Enhancing Fertility: A Case Report of the Frozen Platelet-Rich Plasma Therapy for Thin Endometrium and Poor Ovarian Reserve.

A 33-year-old female patient was assessed for primary infertility due to thin endometrium and poor ovarian reserve (POR). The effectiveness of platelet-rich plasma (PRP) therapy was evaluated in terms of thickening the endometrium and enhancing implantation. The patient also had a history of four intrauterine inseminations and one intracytoplasmic sperm injection (ICSI), along with low anti-Müllerian hormone (AMH) and high follicle-stimulating hormone levels which showed POR. Gonadotropins are given to enhance follicular growth, while agonists and antagonists are given to prevent premature luteinizing hormone surge and suppress the top axis. During the first oocyte pick-up (OPU), five oocytes were retrieved. ICSI was done to make fertilization easier. On day 5, the embryos had degraded from their initial high quality. The patient was advised to undergo treatment with PRP. The endometrial thickness was significantly thicker, raising the chance of implantation. The second OPU was scheduled, resulting in the retrieval of 14 oocytes on the same day ICSI was performed. High-quality blastocysts (4AA) were produced and transferred during embryo transfer, and the patient tolerated the procedure well. The clinical success of the pregnancy outcome was confirmed by another beta-human chorionic gonadotropin test.

The Implications of the Meiotic Spindle Visualization Technique on In Vitro Fertilization (IVF) Outcome in a Perimenopausal Patient.

An infertile couple visited an in vitro fertilization center situated in Maharashtra, India, seeking treatment for primary infertility. The 39-year-old premenopausal woman had a history of two intrauterine inseminations and intracytoplasmic sperm injections (ICSI), along with a history of tuberculosis from six years, and a normal hormonal range. The male was normozoospermic. The patient was given a gonadotropin-releasing hormone antagonist treatment and triggered before 36 hours of ovum pickup (OPU), but the cycle failed. Due to normal blood parameters, it was decided to use an optimal microscope using a polarizing filter to check the timing of meiotic spindle (MS) formation in the oocytes. The patient was triggered again for OPU, and during the procedure, 14 oocytes were retrieved. It was decided to perform ICSI after seven and a half hours of OPU post-observation of MS formation around the same hour. On day 21, the patient was suggested for embryo transfer (ET), where two blastocysts (4AA and 3AA) were transferred into the uterus. After a successful ET, the patient was discharged from the hospital. On day 14, a beta-human chronic gonadotrophin report revealed a positive pregnancy (910 mIU/mL).

A Case Series Based on the Mixed Double-Embryo Transfer (MDET) Outcome in Patients With Recurrent Implantation Failure.

Successful implantation of embryos depends on the synchronous cross-talks between the endometrial wall and the competent blastocyst within the window of implantation (WOI). Hence, the WOI has a major significance in assisted reproductive technology (ART). However, in some cases, women do not have fixed WOI in ART cycles in order to enhance the rate of successful clinical pregnancy. However, there have been stances where women do not have a fixed WOI, and it shifts in subsequent menstrual periods. This contributes to the chances of recurrent implantation failure (RIF). Another factor that contributes to RIF is erratic endometrial receptivity, which hinders the chances of successful implantation of the conceptus in the endometrium. This case series consists of four case studies where the patients were believed to be suffering from RIF due to variable WOI or erratic endometrial receptivity and the routine protocol followed nowadays failed to make them conceive. In order to resolve the condition, we proposed a novel strategy in an attempt to improve pregnancy rates in these cases. An innovative method of embryo transfer known as mixed double-embryo transfer (MDET), which involved the transfer of one day 3 embryo and one day 5 blastocyst on day 6 of progesterone, led to possible pregnancy outcomes. A viable pregnancy was validated based on the human chorionic gonadotropin (ß-hCG) test report, and two of the cases delivered healthy babies. Thus, this case series provides a unique approach to addressing the issues of RIF. However, larger studies are required to validate the possible use of this technique.

