Consecutive Losses Research Articles

Intravenous immunoglobulin and prednisolone to women with unexplained recurrent pregnancy loss after assisted reproductive technology treatment: a protocol for a randomised, double-blind, placebo-controlled trial

IntroductionRecurrent pregnancy loss (RPL), defined as two or more consecutive pregnancy losses in the first trimester, affects around 5% of fertile women. The underlying causes remain unknown in up to...

The Effect of Profitability, Liquidity, and Solvency on Financial Distress of Textile and Garment Companies in Indonesia

Indonesia's manufacturing GDP growth experienced a downward trend from 2015-2020. All manufacturing companies experienced a decline, including textile and garment sub-sector companies. There are 4 textile and garment sub-sector companies that have suffered consecutive losses and high raw material costs caused indications of financial distress in textile and garment sub-sector companies. This study aims to determine the effect of profitability, liquidity, and solvency on financial distress in textile and garment sub-sector companies for the period 2015-2020. Profitability is measured by Return On Asset (ROA), liquidity is measured by Current Asset (CR), solvency is measured by Debt to Asset (DAR), and financial distress is measured by Altman Z-score. This study sample used 15 textile and garment sub-sector companies listed on the Indonesia Stock Exchange. This study uses a quantitative approach. Data analysis method using Pooled Least Square. The results showed that profitability and liquidity had a positive and significant effect on financial distress. Solvency has a negative and significant effect on financial distress.

Detection of p53 codon 72 polymorphisms among Sudanese women with recurrent spontaneous abortion

Recurrent Spontaneous abortion (RSA) is defined as consecutive pregnancy loss before 20 weeks of gestation. This study aimed to detect p53 codon 72 polymorphisms among Sudanese women with recurrent spontaneous abortion. A case-control study was conducted at the national centre of neurological sciences, Khartoum, Sudan. All patients attending the obese and gaina unit at Ibraheim Malike teaching hospital and diagnosed with recurrent spontaneous were included. In addition, healthy women with no history of abortion were selected as a control group. 5 ml of blood for each participant was collected in EDTA containers. DNA was isolated by the standard phenol-chloroform extraction method. The p53gene was amplified using conventional PCR, the PCR products were sent for sequencing to Macrogen Europe Laboratory. The most affected age group was 34 - 40 years 25 (58.1%), and most of the cases had abortions three times with a frequency of 77.3 %. For The PCR 39 (90%) of cases were positive for the p53 allele, while11 (22%) of the controls were positive for the p53 allele. According to this research, the P53 codon72 polymorphism might become one of the main causes of unexplained diagnosis in women with recurrent spontaneous abortion.

Consecutive gain and loss in body weight and waist circumference with risk of subsequent breast cancer in Korean women.

This study investigated the association between longitudinal changes in weight and waist circumference and breast cancer risk according to menopausal status. This retrospective cohort study used data from the population-based Korean National Health Insurance Service (NHI) database. The study population included women aged ≥40 years who consecutively underwent three biennial breast cancer screenings between 2009-2014 and were followed up until 2020. The percentage changes in weight and waist circumference during the three screenings were calculated and categorized into five groups based on the level of increase or decrease in these two factors. Hazard ratios (HRs) and 95% confidence intervals (95% CI) for breast cancer risk were calculated and adjusted for other factors. Of 691,253 premenopausal and 1,519,211 postmenopausal women, 9485 and 12,553 breast cancer cases were identified, respectively, during a median 6.9 follow-up years. Postmenopausal women with two consecutive weight gains had an increased risk of breast cancer risk (HR = 1.11, 95% CI = 1.01 to 1.22); meanwhile, consecutive weight loss was associated with a decreased risk (HR = 0.84, 95% CI = 0.76 to 0.93). Single time and continuous decreases in waist circumference were associated with a decreased risk (HR = 0.91, 95% CI = 0.85 to 0.98, and HR = 0.84, 95% CI = 0.76-0.93), while single time and continuous increases were associated with an increased risk (HR = 1.08, 95% CI = 1.01 to 1.15, and HR = 1.13, 95% CI = 1.04 to 1.22). Single weight gain was associated with the increased breast cancer risk in premenopausal women (HR = 1.07, 95% CI = 1.01 1.13). Our findings suggest a dose-response relationship between weight, waist circumference change, and the risk of future breast cancer.

