Usefulness of random-start progestin-primed ovarian stimulation for fertility preservation

Background Progestin-primed ovarian stimulation (PPOS) has been used in infertility cases in recent years, and several reports have stated that it has oocyte collection results similar to those of gonadotropin-releasing hormone antagonist (GnRH-ant) protocol. For emergency fertility preservation, random-start ovarian stimulation is usually recommended. Therefore we compared the clinical outcomes of random-start PPOS with those of conventional random-start GnRH-ant protocols in fertility-preserving cases. Methods We retrospectively examined 86 cycles of oocyte collection, of which 56 were random-start GnRH-ant and 30 were random-start PPOS for fertility preservation at our hospital between January 2016 and April 2021. The primary outcome was the number of mature oocytes per cycle. The secondary outcome was the number of vitrified blastocysts per cycle for embryo freezing cases. Results No significant differences were noted in the number of days of stimulation, total dose of gonadotropin preparation, and the number of mature oocytes and vitrified blastocysts. The number of hospital visits for monitoring was significantly lower in the PPOS group. The start of menstruation before oocyte collection was significantly less in the PPOS group. Conclusions Random-start PPOS and GnRH-ant were similar in oocyte collection results. PPOS can reduce the number of hospital visits, thus reducing patient stress. PPOS at the start of the luteal phase can prevent the start of menstruation during ovarian stimulation.

Health Inequity by Design: Waiting Rooms and Patient Stress

Little attention has been paid to health inequities designed into the physical spaces themselves. Clearly design is an important part of patient care. Design is simultaneously a complex system itself while existing as part of a larger complex (healthcare) system. For example, it is not enough to say that a patient experiences more stress because she/he is being treated in a hospital in a lower income area. The key, here, is that evidence demonstrates design as an important component, systemically, in healthcare. We know this to be true and base re-design efforts on this fact, but only in certain places. The central addition of this study is to point out that hospitals in higher income areas utilize the waiting room’s ecology and its influence on patient stress and care. Efforts to intervene, through design, in waiting room ecology have consequences to equitable access to healthcare. Therefore, this study examines the implications of health inequities designed-into physical space. Additionally, this study seeks to forefront the influence communication ecologies have in addressing health inequities. Innovations in addressing mental health needs in humanitarian settings: A complexity informed Action Research Case Study. Frontiers in Communication: Health Communication. 10.3389/fcomm.2020.601792 para 19, 2020). Thus, the purpose of this paper is to investigate, but also articulate, the ways design decisions impact people unequally and perpetuate health inequalities. To do so, this study investigates the communication ecologies of waiting rooms and their influence on patient stress and health equity and elucidates under-examined systemic components patient stress and well-being.

The rural tax: comprehensive out-of-pocket costs associated with patient travel in British Columbia

Background A significant concern for rural patients is the cost of travel outside of their community for specialist and diagnostic care. Often, these costs are transferred to patients and their families, who also experience stress associated with traveling for care. We sought to examine the rural patient experience by (1) estimating and categorizing the various out of pocket costs associated with traveling for healthcare and (2) describing and measuring patient stress and other experiences associated with traveling to seek care, specifically in relation to household income. Methods We have designed and administered an online, retrospective, cross-sectional survey seeking to estimate the out-of-pocket (OOP) costs and personal experiences of rural patients associated with traveling to access health care in British Columbia. Respondents were surveyed across five categories: Distance Traveled and Transportation Costs, Accommodation Costs, Co-Traveler Costs, Lost Wages, and Patient Stress. Bivariate relationships between respondent household income and other numerical findings were investigated using one-way ANOVA. Results On average, costs for respondents were $856 and $674 for transport and accommodation, respectively. Strong relationships were found to exist between the distance traveled and total transport costs, as well as between a patient’s stress and their household income. Patient perspectives obtained from this survey expressed several related issues, including the physical and psychosocial impacts of travel as well as delayed or diminished care seeking. Conclusions These key findings highlight the existing inequities between rural and urban patient access to health care and how these inequities are exacerbated by a patient’s overall travel-distance and financial status. This study can directly inform policy related efforts towards mitigating the rural-urban gap in access to health care.

