Introduction: Vascular calcification is a risk factor for cardiovascular mortality in the general population. It is highly prevalent in end stage renal disease (ESRD) patients. Low magnesium (Mg) levels have been reported to have a strong association with vascular calcification in hemodialysis (HD) patients. The aims of this study were to evaluate the prevalence of vascular calcification and its relation to serum Mg concentration in a group of Egyptian HD patients. Methods:We studied 65 stable patients undergoing maintenance HD for more than 6 months. Vascular calcification was evaluated using hand roentgenography. Serum Mg, phosphorus, corrected calcium and intact parathyroid hormone (iPTH) levels were compared between patients with and without vascular calcification. Results:The study included 41 male and 24 female patients, aged 43-70 years. Vascular calcification was present in 38.5% of the patients. Mean serum Mg level was 2.88 ± 0.51 mg/dl. Male gender was more common in patients with vascular calcification, and they had significantly longer HD duration and significantly higher serum phosphorus and iPTH levels. Serum Mg level was significantly lower in patients with vascular calcification (2.36 ± 0.26 mg/dl vs.3.21 ± 0.32 mg/dl, p = 0.001). Serum Mg concentration remained as independent negative predictor of hand-artery vascular calcification after adjustment for age, gender, duration of HD, serum phosphorus and iPTH levels. Conclusion:Vascular calcification is common in the study population and is associated with a lower serum Mg level. High or sustained-normal Mg levels may have a protective role against the development of vascular calcification in HD patients.

The efficacy of dexamethasone and ondansetron on intra and postoperative nausea and vomiting is confusing and still debatable. We conducted this systematic review and meta-analysis to synthesize evidence from published studies on the efficacy and the impact of dexamethasone and ondansetron for cutting the risk of nausea and vomiting in pregnant women. We followed the standard methods of the Cochrane Handbook of Systematic Reviews for interventions and the PRISMA statement guidelines 2020 when conducting and reporting this study. A computer literature search-of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials-conducted from inception until January 2022. We selected randomized controlled trials (RCTs) assessing the efficacy of dexamethasone alone Vs combination of dexamethasone and ondansetron, on nausea and vomiting in pregnant women undergoing cesarean section. All relevant outcomes were pooled in the meta-analysis using Review Manager Software. Five RCTs were included in our study with only four RCTs included in the meta-analysis.The pooled risk ratio suggested that there is no significant difference between Ondansetron and combination or dexamethasone in reducing preoperative vomiting as following respectively: [RR=1.9,95%CI (0.164,22.2), P= 0.605], and [RR=0.549, 95%CI (0.160,1.882), P=0.17]. Also, regarding pre-operative nausea there is no significant difference between ondansetron and combination or between dexamethasone and combination as following: [RR =0.7,95%CI (0.3,1.64), P=0.41], and [RR =1.91,95%CI(0.98,3.71),P=0.06]. while combination intervention reduces the incidence of post-operative nausea and vomiting compared to both ondansetron and dexamethasone as following respectively:[ RR Print

Objectives: Evaluation of serum levels of visfatin, tumor necrosis factor-α (TNF-α), afamin, and fetuin-A in euglycemic women at the time of pregnancy diagnosis (Booking time) as early discriminators for women vulnerable to develop gestational diabetes mellitus (GDM). Patients and Methods: 150 euglycemic newly pregnant women were clinically evaluated and gave blood samples at booking time and at the 24th gestational week (GW). Glucose intolerance was diagnosed using the 75-gm oral glucose tolerance test (OGTT), glycemic control state was checked by the level of glycated hemoglobin (HbA1c), and insulin resistance (IR) was diagnosed using the homeostasis model assessment of IR (HOMA-IR) score. Serum levels of the studied biomarkers were estimated at-booking time and at the 24th GW. Group IR/GDM included women who developed IR and/or GDM, group IS/ NG included women who continued their pregnancy free of IR or GDM. Results: At the 24-GW, all women had higher blood glucose (BG) and HbA1c levels, and HOMA-IR index in comparison to their booking levels, but the difference was significant for women of IR/GDM group and 22 women (14.7%) developed GDM, while 58 women (38.7%) developed IR. At the 24th GW, serum levels of the four biomarkers were significantly higher in blood samples of women of IR/GDM group in comparison to their at-booking levels and to corresponding levels of women of IS/NG group. Statistical analyses defined high at-booking serum TNF-α and afamin levels as early predictors for uncontrolled BG levels, while high TNF-α, visfatin, and afamin serum levels are the significant predictors for HOMA-IR of >2 at the 24th GW. Conclusion: Elevated serum levels of the studied biomarkers early in pregnancy may play a role in the development of GDM. High serum TNF-α and afamin might be used as early discriminative biomarkers for women liable to develop GDM and/or IR later in pregnancy.