New Insights into Human Biotransformation of BDE-209: Unique Occurrence of Metabolites of Ortho-Substituted Hydroxylated Higher Brominated Diphenyl Ethers in the Serum of e-Waste Dismantlers

Extremely high levels of decabromodiphenyl ether (BDE-209) are frequently found in the serum of occupationally exposed groups, such as e-waste dismantlers and firefighters. However, the metabolism of BDE-209 in the human body is not adequately studied. In this study, 24 serum samples were collected from workers at a typical e-waste recycling workshop in Taizhou, Eastern China, and the occurrence and fate of these higher brominated diphenyl ethers (PBDEs) were investigated. The median concentration of the total PBDEs in the serum was 199 ng/g lipid weight (lw), ranging from 125 to 622 ng/g lw. Higher brominated octa- to deca-BDEs accounted for more than 80% of the total PBDEs. Three ortho-hydroxylated metabolites of PBDEs─6-OH-BDE196, 6-OH-BDE199, and 6'-OH-BDE206─were widely detected with a total concentration (median) of 92.7 ng/g lw. The concentrations of the three OH-PBDEs were significantly higher than their octa- and nona-PBDE homologues, even exceeding those of the total PBDEs in several samples, indicating that the formation of OH-PBDEs was a major metabolic pathway of the higher brominated PBDEs in occupationally exposed workers. An almost linear correlation between 6-OH-BDE196 and 6-OH-BDE199 (R = 0.971, P < 0.001) indicates that they might undergo a similar biotransformation pathway in the human body or may be derived from the same precursor. In addition, the occurrence of a series of penta- to hepta- ortho-substituted OH-PBDEs was preliminarily identified according to their unique "predioxin" mass spectral profiles by GC-ECNI-MS. Taken together, the tentative metabolic pathway for BDE-209 in e-waste dismantlers was proposed. The oxidative metabolism of BDE-209 was mainly observed at the ortho positions to form 6'-OH-BDE-206, which later underwent a consecutive loss of bromine atoms at the meta or para positions to generate other ortho-OH-PBDEs. Further studies are urgently needed to identify the chemical structures of these ortho-OH-PBDE metabolites, and perhaps more importantly to clarify the potentially toxic effects, along with their underlying molecular mechanisms.

The extinction time under mutational meltdown driven by high mutation rates.

Mutational meltdown describes an eco‐evolutionary process in which the accumulation of deleterious mutations causes a fitness decline that eventually leads to the extinction of a population. Possible applications of this concept include medical treatment of RNA virus infections based on mutagenic drugs that increase the mutation rate of the pathogen. To determine the usefulness and expected success of such an antiviral treatment, estimates of the expected time to mutational meltdown are necessary. Here, we compute the extinction time of a population under high mutation rates, using both analytical approaches and stochastic simulations. Extinction is the result of three consecutive processes: (a) initial accumulation of deleterious mutations due to the increased mutation pressure; (b) consecutive loss of the fittest haplotype due to Muller's ratchet; (c) rapid population decline toward extinction. We find accurate analytical results for the mean extinction time, which show that the deleterious mutation rate has the strongest effect on the extinction time. We confirm that intermediate‐sized deleterious selection coefficients minimize the extinction time. Finally, our simulations show that the variation in extinction time, given a set of parameters, is surprisingly small.

Genetic Polymorphisms in the 3'-Untranslated Regions of SMAD5, FN3KRP, and RUNX-1 Are Associated with Recurrent Pregnancy Loss.

Recurrent pregnancy loss (RPL) is typically defined as two or more consecutive pregnancy losses prior to 20 weeks of gestation. Although the causes of idiopathic RPL are not completely understood, vascular development and glucose concentration were reported to correlate with the pregnancy loss. The TGF-β signaling pathway which plays a significant role in pregnancy is activated by the interaction between high glucose and SMAD signaling and affects the vascular cells. SMAD5 and RUNX-1 are involved in the TGF-β signaling pathway and contribute to advanced glycation end products (AGEs) production and vascular development. FN3KRP, a newly described gene, is also associated with vascular diseases and suggested to relate to AGEs. Therefore, in the present study, we investigated associations between RPL risk and genetic polymorphisms of SMAD5, FN3KRP, and RUNX-1 in 388 women with RPL and 280 healthy control women of Korean ethnicity. Participants were genotyped using real-time polymerase chain reaction and restriction fragment length polymorphism assay to determine the frequency of SMAD5 rs10515478 C>G, FN3KRP rs1046875 G>A, and RUNX-1 rs15285 G>A polymorphisms. We found that women with RPL had lower likelihoods of the FN3KRP rs1046875 AA genotype (adjusted odds ratio (AOR), 0.553; p = 0.010) and recessive model (AOR, 0.631; p = 0.017). Furthermore, combination analysis showed that SMAD5 rs10515478 C>G and FN3KRP rs1046875 G>A mutant alleles were together associated with reduced RPL risk. These findings suggest that the FN3KRP rs1046875 G>A polymorphism has a significant role on the prevalence of RPL in Korean women. Considering that it is the first study indicating a significant association between FN3KRP and pregnancy disease, RPL, our results suggest the need for further investigation of the role of FN3KRP in pregnancy loss.

