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Abstract Microorganisms, organic matter, heavy metals are the main pollutants in sewage water. The increasing water demand pressurized people to use the sewage water. Different systems, chemicals and physical treatments were used in sewage water treatment. The aim of this work is to study the effect and correlations of primary (Ca(OH)2 filtration and H2O2) and secondary (dissolved oxygen, organic matter, conductivity, pH and OD) factors on fungi present in sewage water in addition to proving the sequence of the system used in the current study. After treatment, fungi were examined, identified on Czapek agar and analyzed using multivariate tools (CANOCO: DCA and CCA) and R software. The treatment includes two main steps: liming filtration and oxidation, respectively. All parameters were negatively or positively correlated (organic matter, pH, conductivity %, optical density, fungal CFU ml-1, dissolved oxygen). Heavy metals were decreased due to the application of Ca(OH)2 and H2O2, respectively. There were two main groups of fungi. The larger was correlated with the organic matter, whereas the second was tolerating calcium hydroxide concentrations. Aspergillus sydowii tolerated hydrogen peroxide (0.2 mll-1(33%); Ca(OH)2, 0.25 gl-1). Sequential steps treatment was healthy and economically efficient. The proposed system improved water characteristics. The recommended amount of Ca(OH)2 and H2O2 was 0.25 gl-1 and 0.2 mll-1(33%), respectively, and can remove more than 99.9% of fungal CFUs. The current study minimized the optimum dose of hydrogen peroxide used in the disinfection of sewage water from 1.5 (Mohamed in Chem Eng J 119:161–165, 2006) to 0.2 mll-1 of H2O2 (the current study).

Abstract Microorganisms, organic matter, heavy metals are the main pollutants in sewage water. The increasing water demand pressurized people to use the sewage water. Different systems, chemicals and physical treatments were used in sewage water treatment. The aim of this work is to study the effect and correlations of primary (Ca(OH)2 filtration and H2O2) and secondary (dissolved oxygen, organic matter, conductivity, pH and OD) factors on fungi present in sewage water in addition to proving the sequence of the system used in the current study. After treatment, fungi were examined, identified on Czapek agar and analyzed using multivariate tools (CANOCO: DCA and CCA) and R software. The treatment includes two main steps: liming filtration and oxidation, respectively. All parameters were negatively or positively correlated (organic matter, pH, conductivity %, optical density, fungal CFU ml-1, dissolved oxygen). Heavy metals were decreased due to the application of Ca(OH)2 and H2O2, respectively. There were two main groups of fungi. The larger was correlated with the organic matter, whereas the second was tolerating calcium hydroxide concentrations. Aspergillus sydowii tolerated hydrogen peroxide (0.2 mll-1(33%); Ca(OH)2, 0.25 gl-1). Sequential steps treatment was healthy and economically efficient. The proposed system improved water characteristics. The recommended amount of Ca(OH)2 and H2O2 was 0.25 gl-1 and 0.2 mll-1(33%), respectively, and can remove more than 99.9% of fungal CFUs. The current study minimized the optimum dose of hydrogen peroxide used in the disinfection of sewage water from 1.5 (Mohamed in Chem Eng J 119:161–165, 2006) to 0.2 mll-1 of H2O2 (the current study).

Abstract Microorganisms, organic matter, heavy metals are the main pollutants in sewage water. The increasing water demand pressurized people to use the sewage water. Different systems, chemicals and physical treatments were used in sewage water treatment. The aim of this work is to study the effect and correlations of primary (Ca(OH)2 filtration and H2O2) and secondary (dissolved oxygen, organic matter, conductivity, pH and OD) factors on fungi present in sewage water in addition to proving the sequence of the system used in the current study. After treatment, fungi were examined, identified on Czapek agar and analyzed using multivariate tools (CANOCO: DCA and CCA) and R software. The treatment includes two main steps: liming filtration and oxidation, respectively. All parameters were negatively or positively correlated (organic matter, pH, conductivity %, optical density, fungal CFU ml-1, dissolved oxygen). Heavy metals were decreased due to the application of Ca(OH)2 and H2O2, respectively. There were two main groups of fungi. The larger was correlated with the organic matter, whereas the second was tolerating calcium hydroxide concentrations. Aspergillus sydowii tolerated hydrogen peroxide (0.2 mll-1(33%); Ca(OH)2, 0.25 gl-1). Sequential steps treatment was healthy and economically efficient. The proposed system improved water characteristics. The recommended amount of Ca(OH)2 and H2O2 was 0.25 gl-1 and 0.2 mll-1(33%), respectively, and can remove more than 99.9% of fungal CFUs. The current study minimized the optimum dose of hydrogen peroxide used in the disinfection of sewage water from 1.5 (Mohamed in Chem Eng J 119:161–165, 2006) to 0.2 mll-1 of H2O2 (the current study).

