TTIMES WORLD: Health News Report

Sunday, October 13, 2019
Washington, DC, USA


Fertility Preservation in Women
Review Article New England Jornal of Medicine Report

Fertility Preservation in Women
J. Donnez and M.-M. Dolmans

CME Exam

Of all the available means of fertility preservation, oocyte cryopreservation by means of vitrification (very rapid freezing) provides the highest yield, not only for women with benign diseases or those seeking fertility preservation for personal reasons but also for women with cancer. Ovarian-tissue cryopreservation is specifically indicated for adolescents and women in whom cancer treatment cannot be postponed.

Clinical Pearls
Clinical Pearl What nononcologic conditions may be associated with premature ovarian insufficiency?
Fertility preservation should be offered to women with certain benign conditions that carry the risk of premature ovarian insufficiency. Many autoimmune and hematologic conditions sometimes require chemotherapy, radiotherapy, or both and sometimes even bone marrow transplantation. Other conditions can also impair future fertility, such as the presence of bilateral ovarian tumors, severe or recurrent ovarian endometriosis, and recurrent ovarian torsion.

Clinical Pearl What is the preferred method for oocyte cryopreservation?
Data from a recent review suggest that the strategy of oocyte vitrification and warming is superior to slow freezing and thawing in terms of clinical outcomes. On the basis of this evidence, laboratories that continue to use slow freezing should consider transitioning to vitrification techniques for purposes of cryopreservation.

Morning Report Questions
Q. How important is the age of the patient when oocyte vitrification is undertaken?
A. Cobo et al. recently reported outcomes for 137 women who had undergone fertility preservation by means of oocyte vitrification for nononcologic reasons and subsequently returned to use their oocytes. A total of 120 women had undergone the procedure to circumvent age-related fertility decline. Among women who were 35 years of age or younger at the time of oocyte vitrification, the cumulative live-birth rate was much lower when only 5 oocytes were used (15.4%) than when 8 or 10 oocytes were used (40.8% and 60.5%, respectively). Among women who were older than 35 years of age at the time of the procedure, the cumulative live-birth rates were 5.1%, 19.9%, and 29.7% with 5, 8, and 10 oocytes, respectively. Hence, with 10 oocytes, the cumulative live-birth rate was twice as high in the group of women who were 35 years of age or younger (60.5%) as in the group of older women (29.7%).

Q. How is ovarian-tissue cryopreservation accomplished?
A. Ovarian tissue is removed in the form of multiple biopsy specimens (or an entire organ) and cut into cortical strips. The tissue is then cryopreserved by slow freezing on site (or transported to a processing site at a temperature of 4°C). After thawing, if there is no risk of transmitting malignant cells, the ovarian tissue can be grafted to the ovarian medulla (if at least one ovary is still present) or reimplanted inside a specially created peritoneal window. After reimplantation of ovarian tissue in the pelvic cavity, ovarian activity is restored in more than 95% of cases. The mean duration of ovarian function after reimplantation is 4 to 5 years, but the function can persist for up to 7 years, depending on the follicular density at the time of ovarian-tissue cryopreservation. The first pregnancy after this procedure was reported in 2004. The number of live births as of June 2017 exceeded 130. Transplanting ovarian tissue to heterotopic sites remains somewhat questionable, however, and only one pregnancy has been reported in a woman who underwent this procedure.

Figure 1. Options for Fertility Preservation.

Evaluation and Management of Lower-Extremity Ulcers

Evaluation and Management of Lower-Extremity Ulcers
A.J. Singer, A. Tassiopoulos, and R.S. Kirsner
CME Exam
General principles of management of lower-extremity ulcers include wound débridement, infection control, application of dressings, off-loading of localized pressure, and treatment of underlying conditions such as diabetes mellitus and peripheral arterial disease. Lifestyle changes (e.g., smoking cessation and dietary modifications) should also be made to help manage underlying diseases.

Clinical Pearls
Clinical Pearl What are some of the typical features of venous and arterial lower-extremity ulcers?
Venous leg ulcers typically occur over the medial aspect of the lower leg between the lower calf and the medial malleolus (the gaiter area) and are associated with edema, pigment deposition (combined hemosiderin and melanin), venous dermatitis, atrophie blanche (porcelain white scars), and lipodermatosclerosis. Venous leg ulcers are shallow and irregularly shaped and contain granulation tissue or yellow fibrin. Arterial ulcers are often dry and appear “punched out,” with well-demarcated edges and a pale, nongranulating necrotic base. Arterial ulcers may also be very deep.

Figure 1. Venous, Arterial, Neuropathic Diabetic, and Pressure Ulcers.

