P-273 Oocyte competence is affected by Body Mass Index in women undergoing in vitro fertilization procedures

Study question

Is body mass index (BMI) an important factor that affects oocyte competence in patients subjected to in vitro fertilization procedures?

Summary answer

High BMI affects oocyte competence, causing abnormal blastocyst development, and reduced clinical outcomes. Overweight and obesity women needed more oocytes to obtain a gestational sac.

What is known already

Overweight and obesity are systemic and tissue-specific conditions that lead to chronic inflammation and oxidative stress to produce an unregulated and persistent secretion of chemokines and cytokines, which are released into circulation inducing inflammatory responses in several tissues, including the ovaries. Cytokines, chemokines and adipokines play essential roles in steroidogenesis, follicular growth, cumulus expansion, and ovulation; however, alterations in their patterns of synthesis and secretion impair meiotic and cytoplasmic maturation of the oocyte, reducing its developmental competence for fertilization and pre-implantation development. Overweight or obese women had significantly lower clinical pregnancy and live birth rates and significantly higher miscarriage rates.

Study design, size, duration

The following work is a retrospective nonrandomized study that included a total of 1839 oocytes obtained from 201 IVF/ICSI non-donor cycles performed between January 2018 and December 2019.

Participants/materials, setting, methods

The oocytes were allocated according to BMI of patients in three groups: Normal group: 18.5-24.9 ( n =  608 oocytes), overweight group: 25.0-29.9 ( n =  832 oocytes) and obese group: ≥30.0 ( n =  399 oocytes). Extended embryo culture until blastocyst stage was done in all patients. Fertilization, development of blastocyst, transferred embryos, pregnancy and implantation rates were compared between groups. Number of oocytes needed to obtain a gestational sac (oocyte competence) were analyzed and compared by group.

Main results and the role of chance

Fertilization rates (87.7%, 85.3%, and 84.0%), and transferred embryos (1.84, 1.84, and 1.86) were similar between three evaluated groups. Blastocyst development rate (48.2%, 40.0%, and 40.1%), pregnancy rate (67.2%, 41.9%, and 39.5%), and implantation rate (53.7%, 31.8%, and 28.2%) were significantly reduced in women with overweight and obesity compared to women with normal weight ( P <  0.05). To obtain a gestational sac, 2.1 and 1.8 more oocytes were needed by obese and overweight women, respectively, than the control group, suggesting oocyte competence is negatively affected by higher BMI.

Limitations, reasons for caution

The retrospective nature of this study and the small sample size may be reasons for caution.

Wider implications of the findings

The findings in this study suggest that a weight above normal will progressively decrease oocyte competence thus, it is necessary to have a greater number of oocytes in patients with overweigh and obesity to have a gestational sac when compared with patients of normal weight.

Trial registration number

non applicable

Extensively Drug-Resistant Carbapenemase-Producing Pseudomonas aeruginosa and Medical Tourism from the United States to Mexico, 2018-2019

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) producing the Verona integron‒encoded metallo-β-lactamase (VIM) are highly antimicrobial drug-resistant pathogens that are uncommon in the United States. We investigated the source of VIM-CRPA among US medical tourists who underwent bariatric surgery in Tijuana, Mexico. Cases were defined as isolation of VIM-CRPA or CRPA from a patient who had an elective invasive medical procedure in Mexico during January 2018‒December 2019 and within 45 days before specimen collection. Whole-genome sequencing of isolates was performed. Thirty-eight case-patients were identified in 18 states; 31 were operated on by surgeon 1, most frequently at facility A (27/31 patients). Whole-genome sequencing identified isolates linked to surgeon 1 were closely related and distinct from isolates linked to other surgeons in Tijuana. Facility A closed in March 2019. US patients and providers should acknowledge the risk for colonization or infection after medical tourism with highly drug-resistant pathogens uncommon in the United States.

Frailty and Risk of Falls in Community-Dwelling Older Adults Living in a Rural Setting. The Atahualpa Project

BACKGROUND

Data supporting a link between frailty and risk of falls is mostly confined to individuals living in urban centers, where risk factors and lifestyles are different from that of rural settings.

OBJECTIVE

To assess the association between frailty and risk of falls in older adults living in rural Ecuador.

DESIGN

Population-based cross-sectional study.

PARTICIPANTS

Community-dwellers aged ≥60 years living in a rural Ecuadorian village, in whom frail status and risk of falls were assessed.

