Publications by authors named "Ghada O Elsedfy"

6 Publications

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Behavioral and emotional effects of repeated general anesthesia in young children.

Saudi J Anaesth 2015 Apr-Jun;9(2):161-6

Department of Community Medicine, Faculty of Medicine, University of Western Kordofan, Sudan.

Background: Preclinical and clinical data suggest the possibility of neurotoxicity following exposure of young children to general anesthetics with subsequent behavioral disturbances. The aim of the study was to determine the overall effect of repeated general anesthesia on behavior and emotions of young children aged 1½-5 years old, compared to healthy children.

Materials And Methods: Thirty-five children underwent repeated anesthesia and surgery were matched with the same number of healthy children who attended vaccination clinic, as a control group. Both groups were administered the child behavior checklist (CBCL) 1½-5 years and Diagnostic and Statistical Manual of Mental Disorders (DSM) oriented scale. Behavior data were collected through a semi-structured questionnaire.

Results: The CBCL score revealed that children with repeated anesthesia were at risk to become anxious or depressed (relative risk [RR]; 95% confidence interval [CI] = 11 [1.5-80.7]), to have sleep (RR; 95% CI = 4.5 [1.1-19.4]), and attention problems (RR; 95% CI = 8 [1.1-60.6]). There was no difference in the risk between the two groups regarding emotionally reactive, somatic complaints, withdrawn problems, aggressive behavior, internalizing or externalizing problems. On DSM scale, children with repeated anesthesia were at risk to develop anxiety problems (RR; 95% CI = 3.7 [1.1-12.0]), and attention deficit/hyperactivity problems (RR; 95% CI = 3 [1.1-8.4]). There was no difference in the risk between the two groups regarding affective, pervasive developmental and oppositional defiant problems.

Conclusion: Young children who undergone repeated surgical procedures under general anesthesia were at risk for subsequent behavioral and emotional disturbances. Proper perioperative pain management, social support, and avoidance of unpleasant surgical experiences could minimize these untoward consequences.
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http://dx.doi.org/10.4103/1658-354X.152843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374221PMC
April 2015

Behavioral impact of sickle cell disease in young children with repeated hospitalization.

Saudi J Anaesth 2014 Oct;8(4):504-9

Department of Community Medicine, Faculty of Medicine, University of Western Kordofan, Sudan.

Background: Sickle cell disease (SCD) in children with a history of repeated hospitalization is distressing for children as well as their parents leading to anxiety and has negative effects on the psychological state of children and their families.

Objective: The aim of the study was to determine the overall effect of SCD on the behavior of young children age 1½ to 5 years old who had repeated history of hospitalization, compared to a control group of healthy children attended a vaccination clinic.

Patients And Methods: Thirty-five children of age 1½ to 5 years who have SCD and repeated history of hospitalization were recruited from pediatric clinic as the study group and matched with same number of healthy children who attended vaccination clinic, as a control group. Both groups were administered the child behavior checklist (CBCL) 1½ to 5 years and diagnostic and statistical (DSM)-oriented scale. Behavior data were collected through a semi-structured questionnaire.

Results: CHILDREN WHO HAVE SCD HAD STATISTICALLY SIGNIFICANT BEHAVIORAL CHANGES ON CBCL COMPARED TO THE CONTROL GROUP: Anxiety/depression (65.2 vs. 55.1; P < 0.001), somatic complaint (66.7 vs. 54.4; P < 0.001) withdrawn (63.4 vs. 53.2; P < 0.001), aggressive behavior (60.4 vs. 56; P=0.04), and internalizing symptoms (64.7 vs. 51.5; P < 0.001), respectively. The DSM scale showed that children with SCD scored significantly higher in pervasive developmental disorder compared to the control group (60.9 vs. 53.9; P < 0.001) respectively.

Conclusion: Children with SCD who had history of repeated hospitalization are at an increased risk of developing behavioral problems. Psychological counseling, social support, and proper pain management could minimize these behavioral consequences.
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http://dx.doi.org/10.4103/1658-354X.140867DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236938PMC
October 2014

Effects of intrapartum epidural analgesia at high altitudes: maternal, fetal, and neonatal outcomes. A randomized controlled trial of two formulations of analgesics.

Acta Obstet Gynecol Scand 2010 Jul;89(7):909-15

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

Objectives: To investigate whether intrapartum epidural analgesics (bupivacaine or ropivacaine) have an influence (safety and efficacy) on mothers, fetuses, or newborns at high altitudes (2,200 m above the sea level).

Design: Prospective randomized trial.

Setting: A tertiary referral hospital in Aseer region, Saudi Arabia.

Population: Eighty parturient women with normal full term pregnancy (37-40 weeks) were randomly allocated to a group receiving epidural bupivacaine 0.125% and the other receiving ropivacaine 0.2%, with fentanyl 100 microg given to both groups.

Methods: Intra- and postpartum clinical management of the pregnant women and newborns and fetal Doppler assessments were performed.

Main Outcome Measures: Severity of pain, onset and duration of analgesia, and occurrence of motor blockade were primary outcomes. Progress of labor, need for oxytocin augmentation, mode of delivery, and neonatal condition were secondary outcomes.

Results: Demographic, labor characteristics, and neonatal outcomes of the two groups were comparable. The onset of analgesia was relatively more rapid for ropivacaine group (p = 0.067). Duration of analgesia after the first bolus dose was longer and the need for supplemental epidural analgesic doses was lesser in the bupivacaine group (p = 0.041 and 0.045, respectively). In both groups, the fetal umbilical and middle cerebral artery pulsatility indices showed significant change when compared to the baseline of the same group.

