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Mourad A, Kamga-Ngande C, Albaini O, Antaki R. Enhancing surgical performance: the role of robotic surgery in myomectomies, a systematic review and metanalysis. J Robot Surg 2024; 18:184. [PMID: 38683450 DOI: 10.1007/s11701-024-01953-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
Examine the role, benefits, and limitations of robotic surgery in myomectomies compared to laparoscopic and open surgical approaches. This review sourced data from CENTRAL, Pubmed, Medline, and Embase up until May 1, 2023. Full articles comparing clinical outcomes of robotic myomectomy with open or laparoscopic procedures were included without language restriction. Initially, 2150 records were found. 24 studies were finally included for both qualitative and quantitative analyses. Two investigators independently assessed all reports following PRISMA guidelines. Meta-analysis was conducted using the software "Review Manager Version 5.4". Risk-of-bias was assessed using the Newcastle-Ottawa scale. Sensitivity analysis was conducted, when feasible. In a comparison between robotic and laparoscopic myomectomies, no significant difference was observed in fibroid weights and the size of the largest fibroid. Robotic myomectomy resulted in less blood loss, but transfusion rates were comparable. Both methods had similar complication rates and operative times, although some robotic studies showed longer durations. Conversion rates favored robotics. Hospital stays varied widely, with no overall significant difference, and pregnancy rates were similar between the two methods. When comparing robotic to open myomectomies, open procedures treated heavier and larger fibroids. They also had greater blood loss, but the robotic approach required fewer transfusions. The complication rate was slightly higher in open procedures. Open surgeries were generally faster, postoperative pain scores were similar, but hospital stays were longer for open procedures. Pregnancy rates were comparable for both robotic and open methods. Robotic surgery offers advancement in myomectomy procedures by offering enhanced exposure and dexterity, leading to reduced blood loss and improved patient outcomes. PROSPERO registration: CRD42023462348.
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Affiliation(s)
- Ali Mourad
- Department of Obstetrics and Gynecology, Western University, London, ON, Canada
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, QC, Canada
| | - Carole Kamga-Ngande
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, QC, Canada
- Miacleo fertility clinic Montreal, Montreal, QC, Canada
| | - Obey Albaini
- Faculty of Medicine, School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Roland Antaki
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, QC, Canada.
- Ovo fertility clinic Montreal, Montreal, QC, Canada.
- Centre Hospitalier de l'Université de Montréal (CHUM), 900, Saint-Denis Street, Montreal, QC, H2X 3H8, Canada.
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Mourad A, Antaki R, Rowen M, Lévesque É, Lapensée L. The POPI-Plus tool: prediction model of outcome of pregnancy in in vitro fertilization from a large retrospective cohort. Fertil Steril 2024; 121:489-496. [PMID: 38043845 DOI: 10.1016/j.fertnstert.2023.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To create a tool that accurately predicts live birth chances after a positive pregnancy test after elective single embryo transfer (ET). DESIGN Retrospective cohort. SETTING CHUM hospital and Ovo clinic in Montreal, Canada. PATIENT(S) Patients with a positive pregnancy test result who underwent their first single ET after in vitro fertilization (IVF) at the CHUM hospital and Ovo clinic in Montreal, Canada, from 2012 to 2016 were selected. A total of 1,995 patients were included in this study. INTERVENTION(S) The data from both centers were combined and divided into training (70%, n = 1,398) and validation (30%, n = 597) sets. The predictive model was developed using backward selection method for the following variables: age of patient at egg retrieval; log β-human chorionic gonadotropin (β-hCG) (β-hCG) 1; log β-hCG 2; and IVF treatment type. Moreover, the classification tree, random forest, and neural network models were generated. MAIN OUTCOME MEASURE(S) The measured outcomes were live birth (live fetus ≥24 weeks of gestation) and nonviable pregnancies. The performance of all models was evaluated by area under the receiver operating characteristic curve (AUC). RESULT(S) Advancing age was negatively correlated with live birth. The odds ratio (OR) of age of patient at the time of egg retrieval was 0.95 (95% confidence interval [CI], 0.91-0.99). The log β-hCG 1 and log β-hCG 2 were positively correlated with live birth in the univariate analysis (OR, 4.15 [95% CI, 3.19-5.39], and OR, 3.84 [95% CI, 2.99-4.93], respectively). The β-hCG 1 level needed for a successful pregnancy was lower in frozen ET and modified natural IVF than in simulated IVF (OR, 0.55 [95% CI, 0.34-0.91], and OR, 0.49 [95% CI, 0.26-0.95], respectively). The best performance in terms of the AUC was the updated logistic model: POPI-Plus. The AUC values were 0.76 (95% CI, 0.73-0.79) and 0.78 (95% CI, 0.74-0.82) for the training and validation data, respectively. The other models (classification tree, random forest, and neural network) also performed adequately, with an AUC of ≥0.7, but remained below POPI-Plus. An open-access calculator was generated and can be found on the website of the University of Montreal on the following link: https://deptobsgyn.umontreal.ca/departement/divisions/medecine-et-biologie-de-la-reproduction/the-popi-plus-tool/. CONCLUSION(S) The POPI-Plus tool offers individualized counseling for patients after an initial positive β-hCG test result. Future studies will assess its impact on patient anxiety while awaiting viability ultrasound and perform prospective validation on new patients.
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Affiliation(s)
- Ali Mourad
- Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada
| | - Roland Antaki
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada; Reproductive Endocrinology and Infertility, Ovo Fertility Clinic, Montreal, Quebec, Canada
| | - Mélanie Rowen
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
| | - Étienne Lévesque
- Faculty of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Louise Lapensée
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada; Reproductive Endocrinology and Infertility, Ovo Fertility Clinic, Montreal, Quebec, Canada.
