Pelvic Inflammatory Disease Research Articles

AYURVEDIC MANAGEMENT OF PARIPLUTAA YONIVYAPAD W.S.R. TO BILATERAL TUBAL BLOCKAGE: A CASE STUDY

Tubal blockage is the second most common cause of female infertility. Acharya Charaka and Vagbhata have considered that complications of Yonivyapad lead to infertility. A common complication of PIDs (Pelvic In-flammatory Diseases) is tubal blockage; hence, tubal blockage can be co-related with Paripluta Yonivyapad, which is caused by Vata and Pitta Dosha is similar to the preliminary stage of the tubal block as all its symptoms are suggestive of PID. The methodology used was a single-armed, open-labelled case study of a subject of 34 years old female. Her history revealed early pregnancy loss, posterior wall intramural fibroid followed by infer-tility due to bilateral tubal blockage and also had dyspareunia. She was advised to undergo surgical manage-ment, but she refused and then approached our hospital. After thorough examinations, she was treated with Ayurvedic medications followed by Uttarabasti, having Shophaghna, Shulahara, Rasayana, Tridoshahara and Pramaathi actions. As a result, she successfully got conceived. It concludes that Ayurvedic management is suc-cessful and safe, so an effort has been made to share the protocol for the advancement of Ayurvedic science for the welfare of mankind.

Tubo-Ovarian Abscess Following Normal Vaginal Delivery: A Case Report

Introduction: Pelvic inflammatory disease (PID) is defined as an acute and subclinical infection of the upper genital system, including the uterus, fallopian tubes, ovaries, and ligaments. It can lead to various complications, such as salpingitis, endometritis, oophoritis, perihepatitis, peritonitis, and tubo-ovarian abscess (TOA). Case Presentation: In our case, a 22-year-old Afghan woman presented with generalized pain in the abdomen and pelvis, accompanied by vaginal discharge and fever, following 17 days of normal vaginal delivery (NVD) and septic shock. She had no previous history of PID. Abdominal ultrasonography revealed a significant amount of free fluid in the paracolic grooves and pelvis, along with a perforated mass on the right adnexa. As a result, she underwent laparotomy and right adnexectomy. A 10-day course of meropenem and vancomycin was prescribed, and the woman was discharged with oral antibiotics. Conclusions: Tubo-ovarian abscess following NVD is a rare condition that can occur in patients with preterm premature rupture of membranes (PPROM) and episiotomy. Therefore, it is essential to prescribe antibiotics in cases involving episiotomy and rupture of the membranous.

A case series on live ectopic pregnancy

A pregnancy which develops outside uterus is called ectopic pregnancy that comprises nearly two percent of total pregnancies. In first case a 25years old female presented with lower abdominal pain and bleeding per vagina with 3 months of amenorrhea and history of irregular oral contraceptive pill use. A live ectopic pregnancy of 12 weeks 3 days gestation found on right fallopian tube during laparotomy and right salpingectomy was done. In second case, a third gravida mother presented with bleeding per vagina and lower abdominal pain with history of 2.5 months of amenorrhea and chronic pelvic inflammatory disease. During laparotomy, both sided hydrosalpinx and left sided live ectopic pregnancy found on the distal end of fallopian tube and left salpingectomy with fimbriectomy with right sided tubal ligation was done. In third case, a third gravida mother with history of lower uterine caesarean section and ruptured left sided tubal ectopic pregnancy previously, presented with lower abdominal pain with 2 months of amenorrhea. Ultrasonography diagnosed a live right sided cornual ectopic pregnancy of 6weeks 6days and conservative management with injection methotrexate was started. Later due to sudden hemodynamic instability, emergency laparotomy was done and ruptured right cornual ectopic pregnancy was found and treated with total abdominal hysterectomy. All these cases were managed successfully. This case series emphasizes that early serological and sonographic diagnosis of location of pregnancy is necessary, there should be high suspicion for ectopic pregnancy even beyond the first trimester and the decision of conservative management in early ectopic pregnancy should be taken judiciously after checking all parameters of the patient.

