Cumulative live birth rate and assisted reproduction: impact of female age and transfer day

BACKGROUND

Many studies on assisted reproductive technology examine live birth rate per cycle. However, after a cycle fails, couples often want to know what their chances are of having a live birth if they continue treatment. From a patients' perspective, the cumulative probability of live birth is more informative.

MATERIALS AND METHODS

This study includes patients who underwent fresh, frozen and non-donor ICSI cycles at our IVF unit between 2006-2012. Patients were divided into two groups; Group 1 represented those who underwent only Day 5 transfers, Group 2 represented only Day 3 transfers. Patients who underwent both were excluded. -Cycles were analyzed until the first live birth or the end of the 3rd cycle. Using Kaplan-Meier analysis, we estimated the cumulative live birth rates for each group and according to female age.

RESULTS

The mean age for Group 1 was significantly lower than for Group 2. After 3 cycles, Group 1's CLBR was 79% versus 66% in Group 2. When analyzing the live births by age and group, there was a significant difference in the CLBR after 3 cycles with the women less than 35 years having the highest CLBR and the women 40 years or older having the lowest CLBR.

CONCLUSION

In women less than 35 years, excellent CLBR can be achieved irrespective of the transfer day. For women 40 years and above, better results of CLBR are observed with Day 5 transfers. Our findings may impact the counseling of couples considering IVF treatment.

A Raman spectroscopic study of uranyl minerals from Cornwall, UK

Raman spectra have been collected using three excitation wavelengths for thirteen uranyl mineral samples, including novác̆ekite, and analysed.

Emphysematous pyelonephritis: Outcome with conservative management

Emphysematous pyelonephritis is a life-threatening condition characterized by necrotising gas forming infection of the renal parenchyma. We describe eight patients seen over a period of 2 years, 62.5% males and 37.5% females with age range between 21 and 65 years. About 75% patients had diabetes mellitus. Six patients were managed conservatively. One patient required nephrectomy with percutaneous drainage and one patient died without surgical intervention.

Feasibility of cochlear implantation in Mucopolysaccharidosis

Mucopolysaccharidoses (MPS) are a group of rare inherited metabolic disorders resulting from deficiencies of particular enzymes involved in the breakdown of glycosaminoglycans. Amongst the manifestations of MPS within the head and neck patients may develop conductive, mixed or sensorineural hearing loss.

OBJECTIVE

The main objective of this paper is to describe the management of profound sensorineural hearing loss in children with Mucopolysaccaridosis. The primary outcome measures for this case series were improvement in auditory performance and speech perception scores following cochlear implantation. Secondary outcome measures included surgical complications.

METHODS

We carried out a casenote review of the first two cases of cochlear implantation (CI) to rehabilitate profound sensory neural hearing loss in Mucopolysaccharidoses. Improvement in auditory performance was measured by categories of auditory performance (CAP) score, speech reception score (SRS) and the IHR McCormick toy discrimination test.

RESULTS

Both patients with MPS had demonstrable benefit from CI in terms of auditory performance and speech perception. The first patient improved from pre-operatively only managing to recognise environmental sounds to understanding conversation without lip-reading with a familiar talker. Following CI, the second patient can discriminate speech in noisy environments to a degree, without lip-reading. No peri-operative complications were noted in either patient.

CONCLUSION

As the medical management of the MPS has progressed there is likely to be a corresponding increase in survival. This increased life-expectancy will likely lead to greater numbers of patients with MPS surviving long enough to develop profound hearing loss. Likewise, when considering the risks and benefits of quality of life interventions such as CI in patients with MPS, it is more likely that the risks of surgery and general anaesthesia will be considered acceptable. Clinicians managing such patients will need to be aware of these developments.

Operative surgical yield from general surgical outpatient clinics; time to change the way we practice?

The aim of this study was to compare the number of patients attending surgical outpatient clinics in a general hospital to the number of resulting elective procedures scheduled in a single year. Patients initially assessed at private consulting rooms are not included in this study. The number of surgical outpatient appointments issued in 2011 totalled 6503 with non-attendances running at 1489 (22.9%). The number of elective surgical theatre cases performed in 2011 (i.e. the surgical yield from that period) came to 1078 with an additional 1470 patients referred for endoscopy and 475 patients referred for minor operations. Operative surgical yield from the currently structured outpatient clinic model is low, with the number of theatre cases coming to only 16.58% of the original number of outpatient appointments issued. Recommendations for the improvement of outpatient services are made. These findings are relevant in the context of streamlining access to surgical services.

