Ruptured cardiac hydatid cyst as a rare cause of acute extremity ischemia: A case presentation

Echinococcosis, also known as a Hydatic cyst (HC), is a chronic parasitic disease that is prevalent in countries where people consume infected grazing animal meat. The heart is involved in 0.5% to 2% of all hydatid cysts. The best diagnostic method for cardiac HC is echocardiography. In addition to radiological examinations, HC diagnosis is dependent on serological reactions such as the Cassoni test and ELISA for Echinococcus multilocularis. Rupture of cardiac HC from the left ventricle is an uncommon but potentially fatal consequence that results in ischemia by numerous emboli. We report a case of a 31year old Nepali male who presented in the emergency room (ER) with anaphylactic shock and lower and upper extremity ischemia. The patient was resuscitated in ER and then shifted to the Intensive Care Unit (ICU). The reperfusion of the lower and upper extremities was achieved after Fogarty embolectomy. To evaluate the source of the emboli, echocardiography was carried out, and a remnant of the ruptured cyst on the left ventricular free wall was found. The histopathology report came consistent with the HC. Accordingly, the patient received Albendazole. He preferred to seek a second opinion regarding the decided cardiac surgery in his home country Nepal

Effect of late coasting used in the prevention of ovarian hyperstimulation syndrome on oocyte quality

Objective: To detect the effect of late coasting on oocyte quality. Design: Retrospective study. Setting: Samir Abbas Medical Center Materials and methods: Patients where estradiol level was over 4000 pg/ml and late coasting was used as a method to prevent OHSS, and patients where estradiol level was over 4000 pg / ml but no coasting was done Main outcome measure(s) : Oocyte quality. Results: number of mature oocytes was identical in both groups,however the significant difference was in the oocyte recovery rate which was higher in the control group (120) than in the coasting group(92) Conclusion(s): Oocyte quality is not affected after using coasting as a method for prevention of OHSS. Effect of late coasting used in the prevention of ovarian hyperstimulation syndrome on oocyte qualit

Fresh versus frozen embryo transfer in women with polycystic ovaries syndrome undergoing in vitro fertilisation

Abstract Background Polycystic ovarian syndrome (PCOS) cases undergoing in vitro fertilisation (IVF) are widely at risk of ovarian hyperstimulation; therefore, elective freezing of all embryos to be transferred in a later cycle is preferred. We aimed to compare the pregnancy outcome between the fresh and the frozen embryo transfer (ET) in PCOS cases undergoing IVF with antagonist ovarian induction using human chorionic gonadotropin (HCG) as a trigger. Methods In this prospective randomised study, 110 infertile PCOS women underwent fresh ET (group A) or frozen ET (group B) with GnRH-antagonist protocol. The primary outcome was the chemical and clinical pregnancy rates. The secondary outcomes were the ongoing pregnancy rate, ovarian hyperstimulation syndrome (OHSS) rate, pregnancy loss rate, ectopic pregnancy rate, and congenital anomalies rate. Results There was no significant difference between both groups regarding chemical pregnancy rate (44.23% vs 47.27%, P = 0.752), clinical pregnancy rate (42.31% vs 43.64%, P = 0.89), ongoing pregnancy rate (38.46% vs 41.82%, P = 0.723), pregnancy loss rate (17.39% vs 15.4%, P = 1), ectopic pregnancy rate (1.92% vs 0%, P = 0.486) and anomaly malformation rate (4.35% vs 3.85%, P = 1). On the other hand, the incidence of OHSS was significantly less in group B than in group A (3.64% vs 19.23%, P = 0.011), and the OHSS grade was less severe in group B than in group A (P = 0.033). However, there was no statistically significant difference between both regarding the need for hospitalisation (P = 0.111), ICU admission (P = 0.486), and ascites tapping (P = 0.486). Conclusions Under GnRH-antagonist protocol, frozen ET has the upper hand in PCOS undergoing IVF treatment for infertility, as it protects against OHSS and decreases its severity. Trial registration It was first registered at ClinicalTrials.gov on 22/12/2021 with registration number NCT05167838

Low dosing of gonadotropins in in vitro fertilization cycles for women with poor ovarian reserve: systematic review and meta-analysis

Objective: To evaluate the effectiveness of low doses of gonadotropins and gonadotropins combined with oral compounds compared with high doses of gonadotropins in ovarian stimulation regimens in terms of ongoing pregnancy per fresh IVF attempt in women with poor ovarian reserve undergoing IVF/intracytoplasmic sperm injection (ICSI) treatment. Design: A systematic review and meta-analysis of randomized controlled studies that evaluate the effectiveness of low dosing of gonadotropins alone or combined with oral compounds compared with high doses of gonadotropins in women with poor ovarian reserve undergoing IVF/ICSI treatment. Setting: Not applicable. Patient(s): Subfertile women with poor ovarian reserve undergoing IVF/ICSI treatment. Intervention(s): We searched the PubMed, EMBASE, Web of Science, the Cochrane Library, and the Clinical Trials Registry using medical subject headings and free text terms up to June 2016, without language or year restrictions. We included randomized controlled studies (RCTs) enrolling subfertile women with poor ovarian reserve undergoing IVF/ICSI treatment and comparing low doses of gonadotropins and gonadotropins combined with oral compounds versus high doses of gonadotropins. We assessed the risk of bias using the criteria recommended by the Cochrane Collaboration. We pooled the results by meta-analysis using the fixed and random effects model. Main Outcomes Measure(s): The primary outcome was ongoing pregnancy rate (PR) per woman randomized. Result(s): We retrieved 787 records. Fourteen RCTs (N = 2,104 women) were included in the analysis. Five studies (N = 717 women) compared low doses of gonadotropins versus high doses of gonadotropins. There was no evidence of a difference in ongoing PR (2 RCTs: risk rate 0.98, 95% confidence interval 0.62-1.57, I-2 = 0). Nine studies (N = 1,387 women) compared ovarian stimulation using gonadotropins combined with the oral compounds letrozole (n = 6) or clomiphene citrate (CC) (n = 3) versus high doses of gonadotropins. There was no evidence of a difference in ongoing PR (3 RCTs: risk rate 0.90, 95% confidence interval 0.63-1.27, I-2 = 0). Conclusion(s): We found no evidence of a difference in pregnancy outcomes between low doses of gonadotropins and gonadotropins combined with oral compounds compared with high doses of gonadotropins in ovarian stimulation regimens. Whether low doses of gonadotropins or gonadotropins combined with oral compounds is to be preferred is unknown, as they have never been compared head to head. A health economic analysis to test the hypothesis that an ovarian stimulation with low dosing is more cost-effective than high doses of gonadotropins is needed. ((C) 2017 by American Society for Reproductive Medicine.