Females Mean Age Research Articles

P-139 Comparison of clinical outcomes between two hyaluronan-rich transfer medium

Abstract Study question Is there any difference in effect on clinical outcomes after single vitrified-warmed blastocyst transfer on day 5 using two hyaluronan-rich transfer medium? Summary answer There was no significant difference in rates of clinical pregnancy, implantation and miscarriage between two hyaluronan-rich transfer medium. What is known already Hyaluronan is one of the glycosaminoglycan that is naturally present in female reproductive organs and promotes the endometrial stroma and preimplantation embryo adhesion through CD44 glycoprotein receptors. Several studies demonstrated that use of hyaluronan-enriched transfer medium in women receiving either cleavage-stage or blastocyst-stage embryo improved clinical outcomes compared to the standard medium. However, studies on clinical outcomes according to two transfer medium containing different concentrations of hyaluronan are still insufficient. Study design, size, duration A retrospective study of 1047 vitrified-warmed blastocyst transfer cycles with normal responders (aged 23-35 years) was conducted from September 2018 to November 2022. All cycles with single vitrified-warmed blastocyst transfer on day 5 were evaluated. Only first IVF attempts cycles were included. All women had undergone a GnRH antagonist protocol. Cycles were divided into two groups: Group A (n = 511, EmbryoGlue®, Vitrolife) and Group B (n = 536, UTMTM, Origio). Participants/materials, setting, methods All blastocyst were graded using Gardner and Schoolcraft’s criteria. The vitrified-warmed blastocysts were equilibrated for an average of 47 minutes in two transfers medium until transfer. All blasotcyst were then loaded into an embryo transfer catheter (COOK® medical). The rates of clinical pregnancy, implantation and miscarriage were compared between the two groups. Statistical analyses were conducted using Chi-square test and Independent t-test using SPSS. Main results and the role of chance There were no significant differences in mean female age (31.6 ± 2.5 vs. 31.8 ± 2.3, P = 0.432), mean endometrial thickness (10.4 ± 1.4 vs. 10.3 ± 1.3, P = 0.478), mean oocytes retrieved (20.8 ± 6.8 vs. 20.5 ± 6.9, P = 0.470) and number of transferred good-quality blastocyst stage rate (≥BB grade, 74.8% vs. 72.6%, P = 0.423) between the two groups. We also observed similar rates of biochemical pregnancy (79.5% vs. 78.0%, P = 0.562), clinical pregnancy (71.4% vs. 69.2%, P = 0.434), implantation (72.4% vs. 70.3%, P = 0.459), ongoing pregnancy (67.5% vs. 66.2%, P = 0.659), miscarriage (5.5% vs. 4.3%, P = 0.463) and multiple pregnancy (1.4% vs. 1.6%, P = 0.782) in Group A and B, respectively. Limitations, reasons for caution This study is limited by its retrospective nature in single-center and absence of live birth information. We investigated only single vitrified-warmed blastocyst on day 5 to have data reliability. Therefore, further studies are needed to evaluate our data with vitrified-warmed blastocyst transfer on day 6 or day 7. Wider implications of the findings The present data showed that clinical outcomes were similar between two transfer medium containing different concentrations of hyaluronan. Our findings could have significant clinical implication for selection of the appropriate commercial embryo transfer medium according to IVF laboratory conditions. Trial registration number not applicable

P-629 Dietary and/or physical activity interventions in women with overweight or obesity prior to fertility treatment – an individual participant data meta-analysis (Venus-IPD)

Abstract Study question Do dietary and/or physical activity interventions prior to fertility treatment improve live birth rates in women with overweight or obesity? Summary answer Dietary and/or physical activity interventions prior to fertility treatment do not significantly increase live birth rates in women with overweight or obesity. What is known already Existing guidelines recommend lifestyle interventions based on dietary and/or physical activity targeting at a 5 to 10% reduction in body weight as an initial step prior to fertility treatment for women with infertility and overweight or obesity. However, the evidence underlying this recommendation is limited and findings from recent randomized controlled trials (RCTs) are inconsistent. Individual participant data meta-analysis (IPDMA) has been considered the “gold standard” for evidence synthesis. Study design, size, duration We performed an IPDMA of RCTs comparing dietary and/or physical activity interventions as core interventions prior to fertility treatment versus standard advice concerning a healthy diet and physical activity, routine care or no intervention. We searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials up to September 2022 to identify potential eligible RCTs. Participants/materials, setting, methods After identifying eligible RCTs in women with infertility and overweight or obesity (BMI ≥ 25 kg/m2), we contacted the investigators of eligible RCTs to share the deidentified IPD and established the Venus-IPD Collaboration. The primary outcome was live birth. Secondary outcomes included weight loss and other fertility outcomes. We performed a two-stage random-effects IPDMA as the primary analysis. Main results and the role of chance Of 14 eligible RCTs, as of January 2023 we obtained IPD of 9 RCTs with 1715 participants (916 in the intervention group and 799 in the control group). The mean female age was 30.7 years (standard deviation 4.5) and the median baseline BMI was 34.8 kg/m2 (Interquartile range 32.4 to 38.5). The duration of the diet/physical activity interventions ranged from 2.5 to 6 months. Physical activity and/or dietary interventions prior to fertility treatment resulted in more weight reduction compared to those in the control group (9 RCTs, 1715 participants, mean difference –5.71 kg, 95%CI –7.76 to –3.66). The intervention group did not have a significantly higher rate of live birth (8 RCTs, 1697 participants, OR 1.30, 95%CI 0.74 to 2.27, I2=60%) or clinical pregnancy (8 RCTs, 1697 participants, OR 1.22, 95%CI 0.81 to 1.83, I2=28%). The asymmetrical contour-enhanced funnel plot indicates possible small-study effects. Limitations, reasons for caution Blinding was not possible due to the nature of the intervention. IPD of three small RCTs are not obtained at this time. The heterogeneity in the type and period for lifestyle interventions and in the follow-up duration was moderate to high. Wider implications of the findings Dietary and/or physical activity interventions are effective in reducing body weight in women with overweight or obesity, but such a benefit in weight loss may not translate to improved live birth rates. Trial registration number CRD42021266201