Unusual cause of urinary retention in a child: inflammatory pseudotumor of the urinary bladder

Background Urinary bladder masses are uncommon in the pediatric age group and pose a diagnostic challenge, often necessitating histopathological differentiation and confirmation. An unusual mimic of neoplastic bladder mass is inflammatory pseudotumor, and timely identification and diagnosis of which prevents undue patient stress and radical treatment. Case presentation We present a case of a 7-year-old female child who presented with hematuria, and a urinary bladder mass was detected on ultrasound which was further characterized by magnetic resonance imaging (MRI) and diagnosed as an inflammatory pseudotumor (IPT) on histopathology. Conclusions This case report describes the imaging features of IPT along with a list of differential diagnoses emphasizing the need for radiologists to be aware of this surprising and rare entity.

P–670 Urine estrone–3-glucuronide (E3G) assay: is there any place during ovarian stimulation for IVF cycles?

Study question Could the urine estrone–3-glucuronide (E3G) assay be used efficiently to monitor a controlled ovarian hyperstimulation (COH) cycle, in comparison to a serum estradiol (E2) assay? Summary answer E3G testing provides an alternative to serum E2 assessment and a new “patient friendly” approach for COH monitoring. What is known already In many IVF clinics basic monitoring tools for controlled ovarian stimulation during IVF procedure are ultrasound measurements of follicle growth and hormone assessment of serum E2 levels. The monitoring can occur 4–6 times during stimulation, but repeated blood sampling causes patient stress. In contrast, E3G sampling, one of principal metabolites of estradiol in urine, is non-invasive and can be performed by the patients themselves and measured by fluorescent immunoassay. A correlation has been shown between concentrations of E2 present in plasma and concentrations of E3G in different phases of menstruation cycle. Study design, size, duration This is a pilot, prospective study, in a single IVF clinic. Twenty female participants were recruited November 2020 -January 2021, aged 25–43 years and BMI: 18–28kg/m2. Dynamic change of serum E2 and urine E3G at ovarian stimulation monitoring are being analyzed. Participants/materials, setting, methods Concurrent urine E3G and serum E2 values were collected from patients who provided between 2 and 4 samples on different days of their COH IVF cycle. Serum E2 values were assessed routinely, while E3G values were measured and validated using a fluorescent immunoassay Mira Fertility Plus® analyzer.Main results and the role of chance: The urine E3G of assay was validated for intra- and inter-assay variability with a coefficient of variation of < 20%. It was also validated for analytical and functional sensitivity and sample stability. Linear regression of serum E2 and E3G values of 56 early morning urine samples who had evaluated between Days 4 and 13 of menstruation cycle provided an R = 0,81. Urine E3G values also correlated to follicle growth. Patient survey results showed that urine sampling was the preferred method of analysis. Limitations, reasons for caution We have provided proof of principle that urine E3G measurement can be accurately carried out using fluorescent immunoassay technology during routine COH for IVF cycles. The patients’ study group has to be expanded in order to enable us to find the appropriate place of urine E3G assay in COH protocol. Wider implications of the findings: Urine E3G testing correlates well to serum E2 assessment in COH. Urine E3G assay provides an alternative to serum-based assessment. The ease of urine sampling allows a reduction in patient discomfort during venopuncture, costs, time, and infection risks in epidemics/pandemics, like COViD–19, and offers a patient-friendly approach to ovarian stimulation. Trial registration number NA

