Hyperthyroidism is a relatively prevalent condition, and is one of the most common endocrine prob... more Hyperthyroidism is a relatively prevalent condition, and is one of the most common endocrine problems seen in clinical practice, high serum cholesterol and increased oxidative stress are common associated risk factors of hyperthyroidism. Multivitamin deficiencies in folate and vitamin C are also one of the hyperthyroidism complications. Individually or combined Folic acid and vitamin C were introduced to hyperthyroid induced rats. A relative enhancement in the thyroid hormones with a normal lipid profile was noticed. Previous researches confirmed that the depletion on the lipid in hyperthyroidism will be gained after treatment.
Lipid nanoparticles are promising carriers to deliver anticancer agents of low aqueous solubility... more Lipid nanoparticles are promising carriers to deliver anticancer agents of low aqueous solubility such as Paclitaxel (PTX). The aim of this work is to improve the efficacy of Paclitaxel through formulation of Solid Lipid Nanoparticles (SLN) and Nanostructured Lipid Carriers (NLC) containing two different liquid lipids. Preparation was done using homogenization and ultrasonication technique. Nanoparticles physical characterization was done by determination of the mean particle size, zeta potential and Transmission electron microscopy (TEM). Entrapment efficiency and Differential Scanning Calorimetry (DSC) was determined. In vitro release and cytotoxicity was done and results were compared to the commercially available product Taxol ® .The mean particle diameter was between 276-314 nm, while zeta potential ranged from-20.2 and-24.9 mV. The entrapment efficiencies of prepared formulae were high(up to 87.6%) and thermal analysis revealed that the drug was in amorphous form. In vitro rel...
Recently, the development of distributed renewable energy resources, smart devices, and smart gri... more Recently, the development of distributed renewable energy resources, smart devices, and smart grids empowers the emergence of peer-to-peer energy trading via local energy markets. However, due to security and privacy concerns in energy trading, sensitive information of energy traders could be leaked to an adversary. In addition, malicious users could perform attacks against the energy market, such as collusion, double spending, and repudiation attacks. Moreover, network attacks could be executed by external attackers against energy networks, such as eavesdropping, data spoofing, and tampering attacks. To tackle the abovementioned attacks, we propose a secure and privacy-preserving energy trading system (SPETS). First, a permissioned energy blockchain is presented to perform secure energy transactions between energy sellers and buyers. Second, a discrete-time double auction is proposed for energy allocation and pricing. Third, the concept of reputation scores is adopted to guarantee ...
Several algorithms have been proposed to avoid the error floor region, such as the concatenation ... more Several algorithms have been proposed to avoid the error floor region, such as the concatenation codes that requires high computational demands in addition to high complexity. This paper proposes a technique based on using cascaded BCH and convolutional codes that leads to better error correction performance. Moreover, an adaptive method based on sensing the channel's noise to determine the number of the parity bits that will be added to the used BCH that reduces the consumed bandwidth and the transmitted parity bits is presented. A further enhancement is fulfilled by using parallel processing branches, resulting in reducing the consumed time and speed up the performance. The results show that the proposed code presents a better performance. A high reduction in the number of cycles that will be used in the encoding and decoding compared with the classical method and finally a flexible parity bits method based on the signal-to-noise ratio of the channel that reduced the parity bi...
Migratory wild birds acquire antimicrobial-resistant (AMR) bacteria from contaminated habitats an... more Migratory wild birds acquire antimicrobial-resistant (AMR) bacteria from contaminated habitats and then act as reservoirs and potential spreaders of resistant elements through migration. However, the role of migratory wild birds as antimicrobial disseminators in the Arabian Peninsula desert, which represents a transit point for birds migrating all over Asia, Africa, and Europe not yet clear. Therefore, the present study objective was to determine antimicrobial-resistant bacteria in samples collected from migratory wild birds around Al-Asfar Lake, located in Al-Ahsa Oasis, Eastern Saudi Arabia, with a particular focus on Escherichia coli virulence and resistance genes. Cloacal swabs were collected from 210 migratory wild birds represent four species around Al-Asfar. E. coli, Staphylococcus, and Salmonella spp. have been recovered from 90 (42.9%), 37 (17.6%), and 5 (2.4%) birds, respectively. Out of them, 19 (14.4%) were a mixed infection. All samples were subjected to AMR phenotypic ...
