Contribution of vaginal infection to preterm premature rupture of membrane and adverse pregnancy outcome

Background:Pretermpremature rupture of membranes (PPROM) is the cause of approximately one third of preterm deliveries. Objectives: assess the relation of vaginal infections and their antimicrobial profile with PPROM and pregnancy outcome. Methodology: Case control study of 320 females with PPROM (case) and 320 females with normal pregnancy (control) at 28- 37 weeks of gestation. Vaginal examination, vaginal pH assessment and Whiff test were done. Vaginal swabs were collected and examined microscopically for diagnosis of different vaginal infections. Swabs were cultivated, identification and antimicrobial susceptibility of revealed bacteria were done. Maternal and neonatal outcomes were assessed. Results: Bacterial vaginosis and aerobic vaginitis were identified in 29.1% and 17.3% of all participants respectively. There was statistically significant difference regarding prevalence of different vaginal infections in case and control groups (p < /em><0.001). Aerobic vaginitis and bacterial vaginosis were risk factors for PPROM. Streptococcus agalactiae was the most prevalent organism. Erythromycin and ampicillin were the least effective antibiotics against Gram positive and Gram-negative isolates respectively. There was significant increase of all maternal and fetal adverse outcomes in cases with aerobic vaginitis. Conclusion: Different vaginal infections carry risk of PPROM and adverse maternal and neonatal outcomes. The variation in prevalence of bacterial isolates in different studies and localities notify the lack of standardized treatment for infected mothers. Accurate diagnosis of vaginal infection, precise medical treatment during pregnancy is essential for maintenance of maternal and neonatal health

Effect of maternal dexamethasone administration on daily fetal movement count and its correlation with Doppler studies and cardiotocography

Background: Decreased fetal movements is a frequent reason for unplanned consultations through the third trimester ranging between 4% and 16% in various populations it is often a sign of fetal compromise and associated with severe outcomes such as fetal growth restriction, preterm birth and fetal death therefore it is important to question the effect of maternal dexamethasone administration for fetal well-being and its relation on decreased fetal movement which is detected by Doppler studies and cardiotocography. Methods: The current study was performed on 220 pregnant women with gestational age between 28-34 weeks who received antenatal dexamethasone at Ain Shams university hospitals.Results: Regarding fetal movements, there was significant decrease in fetal movement at the 24th hour (Day 2) after 1st and 2nd doses of dexamethasone then re-increased at 48th hour and 72nd hour but still significantly lower than baseline.Conclusions: Administration of dexamethasone had no harmful effects on the fetuses or the mothers, except for a transient decrease of fetal movements in only after 24 hours of the first dose.

COVID-19 associated mucormycosis and diabetes mellitus: An exploratory study

Background:Mucormycosis has abruptly increased in Egypt during the third wave of COVID-19 especially in patients with diabetes mellitus (DM). The aim of this study was to investigate the risk factors, clinical presentation and outcome of mucormycosis in COVID-19 patients with diabetes. Methods: Prospective cohort study was conducted on 72 COVID-19 patients with DM presented with mucormycosis at intensive care units and Ear, Nose, and Throat Department of Zagazig University Hospitals over a period of three months from May 2021 to August 2021. All participants were submitted to history taking, examination, laboratory investigation, radiological and histopathology and culture testing. Results: Post COVID-19 new-onset diabetes mellitus (NOD) was detected in 40% of studied patients. 72.2% of patients had poorly controlled diabetes. Majority of studied patients presented by rhino-orbital mucormycosis (90.3%) and about 86% of them were operated. Hundred percent of patients gave history of antibiotic use and also nearly 99.0% of them received corticosteroids, while only 1.4% of them received tocilizumab. There was statistically significant association between operated patients, hemoglobin (HB) level, lymphocyte count, neutrophil-lymphocyte ratio (NLR), and CRP level with disease prognosis. Conclusions: Poorly controlled DM and steroid use are the most important risk for post COVID-19 mucormycosis. Early surgical intervention carried better disease outcome

