Publications by authors named "Ahmed M Abbas"

116 Publications

Effect of piroxicam administration in infertile women undergoing assisted reproductive technologies: A systematic review and meta-analysis.

Gynecol Endocrinol 2021 Mar 18:1-7. Epub 2021 Mar 18.

Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University for Girls, Cairo, Egypt.

Objective: To evaluate piroxicam effect on different pregnancy outcomes among infertile women undergoing assisted reproductive technologies (ART).

Methods: We searched for the available randomized clinical trials (RCTs) in four different databases during January 2021 that compared piroxicam (intervention group) to placebo/no treatment (control group) in infertile women performing ART. We extracted the available data from included studies and pooled them in a meta-analysis model using RevMan software. We pooled the dichotomous data as risk ratios (RR) with the corresponding 95% confidence intervals (CI) using RevMan software. Our outcomes were rates of clinical pregnancy, ongoing pregnancy, miscarriage, and any adverse events.

Results: Seven RCTs met our inclusion criteria with a total number of 1226 patients. Piroxicam was linked to a significant increase in clinical pregnancy rate compared to control group (RR = 1.30, 95% CI [1.09, 1.55],  = .003). However, we did not report any significant difference between both groups in ongoing pregnancy rate (RR = 1.27, 95% CI [0.72, 2.24],  = .41). In addition, the rates of miscarriage and adverse events were not different among both groups.

Conclusions: Piroxicam administration increases the clinical pregnancy rate among infertile women. However, piroxicam does not affect miscarriage and ongoing pregnancy rates.
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http://dx.doi.org/10.1080/09513590.2021.1900818DOI Listing
March 2021

Effect of Metformin on Premature Luteinization and Pregnancy Outcomes in Intracytoplasmic Sperm Injection-Fresh Embryo Transfer Cycles: A Randomized Double-Blind Controlled Trial.

Int J Fertil Steril 2021 Apr 11;15(2):108-114. Epub 2021 Mar 11.

Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.

Background: Premature luteinization (PL) is not unusual in fertilization (IVF) and could not be wholly avoided by using either gonadotropin-releasing hormone (GnRH) agonists or GnRH antagonist regimens. The study aims to evaluate metformin's efficacy in preventing PL in fresh GnRH antagonist intracytoplasmic sperm injection (ICSI) cycles with cleavage-stage embryo transfer.

Materials And Methods: This randomized, double-blind, placebo-controlled trial was conducted in a tertiary university IVF center. We recruited infertile women who were scheduled to perform their first or second ICSI trial. Eligible women were recruited and randomized in a 1:1 ratio into two groups. Metformin was administered in a dose of 1500 mg per day since the start of contraceptive pills in the cycle antecedent to stimulation cycle until the day of ovulation triggering, while women in the placebo group received a placebo for the same regimen and duration. The primary outcome was the incidence of PL, defined as serum progesterone (P) on the triggering day ≥1.5 ng/mL. Secondary outcomes comprised the live birth, ongoing pregnancy, implantation, and good-quality embryos rates.

Results: The trial involved 320 eligible participants (n=160 in each group). Both groups had comparable stimulation days, endometrial thickness, peak estradiol levels, number of oocytes retrieved, and number of mature oocytes. Metformin group experienced lower level of serum P (P<0.001) and incidence of PL (10 vs. 23.6%, P=0.001). Moreover, lower progesterone/estradiol (P/E) ratio and progesterone to mature oocyte index (PMOI) (P=0.002 and P=0.002, respectively) were demonstrated in women receiving metformin. Metformin group generated a better rate of goodquality embryos (P=0.005) and ongoing pregnancy (43.8 vs. 31.8%, P=0.026). A similar trend, though of borderline significance, was observed in the live birth rate in favor of metformin administration (38.15 vs. 27.5%, P=0.04).

Conclusion: Metformin could be used in patients with potential PL to improve fresh cycle outcomes by preventing PL (Registration number: NCT03088631).
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http://dx.doi.org/10.22074/IJFS.2020.134643DOI Listing
April 2021

Self-administrated vaginal 2% lidocaine in-situ gel for pain relief during copper intrauterine device insertion in women with previous caesarean delivery only: a randomised, double-blind placebo-controlled trial.

Eur J Contracept Reprod Health Care 2021 Apr 4;26(2):132-138. Epub 2021 Feb 4.

Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.

Objective: To evaluate the analgesic effect of self-administered vaginal 2% lidocaine gel in pain relief during copper intrauterine device (IUD) insertion in women with previous caesarean delivery only.

