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This observational study was conducted to evaluate the clinical signs and symptoms of maxillary sinus tumors and to propose a clinical examination sieve and a unique risk alarm score to be used for timely patient referral and vigilance. The study consisted of 70 patients between 20 to 82 years of age from both sexes. The clinical information gained was collected from the upper dentoalveolar segment, orbit, and nasal sites. Regarding the early clinical sign and symptoms of patients, nasal obstruction was found in 67 patients (95.7%), facial swelling in 69 patients (98.6%), paresthesia in 41 patients (58.6%), and epistaxis in 50 patients (71.4%). Furthermore, in terms of the late signs and symptoms, a palpable mass in buccal sulcus was observed in 65 (92.9%) of the patients, lymphadenopathy in 24 (34.3%), paresthesia in 38 (54.3%), and diplopia in 22 (31.4%). Furthermore, general sign and symptoms like exophthalmos was present in 35 patients (50%), anosmia was observed in 37 patients (52.9%), and oroantral fistula was noted in 37 patients (55.9%). Additionally, 67 (95.7%) of the patients complained of nasal obstruction. Similarly, facial asymmetry was observed in 69 (98.6%) of the patients and double vision was observed in 24 (34.4%). Tumors of the maxillary sinus have a very insidious course of spread and uncertain clinical signs and symptoms. What makes diagnosis worse is the fact that the symptoms of these tumors are so well hidden in the sponge-like nature of the midfacial region that they are easily misinterpreted by patients. Therefore, diagnoses must be made early, dentists must be vigilant, and patients must be fully investigated at the slightest suspicion of a tumor, albeit benign.

Background Whilst the impact of Covid-19 infection in pregnant women has been examined, there is a scarcity of data on pregnant women in the Middle East. Thus, the aim of this study was to examine the impact of Covid-19 infection on pregnant women in the United Arab Emirates population. Methods A case-control study was carried out to compare the clinical course and outcome of pregnancy in 79 pregnant women with Covid-19 and 85 non-pregnant women with Covid-19 admitted to Latifa Hospital in Dubai between March and June 2020. Results Although Pregnant women presented with fewer symptoms such as fever, cough, sore throat, and shortness of breath compared to non-pregnant women; yet they ran a much more severe course of illness. On admission, 12/79 (15.2%) Vs 2/85 (2.4%) had a chest radiograph score [on a scale 1-6] of ≥3 (p-value = 0.0039). On discharge, 6/79 (7.6%) Vs 1/85 (1.2%) had a score ≥3 (p-value = 0.0438). They also had much higher levels of laboratory indicators of severity with values above reference ranges for C-Reactive Protein [(28 (38.3%) Vs 13 (17.6%)] with p < 0.004; and for D-dimer [32 (50.8%) Vs 3(6%)]; with p < 0.001. They required more ICU admissions: 10/79 (12.6%) Vs 1/85 (1.2%) with p=0.0036; and suffered more complications: 9/79 (11.4%) Vs 1/85 (1.2%) with p=0.0066; of Covid-19 infection, particularly in late pregnancy. Conclusions Pregnant women presented with fewer Covid-19 symptoms but ran a much more severe course of illness compared to non-pregnant women with the disease. They had worse chest radiograph scores and much higher levels of laboratory indicators of disease severity. They had more ICU admissions and suffered more complications of Covid-19 infection, such as risk for miscarriage and preterm deliveries. Pregnancy with Covid-19 infection, could, therefore, be categorised as high-risk pregnancy and requires management by an obstetric and medical multidisciplinary team.

Pneumonia caused by the Novel coronavirus disease 2019 (COVID-19) is a highly infectious disease and the ongoing outbreak has been declared as a Pandemic by the World health organization. Pneumonia is a serious disease in pregnancy and requires prompt attention. Viral pneumonia has higher morbidity and mortality compared to bacterial pneumonia in pregnancy. All efforts are well exerted to understand the newly emerged disease features but still some areas are gray. The treatment is primarily supportive with antivirals, steroids, anticoagulation and antibiotics for secondary bacterial infection. Severe cases require intensive care monitoring with oxygen support, mechanical ventilation. Investigational therapies include convalescent plasma, cytokine release inhibitors and other immunomodulatory agents like interferons. The mortality appears driven by the presence of severe Adult Respiratory Syndrome (ARDS) and organs failure. COVID pandemic is a challenging and stressful socio-economic situation with widespread fear of infection, disease and death. In the specialty of obstetrics and gynecology, studies are being conducted to ascertain the manifestation of disease in pregnant women and the fetal outcome. The aim of our case series is to describe the demographics, clinical characteristics, laboratory and radiological findings, feto- maternal outcome of severe and critical COVID pneumonia in pregnant women in Latifa Hospital.