P-696 Identification of novel candidate genes associated with meitotic aneuploidy in human embryos by whole-exome sequencing (WES)

Abstract Study question Can certain genetic variants in women cause a genetic predisposition to aneuploidy? Summary answer Our results suggest that the maternal variants identified in genes regulating meiotic processes could be useful genetic biomarkers for predicting a predisposition to embryonic aneuploidies. What is known already Errors in chromosome segregation during meiosis as chromosome synapsis, crossing-over and spindle building, occur frequently in human oocytes and cause aneuploidy in embryos. These errors increase dramatically in the oocytes of older women. However, the rate of producing aneuploidy oocytes varies among IVF patients for a given age. Recent publications have identified genetic variants that are crucial for producing healthy oocytes in female IVF patients. The association between maternal genetic variants and embryonic aneuploidy risk suggests the potential of using genomic data to predict embryonic aneuploidy risk. Our aim was to identify novel variants and candidate genes for embryonic aneuploidy. Study design, size, duration A prospective observational cohort study was done including 127 trophoectoderm biopsies from 29 couples who performed whole-exome sequencing (WES) and PGT-A between November 2019 and March 2022. Women were 35 years old or younger and normal karyotype for men and women. Patients were divided in two groups according to the embryo aneuploidy rate expected by their maternal age: ≤ 50% of aneuploid blastocysts as control group(n = 14), and ≥ 50% of aneuploid blastocysts as study group(n = 15). Participants/materials, setting, methods WES was performed using Trusight One Expanded Sequencing Panel (Illumina®). The following criteria were used for filtering and annotation of candidate variants: (1) minor allele frequency (MAF) <0.05 in the gnomAD and 1000 genomes, (2) variants in genes previously associated with chromosome segregation, chromatin cohesion, meiosis and cell division processes, (3) exonic/splicing boundaries variants, (4) variants having potentially strong/moderate functional effects on the protein evaluated using three in silico prediction algorithms (SIFT, PolyPhen-2 and MutationTaster). Main results and the role of chance Overall, the mean female and male age was 26.21 + 4.11y and 40.69 + 9.07y respectively. No differences were shown between groups for patient characteristics. Regarding PGT-A cycle no differences were seen between the number of oocytes and MII retrieved. However, the mean number of biopsied embryos per patient (5.36 + 2.50 vs 3.47 + 1.36; p < 0.05) as well as the percentage of embryos biopsied on day 5 (85.33 vs 32.69; p < 0.05) were higher in the control group. Finally, as expected, the percentage of aneuploidies was higher in the study group (18.64 vs 71.89; p < 0.05). 45 variants were identified in genes potentially associated to the mechanism related to the phenotype. After the variant filtering six probably pathogenic variants were identified. The variants found in the genes were: c.1397T>C (TLE6), c.169G>A (IKBKG), c.1227A>C (BUB1B), c.277G>A (TP73), c.190C>T (PLXNA3) and c.744C>G (AURKC). All variants were heterozygous and all of them were of maternal origin. The females carrying the candidate variants belonged to the study group, and two variants in different genes were identified in one patient. No potentially pathogenic variants were detected in patients from the control group. Therefore, the average detection rate of genetic variants with potential impact in embryo aneuploidy was 33.33% (5/15). Limitations, reasons for caution A notable strength of our study is the inclusion of both (male and female) genomic data. On the other hand, our study has certain limitations including the inherent challenges of any observational study, also, the pathogenicity of the identified variants should be validated in further functional studies. Wider implications of the findings We described new candidate genes that have never been associated to meiotic embryo aneuploidy and are involved in important biological processes (cell division and chromosome segregation). WES may be considered as an efficient tool to identify patients with higher risk of embryo aneuploidy allowing an individualized genetic counselling in advance. Trial registration number Not applicable

P-728 Impact of calling mosaicism for a less stringent threshold on clinical pregnancies in more than 6000 PGT-A cycles

