Competence of Combined Low Dose of Human Chorionic Gonadotropin (HCG) and Clomiphene Citrate (CC) Versus Continued CC during Ovulation Induction in Women with CC-Resistant Polycystic Ovarian Syndrome: A Randomized Controlled Trial.

Background and Objectives: Polycystic ovarian syndrome (PCOS) is a widespread endocrine disorder affecting 5-18% of females in their childbearing age. The aim of this study is to assess the efficacy of combining a low dosage of human chorionic gonadotropin (HCG) along with clomiphene citrate (CC) for stimulating ovulation in infertile women diagnosed with CC-resistant PCOS. Materials and Methods: A randomized controlled trial was carried out on 300 infertile CC-resistant PCOS women. All participants were assigned to two groups: the CC-HCG group and the CC-Placebo group. Subjects in the CC-HCG group were given CC (150 mg/day for 5 days starting on the 2nd day of the cycle) and HCG (200 IU/day SC starting on the 7th day of the cycle). Subjects in the CC-Placebo group were given CC and a placebo. The number of ovarian follicles > 18 mm, cycle cancellation rate, endometrial thickness, ovulation rate, clinical pregnancy rate, and occurrence of early ovarian hyper-stimulation syndrome were all outcome variables in the primary research. Results: Data from 138 individuals in the CC-HCG group and 131 participants in the CC-Placebo group were subjected to final analysis. In comparison to the CC-Placebo group, the cycle cancellation rate in the CC-HCG group was considerably lower. The CC-HCG group exhibited a substantial increase in ovarian follicles reaching > 18 mm, endometrial thickness, and ovulation rate. The clinical pregnancy rate was higher in the CC-HCG group (7.2% vs. 2.3%; CC-HCG vs. CC-Placebo). Upon adjusting for BMI and age, the findings of our study revealed that individuals in the CC-HCG group who had serum prolactin levels below 20 (ng/mL), secondary infertility, infertility duration less than 4 years, baseline LH/FSH ratios below 1.5, and serum AMH levels more than 4 (ng/mL) had a higher likelihood of achieving pregnancy. In the CC-Placebo group, there was a greater prediction of clinical pregnancy for those with serum AMH (<4), primary infertility, serum prolactin ≤ 20 (ng/mL), baseline LH/FSH < 1.5, and infertility duration < 4 years. Conclusions: The use of a small dose of HCG along with CC appeared to be an effective treatment in reducing cycle cancelation, improving the clinical pregnancy rate and ovulation rate in CC-resistant PCOS patients. The trial was registered with Clinical Trials.gov, identifier NCT02436226.

Apparent Diffusion Coefficient of the Placenta and Fetal Organs in Intrauterine Growth Restriction.

PURPOSE: This study aimed to assess apparent diffusion coefficient (ADC) of the placenta and fetal organs in intrauterine growth restriction (IUGR). MATERIALS AND METHODS: A prospective study of 30 consecutive pregnant women (aged 21-38 years with mean age of 31.5 years and a mean gestational week of 35 ± 2.3) with IUGR and 15 age-matched pregnant women was conducted. All patients and controls underwent diffusion-weighted magnetic resonance imaging. The ADCs of the placenta and fetal brain, kidney, and lung were calculated and correlated with neonates needing intensive care unit (ICU) admission. RESULTS: There was a significant difference in ADC of the placenta and fetal brain, lung, and kidney (P = 0.001, 0.001, 0.04, and 0.04, respectively) between the patients and the controls. The cutoff ADCs of the placenta and fetal brain, lung, and kidney used to detect IUGR were 1.45, 1.15, 1.80, and 1.40 × 10 mm/s, respectively, with areas under the curve (AUCs) of 0.865, 0.858, 0.812, and 0.650, respectively, and accuracy values of 75%, 72.5%, 72.5%, and 70%, respectively. Combined ADC of the placenta and fetal organs used to detect IUGR revealed an AUC of 1.00 and an accuracy of 100%. There was a significant difference in ADC of the placenta and fetal brain, lung, and kidney between neonates needing admission and those not needing ICU admission (P = 0.001, 0.001, 0.002, and 0.002, respectively). The cutoff ADCs of the placenta and fetal brain, lung, and kidney used to define neonates needing ICU were 1.35, 1.25, 1.95, and 1.15 × 10 mm/s with AUCs of 0.955, 0.880, 0.884, and 0.793, respectively, and accuracy values of 86.7%, 46.7%, 76.7%, and 70%, respectively. Combined placental and fetal brain ADC used to define neonates needing ICU revealed an AUC of 0.968 and an accuracy of 93.3%. CONCLUSION: Combined ADC of the placenta and fetal organs can detect IUGR, and combined ADC of the placenta and fetal brain can define fetuses needing ICU.

Neurophysiological study of critical illness polyneuropathy and myopathy in mechanically ventilated children; additional aspects in paediatric critical illness comorbidities.

