Cell-free nucleic acids and melatonin levels in human follicular fluid predict embryo quality in patients undergoing in-vitro fertilization treatment.

Despite many advances in assisted reproductive technology (ART), the most viable embryo selection remains a challenge for infertility treatment. This study was designed to investigate whether intra-follicular circulating cell-free DNA (cfDNA) fragments and Melatonin levels predict embryo quality in patients undergoing IVF treatment. A total of eight hundred and ninety-five follicular fluid (ff) samples were collected from 325 infertile patients undergoing IVF treatment. Patients were enrolled from August 2017 to December 2018 in the infertility center of a tertiary care hospital. A clear non-hematic follicular fluid was aspirated after the removal of eggs from the dominant follicles (>18mm) of each patient. Melatonin and E2 levels in each follicular sample were estimated by immune-chemiluminescence using commercially available kits. ALU-qPCR evaluated cfDNA levels in individual follicular fluid samples. Our study presented a significant and negative relationship between intra-follicular cfDNA and melatonin concentration (-0.541: P<0.001). Each individual follicle contains measurable copy number of cfDNA [mean: 1.85±2.98ng/µl (median; 1.86ng/µl (95% Cl: 0.96-2.87)]. In pregnant women cfDNA copy number was significantly decreased in follicular fluid samples(ff) aspirated from matured oocytes than in immature ones [p<0.01; ß = -0.42±0.49; median; 1.45ng/ml (95% Cl: 0.36-2.97) vs. 3.57ng/µl (95% Cl: 0.37-4.01) respectively. While melatonin concentration in ff samples corresponding to mature oocytes was significantly higher than in ff samples related to immature oocytes (p<0.001). Moreover, in pregnant women cfDNA level was significantly lower in ff samples related to oocytes which produces top-quality embryos versus low quality embryos [p<0.001; ß=1.81±0.91; median; 1.25ng/µl (95% Cl: 0.35-1.97)] vs. [(median; 3.65ng/ml (95% Cl: 1.23-6.36)] respectively. Likewise, in non-pregnant women melatonin levels were significantly decreased in ff samples related to embryos with high fragmentation rate (≥25%) than embryos with low fragmentation rate (<25%; p<0.001). Conclusively, this study indicates that Intra-follicular cfDNA and melatonin concentration possibly a new supplemental tool that supports to establish an advanced non-invasive early prognostic test for the patients undergoing IVF/ICSI procedure.

Does Absenteeism Affect Academic Performance Among Undergraduate Medical Students? Evidence From "Rashid Latif Medical College (RLMC)."

BACKGROUND: Despite the strictness in attendance policies, absenteeism is an important current issue among medical and health sciences that affects the performance of undergraduate students worldwide. Attending lectures is the key to reaping the rewards of academic achievements in undergraduate medical students. As attendance pattern and performance go hand in hand- the physical engagement of students in the classroom and practical teaching approach have a synergistic impact on the output of lower-performing students to do their best. METHODS: A total of 404 full-time undergraduate MBBS male and female students of Rashid Latif Medical College (RLMC) of age 18 or above were included in this study. The principal outcome variable, such as class grades or performance, is the dependent variable, while absenteeism is a unique independent variable. RESULTS: Our results capture the positive and significant impact of attendance coefficient in all proxy variables of regression models but exhibit significant decline from OLS3 to OLS4 when proxy variables for ability, effort, and motivation were included. However, we found the effect disappears, when we incorporate panel data fixed effect estimators to minimize the time-invariant student-specific unobservable traits on performance. CONCLUSION: Attendance of the student is only the mandatory variable that must be monitored and regulated by corrective actions to achieve the better academic performance of the students.

Conventional and conservative management of placenta accreta is two ends of a single continuum: A report of three cases and literature review.

Placenta accreta (PA) is a critical condition that represents a significant source of morbidity and mortality observed in women with multiple prior cesarean sections. Precise prenatal identification of affected pregnancies permits optimal obstetric management. Antenatal diagnosis leads to less blood loss and a requirement for blood transfusion than women diagnose during cesarean section.