Search

Background: Fosfomycin is a bactericidal drug that inhibits bacterial cell wall and also reduces the adherence ability of bacteria to uro-epithelial cells with a broad anti-bacterial activity against both Gram-negative and Gram-positive. Objective: To compare the efficacy and safety of fosfomycin compared to nitrofurantoin and cephalosporin in pregnant women presented with lower urinary tract infection. Patients and Methods: This was a double blinded, randomized controlled trial conducted at Shebin El-Kom Teaching Hospital from Aug 2019 to Aug 2020. Patients experienced uncomplicated lower urinary tract infection either asymptomatic bacteriuria or cystitis were recruited. Patients were randomly allocated via a random table number into three groups, each group comprised 35 patients. Group I received 3 g oral fosfomycin weekly, group II received 100 mg oral nitrofurantoin three times daily, and group III received 500 mg oral cephalosporin three times daily. After 7 days of treatment, all studied groups were subjected to urine sampling and culture analysis and were examined for occurrence of side effects. Results: All patients enrolled in our study had uncomplicated lower urinary tract infection either cystitis (n=85 cases) or asymptomatic bacteriuria (n=20 cases). There was clinical difference in urine pus cells and urine culture in fosfomycin after treatment compared to other groups. The side effects were reported in 7 cases with fosfomycin compared to 14 in other two groups with significant difference. Conclusion: Fosfomycin tromethamine was proved to be more effective, safe, and fewer side effects were reported, which makes fosfomycin the drug of choice for uncomplicated lower urinary tract infection during pregnancy.

To assess the efficacy and safety of a new surgical approach for uterine preservation among patients with placenta accreta spectrum in a low-resource setting.The present prospective cohort included 63 women diagnosed with placenta accreta spectrum undergoing cesarean deliveries who desired future fertility at the obstetrics department of Menoufia University Hospital from January 2018 to November 2019. Surgical management involved direct bilateral uterine arteries clamping below placental bed after broad ligament opening by round ligaments division and ligation and gentle downward dissection of vesical from myometrial tissues from lateral aspect toward trigone of the bladder. Outcomes included intraoperative and postoperative adverse events, hysterectomy rate, and postoperative hospitalization.Mean operative blood loss was 1860 ± 537 mL (range, 1040-3111 mL) and the incidence of bladder and ureteric injuries were 6.3% (Our conservative surgical approach is a safe alternative to peripartum hysterectomy with high uterine preservation rate, less intraoperative and postoperative morbidity and less need for blood transfusion in low resource settings.ClinicalTrials.gov; NCT04161521.

Surgical scalpels are traditionally used for skin incisions during a Caesarean delivery; the great evolutions in electrosurgical devices bring an alternative method for skin incision by the usage o...

Surgical scalpels are traditionally used for skin incisions during a Caesarean delivery; the great evolutions in electrosurgical devices bring an alternative method for skin incision by the usage of cutting diathermy. This was a prospective randomised comparative study conducted during the period from March 2016 to February 2017 on 200 patients, 100 patients had skin incisions using the surgical scalpel, while 100 patients had skin incisions with a diathermy, in order to judge the variations in the postoperative pain, the incision time, the incision blood loss, the operative time, the wound healing and the wound complications. We observed a significant difference between the two groups regarding the incision time (p .001), incisional blood loss (p .001), operative time (p .001) and the postoperative pain (p .001), where these parameters were less in the diathermy group. No significant difference observed between the two groups regarding the wound healing (p = .389) and wound complications (p = .470). We can conclude that the proper usage of diathermy in making the skin incision during a Caesarean section in this study achieved better results than the scalpel incision. Impact statement What is already known on this subject? Surgical scalpels are traditionally used in making the skin incisions during a Caesarean section; diathermy incisions, on the contrary, are less popular among the surgeons. It has been hypothesised that the application of extreme heat may result in a significant postoperative pain and poor wound healing. There has been a widespread use of diathermy for hemostasis but fear of production of large scars and improper tissue healing has restricted their usage in making skin incisions. What do the results of this study add? The use of diathermy for skin incisions in Caesarean section in this study was associated with a reduced incisional blood loss, incisional time, operative time and postoperative pain. It had no effect on wound closure and was not associated with any delay in wound healing. Also, the wound complications rate was equal in both types of incisions. What are the implications of these findings for clinical practice and/or further research? Most surgeons prefer the scalpel in making skin incision during a Caesarean section due to the fear of surgical site infection. Our findings proved different, we proved that cutting diathermy could be accepted as an alternative technique for making a skin incision without increased rates of wound infections. Also, the advantages of cutting diathermy will give benefits to both the patients and the surgeons.