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Mourad A, Jamal W, Hemmings R, Tadevosyan A, Phillips S, Kadoch IJ. GROWTH HORMONE IS USELESS IN IVF: THE LARGEST RANDOMIZED CONTROLLED TRIAL. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mourad A, Jamal W, Kadoch I, Antaki R, Helou ME, Grosfils V, Phillips S, Hemmings R. P-106 Total motile sperm count and oral ovulation induction protocols are not predictors of success in donor insemination cycles: Results from a large retrospective cohort study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
to investigate the effect of total motile sperm (TMS) count, and ovulation induction on clinical pregnancy rate in artificial insemination with donor (AID) cycles.
Summary answer
TMS count is not a predictor of sucess, and natural cycles are as effective as oral ovulation induction in donor inseminations
What is known already
There are inconsistent results regarding the effect of sperm parameters on success rates of artificial insemination with donor (AID). Besides, the use of gonadotropin stimulation for ovulation induction in this category of patients is questionable, and its effectiveness over natural cycles is not yet confirmed in the literature.
Study design, size, duration
Patients who underwent AID cycles at the university-affiliated fertility center-OVO clinic in Montreal, Canada between 2011 and 2015 were retrospectively selected. A total of 4333 AID cycles were performed on 1179 patients, resulting in 744 pregnancies.
Participants/materials, setting, methods
Cycles were divided into 8 groups based on TMS count: <0.5, [0.5-1[, [1-5[, [5-10[, [10-20[, [20-40[, [40-80[, and ≥80. A TMS of 10 to 20 million was selected as a reference level. Ovulation induction was divided into oral stimulation, combined oral and gonadotropin stimulation and gonadotropin-only stimulation, and compared to natural cycles. Regression analysis and a predictive model of clinical pregnancy in AID cycles were generated from patient demographic and cycle characteristics.
Main results and the role of chance
There was no significant difference in positive β-hCG result, clinical pregnancy, multiple pregnancy and miscarriage rates when comparing all ranges of TMS count to a reference of 10 to 20 million. When dividing patients based on the protocol for ovulation induction, clinical pregnancy rate was significantly higher in the gonadotropin-only stimulation group (OR 4.116,[1.379,12.287]) but not in other types of stimulation, as compared to natural cycles. hCG triggering resulted in a similar clinical pregnancy and miscarriage rates, but a higher multiple pregnancy rate when compared to urinary LH testing (7.7% versus 1.3%, p = 0.045). A multivariate logistic regression analysis for predictors of clinical pregnancy accounting for relevant demographic and cycle characteristics was conducted. No significant difference was noted in different ranges of TMS and the groups of ovulation induction. In this model, age was found to be a significant predictor. In particular, with every one-year increase in age, the odds of clinical pregnancy decreases by 6.4% (Adjusted OR 0.936; 95%CI [0.914, 0.958]).
Limitations, reasons for caution
In our study, cycles with TMS count below 1 million are limited. Thus, results should be viewed with caution in this group, without cycle cancellation, since clinical pregnancy can be achieved. Moreover, our results cannot be generalized on infertile couples given the characteristics of our population of interest.
Wider implications of the findings
Minimal or maximal cut-off values for TMS in AID cycles should not be used as indicators for cycle cancellation. Natural cycles are as successful as oral ovulation induction. hCG trigger, unless indicated, should not be used as it is associated with higher risk of multiple pregnancy without increasing clinical pregnancy.
Trial registration number
not applicable
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Affiliation(s)
- A Mourad
- University of Montreal, Department of Obstetrics and Gynecology , Montreal, Canada
- OVO fertility center, Reproductive endocrinology and infertility , Montreal, Canada
| | - W Jamal
- University of Montreal, Department of Obstetrics and Gynecology , Montreal, Canada
- OVO fertility center, Reproductive endocrinology and infertility , Montreal, Canada
| | - I.J Kadoch
- University of Montreal, Department of Obstetrics and Gynecology , Montreal, Canada
- OVO fertility center, Reproductive endocrinology and infertility , Montreal, Canada
| | - R Antaki
- University of Montreal, Department of Obstetrics and Gynecology , Montreal, Canada
- OVO fertility center, Reproductive endocrinology and infertility , Montreal, Canada
| | - M.O. El Helou
- American University of Beirut, Scholars in health research program , Beirut, Lebanon
| | - V Grosfils
- University of Montreal, Faculty of medicine , Montreal, Canada
| | - S Phillips
- OVO fertility center, Reproductive endocrinology and infertility , Montreal, Canada
| | - R Hemmings
- University of Montreal, Department of Obstetrics and Gynecology , Montreal, Canada
- OVO fertility center, Reproductive endocrinology and infertility , Montreal, Canada
- McGill University, Department of Obstetrics and Gynecology , Montreal, Canada
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Mourad A, Marcellin F, Rolland B, Authier N, Delorme J, Carrieri P, Protopopescu C. Prévalence de l'hépatite C chez les usagers de drogues par injection en France: modélisation mathématique de l'évolution à l’ère des antiviraux à action directe (FANTASIO). Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.03.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hamze H, Mourad A, Seoud M, Chamsy D. Symptomatic Round Ligament Leiomyoma in a Patient with Müllerian Agenesis. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hassan Hamze
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Mourad
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhieddine Seoud
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dina Chamsy
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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Silvestri F, Saliba-Serre B, Ruquet M, Graillon N, Fakhry N, Mourad A, Maille G. Quality of life of patients irradiated for head and neck cancer and impact of rehabilitation with a removable dental prosthetic: 1-year follow-up study. J Clin Exp Dent 2022; 14:e221-e228. [PMID: 35317300 PMCID: PMC8916605 DOI: 10.4317/jced.59315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 02/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Head and neck cancer and its treatment cause significant functional, aesthetic, and social disabilities. These disabilities have a major impact on the quality of life of patients. When irradiation is required, removable dental prostheses are often the treatment of choice. This study investigated whether removable prosthetic rehabilitation improved patient function and aesthetics over the long term.
