Impact of obesity on ovarian reserve [Utjecaj debljine na ovarijalnu rezervu]

Obesity is the most frequent chronic disease. In the Western world and in these areas the incidence of overweight and obesity is 50–60%. In parallel with an increase in obesity over the past 30 years, there is also an increase in infertility incidence. Obesity is often associated with PCOS and the combined pathophysiology can cause a variety of metabolic and reproductive disorders. Obesity is also associated with subfertility and infertility in men and women. ----- Aim of the study: The aim of this study was to identify the effects of obesity and central obesity on ovarian reserve. We also tried to identify the correlation of obesity with changes in reproductive hormones, which could be a cause of subfertility. We separately investigated the effects of obesity and PCOS on reproductive capacity. Ovarian reserve markers (AMH, AFC and ovarian volume) were investigated according to the body mass index of participating patients. ----- Methodology and methods: In this prospective cross-sectional cohort study on 182 women grouped in 3 categories according to body mass index (normal weight, overweight and obese), 52 had PCOS. We determined and compared hormone and ovarian reserve results in each BMI patient group. ----- Statistical analysis: Statistical analysis was performed by using the statistical package SPSS 17.0. Data is reported as mean±standard deviation. Student’s t test/ANOVA was used to compare the means of parametric data and the Man-Whitney test / the Krusckal Wallis test to compare non-parametric data. The Chi square test were used to analyze categorical outcomes. For statistical significance the value of the factor alpha is ≤ 0.05. ----- Results: In the investigated sample of infertile patients, 35% were normal-weight women, and 65% were overweight or obese. Of that number, 28.6% had PCOS, while the prevalence of abnormal BMI in that patient group was 71%. Central obesity was identified in 68% of obese patients and in 90% of obese PCOS patients. Prolongs of the menstrual cycle, oligomenorrheae, anovulation, hyperandrogenism are more presente in obesity and PCOS patients than in obese respectivly control group. Obesity does not lower AMH, AFC and OV levels. ----- Conclusion: Since the relationship between the indicators and insulin resistance has already been proven, our results emphasize a high correlation of obesity, central obesity and PCOS with subfertility and long-term infertility. Positive or negative effects of excessive adipose tissue on ovarian reserve markers were not identified

Medikamentna prevencija sindroma hiperstimulacije jajnika

The purpose of this review is to analyze current medical strategies in the prevention of ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation for in vitrofertilization. Owing to contemporary preventive measures of OHSS, the incidence of moderate and severe forms of the syndrome varies between 0.18% and 1.40%. Although none of medical strategies is completely effective, there is high-quality evidence that replacing human chorionic gonadotropin (hCG) by gonadotropin-releasing hormone (GnRH) agonists after GnRH antagonists and moderate-quality evidence that GnRH antagonist protocols, dopamine agonists and mild protocols reduce the occurrence of OHSS. Among various GnRH agonists, buserelin 0.5 mg, triptorelin 0.2 mg and leuprolide acetate (0.5-4 mg) have been mostly utilized. Although GnRH trigger is currently regarded as the best tool for OHSS prevention, intensive luteal support with exogenous administration of estradiol and progesterone or low-dose hCG on the day of oocyte retrieval or on the day of GnRH agonist trigger are required to achieve optimal conception rates due to early luteolysis. Among currently available dopamine agonists, cabergoline, quinagolide and bromocriptine are the most common drugs that should be used for prevention of both early and late OHSS. Mild stimulation protocols offer attractive option in OHSS prevention with satisfactory pregnancy rates.Svrha ovoga rada bila je analizirati današnje medikamentne strategije u prevenciji sindroma hiperstimulacije jajnika za vrijeme stimulacije ovulacije u postupku izvantjelesne oplodnje. Zahvaljujući suvremenim metodama prevencije pojavnost sindroma hiperstimulacije se kreće od 0,18% do 1,40%. Premda se nijedna prevencijska strategija nije pokazala u potpunosti djelotvornom, postoje čvrsti dokazi da zamjena humanog korionskog gonadotropina gonadotropnim otpuštajućim hormonom nakon antagonista gonadotropnog otpuštajućeg hormona te umjereni dokazi da protokoli antagonista gonadotropnog otpuštajućeg hormona, agonisti dopamina i blagi protokoli smanjuju pojavnost sindroma hiperstimulacije. Između nekoliko agonista gonadotropnog otpuštajućeg hormona najčešće se koriste buserelin 0,5 mg, triptorelin 0,2 mg i leuprolid (0,5-4 mg). Premda se danas smatra da je gonadotropni otpuštajući hormon najuspješniji u prevenciji sindroma hiperstimulacije jajnika, zbog rane luteolize potrebna je intenzivna potpora žutom tijelu primjenom estradiola i progesterona ili sniženim dozama humanog korionskog gonadotropina na dan aspiracije jajnih stanica da bi se postigle optimalne stope zanošenja. Između danas dostupnih agonista dopamina kabergolin, kinagolid i bromokriptin su lijekovi koji se najčešće primjenjuju i koje bi trebalo primjenjivati u prevenciji ranog i kasnog oblika sindroma hiperstimulacije. Blagi stimulacijski protokoli predstavljaju privlačan izbor u prevenciji sindroma hiperstimulacije sa zadovoljavajućim stopama trudnoće

