Assessment of maternal factors and fetomaternal outcome in pregnant women conceived by artificial reproductive techniques

Background: Infertility is a major issue and a source of social and psychological suffering for many couples. Introduction of assisted reproductive technology (ART) leads to great relief for couples nowadays. Methods: This present observational cross-sectional study was conducted at OBGY Department at Sri Aurobindo Medical College and Post Graduate Institute, Indore and who satisfy the inclusion criteria was studied from 1st April 2021 to 30th September 2022 (18 months). After approval from Institutional ethical committee. Each patient fulfilling the inclusion criteria was included in the study. Informed written consent was taken. Results: The mean age of women in this study was 37.6 years and the most common age group was between 30-50 years. Infertility was mostly unexplained (40%), followed by female factor (33.33%), male factor (16.67%), and combined (10%). 63.33% were singletons, 36.67% twins. Preterm labor (43.33%) was most common. Preeclampsia/eclampsia (33.33%), gestational hypertension, renal failure, gestational diabetes, cardiomyopathy, hepatic failure, HELLP syndrome, and DIC were other complications. 60% were caesarean-sectioned and 40% vaginal delivery. 90.24% of neonates had 5-minute Apgar scores above 7 and 9.76% below 7. 4 stillbirths (9.76%) and 75.68% of live births required NICU admission. 5 neonatal deaths (12.2%) and 21.95% perinatal mortality. Conclusions: There are numerous maternal and perinatal complications linked to ART. Couples should therefore be counselled about these risks while offering them ART as a mode of conception

Assessment of thyroid dysfunction in women with menstrual disorders in reproductive age group

Background: Thyroid disorders are among the most common endocrine disorders in the world. Thyroid dysfunction can disrupt a variety of metabolic and physiological processes, including the menstrual cycle. The purpose of this study was to discover a pattern of thyroid dysfunction in women with menstrual disorders. Methods: It is a cross-sectional study that includes 116 women. With reproductive age menstrual disorder. Thyroid dysfunction was tested in women who had menstrual problems. Serum free triiodothyronine (T3), free thyroxine (T4), and thyroid stimulating hormone (TSH) levels were used to assess thyroid function. Results: The mean age of study patients was 25.7±6.8 years. The most common menstrual disorder was irregular cycle 72.5%, amenorrhea 21.9%, and menorrhagia 5.6%. The majority of the patients were between the ages of 15 and 24 (51.1%), followed by 25-34 (36.1%) and 35-45 (12.9%). The mean free T3 and T4 levels were 2.911.05 pg/ml and 1.420.57 ng/dl, respectively. TSH was 2.0 mIU/L on average (IQR, 1.0-4.0). Thyroid dysfunction was observed in 25.8% of the women (n=60). Subclinical hypothyroidism (14.2%, n=33) was the most common thyroid dysfunction, followed by subclinical hyperthyroidism (6.9%, n=16), overt hyperthyroidism (3%, n=7), and overt hypothyroidism (1.7%, n=4). Conclusions: The study reveals that women with menstrual disorders frequently have thyroid dysfunction, particularly subclinical hypothyroidism. In order to rule out thyroid disorders as potential etiological agents for menstrual disturbances, it may therefore be advantageous to screen patients with menstrual disorders for thyroid function

Tetra-Amelia syndrome with congenital diaphragmatic hernia - A rare entity

Tetra-Amelia syndrome is a very rare disorder characterized by the absence of all four limbs. “Tetra” is the Greek word for “four” and “Amelia” refers to the failure of an arm or leg to develop before birth. This syndrome can also cause severe malformations of other parts of the body, including the face and head, heart, nervous system, skeleton, and genitalia. Tetra-Amelia syndrome with diaphragmatic defects (pulmonary hypoplasia) in a newborn is extremely rare entity. We report a very rare case of Tetra-Amelia associated with congenital diaphragmatic hernia

Isolation and identification of cellulose demoting symbionts from gut of subterranean termite, Odontotermes obesus

The study was carried out to isolate and identify the symbionts, viz. cellulose demoting bacteria and fungus in termite gut. The experiment was conducted during (February 2013- July 2013) at biotechnology laboratory, Institute of Pesticide Formulation Technology, Gurgaon (Haryana). Termites are wood eating insects and are among the most important ligno cellulose- digesting insects and possess a variety of symbiotic microorganisms in their gut. Nutrient agar, potato dextrose and Carboxy Methyl Cellulose (CMC) were used to isolate the dry bacterial strain and fungus. The cellulose is demoted in termite gut by the production of cellulase enzyme which is detected by Congo red stain. Colony morphology and staining technique such as Gram's staining, Congo red staining and oxidase test for bacterial strain gave an idea for the presence of genera Citrobacter and Enterobacter. Aspergillus nidulans has been isolated and identified at division of plant pathology, IARI, New Delhi. These bacteria and fungus were able to assimilate CMC which aid in digestion of cellulose in subterranean termite Odontotermes obesus (Rambur) and this study abetted to understand more about the symbionts associated with digestive mechanism of termites

