Role of Bifidobacterium spp. intake in improving depressive mood and well-being and its link to kynurenine blood level: an interventional study

OBJECTIVES

Evidence for the contribution of the brain-gut-microbiota axis to the depression pathophysiology is increasing nowadays. Disturbed gut microbiota equilibrium along with bad dietary habits both lead to kynurenine pathway abnormalities contributing to the depression pathophysiology. In this respect, many studies are found but the interventional clinical trials are limited. The present interventional study aims to evaluate the impact of Bifidobacterium spp. supplementation together with improving dietary intake on depressive mood and well-being and their correlation with kynurenine blood level in adult Egyptian healthy volunteers.

METHODS

A number of 98 healthy female volunteers with a mean age of 46.96 ± 1.82 years were selected and enrolled in this study. They were given yogurt enriched with Bifidobacterium spp. daily for eight weeks. Clinical examination as well as questionnaires for the evaluation of psychological well-being and depression were done at base line and after eight weeks of intervention. Fasting blood samples and stool samples were collected from all subjects at baseline and eight weeks after the intervention for the investigation of serum kynurenine concentration, blood hemoglobin, serum transaminases (ALT & AST) serum urea and creatinine as well as fecal Bifidobacterium count.

RESULTS

Data revealed that both depression and well-being showed highly significant improvement combined with significant drop in kynurenine blood level after intervention. Also, a significant rise in fecal Bifidobacterium count and a significant improvement in hemoglobin level and activity of liver enzymes were recorded. After intervention, a significant negative correlation was recorded between depression and fecal Bifidobacterium count as well as between serum kynurenine level, and well-being.

CONCLUSION

Bifidobacterium spp. supplementation combined with improvement in dietary intake resulted in improvement of depressive mood and well-being and reduced kynurenine blood level.

Impact of type 2 diabetes mellitus on the immunoregulatory characteristics of adipose tissue-derived mesenchymal stem cells

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with several complications. Adipose tissue-derived mesenchymal stem cells (AT-MSCs) represent an emerging type of MSCs with high plasticity and immunoregulatory capabilities and are useful for treating inflammation-related disorders such as T2DM. However, the pathogenic microenvironment of T2DM may affect their therapeutic potential. We aimed to examine the impact of the diabetic milieu on the immunomodulatory/anti-inflammatory potential of AT-MSCs.

METHODS

We assessed the proliferation potential, cell surface expression of MSC-characteristic markers and immunomodulatory markers, along with the gene expression and protein secretion of pro-inflammatory and anti-inflammatory cytokines and adipokines in AT-MSCs derived from T2DM patients (dAT-MSCs) vs. those derived from non-diabetic volunteers (ndAT-MSCs). Furthermore, we evaluated the IFN-γ priming effect on both groups.

RESULTS

Our data revealed comparable proliferative activities in both groups. Flow cytometric analysis results showed a lower expression of CD200 and CD276 on dAT-MSCs vs. ndAT-MSCs. qPCR demonstrated upregulation of IL-1β associated with a downregulation of IL-1RN in dAT-MSCs vs. ndAT-MSCs. IFN-γ priming induced an elevation in CD274 expression associated with IDO1 and ILRN overexpression and IL-1β downregulation in both groups. ELISA analysis uncovered elevated levels of secreted IL-1β, TNF, and visfatin/NAMPT in dAT-MSCs, whereas IL-1RA and IDO levels were reduced. ELISA results were also evident in the secretome of dAT-MSCs upon IFN-γ priming.

CONCLUSIONS

This study suggests that the T2DM milieu alters the immunomodulatory characteristics of AT-MSCs with a shift towards a proinflammatory phenotype which may restrain their autologous therapeutic use. Furthermore, our findings indicate that IFN-γ priming could be a useful strategy for enhancing dAT-MSC anti-inflammatory potential.

Strengths of community and health facilities based interventions in improving women and adolescents’ care seeking behaviors as approaches for reducing maternal mortality and improving birth outcome among low income communities of Egypt

Background

Provision of emergency obstetric care is considered the key for maternal mortality reduction worldwide. This study evaluated the impact of community- and facility-based educational programs on provision of emergency obstetric care in Egypt. The study focused on evaluating utilization of the available health services and care seeking behaviors of mothers in the childbearing period.

