Day 1 change in maternal serum ß-HCG levels as an early predictor of successful medical therapy in ectopic pregnancies.

Objective: To evaluate the role of ß-HCG level changes between days 0 and 1 as an early predictor of methotrexate success in cases of tubal ectopic pregnancy.Methods: A retrospective study included 86 tubal ectopic pregnancies treated with a single-dose methotrexate protocol of 50 mg/m2 of body surface. ß-HCG measurements were taken on days 0, 1, 4 and 7 where day 0 is the day of methotrexate injection. Day 0 ß-HCG and the percentage change in ß-HCG level between days 0 and 1 (HCG index) were calculated and compared between patients who were successfully or unsuccessfully treated. Receiver operator characteristics (ROC) curves were plotted to identify the best cutoff levels.Results: The average level of ß-HCG (1416.8 versus 2502.5 IU/L, p=.001) and its increment after 24 hours (12.9 versus 27.1%, p=.001) were significantly lower in the successful treatment group. ROC curves for ß-HCG level and its relative increment revealed that cutoff values of ≤1550 IU/L and ≤13% increment showed a sensitivity of 90 and 70% respectively for successful methotrexate treatment.Conclusion: Day 0 ß-HCG level ≤1550 IU/L and an increment of ≤13% after 24 hours are early predictors of successful methotrexate treatment for tubal ectopic pregnancy.

Prevalence and differences between type 1 and type 2 diabetes mellitus regarding female sexual dysfunction: a cross-sectional Egyptian study.

OBJECTIVE: To evaluate the female sexual dysfunction in both type 1 and type 2 diabetes mellitus (DM). METHODS: This cross-sectional study was carried out at Suez Canal University Hospitals from the start of February 2015 to the end of May 2016 among 189 married premenopausal women attending endocrinology and diabetology outpatient clinic for regular follow-up; 25 of whom refused to participate and 18 more were excluded due to incomplete data sets resulting in a final sample of 146 diabetic females. Ninety healthy women were recruited from the administrative staff at the hospital as a control group. Sexual dysfunction was assessed using female sexual function index (FSFI), a validated 19-item, self-administered, screening questionnaire comprising the six major sexual domains: desire, arousal, lubrication, orgasm, satisfaction and pain. Responses to each question were reported and scored on 0-5 scale with 0 representing no sexual activity and 5 suggestive of normal sexual activity. RESULTS: Prevalence of sexual dysfunction was significantly higher in both type 1 and 2 DM groups (44 and 25%, respectively) than in the control group (9%). FSFI mean total score was significantly lower in type 1 DM (21.1 ± 3.9) than type 2 DM (26.4 ± 4.2) and both were significantly lower than the control group (31.5 ± 5.8). With regard to FSFI domains, mean values for desire, arousal, lubrication, orgasm, satisfaction and pain were significantly lower in both type 1 and type 2 DM groups when compared with the controls. CONCLUSION: FSD is a significant health problem among premenopausal diabetic Egyptian women. Type 1 DM women were more affected than type 2 DM that in turn was more affected than healthy control females.

Psychological impact of female genital mutilation among adolescent Egyptian girls: a cross-sectional study.

OBJECTIVES: Worldwide, at least 200 million women and girls have undergone female genital mutilation (FGM). The medical and sexual consequences have been documented, but the psychological impact has not been studied to the same extent. The aim of this study was to explore the relationship between FGM and psychiatric problems among adolescent girls. METHODS: A total of 204 girls, aged 14-19 years, were included in a cross-sectional study conducted at Suez Canal University Hospitals. All participants completed an Arabic-validated, structured questionnaire covering nine symptom scales. Sociodemographic data were also collected. Main outcome measures were the prevalence of psychiatric problems among adolescent girls who had undergone FGM. RESULTS: Overall, 66.2% of girls had undergone FGM. The percentage in rural areas was 91.8%, compared with 43.0% in urban areas. There were no significant differences between the FGM and non-FGM groups as regards religion, educational and socioeconomic levels. FGM girls had a significantly higher level of psychological problems with regard to somatisation, depression, anxiety, phobic anxiety and hostility compared with non-FGM girls (p < .0001). CONCLUSIONS: FGM is a traumatic experience that may leave a lasting psychological mark and a negative impact on the psychological status of affected girls.

Assessment of sexually related personal distress accompanying premenopausal sexual dysfunction with an Arabic version of the Female Sexual Distress Scale.