Gynecological Cancers and Microbiota Dynamics: Insights into Pathogenesis and Therapy.

In recent years, the relationship between the microbiota and various aspects of health has become a focal point of scientific investigation. Although the most studied microbiota concern the gastrointestinal tract, recently, the interest has also been extended to other body districts. Female genital tract dysbiosis and its possible impact on pathologies such as endometriosis, polycystic ovary syndrome (PCOS), pelvic inflammatory disease (PID), and gynecological cancers have been unveiled. The incursion of pathogenic microbes alters the ecological equilibrium of the vagina, triggering inflammation and compromising immune defense, potentially fostering an environment conducive to cancer development. The most common types of gynecological cancer include cervical, endometrial, and ovarian cancer, which occur in women of any age but especially in postmenopausal women. Several studies highlighted that a low presence of lactobacilli at the vaginal level, and consequently, in related areas (such as the endometrium and ovary), correlates with a higher risk of gynecological pathology and likely contributes to increased incidence and worse prognosis of gynecological cancers. The complex interplay between microbial communities and the development, progression, and treatment of gynecologic malignancies is a burgeoning field not yet fully understood. The intricate crosstalk between the gut microbiota and systemic inflammation introduces a new dimension to our understanding of gynecologic cancers. The objective of this review is to focus attention on the association between vaginal microbiota and gynecological malignancies and provide detailed knowledge for future diagnostic and therapeutic strategies.

In silico design and analysis of a multiepitope vaccine against Chlamydia.

Chlamydia trachomatis (Ct) is the most common sexually transmitted bacterial infection worldwide, potentially leading to severe pathologies including pelvic inflammatory disease, ectopic pregnancy, and tubal infertility if left untreated. Current strategies, including screening and antibiotics, have limited effectiveness due to high rates of asymptomatic cases and logistical challenges. A multiepitope prophylactic vaccine could afford long-term protection against infection. Immunoinformatic analyses were employed to design a multiepitope Chlamydia vaccine antigen. B- and T-cell epitopes from five highly conserved and immunogenic Ct antigens were predicted and selected for the vaccine design. The final construct, adjuvanted with cholera toxin A1 subunit (CTA1), was further screened for immunogenicity. CTA1-MECA (multiepitope Chlamydia trachomatis antigen) was identified as antigenic and nonallergenic. A tertiary structure was predicted, refined, and validated as a good quality model. Molecular docking exhibited strong interactions between the vaccine and toll-like receptor 4 (TLR4). Additionally, immune responses consistent with protection including IFN-γ, IgG+IgM antibodies, and T- and B-cell responses were predicted following vaccination in an immune simulation. Expression of the construct in an Escherichia coli expression vector proved efficient. To further validate the vaccine efficacy, we assessed its immunogenicity in mice. Immunization with CTA1-MECA elicited high levels of Chlamydia-specific antibodies in mucosal and systemic compartments.

Laparoscopic polyglycolic acid spacer placement for locally recurrent rectal cancer.

Carbon ion radiotherapy (CIRT) has received attention for the treatment of locally recurrent rectal cancer. When the surrounding primary organs are close to the irradiation site, a spacer is required to ensure safe irradiation. This work describes a novel technique using a bioabsorbable polyglycolic acid spacer placed laparoscopically and presents a technical report with five case studies. The short-term surgical outcomes were as follows: mean operating time 235 min with blood loss of 38 mL. CIRT was planned, and the patients underwent irradiation within 2 months of surgery. No pelvic infections occurred, and all procedures were performed safely. Herein, were present a technical report with reference to a video of the surgical procedure.

