Publications by authors named "Magdy Ibrahim"

15 Publications

  • Page 1 of 1

Correlation of Implant Stability Between Two Noninvasive Methods Using Submerged and Nonsubmerged Healing Protocols: A Randomized Clinical Trial.

J Oral Implantol 2020 Dec;46(6):571-579

Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Various invasive and noninvasive methods have been used for measuring primary implant stability. Periotest damping device and resonance frequency analysis with the Osstell device have been classified as noninvasive methods. Primary and secondary implant stability measurements using both devices have given reproducible quantitative values. In this clinical randomized trial, a general correlation was evaluated between the implant stability recorded using both Osstell and Periotest devices on the day of implant installation and 3 months after healing for the submerged and nonsubmerged loading protocols. The present study also investigated whether the difference in gender of the included patients would have an effect on the correlation between the two devices. Eighty completely edentulous patients were recruited, and all patients ranged from 50 to 69 years of age. Overall, 56 men and 24 women were included, with a mean age of 62.5 years for men and 59.6 years for women. A single implant was installed in the midline of the completely edentulous mandible to improve retention of the patient's lower denture. After implant installation, one implant stability quotient (ISQ) value at the buccal surface was recorded, and then the Periotest M device was used to measure the damping effect (Periotest value [PTV]) of the installed implant using the smart peg screwed to the implant. Patients were then randomized into 2 groups using sealed envelopes: the submerged and nonsubmerged groups. For both groups, all ISQ and Periotest readings were recorded in the patient's case report file on the day of implant installation and 3 months after healing. When the ISQ of the buccal surface was correlated to the PTV, there was a moderate negative statistically significant correlation between the 2 readings (correlation coefficient = -.466, P = .000). There tended to be a weak negative correlation between the 2 devices in the male group (correlation coefficient = .395, P = .046) during implant installation, although there tended to be no correlation between the 2 devices in the female group (correlation coefficient = -.367, P = .342). After 3 months of healing, when correlating the readings of the buccal surface of the Osstell with that of the Periotest within each group (submerged and nonsubmerged), there was no statistically significant correlation between the readings within each group (correlation coefficient = -.014, -.430, P = .942, P = .052, respectively). However, there was a strong negative statistically significant correlation between the 2 devices for the female group for both the nonsubmerged group (correlation coefficient = -.823, P = .003) and submerged group (correlation coefficient = -.857, P = .014), whereas there was no statistically significant correlation within the male group for both the nonsubmerged group (correlation coefficient = -.377, P = .123) and submerged group (correlation coefficient = -.022, P = .940). The correlation between the Osstel and Periotest device remains controversial. The present study concluded that there is a significant negative correlation between the 2 devices when recording primary implant stability, although this significance is lost after 3 months of loading when recording secondary implant stability. Gender also affects the implant stability recording, which is mainly due to the difference in bone density between men and women.
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http://dx.doi.org/10.1563/aaid-joi-D-19-00130DOI Listing
December 2020

The clinical impact of hepatitis C virus infection in Egyptian multiple myeloma patients.

J Egypt Natl Canc Inst 2020 Nov 27;32(1):43. Epub 2020 Nov 27.

Clinical Oncology Department, School of Medicine, Cairo University, Cairo, Egypt.

Background: Multiple myeloma (MM) is a human B cell neoplasia characterized by the clonal proliferation of malignant plasma cells in the bone marrow. Worldwide, hepatitis C virus (HCV) infection is a public health problem. For MM patients, the clinical impact of preexisting HCV infection is still unclear. We aim to assess the clinical characteristics and the prevalence of the HCV infection in Egyptian MM patients. This observational study included 81 MM patients. HCV antibody assay was performed, and positive cases were confirmed using a reverse transcription-quantitative PCR (RT-PCR) method.