Abstract Study question How does calling mosaicism for a higher threshold affect euploidy, the chance of finding at least one euploid embryo and clinical pregnancy? Summary answer Increasing the threshold significantly increased euploidy percentage and the probability of finding at least one euploid embryo, as expected, but also the pregnancy outcomes. What is known already NGS technology has shed light on the occurrence of chromosomal mosaicism at the preimplantation stage of development. Evidence regarding clinical outcomes after transfer of embryos with putative mosaic results are accumulating (ESHRE Working Group on Chromosomal Mosaicism, 2022). A series of studies reporting the birth of healthy babies after the transfer of embryos with a chromosomal mosaic result on PGT-A (Greco et al., 2015; Kahraman et al., 2020; Viotti et al., 2019 and 2021), have been published. Data suggested lower implantation rates and higher miscarriage rates when mosaics were compared with euploid embryo transfers. Study design, size, duration This retrospective study covers a period from January 2017 to October 2022 and includes 6063 PGT-A cycles. A total of 18425 blastocysts were biopsied and analyzed with NGS. From January 2017 to December 2020, the cut-off value for reporting mosaicism and euploidy was %20; the rate of which was increased to 30% after January 2021. Chromosomes with PGT-A profiles that deviate from 2 copies by less than 30% were reported as normal. Participants/materials, setting, methods A total number of 12751 and 5674 blastocysts were biopsied between January 2017-December 2020 and January 2021-October 2022, respectively. PGT-A was performed on Ion Torrent S5 (Thermo Fisher Scientific). The mean female age for 20% and 30% cut-off groups were 36.7+-5.1, 35.9+-5.2, respectively. As this age difference was statistically significant, further analysis was performed in age subgroups < =38 and >38. Main results and the role of chance For PGT-A cycles with female age < =38, cycles with at least one euploid embryo in the 30% cut-off group increased from 74.0% to 77.5% whereas cycles with at least one mosaic embryo decreased from 40.8% to 37.0% (p = 0.0212; p = 0.0274). Cycles with at least one mosaic embryo without any euploid embryos decreased by 2% (9.2% to 7.2%) (p = 0.0522). The euploidy percentage out of all tested biopsies was significantly increased from 40.4% to 45.8% (p = 0.0001). For cycles with female age >38, ratio of PGT-A cycles with at least one euploid embryo increased from 28.1% to 30.3% in the 30% cut-off group but this was not statistically significant (p = 0.28). Cycles with at least one mosaic embryo were decreased from 15.1% to 10.8% and cycles with at least one mosaic embryo without any euploid embryo decreased from 9.5% to 5.6% in the 30% cut-off group (p = 0.006; p = 0.0018). The euploidy percentage was increased by 2.8% from 15.1% to 18.1% (p = 0.0115). The pregnancy outcomes were significantly higher for euploid embryos with the 30% cut-off compared to 20%, as clinical pregnancy was 64.5% vs. 59.1% and clinical pregnancy loss was 7.9% vs. 12.4% (p = 0.0022; p = 0.0011). Similarly, ongoing pregnancy was 5.2% higher, but non-significant. Limitations, reasons for caution These are the results of a single ART center which is using the same protocols for ovarian stimulation and endometrial preparation in the two periods above mentioned. Although not expected, minor changes may have occurred; similar practices have to be reported. Wider implications of the findings Mosaicism is undeniably a true biological phenomenon. However, trophectoderm biopsy and NGS are prone to create an artefactual false mosaicism. Relaxing the mosaicism calling rate by 10% may have added some better-quality blastocysts to the euploid pool giving the opportunity to embryologists of transferring blastocysts with higher implantation potential. Trial registration number Not applicable

P-709 Predictive heatmap in Preimplantation Genetic Testing for Monogenic disorders (PGT-M) and Structural Rearrangements (PGT-SR)

Abstract Study question What is the predicted cumulative live birth rate (CLBR) relative to AMH-level for women undergoing preimplantation genetic testing (PGT) for monogenic disorders and structural rearrangements? Summary answer Anti-müllerian hormone (AMH) and age allow to give an estimate of the CLBR in PGT and becomes poor when AMH is ≤ 2µg/L and age ≥42y. What is known already Ovarian response is an important contributory factor in PGT in order to obtain a sufficient number of embryos for genetic analysis. A proportion of the obtained embryos will be carrier of the disease tested, and another small proportion of the embryos will fail to have a genetic diagnosis hence will not be available for embryo transfer. The number of embryos not suitable for embryo transfer as a result of PGT varies between 25-81% according to the indication for PGT. The combination of female age and AMH are good predictors for CLBR in conventional IVF. Study design, size, duration This is a single-centre retrospective cohort study including 1,522 females undergoing 3,130 PGT cycles over a 6-year period (01/01/2015-31/12/2020) at a university-based referral centre for PGT. The principal outcome measure was CLBR per intention to treat (ITT), and the secondary outcome was live birth rate (LBR) per embryo transfer, in couples undergoing PGT-M and PGT-SR either by polymerase chain reaction (PCR), single nucleotide polymorphism (SNP) array, microarray-based comparative genomic hybridization (aCGH), or next-generation sequencing (NGS). Participants/materials, setting, methods Mean ±SD was applied for continuous outcomes, whereas (relative) frequency was applied for dichotomous outcomes. Multivariable logistic regression analysis was applied with dependent variable being the CLBR or LBR and the independent variables the AMH, female age, BMI, inheritance mode and PGT-technique. Best-fit (Akaike information criterion (AIC)) versus polynomials were analysed. Non-inferiority testing between different technologies was performed. A 3D-prediction mosaic (including AMH, age and CLBR) was created, which can be used for counseling purposes. Main results and the role of chance The mean female age is 32.46 years (SD 4.43), with a mean AMH level of 2.75 µg/L (SD 2.58) and a mean BMI of 24.24 (SD 4.43). Age and AMH significantly affect CLBR irrespective of the inheritance mode or PGT technique used. There is a gradual decline of CLBR from a female age of 25 years onwards reaching a critical threshold of less than 10% CLBR per ITT over the age of 42 with AMH levels ≤2 µg/L. Between cleavage stage biopsy techniques (PCR) and trophectoderm biopsy PGT techniques (SNP array, aCGH, NGS) used there was no significant difference in outcome per ITT, however per embryo transfer there is a significantly higher chance of live birth in SNP array, aCGH and NGS cycles compared to PCR cycles. Limitations, reasons for caution Despite the large sample size, the findings are confined by limited confounder adjustment. Wider implications of the findings In a PGT-program, couples need to be informed on the limited prognosis, if the combination of female age and AMH is unfavourable, in order to allow them to make other reproductive choices. The prediction mosaic produced in this study can be used as an insightful visual tool in counseling PGT-couples. Trial registration number Not applicable

P-296 Supernumerary blastocysts resulting from abnormal cleavage patterns: freeze or not to freeze? A practical question!

