Aug 12, 2016

Deep freeze

The story

When you think 'fresh', you probably don't think hospital. So it's no surprise that human embryos may be better off frozen in in vitro fertilization (IVF) .

The background

Cohort data has shown that adverse outcomes are less common in pregnancies after frozen-embryo transfer than after fresh-embryo transfer, possibly because the hormonally hyperstimulated environment that follows IVF may be a difficult place to launch a pregnancy. Some have asked if all IVF embryos should be cryopreserved to increase the number of successful pregnancies. 

The results

Women with polycystic ovarian syndrome (PCOS) are at high risk for the ovarian hyperstimulation syndrome (OHSS). Researchers compared fresh vs. frozen embryos in 1,500 women with PCOS in a multicenter RCT. The frozen group saw higher rates of live births and lower rates of OHSS, though the frozen pregnancies were at greater risk for pre-eclampsia.

The takeaway

PCOS pregnancies are high risk, so be careful when generalizing these results to other IVF scenarios. But the early data suggests you keep embryos cold. Like, #PhelpsFace cold.

Say it on rounds

When your pager beeps long after you sign out

Better find a way to block it. The same goes for stroke following transcatheter aortic valve implantation (TAVI/TAVR), a complication that affects 6% of high-risk patients. An RCT showed significantly fewer ischemic brain lesions following TAVI with an implanted filter designed to catch dislodged aortic valve debris. The filter group had half as many new lesions as the control group one week post-procedure. The effect on long-term neurologic outcomes is under investigation.  

When your eyes droop after a 27-hour shift

You've got it easy, compared to patients with myasthenia gravis (MG). Thymectomy has been used to treat the disease for decades, though the technique had never been proven to confer clinical benefit. The multicenter MGTX trial found that patients treated with thymectomy and prednisone had a lower steroid requirement and fewer clinical symptoms than those treated with prednisone alone over a 3-year span. 

When you just can't write another IV Dilaudid with Benadryl order

Get alternative. A 300 person RCT found that acupuncture provided faster and more effective analgesia than IV morphine when used to treat ED patients with acute pain. The acupuncture group also suffered fewer adverse effects.
Am J Emerg Med

Brush up


Look for finger pallor and cyanosis to diagnose Raynaud's phenomenon. Young patients with thumb sparing and a family history are more likely to have primary disease, while connective tissue disease (think systemic sclerosis) is often responsible for secondary disease forms. Treatment includes cold avoidance and systemic and local warming. Options for refractory disease include calcium channel blockers and prostacyclin analogues.

What's the evidence

For calcium channel blockers (CCBs) in Raynaud's phenomenon? A 2016 Cochrane review of 296 patients across 7 RCTs found that nifedipine and nicardipine reduced the frequency of Raynaud's attacks compared to placebo, though CCBs did not affect disease severity. CCBs were associated with headaches, flushing and peripheral edema.


That's how a CDC official described the first nationwide study to ask high school students about their sexuality. Gay, lesbian and bisexual teenagers were far more likely to report bullying and violence than their straight peers.

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