(344) Evaluating Time to Conception Changes Over Two Decades

Abstract Introduction The time to conception is an essential factor that influences reproductive outcomes, and understanding its variance aids in appropriate family planning. Factors such as Body Mass Index (BMI), polycystic ovarian syndrome (PCOS), and maternal age significantly impact time to conception. Our study explores these factors in the light of the perceived increase in conception time over the last decade. Existing data show a decrease in births per woman worldwide over several decades; however, there is a lack evidence to prove if this trend is due to fertility or volition. Our goal was to observe whether or not a true increase in time to conception exists. Objective The study aimed to discern whether time to conception has increased over the past decade compared to the previous decade. The secondary aim was to explore the relationship between conception time and several variables, including BMI, PCOS, maternal age, and lifestyle habits. Methods We employed Amazon Mechanical Turk (MTurk) to conduct an online survey of 12 questions. The study population consisted of pregnant women from the year 2000 onwards. The survey assessed a range of factors: maternal and paternal age, pregnancy year, physical activity levels, tobacco and alcohol use, BMI, race/ethnicity, certain aspects of medical history, months to conception, and total number of gestations. Univariable logistic regression models were employed to assess the correlation between these factors and conception time. Results The results from 852 respondents showed no significant differences in time to conception when comparing individuals who became pregnant post-2012 versus pre-2012. However, several factors significantly influenced conception time. Mothers who exercised more than 150 minutes per week or had endometriosis, history of pelvic inflammatory disease (PID), or PCOS were 1.4, 1.7, 1.7, and 2.4 times more likely, respectively, to have longer times to conception (>= 6 months) (p < 0.05). Additionally, paternal factors such as undergoing chemotherapy, having testicular cancer, or varicocele were associated with 1.7, 1.6, and 3.5 times longer conception times, respectively (p < 0.05). Conclusions Although there was no apparent increase in time to conception over the past decade, several factors were significantly associated with extended conception time. These include maternal factors like physical activity, endometriosis, PID, and PCOS, as well as paternal factors like undergoing chemotherapy, having testicular cancer or varicocele. The current guidelines recommend a twelve-month period of attempting conception before pursuing fertility assessment. This study implies that a reevaluation of these guidelines may be warranted. It is plausible that women with one or more of these risk factors should be advised to seek medical attention earlier than twelve months, or even prior to attempting conception. Understanding these relationships provides valuable insights for family planning and infertility treatment, underscoring the importance of comprehensive health and lifestyle evaluation in couples planning to conceive. Future studies should focus on developing targeted interventions to optimize these factors and potentially reduce conception time. Disclosure No.

Punicalagin improves inflammation and oxidative stress in rat model of pelvic inflammatory disease

Pelvic inflammatory disease (PID) is one of the major public health concerns accounting for 30% of infertility and 50% of ectopic pregnancy cases due to severe inflammation and fibrosis. Punicalagin® are known to exhibit potent anti-inflammatory activity. The aim of this study was to demonstrate the anti-inflammatory and antioxidant effects of Punicalagin®, against pelvic inflammatory disease in rats. Female Sprague Dawley rats (n = 24) were divided into 6 groups (n = 4) as control, PID, prophylactic (low dose and high dose) and therapeutic group (low dose and high dose). PID model was constructed by implanting the rat cervix with mixed microbe (Escherichia Coli and Staphylococcus Aureus) solution. Prophylactic group was gavaged with 3 mg/kg (low dose) and 6 mg/kg (high dose) Punicalagin® daily starting one day before PID induction and therapeutic group was gavaged with 3 mg/kg (low dose) and 6 mg/kg (high dose) Punicalagin® daily starting 1 day after confirmation of PID model. Rats were sacrificed at the end of experiment and samples from upper genital tract were collected for ELISA, antioxidant assay and histopathological examination. According to results, obvious signs of inflammation and oxidative stress including infiltration of neutrophils and significantly raised levels of cytokines, and oxidative stress markers were observed in PID group when compared to control group. Punicalagin® significantly decreased the levels of IL-1β, catalase and lipid peroxidation in both prophylactic and therapeutic groups when compared to PID group. Punicalagin® also decreased the infiltration of leucocytes in uterus of prophylactic and therapeutic group when compared to PID group, as determined by histological examination. On basis of these results, we concluded that Punicalagin® showed anti-inflammatory and antioxidant potential in rat model of pelvic inflammatory disease and could be used as possible therapeutic agent in treatment of PID.