Abstract Study question After eSET, the supernumerary blastocysts that showed cleavage anomalies can be vitrified as second choice embryos. Do they display enough implantation chance to be frozen? Summary answer No pregnancy was obtained after frozen transfer of blastocysts with direct uneven cleavage and chaotic cleavage. It is not recommended to freeze those spare embryos. What is known already The use of time-lapse incubation offers stable culture conditions and provides comprehensive information on dynamic embryo development. Studies found that abnormal cleavage affects the genome of human embryos and can reduce its developmental potential with embryonic arrest. Aneuploidy contributes also to failed implantation. It was also reported that cleavage anomalies such as direct uneven cleavage and chaotic cleavage affect negatively implantation and live birth. Even if the good survival rate of blastocysts after vitrification has dramatically improved clinical outcome after frozen embryo transfer, implantation and live birth are correlated to embryonic ploidy and healthy cellular machinery. Study design, size, duration Retrospective qualitative assessment of time-lapse images for 186 vitrified blastocysts resulting from extended culture of 871 embryos showing morphokinetic abnormalities such as direct uneven cleavage first mitosis (DC1), direct cleavage second mitosis (DC2), fast cleavage (FC), complete chaotic cleavage (CC) and multiple anomalies (MA), during 2021-2022 in a single private hospital, and analysis of the clinical outcome after warming and SET. Participants/materials, setting, methods From 871 embryos in Embryoscope + (Vitrolife), 445 total blastocysts and 251 top quality were obtained according to Gardner’s grading. 186 of those were vitrified for further transfer. In 5 subgroups of anomalies (DC1, DC2, FC, CC, MA) pregnancy (PR) and ongoing pregnancy rate (OPR) per warming cycle and per transfer were calculated. The results were compared by SPSS software to overall 2021 center’s results. Main results and the role of chance The mean female age was 35.4 ± 0.5 years. From the 186 top quality blastocysts that were vitrified, 96 were warmed in 94 frozen cycles with a survival rate of 98.3%, resulting in 93 SET transfers. A total of 32 pregnancies were obtained from which 21 were ongoing pregnancies. There was no statistical difference in PR per warming cycle or per transfer, and in OPR per warming cycle or per transfer between the overall study group compared to the center’s annual results 2021: 34.0% vs 40.2%, 34.4% vs 40.1%, 22.3% vs 30.1%, and 22.6% vs 30.7%. Reasonable PR and OPR per transfer were obtained with blastocysts from DC2, FC and MA patterns, with caution to small sample size: 32.0% and 20.0%, 44.1% and 32.3%, 40.0% and 25.0%. The results were statistically comparable to the center’s annual result. All the transfers from DC1 and CC pattern failed to achieve a pregnancy. Limitations, reasons for caution One limitation of the study was its retrospective nature and the other was the small sample size in each subgroup of anomaly. The results should be confirmed prospectively and should compel the live birth rate after delivery of the ongoing pregnancies obtained during the second semester of 2022. Wider implications of the findings Abnormal cleavage patterns such as DC and CC are known to affect negatively implantation and live birth. Deselection of embryos showing these specific patterns could significantly increase successful implantation for the accordingly selected embryos. It is therefore non optimal to freeze the spare blastocysts resulting from these peculiar abnormal patterns. Trial registration number NA

Determination of Meconium Stained Liquor among Fetal Distress Lead Cesarean Mothers

Aim: To determine the frequency of meconium stained liquor in females undergoing cesarean section due to fetal distress. Study type, setting & duration: This descriptive study was conducted at Unit III, Department of Obstetrics & Gynecology, Ganga Ram Hospital, Lahore during August 2018 to February 2019. Methodology: The study was commenced on 240 females fulfilled selection criteria. After taking informed consent their demographic all females underwent cesarean section. During cesarean section, amniotic fluid was evaluated for meconium staining. All the information was recorded in pre-designed Performa. Data was entered and analyzed in SPSS. Results: Mean age of females was 29.05±6.22years, the mean gestational age was 39.48±1.09 weeks and mean BMI of patients was 26.45±4.70 kg/m2. There were 35 (14.6%) patients of parity 0, 72 (30%) had parity 1, 47 (19.6%) had parity 2, 46 (19.2%) had parity 3 and 40 (16.7%) had parity. The meconium stained liquor was present in 40 (16.7%) patients while absent in 200 (83.3%) patients. Practical implication of this study suggests that meconium stained liquor must be observed closely in females bearing a higher gestational age to avoid meconium aspiration syndrome among neonates. Conclusion: Present study suggests a higher frequency of meconium stained liquor and a higher gestational age is associated with higher frequency of meconium stained liquor while no association of age, parity strata and BMI were found. Key words: Cesarean section, pregnancy, trimester, parity, Meconium Aspiration Syndrome, Meconium Stained Liquor.

The role of rumination in shaping emotional symptom trajectories across the menstrual cycle

Premenstrual dysphoric disorder (PMDD) was added to the DSM-5 following evidence that it represents an abnormal brain reaction to normal hormone changes across the menstrual cycle. However, few studies have examined the cognitive and behavioral constructs that may contribute to these adverse psychoendocrine responses. Several small prior studies have found that rumination, a maladaptive form of repetitive thought, may intensify cyclical hormone sensitivity. 232 naturally cycling females (mean age = 30.93; 59% Caucasian) completed the Rumination Response Scale at baseline, then provided 2-3 months of ratings using the Daily Record of Severity of Problems (i.e., emotional, behavioral, physical symptoms). Using a prospective daily survey design and multilevel growth modeling, we tested the hypotheses that higher baseline trait rumination would predict (1) higher baseline symptoms, (2) a more rapid increase in premenstrual symptoms during the luteal phase (i.e., during elevations/fluctuations of E2 and P4), and (3) a slower recovery to baseline after menses onset (i.e., following E2 and P4 withdrawal). Contrary to predictions, higher rumination did not predict baseline level, premenstrual increase, or postmenstrual decrease of any symptom. In post hoc analyses, this failure to predict severity or trajectory persisted in a subsample selected for any cyclical symptom change. This study, which utilized a large sample size and gold-standard daily rating methods, does not support the hypothesis that rumination is a key moderator of premenstrual hormone-sensitive symptoms, suggesting the need to identify other moderators.