Methods: A Randomised, double-blind, placebo-controlled trial (Clinicaltrials.gov: NCT03166111) included reproductive-aged women who previously delivered only by caesarean section (CS) requesting Copper IUD insertion. Eligible women were recruited and randomised (1:1) to lidocaine gel vs. placebo. Each woman was supplied by a syringe filled with five ml lidocaine or placebo in-situ gel to be self-administered vaginally ten minutes before insertion. The primary outcome was the difference in pain scores during IUD placement using a 10-cm Visual Analogue Scale (VAS).

Results: The final analysis included 216 women ( = 108 in each arm). Women in the Lidocaine gel group were more likely to report statistically significant lower pain scores during vulsellum application, uterine sound placement, and during IUD placement [Mean difference (95%CI) = 2.04 (1.66-2.42), 2.62 (2.20-3.04), and 2.57 (2.12-3.01), respectively,  = 0.0001]. A significantly lower IUD insertion score indicating easier insertion was reported in the lidocaine group ( = 0.004). Similarly, the duration of IUD insertion was significantly shorter in the lidocaine group ( = 0.008). There was a higher level of satisfaction in the lidocaine group (5.92 vs. 3.34) in the placebo group ( = 0.0001).

Conclusions: Self-administered vaginal lidocaine gel 10 min before copper IUD insertion is effective in pain reduction in women with previous caesarean delivery only.
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http://dx.doi.org/10.1080/13625187.2020.1868427DOI Listing
April 2021

Abundance, distribution, and growth characteristics of three keystone Vachellia trees in Gebel Elba National Park, south-eastern Egypt.

Sci Rep 2021 Jan 14;11(1):1284. Epub 2021 Jan 14.

Department of Horticulture, Faculty of Agriculture and Natural Resources, Aswan University, Aswan, 81528, Egypt.

This study was conducted to evaluate the abundance and distribution pattern of three keystone Vachellia taxa in wadi Khoda and wadi Rahaba, Gebel Elba National Park, a protected area in south-eastern Egypt. These taxa included Vachellia tortilis subsp. tortilis, Vachellia tortilis subsp. raddiana, and Vachellia ehrenbergiana. In wadi Khoda, only two of these taxa were detected (V. tortilis subsp. raddiana and V. tortilis subsp. tortilis), while all three taxa were encountered in wadi Rahaba. The density of trees in wadi Khoda was 34.3 plant ha compared to 26.3 plant ha in wadi Rahaba. Vachellia tortilis subsp. raddiana was the most frequently observed tree, with an average of 47.93% and 68.25% in wadi Rahaba and wadi Khoda, respectively. Crown depth and tree height were mainly associated with elevation, indicating that elevation plays a key role in the growth of these Vachellia taxa. Our results suggest that human activities have had limited effect on the distribution of these three keystone taxa. Thus, management in Gebel Elba National Park should continue to limit the impact of human activities on these three keystone species.
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http://dx.doi.org/10.1038/s41598-020-79542-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809204PMC
January 2021

Cesarean myomectomy in the last ten years; A true shift from contraindication to indication: A systematic review and meta-analysis.

Eur J Obstet Gynecol Reprod Biol 2021 Jan 11;256:145-157. Epub 2020 Nov 11.

Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, 342005, India.

Background: A lot of debate is present about Cesarean myomectomy (CM) in women with uterine myoma whether to consider it a feasible and safe procedure or an absolute contraindication.

Objective: To assess the safety and feasibility of myomectomy during cesarean section in women with uterine myoma.

Search Strategy: Electronic search was made on MEDLINE, EMBASE, Cochrane Library, ISI web of knowledge and Scopus from January 1, 2008 to December 31, 2019 using terms "Caesarean section", "Myomectomy", "Fibroid", "Caesarean myomectomy".

Selection Criteria: All full length studies either prospective or retrospective that address caesarean myomectomy were included.

Data Collection And Analysis: The outcomes studied were haemorrhage, mean change in haemoglobin, operative time, need for blood transfusion, febrile morbidity and duration of hospital stay.

Results: Total 249 studies were assessed for eligibility and 17 studies included in analysis with 6545 women. There were 4702 (71.85 %) women in caesarean myomectomy (CM) group and 1843 (28.15 %) women in cesarean section (CS) group. There was statistically significant but clinically insignificant decrease in hemoglobin [MD = 0.27, 95 %CI = 0.08-0.45, p = 0.005; very low quality], significant higher need for blood transfusion [RR = 1.45, 95 %CI = 1.05-1.99, p = 0.02; high quality] in CM group versus CS alone. The mean operative time (minutes) [MD = 14.77, 95 %CI = 6.91-22.64, p = 0.0002; moderate quality] and mean hospital stay (days) [MD = 0.36, 95 %CI = 0.19-0.53, p < 0.00001; high quality] was significantly less in CM group, though of not any clinical significance. No difference in incidence of haemorrhage [RR = 1.16, 95 %CI = 0.86-1.56, p = 0.32; moderate quality evidence] and fever [RR = 1.17, 95 %CI = 0.83-1.65), p = 0.36; moderate quality] in two groups.

