Publications by authors named "Sunkara S"

Radiofrequency ablation (RFA) is an interventional procedure that has been used to treat chronic back pain for over 50 years; this unique case report demonstrates the effectiveness of pulsed radiofrequency ablation (PRFA) on the dorsal root ganglion (DRG) in the treatment of chronic radicular pain (Russo et al., 2021, J Pain Res, 14, 3897). The RFA provides pain relief by using thermal energy to disrupt peripheral nerves carrying nociceptive signals back to the central nervous system (Abd-Elsayed et al.

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Ovarian stimulation (OS) is a crucial component of clinical IVF treatment that strongly influences outcomes. As such, it is useful to understand the indicators for successful OS during IVF. As OS leads to multiple follicular recruitment, it can be quantified as number of oocytes retrieved.

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Background: Intracytoplasmic sperm injection (ICSI), a type of assisted reproductive technology (ART), is offered as a treatment option for male factor infertility. Over the years, the indications for ICSI have been expanded, despite uncertainty about its benefits and harms compared to the conventional method of achieving fertilisation. Artificial oocyte activation (AOA), which can be performed by chemical, electrical or mechanical intervention, has been employed during ART ICSI treatment where there has been a history of low fertilization rate or total fertilization failure, and it has been reported to improve reproductive outcomes.

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Article Synopsis
  • This study aimed to evaluate the effectiveness and safety of various hormone triggers (hCG, GnRH agonist, dual, and double triggers) in women undergoing ovarian stimulation for IVF through a systematic review and network meta-analysis of 12 randomized controlled trials.
  • A total of 1,931 women were analyzed, with the primary outcomes focused on clinical pregnancy rates (CPR), live birth rates (LBR), and the incidence of ovarian hyperstimulation syndrome (OHSS).
  • The results indicated that the dual trigger had the best potential for higher CPR, while the GnRH agonist trigger was associated with significantly lower OHSS rates compared to hCG, but overall, no major differences in o
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: Poor outcomes following IVF treatments are speculated to be due to the transfer of aneuploid embryos that cannot be identified based on morphological evaluation alone. This leads to patients requiring numerous embryo transfers and, consequently, a prolonged time interval before live birth. Embryo selection following preimplantation genetic testing for aneuploidy (PGT-A) with next-generation sequencing (NGS) has been suggested as an intervention to shorten time to pregnancy in women undergoing in vitro fertilisation (IVF).

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Article Synopsis
  • A panel of international experts evaluated and discussed the POSEIDON criteria, aiming to improve management strategies for women with low prognosis in assisted reproductive technology (ART).
  • Through a Delphi consensus process involving multiple rounds of voting, 53 experts reviewed 17 statements and reached consensus on their relevance for patient care and outcomes in ART.
  • Key recommendations include using specific treatments and tools to enhance success rates, while emphasizing the need for more large-scale studies to validate existing findings.
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  • The objective of the study is to evaluate how well ovarian stimulation (OS) promotes follicular development and retrieves quality oocytes by examining antral follicle count (AFC) and its relationship to oocyte outcomes.
  • The study emphasizes the need to enhance the key performance indicators (KPIs) used to assess OS effectiveness, introducing new metrics like "early FORT" and "modified FORT" for better evaluation of follicular growth and oocyte retrieval rates.
  • The researchers advocate for incorporating these refined KPIs into clinical practices to improve the assessment of OS and its impact on ovarian follicular development, ultimately aiming for individualized treatments in assisted reproductive technology.
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  • The 2024 Australian evidence-based guideline offers recommendations for diagnosing and treating unexplained infertility in couples, tailored specifically for the Australian healthcare context and approved by national health authorities.
  • The guideline contains 40 evidence-based recommendations, addressing areas such as defining infertility, diagnosing various factors contributing to infertility, and treatment options, with a focus on improving patient care.
  • Key updates include a refined definition of unexplained infertility and a more comprehensive assessment process, integrating considerations of evidence quality, safety, and practicality for implementing these guidelines in Australia.
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Highly purified human menopausal gonadotropin (HP-hMG [Menopur, Ferring Pharmaceuticals, Saint-Prex, Switzerland]) contains a 1:1 ratio of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This analysis aimed to assess gonadotropin (FSH, LH and hCG) abundance in HP-hMG and clarify the source of hCG by assessing the presence of sulfated glycans, which are diagnostic for pituitary hCG forms due to their distinct glycosylation patterns. Additionally, the purity of each sample, their specific components, and their oxidation levels were assessed.

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  • * This study surveyed 91 OALH from an HIV clinic in South Carolina to explore the link between CSA history and current opioid use, using both paper and online questionnaires.
  • * The findings revealed that OALH who experienced CSA were 21 times more likely to use opioids than those without a CSA history, suggesting that unresolved trauma may contribute to higher opioid use; trauma-informed interventions could be beneficial in addressing this issue.
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Fabry disease (FD) is a multisystemic lysosomal storage disorder caused by the loss of α-galactosidase A (α-Gal) function. The current standard of care, enzyme replacement therapies, while effective in reducing kidney pathology when treated early, do not fully ameliorate cardiac issues, neuropathic manifestations, and risk of cerebrovascular events. Adeno-associated virus (AAV)-based gene therapies (AAV-GT) can provide superior efficacy across multiple tissues owing to continuous, endogenous production of the therapeutic enzyme and lower treatment burden.