Objective: The objective of the study was to determine the current prevalence of Helicobacter pylori infection among Dyspepsia patients and correlate this with Endoscopic findings. Methodology: A retrospective, descriptive facility-based study conducted from June to December 2017 to estimate the prevalence of Helicobacter pylori among dyspepsia patients from Majmaah, Sudair, Zulfi and Shaqra areas of Riyadh region, Saudi Arabia. Four years data from January 2012 to December 2016 were reviewd by a checklist and analyzed by SPSS. Results: Out of 1398 dyspepsia patients, 485 (34.7%) were positive, and 913 (65.3%) were negative for H-Pylori infection. Majority of patients (81.7%) had gastritis, out of which, 39.9% of gastritis patients were H-pylori positive. The frequency of H-pylori infection was significantly higher among patients with gastritis (p < 0.001). There was no statistically significant difference in the frequency of H-pylori infection among patients with erosion, ulcer, polyp and cancer (p > 0.05). Conclusion: The prevalence of H.Pylori was low as compared to other governorates in the kingdom and regional countries. Gastritis was dominating finding on upper gastrointestinal (GI) endoscopy. Keywords: Helicobacter pylori, Prevalence, Dyspepsia, Riyadh region

Morbid Adherent Placenta (MAP)/Placenta Accreta Spectrum (PAS) is a serious diagnosis which has a risk of complications. Ultrasound scan helps in early diagnosis and has great value in further confirmation and follow up. Observed new clinical sign and associated clinical triad are discussed here.

Sertoli-Leydig cell tumors (SLCTs) are rare tumors. Mass and pain are the presenting feature. The varying histopathology and differentiation of this tumor present difficulties with proper diagnosis and development of optimal treatment regimens. The prognosis depends on tumors grading and staging. Surgery is main stay management option. Chemotherapy and radiation options are still of choice. We aimed to present Sertoli-Leydig cell tumor managed surgical at Latifa Hospital in Dubai, UAE with acceptable outcome and good patient satisfaction.

Hysterectomy is common major operation performed in gynecological field practice after Caesarean section. Vaginal hysterectomy is preferred surgery for uterovaginal prolapsed. Vaginal hysterectomy has advantages over abdominal hysterectomy. Post hysterectomy hematomas are responsible for serious morbidity. Ultrasound is an accurate diagnostic tool and so Computed tomography. Conservative management, analgesia and antibiotics will work in small hematoma, but the significant sized hematoma needs surgical drainage and the infected hematoma. Refinement in surgical techniques is recommended to minimize the formation vaginal vault hematomas after vaginal hysterectomy.

Background: Obesity is becoming increasingly prevalent in many populations and has become one of the most commonly occurring risk factors in obstetric practice. In nations of the Gulf Cooperation Council (GCC), the prevalence of overweight adults has been reported to be 35% amongst females, while the prevalence of obesity has been reported to be 40% amongst females. The study aimed to identify the rate and outcome of Pregnancy After Bariatric Surgery at Latifa Hospital (PABS). Method: This is a hospital based cross-sectional study including all patients seen at Latifa hospital at Dubai Health Authority (DHA), Dubai, UAE between January 2018 and December 2018. The data included demographic details, gestational age, the mode of delivery, medical history, clinical findings, weight before surgery, weight after at antenatal booking, type of performed surgery, type of pregnancy (spontaneous or after assisted reproductive techniques), pregnancy complications, mode of delivery, and neonatal weight. Results: The reported cases of pregnancy after Bariatric surgery are 18 cases that makes rate 0.45%. Half of the performed surgery among the study group is sleeve surgery. Most of them (83.3%) are multiparous women with spontaneous pregnancy. The mean interval of surgery to pregnancy is 5.3 months. The highest weight before surgery is 155 kg and the mean weight of the study cases is 114.5 kg before surgery. After surgery at booking visit the mean weight is 83.9 kg. The mean weight reduction for this group is 30.6 kg. Anemia is the most common antenatal complication among the study group. Lower segment Caesarean section (LSCS) and vaginal delivery (VD) distributed equally between the women. The study showed good expect neonatal outcome. Conclusion: Pregnancy After Bariatric Surgery (PABS) is high-risk pregnancy with many potential complications. Care of pregnancy after bariatric surgery should be organized in multilateral cooperation of various medical disciplines in specialized center.