Implications of Progestin-Primed Ovarian Stimulation (PPOS) in a Patient With Diminished Ovarian Reserve (DOR) and Its In Vitro Fertilization (IVF) Outcome.

In this case study, a 39-year-old woman pursuing treatment for secondary infertility at our infertility clinic was visited by her 42-year-old husband. The couple had a history of failed attempts, including two intrauterine insemination (IUI), two intracytoplasmic sperm injection (ICSI) cycles, and two miscarriages. Diminished ovarian reserve (DOR) was noted in the patient's medical profile. A gonadotropin-releasing hormone (GnRH) antagonist, cetrorelix acetate, was given to the patient at a daily dosage of 0.25 mg to treat their condition once the maturing follicle had grown to a diameter of 10 mm. Following the administration of the GnRH antagonist, the first oocyte pick-up (OPU) procedure was conducted. During this process, two oocytes were successfully retrieved. Subsequently, ICSI was performed to facilitate fertilization. However, during the fertilization check, it was observed that no pronuclear fertilization (PN) formations occurred, leading to a cessation of development. Following the initial failure, an ovarian stimulation strategy based on progestin priming was implemented. Progestin is administered using this technique to ready the endometrium for the implantation of the embryo. After the modified ovarian stimulation protocol, an additional beta-human chorionic gonadotropin (ß-hCG) test was verified as a successful clinical pregnancy outcome.

Assessment of Reproductive Health Knowledge Among College Students in Northwestern India: A Cross-Sectional Study.

Background Reproductive health knowledge is a critical aspect of overall well-being, particularly among college students who represent a demographic transitioning into adulthood. In northwestern India, where cultural nuances and societal perceptions play a significant role, understanding the factors influencing reproductive health knowledge becomes imperative. This cross-sectional study explores the interplay between demographic factors and awareness of reproductive health and infertility treatment among college students in northwestern India. Methods A diverse sample of 564 college students in northwestern India participated in the study, providing information on key demographic variables, including age, gender, marital status, degree, field of study, and college year. Statistical analysis, including the calculation of p-values, was employed to determine the significance of associations between these demographic factors and the participants' knowledge of reproductive health. Descriptive statistics, including percentages and numbers, were calculated to present a comprehensive overview of the data. To evaluate the significance of associations, chi-square tests were conducted for categorical variables such as age, gender, marital status, degree, field of study, and college year. The p-values were computed to determine the statistical significance of observed relationships, with a significance level set at 0.05. Results The study uncovered notable findings with implications for targeted interventions. Among age groups, participants aged 23-25 exhibited the highest knowledge percentage at 43.22% (51/564), and this association was statistically significant (p = 0.042). Gender disparities were evident, with females showing higher awareness (46.52% (127/564)) compared to males, and this difference was statistically significant (p = 0.001). Marital status revealed significant differences (p = 0.0012), particularly in single individuals who demonstrated a knowledge percentage of 46.52% (127/564). Significant variations were observed based on the degree held, with doctorate holders having the highest awareness at 49.15% (58/564) (p = 0.01). Field of study significantly influenced knowledge (p = 0.0001), particularly in medical and engineering disciplines. College year also exhibited significance (p = 0.003), with the first-year students demonstrating a knowledge percentage of 42.20% (73/564). Conclusions These findings underscore the importance of tailored educational interventions and targeted awareness campaigns. Recognizing the influence of demographic factors on reproductive health knowledge is crucial for developing effective strategies that address the specific needs of college students in northwestern India, promoting a more informed approach to reproductive health and infertility treatment.

The Effect of Superoxide Dismutase Mimetic Drug in an Infertile Patient With Thin Endometrium.

It has been observed that nowadays, millions of couples struggle with infertility, which may be attributed to various conditions. In this case study, a middle-aged couple with a history of recurrent implantation failure (RIF) visited an infertility clinic situated in a rural region in Wardha to seek treatment. The male was normozoospermic. After hysteroscopy, it was noticed that an aggregated level of reactive oxygen species (ROS) was a causative factor for thin endometrium contributing to infertility. The patient was advised to autologous platelet-rich plasma (PRP) treatment and temporary medication. A significant level of amelioration in endometrial thickness was observed, which significantly contributed to the chances of implantation. This resulted in a positive clinical pregnancy outcome for the patient. This case report highlights the fact that a combination of tempol with autologous PRP may contribute to an improved factor for the enhancement of endometrial hyperplasia, which may contribute to an improved in vitro fertilization (IVF) pregnancy outcome.

