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Abu Nofal M, Massalha M, Diab M, Abboud M, Asla Jamhour A, Said W, Talmon G, Mresat S, Mattar K, Garmi G, Zafran N, Reiss A, Salim R. Perinatal Outcomes of Late Preterm Rupture of Membranes with or without Latency Antibiotics. Am J Perinatol 2024. [PMID: 38452793 DOI: 10.1055/a-2282-9072] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE This study aimed to examine whether the addition of latency antibiotics in late preterm rupture of membranes (ROM) decreases neonatal infection and increases latency. STUDY DESIGN This retrospective two-center study was conducted at Holy Family Hospital (HFH) in Nazareth and Emek Medical Center (EMC) in Afula, on data collected between January 2017 and April 2023. HFH is the smaller institution. EMC and HFH implement similar policies regarding ROM at 340/7 to 366/7 weeks' gestation; the only difference is that a 10-day course of latency antibiotics is implemented at EMC. All women with ROM between 340/7 and 366/7 weeks' gestation who were admitted to one of the centers during the study period, and had a live fetus without major malformations, were included. The primary outcome was neonatal sepsis rate. Secondary outcomes included a composite of neonatal sepsis, mechanical ventilation ≥24 hours, and perinatal death. Additionally, gestational age at delivery and delivery mode were examined. RESULTS Overall, 721 neonates were delivered during the study period: 534 at EMC (where latency antibiotics were administered) and 187 at HFH. The gestational age at ROM was similar (35.8 and 35.9 weeks, respectively, p = 0.14). Neonatal sepsis occurred in six (1.1%) neonates at EMC and one (0.5%) neonate at HFH (adjusted p = 0.71; OR: 1.69; 95% Confidence Interval [CI]: 0.11-27.14). The composite secondary outcome occurred in nine (1.7%) and three (1.6%) neonates at EMC and HFH, respectively (adjusted p = 0.71; OR: 0.73; 95% CI: 0.14-3.83). The gestational age at delivery was 36.1 and 36.2 weeks at EMC and HFH, respectively (mean difference: 5 h; adjusted p = 0.02). The cesarean delivery rate was 24.7% and 19.3% at EMC and HFH, respectively (adjusted p = 0.96). CONCLUSION Latency antibiotics administered to women admitted with ROM between 340/7 and 366/7 weeks' gestation did not decrease the rate of neonatal sepsis. KEY POINTS · Latency antibiotics in late preterm ROM does not decrease neonatal sepsis.. · Latency antibiotics in late preterm ROM does not prolong gestational age at delivery.. · Latency antibiotics in late preterm ROM does not affect the mode of delivery..
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Affiliation(s)
- Mais Abu Nofal
- Department of Obstetrics and Gynecology, Holy Family Hospital, Nazareth, Israel
| | - Manal Massalha
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Marwa Diab
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Maysa Abboud
- Department of Obstetrics and Gynecology, Holy Family Hospital, Nazareth, Israel
| | - Aya Asla Jamhour
- Department of Obstetrics and Gynecology, Holy Family Hospital, Nazareth, Israel
| | - Waseem Said
- Department of Neonatology, Holy Family Hospital, Nazareth, Israel
| | - Gil Talmon
- Department of Neonatology, Emek Medical Center, Afula, Israel
| | - Samah Mresat
- Department of Obstetrics and Gynecology, Holy Family Hospital, Nazareth, Israel
| | - Kamel Mattar
- Department of Obstetrics and Gynecology, Holy Family Hospital, Nazareth, Israel
| | - Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Noah Zafran
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ari Reiss
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Holy Family Hospital, Nazareth, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Benyamini Raischer H, Garmi G, Malchi D, Nachshon AA, Inbar S, Romano S, Salim R. Impact of COVID-19 mandatory lockdown on maternal gestational weight gain and neonatal macrosomia rate at an academic medical center in Israel. J Matern Fetal Neonatal Med 2023; 36:2204391. [PMID: 37127549 DOI: 10.1080/14767058.2023.2204391] [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] [Indexed: 05/03/2023]
Abstract
BACKGROUND In an effort to prevent the spread of coronavirus disease 2019 (COVID-19), governments restricted outdoor activities and imposed lockdown quarantine. This change in lifestyle probably affected individuals' eating habits and physical activity. OBJECTIVE To examine the effect of lockdown due to the COVID-19 pandemic on maternal antenatal weight gain, neonatal macrosomia, and other maternal and neonatal outcomes of women delivering at an academic medical center in Israel. METHOD A retrospective, two-period cohort study conducted at a university teaching medical center in Afula, Israel. The study period was between April and September 2020. This period signifies worsening in pandemic situations, during which citizens experienced strict prolonged lockdown measures. The parallel unexposed period (control period) was between April and September 2019. Singleton pregnancies delivered at >24 weeks were eligible. Primary outcome was incidence of macrosomia. Secondary outcomes included gestational weight gain, body mass index (BMI) at delivery, rates of gestational diabetes mellitus (GDM), mode of delivery, postpartum hemorrhage (PPH), and neonatal outcomes reflecting neonatal birth weight and condition at delivery. RESULTS A total of 4,765 women were included, 2,442 in the study group and 2,323 in the control group. The incidence of macrosomia was significantly higher in 2020 (6.2%) than in 2019 (4.9%), (p = .048; OR: 1.29; 95% CI: 1.002- 1.65). Women gained significantly more weight (median 1 kg more), weighed more at delivery (median 1 kg), and had higher BMI at delivery in 2020 compared with those in 2019 (p < .01). The incidence of GDM was 9.5% and 8.5% in the study and control groups respectively (p = .26; OR: 1.12; 95% CI: 0.92-1.37). Greater percentage of women did not perform the glucose challenge test in 2020 (9.9%) compared with those in 2019 (7.5%) (p = .003, OR: 1.36; 95% CI: 1.11-1.67). The incidence of any hypertension related to pregnancy was significantly higher in 2020 compared to 2019 (5.8% vs 4.4% respectively, (p = .042; OR: 1.32; 95% CI: 1.02-1.71). The proportion of women who smoked during pregnancy was also significantly higher in 2020 than in 2019 (5.1% vs 3.7%, respectively, p = .02; OR: 1.40; 95% CI: 1.06-1.86). Delivery mode did not differ, while the incidence of PPH was significantly higher in 2020 than in 2019 (5.6% vs 3.4%, respectively, p = .001; OR: 1.65; 95% CI: 1.25-2.19). Neonatal condition at delivery was comparable. CONCLUSION COVID-19-related lockdown was associated with the increased rate of macrosomic infants. This indirect effect of the pandemic is probably related to poorer maternal antenatal metabolic health status. Long-term consequences should be further examined.
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Affiliation(s)
| | - Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Daniel Malchi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | | | - Shiri Inbar
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Zakaria MN, Ensin EG, Awang MA, Salim R, Nik Othman NA, Rashid MFN. Establishing transducers-dependent sensorineural acuity level normative data among young Malaysian adults. Med J Malaysia 2023; 78:901-906. [PMID: 38159926] [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: 01/03/2024]
Abstract
INTRODUCTION The sensorineural acuity level (SAL) test was developed as an alternative assessment to estimate bone conduction (BC) thresholds in cases where masking problems occur in pure tone audiometry (PTA). Nevertheless, prior to its clinical application, the respective SAL normative data must be made available. As such, the present study was carried out to establish SAL normative data using an insert earphone and two different commercially available bone transducers. Additionally, to determine the effect of earphone type on SAL test results, it was also of interest to compare the present study's findings with those of a previous study (that used a headphone to derive SAL normative data). MATERIALS AND METHODS In this repeated-measures study, 40 Malaysian adults (aged 19-26 years) with normal hearing bilaterally (based on PTA results) were enrolled. They then underwent the SAL test based on the recommended protocol by Jerger and Tillman (1960). The SAL normative data for each ear were obtained by calculating the differences between air conduction (AC) thresholds in quiet and AC thresholds in noise by means of insert earphone, B71 and B81 bone vibrators. RESULTS The SAL normative values were comparable between the ears (p > 0.05), and the data were pooled for subsequent analyses (n = 80 ears). Relative to B81 bone transducer, B71 bone vibrator produced statistically higher SAL normative data at all frequencies (p < 0.05). The SAL normative values established by the present study were statistically lower than those of the previous study (that utilised headphones) at most of frequencies tested (p < 0.05). CONCLUSIONS The SAL normative data produced by the two bone vibrators were significantly different. The SAL normative values were also affected by the type of earphone used. While conducting the SAL test on Malaysian patients, the information provided by this study can be useful to guide the respective clinicians in choosing the appropriate normative data.
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Affiliation(s)
- M N Zakaria
- Universiti Sains Malaysia, School of Health Sciences, Audiology Programme, Kubang Kerian, Kelantan, Malaysia
| | - E G Ensin
- Universiti Sains Malaysia, School of Health Sciences, Audiology Programme, Kubang Kerian, Kelantan, Malaysia
| | - M A Awang
- Universiti Sains Malaysia, School of Health Sciences, Audiology Programme, Kubang Kerian, Kelantan, Malaysia.
| | - R Salim
- Universiti Sains Malaysia, School of Health Sciences, Department of Otorhinolaryngology Head and Neck Surgery (ORL-HNS), Kubang Kerian, Kelantan, Malaysia
| | - N A Nik Othman
- Universiti Sains Malaysia, School of Health Sciences, Department of Otorhinolaryngology Head and Neck Surgery (ORL-HNS), Kubang Kerian, Kelantan, Malaysia
| | - M F N Rashid
- Universiti Sains Malaysia, School of Health Sciences, Audiology Programme, Kubang Kerian, Kelantan, Malaysia
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Peel MD, Croll DMR, Kessler J, Haugland B, Pennell CE, Dickinson JE, Salim R, Zafran N, Palmer KR, Mol BW, Li W. Double-vs single-balloon catheter for induction of labor: Systematic review and individual participant data meta-analysis. Acta Obstet Gynecol Scand 2023; 102:1440-1449. [PMID: 37417714 PMCID: PMC10577628 DOI: 10.1111/aogs.14626] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Evidence comparing double-balloon vs single-balloon catheter for induction of labor is divided. We aim to compare the efficacy and safety of double-vs single-balloon catheters using individual participant data. MATERIAL AND METHODS A search of Ovid MEDLINE, Embase, Ovid Emcare, CINAHL Plus, Scopus, and clinicaltrials.gov was conducted for randomized controlled trials published from March 2019 until April 13, 2021. Earlier trials were identified from the Cochrane Review on Mechanical Methods for Induction of Labour. Randomized controlled trials that compared double-balloon with single-balloon catheters for induction of labor in singleton gestations were eligible. Participant-level data were sought from trial investigators and an individual participant data meta-analysis was performed. The primary outcomes were rates of vaginal birth achieved, a composite measure of adverse maternal outcomes and a composite measure of adverse perinatal outcomes. We used a two-stage random-effects model. Data were analyzed from the intention-to-treat perspective. RESULTS Of the eight eligible randomized controlled trials, three shared individual-level data with a total of 689 participants, 344 women in the double-balloon catheter group and 345 women in the single-balloon catheter group. The difference in the rate of vaginal birth between double-balloon catheter and single-balloon catheter was not statistically significant (relative risk [RR] 0.93, 95% confidence interval [CI] 0.86-1.00, p = 0.050; I2 0%; moderate-certainty evidence). Both perinatal outcomes (RR 0.81, 95% CI 0.54-1.21, p = 0.691; I2 0%; moderate-certainty evidence) and maternal composite outcomes (RR 0.65, 95% CI 0.15-2.87, p = 0.571; I2 55.46%; low-certainty evidence) were not significantly different between the two groups. CONCLUSIONS Single-balloon catheter is at least comparable to double-balloon catheter in terms of vaginal birth rate and maternal and perinatal safety outcomes.
