New record of Philometra species from the marine edible fish Terapon jarbua collected from the Sindh, Arabian Sea, Pakistan.

Diseases in fish due to helminth parasites, especially Philometra species, are the primary worry in aquaculture. Philometra are responsible for health problem in fishes they directly affect fish growth and population parameters. A comprehensive survey was conducted involving the examination of the marine fish species Terapon jarbua, gathered from the coastal waters of Sindh, Pakistan In this research different Philometra species from marine fish Terapon jarbua during 2021 and 2022. Philometra nematodes, belonging to the family Philometridae, are common parasitic organisms inhabiting both marine and freshwater environments. Their prevalence, particularly when existing in high numbers within host organisms, can lead to severe and potentially lethal consequences. Employing light microscopy techniques, diverse species of Philometra were identified, including Philometra teraponi, P. jarbuai, P. arabiai, P. karachii, and P. awarii, localized primarily within the ovaries of the host fish. A total of 140 fish samples were examined and 76 were infected. The intensity of infected fish was 54.28%. The identification process encompassed meticulous analysis of crucial parameters, such as body size, esophagus length, positioning of the nerve ring, dimensions of the ventriculus, and ligament size. Intriguingly, the parasites were found in varying contexts; while some were free within the ovaries, others were embedded within tissues, inducing severe muscular dystrophy. This research presents novel findings of Philometra nematodes in the marine waters of Pakistan, extending their host and geographical distribution records. Future studies are needed to better evaluate and describe the dynamics and the epidemiology of Philometra infection in wild and cultured fish species.

Biodiversity of commercially important finfish species caught by mid-water and bottom trawls from two different coasts of Arabian Sea: threats and conservation strategies / Biodiversidade de espécies de peixes comercialmente importantes capturadas por redes de arrasto de médio e fundo do Baluchistão e costas de Sindh do mar da Arábia no Paquistão: ameaças e estratégias de conservação

This study was conducted to estimate the diversity and the occurrence of commercially important finfish species collected by twenty fish sampling site of Sindh and Baluchistan coasts of the Arabian Sea in Pakistan from January to December 2019. Additionally, physicochemical characteristics of seawater were analyzed from these selected sites and found to be within suitable ranges required for fish growth and survive. A total of 81287 fish individuals were collected and identified as 49 species belonging to 26 families in our study. The most diversified family was Sparidae (13 species) followed by Carangidae and Lutjanidae (4 species), Mullidae, Serranidae, Ariidae (3 species), and Sciaenidae (2 species). The remaining 20 families were represented by only one species. The values of Shannon diversity index calculated for the four selected habitats revealed that high fish diversity was reported at Sonmiani Coast (H’=1.81), while less at Ormara Coast (H’=0.23). Likewise, Evenness index (E) was high at Sonmiani Coast (E=0.50) and less fish diversity was reported at Ormara Coast (E=0.06). Reducing risks to threatened marine species in coastal habitats also requires conservation actions at multiple scales. Thus, it was concluded that our study could be valuable in providing the more information’s regarding to the diversity of finfish species and their occurrence along the Pakistan Coast. Further, to better understand the effects, regular monitoring and conservation measures should be taken to mitigate the influence of anthropogenic activities and protect finfish diversity from further decline.

