Impact of peak/mid luteal estradiol on pregnancy outcome after intracytoplasmic sperm injection

Abstract Objective: To compare peak to mid estradiol ratio with the probability of successful conception after intracytoplasmic sperm injection. Method: The quasi-experimental study was conducted in an infertility clinic at Islamabad from June 2010 till August 2011, and comprised couples subjected to intra-cytoplasmic sperm injection. Down-regulation of ovaries was followed by calculated stimulation, ovulation induction, oocytes retrieval, intra cytoplasmic sperm injection, in vitro maturation of embryos and finally blastocysts transfer. Serum estradiol was measured by enzyme-linked immunosorbent assay on ovulation induction day and the day of embryo transfer. Failure of procedure was detected by beta human chorionic gonadotropin5-25mIU/ml (Group I; non-pregnant).Females with beta human chorionic gonadotropin\u3e25mIU/ml and no cardiac activity after 4 weeks of transfer were placed in Group II (pre-clinical abortion), and confirmation of foetal heart in the latter comprised Group III (clinical pregnancy). Data was analysed using SPSS 15. Results: Of the 323 couples initially enrolled, embryo transfer was carried out in 282(87.3%) females. Clinical pregnancy was achieved in 101(36%) of the cases, while 61(21.63%) had pre-clinical abortion, and 120(42%) remained non-pregnant. The peak/mid-luteal estradiolratio was low (2.3) in patients who had high oocyte maturity (p=0.001) and fertilisation rate (p=0.003) compared to non-pregnant patients with high peak/mid-luteal estradiolratio (2.56). Conclusion: High peak estradiol with maintenance of optimal levels in mid-luteal phase is required for implantation of fertilised ovum and accomplishment of clinical pregnancy

Producing financially literate medical graduates -- a national need for a brighter Pakistan

Objective: To compare the awareness of financial wellness between male and female medical students.Methods: The cross-sectional questionnaire-based survey was conducted from February to December 2011 and comprised first year medical students belonging to different medical colleges of Karachi. Students from both genders, aged 19-24 years, belonging to all ethnic groups willing to participate were included. A close-ended questionnaire evaluated aspects of financial wellness, using four-point Likert\u27s scale: never, sometimes, mostly, and always from 0 to 4. Besides, factor analysis was performed to investigate common financial wellness among the participants.Results: Of the total 800 students approached, complete responses were received from 736(92%); 210(28.5%) boys and 526(71.5%) girls. The mean financial wellness score of boys was 8.60±3.04 and that of the girls was 7.61±3.12 (p \u3c 0.0005). Greater number of boys 93(44%) set both short- and long-term financial goals compared to 180(36%) girls (p=0.03). Besides, 218(42%) girls confined themselves to the budget compared to 81(39%) boys (p \u3e 0.05). More boys 71(34%) were spendthrift (p \u3c 0.0001) and 57(27%) preferred to keep their savings in bank accounts compared to the girls (p \u3c 0.0001). Overall, boys were better in financial security wellness compared to the girls (p=0.001).CONCLUSIONS: Male medical students exhibited awareness of financial wellness better than girls

A comparison between wellness awareness among medical students

Objective: To assess and compare the dimensions of spiritual wellness as elements of quality care in medical students of private and public medical universities.Methods: The cross-sectional study was carried out at private and public medical universities in Karachi from November 2013 to January 2015.Students from both genders and all ethnic groups19-23 years of age were included. The responses of spiritual wellness were obtained and evaluated on a four-point Likert\u27s scale; score ranging from 0-3. Data was analysed using Predictive Analysis Software version 18.Results: Out of 736 students, 286 (38.9%) were from public medical universities and 450 (61.1%) were from private-sector institutions. Students of both types of universities were aware of the concept of spiritual wellness but the level of awareness needed scaling up. Public-sector students had a stronger will, were more physically and mentally alert, more compassionate, empathetic and enthusiastic about their relationship with patients than their private-sector counterparts (p\u3c0.05). They used spiritual wellness as a coping strategy to deal with difficult situations through religious activities. Though attentive listening was a predominant feature in both groups, the use of communication skills required particular attention to improve the element of compassionate care

