Obstetrics & Gynecology at IgMin Research | Medicine Group

This editorial aims to highlight the critical intersections of patient care and technology, as illustrated in our recent article collection and addresses urgent challenges posed by global health crises like the COVID-19 pandemic while exploring broader themes such as personalized medicine, ethical practices, and the nutritional impacts on health. This diverse range of research highlights the necessity of interdisciplinary approaches to address the complexities of modern healthcare.

Clitoromegaly, defined as an enlarged clitoris with a clitoral index of more than 35 mm2 is a frequently seen congenital malformation but an idiopathic entity is a rare one. The most acceptable method of treatment of clitoromegaly is clitoroplasty with preservation of neurovascular pedicle to glans to achieve normal genital anatomy and to preserve tactile sensation. We present a rare case of idiopathic clitoromegaly managed by dorsal nerve sparing reduction clitoroplasty in an HBsAg-positive patient. 

Study objective: Adolescent females are disproportionately affected by Sexually Transmitted Infections (STIs). Endocervical Gram stain smears taken during gynecological examination are inexpensive, relatively easy procedures to perform and interpret. The purpose of this study was to evaluate the performance characteristics of Gram smears in the diagnosis of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and Trichomonas vaginalis (TV) in a female adolescent population presenting to the Emergency Department (ED) with genitourinary complai...nts.Methods: This study was a retrospective, cohort analysis of consecutive females (ages 13 – 19) seen at three academic medical centers over a two-year study period. All patients underwent a pelvic exam with diagnostic testing for STIs. Positive criteria for a Gram stain included greater than ten white blood cells per high-power field, gram-negative intracellular/extracellular diplococci (suggesting GC), or direct visualization of TV organisms. Polymerase Chain Reaction (PCR) assays were used as the gold standard definition for CT/GC infection. Direct microscopic visualization of organisms on a separate wet mount prep was considered the gold standard for TV infection. Demographic information, clinical findings of cervicitis, and the results of diagnostic testing were obtained from ED records using standardized abstraction forms. Results: During the study period, 1303 adolescent females were evaluated for genitourinary complaints. A total of 181 adolescents (12.9%) had at least one documented STI. Overall, 298 patients (22.9%) had positive gram stains. The sensitivity, specificity, and positive likelihood ratio for Gram stain in the diagnosis of STI were 28.7% (95% CI, 22.2 to 35.9), 78.1% (95% CI, 75.5 to 80.5), and 1.31 (95% CI 1.0 to 1.7), respectively. The sensitivity of Gram stain to Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis were 35.9% (95% CI 26.8 to 45.8), 34.5% (95% CI 18.0 to 54.3), and 5.7% (95% CI 1.3 to 15.7), respectively. The consistency of the data recording was excellent, with a median kappa statistic of 0.89.Conclusions: The positive likelihood ratio of inflammation on endocervical Gram stain is too low to recommend its use to direct empiric treatment of adolescents at risk for sexually transmitted infections. Diagnostic uncertainty or treatment failures should prompt specific laboratory testing. Read more

Purpose: Photo-documentation is a critical component of care and an indispensable skill for forensic clinicians treating patients who have experienced violence and trauma. This retrospective study examines the frequency and nature of anogenital injuries identified through colposcope digital imaging in comparison to those detected using a high-resolution camera system.Methods: This retrospective, before-and-after study evaluated genital injuries in all adult women (over 16 years old) who presented to a freestanding Nurse Examiner Clinic (NEC) fo...llowing sexual assault during a 3-year period. The clinic is supervised by forensic clinicians trained in conducting medical-forensic examinations. In 2016-2017, all injuries were documented using the Cooper Surgical Leisegang© colposcope system, while in 2018, injuries were recorded exclusively with a high-resolution camera system. The primary outcome was the frequency of genital findings documented in sexual assault victims from each group.Results: A total of 367 women were evaluated in the "before" period and 180 in the "after" period. Both groups were similar in terms of demographics, assault history, time to examination, alcohol use, and the occurrence of genital injuries (76.1% vs. 74.9%, p = 0.76). However, patients examined with the high-resolution camera system had a significantly higher number of documented anogenital injuries (2.4 vs. 1.8, p < 0.001). This group also had more anogenital abrasions identified (51.1% vs. 27.0%, p < 0.001). The injury patterns between the two groups were not statistically different.Conclusion: Accurate and reliable photo documentation are the key components of forensic medical documentation. Our findings indicate that the detection of anogenital injuries may differ based on the imaging system used.Read more