Este estudo foi conduzido para estimar a diversidade e a ocorrência de espécies de peixes comercialmente importantes coletadas por vinte locais de amostragem de peixes nas costas de Sindh e Baluchistão do mar da Arábia, no Paquistão, de janeiro a dezembro de 2019. Além disso, as características físico-químicas da água do mar foram analisadas a partir desses peixes locais selecionados e considerados dentro dos intervalos adequados necessários para o crescimento e sobrevivência dos peixes. Um total de 8.1287 indivíduos de peixes foi coletado e identificado como 49 espécies pertencentes a 26 famílias em nosso estudo. A família mais diversificada foi Sparidae (13 espécies), seguida por Carangidae e Lutjanidae (4 espécies), Mullidae, Serranidae, Ariidae (3 espécies) e Sciaenidae (2 espécies). As 20 famílias restantes foram representadas por apenas uma espécie. Os valores do índice de diversidade de Shannon calculados para os quatro habitats selecionados revelaram que uma alta diversidade de peixes foi relatada na costa Sonmiani (H’ = 1,81), enquanto menos na costa Ormara (H’ = 0,23). Da mesma forma, o índice de regularidade (E) foi alto na costa de Sonmiani (E = 0,50) e menos diversidade de peixes foi relatada na costa de Ormara (E = 0,06). A redução dos riscos para as espécies marinhas ameaçadas em habitats costeiros também requer ações de conservação em várias escalas. Assim, concluiu-se que nosso estudo pode ser valioso para fornecer mais informações sobre a diversidade de espécies de peixes finos e sua ocorrência ao longo da costa do Paquistão. Além disso, para compreender melhor os efeitos, medidas regulares de monitoramento e conservação devem ser tomadas para mitigar a influência das atividades antropogênicas e proteger a diversidade de peixes finos de um declínio maior.

Biodiversity of commercially important finfish species caught by mid-water and bottom trawls from two different coasts of Arabian Sea: Threats and conservation strategies

Abstract This study was conducted to estimate the diversity and the occurrence of commercially important finfish species collected by twenty fish sampling site of Sindh and Baluchistan coasts of the Arabian Sea in Pakistan from January to December 2019. Additionally, physicochemical characteristics of seawater were analyzed from these selected sites and found to be within suitable ranges required for fish growth and survive. A total of 81287 fish individuals were collected and identified as 49 species belonging to 26 families in our study. The most diversified family was Sparidae (13 species) followed by Carangidae and Lutjanidae (4 species), Mullidae, Serranidae, Ariidae (3 species), and Sciaenidae (2 species). The remaining 20 families were represented by only one species. The values of Shannon diversity index calculated for the four selected habitats revealed that high fish diversity was reported at Sonmiani Coast (H'=1.81), while less at Ormara Coast (H'=0.23). Likewise, Evenness index (E) was high at Sonmiani Coast (E=0.50) and less fish diversity was reported at Ormara Coast (E=0.06). Reducing risks to threatened marine species in coastal habitats also requires conservation actions at multiple scales. Thus, it was concluded that our study could be valuable in providing the more informations regarding to the diversity of finfish species and their occurrence along the Pakistan Coast. Further, to better understand the effects, regular monitoring and conservation measures should be taken to mitigate the influence of anthropogenic activities and protect finfish diversity from further decline

Resumo Este estudo foi conduzido para estimar a diversidade e a ocorrência de espécies de peixes comercialmente importantes coletadas por vinte locais de amostragem de peixes nas costas de Sindh e Baluchistão do mar da Arábia, no Paquistão, de janeiro a dezembro de 2019. Além disso, as características físico-químicas da água do mar foram analisadas a partir desses peixes locais selecionados e considerados dentro dos intervalos adequados necessários para o crescimento e sobrevivência dos peixes. Um total de 8.1287 indivíduos de peixes foi coletado e identificado como 49 espécies pertencentes a 26 famílias em nosso estudo. A família mais diversificada foi Sparidae (13 espécies), seguida por Carangidae e Lutjanidae (4 espécies), Mullidae, Serranidae, Ariidae (3 espécies) e Sciaenidae (2 espécies). As 20 famílias restantes foram representadas por apenas uma espécie. Os valores do índice de diversidade de Shannon calculados para os quatro habitats selecionados revelaram que uma alta diversidade de peixes foi relatada na costa Sonmiani (H' = 1,81), enquanto menos na costa Ormara (H' = 0,23). Da mesma forma, o índice de regularidade (E) foi alto na costa de Sonmiani (E = 0,50) e menos diversidade de peixes foi relatada na costa de Ormara (E = 0,06). A redução dos riscos para as espécies marinhas ameaçadas em habitats costeiros também requer ações de conservação em várias escalas. Assim, concluiu-se que nosso estudo pode ser valioso para fornecer mais informações sobre a diversidade de espécies de peixes finos e sua ocorrência ao longo da costa do Paquistão. Além disso, para compreender melhor os efeitos, medidas regulares de monitoramento e conservação devem ser tomadas para mitigar a influência das atividades antropogênicas e proteger a diversidade de peixes finos de um declínio maior.

