This document summarizes the key findings from 95 Cochrane systematic reviews on interventions for assisted reproductive technology published up to July 2015. 32 reviews identified interventions that were effective (19 interventions) or promising (13 interventions) in improving live birth or pregnancy rates. 14 reviews found interventions that were ineffective (2 interventions) or possibly ineffective (12 interventions). The reviews assessed interventions for various steps of ART including pre-ART strategies, ovarian stimulation, embryo transfer, and luteal phase support. Effective interventions included use of growth hormone, metformin, endometrial injury, and single embryo transfer. Ineffective interventions included follicular flushing and preimplantation genetic screening.
Clomiphene citrate or aromatase inhibitors for superovulation in women with u...Aboubakr Elnashar
Clomiphene citrate or aromatase inhibitors for
superovulation in women with unexplained infertility
undergoing intrauterine insemination:
a prospective
randomized trial
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
Clomiphene citrate or aromatase inhibitors for superovulation in women with u...Aboubakr Elnashar
Clomiphene citrate or aromatase inhibitors for
superovulation in women with unexplained infertility
undergoing intrauterine insemination:
a prospective
randomized trial
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
Dydrogesterone versus progesterone for luteal-phase support: systematic review and meta-analysis of randomized controlled trials
M. W. P. Barbosa, L. R. Silva, P. A. Navarro, R. A. Ferriani, C. O. Nastri and W. P. Martins
Volume 48, Issue 2, Pages 161–170
Slides prepared by Dr Aly Youssef (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15814/full
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
How to practice medicine ? to provide ordinary care or to provide the best available care? Cochrane systematic reviews help u in this issue. This talk illustrates how Cochrane reviews helps with special focus on reproductive medicine
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
3. The Cochrane Collaboration
International collaboration
Prepares, maintains, and disseminates systematic
reviews
Diverse internal structure (Review Groups,
Centres, Fields, Methods Groups, the Consumer
Network)
Cochrane Library
The current resource with the highest methodological
rigor
$235/year or abstracts only
www.cochrane.org
ABOUBAKR ELNASHAR
4. Increasingly, couples are turning to ART for help
with conceiving and ultimately giving birth to a
healthy live baby of their own.
Fertility treatments are complex, and each ART
cycle consists of several steps. If one of the steps is
incorrectly applied, the stakes are high as
conception may not occur.
With this in mind, it is important that each step of
the ART cycle is supported by good evidence from
well-designed studies.
ABOUBAKR ELNASHAR
5. 95 systematic reviews published in The
Cochrane Library up to July 2015 were
included.
All were high quality.
32 reviews identified interventions that were
effective (n = 19) or promising (n = 13)
14 reviews identified interventions that were
either ineffective (n = 2) or possibly ineffective
(n = 12)
13 reviews were unable to draw conclusions
due to lack of evidence.
(Farquhar et al, 2015)
ABOUBAKR ELNASHAR
8. 1. Pre-ART and adjuvant strategies
Effective interventions
• Endometrial injury in women undergoing ART:
performed in the month prior to ovulation induction:
increase both LBR or OPR and CPR
(moderate quality evidence).
•No evidence of a difference between the groups in
miscarriage, multiple pregnancy or bleeding rates.
•Endometrial injury on the day of OR: lower LBR or
OPL
(low quality evidence).
(Nastri , 2015)
ABOUBAKR ELNASHAR
9. • Growth hormone for IVF:
in poor responders: significant improvement in LBR
(moderate quality evidence).
(Duffy 2010)
• Metformin treatment before and during IVF or
ICSI in women with PCOS:
No conclusive evidence for improved LBR
(low quality evidence).
Met increased CPR and decreased risk of OHSS
(moderate quality evidence).
(Tso, 2014)
ABOUBAKR ELNASHAR
10. • Surgical treatment for hydrosalpix:
laparoscopic tubal occlusion is an alternative to
laparoscopic salpingectomy in improving IVF PR
(moderate quality evidence).
(Johnson, 2010)
ABOUBAKR ELNASHAR
11. 2. Down-regulation with agonists or antagonists
Effective interventions
• GnRHa protocols for pituitary suppression in ART:
CPR was higher when GnRHa was used in a long
protocol as compared to a short or ultra-short
protocol
(low quality evidence).
(Maheshwari 2011)
• GnRHan for ART:
Antagonist compared with long GnRHa protocols:
reduction in OHSS
No evidence of a difference in LBR
(moderate quality evidence).
(Al-Inany 2011)
ABOUBAKR ELNASHAR
12. • Long-term pituitary down-regulation before IVF for
women with endometriosis:
GnRHa for a period of 3-6 months prior to IVF or
ICSI: increased CPR
(very low quality evidence).
(Sallam, 2006)
ABOUBAKR ELNASHAR
13. 3. Ovarian stimulation
Effective interventions
• Rec vs urinary gonadotrophin for ovarian
stimulation in ART:
all available gonadotrophins were equally effective
and safe.
Choice will depend upon:
availability of the product
convenience of its use
associated costs.
Any specific differences are likely to be too small to
justify further research
(high quality evidence).