Introduction: Erectile dysfunction is a common condition among diabetic men. Many treatments are now available with variable responses. Aim: This study aimed to evaluate the effect of daily oral L-arginine plus tadalafil in diabetic patients with mild to moderate erectile dysfunction. Methods: A double-blinded, randomized, controlled clinical trial was conducted with 108 diabetic male patients. Each patient was assessed by medical and sexual histories, International Index of Erectile Function 5-item questionnaires, pharmaco-penile duplex ultrasonography, and serum testosterone level. Main Outcome Measure: Improvement in International Index of Erectile Function 5-item, serum testosterone level and pharmaco-penile duplex ultrasonography. Results: Erectile functions were significantly improved in all patients after treatment as compared with baseline and placebo (P .001). Patients who received both drugs showed significant improvement compared to those treated with single drugs, as assessed by International Index of Erectile Function scores and total testosterone (P .001). Pharmaco-penile ultrasound duplex results showed non-significant differences among patients treated with both drugs and those with each drug alone. Conclusion: Daily use of L-arginine with tadalafil significantly increased the International Index of Erectile Function scores and total testosterone levels as compared to each drug alone in diabetic patients with erectile dysfunction. No differences were found based on pharmaco-penile duplex findings

Introduction: Acne scarring is a common undesirable complication of acne vulgaris. Fractional erbium-yttrium aluminum garnet (YAG) 2940 nm laser and platelet-rich plasma have been used in treating acne scars with variable outcomes. The objective of this study is to assess the efficacy of fractional erbium-YAG 2940 nm laser and platelet-rich plasma as a single line of treatment in comparison with combined treatment in atrophic postacne scars. Methods: Seventy-five patients were included in this trial and randomized into three equal groups (25 each). Group A was subjected to six sessions of erbium-YAG laser for 6 months, group B was treated with 12 sessions of plateletrich plasma over the same period, and group C was subjected to six sessions of erbium-YAG laser plus 12 sessions of platelet-rich plasma over the same period. Each subject was evaluated by acne scar grading, photography, and subjective evaluation. Results: Both treatment modalities showed improvement of acne scars, but the improvement with combined treatment was better than that with erbium-YAG laser or platelet-rich plasma alone regarding scar grade improvement (P = 0.007 and 0.001), clinical improvement (P = 0.001 and 0.001), and patient satisfaction (P = 0.005 and 0.001), respectively. Conclusions: The combination of platelet-rich plasma plus erbium-YAG laser is superior to either treatment alone for acne scars, with trivial side effects for all treatment modalities. Trial Registration: ClinicalTrials.gov identifier; NCT03933033

Summary Background: Polycystic ovary syndrome (PCOS) affects up to 13% women and is associated with significant complications. The quality of evidence supporting the recommendations on treatment of nonreproductive outcomes in PCOS is unknown. Objective: To summarize and appraise the methodological quality of systematic reviews and meta-analyses evaluating pharmacological and surgical treatments for nonreproductive outcomes in PCOS. Methods: A literature search from MEDLINE, EMBASE, CINAHL PLUS and PROSPERO was performed from inception until 15th of September 2017. Article selection, data extraction and quality appraisal of included reviews were performed in duplicate. A narrative synthesis of the findings was conducted. Results: This overview included 31 reviews. The quality was low for 7 (23%), moderate for sixteen (52%) and high for 8 reviews (26%). Two reviews assessed psychological outcomes. Metformin improved anthropometric (7 of 10 reviews), metabolic (4 of 14 reviews) and endocrine outcomes (3 of twelve reviews). Thiazolidinediones improved metabolic (2 of 5 reviews) and endocrine outcomes (one of 5 reviews) but worsened weight gain (5 of 5 reviews). Combined oral contraceptive pill (COCP) improved clinical hyperandrogenism (2 of 2 reviews). Statins improved lipid profile (3 of 3 reviews) and testosterone level (2 of 3 reviews). There was no conclusive evidence from included systematic reviews regarding the use of other interventions. Conclusions: There is reliable evidence regarding the use of metformin for anthropometric outcomes and COCPs for hyperandrogenism in women with PCOS but not for other interventions. There is significant gap in knowledge regarding the management of psychological outcomes in women with PCOS which needs further evaluation.

