Atypical tuberculosis presenting with primary infertility and endometrial calcification

Tuberculosis (TB) is caused by mycobacterium tuberculosis. It remains a public health concern especially in developing country. Pulmonary infection is the main presentation. However, genitourinary TB is common especially with the increase in Human Immunodeficiency virus (HIV) infection. Genitourinary TB is one of the most common causes of extrapulmonary tuberculosis which affects 12% patients with pulmonary tuberculosis. It is common in women less than 40 years of age and rarely occurs in post-menopausal. Therefore it is more likely to affect women in reproductive years leading to infertility. Fallopian tube involvement in genital TB is at least 95-100% of cases and is mainly from haematological spread and this leads to infertility. This is a case of a woman who presented a diagnosis of primary infertility and tuberculous endometritis with endometrial calcification

Endometriosis in unicornuate uterus with non-communicating rudimentary horn

Endometriosis, defined as the presence of endometrial tissue outside the uterine cavity, is itself an enigmatic  and multifaceted pathology, a puzzle whose manifold piece remain largely disconnected despite some decades  of investigation. Its medical history and clinical presentation is heterogeneous. Endometriosis affects  approximately 10% of women of reproductive age, given its high prevalence and that women with endometriosis may have severe pelvic pain and infertility, endometriosis poses a significant health problem.  Evaluating and understanding the pathogenesis, clinical presentation, diagnosis of the endometriosis is critical  in the management of this debilitating disease. A rare case of endometriosis in a patient with congenital  anomaly-Unicornuate uterus with one unconnected rudimentary horn is presented

Regulation of informed consent: a focus on fertility treatments in Kenya

No Abstrac

Laparoscopic myomectomy in Kenya : A 15 year retrospective review

Objectives: To evaluate the indications,operative techniques, outcomes, limitations and fertility outcomes following laparoscopic myomectomy.Design: Retrospective case analysisSetting: Various Private Hospitals in KenyaSubjects: One thousand and forty three patients who underwent laparoscopic myomectomyResults: The main indications for laparoscopic myomectomy in our review were Menorrhagia (52.1%), Primary Infertility (22.6 %), Secondary Infertility (14.3 %), Abdominal pain ( 8.2 % ) and pressure symptoms (2.8 %). The dominant myomas that were removed were intramural ( 45.4 %), subserous (34.6 %) and sub-mucous (19.9 %) of the cases respectively.Conclusions: Laparoscopic Myomectomy can be performed safely and effectively by adequately trained and skilled Surgeons and offers all the advantages of laparoscopic surgery including less haemorrhage, quicker recovery and return to work. The clinical outcomes are good and there were no major complications. The fertility outcomes are comparable to open myomectomy with better outcomes for sub mucous fibroids and deep intra-mural fibroids indenting the uterine cavity

Premature ovarian failure in twins: case report

Premature ovarian failure (POF)is a serious life-changing condition that affects young women, remains an enigma and the researchers’ challenge. POF, premature ovarian insufficiency (POI), premature menopause, premature dysfunction (POD), or hypergonadotropic hypogonadism is one of the most perplexing disorders with aheterogeneous origin. Infertility, social and psychological stress are common consequences of this entity. This paper presents a rare condition where both twins had presented with POF

Heterotopic pregnancy in an assisted reproduction conception; case report and literature review

Infertility management by assisted reproduction techniques has had rapid increase. While there is robust evidence supporting the efficacy and safety of assisted reproduction technique (ART), complications are encountered. Heterotopic pregnancy, defined as the presence of both an intrauterine and an ectopic gestation, is a rare eventuality of early pregnancy. A 42 years old patient (Para 0+1) with a diagnosis of secondary infertility is presented; she had In Vitro fertilization (IVF) with egg donation. Two weeks after the IVF, a positive serum Beta Human Chorionic Gonadotropin confirmed the pregnancy and she continued with intake of progestins for luteal phase support. At 7 weeks gestation she presented at a local hospital with acute pelvic pain. A diagnosis of heterotopic pregnancy was made after transvaginal showed right slow leaking ectopic pregnancy andintrauterine missed abortion. Laparoscopic surgery, right salpingectomy and manual vacuum aspiration were performed with good subsequent recovery. The case presented, discusses the aetiology, clinical presentation, diagnosis and management of heterotopic pregnancy

