Genital Research Articles

12333 46 XX/XY Chimerism - Positive NIPT And Post-natal Karyotype Is It Real?

Abstract Disclosure: K.L. Del Rosario: None. N. Sheriden: None. N. Vijayakanthi: None. Introduction: Non-Invasive Prenatal Testing(NIPT) using cell free fetal DNA in plasma of pregnant women has become a routine part of prenatal care in screening for fetal aneuploidies including sex chromosome abnormalities in most regions around the world. False positive results are increasingly imposing challenges in pre-natal as well as post-natal care. Case Discussion: We report a neonate born at 32+2 weeks gestation to a 42-year-old G2 P2 mother. Pregnancy was complicated by insulin dependent maternal type 2 diabetes mellitus, maternal chronic hypertension and a positive NIPT for high-risk monosomy X. Prenatal ultrasound showed male anatomy. Interestingly on physical exam after birth, the neonate had typical male external genitalia with bilateral normal male gonads. Chromosome analysis done immediately after birth revealed the presence of two cell lines: 40 of the 50 cells (80%) had a normal female 46 XX karyotype and 10 of the 50 cells (20%) had a normal male 46 XY karyotype. These findings could be due to reabsorbed twin, Klinefelter syndrome with two trisomy rescue events, maternal cell contamination or true chimerism. In addition, fluorescence in situ hybridization (FISH) analysis for X and Y probes revealed the presence of two cell lines. The first cell line (70% of the cells) had two hybridization signals for chromosome X and the second cell line (∼25% of the cells) had one hybridization signal for chromosome X and one for chromosome Y. Postnatal ultrasound showed normal testicles with no evidence of Mullerian structures. Newborn screening was negative for congenital adrenal hyperplasia (CAH). Genetics was consulted and recommended repeat chromosomal analysis, parental testing to determine sex chromosome segregation, and follow-up with pediatric endocrinology. Repeat cytogenetic testing at 2 weeks of life resulted in a normal male chromosome complement of 46,XY. Previous abnormal cytogenetics were thought to be due to maternal cell contamination. Further endocrine labs showed LH(1.16 uIU/ml) and testosterone levels ( 87 ng/dL), appropriate levels for age indicating normal Hypothalamic Pituitary Gonadal (HPG) axis and testicular Leydig cell function. Since the family was previously counseled regarding the concept of maternal cell contamination, they expressed understanding and were happy with the update of the normal karyotype result. Conclusion: False-positive results concerning for rare chimerism on NIPT can occur and should prompt a thorough history, physical exam, ultrasound studies and repeat testing to confirm its presence. Careful consideration should be taken when counseling family about the implications of these results, especially communication about gender assignment of the infant. Presentation: 6/3/2024

8577 Gonadal function throughout life in XX and XY patients with a germline WT1 variant - lessons from a cohort of 80 patients

