Successful treatment of refractory hypertension with bilateral nephrectomy in a patient with chronic kidney disease stage 3.

We present a case of life-threatening refractory hypertension (rHTN) in a patient with stage 3b chronic kidney disease that was unresponsive to open surgical renal denervation (RDN) but responded to bilateral nephrectomy (BLN). Both RDN and BLN reduce the increased sympathetic activation in rHTN. However, RDN has yet to show reductions in blood pressure adequate for the average patient with rHTN, and BLN has thus far been reserved for patients with preexisting end-stage kidney disease (ESKD). Our case suggests that there are patients with rHTN that warrant consideration of BLN prior to developing ESKD.

Reactive Oxygen Species-Mediated Cytotoxicity in Liver Carcinoma Cells Induced by Silver Nanoparticles Biosynthesized Using Schinus molle Extract.

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and is ranked as the third most common cause of cancer-related mortality worldwide. Schinus molle (S. mole) L. is an important medicinal plant that contains many bioactive compounds with pharmacological properties. The role of S. molle leaf extract in the biosynthesis of silver nanoparticles (AgNPs) was determined. The biosynthesized AgNPs were thoroughly characterized by UV-vis spectrophotometry, transmission electron microscopy (TEM), X-ray diffraction (XRD), and dynamic light scattering (DLS) techniques. Furthermore, the cytotoxic effect of the biosynthesized AgNPs using S. molle (SMAgNPs) against HepG2 liver cancer cells was investigated. Reactive oxygen species generation, apoptosis induction, DNA damage, and autophagy activity were analyzed. The results clearly showed that the biosynthesized silver nanoparticles inhibited the proliferation of HepG2 by significantly (p < 0.05) inducing oxidative stress, cytotoxicity, DNA damage, apoptosis, and autophagy in a dose- and time-dependent manner. These findings may encourage integrating the potential of natural products and the efficiency of silver nanoparticles for the fabrication of safe, environmentally friendly, and effective anticancer agents.

Amelioration of indole acetic acid-induced cytotoxicity in mice using zinc nanoparticles biosynthesized with Ochradenus arabicus leaf extract.

The diversity of natural phytochemicals represents an unlimited source for discovery and development of new drugs. Ochradenus arabicus, (family: Resedaceae) a notable medicinal plant displays a high content of flavonoid glycosides. This study investigates a possible preventative role of zinc nanoparticles biosynthesized by O. arabicus leaf extracts (OAZnO NPs) in limiting genotoxicity and cytotoxicity caused by indole acetic acid (IAA) in laboratory mice. ZnO NPs were synthesized using O. arabicus leaf extracts and characterized with UV-visible spectroscopy, scanning electron microscopy (SEM) and X-Ray diffraction (XRD). The mice were randomly distributed into the following six groups: control, OAZnO NPs treated (10 mg/kg BW), IAA treated (50 mg/kg BW); simultaneous treatment, pre-treatment, and post-treatment. Reactive oxygen species (ROS), DNA damage, chromosome aberration, and apoptosis were analyzed as toxicity endpoints. IAA exposure significantly induced production of ROS, DNA damage, apoptosis, chromosome aberrations, and micronuclei. Pre-, post-, and simultaneous treatment with OAZnO NPs ameliorated the damage caused by IAA exposure. Exposure to OAZnO NPs alone caused no toxicity for any endpoint based on comparison to controls. This study demonstrated that IAA-induced cytotoxic damage in mice could be ameliorated by treatment with OAZnO NPs. These findings require additional verification in mechanistic and in vitro studies.

Does preoperative dental anxiety play a role in postoperative pain perception after third molar surgery?

