Preoperative evaluation of patients with ovarian masses using the risk of malignancy index 4 model

Objective: To evaluate the performance of the RMI 4 in discriminating benign from malignant ovarian masses. Study Design: Cross-sectional study. Setting: Assiut Women Health Hospital- Egypt. Materials and methods: This was an observational cross-sectional study involving 91 patients at Women\u27s Health Hospital, Assiut University, Egypt during the period between January, 2016 and January, 2017. Women with ovarian masses planned for surgical management were recruited from the outpatient gynecology clinic of the hospital. Risk of malignancy index (RMI 4) was calculated for all study participants. Biopsies obtained from the ovarian masses after surgical intervention were sent to the pathology lab for histopathological examination. The histopathologic diagnosis of the ovarian masses is considered the gold standard for diagnosis. Results: The mean age of patients in the benign group was 34.83±16.28 years versus 43.43±15.91 in the malignant group. There were 12 postmenopausal patients (15.6%) in the benign group versus 4 postmenopausal patients (28.6%) in the malignant group (p=0.0001). An ultrasound score of 4 was recorded in 85.7% of patients in the malignant group versus only 6.5% in the benign group (p=0.0001). Additionally, tumor size ≥ 7 cm was observed in 85.7% of patients in the malignant group versus 55.8% in the benign group (p=0.0001). The mean value of CA-125 was significantly higher in malignant group than the benign group (142.09±41.50 versus 54.51±32.86 ml, respectively) with p=0.01. RMI 4 had a sensitivity of 75%, specificity of 97.3%, PPV of 85.7%, NPV of 94.8 % and an overall accuracy of 93.4%. Conclusions: RMI 4 is a simple and reliable tool in the primary evaluation of patients with ovarian masses. It can further be used to discriminate benign from malignant ovarian masses with high sensitivity and accuracy

The Effect of use of Vaginal Lactobacillus Rhamnosus for Prevention of Recurrence of Vulvovaginal Candidiasis: A randomized controlled trial

Objectives:The study aims to investigate the role of vaginal administration of Lactobacillus Rhamnosus after vaginal miconazole for prevention of recurrence among women with vulvovaginal candidiasis (VVC).Materials and Methods:A randomized clinical study was done in Women Health Hospital–Assiut University–Egypt. All women presented with symptoms suggestive of VVC to the clinic had been examined and approached for participation. Eligible participants were randomly assigned to one of three groups: Group (A) received lactobacillus containing vaginal capsules daily for one week postmenstrual. Group (B) received vaginal miconazole 400 mg once daily for 3days at bedtime postmenstrual. Group (C) received vaginal miconazole 400 mg once daily for 3 days at bedtime postmenstrual followed by lactobacillus containing vaginal capsules twice daily for one week. The primary outcome was to study the rate of recurrence of symptoms after 1, 3, 6 months of treatment. Results:During the study period, 202 participants with recurrent VVC were approached to participate in this study. No significant differences were found between the three study groups with regards patients’ age, residence, parity. After 1 month, symptoms of VVC recurred in 68.4%, 24.6% and 17.2% of women in group A, B, C consecutively. The recurrence rate increases after 3 months to become 87.5%, 60% and 33.3% consecutively in the three groups. Finally after 6 months, 94.4%, 88.7%, and 44.6% of women in group A, B, C consecutively suffered from RVVC. The recurrence rate is lower in group C (combination group) with statistically significant difference (p=0.0001).Conclusions:Vaginal administration of Lactobacillus Rhamnosus twice daily for 1 week after vaginal miconazole leads to vaginal colonization and associated at 6 months follow up with decrease the recurrence rate of VVC

Hepatitis B and C infection in haemodialysis patients in Libya: prevalence, incidence and risk factors

Background: Patients receiving maintenance haemodialysis (HD) are at higher risk for acquiring Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections than the general population. Strict infection control measures are essential to prevent nosocomial transmission. We aimed to investigate the incidence and prevalence of HBV and HCV infection in the HD population of Libya as well as risk factors for infection. Methods: All adult patients receiving maintenance HD (n=2382) in Libyan dialysis centres (n=39) were studied between May 2009 and October 2010. Testing for Hepatitis B surface antigen (HBsAg) and anti-HCV antibodies was performed at initiation of dialysis and every 3–6 months thereafter. Patients who were sero-negative for HBV and HCV (n=1160) were followed up for 1 year to detect sero-conversions. Results: Participant median age was 49 years and 58% were male. 831 patients (34.9%) were sero-positive for HBV and/or HCV (anti-HCV positive 31.1%; HBsAg positive 2.6%; both positive 1.2%). Of the sero-positive patients 4.7% were known to be infected before the initiation of HD. The prevalence of HBV±HCV infection varied widely between HD centres from 0% to 75.9%. Sero-positive patients were younger, had longer time on dialysis and more previous blood transfusions. Prospective follow-up revealed an incidence of sero-conversion of 7.7% during 1 year (7.1% HCV; 0.6% HBV). Wide variation in rates of newly acquired infections was observed between dialysis centres. All new HBV cases were referred from centres already treating HBV infected patients. New HCV infections were reported in most centres but the rate of HCV sero-conversion varied widely from 1.5% to 31%. Duration of dialysis, history of previous renal transplant and history of receiving HD in another centre in Libya were significantly associated with sero-conversion. Conclusion: Patients on maintenance HD in Libya have a high incidence and prevalence of HCV infection and lower rates of HBV infection. The factors associated with HBV and HCV infection are highly suggestive of nosocomial transmission within HD units. Urgent action is required to improve infection control measures in HD centres and to reduce dependence on blood transfusions for the treatment of anaemia. Keywords: Haemodialysis, Hepatitis B, Hepatitis C, Incidence, Libya, Nosocomial infection, Prevalenc