MANAGEMENT OF ORAL LICHEN PLANUS TRIGGERED BY STRESS

Introduction: Oral lichen planus (OLP) is a mucocutaneous disorder that rarely occurs around us and only involves the layer of the stratified squamous epithelium. Oral lichen planus is more common in women aged 30-65 years. The etiology of this disorder is not yet known, but there are several predisposing factors that play a role, such as hepatitis C virus infection, food, drugs, malignancy, and psychological factors. Purpose: This case report aims to describe the treatment of stress-induced OLP. Case Report: A 46-year-old man presented with complaints of stinging on the inner right and left cheeks for one month ago. The patient admits that he has a lot of thoughts related to family problems. It is found that the lesion resembles a white streak with redness that forms in the intraoral area. Case management: The patient was given therapy in the form of topical corticosteroids and consulted to psychiatry and got improvement after 1 week of treatment. Discussion: The treatment of OLP lesions is a treatment that requires collaboration between the dentist, the patient and the patient's family. Corticosteroid therapy is the gold standard treatment given to people with OLP. Corticosteroids are widely used in medicine because of their strong effect and fast anti-inflammatory reaction. Corticosteroids are widely used for the management of inflammatory diseases. Besides supporting therapy in consultation with a psychologist or psychiatrist to deal with stress disorders. Conclusion: Treatment of OLP lesions is a complex treatment. Corticosteroid therapy, both topical and systemic, is the most appropriate therapy and the role of a psychologist or psychiatrist is needed in managing patient stress to increase the percentage of patient recovery.

Investigation into the Hybrid Production of a Superelastic Shape Memory Alloy with Additively Manufactured Structures for Medical Implants

The demographic change in and the higher incidence of degenerative bone disease have resulted in an increase in the number of patients with osteoporotic bone tissue causing. amongst other issues, implant loosening. Revision surgery to treat and correct the loosenings should be avoided, because of the additional patient stress and high treatment costs. Shape memory alloys (SMA) can help to increase the anchorage stability of implants due to their superelastic behavior. The present study investigates the potential of hybridizing NiTi SMA sheets with additively manufactured Ti6Al4V anchoring structures using laser powder bed fusion (LPBF) technology to functionalize a pedicle screw. Different scanning strategies are evaluated, aiming for minimized warpage of the NiTi SMA sheet. For biomechanical tests, functional samples were manufactured. A good connection between the additively manufactured Ti6Al4V anchoring structures and NiTi SMA substrate could be observed though crack formation occurring at the transition area between the two materials. These cracks do not propagate during biomechanical testing, nor do they lead to flaking structures. In summary, the hybrid manufacturing of a NiTi SMA substrate with additively manufactured Ti6Al4V structures is suitable for medical implants.

Rare case of extra-peritoneal brown fat (hibernoma) mimicking dumbbell-shaped liposarcoma

Hibernomas are a very rare and benign soft tissue tumour that originate from brown adipose tissue. While they are not histologically malignant, they may be indistinguishable from aggressive tumours such as liposarcomas on imaging. It is, therefore, important to consider it as a differential diagnosis when a suspicious fatty lesion is seen on imaging. This may prevent unnecessary invasive surgery and patient stress. This paper illustrates the clinical presentation, radiological features, and histological diagnosis of a patient with a rare dumbbell-shaped hibernoma in the pelvis.

Healthcare Delivery and Huntington’s Disease During the Time of COVID-19

Background: Safer-at-home orders during the COVID-19 pandemic altered the structure of clinical care for Huntington’s disease (HD) patients. This shift provided an opportunity to identify limitations in the current healthcare infrastructure and how these may impact the health and well-being of persons with HD. Objective: The study objectives were to assess the feasibility of remote healthcare delivery in HD patients, to identify socioeconomic factors which may explain differences in feasibility and to evaluate the impact of safer-at-home orders on HD patient stress levels. Methods: This observational study of a clinical HD population during the ‘safer-at-home’ orders asked patients or caregivers about their current access to healthcare resources and patient stress levels. A chart review allowed for an assessment of socioeconomic status and characterization of HD severity. Results: Two-hundred and twelve HD patients were contacted with 156 completing the survey. During safer-at-home orders, the majority of HD patients were able to obtain medications and see a physician; however, 25% of patients would not commit to regular telehealth visits, and less than 50% utilized an online healthcare platform. We found that 37% of participants were divorced/single, 39% had less than a high school diploma, and nearly 20% were uninsured or on low-income health insurance. Patient stress levels correlated with disease burden. Conclusion: A significant portion of HD participants were not willing to participate in telehealth services. Potential explanations for these limitations may include socioeconomic barriers and caregiving structure. These observations illustrate areas for clinical care improvement to address healthcare disparities in the HD community.