Anatomical Defects Research Articles

Effect of Reproductive System Dysbiosis on the Course of Pregnancy

Abstract Genetic, endocrine and immunological disorders, anatomical defects in the reproductive tract, certain chronic diseases, toxic substances, or advanced age of the mother are most cited among the main causes of pregnancy loss at various stages. However, the cause of miscarriage or preterm labor in some cases remains unclear. Determination of the etiology about these clinical conditions may reduce the rate of reproductive failure. Similarly, the etiology of other obstetric disorders, such as preeclampsia or postpartum hemorrhage, has not been fully explained. One of the postulated and still under-researched causes of these disorders may be dysbiosis within the reproductive tract. A disturbed microbial balance is not always associated with the presence of an acute infection with clear clinical symptoms. Dysbiosis in conjunction with other pathophysiological factors may increase the risk of the mentioned clinical conditions. The aim of this paper is to show the information indicating the existence of a correlation between dysbiosis and an increase in the risk of obstetric disorders. Further analysis is also required to clarify the mechanism of the effect of dysbiosis on the disruption of metabolic and biochemical processes within the reproductive system during pregnancy.

Workshop on cultivating shared decision making to improve surgical outcomes for pelvic organ prolapse

This invited Workshop addressed the treatment of pelvic organ prolapse (POP) through the lens of a shared decision-making framework, based on individual discussions to balance benefits and risks of POP treatment. The framework begins with a consideration of bothersome symptoms as the basis for intervention, and highlights new research to investigate the relationship between POP symptoms and specific anatomical defects. This is followed by a consideration of treatment options including observation, pessaries, and surgery, offering a logical progression. We further consider surgery, focusing on surgical approach and uterine preservation as variables that influence benefits and risks of surgery. Finally, we consider individual variables that further modify specific benefit/risk ratios for a given patient and treatment modality. The goal is to provide a framework that incorporates all of these parameters into evidence informed discussion.

Bacterial urocystitis in dogs and cats (classification, pathogenesis, causative agents, treatment, and prevention)

Diseases of the urinary system are a common problem for small animals. Most often, pathological changes in the urinary bladder and urethra are registered in dogs and cats. In particular, urocystitis ranks first in the list of diseases of the lower urinary tract. The etiology of urocystitis can have a different genesis - infectious and non-infectious. Infectious urocystitis is divided into primary and secondary, which depends on the way of penetration of the uropathogen into the body. They have the same characteristics (bacterial pathogen, pathogenesis, clinical signs) as other infectious diseases, but no clear nosological classification exists. Most often, the causative agents of infectious urocystitis are bacteria that live on the body of animals as conditionally pathogenic microflora. These include escherichia, enterococci, corynebacteria, staphylococci, streptococci, proteus, and pseudomonads. Under favorable conditions, such as urolithiasis, immunosuppression, neoplasia, or congenital or acquired anatomical and functional defects of the urethra and bladder, these bacteria penetrate the urinary canal and begin to multiply uncontrollably there, which leads to the emergence of an infectious inflammatory process. Secondary bacterial urocystitis is more dangerous than primary ones, as constant relapses of the disease characterize their course. The final process of this disease is usually urosepsis. Therefore, according to various authors, the only effective therapy method for secondary infectious urocystitis is using antibiotics to which the pathogen is sensitive. This leads to antibiotic resistance of the bacterial microflora in the patient's body. The emergence of resistance of pathogens to antimicrobial agents makes further treatment of this pathology impossible. Preventive measures, proposed in various publications, ensure only the continuation of the remission of the disease. These measures cannot stop the recurrence of bacterial urocystitis and its irreversible consequences. Due to the cyclic nature of the pathogenetic process, dogs and cats suffering from secondary infectious urocystitis are classified as terminal patients. Alternative solutions to this problem have not yet been proposed. Analysis of literature data indicates that infectious urocystitis occurs more often as a complication of primary pathology. Still, after eliminating the initial cause, they play a vital role in the body of sick animals. Therefore, scientists' research should be directed to developing and implementing therapeutic measures and means that would neutralize bacterial agents without causing them to become resistant to antibiotics. The article describes the mechanisms of infection by uropathogens through the distal part of the urinary system and possible favorable factors that are the key to this process. The frequency of the disease occurrence in cats and dogs is given according to species, age, and sex. Issues of approach and treatment of bacterial urocystitis and related complications are highlighted. Based on the obtained data, an analysis was carried out, and a perspective vector was formed for further scientific research, which would eliminate the problem of this disease in small animals.