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Affiliation(s)
- Morgan D. Peel
- Department of Obstetrics and GynecologyMonash UniversityClaytonVictoriaAustralia
| | - Doortje M. R. Croll
- Wilhelmina Children's Hospital Birth CenterUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Jørg Kessler
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | | | - Craig E. Pennell
- School of Medicine and Public HealthThe University of NewcastleNewcastleAustralia
| | - Jan E. Dickinson
- Division of Obstetrics and GynecologyThe University of Western AustraliaPerthAustralia
| | - Raed Salim
- Department of Obstetrics and GynecologyEmek Medical CenterAfulaIsrael
- Rappaport Faculty of Medicine, TechnionHaifaIsrael
| | - Noah Zafran
- Department of Obstetrics and GynecologyEmek Medical CenterAfulaIsrael
- Rappaport Faculty of Medicine, TechnionHaifaIsrael
| | - Kirsten R. Palmer
- Department of Obstetrics and GynecologyMonash UniversityClaytonVictoriaAustralia
| | - Ben W. Mol
- Department of Obstetrics and GynecologyMonash UniversityClaytonVictoriaAustralia
| | - Wentao Li
- Department of Obstetrics and GynecologyMonash UniversityClaytonVictoriaAustralia
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Abu Nofal M, Abd Elgani S, Zafran N, Garmi G, Romano S, Salim R. Neonatal condition at birth of twins conceived by medically assisted reproductive technology compared to those conceived spontaneously: A retrospective study. Int J Gynaecol Obstet 2023; 163:167-176. [PMID: 37067053 DOI: 10.1002/ijgo.14787] [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: 07/05/2022] [Revised: 03/10/2023] [Accepted: 03/28/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE To examine neonatal outcomes at birth among twins conceived spontaneously or by medically assisted reproduction (MAR). METHODS A retrospective study was conducted at a single university teaching hospital on data collected between January 1995 and September 2019. Live twin deliveries at more than 24 weeks of pregnancy were included. The study group consisted of women who conceived by MAR and the controls were spontaneously conceived twins. The study group was further divided into two groups: in vitro fertilization (IVF) and ovulation induction (OI) groups. The primary outcomes were umbilical artery pH less than 7.1 and/or Apgar score less than 7 of any twin 5 min after birth. RESULTS Overall, 2235 eligible twin gestations were included, corresponding to a total of 4470 live neonates; 1009 (45.1%) conceived by MAR (762 [75.5%] IVF and 247 [24.5%] OI) and 1226 (54.9%) conceived spontaneously. Incidence of the primary outcome was 5.3% and 5.1% in the study and control groups, respectively (P = 0.71). The primary outcome was comparable among the IVF (5%), OI (6.2%), and control (5.1%) groups. The results did not change even after adjusting for demographic and obstetric variables, including mode of delivery, which differed between the groups. CONCLUSION Neonatal condition of twin pregnancies at birth among MAR subgroups is similar to spontaneously conceived twins.
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Affiliation(s)
- Mais Abu Nofal
- Department of Obstetrics and Gynecology, Holy Family Hospital, Nazareth, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Suzan Abd Elgani
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Noah Zafran
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Holy Family Hospital, Nazareth, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Zuarez-Easton S, Erez O, Zafran N, Carmeli J, Garmi G, Salim R. Pharmacological and Non-Pharmacological Options for Pain Relief During Labor: an Expert Review. Am J Obstet Gynecol 2023; 228:S1246-S1259. [PMID: 37005099 DOI: 10.1016/j.ajog.2023.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/22/2023]
Abstract
Labor pain is among the most severe types of physical pain that women may experience during their lifetime. Thus, pain relief is an essential part of medical care during childbirth. Epidural analgesia is considered to be the most efficient method of pain relief during labor. Nevertheless, patient preferences, contraindications, limited availability, and technical failure may require the use of alternative pain reliving methods during labor including systemic pharmacologic agents, and nonpharmacologic methods. Nonpharmacologic methods for pain alleviation during vaginal birth have become popular over the years, either as a complement to pharmacologic agents or at times as the principal therapy. Methods such as relaxation techniques (ie, yoga, hypnosis, and music), manual techniques (ie, massage, reflexology, and shiatsu), acupuncture, birthing ball, and transcutaneous electrical nerve stimulation are considered safe, although the evidence supporting their effectiveness for pain relief is not as robust as it is for pharmacologic agents. Systemic pharmacologic agents are mostly administered by inhalation (nitrous oxide) or through the parenteral route. These agents include opioids such as meperidine, nalbuphine, tramadol, butorphanol, morphine, and remifentanil, and non-opioid agents such as parenteral acetaminophen and nonsteroidal anti-inflammatory drugs. Systemic pharmacologic agents suggest a diverse armamentarium of medication for pain management during labor. Their efficacy in treating pain associated with labor varies, and some continue to be used even though they have not been proven effective for pain relief. In addition, the maternal and perinatal side effects differ markedly among these agents. There is a relative abundance of data regarding the effectiveness of analgesic drugs compared with epidural, but the data regarding comparisons among the different types of alternative analgesic agents are scarce, and there is no consistency regarding the drug of choice for women who do not receive epidural pain management. This review aims to present the available data regarding the effectiveness of the different methods of relieving pain during labor other than epidural. The data presented are mainly based on recent level I evidence regarding pharmacologic and nonpharmacologic methods for pain relief during labor.
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Affiliation(s)
| | - Offer Erez
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI; Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | - Noah Zafran
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Julia Carmeli
- Department of Anesthesiology, Emek Medical Center, Afula, Israel
| | - Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Obstetrics and Gynecology, Holy Family Hospital, Nazareth, Israel.
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Massalha M, Iskander R, Remer C, Izhaki I, Salim R. Meta-analysis on the effect of internal-iliac artery balloon occlusion in placenta accreta spectrum and previa. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.906] [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: 01/09/2023]
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Garmi G, Seh-Shmali K, Zafran N, Erez O, Romano S, Salim R. Efficacy and safety of intrauterine device placement during a planned cesarean section. Heliyon 2022; 8:e12318. [PMID: 36582683 PMCID: PMC9793275 DOI: 10.1016/j.heliyon.2022.e12318] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/12/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Objective Approximately 79% of pregnancies conceived within the first year after delivery are unintended and 50% of the couples report having unprotected intercourse before the first routine postpartum appointment. Unintended pregnancies are associated with unsafe abortions and other poor outcomes. We aimed to determine the efficacy and safety of intrauterine device (IUD) placement during a planned cesarean section (CS) at one year after insertion. Study Design A survey-based retrospective cohort study conducted at a university teaching hospital. The study cohort included term pregnant women delivered by a planned CS between December 2016 and July 2020, and data collection and questionnaires were completed in July 2021. In the study group, copper or Levonorgestrel IUDs were placed through the uterine incision after delivery of the fetus and placenta, while women in the control group did not receive an IUD. Other perioperative managements were similar. The primary outcome was unintended pregnancy rate during the first year after delivery. Results The study comprised a total of 150 women, with 50 and 100 in the study and control groups, respectively. None of the women in the study group became pregnant, compared with nine (9%) in the controls (p = 0.03), of them eight (88.9%) were unplanned. Perioperative outcome was comparable between groups. The rate of contraceptive use one year after delivery was significantly higher in the study group compared to the control group (86.0% vs. 35.0%, respectively, p < 0.001). Conclusion IUD placement during CS is effective in preventing unintended pregnancies within the first year after delivery, with operative outcomes unaffected. Implications Intrauterine device (IUD) placement during a planned cesarean section prevented unintended pregnancies within one year after birth. Additionally, the rate of contraceptive use at one year was significantly higher compared to women who elected not to have an IUD inserted during the cesarean. IUD placement did not affect perioperative outcomes.
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Affiliation(s)
- Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel,The Ruth and Bruce Rappaport, Faculty of Medicine, Technion, Haifa, Israel
| | - Khadeje Seh-Shmali
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Noah Zafran
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel,The Ruth and Bruce Rappaport, Faculty of Medicine, Technion, Haifa, Israel
| | - Offer Erez
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel,Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel,The Ruth and Bruce Rappaport, Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel,The Ruth and Bruce Rappaport, Faculty of Medicine, Technion, Haifa, Israel,Corresponding author.
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Alaoui Mrani S, Salim R, Arrousse N, El Abiad C, Radi S, Saffaj T, Taleb M. Computational, SEM/EDX and experimental insights on the adsorption process of novel Schiff base molecules on mild steel/1 M HCl interface. J Mol Liq 2022. [DOI: 10.1016/j.molliq.2022.120648] [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: 11/07/2022]
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Garmi G, Parasol M, Zafran N, Rudin M, Romano S, Salim R. Efficacy of Single Wound Infiltration With Bupivacaine and Adrenaline During Cesarean Delivery for Reduction of Postoperative Pain: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2242203. [PMID: 36378307 PMCID: PMC9667325 DOI: 10.1001/jamanetworkopen.2022.42203] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Most women report moderate to severe pain after cesarean delivery. The extent of the ability of surgical wound infiltration with local anesthetic agents during cesarean delivery for the reduction of postoperative pain is uncertain. OBJECTIVE To examine the efficacy of single wound infiltration with bupivacaine and adrenaline during cesarean delivery for the reduction of postoperative pain. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted between January 25, 2018, and May 30, 2020, at a university teaching hospital in Afula, Israel. A total of 288 women with singleton pregnancy who were scheduled for a planned cesarean delivery at term were randomized to receive single wound infiltration with bupivacaine and adrenaline during cesarean delivery (intervention group) or no single wound infiltration (control group) at a 1:1 ratio. INTERVENTIONS In the intervention group, the subcutaneous layer was infiltrated on both sides of the wound by a mixture of bupivacaine and adrenaline before wound closure. Other perioperative techniques were similar between the groups. MAIN OUTCOMES AND MEASURES The primary outcome was mean pain intensity over the course of 24 hours after the operation, as measured by a visual analog scale (VAS) score ranging from 0 to 10 (with higher scores indicating greater pain intensity). To detect a mean (SD) reduction of 1 (3) points in the VAS score in the intervention group, 286 women were needed in total. Secondary outcomes included VAS score greater than 4 (indicating moderate pain) at 2 hours after the operation, use of rescue opioids, maternal satisfaction with the pain management procedure (using a scale of 1-5, with higher scores indicating greater satisfaction), duration of the operation, scar complications (hematoma, infection, and separation), and length of stay. RESULTS Among 288 women (mean [SD] age, 32.5 [5.1] years; all of Arab or Jewish ethnicity), 143 were randomized to the intervention group, and 145 were randomized to the control group. Demographic and obstetric variables were similar between groups. The primary outcome (VAS pain score) was significantly lower in the intervention group (mean [SD], 2.21 [0.56]) compared with the control group (mean [SD], 2.41 [0.73]; P = .02). In the intervention group, 11 women (7.7%) had a VAS score greater than 4 at 2 hours compared with 22 women (15.2%) in the control group (odds ratio, 0.47; 95% CI, 0.22-1.00; P = .05). In addition, compared with the control group, the intervention group had significantly lower postpartum use of rescue opioid analgesics (19 women [13.3%] vs 37 women [25.5%]; P = .009) and greater satisfaction with pain management (mean [SD] score, 4.65 [0.68] vs 4.44 [0.76]; P = .007). In the intervention vs control groups, duration of the operation, scar complications (hematoma, infection, or separation), and length of stay were comparable. CONCLUSIONS AND RELEVANCE In this study, wound infiltration with a single administration of bupivacaine and adrenaline during cesarean delivery reduced postoperative pain and opioid use and may have improved maternal satisfaction with pain management. These findings suggest the technique is efficacious, safe, and easy to perform. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03395912.
