Random urine uric acid to creatinine and prediction of perinatal asphyxia: a meta-analysis

<p><b>Objective:</b> The purpose of the present review is to evaluate whether urine uric acid to creatinine ratio is increased in perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE), as well as to assess its predictive accuracy in the disease.</p> <p><b>Methods:</b> We used the Medline (1966–2017), Scopus (2004–2017), Clinicaltrials.gov (2008–2017), Embase (1980–2017), Cochrane Central Register of Controlled Trials CENTRAL (1999–2017), and Google Scholar (2004–2017) databases in our primary search along with the reference lists of electronically retrieved full-text papers. The hierarchical summary receiver operating characteristic (HSROC) model was used for the meta-analysis of diagnostic accuracy.</p> <p><b>Results:</b> Fourteen studies were finally included in the present review, that investigated 1226 neonates. Urinary uric acid to creatinine ratio was significantly higher in neonates with perinatal asphyxia than in healthy controls (mean differences (MD): 1.43 95%CI [1.17, 1.69]). Specifically, the mean difference for Sarnat stage 1 was 0.70 (95%CI [0.28, 1.13]), for stage 2 1.41 (95%CI [0.99, 1.84]), and for stage 3 2.71 (95%CI [2.08, 3.35]). The estimated sensitivity for the summary point was 0.90 (95%CI (0.82–0.95)), the specificity was 0.88 (95%CI (0.73–0.95)) and the diagnostic odds ratio was calculated at 63.62 (95%CI (17.08–236.96)).</p> <p><b>Conclusions:</b> Urinary uric acid to creatinine ratio is a rapid and an easily detected biomarker that may help physicians identify neonates at risk of developing perinatal asphyxia and HIE. However, large-scale prospective studies are still needed to determine its value in predicting mortality, as well as short- and long-term adverse neurological outcomes.</p

Amastigote forms of <i>Leishmania</i> in our patient’s Giemsa-stained bone marrow smear.

<p>Amastigote forms of <i>Leishmania</i> in our patient’s Giemsa-stained bone marrow smear.</p

In Vitro Maturation in Women with vs. without Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis

<div><p>Objective</p><p>To evaluate in vitro maturation (IVM) in sub-fertile women with polycystic ovarian syndrome (PCOS) undergoing in vitro fertilisation (IVF), by comparing outcomes with a control group of non-PCOS.</p><p>Study design</p><p>A search strategy was developed for PubMed and studies reporting rates of the following outcomes (live birth; clinical pregnancy; implantation; cycle cancellation; oocyte maturation; oocyte fertilization; miscarriage) between patients with PCOS, PCO and controls undergoing IVM were deemed eligible. The review was conducted in accordance to the PRISMA guidelines and included studies quality was assessed through the Newcastle-Ottawa Quality scale. ORs with their corresponding 95% CIs were calculated for the main analysis and subgroup analyses were performed for PCOS cases vs. controls and PCOS vs. PCO cases. Alternative analyses were performed for live birth and clinical pregnancy, based on cycles and on women. Subgroup analyses for FSH stimulation, hCG priming and type of procedure (IVF/ICSI) were undertaken for all meta-analyses encompassing at least four study arms. Random effects models were used to calculate pooled effect estimates.</p><p>Results</p><p>Eleven studies were identified. A total of 268 PCOS patients (328 cycles), 100 PCO patients (110 cycles) and 440 controls (480 cycles) were included in the meta-analysis. A borderline trend towards higher birth rates among PCOS patients emerged (pooled OR = 1.74, 95%CI: 0.99–3.04) mainly reflected at the subgroup analysis vs. controls. Clinical pregnancy (pooled OR = 2.37, 95%CI: 1.53–3.68) and implantation rates (pooled OR = 1.73, 95%CI: 1.06–2.81) were higher, while cancellation rates lower (pooled OR = 0.18, 95%CI: 0.06-0.47) among PCOS vs. non-PCOS subjects; maturation and miscarriage rates did not differ between groups, while a borderline trend towards lower fertilization rates among PCOS patients was observed.</p><p>Conclusion</p><p>The present meta-analysis provides preliminary evidence on the effectiveness of IVM as a treatment option when offered in sub-fertile PCOS women, as the latter present at least as high outcome rates as those in non-PCOS.</p></div

PRISMA Flow Diagram of the studies.

<p>PRISMA Flow Diagram of the studies.</p

Results of the meta-analyses addressing the three comparisons (PCOS vs. controls; PCO vs. controls; PCOS vs. PCO) in the examined outcomes (Bold cells denote statistically significant associations).

<p>^§number of study arms</p><p>Results of the meta-analyses addressing the three comparisons (PCOS vs. controls; PCO vs. controls; PCOS vs. PCO) in the examined outcomes (Bold cells denote statistically significant associations).</p

Description of cycle and outcome parameters.

<p>Footnotes:</p><p>N/A: Not Applicable; NR: Not Reported</p><p>IVF: In Vitro Fertilisation; ICSI: Intracytoplasmic sperm injection; PGD: Pre-implantation genetic diagnosis; ART: Assisted reproductive technology; ESHRE/ASRM: European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM); HEPES buffer: N-(2-hydroxyethyl) piperazine-N'-2-ethanesulfonic acid; TCM 199: tissue culture medium 199; EMEM: Eagle's minimal essential medium; LH: Luteinizing hormone; FSH: Follicle stimulating hormone; HCG: Human chorionic gonadotropin; ET: Embryo transfer.</p><p>Description of cycle and outcome parameters.</p

Characteristics of included studies.

<p>N/A: Not Applicable; NR: Not Reported</p><p>Characteristics of included studies.</p

(a). Comparison PCOS vs. non-PCOS regarding live birth rates (women-based analysis), stratified by stimulation with FSH. (b) Comparison PCOS vs. non-PCOS regarding live birth rates (women-based analysis), stratified by priming with hCG.

<p>(a). Comparison PCOS vs. non-PCOS regarding live birth rates (women-based analysis), stratified by stimulation with FSH. (b) Comparison PCOS vs. non-PCOS regarding live birth rates (women-based analysis), stratified by priming with hCG.</p