Surgical approach to uterine myomatosis in patients with infertility: open, laparoscopic, and robotic surgery; results according to the quantity of fibroids.

OBJECTIVE: To compare approaches to myomectomy (laparotomic, laparoscopic, and robotic). To show the relationship between the number of fibroids and the reproduction diagnosis. METHODS: Observational, analytical, retrospective, and cross-sectional study; where the surgical approach used, was evaluated in terms of surgical bleeding, time, number and weight of fibroids and reproductive results. RESULTS: 69 patients were treated through different approaches and divided into 3 groups. The differences found among groups were in favor of laparotomic myomectomy in terms of the number (p=0.000) and weight of fibroids (p=0.004). Robotic surgery was also longer (p=0.000). In the analysis of the influence of the number of fibroids to achieve pregnancy, the result was in favor of the minimally invasive routes, after surgery, both in the group of < 6 fibroids (p=0.017), and that of > 6 fibroids (p=0.001), without differences in the time from surgery to pregnancy (p=0.979). CONCLUSIONS: The surgical approach decision should consider the number and size of resected fibroids, surgical time, and reproductive diagnosis. The minimally invasive route should be offered whenever possible due to its better outcome on achieving pregnancy, without forgetting the benefits of laparotomy, while also accrediting the recently introduced robotic-assisted approach.

Vertical transmission: evidence of COVID-19 in a twin pregnancy.

This article reports the case of a 28-year-old female 31.6 weeks pregnant with twins diagnosed with SARS-CoV-2 infection, who delivered a boy and a girl. The newborns underwent RT-PCR testing for SARS-CoV-2; the male tested negative and the female newborn tested positive, in that the female placenta was SARS-CoV-2 positive and the male placenta negative. Clinical and laboratory findings evincing vertical transmission of SARS-CoV-2 were identified. Strict, multidisciplinary prenatal care is recommended for this group of patients. This case report alone does not provide statistical evidence of vertical transmission, but it is an account of a relevant matter.

Evaluation of the Anti-Müllerian Hormone and its Association with Embryo Quality in Advanced Reproductive Treatments in a Latin American Population.

OBJECTIVE: Serum anti-Müllerian hormone (AMH) presents a strong positive correlation with quantitative aspects of the ovarian reserve, while its correlation with embryo quality is unclear. This study assessed the association between serum AMH as a marker of ovarian reserve and embryo quality, in women undergoing in vitro fertilization. METHODS: This observational analytical retrospective study included patients seen between 2010 and 2018. In vitro fertilization patients with measured AMH levels were analyzed based on the following parameters: number of retrieved oocytes; number of metaphase II oocytes; embryo quality; and treatment outcome. Statistical analysis was performed using ANOVA, Mann-Whitney U test, linear regression, and Pearson and Spearman correlations. RESULTS: We found a positive correlation between AMH levels, number of retrieved oocytes and number of metaphase II oocytes (r 0.649, p=0.000). The numbers of retrieved and metaphase II oocytes were predicted in 42% (R2: 429) of the cases based on AMH levels (p=0.000). Serum AMH levels were not associated with embryo quality on Day 3 (p=0.151); an association was seen between AMH levels and embryo quality on Day 5 (p=0.006). The distribution of AMH levels was the same across patients, regardless of whether they were able to achieve pregnancy (p=0.767). CONCLUSIONS: AMH levels correlated with embryo quality on Day 5; no association was found between AMH levels and embryo quality on Day 3 or pregnancy rate. The use of AMH levels to predict embryo quality still requires further studies; therefore, AMH should be used to assess the ovarian reserve only.

Serum estradiol level on the day of trigger as a predictor of number of metaphase II oocytes from IVF antagonist cycles and subsequent impact on pregnancy rates.

OBJECTIVE: This study aimed to examine the association between serum estradiol levels and number of metaphase II oocytes harvested after in vitro fertilization cycles used in embryo transfers and the subsequent impact on pregnancy rates. METHODS: This observational analytical retrospective study was carried out in 2010-2018 at the Angeles del Pedregal Hospital. It included 181 cases and looked into the number of metaphase II oocytes to predict pregnancy rates. Statistical analysis was based on the calculation of correlations between variables and logistic regressions. RESULTS: Estradiol levels increased with the number of oocytes by a median correlation (r=0.482, p=0.000). On the day of trigger, estradiol levels predicted the number of retrieved oocytes with 23% reliability (R2=0.232, p=0.000); a linear trend correlation of r=0.489, p=0.000 was found between estradiol levels on the day of trigger and number of metaphase II oocytes. CONCLUSIONS: Serum estradiol on the day of trigger as a predictor of metaphase II oocytes in antagonist cycles encourages greater oocyte maturity and fertilization, whereas, in isolation, it does not determine the pregnancy achievement.

Two cases of cutaneous chronic graft versus host disease in treatment with psoralen plus ultraviolet-A-bath photochemotherapy.

BACKGROUND: Up to 50% of patients undergoing allogenic stem cell transplantation or bone marrow transplantation (BMT) can develop acute or chronic graft versus host disease (GVHD) as a severe complication. Immunosuppressive therapies may prove not only ineffective but may cause serious adverse effects. GVHD remains a major clinical problem and is often associated with high mortality rates. METHODS: This article presents the cases of a 48-year-old woman and a 23-year-old man, both presenting with severe cutaneous sclerodermic chronic GVHD following allogenic stem cell transplantation. Despite several years of treatment with oral corticosteroids, mycophenolate mofetil, sirolimus and acitretine, the skin lesions had not improved. Both patients were then treated with psoralen plus ultraviolet (PUVA)-bath photochemotherapy three times weekly, following a standardized treatment protocol. RESULTS: After a total accumulated dose of about 90 J/cm2, skin lesions in both patients had improved, showing complete remission in some body areas. Systemic corticosteroid treatment could be gradually reduced in the case of the female patient and skin conditions remained stable during maintenance treatment of PUVA-bath two times weekly and during a mean follow-up period of eight months. CONCLUSION: Oral PUVA therapy has been established as a successful treatment for acute and chronic GVHD, but unfortunately may result in systemic side effects. Psoralen plus ultraviolet-A-bath photochemotherapy provides clinicians with a therapeutic alternative that offers high clinical efficacy and safety. Therefore, PUVA-bath could be included as an alternative in the treatment protocol for chronic cutaneous GVHD.

Fatores que influenciam sobrre o prognóstico do melanoma maligno / Factors that influenced the prognosis of malignant melanoma

O Grupo de Melanoma de Clínica Dermatológica da Santa Casa está completando nove anos de atividades. Buscando avaliar seus resultados, analisou os assim chamados fatores de prognóstico do melanoma, a saber: espessura de Breslow, níveis de Clark, estádio, número de linfonodos regionais com metástases, tipo histológico, localizaçäo anatômica, áreas de risco, idade, sexo, ulceraçäo da lesäo inicial, associaçäo com nevo adquirido preexistente realizaçäo de biópsia. Para comparaçäo de ressultados, foi utilizada a casuística publicada pelo Grupo da New York University Medical Center, que conta com 1.130 pacientes. A casuística que é objeto do presente trabalho é pequena, composta por 67 pacientes. Estes, entretanto vêm sendo acompanhados com regularidade, a cada três ou seis meses, ininterruptamente, sempre pelo mesmo o grupo muldisciplinar. Os resultados que temos obtido se aproximam daqueles do grupo do New York University