Results: Fifteen (18.5%) patients were anti-HCV antibody positive. Only 6/15 (7.4%) patients were HCV RNA positive by RT-PCR. Liver affection in the form of hyperbilirubinemia with grade 4 adverse events was significantly higher in the anti-HCV positive/HCV RNA positive group versus anti HCV negative group (16.7% vs. 1.5%, p value = 0.005). The median HCV-RNA before the initiation of chemotherapy was 2.5 log IU/ml with mean ± SD = 4.25 ± 1.6 with no HCV reactivation. In the univariate and multivariate analysis, HCV infection was not an independent factor related to DFS. Low hemoglobin level < 10 g/dL (HR 0.59, 95% CI, 0.36-0.97, p value = 0.037) and abnormal serum total bilirubin level (HR 1.9, 95% CI 1.03-3.5, p value = 0.039) influenced DFS in the univariate analysis. However, in the multivariate analysis, serum calcium level greater than 12 mg/dL (HR 7.04, 95% CI 1.12-44.45, p value = 0.038) and abnormal serum total bilirubin level (HR 10.9, 95% CI 2.92-41.02, p value = < 0.001) remained statistically significant worse prognostic factors.

Conclusion: In conclusion, our study revealed the prevalence of HCV infection in Egyptian MM patients. Serologic tests at diagnosis are necessary to identify these patients, and confirmation of positive cases by molecular techniques should be mandatory, with regular follow-up for liver dysfunction. Finally, further larger studies explaining the molecular mechanisms linking HCV and the MM pathogenesis are warranted.
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http://dx.doi.org/10.1186/s43046-020-00054-0DOI Listing
November 2020

Non-ionic Surfactant Based In Situ Forming Vesicles as Controlled Parenteral Delivery Systems.

AAPS PharmSciTech 2018 Apr 6;19(3):1001-1010. Epub 2017 Nov 6.

Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt, End of 90th street, Fifth settlement, New Cairo, Egypt.

Non-ionic surfactant (NIS) based in situ forming vesicles (ISVs) present an affordable alternative to the traditional systems for the parenteral control of drug release. In this work, NIS based ISVs encapsulating tenoxicam were prepared using the emulsion method. Tenoxicam-loaded ISVs were prepared using a 2.3 full factorial experimental design, where three factors were evaluated as independent variables; type of NIS (A), molar ratio of NIS to Tween®80 (B), and phase ratio of the internal ethyl acetate to the external Captex® oil phase (C). Percentage drug released after 1 h, particle size of the obtained vesicles and mean dissolution time were chosen as the dependent variables. Selected formulation was subjected to morphological investigation, injectability, viscosity measurements, and solid state characterization. Optimum formulation showed spherical nano-vesicles in the size of 379.08 nm with an initial drug release of 37.32% in the first hour followed by a sustained drug release pattern for 6 days. DSC analysis of the optimized formulation confirmed the presence of the drug in an amorphous form with the nano-vesicles. Biological evaluation of the selected formulation was performed on New Zealand rabbits by IM injection. The prepared ISVs exhibited a 45- and 28-fold larger AUC and MRT values, respectively, compared to those of the drug suspension. The obtained findings boost the use of ISVs for the treatment of many chronic inflammatory conditions.
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http://dx.doi.org/10.1208/s12249-017-0897-8DOI Listing
April 2018

Synthesis, molecular, electronic structure, linear and non-linear optical and phototransient properties of 8-methyl-1,2-dihydro-4H-chromeno[2,3-b]quinoline-4,6(3H)-dione (MDCQD): Experimental and DFT investigations.

Spectrochim Acta A Mol Biomol Spectrosc 2018 Feb 5;191:478-490. Epub 2017 Oct 5.

Department of Chemistry, Faculty of Education, Ain Shams University, Roxy, 11711, Cairo, Egypt.

