Comparison of ICSI and Conventional IVF in Non-Male Factor Patients with Less Than Four Oocytes

Background: We aimed to analyse our clinical results for a particular subgroup of patients with poor ovarian response (POR) in order to clarify if lower number of oocytes is a drawback for proceeding to C-IVFMaterials and methods: In this retrospective study, patient files of all couples (#1733) who underwent oocyte retrieval between January 2017 and December 2019 were reviewed and 191 cases diagnosed with non-male factor infertility in which ≤3 cumulus-oocyte-complexes available for fertilisation were analysed. Exclusion criteria were: woman age>42, patients with a history of previous ART trial, prenatal genetic testing cycles and couples undergoing total cryopreservation for any indication. Three groups were constructed depending on the method of fertilisation and on semen quality as follows: IVF non-male factor (Group 1,n=77); ICSI non-male factor (Group 2, n=65); ICSI male factor- ICSI/MF n=49 according to WHO reference values. Main outcome parameters were: fertilisation rate, implantation rate and live birth rate. Results: Fertilisation rate per collected COC was significantly higher in group 1 compared to the other two groups (85,68%, 72,58%, 73,33% respectively, p=0,004). FR per inseminated oocyte also tended to be higher in group 1 but not reaching a statistically significant level. Both techniques yielded similar implantation rates (20,42%, 28,49%, 23,33% respectively, p=0,407) and live birth rates (26,8%, 30,6%, 31,1% respectively, p=0.643).Conclusions: In the presence of normal semen parameters, low egg number is not an indication to perform ICSI. The choice of fertilisation method should be based primarily on semen quality, in combination with the patient’s previous history regardless of the ovarian reserve.

Management of obesity with integrated Ayurveda and Yoga intervention: A case report

Obesity is the disease of nutritional deficiency which leads to abnormal growth of adipose tissue resulting in an increase in the body weight to the extent of 20% or more of standard weight for the person’s age, sex, and height. Obesity is one side of the double burden of malnutrition, and today more people are obese than underweight. In Ayurveda Obesity is classified under santarpanjanya rogas and ashtaninditiya purusha by Acharya Charaka. Ayurveda attributes concept of Dosha, dhatus and Mala in which any vikriti in any of dhatus, pramanatah or gunatah then it firmly affects both body and mind. Yoga and Ayurveda both spring as a greater part of spiritual and mental aspect of treatment. Considering all these factors this study is carried out to understand cause, cause effect relationship as well as treatment. In this case study patient was treated with Udwarthana, Shodhana and Shamana chikitsa, also advised Ahara (scheduled diet) and Vihara (life style modification) for the management of obesity. This showed a significant change in anthropometric measurement.

POEMS syndrome causing left ventricular hypertrophy, myocardial dysfunction and pericardial effusion: a case report

Background POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) is a paraneoplastic syndrome caused by a plasma cell proliferative disorder. Characteristics of POEMS syndrome include elevated pro-inflammatory and angiogenic cytokine levels that lead to multi-organ dysfunction. Patients have a variety of initial symptoms, but cardiac involvement is not common. Case summary We report a case of a 31-year-old Chinese woman with chief complaints of chest pain and dyspnoea who was diagnosed with POEMS syndrome. The cardiovascular system in the case study patient was characterized by pericardial effusion, enlarged left atria, abnormal myocardial segmental deformation, left ventricular hypertrophy, pulmonary hypertension, and increased glucose metabolism in the left and right ventricular myocardium. The pericardial effusion diminished, while cardiac function, left ventricular wall thickness, and pulmonary hypertension gradually returned to normal with dexamethasone and bortezomib treatment. Discussion This case suggests that cardiovascular system damage may be related to systemic diseases. Cardiovascular system damage caused by POEMS syndrome is recoverable after chemotherapy treatment. Echocardiography readily visualizes the changes in the heart of a patient with POEMS syndrome, clearly reflecting the changes in the structure and function of the heart before and after treatment.

Clinical Features, Management and Prognostic Factors of Intracranial Solitary Fibrous Tumor

