Chronic endometritis (CE) is a persistent inflammation of the endometrial lining characterized by the presence of plasma cells. CE has been correlated with repeated miscarriage (RM) and repeated implantation failure (RIF), with prevalence rates ranging from 42.9-56% in RM and 30.3-66% in RIF. CE is typically diagnosed through histological examination of an endometrial biopsy sample using hematoxylin and eosin staining or immunohistochemistry, though office hysteroscopy may also be used. Treatment with a 2 week course of antibiotics such as ofloxacin or doxycycline results in histological cure in 70-95% of cases and significantly improves live birth rates in
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Role of adjuvants in poor ovarian responders , undergoing infertility treatment , in terms of Intra uterine inseminations ( IUI ) to In Vitro Fertilization ( IVF )
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Role of adjuvants in poor ovarian responders , undergoing infertility treatment , in terms of Intra uterine inseminations ( IUI ) to In Vitro Fertilization ( IVF )
Comparative Study of the Prevalence and Antibiogram of Bacterial Isolates fro...iosrjce
The study compared the prevalence and antibiogram of bacterial isolates from the urinary and
genital tracts of pregnant women attending ante-natal clinics in Imo State. Urine and High vaginal swab (HVS)
samples were collected from across the three geopolitical zones of Imo State (Owerri, Orlu and Okigwe).
Federal Medical Centre (FMC) Owerri, Imo State University Teaching Hospital (IMSUTH) Orlu and General
Hospital Okigwe (GHO) were used as focal points. A total of 1197 samples were obtained from women and
used. Infection was significantly more with the urine samples than the HVS samples (P < 0.05) while
polymicrobial growth was more observed with the HVS samples. Escherichia coli was the predominantly
isolated organism (38.3%) from the urine samples while Staphylococcus aureus (29.1%) was the predominant
bacterial isolates in HVS. Other commonly isolated bacterial species include; Enterococcus faecalis and
Staphylococcus epidermidis, Klebsiella pneumoniae, Proteus mirabilis and Bacteriodes were solely isolated
from urine while Lactobacillus was solely isolated from HVS. Overall antibiogram showed ciprofloxacin to be
the most effective antibiotic followed by nalidixic acid and pefloxac in for both specimens. Generally, multidrug
resistance was more in urine isolates (55.7%) than vaginal isolates (53.6%) with many showing the same
resistance patterns. The rate of multi/drug resistance in both samples is high (>50%) and worrisome. These call
for routine HVS as well as urine culture to be carried out on all antenatal women to ensure holistic antenatal care/ management.
Background: Cervical screening through conventional cervical cytology is most commonly used throughout the world. The Cervical cancer is the second most common cancer worldwide and in developing countries, the leading cause of death. It is one of the most preventable and curable of all cancers.
Objective: To Study the role of Pap smear in detecting neoplastic and non-neoplastic lesions of cervix and to determine the occurrence of various lesions in remote area of Bagalkot.
Methods: This is prospective study of 240 women with age group 20 to 60 years was carried out from May 2015 to June 2016 cytology section of pathology department, S. Nijalingappa Medical College & H.S.K Hospital & Research Centre, Bagalkot, India. Pap smears were prepared, fixed, stained and carefully examined.
Results: In this study, Reactive cellular changes associated with inflammation was the most common with 182 cases (75.8%) followed by Low-grade squamous intraepithelial lesions (SIL) with 11 cases (4.5%), then atypical squamous epithelial cells of undetermined significance 8 cases (3.3%), High-grade squamous intraepithelial lesions with 5 cases (2.1%), Atrophy with 3 cases (1.3%) and Atypical Glandular Cell in 3 cases (1.3%). The average age of women for all the epithelial abnormalities was 40 years.
Conclusion: This study will increase awareness of the Pap test and cervical cancer, thereby paving a way for the prevention of cervical cancer.
Key-words- Pap smear, Cervical cancer, The Bethesda System, Squamous intraepithelial lesions (SIL)
Prevalence and Characterisation of Beta Lactamases in Multi Drug Resistant Gr...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The prevalence of extended spectrum beta-lactamases (ESBLs) among Escherichia...Open Access Research Paper
The prevalence of extended spectrum β-lactamases among 246 clinical isolates from Abia State University teaching Hospital patients was investigated. The isolates were made up of 134 Escherichia coli and 112 Klebsiella species. Antimicrobial susceptibility of the isolates was determined by the disc diffusion method. ESBL phenotypes were determined by the double disc synergy method using ceftazidime, cefotaxime, ceftriaxone and co-amoxiclav. Out of the 246 isolates, 125 (50.8%) were ESBL producers, made up of 62(50.8%) E. coli and 63 (50.4%) Klebsiella isolates. Seventeen (54.8%) of the ESBL producing E. coli isolates were from in-patients while 45 (47.9%) were from out-patients. For the ESBL positive Klebsiella spp., 14 (45.2%) and 49 (52.1%) were from in-patients and out-patients respectively. ESBL producing isolates were also found to be more prevalent among the female patients (72.8%) than among the male patients (27.2%). The isolates also expressed high rates of resistance to other classes of antibiotics tested. However, Amikacin was found to have excellent performance against the urinary isolates tested and therefore is recommended for the treatment of infections caused by Escherichia coli and Klebsiella species. This study shows high prevalence of ESBL producing E. coli and Klebsiella isolates clinical samples of patients attending the Abia State University Teaching Hospital Aba, Abia State Nigeria.