Biochemical Analysis of Congenital Hypogonadotropic Hypogonadism in the Context of Male Infertility: A Comprehensive Review

Background: Male infertility encompasses various etiologies, with Congenital Hypogonadotropic Hypogonadism (CHH) standing out as a significant factor. CHH arises from multiple systems, including genetic abnormalities and hormonal imbalances that impair reproductive capabilities. Objective: This review aims to dissect the biochemical underpinnings of CHH and evaluate its impact on male infertility, highlighting the complexities in its diagnosis and therapeutic management. Methods: The analysis involved a review of current literature on the genetic causes and hormonal disruptions associated with CHH. Diagnostic criteria were assessed based on biochemical markers and clinical symptoms. Treatment efficacy was evaluated through outcomes of hormone replacement therapy, surgical interventions, and assisted reproductive technologies. Results: The majority of CHH patients treated with hormone replacement therapy demonstrated improved sexual maturation and fertility, with approximately 70% achieving spermatogenesis. Surgical interventions corrected anatomical defects in 90% of cases, while assisted reproductive technologies resulted in successful pregnancies in 60% of treated individuals. Conclusion: CHH significantly affects male reproductive health, influencing testicular development and endocrine function. Advances in diagnostic and treatment strategies have enhanced management outcomes, but ongoing research is essential for developing more targeted therapies.

The digestive Enzyme-Based nasal dysbiosis in Empty nose Syndrome: A theory

Empty nose syndrome (ENS) is described as an empty space in the region of the inferior and middle turbinates of patients who underwent inferior and middle turbinectomy. Patients commonly complained of dry nose, paradoxical nasal obstruction, and crust. Symptoms significantly worsen the quality of life of patients. The pathophysiology of ENS is poorly understood. Several abnormalities in the nasal airflow dynamics, air humidification and warming, mucociliary clearance, and trigeminal-related sensory function were reported but it is misunderstood why some patients with anatomical turbinate defects developed ENS, while others do not experience symptoms with similar anatomy. This paper proposes a theory associating the development of ENS with the presence of laryngopharyngeal reflux disease (LPRD). LPRD is associated with the deposit of gastroduodenal enzymes into the upper aerodigestive tract mucosa, which lead to a decrease of the defense mechanisms of mucosa (mucus hydration, bicarbonate secretion, growth factor production) and an increase of mucosa injuries. In ENS patients, the deposit of digestive enzymes into the nasal mucosa may lead to concurrent injuries of the nasal cells involved in air humidification, warming, or sensory function, and modifications of the nasal microbiome that cannot heal the injured mucosa.

Rhinoplasty for unilateral cleft lip deformity

Cleft nasal deformity is most common sequel after cleft lip and palate surgery. The severity of the nasal deformity is usually decided by initial cleft state, previous operation skill and postoperative care. Secondary cleft rhinoplasty for unilateral cleft patient requires both esthetic and functional results. Understanding the anatomic defect and growth potential after cleft operation help to perform favorable secondary rhinoplasty. Surgical methods for deformed cleft nose are diverse and each methods have pros and cons. Closed or open rhinoplasty with or without cartilage graft and piriform augmentation are the mainstay for cleft rhinoplasty. The purpose of this study was to describe current concepts in secondary rhinoplasty for unilateral cleft lip nasal deformity. Secondary rhinoplasty for cleft patients requires an understanding of the anatomic situation, and the use of cosmetic and functional rhinoplasty techniques for its successful management.

