Wernicke Syndrome: Case Report and Literature Review of Contributing Factors—Can Malpractice Dynamics Be Identified?

Wernicke Encephalopathy (WE) is a neurological acute syndrome related to vitamin B1 deficiency and is relatively common in patients with chronic alcoholism. In the case of Hyperemesis Gravidarum, thiamine body stores become unable to meet the increased demand, resulting in acute deficiency. WE is associated with typical clinical and radiological findings. Treatment pathways rely on thiamine replacement. The case herein reported is centered around a 33-year-old diabetic patient at 12 weeks of gestation, with WE due to hyperemesis gravidarum. The disease manifested itself with weakness, mental confusion, headache, and impaired vision. The diagnosis was established after the detection of typical findings by MRI. Thirty days after therapy was started, most of the patient's neurological disorders were resolved. The patient was discharged 40 days later with instructions to continue daily thiamine supplementation. The pregnancy outcome was good. Unfortunately, mild ataxia persisted in 2-year follow-up as a long-term consequence. When diagnosed and treated, WE has a favorable prognosis. However, roughly 80% of patients experience memory loss, which may continue for a long time, while gait disorders reportedly affect about 35% of patients. Mild ataxia and dysmetria may persist, too. We reviewed the scientific literature on WE in women with HG until February 2023. Hardly any authors report data on long-term sequelae. Our report emphasizes how important it is to take into consideration this complication in clinical practice, referring to published guidelines and recommendations. Neurological maternal sequelae can demonstrably persist despite early diagnosis and appropriate management. For this reason, a long-term follow-up is recommended. Wernicke syndrome management cannot yet rely on well-established conclusive guidelines; hence, a cautionary approach ought to be prioritized in order to ensure medicolegal soundness

Procreazione Medicalmente Assistita: dalla qualità ovocitaria al transfer embrionario

One of the most difficult aspects of assisted reproductive technology (ART) is the determination of which embryos are most suitable for transfer into the uterus. Two factors requiring consideration include the choice of embryos with the best developmental competence and the risk of multiple pregnancy associated with the number of embryos transferred. The development of technological advances such as micromanipulation and a wealth of experience in embryo culturing techniques have resulted in an increase in embryo implantation potential. Numerous criteria have been suggested to optimize the selection process. Despite all the advances in determining embryo developmental competence, no consensus has been reached on how many embryos to transfer. Key words: IVF, oocyte selection, embryo culture, PG

“Outcome” della FIV dopo coltura e transfer di blastocisti ottenute con e senza l’ausilio della cocoltura

La coltura "in vitro" di blastocisti fu messa a punto agli inizi degli anni '80 in alcune specie di animali d'allevamento (Camous, 1984) e solo successivamente applicata agli embrioni umani. Scopo della tecnica era quello di incrementare le percentuali di impianto nei cicli FIV riducendo il numero di embrioni trasferiti. La coltura di blastocisti consentiva, infatti, di effettuare il trasferimento di embrioni con elevate potenzialità evolutive e in perfetto sincronismo con l'endometrio uterino. Attraverso il sistema della cocoltura fu possibile supportare lo sviluppo embrionario "in vitro" dallo stadio di singola cellula a quello di blastocisti con l'ausilio di monostrati cellulari costituiti da cellule del tratto genitale , per lo più dell'epitelio tubarico. Fu solo nei primi anni '90 che la tecnica di cocoltura si avvalse dell'utilizzo di cellule extra-genitali, quali le cellule epiteliali di rene di scimmmia, meglio note come cellule VERO. Le cellule VERO avevano in comune con le cellule del tratto genitale l'origine mesodermica e presentavano, inoltre, notevoli vantaggi: la facile distribuzione commerciale,la disponibilità illimitata e la sicurezza. Negli ultimi anni la cocoltura è stata soppiantata dall'utilizzo dei nuovi terreni sequenziali stadio-specifici, con una composizione simile a quella fisiologica delle secrezioni del tratto genitale e, senza dubbio, più pratici e sicuri. Lo scopo del nostro studio è quello di mettere a confronto i due sistemi di coltura embrionaria "in vitro" valutandone l'efficacia in termini di percentuali di formazione di blastocisti, impianto e gravidanza