Conclusions: The meta-analysis suggests CM is associated with clinical insignificant increase in operative time, blood loss and hospital stay, especially with multiple and large size myomas. CM should be preferred over CS alone especially by experienced surgeons with appropriate haemostatic techniques and tertiary care centres.
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http://dx.doi.org/10.1016/j.ejogrb.2020.11.008DOI Listing
January 2021

Letter to editor: comments on manuscript titled "intravaginal administration of isosorbide mononitrate for cervical ripening in prolonged pregnancy: a randomised clinical trial".

Authors:
Ahmed M Abbas

J Obstet Gynaecol 2021 Feb 24;41(2):331. Epub 2020 Nov 24.

Department of Obstetrics &Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.

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http://dx.doi.org/10.1080/01443615.2020.1819214DOI Listing
February 2021

Comparison of the four malignancy risk indices in the discrimination of malignant ovarian masses: A cross-sectional study.

J Gynecol Obstet Hum Reprod 2020 Nov 13:101986. Epub 2020 Nov 13.

Department of Obstetrics & Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt. Electronic address:

Objective: To evaluate the accuracy of the four malignancy risk indices to distinguish benign from malignant ovarian masses MATERIALS AND METHODS: This was an observational cross-sectional study conducted on 155 patients between January 2016 and January 2019. Women with ovarian masses planned for surgical management were recruited from the outpatient Gynecology clinic of the hospital. The risk of malignancy index (RMI 1-4) was calculated for all women with ovarian masses. Biopsies obtained from the ovarian masses after the surgical intervention was sent to the pathology lab for histopathological examination. The histopathologic diagnosis of the ovarian masses was considered the gold standard for diagnosis.

Results: The participants' mean age in the group of patients with benign masses was 33.50 ± 14.53 years versus 45.09 ± 13.67 years in the malignant group. The two most prominent features in the malignant group were solid areas in 85.3 % of malignant masses and about 91.2 % of malignant masses showing size <7 cm in their largest diameter. The RMI's most sensitive individual parameter was the CA-125 level, while the lowest sensitivity was for the menopausal status. RMI 2 had the highest sensitivity of 76.47 %, while RMI 1 and 3 had the highest specificity, 92.56 %. RMI 2 had the highest AUC, 0.83.

Conclusions: RMI 2 is a simple and reliable tool and had the best performance among all RMIs in benign discrimination from malignant ovarian masses with high sensitivity and accuracy.
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http://dx.doi.org/10.1016/j.jogoh.2020.101986DOI Listing
November 2020

Rheumatoid Arthritis in the Era of COVID-19 Pandemic.

Mediterr J Rheumatol 2020 Sep 21;31(Suppl 2):257-258. Epub 2020 Sep 21.

COvid-19 Research of Assiut University Association (CORAUNA) group.

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http://dx.doi.org/10.31138/mjr.31.3.257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656131PMC
September 2020

leave extracts induce cell death of MCF-7, HepG2, and LS-174T cancer cell lines.

EXCLI J 2020 9;19:1282-1294. Epub 2020 Sep 9.

Department of Biology, College of Science, King Khalid University, Abha, Saudi Arabia.

() is a widespread phreatophytic tree, which belongs to the Fabaceae family. The goal of the present study is to investigate the potential anti-cancer effect of leave extracts and to identify its chemical composition. For this purpose, MCF-7 (breast), HepG2 (liver), and LS-174T (colorectal) cancer cell lines were cultivated and incubated with various concentrations of leave extracts, and its impact on cell viability, proliferation, and cell cycle stages was investigated. leave extracts induced concentration-dependent cytotoxicity against all tested cancer cell lines. The calculated IC was 18.17, 33.1 and 41.9 μg/ml for MCF-7, HePG2 and LS-174T, respectively. Detailed analysis revealed that the cytotoxic action of extracts was mainly via necrosis but not apoptosis. Moreover, DNA content flow cytometry analysis showed cell-specific anti-proliferative action and cell cycle stages arrest. In order to identify the anti-cancer constituents of , the ethyl extracts were analyzed by liquid chromatography-mass spectrometry. The major constituents identified in the ethyl extracts of leaves were hydroxymethyl-pyridine, nicotinamide, adenine, and poly-(methyl methacrylate) (PMMA). In conclusion, ethyl acetate extracts have a potential anti-cancer effect against breast adenocarcinoma, hepatocellular carcinoma, and colorectal adenocarcinoma, and is enriched with anti-cancer constituents. See also Figure 1(Fig. 1).
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http://dx.doi.org/10.17179/excli2020-2830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7658460PMC
September 2020

Vaginal suppositories of cumin seeds essential oil for treatment of vaginal candidiasis: Formulation, in vitro, in vivo, and clinical evaluation.

