The HCG ratio as a predictor of pregnancy outcome in assisted conception cycles

Objective: To determine whether the HCG ratio can be used to predict pregnancy viability in patients undergoing IVF/ICSI treatment. Design and settings: This was a prospective observational study conducted in a private assisted conception unit. Subjects and methods: The patients recruited had one either a long luteal agonist protocol, a short agonist protocol, or an antagonist protocol. All patients had a maximum of three embryos transferred per cycle. Pregnancy detection was by routine serum HCG measurement on day 14 after oocyte retrieval (HCG 0) followed by another HCG sample 48h later (HCG 48). Patients with an initial positive HCG had a transvaginal ultrasound 14days later to determine viability. Results: Three hundred and twenty patients were included in the study. We used receiver operating characteristics (ROC) analysis to predict the ability of HCG measured at 14days (HCG 0), HCG measured at 16days (HCG 48) after oocyte retrieval as well as the HCG ratio (HCG 48/HCG 0) to predict pregnancy viability as well as to predict multiple pregnancy. The HCG ratio with an optimal cut-off of 1.82 had a sensitivity of 97.6%, a specificity of 98.2% and an area under the ROC curve of 98% in the prediction of pregnancy viability. In the prediction of multiple pregnancy the HCG ratio had an optimal cut-off of 2.06 with a sensitivity of 94.5% and a specificity of only 35.6% and an area under of only the ROC curve of 64%. However, the HCG 0 with a cut-off value of 118.56mIU/ml (sensitivity 97%, specificity 96.5%) and the HCG 48 with a cut-off value of 258.16mIU/ml (sensitivity 97.2%, specificity 99.4%) were shown to be accurate in predicting a viable intrauterine multiple pregnancy with an area under the ROC curve of 97% and 99%, respectively. Conclusion: The HCG ratio with a cut-off value of 1.82 can be used to predict pregnancy viability in assisted conception cycles. Also HCG measured 14 and 16days after oocyte retrieval with a cut-off value of 118.56mIU/ml and 258mIU/ml can be used to predict viable multiple pregnancy

Serum anti-Müllerian hormone and basal serum FSH as predictors of poor ovarian response in assisted conception cycles

Objective: The aim of the study was to correlate serum AMH and serum FSH levels with ovarian response to stimulation in IVF–ICSI cycles. Design and settings: This was a prospective observational study conducted in a private assisted conception unit. Subjects and methods: One hundred and two patients were selected on their first IVF cycle. Basal serum FSH and serum AMH were measured one month before the stimulation cycle. A fixed dose GnRH antagonist protocol was used in all cycles transferring a maximum of three day-3 cleavage stage embryos. We defined poor ovarian response as retrieval of fewer than four mature oocytes in cycles requiring ⩾ 3000 IU of gonadotropins for stimulation or cycle cancellation due to poor response. The correlation between different parameters was expressed as a Spearman’s correlation coefficient. The clinical value of AMH and FSH as predictors of poor ovarian response as well as predictors of pregnancy was evaluated by constructing relevant receiver operator characteristics curves (ROC curves). Results: Of these 102 cycles, 28 fitted our definition of poor response while the remaining 74 cycles all produced an adequate response to stimulation. There was a statistically significant difference between the adequate responders group and poor responders group regarding their mean age (31.5 versus 39.6, p < 0.001), the mean value of AMH (2.84 ng/ml versus 0.9 ng/ml, p < 0.0001) as well as the mean value of basal FSH (7.6 IU/ml versus 9.7 IU/ml, p < 0.0001). Serum AMH level had a positive correlation while serum FSH had a negative correlation with the number of oocytes collected while only serum AMH had a significant positive correlation with the occurrence of pregnancy. ROC curve analysis of our results showed that serum AMH with an optimal cut-off value of 1.2 ng/ml is a reliable predictor of poor ovarian response with an area under the ROC curve of 90.4%. Serum basal FSH with an optimal cut-off value of 8.9 IU/ml was of lower value than AMH as a predictor of poor ovarian response with an area under the ROC curve of 81.9%. However, neither serum AMH nor basal serum FSH was found to able to reliably predict the occurrence of pregnancy with an area under the ROC curve of 59.4% and 58.6% respectively. Conclusion: Our results show that serum AMH level is more reliable than basal serum FSH as a predictor of poor ovarian response to stimulation with a cut-off value of 1.2 ng/ml shown to predict poor ovarian response with a sensitivity of 91.7%

