Uterus-sparing vaginolaparoscopic sacrocolpopexy for apical pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: Our aim was to evaluate the safety, feasibility, and effectiveness of a vaginolaparoscopic sacrocolpopexy (VLS) technique for treating apical pelvic organ prolapse (POP). MATERIALS AND METHODS: This was a prospective interventional case series (design classification: Canadian Task Force II3) performed in the endoscopic unit of a tertiary care referral facility and university hospital. We assessed 15 symptomatic parous women with stage ≥2 apical POP according to the POP Quantification (POP-Q) classification. Interventions comprised posterior colpotomy with mesh fixation to the uterosacral ligaments and the back of the uterus that was further fixed to the anterior longitudinal ligament of the sacrum using a tacker via laparoscopy. RESULTS: The main outcome was a significant postoperative improvement in prolapse and resultant improvement in quality of life (QoL) after VLS. Six patients required concomitant reconstructive procedures. Mean operative time for the vaginal phase was 8.54 ± 3.10 (7-12) min and 32.36 ± 8.2 (27-41) min. for the laparoscopic phase Mean duration of VLS ranged from 30 to 50 min. At the 6-months follow-up, the procedure was successful in 14 of 15 patients (93.34%); one woman (6.66%) presented with recurrence at a lower stage. Neither mesh complications nor sacral ostitis were encountered. There was significant improvement in vaginal symptoms, sexual well-being, QoL, and clinical staging after the procedure. CONCLUSION: By eliminating all forms of intraperitoneal suturing, performing a posterior colpotomy, and the advent of tackers without evidence of sacral ostitis, VLS seems to be a simple, feasible, effective, and fast approach for treating POP.

Superb bio-effectiveness of Cobalt (II) phthalocyanine and Ag NPs adorned Sm-doped ZnO nanorods/cuttlefish bone to annihilate Trichinella spiralis muscle larvae and adult worms: In-vitro evaluation.

Herein, innovative biocides are designed for the treatment of Trichinella spiralis muscle larvae (ML) and adult worms. Samarium-doped ZnO nanorods (Sm-doped ZnO) are stabilized onto the laminar structure of cuttlefish bone (CB) matrix and adorned by either Ag NPs or cobalt phthalocyanine (CoPc) species. Physicochemical characteristics of such nanocomposites are scrutinised. Adorning of Sm-doped ZnO/CB with Ag NPs shortens rod-like shaped Sm-doped ZnO nanoparticles and accrues them, developing large-sized detached patches over CB moiety. Meanwhile, adorning of Sm-doped ZnO/CB by CoPc species degenerates CB lamellae forming semi-rounded platelets and encourages invading of Sm-doped ZnO nanorods deeply inside gallery spacings of CB. Both nanocomposites possess advanced parasiticidal activity, displaying quite intoxication for ML and adult worms (≥88% mortality) within an incubation period of <48 h at concentrations around 200 µg/ml. CoPc@Sm-doped ZnO/CB nanocomposite exhibits faster killing efficiency of adult worms than that of Ag@Sm-doped ZnO/CB at a concentration of ∼75 µg/ml showing entire destruction of parasite after 24 h incubation with the former nanocomposite and just 60% worm mortality after 36 h exposure to the later one. Morphological studies of the treated ML and adult worms show that CoPc@Sm-doped ZnO/CB exhibits a destructive impact on the parasite body, creating featureless and sloughed fragments enriched with intensive vacuoles. Hybridization of cuttlefish bone lamellae by CoPc species is considered a springboard for fabrication of futuristic aggressive drugs against various food- and water-borne parasites.

Trichloroacetic acid application versus spray monopolar diathermy for treating benign cervical lesions: a randomized controlled clinical trial.

