New Hysteroscopic Approaches to Uterine Fibroids

The hysteroscopic myomectomy is a very important application of the gynecologic endoscopy, as it allows minimal invasive removal of the type 0, 1, and 2 fibroids with minimal damage to the uterine wall. In the last decade, new developments of this method allowed an even less invasive approach, with possibility of ambulatory procedure. We discuss the importance of these new developments, based very much on the pseudocapsule of the myoma, and analyze the literature data regarding the outcome. The cold loop resection is a technique that could be used in type 1 and type 2 myomas, with less complications and limitations than the classical electrical resectoscope. Another development, more useful for type 0 and 1 myoma, is the hysteroscopic morcellator, similar to the laparoscopic one, but providing a faster and safer procedure. We also update the complications of hysteroscopic myomectomy and their management, including long-term and obstetrical complications related to hysteroscopic myomectomy. In conclusion, new developments and studies show that hysteroscopic myomectomy has become a valid endoscopic technique ready to be used by many specialists

Maternal and fetal outcome in HELLP syndrome in a tertiary care hospital in north east Romania

UMF “Gr.T.Popa”, Iaşi, Spitalul “Cuza Vodă”, IaşiObjective: Hepatic vascular injury in preeclampsia is responsible for HELLP syndrome (Haemolisis, Elevated Liver enzymes, Low Platelet count), sometimes without hypertension or proteinuria. The aim of the study was to evaluate maternal and fetal outcome in pregnant women with HELLP syndrome hospitalized in a third level maternal-fetal unit. Methods: Data concerning the clinical evolution of patients and laboratory analyzes were recuperated from the electronic archive of “Cuza Voda” Hospital. Statistical processing was performed with Microsoft Office Excel 2007 TM. Results: Between 01.01.2009-31.12.2013, in “Cuza Voda” Hospital, Iasi, a number of 29 352 births were recorded, 55 (0.187 %) being diagnosed with HELLP syndrome. Among them, only for 25 cases we could recover complete data for statistical processing. The 25 patients had a mean age of 29.2 years (range 19-39). The mean gestational age when HELLP syndrome was diagnosed, was 31.8 weeks of amenorrhea (range 27-38 ) and the mean biometric age at the preoperative ultrasound was 30.3 weeks of amenorrhea (range 24-37). Caesarean section was completed in 22/25 cases (88 %), the remaining 3 cases delivered vaginally, at a mean of 56.2 hours after admission (range 0.5 – 384 h). Maternal prognosis was burdened with the following complications: severe preeclampsia (10/25 cases), eclampsia (3/25 cases), uteroplacental apoplexy (4/25 cases), pulmonary edema (3/25 cases), acute renal failure (9/25 cases), disseminated intravascular coagulation syndrome (2/25 cases), maternal death (1/25 cases). Fetal evolution presented the following complications: antepartum fetal death (4/25 cases), RCIU (11/25 cases), prematurity (22/25 cases) with a premature birth between 27-34 weeks (17/25 cases) and between 34 -37 weeks (5 cases). One minute Apgar score was 0 in 4 cases, the remaining cases showing an average of 6.3 (range 1-9) at 1 minute and of 7.1 (range 1-9) at 5 minutes. Conclusions: Management and delivery of patients with HELLP syndrome should take place in a tertiary level unit with a trained multidisciplinary team (obstetrician, anesthetist, neonatologist, medical laboratory doctor, operating theater nurses, intensive care nurses, midwives) and technical facilities available. A rapid and accurate diagnosis and a prompt intervention can reduce the risk of maternal and fetal mortality and morbidity.Obiectiv: Atingerea hepatică vasculară în preeclampsie este responsabilă de sindromul HELLP (haemolisis, elevated liver enzymes, low platelet count), uneori fără HTA şi nici proteinurie. Scopul studiului a fost de a evalua prognosticul matern şi fetal la gravidele internate cu HELLP sindrom într-o unitate materno-fetală de nivel trei. Material şi metodă: Datele despre evoluţia clinică a pacientelor şi analizele de laborator au fost preluate din arhiva electronică a Spitalului “Cuza Vodă” cât şi din foile de observaţie. Prelucrarea statistică s-a efectuat utilizând programul Microsoft Office Excel 2007 TM. Rezultate: În perioada 01.01.2009-31.12.2013, în Spitalul Clinic de Obstetrică-Ginecologie Cuza Vodă, Iaşi au fost asistate un număr de 29352 naşteri, dintre care 55 (0.187%) au fost diagnosticate cu HELLP sindrom. Dintre acestea, doar pentru 25 cazuri s-au putut recupera datelele complete pentru prelucrarea statistică. Cele 25 paciente au avut o vârstă medie de 29.2 ani (interval 19-39). Vârsta gestaţională medie la care s-a instalat HELLP sindromul a fost de 31.8 săptămâni amenoree (interval 27-38) iar vârsta medie biometrică conform ecografiei preoperatorii a fost de 30.3 săptămâni amenoree (interval 24-37). Naşterea s-a finalizat prin cezariană în 22/25 cazuri (88%), restul de 3 cazuri care au născut natural internându-se cu naştere declanşată, la o distanţă medie de 56.2 ore de la internare (interval 0,5-384h). Prognosticul matern a fost grevat de următoarele complicaţii: preeclampsie severă (10/25 cazuri), eclampsie (3/25 cazuri), apoplexie utero-placentară (4/25 cazuri), edem pulmonar acut (3/25 cazuri), insuficienţa renală acută (9/25 cazuri), sindrom de coagulare intravasculară diseminată (2/25 cazuri), deces matern (1/25 cazuri). Evoluţia fetală a prezentat următoarele complicaţii: moarte fetală antepartum (4/25 cazuri), RCIU (11/25 cazuri), prematuritate (22/25 cazuri) din care naştere prematură între 27-34 săptămâni (17/25 cazuri), iar între 34-37 săptămâni (5 cazuri). Scorul APGAR la 1 minut a fost 0 în 4 cazuri, restul cazurilor prezentând o medie de 6.3 (interval 1-9) la 1 minut şi de 7.1 (interval 1-9) la 5 minute. Concluzii: Managementul şi naşterea pacientelor cu sindrom HELLP trebuie să aibă loc într-o unitate de nivel trei, cu o echipă multidisciplinară antrenată (obstetrician, anestezist, neonatolog, medic de laborator, asistente de bloc operator, reanimare, moaşe) şi facilităţi tehnice disponibile. Un diagnostic rapid şi corect şi o intervenţie promptă, pot reduce riscul de mortalitate şi morbiditate maternă şi fetală

