Karim H.I. Abd-El-Maeboud

Amnion graft following hysteroscopic lysis of intrauterine adhesions.

Aim:  To evaluate the safety and efficacy of amnion grafting after hysteroscopic lysis of intrauterine adhesions.

Human amnion as a temporary biologic barrier after hysteroscopic lysis of severe intrauterine adhesions: pilot study.

STUDY OBJECTIVE To estimate the efficacy of fresh and dried amnion graft after hysteroscopic lysis of severe intrauterine adhesions in decreasing its recurrence and encouraging endometrial regeneration. DESIGN Pilot prospective randomized comparative study (Canadian Task Force classification I). SETTING Ain Shams Medical School, Cairo, Egypt. PATIENTS Forty-five patients with severe intrauterine adhesions. Primary symptom was infertility with or without menstrual disorders such as amenorrhea or hypomenorrhea. INTERVENTIONS Patients were randomized preoperatively using a computer-generated randomization sheet into 3 groups of 15 patients each. Allocation to any group was concealed in an opaque envelope, which was opened at the time of operation. Hysteroscopic lysis of intrauterine adhesions was followed by insertion of an intrauterine balloon only (group 1) or either fresh amnion graft (group 2) or dried amnion graft (group 3) for 2 weeks. Diagnostic hysteroscopy was performed at 2 to 4 months postoperatively. MEASUREMENTS AND MAIN RESULTS Adhesion grade, menstruation, uterine length, complications, and reproductive outcome were determined. There was significant improvement in adhesion grade with amnion graft vs intrauterine balloon alone (p = .003). Improvement was greater with fresh amnion than with dried amnion (p = .01). Normal menstruation occurred in 4 patients (28.6%) in group 1, 5 (35.7%) in group 2, and 7 (46.7%) in group 3. Of 43 patients, 41 (95.3%) were treated in 2 endoscopic sessions (95.3%), and 2 patients (4.7%) were treated in 3 endoscopic sessions. Uterine perforations occurred in 2 patients (4.7%), and cervical tears in 3 (7.0%). Ten patients (23.3%) achieved pregnancy, 8 (80%) after amnion graft and 2 (20%) without amnion. Six of the 10 patients (60%) miscarried, and 4 (40%) were either still pregnant or delivered at term without complications. CONCLUSION Hysteroscopic lysis of severe intrauterine adhesions with grafting of either fresh or dried amnion is a promising adjunctive procedure for decreasing recurrence of adhesions and encouraging endometrial regeneration.

Genital Chlamydia trachomatis Infection in Egyptian Women: Incidence among Different Clinical Risk Groups

Objective: To investigate genital Chlamydial infection incidence among high risk clinical conditions in Egyptian women.

Effect of vaginal pH on the efficacy of vaginal misoprostol for induction of midtrimester abortion.

Aim:  To evaluate the effect of vaginal pH on the efficacy of misoprostol for induction of midtrimester abortion.

Intravenous infusion of paracetamol versus intravenous pethidine as an intrapartum analgesic in the first stage of labor

To evaluate the efficacy and adverse effects of an intravenous infusion of 1000 mg of paracetamol as compared with an intravenous injection of 50 mg of pethidine hydrochloride for intrapartum analgesia.

A preliminary pilot randomized crossover study of uzara (Xysmalobium undulatum) versus ibuprofen in the treatment of primary dysmenorrhea.

Objective Preliminary evaluation of efficacy and safety of uzara use in treatment of moderate and severe primary dysmenorrhea in comparison to ibuprofen. Materials and Methods This randomized, comparative two way cross-over study comprised 60 single female students at Faculty of Medicine, Ain Shams University, Egypt, aged 19–28 years with moderate (n = 46) or severe (n = 14) primary dysmenorrhea. Participants were randomized to take either uzara (80 mg/8 hours for two doses, then 40 mg/8 hours) then ibuprofen (400 mg/6 hours) in two subsequent cycles or vice versa. The pain intensity, using VAS, was recorded immediately before taking the medication (0 hour) and after 4, 12, 24, 48–60, 96–120 hours. Main outcome measures included effectiveness of pain relief defined as drop of VAS to 3 or less, patients global evaluation of the drug, absence from school, the use of a rescue medication, and, in those who continued the treatment, the pain intensity difference (PID) at different points after start of medication and its sum (SPID). Results Uzara was comparably effective to ibuprofen (78.3% vs. 86.7% of cycles; respectively), with comparable rates of effectiveness on global evaluation (being around 50% for either drug), and rates of school absences (11.7% vs. 13.3%; respectively). The need for rescue medication was different (18.3% and 10%; respectively), albeit with no statistical significance. The means of PID at different time points and SPID were comparable, with significantly lower average mean of VAS scores compared to that felt with no medication (1.6 vs. 6.8, p<0.001). Side effects were less with uzara than ibuprofen (0% vs. 8.3%, p<0.05). Conclusions Uzara might be as effective as ibuprofen in management of primary dysmenorrhea but with less side effects. These findings need to be confirmed by a properly designed trial with a larger sample size. Trial Registration Current Controlled Trials ISRCTN25618258

Hydatid Cyst of Morgagni: Any Impact on Fertility?

On laparoscopy in 3 patients with primary infertility, the only pathology found was hydatid cysts of Morgagni that were excised. In one patient with monolateral hydatid cyst, pregnancy failed to be achieved. Despite prior failure of repeated trials of ovulation induction and intrauterine insemination in the other 2 patients, a spontaneous pregnancy was achieved within 2–3 months following laparoscopic extirpation of hydatid cysts of Morgagni. The hydatid cysts were bilateral in one case; and monolateral (in relation to the only present tube with a unicornuate uterus) in the other dase. Jt is concluded that hydatids of Morgagni, as a single pelvic pathology, might hinder fertility. Laparoscopic extirpation of these cysts would improve ovum pick‐up and enhance fertility.

Randomized controlled trial comparing carbetocin, misoprostol, and oxytocin for the prevention of postpartum hemorrhage following an elective cesarean delivery

To compare the effectiveness and safety of carbetocin, misoprostol, and oxytocin for the prevention of postpartum hemorrhage following cesarean deliveries.

Vaginal acidity enhancement with a 3% acetic acid gel prior to misoprostol treatment for pregnancy termination in the midtrimester

To investigate whether enhancing vaginal acidity improves the success of medical abortions in the midtrimester.

Intravenous infusion of paracetamol for intrapartum analgesia

To evaluate the efficacy and adverse effects of an i.v. infusion of paracetamol during the active phase of labor as compared with sterile water (placebo) as a method for intrapartum analgesia.