Evaluation of Outcomes following Focal Ablative Therapy for Treatment of Localised Clinically Significant Prostate Cancer in Patients >70 Years: A Multi-institute, Multi-energy 15-year Experience

PURPOSE: In older patients who do not wish to undergo watchful waiting, focal therapy could be an alternative to the more morbid radical treatment. We evaluated the role of focal therapy (FT) in patients 70 years and older as an alternative management modality. MATERIALS AND METHODS: 649 patients across 11 UK sites receiving focal high intensity focused ultrasound (HIFU) or cryotherapy between June 2006 - July 2020 reported within the UK based HIFU Evaluation and Assessment of Treatment and the International Cryotherapy Evaluation (ICE) registries were evaluated. Primary outcome was failure free survival (FFS) defined by need for more than 1 focal re-ablation, progression onto radical treatment, development of metastases, need for systemic treatment or prostate cancer specific death. This was compared to the FFS in patients undergoing radical treatment via a propensity score weighted analysis. RESULTS: Median age was 74 years (IQR: 72, 77) and median follow-up 24 months (IQR: 12, 41). 60% had intermediate risk disease and 35% high risk disease. 113 patients (17%) required further treatment. 16 had radical treatment and 44 required systemic treatment. FFS was 82% (95% CI: 76-87%) at 5 years. Comparing patients who had radical therapy to those who had focal therapy, 5-year FFS was 96%, (95% CI: 93-100%) and 82% (95% CI: 75-91%) respectively, P < .001. 93% of those in the radical treatment arm had received Radiotherapy as their primary treatment with its associated use of Androgen Deprivation Therapy (ADT) thereby leading to potential over estimation of treatment success in the radical treatment arm, especially given the similar metastases free and overall survival rates seen. CONCLUSIONS: We propose FT to be an effective management option for the older or comorbid patient who is unsuitable for or not willing to undergo radical treatment

Comparative healthcare research outcomes of novel surgery in prostate cancer (IP4-CHRONOS): a prospective, multi-centre therapeutic phase II parallel randomised control trial

Introduction Focal therapy (FT) targets individual areas of cancer within the prostate, providing oncological control with minimal side-effects. Early evidence demonstrates encouraging short-medium-term outcomes. With no randomized controlled trials (RCT) comparing FT to radical therapies, Comparative Healthcare Research Outcomes of Novel Surgery in prostate cancer (CHRONOS) will compare the cancer control of these two strategies. Patients and methods CHRONOS is a parallel phase II RCT for patients with clinically significant non-metastatic prostate cancer, dependent upon clinician/patient decision, patients will enrol into either CHRONOS-A or CHRONOS-B. CHRONOS-A will randomize patients to either radical treatment or FT. CHRONOS-B is a multi-arm, multistage RCT comparing focal therapy alone to FT with neoadjuvant agents that might improve the current focal therapy outcomes. An internal pilot will determine the feasibility of, and compliance to, randomization. The proposed definitive study plans to recruit and randomize 1190 patients into CHRONOS-A and 1260 patients into CHRONOS-B. Results Primary outcome in CHRONOS-A is progression-free survival (transition to salvage local or systemic therapy, development of metastases or prostate-cancer-related mortality) and in CHRONOS-B is failure-free survival (includes the above definition and recurrence of clinically significant prostate cancer after initial FT). Secondary outcomes include adverse events, health economics and functional outcomes measured using validated questionnaires. CHRONOS is powered to assess non-inferiority of FT compared to radical therapy in CHRONOS-A, and superiority of neoadjuvant agents with FT in CHRONOS-B. Conclusion CHRONOS will assess the oncological outcomes after FT compared to radical therapy and whether neoadjuvant treatments improve cancer control following one FT session

External validation of a risk model predicting failure of salvage focal ablation for prostate cancer

