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F&S Science Jun 2024To evaluate oocyte retrieval experiences and side effects under minimally controlled ovarian stimulation (COS) treatment for in vitro maturation (IVM) of oocytes...
Donor side effects experienced under minimal controlled ovarian stimulation with in vitro maturation vs. conventional controlled ovarian stimulation for in vitro fertilization treatment.
OBJECTIVE
To evaluate oocyte retrieval experiences and side effects under minimally controlled ovarian stimulation (COS) treatment for in vitro maturation (IVM) of oocytes compared with conventional COS treatment.
DESIGN
A retrospective survey study.
SETTING
Clinical in vitro fertilization treatment center.
PATIENT(S)
Data were collected from subjects undergoing minimal COS treatment (n = 110; 600-800 IU follicle-stimulating hormone) for IVM of oocytes and conventional COS treatment for egg donation (n = 48; 1,800-2,600 IU follicle-stimulating hormone) from April 2022 to November 2023.
INTERVENTION(S)
Minimal and conventional COS treatments.
MAIN OUTCOME MEASURE(S)
The most common side effects experienced during ovarian stimulation and after oocyte pick-up, satisfaction level, and the likelihood of recommending or repeating minimal or conventional COS. Statistical analysis included Mann-Whitney U test and χ tests, with a significance level.
RESULT(S)
During minimal COS treatment, most subjects did not experience breast swelling (86%), pelvic or abdominal pain (76%), nausea or vomiting (96%), and bleeding (96%). After oocyte pick-up, the majority (75%) reported no pelvic or abdominal pain. The most common side effect was abdominal swelling (52%). Compared with conventional COS cycles, minimal COS subjects reported significantly less postretrieval pain, with 33% experiencing no pain (vs. 6%) and with a reduced severe level of pain (5% vs. 19%), leading to fewer subjects requiring pain medication (25% vs. 54%). Additionally, 85% of women were very satisfied with minimal stimulation treatment and would recommend or repeat the treatment.
CONCLUSION(S)
Reducing the hormonal dose for ovarian stimulation has a beneficial effect on subjects, suggesting the combination of minimal COS treatment with IVM techniques is a well-tolerated alternative for women who cannot or do not wish to undergo conventionally controlled ovarian hyperstimulation treatment.
PubMed: 38838957
DOI: 10.1016/j.xfss.2024.05.002 -
World Neurosurgery Jun 2024Single-photon emission computed tomography/computed tomography (SPECT/CT) is an emerging imaging modality that identifies sites of heightened bone metabolism in response...
OBJECTIVE
Single-photon emission computed tomography/computed tomography (SPECT/CT) is an emerging imaging modality that identifies sites of heightened bone metabolism in response to increased stresses. The relationship between sacroiliac (SI) joint radiotracer uptake and anatomic biomechanical parameters is poorly understood.
METHODS
Adult patients with SPECT/CT scans performed at our institution between 2021 and 2023 for the workup of low back pain were included. Patient charts were reviewed for demographic factors including age, gender, and prior thoracolumbar fusion history. Biomechanical spinopelvic parameters were measured from standing scoliosis radiographs. SPECT/CT scans were reviewed for uptake at the SI joint. Patients were stratified into 2 cohorts; patients with SI uptake greater than iliac crest uptake were designated "hot," whereas those with less or equal uptake were labeled "cold."
RESULTS
One-hundred and sixty patients met inclusion criteria. Patients were slightly more male (55%) with average age 55 ± 14.9 years. Sixty-eight patients (43%) had evidence of increased SI activity. Interrater reliability showed substantial agreement (kappa = 0.62). The hot cohort demonstrated greater pelvic incidence (54.8 ± 14.0 degrees vs. 51.0 ± 11.0 degrees, P = 0.031) and pelvic tilt (20.8 ± 9.5 degrees vs. 18.4 ± 8.6 degrees, P =0.047) compared with the cold cohort. Patients were otherwise similar between cohorts (P > 0.05).
CONCLUSIONS
Increased pelvic incidence and pelvic tilt angles are associated with SPECT/CT uptake at the SI joint, which may reflect altered biomechanics at the spinopelvic junction. SPECT/CT may be a valuable tool to assess SI degeneration. Future studies are warranted to better characterize the clinical applications of these findings.