Relationship between lymphocytes and idiopathic macular hole

BackgroundAn idiopathic macular hole (IMH) is a full-thickness anatomic defect extending from the internal limiting membrane to the photoreceptor layer of the macula without any known cause. Recently, clinical laboratory markers of systemic inflammatory status derived from complete blood counts have been evaluated in ocular diseases. This study aimed to explore whether they could predict the development and progression of IMHs.MethodsA retrospective review of 36 patients with IMH and 36 sex-and-age-matched patients with cataracts was conducted. We collected complete blood counts of all participating individuals and calculated systemic immunoinflammatory indicators. The maximum base diameter of the IMH (BD), minimum diameter of the IMH (MIN), height of the IMH (H), area of the intraretinal cyst (IRC), and curve lengths of the detached photoreceptor arms were measured on optical coherence tomography (OCT) images. We used these values to calculate the macular hole index (MHI), tractional hole index (THI), diameter hole index (DHI), hole form factor (HFF), and macular hole closure index (MHCI). We performed a receiver operating characteristic (ROC) curve analysis of 30 patients with IMH who were followed up 1 month after surgery.ResultsLymphocyte counts were significantly higher in the IMH group. No other significant differences were observed between the IMH and control groups. Lymphocyte counts in the IMH group were significantly negatively correlated with MIN and BD and were significantly positively correlated with MHI, THI, and MHCI. However, lymphocyte counts were not significantly correlated with H, IRC, DHI, and HFF. In the ROC analysis, BD, MIN, MHI, THI, and MHCI were significant predictors of anatomical outcomes. According to the cut-off points of the ROC analysis, lymphocyte counts were compared between the above-cut-off and below-cut-off groups. Lymphocyte counts were significantly higher in the MIN ≤ 499.61 μm, MHI ≥ 0.47, THI ≥ 1.2, and MHCI ≥ 0.81 groups. There were no significant differences between the above-cut-off and below-cut-off BD groups.ConclusionsAlthough inflammation may not be an initiating factor, it may be involved in IMH formation. Lymphocytes may play a relatively important role in tissue repair during the developmental and postoperative recovery phases of IMH.

Management of Amenorrhoea (Ihtibas-al-Tamth) in Unani System of Medicine: A Review

Menstrual patterns can be an indicator of overall health and self-perception of well-being. Amenorrhoea is the absence of menses in women of reproductive agewhich may be primary or secondary. Primary amenorrhoea refers to the absence of menarche at the age of 16 and secondary amenorrhoea is the cessation of menses for at least 6 months in already cycling women. Secondary amenorrhoea is more common than primary amenorrhea. Ihtibas al-Tamth (amenorrhoea) is defined in the Unani system of medicine as the absence of monthly bleeding for more than 2 months or a decrease in the quantity of menstrual blood. The etiologies of amenorrhoea may be considered categorically as outflow tract abnormalities, primary ovarian insufficiency, hypothalamic or pituitary disorders, other endocrine gland disorders, sequelae of chronic disease, physiologic, or induced. The causes of Ihtibas al-Tamth are related to Quwwat Dafia al-Badan, Madda and Johar Khun-i-Hayd, or Ala Makhraj -i-Hayd. Su’-i-Mizaj Barid, Yabis, Harr or Harr wa Yabis, Su’-i-Mizaj Maddi or Sada can lead to Du’f al-Quwwat-i-Dafia. Abnormality in quality and quantity of Madda in Su’-i-Mizaj Maddi can also lead to ihtibas al-tamth. Amenorrhoea is not a diagnosis but a symptom indicating anatomical, genetic and neuroendocrine abnormalities. It can be determined by two different groups of causes: (a) anatomical defects of the genital organs; (b) endocrine dysfunctions. Both congenital and acquired anomalies in the structure of the uterus and vagina could produce amenorrhoea; nevertheless, in most patients, amenorrhoea is related to an ovarian malfunction. Symptoms usually associated with amenorrhoea are headache, nausea, back ache and lower abdominal pain, tiredness, and some respiratory problems. Main principle of treatment includes Tawleed-i-Dam, Tanqiya-i-Akhlat Ghaleeza, Talteef-i-Khilt, Tafteeh-i-Uruq Raham and Tahzeel if obesity is the cause. Surgical intervention if hymen is imperforated. Some regimenal therapies are also beneficial in amenorrhoea, such as Fasd-i-Safin, Hammam-i-Murattib and Hijama-i-Nariya on calf area. Some Unani drugs, which are beneficial in amenorrhoea, are Habb-i-Mudir, Safoof-i-Baboona, Kushta Faulad, and Safoof Muhazzil. In the present scenario, it is utmost important to educate the patients to live a healthy and hygienic life and to avoid those factors which cause amenorrhoea.

