Effect of Low-Level Laser Therapy versus Electroacupuncture on Postnatal Scanty Milk Secretion: A Randomized Controlled Trial.

OBJECTIVE: Postnatal scanty milk secretion is a common complaint. Some physical and medical interventions were advocated to help milk production. These interventions should be effective and safe for the mother and the infant. This study aimed to compare the effects of low-level laser therapy and electroacupuncture on postnatal scanty milk secretion. STUDY DESIGN: A randomized controlled study conducted on 60 healthy primiparous mothers with insufficient lactation. They were randomly divided into three equal groups: group A (control), group B (those who received low-power He-Ne laser beam on both breasts), and group C (those who received faradic current stimulation at Spleen 6, Liver 3, and Small Intestine 1 acupuncture points on both sides). All participants received 10 mg Domperidone three times a day and were given advice about lactation, nutrition, and fluid intake. Evaluation was done before and after the treatment program. RESULTS: The mean serum prolactin, infant weight, and visual analog scale (VAS) score were significantly increased in the three groups posttreatment when compared with their corresponding levels pretreatment. Posttreatment serum prolactin was significantly elevated in group C more than the other two groups (p = 0.001 and 0.012, respectively). Also, it was significantly elevated in group B more than in group A (p = 0.001). The mean value of infant weight was significantly elevated in group C when compared with its corresponding values in both groups A (p = 0.001) and B (p = 0.029). The VAS score was significantly increased in both groups B and C when compared with group A (p = 0.001). CONCLUSION: Electroacupuncture is more effective than low-level laser therapy in increasing postnatal scanty milk secretion. CLINICAL TRIAL REGISTRATION: NCT03806062.

The Effect of Antenatal Vaginal Progesterone Administration on Uterine, Umbilical, and Fetal Middle Cerebral Artery Doppler Flow: A Cohort Study.

OBJECTIVE: This study aimed to evaluate the effect of vaginal progesterone (P) administration during the second and third trimesters of pregnancy on Doppler velocimetry of uterine, umbilical, and middle cerebral vessels. STUDY DESIGN: A prospective cohort study conducted on 80 women at risk for preterm labor. Uterine artery, umbilical artery, and middle cerebral artery (MCA) Doppler indices were measured before and after 1 week of administration of 200 mg twice daily vaginal P. The primary outcome parameter was the change of MCA pulsatility index (PI) after P administration. Secondary outcomes included changes in uterine artery and umbilical artery Doppler measurement. RESULTS: There was no significant changes of umbilical artery resistance index (RI) (0.69 ± 0.049 vs. 0.68 ± 0.041), umbilical artery PI (1.14 ± 0.118 vs. 1.11 ± 0.116), uterine artery RI (0.66 ± 0.12 vs. 0.66 ± 0.107), uterine artery PI (1.00 ± 0.26 vs. 1.016 ± 0.24), and MCA PI (1.27 ± 0.18 vs. 1.26 ± 0.23) measurements before and after 1 week of P administration, respectively. CONCLUSION: Administration of vaginal P has no significant effects on uterine artery, umbilical artery, and MCA Doppler indices.

Surgeon-tailored polypropylene mesh as a tension-free vaginal tape-obturator versus original TVT-O for the treatment of female stress urinary incontinence: a long-term comparative study.

INTRODUCTION AND HYPOTHESIS: The objective of the study was to compare the safety and efficacy of surgeon-tailored polypropylene mesh (STM) through tension-free vaginal tape-obturator (TVT-O) versus original TVT-O in the treatment of stress urinary incontinence (SUI) aiming to decrease the cost of treatment. This is important in developing countries due to limited health care resources. METHODS: A retrospective cohort study was done at the Urology and Gynecology Departments (dual-center), Cairo University from May 2007 to June 2010. Women evaluated by cough stress test, Stress and Urge Incontinence and Quality of Life Questionnaire (SUIQQ), maximum flow rate (Qmax), and abdominal leak point pressure (ALPP) with follow-up for at least 48 months were included. Patients with post-void residual urine > 100 ml, bladder capacity < 300 ml, or impaired compliance were excluded. The effect of different factors on outcome was compared between both groups pre- and postoperatively using the paired t, Wilcoxon signed rank, McNemar, chi-square, Fisher's exact, independent t, or Mann-Whitney tests. RESULTS: STM and TVT-O were inserted in 79 and 66 women, respectively. Intrinsic sphincter deficiency, ALPP, previous surgeries, associated urgency, urgency urinary incontinence (UUI), and prolapse were comparable in both groups. Operative duration was longer in STM by 10 min. No significant difference was found between both groups in complications (p = 0.462), cure (p = 0.654), and different indices of SUIQQ. In STM, 74 (93 %) were cured and 3 (4 %) improved, while SUI persisted in 2 (2 %) patients. In TVT-O, 59 (89 %) were cured and 4 (6 %) improved, while failure was detected in 3 (4 %) patients. CONCLUSIONS: The 5-year outcome is comparable between STM and TVT-O. Furthermore, STM is more economical due to our resterilizable modified helical passers and the cheap polypropylene mesh.

