The effect of endocervical and catheter bacterial colonisation during in vitro fertilisation and embryo transfer (IVF-ET) on IVF success rate among asymptomatic women: a longitudinal prospective study.

The adverse effects of bacterial contamination during in vitro fertilisation and embryo transfer (IVF-ET) have been studied previously. However, data on asymptomatic women with positive bacterial culture and their IVF outcome are lacking. This prospective longitudinal study was conducted on 74 women undergoing IVF-ET, of whom specimens from the endocervix and ET catheter were taken and sent to a laboratory for microbiological assessment. Then, patients were followed up for evaluation of chemical pregnancy (ß-HCG > 25 mIU/mL) and clinical pregnancy (detected foetal heartbeat). The findings revealed that there was no significant difference in terms of biochemical (35.4% vs. 19.2%, p= .116) and clinical pregnancy rate (25.0% vs. 15.4%, p= .257) among ET catheter culture positive and negative women. This finding allows us to conclude that the positive culture in the absence of clinical signs of infection may not increase the risk of implantation failure.Impact StatementWhat is already known on this subject? There is growing evidence indicating that endometritis may decrease the endometrial receptiveness in in vitro fertilisation (IVF) cycles; however, there is a paucity of knowledge regarding IVF outcomes when the bacterial culture of embryo transfer (ET) catheter is positive.What the results of this study add? The present study demonstrates that positive ET catheter culture in asymptomatic women does not increase the risk of IVF failure.What the implications are of these findings for clinical practice and/or further research? Positive-culture, per se, may not be associated with poor IVF outcomes and further studies should be undertaken on this topic in various clinical settings using different protocols.

A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women.

BACKGROUND: We aimed to investigate the risk factors of placenta accreta spectrum (PAS) disorder, management options and maternal and neonatal outcomes of these pregnancies in a resource-limited clinical setting. METHODS: All women diagnosed with placenta accreta, increta, and percreta who underwent peripartum hysterectomy using a multidisciplinary approach in a tertiary center in Shiraz, southern Iran between January 2015 until October 2019 were included in this retrospective cohort study. Maternal variables, such as estimated blood loss, transfusion requirements and ICU admission, as well as neonatal variables such as, Apgar score, NICU admission and birthweight, were among the primary outcomes of this study. RESULTS: A total number of 198 pregnancies underwent peripartum hysterectomy due to PAS during the study period, of whom163 pregnancies had antenatal diagnosis of PAS. The mean gestational age at the time of diagnosis was 26 weeks, the mean intra-operative blood loss was 2446 ml, and an average of 2 packs of red blood cells were transfused intra-operatively. Fifteen percent of women had surgical complications with bladder injuries being the most common complication. Furthermore, 113 neonates of PAS group were admitted to NICU due to prematurity of which 15 (7.6%) died in neonatal period. CONCLUSION: Our findings showed that PAS pregnancies managed in a resource-limited setting in Southern Iran have both maternal and neonatal outcomes comparable to those in developed countries, which is hypothesized to be due to high rate of antenatal diagnosis (86.3%) and multidisciplinary approach used for the management of pregnancies with PAS.

Effect of piroxicam administration on outcome of frozen-thawed embryo transfer: A randomized, double-blinded, placebo-controlled trial.

AIM: This study aimed to evaluate the effect of piroxicam adjuvant therapy on the clinical and biochemical pregnancy rate in patients undergoing in vitro fertilization (IVF) and frozen-thawed embryo transfer (ET) cycles. METHODS: In a randomized, double-blinded, placebo-controlled clinical trial, 178 patients eligible for IVF-ET received either single dose of piroxicam 1-2 h before frozen-thawed ET or a placebo at the same time. Study participants were then followed and compared regarding the primary outcome of the study, which was biochemical (positive ß-human chorionic gonadotrophin test) and clinical pregnancy (detected fetal heart beat in ultrasound) rate. RESULTS: The results of this study indicated that there is no significant association between the piroxicam administration before frozen-thawed ET and the clinical or biochemical pregnancy rate (P = 0.208 and P = 0.699, respectively). CONCLUSION: The findings of the current study suggest that piroxicam administration before ET has no beneficial effects on pregnancy rate among women undergoing IVF and frozen-thawed ET. However, further studies with larger sample sizes and longer follow-ups are recommended.

Complex Twisted Knots of Umbilical Cord in a Monochorionic-Diamniotic Twin Gestation: A Case Report.

BACKGROUND: True knots and tight loops of umbilical cord can cause serious fetal complications in monochorionic-monoamniotic twins but are usually unexpected in Monochorionic-diamniotic twins because of the presence of the intertwin membrane. This report presents a case of monochorionic-diamniotic twin gestation with a complex cord knots. CASE REPORT: A 31-year-old G2Ab1 with monochorionic-diamniotic twin pregnancy in the gestational age of 30 weeks presented with ruptured membrane since 3weeks before delivery. At the delivery time, multiple umbilical cord knots was found. CONCLUSION: Premature ruptured membrane can cause septostomy of the intertwin membrane, multiple umbilical cord knots and its complications. Therefore, these cases should be considered for evaluation of the presence of intertwin membrane and umbilical cord knots in each sonography examination.