Perceptions of medical students regarding dimensions of environmental wellness

Abstract OBJECTIVE: To explore the status of awareness on environmental wellness in medical students of Karachi. METHODS: The cross-sectional questionnaire-based survey was carried out at Bahria University Medical & Dental College, Karachi, from January 2009 to July 2013, and comprised randomly selected medical students. The response options were; never, sometimes, mostly and always (numbered 0-4) and these were analyzed in terms of frequency, proportion and percentages by Predictive analysis software version18. RESULTS: Out of 800 questionnaires distributed, 736(92%) were received fully completed. There were 210(28.5%) male and 526(71.5%) female respondents, with a male-to-female ratio of 1:2.5. Female medical students were more serious in taking care of their environment tasks (p\u3c 0.0001). They knew their responsibility to preserve environment and consciously tried to conserve energy more than the male students (p=0.034). The proportions of admitting disposal of garbage in dustbins was found more in females than males (p\u3c 0.0005). Though 486(66%) participants were interested in knowing about environmental problems, females tended to be more in liking greenery in their place of residence (p\u3c 0.0005) and lived in harmony with nature and universe (p\u3c 0.001). CONCLUSIONS: Medical students were aware of the concept of environmental wellness, but female medical students had a better perception and were a step ahead in its realization

Impact of social interdependence on emotional well-being of medical students

OBJECTIVE:To observe the effect of social interdependence on emotional well-being in medical students.METHODS:This cross-sectional study was conducted in Karachi from June 2013 to January 2014 and comprised first-year medical students of 5 private and 3 public-sector colleges. Students of both genders aged 19-24 years were included. Quantitative aspects of social and emotional wellness were evaluated using a structured questionnaire from the wellness wheel on a four-point Likert\u27s scale (score ranging from 0 to 3). Two focus group discussions were conducted in each medical college from the qualitative aspect.RESULTS:Of the 736 participants, 526(71.47%) were females and 210(28.53%) were males. Males reported significantly less inclination towards exhibiting fairness, solving problems, teaching batch fellows and attending group discussion (p\u3c0.05). They were significantly least anxious with less frequency of helping others during emotional outbursts (p\u3c0.05). Females had higher frequency of close friends and self-improvement (p\u3c0.05). The scores of social wellness were significantly better in females compared to males (p\u3c0.001) while there was no significant difference in emotional wellness on the basis of gender (p\u3e0.05). Social communication and help was highly positively correlated with self-content in students (p\u3c0.05)

Importance of estimation of follicular output rate (FORT) in females assisted by intracytoplasmic sperm injection

Background: We aimed to estimate pregnancy outcome after ICSI in terms of oocyte parameters, embryo quality, endometrial thickness, hormone and cytokine levels in women stratified on the basis of follicular output rate (FORT).Methods: Quasi experimental design was carried out after approval from “Ethical review board of Islamabad clinic serving infertile couples” from July 2010 to August 2013. One thousand and fifty females were selected with the criteria of age between 21-40 years, infertility of more than 2 years, body mass index of 18-35 kg/m2, menstrual cycle of 25 ± 7 days, both ovaries present with normal uterine cavity, serum FSH levels less than 8 IU/ml and normal thyroid-stimulating hormone levels. Females on short agonist or antagonist protocol with diagnosis of polycystic ovarian syndrome, fibroids or in their male partner sperms retrieved by testicular biopsy were excluded from the study. Down regulation of ovaries was followed by controlled ovarian stimulation, Ovulation Induction (OI), oocyte pick up, in vitro fertilization, Embryo Transfer (ET) and confirmation of pregnancy was done by serum beta hCG of more than 25 mIU/ml and  cardiac activity on trans vaginal scan. Enzyme linked immuno sorbent assay was used for peak and mid luteal estradiol (E2), progesterone (P) and interleukin I-β estimation on OI and ET days respectively. FORT (ratio of preovulatory follicle count to antral follicle count × 100 on OI day) stratified females into low under the 33rd percentile, medium between the 33rd and the 67th percentile and high above the 67th percentile. Characteristics   of groups were compared by one way analysis of variance.  Results: Females 276 (33%), 288 (34%) and 282 (33%) comprised of low, medium and high FORT groups respectively. The number of retrieved, mature and fertilized oocytes, cleaved embryos, endometrial thickness and number of gestational sacs in the high FORT group was significantly high (P <0.001). High peak and midluteal E2 (P = 0.0025, 0.0001), low P (P = 0.0001) and high peak interleukin-1β (P = 0.0001) was observed in high FORT in comparison with medium FORT with resultant greater number of clinical pregnancies 183 (65%).  Conclusions: The FORT in non PCOS patients may reflect good reproductive outcome after ICSI with maximum clinical pregnancies in high FORT group.

