Pentoxifylline increases the level of nitric oxide produced by human spermatozoa.

Pentoxifylline (PF) is a xanthine derivative drug primarily used to treat peripheral vascular disorders. It is currently used in assisted reproductive technologies to enhance human sperm motility. However, the mechanism by which this enhancement occurs is not fully understood. Given that nitric oxide has been identified as a trigger to sperm motion, we asked whether nitric oxide modulates the stimulatory effect of PF on sperm motility. A total of 41 semen samples from infertile males were studied. Nitric oxide production in the presence of 5 mm PF was tested using different bio-analytical methods (spectrophotometry, fluorometry and fluorescence microscopy). The spectrophotometric determination showed higher levels of nitrite, an indirect measure for nitric oxide, in sperm samples supplemented with PF compared to controls. The fluorometric experiment showed higher 4, 5-diaminofluorescein triazole, a product from the reaction between nitric oxide and 4, 5-diaminofluorescein diacetate, after adding PF to spermatozoa. The fluorescence microscopy images of the spermatozoa supplemented with PF showed higher green fluorescence, indicating higher 4, 5-diaminofluorescein triazole levels, compared to controls. It is concluded that PF enhances nitric oxide production in human spermatozoa, which explains, at least in part, the mechanism by which PF stimulates human sperm motility.

Validation of reportable indices of haematology, liver and renal function in pregnancy for the Middle Eastern population.

The objective of this study was to describe normative values of complete blood counts, kidney and liver function tests for Jordanian women. A prospective study of 797 healthy pregnant women, seen at the antenatal clinics of the Jordan University of Science and Technology, in Irbid, north Jordan, was conducted between January 2005 and December 2009. Differences by trimester were analysed using one-way ANOVA. The mean age of the women was 31.0 years. The mean gestational age at delivery was 38.2 weeks. It was concluded that complete blood counts, kidney and liver function values by trimester, of healthy pregnant population of Jordanian women, were consistent with data reported for other populations.

Awareness, practice and attitude to cervical Papanicolaou smear among female health care workers in Jordan.

The objective was to investigate Jordanian female health care workers' awareness, practice and attitude towards screening for cervical cancer. A cross-sectional, interview-based survey of 187 female health care workers (53 physicians, 92 nurses/midwives, 42 others) was conducted. Descriptive statistics were generated. A total of 187 female health care workers were interviewed. Over 80% of sexually active interviewees, with a mean age ± SD of 36.5 ± 9.2 years and an awareness score ± SD of 7.91 ± 2.8, had never undergone Papanicolaou smear testing. Nearly half of them (47.2%) were not aware that screening was available. The majority of those who had been tested (19.1%), with an awareness score ± SD of 9.23 ± 3.03, did so as part of a routine visit to their gynaecologist. Only 26% of the participants were aware of the availability of a vaccine against cervical cancer, of which 63% were physicians. It is concluded that the current screening programme is not effective. There is urgent need to influence women's health care providers to highlight the need for smear tests and to develop educational programmes that will target women and health care workers.

Miscarriage and clinical correlates of leukocyte count in patients with ovarian hyperstimulation syndrome.

SUMMARY: This study was conducted to determine the pregnancy outcome in women with ovarian hyperstimulation syndrome and leukocytosis. From a total of 944 women who underwent IVF-ET, 89 (9.4%) developed OHSS, of whom 67 underwent embryo transfer. The criteria of the study were met by 53 women and underwent WBC count and haematological, hormonal and biochemical tests were performed on the day of HCG administration. Statistical comparison was made between women with a WBC count of >15,000 and those with a WBC count of <15,000. Patients with WBC count of >15,000 at the time of HCG administration (n = 24) had significantly increased rate of early pregnancy loss than women who had WBC count of <15,000 (n = 29). No other blood, chemical and hormonal parameters were different between the two groups. It is concluded that women with ovarian hyperstimulation syndrome in an IVF-ET cycle are more likely to miscarry if they have a WBC count of >15,000 on the day of HCG administration.

Attitudes and beliefs about cervical smear testing in ever-married Jordanian women.