Impacts of enzymes and probiotic in improving the utilization of sieved olive pulp meal in growing rabbit diets.

Objective: This research assesses the utilization of sieved olive pulp (SOP) in the diet of growing rabbits through the use of an exogenous enzyme or dry yeast as a pretreatment. Materials and Methods: One hundred sixty-eight male V-Line rabbits aged 5 weeks (weighing 550 ± 25 gm) were randomly divided into seven groups with eight replicates each as follows: the control group was fed a basal diet without supplementation; while the other six groups were fed basal diets containing 20% and 25% of SOP and supplemented with 0.1 gm/kg Econase (E), 0.5 gm/kg dry yeast (Y), and a combination of both. The experiment lasted for 8 weeks. Results: The results indicated that supplementation of E, Y, and EY into rabbit diets containing SOP improved live body weight, body weight gain, feed conversion ratio, and nutrient digestibility. A higher dressing percentage was observed in the groups fed a 20% and 25% SOP diet supplemented with EY (p < 0.05). The treated groups showed an increase in total protein, albumin, globulin, A/G ratio, total antioxidant capacity, superoxide dismutase, and glutathione peroxidase (p < 0.05), while there was a significant decrease in triglycerides, total cholesterol, and malondialdehyde levels (p < 0.05) compared to the control. Rabbit groups fed an SOP diet supplemented with E, Y, or EY demonstrated higher (p < 0.05) economic efficiency compared to the control. Conclusion: Supplementing the diet of rabbits containing SOP with exogenous enzymes and/or dry yeast enhances the nutritional value of SOP while improving rabbit performance, nutrient digestibility, and antioxidant status.

Retracted: Endometrial scratch injury in infertile women seeking conception through natural or intrauterine insemination cycles: A systematic review and meta-analysis.

Maged, AM, Ogila, AI, Mohsen, RA, et al. Endometrial scratch injury in infertile women seeking conception through natural or intrauterine insemination cycles: A systematic review and meta-analysis. Int J Gynecol Obstet. 2021; 00: 1-20. doi:10.1002/ijgo.14030 The above article, published online on 17 November 2021 on Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal's Editor-in-Chief, Professor Michael Geary, the International Federation of Gynecology and Obstetrics and John Wiley & Sons Ltd. The journal was made aware of concerns regarding the considerable overlap with a previously published systematic review.[1] The authors responded to the concerns raised and it was found that some of the source clinical trial data could not have been accessed in this systematic review. As a result, the journal is issuing this retraction. [1] Bui BN, Lensen SF, Gibreel A, Martins WP, Torrance H, Broekmans FJ. Endometrial injury for pregnancy following sexual intercourse or intrauterine insemination. Cochrane Database of Systematic Reviews 2022, Issue 10. Art. No.: CD011424. DOI: 10.1002/14651858.CD011424.pub4.

Efficacy of Dietary Supplementation with Zinc-Chromium Mixture, Organic Selenium, or Their Combinations on Growth Performance, Carcass Traits, and Blood Profiles of Broilers under Heat Stress Conditions.

To determine the effects of organic selenium (0.0-0.6 mg and 0.9 mg Se/Kg diet) and Zn-Cr mixture (100 mg Zn/Kg diet plus 1.5 mg Cr/Kg diet) on broiler chicken performance, carcass traits, blood hematology, and biochemistry under heat stress conditions, this study was conducted. Under temperatures between 30.21 to 31.82 °C, 240 broiler chickens (Ross-308), which were 7-day-old, were randomly assigned to one of six treatments: T1 (control), T2 (100 mg Zn per kg of diet and 1.5 mg Cr per kg of diet), T3 (0.6 mg Se per kg of diet), T4 (0.9 mg Se per kg of diet), T5 (100 mg Zn, 1.5 mg Cr and (LSe), and T6 (100 mg Zn, 1.5 mg Cr and (HSe)). At 35 days old, the chicks fed a diet containing Zn-Cr with low or high organic selenium (organic-Se) outweighed the control group in terms of live body weight, weight gain, and feed conversion ratio (p < 0.05). In comparison to the control treatment, birds fed diets supplemented with Zn-Cr or organic-Se (LSe, HSe) significantly increased their serum levels of total protein and total antioxidant capacity. However, these additives resulted in a decrease (p < 0.01) in their serum levels of triglycerides, total cholesterol, low-density lipoprotein (LDL) cholesterol, creatinine, and uric acid. Together, it was found that trace elements (Zn-Cr and organic-Se) may greatly lessen the impacts of heat stress on broilers by promoting growth performance and boosting metabolic processes.