OBJECTIVE: This study aimed to compare efficacy, tolerability, and safety of trichloroacetic acid (TCA) painting versus monopolar spray coagulation of the cervix for treating persistent benign cervical lesions. MATERIALS AND METHODS: A prospective randomized controlled trial was done in a tertiary care referral facility and university hospital. A total of 246 cases with objective evidence of benign cervical lesions were divided into 2 groups according to the line of management. Group A was composed of 126 cases subjected to spray monopolar coagulation, whereas group B was composed of 120 cases subjected to TCA application. Cervical smearing and colposcopy with or without cervical biopsy were performed to exclude underlying malignant lesions. Trichloroacetic acid painting or spray monopolar coagulation of the benign cervical lesion(s) was also performed. Follow-up was performed to assess relief of symptoms and cervical morphology for 1 month. Main outcome measures include success of management tool, relief of symptoms, and normal cervical morphology after 1 month of therapy. RESULTS: A statistically significant cure rate of cervical lesions after treatment in both groups without significant difference between both groups was reported. Failure rate was reported more in group B than group A mainly owing to hypertrophied ectopy and cervical polyp. Patient in group A reported low satisfaction (26.9%) and poor tolerability rate (44.5%) as compared with patients in group B, who reported high satisfaction (77.5%) and good tolerability rate (77.5%), this difference was statistically significant. CONCLUSIONS: Both topical application of 70% TCA and monopolar spray coagulation offer considerable efficacy, acceptable success rates, and minimal complications. Spray coagulation is significantly superior in terms of less persistent or incompletely healed lesions. Nevertheless, topical application of 70% TCA has the advantages of simplicity, higher patient tolerability, and safety, which can be widely used by gynecologists who have limited experience with surgical procedures. It is highly recommended if the cervical lesion is ectopy or nonspecific cervicitis but not hypertrophic lesion such as hypertrophic ectopy or polyp.

Reliability of unaided naked-eye examination as a screening test for cervical lesions in a developing country setup.

OBJECTIVE: This study aimed to test the reliability of unaided naked-eye examination (UNEE) of the cervix as a sole cervical cancer screening test in a developing country setup compared with the standard cervical cytology. MATERIALS AND METHODS: A total of 3,500 nonpregnant women aged between 25 and 55 years were included. An unlubricated bivalve speculum was inserted into the vagina under good light to visualize the cervix. A thorough UNEE of the cervix was done to detect any apparent lesions. Cervical smears were obtained using the long tip of an Ayre spatula. An additional endocervical sample was obtained by cytobrush. Women with abnormal Pap smears or visible cervical lesions by UNEE were scheduled for colposcopic examination. A biopsy specimen was obtained in every abnormal colposcopic examination. RESULTS: Of 3,500 cases, there were 9 (2.57%) preinvasive cervical lesions (cervical intraepithelial neoplasia 1-3) diagnosed with various diagnostic tools used in the study and confirmed by histopathologic examination. Of 3,500 cases, invasive cervical lesions were diagnosed in 6 (1.71%). The sensitivity of UNEE is much better than that of Pap smear (80% vs 60%) but less than that of colposcopy (86.7%). However, the specificity of UNEE (100%) is lower than that of Pap smear (91.16%) and better than that colposcopy (83.12%). The UNEE has a poor positive predictive value (3.75%) when compared with Pap smear (100%) and colposcopy (20%). The negative predictive values of the 3 tests were nearly comparable. CONCLUSIONS: Whenever access to Pap smear is limited, UNEE performed by general gynecologists and well-trained nurses is an acceptable alternative for detecting cervical premalignant or malignant lesions especially in low-resource settings.

Intraoperative and Postoperative Outcomes of Modified Bidirectional Intra-Umbilical Incision versus Infra-Umbilical Incision for Direct Trocar Insertion in Gynaecological Laparoscopy: A randomised controlled trial.

Objectives: This study aimed to describe a modified, curved, deep, bidirectional, intra-umbilical, vertical incision for primary trocar insertion and prospectively compare its intraoperative and postoperative outcomes with an infra-umbilical incision in gynaecologic laparoscopy. Methods: Between August 2019 and March 2021, 110 patients subjected to the direct trocar insertion technique for laparoscopic intervention were classified into two groups. Group A comprised 55 cases of infra-umbilical incision, whereas group B comprised 55 cases of a modified, curved, longitudinal, deep, bidirectional, intra-umbilical incision. Afterwards, intraoperative and postoperative assessments were performed. Results: The increase in the numbers of parity, gravidity and previous caesarean sections was found to be statistically significant; a smaller number of infertility complaints were observed in group B. Similarly, group B expressed a statistically significant less peri-trocar CO2 leakage (46 [83.6%] patients versus 28 [50.9%] patients) and more tightness of the primary portal entry (45 [81.8%] patients versus 30 [54.5%] patients) when compared to group A throughout the whole operation. After a one-month follow-up, a statistically significant (P = 0.029) decrease in the Observer Scar Assessment Scale and Patient Scar Assessment Scale scores in group B (10.4 ± 4.2 and 11.8 ± 4.3, respectively), demonstrating better cosmoses when compared to group A (13.3 ± 5.7 and 16.0 ± 6.8, respectively). Conclusion: Performing a modified, curved, deep, bidirectional, intra-umbilical, vertical incision for the insertion of a primary laparoscopic trocar (i.e. Darwish laparoscopic entry) is a simple and fast step that results in the elimination of intraoperative gas leakage and trocar slippage without the need for any additional sutures. Aesthetically, it results in a better scar with satisfactory cosmoses when compared to an infra-umbilical incision.

