Publications by authors named "Ahmed M Hussein"

41 Publications

Reply to letter to the editor article "Placenta accreta spectrum: "placenta accreta" is still used".

Arch Gynecol Obstet 2021 Jan 17. Epub 2021 Jan 17.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt.

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http://dx.doi.org/10.1007/s00404-020-05932-5DOI Listing
January 2021

Impacts alum DWTPs sludge discharge and changes in flow regime of the Nile River on the quality of surface water and cultivated soils in Fayoum watershed, Egypt.

Sci Total Environ 2021 Apr 25;766:144333. Epub 2020 Dec 25.

Department of Geology, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt.

Discharge of Drinking Water Treatment Plants sludge directly on surface waters without any treatment is becoming an important issue in most countries around the world, behavior is not only affecting on the water quality, but also on soil and crops. This study investigated the effect of discharge of alum sludge and the variation in the level of the Nile water (flow regime) on water and soil qualities. The water samples were analyzed for physical, chemical and microbiological parameters. In winter (closure season), the mean values of EC, TDS, major ions, pH, DO and total algae count were higher than in summer. In summer (flooding season), it was noticed that the mean values of SiO, metals, COD, BOD, TOC, nutrients and bacteriological parameters exceed winter season values. Moreover, the concentrations of Al, Fe, Mn were above WHO permissible limits and the concentrations of aggregate organic parameters exceed the FAO permissible limits in sites near the areas of sludge discharge. Most of water samples exceed the national guidelines. For soil, our findings showed that the concentrations of metals in soil samples collected from areas irrigated from canals receiving alum sludge are more (two-three times) than their concentrations from the pure sites. However, Pb concentration in the contaminated soil reaches ten times more than in the pure one. The management of sludge disposal becomes an urgent priority to save waterways, soil and crops from pollution. Finally, the variation in water flow during the winter closure period with reduction by ≈15 BCM is similar to the same reduction in the Nile flow when the Grand Ethiopian Renaissance Dam starts operation. This indicates that the long-term reduction in water flow due to the construction of this dam may cause serious environmental changes in the Nile River in Egypt.
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http://dx.doi.org/10.1016/j.scitotenv.2020.144333DOI Listing
April 2021

Fortified vegetarian milk for prevention of metabolic syndrome in rats: impact on hepatic and vascular complications.

Heliyon 2020 Aug 5;6(8):e04593. Epub 2020 Aug 5.

Nutrition and Food Sciences Department, National Research Centre, Cairo, Egypt.

Metabolic syndrome (MetS) is characterized as a gathering of various metabolic disorders, for example, hyperglycemia, dyslipidemia, and obesity. The present research was conducted to prepare fortified almond milk as functional beverages and evaluate their protective effect against MetS and associated hepatic and vascular complications. Three beverages (I, II, and III) were prepared by fortification almond milk with carrot juice or powder of quinoa seeds and carrot juice or oat powder and banana juice. The sensory attributes, physicochemical properties, bioactive compounds (total phenolic, beta-carotene, tocopherols) and B-complex vitamins were determined in the beverages. In-vitro antioxidant activity of the beverages was assessed. MetS was induced in rats via feeding on high-fat high-fructose diet (HFHF). The biochemical (lipid profile, oxidative stress, liver, and kidney functions), nutritional and histopathological parameters were assessed in rats. The beverage I recorded the highest sensory attributes' scores. The physicochemical properties of the beverages revealed that acidity and viscosity of all beverages ranged from 4.55 to 4.88 and from 40 to 59, respectively. The beverage I showed the highest content of alpha-tocopherol (14.994 μg/g) and beta-carotene (104.541 μg/g), while the beverage II showed the highest content of gamma-tocopherol (0.557 μg/g), folic acid (0.806 μg/g), and total phenols (147.43 μg GAE/g). The results of animals revealed that the beverage II was the most promising in attenuation levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol, malondialdehyde, and tumor necrosis factor-alpha. Also, the beverage II was the superior in the protection of the liver and heart tissues as reflected by the histopathological examination findings. So, it can be concluded that the newly prepared almond milk with quinoa seeds and carrot juice could be used as an effective functional beverage for the prevention of MetS and its complications.
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http://dx.doi.org/10.1016/j.heliyon.2020.e04593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413996PMC
August 2020

The role of ultrasound in prediction of intra-operative blood loss in cases of placenta accreta spectrum disorders.

Arch Gynecol Obstet 2020 11 1;302(5):1143-1150. Epub 2020 Aug 1.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt.

Purpose: To assess the value of various grey-scale ultrasound, 2D color Doppler, and 3D power Doppler sonographic markers in predicting major intraoperative blood loss during planned cesarean hysterectomy for cases diagnosed with placenta accreta spectrum (PAS) disorders.

Methods: 50 women diagnosed with PAS were scanned the day before planned delivery and hysterectomy for various sonographic markers indicative of placental invasion. These women were then later divided according to blood loss in two groups: group A (minor hemorrhage, < 2500 ml), and group B (major hemorrhage, > 2500 ml), and the data were analyzed.

Results: The odds ratio (OR) for major hemorrhage was as follows for the following sonographic markers: 'number of lacunae > 4' OR 3.8 95% CI (1.0-13.8) (p = 0.047); 'subplacental hypervascularity' OR 10.8 95% CI (1.2-98.0) (p = 0.035); 'tortuous vascularity with 'chaotic branching' OR 10.8 95%CI (1.2-98.0) (p = 0.035); 'numerous coherent vessels involving the serosa-bladder interface OR 14.6 95% CI (2.7-80.5) (p = 0.002); and 'presence of bridging vessels OR 2.9 95% CI (1.4-6.9) (p = 0.005). Only the presence of numerous coherent vessels involving the bladder-serosal interface (p = 0.002) was proven to be independent predictor of major hemorrhage during hysterectomy.

