Author: "Yasser Sabr" - Searchworks@Jio Institute Digital Library Search Results

88 results on '"Yasser Sabr"'

1. Spatiotemporal patterns and surveillance artifacts in maternal mortality in the United States: a population-based studyResearch in context

Author: K.S. Joseph, Sarka Lisonkova, Amélie Boutin, Giulia M. Muraca, Neda Razaz, Sid John, Yasser Sabr, Sophie Simon, Johanna Kögl, Elizabeth A. Suarez, Wee-Shian Chan, Azar Mehrabadi, Justin S. Brandt, Enrique F. Schisterman, and Cande V. Ananth
Subjects: Maternal mortality, United States, Cause of death, Epidemiology, Surveillance, Pregnancy complications, Public aspects of medicine, RA1-1270
Abstract: Summary: Background: Reports of high and rising maternal mortality ratios (MMR) in the United States have caused serious concern. We examined spatiotemporal patterns in cause-specific MMRs, in order to obtain insights into the cause for the increase. Methods: The study included all maternal deaths recorded by the Centers for Disease Control and Prevention from 1999 to 2021. Changes in overall and cause-specific MMRs were quantified nationally; in low-vs high-MMR states (i.e., MMRs
Published: 2024
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2. Anesthetic considerations of EXIT procedure: A case report

Author: Narjes S. Alotaibi, Mansour Aqil, Yasser Sabr, Jumana Baaj, and Reem Alsafar
Subjects: exit procedure, fetal airway obstruction, obstetric anesthesia, oral mass, Anesthesiology, RD78.3-87.3
Abstract: The ex-utero intrapartum treatment (EXIT) is a rare surgical procedure performed in cases of expected postpartum fetal airway obstruction. This procedure technique lies in a safe establishment of a patent airway during labor in anticipation of a critical respiratory event, without the interruption of maternal-fetal circulation. Anesthetic management in the EXIT procedure is substantially different from that of the standard cesarean delivery and its main goals include uterine relaxation, fetal anesthesia, and placental blood flow preservation. We report the first case of an EXIT procedure performed on a fetus with a prenatal diagnosis of multiple oral masses at King Khalid University Hospital, Riyadh, Saudi Arabia.
Published: 2024
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3. The Association between Antenatal Tea Drinking and Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis

Author: Ahmed Arafa, Haytham A. Sheerah, Omar Khaled Alzaydan, and Yasser Sabr
Subjects: tea, hypertensive disorders of pregnancy, pre-eclampsia, meta-analysis, Internal medicine, RC31-1245
Abstract: Several adverse maternal outcomes have been linked to the excessive consumption of caffeine during pregnancy. Tea is an important source of caffeine. Hypertensive disorders of pregnancy (HDP) are common pregnancy complications with unfavorable maternal and fetal complications. This study aimed to investigate the relationship between antenatal tea drinking and HDP using a meta-analysis of available evidence. We systematically retrieved eligible studies before computing the pooled odds ratio (OR) and 95% confidence interval (CI) of HDP for women who reported the highest versus the lowest frequencies of antenatal tea drinking. We used the I2 statistic to measure heterogeneity across studies and the test for funnel plot asymmetry to evaluate publication bias. The results showed that the highest frequencies of antenatal tea drinking were associated with increased odds of HDP (pooled OR = 1.16, 95% CI: 1.01, 1.33). We identified no signs of heterogeneity across studies (I2 = 0.0% and p-heterogeneity = 0.498) or publication bias (z = 0.791 and p-publication bias = 0.429). When the outcome was limited to (pre-)eclampsia, the association became statistically non-significant (pooled OR = 1.28, 95% CI: 0.86, 1.89, I2 = 0.0%, and p-heterogeneity = 0.751). In conclusion, our results indicated that the highest frequency of antenatal tea drinking was positively associated with HDP. Pregnant women should be advised against excessive tea consumption. Still, future prospective cohort studies, considering the effects of different tea types and caffeine content, are needed to confirm our conclusions.
Published: 2024
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4. Association of health and lifestyle factors with uterine fibroids among Saudi women: A case–control study

Author: Reema Muawad, MPH, Rufaidah Dabbagh, DrPH, and Yasser Sabr, PhD
Subjects: Fibroids, Fibromyoma, Leiomyomas, Uterine fibroid, Uterine fibroma, Medicine (General), R5-920
Abstract: الملخص: أهداف: الهدف من هذه الدراسة هو قياس العلاقة بين تليف الرحم وعوامل الخطر المختلفة (تعدد الولادات، الإجهاض، السكري، ارتفاع ضغط الدم، النشاط البدني، التدخين، التاريخالعائلي لالتهاب الرحم، واستخدام حبوب منع الحمل) بين النساء السعوديات. طرق: أجريت دراسة الحالات والشواهد في مركزين طبيين في الرياض، بين امرأة. تم تأكيد الحالات عن طريق الموجات فوق الصوتية. تم جمع المعلومات الديموغرافية وعوامل الخطر من خلال المقابلة والسجلات الطبية. تم حساب انتشار عوامل الخطر المختلفة مع فاصلة ثقة ٩٥٪. تم استخدام تحليل الانحدار اللوجستي غير المشروط لقياس الارتباط بين تليف الرحم وعوامل الخطر المختلفة. نتائج: كان أكثر من نصف المشاركين يعانون من السمنة المفرطة. كان متوسط مؤشر كتلة الجسم للحالات ٣١.٢ (±٦.٨١)، بينما كان٢٩.٤ (±٧.٠٢) للشواهد. كان لدى النساء اللواتي يبلغن من العمر ٤٠ عامًا فما فوق أربع أضعاف احتمالات الإصابة بتليف الرحم مقارنة بالنساء الأصغر من ٤٠ عامًا (نسبه الأرجحية المصحح ٤.٢٤ بفاصلة ثقة ٩٥٪ بين ٢.٦٣ و٦.٨٥(ارتبط وجود تاريخ عائلي لتليف الرحم مع احتمالات متزايدة بالإصابة بتليف الرحم بنسبة ٦٩٪ (نسبه الأرجحية المصحح ١.٦٩ بفاصلة ثقة ٩٥٪ بين ١.٠٢ و٢.٨١ (. ارتبطت السمنة بزيادة احتمالات الإصابة بتليف الرحم بنسبة ٧٤٪ (نسبه الأرجحية المصحح ١.٧٤ بفاصلة ثقة ٩٥٪ بين ١.٠٠ و٢.٥٩)، بينما قللت الولادات السابقة من احتمالات الإصابة بتليف الرحم بنسبة ٦٢٪ (نسبه الأرجحية المصحح ٠.٣٨، بفاصلة ثقة ٩٥٪ بين ٠.١٩ و٠.٧٥(. الاستنتاجات: ساعدت هذه الدراسة في تحديد بعض عوامل الخطر المرتبطة بتليف الرحم في النساء السعوديات. العمر فوق ٤٠ عامًا، والسمنة والتاريخ العائلي من تليف الرحم هي عوامل خطر مهمة للتليف الرحم، بينما يبدو أن تعدد الولادات يحمي من الإصابة بتليف الرحم في النساء السعوديات. التعرف المبكر على عوامل الخطر مهم لمنع مضاعفات تليف الرحم. Abstract: Objectives: The objective of this study was to measure the association between uterine fibroids (UFs) and several risk factors (parity, miscarriage, diabetes, hypertension, physical activity, smoking, family history of UF and contraceptive pill use) among Saudi women. Methods: A case–control study was conducted in 478 women at two medical centers in Riyadh. Cases were confirmed by ultrasound. Demographic and risk factor information was collected from interviews and medical records. The prevalence of risk factors was calculated with 95% confidence interval (CI). Unconditional logistic regression analysis was used to measure the associations between UFs and the risk factors. Results: More than half the participants were obese. The average body mass index (BMI) was 31.2 (±6.81) for cases and 29.4 (±7.02) for controls. Women 40 years or older had four times the odds of UFs than women younger than 40 years (adjusted odds ratio [AOR] = 4.24, 95% CI = 2.63, 6.85). Having a family history of UFs was associated with 69% greater odds of UFs (AOR = 1.69, 95% CI = 1.02, 2.81). Being obese was associated with 74% greater odds of UFs (AOR = 1.74, 95% CI = 1.00, 2.59), whereas previous live births decreased the odds of UFs by 62% (AOR = 0.38, 95% CI = 0.19, 0.75). Conclusions: This study identified risk factors associated with UFs in the Saudi population. Age over 40 years, obesity and a family history of UFs are important risk factors for UF, whereas parity appears to be protective against UF development in Saudi women. Early recognition of these risk factors is important to prevent UF complications.
Published: 2022
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5. Clinical practice guidelines for neonatal hypoxic-ischemic encephalopathy: A systematic review using the appraisal of guidelines for research and evaluation (AGREE) II instrument

Author: Yasser S. Amer, Jasim Anabrees, Mohamed Abdelmawla, Ayman Abdalgader, Asmaa Almazroei, Ibrahim Alhifzi, Abdullah Hawash AlOnazi, Yasser Sabr, Layal Hneiny, Ahmed El-Malky, Ayesha Alshalawi, Ahmed Alayoubi, Iftikhar A. Chaudhry, and Omar Elkhateeb
Subjects: hypoxic ischemic encephalopathy, HIE, pediatrics, neonatology, clinical practice guidelines, systematic review, Pediatrics, RJ1-570
Abstract: Background and ObjectiveTo systematically review, critically appraise the quality of recent clinical practice guidelines (CPGs) for neonatal hypoxic ischemic encephalopathy (HIE), and map their recommendations.Data SourcesCPG databases (GIN, ECRI, NICE, SIGN, DynaMed), Bibliographic databases (PubMed, Embase, CINAHL), and related specialized professional societies (e.g., AAP, CPS, BAPM, RCPCH, and SNS).Study SelectionOriginal de-novo developed evidence-based CPGs for HIE, group authorship, Arabic or English languages, and international or national scope. The systematic review was drafted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and Johnston et al methodological guide.Data ExtractionQuality assessment of the included HIE CPGs by the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) Instrument and report their characteristics, AGREE II ratings, and recommendationsData SynthesisOur search retrieved 2,489 citations, of which two recent HIE CPGs were eligible and appraised: Canadian Paediatric Society (CPS) and Queensland Maternity and Neonatal Services (QMN). The overall assessment of the QMN CPG was superior (83%). Domain 1 (Scope & Purpose) scored (47%, 63%), Domain 2 (Stakeholder Involvement) (72%, 39%), Domain 3 (Rigour of Development) (48%, 43%), Domain 4 (Clarity & Presentation) (100%, 96%), Domain 5 (Applicability) (59%, 9%), and Domain 6 (Editorial Independence) (67%, 17%) for the QMN and CPS CPGs respectively. All appraisers recommended the QMN CPG for use in practice.ConclusionThe methodological quality of the QMN CPG was superior with the relevant recommendations for its use in neonatal practice.Limitationslimited to Arabic and English languages.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258291, identifier: CRD42021258291.
Published: 2023
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6. Validity and reliability of the Arabic version of Muller’s prenatal attachment inventory

Author: Dima Arafah, Bejoy Thomas, Tanis R. Fenton, Yasser Sabr, and Amy Metcalfe
Subjects: maternal fetal attachment, psychometrics, translation, arabic, Gynecology and obstetrics, RG1-991
Abstract: Purpose Maternal fetal attachment (MFA) is the bond between the mother and her unborn baby. Presently no tools measuring MFA are available in Arabic. The aim of this study was to translate Muller’s Prenatal Attachment Inventory (PAI) from English to Arabic, examine the cultural appropriateness of this tool, and test its psychometric properties with pregnant women in an Arab country. Materials and methods The PAI was translated from English into Arabic using the Universal Translation Approach (modified tool) and assessed for content validity. During this process four additional items were identified for measurement relevance and cultural acceptability resulting in the revised tool. The psychometric properties of the modified and revised tools were assessed after 250 pregnant Arab women completed the PAI. Factor analysis was conducted to assess construct validity, while reliability was assessed using Cronbach’s alpha coefficient. Results Both tools were shown to be unidimensional with excellent reliability (Cronbach’s alpha = 0.88 for the modified tool and 0.89 for the revised tool). Nulliparity, planning to breastfeed the baby, feeling fetal movements, and downloading a smartphone app to follow the baby’s growth were associated with increased MFA in the PAI, while only planning to breastfeed the baby, feeling fetal movements, and downloading a smartphone app to follow the baby’s growth were associated with increased MFA in the revised PAI. Conclusion The Arabic version of the PAI is a culturally appropriate tool to measure MFA amongst Arabic-speaking women.
Published: 2021
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7. Expression of Glucose Transporters 1 and 3 in the Placenta of Pregnant Women with Gestational Diabetes Mellitus

Author: Waleed Aldahmash, Abdel Halim Harrath, Khaldoon Aljerian, Yasser Sabr, and Saleh Alwasel
Subjects: glucose transporter, placenta, pregnant women, gestational diabetes mellitus, apoptosis, birth weight, Science
Abstract: Background: The annual prevalence of gestational diabetes mellitus—characterized by an increase in blood glucose in pregnant women—has been increasing worldwide. The goal of this study was to evaluate the expression of glucose transporter 1 (GLUT1) and glucose transporter 3 (GLUT3) in the placenta of women with gestational diabetes mellitus. Methods: Sixty-five placentas from women admitted to the King Saud University Medical City, Riyadh, Saudi Arabia, were analyzed; 34 and 31 placentas were from healthy pregnant women and women with gestational diabetes, respectively. The expressions of GLUT1 and GLUT3 were assessed using RT-PCR, Western blotting, and immunohistochemical methods. The degree of apoptosis in the placental villi was estimated via a TUNEL assay. Results: The results of the protein expression assays and immunohistochemical staining showed that the levels of GLUT1 and GLUT3 were significantly higher in the placentas of pregnant women with gestational diabetes than those in the placentas of healthy pregnant women. In addition, the findings showed an increase in apoptosis in the placenta of pregnant women with gestational diabetes compared to that in the placenta of healthy pregnant women. However, the results of gene expression assays showed no significant difference between the two groups. Conclusions: Based on these results, we conclude that gestational diabetes mellitus leads to an increased incidence of apoptosis in the placental villi and alters the level of GLUT1 and GLUT3 protein expressions in the placenta of women with gestational diabetes. Understanding the conditions in which the fetus develops in the womb of a pregnant woman with gestational diabetes may help researchers understand the underlying causes of the development of chronic diseases later in life.
Published: 2023
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8. Quality assessment of evidence-based clinical practice guidelines for the management of pregnant women with sickle cell disease using the AGREE II instrument: a systematic review

Author: Yasser S. Amer, Yasser Sabr, Ghada M. ElGohary, Amer M. Altaki, Osamah T. Khojah, Ahmed El-Malky, and Musa F. Alzahrani
Subjects: Sickle cell disease, pregnancy, practice guidelines, AGREE II instrument, quality assessment, Gynecology and obstetrics, RG1-991
Abstract: Abstract Background The management of pregnant women with sickle cell disease (SCD) poses a major challenge for maternal healthcare services owing to the potential for complications associated with morbidity and mortality. Trustworthy evidence-based clinical practice guidelines (CPGs) have a major impact on the positive outcomes of appropriate healthcare. The objective of this study was to critically appraise the quality of recent CPGs for SCD in pregnant women. Methods Clinical questions were identified and the relevant CPG and bibliographic databases were searched and screened for eligible CPGs. Each CPG was appraised by four independent appraisers using the AGREE II Instrument. Inter-rater analysis was conducted. Results Four eligible CPGs were appraised: American College of Obstetricians and Gynecologists (ACOG), National Heart, Lung, and Blood Institute (NHLBI), National Institute of Health and Care Excellence (NICE), and Royal College of Obstetricians and Gynaecologists (RCOG). Among them, the overall assessments of three CPGs (NICE, RCOG, NHLBI) scored greater than 70%; these findings were consistent with the high scores in the six domains of AGREE II, including:[1] scope and purpose,[2] stakeholder involvement,[3] rigor of development,[4] clarity of presentation,[5] applicability, and [6] editorial independence domains. Domain [3] scored (90%, 73%, 71%), domain [5] (90%, 46%, 47%), and domain [6] (71%, 77%, 52%) for NICE, RCOG, and NHLBI, respectively. Overall, the clinical recommendations were not significantly different between the included CPGs. Conclusions Three evidence-based CPGs presented superior methodological quality. NICE demonstrated the highest quality followed by RCOG and NHLBI and all three CPGs were recommended for use in practice.
Published: 2020
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9. Prevalence of restless legs syndrome among pregnant women: A case–control study

Author: Aljohara S Almeneessie, Nada Alyousefi, Maha Alzahrani, Aisha Alsafi, Raneem Alotaibi, Awad H Olaish, Yasser Sabr, and Ahmed S Bahammam
Subjects: anemia, diabetes mellitus, movement disorders, parity, sleep, vitamin d, Diseases of the circulatory (Cardiovascular) system, RC666-701, Diseases of the respiratory system, RC705-779
Abstract: BACKGROUND: This cross-sectional case–control study aimed to assess the prevalence of restless legs syndrome (RLS) and its correlates and severity among Arab (Saudi) pregnant women attending antenatal care clinics. METHODS: We interviewed 742 consecutive pregnant women attending antenatal clinics face-to-face using the International RLS Study Group (IRLSSG) criteria. We assessed the severity of RLS using the IRLSSG severity scale for RLS (IRLS). A similar number of age-matched nonpregnant women were enrolled in a control group. RESULTS: Among the cases, 104 (14%) were in the first trimester, 232 (31.3%) in the second trimester, and 406 (54.7%) in the third trimester. The RLS prevalence in cases and controls was 30% and 26.5%, respectively, (P = 0.134). Among cases, severe/very severe RLS was diagnosed in 25% and mild/moderate in 75%, compared with 15% of controls having severe/very severe RLS and 85% having mild/moderate RLS (P < 0.001). Multivariate binary logistic regression analysis identified the following parameters as independent predictors of RLS: parity (odds ratio [OR] 1.113 [confidence intervals [CI] 1.012–1.223], P = 0.027), anemia (OR 1.452 [1.033–2.042], P = 0.03), diabetes mellitus (OR 1.734 [CI 1.084–2.774], P = 0.022), Vitamin D deficiency (OR 2.376 [CI 1.488–3.794],P < 0.001), and smoking (OR 3.839 [CI 1.463–10.074], P = 0.006). None of the cases had been diagnosed or treated for RLS in the antenatal clinics. CONCLUSION: RLS is common, but underdiagnosed, among Saudi pregnant women and nonpregnant women of childbearing age. The study revealed that RLS during pregnancy is linked to parity, anemia, diabetes mellitus, Vitamin D deficiency, and smoking.
Published: 2020
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10. Systematic review and meta-analysis of the effectiveness of pre-pregnancy care for women with diabetes for improving maternal and perinatal outcomes.

Author: Hayfaa A Wahabi, Amel Fayed, Samia Esmaeil, Hala Elmorshedy, Maher A Titi, Yasser S Amer, Rasmieh A Alzeidan, Abdulaziz A Alodhayani, Elshazaly Saeed, Khawater H Bahkali, Melissa K Kahili-Heede, Amr Jamal, and Yasser Sabr
Subjects: Medicine, Science
Abstract: BACKGROUND:Pre-gestational diabetes mellitus is associated with increased risk of maternal and perinatal adverse outcomes. This systematic review was conducted to evaluate the effectiveness and safety of pre-conception care (PCC) in improving maternal and perinatal outcomes. METHODS:Databases from MEDLINE, EMBASE, WEB OF SCIENCE, and Cochrane Library were searched, including the CENTRAL register of controlled trials, and CINHAL up until March 2019, without any language restrictions, for any pre-pregnancy care aiming at health promotion, glycemic control, and screening and treatment of diabetes complications in women with type I or type II pre-gestational diabetes. Trials and observational studies were included in the review. Newcastle-Ottawa scale and the Cochrane collaboration methodology for data synthesis and analysis were used, along with the GRADE tool to evaluate the body of evidence. RESULTS:The search identified 8500 potentially relevant citations of which 40 reports of 36 studies were included. The meta-analysis results show that PCC reduced congenital malformations risk by 71%, (Risk ratio (RR) 0.29; 95% CI: 0.21-0.40, 25 studies; 5903 women; high-certainty evidence). The results also show that PCC may lower HbA1c in the first trimester of pregnancy by an average of 1.27% (Mean difference (MD) 1.27; 95% CI: 1.33-1.22; 4927 women; 24 studies, moderate-certainty evidence). Furthermore, the results suggest that PCC may lead to a slight reduction in the risk of preterm delivery of 15%, (RR 0.85; 95% CI: 0.73-0.99; nine studies, 2414 women; moderate-certainty evidence). Moreover, PCC may result in risk reduction of perinatal mortality by 54%, (RR 0.46; 95% CI: 0.30-0.73; ten studies; 3071 women; moderate-certainty evidence). There is uncertainty about the effects of PCC on the early booking for antenatal care (MD 1.31; 95% CI: 1.40-1.23; five studies, 1081 women; very low-certainty evidence) and maternal hypoglycemia in the first trimester, (RR 1.38; 95% CI: 1.07-1.79; three studies; 686 women; very low- certainty evidence). In addition, results of the meta-analysis indicate that PCC may lead to 48% reduction in the risk of small for gestational age (SGA) (RR 0.52; 95% CI: 0.37-0.75; six studies, 2261 women; moderate-certainty evidence). PCC may reduce the risk of neonatal admission to intensive care unit (NICU) by 25% (RR 0.75; 95% CI: 0.67-0.84; four studies; 1322 women; moderate-certainty evidence). However, PCC may have little or no effect in reducing the cesarean section rate (RR 1.02; 95% CI: 0.96-1.07; 14 studies; 3641 women; low-certainty evidence); miscarriage rate (RR 0.86; 95% CI: 0.70-1.06; 11 studies; 2698 women; low-certainty evidence); macrosomia rate (RR 1.06; 95% CI: 0.97-1.15; nine studies; 2787 women, low-certainty evidence); neonatal hypoglycemia (RR 0.93; 95% CI: 0.74-1.18; five studies; 880 women; low-certainty evidence); respiratory distress syndrome (RR 0.78; 95% CI: 0.47-1.29; four studies; 466 women; very low-certainty evidence); or shoulder dystocia (RR 0.28; 95% CI: 0.07-1.12; 2 studies; 530 women; very low-certainty evidence). CONCLUSION:PCC for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations. In addition, it may improve the risk of preterm delivery and admission to NICU. PCC probably reduces maternal HbA1C in the first trimester of pregnancy, perinatal mortality and SGA. There is uncertainty regarding the effects of PCC on early booking for antenatal care or maternal hypoglycemia during the first trimester of pregnancy. PCC has little or no effect on other maternal and perinatal outcomes.
Published: 2020
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11. Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004-2013.

Author: U Vivian Ukah, Hamideh Bayrampour, Yasser Sabr, Neda Razaz, Wee-Shian Chan, Kenneth I Lim, and Sarka Lisonkova
Subjects: Medicine
Abstract: BACKGROUND:Suboptimal weight gain during pregnancy is a potentially modifiable risk factor. We aimed to investigate the association between suboptimal gestational weight gain and severe adverse birth outcomes by pre-pregnancy body mass index (BMI) categories, including obesity class I to III. METHODS AND FINDINGS:We conducted a population-based study of pregnant women with singleton hospital births in Washington State, US, between 2004 and 2013. Optimal, low, and excess weight gain in each BMI category was calculated based on weight gain by gestational age as recommended by the American College of Obstetricians and Gynecologists and the Institute of Medicine. Primary composite outcomes were (1) maternal death and/or severe maternal morbidity (SMM) and (2) perinatal death and/or severe neonatal morbidity. Logistic regression was used to obtain adjusted odds ratios (AORs) and 95% confidence intervals. Overall, 722,839 women with information on pre-pregnancy BMI were included. Of these, 3.1% of women were underweight, 48.1% had normal pre-pregnancy BMI, 25.8% were overweight, and 23.0% were obese. Only 31.5% of women achieved optimal gestational weight gain. Women who had low weight gain were more likely to be African American and have Medicaid health insurance, while women with excess weight gain were more likely to be non-Hispanic white and younger than women with optimal weight gain in each pre-pregnancy BMI category. Compared with women who had optimal weight gain, those with low gestational weight gain had a higher rate of maternal death, 7.97 versus 2.63 per 100,000 (p = 0.027). In addition, low weight gain was associated with the composite adverse maternal outcome (death/SMM) in women with normal pre-pregnancy BMI and in overweight women (AOR 1.12, 95% CI 1.04-1.21, p = 0.004, and AOR 1.17, 95% CI 1.04-1.32, p = 0.009, respectively) compared to women in the same pre-pregnancy BMI category who had optimal weight gain. Similarly, excess gestational weight gain was associated with increased rates of death/SMM among women with normal pre-pregnancy BMI (AOR 1.20, 95% CI 1.12-1.28, p < 0.001) and obese women (AOR 1.12, 95% CI 1.01-1.23, p = 0.019). Low gestational weight gain was associated with perinatal death and severe neonatal morbidity regardless of pre-pregnancy BMI, including obesity classes I, II, and III, while excess weight gain was associated with severe neonatal morbidity only in women who were underweight or had normal BMI prior to pregnancy. Study limitations include the ascertainment of pre-pregnancy BMI using self-report, and lack of data availability for the most recent years. CONCLUSIONS:In this study, we found that most women do not achieve optimal weight gain during pregnancy. Low weight gain was associated with increased risk of severe adverse birth outcomes, and in particular with maternal death and perinatal death. Excess gestational weight gain was associated with severe adverse birth outcomes, except for women who were overweight prior to pregnancy. Weight gain recommendations for this group may need to be reassessed. It is important to counsel women during pregnancy about specific risks associated with both low and excess weight gain.
Published: 2019
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12. Neonatal respiratory morbidity following exposure to chorioamnionitis

Author: Amy Metcalfe, Sarka Lisonkova, Yasser Sabr, Amelie Stritzke, and KS Joseph
Subjects: Chorioamnionitis, Bronchopulmonary dysplasia, Respiratory distress syndrome, Fetuses at risk, Pediatrics, RJ1-570
Abstract: Abstract Background There are conflicting results in the literature on the impact of chorioamnionitis on neonatal respiratory morbidities. However, most studies are based on small clinical samples and fail to account for the competing risk of perinatal death. This study aimed to determine whether chorioamnionitis affects the incidence of respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) after accounting for the increased risk of death. Methods Retrospective cohort study using linked birth and infant death registration and hospitalization records from Washington State between 2002 and 2011 (n = 763,671 singleton infants and n = 56,537 singleton preterm infants). Logistic regression models based on the traditional and fetuses-at-risk approaches were used to model two composite outcomes namely RDS and perinatal death and BPD and perinatal death. Confounders adjusted for in the models included maternal age, race, diabetes, hypertension, antenatal corticosteroids, mode of delivery and infant sex. Results While models using the traditional approach found a significant association only between chorioamnionitis and composite BPD and perinatal death (OR = 1.23, 95% CI: 1.01–1.50); using the fetuses-at-risk approach, there was a significant association between chorioamnionitis and both composite outcomes (RDS and perinatal death OR = 2.74, 2.50–3.01; BPD and perinatal death OR = 5.18, 95% CI: 4.39–6.11). Conclusion The fetuses-at-risk approach models the causal impact of chorioamnionitis on the development of the fetal lung and shows an increased risk of RDS, BPD and perinatal death associated with such maternal infection.
Published: 2017
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13. Maternal age and severe maternal morbidity: A population-based retrospective cohort study.

