Extracellular microRNAs: key players to explore the outcomes of in vitro fertilization.

BACKGROUND: MicroRNAs (miRNAs) are small RNA molecules that modulate post-transcriptional gene regulation. They are often used as promising non-invasive biomarkers for the early diagnosis of cancer. However, their roles in assisted reproduction are still unknown. METHODS: This prospective study was designed to evaluate the expression profiles of seven extracellular miRNAs (miR-7-5p, miR-202-5p, miR-378-3p, miR-224, miR-320a, miR-212-3p, and miR-21-5p) in human follicular fluid (FF) to explore the outcomes of in vitro fertilization (IVF). Of 255 women, 145 were without polycystic ovary syndrome (PCOS), and their ovarian assets were normal (NOR), while 110 were with normo-androgenic PCOS. RESULTS: The combination of six FF miRNAs expression profile discriminated between PCOS and NOR women with a sensitivity of 79.2% and a specificity of 87.32% (AUC = 0.881 [0.61; 0.92], p = 0.001). MiR-202-5p significantly had a lower abundance level, and miR-378-3p had a high abundance level in pooled FF samples from patients treated with human menopausal gonadotropin (hMG) than those treated with recombinant follicle-stimulating hormone (rFSH) (p < 0.001). Our results showed that miRNA-320a was significantly different in top-quality embryos versus non-top-quality embryos on day 3 in NOR patients with a sensitivity of 80% and specificity of 71%, (AUC = [0.753 (0.651; 0.855)], p = 0.001). For clinical pregnancy outcome prediction, FF miRNA-21 exhibited high sensitivity (74.8%) and specificity (83.7%) with the AUC value of 0.774 (0.682; 0.865). CONCLUSION: Conclusively, our results provide evidence that miR-7-5p, miR-378-3p, miR-224, miR-212-3p were a differentially high expression in normo-androgenic PCOS patients than NOR patients. While miRNA-320a was significantly different in top-quality embryos versus non-top-quality embryos on day 3 (p = 0.001). The expression level of FF miR-212-3p was significantly related to the probability of embryos to develop into a high-quality blastocyst in patients with normal ovarian reserve.

Effect of resveratrol and environmental enrichment on biomarkers of oxidative stress in young healthy mice.

Resveratrol (RESV) and Environmental Enrichment (EE) have been separately reported to protect organisms against various diseases. This study investigated the potential benefit of the combination of RESV and EE on biomarkers of oxidative stress in young healthy mice. Fifty mice of both sexes were randomly divided into five groups of 10 animals each: group I served as control, group II were maintained on alternate day feeding, group III received RESV 50 mg/kg, suspended in caboxymethylcellulose orally per kg/day. Group IV received CMC and kept in an Enriched Environment, group V received RESV + EE. The treatment lasted for 28 days. The animals were sacrificed 24 h after the last treatment and brain samples were collected for biochemical evaluation. The results obtained showed a significant decrease (P < 0.05) in malondialdehyde concentration in EE group and RESV treated group kept EE when compared to the control. A significant decrease was also observed in glutathione peroxidase activity in all the treatment groups when compared to the control. A significant decrease in GPx activities in RESV, EE and RESV + EE treated groups in male and female mice when compared to the control groups respectively. However, a significant increase in GPx activities was observed in EE group in male mice and EODF, RESV groups in female mice when compared to RESV + EE groups respectively. In conclusion, the result of our study indicates that EE possesses antioxidant properties by decreasing MDA concentration and attenuating lipid peroxidation in the brain of young Swiss albino mice.

Postwash total motile sperm count: should it be included as a standard male infertility work up.