Background The optimal timing, surgical technique and the influence of Down syndrome on outcome o... more Background The optimal timing, surgical technique and the influence of Down syndrome on outcome of surgical repair of Complete Atrio-Ventricular Canal Defect (CAVC) remains uncertain. We reviewed our experience in repair of CAVC to identify the influence of these factors on operative outcome. Methods A prospective study included 70 patients who underwent repair of CAVC at Ain Shams university hospitals, academy of cardiothoracic surgery during the period from July 2016 to October 2019. Age at surgery (less than 6 months old versus later), surgical technique used [(modified single patch versus double patch technique), (use of posterior annuloplasty for repair of left AV valve or not)] and association of Down syndrome were evaluated for their impact on the outcome of surgical repair using multivariate analysis. Patients were followed up for 6 months; primary end point was mortality and secondary end point was reappearance of LAVV regurgitation. Results No significant difference betwee...
European Journal of Orthopaedic Surgery & Traumatology
Secondary displacement of traumatic ankle fractures with subsequent soft-tissue breakdown is a tr... more Secondary displacement of traumatic ankle fractures with subsequent soft-tissue breakdown is a troublesome issue after inappropriate conservative treatment among non-compliant diabetic patients with severe peripheral neuropathy. This study was conducted to evaluate the results of a less-invasive arthrodesis procedure as an alternative to osteosynthesis in these complex scenarios. A total of 46 diabetics, who underwent fluoroscopy-assisted trans-calcaneal retrograde nailing-based ankle arthrodesis between 2012 and 2018 for salvaging secondary-displaced diabetic ankle fractures in their insensate feet, were evaluated in this retrospective study. All fractures were associated with uninfected mechanical ulcers overlying malleoli, without Charcot changes, after failed conservative cast immobilization. The patients (mean age: 52.52 ± 3.70 years; 18 males; 46 feet) were evaluated radiologically for union and clinically for limb salvage, modified American Orthopedic Ankle and Foot Scale (AOAFS), and the overall subjective patients' satisfaction. The mean follow-up was 29.5 ± 3.1 months. All ulcers have healed with local care only with 100% limb salvage. Four patients experienced minor wound healing problems at posterior heel, and another one developed acute Charcot changes that was successfully managed by offloading and repeat surgery. Forty patients (86.96%) had fully consolidated fusions with a mean time to fusion 15.78 ± 2.58 weeks, while the other six cases had stable fibrous-union. At the final follow-up, the mean modified-AOFAS was 76.85 ± 6.0 from 86 total points. All, but four patients (91.30%) were completely satisfied while the other four patients were partially satisfied. The presented less-invasive arthrodesis technique is reproducible and effective alternative for salvaging unstable diabetic ankle fractures in the insensate feet when standard surgical procedures would be more risky. Level of evidence: IV, retrospective case series
Wild migratory birds are often implicated in the introduction, maintenance, and global disseminat... more Wild migratory birds are often implicated in the introduction, maintenance, and global dissemination of different pathogens, such as influenza A viruses (IAV) and antimicrobial-resistant (AMR) bacteria. Trapping of migratory birds during their resting periods at the northern coast of Egypt is a common and ancient practice performed mainly for selling in live bird markets (LBM). In the present study, samples were collected from 148 wild birds, representing 14 species, which were being offered for sale in LBM. All birds were tested for the presence of AIV and enterobacteriaceae. Ten samples collected from Northern Shoveler birds (Spatula clypeata) were positive for IAV and PCR sub-typing and pan HA/NA sequencing assays detected H5N8, H9N2, and H6N2 viruses in four, four, and one birds, respectively. Sequencing of the full haemagglutinin (HA) gene revealed a high similarity with currently circulating IAV in Egypt. From all the birds, E. coli was recovered from 37.2% and Salmonella from...