Author: Sarka Lisonkova, Jayson Potts, Giulia M Muraca, Neda Razaz, Yasser Sabr, Wee-Shian Chan, and Michael S Kramer
Subjects: Medicine
Abstract: BackgroundOne of the United Nations' Millennium Development Goals of 2000 was to reduce maternal mortality by 75% in 15 y; however, this challenge was not met by many industrialized countries. As average maternal age continues to rise in these countries, associated potentially life-threatening severe maternal morbidity has been understudied. Our primary objective was to examine the associations between maternal age and severe maternal morbidities. The secondary objective was to compare these associations with those for adverse fetal/infant outcomes.Methods and findingsThis was a population-based retrospective cohort study, including all singleton births to women residing in Washington State, US, 1 January 2003-31 December 2013 (n = 828,269). We compared age-specific rates of maternal mortality/severe morbidity (e.g., obstetric shock) and adverse fetal/infant outcomes (e.g., perinatal death). Logistic regression was used to adjust for parity, body mass index, assisted conception, and other potential confounders. We compared crude odds ratios (ORs) and adjusted ORs (AORs) and risk differences and their 95% CIs. Severe maternal morbidity was significantly higher among teenage mothers than among those 25-29 y (crude OR = 1.5, 95% CI 1.5-1.6) and increased exponentially with maternal age over 39 y, from OR = 1.2 (95% CI 1.2-1.3) among women aged 35-39 y to OR = 5.4 (95% CI 2.4-12.5) among women aged ≥50 y. The elevated risk of severe morbidity among teen mothers disappeared after adjustment for confounders, except for maternal sepsis (AOR = 1.2, 95% CI 1.1-1.4). Adjusted rates of severe morbidity remained increased among mothers ≥35 y, namely, the rates of amniotic fluid embolism (AOR = 8.0, 95% CI 2.7-23.7) and obstetric shock (AOR = 2.9, 95% CI 1.3-6.6) among mothers ≥40 y, and renal failure (AOR = 15.9, 95% CI 4.8-52.0), complications of obstetric interventions (AOR = 4.7, 95% CI 2.3-9.5), and intensive care unit (ICU) admission (AOR = 4.8, 95% CI 2.0-11.9) among those 45-49 y. The adjusted risk difference in severe maternal morbidity compared to mothers 25-29 y was 0.9% (95% CI 0.7%-1.2%) for mothers 40-44 y, 1.6% (95% CI 0.7%-2.8%) for mothers 45-49 y, and 6.4% for mothers ≥50 y (95% CI 1.7%-18.2%). Similar associations were observed for fetal and infant outcomes; neonatal mortality was elevated in teen mothers (AOR = 1.5, 95% CI 1.2-1.7), while mothers over 29 y had higher risk of stillbirth. The rate of severe maternal morbidity among women over 49 y was higher than the rate of mortality/serious morbidity of their offspring. Despite the large sample size, statistical power was insufficient to examine the association between maternal age and maternal death or very rare severe morbidities.ConclusionsMaternal age-specific incidence of severe morbidity varied by outcome. Older women (≥40 y) had significantly elevated rates of some of the most severe, potentially life-threatening morbidities, including renal failure, shock, acute cardiac morbidity, serious complications of obstetric interventions, and ICU admission. These results should improve counselling to women who contemplate delaying childbirth until their forties and provide useful information to their health care providers. This information is also useful for preventive strategies to lower maternal mortality and severe maternal morbidity in developed countries.
Published: 2017
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14. Impact of COVID-19 pandemic on urology residency training

Author: Meshari A Alzahrani, Raed Almannie, Mana Almuhaideb, Fahad A Alyami, and Yasser Sabr
Subjects: Response rate (survey), Ordinal data, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, education, Urology, Saudi Arabia, surgical education, COVID-19, Context (language use), Diseases of the genitourinary system. Urology, Test (assessment), Pandemic, Collateral damage, Medicine, Original Article, RC870-923, business, residency, urology, Residency training
Abstract: Context: The COVID-19 pandemic has led a lot of countries worldwide to go on lockdown. Potential collateral damage is the impact of residency. Aims: The aim of this study is to assess the impact of COVID-19 pandemic on urology training aspects, study habits of residents, and their awareness and training regarding COVID-19. Settings and Design: A questionnaire aiming to assess the impact of COVID-19 pandemic on different urology training aspects. The questionnaire was sent to all urology residents under the Saudi Commission for Health Specialties (SCFHS) programs. Subjects and Methods: Urology residents under SCFHS programs, excluding 1st-year residents. The questionnaire included the following sections: demographic data, studying habits during the pandemic, involvement in training before the pandemic, involvement in training during the pandemic, and training related to COVID-19. Statistical Analysis Used: Using the SPSS software, frequencies of all data were calculated, and a Wilcoxon-signed rank test was done to assess the change in ordinal data. Results: A total of 77 residents completed the survey (38% response rate). Most residents (40.5%) reported that they “strongly agree” with the statement that they have more time for reading. There has been a decrease in on-call duties, outpatient visits, diagnostic procedures, endoscopic surgeries urology, minimally-invasive surgeries, and major open surgeries in comparison to before the pandemic, with a decrease in mean scores in all domains, especially in diagnostic procedures. Conclusions: There has been a decrease in residents' involvement in all training domains, and this has been similar to the results of other studies. E-learning sources, during these times, present themselves as a valuable source to compensate for what has been missed in training.
Published: 2021

15. Racial and Ethnic Disparities in the Perinatal Health of Infants Conceived by ART

Author: Sarka Lisonkova, Ugochinyere Vivian Ukah, Sid John, Lauren Yearwood, Giulia M Muraca, Neda Razaz, Yasser Sabr, Paul J Yong, and Mohamed A. Bedaiwy
Subjects: Pregnancy Complications, Pregnancy, Fertilization, Pediatrics, Perinatology and Child Health, Infant, Newborn, Ethnicity, Infant, Humans, Premature Birth, Female, United States, Retrospective Studies
Abstract: BACKGROUND AND OBJECTIVES Although racial and ethnic disparities in adverse birth outcomes have been well documented, it is unknown whether such disparities diminish in women who use medically assisted reproduction (MAR). We examined differences in the association between maternal race and ethnicity and adverse birth outcomes among women who conceived spontaneously and those who used MAR, including assisted reproduction technology (ART), eg, in-vitro fertilization, and also non-ART MAR, eg, fertility drugs. METHODS We conducted a population-based retrospective cohort study using data on all singleton births (N = 7 545 805) in the United States from 2016 to 2017. The outcomes included neonatal and fetal death, preterm birth, and serious neonatal morbidity, among others. Modified Poisson regression was used to estimate adjusted rate ratios (aRR) and 95% confidence intervals (CI) and to assess the interactions between race and ethnicity and mode of conception. RESULTS Overall, 93 469 (1.3%) singletons were conceived by MAR. Neonatal mortality was twofold higher among infants of non-Hispanic Black versus non-Hispanic White women in the spontaneous-conception group (aRR = 1.9, 95% CI: 1.8–1.9), whereas in the ART-conception group, neonatal mortality was more than fourfold higher in infants of non-Hispanic Black women (aRR = 4.1, 95% CI: 2.9–5.9). Racial and ethnic disparities between Hispanic versus non-Hispanic White women were also significantly larger among women who conceived using MAR with regard to preterm birth ( CONCLUSIONS Compared to women who conceived spontaneously, racial and ethnic disparities in adverse perinatal outcomes were larger in women who used MAR. More research is needed to identify preventive measures for reducing risks among vulnerable women who use medically assisted reproduction.
Published: 2022

16. Severe Maternal Morbidity and Maternal Mortality Associated with Assisted Reproductive Technology

Author: Yasser Sabr, Sarka Lisonkova, Amanda Skoll, Rollin Brant, Maria P. Velez, and K.S. Joseph
Subjects: Cohort Studies, HELLP Syndrome, Maternal Mortality, Pre-Eclampsia, Reproductive Techniques, Assisted, Pregnancy, Obstetrics and Gynecology, Humans, Eclampsia, Female, Hemorrhage, Acute Kidney Injury, Retrospective Studies
Abstract: To assess the association between use of assisted reproductive technologies (ART) and severe maternal morbidity and maternal mortality (SMM).We carried out a cohort study that included all hospital deliveries at ≥20 weeks gestation in Canada (excluding Québec) between April 2009 and March 2018. Outcomes of interest included composite SMM and SMM types (e.g., severe preeclampsia, HELLP syndrome, and eclampsia; severe hemorrhage; acute renal failure). Multivariable regression was used to estimate crude and adjusted rate ratios (RR and aRR) and 95% confidence intervals (CI).The study included 2 535 056 women, of whom 72 023 (2.8%) delivered following the use of ART. The composite SMM rate for women who used ART was 34.7 per 1000 deliveries (95% CI 33.0-36.0) versus 11.5 per 1000 deliveries (95% CI 11.4-11.6) for women who did not use ART (RR 3.01; 95% CI 2.89-3.14). ART use was associated with SMM types such as severe preeclampsia, HELLP syndrome, and eclampsia (RR 3.50; 95% CI 3.27-3.73), severe hemorrhage (RR 3.58, 95% CI 3.27-3.92), and acute renal failure (RR 6.79; 95% CI 5.78-7.98). Associations between ART and composite SMM were attenuated but remained elevated after adjusting for maternal characteristics (aRR 2.34; 95% CI 2.24-2.45). Women who used ART and had a multi-fetal pregnancy had a 4.7 times higher rate of composite SMM compared with women who did not use ART and delivered singletons.Women who deliver following the use of ART have increased risks of SMM and require counselling that includes mention of the lower risks of SMM associated with ART-conceived singleton pregnancy.
Published: 2022

17. Saudi Society of Maternal-Fetal Medicine guidance on pregnancy and coronavirus disease 2019

Author: Yaser Faden, Eman S. Alsulmi, Nadia A. Alghilan, Samiha H. Al-Awami, Hythem Al-Sum, Fadwah Tahir, Nabeel S. Bondagji, Yasser Sabr, and Yasir Katib
Subjects: lcsh:Medicine, 030204 cardiovascular system & hematology, medicine.disease_cause, 0302 clinical medicine, Pregnancy, 030212 general & internal medicine, Pregnancy Complications, Infectious, Societies, Medical, Coronavirus, Infectious disease transmission, Obstetrics, Pregnancy Outcome, Prenatal Care, General Medicine, Perinatology, Tocolytic Agents, Female, Coronavirus Infections, Hydroxychloroquine, Postnatal Care, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Critical Illness, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, Saudi Arabia, high-risk pregnancy, Antiviral Agents, Congenital Abnormalities, Maternal-fetal medicine, coronavirus disease 2019, Betacoronavirus, Magnesium Sulfate, 03 medical and health sciences, antenatal care, Thromboembolism, medicine, Humans, Pandemics, Personal Protective Equipment, Heparin, SARS-CoV-2, business.industry, lcsh:R, Infant, Newborn, Anticoagulants, COVID-19, Delivery, Obstetric, medicine.disease, Infectious Disease Transmission, Vertical, COVID-19 Drug Treatment, Statement, business, High risk pregnancy
Abstract: [No Abstract Available] Saudi Med J 2020; Vol. 41 (8): 779-790doi: 10.15537/smj.2020.8.25222 How to cite this article:Yaser A. Faden, Nadia A. Alghilan, Samiha H. Alawami, Eman S. Alsulmi, Hythem A. Alsum, Yasir A. Katib, Yasser S. Sabr, Fadwah H. Tahir, Nabeel S. Bondagji. Saudi Society of Maternal-Fetal Medicine guidance on pregnancy and coronavirus disease 2019. Saudi Med J 2020; Vol. 41 (8): 779-790. doi: 10.15537/smj.2020.8.25222.
Published: 2020

18. Biallelic MFSD2A variants associated with congenital microcephaly, developmental delay, and recognizable neuroimaging features

Author: Pasquale Striano, Ehsan Ghayoor Karimiani, Vincenzo Salpietro, Hao Fan, Yasser Sabr, Cheen Fei Chin, Emer O'Connor, Henry Houlden, Saima Riazuddin, Hessa S. Alsaif, David L. Silver, Elena L. Dadali, Yalda Jamshidi, Artem Borovikov, Galina Baydakova, F. A. Konovalov, Reza Maroofian, Fowzan S. Alkuraya, Mehran Beiraghi Toosi, M. Chiara Manzini, Mariasavina Severino, Federico Zara, Alvin Kuk, Abdullah Alfaifi, Ekaterina R. Lozier, Farah Ashrafzadeh, Marcello Scala, Geok Lin Chua, Mohammad Doosti, and Sheikh Riazuddin
Subjects: Adult, Male, Adolescent, Developmental Disabilities, Congenital microcephaly, Biology, Article, White matter, Protein Domains, Neuroimaging, Genetics, medicine, Humans, Child, Genetics (clinical), Exome sequencing, Symporters, Infant, Transporter, Syndrome, Magnetic Resonance Imaging, Phenotype, Major facilitator superfamily, HEK293 Cells, medicine.anatomical_structure, Child, Preschool, Mutation, Autosomal Recessive Primary Microcephaly, Microcephaly, Female, Agenesis of Corpus Callosum
Abstract: Major Facilitator Superfamily Domain containing 2a (MFSD2A) is an essential endothelial lipid transporter at the blood-brain barrier. Biallelic variants affecting function in MFSD2A cause autosomal recessive primary microcephaly 15 (MCPH15, OMIM# 616486). We sought to expand our knowledge of the phenotypic spectrum of MCPH15 and demonstrate the underlying mechanism of inactivation of the MFSD2A transporter. We carried out detailed analysis of the clinical and neuroradiological features of a series of 27 MCPH15 cases, including eight new individuals from seven unrelated families. Genetic investigation was performed through exome sequencing (ES). Structural insights on the human Mfsd2a model and in-vitro biochemical assays were used to investigate the functional impact of the identified variants. All patients had primary microcephaly and severe developmental delay. Brain MRI showed variable degrees of white matter reduction, ventricular enlargement, callosal hypodysgenesis, and pontine and vermian hypoplasia. ES led to the identification of six novel biallelic MFSD2A variants (NG_053084.1, NM_032793.5: c.556+1G>A, c.748G>T; p.(Val250Phe), c.750_753del; p.(Cys251SerfsTer3), c.977G>A; p.(Arg326His), c.1386_1435del; p.(Gln462HisfsTer17), and c.1478C>T; p.(Pro493Leu)) and two recurrent variants (NM_032793.5: c.593C>T; p.(Thr198Met) and c.476C>T; p.(Thr159Met)). All these variants and the previously reported NM_032793.5: c.490C>A; p.(Pro164Thr) resulted in either reduced MFSD2A expression and/or transport activity. Our study further delineates the phenotypic spectrum of MCPH15, refining its clinical and neuroradiological characterization and supporting that MFSD2A deficiency causes early prenatal brain developmental disruption. We also show that poor MFSD2A expression despite normal transporter activity is a relevant pathomechanism in MCPH15.
Published: 2020

19. Maternal risk factors and adverse birth outcomes associated with HELLP syndrome: a population‐based study

Author: K.S. Joseph, Sarka Lisonkova, Chantal Mayer, Giulia M. Muraca, Amélie Boutin, Neda Razaz, Yasser Sabr, and Michael S. Kramer
Subjects: Adult, Gestational hypertension, Canada, HELLP Syndrome, medicine.medical_specialty, Adolescent, Databases, Factual, HELLP syndrome, Population, Infant, Newborn, Diseases, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Risk Factors, 030202 anesthesiology, 030225 pediatrics, medicine, Humans, education, Retrospective Studies, education.field_of_study, 030219 obstetrics & reproductive medicine, Eclampsia, Obstetrics, business.industry, Infant, Newborn, Obstetrics and Gynecology, Odds ratio, Middle Aged, Stillbirth, medicine.disease, 3. Good health, Case-Control Studies, Female, Maternal death, Live birth, business, Cohort study
Abstract: OBJECTIVES We assessed the incidence, risk factors and adverse birth outcomes associated with elevated liver enzymes and low platelets (HELLP) syndrome. DESIGN A retrospective population-based cohort study. SETTING Canada (excluding Quebec), 2012/2013-2015/2016. POPULATION Mothers with a singleton hospital live birth or stillbirth at ≥24 weeks' gestation (n = 1 078 323). METHODS HELLP syndrome was identified using ICD-10-CA diagnostic code from delivery hospitalisation data. We used logistic regression to identify independent risk factors for HELLP syndrome by obtaining adjusted odds ratios (AOR) and 95% confidence intervals (CI), and to assess the associations with adverse outcomes. MAIN OUTCOME MEASURES Adverse maternal (e.g. eclampsia) and fetal/neonatal outcomes (e.g. intraventricular haemorrhage, perinatal death). RESULTS The incidence of HELLP syndrome was 2.5 per 1000 singleton deliveries (n = 2663). Risk factors included: age ≥35 years, rural residence, nulliparity, parity ≥4, pre-pregnancy and gestational hypertension and diabetes, assisted reproduction, chronic cardiac conditions, systemic lupus erythematosus, obesity, chronic hepatic conditions, placental disorders (e.g. fetomaternal transfusion) and congenital anomalies. PROM and age
Published: 2020

20. 842Prevention of severe preeclampsia at term gestation among women with chronic hypertension

Author: Neda Razaz, Jeffrey N Bone, K.S. Joseph, Giulia M. Muraca, Sarka Lisonkova, Yasser Sabr, and Amélie Boutin
Subjects: medicine.medical_specialty, Pregnancy, Eclampsia, Epidemiology, Obstetrics, business.industry, medicine.medical_treatment, General Medicine, medicine.disease, Severe preeclampsia, Hospital records, Labor induction, medicine, Chronic hypertension, business, Term gestation, Perinatal period
Abstract: Background Chronic hypertension is a strong risk factor for severe preeclampsia/eclampsia (SPE), and timely obstetric intervention can prevent SPE and reduce perinatal complications. We quantified gestational age-specific rates of SPE and estimated the benefits of preventive interventions among women with chronic hypertension at term gestation (≥37 weeks). Methods Women with chronic hypertension and a term, singleton, hospital delivery in Washington State, 2003-2013, were included in the study (N = 9697) with data obtained from birth certificates and hospital records. Adverse outcomes included SPE and composite severe neonatal morbidity (e.g., seizures, intracranial hemorrhage) and perinatal death (SNMM). Preventive interventions included labour induction and pre-labour cesarean delivery. Results There were 1026 cases of SPE (10.6 per 100 women with chronic hypertension). Gestational age-specific SPE rates ranged between 2.8 and 4.1 per 100 ongoing pregnancies; the frequency of preventive intervention at each gestational week ranged between 58% and 66%. Gestational age-specific SPE and SNMM rates were lower following preventive intervention: such intervention reduced the frequency of SPE/SNMM by 28 per 100 additional interventions at 37 weeks, 22 per 100 at 38 weeks, 17 per 100 at 39 weeks, 13 at 40 weeks and 6 per 100 additional interventions at 41 weeks’ gestation. Conclusions Labour induction and pre-labour cesarean delivery at term gestation can prevent a substantial proportion of severe preeclampsia/eclampsia and perinatal death/severe neonatal morbidity among women with chronic hypertension. Key messages SPE occurs in approximately 11% of women with chronic hypertension at term gestation. Obstetric interventions can prevent SPE and improve adverse pregnancy outcomes.
Published: 2021

21. Racial disparities in birth outcomes following assisted reproduction

Author: Sarka Lisonkova, Siddharth John, Lauren M. Yearwood, Vivian Ukah, Yasser Sabr, Giulia M. Muraca, Neda Razaz, and Mohamed A. Bedaiwy
Subjects: Obstetrics and Gynecology
Published: 2022

22. The Role Of Progestogens In Threatened And Idiopathic Recurrent Miscarriage

Author: Hisham Arab, Yaser Faden, Hassan S. Abduljabbar, Ahmed Jaber Alharbi, Yasser Sabr, Emad Sagr, Hana Al Madani, Ayman Oraif, and Osama S. Bajouh
Subjects: medicine.medical_specialty, Threatened miscarriage, medicine.drug_class, medicine.medical_treatment, education, Gestational sac, 03 medical and health sciences, 0302 clinical medicine, parasitic diseases, Maternity and Midwifery, Recurrent miscarriage, medicine, 030212 general & internal medicine, Pregnancy, 030219 obstetrics & reproductive medicine, Progestogen, Obstetrics, business.industry, Obstetrics and Gynecology, medicine.disease, medicine.anatomical_structure, Oncology, Threatened species, business, Progestin, geographic locations
Abstract: It is well known that progesterone plays a major role in the maintenance of pregnancy, particularly during the early stages, as it is responsible for preparing the endometrium for implantation and maintenance of the gestational sac. The management of pregnant women at risk of a threatened or idiopathic recurrent miscarriage is complex and critical. Therefore, a group of obstetricians and gynecologists practicing in Saudi Arabia gathered to update the 2014 Saudi guidelines for threatened and recurrent miscarriage management. In preparation, a literature review was conducted to explore the role of oral, vaginal, and injectable progestogens: this was used as a basis to develop position statements to guide and standardize practice across Saudi Arabia.
Published: 2019

23. Incidence and Risk Factors for Severe Preeclampsia, Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome, and Eclampsia at Preterm and Term Gestation: A Population-based Study

Author: K.S. Joseph, Neda Razaz, Jeffrey N Bone, Li Qing Wang, Yasser Sabr, Sarka Lisonkova, Amélie Boutin, Chantal Mayer, and Giulia M. Muraca
Subjects: Adult, Canada, medicine.medical_specialty, Adolescent, Term Birth, HELLP syndrome, Population, Rate ratio, Hemolysis, Cohort Studies, Young Adult, Liver Function Tests, Pre-Eclampsia, Pregnancy, Risk Factors, Management of Technology and Innovation, medicine, Humans, Eclampsia, Cumulative incidence, education, reproductive and urinary physiology, Retrospective Studies, education.field_of_study, business.industry, Obstetrics, Incidence, Pregnancy Complications, Hematologic, Obstetrics and Gynecology, medicine.disease, Thrombocytopenia, Comorbidity, female genital diseases and pregnancy complications, Parity, Social Class, Premature Birth, Gestation, Female, business
Abstract: The majority of previous studies on severe preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count syndrome were hospital-based or included a relatively small number of women. Large, population-based studies examining gestational age-specific incidence patterns and risk factors for these severe pregnancy complications are lacking.This study aimed to assess the gestational age-specific incidence rates and risk factors for severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia.We carried out a retrospective, population-based cohort study that included all women with a singleton hospital birth in Canada (excluding Quebec) from 2012 to 2016 (N=1,078,323). Data on the primary outcomes (ie, severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia) were obtained from delivery hospitalization records abstracted by the Canadian Institute for Health Information. A Cox regression was used to assess independent risk factors (eg, maternal age and chronic comorbidity) for each primary outcome and to assess differences in the effects at preterm vs term gestation (37 vs ≥37 weeks).The rates of severe preeclampsia (n=2533), hemolysis, elevated liver enzymes, and low platelet count syndrome (n=2663), and eclampsia (n=465) were 2.35, 2.47, and 0.43 per 1000 singleton pregnancies, respectively. The cumulative incidence of term-onset severe preeclampsia was lower than that of preterm-onset severe preeclampsia (0.87 vs 1.54 per 1000; rate ratio, 0.57; 95% confidence intervals, 0.53-0.62), the rates of hemolysis, elevated liver enzymes, and low platelet count syndrome were similar (1.32 vs 1.23 per 1000; rate ratio, 0.93; 95% confidence interval, 0.86-1.00), and the preterm-onset eclampsia rate was lower than the term-onset rate (0.12 vs 0.33 per 1000; rate ratio, 2.64; 95% confidence interval, 2.16-3.23). For each primary outcome, chronic comorbidity and congenital anomalies were stronger risk factors for preterm- vs term-onset disease. Younger mothers (aged25 years) were at higher risk for severe preeclampsia at term and for eclampsia at all gestational ages, whereas older mothers (aged ≥35 years) had elevated risks for severe preeclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome. Regardless of gestational age, nulliparity was a risk factor for all outcomes, whereas socioeconomic status was inversely associated with severe preeclampsia.The risk for severe preeclampsia declined at term, eclampsia risk increased at term, and hemolysis, elevated liver enzymes, and low platelet count syndrome risk was similar for preterm and term gestation. Young maternal age was associated with an increased risk for eclampsia and term-onset severe preeclampsia. Prepregnancy comorbidity and fetal congenital anomalies were more strongly associated with severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia at preterm gestation.
Published: 2022