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  • The study aimed to evaluate the use of indocyanine green (ICG) for detecting and reducing urinary tract injuries during robotic transvaginal surgery for endometriosis.
  • A retrospective analysis was conducted on 53 patients who underwent RvNOTES hysterectomy with ICG, noting an average age of 37.98 years, an operative time of around 181 minutes, and minimal blood loss.
  • Results showed no complications related to ICG, suggesting it's a safe method for ureter visibility during surgery, though further research is necessary for comprehensive benefits confirmation.
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Acute pancreatitis, marked by sudden inflammation of the pancreas, presents a complex spectrum of causative factors including gallstone obstruction, alcohol abuse, and viral infections. Recent studies have illuminated the emergence of vaccine-induced acute pancreatitis, notably associated with COVID-19 vaccinations, presenting diverse mechanisms ranging from direct viral-mediated injury to autoimmune reactions. Understanding this link is pivotal for public health, yet challenges persist in identifying and managing cases post-vaccination.

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Objectives: Single-incision laparoscopic surgery (SILS) and robotic SILS (rSILS) have been found to be safe, minimally invasive techniques in gynaecology. However, one major perceived drawback of these techniques is the increased risk of incisional hernia, compared to multiport laparoscopy or robotic surgery. This study's aim was to determine the optimal technique to reduce postoperative incisional complications such as hernia.

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The prevalence of women with a raised body mass index (BMI) seeking assisted conception treatment is increasing. Findings of existing studies evaluating the effect of female BMI on intrauterine insemination (IUI) treatment outcomes remain inconsistent. This systematic review and meta-analysis evaluate the effect of female BMI on IUI treatment outcomes.

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Heart failure (HF) is a widespread clinical condition that affects numerous individuals globally and is a leading cause of hospitalization, particularly in the elderly population. Despite efforts to manage HF using various pharmacological and nonpharmacological interventions, mortality and hospitalization rates remain alarmingly high. Preventive vaccination has emerged as a key measure endorsed by cardiology societies for reducing the morbidity and mortality associated with HF.

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Background: In vitro fertilisation (IVF) is a treatment for unexplained subfertility but is invasive, expensive, and associated with risks.

Objectives: To evaluate the effectiveness and safety of IVF versus expectant management, unstimulated intrauterine insemination (IUI), and IUI with ovarian stimulation using gonadotropins, clomiphene citrate (CC), or letrozole in improving pregnancy outcomes.

Search Methods: We searched following databases from inception to November 2021, with no language restriction: Cochrane Gynaecology and Fertility Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL.

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Purpose: To provide agreed-upon guidelines on the management of a hyper-responsive patient undergoing ovarian stimulation (OS) METHODS: A literature search was performed regarding the management of hyper-response to OS for assisted reproductive technology. A scientific committee consisting of 4 experts discussed, amended, and selected the final statements. A priori, it was decided that consensus would be reached when ≥66% of the participants agreed, and ≤3 rounds would be used to obtain this consensus.

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Study Question: What is the recommended management for couples presenting with unexplained infertility (UI), based on the best available evidence in the literature?

Summary Answer: The evidence-based guideline on UI makes 52 recommendations on the definition, diagnosis, and treatment of UI.

What Is Known Already: UI is diagnosed in the absence of any abnormalities of the female and male reproductive systems after 'standard' investigations. However, a consensual standardization of the diagnostic work-up is still lacking.

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Hyperthyroidism is more common in women and the sensitivity of thyroid function changes during pregnancy. Excess levels of thyroid hormones and thioamides have a major impact on maternal and fetal outcomes. Our aim was to perform an extensive literature review and provide relevant details concerning the analytical and clinical aspects of the potential effects of the two main drugs used (methimazole and propylthiouracil) in newborns.

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The objective of this study is to evaluate the surgical outcomes for robotic-assisted vaginal natural orifice transluminal endoscopic surgery (R-VNOTES) hysterectomy versus robotic-assisted single-site port (RSSP) hysterectomy when performed for benign indications. This is a retrospective chart review in an academic tertiary setting. 404 patients underwent hysterectomy for benign indications.

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Number of oocytes and IVF outcomes: Real-world evidence.

Best Pract Res Clin Obstet Gynaecol

July 2023

Randomized controlled trials (RCTs) are gold standard to study the effect of an intervention and establish causation between the treatment and outcomes. However, RCTs have the disadvantage of being expensive, entailing high resource investments and involving only selected patient populations under experimental settings. Real-world evidence (RWE) from real-world data (RWD) involves a heterogenous patient population in real-world settings.

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Study Objective: To demonstrate the surgical techniques for robotic vNOTES hysterectomy with bilateral salpingo-oophorectomy (BSO) in a World Health Organization class 3 obesity patient (body mass index = 70) as well as large fibroid uterus (16 weeks sized).

Design: Stepwise demonstration with narrated video footage.

Setting: An academic tertiary care hospital.

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Metformin is known to lower inflammation, independent of its anti-diabetic action. Thus, topical metformin can be a therapeutic strategy for managing ocular inflammation associated with diabetes. To achieve this and address the issues of ocular retention and controlled release an in situ gel of metformin was developed.

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