Sara Abdallah Mohamed Salem

Background: Poor ovarian response (POR) is a serious problem that decreases the effectiveness of conventional ovarian stimulation. Its concern is elevated production of reactive oxygen species, causing DNA destruction and mitochondrial malfunction, which contributes to the decline in oocyte quality. Objective of the Study: This trial aimed to identify the impact of Coenzyme Q10 as an antioxidant on ovarian reserve markers and Intra-cytoplasmic sperm injection results in poor ovarian responders. Methods: A prospective controlled study included 100 patients classified as poor ovarian responders according to the Bologna criteria. The patients were randomly allocated to two groups. Fifty participants in group A were administrated Coenzyme Q10 plus folic acid for one month prior to the ICSI cycle and through the ICSI cycle. Fifty patients in group B were administrated folic acid only for a similar duration. The primary outcome measured was the count of oocytes obtained. The chemical pregnancy rate was considered a secondary outcome. Results: The baseline features were equivalent among the groups. CoQ10 markedly improved the oocyte count and peak E2 (p < 0.001). Higher levels of antral follicle count at the start of the induction were observed in the treated group (p= 0.001). Endometrial thickness was greater in the CoQ10 group than in the control group (p=0.004). Significant differences were found in the count of embryos transferred and the percentage of women who underwent no embryo transfer (p=0.011). No substantial variations were detected in the gonadotropin doses, induction days, or progesterone levels among the two groups. The chemical and clinical pregnancy rates and completed cycles were equivalent between the two groups, with insignificant differences. Conclusion: CoQ10 promotes ovarian response to conventional induction and has a beneficial effect on ovarian reserve and embryological measures in poor responders. Despite this, additional investigations are essential to determine its influence on pregnancy rates. Clinical Trial ID: NCT06405204

Voriconazole, a potent antifungal agent, has emerged as a promising candidate for managing vulvovaginal candidiasis. The market availability of voriconazole as tablets or injections, along with potential side effects, highlights the need for a successful alternative delivery system. Through comprehensive experimental design, voriconazole-loaded spanlastics were developed using a 3²-factorial design. The optimized system based on factorial outcomes exhibited desirable characteristics in terms of entrapment efficiency (74.31 ± 0.39%), vesicle size (246.4 ± 2.2 nm), polydispersibility index (0.369 ± 0.01), & zeta potential (-37.5 ± 0.17 mV). Further characterization for the optimized system was performed in terms of transmission electron microscopy, Fourier transform infrared spectroscopy, and in-vitro antifungal assessment, where the latter showcased the potent effectiveness of voriconazole against various Candida species. Moreover, the integration of the optimized voriconazole-loaded spanlastic system into a gel was implemented for the assessment of ex-vivo permeation through the vaginal mucosa of rats, where the optimized system gel revealed a remarkable 1.3-fold enhancement in permeation relevant to the control VCZ gel. Notably, the clinical performance of optimized system gel was involved in a randomized controlled study for assessment of safety and efficacy in comparison to a market product (Canesten^® 2% clotrimazole). Clinical evaluation revealed that the optimized VCZ-loaded SP gel and the market product, Canesten. (2% clotrimazole) exhibited comparable efficacy in terms of clinical satisfaction, side effects, and time to clinical cure from VVC. These findings highlight the potential of the optimized system as a promising approach for improved treatment outcomes in women with vaginal candidiasis with no adverse effects. Graphical Abstract