Relationship between anthropometric and body composition parameters and anti-SARS-CoV-2 specific IgG titers in females vaccinated against COVID-19 according to the heterologous vaccination course: A cohort study.

The aim of this cohort study was to evaluate the relationship between anthropometric and body composition parameters and anti-SARS-CoV-2 IgG titers in a group of females who were vaccinated against COVID-19 with two doses of ChAdOx1 vaccine and then boosted with the BNT162b2 vaccine. The study group consisted of 63 women. Basic demographic and clinical data were collected. To assess the anti-SARS-CoV-2 immunoglobulin G titers following the vaccination, five blood draws were performed: 1) before the first dose, 2) before the second dose, 3) 14-21 days after the primary vaccination, 4) before the booster, and 5) 21 days after the booster. Blood samples were analyzed using a two-step enzymatic chemiluminescent assay. Body mass index and body composition were evaluated using bioelectrical impedance analysis. To select the most distinguishing parameters and correlations between anthropometric and body composition parameters and anti-SARS-CoV-2 IgG titers, factor analysis using the Principal Component Analysis was conducted. Sixty-three females (mean age: 46.52 years) who met the inclusion criteria were enrolled. 40 of them (63.50%) participated in the post-booster follow-up. After receiving two doses of the ChAdOx1 vaccine, the study group's anti-SARS-CoV-2 IgG titers were 67.19 ± 77.44 AU/mL (mean ± SD), whereas after receiving a heterologous mRNA booster, the level of anti-SARS-CoV-2 IgG titers was about three-times higher and amounted to 212.64 ± 146.40 AU/mL (mean ± SD). Our data shows that seropositivity, obesity, non-fat-related, and fat-related body composition parameters all had a significant effect on the level of IgG titer after a two-dose vaccination of ChAdOx1. However, only non-fat-related and fat-related body composition parameters had a significant effect on the IgG titer after booster vaccination. COVID-19 infection before the first dose of vaccination is not related to IgG titer after booster administration. Body composition has a significant effect on the production of anti-SARS-CoV-2 IgG after booster vaccination in females.

Anti-Thyroid Peroxidase Antibodies in Euthyroid Pregnant Females to Detect Thyroid Autoimmunity

Objective: To show case the early appearance of anti-TPO antibodies, before the onset of thyroid hormone disruption. Methods: It was a cross-sectional study in which 227 antenatal women who were euthyroid (normal free T4 and free T3 levels) were included and their Anti-TPO antibodies were analysed and recorded. Results: The mean age of the pregnant females was 25.67 + 4.531 years and the mean gestational age was 25.18 + 9.214 weeks. Among 227 pregnant females, 97.8% had anti TPO antibodies levels in the 0-30IU/ml range while only 2.2% had >30IU/ml. The mean anti TPO level among pregnant females was 7.020 + 4.004IU/ml. There was significant association (p<0.05) between trimesters and anti TPO Ab level while insignificant association (p>0.05) of anti TPO Ab with gravidity, parity and abortion. Conclusion: Study concluded that adding anti-TPO antibodies together with markers of thyroid function such as TSH, FT4 and FT3 is not cost effective in identifying pregnant females who might develop thyroid dysfunction and associated pregnancy loss, preterm birth. The prevalence of Anti TPO Ab in euthyroid pregnant females in our study was only 2.2%.

Vitamin D receptor gene polymorphisms in Iraqi Arab children with autism spectrum disorder and serum vitamin D and vitamin D receptor levels

The association between a vitamin D receptor gene (VDR) and autism spectrum disorder (ASD) in some ethnic groups is still inconclusive, among Iraq's Arab population, this association hasn't been highlighted as yet. Two hundred and eighteen ASD children were examined; 171 males and 47 females (mean age 6.91 ± 4.11 years). The control group was 211; 162 were males and the rest were females. The purpose of this study was to identify a correlation between four single nucleotide polymorphisms (SNPs); TaqI (rs731236), FokI (rs2228570), ApI (rs7975232) and BsmI (rs1544410) in the VDR using polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) with susceptibility to childhood ASD. An Enzyme-linked immunosorbent assay (ELISA) was used to assess serum vitamin D and vitamin D receptor levels. There was a statistically significant increase in the prevalence of the CC genotype and the C allele in VDR TaqI (rs731236) among patients compared to controls [15.6% vs. 1.8%, OR = 4.39, 95% CI = 2.18–8.81, p = 0.001] and [34.6% vs. 23.2%, OR = 1.74, 95% CI = 1.30–2.32, p = 0.001] respectively. Furthermore, the frequency of the variant CC genotype and C allele of the FokI in codominant model increased significantly in ASD patients than in the controls [23.8% vs. 6.5%, OR = 4.20, 95% CI = 2.22–7.96, p = 0.001] and [34.2% vs. 20.9%, OR = 1.97, 95% CI = 1.44–2.67, p = 0.001] respectively. In addition, the frequency of CC genotype increased significantly in the recessive models of TaqI (rs731236) and FokI (rs2228570) in ASD patients compared to controls (15.6% vs. 1.8% OR = 9.56, 95% CI = 3.32–27.4, p = 0.001) and (27.2% vs. 6.7%, OR = 4.40, 95% CI = 2.35–8.23, p = 0.001), respectively. Mean serum VDR levels decreased significantly in ASD patients with both CC genotypes of TaqI (rs731236) than TT genotypes (P = 0.026) and in CC genotypes of FokI (rs2228570) than TT genotypes (p = 0.012). Moreover, vitamin D and VDR levels were considerably lower in ASD patients than in controls respectively (p = 0.0001). Our findings demonstrate that specific polymorphisms TaqI (rs731236) and FokI (rs731236) in VDR were high risk factors for developing childhood ASD in the Iraqi Arab population.

