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Recently, the active management of the third stage of labor hasbecome a routine practice. In this study we compared two different ecobolics which were oxytocin and methyl ergometrinethrough intra-umbilical route. The method: the trial divided theincluded pregnant full term (>37 weeks) women in two groupsrandomly; one for 0.2 mg methyl ergometrine and the second 10units oxytocin. The outcomes were on the short term; estimatedblood loss (EBL), the need to add another ecobolic, vomiting,blood pressure changes and the duration of the third stage, andthe long-term outcomes were hemoglobin levels and the needfor surgical or medical uterine evacuation. The results: the meanblood loss was 155± 50.45ml and 167± 45.76 in the methyl ergometrine and the oxytocin groups respectively. Three cases inthe oxytocin group (3%) required additional methyl ergometrinewhile in the ergometrine group only one case was given an additional oxytocin (1%). No vomiting was reported in both groupsand there were trivial changes in blood pressure. In the oxytocin group, the third stage duration was average 3.03± 1.02 minin comparison to 2.98± 1.54min in the ergometrine group. Neither did those cases who were injected methyl ergometrine havesignificant changes in the hemoglobin levels nor did they needuterine evacuation. However, only one case in the oxytocin siderequired blood transfusion due to uterine atony. Conclusion: intra-umbilical methyl ergometrine should be considered as an effective safe ecobolic in the third stage of labor.

Purpose: There is debatable data regarding the addition of azithromycin to the routine antibiotic prophylaxis of post-cesarean section (CS)infection. In this work, we tried to evaluate its potential benefit to protect against both post-cesarean maternal and fetalinfections.Methods: The study included 230 women who were intended to haveselective CS at Mansoura university hospital. They were randomlysubdivided into115 women that received azithromycin plus standardcephalosporin and another115 women that received standard cephalosporin alone. The main outcome is evaluation of post-cesarean sectioninfection as endometritis, wound sepsis, etc… across the puerperal period. Results: In comparison between the test group and the control group,there was significant reduction of re-admission during puerperium(0%vs 6.5%, p=0.01). Endometritis manifestations were significantly reduced, including: puerperal Fever >38OC (4.3% versus 15.2%), uterine tenderness (3.2% versus 11.9%), abdominal pain (1.1% versus14.1%), offensive vaginal discharge (2.1% versus 13%) and purulentdrainage from uterus (2.1% versus 9.8%). Wound infection manifestations were significantly reduced, including; erythema around incision(2.1%versus 8.7), induration around incision (3.2 versus 12%) and purulent discharge from incision site (1.1% versus 9.8%). Also, the needfor further antibiotic during puerperium was significantly reduced(3.2% versus 11.9%). There was no significant difference between the2 groups regarding neonatal outcomes.Conclusion: Azithromycin plus the standard cephalosporin administered to women in selective CS reduces maternal infections and maternal episodes of fever, with no clear benefit on the neonatal outcome

Objective: To assess the role of vitamin D deficiency and early pregnancy loss.Patient and Method: A nested case control study conducted in outpatient antenatal care clinic under supervision of Ain Shams University Maternity hospital from the period of March 2020 to June2020. Pregnant ladies in the first trimester were screened for eligibility criteria.Blood samples were taken from the participants at thetime of presentation. All participants were followed till the end of thefirst trimester to report cases of miscarriage. Vitamin d was assessedfor the 40 women who suffered from miscarriage (cases) and for 40selected controls.The primary outcome was the relation between vitamin d level and early pregnancy loss. Secondary outcome was therelation between vitamin d deficiency and obesity.Results: Our findings showed that the miscarriage groupwas significantly olderthan control group as p (42.5%) had 25(OH)D deficiency while (40.0%)&(17.5%) of caseshad either 25(OH)D insufficiencyor sufficiency which significantlydifferent than control group (p=0.049).25(OH)D ≤24.5 (ng/mL) wasa significant factor that increased the likelihood of first-trimestricmiscarriage with sensitivity 80%.No significant differences according to BMI grades regarding 25(OH)D grades.Conclusion: Vitamin d deficiency is one of modifiable risk factors forfirst trimestric abortion. . Preconceptional vitamin D supplementationis an easy method for decreasing incidence of early pregnancy loss.