Infertility, defined as the inability to conceive within 1 year of unprotected intercourse1, is estimated to affect as many as 186 million people worldwide2. Reproductive medicine aims to help these couples by offering them the best treatment option. As individual perception of the effectiveness of any treatment is affected by bias, it is generally accepted that clinical practice should be based on scientific methods. The definition of evidence‐based medicine was first introduced by Sackett as the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients3-5. To achieve this, knowledge should be sought in the medical literature to inform clinical decisions6. Reporting the most relevant and informative outcomes in clinical research, therefore, is mandatory for effective comparison between different interventions6. In 2003, the European Society for Human Reproduction and Embryology recommended that the outcome measure of assisted reproductive techniques (ART) and non‐ART should be ‘singleton live birth’7. Nothing, however, was stated with respect to the treatment cycle or effectiveness over time. Traditionally, success rates of in‐vitro fertilization (IVF) have been reported in terms of live births per fresh cycle or embryo transfer. However, with the increasing use of embryo freezing and thawing, it is essential that outcomes are reported not only following fresh but also after frozen embryo transfer as a complete measure of success of IVF treatment8. Moreover, evaluations should be extended over treatment strategies that incorporate multiple treatment cycles, even if they are of different types, and should also consider any natural conceptions that occur in between treatments. Here, we advocate that, in both clinical trials and clinical practice, the outcome of fertility treatment should be reported as a function of time and as the outcome of multiple transfers from one cycle or the outcome of multiple cycles in a predefined period.

ABSTRACT Objectives: To compare the impact of clomiphene citrate (CC) vs other drug regimens on mid-cycle endometrial thickness (EMT), ovulation, pregnancy and live birth rates in women with World Health Organization (WHO) group II ovulatory disorders. Methods: We searched MEDLINE, EMBASE, Scopus, Web of Science, The Cochrane Central Register of Clinical Trials (CENTRAL) and the non-MEDLINE subset of PubMed from inception to December 2016 and cross-checked references of relevant articles. We included only randomized controlled trials (RCTs) comparing CC used alone vs other drug regimens for ovulation induction in women with WHO group II anovulation. Outcomes were mid-cycle EMT, ovulation, pregnancy and live birth rates. We pooled weighted mean differences (WMD) with 95% confidence intervals (CI) for continuous variables (EMT) and risk ratios (RR) with 95% CI for binary variables (ovulation, pregnancy and live birth rates). Results: We retrieved 1718 articles of which 33 RCTs (4349 women, 7210 ovulation induction cycles) were included. In 15 RCTs that compared CC with letrozole, EMT was lower in the CC group (1957 women, 3892 cycles; WMD, −1.39; 95% CI, −2.27 to −0.51; I2 =100%), ovulation rates after CC and letrozole were comparable (1710 women, 3217 cycles; RR, 0.97; 95% CI, 0.90–1.04; I2 =47%), while CC led to a lower pregnancy rate (1957 women, 3892 cycles; RR, 0.78; 95% CI, 0.63–0.95; I2 =43%) and a lower live birth rate (RR, 0.70; 95% CI, 0.49–0.98; I2 =35%). In two RCTs that compared CC with CC plus metformin, EMT, ovulation and pregnancy rates were comparable (101 women, 140 cycles; WMD, −0.23; 95% CI, −0.92 to 0.45; I2 =78%; RR, 0.84; 95% CI, 0.67–1.06; I2 =0%; and RR, 0.79; 95% CI, 0.33–1.87; I2 =0%). In three studies that compared CC with CC plus N-acetyl cysteine (NAC), EMT was lower in the CC group (340 women, 300 cycles; WMD, −1.51; 95% CI, −1.98 to −1.04; I2 =45%). In two studies that compared CC with CC+nitric oxide (NO) donor, EMT was lower in the CC group (120 women, 304 cycles; WMD, −1.75; 95% CI, −2.08 to −1.41; I2 =0%). Compared with CC plus NO donor or NAC, CC showed statistically significant lower ovulation and pregnancy rates. Compared with tamoxifen in three studies, CC showed a tendency towards lower EMT (571 women, 844 cycles; WMD, −1.34; 95% CI, −2.70 to 0.01; I2 =96%) with comparable ovulation and pregnancy rates. Conclusions: In women with WHO group II ovulatory disorders, ovulation induction with CC might result in lower EMT than other ovulation induction regimens. Whether the lower EMT caused the lower pregnancy and live birth rates remains to be elucidated. Letrozole seems to be beneficial for these women. However, our findings should be interpreted with caution as the quality of evidence was very low. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