Background: Surgical removal of the impacted third molar is associated with inflammatory morbidities which include swelling, trismus, and pain. Pain is the most common postsurgical morbidity associated with third molar surgery. It remains an important factor in patients' perception of recovery after third molar surgery with dental anxiety reported to exert influence on its threshold. Objective: The aim of the study was to determine if preoperative dental anxiety has any significant role on postoperative pain perception after third molar surgery. Materials and Methods: This was a cohort study involving sixty consecutive adult patients requiring extraction of impacted mandibular third molars under local anesthesia. Modified Dental Anxiety Scale Questionnaire was administered to each participant in the waiting area before the surgery. The visual analog scale was also given to each participant to be completed once daily at approximately the same time as the surgery time until day 7 after the surgery. Data collected were analyzed using SPSS version 23. Results: Sixty participants who consented to third molar surgery took part in this study. Five participants were lost to follow-up. There were slightly more males (50.9%) than females (49.1%). Nineteen participants in this study had moderate dental anxiety (34.5%) and 6 participants (11%) had severe dental anxiety with more females having moderate-to-severe dental anxiety. The correlation between pain perception at different days and dental anxiety was not significant (P > 0.05). Conclusion: Preoperative dental anxiety may not significantly influence pain perception after third molar surgery.

RésuméContexte: L'extraction chirurgicale de la troisième molaire incluse est souvent accompagnée d'un gonflement, d'une difficulté à ouvrir la bouche et de douleurs. La douleur est la morbidité post-chirurgicale la plus courante associée à la chirurgie de la troisième molaire. C'est un facteur important qui détermine la façon dont les patients perçoivent la guérison après une chirurgie de la troisième molaire. Il est rapporté que l'anxiété dentaire a une influence sur le seuil de douleur des patients. Objectif: Pour déterminer si l'anxiété dentaire préopératoire a un rôle significatif sur la perception de la douleur postopératoire après une chirurgie de la troisième molaire. Méthodes: Soixante patients adultes nécessitant l'extraction des troisièmes molaires incluses sous anesthésie locale ont été inclus dans cette étude de recherche. Un Modified Dental Anxiety Scale Questionnaire a été administré à chaque participant dans la salle d'attente avant la chirurgie. Le Visual Analogue Scale (VAS) a également été donnée à chaque patient à compléter une fois par jour à peu près au même moment que l'heure de la chirurgie jusqu'au jour 7 après la chirurgie. Les données obtenues ont été analysées à l'aide de la version 23 de SPSS. Résultats: Soixante patients ayant consenti à une chirurgie de la troisième molaire ont participé à cette étude. Cinq patients ont été perdus de vue. Il y avait un peu plus d'hommes (50,9%) que de femmes (49,1%). Dix-neuf patients avaient une anxiété dentaire modérée (34,5%) et 6 (11%) une anxiété dentaire sévère, un plus grand nombre de femmes ayant une anxiété dentaire modérée à sévère. La corrélation entre la perception de la douleur à différents jours et l'anxiété dentaire n'était pas significative (P> 0,05). Conclusion: L'anxiété dentaire préopératoire peut ne pas avoir d'effet significatif sur la perception de la douleur après une chirurgie de la troisième molaire.

Does the scleral encircling band provide a protective effect against the progression of diabetic retinopathy?

AIM: To evaluate the effect of scleral encircling bands on the development and progression of diabetic retinopathy (DR) in diabetic patients. METHODS: The medical records of diabetic patients who underwent unilateral retinal detachment (RD) surgery using scleral buckle and encircling band were reviewed retrospectively. Both eyes of patients were included in the study: one eye in each patient had a scleral buckle with encircling band (the operated eye) and the other one is the non-operated eye. The demographic characters, duration of diabetes and period between surgery and the last recall visit were retrieved from each patient. All the cases underwent fundus photo and fluorescein angiography (when indicated) to confirm the DR staging. RESULTS: Totally 25 patients fulfilled the inclusion and the exclusion criteria were become eligible for the study. A total of 50 eyes of 25 patients were enrolled in this analysis. The mean period of time passed from surgery with encircling band and the last reassessment visit was 12.5±2y. Even though DR could develop in the operated eyes, it was at a less degree of severity compared to the non-operated eyes of same patients (P=0.027). CONCLUSION: Scleral encircling bands have protective effects against the development and progression of DR.

An Effective Multifactor Authentication Mechanism Based on Combiners of Hash Function over Internet of Things.

