Vaginal misoprostol for cervical priming before outpatient hysteroscopy: a randomized controlled trial

Background: Misoprostol has generally shown good efficacy in promoting cervical softness and facilitating hysteroscopic procedures

Objective: To evaluate the efficacy and safety of vaginal misoprostol for cervical priming before diagnostic outpatient hysteroscopy [OH] without anesthesia

Patients and Methods: Design: Double-blind randomized controlled trial. Setting: University teaching hospital. Patient[s]: Ninety patients requiring diagnostic OH for investigation of infertility or abnormal uterine bleeding in the reproductive age. Intervention[s]: Patients were randomly allocated into two equal groups [n= 45]. In group I, 200 mcg misoprostol was inserted into the posterior vaginal fornix 3 hours before OH; in group II [control], 250 mg metronidazole as placebo was inserted into the posterior vaginal fornix by investigator. A rigid 30 4-mm hysteroscope was used in the vaginoscopic technique. Main Outcome Measure[s]: Ease of cervical entry [Likert scale], procedural time, patient acceptability [Likert scale], and pain scoring [visual analog scale]

Result[s]: Vaginal misoprostol significantly facilitated the procedure; cervical entry was easier, procedural time was shorter, patient acceptability was higher, and pain scoring was lower in group I compared with group II. Side effects of misoprostol were infrequent, minor, and transient. No complications were reported

Conclusion[s]: The regimen of 200 mcg vaginal misoprostol administered 3 hours before diagnostic OH is a simple, effective, and safe method of cervical priming to facilitate the procedure without anesthesia

Histologic features of uterine septum

Aim of the Work: this study aimed to detect the assessment of the histological features of the uterine septum as regard the proportion of muscle fibers in relation to fibrous tissue to decide the best management whether incision or excision

Patients and Methods: this study was carried out on 16 women with uterine septum in childbearing period complaining of either infertility or recurrent miscarriage fulfilling the inclusion criteria, attending to Ain Shams University Maternity Hospital between May 2017 and April 2018. The septum was incised or excised by scissors or by resectoscope and then specimen was taken from the middle of the septum sample [A] and another specimen from the uterine wall sample [B]. The retraction of the septal tissue on both sides was observed. This study included 16 specimens of uterine septum [A] and 16 specimens from uterine wall [B]. Histopathological examination was done

Results: there was a statistical significant difference between the uterine septum and uterine wall regarding amount of fibrous tissue, number of cells in the connective tissue, amount of muscle tissue, amount of capillaries and number of vessels with muscle wall [P < 0.05]. Poor retraction of the septal tissue was found in the muscular septum in contrast to good retraction that found in the fibrous septum

Conclusion: poor retraction of the septal tissue was found in the muscular septum in contrast to good retraction that found in fibrous septum

Role of folic acid deficiency as a possible risk factor for erectile dysfunction

Background: erectile dysfunction [ED] is the persistent inability to attain or maintain an erection. ED affects millions of men worldwide. The pathophysiology of ED includes vasculogenic, neurogenic, hormonal, anatomical, drug-induced and psychogenic causes. Endothelial dysfunction [EDys] is an important pathophysiologic factor underlying vasculogenic erectile dysfunction. The pathogenesis of both EDys and ED are linked through decreased expression and activation of endothelial nitric oxide synthase [NOS] which is responsible for formation of Nitric Oxide [NO]. NO is a relaxing factor which plays a major role in activation and maintenance of the erection process

Aim of the work: this study aimed to detect the possible relationship between serum folic acid and erectile dysfunction by measuring serum FA concentration in patients with erectile dysfunction and comparing them with the healthy controls

Methodology: our study has been carried out on 90 individuals who were categorized into two groups. Group 1: 60 married males complained of ED. Group 2: 30 married potent males as a control.All participants were subjected to : personal history, past history of medical diseases and operations, sexual history, general examination, genital examination and evaluation of erectile function according to the International Index of Erectile Function [IIEF-5] Questionnaire]. Fasting serum samples were collected from all participants and assayed for serum total testosterone, serum prolactin, serum cholesterol, serum triglycerides [TG], HbA1c and serum folic acid

Results: results of the current study showed a significant relation between folic acid and ED. FA level was declined as ED severity increased. It is thought that ED severity was related to HHcy which was related to the severity of FA deficiency

Conclusion: a significant association between serum FA level and ED severity was detected in the current study. Serum FA level decreased as the severity of ED increased. These results suggest that FA deficiency might reflect the severity of ED

Recommendations: serum folic acid assessment as a part of the routine investigations for patients complaining with erectile dysfunction. Additional experimental and clinical studies are needed to determine whether FA supplementation may be beneficial for patients having ED

Comparative study between laparoscopic assisted versus open left sided hemicolectomy and sigmoidectomy for cancer colon

Background: Traditionally, open procedure through exploratory incisions remains the gold standard approach for treating colorectal [CRC]. Laparoscopic colectomy was proved to be a better alternative to the open approach. Though in some studies, it was found that the length of the operation tends to be somehow longer. However, in experienced hands it has comparable oncologic outcomes. Moreover, the laparoscopic approach is associated with less postoperative pain, faster return of bowel activity, earlier resumption of oral intake and lesser hospital stay