Medulloblastoma is a rare brain malignant lesion, reported more in children with less prevalence among adults and rarely seen during pregnancy. The diagnosis of Medulloblastoma is a challenging clinical situation in pregnancy as surgery; radiotherapy and chemotherapy are the choices of management.

Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder, defined by a platelet count of less than 100 × 109/L, secondary to impaired production and immune destruction of platelets. Bleeding tendency is the main presentation of this condition. Clinical symptoms and investigations will confirm the diagnosis. Steroid is the first line of treatment. Although Rituximab and Thrombopoietin receptor agonists are useful second line agents in non-pregnant adults, the data about their role in pregnancy are still limited. We present the case of a 30 year old primigravida, who was a known case of chronic ITP since childhood; the course of her disease was fluctuating, for which oral steroids were used accordingly. She presented with gum bleeding and petechial rash with very low platelets count. She was sponsored by the Patient Support Program and was given Eltrombopag during the third trimester. She responded well to Eltrombopag with no noticeable side effects, neither to the mother nor to the baby so far. Eltrombopag has been assigned Category C by the Federal Drugs Agency (FDA) nevertheless there are no well controlled data in the literature about its role in pregnancy.

Female genital mutilation (FGM) is partial or total excision of female external genitalia or other deliberate injury to the female genital organs for non-therapeutic purpose. It is cultural and traditional practice. Female genital mutilation may result in immediate complications such as severe pain and bleeding and long-term complications such as: psychological, psychosexual, trauma, infertility, urinary and genital complications.

Abdominal pregnancy is a rare form of ectopic pregnancy. A high index of suspicion enables early diagnosis and prompt management. Ultrasound is a gold standard tool for diagnosis and Magnetic Resonance imaging has a limited role. Appropriate management of the condition is important to avoid grave maternal morbidity.

Endometriosis is one of the common gynecological disorders in women of reproductive age group. Extra pelvic endometriosis is rare and the most common sites are bladder, gastrointestinal tract, lungs, under the skin especially after obstetric surgical interventions. Total surgical excision is the best option for diagnosis and treatment.

Ruptured ectopic pregnancy is one of the outcomes of mis or delayed diagnosis and the massive hemorrhage resulting is responsible for more than three quarters of the first trimester maternal death. Simultaneous presence of intrauterine pregnancy adds obstacles for the correct diagnosis to take place. The management of this condition is a real dilemma as life threatening condition could be the only presentation which needs immediate intervention. The high index of suspicion is mandatory to ensure timely diagnosis and management to prevent stormy outcome.

The last decade has seen a noticeable advance in diagnosing and treating infertility, however, the overall incidence has remained the same, with an estimated 40% - 50% resulting from factors related to the female [1]. Unexplained infertility where the cause remains elusive, still accounts for up to 30% of cases. Increasing evidence demonstrates the significant of antioxidants in all physiological and biochemical processes in humans, including human reproduction.

