Vaginal agenesis is a rare event occurring at a frequency of 1 case per 4000-10 000 female lives born. The most common etiology of vaginal agenesis is congenital absence of the uterus and vagina called mullerian agenesis (Mayer-Rokitansky-Hauser Syndrome). Although most patients with mullerian agenesis have small rudimentary 2 ‘mullerian bulbs’ without any endometrial activity, 7-8% of these cases possibly have a functioning uterus 3. In vaginal agenesis, genetic females are thought to have persistence of mullerian inhibiting factor MIF, resulting in failure of the vagina and uterus to develop 4. The ovaries, given their separate embryonic source, are normal in structure and function. This condition usually goes undetected until these patients reach puberty, when they start to experience cyclic pelvic pain due to the accumulation of menstrual blood.
Objectives: To evaluate the cost-effectiveness of the new oxytocin regimes in the augmentation of labour and the effect on the maternal and fetal outcome. Design: Randomized controlled trial. Setting: Labour ward of Hospital Tengku Ampuan Afzan, Kuantan. Participants: 230 pregnant women in labour at term with obstetric indications for labour augmentation. Methods: The women were randomly assigned to receive new oxytocin regime of 5 units in 500 cc of D/Saline at titration of 5 dpm with increments of 5 dpm to a maximum of 60 dpm. Or, old oxytocin regime of 1/2/4 units with titration of 20/40/60 dpm for primips and half the dosage for multips.
Main outcome measures: Cost analysis, duration of labour, duration of augmentation, complication of labour, post partum hemorrhage (PPH), mode of delivery and perinatal outcome.
Results: There was no significant difference in the mean duration of labour (6.8 h vs 6.7 h ; p = 0.45) and mean augmentation time (3.86 h vs 4.0 h; p = 0.9) between the regimes studied There seemed to be higher incidence of caesarean section in the old oxytocin group (6.5% vs 24.7%; p = 0.001). There was no significant influence on the neonatal morbidity and mortality (p = 0.07). A moderate reduction of annual cost for augmentation of labour was noted (RM 962.34).
Conclusion: The results showed that the new oxytocin regime was more cost-effective without apparent increased in the maternal and fetal mortality and morbidity.
Thanatophoric dysplasia (TD) was reported earlier in the previous publication. It is one of the most common lethal human skletal dysplasia characterized by severe dwarfism. It occurs in 3 to 4 per 100,000 live births1 and is due to autosomal dominant sporadic de novo mutations in the fibroblast growth factor receptor 3 (FGFR3) gene3 which codes for the FGFR3 transmembrane receptor expressed largely by skeletal and brain tissues in the developing fetus where it is involved with growth regulation. The FGFR3 mutation in TD leads to generalized defects and lack of endochondral ossification, with membranous ossification being less impaired1. Male and female fetuses are equally affected. Two thanatophoric case of this extremely rare occurance are reported and discussed.
Pelvic inflammatory disease (PID) is a common cause of morbidity and accounts for 1 in 60 GP consultations by women under the age of 45 in the UK. Pelvic inflammatory disease encompases a broad category of disease including endometritis, salphingitis, salphingo-oopheritis, tuboovarian abscess and pelvic peritonitis. It most commonly occurs as a result of Chlamydia trachomatis or Nesseria gonorrhea 1,2 infection of the endocervix that eventually spread into the upper genital tract. Direct spread from a nearby infection such as appendicitis and diverticulitis is not that common. Hematogenous spread is rare except in cases of tuberculous pelvic inflammatory disease. This case illustrates atypical presentation of pelvic inflammatory disease in a previously healthy single unmarried lady. The presence of ascites, bilateral ovarian mass and constitutional symptoms closely mimics that of malignant ovarian tumour. This was preceded by empyema which grew E coli.
Objectives: The Bahasa Malaysia (BM) version of Depression Anxiety Stress Scales 21-item (DASS-21) has been widely used ever since the establishment of its validity. To consolidate the evidence of the BM DASS-21 validity by examining its concurrent validity.
Methods: The BM DASS was administered together with the Hospital Anxiety and Depressive Scale (HADS) to a total of 246 patients at International Islamic University Malaysia (IIUM) Infertility Centre.
Results: The anxiety domain of BM DASS-21 had good correlation with anxiety domain in HADS (0.61) but for DASS depressive domain, it had modest correlation with its respective domain in HADS (0.49).
Conclusions: The results of this study further ensconced the evidence that the BM DASS-21 had relatively satisfactory psychometric properties for clinical subjects in Malaysia.
Introduction: FertiQoL questionnaire was developed and validated in 2011. It has been widely used and translated
into many languages to measure QoL among infertile individuals. The use of translated psychometric tools is often
subjected to cross-cultural variations. The objective of this study is to assess the psychometric properties of the
Malaysian FertiQoL. Methods: A study was conducted among attendees of a public infertility clinic. Demographic
details were collected and respondents answered the Malaysian FertiQoL. The questionnaire consists of 34 items.
Factor analysis and internal consistency were analysed using SPSS v24. Results: Data from 175 respondents were
analysed. Mean age is 32.1 ±3.8 SD with 56.6% female and 43.4% male. KMO index were 0.826 and significant
Bartlett’s test for sphericity. For Treatment domain, factor loadings for items T2 and T5 were < 0.32 but for all other
items were acceptable between 0.32 – 0.80 with no cross loadings and Cronbach alpha for environment (0.717)
and tolerability (0.660). For Core items, Q4, Q6 and Q14 loaded onto different domains and Q19 had poor factor
loading. All other items were acceptable. Cronbach alpha for specific domains were emotional (0.788) mind-body
(0.829), relational (0.639) and social (0.666). Cronbach alpha for emotional, relational, social improved to 0.857,
0.643 and 0.732 if Q4, Q6 and Q14 were omitted respectively. Conclusion: The study identified six items that affected the psychometric validity of the questionnaire and maybe explained by language or cross-cultural reasons.