Biodiversity of commercially important finfish species caught by mid-water and bottom trawls from two different coasts of Arabian Sea: Threats and conservation strategies / Biodiversidade de espécies de peixes comercialmente importantes capturadas por redes de arrasto de médio e fundo do Baluchistão e costas de Sindh do mar da Arábia no Paquistão: Ameaças e estratégias de conservação

Abstract This study was conducted to estimate the diversity and the occurrence of commercially important finfish species collected by twenty fish sampling site of Sindh and Baluchistan coasts of the Arabian Sea in Pakistan from January to December 2019. Additionally, physicochemical characteristics of seawater were analyzed from these selected sites and found to be within suitable ranges required for fish growth and survive. A total of 81287 fish individuals were collected and identified as 49 species belonging to 26 families in our study. The most diversified family was Sparidae (13 species) followed by Carangidae and Lutjanidae (4 species), Mullidae, Serranidae, Ariidae (3 species), and Sciaenidae (2 species). The remaining 20 families were represented by only one species. The values of Shannon diversity index calculated for the four selected habitats revealed that high fish diversity was reported at Sonmiani Coast (H'=1.81), while less at Ormara Coast (H'=0.23). Likewise, Evenness index (E) was high at Sonmiani Coast (E=0.50) and less fish diversity was reported at Ormara Coast (E=0.06). Reducing risks to threatened marine species in coastal habitats also requires conservation actions at multiple scales. Thus, it was concluded that our study could be valuable in providing the more information's regarding to the diversity of finfish species and their occurrence along the Pakistan Coast. Further, to better understand the effects, regular monitoring and conservation measures should be taken to mitigate the influence of anthropogenic activities and protect finfish diversity from further decline

Resumo Este estudo foi conduzido para estimar a diversidade e a ocorrência de espécies de peixes comercialmente importantes coletadas por vinte locais de amostragem de peixes nas costas de Sindh e Baluchistão do mar da Arábia, no Paquistão, de janeiro a dezembro de 2019. Além disso, as características físico-químicas da água do mar foram analisadas a partir desses peixes locais selecionados e considerados dentro dos intervalos adequados necessários para o crescimento e sobrevivência dos peixes. Um total de 8.1287 indivíduos de peixes foi coletado e identificado como 49 espécies pertencentes a 26 famílias em nosso estudo. A família mais diversificada foi Sparidae (13 espécies), seguida por Carangidae e Lutjanidae (4 espécies), Mullidae, Serranidae, Ariidae (3 espécies) e Sciaenidae (2 espécies). As 20 famílias restantes foram representadas por apenas uma espécie. Os valores do índice de diversidade de Shannon calculados para os quatro habitats selecionados revelaram que uma alta diversidade de peixes foi relatada na costa Sonmiani (H' = 1,81), enquanto menos na costa Ormara (H' = 0,23). Da mesma forma, o índice de regularidade (E) foi alto na costa de Sonmiani (E = 0,50) e menos diversidade de peixes foi relatada na costa de Ormara (E = 0,06). A redução dos riscos para as espécies marinhas ameaçadas em habitats costeiros também requer ações de conservação em várias escalas. Assim, concluiu-se que nosso estudo pode ser valioso para fornecer mais informações sobre a diversidade de espécies de peixes finos e sua ocorrência ao longo da costa do Paquistão. Além disso, para compreender melhor os efeitos, medidas regulares de monitoramento e conservação devem ser tomadas para mitigar a influência das atividades antropogênicas e proteger a diversidade de peixes finos de um declínio maior.