Background: Unsafe abortions contribute significantly to maternal morbidity and mortality. They are found more frequently in developing countries such as Sudan where abortion laws are restrictive and women have poor access to contraceptives. Gaps in the knowledge exist regarding women’s decision making process to perform an unsafe abortion in Sudan. Understanding these factors is vital for planning and implementing family planning services. The aim of the research was to explore the experience of women exposed to an unsafe abortion in Khartoum—Sudan, and to address the underlying factors that affected women’s decision to seek an unsafe abortion. Design: A descriptive qualitative approach was adopted using in-depth semi-structured interviews with women who had undergone unsafe abortions. Interviews were translated from Arabic; and data were analysed using a thematic approach. Setting and Participants: Participants were recruited from 2 settings: New Omdurman Hospital and Academy Teaching Hospital in Sudan. A convenience sample of women was used in the study. Results: Three core themes emerged: 1) There was an unbalanced relationship dynamic between women and their partners, which affected their use of contraceptives. 2) Maintaining secrecy of the unintended pregnancy and the unsafe abortion was paramount to all women for fear of social stigma. 3) Women tried to internalize and understand their negative experiences of unsafe abortion through religious context. Conclusion: Unsafe abortions have a significant impact on the quality of women’s lives in Sudan. Open dialogue between men and women regarding family planning strategies; community education about the hazardous consequences of unsafe abortion as well as facilitating access to contraceptives and stressing their proper use are necessary steps to decrease the number of unsafe abortions in Sudan. More research is needed to fill the gaps in knowledge regarding unsafe abortions and sexual health among Sudanese women.

Introduction: Hyperemesis gravidarum (HG) is vomiting and/or nausea in pregnancy causes dehydration, electrolytes imbalance, weight loss and further serious organs dysfunction. Methods: This was a descriptive, prospective, cross-sectional hospital based total coverage analytic study, which was conducted from November 2013 to May 2014 at Omdurman New Hospital (ONH) for Obstetrics & Gynecology, Khartoum-Sudan. Results: HG prevalence is 13% of complicated pregnancy of ONH admission. Acetonurea is reported in all cases with significant association between acetonurea and smoking (P value = 0.005). A significant association between Hemoglobulin level and the readmission the (P value = 0.01) was reported. One maternal death is reported from severe hypoglycemia and liver impairment. Conclusion: Hyperemesis gravidarum has serious maternal morbidity with social negative impacts and significant financial burden on the health services.

Background: Trichomoniasis is a common Sexually Transmitted Disease (STD) and the most common curable one. Methodology: This was cross sectional, prospective, total coverage hospital based study. It aimed to determine the incidence, risk factors of the Trichomoniasis among the laboring Sudanese women at Omdurman New Hospital Khartoum-Sudan, from September 2012 to April 2013. Data were obtained, entered and analyzed using soft word package program for social science (SPSS) version 17. Results: The prevalence of Trichomoniasis is 6.8%. It was found that the awareness about the infection is very low only 35%. Diabetes and history of sexual transmitted infections are the risks seen among the study cases. Preterm labor was seen significantly. Conclusion: Syndromic management of all women with abnormal vaginal discharge is important since it causes reproductive morbidity.

Odontogenic myxomas are uncommon tumors of comprising of 3% of all the tumors of odontogenic origin. They usually occur during the second and third decades of life and are more commonly seen in females. The current case report sheds light upon the surgical treatment of a myxoma of odontogenic origin in posterior maxilla of a young female patient. Prosthodontic rehabilitation stages are also briefly described following complete healing of the lesion after surgery.

Left atrial size in atrial fibrillation is a strong predictor of successful ablation and cardiovascular events. Cardiac magnetic resonance multislice method (CMR-MSM) is the current gold standard for left atrial volume (LAV) assessment but is time consuming. We investigated whether LAV with more rapid area-length method by echocardiography (Echo-AL) or cardiac magnetic resonance (CMR-AL) and invasive measurement by 3D-CARTO mapping during ablation correlate with the CMR-MSM. We studied 250 consecutive patients prior to atrial fibrillation ablation. CMR images were acquired on 3T scanner to measure LAV by MSM and biplane area-length method. Standard echocardiography views were used to calculate LAV by biplane area-length method. LAV during ablation was measured by 3D-CARTO mapping. LAV was compared using intra-class correlation (ICC), Pearson's correlation and Bland-Altman plots. CMR-MSM was used as the reference standard. Mean LAV using CMR-MSM was 112.7 ± 36.7 ml. CMR-AL method overestimated LAV by 13.3 ± 21.8 ml (11.2%, p < 0.005) whereas 3D-CARTO and Echo-AL underestimated LAV by 8.3 ± 22.6 and 24.0 ± 27.6 ml respectively (8.7% and 20.0% respectively, p < 0.005). There was no significant difference between paroxysmal and persistent atrial fibrillation. CMR-AL and 3D-CARTO correlated and agreed well with CMR-MSM (r = 0.87 and 0.74, ICC = 0.80 and 0.77 respectively). However, Echo-AL had poor correlation and agreement with CMR-MSM (r = 0.66 and ICC = 0.48). Bland-Altman plots confirmed these findings. CMR-AL method may be used as an alternative to CMR-MSM, as it is non-invasive, rapid, and correlates well with CMR-MSM. LAV by different modalities should not be used interchangeably.