Internet of Thing (IoT) is the most emerging technology in which all the objects in the real world can use the Internet to communicate with each other as parts of a single unified system. This eventually leads to the development of many smart applications such as smart cities, smart homes, smart healthcare, smart transportation, etc. Due to the fact that the IoT devices have limited resources, the cybersecurity approaches that relied on complex and long processing cryptography are not a good fit for these constrained devices. Moreover, the current IoT systems experience critical security vulnerabilities that include identifying which devices were affected, what data or services were accessed or compromised, and which users were impacted. The cybersecurity challenge in IoT systems is to find a solution for handling the identity of the user, things/objects and devices in a secure manner. This paper proposes an effective multifactor authentication (CMA) solution based on robust combiners of the hash functions implemented in the IoT devices. The proposed CMA solution mitigates the authentication vulnerabilities of IoT and defends against several types of attacks. Also, it achieves multi-property robustness and preserves the collision-resistance, the pseudo-randomness, the message authentication code, and the one-wayness. It also ensures the integrity, authenticity and availability of sensed data for the legitimate IoT devices. The simulation results show that CMA outperforms the TOTP in term of the authentication failure rate. Moreover, the evaluation of CMA shows an acceptable QoS measurement in terms of computation time overhead, throughput, and packet loss ratio.

Prevalence and risk factors for domestic violence among infertile Egyptian women: a cross-sectional study.

Objective: Domestic violence (DV) is an important social and public health problem affecting women globally. This study aims to assess the prevalence and risk factors of DV among infertile Egyptian women. Patients and methods: A cross-sectional hospital-based study included infertile women attending the outpatient gynaecological clinic in a tertiary University hospital was carried out between September 2017 and October 2018. After obtaining ethical approval, 304 infertile women were enrolled in the study and investigated using an interview questionnaire of Infertile Women's Exposure to Violence Determination Scale (IWEVDS). The questionnaire was examined for accuracy after translation into the Arabic language. Results: The infertile women's reported DV resulted in an average total score on the IWEVDS of 73 ± 17. The top three domains with the highest scales were DV, punishment and exposure to traditional practices domains with scale 20.84 ± 7.67, 18.25 ± 4.15 and 14.63 ± 3.18 points, respectively. Using Multivariable linear regression analysis, we found that the best-fitting predictors for this scale were the wife's age (p = .001), residency (p = .033), previous intracytoplasmic sperm injection (ICSI) (p = .016), divorce threatens (p = .022) and fear from husband (p = .026). Conclusions: Infertile Egyptian women are at an increased risk of DV. The most common forms of DV are psychological violence and verbal abuse.

A new look at low-dose aspirin: Co-administration with tamoxifen in ovulation induction in anovulatory PCOS women.

BACKGROUND: To evaluate the efficacy of co-administration of low-dose aspirin (LDA) and tamoxifen on ovulation rates, endometrial thickness and clinical pregnancy rates in anovulatory PCOS women. METHODS: A randomized clinical trial was conducted among 188 anovulatory PCOS women at Suez Canal University Hospitals, Ismailia - Egypt. Patients were divided into 2 groups. The study group received a daily oral dose of 81 mg of LDA, while the control group received placebo (oral vitamin B12 tablets). Both groups started tamoxifen 10 mg twice daily from 3rd day to 7th day of the cycle. Folliculometry was performed by transvaginal sonography every other day starting from the 9th day of the cycle. Human Chorionic Gonadotrophin 5000 I.U. was given I.M. when at least one dominant follicle was present. The outcome measures included the number of mature follicles (≥18 mm in diameter), endometrial thickness and appearance in addition to the clinical pregnancy rates. RESULTS: The mean number of follicles per patient was significantly more in the study group (1.4 ± 0.8 vs. 1.1 ± 0.4; p value=<0.05). In addition, the endometrium was significantly thicker on study group (9.6 ± 1.4 mm vs. 7.8 ± 1.2 mm; p value=<0.01). Significantly, the pregnancy rate was more in the study compared to the control group (37.2% vs. 22.3% respectively; p value=<0.03). CONCLUSION: Co-administration of LDA with tamoxifen significantly improves ovarian response to stimulation, endometrial thickness and pregnancy rates in anovulatory PCOS patients. This combination is an effective, cheap and safe protocol for infertile PCOS women undergoing ovulation induction.