Material and Methods In this prospective study, we assessed quality of life in 78 patients with the General Oral Health Assessment Index (GOHAI) questionnaire. Assessments were performed before, and 1 week, 3 months, 6 months, and 12 months after denture insertion. We evaluated whether quality of life was influenced by the type of removable prosthesis and the primary tumour location.
Results We constructed mixed-effects linear regression models to identify correlates of the overall GOHAI score (GOAHI-add score) and the three domain-scores (functional, psychosocial, and discomfort/pain) in a longitudinal analysis over a 12-month follow-up. We compared scores (GOHAI-add score and domain-scores) in multivariate analyses between baseline (T0) and four post-insertion timepoints to determine significant changes.
Conclusions We found that removable prosthetic rehabilitation had an influence on the evolution of quality of life. The psychosocial component scores increased steadily over the year and changed more significantly than the functional and discomfort-pain components. The mandibular location of the primary lesion had a negative influence on quality of life. The type of removable prosthesis did not influence the results. Key words:Quality of life, head and neck cancer, GOHAI, dental prosthesis, radiotherapy.
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Mahdy AA, Mourad A, Mosa E, Kandil A. Influences of pinprofile and transverse speed on microstructure, mechanical properties, and wear behavior of nanocomposite AA6082/WC and fabricated via friction stir processing. Journal of Radiation Research and Applied Sciences 2021. [DOI: 10.1080/16878507.2021.2004720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amir A. Mahdy
- Mining, Metallurgy, and Petroleum Engineering Department, Faculty of Engineering, AL-Azhar University, Nasr City Cairo, Egypt
| | - A. Mourad
- Intercairo Company for Aluminum Industry, Giza, Egypt
| | - E.S. Mosa
- Mining, Metallurgy, and Petroleum Engineering Department, Faculty of Engineering, AL-Azhar University, Nasr City Cairo, Egypt
| | - A. Kandil
- Mining, Metallurgy, and Petroleum Engineering Department, Faculty of Engineering, AL-Azhar University, Nasr City Cairo, Egypt
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9
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Mourad A, Antaki R, Bissonnette F, Al Baini O, Saadeh B, Jamal W. Evidence-based clinical prioritization of embryos with mosaic results: a systematic review and meta-analysis. J Assist Reprod Genet 2021; 38:2849-2860. [PMID: 34472017 DOI: 10.1007/s10815-021-02279-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/09/2021] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The purpose of this review and meta-analysis is to standardize the practice of mosaic embryo transfer, based on the current available evidence. METHODS This is a systematic review and meta-analysis. Relevant studies published were comprehensively selected using PubMed, Medline, Embase, and CENTRAL until 5 March 2021. Prospective and retrospective studies reporting the genetic analysis and clinical outcomes of mosaic embryo transfer were included. Risk of bias assessment was based on the Newcastle-Ottawa scale for the non-randomized studies. The primary and secondary outcomes were combined ongoing pregnancy and live birth rate and miscarriage rate, respectively. RESULTS There were no differences between low and high mosaic embryos when a cut-off of 40% was used in terms of OP/LBR and SAB. However, low mosaics with a cut-off of 50% compared to high mosaics showed a significantly higher OP/LBR in the NGS but not in the a-CGH group, and a significantly lower risk of SAB. No differences were noted between mosaic monosomies versus trisomies and single versus double mosaics for both OP/LBR and SAB. Finally, segmental mosaics showed a higher OP/LBR and a lower SAB compared to whole chromosomes, and single and double mosaics had a higher OP/LBR compared to complex mosaics. CONCLUSIONS A cut-off of 50% in defining low versus high mosaic embryos is preferable to a threshold of 40% when using NGS platform. No priority was established for mosaic trisomies over monosomies. Single and double mosaics must be preferred over complex mosaics and segmental mosaics must be preferred over whole chromosome mosaics. These results should be interpreted in the context of specific chromosomes involved in the mosaicism.
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Affiliation(s)
- Ali Mourad
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Roland Antaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- OVO Fertility Center, 8000 Decarie Blvd, Montreal, QC, H4P 2S4, Canada
| | - François Bissonnette
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- OVO Fertility Center, 8000 Decarie Blvd, Montreal, QC, H4P 2S4, Canada
| | - Obey Al Baini
- Department of Research, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | | | - Wael Jamal
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
- OVO Fertility Center, 8000 Decarie Blvd, Montreal, QC, H4P 2S4, Canada.
