ABSTRACT
Background: This study was aimed to evaluate the effect of sildenafil citrate on Doppler velocity indices in patients with fetal growth restriction (FGR) associated with impaired placental circulation.Methods: A double-blinded, parallel group randomized clinical trial (clinicaltrials.gov NCT02590536) was conducted in Ain Shams Maternity Hospital, in the period between October 2015 and June 2017. Ninety pregnant women with documented intrauterine growth retardation at 24-37 weeks of gestation were randomized to either sildenafil citrate 25 mg orally every 8 hours or placebo visually-identical placebo tablets with the same regimen. The primary outcome of the study was the change in umbilical artery and fetal middle cerebral artery indices.Results: There was a significant improvement in umbilical and middle cerebral artery indices after sildenafil administration p<0.001. Present study observed that, sildenafil group, in comparison to placebo, has a significantly higher mean neonatal birth weight. 1783±241g vs 1570±455g (p<0.001). There was a significantly higher mean gestational age at delivery in women in sildenafil group 35.3±1.67 weeks, whereas it was lower in the placebo group 33.5±1.7 weeks. The side effects as headache, palpitation and facial flushing were significantly higher in sildenafil group compared to placebo group.Conclusions: The use sildenafil citrate in pregnancies with fetal growth restriction (FGR) improved the feto-placental Doppler indices (pulsatility index of umbilical artery and middle cerebral artery) and improved neonatal outcomes.
ABSTRACT
Background: Little is known about the factors that influence the choice of medical specialty by male and female senior medical students at King Abdulaziz University in Jeddah so this study was conducted to investigate these factors. Methods: In this cross sectional study, data was collected through a questionnaire that was adapted to the Saudi culture from. It was distributed to three hundred male and female medical students in their sixth year and the response rate was 79.6%. Data analysis was carried out by using the Statistical Package for the Social Science (SPSS) version during the years 2013-2014. The percentages and the significances of the most and the least factors that influence the choice of medical specialties by the sample of the study were computed. Results: Study showed that 91 out of 121 senior male students and 88 senior female students out of 118 agreed that joining medical school was their first interest. Results illustrated that helping patients is the most considerable reason to choose medicine by the majority of the students (93% of senior male students and 91% of senior female students) whereas family enforcement was the least influential reason to choose medicine (28% of senior male students and 23% of senior female students). Internal medicine was chosen by the majority of the sample of the study as their first interest after graduating from medical school (43 male and female senior students). While only one male medical student chose community medicine. Conclusions: Medicine was the first choice for the majority of both male and female medical students who entered university. Internal medicine was the most desirable specialty following graduation. Most of the graduates have no plan in pursuing a career in general practice. It is advocated to establish a career advising committee at KAU. The committee should focus on medical students during their final clinical years. The lack of physicians in some specialties and its effect on the community should be addressed.
ABSTRACT
A malignant pleural effusion is diagnosed by finding exfoliated malignant cells in pleural fluid or by demonstrating these cells in pleural tissues obtained by closed pleural biopsy, thoracoscopy, or thoracotomy. Precise diagnosis is mandatory as different tumors have different managements. Unlike thoracocentesis and closed pleural biopsy [CPB]; medical thoracoscopy [MT] permits biopsy with direct visualization of the pleural surfaces. The aim of this study was to evaluate of the role of MT in the diagnosis of pleural malignancies in 2 situations: the 1[st] situation; patients with exudative pleural effusion [EPE], in whom thoracocentesis and CPB have failed to establish a diagnosis [15 patients; group I], the 2[nd] situation; patients with EPE, in whom these procedures have established a diagnosis of pleural malignancies [15 patients; group II]. Among the 15 patients of group I; MT established a diagnosis in 14 patients [93%]. Malignancy was the main diagnosis detectable on thoracoscopy; 9 of 15 patients [60%] proved to have pleural malignancies; five patients [33%] proved to have non-malignant conditions after thoracoscopy, MT failed to establish the diagnosis in one patient [7%] [non-specific pleurisy]. Out of the 15 patients in group II, MT confirmed the diagnosis established by thoracocentesis and CPB in 12 cases [80%] and corrected the diagnosis in 3 cases [20%]; a malignant mesothelioma [MM] was corrected to adenocarcinoma, an adenocarcinoma was corrected to MM, and an adenocarcinoma was corrected to squamous cell carcinoma. Few minor complications were reported in five patients [16.7%] including empyema, residual pneumothorax, subcutaneous emphysema and tumor implantation at the site of MT. No bleeding or mortality was reported. In conclusion, MT under local anesthesia and conscious sedation is a safe procedure and could be applied to a variety of indications especially when a pleural malignancy is suspected. Moreover, MT asserts its usefulness in modifying the diagnosis of prior malignancy and to overcome the problem in the distinction between MM and adenocarcinoma thus saving the patients from unnecessary thoracotomy especially in inoperable cases