Amr Hassan

A randomized controlled trial of uterine exteriorization versus in situ repair of the uterine incision during cesarean delivery.

To compare extra‐abdominal repair of the uterine incision at cesarean delivery with in situ repair.

Urinary 6-sulphatoxymelatonin levels and sleep disorders in children with migraine.

We conducted the present study to assess melatonin secretion in a sample of children with migraine, to describe their sleep patterns and problems, and to examine the impact of sleep problems on migraine disability. The parents of 18 children with migraine completed the Childrens Sleep Habits Questionnaire and Pediatric Migraine Disability Assessment Score in Arabic. The parents of 18 healthy controls also completed the Childrens Sleep Habits Questionnaire. Urinary 6-sulphatoxymelatonin levels were determined with the enzyme-linked immunosorbent assay method. There was no significant difference in urinary 6-sulphatoxymelatonin between the migraine and control groups (Z = –0.127, P = .889). There were no significant differences between groups in Childrens Sleep Habits Questionnaire subscales or total scores. There were significant correlations between bedtime resistance, parasomnias subscales, and migraine disability. Our findings indicate that nocturnal production of melatonin is not reduced in children with migraine, and sleep disturbances impact the degree of migraine disability.

A prospective randomized clinical trial comparing immediate versus delayed removal of urinary catheter following elective cesarean section

OBJECTIVE To compare immediate and 12h postoperative removal of urinary catheter after elective cesarean section. STUDY DESIGN In a prospective clinical trial at a university teaching hospital, 300 eligible women admitted for primary or repeat elective cesarean section were randomized into two equal groups. In group A, the catheter was removed immediately after the procedure; whereas in group B, the catheter was removed 12h postoperatively. RESULTS The incidence of postoperative significant bacteruria (p=0.020), dysuria (p=0.030), burning on micturition (p=0.016), urinary frequency (p=0.031), and urgency (p=0.011) were significantly lower in group A compared with group B. The mean postoperative ambulation time (p<0.001), time till the first voiding (p<0.001), and length of hospital stay (p<0.001) were also significantly shorter in group A. There were no significant differences between the two groups in the incidence of urinary retention necessitating recatheterization (p=0.371). CONCLUSION Immediate removal of urinary catheter after elective cesarean section is associated with lower risk of urinary infection and earlier postoperative ambulation.

Diagnostic accuracy of posterior cervical angle and cervical length in the prediction of successful induction of labor

To determine the accuracy of the posterior cervical angle (PCA) compared with the cervical length and the Bishop score in predicting the outcome of induction of labor (IOL).

Characteristics and predictors of progression in an Egyptian multiple sclerosis cohort: a multicenter registry study

Background Multiple sclerosis (MS) is a complex autoimmune disease with a heterogeneous presentation and diverse disease course. Recent studies indicate a rising prevalence of MS in the Middle East. Objective To characterize the demographics and disease features of Egyptian patients attending four tertiary referral MS centers in Cairo. Materials and methods This was a retrospective, observational study on 1,581 patients between 2001 and 2015. Medical records were reviewed and data were identified and extracted in a standardized electronic registry. Results The mean age of disease onset was 26.6±7.8 years, with the majority being female (2.11:1). Relapsing–remitting MS was the most common type (75.1%). The main presenting symptom was motor weakness (43.9%), which was also the most frequent symptom during the disease course. Family history of MS was found in 2.28%. Higher initial Expanded Disability Status Scale score, black holes, and infratentorial lesions on initial magnetic resonance imaging were independent factors for disease progression by univariate analysis (OR 3.87 [95% CI 1.84–6.51], 4.14 [95% CI 3.08–5.58], 4.07 [95% CI 3.21–4.99], respectively); however, in multivariate analysis, only infratentorial lesions were an independent risk for disease progression (OR 6, 95% CI 2.99–12.02; P=0.0005). Conclusion The results from this registry – the largest for MS in the Arab region to date – are comparable to other registries with slight differences.