Aim of the Study: to study and evaluate the effectiveness of laparoscopic left hemicolectomy and sigmoidectomy compared to the open left sided colectomy and sigmoidectomy for malignancy regarding operative time, length of hospital stay, return of bowel function, resumption of oral intake, postoperative pain perception, general postoperative complications, surgical site infections and early recurrence

Patients and methods: This comparative study has been conducted in El-Demerdash hospital, Ain Shams University - Cairo, Egypt and has included 60 patients where half of the patients underwent open left hemicolectomy or sigmoidectomy and the other half underwent laparoscopic left hemicolectomy or simoidectomy. We performed both procedures during the period between 1[st] of January 2016 and 1[st] of January 2017 with 12 months of follow up post-operatively

Results: In our study, the laparoscopic operation was associated with less hospital stay, earlier return of bowel activity, earlier resumption of oral intake without the use of the regular anti-emetics with better pain control and perception postoperatively. Moreover, it was associated with less surgical site infections and general complications including the respiratory ones than the open operation. We had similar anastomotic leak rates and early recurrence rate between both operations. Finally, the laparoscopic operation was associated with more operative time compared to the open operation

Conclusion: Laparoscopic left hemicolectomy and sigmoidectomy are oncologically sound when compared to the open left hemicolectomy and sigmoidectomy for treating left sided and sigmoid cancers. Moreover the laparoscopic approach yielded better outcomes regarding the postoperative recovery compared to the open approach

Recommendation: A further high volume study is needed to assess the long term effects of both procedures in our hospital

value of using platelet rich plasma after hysteroscopic analysis of severe intrauterine adhesions [a randomized controlled trial]

Background: Office hysteroscopic examination is now an established step in the diagnostic work up of cases with abnormal uterine bleeding, infertility, and recurrent miscarriage that can be performed safely and efficiently without anesthesia in most cases

Objectives: This study aimed at assessment of the efficacy of the use of platelet rich plasma [PRP] in decreasing occurrence and recurrence of intrauterine adhesions after operative hysteroscopy

Patient and Methods: This study was conducted in Ain Shams Maternity Hospital [Early Cancer Detection and Endoscopy Unit] during the period between January 2017 and February 2018. 60 patients seeking for conception with a history of primary or secondary infertility with sever intrauterine adhesions. 30 patients [case] injected with PRP and 30 patients [control] with IU balloon. All patients had normal complete blood count, and not taking anticoagulant or NSAID in the 10 days before procedure with no active cervical or uterine infection

Results: It was found that the mean age in PRP group was 31.8 +/- 4 years old and balloon group was 30.5 +/- 4.7 range: [20-45 years old]. The mean of BMI in PRP group was 24.4 +/- 2.2 and balloon group was 25.1 +/- 2.4. In this PRP group [13.3%] of patients were nulliparous and balloon group [10%], [86%] of PRP group are multipara and in balloon group [90%]. There was no significant association between ages, parity with any possible etiology. Our study showed significant increase of menses duration among the PRP group post-operative [3.0 +/- 1.2] days and preoperative menses duration [1.4 +/- 1.5] days. Compared to balloon post-operative [1.8 +/- 1.3] and preoperative [1.3 +/- 1.4] days

Conclusion: platelet rich plasma had high efficacy and safety in improvement of menses duration, amount and adhesion score in cases of sever intrauterine adhesions and decreasing postoperative adhesions

Phytochemical, pharmacological studies of extract of Syrian Cichorium intybus plant and its effect on blood picture in broilers

This study was carried on the Cichorium intybus Plant grown in Syria. We had investigated the active principles of this plant throughout some chemical tests. This plant was found to contains: Carbohydrates, glycosides, saponin, tannic acids, resins, and Lymphocytes and Monocytes were significantly higher [p<0.01], and decreased percentage of Hertophils. Alkaloides. It was also acidic in reaction. This study was planned to investigate: Toxicological studies of the methanolic extract of Cichorium intybus plant on white mice no deaths and would not determine the LD50 up to 1000 mg/kg. Experiment broiler chickens were divided into two groups, methanolic extract of Cichorium Intybus was given in concentration 10% to the first group in average 2 ml/liter of drinking water daily for 42 days, while the second group was kept as a normal group [control]. The obtained results showed that the addition of methanolic extract of Cichorium Intybus plant leads to increase in RBC, WBC, Hb, PCV and the percentage of

Intervention of infection control practices in some Egyptian community based [non governmental] health facilities