Conclusion: The use of 2D color Doppler and 3D power Doppler can help predict massive hemorrhage in cases of PAS disorders.
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http://dx.doi.org/10.1007/s00404-020-05707-yDOI Listing
November 2020

Differences in Hypothalamic Lipid Profiles of Young and Aged Male Rats With Impaired and Unimpaired Spatial Cognitive Abilities and Memory.

Front Aging Neurosci 2020 3;12:204. Epub 2020 Jul 3.

Neuroscience Laboratory, Paracelsus Medical University, Salzburg, Austria.

Lipids play a major role for several brain functions, including cognition and memory. There is a series of work on individual lipids showing involvement in memory mechanisms, a concise lipidome was not reported so far. Moreover, there is no evidence for age-related memory decline and there is only work on brain of young vs. aging animals. Aging animals, however, are not a homogeneous group with respect to memory impairments, thus animals with impaired and unimpaired memory can be discriminated. Following recent studies of hippocampal lipid profiles and hypothalamus controlled hormone profiles, the aim of this study was to compare hypothalamic, lipidomic changes in male Sprague-Dawley rats between young (YM), old impaired (OMI) and old unimpaired (OMU) males. Grouping criterions for aged rats were evaluated by testing them in a spatial memory task, the hole-board. YMs were also tested. Subsequently brains were removed, dissected and hypothalami were kept at -80°C until sample preparation and analysis on liquid chromatography / mass spectrometry (LC-MS). Significant differences in the amounts of a series of lipids from several classes could be detected between young and aged and between OMI and OMU. A large number of lipids were increased in OMI and a smaller number in OMU as compared to young rats. Differences of lipid ratios (log2 of ratio) between OMI and OMU consisted of glycerophosphocholines (aPC 36:2 and 36:3; PC 34:0, 36:1, 36:3 and 40:2); Glycerophosphoethanolamines (aPE 34:2, 38:5 and 40:5; LPE 18:1, 20:1, 20:4, 22:4 and 22:6; PE36:1 and 38:4); glycerophosphoserines (PS 36:1, 40:4, and 40:6); triacylglycerol TG 52:4; ceramide Cer 17:2 and sphingomyelin SM 20:0. Thus, hypothalamic lipid profiles across different lipid classes discriminate aged male animals into OMU and OMI. The underlying mechanisms may be related to different functional networks of lipids in memory mechanisms and differences in metabolic processes. The study underlines the importance of lipidomics in the pathophysiology of age-related cognitive decline. The necessity of evaluating the cognitive status of aged subjects by behavioral tests results in more specific detection of critical lipids in memory decline, on which now can be focused in subsequent memory studies in animals and humans.
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http://dx.doi.org/10.3389/fnagi.2020.00204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349000PMC
July 2020

Reply.

Am J Obstet Gynecol 2020 12 17;223(6):944-945. Epub 2020 Jun 17.

Department of Obstetrics and Gynecology, University of Cairo, Cairo, Egypt.

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http://dx.doi.org/10.1016/j.ajog.2020.06.025DOI Listing
December 2020

Effect of Using the Rapid Shallow Breathing Index as Readiness Criterion for Spontaneous Breathing Trials in a Weaning Protocol.

Am J Med Sci 2020 02 9;359(2):117-122. Epub 2019 Nov 9.

Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, Texas.

Background: This study aimed to compare the effect of using versus not using the Rapid-Shallow Breathing Index (RSBI) as a readiness criterion for Spontaneous Breathing Trials (SBT) on SBT success.

Materials And Methods: Daily readiness screens were performed within a respiratory therapist-driven weaning protocol. Patients who passed these screens underwent a one-time measurement of the RSBI and then a SBT regardless of RSBI result. The proportion of passed readiness screens reaching SBT success was compared to the proportion that would have been obtained if RSBI ≤ 105 br/min/L had been used as an additional screen criterion.

Results: Two hundred and fifty SBTs performed on 157 patients were analyzed. The sensitivity of RSBI ≤ 105 br/min/L to predict SBT success was 94.8% (95% CI 90.6-97.5). Relative to potentially using RSBI, 14.4% additional SBTs were performed. A third of these were successful, and no complications were detected in the rest that failed. The proportion of passed readiness screens reaching SBT success would have been 4% (95% CI 1.2-6.8) (P = 0.002) lower if RSBI had been used.

Conclusions: The inclusion of the RSBI in a readiness screen may not be useful in a weaning protocol.
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http://dx.doi.org/10.1016/j.amjms.2019.11.002DOI Listing
February 2020

A new methodologic approach for clinico-pathologic correlations in invasive placenta previa accreta.

Am J Obstet Gynecol 2020 04 12;222(4):379.e1-379.e11. Epub 2019 Nov 12.

The Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.

Background: The development of new management strategies for women presenting with placenta accreta spectrum requires quality epidemiology data, which have so far been limited by the high variability in clinical and histopathologic data confirming the diagnosis at birth.

Objective: To evaluate the role of a new methodologic approach for the correlation of clinical and pathological data for women with a history of prior cesarean delivery diagnosed prenatally with placenta previa accreta.

Materials And Methods: A modified pathologic technique for gross examination of hysterectomy specimens with placenta in situ consisting of intraoperative examination, immediate postoperative examination, and guided histologic sampling was used prospectively in a cohort of 24 patients with singleton pregnancies complicated by placenta low-lying/placenta previa accreta. Maternal characteristics, detailed ultrasound findings, surgical outcomes, and histopathologic examination were compared with those of a group of 24 patients with similar clinical characteristics and in whom a standard pathologic examination method was used.

Results: The median reporting time for obtaining the complete histopathology results including the microscopic examination was significantly shorter (7 versus 15 days; P < .001) and the median number of samples taken for histologic examination significantly lower (4 versus 14 samples; P < .001) in the study group than in the controls. The number of histologic slides showing villous invasion was significantly higher (2 versus 1 slide; P = .002), and the ratio of the number of samples taken to the numbers of slides confirming villous invasion was significantly lower (2 versus 9; P < .001) in the study group than in the controls. In all cases in the study group, intraoperative examination identified a dense tangled bed of vessels or multiple vessels running laterally and cranio-caudally in the uterine serosa above the placental insertion that were no longer visible during immediate gross postoperative examination of the hysterectomy specimens. Immediate postoperative dissection enables the differential diagnosis between focal and large increta areas, and between abnormally adherent placenta and invasive placenta accreta.