Eur J Pharm Sci 2021 Feb 18;157:105602. Epub 2020 Oct 18.

Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt.

Fungal infections by resistant Candida species continue to be a significant health problem. Novel antifungal agents such as essential oils of cumin seeds (EOCS) are tested against vulvovaginal candidiasis (VVC). The aim of this study was to develop coated polyethylene glycol (PEG) vaginal suppositories containing EOCS for treatment of VVC. PEG suppositories containing EOCS were prepared ppearance, weight variation, drug content, hardness, dissolution time, release, stability and anticandida activity were evaluated. Biocompatibility of selected formulation was tested in female rabbits, followed by clinical evaluation. Coated suppositories showed complete release of the oil after 30 min, in vitro anti-candida activity, enhanced stability and sufficient safety on the vaginal tissues of rabbits. Clinical results showed significant lower rates of vaginal itching, discharge and dyspareunia combined with negative cultures in 70% of patients, revealing efficacy of EOCS-containing vaginal suppositories for treatment of VVC.
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http://dx.doi.org/10.1016/j.ejps.2020.105602DOI Listing
February 2021

Efficacy and Safety of Intravenous Tramadol versus Intravenous Paracetamol for Relief of Acute Pain of Primary Dysmenorrhea: A Randomized Controlled Trial.

Gynecol Obstet Invest 2020 19;85(5):388-395. Epub 2020 Oct 19.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Introduction: Many pharmaceutical, surgical, and complementary medical interventions are used for primary dysmenorrhea treatment. However, no consensus has been reached about the most effective intervention.

Objective: To compare the efficacy and safety of IV tramadol versus IV paracetamol in relieving acute pain of primary dysmenorrhea.

Methods: This randomized controlled trial was conducted in a tertiary referral hospital and included 100 patients between 18 and 35 years old diagnosed with primary dysmenorrhea. Patients received either 1-g paracetamol or 100-mg tramadol in 100-mL normal saline as an IV infusion over 10 min. Pain intensity was measured by using a visual analog scale at 15, 30, 60 min, and 2 h. We recorded drug side effects and requirements for rescue analgesics.

Results: Pain scores were significantly lower in the tramadol group compared with the paracetamol group at 15, 30, 60 min, and 2 h (p < 0.001). Fewer patients in the tramadol group needed rescue analgesics compared with the paracetamol group (p = 0.04). No significant differences were reported in side effects between both groups.

Conclusions: IV tramadol is superior to IV paracetamol in relieving acute pain of primary dysmenorrhea with a comparable side effect profile.
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http://dx.doi.org/10.1159/000510268DOI Listing
April 2021

Practice recommendations for clinicians in ART centers in the context of COVID-19 pandemic: perspective of a developing country.

Middle East Fertil Soc J 2020 17;25(1):28. Epub 2020 Sep 17.

Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.

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http://dx.doi.org/10.1186/s43043-020-00040-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495964PMC
September 2020

High dose vs. low dose oxytocin for labor augmentation: a systematic review and meta-analysis of randomized controlled trials.

J Perinat Med 2021 Feb 21;49(2):178-190. Epub 2020 Sep 21.

Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt.

Objectives: To compare the safety and efficacy between high dose and low dose oxytocin administration for labor augmentation.

Methods: We searched for the available studies during March 2020 in PubMed, Cochrane Library, Scopus, and ISI Web of science. All randomized clinical trials (RCTs) that assessed safety and efficacy of high dose vs. low dose oxytocin for labor augmentation were considered. The extracted data were entered into RevMan software. Dichotomous and continuous data were pooled as odds ratio (OR) and mean difference (MD) respectively, with the corresponding 95% confidence intervals (CI). Our main outcomes were cesarean delivery rate, spontaneous vaginal delivery rate, uterine hyperstimulation and tachysystole, and labor duration from oxytocin infusion.

Results: Eight RCTs with 3,154 patients were included. High dose oxytocin did not reduce cesarean delivery rate compared to low dose oxytocin (OR=0.76, 95% CI [0.52, 1.10], p=0.15). After solving the reported heterogeneity, high dose oxytocin did not increase the rate of spontaneous vaginal deliveries vs. low dose oxytocin (OR=1.06, 95% CI [0.84, 1.32], p=0.64). Low dose oxytocin was linked to a significant decline in uterine hyperstimulation and tachysystole (p>0.001). A reduction in labor duration was found in high dose oxytocin group over low oxytocin regimen (MD=-1.02 h, 95% CI [-1.77, -0.27], p=0.008).