Pelvic abscess treatment: A novel experience with UNICO drainage

Pelvic abscess can be a life-threatening condition due to infected fluid collection. Usually, pelvic abscess occurs as a complication of surgical procedures or pelvic organ tumors, inflammatory pelvic conditions, infectious gastrointestinal tract and gynecological diseases. Drainage is the standard treatment of pelvic abscess especially after failure of the antibiotic therapy. UNICO drainage is an innovative catheter for minimal invasive centesis and miscellaneous drainage procedures. In this report, it was used on three patients with pelvic abscess of different etiology: Pelvic inflammatory disease, Crohn disease, and endometriosis. In all cases, UNICO drainage was applied transrectally under loco-regional anesthesia. The procedure was well tolerated with rapid improvement of clinical conditions in all cases. The procedure was easy and rapid and there were no complications in any of the three cases reported. UNICO drainage is a simple and effective drainage tool and it can be a valid alternative for pelvic abscess drainage.

Vaginal douching and health risks among young women.

Vaginal douching is practiced by women for various reasons. Studies have shown that this practice can upset the normal vaginal flora, increasing susceptibility to certain sexually transmitted diseases (STIs). This study aimed to assess the health risks associated with this practice among women aged 15-54 years in a densely populated community in Kumasi, the second capital city of Ghana. A cross-sectional survey was conducted to gather data on the prevalence of vaginal douching among young women and their beliefs, motivations, and knowledge about the practice. A structured questionnaire was used in recruiting participants. One-hundred and fifteenstructured questionnaires were administered to women aged between 15 and 54 after their consent was sought. The study established that more than half of the participants (69.6%) engaged in douching with a midpoint of 19.5. The study indicated no significant difference between the age of participants and douching (p < 0.93). However, there was an indication of a significant association between educational status, marital status, and perception in relation to douching (p < 0.003, 0.0015, and 0.00, respectively), which also influenced the frequency of douching and contraction of STIs. Most women in the study community recruited, regardless of their educational and marital status, believed that douching is necessary and considered part of feminine hygiene practices. Practicing douching may lead to most health complications including pelvic inflammatory disease and infertility which must be given serious attention by researchers, health personnel, and various women's groups.

Bladder Repair With Irrigation and Debridement and Open Reduction Internal Fixation of the Anterior Pelvic Ring Is Safe and Decreases Risk of Infection in Pelvic Ring Injuries With Extraperitoneal Bladder Ruptures.

To determine the incidence of infection in nonoperative versus operative management of extraperitoneal bladder ruptures in patients with pelvic ring injuries. A retrospective cohort study of 2 prospectively collected trauma registries. Two Level 1 trauma centers. Patients with operative pelvic ring injuries, 68 (6%) had extraperitoneal bladder ruptures. The primary outcome was the incidence and associated risk factors of deep pelvic infection requiring return to OR for surgical debridement. Secondary outcomes included quality of reduction, other complications, and radiographic union. Comparisons were made based on the status of any associated bladder injury. Of 1127 patients with operative pelvic ring injuries, 68 patients had extraperitoneal bladder ruptures, 55 had bladder repair and 13 did not. Of those 13 without repair, none had ORIF of the anterior pelvic ring. Patients without bladder repair had an increased odds of infection 17-fold compared to patients who did have a repair performed (OR 16.9, 95% CI 1.75 - 164, P = 0.01). Other associated factors for deep pelvic infection included use of suprapubic catheter ( p < 0.02) and a closed reduction of the anterior ring ( p < 0.01). Patients undergoing anterior ring ORIF and bladder repair had improved reductions and no increased infection risk. Operative repair of extraperitoneal bladder ruptures decreases risk of infection in patients with pelvic ring injuries. Additionally, ORIF of the anterior pelvic ring does not increase the risk of infection and results in better reductions compared to closed reduction. Treatment algorithms for these combined injuries should consider recommending early bladder repair and anterior pelvic ORIF. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Acupuncture therapies for relieving pain in pelvic inflammatory disease: A systematic review and meta-analysis.

