Outcome of complete primary bladder exstrophy repair: single-center experience.

OBJECTIVE: Reconstruction of bladder exstrophy remains a challenge. We evaluated our experience with complete primary repair in classic bladder exstrophy. METHODS: A retrospective data review was conducted of bladder exstrophy patients presenting at our institution between May 2000 and September 2007. Fifty-one patients (21 females and 30 males) with classic bladder exstrophy were included. Age of presentation ranged from 24h to 14 months. Mean follow up was 3 years (1 month-7 years). Patients were evaluated for continence, upper tract dilatation and cosmetic result. RESULTS: Eight patients (15.6%) had failed closures and six (11.7%) had fistulae. Evaluation of continence excluded 16 patients not followed up at our center. Thirty-seven percent were continent on clean intermittent catheterization after the age of 5 years. Patients became dry only after augmentation cystoplasty. Upper tract changes were mild during our study with all patients having normal serum creatinine. CONCLUSION: Patients may require more than one procedure for reconstruction. In our series, augmentation was required to achieve acceptable dryness. Early promising results with dry intervals in young patients did not translate to continence in older patients.

Socioenvironmental predictors of abortion and stillbirths in an industrial community in Egypt.

Air pollution is considered to be one of the overgrowing problems of cosmopolitan distribution, due to marked progress in industrialization. The applied epidemiological and environmental studies related to reproductive health in the community, are considered as the main principles for comprehensive health development in industrial cities. The present study focused on the role of air pollution on the occurrence of abortion and stillbirths among married fertile women during the childbearing age (15-50 years) in two industrial areas, namely Helwan in Cairo Governorate and Tenth of Ramadan City in Sharqyia Governorate. A cross-sectional epidemiological study based on community background was implemented in the two studied areas. The unit of observation was the family including married fertile women based on specific inclusion criteria. Cluster sampling procedure was used in which the unit of sampling was the household, selected within a radius of not less than five Kilometers around the factories. Using Epi-info program, the total sample size in the two studied areas was 1934 women. The interview questionnaire was the tool adopted for data collection, which includes gynecological and obstetric data related to reproductive health. The socio-economic status of studied women was determined using scoring system that includes the education and occupation of both couples. The environmental study was carried-out in the two areas in order to assess the levels of air pollutants and their chemical nature. Data management using Logistic regression analysis was done to determine the effect of independent variables, such as socioeconomic factor, exposure to air pollutants on the occurrence of abortion and stillbirths as examples of reproductive health problems. The mean age of the studied women was 33.8+/-8.8 years in Helwan and 28.1+/-6.5 years in Tenth of Ramadan. Also the study showed significant differences in both the socioeconomic status, smoking inside houses and parity between the studied women in Helwan and Tenth of Ramadan City. The overall prevalence of abortion and stillbirths among women in the studied areas were 29.2% and 4.5%, respectively. However, the prevalence of such reproductive health hazards among women in Helwan was significantly higher than in Tenth of Ramadan City. Also the results of environmental study indicated that Helwan has higher mean values of total dust count, suspended and respirable dust concentrations as well as lead concentration in the ambient air than in Tenth of Ramadan City. The Logistic regression analysis showed that the respirable dust concentration in the air and smoking inside houses are the significant independent factors for the occurrence of abortion. Moreover, Lead concentration in the air and women education is the main predictors of both abortion and stillbirths. Accordingly, the Egyptian authorities should attempt to improve air quality in urban industrial communities to promote reproductive health and prevent woman' s health hazards.

Materno-foetal transmission of hepatitis B infection.

A cross-sectional study was carried out on 352 pregnant women, chosen randomly from those admitted to the labour ward of Ain Shams University Hospitals, Abbassia, Cairo, Egypt. This study was conducted to determine the prevalence of HBsAg among pregnant women and estimate the materno-foetal transmission. The prevalence of HBsAg among studied women was 15.3%, however, 7.1% showed inconclusive positive results. The materno-foetal transmission was documented in 51.8% of positive HBSAg women. Hepatitis B infection among studied women was usually acquired after 20 years of age. Logistic regression model with stepwise forward selection, demonstrated that maternal age, past history of blood transfusion and abortions were contributing factors for +ve HBsAg maternal status, while parity and past history of abortions were contributing factors in materno-foetal transmission.