Systematic review analyzing significance of endometrial cavity fluid during assisted reproductive techniques.

OBJECTIVE: The objective of our study is to estimate the prevalence of endometrial cavity fluid (ECF) in Assisted Reproductive Techniques (ART) cycles and analyze its effects on pregnancy outcome in such cycles. DATA SOURCES: PubMed, Cochrane Central, Scopus, and clinicaltrials.gov were searched for articles. The reference lists of relevant publications were explored for other studies. STUDY ELIGIBILITY CRITERIA: Studies that had assessed the pregnancy outcome in ART cycles and had commented on ECF accumulation were included. Pregnancy outcomes were assessed in all ART cycles where ECF was observed and were compared to the non-ECF cycles. RESULTS: A total of nine studies were included in the meta-analysis for a total of 28,210 cycles. Pooled analysis of the prevalence of ECF cycles out of total cycles in females undergoing ART using a fixed effect model showed that it was 14% (95% CI is 13% to 14%; I2 = 99%, p = < 0.01). The random effect model prevalence of ECF cycles was around 7% (95% CI: 4% to 10%). There was a statistically significant (25%) decrease in pregnancy rates per cycle transfer in the ECF cycle versus the non-ECF cycle group during ART [OR = 0.75, 95% CI = 0.67-0.84), p < 0.001; moderate quality evidence]. When ECF size was compared, there was a statistically significant increase in pregnancy rates if ECF size was less than 3.5 mm versus greater than or equal to 3.5 mm [OR = 13.67, 95% CI = 1.43-130.40), p = 0.02; high quality evidence]. Sub-group analysis revealed that the ECF present at the time of embryo transfer significantly decreased the pregnancy rates by 26% as compared to the group where the ECF was not present at the time of embryo transfer [OR = 0.74, 95% CI = 0.65-0.85), p < 0.001]. CONCLUSIONS: This meta-analysis proposes that the presence of ECF significantly decreases the implantation and pregnancy rates of ART cycles, and even more so if its size is greater than 3.5 mm. Interventions to decrease ECF formation or treat it have enhanced the pregnancy outcome in ART cycles. PROSPERO REGISTRATION: Date: 17th September 2020; Number: CRD42020182262.

Relationship of anemia with COVID-19 deaths: A retrospective cross-sectional study.

Background and Aims: With the second wave of COVID-19, India lost close to three lakh people within the span of a few months. In this study, we aimed to investigate the impact of anemia on the severity of COVID-19 based on the hemoglobin (Hb) concentration of the patients noted at the time of admission to the intensive care unit (ICU), to mark Hb as a prognostic marker of disease severity for the future. Material and Methods: Retrospective data was collected from 784 patients admitted to the COVID adult ICU between March and June 2021. Patients were identified as anemic and non-anemic based on the World Health Organization (WHO) guidelines. Chi-squared test was applied to see the relationship of anemia with the patient deaths. Results: Among the 784 patients, 507 succumbed to COVID-19. Of these, 49.3% had varying degrees of anemia. Significant correlation of anemia with death due to COVID-19 was found in males and females (P = 0.002106 and P = 0.033071, respectively) and in patients without any other comorbidities except anemia (P = 0.002020). This suggests that anemia is independently an important parameter that plays a role in severity of COVID-19. Conclusion: Upon observing a significant correlation between anemia and COVID-19 severity, it can be stated that anemia should be considered as an independent prognostic risk factor for COVID-19 and that hemoglobin can be used for risk stratification in patients under home or hospital care.

Life cycle of medical oxygen from production to consumption.

Oxygen is used extensively in illnesses involving respiratory system. In emergencies such as the one created by the flare of Covid-19, oxygen consumption has increased tremendously. This article aims to improve our understanding about the medical oxygen, its production (air separation unit, pressure swing adsorption, oxygen concentrators), the supply chain, storage methods, and the final delivery system to the patient. This article also provides a comprehensive review on the additions in the medical infrastructure during the time of oxygen crisis in India along with the introduction of certain novel approaches towards oxygen production and conservation. We aim to minimize the panic among our readers by giving them an insight about the course behind the oxygen supply in that oxygen mask.

Paraquat poisoning with spontaneous pneumothorax in the era of online shopping.

This is a case of a 22-year-old male student who took paraquat as a substance abuse. He presented with flu-like symptoms and chest X-ray depicting changes of acute respiratory distress syndrome (ARDS). After looking at his purchase history in his cell phone, he was found to have purchased paraquat dichloride online and its use was later confirmed by his roommate. The patient developed respiratory distress with renal failure and succumbed to his condition after 11 days of hospital admission. This report highlights an important social issue of probable substance abuse with paraquat which is a commonly used contact herbicide in rural settings but not-so-common in urban population. Also, the report highlights the unusual complication sequalae of pneumothorax. The high mortality with this substance is because of the unavailability of an antidote and of its unscrutinized availability.

The Third Ovary-Superfluous Ovary.

We report a case of a 25-year-old female who presented with primary infertility with AMH value of 9 ng/ml, and ultrasound image suggesting the possibility of three ovaries seen in two different planes and no polycystic pattern in any ovary. Diagnostic laparoscopy performed in this patient revealed two ovaries on the left side, placed in normal anatomical position. Both having their individual ovarian ligaments connecting both the ovaries separately with the cornual end of the uterus on the left side. However, only the lateral one of the two ovaries on the left was attached to the lateral pelvic wall with infundibulopelvic ligament. The adnexa on the right side was normal. Biopsy confirmed this accessory tissue as an ovary. The "third ovary" in our case is a functional ovary. This explains the rise of AMH value. The ovary responded to ovulation induction, and follicles were retrieved thereafter which later showed fertilization. Hence, confirming their functionality. The occurrence of third ovary has been established in the literature. However, none of the definitions supports our finding, that is, the presence of third functional ovary attached with ovarian ligament and no infundibulopelvic ligament. Hence, we name this unique occurrence as "Superfluous Ovary".