Medical Specialties Commons^™

Laparoscopic Management Of An Ovarian Ectopic Pregnancy: Case Report, Y. Patel, Sikolia Wanyonyi, F. S. Rana

Obstetrics and Gynaecology, East Africa

Ovarian pregnancy is a rare variant of ectopic gestation.The diagnosis is often made at surgery and requires histological confirmation. The condition has not been reported locally and its diagnosis is easily missed. A case of an ovarian ectopic pregnancy in a 41year old para 1+ 1with secondary infertility is reported. The patient presented with lower abdominal pain and vaginal bleeding at six weeks gestation with a semm B-hCG of 79.12mlU/L. An ultrasound showed a complex left adnexal mass. She underwent a diagnostic and operative laparoscopy. A left oophorectomy was performed due to difficulty in achieving haemostasis.

Intracytoplasmic Sperm Injection Outcome Using Ejaculated Sperm And Retrieved Sperm In Azoospermic Men., Tahira Naru, M. Nasir Sulaiman, Atiya Kidwai, M. Hammad Ather, Sana Waqar, Saadia Virk, Javed H Rizvi

Department of Obstetrics & Gynaecology

Introduction:We aimed to determine pregnancy and miscarriage rates following intracytoplasmic sperm injection (ICSI) cycles using retrieved epididymal and testicular sperm in azoospermic men and ejaculated sperm in oligospermic and normospermic men. Materials And
Methods: This retrospective study was carried out on 517 couples who underwent ICSI. They included 96 couples with azoospermia and 421 with oligospermia or normal sperm count in the male partner. Of the men with azoospermia, 69 underwent percutaneous epididymal aspiration (PESA) and 47 underwent testicular sperm extraction (TESE). In the 421 men with oligospermia or normal sperm count, ejaculated sperm was used for ICSI. The …

Obstetric Fistula In Mali, Chandler O’Connell

Independent Study Project (ISP) Collection

Obstetric fistula is arguably the most devastating result of childbirth complications, aside from maternal and neonatal mortality, the latter of which almost always occurs during deliveries which result in fistula. Defined as a hole in the birth canal, obstetric fistula is generally caused by prolonged obstructed labor in the absence of prompt medical intervention.20 This injury results in chronic incontinence through the vagina as well as many other secondary health consequences.33 Additionally, it is impossible to measure the extensive social and psychological burdens suffered by women because of this affliction. Despite the fact that obstetric fistula is both preventable and …

Effectiveness Of Assigning Bi-Rads Category-3 To Breast Lesion With Respect To Follow-Up, Imrana Masroor

Department of Radiology

OBJECTIVE: To determine the effectiveness of assigning BI-RADS category-3 to breast lesion with respect to follow-up.STUDY DESIGN: A cohort study.

PLACE AND DURATION OF STUDY: Radiology Department, the Aga Khan University Hospital, Karachi, from January 2002 to December 2004.

PATIENTS AND METHODS: Women undergoing X-ray mammography and assigned BI-RADS category-3 and recommended short-term (6-monthly) follow-up were included. Out of these, 44 patients were lost to follow-up and were excluded from the study. The lesions that remained stable after short-term follow-up were recommended routine (annual) follow-up. Needle localization and open surgical biopsy was performed, if the lesion progressed or calcifications increased …

Social Factors Affecting Treatment Of Cervical Cancer: Ethical Issues And Policy Implications, Shannon N. Westin, Dan Bustillos, Jacalyn B. Gano, Margaret M. Fields, Ann L. Coker, Charlotte C. Sun, Lois M. Ramondetta

CRVAW Faculty Journal Articles

Health care in the United States has become a privilege rather than a right. Patients who have the greatest need are the ones most likely to be denied this privilege. Despite recent advances in disease detection and treatment, many patients do not receive even the bare minimum of care. The high complexity of the health care system in the setting of patients with low levels of health literacy significantly affects the ability to seek and receive treatment in a timely fashion. In addition, lack of insurance, transportation, and social support further complicate access to care. To truly provide a standard …