Purpose Due to low incidence and the constantly changing diagnostic and classification criteria, the clinical features, management and prognostic factors of intracranial solitary fibrous tumor (ISFT) remain unclear and were thus analyzed in this study. Methods A total of 38 patients who were diagnosed as ISFT in our institution were enrolled in this study. Patient data including age, gender, clinical presentation, histopathological features, immunohistochemistry staining, tumor location, tumor size, treatment methods, and prognosis were extracted and retrospectively analyzed. Results The median age at diagnosis was 45.5 years (range 28-66 years) and the male to female ratio was 1:1.53 in our series. The 3-, 5-, and 10-year progression-free survival rate was 82.2%, 62.8%, and 21.4%, respectively; and the 3-, 5-, and 10-year overall survival rate was 97.1%, 86.9% and 64.2%, respectively. Patients with high WHO grade (grade III) ISFTs had impaired PFS (p<0.05) and OS (p<0.01). Subtotal resection (STR) was associated with shorter PFS and OS (p<0.001, respectively). Postoperative radiotherapy (PORT) significantly improved PFS but not OS in patients with WHO grade III ISFTs (P=0.025). The PFS of patients with STR+PORT was improved compared with those who received STR alone, although not significant. Moreover, CD34-negative immunostaining and high Ki-67 index (>10%) were associated with impaired PFS in ISFTs.Conclusion Our study provides evidence that high tumor grade, subtotal tumor resection, CD34 negative immunostaining and high Ki-67 index (>10%) were independent predictors for poor prognosis of ISFTs. PORT should be recommended for patients with high grade ISFTs or STR.

Determination of Factors Influencing Physical Therapy Treatment Compliance

Background: Compliance to long term therapy is the extent to which a person's behavior - taking medication, following a diet or executing lifestyle changes, corresponds with agreed recommendations from a health care provider. Aim: To determine the factors influencing physical therapy treatment compliance and relation of age and gender on compliance. Study Design: Observational study. Methodology: Study conducted for 6 months in public sector hospitals of twin cities of Pakistan. Non-probability convenient sampling technique was used. Data was collected by interviewing the patients, using self-structured questionnaire. 141 patients attending physical therapy treatment in outpatient department for more than three days and willing to participate in the study, were included in the study. Patient who visited OPD for first time, pediatric patient and indoor patients were excluded. Data was analyzed by SPSS software, version 25 as qualitative variables were expressed as frequencies and percentages. Results: Most of patient could not adhere to physical therapy because of unavailability of time (60.28%), lengthy follow up (46.10%), boredom with exercise (23.4%), unavailability of respective gender (23.4%), long distance between home and hospital (20.6%), Physical contact with therapist during session (15.6%) and fear of modality (7.8%). Most patients within age group of 29-42 and 43-56 responded that frequent visits to hospital to attend multiple sessions of physical therapy were the reason they left physical therapy sessions and had unavailability of time to attend physical therapy sessions. Conclusion: We concluded that frequent visits to hospital to attend multiple sessions of physical therapy and unavailability of time are two main factors that led to poor compliance to physical therapy treatment. Keywords: Barriers, Compliance and Physical Therapy Treatment

Risk Factor for Retreatment Episode on Admission Among TB Patients With Schizophrenia

Background: The clinical characteristics of patients with tuberculosis (TB) and schizophrenia remain largely unknown. Furthermore, TB retreatment is associated with a poor outcome. Hence, we aimed to address the risk factors of TB retreatment in schizophrenia patients in this retrospective cohort.Methods: Between March 2005 and August 2020, patients diagnosed with schizophrenia and TB were included in the study. Patient characteristics, such as demographics, medical history, underlying diseases, symptoms, outcome, and lab examinations, were collected from medical records using a structured questionnaire. TB retreatment was defined as treatment failures and relapses. Subsequently, multivariate logistic regression was performed using variables selected based on prior findings as well as factors found to be associated with a retreatment episode in univariate analyses (p &lt; 0.1).Results: A total of 113 TB patients with schizophrenia were included. Of them, 94 (83.2%) patients were classified as initial treatment group, and 19 (16.8%) were classified as retreatment group. The mean age was 53.0 ± 23.2 years, and males accounted for 61.9% of all cases. Multivariate analysis revealed that continuous antipsychotics treatment (OR = 0.226, 95% CI: 0.074, 0.693; p = 0.009) and extra-pulmonary TB (OR = 0.249, 95% CI: 0.080, 0.783; p = 0.017) were associated with the retreatment in TB patients with schizophrenia.Conclusion: Retreatment is a significant concern for TB patients with schizophrenia. To improve the current dilemma, continuous antipsychotics treatment is required, and increasing awareness of schizophrenia would reduce the disease burden.