Base catalysed ring opening ring closure (RORC) reaction of 6-methylchromone-3‑carbonitrile (1) with 1,3-cyclohexanedione afforded 8-methyl-1,2-dihydro-4H-chromeno[2,3-b]quinoline-4,6(3H)-dione (MDCQD). Theoretical calculations by Density Functional Theory (DFT) at the B3LYP/6-311G (d,p) level of theory was utilized to illustrate the equilibrium geometries of MDCQD. Also, the nonlinear optical properties, simple harmonic vibrational frequencies, thermo-chemical parameters and Mullikan atomic charges were calculated. In addition, the electronic absorption spectra in polar and non polar solvents were discussed on the basis of TD-DFT calculations. A nanofiber-like structure with high aggregation was resolved by using scanning electron microscopy images and its particle sizes were measured by particle size analyzer. The spectroscopic characteristics of the prepared thin film of MDCQD were studied in a wide spectral range of 200-2500nm. The analysis of the absorption edges affords two direct optical band gaps with energies of 1.00 and 2.76eV. A characteristic emission peak of photoluminescence spectrum in the visible region was detected and has a red-shift as a result of solvent polarity. The MDCQD film based heterojunction showed rectification behavior and diode-like characteristics. The photovoltaic characteristics under illumination of 100mW/cm were studied. The open-circuit voltage and short-circuit current were found to be 0.22V and 4.25×10A/cm, respectively. Moreover, the prepared heterojunction showed remarkable phototransient characteristics which afford the probability for the operation as a photodiode.
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http://dx.doi.org/10.1016/j.saa.2017.10.014DOI Listing
February 2018

Nanoemulsion-based electrolyte triggered in situ gel for ocular delivery of acetazolamide.

Eur J Pharm Sci 2017 Jun 19;104:302-314. Epub 2017 Apr 19.

Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Misr University for Science and Technology, 6th October City, Egypt.

In the present work the antiglaucoma drug, acetazolamide, was formulated as an ion induced nanoemulsion-based in situ gel for ocular delivery aiming a sustained drug release and an improved therapeutic efficacy. Different acetazolamide loaded nanoemulsion formulations were prepared using peanut oil, tween 80 and/or cremophor EL as surfactant in addition to transcutol P or propylene glycol as cosurfactant. Based on physicochemical characterization, the nanoemulsion formulation containing mixed surfactants and transcutol P was selected to be incorporated into ion induced in situ gelling systems composed of gellan gum alone and in combination with xanthan gum, HPMC or carbopol. The nanoemulsion based in situ gels showed a significantly sustained drug release in comparison to the nanoemulsion. Gellan/xanthan and gellan/HPMC possessed good stability at all studied temperatures, but gellan/carbopol showed partial drug precipitation upon storage and was therefore excluded from the study. Gellan/xanthan and gellan/HPMC showed higher therapeutic efficacy and more prolonged intraocular pressure lowering effect relative to that of commercial eye drops and oral tablet. Gellan/xanthan showed superiority over gellan/HPMC in all studied parameters and is thus considered as a promising mucoadhesive nanoemulsion-based ion induced in situ gelling formula for topical administration of acetazolamide.
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http://dx.doi.org/10.1016/j.ejps.2017.04.013DOI Listing
June 2017

Serum Resistin Level and Its Receptor Gene Expression in Liver Biopsy as Predictors for the Severity of Nonalcoholic Fatty Liver Disease.

Euroasian J Hepatogastroenterol 2014 Jul-Dec;4(2):59-62. Epub 2014 Jul 28.

Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt.

Background: Liver histology remains the gold standard for assessing nonalcoholic fatty liver disease (NAFLD). Noninvasive serological markers have been developed to evaluate steatosis to avoid biopsy. In NAFLD patients, serum resistin was higher than those in control lean and obese patients.

Objective Of The Study: To investigate serum resistin and its receptor gene expression in liver biopsy as predictors for NAFLD severity.

Patients And Methods: This study was conducted on 54 obese patients, with suspected fatty liver by ultrasound (excluding diabetic, alcoholic, hepatitis C virus antibody (HCVAb) or hepatitis B surface antigen (HBsAg) positive patients). They were subjected to anthropometric measurements, laboratory studies including serum resistin, abdominal ultrasonography (US) and liver biopsy. The 15 lean subjects were included as a control group. According to biopsy results, patients were subdivided into nonalcoholic steatohepatitis (NASH) group (46 patients) and non-NASH group (8 patients).