Studies investigating the effectiveness of acupuncture therapies in alleviating pain in pelvic inflammatory disease (PID) have gained increasing attention. However, to date, there have been no systematic reviews and meta-analyses providing high-quality evidence regarding the efficacy and safety of acupuncture therapies in this context. The objective of this review was to assess the efficacy and safety of acupuncture therapies as complementary or alternative treatments for pain relief in patients with PID. A comprehensive search was conducted in eight databases from inception to February 20, 2023: PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and Chinese Biomedical Literature Database. Randomized controlled trials (RCTs) investigating acupuncture therapies as complementary or additional treatments to routine care were identified. Primary outcomes were pain intensity scores for abdominal or lumbosacral pain. The Cochrane risk of bias criteria was applied to assess the methodological quality of the included trials. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system was used to evaluate the quality of evidence. Data processing was performed using RevMan 5.4. This systematic review included twelve trials comprising a total of 1,165 patients. Among these, nine trials examined acupuncture therapies as adjunctive therapy, while the remaining three did not. Meta-analyses demonstrated that acupuncture therapies, whether used alone or in combination with routine treatment, exhibited greater efficacy in relieving abdominal pain compared to routine treatment alone immediately after the intervention (MD: -1.32; 95% CI: -1.60 to -1.05; P < 0.00001). The advantage of acupuncture therapies alone persisted for up to one month after the treatment (MD: -1.44; 95% CI: -2.15 to -0.72; P < 0.0001). Additionally, acupuncture therapies combined with routine treatment had a more pronounced effect in relieving lumbosacral pain after the intervention (MD: -1.14; 95% CI: -2.12 to -0.17; P < 0.00001) in patients with PID. The incidence of adverse events did not increase with the addition of acupuncture therapies (OR: 0.56; 95% CI: 0.21 to 1.51; P = 0.25). The findings also indicated that acupuncture therapies, as a complementary treatment, could induce anti-inflammatory cytokines, reduce pro-inflammatory cytokines, alleviate anxiety, and improve the quality of life in patients with PID. Our findings suggest that acupuncture therapies may effectively reduce pain intensity in the abdomen and lumbosacral region as complementary or alternative treatments, induce anti-inflammatory cytokines, decrease pro-inflammatory cytokines, alleviate anxiety, and enhance the quality of life in patients with PID, without increasing the occurrence of adverse events. However, due to the low quality of the included trials, the conclusion should be interpreted with caution, highlighting the need for further high-quality trials to establish more reliable conclusions.

Three-in-one protocol for the management of hemodynamically unstable paediatric pelvic fracture – a level one trauma centre 15 year review

A three-in-one protocol comprised of pelvic external fixation, retroperitoneal pelvic packing, and angiography with or without embolization has been developed and used in our centre to improve survival outcomes of hemodynamically unstable pelvic fractures since 2008. Fourteen paediatric patients over a period of 15 years are reviewed in this case series. The mean age is 11.6 and standard deviation is 4.6. The mean injury severity score is 31.6. Sixty four percent underwent three-in-one protocol management. The overall survival rate at index hospital admission and at one year is 85.7% which is higher than the adult group (81%) from a study conducted at our centre and comparable to the rate in paediatric group. One patient had pelvic external fixator pin tract infection and two had lower limb ischemia post embolization. At 6 months follow up, one patient had pelvic pain and one had hip protrusio. We conclude that improvement in survival outcome also applies to the paediatric population. Technical differences in the paediatric group is highlighted to minimize potential complications.