Microwave-assisted hydrothermal fabrication of hierarchical-stacked mesoporous decavanadate-intercalated ZnAl nanolayered double hydroxide to exterminate different developmental stages of Trichinella spiralis and Schistosoma mansoniin-vitro.

Hierarchically stacked mesoporous zinc-aluminium nanolayered-double-hydroxide intercalated with decavanadate (ZnAl-LDH-V10O28) is constructed using anion-exchange process via microwave-hydrothermal treatment. Physicochemical properties of ZnAl-LDH-V10O28 are characterized in detail. Decavanadate anions are intimately interacted with ZnAl-LDH nanosheets, generating highly ordered architecture of well-dimensioned stacking blocks of brucite-like nanolayers (∼8 nm). Such hierarchy improves surface-porosity and electrical-impedivity of ZnAl-LDH-V10O28 with declining its zeta-potential (ζav = 8.8 mV). In-vitro treatment of various developmental-stages of Trichinella spiralis and Schistosoma mansoni by ZnAl-LDH-V10O28 is recognized using parasitological and morphological (SEM/TEM) analyses. ZnAl-LDH-V10O28 exterminates muscle-larvae and adult-worms of Trichinella spiralis, and juvenile and adult Schistosoma mansoni, yielding near 100% mortality with rates achieving 5%/h within about 17 h of incubation. This parasiticidal behavior results from the symphony of biological activity gathering decavanadate and LDH-nanosheets. Indeed, ZnAl-LDH-V10O28 nanohybrid sample, as a promissory biocide for killing food-borne/waterborne parasites, becomes a futuristic research hotspot for studying its in-vivo bioactivity and impact-effectiveness on parasite molecular biology.

A Novel Technique for the Reconstructive Formation of an Annular Hymen in Cases of Postpubertal Imperforate Hymen.

OBJECTIVES: Imperforate hymen (IH) is a common genital tract anomaly in women which usually presents after puberty. However, surgical treatment is often considered controversial in religious or conservative communities for sociocultural reasons. This study therefore aimed to assess the efficacy of a novel reconstructive technique involving the preservation of the annular hymen. METHODS: This prospective interventional study was performed between July 2013 and October 2019 at the minimally invasive surgery unit of a tertiary university hospital in Egypt. A total of 36 women presenting with primary amenorrhoea and haematocolpus were diagnosed with postpubertal IH. A circular hymenotomy was performed on each patient using a 10 mm laparoscopy trocar tip and sleeve to form a new annular hymen under general anaesthesia while preserving the annular hymen. The primary outcome measure was the persistence of hymenal patency and integrity at follow-up. The secondary outcome measure included post-operative patient satisfaction and pain relief. RESULTS: The reported technique was feasible in all cases without intraoperative complications. Patency of the reconstructed annular hymen was confirmed at follow-up in all cases; moreover, no intraoperative complications were reported. There was a significant post-operative improvement in pain scores (P <0.001). Both the patients and their parents/guardians reported a high level of satisfaction with the technique. CONCLUSION: This novel technique for the correction of IH involving the reconstruction of an annular hymen was found to be a safe, minimally invasive and effective procedure. This technique should be considered a feasible alternative to a conventional hymenotomy as it allows for the resumption of normal hymenal anatomy without overtreatment.

Simplification of Vaginoscopic Surgery Using a Self-Retaining External Vulvar Sheet (Darwish sheet).