Conclusion: Valuable clinical information on the serosal vascularity, uterine dehiscence, and extension of the accreta area is added with the description of the macroscopic examination during the surgical procedure and immediate dissection of the specimen. This methodological approach is cost-effective and increases the quality of the histologic sampling. It thus provides more accurate correlations with the clinical data and more accurate epidemiologic data collection. Perinatal pathologists should be part of multidisciplinary teams involved the management placenta accreta spectrum disorders.
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http://dx.doi.org/10.1016/j.ajog.2019.11.1246DOI Listing
April 2020

Measurement of maternal serum amyloid A as a novel marker of preterm birth.

J Matern Fetal Neonatal Med 2019 Sep 25:1-6. Epub 2019 Sep 25.

Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University , Cairo , Egypt.

To study the association between maternal serum amyloid A (mSAA) levels and preterm birth (PTB). This prospective observational nested case control study was conducted at Ain Shams University Maternity Hospital, Cairo, Egypt, between May 2017 and December 2017. The study recruited pregnant women at 26-34 weeks presented with threatened preterm labor (PTL). Women with PTB were included in cases group while control group included women who continued pregnancy and delivered at term. Serum samples were collected to measure mSAA levels. The main outcome of the study was the association between mSAA levels and PTB. Secondary outcomes included neonatal intensive care unit admissions and neonatal mortality. Fifty-eight women were included in the final analysis (29 in each group). Women with PTB had a statistically significant higher mSAA levels [5.1 (4.5-7.7) vs. 1.2 (0.0-2.5) mg/l, for cases and controls respectively,  < .001]. Higher mSAA levels were also observed among women whose babies were admitted to NICU, but there was no significant relation between mSAA level and neonatal death. A statistically significant negative correlation was found between mSAA and gestational age at delivery and neonatal birth weight. mSAA had an excellent value to predict PTB (AUC = 0.972 [95% CI, 0.891-0.998],  < .0001), fair value to predict admission to NICU and a poor value to predict neonatal death. mSAA level was found to be elevated among women with threatened PTL who end with PTB; mSAA is a potentially useful predictive marker of PTB that warrant further study. CLINICALTRIALS.GOV: NCT01639027.
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http://dx.doi.org/10.1080/14767058.2019.1668370DOI Listing
September 2019

Transvaginal sonographic measurement of cervical length versus Bishop Score in labor induction at term for prediction of caesarean delivery.

J Matern Fetal Neonatal Med 2019 Aug 22:1-211. Epub 2019 Aug 22.

Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams Maternity Hospital, Ain Shams University , Cairo , Egypt.

The current study aims to compare between a transvaginal sonographic measurement of cervical length and Bishop score in the induction of labor at term for prediction of cesarean delivery (CD). A prospective cohort study included 320 full-term pregnant women attending Ain Shams Maternity Hospital in the period from August 2017 to February 2018 were enrolled. Seventy-three women were delivered by CD (positive group), and 247 women were delivered vaginally (negative group). All patients had a vaginal examination for assessing the Bishop Score before induction of labor then a transvaginal ultrasound for assessment of cervical length. Induction of labor was initiated by using PGE1 analog. The primary outcome measure was the accuracy of the cervical length or the bishop score for prediction of the CD. In our current study, CD was achieved in 22.8% of all participants while vaginal delivery was achieved in 77.8% after induction of labor by misoprostol 25 micrograms within 24 hours from the beginning of induction. Both the cervical length and Bishop Score had poor predictive value for CD (AUC = 0.694 and 0.623, respectively). Both transvaginal sonography for cervical length and Bishop score are useful predictors of the need for CD following labor induction.
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http://dx.doi.org/10.1080/14767058.2019.1659770DOI Listing
August 2019

Utility of 5-(furan-2-yl)-3-(-tolyl)-4,5-dihydro-1-pyrazole-1-carbothioamide in the synthesis of heterocyclic compounds with antimicrobial activity.

BMC Chem 2019 Dec 1;13(1):48. Epub 2019 Apr 1.

5Department of Chemistry, Faculty of Women for Arts, Science and Education, Ain Shams University, Heliopolis, Cairo, 11757 Egypt.

Background: Pyrazolines show different biological activities. In recent years, interest in the chemistry of hydrazonoyl halides has been renewed. 1,3,4-Thiadiazoles are one of the most common heterocyclic pharmacophores with a wide range of biological activities.

Results: Ethyl 2-(5-(furan-2-yl)-3-(-tolyl)-4,5-dihydro-1-pyrazol-1-yl)-4-methyl-thiazole-5-carboxylate, 2-(5-(furan-2-yl)-3-(-tolyl)-4,5-dihydro-1-pyrazol-1-yl)thiazol-4(5)-one, and 1-(2-(5-(furan-2-yl)-3-(-tolyl)-4,5-dihydro-1-pyrazol-1-yl)-4-methylthiazol-5-yl)ethan-1-one were synthesized from the reaction of 5-(furan-2-yl)-3-(-tolyl)-4,5-dihydro-1-pyrazole-1-carbothioamide with different halogenated compounds. Thiazole, 1,3,4-thiadiazole and pyrano[2,3-]thiazole derivatives were also synthesized. The structures of the newly synthesized compounds were elucidated based on elemental analysis, spectral data, and alternative synthetic routes whenever possible. Additionally, the newly synthesized compounds were screened for antimicrobial activity against various microorganisms.

Conclusions: A new series of novel functionalized 1,3,4-thiadiazoles, 1,3-thiazoles, and pyrazoline-containing moieties were synthesized using hydrazonoyl halides as precursors and evaluated for their in vitro antibacterial, and antifungal activities. The antimicrobial results of the examined compounds revealed promising results and some derivatives have activities similar to the references used.
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http://dx.doi.org/10.1186/s13065-019-0566-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661803PMC
December 2019

New evidence-based diagnostic and management strategies for placenta accreta spectrum disorders.

