Bee-honey and yogurt: a novel mixture for treating patients with vulvovaginal candidiasis during pregnancy.

OBJECTIVE: To evaluate the clinical and mycological cure rates of a novel mixture consisting of Bee-honey and yogurt compared to local antifungal agents for treating patients with vulvo-vaginal candidiasis (VVC) during pregnancy. MATERIALS AND METHODS: This is a prospective comparative study which included 129 patients with VVC during pregnancy. The participants were allocated into study group (n = 82) who received a mixture of Bee-honey and yogurt vaginally and control group (n = 47) who received local anti-fungal agents. The Chi-square test was used to evaluate the clinical and mycological cure rates and the side-effects of both modes of therapy. RESULTS: The clinical cure rate was significantly higher in the study than the control group (87.8 vs. 72.3%, respectively) while the mycological cure rate was higher in the control than the study group (91.5 vs. 76.9%, respectively). Both types of therapy were favorably tolerated by most of the patients. Side effects were reported only in 24.3 and 29.7% of patients in group I and II, respectively (p < 0.05). CONCLUSIONS: The mixture of Bee-honey and yogurt produced a high clinical cure rate and a reasonable mycological cure rate. It can be used as a complementary or an alternative to antifungal agents especially in patients with VVC during pregnancy.

Complications among adolescents using copper intrauterine contraceptive devices.

OBJECTIVE: To evaluate the rate and pattern of complications associated with use of the Copper T 380A intrauterine device (IUD) among adolescents. METHODS: A prospective comparative study of women eligible for IUD insertion who attended the family planning clinic of Sohag University Hospital, Egypt, between July 1, 2008 and December 31, 2010. The participants were categorized as adolescents or adults. The Copper T 380A IUD was inserted in all participants and follow-up visits were scheduled at 1, 3, and 6 months. Odds ratio and χ(2) square tests were used to compare the rates of complications at each visit. RESULTS: Of 1512 patients eligible for IUD insertion, 852 met the inclusion criteria: 281 adolescents and 571 adults. The rates of pain, bleeding, displacement, expulsion, and removal of IUDs were significantly higher in adolescents (P<0.05). The rates of these complications were high in adolescents younger than 16 years; the rates then decreased with age and became comparable with the adult rates at 18 years of age. CONCLUSIONS: IUD-associated complications were high in adolescents up to the age of 17 years. Our data suggest that adolescents younger than 18 years of age should be counseled carefully before IUD insertion, and examined more frequently to detect displacement or expulsion of the device.

Hydatid of Morgagni: a possible underestimated cause of unexplained infertility.

OBJECTIVE: To evaluate the possible role of hydatid of Morgagni in patients with unexplained infertility. STUDY DESIGN: This was a non-randomized controlled trial conducted at the Department of Obstetrics and Gynecology of Sohag University, Egypt. Two hundred and thirteen patients with unexplained infertility and hydatid of Morgagni diagnosed at laparoscopy were included. The laterality (bilateral vs unilateral), location (fimbrial vs juxta-fimbrial), number (single vs multiple) and diameter of the hydatids of Morgagni were recorded. Patients were allocated to a study group (n=127) who underwent laparoscopic excision of hydatid of Morgagni and a control group (n=86) who underwent no intervention. Patients were followed for six months without any infertility or hormonal treatment to detect spontaneous pregnancy. Patients missed during the follow-up or who received infertility treatment were excluded. Statistical analysis was done using Chi-square test and Student's t-test. To find the most important character of hydatid of Morgagni which impedes pregnancy, logistic regression analysis of the dependent variable (no pregnancy) and independent variables (different characters of hydatid of Morgagni) was carried out in the control group. RESULTS: Hydatid of Morgagni was detected in 52.1% of patients with unexplained infertility compared to 25.6% of those with explained infertility (p<0.001). The pregnancy rate was higher in the study group than the control group (58.7% vs 20.6%, p<0.001). The pregnancy rate was significantly higher in the study group than the control group if the hydatid cyst was bilateral (85.7% vs 5.3%, p<0.001), fimbrial (85.6% and 9.1%, p<0.001), single (57.6% and 30.3%, p<0.001) or 1-2 cm in diameter (58.1% and 25.5%, p<0.001). Logistic analysis showed that the bilaterality and fimbrial location of the hydatid of Morgagni were the most significant characteristics impeding pregnancy (odds ratio=7.27 and 3.67 respectively). CONCLUSIONS: Hydatid of Morgagni is a possible underestimated cause of unexplained infertility. Laparoscopic removal of hydatid of Morgagni in patients with unexplained infertility was followed with a high spontaneous pregnancy rate. This is particularly obvious with bilateral and fimbrial hydatid of Morgagni.