Role of concentric needle Single Fiber Electromyography in detection of subclinical motor involvement in carpal tunnel syndrome

BackgroundConventional motor nerve conduction studies are usually normal in early and mild carpal tunnel syndrome (CTS). Single-fiber electromyography (SFEMG) measures the mean consecutive difference (MCD) as an expression of the variability in impulse transmission over the motor endplates and along the nerve fibers distally to the last branching point and along the muscle fibers.Application of concentric needle SFEMG in a group of CTS patients who showed pure sensory abnormalities in nerve conduction studies to examine for subclinical motor involvement.MethodsThirty CTS patients having only sensory involvement proved clinically and by conventional electrophysiological studies were included in addition to 30 control subjects. Concentric needle SFEMG was performed to the abductor pollicis brevis (APB), abductor digiti minimi (ADM), and extensor digitorum communis (EDC) muscles.ResultsThere was a statistically significant difference in the MCD between the patient and control groups in the APB only (p = 0.038).ConclusionsThe results suggest the presence of a subclinical motor median neuropathy at the wrist in patients with early and mild carpal tunnel syndrome and highlight the validity of the concentric needle SFEMG in early neuropathies.Trial registrationPACTR201802002971380 registered 12 February 2018, retrospectively registered.

Pediatric-onset multiple sclerosis in Egypt: a multi-center registry of 186 patients

Introduction Although the frequency of pediatric-onset multiple sclerosis (POMS) has increased in recent decades, it is still highly uncommon, which creates a need for the involvement of more registries from various clinical centers. Objective To characterize the demographic, clinical, and paraclinical features of Egyptian patients with POMS. Patients and methods A retrospective chart review study was undertaken on 237 Egyptian patients with demyelinating events which started before the age of 18 years who attended one of five tertiary referral centers in Cairo, Egypt. Results Multiple sclerosis was diagnosed in 186 patients, 47 (25.27%) patients had disease onset before the age of 12 years; “early-onset pediatric multiple sclerosis (EOPMS)”. The mean age of disease onset was (14.13±2.49 years), with a female:male ratio of 1.62:1, none of the enrolled patients had a primary progressive course (PPMS), whereas 10 patients (5.38%) had a secondary progressive form. Approximately two-thirds of the patients had monofocal disease onset, and less than 10% presented with encephalopathy; most of them had EOPMS. Motor weakness was the presenting symptom in half of the patients, whereas cerebellar presentation was detected in 34.95%, mainly in EOPMS. Seizures (not related to encephalopathy) were more frequent in those with EOPMS. Initial brain magnetic resonance images were positive in all patients, with detected atypical lesions in 29.03%, enhanced lesions in 35.48%, black holes in 13.98%, and infratentorial in 34.41%. Cervical cord involvement was found in 68.28%. More than two-thirds of the patients received either immunomodulatory or immunosuppressant (IS) treatment throughout their disease course, and about half of them received their treatment within the first year from symptoms onset, with a more favorable outcome, and patients with highly active disease received natalizumab, fingolimod, or other IS. Conclusion The results from this registry – the largest for MS in the Arab region to date – are comparable to other registries. Immunomodulatory therapies in POMS are well tolerated and efficacious and they can improve the long-term outcome in children.

Objective pain assessment by electrical stimulation

Background and Objectives: Pain estimation remains a difficult medical problem. Many subjective and objective methods were tried. Subjective methods depend on personal difference to a good extent and cannot be accurate. The aim of this work was to evaluate the validity of using electrical stimulation (ES) as an objective and valid method in quantitating the pain intensity and, consequently, the intensity of needed treatment. Methods: Twenty chronic low back pain (LBP) patients with sciatica and 20 normal subjects participated, and they were compared in this study. Electrical threshold and pain tolerance were recorded from the most painful site in the study group and from the corresponding matching site in the control group. Blood analysis for β-endorphin was done to objectively determine the intensity of pain as well as the objectivity and validity of ES in the assessment of pain. Pain intensity was also recorded by the visual analogue scale for each subject. Results: Significant differences between both groups regarding the threshold and pain tolerance to electrical current were noted. A significant positive correlation was also observed between β-endorphin level as well as the threshold and pain tolerance intensity in the patient group. Non-significant correlation was also observed between the visual analogue scale and β-endorphin level. Conclusion: ES is an objective and valid method, whereas visual analogue scale is a subjective method in the assessment of pain intensity in chronic LBP patients.

Genetic Counseling in Primary Immunodeficiency Disorders: An Emerging Experience in Egypt

BackgroundPrimary immunodeficiency disorders (PIDs) are a heterogeneous group of diseases of the immune system leading to life-threatening infections, and, unless urgently treated with immune reconstitution, patients do not usually survive. With the continuing progress in molecular diagnosis, many mutations have been described in more than 300 genes. Genetic counseling has recently been considered an essential part of the management of PIDs. This study presents the experience of genetic counseling services in the largest PID center in Egypt, and reports on our management plan and the impact of prenatal diagnosis (PND) on families.MethodsBased on the biochemical and molecular diagnosis of index cases, PND was offered for 10 families in 12 subsequent pregnancies. Five different genes were sequenced by Sanger sequencing in fetal samples.ResultsSeven fetuses were either normal or were carriers, while five fetuses were affected and human leukocyte antigen typing was performed, seeking a suitably related donor for stem cell transplantation.ConclusionIn spite of the genetic heterogeneity behind PIDs, genetic counseling should play a critical role in the management and future decisions of affected families.

Comparison between catheter-based delivery of paclitaxel after bare-metal stenting and drug-eluting stents in coronary artery disease patients at high risk for in-stent restenosis

BACKGROUND Drug eluting stents reduce the risk of in-stent restenosis but delay healing of the vascular wall. Recent data on late and very late stent thrombosis after drug-eluting stent (DES) implantation have raised concerns about the long-term safety. High lipophilicity of paclitaxel promotes rapid cellular uptake and prolongs its action. This makes paclitaxel a very promising candidate for local drug therapy intended to inhibit the proliferative and migratory processes involved in restenosis following PCI. OBJECTIVES In a prospective randomized trial, we compared the efficacy of the new catheter based delivery of fluid paclitaxel after bare metal stenting with that of drug eluting stents in patients at high risk for in-stent restenosis. METHODS AND RESULTS We conducted a prospective, randomized trial comparing the local delivery of fluid paclitaxel after bare metal stent implantation (DDB+BMS group) with the implantation of drug eluting stent (DES group) (1:1) in 68 patients at high risk for in-stent restenosis. The primary end points were in-stent late lumen loss and binary restenosis rate ›50%. Secondary end points were procedure success and composite clinical end points (major adverse cardiac events and revascularization of the target lesion) 6months after intervention. At 6months, follow-up angiography showed an in-stent late lumen loss of 1.0±1.3mm in (DDB+BMS group) versus 0.94±1.3mm in DES group (P=.743) without statistically significant difference in the cumulative overall rate of major cardiac events between both groups. DES subgroup analysis showed in-stent late lumen loss of 0.09±0.3mm in everolimus eluting stent (EES) subgroup patients that was statistically significant in comparison with (DDB+BMS group, n=30) (P=.033) and paclitaxel eluting stent (PES, n=19) subgroup patients (P=.006).Target lesion revascularization was 0% in EES subgoup patients, 36.7% in DDB+BMS group patients and 47.7% in PES subgroup patients (P=.026). CONCLUSION Paclitaxel either in fluid form used in drug delivery balloons or in polymerized form used in drug eluting stents was ineffective in reducing neointimal proliferation, in-stent restenosis, and clinical events. EES was superior compared with PES and catheter based delivery of fluid paclitaxel after bare metal stent implantation regarding primary and secondary end points.