Results: Significantly higher levels of resistin were detected in NAFLD patients compared to control subjects (p = 0.0001). Also, higher levels of resistin were recorded in NASH group compared to the non-NASH group; however, the difference was not statistically significant (p = 0.584). Serum alanine aspirate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase (GGT) were higher in NASH patients than non-NASH group (p = 0.223, p = 0.005 and p = 0.006 respectively). Abdominal US showed high sensitivity in NAFLD diagnosis (sensitivity of sonar in detecting steatosis grade compared to biopsy was 61% in grade 1, 25% in grade 2 and 75% in grade 3).

Conclusion: Serum resistin can be combined with other noninvasive markers to predict the presence of NASH as an alternative to liver biopsy. Hegazy M, Abo-Elfadl S, Mostafa A, Ibrahim M, Rashed L, Salman A. Serum Resistin Level and Its Receptor Gene Expression in Liver Biopsy as Predictors for the Severity of Nonalcoholic Fatty Liver Disease. Euroasian J Hepato-Gastroenterol 2014;4(2):59-62.
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http://dx.doi.org/10.5005/jp-journals-10018-1102iDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913896PMC
July 2014

Role of the levonorgestrel intrauterine system in effective contraception.

Patient Prefer Adherence 2013 9;7:777-85. Epub 2013 Aug 9.

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

Norgestrel, a synthetic progestin chemically derived from 19-nortestosterone, is six times more potent than progesterone, with variable binding affinity to various steroid receptors. The levonorgestrel-releasing intrauterine system (LNG IUS) provides a long-acting, highly effective, and reversible form of contraception, with a pearl index of 0.18 per 100 women-years. The locally released hormone leads to endometrial concentrations that are 200-800 times those found after daily oral use and a plasma level that is lower than that with other forms of levonorgestrel-containing contraception. The contraceptive effect of the LNG IUS is achieved mainly through its local suppressive effect on the endometrium, leading to endometrial thinning, glandular atrophy, and stromal decidualization without affecting ovulation. The LNG IUS is generally well tolerated. The main side effects are related to its androgenic activity, which is usually mild and transient, resolving after the first few months. Menstrual abnormalities are also common but well tolerated, and even become desirable (eg, amenorrhea, hypomenorrhea, and oligomenorrhea) with proper counseling of the patient during the choice of the method of contraception. The satisfaction rates after 3 years of insertion are high, reaching between 77% and 94%. The local effect of the LNG IUS on the endometrium and low rates of systemic adverse effects have led to its use in other conditions rather than contraception, as for the treatment of endometrial hyperplasia, benign menorrhagia, endometriosis, adenomyosis, and uterine fibroids.
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http://dx.doi.org/10.2147/PPA.S36948DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749061PMC
August 2013

A clinical evaluation of skin tags in relation to obesity, type 2 diabetis mellitus, age, and sex.

Indian J Dermatol 2011 Jul;56(4):393-7

Department of Dermatology, Faculty of Medicine, Cairo University, Egypt.

Background: Skin tags (STs) have been investigated as a marker of type 2 diabetes mellitus (DM), yet the relation of STs to obesity is still a matter of controversy.

Aim: The aim of the study is to explore the relation of number, size and color of STs to obesity, diabetes, sex and age in one study.

Methods: The study included 245 nondiabetic (123 males and 122 females) and 276 diabetic (122 males and 154 females) subjects. We recorded age, sex, body mass index (BMI), relevant habits, STs color, size, and number in different anatomical sites.

Results: The presence and the mean number of STs was more in obese than nonobese participants (P = 0.006 and P < 0.001, respectively) and was not affected by sex. However, the number increased significantly with age. The presence of mixed-color STs was related to obese (P < 0.001) participants. Multivariate logistic regression revealed that only BMI was significantly associated with the mixed-color STs (OR = 3.5, P < 0.001). The association of DM (OR = 1.7) with mixed-color STs was nonsignificant (P = 0.073). Neither age nor sex had any association with mixed-color STs. Within cases that developed mixed-color STs, the multivariate analysis showed that only BMI had a significant correlation to the number of STs (beta = 0.256, P = 0.034).