ARTERIAL WALL CONDITION IN WOMEN WITH HYPERTENSION AND POSTMENOPAUSAL OSTEOPOROSIS

Objective: The aim of the study was to investigate the indices of arterial stiffness and central aortic pressure in women with hypertension in combination with osteoporosis. Design and method: The study included 68 females (mean age 62.7±3.8 years) with hypertension, grade 2 in postmenopause including 35 females with osteoporosis (group 1) and 33 females without signs of osteoporosis (group 2) according to osteodensitometry investigation. The control group consisted of 20 healthy females (mean age 61.3±3.5 years). Before the study, the patients did not receive regular antihypertensive drugs and hormone replacement therapy. In addition to conventional studies the levels of calcium, phosphorus, alkaline phosphatase, deoxypyridinoline, parathyroid hormone, 25(OH) vitamin D, osteocalcin, C-terminal telopeptide of type I collagen in blood were determined. Fracture risk assessment (FRAX), daily blood pressure monitoring, applanation tonometry and dual-energy X-ray absorptiometry were performed. Results: It was found that in group 1 the levels of office systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 3.7% and 4.9% (p<0.05) higher than in group 2. According to the data of daily BP monitoring a more pronounced increase of mean daily SBP and DBP by 4.1% and 6.6% (p<0.05) was observed in group 1 in comparison to group 2. Indicators of pressure load according to the time index of hypertension by SBP and DBP were significantly higher by 21.7% and 25.4% during the day and 22% and 18.2% at night (all p<0.05). In patients of group 1 an increase in the aortic augmentation index of wave reflection (Aix) and the augmentation index of wave reflection, adjusted for heart rate (AIx @ HR 75) by 26.6% and 29.8% compared to patients of group 2 respectively, was revealed. It was found that in group 1, compared with the control group and group 2, an increase in pulse wave velocity by 37.2% and 26.4% respectively was detected. Conclusions: It was found that in patients with hypertension in combination with postmenopausal osteoporosis, according to office, daily monitoring and applanation tonometry, blood pressure levels and arterial stiffness parameters were significantly higher than in patients with hypertension without osteoporosis.

Pandemic caregiving: Results from a survey of Alzheimer’s disease research center study partners

AbstractBackgroundCaregivers are at increased risk for psychological distress and social isolation. The COVID‐19 pandemic presents extra challenges for caregivers of research participants.MethodUsing NACC’s caregiver COVID survey as a model, we developed a 25‐item questionnaire with Likert‐type questions concerning the pandemic’s impact on caregiving, the emotional/cognitive health of the research participant, and willingness to participate in research. Data was collected in summer 2021, with responses focused on 3/2020‐3/2021. ADRC participants with CDR ≥ 1 and their caregivers were identified. Data was previously collected on 267 participants with CDR 0‐0.5.Result32 caregivers of research participants (50% adult children, 41% spouses, 9% other) completed the survey (15‐75 minutes). Participants were 59% female (mean age 80 and education 15y). 66% non‐Hispanic White, 13% non‐Hispanic Black, 19% Hispanic. Mean CDR SOB was 12±5. Demographics on the 267 normal/MCI participants not shown.Caregivers (55%) felt “some‐extremely” isolated compared to 39% of CDR 0‐0.5 participants; mean caregiver isolation scores were 3.4/5 and 2.5/5 for those who cared for participants with CDR = 3 and 1‐2, respectively. Caregivers (91%) and participants (56%) found the pandemic “some‐extremely” disruptive; mean caregiver disruption scores were 4/5, 3.6/5 and 3.8/5 for those who cared for participants with CDR = 3, 2 and 1, respectively. Caregivers (63%) said that vaccination “very‐extremely” reduced caregiving stress. 41% endorsed “a lot” as to how challenging it was to ensure participants complied with COVID safety precautions. 47% felt that COVID “moderately‐severely” impacted the participant’s cognition. Caregivers’ biggest barriers were lack of access to day programs (31%), decreased support from family/friends (31%), and lack of in‐person medical care (25%). 42% of caregivers were “somewhat‐extremely” uncomfortable with in‐person research. Caregivers (63%) said that going forward, flexibility of in‐person vs. remote evaluations was “very‐extremely” important.ConclusionThis diverse group of caregivers reported more isolation and disruption than CN/MCI participants, particularly with participants with CDR’s of 2‐3. Caregivers also expressed continued desire to participate in research. Research centers should be mindful of the impact of isolation, loss and stress (e.g. helping loved ones with cognitive impairment manage safety protocols). Increased social work services and prioritizing flexibility (e.g. telehealth) is key.

Clinical Features and Outcomes of COVID-19 Infections at a Teaching Hospital in Kingston, Jamaica