Adolescent pregnancy in Upper Egypt.

OBJECTIVE: To determine the reasons for adolescent pregnancy in Upper Egypt and to evaluate maternal, fetal, and neonatal outcomes. METHODS: All primigravidae under 30 years of age who attended the labor/delivery ward at Sohag University Hospital, Sohag, Egypt, between December 31, 2005, and December 31, 2009, were invited to participate. Participants were allocated to the study group (up to 19 years of age at first pregnancy) or the control group (20-30 years of age at first pregnancy). Maternal, obstetric, fetal, and neonatal complications were compared between the groups, and adolescent participants completed a questionnaire to identify the reasons for pregnancy. RESULTS: In total, 58.2% had married seeking motherhood. Rates of ectopic pregnancy, pre-eclampsia, eclampsia, premature rupture of membranes, preterm labor, and cesarean were significantly higher among adolescents younger than 15 years of age; the risk then decreased steadily with age and became comparable to the control group after 16 years of age. CONCLUSION: Adolescent pregnancy increases the risk of ectopic pregnancy, pre-eclampsia, eclampsia, premature rupture of membranes, preterm labor, and cesarean among mothers up to 16 years of age. After 16 years of age, pregnancy is not associated with increased risk of obstetric or neonatal complications.

Vaginal length and incidence of dyspareunia after total abdominal versus vaginal hysterectomy.

OBJECTIVE: To evaluate the vaginal length and incidence of dyspareunia after total abdominal hysterectomy compared to vaginal hysterectomy. STUDY DESIGN: This is a prospective observational study. Sixty-six patients were invited to participate in the study who were already planned to undergo abdominal or vaginal hysterectomy for different benign indications in the OB/GYN department, Sohag University Hospital, during the period from March 2007 till April 2009. Patients were classified into two groups. Thirty-six patients who were planned to undergo total abdominal hysterectomy (TAH) represented the first group, and 30 patients who were planned to undergo vaginal hysterectomy (VH) represented the second group. Vaginal length was obtained just before the operation and three times postoperatively. Pre- and post-operative dyspareunia was reported. RESULTS: The mean pre-operative and post-operative vaginal lengths in the TAH group were nearly the same (10.5+/-2.1cm vs. 10.2+/-1.8 cm) without statistically significant difference. In the VH group, there was a statistically significant difference between pre- and post-operative vaginal length (10.1+/-1.9 cm vs. 8.4+/-1.6 cm). In the TAH group, 2 patients (5%) reported a newly developed post-operative dyspareunia. In VH group, 6 patients (20%) developed dyspareunia after surgery. CONCLUSION: Postoperative dyspareunia is more common after vaginal hysterectomy compared to abdominal hysterectomy. This may be attributed to postoperative shortening of the vagina secondary to excessive trimming of the vaginal walls especially if VH was done for utero-vaginal prolapse.

Serological markers as indicators for congenital cytomegalovirus infection.