Female reproductive tract microbiota and recurrent pregnancy loss: a nested case-control study

Research questionIs the composition of the endometrial or vaginal microbiota associated with recurrent pregnancy loss (RPL)? DesignEndometrial and vaginal samples were collected from 47 women with two or more consecutive pregnancy losses and 39 healthy control women without a history of pregnancy loss, between March 2018 and December 2020 at Helsinki University Hospital, Helsinki, Finland. The compositions of the endometrial and vaginal microbiota, analysed using 16S rRNA gene amplicon sequencing, were compared between the RPL and control women, and between individual vaginal and endometrial samples. The mycobiota composition was analysed using internal transcribed spacer 1 amplicon sequencing for a descriptive summary. The models were adjusted for body mass index, age and parity. False discovery rate-corrected P-values (q-values) were used to define nominal statistical significance at q < 0.05. ResultsLactobacillus crispatus was less abundant in the endometrial samples of women with RPL compared with controls (mean relative abundance 17.2% versus 45.6%, q = 0.04). Gardnerella vaginalis was more abundant in the RPL group than in controls in both endometrial (12.4% versus 5.8%, q < 0.001) and vaginal (8.7% versus 5.7%, q = 0.002) samples. The individual vaginal and endometrial microbial compositions correlated strongly (R = 0.85, P < 0.001). Fungi were detected in 22% of the endometrial and 36% of the vaginal samples. ConclusionsDysbiosis of the reproductive tract microbiota is associated with RPL and may represent a novel risk factor for pregnancy losses.

Evaluating the Association Between Genetic Polymorphisms Related to Homocysteine Metabolism and Unexplained Recurrent Pregnancy Loss in Women.

ObjectiveTo investigate the relationship between unexplained recurrent pregnancy loss (URPL) and polymorphisms of homocysteine metabolism-related genes in women.Materials and MethodsA case–control study included 90 women with two or more consecutive unexplained pregnancy losses and 92 controlled women without miscarriage history; the female participants were in the age category of 18–35 years. The high-resolution melting technique was used to detect the single-nucleotide variants related to homocysteine metabolism disorder, namely MTHFR C677T, MTHFR A1298C, MTR A2756G, and MTRR A66G polymorphism.ResultsThe MTHFR C677T polymorphism had significantly correlation with URPL. Indeed, the frequency of the677T allele and genotypes (677CT, 677TT) in the URPL group was significantly higher than that in the control group (p < 0.05). However, the allele, as well as genotype distribution of MTHFR A1298C, MTR A2756G, and MTRR A66G polymorphisms showed no significant difference (p > 0.05). MTHFR 677CT-1298AC genotype combination led to a 9.0-fold increased risk of URPL (OR 9.0; 95% CI, 2.25–35.99; p = 0.001), while the risk increased 10.0-fold (OR 10.0; 95% CI, 1.8–55.53; p = 0.008) when participants had more than the 3 variant loci.ConclusionThe MTHFR C677T polymorphism was a risk factor for URPL, and determining the MTHFR C677T polymorphism had a potential prediction of URPL risk. Moreover, the MTHFR C677T and MTHFR A1298C joint mutants might have a synergistic effect on URPL. Conversely, there is a lack of evidence suggesting the URPL risk of MTHFR A1298C, MTR A2756G, and MTRR A66G polymorphisms.