Background Thin endometrium could be a major contributing factor in decreasing pregnancy rates wi... more Background Thin endometrium could be a major contributing factor in decreasing pregnancy rates with in-vitro fertilization. Several treatments have been studied in patients with thin endometrium, like hormonal therapy by GnRH-agonist and estrogen. Additionally, vasoactive measures like aspirin, a mix of pentoxifylline, vitamin E, l-arginine, sildenafil, and intrauterine infusion of a growth factor such as G-CSF, and the recent application of regenerative medicine were reported in previous trials. Main body of the abstract We discuss here a new modality for thin endometrium treatment using platelet-rich plasma (PRP) administered as an intrauterine infusion. The purpose of this review is to evaluate the effectiveness of PRP in cases of infertility. All relevant articles addressing the use of PRP, published from January 2000 to September 2018, were reviewed and analyzed. The studies published on the PRP treatment model for thin endometrium in the gynecology field were mainly case serie...
Adenomyosis is a prevalent disorder characterized by the presence of ectopic endometrial tissues ... more Adenomyosis is a prevalent disorder characterized by the presence of ectopic endometrial tissues within the myometrium. Its etiology and pathogenesis are unclear. The most debilitating adenomyosis-related symptoms are considered to be dysmenorrhea and nonmenstrual pelvic pain, which are reported to affect more than one third of patients. Women with adenomyosis also present with menorrhagia, dyspareunia and infertility. Previous studies have shown that adenomyosis has a negative impact on daily activities and the quality of life and increases the risk of anxiety, depression, and other psychological disorders. Hysterectomy is the only definitive treatment for adenomyosis, but it is associatedwith increased risks of bladder injury, persistent pelvic pain, and other perioperative complications. At present, medical treatment is the first-line option for symptomatic relief. Themost commonly prescribed drugs for pain relief are nonsteroidal anti-inflammatory drugs. Other widely used options include gonadotropin-releasing hormone analog, progesterone, androgen derivatives, combined oral contraceptives, and hormonal receptor modulators. Health, Inc. All rights reserved. 348 Obstetrical and Gynecological Survey Along with its contraceptive properties, the levonorgestrel intrauterine system (LNG-IUS), a long-acting hormone-releasing uterine device, has a number of noncontraceptive health benefits for many gynecological conditions. A growing body of evidence over the past 2 decades has suggested a beneficial role of LNG-IUS in themanagement of adenomyosis, but only a limited number of published studies have investigated the efficacy of LNG-IUS as a first-line option for adenomyosis. The aim of this systematic review and meta-analysis was to assess the safety and efficacy of LNG-IUS for the management of adenomyosis. Another aim was to evaluate the effect of LNG-IUS on symptoms of adenomyosis as well as uterine volume and endometrial thickness. To identify relevant studies, which used LNG-IUS in management of patients with clinically or ultrasonographic diagnosed adenomyosis, the authors conducted an electronic search of the following 6 databases from inception until May 31, 2019: MEDLINE via PubMed, SCOPUS,Web of Science, Cochrane Central Register of Controlled–Trials (CENTRAL), EMBASE, and Google Scholar. There were no restrictions regarding language or date of publication. The primary study outcome measures included pain score at the end of follow-up, symptomatic relief, bleeding, uterine volume (milliliters), endometrial thickness (millimeters), and/or hemoglobin level. After initial title and abstract screening, 102 citations were retained for full-text evaluation. Among these, 10 articles (n = 510) met study criteria and were included in the analysis. All studies included were prospective open-label, randomized controlled studies (RCTs), single-arm, or observational. Effect estimates showed that the LNG-IUS led to significant reductions in pain score up to 36 months after insertion; the standardized mean difference (SMD) at 12 months was −3.87 (95% confidence interval [CI], −5.51 to −2.23; P < 0.001); SMD at 24 months was −5.56 (95% CI, −9.80 to −1.32; P = 0.01); and SMD at 36 months was −3.81 (95%CI, −4.27 to −3.36; P < 0.001). Likewise, the Pictorial Blood Assessment Chart showed that insertion of LNG-IUS significantly reduced heavy menstrual bleeding up to 36 months; SMDwas −2.32 at 36 months, with a 95% CI of −2.91 to −1.73, P < 0.001. After insertion, there were also significant reductions in the uterine volume at 12 months (SMD, −0.60; 95% CI, −0.88 to −0.31; P < 0.001) and 36 months (SMD, −0.42; 95% CI, −0.69 to −0.14; P = 0.003). These data show that LNG-IUS is a promising nonsurgical option for the management of adenomyosis. Its use reduced the severity of symptoms of adenomyosis as well as uterine volume and endometrial thickness, and improved laboratory outcomes. High-quality RCTs are needed to assess the impact of LNG-IUS on patient-centered outcomes and to investigate the relationship between the response of LNG-IUS and the severity of symptoms or size of adenomyosis lesions.