The association between helicobacter pylori infection and hyperemesis gravidarum

Background: Hyperemesis gravidarum (HG), a disorder characterized by ongoing severe nausea and vomiting with resulting ketosis, affects 0.3–2% of women during pregnancy. Helicobacter pylori (H. pylori) infection is one of the most common and endemic human infections worldwide, causing a number of very common and important gastrointestinal problems.Objective: We aimed to find the association between H. pylori infection and hyperemesis gravidarum.Patients and Methods: This prospective case control study was conducted at Manshiet El-Bakry General Hospital from October 2020 till June 2021 and performed on 32 patients who had a clinical diagnosis of hyperemesis gravidarum in the first trimester and 32 normal pregnant women who served as control groupResults: Our results revealed that Helicobacter pylori stool antigen was significantly more frequent in hyperemesis gravidarum group.Conclusion: As evident from the current study, there was a strong association between H. pylori infection and HG, allowing us to conclude that H. pylori should, therefore, be considered as one of the risk factors of HG pointing to H. pylori as one contributing factor of this complication of pregnancy. H. pylori testing should be included in investigations of HG, especially when the condition does not respond to treatment and in cases continuing past the first trimester. Appropriate therapeutic non-teratogenic regimens for eradication of H. pylori could be considered to relieve the symptoms of HG in some intractable cases

Combining COVID-19 and seasonal influenza vaccines together to increase the acceptance of newly developed vaccines in the Eastern Mediterranean Region: a cross-sectional study

AbstractBackground and aim The World Health Organization (WHO) recommended the concomitant administration (co-administration) of inactivated seasonal influenza and coronavirus disease 2019 (COVID-19) vaccines, encouraging the practice for the 2021–2022 flu season. This study aimed to assess the acceptance of simultaneously receiving the seasonal influenza vaccine (SIV) and the COVID-19 vaccine in a single administration to reduce vaccine rejection towards the COVID-19 vaccination.Methods An online-based cross-section survey was conducted from 1 September to 9 November 2022, in the Eastern Mediterranean Region (EMR) through distributing the survey on different social media platforms, including Facebook, Twitter, LinkedIn and WhatsApp. We used the multi-level model to assess the variation of vaccine countries across EMR countries.Results In total, 3300 participants were included in this survey from 11 countries distributed in the EMR. More than one-third (40.7%) were aged 18–25 years, 60.6% were females, 54.0% had a university degree, 43.1% had previous COVID-19, and 41.9% had relatives or friends who died from COVID-19. In total, 43.3% accepted this combination because it is less costly (9%), safer (18%), more effective (17%), and has fewer doses (19%). Rejection of this combination was due to fear of side effects (31%), and no studies have been published on their effects (31%). There was a significant difference across countries, which accounted for 6% of the variance in the log-odds of accepting the combined vaccination. Multi-level analysis revealed that being male, African and losing a family member or friend from COVID-19 increased the acceptance of the theoretical combined vaccines. Additionally, the number of doses taken of the COVID-19 and influenza vaccines separately significantly affected the combined vaccine acceptance. However, previous COVID-19 infection and older age reduced the odds of accepting the combined vaccines. Occupational level, social status and educational level didn’t significantly affect the acceptance odds.Conclusions We can conclude that combining SIV and COVID-19 vaccines in one shot increased the overall acceptance of COVID-19 vaccines among vaccine rejectors

COVID-19 Vaccine Hesitancy among Parents of Children with Chronic Liver Diseases

Children with chronic medical conditions are more susceptible to developing a serious negative outcome from corona virus disease 2019 (COVID-19) than healthy children. This study investigated the extent of COVID-19 vaccine hesitancy (VH) and its predictors in parents of children with chronic liver disease (CLD) in Egypt. Methods: A cross-sectional study was conducted at the National Liver Institute from September to October 2022, using a random sampling method. Data were collected using the validated Arabic version of parents’ attitudes about childhood vaccines (PACV) scale. Structural equation modeling (SEM) and discriminant analysis were used to identify direct and indirect determinants of VH. Results: Of the 173 participating parents, 81.5% hesitated to vaccinate their child. Relevant characteristics for hesitancy included being the mother of the child (88.2%), younger than 40 years (92.9%), illiterate (92%), unemployed (88.8%), without health insurance (87.8%), unvaccinated against COVID-19 (97.2%), refused to complete vaccinations (85.7%), and not having chronic disease (85.7%) (p < 0.05). Previous COVID-19 infection of children motivated vaccination (p < 0.0001). Median total PACV, attitude, and trust scores were significantly higher in the hesitant group than the vaccinated group (p = 0.023). SEM suggests that child age and family size have a direct effect, while education level, and income have indirect effects on parents’ hesitancy. The model showed acceptable goodness of fit (GFI = 0.994, CFI = 1, RMSEA < 0.0001). A 92.9% corrected classification of the discriminator VH variables was determined using the discriminant analysis model (safety and efficacy, attitude and trust, child age, and family size). Conclusions: Many socioeconomic factors significantly affect parents’ attitudes toward their child’s vaccination. Thus, increasing parents’ awareness of the importance of childhood vaccination, especially among this risky group, may enhance their decision-making ability regarding vaccinating their children