INTRODUCTION: Pregnancy rates after intrauterine insemination (IUI) varies greatly. We aimed to identify pre and post processing semen analysis parameters that may be predictive of successful pregnancy in couples undergoing IUI. MATERIALS AND METHODS: A retrospective study of the records of all couples underwent IUI for a 2 year period at our infertility center. Different characteristics of female subjects, pre and post processing semen parameters and treatment parameters were compared statistically. RESULTS: Thirty-two clinical pregnancies followed 526 IUI cycles in 294 couples, for a clinical pregnancy rate of 6.1% per cycle and a 10.9% per couple. The mean age of the women at IUI was 31.14 ± 6 years (range 19-45 years). Neither maternal age, body mass index, number of mature follicles, maximum day 3 follicle stimulating hormone level, presence or absence of previous children, number of previous miscarriages, nor prewash semen parameters had any impact on pregnancy rate post IUI. Postwash total motile sperm count (TMSC) (p = .027) and number of cycles (p = .042) were independent predictors of successful pregnancy after IUI. CONCLUSIONS: A postwash TMSC of 5 million sperm or more is significantly associated with a high pregnancy rate. After ruling out medically or surgically correctable male factors that may contribute to infertility, we recommend including a pretreatment sperm processing during routine male fertility work up for proper patient counseling and direction to the suitable assisted reproduction technique.

Evaluation of sperm DNA damage in men from infertile Saudi couples.

OBJECTIVE: To evaluate sperm DNA quality of the male partner in Saudi infertile couples in order to establish prevalence of sperm DNA damage and to help future identification of responsible etiologies and possible treatments. STUDY DESIGN: A retrospective study of semen analysis and sperm DNA integrity using the sperm chromatin dispersion (SCD) technique in male partners of infertile couples examined for infertility in a dedicated fertility clinic, King Khalid University Hospital, Riyadh, Saudi Arabia, from January 1, 2009-December 31, 2011. RESULTS: Reports of semen and SCD analysis of 405 men were reviewed; 384 met the inclusion criteria. Normal semen parameters were demonstrated in 133 (34.6%) male subjects, while 251 (65.4%) had ≥ 1 abnormal semen parameters. Saudi male partners showed increasing level of sperm DNA fragmentation index (DFI) at 25.4 (range, 5-97). Men with normal semen parameters had a significantly lower DFI (17.5; range, 5-32) than did men with abnormal semen parameters (49; range, 21-97, p < 0.001). DFI > 30% was encountered in 59.1% of the study group. Teratospermia single abnormality was significantly associated with DFI > 30% (p < 0.00007). CONCLUSION: This study demonstrates a high percentage of sperm DNA damage in the male partner in Saudi infertile couples, and the damage was more obvious in men with suboptimal semen parameters. Patients with abnormal sperm morphology showed a high rate of DNA fragmentation.

Pattern of semen fluid abnormalities in male partners of infertile couples in Riyadh, Saudi Arabia.

INTRODUCTION: A decline in semen quality in men with increasing percentage of male factor abnormalities in infertile couples has been reported. The pattern of abnormalities differs from one part of the world to another, and it is probably multifactorial. Our objectives were to review the pattern of semen fluid abnormalities in Saudi male partners of infertile couples, to establish prevalence and help future identification of responsible etiologies and possible treatments. MATERIALS AND METHODS: A retrospective study of semen analysis results of male partners of infertile couples examined in a dedicated infertility clinic, King Khalid University Hospital, Riyadh, Saudi Arabia from January 2009 through December 2011. RESULTS: A total of 1485 male semen analysis reports were reviewed. According to 1999 WHO reference values for normal semen analysis, 61 (4.1%) of patients had normal semen parameters while 149 (10%) had azoospermia. Half of the samples (783, 52.7%) had single factor abnormality; the majority (97%) being teratospermia. Oligo-teratospermia was evident in 133 (9%) of the samples constituting nearly half of those who had 2 factor abnormality. Oligo-astheno-teratospermia was encountered in 191 (12.9%) patients. Oligospermia was evident in 403 (27.2%) patients; 52% of them had sperm concentrations of more than 10 million/mL. Twelve patients had only low volume ejaculate. CONCLUSION: A high percentage of semen fluid and sperm morphology abnormalities were found in males of infertile couples in Riyadh, Saudi Arabia which may contribute to subfertility. Further studies are needed to address possible etiologies and treatment of oligospermia and teratospermia in our region in order to improve fertility rates.

Fever assessment in children under five: Are we following the guidelines?

