Random antral follicle count performed on any day of the menstrual cycle has the same predictive value as AMH for good ovarian response in IVF cycles

OBJECTIVE

To determine whether the predictive value of AFC for ovarian response to stimulation for IVF depends on the day of the menstrual cycle when ultrasound is performed.

METHODS

410 women undergoing their first IVF cycle were included. All the women had AFC performed twice. The first measurement, random AFC (r-AFC), was performed during the fertility workup whatever the day of their menstrual cycle. Three groups were constituted according to the period of ultrasound performance: at early follicular phase i.e., day 1 to day 6 (eFP-AFC); at mid follicular phase i.e., day 7 to 12 (mFP-AFC) and at luteal phase i.e., day 13 or after (LP-AFC). A second AFC measurement was performed before the start of the ovarian stimulation (SD1-AFC). AMH dosing was done in the early follicular phase.

RESULTS

Random AFC (r-AFC) was correlated to AMH (r = 0.69; p<0.001), SD1-AFC (r = 0.75; p<0.001) and number of oocytes retrieved (r = 0.49; p<0.001). When regarding AFC depending on the cycle day group, the correlation with AMH was 0.65, 0.66 and 0.85 for the eFP-AFC, the mFP-AFC and the LP-AFC respectively (all p were <0.001). The ROC analysis showed the same predictive value for good ovarian response (more than 6 oocytes retrieved) for the eFP-AFC, mFP-AFC and LP-AFC (AUC 0.73, 0.75 and 0.84 respectively; p = 0.28). The AUC of r-AFC (0.76) were similar to those of AMH (0.74) and SD1-AFC (0.74) (p = 0.21 and 0.92 respectively).

CONCLUSION

AFC is strongly correlated with AMH and highly predictive of good ovarian response during the whole menstrual cycle.

P–599 random antral follicle count, performed at any day of the menstrual cycle, demonstrates the same predictive value for ovarian response in in vitro fertilization cycles

Study question

Does antral follicle count (AFC) retains its predictive value for ovarian response to stimulation for in vitro fertilization (IVF) throughout the whole menstrual cycle?

Summary answer

AFC is strongly correlated to anti-mullerian hormone (AMH) and highly predictive of good ovarian response whatever the day of cycle the ultrasound is performed.

What is known already

Usually performed in the early follicular phase (at day 2–3 of the menstrual cycle), AFC and AMH are the most accurate markers of ovarian reserve. They are routinely used to predict ovarian response to ovarian stimulation for IVF and eventually to individualize the gonadotropin starting dose.

Study design, size, duration

Retrospective cohort study performed between January, 2017 and December, 2019.

Participants/materials, setting, methods

410 consecutive women aged 20 to 42 years were included. Random AFC (r-AFC) was performed during the fertility workup whatever the day of their menstrual cycle was: early follicular phase i.e. day 1 to day 6 (eFP-AFC), mid follicular phase i.e. day 7 to 12 (mFP-AFC) and luteal phase i.e. day 13 or after (LP-AFC). A second AFC was performed before the start of the stimulation (SD1-AFC). AMH was measured in the early follicular phase.

Main results and the role of chance

Random AFC (r-AFC) was correlated to AMH (r = 0.692; p &lt; 0.001), SD1-AFC (r = 0.756; p &lt; 0.001) and number of oocytes retrieved (r = 0.491; p &lt; 0.001). When regarding AFC depending on the cycle day group, the correlation with AMH was significantly higher for the LP-AFC, (LP-AFC) (r = 0.853) than for the eFP-AFC (r = 0.657; p &lt; 0.001) and for the mFP-AFC (r = 0.668). The correlation with SD1-AFC was similar regardless of the time of performance of r-AFC (r = 0.739, 0.783, 0.733, respectively for eFP, mFP and LP-AFC). Moreover, the ROC analysis showed the same predictive value for good ovarian response (more than 6 oocytes retrieved) for the eFP-AFC, mFP-AFC and LP-AFC (AUC 0.73, 0.75 and 0.84 respectively) as well as for AMH and SD1-AFC (AUC 0.74 and 0.74, respectively).

Limitations, reasons for caution

This is a retrospective analysis, however data were prospectively collected and the method for ultrasound acquisition of AFC was standardized.

Wider implications of the findings: The absence of significant variation of AFC across the menstrual cycle allows to its random performance. Ultrasound performed besides early follicular phase discloses informations on ovaries, the uterus and the endometrium. It is more comfortable and convenient for women and physicians by limiting targeted appointment during menstruation and reiterated examination.