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Mourad A, Antaki R, Jamal W, Albaini O. Aspirin for Endometrial Preparation in Patients Undergoing IVF: A Systematic Review and Meta-analysis. J Obstet Gynaecol Can 2021; 43:984-992.e2. [PMID: 33892182 DOI: 10.1016/j.jogc.2021.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the effect of aspirin on IVF success rates when used as an adjuvant treatment for endometrial preparation. DATA SOURCES Relevant publications were comprehensively selected from PubMed, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to November 15, 2020. STUDY SELECTION Randomized controlled trials (RCTs) and retrospective cohort studies that used aspirin as an adjuvant treatment for endometrial preparation and reported subsequent pregnancy outcomes were included. Studies were excluded if aspirin was used before and/or during ovarian stimulation. DATA EXTRACTION AND SYNTHESIS This systematic review and meta-analysis included a total of 7 studies. Risk of bias assessment was based on the methodology and categories listed in the Cochrane Handbook for the RCTs and the Newcastle-Ottawa scale for the retrospective studies. The primary outcome was live birth rate. Summary measures were reported as odds ratios (ORs) with 95% confidence intervals (CIs). There was significant evidence that aspirin for endometrial preparation improved live birth rates (OR 1.52; 95% CI 1.15-2.00). No effect was noted for clinical pregnancy rates (OR 1.37; 95% CI 1.00-1.87); however, aspirin was associated with improved pregnancy rates in a subgroup analysis of patients receiving oocyte donation (OR 2.53; 95% CI 1.30-4.92) and in the sensitivity analysis (OR 1.3; 95% CI 1.02-1.66). No effect of aspirin was found for implantation or miscarriage rates (OR 1.31; 95% CI 0.51-3.36 and OR 0.41; 95% CI 0.02-7.42, respectively). CONCLUSION These findings support a beneficial effect of aspirin for endometrial preparation on IVF success rates, mainly live birth rates, outside the context of ovarian stimulation. However, this evidence is based on poor quality data and needs to be confirmed with high-quality RCTs.
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Affiliation(s)
- Ali Mourad
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montréal, Montréal, QC; OVO Fertility Clinic, Montréal, QC
| | - Roland Antaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montréal, Montréal, QC; OVO Fertility Clinic, Montréal, QC.
| | - Wael Jamal
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montréal, Montréal, QC; OVO Fertility Clinic, Montréal, QC
| | - Obey Albaini
- Department of Research, Gilbert and Rose-Marie Chagouri School of Medicine, Lebanese American University, Beirut, Lebanon
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Khudhari A, Mourad A, Phillips S, Alam MZ, Hemmings R, Jamal W. Perinatal outcomes of human singletons conceived naturally versus assisted reproductive technologies: analysis of the effect of stimulated IVF, modified natural IVF, and frozen embryo transfer. Middle East Fertil Soc J 2021. [DOI: 10.1186/s43043-021-00051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Obstetrical outcomes in assisted reproduction techniques (ART) were compared with naturally conceived pregnancies and among each other in multiple reports. However, many important changes in the practice of in vitro fertilization (IVF) over the years, including single embryo transfers (sET) and the introduction of modified natural IVF (mnIVF), and the advances in the frozen embryo transfer (FET) might have impacted the outcomes. Our study is the first to our knowledge to assess four different groups, including spontaneous pregnancies, mnIVF, stimulated IVF (sIVF), and FET altogether in a head-to-head comparison. This is a retrospective study on perinatal outcomes of singleton babies conceived naturally or using three different ART protocols between 2011 and 2014. The primary objective was the comparison of gestational age and birth weight between spontaneously conceived pregnancies (NAT, n= 15,770), mnIVF (n=235), sIVF (n=389), and FET (n=222).
Results
Our results show a significant difference in favor of naturally conceived pregnancies over ART in term of gestational age. In fact, the gestational age of babies in the NAT group was statistically higher compared to each one of the ART groups alone. Regarding the birth weight, the mean was significantly higher in the FET group compared to the other categories.
Conclusion
Differences in perinatal outcomes are still found among babies born after different modes of conception. However, there is still need for well-designed high-quality trials assessing perinatal outcomes between naturally conceived pregnancies and different ART protocols based on different maternal and treatment characteristics.
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Bader R, Ibrahim JN, Mourad A, Moussa M, Azoury J, Azoury J, Alaaeddine N. Improvement of Human Sperm Vacuolization and DNA Fragmentation Co-Cultured with Adipose-Derived Mesenchymal Stem Cell Secretome: In Vitro Effect. Int J Stem Cells 2019; 12:388-399. [PMID: 31474028 PMCID: PMC6881046 DOI: 10.15283/ijsc19047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives Oxidative stress (OS) is known to be an important factor of male infertility. Adipose-derived mesenchymal stem cells (AD-MSCs) are known to have immune-modulatory and anti-oxidant effects through their secretions, hence raising the idea of their potential benefit to improve sperm parameters. This study aims at investigating the effect of AD-MSCs conditioned medium (CM) on human sperm parameters in the presence and absence of H2O2-induced OS. Methods and Results Sperm samples were collected from 30 healthy men and divided into two groups: non-stressed and H2O2-stressed. Isolated AD-MSCs from healthy donors undergoing liposuction were cultured and CM was collected at 24, 48 and 72 h. Both sperm groups were cultured with CM and a time course was performed followed by an evaluation of sperm parameters. The incubation of non-stressed and stressed sperm samples with AD-MSCs-CM for 24 h was found to have the optimum impact on sperm vacuolization, DNA fragmentation and OS levels in comparison to other incubation timings, while preserving motility, viability and morphology of cells. Incubation with CM improved all sperm parameters except morphology in comparison to the non-treated group, with the best effect noted with CM collected at 24 h rather than 48 or 72 h for sperm vacuolization and DNA fragmentation. When compared to fresh semen parameters (T0), samples cultured with CM 24 h showed a significant decrease in sperm vacuolization and DNA fragmentation while keeping other parameters stable. Conclusions AD-MSCSs-CM improves sperm quality, and hence can be used in treating infertility and subsequently enhancing IVF outcomes.
