Publications by authors named "Amr Wahba"

13 Publications

  • Page 1 of 1

High-sodium diet does not worsen endothelial function in female patients with postural tachycardia syndrome.

Clin Auton Res 2021 Mar 10. Epub 2021 Mar 10.

Division of Clinical Pharmacology, Department of Medicine, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, 560A RRB, 2222 Pierce Ave,, Nashville, TN, 37232, USA.

Purpose: Postural tachycardia syndrome (POTS), a syndrome characterized by orthostatic symptoms and a heart rate increase of at least 30 beats per minute in the absence of hypotension upon standing, is often accompanied by increased sympathetic activity and low blood volume. A common non-pharmacologic recommendation for patients with POTS is a high-sodium (HS) diet with the goal of bolstering circulating blood volume. The objective of this study is to assess the effects of 6 days of a HS diet on endothelial function in POTS.

Methods: A total of 14 patients with POTS and 13 age-matched healthy controls, all females, were studied following 6 days on a low-sodium (LS) diet (10 mEq/day) and 6 days on a HS diet (300 mEq/day) in a crossover design. We measured endothelial function following reactive hyperemia in the brachial artery using flow-mediated dilation (FMD), leg blood flow (LBF) using strain gauge plethysmography in the calf, and reactive hyperemic index (RHI) in the microcirculation of the hand using pulsatile arterial tonometry.

Results: On the LS diet, FMD% did not differ between patients with POTS and the healthy controls although peak brachial artery diameter was lower for the patient group. RHI was higher for the patient group than for the controls, but there were no differences in post-ischemic LBF increase. On the HS diet, there were no between-group differences in FMD%, LBF increase, or RHI.

Conclusion: In summary, a HS diet for 6 days did not induce endothelial dysfunction. This non-pharmacologic treatment used for patients with POTS does not negatively affect endothelial function when used for a sub-acute duration.

Trial Registration: ClinicalTrials.gov NCT01550315; March 9, 2012.
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http://dx.doi.org/10.1007/s10286-021-00772-yDOI Listing
March 2021

Impaired Endothelial Function in Patients With Postural Tachycardia Syndrome.

Hypertension 2021 Mar 25;77(3):1001-1009. Epub 2021 Jan 25.

Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN.

The purpose of this study is to evaluate endothelial function in postural tachycardia syndrome (PoTS), a poorly understood chronic condition characterized by a state of consistent orthostatic tachycardia (delta heart rate ≥30 beats per minute) upon standing without orthostatic hypotension. Nineteen patients with PoTS and 9 healthy controls were studied after 3 days of a fixed, caffeine-free, normal sodium (150 milliequivalents/day) diet. All participants underwent autonomic function testing, including sinus arrhythmia, valsalva maneuver, hyperventilation, cold pressor, handgrip, and a standing test with catecholamine measurements, followed by endothelial function testing. We analyzed 3 measures of endothelial function: percent brachial flow-mediated dilation, digital pulsatile arterial tonometry, and postischemic percent leg blood flow. Flow-mediated dilation was significantly lower in patients with PoTS (6.23±3.54% for PoTS) than in healthy controls (10.6±4.37% for controls versus, =0.014). PoTS and controls had similar digital pulsatile arterial tonometry (1.93±0.40 arbitrary units for controls versus 2.13±0.63 arbitrary units for PoTS). PoTS had similar but suggestive percent leg blood flow to controls (313±158% for PoTS versus 468±236% for controls, =0.098). Patients with PoTS have significantly reduced flow-mediated dilation compared with healthy controls, suggesting that PoTS is characterized by endothelial dysfunction in conduit arteries. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01308099.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.16238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878337PMC
March 2021

A Rare Interlabial Mass in a 9-Month-Old Infant: A Case Report and Review of Literature.

J Pediatr Adolesc Gynecol 2021 Jun 21;34(3):415-417. Epub 2021 Jan 21.