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Affiliation(s)
- Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine Technion Haifa, Haifa, Israel
| | - Mark Parasol
- Department of Anesthesia, Emek Medical Center, Afula, Israel
| | - Noah Zafran
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine Technion Haifa, Haifa, Israel
| | - Michael Rudin
- Department of Anesthesia, Emek Medical Center, Afula, Israel
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine Technion Haifa, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine Technion Haifa, Haifa, Israel
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11
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Zafran N, Massalha M, Suleiman A, Massalha R, Mahagna L, Weiner SA, Romano S, Shalev E, Salim R. Association between betamethasone levels and respiratory distress syndrome in preterm births: A prospective cohort study. Clin Transl Sci 2022; 15:2528-2537. [PMID: 35923139 PMCID: PMC9579395 DOI: 10.1111/cts.13382] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 01/25/2023] Open
Abstract
The recommended fixed dosage of betamethasone for pregnancies at risk of preterm birth was determined in the 1970s, regardless of gestational age (GA), number of fetuses, and maternal weight. We aimed to examine the association between maternal and neonatal betamethasone serum levels and neonatal respiratory distress syndrome (RDS) and to examine whether levels correlate with maternal weight, GA, or number of fetuses. A prospective study was conducted at a single academic medical center between August 2016 and February 2019. Women received betamethasone and delivered between 28+0 and 34+6 weeks were included. Maternal serum levels (MSLs), and neonatal serum levels (NSLs) of betamethasone at delivery were analyzed using Corticosteroid enzyme-linked immunosorbent assay kit. RDS was diagnosed according to clinical and radiographic findings. We assumed that the sensitivity of NSLs to detect RDS is 95%; hence, 150 neonates were needed (power 80%, alpha 0.05). Overall, 124 women were included; including 96 (77.4%) singletons, 26 (21.0%) twins, and 2 (1.6%) triplets, corresponding to 154 neonates. RDS was diagnosed in 35 neonates (22.7%). After adjusting for GA, time elapsed from the last dose, and number of doses, NSLs were associated with RDS (relative risk: 0.97, 95% confidence interval: 0.94-0.99, p = 0.011). A level of 6.00 ng/ml predicted RDS with a sensitivity of 80.0% and specificity of 64.7%. Adjusted MSLs were not associated with RDS. Both maternal and neonatal serum levels were not associated with the number of fetuses and maternal weight. In conclusion, NSLs are associated with RDS whereas MSLs are not.
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Affiliation(s)
- Noah Zafran
- Department of Obstetrics and GynecologyEmek Medical CenterAfulaIsrael,The Ruth and Bruce Rappaport Faculty of Medicine, TechnionHaifaIsrael
| | - Manal Massalha
- Department of Obstetrics and GynecologyEmek Medical CenterAfulaIsrael
| | - Abeer Suleiman
- Department of Obstetrics and GynecologyEmek Medical CenterAfulaIsrael
| | | | - Lila Mahagna
- Endocrinology LaboratoryEmek Medical CenterAfulaIsrael
| | | | - Shabtai Romano
- Department of Obstetrics and GynecologyEmek Medical CenterAfulaIsrael,The Ruth and Bruce Rappaport Faculty of Medicine, TechnionHaifaIsrael
| | - Eliezer Shalev
- Department of Obstetrics and GynecologyEmek Medical CenterAfulaIsrael,The Ruth and Bruce Rappaport Faculty of Medicine, TechnionHaifaIsrael
| | - Raed Salim
- Department of Obstetrics and GynecologyEmek Medical CenterAfulaIsrael,The Ruth and Bruce Rappaport Faculty of Medicine, TechnionHaifaIsrael
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12
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van Winden TMS, Nijman TAJ, Kleinrouweler CE, Salim R, Kashanian M, Al-Omari WR, Pajkrt E, Mol BW, Oudijk MA, Roos C. Tocolysis with nifedipine versus atosiban and perinatal outcome: an individual participant data meta-analysis. BMC Pregnancy Childbirth 2022; 22:567. [PMID: 35840927 PMCID: PMC9284745 DOI: 10.1186/s12884-022-04854-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Worldwide, nifedipine and atosiban are the two most commonly used tocolytic agents for the treatment of threatened preterm birth. The aim of this study was to evaluate the effectiveness of nifedipine and atosiban in an individual participant data meta-analysis (IPDMA). Methods We investigated the occurrence of adverse neonatal outcomes in women with threatened preterm birth by performing an IPDMA, and sought to identify possible subgroups in which one treatment may be preferred. We searched PubMed, Embase, and Cochrane for trials comparing nifedipine and atosiban for treatment of threatened preterm birth between 240/7 and 340/7 weeks’ gestational age. Primary outcome was a composite of perinatal mortality and neonatal morbidities including respiratory distress syndrome, intraventricular haemorrhage, periventricular leucomalacia, necrotising enterocolitis, and sepsis. Secondary outcomes included NICU admission, prolongation of pregnancy and GA at delivery. For studies that did not have the original databases available, metadata was used. This led to a two-stage meta-analysis that combined individual participant data with aggregate metadata. Results We detected four studies (N = 791 women), of which two provided individual participant data (N = 650 women). The composite neonatal outcome occurred in 58/364 (16%) after nifedipine versus 69/359 (19%) after atosiban (OR 0.76, 95%CI 0.47–1.23). Perinatal death occurred in 14/392 (3.6%) after nifedipine versus 7/380 (1.8%) after atosiban (OR 2.0, 95%CI 0.80–5.1). Nifedipine results in longer prolongation of pregnancy, with a 18 days to delivery compared with 10 days for atosiban (HR 0.83 (96% CI 0.69–0.99)). NICU admission occurred less often after nifedipine (46%) than after atosiban (59%), (OR 0.32, 95%CI 0.14–0.75). The sensitivity analysis revealed no difference in prolongation of pregnancy for 48 hours (OR 1.0, 95% CI 0.73–1.4) or 7 days (OR 1.3, 95% CI 0.85–5.8) between nifedipine and atosiban. There was a non-significant higher neonatal mortality in the nifedipine-exposed group (OR 1.4, 95% CI 0.60–3.4). Conclusions In this IPDMA, we found no differences in composite outcome between nifedipine and atosiban in the treatment of threatened preterm birth. However, the non-significant higher mortality after administering nifedipine warrants further investigation of the use of nifedipine as a tocolytic drug. Study registration We conducted this study according to a prospectively prepared protocol, registered with PROSPERO (the International Prospective Register of Systematic Reviews) under CRD42016024244. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04854-1.
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Affiliation(s)
- Tijn M S van Winden
- Department of Obstetrics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Tobias A J Nijman
- Department of Obstetrics and Gynecology, Medisch Centrum Haaglanden, The Hague, Netherlands
| | - C Emily Kleinrouweler
- Department of Obstetrics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Maryam Kashanian
- Department of Obstetrics & Gynecology, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Wafa R Al-Omari
- Department of Obstetrics and Gynecology, Medical City Teaching Hospital, Baghdad, Iraq
| | - Eva Pajkrt
- Department of Obstetrics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Martijn A Oudijk
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands. .,Department of Obstetrics, Amsterdam UMC, location Vrije Universiteit Amsterdam, Boelelaan, 1117, Amsterdam, The Netherlands. .,Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Location AMC, H4-275, PO Box 22660, Amsterdam, 1100, DD, the Netherlands.
| | - Carolien Roos
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.,Department of Obstetrics, Amsterdam UMC, location Vrije Universiteit Amsterdam, Boelelaan, 1117, Amsterdam, The Netherlands
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Salim R, Taherparvar P. Dosimetry assessment of theranostic Auger-emitting radionuclides in a micron-sized multicellular cluster model: A Monte Carlo study using Geant4-DNA simulations. Appl Radiat Isot 2022; 188:110380. [PMID: 35868198 DOI: 10.1016/j.apradiso.2022.110380] [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: 04/04/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 11/02/2022]
Abstract
The present work is aimed at improving the multicellular dosimetry of several Auger radionuclides of interest for targeted cancer therapy, including 99mTc, 111In, 123I, 125I, and 201Tl. For this purpose, using the Geant4-DNA Monte Carlo code, a cluster of 13 similar spherical cells with a hexagonal packed arrangement was modeled, and the mean absorbed doses per unit cumulated activity (S-values) were calculated by considering two target←source configurations, cell←cell and nucleus←nucleus. The obtained ratios of cross-dose to self-dose S-value in terms of the distance between the source and target regions were evaluated and also compared to those estimated by the Medical Internal Radiation Dose (MIRD) method. Besides, the contribution of the Coster-Kronig, Auger and internal conversion electrons to the S-values was provided for each radionuclide. According to the results, it can be concluded that in contrast to self-absorption, the cross-absorption due to the Auger-emitters has not a significant role in the total energy deposition within a cell in the cluster.
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Affiliation(s)
- R Salim
- Department of Physics, Faculty of Science, University of Guilan, Rasht, Iran
| | - P Taherparvar
- Department of Physics, Faculty of Science, University of Guilan, Rasht, Iran.
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Zafran N, Garmi G, Abdelgani S, Inbar S, Romano S, Salim R. Impact of "natural" cesarean delivery on peripartum blood loss: a randomized controlled trial. Am J Obstet Gynecol MFM 2022; 4:100642. [PMID: 35398585 DOI: 10.1016/j.ajogmf.2022.100642] [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: 02/09/2022] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early skin-to-skin contact after vaginal delivery increases milk production and may increase oxytocin release, leading to a reduction in the rate of postpartum hemorrhage. OBJECTIVE This study aimed to examine the effect of "natural" cesarean deliveries on perioperative maternal blood loss. STUDY DESIGN This was a randomized controlled trial conducted at a single university-affiliated medical center, between August 2016 and February 2018. Term singleton pregnancies scheduled for a planned cesarean delivery under spinal anesthesia were included. Women were randomized at a ratio of 1:1 to natural cesarean delivery (study group) or traditional cesarean delivery (control group) during the routine preoperative assessment. Women in the study group watched fetal extraction, had early skin-to-skin contact, and breastfed until the end of surgery. Neonates in the control group were presented to the mother for a few minutes. Blood samples were drawn from all women, during fascia closure, to determine oxytocin levels using an enzyme-linked immunosorbent assay kit. The laboratory component was performed after recruitment completion and was accomplished in February 2019. The primary outcome was postpartum hemoglobin levels. To detect a difference of 0.5 g/dL between the groups with α=0.05 and β=80%, 214 women were needed. RESULTS Of 214 randomized women, 23 were excluded. There was no difference in demographic and obstetrical variables between the groups. Postpartum hemoglobin levels were 10.1±1.1 and 10.3±1.3 g/dL in the study and control groups, respectively (P=.19). There was no difference in the rates of postpartum hemorrhage and blood transfusion. Maternal pain scores, satisfaction, and exclusive breastfeeding were comparable. Maternal oxytocin blood levels were 389.5±183.7 and 408.5±233.6 pg/mL in the study and control groups, respectively (P=.96). The incidence of neonatal hypothermia was comparable between the groups (P=.13). CONCLUSION Natural cesarean delivery did not affect perioperative hemoglobin level or maternal oxytocin blood concentration.