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Affiliation(s)
- Robert Bader
- Regenerative Medicine and Inflammation Laboratory, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | | | - Ali Mourad
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mayssam Moussa
- Regenerative Medicine and Inflammation Laboratory, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Joan Azoury
- OB-GYN Department, Inova Fairfax Hospital, Falls Church, VI, USA
| | | | - Nada Alaaeddine
- Neuroscience Research Science, Faculty of Medicine, Lebanese University, Beirut, Lebanon
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Bader R, Ibrahim JN, Moussa M, Mourad A, Azoury J, Azoury J, Alaaeddine N. In vitro
effect of autologous platelet‐rich plasma on H
2
O
2
‐induced oxidative stress in human spermatozoa. Andrology 2019; 8:191-200. [DOI: 10.1111/andr.12648] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 12/14/2022]
Affiliation(s)
- R. Bader
- Mount Lebanon HospitalAzoury IVF Clinic Beirut Lebanon
- Faculty of Medicine Regenerative Medicine and Inflammation Laboratory Saint‐Joseph University Beirut Lebanon
| | - J. N. Ibrahim
- Faculty of Public Health II Medical Laboratory Department Lebanese University Beirut Lebanon
| | - M. Moussa
- Faculty of Medicine Regenerative Medicine and Inflammation Laboratory Saint‐Joseph University Beirut Lebanon
| | - A. Mourad
- Department of Obstetrics and Gynecology American University of Beirut Medical Center Beirut Lebanon
| | - J. Azoury
- OB‐GYN Department Inova Fairfax Hospital Falls Church VA USA
| | - J. Azoury
- Mount Lebanon HospitalAzoury IVF Clinic Beirut Lebanon
| | - N. Alaaeddine
- Faculty of Medical Sciences Neuroscience Research CenterLebanese University Beirut Lebanon
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14
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Mourad A, Straube S, Armijo‐Olivo S, Gniadecki R. Factors predicting persistence of biologic drugs in psoriasis: a systematic review and meta‐analysis. Br J Dermatol 2019; 181:450-458. [DOI: 10.1111/bjd.17738] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 01/19/2023]
Affiliation(s)
- A. Mourad
- Faculty of Medicine & Dentistry University of Alberta Medical School Edmonton ABCanada
| | - S. Straube
- Division of Preventive Medicine University of Alberta Edmonton ABCanada
| | - S. Armijo‐Olivo
- Research Center Faculty of Rehabilitation Medicine University of Alberta Edmonton ABCanada
| | - R. Gniadecki
- Division of Dermatology Department of Medicine University of Alberta Edmonton AB Canada
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15
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Nassif J, Nahouli H, Mourad A, Yammine R, Khoury S, Khalil A. Laparoscopic Excision of an Unusual Presentation of a Nabothian Cyst: Case Report and Review of the Literature. Surg Technol Int 2017; 31:140-143. [PMID: 29313317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Nabothian cysts are mucinous retention cysts formed through the accumulation of cervical mucus inside blocked cervical crypts leading to non-neoplastic mucinous cystic lesion in relation to the uterine cervix. The formation of Nabothian cysts is a common gynecological benign condition in women of reproductive age. While the presence of small-sized Nabothian cysts is usually clinically asymptomatic and requires no treatment or intervention, the diagnosis of larger Nabothian cysts can be mistaken with malignant tumors, including mucin producing carcinomas such as Adenoma malignum. In this study, we report the case of a large Nabothian cyst that was correctly diagnosed preoperatively using ultrasonography and magnetic resonance imaging (MRI), and successfully treated through laparoscopic excision, avoiding the performance of unnecessary hysterectomy. A 44-year old Lebanese patient presented with chronic dyspareunia and pelvic pain. An ultrasound was performed and revealed an 8cm multiloculated anechoic pelvic cystic lesion with no solid components. An MRI was performed and showed an 8cm mass lateral to the right vaginal wall, suggestive of a Nabothian cyst. The patient was scheduled for laparoscopic removal of the Nabothian cyst. The patient tolerated the procedure well and was discharged under stable condition a few hours after the operation. Careful preoperative examination, including the use of imaging methods such as ultrasonogoraphy and MRI, is crucial for diagnosis and differentiation of atypical presentation of benign, but large and complex, Nabothian cysts from other differential conditions of malignancies, consequently avoiding unnecessary hysterectomy. Use of laparoscopy as a minimally-invasive technique to excise such cysts is considered a valid option, allowing for a fast recovery for the patients.
