Medicine Center Research Articles

Out of pocket costs and financial hardships among breast cancer patients in Egypt: a pilot study

ABSTRACT Breast cancer shows high global prevalence with high mortality rates and hence high financial burden specifically in low and middle-income countries (LMICs). This pilot study took place in Egypt to quantify the out-of-pocket expenses and analyze the financial burden faced by breast cancer patients under the governmental reimbursement system. The study took place at the Center of Clinical Oncology and Nuclear Medicine, Cairo University. We collected data on out-of-pocket costs, subjective financial burden and disease coping strategies through an interviewer-administered questionnaire. Then, we used descriptive statistics and Pearson correlations for analysis and the results were presented in Egyptian pound (EGP) and dollars (USD). The study included 60 breast cancer patients from Cairo University's oncology center, aged 27–75 years. The average direct medical costs, including medications, diagnostics, and medical care outside the center was 1096 EGP (35.47 USD) per month. Non-medical costs, such as food and travel, cost an average of 381 EGP (12.33 USD) per month and indirect costs of 1160 EGP (37.47 USD) per month. The total out of pocket costs of breast cancer showed an average of 2637 EGP (85.34 USD) per month. Around 32% of patients experienced catastrophic financial burden. Coping strategies included medication adjustments and lifestyle changes due to financial constraints. There was moderate positive correlation (r = 0.7) between the perceived financial burden and the number of adopted strategies. Breast cancer patients face financial challenges that may lead to impoverishment due to the excessive direct and indirect expenses associated with treating the disease. Therefore, we recommend disease screening, early detection, and facilitated access to subsidized healthcare.

Transformation of Traditional Oriental Medicine in the Modern World

The article examines one of the most important modern issues concerning the development of traditional medicines: their transformation into TMS — traditional medical systems. It is known that in some Asian countries (China, India, Vietnam, etc.) such TMS legitimately exist since the middle or end of the XX century; they are institutionalized and structured similarly to the conventional/biomedical healthcare system. TMS operates there in parallel with and in close interaction with the main medical system, with biomedicine as the primary educational basis for specialist training. Healthcare in these countries includes in its unified system a parallel with a second ministry or department, a complex structure of university training of specialists, specialized hospitals and clinics of various kinds — either separate or organized on the basis of complementarity, different pharmaceutical bases. At the same time, TMS, primarily from India and China, have long since spread to many other countries of the world and, as complementary or alternative forms of medicine, strive to form global forms (for example, the concept of “global Ayurveda” is already being used). The article first of all considers the specifics of the terminological apparatus associated with non-conventional medicine. Further the author analyzes the current situation of TM and TMS as it has developed to date in foreign countries, and compares it with what has been happening in the last three decades in the Russian Federation, primarily in the Republic of Buryatia and the Zabaykalsky Krai. Traditional medicine was initially introduced there with the practice of Buddhist lamas and with written sources from Tibet through Mongolia; later the Buryats on the basis of translated sources developed a relatively independent branch of Buryat-Tibetan medicine, which back in the XIX century spread first to St. Petersburg, and then to other cities and regions of the Russian Empire. Nowadays, in the main centers of traditional medicine in Buryatia and the Zabaykalsky Krai, the institutions of a medical system have been formed, making it possible to create a full-fledged TMS — a parallel, but closely intertwined with biomedicine branch of healthcare, which can easily become an alternative branch of healthcare in the Republic of Buryatia, where the traditional Buryat-Tibetan medicine has been institutionalized within the healthcare system since the 1980s. Currently, the Center for Oriental Medicine and its units are receiving a significant number of combatants for rehabilitation and are actively working in the field of restorative medicine.

A Systematic Review of Micropulse Laser Trabeculoplasty (MLT) in Primary Open-Angle Glaucoma (POAG) Management: Efficacy, Safety, and Future Perspectives.