Conclusion: At high altitudes, no major advantage was found for epidural ropivacaine over bupivacaine in addition to fentanyl for labor analgesia and no harmful effects of the medications were found on mothers, fetuses, or newborns.
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http://dx.doi.org/10.3109/00016349.2010.484042DOI Listing
July 2010

Effects of antenatal magnesium sulfate therapy on cerebral and systemic hemodynamics in preterm newborns.

Acta Obstet Gynecol Scand 2010 Jun;89(6):801-6

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

Objectives: To investigate whether antenatal magnesium sulfate (MgSO(4)) exposure has an influence on cerebral blood flow and systemic hemodynamics in preterm infants during the first few days of life.

Design: Prospective case-control study.

Setting: University affiliated referral hospital.

Population: A total of 48 women who delivered preterm (30-34 weeks) and their offspring.

Methods: Mothers and newborns were divided into two groups based on maternal exposure to MgSO(4) (n = 28) or not (n = 20). Cerebral blood flow velocity measurements were obtained from the neonatal anterior cerebral artery and right and left middle cerebral arteries.

Main Outcome Measures: Neonatal Doppler examinations of the brain circulation, heart rate, systemic blood pressure and echocardiographic assessment of ductus arteriosus shunting during the first week of life.

Results: Maternal MgSO(4) had a significant lowering effect on neonatal cerebral blood flow. Peak systolic velocity was significantly lower in anterior cerebral artery and right and left middle cerebral arteries (p = 0.031, 0.027 and 0.039, respectively), as was end-diastolic velocity (p = 0.035, 0.012 and 0.025, respectively) and mean velocity (p = 0.036, 0.024 and 0.003, respectively). The resistance index and relative vascular resistance in the three cerebral arteries showed no significant difference between the two studied groups.

Conclusion: Antenatal MgSO(4) exposure before preterm birth has potent systemic vascular effects in the preterm offspring, which is reflected in decreased neonatal cerebral perfusion during the critical first few days of life. This is associated with an increased incidence of patent ductus arteriosus, which may require operative intervention.
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http://dx.doi.org/10.3109/00016341003739542DOI Listing
June 2010

Expression of matrix metalloproteinases 2 and 9 in human trophoblasts of normal and preeclamptic placentas: preliminary findings.

Exp Mol Pathol 2009 Dec 28;87(3):219-25. Epub 2009 Aug 28.

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

Objective: Here we test the hypothesis that "the expression of matrix metalloproteinase 2 and 9 proteins is altered in preeclamptic placentas compared to placentas of normal pregnancy."

Patients And Methods: This case-control study includes preeclamptic placentas (40 women with preeclampsia) from a singleton pregnancy and placentas of normal pregnancies (control group, 40 women with uncomplicated pregnancy). The expression patterns of metalloproteinases 2 and 9 were examined using immunohistochemical staining methods.

Results: Compared to uncomplicated pregnancy, the incidence of intrauterine growth restriction was high and the mean birth weight was markedly low in patients with preeclampsia. Both metalloproteinase 2 and 9 proteins were frequently and strongly expressed in the majority of placentas of uncomplicated pregnancies (control group). Metalloproteinase 9 expression was absent in the majority of the preeclamptic placentas. In the remaining cases of preeclamptic placentas, the expression of metalloproteinase 9 was weak. In contrast, a strong metalloproteinase 2 protein expression was seen in the majority of the preeclamptic placentas.

Conclusions: These preliminary data demonstrate the expression of metalloproteinase 2 and 9 proteins in the placentas of uncomplicated pregnancies. The absence/reduced expression of metalloproteinase 9 in the preeclamptic placentas may be related to insufficient invasion of trophoblast, leading to superficial and unsuccessful placentation.
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http://dx.doi.org/10.1016/j.yexmp.2009.08.001DOI Listing
December 2009

The effect of calcium supplementation during pregnancy on fetal and infant growth: a nested randomized controlled trial within WHO calcium supplementation trial.

J Matern Fetal Neonatal Med 2009 Feb;22(2):94-100

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

Objective: To evaluate whether prenatal calcium supplementation affects fetal and infant growth during the first year of life.

Methods: Ninety-one pregnant women and 159 mothers and their infants enrolled beginning before 20 weeks gestation, and women received daily supplements containing either 1.5 g calcium or placebo. Women were examined by ultrasound at 20, 24, 28, 32 and 36 weeks to evaluate fetal biometry. During the first year after delivery, sub-groups of infants born from mothers participating in the trial were examined to assess infant growth. Anthropometric measurements of the infants were assessed. Mothers were inquired about lactation patterns, morbidities of the infants, separation from the mother, and admission to hospital.

Results: Ultrasound measurements of fetal biometry did not show any differences between fetuses whose mothers received calcium supplementation during pregnancy and those who received placebo. Concerning infant growth, the mean weight and head circumference of infants born to calcium-supplemented mothers were similar to those born to placebo-supplemented mothers during the first year of life. The mean mid-arm circumference and mean length were significantly higher in the infants of the calcium group at sixth and ninth month, respectively. But, at 12 months, there were no significant differences in any of the anthropometric measurements.

Conclusion: Calcium supplementation during pregnancy of women with low calcium intake does not have a noticeable impact on fetal and infant growth during the first year of life.
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http://dx.doi.org/10.1080/14767050802464569DOI Listing
February 2009