Anthea B. Mahesan Paul - Academia.edu (original) (raw)

Papers by Anthea B. Mahesan Paul

Fertility and Sterility, 2017

Purpose We sought to explore the utility of preimplantation genetic testing for aneuploidy (PGT-A... more Purpose We sought to explore the utility of preimplantation genetic testing for aneuploidy (PGT-A) in a poor prognosis group of women with few embryos available for transfer. Methods This was a retrospective matched cohort study examining records for first or second-cycle IVF patients with 1 to 3 blastocysts. The study group comprised 130 patients who underwent PGT-A on all embryos. The control group included 130 patients matched by age, BMI, and blastocyst number and quality who did not undergo PGT-A during the same time period. Results The live birth rate (LBR) per embryo transfer (ET) were similar in the PGT-A and control groups, and the spontaneous abortion (SAB) rate was the same (23%). However, we found a significantly higher LBR per oocyte retrieval in the control group vs the PGT-A group (43% vs 20%, respectively) likely due to the many no-euploid cycles in the PGT-A group. In a subgroup analysis for age, the similar LBR per ET persisted in women < 38. However, in older women, there was a trend to a higher LBR per ET in the PGT-A group (43%) vs the control group (22%) but a higher LBR per oocyte retrieval in the control group (31%) vs the PGT-A group (13%). Conclusions Overall, we observed a significant increase in LBR per oocyte retrieval in women in the control group compared to women undergoing PGT-A, and no difference in SAB rate. Our data suggests that PGT-A has no benefit in a subpopulation of women with few embryos and may cause harm.

Introduction: Members of the S. milleri group Streptococcus intermedius, Streptococcus anginosus,... more Introduction: Members of the S. milleri group Streptococcus intermedius, Streptococcus anginosus, and Streptococcus constellatus intermedius, are important pathogens implicated in respiratory illnesses such as bacterial pneumonia, pulmonary abscesses and empyema. Diagnosis of respiratory illnesses is largely dependent on accurate identification of symptomology and physical exam as radiological evidence is not always present. Case Report: In this case report, we present a fatal case of Streptococcus intermedius associated pneumonia causing empyema with an unusual constellation of symptoms and laboratory tests masquerading as acute pancreatitis in an otherwise healthy middle-aged woman. Conclusion: Our case adds to literature a novel clinical and laboratory presentation of S. intermedius empyema and the potentially fatal ramifications if not accurately diagnosed in an otherwise healthy woman. (This page in not part of the published article.) International Journal of Case Reports and I...

Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, 2020

The COVID-19 pandemic has presented challenges in symptomology identification, diagnosis, managem... more The COVID-19 pandemic has presented challenges in symptomology identification, diagnosis, management and follow-up in common respiratory diseases, and in particular asthma. Research is rapidly ongoing to try and understand how the SARS-CoV-2 virus affects individuals with asthma, as well as, how underlying asthma affects Covid-19 risk, symptomology and prognosis. In light of this unique medical challenge, clinicians are faced with case-by-case based decisions to implement or continue current asthma therapy. This review will discuss the current literature regarding asthma and COVID-19 based on best available evidence at this time (See box 1).

The Journal of Maternal-Fetal & Neonatal Medicine, 2020

OBJECTIVE The aim of this study is to review the current evidence on the vertical transmission of... more OBJECTIVE The aim of this study is to review the current evidence on the vertical transmission of SARS CoV-2. METHODS Combination of the following keywords; COVID-19, SARS CoV-2, placenta, vertical transmission, intrauterine infection, breast milk were searched in databases. RESULTS In the 50 studies included, 17 newborns testing positive for SARS CoV-2 by RT-PCR were reported. In three neonates, SARS-CoV-2 IgG and IgM levels were elevated. Eight placental tissues testing positive for the virus were reported. Three positive RT-PCR results of test of breast milk have been reported recently. One amniotic fluid testing positive was reported. CONCLUSION Possible vertical transmission of SARS CoV-2 has been observed in some studies currently. More RT-PCR tests on amniotic fluid, placenta, breast milk and cord blood are required.

Introduction: Intussusception is commonly discussed in the context of children. However in adults... more Introduction: Intussusception is commonly discussed in the context of children. However in adults, intussusception is an identified diagnosis accounting for 5% of all intussusceptions. A malignant etiology is always suspected in adults; however, rarely as in this case, a benign bowel lesion may be the underlying cause. case report: In this case report, we present an unusual case of a 36-year-old female patient with pain in her left lower abdomen with loss of appetite, abdominal distension, and diarrhea lasting three days. computed tomography scan confirmed the diagnosis of intussusception. A lipoma of the descending colon was the lead point for the intussusception into the sigmoid lumen. sigmoid colectomy with primary anastomosis was performed. the resected specimen was a yellowish, oval, and broader-based homogeneous tumor, 4x4x3 cm in size, rising from the submucosal layer of the colonic wall. conclusion: While an intussusception is clinically nonspecific, intestinal obstruction is usually found to be the common presentation. this case highlights