Micropulse laser trabeculoplasty (MLT) is gaining attention as a non-invasive treatment option for primary open-angle glaucoma (POAG), offering an alternative to traditional surgeries and medications. This systematic review evaluates the effectiveness, safety, and potential of MLT in glaucoma management. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, following the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) recommendations. We identified 79 articles, and after removing duplicates and screening abstracts, 56 articles were eligible for further review. A detailed full-text analysis was conducted on 26 articles, of which 15 met the predefined inclusion criteria. MLT shows promise as a primary or adjunctive treatment for reducing intraocular pressure (IOP) in glaucoma and ocular hypertension patients. Current evidence supports its efficacy and safety; however, additional long-term studies are needed to confirm its durability and compare its effectiveness with traditional surgical and pharmacological approaches. Standardizing treatment protocols and refining patient selection criteria could enhance MLT's clinical value and support its broader adoption in glaucoma care.

Consensus evidence-based clinical practice guide for the diagnosis and management of osteoporosis in childhood and adolescence

BackgroundThe incidence of osteoporosis in children has increased dramatically during the last decade. This has been attributed to better survival rates of children living with chronic disorders, the increased use of medications known to have a negative impact on the children’s bones, and the increased preference for indoor activities and sedentary life in healthy children. Recent advances in pediatric osteoporosis definition, along with a lack of management recommendations or national consensus on its diagnosis and treatment, have led to a wide range of approaches being implemented to manage this illness. The aim of this work was to develop an optimal evidence-based consensus, target-oriented, on-steered therapeutic approach for children with osteoporosis. Based on 15 key clinical questions, a qualitative literature evaluation was conducted to provide evidence-based recommendations for the treatment of pediatric osteoporosis. An expert panel of 14 pediatric osteoporosis specialists conducted a Delphi survey. The level of evidence for each element was assessed using the Oxford Centre for Evidence-based Medicine (CEBM) System, when available, and/or based on the expert panel’s personal experience. All recommendations with an agreement rate of 75% or higher were included.ResultsThirty-six recommendations, categorized into 13 domains, had evidence 4 or 5 and consequently were included in the Delphi survey. This was assessed online and a response rate of 82.4% was achieved. Delphi 2 round revealed that all the recommendations achieved 75% or more level of agreement and therefore have been accepted and included in this management recommendations. Based on that an algorithm showing an approach to pediatric osteoporosis management and maintenance of therapy has been developed.ConclusionFor the management of children with osteoporosis, consulting a pediatric bone specialist is strongly advised, either by referral or by advice. This is extremely relevant because children are uniquely capable of recovering spontaneously or with the assistance of medication. This includes also vertebral fractures reshaping. Consequently, there is a huge opportunity to improve bone mass accretion and thus musculoskeletal health in children with osteoporosis.

Evaluation of five questionnaires for obstructive sleep apnea screening in the elderly

Obstructive sleep apnea (OSA) often leads to complications in the elderly. This study compares the usefulness of five screening tools for OSA in elderly patients. Data from elderly patients diagnosed with OSA, collected from the Sleep Medicine Center of the First Affiliated Hospital of Guangzhou Medical University from January 2012 to June 2017, is analyzed. The sensitivity, specificity, predictive values, area under the curve (AUC), and diagnostic odds ratio (DOR) of the five screening tools are computed and compared. 273 elderly patients with suspected OSA are included, of whom 189 are male (69.2%). The Berlin Questionnaire has an AUC of 0.670 (95%CI: 0.611–0.725) at different cut-off points. The sensitivity and specificity of the Berlin Questionnaire are noticeably high at 0.653 (0.587–0.719) and 0.608 (0.497–0.719), 0.699 (0.621–0.776) and 0.533 (0.449–0.616), and 0.803 (0.713–0.892) and 0.503 (0.433–0.572) when the AHI is 5, 15, and 30 times/hour, respectively. The GOAL Questionnaire has the highest DOR at AHI cut-off points of 5 and 15 times/hour, while Berlin has the highest DOR at an AHI cut-off point of 30 times/hour. Comprehensive use of these five screening questionnaires for suspected OSA in elderly patients aged 60 years and older is valuable and worth promoting among the elderly population.