Pojavnost genskog polimorfizma receptora 2039A>G folikularno stimulirajućeg hormona i rizik muške neplodnosti u albanskoj populaciji

The purpose of this study was to determine the prevalence of allele and genotype variants of the follicle-stimulating hormone receptor (FSHR) gene polymorphic region at position Asn680Ser in the Albanian male population and associate them with the clinical parameters of infertility. The study included 114 infertile men (mean age 35.04±5.85 years) stratified according to the level of spermatogenetic impairment (oligoasthenozoospermia, asthenozoospermia and normospermia) and 112 fertile men (mean age 36.44±7.05 years) with normal semen parameters. Genotyping of the FSHR gene at position 680 was performed by TaqMan genotyping assay. All the participants underwent semen analysis, and serum reproductive hormones (FSH, luteinizing hormone, prolactin and testosterone) were also measured. The FSHR Asn680Ser genotype frequencies were as follows: Asn/Ser 42%, Ser/Ser 33.9% and Asn/Asn 24.1% in the control group, and Asn/Ser 56.1%, Ser/Ser 22.8% and Asn/Asn 21.1% in the whole group of infertile men (χ2-test: P=0.08). There was no statistically significant correlation between serum hormone levels and semen characteristics or between fertility status and FSHR Asn680Ser gene variants in the control group and the group of infertile men. However, adjusted logistic regression analysis (age, body mass index, smoking and alcohol as covariates) revealed increased odds ratio for male infertility among heterozygous Asn/Ser genotype carriers associated with lower values of semen parameters (normal morphology, concentration, total sperm count and motility). In conclusion, our case-control study further confirmed previous reports on no significant association between the FSHR Asn680Ser polymorphisms and male infertility. Nevertheless, the data presented herein indicate that the Asn/Ser genotype may increase the risk of male infertility in Albanian population.Cilj ovoga istraživanja bio je odrediti pojavnost alela i varijante genotipa receptora folikularno stimulirajućeg hormona (FSHR) na poziciji Asn680Ser kod muškaraca albanske populacije u odnosu na kliničke parametre neplodnosti. Istraživanje je obuhvatilo 114 neplodnih muškaraca (srednja dob 35,04±5,85 godina) svrstanih prema razini oštećenja spermiograma (oligoastenozoospermija, astenozoospermija i normospermija) te 112 plodnih muškaraca (srednja dob 36,44±7,05 godina) s urednim nalazom spermiograma. Genotipizacija gena FSHR na poziciji 680 učinjena je primjenom TaqMan probe. Kod svih sudionika istraživanja učinjena je analiza sjemena i reprodukcijskih hormona uključujući FSH, luteinizirajući hormon, prolaktin i testosteron. U kontrolnoj skupini ispitanika kod FSHR Asn680Ser genotipa utvrđena pojavnost Asn/Ser bila je 42%, Ser/Ser 33,9% i Asn/Asn 24,1%, dok se u skupini neplodnih ispitanika incidencija kretala od 56,1% za Asn/Ser, 22,8% za Ser/Ser i 21,1% za Asn/Asn (χ2-test; p=0,08). Nije ustanovljena značajna statistička povezanost između razine hormona, karakteristika sjemena, stanja plodnosti u varijanti gena FSHR Asn680Ser u kontrolnoj skupini u odnosu na ispitanike u skupini neplodnih muškaraca. Ipak, primjenom prilagođene, logističke i regresijske analize (dob, indeks tjelesne mase, pušenje i alkohol kao kovarijable) utvrđeno je da postoji veća vjerojatnost javljanja muške neplodnosti kod nositelja heterozigota Asn/Ser koji su povezani sa sniženim vrijednostima parametara sjemena (morfologija, koncentracija, ukupan broj i pokretljivost). Zaključno možemo utvrditi da ovo istraživanje potvrđuje ranija izvješća kako ne postoji značajna povezanost između polimorfizma FSHR Asn680Ser i muške neplodnosti. Ipak, navedeni podaci upućuju na to da Asn/Ser genotip može povisiti rizik muške neplodnosti u albanskoj populaciji