Introduction: Caesarean section has avoidable morbidity which may lead to mortality especially in developing world. Caesarean section is a major operation which should be performed with maximum care and safety. Objectives: This study aimed to find incidence, indications, procedures and maternal outcome of re-laparotomy after caesarean delivery. Methods: This was a descriptive cross sectional prospective total coverage hospital based study conducted at Omdurman Maternity Hospital from June 2014 to January 2015. Results: The incidence for re-laparotomy after Caesarean section is (0.66%) and the main indication for re-laparotomy is hemorrhagic events. Re-laparotomy outcome reported 22 cases (64.7%) alive and well and 6 cases (17.6%) alive with morbidity (renal failure and massive blood transfusion complications) and 6 cases (17.6%) of maternal mortality mainly due to sepsis. Conclusion: Re-laparotomy after Caesarean section is contributing to morbidity and maternal mortality. The majority of re-laparotomy was done after emergency Caesarean section. Lacks of skills, experience; safety measures of perfection and infection control are points to be concern.

Introduction: Venous thromboembolism (VTE) is a major medical complication during pregnancy and one of the leading causes of the maternal mortality. Pregnancy and puerperium are well-recognized risk factors. Objectives: The study aimed to determine the rate, clinical features and mortality of venous thromboembolism (VTE) at Omdurman Maternity Teaching Hospital, Khartoum, Sudan. Methodology: This is a cross-sectional descriptive, total coverage, hospital-based study carried at Omdurman Maternity Teaching Hospital from January 2015 to July 2015. Eighty patients had been studied, while their data were analyzed using Statistical Package of Social Sciences (SPSS) Version 17. Results: The rate of VTE occurrence is 7 in 1000 births. The mean age of the study cases was 25.9 years and among all cases, 50% are primigravida. The mortality rate is high among cases with pulmonary embolism (PE) with significant P value of 0.005. Conclusion: VTE occurs in low risk patients who have vaginal delivery and are primiparous. PE causes high maternal mortality. Prophylaxis measures are highly recommended for all deliveries along with risk factor studies.

Vulvar carcinoma is a rare cancer even among the female genital tract cancer. Vulvar squamous cell carcinoma is the most common. We report a case of stage III squamous cell carcinoma of the vulva in a 71-year-old- patient with type III mutilated vulva. Clinical presentation, Histopathological diagnosis, surgical staging, and treatment options with the case challenges will be discussed.

Introduction Female genital mutilation (FGM) involves the partial or complete removal of the external female genitalia and/or other injury to the female genital organs whether for cultural or other nontherapeutic reasons. Aims The study aims to describe the method of and findings from reconstructive surgery for FGM victims. Methods We present a case of a 24-year-old Sudanese female, who had undergone ritual FGM type III as a young girl. She had suffered from a large, vulval mass for the last 6 years and came to the clinic because of apareunia. We performed mass excision and reconstructive surgery of the mutilated genital tissue. Results The giant mass was successfully removed. Remaining genital tissues were approximated and sutured, with hemostasis assured for the reconstructed organs on each side. Conclusion Reconstructive surgery for women who suffer sexual consequences from FGM is feasible, with a high degree of client acceptance and satisfaction. It restores some of women's natural genital anatomy, and offers the potential for improved female sexuality. Fazari ABE, Berg RC, Mohammed WA, Gailii EB, and Elmusharaf K. Reconstructive surgery for female genital mutilation starts sexual functioning in S udanese woman: A case report. J Sex Med 2013;10:2861–2865.