Evaluation of prenatal-postnatal outcomes and risk factors in fetal jejunoileal atresia

Aims: The aim of the current study is to reveal ultrasonographic and clinical features, evaluation of prenatal-postnatal outcomes and risk factors of fetal jejunoileal atresia. Methods: This retrospective study evaluated all cases of fetal jejunoileal atresia identified between 2018 and 2024 at a tertiary centre of maternal-fetal medicine. In all cases, the pediatric surgery team confirmed the definitive diagnosis of jejunoileal atresia during the postnatal period. The cohort was divided into two groups, the "poor outcome" and "good outcome", in order to compare and evaluate risk factors determining the outcome. Results: During the study period, a total of 18 cases were recorded. All cases in the cohort managed to reach live birth. 15 (83.3%) neonates survived after the surgical procedure, whereas 3 (16.7%) neonates were deceased during the post-operative period. Short bowel syndrome was diagnosed in 2 (11.1%) living cases during postoperative follow-ups.

Study of the feasibility of polar body transfer combined with preimplantation genetic testing for blocking the intergenerational transmission of mitochondrial genetic diseases

To assess the feasibility of first polar body transfer (PB1T) combined with preimplantation mitochondrial genetic testing for blocking the transmission of a pathogenic mitochondrial DNA 8993T>G mutation. A Chinese family affected with Leigh syndrome which had attended the Reproductive Medicine Centre of the First Affiliated Hospital of Anhui Medical University in September 2021 was selected as the study subject. Controlled ovarian hyperstimulation was carried out for the proband after completing the detection of the mitochondrial DNA 8993T>G mutation load among the pedigree members. Mature MII oocytes were inseminated by intracytoplasmic sperm injection (ICSI), cultured in vitro for 5 to 6 days to the blastocyst stage, and trophoblastocytes were obtained by microbiopsy. Mitochondrial DNA testing (PGT-MT) and chromosomal aneuploidy (PGT-A) analyses were carried out after whole-genome amplification, and the embryos with zero mutation load were selected for transfer. Amniotic fluid and umbilical cord blood samples were collected during middle pregnancy and after birth respectively for mitochondrial DNA testing to verify the reliability of embryo screening. As an attempt, PB1 with good morphology of MII oocytes was selected for transfer into the enucleated oocytoplasm from healthy donors, followed by ICSI fertilization, blastocyst culture and PGT of embryos using the same procedure. This study has been approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (No. 2021zhyx-B12). An antagonist protocol was used for ovarian stimulation, and a total of 19 oocytes were obtained, of which 14 MII were fertilized by ICSI, and 2 had developed into blastocysts. PGT-MT was carried out on biopsied trophoblastocytes, in which the mitochondrial DNA 8993T>G mutation load was not detected in one embryo, the other was 100% mutated, and the mutation loads of the remaining unfertilized eggs and developmentally arrested embryos ranged from 0% ~ 100%, presenting a clear biased distribution. With fully informed consent, one PGT-MT zero mutation load blastocyst was transferred and clinical pregnancy was achieved. Mitochondrial DNA and chromosomal testing of amniotic fluid cells during middle pregnancy had revealed no abnormalities. The proband had delivered a healthy boy through Caesarean section at 39+5 weeks of gestation, and no mutation was detected in the cord blood sample. Five well-formed PBs from 14 eggs were selected for PB1 transfer, followed by ICSI and culture, and two of the reconstituted embryos had formed blastocysts, with none of the above mutations detected in the biopsied samples. The PGT-MT technology can help families affected with mitochondrial diseases to have healthy offspring. PB1 transfer in combination with ICSI and PGT-MT holds the promise of turning waste into treasure and providing an alternative means of fertility for such families.

The Impact of Dating Twin Pregnancy by the Larger, Smaller or Mean Twin Crown-Rump Length: A Retrospective Cohort Study.

To evaluate the impact of twin dating by ultrasound-measured crown-rump length (CRL) of the larger (CRL-L), smaller (CRL-S) or mean twin measurement (CRL-M) on the rates of preterm birth (PTB) and detection of small for gestational age (SGA) births. A retrospective cohort study. A tertiary fetal medicine centre (London, UK). All twin pregnancies between 1998 and 2023 who underwent first trimester CRL ultrasound assessment and fetal growth assessment. Data collection included CRL measurement, estimated fetal weight (EFW), pregnancy outcome and birthweight (BW) for each twin. Pregnancies were retrospectively re-dated by CRL-S, CRL-L and CRL-M. SGA < 10th centile and extreme PTB rates (< 28 weeks). In the 1129 twin pregnancies, median CRL-S was 61 mm (interquartile range [IQR]: 56.0-66.0) and CRL-L was 63 mm (IQR: 58.4-68.9) with a mean discordance of 4.0%. Prenatal SGA diagnosis occurred in 19.8% and 23.1% of smaller twins when dated by CRL-S and CRL-L, respectively. When pregnancies were dated by CRL-M versus CRL-S or CRL-L, there was no difference in prenatal SGA diagnosis (p = 0.275 and p = 0.419); SGA at birth (p = 0.132 and p = 0.325); or extreme PTB (p = > 0.999 and p = 0.765 respectively). Dating by the smaller, larger or mean twin CRL does not significantly alter rates of extreme preterm birth, SGA detection or SGA birth. Dating by the mean twin CRL reduces stigmatisation of the smaller twin and retains the utility of accurate gestational age assessment without impacting clinical outcomes.