To investigate attitudes and beliefs that affect a woman's decision to undergo cervical smear screening, we carried out a survey of 760 women attending general obstetrics and gynaecology clinics in Irbid, Jordan between June 2004 and April 2005. Knowledge of cervical cancer and the Pap smear test was inadequate in less-educated and older patients. Of the 109 women who had previously had the test, 104 (95.4%) had opportunistic testing. Around 95% of the sample had never had the test. Major barriers to Pap smear screening included inadequate knowledge about the test, not being referred by a health professional and fear of having a bad result. The current screening programme is not effective in reaching the majority of the population.

Attitudes and beliefs about cervical smear testing in ever-married Jordanian women

To investigate attitudes and beliefs that affect a woman's decision to undergo cervical smear screening, we carried out a survey of 760 women attending general obstetrics and gynaecology clinics in Irbid, Jordan between June 2004 and April 2005. Knowledge of cervical cancer and the Pap smear test was inadequate in less-educated and older patients. Of the 109 women who had previously had the test, 104 [95.4%] had opportunistic testing. Around 95% of the sample had never had the test. Major barriers to Pap smear screening included inadequate knowledge about the test, not being referred by a health professional and fear of having a bad result. The current screening programme is not effective in reaching the majority of the population

Does the number of previous caesarean deliveries affect maternal outcome and complication rates?

We evaluated maternal complications in relation to number of previous caesarean sections in Princess Badea Teaching Hospital, Irbid, Jordan. Analysis of the medical records of 1739 patients delivered by caesarean section was conducted. It revealed a 14-fold increase in the risk of caesarean hysterectomy in patients with placenta praevia and previous caesarean section compared to patients with placenta praevia and no previous caesarean section. The risk of caesarean hysterectomy increased with increasing number of previous caesarean sections. Those with 3 or more previous caesarean sections were at significantly higher risk of blood transfusion. Post-operative pyrexia was commoner in women with 3 or more previous caesarean sections compared to those undergoing their first one.

Does the number of previous caesarean deliveries affect maternal outcome and complication rates?

We evaluated maternal complications in relation to number of previous caesarean sections in Princess Badea Teaching Hospital, Irbid, Jordan. Analysis of the medical records of 1739 patients delivered by caesarean section was conducted. It revealed a 14-fold increase in the risk of caesarean hysterectomy in patients with placenta praevia and previous caesarean section compared to patients with placenta praevia and no previous caesarean section. The risk of caesarean hysterectomy increased with increasing number of previous caesarean sections. Those with 3 or more previous caesarean sections were at significantly higher risk of blood transfusion. Post-operative pyrexia was commoner in women with 3 or more previous caesarean sections compared to those undergoing their first one

Acute splenic sequestration in female children with sickle cell disease in the North of Jordan.

The objective of this study was to evaluate the rate of acute splenic sequestration (ASSC) in patients with sickle beta-thalassaemia and sickle cell anaemia, the risk of recurrence in those who survive the first episode, and the relationship between ASSC episodes and subsequent hypersplenism. All patients with confirmed diagnosis of sickle cell disease at a tertiary referral teaching hospital, between January 1994 and December 2002 were interviewed and had their medical records reviewed. Seventy-seven patients with sickle cell disease were identified. Their ages ranged between 2 and 18 years (mean, 10.1 years). There were 35 females and 38 males. Thirty-seven (50.6%) had sickle beta-thalassaemia, and 36 (49.4%) had homozygous sickle cell anaemia. Of these, 26 had high level of Hb F and 11 had normal level of fetal haemoglobin (Hb F). Twenty-one patients (28%) had 63 episodes of acute splenic sequestration. Thirty-seven episodes were experienced by 12 patients with sickle beta-thalassaemia; of these 11 were major attacks with one fatality. Twenty-six episodes were experienced by nine patients with sickle cell anaemia. Splenomegaly and hypersplenism were greater in the acute splenic sequestration group than in the rest of the sickle cell anaemia patients, and the differences were extremely significant. ASSC was found in nine siblings of sickle beta-thalassaemia group, while none were found in the sickle cell anaemia group. The mean age of the first episode was significantly higher in sickle beta-thalassaemia, with significant differences in the levels of Hb F, Hb S, size of spleen and severity of crisis between both groups. In the sickle cell anaemia group the only significant difference between patients with and these without acute splenic sequestration was the difference in the size of spleen. In this study, the rate of ASSC in the sickle beta-thalassaemia patients was 32%, in contrast to 25% in the sickle cell anaemia patients. The risk of recurrence was about 70% in those who survived their first episodes. There was a close relationship between ASSC and subsequent hypersplenism. Important predictable factors for ASSC in sickle beta-thalassaemia patients were the presence of splenomegaly of more than 5 cm below the costal margin, history of acute splenic sequestration in siblings and high Hb F. Most of first episodes in sickle cell anaemia occur under the age of 2 years, while in sickle beta-thalassaemia the majority of patients have their first crisis at the age of > or =3.5 years.