Long-term outcome of internal limiting membrane peeling with and without foveal sparing in myopic foveoschisis.

PURPOSE:: To compare between vitrectomy with internal limiting membrane peeling over the whole macula and preservation of the epi-foveal internal limiting membrane in myopic foveoschisis. PATIENTS AND METHODS:: A prospective controlled non- randomized comparative study included patients with myopic foveoschisis recruited between 2013 and 2017. Patients were allocated into two groups: group A included patients who underwent vitrectomy with complete macular internal limiting membrane peeling and group B included those who underwent preservation of the epi-foveal membrane. Pre- and postoperative best corrected visual acuity and macular optical coherence tomography were obtained and compared. RESULTS:: There was no statistically significant difference between the two groups regarding the preoperative baseline data. The difference between the two groups was insignificant as regard postoperative best corrected visual acuity (p = 0.18) and central foveal thickness (p =0.504). There was statistically significant improvement in final best corrected visual acuity within each group (p < 0.0001). Central foveal thickness significantly decreased postoperatively within each group (p < 0.001). No macular holes or other visual-threatening complications were recorded in either group. CONCLUSION:: Vitrectomy with complete internal limiting membrane peeling resulted in comparable outcomes to those achieved with preservation of the epi-foveal membrane in treating cases with myopic foveoschisis. There was no statistically significant difference in final visual acuity between the two groups. No macular holes were recorded in either group.

Optimal management of umbilical cord prolapse.

Umbilical cord prolapse (UCP) is an uncommon obstetric emergency that can have significant neonatal morbidity and/or mortality. It is diagnosed by seeing/palpating the prolapsed cord outside or within the vagina in addition to abnormal fetal heart rate patterns. Women at higher risk of UCP include multiparas with malpresentation. Other risk factors include polyhydramnios and multiple pregnancies. Iatrogenic UCP (up to 50% of cases) can occur in procedures such as amniotomy, fetal blood sampling, and insertion of a cervical ripening balloon. The perinatal outcome largely depends on the location where the prolapse occurred and the gestational age/birthweight of the fetus. When UCP is diagnosed, delivery should be expedited. Usually, cesarean section is the delivery mode of choice, but vaginal/instrumental delivery could be tried if deemed quicker, particularly in the second stage of labor. Diagnosis-to-delivery interval should ideally be less than 30 minutes; however, if it is expected to be lengthy, measures to relieve cord compression should be attempted. Manual elevation of the presenting part and Vago's method (bladder filling) are the most commonly used maneuvers. Care should be given not to cause cord spasm with excessive manipulation. Simulation training has been shown to improve/maintain all aspects of management and documentation. Prompt diagnosis and interventions and the positive impact of neonatal management have significantly improved the neonatal outcome.

Fitting Tips and Visual Rehabilitation of Irregular Cornea with a New Design of Corneoscleral Contact Lens: Objective and Subjective Evaluation.

OBJECTIVES: To study the fitting and the visual rehabilitation obtained with a corneoscleral contact lens, namely, Rose K2 XL in patients with irregular cornea. METHODS: This prospective study included 36 eyes of 36 patients with irregular cornea fitted with Rose K2 XL. Refractive and visual outcomes and mesopic and aberrometric parameters of fitted eyes were assessed at 2 weeks, 3 months, and 6 months after the initial lens use. Objective and subjective parameters of patient satisfaction and lens comfort were noted. Causes of lens discontinuation and complications were also recorded. RESULTS: Average logMAR VA improved significantly from 0.95 ± 0.09 without correction to 0.04 ± 0.05 six months after lens wear. Similarly, mesopic and aberrometric measures were significantly improved. Statistical analysis of the subjective patients' responses showed a significant acceptance of the lens by most of them. At the end of follow-up, the mean wearing time was 9.9 ± 2.9 hours per day. The most common cause of wearing discontinuation was persistent discomfort (16.7%) and high lens expenses(16.7%). Self-assessed questionnaire showed statistically significant improvement in nearly all measured subjective parameters. CONCLUSION: Rose K2 XL lenses provide patients with irregular cornea with both quantitative and qualitative optimal visual function with high degree of patient comfort and satisfaction.