Association of serum vitamin D level and live birth rate in women undergoing frozen embryo transfer-a retrospective cohort study.

To assess the association of serum vitamin D level and the live birth rate in women undergoing frozen embryo transfer (FET). This is a retrospective cohort study involving 1489 infertile women who had frozen embryo transfer at two tertiary reproductive medicine centres from 2019 to 2021. Only the first frozen embryo transfer was included for women who had repeated transfers during the period. Archived serum samples taken at LH surge or before the start of progestogens for FET were analysed for 25(OH)D levels using mass spectrometry. The main outcome measure was the live birth rate. Vitamin D deficiency was defined as serum 25(OH)D < 50nmol/l (< 20ng/ml) based on the Endocrine Society Clinical Practice guidelines. The median age was 36 (25th-75th percentile 34-38) years. 37.7% (561/1489) women had cleavage stage embryo transfer and 62.3% (928/1489) women had blastocyst transfer. When analysing the results based on the threshold in the Endocrine Society guideline of 50 nmol/l (20 ng/ml) for vitamin D deficiency, there were no statistically significant differences in the live birth rate in the vitamin D deficient and non-deficient groups [151/489 (30.9%) vs 341/998 (34.2%), OR 0.861, 95% CI 0.683-1.086 P = 0.205]. There were no statistically significant differences in the pregnancy rates, ongoing pregnancy rates, and miscarriage rates between the two groups. Serum vitamin D is not associated with birth rate in women undergoing FET.

IMPACT MONITORING OF LOW AND HIGH DEXAMETHASONE DOSES ON COVID-19 OUTCOMES IN HODEIDAH, YEMEN: A PHARMACOEPIDEMIOLOGICAL STUDY

Objectives: The study aimed to describe the pharmacoepidemiological properties of high and low dexamethasone doses on patients from COVID-19 in Hodeidah, Yemen. Methodology: A randomized clinical trial included 192/323 patients with COVID-19 (28/49 cases in the first wave 2020 and 164/274 cases in the second wave 2021), aged from 3 to 80 years old, confirmed by real time-polymerase chain reaction. All patients were admitted in the isolation department, Center of Tropical Medicine and Infectious Diseases, AL Thawara Public Hospital Authority, Hodeidah, Yemen. 28 patients received high dose of dexamethasone (20–10 mg daily for 10 days) with standard care in the first wave and 164 patients received low dose of dexamethasone (6–8 mg daily for 10 days) in the second wave with standard care. Results: The results showed non-significant differences between the impact of dexamethasone in both waves with different doses of dexamethasone (X2: 1.70; p=0.91). On the other mean, the case fatality rate (CFR) in the first wave with high dose was 10.71% and CFR of the second wave with low dose was 22.29%. While the results showed significant differences between high dose and low dose group with mechanical ventilator “mechanical ventilation (MV)” (X2: 7.10; p=0.0076), the CFR of patients with MV and high dose was 37% and CFR of the second wave with low dose was 77% In addition, all admitted cases had acute respiratory distress syndrome and the onset date of symptom was 2 weeks before hospitalization. Old age, chronic diseases, and co-infection may be contributing factors to effect on dexamethasone efficacy and excess mortality among COVID-19 patients. Conclusion: The study assessed the effectiveness of dexamethasone in high and low dose in treating patients hospitalized with COVID-19 in Hodeidah, Yemen and found difference between mortality and recovery outcomes with high and low dose where the high doses of dexamethasone had good outcome for critical cases with MV.