BACKGROUND: Fever is a common cause of medical consultation and hospital admission, particularly among children. Recently, the United Kingdom's National Institute for Health and Care Excellence (NICE) updated its guidelines for assessing fever in children under five years of age. The efficient assessment and management of children with fever are crucial for improving patient outcomes. AIM: To evaluate fever assessment in hospitalized children and to assess its adherence with the NICE Fever in under 5s guideline. METHODS: We conducted a retrospective cohort review of the electronic medical records of children under five years of age at the Department of Pediatrics, Salmaniya Medical Complex, Bahrain, between June and July 2023. Demographic data, vital signs during the first 48 h of admission, route of temperature measurement, and indications for admission were gathered. Fever was defined according to the NICE guideline. The children were divided into five groups according to their age (0-3 months, > 3-6 months, > 6-12 months, > 12-36 months, and > 36-60 months). Patients with and without fever were compared in terms of demography, indication for admission, route of temperature measurement, and other vital signs. Compliance with the NICE Fever in the under 5s guideline was assessed. Full compliance was defined as > 95%, partial compliance as 70%-95%, and minimal compliance as ≤ 69%. Pearson's χ2, Student's t test, the Mann-Whitney U test, and Spearman's correlation coefficient (rs) were used for comparison. RESULTS: Of the 136 patients reviewed, 80 (58.8%) were boys. The median age at admission was 14.2 [interquartile range (IQR): 1.7-44.4] months, with the most common age group being 36-60 months. Thirty-six (26.4%) patients had fever, and 100 (73.6%) were afebrile. The commonest age group for febrile patients (> 12-36 months) was older than the commonest age group for afebrile patients (0-3 months) (P = 0.027). The median weight was 8.3 (IQR: 4.0-13.3) kg. Patients with fever had higher weight than those without fever [10.2 (IQR: 7.3-13.0) vs 7.1 (IQR: 3.8-13.3) kg, respectively] (P = 0.034). Gastrointestinal disease was the leading indication for hospital admission (n = 47, 34.6%). Patients with central nervous system diseases and fever of unknown etiology were more likely to be febrile (P = 0.030 and P = 0.011, respectively). The mean heart rate was higher in the febrile group than the afebrile group (140 ± 24 vs 126 ± 20 beats per minute, respectively) [P = 0.001 (confidence interval: 5.8-21.9)] with a positive correlation between body temperature and heart rate, r = 0.242, n = 136, P = 0.004. A higher proportion of febrile patients received paracetamol (n = 35, 81.3%) compared to the afebrile patients (n = 8, 18.6%) (P < 0.001). The axillary route was the most commonly used for temperature measurements (n = 40/42, 95.2%), followed by the rectal route (n = 2/42, 4.8%). The department demonstrated full compliance with the NICE guideline for five criteria: the type of thermometer used, route and frequency of temperature measurement, frequency of heart rate measurement, and use of antipyretics as needed. Partial compliance was noted for two criteria, the threshold of fever at 38 °C or more, and the respiratory rate assessment in febrile patients. Minimal compliance or no record was observed for the remaining three criteria; routine assessment of capillary refill, temperature reassessment 1-2 h after each antipyretic intake, and refraining from the use of tepid sponging. CONCLUSION: This study showed that fever assessment in hospitalized children under five years of age was appropriate, but certain areas of adherence to the NICE guideline still need to be improved.

An investigation on the role of oxytocin in chronic neuropathic pain in a Wistar rat model.