Methods

We implemented a package of community- and facility-focused educational interventions in two of Egypt’s lowest income governorates. At facility level, health professionals at rural health units from 21 villages over 5 years were trained. Mass media gathering, individual teaching at health facilities, printed materials and home-based care sessions were provided. Collectively, these interventions were designed to focusing on recognition of the early warning signs during pregnancy, delivery and postpartum period for timely referral to hospitals for 20,494 women and adolescents mothers.

Results

The impact of the interventions was highly reflected on the percent of mothers received care during their pregnancy period. Proper antenatal care at governmental or private health facilities was raised dramatically from 0.6 to 59.3% and those who utilized at least one family planning method from 61.4 to 74.4%. Accordingly, the rate of complications significantly reduced during pregnancy (38.1 to 15.1%), during delivery (24.1 to 13.1%) and during postpartum (81.7 to 7.0%). As an impact to the improvement, there was a marked reduction in adolescent pregnancy by 55% and better birth outcome with a reduction in the percent of stillbirth by 11.5%.

Conclusion

It is important to provide a comprehensive package that works at both improving qualities of care as well as empowering women by knowledge to first aid measures at the community level. The cost-effective way to empower mothers to provide first aid measures as emergency obstetric care is to adopt the outreach approach which could be more influential than mass media campaigns for the at-risk and vulnerable and low-income communities.

Building Oncofertility Core Competency in Developing Countries: Experience From Egypt, Tunisia, Brazil, Peru, and Panama

PURPOSE

Little is known about oncofertility practice in developing countries that usually suffer from a shortage of health services, especially those related to cancer care.

MATERIALS AND METHODS

To learn more about oncofertility practice in developing countries, we generated a survey to explore the barriers and opportunities associated with oncofertility practice in five developing countries from Africa and Latin America within our Oncofertility Consortium Global Partners Network. Responses from Egypt, Tunisia, Brazil, Peru, and Panama were collected, reviewed, and discussed.

RESULTS

Common barriers were identified by each country, including financial barriers (lack of insurance coverage and high out-of-pocket costs for patients), lack of awareness among providers and patients, cultural and religious constraints, and lack of funding to help to support oncofertility programs.

CONCLUSION

Despite barriers to care, many opportunities exist to grow the field of oncofertility in these five developing countries. It is important to continue to engage stakeholders in developing countries and use powerful networks in the United States and other developed countries to aid in the acceptance of oncofertility on a global level.

Immunomodulatory and Antioxidative potentials of adipose-derived Mesenchymal stem cells isolated from breast versus abdominal tissue: a comparative study

BACKGROUND

Adipose-derived stem cells (ASCs) are considered ideal candidates for both research and cellular therapy due to ease of access, large yield, feasibility, and efficacy in preclinical and clinical studies. Unlike the subcutaneous abdominal fat depot, breast ASCs features are still not well recognized, limiting their possible therapeutic use. ASCs were found to exert immunomodulatory and antioxidative activities for maintaining homeostasis and functionality of diseased/damaged tissues. This study aims to investigate the immunomodulatory and antioxidative potentials of breast versus abdominal isolated ASCs to find out which anatomical site provides ASCs with better immunoregulatory and oxidative stress resistance capabilities.

METHODS

ASCs were isolated from abdominal and breast tissues. Gene expression analysis was conducted for a panel of immunomodulatory and antioxidative genes, as well as adipokines and proliferation genes. Flow cytometric analysis of a group of immunomodulatory surface proteins was also performed. Finally, the significantly expressed genes have undergone protein-protein interaction and functional enrichment in silico analyses.

RESULTS

Our results revealed similar morphological and phenotypic characteristics for both breast and abdominal ASCs. However, a significant elevation in the expression of two potent immunosuppressive genes, IL-10 and IDO as well as the expression of the multifaceted immunomodulatory adipokine, visfatin, was detected in breast versus abdominal ASCs. Moreover, a significant overexpression of the antioxidative genes, GPX1, SIRT5, and STAT3 and the proliferation marker, Ki67, was also observed in breast ASCs relative to abdominal ones. In silico analysis showed that both of the differentially upregulated immunomodulatory and antioxidative mediators integratively involved in multiple biological processes and pathways indicating their functional association.