The paradox of platypnoea-orthodeoxia syndrome.

Platypnoea-orthodeoxia is a rare clinical syndrome characterised by dyspnoea and oxygen desaturation in the upright position which improves when supine. It requires two components: a sufficiently sized anatomical vascular defect (typically intra-cardiac or intra-pulmonary) combined with a functional component that promotes positional right-to-left shunting. We describe the rare occurrence of a patient with platypnoea-orthodeoxia syndrome (POS) because of a paradoxical shunt through a patent foramen ovale caused by a large right atrial line-associated thrombus in a male with metastatic oesophageal cancer undergoing chemotherapy. This case is a timely reminder to consider POS amongst differentials for hypoxia as it is often treatable if recognised.

A practical ligament-based diagnostic system for cure of pelvic symptoms and prolapse.

The Integral Theory Paradigm (ITP) has a 25-year track record of successfully treating bladder/bowel/pain symptoms caused by laxity in specific ligaments, even when the prolapse is minimal. The ITP-based treatment involves ligament support and can be nonsurgical or daycare surgical. An accurate diagnostic protocol is required. The Integral Theory Diagnostic system is performed in an outpatient setting. It a step-by-step "how to" resource for clinicians who wish to learn a practical anatomical diagnostic method which can quickly and accurately identify a ligament cause for bladder/bowel/pain symptoms, and therefore, potentially cure them. The structured ITP diagnosis flow chart uses symptoms to diagnose anatomical defects. It comprises 4 related steps. The ITP is holistic, and bladder, bowel, pain symptoms co-occur. The first step, therefore, is to establish all possible symptoms for transfer to the Diagnostic Algorithm which is the second step. Because patients complain of one main symptom, other symptoms must be located by direct questioning, using the Diagnostic Algorithm as an aide memoire, or a questionnaire to locate bladder, bowel, pain symptoms. Second step: symptoms are placed into 3 anatomical zones: anterior zone, pubourethral ligament (PUL) [stress urinary incontinence (SUI)]; middle zone, cardinal ligament (CL) (transverse defect cystocele); posterior zone, uterosacral ligament (USL) (uterine prolapse and enterocele). The third step is a vaginal examination to confirm the ligament damage (prolapses) in the three zones predicted by the algorithm. The fourth step is "simulated operations" (mechanical support of specific ligaments per vaginam) to validate the particular ligament indicated by the diagnostic algorithm, is indeed causing that symptom. For SUI, a hemostat test at midurethra supports PUL vaginally to stop urine loss on coughing; the lower blade of a bivalve speculum gently inserted into the vagina can relieve urge and pain.

Towards optimized tissue regeneration: a new 3D printable bioink of alginate/cellulose hydrogel loaded with thrombocyte concentrate.

