Transperineal ultrasound evaluation of females with stress urinary incontinence

Background: Urinary incontinence has a significant influence on the well-being of affected females. No standard imaging modality is mandatory in initial evaluation of patients with urinary incontinence. Transperineal ultrasound has been proposed as a reliable method to assess female stress urinary incontinence. This study was conducted to evaluate the transperineal ultrasound findings in females with stress urinary incontinence.Methods: A case-control study including 40 females diagnosed to have stress urinary incontinence and 40 healthy females as their controls. The proximal pubo-urethral distance, the posterior urethro-vesical angle (β-angle) and the angle of urethral inclination (α-angle) were measured at rest and during straining.Results: On analyzing the transperineal ultrasound findings, no statistical significant difference was found between cases and controls at rest, but on straining, statistical significant difference was found regarding dynamic posterior urethral angle and dynamic pubo-urethral distance (p <0.001). Of the included 40 cases with SUI, 27 (67.5%) had cysto-urethrocele, and 5 (12.5%) had intrinsic sphincter defect (ISD). Urethral diameter was significantly different in patients with ISD (6.64±1.23 mm) when compared with patients with SUI without ISD (4.83±1.16 mm).Conclusions: Transperineal ultrasound is a simple, noninvasive, and easily conducted examination that can be used in the diagnostic workup of stress incontinence

Anti-Müllerian hormone and response to ovulation induction with clomiphene citrate in women with polycystic ovary syndrome

Background: Anti-Müllerian hormone (AMH) is suggested as an important marker for women with polycystic ovary disease (PCOS). Several studies have found serum level of AMH correlate well to ovarian response to ovulation induction in women with PCOS. This study was conducted to assess the relationship between AMH in women with PCOS and response to ovulation induction with clomiphene citrate.Methods: Prospective observational cohort study conducted at Ain-Shams university maternity hospital from February 2013 to February 2014. 100 women with PCOS were recruited from the infertility outpatient clinic. Serum AMH levels were measured by enzyme linked immunosorbent assay in the early follicular phase (days 3-5). Ovulation induction by clomiphene citrate was started on day 5 as 50 mg daily tablet for 5 days. Ovulation was documented by transvaginal ultrasonography and women who failed to ovulate till day 35 were considered anovulatory.Results: 72 women ovulated within 12 to 33 days of the menstrual cycle, while 28 had undetectable ovulation till day 35. The median serum AMH level was significantly higher in women with failed ovulation [4.05 ng/mL (3.7 - 4.4)] than in ovulating women [2.7 ng/mL (1.9 - 3.1)] (p<0.001). Receiver-operating characteristic (ROC) curve analysis found the best cutoff value of AMH for prediction of successful ovulation ≤3.6 ng/mL (sensitivity = 97.2%, specificity = 82.1%).Conclusions: Anti-Müllerian hormone is a very useful predictor of poor responders to clomiphene citrate among women with polycystic ovary disease

Tissue trauma and inflammatory response following laparoscopic versus abdominal hysterectomy: a prospective randomized clinical trial

Background: Laparoscopic surgery is associated with more favorable clinical outcome than conventional open surgery. This might be related to the magnitude of tissue trauma and tissue stress response. This study compares the intensity of tissue injury by assessing plasma C-reactive protein (CRP), lactic dehydrogenase (LDH), and cancer antigen 125 (CA 125) in patients undergoing laparoscopic hysterectomy compared to abdominal hysterectomy.Methods: This study was conducted at Ain Shams University Maternity Hospital from May 2018 to February 2020. 74 women candidate for hysterectomy were recruited and randomized into two groups: group A included 37 cases who underwent abdominal hysterectomy, and group B included 37 cases that underwent laparoscopic hysterectomy.Results: CRP, LDH and CA125 significantly increased post-operatively in both groups. Postoperative mean serum CRP, LDH and CA125 were significantly higher in the laparotomy group (10.84±2.47, 262.21±76.77, and 13.41±2.6 respectively) compared to laparoscopy group (7.92±2.25, 148.53±43.56, 11.79±2.77 respectively) (p<0.05).Conclusions: Surgery is a significant cause of tissue injury that can be assessed by specific markers. We suggest that laparoscopic surgery causes less tissue damage as assessed by lower postoperative CRP and LDH values, which might account for the earlier recovery and reduced hospital stay in laparoscopic surgery

