Endometriosis and ART outcome: a retrospective analysis

Background: Endometriosis affects up to 30-40% of women seeking fertility treatment and is known to reduce fecundity. There remains a debate on the effect of endometriosis on the IVF outcome, with live birth not reported in most studies. This study looks at the impact of endometriosis on live birth rates after IVF and compares the chances of success with those without endometriosis.Methods: Retrospective analysis of women who underwent IVF at our institution for 2 years were included. Multiple factor infertility, ovulation disorders and donor program were excluded. The outcomes were compared for 4 cohorts - women with endometriosis, male factor infertility, tubal factor infertility and unexplained infertility. The primary outcome was live birth rate. Other outcome measures were total dose of gonadotropins used, mean number of oocytes collected, M2 oocyte rate, fertilization rate, implantation rate, and clinical pregnancy rate.Results: Patients diagnosed with endometriosis had lower mean number of oocytes collected (6.86 vs 7.69, 7.94, 7.45) and lower mean number of M2 oocytes (5.31 vs 6.21, 6.44, 5.91) but was not statistically significant. Endometriosis patients required significantly higher dose of gonadotropins when compared to controls (5365.79 IU;  p-0.001). The per ET implantation rate (10.4% vs 17.8%, 22.5%, 19.2%), clinical pregnancy rate (8% vs 15%, 20%, 17%), live birth rate (7.92% vs 16.6%, 15.14%, 12%) and the cumulative live birth rate (27.9% vs 46.5%, 60%, 46.7%) were significantly less in women with endometriosis (p-0.039, p-0.021, p-0.001, p-0.039 respectively) and the effect is more pronounced with increasing disease severity.Conclusions: Endometriosis affects all aspects of IVF outcomes including folliculogenesis, embryo development and implantation. Though ovarian factor can be overruled by increasing the stimulation doses as in our study, methods to improve the implantation rates should be thought about in future.

Caudal regression syndrome: a rare case report

Caudal regression syndrome is a rare disorder characterised by abnormal development of structures in the caudal region of the embryo like lower lumbar and sacral vertebrae, urogenital and lower gastrointestinal system. It is secondary to abnormal development of mesoderm. Multiple hypotheses like genetic, metabolic and vascular hypoperfusion have been proposed as etiologies. It can be picked up in early second trimester by ultrasound. It has a higher incidence in diabetic pregnancies

Trauma and the Periodontal Tissues: A Narrative Review

The health of the periodontium including the soft tissues – gingiva and periodontal ligament; and the hard tissues – cementum and alveolar bone is of key importance in the overall homeostasis of the dentition. Injury to the periodontal tissues in any form such as microbial, physical, thermal, chemical, mechanical, occlusal and habitual injury affects the harmony of the periodontal attachment apparatus thereby altering the entire functioning of the dentition. The type of tissue damage when trauma is unintentional and iatrogenic tends to be acute and self-limiting. On the other hand, mechanical and occlusal forces could result in chronic damage. This book chapter provides a review on the various forms of non-microbial trauma to the periodontal tissues, their clinical manifestations and its management

Circulating Biomarkers of Pulmonary and Extrapulmonary Tuberculosis in Children

Tuberculosis (TB) in children is not only more likely to cause more severe disease than that seen in adults, it is also more likely to be extrapulmonary. Moreover, pediatric TB is very difficult to diagnose and suffers from a lack of understanding of host biomarkers for monitoring the progression of disease. Hence, we sought to identify the expression patterns of a variety of biomarkers in the plasma of children with pulmonary TB (PTB) and extrapulmonary TB (ETB), as well as in healthy control (HC) children. Thus, we examined a variety of circulating markers reflecting tissue inflammation, oxidative stress, innate immune activation, fibrosis, and the cytokine response. Children with active TB, compared to HC children, showed markedly elevated plasma levels of matrix metalloproteinases and their endogenous inhibitors. In addition, children with active TB had significantly elevated levels of C-reactive protein, α-2 macroglobulin, and haptoglobin, as well as hemoxygenase 1. Markers of innate immune activation (lipopolysaccharide [LPS] and lipopolysaccharide-binding protein [LBP]) were significantly lower in ETB than in PTB children. Although there were no significant differences between the two groups in their levels of cytokines (type 1 [gamma interferon (IFN-γ), tumor necrosis factor α (TNF-α), interleukin 2 (IL-2), and IL-12], type 2 [IL-4, IL-5, IL-13, and IL-33], and most type 17 [IL-17A, IL-22, IL-1β, and IL-6] and type 1 interferons [IFN-α and IFN-β]) or most of the cytokines associated with immune modulation (IL-10 and IL-20), pediatric TB was associated with elevated plasma transforming growth factor β (TGF-β), IL-21, and IL-23 levels. Thus, pediatric TB is characterized by elevated levels of a variety of biomarkers at homeostasis, suggesting that these responses may play a crucial role in disease pathogenesis