Aim: To determine the optimum time for endometrial scratching in patients with unexplained primary infertility undergoing ICSI-ET cycles after one or more implantation failure. Methods: A randomized clinical trial wasconducted at fertility care unit, Mansoura University Hospital and 2 private fertility centers, Egypt, fromNovember 2016 tillJune 2018. Eligible participants [142] had unexplained primary infertility, were prepared and sched- uled to obligate for ICSIcycles. Patients were randomly allocated into two equal groups using computer-generated tables and sealed opaque envelopes. Endometrial scratching was done either just af- ter oocyte retrieval in (group 1) or mid-luteal in the cycle before induction (group 2). Patients, investigators, and data analysts were not masked to group assignment. The primary outcome measure was implantation rate while the clinical pregnancy rate was settled as the secondary outcome measure. Results: one hundred forty two clients were included (71 in each group). Baseline characteristics did not differ between both groups as regard the age, BMI, duration of infertility and basic laboratory inves- tigations (p>0.05). The mean estimated day of triggering (14.2 ± 2.1 in G1 vs 13.6 ± 2.2 in G2) together with the mean follicular size (19.3 ± 0.8 in G1 vs 18.5 ± 1.8 in G2) showed also no statistical significance (p values 0.690 and 0.751 respectively). Again, the mean estimated number of ova retrieved (7.4+ 2.1 in G1 vs 7.1+ 1.3 in G2) and zy- gote transferred (2 in each group) presented no significant differences together with the chemical pregnancy rates (54 in G1 vs 52 in G2, p>0.05). On the other hand, IR and CPR are found significantly high- er in group 1 compared to group 2, (IR 53.5% vs, 40.8%; whilst CPR 49.3% vs 35.2%, p

Mohamed Ibrahem Eid,1 Mohamed Sayed Abdelhafez,1 Waleed El-refaie,2 Ahmed A El-Zayadi,1 Khaled Samir,1 Mahmoud Mohamed Abdelrazik,1 Mahmoud Thabet,1 Alaa Wageh,1 Emad Ahmed Fyala,1 Yasser Abdeldayem,1 Ahmed Badawy1 1Department of Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt; 2Department of Obstetrics and Gynecology, Port Said University, Port Said, Egypt Objective: We aimed to evaluate the effect of different timing of initiation of low-molecular- weight heparin (LMWH) administration on the pregnancy outcomes in women with antiphospholipid syndrome (APS). Materials and methods: A randomized controlled study was conducted on women with obstetrical APS. All participants were randomly divided at documentation of positive pregnancy test into two groups; early initiation group in which LMWH therapy was started once positive pregnancy test was established (in the fifth week of gestation), and later initiation group in which LMWH therapy was started after sonographic confirmation of fetal cardiac pulsation (in the seventh week of gestation). In both groups, LMWH (enoxaparin) was given at a dose of 40 mg/day subcutaneously and the therapy continued until end of pregnancy. The primary outcome measure was ongoing pregnancy rate and the secondary outcome measures were fetal loss, live birth rate, preterm labor before 34 weeks of gestation, intrauterine growth restriction (IUGR), and congenital fetal malformations. Results: Ninety-four women (48 in the early initiation group and 46 in the later initiation group) were subjected to final analysis. The ongoing pregnancy rate was significantly higher in the early initiation group than in the later initiation group (81.2% vs 60.9%; P=0.040). However, both groups were similar in the incidences of fetal loss, preterm labor before 34 weeks of gestation, and IUGR, and live birth rate. No recorded congenital fetal malformations in both groups. Conclusion: Early administration of LMWH for pregnant women with obstetrical APS reduces early pregnancy loss, but does not affect the incidence of late obstetrical complications. Keywords: APS, LMWH, fetal loss

Many pro-inflammatory cytokines especially tumor necrotic factor alpha (TNFα), interleukin (IL)-1β, and IL-6 have crucial role in the pathogenesis of endometriosis. In this study, we investigated the immune-modulatory role of humanized anti-IL-6 receptor monoclonal antibodies in the treatment of endometriosis. This is a prospective, randomized, controlled, blinded study in which Sprague Dawley rats were used as animal model of endometriosis. Animals were randomly divided into two groups, a test group which received tocilizumab (Actemra; Roche, Switzerland) and a control group which received saline. Afterwards, a comparison was done between the eutopic and ectopic endometrium that was excised from both groups, histopathologically and immune-histochemically. Histopathologic assessment and immune-histochemical staining were performed using antibodies against IL-6. Tocilizumab significantly suppressed the volume of endometriotic lesions compared with non-treated rats (P = 0.006) and atrophied the ectopic endometrial-like epithelium (in 42.8% of treated rats vs 0% in the control group). Tocilizumab also decreased the anti-IL-6 receptor immune-histochemical staining intensity in ectopic endometrium (from non to +++ in the test group vs ++ or more in the control group), with no apparent difference in the eutopic one reflecting the down-regulation of IL-6-producing cells in ectopic endometriotic lesions. In rats with induced endometriosis, anti-IL-6 receptor monoclonal antibodies could offer a new horizon of usage of this immune-modulatory biologic drug, used in other autoimmune diseases, in treatment of endometriosis.

