Mohamed A.F.M. Youssef

Maternal and foetal consequences of dengue fever during pregnancy.

OBJECTIVE The aim of the study was to assess the maternal and foetal consequences of dengue fever infection during pregnancy. STUDY DESIGN A retrospective study was carried out from 1 January 1992 to 10 September 2006 on 53 pregnant women infected with the dengue virus during pregnancy. The women were patients of the obstetrics and gynaecology department of Saint Laurent du Maroni hospital. A dengue infection was confirmed either by the presence of specific IgMs or by isolation of the virus (PCR or culture). The data collected related to obstetric and foetal consequences both during pregnancy and at birth, as well as the effect on the newborn. The risk of maternal-foetal transmission was assessed from 20 samples of blood taken from the umbilical cord at birth. RESULTS The principal maternal consequences were: premature labour (41%), premature birth (9.6%), haemorrhage during labour (9.3%: 5 cases) and retroplacental haematoma (1.9%: 1 case). Foetal consequences were: prematurity (20%), foetal death in utero (3.8%: 2 cases), late miscarriage (3.8%: 2 cases), acute foetal distress during labour (7.5%: 4 cases), maternal-foetal transmission (5.6%: 3 cases) and neonatal death (1.9%: 1 case). CONCLUSIONS Maternal infection with the dengue virus during pregnancy represents a real risk of premature birth. There is also a risk of haemorrhage both for the mother and the baby when infection occurs near term.

Can dopamine agonists reduce the incidence and severity of OHSS in IVF/ICSI treatment cycles? A systematic review and meta-analysis

BACKGROUND Recently, dopamine agonists were proposed as a prophylactic treatment for ovarian hyperstimulation syndrome (OHSS) in women at high risk in IVF/ICSI treatment cycles. METHODS We conducted a systematic review and meta-analysis of randomized trials comparing the prophylactic effect of the dopamine agonist, cabergoline, versus no treatment in IVF/ICSI cycles. Primary outcome was OHSS incidence per randomized woman. Secondary outcomes were live birth rate, ongoing pregnancy rate, clinical pregnancy rate and miscarriage rate. Searches (until September 2009) were conducted in MEDLINE, EMBASE, Science Direct, Cochrane Library and databases of abstracts. RESULTS Four randomized trials entailing 570 women were included. There was evidence of a statistically significant reduction in the incidence of OHSS in the cabergoline group (OR 0.41, 95% CI 0.25-0.66) with an absolute risk reduction of 12% (95% CI 6.1-18.2%), but there was no statistically significant evidence of a reduction in severe OHSS (OR 0.50, 95% CI 0.20-1.26). There was no evidence for a difference in clinical pregnancy rate (OR 1.07, 95% CI 0.70-1.62) and miscarriage rate (OR 0.31, 95% CI 0.03-3.07). CONCLUSION Prophylactic treatment with the dopamine agonist, cabergoline, reduces the incidence, but not the severity of OHSS, without compromising pregnancy outcomes.

GnRH antagonists are safer than agonists: an update of a Cochrane review

GnRH agonists or antagonists can be used to prevent LH surges duringovarian stimulation for assisted reproduction. GnRH agonists down-regulate GnRH pituitary receptors. GnRH antagonists directly andrapidly inhibit gonadotrophin release. In a 2006 systematic review invol-ving 29 trials, the average clinical pregnancy rate was 4.7% lower withGnRH antagonist treatment and the incidence of ovarian hyperstimula-tion syndrome (OHSS) was 2% lower compared with GnRH agonisttreatment (Al-Inany et al.,2006). The current update includes 45trials which addressed live birth or ongoing pregnancy rate (OPR) inGnRH antagonist and GnRH agonist protocols among women under-going assisted reproduction treatment (Youssef et al.,2011).

