Disorders of sex development: Challenges in a low-resource country.

AIM: We aimed to identify the challenges in the management of sexual development abnormalities in a low-resource country. METHODS: The study was retrospective from January 2000 to December 2017 based on patient records from two pediatric surgery departments. Epidemiological, clinical, paraclinical, treatment, and outcome data were studied. RESULTS: We collected data on 13 patients (average age = 7.95 years). The sex of rearing was as follows: three females (23%), 10 males (77%). Atypical genitalia other than hypospadias represented the reason for consultation in 92% of the cases. We could not find complete hormonal analyses; testosterone levels were studied in 69.23% of cases. We found the following disorders of sexual development (DSD): four patients with 46,XX karyotype (30.77%), eight patients with 46,XY karyotype (61.53%), and one patient with 46,XX/XY karyotype. Four patients had medical treatment only, four had surgical treatment only, and one patient had medical and surgical treatment. The medical treatment comprised topical administration of androgen. The surgical treatment consisted of feminizing genitoplasty for one patient and masculinizing genital surgeries for two patients. Six of the 13 patients were lost to follow-up. CONCLUSION: The socioeconomic difficulties of the population and the lack of access to basic diagnostic and paraclinical methods, coupled with the negative cultural representations of the pathology, constitute the challenges in the management of DSD in our practice.

Intra operative lesion of the pelvic ureter solved in a minimally invasive manner.

Ureteral lesions during open hysterectomy, vaginal hysterectomy or laparoscopic hysterectomy have a rate of 0.2% up to 6%. Multiple complications may occur if the lesion is not recognised intra operatively: hydronephrosis, anuria (bilateral lesion), ureterovaginal fistula, ileus, peritonitis. The rate of recognition of an intra operative ureter lesion is 30% and it could rise up to 90% when cystoscopy with ureteroscopy is used at the end of the intervention. The article presents the case of a 46-year-old patient with uterine fibromatosis, whose pelvic ureter was sectioned during surgery. The lesion was recognised during surgery because, at the end of each intervention, the diuresis was stimulated by injecting Furosemide in order to detect the lesions of the ureters and urinary bladder.

Controlled ovarian hyperstimulation and IVF pregnancy prognosis.

IVF (in vitro fertilization) often represents the ultimate step in our attempt to treat infertility. Nowadays this method is more and more used, couple's expectations are higher and higher, so that optimizing the chance that one IVF pregnancy became a healthy newborn child is becoming an important issue. In this study we analyzed the controlled ovarian hyperstimulation impact on IVF pregnancy prognosis. We studied 307 patients who had IVF fresh procedures in "Panait Sirbu" Clinical Hospital of Obstetrics and Gynecology - Department of Assisted Human Reproduction between 01.01.2008 - 31.12.2010 and obtained pregnancy; pregnancy rate according to our statistics is 34%. For statistic analysis we used the odd Student test. Our data proved better results (defined as a better birth/abortion ratio) for the patients where recombinant FSH was used towards patients where highly purified urinary gonadotropin or the combination of the two drugs was used. Our statistical data also proved that none of the variables: age, BMI (body mass index), endometrium thickness, number of oocytes, number of embryos or number of days of stimulation is a favorable variable for this better result, but the number of units of gonadotropin is a favorable variable for a better birth/abortion ratio. We consider that our data gives an interesting perspective upon the connection between controlled ovarian hyperstimulation and pregnancy outcome, especially these days when tendencies are to obtain as many oocytes in one procedure as we can, which often means to use high doses of gonadotropin.

Human colon adenocarcinoma HT-29 cell: electrochemistry and nicotine stimulation.

Recently, it was demonstrated that colorectal cancer HT-29 cells can secrete epinephrine (adrenaline) in an autocrine manner to auto-stimulate cellular growth by adrenoreceptors activation, and that this secretion is enhanced by nicotine, showing an indirect relation between colorectal cancer and tobacco. The electrochemical behaviour of human colon adenocarcinoma HT-29 cells from a colorectal adenocarcinoma cell line, the hormone and neurotransmitter epinephrine, and nicotine, were investigated by cyclic voltammetry, using indium tin oxide (ITO), glassy carbon (GC) and screen printed carbon (SPC) electrodes. The oxidation of the HT-29 cells, previously grown onto ITO or SPC surfaces, followed an irreversible oxidation process that involved the formation of a main oxidation product that undergoes irreversible reduction, as in the epinephrine oxidation mechanism. The effect of nicotine stimulation of the HT-29 cells was also investigated. Nicotine, at different concentration levels 1, 2 and 15 mM, was introduced in the culture medium and an increase with incubation time, 0 to 3h and 30 min, of the HT-29 cells oxidation and reduction peaks was observed. The interaction of nicotine with the HT-29 cells stimulated the epinephrine secretion causing an increase in epinephrine release concentration, and enabling the conclusion that epinephrine and nicotine play an important role in the colorectal tumour growth.