Asthma Is Associated With Pregnancy Loss and Recurrent Pregnancy Loss: A Nationwide Cohort Study

Women with asthma appear to have an increased risk of pregnancy loss (PL). The impact of asthma on recurrent pregnancy loss (RPL), defined as 3 consecutive losses, is, however, unknown. The aim of this study was to investigate whether having asthma before or during the fertile age is associated with PL and RPL. Based on Danish national health registers, we identified all women aged 6 to 45 years with at least 2 filled prescriptions of an antiasthma drug during the period 1977 to 2019. Women with asthma were compared with women without asthma. Pregnancy outcomes were retrieved for both groups from national health registers. Logistic regression with adjustment for the year of birth and educational level provided odds ratios (ORs) for the number of PLs. Subgroup analyses were conducted for early-onset (age 6-15 years), adult-onset (age 16-39 years), and late-onset (age 40-45 years) asthma. Lastly, we compared uncontrolled asthma (defined as ≥ 400 doses of a short-acting beta-2 agonist in a year) to controlled asthma (defined as < 400 doses of a short-acting beta-2 agonist in a year). In a population of 1,309,786 women, we identified 128,553 women with asthma and 1,297,233 women without asthma. Compared with nonasthmatic women, women with asthma had ORs for 1, 2, and 3 or more PLs of 1.05 (95% CI 1.03-1.07), 1.09 (95% CI 1.05-1.13), and 1.18 (95% CI1.11-1.24), respectively, and for RPL of 1.19 (95% CI 1.12-1.27). In women with early-onset asthma, the OR of 3 or more PLs was 1.47 (95% CI 1.24-1.72). For women classified as having uncontrolled asthma compared with controlled asthma, we found a significant OR of 1.60 (95% CI 1.16-2.16) for 3 or more PLs. We found a significant positive association between asthma and number of PLs and RPLs. Early-onset asthma and uncontrolled asthma were more strongly associated with PL than adult-onset and late-onset asthma and controlled asthma.

Plasma level of mannose-binding lectin is associated with the risk of recurrent pregnancy loss but not pregnancy outcome after the diagnosis.

STUDY QUESTIONAre low or high plasma mannose-binding lectin (p-MBL) levels associated with recurrent pregnancy loss (RPL) and the reproductive and perinatal outcomes before and after RPL?SUMMARY ANSWERThe prevalence of low p-MBL levels was significantly higher in RPL patients, while high levels were significantly less prevalent. No association was found between p-MBL level and reproductive and perinatal outcomes before and after RPL.WHAT IS KNOWN ALREADYMannose-binding lectin (MBL) is an important component in the innate immune system. Low p-MBL levels have been associated with RPL, while the correlation with high levels has been poorly studied. Adverse perinatal outcomes are generally more frequent among RPL patients, but reports concerning the association between maternal p-MBL levels and perinatal outcomes, including birth weight (BW) and gestational age (GA), are conflicting.STUDY DESIGN, SIZE, DURATIONThis study was a combined cross-sectional and cohort study of 267 RPL patients admitted to the RPL Center of Western Denmark between January 2016 and March 2020. RPL patients were followed until birth of a liveborn child or until end of follow-up, March 2021. A sample of 185 healthy female blood donors of reproductive age was used as a MBL reference group.PARTICIPANTS/MATERIALS, SETTING, METHODSAll RPL patients had ≥3 consecutive pregnancy losses, a regular menstrual cycle and no known significant chromosomal or uterine malformations. At the first consultation, routine blood samples including p-MBL measurement and detailed obstetrical and perinatal information were collected. p-MBL levels in RPL patients were compared to the MBL reference group. A logistic regression analysis adjusted for relevant confounders assessed the association between low p-MBL levels and an unsuccessful reproductive outcome in RPL patients in first pregnancy after admission. Perinatal outcomes before and after RPL were compared between RPL subgroups according to low (≤500 µg/l), intermediate (501–3000 µg/l) and high (>3000 µg/l) p-MBL levels.MAIN RESULTS AND THE ROLE OF CHANCESignificantly more RPL patients had low p-MBL levels (prevalence proportion ratio (PPR): 1.79, 95% CI: 1.34–2.38) and fewer had high p-MBL levels (PPR: 0.56, 95% CI: 0.40–0.79) compared to the reference group, while the prevalence of intermediate p-MBL level was not different between the groups (PPR: 0.86, 95% CI: 0.69–1.08). In the prospective study, low p-MBL level was not a significant risk factor for a pregnancy loss in the first pregnancy after admission after adjustment for age, BMI and smoking. Neither before nor after the RPL diagnosis were maternal p-MBL levels significantly associated with BW or GA.LIMITATIONS, REASONS FOR CAUTIONOnly 161 (60.3%) patients had given birth after RPL during the follow-up period, which limited the possibility to detect clear associations between p-MBL levels and perinatal outcomes after RPL.WIDER IMPLICATIONS OF THE FINDINGSIn agreement with several previous studies, low p-MBL levels are strongly associated with RPL, while this study for the first time documents that high levels may play a protective role, which suggests a causal relationship. We suggest that larger prospective studies evaluate the association between p-MBL levels and RPL prognosis.STUDY FUNDING/COMPETING INTEREST(S)No external funding was received. We acknowledge the Department of Obstetrics and Gynaecology at Aalborg University Hospital for financial support. U.S.K. has reported personal fees from Merck, consulting fees from IBSA Nordic, and a grant from Gedeon Richter, Merck and IBSA Nordic outside of the submitted work.TRIAL REGISTRATION NUMBERID from clinicaltrials.gov is NCT04017754.