Most studies find lower live-delivered pregnancy rates (LDPRs) following in vitro fertilization-embryo transfer (IVF-ET) in women with diminished oocyte reserve (DOR) vs. normal oocyte reserve (NOR) even in a younger population. How much of a discrepancy may depend on the degree of oocyte depletion in the DOR group and the follicular stimulation protocol. Some fertility specialists favor an FSH receptor up-regulation technique as the protocol to attain the maximum LDPRs in women with DOR. The objective of this study was to compare chemical, cli...nical, and LDPRs following IVF-ET to determine if the main time of embryo loss is very early, as evidenced by the largest discrepancy occurring in attaining even a chemical pregnancy, and/ or a large discrepancy between a chemical pregnancy and attaining a clinical pregnancy (ultrasound evidence of a gestational sac) or later losses as evidenced by showing a greater loss rate from clinical evidence of pregnancy to live delivery in those with DOR compared to NOR. Overall, the DOR group, with a mean serum anti-Mullerian hormone (AMH) level of 0.42 ng/mL, had 50% as much chance to have an LDPR/transfer as women with NOR (AMH of 4.66) despite the same number of day 3 embryos transferred. The main reduction in LDPRs occurred from embryo transfer failing to attain a positive clinical pregnancy in the DOR group. The least discrepancy was from attaining a clinical pregnancy to live delivery. Thus, for NOR from positive pregnancy test 59% of this younger age group will have a live delivery vs. 50% for DOR. Thus, the reduction in LDPRS/transfer in young women with DOR vs. NOR seems mostly very early so the DOR group does not even attain a positive serum beta human chorionic gonadotropin level. This suggests that this inferiority in attaining a live delivery may be related to aneuploidy involving large chromosomes or a marked decrease in the mitochondrial DNA of the embryo.Read more

Breast cancer is the most common type of cancer in women worldwide. It can be spread when cancer cells get into the blood or lymph system and then are carried to other parts of the body. As it is one of the leading causes of death among women, this study aims to identify the most relevant risk factors for breast cancer through several prevention methods for early detection. The social impact of breast cancer is so strong that the World Health Organization (WHO) has established 19 October as International Breast Cancer Day. The pink ribbon is th...e symbol of this important day worldwide. The objective is precisely to raise awareness among the population about the disease and promote access to timely and effective diagnoses, checks, and treatments.Good prevention should be carried out through behavior or lifestyle modifications (e.g., diet, physical activity, alcohol limitation, etc.). Although, certain risk factors cannot be modified (e.g., aging, family history). Screenings are a fundamental tool to deal with breast cancer, even if sometimes they are not enough as in the case of interval cancers or in cases of particularly ambiguous presentation. Worldwide organizations recommend screening by means of ultrasound, mammography, and magnetic resonance, with appropriate follow-up for an abnormal screening test. To avoid overdiagnosis and overtreatment that can lead to long-term complications and false negatives, these screening differs by recommended ages and frequency. Identification of women at risk for BRCA1 and BRCA2 mutations is also recommended with a referral for genetic testing and, in the presence of dubious lesions, a biopsy is needed. In order to fight this disease, is important to act on time, so, information is fundamental. First of all, the female population should be conscious of risk factors and of the importance of breast examinations from a young age, lastly, they should be aware of the possibility of joining programs of free screening.Read more

Smooth muscle tumours are the most common mesenchymal tumors of the vulva and vagina, yet their infrequency is demonstrated by the prevalence of published reports as individual cases or small case series.This article reports a case of a 42-year-old woman who presented with apparently recurrent vulvovaginal leiomyoma and a past history of surgical excisions. Histopathology revealed Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP).