OBJECTIVE: Prenatally compromised fetal head growth leading to smaller brain volumes (BV) is a risk factor for neurodevelopmental delay in children with CHD. Little is known about the dynamics of fetal head growth in different types of CHD. Aim of this study was to characterize fetal brain growth in relation to the type of CDH and associated cardiovascular dynamics. STUDY DESIGN: 89 chromosomally normal fetuses with isolated CHD had head circumference (HC), calculated BV (HC3/6_2), fetal cephalization index (CI_HC/EFW), growth potential (GP), middle cerebral artery Pulsatility index(MCAPI) and central hemodynamic measurements. Z-scores for these parameters were compared between cases and 1535 normal singleton controls. CHD was grouped as follows: group 1: transposition of the great arteries (TGA, n_7), group 2: Hypoplastic left heart and critical aortic stenosis with retrograde aortic flow (n_55), group 3: (right sided lesions) pulmonary stenosis, Tetralogy of Fallot, Tricuspid atresia (n_ 14), group 4: Left ventricular outflow obstructions with net antegrade isthmic flow (n_13). RESULTS: HC, BV and GP were lower in groups 1 and 2 (all p_0.001). BVs were smaller in group 1 (_1.98 vs_0.72, p_0.001). The MCAPI z-score was significantly decreased in groups 2 and 4 (p_0.001 compared to controls) with the lowest median values in the latter (_0.65 vs. _1.51, p_0.04). MCA PI z-score was not correlated with head growth in group 2 but was inversely correlated to BV in group 4 (p_0.04). CONCLUSION: Transposition of the great arteries and left sided CDH leading to isthmic blood flow reversal are associated with significantly smaller head size. TGA is not associated with MCA brain sparing and delayed brain growth probably results from central switching of nutrient streams. Left sided lesions are associated with MCA brain sparing but head growth is only spared when net antegrade flow in the aortic isthmus can be maintained. Prenatal evaluation of central hemodynamics in CDH may become essential for predicting neurodevelopmental risks and potentially critical to direct prenatal interventions

Aim: To estimate the prevalence of low bone mineral density (BMD) among rural women of reproductive age in Upper Egypt and to evaluate the association of selected anthropometric, reproductive, lifestyle and socioeconomic class factors on BMD. Methods: A cross-sectional study was conducted among contraceptive users in rural Sohag Governorate, Upper Egypt. A structured questionnaire was administered for 362 eligible participants. Anthropometric measurements were made, and BMD was measured by ultrasonographic bone densitometry. Results: Of the participants, aged 20–50 years, 61% were of low socioeconomic level and 47.8% were illiterate. The prevalence of low BMD was 31.8%. Age, low socioeconomic level, BMI, illiteracy, family history, the total duration of breastfeeding and reproduction, total number of pregnancies and decreased intake of food rich in calcium were significant factors according to bivariate analysis. Low BMD was significantly associated with an increase in the duration of depomedroxy progesterone acetate (DMPA) use, low dietary calcium intake, low BMI and an increase in the duration of reproduction according to multivariate regression analysis. Conclusion: Focusing on improving the bone health of reproductive age females of low socioeconomic levels will improve the outcomes of programs to prevent pre- and postmenopausal osteoporosis.

Aim: To estimate the prevalence of low bone mineral density (BMD) among rural women of reproductive age in Upper Egypt and to evaluate the association of selected anthropometric, reproductive, lifestyle and socioeconomic class factors on BMD. Methods: A cross-sectional study was conducted among contraceptive users in rural Sohag Governorate, Upper Egypt. A structured questionnaire was administered for 362 eligible participants. Anthropometric measurements were made, and BMD was measured by ultrasonographic bone densitometry. Results: Of the participants, aged 20–50 years, 61% were of low socioeconomic level and 47.8% were illiterate. The prevalence of low BMD was 31.8%. Age, low socioeconomic level, BMI, illiteracy, family history, the total duration of breastfeeding and reproduction, total number of pregnancies and decreased intake of food rich in calcium were significant factors according to bivariate analysis. Low BMD was significantly associated with an increase in the duration of depomedroxy progesterone acetate (DMPA) use, low dietary calcium intake, low BMI and an increase in the duration of reproduction according to multivariate regression analysis. Conclusion: Focusing on improving the bone health of reproductive age females of low socioeconomic levels will improve the outcomes of programs to prevent pre- and postmenopausal osteoporosis.

Aim: To estimate the prevalence of low bone mineral density (BMD) among rural women of reproductive age in Upper Egypt and to evaluate the association of selected anthropometric, reproductive, lifestyle and socioeconomic class factors on BMD. Methods: A cross-sectional study was conducted among contraceptive users in rural Sohag Governorate, Upper Egypt. A structured questionnaire was administered for 362 eligible participants. Anthropometric measurements were made, and BMD was measured by ultrasonographic bone densitometry. Results: Of the participants, aged 20–50 years, 61% were of low socioeconomic level and 47.8% were illiterate. The prevalence of low BMD was 31.8%. Age, low socioeconomic level, BMI, illiteracy, family history, the total duration of breastfeeding and reproduction, total number of pregnancies and decreased intake of food rich in calcium were significant factors according to bivariate analysis. Low BMD was significantly associated with an increase in the duration of depomedroxy progesterone acetate (DMPA) use, low dietary calcium intake, low BMI and an increase in the duration of reproduction according to multivariate regression analysis. Conclusion: Focusing on improving the bone health of reproductive age females of low socioeconomic levels will improve the outcomes of programs to prevent pre- and postmenopausal osteoporosis.

OBJECTIVE: To measure amniotic fluid levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor (TGF)-beta2 and to characterize their levels with respect to advancing gestational age and pregnancy-related complications. STUDY DESIGN: Amniotic fluid was collected from a total of 37 patients, 2 of whom had twin pregnancies. Twenty-seven specimens were collected in the second trimester and 10 specimens were collected in the third trimester. VEGF, bFGF and TGF-beta2 were isolated from centrifuged amniotic fluid and quantified using commercially available ELISA kits. Concentrations of growth factors were expressed in pg/mL. RESULTS: The growth factors under investigation were present in most but not all amniotic fluid specimens throughout pregnancy. The levels of VEGF, bFGF and TGF-beta2 were inconsistent and did not show a statistically significant association with gestational age, number of fetuses, or the presence of hypertension and/or diabetes. One significant finding emerged from the data: smokers had significantly higher amniotic fluid levels of VEGF compared to nonsmokers (p = 0.03). CONCLUSION: VEGF, bFGF and TGF-beta2 are detectable in second and third trimester amniotic fluid. Smoking appears to correlate with increased amniotic fluid VEGF during pregnancy. VEGF may represent a molecular marker of hypoxia and is an interesting focus for future investigation.

OBJECTIVE: To measure amniotic fluid levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor (TGF)-beta2 and to characterize their levels with respect to advancing gestational age and pregnancy-related complications. STUDY DESIGN: Amniotic fluid was collected from a total of 37 patients, 2 of whom had twin pregnancies. Twenty-seven specimens were collected in the second trimester and 10 specimens were collected in the third trimester. VEGF, bFGF and TGF-beta2 were isolated from centrifuged amniotic fluid and quantified using commercially available ELISA kits. Concentrations of growth factors were expressed in pg/mL. RESULTS: The growth factors under investigation were present in most but not all amniotic fluid specimens throughout pregnancy. The levels of VEGF, bFGF and TGF-beta2 were inconsistent and did not show a statistically significant association with gestational age, number of fetuses, or the presence of hypertension and/or diabetes. One significant finding emerged from the data: smokers had significantly higher amniotic fluid levels of VEGF compared to nonsmokers (p = 0.03). CONCLUSION: VEGF, bFGF and TGF-beta2 are detectable in second and third trimester amniotic fluid. Smoking appears to correlate with increased amniotic fluid VEGF during pregnancy. VEGF may represent a molecular marker of hypoxia and is an interesting focus for future investigation.

We evaluated the feasibility and operative and postoperative outcomes of office balloon vaginoplasty. Office balloon vaginoplasty was performed successfully for a case with vaginal aplasia. She was currently married and presenting with minimal penetration and dyspareunia. We successfully performed the procedure through retro-pubic space under local anesthesia within 25 min total operative time and it was well tolerated by the patient. No operative complications were reported. The resulting neovagina was cosmetically attractive and 10 cm in depth. Sexual intercourse was started on the day of catheter removal. Penetration and satisfaction scores increased up to 90 points for both partners.

We evaluated the feasibility and operative and postoperative outcomes of office balloon vaginoplasty. Office balloon vaginoplasty was performed successfully for a case with vaginal aplasia. She was currently married and presenting with minimal penetration and dyspareunia. We successfully performed the procedure through retro-pubic space under local anesthesia within 25 min total operative time and it was well tolerated by the patient. No operative complications were reported. The resulting neovagina was cosmetically attractive and 10 cm in depth. Sexual intercourse was started on the day of catheter removal. Penetration and satisfaction scores increased up to 90 points for both partners.

We evaluated the feasibility and operative and postoperative outcomes of office balloon vaginoplasty. Office balloon vaginoplasty was performed successfully for a case with vaginal aplasia. She was currently married and presenting with minimal penetration and dyspareunia. We successfully performed the procedure through retro-pubic space under local anesthesia within 25 min total operative time and it was well tolerated by the patient. No operative complications were reported. The resulting neovagina was cosmetically attractive and 10 cm in depth. Sexual intercourse was started on the day of catheter removal. Penetration and satisfaction scores increased up to 90 points for both partners.

The objective of this study was to compare letrozole-stimulated cycles to natural cycles in 208 patients undergoing intrauterine insemination (IUI) between July of 2004 and January of 2007. Group I (n = 47) received cycle monitoring only (natural group), Group II (n = 125) received letrozole 2.5 mg/day on cycle days three to seven, and Group III (n = 36) received letrozole 5 mg/day on cycle days three to seven. There were no differences between the groups in endometrial thickness or P4 on the day of hCG. Estradiol levels had higher variation in the second half of the follicular phase in both letrozole-treated groups compared to the control group. Estradiol per preovulatory follicle was similar in both letrozole cycles to that observed in the natural cycles. LH was lower on the day of hCG administration in the letrozole 2.5 mg/day group vs. the natural group. In summary, letrozole results in some minor changes in follicular, hormonal and endometrial dynamics compared to natural cycles. Increased folliculogenesis and pregnancy rates were observed in the letrozole-treated groups compared to the natural group. These findings need to be confirmed in larger, prospective studies.