Radical-based destruction of nitramines in water: kinetics and efficiencies of hydroxyl radical and hydrated electron reactions.

In support of the potential use of advanced oxidation and reduction process technologies for the removal of carcinogenic nitro-containing compounds in water reaction rate constants for the hydroxyl radical and hydrated electron with a series of low molecular weight nitramines (R(1)R(2)-NNO(2)) have been determined using a combination of electron pulse radiolysis and transient absorption spectroscopy. The hydroxyl radical reaction rate constant was fast, ranging from 0.54-4.35 × 10(9) M(-1) s(-1), and seen to increase with increasing complexity of the nitramine alkyl substituents suggesting that oxidation primarily occurs by hydrogen atom abstraction from the alkyl chains. In contrast, the rate constant for hydrated electron reaction was effectively independent of compound structure, (k(av) = (1.87 ± 0.25) × 10(10) M(-1) s(-1)) indicating that the reduction predominately occurred at the common nitramine moiety. Concomitant steady-state irradiation and product measurements under aerated conditions also showed a radical reaction efficiency dependence on compound structure, with the overall radical-based degradation becoming constant for nitramines containing more than four methylene groups. The quantitative evaluation of these efficiency data suggest that some (~40%) hydrated electron reduction also results in quantitative nitramine destruction, in contrast to previously reported electron paramagnetic measurements on these compounds that proposed that this reduction only produced a transient anion adduct that would transfer its excess electron to regenerate the parent molecule.

Photochemical fate of atorvastatin (lipitor) in simulated natural waters.

Cholesterol-lowering statin drugs are among the most frequently prescribed for reducing human blood cholesterol and they have been detected as contaminants in natural waters. In this study the photochemical behavior of atorvastatin (lipitor) was investigated at two different concentrations of 35.8 µM (20 mg L(-1)) and 35.8 nM (20 µg L(-1)) using a solar simulator and a UV reactor. Photochemical fate in natural waters can be described in most cases by the sum of the loss due to hydrolysis, direct photolysis, and, reaction with hydroxyl radical (•OH), singlet oxygen ((1)O(2)) (or O(2) ((1)D)), and excited state dissolved organic matter (DOM). The absolute bimolecular reaction rate constant with OH was measured, using pulsed radiolysis, (1.19 ± 0.04) × 10(10) M(-1) s(-1). The reaction rate constant of (1)O(2) was determined to be (3.1 ± 0.2) × 10(8) M(-1) s(-1). Under the experimental conditions used, at high atorvastatin concentration (35.8 µM) the contribution of singlet oxygen ((1)O(2)) to the photodegradation of atorvastatin in natural waters was higher than that of hydroxyl radical, and accounted for up to 23% of the loss in aqueous solutions. Whereas, at a concentration of 35.8 nM, (1)O(2) (and •OH) both played a minor role in the removal of this compound. Lastly, it also appears that atorvastatin reacts with (3)DOM* contributing to its loss in simulated natural waters.

Free-radical-induced oxidative and reductive degradation of fibrate pharmaceuticals: kinetic studies and degradation mechanisms.

The presence of pharmaceutically active compounds (PhACs) in aquatic systems is an emerging environmental issue and poses a potential threat to ecosystems and human health. Unfortunately, current water treatment techniques do not efficiently remove all of the PhACs, which results in the occurrence of such compounds in surface and ground waters. Advanced oxidation/reduction processes (AO/RPs) which utilize free radical reactions to directly degrade chemical contaminants are alternatives to traditional water treatment methods. This study reports the absolute bimolecular reaction rate constants for three pharmaceutical compounds (fibrates), clofibric acid, bezafibrate, and gemfibrozil, with the hydroxyl radical (*OH) and hydrated electron (e(-)(aq)). The bimolecular reaction rate constants for *OH were (6.98 +/- 0.12) x 10(9), (8.00 +/- 0.22) x 10(9), and (10.0 +/- 0.6) x 10(9), and for e(-)(aq) were (6.59 +/- 0.43) x 10(8), (112 +/- 3) x 10(8), and (6.26 +/- 0.58) x 10(8), for clofibric acid, bezafibrate, and gemfibrozil, respectively. Transient spectra were obtained for the intermediate radicals produced by the hydroxyl radical reactions. In addition, preliminary degradation mechanisms and major products were elucidated using (137)Cs gamma-irradiation and LC-MS. These data are required for evaluating the potential use of AO/RPs for the destruction of these compounds in treating water for various purposes.