Fetal Therapy for Severe Drug-Resisted Tachyarrhythmia With Progressive Hydrops by Fetoscopic Transesophageal Pacing: A Successful Attempt in Single Chinese Fetal Medicine Center.

To describe the outcome of a case of severe drug-resistant fetal tachyarrhythmia with progressive hydrops treated with fetoscopic transesophageal pacing (FTEP). A case of fetal tachyarrhythmia complicated by progressive hydrops is presented. The fetus, diagnosed at 26+2weeks of gestation, had supraventricular tachycardia with a mechanism suggestive of atrial reentry. Maternal treatment included digoxin, sotalol and amiodarone, which were ineffective in controlling the arrhythmia. After failure of pharmacological therapy, FTEP was performed. A male baby was delivered by cesarean section, with the Apgar scores of 10 at 1min, 5 and 10min at 35+2weeks of gestation. An initial neonatal electrocardiogram demonstrated normal sinus rhythm. Follow-up is now up to 1year, without tachyarrhythmia or cardiac dysfunction. FTEP offers a potential rescue therapy for cases of severe drug-resistant fetal tachyarrhythmia associated with progressive fetal hydrops and cardiac dysfunction.

Baitul Hikmah Pusat Keemasan Ilmu Pengetahuan Dinasti Abbasiyah

The Islamic Abbasid Dynasty experienced progress in the field of Education which was advanced, solid, complete and well integrated supported by an adequate education system at that time. Baitul Hikmah which became the center of scientific development, especially mathematics (Al-Khwarizmi), astronomy (Al-Biruni), and medicine (Ibn Sina) which became an intellectual center and packaging period during the Abbasid Dynasty. This study uses a systematic literature review research method with a qualitative descriptive research approach through literature review or literature studies, journals, articles, and books that discuss Baitul Hikmah during the Abbasid Dynasty. The results of this study show that Baitul Hikmah was a library and translation center during the Abbasid Dynasty located in Baghdad. In addition, Baitul Hikmah has a considerable role in developing Islamic civilization, even at that time Islam experienced its heyday "The golden age of Islam".

Clinical characteristics, management, and malignancy rate of oral lichen planus: A European multicenter study.

Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous condition that includes a spectrum of oral clinical manifestations ranging from mild painless white lesions to painful erosions and ulcers. The purpose of this European multicenter study is to describe the general characteristics of OLP lesions, the clinical and histopathological diagnosis, and the management of OLP at different European Oral Medicine and Maxillofacial Surgery centers, in order to minimize selections biases and provide information about the current trends in the treatment of OLP across Europe. Data and histopathological records of patients with OLP were retrospectively revised and only those patients that fulfilled the diagnostic criteria from the 2016 position paper by American Academy of Oral and Maxillofacial Pathology were included. The following data were recorded for each patient: gender, age, voluptuary habits, risk factors for OLP (psychological stress, medications, systemic diseases), location of OLP lesions, clinical presentation, patterns of clinical expression, symptoms, treatment, possible clinical improvement, and malignant transformation. A total of 565 OLP patients (422 females, 143 males) fulfilled the inclusion criteria. The mean age of the study population at diagnosis was 60.11 years. In 262 patients (46.4 %), just a site of OLP was identified: in 186 of these "one-site" patients, OLP was diagnosed just in buccal mucosa. The most frequently observed clinical pattern was reticular. When evaluating the treatment received, 294 patients were kept in follow up with a Wait-and-see approach. The most frequent treatment regimen was the use of topical corticosteroids (123 patients). A significant statistical association was found between the prescription of topical corticosteroids (P < .0005) or retinoids (P < .000005) and symptoms improvement. Squamous cell carcinoma associated with OLP lesions was observed during the follow-up in 9 OLP patients out of 565 (1.6 %). Reticular and mixed clinical patterns are the most frequent subtypes of OLP. The use of topical corticosteroids and retinoids for the management of OLP seems to allow good improvement results of symptoms and signs. A clinical long-term follow-up is fundamental due to the chronic nature of OLP and possible malignant transformation.

