OFFARM 123 E reservorio principal de Toxoplasma gondii es el gato doméstico (Felis catus), que por medio de los ooquistes que elimina con las heces, disemina la infección en el medio ambiente pudiendo transmitirla a multitud de animales, al hombre o incluso a pájaros y peces. La infección causada por este parásito pasa, en el hombre sano, casi inadvertida, pero no sucede lo mismo en individuos inmunodeprimidos en los que puede llegar a provocar la muerte. También el contraer la toxoplasmosis durante el embarazo entraña para la mujer, y principalmente para su feto, daños que pueden ser fatales pudiendo ocasionar abortos espontáneos o daños irreversibles en el sistema nervioso central del neonato. A pesar de los riesgos tan elevados que supone el contraer la toxoplasmosis para estos grupos y de que un individuo se pueda infectar después de una trasfusión sanguínea, ésta no es una enfermedad de declaración obligatoria.

돼지의 Toxoplasmosis의 진료

Toxoplasma gondii is an obligate intracellular parasite belonging to the phylum Apicomplexa. It has a worldwide distribution and can infect a wide variety of intermediate hosts, including humans. In South America, toxoplasmosis shows high health impacts, and the incidence of the disease is frequently reported and more severe than in other regions, such as Europe. Although most T. gondii infections are asymptomatic, severe manifestations can occur in cases of congenital toxoplasmosis and immunocompromised individuals. In South America, the ocular disease in immunocompetent individuals is also frequently reported. Treatment for any clinical manifestation of toxoplasmosis consists of the combination of sulfadiazine (SDZ) and pyrimethamine (PYR). However, failures in the treatment of toxoplasmosis have been reported, especially in South America, suggesting the acquisition of resistance against SDZ and PYR. Another paradigm present in the literature is that once infected with T. gondii, the host is immunologically protected from further reinfections. However, some studies indicate cases of congenital transmission of T. gondii from immunocompetent pregnant women with chronic infection, suggesting the possibility of reinfection in humans. Thus, in this review, we will cover several aspects of South American T. gondii isolates, such as genetic characterization, disease manifestation, host reinfection and drug resistance.

Toxoplasma gondii in South America: a differentiated pattern of spread, population structure and clinical manifestations

Background and Objectives: Uterine myomas represent one of the most prevalent pathologies affecting the female population. These benign neoplasms originate from the smooth muscular cells of the uterus, and they can be either single or multiple. Often associated with debilitating symptoms such as pelvic heaviness, pain, constipation, and urinary dysfunctions, the surgical management of myomectomy exhibits considerable variability. This diversity in approaches is influenced by factors such as the number and size of myomas, the patient’s age, and overall clinical conditions. This study aims to elucidate and compare the advantages and disadvantages of different surgical approaches, specifically endoscopic procedures versus open surgery, providing valuable insights for clinical decision making. Materials and Methods: A comprehensive bibliographic search spanning from 2013 to 2023 was systematically conducted across databases including Medline, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. The search utilized keywords such as “myomectomy laparoscopic and open”, “myomectomy open and minimally invasive”, “myomectomy open and laparoscopic”, and “myomectomy open vs. laparoscopic.” The research methodology, along with predetermined inclusion and exclusion criteria, was established prior to the search, ensuring a systematic and rigorous approach. Subsequently, data analysis was carried out. Results: Following the study selection process, 25 articles met the eligibility criteria for inclusion in this analysis. The average numbers of myomas were 3.7 (ranging from 1 to 13.7) and 5.4 (ranging from 1 to 13.5) for the minimally invasive surgery and open surgery groups, respectively. In terms of myoma size, the total averages across studies were 7 cm (ranging from 4.8 to 14) for the minimally invasive group and 8 cm (ranging from 3.9 to 11.2) for the open surgery group. The average pregnancy and delivery rates were 29.7% (ranging from 1.8 to 100) for the minimally invasive group and 28.5% (ranging from 1.8 to 100) for the open surgery group. Regarding complications, the average rate was 14.2% (ranging from 0 to 50) for the endoscopic group and 22.3% (ranging from 0 to 60.3) for the laparotomic group. Conclusions: In conclusion, a critical factor influencing the choice of surgical approach is primarily the size and quantity of fibroids. The mini-laparotomic approach emerges as a viable alternative to endoscopy, demonstrating favorable surgical outcomes and aesthetic results. Interestingly, the type of surgical procedure appears to have no significant impact on the pregnancy rate.