Best Pract Res Clin Obstet Gynaecol 2019 Nov 30;61:75-88. Epub 2019 Apr 30.

Nuffield Department of Women's and Reproductive Health, University of Oxford, and the Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK.

The increasing incidence of caesarean delivery (CD) has resulted in an increase in placenta accreta spectrum (PAS), adversely impacting maternal outcomes globally. Currently, more than 90% of women diagnosed with PAS present with a placenta praevia (praevia PAS). Praevia PAS can be reliably diagnosed antenatally with ultrasound, and it is unclear whether magnetic resonance imaging improves diagnosis beyond what can be achieved by skilled ultrasound operators. Therefore, any screening programme for PAS will require improved training in the diagnosis of placental disorders and development of targeted scanning protocols. Management strategies for praevia PAS vary depending on the accuracy of prenatal diagnosis, findings at laparotomy and local surgical expertise. Current epidemiological data for PAS are highly heterogeneous, mainly due to wide variation in the clinical criteria used to diagnose the condition at birth. This significantly impacts research into all aspects of the condition, especially comparison of the efficacy of different management strategies.
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http://dx.doi.org/10.1016/j.bpobgyn.2019.04.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929563PMC
November 2019

Proteome Changes Paralleling the Olfactory Conditioning in the Forager Honey Bee and Provision of a Brain Proteomics Dataset.

Proteomics 2019 07 24;19(13):e1900094. Epub 2019 Jun 24.

Paracelsus Private Medical University, Salzburg, A-5020, Austria.

The olfactory conditioning of the bee proboscis extension reflex (PER) is extensively used as a paradigm in associative learning of invertebrates but with limited molecular investigations. To investigate which protein changes are linked to olfactory conditioning, a non-sophisticated conditioning model is applied using the PER in the honeybee (Apis mellifera). Foraging honeybees are assigned into three groups based on the reflex behavior and training: conditioned using 2-octanone (PER-conditioned), and sucrose and water controls. Thereafter, the brain synaptosomal proteins are isolated and analyzed by quantitative proteomics using stable isotope labeling (TMT). Additionally, the complex proteome dataset of the bee brain is generated with a total number of 5411 protein groups, including key players in neurotransmitter signaling. The most significant categories affected during olfactory conditioning are associated with "SNARE interactions in vesicular transport" (BET1 and VAMP7), ABC transporters, and fatty acid degradation pathways.
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http://dx.doi.org/10.1002/pmic.201900094DOI Listing
July 2019

Moderate differences in common feeding diets change lipid composition in the hippocampal dentate gyrus and affect spatial cognitive flexibility in male rats.

Neurochem Int 2019 09 30;128:215-221. Epub 2019 Apr 30.

Paracelsus Medical University, 5020, Salzburg, Austria. Electronic address:

There is growing evidence that lipids play a fundamental role in neuronal plasticity and learning and memory. Effects of nutrition on brain lipid composition and neuronal functioning are known, but the feeding interventions are often severe and may not reflect nutritional effects below clinical relevance. Therefore, we tested two commercially available rat feeding diets with only moderate differences in the food compositions, a standard diet (gross energy metabolizable 12.8 MJ/kg) and a energy reduced diet (gross energy metabolizable 8.9 MJ/kg) on possible effects upon dentate gyrus lipid composition, spatial learning and memory in a water maze and corticosterone release (blood serum concentrations) in adult male rats. Rats were fed with the standard diet up to an age of 8 weeks. One group was further fed with the standard and another with the energy reduced diet until an age of 5 months. We did not found differences in serum corticosterone levels. We found group differences in a variety of lipids in the hippocampal dentate gyrus.. Most of the lipid levels were lower in energy reduced diets, namely glycerophosphoethanolamines, sphingomyelins and hexosyceramides, whereas some ceramides (Cer18:0 and Cer24:1) and glycerophosphocholines (PC34:3 and PC36:2) were upregulated compared to the standard diet group. The performance in a common reference memory water maze task was not different between groups, however during reversal learning (platform in a different position) after the initial training, the standard diet fed rats learned better and spatial memory was improved compared to the energy reduced diet group. Thus, moderate differences in feeding diets have effects specifically upon spatial cognitive flexibility. Possible relations between differences in lipid composition and cognitive flexibility are discussed.
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http://dx.doi.org/10.1016/j.neuint.2019.04.017DOI Listing
September 2019

The prevalence of combined vascular endothelial growth factor, endothelial nitric oxide synthase and thrombin-activatable fibrinolysis inhibitor genetic polymorphisms among Egyptian patients with recurrent spontaneous abortion.

J Obstet Gynaecol Res 2019 Jun 10;45(6):1106-1113. Epub 2019 Apr 10.

Department of Obstetrics and Gynecology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.

Aim: As angiogenesis is an essential step for chorionic villi formation. Vascular endothelial growth factor (VEGF) is essential for endothelial cell proliferation. Endothelial nitric oxide synthase (eNOS) is a powerful playmaker in hypoxia-induced angiogenesis. Thrombin-activatable fibrinolysis inhibitor (TAFI) regulates both fibrinolysis and inflammation. Genetic alterations of these factors may lead to recurrent spontaneous abortion (RSA). We aimed to investigate the combined genetic variants of VEGF G-1154A and two eNOS genetic variants: T-786C promoter region and intron 4 variable number of tandom repeats in addition to TAFI C-1040T among RSA patients.

Methods: The study included 50 patients with RSA and 50 healthy controls. Polymerase chain reaction and restriction fragment length polymorphism were used for genotyping.

Results: Both genetic alterations of eNOS confirmed at least a sixfold increase of RSA risk. Interestingly, they were associated with TAFI C-1040Tgenetic variant in 21 patients, eight of them had both studied eNOS genetic alterations and TAFI C-1040Tgenetic variant, while each eNOS genetic variant associated with TAFI C-1040Tconfirmed an almost one and half fold increase risk of RSA.