(van Wely 2011)
ABOUBAKR ELNASHAR
14. • Long-acting FSH vs daily FSH for ART:
medium dose (150 to 180 μg) of long-acting FSH
appeared to be a safe and as effective as daily FSH
in women with unexplained subfertility.
low dose (60 to 120 μg) of long-acting FSH
compared to daily FSH: Reduced LBR
(moderate quality evidence).
(Pouwer, 2015)
ABOUBAKR ELNASHAR
15. 4. Ovulation triggering
Effective interventions
• Rec Vs. u hCG for final oocyte maturation
triggering in IVF and ICSI cycles:
u hCG remains the best choice for final oocyte
maturation triggering in ART
{availability and cost}
(moderate quality evidence).
(Youssef, 2011)
ABOUBAKR ELNASHAR
16. • GnRHa Vs. hCG for oocyte triggering in
antagonist ART cycles:
GnRHa:
lower LBR
reduced OPR
higher miscarriage rate
reduction in OHSS rates
A trade off between benefits and harms (moderate
quality evidence).
(Youssef , 2014)
ABOUBAKR ELNASHAR
17. 5. Oocyte retrieval
Effective interventions
• Pain relief:
5 different categories of conscious sedation and
analgesia appeared to be acceptable and were
associated with a high degree of satisfaction in
women.
The optimal method may be individualised
depending on
preferences of the women and their clinicians
resource availability
(very low quality evidence).
(Kwan , 2013)
ABOUBAKR ELNASHAR
18. Ineffective interventions
• Follicular flushing:
No improved C or OPR
No increase in oocyte yield.
Increase operative time
More opiate analgesia
(moderate quality evidence).
(Wongtra-ngan 2010)
ABOUBAKR ELNASHAR
19. 6. Laboratory phase
Effective interventions
• Low oxygen concentrations for embryo culture in
ART:
:an increase in LBR
(moderate quality evidence).
(Bontekoe , 2012)
ABOUBAKR ELNASHAR
20. Ineffective interventions
• Preimplantation genetic screening for abnormal
number of chromosomes (aneuploidies):
using fluorescent in situ hybridization significantly
decreased LBR in women of advanced maternal
age and those with repeated IVF failure
Trials in which PGS was offered to women with a
good prognosis suggested similar outcomes
(moderate quality evidence).
(Twisk, 2006)
ABOUBAKR ELNASHAR
21. 7. Embryo transfer
Effective interventions
• Ultrasound versus ’clinical touch’ for catheter
guidance:
significant increase in CPR
(low quality evidence).
(Brown, 2010)
ABOUBAKR ELNASHAR
22. • Adherence compounds in ET media for ART:
use of hyaluronic acid.
improved LBR and CPR with the
Increase Multiple pregnancy rates
(moderate quality evidence).
(Bontekoe, 2014)
ABOUBAKR ELNASHAR
23. • Number of embryos for transfer:
single embryo transfer compared with double
embryo transfer
LBR was lower
fewer multiple pregnancies
(high quality evidence).
cumulative LBR associated with single embryo
transfer followed by a single frozen and thawed ET
was comparable with that after one cycle of double
embryo transfer
(low quality evidence).
(Pandian, 2013)
ABOUBAKR ELNASHAR
24. 8. Luteal phase support
Effective interventions
• LPS:
Progesterone appears to be the best method,
higher LBR and OPR than placebo
lower rates of OHSS than hCG.
Addition of one or more doses of GnRHa to
progesterone:
higher LBR and OPR than progesterone alone.
ABOUBAKR ELNASHAR
25. Addition of oestrogen or hCG did not improve
outcomes, and hCG was associated with higher risk
of OHSS.
The route of progesterone administration did not
seem to matter
(quality of evidence low for most comparisons).
(van der Linden, 2015)
ABOUBAKR ELNASHAR
26. 9. Prevention of OHSS
Effective interventions
•hydroxyethyl starch
decreased the incidence of severe OHSS
(very low quality evidence)
(Youssef 2011)
• Cabergoline:
reduce the risk of OHSS in high risk women,
especially for moderate OHSS
did not affect CPR or miscarriage rates
No increased risk of other adverse events
(low quality evidence).
(Tang, 2012)
ABOUBAKR ELNASHAR
27. • GnRHan compared with long GnRHa protocols:
reduction in OHSS
no evidence of a difference in LBR
(moderate quality evidence).
(Al-Inany, 2011)
ABOUBAKR ELNASHAR
28. • GnRHa versus hCG for oocyte triggering in
antagonist ART cycles:
lower LBR
reduced OPR
higher miscarriage rate
reduction in OHSS rates
a trade off between benefits and harms
(moderate quality evidence).
(Youssef , 2014)
ABOUBAKR ELNASHAR
29. C O N C L U S I O N S
This overview provides the most up to date
evidence on ART cycles from systematic reviews of
RCT
Fertility treatments are costly and the stakes are
high.
Best practice requires using the best available
evidence to optimise outcomes.
The evidence from this overview could be used to
develop clinical practice guidelines and protocols for
use in daily clinical practice, in order to improve
LBR and reduce rates of multiple pregnancy, cycle
cancellation and OHSS.
ABOUBAKR ELNASHAR