Health care - associated infection remain a major issue of patient safety. Parameters for successful infection control program include implementation of interventions to decrease infection rates spread. to improve knowledge and practices of the selected physicians and nurses towards standard infection control practices, to improve the performance of infection control teams inside the selected health facilities and to minimize the incidence rate of cannula site infection and surgical site infection after the intervention inside the selected health facilities an intervention study was conducted in some selected community based health facilities. These are linked to Community Development Associations [CDAs] in three governorates and they are already there. Selected physicians and nurses were subjected to training course on standard infection control practices, monitoring of infection control practices inside the selected health facilities was done before and three months after the intervention and surveillance of cannula site infection and surgical site infection was done before and three months after the intervention. accepted knowledge of physicians towards; use of no touch technique, use of antibiotics, storage of medical waste, boiling as a type of high level disinfection, flame as a method for disinfection and hand washing as an important factor for disinfection in dental clinics were 65%, 42.5%, 67.5%, 65%, 77.5% and 77.5% respectively before the intervention. These proportions increased to 100% after the intervention. Regarding nurses; only accepted knowledge about hand washing as an important factor for disinfection in dental clinics had increased from 72.5% to 100% after the intervention. It was observed that the proportion of availability of disinfectants and personal protective devices was forming a range from 10.8% to 87.5% before the intervention. This increased to range from 30% to 92.5% after the intervention. Practices used for I.V. injections were performed before the intervention in accepted way in range 22.5%: 70.0%. This increased to range 52.5%:91.7% after the intervention. Processes used for sterilization of instruments were performed in an accepted way before the intervention in a range 20%:45%. This increased after the intervention to range 35%: 100%. Processes of waste disposal were performed in an accepted way before the intervention in range 25%:40%. This increased after the intervention to range 55%: 100%. Incidence rate of cannula site infection and surgical site infection were 64.7% and 75% respectively before the intervention. These proportions decreased after the intervention to 23.5% and 25% respectively. The duties of the infection control teams were performed in a range 15%:45% after the intervention. knowledge and practices of the physicians and nurses towards the standard infection control practices had improved after the intervention. regular monitoring of infection control practices and application of the needed intervention inside the community based health facilities

Performance of helicobacter pylori, [HP] stool test in comparison to urea breath test and invasive tests in patients undergoing endoscopy

One hundred dyspeptic patients [52 females and 48 males with mean age 52 years, range 15-69] undergoing gasteroscopy and tested for Helicobacter pylori using non invasive method which detect Helicobacter antigen in stool samples by an immunoenzymatic assay and urea breath test were included in this study. The results of HPSA were compared to urea breath test and invasive tests to detect sensitivity, specificity, positive and negative predictive values of HP stool test. During endoscopic examination, biopsies from antrum and body of stomach were taken for culture, histology and rapid urease; patients were subjected to urea breath test and stool samples were also collected from patients for helicobacter stool antigen enzyme linked immunoassay [Premier platinum HPSA, Meridian Diagnostic]. The results revealed that 56 patients were considered as Helicobacter pylori positive and 44 as Helicobacter pylori negative according to invasive tests and urea breath test. Moreover, 52/56 patients were positive in stool tests whereas 4 were false negative and 36/44 were true negative in stool test whereas 8 were false positive. H. pylori patients as regard 13C-urea breath test and invasive test were treated with omeprazole 20 mg twice daily, clarithromycin 250mg twice daily and metronidazole 400mg twice daily for seven days; at least 4 weeks after the end of treatment, patients were retested with invasive test, breath test and antigen detection. Based on these results, HP stool test has a sensitivity of 93.5%, a specificity of 93.7%, positive predictive value of 98% and negative predictive value of 96.5%

Radiological intervention management of complicated biliary problems

In this study, percutaneous treatment for biliary obstruction was done to 33 patients. An external drainage was performed for 17 patients, an internal external drainage was done for eight patients and internal drainage by endoprostheses was done for eight patients. The biliary tree was successfully catheterized in all the cases. Failure of bypassing the obstructive lesion occurred in seven patients. No major complications occurred and the minor complications were properly managed as fever and there was no mortality

Glucose tolerance in patients with chronic liver diseases of variable etiologies

In this work, the disturbance of carbohydrate metabolism as reflected by changes in the glucose tolerance test was studied in 30 patients [22 males and 8 females] with a mean age of 39.4 +/- 9.1 years [from 18 to 54 years], with liver cirrhosis of variable aetiologies. The patients were classified into 3 groups according to the aetiology of hepatic cirrhosis. Group 1 with viral cirrhosis group II with pure bilharzial periportal fibrosis and group Ill included patients with mixed viral and bilharzial cirrhosis. The patients in each group were further subdivided according to the presence or absence of oesophageal varices into two subgroups a and b respectively. The fasting blood glucose levels in the 3 groups of patients either with or without varices showed no significant differences [compared to each others and to controls]. The percentages of the impaired glucose tolerance were 50%, 20% and 60% in group I; II and III respectively and the overall incidence in the 3 groups was 43.33%. None of the cirrhotic patients without oesophageal varices had impaired glucose tolerance test insptie of the altered liver function tests in them, while, in those with oesophageal varices the percentage of the glucose intolerance was as high as 68.42%. Similarly, comparison between patients with viral cirrhosis and those with pure bilharzial periportal fibrosis showed no significant difference in any of the readings of the glucose tolerance test although most of liver function tests were much more altered in the first group than in the second one. Our study demonstrates that, the type of cirrhosis or its cause, do not seem to alter the blood glucose level which is affected mainly by th presence or absence of portal systemic shunting