OBJECTIVE: To assess sexually related personal distress among premenopausal women with female sexual dysfunction (FSD) via a validated Arabic version of the Female Sexual Distress Scale (FSDS). METHODS: A cross-sectional study was conducted among women attending Suez Canal University Hospital, Egypt, between May 2015 and July 2016. In a pilot study to evaluate test-retest reliability and internal consistency, 42 sexually active premenopausal women (aged ≥20 years) completed the Arabic FSDS at recruitment and 2 weeks later. Subsequently, premenopausal sexually active women (aged 20-45 years) were asked to complete the female sexual function index (FSFI) questionnaire; those with FSD (FSFI score ≤26.55) were invited to return to complete the validated version of the Arabic FSDS. RESULTS: The Arabic FSDS showed good test-retest reliability (Pearson correlation coefficient 0.93-0.98) and internal consistency (Cronbach α 0.83-0.92). Overall, 140 (58.1%) of 241 women who completed the FSFI had sexual dysfunction, of whom 51 (36.4%) had sexually related personal distress. Marriage duration was significantly increased among women with FSD (P<0.001). All FSFI sexual domains except lubrication were negatively correlated with FSDS. CONCLUSION: FSD and sexually related personal distress were highly interrelated and prevalent. An Arabic version of the FSDS was found to be valid and reliable for evaluation of sexually related personal distress.

Chlorhexidine vaginal wipes prior to elective cesarean section: does it reduce infectious morbidity? A randomized trial.

OBJECTIVE: To evaluate the efficacy of preoperative vaginal cleansing using chlorhexidine 0.25% antiseptic wipes on rates of postcesarean section (CS) infectious morbidities (endometritis, febrile morbidity and wound infection). METHODS: This prospective randomized trial was conducted among 218 pregnant women scheduled for term elective CS. Patients were equally divided into two groups by simple randomization. After spinal anesthesia and catheterization under aseptic technique, the study group had preoperative vaginal cleansing using chlorhexidine 0.25% antiseptic wipes for about 1 min, while the control group did not. All cases received the prophylactic antibiotics and the usual abdominal scrub. All participants received the routine postoperative care without other interventions. Adverse postcesarean infectious morbidities such as endometritis, febrile morbidity and wound infection were observed at the time of hospital discharge and weekly for 6 weeks postpartum. RESULTS: Both groups were matched regarding the baseline patients' characteristics (age, gestational age, BMI, operative time and postoperative hospital stay). Overall, post-CS infectious morbidity were significantly reduced from 24.4% in the control group to 8.8% in the intervention group; p value <0.05. Marked reduction was seen in the incidence of endometritis (13.2% in the control group versus 2.9% in the intervention group; p value <0.05). However, fever and wound infection showed no significant difference between both groups. CONCLUSION: Cleansing the birth canal with chlorhexidine 0.25% wipes prior to elective CS appears to be effective in reducing rates of post-CS infectious morbidity mainly endometritis.

Efficacy of Tranexamic Acid on Myomectomy-Associated Blood Loss in Patients With Multiple Myomas: A Randomized Controlled Clinical Trial.

OBJECTIVE: To evaluate the efficacy of tranexamic acid (TA) in decreasing blood loss during and after open myomectomy for patients with 3 or more uterine fibroids. METHODS: This prospective randomized trial was conducted among 132 women subjected to abdominal myomectomy. Patients were equally divided into 2 groups by simple randomization. The study group received perioperative intravenous TA while the control group did not. Intraoperative blood loss was calculated by measuring the volume in the suction apparatus and weighing the surgical swabs in addition to postoperative blood loss collected via a suction drain. Hemoglobin and hematocrit values were determined preoperatively and on the third postoperative day for all cases. Any adverse effects were recorded in both groups. RESULTS: No significant difference was found between the two groups regarding age, body mass index, number, and size of myomas removed. The TA group showed lower amount of blood loss (407 mL) when compared to control group (677 mL; P < .01). Risk estimation has revealed that treatment with TA resulted in decrease in risk of perioperative blood loss by 40%. In the study group, 13 (19.7%) patients required blood transfusion in contrast to 23 (34.8%) patients in the control group (P < .01). Hemoglobin and hematocrit levels were significantly lower in the control group on the third postoperative day (P value = .001) . CONCLUSION: The TA reduces blood loss during and after myomectomy for patients with multiple uterine fibroids.

Prevalence of female sexual dysfunction during pregnancy among Egyptian women.