Mini-Review Regarding the Applicability of Genome Editing Techniques Developed for Studying Infertility

Infertility is a highly debated topic today. It has been long hypothesized that infertility has an idiopathic cause, but recent studies demonstrated the existence of a genetic substrate. Fortunately, the methods of editing the human genome proven to be revolutionary. Following research conducted, we identified a total of 21 relevant studies; 14 were performed on mice, 5 on zebrafish and 2 on rats. We concluded that over forty-four genes in total are dispensable for fertility in both sexes without affecting host homeostasis. However, there are genes whose loss-of-function induces moderate to severe phenotypic changes in both sexes. There were situations in which the authors reported infertility, exhibited by the experimental model, or other pathologies such as cryptorchidism, cataracts, or reduced motor activity. Overall, zinc-finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs), and clustered regularly interspaced short palindromic repeat (CRISPR)/Cas9 are techniques that offer a wide range of possibilities for studying infertility, even to create mutant variants. It can be concluded that ZFNs, TALENs, and CRISPR/Cas9 are crucial tools in biomedical research

A Mini-Review Regarding the Clinical Outcomes of In Vitro Fertilization (IVF) Following Pre-Implantation Genetic Testing (PGT)-Next Generation Sequencing (NGS) Approach

Background: PGT-based NGS revolutionized the field of reproductive medicine, becoming an integrated component within current assisted reproductive technology (ART) protocols. Methods: We searched the literature published in the last half a decade in four databases (PubMed/Medline, ISI Web of Knowledge, ScienceDirect, and Scopus) between 2018 and 2022. Results: A total of 1388 articles were filtered, from which 60 met, initially, the eligibility criteria, but only 42 were included (≥100 patients/couples—62,465 patients and 6628 couples in total) in the present mini-review. In total, forty-two (70.0%) reported reproductive outcomes, while eighteen (30.0%) had distinct objectives. Furthermore, n = 1, 1.66% of the studies focused on PGT, n = 1, 1.66% on pre-implantation genetic testing for monogenic disorders (PGT-M), n = 3, 5.0% on pre-implantation genetic testing for structural rearrangements (PGT-SR) and n = 55, 91.66% on pre-implantation genetic testing for aneuploidies (PGT-A). Conclusions: PGT using NGS proved to be an excellent companion that folds within the current ascending tendency among couples that require specialty care. We strongly encourage future studies to provide a systematic overview expanded at a larger scale on the role of the PGT-NGS

