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Medical management
Published in Neeraj Parakh, Ravi S. Math, Vivek Chaturvedi, Mitral Stenosis, 2018
Patients with MS exhibit a certain degree of dynamic valve reserve. This dynamic reserve is defined as the maximum exercise burden that the stenotic orifice is able to sustain before clinical symptoms or hemodynamic impairment becomes evident. Exercise testing provides additional information in asymptomatic patients or in patients in whom MS severity and symptoms do not seem to correlate. Decisions regarding intervention versus continuation of medical therapy needs exercise testing in these patients. The resting transmitral gradient and pulmonary arterial pressure may not necessarily reflect the actual severity of the disease. It is debatable whether the severity of MS should be expressed as mitral valve area or as pressure gradients across the valve. While expressing area as an anatomical measurement does not give any further information about its functional status, there are no clear cutoff values of gradients at which one can grade the severity of MS, especially because gradients are highly heart rate-dependent and, even in severe MS, heart rates of <50 bpm could actually decrease the end diastolic gradient to as low as 5 mmHg. However, it is generally agreed that obstructions are better expressed as resistance.3
The effect of micronutrient supplementation on serum anti-Mullerian hormone levels: a retrospective pilot study
Published in Gynecological Endocrinology, 2022
Markus Lipovac, Judith Aschauer, Hannah Imhof, Clara Herrmann, Michaela Sima, Patricia Weiß, Martin Imhof
Monniaux et al. demonstrated in an animal model that the administration of AMH would lower follicle growth activation preserving more follicles for development in later life, which also could result in a delay in the onset of menopause [11]. More research is needed to determine if this is the same among humans. Although ovarian reserve screening is not thought to be performed in every woman at every age; AMH as a possible marker of ovarian screening could provide a more informed decision making to some women in their family planning [17]. AMH has shown to have several advantages compared to other ovarian reserve markers such as FSH and antral follicle count (AFC) [18]. Some critizicee that AMH is not a marker for the ovarian reserve, as it is not secreted by the primordial follicles of the dormant pool, but the dynamic reserve [17]. Despite this, there are observations that seem to show a functional relation between the two reserves and both seem to be influenced by genetic and the environmental control [11]. The validity of AMH as an indirect marker was supported by a study in which 42 women had oophorectomy due to benign gynecologic reasons. The results demonstrate that AMH and AFC correlated well with the number of primordial follicle in the tissue [19]. The ideal ovarian reserve test should be, i.e. affordable, noninvasive, reproducible, displaying only minimal intracycle and intercycle variability, and also being able to detect diminished ovarian reserve at an early state and have good sensitivity/specificity [7].