Comparative study between single versus dual trigger for poor responders in GnRH-antagonist ICSI cycles: A randomized controlled study.

OBJECTIVE: To investigate whether dual triggering of final oocyte maturation with a combination of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG) can improve the number of retrieved oocytes and clinical pregnancy rate in poor responders undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) cycles using a GnRH-antagonist protocol. METHODS: A randomized controlled trial included poor ovarian responders indicated for ICSI using a GnRH-antagonist protocol. They were divided equally into two groups: group I received 10 000 units of hCG plus 0.2 mg of triptorelin while group II received 10 000 units of hCG only for triggering of ovulation. The primary outcome parameter was the number of oocytes retrieved. Secondary outcomes included metaphase II oocytes number, cancellation rate, number of obtained embryos, chemical and clinical pregnancy rates. RESULTS: One hundred and sixty women were included in the study, with 80 women in each treatment group. Dual triggering was associated with higher number of retrieved oocytes (5.3 ± 1.9 vs 4.5 ± 2.4, P=0.014), metaphase II oocytes (3.8 ± 1.4 vs 3.1 ± 1.7, P=0.004), total and grade 1 embryos (2.7 ± 1.1 and 2.3 ± 1.0 vs 1.9 ± 1.2 and 1.1 ± 0.2, P=0.001 and 0.021 respectively), and transferred embryos (2.2 ± 0.9 vs 1.6 ± 0.9, P=0.043, and lower cancellation rate (7.5% vs 20%, P=0.037) compared with single triggering. There were significantly higher chemical (25% vs 11.3%, P=0.039) and clinical (22.5% vs 8.8%, P=0.028) pregnancy rates in women with dual triggering compared with those with single triggering. CONCLUSION: Dual triggering is associated with better IVF outcome in poor responders compared with single trigger. Clinical trial registration NCT04008966.

The value of ultrasound guidance during IUD insertion in women with RVF uterus: A randomized controlled trial.

OBJECTIVE: The study objective is to evaluate the benefits of using ultrasound guidance during insertion of Intrauterine device IUD in women with retroverted flexed RVF uteri. STUDY DESIGN: A randomized controlled trial conducted on 400 women with RVF uteri eligible for IUD insertion. They were randomly divided into 2 groups. Group 1 underwent IUD insertion under ultrasound guidance while in group 2 no ultrasound guidance was used. The primary outcome measure was the(Visual Analogue Scale) VAS pain score reported by the women during insertion. Other outcome included easiness of insertion, the procedure time and occurrence of complications as nausea, vomiting, abdominal cramps, failure of insertion, uterine perforation and bleeding. RESULTS: The VAS pain score was significantly lower (2.36 ± 1.77 vs. 4.74 ± 2.35, p < 0.001), the insertion was much easier (score 4.0 ± 0.9 vs. 2.5 ± 1.27, p < 0.001) and the time needed for the procedure was significantly shorter (5.82 ± 2.56 vs. 9.4 ± 4.99 min, p < 0.001) in women within the ultrasound guided group when compared to control group. The total rate of complications was significantly lower (6 vs. 16 %, p 0.001) especially bleeding (2 vs. 9%, p = 0.002), abdominal cramps (10.5 vs. 28 %, p 0.012) and failure of the procedure (0 vs. 3%, p = 005) in ultrasound guided group women when compared to control. CONCLUSION: Insertion of Intrauterine device IUD under ultrasound guidance in women with Retroverted flexed RVF uterus easier and less painful than the blind standard technique.

The value of amniopatch in pregnancies associated with spontaneous preterm premature rupture of fetal membranes: a randomized controlled trial.

