Birth after low-level +20 Aneuploid Mosaic Embryo Transfer: A Case Report.

OBJECTIVE: Recently, it has been discussed whether or not mosaic embryo transfers should be performed since they might result in viable pregnancies, although they often end up being discarded. We report a case of successful pregnancy, after a mosaic embryo transfer from an in vitro matured egg and frozen PESA sperm. CASE DESCRIPTION: Tests performed on a female aged 40 years and a male aged 37 years seeking fertility treatment found she had an adequate ovarian reserve and patent fallopian tubes. He had a history of cryptorchidism and inguinal hernia repair. The spermogram showed azoospermia, and testicular ultrasound showed an atrophic left testicle and a normal right testis. The vas deferens was palpated during physical examination. Intracytoplasmic sperm injection with percutaneous epididymal sperm aspiration (PESA) was indicated. Two cycles of IVF after controlled ovarian stimulation with follitropin delta was performed. In the first cycle, seven mature eggs were inseminated, two fertilized normally, resulting in one blastocyst biopsied and analyzed by NGS with complex aneuploid results. In the second cycle, frozen sperm from PESA was used. Three eggs were inseminated on the day of the procedure (resulting in 2 blastocysts), and three in vitro matured eggs were inseminated after 24 hours (resulting in 1 blastocyst). NGS analysis showed two complex aneuploid embryos and one 40% low-level trisomy 20 aneuploid mosaicism (+20) for the post 24-hour embryo. A mosaic embryo transfer was performed, resulting in clinical pregnancy and birth of a healthy baby girl with a normal blood karyotype. DISCUSSION: Mosaic embryo transfer is a topic for discussion. Certain levels of mosaicism do not seem to pose risks to the development of the fetus.

Ten-Year Survival of Heart Failure Patients with Left Ventricular Ejection Fraction of 40-59%: A Potential Phenotypic Classification? / Sobrevida em 10 Anos de Pacientes com Insuficiência Cardíaca com FEVE 40-59%: Uma Classificação Fenotípica Viável?

Definitions of left ventricular ejection fraction (LVEF) cut-off values for HF with mildly reduced LVEF (HFmrEF) have been a subject of debate, in the face of evidence that some drugs used in the treatment of HF with LFEV < 40% (HFrEF) are also effective in patients with LVEF < 60%. The aim of this study was to compare overall survival and cardiovascular survival in HF patients with LVEF of 40-59% in patients with HFrEF and HF with LVEF ≥ 60%. Patients with decompensated HF who met the Framingham diagnostic criteria at hospital admission between 2009 and 2011 were included. Patients were divided into HFrEF, HF with LVEF 40-59%, and HF with LVEF ≥ 60%. The Kaplan-Meier was used to determine ten-year overall survival and cardiovascular survival. The statistical significance was established at p<0.05. A total of 400 patients were included, with a mean age of 69 ± 14 years. Cardiovascular survival in patients with HF and LVEF of 40-59% was not significantly different than in patients with HFrEF (adjusted Hazard Ratio [HR] 0.86; 95% Confidence Interval [CI] 0.61-1.22, Ptrend = NS), but was statistically different compared with patients with LVEF ≥ 60% (adjusted HR of 0.64; 95% CI 0.44-0.94, Ptrend = 0.023). No difference was found in 10-year survival between the LVEF groups. Patients with HF and LVEF ≥ 60% had significantly higher cardiovascular survival compared with the other groups.

Os limites da fração de ejeção do ventrículo esquerdo (FEVE) para a insuficiência cardíaca (IC) com FEVE levemente reduzida (ICFElr) têm sido questionados, já que evidências demonstram que alguns medicamentos utilizados para IC com FEVE <40% (ICFEr) demonstram eficácia também em populações com FEVE < 60%. Objetivo do estudo foi comparar a sobrevida total e cardiovascular de pacientes com IC com FEVE 40-59% com paciente com ICFEr e IC com FEVE ≥ 60%. Foram incluídos pacientes com IC descompensada que preencheram os critérios diagnósticos de Framingham na admissão hospitalar entre 2009 e 2011. Os pacientes foram divididos em ICFEr, IC com FEVE 40-59% e IC com FEVE ≥ 60%. O método de Kaplan-Meier foi usado para detectar a sobrevida geral e cardiovascular em 10 anos. A significância estatística foi estabelecida em p <0,05. Foram incluídos 400 pacientes, com idade média de 69 ± 14 anos. A sobrevida cardiovascular nos pacientes com IC e FEVE 40-59% não foi diferente em comparação aos pacientes com ICFEr [Hazard Ratio (HR) ajustado 0,86 ­ Intervalo de Confiança (IC) 95% 0,61-1,22; Ptrend = NS], mas foi estatisticamente diferente em comparação aos com FEVE ≥ 60% (HR ajustado = 0,64 - IC95% 0,44-0,94; Ptrend = 0,023). Não houve diferença na taxa de sobrevida de 10 anos entre diferentes grupos de FEVE. O grupo de pacientes com IC e FEVE ≥ 60% teve maior sobrevida cardiovascular que os outros grupos.