OBJECTIVE: One of the main difficulties of vaginoscopy is continuous leakage of distension medium from the introitus hindering proper visualization. This study evaluates the effectiveness and success of performing diagnostic or operative vaginoscopic surgery via a tight self-retaining external vulvar sheet (Darwish sheet) expressed as tight vaginoscopy (TV) compared with conventional vaginoscopy (CV). PATIENTS AND METHODS: Females referred for vaginoscopy were initially examined by diagnostic CV followed by TV, and whenever indicated, operative TV via Darwish sheet was performed. RESULTS: Diagnostic TV was more feasible with excellent visualization if compared with CV. The mean infused distension fluid volume was 325 ml versus 485 ml, and the mean leaked fluid volume was 37 ml versus 94 ml in diagnostic TV versus CV, respectively. Operative TV via Darwish sheet was done in 21 cases (56.7%) that required surgery with 100% success rate without any reported complications. CONCLUSIONS: Accomplishing vulvar tightness using a cheap self-retaining external vulvar sheet (Darwish sheet) during vaginoscopy (TV) is associated with a clearer visualization of vagina or cervix, a lesser amount of irrigating fluid and lesser leakage as compared with CV.

Destructive effect of iron overload in brain tissue of albino rats: Ameliorative role of silver immobilized organo-modified casein nanocomposite as co-treating agent with Deferasirox.

BACKGROUND: Iron (Fe) is one of the most essential trace elements in the body that play crucial role in organisms' survival, however, excess deposition of it puts patients at higher risk of iron overload and tissue injury through production of reactive oxygen species (ROS), elevation of oxidative stress, development of endocrine disorders among which hypogonadism, and increased incidence of cells damage in vital organs. As deferasirox (DFX) is an approved Fe chelator drug, its inability to cross blood brain barrier (BBB) remains a definite obstacle against its use as Fe chelator in the brain. Lately, attention to nanoparticles usage in researches has been widely grown since their role in improving drug therapeutic effects and scavenging free radicals make them good candidates as chelating and antioxidant agents. AIMS: Herein, after induction of iron overload, organo-modified casein immobilized silver nanocomposite (Ag@Tr-CA) was designed and explored as combined therapy with DFX drug to develop its penetrating efficiency toward BBB and its Fe chelating affinity. Moreover, to distinguish the advanced antioxidant character as well as the beneficial impact of it on lowering brain's oxidative stress. Meanwhile, its capability in regulating serum pituitary hormones such as follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and testosterone (T), ameliorating DNA damage, and improving brain's histopathological alterations was also assessed. METHODS: The physicochemical characteristics of Ag@Tr-CA was carried out using X-ray powder diffractometry (XRD), Fourier transform infrared (FTIR), dynamic light scattering (DLS), field emission scanning electron microscope (FE-SEM), and high-resolution transmission electron microscope (HR-TEM) analyses. Effect of iron overload and subsequent treatment with DFX + Ag@Tr-CA on brain of adult male albino rats were evaluated using colorimetric methods to determine brain Fe concentration and brain oxidative stress biomarkers. Assessment of serum Fe indices and serum pituitary hormones (FSH, LH, PRL) and T were estimated by ELISA technique. Determination of DNA damage in cerebral cortex cells was accomplished using the alkaline version of comet assay, while detection of brain's histopathological alterations was performed by examination of H&E sections under light microscope. RESULTS: The physicochemical characteristics of Ag@Tr-CA showing the proficiency of Ag nanoparticles (∼35 nm) in creating highly-ordered negatively charged micro-sized casein particles (∼450 µm). After induction of iron overload, DFX + Ag@Tr-CA combination efficiently down brain Fe concentration, brain oxidative stress markers, and DNA damage in cerebral cortex cells linked with improvements in brain histopathological alterations. Comparing DFX therapeutic action alone to its combination to whether Ag@Tr-CA or Tr-CA (organo-modified cross-linked casein nanoparticles) as co-treating agents revealed no significant effect on serum Fe indices, FSH, LH, PRL, and T against iron overload disease. CONCLUSION: The present results showed that combination of Ag@Tr-CA nanocomposite with DFX makes it a promising co-treating agent against iron overload through improving the physiological, molecular, and histological structure of the brain in iron overloaded rats.

Biological effects of distension media in bipolar versus monopolar resectoscopic myomectomy: a randomized trial.

