An unprecedented surge in SARS-CoV-2 infections driven by the Delta variant was reported from India recently [1]. The total reported new cases from its capital, New Delhi, in April and May 2021 were more than those reported in a 13-month period since the onset of the pandemic (765,117 vs 661,123)[2]. We estimated ChAdOx1 nCoV-19 effectiveness during this surge.Sir Gangaram Hospital is a tertiary care private hospital in New Delhi, having 4296 employees with equitable access to medical benefits, including investigations, medicines and hospitalization. Of these, between 16.1.21 to 30.4.21, 2716 received two doses, and 623 received a single dose of ChAdOx1-nCoV2. 927 remained unvaccinated till 30.4.21. 20 received the BBV152 vaccine or the BNT162b2 vaccine and were excluded from our analysis. We studied infection rates, moderate to severe disease rates, supplemental oxygen therapy rates and death rates in the ChAdOx1 2-doses and single-dose cohorts against the unvaccinated cohort in the period from 1.3.21 to 31.5.21. Disease severity was assigned as per the Indian Council of Medical Research guidelines[3]. Cumulative event rates were calculated using the Kaplan Meier estimator. Cox Proportional Hazard regression model was used to calculate Hazard Ratios (aHR) adjusting for age, gender, health-worker role, previous SARS-CoV-2 infections, active or retired status and comorbidities. Vaccine effectiveness was calculated as (1-aHR)x100.In total, 560 (13.1%) employees out 4276 tested positive for COVID-RTPCR between 1.3.21 to 31.5.21. Of these, 9 (1.6%) were lost to follow-up, 10 (1.8%) were asymptomatic, 458 (81.79%) had mild disease, 57 (10.2%) had moderate disease, and 26 (4.64%) had severe disease. There were six deaths totally in the study population (1.06%).Of those testing positive, 61 were hospitalized, and 499 remained in home quarantine(HQ). Notably, 57.5% of those with moderate to severe disease were in home quarantine (due to non-availability of hospital beds) and would have been missed had it not been through strict disease surveillance and follow up. Since hospitalization rates alone would not have been entirely indicative of disease severity, we did not take it as an outcome measure in our study.Marginal lowering of the incidence of symptomatic infections [12.0% (327/2716) vs 14.2% (133/937) aHR:0.76 (95%CI: 0.62-0.94)] and significant lowering of moderate to severe disease [1.2% (33/2716) vs. 3.4% (32/937); aHR: 0.35 (95% CI: 0.21-0.58)] and supplemental oxygen therapy [0.4% (11/2716) vs. 1.8% (17/937); aHR: 0.25 (95%CI: 0.11-0.58)] was observed in the 2-dose as compared to the unvaccinated cohort. This effect persisted for all events occurring beyond 14 days from dose 2.However, when analyzing for events beyond 21 days from the single dose, the incidence of symptomatic infections [12.3% (75/607) vs.
OBJECTIVES:(a) To establish the cut-off levels for anti-Mullerian hormone (AMH) in a population of Indian women that would determine poor response. (b) To determine which among the three ie.,: age, follicle stimulating hormone (FSH), or AMH, is the better determinant of ovarian reserve.STUDY DESIGN:Prospective observational study.SETTING:In vitro fertilization (IVF) unit of a tertiary hospital.MATERIALS AND METHODS:The inclusion criterion was all women who presented to the center for in-vitro fertilization/Intracytoplasmic sperm injection (IVF/ICSI). The exclusion criteria were age >45 years, major medical illnesses precluding IVF or pregnancy, FSH more than 20 IU/L, and failure to obtain consent. The interventions including baseline pelvic scan, day 2/3 FSH, luteinizing hormone (LH), estradiol estimations, and AMH measurement on any random day of cycle were done. Subjects underwent IVF according to long agonist or antagonist protocol regimen. Oocyte recovery was correlated with studied variables. The primary outcome measure was the number of oocytes aspirated (OCR). Three categories of ovarian response were defined: poor response, OCR ≤ 3; average response, OCR between 4 and 15; hyperresponse, OCR > 15.RESULTS:Of the 198 patients enrolled, poor, average, and hyperresponse were observed in 23%, 63%, and 14% respectively. Correlation coefficient for AMH with ovarian response was r = 0.591. Area under the curve (AUCs) for poor response for AMH, subject's age, and FSH were 0.768, 0.624, and 0.635, respectively. The discriminatory level of AMH for prediction of absolute poor response was 2 pmoL/l, with 98% specificity and 20% sensitivity.CONCLUSIONS:AMH fares better than age and FSH in predicting the overall ovarian response and poor response, though it cannot be the absolute predictor of non-responder status. A level of 2 pmol/l is discriminatory for poor response.
Young women diagnosed with cancer today have a greater chance of long-term survival than ever before. Successful survivorship for this group of patients includes maintaining a high quality of life after a cancer diagnosis and treatment; however, lifesaving treatments such as chemotherapy, radiation, and surgery can impact survivors by impairing reproductive and endocrine health. Expert oncologists along with reproductive medicine specialists discuss fertility preservation options in this chapter since fertility preservation is becoming a priority for young women with breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.
Purpose. To improve success of in vitro fertilization (IVF), assisted reproductive technology (ART) experts addressed four questions. What is optimum oocytes number leading to highest live birth rate (LBR)? Are cohort size and embryo quality correlated? Does gonadotropin type affect oocyte yield? Should “freeze-all” policy be adopted in cycles with progesterone >1.5 ng/mL on day of human chorionic gonadotropin (hCG) administration? Methods. Electronic database search included ten studies on which panel gave opinions for improving current practice in controlled ovarian stimulation for ART. Results. Strong association existed between retrieved oocytes number (RON) and LBRs. RON impacted likelihood of ovarian hyperstimulation syndrome (OHSS). Embryo euploidy decreased with age, not with cohort size. Progesterone > 1.5 ng/dL did not impair cycle outcomes in patients with high cohorts and showed disparate results on day of hCG administration. Conclusions. Ovarian stimulation should be designed to retrieve 10–15 oocytes/treatment. Accurate dosage, gonadotropin type, should be selected as per prediction markers of ovarian response. Gonadotropin-releasing hormone (GnRH) antagonist based protocols are advised to avoid OHSS. Cumulative pregnancy rate was most relevant pregnancy endpoint in ART. Cycles with serum progesterone ≥1.5 ng/dL on day of hCG administration should not adopt “freeze-all” policy. Further research is needed due to lack of data availability on progesterone threshold or index.
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