Department of Obstetrics and Gynecology, Cairo University, Egypt. Electronic address:

Background: Interlabial masses in infants and children are quite rare. One of their rarest causes is urethral polyp or urethral caruncle. It is a benign fleshy outgrowth at the urethral meatus. Certain etiology is still unknown.

Case: A healthy 9-month-old female infant presented with a mass protruding from the vulva with no other complaints. Examination with the patient under general anesthesia revealed an interlabial mass appearing as a pedunculated pinkish polyp, originating from the posterior lip of the external urethral meatus. Surgical excision of the mass was done and histopathology confirmed it to be a urethral polyp.

Summary And Conclusion: Urethral polyps are rare in the pediatric age group. Their occurrence in this age group might support a congenital etiology. Surgical resection of polyps allows histopathological examination and a high cure rate with no risk of recurrence.
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http://dx.doi.org/10.1016/j.jpag.2021.01.008DOI Listing
June 2021

Physical endometrial manipulation and its impact on success rate and live birth rate in ICSI in patients with unexplained infertility after recurrent ICSI failure, a double blinded randomized controlled trial.

J Matern Fetal Neonatal Med 2020 Sep 22;33(17):2983-2989. Epub 2019 Jan 22.

Obstetrics and Gynecology Department, AlAzhar University, Cairo, Egypt.

Unexplained infertility is a rising problem and endometrial manipulation could be one of the solutions for enhancing the pregnancy rate and live birth rate in such circumstances. To evaluate the influence of local endometrial physical manipulation with specializd method for endometrial and tubal hydration (Elgazzar and Alalfy technique) on ICSI outcome and in increasing chemical, clinical, and live birth rate in ICSI after previous recurrent ICSI failure in patients with unexplained infertility. When comparing group 1 (hydrotubation group) and group 2 (the control group with no intervention) with regards to the biochemical, clinical, and live birth rate, the hydrotubation group revealed higher rates and a better ICSI outcome. Hydrotubation is useful in increasing biochemical, clinical, and live birth rates after recurrent failed ICSI trials with a specialized method for hydration of endometrium and tubes (Elgazzar and Alalfy technique).
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http://dx.doi.org/10.1080/14767058.2019.1566897DOI Listing
September 2020

Complicated Infective Endocarditis Limited to a Chiari Network.

Case Rep Cardiol 2018 26;2018:3837825. Epub 2018 Jun 26.

Meharry Medical College, Nashville, TN, USA.

Introduction: The Chiari network is an uncommon vestigial structure of the heart that is often clinically insignificant. We present an unusual case of infective endocarditis affecting only the Chiari network in a patient who presented with septic emboli to the lungs and brain.

Case Summary: A 61-year-old man was admitted with a 2-month history of hemoptysis, pleuritic chest pain, and right upper extremity numbness and weakness. He was found to have multifocal bilateral pulmonary opacities and an abscess collection in the brain. Blood cultures grew and transthoracic echocardiogram (TTE) was normal. Subsequent transesophageal echocardiogram (TEE) revealed an 8.3 × 4.6 mm vegetation arising from the Chiari network, close to the right atrial appendage, without involvement of the tricuspid valve or any of the other valves. There were no atrial or ventricular septal defects. He was treated with appropriate antibiotics with improvement of symptoms. Repeat imaging showed improvement of the lung opacities, but not the brain abscess, warranting transfer to another hospital for neurosurgical intervention.

Conclusion: The diagnosis and management of isolated Chiari network endocarditis require a high index of clinical suspicion. A multidisciplinary approach incorporating both medical and surgical approaches where necessary is essential for optimal outcome.
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http://dx.doi.org/10.1155/2018/3837825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038650PMC
June 2018

Follicular sensitivity index (FSI): a novel tool to predict clinical pregnancy rate in IVF/ICSI cycles.

J Assist Reprod Genet 2017 Oct 3;34(10):1317-1324. Epub 2017 Jul 3.

Department of Gynecology and Obstetrics, Cairo University, 1 Alsaraya street AlKasr AlAiny, Cairo, Egypt.