Chronic endometritis and its effect on FertilityKaberi Banerjee
Chronic endometritis, inflammation of the endometrial lining, may hinder fertility by disrupting the implantation process. Early diagnosis and treatment are crucial for optimizing reproductive outcomes and addressing infertility challenges.
Isolation, Characterization, and Antibiotics Resistance Profile of Staphyloco...AdeyemiKayode2
Isolation, Characterization, and Antibiotics Resistance Profile of Staphylococci from Indoor Air of the Students’ Halls of Residence at the Obafemi Awolowo University, Ile Ife, Nigeria.
Similar to Chronic Endometritis in Repeated miscarriage and Repeated implantation failure (20)
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
3. 1. DEFINITION
CE:
Chronic inflammation of the endometrial lining
(Romero et al, 2004).
Persistent inflammation of the endometrium that is
characterized by the presence of plasma cells
(Johnston-MacAnanny, 2010).
4/20/2017ABOUBAKR ELNASHAR
4. RM:
3 or more consecutive failed pregnancies
(RCOG, 2011)
2 or more
(ASRM, 2008)
Causes:
uterine abnormalities
Antiphospholipid antibody syndrome
endocrine disorders.
parental chromosomal imbalances/translocations
50% unexplained
(Stephenson,1996).
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5. RIF
Failure to conceive following
2 or 3 ET cycles, or
Cumulative transfer of 10 good quality embryos
(El-Toukhy and Taranissi, 2006).
Causes:
Embryonic
Maternal:
uterine anatomic abnormalities
thrombophilia,
non-receptive endometrium
immunological
(Salim et al., 2002).
Idiopathic
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6. Recently, there has been increasing interest in the role
of CE in RM and RIF
Limited publications
The impact of CE on reproductive capacity:
controversial
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7. 2. CLINICAL IMPLICATION
1. Infertility:
CE:
RM: 42.9% to 56%.
RIF: 30.3% to 66%
Infertile women: 2.8-9%
(Kasius et al, 2011, Viana et al, 2015) suggesting:
Correlation between CE and RM or RIF rather
than infertility
{create a suboptimal IU environment
hamper endometrial receptivity}
±cause infertility
{endometrium is characterized by an abnormal
pattern of lymphocyte: an aberrant endometrial
microenvironment }
(Matteo et al., 2009). 4/20/2017ABOUBAKR ELNASHAR
8. 2. In RM:
CE is a frequent finding (42.9% to 56%).
Antibiotic tt: significantly higher rate of
successful pregnancies compared with women
who were not treated or
with persistent disease
(Cicinelli et al., 2014).
4/20/2017ABOUBAKR ELNASHAR
9. 3. In RIF:
CE was identified in 30.3% to 66%
Women diagnosed with CE had lower IR
(11.5%) after IVF
(Quaas and Dokras, 2008).
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10. Mechanism
Altered endometrial receptivity by
1. Abnormal infiltration of plasma cells
2. Secretion of IgM, IgG, and IgA antibodies
(Kasius et al, 2011).
3. Alteration in:
Endometrial cytokine production
[Maybin et al, 2011],
Secretion of paracrine factors
[Matteo et al, 2009, Di Pietro et al, 2013].
Endometrial expression of genes
(Johnston-MacAnanny, 2010).
4. Delay differentiation of the EM in the mid-
secretory phase (out-of-phase morphology)
[Mishra et al, 2008].
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11. 3. PREVALENCE
Highly variable
RM: 42.9% to 56%.
RIF: 30.3% to 66%
(Johnston-MacAnanny et al, 2010; Cicinelli et al, 2015)
1. Small sizes of some studies
2. Difference in:
1. Ethnicities
2. Definitions of RM and RIF
3. Techniques used for diagnosis.
4. Histologic definition of CE
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12. 4. CAUSES
Infectious agents:
(Cicinelli et al, 2014).
Gonorrhea
Chlamydia
mycoplasma,
ureaplasma,
Escherichia coli,
Streptococcus spp.,
Staphylococcus spp.,
Enterococcus faecalis,
Yeast, and
Tuberculosis (Romero et al, 2004).
CE can result from retained tissue:
incomplete pregnancy loss or
retained placental tissue
(Haggerty et al, 2005).
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15. 1. Histologic diagnosis using H&E
Gold standard for the diagnosis
(Kasius et al.,2011)
Time-consuming and difficult.
