Spontaneous triplet pregnancy with twin fetuses papyraeci: a rare case report and review of the literature

A fetal death in a multiple pregnancy with one or more normally surviving fetus is unusual. Fetus papyraceous (FP) is a rare obstetric complication in multiple gestations. It is defined as retention of a mummified parchment like remains of a dead fetus in multiple pregnancy associated with a viable twin. It is important to reassure the patient of the normal outcome expected in most of the cases. Herein, we report a rare case of twin FP in a spontaneous triplet pregnancy with a literature review of maternal and neonatal outcomes and management of similar cases

An Efficient In Vitro Propagation Protocol of Cocoyam [Xanthosoma sagittifolium (L) Schott]

Sprouted corm sections of “South Dade” white cocoyam were potted and maintained in a greenhouse for 8 weeks. Shoot tips of 3–5 mm comprising the apical meristem with 4–6 leaf primordial, and approximately 0.5 mm of corm tissue at the base. These explants were treated to be used into the culture medium. A modified Gamborg's B5 mineral salts supplemented with 0.05 μM 1-naphthaleneacetic acid (NAA) were used throughout the study. Thidiazuron (TDZ) solution containing 0.01% dimethyl sulfoxide (DMSO) was used. Erlenmeyer flasks and test tubes were used for growing cultures. The effect of different media substrate, thidiazuron, and the interaction between TDZ and Benzylaminopurine (BAP) on cocoyam culture were tested. Results indicated that cocoyam can be successfully micropropagated in vitro through various procedures. All concentrations tested (5–20 μM BAP and 1–4 μM TDZ) produced more axillary shoots per shoot tip than the control without cytokinins. Greater proliferation rates were obtained through the use of 20 μM BAP and 2 μM TDZ, respectively, 12 weeks from initiation. Shoots produced with BAP were larger and more normal in appearance than those produced with TDZ, which were small, compressed, and stunted. The use of stationary liquid media is recommended for economic reasons

Uncommon case of hydrosalpinx-induced adnexal torsion in a postmenopausal woman

Adnexal torsion is a twisting of the adnexa, including the ovary and/or the fallopian tube, around its own vascular axis. Most cases of adnexal torsion occur in women of reproductive age and only rarely in postmenopausal women. Here, we report a case of 58-year-old woman, postmenopausal for 6 years, who presented with acute lower abdominal pain. Ultrasound scan showed a right-sided, well-circumscribed, cystic mass measuring 50x57 mm with low level echoes. Doppler evaluation revealed no blood flow signals inside the mass. Abdominal exploration revealed right adnexal torsion. Salpingo-oophorectomy was done and histopathological examination revealed a twisted, gangrenous hydrosalpinx with no pathological lesion in the ovary. The patient was discharged on the fourth postoperative day. Although adnexal torsion in postmenopausal women is a rare event, it should not be ignored in those women who present with abdominal pain. A longer delay between admission and surgery may be attributed to the rarity and non-specific symptoms of the disease in this age group

Tissue trauma and inflammatory response following laparoscopic versus abdominal hysterectomy: a prospective randomized clinical trial

Background: Laparoscopic surgery is associated with more favorable clinical outcome than conventional open surgery. This might be related to the magnitude of tissue trauma and tissue stress response. This study compares the intensity of tissue injury by assessing plasma C-reactive protein (CRP), lactic dehydrogenase (LDH), and cancer antigen 125 (CA 125) in patients undergoing laparoscopic hysterectomy compared to abdominal hysterectomy.Methods: This study was conducted at Ain Shams University Maternity Hospital from May 2018 to February 2020. 74 women candidate for hysterectomy were recruited and randomized into two groups: group A included 37 cases who underwent abdominal hysterectomy, and group B included 37 cases that underwent laparoscopic hysterectomy.Results: CRP, LDH and CA125 significantly increased post-operatively in both groups. Postoperative mean serum CRP, LDH and CA125 were significantly higher in the laparotomy group (10.84±2.47, 262.21±76.77, and 13.41±2.6 respectively) compared to laparoscopy group (7.92±2.25, 148.53±43.56, 11.79±2.77 respectively) (p<0.05).Conclusions: Surgery is a significant cause of tissue injury that can be assessed by specific markers. We suggest that laparoscopic surgery causes less tissue damage as assessed by lower postoperative CRP and LDH values, which might account for the earlier recovery and reduced hospital stay in laparoscopic surgery

Urinary iodine level assessment during third trimester in a sample of Egyptian pregnant women and its relation to thyroid function

