Investigation of the risk of paternal cell contamination in PGT and the necessity of intracytoplasmic sperm injection

ICSI is widely recommended for patients undergoing preimplantation genetic testing (PGT), but are sperm a potential source of paternal cell contamination in PGT? Semen samples were obtained from five normozoospermic men consenting to research. From each sample 1, 2, 4, 8 and 10 sperm were collected in PCR tubes and whole genome amplification according to PGT-A and PGT-SR processing protocols was undertaken. None of the 25 samples submitted (a total of 125 sperm) showed evidence of DNA amplification. Thus, paternal cell contamination resulting from using conventional in vitro fertilization (IVF) as the insemination method, carries a low risk of an adverse event or misdiagnosis in PGT-A. Due to the higher risk incurred with PGT-SR, clinics may wish to exercise increased caution and continue using ICSI, while PGT-M involves different processing protocols, presenting a different risk profile.

Challenges in Managing Metabolic Complications in a Patient With Familial Partial Lipodystrophy Type 3

Familial partial lipodystrophy (FPL) is a rare group of autosomal dominant genetic disorders which causes variable loss of subcutaneous fat from abdomen, thorax or extremities in addition to the numerous metabolic complications like insulin resistance, diabetes mellitus and dyslipidemia1. FPL type 3 was first characterized by Agarwal et al. in 20021, in which peroxisome proliferator-activated receptor-γ (PPARγ) gene was the molecular basis of this disorder. It is extremely rare and so far only 30 patients or so have been recognized with this mutation2. FPL3 is unique because it generally spares the loss of fat from trunk, face and neck region and also presents with more severe metabolic derangements. We report a case of a young female with PPARγ mutation leading to numerous metabolic complications. A 19 year old female with FPL3 was seen by adult endocrinology as a transition from pediatric endocrinology. She was found to have hypertriglyceridemia on routine labs done at the age of 11. Patient reported loss of subcutaneous fat from her extremities and eruptive xanthoma on flexor surfaces at the time of diagnosis along with a positive family history of hypertriglyceridemia induced pancreatitis and Myocardial infarction at the age of 40 in her father. Her triglyceride level has varied between 600 and 3000 (normal 20–149 mg/dl) over the years. FPL3 was diagnosed based on genetic testing. She was prescribed fenofibrate and fish oil, and statin was added thereafter. She developed type 2 diabetes and was started on metformin and pioglitazone. She was noted to have hypertension and was treated with amlodipine and lisinopril. She also was found to have Polycystic Ovarian Syndrome (PCOS) based on menstrual irregularities, hirsutism and ultrasound showing multiple ovarian cysts, and was treated with spironolactone. Her most recent labs show triglyceride level of 2400 mg/dl and HbA1c of 8.3. PPARγ gene mutation in FPL3 leads to insulin resistance and hence patients often develop hypertriglyceridemia, type 2 diabetes, PCOS and hypertension. In terms of treatment options, we are still limited to pioglitazone, metformin, statins and fish oil. Often these are not sufficient in addressing the complexity of metabolic derangements in these patients who have an increased risk of cardiovascular events at a young age. Further research about agents targeting this gene in particular would be beneficial. 1. Agarwal et al. A novel heterozygous mutation in peroxisome proliferator-activated receptor-gamma gene in a patient with familial partial lipodystrophy. J Clin Endocrinol Metab. 2002 Jan; 87(1):408–411. 2. Garg A. Lipodystrophies: Genetic and Acquired Body Fat Disorders. J Clin Endocrinol Metab. 2011;96(11): 3313–3325.

Personal Digital Assistants: A Review of Their Application in Graduate Medical Education

Personal digital assistants (PDAs) have become widely used in medicine and may be especially useful in achieving the goals of graduate medical education. The complex challenges that residents and their program directors in graduate medical education programs confront may be met more readily with the use of these devices. The PDA's ability to serve as an informational database, an organizer of patient-specific information, a tracking tool that can be used by program directors to enhance curriculum design, and a tool for conducting education research are some of the ways that these devices might favorably affect residency training in graduate medical education programs.

Cultural factors in orthodox Jewish adolescents treated in a day program for eating disorders

This study explores the specific role of culture and religion in the development of eating disorders (ED) in Orthodox Jewish female adolescents. We present eight cases admitted to a Day Treatment Program (DTP) for Eating Disorders. Additionally, some preliminary comparisons are examined between Orthodox and all other patients, and also between ultra and modern Orthodox patients. All eight adolescents were transferred from inpatient care, three met program treatment goals, two left prematurely, and three required re-hospitalization. The only significant differences between the Orthodox group and all other patients were on length of stay in the DTP and current use of psychotropic medications. Overall, results suggest that Orthodox patients and all other patients show similar ED presentation and course. However, there are unique cultural and religious circumstances, which require consultation with rabbinic authorities.