Preimplantation Embryo Programming: Transcription, Epigenetics, And Culture Environment., Veronique Duranthon, Andrew J Watson, Patrick Lonergan

Obstetrics & Gynaecology Publications

Preimplantation development directs the formation of an implantation- or attachment-competent embryo so that metabolic interactions with the uterus can occur, pregnancy can be initiated, and fetal development can be sustained. The preimplantation embryo exhibits a form of autonomous development fueled by products provided by the oocyte and also from activation of the embryo's genome. Despite this autonomy, the preimplantation embryo is highly influenced by factors in the external environment and in extreme situations, such as those presented by embryo culture or nuclear transfer, the ability of the embryo to adapt to the changing environmental conditions or chromatin to become reprogrammed …

Human Papillomavirus (Hpv) Vaccine: Attitudes, Behaviors, And Beliefs Of At-Risk Women, Rosemary M. Caron, Elisabeth Kispert, Robert J. Mcgrath

Health Management & Policy

Cervical cancer is primarily caused by human papillomavirus (HPV) and is the second most common cause of cancer-related mortality among women. Female college students may be at risk for contracting HPV based on their sexual behavior. Following the release of the HPV vaccine, Gardasil®, this cross-sectional study was developed to (1) determine awareness of HPV and Gardasil®, (2) assess attitudes, behaviors, and beliefs about the HPV vaccine, and (3) identify information sources that female college students are accessing. Female college students voluntarily completed a self-administered questionnaire. Statistical analyses included descriptive statistics, Pearson’s correlations and paired sample t-tests. Sexually active respondents …

Tampons And Menstrual Hygiene Products, Shibani Kanungo, Hatim A. Omar

Obstetrics and Gynecology Faculty Publications

No abstract provided.

Sensitization Of Ovarian Cancer Cells To Cisplatin By Genistein: The Role Of Nf-Kappab, Leigh A. Solomon, Shadan Ali, Sanjeev Banerjee, Adnan R. Munkarah, Robert T. Morris, Fazlul H. Sarkar

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Platinum-resistance (PR) continues to be a major problem in the management of epithelial ovarian cancer (EOC). Response to various chemotherapeutic agents is poor in patients deemed PR. Genistein, a soy isoflavone has been shown to enhance the effect of chemotherapy in prostate and pancreatic cancer cells in vitro and in vivo by reversing chemo-resistance phenotype. The goal of this study was to investigate the effects of combination therapy with genistein and cisplatin as well as other cytotoxic conventional chemotherapeutic agents in platinum-sensitive (PS) and resistant EOC cells.

Methods

The PS human ovarian cancer cell line A2780 and its …

Reducing Hiv/Aids In Young People In Sub-Sahara Africa: Gaps In Research And The Role Of Theory, Kristien Michielsen, Marleen Bosmans, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

This paper discusses the role of education in preventing HIV in children and young people in sub-Sahara Africa and presents the results of policy advisory research conducted on behalf of the Belgian Development Cooperation. The research consisted of a literature review and a field study in Rwanda. Relative to the high number of HIV prevention activities in sub-Sahara Africa, there is a limited number of scientific data on HIV risk reduction interventions for young people in this region. Longitudinal studies are especially scarce. Preliminary results show that many interventions have only a marginal impact on reducing sexual risk behaviour. Factors …

Successful Pregnancy Outcome Following Laparoscopic Myomectomy: Case Report, R. B. Parkar, Sikolia Wanyonyi, W. J. Kamau, D. Otieno

Obstetrics and Gynaecology, East Africa

Laparoscopic myomectomy is now widely used as an alternative to laparotomy in the management of symptomatic uterine fibroids. The advantages of this minimal access approach outweigh those of the open techniques. The pregnancy outcomes between the two methods have been studied and are comparable, but there still exists a lot of scepticism locally concerning this. It is against this background that we present a 31 year old nulliparous lady who had a two year history of primary infertility secondary to multiple uterine fibroids, the largest being fundal and measuring 6.6cm. She underwent a successful laparoscopic myomectomy in November, 2006 and …