Gingival Crevicular Fluid and Placental Tissue Levels of Interleukin-17 as a Possible Marker for Preterm Labor in Patients with Chronic Periodontitis

Background:  The present study was conducted to evaluate the levels of interleukin (IL)-17 in gingival crevicular fluid (GCF) and placental tissue samples of pregnant females as a possible marker in determining whether or not an association exists between chronic periodontitis and preterm labor. Methods:  This case-control study included a random sample of 40 female patients, aged 18 to 35 years, who were assigned to one of the following four groups (10 subjects each): group 1 included patients who underwent spontaneous preterm birth (PB) and were diagnosed with chronic periodontitis upon clinical examination (preterm/periodontitis); group 2 included patients who underwent spontaneous PB and who had a healthy periodontium upon clinical examination (preterm/healthy periodontium); group 3 included patients who underwent spontaneous normal term birth and were diagnosed with chronic periodontitis upon clinical examination (term/periodontitis); and group 4 included patients who underwent spontaneous normal term birth and who had a healthy periodontium upon clinical examination (term/healthy periodontium). GCF and placental tissue samples were obtained from each patient and IL-17 levels were measured using enzyme-linked immunosorbent assay (ELISA). Results: GCF levels of IL-17 were significantly higher (P=0.010) in patients with chronic periodontitis compared to those with a healthy periodontium. No significant differences were observed in IL-17 levels in placental tissue samples of all study groups. Conclusion: An association between chronic periodontitis and preterm labor could not be established based on IL-17 levels measured in the present study

Modified technique for sacrospinous-sacrotuberous ligament complex colpopexy in apical prolapse: preliminary results of a pilot randomized study

Background: Apical prolapse is frequently encountered following vaginal hysterectomy either or as a primary finding in patients with pelvic organ prolapse. This pilot comparative study introduces a modified sacrospinous sacrotuberous ligament fixation with biologic mesh augmentation which necessitates no special kits to be performed.Methods: This study was conducted at Department of Obstetrics and gynecology, Ain Shams University, Cairo, Egypt, and Department of Women Health of Bethanien Hospital, Iserlöhn, Germany from March 2018 to May 2020. 40 women with either utero-vaginal or vaginal vault prolapse were randomized to either; group (A): 20 women scheduled for modified sacrospinous-sacrotuberous fixation procedure, or group (B): 20 women scheduled for conventional sacrospinous-sacrotuberous fixation procedure.Results: Improvement of the Pelvic organ prolapse quantification system (POP-Q) stage from the base line pre-operative stage was 1 stage higher in the modified SS/ST-F group compared to the conventional SSF group (3 stage improvement from baseline in SS/ST-F group versus 2 stage improvement only in conventional SSF group).Conclusions: This pilot study provides a modified sacrospinous sacrotuberous ligament colpopexy technique which is easier to be performed and mastered, does not need the use of special devices, provides better improvement of grade of prolapse and less complications compared to the conventional technique.

Transperineal ultrasound evaluation of females with stress urinary incontinence

Background: Urinary incontinence has a significant influence on the well-being of affected females. No standard imaging modality is mandatory in initial evaluation of patients with urinary incontinence. Transperineal ultrasound has been proposed as a reliable method to assess female stress urinary incontinence. This study was conducted to evaluate the transperineal ultrasound findings in females with stress urinary incontinence.Methods: A case-control study including 40 females diagnosed to have stress urinary incontinence and 40 healthy females as their controls. The proximal pubo-urethral distance, the posterior urethro-vesical angle (β-angle) and the angle of urethral inclination (α-angle) were measured at rest and during straining.Results: On analyzing the transperineal ultrasound findings, no statistical significant difference was found between cases and controls at rest, but on straining, statistical significant difference was found regarding dynamic posterior urethral angle and dynamic pubo-urethral distance (p &lt;0.001). Of the included 40 cases with SUI, 27 (67.5%) had cysto-urethrocele, and 5 (12.5%) had intrinsic sphincter defect (ISD). Urethral diameter was significantly different in patients with ISD (6.64±1.23 mm) when compared with patients with SUI without ISD (4.83±1.16 mm).Conclusions: Transperineal ultrasound is a simple, noninvasive, and easily conducted examination that can be used in the diagnostic workup of stress incontinence