CONCLUSION

Breast ASCs possess superior immunomodulatory and antioxidative capabilities over abdominal ASCs. Our findings shed light on the possible therapeutic applications of breast ASCs in immune-related and oxidative stress-associated diseases.

Strengths of community and health facilities based interventions in improving women and adolescents' care seeking behaviors as approaches for reducing maternal mortality and improving birth outcome among low income communities of Egypt

BACKGROUND

Provision of emergency obstetric care is considered the key for maternal mortality reduction worldwide. This study evaluated the impact of community- and facility-based educational programs on provision of emergency obstetric care in Egypt. The study focused on evaluating utilization of the available health services and care seeking behaviors of mothers in the childbearing period.

METHODS

We implemented a package of community- and facility-focused educational interventions in two of Egypt's lowest income governorates. At facility level, health professionals at rural health units from 21 villages over 5 years were trained. Mass media gathering, individual teaching at health facilities, printed materials and home-based care sessions were provided. Collectively, these interventions were designed to focusing on recognition of the early warning signs during pregnancy, delivery and postpartum period for timely referral to hospitals for 20,494 women and adolescents mothers.

RESULTS

The impact of the interventions was highly reflected on the percent of mothers received care during their pregnancy period. Proper antenatal care at governmental or private health facilities was raised dramatically from 0.6 to 59.3% and those who utilized at least one family planning method from 61.4 to 74.4%. Accordingly, the rate of complications significantly reduced during pregnancy (38.1 to 15.1%), during delivery (24.1 to 13.1%) and during postpartum (81.7 to 7.0%). As an impact to the improvement, there was a marked reduction in adolescent pregnancy by 55% and better birth outcome with a reduction in the percent of stillbirth by 11.5%.

CONCLUSION

It is important to provide a comprehensive package that works at both improving qualities of care as well as empowering women by knowledge to first aid measures at the community level. The cost-effective way to empower mothers to provide first aid measures as emergency obstetric care is to adopt the outreach approach which could be more influential than mass media campaigns for the at-risk and vulnerable and low-income communities.

Adipose tissue-derived mesenchymal stem cells and chitosan/poly (vinyl alcohol) nanofibrous scaffolds for cartilage tissue engineering

Osteoarthritis (OA) has been defined as a chronic inflammatory joint disease characterized by progressive articular cartilage degeneration. Recently growing interest in regenerative medicine, using cell therapy and tissue engineering, where cellular components in combination with engineered scaffolds and bioactive materials were used to induce functional tissue regeneration. In the present study, nanofibrous scaffold based on chitosan (CS)/poly (vinyl alcohol) (PVA) were used to develop biologically functionalized biomaterial to mimic the extracellular matrix, allowing the human adipose tissue derived mesenchymal stem cells (ADSCs) to proliferate and differentiate to chondrogenic cells. The morphology of the nanofibrous mat was examined using field emission scanning electron microscope (FE/SEM). The characteristic functional groups and the nature of the chemical bonds between atoms were evaluated using Fourier transform infrared spectroscopy (FTIR) spectrum. Characterization of the seeded cells was morphologically evaluated by scanning electron microscopy and by flow cytometry for the expression of the stem cell surface markers. The differentiation potential was verified after chondrogenic induction by analyzing the expression of chondrogenic marker genes using real-time (RT PCR). Current study suggest significant potential for the use of ADSCs with the nanofibrous scaffolds in improving the osteoarthritis pathology.

Survey of Fertility Preservation Options Available to Patients With Cancer Around the Globe

Oncofertility focuses on providing fertility and endocrine-sparing options to patients who undergo life-preserving but gonadotoxic cancer treatment. The resources needed to meet patient demand often are fragmented along disciplinary lines. We quantify assets and gaps in oncofertility care on a global scale.

Survey of Third-Party Parenting Options Associated With Fertility Preservation Available to Patients With Cancer Around the Globe

In the accompanying article, “Survey of Fertility Preservation Options Available to Patients With Cancer Around the Globe,” we showed that specific fertility preservation services may not be offered at various sites around the world because of cultural and legal barriers. We assessed global and regional experiences as well as the legal status of third-party reproduction and adoption to serve as a comprehensive international data set and resource for groups that wish to begin oncofertility interventions.

Can Amlodipine Improve the Pre-ovulatory Follicle Blood Flow in Women with Polycystic Ovarian Syndrome?

BACKGROUND

A reduction in intra-ovarian vascular resistance is necessary to achieve pregnancy in a natural cycle. The aim of this RCT was to detect whether a vasodilator calcium channel blocker, amlodipine, could increase the pre-ovulatory follicular blood flow, enhance follicular maturation in women with PCOS and improve ovulatory outcome.

METHODS

Sixty women received induction by clomiphene citrate (CC); thirty were given amlodipine (Amlodipine group) and the other 30 women were given placebo (Placebo group). The pattern of pre-ovulatory follicle blood flow was studied by color and power Doppler ultrasonography pre and post drug administration. Independent t-test was used to compare mean values of the 2 groups. The p<0.05 is considered statistically significant.

RESULTS

When comparing the Doppler effect of amlodipine versus placebo in the treatment cycle, it was found that mean value of ovarian arteries (OA) pulsatility index was lower in amlodipine group but it didn't reach statistical significance (p= 0.063); however, the mean value of OA resistance index reached statistical significance (p=0.028) in amlodipine group. Moreover, in the second cycle, endometrial thickness was significantly higher (p=0.006) in women of the amlodipine group when compared to those of the placebo group. At least one sonographically detectable mature follicle (≥18 mm) was observed in 54.5% (36/66) during the first cycle. At the second cycle, this proportion significantly rose to 86.7% (26/30) in the amlodipine group, but marginally and non-significantly to 56.7% (17/30) in the placebo group.

CONCLUSION

Amlodipine as calcium channel blocker was proved to have a role in improving ovarian blood flow at the time of ovulation and enhancing follicular maturation and thus, it may increase the chances of conception.

The use of laser assisted hatching of frozen/thawed embryos versus laser assisted hatching of fresh embryos in human intracytoplasmic sperm injection

Cryopreservation of human embryos has become an essential part of assisted reproduction. It limits the number of embryo transferred while supernumerary embryos can be transferred in subsequent cycles, however, it is associated with zonal hardening, which lowers the success rate in the majority of (ICSI) centres, associated with decreased implantation rate and clinical pregnancy rates. Assisted hatching has been used to induce microdissection of the zona pellucida. Many techniques have been used, such as mechanical, chemical, piezo and laser techniques.

AIM

To compare the efficacy of laser assisted hatching of vitrified embryos and fresh embryos with regards to implantation rate and clinical pregnancy rate.

STUDY DESIGN

Prospective randomised study.

PATIENTS AND METHODS

One hundred twenty women with fresh embryos scheduled for (ICSI) were randomised in two groups; laser assisted hatching (LAH) group (test group), containing 60 women and the other is (non LAH) (control group). Second group with 120 women with frozen embryos were randomised in (LAH group) and (non LAH group). On the day of embryo transfer, 1.48 μm Infrared Diode laser, class 1 M, was used in test group to induce zonal microdissection, the quality and safety of embryos is assessed morphologically after hatching. On the other hand, the zona of the control group were left intact. Both clinical pregnancy and implantation rates were estimated.

RESULTS

Laser assisted hatching group had clinical pregnancy and implantation rates of 38% and 50%, respectively. Non laser assisted hatching group had lower clinical pregnancy and implantation rates; 30% (p = .442) and 33% (p = .095), respectively, with no statistically significant difference p < .05.

CONCLUSION

LAH does not improve statistically both pregnancy rate and implantation rate in fresh embryos. However, there is improvement in both implantation and pregnancy rate in Vitrified group.

Multicenter randomized controlled trial assessing the impact of a cervical traction maneuver (Amr's maneuver) on the incidence of postpartum hemorrhage

OBJECTIVE

To assess the impact of a cervical traction maneuver (Amr's maneuver) used in conjunction with active management of the third stage of labor (AMTSL) on the incidence of postpartum hemorrhage (PPH).

METHOD

The present multicenter randomized controlled trial was conducted in Cairo between March 1, 2016, and June 30, 2017. Women aged at least 18 years who had singleton pregnancies and were candidates for vaginal delivery were enrolled. After block randomization, AMTSL was performed for all participants. Following placental delivery, Amr's maneuver using cervical traction for 90 seconds was carried out in the study group. The primary outcome, incidence of PPH (>500 mL blood loss) within 6 hours of delivery, was compared between the study and control groups in an intention-to-treat analysis.

RESULTS

There were 852 patients randomized to the study (n=426) and control (n=426) groups. The incidence of PPH was significantly lower in the study group compared with the control group (6 [1.4%] vs 19 [4.5%]; P=0.015). Absolute risk reduction of 3.1% (95% CI 0.8-5.6), relative risk reduction of 0.32 (95% CI 0.13-0.78), and number needed to treat of 33 (95% CI 129-18) were observed in the study group.

CONCLUSION

Amr's maneuver was effective in decreasing the incidence of PPH. ClinicalTrials.gov Identifier: NCT02660567.

Fetal Biometric Charts and Reference Equations for Pregnant Women Living in Port Said and Ismailia Governorates in Egypt

AIM:

To construct new fetal biometric charts and equations for some fetal biometric parameters for women between 12^th and 41^st weeks living in Ismailia and Port Said Governorates in Egypt.

MATERIAL AND METHODS:

This cross-sectional study was carried out on 656 Egyptian women (from Ismailia and Port Said governorates) with an uncomplicated pregnancy, and all were sure of their dates. The selected group was between the 12^th and 41^st weeks of gestation, recruited from the district general hospital in Ismailia and Port Said to measure ultrasonographically biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL), then for each measurement separate regression models were fitted to estimate both the mean and the Standard deviation at each gestational age.

RESULTS:

New Egyptian charts were reported for BPD, HC, AC, and FL. Reference equations for the dating of pregnancy were presented. The mean of the previous measurements at 12^th and 41^st weeks were as follows: (23.37, 98.72), (83.05, 336.12), (67.85, 332.57) and (12.50, 74.92) respectively.

CONCLUSION:

New fetal biometric charts and regression equations for pregnant women living in Port Said & Ismailia governorates in Egypt.

Variants of CDKAL1 rs7754840 (G/C) and CDKN2A/2B rs10811661 (C/T) with gestational diabetes: insignificant association

Objectives

Pathophysiological similarity exists between gestational diabetes mellitus (GDM) and type 2 diabetes mellitus with common genetic origin. Genetic liability for GDM in our population is still not researched. The goal was to reveal the genotypic and allele frequency differences of 2 single nucleotide polymorphisms (SNPs) namely, CDKAL1 (rs7754840) and CDKN2A/2B (rs10811661) between GDM pregnancies and normal pregnancies. We assessed them by real time polymerase chain reaction using Taqman^® allelic discrimination assays. We included 47 GDM pregnant subjects and 51 normal glucose tolerance (NGT) pregnant women as controls.

Results

The genotype frequencies in the GDM group and the NGT group of rs7754840-GG/GC/CC were 6.4/15.7% (3/8), 55.3/45.1% (26/23) and 38.3/39.2% (18/20) respectively. Also, those of rs10811661-CC/CT/TT were 74.5/14.9/4.3% (38/7/2) and 80.9/19.6/5.9% (38/10/3) respectively. The allele frequencies in the GDM group and the NGT group of C/G and T/C were 66/34% (62/32), 61.8/38.2% (63/39) and 11.7/88.3% (11/83), 15.7/84.3% (16/86) respectively. There were no statistical differences between the two groups in allele frequencies and genotype frequencies (all P > 0.05). Non-significant association was seen in the two SNPs of CDKAL1 and CDKN2A/B genes with GDM. Further studies are essential to validate data.

Building Oncofertility Core Competency in Developing Countries: Experience From Egypt, Tunisia, Brazil, Peru, and Panama

Purpose

Little is known about oncofertility practice in developing countries that usually suffer from a shortage of health services, especially those related to cancer care.

Materials and Methods

To learn more about oncofertility practice in developing countries, we generated a survey to explore the barriers and opportunities associated with oncofertility practice in five developing countries from Africa and Latin America within our Oncofertility Consortium Global Partners Network. Responses from Egypt, Tunisia, Brazil, Peru, and Panama were collected, reviewed, and discussed.

Results

Common barriers were identified by each country, including financial barriers (lack of insurance coverage and high out-of-pocket costs for patients), lack of awareness among providers and patients, cultural and religious constraints, and lack of funding to help to support oncofertility programs.

Conclusion

Despite barriers to care, many opportunities exist to grow the field of oncofertility in these five developing countries. It is important to continue to engage stakeholders in developing countries and use powerful networks in the United States and other developed countries to aid in the acceptance of oncofertility on a global level.