Prevalence of a carbapenem-resistance gene (KPC), vancomycin-resistance genes (van A/B) and a methicillin-resistance gene (mecA) in hospital and municipal sewage in a southwestern province of Saudi Arabia.

OBJECTIVE: According to the World Health Organization, the increasing antibiotic resistance of pathogens is one of the most important threats to human health. Prevalence of a carbapenem-resistance gene (KPC), vancomycin-resistance genes (van A/B) and a methicillin-resistance gene (mecA) in hospital and municipal sewages will be potential threat to public health. RESULTS: Vancomycin-resistance genes were detected in the sewage of community tank-II, sewage tank of the tertiary and general hospital. Carbapenem-resistance gene was detected in sewage of community tank-II and sewage from tertiary hospital. Methicillin-resistance gene was detected in sewage of community tank-II, sewage from a fish market sewage tank and sewage from an animal slaughter house sewage tank. The detection of a KPC, van A/B and a mecA in sewages will help further the process to take the appropriate measures to prevent the spread of such bacteria in the environment.

Design, synthesis, biological evaluation and docking studies of new 3-(4,5-dihydro-1H-pyrazol/isoxazol-5-yl)-2-phenyl-1H-indole derivatives as potent antioxidants and 15-lipoxygenase inhibitors.

New candidates of 3-(4,5-dihydro-1H-pyrazol/isoxazol-5-yl)-2-phenyl-1H-indole derivatives (4-7) were designed combining the pyrazoline/isoxazoline heterocycles and 2-phenylindole to explore its potential as 15-lipoxygenase (15-LOX) inhibitors. The design of the new derivatives was based on utilizing the antioxidant properties of pyrazoline, 2-phenylindole and the good 15-LOX inhibition properties of indolylpyrazoline. The derivatives were synthesized adopting simple and laboratory friendly reaction conditions to give the target compounds in quantitative yields. The resulting indolylpyrazolines/isoxazolines were evaluated as antioxidants against 2,2-diphenyl-1-picrylhydrazyl (DPPH), nitric oxide (NO) and superoxide dismutase (SOD); indolylpyrazoline (4b) was the most potent antioxidant against SOD assay (IC50 = 1.78 µM) to be superior to ascorbic by 2 folds. Consistently, (4b) was the most potent inhibitor when tested against Soybean 15-LOX (IC50 = 3.84 µM) excelling quercetin as standard inhibitor by 1.8 folds. Some of the new derivatives were docked into the active binding site of human 15-LOX (PDB entry 4NRE) emphasizing the most potent derivative (4b) and the least potent one (4c). Docking solutions of compounds (4b), (4c), (5b) and (6c) revealed that (4b) was the only compound that got stabilized into the catalytic pocket of enzyme by π-cation interaction with the catalytic Fe+ and formation of one hydrogen bond with Ile 676 amino acid. Other derivatives including the least potent one variably got stabilized into the active binding pocket by π-cation interaction with the catalytic Fe+ but failed to form hydrogen bond with Ile 676. For the future optimization of the generated inhibitors, (i) antioxidant activity against SOD, (ii) the inhibitor stabilization by π-cation interaction with the catalytic Fe+3 and (iii) formation of hydrogen bond with Ile 676 should be regarded.

Objective and Subjective Outcome of Clear Lensectomy With Toric IOL Implantation After Corneal Collagen Cross-Linking in Selected Cases of Keratoconus.

