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

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially