Is there a perfect protocol for patients with low ovarian reserve: a retrospective study comparing antagonist or agonist protocol in patients with low ovarian reserve

Background: The high prevalence of infertility has made it a major healthcare problem in the present era. A majority of patients presenting with infertility have poor ovarian reserve (POR). Patients with POR are challenging to treat due to reduced treatment success and high cycle cancellation rate as there is no uniform definition and treatment protocol for these patients. The present retrospective study was performed to compare the pregnancy outcome between a long agonist protocol and flexible antagonist protocol in patients with POR. Patients with AMH ≤1.5 ng/mL and AFC ≤4 was included in the study. Controlled ovarian hyperstimulation is the basis of any in vitro fertilisation (IVF) procedure. There is no universally accepted ideal stimulation protocol for patients with POR, and it remains a challenge.Methods: This was a retrospective study covering the period from May 2019 to March 2020. Ninety-nine patients with low ovarian reserve (AMH ≤1.5 ng/mL and AFC ≤4) were included in the study. The patients underwent GnRH agonist/GnRH antagonist stimulation protocol using recombinant FSH. Demographic characteristics like age, BMI, duration of infertility was comparable. Total days of stimulation, total Gonadotropin dose used and clinical pregnancy rate in both the protocols was analyzed. Difference between the two groups was considered statistically significant at p-value <0.05.Results: Fifty-three patients underwent antagonist stimulation protocol and forty-six long agonist protocol. The clinical pregnancy rate was 37.7% (20/53) and 32.6% (15/46) in antagonist and agonist protocol respectively (p-value=0.5983). Pregnancy rate was higher in the antagonist group but the difference was not statistically significant.Conclusions: Antagonist protocol could marginally increase pregnancy rate in patients with low ovarian reserve. However, patients with poor ovarian reserve require a tailor-made protocol.

The missing gonadotropin-releasing hormone agonist trigger leading to missing oocytes

Authors present a case of Genuine EFS in a young woman where no oocytes were retrieved in the first stimulation cycle after single ovulation trigger. However, a repeat stimulation performed with double ovulation trigger yielded enough oocytes.

Surveillance of water quality in a medical college campus in a rural area in North West India.

Water bacteriology is an important component of providing safe and potable water supply. Surveillance of drinking water helps in identifying possible sources of water contamination. The present study was done in DRPGMC Tanda campus to monitor the quality of water samples. A total of 79 water samples were collected and tested over a period of two and a half years. About 33 % of these were found to be not fit for drinking. The findings of the study underscore the importance of following the steps of water purification.

Intrathecal morphine in two patients undergoing deep hypothermic circulatory arrest during aortic surgery: A case report / 대한마취과학회지

We retrospectively report the first use of intrathecal morphine prior to incision in two male patients undergoing a complex aortic reconstruction, who required complete circulatory arrest under deep hypothermia for intraoperative and postoperative pain control. We administered intrathecal morphine to two male patients undergoing circulatory arrest and deep hypothermia. Patients were fully heparinized prior to cardiopulmonary bypass. Deep hypothermic circulatory arrest was performed by cooling the patients to 18degrees C. Following the surgery, the neurologic status was monitored. The management of postoperative pain is a quality standard in health care. During the first 24 hours after surgery, we observed excellent analgesia without the associated side effects, thus, reducing the time required for pain control by the nursing staff. A successful analgetic strategy not only enhances the patient satisfaction, but may improve the postoperative outcome. However, complications, such as increased risk of epidural hematoma formation, are of special concern in cardiac surgery.

The molecular basis of speciation: from patterns to processes, rules to mechanisms.

The empirical study of speciation has brought us closer to unlocking the origins of life's vast diversity. By examining recently formed species, a number of general patterns, or rules, become apparent. Among fixed differences between species, sexual genes and traits are one of the most rapidly evolving and novel functional classes, and premating isolation often develops earlier than postmating isolation. Among interspecific hybrids, sterility evolves faster than inviability, the X-chromosome has a greater effect on incompatibilities than autosomes, and hybrid dysfunction affects the heterogametic sex more frequently than the homogametic sex (Haldane's rule). Haldane's rule, in particular, has played a major role in reviving interest in the genetics of speciation. However, the large genetic and reproductive differences between taxa and the multi-factorial nature of each rule have made it difficult to ascribe general mechanisms. Here, we review the extensive progress made since Darwin on understanding the origin of species. We revisit the rules of speciation, regarding them as landmarks as species evolve through time. We contrast these 'rules' of speciation to 'mechanisms' of speciation representing primary causal factors ranging across various levels of organization-from genic to chromosomal to organismal. To explain the rules, we propose a new 'hierarchical faster-sex' theory: the rapid evolution of sex and reproduction-related (SRR) genes (faster-SRR evolution), in combination with the preferential involvement of the X-chromosome (hemizygous X-effects) and sexually selected male traits (faster-male evolution). This unified theory explains a comprehensive set of speciation rules at both the prezyotic and postzygotic levels and also serves as a cohesive alternative to dominance, composite, and recent genomic conflict interpretations of Haldane's rule.

Physico-chemical characterisation and molecular organisation of the collagen from the skin of an air-breathing fish (Ophiocephalus striatus).

Collagen has been prepared from the skin of an air-breathing Indian fish (Ophiocephalus striatus) by extraction with cold 0.5M acetic acid and purification by alternate precipitation with NaCl and dialysis against 0.02M Na2HPO4. The purified collagen was characterised with respect to physico-chemical properties, amino acid composition and chromatography of the denatured collagen. The fish collagen has a higher shrinkage temperature and denaturation temperature compared to that of the allied teleosts living in exclusively aquatic medium. These differences could possibly be reflections of the response to the rigours of the environment. As found for other vertebrate collagens, the fish collagen contains two kinds of single chains the α1 and α2 chains as revealed by sodium dodecyl sulphate–polyacrylamidegel electrophoresis and carboxymethylcellulose chromatography.