Background: Inadequate intakes of iodine during pregnancy may cause thyroid dysfunctions that adversely affect pregnancy outcomes. Aim of the work was to evaluate the urinary iodine level as a marker of iodine status in a sample of Egyptian pregnant women during 3rd trimester and assess its relation to thyroid functions.Methods: This cross-sectional study was conducted on 100 pregnant females at their 3rd trimester aged (18-35) years. They were divided according to their urinary iodine concentration into 3 groups; Group (I): Pregnant females with deficient iodine (<150 μg/l), Group (II): Pregnant females with adequate iodine (150-249) μg/l, Group (III): pregnant females including who have above requirements (250-499 μg/l), and excessive (≥500 μg/l). TSH, free t4, free t3, Anti-Thyroglobulin (TgAb) and anti-thyroid perioxidase (TPOAb), medium urinary Iodine concentration (UIC) by ELISA and neck U/S were performed to all participants.Results: 18% of the pregnant women in our study had iodine deficiency during 3rd trimester (UIC<150 ug/l) whereas 55% of pregnant women had excess iodine level, and adequate iodine level was observed in 27%.  Serum TSH was significantly higher in group I with deficient iodine level (p value<0.01). All pregnant women included at group I were suffering from subclinical hypothyroidism. Serum TSH and thyroid volume were inversely correlated with urinary iodine among pregnant females at 3rd trimester (p value<0.01).Conclusions: Serum TSH and thyroid volume were inversely correlated with urinary iodine level among pregnant females at 3rd trimester

Opportunistic salpingectomy during hysterectomy for benign indications in women at low and high risk for ovarian cancer: a cross-sectional study

Objective Our study aims to evaluate the role of pathology evaluation of fallopian tubesduring hysterectomy for benign indications for the purpose ofearly detection of serous tubal intraepithelial carcinoma (STIC) in women at high and low risk for ovarian cancer. Material and methods This cross-sectional study was conducted at Minia Maternity University Hospital, Egypt, between June 2015 and December 2017. Our study included all women undergoing hysterectomy for benign conditions in the genital tract. Appropriate histories were taken, as well as physical exams, and laboratory and ultrasound evaluations were done prior to scheduling surgery. Abdominal hysterectomies including opportunistic salpingectomies were performed and the whole specimens including the tubal fimbria were sent to the pathology lab for histo-pathological examination. Results A total of 526 patients met inclusion criteria for this study. The mean age of the study participants was 49.75±8.95 years, the mean parity was 3.91±1.62 and the mean BMI was 24.21±2.38 Kg/m2. The most common surgical indications for hysterectomy were postmenopausal bleeding (34.6%), a clinically benign adnexal/pelvic mass (31.7%), and menorrhagia (24.7%). The fallopian tubes were found to have either no pathology or benign conditions in 500 out of the 526 patients. Among these patients, 56% had no pathologic abnormality. The most common benign conditions were paratubal cysts (25%), endometriosis (9%), torsion (2%) and hydrosalpinx (1%). STIC was identified in the fallopian tubes of 8 out of 526 patients. Conclusions Microscopic examination of the entire fimbriae from all patients regardless of the clinical context represents a novel method of early detection of sporadic tubal carcinoma, a putative precursor to advanced-stage pelvic cancer

Does Glycine Betaine and Salicylic Acid Ameliorate the Negative Effect of Drought on Wheat by Regulating Osmotic Adjustment through Solutes Accumulation?

A pot experiment was conducted to evaluate the beneficial effect of foliar application of glycine betaine (10mM), grain presoaking in salicylic acid (0.05 M) and their interaction on drought tolerance of two wheat (Triticum aestivum L.) cultivars (sensitive, Sakha 94 and resistant, Sakha 93). Osmotic pressure, some osmolytes concentration and grain yield were determined. Water stress caused an increase in osmotic pressure, proline, total soluble nitrogen, total soluble sugars, organic acids, ions (Na+, K+, Ca+2, Mg+2 and Cl-) content as well as Na+/K+ ratio in cell sap flag leaves of both wheat cultivars. The resistant variety had higher values of osmotic pressure, proline, organic acids and ions content than the sensitive one. On the other hand, water stress induced marked decrease (P<0.05) in grain yield. The applied chemicals mitigated the effect of water stress on the used wheat cultivars. The effect was more pronounced with glycine betaine + salicylic acid treatment. The applied chemicals increased the osmotic pressure, the osmolytes concentrations as well as the grain yield. Furthermore, the osmotic pressure of flag leaf sap appeared to depend on proline, TSN, TSS, organic acids and the ions content. The economic yield (grain yield) was positively correlated with proline, keto-acids and osmotic pressure but negatively correlated with TSN, TSS and citric acid

Ultrasonographic evaluation of fetal lung histogram versus lamellar body count in the prediction of fetal lung maturity

