Mohamed Khalaf

Bakri balloon versus condom-loaded Foley’s catheter for treatment of atonic postpartum hemorrhage secondary to vaginal delivery: a randomized controlled trial

Abstract Objective: To assess the efficacy and safety of condom-loaded Foley’s catheter versus Bakri Balloon in the management of primary atonic post partum hemorrhage (PPH) secondary to vaginal delivery. Study design: This study was single blinded randomized controlled trial conducted at Assiut Woman’s Health Hospital, Egypt in the period between October 2014 and December 2015. It Comprised 66 women with primary atonic PPH following vaginal delivery. Eligible participants were randomly assigned to Bakri balloon (group A) or condom-loaded Foley’s catheter (group B). The primary outcome was the success of tamponade to stop the uterine bleeding without additional surgical interventions. Secondary outcomes included time between insertion and stoppage of the bleeding, the amount of blood transfusion and maternal complications. Results: Both treatment modalities successfully controlled the primary atonic PPH without a statistically significant difference [30/33(91.0%) and 28/33(84.84%), p = .199; respectively]. However; Bakri balloon required shorter time to stop the uterine bleeding (9.09 min vs. 11.76 min, p = .042; respectively). There was no statistically significant difference between both groups regarding postpartum maternal complications, the vital signs, urine output, hemoglobin and hematocrit levels from before to after tamponade insertion. Conclusions: Condom-loaded Foley’s catheter is as effective as Bakri balloon in the management of primary atonic PPH following vaginal delivery but requires a significant bit longer time to stop the attack.

Fetal biacromial diameter as a new ultrasound measure for prediction of macrosomia in term pregnancy: a prospective observational study

Abstract Objective: The current study aims to evaluate a simple method for sonographic measurement of the fetal biacromial diameter for prediction of fetal macrosomia in term pregnancy. Materials and methods: The current study was a single center prospective observational study conducted in a tertiary University Hospital from January 2015 to May 2017. We included all consecutive term (37–42 weeks) pregnant women presented to the labor ward for delivery. Ultrasound parameters were measured as biparietal diameter, head circumference, transverse thoracic diameter, mid arm diameter, abdominal circumference, femur length, estimated fetal weight, and amniotic fluid index. The proposed ultrasound formula “Youssef’s formula” to measure the fetal biacromial diameter is: [Transverse thoracic diameter +2 × midarm diameter]. The accuracy of proposed formula was compared to the actual biacromial diameter of the newborn after delivery. The primary outcome of the study was accuracy of sonographic measurement of fetal biacromial diameter in prediction of fetal macrosomia in terms of sensitivity and specificity Results: The study included 600 participants; 49 (8.2%) of them delivered a macrosomic neonates and 551 (91.8%) delivered average weight neonates. There was no statistical significant difference between the proposed fetal biacromial diameter measured by ultrasound and the actual neonatal biacromial diameter measured after birth (p = .192). The area under the curve (AUC) for prediction of macrosomia at birth based on the fetal biacromial diameter and the abdominal circumference was 0.987 and 0.989, respectively, on receiver operating characteristic (ROC) curve analysis. Using the biacromial diameter cutoff of 15.4 cm has a PPV for prediction of macrosomia (88.4%) and 96.4% sensitivity with overall accuracy of 97%. Similarly, with the abdominal circumference (AC) cutoff of 35.5 cm, the PPV for prediction of macrosomia (87.7%) and 96.4% sensitivity with overall accuracy of 96.83%. No statistical significant difference between both of them was observed for prediction of fetal macrosomia (p = .841) Conclusions: The sonographic measurement of fetal biacromial diameter seems to be a new simple and accurate method for prediction of fetal macrosomia and shoulder dystocia at birth.

Peripartum hysterectomy for cesarean section with morbidly adherent placenta: case series of 25 patients

Three variants of morbidly adherent placenta are recognized: placenta accreta, in which placental villi invade the surface of the myometrium; placenta increta, in which placental villi extend into the myometrium; and placenta percreta, where the villi penetrate through the myometrium to the uterine serosa and may invade adjacent organs, such as the bladder. In some rare instances, the placenta could invade beyond the abdominal viscera and reach to the anterior abdominal wall.

Tactile Electrosurgical Ablation: A Technique for the Treatment of Intractable Heavy and Prolonged Menstrual Bleeding.

Objective. To study the efficacy and safety of tactile electrosurgical ablation (TEA) in stopping a persistent attack of abnormal uterine bleeding not responding to medical and hormonal therapy. Methods. This is a case series of 19 cases with intractable abnormal uterine bleeding, who underwent TEA at the Womens Health Center of Assiut University. The outcomes measured were; patients acceptability, operative time, complications, menstrual outcomes, and reintervention. Results. None of the 19 counseled cases refused the TEA procedure which took 6–10 minutes without intraoperative complications. The procedure was successful in the immediate cessation of bleeding in 18 out of 19 cases. During the 24-month follow-up period, 9 cases developed amenorrhea, 5 had scanty menstrual bleeding, 3 were regularly menstruating, 1 case underwent repeat TEA ablation, and one underwent a hysterectomy. Conclusions. TEA represents a safe, inexpensive, and successful method for management of uterine bleeding emergencies with additional long-term beneficial effects. However, more studies with more cases and longer follow-up periods are warranted.

Evaluation of multidrug resistance in acute leukemia using real-time polymerase chain reaction

Background Despite the advances in the cure rate for acute leukemia, ~25% of affected patients develop relapses. Expression of genes for the multidrug resistance (MDR1) and breast cancer-resistance protein (BCRP) may confer the phenotype of resistance to the treatment of acute leukemia. Objective To analyze the expression of the MDR1 and BCRP genes in new cases of acute leukemia using real-time PCR (RT-PCR) and to determine the correlation between their expression and overall survival (OS). Patients and methods Patients diagnosed with acute myeloblastic leukemia (AML) (n = 15) and acute lymphoblastic leukemia (ALL) (n = 35), and 20 blood donors as a control group were included in this study. The expressions of mRNA for the MDR1 and BCRP genes were assessed by RT-PCR. Myeloid surface markers such as CD34, CD33, CD13, and CD14 and lymphoid surface markers such as CD3, CD5, CD2, CD4, CD8, and CD19 were analyzed using flow cytometry. Results The groups with the MDR gene and the BCRP gene showed a highly significant difference compared with the control group (P < 0.000). The relation between MDR and BCRP in both AML and ALL groups showed no significant difference. There was a significant difference between BCRP expression in the AML and ALL groups (P < 0.01). There was no significant difference in the OS between MDR+ cases and MDR- cases in the AML and ALL groups. In contrast, the OS in BCRP+ cases and BCRP- cases showed a significant difference between AML and ALL groups (P < 0.01). No significant difference was detected between OS in AML (MDR+, CD34+) and AML (MDR+, CD34−). In contrast, OS between AML (BCRP+, CD34+) and AML (BCRP+, CD34−) showed a significant difference (P < 0.01). The difference between OS in ALL (MDR+, CD34+) and ALL (MDR+, CD34−) was not significant. In contrast, a significant difference was detected between OS in ALL (BCRP+, CD34+) and ALL (BCRP+, CD34−) (P < 0.01). OS in the AML group that was BCRP+ (CD13+) showed a significant difference (P < 0.01). In the ALL group, the association between MDR+ and CD19+ or BCRP+ and CD19+ did not affect the survival significantly. Conclusion We concluded that the evaluation of the expression of genes for resistance to antineoplastic drugs in acute leukemia upon diagnosis, and particularly the expression of the BCRP gene, may be of clinical relevance.