Vinita Singh

BackgroundMillions of people of reproductive age worldwide struggle with infertility. Treatments such as controlled ovarian hyperstimulation and intrauterine insemination (IUI) are commonly used to address various causes of infertility. Medications such as clomiphene citrate (CC) and letrozole, when combined with human menopausal gonadotropin (HMG), have been shown to improve pregnancy rates and reduce treatment costs.ObjectiveThis study aimed to compare the effect of minimal stimulation using HMG with either CC or letrozole for ovulation induction in women with CC-resistant anovulatory infertility. It also assessed the impact of these combinations on follicular development and endometrial thickness.Materials and methodsThis retrospective cohort study included data from 84 infertile women diagnosed with polycystic ovary syndrome (PCOS). Participant records were retrieved from the hospital database at AIIMS, Raipur, India, covering the period from April 2021 to August 2022. Women were divided into two groups based on their treatment: one group received CC 100 mg and the other letrozole 5 mg, both in combination with HMG administered on alternate days. Forty-two women received letrozole + HMG and 40 received CC + HMG. Two participants in the CC group were excluded due to the development of four dominant follicles. Transvaginal ultrasound was performed on alternate days until follicles exceeded 17 mm. IUI was carried out 36 hours after HCG administration. Fourteen days later, a urinary pregnancy test was done if the participant had not yet menstruated. The clinical pregnancy rates were compared between the two groups.ResultsThere was no significant difference between the two groups in terms of mean follicular diameter, number of dominant follicles, endometrial thickness, HMG dosage required, or the number of days to achieve dominant follicle formation. The IUI outcomes were also comparable in both groups.ConclusionThe study concludes that both letrozole and CC, when combined with HMGs, are equally effective in inducing ovulation and achieving successful IUI outcomes in women with CC-resistant anovulatory infertility.

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IntroductionPlacement of lumbar epidural catheters is the gold standard practice for providing labor analgesia in parturients. The optimal insertion of the epidural catheter is determined by several patient-related factors, including body mass index (BMI), gestational age, race, ethnic background, and the anatomy of the spine. To date, several studies have been conducted to evaluate the lumbar epidural space depth in varied populations across the globe. However, limited data are available regarding the BMI and its correlation with the skin-to-lumbar epidural distance (SLED) in Indian parturients. Hence, this observational study was undertaken to investigate the correlation between the BMI and the SLED under ultrasound guidance in parturients with 37 to 42 weeks of gestational age visiting the labor room of a tertiary care institute in central India.MethodsThis observational study was conducted from January 2023 to December 2023 at the All India Institute of Medical Sciences (AIIMS), Raipur. Informed and written consent was acquired from all the participants before enrolling them in the study. Parturients with 37 to 42 weeks of gestational age, aged 20-40 years, belonging to the American Society of Anesthesiologists physical status 2, were included. Patients who refused to give consent, with a diagnosed mental disorder, intellectual disabilities, pre-eclamptic/eclamptic patients, or those with spine deformity were excluded. Baseline patient parameters, including age, height, weight, and gestational age, were recorded, and BMI was calculated. Patients were categorized into different BMI classes, as classified by the World Health Organization. Ultrasound imaging of the L3-L4 interspace was done. An in-built caliper of the ultrasound machine was used to measure the SLED. The mean SLED in each BMI category was noted. The primary outcome of the study was to determine the correlation between BMI and SLED. A P-value of less than 0.05 was regarded as statistically significant.ResultsTwo hundred patients were included in the final analysis. The BMI (kilogram/meter²) of the patients ranged from 19.67 to 40.00, with the mean ± standard deviation (SD) of 28.40 ± 4.35 and the median interquartile range (IQR) of 27.60 (25.20-31.24). The SLED of the participants in centimeters (cm) ranged from 3.12 to 5.17, with the mean ± SD of 4.01 ± 0.42 and median (IQR) of 4.03 (3.82-4.18). The SLED in five groups of BMI was not normally distributed; therefore, the Kruskal-Wallis test was used to make group comparisons, and a significant difference was noted (χ2 = 159.650, P < 0.001). The data regarding BMI and SLED among the patients were normally distributed. Pearson's correlation was used to explore the correlation between the two variables, and a strong positive correlation was noted with a correlation coefficient (r) = 0.94 and P < 0.001.ConclusionThe ultrasound may be incorporated as a useful tool in routine clinical practice in the care of parturients to determine the SLED before the actual insertion of the epidural needle. This approach may reduce the number of attempts at lumbar epidural catheter placement. It may be particularly helpful in obese parturients, in whom it is difficult to identify the anatomical landmarks of the spine by palpation.

Background Outcome selection in regional anesthesia and acute pain research is inconsistent, often lacking patient-centered priorities and validated instruments. We aimed to prioritize key outcomes and propose suitable measurement tools to improve the quality, consistency, and relevance of regional anesthesia research.Methods We conducted a multiround Delphi process, including two electronic voting rounds, a multiday in-person meeting, and a patient panel. Experts and patients evaluated existing and proposed outcomes for importance, validity, and relevance. Outcomes reaching ≥70% agreement were prioritized, and appropriate measurement instruments were identified.Results Thirty-two experts and three patients participated. Across three Delphi rounds, 10 outcomes were prioritized for future regional anesthesia research: seven efficacy outcomes (pain scores; opioid consumption; Brief Pain Inventory; functional outcomes; cognitive function; length of stay; block duration); two multidimensional outcomes (quality of recovery and development of a regional anesthesia-specific quality-of-recovery instrument); one safety outcome (chronic postsurgical pain). Patients prioritized cognitive recovery, function, chronic pain, and pain scores.Conclusions This consensus-based, patient-centered framework defines the core priorities for future regional anesthesia and acute pain research. Future work should focus on developing and validating a regional anesthesia-specific quality-of-recovery instrument, refining multidimensional measures such as functional recovery, cognitive outcomes, and the Brief Pain Inventory, and standardizing the reporting of chronic pain and opioid-related outcomes. Adoption of these priorities will enhance methodological consistency, comparability, and patient relevance in future clinical trials.Data are available upon reasonable request.