24. Women Health Right and Empowerment during Childbirth

Author: Yasser Sabr, Khalid Alshehri, Shahad Alqahtani, Norah Alshehri, Mouaiad Ghabban, Alanoud AlAlshaikh, and Yara Alzamil
Subjects: medicine.medical_specialty, business.industry, media_common.quotation_subject, Institutional review board, Dignity, Snowball sampling, Denial, Informed consent, Family medicine, Health care, medicine, Childbirth, Empowerment, Psychology, business, media_common
Abstract: Background: Women health right and empowerment during childbirth is an emerging important topic worldwide. Violation of women dignity, privacy, and confidentiality impact birth outcomes as consequence influencing both morbidity and mortality rate. This occurs as result to complex reasons that attributable to health services which include inadequate coverage of health care, lack of trained assistance, insufficient essential obstetric care and poor health referral system. Objective: To explore women experience during childbirth in terms of health rights and the quality of care provided and to further study women attuited and experience with midwives and their future role in obstetric care. Method: Based on informant report, a random snowballing sampling technique was carried out through using an anonymous online - based questionnaire. Participants in this study were (n=360) women. Ethical approval was obtained by the institutional review board at King Saud University (IRB No. E-18-32836). Results: The majority of women reported their childbirth experience as unfavourable. According to our findings, women encounter various kinds of obstetric violence including denial of access to a health care, restriction of analgesia, violation of privacy and failure of obtaining an informed consent which found to be high as (91.0%), (53.0%) respectively. Conclusion: Optimal maternity care can be assured through appropriate access to medical resources and health care expertise with a higher priority committed to supporting midwife-led care during childbirth.
Published: 2021

25. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study

Author: Dmitri, Nepogodiev, Joana Ff Simoes, Elizabeth, Li, Maria, Picciochi, James, C Glasbey, Glauco, Baiocchi, Ruth, Blanco-Colino, Daoud, Chaudhry, Ehab, Alameer, Kariem, El-Boghdadly, Funmilola, Wuraola, Dhruva, Ghosh, Rohan, R Gujjuri, Ewen, M Harrison, Herman, Lule, Haytham, Kaafarani, Mohammad, Khosravi, Irmgard, Kronberger, Sezai, Leventoğlu, Harvinder, Mann, Kenneth, A Mclean, Mengistu Gebreyohanes Mengesha, Maria Marta Modolo, Faustin, Ntirenganya, Lisa, Norman, Oumaima, Outani, Riinu, Pius, Peter, Pockney, Ahmad Uzair Qureshi, April Camilla Roslani, Sohei, Satoi, Catherine, Shaw, Aneel, Bhangu, Omar, M Omar, Waheed-Ul-Rahman, Ahmed, Leah, Argus, Alasdair, Ball, Edward, P Bywater, Amanpreet, Brar, Brett, E Dawson, Irani, Duran, Muhammed, Elhadi, Conor, S Jones, Sivesh, K Kamarajah, James, M Keatley, Samuel, Lawday, Ella, J Marson, Riinu, Ots, Irène, Santos, Elliott, H Taylor, Isobel, M Trout, Chris, Varghese, Mary, L Venn, William, Xu, Irida, Dajti, Arben, Gjata, Salah Eddine Oussama Kacimi, Luis, Boccalatte, Daniel, Cox, Philip, Townend, Felix, Aigner, Irmgard Elisabeth Kronberger, Elgun, Samadov, Amer, Alderazi, Kamral, Hossain, Greg, Padmore, Gabrielle van Ramshorst, Ismaïl, Lawani, Anis, Cerovac, Samir, Delibegovic, Gustavo Mendonça Ataíde Gomes, Igor Lima Buarque, Muhammad, Gohar, Mihail, Slavchev, Chukwuemeka, Nwegbu, Arnav, Agarwal, Janet, Martin, Joshua, Ng-Kamstra, Maricarmen, Olivos, Wenhui, Lou, Dong-Lin, Ren, Jose Andres Calvache, Carlos, J Perez Rivera, Ana Danic Hadzibegovic, Tomislav, Kopjar, Jakov, Mihanovic, Pablo Mijahil Avilés Jiménez, Nikolaos, Gouvas, Jaroslav, Klat, René, Novysedlák, Nicolas, Amisi, Peter, Christensen, Alaa, El-Hussuna, Sylvia, Batista, Eddy, Lincango-Naranjo, Sameh, Emile, Danilo Alfonso Arévalo Sandoval, Hailu, Dhufera, Samuel, Hailu, Mengistu, G Mengesha, Joonas, H Kauppila, Alexis, P Arnaud, Zaza, Demetrashvili, Markus, Albertsmeier, Hans, Lederhuber, Markus, W Löffler, Daniel Kwesi Acquah, Bernard, Ofori, Stephen, Tabiri, Symeon, Metallidis, Georgios, Tsoulfas, Maria-Lorena, Aguilera-Arevalo, Gustavo, Recinos, Tamás, Mersich, Dániel, Wettstein, Gabriele, Kembuan, Peiman Brouki Milan, Mohammad Hossein Khosravi, Masoud, Mozafari, Ahmed, Hilmi, Helen, Mohan, Oded, Zmora, Gaetano, Gallo, Francesco, Pata, Gianluca, Pellino, Yuki, Fujimoto, Naoto, Kuroda, Mohamad, K Abou Chaar, Faris, Ayasra, Ildar, Fakhradiyev, Intisar Hisham Said Hamdun, Jang, Jin-Young, Mohammad, Jamal, Lina, Karout, Aiste, Gulla, Fanjandrainy, Rasoaherinomenjanahary, Luc Hervé Samison, Iran Irani Durán Sánchez, Diana Samantha Gonzalez, Laura, Martinez, María José Martínez, Alejandra, Nayen, Antonio Ramos-De la Medina, Jade, Nunez, Pueya Rashid Nashidengo, Rakesh, Shah, Ashish Lal Shrestha, Pascal, Jonker, Schelto, Kruijff, Milou, Noltes, Pieter, Steinkamp, Deborah, Wright, Lukman, Abdur-Rahman, Adesoji, Ademuyiwa, Adewale, Adisa, Babatunde, Osinaike, Justina, Seyi-Olajide, Omolara, Williams, Emmanuel, Williams, Sofija, 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Volpe, Arthur, Gatti, Caroline, Nardi, Ramon, Oliva, Layze Braz de Oliveira, Herica Emilia Félix de Carvalho, Ivonizete Pires Ribeiro, Gabriel Renan Soares Rodrigues, Álvaro Francisco Lopes de Sousa, Michel, Chebel, Paulo Henrique de Sousa Fernandes, Marcelo Augusto Faria Freitas, Juliano Rodrigues da Cunha, Zeenia, Ather, Dobromir, Dimitrov, Emil, Filipov, Elitsa, Gyokova, Ivelina, Ilieva, Tsvetomir, Ivanov, Martin, Karamanliev, Vasil, Neykov, Boyko, Atanasov, Nikolay, Belev, Paolina, Kamenova, Kaloyan, Tonev, Tsanko, Yotsov, Evguenia, Hristova, Kolyo, Spassov, Tsanko, Tsankov, Dragomir, Dardanov, Petar, Gribnev, Manol, Sokolov, James, Brown, John, Tanyi, Heather, Hurdle, Anthony, Maclean, Michael, Sander, Salim Al Riyami, Krittika, Bali, David, Bigam, Khaled, Dajani, Mehran, Anvari, Rafik, Bolis, David, Choi, Susan, Ellis, Michael, Gupta, Wael, Hanna, Dennis, Hong, Cynthia, Horner, Lea, Luketic, Peter, Moisiuk, Yaron, Shargall, Hilda, Alfaro, Nawar, Alkhamesi, Laura, Allen, Muriel, Brackstone, Eunice, Chan, Davy, Cheng, Jason, Chui, Nelson, Gonzalez, Brent, Lanting, S Danielle MacNeil, Robert, Mayer, Jacob, Mcgee, Mahesh, Nagappa, Nicholas, Power, Agya, Prempeh, Mehdi, Qiabi, Hassan, Razvi, Emil, Schemitsch, Herman, Sehmbi, Ushma, Shah, Yamini, Subramani, Edward, Vasarhelyi, Kelly, Vogt, Homer, Yang, Ali Ghorbani Abdehgah, Saba, Balvardi, Liane, Feldman, Julio Flavio Fiore Jr, Melissa, Hanson, Brent, Hopkins, Pepa, Kaneva, Lawrence, Lee, Julia, Leonard, Jad, Abou-Khalil, Andre, Martel, James, Stevenson, Susan, Lee, Richard, Merchant, Samuel, Avoine, Laurence, Belanger, Mathieu, Belanger, Etienne, Belzile, Anne-Sophie, Blais, Sofia, Boucher-Kovalik, Cindy, Boulanger-Gobeil, Etienne, Cardinal, Pierre-Olivier, Champagne, Jonathan, Cloutier, Simon, Corriveau-Durand, Mathieu, Cote, Maxime, Cote, Mathilde, Côté, Valérie, Courval, Suzanne, Demers, Christine, Desbiens, Mehdi El Ouazzani, Karine, Girard, Ève-Marie, Girard, Karo, Gosselin, Helene, Khuong, Nathalie, 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Pu, Hanlin, Yin, Camilo, Caicedo, Diego Felipe Tellez Beltran, Alejandro, Escobar, Carolina Perez Granados, Lisbeth Alexandra Urueña Pinzon, Carlos, Bonilla, Diana, Santana, Oscar, Serrano, Andrea, Garcia, Fernando Giron Luque, Nasly, G Patino-Jaramillo, Laura Giselle Contreras Baquero, Nestor Augusto Muñoz Botero, Jhoana Andrea Murillo Castellanos, Andrea Juliana Vega Calvera, Lina, M Acosta Buitrago, Maria Paz Bohórquez-Tarazona, Paulo Andrés Cabrera Rivera, J Felipe Casas, Valeria Cormane Alfaro, Julian, Corso, Bayron, Guerra, Albert Franz Guerrero-Becerra, Akram Kadamani Abiyomaa, Felix Ramon Montes, Manuel Santiago Mosquera Paz, Camilo Andrés Polanía Sandoval, Natalia, Quintana, Carlos Fernando Roman Ortega, Carlos, Santacruz, Manuela, Téllez, Camilo Alejandro Velandia Sánchez, Fernando, Arias-Amézquita, Luis Felipe Cabrera Vargas, Natalia Cortes Murgueitio, Elkin, Escorcia, Kemel Ahmed Ghotme Ghotme, Jorge Luis Gomez-Mayorga, Alvaro Felipe Guerrero Vergel, Gabriel, Herrera-Almario, Eduardo, Londono-Schimmer, Juan, A Mejia, Guillermo, Monsalve, Camilo, Rodriguez, Juan Nicolas Rodriguez Niño, Luis Martín Rodríguez Ortegón, Daniel, Sanabria, Andres, Alvarez, Arnulfo, Andrade, Javier, Ardila-Montealegre, David, Baquero, Edgar Mauricio Barrios Vidales, María Alejandra Caicedo Giraldo, María Camila Carvajal, Maria, Castillo, Maria Carolina Castillo Florez, María Angelica Cendales, Danny Conde Monroy, Henry, Cortes, Mario, Daniel, Jairo De la Peña, Elena Leonor Delgado-Nieto, Hernando, Espitia, Carlos Figueroa Avendaño, Edgar Oswaldo Hernandez Burgos, Andres, Isaza-Restrepo, German, Londono, Margarita Maria Maldonado, Andrea, Montenegro, Juan Carlos Navarro, Jorge, Navarro-Alean, Katherine Parra Abaunza, Eliana, Pulido, Erika, M Ramírez Amaya, Carlos Eduardo Rey Chaves, Natalia Andrea Rivera Rincón, William Mauricio Riveros Castillo, Lizeth Rodriguez Sanchez, Wilson, Rubiano, Maria, Russi, Juan Carlos Sabogal Olarte, Javier Mauricio Salgado Tovar, Maria Juliana Sanchez, David Mauricio Solano Varela, Paula Torres Gomez, Marcial, Trillos, Ana María Vargas Patiño, Felipe, Vargas-Barato, Juan Pablo Villate Leon, María Alejandra Wagner Useche, Jesus, Acosta, Adriana, Almeciga, Luis Becerra Mendez, Rafael Jose Beltran, Ana, Bonilla, Miguel, Buitrago, Marino, Cabrera, Pedro Hernando Calderon Quiroz, Diego, Camacho-Nieto, Carlos Andrés Carvajal Fierro, Sergio Cervera Bonilla, Sandra, Diaz, Helena, Facundo, Jorge, Forero, Mauricio Garcia Mora, Karena Victoria Garcia Tirado, German Fabian Godoy Perez, Felipe, Gonzalez, Oscar, Guevara, Jairo Alonso Hernandez, David Ricardo Herrera Mora, Juan David Lalinde, Carlos, Lehmann, Eduardo Leon Llanos, Byron Eduardo Lopez De Mesa Lopez, Ivan, Mariño, Monica, Medina, Raúl Eduardo Pinilla Morales, Angela, Puerto, Andrea, Quintero-Ortíz, Juliana Rendón Hernández, Elio Fabio Sánchez Cortés, Alvaro Eduardo Sánchez Hernández, Raul, Suarez, Oscar, Suescun, Marco, Vanegas, Rodolfo, Varela, Jorge Luis Velez 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Alvarez, Cesar David Galindo Regino, Angela Maria Giraldo Velasquez, Carlos Enrique Melo Moreno, Jorman, H Tejada, Jesus Hernan Tovar, German Alirio Tovar, Edison Alexander Benavides Hernández, Claudia Milena Orozco-Chamorro, Gustavo Adolfo Angel, Christian Ali Buesaquillo, Victor David Olave Montaño, Andrés, Sánchez-Gómez, Daniela Patricia Escalante Ureche, Jairo Martinez Garrido, Eben-Ezer, Genda, Fabrice, Eboma, Kristina, Bitunjac, Karlo, Grulović, Marijana, Vučković, Goran, Šantak, Emanuel, Borovic, Ana Bosak Versic, Damir, Hasandić, Natasa Poldan Grabar, Suzana Srsen Medancic, Lucija, Brkic, Sara, Cokarić, Petra Pavic Palac, Zeljka, Samac, Josipa, Tomić, Marija, Vrdoljak, Ivan, Bacic, Bernarda, Bakmaz, Nikolina Bratošević Vučičić, Domagoj, Brzic, Samir, Canovic, Emilio, Dijan, Maja Grgec Dragicevic, Robert, Karlo, Suzana, Konjevoda, Petra, Kovačević, Ivan, Kovačić, Frane, Markulić, Luka, Matak, Domagoj, Morović, Gordan, Perišić, Andrea, Simic, Neven, Skitarelić, Matea, Veršić, 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Ioanna, Pozotou, Olga, Stavrinidou, Anneza, Yiallourou, Lukáš, Burda, Michal, Dosoudil, Lubomir, Martinek, Wladyslaw, B Gawel, Milan, Lerch, Matúš, Peteja, Jan, Žatecký, Toman, Daniel, Martin, Formánek, Veronika, Javurkova, Markéta, Kepičová, Nicole, Macečková, Petr, Matousek, Ondrej, Simetka, Petr, Vavra, Karol, Zelenik, Jan, Černý, Sami, Khan, Robert, Lischke, Martin, Přibyl, Temoore, Younus, Yenuksha, Amarasena, Karel, Klíma, Setareh, Pirmorad, Zuzana, Hotová, Aleš, Mladěnka, Nulvin, Bozo, Julie Lykke Harbjerg, Louise, Hviid, Helle, Ø Kristensen, Mira, Mekhael, Mette Fugleberg Nielsen, Laerke, Paulsen, Saija, Sinimäki, Louise Zinck Mogensen, Peter, Bonde, Anders Lyng Ebbehøj, Anne-Sophie, Fenger, Aleksander Fjeld Haugstvedt, Christine Hangaard Hansen, Maria Lovisa Jönsson, Lars, N Jorgensen, Peter-Martin, Krarup, Anne-Louise, Lihn, Christian, Meyhoff, Helena, Otte, Anas Ould Si Amar, Henrik, Palm, Nis, Schlesinger, Henry, Smith, Ida, Tryggedsson, Anne Reiss Axelsen, Jens Kristian Baelum, Mark Bremholm Ellebaek, Signe Bremholm Ellebaek, Anders, Hogh, Maria, Acosta, Yancy, Acosta, Pedro, Baez, Luis Alfredo Betances, Luis Rodolfo Bonilla, Daniel, Cabreja, Wilton Cabrera Cruz, María Mabel Collado Expósito, Aldo, Crespo, Octavio, Cruz-Pineda, Claudio Samuel D'óleo García, Pedro, Díaz, Remberto, Escoto, Jatnna, Figueroa, Luis, Garcia, U Garcia-Dubus Rodriguez, Humberto, Gomez, Adrian, Grullon, Fatherin, Guerrero, Lillian, Guzman, Thelma Rocío Jiménez Mosquea, Engels, Lazala, Ariela, Lopez, Leeany Maletta Francisco, Jhomayri, Mercado, Herisardy, Munoz, Jeffrey, Paulino, Maricely Ambar Perez Fernandez, Rudeily, Reyes, Lilia Rosa Reyes Guilamo, Ruben, Rivas, Claudia Alejandra Rivas Torres, Ada, Rodríguez, Madelin Tamar Rosario Villa, Eleazar, Santana, Joel, Soto, Nassin, Tactuk, Cristina Kristel Tonos Sardiñas, Raul, Ubinas, Jose, Victoria, Aaron, Villegas, Ricardo, Acra-Tolari, Larissa, Beltran, Luis Fernand Betances, Alejandro, Blaubach, Denisse Idalia Campos Mejía, Nathalia, Capellan, María Fernanda Cedeño Bruzual, Saray Cordero Spencer, Gabriella Cuevas Lantigua, Luis De Jesus, Gabriela, Díaz, Pedro Pablo Díaz Vásquez, Karla, Disla, Jesús Antonio Echavarría Uceta, Paola Irina Eusebio Jimenez, Damaris, Fernandez, Marlin Fernandez Camilo, Jiomar Manuel Figueroa Germosen, Maruel, Fortunato, Leyla Gabriel Fernández, Alicia German Dihmes, Héctor, Herrera, Elizabeth Leon Cuevas, Jose Alejandro Mata, Mirian Mateo De La Cruz, Dolores Mejia De la Cruz, Marcos, Mirambeaux, Fabio Ortiz De La Cruz, Henry, Paulino, Gabriela, Pelletier, Merycarla, Pichardo, Rodriguez Pumarol Próspero Enrique, Julio, Rivas, Ann Stephany Sanchez Marmolejos, Roman Santana Santana, Irina Suero Almanzar, María Magdalena Vásquez Sánchez, Nicolás, Campuzano, José Ricardo Negrete Ocampo, Maria, Armas, Alvaro Santiago LeMarie Guerra, Gustavo León Vizcaya, Omar Ahmed Abdelwahab, Ahmed, O Elmehrath, Mohammed Ezzat Mostafa, Gamal, Amira, Ibrahim, Sallam, Mohamed, Sherief, Ahmed, Abdelmajeed, Mostafa, Abdou, Ahmed Abo Shanab, Aya, Abodeeb, Roger, Aboelkhel, Nour Eldin Abosamak, Amna Abou Bakr, Samar, Aboubakr, Yossof, Abouelnagah, Omar, Aboumadawy, Dina, Adel, Nermeen, Afifi, Sara, Ahmed, Abedelrahman, Ahmed, Mohamed Al Sayed, Abdelrahman, Alberkamy, Mohamed, Aldahma, Ahmed, Ali, Mostafa, Ali, Mohamed Amin Bakr, Alaa, Anter, Doaa, Asal, Fouad, Ashoush, Olfat, Ashraf, Abdel Rahman Ashraf, Rewan, Atta, Salma, Badr, Mohamed, Bahaaeldin, Mostafa, Bastawesy, Sara, Darwish, Rasha El Kharashy, Ziad, Elassar, Seifeldin, Elbadawy, Dina, Elkhity, Alromisaa, Elsaka, Manal, Elsayed, Mostafa Elsayed Elsayed Hewalla, Mohamed, Elshafey, Youssof, Eshac, Fares, Eshac, Amr, Essameldin, Moataz, Ewedah, Yara, Ezz, Mohamed, Farag, Inas, Gadelkarim, Ziyad, Gadelrab, Dina, Gamal, Mira, Ghaly, Nathalie, Girgis, Omar, Gouda, Nancy, H El Goweini, Nour, Hafez, Youssef, Hafez, Abdelkader Hamed Abdin, Rodina, Hanno, Aliaa, Hassanin, Mohamed, Hassanin, Hanan, M Hemead, Abdelrahman, Hemida, Maher, Hosain, Ahmed, Hossam, Hamza Hussein Aly Salama Aly, Mohamed, Ibrahim, Abdelrahman, Ibrahim, Nourhan, Ibrahim, Noha Mohamed Salah Ibrahim Moussa Hamouda, Monica, Iskander, Islam, Khalifa, Mostafa, Kotb, Nada, Mahmoud, Alaa Mahmoud Abo Shabana, Nora, Mamdouh, Maram, Metwalli, Khaled, Metwally, Mahmoud, Moghazy, Moustafa, Mohamed, Mohamed, Mourad, Esraa, Moustafa, Kamilia, Mubarek, Nour Eldin Nader, Ahmed, Nasser, Samaa, Omar, Mostafa Shehata Qatora, Mohamed, Ragab, Marawan, Ragal, Dina, Ramadan, Rana, Ramadan, Sara, Ramadan, John, Romany, Ahmed, Sabry, Yasmeen, Said, Sara, Salamah, Ahmed Mostafa Saleh, Mona Saleh Mesbah Mohamed Elkaffas, Alaa, Salem, Hashem, Salim, Ahmed, Samih, Ahmed Samir Abdelaal, Ahmed, Shaheen, Yassmeen Sharafeldin Mohammed, Abdelrahman, Shehata, Mohamed, Shemeis, Karim, Shenit, Mennatallah, Sheta, Asmaa, Soffar, Yousef, Tanas, Ahmed, Tarek, Nermin, Yehia, Omar Khaled Mohamed Eid, Ammar Yasser Abdulfattah, Ahmed, Elsaghir, Mohamed Fouad Elganainy, Omar Ibrahim Elsayed, Omar, Elmandouh, Omar, Hamam, Mostafa Ahmed Shehata, Areej, A Abdelaziz, Ahmed, M Abbas, Wael Abd El-Ghani, Hossam Aldein, S Abd Elazeem, Mustafa Abd Elsayed, Ahmed Yassien Abd-Elkariem, Shimaa, Abdalla, Mahmoud, Abdel-Aleem, Khaled, Abdelazeem, Mahmoud, Abdelfattah, Mohammed, Abdelhafez, Mohamed, M Abdelkarem, Ali, Abdelraouf, Lamess, Abdullaha, Hossam, Abubeih, Moaiad Eldin Ahmed, Nagm Eldin Abu Elnga Ahmed, Ahmed, Ahmed, Sarah Ahmed Saad, Sherif, Alaa, Ali, Alhussaini, Abdelrahman Ahmed Abdelrahman Ali, Ibrahim, Ali, Wagdi, Ali, Mohamed Ali Mohamed, Mohamed, Ashraf, Muhammad, Bassiouni, Mohamed, G El-Adawy, Mohammad, El-Sharkawi, Hussein, Elkhayat, Khaled, Elmaghraby, Shady, Elsdfy, Mohamed, Elsharkawy, Almoutaz, Eltayeb, Mohamed Esmat Mohamed, Esraa, Essam, Mahmoud, Fahd, Osama, Farouk, Rabea, Gadelkareem, Ahmed, Ghoneim, Mohammed Hamada Takrouney, Ahmed, Hamdan, Abd El-Rahman Hamed, Ahmad, Hasan, Mohamed Abdelghafor Hassanin, Islam, Hawal, Kerollos, Henes, Mohamed Omar Herdan, Helal, F Hetta, Omar, Ibrahem, Mostafa, Ibrahim, Islam, H Ibrahim, Mahmoud, Kamel, Mohamed, Khallaf, Shrouk, M Elghazaly, Abobakr, Mahfouz, Osman, Mahmoud, Wesam, Mahran, Doha, Mahrous, Abadeer, Marsis, Ayman, Mohamed, Aliae Mohamed Hussein, Amr Mohamed Sayed, Mahmoud, M Mohammed, Ahmed, Mokhtar, Fatma, A Monib, Ahmed, Nageeb, Mariam Albatoul Nageh, Mohammed, Nageh, Nehal Gamal Omar, Abdelrahman, Ragab, Abdelrahman, Ramadan, Abdallah Rashad Temerik, Aya, Sabry, Hadeer, Safwat, Omar, Salah, Ahmed Elhussiny Salah Mahmoud, Ahmed, Saleh, Mahmoud, Sallam, Ahmed, Samir, Reem, Sayad, Esraa, Sayed, Ahmed, S Sedik, Mohammed, Shahine, Antonios, Soliman, Wael, Soliman, Mohamed Gamal Taher, Randa, Wanees, Ebrahim Ahmed Yousof, Ahmed, Youssef, Omar Zein Elabedeen, Ahmed Emad Sayed Hassan, Shrouk Abdel Fattah, Ahmed, Abostate, Samar, Ali, Saad Ali Saad Salama, Mohamed, Allam, Ahmed, Alsadek, Ebrahim, Arafa, Ahmed, Barakat, Mohammed El Sherpiny, Gehad, Elbehairy, Mahmoud, Eleisawy, 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Venkateshwaran, Narasiman, Meer, Chisthi, Gejoe, George, Harihara, Jothi, Dilber, Pareed, Godwin David, C Mathew, Livingston, Abel, Mansi, Agrawal, Rabindranath, B, Manish, Baldia, Ravi Kishore Barla, Manisha, Beck, Santosh, Benjamin, Jeremy, Bliss, Lisa, Cherian, Sreekar, Devarakonda, Geley, Ete, Arun Jacob Philip George, Amish, Gohil, Deeptiman, James, Mark Ranjan Jesudason, Lallu, Joseph, Treasa, Joseph, Kathir, Joyson, Gomathi, Karnan, Albert, Kota, Pushplata, Kumari, Anitha, Loganathan, Vasanth Mark Samuel, John, Mathew, Senthil, K Nathan, Joby Elizabeth Ninan, Ajay, Philip, R Priyadarshini Priyadarshini, Suganya, S, Habie, Samuel, Gilbert, Samuel, Daniel, Selvaraj, Srujan, Sharma, Suraj, Surendran, D Hariharan, T, Santhosh Kumar Thangaraj, Vinotha, Thomas, Varghese, Thomas, John, K Thomas, S Harish, Y, Manobhiram, Boggavarapu, Murali Krishna Voonna, Marilaeta Cindryani Lolobali, Christopher, Ryalino, Tjokorda Gde Agung Senapathi, Mahadewa, Tjokorda, I Made Gede Widnyana, Dita, Aditianingsih, Aino, Auerkari, Susilo, Chandra, Fachreza Aryo Damara, Mohammad Adya Firmansha Dilmy, Achmad Kemal Harzif, Sidharta Kusuma Manggala, Dedy, Pratama, Affan, Priyambodo, Andi Ade Ramlan, Ratna Farida Soenarto, Adhrie, Sugiarto, Ilham Utama Surya, Tamara, Tango, Aida Rosita Tantri, Raihanita, Zahra, Dedy, Fachrian, Andi, Hasyim, Ade, Susanti, Teddy, Saputra, Erwin, Syarifuddin, Andi Asadul Islam, Hendra, Pajan, Ahmad Hannan Amrullah, Khoirul, Anam, Thirza, Hadipranata, Julius Albert Sugianto, Aidyl, Fitrisyah, Mayang Indah Lestari, Nur Rachmat Lubis, Rizal, Zainal, Zulkifli, Zulkifli, Erick Gamaliel Amba, Warren, Lie, Andika Adiputra Thehumury, Tedy, Apriawan, Yunus Kuntawi Aji, Roidah Taqiyya Zahra Wathoni, Sumadi Lukman Anwar, Teguh, Aryandono, Wirsma Arif Harahap, Juni, Kurniawaty, Djayanti, Sari, Artanto, Wahyono, Yunita, Widyastuti, Akhmad Yun Jufan, Parisa, Arjmand, Mohammad, Etezadpour, Babak, Ganjeifar, Masoumeh, Hosseinpoor, Hassan, Mehrad-Majd, Mohsen, Rajati, 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Orlaith, Kelly, Rory, Kennelly, Aoife, Kiernan, Sean, T Martin, Nawar, Masarani, Damian, Mccartan, Enda, W McDermott, Ben, Murphy, Kin Cheung Ng, Nwabundo, Njeze, Aine, O'Neill, Ruth, S Prichard, Ned, Quirke, Ian Sean Reynolds, Des, Winter, Rowan, Casey, Mutaz, Elamin, Amy, Gillis, Dara, Kavanagh, Michael, Kelly, Áine, Mcnamee, Paul, Neary, Patrick, Owens, Akshaya, Ravi, Paul, Ridgway, Paul, Carroll, Chris, Collins, Amenah, Dhannoon, Amy, Fowler, Aisling, Hogan, Aoife, Lowery, Peter, Mcanena, Charlie, Timon, Stewart, Walsh, Wisam, Al-Ramli, Imran, Azeem, Muhammad Usaama Bahadoor, Zsolt, Bodnar, Hassan, Elmusharaf, Faisal Saeed Hassan, Adam, Hingum, Huilun, Huan, Seamus, Jennings, Mohamed Hamed Khalid, Mariya, Kuteva, Syed Nadeem Mujtaba, Shanell, Peeriyah, Hina, Rehman, Muhammad Assam Sarwar, Tony, Shaju, Ian, Stephens, Michael, Sugrue, Joseph, Thomas, Manvydas, Varzgalis, Saqib, Zeeshan, Alisha, Jaffer, Larne, Jones-Whiting, Colin, Peirce, Sean, Johnston, Seantee, Lim, Alwaleed, 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Baccellieri, Luca, Bertoglio, Giulia, Bonavina, Massimo, Candiani, Giorgio, Candotti, Arianna, Casiraghi, Laura Mariangela Castellano, Paolo Ivo Cavoretto, Roberto, Chiesa, Federica, Cipriani, Paola De Nardi, Guido, Fiorentini, Filippo, Gagliardi, Alessandro, Galdini, Alessandro, Grandi, Elena, Marotta, Simonetta, Massaron, Andrea, Melloni, Pietro, Mortini, Gianluca, Nocera, Martina, Piloni, Mirko, Pozzoni, Francesca, Ratti, Riccardo, Rosati, Alessandro Ferdinando Ruffolo, Pierpaolo, Sileri, Alfio, Spina, Andrea, Vignali, Cristina, Barberio, Luigi, Beretta, Francesca, Cavenago, Nora Di Tomasso, Stefano, Fresilli, Giovanni, Landoni, Stefano, Lazzari, Gaetano, Lombardi, Marilena, Marmiere, Fabrizio, Monaco, Gabriele, Todaro, Stefano, Turi, Alberto, Zangrillo, Francesca, Bertolina, Giorgio, Bogani, Stefano, Bonomi, Pierfrancesco, Cadenelli, Valentina, Chiappa, Stefano Piero Bernardo Cioffi, Davide, Citterio, Lara Valentina Comini, Umberto, Cortinovis, Maurizio, Cosimelli, Antonino, Ditto, Massimiliano, Gennaro, Lorenzo, Giannini, Marcello, Guaglio, Marco, Guzzo, Andrea, Leva, Alberto, Macchi, Elena, Manzo, Fabio, Martinelli, Ilaria, Mattavelli, Vincenzo Maria Mazzaferro, Francesco, Raspagliesi, Luigi, Rolli, Laura, Sala, Roberto, Salvioni, Mario, Santinami, Silvia, Segattini, Luca, Sorrentino, Carlotta, Zaborra, Alexandre, Anesi, Gianmaria Casoni Pattacini, Mattia Di Bartolomeo, Francesca, Pecchini, Arrigo, Pellacani, Micaela, Piccoli, Federico, Fusini, Andrea, Gattolin, Marco, Migliore, Roberto, Rimonda, Diego, Sasia, Elisabetta, Travaglio, Federica, Brunetti, Marco, Cereda, Marco, Ceresoli, Luca, Cigagna, Cristina, Dell'Oro, Alessandro, Fogliati, Robert, Fruscio, Tommaso, Grassi, Maini Marzia Isabella, Luca Carlo Nespoli, Massimo, Oldani, Sara, Ornaghi, Nicolò, Tamini, Carmine, Antropoli, Antonio, Castaldi, Alessio, Palumbo, Gaia, Altieri, Umberto, Bracale, Francesco, Corcione, Marcello De Luca, Giovanni Domenico De Palma, Maria Michela Di Nuzzo, Ruggero, Lionetti, 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Matteo, Filardo, Marika Sharmayne Milani, Franco, Ragni, Andrea de Manzoni Garberini, Edoardo, Baldini, Diana, Carpaneto, Michele, Cauteruccio, Corrado, Ciatti, Luigi, Conti, Serena, Gattoni, Pietro, Maniscalco, Gerardo, Palmieri, Calogero Puma Pagliarello, Giuseppe, Caristo, Raffaele, Galleano, Michele, Malerba, Marcello, Calabrò, Francesca, Farnesi, Elia Giuseppe Lunghi, Andrea, Muratore, Nicoletta Sveva Pipitone Federico, Joel Reuben Abel, Lorenzo, Andreani, Darienzo, Antonio, Vittorio, Aprile, Riccardo, Balestri, Giacomo, Benettini, Stefano, Berrettini, Luca, Bruschini, Massimo, Chiarugi, Federico, Coccolini, Simone, Colangeli, Camilla, Cremonini, Lodovica Cristofani Mencacci, Iacopo, Dallan, Silvia De Santi, Gregorio Di Franco, Lorena Di Girolami, Giacomo, Fiacchini, Niccolò, Furbetta, Stylianos, Korasidis, Marco, Lucchi, Andrea, Morandi, Luca, Morelli, Serena, Musetti, Carlo Maria Neri, Matteo, Palmeri, Miriana, Picariello, Francesco, Porcelli, Marco, Puccini, Nicolo, Roffi, Erica, Statuti, Dario, Tartaglia, Alberto, Tonelli, Matteo, Vianini, Gianluca, Baronio, Mauro, Montuori, Enrico, Pinotti, Stefano Maria Massimiliano Basso, Federica, Maffeis, Paolo, Ubiali, Lorenzo, Aguzzoli, Saverio, Coiro, Giuseppe, Falco, Vincenzo Dario Mandato, Valentina, Mastrofilippo, Simone, Mele, Caterina, Baldi, Carlo, Corbellini, Gianluca Matteo Sampietro, Massimo, Dugo, Mauro, Garino, Chiara, Marafante, Antonio, Masciandaro, Elisabetta, Moggia, Alessandra, Murgese, Felice Eugenio Agro, Gabriella Teresa Capolupo, Filippo, Carannante, Marco, Caricato, Vincenzo, Denaro, Erica, Mazzotta, Rocco, Papalia, Giuseppe, Pascarella, Alessandro, Strumia, Biagio, Zampogna, Matteo, Cinquepalmi, Marco, Colasanti, Celeste Del Basso, Federica, Falaschi, Nicola, Guglielmo, Roberto Luca Meniconi, Alessandra, Pecoraro, Sofia, Usai, Giacomo, Crescentini, Antonella, Larcinese, Emanuele, Picone, Giovanni, Sinibaldi, Annamaria, Agnes, Salvatore, Agnes, Sergio, Alfieri, Francesco, Belia, Valentina, Bianchi, Giuseppe, Bianco, Alberto, Biondi, Paola, Campennì, Valerio, Cozza, Sabatino, D'Archi, Domenico, D'Ugo, Veronica De Simone, Marta Di Grezia, Sofia Di Lorenzo, Federica, Ferracci, Valeria, Fico, Gianluca, Franceschini, Pietro, Fransvea, Giulio, Gasparini, Luca, Gordini, Antonio La Greca, Francesco, Litta, Celestino Pio Lombardi, Angelo Alessandro Marra, Angelo, Parello, Marco Maria Pascale, Romeo, Patini, Gilda, Pepe, Roberto, Persiani, Caterina, Puccioni, Carlo, Ratto, Fausto, Rosa, Gianmarco, Saponaro, Lorenzo, Scardina, Tedesco, Silvia, Giuseppe, Tropeano, Maria, Benevolo, Daniele, Bugada, Flaminia, Campo, Maria Gabriella Dona, Valentina, Manciocco, Paolo, Marchesi, Riccardo, Mastroianni, Francesco, Mazzola, Silvia, Moretto, Raul, Pellini, Gerardo, Petruzzi, Barbara, Pichi, Giuseppe, Simone, Gabriele, Tuderti, Jacopo, Zocchi, Luigi Marino Cosentino, Andrea, Sagnotta, Roberta, Angelico, Vittoria, Bellato, Michela, Campanelli, Marzia, Franceschilli, Michele, Grande, Giorgio, Lisi, Tommaso Maria Manzia, Lorenzo, Petagna, Bruno, Sensi, Giuseppe, Sica, Leandro, Siragusa, Giuseppe, Tisone, Marco, Assenza, Barbara, Binda, Massimo, Biondi, Gioia, Brachini, Placido, Bruzzaniti, Mauro, Casagrande, Flavia, Ciccarone, Pierfranco Maria Cicerchia, Bruno, Cirillo, Daniele, Crocetti, Giancarlo, D'Ambrosio, Vito, D'Andrea, Francesca De Felice, Giorgio De Toma, Carlo Della Rocca, Giulia, Duranti, Pietro, Familiari, Enrico, Fiori, Giovanni Battista Fonsi, Alessandro, Frati, Stefania La Rocca, Filippo La Torre, Pierfrancesco, Lapolla, Giovanni, Marruzzo, Simona, Meneghini, Andrea, Mingoli, Andrea, Picchetto, Antonella, Polimeni, Diego, Ribuffo, Maurizio, Salvati, Antonio, Santoro, Paolo, Sapienza, Luigi, Simonelli, Valentino, Valentini, Martina, Zambon, Giuseppa, Zancana, Emma, Zuppi, Simone, D'Annunzio, Cosimo De Nunzio, Silvia, Fiorelli, Mohsen, Ibrahim, Chiara, Loffredo, Domenico, Massullo, Cecilia, Menna, Rocco, Monica, Massimiliano, Pelli, Erino Angelo Rendina, Leonardo, Teodonio, Andrea, Tubaro, Giulio, Argenio, Giulio, Accarino, Accarino, Giancarlo, Antonio Nicola Giordano, Luca, Cardinali, Elisa, Sebastiani, Grazia, Travaglini, Erika, Andreatta, Emanuele Luigi Giuseppe Asti, Daniele, Bernardi, Luigi, Bonavina, Caterina, Froiio, Andrea, Lovece, Chiara, Copelli, Alfonso, Manfuso, Pasquale Di Maio, Marco, Giudice, Oreste, Iocca, Rosario, Cennamo, Tommaso, Cornali, Francesco Di Marzo, Cristian, Altana, Francesco, Bussu, Giampiero, Capobianco, Anna Giacomina Carta, Sandro, Ciccarello, Maria Laura Cossu, Pietrina, Cottu, Giacomo De Riu, Salvatore, Dessole, Francesco, Dessole, Salvatora, Dettori, Carlo, Doria, Alessandro, Fancellu, Claudio, F Feo, Giorgio Carlo Ginesu, Giuliana, Giuliani, Marco Giuseppe Iannuccelli, Massimo, Madonia, Roberto, Mancino, Olindo, Massarelli, Gianfranco, Meloni, Fabio, Milia, Andrea, Mulliri, Teresa, Perra, Marco, Petrillo, Antonio, Piras, Franco, Piredda, Francesco, Pisanu, Alberto, Porcu, Davide, Rizzo, Angelino, Sanna, Antonio Mario Scanu, Fabrizio, Scognamillo, Damiano, Soma, Anna Rita Tanca, Alessandro, Tedde, Matteo, Tedde, Luigi Angelo Vaira, Andrea Bartalini Cinughi de Pazzi, Osvaldo Carpineto Samorani, Daniele, Fusario, Luigi, Marano, Gaia, Oldrà, Anna Lisa Pesce, Stefania Angela Piccioni, Luca, Resca, Vincenzo, Ricchiuti, Franco, Roviello, Vinno, Savelli, Alberto, Abrate, Pierpaolo, Bordoni, Lorenzo, Bosio, Guglielmo, Clarizia, Francesco, Fleres, Marco, Franzini, Antonio, Fratto, Pierluigi, Giumelli, Alessandro, Grechi, Alessandro, Longhini, Fabrizio, Lorusso, Elisa, Scarnecchia, Federica, Scolari, Alessandro, Spolini, Vincenzo, Maiuri, Matteo, Papandrea, Arturo, Roncone, Lorenzo, Conti, Andrea, Rizzi, Marco, Rovagnati, Alberto, Brolese, Tommaso, Cai, Francesco Antonio Ciarleglio, Francesca, Dalprà, Gianni, Malossini, Liliana, Mereu, Irene, Tamanini, Saverio, Tateo, Giovanni, Viel, Enrico, Battistella, Paolo Boscolo Rizzo, Cristoforo, Fabbris, Marco, Massani, Giacomo, Spinato, Roberta, Tutino, Ugo, Grossi, Alessandro, Iacomino, Simone, Novello, Maurizio, Romano, Serena, Rossi, Giulio, Santoro, Giacomo, Zanus, Sokol, Trungu, Giada, Aizza, Gabriele, Bellio, Selene, Bogoni, Marina, Bortul, Biagio, Casagranda, Sara, Cortinovis, Nicolò de Manzini, Davide, Drigo, Paola, Germani, Manuela, Mastronardi, Lucia, Paiano, Silvia, Palmisano, Pier Luigi Filosso, Francesco, Guerrera, Matteo, Marro, Mauro, Rinaldi, Enrico, Ruffini, Stefano, Salizzoni, Laura, Bardelli, Mattia, Berselli, Giacomo, Borroni, Eugenio, Cocozza, Matteo, Desio, Bottazzoli, Elisa, Giuseppe, Ietto, Valentina, Iori, Domenico, Iovino, Lorenzo, Livraghi, Valentina, Marchionini, Stefano, Megna, Emma Amal Nahal, Mara, Palumbo, Valeria, Quintodei, Alessandra, Zullo, Lucrezia, D'Alimonte, Giovanni, Pirozzolo, Chiara, Vignotto, Tommaso, Campagnaro, Andrea, Caravati, Simone, Conci, Carlotta De Cristofaro, Gabriele, Gecchele, Tommaso, Giuliani, Jacopo, Graziosi, Alfredo, Guglielmi, Salvatore, Paiella, Corrado, 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Rakotoarisoa, Maharo, Ramifehiarivo, Solonirina Harinarindra Ranaivoson, Hajamihamina Marina Parfaite Randriantsoa, Narindra Njarasoa Mihaja Razafimanjato, Jeannie Ba Razafindrahita, Solofoarimanana, Solofoarimanana, Guillaume Odilon Tsiambanizafy, Rakotonaivo Mamisoa Judicaël, Corinne Eulalie Solo, Tojomamy Herinjaka Ralaizafindraibe, Fanonjomahasoa Safiry Andofenohasina, Hanta, Rasataharifetra, Vanona Barijaona Razafindraibe, Angelin Sablon Herinirina, Andre, Das, Thanga, Ganapathy, Yohesuwary, Gunarasa, Kalyani, Mariapan, Maathichsudhaar, Muniandy, Mohd Firdauss Osman, Mohd Azem Fathi Mohammad Azmi, Jien Yen Soh, Wan Zainira Wan Zain, Andee Dzulkarnaen Zakaria, Zaidi, Zakaria, Kheng Hooi Chan, Firdaus, Hayati, Syamim, Johan, Jin Jiun Mah, Ratha Krishnan Sriram, Sentilnathan, Subramaniam, Nur Shahirah Binti Muhammad Shahimi, Khairul Hazim Hamdan, Mohd Razali Ibrahim, Guhan, Muthkumaran, Ju Ann Tan, Mohana Raj Thanapal, Dayang Anita Abdul Aziz, Mae-Lynn, Bastion, Mohd Hairul Nizam Harun, Farrah-Hani, Imran, Norshamsiah Md Din, Ayesha Mohd Zain, Mushawiahti, Mustapha, Syed, Nabil, Ainal Adlin Naffi, Abd Jabar Nazimi, Roszalina, Ramli, Bee Hong Soon, Pavin, Bal, Joo Qing Cheng, Mohd Rusdi Draman, Ahmad Nazran Fadzli, Sakina, Ghauth, Weipin, Hung, Suniza, Jamaris, Peng Soon Koh, Sivakumar, Krishnasamy, Yeong Sing Lee, Yew Toong Liew, Jeffery Zk Lim, Raymond Chung Siang Lim, Hiong Chin Lim, Siti Farhan Moh Pauzi, Shireen Anne Nah, Ashvin Krishna Nair, Doris Sin Wen Ng, Yuki Julius Ng We Yong, Kamarajan, Ramayah, Rahmah, Saaid, Anand, Sanmugam, Mee Hoong See, Kanesh Kumaran Seevalingam, Neha, Sethi, Srihari, Singaravel, Syeda Nureena Syed Jafer Hussain Zaidi, Chu Yik Tang, Li Ying Teoh, Kian Boon Wong, Ruben, Xavier, Ahmad Shuib Yahaya, Norhafiza, Ab, Rahman, Islah Munjih Ab, Rashid, Mohd Fahmi Abd Aziz, Mohd Norhisham Azmi Abdul Rahman, Nasser Muhammad Amjad, Shahidah Che Alhadi, Faisal, Elagili, Mohd Nazli Kamarulzaman, Azmi Md Nor, Ahmad Faidzal Othman, Mohd Yusof Sainal, Mat Salleh Sarif, Richelle, Chua, Aini Fahriza Ibrahim, Abdul Rauf Bin Ahmad, Yii Ling Lau, Ka Yee Liew, Kandasami, Palayan, Hui Yu Wong, Jasiah, Zakaria, Nor Azimah Abd Aziz, Norazila Abdul Rahim, Noorneza Abdul Rahman, Bahiyah, Abdullah, Mohamed Faizal Bin Sikkandar, Fatin, Firman, Nik Mohd Hazleigh, Intan Kartika Kamarudin, Shahril, Khalid, Mohd Fairudz Mohd Miswan, Akmal Zulayla Mohd Zahid, Norasyikin, Mustafa, Kadhim, Obaid, Mohd Yusoff Bin Yahaya Yahaya, Ahmad Ramzi Yusoff, Predrag, Andrejevic, Jeremy Borg Myatt, Svetlana, Brincat, Clifford, Caruana, Kurt Lee Chircop, Francesca, Chircop, Daniel Mario Chircop, Charles, Cini, Viktoria, Czok, Melanie, Farrugia, Gabriella, Grima, Fatimah Mj Hassan Almukhariq, Esther, Muscat, Darryl, Pisani, Mohsin Hassan Khan Roshan, Nicholas, Schembri, Mohamed, Shoukry, Neville, Spiteri, Gilbert, Tanti, Ziad Aboharp Hasan, Alberto Bazan Soto, Cedillo Rodrìguez Jonathan Rubén, Gustavo Esteban Lugo Zamudio, David Gerardo Miranda Gómez, José Alfredo Pérez Meave, Victor Pinto Angulo, Antonio Rojas Aguilar, Erik Efrain Sosa Duran, Alejandro Vàzquez Perez, Diego, Arroyo, Jose, Corona-Cruz, Hector, Martinez-Said, Heriberto, Medina-Franco, Manuel, Mendez, Teresa Moreno, Y Suárez Ma, Dolores Orta Díaz, Martha Patricia Pérez de León Vázquez, Angélica Azucena Soto Carvajal, Fidel Soto Hernández, Juan Ignacio Stenner, Adriana Valenzuela López, Mauricio Rene Hernandez, Rey Jesus Romero, Aldo Bernal Hernandez, Ana Olivia Cortes-Flores, Carlos Jose Zuloaga Fernandez Del Valle, Carlos Andres Colunga Tinajero, Jaime, Orozco-Perez, Laura Gabriela Peña Balboa, Guillermo, Yanowsky-Reyes, Víctor Hugo Alcalá Torres, Francisco José Barbosa Camacho, Irma Valeria Brancaccio Perez, Miguel Angel Calderon-Llamas, Aldo Camacho Gomez, Edgar-Joaquin, Cortes-Torres, Esteban, Cueva-Martinez, Oscar Durán Anguiano, Isaac Esparza Estrada, Roberto, Fierro-Rizo, Paola Flores Becerril, Clotilde Fuentes Orozco, Miguel García Castillo, Alejandro Gonzalez Ojeda, Ana Sofia Gonzalez Rubio, Erick Alonso González-García de Rojas, Luis Humberto Govea-Camacho, Jose Aldo Guzman Barba, Juan Carlos Ibarrola Peña, César Íñiguez Martínez, Francisco Javier Llamas-Macias, Ruben Eduardo Morán Galaviz, Cesar, Nuño-Escobar, Oscar-Everardo, Olvera-Flores, Jaqueline, Osuna-Rubio, Jose Victor Pérez-Navarro, Rodrigo, Prieto-Aldape, Luis Ricardo Ramirez Gonzalez, Marco Vinicio Ramírez Sánchez, Emilio, Reyes, Olaya Moramay Romero-Limón, Carlos Beas Ruiz-Velasco, José Antonio Sánchez Martínez, Guillermo, Sanchez-Villaseñor, Ismael, Sedano-Portillo, Gabriela Ambriz Gonzalez, Pedro Berrones Moreno Berrones Moreno, Ana Beatriz Calderon Alvarado, José de Jesús Cárdenas Barón, Araceli, Hernández, Francisco Javier León Frutos, Edgard Efren Lozada Hernandez, Eduardo Morales Valencia, Karla Daniela Pérez, Francina, Bolanos-Morales, Julio, Herrera-Zamora, Patricio, Santillan-Doherty, David Omar Arriaga Zavala, Salvador Francisco Campos Campos, Lizette, Carmona, Antonio Galindo Nava, Blanca, Santos, Juan Roberto Torres Cisneros, Katya, Bozada-Gutiérrez, Jose Jesus Herrera, Mucio Moreno Portillo, Francisco Pérez López, Mario, Trejo-Avila, Carlos Valenzuela Salazar, Maria Regina Alvarez, Fernando, Cordera, Marco Antonio de la Rosa Abaroa, Antonio, Gómez-Pedraza, Roberto, Hernandez, Antonio, Maffuz-Aziz, José Antonio Posada, Carlos Robles Vidal, Jose-Luis, Beristain-Hernandez, Blas Eduardo Quintero