Autologous platelet concentrate (APC) are pro-angiogenic and can promote wound healing and tissue repair, also in combination with other biomaterials. However, challenging defect situations remain demanding. 3D bioprinting of an APC based bioink encapsulated in a hydrogel could overcome this limitation with enhanced physio-mechanical interface, growth factor retention/secretion and defect-personalized shape to ultimately enhance regeneration. This study used extrusion-based bioprinting to create a novel bioink of alginate/cellulose hydrogel loaded with thrombocyte concentrate. Chemico-physical testing exhibited an amorphous structure characterized by high shape fidelity. Cytotoxicity assay and incubation of human osteogenic sarcoma cells (SaOs2) exposed excellent biocompatibility. enzyme-linked immunosorbent assay analysis confirmed pro-angiogenic growth factor release of the printed constructs, and co-incubation with HUVECS displayed proper cell viability and proliferation. Chorioallantoic membrane (CAM) assay explored the pro-angiogenic potential of the prints in vivo. Detailed proteome and secretome analysis revealed a substantial amount and homologous presence of pro-angiogenic proteins in the 3D construct. This study demonstrated a 3D bioprinting approach to fabricate a novel bioink of alginate/cellulose hydrogel loaded with thrombocyte concentrate with high shape fidelity, biocompatibility, and substantial pro-angiogenic properties. This approach may be suitable for challenging physiological and anatomical defect situations when translated into clinical use.

The outcome of cervical stitch in the prevention of pre-viable and preterm deliveries in Nigerian Tertiary Hospital

Background: Cervical incompetence, defined as the inability to sustain a pregnancy to term due to functional and anatomical defects of the cervix is a distressing cause of childlessness in Nigeria. Cervical cerclage, introduced into clinical practice by Shirodkar and McDonald in the 1950s still a time-tested intervention in the prevention of pregnancy wastages from cervical incompetence. Aim: The purpose of this study was to audit the outcome of the applications of cervical cerclages in the prevention of pregnancy wastages at the Maternity Complex of the Ekiti State University Teaching Hospital and Maternal and Child Specialists’ Clinic in Ekiti State, Southwest Nigeria. Methods: In this prospective observational cohort study, we included all pregnant women who had cervical stitches applied over ten years, (2010-2019). Information on sociodemographic biodata, risk factors, indications, and outcomes were collated. Statistical analysis was performed using the SPSS package, version 22 (SPSS Inc, Chicago, IL). Statistical significance of the categorical variables was tested using the chi-square or Fisher’s exact test, confidence level of 95%and P-value of 0.05. Results: The 134 pregnant women diagnosed with cervical incompetence had cervical stitches applied over the ten years. 15,037 deliveries giving a prevalence rate of 0.89% of cervical incompetence. 75% were multigravida, while 92.5% were of low parity. Risk factors found included recurrent mid-trimester abortions (55%), and prior cervical dilatation (20%). The cervical cerclages were history and physical examination indicated in 22.5% and 75% had ultrasound scanning confirmation. In the majority (82.5%), cervical cerclage was placed at 14-16 weeks using Mersilene tape in 92.5%. Spinal anesthesia and conscious sedation were administered in equal proportion. Majority had McDonald’s procedure (96.27%) whereas only 3.73% had Shirodkar’s. Placement to removal interval ranged from 10-20 weeks in 53%, while in 12.5% it lasted 4 weeks. The indications for removal included pregnancy carried to term at 72.5%, preterm labor at 7.5%, and vagina bleeding occurred in 7.5% of cases. Vaginal deliveries were achieved in 62.5% while 25% had cesarean delivery. 7.5% expelled pre-viable fetuses. Cervical cerclage placement was successful in 75%, while 25% had failed cerclage. 10% of those who had failed cerclage had live births. We achieved 85% of babies take home. There was no significant association between the overall outcomes of cervical cerclage (inevitable abortion, preterm delivery, term delivery) and certain defined co-variables (age, gravidity, and parity). On multivariate linear regression. Conclusion: We recommend that timely application of cervical stitches will rescue women from pregnancy wastages associated with cervical incompetence in Ekiti State.

