Game Changer In Management Research Articles

Novo software para reserva de fluxo fracionada tridimensional quantitativa baseado em angiografia coronária. Primeiro caso na América Latina

Fractional flow reserve has become the mainstay of functional hemodynamic assessment and is considered the gold standard to identify ischemic coronary stenoses. However, adopting the method into daily practice has been limited. Indeed, it requires the use of a costly pressure wire and the administration of a hyperemic agent. Vessel fractional flow reserve is a 3D-QCA based fractional flow reserve, using CAAS Workstation (version 8.4; Pie Medical Imaging, Maastricht, the Netherlands). It is a non-invasive method that does not require pressure wire or hyperemic agent; therefore it is time saving and easy to use. This is the first case performed in Brazil and demonstrates the correlation between fractional flow reserve and vessel fractional flow reserve performed in the same lesion, and the feasibility of calculation of vessel fractional flow reserve using 3D QCA-based software. We report the case of a 61-year-old male, who was admitted for typical chest pain. Coronary angiography revealed serial intermediate lesions in the mid- and distal left anterior descending. We evaluated left anterior descending lesions initially by fractional flow reserve then by vessel fractional flow reserve. Fractional flow reserve in distal left anterior descending was 0.65. Then, vessel fractional flow reserve value was calculated at 0.61. In our case, the correlation was adequate and the feasibility with offline calculation was excellent and fast. To the best of our knowledge, this is the first case of vessel fractional flow reserve performed in Latin America. Therefore, we expect vessel fractional flow reserve to be a game changer in management of coronary artery disease patients, particularly those with intermediate lesions.

P–638 Status of insulin resistance in infertile women and its effect on ovulation induction

Abstract Study question Is insulin resistance ( IR) a confounding variable in infertile women, other than those those having polycystic ovarian syndrome (PCOS) Summary answer IR was identified in 20.5% of infertile women. The presence of IR did not affect response to ovulation induction but reduced chances of conception What is known already Obesity is strongly correlated with insulin resistance. Obesity also has an adverse effect on fertility. In 2008 Steeg et al reported 5% reduction in chances of spontaneous conception with each unit increase in body mass index (BMI). Tetsurou Sakumoto et al (2010) reported hyperinsulinemia to affect granulose cells in small follicles inducing early response to luteinising hormone and anovulation. Adverse effect on endometrial function and implantation was also postulated. Insulin resistance has been studied in cases of PCOS but has not been studied in infertile women not fulfilling criteria for diagnosis of PCOS . So the present study was planned Study design, size, duration A prospective cohort study was conducted in infertility unit, King George Medical University, Lucknow, India over a period of one year from August 2018 to July 2019. Total 102 women with unexplained infertility were enrolled. Ethical clearance was obtained from institutional ethical committee Participants/materials, setting, methods Women with PCOS; diminished ovarian reserve documented by antral follicle count <7 and anti Mullerian hormone < 1.1ng/ml; bilateral tubal block; abnormal semen analysis; untreated hypothyroidism, hyperprolactinaemia; known diabetes were excluded. All women underwent ovulation induction with clomiphene citrate followed by single intrauterine insemination. Homeostasis model assessment insulin resistance index (HOMA IR) was calculated HOMA-IR = Fasting S. Glucose (mg/dl) x Fasting insulin (µlU) / 405. Value ≥ 2 denoted insulin resistance Main results and the role of chance : IR was identified in 21/102 (20.5%) cases. Fasting insulin levels were in the range of 5 – 9.9 mIU/ml in 53/102 women; <5mIU/ml in 29 and >10mIU/ml in 20. Fasting insulin > 9.45mIU/ml was found to have 90.5% sensitivity and 96.3% specificity in predicting insulin resistance. None of the cases had abnormal fasting and post prandial plasma glucose levels. IR was seen to be significantly correlated with BMI > 25kg/m2 (p = 0.0018) and waist hip ratio of > 0.85 (p = 0.0024).All women had follicular development and follicle rupture irrespective of presence of IR. Women with IR were more likely to have monofollicular development (17/21 IR cases). Correlation of endometrial thickness with IR was not seen. Mean endometrial thickness was 8.9mm. There were 6 pregnancies among the 102 women studied. None of the women with IR conceived. So IR was found to be affecting one fifth of women with unexplained infertility. Failure of any woman with IR to conceive was significant but the finding needs to be further studied. Limitations, reasons for caution : It was a small study with only 102 cases and the women were followed for only one cycle of ovulation induction and intrauterine insemination so results need to be validated in a larger study with a longer follow up. Wider implications of the findings: If further larger studies corroborate the role of IR in women with unexplained infertility it could elucidate the possibility of using insulin sensitisers in management of such cases. IR may emerge as an important gamechanger in management of unexplained infertility. Trial registration number Not applicable

An Observational Study Depicting Role of p16 in Detecting Human Papilloma Virus in Oral and Oropharyngeal Cancer and Associated Factors.

The longstanding phrase, traditional risk factors like-smoking, tobacco and alcohol are the only causative agents of oral and oropharyngeal squamous cell carcinoma (SCC) is changing now. Etiological divergence is taking place which we have to know to reach upon an exact cause of the disease. Human papilloma virus (HPV) infection is a well-established cause of oral cancer. Escalating incidence of HPV associated cancer has a strong impact on its management. So, a concern clinician needs to get aware for it. Among various types of HPV, HPV-16 is more frequently associated with oral cancers. HPV detection will become a game changer in management of oral cancers. HPV infection and p16 protein expression has a strong and consistent correlation. Therefore, immunohistochemical analysis of p16 protein can be a surrogate biomarker in high risk groups. This hospital based prospective observational study recruited 180 subjects of oral and oropharyngeal SCC. We underwent immunohistochemical analysis of p16 in biopsy specimen of subjects and studied HPV status and associated environmental, clinical and behavioral factors. We observed 9.4% (17/180) incidence of p16 positivity with female predominance. Our observations showed that its prevalence was higher in urban patients who were non tobacco users, had sexually transmitted disease, early stage (T1-T2), poorly differentiated SCC with nodal metastasis. We conclude that keeping in mind HPV as a cause of oral and oropharyngeal SCC, p16 should be use as a biomarker for its detection in high risk cases.