Conclusions: We found no advantages for high dose oxytocin over low dose oxytocin in labor augmentation except in reducing labor duration. Low dose oxytocin is safer as it decreases the incidence of uterine hyperstimulation and tachysystole. More trials are needed to confirm our findings.
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http://dx.doi.org/10.1515/jpm-2020-0042DOI Listing
February 2021

The effect of BCG vaccine in the era of COVID-19 pandemic.

Scand J Immunol 2020 12 27;92(6):e12947. Epub 2020 Aug 27.

Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.

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http://dx.doi.org/10.1111/sji.12947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404532PMC
December 2020

COVID-19 and hydatidiform mole.

Am J Reprod Immunol 2020 11 4;84(5):e13310. Epub 2020 Aug 4.

Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.

The emergence of coronavirus disease 2019 (COVID-19) as a pandemic threatens the entire world resulting in severe consequences for people's health. Pregnant patients with COVID-19 had immune dysregulation that could result in abnormal pregnancy outcomes such as hydatidiform mole (HM), recurrent pregnancy loss, and early-onset preeclampsia. In this article, we tried to summarize the possible association between COVID-19 and the HM's development by reviewing the role of NOD-Like Receptor (NLR) Family Pyrin Domain Containing 7 (NLRP7), cytokines, zinc, and leukocytes in the pathogenesis of HM.
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http://dx.doi.org/10.1111/aji.13310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404502PMC
November 2020

Psychological effect of COVID-19 on medical health-care workers.

Int J Psychiatry Clin Pract 2020 Jul 15:1-2. Epub 2020 Jul 15.

COvid-19 Research of Assiut UNiversity Association (CORAUNA) group, Assiut, Egypt.

Objective: To review the psychological Effect of COVID-19 on medical health-care workers.

Conclusions: Social support is a cornerstone in facing COVID-19 and uplifting the spirits of both patients and their doctors along with the whole medical staff dealing with the pandemic.
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http://dx.doi.org/10.1080/13651501.2020.1791903DOI Listing
July 2020

A focused review on the genital and sexual affection of COVID-19 patients.

J Gynecol Obstet Hum Reprod 2020 Oct 30;49(8):101848. Epub 2020 Jun 30.

COvid-19 Research of Assiut UNiversity Association (CORAUNA) Group, Egypt; Faculty of Medicine, Assiut University, Egypt.

The pandemic of coronavirus disease-2019 (COVID-19) could harm the reproductive and sexual health of both males and females. This could be through psychological, immunological, or systemic effects. In this article, we tried to elucidate the mechanisms that could explain the current and future genital affection of COVID-19 patients.
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http://dx.doi.org/10.1016/j.jogoh.2020.101848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326390PMC
October 2020

COVID-19 and maternal pre-eclampsia: A synopsis.

Scand J Immunol 2020 09 3;92(3):e12918. Epub 2020 Jul 3.

Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.

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http://dx.doi.org/10.1111/sji.12918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323068PMC
September 2020

Outpatient versus inpatient balloon catheter insertion for labor induction: A systematic review and meta-analysis of randomized controlled trials.

J Gynecol Obstet Hum Reprod 2020 Oct 31;49(8):101823. Epub 2020 May 31.

Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt. Electronic address:

Objective: To compare between outpatient and inpatient balloon catheter insertion for labor induction.

Methods: We searched in four different databases for the available trials during May 2020. We included randomized controlled trials (RCTs) that compared outpatient to inpatient balloon catheter for induction of labor. We extracted the available data from the included studies and pooled them in meta-analysis using RevMan software. The dichotomous data were pooled as risk ratio (RR) and the continuous data were pooled as mean difference (MD) with the corresponding 95% confidence intervals (CI).Our primary outcome was the rate of cesarean delivery. Our secondary outcomes were the length of hospital stay, Bishop score, and different adverse events including postpartum hemorrhage, Apgar score less than 7 at 5 minutes, and chorioamnionitis.

Results: Eight RCTs with a total number of 740patients were included. The cesarean delivery rate was significantly reduced among outpatient balloon catheter compared to inpatient balloon catheter (RR = 0.63, 95% CI [0.46, 0.86], p = 0.004). Outpatient balloon catheter was associated with shorter hospital stay duration in comparison with inpatient group (MD= -0.38, 95% CI [-0.61, -0.14], p = 0.002). Outpatient group was linked to a more favorable increase in Bishop score (MD = 0.88, 95% CI [0.78, 0.98], p>0.001). There were no significant differences between both groups regarding different adverse events.

Conclusion: Outpatient balloon catheter priming is safe and effective in reducing cesarean delivery rates and shortening the length of hospital stay with a better Bishop score.
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http://dx.doi.org/10.1016/j.jogoh.2020.101823DOI Listing
October 2020

Knowledge, attitude and practice towards abortion and post abortion care among Egyptian private obstetricians and gynaecologists.

Eur J Contracept Reprod Health Care 2020 Aug 2;25(4):245-250. Epub 2020 Jun 2.

Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

Objective: To assess the knowledge, attitude, and practice of private obstetricians and gynaecologists towards abortion, post-abortion care, and post-abortion family planning.

Patients And Methods: A cross-sectional study, from June 2017 to May 2018, using a self-administered questionnaire of 150 obstetricians/gynaecologists at private clinics, centres, hospitals in Ismailia, Egypt. The questionnaire was composed of four broad sections: section one was about the socio-demographic characteristics of the participants; section two was about physicians' knowledge, attitude and practices regarding abortion; section three was about their attitudes and practices regarding post-abortion family planning and screening for sexually transmitted diseases (STDs) in patients presenting for induced abortion; and section four was about the socio-demographic characteristics of women seeking induced abortion taken from the physicians' views.

Results: Only 15.2% of participants had performed an abortion for unwanted pregnancies at ≤12 weeks vs. 3.8% for unwanted pregnancies >12 weeks' gestation. The most common reason for not performing an abortion was religious prohibition (80.35% vs. 86.6% for unwanted pregnancy ≤12 and > 12 weeks, respectively). Social causes were the most common reason for seeking an induced abortion. None of the physicians used manual vacuum aspiration (MVA) for abortion or had received training in MVA. Post-abortion family planning counselling was offered by 20.5% of physicians, while 13.6% screened for STDs.

Conclusions: The majority of private obstetricians/gynaecologists in Ismailia, Egypt, do not perform abortions for unwanted pregnancies because of their religious beliefs. Post-abortion screening for STDs and family planning services are not sufficiently integrated into post-abortion care.
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http://dx.doi.org/10.1080/13625187.2020.1760239DOI Listing
August 2020

External pop-out versus classic technique for delivery of the fetal head during elective cesarean section: A randomized clinical trial.

J Gynecol Obstet Hum Reprod 2020 Nov 11;49(9):101806. Epub 2020 May 11.

Department of Obstetrics & Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt.

Objective: This study aims to compare two techniques (External pop-out versus classic technique) for delivery of the fetal head during elective cesarean section (CS).The potential clinical predictors associated with unintended uterine incision extension during fetal head delivery among women delivered by elective CS were also assessed.

Methods: A randomized clinical trial conducted at a tertiary University hospital between February 2017 and January 2019. Participants were randomly assigned to the classic head delivery technique (group I) or external Pop-out (EPO) technique (group II). The primary outcome was the incidence of unintended uterine incision extension during elective CS. A logistic regression model was utilized to examine the association between patient's characteristics and the occurrence of unintended uterine incision extension.

Results: Participants in both groups (455 women in each group) had similar demographic characteristics. The EPO group had a significantly lower incidence of uterine incision extension than the classic group (p = 0.006). The operative time was significantly shorter in the EPO group (p = 0.000), which was also significantly easier than the classic technique (p = 0.001). The high body mass index (p = 0.004), previous delivery by CS (p = 0.010), high birth weight (p = 0.001) and the classic technique for head delivery (p = 0.002) were significant predictors for uterine incision tears.

Conclusions: EPO technique is an easy technique for fetal head delivery during elective CS with a lower risk of uterine incision extension and shorter operative time.
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http://dx.doi.org/10.1016/j.jogoh.2020.101806DOI Listing
November 2020

Effect of a mobile phone-assisted postpartum family planning service on the use of long-acting reversible contraception: a randomised controlled trial.

Eur J Contracept Reprod Health Care 2020 Aug 21;25(4):264-268. Epub 2020 May 21.

Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Assiut, Egypt.

Objective: The aim of the study was to evaluate the effect of adding mobile phone call reminders to a postpartum family planning service on the initiation of long-acting reversible contraception (LARC).

Methods: A randomised, open-label controlled trial (ClinicalTrials.gov NCT03135288) was carried out at a university hospital between July 2017 and March 2019. The study comprised women who delivered a live birth at >28 weeks' gestation and who requested birth spacing for ≥1 year. Eligible women were recruited and randomised to two groups. The study group received contraceptive counselling and two reminders of their first postpartum appointment, one week and again 48 h before the appointment. The control group received contraceptive counselling but no mobile phone reminders of their first postpartum appointment. The primary outcome was the rate of initiation of a LARC method in the first 6 months postpartum.

Results: The study comprised 500 participants in each group. The rate of initiation and continuation of a LARC method was significantly higher in the study group compared with the control group (30.2% vs 8.4% and 95.4% vs 83.3%, respectively; < .001). In the study group, 382 (76.4%) women had started using a contraceptive method during the first 6 months, compared with 218 (43.6%) women in the control group ( < .001).

