The need for simplified in-vitro fertilization (IVF) treatment approaches with the aim of reducing treatment burden and to prevent drop-outs after a failed IVF cycle can be met by the use of corifollitropin alfa for COS in association with a GnRH antagonist protocol. This is a report of the first local case of a successful pregnancy using corifollitropin alfa in IVF. This is a case of a 33 year-old G3 PO (0030) whose partner has teratozoospermia. COS using corifollitropin alfa yielded eight mature oocytes with no occurrence of OHSS. Six oocytes were fertilized using ICSI with six good quality embryos reaching cleavage stage. Two grade 1 embryos at day 3 cleavage stage were transferred. A clinical pregnancy was documented at 7 weeks age of gestation. Congenital anomaly scanning at 24 weeks age of gestation revealed a grossly normal fetus. Patient delivered a healthy, live, term baby boy. Review of literature suggests that corifollitropin alfa is as effective as rFSH in delivering live birth rate, ongoing pregnancy rate and clinical pregnancy rate. The sustained and higher FSH immunoreactivity concentrations and the inability for dose adjustment after treatment with a single dose of corifollitropin compared with the daily rFSH regimen underscores the need for careful patient selection in the use of corifollitropin alfa.

Human ; Male ; Adult ; Pregnancy Rate ; Follicle Stimulating Hormone, Human, With Hcg C-terminal Peptide ; Sperm Injections, Intracytoplasmic ; Teratozoospermia ; Fertilization In Vitro ; Oocytes ; Gonadotropin-releasing Hormone

The term "disorders of sexual development" (DSD) is defined by congenital conditions in which there is atypical development of the chromosomal, gonadal and anatomical sex. As an expert in this field of subspecialty, should the physician always disclose the truth to the patient regarding their medical condition? This is a case of androgen insensetivity syndrome diagnosed in adulthood. The aim of this paper was to discuss issues of disclosure or truth-telling as an integral part of management of AIS. The multidisciplinary team approach appears to provide the patient the best options in dealing with the syndrome and living as normal a life as possible despite it.
Human ; Female ; Adult ; DISORDERS OF SEX DEVELOPMENT ; ANDROGEN-INSENSITIVITY SYNDROME ; DISCLOSURE

Background: In Malaysia, training to enter dentalnursing profession is only open to women. Ironically,there are no such gender restrictions on training forany other health related professions in Malaysia.Aim: Therefore this study aims to assess theperceptions of Malaysian Senior Dental Officers(SDOs) towards the employability of male workers inthe dental nursing profession and to compare findingsfrom male and female SDOs. Methods: This crosssectional study was carried out on all SDOs inMinistry of Health, Malaysia, using a self-administeredquestionnaire. Descriptive statistics and a chi squaretest were used to address the study objectives. Results:Of the 112 participants, 78 SDOs returned thequestionnaire, yielding a response rate of 70%. Themajority of SDOs had positive perceptions of theemployment of male dental nurses. It was indicated thatgender is an important indicator for workforcedevelopment, and that the employment of both maleand female dental nurses would enhance productivity.Almost 70% of SDOs perceived that the productivityof oral health service would be enhanced by havingmale and female dental nurses but 84.6% disagreedthat male dental nurses would be more productive thanfemale. Two thirds of SDOs disagreed that male dentalnurses would increase satisfaction among malepatients. About 64% of male SDOs disagreed thatdental nursing profession is associated with femaletraits. There was no significant difference betweenperceptions by male and female SDOs for anystatements. Conclusion: The majority of MalaysianSDOs have positive perceptions towards theemployability of male dental nurses, and perceiveddental nursing as a suitable profession for bothgenders. Training for the dental nursing professionshould therefore be made available for men.