Sada, Nicolás Uxmal Soruco Heredia, Ernesto, Anaya, Ricardo, Arceo-Olaiz, Bernardo Gutiérrez Sougarret, Sonia Lopez Flores, Francisco, J Ochoa Carrillo, Raymundo Alfredo Pérez Uribe, Ludwigvan Adriano Bustamante Silva, Arianne, I Lupián-Angulo, Christian Enrique Soulé Martínez, Francisco César Becerra García, Ernesto Javier Guerrero Casillas, Edgar, Uribe, Nereida Esparza Arias, J Mindy Hernández-Nava, David, Isla-Ortiz, Javier, Melchor-Ruan, Esmeralda Romero Bañuelos, Rosa, Salcedo-Hernández, Diana, Vilar-Compte, Paola Zinser Peniche, Jorge, L Aguilar Frasco, Alejandro, Alfaro-Goldaracena, Gabriela Alejandra Buerba, Emma, Castro, Carlos, Chan, Ruben, Cortes, Ismael, Dominguez-Rosado, Daniel Garay Lechuga, Miguel, Herrera, Carlos, Hinojosa, Gabriel, Lopez-Pena, Edgar, Martos, Miguel Ángel Mercado, Paulina Moctezuma Velázquez, Roberto, Moguel, Mariano, Oropeza, Emmanuel Peña Gómez Portugal, Oscar Emmanuel Posadas-Trujillo, Noel, Salgado-Nesme, Oscar Santes Jasso, Catherine, Sarre, Karla Yareli Hernandez Skewes, Cristian, Jimenez, Roque Delfino Licona-Meníndez, Guillermo, Montiel, Alberto, Navarrete-Peón, Shannat, Ortega, Fernanda Romero Lechuga, Oscar, Roque, Fernando, Sevilla, Rogelio, González-López, Roberto Ángel Núñez-González, José Antonio Ortega-Jiménez, Antonio, Alvarado, Alfonso Alvarez Manilla Orendain, José Alberto Atristain Pesquera, Diego, Frutos, Felipe, Garcia, Juan Antonio González León, Marlin, Guzman, Dorihela, Herappe, Jesús Giovanni Inzunza Miranda, Miguel Angel Jimenez Botello, Ricardo, Lerma, Fabián Hilario Mendoza Pedraza, Monica Noguez Castillo, Jose Anatolio Resendiz, Oscar Alejandro Sánchez García, Laura Elena Fernandez Rios, Pamela, Frigerio, Iset, Garcia, Gloria Isela Mendoza Frías, Emmanuel, Moreno, Raquel, Quiroga, Alejandra Anzures Mendoza, Arantza Govela Hinojosa, Aldo, Izaguirre, Luis Hdez Miguelena, Jose Manuel Luna Vazquez, Indalecio Barcelata Rodriguez, Raul Ramos Mange, Carlos Reyes Utrera, David Zarate Saenz, Miguel Angel Zavala Gonzalez, Francisco Andrade González, Ludivina, Cortes, David, Roman, Aaron, Sanchez, Radu, Gurghiș, Gheorghe, Rojnoveanu, Marin, Vozian, Petru, Caraja, Gheorghe, Croitor, Roman, Mosneaga, Sarnai, Erdene, Lundeg, Ganbold, Sergelen, Orgoi, Soyombo, Orsoo, Altanchimeg, Sainbayar, Erdene, Sandag, Burmaa, Sanjaa, Rita Ait Benhamou, Abdessamad El Azhari, Bennis, Ghita, Sara, Lhassani, Sidi Mamoun Louraoui, Mounir, Rghioui, Sarra, Saaf, Taha, Gadouali, Iltimass, Gouazar, Moniba, Korch, Ahmed, Letrache, Amina, Louari, Anas, Zamame, Samia, Ousouss, Meryem, 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Alexander, Borgstein, Suzanne, Gisbertz, Sarah, Mikdad, Mark van Berge Henegouwen, Roel, Bakx, Marc, Besselink, Daniel Hl Lemmers, Anne-Jasmin, Roelofs, Paul van Amstel, Claire van Helsdingen, Ludi, Smeele, Niels, Harlaar, Frederik, Jonker, Sjirk van der Burg, Justin, Y van Oostendorp, Saranda, Ombashi, Tim van der Voort, Martijn van Geldorp, Lisanne, Posma-Bouman, Hans Donald de Boer, Annette, Olieman, Henriette, Smid-Nanninga, Jean-Paul P, M De Vries, Rianne, Hogenbirk, Tyche, Derksen, Josephine, Franken, Steven, Oosterling, Peter, Nolte, Jelle van der List, Ian, Alwayn, Okker, Bijlstra, Andries, Braat, Ruth, Bulder, Michèle de Kok, Robin, Faber, Ben, Goudsmit, Jaap, Hamming, Sven, Mieog, Alexander, Vahrmeijer, Fenna E, M van de Leemkolk, Joost van der Vorst, Jan van Schaik, Merel, Verhagen, Kim, Albers, Larsa, Gawria, Harry Van Goor, Michiel, Warle, Tessa, M van Ginhoven, Charlotte, Viëtor, Evert-Jan, Boerma, Lara, Lallitsch, Donald, Schweitzer, Wouter, Leclercq, Julie, Sijmons, 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Mohammad, Altuwaijri, Muath, Alwabel, Mohamed, Aly, Mosa, Alzahrani, Adel, Assiri, Ahmed, Bakhsh, Mohammed, Sbaih, Jubran Al Faifi, Shehanah Al Omair, Saad, Alobaysi, Khalid, Beidas, Nawaf, Modahi, Norah, Musallam, Khaled El Gazzar, Khaled, Ghabban, Ahmed, Abdulmohsen, Hussam, Adi, Amgad, Afifi, Khaled Ai Nwijy, Turki Ai Zahrani, Jehad, Akiely, Abdulaziz Al Harthi, Attiya Al Zahrani, Feras, Alahmad, Ahmad, Alayed, Abdallah, Alghazo, Nawaf, Alharthi, Sultan, Alharthi, Mohammad, Alnoaiji, Bandar, Alqahtani, Abdulellah, Alqarni, Noorsabah, Alrubays, Mohammed, Alshehri, Abdulmajeed, Alshehri, Mamdouh, Alzaibak, Majed Attoun Attoun, Ahmed, Awaji, Yaquob, Daghriri, Reda, Daoud, Aymad, Eltawab, Sherif, Emara, Ayman, Farouk, Anas, Fatani, Mojahid, Ghazi, Talal, Khewater, Elsayed, Monier, Nizar, Musawa, Magdy, S El-Bahnasawy, Mahmoud, Zakaria, Saleh, Alghamdi, Waleed, Althobaiti, Ivan, Paunovic, Nikola, Slijepcevic, Nouf, Alajaji, Lidija, Aleksić, Goran, Barisic, Aleksandar, Bogdanovic, Miljan, Ceranic, Ivan, Dimitrijevic, Keramatollah, Ebrahimi, Daniel, Galun, Željko, Grubač, Nikola, Grubor, Nenad, Ivanović, Jelenko, Jelenkovic, Stefan, Kmezić, Djordje, Knezevic, Zoran, Krivokapic, Stojan, Latinčić, Velimir, Markovic, Slavko, Matić, Marko, Miladinov, Aleksandar, Ninic, Maja, Pavlov, Ivana, Pavlovic, Ilija, Pejovic, Zeljko, Radojkovic, Slobodan, Rašić, Milorad, Reljic, Predrag, Sabljak, Aleksandar, Sekulić, Vladimir, Šljukić, Boris, Tadic, Jovica, Vasljević, Dejan, Veličković, Marko, Zivanovic, Pavle, Gregoric, Zlatibor, Loncar, Dusan, Micic, Drago, Jelovac, Srbislav, Pajić, Milan, Petrovic, Sanela, Sumrak, Vladimir, Bascarevic, Ivan, Bogdanovic, Danica, Grujičić, Rosanda, Ilic, Miloš, Joković, Mihailo, Milićević, Filip, Milisavljević, Aleksandar, Miljković, Aleksandra, Paunovic, Vuk, Šćepanović, Aleksandar, Stanimirovic, Marko, Todorovic, Miljan, Folic, Ana, Jotic, Sanja Krejovic Trivic, Jovica, Milovanovic, Aleksandar, Trivic, Lazar, Davidovic, Stefan, Ducic, Igor, Koncar, 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Sanja, Zahorjanski, Adrian, Chiow, Jun Xian Hing, Lip Seng Lee, Sey Kiat Terence Lim, Chi Wei Mok, Su-Ming, Tan, Hiang Jin Tan, Hana, Arbab, Candy, Choo, Doris Mae Dimatatac, Yee, Low, Hui Wen Chua, Tousif, Kabir, Sabrina, Ngaserin, Lester, Ong, Kiat Tee Benita Tan, Alvin, Tan, Wei-Wen, Ang, Yew-Lam, Chong, Jeffrey, J Leow, Biquan, Liu, Ming Ngan Aloysius Tan, Ern Yu Tan, Kar Yong Wong, Sharon, Yeo, Ladislav, Czako, Branislav, Gális, Kristián, Šimko, Radoslav, Morochovič, Martin, Paulo, Marián, Sedlák, Jan, Grosek, Ales, Tomazic, Leyla Al Mahdawi, Nuhi, Arslani, Andrej, Avsenak, Andrej, Bergauer, Krešimir, Blažević, Dejan, Bratus, Dalibor, Cankoski, Andrej, Cokan, Bojana, Crnobrnja, Andraz, Dovnik, Vojko, Flis, Samo, Fokter, Urska, Gajsek, Minja, Gregorič, Marko, Hazabent, Tomaz, Jagric, Niko, Kavčič, Jure, Knez, Nina, Kobilica, Rok, Kovačič, Lara, Lukman, Urska, Marolt, Jan, Mlakar, Tamara, Mohorko, Andrej, Moličnik, Ivan, Perić, Stojan, Potrč, Milena Senica Verbic, Mateja, Sirše, 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Raquel Angulo Artal, Luis, Barbier, Guillermo, García-Operé, Marta, Jiménez-Jiménez, Héctor, Marín, Mikel, Oñate, Luis Antonio Pascua-Gómez, María Alexandra Pesántez Peralta, Ibabe Villalabeitia Ateca, Ladislao Cayetano Paniagua, Joan, Camí, Pablo, Collera, Martínez, David, Carlos Javier Gómez Díaz, Jordi Querolt Coll, M Dolors Rosines Cubells, Cristina Soto Montesinos, Guillermo, Triana, Marina, Xicola, Alfonso, Alias, Albert, Baduell, Mariano, Balaguer-Castro, María Pilar Camacho Carrasco, Marina Cámara Vallejo, Borja Campuzano Bitterling, Guillem, Claret, Francisco, J Cuesta-González, Alberto Di Somma, Joaquim Enseñat Nora, Neus, Fabregas, Ada Ferrer Fuertes, Abel, Ferrés, Cesar, Ginesta, Jose Juan Gonzalez Sanchez, Isabel, Gracia, Jhon Alexander Hoyos Castro, Montsant, Jornet-Gibert, Xavier, Morales, Alejandra, Mosteiro-Cadaval, Leire, Pedrosa, José Poblete Carrizo, Marina, Renau-Cerrillo, Luis Alberto Reyes Figueroa, Pedro Roldan Ramos, Jordi Rumià Arboix, Marta, Sabater-Martos, 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Barbara, Algar-Yañez, Gutiérrez, Bérénice, Olga De La Varga-Martínez, Paula, Fernandez-Valdes-Bango, Sandra Maria Gadin-Lopez, José María Martínez-Gómiz, Elena, Nieto-Moreno, Ana, Nieto-Moreno, Montserrat Ocampos Hernandez, Maria Laura Pelegrina-Lopez, Alicia Ruiz Escobar, Elena, Sáez-Ruiz, Beatriz, Vazquez-Rivero, Antonio, Lara, Belén Vielva Del Campo, Fernando Alcaide Matas, Simbad, Costas-Ochoa, José María García Pérez, Elizabeth, Marmol, Paula Troncoso Pereira, Maria Del Pilar Concejo Cutoli, Juan Ramón Gómez López, Juan Carlos Martín Del Olmo, Paloma Guillamot Ruano, Javier Páramo Zunzunegui, Antonio Albarracín Marín Blázquez, Alfonso, Aliaga-Sanchez, Marta María Arroyo Domingo, Miriam Artés Artés, Ana Isabel Avellaneda Camarena, Aida, Blaya, Emny Rochell Bobadilla Romero, Pedro Vicente Fernández-Fernández, Lorena Galindo Iñiguez, Víctor Javier García Porcel, Clara Giménez Francés, Antonio Javier Gomez Poveda, Rebeca Gonzalez Celdran, Francisco Miguel González Valverde, Laura Guillamon Vivancos, Elena, Gurrea-Almela, Alejandra Jara Maquilón, Jose David Jimenez Parra, Abd Al Aziz Lanagrán Torres, Raquel Lax Perez, Carmen Maria Lopez Lopez, Francisco, Machado, Alfonso Marco Garrido, Florencio Manuel Marin Martinez, Victoria Martínez Muñoz, Esther, Medina, Olimpia, Molina, José Manuel Muñoz Camarena, Julian, Onate, Pedro Antonio Parra Baños, Emilio Peña Ros, Enrique, Rubio, Marina Sánchez Robles, Carlos Sanchez Rodriguez, María Valero Soriano, María Teresa Yepes García, Felipe, Alconchel, Andrés Balaguer Román, Valentín, Cayuela, Ana, Conesa, Ana Delegido García, Pedro José Gil Vázquez, Paula Gómez Valles, Francisco, Gómez-Bosch, Vicente, J León-Muñoz, Francisco, Martínez, Alvaro, Navarro-Barrios, Tatiana, Nicolás-López, Pablo Ramirez Romero, Emiliano, Cano-Trigueros, María Concepcion Alonso González, Leticia Gómez Viana, Ana Pastor Zapata, Elisa Contreras Saiz, Tamara Díaz Vico, Maria, Fernandez-Hevia, Luis Joaquín García Flórez, Raquel, Rodríguez-Uria, Sandra, Sanz, Lorena, Solar-Garcia, Aida Suárez Sánchez, Jaume, Gelonch, Dietmar, Reinaldo, Miriam Abdulkarim Polo, Asier, Aguirre, Marta Alomar Bofill, Santiago, Baena, Ashish, Bartakke, Carmen Cabeza Oliver, Marta Castro Suárez, José Andrés Cifuentes Rodenas, Olga Claramonte Bellmunt, Ant Onia Crespí Mir, Anabel De La Llave Serralvo, Mar, Escales, Isabel Rosa Fernández Burgos, Pablo Gandia Gonzalez, Juan Lliteras Jorge, María Cristina Martínez Canto, Javier, Mata, Andreu, Morell, Naila, Pagès, Sara Pérez Palao, Cristian Plaza Valiente, Catalina Ramon Barcelo, Carmen Reyero Fernández, Albert Reyes Claret, Leticia Rodriguez Vaquero, Maialen Saez de Vicuña Salinas, Pilar Santos Cidon, Concepcion, Segura, Aina, Serra, Maria Serra Guivernau, Maria Soler Pedrola, Marta, Tasende, Marta Torrent Lluch, María Inmaculada Valldeperas Hernández, Rosa-Maria, Yañez-Lpez, Andrea, Craus-Miguel, Laura Fernández Vega, Natalia Pujol Cano, Juan José Segura-Sampedro, Laura Colet Oliver, Ivan Dot Pascuet, Mireia, Duart, Isabel Tello Galindo, Eduardo Arrea Salto, Jaume Cámara Cabrera, Marta Camats Terré, Juan Gabriel Castro Ríos, Marta de la Rosa-Estadella, Anna, Fernandez-Colorado, Anna, Gasulla-Rodriguez, Antonio, Gimenez-Gaibar, Elena, Gonzalez, Yeray Maldonado Sotoca, Matilde, Molina-Corbacho, Montserrat Monfort Mira, Josep, Rodoreda, Marta Santos Espí, Arnau Verdaguer Figuerola, Elisa Angela Diego-Alonso, Jaime, López-Sánchez, Luis, Muñoz-Bellvis, Jacobo, Trebol, Borja, Aguinagalde, Cristina Gabriela Alzate Arsuaga, Ainhoa Andres Imaz, Iñigo, Arana, Coro Aranzabal Urrutia, Mikel, Armendariz, Lorena, Arrabal, Iñigo, Augusto, Adolfo, Beguiristain, Laura, Busto, Ainhoa, Cuevas, Itziar De Ariño, Alejandro, Elúa, Leticia, Fernandez, Arantza, Fernandez-Monge, Lander, Gallego, Alba, Garcia, Amaia Garcia Dominguez, Gregorio, Garmendia, Carmen, Grañén, Pelayo Hevia Rodríguez, Maria, Iraola, José Miguel Izquierdo, Aintzane, Lizarazu, Jon Ander Lizarbe, Claudia Cristina Lopes Moreira, Iker, López, Ruth Marquina González, Tania, Pastor, Adrián Recio Ayesa, Ana Paula Riverola Aso, Carballo, Rodríguez, Araceli, Rodrìguez, Maria Inmaculada Ruiz Montesinos, Patricia, Torres, Jose, Undabeitia, Ainara, Villafruela, Maria Barrionuevo Ramos, David, Blanco, Marta, Calderón, Eva Corral Rubio, Angel, Cuadrado-García, Daniela, Cubek, Ignacio, Fariña, Maria Fernandez LLorente, Natalia Flores Amador, Mariana García Virosta, Luis Garcia-Sancho Tellez, Adelina Gonzalez Martinez, María, Hernandez, Rubén Herreros Ruiz-Valdepeñas, Carmen Jimenez Sanchez, Eduardo Llamazares Cobo, María, López, Javier, López-Martin, Teresa Martínez Marivela, Luis Miguel Martinez Parra, Paloma Maté Mate, Paloma, Medrano, Manuel Moriche Carretero, Sara Núñez O'Sullivan, Manuel Ortega Oria de Rueda, María Begoña Pastor Nieto, Clara, Pérez, Antonio, L Picardo, Remedios Revilla Amores, Carmen Rodríguez Haro, Jose Alberto Rojo López, Fatima Sanchez Cabezudo Noguera, Cristina, Sanz, Daniel Serralta de Colsa, Cristina Valor Garcia, Marta Velasco Martinez, Iván Andújar Lara, Aranzazu, Calero-Lillo, Enrique, López-Ruiz, Alberto Díaz García, Alejandro Menéndez Moreno, Luis Eduardo Pérez-Sánchez, Ángela, Pascual, Miguel Adeba García, Marta Alonso Fernández, Javier Alvarez Gama, Roberto, Ballestero, Loreto Berjon De La Vega, Paola Calleja Hermosa, Mariana, Carrillo-Rivas, Alfonso, Casado, Andrea, Cerveró, Bonifacio Cimadevilla Calvo, Patricia Corriols Noval, Paloma de la Dehesa Cueto-Felgueroso, Miren Jasone Diez Zapirain, José Estevez Tesouro, José Antonio Fernández-Dívar Sánchez, Lucia Garcia Alcalde, Juan García Cardo, Tito García Moreno, Daniel, García-López, Belen Garcia-Montesinos Perea, Miren Gonzalez Benito, Rocio, Gonzalez-Aguado, Miguel Ángel Gordo Vega Gordo-Vega, Jose, Gutierrez-Banos, Jaime Jimeno Fraile, Yolanda Jubete Castañeda, Patricia Lopez Gomez, Antonia Jesús López López, David Mato Mañas, Carmelo, Morales-Angulo, Dieter, Morales-Garcia, Sara, Naranjo, Jose Luis Rabago, Jose Manuel Rabanal, Rocio Revuelta Zorrilla, Adriana Reyes Echeverría, Juan Carlos Rodríguez-Sanjuán, Juan Ramón Sanz, Isabel Simal Badiola, Guillermo, Tejón, Enrique Toledo Martínez, Raquel Varea Malo, Begoña, Fadrique, Tania, Funes, Elena González Revilla, Isaias, Alarcón, Daniel Aparicio Sánchez, Pablo Beltran Miranda, Carmen, Cepeda-Franco, María Josefa Cuevas López, Sandra, Dios-Barbeito, Virginia María Durán Muñoz-Cruzado, Carlos Gonzalez De Pedro, Rosa, M Jimenez-Rodriguez, Francisco, Manresa-Manresa, Gabriel, Marin, Cristobalina, Martin-Garcia, Sara, Martínez-Núñez, Juan Manuel Martos Martinez, Lucas, Mengíbar, Felipe Pareja Ciuro, Eduardo Perea Del Pozo, Veronica Pino Diaz, José, Pintor-Tortolero, Claudia, Quintero-Pérez, Maria Luisa Reyes Diaz, Mercedes Rubio Manzanares Dorado, Alejandro Sanchez Arteaga, Ana, Senent-Boza, Luis, Tallon-Aguilar, Jose, Tinoco-Gonzalez, Luis-Cristobal, Capitan-Morales, Juan Cintas Catena, Javier, Valdes-Hernandez, María Del Campo Lavilla, Alina López De Fernández, Miriam Abellan Lucas, Alba Diaz Padillo, Maria Gómez Romero, Linda Grace Puerto Tamayo, El Mostafa El Yaqine Er Raoudi, Melody García Domínguez, María Ángeles Gascón Domínguez, Marta González Pérez, Alba Hernáez Arzoz, Joana San Anton, Cristian, Ruminot, Hander Guillermo Acosta Diaz, Daniella, Laguado, Kristina, Aghababyan, Alba, Jr, Enrique, Artigues, Rocío, Belda, Miguel, Beltran, Jose Ignacio Blanes, Elena Campos Carot, Miriam, Cantos, Laura, Costa, Carolina Ferrer Gomez, José María Gallego Sánchez, Oscar, Gil-Albarova, Juan, Gilabert-Estellés, Emilio Lopez Alcina, Isabel López Sánchez, Severiano Marin Bertolin, Carolina, Martinez-Perez, Antonio Melero Abellán, Claudia Mulas Fernández, Beatriz, Novoa, Ruth, Nuñez, Pablo Renovell Ferrer, Guijarro-Jorge, Ricardo, Carolina Soledad Romero Garcia, Miguel Sanfeliu Giner, Silvia, M West, Enrique, Zapater, Ignacio, Miranda, Ana, Monís, Alejandro Roselló Añón, María José Sangüesa, Jorge Sanz Romera, Marcos, Adrianzén, Maria Barrios Carvajal, Mireia, Bauzá, Ana Benítez Riesco, Jose Antonio Carbonell Lopez, María-Carmen, Fernández-Moreno, Ricardo Gadea Mateo, Francisco, Garcia, Maris Luisa García-Pérez, Luisa Paola Garzon, Ana, Izquierdo, Maria Lapeña Rodríguez, Carlos, León-Espinoza, Fernando, Lopez, Rosa Martí Fernández, Sara Martínez Castro, Berta Monleón López, Isabel Mora Oliver, David, Moro-Valdezate, Ernesto Muñoz Sornosa, Sara Palomares Casasús, Leticia Pérez Santiago, Mara Albert Fort, Reyes, Balanzá, Lorena Bermell Marco, Carla Carratalá Pérez, Claudia Pilar Clemente Tomas, Marta, Córcoles, Jose Ángel Diez Ares, Carlos Domingo Del Pozo, Nuria Estellés Vidagany, Gonzalo, Garrigos, Mar Gimeno Gimeno Vicente, Blanca Alastrue Giner, Segundo, Gomez-Abril, Paloma, Gonzalez, Paula Gonzálvez Guardiola, Guillermo Sebastian Martínez Fernández, Charo Martínez García, Lucía, Martínez-Costa, Luz María Moratalla Charcos, Sergio Navarro Martínez, Carmen, Payá-Llorente, Álvaro Pérez Rubio, Nuria, Peris, Eduardo Picazo Pineda, Jordi Planelles Gómez, Francisco Ripoll Vidal, Andrea, Roca, Enrique, Salmerón-González, Raquel Segura Roselló, Ramon Trullenque Juan, Cristina Verdejo Gimeno, Jose Miguel Zaragozá García, Gema Zomeño Bravo, Marcos Bruna Esteban, Hanna, Cholewa, Milton de Jesus, Matteo, Frasson, Luis Oliver García, Héctor, J Aguado, Antonio Jose Alonso Villalba, Francisco, Ardura, Carmen Elena Badillo Bercebal, María Bedate Núnez, Alvarez-Ramos Begoña Aranzazu, Juan Beltrán de Heredia, Hugo, Bermejo, Juan Berrocal Cuadrado, Maria Bragado González, Juan, Bustamante-Munguira, Raul Calvo Gonzalez, Yolanda, Carrascal, Ana Belén Casas Marcos, María Carmen Cervera, Sergio Chávez Valladares, Ángel Cilleruelo Ramos, Susana, Cortes, Jesús, Crespo-Sanjuán, María, Cuaresma, Luis Antonio Cuellar Martin, Carlos Ferreras García, Alvaro, Fuentes-Martín, Abel, Ganso, Elena García García, Luis, Garcia-Florez, Virginia, Garcia-Virto, Juan, Gatón, Julio Alberto Gobernado Tejedor, Tania Gómez Sanz, Jose Ignacio González Martín, María Begoña Gregorio Crespo, Ana Herranz Arriero, Jose, Herreros, Marta Ibáñez Nieto, César, Infante, Carlos, Jezieniecki, Moises, Juarez, Gregorio de Jesus Labrador Hernandez, Ana Patricia Legido Morán, Ricardo León Fernández, Alejandro, Leon-Andrino, Almudena, Llorente, Maria Lopez Pais, Mauricio Loucel Bellino, Sergio, Martin, Miguel Angel Martin-Ferrero, Gonzalo Martinez Municio, Elvira Mateos Alvarez, José María Matilla, Luis María Merino Peñacoba, Mario, Montes-Manrique, Fernando Natal Álvarez, David, C Noriega, Henar Nuñez Del Barrio, Francisco Javier Ortiz de Solórzano Aurusa, Lucía, Pañeda, Victoria Pascual Escudero, Miguel Pascual Samaniego, Adela, Pereda, Marta Pérez Febles, Laura, Pesquera, Maria, Plata, Emma Puertas Ruiz, Mario, Rodriguez-Lopez, Alejandro Romero de Diego, Ana, Ruano, María Ruiz Soriano, Cristina Sánchez Torralvo, Silvia Santiago Maniega, Bárbara, Segura-Méndez, Clarisa Simon Perez, José, Soro-García, Paula Suárez Mansilla Suárez-Mansilla, Jeancarlos Trujillo Díaz, Mª Esther Valsero Herguedas, Andrea Vazquez Fernandez, Eduardo Velasco García, Ana, Zabalza, Álvaro Zamora Horcajada, Fernando Acebes García, Enrique Asensio Díaz, Martín, Bailón, Alejandro David Bueno Cañones, Alvaro Centeno Velasco, Ekta Choolani Bhojwani, Fernando Labarga Rodríguez, Sara, Mambrilla, Pablo, Marcos-Santos, Toledano, Miguel, David Pacheco Sánchez, Baltasar, Pérez-Saborido, Pilar, Pinto, Katherine, Plua, Javier Sanchez Gonzalez, Vicente, Simo, Rosalía Velasco López, Sandra Veleda Belanche, Fabiola Eugenia Michel Campos, Iciar Muñoz Lindez, Maria, Balluerca, Maite, Camuera, Pablo, Helguera, Imanol, Herrero, Patricia Paunero Vazquez, María, Sánchez-Rubio, Isami, Soeda, María Dolores Arribas Del Amo, Vicente Manuel Borrego Estella, Estefania, Casas, Néstor Castán Villanueva, Daniel Delfau Lafuente, Elena Delgado Blanco, María, Domingo, Ismael Gil Romea, Azucena, Gonzalo, Emilio Lagunas Lostao, Noelia Lete Aguirre, Yaiza Martinez Lahoz, Jesús Víctor Pérez-Tierra Ruiz, Maria Del Mar Soriano, Isabel Valero Lázaro, Esmeralda Carnicer Escusol, Guillermo Pola Bandres, Juan Luis Blas Laina, Beatriz, Cros, Patricio Andrés Freile Pazmiño, David, Garcia-Aguilera, Ana Mejía Casado, Ana, Nogués, Issa Talal El-Abur, Carlos, Yánez, Isabel Gascon Ferrer, Carlos, Gracia-Roche, Ursula María Jariod Ferrer, María Victoria Simón Sanz, Tomas, Uson, Waseem, Ahamed, Sumudu, Jayasinghe, Eranda, Karunadasa, Prathibha, Nelihela, Sujeewa Priyantha Bandara Thalgaspitiya, Dickson, Wickramarathna, Nagenthiram, Harivallavan, Pirashanthan, Nagarasa, Eranga, Perera, Kanapathipillai, Piratheep, Vithranage Srimantha Dewsiri Rodrigo, Meera, Thayalan, Rajendram, Thayaparren, Arulprashanth, Arulanantham, Kanishka De Silva, Gagana, Ganga, Anuja Nadeeshan Kumarasinghe, Mahanada, Udukala, Koculen, Vimaleswaran, Prashanthan, Yogarajah, Ravindri, Jayasinghe, Probhodana, Ranaweera, Mohamed, Rishard, Dharmabandhu, N Samarasekera, Sanjeewa, Seneviratne, Sivasuriya, Sivaganesh, Chamal, Fernando, Nishantha, Mendis, Balasingam, Balagobi, Balasupramaniam, Sathesan, Lanka, Dasanayake, Malitha, Patabendige, Wickramasooriya, Dj, Kugarajh, Ganeshapillai, Sathyamoorthy, Prasanna, Dileepa, Ediriweera, Sumudu, Kumarage, Asanka, Jayawardane, Athula, Kaluarachchi, Pituwala Liyanage Adithya Sirisena, Abubakr, Abubakr, Hozifa, Mohamed, Ismail, Mustafa, Mogahid, Sharfeldein, Samir, Ismail, Reem, Musa, Monira, Sarih, Mussab, Abaker, Eman Adam Abdalla, Mohamad, Abdelbagi, Alsafe, Adlan, Ahmed, Alnaeem, Safa, Atyah, Yasir, Awad, Rsheeda, Dawelbait, Mohamed El Hag, Ibrahim, Elbashir, Sami, Eldirdiri, Samwal, Eldirdiri, Mohammed Eltahier Abdalla Omer, Lana Abdalgadir Ahmed Mohamed, Hiba Hassan Rehmtallah Ahmed, Mohammed Balla Yousif Balla, Abdulmoiz, Aljafari, Abdulmalek, Aljafari, Elsagad, Mohamed, Abdulkader, Mohammad, Abdulkader, Shaar, Mohamed Nafea Shaar, Maab Hussein Yousif Elhafiz, Mohammed Husien Yosif Elhafiz, Abubakr Ali Mohammed Alhassan Humidan, Almigdad, Ali, Hisham, Eljack, Mohamedyasin, Elrashid, Manhal, Ahmed, Albrra, Alhag, Douaa, Ali, Mohammed Ahmed Babikir, Imad, Bakheit, Hytham K, S Hamid, Sami, Mohamed, Walid, Shaban, Nidhal, Siddig, Mohamed, Suliman, Rihab Yasir Abdelmagid, Abubaker, Yassin, Omer, Abbas, Eltahir, Abdelrahim, Muhammed, Ahmed, Mohamed, Elobaid, Adil, Hashim, Ali, Mohamed, Omer, Mohamed, Khalid, Osman, Abdallah, Yousif, Safaa, Abdulaal, Marwa, Elsadig, Mohammed, Hussain, Malaz Amir Ataalmanan, Doha Amir AtaAlmanan, Tebyan Amir AtaAlmanan, Alaa, Elgaili, Maria, Mohamed, Usra, Omara, Alkhansa, Osman, Amna, Osman, Safaa, Saad, Abdelkareem, Ahmed, Ali Adil Ali Karar, Aya, Alhassan, Mohanad, Alsidig, Mohamed, Eljack, Mohammed Ibrahim Mohammed Ali, Awad Kamal Awad Osman, Liena, Mohamed, Samah Ibrahim Omer Mohamed Osman Mohamed Osman, Altayeb, Mohammed, Ayman, Mohammed, Khadija, Muhmmed, Eltahir, Musa, Egbal Sahal Abdelmajed, Khalid Z M, Y Hamid, Omnia M, M Yousif, Mahmoud, Saleh, Osman, Bashir, Yassein, Elhussein, Omar, Madani, Eva, Angenete, Jennifer, Park, Lars, Gillberg, Monir, Jawad, Linas, Pieteris, Yousif, Saeed, Sergej, Safonov, Martin, Spångfors, Henrik, Andersson, Hans, Bahlmann, Karin Björnström Karlsson, Michelle, Chew, Lara, Daham, Lina De Geer, Helen, Didriksson, Gunilla, Gagnö, Carina, Jonsson, Anna, Oscarsson, Pamela, Buchwald, Mathilde, Delorme, Marie-Louise, Lydrup, Shahin, Mohseni, Arvid, Pourlotfi, Souheil, Reda, Kajsa, Anderin, Nina, Blomme, Josefin, Segelman, Malin, Simlund, Anders, Thorell, Fredrik, Wogensen, Daniel, Danielsson, Peter, Elbe, Rebecka, Hultgren, Boel, Hynning, Fredrik, Klevebro, Karin, Lind, Ebba, K Lindqvist, Carl, Montan, Ernesto, Sparrelid, Clara Svenberg Lind, Jeremy, Wales, Andreas, Älgå, Martin, Nordberg, Emil, Pieniowski, Ioannis, Gkekas, Niklas, Löfgren, Karolina, Niska, Robert, Zürner, Silvio, Däster, Otto, Kollmar, Savas, Soysal, Stephanie, Taha-Mehlitz, Athanasios, Tampakis, Dominik Valentin Flury, Marie, Heyne-Pietschmann, Gregor Jan Kocher, Ana, M Calinescu, Barbara, Wildhaber, Markus, Gass, Jürg, Metzger, Andreas, Scheiwiller, Lukas, Briner, Oliver, Dwidar, Steven, Grandjean, Pietro, Ricciardi, Alexandra, Calmels, Christodoulou, Michel, Morena, Antonilli, Dimitrios, Christoforidis, Alessandra, Cristaudi, Jacopo, Galafassi, Maria Luisa Gasparri, Francesco, Mongelli, Martino, Munini, Andrea, Papadia, Sotirios Georgios Popeskou, Alex, Alfieri, Thomas, Bächler, Matteo, Giardini, Christian, Gingert, Laura, Guglielmetti, Inna, Meyer, Tobias, Müller, Daniel, Schöni, Folco, Solimene, Frank, Weidner, Marco, Bueter, Daniel, Gero, Amelie, Müller, Carmen, Portenkirchner, Andreas, Thalheimer, Jeannette, Widmer, Ahmad, Hmaideh, Alaa, Kour, Saleem, Swaes, Omar, Alannaz, Ramez, Aljasem, Ezeddin, Dabbagh, M Wafa Hamoud Alhussein, Amr, Hamza, Mazen, Mohammad, Abd El-Fattah Mouhandes, Mohamad, Shareeda, Mohammad Nour Shashaa, Mousa, Sifat, Sheraa, Tahhan, Rahaf, Toutounji, Mohamed, Abdulrahman, Albaraa, Abdulsalam, Ziad Al Jarad, Hala, Alayyoubi, Dina, Alfarra, Ahmad, Alhamid, Mahmoud, Alnasser, Mulham, Gharib, Ruwaid, Gharib, Obaida, Kabel, Osama, Kherallah, Abdulqader, Klaho, Mohamed Shukri Najjar, Ahmad, Razouk, Joud, Shiekhoni, Wael, Alkhaleel, Amira, Almosa, Mohammad, Aloulou, Maen, Alzaeem, Khaled, Arnaout, Muhamad Zakaria Brimo Alsaman, Mohamad, Estanbouli, Hanadi, Hawa, Ahmad Nbrass Kabawi, Ghina, Maarawi, Yehia, Mashhadany, Sana Shaikh Torab, Waleed, Abd, Tayma Abd Alghafour, Hani, Abdalnour, Nazeeh Al Aktaa, Marwan Al Aliwy, M Maher Al Arje, Tasneem Al Najjar, Ahmad, Al-Mouakeh, Ahmad, Aldakhil, Aos, Alhamid, Hasan, Alhasan, Mohamad Shadi Alkarrash, Jumaa, Alkhamis, Sara, Alshekh, Ahmad Yamen Arnaout, Oula, Azizeh, Mohammed, Dalaleh, Aghyad, Danial, Zain, Douba, Raghad, Ghadri, Mohammad Maen Ghannam, Anas, Ghawi, Luma Haj Kassem, M Yasser Halwani, Shahed, Hamadieh, Mohammad, Hanino, Ala Aldeen Hasan, Haya, Jawish, Nasr Ullah Kabbani, Saadullah, Kabbany, Mohamad, Kadi, Lama, Kadoura, Ahmad Amir Kayali, Ammar, Kayyali, Aya, Kelzia, Amana, Kezze, Abdullah, Khalaf, Maymona, Khayata, Mohammad Nour Kitaz, Mohammad, Kour, Raghad, Makki, Ruqaya, Masri, Joseph, Masri, Noor, Masri, Muhammad, Mazketly, Shiar, Mustafa, Ezzeldin, Nashed, Yaman Qoudra Danial, Hasan, Raslan, Rima, Salem, Mohammed Asaad Salem, Thabet Sayed Bakir, Manaf, Sharabaji, Majd Sheikh Alganameh, Duaa Sheikh Kadro, Joudy, Shurbatji, Mohammad Noor Sultan, Dana, Sultan, Hala, Swied, Bakri Tarras Jarkas, Tayf, Toutounji, Fadi, Ward, Rama, Zazo, Aya, Zazo, Zainab, Zeino, Mohamed, Alaktaa, Wael, Alsado, Hala, Fares, Nouran, Hawa, Hamza, Ibrahim, Abdulmonem, Kawas, Mourad, Niazi, Bayan, Toutounji, Mohammad, Abdow, Mohamad, Ahmad, Tareq, Ahmad, Rawan Al Azhar, Hiba Al Hage Diab, Rahaf Al Mulke, Mohammad, Al-Jadaan, Ahmad, Alhussein, Zahra, Alnajem, Omar, Alneser, Bayan, Alsaid, Elias, Azar, Lubna, Bakr, Ammar, Hamza, Yara, Houdifa, Sami, Jomaa, Samer, Kefo, Hiba, Mardini, Alaa, Mohammad, Fadi, Rayya, Fatima, Razzouk, Mohannad, Saleh, Anwar, Shamandi, Ammar Youzkatli Alkhatib, Omar Abdul Salam, Dany, Ajami, Mohammad, Alhamid, Ahmad, Alkhaledi, Danny, Hadidi, Massa, Jabra, Mamdouh, Kallas, Antoine, Laktine, Joelle, Naem, Naya, Naoum, Ghena Mohammed Fawaz Ashour, Ahmad, Alhouri, Deema, Fallouh, Ahmad, N Mohammad, Ahmad, Rmman, Ali, Slitin, Christine, Tanos, Ibrahim, Wakim, Hanaa, Zahrawi, Majd, Abouassi, Layth, Abouassi, Ayham, Aboutrab, Basel, Ahmad, Ahmad Mustafa Ahmad, Aya, Ahmad, Afaf, Ahmad, Mohamad, Alabras, Mohammad, Albasheer, Ola, Alkasser, Mhd Khaled Alkasser, Ali, Alkhdor, Marah, Azkoul, Mohammad Karam Chaaban, Haya, Deeb, Basel, Jazieh, Basel, Kouz, Youssef, Kozah, Raied, Mohamad, Ammar, Mohammad, Mhd Zied Nasri, Mohammed Mouaz Shebani, Mohammed, Shwin, Alaa, Sommaq, Amal, Youssef, Tala Al Asadi, Suhad, Alkhateb, Rasha Khalil Alsayyad, Roula, Altom, Mhd Amin Alzabibi, Batoul, Bakkar, Hlma, Ismail, Salma Khadem Alsrouji, Sara, Melhem, Mohamad, Sankari, Mosa, Shibani, Noura, Shujaa, Ibrahim, Adham, Salma, Al-Houssami, Maram, Balouli, Yazan, Rahmeh, Simon, Yanni, Sally, Yousef, Aline, Ahmad, Marah, Ali, Abdulrahman, Almjersah, Aya, Almoustafa, Hiba, Dahhan, Bashar Haj Hassan, Alaa, Hamdan, Salah, Hammed, Rawan, Harfoush, Rama, Hasan, Natalie, Jarkas, Moufid, Mahfoud, Ahmed, Moussa, Alaa, Sulaiman, Siba, Suliman, Yu-Ning, Hu, Jun-Neng, Roan, Meng-Ta, Tsai, Yi-Chen, Wang, Thammawat, Parakonthun, Nicha, Srisuworanan, Voraboot, Taweerutchana, Somcharoen, Saeteng, Sophon, Siwachat, Apichat, Tantraworasin, Danielle, Dimsoy, Shane, Khan, Akash, Ramsaroop, Shivanand, Ramsubhagh, Karim, Ayed, Oussama, Baraket, Mohamed Hedi Ghalloussi, Abbassi, Imed, Nahla, Kechiche, Waad, Farhat, Ammar, Houssem, Erdal Birol Bostanci, Volkan, Oter, Erol, Pişkin, Cihangir, Akyol, Sibel, Demirel, Mehmet Ali Koç, Can, Konca, Özge, Yanık, Basak, Bolukbasi, Huseyin, Gobut, Emre, Gülçek, Kerim, Karabulut, Ramazan, Kozan, Farshad, Noori, Elif, Özeller, Can, Şahin, Ali, Yalcinkaya, Mesut, Yavaş, Aydın, 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Giorgini, Carlo Ingaldi, Elio Jovine, Kenji Kawamukai, Antonio Lanci Lanci, Raffaele Lombardi, Maria Elisa Lozano Miralles, Claudio Marchetti, Michele Masetti, Francesco Minni, Daniele Morezzi, Daniele Parlanti, Alice Pellegrini, Anna Myriam Perrone, Anna paola Pezzuto, Marco Pignatti, Gianluigi Pilu, Valentina Pinto, Gilberto Poggioli, Silvana Bernadetta Puglisi, Diego Raimondo, Matteo Ravaioli, Claudio Ricci, Sara Ricciardi, Francesco Ricotta, Roberta Rizzo, Angela Romano, Matteo Rottoli, Riccardo Schiavina, Renato Seracchioli, Matteo Serenari, Margherita Serra, Piergiorgio Solli, Gioia Sorbi, Mario Taffurelli, Marta Tanzanu, Achille Tarsitano, Marco Tesei, Gabriele Vago, Tommaso Violante, Simone Zanotti, Tommaso Frisoni, leonardo solaini, giorgio ercolani, Fruscio, R, Ornaghi, S, Collaborative, Covidsurg, Collaborative, Globalsurg, Palmisano, Silvia, de Manzini, Nicolo', Žundienė, Laura, Dulskas, Audrius, Kuliavas, Justas, Čekauskas, Albertas, Kielaitė-Gulla, Aistė, Poškus, Tomas, Strupas, Kęstutis, Želvys, Arūnas, COVIDSurg Collaborative, GlobalSurg Collaborative, Department of Surgery, HUS Abdominal Center, Simoes, Jff, Li, E, Picciochi, M, Glasbey, Jc, Baiocchi, G, Blanco-Colino, R, Chaudhry, D, Alameer, E, El-Boghdadly, K, Wuraola, F, Ghosh, D, Gujjuri, Rr, Harrison, Em, Lule, H, Kaafarani, H, Khosravi, M, Kronberger, I, Leventoglu, S, Mann, H, Mclean, Ka, Mengistu, Gm, Modolo, Mm, Ntirenganya, F, Norman, L, Outani, O, Pius, R, Pockney, P, Qureshi, Au, Roslani, Ac, Satoi, S, Shaw, C, Bhangu, A, Omar, Om, Ahmed, Wur, Argus, L, Ball, A, Bywater, Ep, Brar, A, Dawson, Be, Duran, I, Elhadi, M, Jones, C, Kamarajah, Sk, Keatley, Jm, Lawday, S, Marson, Ej, Ots, R, Santos, I, Taylor, Eh, Trout, Im, Varghese, C, Venn, Ml, Xu, W, Dajti, I, Gjata, A, Kacimi, Seo, Boccalatte, L, Cox, D, Townend, P, Aigner, F, Kronberger, Ie, Samadov, E, Alderazi, A, Hossain, K, Padmore, G, van Ramshorst, G, Lawani, I, Cerovac, A, Delibegovic, S, Gomes, Gma, Buarque, Il, Gohar, M, Slavchev, M, Nwegbu, C, Agarwal, A, Martin, J, Ng-Kamstra, J, Olivos, M, Lou, Wh, Ren, Dl, Calvache, Ja, Rivera, Cjp, Hadzibegovic, Ad, Kopjar, T, Mihanovic, J, Jimenez, Pma, Gouvas, N, Klat, J, Novysedlak, R, Amisi, N, Christensen, P, El-Hussuna, A, Batista, S, Lincango-Naranjo, E, Emile, S, Sandoval, Daa, Dhufera, H, Hailu, S, Mengesha, Mg, Kauppila, Jh, Arnaud, Ap, Demetrashvili, Z, Albertsmeier, M, Lederhuber, H, Loffler, Mw, Acquah, Dk, Ofori, B, Tabiri, S, Metallidis, S, Tsoulfas, G, Aguilera-Arevalo, Ml, Recinos, G, Mersich, T, Wettstein, D, Kembuan, G, Milan, Pb, Khosravi, Mh, Mozafari, M, Hilmi, A, Mohan, H, Zmora, O, Gallo, G, Pata, F, Pellino, G, Fujimoto, Y, Kuroda, N, Abou Chaar, Mk, Ayasra, F, Fakhradiyev, I, Hamdun, Ih, Jin-Young, J, Jamal, M, Karout, L, Gulla, A, Rasoaherinomenjanahary, F, Samison, Lh, Sanchez, Iid, Gonzalez, D, Martinez, L, Martinez, Mj, Nayen, A, and Ramos-De la Medina, A
Subjects: Male, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], MULTICENTER, infectious diseases, 0302 clinical medicine, 030202 anesthesiology, Anesthesiology, Cirugía, 80 and over, Prospective Studies, Young adult, Child, Lung, Aged, 80 and over, COVID-19, delay, SARS-CoV-2, surgery, timing, SARS‐CoV‐2 infection, Operative, Child, Preschool, Pneumonia & Influenza, Infection, Cohort study, Human, medicine.medical_specialty, Clinical Sciences, Sars-cov-2, GlobalSurg Collaborative, Settore MED/28 - MALATTIE ODONTOSTOMATOLOGICHE, 03 medical and health sciences, Clinical Research, Biodefense, Correspondence, Humans, PULMONARY COMPLICATIONS, CRIANÇAS EM IDADE PRÉ-ESCOLAR, Aged, Science & Technology, Cirurgia, Prevention, Infant, Odds ratio, Pneumonia, Prospective Studie, Clinical research, Surgery, Human medicine, 610 Medizin und Gesundheit, 1109 Neurosciences, Internationality, Settore MED/29 - CHIRURGIA MAXILLOFACCIALE, Settore MED/18 - CHIRURGIA GENERALE, Adolescent, Adult, Cohort Studies, Female, Middle Aged, Surgical Procedures, Operative, Time, Young Adult, Practice Guidelines as Topic, gastroenterology, Medicine and Health Sciences, 030212 general & internal medicine, Prospective cohort study, Mortality rate, Covid19, Infectious Diseases, Patient Safety, medicine.symptom, 6.4 Surgery, Life Sciences & Biomedicine, 610 Medicine & health, COVID-19, SARS-CoV-2, delay, surgery, timing, Asymptomatic, NO, COVIDSurg Collaborative, Vaccine Related, All institutes and research themes of the Radboud University Medical Center, medicine, Mortalitat, ddc:610, Mortality, Preschool, LS7_4, Surgical Procedures, business.industry, Neurosciences, Evaluation of treatments and therapeutic interventions, 1103 Clinical Sciences, 3126 Surgery, anesthesiology, intensive care, radiology, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Anesthesiology and Pain Medicine, Emerging Infectious Diseases, Good Health and Well Being, Mortalidad, Cohort Studie, business
Abstract: Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay. ispartof: ANAESTHESIA vol:76 issue:6 pages:748-758 ispartof: location:England status: published
Published: 2021