Correlation of Pleural Fluid Analysis with Thoracoscopy Guided Biopsy in Undiagnosed Exudative Pleural Effusion

Abstract Background: Despite having a high burden of tuberculosis (TB) and thus pleural effusions, there is very little data or studies available based in India on pleural fluid analysis and thoracoscopic-guided biopsy, and their correlation with each other. The aim of this study was to compare and correlate various parameters of pleural fluid analysis with thoracoscopic-guided biopsy especially in undiagnosed pleural effusions in Indian setting. Patients and Methods: This prospective observational study was carried out in a total of 40 patients above 18 years of age after obtaining institutional ethics committee clearance and written informed consent who were admitted in the Department of Pulmonary Medicine, Sarvodaya Hospital and Research Centre, from August 2022 to January 2024 covering a total duration of 18 months. The data were entered into MS excel and analyzed by SPSS statistical software. Descriptive statistics such as frequency, standard deviation, and t-test was used to determine level of statistical significance which was set at 0.05. Results: The mean age of the study participants was found to be 53.23 ± 19.95 years, male-to-female sex ratio was 1.6:1. The most common cause of exudative pleural effusion was tuberculous pleuritis (40%) followed by malignancy (22.5%). Shortness of breath (67.5%) and chest pain (50%) were the predominant clinical symptoms. Malignant pleural effusions showed a polymorphic predominant cytology while lymphocytic predominant cytology was present in chronic inflammatory effusions predominantly tubercular. Parapneumonic effusions exhibited elevated adenosine deaminase (ADA) levels and more neutrophils in pleural fluid, whereas tubercular effusions demonstrated increased ADA levels with abundance of lymphocytes. Metastatic adenocarcinoma was the most common type of malignancy found on histopathology. Necrotizing granulomatous inflammation and granulomas were the predominant findings on histopathological examination and imprint cytology, observed in 40% and 35% of the study participants, respectively. Pleural biopsy has a significantly higher diagnostic yield for TB as well as malignancy (P &lt; 0.05). Conclusion: Medical thoracoscopy serves as an effective, safe, and well tolerate diagnostic tool for pulmonologists in assessing undiagnosed pleural effusions postthoracentesis.

Увеит, ассоциированный с ювенильным идиопатическим артритом у детей Республики Саха (Якутия): эпидемиологические данные и серия клинических наблюдений

The article presents a comprehensive cohort retrospective study of patients diagnosed with JIA who underwent examination and treatment in the cardiorheumatology department of the Pediatric Center of the Republican Hospital No. 1 – the National Center of Medicine named after M.E. Nikolaev in 2016-2023. Patients who have developed uveitis have been selected for a detailed analysis. The prevalence of uveitis in the RS(I) was 8.6 per 100,000 children, of which 11.8 among Sakha children and 5.6 among Russians. Uveitis among children with JIA is more common in boys of Sakha nationality, and is more common in older children without correlation with types of JIA. Low efficacy of initial methotrexate therapy has been demonstrated. All cases of de novo uveitis have been recorded only in children of Sakha nationality, most of whom are boys. Keywords: uveitis, juvenile idiopathic arthritis, children, Russians, Sakha, Yakutia.

Impact of previous cesarean delivery on pregnancy and neonatal outcomes in subsequent in vitro fertilization/intracytoplasmic sperm injection and single frozen-thawed embryo transfer: a historical cohort study with a large sample size.

This study aims to explore the impact of a woman's previous cesarean delivery (CD) on pregnancy and neonatal outcomes for subsequent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and single frozen-thawed embryo transfer (FET), compared with vaginal delivery (VD). This was a retrospective cohort study that included a total of 5817 patients who desired to transfer a single vitrified-thawed blastocyst from the same oocyte retrieval cycle as their last live birth between January 2011 and January 2021 at a single reproductive medicine center. Patients with a single previous CD were classified in the CD group, while those with a single VD were assigned to the VD group. All patients underwent single blastocyst transfer. To minimize the effect of confounding factors, modified Poisson regression analyses with different adjustment models and propensity score matching (PSM) analyses were performed. Women with a previous CD had significantly lower rates of biochemical pregnancy, clinical pregnancy, and live births than those with a previous VD. Meanwhile, the CD rate was significantly higher in the CD group. There were no significant differences in the rates of multiple pregnancies, miscarriage, ectopic pregnancy, multiple live births, maternal complications, or preterm and neonatal outcomes. A previous CD is associated with a significant reduction in the rates of biochemical pregnancy, clinical pregnancy, and live birth in patients undergoing subsequent single frozen-thawed blastocyst transfer. Additionally, it increases the rates of repeat CD.