A palato-radicular groove (PRG) is a developmental anomaly primarily found in the maxillary lateral incisors. It is a potential communication path between the root canal and the periodontium that decreases the survival prognosis of the affected tooth, therefore compromising the stability of the dental structure in the oral cavity. The aim of this case report is to present an original technique where a PRG was treated by means of intracanal disinfection, PRG sealing with glass ionomer, replantation with intentional horizontal 180 degree rotation of the tooth, and an aesthetic veneer placed to provide adequate tooth morphology. The clinical and biological benefits of this novel technique are presented and discussed.
Dental Pulp Cavity ; Disinfection ; Glass ; Incisor ; Mouth ; Periodontium ; Prognosis ; Replantation* ; Tooth*

A palato-radicular groove (PRG) is a developmental anomaly primarily found in the maxillary lateral incisors. It is a potential communication path between the root canal and the periodontium that decreases the survival prognosis of the affected tooth, therefore compromising the stability of the dental structure in the oral cavity. The aim of this case report is to present an original technique where a PRG was treated by means of intracanal disinfection, PRG sealing with glass ionomer, replantation with intentional horizontal 180 degree rotation of the tooth, and an aesthetic veneer placed to provide adequate tooth morphology. The clinical and biological benefits of this novel technique are presented and discussed.
Dental Pulp Cavity ; Disinfection ; Glass ; Incisor ; Mouth ; Periodontium ; Prognosis ; Replantation* ; Tooth*

Sarcopenia, defined as decrease in muscle function and mass, is common in patients with moderate to advanced chronic kidney disease (CKD) and is associated with poor clinical outcomes. Muscle mitochondrial dysfunction is proposed as one of the mechanisms underlying sarcopenia. Patients with moderate to advanced CKD have decreased muscle mitochondrial content and oxidative capacity along with suppressed activity of various mitochondrial enzymes such as mitochondrial electron transport chain complexes and pyruvate dehydrogenase, leading to impaired energy production. Other mitochondrial abnormalities found in this population include defective beta-oxidation of fatty acids and mitochondrial DNA mutations. These changes are noticeable from the early stages of CKD and correlate with severity of the disease. Damage induced by uremic toxins, oxidative stress, and systemic inflammation has been implicated in the development of mitochondrial dysfunction in CKD patients. Given that mitochondrial function is an important determinant of physical activity and performance, its modulation is a potential therapeutic target for sarcopenia in patients with kidney disease. Coenzyme Q, nicotinamide, and cardiolipin-targeted peptides have been tested as therapeutic interventions in early studies. Aerobic exercise, a well-established strategy to improve muscle function and mass in healthy adults, is not as effective in patients with advanced kidney disease. This might be due to reduced expression or impaired activation of peroxisome proliferator-activated receptor-gamma coactivator 1α, the master regulator of mitochondrial biogenesis. Further studies are needed to broaden our understanding of the pathogenesis of mitochondrial dysfunction and to develop mitochondrial-targeted therapies for prevention and treatment of sarcopenia in patients with CKD.

Background: A considerably large portion of the cases of cancer, particularly squamous cell carcinoma (SCC) involving the head and the neck may be due to consumption of tobacco and alcohol. However, its increase in occurrence at specific sites of the head and neck may indicate the possibility of other etiological factors. One of which is infection by certain high-risk human papillomavirus (HPV). P16 immunochemistry serves as a very good surrogate marker of active HPV in these tumors. The detection of HPV-related head and neck cancers have relevance in clinical practice because of its prognostic implications. Objectives: The general objective of this study is to determine the prevalence of p16-positive squamous cell carcinoma in the oral cavity, oropharynx, and larynx in Rizal Medical Center from January 2019 to December 2019. The specific objective is to compare the Hematoxylin and Eosin (H&E) stain histomorphology (keratinization and mitotic activity) of p16-positive versus p16-negative specimens. Methodology: This is a cross-sectional study which included all routine histopathology specimens coming from the oral cavity, oropharynx and larynx in Rizal Medical Center for the year 2019 with a diagnosis of squamous cell carcinoma. The tissue specimens considered were those that measured at least 1 cm in diameter, or aggregate diameter if tissue is fragmented. The slides of all eligible cases were reviewed and immunohistochemically stained for p16. The p16 IHC slides were read as either positive or negative, while the mitotic activity and keratinization were observed in the H&E-stained slides. The interpretation of the diplomate pathologists for each of the slides were documented and corresponding statistical analyses were performed. Results: P16 IHC showed twenty-one (88%) p16 negative cases and three (12%) p16 positive cases. In terms of mitosis, ten cases have mitosis falling within the 1-10 per high power field (HPF) range (42%), six within 11-20 per HPF (25%), and 8 cases have ≥21 mitosis per HPF (33%). In terms of keratinization, three cases are non-keratinizing (12%) and twenty-one cases are keratinizing (88%). There is significant difference in the keratinization histology (p<0.05) of the p16-positive versus the P16-negative cases. On the other hand, no significant difference in the mitotic activity (p>0.05) was noted. Conclusion There is a low prevalence of HPV-related SCC of the oral cavity, oropharynx, and larynx in Rizal Medical Center. The histomorphologic findings confirm that keratinization, significantly predicts HPV status in oropharyngeal SCC. Mitotic activity may not be reliable in predicting the HPV status or p16 IHC reactivity of a case. Keratinization in oropharyngeal SCCs may provide valuable information in certain instances, particularly when HPV testing is not immediately available, although the combined tumor morphology and p16 IHC is more ideal.
Papillomavirus Infections ; Squamous Cell Carcinoma of Head and Neck ; Mouth ; Larynx