Impact of peak estradiol levels on reproductive outcome of intracytoplasmic sperm injection

Objective: To observe effect of peak estradiol (E2) levels on outcome after intra cytoplasmic sperm injection (ICSI).Methods: Quasi experimental design conducted in Islamabad Clinic Serving Infertile Couples from June 2010 till August 2011. Down regulation with mid luteal suppression of 564 females aged 18-41 years was done with gonadotrophin releasing hormone agonist followed by controlled ovarian stimulation, ovulation induction (OI), oocytes pickup and embryo transfer. Samples for peak serum E2 at the time of OI was estimated by Enzyme Linked Immuno Sorbent Assay. The association of peak E2 with outcome groups of Intracytoplasmic sperm injection (ICSI) (Group I) beta hCG \u3c5 m IU/ml, (Group II) with beta hCG\u3e5 mI U/ml and no cardiac activity and (Group III) with beta hCG\u3e5mIU/ml and cardiac activity on trans vaginal scan was identified. Statistical comparison by one way analysis of variance (ANOVA) via SPSS version 15 was done.Results: A clinical pregnancy rate of 36% was achieved, pregnant females(Group III) had higher peak E2 2269 ± 80.97 as compared to 1419 ± 37.07 and 1807±90.28 pg/ml (mean ± SD) in Groups I and II respectively (p\u3c0.0001) Elevated serum E2 was significantly associated with better oocyte recovery, fertilization, cleavage and implantation rates (p\u3c0.0001) .CONCLUSION: A high serum E2 measured on OI day can predict success of treatment after ICSI. Females who had high peak E2 had greater number of retrieved, mature and fertilized oocytes with thick endometrial lining that helped in implantation and clinical pregnancy

Financial wellness awareness: A step closer to achieve Millennium Development Goals for Pakistan

Objective: To explore financial wellness (FW) awareness amongst public and private sector medical college students of Karachi.Methods: A cross sectional questionnaire based survey was conducted on medical students from 3 public and 5 private sector medical colleges of Karachi from February 2011 to December 2011. All ethnic groups having age range of 18-23 years were included. A questionnaire tailored from wellness wheel evaluated the responses of FW on a four point Likert\u27s scale ranging from 0-3(never, sometimes, mostly, and always). Factor analysis explored common FW factors among both public and private sector medical college (MC) students.Results: Private MC Students were better in terms of making short and long terms financial goals compared to students in public sector. The students of public MC were more focused to make and restricting to given budgets (p=0.05). The FW element of keeping savings in bank account was responded more by private MC candidates (P \u3c 0.0001) but was spent thrift as well (P \u3c 0.0001). Factor analysis revealed two factors; \u27Financial Security Wellness\u27 which was better in Private MC Students (p=0.001) and \u27Care towards Expenses Wellness in which results were not significant.CONCLUSION: Both groups of medical college students lacked FW awareness element in terms of caring towards financial expenses. The awareness of importance of financial security was practiced better by private MC students in terms of making short and long term financial goals and keeping savings in bank accounts. They were however deficient in the knowledge of making and restricting themselves to budgets

An Ounce of Discretion Is Worth a Pound of Wit — Ergonomics Is a Healthy Choice

<div><p>Objective</p><p>The objective of the study was to identify the occurrence and outcome of low back ache amongst computer users and their relation to age, gender, occupation and duration of computer use.</p><p>Materials and Methods</p><p>A self reported questionnaire tailored from Occupational Health and Safety Act of the Ministry of Labor, Ontario, Canada was used.</p><p>Results</p><p>416 participants 55.5% males and 45% females using computers for a minimum of five years with age range 22 to 59 years belonged to different occupational groups. Consecutive hours of computer work was found to be associated with work related backache or discomfort in 27.4% (n = 114) participants (16.1% male, 11.3% female). Frequent short breaks improved backache (p value <0.001) in 93 (22.4%) participants (13.2% male, 9.2% female). No significant relation was observed with the duration of computer usage or usage per day; between the two genders or occupational groups. Backache had no significance within age groups.</p><p>Conclusion</p><p>Our study identifies the occurrence of low back pain among those who are using computer for consecutive hours without breaks and the results suggest the need to create health awareness especially use of short breaks to minimize the risk and occurrence of low back pain. The result of this study can also be used to improve ergonomic design and standards.</p></div

Dimensions of physical wellness among medical students of public and private medical colleges in Pakistan

Objectives: To determine adherence to dimensions of physical wellness among medical students of public and private medical colleges in Pakistan. Methods: This cross-sectional study was carried out from January to July 2011 among 820 students of private and public medical colleges in Karachi, Pakistan. Results: Overall, medical students scored low in dimensions of physical wellness. Private medical colleges students were fond of vigorous activities such as aerobics and swimming, whereas public medical colleges students were involved in moderate intensity activities such as walking and use of stairs (p less than 0.0001). Private students reported to consume more fast food (p=0.0001), had less sleep (p=0.0001), but attended regular annual medical checkups (p=0.009) as compared with their public institute counterparts. Safe practices such as avoidance of tobacco were almost the same. CONCLUSION: Comprehensive adherence to all dimensions of physical wellness was lacking among medical students