Dr Pranjivandas Manekchand Mehta MD, MS, FCPS 1889-1981 and Caraka Samhita (1949).

Pranjivandas Manekchand Mehta (1889-1981), MD, MS, FCPS, also known as Dr P M Mehta, was an Indian physician and surgeon in Bombay, who then became the personal physician of the Maharajah Jamsaheb of the former Princely State of Nawanagar, Gujarat, British India. The Jamsaheb appointed Mehta as the Chief Medical Officer of Nawanagar, and with the guidance of the French radiologist, Jean Saidman, oversaw the construction of the first solarium in India. Mehta persuaded the Jamsaheb to fund an institution dedicated to Ayurvedic studies, named the Shri Gulabkunverba Ayurvedic Society, the precursor to the first Ayurveda college in India, and he became the Director of the Central Institute of Research on Indigenous Systems, which later came under the umbrella of the Institute of Teaching and Research in Ayurveda, Jamnagar. P M Mehta was instrumental in establishing a medical college in Nawanagar's capital, now known as the M. P. Shah Medical College, Jamnagar. His work in Ayurvedic medicine and assembling a group of Sanskrit scholars led to a detailed translation of the ancient Sanskrit medical text Çaraka Samhita, also spelt Charaka Samhita, into English, Hindi and Gujarati, published in six volumes in 1949. In 2022, the World Health Organization and the Indian Government established the Global Centre for Traditional Medicine in India, and chose Jamnagar as its location, noting that that was where graduate-level Ayurvedic studies began. Mehta's efforts in Ayurvedic education and the Çaraka Samhita translations have largely been forgotten over several decades, and a recently issued reprint omits the mention of his name. The aim of this paper is to give some glimpses into Mehta's life and his role in the revival of Ayurveda in India, during the lead-up to and during the early years of independent India.

Diagnostic and therapeutic hysteroscopy in Ethiopia: a retrospective study on practice and outcomes

BackgroundHysteroscopy is considered the standard for evaluating the uterine cavity. Limited data exists regarding hysteroscopy in Ethiopia. Therefore, the objective of the study was to describe the diagnostic and operative hysteroscopic procedures at St. Paul’s Hospital.MethodologyA three-year retrospective descriptive study examined patients who underwent diagnostic and therapeutic hysteroscopy at the Center for Fertility and Reproductive Medicine, St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia, from June 2018 to June 2021. Descriptive statistics were employed to summarize the findings observed during the hysteroscopy procedures.ResultA total of 328 patient records underwent review and analysis in the study. The mean participant age was 31.9 years (31.9 ± 5.1 years), with about 81.4% being nulliparous. Primary infertility (48.5%) was the leading indication for hysteroscopic evaluation, followed by secondary amenorrhea (18%), secondary infertility (17.4%), and abnormal uterine bleeding (8.8%). Concerning hysteroscopic procedures, 6.1% of participants exhibited no uterine cavity abnormalities. Primary hysteroscopy findings comprised intracavitary adhesions (48.2%), endometrial polyps (18%), and submucosal myomas (9%). Adhesiolysis stood out as the foremost surgical procedure, conducted in 48.2% of patients, followed by polypectomy in 20.7%, and fibroid removal in 9%. The complication rate was 2.4%, exclusively during operative hysteroscopy, with uterine perforation observed in six patients.ConclusionOur hysteroscopic evaluation was predominantly requested for primary infertility cases, with secondary amenorrhea, secondary infertility, and abnormal uterine bleeding also being commonly encountered indications. Adhesiolysis was the leading intervention during hysteroscopy, while uterine perforation was the main complication. The hysteroscopy procedures exhibited a strong safety profile, with few complications noted. Future studies should address factors affecting outcomes in diagnostic and operative hysteroscopy, and common factors linked to intrauterine adhesions.

