Same cycle shift from IVF with own oocytes to oocyte donation in no or poor response cycles

Our In-Vitro Fertilisation Centre is situated in a large developing country, Madagascar, with very bad roads and low income patients. Therefore we try to find ways to reduce as much as possible the number of attempts to obtain a pregnancy. Poor or no response to ovarian stimulation in In Vitro Fertilization (IVF) cycles is a great challenge. Here we describe a method whereby we shift from IVF to Oocyte Donation (OD) during the same cycle for patients whose ovaries do not respond properly to ovulation stimulation. Patients were superovulated with a long protocol agonist treatment and ultrasonically monitored for IVF/ICSI. When, at half way of the stimulation, it was clear that there was a no or poor response, gonadotropin administration was stopped and immediately replaced by estrogens; when the endometrium was considered to be sufficiently receptive, some donated oocytes from our concomitant oocyte donation (OD) program were fertilized with the patient‘s husband sperm and progesterone was added to the patients‘ treatment. After 48 hours the resulting embryos were transferred. Five poor responders patients underwent the described procedure. Three conceived, one of which aborted at 9 weeks, while the other two are ongoing. These patients signed the consent form accepting the possibility to shift from IVF to OD during the same cycle and three clinical pregnancies were obtained. OD through this technique seems more acceptable by poor responders than planned OD. This is a preliminary report and to our knowledge it is the first report of such a method.Keywords: IVF, Poor responders, Oocyte donation, Same cycle, Shift, Conversio

Mediastinite Descendante Necrosante Aigue: Quatre Annees D’experience Dans Un Centre Hospitalier A Madagascar

Background: The acute mediastinitis also called Descending Necrotizing Mediastinitis or Cervico-mediastinitis necrotizing fasciitis is a disease which is the result of a spread of severe cervical infection down to the mediastinum. Method: A retrospective study was done at the surgical intensive care unit of Joseph Ravoahangy Andrianavalona’s hospital about the management of descending necrotizing mediastinitis from 1 st January 2009 to 31st December 2012. Result: Fourteen cases were reported during four years. The mean age of the patients was 30 years and 8 months, the sex ratio was 1.33. The most common cause found in every cases were severe cervical infections such as fasciitis by dental origin, peritonsillar abcess, sore throat, combined with the administration of non steroid antiinflammatory, of corticoid, of inappropriate antibiotic and also the patients’ health status. The suspicion of diagnosis is made clinically with chest pain associated with dyspnea, fever or septic shock and confirmed by radiologic findings. Conclusion: Nowadays, the mortality rates is high about 71, 42% for our cases. Collaboration of the thoracic surgeons and anesthetists is recommended for an early trancervical drainage of the mediastinitis. In Madagascar, the fasciitis by odontogenic infection is the most common cause of mediastinitis due to the lack of dental care

Enhanced Recovery after Caesarian Section, Madagascar

Introduction: Few hospital practice enhanced recovery after caesarian section. Our aims is to evaluate the application of enhanced recovery after caesarian section after implementation in our service. Materials and Methods : An observational audit prospective was conducted, from November 2018 to January 2019, in the complex mother-child Military Hospital, Antsiranana. Patients between 18 to 35 years, ASA 1 or 2 before surgery were included. General anesthesia procedures are excluded. Results: Thirty-one patients were identified. Each received antiotic prophylaxis and prevention of postoperative nausea/ vomiting and intratechal morphine. Fluid infusion was optimized in 18 patients. In post-interventional recovery room, multimodal analgesia were given orally after the intervention in 15 patients (48%), Sixteen (52%) cases drunk. Forty-four patients (45%) ate food four hour after intervention. Stop infusion performed in 13 cases (42%). The bladder catheter removed in 13 patients (42%). The median length of stay was 3.5 days. Conclusion : Early food, removal of the bladder catheter and the infusion stop have low compliance to the protocol. An audit and formation were needed