Poboljšanje spolne i reprodukcijske funkcije u muškaraca s oštećenjem kralježnične moždine

The aim of the review is to establish sexual and reproductive functions in men with spinal cord lesion (SCL). Many sexual and reproductive dysfunctions may be found in these patients including individual’s low self-esteem, delay of orgasm, erectile or ejaculatory disorder and abnormalities of semen, which are characterized by lower sperm motility or viability. Owing to improvements in physical medicine and rehabilitation, the focus has been shifted from keeping patients alive towards ensuring the quality of life and improvements of sexual dysfunctions and later reproduction. Erectile dysfunction can be treated by using phosphodiesterase-5 inhibitors, intracavernosal injections, vacuum devices and penile prostheses. Semen can be retrieved from anejaculatory patients by medically assisted methods utilizing penile vibratory stimulation, electroejaculation, prostate massage, or surgically. Although there is low chance for pregnancy in natural way in most of SCL patients, fatherhood is possible through the introduction of assisted medical management. By use of various medical, technical and surgical procedures for sperm retrieval combined with assisted reproductive methods, high pregnancy rates have been reported comparable to those in able-bodied subfertile patients. Nevertheless, future studies are needed to improve semen quality and methods of assisted ejaculation in patients with SCL.Svrha ovoga preglednog članka je analizirati spolne i reprodukcijske funkcije u muškaraca s oštećenjem kralježnične moždine (OKM). Mnoge spolne i reprodukcijske funkcije u ovih bolesnika mogu biti oštećene uključujući vlastitu podcjenjenost, nedostatak spolnog zadovoljstva, erekcijsku i ejakulacijsku disfunkciju te nepravilnosti spermiograma koje karakteriziraju slabija pokretljivost i vijabilnost. Zahvaljujući napretku u fizikalnoj medicini i rehabilitaciji pomiče se glavna usmjerenost na omogućavanje preživljenja takvih bolesnika prema osiguranju kvalitete života, poboljšanju spolne disfunkcije i kasnije reprodukcije. Erekcijska disfunkcija može se liječiti primjenom inhibitora fosfodiesteraze-5, intrakavernoznih injekcija, vakumskih uređaja i proteza za penis. U većine muškaraca s anejakulacijom sjeme se može dobiti postupkom medicinski pomognute ejakulacije primjenom vibracijske stimulacije penisa, elektroejakulacije, masaže prostate ili kirurških zahvata. Premda većina muškaraca s OKM ne uspijeva postići trudnoću na prirodan način, stvaranje potomstva ipak je moguće uvođenjem specijalističkog medicinskog liječenja. Primjenom raznih medicinskih, tehničkih i kirurških tehnika za dobivanje spermija u kombinaciji s metodama za pomognutu oplodnju postignute su zavidne stope trudnoća slično kao u subfertilnih osoba bez tjelesnih oštećenja. Ipak, potrebna su daljnja istraživanja za poboljšanje kvalitete sjemena i metoda za pomognutu ejakulaciju u bolesnika s OKM

Kisspeptin as a promising oocyte maturation trigger for in vitro fertilisation in humans

The aim of this review is to analyse the effectiveness of exogenous kisspeptin administration as a novel alternative of triggering oocyte maturation, instead of currently used triggers such as human chorionic gonadotropin (hCG) or gonadotropin releasing hormone (GnRH) agonist, in women undergoing in vitro fertilisation (IVF) treatment. Kisspeptin has been considered a master regulator of two modes of GnRH and hence gonadotropin secretion, pulses and surges. Administration of kisspeptin-10 and kisspeptin-54 induces the luteinising hormone (LH) surge required for egg maturation and ovulation in animal investigations and LH release during the preovulatory phase of the menstrual cycle and hypothalamic amenorrhoea in humans. Exogenous kisspeptin-54 has been successfully administered as a promising method of triggering oocyte maturation, following ovarian stimulation with gonadotropins and GnRH antagonists in women undergoing IVF, due to its efficacy considering achieved pregnancy rates compared to hCG and GnRH agonists. Also, its safety in patients at high risk of developing ovarian hyperstimulation syndrome is noteworthy. Nevertheless, further studies would be desirable to establish the optimal trigger of egg maturation and to improve the reproductive outcome for women undergoing IVF treatment

A Latin American, Portuguese and Spanish consensus on a core communication curriculum for undergraduate medical education

The autors would like to acknowledge the contributions of the participantsin the panel of experts. Their comments have helped us to reach moresuitable learning outcomes.They also want to thank the Universidad Francisco de Vitoria (Madrid, Spain)the financial support for the achievement of the projectTo present learning outcomes in clinical communication for a Core Curriculum for medical undergraduate students in Latin America, Portugal and Spain (LAPS-CCC) and to establish an expert network to support a transnational implementation. Through an iterative process, an international group of 15 experts developed an initial set of learning outcomes following a review and discussion of relevant international and local literature. A two-round Delphi survey involving 46 experts from 8 countries was performed. Quantative and qualitative analisis permited the definition of the final consensus. The initial proposal included 157 learning outcomes. The Delphi process generated 734 comments and involved the modification, deletion and addition of some outcomes. At the end of the process, a consensus was reached on 136 learning outcomes grouped under 6 competency domains with a high overall acceptance (95.1 %). The learning outcomes of this proposal provide a guide to introduce, support and develop communication curriculae for undergraduate medical studies in the countries involved or in other Spanish- or Portuguese-speaking countries. The online version of this article (doi:10.1186/s12909-016-0610-8) contains supplementary material, which is available to authorized users

The Self Model and the Conception of Biological Identity in Immunology

The self/non-self model, first proposed by F.M. Burnet, has dominated immunology for sixty years now. According to this model, any foreign element will trigger an immune reaction in an organism, whereas endogenous elements will not, in normal circumstances, induce an immune reaction. In this paper we show that the self/non-self model is no longer an appropriate explanation of experimental data in immunology, and that this inadequacy may be rooted in an excessively strong metaphysical conception of biological identity. We suggest that another hypothesis, one based on the notion of continuity, gives a better account of immune phenomena. Finally, we underscore the mapping between this metaphysical deflation from self to continuity in immunology and the philosophical debate between substantialism and empiricism about identity

Development and Evaluation of Two Simple, Rapid Immunochromatographic Tests for the Detection of Yersinia pestis Antibodies in Humans and Reservoirs

Plague is due to the bacterium Yersinia pestis. It is accidentally transmitted to humans by the bite of infected fleas. Currently, approximately 20 developing countries with very limited infrastructure are still affected. A plague case was defined according to clinical, epidemiological and biological features. Rapid diagnosis and surveillance of the disease are essential for its control. Indeed, the delay of treatment is often rapidly fatal for patients and outbreaks may occur. Bubo aspirate is the most appropriate specimen in case of bubonic plague, but its collection is not always feasible. The main current biological approaches for the diagnosis of human plague are F1 antigen detection, serology for antibody detection by ELISA and Y. pestis isolation. The biological diagnosis of plague remains a challenge because the clinical signs are not specific. In this study, we developed some simple, rapid and affordable tests able to detect specific plague antibodies. These tests can be used as alternative methods for plague diagnosis in the field and for plague surveillance

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6+/-9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; pPeer reviewe