Mayer-Rokitansky-Kuster-Hauser syndrome complicated with giant mucinous cystadenoma and inguinal herniation: case report.

INTRODUCTION: Coexistence of Mayer-Rokitansky-Kuster-Hauster syndrome (MRKH) with other conditions is rare, especially when MRKH was found in a young woman presenting with ovarian malignancy. This case report wishes to highlight MRKH complicated with giant mucinous cystadenoma and bilateral inguinal hernia. CASE REPORT: A 22-year-old nulligravid woman was admitted with primary amenorrhea and abdominal mass. Abdominal examination revealed a cystic mass 25 × 25 × 20 cm in size and a vagina 1 cm in length. Pelvic magnetic resonance imaging (MRI) showed a giant multiloculated left ovarian mass amidst the absence of uterus. During the surgery, the giant multiloculated cystic mass was identified as mucinous cystadenoma on frozen section. Bilateral medial inguinal hernia was also identified. DISCUSSION: MRKH coexisting with other disease is rare but considering other structures arising from paramesonephric duct (PMD) may exist, allows the possibility of other structural anomalies. CONCLUSIONS: The present report illustrates a rare case of MRKH syndrome with giant ovarian cystadenoma and inguinal hernia.

Comparison of salpingectomy and tubal occlusion for hydrosalpinx in in-vitro fertilization outcome.

The occurrence of hydrosalpinx can reduce the success rate of assisted reproductive technology. The laparoscopic salpingectomy and tubal occlusion have been shown to improve in-vitro fertilization (IVF) outcomes in this disease. The primary goal of this review was to assess and compare the IVF outcome following salpingectomy or tubal occlusion in the published literature. The authors included studies with at least one of the following outcomes: days of controlled ovarian hyperstimulation, retrieved oocyte number, fertilization rates, clinical pregnancy rate, miscarriage rate, or ectopic pregnancy rate. In conclusion, proximal tubal occlusion outperforms salpingectomy in terms of fertilization rate while offering no evident advantages in terms of days of controlled ovarian hyperstimulation, retrieved oocytes number, IVF results, or problems in treating hydrosalpinx patients prior to IVF. These data may help clinicians choose the best therapy for patients with hydrosalpinx prior to IVF.

Association between follicle size, endometrial thickness, and types of ovarian stimulation (Clomiphene citrate and Letrozole) with biochemical pregnancy rate in women undergone intrauterine insemination.

OBJECTIVE: There was also a lack of data regarding the effect of follicle size, endometrial thickness, and ovarian stimulation as predictors of intrauterine insemination (IUI) success rate in Indonesia, especially in the Aster Clinic and Bandung Fertility Centre. This study was performed to explore the relationship between follicle size, endometrial thickness, and types of ovarian stimulation (Clomiphene citrate/CC vs Letrozole) with biochemical pregnancy rate in women undergone IUI. We performed a case-control study in 122 women aged 20-40 years with unexplained infertility who had completed the IUI program for a maximum of three cycles. Data were extracted from medical records. Independent T-test and multivariate analyses were used to analyse the difference between variables using IBM SPSS 24.0. P-value < 0.05 was considered statistically significant. RESULT: Follicle sizes of 18-22 mm in both Clomiphene citrate (CC) and Letrozole groups were shown to increase biochemical pregnancy rate (P = 0.001). There is no relationship between endometrial thickness and pregnancy rate. Biochemical pregnancy rate in women using Letrozole was 1.513 times higher than women using CC. The follicle size of 18-22 mm and using Letrozole rather than CC as ovarian stimulators are predictive factors associated with a higher pregnancy rate in women undergone IUI.

Comparison of glutaminase and cancer antigen 125 for distinguishing benign and malignant ovarian tumors.