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Affiliation(s)
- Joseph Nassif
- Obstetrics and Gynecology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hasan Nahouli
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ali Mourad
- Obstetrics and Gynecology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ryan Yammine
- Department of Chemistry, American University of Beirut, Beirut, Lebanon
| | - Sally Khoury
- ikhazi Medical Group, Trad Hospital Medical Center, Beirut, Lebanon
| | - Ali Khalil
- Obstetrics and Gynecology Department, American University of Beirut Medical Center, Beirut, Lebanon
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16
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Shatila AR, Koussa S, Jabbour R, Mourad A, Aouad A, Sabbagh G, Kallab K, Hilal R, Khalifeh R, Gebeily S, Tourbah A. LSN MS guidelines for the management of multiple sclerosis. Rev Neurol (Paris) 2013; 169:950-5. [PMID: 23434141 DOI: 10.1016/j.neurol.2012.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 09/21/2012] [Accepted: 12/13/2012] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The prevalence of multiple sclerosis (MS) in Lebanon is unknown, as there are no available or reliable epidemiological studies to date. The circumstances of Middle East countries are different from those of Europe and North America in terms of differential diagnoses and disease management. The aim of the conference is to establish guidelines for diagnosis, treatment, follow-up and management of patients with MS in Lebanon. Another objective is to discuss and participate in research projects based on epidemiology, clinical trials and more fundamental aspects of the disease in the future. METHODS Under the authority of the Lebanese Society of Neurology (LSN), a group of neurologists took the initiative to participate in this LSN MS committee with the purpose of establishing a consensus for the management of patients with MS, and under the supervision of a Coordinator (A.T.) designed by the LSN board. RESULTS Diagnostic and therapeutic, follow-up and research recommendations were proposed with special emphasis on the specific needs and circumstances of Lebanon. The experts highlighted the importance of considering particular needs, the identification of patients at high risk of developing MS in order to maximize therapeutic opportunities, and cost-effective control of treatment efficacy, as well as global assessment of disability. CONCLUSIONS The experts established guidelines concerning diagnosis, treatment, and follow-up of patients with MS in Lebanon. Furthermore, they recommended some clinical and fundamental research projects.
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Affiliation(s)
- A R Shatila
- Neurology Division Makassed Hospital, Ouzai Street Tarik Al-Jadida, Beirut, Lebanon
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17
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Hollebecque A, Cattan S, Romano O, Sergent G, Mourad A, Louvet A, Dharancy S, Boleslawski E, Truant S, Pruvot FR, Hebbar M, Ernst O, Mathurin P. Safety and efficacy of sorafenib in hepatocellular carcinoma: the impact of the Child-Pugh score. Aliment Pharmacol Ther 2011; 34:1193-201. [PMID: 21958438 DOI: 10.1111/j.1365-2036.2011.04860.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sorafenib increases median survival and time to radiological progression in patients with advanced hepatocellular carcinoma, but its benefit for Child-Pugh B patients remains uncertain. AIM To evaluate the safety and efficacy of sorafenib in real-life clinical practice conditions and to assess the influence of Child-Pugh class B on safety and efficacy. METHODS All patients treated with sorafenib for advanced hepatocellular carcinoma in our institution were included prospectively. Adverse events, overall survival and time to progression were recorded. A case control study was performed to compare outcome of patients with comparable stages of hepatocellular carcinoma, but a different Child-Pugh class. RESULTS From March 2007 to May 2009, 120 patients were included. Overall survival was 11.1 months, Child-Pugh A patients (n=100) had significantly higher median survival than Child-Pugh B patients (n=20) (13 vs. 4.5 months, P=0.0008). In multivariate analysis, Child-Pugh class B, α-fetoprotein level and total size of lesions were independent predictive factors of death. Patients with radiological progression in the first 3 months had shorter median survival (5.4 vs. 17.4 months). In a case control study, time to symptomatic progression (2.5 vs. 3.6 months), frequency of adverse events and discontinuation of sorafenib were not correlated with Child-Pugh class. CONCLUSIONS Patients with advanced hepatocellular carcinoma treated with sorafenib had a median survival of 11 months. Sorafenib therapy must be considered with caution in Child-Pugh B patients due to their poor survival. Radiological assessment of tumour progression at an early stage may be advantageous when tailoring sorafenib therapy.
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Affiliation(s)
- A Hollebecque
- Service d'Hépato-Gastroentérologie, CHRU Lille, France
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18
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Mourad A, Guichard JP, Vignal C, Bousser MG, Vahedi K. Sphenoid and optic nerve sheath meningioma revealed by recurrent brain infarctions. Rev Neurol (Paris) 2010; 165:1092-4. [PMID: 19324384 DOI: 10.1016/j.neurol.2009.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 01/05/2009] [Accepted: 02/15/2009] [Indexed: 11/28/2022]
Abstract
Meningioma, though benign, may invade adjacent structures such as bone, soft tissues, dural sinuses and arteries. However brain infarctions secondary to meningioma involving the cavernous sinus and encasing and narrowing the intracranial carotid artery are rare. We report the case of a young man with recurrent left carotid artery infarctions due to a left sphenoid meningioma infiltrating the posterior optic nerve sheath through the optic canal and circumscribing the intracranial carotid artery. The patient had a gradually progressive occlusion of the middle cerebral artery, the distal internal carotid artery and finally the anterior cerebral artery ipsilateral to the sphenoid meningioma.
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Affiliation(s)
- A Mourad
- Department of Neurology, Lariboisière Hospital, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75010 Paris, France
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19
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ten Tusscher KHWJ, Mourad A, Nash MP, Clayton RH, Bradley CP, Paterson DJ, Hren R, Hayward M, Panfilov AV, Taggart P. Organization of ventricular fibrillation in the human heart: experiments and models. Exp Physiol 2009; 94:553-62. [PMID: 19168541 DOI: 10.1113/expphysiol.2008.044065] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sudden cardiac death is a major health problem in the industrialized world. The lethal event is typically ventricular fibrillation (VF), during which the co-ordinated regular contraction of the heart is overthrown by a state of mechanical and electrical anarchy. Understanding the excitation patterns that sustain VF is important in order to identify potential therapeutic targets. In this paper, we studied the organization of human VF by combining clinical recordings of electrical excitation patterns on the epicardial surface during in vivo human VF with simulations of VF in an anatomically and electrophysiologically detailed computational model of the human ventricles. We find both in the computational studies and in the clinical recordings that epicardial surface excitation patterns during VF contain around six rotors. Based on results from the simulated three-dimensional excitation patterns during VF, which show that the total number of electrical sources is 1.4 +/- 0.12 times greater than the number of epicardial rotors, we estimate that the total number of sources present during clinically recorded VF is 9.0 +/- 2.6. This number is approximately fivefold fewer compared with that observed during VF in dog and pig hearts, which are of comparable size to human hearts. We explain this difference by considering differences in action potential duration dynamics across these species. The simpler spatial organization of human VF has important implications for treatment and prevention of this dangerous arrhythmia. Moreover, our findings underline the need for integrated research, in which human-based clinical and computational studies complement animal research.