Conclusion: Using mobile phone reminders as part of the postpartum service increases the frequency of women who attends family planning clinics and initiates contraception, including a LARC methods, as well as the proportion who continue LARC use through the first 6 months postpartum.
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http://dx.doi.org/10.1080/13625187.2020.1764528DOI Listing
August 2020

Impact of COVID-19 on reproductive health and maternity services in low resource countries.

Eur J Contracept Reprod Health Care 2020 Oct 21;25(5):402-404. Epub 2020 May 21.

Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.

Purpose: Coronavirus Disease-2019 (COVID-19) is a rapidly evolving pandemic. It is well-known that pregnant women are more susceptible to viral infection due to immune and anatomic factors. Therefore, the viral pandemic might affect the reproductive health and maternity services especially in low-resource countries.

Materials And Methods: In this article, we tried to highlight the impact of COVID-19 on reproductive health and maternity health services in low resource countries with emphasis on adapting some of the published best practice recommendations to suit a struggling environment.

Conclusion: Pregnant women residing in low resource countries represent a uniquely vulnerable group in epidemics due to several factors. Maternity services in low resource countries are adapting to provide antenatal and postnatal care amidst a rapidly shifting health system environment due to the COVID-19 pandemic.
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http://dx.doi.org/10.1080/13625187.2020.1768527DOI Listing
October 2020

Dietary habits in adults during quarantine in the context of COVID-19 pandemic.

Obes Med 2020 Sep 15;19:100254. Epub 2020 May 15.

COvid-19 Research of Assiut UNiversity Association (CORAUNA) Group, Egypt.

•COVID-19 pandemic lead to stress conditions that can cause a dramatic change in our dietary habits.•Eating a well-balanced diet is the best way to get all the essential nutrients we need for normal immune function.•Poor quality sleep can negatively affect both physical and mental health.
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http://dx.doi.org/10.1016/j.obmed.2020.100254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227490PMC
September 2020

The mutual effects of COVID-19 and obesity.

Obes Med 2020 Sep 6;19:100250. Epub 2020 May 6.

COvid-19 Research of Assiut UNiversity Association (CORAUNA) Group, Egypt.

•The rate of obesity was increased during this era of the COVID-19 epidemic.•Obesity is dangerous in COVID-19 patients.•Obesity is associated with other co-morbidities could affect the prognosis of COVID-19 patients.
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http://dx.doi.org/10.1016/j.obmed.2020.100250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202807PMC
September 2020

Concordance between peripheral and decidual NK cell subsets and killer immunoglobulin-like receptors in women with recurrent spontaneous miscarriages.

J Reprod Immunol 2020 08 15;140:103130. Epub 2020 Apr 15.

Medical Microbiology & Immunology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.

Background: The role of decidual natural killer (dNK) cells in normal and complicated pregnancy and their relation with peripheral NK (pNK) cells remains unclear. The study aim was phenotypic analysis of pNK and dNK cells at time of miscarriage in recurrent spontaneous miscarriage (RSM) patients to assess whether measuring levels of pNK cell populations can reflect changes in dNK cells or not.

Methods: This study included 40 middle aged pregnant women in the 1st trimester subjected to evacuation because of a current miscarriage. They had a history of previous ≥ two unexplained miscarriages. Frequencies of pNK and dNK cells, based on the expression of CD56, CD16, inhibitory (CD158b) and activating (CD161) Killer immunoglobulin-like receptors (KIRs), were detected by flow cytometry.

Results: Percentages of CD56 NK cells in peripheral blood and decidua were 17.5 % and 17.3 %, respectively. In both blood and decidua, CD56 NK cells were exceeding CD56 NK cells. The CD56 CD16 NK cells were the predominating subset of NK cells, followed by CD56 CD16. No substantial differences were detected in the levels of KIRs expression by the different NK subsets between blood and decidua. Abnormal up-regulation of both CD161 and CD158b on NK cells was observed in blood and decidua.

Conclusion: At the time of miscarriage, patients with RSM have an extremely active immune system and an increased number of toxic NK cells both in blood and decidua. The pNK cells reflect dNK cell changes during miscarriage and may be a useful non-invasive predicting tool in reproductive failure setting.
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http://dx.doi.org/10.1016/j.jri.2020.103130DOI Listing
August 2020

Hydatidiform mole in the era of COVID-19 pandemic. Is there an association?

Am J Reprod Immunol 2020 07 5;84(1):e13253. Epub 2020 May 5.

Faculty of Medicine, Department of Medical Microbiology & Immunology, Assiut University, Assiut, Egypt.

Coronavirus disease 2019 (COVID-19) is considered a worldwide pandemic. COVID-19 patients had profound immune dysregulation so they could be susceptible for adverse pregnancy outcomes as hydatidiform mole. In this article, we tried to explain the link between hydatidiform mole and COVID-19.
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http://dx.doi.org/10.1111/aji.13253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235493PMC
July 2020

Effect of adjunctive vaginal progesterone after McDonald cerclage on the rate of second-trimester abortion in singleton pregnancy: a randomized controlled trial.

