scholarly journals P–185 Overcoming a sudden COVID–19 lockdown and other similar unforeseen adverse events: Oocyte-sperm cryopreservation 4 hours after conventional in vitro insemination

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
C Bisioli ◽  
M Otegui ◽  
F Migliora ◽  
R Crowley
Keyword(s):  
Case Report ◽  
Scientific Information ◽  
Secondary Outcome ◽  
Large Sample Size ◽  
Oocyte Vitrification ◽  
Fertilization Process ◽  
Human Oocytes ◽  
Stage 4 ◽  
Registration Number

Abstract Study question Can human oocytes be cyropreserved when they were previously inseminated while obtaining normal fertilization, embryo development and pregnancies? Summary answer Cryopreservation of recently inseminated human oocytes produces normal 2PN zygotes, viable embryos and ongoing pregnancies. What is known already Oocyte vitrification is a well-established technique in the infertility field supported by its effectiveness to freeze and thaw embryos at various stages of development. However, it is yet unknown whether cryopreservation performed in a period between conventional in vitro insemination and the appearance of pronuclei, affects any of the steps leading to fertilization, thereby arresting this process. Study design, size, duration Case report that includes 5 IVF cycles where cryopreservation and thawing were performed in a pre-zygote stage, 4 hours after the conventional insemination of oocytes. The rationale for this procedure was to comply with a government restriction to circulate and work in order to prevent the spread of the SARS-CoV–2 virus, unexpectedly 3 days ahead (effective on 03/19/2020). Participants/materials, setting, methods: Off-site embryologists cancelled all pending embryo transfers and returned home (2,000 km away) before the stay-home quarantine. Five couples were informed and consent was obtained on the urgent need to cryopreserve their already inseminated oocytes despite of the limited scientific information. We vitrified 28 oocyte-sperm pairs in vitrification devices containing 2 to 3 inseminated oocytes each. Main results and the role of chance Eight months later all non-essential activities, including non-urgent procedures in hospital facilities, were permitted again, allowing embryologists to travel and resume their postponed work. We thawed 19 of the so-called “pre-zygotes” corresponding to 4 of the 5 initial couples. Female ages were 29, 39, 38 and 37 years old. Our primary outcomes were detection of pronuclei and the occurrence of fertilization. The secondary outcome was pregnancy success. On day 1, we observed the presence of 2PN in 16 oocytes (84%). Only one patient with 2 oocytes failed to fertilize. We transferred 2 good-to-fair-grade cleaved embryos to each of the 3 patients, obtaining one pregnancy with a positive fetal heartbeat from the 39 years old patient. Two of the couples were also able to cryopreserve 2 and 1 surplus embryos on day 5, respectively. Limitations, reasons for caution Our strategy was used exclusively to overcome an unexpected adverse event while complying with State and County regulations on COVID–19. As a case report, a large sample size is needed to confirm and extend these results including the putative detrimental effects of arresting the fertilization process through vitrification. Wider implications of the findings: Although cryopreservation implies to arrest of any stage of a development continuum, to the best of our knowledge, this is the first time that both fertilization and pregnancy were achieved after halting the fertilization process long before the appearance of pronuclei (at ∼4 hours after insemination). Trial registration number Not applicable

In vitro fertilization and development of one of two human oocytes with fused zonae pellucidae: case report

1990 ◽  
Vol 54 (5) ◽  
pp. 947-949 ◽  
Author(s):  
Geraldine M. Hartshorne ◽  
Martyn Blayney ◽  
Heather Dyson ◽  
Kay Elder
Keyword(s):  
Case Report ◽  
In Vitro Fertilization ◽  
Vitro Fertilization ◽  
Human Oocytes

scholarly journals Lymphocutaneous spread of Mycobacterium elephantis in an immunocompetent individual: A case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110349
Author(s):  
Brett D Edwards ◽  
Ranjani Somayaji ◽  
Dina Fisher ◽  
Justin C Chia
Keyword(s):  
Case Report ◽  
Chronic Lung Disease ◽  
Contaminated Soil ◽  
Lung Abscess ◽  
Immunocompetent Individual ◽  
First Case ◽  
Antimycobacterial Agents ◽  
Vitro Data ◽  
In Vitro Data

Mycobacterium elephantis was first described when isolated from an elephant that succumbed to lung abscess. However, despite this namesake, it is not associated with animals and has been described most often as a probable colonizer rather than pathogen in humans with chronic lung disease. In this report, we describe the first case of lymphocutaneous infection from M. elephantis, likely as a result of cutaneous inoculation with contaminated soil. This offers further evidence to its capabilities as a pathogen. We provide a review of the limited prior reports of M. elephantis and outline the available in vitro data on efficacy of various antimycobacterial agents.

