Introduction Despite literature’s proofs about their safety, concerns arose regarding adverse events due to Covid-19 vaccines, including the possible impact on fertility, accentuated by misinformation and anti-vaccine campaigns. The aim of this study was to evaluate the Covid-19 vaccines’ impact on male and female fertility. Methods PubMed, Scopus, Web of Science, Cochrane and Embase databases were searched for eligible studies until March 7th, 2022. Primary studies investigating the Covid-19 vaccines impact on male and female fertility, were included. Studies’ quality was assessed by the Newcastle-Ottawa and the Before and After Quality Assessment scales for cohort and pre-post studies, respectively. Random-effect meta-analyses were performed for parameters considered in ≥ 2 studies, calculating means, p-values and 95% Confidence Intervals (CIs). I2 statistics was used to assess statistical heterogeneity. Results Out of 1406 studies screened, 20 studies were included in the systematic review. These studies, conducted in Israel (35%), USA (30%), Russia (25%), China (5%) and Italy (5%), were of poor (15%), moderate (75%) and good (10%) quality. Meta-analyses among five studies considering several vaccines were performed for pre- and post-vaccination sperm progressive motility ((49%, 95% CI 36-67% vs 49%, 95% CI 39-61%; p = 0.963) and concentration (64.39 mln/ml, 95% CI 47.51-87.28 and 72.00 mln/ml, 95% CI 51.22-101.21; p = 0.03). Subgroup meta-analyses based on the type of vaccine showed no significant difference: between vaccinated with mRNA vaccines and non-vaccinated regarding biochemical pregnancy rates; pre- and post-vaccination with Gam-COVID-Vac regarding testosterone, FSH and LH levels; pre- and post-vaccination with BNT162b2 vaccines regarding sperm volumes. Discussion There is no scientific proof of any association between Covid-19 vaccines and infertility in men or women. Misinformation and doubts about vaccines should be properly addressed. Key messages • The doubts regarding Covid-19 vaccines’ impact on both male and female fertility resulted to be unfounded. Covid-19 vaccines remain the most important weapon to fight the pandemic. • It is important to keep providing to public opinion and health care providers evidence-based scientific information, in order to effectively combat misinformation and anti-vaccines campaigns.
Background Robotic surgery has many clinical advantages but high costs, raising the issue of healthcare sustainability. This study aims to a comparative analysis of the value, in terms of costs and outcomes, of robotic, laparoscopic, and laparotomy surgery for uterine cancer in a University Hospital. Methods An observational retrospective study was carried out on hospitalizations between 1 Jan 2019 and 31 Oct 2021 for uterine cancer surgery. DRG amount, costs, economic margins and 30-days readmissions percentage (mean values and 95% CIs) were calculated for robotic, laparoscopic and laparotomy surgery. Student’s t and Chi-square tests were used to assess differences and the break-even point was calculated. Results 1336 hospitalizations were analyzed, 366 with robotic, 591 with laparoscopic, and 379 with laparotomy surgery. Robotic surgery compared to laparoscopic and laparotomy ones showed a significant difference (p < 0,001) for economic margin, which was largely negative (-1069.18 €; 95%CI: -1240.44 - -897.92 €) mainly due to devices cost (3549.37 €; 95%CI: 3459.32 € - 3639.43 €), and a lower 30-days readmissions percentage (1.4%; 95%CI: 0.2% - 2.6%) with a significant difference only versus laparotomy (p = 0.029). Laparoscopic compared to laparotomy surgery showed a significantly (p < 0,001) more profitable economic margin (1692.21 €; 95%CI: 1531.75 € - 1852.66 €) without a significant difference for 30-days readmissions. The break-even analysis showed that, on average, for every uterine cancer laparoscopic elective surgery, 1.58 elective robotic surgeries are sustainable for the hospital (95% CI: 1.23 - 2.06). Conclusions The systematic application of the break-even analysis will allow defining over time the right distribution of robotic, laparoscopic and laparotomy surgeries’ volumes to perform in order to ensure both quality and economic-financial balance and therefore value of uterine oncological surgery in the University Hospital. Key messages • The value-based healthcare approach, defined as the measured improvement in a patient’s health outcomes in relation to its cost, finds effective application in uterine cancer surgery. • The use of the break-even approach allows to promote the value-based view by identifying a useful criterion for the planning and governance of interventions for uterine malignancies.
Background Infertility is a multifactorial health issue, with males accounting for half of the cases, part of which appears to be idiopathic. Several genome-wide association studies (GWAS) have explored the role of single-nucleotide polymorphisms (SNPs) in idiopathic male infertility (IMI). However, considering the inconsistent evidence, this systematic review and meta-analysis aimed to assess the association between SNPs and IMI susceptibility, via GWAS. Methods PubMed, Scopus, Web of Science and GWAS databases were searched for eligible GWAS in English until March 17th, 2021. Primary data studies on the association between SNPs and IMI were included. Studies' quality was assessed by the Q-Genie tool. Random-effect meta-analyses were performed for SNPs evaluated in ≥ 2 studies for the same genotype, calculating pooled odds ratios (ORs) and 95% confidence intervals (CIs). I2 statistics was used to assess statistical heterogeneity. Results Out of 1356 articles, nine were included in the systematic review. These studies, conducted in Asian populations (78% in China and 22% in Japan), were of moderate to good quality. 121 genes and 199 SNPs were evaluated for their association with Non-Obstructive Azoospermia (NOA) (78%), oligoasthenospermia, oligozoospermia and asthenozoospermia, in 13145 cases and 21152 controls. 43% of the SNPs, among which 38 haplogroups of the Y chromosome, were significantly associated to IMI. Meta-analysis was conducted only for two SNPs: rs498422 and rs3129878, which were significantly associated to NOA (OR = 1.3, 95% CI 1.07-1.58 and OR = 1.36, 95% CI 1.28-1.44, respectively). Discussion Although several genetic variants have been identified, their contribution to IMI pathogenesis remains poorly understood. Further research is needed to establish the role of these SNPs for genetic testing in clinical and public health practice. Identifying populations at greater risk of infertility may result in personalized prevention and diagnostic programs. Key messages Genome wide association studies included in this metanalysis, conducted all in Asian countries, report several single nucleotide polymorphisms associated to idiopathic male infertility. Despite the number of SNPs identified in these studies, further research is needed to establish their role in clinical and public health practice, which may result in personalized prevention.
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