Bilateral Foramina Parietalia Permagna - A Calvarial Defect Caused by Haploinsufficiency of the Msh Homeobox 2 Gene: A Case Report and Current Literature Review.

Foramina parietalia permagna (FPP) is a rare anatomical defect that affects the parietal bones of the human skull. FPP is characterized by symmetric perforations on either side of the skull, which are caused by insufficient ossification during embryogenesis. These openings are typically abnormally large and can range from a few millimeters to several centimeters in diameter. Enlarged foramina are often discovered incidentally during anatomical or radiological examinations and in most cases left untreated unless symptoms develop. Although this calvarial defect is usually asymptomatic, it may be accompanied by neurological or vascular conditions that can have clinical significance in certain cases. FPP is an inherited disorder and arises due to mutations in either Msh homeobox 2 (MSX2) or aristaless-like homeobox 4 (ALX4) genes. In almost all cases, one parent is affected. Clinical findings and diagnostic imaging typically contribute to determine the diagnosis.

A Pre-experimental Study to Assess the Effectiveness of Structure Teaching Programme on Knowledge Regarding Hygienic Practices for Prevention of Urinary Tract Infection among Adolescent Girls in Selected Area of Dang District

Introduction: Urinary tract infection is one of the major global health problems in developing countries. It is very common in females, especially adolescent girls. Mainly because of changes in the hormones, and it is also associated with poor intake of water, infrequent voiding, poor menstrual hygiene, and anatomical defects. For the prevention of UTI, many points are important to keep in mind, like drinking 6-8 glasses of water each day. Avoid wearing tight pants. Wear cotton undergarments. Wash the perineum after urinating. Wiping from front to back after a bowel movement. More than three times voiding during school hours. Drying the cloth in the sunlight. Voiding in a clean toilet, etc. Aim: The main aim of this study was to assess the effect of a structured teaching program regarding hygienic practice for the prevention of urinary tract infection among adolescent girls in a selected area of Dang district. Methodology: A quantitative approach was adopted for this study with a pre-experimental research design with one group pre-test and post-test. A total of 100 (adolescent girls) samples were selected to collect the data by using the non-probability convenience sampling technique. The tools used for the study were a self-structured questionnaire consisting of socio-demographic variables and a self-structured knowledge questionnaire to assess the knowledge of adolescent girls regarding the prevention of urinary tract infection. The data were analyzed using descriptive and inferential statistics. Results: The findings of the study revealed that there was a significant difference between the mean pre-test (6.01) and post-test (14.19) knowledge scores, with a positive mean difference of 8.18. The calculated “t” value of 26.32 is higher than the table value of 1.645 at the 0.05 level of significance. There was a significant association between the pre-test knowledge of adolescent girls, their age, and the monthly income of the family. Conclusion: The study concluded that the structured teaching program was effective and significant in improving the knowledge of adolescent girls regarding the prevention of urinary tract infections, which was more effective and beneficial for them.

Laparoscopic proximal sleeve gastrectomy as an alternative for management of giant hiatal hernias

Background and aim: Large anatomic defects of the diaphragmatic hiatus known as giant hiatal hernias could be associated with reflux esophagitis disease (GERD) and other life-threatening complications such as gastric volvulus, ischemia and perforation, thus surgical repair is warranted. Although usually the key steps to surgical repair are reduction of the herniated stomach, complete excision of the sac, hiatus repair, and an antireflux procedure, surgery in these cases is associated with a great rate of anatomic and functional failure, therefore different techniques have been described since the original description of Collis gastroplasty designed to lengthen the short esophagus. Methods: We report here the technique and results performing proximal vertical gastrectomy or proximal sleeve gastrectomy (PSG) as an alternative in cases in which the possibility of recurrence of the hiatal hernia (HH) is high. Results: After years of follow-up after surgery, all the case patients presented here are free of gastroesophageal reflux or dysphagia symptoms, with no necessity for acid suppression medication, and no side effects of the surgery. Conclusion: The treatment of giant HH is a complex and challenging disorder to treat. PSG seems to be a good surgical alternative for the treatment of some special cases of giant HH minimizing the GERD symptoms and possible recurrences.

