Aboubakr Elnashar

Gonadotropin-releasing hormone agonists for prevention of chemotherapy-induced ovarian damage: prospective randomized study

OBJECTIVE To determine whether GnRHa administration before and during combination chemotherapy for breast cancer could preserve posttreatment ovarian function in young women or not. DESIGN Prospective randomized controlled study. SETTING Department of Obstetrics and Gynecology, Mansura University Hospital, Mansura, Egypt. PATIENT(S) Eighty patients with unilateral adenocarcinoma of the breast and with no metastasis who had undergone modified radical mastectomy or breast-conserving surgery plus full axillary lymph node dissection were included in the study. Patients were assigned randomly to receive combined GnRHa and chemotherapy or chemotherapy alone. One woman in each group dropped out. MAIN OUTCOME MEASURE(S) Return of spontaneous menstruation and ovulation. Hormonal changes (FSH, LH, E(2), P) during and after the course of treatment. RESULT(S) In the study group, 89.6% resumed menses and 69.2% resumed spontaneous ovulation within 3-8 months of termination of the GnRHa/chemotherapy cotreatment; 11.4% experienced hypergonadotrophic amenorrhoea and ovarian failure 8 months after treatment. In the control group (chemotherapy without GnRHa), 33.3% resumed menses and 25.6% resumed normal ovarian activity. The median FSH and LH concentrations, 6 months after completion of the GnRHa/chemotherapy cotreatment group, were significantly less than the control group. During the GnRHa/chemotherapy cotreatment the concentrations of FSH, LH, and P decreased to almost prepubertal levels. However, within 1-3 months after the last GnRHa injection, an increase in LH and FSH concentrations was detected, followed several weeks later in by an increase in P concentrations to within normal levels. CONCLUSION(S) GnRHa administration before and during combination chemotherapy for breast cancer may preserve posttreatment ovarian function in women <40 years. Long-term studies are required.

The impact of female genital cutting on health of newly married women

Objective: To detect the rate of female genital cutting among a sample of newly married women in Benha city, and make a comparison between circumcised and non‐circumcised women regarding long‐term health problems. Methods: Randomly selected (264) newly married women were the subjects of this work. Results: Circumcised group constitutes 75.8% of the sample. All non‐circumcised women were living in an urban area. Dysmenorrhea was more common among circumcised rather than non‐circumcised, with statistically significant difference (P < 0.01). Marital problems (dyspareunia, loss of libido, failure of orgasm and husbands unsatisfaction) had statistically different levels of significance among circumcised women. Obstetric problems such as tears, episiotomy and consequently distressed babies were more events among circumcised mothers with statistical significance. Circumcised females had significant mental problems such as somatization, anxiety and phobia (P < 0.001). Conclusion: Female genital cutting remains a widely practiced custom in our society. Grave complications of circumcision may last throughout womens life particularly the time of consummation of marriage and the time of childbirth.

Effect of sperm morphology and number on success of intrauterine insemination

OBJECTIVE To assess the effects of the number of motile spermatozoa inseminated and percentage of morphologically normal spermatozoa on the success of IUI. DESIGN A prospective observational study. SETTING University teaching hospital and private practice setting. PATIENT(S) The study comprised 393 couples who underwent 714 IUI cycles. INTERVENTION(S) All IUI cycles were preceded by ovarian superovulation with clomiphene citrate 50 mg tablets orally twice daily for 5 days starting on the second day of menses and one hMG ampule 75 IU IM daily for 5 days starting day 5 of the cycle. Cycles were monitored by transvaginal ultrasound. The IUI was performed with a catheter 36 +/- 4 hours after hCG injection. MAIN OUTCOME MEASURE(S) Clinical pregnancy. RESULT(S) A total of 79 clinical pregnancies were obtained, for a pregnancy rate per cycle of 11.06%. The pregnancy rate per cycle was 5.55% when the number of motile spermatozoa was <5 x 10(6) and 24.28% with normal motile sperm >5 x 10(6). For patients <25 years old, with number of motile spermatozoa >5 x 10(6), the pregnancy rate per cycle was 28.2%, which is significantly higher than that of other age groups. Above the age of 35 years, no pregnancies were reported with number of motile spermatozoa <5 x 10(6), and the pregnancy rate was very low (0.84%) with number of motile spermatozoa >5 x 10(6). When the normal sperm morphology was >30% and number of motile spermatozoa inseminated >5 x 10(6), the pregnancy rate was 20.77%. CONCLUSION(S) Intrauterine insemination used for treating male factor infertility has little chance of success when the woman is older than 35 years, the number of motile spermatozoa inseminated is <5 x 10(6), or normal sperm morphology is <30%.