Abstract Objective We examined the demographic, clinical characteristics and indicators of poor outcomes among hospitalised adults with COVID-19 infection at the University Hospital of the West Indies, Jamaica. Methods A retrospective medical record review between March 10 and December 31, 2020 was done and demographic clinical data were collected. Results There were 218 males (mean age 59.5 years) and 144 females (mean age 55.7 years). Hypertension, diabetes mellitus, cardiovascular disease, obesity and chronic kidney disease were the most common comorbidities. Cough, shortness of breath, fever and malaise were the most common presenting complaints. Fifty-one per cent of patients were moderately to severely ill on admission; 11% were critically ill; 18% were admitted to the Intensive Care Unit (ICU). Death occurred in 62 (17%) patients (95% CI 13.6-21.4). Among obese participants, there were increased odds of developing respiratory failure (OR 5.2, p < 0.001), acute kidney injury (OR 4.7, p < 0.001), sepsis (OR 2.9, p =0.013) and the need for ICU care (OR 3.7, p < 0.001). Factors independently associated with increased odds of death were age (OR 1.03 per year, p = 0.013) and obesity (OR 2.26, p = 0.017). Mortality also correlated significantly with D-dimer > 1000 ng/mL (OR 2.78; p = 0.03), serum albumin < 40 g/L (OR 3.54; p = 0.03) and serum LDH > 485 U/L OR 1.92, p = 0.11). Conclusions Comorbidities were prevalent among COVID-19 cases in this study. Significant correlates of mortality were older age and obesity. Hypoalbuminaemia, elevated D-dimer and serum LDH at admission also portend a poor prognosis. Keywords: SARS-CoV-2, COVID-19, Jamaica, outcomes, mortality

ST-segment elevation myocardial infarction and the clinical significance of differentiated electrocardiogram

Aim. To evaluate the markers of changing dynamics recorded by digital processing of routine ECG using own diagnostic complex software “Smart-ECG” in patients with ST-segment elevation myocardial infarction (STEMI) based on the results of a 40-day follow-up. Materials and methods. The main group consisted of 20 patients with STEMI according to the ESC guidelines (2017) (mean age of males 56.11 ± 11.62, n = 10; mean age of females 58.22 ± 13.11, n = 10). ECG were analyzed using own developed diagnostic complex software “Smart-ECG” on the 1st, 10th, 40th day after STEMI. The first derivative of T wave – ratio of maximum velocity (MVR), inclination angle (β) and inclination height (H) of ST segment was calculated. The control group – 20 apparently healthy people. Results. MVR indicators decreased by 61.90 %, 68.20 % and 51.48 % on the 1st, 10th and 40th day, respectively, after STEMI as compared to those of the control group (p < 0.01). At the moment of the maximum ST segment elevation, the height (H) of ST inclination was 347.7 % increased (p < 0.01); on the 40th day, H was 25 % increased, close to control indicators, with ST segment shift to isoline (р > 0.05). During the acutest period, the angle β increased by 172.2 % (p < 0.01) and then decreased by 15.8 % at the recovery phase, but insignificantly. Conclusions. Self-developed medical software “Smart-ECG” for qualitative evaluation of ECG is an effective tool to diagnose pathological changes in the myocardium, makes it possible to improve the specificity, sensitivity and prognostic significance of ECG in STEMI. The significant decrease in MVR has been detected at all stages of STEMI, which was associated with a violation of electrogenesis in the repolarization phase; the critical increase in ST slope indicators (angle β and height H) on the 1st day has been found as a characteristic of ST elevation, as well as its decrease on the 40th day as a sign of reduced potential difference between healthy and damaged areas of the myocardium during the recovery stage.

Lugol's iodine and methylene blue as an adjunctive tool for early diagnosis of premalignant oral lesions.

Objective: To compare Lugol’s Iodine and Methylene blue as an adjunctive tool for early diagnosis of premalignant oral lesions by taking histopathology as the gold standard. Study Design: Cross-sectional descriptive. Setting: Outpatient Department of Isra Dental College Hospital, Isra University Hyderabad. Period: January 2021 to July 2021. Material & Methods: All patients with oral premalignant lesions were selected. Methylene blue and iodine staining were used in the lesion area. The dye was applied directly with a cotton bud for 10–20 seconds, and the mouth was resigned with tap water. The dye retention pattern was evaluated by the stain retention intensity on the lesion. Incisional biopsy was performed simultaneously at that site as a gold standard. Results: Out of 60 cases, males were 49 (81.6%) and females were 11(18.3%). The mean age of males and females was 41.910.7 years and 39.87.74 years, respectively. Out of all patients, 65.0% had more than one addictive habit of mainpuri, gutka, or supari. The commonest region of oral lesions was the buccal mucosa among 61.6% of patients, followed by the alveolus in 16.6%, lips 8.3%, tongue 6.6%, and retro molar area 3.33%, while the palate and floor of the mouth were involved in 1.66% of patients. According to the diagnostic accuracy of methylene blue, the sensitivity was 89.4% and the specificity was 66.6%. According to the Lugol’s, iodine sensitivity was 83.3% and specificity was 50%. Conclusion: It has been determined that methylene blue and lugols iodine staining are the best, easy, and noninvasive screening tools to detect the early diagnosis of malignancy.

Association of longitudinal changes in skeletal muscle mass with prognosis and nutritional intake in acutely hospitalized patients with abdominal trauma: a retrospective observational study.

The objective of this study was to explore whether longitudinal changes in skeletal muscle mass, from hospital admission to 3 weeks post-trauma, are associated with poor prognosis and nutritional intake in acutely hospitalized patients with abdominal trauma. A single-center retrospective observational review was conducted on 103 patients with abdominal trauma admitted to the Affiliated Jinling Hospital, Medical School of Nanjing University between January 2010 and April 2020. Skeletal muscle mass was assessed by abdominal computed tomography (CT) performed within 14 days before surgery and on post-trauma days 1-3 (week 0), 7-10 (week 1), 14-17 (week 2), and 21-24 (week 3). The skeletal muscle index (SMI) at L3, change in SMI per day (ΔSMI/day), and percent change in SMI per day (ΔSMI/day [%]) were calculated. The receiver-operating characteristic (ROC) curve was used to evaluate the discriminatory performance of ΔSMI/day (%) for mortality. Linear correlation analysis was used to evaluate the associations between ΔSMI/day (%) and daily caloric or protein intake. Among the included patients, there were 91 males and 12 females (mean age ± standard deviation 43.74 ± 15.53 years). ΔSMI4-1/d (%) had a ROC-area under the curve of 0.747 (p = 0.048) and a cut-off value of -0.032 for overall mortality. There were significant positive correlations between ΔSMI4-1/d (%) and daily caloric intake and protein intake (Y = 0.0007501*X - 1.397, R2 = 0.282, R = 0.531, p < 0.001; Y = 0.008183*X - 0.9228, R2 = 0.194, R = 0.440, p < 0.001). Δ SMI/day (%) was positively correlated with daily caloric intake ≥80% of resting energy expenditure in weeks 2, 3, and 1-3 post-trauma and with protein intake >1.2 g/kg/d in weeks 3 and 1-3 post-trauma. Loss of skeletal muscle mass is associated with poor prognosis and nutritional intake in patients admitted to hospital with abdominal trauma.