Effects of replacement of dietary fish oil with plant oil on growth performance and fatty acid composition of spinefoot rabbitfish, Siganus rivulatus.

A 95-day feeding study was carried out to evaluate the impact of complete replacement of fish oil by plant oils in the growth performance, feed consumption fatty acid and body composition of juvenile rabbitfish, Siganus rivulatus. There were four treatments i.e., A (fish oil diet), (linseed oil diet), C (soybean meal oil diet) and D (sunflower oil diet). The experimental trial was conducted in twelve 1.5-m3 fiber glass tanks (n=3). Spinefoot rabbitfish juveniles had an average initial weight of 0.948 g ± 0.124 g and they were stocked at 50 fish per tank. Fish fed diet A showed significantly better growth rate, final body weight, and total body weight than fish fed on the other diets. Moreover, the best FCR was observed for diet A followed by diet C and diets B and D had the worst FCR. Fish body composition for crude protein, dry matter, ashes and gross energy at the end of the trial had not differed between the treatments. The highest polyunsaturated fatty acids (PUFA) was found in fish fed diet A followed in decreasing order by diets D, B, and C. Fish oil is a better dietary lipid source for Spinefoot rabbitfish juveniles, Siganus rivulatus, than plant oils. Among plant oils, soybean oil was better than linseed oil and sunflower oil as the main dietary fat source.

Effect of feeding frequency as a rearing system on biological performance, survival, body chemical composition and economic efficiency of Asian seabass Lates calcarifer (Bloch, 1790) reared under controlled environmental conditions.

A 70-day rearing trial was done to determine the optimal frequency of feeding on growth performance (GP), feed conversion rate (FCR), cannibalism, survival rate (SR), body chemical composition and economic efficiency of the Asian sea bass. This study tested four different treatments of feeding frequencies (FF), once (T1), twice (T2), three times (T3), and four times (T4) per day. An average initial weight of Asian sea bass fry was 0.2 g (SD = ±0.12) were stocked 10 individuals per m3 (9.14 m × 1.82 m × 1.22 m, L × W × H; water depth 0.61 m) with two replicates per treatment (4 × 2 = 8). Fry were fed a mixture of larval commercial feed and shrimp with a pellet diet containing (46% CP). Initially, the feeding rate of 8% biomass per day was further adjusted according to fish biomass on a weekly basis. Results showed that, the FF significantly affected (p < 0.05) on growth indictors and survival rate (SR). Specifically fry fed three times a day (T3) had the best FBW, FL, SGR, ADWG and FCR followed by T4 and T2 while fry fed one time a day was the lowest in these parameters. Also, VSI, HSI and CF (k) significantly differed among the treatments. The fish whole body content of protein, moisture and ash did not significantly (p < 0.05) be affected by feeding frequency, but lipid content differed and both T3, T4 were the highest. It could be concluded that, increasing FF up to three times a day had a positive effect on weight gain, survival rate and feed utilization of Lates calcarifer. The second degree polynomial regression indicates that fed three times a day is optimum for best growth performance and survival for Asian sea bass.

Biodiversity of commercially important finfish species caught by mid-water and bottom trawls from two different coasts of Arabian Sea: Threats and conservation strategies.

This study was conducted to estimate the diversity and the occurrence of commercially important finfish species collected by twenty fish sampling site of Sindh and Baluchistan coasts of the Arabian Sea in Pakistan from January to December 2019. Additionally, physicochemical characteristics of seawater were analyzed from these selected sites and found to be within suitable ranges required for fish growth and survive. A total of 81287 fish individuals were collected and identified as 49 species belonging to 26 families in our study. The most diversified family was Sparidae (13 species) followed by Carangidae and Lutjanidae (4 species), Mullidae, Serranidae, Ariidae (3 species), and Sciaenidae (2 species). The remaining 20 families were represented by only one species. The values of Shannon diversity index calculated for the four selected habitats revealed that high fish diversity was reported at Sonmiani Coast (H'=1.81), while less at Ormara Coast (H'=0.23). Likewise, Evenness index (E) was high at Sonmiani Coast (E=0.50) and less fish diversity was reported at Ormara Coast (E=0.06). Reducing risks to threatened marine species in coastal habitats also requires conservation actions at multiple scales. Thus, it was concluded that our study could be valuable in providing the more information's regarding to the diversity of finfish species and their occurrence along the Pakistan Coast. Further, to better understand the effects, regular monitoring and conservation measures should be taken to mitigate the influence of anthropogenic activities and protect finfish diversity from further decline.

