pregnancy

VACTERL (V: Vertebral anomalies, A: Anal malformation, C: Cardiac defect, TE: Tracheoesophageal malformation, R: Renal anomalies, L: Limb anomalies) is a cluster of congenital malformations. It is a rare association with sporadic and non-random occurrence where multiple organs are affected due to developmental defect during blastogenesis (2-4 weeks of gestation), where abnormal structures are derived from the embryonic mesoderm. Multiple environmental and genetic factors have been implicated. We report the successful management of a patient  with VACTERL association born to a mother through an emergency cesarean section due to fetal distress.

Stress in acute stroke may increase mortality and complications, but there is a paucity of information on the efficacy of beta blockers  over other anti-hypertensive. To report efficacy of metoprolol over amlodipine in reducing mortality, disability and infections in acute stroke. CT/MRI confirmed stroke patients within 3 days of onset were included whose age was 18 to 75 years. Patients with secondary intracerebral hemorrhage, organ failure, pregnancy, malignancy, and immunosuppressant or on beta-blocker/amlodipine were excluded. Stroke risk factors, Glasgow Coma Scale (GCS) score, National Institute of Health Stroke Scale (NIHSS) score and CT/MRI findings were noted. Patients with a blood pressure of > 160/90 mm of Hg were randomized using 1:1 randomization to metoprolol (25 mg on day 1, 50 mg if BP is not controlled) or amlodipine (2.5 mg on day 1, then 5 mg then 10 mg on, subsequent days if BP is not controlled). Other standard treatment was continued. The primary outcome was mortality at 1 month; secondary outcomes included  were in-hospital gastrointestinal hemorrhage, pneumonia, sepsis and 3 months functional outcome based on modified Rankin Scale (mRS). Side effects were noted. 18 (14.4%) patients died; 6 (9.7%) in metoprolol and 12 (19%) in amlodipine (p = 0.20) group. At 3-months, 66 patients had good outcome; 45 (80.4%) in metoprolol and 21 (43.3%) in amlodipine group (p < 0.001). The other secondary outcomes were comparable between the two groups. Metoprolol was withdrawn in 6 patients due to bradycardia, and amlodipine in 5 due to hypotension and in 1 due to allergic reaction. Metoprolol is associated with improved functional outcomes in acute stroke  compared to amlodipine.

Background: Endometrial Thickness (EMT) is considered an important prognostic factor in assisted reproductive technology (ART), particularly in frozen embryo transfer (FET) cycles. Thin endometrium (< 7 mm) is often associated with implantation failure and reduced pregnancy rates, although its precise impact remains controversial.Objective: This thesis summary evaluates the role of thin endometrium in FET cycles, discusses etiologies, diagnostic modalities, treatment approaches, and reviews available patient data.Methods: We retrospectively analyzed 69 patients who underwent FET at Saveetha Medical College. Endometrial thickness was assessed via transvaginal ultrasound. Various treatment strategies including hormonal therapies (estradiol, progesterone), vasoactive agents, granulocyte colony-stimulating factor (G-CSF), platelet-rich plasma (PRP), L-arginine, sildenafil citrate, vitamin E, pentoxifylline, and stem cell therapy were reviewed for their efficacy in improving endometrial receptivity.Results: Endometrial thickness < 7 mm correlated with lower pregnancy rates compared to patients with thickness ≥ 7 mm. Hormonal and adjuvant therapies reported varying degrees of success in improving EMT and subsequent pregnancy outcomes. Vascularity, angiogenesis, and Doppler studies also demonstrated a significant association with endometrial receptivity.Conclusion: Thin endometrium remains a critical challenge in ART cycles. Multimodal therapeutic approaches may improve outcomes; however, larger prospective studies are required to establish standardized protocols. Our patient data support that even minimal increases in EMT can enhance implantation success.