The role of sildenafil citrate in the treatment of fetal growth restriction: a randomized controlled trial

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.

High efficacy and low toxicity of short-course oral valganciclovir as pre-emptive therapy for hematopoietic stem cell transplant cytomegalovirus infection

Cytomegalovirus [CMV] infection is a major infectious complication post-allogeneic hemato-poietic stem cell transplantation [HSCT]. CMV seropositivity in Eastern Mediterranean and certain Asian countries is reported to be close to 100%; hence, the need for effective pre-emptive treatment strategy that has low toxicity. Valganiciclovir [VGC] is a prodrug of ganciclovir with high biovailability. HSCT patients with documented CMV infection [as defined by positive CMV anti-genemia] were treated as outpatients with VGC at a starting dose of 900 mg once daily for antoher week and treatment was subsequently discontinued. Those who were positive after one week of therapy continued on the twice daily treatment schedule for another week and changed to a daily schedule once they converted to antigenemia negativity. From January 2004 to December 2007, 47 HSCT patients received preemptive treatment with VGC for 61 episodes of CMV infection. The antigenemia range was 1 to 700 infected cells/slide. Complete responses were observed in 92% and 97% after the 1st and 2nd week of treatment, respectively. Three percent of the episodes were considred refractory, requiring alternative therapy. No CMV disease was observed in this cohort. Neutropenia was the main observed toxicity, requiring granulocyte-colony stimulating factor in 8 episodes. Outpatietn treatment of CMV infection with "short-course oral VGC" given as a one week twice dialy treatment and one week once daily maintenance is a highly effective therapy with minimal toxicity. These results require validation in a larger, randomized study

Role of sonohysterography in evaluation of abnormal uterine bleeding

Transvaginal ultrasound is an excellent method for imaging uterine abnormalities. However, evaluation of the uterine cavity is limited. Hysterosonography, an ultrasound technique in which the endometrial cavity is distended with saline, enables the radiologist to reliably distinguish focal from diffuse endometrial pathologic conditions Study Objective: To evaluate its diagnostic value in the evaluation of endometrial abnormalities, and correlating it to the histopathulogical examination to help determine its role in clinical decision making in patients with abnormal uterine bleeding. Prospective randomized study. Settings: El-Shatby Maternity Hospital, and Radiology department, Alexandria Main University Hospital. This study was carried on 30 married women of different age groups complaining of abnormal uterine bleeding. All patients were examined by transvaginal ultrasound, then hysterosonography by saline infusion, to be followed by a surgical intervention D and C, hysteroscopy, or hysterectomy for which the whole uterus or the biopsied lesion was sent for histopathological examination. Sonohysterography is far more superior than transvaginal ultrasound in diagnosing focal and diffuse endometrial lesions, which did match the final histopathological examination in 80% of cases. Hysterosonography has further enhanced the transvaginal examination of the uterine cavity. This can be used for further evaluation of the site, nature, and even reach a final diagnosis of the lesion yet it could not replace the histopathologic diagnosis, however it can help determine the best mode of the treatment, whether medical or surgical