Is there a place for corifollitropin alfa in IVF/ICSI cycles? A systematic review and meta-analysis

OBJECTIVE To evaluate the role of corifollitropin alfa, a newly developed weekly administrated long-acting recombinant FSH (rFSH), as an alternative for daily rFSH administration in women undergoing controlled ovarian stimulation in GnRH antagonist down-regulated in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment cycles. DESIGN Systematic review and meta-analysis of randomized controlled trials. SETTING University and private centers. PATIENT(S) Infertile women undergoing IVF/ICSI treatment. INTERVENTION(S) Comparing long-acting rFSH corifollitropin alfa versus standard daily administrated rFSH in GnRH antagonist IVF/ICSI cycles. MAIN OUTCOME MEASURE(S) Ongoing pregnancy rate, live birth rate, clinical pregnancy rate, miscarriage rate, duration of stimulation, amount of FSH, number of retrieved oocytes, number of mature oocytes, number of embryos obtained, fertilization rate, ovarian hyperstimulation syndrome (OHSS) incidence, and adverse events. Searches (of literature through November 2011) were conducted in Medline, Embase, Science Direct, the Cochrane Library, and databases of abstracts. RESULT(S) Four randomized trials involving 2,326 women were included. There was no evidence of a statistically significant difference in ongoing pregnancy rate for corifollitropin alfa versus rFSH. There was evidence of increased ovarian response and risk of OHSS in corifollitropin alfa. CONCLUSION(S) In view of its equivalence and safety profile, corifollitropin alfa in combination with daily GnRH antagonist seems to be an alternative for daily rFSH injections in normal responder patients undergoing ovarian stimulation in IVF/ICSI treatment cycles.

Can dopamine agonist at a low dose reduce ovarian hyperstimulation syndrome in women at risk undergoing ICSI treatment cycles? A randomized controlled study

OBJECTIVE Dopamine agonists were proposed as a preventive strategy for severe ovarian. The aim of this randomized controlled study is to evaluate the role of dopamine agonist at lower doses (0.25mg) as a preventive strategy of severe hyperstimulation syndrome (OHSS) in women at high risk in IVF/ICSI treatment cycles. STUDY DESIGN Two hundred women at risk to develop OHSS undergoing IVF/ICSI treatment cycle were included; the study group received 0.25mg of cabergoline for 8 days from the day of HCG administration versus no treatment for the prevention of OHSS. Reduction of the incidence OHSS was the primary outcome. RESULTS The overall incidence of OHSS was significantly reduced, almost 50%, in cabergoline group in comparison with control group (RR: 0.5, 95% CI: 0.29-0.83), with absolute risk reduction following cabergoline administration 11% (ARR: 0.11, 95% CI: 1.09-20.91). The corresponding number needed to treat (NNT) was 9. CONCLUSION Prophylactic treatment with the dopamine agonist, cabergoline, at lower doses (0.25mg) reduces the incidence of OHSS in women at high risk undergoing IVF/ICSI treatment.

Could first-trimester assessment of placental functions predict preeclampsia and intrauterine growth restriction? A prospective cohort study.

Abstract Objective: To examine the role of first-trimester uterine artery Doppler, serum β-hCG and pregnancy-associated placental protein-A (PAPP-A) in prediction of preeclampsia and IUGR. Methods: A total of 100 pregnant women in the 11–14 weeks’ gestation were examined using uterine artery Doppler, serum β-hCG and PAPP-A. All women were followed-up for development of preeclampsia or IUGR. Results: A total of 94 women completed the study of which 7 (7.4%) developed complications. Uterine artery PI and RI were significantly higher whereas serum β-hCG and PAPP-A levels were significantly reduced in patients who developed complications when compared with those who did not. Uterine artery PI had the highest sensitivity (100%) but a low specificity (56% and 45%) in prediction of preeclampsia and IUGR, respectively. Adding PAPP-A to uterine artery PI elevated the specificity into 94.44% and 95.51%, respectively. Combined PI and β-hCG elevated the specificity into 88.89% and 89.89%, respectively. Conclusion: Our study suggests that first-trimester uterine artery impedance, as measured by Doppler ultrasound as well as low serum biomarkers (β-hCG and PAPP-A) can be used for prediction of preeclampsia and IUGR. The most sensitive is uterine artery PI. Adding β-hCG to PI improves specificity in prediction of both preeclampsia and IUGR. Uterine artery PI plus PAPP-A is the best combination for prediction of both preeclampsia and IUGR

