Prevalence of vitamin D deficiency in Egyptian patients with pregnancy-induced hypertension.

Background Hypertensive disorders of pregnancy can cause severe maternal and fetal acute morbidity and mortality. Women with pre-eclampsia have been found to have alterations in calcium and vitamin D metabolism. There are conflicting results regarding the role of vitamin D deficiency in the development of pre-eclampsia. The aim was to compare 25 (OH) D level in patients with pre-eclampsia, eclampsia and normotensive pregnant women as well as to study the prevalence of Vitamin D deficiency among the 3 groups. Patients and methods Two hundred patients with pre-eclampsia, 100 with eclampsia and 200 normotensive pregnant controls were compared as regards vitamin D level. Results Mean 25(OH)D level was lower in the pre-eclampsia (14.8 ± 5.4 ng/mL) and in the eclampsia group (10.5 ± 1.6 ng/mL) than in the pregnant controls (19.5 ± 6.5 ng/mL) (P = 0.002). This difference was only significant between the eclampsia group and the pregnant controls (P = 0.02). All eclampsia cases had vitamin D insufficiency as compared to 17.5% in the pre-eclampsia group and 39.5% in the control group. Deficiency of vitamin D (<12 ng/mL) was 47.5% in the pre-eclampsia group, 80% in the eclampsia group and only 10.5% in the control group (P = 0.035). Conclusion Vitamin D deficiency is highly prevalent among Egyptian pregnant females. Our study supports the hypothesis that low vitamin D level can play a role in the development of pre-eclampsia and eclampsia. Thus, supplementation might prevent or delay the development of pre-eclampsia and eclampsia especially in patients at a high risk.

Effect of subcutaneous tissue closure technique in cesarean section on postoperative wound complications in obese Egyptian women.

Subcutaneous tissue closure technique is a wide area of interest for obstetricians who perform cesarean section especially on obese women while many observers studied in an extensive manner postoperative pain and wound cosmetic results. AIM OF THE WORK: The main goal of our work was to display the differences in wound outcome results as regard postoperative wound complications comparing the two widely implemented techniques in subcutaneous tissue closure (interrupted versus continuous methods). RESULTS: A comparative analysis between continuous and interrupted techniques regarding wound complications (gapping, seroma, erythema, and infection) showing statistical significant differences in all four wound complications presented with p values = .019, .011, .015, and .001, in consecutive order with odds ratio in wound gapping = 5.239, wound seroma OR = 9.429, wound erythema OR = 3.709, and wound infection OR = 6.136. CONCLUSIONS: Subcutaneous wound closure using interrupted technique of suturing in obese patients is superior to continuous technique as regard wound complications. Clinical trials.gov ID Identifier (NCT03354078).

Effects of preincisional analgesia with surgical site infiltration of ketamine or levobupivacaine in patients undergoing abdominal hysterectomy under general anesthesia; A randomized double blind study.

CONTEXT: Postoperative pain management remains a cornerstone in patient's management to ensure a better quality of life. Preemptive analgesia is reported to inhibit the persistence of postoperative pain. AIMS: The aim of this study is to assess the analgesic effectiveness of preincisional infiltration of ketamine following elective abdominal hysterectomy as compared to levobupivacaine. SETTINGS AND DESIGN: This was a prospective, randomized, double-blind study. SUBJECTS AND METHODS: This study included 48 patients undergoing abdominal hysterectomy under general anesthesia. They were randomized into two equal groups; Group K received subcutaneous infiltration of 20 ml containing ketamine 2 mg/kg and Group L received subcutaneous infiltration of 20 ml of levobupivacaine 0.25% along the Pfannenstiel incision 5 min before incision. Postoperative pain was assessed using visual analog scale (VAS) at rest and on coughing with evaluation of additional opioid analgesic requirements. STATISTICAL ANALYSIS USED: Numerical variables were presented as mean and standard deviation or median and range as appropriate. The intergroup differences were compared using the independent-sample Student's t-test or Mann-Whitney test for numerical variables. RESULTS: VAS score decreased significantly in Group L from 10 to 24 h and in Group K from 8 to 24 h as compared to the immediate postoperative reading. VAS score in ketamine group was significantly lower than that in the levobupivacaine group 8, 10, and 24 h postoperatively. Ketamine group showed delayed request of additional opioid analgesia (P < 0.001) with significantly less opioid consumption (P < 0.001) as compared to levobupivacaine. The total dose of meperidine consumed during the 24 postoperative h was significantly smaller in ketamine group (P < 0.001). CONCLUSION: Surgical site infiltration of ketamine is a promising preemptive analgesic method in the lower abdominal surgery with minimal sedation and adverse effects.