Sindroma feminisasi testikular pada usia prepubertas - Laporan Kasus

ABSTRACT Background: It is important to diagnose testicular feminization due to other abnormalities with similar clinical findings which needs different treatments. Aim: To diagnose early testicular feminization syndrome by clinical findings, hormone levels, and chromosome analysis. Design: Review of reported cases. Setting: A university hospital. Patient: Phenotypic girl aged 9 years with abnormal external genitalia revealed large clitoris-like structure, normal labia majora, a blind vaginal pouch and no palpable uterus and adnexa. Results: The uterus and adnexa of the patient at ultrasonography and laparoscopy examination were proved to be absent. The serum testosterone concentration was not substantially increased and the karyotype was 46XY. Further examination found left testis in inguinal canal and the right one in labia majora. From biopsy it was found that both seminiferous tubules were in development phase mostly with spermatogonia, and several part in spermatocyte phase. The diagnosis was testicular feminization (androgen insensitivity syndrome). Conclusions: Cases of primary amenorrhea, incomplete external genitalia, and vagina agenesis/hypogenesis, are important to be early diagnosed by investigating the sex chromosome, gonads, sex hormone, genitalia, and sex psychology. Because of the increased risk of malignancy, an orchidectomy has to be performed. Key words : testicular feminization - normal male 46XY - female external genitalia - orchidectomy Latar belakang: Diagnosis feminisasi testikular perlu ditegakkan karena banyak kelainan lain yang memberikan gejala klinis yang sama dengan penanganan yang berbeda. Tujuan penelitian: Mendiagnosis secara dini sindrom feminisasi testikular dengan pemeriksaan klinis, kadar hormon, dan analisa kromosom. Disain: Laporan kasus. Setting: Rumah Sakit. Pasien: Anak perempuan usia 9 tahun, dengan kelainan genitalia eksterna, ditemukan bangunan yang menyerupai struktur klitoris, labia mayora normal serta lubang vagina yang buntu. Uterus dan adneksa tidak teraba. Hasil penelitian: Pada pemeriksaan ultrasonografi dan laparoskopi, dipastikan uterus dan adneksa tidak ada. Pada pemeriksaan hormon, testosteron didapatkan tidak meningkat secara substansial, dan karyotip pemeriksaan kromosom menunjukkan 46XY. Pada pemeriksaan Iebih lanjut, ditemukan testis kin berada di kanalis inguinalis, dan testis kanan di dalam labia majora. Dari biopsi, kedua tubulus seminiferus sebagian berada di fase spermatogonia, sisanya pada fase spermatosit. Diagnosis yang ditegakkan adalah testikuler feminisasi (sindroma insensitifitas terhadap androgen). Simpulan: Penegakan diagnosis secara dini sangat penting dilakukan terhadap kasus dengan amenore primer, tidak lengkapnya genitalia eksterna, dan agenesis/hipogenesis vagina, dengan pemeriksaan: kromosomal seks, gonad, hormon seks, genitalia, serta psikologi seks. Orkhidektomi perlu dilakukan mengingat risiko ke arah malignansi

Neonatal outcomes in In vitro fertilization (IVF) pregnancies

small-for-gestational age (SGA), and low birth weight (LBW) rates are approximately twiceas high in IVF pregnancies than in natural pregnancies. The IVF procedures have becomemore routine in recent years in Indonesia, but there have been few assessments ofneonatal outcomes. The study aimed to evaluate the risk of preterm birth, SGA, and LBWin IVF infants. This was a retrospective cohort study performed in Dr. Sardjito GeneralHospital, Yogyakarta from January 2012 to December 2016. Pre-coded questionnaireswere used to collect data from medical records. The relative risk of preterm birth, SGA,and LBW among IVF infants were calculated and compared to naturally conceived infants.A total sampling method was used for the IVF infants and a simple random samplingmethod was used for naturally conceived infants, who were born on the same day as aninfant in the IVF group.A total of 108 infants were recruited, consisting of 54 IVF infants and 54 naturallyconceived infants. The IVF infants had increased risk of preterm birth (RR = 2.0; 95%CI0.52 - 7.58) and LBW (RR = 1.25; 95%CI 0.53 - 2.92). However, the IVF infants didnot have an increased risk of SGA (RR = 1.0; 95%CI 0.21 - 4.73). In conclusion, therisk of preterm birth and LBW in IVF infants are higher than in naturally conceived infants,but not statistically significant. However, there is no increased risk of SGA in IVF infants