OBJECTIVES: To externally validate a published model predicting failure within 2 years after salvage focal ablation in men with localised radiorecurrent prostate cancer using a prospective, UK multicentre dataset. PATIENTS AND METHODS: Patients with biopsy-confirmed ≤T3bN0M0 cancer after previous external beam radiotherapy or brachytherapy were included from the FOcal RECurrent Assessment and Salvage Treatment (FORECAST) trial (NCT01883128; 2014-2018; six centres), and from the high-intensity focussed ultrasound (HIFU) Evaluation and Assessment of Treatment (HEAT) and International Cryotherapy Evaluation (ICE) UK-based registries (2006-2022; nine centres). Eligible patients underwent either salvage focal HIFU or cryotherapy, with the choice based predominantly on anatomical factors. Per the original multivariable Cox regression model, the predicted outcome was a composite failure outcome. Model performance was assessed at 2 years post-salvage with discrimination (concordance index [C-index]), calibration (calibration curve and slope), and decision curve analysis. For the latter, two clinically-reasonable risk threshold ranges of 0.14-0.52 and 0.26-0.36 were considered, corresponding to previously published pooled 2-year recurrence-free survival rates for salvage local treatments. RESULTS: A total of 168 patients were included, of whom 84/168 (50%) experienced the primary outcome in all follow-ups, and 72/168 (43%) within 2 years. The C-index was 0.65 (95% confidence interval 0.58-0.71). On graphical inspection, there was close agreement between predicted and observed failure. The calibration slope was 1.01. In decision curve analysis, there was incremental net benefit vs a 'treat all' strategy at risk thresholds of ≥0.23. The net benefit was therefore higher across the majority of the 0.14-0.52 risk threshold range, and all of the 0.26-0.36 range. CONCLUSION: In external validation using prospective, multicentre data, this model demonstrated modest discrimination but good calibration and clinical utility for predicting failure of salvage focal ablation within 2 years. This model could be reasonably used to improve selection of appropriate treatment candidates for salvage focal ablation, and its use should be considered when discussing salvage options with patients. Further validation in larger, international cohorts with longer follow-up is recommended

External validation of a risk model predicting failure of salvage focal ablation for prostate cancer

OBJECTIVES: To externally validate a published model predicting failure within 2 years after salvage focal ablation in men with localised radiorecurrent prostate cancer using a prospective, UK multicentre dataset. PATIENTS AND METHODS: Patients with biopsy-confirmed ≤T3bN0M0 cancer after previous external beam radiotherapy or brachytherapy were included from the FOcal RECurrent Assessment and Salvage Treatment (FORECAST) trial (NCT01883128; 2014-2018; six centres), and from the high-intensity focussed ultrasound (HIFU) Evaluation and Assessment of Treatment (HEAT) and International Cryotherapy Evaluation (ICE) UK-based registries (2006-2022; nine centres). Eligible patients underwent either salvage focal HIFU or cryotherapy, with the choice based predominantly on anatomical factors. Per the original multivariable Cox regression model, the predicted outcome was a composite failure outcome. Model performance was assessed at 2 years post-salvage with discrimination (concordance index [C-index]), calibration (calibration curve and slope), and decision curve analysis. For the latter, two clinically-reasonable risk threshold ranges of 0.14-0.52 and 0.26-0.36 were considered, corresponding to previously published pooled 2-year recurrence-free survival rates for salvage local treatments. RESULTS: A total of 168 patients were included, of whom 84/168 (50%) experienced the primary outcome in all follow-ups, and 72/168 (43%) within 2 years. The C-index was 0.65 (95% confidence interval 0.58-0.71). On graphical inspection, there was close agreement between predicted and observed failure. The calibration slope was 1.01. In decision curve analysis, there was incremental net benefit vs a 'treat all' strategy at risk thresholds of ≥0.23. The net benefit was therefore higher across the majority of the 0.14-0.52 risk threshold range, and all of the 0.26-0.36 range. CONCLUSION: In external validation using prospective, multicentre data, this model demonstrated modest discrimination but good calibration and clinical utility for predicting failure of salvage focal ablation within 2 years. This model could be reasonably used to improve selection of appropriate treatment candidates for salvage focal ablation, and its use should be considered when discussing salvage options with patients. Further validation in larger, international cohorts with longer follow-up is recommended

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

In vitro propagation and quercetin quantification in callus cultures of Rasna (Pluchea lanceolata Oliver & Hiern.)

383-387A protocol for micropropagation of Pluchea lanceolata, an important medicinal herb was developed. Leaf explants obtained from field grown plants when tested for callus induction on Murashige and Skoog’s (MS) medium, supplemented with NAA in combination with BAP, produced the best callus. Maximum number of multiple shoots from the callus (26.6±0.67) was obtained on MS medium supplemented with BAP (1.0 mg/L) and Kn (1.0 mg/L). More or less uniform elongation of multiple shoots was obtained on MS medium with lower concentrations of cytokinins, i.e., BAP (0.25 mg/L) and Kn (0.5 mg/L). Further elongation and profuse rooting were achieved when the well-grown shoots were cultured on half strength MS medium supplemented with IBA (1.0 mg/L). The regenerated plantlets were hardened and established at 70% survival rate in pots. The bioactive secondary metabolite, quercetin, was isolated from callus tissues of different age groups and its identification and confirmation was carried out by the colour reaction, TLC behaviour, IR spectrum and HPLC techniques. Maximum quercetin content (0.23 mg/g dry wt of tissue) was obtained in 6-wk-old callus tissues