Postoperative Hypothermia after Cardiac Surgery: A Retrospective Cohort Study of Incidence and Risk Factors

Background: Postoperative hypothermia (PH) may result in perioperative complications such as adverse cardiovascular events, coagulopathy with consecutive blood loss, and wound infection. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at risk for hypothermia throughout the postoperative period. Objective: To determine the incidence and risk factors of PH in patients after open cardiac surgery. Materials and Methods: The present study was a retrospective cohort study of patients that underwent open cardiac or thoracic aortic surgery using CPB between January and December 2013. Patient characteristics, clinical data, and perioperative outcomes were abstracted and analyzed. PH was defined as body temperatures of less than 36℃ upon arrival at the cardiac surgical intensive care unit (CSICU). Postoperative outcomes including bleeding from the chest tube, postoperative inotropic support, ventilator days, CSICU length of stay, and mortality were reviewed. Results: Seven hundred sixty patients were included in the present study with 60.4% male, a mean age of 61.7 years, and 92.4% elective surgery with 96.3% first time surgery. The incidence of PH was 43.4%. Multiple logistic regression analysis demonstrated that factors associated with PH were increasing age (odds ratio 1.013 per year, 95% CI 1.002 to 1.023, p=0.020), female patients (odds ratio 1.40, 95% CI 1.03 to 1.89, p=0.032), deep hypothermia during CPB (odds ratio 2.33, 95% CI 1.26 to 4.30, p=0.007), and administration of more than 3L of intravenous fluid including crystalloids, colloids, and blood products, after separation of CPB until discharge from the operating room (OR) (odds ratio 1.52, 95% CI 1.09 to 2.12, p=0.014). Conclusion: Approximately 43.4% of the cardiac surgical patients develop hypothermia following open cardiac or thoracic aortic surgeries. Factors associated with PH were increasing age, female patients, deep hypothermia during CPB, and administration of more than 3L of intravenous fluid after separation of CPB until discharge from the OR. Keywords: Hypothermia; Postoperative; Cardiac surgical procedures; Cardiopulmonary bypass

Thalassemia and pregnancy complications

Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form or inadequate amount of hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen. The disorder results in large numbers of red blood cells being destroyed, which leads to anemia. This abnormal alpha- to beta-chain ratio causes the unpaired chains to precipitate and causes destruction of red blood cell precursors in the bone marrow (ineffective erythropoiesis) and circulation (hemolysis). Affected individuals with thalassemia have variable degrees of anemia and extramedullary hematopoiesis, which in turn can cause bone changes, impaired growth, and iron overload. Recurrent pregnancy loss (RPL), also known as recurrent miscarriages, is defined by the consecutive loss of two or more pregnancies with the same partner and having no more than one living child. Objective of the current review was to determine the maternal and fetal outcomes of women complicated with thalassemia .Conclusion: There are many changes as complications of thalassemia and the stress of pregnancy can make the symptoms of thalassemia worse . pregnancy in thalassemia should be considered high risk and should always be preceded by a complete preconception assessment.

One-year surgical outcomes of the PreserFlo MicroShunt in glaucoma: a multicentre analysis

Background/aimsTo evaluate the efficacy and safety of the PreserFlo MicroShunt glaucoma device in a multicentre cohort study.MethodsAll consecutive patients who received the microshunt with mitomycin-C (MMC) 0.4 mg/mL from May...