Sobrevida em 10 Anos de Pacientes com Insuficiência Cardíaca com FEVE 40-59%: Uma Classificação Fenotípica Viável? / Ten-Year Survival of Heart Failure Patients with Left Ventricular Ejection Fraction of 40-59%: A Potential Phenotypic Classification?

Resumo Os limites da fração de ejeção do ventrículo esquerdo (FEVE) para a insuficiência cardíaca (IC) com FEVE levemente reduzida (ICFElr) têm sido questionados, já que evidências demonstram que alguns medicamentos utilizados para IC com FEVE <40% (ICFEr) demonstram eficácia também em populações com FEVE < 60%. Objetivo do estudo foi comparar a sobrevida total e cardiovascular de pacientes com IC com FEVE 40-59% com paciente com ICFEr e IC com FEVE ≥ 60%. Foram incluídos pacientes com IC descompensada que preencheram os critérios diagnósticos de Framingham na admissão hospitalar entre 2009 e 2011. Os pacientes foram divididos em ICFEr, IC com FEVE 40-59% e IC com FEVE ≥ 60%. O método de Kaplan-Meier foi usado para detectar a sobrevida geral e cardiovascular em 10 anos. A significância estatística foi estabelecida em p <0,05. Foram incluídos 400 pacientes, com idade média de 69 ± 14 anos. A sobrevida cardiovascular nos pacientes com IC e FEVE 40-59% não foi diferente em comparação aos pacientes com ICFEr [Hazard Ratio (HR) ajustado 0,86 - Intervalo de Confiança (IC) 95% 0,61-1,22; Ptrend = NS], mas foi estatisticamente diferente em comparação aos com FEVE ≥ 60% (HR ajustado = 0,64 - IC95% 0,44-0,94; Ptrend = 0,023). Não houve diferença na taxa de sobrevida de 10 anos entre diferentes grupos de FEVE. O grupo de pacientes com IC e FEVE ≥ 60% teve maior sobrevida cardiovascular que os outros grupos.

Abstract Definitions of left ventricular ejection fraction (LVEF) cut-off values for HF with mildly reduced LVEF (HFmrEF) have been a subject of debate, in the face of evidence that some drugs used in the treatment of HF with LFEV < 40% (HFrEF) are also effective in patients with LVEF < 60%. The aim of this study was to compare overall survival and cardiovascular survival in HF patients with LVEF of 40-59% in patients with HFrEF and HF with LVEF ≥ 60%. Patients with decompensated HF who met the Framingham diagnostic criteria at hospital admission between 2009 and 2011 were included. Patients were divided into HFrEF, HF with LVEF 40-59%, and HF with LVEF ≥ 60%. The Kaplan-Meier was used to determine ten-year overall survival and cardiovascular survival. The statistical significance was established at p<0.05. A total of 400 patients were included, with a mean age of 69 ± 14 years. Cardiovascular survival in patients with HF and LVEF of 40-59% was not significantly different than in patients with HFrEF (adjusted Hazard Ratio [HR] 0.86; 95% Confidence Interval [CI] 0.61-1.22, Ptrend = NS), but was statistically different compared with patients with LVEF ≥ 60% (adjusted HR of 0.64; 95% CI 0.44-0.94, Ptrend = 0.023). No difference was found in 10-year survival between the LVEF groups. Patients with HF and LVEF ≥ 60% had significantly higher cardiovascular survival compared with the other groups.

The impact of preoperative immune checkpoint inhibitors on kidney and bladder cancer surgeries: a systematic review☆.