BACKGROUND AND PURPOSE: Critical illness polyneuropathy and myopathy (CIP/CIM) is being increasingly recognized as a significant clinical problem in critically ill children especially if they have spent long periods in the intensive care unit. So the aim was to determine the frequency of CIP/CIM amongst mechanically ventilated children and to analyse the associated risk factors and drawbacks frequently encountered in this cohort. METHODS: The study included 105 patients admitted to the paediatric intensive care unit who underwent mechanical ventilation for ≥7 days. These patients were screened daily for awakening. Patients with severe muscle weakness on day 7 post-awakening underwent nerve conduction studies and electromyography. Accordingly, the patients were classified as CIP/CIM patients if they had abnormal neurophysiology studies or control patients if normal neurophysiology studies were obtained. Their clinical and laboratory profiles had been recorded as well. RESULTS: Overall, of 105 patients who achieved satisfactory awakening, 34 patients (32.4%) developed CIP/CIM mostly of the axonal polyneuropathy pattern (27.6%) whilst 71 control patients (67.6%) showed normal electrophysiological studies. The mean duration of mechanical ventilation was significantly longer in patients with CIP/CIM compared to control patients (P = 0.001). The study also revealed that 62.1% of our CIP/CIM patients failed weaning trials and finally died. CIP/CIM was significantly associated with decreased platelets, elevated liver enzymes and prolonged prothrombin time. Acidosis, low serum calcium and albumin levels and higher blood glucose were also found to be more significant in CIP/CIM patients compared to control patients. CONCLUSION: Critically ill children frequently develop CIP/CIM, mostly of axonal polyneuropathy pattern, which compromises rehabilitation and recovery and is associated with a number of comorbidities.

Human papillomavirus (HPV) is not the main cause of preinvasive and invasive cervical cancer among patients in Delta Region, Egypt.

BACKGROUND: Cervical cancer remains a significant problem worldwide particularly in underdeveloped countries. It is necessary to have a persistent infection of the cervix with a high-risk or oncogenic human Papillomavirus (HPV) virus to develop cervical cancer. OBJECTIVES: To study the association between HPV and pre-invasive and invasive cancer cervix among patients referred to Early Cancer Detection Clinic of Obstetrics and Gynecology Department, Mansoura University Hospital, Delta region, Egypt. METHODS: Cervical specimens of 100 histologically confirmed premalignant and malignant cervical lesions were subjected to HPV detection and genotyping by extraction of DNA from cervical biopsy using a commercial PCR kit. RESULTS: HPV DNA testing was done, 36 cases were positive (36%). Correlations of age, duration of marriage, and parity were non significant (P = 0.56, 0.72, and 0.35 respectively) while correlations of residence, oral contraceptive use, smoking, and immunosuppresion were sig- nificant (P = 0.006, 0.001, 0.001, and 0.01 respectively). The prevalence of HPV in premalignant and malignant cervical lesions in our study was 39.5% & 33.3% respec tively. The commonest HPV genotypes associated with premalignant cervical lesions were HPV16; 11/17(64.7%) and HPV18; 11/17 (64.7%) mostly in the form of mul- tiple infections with HPV16+18; 7/17 (41.17%). The commonest HPV genotypes associated with malignant cervical lesions in our cases were HPV16; 15/19 (78.9%) and HPV18; 13/19 (68.42%) also in the form of multiple infections with HPV16+18; 10/19 (52.63%). CONCLUSION: The prevalence of HPV in premalignant and malignant cervical lesions was 39.5% & 33.3% respectively, this means that HPV is not the main cause of premalignant and malignant cervical lesions in Delta region in Egypt. HPV infection mostly in the form of multiple infections with HPV16+18 genotypes. Further studies are needed to clarify actual association of HPV and premalignant and malignant cervical lesions to determine the usefulness of HPV vaccination in our locality.

pH-Dependent selective extraction of gold(iii) from synthetic solution and computer motherboard leachate using a hybrid nanocomposite.

Recycling gold from electronic waste offers significant benefits for both environmental protection and resource sustainability. However, this process presents considerable challenges due to high costs, prolonged processing times, and interference from coexisting metals. In this study, we synthesized a hybrid mesoporous nanocomposite comprising platelets-like CoNi2S4 incorporated with g-C3N4 nanosheets (CoNi2S4@g-C3N4) for the selective recovery of gold (Au(iii)) ions from spent computer motherboards. Comprehensive characterization of the CoNi2S4@g-C3N4 nanocomposite was conducted, including its physicochemical properties, textural and structural characteristics, morphology, and elemental composition. The CoNi2S4@g-C3N4 extractor demonstrated an exceptional adsorption capacity of 200.6 mg g-1, with high selectivity at pH 2, rapid equilibrium time of 60 minutes, and satisfactory reusability for over ten cycles. Adsorption isotherm and kinetic studies revealed that the CoNi2S4@g-C3N4 nanocomposite adheres to the Langmuir adsorption model and the pseudo-second-order kinetic model for Au(iii) ion adsorption. Overall, this study introduces a viable adsorbent that shows considerable promise for industrial-scale Au(iii) extraction from e-waste.

A hybrid mesoporous composite of SnO2 and MgO for adsorption and photocatalytic degradation of anionic dye from a real industrial effluent water.

