Thyroid and Its Ripple Effect: Impact on Cardiac Structure, Function, and Outcomes

Thyroid dysfunction is a widespread and complex issue in the field of endocrine disorders. It has a significant impact on multiple physiological systems, particularly on the heart. This review explores the complex interaction between thyroid dysfunction and cardiac dynamics, examining the detailed network of molecular, cellular, and systemic changes that underlie the close connection between these two physiological areas. Thyroid dysfunction, which includes both hyperthyroidism and hypothyroidism, is a common endocrine condition that affects millions of people worldwide. The thyroid hormones thyroxine and triiodothyronine regulate various metabolic activities essential for maintaining cellular balance. Disruptions in thyroid function result in widespread consequences, affecting the cardiovascular system. Thyroid hormones directly impact cardiac muscle cells, controlling their ability to contract, their electrical properties, and their reaction to hypertrophy. Thyroid dysfunction goes beyond the level of individual cells and involves complex interactions among vascular dynamics, neurohormonal control, and endothelial function. These factors all contribute to the development of cardiovascular illness. The impact of thyroid dysfunction on cardiac structure, function, and outcomes is not limited to a one-way pattern. Instead, it involves a dynamic two-way interaction. The manifestations of this condition can vary from minor changes in the electrical activity of the heart to more obvious structural abnormalities, such as an increase in the size of the heart muscle and a decrease in its ability to relax during the filling phase. Furthermore, the correlation between thyroid dysfunction and adverse cardiovascular outcomes, such as heart failure and arrhythmias, highlights the clinical importance of this connection. This review provides a complete overview of the relationship between thyroid dysfunction and cardiac dynamics by analyzing a wide range of research from clinical, molecular, and epidemiological perspectives. This study seeks to enhance our comprehension of the comprehensive effects of thyroid dysfunction on the anatomy and function of the heart by explaining the complex molecular mechanisms and systemic consequences. The goal is to establish a basis for informed clinical treatment and future research efforts.

P-229 Has rampant use of ICSI wiped out Conventional IVF for non male factor infertility, or can Conventional IVF hold its ground

Study question

Can ICSI completely replace and produce higher implantation rates as compared to conventional IVF for non-male factor infertility patients?

Summary answer

ICSI has no advantage over Conventional IVF in improving fertilization and implantation rates in non-male factor infertility. Rampant use of ICSI is not recommended.

What is known already

ICSI is the technique of choice for male factor infertility, no argument there. But in the recent times, the unbridled use of ICSI for non male factor patients worldwide has pushed Conventional IVF out of the picture. The evidence states otherwise, ICSI holds no significant advantage over Conventional IVF in couples with normal semen parameters when it comes to fertilization and implantation rates. The mechanical damage as a result of ICSI to oocytes cannot be ignored. Conventional IVF holds a certain advantage in allowing the oocyte to choose the sperm, mimicking in vivo selection.

Study design, size, duration

Prospective randomized study conducted in 140 patients, undergoing IVF & ICSI with non-male factor infertility. The oocytes recovered for all the patients included in the study underwent split insemination, and were divided into 2 groups:

Group 1: Insemination by Conventional IVF, and

Group 2: Insemination by ICSI.

Fertilization and Implantation rates were recorded.

Participants/materials, setting, methods

140 patients with non-male factor cause of infertility were undergoing IVF/ICSI cycle were included in this study. Post ovum pick-up, the oocytes recovered for each patient were split into 2 separate groups and inseminated using Conventional IVF (413) and ICSI (679). The fertilization check was done at 17±1 hours. The implantation rates were noted 14 days after embryo transfer using the beta HCG values. The results were noted and compared.

Main results and the role of chance

In the Conventional IVF(C-IVF) group, fertilization rates were 69.23% compared to 71.44% in the ICSI group.

The implantation rates were 26.50% in C-IVF group vs 22.10% in ICSI group.

Limitations, reasons for caution

A major limitation is the time constraint which did not allow us to track the live birth rates along with the small sample size, the lack of data showing clinical outcomes of this study can be improved upon in the future and with similar studies.

Wider implications of the findings

While ICSI holds the gold standard as the technique of choice for male factor infertility, it is not superior to C-IVF in patients with normal semen parameters. ICSI for all cannot be justified at this moment. Larger RCTs are required to establish superiority of one technique over the other

Trial registration number

not applicable

P–069 microfluidic sperm sorting vs density gradient to yield sperm with reduced DFI for patients undergoing IVF-ICSI

Study question

To compare the effect of sperm preparation methods on the DFI of semen sample for patients undergoing ICSI.

Summary answer

On comparing the results, microfluidic sperm sorting yielded sperms with significantly less DFI as compared to density gradient method of sperm preparation.

What is known already

The DNA integrity of the sperm plays an important role to ensure formation of good quality embryos with increased potential of fertilization, growth and ultimately implantation.. Centrifugation has shown to add stress to the sperm and leading to DNA damage, therefore there is a need to develop techniques of sperm preparation which help in retrieving as many sperms with intact DNA from the unprocessed sample as possible. Microfludic is fluid dynamic based technique of sperm preparation. in this study, we evaluated if microfluidic sperm sorter can recover motile sperm with better DNA integrity compared to density gradient preparation method.

Study design, size, duration

Prospective randomized study conducted in 80 patients undergoing IVF-ICSI with normal semen parameters (based WHO criteria 2010). DFI was done using Sperm Chromatin Dispersion (SCD) test in split semen samples prepared by microfluidic sperm sorter and density gradient method. Sperm morphology and motility were also recorded and evaluated based on the WHO 2010 criteria.

Participants/materials, setting, methods

Semen parameters of the sample were assessed by microscopic examination. DFI of each unprocessed sample was carried out using SCD test, following that the sample was split and sperm preparation was done using microfluidic sperm sorter and density gradient. the recovered sperm were tested for DFI and the results were compared.

Main results and the role of chance

Mean DFI in unprocessed semen samples was 23%. the analysis of split semen samples post preparation showed that the DFI was significantly reduced with the use of microfluidic sperm sorter (mean DFI 0.6%) as compared to density gradient (mean DFI 9%).

Limitations, reasons for caution

A major limitation of the microfluidic sperm sorter is the use sperm concentration and motility of the semen sample. In oligospermic and asthenospermic samples, density gradient is the preferred method of preparation. Lack of data showing improvement in clinical outcomes with reduced DFI is also a major limitation.

Wider implications of the findings: Microfluidics has shown to significantly reduce the DFI of the semen sample, it requires no extra equipment and cost and is relatively easy to pick up. Density gradient method of sperm preparation continues to be the preferred method due to its versatility and recovery of good quality sperm.

Trial registration number

Not applicable

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.