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Affiliation(s)
- K H W J ten Tusscher
- Department of Scientific Computing, Simula Research Laboratory, Lysaker, Norway.
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20
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Abstract
INTRODUCTION CADASIL is a hereditary cerebral arteriopathy leading to progressive disability and dementia usually observed at 60 years. OBSERVATION We report four patients aged>60 years with typical Notch3 mutations leading to CADASIL who did not have dementia or disability. Three of them presented with only transient neurological manifestations. MRI results showed extensive hyperintense signals in the white-matter on T2-weighted images contrasting with very few lacunar infarcts. CONCLUSION These observations suggest that silent or symptomatic infarcts, which were rare in the present cases may be responsible for the clinical severity in this disorder.
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Affiliation(s)
- A Mourad
- Service de Neurologie CHG, Place du Général Leclerc, Orsay
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21
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Abstract
Although arm position significantly alters blood pressure, this aspect of clinical behaviour has not been evaluated. Consequently, an audit of arm position preference involving 182 clinicians including physicians, general practitioners and nurses was performed. A marked variation in standing and sitting arm position preference, both between and within the three groups, was recorded, although approximately two-thirds of clinicians preferred the same arm position in the standing and sitting position. In particular, only 8 and 4% of clinicians chose the horizontal arm position in sitting and standing subjects, respectively. Choosing the dependent arm is a behaviour likely to lead to the overdiagnosis of hypertension and inappropriate treatment of hypertension because the dependent arm falsely elevates both systolic and diastolic blood pressure. These results should encourage national and international organizations to reaffirm the importance of the horizontal arm in the measurement of blood pressure.
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Affiliation(s)
- A Mourad
- Department of Nephrology, John Hunter Hospital, Newcastle, New South Wales, Australia.
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22
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Abstract
The objective of this study was to re-evaluate the effect of arm position on blood pressure (BP) measurement with auscultatory and oscillometric methods including ambulatory blood pressure monitoring (ABPM). The setting was the hospital outpatient department and the subjects chosen were normotensive and hypertensive. The effect of lowering the arm from heart level on indirect systolic BP (SBP) and diastolic BP (DBP) measurement as well as the importance of supporting the horizontal arm were measured. In the sitting position, lowering the supported horizontal arm to the dependent position increased BP measured by a mercury device from 103+/-10/60+/-7 to 111+/-14/67+/-10 mmHg in normotensive subjects, a mean increase of 8/7 mmHg (P<0.01). In hypertensive subjects, a similar manoeuvre increased BP from 143+/-21/78+/-17 to 166+/-29/88+/-20 mmHg, an increase of 23/10 mmHg (P<0.01). Combined results from normotensive and hypertensive subjects demonstrate a direct and proportional association between BP (SBP and DBP) and the increase produced by arm dependency. Similar changes and associations were noted with oscillometric devices in the clinic situation. However, supporting the horizontal arm did not alter BP. Of particular interest, analysis of 13 hypertensive subjects who underwent ABPM on two occasions, once with the arm in the 'usual' position and once with the arm held horizontally for BP measurement during waking hours, demonstrated changes comparable to the other devices. The mean 12-hour BP was 154+/-19/82+/-10 mmHg during the former period and significantly decreased to 141+/-18/74+/-9 mmHg during the latter period (P<0.01). Regression analysis of the change in SBP and DBP with arm position change again demonstrated a close correlation (r(2)=0.8113 and 0.7273; P<0.001) with the artefact being larger with higher systolic and diastolic pressures. In conclusion, arm movements lead to significant artefacts in BP measurement, which are greater, the higher the systolic or diastolic pressure. These systematic errors occur when using both auscultatory and oscillometric (clinic and ABPM) devices and might lead to an erroneous diagnosis of hypertension and unnecessary medication, particularly in individuals with high normal BP levels. Since clinical interpretations of heart level vary, the horizontal arm position should be the unambiguous standard for all sitting and standing BP auscultatory and oscillometric measurements.
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Affiliation(s)
- A Mourad
- Department of Nephrology, John Hunter Hospital, Hunter Region Mail Centre, NSW, Australia
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23
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Hadi HA, Mohran ZS, Hakam AA, Mourad A, Oyofo BA. Characterization of Campylobacter spp. using restriction fragment length polymorphism and SDS-polyacrylamide gel electrophoresis. J Egypt Public Health Assoc 1998; 73:1-10. [PMID: 17249207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Twenty four Campylobacter jejuni and coli isolates obtained from Egyptian children were characterized using restriction fragment length polymorphism (RFLP) of flagellin genes and polyacrylamide gel electrophoresis of whole cell and glycine-extracted proteins. The isolates were found to fall into nine polymorphism groups, eight of which were reported previously in Egypt but one group displayed by 3 isolates represented a new group that was not reported before. Furthermore, the relative prevalence of polymorphic groups in the population studied is different from that reported previously. Analysis of whole-cell and acid glycine-extracted proteins showed that the profiles of these isolates are typical profiles of Campylobacters isolated from other humans.