Abstract Disclosure: M. Carré Lecoindre: None. D. Mallet: None. C. Dossier: None. M. Glenisson: None. M. Grapin: None. A. Brac de la Perriere: None. Z. Chakhtoura: None. C. Bouvattier: None. M. Houang: None. C. Pienkowski: None. N. Zaegel: None. R. Rayneau,MD and PhD: None. T. Blanc: None. L. Martinerie: None. The WT1 gene is involved in tissue homeostasis, tumorigenesis, as well as embryonic development of kidneys, bipotential gonads and ovarian determinism. Germline WT1 variants are known to generate kidney and gonadal developmental diseases associated with differences in genital development (DSD). However, the state of gonadal function, its evolution over time, and the impact of WT1 variants on pubertal development and fertility potential in patients have never been studied. A French national, retrospective, multi-center, observational study evaluated gonadal function over time in patients with a germline variant of the WT1 gene, according to XX or XY karyotype and genotype. Among the 80 patients included - the largest cohort to date - 30% had a XX karyotype, 95% of whom were assigned female at birth. Importantly, 40% of them had uterine malformation, which was not known to be associated with WT1 anomalies. Patients with a XY karyotype presented with DSD (59%), typical female genitalia (15%) or typical male genitalia with or without bilateral cryptorchidism (27%). Thirty percent of XX and 87% of XY patients had gonadal dysgenesis defined as gonads with a dysplastic and/or dysmorphic appearance on histology, surgery and/or imaging or biological hormonal markers compatible with gonadal insufficiency. However only 3 patients (4%) developed gonadal tumors to date. Spontaneous puberty was observed in 94% of XX and 60% of XY patients. However, 67% had impaired gonadal function - defined as AMH and/or inhibin B below the threshold for age and/or elevated FSH and/or LH above 10 UI/L - at the age of 12.6 years and 83% at the age of 16.2 years, considering all karyotypes and genotypes. Hormonal treatment had to be initiated in 57% of XY patients with a median age at 14.4 years old. No difference was seen between patients with or without renal failure (p-value = 0,37), nor regarding the timing of renal insufficiency. In addition, increased FSH, LH and decreased AMH or inhibin B plasma levels were observed independently from gonadotoxic treatment exposure in most patients. None of the patient has had children to date.In conclusion, most XX and XY patients with a germline variant of WT1 gene are affected by early gonadal insufficiency of variable severity with potential impact on puberty and fertility. Even though dialysis, immunosuppressors, gonadotoxic chemotherapies, local radiotherapy and gonadal surgery are known to impair gonadal function, the gonadal disease linked to WT1 variants is the principal factor of gonadal impairment. For these reasons, regular follow-up by an endocrinologist appears essential for both XY and XX patients, providing clear information about gonadal function and fertility. Presentation: 6/1/2024

8314 Masculinizing Hormone Therapy and Gynecological Neoplasm: a Single Institution Cohort

Abstract Disclosure: S. Korpaisarn: None. T. Ngaothepphurktharam: None. Y. Tingthanatikul: None. Background: Gynecological neoplasm/malignancy is one of the concerned areas among transgender men on masculinizing hormone therapy (MHT). Long-term MHT and gynecological neoplasm/malignancy remain unclear. Methods: A retrospective cohort chart review was done on all transgender men (TM) who underwent hysterectomy with or without oophorectomy between January 2014 and October 2022. Intraoperative findings and pathological results of genital organs, including the cervix, endometrium, myometrium, and fallopian tubes, were extracted. The pathological results were classified as benign, precancerous, and malignant. Descriptive statistical analysis was used to demonstrate the prevalence of gynecological neoplasm and malignancy. Results: A total of 30 TM underwent hysterectomy with oophorectomy. Twenty-eight (93%) had bilateral oophorectomy, and 7% had unilateral oophorectomy due to gynecological conditions. The mean age when TM underwent surgery was 32.1 ± 5.1 years, and the mean age of gender-affirming hormone initiation was 28.7± 5.1 years. The median duration of MHT before gynecological surgery was 32 months (IQR 22-59). Most TM (73%) used testosterone enanthate, 17% testosterone undecanoate, and 2 transgender men did not start MHT before genital surgery. All TM who used GHT became amenorrheic before surgery. The median preoperative testosterone level was 561.5 ng/dL (IQR 776-1189). Intraoperative findings revealed that most TM (86.7%) had unremarkable uterus size, and 13% showed enlarged uterus size. In the latter, all were from myoma uteri. Most intraoperative findings of ovaries showed 93% unremarkable. One TM had intraoperative polycystic ovarian morphology, and one showed a unilateral ovarian cyst. Cervical pathological reports showed unremarkable results in 67%. Five TM (17%) had chronic cervical inflammation. There was 1 TM (3%) who showed low-grade squamous intraepithelial lesion (LSIL) with squamous metaplasia. Regarding endometrial pathology, the mean endometrial thickness was 0.13 ± 0.08 cm. Most endometrial reports (66%) were in a proliferative phase, 27% were in an atrophic or inactive endometrium, and 7% were in the secretory phase. Regarding pathological reports of ovaries, 80% had cystic ovaries. None of the TM showed precancerous or malignant conditions of endometrium, ovaries, and fallopian tubes. PAP smear was available in 27 TM; all were negative for intraepithelial lesions or malignancy. Conclusion: Among a cohort of TM who received MHT for 32 months, there is no evidence of precancerous or malignant pathology of the endometrium, ovaries, and fallopian tubes. Most of them had thin endometrium with cystic ovaries. One TM showed LSIL with squamous metaplasia of the cervix. Healthcare providers should follow local gynecological cancer screening guidelines developed for cisgender women in their clinical practice. Presentation: 6/2/2024