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Affiliation(s)
- Noah Zafran
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Drs Zafran, Garmi, and Abdelgani, Ms Inbar, and Drs Romano and Salim); The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Drs Zafran, Garmi, Romano, and Salim)
| | - Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Drs Zafran, Garmi, and Abdelgani, Ms Inbar, and Drs Romano and Salim); The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Drs Zafran, Garmi, Romano, and Salim)
| | - Suzan Abdelgani
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Drs Zafran, Garmi, and Abdelgani, Ms Inbar, and Drs Romano and Salim)
| | - Shiri Inbar
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Drs Zafran, Garmi, and Abdelgani, Ms Inbar, and Drs Romano and Salim)
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Drs Zafran, Garmi, and Abdelgani, Ms Inbar, and Drs Romano and Salim); The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Drs Zafran, Garmi, Romano, and Salim)
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Drs Zafran, Garmi, and Abdelgani, Ms Inbar, and Drs Romano and Salim); The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Drs Zafran, Garmi, Romano, and Salim)..
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Yeung A, Balfoussia D, Rattos A, Salim R. P-402 The association between embryo morphology and first trimester miscarriage after single blastocyst transfer. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.379] [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
Can standard morphological assessment of blastocyst quality accurately predict first trimester miscarriage?
Summary answer
Decreasing trophectoderm and inner cell mass grade equally predicted first trimester miscarriage independently. After adjusting for confounders, poor embryo quality was not associated with miscarriage.
What is known already
Embryo quality determined by morphological assessment is a well-established predictor of successful implantation and live birth with in vitro fertilization treatment. Chromosomal abnormalities account for over half of first trimester miscarriages, and links between ploidy status and embryo morphology have been demonstrated. However, the association between blastocyst morphology and first trimester miscarriage is still poorly understood with consensus opinion yet to be established.
Study design, size, duration
This single centre retrospective cohort study included 2020 fresh and frozen single embryo transfers between October 2010 and October 2020. Blastocyst degree of expansion, inner cell mass (ICM) grade, and trophectoderm (TE) grade were compared for 354 pregnancies ending in first trimester miscarriage and 1666 pregnancies that surpassed 12 weeks of gestation. The association between blastocyst morphology and miscarriage was examined by logistic regression analysis.
Participants/materials, setting, methods
All single blastocyst transfers over a 10-year period resulting in first trimester miscarriage or pregnancy beyond 12 weeks of gestation were included in our analysis. Cycles involving donor oocytes, preimplantation genetic testing, resulting in biochemical pregnancy, or ectopic pregnancy were excluded. Differences between groups were analysed with chi-square and logistic regression analysis. Odds ratios (aOR) for miscarriage versus ongoing pregnancy were adjusted for maternal age, cycle type, blastocyst expansion, ICM grade, and TE grade.
Main results and the role of chance
Out of 2020 single embryo transfer cycles, a total of 354 resulted in first trimester miscarriage (17.5%). Independently, miscarriage rates increased with decreasing ICM grade (A to C; 14.6%, 18.9%, and 26.5%, p = 0.003) and TE grade (A to C; 14.6%, 17.7%, and 26.6%, p = 0.004). Univariate logistic regression showed higher risks of miscarriage with ICM grade C compared to ICM grade A (OR 2.241, 95%CI 1.292-3.886, p = 0.004), TE grade C compared to TE grade A (OR 2.116, 95%CI 1.360 – 3.292, p = 0.001), and expansion grades of 1 and 2 compared to expansion of 5 and 6 (OR 2.514, 95%CI 1.477 – 4.278, p = 0.001). After multivariable logistic regression adjusting for maternal age at embryo transfer, cycle type, and all morphological parameters (degree of expansion, ICM, and TE), only expansion grade of 1 and 2 showed a statistically significant association with first trimester miscarriage.
Limitations, reasons for caution
The main limitation of this study is the retrospective design of the analysis, and subjective nature of embryo morphological assessment. There may also be residual confounding by unknown or unmeasured confounders such as paternal age or maternal BMI.
Wider implications of the findings
Embryo selection for transfer should continue to be guided by standard morphological assessment. Decreasing grade of ICM and TE are both positively associated with an increased miscarriage risk, while poorly expanded blastocysts are most predictive of first trimester miscarriage. Patients undergoing embryo transfer should be adequately counselled about these risks.
Trial registration number
Not applicable
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Affiliation(s)
- A Yeung
- Imperial College Healthcare NHS Trust, Reproductive Medicine , London, United Kingdom
| | - D Balfoussia
- Imperial College Healthcare NHS Trust, Reproductive Medicine , London, United Kingdom
| | - A Rattos
- Imperial College Healthcare NHS Trust, Reproductive Medicine , London, United Kingdom
| | - R Salim
- Imperial College Healthcare NHS Trust, Reproductive Medicine , London, United Kingdom
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Balfoussia D, Yeung A, Yamanouchi L, Rattos A, Salim R. P-282 Blastocyst transfer in advanced maternal age: Single versus double embryo transfer. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.271] [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: 11/14/2022] Open
Abstract
Abstract
Study question
Is there a role for elective single blastocyst transfer (eSBT) in advanced maternal age?
Summary answer
Double blastocyst transfer (DBT) versus eSBT resulted in higher live birth rates except for those undergoing their first cycle.
What is known already
Women with advanced maternal age are generally considered poorer prognosis patients with lower live birth rates compared to their younger counterparts. This often results in a higher likelihood of double embryo transfer in this group. This is not without risk as multiple pregnancy is associated with significant maternal and neonatal morbidity especially with advancing maternal age. In older women with blastocysts available for transfer, it is unclear who should be recommended double versus elective single transfer. The concept of the “good-prognosis” older woman remains elusive.
Study design, size, duration
This was a retrospective observational study looking at 511 IVF/ICSI cycles between January 2010 and January 2020. Treatment cycle details and clinical outcomes were entered prospectively into a dedicated clinic database. Data was retrieved and analysed using SPSS V25.
Participants/materials, setting, methods
The study was conducted in a large London IVF centre. Data was collected on women aged 40 or above undergoing an IVF/ICSI cycle with eSBT (Group 1, n = 79) or DBT (Group 2, n = 430). Women with more than three previous IVF attempts were excluded. eSBT was defined as a single blastocyst transfer with at least one further blastocyst available for cryopreservation. Subgroup analysis was performed for those undergoing their first cycle.
Main results and the role of chance
Data from 511 cycles was analysed. The mean age was 40.6±1.2years. The live birth rate was 27%. Group 1 was marginally younger (40.2±0.6 v 40.8±1.2, p < 0.005) and was more likely to be undergoing their first IVF cycle (84% v 68%, p = 0.003). Those in Group 1 had more eggs collected (13.6±7.3 v 11.3±5.5, p = 0.009), more zygotes (8.9±4.7 v 7.3±3.6) formed and more blastocysts frozen (3.4±2.6 v 1.1±1.7, p < 0005). More women in Group 1 had a top quality blastocyst (expansion of > 2 and inner cell mass and trophectoderm of AA, AB, BA or BB) transfer (91% v 71%, p < 0.005).
After logistic regression controlling for maternal age, number of previous IVF cycles and blastocyst quality, Group 1 had a lower likelihood of livebirth (aOR 0.550, 95%CI 0.306-0.988) but with a significantly lower multiple pregnancy rate (0% v 24%, p = 0.024).
Importantly, for those undergoing their first IVF cycle (n = 359), there was no difference in live birth rate in the two groups (aOR 0.617, 95%CI 0.329-1.156) after controlling for age and blastocyst quality but Group 2 had a higher multiple pregnancy rate (24% v 0%, p = 0.020).
Limitations, reasons for caution
This study is limited by its retrospective nature putting it at risk of information bias as it relied on accurate documentation of studied variables into the patient database. The study did not examine cumulative birth rates of fresh and subsequent frozen cycles in Group 1.
Wider implications of the findings
Women should have individualised counseling about number of blastocysts to transfer taking into account their circumstances. Those undergoing their first IVF attempt and with a blastocyst available for transfer, should be counselled that DBT is associated with a higher multiple pregnancy rate with no increase in overall live birth rate.
Trial registration number
Not Applicable
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Affiliation(s)
- D Balfoussia
- Imperial College Healthcare NHS Trust, Wolfson Fertility Centre- Hammersmith Hospital , London, United Kingdom
| | - A Yeung
- Imperial College Healthcare NHS Trust, Wolfson Fertility Centre- Hammersmith Hospital , London, United Kingdom
| | - L Yamanouchi
- Imperial College Healthcare NHS Trust, Hammersmith Hospital , London, United Kingdom
| | - A Rattos
- Imperial College Healthcare NHS Trust, Wolfson Fertility Centre- Hammersmith Hospital , London, United Kingdom
| | - R Salim
- Imperial College Healthcare NHS Trust, Wolfson Fertility Centre- Hammersmith Hospital , London, United Kingdom
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Fernine Y, Salim R, Arrousse N, Haldhar R, El Hajjaji F, Kim SC, Ebn Touhami M, Taleb M. Anti-corrosion performance of Ocimum basilicum seed extract as environmental friendly inhibitors for mild steel in HCl solution: Evaluations of electrochemical, EDX, DFT and Monte Carlo. J Mol Liq 2022. [DOI: 10.1016/j.molliq.2022.118867] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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18
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Salim R, Taherparvar P. A Monte Carlo study on the effects of a static uniform magnetic field on micro-scale dosimetry of Auger-emitters using Geant4-DNA. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Raischer HB, Massalha M, Iskandar R, Izhaki I, Salim R. Knotless barbed versus conventional suture for closure of the uterine incision at cesarean delivery: a systematic review and meta-analysis. J Minim Invasive Gynecol 2022; 29:832-839. [DOI: 10.1016/j.jmig.2022.05.001] [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] [Received: 02/13/2022] [Revised: 04/23/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
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Arrousse N, Salim R, Bousraf FZ, Ech-chihbi E, Hammouti B, Abdellaoui A, El Hajjaji F, M.Taleb. Experimental and theoretical study of xanthene derivatives as corrosion inhibitor for mild steel in hydrochloric acid solution. J APPL ELECTROCHEM 2022. [DOI: 10.1007/s10800-022-01705-x] [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: 10/18/2022]
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21
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Massalha M, Izhaki I, Iskander R, Salim R. Effect of nitrous oxide use on external cephalic version success rate; a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2022; 35:9702-9708. [PMID: 35282744 DOI: 10.1080/14767058.2022.2050898] [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] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Several adjuvant interventions have been evaluated for improving the success rate of the external cephalic version (ECV) and reducing the rate of cesarean delivery (CD). Evidence regarding the effect of Nitrous oxide is limited to a small number of participants with inconsistent results on pain score and success rate. This study aims to examine the effect of inhaled nitrous oxide on the success rate and pain score for women undergoing ECV. MATERIAL AND METHODS Survey on ECV reports from inception till June 2020 were made from MEDLINE, EMBASE, PubMed, Ovid Medline, ClinicalTrials.gov, the Cochrane Library and Google Scholars. Peer-review studies that examined the success rate of ECV from the application of nitrous oxide during ECV attempts compared with or without the use of other analgesic agents were obtained. The study population comprising women with singleton pregnancies having a non-vertex presentation at least 36 weeks, were categorized into one of two treatment groups: ECV attempt with nitrous oxide (nitrous oxide group) and ECV attempt with or without another analgesia (control group). The primary outcome was the ECV success rate, defined by conversion to vertex-presentation following the procedure. The secondary outcomes were pain scores during ECV attempt and CD rate. The study quality scores were evaluated as a source of heterogeneity by fitting meta-regression models to the individual study effect sizes. RESULTS Of the 26 records identified, two randomized trials and one prospective cohort study (720 women; 434 in the nitrous oxide group and 286 controls) were deemed adequate for meta-analysis. ECV success rate did not differ significantly between the nitrous oxide group and the control group (p = .825; OR 1.036; 95% CI, 0.756, 1.419). In addition, the use of nitrous oxide did not affect pain scores during ECV attempt (p = .457; OR 0.759; 95% CI, -1.240, 2.759) and there was no difference in the incidence of CD as well (p = .943; OR 1.013; 95% CI, 0.703, 1.46). CONCLUSION The use of nitrous oxide during ECV attempts was not associated with an increase in ECV success rate and does not affect pain scores. PROSPERO Registration No. CRD42020197933.