Peptide methionine sulfoxide reductase A (MsrA): direct electrochemical oxidation on carbon electrodes.

The direct electrochemical behaviour of peptide methionine sulfoxide reductase A (MsrA) adsorbed on glassy carbon and boron doped diamond electrodes surface, was studied over a wide pH range by cyclic and differential pulse voltammetry. MsrA oxidation mechanism occurs in three consecutive, pH dependent steps, corresponding to the oxidation of tyrosine, tryptophan and histidine amino acid residues. At the glassy carbon electrode, the first step corresponds to the oxidation of tyrosine and tryptophan residues and occurs for the same potential. The advantage of boron doped diamond electrode was to enable the separation of tyrosine and tryptophan oxidation peaks. On the second step occurs the histidine oxidation, and on the third, at higher potentials, the second tryptophan oxidation. MsrA adsorbs on the hydrophobic carbon electrode surface preferentially through the three hydrophobic domains, C1, C2 and C3, which contain the tyrosine, tryptophan and histidine residues, and tryptophan exists only in these regions, and undergo electrochemical oxidation.

Boron doped diamond and glassy carbon electrodes comparative study of the oxidation behaviour of cysteine and methionine.

The electrochemical oxidation behaviour at boron doped diamond and glassy carbon electrodes of the sulphur-containing amino acids cysteine and methionine, using cyclic and differential pulse voltammetry over a wide pH range, was compared. The oxidation reactions of these amino acids are irreversible, diffusion-controlled pH dependent processes, and occur in a complex cascade mechanism. The amino acid cysteine undergoes similar three consecutive oxidation reactions at both electrodes. The first step involves the oxidation of the sulfhydryl group with radical formation, that undergoes nucleophilic attack by water to give an intermediate species that is oxidized in the second step to cysteic acid. The oxidation of the sulfhydryl group leads to a disulfide bridge between two similar cysteine moieties forming cysteine. The subsequent oxidation of cystine occurs at a higher potential, due to the strong disulfide bridge covalent bond. The electro-oxidation of methionine at a glassy carbon electrode occurs in two steps, corresponding to the formation of sulfoxide and sulfone, involving the adsorption and protonation/deprotonation of the thiol group, followed by electrochemical oxidation. Methionine undergoes a one-step oxidation reaction at boron doped diamond electrodes due to the negligible adsorption, and the oxidation also leads to the formation of methionine sulfone.

[Considerations on the results of initial chemotherapy in pulmonary tuberculosis]. / Consideratii privind rezultatele chimioterapiei initiale în tuberculoza pulmonara.

The results of initial chemotherapy applied in 501 patients with secondary pulmonary tuberculosis hospitalized and treated between 1973 and 1978 are analized. At the end of the treatment the following results have been noted: 94.8% bacteriological negativation, and 5.2% of cases which had not been influenced by chemotherapy and had constantly presented Koch bacilli in their sputum. From the clinical and radiological viewpoints a persistence of cavitary lesions was noted in 12.1% of all patients, or in 22.4% of those who presented initially with cavities. In the surveillance period 7.5% of the patients again became positive, and another course of therapy solved the new positivity in 84.2% of those involved. A percentage of 95.2% global favourable results have been noted in the final stage of the therapy, and 4.8% failures. Relapses, and bacteriological failures were noted with a higher frequency in males, and are in direct proportion with the extension of the lesions and the severity of the clinical forms. Eighteen of the patients (3.6%) had a course which led to chronicization of the disease. The favourable results and the reduction to a minimum of the therapeutic failures could be obtained by a correct application of chemotherapy and dispensarization of the patients under control.

[Radiophotographic and simultaneous bacteriological detection in an industrial group]. / Depistari radiofotografice si bacteriologice simultane într-o collectivitate industriala

After carrying out a complex investigation of the workers of a confections factory the authors detected 2 new cases of tuberculosis (0,5 0/00), with the aid of radiophotography and another 2 cases (3,4 per 1000 subjects examined) by bacteriological investigation of the subjects that coughed. These last 2 cases were detected between those that had a normal thoracic aspect on the radiophotographic film alone. The observation of the authors allows to conclude that a bacteriological investigation of the suspects following radiophotography is not sufficient and that this type of investigation should be extended to certain groups of the population that show broncho-pulmonary symptoms. The association of the two methods, in well-defined technical and organisational conditions will allow for a significant increase of the efficiency of systematic examinations for the detection of pulmonary tuberculosis.