Publications by authors named "Mahmoud Shokry"

9 Publications

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Spinal versus general anesthesia for Cesarean section in patients with sickle cell anemia.

Korean J Anesthesiol 2015 Oct 30;68(5):469-75. Epub 2015 Sep 30.

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

Background: Sickle cell anemia (SCA) increases the rate of maternal and fetal complications. This pilot study was designed to compare the maternal and fetal outcomes of spinal versus general anesthesia (GA) for parturients with SCA undergoing cesarean delivery.

Methods: Forty parturients with known SCA scheduled for elective Cesarean delivery were randomized into spinal anesthesia (n = 20) and GA groups (n = 20). Perioperative hemodynamic parameters were recorded. Postpartum complications were followed up. Opioid consumption was calculated. Blood loss during surgery and the number of patients who received intraoperative or postpartum blood transfusion were recorded. Patient satisfaction with the type of anesthesia was assessed. The Apgar score at 1 and 5 min, neonatal admission to the intensive care unit, and mortality were also recorded.

Results: Blood loss was significantly higher in the GA than spinal group (P = 0.01). However, the number of patients who received an intraoperative or postpartum blood transfusion was statistically insignificant. Significantly more patients developed intraoperative hypotension and bradycardia in the spinal than GA group. Opioid use during the first 24 h was significantly higher in the GA than spinal group (P < 0.0001). More patients had vaso-occlusive crisis in the GA than spinal group without statistical significance (P = 0.4). There was one case of acute chest syndrome in the GA group. No significant differences were observed in postoperative nausea and/or vomiting, patient satisfaction, or hospital length of stay. Neonatal Apgar scores were significantly better in the spinal than GA group at 1 and 5 min (P = 0.006 and P = 0.009, respectively). Neonatal intensive care admission was not significantly different between the two groups, and there was no neonatal mortality.

Conclusions: Spinal anesthesia may have advantages over GA in parturients with SCA undergoing Cesarean delivery.
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http://dx.doi.org/10.4097/kjae.2015.68.5.469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610926PMC
October 2015

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

Maternal serum placental growth factor and soluble fms-like tyrosine kinase 1 as early predictors of preeclampsia.

Acta Obstet Gynecol Scand 2010 ;89(1):143-6

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

Abstract The aim of this study was to identify pregnant women at risk of preeclampsia (PE) before clinical manifestations appeared using a panel of serum markers. We recruited 240 consecutive women who presented for antenatal care. We investigated whether serum levels of placental growth factor (PlGF), its inhibitor, soluble fms-like tyrosine kinase-1 (sFlt-1), measured at 13-16 weeks gestation and the expression of fms-like tyrosine kinase-1 (Flt-1) in the maternal neutrophils measured by flow cytometry could be predictive of the subsequent development of PE. Serum PlGF levels were found to be significantly lower among women who developed PE than patients with gestational hypertension or patients in the control group (p < 0.001). In contrast, serum sFlt1 levels were most elevated in patients who developed PE versus those with gestational hypertension or the control group (p < 0.001). Serum levels of neutrophil-Flt-1, however, were lower in women who developed PE than in those with gestational hypertension or those in the control group (p < 0.001). Increased serum levels of sFlt-1, decreased levels of neutrophil-Flt-1, and decreased levels of PlGF may predict women at risk of developing PE later in pregnancy.
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http://dx.doi.org/10.3109/00016340903289892DOI Listing
January 2010

Bilateral uterine artery ligation plus B-Lynch procedure for atonic postpartum hemorrhage with placenta accreta.

Int J Gynaecol Obstet 2010 Mar 27;108(3):187-90. Epub 2009 Nov 27.

Department of Obstetrics and Gynecology, Women's Health Centre, Assiut University, Egypt.

Objective: To assess the effectiveness of bilateral uterine artery ligation followed by B-Lynch compression suturing in women with atonic postpartum hemorrhage and placental site bleeding due to adherent placenta accreta.

Method: This protocol was followed in 26 women undergoing cesarean delivery for placenta accreta.

Results: Two women died from disseminated intravascular coagulopathy. In the remaining 24 women, placental remnants completely disappeared within 8 months and ovulation resumed after a mean+/-SD of 51.6+/-3.2 days. Moreover, 18 women (75%) became pregnant within 12 months.

Conclusion: Atonic postpartum hemorrhage and placental site bleeding due to adherent placenta accreta can be safely controlled by bilateral uterine artery ligation followed by B-Lynch compression suturing in women who desire to remain fertile.
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http://dx.doi.org/10.1016/j.ijgo.2009.08.035DOI Listing
March 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

Oral misoprostol reduces vaginal bleeding following surgical evacuation for first trimester spontaneous abortion.

Int J Gynaecol Obstet 2009 Nov 18;107(2):117-20. Epub 2009 Jul 18.