Therapies based on the use of immune checkpoint inhibitors (ICIs), such as nivolumab, pembrolizumab, ipilimumab, atezolizumab, avelumab, and durvalumab, have proven effective in the treatment of metastatic urological neoplasms. Recently, it has been hypothesized that the use of this type of treatment prior to surgery could lead to an increased difficulty in renal and bladder surgeries. The literature concerning this topic, however, is still scarce and non-consensual. In our systematic review, we used the PRISMA guidelines methodology to search the pertinent literature available up to June 18, 2020 in PubMed. Additionally, we searched the related grey literature in the abstracts of the meetings of the American Society of Clinical Oncology (ASCO), American Society of Clinical Oncology Genitourinary (ASCO-GU), European Society of Medical Oncology (ESMO), and American Urological Association (AUA) from 2015 to 2020. We were able to find only 16 publications that addressed the use of ICIs prior to surgery in kidney and bladder neoplasms. The results were conflicting, and usually the issue of surgical difficulties after the use of ICIs was not directly approached. We hope that our publication may raise the awareness towards the need to further investigate the effects of neoadjuvant ICIs on surgical outcomes in urologic cancers.

Desfechos obstétricos e neonatais na vigência da infecção por SARS-CoV-2: o que sabemos até agora? Uma revisão não-sistemática da literatura / Obstetric and neonatal outcomes in the presence of SARS-CoV-2 infection: What do we know so far? A non-systematic literature review

Introdução: A pandemia causada pelo SARS-CoV-2, responsável pela COVID-19, tem impactado a saúde de milhares de pessoas e contabilizado um número expressivo de infectados e de mortes. A população idosa e com comorbidades são os grupos de maior risco para as formas graves da doença. Dados sobre a infecção por SARS-CoV-2 em grávidas e recém nascidos ainda são limitados. Essa revisão objetiva analisar a literatura existente acerca dos resultados obstétricos, perinatais e neonatais da COVID-19. Síntese dos dados: Sobre as formas de infecção, não se exclui a possibilidade da transmissão vertical apesar da infecção ocorrer mais comumente após o parto. Os desfechos obstétricos mais encontrados foram uma maior porcentagem de cesárea e nascimento pré-termo. Quanto aos desfechos perinatais, sugere-se uma maior prevalência de baixo peso ao nascer e maior admissão em UTI. A maioria dos recém-nascidos com COVID-19 eram assintomáticos, constatando-se baixa mortalidade. O risco de infecção por SARS-CoV-2 pelo aleitamento materno parece ser pequeno, e esse permanece sendo recomendado. Conclusões: Apesar dos diversos estudos disponíveis, evidências em relação aos desfechos obstétricos e pediátricos da COVID-19 ainda são escassas. Sugere-se que o risco de infecção por SARS-COV-2 em neonatos é pequeno, e a transmissão pós parto parece ser a forma mais comum de infecção dos recém-nascidos, ainda que não se possa descartar a transmissão vertical. A infecção por COVID-19 pode estar associada a maior risco de morbidades maternas e neonatais. É fundamental que as gestantes e os neonatos sejam monitorados quanto a alterações clínicas precoces visando evitar complicações da doença.

Introduction: The pandemic caused by SARS-CoV-2, responsible for COVID-19, has impacted the health of thousands of people and accounted for a significant number of infected people and deaths. The elderly population and those with comorbidities are the groups at greatest risk for severe forms of the condisease. Data on SARS-CoV-2 infection in pregnant women and newborns are still limited. This review aims to analyze the existing literature on obstetric, perinatal and neonatal outcomes of COVID-19. Summary of the data: Regarding the forms of infection, the possibility of vertical transmission is not excluded, although the infection occurs more commonly after childbirth. The most common obstetric outcomes were a higher percentage of cesarean sections and preterm birth. Regarding perinatal outcomes, a higher prevalence of low birth weight and greater ICU admission are suggested. Most newborns with COVID-19 were asymptomatic, with low mortality. The risk of SARS-CoV-2 infection through breastfeeding appears to be small, and this remains recommended. Conclusions: Despite the many studies available, evidence regarding obstetric and pediatric outcomes of COVID-19 is still scarce. It is suggested that the risk of SARS-COV-2 infection in newborns is small, and postpartum transmission seems to be the most common form of infection in newborns, although vertical transmission cannot be ruled out. COVID-19 infection may be associated with an increased risk of maternal and neonatal morbidities. It is essential that pregnant women and newborns are monitored for early clinical changes in order to avoid complications of the disease.