Role of gonadal hormones on brain sexualisation

It is now definitively established that the differentiation that leads to sexual dimorphism is not limited to the genital area but affects the entire individual. In particular, while knowledge of the dimorphism of the cerebral pole concerning the hypothalamic-pituitary-gonadal axis, which subtends, in its vast complex, functions and behaviours connected with reproductive activity, has become fairly clear thanks to recent studies, nothing has yet been definitively established concerning the sexualisation of other cerebral areas and in particular of the neocortex, which represents the part of the brain particularly involved in cognitive activities.

Expert opinion on characteristics of vulval LS: initial identification of important clinical features through an international electronic-Delphi consensus study.

Lichen sclerosus (LS) is a chronic inflammatory condition mainly affecting genital skin. It causes distressing symptoms that impact daily quality of life as well as progressive anatomical changes and potential risk of cancer. Vulval LS is often misdiagnosed and treatment delayed. If non-experts are supported to identify clinical features of LS, they may diagnose the condition sooner and commence timely treatment or refer to specialist services for assessment and confirmatory biopsy. To reach international expert consensus on clinical diagnostic features for vulval LS. Between March and May 2023, a four-stage electronic-Delphi consensus exercise was conducted. In the first three rounds, participants were asked to rate the importance of a list of clinical features. Responses from round one were summarised and presented in rounds two and three, along with additional features suggested by participants. Any items which met the definition of consensus as 'very important/critical', or 'not important' were not voted upon again in subsequent rounds. In round four, items which met agreement for 'important but not critical' were ranked in order of their importance. Consensus was defined a priori, and all rounds were conducted anonymously. A total of 47 participants from 14 countries completed round one with 42 (89%) retained by round 3 when consensus was determined. Round four was completed by 36 (77%) participants. Participants completing all four rounds predominantly included healthcare professionals (78%, n=28) and patient support group representatives (19%, n=7). In round one, 21 diagnostic features were voted upon. Participants suggested an additional 10 features which were subsequently added to the round two survey. After three rounds, consensus was achieved for five diagnostic features: whiteness, itch, changes in anatomy, burying of the clitoral area, and improvement in response to topical steroids. There were also 12 features voted as 'important but not critical' and participants subsequently ranked them in the 4th round. Experts have agreed on five critical diagnostic features for vulval LS in adults and an additional 12 features that may also be important. Future research should assess these clinical features for diagnostic validity through a multicentre diagnostic test accuracy study.

Prospective observational study on scar sequelae after MPOX infection: an analysis of 40 patients.

Monkeypox (MPOX) caused a public health emergency of international concern (PHEIC) outbreakbetween 2022 and 2023, with a recent rise in cases that prompted the World Health Organization (WHO) to declare the disease a PHEIC once again. There is little information on its long-term scarring sequelae. The objective of this study was to assess the risk and characteristics of scarring in patients with MPOX in a tertiary hospital. This is a prospective cohort study including patients diagnosed using polymerase chain reaction (PCR) tests. Clinical data were collected and followed up at 12-15 months to assess scarring and its impact on quality of life. Of the 40 patients, 19 (47.5%) developed scars, which were more common in those with initial cutaneous manifestations. Scars significantly affected the quality of life, especially in the genital and mucosal areas. The limited sample and loss to follow-up may affect the validity of the results. Scarring is a frequent and disfiguring sequela of MPOX, particularly in patients with early skin symptoms. Prevention and close follow-up are crucial in mitigating these complications.