Long-term results of endonasal dacryocystorhinostomy with and without stenting

INTRODUCTION

This study aimed to evaluate the short and long-term results of endoscopic dacryocystorhinostomy (DCR) with and without silicone stenting in chronic dacrocystorhinitis due to postsaccal blockage.

METHODS

The study involved a case series of consecutive 89 patients (128 eyes) who underwent endoscopic DCR. All patients were operated on by the senior author. The stent group comprised 63 eyes (44 patients), for which the DCR was performed between September 2002 and September 2005. The non-stent group with 65 eyes (45 patients) underwent the DCR between October 2005 and December 2006. The follow-up duration was up to 33 months after surgery. The statistical significance (p-value) was calculated using the chi-squared test.

RESULTS

The short-term success rate at six months' follow-up was 70% in the stent group and 97% in the non-stent group (p=0.0005) while the long-term success rate at 33 months was only 57% in stent group compared with 89% in the non-stent group (p=0.0003).

CONCLUSIONS

In this study, the non-stent group showed a higher success rate than the stent group on both short and long-term follow-up. Our study suggests that postoperative stents are not necessary for primary DCR and may be associated with a worse outcome.

Pinhole castration technique: an alternative to orchiectomy in stray dogs

The study evaluates a pinhole castration technique in male stray dogs. Animals (n=18) were randomly allotted to 2 groups: group I (n=12, pinhole castration) and group II (n=6, sham control). Percutaneous (in situ) spermatic cord ligation was performed under xylazine-ketamine anesthesia in all animals of group I. Scrotal and the testicular dimensions and testicular volume were measured on day 28 followed by bilateral orchiectomy in both the groups. Significantly lower readings were obtained from animals of group I when compared with pre-ligation readings as well as the corresponding readings from group II animals. In ligated animals volume of testicles showed a reduction by 40.57%. Histopathological examination of testicles revealed degeneration and atrophy in Group I animals. On the whole pinhole castration was found effective, minimally invasive, cheap, simple and a quick technique for male dog sterilization with potential for adoption in large-scale animal birth control programs.

Preclinical profile of bacopasides from Bacopa monnieri (BM) as an emerging class of therapeutics for management of chronic pains

Chronic pains management costs billions of dollars in medical exchequer to the world population. Additionally, 77% of people with chronic pains also have a degree of medically treatable depression. Opioids have a narrower safety index due to their side effects associated with its tolerance, hyperalgesia and subsequent dependence. Likewise, non steroidal anti-inflammatory drugs and anticonvulsants, also have limited safety and tolerability profile in the management of chronic pains. Bacopa monnieri, a renowned ayurvedic medicine has a strong antidepressant effect and significant antinociceptive effect, which is comparable to the effect of morphine via adenosinergic, opioidergic, and adrenergic mechanisms. BM has been also reported to be effective in neuropathic pains. Additionally, it has a strong anti-inflammatory effect mediated via COX-2 inhibitory mechanism. Apart from its effect of augmenting morphine analgesia, BM also inhibits opioid-withdrawal induced hyperalgesia, and acquisition and expression of morphine tolerance. BM is reported to have a strong protective effect against toxic effects of opiates on major organs like brain, kidneys and heart. BM is well documented to be safe and well tolerated herbal therapy in multiple clinical trials including various age groups. This minireview evaluated the preclinical data that highlights potential of BM as a future candidate for clinical management of chronic pains.

Early postnatal lead exposure induces tau phosphorylation in the brain of young rats

Cognitive impairment is a common feature of both lead exposure and hyperphosphorylation of tau. We, therefore, investigated whether lead exposure would induce tau hyperphosphorylation. Wistar rat pups were exposed to 0.2% lead acetate via their dams' drinking water from postnatal day 1 to 21. Lead in blood and brain were measured by atomic absorption spectrophotometry and the expression of tau, phosphorylated tau and various serine/threonine protein phosphatases (PP1, PP2A, PP2B and PP5) in the brain was analyzed by Western blot. Lead exposure significantly impaired learning and resulted in a significant reduction in the expression of tau but increased the phosphorylation of tau at Ser199/202, Thr212/Ser214 and Thr231. PP2A expression decreased, whereas, PP1 and PP5 expression increased in lead-exposed rats. These results demonstrate that early postnatal exposure to lead decrease PP2A expression and induce tau hyperphosphorylation at several serine and threonine residues. Hyperphosphorylation of tau may be a mechanism of Pb-induced deficits in learning and memory.