Trial registration number

Not applicable

Differences in controlled versus uncontrolled arterial hypertension in a primary health care centre—a quality improvement cycle study

Background

Cardiovascular diseases are the leading cause of death worldwide and uncontrolled Arterial Hypertension (AH) is the most important involved risk factor. An observational study published in 2019 found differences between controlled and uncontrolled AH patients, namely less frequent chronotherapy and family history health records. We aimed to study medical designed population based interventions to reach an increase in controlled AH defining a set of growth dynamics (Δ) ≥ +5 in AH prevalence of control defined for a value of 140/90 mmHg.

Methods

2019 results were presented in small medical teams weekly periodic scientific meetings and upon such awareness strategies were developed for improving AH control, according to the best practice evidence available. Data were collected, 6 months later, in a randomized representative sample of AH patients in each Primary Care Health Unit for a confidence interval 95%, error margin of 5%. Descriptive and inferential analysis, for a P &lt; 0.001 and growth dynamics (Δ) were calculated.

Results

In a n = 148 sample there was a significant improvement in the rate of controlled hypertension (43.9% to 67.9%, P &lt; 0.001, Δ = +54.0). Chronotherapy improved from 29.0% to 66.2% (P &lt; 0.001), Δ = +128.3) and family medical records also improved (88.1% to 100%, Δ + 11.9).

Conclusions

Significant rise in the prevalence of AH control was achieved after informative and formative intervention. Chronotherapy was significantly improved, allowing a 67.9% AH control. Family medical records also significantly improved. Healthcare professional’s knowledge and reflection about their clinical activity seem to be important tools to achieve better results and hopefully health outcomes, in Arterial Hypertension.

Influence of oceanic and climate conditions on the early life history of European seabass Dicentrarchus labrax

Understanding how marine fish early-life history is affected in the long-term by environmental and oceanographic factors is fundamental given its importance to population dynamics and connectivity. This work aimed at determining the influence of these processes on the interannual variability in hatch day and early-life growth patterns of European seabass, over a seven-year period (2011-2017) in the Atlantic Iberian coast. To accomplish this, otolith microstructure analysis was used to determine seabass hatch day and to develop early-growth correlations. In most years, hatching occurred from February to April, with two exceptions: in 2012, hatching started in early-January, and in 2016 an exceptionally long hatching period was registered. Using generalized additive models (GAM), we observed that sea surface temperature (SST), the North Atlantic Oscillation index (NAOi) and Chlorophyll-a (Chla) were the main drivers behind the inter-annual variability in seabass hatch day. Analysis of correlations between growth increments allowed assessing important periods of seabass growth and how future growth is affected. Since seawater temperature is among the main drivers for seabass recruitment and growth, its life cycle may be hampered due to ocean warming and an increasingly unstable climate, with consequences for the natural marine stocks and their harvest.

Corticosteroid induced mania with psychotic symptoms

Introduction

Corticosteroids may induce psychiatric symptoms (agitation, fear, hypomania, insomnia, irritability, labile mood, pressured speech and restlessness) with incidence rates ranging from 1,8% to 57%. We present a case of corticosteroid-induced mania and psychosis.

Objectives

Non-systematic review on corticosteroid therapy induced psychiatric symptoms. Analysis and comparison of a patient’s case with the existing literature.

Methods

Case report and a non-systematic review through databases as Pubmed, UpToDate, Medscape, between 2000 and 2020.

Results

We present a female 70 year-old patient without psychiatric background, diagnosed with Rhizomelic Pseudopolyarthritis, who started treatment with prednisone 20 mg. During the third month of treatment the patient started progressively worse behavior changes (such as destruction of the neighbor’s property), developed persecutory delusions, decreased sleep and increased energy. The patient was committed to our psychiatric ward and started on diazepam 10 mg and olanzapine 15 mg per day. Despite introduction of antipsychotics, which has evidence for mood stabilization, the patient maintained the symptoms, so it was necessary to gradually reduce corticosteroids until symptomatic control.

Conclusions

Psychosis (24%), hypomania and mania (35%), are the most common psychiatric reactions to corticosteroid therapy. Several studies show that even a low dosage may induce psychiatric disturbances, most frequently during the first two weeks of treatment. However, as reported in this case, symptoms may occur at any time. Thus, a multidisciplinary team, as well as training of professionals from different specialties, such as psychiatry, rheumatology and endocrinology, are needed, since these syndromes may be confused with pure psychiatric conditions and consequently delay treatment and compromise prognosis.

Disclosure

No significant relationships.

Different disease, same challenges: Social determinants of tuberculosis and COVID-19

Infectious diseases, such as tuberculosis (TB) and the novel coronavirus (COVID-19) relate to environmental factors, understanding of which is essential to inform policy and practice and tackle them effectively.