Oral antioxidants supplementation for women with unexplained infertility undergoing ICSI/IVF: Randomized controlled trial

Abstract Objective: Good oocyte quality and maturity are important prerequisites for high fertilization and implantation rates in IVF/ICSI treatment cycles. Reactive oxygen species (ROS) are produced within ovarian follicles, especially during the ovulation process, and increased ROS activity may be a cause of impaired oocyte maturation and higher rate of failure of IVF/ICSI cycles. Study design: RCT evaluating the effect of antioxidant supplementation on ICSI/IVF outcomes. Two hundred and eighteen women with unexplained subfertility undergoing IVF/ICSI were randomized into two groups. The study group (n = 112) received daily oral antioxidants in the form of multivitamins and minerals (amino acid chelated) while the control group (n = 106) did not. Main outcomes were number of mature metaphase II (MII) oocytes and clinical pregnancy rate. Results: There were no significant changes between the groups as regards age, BMI, basal FSH, number of mature (MII) oocytes (12.7 ± 9.4 vs. 13.2 ± 8.6, P = 0.7) and clinical pregnancy rate per woman randomized (38% vs. 34%; [OR = 1.2; 95% CI, 0.70–2.11]. Conclusion: Oral antioxidants in the form of a combination of multivitamins and minerals (amino acid chelated) did not improve oocyte quality and pregnancy rates in women with unexplained infertility undergoing IVF/ICSI treatment.

A New CMOS Rail-to-Rail Low Distortion Balanced Output Transconductor

This paper presents a new CMOS transconductor providing low distortion for rail-to-rail signals. The circuit is based on using the anti-phase common source topology with the floating current source to extend its linearity range. The difference in the biasing currents of the floating current source is compensated to maintain the two output currents balanced by subtracting it at the output nodes. The proposed transconductor is suitable for applications requiring wide dynamic ranges. Rail-to-rail operation is achieved with THD less than −37 dB. The bandwidth achieved by the transconductor is 67.5 MHz using a supply voltage of ±1.5 V.

A Modified CMOS Balanced Output Transconductor with Extended Linearity

A new CMOS balanced output transconductor is presented. The circuit is based on applying the dynamic biasing technique on the floating current source to extend its linearity range. The difference in the biasing currents is compensated to maintain the two output currents balanced by subtracting it at the output nodes. The proposed transconductor is suitable for high frequency applications requiring a wide dynamic range. Rail-to-rail operation is achieved with THD of −33.64 dB. The bandwidth achieved by the transconductor is 240 MHz, and the supply voltage used is ±1.5 V.

Microwave-Assisted Synthesis and Antimicrobial Evaluation of Novel Spiroisoquinoline and Spiropyrido(4,3-d)pyrimidine Derivatives

Bromination of N-substituted homophthalimides and tetrahydropyrido[4,3-d]-pyrimidine-5,7-diones produces 4,4-dibromohomophthalimide and 8,8-dibromo-tetrahydropyrido[4,3-d]pyrimidine-5,7-dione derivatives, respectively, that can be used as precursors for spiro derivatives. The dibromo derivatives react with different binucleophilic reagents to produce several spiroisoquinoline and spirotetrahydropyrido[4,3-d]-pyrimidine-5,7-dione derivatives, respectively. Reaction of the dibromo derivatives with malononitrile produces dicyanomethylene derivatives which react with different binucleophiles to produce new spiro derivatives. All new compounds are prepared by using the usual chemical conditions and microwave assisted conditions. The latter conditions improved the reaction yields, reduced reaction times and ameliorated the effects on the surrounding environment as the reactions are carried out in closed systems. Structures of the newly synthesized compounds are proved using spectroscopic methods such as IR, MS, 1H-NMR and 13C-NMR and elemental analyses. Some of the newly synthesized compounds were tested for their antimicrobial activities, whereby four of them showed moderate activities and the rest showed low or no activities towards the investigated species.