A Case Report Based on a Holistic Approach to Improve Assisted Reproductive Technology (ART) Pregnancy Outcomes in a Patient With Thyroid Dysfunction.

To address infertility in a 34-year-old woman with hypothyroidism, this case study investigated an integrated holistic therapy approach. The woman presented with primary infertility and sought treatment at an infertility centre in Maharashtra, India. She underwent thorough evaluations for infertility, revealing a history of hypothyroidism. The therapy strategy included a six-month course of 50 mg levothyroxine, along with yoga and yog nidra. The yoga interventions, incorporating techniques such as surya namaskar, kriyas, yoga asanas, and pranayama, proved beneficial for weight management, stress reduction, and overall well-being. The deep relaxation method known as yog nidra played a crucial role in achieving hormonal balance. After six months, the patient's body mass index (BMI) improved from 28 to 24, and the male partner's semen analysis showed results within normal limits. The patient's thyroid-stimulating hormone (TSH) levels also returned to the normal range. Further in-vitro fertilization (IVF) treatment, including a successful embryo transfer, resulted in a positive clinical pregnancy test. This research underscores the effectiveness of alternative therapies like yoga and meditation in conjunction with traditional medicine to address both the psychological and physiological components of infertility caused by hypothyroidism. The case suggests that an integrated approach like this could offer a comprehensive solution for infertile couples. However, for broader applicability, additional investigation and clinical validation are warranted.

Hirayama's Disease: A Rare Clinical Variant of Amyotrophic Lateral Sclerosis.

Hirayama's disease is a rare clinical variant of amyotrophic lateral sclerosis where distal muscles are involved more compared to proximal muscles and vice-versa occurs only in 10% cases and so it is differentiated from O'Sullivan McLeod syndrome which involves only small muscles of single limb. Here, we present a case of Hirayama's disease where disease achieved a plateau after 3 years with no further progression. His electrophysiological studies, and clinical picture, and magnetic resonance imaging findings were consistent with a diagnosis of Hirayama's disease.

A mixed toxidrome presenting with bilateral ptosis with normal pupils: The first case in the literature.

Snakebite is an environmental hazard associated with a significant morbidity and mortality. Two main types of toxicity occur due to snakebite, namely vasculotoxicity and neurotoxicity. Neurotoxic snakebites present mainly with bilateral ptosis with dilated pupils and/or difficulty in breathing. Jatropha curcas belongs to the family Euphorbiaceae and is commonly referred to as "Ratanjyot" in Gujarati. It has got many medicinal uses such as anticancerous properties and bio-oil. There are very few cases of its toxicity in adults. Toxicity from it causes meiosis, vomiting, diarrhea, etc., We will hereby discuss one such patient who consumed J. curcas seeds intentionally, became drowsy and accidentally got bit by a snake, and then, the patient started having bilateral ptosis, but with normal-sized pupils. There is no case reported yet in the literature mentioning the combined toxicity of snakebite and J. curcas, so we thought to publish this first case report of its kind in the world, thus discussing its diagnosis, symptoms, and treatment modalities.

A study of the prevalence of serum vitamin B12 and folic Acid deficiency in Western maharashtra.