Pentacentrus rectangulus sp. nov., the twelfth Pentacentrus species recorded in China (Orthoptera: Gryllidae; Pentacentrinae)

Pentacentrus rectangulus sp. nov. is the twelfth Pentacentrus species we have found in China. This new species has a uniformly colored head (without longitudinal yellow stripe on the occiput, and the color of the scape and peduncle segments is the same as that of the first three flagellar segments), and significantly curved ectoparamere. It has a similar coloration (coloration of the forewings and hind feet) to that of both Pentacentrus bituberus Liu & Shi, 2011 and Pentacentrus medogensis Zong, Qiu & Liu, 2017, but the morphology of the male genitalia differs markedly (the ventral inner margin of the epiphallus of the new has tufts of bristles, which is not present in either P. bituberus or P. medogensis). Here, we describe and illustrate the new species, and we also provide a key to the Chinese species of the genus.

Congenital solitary functioning kidney: evaluations to do which, when, and how

Congenital solitary functioning kidney (CSFK) is characterized by an anatomical or functional absence of one kidney from birth. When suspected on perinatal ultrasonography (US), repeat US after birth should be performed for confirmation. Although postnatal 99mTc-dimercaptosuccinic acid scintigraphy (DMSA scan) is the gold standard for confirming CSFK, it carries the risk of radiation exposure; US alone is sufficient when performed by an experienced radiologist. One-third of patients with CSFK have additional congenital anomalies of the kidney and urinary tract at the solitary functioning kidney, the most common of which is vesicoureteral reflux. As evidence regarding vesicoureteral reflux with normal kidney US is correlated with significant urinary tract infection is lacking, voiding cystourethrogram may be considered in patients with CSFK with abnormal US findings. Furthermore, approximately 30% of patients with CSFK have extrarenal malformations. Moreover, up to 10% of them have syndromic features. In particular, examining for female genitalia malformations, which can have potential for complications from untreated obstructive malformations, is important. In conclusion, DMSA scan and voiding cystourethrogram are not necessary for all patients with CSFK, and the risk of each patient should be assessed to determine which test is needed during follow-up. The presence of extrarenal manifestations should also always be considered.

Hybrid high and low molecular weight chains of hyaluronan for clitoral injection is an effective modality treatment for increasing female sexual satisfaction: an interventional, randomized-controlled parallel study.

Hormonal, behavioral, psychological, surgical, and pharmacopsychological treatment approaches contribute to female sexual dysfunction (FSD). Aim: The study is conducted to assess the effectiveness of hyaluronan high and low molecular weight hybrid cooperative complexes (hybrid H-HA/L-HA) in treating females with SD and to compare the female sexual function index (FSFI), dermatological life quality index (DLQI), and female genital self-image scale (FGSIS) before and after therapy. We divided the 60 female participants into two groups. Hybrid H-HA/L-HA was administered to form pili of 0.25cc around the clitoris in the direction of clock positions of 12, 3, 6, and 9. In Skene's gland; 0.25cc for each and 0.5cc into the corpus/body of the clitoris. Two treatments were held 30days apart.The same procedure was repeated on the control group, but with saline as a placebo. Women completed self-report questionnaires assessing sexual functioning using the FSFI, DLQI, and FGSIS before and after therapy. There was a significant (P= 634.152; P< .05) increase in the study group's weekly sexual interactions compared with the controls. The study group showed statistically significant amelioration in desire, arousal, lubrication, orgasm, satisfaction domains, overall score, and a decrease in pain following the first and second injection sessions (P= .014, .031, .003, .001, .011, .004, and .011, respectively). A comparison of the results between the two groups revealed significant improvement were found (P= .025).There were significant improvements in the domains of the FGSIS compared with the controls (P= .026). The study group showed a substantial improvement in satisfaction with the way their genital area looked, comfort level when allowing a sexual partner to view their genital area, belief that their genitals smell perfectly fine without being self-conscious about them, and overall score (P= .022, .031, .003, .001, and .004, respectively) (P< .05).The hybrid H-HA/L-HA sessions resulted in significantly greater positive perceptions and feelings, leisure activities, interpersonal interactions, and general assessments (P= .021, .021, and .020, respectively) (P< .05). Female individuals with SD experience sexual improvements after hybrid H-HA/L-HA injection. This is the first study focusing on female individuals with SD. We recommend conducting the study on a larger population and including their partners. Hybrid H-HA/L-HA injection for rejuvenating the clitoral injection appears to be a reliable and safe method for enhancing female genital self-image, sexuality, and quality of life.