Clinical Pearl Is there evidence to support the routine use of prophylactic systemic antibiotics for lower-extremity ulcers?
A systematic review of 45 randomized, controlled trials involving a total of 4486 patients showed no evidence that supported the routine use of prophylactic systemic antibiotics for lower-extremity ulcers. Although the review did show evidence that supported the topical use of cadexomer iodine, no evidence supported the prolonged or routine use of silver-based or honey-based products.

Morning Report Questions
Q. How should one choose among the wound dressings that are available for lower-extremity ulcers?
A. Wound dressings that promote an appropriate level of moisture (while limiting maceration) and protect the ulcer from further injury and shear stress should be used. A large number of wound dressings are available, including hydrocolloids, alginates, and foams. Many advanced dressings may be left in place for up to a week unless they are malodorous or saturated with exudate. The decision of which dressing to use should be based on the preferences of the patient and practitioner. In general, dry wounds should be treated with moisture-promoting dressings, whereas exudative wounds should be managed with absorptive dressings. Dressings are also available in combination with antiseptic agents (e.g., nanoparticles of silver); these may be helpful in the short term to reduce the concentration of bacteria when infection is present, but they are not recommended for long-term use. Foam dressings, despite their frequent use, are no more effective than other standard dressings.

Q. What are some details of the guidelines for the use of compression therapy in the management of venous leg ulcers?
A. Compression therapy is strongly recommended for venous leg ulcers. The compression dressing is applied from the toes to the knees and should include the heel. Graded pressure is applied, with more pressure applied distally. Each successive wrap should overlap the previous one by 50%. Several large clinical trials and systematic reviews have concluded that compression therapy, as compared with no compression, promotes the healing of venous leg ulcers and reduces the risk of recurrence and is similar to surgical intervention. Multicomponent systems that contain an elastic bandage appear to be more effective than those that have only inelastic components. The recommended compression pressures for the treatment of venous leg ulcers with varicose veins, the postthrombotic syndrome, or lymphedema are between 30 and 40 mm Hg. In the authors’ practices, compression therapy is modified in patients with mild-to-moderate arterial disease (e.g., an ankle–brachial index [ABI] between 0.5 and 0.8) by using inelastic wraps or by reducing the number of layers of compression; the patient is followed closely to ensure that arterial flow is adequate. In severe cases (ABI <0.5), compression should not be used because it may further reduce arterial flow.>



With the 2014 Sochi Winter Olympics well under way, millions of people are yet again drawn to the visual spectacle that is figuring skating. Figure skaters mesmerize us with their effortless elegance and artistic precision as they glide across the ice. Conveying the perfect balance of artistic expression and dynamic aerial maneuvers, figure skating encompasses a skill set that is unlike any other sport. With most figure skaters reaching their peak between the ages of 16 and 20, mastering the art of figure skating requires an unprecedented determination and discipline at a very young age, as well as a large financial and physical support team. In an article by Huffington Post, Scott Hamilton, former US Olympic Gold medalist, says training to be an Olympic figure skater can cost as much as $25,000-$80,000 when you add up choreographers, costumes, ice time, trainers, and coaches. US Olympic skaters such as Gracie Gold and Jason Brown have most likely had skates on from the second they can stand, and spend an average of 5-7 hours devoted to on and off-ice training. With 15+ years of intense training, figure skaters are no stranger to injury, and have their share of “sports-specific problems”. A recent article in Current Sports Medicine Reports, discusses the most common injuries behind these artistic athletes.

As you would imagine, with all of that time in ice skates, the feet and ankles are prime targets for injuries in skaters. The stiff leather boots and rigid blades, can cause conditions such as “Lace Bite”, which is irritation of the muscle tendons that cross the ankle joint underneath the laces, and “Pump Bump”, where the outside of the heel grows outward, caused by repeated friction from an improperly sized skate. Stress fractures of the foot bones are also extremely common, because of the excessive force and constant pounding from jumping and landing. Some skaters actually limit their number of jumps, to minimize this type of injury. However, ankle sprains are without a doubt the most common injury. But, rarely are ankles rolled when inside the skate. Advancements in ankle support have provided skaters with the support they need for larger aerial tricks, but have caused figure skaters to develop weak muscles on the outside of the ankle (Peroneus muscles), and many figure skaters roll their ankle when performing off-ice training.

The knee joint also takes quite a pounding from the constant jumping and impact of landing on the hard ice. Patellofemoral Pain Syndrome and Patellar Tendinitis (AKA “Jumper’s knee”) are common condition seen in many athletes who jump repeatedly, such as basketball players. The explosive contractions and consistent pounding can cause irritation of the kneecap and Quadriceps tendon. Unlike other sports, acute injuries such as ACL and Meniscus injuries are actually rather uncommon in figure skating.