AIM: To evaluate the visual and topographic outcomes of a two-stage approach treatment for selected cases of progressive keratoconus (KC); corneal collagen cross-linking (CXL) followed by phacoemulsification with toric intraocular lens (IOL) implantation. METHODS: The study included 9 eyes of 6 patients diagnosed with progressive KC, aged from 35 to 47 years (41.6±11.2 years). All studied eyes underwent a two-stage approach treatment: first corneal collagen CXL followed after at least 6 months by phacoemulsification with foldable toric IOL implantation in both eyes of three patients and only one eye of the other three patients. A complete ophthalmological examination was performed preoperatively and postoperatively. Topographical and visual outcomes were evaluated during 1-year follow-up period. RESULTS: At baseline, seven eyes had mild and two eyes had moderate KC. Sphere ranged from -3.00 to -8.00 diopter (D) and cylinder from -3.50 to -5.50 D. All eyes could be corrected by glasses to 0.50 (log of minimal angle of resolution [logMAR]) or more. At 6 months after CXL, only Kmax decreased significantly from baseline, with no change in visual acuity or manifest refraction. After phacoemulsification with toric IOL implantation, sphere changed from -5.74±1.88 D preoperatively to 0.33±0.72 D 12 months postoperatively (P<0.001), and cylinder changed from -4.53±0.98 to -1.10±0.76 D (P<0.001). There was significant improvement in mean uncorrected distance visual acuity from logMAR 1.43±0.51 preoperatively to 0.30±0.09 postoperatively (P<0.001) and the mean corrected distance visual acuity (CDVA) from 0.34±0.12 preoperatively to 0.24±0.13 (P=0.03) 1 year after IOL implantation. All patients were satisfied with their visual improvement. CONCLUSIONS: This two-stage approach in selected cases of progressive KC is a safe and effective procedure regarding keratometric stability, and visual and refractive results.

Clinical Performance of a Spherical Hybrid Lens Design in High Regular Astigmatism.

OBJECTIVES: To evaluate safety, efficacy, and comfort of a spherical hybrid contact lens design in management of the regular astigmatic cornea. METHODS: This prospective study included 18 eyes from 18 subjects with regular corneal astigmatism greater than -3.00 diopters. All patients were fitted with optimal hybrid contact lenses. Demographic data and fitting parameters were recorded. Patient refraction, visual outcomes, contrast sensitivity, and glare levels were measured 2 weeks, 3 months, and 6 months after the start of lens use. Duration of lens use, comfort grades, causes of lens discontinuation, and any noticed complications were recorded. RESULTS: An average of 1.8 lenses (range 1-3) was required to achieve the optimal fit. Average logMAR visual acuity had improved significantly from 0.92±0.03 to 0.03±0.04 (P<0.001) at the last follow-up. Contrast sensitivity and glare tests were also significantly improved. Statistical analysis of the subjective responses indicated a strong acceptance of the lens by most of the patients. Mean wearing time of lenses was 10.1±3.2 hr/d. Causes of discontinuation were discomfort (2 patients), high lens price (2 patients), and handling problems (1 patient). Minimal complications were demonstrated in wearers of the lenses during follow-up visits. CONCLUSION: Spherical hybrid contact lenses provide a good option for patients with regular astigmatic corneas. They provide optimal visual function with high comfort and patient satisfaction, especially when surgery is undesirable or contraindicated.

Predictive Factors of the Standard Cross-linking Outcomes in Adult Keratoconus: One-Year Follow-Up.

PURPOSE: To evaluate the effects of preoperative presumed predictor factors on clinical and topographic outcomes in adult keratoconus (KC) 1 year after the standard corneal cross-linking (CXL). DESIGN: Retrospective cohort study. METHODS: The study included 84 KC patients (136 eyes) who were treated with conventional CXL. Postoperative best-corrected visual acuity (BCVA) and K max were considered the main predicted variables. The entire participants were divided into subgroups with cutoff values in accordance with the predictive variables. The predicted postoperative outcomes at one year were compared between the subgroups. Next, the predictive variables were analyzed by univariate and multivariate linear regression. RESULTS: In respect to the BCVA, univariate analysis showed that the worse BCVA, the higher K max, and the relative thinner corneas were relatively good predictors of improvement, while multivariate evaluation revealed a strong interrelation with preoperative BCVA only. Regarding the postoperative flattening, univariate analysis found that the cone location and worse preoperative BCVA were the pronounced predictors, whereas the multivariate evaluation focused on the impact of the cone location only. CONCLUSIONS: The multivariate analysis disclosed a significant negative association between the baseline BCVA and postoperative BCVA and a positive relationship between the cone eccentricity and postoperative K max.

Rupture of the pregnant uterus - a 20-year review.