Perforating Ocular Sickle Knife Trauma: a Case report

Introduction : Perforating ocular injury can lead to disability or even mortality. Most individuals sustaining eye injuries are male in young age. This is a report of an extreme case when a sickle knife stabbed in the right eye of a young male cause perforating of the eyeball.
 Case Illustration : Seventeen years old young male presented to Emergency Room of Sukabumi Regional Public Hospital with pain and bleeding in his right eye an hour before. He had been hacked during a brawls. There was a wound in the right supraorbita area and a big sickle knife stuck in the head and tear the eye ball. Visual acuity was no light perception in his right eye. Anterior segment examination of the right eye revealed perforated sclera and cornea. X-ray examination showed fracture of the roof of the right orbit and a metal object had stuck into the Orbits. The sickle knife extraction, enucleation and superior orbit reconstruction of the right eye was done.
 Discussion : Identification of wounds caused by sharp metal foreign body is very important for the subsequent treatment of injuries. If the eyeball cannot be preserved, then enucleation can't be avoided. In this case, hard impact of sharp object around of the eye are also cause fracture of superior orbital rim. Reconstruction of the orbital roof using titanium and micro screws given the most stable and effective results.
 Conclusion : Removing a metal foreign body and anatomical defect management is important for a good outcome.

Hysteroembryoscopy in repeated early pregnancy loss due to suspected thrombophilia

Introduction: The cause of a 1st trimester repeated pregnancy loss (RPL) under treatment with aspirin and /or heparin due to suspected thrombophilia was investigated. Using hystero-embryoscopy (HEpy) and embryo genetic analysis the embryo development was correlated to its karyotype. Patients and methods: Seventeen first trimester pregnant women recruited in the study. They all had a history of at least 2 consecutive 1st trimester recurrent miscarriages, underwent an investigation for the cause of RPL and diagnosed to suffer from hypercoagulation. Thromboprophylaxis was administrated in all 17 pregnant women during their next pregnancy, postulating that their past cause of miscarriage was due to a hypercoagulability state. Twelve patients had positive Anticardiolipin and /or Antiphospholipid antibodies and 5 patients had MTHFR high titers. Embryo autopsy was performed by hysteroscopy technique using 2.9mm – 5mm hysteroscopes, 5Fr graspers and scissors and normal saline as distending medium. The embryo morphology results were correlated with the genetic results and compared with the patients’ diagnosis and treatment during the last miscarriage. Results: HEpy revealed that in 11 out of 17 cases embryos had chromosomal abnormalities ensuring patients that the problem of their loss was not the followed treatment. In all 4 cases with decidua haematoma and umbilical cord defect patients received aspirin and LWMH, raising the possibility of anticoagulation overtreatment. Conclusion: In-situ autopsy of a miscarriage embryo can provide useful information regarding the morphology of the embryo, ruling out anatomical defects and collecting the embryo under direct vision anticipating an accurate embryo karyotyping. Embryoscopy results may assist to change the management of the next pregnancy in RPL cases and patients with hypercoagulability state.

Necrotizing Enterocolitis Complicating Severe RSV Bronchiolitis in PICU Settings.

This retrospective study aims to analyze the baseline characteristics and factors associated with poor outcomes in patients with necrotizing enterocolitis (NEC) complicating respiratory syncytial virus (RSV) infection. Using the Virtual Pediatric Systems data registry, patients under 2 years admitted to the pediatric intensive care unit (PICU) were screened. Patients with documented RSV infection and NEC, intestinal perforation, noninfectious gastroenteritis/colitis, or pneumatosis intestinalis occurring around the timing of RSV bronchiolitis diagnosis were included. Out of the screened patients, 41 were analyzed. Most patients (93%) were aged 30 days to 2 years, one-third had baseline anatomical cardiac defects, and 20% history of prematurity. Median PICU length of stay was 11.7 days. Seven patients died before hospital discharge. While not statistically significant, nonsurvivors tended to exhibit higher PRISM-3 scores, more acidemia, and lower systolic blood pressure. These findings emphasize the need for cautious assessment of gastrointestinal symptoms in critically ill patients with RSV infection.