AIM: To estimate the effect of 0.9% saline during bipolar resectoscopy and 1.5% glycine during monopolar resectoscopy on hemodynamic, biochemical and hematological parameters. MATERIAL & METHODS: A prospective randomized study in a tertiary care university hospital and comprising of 155 patients scheduled for hysteroscopic myomectomy. They were subjected to bipolar resectoscopic myomectomy utilizing 0.9% saline in group A, and monopolar resectoscopic myomectomy utilizing 1.5% glycine in group B. Perioperative measurements of hemodynamic, hematological, and biochemical changes in all cases were reported. Likewise, intrauterine pressure throughout the different procedures was recorded. MAIN OUTCOME MEASURES: intraoperative difference with regards to fluid volume and subsequent systemic changes specially osmolarity. RESULTS: A significant increase of central venous pressure, end diastolic volume, end diastolic index, stroke volume, stroke index, cardiac output, cardiac index, postoperative prothrombin time and postoperative partial thromboplastin time in both groups with positive correlations between the absorbed fluid volume and these measurements in both groups. Moreover, there was a significant decrease in systemic vascular resistance, postoperative hemoglobin concentration, postoperative hematocrit value ratio, postoperative platelet count and postoperative prothrombin concentration in both groups and there were negative correlations between the absorptive fluid volume and these measurements in both groups. There were significant decrease in serum sodium concentration and postoperative serum osmolarity in glycine group (B) with negative correlations between the absorptive fluid volume and both serum sodium concentration and serum osmolarity in glycine group (B). CONCLUSIONS: The use of bipolar resectoscope utilizing 0.9% saline as a distention media is not associated with hyponatremia or hyposmolarity unlike monopolar resectoscope utilizing 1.5% glycine distending media in cases with submucous myoma of considerable size.

Office Cervicoscopy versus Stationary Colposcopy in Suspicious Cervix: A Randomized Controlled Trial.

STUDY OBJECTIVE: The objective of the study was to estimate the diagnostic accuracy and doctor satisfaction of small caliber office cervicoscopy versus stationary colposcopy in diagnosis of ectocervical as well as endocervical lesions in women clinically presented with suspicious cervix. PATIENTS AND METHODS: Eligible 112 cases with clinically suspicious cervix were randomized into Group A (56 cases) and Group B (56 cases) who were subjected to small caliber office cervicoscopy and stationary colposcopy, respectively. The outcome was the diagnostic accuracy and safety of both tools for detection of ectocervical and endocervical cervical lesions. RESULTS: There was no statistically significant difference between both groups regarding parity, previous abortion, age at marriage, duration of marriage, and age at menarche and menopause. On unaided naked eye examination of the cervix (UNEE), there were no statistically significant differences between both groups. Diagnostic indices were similar in both groups apart from the finding that office cervicoscopy was more sensitive for detection of endocervical abnormalities. Doctors were significantly more satisfied with stationary colposcopy than office cervicoscopy. CONCLUSIONS: Office cervicoscopy is a good complementary tool added to stationary colposcopy for detection of cervical lesions in cases with suspicious cervix as an example of high-risk group for cervical cancer. Due to its small caliber, cervicoscopy offers a better evaluation of the endocervical canal, especially in cases of Type 2 and 3 transformation zone with a possibility of examination of the endometrial cavity.

Photoactivated water-disinfecting, and biological properties of Ag NPs@Sm-doped ZnO nanorods/cuttlefish bone composite: In-vitro bactericidal, cercaricidal and schistosomicidal studies.

Herein, eco-friendly composite was synthesized by embedding silver (Ag) nanospheres onto aragonitic cuttlefish bone (CB)-stabilized samarium doped zinc oxide (Sm-doped ZnO) nanorods. The operating interaction profile and the photoactive behavior of this nanocomposite were assessed via XRD, FTIR, Raman, TEM, FE-SEM, DLS, DRS and PL techniques. Locality of Sm-doped ZnO and its attaching modes to the cuttlefish bone lamella were highly dominated by embedding Ag NPs that encouraged Zn2+ Lewis acid sites to electrostatically interact with aragonite carbonates in the channeled porous CB system. Such interacting approach enhanced photoactivity of Sm-doped ZnO by lowering its energy band gap (from 3.26 eV for Sm-doped ZnO/CB to 2.12 eV for Ag@Sm-doped ZnO/CB). Besides, plasmon-induced silver electrons provided Sm-doped ZnO by extra photosensitivity. Ag@Sm-doped ZnO/CB nanocomposite exhibited pronounced photo-activated disinfection efficiencies for Staphylococcus aureus (80%), Pseudomonas aeruginosa (60%), and Schistosoma mansoni cercariae (100%) linked with progressive demolition in cercarial body. Such nanocomposite also possessed exterminating action against Schistosoma mansoni adult worms serving near 100% worm-mortality accompanied by significant disintegration of worm body. These findings were successfully drawn Ag@Sm-doped ZnO/CB as an efficient weapon in the biocides arsenal being even capable of destructing pathogenic bacteria and parasites in dark- and photo- conditions.