In this prospective cohort study, one hundred participants were allocated into four groups according to their body mass indices. Vaginal ultrasound was performed at enrolment to measure cervical length. The shortest cervical measurement was recorded. Overweight and obese groups had significantly longer mean cervical length than women in the normal weight group when measured at 20–22 weeks of gestation (p

Epithelial ovarian cancer (EOC) is one of the most lethal gynaecologic malignancies with an increasing incidence worldwide; there is an increasing need for the identification of novel prognostic biomarkers in EOC patients. Given the key role of angiogenesis and growth factors in the biology of tumorigenesis, vascular endothelial growth factor (VEGF) is considered a milestone in the process of ovarian cancer progression and invasiveness. Authors aimed in the present study to evaluate the relevance of serum level of VEGF with clinicopathological parameters in patients with EOC. VEGF is reported to be correlated with variable parameters in EOC patients including International Federation of Gynecology and Obstetrics (FIGO) classification, lymph nodal involvement and ascites formation. In the following review, authors discussed these correlations and distinguished the possible future role of VEGF as a promising prognostic biomarker for EOC patients.

Objective The aim was to compare the use of diathermy versus scalpel in making skin incision during cesarean section to judge the variations in postoperative pain, incision time, incisional blood loss, operative time, wound healing, and wound complications. Background Surgical scalpels are traditionally used for making skin incisions during cesarean delivery. The evolutions in electrosurgical devices bring an alternative method for making skin incision by the usage of cutting diathermy. Patients and methods This was a prospective, randomized comparative study conducted during the period from March 2016 to February 2017 on 200 patients; 100 patients had skin incisions using the surgical scalpel, while 100 patients had skin incisions with diathermy. The comparison between the two groups was done regarding postoperative pain, incision time, incisional blood loss, operative time, wound healing, and wound complications. Results We observed a significant difference between the two groups regarding incision time (P Conclusion The use of diathermy for skin incisions to perform cesarean section in this study was associated with reduced incisional blood loss, incisional time, operative time, and postoperative pain. It had no effect on wound complications, and was not associated with any delay in wound healing. We can conclude that the usage of diathermy in making skin incision during cesarean section in this study achieved better results than scalpel incision.

Objective This study aimed to compare the effect of sildenafil citrate on pulsatility index of uterine, umbilical and middle cerebral arteries to that of nitroglycerine in cases of intrauterine growth restriction (IUGR). Background IUGR is one of the most common and serious complications of pregnancy. Sildenafil citrate and nitroglycerine are emerging as potential candidates for the treatment of IUGR through improving uteroplacental blood flow. Participants and methods Ninety singleton pregnancies, with IUGR and abnormal uterine and umbilical arteries Doppler, were included in the study and randomized into three groups to receive either oral sildenafil citrate (50 mg), a transdermal nitroglycerine patch (10 mg), or placebo. Maternal mean arterial blood pressure and the pulsatility index (PI) of uterine (Ut.A), umbilical (UA) and fetal middle cerebral (MCA) arteries were measured before and two hours after application of drugs. Results A significant reduction of Ut.A-PI occurred after application of both sildenafil citrate (16.7%, P = 0.001) and nitroglycerine (18.7%, P = 0.001). UA-PI also showed a significant decrease with both sildenafil citrate (17.8%, P = 0.001) and nitroglycerine (17.03%, P = 0.001), with no significant difference between the two drugs. No changes were observed in Doppler velocimetry in the placebo group, and no significant change in MCA-PI was observed in any group. Maternal arterial blood pressure decreased significantly with administration of both sildenafil citrate and nitroglycerine. Conclusion Sildenafil citrate has an effect similar to nitroglycerine in improving Doppler indices and blood flow of uterine and umbilical arteries in growth-restricted fetuses.

Objective To evaluate the role of placenta accreta index in predicting placental invasion in patients with placenta previa. Background Placenta accreta placenta is a condition in which placenta is adherent to the uterine wall because of myometrial invasion. Patients and methods In this prospective study, 60 pregnant women with placenta previa were enrolled at the Obstetrics Clinics of Menoufia University Hospitals in the period from January 2016 to December 2017. The placenta was scanned using gray-scale ultrasound and color Doppler. Placenta accreta index was formulated for each patient. Definitive diagnosis was made at delivery when the myometrium invasion by the placenta was seen. The hysterectomy specimens were sent for pathological confirmation of placental invasion. Data were collected and entered using Statistical Packages for the Social Science program for statistical analysis. Results Nineteen patients were found to have placenta accreta. All the parameters of placenta accreta index were statistically significant. The total score was significantly higher in accreta patients (P Conclusion Placenta accreta index score 4 can be used as a cut-off value for prediction of placental invasion in patients with placenta previa.

