How effective are the non-conventional ovarian stimulation protocols in ART? A systematic review and meta-analysis

Purpose: To compare the effectiveness of starting the ovarian stimulation on the early follicular phase (“Conventional”) with the newer range of non-conventional approaches starting in the luteal phase (“Luteal”), random-start, and studies implementing them in DuoStim (“Conventional”+“Luteal”). Methods: Systematic review. We searched CENTRAL, PubMed, and Embase, on March 2020. We included randomized and non-randomized controlled trials that compared “Luteal,” random-start ovarian stimulation or DuoStim with “Conventional”; we analyzed them by subgroups: oocyte freezing and patients undergoing ART treatments, both, in the general infertile population and among poor responders. Results: The following results come from a sensitivity analysis that included only the low/moderate risk of bias studies. When comparing “Luteal” to “Conventional,” clinically relevant differences in MII oocytes were ruled out in all subgroups. We found that “Luteal” probably increases the COH length both, in the general infertile population (OR 2.00 days, 95% CI 0.81 to 3.19, moderate-quality evidence) and in oocyte freezing cycles (MD 0.85 days, 95% CI 0.53 to 1.18, moderate-quality evidence). When analyzing DuoStim among poor responders, we found that it appears to generate a higher number of MII oocytes in comparison with a single “Conventional” (MD 3.35, 95%CI 2.54–4.15, moderate-quality evidence). Conclusion: Overall, this systematic review of the available data demonstrates that in poor responders, general infertile population and oocyte freezing for cancer stimulation in the late follicular and luteal phases can be utilized in non-conventional approaches such as random-start and DuoStim cycles, offering similar outcomes to the conventional cycles but potentially with increased flexibility, within a reduced time frame. However, more well-designed trials are required to establish certainty.Fil: Glujovsky, Demian. Centro de Estudios en Ginecología y Reproducción; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Pesce, Romina. Hospital Italiano; ArgentinaFil: Miguens, Mariana. Centro de Estudios en Ginecología y Reproducción; ArgentinaFil: Sueldo, Carlos E.. Centro de Estudios en Ginecología y Reproducción; Argentina. University Of California, San Francisco; Estados UnidosFil: Lattes, Karinna. No especifíca;Fil: Ciapponi, Agustín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin

Oral health and non communicable diseases in patients of a higher education institution, Montevideo, Uruguay 2016

Determinar la prevalencia ENT y sus factores de riesgo conductuales y metabólicos en personas que concurrieron a la Facultad de Odontología de la Universidad de la República. Estudio transversal en el que se aplicó un cuestionario sobre características sociodemográficas y hábitos vinculados a factores de riesgo comportamentales. Se realizaron mediciones antropométricas, de presión arterial y glicemia capilar

A View from the Past Into our Collective Future: The Oncofertility Consortium Vision Statement

Today, male and female adult and pediatric cancer patients, individuals transitioning between gender identities, and other individuals facing health extending but fertility limiting treatments can look forward to a fertile future. This is, in part, due to the work of members associated with the Oncofertility Consortium. The Oncofertility Consortium is an international, interdisciplinary initiative originally designed to explore the urgent unmet need associated with the reproductive future of cancer survivors. As the strategies for fertility management were invented, developed or applied, the individuals for who the program offered hope, similarly expanded. As a community of practice, Consortium participants share information in an open and rapid manner to addresses the complex health care and quality-of-life issues of cancer, transgender and other patients. To ensure that the organization remains contemporary to the needs of the community, the field designed a fully inclusive mechanism for strategic planning and here present the findings of this process. This interprofessional network of medical specialists, scientists, and scholars in the law, medical ethics, religious studies and other disciplines associated with human interventions, explore the relationships between health, disease, survivorship, treatment, gender and reproductive longevity. The goals are to continually integrate the best science in the service of the needs of patients and build a community of care that is ready for the challenges of the field in the future

Repair of Block Masonry Panels with CFRP Sheets

In the 1980s, block masonry started to be widely used for new constructions in Italy’s earthquake prone areas. However, recent seismic events demonstrated that block masonry buildings may need to be repaired after earthquakes due to cracking. Construction defects are the main cause for cracking of block work masonry. Carbon fibre reinforced polymer (CFRP) sheets have been used as a local repair method for non-defective and defective wall panels. An experimental program was formulated to investigate the shear behaviour of block masonry walls repaired with CFRP sheets. A total of six wall panels were constructed in the laboratory and tested in shear (in-plane lateral loading). It was found that, although the control (non-defective) wall panels had a high ultimate load capacity, the use of CFRPs reduces the effects of construction defects and restores the lateral load capacity in non-defective walls. Overall, this research suggests that the use of epoxy-bonded CFRP sheets could be used for local repair of cracked wall panels

Endometrial preparation for women undergoing embryo transfer with frozen embryos or embryos derived from donor oocytes