Development of Antimicrobial Laser-Induced Photodynamic Therapy Based on Ethylcellulose/Chitosan Nanocomposite with 5,10,15,20-Tetrakis(m-Hydroxyphenyl)porphyrin

The development of new antimicrobial strategies that act more efficiently than traditional antibiotics is becoming a necessity to combat multidrug-resistant pathogens. Here we report the efficacy of laser-light-irradiated 5,10,15,20-tetrakis(m-hydroxyphenyl)porphyrin (mTHPP) loaded onto an ethylcellulose (EC)/chitosan (Chs) nanocomposite in eradicating multi-drug resistant Pseudomonas aeruginosa, Staphylococcus aureus, and Candida albicans. Surface loading of the ethylcelllose/chitosan composite with mTHPP was carried out and the resulting nanocomposite was fully characterized. The results indicate that the prepared nanocomposite incorporates mTHPP inside, and that the composite acquired an overall positive charge. The incorporation of mTHPP into the nanocomposite enhanced the photo- and thermal stability. Different laser wavelengths (458; 476; 488; 515; 635 nm), powers (5–70 mW), and exposure times (15–45 min) were investigated in the antimicrobial photodynamic therapy (aPDT) experiments, with the best inhibition observed using 635 nm with the mTHPP EC/Chs nanocomposite for C. albicans (59 ± 0.21%), P. aeruginosa (71.7 ± 1.72%), and S. aureus (74.2 ± 1.26%) with illumination of only 15 min. Utilization of higher doses (70 mW) for longer periods achieved more eradication of microbial growth

Value of lung ultrasound in detection of volume overload in children chronic kidney disease on regular hemodialysis: prospective cohort study

Abstract Background Several methods have emerged to predict the occurrence of early volume overload (VO) in pediatric patients with chronic kidney disease undergoing regular hemodialysis (HD). Nevertheless, achieving an accurate assessment remains challenging. Consequently, this study aimed to identify VO in pediatric HD patients using lung ultrasound (LUS). Additionally, the study sought to investigate the relationship between various clinical parameters employed to detect VO and the ultrasonographic B-line score. Methods This prospective observational cohort study was conducted on 30 pediatric patients with end-stage renal disease undergoing a maintenance HD program for 4 months. The clinical evaluation of the fluid status of pediatric patients involved using LUS pre-, intra, and post-HD. The study included the dry weight (DW) and non-DW groups; within these groups, the B-line scores were evaluated pre-, intra, and post-HD sessions. Tabulations were conducted to document the variations in body weight and B-line scores during pre-, intra-, and post-dialytic periods. Results The results of the LUSs performed on the 30 pediatric patients pre-, intra, and post-HD revealed that the B-line scores significantly reduced post-HD in all pediatric patients with more significant reduction in non-dry weight group (p < 0.001). There was a positive relation between the total number of B-lines pre-HD and inter-dialytic weight gain, pre-dialytic blood pressure, and clinical fluid score (r = 0.811, p < 0.01; r = 0.59, p < 0.001; and r = 0.75, p < 0.001, respectively) and also post-dialysis. Eventually, dialytic weight loss exhibited a significant direct positive correlation to B-line score reduction (r = 0.891, p < 0.01). Conclusions LUS is an innovative, simple noninvasive bedside method that provides real-time evaluation of fluid volume alterations in pediatric HD patients with chronic conditions. LUS shows excellent potential as a viable approach for assessing DW and non-dry weight in pediatric HD patients