ABSTRACT Objectives: To compare the impact of clomiphene citrate (CC) vs other drug regimens on mid-cycle endometrial thickness (EMT), ovulation, pregnancy and live birth rates in women with World Health Organization (WHO) group II ovulatory disorders. Methods: We searched MEDLINE, EMBASE, Scopus, Web of Science, The Cochrane Central Register of Clinical Trials (CENTRAL) and the non-MEDLINE subset of PubMed from inception to December 2016 and cross-checked references of relevant articles. We included only randomized controlled trials (RCTs) comparing CC used alone vs other drug regimens for ovulation induction in women with WHO group II anovulation. Outcomes were mid-cycle EMT, ovulation, pregnancy and live birth rates. We pooled weighted mean differences (WMD) with 95% confidence intervals (CI) for continuous variables (EMT) and risk ratios (RR) with 95% CI for binary variables (ovulation, pregnancy and live birth rates). Results: We retrieved 1718 articles of which 33 RCTs (4349 women, 7210 ovulation induction cycles) were included. In 15 RCTs that compared CC with letrozole, EMT was lower in the CC group (1957 women, 3892 cycles; WMD, −1.39; 95% CI, −2.27 to −0.51; I2 =100%), ovulation rates after CC and letrozole were comparable (1710 women, 3217 cycles; RR, 0.97; 95% CI, 0.90–1.04; I2 =47%), while CC led to a lower pregnancy rate (1957 women, 3892 cycles; RR, 0.78; 95% CI, 0.63–0.95; I2 =43%) and a lower live birth rate (RR, 0.70; 95% CI, 0.49–0.98; I2 =35%). In two RCTs that compared CC with CC plus metformin, EMT, ovulation and pregnancy rates were comparable (101 women, 140 cycles; WMD, −0.23; 95% CI, −0.92 to 0.45; I2 =78%; RR, 0.84; 95% CI, 0.67–1.06; I2 =0%; and RR, 0.79; 95% CI, 0.33–1.87; I2 =0%). In three studies that compared CC with CC plus N-acetyl cysteine (NAC), EMT was lower in the CC group (340 women, 300 cycles; WMD, −1.51; 95% CI, −1.98 to −1.04; I2 =45%). In two studies that compared CC with CC+nitric oxide (NO) donor, EMT was lower in the CC group (120 women, 304 cycles; WMD, −1.75; 95% CI, −2.08 to −1.41; I2 =0%). Compared with CC plus NO donor or NAC, CC showed statistically significant lower ovulation and pregnancy rates. Compared with tamoxifen in three studies, CC showed a tendency towards lower EMT (571 women, 844 cycles; WMD, −1.34; 95% CI, −2.70 to 0.01; I2 =96%) with comparable ovulation and pregnancy rates. Conclusions: In women with WHO group II ovulatory disorders, ovulation induction with CC might result in lower EMT than other ovulation induction regimens. Whether the lower EMT caused the lower pregnancy and live birth rates remains to be elucidated. Letrozole seems to be beneficial for these women. However, our findings should be interpreted with caution as the quality of evidence was very low. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.