Treatment strategies for erosive genital lichen planus: A systematic review of therapeutic modalities and emerging breakthroughs.

Erosive genital lichen planus (EGLP) is a severe form of lichen planus characterized by painful erosions in the genital area, leading to significant distress and complications. This review aims to provide a thorough examination of EGLP, focusing on its clinical manifestations, diagnostic challenges, and various treatment strategies, with an emphasis on patient-centered care. Adhering to PRISMA guidelines, we conducted a systematic review of 26 studies that explored dermatological treatments for EGLP. Our literature search was comprehensive, covering PubMed, Scopus, and Web of Science. Data were extracted systematically using established tools to ensure a robust analysis of the treatment modalities. EGLP presents with a range of symptoms, including severe pain, itching, and sexual dysfunction. Treatment options include topical corticosteroids, systemic medications, and surgical interventions. Despite the availability of various therapies, many cases are refractory to treatment, resulting in chronic symptoms and reduced quality of life. Emerging therapies show promise but are not yet established as standard practice. Management of EGLP requires a tailored, multidimensional approach. While topical corticosteroids remain essential, the development of new therapies offers hope for improved outcomes. A patient-centered approach is vital to address both the physical and psychosocial impacts of EGLP. Continued research is necessary to refine treatment protocols and enhance patient care.

Neuro-Behcet's Masquerading as Status Epilepticus and Meningoencephalitis in the Emergency Department

BackgroundBehcet disease (BD) is a rare small vessel vasculitis that commonly manifests as recurrent painful oral or genital ulcerations, uveitis, and skin lesions. Some patients with BD develop neurological symptoms termed neuro-Behcet's disease. In the emergency department (ED) setting, these symptoms can be mistaken for other common acute issues including stroke, infection, epilepsy, multiple sclerosis, toxin ingestion, or psychiatric conditions. Case ReportWe present a case of a 28-year-old male with neuro-Behcet disease mimicking status epilepticus and meningoencephalitis. He was actively seizing on arrival and febrile at 103.8 F. The patient also had a history of vasculitis, uveitis and genital lesions which raised suspicion for a rheumatological process. Cerebrospinal fluid (CSF) samples were obtained and computed tomography (CT) of the head revealed no acute findings. The patient was started on treatment for seizure and meningoencephalitis and admitted to neurology for continuous electroencephalogram (EEG) monitoring with additional consults placed for rheumatology, ophthalmology, and infectious disease. The patient was ultimately diagnosed with neuro-Behcet's disease and treated appropriately.Why should an emergency physician be aware of this?: In a patient presenting with neurological symptoms and signs of rheumatological disease providers should consider neuro-Behcet's disease as a differential diagnosis. This case exemplifies the vital role of reviewing past medical history to expand differential diagnoses and early coordination with specialists so treatment can be initiated early to prevent morbidity and mortality. The case will also review different presentations of this unfamiliar diagnosis for a more comprehensive understanding.