Fungal infection profile in critically ill COVID-19 patients: a prospective study at a large teaching hospital in a middle-income country

Abstract Background Critically ill COVID-19 patients are highly susceptible to opportunistic fungal infection due to many factors, including virus-induced immune dysregulation, host-related comorbidities, overuse and misuse of antibiotics or corticosteroids, immune modulator drugs, and the emergencies caused by the pandemic. This study aimed to assess the incidence, identify the potential risk factors, and examine the impact of fungal coinfection on the outcomes of COVID-19 patients admitted to the intensive care unit (ICU). Methods A prospective cohort study including 253 critically ill COVID-19 patients aged 18 years or older admitted to the isolation ICU of Zagazig University Hospitals over a 4-month period from May 2021 to August 2021 was conducted. The detection of a fungal infection was carried out. Results Eighty-three (83) patients (32.8%) were diagnosed with a fungal coinfection. Candida was the most frequently isolated fungus in 61 (24.1%) of 253 critically ill COVID-19 patients, followed by molds, which included Aspergillus 11 (4.3%) and mucormycosis in five patients (1.97%), and six patients (2.4%) diagnosed with other rare fungi. Poor diabetic control, prolonged or high-dose steroids, and multiple comorbidities were all possible risk factors for fungal coinfection [OR (95% CI) = 10.21 (3.43–30.39), 14.1 (5.67–35.10), 14.57 (5.83–33.78), and 4.57 (1.83–14.88), respectively]. Conclusion Fungal coinfection is a common complication of critically ill COVID-19 patients admitted to the ICU. Candidiasis, aspergillosis, and mucormycosis are the most common COVID-19-associated fungal infections and have a great impact on mortality rates

Influence of Schroth Best Practice Therapy on Ventilatory Function in Adolescent Idiopathic Scoliosis: Randomized Controlled Study Design

Introduction: Approximately 2%-3% of the population develops idiopathic scoliosis, making it the most prevalent structural spinal deformity in children as well as adolescents. Objective: To find out the efficacy of Schroth Best Practice therapy on pulmonary functions in adolescent idiopathic scoliosis. Methods: Sixty female subjects with adolescent idiopathic scoliosis were recruited from Outpatient Department at AlKasr Al-Ainy Hospital from May 2022 to July 2023 were enrolled in that study. They were randomized into two equivalent groups: Either the intervention group: Group A (Study group) consists of 30 subjects received the Schroth Best Practice exercises program for 18 weeks, or the control group Group B: consists of 30 subjects received traditional exercise program for 18 weeks. Both groups were given 3 sessions a week. Both groups received assessment of pulmonary functions: Forced Vital Capacity (FVC), forced expiratory volume in the first second (FEV1) As well as Peak Expiratory Flow (PEF) on 1st and 18th week. Measuring pulmonary function with digital handheld spirometer before and after treatment. These selective subjects were randomized into two equal groups. Results: There was a statistically significant difference (p&lt;0.05) among the two groups when comparing the mean values of all measured variables pre and post treatment. All analyses were performed at the 0.05 level of significance. With the initial alpha level set at 0.05, in favor of group A. Conclusion: Both Schroth Best Practice exercise program and traditinal exercise program have a significant effect in adolescent idiopathic scoliosis, and the integrated Schroth Best Practice exercise program was more effective than traditional exercise alone

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research