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Affiliation(s)
- Manal Massalha
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ido Izhaki
- Department of Evolutionary and Environmental Biology, University of Haifa, Israel
| | - Rula Iskander
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
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22
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Massalha M, Faranish R, Romano S, Salim R. Decreased inferior vena cava diameter as an early marker in postpartum hemorrhage. Ultrasound Obstet Gynecol 2022; 59:234-240. [PMID: 34076923 DOI: 10.1002/uog.23695] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/12/2021] [Accepted: 05/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To examine the association between inferior vena cava (IVC) diameter and postpartum blood loss and assess whether IVC diameter is a useful marker in the evaluation of intravascular volume status in women with postpartum hemorrhage (PPH). METHODS This was a prospective case-control study conducted in a university medical teaching center in Afula, Israel, between November 2018 and March 2020. The study cohort consisted of women with a singleton pregnancy who delivered vaginally at term. The PPH group included women diagnosed with PPH based on visually estimated blood loss of 1000 mL or more at the time of enrolment. Hemodynamically unstable women or women with major bleeding at the time of diagnosis were not included. The control group consisted of women with an uneventful fourth stage of labor. IVC diameter was measured using transabdominal ultrasonography during inspiration (IVCi diameter) and expiration (IVCe diameter), and the collapsibility index was calculated ((IVCe - IVCi)/IVCe × 100). The primary outcome was the percentage difference in IVC diameter and collapsibility index between the PPH group and controls. The performance of the IVC collapsibility index in the prediction of the need for blood transfusion in women with PPH was assessed. In order to demonstrate a difference of 20% with a power of 80% and alpha of 0.05, 108 women, at a ratio of 1:2 in the study and control groups, respectively, were needed. RESULTS Overall, 36 and 72 women were included in the final analysis in the PPH and control groups, respectively. IVCi and IVCe diameters were significantly smaller in the PPH group (0.93 ± 0.30 cm and 1.26 ± 0.32 cm, respectively) than in controls (1.42 ± 0.31 cm and 1.75 ± 0.28 cm, respectively) (P = 0.001 for both). The percentage reductions in IVCi and IVCe diameters in the PPH group compared with controls were 35.0% and 28.0%, respectively. IVC collapsibility index was increased significantly, by 42.9% (26.04 ± 8.67% vs 18.15 ± 5.07%; P = 0.001) in the PPH group compared with controls. IVC collapsibility index was a significant predictor of the need for blood transfusion and correctly predicted 81% of cases. Logistic regression analysis demonstrated that IVC collapsibility index was also a significant predictor of a drop in hemoglobin level of ≥ 2 g/dL (P = 0.001). CONCLUSIONS IVC diameter changes in response to postpartum blood loss. Measurement of IVC diameter using transabdominal ultrasonography is an objective and useful non-invasive method for the early evaluation of intravascular volume status in women with PPH and for the prediction of cases that might require blood transfusion. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Massalha
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Ultrasound Unit, Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - R Faranish
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - S Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Ultrasound Unit, Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - R Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Ultrasound Unit, Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
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Beniken M, Salim R, Ech–chihbi E, Sfaira M, Hammouti B, Ebn Touhami M, Mohsin M, Taleb M. Adsorption behavior and corrosion inhibition mechanism of a polyacrylamide on C–steel in 0.5 M H2SO4: Electrochemical assessments and molecular dynamic simulation. J Mol Liq 2022. [DOI: 10.1016/j.molliq.2021.118022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Garmi G, Prasol M, Zafran N, Roden M, Romano S, Salim R. A Randomized Trial of Incisional Infiltration With Bupivacain/Adrenalin During Cesarean Section in Reducing Postoperative Pain. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.077] [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: 11/01/2022]
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25
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Arrousse N, Fernine Y, Al-Zaqri N, Boshaala A, Ech-chihbi E, Salim R, El Hajjaji F, Alami A, Touhami ME, Taleb M. Thiophene derivatives as corrosion inhibitors for 2024-T3 aluminum alloy in hydrochloric acid medium. RSC Adv 2022; 12:10321-10335. [PMID: 35425019 PMCID: PMC8972391 DOI: 10.1039/d2ra00185c] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/17/2022] [Indexed: 11/24/2022] Open
Abstract
Thiophene derivatives, namely (E)-thiophene-2-carbaldehyde oxime (OXM) and (E)-5-(thiophen-2-yl)-1H-tetrazole (TET), were synthesized and characterized via1H and 13C NMR. Furthermore, their inhibitory property for AA2024-T3 in 1 M HCl solution was investigated via electrochemical impedance spectroscopy and potentiodynamic polarization at 293 K, together with DFT/B3LYP-based calculations. Numerous global and local descriptors of reactivity such as EHOMO, ELUMO, energy gap, electronegativity (χ), hardness (η), and frontier molecular orbital repartitions were investigated to describe the reactivity of each molecule. Alternatively, Monte Carlo simulations were performed under the solvation condition on the Al (111) surface to understand the adsorption behavior of the as-studied inhibitors deeply. The inhibition efficiency increased with an increase in the inhibitor concentration, achieving maximum values of 94.0% and 96% at 10−3 M, respectively. The polarization curves showed that the examined compounds act as mixed-type inhibitors. In addition, the adsorption of these compounds obeyed the Al Awady, Flory-Huggins and Temkin isotherms. The surface characterization analysis via SEM/EDX confirmed the presence of a barrier layer covering the aluminum surface. The experimental inhibition efficiencies were correlated with global descriptors, which confirmed that this theoretical study is useful for the protection of aluminum alloy metal in an acidic medium. Thiophene derivatives: thiophene-2-carbaldehyde oxime (OXM) and 5-(thiophen-2-yl)-1H-tetrazole (TET), were synthesized and characterized. Furthermore, their inhibitory property for AA2024-T3 in 1 M HCl solution was investigated via electrochemical and with theoretical study.![]()
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Affiliation(s)
- N. Arrousse
- Laboratory of Engineering, Organometallic, Molecular and Environment (LIMOME), Faculty of Science, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Y. Fernine
- Laboratory of Engineering, Organometallic, Molecular and Environment (LIMOME), Faculty of Science, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Nabil Al-Zaqri
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Ahmed Boshaala
- Research Centre, Manchester Salt & Catalysis, Unit C, 88- 90 Chorlton Rd, M15 4AN Manchester, UK
| | - E. Ech-chihbi
- Laboratory of Engineering, Organometallic, Molecular and Environment (LIMOME), Faculty of Science, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - R. Salim
- Laboratory of Engineering, Organometallic, Molecular and Environment (LIMOME), Faculty of Science, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - F. El Hajjaji
- Laboratory of Engineering, Organometallic, Molecular and Environment (LIMOME), Faculty of Science, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Anouar Alami
- Organic Chemistry Laboratory (LCO), Dhar Mahraz Faculty of Sciences, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - M. Ebn Touhami
- Laboratory Materials, Electrochemistry and Environment (LMEE), Faculty of Sciences, University Ibn Tofail, Kénitra, B.P. 133, Morocco
| | - M. Taleb
- Laboratory of Engineering, Organometallic, Molecular and Environment (LIMOME), Faculty of Science, University Sidi Mohamed Ben Abdellah, Fez, Morocco
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Arrousse N, Fernine Y, Al-Zaqri N, Boshaala A, Ech-chihbi E, Salim R, El Hajjaji F, Alami A, Touhami ME, Taleb M. Correction: Thiophene derivatives as corrosion inhibitors for 2024-T3 aluminum alloy in hydrochloric acid medium. RSC Adv 2022; 12:15240. [PMID: 35693239 PMCID: PMC9116172 DOI: 10.1039/d2ra90052a] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 12/03/2022] Open
Abstract
Correction for ‘Thiophene derivatives as corrosion inhibitors for 2024-T3 aluminum alloy in hydrochloric acid medium’ by N. Arrousse et al., RSC Adv., 2022, 12, 10321–10335, https://doi.org/10.1039/D2RA00185C.
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Affiliation(s)
- N. Arrousse
- Laboratory of Engineering, Organometallic, Molecular and Environment (LIMOME), Faculty of Science, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Y. Fernine
- Laboratory of Engineering, Organometallic, Molecular and Environment (LIMOME), Faculty of Science, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Nabil Al-Zaqri
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Ahmed Boshaala
- Research Centre, Manchester Salt & Catalysis, Unit C, 88- 90 Chorlton Rd, M15 4AN Manchester, UK
| | - E. Ech-chihbi
- Laboratory of Engineering, Organometallic, Molecular and Environment (LIMOME), Faculty of Science, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - R. Salim
- Laboratory of Engineering, Organometallic, Molecular and Environment (LIMOME), Faculty of Science, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - F. El Hajjaji
- Laboratory of Engineering, Organometallic, Molecular and Environment (LIMOME), Faculty of Science, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Anouar Alami
- Laboratory of Engineering, Organometallic, Molecular and Environment (LIMOME), Faculty of Science, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - M. Ebn Touhami
- Laboratory Materials, Electrochemistry and Environment (LMEE), Faculty of Sciences, University Ibn Tofail, Kénitra, B.P. 133, Morocco
| | - M. Taleb
- Laboratory of Engineering, Organometallic, Molecular and Environment (LIMOME), Faculty of Science, University Sidi Mohamed Ben Abdellah, Fez, Morocco
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Arrousse N, Salim R, Benhiba F, Mabrouk E, Abdelaoui A, El Hajjaji F, Warad I, Zarrouk A, Taleb M. Insight into the corrosion inhibition property of two new soluble and non-toxic xanthenbenzoate derivatives. J Mol Liq 2021. [DOI: 10.1016/j.molliq.2021.116610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Balfoussia D, Salim R, Rai R. P–635 Standard versus mild ovarian stimulation in women with polycystic ovaries (PCO): Impact on outcomes in subsequent frozen embryo treatment cycles (FET). Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.634] [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: 11/13/2022] Open
Abstract
Abstract
Study question
Does mild ovarian stimulation in women with PCO result in higher live birth rates during subsequent FET cycles?
Summary answer
Mild ovarian stimulation with FSH doses <150IU did not result in higher clinical pregnancy or livebirth rates in subsequent FET.
What is known already
Ovarian stimulation during IVF in women with PCO is associated with an exaggerated response, ovarian hyperstimulation syndrome, poor egg to follicle ratio, low fertilisation rates and poor blastocyst conversion. Mild ovarian stimulation, often referred to as protocols with FSH doses under 150IU, is often employed to overcome these challenges. One of the perceived benefits of this approach is improved oocyte and embryo quality reflected in lower aneuploidy rates.
Study design, size, duration
This was a retrospective observational study looking at 99 FET between January 2011 and Jan 2021 that followed a fresh cycle in women with a pre-treatment antral follicle count of 12 + 12 or greater. Patients were identified through the antral follicle count at the pre-treatment investigation ultrasound scan. Ultrasound findings, treatment cycle details and clinical outcomes were entered prospectively into a dedicated clinic database. Data was retrieved and analysed using SPSS V25.
