In Vitro Fertilization(IVF) for Gilbert Syndrome Associated with ßeta-Thalassemia, A Case Report

The Gilbert syndrome is a familial tip of a benign condition characterized by a high level of unconjugated bilirubin without hemolysis or liver disease. In this syndrome, there is a mutation of the UGT1A1 gene on the long arm (q) of chromosome 2, which synthesize the enzyme uridine diphosphate-glucuronosyltransferase-1A1 (UGT1A1), that conjugate bilirubin. Hepatic glucuronidation activity is diminished by 30%. The association between Gilbert syndrome and in vitro fertilization (IVF) is not yet presented in the literature. A 34-year-old nulliparous woman presented to our clinic for primary infertility. Antimullerian hormone level was normal: 3.5 ng/ml. Her partner sperm analysis showed severe oligoasthenoteratozoospermia: 5milion/ml concentration, 25 % progressive motility, 3% standard form. She was known for Gilbert syndrome and ßeta thalassemia. She decided to go for in vitro fertilization (IVF) with ICSI (intracytoplasmic sperm injection). We used a short antagonist protocol with letrozole 2.5mg twice a day and 150 UI menotropins to avoid estradiol rising, which could determine, in her case, the level of serum bilirubin to increase. We collected fourteen oocytes; twelve of them were in metaphase II, nine fertilized by ICSI, and we obtained three good blastocyst 4aa, 4ab, and 4ba (according to Gardner-Schoolcraft criteria). We transferred one blastocyst, and ß HCG was negative on day eleven after embryo transfer. Next month, we transferred on a natural cycle one blastocyst: 4ab after thawing. Ultrasound confirmed a single pregnancy with a heartbeat. In this Gilbert syndrome, to avoid estradiol rising, we used aromatase inhibitors in conjunction with gonadotropins for IVF ovarian stimulation

Risk factors, predictive markers and prevention strategies for intrauterine fetal death. An integrative review

According to World Health Organization (WHO), fetal death is defined as the death of the fetus prior to its complete expulsion, independent of the duration of pregnancy, thus only ascribing the term stillbirth to fetal deaths in the case of pregnancies after 28 weeks of gestation. The great progress of perinatology care is reflected in a significant reduction in the rate of stillbirths, especially in well-developed countries, with approximately 98% of stillbirth cases now occurring in poor and developing countries. Stillbirth powerfully impacts both the patient and the practitioner. Because nearly half of stillbirth cases result from apparently uncomplicated pregnancies, we considered it critical to review the known predictive markers for intrauterine fetal death. In both preterm and term infants, perinatal mortality is increased in fetuses small for their gestational age, and this risk grows proportionally with the severity of the fetal growth restriction. A protracted first stage of labor has not been associated with an increased risk of perinatal mortality and morbidity, but a prolonged second stage of labor has been associated with mortality and neonatal morbidity characterized by sepsis, seizures, and hypoxic-ischemic encephalopathy. Ultrasound examination of the placenta and the umbilical cord is essential for appropriate pregnancy monitoring. Various findings from ultrasound examination have been related to variable adverse perinatal outcomes, including intrauterine fetal death. After reviewing the evidence for predictors of intrauterine fetal death, we offer a general strategy for reducing the likelihood of stillbirths

A mini-review regarding the carcinogenesis and morphology of serous tumors of the ovary, fallopian tube and peritoneum

Similar to the already well-recognized adenoma-carcinoma sequence in colorectal cancer pathogenesis, it has been believed for many decades that the progression of ovarian epithelial tumors occurs from benign serous cystadenomas to borderline tumors, to well-differentiated carcinomas, and ultimately, to poorly differentiated carcinomas. However, it is currently accepted that low-grade serous carcinoma (LGSC) and high-grade serous carcinoma (HGSC) are fundamentally different tumor types and, consequently, different diseases. In fact, whereas the benign-borderline-malignant sequence seems to apply quite well to low-grade serous carcinoma, the sequence of genetic alterations in high-grade serous carcinoma is substantially different. In this mini-review, we included the current consensus regarding the morphological and etiopathogenic results regarding serous tumors of the ovary, fallopian tube and peritoneum. It also briefly describes the history of benign, borderline and malignant serous tumors, discussing multiple types of dichotomies in serous carcinomas of the female genital tract and summarizing the current molecular classification

The role of spinal ultrasound in the diagnosis of spinal dysraphism – correlation with MRI examination