Objective To evaluate uterine balloon tamponade using a condom catheter for the management of early postpartum hemorrhage (PPH). Methods In a prospective observational study at Menoufia University Hospital, Shebin Elkom, Egypt, women with early PPH were enrolled between May 2011 and September 2012. Uterine balloon tamponade with a condom catheter was applied in women who were unresponsive to uterotonics and bimanual compression; patients with successful catheter placement were included in analyses. The primary outcome was successful control (reduction or cessation) of bleeding. Results A condom catheter was successfully placed for 50 of the 151 women enrolled. The overall success rate of the procedure was 96% (48/50). The condom catheter was successful in all 28 cases of atonic PPH after vaginal or cesarean delivery. It successfully controlled PPH due placental site bleeding in 20 (91%) of 22 patients with placenta previa and a well-contracted uterus. Conclusion Condom balloon catheter was found to effectively control PPH. The procedure is simple, inexpensive, and safe, and can preserve reproductive capacity, as well as saving the life of the mother. ClinicalTrials.gov: NCT02672891 .

To identify predictors of clomiphene citrate-induced ovulation in patients with polycystic ovary syndrome (PCOS).A prospective observational study of patients 18-40 years of age with PCOS experiencing infertility was conducted at Menoufia University Hospital between January 2011 and January 2013. A range of potential predictors of ovulation were recorded before patients received a 50-mg dose of clomiphene citrate. Following ovulation or no response to increasing clomiphene-citrate doses, correlations between predictors and treatment responses were analyzed.In total, 150 patients with PCOS experiencing infertility were enrolled. Following treatment, 110 (73.3%) patients ovulated. Highly significant differences were observed between treatment responders and non-responders in baseline amenorrhea, body mass index (BMI), waist circumference, total testosterone, anti-Müllerian hormone, fasting insulin, homeostatic model assessment of insulin resistance, and visceral fat area (P0.001). Significant differences in mean ovarian volume (P0.009) and ovarian stromal artery pulsatility index (P0.003) were also observed. Total testosterone was the best individual predictor of clomiphene citrate treatment response. The area under the receiver operating characteristic curve in a multivariate prediction model was 0.98.A combination of patient amenorrhea, BMI, total testosterone, anti-Müllerian hormone, ovarian volume, ovarian stromal artery pulsatility index, and visceral fat area could be used to predict clomiphene-citrate treatment response in patients with PCOS experiencing infertility. ClinicalTrials.gov: NCT02269306.

To investigate the patterns of medication errors in the obstetric emergency ward in a low resource setting.This prospective observational study included 10,000 women who presented at the obstetric emergency ward, department of Obstetrics and Gynecology, Menofyia University Hospital, Egypt between March and December 2010. All medications prescribed in the emergency ward were monitored for different types of errors. The head nurse in each shift was asked to monitor each pharmacologic order from the moment of prescribing till its administration. Retrospective review of the patients' charts and nurses' notes was carried out by the authors of this paper. Results were tabulated and statistically analyzed.A total of 1976 medication errors were detected. Administration errors were the commonest error reported. Omitted errors ranked second followed by unauthorized and prescription errors. Three administration errors resulted in three Cesareans were performed for fetal distress because of wrong doses of oxytocin infusion. The rest of errors did not cause patients harm but may have lead to an increase in monitoring. Most errors occurred during night shifts.The availability of automated infusion pumps will probably decrease administration errors significantly. There is a need for more obstetricians and nurses during the nightshifts to minimize errors resulting from working under stressful conditions.

To determine the patterns of uterine action potentials in laboring and non-laboring women at term using the non-invasive abdominal electromyography technique.One hundred pregnant women at term who fulfilled the inclusion criteria were enrolled in the study and equally divided into two groups. Group I consisted of 50 women in active labor, while group II included 50 women not in labor. After enrollment, the cardiotocograph was applied to all women. Abdominal electromyographic recording was started and for every burst of action potential, we measured the amplitude, frequency and duration of action potential. The results were tabulated and statistically analyzed.Both groups were comparable in demographic characteristics. Four patterns of EMG were detected. The amplitude of action potentials was significantly higher in laboring compared to non-laboring women (77.44 ± 11.25 vs 13.71 ± 8.57, P0.001). Similar significantly longer durations of electrical bursts were also noted in laboring women (45.94 ± 8.77 vs 7.11 ± 4.68 s, P0.001). Specific electromyographic changes were noted in women passing from the non-laboring to laboring state and in women who required oxytocin augmentation during labor.Abdominal electromyography may help to distinguish between women in true active labor from those who are not. It also may help to identify women who will enter into labor within 24-72 h and those who require augmentation of labor.