groups. Conclusions: The visual analogue scale of dysmenorrhea was statistically higher in the underweight adolescent group compared to normal-weight, and overweight adolescent groups, and there was a strong negative relation between the VAS and BMI in the underweight adolescent group. In addition, the VAS of dysmenorrhea was statistically higher when the obese adolescent group was compared with the overweight, normal-weight and underweight adolescent groups, and there was a moderate positive relation between the VAS and BMI in the obese adolescent group.

Vitamin D and vitamin D receptor polymorphism in Asian adolescents with primary dysmenorrhea.

BACKGROUND: The expression of vitamin D receptor in the normal endometrium and ovaries supports the role of vitamin D in local immunity and inflammatory cytokines regulation. OBJECTIVE: This study aimed to detect the relation between serum 25(OH)D and primary dysmenorrhea in Asian Adolescents. METHODS: Two hundred and five (205) adolescents complaining of primary dysmenorrhea (study group) were compared in this prospective study to matched controls (210 controls) after informed consent following the Helsinki Declaration. After thorough evaluation, including a thorough history and pelvic ultrasound examination, blood samples were collected from the studied adolescents to measure serum 25(OH)D and for vitamin D receptor TaqI (rs731236) genotyping. The studied adolescents' data were analyzed using the Pearson's correlation to detect the relation between serum 25(OH)D and primary dysmenorrhea (primary outcome). The secondary outcome measures the odds of primary dysmenorrhea in Asian adolescents with vitamin D receptor TaqI (rs731236) polymorphism. RESULTS: The serum 25(OH)D was significantly lower in the studied-dysmenorrhea group compared to controls (16.17 ± 7.36 versus 17.65 ± 6.36 ng/ml, respectively), (P = 0.01). The correlation analysis showed a significant negative correlation between the serum 25(OH)D and visual analogue scale of dysmenorrhea (r = -0.9003, P < 0.0001). The studied-dysmenorrhea cases with vitamin D receptor T/t and t/t genotypes had significantly lower serum 25(OH)D (16.7 ± 8.05 and 14.4 ± 4.1 ng/ml, respectively) compared to controls (18.97 ± 6.7 and 21.4 ± 2.45 ng/ml, respectively), (P = 0.02 and 0.004, respectively). The VDR T/t and t/t polymorphisms significantly increase the odds of primary dysmenorrhea (OR 1367.2, P < 0.0001 and OR 106.2, P = 0.001, respectively). CONCLUSION: The serum 25(OH)D was significantly lower in the studied-dysmenorrhea group compared to controls. The studied-dysmenorrhea cases with VDR T/t and t/t TaqI genotypes had significantly lower serum 25(OH)D compared to controls. The VDR T/t and t/t polymorphisms significantly increase the odds of primary dysmenorrhea.

Intraperitoneally Retained Contraceptive Device After Uterine Perforation: A Case Report.

A 29-year-old parous woman with a history of a T-shaped copper intrauterine device (IUD) insertion presented 8 months later with a complaint of the contraceptive device being missing. Computed tomography with contrast turned out to be superior to the combined abdominal and pelvic X-ray and transvaginal ultrasound in providing the detailed extrauterine location of the device between the urinary bladder and uterus. A laparoscopy was successful in the atraumatic freeing of the IUD from omental and bladder adhesions, and in its final removal.

Efficacy of ferric carboxy maltose in treatment of iron deficiency/iron deficiency anaemia during pregnancy.

Introduction: To evaluate the efficacy of ferric carboxy maltose (FCM) in the treatment of iron deficiency/iron deficiency anaemia (ID/IDA) during pregnancy. Material and methods: Pregnant women ≥ 20 years old diagnosed with ID (serum ferritin < 15 µg/l) and moderate IDA were included in this study for correction of their ID/IDA. The participants received an FCM infusion for correction of their ID/IDA. The pre-treatment ferritin, haemoglobin (Hb), and red blood cell (RBC) indices were compared with the 6- and 12-week post-treatment values to evaluate the efficacy of FCM in the treatment of ID/IDA during pregnancy. Results: The pre-treatment ferritin and Hb significantly increased from 10.3 ±2.3 µg/l and 7.99 ±0.6 g/dl, respectively, to 139.5 ±1.9 and 14.04 ±0.45, respectively, 6-weeks after FCM infusion (p = 0.02 and 0.001, respectively), and to 128.9 ±1.7 and 13.02 ±0.5, respectively, 12-weeks after FCM infusion (p = 0.0008 and 0.02, respectively). In addition, the pre-treatment RBCs mean corpuscular volume and RBCs mean corpuscular haemoglobin (MCH) significantly increased from 72.02 ±3.5 fl and 23.9 ±1.9 pg, respectively, to 90.6 ± 2.8 fl and 29.98 ±1.5 pg, respectively, 6 weeks after FCM infusion (p = 0.01 and p = 0.007, respectively), and to 89.5 ±2.9 fl and 30.2 ±1.5 pg, respectively, 12 weeks after FCM infusion (p = 0.02 and 0.007 respectively). Conclusions: The ferric carboxy maltose was safe and effective for the treatment of ID/IDA during pregnancy within 6 weeks. The serum ferritin and Hb levels and the RBC indices remained significantly high 12 weeks after FCM infusion compared to the pre-treatment values.