Objective: To evaluate the efficacy and safety of amniopatch in pregnancies associated with spontaneous preterm premature rupture of fetal membranes (PPROM).Methods: A randomized controlled trial that involved 100 women diagnosed with PPROM between 24 and 34 weeks of gestational age. Participants were randomized equally into two groups. Group I in which amniopatch was done in addition to the routine management. Group II was treated with routine management including antibiotics and corticosteroids.Results: Amniopatch was successful in complete sealing of the membrane defect in 6/50 (12%) of women while none the control group have undergone similar sealing (p = .0144, RR = 0.88). Women in the amniopatch group showed a significant increase of AFI compared to controls (12 versus 0, p = .0001, RR = 0.56).Conclusion: The amniopatch procedure is a successful technique that safely enhances sealing of fetal membranes and restore the AFI.Clinical trial registration: NCT03473210SynopsisThe amniopatch procedure is a successful technique that could be done safely to enhance sealing the fetal membranes and restoring the AFI after PPROM.

Carbetocin versus rectal misoprostol for management of third stage of labor among women with low risk of postpartum hemorrhage.

OBJECTIVE: To compare effectiveness and safety of carbetocin and misoprostol for prevention of postpartum hemorrhage (PPH) among low-risk women. METHODS: Randomized controlled trial among 150 pregnant women with low risk of PPH admitted for vaginal delivery at Kasr Al Ainy Hospital, Cairo, Egypt, between July 2018 and May 2019. Participants were assigned to two groups by a web-based randomization system ensuring allocation concealment. After neonatal delivery, the carbetocin group received one ampoule of carbetocin (100 µg/mL) intravenously and the misoprostol group received two rectal tablets of misoprostol (800 µg) for active management of the third stage. Blood pressure, blood loss, and hemoglobin levels were monitored. The primary outcome measure was need for additional uterotonic drugs. RESULTS: The carbetocin group had significantly less blood loss (P<0.001), shorter third stage (P<0.001), and less need for additional uterotonics (P=0.013) or uterine massage (P=0.007). The two drugs were hemodynamically safe. Hemoglobin levels after delivery were comparable in the two groups (P=0.475). Adverse effects were more common in the misoprostol group (P<0.001). CONCLUSION: Among low-risk women, carbetocin seems to be a better alternative to misoprostol for active management of the third stage of labor; it reduced blood loss and use of additional uterotonic drugs. CLINICALTRIALS.GOV: NCT03556852.

The value of endocervical and endometrial lidocaine flushing before office hysteroscopy: A randomized controlled trial.

OBJECTIVE: To evaluate the safety and efficacy of flushing the cervical canal and the uterine cavity with local anesthetic in order to reduce the pain felt by patients during office hysteroscopy. METHODS: A double-blind randomized controlled trial was conducted between May 1, 2018, and February 28, 2019, involving 260 women undergoing office hysteroscopy at Kasr Al Ainy Hospital, Cairo, Egypt. Women were randomized using a computerized random number generator to intrauterine and intracervical instillation 5 minutes before the procedure of either 5 mL lidocaine 2% diluted in 15 mL normal saline, or 20 mL normal saline alone. The primary outcome measure was the visual analog scale (VAS) pain score reported by women during the procedure. Secondary outcomes included VAS score at 10 and 30 minutes after the procedure, the need for analgesia, and occurrence of vasovagal attacks. RESULTS: Women in the lidocaine flushing group reported a significantly lower VAS score during the procedure (1.8 ± 1.1 vs 5.2 ± 1.8) and 10 and 30 minutes after it (1.3 ± 1.15 and 0.8 ± 0.9 vs 4.3 ± 2.1 and 2.98 ± 1.96) when compared with control women (P<0.001). More women without lidocaine flushing experienced vasovagal attacks (25/130 vs 9/130, P<0.001) and needed analgesia (84/130 vs 13/130, P<0.001) when compared with women with lidocaine flushing. CONCLUSION: Flushing of the cervical canal and uterine cavity with local anesthetic significantly decreased pain sensation in women undergoing office hysteroscopy. CLINICALTRIALS.GOV: NCT03530488.

A randomized controlled trial of the safety and efficacy of preoperative rectal misoprostol for prevention of intraoperative and postoperative blood loss at elective cesarean delivery.