The review follows the conceptual framework offered by the World Health Organization Commission on Social Determinants of Health (defined as “all those material, psychological and behavioural circumstances linked to health and generically indicated as risk factors’ in the conventional epidemiological language”). It describes the social factors behind TB and COVID-19, the commonalities between the two diseases, and what can be learned so far from the published best practices.

The social determinants sustaining TB and COVID-19 underline the importance of prioritising health and allocating adequate financial and human resources to achieve universal health coverage and health-related social protection while addressing the needs of vulnerable populations. Rapid and effective measures against poverty and other major social determinants and sources of inequality are urgently needed to develop better health in the post-COVID-19 world.

A filtering approach for PET and PG predictions in a proton treatment planning system

Positron emission tomography (PET) and prompt gamma (PG) detection are promising proton therapy monitoring modalities. Fast calculation of the expected distributions is desirable for comparison to measurements and to develop/train algorithms for automatic treatment error detection. A filtering formalism was used for positron-emitter predictions and adapted to allow for its use for the beamline of any proton therapy centre. A novel approach based on a filtering formalism was developed for the prediction of energy-resolved PG distributions for arbitrary tissues. The method estimates PG yields and their energy spectra in the entire treatment field. Both approaches were implemented in a research version of the RayStation treatment planning system. The method was validated against PET monitoring data and Monte Carlo simulations for four patients treated with scanned proton beams. Longitudinal shifts between profiles from analytical and Monte Carlo calculations were within -1.7 and 0.9 mm, with maximum standard deviation of 0.9 mm and 1.1 mm, for positron-emitters and PG shifts, respectively. Normalized mean absolute errors were within 1.2 and 5.3%. When comparing measured and predicted PET data, the same more complex case yielded an average shift of 3 mm, while all other cases were below absolute average shifts of 1.1 mm. Normalized mean absolute errors were below 7.2% for all cases. A novel solution to predict positron-emitter and PG distributions in a treatment planning system is proposed, enabling calculation times of only a few seconds to minutes for entire patient cases, which is suitable for integration in daily clinical routine.

Calculated beam quality correction factors for ionization chambers in MV photon beams

The beam quality correction factor, [Formula: see text], which corrects for the difference in the ionization chamber response between the reference and clinical beam quality, is an integral part of radiation therapy dosimetry. The uncertainty of [Formula: see text] is one of the most significant sources of uncertainty in the dose determination. To improve the accuracy of available [Formula: see text] data, four partners calculated [Formula: see text] factors for 10 ionization chamber models in linear accelerator beams with accelerator voltages ranging from 6 MV to 25 MV, including flattening-filter-free (FFF) beams. The software used in the calculations were EGSnrc and PENELOPE, and the ICRU report 90 cross section data for water and graphite were included in the simulations. Volume averaging correction factors were calculated to correct for the dose averaging in the chamber cavities. A comparison calculation between partners showed a good agreement, as did comparison with literature. The [Formula: see text] values from TRS-398 were higher than our values for each chamber where data was available. The [Formula: see text] values for the FFF beams did not follow the same [Formula: see text], [Formula: see text] relation as beams with flattening filter (values for 10 MV FFF beams were below fits made to other data on average by 0.3%), although our FFF sources were only for Varian linacs.

Attitudes and awareness of suture anchor cost: a survey of shoulder surgeons performing rotator cuff repairs

BACKGROUND

The cost of health care in the United States accounts for 18% of the nation's gross domestic product and is expected to reach 20% by 2020. Physicians are responsible for 60%-80% of decisions resulting in health care expenditures. Rotator cuff repairs account for $1.2-$1.6 billion in US health care expenditures annually. The purpose of this study is to assess surgeons' cost awareness in the setting of rotator cuff repairs. The hypothesis is that practice environment and training affect cost consciousness and incentivization will lead to more cost-effective choices.

METHODS

In this cross-sectional study, a 21-item survey was distributed via the email list services of the American Shoulder and Elbow Surgeons and Arthroscopy Association of North America. Data collected included demographics, variables regarding rotator cuff repair (technique, number of companies used, procedures per month), and knowledge of costs.

RESULTS

Responses from 345 surgeons in 23 countries were obtained with the majority (89%) being from the United States. Most surgeons were "cost-conscious" (275, 70.7%). Of these surgeons, 62.9% are willing to switch suture anchors brands to reduce overall costs if incentivized. Cost-conscious surgeons were more likely to be fellowship trained in shoulder and elbow (51.81% vs. 38.57%, P = .048), be paid based on productivity (73.53% vs. 61.43%, P = .047), and receive shared profits (85.4% vs. 75%, P = .02).

CONCLUSION

The majority of orthopedic surgeons are both cost-conscious and willing to change their practice to reduce costs if incentivized to do so. A better understanding of implant costs combined with incentives may help reduce health care expenditure.