Pregnancy outcome after blastocyst stage transfer comparing to early cleavage stage embryo transfer.

Blastocyst transfer has been introduced as an alternative for improving the chance for in vitro fertilizations (IVF) implantation. The present study was to evaluate pregnancy rates when embryo transfer was performed either on day 2-3 (cleavage stage) or on day 4-5 (blastocyst stage). This randomized clinical trial included 118 infertile women. All the study subjects underwent controlled ovarian stimulation using a long protocol and randomized into two groups. BS group (n = 57), the culture was extended to day 5 (blastocyst stage) and in the CS-group (n = 61), embryo culture was continued to day 3 (cleavage stage). Ongoing pregnancies, abortion, implantation rate were evaluated. No significant differences were seen in the pregnancy rate between the two groups (33.3% in the BS group versus 27.9% in the CS group; p = 0.519). Abortion, implantation rate in two groups are not significant. Despite the lack of statistical difference between the two study groups, our data suggest that blastocyst transfer may be associated with a higher pregnancy and an overall better implantation rates. However, further studies with larger sample size are mandatory to confirm these findings.

The Role of Anticoagulation on Venous Thromboembolism Primary Prophylaxis in Low- to Intermediate-Risk Ambulatory Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: The role of anticoagulants in the primary prevention of venous Thromboembolism(VTE) in high-risk cancer patients has been proven in previous studies; however, the routine use of thromboprophylaxis in cancer patients with Khorana score≤ 2 is still debated. This systematic review and meta-analysis aimed to investigate the role of prophylaxis with anticoagulants in cancer patients with low to moderate risk for first time. METHODS: PubMed, Scopus, Google Scholar, and Web of Science databases were searched with Mesh terms to find Randomized controlled trial studies (RCTs) that evaluated the effect of thromboprophylaxis against placebo on VTE up to January 2024 in low-risk cancer patients. This systematic review was conducted based on the PRISMA guidelines. Heterogeneity between studies was evaluated using the I2 test. Egger's test was used to check publication bias. In general, 21 studies with 9985 participants were included. RESULTS: The majority of studies had high quality and low risk of bias. The pooled estimate showed that using anticoagulants compared to placebo significantly reduces the risk of VTE (HR: 0.53, 95% CI: 0.43, 0.60, I2: 8.1%). Analysis of subgroups based on the class of anticoagulants showed that both direct oral anticoagulants (DOACs) (HR: 0.46, 95% CI: 0.36, 0.56, I2:8.5%) and Low molecular weight heparin (LMWH) (HR: 0.60, 95% CI: 0.51, 70, I2:0%) were significantly related to VTE risk compared to placebo. A pooled estimate of 18 studies did not show a significant association between increased major bleeding and anticoagulant prophylaxis. (HR: 1.25, 95% CI: 0.96, 1.54, I2: 4%). CONCLUSION: Anticoagulant prophylaxis with both classes of LMWHs and DOACs compared to placebo can be associated with a reduction in VTE risk in low-to-intermediate risk cancer patients. DOACs were associated with a greater reduction in VTE risk. Anticoagulant prophylaxis had no significant relationship with increased major bleeding.

Cardiac lipoma in a young lady.

Key Clinical Message: To confirm the diagnosis of cardiac lipomas, it is crucial to use multimodality imaging and also histopathology examination if the patient underwent surgery. But surgery is not needed in many cases unless there are life-threatening situations. Abstract: Cardiac lipoma is a rare condition which is believed as a benign tumor; here, we want to present a case of young adult lady who came to our hospital complaining of chest pain and diagnosed cardiac mass by echocardiography that underwent cardiac MRI which showed cardiac lipoma and managed conservatively by serial echocardiography.

Post-Pulmonary Embolism Impairment Six Months after Acute Pulmonary Embolism: A Prospective Registry.

BACKGROUND: Little evidence is available on post-pulmonary embolism impairment (PPEI), a recently defined complication of pulmonary embolism (PE) encompassing dysfunctional clinical and imaging parameters. In the present study, we sought to evaluate its frequency with a focus on the main components. METHODS: In this prospective registry, we included patients with a confirmed diagnosis of acute PE and focused on those with initial right ventricular (RV) dysfunction. Their baseline, pre-discharge, and 6 month follow-up clinical and imaging characteristics were recorded. The main study outcomes were incomplete RV functional recovery, exercise capacity limitations (based on the 6 minute walk test), and their combination, which defines PPEI, within six months of acute PE. RESULTS: Of 170 consecutive patients with a confirmed diagnosis of acute PE, 123 accepted to participate in the follow-up study, of whom 87 had initial RV dysfunction. The 6 month rates of incomplete RV functional recovery, signs of an intermediate-to-high echocardiographic probability of PH, and exercise limitations were observed in 58.6, 32.1, and 45.9%, respectively. A total of 22 (25.2%; 95% CI 15.5-34.4%) patients had PPEI. The RV/LV ratio and the fractional area change on discharge after acute PE were more often impaired among patients with incomplete RV recovery, exercise limitations, and a high probability of PH at 6 months. In contrast, an initial impaired RV diastolic function indices appeared to characterize patients with a limited exercise capacity at 6 months. DISCUSSION: PPEI affects one fourth of patients surviving acute PE with half of them presenting with RV dysfunction or exercise limitations.

Clinically suspected myocarditis in COVID-19 patients: Case series and review of the literature.

This Study describes eleven patients positive for severe acute respiratory syndrome coronavirus 2. In our cases, females and younger patients developed more severe disease. In contrast, improvement in left ventricular ejection fraction and N-terminal prohormone brain natriuretic peptide within the first week of treatment contributed to promising outcomes.