Exploring Surgical Strategies for Uterine Fibroid Treatment: A Comprehensive Review of Literature on Open and Minimally Invasive Approaches

Background. The Herlyn-Werner-Wunderlich syndrome (HWWS) is an uncommon congenital anomaly, characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. We report a unique case of association of HWWS and central placenta previa (CPP) in a COVID-19-positive pregnant woman. Case presentation. A 39-year-old pregnant woman was admitted to our hospital for preterm labour risk at 32 gestational weeks. She referred a previous caesarean section (CS) and three miscarriages. Speculum examination allowed visualization of the left cervix, whereas the contralateral one was hidden under the obliterated vaginal septum. Ultrasound examination showed poste-ro-lateral CPP, double uterus, and right renal agenesis. Subsequent Magnetic Resonance Imaging confirmed the condition of uterus didelphys and right renal agenesis, associated with CPP. The patient was treated with tocolytics and progesterone and was discharged in good physical condition. At 35 gestational weeks, the patient became COVID-19-positive with few symptoms. Elective CS was performed at 36 gestational weeks, and she delivered a small-for-gestational-age newborn in good health conditions. The left womb was particularly bleeding on the lower uterine segment and ligation of the left uterine artery was necessary. The postoperative course was uneventful. Conclusions. We describe a unique association of HWWS and CPP in a COVID-19-positive pregnant woman solved by means of elective CS and uterine artery ligation. Pregnancy in women with HWWS is possible, although obstetric complications may arise. When HWWS is associated with CPP, the risk of haemorrhage is the rule. A correct management determined positive both maternal and foetal outcomes.

http://www.gynaecology-obstetrics-journal.com/wp-content/uploads/2022/07/INCOGNITO.pdf

Herlyn-Werner-Wunderlich syndrome and central placenta previa in a COVID-19 positive pregnant woman: a case report

Hysteroscopy is considered not only a diagnostic instrument but also a therapeutic tool for many uterine pathologies. In the early 1990s, advances in technology and techniques made hysteroscopy less painful and invasive, allowing to increase in the number of gynecological procedures performed in an ambulatory setting without significant patient discomfort and with potentially significant cost savings. This is the so-called “office hysteroscopy” or “see-and-treat hysteroscopy”, whose spread has permitted the decrease of the number of procedures performed in the operating room with the benefit of obviating the need for anesthesia and dilatation of the cervical canal.

/pdf/hysteroscopic-findings-and-operative-treatment-all-at-once-2v9bueqz.pdf

Hysteroscopic Findings and Operative Treatment: All at Once?

Failed diagnostic hysteroscopy: Analysis of 62 cases.

Congenital toxoplasmotic chorioretinitis following reinfection.

Although pregnant neurofibromatosis or HIV patient established a high-risk group, this report demonstrated that a careful planning and widespread valuations should be associated with a favorable prognosis for both mother and newborn.

Neurofibromatosis and HIV infection in a pregnant woman.

A 25-year-old woman presented to the obstetric clinic in her first pregnancy. The patient was accompanied by her mother who reported an episode of intracerebral hemorrhage after birth and also remembered access to the emergency department after generalized tonic-clonic seizure as an infant. She was not able to describe the therapy for seizure preventions and even when and why it was suspended, but she affirmed that no residual neurological consequences were detected in the following years. Actually, the pregnant woman was in good health without neurological symptoms nor assumed any therapy. A neurologist reviewed the patient's CT scan in which arachnoid cyst and porencephalic cyst were evident, and he assessed that no abnormalities were found in motor, sensory, and mental state examination. EEG did not show any epileptiform or seizure-like activity. No antiepileptic drug was prescribed due to the absence of symptoms since many years. The patient had no neurological symptoms during pregnancy or obstetric complications and delivered at term a healthy baby through a caesarean section. She breastfed, and after two years, the patient and the baby are healthy. The association of porencephalic and arachnoid cyst in pregnancy is an extremely rare neurological condition that needs a multidisciplinary counseling in pregnancy, but an uneventful course is possible.

/pdf/pregnancy-in-an-asymptomatic-woman-with-porencephalic-and-1yh2bhmsmi.pdf

Pregnancy in an Asymptomatic Woman with Porencephalic and Arachnoid Cysts.

Pregnant women affected by Alport syndrome often struggle with worsening of renal function during pregnancy. We focused the attention on the optimal management of the kidney disease in these women in order to avoid maternal-fetal complications.

Renal impairment in Alport syndrome pregnant woman: Case report and review of the literature.

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