To assess the effectiveness of prophylactic bilateral uterine artery ligation (BUAL) in reducing ... more To assess the effectiveness of prophylactic bilateral uterine artery ligation (BUAL) in reducing the incidence of postpartum hemorrhage (PPH) during cesarean delivery among women at risk of uterine atony.
Debate exists for the optimal tool to select embryos for transfer in assisted reproductive techno... more Debate exists for the optimal tool to select embryos for transfer in assisted reproductive technology (ART). Time-lapse monitoring (TLM) is a noninvasive tool suggested where each embryo can be captured every 5–20 min. Given the inconsistency in the existing studies, we conducted this meta-analysis of RCTs to summarize the evidence available concerning the predictive ability of morphokinetics compared with the routine assessment of embryo development in ART. The primary databases MEDLINE, EMBASE, Cochrane, NHS, WHO, and Other Non-Indexed Citations were consulted for RCTs that have been published until November 2018, with no language restriction. Our review includes 6 RCTs (n = 2057 patients). The data showed an improvement (~ 9%) in live birth TLM (OR 1.43; 95% CI 1.10–1.85; P = 0.007), with low-quality evidence. There was no evidence of a significant difference between both groups concerning ongoing pregnancy, clinical pregnancy and implantation rates. The data further showed that morphokinetics is associated with decreased early pregnancy loss rate. These estimates must be interpreted with caution owing to the statistical and clinical heterogeneities and the consequent difficulty in drawing any meaningful conclusion.
Hyperthyroidism is a relatively prevalent condition, and is one of the most common endocrine prob... more Hyperthyroidism is a relatively prevalent condition, and is one of the most common endocrine problems seen in clinical practice, high serum cholesterol and increased oxidative stress are common associated risk factors of hyperthyroidism. Multivitamin deficiencies in folate and vitamin C are also one of the hyperthyroidism complications. Individually or combined Folic acid and vitamin C were introduced to hyperthyroid induced rats. A relative enhancement in the thyroid hormones with a normal lipid profile was noticed. Previous researches confirmed that the depletion on the lipid in hyperthyroidism will be gained after treatment.
Lipid nanoparticles are promising carriers to deliver anticancer agents of low aqueous solubility... more Lipid nanoparticles are promising carriers to deliver anticancer agents of low aqueous solubility such as Paclitaxel (PTX). The aim of this work is to improve the efficacy of Paclitaxel through formulation of Solid Lipid Nanoparticles (SLN) and Nanostructured Lipid Carriers (NLC) containing two different liquid lipids. Preparation was done using homogenization and ultrasonication technique. Nanoparticles physical characterization was done by determination of the mean particle size, zeta potential and Transmission electron microscopy (TEM). Entrapment efficiency and Differential Scanning Calorimetry (DSC) was determined. In vitro release and cytotoxicity was done and results were compared to the commercially available product Taxol ® .The mean particle diameter was between 276-314 nm, while zeta potential ranged from-20.2 and-24.9 mV. The entrapment efficiencies of prepared formulae were high(up to 87.6%) and thermal analysis revealed that the drug was in amorphous form. In vitro rel...
Recently, the development of distributed renewable energy resources, smart devices, and smart gri... more Recently, the development of distributed renewable energy resources, smart devices, and smart grids empowers the emergence of peer-to-peer energy trading via local energy markets. However, due to security and privacy concerns in energy trading, sensitive information of energy traders could be leaked to an adversary. In addition, malicious users could perform attacks against the energy market, such as collusion, double spending, and repudiation attacks. Moreover, network attacks could be executed by external attackers against energy networks, such as eavesdropping, data spoofing, and tampering attacks. To tackle the abovementioned attacks, we propose a secure and privacy-preserving energy trading system (SPETS). First, a permissioned energy blockchain is presented to perform secure energy transactions between energy sellers and buyers. Second, a discrete-time double auction is proposed for energy allocation and pricing. Third, the concept of reputation scores is adopted to guarantee ...
