Low versus standard dose intravenous alteplase in the treatment of acute ischemic stroke in Egyptian patients.

OBJECTIVES: To assess low dose altepase outcome and safety in comparison with a standard-dose regimen for acute ischemic stroke treatment in Egyptian patients. MATERIALS: An observational prospective cohort non-randomized single blinded study was carried out during the period from November 2017 to December 2018. Eighty Egyptian acute ischemic stroke patients, all eligible for intravenous alteplase, were subdivided into 2 groups (40 patients in each group). Patients were thrombolysed at a dose of 0.6 mg/kg in the first group and 0.9 mg/kg in the second group. Both groups were compared in regard to safety and outcome. Safety was expressed by the rate of symptomatic intracranial hemorrhage (SICH) and 3 months mortality, while outcome was expressed by favorable outcomes at three months (modified Rankin Scale [mRS] of 0 to 2). RESULTS: In the first group, 69.2% (n=27) achieved favorable outcomes at 90 days compared with 64.1% (n=25) in the second group (p=0.631). Ninety-day mortality was 5% (n=2) in the first group versus 2.5% (n=1) in the second group (p=0.556). Symptomatic intracranial hemorrhage was noted in 3 patients in the second group and zero patients in the first group (p=0.077). CONCLUSION: Low-dose alteplase could be a practical alternative for Egyptian populations with acute ischemic stroke especially in 3 to 4.5 hours window.

Blood loss from transverse versus longitudinal uterine incision in abdominal myomectomy: a randomized controlled trial.

BACKGROUND: It is unclear whether transverse uterine incision is non-inferior to longitudinal incision during myomectomy with regard to bleeding. Our aim was to compare between transverse and longitudinal uterine incisions in myomectomy. METHODS: A parallel randomized controlled single-blinded study in a university affiliated hospital, in the period between January 2017 and April 2018, in which 52 women candidates for abdominal myomectomy were randomized into transverse uterine incision or longitudinal uterine incision groups (26 in each group). Intraoperative blood loss (estimated directly by blood volume in suction bottle and linen towels and indirectly by difference between preoperative and postoperative hematocrit), operative time and postoperative fever were analyzed. RESULTS: No statistically significant difference was found between transverse and longitudinal incisions regarding intraoperative blood loss (389.7 ± 98.56 ml vs 485.04 ± 230.6 ml respectively, p value = 0.07), operative time (59.96 ± 16.78 min vs 66.58 ± 17.33 min respectively, p value = 0.18), and postoperative fever (4% vs 8.33%, p value = 0.6). CONCLUSION: Transverse uterine incision does not cause more blood loss than longitudinal incision and is a reasonable option during abdominal myomectomy. TRIAL REGISTRATION: NCT03009812 at clinicaltrials.gov, registered January 2017.

Management of endometrial polyps in subfertile women: a systematic review.

The aim of this systematic review is to evaluate the evidence for the impact of polypectomy on fecundity, implantation and live birth rates in women who are trying to conceive spontaneously or by assisted conception. A literature search was performed to identify all controlled studies that compared the effects of polypectomy or conservative management of the polyp on pregnancy outcome. Among the three studies that met the inclusion criteria, only one was a randomized controlled trial, which reported a significantly higher pregnancy rates after polypectomy in women undergoing intrauterine insemination. The other two studies were retrospective and suggested no beneficial effects of polypectomy on women undergoing assisted conception. Meta-analytic pool was not feasible as the studies varied in their design and the characteristics. While there is some evidence from basic science studies to suggest a detrimental effect of polyps on fertility, the evidence from clinical studies is scarce and conflicting. Polyps diagnosed prior to commencement of controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) should therefore be removed. The management of polyps seen during the course of COH for IVF should be individualized given the number of embryos created, the previous reproductive history of the patient and the individual clinics' success rates for their frozen embryo programme.