Clinical management of autoimmune gastritis

Autoimmune gastritis (AIG) is a chronic immune-mediated inflammation of the gastric corpus/fundus mucosa leading to progressive atrophy of the oxyntic gastric glands (AOM) and their consecutive loss of function. Possible clinical consequences of AIG include iron deficiency anemia, pernicious anemia, gastric neuroendocrine tumors (gNET), and gastric adenocarcinoma. This article provides a review of interdisciplinary aspects of the diagnosis and treatment of AIG.

Pregnancy loss and risk of multiple sclerosis and autoimmune neurological disorder: A nationwide cohort study

The loss of one or more pregnancies before viability (i.e. pregnancy loss or miscarriage), has been linked to an increased risk of diseases later in life such as myocardial infarction and stroke. Recurrent pregnancy loss (i.e. three consecutive pregnancy losses) and multiple sclerosis have both been linked to immunological traits, which could predispose to both occurrences. The objective of the current study was to investigate if pregnancy loss is associated with later autoimmune neurological disease. This register-based cohort study, included the Danish female population age 12 or older between 1977-2017. Women were grouped hierarchically: 0, 1, 2, ≥3 pregnancy losses, primary recurrent pregnancy loss (i.e. not preceded by a delivery), and secondary recurrent pregnancy loss (i.e. preceded by a delivery). The main outcome was multiple sclerosis and additional outcomes were amyotrophic lateral sclerosis, Guillain-Barré syndrome, and myasthenia gravis. Bayesian Poisson regression estimated incidence rate ratios [IRR] and 95% credible intervals [CI] adjusted for year, age, live births, family history of an outcome, and education. After 40,380,194 years of follow-up, multiple sclerosis was diagnosed among 7,667 out of 1,513,544 included women (0.5%), median age at diagnosis 34.2 years (IQR 27.4-41.4 years), and median age at symptom onset 31.2 years (IQR 24.8-38.2). The adjusted IRR of multiple sclerosis after 1 pregnancy loss was: 1.03 (95% CI 0.95-1.11), 2 losses: 1.02 (95% CI 0.86-1.20), ≥3 non-consecutive losses: 0.81 (95% CI 0.51-1.24), primary recurrent pregnancy loss: 1.18 (95% CI 0.84-1.60), secondary recurrent pregnancy loss: 1.16 (95% CI 0.81-1.63), as compared to women with no pregnancy losses. Seven sensitivity analyses and analyses for additional outcomes did not show significantly elevated adjusted risk estimates. In this nationwide study, pregnancy loss was not significantly associated with autoimmune neurological disorder.

Live Birth Rate in Women with Recurrent Pregnancy Loss after In Vitro Fertilization with Concomitant Intravenous Immunoglobulin and Prednisone.

Pregnancy loss after in vitro fertilization (IVF) is at least as common as after spontaneous conception. Recurrent pregnancy loss (RPL) may often have an immunological background, and it is therefore relevant to test immune-based interventions in these patients. The objective was to investigate the effect of immunotherapy with intravenous immunoglobulin (IvIg) and prednisone (PRS) as concomitant therapy to IVF in women with RPL after earlier IVF treatments. In a cohort study conducted at The Danish RPL Clinic, 41 women with three or more consecutive pregnancy losses after IVF underwent at least one further IVF cycle with concomitant immunotherapy from 2012 to 2017. The immunotherapy with IvIg and PRS was given before embryo transfer and repeatedly in the first trimester when pregnancy was achieved. Fourteen women (34.2%) achieved a live birth after the first embryo transfer with immunotherapy, and a total of 32/41 (78%) achieved a live birth after up to 4 embryo transfers. Baseline characteristics and the presence of autoantibodies were not significantly different among women achieving live birth or not. The observed 34% birth rate in women with RPL after IVF receiving immunotherapy appears higher than the expected 16–19% birth rate without immunotherapy and is similar to findings in a previous cohort from our clinic. Concomitant immunotherapy as described may be a promising intervention for women with RPL after IVF; however, the effect must be tested in a randomized controlled trial.