Increasing demand for glutaminase (GLS) due to high rates of glutamine metabolism is considered one of the hallmarks of malignancy. In parallel, cancer antigen 125 (CA-125) is a commonly used ovarian tumor marker. This study aimed to compare the roles of GLS and CA-125 in distinguishing between benign and malignant ovarian tumors. The research was conducted as a comparative study, enrolling 156 patients with ovarian tumors. Preoperative serum CA-125 and GLS levels were analyzed to evaluate their effectiveness in distinguishing between benign and malignant ovarian tumors. The results revealed that the mean levels of CA-125 and GLS were significantly higher in malignant ovarian tumors compared with benign ones (389.54 ± 494.320 vs. 193.15 ± 529.932 (U/mL) and 17.37 ± 12.156 vs. 7.48 ± 4.095 (µg/mL), respectively). The CA-125 and GLS cutoff points of 108.2 U/mL and 18.32 µg/mL, respectively, were associated with malignant ovarian tumors. Multivariate analyses showed that GLS had higher predictive capabilities compared with CA-125 (odds ratio 9.4 vs. 2.1). The accuracy of using GLS combined with CA-125 was higher than using CA-125 alone (73.1% vs. 68.8%). In conclusion, higher levels of CA-125 and GLS are associated with malignant ovarian tumors. GLS outperforms CA-125 in distinguishing between benign and malignant ovarian tumors. The combination of GLS and CA-125 demonstrated improved accuracy for distinguishing benign and malignant ovarian tumors when compared with using CA-125 alone.

An acetylcholinesterase-based biosensor for isoprocarb using a gold nanoparticles-polyaniline modified graphite pencil electrode.

An analysis tool for isoprocarb has been successfully developed as a biosensor system based on enzymatic inhibition of acetylcholinesterase (AChE) by isoprocarb. A gold nanoparticles-polyaniline modified graphite pencil electrode (AuNPs-PANI-GPE) was utilized to detect the change of thiocholine in the presence of isoprocarb. This electrode was prepared by two cyclic voltammetry steps, including the electro-polymerization of aniline on a graphite pencil and the electro-deposition of gold nanoparticles on the polyaniline surface. Characterization performed by SEM-EDX indicates that 8-80 nm size of gold nanoparticles could be deposited on the surface of polyaniline-modified graphite pencil (PANI-GPE). Electrochemical characterization using cyclic voltammetry suggested that the active surface area of the prepared electrode was 0.17019 cm2, which was about 4 times higher than (PANI-GPE) and 13 times higher than the unmodified GPE. Furthermore, an oxidation peak of thiocholine could be observed at the modified GPE at a potential of + 0.675 V (vs. Ag/AgCl), formed by an enzymatic reaction of AChE in the presence of acetylthiocholine. This peak current was found to linearly increase with acetylthiocholine concentrations, while in the presence of isoprocarb in a constant concentration of AChE and acetylthiocholine the peak linearly decreases. At the optimum condition of 0.1 M phosphate buffer solution pH 7.4 containing 0.1 M KCl; 100 mU/ml AChE; and 1 mM acetylthiocholine chloride in an inhibition and contact time of 25 and 15 min, respectively, a linear calibration curve of isoprocarb in the concentration range of 0.05-1.0 µM could be provided. Estimated limits of detection and quantifications of 0.1615 nM and 0.5382 nM, respectively, with a sensitivity of 1.7771 µA/µM.mm2 could be achieved. Furthermore, an excellent stability for 8 times measurements was observed with an RSD of 4.87%, suggesting that the developed tool is promising for the real detection of isoprocarb.

Isolated growth hormone deficiency and amenorrhea - Case report.

Introduction and importance: Growth hormone (GH) deficiency is the most common hypopituitarism disorder. We highlight the challenges to its diagnosis and management in the setting of a developing country. Case description: A 14-year-old came with a chief complaint of inability to menstruate. Menarche was at 12-years old, lasted 7 days, soaking 2 pads/day which discontinued shortly after. Thelarche was at 12-years-old and her breast is at Tanner stage 3. Her axillary and pubic hair are at Tanner stage 1. Height was 120 cm, weight 34.8 kg, height for age z-score < -3. Her lab results were normal for estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin. Bone age was suitable for age. Magnetic resonance imaging revealed pituitary gland hypoplasia (5.3 mm). A hormonal panel 3 years prior showed abnormally low GH level but normal cortisol and thyroid hormone levels. She was diagnosed with isolated growth hormone deficiency (IGHD) with delayed puberty. She was treated with medroxyprogesterone tablets once daily, after which her menstruation restarted. However, due to her economic background, she declined genetic tests, discontinued her medication and amenorrhea recurred. Clinical discussion: Amenorrhea present after a brief menarche should alert gynaecologists of a possible multi-hormone disorder with an underlying structural abnormality. IGHD may be due to a structural abnormality, such as pituitary gland hypoplasia. Unfortunately, economic reasons prevented the patient from receiving optimal treatment. Conclusion: IGHD rarely presents with a gynaecological complaint. Hormonal and genetic tests along with imaging should be undertaken. Growth hormone supplementation is the treatment of choice.