Department of Obstetrics and Gynecology, Women's Health Centre, Assiut University, Assiut, Egypt.

Objective: To assess the effectiveness and tolerability of misoprostol to reduce the amount and duration of vaginal bleeding following surgical evacuation for first trimester spontaneous abortion.

Methods: A total of 160 patients who underwent surgical evacuation for first trimester spontaneous abortion between 8 and 12 weeks of pregnancy were randomized into 2 groups to receive either 200 microg of oral misoprostol immediately after evacuation followed every 6 hours for 48 hours or no misoprostol. Pain scores, duration and amount of bleeding, and endometrial thickness were assessed over 10 days.

Results: Women who received misoprostol had significantly fewer bleeding days after evacuation (4.11+/-2.69 vs 5.89+/-3.06; P<0.001), fewer patients reported vaginal bleeding lasting 10 days or more (3.8% vs 15.0%; P=0.014), and endometrial thickness 10 days after evacuation was less (6.25+/-2.38 vs 7.23+/-1.94; P=0.05). Pain scores were comparable in both groups (1.54+/-0.65 vs 1.63+/-0.83; P=0.40) after 10 days.

Conclusion: Oral misoprostol is effective in reducing the prevalence and amount of vaginal bleeding after surgical evacuation for first trimester spontaneous abortion.
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http://dx.doi.org/10.1016/j.ijgo.2009.06.008DOI Listing
November 2009

Letrozole co-treatment in infertile women 40 years old and older receiving controlled ovarian stimulation and intrauterine insemination.

Fertil Steril 2009 Jun 23;91(6):2501-7. Epub 2008 May 23.

Toronto Centre For Advanced Reproductive Technologies (TCART), and Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.

Objective: To investigate the effect of a combination of letrozole and gonadotropins in advanced reproductive age infertile women who were treated with IUI.

Design: A retrospective case control study.

Setting: A private practice affiliated with an academic institute.

Patient(s): Infertile women 40 years old and older who were treated with IUI and controlled ovarian hyperstimulation (COH) using either letrozole in combination with FSH (n = 90) or FSH alone (n = 69).

Main Outcome Measure(s): Pregnancy rates (PR), mature follicles, serum levels of E(2), P, LH, endometrial thickness, rates of cycle cancellation, and FSH dose.

Result(s): Pregnancy rates were comparable between the letrozole-FSH co-treatment group and the FSH alone group. Significantly fewer cycles were cancelled in the letrozole co-treatment group. The E(2) levels and the number of follicles were significantly higher in the FSH-only group. Serum levels of LH were significantly higher in the co-treatment group on cycle day 7. The P levels were significantly higher in the FSH alone group on the day of hCG administration.

Conclusion(s): Letrozole co-treatment compared with using FSH alone has significantly modified the cycle characteristics without reducing PRs and could be of potential benefit in IUI cycles in older infertile women.
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http://dx.doi.org/10.1016/j.fertnstert.2008.03.020DOI Listing
June 2009

The pharmacokinetics of the prostaglandin E1 analogue misoprostol in plasma and colostrum after postpartum oral administration.

Eur J Obstet Gynecol Reprod Biol 2003 May;108(1):25-8

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

Objective: To study pharmacokinetics of prostaglandin E1 analogue, misoprostol in plasma and colostrum after postpartum oral administration.

Study Design: Twenty women received 600 microg doses of misoprostol orally after delivery. Plasma levels of the principal metabolite, misoprostol acid, were measured at 2, 10, 20, 30, 40, 50, 60, 90, 120, 180, 240 and 300 min (48 samples). Colostrum was expressed from the breasts to measure misoprostol acid at 60, 120, 180, 240, and 300 min (24 samples). Assay was done using isotope dilution gas chromatography (GC)/negative ion chemical ionisation mass spectrometry (MS).

Results: The plasma concentration of misoprostol acid rose quickly. Two minutes after oral administration its mean level was 91.5 pg/ml, peaked at 20 min (344 pg/ml), then fell steeply by 120 min (27.8 pg/ml) and remained low for the duration of the study. Misoprostol acid in colostrum reached maximum concentration of 20.9 pg/m within 1h after oral administration. It then declined gradually to 17.8 pg/ml at 2h, 2.8 pg/ml at 4h and to <1 pg/ml at 5h. Areas under misoprostol concentration versus time curves up to 5h were 290.1 pgh/ml in the plasma and 51.4 pgh/ml in colostrum, respectively.

Conclusion: Misoprostol acid is secreted in colostrum within 1h of oral administration of 600 microg of misoprostol; the pharmacokinetics of misoprostol after oral administration during postpartum is similar to that of other pregnancy periods.
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http://dx.doi.org/10.1016/s0301-2115(02)00355-xDOI Listing
May 2003