Bojana Salovic

Background: Estradiol-to-oocyte ratio (EOR) was proposed as an assisted reproductive technology (ART) outcome predictor in general population. In women with polycystic ovary syndrome (PCOS), hormonal imbalances, especially estradiol and luteinizing hormone (LH) may affect the predictive value of EOR. Objectives: We hypothesized that EOR plays a specific predictive role in PCOS and LH activity during ovarian stimulation modulates EOR and ART outcomes. Design: Retrospective cross-sectional design. Methods: The study included 276 patients with PCOS undergoing ART, stratified into four EOR groups: I (886). Additionally, patients were categorized based on LH activity during ovarian stimulation: no LH, recombinant LH, or LH-like activity. Key-outcome variables included counts of periovulatory follicles, retrieved oocytes, metaphase II (MII) oocytes, total number of embryos, good-quality (GQ) and frozen embryos, biochemical pregnancy rate (BPR), and clinical pregnancy rate (CPR). Comparisons were made across EOR and LH activity groups. Results: Group I (lowest EOR) demonstrated the highest counts of MII oocytes, total number of embryos, GQ and frozen embryos. BPR and CPR showed a decreasing trend with increasing EOR, peaking in Group I. Multivariable analysis identified the absence of LH activity, higher periovulatory follicle count, and lower EOR as independent predictors of improved ART outcomes. The lowest EOR was observed in patients without LH supplementation, who achieved the best clinical results, though the differences between BPR and CPR were not statistically significant. Conclusion: EOR is a valuable prognostic biomarker for ART outcomes in PCOS patients. Lower EOR is associated with more favorable outcomes. LH activity during stimulation influences EOR and ART success, particularly in patients with PCOS.

Background: Job satisfaction significantly influences the quality of patient care. Healthcare staff working with vulnerable patients in tertiary obstetrics and gynaecology hospitals faces specific work challenges and higher expectations from patients. The secondary data analysis from the National Survey of Employee Satisfaction aimed to evaluate job satisfaction and its association with intrinsic and extrinsic factors. Methods: A cross‐sectional study was conducted involving 385 employees (physicians, nurses, administrative and technical staff) at two tertiary obstetrics and gynaecology hospitals. Data were collected using a self‐administered, anonymous questionnaire (National Survey of Employee Satisfaction). This single instrument assessed demographic characteristics and 14 factors of the work environment and working conditions. Participants rated their level of satisfaction on a 5‐point Likert scale, with scores ranging from 1 (‘very dissatisfied’) to 5 (‘very satisfied’). Results: Participants were aged 35–54 years, with nurses comprising the largest proportion of the sample (60.3%). The greatest proportion reported dissatisfaction with their salary (61.8%), while the highest level of satisfaction was reported for work equipment (41.5%). Overall job satisfaction varied across professional categories of employees. Exploratory factor analysis among healthcare professionals identified two underlying dimensions of job satisfaction: extrinsic (hospital‐related) and intrinsic (profession‐related) factors, which together explained 59% of the total variance. Both factors were significantly associated with overall job satisfaction, with extrinsic factors showing a slightly stronger correlation. Conclusion: Improving non‐financial incentives (recognition of work, organizational support and workload management) may enhance healthcare staff engagement, communication, staff morale, retention and service quality. Given the identified intrinsic and extrinsic dimensions of job satisfaction and their significant association with overall job satisfaction, this empirically derived framework may be used for comparative analyses across different healthcare contexts and may inform the development of more targeted measurement tools and intervention models.

Obesity-related pathophysiological mechanisms adversely affect human fertility and infertility treatment. Conventional anthropometric indices for assessing obesity poorly differentiate visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). This explains inconsistencies between the studies evaluating the influence of obesity on semen parameters and assisted reproductive technology (ART) outcomes. A Body Shape Index (ABSI) and body roundness index (BRI) are novel indices that offer better differentiation of VAT and SAT. Our study assessed the correlation between traditional and novel indices with semen parameters and ART outcomes. A cross-sectional study, conducted at a tertiary fertility center from January 2023 to March 2025, encompassed 319 men undergoing ART. They were divided into four groups based on body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), BRI, and ABSI quartiles. Anthropometric indices were measured and correlated with semen parameters (semen volume, sperm concentration, motility, and morphology) and ART outcomes (number of obtained embryos, transferred embryos, frozen embryos, and usable blastocyst development and embryo utilization rates). Our analysis revealed that anthropometric indices correlated differently with semen parameters and ART outcomes. BMI, BRI, and WHtR correlated negatively with semen parameters, whereas WHR and ABSI did not. ABSI negatively correlated with all analyzed ART outcomes, while WHR significantly correlated only with total number of embryos. Traditional anthropometric indices that inform us on general obesity are linked to semen analysis parameters. Novel indices that differentiate VAT and SAT are linked with ART outcomes, suggesting possible epigenetic consequences of increased VAT.