Several algorithms have been proposed to avoid the error floor region, such as the concatenation ... more Several algorithms have been proposed to avoid the error floor region, such as the concatenation codes that requires high computational demands in addition to high complexity. This paper proposes a technique based on using cascaded BCH and convolutional codes that leads to better error correction performance. Moreover, an adaptive method based on sensing the channel's noise to determine the number of the parity bits that will be added to the used BCH that reduces the consumed bandwidth and the transmitted parity bits is presented. A further enhancement is fulfilled by using parallel processing branches, resulting in reducing the consumed time and speed up the performance. The results show that the proposed code presents a better performance. A high reduction in the number of cycles that will be used in the encoding and decoding compared with the classical method and finally a flexible parity bits method based on the signal-to-noise ratio of the channel that reduced the parity bi...
Migratory wild birds acquire antimicrobial-resistant (AMR) bacteria from contaminated habitats an... more Migratory wild birds acquire antimicrobial-resistant (AMR) bacteria from contaminated habitats and then act as reservoirs and potential spreaders of resistant elements through migration. However, the role of migratory wild birds as antimicrobial disseminators in the Arabian Peninsula desert, which represents a transit point for birds migrating all over Asia, Africa, and Europe not yet clear. Therefore, the present study objective was to determine antimicrobial-resistant bacteria in samples collected from migratory wild birds around Al-Asfar Lake, located in Al-Ahsa Oasis, Eastern Saudi Arabia, with a particular focus on Escherichia coli virulence and resistance genes. Cloacal swabs were collected from 210 migratory wild birds represent four species around Al-Asfar. E. coli, Staphylococcus, and Salmonella spp. have been recovered from 90 (42.9%), 37 (17.6%), and 5 (2.4%) birds, respectively. Out of them, 19 (14.4%) were a mixed infection. All samples were subjected to AMR phenotypic ...
Background The optimal timing, surgical technique and the influence of Down syndrome on outcome o... more Background The optimal timing, surgical technique and the influence of Down syndrome on outcome of surgical repair of Complete Atrio-Ventricular Canal Defect (CAVC) remains uncertain. We reviewed our experience in repair of CAVC to identify the influence of these factors on operative outcome. Methods A prospective study included 70 patients who underwent repair of CAVC at Ain Shams university hospitals, academy of cardiothoracic surgery during the period from July 2016 to October 2019. Age at surgery (less than 6 months old versus later), surgical technique used [(modified single patch versus double patch technique), (use of posterior annuloplasty for repair of left AV valve or not)] and association of Down syndrome were evaluated for their impact on the outcome of surgical repair using multivariate analysis. Patients were followed up for 6 months; primary end point was mortality and secondary end point was reappearance of LAVV regurgitation. Results No significant difference betwee...