Water pollution by synthetic anionic dyes is one of the most critical ecological concerns and challenges. Therefore, there is an urgent need to find an efficient adsorbent and photocatalyst for dye removal. In the present study, we aimed to fabricate a hybrid mesoporous composite of spongy sphere-like SnO2 and three-dimensional (3D) cubic-like MgO (SnO2/MgO) as a promising adsorbent/photocatalyst to remove the anionic sunset yellow (SSY) dye from real wastewater at neutral pH conditions. The as-synthesized SnO2 and MgO composite was investigated using XRD, SEM, EDX, TEM, XPS, BET, and zeta potential. The experimental study of the SSY removal using SnO2/MgO composite was performed at different conditions, such as pH, stirring time, dose, and temperature. More than 99% of 10 mg/L SSY was effectively adsorbed from aqueous solution using 40 mg of SnO2/MgO composite at pH 7 and a stirring time of 60 min. The SSY adsorption behavior was well fitted by pseudo-second order and the Langmuir model, indicating that the SSY was chemisorbed to the composite-active sites as a monolayer. On the other hand, photocatalytic degradation process exhibited better results in terms of speed of removal and used quantity of photocatalyst, where 20 mg of SnO2/MgO composite can be used to remove > 99% of SSY dye within 30 min. Mechanism of SSY adsorption and photocatalytic degradation was discussed. In addition, elution experiments demonstrated that the SnO2/MgO composite as an SSY adsorbent could be reused for nine cycles without considerable reduction in the SSY adsorption efficiency. Therefore, this work exhibited that the mesoporous SnO2/MgO composite can be considered an effective adsorbent/photocatalyst to remove SSY dye from real industrial effluent water at neutral pH conditions.

Stroke incidence between stenting and endarterectomy for asymptomatic carotid artery stenosis.

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients with significant asymptomatic carotid artery stenosis (ACAS), Does Carotid artery stenting (CAS) has a peri-procedural lower Stroke rate, As compared to Carotid endarterectomy (CEA)? The outcomes assessed were the stroke rate in the two management modalities. The best evidence showed no statistically significant difference between CAS and CEA regarding the peri-procedural and the long-term non-procedural stroke incidence. However, in high-risk patients, CAS may be a better option.

Timing of initiation of low-molecular-weight heparin administration in pregnant women with antiphospholipid syndrome: a randomized clinical trial of efficacy and safety.

OBJECTIVE: We aimed to evaluate the effect of different timing of initiation of low-molecular-weight heparin (LMWH) administration on the pregnancy outcomes in women with antiphospholipid syndrome (APS). MATERIALS AND METHODS: A randomized controlled study was conducted on women with obstetrical APS. All participants were randomly divided at documentation of positive pregnancy test into two groups; early initiation group in which LMWH therapy was started once positive pregnancy test was established (in the fifth week of gestation), and later initiation group in which LMWH therapy was started after sonographic confirmation of fetal cardiac pulsation (in the seventh week of gestation). In both groups, LMWH (enoxaparin) was given at a dose of 40 mg/day subcutaneously and the therapy continued until end of pregnancy. The primary outcome measure was ongoing pregnancy rate and the secondary outcome measures were fetal loss, live birth rate, preterm labor before 34 weeks of gestation, intrauterine growth restriction (IUGR), and congenital fetal malformations. RESULTS: Ninety-four women (48 in the early initiation group and 46 in the later initiation group) were subjected to final analysis. The ongoing pregnancy rate was significantly higher in the early initiation group than in the later initiation group (81.2% vs 60.9%; P=0.040). However, both groups were similar in the incidences of fetal loss, preterm labor before 34 weeks of gestation, and IUGR, and live birth rate. No recorded congenital fetal malformations in both groups. CONCLUSION: Early administration of LMWH for pregnant women with obstetrical APS reduces early pregnancy loss, but does not affect the incidence of late obstetrical complications.

Intrauterine Inflated Foley's Catheter Balloon in the Management of Abnormally Invasive Placenta Previa: A Case-Control Study.

OBJECTIVE: To describe the use of intrauterine inflated Foley's catheter balloon for control of postpartum hemorrhage (PPH) during cesarean section (CS) in cases of abnormally invasive placenta previa aiming to preserve the uterus. METHODS: Retrospective case-control study of the data of women who underwent elective CS on abnormally adherent placenta previa was carried out. Women in whom inflated Foley's catheter balloon was used for control of PPH during CS (n = 40) were compared with a control group of women who underwent elective CS by the same technique but without use of intrauterine catheter balloon (n = 38). RESULTS: Use of intrauterine inflated Foley's catheter balloon significantly reduced the estimated amount of blood loss (P = 0.008), amounts of crystalloids, colloids and packed red blood cells transfusion (P = 0.025, 0.017 and 0.022, respectively), and the need for bilateral internal iliac artery (IIA) ligation (P = 0.016). No significant difference was observed between both groups regarding the use of massive transfusion protocol, performing cesarean hysterectomy, relaparotomy, and admission to the intensive care unit. CONCLUSION: Application of an intrauterine inflated Foley's catheter balloon during CS in cases of morbidly adherent placenta previa helps to control PPH with preservation of the uterus and decreases the need for the invasive IIA ligation.