Variation in repeat caesarean section complication rates among 3 hospitals in northern Jordan.

We investigated the complication rates of repeat caesarean deliveries in 3 hospitals (national health, military, university) in Irbid by examining the obstetric records of 989 women from 1 December 1999 to 30 March 2004. There was a statistically significant difference between the number of previous caesarean sections and hospital. In total, 579 (58.5%) patients underwent elective caesarean section. There were statistically significant differences between hospitals for "failure to progress in labour" and "other" indications for caesarean section. After adjusting for the number of caesarean sections, regression analysis revealed that women from the military and university hospitals were more likely to have placenta praevia. There were no statistically significant differences between hospitals as regards post-operative complications.

Variation in repeat caesarean section complication rates among 3 hospitals in northern Jordan

We investigated the complication rates of repeat caesarean deliveries in 3 hospitals [national health, military, university] in Irbid by examining the obstetric records of 989 women from 1 December 1999 to 30 March 2004. There was a statistically significant difference between the number of previous caesarean sections and hospital. In total, 579 [58.5%] patients underwent elective caesarean section. There were statistically significant differences between hospitals for "failure to progress in labour" and "other" indications for caesarean section. After adjusting for the number of caesarean sections, regression analysis revealed that women from the military and university hospitals were more likely to have placenta praevia. There were no statistically significant differences between hospitals as regards post- operative complications

Hypothalamic-pituitary-gonadal function in adolescent females with beta-thalassemia major.

OBJECTIVE: To evaluate the function of the hypothalamic-pituitary-gonadal axis in adolescent female patients with beta-thalassemia major. MATERIALS AND METHODS: A prospective study of the function of the hypothalamic-pituitary-gonadal axis function of 31 beta-thalassemia major females aged between 13 and 22 years and in 12 control females aged between 12 and 22 years. All were treated at Princess Rahma Teaching Hospital, Irbid, Northern Jordan between April 2001 and April 2003. RESULTS: Of the 31 beta-thalassemia major females, 13 (41.9%) had delayed puberty. Hypothalamic-pituitary-ovarian axis dysfunction was found in 15 patients (48.4%). Twelve patients (38.7%) had hypogonadotropic hypogonadism and 5 (16.1%) had ovarian failure. High levels of serum ferritin were significantly higher in patients with delayed puberty. CONCLUSION: Pituitary and ovarian dysfunction are common problems in beta-thalassemia major patients. The main possible cause is iron overload. This stresses the need for intensive and regular use of chelation therapy to prevent damage to the hypothalamic-pituitary-ovarian axis.

Risk of malignancy index in the preoperative evaluation of pelvic masses.

OBJECTIVES: To assess the ability of a risk malignancy index (RMI) based on serum levels of CA 125, ultrasound findings, and menopausal status to discriminate between benign and malignant pelvic masses in a particular population. METHODS: A retrospective study was conducted of 100 women with pelvic masses admitted for laparotomy. The sensitivity and specificity of serum levels of CA 125, ultrasound findings, and menopausal status were calculated both separately and combined into a RMI to diagnose malignancy. RESULTS: The RMI was more accurate than any single criterion in diagnosing malignancy. Using a cut-off level of 200 to indicate malignancy, the RMI gave a sensitivity of 90%, specificity of 89%, positive predictive value of 96%, and negative predictive value of 78%. CONCLUSION: The RMI is able to correctly discriminate between malignant and benign pelvic masses. It is a simple scoring system that can be introduced easily into clinical practice to facilitate the selection of patients who would benefit from primary surgery.

Does consanguinity affect the severity of pre-eclampsia?