CONTEXT: This study summarizes the prevalence of vitamin B12 and folic acid deficiency in the population coming to tertiary care center in Western Maharashtra along with the main presenting symptom routinely misinterpreted in daily practice. AIMS AND OBJECTIVES: 1. To study the prevalence of vitamin B12 and folic acid deficiency in the population of western Maharashtra. 2. To correlate the symptoms with serum vitamin B12 and folic acid levels. MATERIALS AND METHODS: The present study is a cross-sectional observation study carried out on patients from western Maharashtra seeking medical attention on outpatient and inpatient basis in the medicine department of a teaching institute in Karad. One-hundred patients were selected on basis of below mentioned symptoms viz. tingling and numbness in extremities, dizziness, unsteady gait, early tiredness, forgetfulness, proximal weakness, distal weakness, chronic headache, less interest in work, chronic loose stools, strict vegetarians, alcoholics, intake of medications like anti-tubercular treatment, surgery involving terminal ileum. Serum vitamin B12 and folic acid levels of these patients were observed. Deficiency of vitamin B12 and folic acid was studied in 4 groups: (a) Absolute vitamin B12 deficiency; (b) Absolute folic acid deficiency; (c) Borderline vitamin B12 deficiency; (d) Combined vitamin B12 and folic acid deficiency. RESULTS: Of the 100 cases, 33% patients were vegetarian. Folic acid deficiency formed the major chunk of deficiency group. Six percent patients had neuropsychiatric manifestations. Depressive illness in 1% patients, dementia in 0% patients, forgetfulness in 1% patients, mania/hallucination in 0% patients each, and chronic headache in 1% patients. Neuropathy in form of loss of reflexes, decreased touch sensation was present in 9% patients. Posterior column involvement viz. Loss of joint position, vibration, positive Romberg's sign were present in 34% patients of vitamin B12 and folic acid deficiency. CONCLUSION: In a small study, it was found that megaloblastic anemia may have symptoms and signs referable to several systems including hematology, dermatology, gastrointestinal, neurology, and neuropsychiatry.

Ischaemic Stroke Following Percutaneous Transluminal Coronary Angioplasty (PTCA): A Rare Complication.

Stroke following coronary interventions is a devastating and most dreaded complication with significant morbidity and mortality. Various factors have been ascribed for this complication including the technical errors. We hereby describe such a patient who presented to us with the diagnosis of acute coronary syndrome and underwent percutaneous coronary intervention (PCI) but unfortunately developed left sided hemiparesis due to ischaemic stroke (right middle cerebral artery). She was managed as per the standard treatment protocols for acute coronary syndrome and later on for ischaemic stroke which she nicely responded to and was discharged in a haemodynamically stable condition. On follow-up after 15 days, she was totally symptom-free. We will discuss all the possible preventive and treatment measures for this rare complication of (PCI).

Delayed cerebellar ataxia: A rare self limiting complication of plasmodium falciparum malaria.

The classic presentation of malaria with paroxysms of fever is seen only in 50-70% of the patients. The development of immunity, the increasing resistance to anti-malarial drugs, and the indiscriminate use of anti-malarial drugs have led to malaria with the presentation of unusual features. Cerebellar ataxia, extrapyramidal rigidity and various psychiatric symptoms have been described either as early manifestations of cerebral malaria or as a part of post malaria neurological syndrome. In this case report, we will discuss one such patient of falciparum malaria infection who developed midline cerebellar signs, and responded to anti-malarial treatment.

Reactive thrombocytosis leading to acute myocardial infarction.

Thrombocytosis is defined as platelet count of > 600000. An elevated platelet count may be primarily (essential) or secondary (reactive). Acute myocardial infarction and other vaso-occlusive phenomenon are seen in less than 5% of the patients of reactive thrombocytosis. Here we report such a case. A 49 yr old lady presented with chest pain and had isolated right ventricular infarction that progressed to anteroseptal wall STEMI. Her platelet count was 11 lac; the triggering factor in this case was reactive thrombocytosis secondary to lower respiratory tract infection and iron-deficiency anaemia confirmed after investigations. The clinical diagnosis was confirmed through IL6 levels. The patient was managed aggressively in ICCU, she had an uneventful recovery and was discharged with a normal platelet count.

A study of the clinical profile of right ventricular infarction in context to inferior wall myocardial infarction in a tertiary care centre.