Bakri balloon versus condom-loaded Foley's catheter for treatment of atonic postpartum hemorrhage secondary to vaginal delivery: a randomized controlled trial.

OBJECTIVE: To assess the efficacy and safety of condom-loaded Foley's catheter versus Bakri Balloon in the management of primary atonic post partum hemorrhage (PPH) secondary to vaginal delivery. STUDY DESIGN: This study was single blinded randomized controlled trial conducted at Assiut Woman's Health Hospital, Egypt in the period between October 2014 and December 2015. It Comprised 66 women with primary atonic PPH following vaginal delivery. Eligible participants were randomly assigned to Bakri balloon (group A) or condom-loaded Foley's catheter (group B). The primary outcome was the success of tamponade to stop the uterine bleeding without additional surgical interventions. Secondary outcomes included time between insertion and stoppage of the bleeding, the amount of blood transfusion and maternal complications. RESULTS: Both treatment modalities successfully controlled the primary atonic PPH without a statistically significant difference [30/33(91.0%) and 28/33(84.84%), p = .199; respectively]. However; Bakri balloon required shorter time to stop the uterine bleeding (9.09 min vs. 11.76 min, p = .042; respectively). There was no statistically significant difference between both groups regarding postpartum maternal complications, the vital signs, urine output, hemoglobin and hematocrit levels from before to after tamponade insertion. CONCLUSIONS: Condom-loaded Foley's catheter is as effective as Bakri balloon in the management of primary atonic PPH following vaginal delivery but requires a significant bit longer time to stop the attack.

Is there a role for hysteroscopic tubal occlusion of functionless hydrosalpinges prior to IVF/ICSI in modern practice?

OBJECTIVES: To determine whether hysteroscopic tubal occlusion will produce the same efficacy as laparoscopic tubal occlusion of functionless hydrosalpinx prior to IVF/ICSI. DESIGN: A prospective comparative study. Setting. Endoscopy Unit of the Women's Health Center, Faculty of Medicine, Assiut University, Assiut, Egypt. SUBJECTS: A pilot safety phase included 10 uteri removed by hysterectomy in perimenopausal women subjected to roller ball coagulation of the peritubal bulge. The study phase included 27 patients with uni- or bilateral functionless hydrosalpinges, who were randomly divided into 2 groups. Group A comprised 14 patients who were randomly allocated for laparoscopic occlusion. Group B included 13 patients scheduled for a hysteroscopic approach. Interventions. Laparoscopic occlusion of the isthmic part of the fallopian tube was carried out using bipolar diathermy in 9 (64%) cases or clips in 3 (21.4%) cases in Group A. Roller ball electrode of the resectoscope was utilised for occlusion of the tubal ostium under local, spinal, or general anesthesia in Group B. Second-look office hysteroscopy was performed in Group B whenever possible. In both groups, hysterosalpingography or sonohysterography was carried out 1 month later to confirm tubal occlusion. MAIN OUTCOME MEASURES: Safety phase aimed at confirming tubal occlusion with minimal harm to adjacent tissues. Confirmed tubal occlusion of the functionless hydrosalpinx. RESULTS: The safety phase resulted in bilateral complete occlusion of the proximal part of the tubes with secondary coagulation <8 mm, as shown in the histopathologic sections. The suspected main cause of functionless hydrosalpinges was iatrogenic (pelvic surgery) in 9 (64%) and 8 (61.5%) cases in both groups, respectively. The mean number of abdominal scars/patient was 1.4 and 1.5 in both groups, respectively. Unilateral functionless hydrosalpinx was encountered in 7 (50%) and 5 (38%) cases in both groups, respectively. In Group A, the procedure was possible and successful in 10 cases (76.9%), while in Group B, hysteroscopic access and occlusion were achieved in 12 (85.7%) and 9 (64.2%) cases, respectively. In Group B, diagnostic hysteroscopy showed fine marginal adhesions in 2 cases (15%), and a small polyp in 1 case (7.7%). Hysteroscopic tubal occlusion showed shorter operative time (9+/-2.8 versus 24+/-4.8 min, p=0.0001) and hospital stay (2+/-1.8 versus 5+/-1.1h, p=0.0001). Second-look office hysteroscopy was performed in 8 cases in Group B and revealed no significant corneal lesions at the site of hysteroscopic occlusion. CONCLUSIONS: This preliminary study demonstrates the feasibility of hysteroscopic tubal occlusion of functionless hydrosalpinx in all cases with acceptable efficacy. It has the advantage of adding a valuable evaluation of the endometrial cavity prior to IVF/ICSI. It should be an option for treatment protocol in cases of functionless hydrosalpinges. Further large sample-sized studies are required to test its impact on the implantation rate and clinical outcome.

