Improved Pregnancy Outcomes and Endometrial Receptivity by Thawed Frozen Embryo Transfer in Mildly Stimulated Cycles with Letrozole Combined with Estrogen in Women with Unresponsive Thin Endometrium Compared to Standard Endometrial Preparation with Estrogen Alone: A Retrospective Study.

Context: Infertile women undergoing frozen embryo transfer (FET) cycles may not show optimal endometrial growth with estrogens alone. Aim: To evaluate clinical effect of mild stimulation with letrozole and estrogens on endometrial growth in comparison to standard endometrial preparation with oral and topical estrogens in infertile women with unresponsive thin endometrium undergoing FET. Settings and design: Retrospective observational case-control study. Material and methods: Forty women unresponsive to first AC-FET cycle were given mild stimulation with letrozole and estrogens as second LE-FET cycle for endometrial preparation (LE-FET study group) and compared with 40 historical controls who had received two cycles of AC-FET (AC-FET control group). Responses were assessed by optimal endometrial thickness (≥ 7 mm) and clinical pregnancy. Statistical analysis: Descriptive statistics were elaborated by mean ± SD and percentages. Results were expressed by mean ± SD, unpaired t test for difference in endometrial thickness, chi square and Fisher exact test to compare the difference in pregnancy among both groups. Results: Mean endometrial thickness was significantly increased in LE-FET study group (6.68 ± 2.09 mm) versus AC-FET control group (5.35 ± 1.90 mm). Higher clinical pregnancy rate was noted in study group as compared to control group (35% versus 12.5%). Conclusion: This study suggests that letrozole with estradiol (LE-FET) compared to estradiol alone (AC-FET) for second cycle significantly increased endometrial thickness and improved clinical pregnancy rates in women with unresponsive thin endometrium after first AC-FET cycle with estradiol alone. Addition of letrozole to estrogen upfront for FET cycles may enhance endometrial receptivity and might improve pregnancy outcomes.

Clinical Spectrum of Rheumatic Manifestations in HIV Infected Males at a Tertiary Care Hospital.

BACKGROUND: In the current era of effective Anti retroviral therapy (ART), and Human Immunodeficiency Virus (HIV) infection becoming a chronic illness, there has been a gradual rise in the prevalence of rheumatic manifestations associated with this disease. These are characterized by a modified clinical course and widened spectrum of a few emerging rheumatic manifestations seen with HIV infection. AIMS AND OBJECTIVES: To assess the type, frequency, prevalence and clinical spectrum of rheumatic manifestations among &male patients followed at an HIV clinic of a tertiary care defence hospital. MATERIALS AND METHODS: All male patients with confirmed HIV infection at the study centre were studied after obtaining informed consent. A detailed history was taken including the date of seropositivity, symptoms of rheumatic disease, family history of rheumatic illness, and treatment history with ART. A detailed general and systemic examination was performed and rheumatic symptoms guided appropriate investigations were carried out on as required basis. RESULTS: 879 confirmed HIV cases were evaluated for rheumatic manifestations during the study period. Of these 499 cases were newly detected HIV cases and the rest 380 were old cases on follow up. Rheumatic disorders were diagnosed in 16 cases (1.82%). Spondyloarthropathy was the commonest presentation i.e. 5 out of 16 cases (31.25 % of the rheumatic disorders). Mean age was 37 years (range 27-52 yrs). 2 patients of the study group had the rheumatic illness prior to detection of HIV. Psoriatic Arthritis (0.114 %) was seen in 1 patient who was HLA B-27 negative. Reactive arthritis (0.227 %) was noted in 2 patients. 1 patient had cutaneous small vessel vasculitis (0.114 %), whereas 1 of the patient developed DLE (0.114 %) over neck. HIV related non specific polyarthritis (0.114 %) of the large joints was noted in 1 patient who was RF negative, while polyarthralgia (0.340 %) was noted in 3 patients. 10 patients (60 %) had CD 4 count < 200 cells/ µL, whereas 6 patients had a CD 4 count between 200 and 500 cells/µL. 13 out of 16 patients detected to have rheumatic illnesses were on ART. CONCLUSION: With the advent of ART, the clinical spectrum of HIV infection is changing as a chronic treatable disease. Present study consisting mainly adult males, showed only 1.82 % prevalence of rheumatic disorders in HIV infection. Early diagnosis, availability of ART and prompt treatment of opportunistic infections have changed the clinical profile of HIV patients. Impact of ART in producing and affecting the clinical spectrum of rheumatic disease has to be kept in mind while treating HIV-infected patients.