Introduction The incidence of caesarean scar pregnancy (CSP) and cervical pregnancy (CP) has increased significantly in recent years. The related hemorrhage can be lethal and often needs hysterectomy. This study aims to assess the technical and clinical results of uterine artery embolization (UAE) combined with intra-arterial methotrexate (MTX) infusion for CSP and CP. Methods A retrospective study was conducted for 11 patients (age range from 25–40 years, mean; 31.8 y) with CSP (7/11) and CP (4/11). The diagnosis was confirmed by elevated b-hCG levels (mean 31.245 mIU/mL) with sonography and/or magnetic resonance imaging. They were treated with UAE using particulate embolic material. In all patients, the infusion of MTX (50 mg/m2) was performed before UAE. Follow-up periods after UAE ranged between 6-24 months included weekly sonography and b-hCG level assessment. A literature review was performed using standard online search tools. Results In 10 patients, UAE controlled active vaginal bleeding and reduced post-procedural b-hCG levels significantly by the second week. One patient presented with persistent elevated b-hCG level and vaginal rebleeding. The rebleeding was successfully controlled by second UAE procedure. The ectopic pregnancies were resolved, and the uterus was preserved in all patients. No major complications were detected. Normal menses resumed within 2 months after UAE. Two patients had subsequent natural successful intrauterine pregnancies. Conclusion UAE combined with intra-arterial MTX infusion resulted in resolution of ectopic pregnancies with control of hemorrhage and without hysterectomy in this small group of patients.

The purpose of this study is to compare the early outcome of tricuspid valve repair using prosthetic ring annuloplasty versus suture annuloplasty. Methods: In the period between March 2016 and September 2017, 40 patients with severe functional tricuspid regurgitation (TR) secondary to rheumatic mitral with or without aortic valve pathology divided into two equal groups underwent open heart surgery at Kasr Al-Aini Hospitals, Cardiothoracic surgery department. Group (1) had tricuspid valve repair using suture annuloplasty, while Group (2) had tricuspid valve repair using prosthetic ring annuloplasty. All patients were evaluated thoroughly preoperative, intra-operative, and post-operative. Particular attention was paid to clinical and echocardiographic findings of presence of tricuspid regurgitation (TR), its nature and degree, postoperative intensive care unit (ICU) events, ICU stay, hospital stay and follow up of the degree of TR post-operatively.

Objectives. The Spondyloarthropathies (SpAs) are genetically and therapeutically linked to IL-23, which in turn regulates IL-22, a cytokine that has been implicated in the regulation of new bone formation in experimental models. We hypothesised that IL-22, a master regulator of stem cells in other niches, might also regulate human mesenchymal stem cell (MSC) osteogenesis.\ud \ud Methods. The effects of IL-22 on in vitro MSC proliferation, migration and osteogenic differentiation were evaluated in the presence or absence of IFN-け and TNF (to ascertain IL-22 activity in pro-inflammatory environments). Colorimetric XTT assay, trans-well migration assays, quantitative real time-polymerase chain reaction (qRTPCR) for MSC lineage markers and osteogenesis assays were used.\ud \ud Results. Combined treatment of MSC with IL-22, IFN-け and TNF resulted in increased MSC proliferation (p=0.008) and migration (p=0.04); an effect which was not seen in cells treated with IL-22 alone and untreated cells. Osteogenic, adipogenic but not chondrogenic transcription factors were up-regulated by IL-22 alone (p

At each stage of the life cycle of the virus, hepatitis C virus (HCV) interferes with the cellular antiviral mechanisms of the host. Therefore, HCV infection represents a fencing match between the virus and the host cell. The host’s defense depends primarily on activation of the immune response, including activation of interferon (IFN) signalling, expression of cytokines (TNF-α, IL-12, IL-10, IFN-α) and stimulation of cellular immune response (CIR) and humoral immune response (HIR). HCV offense relies on envelope mutation, evasion of the host immune response and interference with the endogenous cellular antiviral factors.