Influenza B outbreak in female psychiatric ward of Hospital Kuala Lumpur, Malaysia.

Influenza outbreaks in tropical countries are rarely reported. This article reports four cases of influenza within a psychiatric ward of a tertiary hospital in Malaysia. These were patients with severe mental illness who were involuntarily admitted and did not show the classical triad of influenza-like-illness (ILI) at the beginning. However, severe respiratory complications developed requiring intubation. Referral and cooperation with the infectious disease team was initiated to help manage the outbreak while continuing psychiatric treatment. Incidences of influenza among hospitalised psychiatric patients should be treated seriously with immediate multidisciplinary approach to prevent severe unwanted complications.

Predictors of difficult videolaryngoscopy with GlideScope® or C-MAC® with D-blade: secondary analysis from a large comparative videolaryngoscopy trial.

BACKGROUND: Tracheal intubation using acute-angle videolaryngoscopy achieves high success rates, but is not without difficulty. We aimed to determine predictors of 'difficult videolaryngoscopy'. METHODS: We performed a secondary analysis of a data set (n=1100) gathered from a multicentre prospective randomized controlled trial of patients for whom difficult direct laryngoscopy was anticipated and who were intubated with one of two videolaryngoscopy devices (GlideScope(®) or C-MAC(®) with D-blade). 'Difficult videolaryngoscopy' was defined as 'first intubation time >60 s' or 'first attempt intubation failure'. A multivariate logistic regression model along with stepwise model selection techniques was performed to determine independent predictors of difficult videolaryngoscopy. RESULTS: Of 1100 patients, 301 were identified as difficult videolaryngoscopies. By univariate analysis, head and neck position, provider, type of surgery, and mouth opening were associated with difficult videolaryngoscopy (P<0.05). According to the multivariate logistic regression model, characteristics associated with greater risk for difficult videolaryngoscopy were as follows: (i) head and neck position of 'supine sniffing' vs 'supine neutral' {odds ratio (OR) 1.63, 95% confidence interval (CI) [1.14, 2.31]}; (ii) undergoing otolaryngologic or cardiac surgery vs general surgery (OR 1.89, 95% CI [1.19, 3.01] and OR 6.13, 95% CI [1.85, 20.37], respectively); (iii) intubation performed by an attending anaesthestist vs a supervised resident (OR 1.83, 95% CI [1.14, 2.92]); and (iv) small mouth opening (OR 1.18, 95% CI [1.02, 1.36]). CONCLUSION: This secondary analysis of an existing data set indicates four covariates associated with difficult acute-angle videolaryngoscopy, of which patient position and provider level are modifiable.

Endoscopic approaches to benign sphenoid sinus lesions: development of an algorithm based on 13 years of experience.

OBJECTIVE: To develop an algorithm for selecting the optimal endoscopic approach for benign sphenoid lesions. METHODS: Charts of 392 patients were reviewed and categorised according to disease nature and extent as follows: group 1 comprised isolated sphenoid sinus lesion cases, group 2 consisted of pansinus lesion cases and group 3 comprised lateral sphenoid recess lesion cases. Surgical approaches, difficulties and complications were noted. RESULTS: A transnasal approach was employed in 40.8 per cent of cases (23.2 per cent were group 1 patients, 16.1 per cent were group 2 patients and 1.5 per cent were group 3 patients), a transethmoidal approach was utilised in 54.3 per cent of cases (group 2 patients) and a transpterygopalatine fossa approach was selected in 4.9 per cent of cases (group 3 patients). Surgical difficulties were encountered in 11.9, 10.8 and 0 per cent of patients in whom transnasal, transethmoidal or transpterygopalatine approaches were utilised, respectively. CONCLUSION: Radio-pathological categorisation provided a means of developing an algorithm for selecting the most appropriate endoscopic approach. Transnasal sphenoidotomy should be the first choice of approach whenever applicable. Lateral sphenoid recess non-inflammatory diseases should be managed through a transpterygopalatine fossa approach. Revision surgery does not play a key role in the algorithm.

Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Despite the growing interest in the use of ultrasound (US) imaging to guide performance of regional anaesthetic procedures such as peripheral nerve blocks, controversy still exists as to whether US is superior to previously developed nerve localization techniques such as the use of a peripheral nerve stimulator (PNS). We sought to clarify this issue by performing a systematic review and meta-analysis of all randomized controlled trials that have compared these two methods of nerve localization. METHODS: We searched Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and Google Scholar databases and also the reference lists of relevant publications for eligible studies. A total of 13 studies met our criteria and were included for analysis. Studies were rated for methodological quality by two reviewers. Data from these studies were abstracted and synthesized using a meta-analysis. RESULTS: Blocks performed using US guidance were more likely to be successful [risk ratio (RR) for block failure 0.41, 95% confidence interval (CI) 0.26-0.66, P<0.001], took less time to perform (mean 1 min less to perform with US, 95% CI 0.4-1.7 min, P=0.003), had faster onset (29% shorter onset time, 95% CI 45-12%, P=0.001), and had longer duration (mean difference 25% longer, 95% CI 12-38%, P<0.001) than those performed with PNS guidance. US guidance also decreased the risk of vascular puncture during block performance (RR 0.16, 95% CI 0.05-0.47, P=0.001). CONCLUSIONS: US improves efficacy of peripheral nerve block compared with techniques that utilize PNS for nerve localization. Larger studies are needed to determine whether or not the use of US can decrease the number of complications such as nerve injury or systemic local anaesthetic toxicity.

Human papillomavirus type 18 and other risk factors for cervical cancer in Jakarta, Indonesia.

Infection with human papillomavirus (HPV) has now been established as a necessary cause of cervical cancer. Indonesia is a country with a high cervical cancer incidence and with the world's highest prevalence of HPV 18 in cervical cancer. No information exists about the prevalence of HPV 18 or other HPV types in the Indonesian population. We conducted a hospital-based case-control study in Jakarta, Indonesia. A total of 74 cervical carcinoma cases and 209 control women, recruited from the gynecological outpatient clinic of the same hospital, were included. All women were HPV typed by the line probe assay, and interviews were obtained regarding possible risk factors for cervical cancer. HPV was detected in 95.9% of the cases and in 25.4% of the controls. In the control group, 13.4% was infected with a high-risk HPV type. HPV 16 was detected in 35% of the case group and in 1.9% of the control group and HPV 18 was identified in 28% of the case group and in 2.4% of the control group, suggesting that the oncogenic potentials of HPV 16 and HPV 18 in Indonesia are similar. In addition to HPV infection, young age at first intercourse, having a history of more than one sexual partner, and high parity were significant risk factors for cervical cancer. Within the control group, we did not identify determinants of HPV infection. We hypothesize that the high prevalence of HPV 18 in cervical cancer in Indonesia is caused by the high prevalence of HPV 18 in the Indonesian population.

Thyroplasty for functional rehabilitation of the incompetent larynx.

Type I thyroplasty was performed in 12 patients with unilateral paralysis of the vocal fold. Subjective as well as objective improvement in vocal performance was reported in 11 patients. Aspiration was improved in six out of eight patients. Effort closure was evaluated by the ability of the patient to voluntarily raise his intra-abdominal pressure during Valsalva's manoeuvre. A comparison of pre- and post-thyroplasty measures, showed a statistically significant improvement in the efficacy of effort glottic closure (p < 0.05), indicating a better physical performance. We had one case of wound sepsis and another case of implant extrusion.