Between wonder and anxiety: a socio-cultural history of snakes in Singapore

This thesis focuses on the changes of public attitudes towards snakes in a colonial and postcolonial Singapore. While this thesis is not a biological sketch, it uses snakes as a lens to interrogate how changing ideas of nature, race, and modernity were in constant competition for dominance in Singapore. This thesis serves two purposes. Firstly, it presents the first detailed study of the social and cultural history of snakes in Singapore’s colonial and post-independence history. Although a majority of the thesis centres on developments in Singapore, the island-state’s connection to the colonial and scientific networks in the metropole of Britain and Asian communities within East, South and Southeast Asia, necessitates an examination on the sources and networks related to these regions. Secondly, this thesis argues that knowledge and popular cultural attitudes toward snakes were persistently varied and have often competed for attention at different points in Singapore’s history. These developments cannot be examined in isolation from shifts in Singapore's position in the international economy, along with competing ontologies and epistemologies of the slithery reptile from 1819 to 1989.Bachelor of Arts in Histor

Eigen Value Analysis for Sub Synchronous Resonance Mitigation in Transmission Lines

Series compensation for transmission line is vital as it increases the electricity switch capability of a transmission line. Employing series reimbursement also ends in phenomenon of sub synchronous resonance (SSR) wherein, the electrical and mechanical herbal frequencies suit and alternate strength leading to excitation of herbal torsional modes of the turbine generator unit. Thyristor controlled series capacitor (TCSC) has made it viable for the short manipulate of power go with the flow within the transmission line. The side-line of TCSC is to boom transmission traces functionality and also damps out sub-synchronous resonances (SSR) as result of energy oscillation damping. It has been known due to the fact a long time that series reimbursement for fixed capacitors is a both value and useful resource effective manner of enhancing strength float in comparison to conventional production of recent traces. It turned into generally believed that 70% reimbursement may be used with none hassle up to 1971. It was learnt that constant series reimbursement can motive sub-synchronous resonance (SSR) through 1971. The TCSC is a reactive electricity compensating flexible alternating current transmission system tool for many advantages which include variable compensation and strength manipulate. A controller that's able to SSR detection as soon because the guide transfer is put on is designed, which is sub synchronous damping controller (SSDC). SSDC detects the sub synchronous resonance phenomenon and directs the correct sign of the TCSC. TCSC can in all likelihood mitigate the SSR. In this papers Eigen price evaluation technique and manipulate of strength machined oscillations the usage of TCSC was advanced. The description of energy machine oscillations using the Eigen values and eigenvectors of the state matrix are in element. The effectiveness of the method used improves the transmission functionality

Detection of Macrolide Resistant Mycoplasma pneumoniae in Children with Lower Respiratory Tract Infection by Sanger Sequencing Targeting Domain V Region of 23S rRNA Gene

Mycoplasma pneumoniae is recognized as the leading cause of community-acquired lower respiratory tract infection in children, accounting for a significant proportion of pediatric mortality. Macrolides are the first-line treatment for M. pneumoniae infections. However, the extensive use of macrolides in clinical practice resulted in the emergence of macrolide-resistant M. pneumoniae (MRMP), which has a negative impact on treatment outcomes. Hence, in the present study, MRMP was determined in hospitalized children with community-acquired pneumonia (CAP). Real-time PCR detected M. pneumoniae in 41 of 348 clinical samples. Sanger sequencing revealed that none of the isolates were associated with the A2063G or A2064G base mutation, which confers macrolide resistance, in domain V of the 23S rRNA gene. Although MRMP was not observed in children with CAP in our study, healthcare practitioners should be vigilant about the potential risk of MRMP infections

GAP between knowledge and skills for the implementation of the ACCM/PALS septic shock guidelines in India: Is the bridge too far?

Objective: To determine whether physicians were aware of and had the skills to implement the American College of Critical Care Medicine/Pediatric Advanced Life Support Course septic shock protocol. Design: A cross-sectional questionnaire survey. Setting: Four academic institutions in Chennai, Manipal, Mangalore, and Trivandrum - cities representing the three southern states of Tamil Nadu, Karnataka, and Kerala, respectively, between February and April 2006. Interventions: Pre and post lecture questions. They were evaluated using 11 questions testing knowledge and 10 questions testing their comfort level in performing interventions related to the initial resuscitation in septic shock. Measurement and Main Result: The ACCM/PALS sepsis guidelines were taught during the PALS course conducted in the four academic institutions. A total of 118 delegates participated, of whom 114 (97%) were pediatricians and four (3%) were anaesthetists. The overall mean number of correct responses for the 11 questions testing knowledge before and after the lecture was 2.1 and 4.07, respectively P=0.001(paired t test). Although, 42% of the respondents (n=50) were aware of the ACCM guidelines, 88% (n=104) did not adhere to it in their practice. A total of 86% (n=101) and 66% (n=78) did not feel comfortable titrating inotropes or intubating in the ED; 78% (n=92) and 67% (n=78), respectively felt that central venous access (CVA) and arterial pressure (AP) monitoring were unimportant in the management of fluid refractory shock. Of the physicians, 20% (n=24) had never intubated a patient, 78% (n=92) had not introduced a central venous catheter, and 76% (n=90) had never introduced an intra-arterial catheter. Conclusions: In view of the lack of skills and suboptimal knowledge, the ACCM/PALS sepsis guidelines may be inappropriate in its current format in the Indian setting. More emphasis needs to be placed on educating community pediatricians with a simpler clinical protocol, which has the potential to save many more children