Participants/materials, setting, methods
The study was conducted in a large IVF centre. Data on women with an AFC of 12 + 12 or above, undergoing an autologous FET cycle following a fresh cycle were collected. Women were split into those receiving <150IU of FSH (Group1, n = 51) and those receiving FSH ³150 IU (Group 2, n = 48). Binary logistic regression analysis was performed to control for confounders. Live birth was the primary outcome, with biochemical and clinical pregnancy being secondary outcomes.
Main results and the role of chance
Women in Group 1 were younger (30.8±3.6 v 33.8±3.65, p < 0.005) but had a similar antral follicle count (38.2±11.7 v 34.2±9.1, p = 0.07). The total number of eggs collected (24.1±13.8 v 25.9±8.8, p = 0.45) and fertilisation rate (0.59±0.2 v 0.58±0.18, p = 0.77) during their fresh cycle were comparable. Women in Group 2 had a larger number of embryos suitable for cryopreservation (7.36±4.2 v 4.8±3.5, p = 0.001)
In the subsequent frozen embryo replacement cycle, there was no difference in the number or quality of embryos transferred with most women having a single embryo transfer (63% v 48%, p = 0.14) and at least one top quality embryo transferred (68.6% v 81%, p = 0.15). There was a higher biochemical pregnancy rate in Group 1 (84% v 66%, p = 0.035) but with no difference in clinical pregnancy rate (53% v 44%, p = 0.37) or live birth rate (49% v 42%, p = 0.76). Live birth rates remained comparable even after controlling for age, and number and quality of embryos transferred (OR: 1.21 (95% CI 0.50–2.94).
Limitations, reasons for caution
This was a retrospective analysis raising the risk of allocation bias. This study was also at risk of information bias as it relied on accurate documentation of the AFC at the pre-treatment scan.
Wider implications of the findings: Patients can be reassured that both stimulation protocols result in similar live birth rates in subsequent frozen embryo replacement cycles.
Prospective trials using PGT-A are required to assess whether aneuploidy could account for the discrepancy in biochemical pregnancy rates in the two groups considering the subsequent comparable clinical pregnancy rates.
Trial registration number
Not applicable
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Affiliation(s)
- D Balfoussia
- Imperial College Healthcare NHS Trust, Obstetrics and Gynaecology- St Mary’s Hospital, London, United Kingdom
| | - R Salim
- Imperial College Healthcare NHS Trust, Wolfson Fertility Centre, London, United Kingdom
| | - R Rai
- Imperial College Healthcare NHS Trust, Wolfson Fertility Centre, London, United Kingdom
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Rom E, Yogev M, Sela N, Jehassi A, Romano S, Salim R. The association between ABO blood groups and gestational diabetes mellitus: a retrospective population-based cohort study. J Matern Fetal Neonatal Med 2021; 35:7065-7069. [PMID: 34167428 DOI: 10.1080/14767058.2021.1941852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE There is a lot of evidence that connects blood type to several diseases, including the development of diabetes mellitus type 2. The evidence for an association between ABO blood groups and the possibility of developing gestational diabetes mellitus (GDM) is scant and inconclusive. We aimed to examine the link between ABO blood group types and GDM by the use of a large population-based cohort of pregnant women. STUDY DESIGN A retrospective population-based cohort study was conducted using data collected from January 2013 to December 2017 from the Emek Medical Center, Afula, Israel. All pregnant women who underwent the two-step screening and diagnosed with GDM and delivered at >24 weeks were included. Women who had pre-gestational diabetes or whose pregnancies were terminated were excluded. The odds ratio (OR) were obtained through binary logistic regression analysis and the corresponding 95% confidence interval (CI) by the use of both the univariable and multivariable analysis. RESULTS Of all 16,067 women included in the study cohort, 1712 (10.7%) had GDM. The incidence of GDM was 11.0%, 10.8%, 10.6%, and 8.8% in blood group A, B, O, and AB, respectively. After adjusting for maternal age, parity, and number of fetuses, AB blood group was associated with reduced risk for developing GDM compared to the other blood groups (p = .038; adjusted OR: 0.79; 95% CI: 0.64-0.99). There was no difference in Rhesus factor between GDM and controls. CONCLUSIONS Women with AB blood group have a lower risk for developing GDM compared to other blood group types.
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Affiliation(s)
- Eyal Rom
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Merav Yogev
- Nursing Department, The Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - Nitzan Sela
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Ayellet Jehassi
- Department of Biostatistics, Emek Medical Center, Afula, Israel
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
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30
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Salim R, Nahlé A, El-Hajjaji F, Ech-chihbi E, Benhiba F, El Kalai F, Benchat N, Oudda H, Guenbour A, Taleb M, Warad I, Zarrouk A. Experimental, Density Functional Theory, and Dynamic Molecular Studies of Imidazopyridine Derivatives as Corrosion Inhibitors for Mild Steel in Hydrochloric Acid. Surf Engin Appl Electrochem 2021. [DOI: 10.3103/s1068375521020083] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE The aim of the study is to examine the incidence and risk factors for death among neonates who developed neonatal seizures (NS) in an ethnically distinctive community with high consanguinity rate in Israel. METHODS Retrospective study was conducted at a single institution on data between January 2001 and January 2016. All neonates diagnosed with NS developed up to age 28 days were included. Mortality was defined as death within the first year of life. RESULTS Of all 69,460 neonates born during the study period, 118 (1.7 per 1,000 live births) developed NS; 35 (29.7%) died within the first year while 83 (70.3%) survived. The leading causes of death were developmental brain malformation (31.4%), genetic/metabolic (20%), hypoxic ischemic encephalopathy (20%), intracranial hemorrhage (11.4%) and infections (11.4%). Any consanguinity between the parents was found in 18 and 14.6% among the survivors and deceased groups, respectively (p = 0.24). Developmental brain malformations that lead to death were present in 3.6 and 31.4% in the survivors and deceased groups, respectively (p = 0.001; relative risk 8.70; 95% confidence interval 2.58-29.27). Stepwise backward logistic regression analysis revealed that developmental brain malformations (p < 0.0001), use of more than one antiepileptic medication (p = 0.006), and multiorgan failure (p = 0.004) were significant risk factors that predicted death. CONCLUSION The results of the current study show that developmental brain malformations that cause NS were the leading risk factor for death.
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Affiliation(s)
- Osama Tanous
- Pediatric Department A', Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Mohamad Watad
- Pediatric Department A', Emek Medical Center, Afula, Israel
| | | | - Marina Peniakov
- Neonatal Intensive Care Unit, Emek Medical Center, Afula, Israel
| | - Dan Miron
- Pediatric Department A', Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
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32
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Nahlé A, Salim R, El Hajjaji F, Aouad MR, Messali M, Ech-chihbi E, Hammouti B, Taleb M. Novel triazole derivatives as ecological corrosion inhibitors for mild steel in 1.0 M HCl: experimental & theoretical approach. RSC Adv 2021; 11:4147-4162. [PMID: 35424362 PMCID: PMC8694344 DOI: 10.1039/d0ra09679b] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/28/2020] [Indexed: 11/21/2022] Open
Abstract
The present paper illustrates the investigation of two novel ecological triazole derivative corrosion inhibitors, namely ethyl 2-(4-phenyl-1H-1,2,3-triazol-1-yl) acetate [Tria-CO2Et], and 2-(4-phenyl-1H-1,2,3-triazol-1-yl) acetohydrazide [Tria-CONHNH2].
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Affiliation(s)
- A. Nahlé
- Department of Chemistry
- College of Sciences
- University of Sharjah
- Sharjah
- United Arab Emirates
| | - R. Salim
- Laboratory of Engineering, Electrochemistry, Modeling and Environment (LIEME)
- Faculty of Sciences
- University Sidi Mohamed Ben Abdellah
- Fez
- Morocco
| | - F. El Hajjaji
- Laboratory of Engineering, Electrochemistry, Modeling and Environment (LIEME)
- Faculty of Sciences
- University Sidi Mohamed Ben Abdellah
- Fez
- Morocco
| | - M. R. Aouad
- Department of Chemistry
- College of Science
- Taibah University
- Al-Madinah Al-Munawarah 30002
- Saudi Arabia
| | - M. Messali
- Department of Chemistry
- College of Science
- Taibah University
- Al-Madinah Al-Munawarah 30002
- Saudi Arabia
| | - E. Ech-chihbi
- Laboratory of Engineering, Electrochemistry, Modeling and Environment (LIEME)
- Faculty of Sciences
- University Sidi Mohamed Ben Abdellah
- Fez
- Morocco
| | - B. Hammouti
- Laboratory of Applied Chemistry and Environment (LCAE)
- Faculty of Sciences
- University Mohammed Premier Oujda
- Morocco
| | - M. Taleb
- Laboratory of Engineering, Electrochemistry, Modeling and Environment (LIEME)
- Faculty of Sciences
- University Sidi Mohamed Ben Abdellah
- Fez
- Morocco
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33
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Zuarez-Easton S, Berkovich I, Birenbaum-Carmeli D, Tal A, Zoabi R, Salim R. Effect of lactation on the recurrence rate of gestational diabetes mellitus: a retrospective cohort study. Arch Gynecol Obstet 2020; 301:973-979. [PMID: 32189064 DOI: 10.1007/s00404-020-05497-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 03/05/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the impact of lactation on the recurrence rate of gestational diabetes mellitus (GDM). METHODS Retrospective cohort study performed in a single teaching hospital on data between 2009 and 2016. The study group consisted of women who had a diagnosis of GDM and breastfed exclusively for ≥ 1 month. The control group consisted of women who had a diagnosis of GDM and did not breastfeed or added formula < 1 month postpartum. Data regarding breastfeeding duration, timing and amount of formula supplementation were obtained by a telephone questionnaire. We hypothesized that the recurrence of GDM would be lower in women who breastfed exclusively for ≥ 1 month. Therefore, to detect a decrease from 50 to 30% in the recurrence rate of GDM with alpha (one-sided) of 0.05 and 80% power, a sample size of 168 (84 per group) was needed. RESULTS Overall, 229 women were found eligible; 139 and 90 in the study and control groups, respectively. Except for parity, baseline demographic and obstetric variables were not different between the two groups. After adjusting for parity, the incidence of GDM in subsequent pregnancy was significantly lower among the study compared to the control group [48 (34.5%) and 41 (45.6%), respectively; one-tailed p = 0.043; RR 0.56; 95% CI 0.35-0.90)]. The cesarean delivery (CD) rate was significantly lower as well [28 (20.1%) and 31 (34.4%), respectively; two-tailed p = 0.02; RR 0.48, 95% CI 0.26-0.89)]. CONCLUSION Exclusive lactation for ≥ 1 month reduced the recurrence rate of GDM and possibly the risk of CD in the subsequent pregnancy.
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Affiliation(s)
- Sivan Zuarez-Easton
- Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Ilanit Berkovich
- Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel
| | | | - Alon Tal
- Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Raja Zoabi
- Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel.