PubMed: 38838939
DOI: 10.1016/j.wneu.2024.05.176 -
BMC Women's Health Jun 2024Violence against women is a phenomenon that involves at least 35% of women worldwide. Violence can be sexual, physical, and/or psychological, perpetrated by the partner,... (Meta-Analysis)
Meta-Analysis
Violence against women is a phenomenon that involves at least 35% of women worldwide. Violence can be sexual, physical, and/or psychological, perpetrated by the partner, another family member, or a stranger. Violence is a public health problem because its consequences include higher morbidity, higher mortality, and short and long-term physical and psychological health diseases. Most studies prove an association between any type of violence and some chronic pain diagnoses but no one has done a complete collection of this evidence. This systematic review and meta-analysis aimed to evaluate whether this association is statistically significant, including the largest number of studies. Through the inclusion of 37 articles, the association has been demonstrated. Compared with no history of violence, women who did experience violence showed 2 times greater odds of developing chronic pain. The impact of violence was significant also on fibromyalgia separately, but not on pelvic pain.PROSPERO registrationPROSPERO CRD42023425477.
Topics: Humans; Chronic Pain; Female; Pelvic Pain; Fibromyalgia
PubMed: 38834977
DOI: 10.1186/s12905-024-03097-w -
Sports Medicine - Open Jun 2024Abnormal posture (e.g. loss of lordosis) has been associated with the occurrence of musculoskeletal pain. Stretching tight muscles while strengthening the antagonists...
BACKGROUND
Abnormal posture (e.g. loss of lordosis) has been associated with the occurrence of musculoskeletal pain. Stretching tight muscles while strengthening the antagonists represents the most common method to treat the assumed muscle imbalance. However, despite its high popularity, there is no quantitative synthesis of the available evidence examining the effectiveness of the stretch-and-strengthen approach.
METHODS
A systematic review with meta-analysis was conducted, searching PubMed, Web of Science and Google Scholar. We included controlled clinical trials investigating the effects of stretching or strengthening on spinal and lumbopelvic posture (e.g., pelvic tilt, lumbar lordosis, thoracic kyphosis, head tilt) in healthy individuals. Effect sizes were pooled using robust variance estimation. To rate the certainty about the evidence, the GRADE approach was applied.
RESULTS
A total of 23 studies with 969 participants were identified. Neither acute (d = 0.01, p = 0.97) nor chronic stretching (d=-0.19, p = 0.16) had an impact on posture. Chronic strengthening was associated with large improvements (d=-0.83, p = 0.01), but no study examined acute effects. Strengthening was superior (d = 0.81, p = 0.004) to stretching. Sub-analyses found strengthening to be effective in the thoracic and cervical spine (d=-1.04, p = 0.005) but not in the lumbar and lumbopelvic region (d=-0.23, p = 0.25). Stretching was ineffective in all locations (p > 0.05).
CONCLUSION
Moderate-certainty evidence does not support the use of stretching as a treatment of muscle imbalance. In contrast, therapists should focus on strengthening programs targeting weakened muscles.
PubMed: 38834878
DOI: 10.1186/s40798-024-00733-5 -
International Journal of Surgery Case... Jul 2024Fallopian tube cancer is a rare tumor, representing between 0.3 and 1.8 % of all malignant tumors in the gynecological sphere. Due to the proximity of the uterus and...
INTRODUCTION
Fallopian tube cancer is a rare tumor, representing between 0.3 and 1.8 % of all malignant tumors in the gynecological sphere. Due to the proximity of the uterus and ovary, the diagnosis of primary fallopian tube cancer is very difficult to establish and relies on very strict criteria. The endometrioid form is exceptional and of controversial etiopathogenesis. Only a few cases have been previously reported. Diagnosis most often occurs incidentally during histological examination. This case presents a distinctive aspect with the rare occurrence of endometrioid-type fallopian tube cancer, notably associated with endometriosis, and initially misdiagnosed as an infected endometrioma. It underscores the diagnostic complexities encountered in identifying primary fallopian tube cancer.
CASE REPORT
We present the case of a 49-year-old patient, followed for chronic pelvic pain associated with menorrhagia. Imaging revealed a myomatous and adenomyotic uterus, a right ovarian endometrioma, and a left multicystic ovarian formation with thick walls, measuring 135 mm, requiring histological verification. She underwent an exploratory laparotomy. During the procedure, extensive retro- and supravaginal adhesive tissue involving the uterus, both adnexa, and the digestive tract was found. Careful adhesiolysis was performed. The left adnexa harbored a formation suggestive of an infected endometrioma. A total hysterectomy with bilateral adnexectomy and peritoneal washing was performed. The postoperative course was uneventful. Histopathological examination revealed an endometrioid carcinoma of the left fallopian tube, classified as pT1a according to FIGO guidelines.