Introduction Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting side effect with ineffective preventative and curative treatment. Currently, only Duloxetine has been recommended as effective treatment for CIPN, which has shown individual-dependent, short-term analgesic effects, with limiting adverse effects and poor bioavailability. The neuropeptide, oxytocin, may offer significant analgesic and anxiolytic potential, as it exerts central and peripheral attenuating effects on nociception. However, it is unknown whether the intervention administered in a model of CIPN is an effective therapeutic alternative or adjuvant. Materials and Methods The intervention was divided into two phases. Phase 1 aimed to induce CIPN in adult Wistar rats using the chemotherapeutic agent Paclitaxel. Mechanical (electronic von Frey filament) and thermal (acetone evaporation test and Hargreaves test) hypersensitivity testing were used to evaluate changes due to the neuropathic induction. Phase 2 consisted of a 14-day intervention period with saline (o.g.), duloextine (o.g.), or oxytocin (i.n.) administered as treatment. Following the intervention, anxiety-like behaviour was assessed using the elevated plus maze (EPM) and light-dark box protocols. Analysis of peripheral plasma corticosterone, peripheral plasma oxytocin, and hypothalamic oxytocin concentrations were assessed using ELISA assays. Results The findings showed that we were able to successfully establish a model of chemotherapy-induced peripheral neuropathy during Phase 1, determined by the increase in mechanical and thermal nociceptive responses following Paclitaxel administration. Furthermore, the animals treated with oxytocin displayed a significant improvement in mechanical sensitivity over the intervention phase, indicative of an improvement in nociceptive sensitivity in the presence of neuropathic pain. Animals that received Paclitaxel and treated with oxytocin also displayed significantly greater explorative behaviour during the EPM, indicative of a reduced presence of anxiety-like behaviour. Conclusion Our results support the hypothesis that intranasally administered oxytocin may augment the analgesic and anxiolytic effects of duloxetine in a chemotherapy induced peripheral neuropathy model in a Wistar rat. Future studies should consider administering the treatments in combination to observe the potential synergistic effects.

Overlap Syndrome in a Male Presenting With Progressive Lower Limb Weakness: A Case Report.

Overlap syndrome refers to a large group of inflammatory rheumatic conditions characterized by the co-existence of clinical manifestations that include different organ systems and meet the criteria of more than one rheumatic disease. Overlap syndromes are less common compared with the conditions they encompass, for example, the global prevalence of systemic lupus erythematosus (SLE) is estimated to be 43.7 per 100,000 persons, of which only around 3.4-6.3% present with SLE-myositis overlap. Although rare, overlap syndromes commonly include lupus, rheumatoid arthritis, scleroderma, and myositis. Because overlap syndrome can manifest in several ways and has an unpredictable course, it poses a challenge to multidisciplinary teams that examine and treat patients. Therefore, we must not disregard any signs and symptoms as they might have a huge impact on the progression of the disease and the overall outcome of the treatment. We present a rare case of SLE-myositis overlap syndrome in a 44-year-old male. He initially presented with gradual weakness in the proximal muscles of the bilateral lower limb. This patient was diagnosed as having SLE with positive 5g protein/24 hours, anti-nuclear, low C3, anti-U1RNP, anti-Ro, and anti-La antibodies, as well as membranous lupus nephritis evident by the results of renal biopsy. The diagnosis of myositis was also made according to the history and evaluation of the patient, the high titer of muscle enzymes creatine kinase level, and MRI result. Although the patient tested positive for anti-U1RNP, he did not meet the criteria of mixed connective tissue disease. Eventually, the patient was found to have overlap syndrome. The prevalence of overlap between SLE and myositis is relatively rare and varies from 3.4% to 6.3%. To our knowledge, no study has discussed or reported its prevalence among males.

Levels and profiles of pentabromodiphenyl ether contaminants in human breast milk from Riyadh, Saudi Arabia.

OBJECTIVES: To investigate levels of pentabromodiphenyl ether (PBDEs) in breast milk samples from healthy mothers who had lived in Riyadh for the last 5 years. METHODS: In this cross sectional study, 75 samples were collected and were extracted, cleaned by solid-phase extraction (SPE) and PBDEs analysis was done using gas chromatography-mass spectrometry. RESULTS: Total PBDEs (∑PBDEs) ranged from 0.2 to 3.6 ng/g lipid weight (lw). BDE-47, -153, -99, and -209 were the dominant congeners. The mothers in this study consumed more meat (69%), followed by the egg (50%), and milk (36%). The majority of donors consumed fish (44%) and egg (33%) 2 times per week. The majority of the participating mothers had completed higher education (68%). All PBDE congeners were detected in the human breast milk samples with high detection frequency (98%). The dominant congener was BDE 47, accounting more than 39% of all BDE congeners, followed by BDE-99 and BDEs 153 which accounted for18% and 12% of the total BDE congeners respectively. CONCLUSION: Higher rates of meat and poultry consumption were positively associated with higher breast milk levels of ∑PBDEs. The significant levels of PBDEs that occur in the meat and poultry reared in Saudi Arabia need further investigation especially as Saudis among largest consumers of poultry meat.