Purpose: This study aims to introduce a new tool (the Follicular Sensitivity Index; FSI) for objective assessment of follicular responsiveness to exogenous gonadotropins and to evaluate its ability to predict the clinical pregnancy rate in women with unexplained infertility or tubal factor undergoing IVF/ICSI.

Methods: FSI was calculated as preovulatory follicle count (PFC) × 100,000/[antral follicle count (AFC) × total received FSH doses]. One thousand women were included and were divided according to the FSI tertile values into three groups. The primary outcome was clinical pregnancy defined by the presence of an intrauterine gestational sac 5 weeks after embryo transfer.

Results: There was progressive increase in the clinical pregnancy rate from the low to the high FSI groups (0.27 ± 0.4 vs 0.4 ± 0.4 and 0.58 ± 0.4; p < 0.001). Receiver operator curves showed that FSI had a greater area under the curve than those of the AFC, PFC, and the FSH dose (0.638 vs 0.509, 0.538, and 0.589 respectively). Multivariate logistic regression analysis showed that the correlation between FSI and pregnancy was independent of potential confounding factors like age and body mass index (p < 0.001).

Conclusion: FSI can predict the clinical pregnancy rate in women with unexplained infertility or tubal factor undergoing IVF/ICSI using GnRH agonist protocol. Higher FSI values had significantly higher oocyte yield and fertilization and clinical pregnancy rates. Wider implications of these findings include the potential use of FSI to define absolute criteria of poor/good ovarian response in IVF/ICSI cycles, guide future IVF cycle management for the same couples, and guide cycle cancelation criteria for poor ovarian response.
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http://dx.doi.org/10.1007/s10815-017-0984-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633572PMC
October 2017

A randomized double-blind controlled trial of different filling pressures in operative outpatient hysteroscopy.

Int J Gynaecol Obstet 2017 Oct 25;139(1):55-60. Epub 2017 Jul 25.

Department of Obstetrics and Gynaecology, University of Würzburg, Würzburg, Germany.

Objective: To identify the optimal filling pressure during operative outpatient hysteroscopy that allows completion of the procedure while minimizing pain.

Methods: A double-blind randomized controlled trial of women aged 20-60 years undergoing operative hysteroscopy (including biopsy sampling, polypectomy, septum excision, adhesiolysis, or intrauterine device removal) was undertaken at a university hospital in Egypt between May 2014 and July 2016. Using a computer-generated randomization sequence, patients were randomly assigned into three equal groups: filling pressures of 40 mm Hg (group 1), 60 mm Hg (group 2), and 80 mm Hg (group 3; control). The primary outcome was the proportion of successfully completed procedures. Analyses were by intention to treat.

Results: Each group contained 80 women. The procedure was completed for 63 (79%) women in group 1, 73 (91%) in group 2, and 76 (95%) in group 3 (P=0.004). The proportion of completed procedures in group 3 was significantly different from that in group 1 (P=0.002), but did not differ significantly from that in group 2 (P=0.349).

Conclusion: A uterine filling pressure of 60 mm Hg does not reduce the frequency of completion when compared with 80 mm Hg in operative outpatient hysteroscopy. CLINICALTRIALS.

Gov Registration: NCT02142673.
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http://dx.doi.org/10.1002/ijgo.12247DOI Listing
October 2017

3D ultrasound assessment of endometrial junctional zone anatomy as a predictor of the outcome of ICSI cycles.

Eur J Obstet Gynecol Reprod Biol 2017 May 28;212:160-165. Epub 2017 Mar 28.

Obstetrics and Gynecology Department, Kasr AlAiny hospital, Cairo University, Egypt.

Objective: To study the relation between junctional zone thickness (JZ) and success of implantation in IVF/ICSI cycles.