MEASUREMENTS

Frailty was evaluated by the Edmonton Frailty Scale (EFS) and risk of falls by the Downton Fall Risk Index (DFRI). Multivariate models were fitted to evaluate whether frailty was associated with risk of falls (dependent variable), after adjusting for demographics, alcohol intake, cardiovascular risk factors, sleep quality, symptoms of depression, and history of an overt stroke. Correlation coefficients were constructed to assess confounders modifying this association.

RESULTS

A total of 324 participants (mean age: 70.5±8 years) were included. The mean EFS score was 4.4±2.5 points, with 180 (56%) participants classified as robust, 76 (23%) as pre-frail and 68 (21%) as frail. The DFRI was positive in 87 (27%) participants. In univariate analysis, the EFS score was higher among participants with a positive DFRI (p<0.001). The number of frail individuals was higher (p<0.001), while that of robust individuals was lower (p<0.001) among those with a positive DFRI. Adjusted logistic regression models showed no association between frailty and the DFRI. Correlation coefficients showed that age, high glucose levels, and history of an overt stroke tempered the association between frailty and the risk of falls found in univariate analyses.

CONCLUSIONS

Frailty is not independently associated with risk of falls in older adults living in a remote rural setting. Further studies are needed to assess the impact of frailty on the risk of falls in these populations.

Green liquor dregs effect on Kraft mill secondary sludge composting

Increased Kraft pulp mill production generates increased solid wastes. In response, composting has emerged as an interesting alternative for disposal of these solid wastes. A central composite factor design was used to investigate the influence of incubation conditions (dregs addition and operation time) on chemical and biological parameters, determining the best in-vessel conditions in order to develop a correct composting design. Dregs helped reduce the pH drop that occurs at the beginning of the process. Biological activities presented high values during the active phase, followed by a decrease with stable final values along with N-NH(4)(+) and N-NO(3)(-) trend, which were indicative of mature compost. Dregs addition had not significant effect on the biological activities during composting of Kraft mill sludge. However, moderate amounts of dregs (between 5% and 8%) at operation time of 60-70 days would be the best compromise.

Using a second-order polynomial model to determine the optimum dregs/bark ratio for industrial-biosolid composting: the initial conditioning stage

Increasing pulp industry production has generated additional solid waste (i.e. biological sludge, dregs, etc.) and therefore an increasing disposal problem. On the other hand, composting is emerging as an interesting alternative for the disposal of residues. The objective of this study was to evaluate the physical and chemical properties of sludge, dregs and bark and the effect on their initial conditioning stage prior to composting, using pine chips as bulking agent. After their characterization, these solid wastes were combined in different mixture proportions defined by a 32 experimental design based on the response surface methodology (RSM), in which 18 observations were required for the independent variables (dregs and bark) and the C: N ratio, moisture content and pH were the dependent variables. The characterization indicated that the dregs have alkaline properties with the presence of some essential plant nutrients, such as phosphorous (0.37%), potassium (0.76%), magnesium (1.4%) and calcium (27%). The combination of the macronutrients (phosphorous: 0.39%, potassium: 0.24%, calcium: 1.7%, magnesium: 0.44%) and micronutrients such as ferrous material (0.47%) and zinc (0.12%) found in the sludge suggest a promising alternative despite the potential problem due to the high pH of the dregs. The RSM design indicated a feasible region that satisfied the optimal dregs: bark ratio of 0.25 without exceeding the addition of 12.5% dregs, due to the alkaline properties of these inorganic wastes and the quadratic influence over the C:N ratio. The experimental results indicated that the composting process of dregs, bark and sludge is technically suitable, although the use of a rapidly available C source needs to be evaluated.

Paradigms of polyamory

SUMMARY The paradigm theory of Thomas Kuhn is used as a framework to discuss alternative ways of intimacy. The author discusses the implications of structuring actual lesbian relationships by a paradigm of monogamy among Latin-American women. The author proposes that creating alternative paradigms of multiple relationships would be useful for many lesbians as models for alternative life patterns.

Neuroradiology and clinical aspects of Usher syndrome

We describe the neurological evaluation and MRI analysis of 30 patients, belonging to 16 families with Usher syndrome (US) type I and type II (US1 and US2). In addition to the classic visual and audiological abnormalities seen in these patients, we observed abnormal gait in 88.9% of US1 and in 66.7% of US2 patients and abnormal coordination in 33.4% of US1, and in 58.3% of US2. Borderline mental retardation, depression or bipolar affective disorder were observed in 16.7% of US1 and 33.3% of US2 patients. MRI analysis showed cerebellar abnormalities in 50% of US1 and 75% of US2 patients, but no clear correlation was observed between structural abnormalities and clinical findings. A pattern for the MRI classification of US patients is suggested.