Differentially expressed genes: OCT-4, SOX2, STAT3, CDH1 and CDH2, in cultured mesenchymal stem cells challenged with serum of women with endometriosis

Endometriosis is a common chronic gynecological disorder defined as the presence of ectopic functional endometrial tissues, outside uterine cavity, primarily on the pelvic peritoneum and the ovaries. Several studies revealed a correlation between aberrant stem-cell activity in the endometrium and endometriosis. Yet the molecular and cellular behaviors of mesnchymal stem cells in development of endometriosis are hampered by lack of invitro experiments. Our aim was to explore morphological and molecular changes associated with mesenchymal stem cells (MSCs) exposition to serum derived from women with severe endometriosis. Two cell cultures of MSCs isolated from endometrial tissues of two endometriosis-free women. Each cell culture was treated individually with the serum of women with endometriosis (experimental group/n = 7), and serum of women without endometriosis (control group/ n = 4) for 14 days. Quantitative Real-Time PCR was performed later to reveal expression of OCT-4, CDH1 and CDH2, STAT3 and SOX2 genes. Morphologically, cells showed no significant changes. However from molecular point of view, we found increased expression in OCT-4, CDH1 and CDH2. For STAT3 and SOX2 we did not find a significant difference. This study shows that endometriosis serum induced molecular changes in human endometrial MSCs (EnMSCs) that might be related to altered cell behavior which may be a step in differentiation that may be completed invivo by other factors to complete the process of transition. Further researches are needed for optimization to reach differentiation.

Role of maternal serum ferritin in prediction of preterm labour

The aim of this study was to evaluate the value of measurement of serum ferritin level in pregnant women to predict preterm labour. The study included 236 women whose haemoglobin (Hb) levels were ≥10.5 gm/dl and gestational age (GA) was less than 30 weeks. Serum ferritin levels were measured at 30 weeks of gestational age. At the end of the study, 23 women delivered with preterm premature rupture of membrane (PPROM) and 17 women delivered before 37 weeks but without PROM (study group). The rest of the pregnant women (196 women) delivered between 37 and 40 weeks (control group). We found a significant difference between the two groups with respect to serum ferritin level. The cut off value of serum ferritin between the two groups was 31 ng/ml with sensitivity 92.8%, specificity 99.4%, positive predictive value 97.5%, negative predictive value 98.4% and accuracy 98.3%. Impact statement What is already known on this subject: maternal serum ferritin has been found to be elevated in women who delivered preterm. What the results of this study add: In this study, we have shown that serum ferritin 31 ng/ml is the optimal cut-point between preterm and full-term women. What the implications are of these findings for clinical practice and/or further research: Serum ferritin 31 ng/ml could be proposed as a potential helpful marker to predict preterm labour.

MicroRNA expression analysis in endometriotic serum treated mesenchymal stem cells

Endometriosis is defined by presence of endometrial-like-tissue outside the uterus. Recently, ectopic endometriotic lesions have been suggested to originate by abnormal differentiation of endometrial mesenchymal stem cells (eMSCs). MicroRNAs (miRNAs) play an important role in the pathophysiology of endometriosis. Through a PCR array approach, we aimed to assess the differential expression of microRNAs in human eMSC treated in culture with sera derived from women with severe endometriosis. Sera were collected from five patients with severe endometriosis and three control women and added individually in the culture medium to conduct experimental and control eMSC sets, respectively. Regular microscopic follow-up for cell morphology was performed. SYBR Green based real-time PCR array was used to assess the expression of 84 miRNAs. Bioinformatics analysis was done to predict the target genes of the significantly dysregulated miRNAs and their enriched biological processes and pathways. Thirty-two miRNAs were found significantly dysregulated in experimental cultures. Functional enrichment analysis revealed several endometriosis associated biological processes and pathways were enriched by target genes of these miRNAs. In conclusion, treatment of human eMSCs with sera of severe endometriosis cases affects the expression of certain miRNAs and their target genes. This may result in altering cell functions and consequently, endometriosis development.

Association of the Pro12Ala Polymorphism with the Metabolic Parameters in Women with Polycystic Ovary Syndrome

AIM:

To investigate the association of peroxisome proliferator-activated receptor gamma (PPARG) Pro12Ala polymorphism with polycystic ovary syndrome (PCOS) and its effect on the metabolic parameters in PCOS women.