Association of Factor V Leiden Mutation with Unexplained Recurrent Pregnancy Loss

Introduction: Recurrent pregnancy loss (RPL) is considered as a significant public health problem. In many studies, Factor V Leiden mutation is considered to have significant relationship with unexplained recurrent pregnancy loss. Aim of the study: The aim of this study was to determine the association of Factor V Leiden mutation with unexplained recurrent pregnancy loss. Methods: This case-control study was conducted in the out-patient Department of Fetomaternal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from November 2020 to April 2021 (6 months). Sample size was taken as 40 for each case and healthy control group. Result: Mean (±SD) age was found 28.2±4.9 years in RPL group and 27.1±5.24 years in non-RPL group. Maximum number of patients fell into the BMI category of 23.0-26.9 kg/m2 (BMI for Asian women) in both groups. Among the RPL cases, 30% had experienced consecutive 2 pregnancy losses with mean (±SD) number of losses 3.07±1.14. About more than half percentages (n=23, 57.5%) shared the primary RPL group. In this study, normal homozygous FVL mutation was equally distributed among RPL patients and control individuals. Only 2 cases (5%) were found positive for Factor V heterozygous mutation (GA) in the RPL group. G allele occurred in most of the cases (97.5%) of RPL. Two cases aged 25 years and 35 years respectively were found positive for heterozygous mutation of Factor V Leiden. Both of them exhibited 3 consecutive recurrent second trimester pregnancy losses. Factor V Leiden was found in higher prevalence (100%) in 2nd trimester recurrent pregnancy loss sub-group of cases and revealed significant association (p &lt;0.001) between two variables. Conclusion: The impact of Factor V Leiden mutation has not stated any causal association with unexplained recurrent pregnancy loss. The results do not support Factor V mutation screening as an initial approach in Bangladeshi women suffering from recurrent pregnancy loss.

Analysis of Reporting Consecutive Losses in ABC Finance Plc Since Financial Year 2009/2010: A Case Study

The study mainly focuses on the ABC Finance PLC, a company listed in the Colombo Stock Exchange (CSE) under the diversified financial sector according to the Global Industry Classification Standards (GICS). The company is registered as a licensed finance company and registered finance leasing establishment as well. During the FY 2008/2010 the company has acquired ABC credit card company, a financially weak company that was engaged in local credit card operations, through debt funding, which is a significant event of the company. The main focus of this study is to identify the reasons for reporting consecutive losses in ABC Finance PLC since financial year 2009/2010, and provide recommendations. The study employed ratio analysis and graphical analysis to find out the reasons behind reporting consecutive losses. Accordingly, the study finds that company's interest expense on is higher during the period between FY 2008/2009 to 2017/2018 compared to other financial years because of the acquisition funded by debt. Another observation is loans and advances interest income are decreasing while there is a loan and advances growth in the company, mainly because of more loans being non-Performing as a result of high credit risk of borrowers. The hire purchase interest incomes show a decreasing trend during the period of company making losses mainly because of decrease in the demand for hire purchase service of ABC Finance Plc. Further, the company's fee-based income is decreasing, establishment expenses are increasing, director's emoluments of the company are increased bylarge percentage (395.6%) from FY 2008/2009 to 2009/2010 and it is maintained in the same level after that year which is as a result of a decision made with the intention to motivate the directors to increase the performance. In order to be away from the consecutive loss-making situation, it is recommended that the company should settle the debt obtained for the acquisition to reduce the interest expense on borrowing, reduce the credit risk, engage with promotion for its services, use a performance-based payment method for directors, and have a better expense management system for this company

Different faces of cigarette butts, the most abundant beach litter worldwide.

Cigarette butts (CBs) are non-biodegradable residues of synthetic origin, prevalent on beaches all over the world. The study evaluates discarded CBs on an intensely used urban beach, determining variations in physical and chemical characteristics. CBs collected were observed, classified, and visually separated according to a proposed scale of four levels of degradation to test the potential match between physical and chemical decay. CBs (un-smoked, smoked, and discarded) were used to determine the average length (cm) and mass (g) in order to observe changes in these parameters among the levels. Cigarette butts experience consecutive mass loss during environmental exposure. Scanning electron microscopy (SEM) images were obtained to assess physical changes in fibers due to smoking. FTIR-ATR was used to assess CBs new (un-smoked), smoked, and discarded samples in relation to cellulose acetate decay. The FTIR-ATR spectroscopy of the most visually degraded cigarette butts indicated modifications in the spectra when compared to un-smoked cigarettes.