Fertility and Sterility, 2018

Obstetrics & Gynecology, 2019

Journal of assisted reproduction and genetics, Jan 12, 2018

MicroRNAs (miRNAs) are emerging as important in human embryo implantation, and we present here a ... more MicroRNAs (miRNAs) are emerging as important in human embryo implantation, and we present here a review of the literature from a clinical perspective. Implantation involves complex interactions between the blastocyst and endometrium. miRNAs have been shown to be differentially expressed in implanted compared with non-implanted blastocysts and euploid compared with aneuploid blastocysts. Further, miRNAs are differentially expressed in proliferative compared with decidualized endometrium, and in receptive compared with pre-receptive endometrium. miRNAs are also differentially expressed in endometrium of women who failed implantation, and in endometrium of women with recurrent implantation failure. Due to the complexity of miRNA signaling, studies have suffered from inconsistency in reproducibility of results. However, miRNAs show potential as biomarkers in the pursuit of more reliable prediction of embryo implantation.

Forensic science international, Jan 3, 2018

Homicide occurs in approximately one in five injury-related deaths among infants in the United St... more Homicide occurs in approximately one in five injury-related deaths among infants in the United States and studies suggest that male caretakers (fathers or mothers' intimate partners) are the perpetrators of the majority of infant homicides. Opioid abuse is common and it is estimated that between 26.4 million and 36 million people abuse opioids worldwide. In this case report, we add to the literature the first reported homicide by intentional heroin administration in a 10-month old infant. Toxicology revealed morphine 1092ng/L, codeine 74ng/mL, and 6-monoacetyl-morphine 359ng/L in cardiac blood. Morphine 803ng/g, codeine 54ng/g in liver tissue, and morphine 181ng/mL was found in vitreous humor. With the prevalence of opioid abuse on the rise accidental opioid ingestions in the pediatric population have increased. However, forensic personnel must recognize the possibility of intentional poisoning in this vulnerable population.

Journal of forensic sciences, 2017

Synthetic cannabinoids (SCs) are commonly abused by adolescents with reported past year (2013) us... more Synthetic cannabinoids (SCs) are commonly abused by adolescents with reported past year (2013) use in high school students between 3 and 10%. Standard adolescent postmortem toxicology does not include routine SC analysis, and thus, the true burden of fatalities related to SCs is unknown. A retrospective case review of two cases included scene investigation, interviews, autopsy, and toxicology. SCs were confirmed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Review of the eight adolescent SC-associated fatalities in the literature revealed five of eight cases had no other discernible cause of death on autopsy. Compounds detected included PB-22 (1.1 ng/mL), JWH-210 (12 ng/mL), XLR-11 (1.3 ng/mL), JWH-122, AB-CHMINACA (8.2 ng/mL), UR-144 (12.3 ng/mL), and JWH-022 (3 ng/mL). With synthetic drug use on the rise, forensic experts should have a high index of suspicion for the possibility of SC intoxication in adolescent fatalities with no other discernible cause of death.

Journal of Forensic Sciences, 2017

Methadone-related fatalities occur rarely in infants under 1 year, with five confirmed cases in t... more Methadone-related fatalities occur rarely in infants under 1 year, with five confirmed cases in the literature. The interpretation of pediatric postmortem toxicology relies on adult data; however, infants have crucial physiological differences that may impact interpretation of results. Retrospective case review included scene investigation, interviews, autopsy, and NIH/CDC Sudden Unexplained Infant Death Investigation Reporting Form. Methadone levels were confirmed by liquid chromatography/tandem mass spectrometry (LC-MS/MS). The fatal blood methadone levels in this case series ranged from 69 to 700 ng/mL. This review of the literature adds toxicological findings of three methadonerelated infant fatalities and reviews the current literature on methadone-related death in infants under 1 year. With opioid use on the rise in today's society, forensic experts should have a high index of suspicion for the possibility of intentional or unintentional poisoning in infants.

Journal of Forensic and Legal Medicine, 2016

This study reports descriptive data assessing the prevalence of various risk factors and associat... more This study reports descriptive data assessing the prevalence of various risk factors and associations among pregnancy-related death by unnatural causes (PRUD), namely suicide, homicide and accidental causes in the city of Las Vegas. In 7215 women referred for autopsy, results showed PRUD 0.1% (n=37) was more common in the Caucasian race 45.9%(n=17), and ages 20 to 30 years 43.2%(n=16). We also identified high prevalence of mental illness 51.3% (n=19) and low prenatal care 37.8%(n=14), particularly in our suicide cohort 100.0%(n=13), and 15.3%(n=2) respectively. Our study demonstrates the first investigation to identify the relationship between mental illness, particularly mood and substance disorders with pregnancy-related unnatural death.

International Journal of Case Reports and Images, 2016

Urology Case Reports, 2016

The CDC estimates that 12e25% of all hospitalized patients receive a urinary catheter during thei... more The CDC estimates that 12e25% of all hospitalized patients receive a urinary catheter during their hospital stay. Foley catheter failure is uncommon and Foley catheter failure associated with iatrogenic urinary bladder rupture (IUBR) is extremely rare. Symptoms are often nonspecific and thus misdiagnosis and delayed treatment is common. In this case report, we present a case of IUBR in a woman from Foley catheter failure, which ultimately led to her demise. This case adds to the literature the importance of suspicion for IUBR in patients with indwelling Foley catheters presenting with lower abdominal pain, hematuria, and decreased urine output.