Technical Assistance For Implementing Best Practices In The Asia And Near East Region, M.E. Khan, Sohini Roychowdhury, Mary Philip Sebastian, Sitanshu Sekhar Kar, Anurag Mishra, Vivek Sharma, G. Narayana, Bhawana Sharma, Nahla G. Abdel-Tawab, Ahmed Afifi

Reproductive Health

The Population Council's Frontiers in Reproductive Health (FRONTIERS) program offered technical assistance to any Asia Near East (ANE) country mission interested in funding adaptation of USAID‟s “best practices” in family planning or reproductive health. The ANE Bureau provided funding for the costs of FRONTIERS technical assistance. The overall objective of this study was to replicate and scale up "best practices" based on findings from FRONTIERS. The specific objectives were to institutionalize the Systematic Screening Instrument in the entire state of Uttarakhand, India; to strenghten emergency contraceptive pills service provision in Uttarakhand, India; and to enhance the use of Lactational Amenorrhea …

Sexual And Reproductive Health Needs Of Adolescents Perinatally Infected With Hiv In Uganda, Harriet Birungi, John Frank Mugisha, Juliana K. Nyombi, Francis Obare, Humphres Evelia, Hannington Nyinkavu

Reproductive Health

In Uganda, HIV/AIDS treatment, care and support programs are still organized around either adult or pediatric care and fail to adequately address the needs of adolescents, specifically perinatally-infected adolescents. This study, implemented jointly by the Population Council's Frontiers in Reproductive Health (FRONTIERS) program and the AIDS Support Organization (TASO), aimed to better understand the reproductive health and sexuality of this population group, and to identify anxieties or fears they have around entering social stages of adulthood. This study confirms that wide programmatic gaps exist in addressing the sexual and reproductive health needs of young people perinatally infected with HIV who …

Situation Analysis Of The Integration Of Family Planning Services In Postpartum, Postabortion And Prevention Of Mother To Child Transmission Programs In Nicaragua, Freddy Solis, Ana Del Carmen Rojas, Gadea Adilia, M. Estela Rivero-Fuentes, Ricardo Vernon

Reproductive Health

Between September 2005 and April 2007, FRONTIERS and Alva, a Nicaraguan consulting firm, conducted a situation analysis of the provision and use of contraceptive services in postpartum, postabortion and prevention of mother-to-child transmission of HIV (PMTCT) programs. The project‘s objective was to assess the degree to which contraceptive services were linked to postpartum, postabortion and PMTCT services and if this allowed the programs to meet the contraceptive needs of their clients. The project proposes recommendations for improving the quality of these programs.

Using Operations Research To Enhance Delivery Of Postpartum/Postabortion Family Planning Services In The Arab Region, Frontiers In Reproductive Health

Reproductive Health

The FRONTIERS program in Cairo organized a two-and-half day workshop to share programmatic experiences and lessons learned in integrating family planning with service providers from Egypt, Jordan, Sudan, and Yemen representing mid-level program managers and researchers. It was held in 2008 in tandem with a national end-of-project seminar for stakeholders in Egypt. Participants emphasized the need to capture missed opportunities in antenatal, delivery, postpartum or postabortion care by providing family planning services in all encounters between women and the health care system. They also agreed on an overarching need for operations research in assisting policy makers and program managers in …

Assessment Of Progress Of The Postabortion Care Initiative In Francophone Africa, Thierno Dieng, Mohamed Diadhiou, Nafissatou J. Diop, Youmane Niang Faye

Reproductive Health

The goals of this study were to assess the national situation concerning postabortion care (PAC) in six countries (Burkina Faso, Guinea, Mali, Niger, Senegal and Togo), including the process of introduction, integration and decentralization of PAC; the successes and obstacles in the process of introducing PAC; and recommended key steps to strengthen the introductory process. The study used two approaches: a comprehensive review of the introduction and institutionalization of PAC in the six countries, and a situation analysis of PAC services within each country.