scholarly journals Protocol for a randomised clinical trial of multimodal postconcussion symptom treatment and recovery: the Concussion Essentials study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041458
Author(s):  
Vicki Anderson ◽  
Vanessa C Rausa ◽  
Nicholas Anderson ◽  
Georgia Parkin ◽  
Cathriona Clarke ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomised Clinical Trial ◽  
Normal Activity ◽  
Secondary Outcome ◽  
Open Label ◽  
Human Research Ethics ◽  
Postconcussive Symptoms ◽  
Study Results ◽  
Registration Number ◽  
Initial Injury

IntroductionWhile most children recover from a concussion shortly after injury, approximately 30% experience persistent postconcussive symptoms (pPCS) beyond 1-month postinjury. Existing research into the treatment of pPCS have evaluated unimodal approaches, despite evidence suggesting that pPCS likely represent an interaction across various symptom clusters. The primary aim of this study is to evaluate the effectiveness of a multimodal, symptom-tailored intervention to accelerate symptom recovery and increase the proportion of children with resolved symptoms at 3 months postconcussion.Methods and analysisIn this open-label, assessor-blinded, randomised clinical trial, children with concussion aged 8–18 years will be recruited from The Royal Children’s Hospital (The RCH) emergency department, or referred by a clinician, within 17 days of initial injury. Based on parent ratings of their child’s PCS at ~10 days postinjury, symptomatic children (≥2 symptoms at least 1-point above those endorsed preinjury) will undergo a baseline assessment at 3 weeks postinjury and randomised into either Concussion Essentials (CE, n=108), a multimodal, interdisciplinary delivered, symptom-tailored treatment involving physiotherapy, psychology and education, or usual care (UC, n=108) study arms. CE participants will receive 1 hour of intervention each week, for up to 8 weeks or until pPCS resolve. A postprogramme assessment will be conducted at 3 months postinjury for all participants. Effectiveness of the CE intervention will be determined by the proportion of participants for whom pPCS have resolved at the postprogramme assessment (primary outcome) relative to the UC group. Secondary outcome analyses will examine whether children receiving CE are more likely to demonstrate resolution of pPCS, earlier return to normal activity, higher quality of life and a lower rate of utilisation of health services, compared with the UC group.Ethics and disseminationEthics were approved by The RCH Human Research Ethics Committee (HREC: 37100). Parent, and for mature minors, participant consent, will be obtained prior to commencement of the trial. Study results will be disseminated at international conferences and international peer-reviewed journals.Trial registration numberACTRN12617000418370; pre-results.

scholarly journals Large intraperitoneal lipoleiomyoma in a pre-menopausal woman: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sara L. Schaefer ◽  
Amy L. Strong ◽  
Sheena Bahroloomi ◽  
Jichang Han ◽  
Michella K. Whisman ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Smooth Muscle ◽  
Case Report ◽  
Smooth Muscle Actin ◽  
Abdominal Mass ◽  
Histopathological Analysis ◽  
Menopausal Woman ◽  
En Bloc ◽  
Cross Sectional

Abstract Background Lipoleiomyoma is a rare, benign variant of the commonplace uterine leiomyoma. Unlike leiomyoma, these tumors are composed of smooth muscle cells admixed with mature adipose tissue. While rare, they are most frequently identified in the uterus, but even more infrequently have been described in extrauterine locations. Case presentation We describe a case report of a 45-year-old woman with a history of in vitro fertilization pregnancy presenting 6 years later with abdominal distention and weight loss found to have a 30-cm intra-abdominal lipoleiomyoma. While cross-sectional imaging can narrow the differential diagnosis, histopathological analysis with stains positive for smooth muscle actin, desmin, and estrogen receptor, but negative for HMB-45 confirms the diagnosis of lipoleiomyoma. The large encapsulated tumor was resected en bloc. The patients post-operative course was uneventful and her symptoms resolved. Conclusions Lipoleiomyoma should be considered on the differential diagnosis in a woman with a large intra-abdominal mass. While considered benign, resection should be considered if the mass is symptomatic, and the diagnosis is unclear or there is a concern for malignancy.

scholarly journals Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045343
Author(s):  
Ray Moynihan ◽  
Sharon Sanders ◽  
Zoe A Michaleff ◽  
Anna Mae Scott ◽  
Justin Clark ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Outcome ◽  
Unmet Need ◽  
Healthcare Utilisation ◽  
Healthcare Services ◽  
Risk Of Bias ◽  
Secondary Outcome ◽  
Severe Illness ◽  
Service Utilisation ◽  
Registration Number

ObjectivesTo determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic.DesignSystematic review.EligibilityEligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19.Data sourcesPubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact.Data analysisRisk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis.Outcome measuresPrimary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores).Results3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference.ConclusionsHealthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery.PROSPERO registration numberCRD42020203729.