However, the Malaysian FertiQoL can still be useful to measure QoL in those with infertility.
For centuries, people have been practising phytomedicine in treating ailments or reducing risk of suffering certain diseases. It is considered as a part of an ancient medicine with interest in it becomes rapidly escalating in this modern era. Expansive and prescribed medicine is not the only true path to treat various illnesses. Without disclaiming the modern medicine, herbs can be used as an alternative or a combined therapy with conventional medication. Phytomedicine or ethnomedicine is not a new
field in the world of research. It has been started long ago since the ancient times. As we realized the expensive modern medication is not the only mean to treat illness, interest in the discovery of remedy through natural or conventional products has become more escalating. (Copied from article)
Expression of beta-human chorionic gonadotropin (bHCG) mRNA in early cleavage cell stages is important in predicting embryo viability at blastocyst stage of development. Embryo viability is crucial for in vitro fertilization (IVF) treatment to be successful in terms of increment of implantation and pregnancy rate. In order to establish fertilization outside the human body, optimum condition mimicking the natural body environment like hormones and growth factors as well as impeccable timing must be established. ImamMuslim narrated from Hudhayfa ibn Asad that the Prophet Muhammad (SAW) said: “After the sperm-and-ovum drop (nut.fa) has been [in the uterus] forty-two days, Allah sends it an angel that gives it form and fashions its hearing, sight, skin, flesh, and skeleton”. Therefore the aim of this study is to find the significant association of bHCG expression with early cell stage cleavages and its relationship as predictive marker for potential embryo implantation. Our study focuses on leftover frozen embryos from eight patients consists of six pregnant patients and two non-pregnant patients. We assessed the human bHCG mRNA expression at different cell cleavage stages in these frozen embryos using reverse transcriptase-polymerase chain reaction (RT-PCR). Our results have shown three out of eight patients with five to ten cells of blastomeres were expressed with bHCG. This study indicated that bHCG was expressed on froze-thawed late cleavage stage of embryos in IVF patients.
The expression product of VASA gene is widely conserved germ line marker and participates to regulate the development of reproductive system and spermatogenesis in healthy man. Azoospermic is a condition which the man is unable to produce any sperm cells for reproduction activity. This condition produced has bad impact to the man since the ability to produce their own progeny will be interrupted or blocked forever. Not only the family bloodline of the man would be ended, the psychological issue like shamefulness and low self-esteem occurs. In Islam, seeking knowledge is an obligatory to Muslims in order to solve problems and improve lives. Thus to unveil the problem of azoospermic man we aimed to determine the level of VASA gene expression in samples of testes cells of non-obstructive azoospermic (NOA) and compare it with sperms of healthy man. Samples were taken from three NOA patients by testicular sperm extraction (TESE) to obtain testicular biopsies. Testicular cells were isolated and cultured in supplemented knockout DMEM media. VASAgene expression was determined by reverse transcriptase polymerase chain reaction (RT-PCR). The VASA gene expression from sperm of healthy man was also determined for comparison purpose. It was demonstrated that the addition of growth factor significantly increased SSC-like cells colony formation in tissues obtained from NOA patients. No VASA expression was detected in spermatogonial-like stem cells culture on day 1, 7, 14 and 21 in each of the azoospermic samples. Our findings shown VASA gene was not expressed in spermatogenesis in vitroculture that might be associated with the abnormal differentiation of primordial germ cells that lead to male infertility. Islam also teaches us to not have feelings of despair and for problems that we are facing but to find the solution and consider the problem as a test from the Almighty. All the tests should be handled with strong believe since only Allah (SWT) knows what the best for us and each of the tests will have justified wisdom and benefits which we as human being are unable to realise thoroughly.
Azoospermia is present in 15% of infertile cases and it is a major concern due to inability to produce sperm. Most of IVF (in-vitro fertilization) clinics abroad has been using sperm donation via sperm bank facilities as a solution for infertile couple to have their own offspring. In Islam, it is forbidden to use sample from male other than their spouse. It is according to maqasid syari’ah to ensure the heredity of the human being. Based on the latest technology, one approach of stem cell differentiation process had been established to produce mature cells from primitive or immature cells (stem cells). This technology is in line with the concept of maqasid syari’ah since we are using the cells from one person. We try to adopt this technology to study the potential of testicular cells from non-obstructive azoospermic (NOA) patient to undergo in vitrospermatogenesis.Samples were cultured in modified human embryonic stem cells (HESC) media with specific growth factors; basic fibroblast growth factor (bFGF) and leukemia inhibitory factor (LIF). Protein expressions were analyzed by immunofluorescent staining on day 49 and 90 of culture. Results show spermatogonial stem cell-like cells (SSC-like cells) colonies formed after 14 to 21 days, the cells were expanding successfully and were stable for 49 days duration. Then SSCs differentiated into later stage of spermatogenesis on day 90. Four specifics SSCs protein markers were identified on day 49; ITGA1, ITGB1, CD9 and GFRA1 whereas SCP3 and TP1 proteins were expressed on day 90. This in vitrospermatogenesis suggests a possible approach for future for Muslim NOA patients in order to have their own children.