Constructing 'Health', Defining 'Choice': Legal And Policy Perspetives On The Post-Pgd Embryo In Four Jurisdictions, Estair Van Wagner, Roxanne Mykitiuk, Jeff Nisker

Articles & Book Chapters

Through Preimplantation Genetic Diagnosis, embryos created by IVF are selected for transfer to a woman based on particular characterisations, including the presence of genetic markers or a tissue match for a sibling. In this paper we examine the precise language used in the recent policy and regulatory documents of four jurisdictions (the United Kingdom, Australia, Canada and New Zealand) that in any way characterises the post-PGD embryo. We then explore the mutually constructed relationship between how that embryo is characterised and the purposes for which PGD is applied, as well as the types of uses to which the post-PGD embryo …

P1: Effect Of Age, Oestradiol Levels And Endometrial Thickness On Determining Success Of Frozen Embryo Transfers, Alfred Murage, Maybeth Jamieson, Robin Yates, Isabel Traynor, Helen Lyall, Scott Nelson

Obstetrics and Gynaecology, East Africa

Introduction: Frozen-thawed embryo transfer (FET) is a widely used technique, with replacement of embryos during natural menstrual cycles or in cycles constructed by exogenous steroids having similar outcomes in many series. Multiple factors have been proposed to have a positive influence on the success rate of FET, including increased endometrial thickness, younger maternal age and lower circulating oestradiol. The impact of these variables in the context of constructed cycles, using GnRH agonists to facilitate suppression of ovarian function prior to exogenous steroid administration, is not known. The aim of this study was to determine the predictive ability of these indices …

Racial Differences In Birth Outcomes: The Role Of General, Pregnancy, And Racism Stress, Tyan Parker Dominguez, Christine Dunkel Schetter, Laura M. Glynn, Calvin J. Hobel, Curt A. Sandman

Psychology Faculty Articles and Research

Objective: This study examined the role of psychosocial stress in racial differences in birth outcomes.

Design: Maternal health, sociodemographic factors, and 3 forms of stress (general stress, pregnancy stress, and perceived racism) were assessed prospectively in a sample of 51 African American and 73 non-Hispanic White pregnant women.

Main Outcome Measures: The outcomes of interest were birth weight and gestational age at delivery. Only predictive models of birth weight were tested as the groups did not differ significantly in gestational age.

Results: Perceived racism and indicators of general stress were correlated with birth weight and tested in regression analyses. In …

Timing Of Fetal Exposure To Stress Hormones: Effects On Newborn Physical And Neuromuscular Maturation, Lauren M. Ellman, Christine Dunkel Schetter, Calvin J. Hobel, Aleksandra Chicz-Demet, Laura M. Glynn, Curt A. Sandman

Psychology Faculty Articles and Research

The purpose of the study was to determine the specific periods during pregnancy in which human fetal exposure to stress hormones affects newborn physical and neuromuscular maturation. Blood was collected from 158 women at 15, 19, 25, and 31 weeks' gestation. Levels of placental corticotropin-releasing hormone (CRH) and maternal cortisol were determined from plasma. Newborns were evaluated with the New Ballard Maturation Score. Results indicated that increases in maternal cortisol at 15, 19, and 25 weeks and increases in placental CRH at 31 weeks were significantly associated with decreases in infant maturation among mates (even after con trolling for length …

Stress And Blood Pressure During Pregnancy: Racial Differences And Associations With Birthweight, Clayton J. Hilmert, Christine Dunkel Schetter, Tyan Parker Dominguez, Cleopatra M. Abdou, Calvin J. Hobel, Laura M. Glynn, Curt A. Sandman

Psychology Faculty Articles and Research

OBJECTIVE: To extend findings that African American women report greater stress during pregnancy, have higher blood pressure (BP), and are twice as likely to have low birthweight infants relative to white women. This study examines a) racial differences in associations between stress and BP during pregnancy, and b) the combined effects of stress and BP on infant birthweight in a sample of 170 African American and white women.