Successful pregnancy outcome following laparoscopic myomectomy: case report

Laparoscopic myomectomy is now widely used as an alternative to laparotomy in the management of symptomatic uterine fibroids. The advantages of this minimal access approach outweigh those of the open techniques. The pregnancy outcomes between the two methods have been studied and are comparable, but there still exists a lot of scepticism locally concerning this. It is against this background that we present a 31 year old nulliparous lady who had a two year history of primary infertility secondary to multiple uterine fibroids, the largest being fundal and measuring 6.6cm. She underwent a successful laparoscopic myomectomy in November, 2006 and conceived spontaneously in February 2007. Her antenatal follow up was uneventful. She delivered a live male, 2,650 grams by Caesarean section in October, 2007 and had an unremarkable peuperium. With the availability of proper equipment, instruments, and adequately developing skills, laparoscopic myomectomy is feasible locally and with proper patient selection could result in favourable outcome as it is elsewhere

Day care laparoscopic surgery in gynaecology at a dedicated unit in Nairobi, Kenya

Objective: To evaluate and audit the outcomes of Gynaecological Day care Laparoscopic Surgery inNairobi,KenyaDesign: Retrospective case analysisSetting: The International Centre for Minimal Access Surgery, NairobiSubjects: one thousand three hundred and seventy nine patients undergoing Laparoscopic SurgeryResults: Between January 2011 to December 2015 a total of 1,379 Laparoscopic procedures were undertaken during the reporting period of which 1,121 ( 88.5 % ) were done as day procedures. In total 137 patients ( 9.9 % ) spent one night at ICMAS, 21 ( 1.5 % ) were transferred to a Major Hospital and 41 patients (2.9 %) underwent conversion to Laparotomy. There were two Hospital re-admissions (0.14 % ) and one complication ( 0.07% ), a bladder injury was encountered.Conclusions: Daycare surgery is a continually evolving speciality being competently performed by several units by various disciplines world over , including Kenya. In recent years the complexity of the procedures has increased with a wider range of patients being considered for challenging surgeries including those presenting with acute conditions. Our experiences have been favourable

Solution Structure of the Link Module: A Hyaluronan-Binding Domain Involved in Extracellular Matrix Stability and Cell Migration

AbstractLink modules are hyaluronan-binding domains found in proteins involved in the assembly of extracellular matrix, cell adhesion, and migration. The solution structure of the Link module from human TSG-6 was determined and found to consist of two α helices and two antiparallel β sheets arranged around a large hydrophobic core. This defines the consensus fold for the Link module superfamily, which includes CD44, cartilage link protein, and aggrecan. The TSG-6 Link module was shown to interact with hyaluronan, and a putative binding surface was identified on the structure. A structural database search revealed close similarity between the Link module and the C-type lectin domain, with the predicted hyaluronan-binding site at an analogous position to the carbohydrate-binding pocket in E-selectin

Fusion of 6^{6}Li with 159^{159}Tb} at near barrier energies

Complete and incomplete fusion cross sections for $^{6}$Li+$^{159}$Tb have been measured at energies around the Coulomb barrier by the $\gamma$-ray method. The measurements show that the complete fusion cross sections at above-barrier energies are suppressed by $\sim$34% compared to the coupled channels calculations. A comparison of the complete fusion cross sections at above-barrier energies with the existing data of $^{11,10}$B+$^{159}$Tb and $^{7}$Li+$^{159}$Tb shows that the extent of suppression is correlated with the $\alpha$-separation energies of the projectiles. It has been argued that the Dy isotopes produced in the reaction $^{6}$Li+$^{159}$Tb, at below-barrier energies are primarily due to the $d$-transfer to unbound states of $^{159}$Tb, while both transfer and incomplete fusion processes contribute at above-barrier energies.Comment: Phys. Rev. C (accepted