DISCUSSION
Tubal cancer is a rare cancer of unknown etiology, underestimated, and sometimes confused with ovarian pathology. Preoperative diagnosis is difficult because the clinical presentation is polymorphic and imaging is nonspecific. The endometrioid form is exceptional and of controversial etiopathogenesis. Treatment mirrors that of malignant epithelial ovarian tumors, with prognosis depending on FIGO stage and histological type.
CONCLUSION
Due to its unpredictable nature, fallopian tube cancer should not be overlooked as a differential diagnosis for any adnexal mass.
PubMed: 38833903
DOI: 10.1016/j.ijscr.2024.109796 -
The American Journal of Case Reports Jun 2024BACKGROUND Persistent truncus arteriosus is a rare congenital cyanotic heart defect characterized by a single ventricular outflow tract. Without surgical intervention,...
BACKGROUND Persistent truncus arteriosus is a rare congenital cyanotic heart defect characterized by a single ventricular outflow tract. Without surgical intervention, it has a poor prognosis in infancy. Here, we report an adult female patient with uncorrected truncus arteriosus type I, who presented with acute-onset abdominal pain due to torsion of a small bowel gastrointestinal stromal tumor (GIST). CASE REPORT A 41-year-old woman came to our Emergency Department with acute-onset lower abdominal pain for 2 days. Congenital heart disease, truncus arteriosus, had been diagnosed at birth, and there had been no surgical intervention. Abdominal computed tomography revealed a 10×9×12-cm mixed-density mass in the pelvic capacity. Transthoracic echocardiography revealed a 33-mm ventricular septal defect. The ascending aorta originated mainly from the right ventricle, and the pulmonary artery originated from the beginning of the aorta (type I truncus arteriosus, according to Collett and Edwards classification). After a quick and detailed preoperative workup, the patient underwent tumor resection by open surgery with general anesthesia. CONCLUSIONS This is the first case to report emergency surgery for a patient with uncorrected persistent truncus arteriosus due to torsion of a small bowel GIST. A multidisciplinary team with deep understanding of the disease entity was crucial. By considering the fixed hemodynamic and respiratory physiology, overtreatment and unrealistic goals were avoided. Eventually, the patient was discharged after being hospitalized for 2 weeks.
Topics: Humans; Female; Adult; Gastrointestinal Stromal Tumors; Torsion Abnormality; Truncus Arteriosus, Persistent; Intestine, Small
PubMed: 38833428
DOI: 10.12659/AJCR.943604 -
BMC Pregnancy and Childbirth Jun 2024Perineal massage, as a preventive intervention, has been shown to reduce the risk of perineal injuries and may have a positive impact on pelvic floor function in the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Perineal massage, as a preventive intervention, has been shown to reduce the risk of perineal injuries and may have a positive impact on pelvic floor function in the early postpartum period. However, there is still debate concerning the best period to apply perineal massage, which is either antenatal or in the second stage of labor, as well as its safety and effectiveness. Meta-analysis was used to evaluate the effect of implementing perineal massage in antenatal versus the second stage of labor on the prevention of perineal injuries during labor and early postpartum pelvic floor function in primiparous women.
METHODS
We searched nine different electronic databases from inception to April 16, 2024. The randomized controlled trials (RCTs) we included assessed the effects of antenatal and second-stage labor perineal massage in primiparous women. All data were analyzed with Revman 5.3, Stata Statistical Software, and Risk of Bias 2 was used to assess the risk of bias. Subgroup analyses were performed based on the different periods of perineal massage. The primary outcomes were the incidence of perineal integrity and perineal injury. Secondary outcomes were perineal pain, duration of the second stage of labor, postpartum hemorrhage, urinary incontinence, fecal incontinence, and flatus incontinence.
RESULTS
This review comprised a total of 10 studies that covered 1057 primigravid women. The results of the analysis showed that perineal massage during the second stage of labor reduced the perineal pain of primigravid women in the immediate postpartum period compared to the antenatal period, with a statistical value of (MD = -2.29, 95% CI [-2.53, -2.05], P < 0.001). Additionally, only the antenatal stage reported that perineal massage reduced fecal incontinence (P = 0.04) and flatus incontinence (P = 0.01) in primiparous women at three months postpartum, but had no significant effect on urinary incontinence in primiparous women at three months postpartum (P = 0.80).