METHODS:

The study used PCR to identify the presence of the PPARG Pro12Ala polymorphism in 100 PCOS women and 120 age-matched healthy women. All participants were subjected to anthropometry, biochemical and metabolic evaluation.

RESULTS:

Significant difference in the genotypes distributions of PPARG Pro12Ala polymorphism was observed among PCOS women and controls (p = 0.03). The frequency of the polymorphic allele Ala was significantly higher in PCOS cases than that in the controls (OR = 2.01, p = 0.01). The carries of the variant allele Ala in PCOS women showed significant higher values in body mass index (BMI), systolic and diastolic blood pressure, waist circumference, waist to hip ratio, sum of skin folds, fasting blood glucose, fasting blood insulin, HOMA-IR, fasting triglycerides, total cholesterol and low-density lipoprotein than non-carriers.

CONCLUSION:

The PPARG Pro12Ala polymorphism might contribute to the risk of PCOS and abnormal metabolic parameters and could be considered as a biomarker for early diagnosis and clinic prediction of metabolic complications.

Evaluation of the Effectiveness of Fluorescent Visualization of Bile Ducts Using Fluorescein and Ultraviolet A at Laparoscopic Cholecystectomy

Background. This work studied the diagnostic effectiveness of a new technology and device to augment visualization of bile ducts at laparoscopic cholecystectomy. It depends on excitation of fluorescein in bile by ultraviolet light to get green fluorescent light emanating from these ducts. Methods. Forty laparoscopic cholecystectomy patients received fluorescein sodium injections either in the gallbladder or intravenously, followed by exposure of the expected bile ducts area to ultraviolet light that was delivered by a specially designed device. Neutral observing surgeons were asked to judge whether or not they could see fluorescent bile ducts early in the operation before they were displayed by dissection. Accordingly, specificity, sensitivity, likelihood ratios, and predictive values of the technique were calculated. Results. Fluorescent bile ducts were seen at an earlier stage than their detection by dissection in 33 out of 40 operations. The technique had 100% specificity, 82.5% sensitivity, 0.18 negative likelihood ratio, 100% positive predictive value, and 85.11% negative predictive value. There were no complications related to the technique. Conclusions. The developing ultraviolet/fluorescein technique is helpful in early localization of bile ducts at laparoscopic cholecystectomy. When fluorescence is detected in the field, the technique can be completely relied on to denote the position of bile ducts. In a few cases fluorescence is not detected. Here further development of the device is the need to improve its sensitivity. Otherwise, the technique is quite simple and safe.

A novel endometriosis inducing factor in women with endometriosis

AIM

To confirm the hypothesis of the presence of a possible endometriosis inducing factor(s) (EIF) in the blood of women with endometriosis.

PATIENTS AND METHODS

Forty infertile women were studied. The study group compromised of fifteen women of each three different degrees of endometriosis and fifteen women without endometriosis as a control group. Stem cells are characterized by being spindle shaped and proliferate in appropriate culture indefinitely. The women sera were co-cultured with mesenchymal stem cells (MSCs) which were followed up weekly to look for morphological changes and to detect Annexin 1 marker and ß-actin gene by reverse transcriptase polymerase chain reaction.

RESULTS

MSCs cultured with sera of cases with, mild, moderate and severe endometriosis, showed morphological changes to be columnar and cuboidal shaped cells -resembling endometrial cells and glands- by the 4th week in 60%, 60% & 100% respectively. These cells were detected from as early as the first week in women with moderate and severe types (20% for each group). The percentage of the change into endometrial like cells increased among the three groups where it was 30±25.8%, 45±29.9% and 75±37.9% respectively. Moreover, increasing number of endometrial like cells are detected weekly, the more severe the disease is. None of the cultures of serum of the control group had made such changes all over the study. Furthermore, with more differentiation there was a considerable decrease in number of stem cells. These differentiated cells expressed the Annexin-1 marker.

CONCLUSION

It was evident that serum of women with endometriosis posses a factor(s) that enables the MSCs to be transformed into endometrial like cells and glands in vitro. This finding supports a new theory for the etiology of endometriosis. This observation may have a tremendous effect on the therapeutic implications of this debilitating condition.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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