Conclusion: The study showed that not only the number but also the presence of mixed-color ST was related to obesity, but not to diabetes. The presence of mixed-color STs in nondiabetic subjects needs close inspection of BMI.
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http://dx.doi.org/10.4103/0019-5154.84765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3179001PMC
July 2011

Polymeric surfactant based etodolac chewable tablets: formulation and in vivo evaluation.

AAPS PharmSciTech 2010 Dec 7;11(4):1730-7. Epub 2010 Dec 7.

Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo, 11562, Egypt.

Etodolac (ET) is a nonsteroidal anti-inflammatory drug with proved potential antitumor and uric acid lowering effects. It shows dissolution rate-dependent bioavailability. This work was carried out to improve the dissolution rate of etodolac using three carriers of known potential to improve solubility and hence dissolution rate of poorly soluble drugs through coevaporation technique. The polymeric surfactant inutec, 2-hydroxypropyl-β-cyclodextrin, and tromethamine were used at three different drug/carrier ratios. The dissolution rate of ET at pH 1.2 and 6.8 is improved in all of the solid dispersion systems compared to that of the pure drug and physical mixtures. DSC of coevaporates at 1:5 drug/carrier ratio providing the fastest dissolution rate suggested loss of ET crystallinity which was further confirmed by X-ray diffraction. Inutec-based coevaporate was chosen for the formulation of ET chewable tablets. Chewable tablets (F3) that met the USP monograph specifications for ET tablets, with 86% dissolved amount within 15 min, was chosen for in vivo absorption study in comparison with pure ET-filled hard gelatin capsules. The results showed significantly higher mean C (max) and shorter mean T (max) (about 2 h earlier) and about 1.32-fold higher mean AUC(0-24) values for the F3 chewable tablets compared to ET-filled capsules.
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http://dx.doi.org/10.1208/s12249-010-9548-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011074PMC
December 2010

Clinical relevance of carotid atherosclerosis among Egyptians: a 5-year retrospective analysis of 4,733 subjects.

Neuroepidemiology 2010 29;35(4):275-9. Epub 2010 Sep 29.

Department of Neurology, Medical Education Development Center, Cairo University, Cairo, Egypt.

Background And Purpose: The prevalence of carotid artery stenosis has been studied in several cohorts and groups of populations. Prevalence estimates were mostly based on ultrasound studies, because duplex ultrasound is accurate, reproducible and inexpensive to diagnose and follow up patients with arterial disorders. The purpose of our study was to describe the pattern of carotid artery disease in a large sample of Egyptians.

Methods: We analyzed the data of 4,733 Egyptian subjects, who underwent extracranial carotid duplex scanning at the vascular laboratories of Cairo University Hospitals from January 1, 2003, to January 1, 2008. Demographic, clinical data and causes of referral were correlated with ultrasound findings.

Results: Atherosclerotic carotid artery disease was present in 41% of the study population in the form of intimal thickening in 835 (17.6%), <50% stenosis in 983 (20.8%), 50-69% stenosis in 81 (1.7%), ≥70% stenosis in 38 (0.8%) and occlusion of internal carotid artery in 3 (0.06%) patients. Nonatherosclerotic disease was detected in 9 (0.2%) patients only. Significant and clinically relevant stenosis ≥50% was detected in 19 (2.5%) of the atherosclerotic symptomatic subjects. Multivariate stepwise logistic regression analysis selected age, diabetes mellitus, hypertension, smoking and dyslipidemia as independent predictors of the presence of carotid atherosclerotic disease.

Conclusion: Hemodynamically significant and clinically relevant extracranial atherosclerotic carotid disease is rare among Egyptians. Risk factors for carotid atherosclerosis are the same as in societies where carotid disease is more prevalent.
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http://dx.doi.org/10.1159/000319899DOI Listing
March 2011

A study of androgen and estrogen receptors alpha, beta in skin tags.

Indian J Dermatol 2010 ;55(1):20-4

Department of Dermatology, Faculty of Medicine, Cairo University, Egypt.