Penyuluhan Pengetahuan Bahaya merokok pada Remaja di Desa Doda Kecamatan Kinovari Kabupaten Sigi Sulawesi Tengah

Adolescence according to WHO is the phase between childhood and adulthood in the age range between 10 to 19 years. The world's youth age group is 1.2 billion or 18% of the world's population. Cigarettes and tobacco products consumed by humans are generally are plant leaves (Nicotina, tabacum, nicotina rustica, and other species) that are burned, smoked, inhaled or chewed. There is 2550, a chemical in processed tobacco leaves. Some chemicals quickly cause health problems, lung damage, and weakening of stamina, if burnt cigarette smoke contains about 4000 chemicals, 43 of which are toxic such as nicotine such as nicotine (pesticide), CO (toxic gas), tar. The high prevalence of smokers in Indonesia will increase the risk of these diseases which threaten not only active smokers but also smokers. In active smokers, the danger threatens all organs of the body with impaired function to cancer such as those of the heart and blood vessels (coronary heart disease and blood vessels), respiratory tract (COPD, asthma and nasopharyngeal cancer), and disorders of the reproductive system and pregnancy (disability fetuses, miscarriages, pelvic infections and cancer in the organs of passive smoking adults and children). Users of tobacco products are decreasing, the number of teenagers aged 13-15 who smoke cigarettes has increased in 2014 (18.3%), 2019 (18.8% ). The method used is face-to-face through counseling and using questionnaires, the application of education in the health sector. The results of health education activities through this training are that there is an increase in knowledge about the dangers of smoking by 70% and 70% of adolescents wish to stop smoking

Chlamydial and Gonococcal Infections and Adverse Reproductive Health Conditions Among Patients Assigned Female at Birth in the Veterans Health Administration.

Reproductive age female individuals comprise the fastest-growing segment of Veterans Health Administration patients, but little is known about rates of reproductive health outcomes among those with chlamydia or gonorrhea infections. Our aim was to estimate the risk of pelvic inflammatory disease, ectopic pregnancy, infertility, and pelvic pain in female veterans tested for chlamydia or gonorrhea. We performed a retrospective cohort analysis of female veterans tested for chlamydia or gonorrhea between January 1, 2010, and December 31, 2020. We calculated rates of pelvic inflammatory disease, ectopic pregnancy, infertility, and pelvic pain per 100,000 person-years and used Cox proportional hazards regression models to estimate the risk of these reproductive health conditions according to infection status after adjustment for age, race, ethnicity, military sexual trauma, mental health diagnoses, and substance use disorder. Of female veterans, 232,614 were tested at least once for chlamydia or gonorrhea, with a total of 1,665,786 person-years of follow-up. Of these, 12,971 had positive chlamydia or gonorrhea results (5.8%, 796 cases per 100,000 person-years). Compared with people who tested negative, those testing positive had double the risk of pelvic inflammatory disease (adjusted hazard ratio [aHR], 1.94; 95% confidence interval [CI], 1.81-2.07), 11% increased risk of infertility (aHR, 1.11; 95% CI, 1.04-1.18), 12% increased risk of pelvic pain (aHR, 1.12; 95% CI, 1.08-1.17), and 21% increased risk of any of these conditions (aHR, 1.21; 95% CI, 1.17-1.25). People with positive chlamydia or gonorrhea testing tended to have an increased risk of ectopic pregnancy (aHR, 1.14; 95% CI, 1.0-1.30). Among those with a positive test result, 2218 people (17.1%) had 1 or more additional positive test results. Compared with those with 1 positive test result, people with more than 1 positive test result had a significantly increased risk of pelvic inflammatory disease (aHR, 1.37; 95% CI, 1.18-1.58), infertility (aHR, 1.20; 95% CI, 1.04-1.39), and pelvic pain (aHR1.16; 95% CI, 1.05-1.28), but not ectopic pregnancy (aHR, 1.09; 95% CI, 0.80-1.47). Female veterans with positive chlamydia or gonorrhea results experience a significantly higher risk of pelvic inflammatory disease, infertility, and pelvic pain, especially among those with repeat infection.