Pelvic Floor Ultrasound Findings and Symptoms of Pelvic Floor Dysfunction During Pregnancy.

Pregnancy and childbirth predispose to pelvic floor dysfunction (PFD), coinciding with functional and anatomical changes in the pelvic floor. To some extent, these can be assessed by transperineal ultrasound (TPUS), yet the correlation between ultrasound findings and symptoms has not been well elucidated. We hypothesised that pregnant women with PFD would show different findings at TPUS. This is a planned secondary analysis of a prospective cohort study. Pregnant women were asked to fill out standardised questionnaires on PFD and undergo TPUS at 12-14weeks and 28-32weeks of gestation. We compared bladder neck descent, urethral rotation, retrovesical angle, pelvic organ descent, genital hiatus dimensions and the presence of anal sphincter defects between women with and those without PFD using t test and Fisher's exact test. Linear mixed-effects models were used to assess the correlation between TPUS findings and PFD severity. As this is a secondary subgroup analysis of participants who underwent TPUS, no sample size was determined upfront. At Valsalva, women with urinary incontinence had more pronounced bladder neck descent (p = 0.02) and urethral rotation (p < 0.01), as well as wider retrovesical angles (p = 0.04) and larger genital hiatus areas (p < 0.01). After controlling for age, BMI and parity, the retrovesical angle was the only persistent predictor of urinary incontinence. No correlation was observed between any TPUS marker and symptoms of either prolapse or anorectal dysfunction. In pregnant women, symptoms of urinary incontinence, but not of prolapse and anorectal dysfunction, are associated with differences in pelvic floor anatomy at TPUS.

Two new species of Caribbiantes, with the redescription of the type species and a review of male genital patterns in Antillean Stenostygninae (Opiliones: Laniatores: Biantidae)

Caribbiantes cubanus Šilhavý, 1973, type species of genus Caribbiantes Šilhavý, 1973, is redescribed based on abundant material from the type locality, providing new data on its morphological variability and penis morphology. Two new species of Caribbiantes are described, C. obtusus sp. nov. and C. barbai sp. nov., based on additional specimens from central and eastern Cuba, for which we give information on their geographical distribution, intraspecific variability and habitat. A new diagnosis for Caribbiantes and updated geographic distributions of the included species are provided. The sexually dimorphic glandular structures on the metatarsus III of males for all Caribbiantes species are described. Male dimorphism, most evident in the robustness of the chelicerae, is reported for the studied species. The male genitalia patterns of Antillean stenostygnines species are described. The phylogenetic affinity of Antillean stenostygnines with Stenostygnus Simon, 1879, a genus from the north of South America, is discussed based on some morphological traits.

Two new species of Austrelatus diving beetles from continental Southeast Asia, linking the distribution area of the genus (Coleoptera: Dytiscidae: Copelatinae)

Two new species of predominantly Australasian genus Austrelatus Shaverdo et al., 2023 are described and illustrated: Austrelatus mirai sp. nov. from Selangor State in Peninsular Malaysia is similar in habitus to the South Indian species A. boukali (Hendrich &amp; Balke, 1998) and A. davidi (Wewalka, 2017); however, the shape of the male genitalia suggests that it is closely related to Austrelatus species from Kalimantan. Austrelatus riberai sp. nov. from Shan State in Myanmar is most similar to Sino-Japanese A. parallelus (Zimmermann, 1920). Findings of Austrelatus species in continental Southeast Asia fill the gap in the distribution area of the genus between India, China and Japan on one side, and the Sunda Islands on the other side.

ADVANCES IN AESTHETIC GYNAECOLOGY IN THE MODERN WORLD

The article is devoted to the achievements of aesthetic gynecology in the modern world, including innovative technologies and methods that allow for improvement in the appearance and functionality of female genitalia. The main directions in aesthetic gynecology, such as laser therapy, radiofrequency procedures, and injection technologies, as well as genital correction with the help of labioplasty and vaginoplasty, are considered. Particular attention is paid to the psycho-emotional health of patients and the growing awareness of available methods. The article emphasizes the importance of an individualized approach in the treatment and maintenance of women's health.