Background: In women, the age of 50 is suggested to be the turning point of life at which the development of skin tags comes to a stop. A major event that occurs around this period of life is menopause/andropause. After menopause, estrogen receptors amounts decrease significantly. As skin is considered as the largest nonreproductive target on which estrogens and androgens act, we assume a possible relationship between the pathogenesis of skin tags and sex steroid balance. Another phenomenon is the association of skin tags in obese patients, which may also be explained by the interplay of sex steroids and their receptors in skin tags.

Aims: Here we see that in obese patients, hyperandrogenism occurs as a result of hyperinsulinemia as well as peripheral conversion of estrogens into androgens in the excessive adipose tissue. To examine the possible role of androgen and estrogen receptors in etiopathogenesis of skin tags.

Materials And Methods: To examine these hypotheses, we measured the level of androgen and estrogen receptors (both alpha and beta) in skin tags compared to control. We also correlated the level of receptors to body mass index, and compared those levels in patients with acanthosis nigricans compared to normal.

Results: The level of estrogen receptors (both alpha and beta) was significantly higher in skin tags than in controls with a P value of 0.004 and 0.001, respectively. The same upsurge was found for androgen receptors in skin tags relative to control with a P value of 0.001. No statistically significant difference in receptor level was found either among patients with acanthosis nigricans and those without, or in correlation to body mass index (our participants were overweight non diabetic).

Conclusion: These results suggest the possible role of androgen and estrogen receptors in etiogenesis of skin tags, and propose that the neck is an androgen dependent area just similar to the axillae and the groins, though hairless.
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http://dx.doi.org/10.4103/0019-5154.60345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856367PMC
June 2010

Treatment of periocular hyperpigmentation due to lead of kohl (surma) by penicillamine: a single group non-randomized clinical trial.

Indian J Dermatol 2009 ;54(4):361-3

Department of Dermatology, Research Biostatistics Unit, Management Team, EBM Unit, MEDC, Cairo University, Egypt.

Background: Periocular hyperpigmentation is a condition in which skin of eyelids become darker in color than the normal surrounding skin. Lead and other heavy metals produce increased pigmentation because of deposition of metal particles in the dermis and increased epidermal melanin production.

Aims: This study was conducted to evaluate the dual effect of chelation therapy in treating periocular hyperpigmentation and lead toxicity.

Methods: The study population consisted of nine females complaining from dark coloration of their eyelids. The nine females were continuously using kohl as eyeliner. Lead levels in conjunctiva and serum before and after D-penicillamine (D-PCN) oral administration were estimated in relation to vertical, horizontal length, and degree of hyperpigmentation score.

Results: Highly significant P values (0.000) were obtained as regard to the conjunctival lead levels, serum lead levels, horizontal length, and degree of darkness score before and after D-PCN therapy. A less significant P value (0.040) was recorded as regard to the vertical length.

Conclusion: Regardless other causes, this study spots the light on a new concept for periocular hyperpigmentation from lead toxicity in adult females using kohl and suggests D-PCN in a low divided dose (750 mg/day) for its treatment.
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http://dx.doi.org/10.4103/0019-5154.57614DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807714PMC
June 2010

Usefulness of aspirin therapy in high-risk pregnant women with abnormal uterine artery Doppler ultrasound at 14-16 weeks pregnancy: randomized controlled clinical trial.

Croat Med J 2005 Oct;46(5):826-31

Kasr El Aini School of Medicine , Cairo University, 19 Tunis st, Maadi, PO 11435, Cairo, Egypt.

Aim: To assess the effectiveness of low-dose aspirin in the prevention of preeclampsia and intrauterine growth restriction (IUGR) in high-risk pregnant women with abnormal findings at uterine artery Doppler velocimetry performed at 14-16 weeks.

Design: Randomized controlled clinical trial.