Bioactivity of Samsum ant (Pachycondyla sennaarensis) venom against lipopolysaccharides through antioxidant and upregulation of Akt1 signaling in rats.

BACKGROUND: This study aimed at investigating the oxidative stress ameliorating effect, lipids profile restoration, and the anti-inflammatory effect of Samsum Ant Venom (SAV) in induced endotoxemic male rats, injected with bacterial lipopolysaccharides (LPS). RESULTS: Results revealed that LPS significantly increased the oxidative stress indications in LPS-injected rats. A significant increase of both malondialdehyde (MDA), and advanced oxidative protein products (AOPP), as well as a significant suppression of glutathione were all detected. Treatment with 100 µg/kg dose of SAV significantly restored the oxidative stress normal indications and increased the total glutathione levels. Treatment of the LPS-rats with 100 µg/kg dose of SAV showed a clear anti-inflammatory function; as the histological architecture of the hepatic tissue was partially recovered, along with a valuable decrease in the leukocytes infiltrated the hepatic tissues. Treatment of some rat groups with 600 µg/kg dose of SAV after LPS injection induced a severe endotoxemia that resulted in very high mortality rates. SAV versus the effects of LPS on AKT1, Fas, TNF-α and IFN-γ mRNA expression. SAV was found to significantly lower Fas gene expression comparing to the LPS group and restore the level of IFN-γ mRNA expression to that of the control group. CONCLUSION: In conclusion, SAV, at the dose of 100 µg/kg body weight, maintained and restored the oxidative stability, the anti-inflammatory, and the hypolipidemic bioactivity in rats after induced disruption of these parameters by LPS injection. This improvement by SAV was mediated by upregulation of AKT1.

Autoimmune thyroiditis a fibrous variant of Hashimoto's thyroiditis: A rare case.

Hashimoto thyroiditis (HT) is an autoimmune disorder characterized by inadequate thyroid hormone production. A fibrous variant is one of the rarest entities of Hashimoto's thyroiditis disease. A 42 -year-old female patient presented to our service with neck swelling associated with difficulty swallowing; she was discovered to have an enlarged thyroid gland with mass effect. She underwent an ultrasound and fine-needle aspiration (FNA), which was consistent with Hashimoto's thyroiditis -Bethesda category II-. Due to compressive symptoms, we proceeded to total thyroidectomy. The final histopathology revealed numerous polymorphic lymphoid cells, plasma cells, follicular cells, and scattered Hürthle cells, characteristic of fibrous variants. The surgery was complicated with voice hoarseness and hypocalcemia, which was managed successfully with corticosteroids and calcium supplements. The mainline treatment of HT is medical, but surgical intervention can be considered in some cases. A multidisciplinary approach is needed for successful management. Continuous patient monitoring post-operatively is vital to detect and intervene with early surgical complications.

Taurine and Camel Milk Modulate Neurobehavioral and Biochemical Changes in Aluminum Chloride-Induced Alzheimer's Disease in Rats.

BACKGROUND: Alzheimer's disease (AD) is a neurodegenerative disease associated with deficiency in motor coordination, cognitive impairment, and excessive reactive oxygen species production in the brain. OBJECTIVE: The study evaluated effects of taurine and camel milk (CM) on neurobehavior, amyloid-beta peptide 1-42 (Aß) expression, acetylcholinesterase, and superoxide dismutase activities in aluminum chloride (AlCl3) model of Alzheimer's disease in rats. METHODS: Thirty-five female Wistar rats were divided into seven groups (n = 5): Normal saline (0.2 mL/kg body weight); AlCl3 (100 mg/kg) (AD); CM (33 mL/kg); Taurine (50 mg/kg); AlCl3 (100 mg/kg) + CM (33 mL/kg); AlCl3 (100 mg/kg) + Taurine (50 mg/kg); and AlCl3 (100 mg/kg) + CM (33 mL/kg) + Taurine (50 mg/kg). The administration lasted for eight weeks via oral gavage. After the eighth week, neurobehavior assessments were performed. Rats were sacrificed, and brain and blood samples collected for analysis. RESULTS: There was a significant (p < 0.0001) increase in the duration of motor endurance in AD + CM rats, compared to AD rats. Duration of forced swimming time was lowest (p < 0.0001) in AlCl3 + Taurine rats, compared to that of AD rats. Concentration of Aß peptide decreased (p < 0.05) in AD rats, treated with CM and/or combination. In taurine-treated rats, superoxide dismutase activity was significantly (p < 0.05) higher than in AD rats. Treatment with taurine + CM increased (p < 0.05) acetylcholinesterase activity compared to controls. CONCLUSION: Taurine and CM enhanced cognition and sensorimotor activity by decreasing Aß peptide concentration and increasing superoxide dismutase and acetylcholinesterase activities in AD rats.