With so much of a skater’s technique and skill rooted in practice and routine, the excessive repetition of the same motions during take off, landing, and spin direction, apply an unbalanced set of forces on the body, creating skeletal and muscular imbalances. Often times this asymmetry manifests itself with pain in the hips and pelvis, due to differences in flexibility and strength in the lower extremities. Figure skaters often experience pain in the SI Joint, where the Sacrum connects with the ileum of the pelvis. It is also common for young figure skaters to experience inflammation of the abdominal muscles where they attached to the hip bones. This condition is called iliac crest apophysitis. It is caused when young skaters, who still have open growth plates at the hips, over exert their oblique muscles, trying to produce more torque to complete more rotations during a jump.

Back injury is also extremely common amongst figure skaters. Their excessive mobility and frequent hyperextension can predispose them to conditions such as Spondylolisthesis or Spondylolysis, where the lumbar vertebrae move forward on top of each other, even causing fracture in some cases. Furthermore, muscle strains, spasms, and injury to the facet joints between each vertebrae are also very common. A skater’s style, nutritional status and muscle tone can potentially contribute to a predisposition for back injury.

I think if you were to ask an Olympic skater to count the number of times they have crashed landed on the ice, they wouldn’t be able to count them on one hand. But they might be able to count it on one wrist. Falling on an outstretch hand is the primary cause of injuries to the upper extremity in figure skaters. Although injuries to the hips, knees and ankles are much more common, every skater has most likely had atleast one wrist injury. Wrist sprains or fractures of the Radius and Scaphoid bones are common with impact in such position, and are much more common in unexpected falls.

With such a rigorous training schedule and high degree of risk, figure skaters are prone to many “sports specific injuries”, and require a multitude of treatments to stay on the ice. Copious amounts of rehabilitation and medical therapy are required to properly treat a skater’s ailments. With advancements in Orthobiologic therapy and approval by the World Anti Doping Agency, figure skaters have turned to Platelet Rich Plasma (PRP) to help speed up recovery time from injury. Canadian Figure Skating star Kaetlyn Osmond was hampered with many chronic injuries, including a chronic hamstring tear, prior to the Olympics. After undergoing a PRP injection to the hamstring, Kaetlyn was able to return to jumping and managed to gain momentum just in time for the Sochi games.

Orthobiologic treatments such as PRP are gaining much exposure for their use in professional athletes, such as Olympic figure skater Kaetlyn Osmond, and have exhibited regenerative potential and tissue healing properties in extensive clinical trials. Pioneers such as the Orthohealing Center are constantly working to progress the field of Orthobiologics. Check out the Orthohealing website for more information about Platelet Rich Plasma and Orthobiologic treatment.

Summer Heat and How To Protect Your Skin
By Dan E. Austin MD

How To Protect Your Skin
From The Scorching Heat of Summer

How To Protect Your Skin From The Scorching Heat Of Summer
Often you might have heard the horrifying tale of women who applied essential oils before hitting the tanning beds and ended up with severe chemical burns. Even after months either the skin was in the process of healing from those burns or has not yet started with the healing. These horrifying skin stories may make you question how really do you keep your skin safe especially in the summer months? The best skin doctor in Washington D.C. and their team are ever ready to help the clients on what’s best to skip this summer to protect your glowing skin.
KEEP YOURSELF AWAY FROM THE TANNING BEDS – It might seem to be a tricky task. Whether you are trying to get a “base tan” to start the summer or want a beautiful glow before going on vacation, it is highly advisable to skip the tanning beds. Tanning beds are more dangerous than you think. From the studies it has been revealed that tanning beds emit 15 times more UV radiation than sun exposure, thereby increasing your chances of getting tanned up to an incredible level of 50%. If you are experiencing the same or have been diagnosed, its high time to get in touch with a renowned dermatologist who can look help you get back your glowing skin.
SIMPLY DONT IGNORE THE SUNSCREEN LOTION – This rule is applicable to everyone and anyone. Even if you have never got a sunburn or you have a darker skin, then too sunscreen does more than only preventing you from becoming a lobster on the hottest of days. It protects you from the harmful ultraviolet rays that damage your skin and cause sun spots, wrinkles, and even skin cancer. Tossing the sunscreen out this summer thus increases the risk of above-mentioned skin problems and also makes your skin age faster. Instead, lather up to ensure that your skin is happy and healthy this summer. Years from now your skin will thank you by continuing to look youthful.
FOLLOW THE RITUAL “SAFE SUN” THIS SUMMER – The team of skin doctors in Washington DC always encourage their clients to practice “safe sun” ritual. With “safe sun” they mean wear hats, sun-protective clothing, apply sunscreen and take wise decisions before exposing yourself to sun. Protection and covering yourself from top to bottom might seem to be a hassle in the initial days, but it is no different than brushing your teeth or wearing a seatbelt. It is protecting your skin and ensuring that it will be healthy in the years to come. If you already have sun damage, there are ways to eliminate sun spots, wrinkles, enlarged pores, and brown spots. There are number of treatments available for sun damage including chemical peels, laser treatments, and micro needling.
The main aim of the dermatologists is to make sure that all of their patients take care of their skin every time and especially during the summers in the best possible way. The best skin doctor in Washington DC ensures that the client protects their skin against sun damage and Melanoma. If you already have sun damage, you can search and schedule an initial consultation from the array of doctors available at Healthcare 800 – one stop search engine to address your health issues. Be ready to receive worth satisfying skin care evaluation and discuss the various treatment options for sun damage.