Ectopic pregnancy is associated with increased risk of displaced implantation window: a retrospective study

BackgroundTo evaluate the risk factors associated with WOI (window of implantation) displacement based on ERT (endometrial receptivity test), and to confirm the association of ectopic pregnancy with WOI displacement.MethodsThis is a retrospective study at the Reproductive Medicine Center of Xiangya Hospital from January 2020 to April 2024, consisting of 934 patients who performed ERT. The patients underwent 3771 assisted reproductive technology (ART) cycles and 2629 embryo transfer (ET) cycles, with each patient experiencing at least one implantation failure. The study utilized generalized estimation equation (GEE) models to examine factors associated with WOI displacement, adjusting for confounding factors like age, body mass index (BMI), and infertility type. Non-linear relationships between age or BMI with WOI displacement were explored using generalized additive models (GAM) with thresholds detected by segmented regression.ResultsAmong the patients, 60.17% were in the receptive phase, 39.40% in the pre-receptive phase, and 0.43% in the post-receptive phase. Ectopic pregnancy history increased the risk of WOI displacement by 62% (aOR 1.62, 95%CI 1.03–2.53, P = 0.035), patients over 35 years old had a 50% higher risk of WOI displacement compared to patients under 34 (aOR 1.50, 95% CI 1.12-2.00, P = 0.007). Secondary infertility showed a 26% lower risk of WOI displacement than primary infertility without statistical significance (aOR 0.74 95% CI 0.54–1.02, P = 0.062). BMI ≥ 22 kg/m2 was associated with a 25% increased risk of WOI displacement without statistical significance (aOR 1.25, 95% CI 0.94–1.67, P = 0.12).ConclusionEctopic pregnancy and advanced age (≥ 35) are significantly associated with increased risk of WOI displacement. Primary infertility and higher BMI (≥ 22 kg/m2) tend to increase the risk of WOI displacement though without statistical significance.Clinical trial numberNot applicable.

Bile acids in follicular fluid: potential new therapeutic targets and predictive markers for women with diminished ovarian reserve

ObjectiveTo investigate the changes in bile acid (BA) metabolites within the follicular fluid (FF) of patients with diminished ovarian reserve (DOR) and to identify novel diagnostic markers that could facilitate early detection and intervention in DOR patients.DesignA total of 182 patients undergoing assisted reproductive technology (ART) were enrolled and categorized into the normal ovarian reserve (NOR) group (n = 91) or the DOR group (n = 91) to measure BA levels in FF. To identify the changes in granulosa cells (GCs), we collected GCs from an additional 7 groups of patients for transcriptome sequencing.SettingReproductive medicine center within a hospital and university research laboratory.PopulationA total of 182 patients undergoing assisted reproductive technology were enrolled and categorized into the NOR group (n = 91) or the DOR group (n = 91).MethodsIn this study, BA metabolites in FF of DOR and NOR patients were analyzed in detail by targeted metabolomics, and the correlation between BA levels in FF and clinical indicators was discussed. Then, we constructed a diagnostic model for DOR using the random forest algorithm based on five different BAs. Additionally, we performed a functional enrichment analysis on differentially expressed genes (DEGs) in GCs from both DOR and NOR patients.Main outcome measuresBA levels in FF and their correlation with clinical indicators; the areas under the curve (AUCs) of the random forest diagnostic model for DOR; and the DEGs and corresponding functional enrichment results of GC RNA analysis.Result (s)The levels of lithocholic acid, chenodeoxycholic acid, ursodeoxycholic acid, deoxycholic acid and cholic acid in FF of DOR group were lower than those of NOR group. And significant reductions in total, primary, secondary, and unconjugated BA levels were observed in the DOR group. The above five BAs levels were closely related to indicators of ovarian reserve. The AUC of the diagnostic model based on the above five BAs was 0.964. Based on transcriptome sequencing data from two groups of GCs, a total of 482 up-regulated and 654 down-regulated DEGs were identified. Gene ontology analysis revealed that the metabolic and biosynthetic processes of fatty acids, steroids, and cholesterol were enriched in these DEGs, whereas Kyoto Encyclopedia of Genes and Genomes analysis indicated enrichment of fatty acid and ovarian steroidogenesis.Conclusion(s)The levels of multiple BA metabolites in FF are significantly lower than those in patients with DOR and are closely related to the evaluation of ovarian reserve function.