Objective: The current study aims to compare the ultrasonographic evaluation of fetal lung Gray-level histogram width (GLHW) ratio with an amniotic fluid lamellar body count (LBC) in the prediction of fetal lung maturity. Methods: A prospective cohort study was conducted at a tertiary University Hospital in the period between May 1, 2017 and March 31, 2018. The study included pregnant women with a single fetus at ≥37 weeks of gestation scheduled for delivery by elective cesarean section (CS). Ultrasound evaluation was performed for assessment of the fetal lung to liver GLHW ratio to predict lung maturity. Lamellar body count was determined from an amniotic fluid sample obtained via amniotomy during CS. The lamellar body count for this sample was measured using a hematology analyzer. These data were further compared to Apgar scores at 1 and 5 minutes after delivery to assess the condition of the newborn immediately after birth, the degree of respiratory distress syndrome (RDS) and the need for resuscitation. Results: One hundred twenty women and their neonates were included in the study. There was a statistically significant decrease in the levels of both GLHW and LBC among those neonates that showed distressed respiration after Apgar testing as compared with those who did not show similar distress, with p-value <0.001. The Receiver Operating Characteristic Curve (ROC) for LBC levels in the prediction of respiratory distress shows the best cutoff point for LBC was found at ≤20214/μL with a sensitivity of 100.0%, specificity of 75.47% and area under the curve (AUC) of 88.4%. The ROC curve for GLWH levels in the prediction of respiratory distress shows the best cutoff point for GLWH was found at ≤0.93 with sensitivity of 100.0%, specificity of 84.91% and AUC of 97.1%. Conclusions: Ultrasonographic evaluation of GLHW of the fetal lung and liver is a non-invasive, inexpensive and time-efficient test for prediction of fetal lung maturity that has higher sensitivity and specificity

Influence of immediate postpartum contraception counseling on the rate of unintended pregnancy in primigravida: a randomized controlled study

Background: The current study aims to assess the influence of immediate postpartum counselling about effective contraceptive methods to be used by primigravida on the rate of unintended pregnancy during first 6 months post-partum.Methods: The study was a prospective randomized controlled trial for assessment the influence of immediate postpartum counseling about effective contraceptive methods to be used by primigravida on the rate of unintended pregnancy during first 6 months post-partum who delivered at the period between the 1st of December 2016 and 31st of December 2017. The study patients were randomly assigned into two groups: Group (A) were received counseling about contraceptive methods using illustrations through postpartum interview with the study researcher. Group (B) were not received any counseling about contraceptive methods. The primary outcome was the difference in the rate of unintended pregnancy in both groups.Results: No significant difference between both groups in preventing unintended pregnancy. In group (A): After 3 months postpartum 140 women (93.3%) were used the contraceptive method correctly. 10 women used method incorrectly and 2 of them get pregnant. After 6 months postpartum 8 women did not use any method but 134 women (95.7%) were correctly used the contraceptive method. In group (B): After 3 months postpartum 127 women (84.7%) were used the contraceptive method correctly. 23 women used method incorrectly and 4 of them get pregnant. After 6 months postpartum 1 woman did not use any method but 30 women (20.7%) were incorrectly used the contraceptive method.Conclusions: Immediate post-partum counseling about contraceptive methods is good tool to educate women who intend to have optimal inter–pregnancy period about the effective methods that suit them and when to initiate

Glycine betaine and salicylic acid induced modification in productivity of two different cultivars of wheat grown under water stress

A pot experiment was conducted to evaluate the beneficial effect of foliar application of glycine betaine (10mM), grain presoaking in salicylic acid (0.05 M) and their interaction on drought tolerance of two wheat (Triticum aestivum L.) cultivars (sensitive, Sakha 94 and resistant, Sakha 93). Water stress decreased wheat yield components (spike length, number of spikelets / main spike, 100 kernel weight, grain number / spike, grain yield / spike, grain yield / plant, straw yield / plant, crop yield / plant, harvest, mobilization and crop indices) and the biochemical aspects of grains(grain biomass, carbohydrates, total protein, total phosphorus, ions content and amino acids) in both wheat cultivars. The applied chemicals appeared to alleviate the negative effects of water stress on wheat productivity (particularly the sensitive one) and the biochemical aspects of yielded grains. The effect was more pronounced with GB+SA treatment. This improvement would result from the repairing effect of the provided chemicals on growth and metabolism of wheat plants grown under water deficit condition. In response to the applied water stress and the used chemicals, the grain yield of the sensitive and resistant wheat cultivars was strongly correlated with all the estimated yield components (shoot length, spike length, plant height, main spike weight, number of spikelets per main spike, 100 kernel weight, grain number per spike, grain weight per plant, straw weight per plant, crop yield per plant, harvest, mobilization and crop indices)