To determine whether consanguinity is more likely to be associated with severe forms of pre-eclampsia/eclampsia. Presuming a pure genetic contribution, we speculated that consanguineous marriages would increase the occurrence of severe forms of pre-eclampsia/eclampsia, through an expected increased chance for homozygosity to the putative gene. The study is a clinical case series on pre-eclamptic/eclamptic primiparae delivered at Princess Badea Teaching Hospital, which is a tertiary referral center. The internationally accepted definitions for hypertension, proteinuria, mild and severe pre-eclampsia were adopted. The study included 77 primiparae. The incidence of consanguinity in the studied sample was 38%. Of them, 28 (36.4%) had mild pre-eclampsia, 45 (58.4%) had severe pre-eclampsia and four (5.2%) had eclampsia. There was no statistically significant difference in the occurrence of severe pre-eclampsia/eclampsia between primiparae married to a first cousin or a relative other than a first cousin and primiparae married to a non-relative, odds ratio 1.1 (95% CI 0.33-3.87), P value 0.94, odds ratio 2.6 (95% CI 0.45-27.6), P value 0.30, respectively. Also, there was no statistically significant difference in occurrence of severe pre-eclampsia/eclampsia between primiparae whose parents are first cousins or relatives other than a first cousin and primiparae whose parents are non-relatives, odds ratio 1.3 (95% CI 0.36-4.72), P value 0.81, odds ratio 1.61 (95% CI 0.23-18.4), P value 0.70, respectively. Our study did not support a causal relationship between consanguinity and the occurrence of severe pre-eclampsia/eclampsia. The role of more complex genetic, immunologic, metabolic, hemostatic or, possibly yet, other unknown factors have to be explored.

Bilateral partial oophorectomy in the management of severe ovarian hyperstimulation syndrome. An aggressive, but perhaps life-saving procedure.

Two case histories are described, in which protracted courses of severe ovarian hyperstimulation syndrome (OHSS) responded poorly to conservative treatment. Each patient underwent bilateral partial oophorectomy at 14 and 16 days respectively, post oocyte retrieval. Serum albumin levels returned to normal within three days of the operation in each case and the patients, one pregnant with twins, made a rapid recovery. This seemingly 'aggressive' procedure is proposed as a potentially useful treatment when faced with patients who are severely or critically affected with OHSS.

The use of intrapartum defibulation in women with female genital mutilation.

OBJECTIVE: To assess the use of intrapartum defibulation for women who have had female genital mutilation. DESIGN: A retrospective case analysis. SETTING: King Abdulaziz University Hospital, a teaching hospital in Jeddah, Saudi Arabia. SAMPLE: Two hundred and thirty-three Sudanese and 92 Somali women who were delivered at the hospital between January 1996 and December 1999. METHODS: The outcome of labour of women with female genital mutilation who needed intrapartum defibulation were compared with the outcome of labour of women without female genital mutilation who did not need intrapartum defibulation. RESULTS: One hundred and fifty-eight (48.6%) women had infibulation and needed intrapartum defibulation to deliver vaginally, 116 women (35.7%) did not have infibulation and gave birth vaginally without defibulation, and 51 (15.7%) women were delivered by caesarean section. There were no statistically significant differences, between women who underwent intrapartum defibulation and those who did not, in the duration of labour, rates of episiotomy and vaginal laceration, APGAR scores, blood loss and maternal stay in hospital. The surgical technique of intrapartum defibulation was easy and no intraoperative complications occurred. CONCLUSIONS: Intrapartum defibulation is simple and safe, but sensitivity to the cultural issues involved is essential. In the longer term, continuing efforts should be directed towards abandoning female genital mutilation altogether.

Round spermatid separation and in-vitro maturation.

OBJECTIVE: To combine 2 methods; spermatid isolation and in-vitro maturation to improve their quality and enhance their ability of fertilization. METHODS: A discontinuous Percoll gradient was used to separate immature germ cells. Co-culture with Vero cells was attempted to convert round spermatids into more mature forms. In total 87 spermatids were studied. RESULTS: Of a final number of 77 round spermatids only 12 (15.5%) showed a certain degree of maturation in 3 out of 7 patients (42%). Of those 12 maturing spermatids, only 4 developed to an early elongated spermatid stage Sc1, but without flagella. CONCLUSION: Considering the limited in-vitro round spermatid maturation achieved in this study, the low fertilization and pregnancy rate with spermatids in general and round spermatids in particular, further refinements of this technology have to be achieved before its regular implementation in routine clinical practice is justifiable.