Conclusion: These findings highlighted the role of eNOS and nitric oxide metabolism in RSA and opened the gate to investigate the interaction of vasoconstrictive and fibrinolytic inhibitor systems.
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http://dx.doi.org/10.1111/jog.13961DOI Listing
June 2019

Reply to the comments on "Modified hysterectomy for placenta increta and percreta: modifications of what?"

Arch Gynecol Obstet 2019 06 20;299(6):1753-1755. Epub 2019 Mar 20.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

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http://dx.doi.org/10.1007/s00404-019-05118-8DOI Listing
June 2019

Modified cesarean hysterectomy technique for management of cases of placenta increta and percreta at a tertiary referral hospital in Egypt.

Arch Gynecol Obstet 2019 03 4;299(3):695-702. Epub 2019 Jan 4.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt.

Purpose: To evaluate the effect of a modified type II radical hysterectomy on maternal morbidities and mortality in cases with abnormally invasive placenta (AIP).

Methods: 63 cases with AIP were managed at one of the largest referral centers in Egypt in a prospective study design. This technique entails devascularization of the uterus laterally on both sides and to clamp the uterus at the lowest possible point just below the level of the placenta while sparing the ureters.

Results: The difference between pre- and post-operative hemoglobin was only about 1 gm/dl, and the mean blood loss was 1673 ± 958 ml. There was a significant drop in the post-operative need for blood and blood product replacement, packed red blood cells (p = 0.013), fresh red blood cells (p < 0.001), and plasma units (p = 0.012). Operative time (skin to skin) averaged 190 ± 58.2 min as the technique is slow and utilizes meticulous hemostatic steps. ICU admission was 4.8% with a mean total hospital stay of 8.6 ± 3.6 days. Histopathological examination revealed 58 cases of placenta increta and five percreta cases. We also had 16 bladder injuries (25.4%) and two ureteric injuries, and no maternal mortalities.

Conclusion: This technique reduces maternal morbidity and mortality while performing cesarean hysterectomy for cases with AIP.
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http://dx.doi.org/10.1007/s00404-018-5027-7DOI Listing
March 2019

Mesenchymal Stem Cell-Derived Exosomes Ameliorated Diabetic Nephropathy by Autophagy Induction through the mTOR Signaling Pathway.

Cells 2018 Nov 22;7(12). Epub 2018 Nov 22.

Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Cairo 11562, Egypt.

Background: Diabetic nephropathy (DN) is a serious complication of diabetes mellitus and a common cause of end-stage renal disease. Autophagy has a defensive role against kidney damage caused by hyperglycemia. Mesenchymal stem cell (MSC)-derived exosomes are currently considered as a new promising therapy for chronic renal injury. However, the renal-protective mechanism of exosomes on DN is not completely understood. We examined the potential role of MSC-derived exosomes for enhancement of autophagy activity and their effect on DN. In our study, we used five groups of rats: control; DN; DN treated with exosomes; DN treated with 3-methyladenine (3-MA) and chloroquine (inhibitors of autophagy); and DN treated with 3-methyladenine (3-MA), chloroquine, and exosome groups. We assessed renal function, morphology, and fibrosis. Moreover, ratios of the autophagy markers mechanistic target of rapamycin (mTOR), Beclin-1, light chain-3 (LC3-II), and LC3-II/LC3-I were detected. Additionally, electron microscopy was used for detection of autophagosomes.

Results: Exosomes markedly improved renal function and showed histological restoration of renal tissues, with significant increase of LC3 and Beclin-1, and significant decrease of mTOR and fibrotic marker expression in renal tissue. All previous effects were partially abolished by the autophagy inhibitors chloroquine and 3-MA.

Conclusion: We conclude that autophagy induction by exosomes could attenuate DN in a rat model of streptozotocin-induced diabetes mellitus.
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http://dx.doi.org/10.3390/cells7120226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6315695PMC
November 2018

Comparative Study of Orange and its Main Bioactive Constituents as Remedy for Non-alcoholic Fatty Liver in Rats.

Pak J Biol Sci 2018 Jan;21(7):359-368

Background And Objectives: Non-alcoholic fatty liver disease (NAFLD) is accused as inducer of both cardiovascular and chronic liver diseases. The aim of the present study was to evaluate the therapeutic effect of combined freeze dried orange juice with its dried pulp supplemented with methionine, as functional food, in comparison to orange bioactive constituents, as parallel formula, in NAFLD rat model.

Materials And Methods: Proximate composition, dietary fibers, minerals, total phenolics, fatty acids and phytosterols were determined in the orange functional food. The NAFLD was induced in rats through feeding high fructose diet. The prepared functional food and its parallel formula were evaluated in NAFLD rats through determination of liver fat and plasma lipid profile, malondialdehyde, tumor necrosis factor-α, leptin, insulin and glucose as well as liver and kidney function with histopathological examination of the liver. Insulin resistance (IR) and total cholesterol/high density lipoprotein cholesterol were calculated.

Results: Orange functional food was shown to contain 9.17% dietary fibers, 1.4% potassium, 1.4 phenolic content as mg gallic acid/g, oleic acid as the major fatty acid (29.75% of total fatty acids) and 11.97% phytosterols from unsaponifiable matter. The studied formulas produced reduction of liver and plasma lipids, inflammatory and oxidative stress biomarkers, IR and leptin with improving liver function and histopathology pointing to potential management of NAFLD.

Conclusion: Orange functional food and its parallel formula were promising in management of NAFLD; with superiority to orange functional food. Phenolic compounds, dietary fibers, phytosterols and mono and poly-unsaturated fatty acids could be responsible to the bioactivity of orange formula.
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http://dx.doi.org/10.3923/pjbs.2018.359.368DOI Listing
January 2018

Health Benefits of Fennel, Rosemary Volatile Oils and their Nano-Forms in Dyslipidemic Rat Model.