Aromatase inhibitors or gonadotropin-releasing hormone agonists for the management of uterine adenomyosis: a randomized controlled trial

Objective. To compare the efficacy of aromatase inhibitor vs. gonadotrophin‐releasing hormone agonists in treating premenopausal women with uterine adenomyosis. Design. A prospective randomized controlled study. Setting. A university hospital and a private practice setting. Population. Thirty‐two patients with uterine adenomyosis. Methods. Patients were randomly allocated to receive oral letrozole (2.5mg/day) or a subcutaneous gonadotropin‐releasing hormone agonist (goserelin, 3.6mg) for 12 weeks. Uterine and adenomyoma volumes were determined at baseline and during treatment at four, eight and 12 weeks. Outcome measures. Measurements were performed at baseline and during treatment at four, eight 8 and 12 weeks, and mean values were calculated. Symptoms at the start and after 12 weeks were evaluated. Results. No significant differences in the total uterine size between the post treatment uterine volumes in the two groups (20.1, 15.4 and 13.0cm3 vs. 21.7, 15.1 and 11.7cm3, at four, eight and 12 weeks, respectively). Total adenomyoma volume decreased by 8.6, 29.7 and 40.9% vs. 5.7, 34.6 and 49.1% after four, eight and 12 weeks of treatment, in group A and B, respectively. Two patients became pregnant in group A during treatment. Conclusions. Aromatase inhibitors are as effective as gonadotropin‐releasing hormone agonists in reducing adenomyoma volume and improving symptoms.

Sexual abuse experienced by married Egyptian women

To assess the prevalence of sexual abuse (SA) and associated factors among married women in Lower Egypt.

Evaluation of a single-step diagnosis and treatment of premalignant cervical lesion by LEEP

To explore whether a single‐step diagnosis and treatment of premalignant cervical lesions by the loop electrosurgical excision procedure (LEEP) is appropriate in women at high risk in low‐resource countries.

Cytologic, colposcopic, and virologic detection of cervical herpes simplex virus.

Studies on cervical herpes simplex virus (HSV) in Egypt are scant. The clinical symptoms of genital herpes are a poor indicator of infection w1x. The exact prevalence of genital herpes is unknown because not all patients with active infections seek medical care and because the proportion of asymptomatic disease is high. The principal site of HSV infection in the female is the cervix. Initial genital infection involves the cervix in more than 80% of cases and both the ectocervix and the endocervix may be involved. Herpes infection of the lower genital tract has been associated with cervical cancer although a causative role remains unproven. Several adverse outcomes of pregnancies complicated by gestational HSV infections have been described. These include spontaneous abortion prematurity intrauterine growth retardation congenital infection and neonatal infection. The objectives of this study were: (1) to determine the isolation rate of cervical HSV in relation to different clinical conditions and colposcopic findings; and (2) to determine the sensitivity and specificity of the Papanicolaou (Pap) smear direct fluorescence antibody (DFA) stain and tissue culture in patients attending the outpatient clinic of Benha University Hospital. (excerpt)

Treatment with misoprostol by midwives is safe and effective

www.thelancet.com Vol 385 June 13, 2015 2335 Incomplete abortion is defi ned as the presence of retained products of conception with no well-defi ned gestation sac. It is a potentially life-threatening condition that without well-timed and proper treatment can lead to severe complications such as haemorrhagic shock, sepsis, and death. Abortionrelated complications still contribute substantially to maternal morbidity and mortality in sub-Saharan Africa. Backup treatment of complications from unsafe abortion and spontaneous abortion (postabortion care) is an eff ective intervention to reduce maternal mortality. The post-abortion care model consists of emergency treatment of abortionrelated complications, post-abortion contraceptive counselling, and free contraception. The lack of physicians in many low-income countries restricts women’s access to post-abortion care. In Africa, the shortage of trained health-care providers is greatest in rural and remote areas where maternal mortality and morbidity is highest. In The Lancet, Marie KlingbergAllvin and colleagues report the results of a multicentre equivalence randomised controlled trial to examine Treatment with misoprostol by midwives is safe and eff ective Because a test can only aff ect outcomes by changing care, the failure to follow best practices, or the ineff ectiveness of treatments, can be falsely attributed to the test. Indeed in the PARR-2 trial, although performance of a cardiac PET viability scan did not change outcomes in patients with heart failure overall, patients who received PET-guided care (and not just a scan) had fewer events. SCOT-HEART bypassed this issue by using the upstream outcome of diagnostic certainty, but clinical events remain the preferred evidentiary standard. Third, if intermediate outcomes are used, what outcomes are most important to both patients and clinicians in guiding test selection? Diagnostic thinking is important, and might change processes of care, as shown in SCOT-HEART, but other unexamined parameters such as effi ciency, safety, and avoidance of unnecessary invasive procedures might be equally, if not more, salient. Finally, although the very low rate of clinical events in SCOT-HEART (ie, cardiovascular death or myocardial infarction were reported in just 68 [1·6%] participants in 1·7 years of follow-up) is encouraging in documenting an excellent prognosis for patients with new-onset stable chest pain receiving contemporary care, to show a diff erence in patient outcomes with diff erent testing strategies in view of this excellent prognosis would need a large incremental test eff ect driving diff erences in downstream care, an extremely large study sample, prolonged follow-up, or a combination of these factors. SCOT-HEART provides important data regarding the eff ect of the addition of a new technology to usual care, and explores new methods for the theory and practice of imaging outcomes research. However, more work is needed in this new specialty before the value of cardiovascular imaging can be fully understood.