Ultrasound fetal biometry in third trimester in urban Nepalese population

INTRODUCTION: Fetal biometry is an important component of fetal growth surveillance and can detect small for gestation age fetuses. However, we use growth curves from studies done in other high-income countries and do not have a standard of our own. This study aims to study the deviation of biometry and expected fetal weight from these curves in pregnancy with normal birth weight term deliveries. METHODS: The study was a retrospective hospital record-based study including term delivery from 2018 May to 2020 January. All lowrisk patients visiting ultrasound OPD in our hospital in 3rd trimester were retrieved and included in the study. Patient with low AFI, major fetal anomaly, abnormal fetal heart rate, preterm delivery, birth weight less than 2500 gm (low birth weight), intrauterine fetal demise, preeclampsia or other complications were excluded from the study. Fetal biometry and expected fetal weight were evaluated. Data was entered in predesigned performa and analysis was performed with IBM SPSS 20.0. RESULTS: A total of 590 ultrasound examinations done in 372 patients were included in the study. Mean age of the patients was 30.78+/-3.98 years, median age was 30 years (IQ range-5). Approximately 316(53.6%) patients were under 30 years of age, 198(33.6%) patients were between 30-35 and 76(12.9%) patients were above 35 years. Median gestational age at birth was 39 weeks and median birth weight was 3120 grams. Median and percentile for various biometry was calculated. EFW was below 50th percentile in 424(71.9%) according to WHO chart. The median percentile for EFW was 30.6 (IQ-33.6). CONCLUSION: Expected fetal weight in Nepalese population is smaller than that predicted by WHO chart. Development of country specific fetal growth curve is recommended for accurate fetal growth surveillance.

Identification of Novel Gene Variants in Turkish Families with Non-Syndromic Congenital Cataracts Using Whole-Exome Sequencing

Purpose The present study aimed to identify the molecular etiology of non-syndromic congenital cataract (CC) using whole-exome sequencing (WES) analysis. Methods In the present study, ophthalmologic results and pedigree analysis of the families of 12 patients with non-syndromic CC were evaluated. WES analysis was conducted after DNA was isolated from peripheral blood samples obtained from the patients.Results Twelve non-syndromic probands (10 male and 2 female) with bilateral CC were included in the study. Patient age ranged between 1 and 11 months. WES analysis showed pathogenic/likely pathogenic variant in 7 (58%) of the 12 families and variant of unknown significance (VUS) in 5 (42%) of them. All the 13 different variants detected in 9 different CC-related genes were co-segregated with the disease. Autosomal dominant inheritance was found in 7 (58%) of the families and autosomal recessive inheritance was found in 5 (42%) of them.Conclusion To the best of our knowledge, the present research is one of the limited numbers of studies in the Turkish population in which genetically heterogeneous non-syndromic CC was investigated using WES analysis. Novel variants that we identified in DNMP, LSS, and WFS1 genes, which are rarely associated with the CC phenotype, have contributed to the mutation spectrum of this disease. Identifying the relevant molecular genetic etiology allows accurate genetic counseling to be provided to the families.

Effectiveness of decision aids on cancer-screening decision-making: an umbrella review protocol

IntroductionAlthough systematic reviews have shown how decision aids about cancer-related clinical decisions improve selection of key options and shared decision-making, whether or not particular decision aids, defined by their specific presentation formats, delivery methods and other attributes, can perform better than others in the context of cancer-screening decisions is uncertain. Therefore, we planned an overview to address this issue by using standard umbrella review methods to repurpose existing systematic reviews and their component comparative studies.Methods and analysisWe will search PubMed, Embase, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects from inception through 31 December 2021 with no language restriction and perform full-text evaluation of potentially relevant articles. We will include systematic reviews of randomised controlled trials or non-randomised studies of interventions that assessed a decision aid about cancer-screening decisions and compared it with an alternative tool or conventional management in healthy average-risk adults. Two reviewers will extract data and rate the study validity according to standard quality assessment measures. Our primary outcome will be intended and actual choice and adherence to selected options. The secondary outcomes will include attributes of the option-selection process, achieving shared decision-making and preference-linked psychosocial outcomes. We will qualitatively assess study, patient and intervention characteristics and outcomes. We will also take special care to investigate the presentation format, delivery methods and quality of the included decision aids and assess the degree to which the decision aid was delivered and used as intended. If appropriate, we will perform random-effects model meta-analyses to quantitatively synthesise the results.Ethics and disseminationEthics approval is not applicable as this is a secondary analysis of publicly available data. The review results will be submitted for publication in a peer-reviewed journal.Prospero registration numberCRD42021235957.

Tidlig avklaring – et møte mellom mennesker. Ny tilnærming for vurdering og planlegging av behandling i poliklinisk psykisk helsevern.

Background: Mental health care services are facing challenges due to the increasing number of referrals of patients with multifaceted problems. This study aims to describe the Early Assessment Team, a novel method of organizing intake assessments for the outpatient mental health service in a community mental health center. Method: During the first two years of EAT, 1,034 cases were included in a descriptive quality assurance study. Patient population, method of work, re-referrals and patient satisfaction were evaluated. Results: After contact with EAT, two-thirds of patients were assessed as not in need of further treatment in the outpatient clinic. The assessment was performed during one to three sessions in 90% of cases. Fewer than 20% of cases that were screened out by EAT were re-referred to the CMHC within six months. Patients expressed satisfaction with the service. Implications: The results indicate that intake assessment by an early assessment team may be an alternative in clinical practice, though further controlled studies are needed. Keywords: community mental health center (CMHC), health service development, intake assessment, general mental health