Introduction: Goal-directed fluid therapy "GDFT" is a method of oxygen delivery and hemodynamics optimization using vasoactive and fluid infusions. According to several studies, GDFT has shown better results than traditional fluid therapy to maintain hemodynamic stabilization Material and Methods: Our systematic review and meta-analysis was carried out according to the PRISMA guidelines for randomized studies. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until February 2022. All relevant outcomes were pooled in the meta-analysis using Review Manager Software Results: Our systematic review included three RCTs. All of them were included in our meta-analysis. There was no significant difference between GDFT group and the control group in the maternal adverse events except in the incidence of hypotension which was less in the intervention group. Also, there is no significant difference between the two groups in terms of PH, PO2, PCO2, lactic acid, and base deficit. GDFT group was better in SO2 than the control group in both artery and vein. Regarding the umbilical vein, the number of neonates who had PCO2 >46 mmHg and PO2 ≤21 mmHg was less in the intervention group than the control group. On the other hand, there were no significant difference between the two groups in the number of neonates whose PH <7.28. Finally, regarding the umbilical artery, the number of neonates who had PCO2 >46 mmHg and PO2 ≤21 mmHg was less in the intervention group. Conclusion: GDFT shows promising results in controlling the hypotension and blood gases in pregnant women compared with the control group. Also, GDFT may provide benefits to healthy parturient women and their newborns.

Aim: Evaluation of the predictive ability of serum soluble endoglin (sEng) and placental growth factor (PLGF) levels estimated at the 12 th gestational week (GW) for discrimination of women liable to develop preeclampsia (PE). Materials and Methods: 102 PE women were diagnosed according to the American Society of Hypertension and categorized according to guidelines of American College of Obstetricians and Gynecologists. The severity of PE was judged by the difference between blood pressure (∆BP) measures at time of PE diagnosis and at time of enrolment. Blood samples were obtained at the 12 th GW for ELISA estimation of serum sEng and PLGF. Study outcomes included the predictive ability of these markers for development of PE and the relation between age, body mass index (BMI) and serum levels of studied biomarkers and ΔSBP and ΔDBP. Results: 29 and 73 women developed early-and late-onset PE, respectively and 18 women had severe, while 84 women had mild PE. At time of PE diagnosis, BP measures were increased significantly in PE women in comparison to enrolment measures and to control measures. Serum levels of sEng were significantly higher, while serum PLGF levels were significantly lower in PE women than in controls. Development of PE was positively correlated with serum sEng, while was negatively correlated with serum PLGF levels. Also, there was positive significant correlation between ΔBP and BMI and serum levels of sEng, and negative significant correlation with at enrolment BP and serum levels of PLGF. ROC curve analysis defined ΔSBP and ΔDBP by 33 and 10 mmHg as a cutoff point for diagnosis of PE and defined high serum sEng as the significant sensitive predictor for development of PE at both cutoff points. Conclusion: At 12 th GW, estimated levels of sEng and PLGF could discriminate pregnant women vulnerable for development of PE. Statistical analyses defined high serum sEng levels estimated at the 12 th GW as the significant early predictor for upcoming PE. Maternal obesity and old age are also related to PE severity and must be considered for prediction.