scholarly journals Risk factors for severity on admission and the disease progression during hospitalisation in a large cohort of patients with COVID-19 in Japan

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047007
Author(s):  
Mari Terada ◽  
Hiroshi Ohtsu ◽  
Sho Saito ◽  
Kayoko Hayakawa ◽  
Shinya Tsuzuki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Chronic Respiratory Disease ◽  
Major Effect ◽  
Secondary Outcome ◽  
Healthcare Facilities ◽  
Wide Range ◽  
Registration Number ◽  
Using Data ◽  
Obesity Hypertension

ObjectivesTo investigate the risk factors contributing to severity on admission. Additionally, risk factors of worst severity and fatality were studied. Moreover, factors were compared based on three points: early severity, worst severity and fatality.DesignAn observational cohort study using data entered in a Japan nationwide COVID-19 inpatient registry, COVIREGI-JP.SettingAs of 28 September 2020, 10480 cases from 802 facilities have been registered. Participating facilities cover a wide range of hospitals where patients with COVID-19 are admitted in Japan.ParticipantsParticipants who had a positive test result on any applicable SARS-CoV-2 diagnostic tests were admitted to participating healthcare facilities. A total of 3829 cases were identified from 16 January to 31 May 2020, of which 3376 cases were included in this study.Primary and secondary outcome measuresPrimary outcome was severe or nonsevere on admission, determined by the requirement of mechanical ventilation or oxygen therapy, SpO2 or respiratory rate. Secondary outcome was the worst severity during hospitalisation, judged by the requirement of oxygen and/orinvasive mechanical ventilation/extracorporeal membrane oxygenation.ResultsRisk factors for severity on admission were older age, men, cardiovascular disease, chronic respiratory disease, diabetes, obesity and hypertension. Cerebrovascular disease, liver disease, renal disease or dialysis, solid tumour and hyperlipidaemia did not influence severity on admission; however, it influenced worst severity. Fatality rates for obesity, hypertension and hyperlipidaemia were relatively lower.ConclusionsThis study segregated the comorbidities influencing severity and death. It is possible that risk factors for severity on admission, worst severity and fatality are not consistent and may be propelled by different factors. Specifically, while hypertension, hyperlipidaemia and obesity had major effect on worst severity, their impact was mild on fatality in the Japanese population. Some studies contradict our results; therefore, detailed analyses, considering in-hospital treatments, are needed for validation.Trial registration numberUMIN000039873. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045453

scholarly journals The use of an in-vitro batch fermentation (human colon) model for investigating mechanisms of TMA production from choline, l-carnitine and related precursors by the human gut microbiota

2021 ◽  
Author(s):  
Priscilla Day-Walsh ◽  
Emad Shehata ◽  
Shikha Saha ◽  
George M. Savva ◽  
Barbora Nemeckova ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Metabolic Diseases ◽  
Human Colon ◽  
Human Studies ◽  
Bacterial Strains ◽  
Increased Risk ◽  
Carnitine Metabolism ◽  
Registration Number ◽  
Vitro Model

Abstract Purpose Plasma trimethylamine-N-oxide (TMAO) levels have been shown to correlate with increased risk of metabolic diseases including cardiovascular diseases. TMAO exposure predominantly occurs as a consequence of gut microbiota-dependent trimethylamine (TMA) production from dietary substrates including choline, carnitine and betaine, which is then converted to TMAO in the liver. Reducing microbial TMA production is likely to be the most effective and sustainable approach to overcoming TMAO burden in humans. Current models for studying microbial TMA production have numerous weaknesses including the cost and length of human studies, differences in TMA(O) metabolism in animal models and the risk of failing to replicate multi-enzyme/multi-strain pathways when using isolated bacterial strains. The purpose of this research was to investigate TMA production from dietary precursors in an in-vitro model of the human colon. Methods TMA production from choline, l-carnitine, betaine and γ-butyrobetaine was studied over 24–48 h using an in-vitro human colon model with metabolite quantification performed using LC–MS. Results Choline was metabolised via the direct choline TMA-lyase route but not the indirect choline–betaine-TMA route, conversion of l-carnitine to TMA was slower than that of choline and involves the formation of the intermediate γ-BB, whereas the Rieske-type monooxygenase/reductase pathway for l-carnitine metabolism to TMA was negligible. The rate of TMA production from precursors was choline > carnitine > betaine > γ-BB. 3,3-Dimethyl-1-butanol (DMB) had no effect on the conversion of choline to TMA. Conclusion The metabolic routes for microbial TMA production in the colon model are consistent with observations from human studies. Thus, this model is suitable for studying gut microbiota metabolism of TMA and for screening potential therapeutic targets that aim to attenuate TMA production by the gut microbiota. Trial registration number NCT02653001 (http://www.clinicaltrials.gov), registered 12 Jan 2016.

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