Current management of malignant germ cell tumor of the ovary.

Malignant germ cell tumors are an uncommon type of ovarian cancer which account for fewer than 5% of the total in Western countries and 20% in Japan. In females younger than 20, they represent approximately two-thirds of malignant ovarian tumors. Immature teratoma, endodermal sinus tumor, dysgerminoma and mixed type account for the majority (more than 80%), while embryonal carcinoma and polyembryoma are very few. The age of the patients ranges from 6 to 69 years with a median of 16-20 years. Clinically, these tumors are characterized by rapid growth and extensive intraabdominal spread. The symptoms and signs range from 1 day to 6 months with a median of 4 weeks, and the patients usually present with abdominal pain, palpable mass, abdominal distention and vaginal bleeding, and a very few with amenorrhea and precocious puberty. The size of tumors varies from 7 cm to 40 cm with a median of 15-16 cm. The tumor is rarely bilateral (12-19%) and never so in cases of endodermal sinus tumor. Diagnosis depends mainly on age, abdominal symptoms, size and consistency of the tumor, and tumor markers AFP and hCG. Surgery is the first step of management followed by adjuvant therapy, which depends on the histologic type. Dysgerminoma is very sensitive to radiation while other germ cell tumors are not. A combination chemotherapy currently used is VAC or VBP. Both are highly effective. The VBP regimen seems to have a stronger cancerocidal effect, while the VAC regimen is less toxic. VAC produces excellent results in stage I, while VBP is more effective for advanced disease. Conservative surgery and a combination chemotherapy (VAC, VBP) are appropriate for young patients who desire to retain their fertility. Second-look laparotomy is still controversial. As long as AFP or hCG or both can be used to monitor the disease in patients positive for these sensitive and reliable markers, or in an early stage with complete resection, second-look laparotomy is not useful. Survival is associated with prognostic factors, i.e., histologic type, clinical staging operation, lymph node and residual tumor. Patients with endodermal sinus tumor or mixed type tumor had a poorer outcome. The survival rate was higher in patients with earlier disease (stage I or II) and those who underwent primary surgery. Metastasis to the lymph node is not related to prognosis. The presence and size of residual tumors after surgery were closely related to the prognosis.

Epidemiology of gestational trophoblastic neoplasm at the Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

This retrospective research was conducted in the Department of Obstetrics and Gynaecology of the Dr. Cipto Mangunkusumo Hospital, Jakarta, covering the period between 1977 and 1981. The incidence of hydatidiform mole was 1 in 77 pregnancies. The incidence of malignant trophoblastic disease was 1 in 185 pregnancies. Of the 406 cases of hydatidiform mole, 22.9% became malignant. Patients of 24 years of age or younger had a higher risk of getting hydatidiform mole (P less than 0.05) compared to older patients. The risk of becoming malignant increased with age and became evident after 40 years of age. Parity 1 or less was associated with a higher risk of getting hydatidiform mole (P less than 0.05), but had no influence on hydatidiform mole becoming malignant. The influence of blood group was not so clear, although there was a tendency for moles to occur more frequently in patients with blood groups A or B. By contrast, there was a tendency for the change into malignancy to occur more frequently in women with blood groups B or O. Gestational age had no influence towards the change into malignancy or metastasis. Uterine size (greater than 20 weeks gestation) correlated with the progression of hydatidiform mole into malignancy. However, subsequent metastasis was not influenced by the size of the uterus. It was found that 76.4% of malignant trophoblastic diseases originated from hydatidiform moles, 12.4% from abortions, 9.5% from normal deliveries, and 1.2% from ectopic pregnancies. Non-hydatidiform moles had a slightly greater risk for metastasis, although this was not significant. Hydatidiform mole in histologic stages II or III (Hertig-Mansell classification) had a significantly greater tendency (P less than 0.05) to become malignant than in stage I.