Background: This review aimed to implement a search strategy focused on vaginal candida infections in pregnant women and to analyze specific vulvovaginal symptom questionnaires (VSQs) for Candida infections. Methods: A literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The MEDLINE, Web of Science, and Scopus databases were searched for studies published between 1997 and 2023. The search strategy included keywords related to vaginal candidiasis, pregnancy, risk factors, symptoms, and self-assessment VSQs. The studies were assessed for quality using Joanna Briggs Institute Critical Appraisal Tools, focusing on validity, reliability, and appropriate statistical methods. Results: A total of 36 papers with vaginal candidiasis reported during pregnancy were included (1997–2023), along with 14 papers reporting the use of VSQs. The literature was found to lack sufficient data, with a wide variation in population size and data across studies. Sample sizes ranged from as few as 80 patients to as many as 13,863 patients in other studies. Notably, a significant age range was observed among the participants, spanning from 10 to 64 years. Additionally, symptoms and signs were not investigated in 17 studies, while risk factors were not discussed in 20 studies. A total of 14 studies were identified; however, only one was presented with a fully developed VSQ, which had been validated and was available in multiple languages. Meanwhile, none of the studies focused on pregnant women and the role of VSQs. Conclusions: Incorporating self-assessment VSQs into clinical practice would improve everyday practice and increase awareness among pregnant women regarding vulvovaginal Candida infections, improve the identification and management of these infections, leading to earlier detection, more timely treatment, and improved health outcomes for newborns.

Introduction: We present a case of Hashimoto's thyroiditis and severe autonomic dysfunction three months after the resolution of the acute phase of COVID-19 infection in a patient with no prior thyroid disease and autonomic dysfunction. Patient Review: We discuss our patient's clinical presentation, diagnostic evaluation, and subsequent management and follow-up. The patient had previously tested positive for COVID-19. A 53-year-old female developed Hashimoto's thyroiditis with normal thyroid function and severe autonomic dysfunction. Her heart rate variability (HRV) is depressed, and her High-Frequency power (HF) is high. Conclusion: Our findings suggest that COVID-19 could have long-term negative effects on antithyroid antibodies. Therefore, testing antithyroid antibodies should be included in the follow-up algorithm for COVID-19 survivors. Autonomic nervous system dysfunction related to COVID-19 may be reversible and early aggressive therapy is necessary. The new technique is important for the early detection of post-acute sequelae of SARS-CoV-2 infection (PASC) in the autonomic nervous system.

Purpose We aimed to evaluate if ovarian stimulation with individualized dosing of recombinant follicle-stimulating hormone (rec-FSH) with follitropin delta compared with standard gonadotropin dosing reduce occurrence of follicular asynchrony in women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF). Methods Matched case–control study analyzed occurrence of follicular growth asynchrony during ovarian stimulation and IVF outcomes in women with PCOS. Follicular growth was considered to be asynchronous when one or two leading follicles were at least 4 mm larger in diameter than the rest of the cohort on day 5 and 9 of stimulation. Analysis encompassed 44 women stimulated with individualized rec-FSH dosing, and 88 women treated with standard dosing. The patients were matched in terms of age, Anti-Müllerian hormone levels and body weight. Results Early and late follicular asynchrony were present less frequently in individualized dosing compared to standard dosing group (4.5% vs 17%, p = 0.04 and 2.3% vs 37.5%, p < 0.001, on stimulation day 5 and 9, respectively). Multivariate logistic regression on follicular asynchrony revealed that individualized dosing significantly decreases the occurrence and chances for late follicular asynchrony (Odds Ratio 0.28, p < 0.001). Shorter duration of stimulation (9.6 vs 10.4 days, p = 0.001), lower total gonadotropin dose (1118 vs 1940 IU, p < 0.001), higher number of metaphase II oocytes (7.1 + 4.3 vs 5.4 ± 3.0, p = 0.001), good quality embryos (3.8 vs 2.0, p < 0.001), and implantation rates (31.0 vs 23.4, p = 0.04) were observed in the individualized dosing group. Conclusion Individualized rec-FSH dosing reduces asynchronous follicular growth and improves ovarian stimulation efficiency in women with PCOS undergoing IVF.

COVID-19, a global epidemic of infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), not only initially refers to acute manifestations but also chronic symptoms known as Long COVID-19. Long COVID-19 represents a significant burden to healthcare systems worldwide. This syndrome encompasses a wide range of continuing health problems with variable durations and consequences for patients’ everyday lives. A notable aspect of Long COVID-19 is the emergence of new-onset autoimmune diseases that could be triggered in predisposed patients with altered immune responses. Common autoimmune conditions that arise in post-COVID patients include autoimmune hemolytic anemia, immune thrombocytopenic purpura, autoimmune thyroid diseases, Kawasaki disease, Guillain-Barre syndrome, etc., but with unclear evidence of associated disease occurrence. We present a case of a female rheumatoid arthritis patient who developed autoimmune thyroid disease, latent autoimmune diabetes of adults (LADA), and pernicious anemia after SARS-CoV-2 infection.