European Journal of Orthopaedic Surgery & Traumatology
Secondary displacement of traumatic ankle fractures with subsequent soft-tissue breakdown is a tr... more Secondary displacement of traumatic ankle fractures with subsequent soft-tissue breakdown is a troublesome issue after inappropriate conservative treatment among non-compliant diabetic patients with severe peripheral neuropathy. This study was conducted to evaluate the results of a less-invasive arthrodesis procedure as an alternative to osteosynthesis in these complex scenarios. A total of 46 diabetics, who underwent fluoroscopy-assisted trans-calcaneal retrograde nailing-based ankle arthrodesis between 2012 and 2018 for salvaging secondary-displaced diabetic ankle fractures in their insensate feet, were evaluated in this retrospective study. All fractures were associated with uninfected mechanical ulcers overlying malleoli, without Charcot changes, after failed conservative cast immobilization. The patients (mean age: 52.52 ± 3.70 years; 18 males; 46 feet) were evaluated radiologically for union and clinically for limb salvage, modified American Orthopedic Ankle and Foot Scale (AOAFS), and the overall subjective patients' satisfaction. The mean follow-up was 29.5 ± 3.1 months. All ulcers have healed with local care only with 100% limb salvage. Four patients experienced minor wound healing problems at posterior heel, and another one developed acute Charcot changes that was successfully managed by offloading and repeat surgery. Forty patients (86.96%) had fully consolidated fusions with a mean time to fusion 15.78 ± 2.58 weeks, while the other six cases had stable fibrous-union. At the final follow-up, the mean modified-AOFAS was 76.85 ± 6.0 from 86 total points. All, but four patients (91.30%) were completely satisfied while the other four patients were partially satisfied. The presented less-invasive arthrodesis technique is reproducible and effective alternative for salvaging unstable diabetic ankle fractures in the insensate feet when standard surgical procedures would be more risky. Level of evidence: IV, retrospective case series
Wild migratory birds are often implicated in the introduction, maintenance, and global disseminat... more Wild migratory birds are often implicated in the introduction, maintenance, and global dissemination of different pathogens, such as influenza A viruses (IAV) and antimicrobial-resistant (AMR) bacteria. Trapping of migratory birds during their resting periods at the northern coast of Egypt is a common and ancient practice performed mainly for selling in live bird markets (LBM). In the present study, samples were collected from 148 wild birds, representing 14 species, which were being offered for sale in LBM. All birds were tested for the presence of AIV and enterobacteriaceae. Ten samples collected from Northern Shoveler birds (Spatula clypeata) were positive for IAV and PCR sub-typing and pan HA/NA sequencing assays detected H5N8, H9N2, and H6N2 viruses in four, four, and one birds, respectively. Sequencing of the full haemagglutinin (HA) gene revealed a high similarity with currently circulating IAV in Egypt. From all the birds, E. coli was recovered from 37.2% and Salmonella from...
Background Thin endometrium could be a major contributing factor in decreasing pregnancy rates wi... more Background Thin endometrium could be a major contributing factor in decreasing pregnancy rates with in-vitro fertilization. Several treatments have been studied in patients with thin endometrium, like hormonal therapy by GnRH-agonist and estrogen. Additionally, vasoactive measures like aspirin, a mix of pentoxifylline, vitamin E, l-arginine, sildenafil, and intrauterine infusion of a growth factor such as G-CSF, and the recent application of regenerative medicine were reported in previous trials. Main body of the abstract We discuss here a new modality for thin endometrium treatment using platelet-rich plasma (PRP) administered as an intrauterine infusion. The purpose of this review is to evaluate the effectiveness of PRP in cases of infertility. All relevant articles addressing the use of PRP, published from January 2000 to September 2018, were reviewed and analyzed. The studies published on the PRP treatment model for thin endometrium in the gynecology field were mainly case serie...
Adenomyosis is a prevalent disorder characterized by the presence of ectopic endometrial tissues ... more Adenomyosis is a prevalent disorder characterized by the presence of ectopic endometrial tissues within the myometrium. Its etiology and pathogenesis are unclear. The most debilitating adenomyosis-related symptoms are considered to be dysmenorrhea and nonmenstrual pelvic pain, which are reported to affect more than one third of patients. Women with adenomyosis also present with menorrhagia, dyspareunia and infertility. Previous studies have shown that adenomyosis has a negative impact on daily activities and the quality of life and increases the risk of anxiety, depression, and other psychological disorders. Hysterectomy is the only definitive treatment for adenomyosis, but it is associatedwith increased risks of bladder injury, persistent pelvic pain, and other perioperative complications. At present, medical treatment is the first-line option for symptomatic relief. Themost commonly prescribed drugs for pain relief are nonsteroidal anti-inflammatory drugs. Other widely used options include gonadotropin-releasing hormone analog, progesterone, androgen derivatives, combined oral contraceptives, and hormonal receptor modulators. Health, Inc. All rights reserved. 