Pak J Biol Sci 2018 Jan;21(7):348-358

Background And Objective: Dyslipidemia is a major health problem that may lead to cardiovascular diseases (CVDs). In the present research, a biological experiment was run on dyslipidemic rats to study the health benefits of the volatile oils (VOs) of fennel and rosemary in its original and nano-form using chitosan as carrier.

Materials And Methods: Rats were divided into 6 groups; normal control, dyslipidemic control and 4 test groups with dyslipidemia and treated by VOs of fennel and rosemary and their respective nano-forms separately. Glucose tolerance test was carried out after 4 weeks. Parameters reflecting oxidative stress/antioxidant plasma catalase, malondialdehyde (MDA) and blood uric acid, were assessed. Plasma lipid profile and tumor necrosis factor alpha (TNF-α) as inflammatory biomarker were determined. Liver and kidney function were assessed as determinant of the safety of the different VO forms. Twenty four hour urinary volume was measured to assess creatinine clearance and to evaluate the possible diuretic activity of the VOs.

Results: Dyslipidemic control rats showed dyslipidemia, increased CVDs risk, liver dysfunction, elevated MDA and TNF-α with marked increase in blood sugar after half an hour of glucose ingestion compared to normal control. Treatment with the four VOs forms improved the majority of the biochemical parameters.

Conclusion: All treatment showed cardio and hepato- protective effect and safety towards kidney and blood sugar. Oxidative stress and inflammatory biomarkers were significantly improved by the different treatments; both VO forms of fennel were more efficient in ameliorating inflammation.
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http://dx.doi.org/10.3923/pjbs.2018.348.358DOI Listing
January 2018

Moderate Differences in Feeding Diets Largely Affect Motivation and Spatial Cognition in Adult and Aged but Less in Young Male Rats.

Front Aging Neurosci 2018 15;10:249. Epub 2018 Aug 15.

Center for Brain Research, Medical University of Vienna, Vienna, Austria.

Nutrition can have significant effects on behavior and cognitive processes. Most of the studies related to this use extremely modified diets, such as high fat contents or the exclusion of distinct components needed for normal development and bodily homeostasis. Here we report significant effects of diets with moderate differences in compositions on food rewarded spatial learning in young (3-4 months), adult (6-7 months), and aged (17-18 months) rats. Young rats fed with a lower energy diet showed better performance only during aquisition of the spatial task when compared to rats fed with a standard diet. Adult rats (6-7 months) fed with a standard diet performed less well in the spatial learning task, than rats fed with lower energy diet. Aged rats fed with a lower energy diet (from 13 to 18 months of age) performed better during all training phases, as in a previous test when they were adult and fed with a standard diet. This difference could only be partly explained by lower motivation to search for food in the first test. Correspondingly, the variability of individual performance was significantly higher and increased over trials in adult rats fed with the standard diet as compared to adult rats fed with lower energy diet. Thus, moderate changes in feeding diets have large effects on motivation and cognition in elderly and less in young rats in a food rewarded spatial learning task. Therefore, nutrition effects upon food rewarded spatial learning and memory should be considered especially in aging studies.
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http://dx.doi.org/10.3389/fnagi.2018.00249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6104161PMC
August 2018

Spectrum of Gastrointestinal Manifestations in Joint Hypermobility Syndromes.

Am J Med Sci 2018 Jun 5;355(6):573-580. Epub 2018 Mar 5.

Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas. Electronic address:

Joint hypermobility is a common, primarily benign finding in the general population. However, in a subset of individuals joint hypermobility causes a range of clinical problems mainly affecting the musculoskeletal system and, to a lesser extent, extra-articular disorders. Joint hypermobility often appears as a familial trait and is shared by several inherited connective tissue disorders, including the hypermobility subtype of Ehlers-Danlos syndrome (hEDS) and benign joint hypermobility syndrome (BJHS/JHS). Although joint hypermobility has primarily been thought of as a rheumatological disorder, increasing evidence shows significant associations between both hEDS and BJHS with specific extra-articular disorders. To date, the strongest associations of these 2 conditions are with anxiety disorders, orthostatic tachycardia, various functional gastrointestinal (GI) disorders and pelvic and bladder dysfunction. This review article focuses on GI disorders associated with both hEDS and BJHS. The aim of this review is to evaluate existing research and literature regarding associations between JHS (hEDS/BJHS) and GI disorders. Our goal is to raise awareness of BJHS/JHS and hEDS as an explanation for chronic unexplained symptoms and functional GI disorders as well as to review the current standard tests available for proper evaluation of GI symptoms in these patients.
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http://dx.doi.org/10.1016/j.amjms.2018.03.001DOI Listing
June 2018

Changes in serum prolactin level during intracytoplasmic sperm injection, and effect on clinical pregnancy rate: a prospective observational study.

BMC Pregnancy Childbirth 2018 May 9;18(1):141. Epub 2018 May 9.

Obstetrics and Gynecology Department, Cairo University, P.O. Box: 11562, KasrAlainy St., Garden City, Cairo, Egypt.

Background: Transient hyperprolactinemia was proven to adversely affect the outcome of IVF. We aimed to identify changes in serum prolactin levels in patients undergoing ICSI, and to evaluate the effect of these changes on the clinical pregnancy rate.

Methods: A prospective observational study included 90 patients scheduled for ICSI cycles. In each case 4 serum samples were collected during the cycle (midluteal, before ovum pick up procedure (OPU), 2 h after OPU, and before embryo transfer). Serum prolactin level was determined by immunoassay each time.

Results: The sample collected 2 h after OPU had a mean difference of 25.8 ± 2.8 ng/ml compared to the basal serum prolactin (p < 0.01). In comparison to other samples, this highlighted a significant hyperprolactinemia occurring after OPU, and resolving before embryo transfer. No statistically significant difference between the different serum prolactin samples amongst the pregnant and non pregnant patients. There was a significant positive pearson correlation between the prolactin levels before OPU, and the presence of higher quality embryos (r = 0.274, p = 0.019).

