Teleconsultation Platforms Versus WhatsApp Consultations: Evaluating Patients and Physicians' Attitudes.

Background: Since the 1990s, society has witnessed a surge in information and communication technologies that extended to the health care system. Teleconsultation platforms have become widely established tools that provide an opportunity for emerging countries such as Lebanon to expand and advance health care services. However, their use in Lebanon remains limited considering many people's preference to resort to nonmedical platforms such as WhatsApp for consultations. Methods: The purpose of this mixed-method study is to evaluate patients' and physicians' attitudes toward teleconsultation platforms versus WhatsApp consultations in Lebanon. In the quantitative component, 1,467 patients were administered a self-developed questionnaire, while in the qualitative component, a semistructured interview was conducted with 14 physicians practicing in Lebanon. Results: Results revealed that teleconsultation platforms and WhatsApp are not interchangeable. Patients' and physicians' experiences, perceptions, and satisfaction with teleconsultation platforms and WhatsApp are discussed. Conclusions: Individual and governmental recommendations for safer, more controlled, and more ethical online consultation practices are provided for both physicians and patients, through both modalities.

The Psychological Impact of the COVID-19 Outbreak on Pregnancy and Mother-infant Prenatal Bonding.

This study aimed to assess the impact of the COVID-19 stress and anxiety on prenatal attachment during the second trimester of gestation. Pregnancy is an important stage for mothers-to-be in creating representations of themselves as a "mother", with the developing attachment relationship to the unborn child considered as a milestone in the future parent's developmental trajectory. The outbreak of the COVID-19 pandemic and the national health measures installed can hence have consequences on these representations and on prenatal attachment. Our sample consisted of 95 mothers that were recruited from a prenatal ultrasound screening center. Results suggested that the COVID-19 pandemic significantly affected prenatal attachment (PAI) with significant correlations between PAI total score and age, anxiety (DASS) and stress (IES-R). When entered in one model looking for predictors of PAI total score, age and COVID-19 stress were the only variables found to significantly predict prenatal attachment. We argue for a cultural component in explaining these results, hypothesizing that stress could trigger defensive strategies, leading to more investment in the attachment relationship, potentially playing the role of a protective factor.

Transplantation of testicular tissue in alginate hydrogel loaded with VEGF nanoparticles improves spermatogonial recovery.

Transplantation of cryopreserved immature testicular tissue (ITT) is a promising strategy to restore fertility in young boys facing gonadotoxic treatments. However, up to now, limited spermatogonial recovery has been achieved in xenografting models used to evaluate the potential of cryopreserved tissue transplantation. When comparing avascular xenografts of cryopreserved and fresh human ITT into a mouse model, the number of spermatogonia was significantly reduced, regardless of the cryopreservation procedure used. To improve tissue engraftment, revascularization and hence spermatogonial survival, ITT was embedded in two types of hydrogel loaded with VEGF nanoparticles. Small pieces (±1mm(3)) of testicular tissue were grafted in NMRI mice as follows: grafted without encapsulation, grafted after encapsulation in fibrin, in alginate, in fibrin-VEGF-nanoparticle (NP) and in alginate-VEGF-NP. Non-grafted tissue served as control. After 5 and 21days of implantation, seminiferous tubule integrity, revascularization and spermatogonial recovery were evaluated by histology and immunohistochemistry. Seminiferous tubule integrity ranged from 13.3% to 39.6% and 42.7% to 68.7% on day 5 and day 21, respectively. Vascular density on day 5 was found to be higher in VEGF supplemented groups, regardless of the hydrogel used. Staining for phosphorylated VEGF receptor 2 and endothelial proliferation on day 5 was higher in all groups compared to non-grafted avascular controls. Spermatogonial recovery ranged between 14.8% and 27.3% on day 21 and was significantly higher in the alginate and alginate-VEGF-NP groups. The present study demonstrates the potential of alginate hydrogel loaded with nanoencapsulated growth factors to improve cryopreserved tissue engraftment.

In Search of Better Spermatogonial Preservation by Supplementation of Cryopreserved Human Immature Testicular Tissue Xenografts with N-acetylcysteine and Testosterone.

Controlled slow-freezing is the procedure currently applied for immature testicular tissue (ITT) cryobanking in clinical practice. Vitrification has been proposed as a promising alternative, with a view to better preserve the spermatogonial stem cells for future fertility restoration by autografting in young boys suffering from cancer. It appears that besides the potential influence of the cryopreservation technique used, the transplantation procedure itself has a significant impact on spermatogonial loss observed in ITT xenografts. Eighteen ITT pieces issued from 6 patients aged 2-15 years were used. Fragments of fresh tissue (serving as ungrafted controls), frozen-thawed tissue, frozen-thawed tissue supplemented with N-acetylcysteine (NAC), and frozen-thawed tissue supplemented with testosterone xenografted to nude mice for 5 days were compared. Upon graft removal, histological and immunohistochemical analyses were performed to evaluate spermatogonia, intratubular proliferation, and intrinsic and extrinsic apoptosis. A significant decrease in the integrity of intact seminiferous tubules was found in all three grafted groups. Spermatogonia were observed by immunohistochemistry in all grafted groups, with recovery rates of 67, 63, and 53%, respectively, for slow-frozen tissue, slow-frozen tissue supplemented with NAC, and slow-frozen tissue supplemented with testosterone. Apoptosis evidenced by active caspase-3 and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling was similar in all grafts. The study is limited by the low availability of ITT samples of human origin, and no clear impact of graft supplementation was found. The mouse xenotransplantation model needs to be refined to investigate human spermatogenesis in human ITT grafts.

Female urethral dilation.

INTRODUCTION AND HYPOTHESIS: The aim of this manuscript is to review the subject of urethral dilation (UD) in female patients and to conduct a critical appraisal of the available evidence for its use. METHODS: We used an online search of electronic databases. RESULTS: UD has been cited as a treatment option for various conditions that do not share common etiologies and that affect the lower urinary tract in female patients. Outcome measurement was not consistent, even when performed for the same conditions. A total of six randomized controlled trials failed to prove any benefit for UD in repetitive urinary tract infections (UTI), urethral syndrome, and overactive bladder. CONCLUSIONS: Conflicting results and diverse opinions have characterized the use of UD until present time. Professional societies are urged to attend to this issue, and to identify possible areas where UD could be potentially investigated.

Indomethacin in pregnancy: applications and safety.

Preterm labor (PTL) is a major cause of neonatal morbidity and mortality worldwide. Among the available tocolytics, indomethacin, a prostaglandin synthetase inhibitor, has been in use since the 1970s. Recent studies have suggested that prostaglandin synthetase inhibitors are superior to other tocolytics in delaying delivery for 48 hours and 7 days. However, increased neonatal complications including oligohydramnios, renal failure, necrotizing enterocolitis, intraventricular hemorrhage, and closure of the patent ductus arteriosus have been reported with the use of indomethacin. Indomethacin has been also used in women with short cervices as well as in those with idiopathic polyhydramnios. This article describes the mechanism of action of indomethacin and its clinical applications as a tocolytic agent in women with PTL and cerclage and its use in the context of polyhydramnios. The fetal and neonatal side effects of this drug are also summarized and guidelines for its use are proposed.