OBJECTIVE: To assess the safety and efficacy of preoperative rectal misoprostol for the prevention of intraoperative and postoperative blood loss in women undergoing elective cesarean delivery. METHODS: A single-blind randomized controlled trial of 200 full-term pregnant women scheduled for elective cesarean delivery. Computer-generated randomization allocated women to receive 400 µg rectal misoprostol at urinary catheter insertion plus 400 µg rectally after abdominal closure (preoperative group, n=100) or 800 µg of rectal misoprostol after abdominal closure (postoperative group, n=100). Primary outcome was intraoperative blood loss. RESULTS: Intraoperative blood loss was significantly lower in the preoperative misoprostol group compared with the postoperative group (528.7 ± 114.8 mL vs 788.6 ± 165.8 mL; P<0.001). Blood loss during the first 24 hours after delivery was also lower in the preoperative group (199.3 ± 84.5 mL vs 302.9 ± 125.6 mL; P<0.001). Fewer women in the preoperative group needed additional uterotonics (7 vs 21; P<0.001). After delivery, the decrease in both hemoglobin and hematocrit levels was significantly less in the preoperative group (-6.8 vs -12.8% and -6.05 vs -17.8%, respectively; P<0.001). CONCLUSION: Preoperative rectal administration of misoprostol significantly reduced intraoperative and postoperative blood loss during and after elective cesarean delivery. ClinicalTrial.gov ID: NCT03680339. Date of registration 9/2018.

Surgeon-tailored polypropylene mesh as a needleless single-incision sling versus TVT-O for the treatment of female stress urinary incontinence: a comparative study.

PURPOSE: To compare safety and efficacy of surgeon-tailored polypropylene mesh through needleless single-incision technique (STM) versus tension-free vaginal tape-obturator (TVT-O) aiming to decrease cost of treatment of stress urinary incontinence (SUI). This is important in developing countries due to limited healthcare resources. PATIENTS AND METHODS: A retrospective cohort study was done at Urology and Gynecology Departments (dual-center), Cairo University, from January 2011 to August 2013. STM was inserted in 72 females, while TVT-O was inserted in 48 females. Females evaluated by cough stress test, stress and urge incontinence quality of life questionnaire (SUIQQ), Q max and abdominal leak point pressure (ALPP) were included. Different factors were compared between both groups using paired t, Wilcoxon's signed rank, McNemar, Chi-square, Fisher's exact, independent t or Mann-Whitney tests. RESULTS: Age, parity, previous surgeries, ALPP, intrinsic sphincter deficiency (ISD), associated prolapse and associated prolapse repair were comparable in both groups. No significant difference was found between both groups in postoperative complications (except groin pain), cure, SUIQQ indices improvement and Q max decline. In total, 65 (90 %) cured, 6 (8 %) improved while failure was detected in one (1 %) patient in STM group, while 42 (87 %) cured, 4 (8 %) improved and failure was detected in two (4 %) patients in TVT-O group. Presence of ISD (p = 0.565), urgency (p = 0.496), UUI (p = 0.531), previous surgeries (p = 0.345), associated urogenital prolapse (p = 0.218) or associated prolapse repair (p = 0.592) did not lead to any significant difference in outcome between both groups. Cost of mesh decreased from US$500 (TVT-O) to US$10 (STM). CONCLUSION: Outcome of STM is comparable to TVT-O. Furthermore, STM is more economic.

Use of surgeon-tailored polypropylene mesh as a needle-less single-incision sling for treating female stress urinary incontinence: Preliminary results.

OBJECTIVE: To evaluate the safety and efficacy of a procedure using surgeon-tailored polypropylene mesh (STM) through a needle-less single-incision technique for treating stress urinary incontinence (SUI), aiming to decrease the cost of treatment, which is important in developing countries. PATIENTS AND METHODS: In all, 43 women diagnosed using a cough stress test were treated from January 2011 to June 2013 at the Urology and Gynaecology Departments (dual-centre), Cairo University Hospitals. Previous surgery was not a contra-indication. Patients with a postvoid residual urine volume of >100 mL, a bladder capacity of <300 mL, impaired compliance or neurological lesions were excluded. The Stress and Urge incontinence Quality of life Questionnaire (SUIQQ) and urodynamic variables were compared before and after surgery. The variables were compared between the baseline and postoperative follow-up values using a paired t-test, a Wilcoxon signed-rank test or McNemar's test. RESULTS: The mean age was 42.7 years and 20 (47%) patients had associated urgency UI (UUI), whilst 21 (49%) had intrinsic sphincter deficiency. The median (range) operative duration was 14 (5-35) min. There were no complications during surgery. The mean (SD, range) follow-up was 28.1 (5.1, 18-36) months. Postoperative complications were vaginal discharge (5%), failure of wound healing (5%), dyspareunia (5%) and UTI (5%). The sling was removed in one case. SUI, UUI and quality-of-life indices improved significantly after surgery. There were no significant differences in pressure-flow studies before and after surgery. In all, 38 (88%) patients were cured, four (9%) improved and in one only the treatment failed (2%). CONCLUSION: This technique is simple, safe, effective, reproducible and economical for treating SUI. The STM was easy to insert in a short operation.