Conclusion: In normoprolactinemic women transient hyperprolactinemia is identified in patients undergoing ICSI, and it doesn't affect the clinical pregnancy rates. A positive correlation was identified between higher quality embryos, and serum prolactin level before OPU.

Trial Registration: ClinicalTrials.gov Identifier: NCT02292953 , First received: November 10, 2014.
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http://dx.doi.org/10.1186/s12884-018-1783-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5941656PMC
May 2018

The role of prophylactic internal iliac artery ligation in abnormally invasive placenta undergoing caesarean hysterectomy: a randomized control trial.

J Matern Fetal Neonatal Med 2019 Oct 25;32(20):3386-3392. Epub 2018 Apr 25.

a Department of Obstetrics and Gynaecology , Cairo University , Cairo , Egypt.

To identify the role of bilateral internal iliac artery (IIA) ligation on reducing blood loss in abnormally invasive placenta (AIP) undergoing caesarean hysterectomy. In this parallel-randomized control trial, 57 pregnant females with ultrasound features suggestive of AIP were enrolled. They were randomized into two groups; IIA group ( = 29 cases) performed bilateral IIA ligation followed by caesarean hysterectomies, while Control group ( = 28 cases) underwent caesarean hysterectomy only. The main outcome was the difference in the estimated intraoperative blood loss between the two groups. There was no significant difference between the two groups regarding the intraoperative estimated blood loss (1632 ± 804 versus 1698 ± 1251, value .83). The operative procedure duration (minutes) (223 ± 66 versus 171 ± 41.4, value .001) varied significantly between the two groups. Bilateral internal iliac artery ligation, in cases of AIP undergoing caesarean hysterectomy, is not recommended for routine practice to minimize blood loss intraoperatively.
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http://dx.doi.org/10.1080/14767058.2018.1463986DOI Listing
October 2019

Effect of intramural fibroid on uterine and endometrial vascularity in infertile women scheduled for in-vitro fertilization.

Arch Gynecol Obstet 2018 02 14;297(2):539-545. Epub 2017 Dec 14.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, 11431, Egypt.

Purpose: To study the effect of intramural fibroids on uterine and endometrial vascularity in infertile women scheduled for in-vitro fertilization (IVF).

Methods: 3D power Doppler was used to measure the endometrial volume and blood flow indices in 182 women with intramural fibroids not affecting the uterine cavity and compared them to a matched control group without fibroids.

Results: There was significantly increased vascularity in the endometrium of the fibroid group as denoted by higher endometrial VI (p = 0.018), FI (p = 0.027) and Endometrial VFI. No significant difference in mean uterine artery RI (p = 0.277) or PI (p = 0.187). Among the fibroid group 62.6% had a fibroid > 4 cm. Women with fibroids > 4 cm had a significantly higher Endometrial FI (p = 0.037), and VFI (p = 0.02). Uterine artery blood flow was not affected, as uterine RI (p = 0.369) and PI (p = 0.321) were not statistically different. Compared with the control group (non fibroid), women with fibroids > 4 cm had significantly higher endometrial VI (p = 0.013), FI (p = 0.004), and VFI (p < 0.001), whereas women with fibroid ≤ 4 cm had no statistically significant differences in VI (p = 0.292), FI (p = 0.198), and VFI (p = 0.304).

Conclusion: Intramural fibroids > 4 cm significantly increase endometrial vascularity. This increase in blood flow may be a factor that affects the outcome of IVF.
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http://dx.doi.org/10.1007/s00404-017-4607-2DOI Listing
February 2018

Manual removal versus spontaneous delivery of the placenta at cesarean section in developing countries: a randomized controlled trial and review of literature.

J Matern Fetal Neonatal Med 2018 12 30;31(24):3308-3313. Epub 2017 Aug 30.

a Department of Obstetrics and Gynecology, Faculty of Medicine , Cairo University , Cairo , Egypt.

Purpose: Cesarean section (CS) rates have increased; this is especially concerning in developing countries. The mode of placental delivery contributes to morbidity associated with CS and determines blood loss during CS. We aimed to compare manual removal versus spontaneous delivery of the placenta at CS.

Methods: In a randomized controlled trial, 574 women admitted for primary or repeat elective CS were randomized into two groups. In group A, the placenta was manually removed, whereas in group B, the placenta was left for spontaneous delivery. Blood loss, operative and postoperative data were recorded.

Results: Blood loss was 875.2 ± 524.2 ml in group A versus 731.8 ± 426.7 ml in group B (p = .001), with a significant drop in postoperative HB (p = .015) and HCT (p = .031). In group A, odds ratios for blood loss (>1000 ml), HB drop (> 4g/dl), postpartum hemorrhage and blood transfusion were 2.581, 2.850, 2.614 and 1.665, respectively. However, the total operative time (p = .326), duration of hospital stay (p = .916) and intensive care unit (ICU) admission (p = .453) were not statistically different between the two groups.

Conclusions: Manual removal of the placenta at CS is associated with a higher risk of blood loss, postpartum hemorrhage and blood transfusion, with no decrease in operative time.
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http://dx.doi.org/10.1080/14767058.2017.1369522DOI Listing
December 2018

Effect of oral contraceptives on balance in women: A randomized controlled trial.

Taiwan J Obstet Gynecol 2017 Aug;56(4):463-466

Physical Therapy Department, Cairo University, Egypt. Electronic address:

Objective: To detect the effect of combined oral contraceptive pills (COC) on dynamic postural balance in healthy middle aged women.

Materials And Methods: A prospective randomized controlled study included 200 patients classified into two groups. Group I received COC containing 30 μg of EE and 3 mg of drospirenone for 12 consecutive cycles and Group II received no treatment. Overall, medio-lateral and antero-posterior stability were measured using Biodex system after 12 months.

