Self-made transvaginal ultrasound simulator: new training equipment in ultrasound evaluation of controlled ovarian stimulation and oocyte retrieval.

Aim: We sought to create and describe a self-made simulator designed and created for teaching purposes: a high-fidelity ultrasound phantom for demonstrating antral follicle count, ultrasound supervision of controlled of ovarian stimulation, and ultrasound-guided oocyte retrieval. Materials and methods: The uterus and ovaries of the ultrasound phantom were made from beef tongue, a male condom, latex gloves, cotton suture threads, bi-distilled water, and ultrasound gel. The components were placed in a pelvis created using three-dimensional (3D) printing. The phantom was presented to and evaluated by a group of 14 physicians pursuing a postgraduate course in reproductive medicine. Two training stations were structured: one to simulate antral follicle count and controlled ovarian stimulation and the other to simulate ultrasound-guided oocyte retrieval. Future specialists were requested to complete a feedback questionnaire evaluating the self-made simulator and the two practice stations. Results: The transvaginal ultrasound phantom was successfully created, making it possible to simulate antral follicle count, ultrasound control of ovarian hyperstimulation, and oocyte retrieval, and to capture ultrasound images. A review of the answers provided in the feedback questionnaire showed that the phantom had a good appearance and design, was realistic, helped to improve motor coordination, and could be a useful tool in the training of specialists in assisted reproduction. Conclusion: This phantom was designed to enable instruction and practice in the evaluation of ovarian follicles and ultrasound-guided oocyte retrieval in a supervised training environment. This self-made simulator is proposed as a training tool that could be included in the curricular structure of residency and postgraduate programs in reproductive medicine.

Peripheral blood natural killer cell cytotoxicity in recurrent miscarriage: a systematic review and meta-analysis.

Dysregulated natural killer (NK) cells have been associated with recurrent miscarriages (RM). Studies have suggested that high peripheral blood NK cell cytotoxicities (pNKCs) are associated with an increased risk of RM. The aim of this systematic review (SR) and meta-analysis (MAs) is to investigate the difference in pNKC between nonpregnant and pregnant women with RM and controls and determine whether pNKC is reduced by immunotherapy. We searched the PubMed/Medline, Embase, and Web of Science databases. The MAs were conducted to compare pNKCs between women with and without RM before and during pregnancy as well as pre- and post-immunotherapy. Risk of bias in nonrandomized studies was assessed by the Newcastle-Ottawa Scale. Statistical analysis was performed using the Review Manager software. A total of 19 studies were included in the SR and 14 studies in the MAs. The MAs revealed higher pNKCs among nonpregnant women with RM compared to controls (MD, 7.99 95 %CI 6.40-9.58; p < 0.00001). pNKCs were also higher in pregnant women with RM than in pregnant controls (MD, 8.21 95 %CI 6.08-10.34; p < 0.00001). Women with RM showed significantly decreased pNKCs after the immunotherapy compared to before (MD, -8.20 95 %CI -10.20 - -6.19; p < 0, 00001). Additionally, there is an association between high pNKCs and the risk of pregnancy loss in women with RM. However, included studies showed substantial heterogeneities regarding the inclusion criteria of patients, techniques measuring pNKC, and types of immunotherapies. More studies are needed to evaluate the clinical efficiency of pNKCs in managing RM.

Prevalence of Access to Prenatal Care in the First Trimester of Pregnancy Among Black Women Compared to Other Races/Ethnicities: A Systematic Review and Meta-Analysis.

Objective: To analyze the prevalence of access to prenatal care in the first trimester of pregnancy among black women compared to other races/ethnicities through a systematic review and meta-analysis. Methods: Searches were carried out at PUBMED, LILACS, Web of Science, Scopus, CINAHL, and in the grey literature. The quality of the studies and the risk of bias were analyzed using the Joanna Briggs Critical Appraisal Checklist for Analytical Cross-Sectional Studies instrument. The extracted data were tabulatesd and analyzed qualitatively and quantitatively through meta-analysis. Results: Black women had the lowest prevalence of access to prenatal services in the first trimester, with prevalence ranging from 8.1% to 74.81%, while among white women it varied from 44.9 to 94.0%; 60.7% of black women started prenatal care in the first trimester, while 72.9% of white women did so. Conclusion: Black women compared to other racial groups had lower prevalence of access to prenatal care, with less chance of access in the first trimester, and it can be inferred that the issue of race/skin color is an important determinant in obtaining obstetric care. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020159968_, PROSPERO CRD42020159968.