OBJECTIVES: To examine the incidence, causative factors, maternal and foetal outcomes and subsequent fertility in cases of uterine rupture in scarred and unscarred uteri. METHODS: A 20 years' retrospective review was carried out where relevant data were collected from the medical records. Outcome measures included labour characteristics, operative procedures, maternal and perinatal outcome in addition to subsequent fertility. RESULTS: Forty-nine cases of complete uterine rupture were identified. Women in the unscarred group were older, had higher parity and heavier babies (p values < 0.05). Alternatively, the scarred group cases were associated with more silent rupture discovered at time of surgery, recession of the presenting part and more visceral involvement in particularly the urinary bladder. Admission to NICU and birth asphyxia were more frequent in the scarred group while stillbirth and early neonatal death were more common in the unscarred one. Twenty-four out of 49 cases had repair with no bilateral tubal ligation and out of these, 13 patients subsequently conceived and had 22 babies. CONCLUSION: Physicians should be vigilant to the risk factors and clinical presentations of uterine rupture during pregnancy. Cautious attempts to repair the ruptured uterus should be tried for patients' wellbeing and to help maintain fertility.

Female sexual function following different degrees of perineal tears.

INTRODUCTION AND HYPOTHESIS: Perineal tears may have a negative impact on female sexual function (FSF). The aim of the study was to assess the effect of different degrees of perineal tears sustained during delivery on subsequent FSF. METHODS: This prospective cohort study assessed women with third- or fourth-degree perineal tears following vaginal delivery (study group) and compared them with women who underwent episiotomy or had minor lacerations (control group). Sexual function of postpartum women meeting inclusion criteria was assessed using the validated Arabic version of the Female Sexual Function Index (FSFI) questionnaire at 6 and 12 months postpartum. RESULTS: One hundred and fifty-six women completed the study: 56 and 100 in the study and control groups, respectively. Mean total FSFI scores were significantly different between groups at 6 months postpartum [28.1 ± 4.1 vs. 18 ± 2.4 (p < 0.002)]. After 12 months, and despite slight improvement, sexual function was significantly lower in the repaired compared with the control group (21.8 ± 2.9 vs. 29.2 ± 4.1). Women in the study group showed significant decreases in the scores of desire, arousal, lubrication, orgasm, satisfaction, and pain domains 12 months postdelivery. CONCLUSION: Higher-degree perineal tears negatively affect FSF up to 1 year after delivery. Evaluation of FSF and appropriate counseling are necessary for women with perineal tears, especially the higher degree tears.

Use of the Foley catheter versus a double balloon cervical ripening catheter in pre-induction cervical ripening in postdate primigravidae.

AIM: To compare the efficacy of two mechanical devices for pre-induction of labor cervical ripening: the Foley catheter and the Cook cervical ripening balloon. METHODS: This interventional study included 78 postdate primigravid women randomly allocated into two groups: the Foley or Cook balloon catheter. Removal of the catheters was planned approximately 12 h after insertion if spontaneous expulsion had not occurred. The main outcome measures included changes in Bishop score, insertion to delivery time, mode of delivery and occurrence of adverse effects. RESULTS: Spontaneous expulsion of the Foley catheter was encountered more frequently than the Cook (89.2% vs 78.4%; P = 0.03). However, the median Bishop score was significantly higher when using the Cook compared with the Foley catheter after balloon removal (6 vs 5; P = 0.03). The duration from balloon insertion to expulsion and from insertion to delivery was significantly shorter in the Foley group compared with the Cook balloon group (6:19 ± 2:1 vs 7:26 ± 2:25 h; P = 0.03 and 13:50 ± 4:00 vs 15:16 ± 4:30 h; P = 0.03, respectively). There were no significant differences in other outcomes, such as the amount of oxytocin units used, mode of delivery, pain encountered during or after insertion and overall patient satisfaction. CONCLUSIONS: Use of the Cook cervical ripening catheter results in greater cervical ripening compared with the Foley catheter. However, the duration from balloon insertion to expulsion and then delivery were significantly shorter when using the Foley catheter; therefore, we recommend its use, particularly in low resource settings.