Usefulness of the WHO C-Model to optimize the cesarean delivery rate in a tertiary hospital setting.

OBJECTIVE: To assess use of the C-Model in a tertiary hospital setting in terms of its validity and utility for optimizing the cesarean delivery (CD) rate. METHODS: A prospective observational study included women admitted for delivery at a university teaching hospital in Assiut, Egypt, in 2015. The women were asked about the demographic and obstetric information needed to calculate the probability of CD using the WHO C-Model. A receiver operating characteristic (ROC) curve comparing the predicted and observed CD rates was constructed. In addition, the mean predicted CD rates were compared with the mean observed CD rates in the 10 groups of the Robson classification. RESULTS: In total, 1000 women were recruited; 38.6% had a previous CD and 13.5% had complications during the current pregnancy. The final mode of delivery was vaginal delivery in 38.7% and CD in 61.3%; the predicted CD rate for this cohort was 45.0%. The area under the ROC curve was 0.928 (95% confidence interval 0.912-0.945). Comparison of the predicted and observed CD rates in the 10 Robson groups showed an overuse of CD ranging from 2% to 50%. CONCLUSION: The WHO C-Model is valid and can be used in hospital settings to optimize CD rates.

Exfoliated Egyptian kaolin immobilized heteropolyoxotungstate nanocomposite as an innovative antischistosomal agent: In vivo and in vitro bioactive studies.

This study aims to manipulate an antischistosomal nanocomposite based on exfoliated clay immobilized heteropolyoxotungstate. The nanocomposite's physicochemical characteristics were examined using XRD, Raman spectroscopy, FTIR, DLS, SEM, HR-TEM and AFM. Nano-sized spheroidal negatively charged Keggin-type heteropolyoxotungstate particles were developed along and between the exfoliated clay layers. The impact of the nanocomposite on Schistosoma mansoni-infected mice was studied through parasitological, physiological and histological analyses. Infected mice were orally vaccinated by a single nanocomposite dose (15mg/kg/day) for two weeks. The schistosomicidal activities of the nanocomposite in vitro were investigated by examining its dose- and time-dependent responses in terms of % worm mortality. The time-dependent morphological alterations in schistosomes at a nanocomposite dosage of 15µg/mL were followed by SEM. The nanocomposite exhibited potential schistosomicidal properties with a marked reduction in worm burden (~85% mortality), extensive deformities in the adult worm tegument and suckers, improvement of serum biochemical activities, and diminishment in granulomatous lesions. The in vitro release of heteropolyoxotungstate from exfoliated clay indicates the clay's ability to embrace the heteropolytungstate until its liberation at the parasitic districts.

Ceria-containing uncoated and coated hydroxyapatite-based galantamine nanocomposites for formidable treatment of Alzheimer's disease in ovariectomized albino-rat model.