Implementation and impact of mobile health (mHealth) in the management of diabetes mellitus in Africa: a systematic review protocol.

INTRODUCTION: The WHO has proposed the concept of mobile health (mHealth) to support healthcare systems delivery worldwide. mHealth basically involves the use of Information and Communication Technology for healthcare provision or delivery services. Africa has seen a remarkable increase in mobile phone availability and usage in the last decade. The incidence and prevalence of diabetes mellitus (DM) in Africa have also been on the increase in the last decade, in sharp contrast to an ailing healthcare system. We aim to review the extent of implementation of mHealth in the management of DM in Africa, and estimate its impact in helping patients achieve desired glycaemic target, sustain control and prevent complications in the past decade. METHODS AND ANALYSIS: Studies assessing the utilisation of mhealth in the management of patients with DM in Africa will be considered based on the PICO method: Population, Intervention, Comparator, and Outcomes. Medline, PubMed, SCOPUS and the Pan African Clinical Trials Registry, among others will be searched. Two authors independent of each other shall screen titles and abstracts retrieved using the search strategy, retrieve the full text articles and assess them for eligibility and extract data. A third reviewing author will be brought in to resolve any disagreement between the two authors by discussion. The 'Cochrane Collaboration Risk of Bias Tool' will be used to assess the quality of included studies. A narrative synthesis of extracted data and, where the characteristics of the eligible studies permit, a meta-analysis (which will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) will be done. ETHICS AND DISSEMINATION: No ethical approval will be required since only published data will be used. Dissemination of results will be through peer reviewed publication and conference presentation. PROSPERO REGISTRATION NUMBER: CRD42021218674.

The use of alemtuzumab in patients with relapsing-remitting multiple sclerosis: the Gulf perspective.

Over the past decade, the development of high-efficacy disease-modifying therapies (DMTs) has been responsible for more effective management of relapsing-remitting multiple sclerosis (RRMS). However, the gaps in optimal care for this complex disease remain. Alemtuzumab (Lemtrada®) is a highly efficacious DMT that shows better patient outcomes and therapeutic benefits, but its use is under-recognized in the Gulf region. Experts in the care of multiple sclerosis shared their opinions based on study data and daily clinical experience in identifying the appropriate patient profile suitable for alemtuzumab's therapeutic benefits. Age, disease activity and severity, disability status, physician experience, and economic condition are some of the key indicators for alemtuzumab use.

Immune Reconstitution Therapy or Continuous Immunosuppression for the Management of Active Relapsing-Remitting Multiple Sclerosis Patients? A Narrative Review.

The majority of disease-modifying drugs (DMDs) available for the management of active relapsing-remitting multiple sclerosis (RMS) depend on continuous drug intake for maintained efficacy, with escalation to a more active drug when an unacceptable level of disease activity returns. Among continuously applied regimens, interferons and glatiramer acetate act as immunomodulators, while dimethyl fumarate, fingolimod, ocrelizumab, natalizumab and teriflunomide are associated with continuous immunosuppression. By contrast, immune reconstitution therapy (IRT) provides efficacy that outlasts a short course of treatment. Autologous hemopoietic stem cell transplantation is perhaps the classic example of IRT, but this invasive and intensive therapy has challenging side-effects. A short treatment course of a pharmacologic agent hypothesized to act as an IRT, such as Cladribine Tablets 3.5 mg/kg or alemtuzumab, can provide long-term suppression of MS disease activity, without need for continuous treatment (the anti-CD20 mechanism of ocrelizumab has the potential to act as an IRT, but is administered continuously, at 6-monthly intervals). Cladribine Tablets 3.5 mg/kg shows some selectivity in targeting adaptive immunity with a lesser effect on innate immunity. The introduction of IRT-like disease-modifying drugs (DMDs) challenges the traditional maintenance/escalation mode of treatment and raises new questions about how disease activity is measured. In this review, we consider a modern classification of DMDs for MS and its implications for the care of patients in the IRT era.