The paper presents the clinical, ultrasound and MRI appearances in the case of the closed spinal dysraphisms with a cutaneous/subcutaneous mass: lypomyelomeningocele, posterior meningocele and cervical meningocele. There is mentioned first the classification of these defects, then, for each type, a case example is presented, showing the clinical aspect of the lesion, the ultrasound features and the correlation of ultrasound with MRI images. The examples show a good correlation between ultrasound and MRI, entitling the ultrasound exam to be the first line of exploration in the case of this category of patients

Spinal ultrasound – Identification of the normal structures

The incomplete ossification of the spinal processes allows the ultrasonographic evaluation of the spinal cord and the adjacent structures in neonates and small infants. The paper describes the ultrasonographic examination of the spinal structures and the normal appearance of the spinal cord, the structures within the spinal canal, and the bony and muscular adjacent structures. Sagittal and axial sections at cervical, thoracic, lumbar, and sacral levels are described. There are also mentioned findings in the M mode and Doppler examinations

Menopause and oral health

At menopause, a woman's body undergoes radical hormonal changes, which predisposes to damage of the oral cavity. The onset of menopause is a series of morpho functional physiological adaptive changes with systemic and oral action in women. Oral health is closely related to dental hygiene, a major concern in menopause. The addressability of women to dental services tends to increase due to perimenopausal changes that occur in the gums and teeth and the oral microbiome. These changes have a hormonal substrate that significantly influences the evolution of oral health. The purpose of this review is to understand the occurrence and evolution of oro-dental complications in menopause and the systematization of therapeutic regimens. The PubMed and Web Of Science databases searched identified approximately 21 eligible articles. Periodontal damage is the most common, followed by dryness and burning sensation in the mouth. The role of hormone replacement therapy is controversial in terms of prophylaxis or the obvious therapeutic aspect of menopausal women with oral symptoms. The lack of extensive research, at least for the time being, does not establish clear therapeutic protocols to resolve these dental conditions

Gestational periodontitis impact on the fetus and neonate

Maternal oral pathologies during pregnancy represent a controversial subject. The incidence of periodontal disease is approximatively 40% among pregnant women. Periodontal disease has been associated with several unfortunate outcomes; among them, the most important are cardiovascular disorders, respiratory infections, diabetes and Alzheimer's disease. Regarding mechanisms, bacteria enter the blood stream and cross the placenta or the inflammatory mediators can affect the fetoplacental unit or generate an increased inflammatory response with subsequent consequences on the fetus. The most disputed subjects concerning periodontal disease in pregnancy are related to the effects on the pregnancy outcome and the offspring, respectively the associations between maternal periodontal disease and small for gestational age, preeclampsia, arteriosclerosis, gestational diabetes and perinatal mortality. In order to improve neonatal outcome and ensure maternal oral health, we should assure that the necessary dental treatment is provided during the entire pregnancy, preferably between 14 and 20 gestational weeks. Moreover, women should be encouraged to received dental treatment preconceptionally

The influence of vaginal ovules on vaginal microbiome and vulvovaginitis

Vaginal microbiome is submitted to permanent changes accordingly to age, menopausal status or association of different pathological conditions such as inflammation or mucosal atrophy. The presence of these modifications is usually associated with local development of infectious, inflammatory or atrophic vulvovaginitis. These represent the most commonly complaints which affect women at all ages. Therefore, attention was focused on creating a topic product which is able to control the local process and to alleviate the symptoms. The aim of the current paper is to analyze the physiology, physiopathology and therapeutic strategies in such cases with special focus on Cerviron, a product which seems to provide multiple therapeutic benefits in such cases

Case report of a rare bullous variant of oral lichen planus

The aim of this report is to describe the lichen planus on the oral mucosa in the bullous variant of the disease. It is often misdiagnosed with other mucosa disorders (allergies, bullous dermatosis). A 37-year-old-female patient presented for oral mucosa painful lesions of 3 months duration. A microscopic examination of the lesional areas was consistent with the diagnosis of oral lichen planus and direct immunofluorescence confirmed it. This case showed that although a rare condition the variant of bullous lichen planus can be encountered in daily clinical practice

Vitamin D supplementation – still a subject of debate

Vitamin D is a standard vitamin supplementation for children in many countries, used mainly for preventing rickets. Many studies were published about the efficiency of vitamin D administration in children and adults for other pathologies besides rickets. Very often the results were contradictory, but nevertheless, more and more articles are published on this matter. There is no consensus for the effective vitamin D dosage nor for the vitamin D normal serum values. Both vitamin D deficiency and vitamin intoxication are dangerous for children. Recently some studies are showing controversial data that advise being more careful in prescribing vitamin D as a routine