Low diagnostic rate (<10%)
[Kasius et al, 2011, McQueen et al, 2014]
±miss the diagnosis.
{normal presence of leukocytes in the
endometrium especially before
menstruation}
[Kasius et al, 2012].
± over diagnosis
{Plasma cells can appear morphologically
similar to other stromal cells and leukocytes}
(Greenwood, Moran, 1981).
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16. For diagnosis:
one plasma cell in the endometrial stroma
(Johnston-MacAnanny et al 2011, Kasius et al, 2011; McQueen et al, 2014).
At least 5 plasma cells
(Bayer-Garner et al, 2004).
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17. Chronic endometritis on endometrial biopsy.
Plasma cells identified by morphology using H&E
staining.
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18. 2. Immunohistochemistry (IHC)
with CD138 (syndecan-1)
Chronic endometritis on endometrial biopsy.
Plasma cells identified in brown by immunohistochemical CD138 staining.
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19. Higher sensitivity
56%, as compared to a 13%for H&E staining
[McQueen et al, 2015].
(Miguel et al, 2011)
More accurate:
(Bayer-Garner et al, 2001).
Reducing false-negative diagnosis
(McQueen et al.2014)
Not yet recommended in daily clinical practice
Not widely used for the diagnosis of CE
IHCH&E
100%75%Sensitivity
100%65%Specificity
4/20/2017ABOUBAKR ELNASHAR
20. 3. Office Hysteroscopy
In the follicular phase (between D6 and 12) of the
menstrual cycle.
Diagnosis:
1. Mucosal edema,
2. Focal or diffuse endometrial hyperemia,
3. Micropolyps (<1 mm)
(Cicinelli et al, 2005).
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21. Micropolyps
identified in 50%-54% of patients with a
histologically confirmed CE
(Cicinelli et al, 2005; Bouet et al, 2016)
{inflammatory microenvironment}.
Biopsy:
1. Higher density of B cells and plasma cells
2. Lower density of natural killer cells
(Kitaya et al, 2012).
This explains decreased endometrial receptivity in
CE: RM and RIF
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22. Chronic endometritis: ‘‘strawberry aspect.’’
Large area of hyperemic endometrium flushed with
white central points 4/20/2017ABOUBAKR ELNASHAR
23. Sensitivity:
40%
(Bouet et al, 2016).
much greater sens
Specificity
80%
(Bakas et al, 2014; Bouet et al, 2016)
dependent on the clinician's experience
Accuracy
93.4%
[Cicinelli et al, 2008,2010].
Normal hysteroscopy
relatively accurate predictor of successful pregnancy
after ART
[Cicinelli et al , 2015].
4/20/2017ABOUBAKR ELNASHAR
24. 4. Culture:
Positive in 75% of histologically confirmed CE
Common bacteria:
Escherichia coli, Enterococcus faecalis
Streptococcus agalactiae: 77.5%
Mycoplasmae/Ureaplasma: 25%
Chlamydia: 13%
(Cicinelli et al, 2014).
Often a causal organism cannot be identified.
CE have no correlation with
Bacterial colonization of the EM or
Clinical presentation of PID
[Korrn et al, 1995; Andrews et al, 2005].
4/20/2017ABOUBAKR ELNASHAR
25. The recent view that
Uterine cavity is normally not sterile
Presence of micro-organisms does not mean
inflammation
(Cowling et al., 1992; Eckert et al.,2003).
It is not just the presence of infectious agent within
the internal genital tract
The most critical issue that determines the pathology
interactions between:
infectious agents and
endometrial environment
(Eckert et al.,2003)
4/20/2017ABOUBAKR ELNASHAR
26. 7. TREATMENT
Regimen:
Ofloxacin: 400 mg daily for 2w OR
Doxycycline: 100 mg twice daily for 2 w
Histological cure:
70-95%
Persistent CE:
Ciprofloxacin: 500mg and
Metronidazole: 500 mg twice daily for 2 w
4/20/2017ABOUBAKR ELNASHAR
27. LBR in RM with CE
After ttBefore tt
56%7%McQueen et al. 2014
LBR in RIF with CE
After ttBefore tt
60.8%13.3%Cicinelli et al, 2015
Results of treatment
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28. CONCLUSIONS
1. Definition:
Persistent inflammation of the endometrium
characterized by the presence of plasma cells
2. Clinical implication
Correlation between CE and RM or RIF
3. Prevalence
Highly variable
RM: 42.9% to 56%.
RIF: 30.3% to 66%
4. Clinical picture
Usually asymptomatic
4/20/2017ABOUBAKR ELNASHAR
30. You can get this lecture from:
1.My scientific page on Face book:
Aboubakr Elnashar Lectures.
https://www.facebook.com/groups/2277
44884091351/
2.Slide share web site
3. elnashar53@hotmail.com
4.My clinic: Althwara st, Mansura, Egypt
4/20/2017ABOUBAKR ELNASHAR