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Affiliation(s)
- H A Hadi
- Enteric Microbiology Branch, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
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24
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Stazzone AM, Slaats S, Mortagy A, Kleinosky M, Diab A, Mourad A, Hebert A, Merrell BR, Watson RR, Murphy JR. Frequency of Giardia and Cryptosporidium infections in Egyptian children as determined by conventional and immunofluorescence methods. Pediatr Infect Dis J 1996; 15:1044-6. [PMID: 8933557 DOI: 10.1097/00006454-199611000-00023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A M Stazzone
- Undergraduate Biology Research Program, University of Arizona Tucson, USA
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25
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Bouhaouala MH, Abid R, Ayedi K, Fitouri-Ayedi R, Mourad A, Gannouni A. [Spinal cord compression by intra-dural arachnoid cysts: a case report and review of the literature]. Tunis Med 1993; 71:401-5. [PMID: 8279083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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26
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Pazzaglia G, Bourgeois AL, Araby I, Mikhail I, Podgore JK, Mourad A, Riad S, Gaffar T, Ramadan AM. Campylobacter-associated diarrhoea in Egyptian infants: epidemiology and clinical manifestations of disease and high frequency of concomitant infections. J Diarrhoeal Dis Res 1993; 11:6-13. [PMID: 8315255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A diarrhoeal disease survey in Alexandria, Egypt determined the prevalence, seasonality, and household risk factors for Campylobacter-associated diarrhoea in young children. The study population was 880 children (mean age = 9.8 months) presenting with diarrhoea at one of two hospitals. A control group consisted of 1,079 healthy children (mean age = 8.8 months) attending two nearby vaccination clinics. The overall isolation frequencies for Campylobacter spp. were 16.8% for cases and 6.4% for the comparison group (p = 1 x 10(-8)). Other enteropathogens detected in diarrhoeal stools were: rotavirus (28.6%), Giardia lamblia trophozoites (21.3%), enterotoxigenic Escherichia coli (8.7%), Entamoeba histolytica (3.9%), Salmonella spp. (2.7%), and Shigella spp. (1.8%). There were few or no isolates of Aeromonas spp., Vibrio spp., Yersinia spp., or Plesiomonas spp. Comparisons among cases showed that Campylobacter spp. isolations were more prevalent during the rainy season (p = 0.001) and positively associated with keeping fowl in the home (p = 0.003) or having an outdoor source of drinking water (p = 0.029). Among Campylobacter-positive diarrhoeal patients, 69.0% had faecal leukocytes present and 16.3% had bloody stools. Patients with Campylobacter-positive diarrhoeal stools were frequently co-infected with rotavirus (28.6%) or G. lamblia (24.5%).
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Affiliation(s)
- G Pazzaglia
- U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
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27
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Bergaoui N, Ladeb F, Ben Hammouda M, Gannouni A, Essgaier K, Guefrech I, Mourad A, Elmay M. [Diagnosis of extruded herniated disks]. Rev Rhum Mal Osteoartic 1992; 59:478-81. [PMID: 1485138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a patient with disk herniation it is often difficult to establish that the disk is free in the spinal canal. A retrospective medical record study comparing 65 cases of free herniated disk (FHD) confirmed upon surgery and 65 cases of disk protrusion (DP) demonstrated that FHD was more common in young male blue collar workers, especially those who worked in the sitting position. No clinical findings were diagnostic of FHD although the straight-leg raising test was positive at smaller angles than in disk protrusion. In this study, sensitivity and specificity of CT scan for the diagnosis of FHD were 75% and 80%, respectively. CT scan findings suggestive of FHD included a free disk fragment, found in 22.5% of cases, and an acute connecting angle. Saccoradiculography was more sensitive but less specific than CT scan in this study. In FDH, migration was common and ragged hernia contours were seen on the saccoradiculography images.
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Affiliation(s)
- N Bergaoui
- Service de Médecine Interne, Faculté de Médecine de Monastir, Tunisie
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Abstract
Recent Chlamydia trachomatis isolates were tested in a tissue culture system for susceptibility to tetracycline, erythromycin, rosaramicin, rifampin, and clindamycin. Rifampin was the most active drug (minimal inhibitory concentration, less than or equal to 0.02 microgram/ml). Tetracycline and rasaramicin were highly active, with a concentration of less than or equal to 0.25 microgram/ml being chlamydicidal. Clindamycin was least active on a weight basis, requiring up to 16 microgram/ml to prevent the passage of chlamydiae into a drug-free tissue culture system. Relative resistance to erythromycin was detected; two isolates were capable of limited replication in 1 microgram/ml.
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El Khamlichi A, Mourad A, El Ouarzazi A. [Injuries of the cervical spinal cord from traffic accidents: 1-year evaluation]. Maghrib Tibbi 1980; 2:139-46. [PMID: 7218869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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30
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El Ouarzazi A, El Khamlichi A, Belghmaidi M, Mourad A, Cherkaoui M. [Etiologic survey of 21 cases of metastatic brain tumor]. Maghrib Tibbi 1979; 1:293-6. [PMID: 550035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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31
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el Ouarzazi A, Ouammou A, Bellakhdar F, Mourad A, Belghmaidi M. [Diastematomyelia and scoliosis]. Maghrib Tibbi 1978; 1:111-5. [PMID: 750770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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32
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Level MC, Bonnaud G, Mourad A, Bureau G. [Double cancer or diagnostic error?]. Sem Hop 1977; 53:2208. [PMID: 204036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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