Int J Gynaecol Obstet 2020 Jun 29;149(3):370-376. Epub 2020 Apr 29.

Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.

Objective: To evaluate the effect of adjunctive use of vaginal progesterone after McDonald cerclage on the rate of second-trimester abortion in singleton pregnancy.

Methods: A randomized controlled trial at Woman's Health Hospital, Assiut University, Egypt, between April 2017 and March 2019 enrolled women eligible for McDonald cerclage. After cerclage, participants were randomly assigned to receive progesterone (400 mg pessary) once daily until 37 weeks or no progesterone. The primary outcome was rate of abortion before 28 weeks. Secondary outcomes included gestational age at delivery, preterm delivery, mean birthweight, Apgar score, and admission to the neonatal intensive care unit (NICU).

Results: The rate of spontaneous abortion was higher in the no-progesterone group (P=0.016). Mean gestational age and mean birthweight was higher in the progesterone group (P<0.001 and P=0.002, respectively). The frequency of preterm neonates, neonates with Apgar score less than 7, and admission to NICU was higher in the progesterone group than in the no-progesterone group (P=0.005, P=0.008, and P=0.044, respectively).

Conclusion: Adjunctive use of vaginal progesterone after McDonald cerclage was found to decrease the frequency of second-trimester abortion and to improve perinatal outcomes in singleton pregnancy. Clinicaltrials.gov: NCT02846909.
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http://dx.doi.org/10.1002/ijgo.13148DOI Listing
June 2020

The effect of antenatal exercise on delivery outcomes: A systematic review and meta-analysis of randomized controlled trials.

J Gynecol Obstet Hum Reprod 2020 Jun 29;49(6):101736. Epub 2020 Mar 29.

Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt. Electronic address:

Background: Practicing different forms of exercises during pregnancy could have beneficial effects on maternal outcomes during labor.

Objective: To evaluate the effect of antenatal exercise on the duration of the delivery.

Search Strategy: Electronic databases including Web of Science, SCOPUS, The Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed were searched using the relevant keywords during August 2019.

Selection Criteria: Randomized controlled trials (RCTs) that compared any type of antenatal exercise versus no exercise in women who had vaginal delivery.

Data Collection And Analysis: Data were extracted from eligible studies and pooled in a meta-analysis model. Mean Difference (MD) was used in continuous outcomes, while Risk Ratio (RR) was used to deal with dichotomous outcomes. The main outcome was the duration of the first and second stages of labor while the secondary outcomes included the rate of perineal lacerations and analgesia request by women.

Results: Exercise significantly reduced the duration of second stage of labor (SMD= -0.82, 95 % CI [-1.48, -0.16], p = 0.01). No significant difference was noticed regarding the duration of the first stage of labor, perineal lacerations and request for analgesia.

Conclusion: Antenatal exercise could reduce the duration of the second stage of labor with racial differences.
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http://dx.doi.org/10.1016/j.jogoh.2020.101736DOI Listing
June 2020

Dual trigger using recombinant HCG and gonadotropin-releasing hormone agonist improve oocyte maturity and embryo grading for normal responders in GnRH antagonist cycles: Randomized controlled trial.

J Gynecol Obstet Hum Reprod 2020 May 12;49(5):101728. Epub 2020 Mar 12.

Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Egypt.

Objectives: To evaluate the effectiveness of dual trigger using gonadotropin-releasing hormone (GnRH) agonist and recombinant human chorionic gonadotropin (rHCG) versus rHCG alone for normal responders in GnRH antagonist intracytoplasmic sperm injection (ICSI) cycles.

Patients And Methods: The current study was a registered open-labeled randomized controlled trial (clinical trial.gov: NCT02916173) conducted in the ART Unit of a tertiary University hospital between October 2016 and October 2018. The study participants were randomized to either group I (HCG group) or group II (dual trigger group). The primary outcome was the number of mature (MII) oocytes in both groups.

Results: Both groups were similar regarding the baseline demographic and clinical characteristics. Women in the dual trigger group had a statistically significant higher number of retrieved oocytes (p = 0.001), MII oocytes (p = 0.01) and the number of grade one embryos (p = 0.04). Both groups were similar regarding the fertilization, implantation, clinical pregnancy and live birth rates in a fresh cycle. Dual trigger group was significantly higher in the clinical pregnancy rate and live birth rate after frozen embryo transfer (p = 0.04, 0.03, respectively).

Conclusion: Dual trigger by GnRH agonist and rHCG improve the oocyte maturity and embryo grading for normal responders in GnRH antagonist ICSI cycles.
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http://dx.doi.org/10.1016/j.jogoh.2020.101728DOI Listing
May 2020