METHODS: A prospective, longitudinal study of pregnant women was conducted in which measures of BP, stress, and other relevant variables were collected. Multiple measures of systolic and diastolic BP were taken at …

Understanding Barriers For Adherence To Follow-Up Care For Abnormal Pap Tests, Katherine S. Eggleston, Ann L. Coker, Irene Prabhu Das, Suzanne T. Cordray, Kathryn J. Luchok

CRVAW Faculty Journal Articles

Objective: Approximately 4000 women annually will die from preventable and treatable cervical cancer. Failure to adhere to follow-up recommendations after an abnormal Pap test can lead to development of cervical cancer. This paper summarizes the body of literature on adherence to follow-up after an abnormal Pap test in order to facilitate development of interventions

to decrease morbidity and mortality due to cervical cancer.

Methods: We conducted a comprehensive search of published literature addressing risk factors for adherence or interventions to improve adherence following an abnormal Pap test as the outcome. We included peer-reviewed original research conducted in the …

Factors Associated With Teenage Pregnancy In The European Union Countries: A Systematic Review, Mari Imamura, Janet Tucker, Phil Hannaford, Miguel Oliveira Da Silva, Margaret Astin, Laura Wyness, Kitty Wm Bloemenkamp, Albrecht Jahn, Helle Karro, Jørn Olsen, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: As part of the REPROSTAT2 project, this systematic review aimed to identify factors associated with teenage pregnancy in 25 European Union countries.

Methods: The search strategy included electronic bibliographic databases (1995 to May 2005), bibliographies of selected articles and requests to all country representatives of the research team for relevant reports and publications. Primary outcome measure was conception. Inclusion criteria were quantitative studies of individual-level factors associated with teenage (13–19 years) pregnancy in EU countries.

Results: Of 4444 studies identified and screened, 20 met the inclusion criteria. Most of the included studies took place in UK and Nordic countries. …

Pregnancy Outcome In Primiparae Of Advanced Maternal Age, Ilse Delbaere, Hans Verstraelen, Sylvie Goetgeluk, Guy Martens, Guy De Backer, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: To investigate the impact of maternal age on singleton pregnancy outcome, taking into account intermediate and confounding factors.

Study design: In this population-based retrospective cohort study, perinatal data of primiparous women aged 35 years or more ( n = 2970), giving birth to a singleton child of at least 500 g, were compared to data of primiparous women aged 25–29 years old ( n = 23,921). Univariate analysis was used to assess the effect of maternal age on pregnancy outcomes. The effects of intermediate (hypertension, diabetes and assisted conception) and confounding factors (level of education) were assessed through multivariable …

Umbilical Cord Prolapse--A Review Of Diagnosis To Delivery Interval On Perinatal And Maternal Outcome, Rozilla Sadia Khan, Tahira Naru, Faryal Nizami

Department of Obstetrics & Gynaecology

Objective: To determine the significance of the Diagnosis to Delivery Interval (DDI) on perinatal outcome and maternal complications in patients with umbilical cord prolapse.
Methods: This was a case series of 44 patients identified with "Umbilical cord prolapse" during a 10-year period at the Aga Khan University Hospital. Data was retrieved for gestational age, foetal presentation, DDI, incision to delivery time, delivery method, apgar score, birth weight and outcome, and maternal complications. The influence of DDI on perinatal mortality, apgar scores at 5 minutes, neonatal intensive care unit (NICU) admission and maternal complications resulting from mode of delivery with cord …

Factors Influencing Medical Student Participation In An Obstetrics And Gynaecology Clinic, Ferha Saeed, Mahwash Kassi, Samia Ayub, Rabeea Rehman, Pashtoon M. Kasi, Javed H. Rizvi