CONCLUSIONS
Reducing perineal injuries in primiparous women can be achieved by providing perineal massage both antenatally and during the second stage of labor. Pelvic floor function is improved in the postnatal phase by perineal massage during the antenatal stage.
TRIAL REGISTRATION
CRD42023415996 (PROSPERO).
Topics: Humans; Female; Perineum; Massage; Pregnancy; Pelvic Floor; Parity; Postpartum Period; Labor Stage, Second; Obstetric Labor Complications; Randomized Controlled Trials as Topic; Fecal Incontinence
PubMed: 38831257
DOI: 10.1186/s12884-024-06586-w -
BMJ Open Jun 2024Synthesis of the experience of women with pain from pelvic or vaginal mesh or its removal, to identify pain-related problems and to formulate psychological aspects of...
OBJECTIVES
Synthesis of the experience of women with pain from pelvic or vaginal mesh or its removal, to identify pain-related problems and to formulate psychological aspects of pain.
DESIGN
Systematic review and thematic analysis of qualitative studies of pain from pelvic or vaginal mesh, or mesh removal, in women over 18 years, using individual interviews, focus groups, free text, or written or oral contributions to formal enquiries.
DATA SOURCES
Medline, Embase and PsycINFO, from inception to 26 April 2023.
ELIGIBILITY CRITERIA
Qualitative studies of pain and other symptoms from pelvic or vaginal mesh or its removal; adults; no language restriction.
DATA EXTRACTION AND SYNTHESIS
Line-by-line coding of participant quotations and study author statements by one author to provide codes that were applied to half the studies by another author and differences resolved by discussion. Codes were grouped into subthemes and themes by both authors, then scrutinised and discussed by a focus group of mesh-injured women for omissions, emphasis and coherence. Studies were appraised using an amalgamation of the CASP and COREQ tools.
RESULTS
2292 search results produced 9 eligible studies, with 7-752 participants, a total of around 2000. Four recruited patients, four totally or partially from mesh advocacy groups, and two were national enquiries (UK and Australia). Four major themes were as follows: broken body, broken mind; distrust of doctors and the medical industry; broken life and keeping going-a changed future. Psychological content mainly concerned the loss of trust in medical care, leaving women unsupported in facing an uncertain future. Mesh-injured women strongly endorsed the findings.
CONCLUSIONS
Pain and other problems associated with pelvic mesh are profound and far-reaching for women affected. Worse, they feel subject to continued gaslighting, including denial of their mesh-related problems and dismissal of their concerns about continued mesh insertion.
PROSPERO REGISTRATION NUMBER
CRD42022330527.
Topics: Humans; Female; Surgical Mesh; Qualitative Research; Pelvic Organ Prolapse; Pelvic Pain
PubMed: 38830733
DOI: 10.1136/bmjopen-2024-085879 -
Journal of Psychosomatic Obstetrics and... Dec 2024This retrospective cohort study identifies differences between rates of selected mental illnesses and sleep disorders according to eight gynecological problems. Analyses...
This retrospective cohort study identifies differences between rates of selected mental illnesses and sleep disorders according to eight gynecological problems. Analyses utilize medical claims data for adult employees of a large corporation during 2017-2021. Women with a gynecological problem (most notably pain, endometriosis, pelvic inflammation and bleeding) are significantly more likely to experience mental illness. Several gynecological problems are also significantly associated with sleep disorders. Women with a gynecological problem (vs. none) are 50% more likely to have a mental health problem and 44% more likely to have a sleep disorder after adjusting for age, marital status, dependent children and year. The largest differences between higher (%) mental illness and sleep disorders appear for hyperplasia (6% vs. 45%), cancer (11% vs. 68%), pelvic inflammation (46% vs. 79%) and pain (79% vs. 43%), respectively. On the other hand, the rate of having one or more gynecological problems ranges from 7.1% for women with no mental illness or sleep disorder to 20.6% for women with schizophrenia. Understanding the association between gynecological problems, mental illness and sleep disorders can help clinicians more effectively identify and treat patients.
Topics: Humans; Female; Sleep Wake Disorders; Adult; Mental Disorders; Genital Diseases, Female; Retrospective Studies; Middle Aged; Comorbidity; Young Adult
PubMed: 38823418
DOI: 10.1080/0167482X.2024.2354330