Study Design: A prospective study included 100 infertility patients undergoing ICSI. The long protocol was used in all patients. JZ was measured using 3D ultrasound, in the coronal section, at three places, on two occasions. First measurement was done before HMG was started (i.e. when down regulation was achieved). Second measurement was done on the day of ovum pick up (OPU). Follow up after treatment was done to determine the rate of implantation.

Results: There was a highly significant difference between pregnant and non pregnant treated women regarding the measurement of JZ at the day of OPU at all sites named fundal (0.27±0.1 vs. 0.38±0.14), anterior (0.28±0.07 vs. 0.36±0.09), posterior (0.32±0.1 vs. 0.37±0.09) and average (0.29±0.08 vs. 0.37±0.09) respectively. The cut off value, sensitivity and specificity of measurement of JZ at fundus were (≤0.31,90% and 66.7%), at anterior wall were (≤0.35,90% and 60%), at posterior wall (≤0.25, 50% and 93.3%) and average were (≤0.32,70% and 70%) respectively.

Conclusion: The thinner the junctional zone at day of OPU, the higher the implantation rate and the difference between JZ measured at the day of down regulation and the day of OPU is a predictor of the outcome of ICSI cycles.
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http://dx.doi.org/10.1016/j.ejogrb.2017.03.035DOI Listing
May 2017

Impact of Uterine Scar on Pain Experienced During Outpatient Hysteroscopy: A Prospective Blinded Comparative Study.

J Minim Invasive Gynecol 2017 May - Jun;24(4):626-631. Epub 2017 Feb 1.

Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt; Department of Obstetrics and Gynecology, University of Wuerzburg, Wuerzburg, Germany.

Study Objective: To study the impact of uterine scar on pain experienced during outpatient hysteroscopy.

Design: A prospective blinded comparative study (Canadian Task Force classification II-1).

Setting: Outpatient hysteroscopy clinic at a university hospital.

Patients: We included 140 women in the childbearing period attending an outpatient hysteroscopy clinic. Patients were divided into 2 groups. Group A included patients with previous uterine scar (n = 70) and Group B included those with unscarred uterus (n = 70). None of the patients had a previous attempt of a vaginal delivery.

Intervention: Diagnostic outpatient hysteroscopy without the use of anesthesia or analgesia.

Measurements: We assessed pain experienced during and immediately after the procedure using a 100-mm visual analog scale. We also evaluated the successful completion of the procedure.

Results: There were no statistically significant differences in the pain scores between patients with scarred uterus and those with unscarred uterus during or immediately after the procedure. The procedure was aborted in only 1 case in the scarred uterus group. This patient had a history of surgical site infection, which may denote a weak scar. There were no statistically significant differences in pain scores between patients with cesarean scar and those with myomectomy scar. No statistically significant differences in pain scores were found between patients with 1, 2, 3, or 4 cesarean deliveries.

Conclusion: Uncomplicated uterine scars do not have an impact on pain experienced during or immediately after diagnostic outpatient hysteroscopy using a 3.8-mm hysteroscope.
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http://dx.doi.org/10.1016/j.jmig.2017.01.018DOI Listing
December 2017

Cost effectiveness of letrozole and purified urinary FSH in treating women with clomiphene citrate-resistant polycystic ovarian syndrome: a randomized controlled trial.

Hum Fertil (Camb) 2017 Apr 8;20(1):37-42. Epub 2016 Nov 8.

a Cairo University , Cairo , Egypt.

We aimed to compare the cost effectiveness of letrozole versus purified urinary follicle stimulating hormone (FSH) in treating patients with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). This was a randomized trial conducted in Cairo University and Beni-Suef University Hospitals, Egypt. A cohort of 140 eligible women was randomized to receive either letrozole 2.5 mg twice daily for five days, or FSH using a graduated regimen starting with a dose of 75 IU. Treatment was repeated for three months if pregnancy did not occur. There were no significant differences between the two treatments in the cumulative clinical pregnancy rate (30% vs. 34%; p = 0.578), cumulative ovulation rate (47% vs. 57%; p = 0.236), miscarriage rate (9% vs. 4%, p > 0.999) or multiple pregnancy rate (0% and 8%, p = 0.491) but the FSH cycles were 4.8 times more expensive. Letrozole and FSH were both effective in treating women with CC-resistant PCOS but letrozole was more cost effective.Study registration number: NCT02304107.
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http://dx.doi.org/10.1080/14647273.2016.1242783DOI Listing
April 2017

Gonadotropin-releasing hormone antagonists versus standard androgen suppression therapy for advanced prostate cancer A systematic review with meta-analysis.