Mini-Review Discussing the Reliability and Efficiency of COVID-19 Vaccines

Severe Acute Respiratory Syndrome Coronavirus 2 is a novel strain of human beta-coronavirus that has produced over two million deaths and affected one hundred million individuals worldwide. As all the proposed drugs proved to be unstable, inducing side effects, the need to develop a vaccine crystallized in a short time. As a result, we searched the databases for articles in which the authors reported the efficacy and safety of the use of several vaccines vaccines by sex, age group, and frequency of adverse reactions. We identified a total of 19 relevant articles that were discussed throughout this manuscript. We concluded that from all eleven vaccines, three had an efficacy >90% (Pfizer–BioNTech (~95%), Moderna (~94%), and Sputnik V (~92%)) except for Oxford–AstraZeneca (~81%). However, Moderna, Sputnik V, and Oxford–AstraZeneca also alleviate severe adverse reactions, whereas in Pfizer–BioNTech this was not revealed. The remaining five (Convidicea (AD5-nCOV); Johnson & Johnson (Ad26.COV2.S); Sinopharm (BBIBP-CorV); Covaxin (BBV152), and Sinovac (CoronaVac)) were discussed based on their immunogenicity, and safety reported by the recipients since only phases 1 and 2 were conducted without clear evidence published regarding their efficacy. CoviVac and EpiVacCorona have just been approved, which is why no published article could be found. All adverse events reported following the administration of one of the four vaccines ranged from mild to moderate; limited exceptions in which the patients either developed severe forms or died, because most effects were dose-dependent. It can be concluded that aforementioned vaccines are efficient and safe, regardless of age and sex, being well-tolerated by the recipients

Mathematical Modeling to Predict COVID-19 Infection and Vaccination Trends

Background: COVID-19 caused by the Severe Acute Respiratory Syndrome Coronavirus 2 placed the health systems around the entire world in a battle against the clock. While most of the existing studies aimed at forecasting the infections trends, our study focuses on vaccination trend(s). Material and methods: Based on these considerations, we used standard analyses and ARIMA modeling to predict possible scenarios in Romania, the second-lowest country regarding vaccinations from the entire European Union. Results: With approximately 16 million doses of vaccine against COVID-19 administered, 7,791,250 individuals had completed the vaccination scheme. From the total, 5,058,908 choose Pfizer–BioNTech, 399,327 Moderna, 419,037 AstraZeneca, and 1,913,978 Johnson & Johnson. With a cumulative 2147 local and 17,542 general adverse reactions, the most numerous were reported in recipients of Pfizer–BioNTech (1581 vs. 8451), followed by AstraZeneca (138 vs. 6033), Moderna (332 vs. 1936), and Johnson & Johnson (96 vs. 1122). On three distinct occasions have been reported >50,000 individuals who received the first or second dose of a vaccine and >30,000 of a booster dose in a single day. Due to high reactogenicity in case of AZD1222, and time of launching between the Pfizer–BioNTech and Moderna vaccine could be explained differences in terms doses administered. Furthermore, ARIMA(1,1,0), ARIMA(1,1,1), ARIMA(0,2,0), ARIMA(2,1,0), ARIMA(1,2,2), ARI-MA(2,2,2), ARIMA(0,2,2), ARIMA(2,2,2), ARIMA(1,1,2), ARIMA(2,2,2), ARIMA(2,1,1), ARIMA(2,2,1), and ARIMA (2,0,2) for all twelve months and in total fitted the best models. These were regarded according to the lowest MAPE, p-value (p < 0.05, p < 0.01, and p < 0.001) and through the Ljung–Box test (p < 0.05, p < 0.01, and p < 0.001) for autocorrelations. Conclusions: Statistical modeling and mathematical analyses are suitable not only for forecasting the infection trends but the course of a vaccination rate as well

An Updated Narrative Mini-Review on the Microbiota Changes in Antenatal and Post-Partum Depression

Background: Antenatal depression (AND) and post-partum depression (PPD) are long-term debilitating psychiatric disorders that significantly influence the composition of the gut flora of mothers and infants that starts from the intrauterine life. Not only does bacterial ratio shift impact the immune system, but it also increases the risk of potentially life-threatening disorders. Material and Methods: Therefore, we conducted a narrative mini-review aiming to gather all evidence published between 2018–2022 regarding microflora changes in all three stages of pregnancy. Results: We initially identified 47 potentially eligible studies, from which only 7 strictly report translocations; 3 were conducted on rodent models and 4 on human patients. The remaining studies were divided based on their topic, precisely focused on how probiotics, breastfeeding, diet, antidepressants, exogenous stressors, and plant-derived compounds modulate in a bidirectional way upon behavior and microbiota. Almost imperatively, dysbacteriosis cause cognitive impairments, reflected by abnormal temperament and personality traits that last up until 2 years old. Thankfully, a distinct technique that involves fecal matter transfer between individuals has been perfected over the years and was successfully translated into clinical practice. It proved to be a reliable approach in diminishing functional non- and gastrointestinal deficiencies, but a clear link between depressive women’s gastrointestinal/vaginal microbiota and clinical outcomes following reproductive procedures is yet to be established. Another gut-dysbiosis-driving factor is antibiotics, known for their potential to trigger inflammation. Fortunately, the studies conducted on mice that lack microbiota offer, without a shadow of a doubt, insight. Conclusions: It can be concluded that the microbiota is a powerful organ, and its optimum functionality is crucial, likely being the missing puzzle piece in the etiopathogenesis of psychiatric disorders