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
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Garmi G, Pollig M, Inbar S, Fux S, Romano S, Salim R. Implementing military aviation debriefing methods to improve outcome of peripartum interventional procedures. Eur J Obstet Gynecol Reprod Biol 2020; 245:216-217. [PMID: 31892436 DOI: 10.1016/j.ejogrb.2019.12.031] [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] [Received: 12/07/2019] [Revised: 12/11/2019] [Accepted: 12/23/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michael Pollig
- Shamaym Social Business, Hospital & Health Care Division, Tel Aviv, Israel
| | - Shiri Inbar
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Shalva Fux
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Arrousse N, Mabrouk E, Salim R, Ismaily alaoui K, El Hajjaji F, Rais Z, Taleb M, Hammouti B. Fluorescein as commercial and environmentally friendly inhibitor against corrosion of mild steel in molar hydrochloric acid medium. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.matpr.2020.04.201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Garmi G, Seh K, Rubin H, rom E, Wattad M, Levi N, Romano S, Salim R. 879: Antimicrobial prophylaxis within 30 versus 30-60 minutes before cesarean delivery and surgical site infection rate. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.892] [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: 11/24/2022]
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Marsoul A, Ijjaali M, Elhajjaji F, Taleb M, Salim R, Boukir A. Phytochemical screening, total phenolic and flavonoid methanolic extract of pomegranate bark (Punica granatum L): Evaluation of the inhibitory effect in acidic medium 1 M HCl. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.matpr.2020.04.202] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Salim R, Hakim M, Zafran N, Nachum Z, Romano S, Garmi G. Double-blind randomized trial of progesterone to prevent preterm birth in second-trimester bleeding. Acta Obstet Gynecol Scand 2019; 98:1318-1325. [PMID: 31087325 DOI: 10.1111/aogs.13641] [Citation(s) in RCA: 1] [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: 09/05/2018] [Revised: 04/13/2019] [Accepted: 04/28/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Second-trimester vaginal bleeding increases the risk of spontaneous preterm birth. We aimed to examine the efficacy of vaginal progesterone to reduce preterm birth rate in women with second-trimester vaginal bleeding. MATERIAL AND METHODS Two-center, double-blind, placebo-controlled trial involving pregnant women with second-trimester vaginal bleeding. Women with documented uterine bleeding were randomly assigned in a 1:1 ratio to receive 200 mg of micronized vaginal progesterone or placebo once daily at 16-26 weeks until 36 weeks of gestation. Women who had prior preterm birth or short cervix diagnosed before recruitment were not eligible. The primary outcome was spontaneous delivery <37 weeks. CLINICAL TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01269450. RESULTS Between March 2011 and January 2017, 128 women gave consent and were randomized; 16 withdrew consent and 3 had a second-trimester termination of pregnancy. The final analysis included 109 women: 60 in the progesterone group and 49 in the placebo group. Demographic and obstetric characteristics did not differ between the groups. Primary outcome occurred in 19 (31.7%) and 12 (24.5%) in the progesterone and placebo groups, respectively (odds ratio [OR] 1.32; 95% confidence interval [CI] 0.55-3.16; P = 0.53). The proportion of births <34 weeks was similar between the groups (OR 1.19; 95% CI 0.47-3.02; P = 0.72), as were the survival curves from randomization to delivery (hazard ratio, 1.24; 95% CI, 0.60-2.56; P = 0.57). There were no significant differences in neonatal morbidities between the groups. The study was ended prematurely because of slow recruitment. CONCLUSIONS Antepartum vaginal progesterone does not seem to reduce the incidence of preterm birth in women with second-trimester bleeding.
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Affiliation(s)
- Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Marwan Hakim
- Nazareth Hospital EMMS, Nazareth, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - Noah Zafran
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Zohar Nachum
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Tal A, Zafran N, Peretz H, Garmi G, Romano S, Salim R. Trend in cesarean delivery rate among twin pregnancies over a 20 years epoch and the accompanied maternal and perinatal outcomes. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100023. [PMID: 31403115 PMCID: PMC6687378 DOI: 10.1016/j.eurox.2019.100023] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/30/2019] [Accepted: 04/16/2019] [Indexed: 01/15/2023] Open
Abstract
Objective To examine the trend of cesarean delivery (CD) rate among twin pregnancies and the trend in maternal and neonatal morbidities within two decades. Study design Population-based cohort study, conducted at a single teaching hospital in Israel on data between January 1995 and December 2015. All pregnant women with twin gestation who delivered at a gestational age of 24 weeks or more were included. Data on mode of deliveries, Apgar score <7 at 5 min, cord artery pH < 7.1, early postpartum hemorrhage, blood transfusion, and intrapartum fever for each year were extracted and plotted, and trends were analyzed. CDs performed for one or both twins were divided to laboring, i.e., after a trial of labor, and non-laboring CDs. Data was obtained from the hospital discharge register with ICD-9 codes and crosschecked with the labor medical records. The Cochran-Armitage Trend Test was used to identify trends and correlations. Results Of all 88,145 deliveries that took place during this period, 1955 (2.2%) were twins. Of these 53 were ineligible and were excluded. There was a statistically significant trend (increase) in twins birth over time (p = 0.004). CD rate increased significantly from 43.4% in 1995 to 66.0% in 2015 (p = 0.001). This increase was observed only among non-laboring cesareans (p = 0.001). Multivariate logistic regression analysis revealed that maternal and early neonatal morbidities examined did not differ significantly during the study period. Conclusion Non-laboring CD rate increased significantly over the past two decades among twin pregnancies. Despite this increase, maternal and early neonatal morbidities did not change.
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Affiliation(s)
- Alon Tal
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Noah Zafran
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Hadar Peretz
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Peretz H, Tal A, Garmi G, Zafran N, Romano S, Salim R. Impact of epidural on labor duration and vacuum deliveries in twin gestations. Midwifery 2019; 74:134-139. [PMID: 30953969 DOI: 10.1016/j.midw.2019.03.025] [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: 08/13/2018] [Revised: 02/08/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Epidural analgesia may lead to a prolonged second stage, and increased instrumental vaginal deliveries rate in singleton gestations. We aimed to examine the association between epidural and vacuum deliveries rate and second stage duration among twin deliveries. METHODS Retrospective study conducted at a single teaching hospital on data between January 1995 and December 2015. All twin pregnancies, >24 weeks that had a trial of labor were included. Twins with major malformations, intrauterine death, or had a caesarean delivery without a trial of labor, were excluded. Women were divided to those who had an epidural analgesia (group 1) and those who did not (group 2). Primary outcome was vacuum delivery rate. RESULTS Of all 1955 twin pregnancies delivered during the study period, 827 (42.3%) were eligible and included; 332 (40.1%) in group 1 and 495 (59.9%) in group 2. Vacuum delivery rate of any twin was 7.5% and 6.3% in groups 1 and 2, respectively (p = 0.48; Relative Risk 1.20; 95% Confidence Interval: 0.72-2.0). Vacuum delivery rate of first twin only or second twin only did not differ significantly as well. After adjusting for variables that differed significantly between the groups in univariate analysis, second stage duration of first and second twins in group 1 was significantly longer than in group 2 (p = 0.001; ratio=1.66; 95% Confidence Interval: 1.42-1.94 and p = 0.001; ratio=1.40; 95% Confidence Interval: 1.24-1.58, respectively). CONCLUSIONS Epidural use in twin deliveries did not affect vacuum deliveries rate. Epidural was associated with a prolonged second stage of both twins.
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Affiliation(s)
- Hadar Peretz
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Alon Tal
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Noah Zafran
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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El-Hajjaji F, Merimi I, Messali M, Obaid R, Salim R, Taleb M, Hammouti B. Experimental and quantum studies of newly synthesized pyridazinium derivatives on mild steel in hydrochloric acid medium. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.matpr.2019.04.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Zafran N, Elgani SA, Garmi G, Zuarez-Easton S, Carmeli J, Inbar S, Romano S, Salim R. 978: The impact of "Natural” cesarean delivery on peripartum maternal blood loss. A randomized controlled trial. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.1002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Garmi G, Zafran N, Okopnik M, Gavish I, Romano S, Salim R. Placental Pathological Findings following Adjusting Enoxaparin Dosage in Thrombophilic Women: Secondary Analysis of a Randomized Controlled Trial. Thromb Haemost 2018; 119:87-91. [PMID: 30597503 DOI: 10.1055/s-0038-1676521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Randomized trials showed no improvement in pregnancy outcomes with the use of low molecular weight heparin (LMWH) to prevent placenta-mediated pregnancy complications (PMPCs) among thrombophilic women. However, the effect of treatment on placental findings was not examined. We aimed to examine the occurrence of placental vascular lesions in thrombophilic women treated with LMWH dose adjusted according to anti-factor Xa compared with a fixed dose. STUDY DESIGN This study was a secondary analysis of a randomized trial designed to examine whether LMWH dose adjusted according to anti-factor Xa levels compared with a fixed dose would reduce the risk of PMPC. Eligible women were randomly allocated in a 1:1 ratio to either a fixed dose of 40 mg daily LMWH (fixed dose group) or adjusted dose according to anti-factor Xa levels (adjusted dose group). Placentas were examined by the same perinatal pathologist who was blinded to group allocation. The primary outcome for this analysis was the incidence of maternal placental vascular lesions. RESULTS During the study period, 88 placentas were examined; 41 and 47 from the fixed and adjusted dose groups, respectively. Demographics, obstetrics and types of thrombophilias were similar between the groups. Maternal placental vascular lesions were observed in 23 (56.1%) and 21 (44.68%) placentas (p = 0.28) and foetal placental vascular lesions in 2 (4.88%) and 1 (2.13%) placentas (p = 0.59) in the fixed and adjusted groups, respectively. CONCLUSION Adjusted dose of enoxaparin according to anti-factor Xa levels compared with a fixed dose did not affect placental vascular lesions in thrombophilic women.
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Affiliation(s)
- Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Noah Zafran
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Marina Okopnik
- Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Department of Pathology, Emek Medical Center, Afula, Israel
| | - Israel Gavish
- Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Hematology Unit, Emek Medical Center, Afula, Israel
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Ali AH, Salahuddin Z, Salim R. Sudden sensorineural hearing loss: A missed opportunity for treatment. Malays Fam Physician 2018; 13:29-30. [PMID: 30800231 PMCID: PMC6382091] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sudden sensorineural hearing loss (SSNHL) is an otology emergency and carries significant morbidity if the diagnosis is missed. It can present to any specialty but in our local setting the patient usually presents to primary care as it is easily accessible. We present a case of SSNHL that was initially presented to a primary care centre and the patient was reassured without any investigation being carried out. SSNHL has many causes thus making diagnosis difficult. However, with knowledge of its possible, a diagnosis can be made and appropriate management can be advocated to the patient. Hence, we discuss the three main causes of SSNHL, while emphasizing the immune system-mediated mechanism as the main cause in this case.
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Affiliation(s)
- A H Ali
- (MBBCh BAO) Department of Otorhinolaryngology-Head & Neck Surgery School of Medical Sciences Universiti Sains Malaysia 16150 Kota Bharu, Kelantan Malaysia
| | - Z Salahuddin
- (MD, MS ORL HNS) Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Raja Perempuan Zainab II Kelantan, Malaysia
| | - R Salim
- (MD, MMED ORL-HNS) Department of Otorhinolaryngology-Head & Neck Surgery Universiti Sains Malaysia Kelantan, Malaysia
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Noh KB, Salim R, Abdullah MS, Mohamad I. Metallic hair pin aspiration into the left tertiary bronchus. Malays Fam Physician 2018; 13:36-38. [PMID: 30302183 PMCID: PMC6173961] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Foreign body aspiration is commonly described in infants and children. However, recently, a new high-risk group was identified among young women, especially those from the Muslim population who wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between the lips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing the scarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present a case of scarf pin inhalation and the challenges encountered in managing this patient during the successful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particular case was technically challenging for us as the sharp tip of the needle was pointing upward and piercing the bronchial mucosa.