26. Prevalence of symptoms and risk of obstructive sleep apnea in Saudi pregnant women

Author: Awad H Olaish, Aamer Altaki, Abdulrahman M. Alsharidah, Yasser Sabr, Ahmed S. BaHammam, Mohammed Alangari, Abdulmalik Aldubayan, and Aljohara S Almeneessier
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, Early detection, Antenatal care, Third trimester, Risk groups, gestation, Second trimester, Medicine, Restless legs syndrome, lcsh:RC705-779, business.industry, Obstetrics, pregnancy-induced hypertension, lcsh:Diseases of the respiratory system, Berlin questionnaire, medicine.disease, Obstructive sleep apnea, lcsh:RC666-701, parity, restless legs syndrome, Gestation, Surgery, Original Article, Cardiology and Cardiovascular Medicine, business, Body mass index
Abstract: BACKGROUND: This case-control study aimed to assess the prevalence of symptoms and risk of obstructive sleep apnea (OSA) among Saudi pregnant women. METHODS: The study included consecutive Saudi pregnant women attending the antenatal service between July 2015 and December 2016. Pregnant women were compared with an age-matched group of nonpregnant women. OSA symptoms and risk were assessed using a validated Arabic version of the Berlin questionnaire (BQ). RESULTS: The study included 742 pregnant women and 742 age-matched nonpregnant women. At the time of the survey, 8.2% were in the first trimester; 33.4% in the second trimester; and 58.4%in third trimester. Snoring was reported by 14% of pregnant women, and 5% reported breathing pauses during sleep. Based on the BQ stratification for risk of OSA, 19.3% of pregnant women and 16.6% of the control group were at high risk for OSA. A comparison between the high OSA-risk and low OSA-risk pregnant women revealed that the pregnant women in high risk group were older (30.9 ± 5.9 years vs. 29 ± 5.4 years, P = 0.001), had a higher body mass index (BMI) (34.3 ± 5.2 kg/m2 vs. 28.7 ± 5.8 kg/m2, P < 0.001), and higher parity (1.9 ± 2 vs. 1.5 ± 1.7, P = 0.020). A multivariate logistic regression analysis revealed the following independent variables, BMI (odds ratio [OR] 1.173 [95% confidence interval [CI] 1.129–1.219],P < 0.001), pregnancy-induced hypertension (OR 7.85 [95% CI 1.691–36.447], P = 0.013), and the presence of restless legs syndrome (OR 2.209 [95% CI 1.332–3.279],P < 0.001). CONCLUSIONS: OSA symptoms and risk were relatively common among Saudi pregnant women. Increasing the awareness among physicians about this association is essential to improve early detection of the disorder.
Published: 2020

27. Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004-2013

Author: Kenneth Lim, Neda Razaz, Yasser Sabr, U. Vivian Ukah, Hamideh Bayrampour, Wee-Shian Chan, and Sarka Lisonkova
Subjects: Physiology, Maternal Health, 030204 cardiovascular system & hematology, Overweight, Weight Gain, Body Mass Index, Cohort Studies, Labor and Delivery, 0302 clinical medicine, Pregnancy, Risk Factors, Medicine and Health Sciences, Birth Weight, 030212 general & internal medicine, 2. Zero hunger, education.field_of_study, Obstetrics, Pregnancy Outcome, Obstetrics and Gynecology, Gestational age, General Medicine, Gestational Weight Gain, 3. Good health, Physiological Parameters, Medicine, Female, Maternal death, medicine.symptom, Underweight, Research Article, Adult, Washington, medicine.medical_specialty, Population, Gestational Age, Young Adult, 03 medical and health sciences, medicine, Humans, Obesity, education, Retrospective Studies, business.industry, Body Weight, Infant, Newborn, Biology and Life Sciences, medicine.disease, Morbid Obesity, Pregnancy Complications, Health Care, Birth, Women's Health, Health Statistics, Morbidity, business, Body mass index, Weight gain
Abstract: Background Suboptimal weight gain during pregnancy is a potentially modifiable risk factor. We aimed to investigate the association between suboptimal gestational weight gain and severe adverse birth outcomes by pre-pregnancy body mass index (BMI) categories, including obesity class I to III. Methods and findings We conducted a population-based study of pregnant women with singleton hospital births in Washington State, US, between 2004 and 2013. Optimal, low, and excess weight gain in each BMI category was calculated based on weight gain by gestational age as recommended by the American College of Obstetricians and Gynecologists and the Institute of Medicine. Primary composite outcomes were (1) maternal death and/or severe maternal morbidity (SMM) and (2) perinatal death and/or severe neonatal morbidity. Logistic regression was used to obtain adjusted odds ratios (AORs) and 95% confidence intervals. Overall, 722,839 women with information on pre-pregnancy BMI were included. Of these, 3.1% of women were underweight, 48.1% had normal pre-pregnancy BMI, 25.8% were overweight, and 23.0% were obese. Only 31.5% of women achieved optimal gestational weight gain. Women who had low weight gain were more likely to be African American and have Medicaid health insurance, while women with excess weight gain were more likely to be non-Hispanic white and younger than women with optimal weight gain in each pre-pregnancy BMI category. Compared with women who had optimal weight gain, those with low gestational weight gain had a higher rate of maternal death, 7.97 versus 2.63 per 100,000 (p = 0.027). In addition, low weight gain was associated with the composite adverse maternal outcome (death/SMM) in women with normal pre-pregnancy BMI and in overweight women (AOR 1.12, 95% CI 1.04–1.21, p = 0.004, and AOR 1.17, 95% CI 1.04–1.32, p = 0.009, respectively) compared to women in the same pre-pregnancy BMI category who had optimal weight gain. Similarly, excess gestational weight gain was associated with increased rates of death/SMM among women with normal pre-pregnancy BMI (AOR 1.20, 95% CI 1.12–1.28, p < 0.001) and obese women (AOR 1.12, 95% CI 1.01–1.23, p = 0.019). Low gestational weight gain was associated with perinatal death and severe neonatal morbidity regardless of pre-pregnancy BMI, including obesity classes I, II, and III, while excess weight gain was associated with severe neonatal morbidity only in women who were underweight or had normal BMI prior to pregnancy. Study limitations include the ascertainment of pre-pregnancy BMI using self-report, and lack of data availability for the most recent years. Conclusions In this study, we found that most women do not achieve optimal weight gain during pregnancy. Low weight gain was associated with increased risk of severe adverse birth outcomes, and in particular with maternal death and perinatal death. Excess gestational weight gain was associated with severe adverse birth outcomes, except for women who were overweight prior to pregnancy. Weight gain recommendations for this group may need to be reassessed. It is important to counsel women during pregnancy about specific risks associated with both low and excess weight gain., In a population-based retrospective cohort study, Ugochinyere Vivian Ukah and colleagues investigate the association between gestational weight gain and severe adverse birth outcomes in Washington State, USA., Author summary Why was this study done? The Institute of Medicine (IOM) has guidelines for optimal weight gain during pregnancy for women who have normal body mass index (BMI) and those who are underweight, overweight, and obese prior to pregnancy. Suboptimal weight gain is associated with adverse health outcomes for the mother and baby. The prevalence of obesity is rising, yet knowledge gaps exist in gestational weight gain recommendations specifically for women with various degrees of obesity (class I to III). Limited information is available about severe maternal and neonatal morbidity in women with suboptimal weight gain in each pre-pregnancy BMI category, particularly in class I to III obesity. What did the researchers do and find? We conducted a study including all 722,839 women with singleton delivery in Washington State, US, between 2004 and 2013, to assess birth outcomes associated with suboptimal weight gain. Less than half of women achieved the recommended optimal gestational weight gain. Low gestational weight gain was associated with an increase in adverse perinatal outcomes, particularly with maternal death and stillbirth, and with an increase in severe maternal morbidity in normal weight and overweight women. Excess gestational weight gain was associated with an increase in adverse maternal and perinatal outcomes in women with pre-pregnancy BMI within or below the normal range; such association was not observed in women who were overweight prior to pregnancy, while severe maternal morbidity was elevated in obese women with excess weight gain. Among obese women, low weight gain was associated with perinatal death and/or severe neonatal morbidity in all obesity classes, while excess weight gain was associated with adverse maternal and perinatal outcomes in women who had class III obesity. What do these findings mean? The IOM weight gain recommendations for women who are overweight prior to pregnancy may need reassessment. Weight gain below the recommended range in women who are obese prior to pregnancy may increase the risk of perinatal death/severe neonatal morbidity. Low weight gain may potentially be used as a marker of elevated risk of stillbirth; however, further studies are needed to assess such utility.
Published: 2019

28. Mode of delivery after a previous cesarean birth, and associated maternal and neonatal morbidity

Author: Shiliang Liu, K.S. Joseph, Tracy Pressey, Yasser Sabr, Carmen B Young, Robert M. Liston, and Giulia M. Muraca
Subjects: Pregnancy, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Research, General Medicine, Logistic regression, medicine.disease, Confidence interval, Neonatal morbidity, 03 medical and health sciences, 0302 clinical medicine, Mode of delivery, Number needed to treat, Gestation, Medicine, 030212 general & internal medicine, business, Risk assessment
Abstract: BACKGROUND: The mode of delivery for women with a previous cesarean delivery remains contentious. We conducted a study comparing maternal and infant outcomes after attempted vaginal birth after cesarean delivery versus elective repeat cesarean delivery. METHODS: We used data from the Discharge Abstract Database that includes all hospital deliveries in Canada (excluding Quebec). In our analysis, we included singleton deliveries to women between 37 and 43 weeks gestation who had a single prior cesarean delivery between April 2003 and March 2015. The primary outcomes were severe maternal morbidity and mortality, and serious neonatal morbidity and mortality. We used logistic regression to estimate adjusted rate ratios (RRs) and 95% confidence intervals (CIs). RESULTS: Absolute rates of severe maternal morbidity and mortality were low but significantly higher after attempted vaginal birth after cesarean delivery compared with elective repeat cesarean delivery (10.7 v. 5.65 per 1000 deliveries, respectively; adjusted RR 1.96, 95% CI 1.76 to 2.19). Adjusted rate differences in severe maternal morbidity and mortality, and serious neonatal morbidity and mortality were small (5.42 and 7.09 per 1000 deliveries, respectively; number needed to treat 184 and 141, respectively). The association between vaginal birth after cesarean delivery, and serious neonatal morbidity and mortality showed a temporal worsening (adjusted RR 0.94, 95% CI 0.77 to 1.15 in 2003–2005; adjusted RR 2.07, 95% CI 1.83 to 2.35 in 2012–2014). INTERPRETATION: Although absolute rates of adverse outcomes are low, attempted vaginal birth after cesarean delivery continues to be associated with higher relative rates of severe morbidity and mortality in mothers and infants. Temporal worsening of infant outcomes after attempted vaginal birth after cesarean delivery highlights the need for greater care in selecting candidates, and more careful monitoring of labour and delivery.
Published: 2018

29. Ruptured Renal Artery Aneurysm during Labor: a Case Report

Author: Talal A. Altuwaijri, Abdulmajeed Altoijry, Magdi Ibrahim, Thamer Nouh, Kaisor Iqbal, Yasser Sabr, and Ouhoud I. Kaddour
Subjects: medicine.medical_specialty, Pregnancy, business.industry, General surgery, medicine.disease, Cardiac surgery, Renal artery aneurysm, 03 medical and health sciences, 0302 clinical medicine, Cardiothoracic surgery, 030220 oncology & carcinogenesis, Pediatric surgery, medicine, 030211 gastroenterology & hepatology, Surgery, Neurosurgery, Caesarian section, Presentation (obstetrics), business
Abstract: Ruptured renal artery aneurysm (RAA) during pregnancy is unusual, and its presentation is often misdiagnosed or delayed in diagnosis. With its high and preventable feto-maternal mortality, RAAs during pregnancy requires a quick and accurate diagnosis to be managed efficiently. We present a rare case of RAA during labor, managed intra-operatively after a successful caesarian section delivery. We conclude that a multidisciplinary approach with a high margin of suspicion is necessary to improve the outcomes of this occurrence.
Published: 2019

30. Maternal Mortality in the United States: Recent Trends, Current Status, and Future Considerations

Author: Azar Mehrabadi, Amélie Boutin, K.S. Joseph, Giulia M. Muraca, Sarka Lisonkova, Yasser Sabr, Enrique F. Schisterman, Sid John, Neda Razaz, and Cande V. Ananth
Subjects: Adult, medicine.medical_specialty, Adolescent, MEDLINE, Death Certificates, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, medicine, Humans, 030212 general & internal medicine, Social determinants of health, Healthcare Disparities, Young adult, Child, Health statistics, Black women, 030219 obstetrics & reproductive medicine, business.industry, Public health, Mortality rate, Obstetrics and Gynecology, medicine.disease, United States, Pregnancy Complications, Maternal Mortality, Population Surveillance, Female, Maternal death, Death certificate, business, Forecasting, Demography
Abstract: Rigorous studies carried out by the National Center for Health Statistics show that previously reported increases in maternal mortality rates in the United States were an artifact of changes in surveillance. The pregnancy checkbox, introduced in the revised 2003 death certificate and implemented by the states in a staggered manner, resulted in increased identification of maternal deaths and in reported maternal mortality rates. This Commentary summarizes the findings of the National Center for Health Statistics reports, describes temporal trends and the current status of maternal mortality in the United States, and discusses future concerns. Although the National Center for Health Statistics studies, based on recoding of death certificate information (after excluding information from the pregnancy checkbox), showed that crude maternal mortality rates did not change significantly between 2002 and 2018, age-adjusted analyses show a temporal reduction in the maternal mortality rate (21% decline, 95% CI 13-28). Specific causes of maternal death, which were not affected by the pregnancy checkbox, such as preeclampsia, showed substantial temporal declines. However, large racial disparities continue to exist: Non-Hispanic Black women had a 2.5-fold higher maternal mortality rate compared with non-Hispanic White women in 2018. This overview of maternal mortality underscores the need for better surveillance and more accurate identification of maternal deaths, improved clinical care, and expanded public health initiatives to address social determinants of health. Challenges with ascertaining maternal deaths notwithstanding, several causes of maternal death (unaffected by surveillance artifacts) show significant temporal declines, even though there remains substantial scope for preventing avoidable maternal death and reducing disparities.
Published: 2021

31. Trends in Obstetric Intervention and Pregnancy Outcomes of Canadian Women With Diabetes in Pregnancy From 2004 to 2015

Author: Jason Burrows, Jennifer A. Hutcheon, Amy Metcalfe, Janet Lyons, Yasser Sabr, Lois E. Donovan, and K.S. Joseph
Subjects: medicine.medical_specialty, endocrine system diseases, Endocrinology, Diabetes and Metabolism, Population, Context (language use), maternal morbidity, 03 medical and health sciences, temporal trends, 0302 clinical medicine, Reproductive Biology and Sex-Based Medicine, Diabetes mellitus, medicine, 030212 general & internal medicine, education, Clinical Research Articles, Type 1 diabetes, Pregnancy, education.field_of_study, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, nutritional and metabolic diseases, Type 2 Diabetes Mellitus, neonatal morbidity, medicine.disease, gestational diabetes mellitus, 3. Good health, Gestational diabetes, diabetes mellitus, Cohort, pregnancy, business
Abstract: Context: Multiple consensus statements decree that women with diabetes mellitus should have comparable birth outcomes to women without diabetes mellitus; however, there is a scarcity of contemporary population-based studies on this issue. Objective: To examine temporal trends in obstetric interventions and perinatal outcomes in a population-based cohort of women with type 1, type 2, or gestational diabetes mellitus compared with a control population. Design: Cross-sectional study. Setting: National hospitalization data (Canada except Quebec) from 2004 to 2015. Patients: Pregnant women with type 1 (n = 7362), type 2 (n = 11,028), and gestational diabetes mellitus (n = 149,780) and women without diabetes mellitus (n = 2,688,231). Main Outcome Measures: Rates of obstetric intervention, maternal morbidity, and neonatal morbidity/mortality. Results: A consistent relationship was generally observed between diabetes mellitus subtype and obstetric outcomes, with women with type 1 diabetes mellitus having the highest rate of intervention and the highest rates of adverse perinatal outcomes followed by women with type 2 diabetes mellitus and women with gestational diabetes mellitus. Rates of severe preeclampsia were 1.2% among women without diabetes mellitus, 2.1% among women with gestational diabetes mellitus, 4.2% among women with type 2 diabetes mellitus, and 7.5% among women with type 1 diabetes mellitus (P < 0.001). The rate of neonatal morbidity ranged from 8.7% in women without diabetes mellitus to 11.0%, 17.4%, and 24.1% in women with gestational, type 2, and type 1 diabetes mellitus, respectively (P < 0.001). Conclusions: In a contemporary obstetric population, women with diabetes mellitus remain at increased risk of adverse pregnancy outcomes compared with women without diabetes mellitus., This population-based study of Canadian women found that women with diabetes mellitus are increased risk of adverse pregnancy outcomes; however, results differed by subtype of diabetes mellitus.
Published: 2017

32. Neonatal respiratory morbidity following exposure to chorioamnionitis

Author: Amelie Stritzke, Amy Metcalfe, K.S. Joseph, Sarka Lisonkova, and Yasser Sabr
Subjects: Male, medicine.medical_specialty, Pediatrics, Respiratory distress syndrome, Chorioamnionitis, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Risk Factors, 030225 pediatrics, medicine, Humans, Retrospective Studies, Respiratory Distress Syndrome, Newborn, 030219 obstetrics & reproductive medicine, Respiratory distress, business.industry, Obstetrics, Incidence, Incidence (epidemiology), Infant, Newborn, lcsh:RJ1-570, Retrospective cohort study, lcsh:Pediatrics, Fetuses at risk, medicine.disease, Bronchopulmonary dysplasia, Infant mortality, 3. Good health, Logistic Models, Pediatrics, Perinatology and Child Health, Female, business, Infant, Premature, Research Article, Cohort study
Abstract: Background There are conflicting results in the literature on the impact of chorioamnionitis on neonatal respiratory morbidities. However, most studies are based on small clinical samples and fail to account for the competing risk of perinatal death. This study aimed to determine whether chorioamnionitis affects the incidence of respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) after accounting for the increased risk of death. Methods Retrospective cohort study using linked birth and infant death registration and hospitalization records from Washington State between 2002 and 2011 (n = 763,671 singleton infants and n = 56,537 singleton preterm infants). Logistic regression models based on the traditional and fetuses-at-risk approaches were used to model two composite outcomes namely RDS and perinatal death and BPD and perinatal death. Confounders adjusted for in the models included maternal age, race, diabetes, hypertension, antenatal corticosteroids, mode of delivery and infant sex. Results While models using the traditional approach found a significant association only between chorioamnionitis and composite BPD and perinatal death (OR = 1.23, 95% CI: 1.01–1.50); using the fetuses-at-risk approach, there was a significant association between chorioamnionitis and both composite outcomes (RDS and perinatal death OR = 2.74, 2.50–3.01; BPD and perinatal death OR = 5.18, 95% CI: 4.39–6.11). Conclusion The fetuses-at-risk approach models the causal impact of chorioamnionitis on the development of the fetal lung and shows an increased risk of RDS, BPD and perinatal death associated with such maternal infection.
Published: 2017

33. Timing of Delivery in Women With Diabetes: A Population-Based Study

Author: Jennifer A. Hutcheon, Amy Metcalfe, Janet Lyons, K.S. Joseph, Jason Burrows, Lois E. Donovan, and Yasser Sabr
Subjects: Type 1 diabetes, education.field_of_study, medicine.medical_specialty, business.industry, Obstetrics, Population, Obstetrics and Gynecology, General Medicine, Type 2 diabetes, medicine.disease, Lower risk, Gestational diabetes, Diabetes mellitus, medicine, Gestation, business, education, Cohort study
Abstract: Introduction Women with diabetes, and their infants, have an increased risk of adverse events due to excess fetal growth. Earlier delivery, when fetuses are smaller, may reduce these risks. This study aimed to evaluate the week-specific risks of maternal and neonatal morbidity/mortality to assist with obstetrical decision making. Material and methods In this population-based cohort study, women with type 1 diabetes (n = 5889), type 2 diabetes (n = 9422) and gestational diabetes (n = 138 917) and a comparison group without diabetes (n = 2 553 243) who delivered a singleton infant at ≥36 completed weeks of gestation between 2004 and 2014 were identified from the Canadian Institute of Health Information Discharge Abstract Database. Multivariate logistic regression was used to determine the week-specific rates of severe maternal and neonatal morbidity/mortality among women delivered iatrogenically vs those undergoing expectant management. Results For all women, the absolute risk of severe maternal morbidity/mortality was low, typically impacting less than 1% of women, and there was no significant difference in gestational age-specific severe maternal morbidity/mortality between iatrogenic delivery and expectant management among women with any form of diabetes. Among women with gestational diabetes, iatrogenic delivery was associated with an increased risk of neonatal morbidity/mortality compared with expectant management at 36 and 37 weeks' gestation (76.7 and 27.8 excess cases per 1000 deliveries, respectively) and a lower risk of neonatal morbidity/mortality at 38, 39 and 40 weeks' gestation (7.9, 27.3 and 15.9 fewer cases per 1000 deliveries, respectively). Increased risks of severe neonatal morbidity following iatrogenic delivery compared with expectant management were also observed for women with type 1 diabetes at 36 (98.3 excess cases per 1000 deliveries) and 37 weeks' gestation (44.5 excess cases per 1000 deliveries) and for women with type 2 diabetes at 36 weeks' gestation (77.9 excess cases per 1000 deliveries) weeks. Conclusions The clinical decision regarding timing of delivery is complex and contingent on maternal-fetal wellbeing, including adequate glycemic control. This study suggests that delivery at 38, 39 or 40 weeks' gestation may optimize neonatal outcomes among women with diabetes.
Published: 2020

34. The Role of Progestogens in Threatened and Idiopathic Recurrent Miscarriage [Corrigendum]

Author: Hassan S. Abduljabbar, Ahmed Jaber Alharbi, Hana Al Madani, Yaser Faden, Yasser Sabr, Hisham Arab, Osama S. Bajouh, Emad Sagr, and Ayman Oraif
Subjects: medicine.medical_specialty, Oncology, Obstetrics, business.industry, Maternity and Midwifery, Threatened species, Recurrent miscarriage, medicine, Obstetrics and Gynecology, business, medicine.disease
Published: 2020

35. 475: Do competing risks matter? The case of chronic hypertension and the incidence of severe preeclampsia

Author: Giulia M. Muraca, Sarka Lisonkova, Neda Razaz, K.S. Joseph, Yasser Sabr, and Amélie Boutin
Subjects: Pediatrics, medicine.medical_specialty, business.industry, Incidence (epidemiology), medicine, Obstetrics and Gynecology, Chronic hypertension, Competing risks, business, Severe preeclampsia
Published: 2020

36. Systematic review and meta-analysis of the effectiveness of pre-pregnancy care for women with diabetes for improving maternal and perinatal outcomes

Author: Yasser S. Amer, Hala Elmorshedy, Melissa Kahili-Heede, Samia A. Esmaeil, Maher A. Titi, Yasser Sabr, Rasmieh A. Alzeidan, Elshazaly Saeed, Hayfaa A. Wahabi, Khawater Hassan Bahkali, Amr Jamal, Amel Fayed, and Abdulaziz A Alodhayani
Subjects: Epidemiology, Maternal Health, Pregnancy in Diabetics, Cochrane Library, Biochemistry, Miscarriage, 0302 clinical medicine, Endocrinology, Medical Conditions, Pregnancy, Medicine and Health Sciences, Diabetes diagnosis and management, 030212 general & internal medicine, Multidisciplinary, Obstetrics, Pregnancy Outcome, Obstetrics and Gynecology, Prognosis, Congenital Anomalies, Treatment Outcome, Meta-analysis, Medicine, Female, Preconception Care, Research Article, medicine.medical_specialty, HbA1c, Endocrine Disorders, Science, 030209 endocrinology & metabolism, Health Promotion, Preterm Birth, 03 medical and health sciences, Shoulder dystocia, medicine, Diabetes Mellitus, Congenital Disorders, Humans, Hemoglobin, Gestational Diabetes, Biology and life sciences, business.industry, Neonatal hypoglycemia, Infant, Newborn, Proteins, medicine.disease, Diagnostic medicine, Hypoglycemia, Pregnancy Complications, Relative risk, Metabolic Disorders, Medical Risk Factors, Birth, Small for gestational age, Women's Health, business, Program Evaluation
Abstract: Background Pre-gestational diabetes mellitus is associated with increased risk of maternal and perinatal adverse outcomes. This systematic review was conducted to evaluate the effectiveness and safety of pre-conception care (PCC) in improving maternal and perinatal outcomes. Methods Databases from MEDLINE, EMBASE, WEB OF SCIENCE, and Cochrane Library were searched, including the CENTRAL register of controlled trials, and CINHAL up until March 2019, without any language restrictions, for any pre-pregnancy care aiming at health promotion, glycemic control, and screening and treatment of diabetes complications in women with type I or type II pre-gestational diabetes. Trials and observational studies were included in the review. Newcastle-Ottawa scale and the Cochrane collaboration methodology for data synthesis and analysis were used, along with the GRADE tool to evaluate the body of evidence. Results The search identified 8500 potentially relevant citations of which 40 reports of 36 studies were included. The meta-analysis results show that PCC reduced congenital malformations risk by 71%, (Risk ratio (RR) 0.29; 95% CI: 0.21–0.40, 25 studies; 5903 women; high-certainty evidence). The results also show that PCC may lower HbA1c in the first trimester of pregnancy by an average of 1.27% (Mean difference (MD) 1.27; 95% CI: 1.33–1.22; 4927 women; 24 studies, moderate-certainty evidence). Furthermore, the results suggest that PCC may lead to a slight reduction in the risk of preterm delivery of 15%, (RR 0.85; 95% CI: 0.73–0.99; nine studies, 2414 women; moderate-certainty evidence). Moreover, PCC may result in risk reduction of perinatal mortality by 54%, (RR 0.46; 95% CI: 0.30–0.73; ten studies; 3071 women; moderate-certainty evidence). There is uncertainty about the effects of PCC on the early booking for antenatal care (MD 1.31; 95% CI: 1.40–1.23; five studies, 1081 women; very low-certainty evidence) and maternal hypoglycemia in the first trimester, (RR 1.38; 95% CI: 1.07–1.79; three studies; 686 women; very low- certainty evidence). In addition, results of the meta-analysis indicate that PCC may lead to 48% reduction in the risk of small for gestational age (SGA) (RR 0.52; 95% CI: 0.37–0.75; six studies, 2261 women; moderate-certainty evidence). PCC may reduce the risk of neonatal admission to intensive care unit (NICU) by 25% (RR 0.75; 95% CI: 0.67–0.84; four studies; 1322 women; moderate-certainty evidence). However, PCC may have little or no effect in reducing the cesarean section rate (RR 1.02; 95% CI: 0.96–1.07; 14 studies; 3641 women; low-certainty evidence); miscarriage rate (RR 0.86; 95% CI: 0.70–1.06; 11 studies; 2698 women; low-certainty evidence); macrosomia rate (RR 1.06; 95% CI: 0.97–1.15; nine studies; 2787 women, low-certainty evidence); neonatal hypoglycemia (RR 0.93; 95% CI: 0.74–1.18; five studies; 880 women; low-certainty evidence); respiratory distress syndrome (RR 0.78; 95% CI: 0.47–1.29; four studies; 466 women; very low-certainty evidence); or shoulder dystocia (RR 0.28; 95% CI: 0.07–1.12; 2 studies; 530 women; very low-certainty evidence). Conclusion PCC for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations. In addition, it may improve the risk of preterm delivery and admission to NICU. PCC probably reduces maternal HbA1C in the first trimester of pregnancy, perinatal mortality and SGA. There is uncertainty regarding the effects of PCC on early booking for antenatal care or maternal hypoglycemia during the first trimester of pregnancy. PCC has little or no effect on other maternal and perinatal outcomes.
Published: 2019

37. The morbid genome of ciliopathies: an update

Author: Maha Tulba, Amal Alhashem, Ali Howaidi, Tarfa Alshidi, Sawsan R. Nowilaty, Abdullah Alfaifi, Mais Hashem, Mohammad Shagrani, Mustafa A. Salih, Rubina Khan, Dalal K. Bubshait, Maged H. Hussein, Essam Al Sabban, Maisoon Almugbel, Ranad Shaheen, Hisham Alkuraya, Nour Ewida, Mohammad A. Al Muhaizea, Eman Alobeid, Zuhair Rahbeeni, Jameel M. Alghamdi, Niema Ibrahim, Yasser Sabr, Sameera Sogaty, Elham Al-Mardawi, Neama Meriki, Khalid Alhazmi, Mona M. Alenazi, Mohammed Zain Seidahmed, Heba Morsy, Ebtesam M. Abdalla, Mohammed Mahnashi, Abrar K. Alsalamah, Fowzan S. Alkuraya, Ahmed Alfares, Hamad Al-Zaidan, Afaf Alsagheir, Alya Qari, Firdous Abdulwahab, Hanan E. Shamseldin, and Mohammed Al–Owain
Subjects: Candidate gene, Cilium, Computational biology, Biology, medicine.disease, Genome, Phenotype, Ciliopathies, Human genetics, Sodium Channels, Stargardt disease, medicine, Humans, Cilia, Gene, Bardet-Biedl Syndrome, Genetics (clinical), Alleles
Abstract: Ciliopathies are highly heterogeneous clinical disorders of the primary cilium. We aim to characterize a large cohort of ciliopathies phenotypically and molecularly. Detailed phenotypic and genomic analysis of patients with ciliopathies, and functional characterization of novel candidate genes. In this study, we describe 125 families with ciliopathies and show that deleterious variants in previously reported genes, including cryptic splicing variants, account for 87% of cases. Additionally, we further support a number of previously reported candidate genes (BBIP1, MAPKBP1, PDE6D, and WDPCP), and propose nine novel candidate genes (CCDC67, CCDC96, CCDC172, CEP295, FAM166B, LRRC34, TMEM17, TTC6, and TTC23), three of which (LRRC34, TTC6, and TTC23) are supported by functional assays that we performed on available patient-derived fibroblasts. From a phenotypic perspective, we expand the phenomenon of allelism that characterizes ciliopathies by describing novel associations including WDR19-related Stargardt disease and SCLT1- and CEP164-related Bardet–Biedl syndrome. In this cohort of phenotypically and molecularly characterized ciliopathies, we draw important lessons that inform the clinical management and the diagnostics of this class of disorders as well as their basic biology.
Published: 2019