Results: There was a highly statistically significant difference between the 2 study groups regarding estradiol level (12.84 ± 1.96 vs. 38.86 ± 3.99, P value < 0.001) and progesterone level (0.52 ± 0.25 vs. 11.64 ± 4.53, P value < 0.001). There was a highly statistically significant difference between the 2 study groups regarding mediolateral stability (1.84 ± 0.23 vs. 2.40 ± 0.56, P value < 0.001), antereoposterior stability (1.91 ± 0.29 vs. 2.33 ± 0.61, P value < 0.001) or overall stability (2.42 ± 0.29 vs. 2.95 ± 0.53, P value < 0.001).

Conclusion: COC are effective method of contraception to improve postural balance and decrease risk of injury in normal and athletic women. NCT02855294.
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http://dx.doi.org/10.1016/j.tjog.2017.02.003DOI Listing
August 2017

A novel heterocyclic compound improves working memory in the radial arm maze and modulates the dopamine receptor D1R in frontal cortex of the Sprague-Dawley rat.

Behav Brain Res 2017 08 16;332:308-315. Epub 2017 Jun 16.

Neuroproteomics Laboratory, Science Park, Ilkovicova 8, SK-84104 Bratislava, Slovakia. Electronic address:

A series of compounds have been shown to enhance cognitive function via the dopaminergic system and indeed the search for more active and less toxic compounds is continuing. It was therefore the aim of the study to synthetise and test a novel heterocyclic compound for cognitive enhancement in a paradigm for working memory. Specific and effective dopamine re-uptake inhibition DAT (IC50=4,1±0,8μM) made us test this compound in a radial arm maze (RAM) in the rat. CE-125 (4-((benzhydrylsulfinyl)methyl)-2-cyclopropylthiazole), was tested for dopamine (DAT), serotonin and norepinephrine re-uptake inhibition by a well-established system. The working memory index (WMI) was evaluated in male Sprague Dawley rats that were intraperitoneally injected with CE-125 (1 or 10mg/kg body weight). In order to evaluate basic neurotoxicity, the open field, elevated plus maze, rota rod studies and the forced swim test were carried out. Frontal cortex was taken at the last day of the RAM test and dopamine receptors D1R and D2R, DAT and phosphorylated DAT protein levels were determined. On the 10th day both doses were increasing the WMI as compared to the vehicle-treated group. In both, trained and treated groups, D1R levels were significantly reduced while D2R levels were unchanged. DAT levels were comparable between all groups while phosphorylated DAT levels were increased in the trained group treated with 1mg/kg body weight. CE-125 as a probably non-neurotoxic compound and specific reuptake inhibitor was shown to increase performance (WMI) and modulation of the dopaminergic system is proposed as a possible mechanism of action.
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http://dx.doi.org/10.1016/j.bbr.2017.06.023DOI Listing
August 2017

Can AMH levels predict the need for increased medication during IVF/ICSI in PCOS women?

J Matern Fetal Neonatal Med 2018 Jan 12;31(1):32-38. Epub 2017 Jan 12.

a Obstetrics and Gynecology department , Cairo University , Cairo , Egypt.

Purpose: To investigate the ability of anti-Mullerian hormone (AMH) to predict the step up of human menopausal gonadotropins (HMG) dose in women with polycystic ovarian syndrome (PCOS) undergoing IVF/ICSI cycles.

Methods: AMH was drawn before ovulation induction in 976 PCOS women scheduled for IVF/ICSI. After all cycles ended, a receiver operating characteristic (ROC) curve analysis was done to investigate the ability of AMH to predict step up of the HMG.

Results: The area under the curve (AUC) was 0.820 95%CI (0.792-0.848), and a cutoff value of 4.6 ng/ml (sensitivity 74%, specificity 82%) for AMH was taken (p < 0.01). Cases were divided into two groups retrospectively; group (A) (AMH ≤4.6 ng/ml), and group (B) (AMH >4.6 ng/ml). No difference in the mean age (p = 0.147); BMI (p = 0.411), basal FSH (p = 0.221), and starting dose (p = 0.195); however, the dose at which the first response occurred was higher in group (B) (p < 0.01). The total dose and number of days were higher in group (B) (both p < 0.01) irrespective of the PCOS subtype or androgen levels. Severe OHSS was also higher in group (B) (p = 0.026).

Conclusions: PCOS with AMH >4.6 ng/ml are resistant to HMG stimulation, require dose step up during ART cycles, and are at higher risk for severe OHSS.
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http://dx.doi.org/10.1080/14767058.2016.1272567DOI Listing
January 2018

Effect of ovarian endometrioma on uterine and ovarian blood flow in infertile women.

Int J Womens Health 2016 28;8:677-682. Epub 2016 Nov 28.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background: Angiogenesis has been found to be among the most important factors in the pathogenesis of endometriosis. The formation of new blood vessels is critical for the survival of newly implanted endometriotic foci. The use of 3-D power Doppler allows for the demonstration of the dynamic vascular changes that occur during the process of in vitro fertilization (IVF). We aimed to evaluate the effect of ovarian endometrioma on uterine and ovarian blood flow in infertile women.

Materials And Methods: In a case-control study at a university teaching hospital, 138 women with unilateral ovarian endometrioma scheduled for IVF were compared to 138 women with male-factor or unexplained infertility. In the mid-luteal (peri-implantation) phase of the cycle, endometrial thickness, uterine and ovarian artery pulsatility index and resistance index, endometrial and ovarian volume, 3-D power Doppler vascularization index (VI), flow index (FI), and vascularization FI (VFI) values were measured in both groups.

Results: There were no significant differences (>0.05) in endometrial thickness, uterine ovarian artery pulsatility index and resistance index, endometrial and ovarian volume, or VI, FI, and VFI between the two groups. Furthermore, the endometrial and ovarian Doppler indices were not influenced by endometrioma size. No significant differences were observed in the ovarian Doppler indices between endometrioma-containing ovaries and contralateral ovaries.

Conclusion: Ovarian endometrioma is not associated with impaired endometrial and ovarian blood flows in infertile women scheduled for IVF, and it is not likely to affect endometrial receptivity or ovarian function through a vascular mechanism.
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http://dx.doi.org/10.2147/IJWH.S124229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135397PMC
November 2016