Hend Shalaby

Paternal occupational exposures and the risk of congenital malformations — A case-control study

ObjectivesThis study examined the association between certain paternal occupational exposures during the periconceptional period and the risk of congenital malformations.Materials and MethodsA case-control study was carried out from December 2009 to April 2010; on 242 congenital malformation cases and 270 controls. Paternal occupational exposure to certain workplace hazards was assessed by a detailed questionnaire to evaluate the occupational exposure for both fathers and mothers including pesticides, solvents, welding fumes, lead, working with video display terminals (VDTs) and computer monitors. In addition, the questionnaire assessed the presence of other risk factors such as consanguinity, smoking and history of any maternal diseases during the pregnancy with the child.ResultsThe results revealed that the odds of having a child with congenital malformation was higher (P < 0.01) if the father was occupationally exposed to pesticides (OR: 3.42, 95% CI: 1.97–5.92), solvents (OR: 5.63, 95% CI: 2.77–11.42), or welding fumes (OR: 2.98, 0.99–8.54) during the periconceptional period. However, consanguinity (OR: 1.91, 95% CI: 1.25–2.92) was a risk factor of developing congenital malformations among offspring.ConclusionControl of workplace exposures and adherence to threshold limit values of those hazards should be adopted to minimize the risk of developing congenital malformations among offspring.

Reducing blood loss at abdominal myomectomy with preoperative use of dinoprostone intravaginal suppository: a randomized placebo-controlled pilot study

OBJECTIVE To determine the effect of a single preoperative intravaginal prostaglandin E(2) (PGE(2); dinoprostone) suppository on reducing intraoperative blood loss and the need for subsequent blood transfusion at abdominal myomectomy for symptomatic leiomyomas. STUDY DESIGN In a prospective randomized double-blind placebo-controlled pilot study, 108 women who had abdominal myomectomy for symptomatic leiomyomas were enrolled. Patients were randomly assigned to receive a single dose of intravaginal 20mg dinoprostone (n=54) or placebo (n=54) 60 min before the operation. The primary outcome was the operative blood loss. The secondary outcomes were the need for blood transfusion, change in hemoglobin (Hb) level 24h after operation, and the prevalence of side effects. RESULTS Blood loss and transfusion rate were significantly greater in the group without PGE(2) suppository (group B) than in the group with PGE(2) (group A): they were respectively 485.7 ± 361.3 mL vs 364.1 ± 279.4 mL (P=.02; relative risk [RR] 0.95; 95% confidence interval [CI], 0.63-1.45) and 18.5% vs 3.7% (P=.04; RR 1.32; 95% CI, 3.7-18.5). Group B had a significant decrease in Hb level 24h after operation compared with group A (P<.05). There was no difference in the patient demographics, intraoperative characteristics, postoperative stay, complications, and the side effects between the two groups. CONCLUSION A single pre-operative dose of dinoprostone administered intravaginally could be a safe and reliable method to help decrease blood loss during abdominal myomectomy. Further larger prospective studies are required to support this conclusion.

Paraumbilical hernia repair during cesarean delivery.

Background and Objectives: Pregnant women with paraumbilical hernia usually postpone hernia repair until after delivery, but some patients request that it be done during cesarean delivery. Therefore, we evaluated the outcome of combined cesarean delivery and paraumbilical hernia repair in a prospective study at a tertiary referral university hospital. Patients and Methods: In a prospective study, we compared the outcome of 48 patients undergoing cesarean delivery combined with paraumbilical hernia repair versus 100 low-risk patients undergoing cesarean delivery alone. The main outcome measures were operation time, blood loss, severity of pain, peripartum com--plications, , hospital stay, hernia recurrence, and patient satisfaction. Results: The combined procedure took significantly longer than cesarean delivery alone (75.2 minutes versus 60.5 minutes, P< .001)). There were no major complications. Wound infection occurred in 6 patients (4.1%). Hospital stay did not differ significantly from those of controls. Pain at the hernia site repair occurred in two pa--tients, and one hernia recurred in the hernia repair group during a mean follow-up period of 22 months (range, 6-36 months). All hernia patients reported that they preferred the combined operation. Conclusions: Combined cesarean delivery and paraumbilical hernia repair had the advantage of a single in--cision, single anesthesia, and a single hospital stay while avoiding re-hospitalization for a separate hernia repair. Our results indicate that the combination approach is safe, effective, and well accepted.

Study of aflatoxin B1 as a risk factor that impairs the reproductive performance in females – Egypt

Infertility among couples in Egypt is causing increasing concern. Investigations showed a relationship between ovulatory disorders and the incidence of female factor-mediated fertility difficulties in couples. However, the factors responsible for the sudden increase in ovulatory disorders are not fully understood. The aim of this study was to assess the presence of aflatoxin in sera of infertile women and to correlate this with ovarian functions and hormonal parameters. Blood samples were collected from 70 adult Egyptian females comprising 50 infertile and 20 fertile control individuals, and screened for the presence of aflatoxin B1 (AFB1). Ovarian function was examined by measuring mean ovarian volume, and the umber and size of ovarian follicles. Blood hormonal levels were determined. All blood samples (patients and controls) showed negative results as regards AFB1 analysis. However, there was a significant enlargement in the mean ovarian volume but a significant decrease in follicular size. In addition, there were significant higher levels of lutinizing hormone (LH) and significant lower levels of mid-luteal progesterone in infertile females. Although blood samples were negative with respect to AFB1, the role of aflatoxin cannot be excluded as a contributing factor to female infertility, since the toxin was found to produce deleterious effects on the reproductive system in animals. More studies including aflatoxin analysis in ovarian biopsies are recommended to ascertain involvement of this toxin.

Expulsion of Nova‐T380, Multiload 375, and Copper‐T380A contraceptive devices inserted during cesarean delivery

To compare the expulsion rate of Nova‐T380, Multiload 375, and Copper‐T380A intrauterine contraceptive devices (IUCDs) inserted during cesarean delivery.