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Affiliation(s)
- K B Noh
- Department of Otorhinolaryngology - Head & Neck Surgery School of Medical Sciences Universiti Sains Malaysia Health Campus, 16150 Kota Bharu Kelantan, Malaysia.
| | - R Salim
- Department of Otorhinolaryngology-Head & Neck Surgery School of Medical Sciences Universiti Sains Malaysia Health Campus, 16150 Kota Bharu Kelantan, Malaysia
| | - M S Abdullah
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kota Bharu, Kelantan Malaysia
| | - I Mohamad
- School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kota Bharu Kelantan, Malaysia
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Riegel M, Quist-Nelson J, Saccone G, Locci M, Shrivastava VK, Salim R, Fisher A, Nordstrom L, Kunselman AR, Repke J, Fong A, Smulian J, Xodo S, Mokhtari N, Zullo F, Berghella V. Dextrose intravenous fluid therapy in labor reduces the length of the first stage of labor. Eur J Obstet Gynecol Reprod Biol 2018; 228:284-294. [PMID: 30055509 DOI: 10.1016/j.ejogrb.2018.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 06/26/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
The aim of this systematic review with meta-analysis was to evaluate the effect on length of labor when patients receive IVF with or without dextrose. Searches were performed in electronic databases from inception of each database to May 2018. Trials comparing intrapartum IVF containing dextrose (i.e. intervention group) with no dextrose or placebo (i.e. control group) were included. Only trials examining low-risk pregnancies in labor at ≥36 weeks were included. Studies were included regardless of oral intake restriction. The primary outcome was the length of total labor from randomization to delivery. The meta-analysis was performed using the random effects model. Sixteen trials (n = 2503 participants) were included in the meta-analysis. Women randomized in the IVF dextrose group did not have a statistically significant different length of total labor from randomization to delivery compared to IVF without dextrose (MD -38.33 min, 95% CI -88.23 to 11.57). IVF with dextrose decreased the length of the first stage (MD -75.81 min, 95% CI -120.67 to -30.95), but there was no change in the second stage. In summary, use of IVF with dextrose during labor in low-risk women at term does not affect total length of labor, but it does shorten the first stage of labor.
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Affiliation(s)
- Melissa Riegel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States
| | - Johanna Quist-Nelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Mariavittoria Locci
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vineet K Shrivastava
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, CA, United States
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Allan Fisher
- Department of Gynecology and Obstetrics, Saint Louis University School of Medicine, United States
| | - Lennart Nordstrom
- Department of Obstetrics and Gynecology, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Allen R Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - John Repke
- Penn State University College of Medicine-Milton S. Hershey Medical Center, United States
| | - Alex Fong
- Kaiser Permanente Southern California Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Irvine, CA, United States
| | - John Smulian
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Serena Xodo
- Department of Gynaecology and Obstetrics, School of Medicine, University of Udine, Udine, Italy
| | - Neggin Mokhtari
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States.
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Abbara A, Islam R, Clarke S, Jeffers L, Christopoulos G, Comninos A, Salim R, Lavery S, Vuong T, Humaidan P, Kelsey T, Trew G, Dhillo W. Clinical parameters of ovarian hyperstimulation syndrome following different hormonal triggers of oocyte maturation in IVF treatment. Clin Endocrinol (Oxf) 2018; 88:920-927. [PMID: 29446481 PMCID: PMC6001461 DOI: 10.1111/cen.13569] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 01/24/2018] [Accepted: 02/11/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Ovarian hyperstimulation syndrome (OHSS) is a serious iatrogenic condition, predominantly related to the hormone used to induce oocyte maturation during IVF treatment. Kisspeptin is a hypothalamic neuropeptide that has recently been demonstrated to safely trigger final oocyte maturation during IVF treatment even in women at high risk of OHSS. However, to date, the safety of kisspeptin has not been compared to current hormonal triggers of oocyte maturation. DESIGN We conducted a retrospective single-centre cohort study investigating symptoms and clinical parameters of early OHSS in women at high risk of OHSS (antral follicle count or total number of follicles on day of trigger ≥23) triggered with human chorionic gonadotrophin (hCG) (n = 40), GnRH agonist (GnRHa; n = 99) or kisspeptin (n = 122) at Hammersmith Hospital IVF unit, London, UK (2013-2016). RESULTS Clinical Parameters of OHSS: Median ovarian volume was larger following hCG (138 ml) than GnRHa (73 ml; P < .0001), and in turn kisspeptin (44 ml; P < .0001). Median ovarian volume remained enlarged 20-fold following hCG, 8-fold following GnRHa and 5-fold following kisspeptin compared to prestimulation ovarian volumes. Mean (±SD) ascitic volumes were lesser following GnRHa (9 ± 44 ml) and kisspeptin (5 ± 8 ml) than hCG (62 ± 84 ml; P < .0001). Symptoms of OHSS were most frequent following hCG and least frequent following kisspeptin. Diagnosis of OHSS: The odds ratio for OHSS diagnosis was 33.6 (CI 12.6-89.5) following hCG and 3.6 (CI 1.8-7.1) following GnRHa, when compared to kisspeptin. CONCLUSION Triggering oocyte maturation by inducing endogenous gonadotrophin release is preferable to the use of exogenous hCG in women at high risk of OHSS.
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Affiliation(s)
- A. Abbara
- Hammersmith HospitalImperial College LondonLondonUK
| | - R. Islam
- IVF UnitHammersmith HospitalLondonUK
| | - S.A. Clarke
- Hammersmith HospitalImperial College LondonLondonUK
| | - L. Jeffers
- Hammersmith HospitalImperial College LondonLondonUK
| | | | | | - R. Salim
- IVF UnitHammersmith HospitalLondonUK
| | | | - T.N.L. Vuong
- University of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
- My Duc HospitalIVFMDHo Chi Minh CityVietnam
| | - P. Humaidan
- The Fertility ClinicSkive Regional Hospital and Faculty of Health Aarhus UniversityAarhusDenmark
| | - T.W. Kelsey
- School of Computer ScienceUniversity of St AndrewsSt AndrewsUK
| | - G.H. Trew
- IVF UnitHammersmith HospitalLondonUK
| | - W.S. Dhillo
- Hammersmith HospitalImperial College LondonLondonUK
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Vong KS, Mohamad I, Salim R. A food bolus obstructing the oesophagus in a patient with infantile cerebral palsy. Malays Fam Physician 2018; 13:34-36. [PMID: 29796208 PMCID: PMC5962232] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION A foreign body (FB) in the upper aerodigestive tract is a fairly common encounter. Fish bones are the commonest FB seen in adults. The commonest presentation is odynophagia. Usually, the patient will point at the level of FB on the neck to indicate the location. METHODS Clinical report. RESULTS This case report describes a large FB in an adult with underlying infantile cerebral palsy. Besides dysphagia, it was associated with drooling of saliva and pain in the throat region. CONCLUSION FB ingestion with complete obstruction of the oesophagus is an emergency. It may cause total dysphagia as the passage of food is completely blocked.
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Affiliation(s)
- K S Vong
- MD, Department of Otorhinolaryngology-Head & Neck Surgery, Universiti Sains Malaysia Health Campus Kota Bharu, Kelantan, Malaysia. Irfan Mohamad
| | - I Mohamad
- MD, M.Med (ORL-HNS), Department of Otorhinolaryngology-Head & Neck Surgery, Universiti Sains Malaysia Health Campus Kota Bharu, Kelantan, Malaysia
| | - R Salim
- MD, M.Med (ORL-HNS), Department of Otorhinolaryngology-Head & Neck Surgery, Universiti Sains Malaysia Health Campus Kota Bharu, Kelantan, Malaysia
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Tal A, Peretz H, Garmi G, Zafran N, Romano S, Salim R. Effect of inter-twin delivery interval on umbilical artery pH and Apgar score in the second twin. Birth 2018; 45:37-42. [PMID: 29094369 DOI: 10.1111/birt.12317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/15/2017] [Accepted: 09/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND To examine the effect of inter-twin delivery interval on umbilical artery pH and Apgar score of the second twin after vaginal delivery of the first twin. METHODS Retrospective study conducted at a single teaching hospital. All pregnant women with twin gestation who delivered the first twin vaginally at more than 24 weeks between 1995 and 2015 were included. Major malformations and intrauterine deaths of one or both twins were excluded. Women were divided into those who had an inter-twin delivery interval of less than 30 minutes (group 1) or 30 minutes or more (group 2). Primary outcome was umbilical artery pH less than 7.1 and/or Apgar score less than 7 at 5 minutes of the second twin. Generalized linear regression with log was performed to evaluate the association with delivery interval. RESULTS Of 88 145 deliveries during this period, 1955 (2.2%) were twins. Overall, 713 twin pregnancies, 596 (83.6%) in group 1 and 117 (16.4%) in group 2, were eligible and included. Mean inter-delivery interval was 11.0 ± 6.5 and 52.5 ± 31.5 minutes in groups 1 and 2, respectively. After adjusting for variables found significantly different between the groups in univariate analysis, inter-delivery interval of less than 30 minutes or 30 minutes or more was not a significant risk factor for pH less than 7.1 and/or Apgar less than 7 (P = .91). The cesarean rate for delivery of the second twin after vaginal delivery of the first twin was 4.3% overall, with a higher rate among group 2 compared with group 1 (18.2% and 3.2%, respectively; P = .001). CONCLUSIONS The second twin's Apgar score and cord artery pH are probably not affected when the inter-twin delivery interval exceeds 30 minutes.
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Affiliation(s)
- Alon Tal
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Hadar Peretz
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Noah Zafran
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Salim R, Schwartz N, Zafran N, Zuarez-Easton S, Garmi G, Romano S. Comparison of single- and double-balloon catheters for labor induction: a systematic review and meta-analysis of randomized controlled trials. J Perinatol 2018; 38:217-225. [PMID: 29203813 DOI: 10.1038/s41372-017-0005-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Received: 05/05/2017] [Accepted: 10/09/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE There is a paucity of head-to-head randomized trials that compare single- and double-balloon catheters, and the results of the available data in terms of time from catheter insertion to delivery and delivery mode are mixed. This meta-analysis of randomized controlled trials compares the efficacy of single- and double-balloon catheters in women undergoing labor induction. STUDY DESIGN Searches were made in MEDLINE, EMBASE, PubMed, ClinicalTrials.gov, and the Cochrane Library from inception through June 2016. Peer-reviewed randomized and quasi-randomized trials that compared single- and double-balloon catheters head-to-head for cervical ripening or labor induction were identified. Eligible study populations consisted of women with singleton pregnancies that had any indication for labor induction and were randomly assigned to undergo induction with a single- or a double-balloon catheter. The primary outcome was time from catheter insertion to delivery and delivery mode. The secondary outcomes were intrapartum fever or chorioamnionitis, woman's satisfaction, and neonatal Apgar score. RESULTS Of the 520 records identified, five randomized trials (996 women; 491 with single-balloon and 505 with double-balloon catheters) were considered eligible and included in the meta-analysis. Time from catheter insertion to delivery did not differ between the two types of catheter (p = 0.527; WMD -0.87; 95% CI: -3.55, 1.82). The incidence of cesarean delivery also did not differ (p = 0.844; RR 0.97; 95% CI: 0.69, 1.35). Delivery within 24 h, delivery mode, incidences of intrapartum fever or chorioamnionitis, and neonatal Apgar score <7 at 5 min did not differ between the two types of catheter as well. Women who were induced with the single-balloon catheter were more satisfied (p = 0.029; WMD 0.56; 95% CI: 0.06, 1.06). CONCLUSION Time from catheter insertion to delivery and delivery mode were comparable between the two types of catheter.
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Affiliation(s)
- Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel. .,Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Naama Schwartz
- Clinical Research Unit, Emek Medical Center, Afula, Israel
| | - Noah Zafran
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
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