Common bile duct injury following open conversion of laparoscopic cholecystectomy in 14-15 Weeks pregnancy: A rare case report.

Introduction: Common bile duct (CBD) injury is the most serious complication of Laparoscopic Cholecystectomy (LapC). Nonetheless, complications of LapC as a treatment for CBD injury are rare in pregnancy. There have been no published case reports regarding complications of CBD injury in gravida patients and their management. Case presentation: We reported a 32-year-old primiparous woman with CBD injury following open conversion of LapC in 14-15 weeks of pregnancy with enterocutaneous fistula complications. She presented with yellowish fluid leakage from an open wound in her abdomen, and had a history of gallbladder removal and corrective surgery due to bile leakage and intestinal adhesions. Tenderness and serous fluid were found in the area of the previous surgery scar. The laboratory examination showed that the patient was in anaemic condition; Fetal ultrasound examinations showed that the fetus' condition was within normal limits. The patient was given supportive and medical management with further MRCP plans as well as maternal-fetal close and regular monitoring. Clinical discussion: In addition to the history and physical examinations, biliary tract imaging holds a pivotal role in this case. LapC is a surgical technique recommended to treat symptomatic cholelithiasis in pregnancies. Despite being rare in pregnancy, prevention of CBD injury by recognizing the pearls and pitfalls of LapC should be done. Conclusion: Key points for successful treatment of this case are characterized by early recognition of CBD injury, fluid collection and infection control, nutritional balance, and multidisciplinary approaches of the Surgery Department and Obstetrics-Gynaecology Department.

Ovarian Cancer-Self Assessment: An Innovation for Early Detection and Risk Assessment of Ovarian Cancer.

OBJECTIVE: The modality to detect ovarian cancer at an early stage is very limited. Early diagnosis determines the prognosis. This study aimed to develop a risk assessment tool for early detection of ovarian cancer using artificial intelligence. To accomplish this, the presence of ten signs and symptoms reported by patients with ovarian cancer was assessed. METHODS: This study was carried out as a cohort study of patients diagnosed with suspected ovarian tumors undergoing cytoreduction operation at Hasan Sadikin Hospital, Bandung, from December 2019 to September 2020. Compared to ovarian cancer self-assessment through questionnaire, postoperative histopathology in patients with suspected ovarian tumors. The questionnaire proceeded by artificial intelligence is grouped into risk and no risk. Statistical analyses were done using Chi-Square and Exact Fisher Test. RESULT: In total, 115 patients included in this study. The differences were statistically significant in terms of the six variables (abdominal bloating, nausea/vomiting, decreased of appetite, fullness, menstrual disturbance, and weight loss) ovarian cancer self-assessment compared to postoperative histopathology with a tendency towards benign ovarian tumors (p<0.05), while there was no statistically significant difference in the four variables (abdominal enlargement, abdominal pain, urinating disturbance, and defecation disturbance)  (p>0.05).  According to the artificial intelligence grouping, fifty-five patients were at risk, and sixty patients were not at risk. The Fifty-five risk patients were related  with postoperative histopathology diagnosis (with RR 0.682 and CI 95% 0.519-0.895). CONCLUSION: Risk assessments based on ovarian cancer self-assessment unfortunately were not comparable to postoperative histopathology as a single predictor. Ten variables in ovarian cancer artificial intelligence self-assessment for early detection needs improvement in adding another variable like tumor marker and ultrasonography assessment.