A Quantitative Investigation of Gender-Related Variations in Coronary Artery Diameters

Objective: To evaluate the association between gender and coronary artery diameter at the cardiac ward of a tertiary care hospital. Background: Understanding the normal structure of the coronary arteries is essential for accurately describing the amount of coronary atherosclerosis. However, studies on the true normal coronary arteries' luminal diameters are scarce. Although numerous studies have assessed the post-mortem coronary artery dimensions. A few studies have been conducted in living patients with presumed normal arteries utilizing quantitative coronary arteriography techniques Study Design: A cross-sectional study Place and Duration: This study was conducted at Peoples University of Medical and Health Sciences for women Nawabshah from December 2021 to December 2022. Methodology: The study has 121 participants. The statistical analysis was performed using SPSS version 23. We used the t-test to analyse the connection between numerical and categorical variables. A P value of 0.05 or less was considered statistically significant in every case. The patient identification number was substituted for the patient's name, angiography film number, and medical record number in the proforma, and each patient's identity was kept private. Films from coronary angiography that were deemed to be normal were gathered and examined. Results: In the present study, males were in higher proportion compared to the females with 53.72 % against 46.28%. The mean age of females was 54.9 ± 8.3 and the mean age of males was 58.7 ±9.1 Years. The mean body surface area (BSA) for males was 1.79 ±0.07 and the mean BSA for females was 1.73 ±0.02. Conclusion: Although multiple alternative explanations for the difference in coronary dimensions with gender and age have been discussed, however, in our results, coronary dimensions didn’t show a significant association with gender. There is still huge space for large-scale studies on the subject. Keywords: Coronary artery diameters, Gender Association, comparison

Evaluation of the Efficacy of Ultrasound-Guided Interventions in Managing First-Trimester Vaginal Bleeding

Objective: Aim was to evaluate the efficacy of ultrasound-guided interventions in managing first-trimester vaginal bleeding. Study Design: Observational study Place and Duration: Gynaecology and Obstetrics Department people university of Medical and health sciences jamshoro Hyderabad. January 2022-December 2022 Methods: Total 116 pregnant females of first trimester were presented in this study. All the presented women had complaint of vaginal bleeding. Included patients had gestational age between 6-12 weeks. After a thorough clinical evaluation and diagnosis, patients were sent for an ultrasound. Ultrasound results were evaluated in terms of pregnancy type and types of abortions. SPSS 23.0 was used to analyze all data. Results: There were majority primi-gravida women 72 (62.1%) and 44 (37.9%) females were multigravida. Females mean age 27.5±12.19 years and had mean BMI 27.8±4.23 kg/m2. Mean gestational age of the females was 10.2±4.17 weeks. Frequency of viable patients was 36 (31.03%) and non-viable patients was 80 (68.97%). Among 80 non-viable cases, different type of abortions was found in 62 (67.5%) cases, ectopic pregnancy in 10 (12.5%) cases and molar pregnancy in 8 (10%) cases. Conclusion: Ultrasonography is the most accurate and non-invasive diagnostic method for distinguishing between the various conditions and phases of first trimester bleeding in pregnant women. The use of ultrasonography for prenatal screening has opened up new avenues for the timely treatment of patients, which has been shown to minimize death rates associated with pregnancy complications. Keywords: Abortion, First Trimester, Molar pregnancy, Ectopic Pregnancy

Determination of Anemia Iron Deficiency Anemia and β-thalassemia during Pregnancy

Aim: To observe the frequency of anemia, iron deficiency anemia and β-thalassemia during pregnancy. Study type, setting &amp; duration: This cross sectional study was undertaken at antenatal clinic of gynecology, Unit V of Lady Aitcheson Hospital Lahore from October 2018 to March 2019. Methodology: The study was commenced after formal written permission. A total of 310 pregnant women were included in this study andtheir demographic information was taken on predesigned Performa. Blood samples from all females were collected from the peripheral vein of upper limb and was sent to hospital laboratory for analysis of Hemoglobin and other necessary parameters. All female were labeled as iron deficiency anemia or β thalassaemia as per operational definition. Data was entered and analyzed in SPSS. Results: Mean age of females was 26.23± 5.26 years and mean gestational age was remained to be 16.632±10.62 weeks. The mean hemoglobin 8.55±2.10 g/dl, mean iron binding capacity was 13.07 ± 6.55 µg/dl and mean serum ferritin was 43.50 ± 76.93 µg/L. Anemia was seen in 270(87.1%), iron deficiency anemia was diagnosed in 239(77.1%) while β thalassemia was seen in 29(9.4%) of the pregnant women. There was significant association between parity with anemia and β thalassemia, p-value &lt; 0.05. While iron deficiency anemia was not associated with parity. Conclusion: Anemia, iron deficiency anemia and β-thalassemia are much high and require recognition at early gestations. Various factors are reported to be involved which may be controlled by early supplementation. Keywords: Anemia, Iron deficiency, β-thalassemia, pregnancy, trimester, parity.