Uncommon Infections in Children Suggest Underlying Immunodeficiency: A Case of Infective Endocarditis in a 3-Year-Old Male.

Infective endocarditis (IE) results from bacterial or fungal infection and is associated with significant morbidity and mortality. Several known risk factors exist for endocarditis, and 90% of pediatric cases have an underlying structural or congenital heart disease or prosthetic heart valve. Literature on IE in previously healthy children is relatively sparse, and the pathogenesis and underlying risk factors remain mostly unknown. Our patient was a 3-year-old male with a unique presentation of IE. His lack of structural and congenital risk factors for endocarditis prompted further workup, and labs were consistent with insufficient immunoglobulin, suggesting a primary immunodeficiency (PAD). PAD presents as heightened susceptibility to infections, commonly seen as recurrent pneumonia, meningitis, septic arthritis, and otitis media. Pediatric patients commonly have infections, yet as many as in 1 in 2000 patients have PAD. Our case emphasizes the potential need for further investigation into PAD in a young patient with no known risk factors who develops an uncommon infection such as IE.

Ovarian stimulation medications and patients' responses as prognostic factors in IUI-treated infertile Saudi patients.

BACKGROUND: Intrauterine Insemination (IUI) remains the first thought of infertility treatment. OBJECTIVE: To compare the stimulation effects and Pregnancy rate (PR) outcomes of two ovulation induction (OI) medications, human-derived menopausal gonadotrophins (hMGH), Merional (MER), and recombinant follicular stimulating hormone (rFSH), Puregon (PUR), in a cohort of Saudi infertile patients, for better predictability of treatment results. MATERIALS AND METHODS: During a 24-month period, 296 women underwent IUI single treatments. PR's were correlated with the type of stimulation medication that were prospectively and randomly assigned to each patient, and with the number and size of maturing follicles detected on the hCG injection day. RESULTS: MER and PUR needed comparable number of days (9.26±4.74 and 9.73±6.27 respectively) before follicles were ready for IUI, although the average amount used from MER, 1199.90 IU, was about double that was used from PUR, 621.08 IU. The overall PR in case of PUR however was nearly double that of MER, 13.28% and 7.14% respectively. The best PR, 16.22%, occurred when the follicles matured within 12-13 days. Three follicles of at least 15-mm diameter on the hCG day had better PR's than one or two, however when the follicles' diameters were at least 18-mm, PR was significantly higher, (p=0.013). CONCLUSION: MER and PUR had comparable stimulation effects; however PUR had noticeably higher PR. The best PR occurred when the follicles matured within 12-13 days. PR in case of three maturing follicles on the hCG day was better than only one or two, and significantly better when their diameters were at least 18 mm.

Exposure to difenoconazole, diclofop-methyl alone and combination alters oxidative stress and biochemical parameters in albino rats.