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

Methods: The trial enrolled 139 women at risk of preeclampsia or IUGR, with abnormal uterine artery Doppler findings that included the presence of unilateral or bilateral diastolic notch, high resistance index (RI), or high pulsatility index (PI) at 14-16 weeks of gestation. The women were randomly allocated into two groups, one receiving aspirin since admission to hospital (n=74) and the other serving as control (n=65). All women were followed up until delivery to assess maternal and perinatal outcomes. T-test was used for comparison of quantitative variables, and categorical variables were compared by chi2 test. OUTCOME CRITERIA: Development of mild or severe preeclampsia, time of onset of preeclampsia, preterm delivery, and the development of IUGR.

Results: Preeclampsia developed in 35% of women receiving aspirin and 62% of women in the control group (P=0.003), with severe preeclampsia developing in 8% and 23% of women (P=0.215), respectively. Preeclampsia before 37 weeks of gestation was recorded in only 4% of women receiving aspirin as opposed to 83% of controls (P<0.001). In the group of women receiving aspirin, 19% of newborns suffered from IUGR as opposed to 32%of newborns in the control group (P=0.106). There was no significant difference between the two groups in the rate of preterm delivery (P=0.080), mode of delivery (P=0.971), Apgar score <5 after one minute (P=0.273) and after 5 minutes (P=0.941), maternal or neonatal bleeding (P=0.948), and neonatal birth weight (P=0.399).

Conclusion: Low-dose aspirin administered as early as 14-16 weeks of gestation to pregnant women at high risk of preeclampsia with abnormal uterine Doppler findings may reduce or modify the course of severe preeclampsia. Its effects on the prevention of IUGR need further evaluation.
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October 2005

Middle cerebral/umbilical artery resistance index ratio as sensitive parameter for fetal well-being and neonatal outcome in patients with preeclampsia: case-control study.

Croat Med J 2005 Oct;46(5):821-5

Kasr El Aini School of Medicine, Cairo University, 19 Tunis st, Maadi, PO 11435, Cairo, Egypt.

Aim: To evaluate the accuracy of middle cerebral/umbilical artery resistance index (C/U RI) ratio in predicting acidemia and low Apgar score at 5 minutes after birth in the infants of women with preeclampsia.

Methods: This prospective case-control study performed at Kasr El Aini University Hospital included 50 pregnant women with preeclampsia with or without intrauterine growth restriction (IUGR). Thirty women with uneventful pregnancies, matched for age, parity, and gestational age, served as controls. Ultrasound and Doppler studies were carried out to estimate fetal weight (EFW) and determine fetal biophysical profile and resistance indices of the middle cerebral and umbilical arteries. C/U RI <1.0 was considered abnormal. Apgar scores were assessed at 5 minutes after birth, and fetal cord blood sampling to determine blood pH was done immediately after delivery. Apgar score <6 at 5 minutes, neonatal acidemia (pH<7.2), and/or neonatal admission to neonatal intensive care unit (NICU) indicated neonatal morbidity.

Results: There were no significant differences in fetal biophysical profile, middle cerebral artery RI, or umbilical artery RI between the fetuses of women with preeclampsia and those in the control group. C/U RI <1.0 was found in significantly more fetuses of women with preeclampsia than in their controls (0.7-/+0.3 and 1.3-/+0.7, respectively; P<0.001). In the preeclampsia group, C/U RI was abnormal in 32 out of 38 fetuses with IUGR, and in only 5 out of 12 of fetuses without IUGR. Neonatal acidemia was found in 30 out of 38 newborns with IUGR and in 3 out of 12 of newborns without IUGR. Preeclampsia and C/U RI <1.0 carried a relative risk of 1.4 for neonatal morbidity (neonatal academia pH<7.2, 5-minute Apgar score <6, and/or admission to NICU). C/U RI had 64.1% sensitivity, 72.7% specificity, 89.2% positive predictive value, and 36.3% negative predictive value for neonatal morbidity.

Conclusion: There was a strong correlation between the C/U RI and neonatal outcome in women with preeclampsia. C/U RI <1.0 may be helpful in the identification of newborns at risk of morbidity, irrespective of whether they are small or appropriate for their gestational age.
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October 2005