38. Episiotomy use among vaginal deliveries and the association with anal sphincter injury: a population-based retrospective cohort study

Author: Shiliang Liu, Neda Razaz, Rollin Brant, Geoffrey W. Cundiff, K.S. Joseph, Olof Stephansson, Yasser Sabr, Giulia M. Muraca, Sarka Lisonkova, and Amanda Skoll
Subjects: Episiotomy, education.field_of_study, Pregnancy, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, Obstetrics, Vaginal delivery, business.industry, Incidence (epidemiology), medicine.medical_treatment, Research, Population, Forceps, Retrospective cohort study, General Medicine, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, medicine, Population study, 030212 general & internal medicine, education, business
Abstract: BACKGROUND: The rate of obstetric anal sphincter injury has increased in recent years, particularly among operative vaginal deliveries. We sought to characterize temporal trends in episiotomy use and to quantify the association between episiotomy and obstetric anal sphincter injury. METHODS: Using a population-based retrospective cohort study design of hospital data from 2004 to 2017, we studied all vaginal deliveries of singleton infants at term gestation in Canada (excluding Quebec). Rates of obstetric anal sphincter injury were contrasted between women who had an episiotomy and those who did not. Log-binomial regression was used to estimate the association between episiotomy and obstetric anal sphincter injury among women with spontaneous and operative vaginal deliveries after controlling for confounders. RESULTS: The study population included 2 570 847 deliveries. Episiotomy use declined significantly among operative vaginal deliveries (53.1% in 2004 to 43.2% in 2017, p < 0.0001) and spontaneous vaginal deliveries (13.5% in 2004 to 6.5% in 2017, p < 0.0001). Episiotomy was associated with higher rates of obstetric anal sphincter injury among spontaneous vaginal deliveries (4.8 with episiotomy v. 2.4% without; adjusted rate ratio [RR] 2.06, 95% confidence interval [CI] 2.00–2.11) and this association remained after stratification by parity and obstetric history. In contrast, episiotomy was associated with lower rates of obstetric anal sphincter injury among forceps deliveries in nulliparous women (adjusted RR 0.63, 95% CI 0.61–0.66), and women with vaginal birth after cesarean (adjusted RR 0.71, 95% CI 0.60–0.85), but not among parous women without a previous cesarean (adjusted RR 1.16, 95% CI 1.00–1.34). INTERPRETATION: Episiotomy use has declined in Canada for all vaginal deliveries. The protective association between episiotomy and obstetric anal sphincter injury among women who gave birth by operative vaginal delivery (especially forceps) warrants reconsideration of clinical practice among nulliparous women and those attempting vaginal birth after cesarean.
Published: 2019

39. Timing of delivery in women with diabetes: A population-based study

Author: Lois E. Donovan, Janet Lyons, Amy Metcalfe, Jason Burrows, Yasser Sabr, Jennifer A. Hutcheon, and K.S. Joseph
Subjects: Adult, Male, medicine.medical_specialty, Canada, Databases, Factual, Population, Decision Making, Pregnancy in Diabetics, Gestational Age, Type 2 diabetes, neonatal outcome, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Risk Factors, Diabetes mellitus, Infant Mortality, medicine, Humans, 030212 general & internal medicine, Original Research Article, education, education.field_of_study, Type 1 diabetes, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, Obstetrics and Gynecology, Infant, General Medicine, medicine.disease, Delivery, Obstetric, 3. Good health, Gestational diabetes, Diabetes, Gestational, Diabetes Mellitus, Type 1, Maternal Mortality, Diabetes Mellitus, Type 2, obstetric delivery, diabetes mellitus, Gestation, Female, gestational diabetes, business, Cohort study
Abstract: Introduction Women with diabetes, and their infants, have an increased risk of adverse events due to excess fetal growth. Earlier delivery, when fetuses are smaller, may reduce these risks. This study aimed to evaluate the week‐specific risks of maternal and neonatal morbidity/mortality to assist with obstetrical decision making. Material and methods In this population‐based cohort study, women with type 1 diabetes (n = 5889), type 2 diabetes (n = 9422) and gestational diabetes (n = 138 917) and a comparison group without diabetes (n = 2 553 243) who delivered a singleton infant at ≥36 completed weeks of gestation between 2004 and 2014 were identified from the Canadian Institute of Health Information Discharge Abstract Database. Multivariate logistic regression was used to determine the week‐specific rates of severe maternal and neonatal morbidity/mortality among women delivered iatrogenically vs those undergoing expectant management. Results For all women, the absolute risk of severe maternal morbidity/mortality was low, typically impacting less than 1% of women, and there was no significant difference in gestational age‐specific severe maternal morbidity/mortality between iatrogenic delivery and expectant management among women with any form of diabetes. Among women with gestational diabetes, iatrogenic delivery was associated with an increased risk of neonatal morbidity/mortality compared with expectant management at 36 and 37 weeks’ gestation (76.7 and 27.8 excess cases per 1000 deliveries, respectively) and a lower risk of neonatal morbidity/mortality at 38, 39 and 40 weeks’ gestation (7.9, 27.3 and 15.9 fewer cases per 1000 deliveries, respectively). Increased risks of severe neonatal morbidity following iatrogenic delivery compared with expectant management were also observed for women with type 1 diabetes at 36 (98.3 excess cases per 1000 deliveries) and 37 weeks’ gestation (44.5 excess cases per 1000 deliveries) and for women with type 2 diabetes at 36 weeks’ gestation (77.9 excess cases per 1000 deliveries) weeks. Conclusions The clinical decision regarding timing of delivery is complex and contingent on maternal‐fetal wellbeing, including adequate glycemic control. This study suggests that delivery at 38, 39 or 40 weeks’ gestation may optimize neonatal outcomes among women with diabetes.
Published: 2019

40. Association between fertility treatments and early placentation markers

Author: Cédric Gasse, Alexandra Côté, Sarah Maheux-Lacroix, Emmanuel Bujold, Amélie Boutin, and Yasser Sabr
Subjects: 0301 basic medicine, Infertility, Adult, medicine.medical_specialty, Reproductive Techniques, Assisted, media_common.quotation_subject, Fertility, Reproductive technology, Insemination, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Pregnancy, medicine, Humans, Pregnancy-Associated Plasma Protein-A, Chorionic Gonadotropin, beta Subunit, Human, Ovulation, media_common, Placenta Growth Factor, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, Obstetrics and Gynecology, Ultrasonography, Doppler, medicine.disease, Placentation, 3. Good health, Pregnancy Trimester, First, 030104 developmental biology, Reproductive Medicine, Relative risk, Gestation, Female, business, Biomarkers, Developmental Biology, Cohort study
Abstract: Introduction Pregnancies resulting from fertility treatments are at higher risk of placenta-mediated complications. Hence, we aimed to estimate the association between fertility treatment and levels of first-trimester markers of placentation. Methods We conducted a cohort study in an academic center from 03/2011 to 12/2014. Adult nulliparous women with singleton pregnancies were recruited between 11 + 0 and 13 + 6 weeks of gestation. Data on maternal characteristics, medical history, and pregnancies conceived through fertility treatments (whether ovulation agents, insemination or assisted reproductive technologies) were collected. Maternal serum concentrations of PlGF, sFlt-1, PAPP-A, AFP, and free β-hCG were obtained, and notches and UtA-PI were measured using Doppler ultrasound. Mean Multiple of the Medians (MoM) and frequencies were computed to estimate the mean differences (MD) or risk ratios (RR) comparing fertility treatment to spontaneous pregnancies. Results 427 (9%) pregnancies out of 4815 were conceived through fertility treatments, using ovulation agents (n = 233, 5%), insemination (n = 174, 4%) and/or assisted reproductive technologies (n = 85, 2%). The latter were associated with significantly lower log10PAPP-A MoM (adjusted MD: −0.02, 95%CI: −0.04 to −0.01), lower log10PlGF MoM (adjusted MD: −0.04, 95%CI: −0.06 to −0.01) and higher log10free β-hCG MoM (adjusted MD: 0.05, 95%CI: 0.01 to 0.09) compared to spontaneous pregnancies. Ovulation agents and insemination were associated with the presence of notches (adjusted RR: 1.24, 95%CI: 1.14 to 1.35; and 1.27, 95%CI: 1.15 to 1.42, respectively) and higher log10UtA-PI MoM (adjusted MD: 0.16, 95%CI: 0.08 to 0.24; and 0.17, 95%CI: 0.07 to 0.27, respectively) than spontaneous pregnancies. Conclusion Fertility treatments are associated with significant variations in markers of placentation.
Published: 2019

41. Modern obstetrics: beyond early delivery for fetal or maternal compromise

Author: Nandini Dendukuri, Kathleen H. Chaput, Neda Razaz, K.S. Joseph, Yasser Sabr, Natalie V. Scime, Giulia M. Muraca, Sarka Lisonkova, Sid John, and Amélie Boutin
Subjects: EARLY DELIVERY, medicine.medical_specialty, Compromise, media_common.quotation_subject, medicine.medical_treatment, law.invention, 03 medical and health sciences, Fetus, 0302 clinical medicine, Randomized controlled trial, Pregnancy, law, medicine, Humans, 030212 general & internal medicine, media_common, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, Obstetrics and Gynecology, Prenatal Care, General Medicine, medicine.disease, 3. Good health, Perinatal morbidity, Labor induction, Gestation, Female, business
Abstract: The ARRIVE trial showed that adverse perinatal outcomes among low-risk nulliparous women at 39 weeks’ gestation were lower following labor induction (4.3%) compared with expectant management (5.4%; P value 0.049). Although this difference was deemed to be not statistically significant (since the significance threshold had been set at 0.046), there is a need to interpret trial results using a Bayesian approach and to review the conceptual significance of trial findings. The ARRIVE trial hypothesis represents a challenge to the central paradigm of modern obstetrics because it abandons maternal or fetal compromise as a pre-requisite for early delivery. The P value function based on the ARRIVE trial shows that study findings are not consistent with even a modest increase in adverse perinatal outcomes following labor induction for 39 weeks’ gestation, and instead, consistent with a substantial reduction in adverse perinatal outcomes. Physiologic evidence, epidemiologic evidence (on gestational age-specific rates of pregnancy complications, fetal growth-restriction and perinatal morbidity and mortality), and meta-analyses of related randomized trials show that pregnancies accrue small and progressively increasing risks of adverse outcomes at later gestation. Bayesian analysis, based on previous randomized trials updated with ARRIVE trial results, also shows that labor induction for 39 weeks’ gestation has a protective effect with regard to adverse perinatal outcomes. Obstetricians need to be cognizant of this balance of risks and benefits with regard to labor induction and expectant management at 39 weeks’ gestation and beyond, though as always, the ultimate valuation in decision-making has to be guided by principles of patient autonomy.
Published: 2021

42. Temporal and Regional Variations in Operative Vaginal Delivery in Canada by Pelvic Station, 2004-2012

Author: Geoffrey W. Cundiff, Rollin Brant, Giulia M. Muraca, K.S. Joseph, and Yasser Sabr
Subjects: Canada, medicine.medical_specialty, Vacuum Extraction, Obstetrical, genetic structures, medicine.medical_treatment, Forceps, Geographic variation, Obstetrical Forceps, Pelvis, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Caesarean section, 030212 general & internal medicine, Gynecology, 030219 obstetrics & reproductive medicine, Cesarean Section, Vaginal delivery, Singleton, business.industry, Obstetrics, Vacuum extraction, Obstetrics and Gynecology, Delivery, Obstetric, Confidence interval, 3. Good health, Female, Health information, business
Abstract: To describe temporal and regional variations in Canada in the use of operative vaginal delivery (OVD) at term for singleton pregnancies by pelvic station between 2004 and 2013.Rates of OVD among term singleton pregnancies in Canada (excluding Quebec) were estimated using information from the Discharge Abstract Database of the Canadian Institute for Health Information for the years 2004-2012 (n = 2 284 109). Deliveries were stratified by pelvic station. Temporal trends were assessed using the Cochran-Armitage test for linear trend in proportions by year. Geographic variation was assessed by calculating the rate and 95% confidence interval of each mode of delivery from 2010-2012 for each province and territory.Among singleton pregnancies at term, the OVD rate decreased from 12.0% in 2004 to 10.7% in 2012 (P0.001), whereas Caesarean section rates (excluding those following failed OVDs) increased from 24.9% to 26.7%. Forceps deliveries decreased from 3.1% to 2.5%, primarily due to decreases in midpelvic forceps delivery. Vacuum-assisted delivery increased significantly at outlet and low stations (by 26.0% and 15.1%, respectively) and remained stable at midpelvic station. The failed OVD rate was 0.3% and decreased by 23.7% (P0.001). There were large variations in OVD rates by province.Temporal trends in OVD rates varied by pelvic station, with rates of outlet and low OVD increasing and rates of midpelvic and failed OVD decreasing. Vacuum extraction is increasingly replacing forceps deliveries at outlet and low stations, whereas Caesarean sections are replacing forceps deliveries at midpelvic stations. Variations in OVD rates across provinces suggest differences in instrument preference and/or an evolution in standards of practice.
Published: 2016

43. Prevalence of restless legs syndrome among pregnant women: A case–control study

Author: Ahmed S. BaHammam, Nada A Alyousefi, Awad H Olaish, Aljohara S Almeneessie, Maha Alzahrani, Yasser Sabr, Aisha Alsafi, and Raneem Alotaibi
Subjects: Pulmonary and Respiratory Medicine, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Movement disorders, Anemia, macromolecular substances, vitamin D deficiency, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, mental disorders, medicine, Vitamin D and neurology, 030212 general & internal medicine, Restless legs syndrome, sleep, Vitamin D, lcsh:RC705-779, Pregnancy, business.industry, Obstetrics, Case-control study, lcsh:Diseases of the respiratory system, medicine.disease, 030228 respiratory system, lcsh:RC666-701, parity, diabetes mellitus, movement disorders, Original Article, Surgery, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: BACKGROUND: This cross-sectional case–control study aimed to assess the prevalence of restless legs syndrome (RLS) and its correlates and severity among Arab (Saudi) pregnant women attending antenatal care clinics. METHODS: We interviewed 742 consecutive pregnant women attending antenatal clinics face-to-face using the International RLS Study Group (IRLSSG) criteria. We assessed the severity of RLS using the IRLSSG severity scale for RLS (IRLS). A similar number of age-matched nonpregnant women were enrolled in a control group. RESULTS: Among the cases, 104 (14%) were in the first trimester, 232 (31.3%) in the second trimester, and 406 (54.7%) in the third trimester. The RLS prevalence in cases and controls was 30% and 26.5%, respectively, (P = 0.134). Among cases, severe/very severe RLS was diagnosed in 25% and mild/moderate in 75%, compared with 15% of controls having severe/very severe RLS and 85% having mild/moderate RLS (P < 0.001). Multivariate binary logistic regression analysis identified the following parameters as independent predictors of RLS: parity (odds ratio [OR] 1.113 [confidence intervals [CI] 1.012–1.223], P = 0.027), anemia (OR 1.452 [1.033–2.042], P = 0.03), diabetes mellitus (OR 1.734 [CI 1.084–2.774], P = 0.022), Vitamin D deficiency (OR 2.376 [CI 1.488–3.794],P < 0.001), and smoking (OR 3.839 [CI 1.463–10.074], P = 0.006). None of the cases had been diagnosed or treated for RLS in the antenatal clinics. CONCLUSION: RLS is common, but underdiagnosed, among Saudi pregnant women and nonpregnant women of childbearing age. The study revealed that RLS during pregnancy is linked to parity, anemia, diabetes mellitus, Vitamin D deficiency, and smoking.
Published: 2020

44. Ecological association between operative vaginal delivery and obstetric and birth trauma

Author: Sarka Lisonkova, Geoffrey W. Cundiff, Rollin Brant, Giulia M. Muraca, K.S. Joseph, Amanda Skoll, and Yasser Sabr
Subjects: Episiotomy, Adult, medicine.medical_specialty, Canada, Birth trauma, medicine.medical_treatment, Forceps, Population, Rate ratio, Perineum, Lacerations, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Birth Injuries, medicine, Humans, 030212 general & internal medicine, education, education.field_of_study, 030219 obstetrics & reproductive medicine, business.industry, Vaginal delivery, Obstetrics, Cesarean Section, Infant, Newborn, Extraction, Obstetrical, General Medicine, medicine.disease, Delivery, Obstetric, Confidence interval, Obstetric Labor Complications, Health Care Surveys, Commentary, Female, business
Abstract: BACKGROUND: Increased use of operative vaginal delivery (use of forceps, vacuum or other device) has been recommended to address high rates of cesarean delivery. We sought to determine the association between rates of operative vaginal delivery and obstetric trauma and severe birth trauma. METHODS: We carried out an ecological analysis of term, singleton deliveries in 4 Canadian provinces (2004–2014) using data from the Canadian Institute for Health Information. The primary exposure was mode of delivery. The primary outcomes were obstetric trauma and severe birth trauma. RESULTS: Data on 1 938 913 deliveries were analyzed. The rate of obstetric trauma was 7.2% in nulliparous women, and 2.2% and 2.7% among parous women without and with a previous cesarean delivery, respectively, and rates of severe birth trauma were 2.1, 1.7 and 0.7 per 1000, respectively. Each 1% absolute increase in rates of operative vaginal delivery was associated with a higher frequency of obstetric trauma among nulliparous women (adjusted rate ratio [ARR] 1.06, 95% confidence interval [CI] 1.05–1.06), parous women without a previous cesarean delivery (ARR 1.10, 95% CI 1.08–1.13) and parous women with a previous cesarean delivery (ARR 1.11, 95% CI 1.07–1.16). Operative vaginal delivery was associated with more frequent severe birth trauma, but only in nulliparous women (ARR 1.05, 95% CI 1.03–1.07). In nulliparous women, sequential vacuum and forceps instrumentation was associated with the largest increase in obstetric trauma (ARR 1.44, 95% CI 1.35–1.55) and birth trauma (ARR 1.53, 95% CI 1.03–2.27). INTERPRETATION: Increases in population rates of operative vaginal delivery are associated with higher population rates of obstetric trauma, and in nulliparous women with severe birth trauma.
Published: 2018

45. Delayed Interval Delivery and Chorionicity

Author: Sarah Wahid Yousef and Yasser Sabr
Subjects: medicine.medical_specialty, Fetus, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, medicine.medical_treatment, Improved survival, 03 medical and health sciences, Monochorionic Diamniotic Twin Pregnancy, 0302 clinical medicine, Dichorionic Diamniotic Twin Pregnancy, Delayed delivery, medicine, Gestation, Cervical cerclage, 030212 general & internal medicine, business, reproductive and urinary physiology
Abstract: Two multiple pregnancies with delayed delivery after expulsion of the first twin are presented. Case 1: A 37 years old woman with dichorionic diamniotic twin pregnancy and the first foetus was aborted at 16 weeks of gestation. She delivered a healthy male infant at 38 weeks of gestation (22 weeks after the delivery of the first twin). Case 2: A 31 years old monochorionic diamniotic twin pregnancy she aborted the first foetus at 19 weeks of gestation and was managed with cervical cerclage and delivered a healthy male infant at 38 weeks of gestation (19 weeks after the delivery of the first twin). Based on our experience and the review of literature, delayed delivery with careful observation of foetal and maternal condition is recommended for improved survival and decreased morbidity among latter-born siblings.
Published: 2018

46. TEMPORAL TRENDS IN EPISIOTOMY USE AMONG SPONTANEOUS AND OPERATIVE VAGINAL DELIVERIES IN CANADA AND THE ASSOCIATION WITH OBSTETRIC ANAL SPHINCTER INJURY

Author: Yasser Sabr, K.S. Joseph, Giulia M. Muraca, Geoffrey W. Cundiff, Sarka Lisonkova, Amanda Skoll, and Rollin Brant
Subjects: Episiotomy, medicine.medical_specialty, genetic structures, Obstetrics, business.industry, medicine.medical_treatment, Forceps, Obstetrics and Gynecology, Spontaneous vaginal, Previous cesarean delivery, Logistic regression, Mode of delivery, medicine, Anal sphincter, business, Cohort study
Abstract: Objectives To quantify, firstly, temporal trends in episiotomy use among spontaneous vaginal deliveries (SVDs) and operative vaginal deliveries (OVDs) in Canada, and secondly, the associations between episiotomy and obstetric anal sphincter injury (OASI) among SVDs and OVDs. Methods Population-based, retrospective, cohort study of all singleton, term deliveries in Canada (2004-2014) using hospitalization data. Temporal trends in episiotomy use by parity, previous cesarean delivery and mode of delivery were tested using the Cochran-Armitage test. Logistic regression was used to estimate the association between episiotomy and OASI among women with SVD and OVD after controlling for confounders. Results The study included 1,442,484 deliveries. Among nulliparous women, there was a smaller absolute decline in episiotomy use among SVDs (22.9% in 2004 to 14.1% in 2014; p Conclusions Episiotomy use has declined in Canada in recent years among SVDs and OVDs. There is a pressing need to consider episiotomy use in OVD (especially with forceps) given the protective association between episiotomy and OASI.
Published: 2019

47. 612: Severe maternal morbidity among women with solid organ transplants: A population-based study

Author: K.S. Joseph, Sarka Lisonkova, Yasser Sabr, Amanda Skoll, and Rollin Brant
Subjects: Population based study, medicine.medical_specialty, Obstetrics, business.industry, medicine, Obstetrics and Gynecology, Maternal morbidity, Solid organ, business
Published: 2019

48. 737: Severe maternal morbidity and mortality associated with assisted reproduction: A population-based study

Author: K.S. Joseph, Rollin Brant, Maria P. Velez, Yasser Sabr, Amanda Skoll, and Sarka Lisonkova
Subjects: Population based study, business.industry, media_common.quotation_subject, Obstetrics and Gynecology, Medicine, Maternal morbidity, Reproduction, business, media_common, Demography
Published: 2019

49. Perinatal and Maternal Morbidity and Mortality Among Term Singletons Following Midcavity Operative Vaginal Delivery Versus Cesarean Delivery

Author: Sarka Lisonkova, K.S. Joseph, Giulia M. Muraca, R. Brant, Yasser Sabr, G.W. Cundiff, and Amanda Skoll
Subjects: medicine.medical_specialty, 030219 obstetrics & reproductive medicine, Vaginal delivery, business.industry, Obstetrics, Maternal morbidity, 3. Good health, Term (time), 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Medicine, Cesarean delivery, business
Published: 2018

50. Expanding the phenome and variome of skeletal dysplasia

Author: Fatima Alfadli, Ghada M H Abdel-Salam, Tamer Rizk, Lamees Alhabeeb, Dorota Monies, Gamal Ahmed Hosny, Nadia Al-Hashmi, Hessa S. Alsaif, Mohamed Abouelhoda, Ghada A. Otaify, Mais Hashem, Amira Nabil, Saeed Al Tala, Hisham Alkuraya, Anas M. Alazami, Aida Alaqeel, Muneera J. Alshammari, Mahmoud R. Fassad, Muddathir H. Hamad, Majid Alfadhel, Seema Kapoor, Mohammed Zain Seidahmed, Mona Aglan, Fowzan S. Alkuraya, Nour Ewida, Mustafa A. Salih, Arif O. Khan, Samira Sogati, Niema Ibrahim, W T Keng, Afaf Alsagheir, Yasser Sabr, Samira Ismail, Ranad Shaheen, Ahlam A. Hamed, Winnie Ong Peitee, Abdulmonem Alsiddiky, Saji Alexander, Shams Anazi, Amal Alhashem, Ankur Singh, Maha S. Zaki, Firdous Abdulwahab, Alka V. Ekbote, Nada Al Tassan, Fatema Alzahrani, Saud Alsahli, Samia A. Temtamy, Jawahir Y. Mohamed, Abdullah Qasem, Eissa Faqeih, Sateesh Maddirevula, Aziza M. Mushiba, Khalda Amr, Hanan E. Shamseldin, and Nisha Patel
Subjects: 0301 basic medicine, Fetal Proteins, Male, Population, Receptors, Cell Surface, Biology, Phenome, Cohort Studies, 03 medical and health sciences, Genetic Heterogeneity, Locus heterogeneity, Wnt3A Protein, medicine, Humans, Exome, Genetic Predisposition to Disease, Allele, education, Genetics (clinical), Alleles, Genetics, Oncogene Proteins, education.field_of_study, Intracellular Signaling Peptides and Proteins, High-Throughput Nucleotide Sequencing, Membrane Proteins, Blood Proteins, medicine.disease, Phenotype, Founder Effect, Musculoskeletal Abnormalities, Neoplasm Proteins, 030104 developmental biology, Genetics, Population, Dysplasia, Exoribonucleases, Female, Carboxylic Ester Hydrolases, Founder effect
Abstract: To describe our experience with a large cohort (411 patients from 288 families) of various forms of skeletal dysplasia who were molecularly characterized. Detailed phenotyping and next-generation sequencing (panel and exome). Our analysis revealed 224 pathogenic/likely pathogenic variants (54 (24%) of which are novel) in 123 genes with established or tentative links to skeletal dysplasia. In addition, we propose 5 genes as candidate disease genes with suggestive biological links (WNT3A, SUCO, RIN1, DIP2C, and PAN2). Phenotypically, we note that our cohort spans 36 established phenotypic categories by the International Skeletal Dysplasia Nosology, as well as 18 novel skeletal dysplasia phenotypes that could not be classified under these categories, e.g., the novel C3orf17-related skeletal dysplasia. We also describe novel phenotypic aspects of well-known disease genes, e.g., PGAP3-related Toriello–Carey syndrome–like phenotype. We note a strong founder effect for many genes in our cohort, which allowed us to calculate a minimum disease burden for the autosomal recessive forms of skeletal dysplasia in our population (7.16E-04), which is much higher than the global average. By expanding the phenotypic, allelic, and locus heterogeneity of skeletal dysplasia in humans, we hope our study will improve the diagnostic rate of patients with these conditions.
Published: 2017

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