To assess the problem of CMV infection in pregnant women in Sohag community and to determine the risk of congenital CMV infection. The study was performed on 900 pregnant women residing in Sohag, during the period from June, 2006 till January 2010. Detection of CMV antibodies (IgM and IgG) was carried out using microparticle enzyme immunoassay. Women proved positive (+ve) for CMV IgM or IgG antibodies were considered the seropositive group (group 1), while women proved negative (-ve) for both antibodies were the seronegative group (group II). Serum samples of IgM +ve females and with rising IgG titers were further subjected to PCR to detect CMV DNA. Of the 900 pregnant women, 850 (94.4%) were seropositive for CMV antibodies. Of these, 828 females (97.4%) had +ve IgG and -ve IgM antibodies, and 22 (2.6%) women had positive IgM. Viral DNA was detected in 12 of the 22 IgM +ve and 8 out of 10 women with rising IgG titer. CMV antibodies and serum PCR were done for 15 live births whose mothers had positive CMV PCR. Of 7 infants whose mothers had CMV IgM and CMV PCR positive, 4 infants had positive PCR results. Eight live births, whose mothers had rising IgG titer and positive PCR test, were negative for viral DNA. In conclusions, CMV specific IgM or rising IgG antibodies in maternal serum could predict congenital CMV infection.

Comparison of cervical detachment using monopolar lap loop ligature and conventional methods in laparoscopic supracervical hysterectomy.

OBJECTIVES: Our aim was to evaluate a new electrosurgical instrument (Lap Loop device) that amputates the uterine corpus from the cervix during a laparoscopic supracervical hysterectomy (LSH) and to compare the time required for cervical amputation with traditional methods. METHODS: This comparative trial was conducted at the University of Louisville and Norton Healthcare Hospitals, Louisville, KY. The patients comprised 29 women scheduled for hysterectomy for benign conditions. All patients underwent laparoscopic supracervical hysterectomy. The Lap Loop device was used in 17 patients to section the cervix. Conventional methods with either laparoscopic monopolar scissors or Harmonic scalpel were used in 12 patients. RESULTS: In the control group, the mean cervical cutting time with laparoscopic scissors or Harmonic scalpel was 14.4 minutes. The mean time for the application of the loop electrode and cutting time was 6.6 minutes and was significantly shorter than the cutting time of conventional methods. Two minor complications (7.4% of cases) and one relatively major complication (3.7%), an incisional hernia, occurred in the study patients. None of the complications were related to the new device. CONCLUSION: An electrosurgical loop decreased the time required for resection of the uterine cervix during LSH for benign uterine conditions. This device facilitates and increases the safety of this procedure.

Observational comparison of abdominal, vaginal and laparoscopic hysterectomy as performed at a university teaching hospital.

OBJECTIVE: To compare short-term outcomes of total abdominal hysterectomy (TAH) to total vaginal hysterectomy (TVH) and laparoscopic hysterectomy (LH) regarding operative time, estimated blood loss, postoperative pain, recovery milestones, complication rates, hospital stay, hospital costs and patient satisfaction. STUDY DESIGN: A prospective, observational study examined the above criteria for 177 women with the following distribution of hysterectomy type: TAH (n = 50, 28%), TVH (n = 76, 43%) and LH (n = 51, 29%). RESULTS: Operative time was shortest for TVH (103 minutes), followed by TAH (127 minutes), and longest for LH (157 minutes) (p = 0.000). Blood loss was significantly higher in the TAH groups as compared to the TVH and LH groups. Pain estimates and analgesia requirements were significantly lower for the LH and TVH groups as compared to the TAH group. Recovery milestones were met significantly earlier in the TVH and LH groups. Complication rates did not differ significantly between the groups. Hospital stay was significantly longer for the TAH group (3.7 days) than for the TVH (1.9 days) and LH (1.5 days) groups. Hospital costs were significantly lower for the TVH groups as compared to TAH and LH groups. No significant cost difference was seen between TAH and LH. Satisfaction rates did not differ significantly between the groups though a greater percentage of patients in the LH group reported high satisfaction as compared to the other groups. CONCLUSION: Vaginal hysterectomy remains the most cost-effective approach; laparoscopy's role may be best suited to allowing conversion of laparotomy cases to a vaginal approach with assistance of a laparoscope.