Open-label randomized control trial of hydroxychloroquine in patients with moderate to severe coronavirus disease 2019 infection.

BACKGROUND: At onset of coronavirus disease 2019 (COVID-19) pandemic, hydroxychloroquine (HCQ) was repurposed for treatment of patients based on reports that it had in vitro activity. The aim of this study was to find out if HCQ reduces number of days of hospitalization when given to patients with moderate to severe COVID-19 infections who require hospitalized care. METHODS: This was an open-label randomized control trial of HCQ administered 400 mg twice on day 1, then 400 mg once daily from day 2 to day 5 in patients with moderate to severe COVID-19 infection. Assessment was not blinded. Standard of care was given to both arms.Primary outcome was number of days of hospitalization till discharge or death. RESULT: One hundred ten patients (55 in each arm) were included. Mean age was 58 years. Baseline characteristics were well matched. There was no difference in the primary outcome (13.67 vs 13.89; p = 0.98). Number of deaths were more in HCQ arm (RR: 1.81; 95% CI: 1.13-2.93; p = 0.03). There was no difference in number of days on oxygen or normalization of oxygen saturation, number who needed ventilator, days to ventilator requirement and days on ventilator. Twenty-nine patients in control arm received remdesivir. When adjusted analysis was done after removal of these patients, there was no difference in primary or secondary outcomes. Number of deaths in adjusted analysis were not significant (RR: 1.28; 95% CI: 0.87-1.88; p = 0.37). CONCLUSION: HCQ does not change the number of days of hospitalization when compared with control.

Survey of prevalence of anxiety and depressive symptoms among 1124 healthcare workers during the coronavirus disease 2019 pandemic across India.

BACKGROUND: A prospective study was conducted during the second phase of the coronavirus disease 2019 (COVID-19) pandemic in India to assess the prevalence of anxiety and depressive symptoms among healthcare workers (HCWs) and factors that influence the outcome. METHODS: A self-administered questionnaire was completed by 1124 HCWs during the COVID-19 pandemic (March 30, 2020, to April 2, 2020). Demographic data, questions on COVID-19 and scores of the Hospital Anxiety and Depression Scale were analysed using the chi-square test (Bonferroni correction) and binary logistic regression. RESULTS: The study consists of 1124 HCWs, including 749 doctors, 207 nurses, 135 paramedics, 23 administrators and ten supporting staff members. The prevalence of anxiety and depressive symptoms were reported as 37.2% and 31.4%, respectively. The risk factors for anxiety were female gender (30.6% vs 45.5%), age group (20-35 years) (50.4% vs 61.2%), unmarried (21.2% vs 30.6%) and job profile (nurse) (14.7% vs 26.4%). The protective factor was having service of more than 20 years (23.4% vs 14.8%). The risk factors for depression were age group (20-35 years) (51.3% vs 61.3%) and employed at a primary care hospital (16.2% vs 23.4%). The protective factors were job profile (doctor) (69.9% vs 59.6%) and having service of more than 20 years (22.3% vs 15.5%). CONCLUSION: Approximately one-third of the HCWs reported anxiety and depressive symptoms. The risk factors for anxiety symptoms were female gender, younger age and job profile (nurse) and for depressive symptoms were younger age and working at a primary care hospital. Future research studies should identify strategies for providing a safer and supportive work environment for HCWs to face epidemics/pandemics.