Background: A frozen embryo transfer (FET) cycle is when one or more embryos (frozen during a previous treatment cycle) are thawed and transferred to the uterus. Some women undergo fresh embryo transfer (ET) cycles with embryos derived from donated oocytes. In both situations, the endometrium is primed with oestrogen and progestogen in different doses and routes of administration. Objectives: To evaluate the most effective endometrial preparation for women undergoing transfer with frozen embryos or embryos from donor oocytes with regard to the subsequent live birth rate (LBR). Search methods: The Cochrane Gynaecology and Fertility Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, LILACS, trials registers and abstracts of reproductive societies' meetings were searched in June 2020 together with reference checking and contact with study authors and experts in the field to identify additional studies. Selection criteria: Randomised controlled trials (RCTs) evaluating endometrial preparation in women undergoing fresh donor cycles and frozen embryo transfers. Data collection and analysis: We used standard methodological procedures recommended by Cochrane. We analysed all available interventions versus placebo, no treatment, or between each other. The primary review outcome was live birth rate. Secondary outcomes were clinical and multiple pregnancy, miscarriage, cycle cancellation, endometrial thickness and adverse effects. Main results: Thirty-one RCTs (5426 women) were included. Evidence was moderate to very low-quality: the main limitations were serious risk of bias due to poor reporting of methods, and serious imprecision. Stimulated versus programmed cycle. We are uncertain whether a letrozole-stimulated cycle compared to a programmed cycle, for endometrial preparation, improves LBR (odds ratio (OR) 1.26, 95% confidence interval (CI) 0.49 to 3.26; 100 participants; one study; very low-quality evidence). Stimulating with follicle stimulating hormone (FSH), letrozole or clomiphene citrate may improve clinical pregnancy rate (CPR) (OR 1.63, 95% CI 1.12 to 2.38; 656 participants; five studies; I2 = 11%; low-quality evidence). We are uncertain if they reduce miscarriage rate (MR) (OR 0.79, 95% CI 0.36 to 1.71; 355 participants; three studies; I2 = 0%; very low-quality evidence). Endometrial thickness (ET) may be reduced with clomiphene citrate (mean difference(MD) -1.04, 95% CI -1.59 to -0.49; 92 participants; one study; low-quality evidence). Other outcomes were not reported. Natural versus programmed cycle. We are uncertain of the effect from a natural versus programmed cycle for LBR (OR 0.97, 95% CI 0.74 to 1.28; 1285 participants; four studies; I2 = 0%; very low-quality evidence) and CPR (OR 0.79, 95% CI 0.62 to 1.01; 1249 participants; five studies; I2 = 60%; very low-quality evidence), while a natural cycle probably reduces the cycle cancellation rate (CCR) (OR 0.60, 95% CI 0.44 to 0.82; 734 participants; one study; moderate-quality evidence). We are uncertain of the effect on MR and ET. No study reported other outcomes. Transdermal versus oral oestrogens. From low-quality evidence we are uncertain of the effect transdermal compared to oral oestrogens has on CPR (OR 0.86, 95% CI 0.59 to 1.25; 504 participants; three studies; I2 = 58%) or MR (OR 0.55, 95% CI 0.27 to 1.09; 414 participants; two studies; I2 = 0%). Other outcomes were not reported. Day of starting administration of progestogen. When doing a fresh ET using donated oocytes in a synchronised cycle starting progestogen on the day of oocyte pick-up (OPU) or the day after OPU, in comparison with recipients that start progestogen the day prior to OPU, probably increases the CPR (OR 1.87, 95% CI 1.13 to 3.08; 282 participants; one study, moderate-quality evidence). We are uncertain of the effect on multiple pregnancy rate (MPR) or MR. It probably reduces the CCR (OR 0.28, 95% CI 0.11 to 0.74; 282 participants; one study; moderate-quality evidence). No study reported other outcomes. Gonadotropin-releasing hormone (GnRH) agonist versus control. A cycle with GnRH agonist compared to without may improve LBR (OR 2.62, 95% CI 1.19 to 5.78; 234 participants; one study; low-quality evidence). From low-quality evidence we are uncertain of the effect on CPR (OR 1.08, 95% CI 0.82 to 1.43; 1289 participants; eight studies; I2 = 20%), MR (OR 0.85, 95% CI 0.36 to 2.00; 828 participants; four studies; I2 = 0%), CCR (OR 0.49, 95% CI 0.21 to 1.17; 530 participants; two studies; I2 = 0%) and ET (MD -0.08, 95% CI -0.33 to 0.16; 697 participants; four studies; I2 = 4%). No study reported other outcomes. Among different GnRH agonists. From very low-quality evidence we are uncertain if cycles among different GnRH agonists improves CPR or MR. No study reported other outcomes. GnRH agonists versus GnRH antagonists. GnRH antagonists compared to agonists probably improves CPR (OR 0.62, 95% CI 0.42 to 0.90; 473 participants; one study; moderate-quality evidence). We are uncertain of the effect on MR and MPR. No study reported other outcomes. Aspirin versus control. From very low-quality evidence we are uncertain whether a cycle with aspirin versus without improves LBR, CPR, or ET. Steroids versus control. From very low-quality evidence we are uncertain whether a cycle with steroids compared to without improves LBR, CPR or MR. No study reported other outcomes. Authors' conclusions: There is insufficient evidence on the use of any particular intervention for endometrial preparation in women undergoing fresh donor cycles and frozen embryo transfers. In frozen embryo transfers, low-quality evidence showed that clinical pregnancy rates may be improved in a stimulated cycle compared to a programmed one, and we are uncertain of the effect when comparing a programmed cycle to a natural cycle. Cycle cancellation rates are probably reduced in a natural cycle. Although administering a GnRH agonist, compared to without, may improve live birth rates, clinical pregnancy rates will probably be improved in a GnRH antagonist cycle over an agonist cycle. In fresh synchronised oocyte donor cycles, the clinical pregnancy rate is probably improved and cycle cancellation rates are probably reduced when starting progestogen the day of or day after donor oocyte retrieval. Adequately powered studies are needed to evaluate each treatment more accurately.Fil: Glujovsky, Demián. Centro de Estudios en Ginecología y Reproducción; ArgentinaFil: Pesce, Romina. Instituto Universitario del Hospital Italiano de Buenos Aires; ArgentinaFil: Sueldo, Carlos. Centro de Estudios en Ginecología y Reproducción; ArgentinaFil: Quinteiro Retamar, Andrea Marta. Centro de Estudios en Ginecología y Reproducción; ArgentinaFil: Hart, Roger J.. Division Of Obstetrics And Gynaecology; AustraliaFil: Ciapponi, Agustín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin

Salud Bucal y Enfermedades no transmisibles en pacientes de un centro de enseñanza universitaria, Montevideo-Uruguay. Parte 1

Las enfermedades no transmisibles (ENT) comparten factores de riesgo conductuales y metabólicos con las enfermedades bucales y ambas representan un problema de salud pública. Objetivo: Determinar la prevalencia ENT y sus factores de riesgo conductuales y metabólicos en personas que concurrieron a la Facultad de Odontología de la Universidad de la República. Métodos: Estudio transversal en el que se aplicó un cuestionario sobre características sociodemográficas y há­bitos vinculados a factores de riesgo comportamentales. Se realizaron mediciones antropométricas, de presión arterial y glicemia capilar. Resultados: Fueron encuestados 602 individuos Conclusiones: En función de las prevalencias elevadas de varios factores de riesgo, se recomienda la instalación de un programa preventivo-educativo en las salas de espera de la Facultad

Composición y estructura de la ictiofauna del Río Ceballos-Saldán (Córdoba, Argentina) Composition and structure of the icthyofauna of the Ceballos-Saldán River (Córdoba, Argentina)

Los ríos presentan un gradiente longitudinal desde su naciente hasta su desembocadura, con los consiguientes cambios en sus características ambientales y en la composición específica. El objetivo de este trabajo fue describir esa variación longitudinal en las características de la fauna de peces del Río Ceballos-Saldán. Los muestreos se realizaron en cinco puntos, ubicados antes y después de las ciudades más importantes, durante un año. Los ensambles de peces fueron descriptos a través de la composición específica, abundancia, riqueza, diversidad y dominancia, atributos que fueron estimados para cada localidad de muestreo. Se aplicaron diferentes modelos especie/abundancia a cada ensamble de peces a lo largo del curso. Se capturaron 1.914 individuos pertenecientes a 17 especies. Once corresponden a primeras citas para este río. El orden más representativo fue el de los Siluriformes y la especie más abundante fue Hypostomus cordovae (Günther, 1880). La abundancia total fue el único atributo que varió significativamente a lo largo del curso, siendo menor antes de la ciudad de Río Ceballos. Los ensambles de peces fueron significativamente descriptos por tres modelos diferentes de abundancia poblacional, a lo largo del río.<br>Rivers show a longitudinal gradient from upstream to downstream, with consecutive changes in environmental characteristics and community composition. The main goal of this study was to describe the longitudinal variations in the characteristics of the fish fauna of Ceballos-Saldán River. Fish collection was performed at five sites along the river, before and after the main cities. Fish assemblages were described by specific composition, fish abundance, richness, diversity and dominance. These assemblage attributes were estimated for each sampling site. Species/abundance models were applied to each fish assemblage along the river. A total of 1,914 individuals were collected in Ceballos-Saldán River, which correspond to 17 species. Eleven of them were cited for the first time in the basin. The most abundant order was the Siluriformes. The most abundant species was Hypostomus cordovae (Günther, 1880). The only community attribute that significantly changed along Ceballos-Saldán River was total abundance, which presented its minimum value before Río Ceballos city. Three different species abundance models, along the river, described fish assemblages