BMJ Open 2015 Nov 13;5(11):e008217. Epub 2015 Nov 13.

German Cochrane Centre, Medical Center-University of Freiburg, Freiburg, Germany.

Objectives: To evaluate efficacy and safety of gonadotropin-releasing hormone (GnRH) antagonists compared to standard androgen suppression therapy for advanced prostate cancer.

Setting: The international review team included methodologists of the German Cochrane Centre and clinical experts.

Participants: We searched CENTRAL, MEDLINE, Web of Science, EMBASE, trial registries and conference books for randomised controlled trials (RCT) for effectiveness data analysis, and randomised or non-randomised controlled studies (non-RCT) for safety data analysis (March 2015). Two authors independently screened identified articles, extracted data, evaluated risk of bias and rated quality of evidence according to GRADE.

Results: 13 studies (10 RCTs, 3 non-RCTs) were included. No study reported cancer-specific survival or clinical progression. There were no differences in overall mortality (RR 1.35, 95% CI 0.63 to 2.93), treatment failure (RR 0.91, 95% CI 0.70 to 1.17) or prostate-specific antigen progression (RR 0.83, 95% CI 0.64 to 1.06). While there was no difference in quality of life related to urinary symptoms, improved quality of life regarding prostate symptoms, measured with the International Prostate Symptom Score (IPSS), with the use of GnRH antagonists compared with the use of standard androgen suppression therapy (mean score difference -0.40, 95% CI -0.94 to 0.14, and -1.84, 95% CI -3.00 to -0.69, respectively) was found. Quality of evidence for all assessed outcomes was rated low according to GRADE. The risk for injection-site events was increased, but cardiovascular events may occur less often by using GnRH antagonist. Available evidence is hampered by risk of bias, selective reporting and limited follow-up.

Conclusions: There is currently insufficient evidence to make firm conclusive statements on the efficacy of GnRH antagonist compared to standard androgen suppression therapy for advanced prostate cancer. There is need for further high-quality research on GnRH antagonists with long-term follow-up.

Trial Registration Number: CRD42012002751.
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http://dx.doi.org/10.1136/bmjopen-2015-008217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654283PMC
November 2015

Abnormal uterine bleeding in midlife: The role of levonorgestrel intrauterine system.

J Midlife Health 2013 Jan;4(1):36-9

Department of Obstetrics and Gynecology, Cairo University Hospital, Egypt.

Abnormal uterine bleeding is a common gynecological complaint affecting 10-30% of women in midlife and constitute about one-third of all outpatient gynecological visits. It adversely affects the quality of woman's life and can lead to psychological, social, medical, and sexual problems and thus necessitating appropriate and adequate management. Different treatment modalities for such problems are available, yet the levonorgestrel intrauterine system (LNG-IUS) has recently provided a good treatment option effective in treating such complaints and at the same time, having a reliable contraceptive effect which is desired by such age group. For women in their reproductive years, the LNG-IUS has become one of the most acceptable medical treatments for menorrhagia, reducing referrals to specialists, and decreasing the recourse to operative treatments. It is easy to insert, has a sustained effect, cost-effective, and well tolerated besides providing reliable contraception.
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http://dx.doi.org/10.4103/0976-7800.109634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702063PMC
January 2013

Changing attitudes in ovarian stimulation.

Womens Health (Lond) 2011 Sep;7(5):505-7

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http://dx.doi.org/10.2217/whe.11.51DOI Listing
September 2011