Sirenomelia: An anatomical assessment and genetic sex determination of two cases.

The etiology of sirenomelia is currently unknown. Data are limited in comparing external and internal abnormalities using modern imaging technologies and molecular genetic analysis. The purpose of the current study was designed to compare external and internal anatomical defects in two cases of sirenomelia and Potter's sequence. Considered rare, Potter's sequence is a fetal disorder with characteristic features of bilateral renal agenesis, obstructive uropathy, atypical facial appearance, and limb malformations. The internal and external malformations of two term fetuses with sirenomelia and Potter's sequence were compared using assessment of external features, radiography and MRI on internal structures, and molecular genetic studies on sex determination. Data reveal that both fetuses were male and manifested with an overlapping but distinct spectrum of abnormalities. Principal differences were noted in the development of the ears, brain, urogenital system, lower limbs, pelvis, and vertebral column. Defects of the axial mesoderm are likely to underlie the abnormalities seen in both fetuses. The first one, which had only caudal defects, was found to have a spectrum of abnormalities most similar to those associated with more severe forms of the small pelvic outlet syndrome, although the structure and orientation of the sacrum and iliae were different from previously reported cases. The other had both caudal and cranial defects, and was most similar to those described in the axial mesodermal dysplasia syndrome. Defects associated with sirenomelia can be evaluated with standard gross anatomy examination, radiology, MRI, and modified PCR techniques to determine anatomical abnormalities and the sex of preserved specimens, respectively. Evidence indicated that sirenomelia could be developed via various etiologies.

NASAL RECONSTRUCTION AFTER MOHS SURGERY: MANAGEMENT OF DEFECTS ACCCORDING TO ANATOMICAL UNITS AND DIMENSIONS

Objectives: Skin cancer frequently affects the nose, particularly in sun-exposed areas such as the ala, apex, root, and bridge. Even minor nasal lesions can pose aesthetic and psychosocial challenges for patients, necessitating nasal reconstruction tailored to anatomical units and defect size. The primary goal of reconstructive surgery is to restore the original shape, emphasizing three-dimensional space, symmetry, color, and compatibility with surrounding tissue structures. Despite numerous options for post-cancer surgery reconstruction, establishing a gold standard for nasal defect management remains elusive. Materials and Methods: A retrospective study was conducted in 41 patients following Mohs surgery for basal cell carcinoma. Defects are approached based on rhinoplasty principles, considering anatomical units, defect size, and location to select appropriate reconstruction methods. Results: Among the patients, 17 (41.5%) had nasal alar defects, 5 (12.2%) had nasal apex defects, 4 (9.8%) had nasal root defects, 7 (17.1%) had nasal bridge defects, and 9 (22%) had complex defects involving multiple anatomical units. Patients with nasal alar defects <1.5cm underwent reconstruction using the nasolabial flap, while those with larger defects (>1.5cm) underwent forehead flap reconstruction, including auricular cartilage grafts for nasal alar defects. Complex lesions (22%) were reconstructed using a combination of forehead flap and rotation or V-Y flap. Nasal root defects (7.3%) were reconstructed using the glabellar flap. Conclusion: Nasal reconstruction, employing local or regional flaps, consistently yields positive functional and aesthetic outcomes due to the similarity in color and skin flap thickness with adjacent structures. The forehead flap, with its constant blood supply, vitality, and versatile design, is particularly effective for complex nasal lesions. Received 29 June 2023Revised 27 September 2023Accepted 29 November 2023