Diabetes constitutes a worldwide epidemic that affects all ethnic groups. Cell therapy is one of the best alternatives of treatment, by providing an effective way to regenerate insulin-producing cells lost during the course of the disease, but many issues remain to be solved. Several groups have been working in the development of a protocol capable of differentiating Mesenchymal Stem Cells (MSCs) into physiologically sound Insulin Producing Cells (IPCs). In order to obtain a simple, fast and direct method, we propose in this manuscript the induction of MSCs to express NESTIN in a short time period (2 h), proceeded by incubation in a low glucose induced medium (24 h) and lastly by incubation in a high glucose medium. Samples from cell cultures incubated in high glucose medium from 12 to 168 h were obtained to detect the expression of INSULIN-1, INSULIN -2, PDX-1 and GLUT-2 genes. Induced cells were exposed to a glucose challenge, in order to assess the production of insulin. This method allowed us to obtain cells expressing PDX-1, which resembles a progenitor insulin-producing cell.
Cell Culture Techniques ; Cell- and Tissue-Based Therapy ; Ethnic Groups ; Glucose ; Humans ; Insulin* ; Mesenchymal Stromal Cells* ; Methods ; Nestin*

Muüllerian duct anomalies (MDAs) are congenital defects arising from probable teratogenic assault at 6–22 weeks of gestation.Uterine didelphys arises from complete lack of fusion of Muüllerian ducts, resulting in two entirely separate hemiuteri, cervices and vaginas.The incidence of MDA is <5% and the frequency of uterine didelphys is 1 in 1000–30,000 women and twin pregnancy in uterus didelphys is only 1 in a million. This is a case of a gravida 1 para 0, with uterine didelphys and unilateral renal agenesis diagnosed of single live intrauterine pregnancy in the left half of uterine didelphys who had a spontaneous passage of meaty material from the right hemiuterus which were histopathologically consistent with degenerating products of conception, hence confirming a dicavitary twin pregnancy. Management should be wholistic encompassing preconception, prenatal, intrapartum, and postpartum period as any complications may arise at any point.
Uterine Anomalies ; Urogenital Abnormalities ; Abortion, Spontaneous

Atypical parathyroid adenoma (APA) is a rare cause of primary hyperparathyroidism (PHPT) and represents a diagnostic challenge since it is an intermediate form of parathyroid neoplasm of uncertain malignant potential with atypical histological features that require differential diagnosis of parathyroid carcinoma (PC). We present 2 cases of parathyroid crisis as a presentation of APA. The first case was that of a 56-year-old man with parathyroid crisis, constitutional syndrome, and anemia, with evidence of APA after en bloc resection, evolving with hungry bone syndrome after surgery and curation criteria at 6 months after parathyroidectomy (PTX). The second case was a 64-year-old woman with acute chronic kidney disease and parathyroid crisis, with evidence of APA after selective PTX and >50% reduction in parathyroid hormone levels after surgery; however, persistent PHPT at 6 months post-surgery was observed. These cases represented a diagnostic challenge due to their rare clinical presentation (parathyroid crisis), with a heterogeneous spectrum of target organ damage and infrequent symptoms (constitutional syndrome and acute chronic renal disease), in turn caused by a rare pathology (APA). The presentation of these patients may be indicative of PC; however, histopathological diagnosis is a key to the diagnosis of APA. The differential diagnosis of APA vs. PC in clinical practice is indispensable.