AIM: The aim of this study was to assess the prevalence of female sexual dysfunction (FSD) during pregnancy in a sample of women from Egypt. MATERIALS AND METHODS: This prospective cohort study was conducted among pregnant women who presented to the Obstetrics Outpatient Clinic - Suez Canal University Hospital for routine antenatal care between February 2012 and February 2013. The 451 women who completed the study attended during their first trimester with a singleton pregnancy and were in a stable relationship with their partners for the last 6 months. Sexual function was assessed using the Female Sexual Function Index (FSFI) questionnaire during the 4 weeks preceding pregnancy and then in each trimester during the antenatal visits. RESULTS: Prevalence of FSD during pregnancy was estimated to be 68.8%. According to the FSFI, scores of all domains and total score were significantly reduced during the whole period of pregnancy (average 22.5 ± 3.7) compared to the pre-conception period (30.5 ± 5.6). However, there was significant increase of all domains and total score during the second trimester (26.6 ± 3.9) in comparison to the first and third trimesters (22.4 ± 4.1 and 18.6 ± 3.8, respectively). Total FSFI score was found to be positively correlated to pre-conception total FSFI score. However, age, parity and duration of marriage were negatively correlated. CONCLUSION: FSD is a prevalent problem during pregnancy among Egyptian women. The magnitude of the problem is highest during the third trimester while the second trimester represents the peak of sexual function during pregnancy.

Timing of urinary catheter removal after uncomplicated total abdominal hysterectomy: a prospective randomized trial.

OBJECTIVE: To assess whether immediate (0h), intermediate (after 6h) or delayed (after 24h) removal of an indwelling urinary catheter after uncomplicated abdominal hysterectomy can affect the rate of re-catheterization due to urinary retention, rate of urinary tract infection, ambulation time and length of hospital stay. STUDY DESIGN: Prospective randomized controlled trial conducted at Suez Canal University Hospital, Egypt. Two hundred and twenty-one women underwent total abdominal hysterectomy for benign gynecological diseases and were randomly allocated into three groups. Women in group A (73 patients) had their urinary catheter removed immediately after surgery. Group B (81 patients) had the catheter removed 6h post-operatively while in group C (67 patients) the catheter was removed after 24h. The main outcome measures were the frequency of urinary retention, urinary tract infections, ambulation time and length of hospital stay. RESULTS: There was a significantly higher number of urinary retention episodes requiring re-catheterization in the immediate removal group compared to the intermediate and delayed removal groups (16.4% versus 2.5% and 0% respectively). Delayed urinary catheter removal was associated with a higher incidence of urinary tract infections (15%), delayed ambulation time (10.3h) and longer hospital stay (5.6 days) compared to the early (1.4%, 4.1h and 3.2 days respectively) and intermediate (3.7%, 6.8h and 3.4 days respectively) removal groups. CONCLUSIONS: Removal of the urinary catheter 6h postoperatively appears to be more advantageous than early or late removal in cases of uncomplicated total abdominal hysterectomy.

Assessment of female sexual function among women with pelvic organ prolapse or urinary incontinence via an Arabic validated short-form sexual questionnaire.

OBJECTIVE: To assess female sexual function among women with pelvic organ prolapse or urinary incontinence via an Arabic, validated, short-form sexual questionnaire (PISQ-12). METHODS: The present study was conducted among women attending Suez Canal University Hospital, Ismailia, Egypt, between September 2009 and August 2011. In the pilot study, 42 women completed the final version of the Arabic PISQ-12 at recruitment and then 2 weeks later, and the data were compared to evaluate reliability and internal consistency. The formal comparative study included 154 premenopausal sexually active women: 80 control women, and 74 women with some degree of pelvic prolapse with or without stress incontinence. All participants had a vaginal examination and completed the questionnaire. The main outcome measures were the mean questionnaire scores within its 3 domains (behavioral, physical, and partner-related). RESULTS: The test-retest reliability and internal consistency of the Arabic PISQ-12 were excellent. Validity was approved by an expert panel. The case group had a significantly lower mean total questionnaire score (31.07 ± 4.2 vs 34.7 ± 6.2; P<0.05) but a higher partner-related score (9.0 ± 2.4 vs 8.4 ± 2.5; P<0.05). CONCLUSION: The Arabic version of PISQ-12 was shown to be an effective and objective method of evaluating sexual function among patients with pelvic organ prolapse.