Endometrial Cancer - Long-Term Survival in Certified Cancer Centers and Non-Certified Hospitals: Comparative Analysis Based on a Large German Retrospective Cohort Study (WiZen).

Introduction Endometrial cancer is the most common malignant tumor of the female genital organs. In Germany, treatment is provided in both cancer centers certified by the German Cancer Society (Deutsche Krebsgesellschaft, DKG) and in non-certified hospitals. This study investigated whether treatment in DKG-certified centers leads to improved overall survival of patients with endometrial cancer. Materials and Methods Data from 11 legally independent German statutory health insurance (SHI) funds of the AOK were analyzed as well as data from four clinical cancer registries (CCR), resulting in inclusion of 30 102 AOK patients and 8190 registry patients with a diagnosis (incidental cases) of ICD-10-GM code C54 (malignant neoplasm of corpus uteri). For comparative survival analyses, multivariable Cox regressions and Kaplan-Meier analyses were used. Results The Kaplan-Meier estimator for 5-year overall survival was 66.7% for patients from certified centers and 65.0% for patients from non-certified hospitals (using SHI data; CCR data: 63.4% vs. 60.7%). Cox regression adjusted for relevant confounders showed a hazard ratio (HR) of 0.93 (SHI data; 95%CI 0.86 - 1.00; p = 0.050) and 0.935 (CCR data; 95% CI 0.827 - 1.057; p = 0.281) for all-cause mortality. In a subgroup analysis (CCR), patients with International Union against Cancer Control (UICC) stage I had a significant survival benefit if treated in a certified center (HR 0.783; 95% CI 0.620 - 0.987; p = 0.038). Conclusion The study presented herein shows that patients with endometrial cancer treated in a certified cancer center tend to have better survival rates. This should be considered when selecting the treating hospital.

Prevalence of Congenital Anomalies in Iran.

Annually, 3-8 million infants are born with congenital anomalies worldwide, ranging from 3% to 7% of births in different countries. This study aimed to investigate the nationwide epidemiological features of birth defects in Iran. This cross-sectional study was conducted in six major regions across Iran. The data sources were the maternity facilities affiliated with regional universities of medical sciences. All children were examined by obstetricians, pediatricians, or midwives at birth, and newborns were followed until discharge from the facility for health status, maturity, and congenital defects. A total of 138,643 births were registered in the maternity facilities across the study regions. Among these newborns, 3,458 cases were diagnosed with congenital anomalies, representing an overall prevalence rate of 249.4 per 10000 births (95% CI: 241.2-257.8). Genital organ anomalies exhibited the highest rates of defects in the country with 92.7 per 10000 births (95% CI: 86.4-98.9), followed by limb anomalies at 83.3 per 10000 births (95% CI: 77.4-89.3). The prevalence of respiratory system, chromosomal, and urinary tract anomalies was less than 10 per 10000 births. Until a national registry for congenital anomalies is established, this study provides essential data on the magnitude of the health problems caused by congenital anomalies in Iran. The findings would be vital for planning and evaluating antenatal screening for birth defects, particularly for high-risk groups and regions in the country.