Background Left atrial (LA) size is a strong predictor of cardiovascular events in patients with atrial fibrillation (AF) and a variety of other cardiovascular diseases. Left atrial volume (LAV) measurement is the preferred method for assessment of LA size. The most widely used technique for LAV assessment is the area-length (AL) method using 2D echocardiography. Studies have shown that AL method by echocardiography significantly underestimates LAV when compared with CMR using multislice volumetric (MSV) method. However, MSV method is time consuming due to increased acquisition and analysis time. We sought to compare LAV assessment by CMR using the more rapid AL method with MSV method. Methods We prospectively studied 273 patients with AF who underwent CMR on a 3T scanner (Siemens Trio). Image acquisition included SSFP cine of LA in short axis-stack, horizontal long-axis (4 chamber) and vertical long-axis (2 chamber) views. LAV by AL method was measured on CMR long axis views in end-systole as recommended by the American Society of Echocardiography. LAV by MSV method was performed by tracing the LA endocardial border on LA short axis stack in a phase with largest LA dimension. LA appendage and pulmonary veins were excluded by both methods. LAV and LAV index measurements by AL and MSV methods were compared using Pearson’s correlation, Regression analysis and Bland-Altman plots. Results CMR was successfully completed and analyzed in 252 patients; mean age 60.5 ± 10.7 years, 185 males (73.4%). Paroxysmal AF was the most common arrhythmia (57.5%). Mean CHA2DS2-VASc score was 1.7 ± 1.3. Coronary artery disease was present in 31 (12.3%), hypertension 154 (61.1%), heart failure 7 (2.8%), diabetes mellitus 34 (13.5%), TIA/CVA 18 (7.1%) and peripheral vascular disease in 7 (2.8%) patients. Mean heart rate during CMR was 68.7 ± 15.6 beats/ min, 82% were in sinus rhythm. Mean left ventricular EF was 58.6 ± 8.1% and right ventricular EF was 47 ± 7.2%. Table 1 shows the mean LAV and LAV index by AL and MSV methods and their correlation. LAV and LAV index by the AL method was significantly higher compared to MSV method (p

To ascertain the knowledge, attitudes and practices of selected adult population in Pakistan regarding Dengue Fever.A cross sectional survey was conducted among selected communities with different socio-economic backgrounds in Karachi, Pakistan. A sample size of 440 adults (aged 18 years and above) were interviewed using a pre-tested questionnaire regarding their knowledge, attitude and practices about dengue fever. A composite scoring system, based on the answers given in the questionnaire, was used to establish the level of awareness in the population. The division of the higher and lower socio-economic groups was based on their income and locality; both these variables were determined as a part of our survey.Data from 400 respondents (244 males, 156 females) was used for primary analysis. About thirty five percent of the sample had adequate knowledge about dengue fever and its vector. Knowledge had significant associations with education (p = 0.004) and socioeconomic status (p = 0.02). The high socioeconomic group showed better preventive practices.Knowledge of dengue is inadequate in the low socioeconomic class. Better preventive practices against the vector are prevalent in the high socioeconomic group. Hence, a greater focus should be accorded to the low socioeconomic areas in future health campaigns.

The case of a 65 years old lady, diabetic, hypertensive, reduced functional class with history of episodic dyspnoea lasting for few weeks for the last two years. On presentation she was tachypnoiec with reduced oxygen saturation. Jugular venous distension was present with bibasal crackles. Her ECG was normal. Echocardiogram revealed, dilated right sided chambers with right ventricular systolic dysfunction and severe pulmonary hypertension. A CT chest was performed which showed multiple thrombi in the main and branch pulmonary arteries establishing the diagnosis of chronic thromboembolic pulmonary hypertension.

A female, 32 years of age, presented with complaint of easy fatigability and exertional dyspnoea for the last one year. She had no previous history of cardiac disease. On clinical examination, there was a diastolic murmur at apex. Transthoracic echocardiography and subsequently a transesophageal echocardiogram was performed, which showed biatrial pedunculated masses, suggestive of cardiac myxoma. The left atrial mass was 28 x 15 mm and right atrial mass was 35 x 25 mm in dimension and both appeared attached with interatrial septum. On surgical excision and histopathological examination, findings were consistent with cardiac myxoma.