INTRODUCTION: Right ventricular infarction, previously thought to be rare and recently thought to be common, is commonly associated with inferior wall myocardial infarction. We will hereby study the clinical profile of right ventricular infarction (as diagnosed by right precordial electrocardiography) in patients with acute inferior wall myocardial infarction and the clinical course of RV infarction in inferior wall myocardial infarction in terms of complications. AIMS AND OBJECTIVES: 1. To study the incidence of right ventricular infarction in patients of acute inferior myocardial infarction using right precordial electrocardiography. 2. To study the complications of right ventricular infarction. 3. To study the response of specific therapy in patients with right ventricular infarction. MATERIALS & METHODS: 50 patients with a history of chest pain less than 24 h were included in the study, standard 12 leads electrocardiography along with right side chest leads were taken on admission and on daily morning at 7 AM routinely for the first three days. A detailed clinical examination was done to find out the presence of right ventricular failure, left ventricular failure, hypotension and cardiogenic shock at the time of admission. Each patient was subjected to investigations viz. cardiac enzymes. Patients were grouped into two groups group A and group B according to the presence or absence of right ventricular infarction respectively. RESULTS: Of the total studied 50 patients, 16 patients had right ventricular infarction in association with inferior wall infarction of left ventricle. Complicated course was present in 75% of patients in group A as compared to 29.42% of patients in group B. CONCLUSION: Complications and in-hospital mortality rates were more common in patients with right ventricular infarction than in patients without it.

Cardiorenal syndrome: Resistant to diuretics, sensitive to ultraflitration.

Cardiac and renal diseases are becoming increasingly common today, and are seen to frequently coexist, thus causing a significant increase in the mortality rate, morbidity, complexity of treatment and cost of care. Syndromes describing the interaction between heart and kidney have been defined and classified; however, never as a result of a consensus process. Though the incidence of cardiorenal syndrome is increasing, the associated pathophysiology and effective management are still not well understood. For many years, diuretics and ultrafiltration, have been the mainstay of treatment for cardiorenal syndrome, although a significant proportion of patients develop resistance to diuretics, and even deteriorate while on diuretics. Here, we will discuss one such patient who failed to respond to the optimum doses of diuretics; however, his blood urea and serum creatinine touched the baseline levels post-ultrafiltration.

Lutembacher's syndrome.

The definition of Lutembacher's syndrome has undergone many changes. It refers to combination of congenital Atrial Septal Defect with acquired mitral stenosis. Lutembacher's syndrome is a very rare disease and in the past, it has been either overdiagnosed or misdiagnosed. Here, we will discuss a case of a pregnant lady who developed breathlessness during her third trimester of pregnancy and on detailed examination and investigation, she was found to be having Lutembacher's syndrome.

Estimating thermal conductivity of amorphous silica nanoparticles and nanowires using molecular dynamics simulations.

In several recent applications, including those aimed at developing thermal interface materials, nanoparticulate systems have been proposed to improve the effective behavior of the system. While nanoparticles by themselves may have low conductivities relative to larger particles owing to interfacial resistance, their use along with larger particles is believed to enhance the percolation threshold leading to better effective behavior overall. One critical challenge in using nanoparticulate systems is the lack of knowledge regarding their thermal conductivity. In this paper, the thermal conductivity of silica clusters (or nanoparticles) as well as nanowires is determined using molecular dynamics (MD) simulations. The equilibrium MD simulations of nanoparticles using Green-Kubo relations are demonstrated to be computationally very expensive and unsuitable for such nanoscaled systems. A nonequilibrium MD method adapted from the study of Müller-Plathe is shown to be faster and more accurate. The method is first demonstrated on bulk amorphous silica (using both cubic and orthorhombic simulation cells) and silica nanowires. The thermal conductivity values are compared to those reported in the literature. The mean thermal conductivity values for bulk silica and silica nanowire were estimated to be 1.2 W/mK and 1.435 W/mK, respectively. To model nanoparticles, the Müller-Plathe technique is adapted by dividing the cluster into concentric shells so as to capture the naturally radial mode of heat transfer. The mean thermal conductivity value of a 600-atom silica nanoparticle obtained using this approach was 0.589 W/mK. This value is approximately 50-60% lower than those of bulk silica or silica nanowire.