Stretched penile length for Syrian children aged 0–5 years: Cross-sectional study

BackgroundThe early detection of the anatomical anomalies (e.g. micropenis) of the male external genital organs is crucial for both medical and psychological reasons. During routine pediatric visits, careful inspection using standards of penis size is beneficial for the diagnosis of micropenis and macropenis. Stretched penile length (SPL) has been shown to be more dependable than the flaccid penis length. Consequently, the SPL must be measured and compared to age-appropriate normal values. ObjectiveThis cross-sectional study aimed to determine the normal range of stretched penile length in newborns and children aged 1 month to 5 years in Syria and explore the correlation between SPL, height, and weight. Study DesignData was collected from 300 Syrian males aged 0 to 5 years. SPL measurements were taken using a standardized procedure. Participants were divided into eight age groups. Statistical analysis determined the mean SPL, standard deviation, range, and rate of increase in SPL for each group. The distribution of SPL data was assessed using the Shapiro-Wilk test. Pearson correlation analysis examined the relationship between SPL and height, weight, and BMI. ResultsMean SPL increased with age, ranging from 2.36 cm in newborns to 4.29 cm in children aged 48-60 months. The 48-60 months group exhibited the largest range of SPL. The rate of SPL increase was highest in children aged 1-2.9 months. SPL values followed a normal distribution. Significant positive correlations were found between SPL and weight in the 36-47.99 months group and between SPL and height in the 6-11.9 months and 36-47.99 months groups. ConclusionThis study establishes the normal reference range of SPL in Syrian newborns and children aged 1 month to 5 years. The findings indicate that SPL is influenced significantly by height and weight in certain age groups. These results contribute to understanding penile development and can assist in the diagnosis and treatment of conditions affecting penile size.

A Clinico-dermatoscopic Study of Vulvar Dermatosis at Rural-based Tertiary Care Teaching Institute

Introduction: The frequency and importance of vulval diseases are often underestimated due to the multifactorial nature of disease on the vulva. Dermoscopy can help provide clues for early diagnosis and insight into dermoscopic patterns. The present study was done with the objective to study the clinico-dermoscopic pattern of dermatosis and correlate the dermatoses with the age of the patient. Materials and Methodology: This was a prospective cross-sectional observational study conducted in the department of dermatology at a tertiary health care center over a period of 1½ year. All females with dermatosis affecting genital areas attending the skin outpatient department or ward were recruited after taking written consent. A detailed history was taken to collect demographic data. A thorough clinical examination and dermatoscopy were done. Descriptive statistics was used to depict the profile and dermatoscopic pattern. Results: Out of the 103 patients with vulvar dermatoses, 24 (23.30%) patients were in the age group of 41–50 years. A total of 43 (41.74%) patients had infective conditions, followed by 16 (15.53%) patients of papulosquamous group of disorders and 11 (10.67%) patients of eczema. Dermatoscopic findings had a surface scale in 40 (38.83%), vascular patterns in 22 (21.36%), red dots in 19 (18.45%), and structureless patterns in 13 (12.62%) with different vulvar dermatosis. In tinea cruris, out of 30 cases, 28 (93.33%) had surface scales, followed by 5 (16.67%) showing vascular pattern, whereas in lichen sclerosus et atrophicus, out of total of 10 cases, 8 (80%) had structureless pattern and 6 (60%) had vascular patterns. Discussion and Conclusion: Genital diseases represent a diagnostic challenge for clinicians. The use of dermoscopy improves the diagnostic accuracy by recognizing specific dermoscopic patterns. Limitation: Small sample size was the only limitation.

Exploring the diversity of coccinellid species: A comprehensive study on polymorphism and species-specific male genitalia identification

In this study, the diversity of coccinellids along with their polymorphic forms is presented, by studying the structure of male genitalia and siphon. Out of the fourteen species of coccinellids listed, eleven species were predaceous on aphids. The male genitalia structures of the five most common species i.e., occinella septempunctata, Co. transversalis, Cheilomenes sexmaculata, Micraspis discolor and M. yasumatsui have been described and found to exhibit characteristic differentiating features. The melanic and non-melanic forms of Ch. sexmaculata, the most ubiquitous coccinellid in the Indian subcontinent, were dissected and shown to have similar male genitalia structures. Problem of misidentification due to polymorphic forms of coccinellid beetles can be mitigated by studying male genitalia and siphonal structures in addition to external morphological studies.