Department of Obstetrics & Gynaecology

Objective: To identify factors influencing medical student participation in an obstetrics and gynaecology (OBGYN) setting.
Methods:This was a cross sectional study carried out on patients admitted in OBGYN wards of Aga Khan University Hospital, Karachi, Pakistan. A total of 250 patients consented to participate in this study.
Results: Eighty three percent of the people responded 'yes' to the question of being initially seen by a medical student. People who consented were 3.5 times more likely to know that their primary consultant was a teacher at a medical school i.e. they were initially aware that they were in a teaching …

Simulation To Augment Standardized Patients In Obstetric Ultrasound Training, Scott Richard Guirlinger

Computational Modeling & Simulation Engineering Theses & Dissertations

Standardized patients are actors used in medical training to teach and eval11atc clinical skills of students prior to their using these skills on an actual patient. Augmented Reality is a relatively new technology that can be used to augment standardized patients with abnonnalitie8 and pathologies that they cannot portray themselves as normal healthy human beings. In our project, we sought to augment standardized patients with a 12-week- old fetus in order to train and possibly evaluate medical students and professionals in performing obstetric ultrasound procedures and interpreting the corresponding ultrasound image results.

The software library ARToolkit provided the framework for …

Planning Initiative Award – 2006-2007 Access To Reproductive Health Services For Low-Ses Pregnant/Parenting Teens In Clark County: A Comprehensive Needs Assessment, Nevada Institute For Children's Research And Policy Reports, Jennifer Zipoy, Tara Swanson, Jean Henry, Denise Tanata, Uzma Farmanali,, Karen Silcott

Nevada Institute for Children's Research and Policy Reports

The Planning Initiative Award (PIA) project was a collaborative effort between the Nevada Institute for Children’s Research and Policy (NICRP) and the Center for Health Promotion (CHP)/Department of Health Promotion, research centers in the School of Public Health. The purpose of the project was to conduct an assessment of the access to reproductive health services among lower SES pregnant and parenting teens in the Las Vegas Valley. The project was designed to identify gaps in existing services and assist researchers in developing communication networks between community members, providers, educators, and policymakers. The data collected during the project period has great …

Let-7 Expression Defines Two Differentiation Stages Of Cancer, Scott Shell, Sun-Mi Park, Amir Reza Radjabi, Robert Schickel, Emily Kistner, David Jewell

Dartmouth Scholarship

The early phases of carcinogenesis resemble embryonic development, often involving the reexpression of embryonic mesenchymal genes. The NCI60 panel of human tumor cell lines can genetically be subdivided into two superclusters (SCs) that correspond to CD95 Type I and II cells. SC1 cells are characterized by a mesenchymal and SC2 cells by an epithelial gene signature, suggesting that SC1 cells represent less differentiated, advanced stages of cancer. miRNAs are small 20- to 22-nucleotide-long noncoding RNAs that inhibit gene expression at the posttranscriptional level. By performing miRNA expression analysis on 10 Type I and 10 Type II cells, we have determined …

Pp2cdelta (Ppm1d, Wip1), An Endogenous Inhibitor Of P38 Mapk, Is Regulated Along With Trp53 And Cdkn2a Following P38 Mapk Inhibition During Mouse Preimplantation Development., Jenny A Hickson, Barry Fong, Patricia H Watson, Andrew J Watson

Obstetrics & Gynaecology Publications

Preimplantation embryos utilize mitogen-activated protein kinase signaling (MAPK) pathways to relay signals from the external environment to prepare appropriate responses and adaptations to a changing milieu. It is therefore important to investigate how MAPK pathways are regulated during preimplantation development. This study was conducted to investigate whether PP2Cdelta (Ppm1d, WIP1) is expressed during mouse preimplantation development and to determine the influences of p38 MAPK inhibition on expression of Trp53 (p53), Ppm1d, (WIP1), and Cdkn2a (p16) during mouse preimplantation development. Our results indicate that Trp53, Ppm1d, and Cdkn2a mRNAs and TRP53 and PP2Cdelta proteins are expressed throughout mouse preimplantation development. Treatment …