The herbicides diclofop-methyl and the fungicide difenoconazole are widely used in agriculture and may lead to serious toxicity risks. However, limited studies have been done to evaluate differences in the metabolic effects of these herbicides. Difenoconazole (10 mg/kg) and Diclofop-methyl (1 mg/kg) were orally administrated individually (Groups 1 and 2 respectively) as well as combined (G3) to rats for 28 days. In all treated groups, alanine aminotransferase (ALT) and urea were significantly higher than the control group. Plasma creatinine was also significantly higher in groups G1 and G2 than control. Significant inhibition in gamma glutamyltransferase (γGT) was observed in all treated groups, in addition to significant inhibition of plasma acetylcholinesterase enzyme (AChE) in G3 (p < 0.01). There was no effect in aspartate aminotransferase (AST) and albumin. Total plasma triiodothy-ronine (T3) hormone was significantly higher in groups G2 and G3 (p < 0.01), but significantly lower in G1 group as compared to control. Thyroxin (T4) was significantly lower in all treated groups than control. Cholesterol level was significantly lower in G3 than control, and a total protein (TP) was significantly higher in all treated groups than control. No differences were observed in glucose levels. Malondialdehyde (MDA) and superoxide dismutase (SOD), an oxidative stress biomarker, was significantly increased in all treated groups comparing to control. Sulphur containing protein (SH-protein) was significantly lower in G1 than control. No significant changes were observed for GST in all treatments. The significant differences in measured biomarkers after application of diclofop-methyl, difenoconazole individually and combined indicate that the investigated pesticides may have potentially harmful effects on humans and the surrounding environment. We suggest that larger studies be conducted to better understand the toxicity mechanisms of these pesticides.

Age, body mass index, and number of previous trials: are they prognosticators of intra-uterine-insemination for infertility treatment?

BACKGROUND: To examine whether pregnancy rate (PR) of intrauterine insemination (IUI) is related to certain demographic factors, such as age and body mass index (BMI), along with number of IUI cycles performed, a set of infertile Saudi women. MATERIALS AND METHODS: During this prospective study (a 24-month period), 301 Saudi women with infertility underwent IUI in our infertility clinic. We investigated whether PR is correlated with patient age and BMI, and the number of IUI trials, in order to determine if they could be used as prognosticators of pregnancy success. RESULTS: The highest PR was 14.89% for ages 19-25 and the lowest PR was 4.16% for ages 41-45, indicating no statistically significant difference among PR in all age groups (p value of 0.225). Also, in terms of BMI, the highest PR was 13.04% for BMI ≥35 and the lowest was 7.84% for BMI of <25 to 18.5, indicating no significant difference among different BMI groups (p value of 0.788). One-cycle treatment, as expected, was more successful (PR=12.84%) than 2-cycle treatment (PR=5.75%), however, 3-5-cycles treatment still showed encouraging results (PR=17.24%); but the difference did not reach statistical significance (p value=0.167). CONCLUSION: PR after IUI treatment remained approximately 10% from 19 to 40 years of age and declined after 40. Although no significant difference was observed among different age groups, earlier treatment is still recommended. There was a positive but not statistically significant correlation between PR and patient's BMI indicating that BMI is not a determining factor. There was also no correlation between PR and number of IUI trials. Patients can thus try as many times as they want before moving on to in vitro fertilization (IVF) treatment.

Accurate diagnosis as a prognostic factor in intrauterine insemination treatment of infertile saudi patients.

BACKGROUND: The study meant to define the prognostic factors that help in prescribing intrauterine insemination (IUI) for infertility treatment which remains an area of continuous improvements. METHODS: The diagnostic indications of a cohort of IUI-treated patients and their corresponding pregnancy rates (PRs) were randomly and prospectively studied among Saudi cohort of 303 patients for a period of 20 months. The indications of IUI cases were statistically analyzed for those eligible patients over a period of twenty months (January 2010 till August 2011), and the PR that corresponded to each group was investigated as well. P-value less than 0.05 was considered significant. RESULTS: The highest PR, 18.87%, of the polycystic ovarian syndrome (PCOS)-only diagnosed patients, was significantly higher than the average PR of all other indications combined, 7.22%, (p = 0.011, compared to all other groups combined). The second highest PR, 14.0%, of the tubal factor (TF)-only indication, was double the PR average of all other indications combined, though it did not reach significance. However, PCOS and TF accompanied by other indications caused the PR to drop to 5.88% and 5.56%, respectively. However, a group of some hormonal-imbalance based indications had the least PR (0.0% to 2.70%). Those indications were elevated serum FSH, hyperprolactinemia, hypogonadotrophy, hypothyroidism and endometriosis. The rest of the indications had an average PR (8.33% to 11.11%). CONCLUSION: There is a reasonable chance of conception after IUI treatment for female factor infertility except in cases with sever hormonal imbalance. The PCOS cases having the best success chances.