This paper upraises delivery and therapeutic actions of galantamine drug (GAL) against Alzheimer's disease (AD) in rat brain through attaching GAL to ceria-containing hydroxyapatite (GAL@Ce-HAp) as well ceria-containing carboxymethyl chitosan-coated hydroxyapatite (GAL@Ce-HAp/CMC) nanocomposites. Physicochemical features of such nanocomposites were analyzed by XRD, FT-IR, Raman spectroscopy, UV-vis spectrophotometer, N2-BET, DLS, zeta-potential measurements, SEM, and HR-TEM. Limited interactions were observed in GAL@Ce-HAp with prevailed existence of dispersed negatively charged rod-like particles conjugated with ceria nanodots. On contrary, GAL@Ce-HAp/CMC was well-structured developing aggregates of uncharged tetragonal-shaped particles laden with accession of ceria quantum dots. Such nanocomposites were i.p. injected into ovariectomized AD albino-rats at galantamine dose of 2.5mg/kg/day for one month, then brain tissues were collected for biochemical and histological tests. GAL@Ce-HAp adopted as a promising candidate for AD curativeness, whereas oxidative stress markers were successfully upregulated, degenerated neurons in hippocampal and cerebral tissues were wholly recovered and Aß-plaques were vanished. Also, optimizable in-vitro release for GAL and nanoceria were displayed from GAL@Ce-HAp, while delayed in-vitro release for those species were developed from GAL@Ce-HAp/CMC. This proof of concept work allow futuristic omnipotency of rod-like hydroxyapatite particles for selective delivery of GAL and nanoceria to AD affected brain areas.

Sugarcane bagasse lignin, and silica gel and magneto-silica as drug vehicles for development of innocuous methotrexate drug against rheumatoid arthritis disease in albino rats.

The present study clarifies co-therapy action of deliveries from their textural changes point of view. Methotrexate (MTX) was immobilized onto biodegradable lignin, silica gel and iron/silica nanocomposite. Loaded-MTX was i.p. injected into albino rats at doses of 0.25 and 0.5mg/kg/week for 2.5months, after which spleen, liver, testes and knee joint tissues were collected for tests. IFN-γ and IL-17A mRNA gene expressions in spleen in all biological samples were determined by RT-PCR. Physicochemical features of drug carriers were monitored by XRD, BET-PSD, SEM and TEM. Drug inflammatory-site targeting was found to be closely related to the physico-features of deliverers. The interlayered lignin of micro- and meso-pore channels directed MTX toward concealed infected cells in liver and testes tissues, while meso-structured silica flacks satisfied by gathering MTX around knee joints. The magneto-silica nanocomposite targeted MTX toward spleen tissue, which is considered as a lively factory for the production of electron rich compounds.

Evaluation of the impact of laparoscopic ovarian drilling on Doppler indices of ovarian stromal blood flow, serum vascular endothelial growth factor, and insulin-like growth factor-1 in women with polycystic ovary syndrome.

OBJECTIVE: To study the serum levels and correlation of vascular endothelial growth factor (VEGF), insulin-like growth factor 1 (IGF-1), hormonal profile, and Doppler blood flow changes within the ovarian stroma before and after laparoscopic ovarian drilling (LOD) in women with clomiphene-resistant polycystic ovary syndrome (PCOS). DESIGN: Prospective controlled study. SETTING: University teaching hospital. PATIENT(S): Twenty-five women with clomiphene-resistant PCOS (group 1) and 20 women with regular menstrual cycles as a comparison group (group 2). INTERVENTION(S): Laparoscopic ovarian drilling. MAIN OUTCOME MEASURE(S): Serum levels of VEGF, IGF-1, and Doppler indices of ovarian stromal blood flow. RESULT(S): The serum levels of VEGF, IGF-1, T, and LH were significantly higher in group 1 before LOD than in group 2. The Doppler indices (pulsatility index and resistance index) of ovarian stromal blood flow were also significantly lower in group 1 before LOD than in group 2. The serum levels of VEGF, T, and LH were significantly reduced in group 1 after LOD compared with in group 1 before LOD. Doppler indices (pulsatility index and resistance index) of ovarian stromal blood flow were significantly increased after LOD. The VEGF levels before LOD were positively correlated with IGF-1, LH, and T. After LOD, the VEGF levels were positively correlated with LH and T. CONCLUSION(S): Higher serum levels of VEGF and IGF-1 may explain the increased vascularity that was demonstrated by Doppler blood flow measurements in PCOS. Laparoscopic ovarian drilling reduced serum VEGF, IGF-1, T, and LH and reduced ovarian blood flow velocities, which may explain the reduction of ovarian hyperstimulation syndrome in women with PCOS after LOD.