The Dietary Inflammatory Index as a predictor of pregnancy outcomes: Systematic review and meta-analysis.

Unhealthy diets have been linked to low-grade chronic inflammation, a condition known to play a role in the pathophysiology of non-communicable diseases as well as pregnancy complications. The Dietary Inflammatory Index (DII) is a tool for evaluating the inflammatory potential of various diets. The goal of this systematic review and meta-analysis is to assess the current state of evidence on the use of DII as a predictor of pregnancy outcomes in pregnant women. This study was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PROSPERO, number CRD42021288966). DII was evaluated as a predictor of obstetric complications in observational studies. The search was conducted in PubMed/Medline, Embase, and Web of Science. Data from eligible studies were extracted independently by two reviewers. The Newcastle-Ottawa Scale was used to assess the methodological quality of the studies. A total of eight studies were eligible for the review. In a meta-analysis of continuous and categorical variables, DII was a predictor of any obstetric complications [mean difference: 0.39, 95 %CI 0.02-0.75, (p = 0.04); and odds ratio: 1.24, 95 %CI 1.11-1.40, (p = 0.0002)]. High DII was associated with pregnancy complications, particularly preeclampsia/hypertensive disorder of pregnancy and preterm birth. The DII is a tool that can assist in the food and therapeutic planning of pregnant women with obstetric risks. Well-designed clinical trials are necessary, especially studies that focus on recurrent pregnancy losses and implantation failures.

Correlation of mammographic and histopathological findings in patients submitted to mammotomy / Correlação de achados mamográficos e histopatológicos de pacientes submetidas a mamotomia

Objective: To correlate patients with BI-RADS 4 or 5 mammographic results submitted to mammotomy and compare these findings to histopathological ones. Method: We selected 111 patients with non-palpable breast lesions detected on mammography and who underwent mammotomy at Clínica de Oncologia e Mastologia de Natal. The samples were sent to the laboratory Dr. Getulio Sales, after x-ray of the pieces, and all patients had to use a titanium clip. Results: The prevalent age group was 41-50 years (40.5%); approximately 30.6% had a family history of breast cancer; among the patients selected, 97.3% had a BI-RADS 4 classification and 2.7%, a BI-RADS 5; with microcalcifications being the main reason for mammotomy indication in both cases. The distribution of benign and malignant lesions was 70 and 30%, respectively. The prevalent malignant lesion was ductal carcinoma in situ (58%). Clinical suspicion of malignancy according to BI-RADS 4 and 5 was statistically significant, p=0.018 [95%CI 0.28 (0.209­0.383)]. The degree of association verified through odds ratio showed that the BI-RADS 5 group had 72% less chance of having a benign lesion when compared to the BI-RADS 4 group. There were no reports of complications in patients submitted to mammotomy in the present study. Conclusion: Mammotomy proved to be a safe method to diagnose suspicious lesions (BI-RADS 4 and 5), and its results fit what is observed in the literature.

bjetivo: Correlacionar as pacientes com resultado mamográfico BI-RADS 4 ou 5 submetidas a mamotomia e comparar os achados com os encontrados na histopatologia. Método: Foram selecionadas 111 pacientes as quais apresentavam lesões mamárias não palpáveis detectadas na mamografia e que realizaram mamotomia na Clínica de Oncologia e Mastologia de Natal. As amostras foram enviadas para o laboratório Dr. Getulio Sales, após radiografia das peças, e todas as pacientes tiveram de colocar clipe de titânio. Resultados: A faixa etária predominante foi de 41­50 anos (40,5%); cerca de 30,6% possuía histórico familiar de câncer de mama; entre as selecionadas, 97,3% possuíam classificação 4 do BI-RADS e 2,7% tinham classificação 5, predominando, em ambos os casos, as microcalcificações como indicação de mamotomia. A distribuição entre lesões benignas e malignas foi de 70 e 30%, respectivamente. A prevalência de lesões malignas foi de carcinoma ductal in situ (58%). Houve significância estatística com relação à suspeição de malignidade de acordo com o BI-RADS 4 e 5, p=0,018 [IC95%0,28 (0,209­0,383)]. O grau de associação verificado por meio da odds ratio mostra que o grupo BI-RADS 5 tinha 72% menos chance de ser benigno quando comparado ao grupo BI-RADS 4. Não houve relato de complicações nas pacientes submetidas a mamotomia no presente estudo. Conclusão: A mamotomia mostrou-se um método seguro no diagnóstico de lesões suspeitas (BI-RADS 4 e 5), estando dentro do observado na literatura