A systematic review exploring the patient decision-making factors and attitudes towards pre-implantation genetic testing for aneuploidy and gender selection.

INTRODUCTION: Pre-implantation genetic testing for aneuploidy (PGT-A) is in high demand worldwide, with ongoing debate among medical societies as to which patient groups it should be offered. The psychological aspects for patients regarding its use, lag behind the genomic technological advances, leaving couples with limited decision-making support. The development of this technology also leads to the possibility for its utilization in gender selection. Despite the controversy surrounding these issues, very few studies have investigated the psychological aspects of patients using PGT-A. MATERIAL AND METHODS: This systematic review provides an up-to-date analysis of the psychosocial aspects surrounding PGT for aneuploidy and sex selection, as well as decision-making factors. A systematic search of English peer-reviewed journals of three computerized databases were undertaken following PRISMA guidelines. The qualitative data were extracted using thematic analysis. PROSPERO Registration number: CRD42019126439. RESULTS: The main outcome measures were patients' motivations, decision-making factors, attitudes and experiences surrounding the use of PGT for aneuploidy and sex selection. Ten studies were included, four for PGT-A and six for sex selection. Attitudes towards PGT-A were positive, with the main motivating factors being decreasing miscarriage rate, reducing the risk of termination of pregnancy and reducing the time to pregnancy. Consistently raised concerns regarding PGT-A were the financial burden and moral beliefs. The vast majority of patients felt sufficiently knowledgeable to make the decision; however, studies did reveal that a minority mis-interpreted certain potential benefits of PGT-A. Studies investigating PGT for sex selection predominantly reported the main motivation was to achieve gender balance within the family dynamic, with most studies finding no difference between couples using PGT for gender selection to have male or female offspring. CONCLUSIONS: Although this systematic review was limited by the small number of studies investigating this topic, a significant minority of patients appeared to misunderstand certain benefits and limitations of PGT-A. Fertility clinics must ensure they provide adequate counseling to all patients using PGT-A. With the use of PGT-A on the rise globally, there is a need to develop decision support tools for couples who have an increasing number of genetic testing options becoming available to them.

The Use of Monoclonal Antibody-Based Proprotein Convertase Subtilisin-Kexin Type 9 (PCSK9) Inhibitors in the Treatment of Hypercholesterolemia.

In this review, we evaluated several studies in the literature to analyze the benefits and deleterious effects of the use of monoclonal antibodies (MABs)-based proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors in patients with hypercholesterolemia. Increased low-density lipoprotein cholesterol (LDL-C) levels lead to an increase in the risk of cardiovascular (CV) disease. Statins are the cornerstones of hypercholesterolemia treatment, but the patient response may often vary, and additional therapies may be needed to control the increased LDL-C levels. MABs bind to PCSK9 receptors, causing a reduction in LDL-C levels. MAB-based PCSK9 inhibitors such as alirocumab and evolocumab have been approved for use in hypercholesterolemia in combination with statins. Studies have suggested that both alirocumab and evolocumab are effective in lowering LDL-C levels, have favorable side effect profiles, and can be administered at convenient dosing intervals; however, further double-blind, randomized trials evaluating the long-term safety and efficacy of both the agents could assist with clinical decision-making.

Effects of Digoxin in Heart Failure (HF) With Reduced Ejection Fraction (EF).

In this review, we evaluated the literature on the benefits and deleterious effects of digoxin in heart failure (HF) with reduced ejection fraction (EF). Although digoxin was considered an effective treatment for HF, the supporting evidence is conflicting. Before the conventional use of modern HF therapies, digoxin was widely used for symptomatic relief on these patients. Further randomized trials are required to reach a definite conclusion about its efficacy and safety in patients experiencing HF with a reduced EF (HFrEF).

Lower Socio-Economic Position Associated With Higher Odds Of Diabetes-Depression Comorbidity.

Diabetes-depression comorbidity (DDC) adversely affects the quality of life of diabetic patients, complicates the clinical treatment and makes diabetes management very challenging. Therefore, early identification and diagnosis of DDC is crucial to prevent complications and improve the health outcomes among the diabetic patients. This work explores the association between demographic, lifestyle, social economic factors and DDC. The analysis is based on data obtained from the Behavioral Risk Factor Surveillance System (BRFSS), Centers for Disease Control and Prevention (CDC), USA. Logistic Regression was used to explore this association. Women were found to have higher odds of DDC as compared to men [OR 1.30, 95%CI(1.17-1.44), p <0.001]. Additionally, sedentary behaviour and lower socio-economic position was found to be associated with higher odds of DDC. Moreover, a gradient association was observed between socio-economic position (SEP) and DDC. The odds of DDC tend to reduce with improvement in SEP. Our findings underscore the importance of examining and addressing the disproportionate burden of DDC among the lower socio-economic groups.

Investigating attitudes towards oocyte donation amongst potential donors and the general population: a systematic review.

With a current shortage of oocyte donors in the United Kingdom (UK), the psychological factors determining intentions to donate oocytes are important to understand. The objectives of this review were to explore psychosocial aspects of potential oocyte donors, including attitudes, motivations, as well as any issues surrounding potential donor disclosure and anonymity. A systematic search of English peer-reviewed journals of three computerized databases following PRISMA guidelines was conducted. Only English language peer-reviewed studies that have examined the psychosocial aspects of oocyte donation (OD) amongst potential oocyte donors were included. No time restriction was set for date of publication. A total of 39 studies were included which were analysed using thematic analysis. Broadly, authors have reported positive attitudes towards OD, however, knowledge surrounding OD within the general population is poor. Three key themes were identified as influencing the decision to donate: (i) altruism; (ii) financial motivation; and (iii) experience of fertility problems through friends. There were distinct differences in motivations to donate amongst potential donors according to demographics including fertility status, parity, ethnicity and religious background. Attitudes towards disclosure and anonymity appear complex. This is the first systematic review to examine potential oocyte donors exclusively and provides progressive information on the psychosocial complexities which may influence the crucial decision to donate. An increased number of well-designed studies exploring the psychological factors affecting the donation decision could allow more directed assessment and counselling for potential oocyte donors, which may lead to an increase in donor recruitment.