Dan E. Austin MD
Chief Editor
TTimes World
Health News Magazine
Washington, DC USA

Where To Get The Best Deals on Eye Glasses
Online Stores with The Best Deals

Top 5 Online Stores
To Get Good Deals on Eyeglasses

1. Warby Parker

Warby Parker is probably one of the web’s most well known frame retailers. The company made waves when it launched, embodied the idea of what a good, problem-solving startup should be, and earned the loyalty of its customers by giving them the option to try multiple frames before they put their money down on the ones they’d want to keep. The service offers a wide selection of high-quality frames and styles, free shipping, and for every pair of glasses you buy, they donate a pair to someone who needs them but can’t afford them. Warby Parker’s story is compelling, and while their glasses may not be the cheapest on the block, they are some of the best.
Those of you who nominated Warby Parker highlighted their try-at-home program, where they’ll send up you to five different sets of frames, for free, for you to try out. You can wear them around for five days—get your friends’ opinions, and choose the ones you like the best. When you pick the ones you like, order them online with your prescription, and they’ll be sent right out to you.

2. Eye Buy Direct

If you’re walking the line between style savvy and budget buying, Eye Buy Direct is the retailer for you. They regularly offer steep discounts, buy-one-get-one-free sales, and other special savings on their massive selection of eyewear and frames. The company has interesting and unique frame options for men and women, prescription and nonprescription sunglasses, sport sunglasses, and even computer glasses designed to reduce glare. They also sell bifocal, progressive, and even Transitions lenses, so they can accommodate you regardless of your prescription or needs. These folks live on the notion that you don’t have to pay a ton of money for a pair (or several pairs) of great glasses.

3. Zenni Optical
Zenni Optical’s claim to fame are super-cheap frames and glasses. They have a solid frame selection of men’s and women’s glasses, and great styles too, but almost everyone who has anything to say about Zenni points to the fact that they offer great glasses super-cheap. So cheap, in fact, that you don’t have to worry too much if they’re lost, damaged, or destroyed. At the same time, that great price point comes with a caveat—you’re not exactly going to get heavy, sturdy frames here; you’re getting frames that can probably take a beating and keep going, but you’re getting drug-store-style plastic in those frames (of course, that’s not all they have, but those are their most affordable designs.) Even so, if budget is the most important thing for you, or you’re notoriously hard on glasses, you could do much worse than Zenni. Their online tools let you snap a photo of your face and see how their glasses will look on you before you buy, which is a nice bonus. Plus, they have a great selection of sunglasses.

4. Coastal/ClearlyContacts
Coastal, and their Canadian counterpart, ClearlyContacts, both turned up separately in the nominations round, but because they’re the same company, we opted to combine them. Coastal offers a massive selection of in-stock designer frames, and regularly runs promotions where your first pair of glasses or contacts from the company are completely free, or at least significantly discounted. Their prices are affordable—they’re not the cheapest in the roundup, but they’re also not the most expensive, and their prices are somewhat similar to what you’ll find at many brick and mortar glasses stores, without the hassle that comes with shopping at one. Coastal will also take care of your contacts needs if you prefer those, sell you sunglasses, and more, all with free shipping.

5. Goggles 4 U
Googles 4 U offers a wide variety of frames at pretty low prices, which is always good to see. They offer hundreds of styles and designer names to choose from, so how much you wind up spending will likely depend on the types of frames you select. If you go designer, expect to pay designer prices, but if you don’t need a name, you can get away with spending very little for a great pair of glasses here. The company offers prescription and designer styles for men and women and sunglasses, and you can spend hours just browsing the available frames. The site itself is a bit no-nonsense, which is just fine if you just want to buy some frames and be done with the process.

For more information Email:

Copyright © 2017 TTimes. All rights reserved. Reproduction in whole or in part without permission is prohibited