An Unusual Case of Urachal Cyst Misdiagnosed as a Paraovarian Cyst: Ultrasound Assessment and Differential Diagnosis

The urachus is an embryologic remnant of the cloaca that usually degenerates after birth, resulting from the obliteration of the allantois, whose role is to connect the bladder to the umbilicus. Incomplete removal of the lumen may give rise to different malformations of the median umbilical ligament after birth. Although in the pediatric population urachus are common, most cases are asymptomatic and may go unrecognized until adulthood and give rise to cysts, rarely reported in the literature. Thus, in this manuscript we present the circumstances of a 43-year-old Romanian woman showing hypogastric pain of moderate intensity for three weeks, radiation in the left lower limb, menstrual cycle abnormalities, and dysmenorrhea. Based on the initial examinations, a paraovarian cyst measuring 80 mm was noted. Through the subsequent magnetic resonance imaging (MRI) conducted, a hypoechoic mass was detected, and the patient underwent a tumorectomy and partial cystectomy. A 9.7/7.5-cm tumor was excised, and the anatomopathological result was urachal mucinous cystadenoma. It came to our attention that relatively scarce data were found in the literature, with only seven studies with the diagnosis of the urachal cyst

A Narrative Review Discussing the Efficiency of Personalized Dosing Algorithm of Follitropin Delta for Ovarian Stimulation and the Reproductive and Clinical Outcomes

Background: Follitropin delta is the third recombinant human follicle-stimulating hormone (r-hFSH) expressed in a host cell line of human fetal retinal origin that currently emphasizes that the actual tendency of administration is a personalized dosing algorithm based on the anti-Müllerian hormone (AMH) and body mass index (BMI) for ovarian stimulation. Methods: In this context, we aimed, in the present manuscript, to gather all available data published between 2018–2022 regarding the co-administration and administration of follitropin delta and the clinical outcomes reported following an in vitro fertilization (IVF). Results: Follitropin delta is non-inferior in contrast to its previously launched agents for ovarian stimulation, enhancing a similar-to-superior response reflected by both the reproductive and pregnancy outcomes in parallel with a low risk of ovarian hyperstimulation syndrome (OHSS), being well tolerated. The body weight and AMH level are factors that may influence the outcome in a patient. Despite controversy and results that refute these arguments on several occasions, follitropin delta exceeds the benefits of conventional dosing with either follitropin alfa or follitropin beta. Thus, all post hoc, derived analyses and subsets of patients that participated in subsequent studies support this statement. Conclusions: Despite the relatively limited spectrum of data in the current literature, most authors brought potent proof, supporting the subsequent use of this drug depending on the patient’s profile and overcoming ethnic-related limitations. Although others contradict these observations, this topic and drug possess substantial potential, which is why additional studies are mandatory to fill the existing gaps in our knowledge and expand these experiences at a larger scale supported by the obtained reproductive and clinical outcomes that clearly indicate an overcoming of all limitations

Factors Influencing Burnout Syndrome in Obstetrics and Gynecology Physicians

Aim. To identify the influence of environmental, personality, and alexithymia factors on burnout syndrome among obstetrics and gynecology physicians. Material and Methods. A total of 116 physicians (35 men and 81 women) completed questionnaires and sociodemographic data sheets. The Maslach Burnout Inventory, the Big Five Inventory, and the Toronto Alexithymia Scale were used to measure burnout, innate personality traits, and alexithymia, respectively. The t-test and Pearson correlations were used for other measurements. Results. Of the 116 study physicians, 12.9% have suffered or still suffer from depression and 35.3% have had or still have problems related to insomnia. Regarding emotional exhaustion and depersonalization factors, men obtained lower scores than women (18.73±13.48 versus 24.14±11.71 for emotional exhaustion; 5.97±5.45 versus 7.70±5.29 for depersonalization). Self-reported depression was related to higher scores for all 3 domains, to higher total scores for alexithymia and neuroticism, and to lower scores for extraversion, conscientiousness, and openness. Residents and consultants had markedly different scores. Conclusion. The results of this study will help obstetrics and gynecology physicians cope with professional burnout and to consider personality traits, alexithymia domains, and environmental factors when finding strategies to cope with their professional stress