Ahmed Abdelaziz

Prevention of preterm birth: a randomized trial of vaginal compared with intramuscular progesterone

Objective. To assess efficacy and tolerability of vaginal compared with intramuscular progesterone in reducing the rate of recurrent preterm birth before 34 weeks of gestation. Design. Prospective randomized study. Setting. Obstetrics and Gynecology Department, Armed Forces Hospital Southern Region, Kingdom of Saudi Arabia. Sample. Five‐hundred and eighteen women with a prior history of preterm birth. Methods. Women were randomized to receive either 90 mg of vaginal progesterone gel once daily or 250 mg of intramuscular progesterone weekly. Treatment began between 14 and 18 weeks of gestation and continued until 36 complete weeks of gestation, delivery or the occurrence of premature rupture of membranes. Main outcome measures. The primary outcome measure was delivery before 34 weeks of gestation. The secondary outcome measures were PTB between 34 and 37 weeks of gestation and neonatal outcomes including birthweight, neonatal death, and the need for admission to the neonatal intensive care unit. Results. The baseline characteristics of the study participants were similar. Two‐hundred and thirty‐eight (94.1%) patients in the vaginal group and 226 (90.8%) patients in the intramuscular group were compliant with their medications. Vaginal progesterone was associated with a lower percentage of deliveries before 34 weeks of gestation than the intramuscular preparation (p= 0.02). This association was also observed at 28 and 32 weeks of gestation (p= 0.04). Adverse effects were reported in 14.1% of patients in the intramuscular group, but in only 7.5% of patients in the vaginal group (p= 0.017). Conclusions. Vaginal progesterone was more effective than intramuscular progesterone for the prevention of preterm birth and had fewer adverse effects.

Diagnostic accuracy of ultrasound and MRI in the prenatal diagnosis of placenta accreta

To analyze the value of ultrasound followed by magnetic resonance imaging (MRI) in doubtful cases for antenatal detection of placenta accreta.

Early pregnancy screening for hypertensive disorders in women without a‐priori high risk

To evaluate the performance of mean arterial pressure, uterine artery pulsatility index and soluble endoglin level alone or in combination in screening for hypertensive disorders in pregnant women without a‐priori high risk.

Utilization of a pyrrole derivative based antimicrobial functionality impregnated onto CaO/g-C3N4 for dyes adsorption

A novel functionalization of CaO/g-C3N4 based nanocomposite using 4,5-diphenyl-2-thioxo-2,5-dihydro-1H-pyrrole-3-cabonitrile (P3C@CaO–HCN) was performed for wastewater remediation from organic dyes and microbial pollutants. Adsorption performance of multiple mixtures of basic and acidic dyes by P3C@CaO–HCN was investigated and optimized using a three-level Box–Behnken design of experiment (BBD-DOE). The quadratic Box–Behnken polynomial equation showed the best fit with experimental adsorption capacities of crystal violet (CV), methylene blue (MB), and methyl orange (MO) model dyes. The simultaneous influence of adsorption conditions was tested based on the developed Box–Behnken equation, 3D contour plots, and ANOVA analysis. Nonlinear regression analysis of kinetics and isotherm constants were computed and validated to propose the adsorption mechanism. Adsorption was found within the ranges of endothermic physical adsorption (ΔH° = 6.17 to 8.58 kJ mol−1) and controlled by both π–π and electrostatic forces depending on the pH level in addition to film diffusion mechanism. The maximum adsorption affinity can be arranged in the order of MB > CV ≥ MO with qe (µmol g−1) of 1915.8, 1227.8, and 1221 µmol g−1, respectively. At 500 mg L−1 P3C@CaO–HCN as the minimum inhibitory dose, the inhibition rates (I%) were 87.9%, 46.9%, and 72.5% for E. coli, P. aeruginosa, and C. albicans, respectively. The antimicrobial effect can result from the free cyanide (CN) functionality of a pyrrole-3-cabonitrile and protonated g-C3N4 (HCN) sheet, which depends on the P3C@CaO–HCN concentration and pathogen types.

Comparison between two management protocols for postpartum hemorrhage during cesarean section in placenta previa: Balloon protocol versus non‐balloon protocol

This study was conducted to compare two management protocols for post‐partum hemorrhage (PPH) during cesarean section (CS) in placenta previa (PP), Bakri balloon protocol versus non‐balloon protocol. Secondary analysis among balloon treated cases was also performed to identify predictors of success, failure or complications, if any.

Outcome prediction in pregnancies of unknown location using endometrial thickness measurement: is this of real clinical value?

OBJECTIVE To re-evaluate the role of measuring endometrial thickness (ET) in prediction of intrauterine pregnancy (IUP) among women with pregnancy of unknown location (PUL). STUDY DESIGN 987 women with PUL were included in a prospective observational multicenter study. Transvaginal ultrasonography was performed to measure ET and a blood sample was taken to measure serum β-hCG and progesterone levels. All patients were then managed expectantly till the final PUL outcome was diagnosed. RESULTS 78 patients (8.9%) were finally diagnosed as having IUP. The best cutoff point of ET as a possible predictor for IUP was 10mm, with an area under receiver-operating characteristic (ROC) curve of 69.0%. At this cutoff point, ET was able to predict IUP with positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of 1.43 and 0.19, respectively. Serum progesterone at a cutoff point of 50 nmol/L was able to predict IUP with PLR and NLR of 9.0 and 0.06, respectively. Variables showing statistically significant differences among those with IUP and those with the other PUL outcomes using univariate analysis (ET, gestational age, β-hCG, parity, serum progesterone and maternal age) were entered into logistic regression analysis. Logistic regression models were constructed. The performance of these models was better than using ET alone to predict the outcome of PUL. CONCLUSION Measurement of ET is not recommended as a single clinical test for intrauterine pregnancy prediction in women with pregnancy of unknown location.

Medial Meniscus Posterior Root Tear Repair Using a 2-Simple-Suture Pullout Technique

Medial meniscus posterior root tear is one of the underestimated knee injuries in terms of incidence. Despite its grave sequelae, using simple but effective technique can maintain the native knee joint longevity. In the current note, a 2-simple-suture pullout technique was used to effectively reduce the meniscus posterior root to its anatomic position. The success of the technique depended on proper tool selection as well as tibial tunnel direction that allowed easier root suturing and better suture tensioning, without inducing any iatrogenic articular cartilage injury or meniscal tissue loss. Using anterior knee arthroscopy portals, anterolateral as a viewing portal and anteromedial as a working portal, a 7-mm tibial tunnel starting at Gerdy tubercle and ending at the medial meniscus posterior root bed was created. The 2 simple sutures were retrieved through the tunnel and tensioned and secured over a 12-mm-diameter washer at the tibial tunnel outer orifice. Anatomic reduction of the medial meniscus posterior root tear was confirmed arthroscopically intraoperatively and radiologically by postoperative magnetic resonance imaging.

Effect of follicular diameter at the time of ovulation triggering on pregnancy outcomes during intrauterine insemination

To compare pregnancy outcomes when triggering ovulation at different follicle sizes during intrauterine insemination (IUI) cycles.