An optimal thickness of the endometrium is considered to be one of the prerequisites for successful implantation of the embryo. A retrospective analysis was carried out to investigate the use of Pentoxyfylline and tocopherol in improving the endometrial thickness in cases that are unresponsive to conventional therapy. Twenty women with thin endometrium (<6 mm) undergoing either ovulation induction or frozen embryo transfer cycles were prescribed 800 mg of PTX and 1000 IU of Vit E daily. In 11 cases, the etiology for thin endometrium was unknown. The known causes included Turners' syndrome (3), Kallman's syndrome (1), idiopathic hypogonadotrophic hypogonadism (2), premature ovarian failure (1) and Asherman's syndrome (2), none of which had responded to conventional hormonal stimulation. The mean duration of treatment was 8.1 months (+/-4.5, range 1-18 months). The mean thickness of endometrium before and after treatment was 4.37 mm (+/-1.5 mm) and 6.05 mm (+/-1.83 mm), respectively (p = 0.001, 95% CI 0.84-2.5). Overall, 14 (73.7%) women showed improvement in endometrial thickness which was the primary outcome. Pregnancy occurred in eight women (40%) of which three were natural, one had ovulation induction and another five had frozen embryo transfers. We conclude that a combination of pentoxyfylline and tocopherol may improve endometrial growth in resistant cases that are unresponsive to conventional therapy.
Etiopathogenesis of acute hepatic failure (AHF) in Eastern and Western countries is distinct. In the East hepatitis viruses cause AHF in more than 95% of such cases, while causes of AHF in the West are quite heterogenous. Hepatitis E virus is the major etiological agent of AHF in countries like India where the virus is hyperendemic. Occult HBV infection may also be causing AHF in a sizable proportion of cases in areas where chronic HBV infection frequency is high. Paracetamol causes AHF in about 70% cases in the UK and about 20% cases in USA, whereas in France and Denmark, non-steroidal anti-inflammatory drugs are more frequently associated with AHF. Hepatitis B virus causes AHF in about one-third of cases in the latter two countries.
The global severe acute respiratory syndrome-related coronavirus SARS-CoV-2 (COVID-19) pandemic has had an unprecedented impact on all aspects of daily life and healthcare. Information on the infection risks for pregnant women and their offspring have so far been limited to small case series, until a large UK report on 427 SARS-CoV-2 infected pregnant women was published. Previous SARS epidemic experiences were drawn upon. Diagnostic use of real time polymerase chain reaction (RT-PCR) and IgG and IgM antibody tests are fraught with concerns of non-validation and false negative results, as are sampling methodologies. Virtually no information on controls accompany these reports. Infection of the mother and baby has serious implications for obstetric and neonatal care. Information on early and late stage pregnancy infection and the relationship to severity of infection on fetal development is both useful and clearly warranted. An increasing number of reports centre around mildly infected women showing no evidence of fetal infection while a few reports suggesting vertical transmission require further validation. Vertical transmission from mother to baby however small would have profound health implications for obstetric and neonatal care and fetal abnormalities. Some data suggesting intrapartum vertical transmission from mother to baby cannot be dismissed given the lack of controls and limitations of diagnostic viral tests. This analysis covers some key early reports addressing pregnancy outcomes following SARS-CoV-2 infection.
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