Prevalence of Gonorrhea and Associated Knowledge, Attitudes, and Practices among High School Students in Burao City, Somaliland

Background: Gonorrhea, caused by the bacterium Neisseria gonorrhea, is a prevalent sexually transmitted infection (STI) that significantly impacts the health and well-being of individuals worldwide. It is the second most common preventable and treatable STI. In women, gonococcal infections often do not exhibit noticeable symptoms, leading to undetected and untreated infections. This can result in severe complications such as pelvic inflammatory disease, ectopic pregnancy, and infertility. Hence, the objective of this research was to evaluate the prevalence of gonorrhea infection among high school students in Burao city, Somaliland, while also examining their knowledge, attitudes, and practices associated with this infection. Methods: A quantitative method was employed to conduct an institutional-based cross-sectional study in selected schools in Burao city. The sampling method used was systematically random. To collect the data, a structured questionnaire with four parts was utilized. The collected data underwent a thorough process of checking for completeness, cleaning, coding, and entry using Kobo toolbox software (ODK). Subsequently, the data were exported to the Statistical Package for Social Sciences (SPSS) version 27 for analysis. Descriptive statistics were utilized to describe the study population to relevant variables. Furthermore, the chi-square test and odds ratio were performed at a 95% confidence interval using a p value of less than 0.05. Results: The study included 384 participants, with almost equal sex distributions. The response rate was high at 99%. The majority of participants had a negative attitude toward gonorrhea, while a significant proportion had accepted practices. The prevalence of gonorrhea was 2.1%. Logistic regression analysis revealed that good knowledge and a positive attitude toward gonorrhea were associated with higher levels of acceptable sexual practices. Additionally, practices and attitudes toward gonorrhea were strongly associated with each other. Conclusion: According to this study, the level of awareness regarding gonorrhea infection among schoolchildren in Burao city was significantly inadequate. Even though more than half of the students reported no sexual relationships, a considerable number of them were still engaging in risky sexual behaviors such as unprotected sex.

A Unique Case of Heterotopic Pregnancy

Heterotopic pregnancy, characterized by simultaneous intrauterine and extrauterine pregnancies, is a rare but potentially life-threatening condition. Its incidence has increased, attributed to factors such as pelvic inflammatory disease and assisted reproductive technologies. We present a case of spontaneous heterotopic pregnancy in a 28-year-old woman with lower abdominal pain. Initial examination revealed a ruptured left tubal ectopic pregnancy alongside a live intrauterine pregnancy. Prompt diagnosis via transvaginal ultrasonography led to emergency laparotomy, confirming sonographic findings. The ruptured ectopic pregnancy was successfully removed, preserving intrauterine gestation. Follow-up ultrasounds demonstrated a progressing intrauterine pregnancy. This case underscores the diagnostic challenges and emphasizes the importance of early recognition and intervention in heterotopic pregnancies, especially in the absence of predisposing risk factors. Increased awareness, thorough pelvic examination, and close follow-up are crucial for optimal outcomes in both pregnancies.

Long-term outcomes of pelvic exenterations for gynecological malignancies: a single-center retrospective cohort study

BackgroundRecently, with the advancement of medical technology, the postoperative morbidity of pelvic exenteration (PE) has gradually decreased, and it has become a curative treatment option for some patients with recurrent gynecological malignancies. However, more evidence is still needed to support its efficacy. This study aimed to explore the safety and long-term survival outcome of PE and the feasibility of umbilical single-port laparoscopic PE for gynecologic malignancies in a single medical center in China.Patients and methodsPE for gynecological cancers except for ovarian cancer conducted by a single surgical team in Sun Yat-sen University Cancer Center between July 2014 and December 2019 were included and the data were retrospectively analyzed.ResultsForty-one cases were included and median age at diagnosis was 53 years. Cervical cancer accounted for 87.8% of all cases, and most of them received prior treatment (95.1%). Sixteen procedures were performed in 2016 and before, and 25 after 2016. Three anterior PE were performed by umbilical single-site laparoscopy. The median operation time was 460 min, and the median estimated blood loss was 600 ml. There was no perioperative death. The years of the operations was significantly associated with the length of the operation time (P = 0.0018). The overall morbidity was 52.4%, while the severe complications rate was 19.0%. The most common complication was pelvic and abdominal infection. The years of surgery was also significantly associated with the occurrence of severe complication (P = 0.040). The median follow-up time was 55.8 months. The median disease-free survival (DFS) was 17.9 months, and the median overall survival (OS) was 25.3 months. The 5-year DFS was 28.5%, and the 5-year OS was 30.8%.ConclusionPE is safe for patient who is selected by a multi-disciplinary treatment, and can be a curative treatment for some patients. PE demands a high level of experience from the surgical team. Umbilical single-port laparoscopy was a technically feasible approach for APE, meriting further investigation.