Occult hepatitis B virus (HBV) in blood donors is considered as a potential risk for transmission of HBV infection. The aim of this study was to determine the prevalence of anti-hepatitis B core antibody (anti-HBC) positivity in Egyptian blood donations as well as to estimate the frequency of HBV-DNA in anti-HBc-positive donations. The study included 760 Egyptian healthy blood donors, representing 26 different Egyptian governorates screened according to routine practice for the presence of hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibodies (Abs), HIV-1/2 Abs and Treponema Abs. The accepted blood units for donation were tested for the presence of total anti-HBc Abs by two tests. Positive units for anti-HBc were further tested for HBV-DNA by polymerase chain reaction. According to routine screening, a total of 48/760 units (6.3%) were rejected [38 (5%) HCV-Ab-positive units, 9 (1.18%) HbsAg-positive units and 1 (0.13%) Treponema-Ab-positive unit]. Among the accepted blood units for donation, prevalence of anti-HBc was 78/712 units (10.96%). HBV-DNA was detected in 9/78 (11.54%) of the anti-HBc-positive units, and thus, occult HBV infection was detected in 9/712 (1.26%) of the accepted blood donations. Implementing anti-HBc test to the routine assay for the forthcoming two decades would certainly eliminate possible HBV-infected units. Rejection of these units will be beneficial to decrease the risk of HBV transmission with its potential consequences particularly in immunocompromised recipients.

Currently, pegylated interferon is the most effective therapy for hepatitis C but its cost is out of reach of most patients in the developing countries. The aim of this study was to assess the response rate of genotype-4 patients to 24 wks of peg-interferon-alpha2b (Peg-IFN-alpha2b) and ribavirin (RBV) or interferon-alpha2b (IFN-alpha2b) with RBV and amantadine (AMD) as an alternative option.In a controlled study, 180 biopsy-proven naïve chronic hepatitis C patients were allocated into three groups based on their financial affordability to any of the study regimens. Group I (control) comprised 40 patients who received Peg-IFN-alpha2b in a flat dose of 100 mug/wk (the dose available in Egypt) plus RBV 1,000-1,200 mg per day based on body weight for 48 wks. Group II comprised 70 patients who received the same regimen for 24 wks. Group III comprised 70 patients who received induction-dose triple therapy (IDTT) in the form of IFN-alpha2b 3 MU once daily for the first 4 wks then reduced to TIW for 20 wks plus RBV 1,000-1,200 mg per day based on body weight and AMD 100 mg twice daily for 24 wks. Six patients from group I, eight patients from group II, and four from group III discontinued the study either due to financial limitations and/or intolerable adverse effects of the drugs.Intention-to-treat analysis revealed that sustained virological response (SVR) achieved in 22 (55.0%), 34 (48.6%), and 20 (28.6%) in groups I, II, and III, respectively. Adherence-to-treatment analysis (80/80/80) revealed that SVR achieved in 22 (64.7%), 34 (54.8%), and 20 (30.3%) in groups I, II, and III, respectively. In absence of eradication of hepatitis-C-virus-RNA at week 12, there was virtually no chance of achieving SVR. These data collectively may indicate that genotype 4 is "not difficult to treat" as previously reported.Response of genotype-4 patients to 24 wks of Peg-IFN-alpha2b/RBV did not significantly differ from 48 wks, but was significantly higher than IDTT. Although SVR achieved by IDTT is less than Peg-IFN-alpha, yet it might provide a second option when the latter is not affordable. Early virological response should be used as a predictor to SVR to avoid unnecessary expenses in nonresponders patients.

Ethnic differences in the outcome of hepatitis C have been described. Our aim was to investigate ethnic differences in the distribution of genotypes associated with polymorphisms of the tumor necrosis factor-alpha promoter, interleukin-10 promoter, and transforming growth factor-beta1 leader sequence in patients with hepatitis C. Genomic DNA was obtained from 71 Egyptians and 67 Caucasians (hepatitis C and control patients). Amplification of appropriate gene segments was followed by direct sequencing. Infrequently occurring polymorphisms were identified at positions -244 and -77 of the tumor necrosis factor-alpha promoter and at positions -851 and -657 of the interleukin-10 promoter. The G/A genotype associated with tumor necrosis factor-alpha promoter positions -376 and -244 was more frequent in Egyptians (P =0.001 and P =0.004, respectively). The -244 G/A genotype occurred only in healthy Egyptians (P =0.024). Thus, ethnic differences in the distribution of genotypes of the tumor necrosis factor-alpha promoter exist, which may have clinical implications on the outcome of hepatitis C.