Relationship between routine urinary catheterization and postoperative urinary symptoms and urinary tract infections in women undergoing elective caesarean section.

Introduction: The aim of the study was to detect the relationship between routine urinary catheterization and postoperative urinary symptoms and urinary tract infections (UTIs) in women undergoing elective caesarean sections (ECSs). Material and methods: One hundred women undergoing ECSs were included in this observational study and randomized into a catheterized (C) group, including women who underwent ECS after insertion of indwelling Foley's catheter, and a non-catheterized (NC) group, including women who underwent ECS without Foley's catheter. The Foley's catheters were removed from all participants in the C group once they were freely ambulant and had recovered from the effect of the spinal anaesthesia. Participants were asked about any abnormal postoperative urinary symptoms (dysuria, frequency, urgency, and/or urinary retention), and to collect urine samples (mid-stream) once they were freely ambulant for urine cultures. Results: The postoperative dysuria, frequency, and urgency were significantly higher in the C group compared to the NC group [36% (18/50), 40% (20/50), and 34% (17/50) vs. 8% (4/50), 6% (3/50), and 6% (3/50), respectively], (p = 0.006, 0.001 and 0.004, respectively). The urinary tract infections and the postoperative antimicrobials used were significantly higher in the C group compared to the NC group [40% (20/50) and 40% (20/50) vs. 6% (3/50) and 6% (3/50), respectively], (p = 0.001 and 0.001, respectively). The postoperative hospital-stay after the ECSs was significantly higher in the C group compared to the NC group (5.4 ±1.8 days vs. 3.8 ±1.15, respectively), (p = 0.001). Conclusions: Routine urinary catheterizations in women undergoing ECS significantly increase the odds of postoperative dysuria, frequency, urgency, UTIs, and the postoperative antimicrobials used.

Relationship between vitamin D and adolescents' hypothyroidism - a cross-sectional study.

Introduction: To detect the relationship between 25(OH)D and hypothyroidism in adolescents. Material and methods: A total of 180 adolescents were included in the current study, which was conducted in West Kazakhstan (Aktobe) over 2 years. After thorough evaluation, blood samples were collected from the studied participants to measure the thyroid stimulating hormone (TSH), free thyroxine (T4), prolactin, glycosylated haemoglobin, and 25(OH)D. Participants were classified into a 25(OH)D-deficient group (study group) and controls. MedCalc and correlation analysis (Pearson's correlation) were used to detect the odds of hypothyroidism and the relationship between 25(OH)D and adolescents' hypothyroidism, respectively. Results: Thyroid-stimulating hormone was statistically higher in the 25(OH)D-deficient group than in the normal controls (3.71 ±1.4 mIU/ml vs. 2.67 ±0.99) (p = 0.0006), and the free T4 was statistically lower in the 25(OH)D-deficient group than in normal controls (1.4 ±0.56 ng/ml vs. 1.5 ±0.4) (p = 0.0008). The 25(OH)D deficient group had higher odds of subclinical (OR 4.89; p = 0.016), and clinical hypothyroidism (OR 4.3; p = 0.013) compared to controls. A significant negative correlation between the 25(OH)D and TSH (r = -0.793; p < 0.00001), and a significant positive correlation between the 25(OH)D and free T4 (r 0.55; p < 0.00001) were detected in this study. Conclusions: The thyroid-stimulating hormone was statistically higher and the free T4 was statistically lower in the 25(OH)D-deficient group than in normal controls. The 25(OH)D-deficient group had higher odds of both subclinical and clinical hypothyroidism compared to controls. A significant negative correlation between the 25(OH)D and TSH, and a significant positive correlation between the 25(OH)D and the free T4 were detected in this study.

Relation between vitamin D and adolescents' serum prolactin.

Introduction: To detect whether there is a relation between vitamin D (Vit. D) and adolescents' serum prolactin (PRL) or not. Material and methods: Hundred and seventy-six adolescent girls were recruited for the current study, which was conducted in West Kazakhstan (Aktobe) over two years. After thorough evaluation, blood samples were taken from adolescents to measure thyroid stimulating hormone (TSH), free thyroxine (T4), PRL, glycosylated hemoglobin and 25(OH)D. The studied adolescents were classified into study group [25(OH)D deficient] and controls [normal 25(OH)D]. The acquired adolescents' variables were analyzed using the Student t-test and Pearson's correlation. Results: The serum TSH and PRL were statistically higher in the study group than normal controls (3.73 ±1.45 mIU/ml and 47.5 ±7.6 ng/ml vs. 2.67 ±1.0 and 10.8 ±5.1, respectively), (p = 0.0003 and p = 0.0001, respectively). The free T4 was statistically lower in the study group than normal controls (1.4 ±0.6 ng/ml vs. 1.5 ±0.4), (p = 0.0001). Strong negative associations between the serum PRL and 25(OH)D [r = -0.803 (p < 0.00001)], and between the serum PRL and free T4 [r = -0.6959 (p < 0.00001)] were detected in this study. Additionally, there was a strong positive association between the serum PRL and TSH [r = 0.8137 (p < 0.00001)]. Conclusions: A strong negative association between the serum PRL and 25(OH)D and a strong positive association between the serum PRL and TSH were detected in this study. This study recommends further studies to confirm the relation between Vit. D and PRL and screening Vit. D deficient adolescents for PRL and thyroid disorders.