348 Obstetrical and Gynecological Survey Along with its contraceptive properties, the levonorgestrel intrauterine system (LNG-IUS), a long-acting hormone-releasing uterine device, has a number of noncontraceptive health benefits for many gynecological conditions. A growing body of evidence over the past 2 decades has suggested a beneficial role of LNG-IUS in themanagement of adenomyosis, but only a limited number of published studies have investigated the efficacy of LNG-IUS as a first-line option for adenomyosis. The aim of this systematic review and meta-analysis was to assess the safety and efficacy of LNG-IUS for the management of adenomyosis. Another aim was to evaluate the effect of LNG-IUS on symptoms of adenomyosis as well as uterine volume and endometrial thickness. To identify relevant studies, which used LNG-IUS in management of patients with clinically or ultrasonographic diagnosed adenomyosis, the authors conducted an electronic search of the following 6 databases from inception until May 31, 2019: MEDLINE via PubMed, SCOPUS,Web of Science, Cochrane Central Register of Controlled–Trials (CENTRAL), EMBASE, and Google Scholar. There were no restrictions regarding language or date of publication. The primary study outcome measures included pain score at the end of follow-up, symptomatic relief, bleeding, uterine volume (milliliters), endometrial thickness (millimeters), and/or hemoglobin level. After initial title and abstract screening, 102 citations were retained for full-text evaluation. Among these, 10 articles (n = 510) met study criteria and were included in the analysis. All studies included were prospective open-label, randomized controlled studies (RCTs), single-arm, or observational. Effect estimates showed that the LNG-IUS led to significant reductions in pain score up to 36 months after insertion; the standardized mean difference (SMD) at 12 months was −3.87 (95% confidence interval [CI], −5.51 to −2.23; P < 0.001); SMD at 24 months was −5.56 (95% CI, −9.80 to −1.32; P = 0.01); and SMD at 36 months was −3.81 (95%CI, −4.27 to −3.36; P < 0.001). Likewise, the Pictorial Blood Assessment Chart showed that insertion of LNG-IUS significantly reduced heavy menstrual bleeding up to 36 months; SMDwas −2.32 at 36 months, with a 95% CI of −2.91 to −1.73, P < 0.001. After insertion, there were also significant reductions in the uterine volume at 12 months (SMD, −0.60; 95% CI, −0.88 to −0.31; P < 0.001) and 36 months (SMD, −0.42; 95% CI, −0.69 to −0.14; P = 0.003). These data show that LNG-IUS is a promising nonsurgical option for the management of adenomyosis. Its use reduced the severity of symptoms of adenomyosis as well as uterine volume and endometrial thickness, and improved laboratory outcomes. High-quality RCTs are needed to assess the impact of LNG-IUS on patient-centered outcomes and to investigate the relationship between the response of LNG-IUS and the severity of symptoms or size of adenomyosis lesions.
To assess the effectiveness of prophylactic bilateral uterine artery ligation (BUAL) in reducing ... more To assess the effectiveness of prophylactic bilateral uterine artery ligation (BUAL) in reducing the incidence of postpartum hemorrhage (PPH) during cesarean delivery among women at risk of uterine atony.
Debate exists for the optimal tool to select embryos for transfer in assisted reproductive techno... more Debate exists for the optimal tool to select embryos for transfer in assisted reproductive technology (ART). Time-lapse monitoring (TLM) is a noninvasive tool suggested where each embryo can be captured every 5–20 min. Given the inconsistency in the existing studies, we conducted this meta-analysis of RCTs to summarize the evidence available concerning the predictive ability of morphokinetics compared with the routine assessment of embryo development in ART. The primary databases MEDLINE, EMBASE, Cochrane, NHS, WHO, and Other Non-Indexed Citations were consulted for RCTs that have been published until November 2018, with no language restriction. Our review includes 6 RCTs (n = 2057 patients). The data showed an improvement (~ 9%) in live birth TLM (OR 1.43; 95% CI 1.10–1.85; P = 0.007), with low-quality evidence. There was no evidence of a significant difference between both groups concerning ongoing pregnancy, clinical pregnancy and implantation rates. The data further showed that morphokinetics is associated with decreased early pregnancy loss rate. These estimates must be interpreted with caution owing to the statistical and clinical heterogeneities and the consequent difficulty in drawing any meaningful conclusion.
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