A Comparison of Hysterosalpingographic Results in Individuals Experiencing Primary and Secondary Infertility: A Prospective Approach

Introduction: In order to examine the uterine and fallopian tubes in women suffering from infertility, Hysterosalpingography (HSG) technique is commonly used in process of different investigations. The technique is used to assess any blockages in the tubes or normal morphology of the uterus. This study aims to compare the HSG results in a study population having primary and secondary infertility.&#x0D; Materials and Methods: We conceded a one-year prospective study at Islamabad Diagnostic Center in Islamabad, Pakistan after getting institutional review board approval. The study duration was from July 1, 2022 to June 30, 2023. Sample size was calculated using online software “Raosoft” which estimated it to 242. All the patients who gave informed consent and having primary and secondary infertility were enrolled. Demographics of the patients including age, duration of infertility, and the presence of tubal and uterine abnormalities, were collected by reviewing clinical notes and X-ray findings.&#x0D; Results: Among 242 enrolled patients with infertility, the ratio of primary infertility was 70.27% (n=170) and that of secondary infertility was 29.75% (n=72). In both the groups, fallopian tube blockage was observed as a major abnormality that affected 20.00% (n=34/170) of patients with primary infertility and 30.55% (n=22/72) of patients with secondary infertility. Unilateral tube blockage was observed in 26.47% (n=9/34) whereas, bilateral blockage was observed in 29.41% (n=10/34) patients with primary infertility. 23.52% (n=8/34) of patients got affected with Bilateral hydrosalpinx, whereas unilateral loculated spill was perceived in 8.82% (n=3/34) of. In patients with uterine congenital abnormalities, 5.88% (n=2/34) had a bicornuate uterus, 2.94% (n=1/34) had a unicornuate uterus, and 2.94% (n=1/34) had uterine didelphys.&#x0D; Conclusion: In order to examine the uterine and fallopian tubes in women suffering from infertility, Hysterosalpingography (HSG) technique is commonly used. The technique is used to assess any blockages in the tubes or normal morphology of the uterus. In this study, fallopian tube abnormalities were most predominant among barren women. So, taking deterrent actions and efficiently management of pelvic infections are indispensable in plummeting the manifestation of infertility resultant of the tubal issues.&#x0D; Keywords: Hysterosalpingography, Infertility, Subfertility, Tubal blockage&#x0D; &#x0D;

Proteomic Profiling Identifies Candidate Diagnostic Biomarkers of Hydrosalpinx in Endometrial Fluid: A Pilot Study.

Hydrosalpinx is a fluid occlusion and distension of the fallopian tubes, often resulting from pelvic inflammatory disease, which reduces the success of artificial reproductive technologies (ARTs) by 50%. Tubal factors account for approximately 25% of infertility cases, but their underlying molecular mechanisms and functional impact on other reproductive tissues remain poorly understood. This proteomic profiling study applied sequential window acquisition of all theoretical fragment ion spectra mass spectrometry (SWATH-MS) to study hydrosalpinx cyst fluid and pre- and post-salpingectomy endometrial fluid. Among the 967 proteins identified, we found 19 and 17 candidate biomarkers for hydrosalpinx in pre- and post-salpingectomy endometrial fluid, respectively. Salpingectomy significantly affected 76 endometrial proteins, providing insights into the enhanced immune response and inflammation present prior to intervention, and enhanced coagulation cascades and wound healing processes occurring one month after intervention. These findings confirmed that salpingectomy reverses the hydrosalpinx-related functional impairments in the endometrium and set a foundation for further biomarker validation and the development of less-invasive diagnostic strategies for hydrosalpinx.