MICROVOLUME OF 0.1µL GAMA SLEEVED CRYOLOOPS FOR BLASTOCYST VITRIFICATION OF ASSISTED REPRODUCTIVE TECHNOLOGY PATIENTS

Ita Fauzia Hanoum1,2, Arief Boediono3, Mulyoto Pangestu4,5, Dwi Haryadi1,Shofwal Widad1,2, Djaswadi Dasuki1,2 ABSTRAK Latar Belakang: Prosedur embrio vitrifikasi menggunakan alat berupa grid, straw atau cryoloop. Gama Sleeved cryoloop dibuat dan dikembangkan di klinik Permata Hati. Untuk itu, dilakukan pengamatan keberhasilan prosedur vitrifikasi menggunakan 0.1µl Gama Sleeved cryoloop.Metode: Vitrifikasi dilakukan pada blastokis dengan kualitas baik yang diperoleh pada hari ke 5 setelah fertilisasi. Inform consent telah disampaikan sebelumnya kepada pasien program bayi tabung di Klinik Permata Hati. Prosedur dilakukan dengan menggunakan media handling (GMOPS Plus; Vitrolife) embrio diinkubasi selama 1 menit; (7.5% EG (v/v); 7.5% DMSO (v/v)) selama 2-3 menit, (15% EG (v/v); 15% DMSO v/v; 10 mg/ml Ficoll; 0.65 M Sucrosa) selama 30 detik pada suhu ruang sebelum kemudian diletakkan di dalam cryoloop, setelah itu secara cepat cryoloop yang berisi embrio dibenamkan ke dalam nitrogen cair. Sebelum dilakukan embryo transfer (ET), embrio dihangatkan dengan cara two step technique (sucrose 0.25M) selama 2 menit dan selama 3 menit (sucrose 0.125M).Hasil: Sejumlah 97 blastokis divitrifikasi dan dihangatkan (67 pasien), dimana 91 blastokis berhasil ditransfer ke rahim ibu (93.8%). Blastokis yang tidak berhasil selamat dari prosedur penghangatan adalah blastokis dengan kerusakan lebih dari 50%. Diperoleh kehamilan klinis 43.3% sedangkan angka implantasi adalah 37.4%. Sampai saat ini, dilaporkan 20 kelahiran (23 bayi) dari program vitrifikasi menggunakan 0.1µl Gama Sleeved cryoloop, sementara 5 kehamilan masih berlangsung. Satu kehamilan dilaporkan gugur pada usia kehamilan yang masih sangat awal, dua keguguran pada usia kehamilan 12 minggu dan satu bayi lahir meninggal karena kelainan kongenital.Kesimpulan: 0.1µl Gama Sleeved cryoloop merupakan pilihan untuk digunakan sebagai alat vitrifikasi blastokis. Data awal yang kami sampaikan dan kelahiran bayi dari program tersebut memberikan harapan untuk kesuksesan program simpan beku embrio di klinik Permata Hati RSUP DR Sardjito Yogyakarta.Kata kunci: kriopreservasi, blastokis, vitrifikasi ABSTRACTBackground: Vitrification has been applied succesfully in human embryo using grid, straw and cryoloop. Gama Sleeved is a home made device develop at Permata Hati. We assessed the survival rate of human blastocyst vitrified in 0.1µl Gama Sleeved cryoloop as device.Method: Excess good grade human D5 embryos were vitrified, upon a detailed informed consent. Embryos were hold in handling media (GMOPS Plus; Vitrolife) for 1 minute; (7.5% EG (v/v); 7.5% DMSO (v/v)) for 2-3 minutes, (15% EG (v/v); 15% DMSO v/v; 10 mg/ml Ficoll; 0.65 M Sucrosa) for 30 seconds at room temperature before inserted in to the loops, then directly plunged into the liquid nitrogen. Prior to ET, embryos were warmed by two step technique in sucrose 0.25M for 2 min and 0.125M sucrosa for 3 min. Embryos were then cultured.Results: Total of 97 vitrified warmed human blastocyst (67 patients) were used and 91 (93.8%) were transferred. Non-transferred blastocyst (6.2%) has more than 50% lyse. The clinical pregnancy rate was 43.9%. The implantation rate was 37.4%. Currently, 20 deliveries of 23 babies born from vitrified blastocyst using 0.1µl Gama Sleeved cryoloop, and another 5 ongoing pregnancy. So far there was 1 early pregnancy loss, 2 miscarriages at 12 weeks pregnancy, and one infant died due to a congenital anomaly.Conclusion: 0.1µl Gama Sleeved cryoloop provides an excellent alternative to existing vitrification devices. These initial data and babies delivered from the program have been promising to a vitrification system in our own ART program.Keywords: cryopreservation, blastocyst, vitrification1Permata Hati Infertility Clinic RSUP DR Sardjito, Yogyakarta2Div Reproductive Endocrinology and Fertility OBGYN Medical Faculty Gadjah Mada University, Yogyakarta3Lab. Anatomi Embriologi FKH, Institut Teknologi Pertanian, Bogor4EPRD- Dept. Obstetrics and Gynecology, Monash University, Monash Medical Center,Victoria, Melbourne5Lab. Reproductive Physiology, Jenderal Soedirman University, Purwokerto Correspondence address: + 62 274 518684; fax + 62 274 553575; email: [email protected]

Ethanol Extract of Tithonia diversifolia (Hemsley) A Gray Standardized Ameliorates Hyperglycemia, Polyphagia, and Weight Loss in Diabetic Rats

Diabetes mellitus is a state of chronic hyperglycemia which causes various complications. Traditionally, The Tithonia diversifolia (Hemsley) A Gray leaf has long been used for the treatment of diabetes. The aim of this study is to investigate the effect of the T. diversifolia leaf on blood glucose, polyphagia, and weight loss in a diabetic rat model. Rats were made diabetic with intraperitonial injection of Nicotinamide and Streptozotocin and divided into 5 groups. Group 1 were healthy rats, group 2 were diabetic rats, while groups 3, 4, and 5 were diabetic rats treated with 25, 50, and 100 mg/kg body weight of 70% ethanol extract of Tithonia diversifolia leaf respectively for 28 days. Blood was taken after treatment for measuring glucose. The ethanol extract of T. diversifolia leaf decreased blood glucose in diabetic rats (P<0.05). The ethanol extract of T. diversifolia leaf significantly suppresses polyphagia and improves diabetic rat weight (P <0.05). In conclusion, Tithonia diversifolia ethanolic extract has anti-hyperglycemic effect and ameliorated the effect of diabetes mellitus symptoms, namely polyphagia and weight loss