Journal of Midwifery & Women's Health, 2016

The objective of this study was to assess the utility of the pelvic examination at the 6-week pos... more The objective of this study was to assess the utility of the pelvic examination at the 6-week postpartum visit after cesarean birth. Data were collected from retrospective chart review in an obstetric resident clinic in Detroit, Michigan. Women included were those who had a cesarean birth between January 2012 and June 2014. Of 388 women who had a cesarean birth, 211 (54.4%) presented for the 6-week postpartum visit and underwent pelvic examination. Of these women, 185 (87.7%) were asymptomatic, and 26 (12.3%) reported vaginal discharge. No other concerns were elicited. Of those with symptoms, 4 (15%) had no finding, 13 (50%) had bacterial vaginosis (BV) alone, 2 (8%) had BV and Candida sp, 2 (8%) had BV and Trichomonas vaginalis, 2 (8%) had T vaginalis alone, and 3 (11%) had Chlamydia trachomatis. One woman with C trachomatis had tested positive during pregnancy and possibly had treatment failure. Of the 185 asymptomatic women, 91 (49%) were deemed to have vaginal discharge on examination and underwent testing for Neisseria gonorrhoeae and C trachomatis; results were negative in all cases. In this population, it appears unnecessary to perform routine pelvic examination on asymptomatic women at the 6-week postpartum visit after cesarean birth. When vaginal discharge was noted during pelvic examination of asymptomatic women, no pathology was identified.

Journal of Diabetes Mellitus, 2016

Aims: To determine correlations of insulin sensitivity to gene expression in omental and subcutan... more Aims: To determine correlations of insulin sensitivity to gene expression in omental and subcutaneous adipose tissue of non-obese, non-diabetic pregnant women. Methods: Microarray gene profiling was performed on subcutaneous and omental adipose tissue from 14 patients and obtained while fasting during non-laboring Cesarean section, using Illumina HumanHT-12 V4 Expression BeadChips. Findings were validated by real-time PCR. Matusda-Insulin sensitivity index (IS) and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated from glucose and insulin levels obtained from a frequently sampled oral glucose tolerance test, and correlated with gene expression. Results: Of genes differentially expressed in omental vs. subcutaneous adipose, in omentum 12 genes were expressed toward insulin resistance, whereas only 5 genes were expressed toward insulin sensitivity. In particular, expression of the insulin receptor gene (INSR), which initiates the insulin signaling cascade, is strongly positively correlated with IS and negatively with HOMA-IR in omental tissue (r = 0.84). Conclusion: Differential gene expression in omentum relative to subcutaneous adipose showed a pro-insulin resistance profile in omentum. A clinical importance of omental adipose is observed here, as downregulation of insulin receptor in omentum is correlated with increased systemic insulin resistance.

American Journal of Obstetrics and Gynecology, 2015

OBJECTIVE: To evaluate the associations between urinary arsenic metabolites with pregnancy and se... more OBJECTIVE: To evaluate the associations between urinary arsenic metabolites with pregnancy and select demographic, biometric, dietary, hormonal factors. STUDY DESIGN: This cross-section study analyzed 195 pregnant (PG) and 1178 not pregnant (not PG) women <55 years with urinary arsenic results from NHANES 2000-2010. We analyzed 8 Arsenic values and also mean Arsenic value of URXUAS-Urinary total Arsenic (Âmg/L) , URXUAB-Urinary Arsenobetaine (Âmg/L) and URXUDMA-Urinary Dimethylarsonic acid (Âmg/L). The database included all dietary intakes (total energy calories, lipids, sugars, protein, fibers), vitamin intakes (A,B1, B12, B6, folate, niacin, C, E, K), trace metals intakes (calcium, phosphorus, magnesium, zinc, iron, selenium, copper, potassium), alcohol, caffeine, and theobromine intakes. HOMA IR Insulin resistance was calculated. We analyzed Arsenic quartiles using Chi-square, Fisher's Exact tests, Kruskal-Wallis tests, Jonckheere-Terpstra tests of trend (JT p¼). Logistic regression of the highest Arsenic quartile was performed with PG/noPG using the following covariates (urine creatinine, ethnicity, total Kcal of energy, total fats, age, smoking, waist circumference, arm circumference, BMI, Iron). RESULTS: Pregnant subjects had significantly lower values for most of the urinary arsenic metabolites. Sub scapular skin-fold; dietary intake of cholesterol, vitamin C, selenium, caffeine, and vitamin K were statistically significantly different with significant JT p values for linear trend. Logistic regression showed association between decreased arsenic levels with pregnancy only when creatinine was a covariate (OR¼0.651,95%CI:0.434, 0.975), the most significant associations were with non-Hispanic Blacks (OR¼1.532,95% CI:1.077,2.178) and non-Hispanic whites (OR¼0.685, 95% CI:0.498,0.943). CONCLUSION: There are possible correlations between pregnancy and ethnicity with arsenic exposure.