Ayman Dawood

ObjectiveTo evaluate the feasibility, safety, and surgical outcomes of laparoscopic trachelectomy after supracervical hysterectomy.MethodsThis multicenter study was conducted at Tanta University, Benha University, and Aminah Laparoscopy Center (Benha, Egypt) from June 1, 2018 to October 31, 2021. Forty patients were recruited for this study and counseled on laparoscopic trachelectomy to treat their symptoms after supracervical hysterectomy. Furthermore, cervical biopsy was performed to detect and exclude any malignancy. Histopathological examination of cervical specimens was performed after surgery. Operative details and outcomes were recorded.ResultsThe median age of the patients was 42 years (range, 38-47). The median body mass index was 25 years (range, 22- 28). The median interval between hysterectomy and the clinical presentation was 4.40 years (range, 3.58-5.25). Most patients presented with abnormal vaginal discharge (40%) and bleeding (25%). Moreover, a cervical biopsy resul...

Background: Clomiphene citrate (CC) is first choice as an ovulation-stimulating drug in polycystic ovarian syndrome. Anovulation problems could occur in some patients presenting with CC resistance. In PCOS patients, very high levels of AMH were observed. The role of anti-Müllerian hormone (AMH) in the prediction of ovarian response to CC in women with the polycystic ovarian syndrome (PCOS) is investigated in this study. Objective: To assess the predictive value of Anti Mullerian hormone (AMH) in Clomiphene citrate response in patients with polycystic ovary syndrome. Methods: This cross-sectional study was conducted at Tanta University Hospitals, Egypt. The study included 120 anovulatory PCOS women who underwent ovarian stimulation with clomiphene citrate. Day 3 measurement of AMH concentrations was done. Results: Cycles with poor response had significantly (p<0.0001) higher basal serum AMH concentration compared to that of cycles with normal response. AMH area under receiver oper...

BACKGROUND: Ovarian a syndrome (OHSS) is the most dangerous complication of assisted reproductive technologies. The syndrome has 3 degrees mild, moderate and severe. The severe form is characterized by marked enlargement of ovaries and ascites. Fluid management in sever OHSS was the main purpose of all relevant studies. OBJECTIVE: To detect the efficacy, safety, applicability and patient satisfaction for the continuous paracentesis method in relation to intermittent method in management of severe cases of OHSS. PATIENTS and METHODS: Patients with severe OHSS (n=118) were allocated into 2 groups continuous paracentesis group I, and intermittent paracentesis group II. RESULTS: The demographic and cycle characteristics were compared. There were significant differences between both groups as regard duration of hospitalization, symptom relief, time to complete drainage of ascites and patient satisfaction, where marvelous improvement of symptoms and clinical signs were noticed within 24 h...

Background: Caesarean delivery (CD) rates in developing countries are rising beyond the recommended rates of World health organization. Objective of this study was to evaluate whether Dexamethasone injections reduce neonatal incubation admissions when given before scheduled caesarean delivery (CD) at term or not.Methods: A double blinded, two armed, randomized clinical trial was conducted at Tanta University hospitals in the period from October 2017 to March 2019. Four hundred pregnant women admitted for scheduled CD with gestational age ≥37 weeks were included. Patients were randomized into study group and control group. The study group was given 3 dexamethasone doses, 8 mg each while control group was given saline injections simultaneously as a placebo drug. The primary outcome was the neonatal incubatory admissions.Results: Demographic data in both groups were comparable. Transient tachypnea of newborn (TTN) was 15.47% in study group versus 20.33% in control group with p=0.227. T...

Polycystic ovary syndrome (PCOS) is a complex syndrome showing the clinical features of an endocrine/metabolic disorder, including hyperinsulinemia and hyperandrogenism. Two phenotypes are present, either lean or obese, with different biochemical, hormonal, and metabolic profiles. Evidence suggests many treatment modalities that can be applied. However, many of these modalities were found to be not suitable for the lean phenotype of PCOS. Much contradictory research was found regarding lean patients with PCOS. The aim of this narrative review is to shed light on the debate prevailing regarding characteristics, as well as metabolic, hematological, and potential management modalities. Literature review was performed from January 1, 2000 to March 31, 2017 with specific word search such as lean PCOS, hormonal abnormalities in lean PCOS, and the management of lean PCOS. All retrieved articles were carefully assessed, and data were obtained. We could conclude that the debate is still prev...

To determine whether reducing the cetrorelix dose in the antagonist protocol to 0.125 mg had any deleterious effects on follicular development, the number and quality of retrieved oocytes, or the number of embryos, and to characterize its effects on the affordability of assisted reproductive technology. This randomized controlled study was conducted at the Fertility Unit of Tanta Educational Hospital of Tanta University, the Egyptian Consultants' Fertility Center, and the Qurrat Aien Fertility Center, from January 1 to June 30, 2017. Patients' demographic data, stimulation protocol, costs, pregnancy rate, and complications were recorded. Patients were randomly allocated into two groups: group I (n=61) received 0.125 mg of cetrorelix (the study group), and group II (n=62) received 0.25 mg of cetrorelix (the control group). The demographic data were comparable regarding age, parity, duration of infertility, and body mass index. The dose of recombinant follicle-stimulating horm...

Cesarean section being the most commonly performed surgery in Egypt, the incidents of cesar-ean delivery in general hospitals were found to be nearly 50.6%, whereas, in private hospitals such cases were reported to be much higher. Many disorders, either gynecological or non-gy-necological could coexist or precede a cesarean delivery. These disorders need to be managed surgically; invariably most patients will prefer to undergo a cesarean section with concomitant surgery for any associated pathology. The feasibility and complications of such dual surgeries have been addressed in this review article.

Objectives: To evaluate the efficacy, compliance, safety and economic cost for Fosfomycin trometamol and Nitofurantoin in uncomplicated lower urinary tract infections during pregnancy. Background: Nitofurantoin and Fosfomycin trometamol are recommended as the first-line agents for treatment of urinary tract infections (UTIs) in the latest guidelines endorsed by the Infectious Diseases Society of America (IDSA) and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID). Fosfomycin is bactericidal and inhibits bacterial cell wall biogenesis and reduces bacterial adherence to uroepi-thelial cells. Fosfomycin has broad antibacterial activity against both Gram-positive and Gram-negative pathogens, as Escherichia coli, Escherichia faeca-lis, and various Gram-negatives like Citrobacter and Proteus. Both Nitofu-rantoin and Fosfomycin are category B in pregnancy. Patients and Methods: This study was conducted at Tanta University Hospitals in the period from June, 1, 2015 to January, 1, 2017. Patients were recruited from outpatient clinics of Obstetrics and Gynecology and Urology Departments presenting with asymptomatic bacteruria or cystitis. Patients were allocated randomly into 2 groups: group I (n = 50 cases) received Fosfomycin therapy and group II (n = 50 cases) received Nitofurantoin therapy (n = 50 cases). After treatment, evaluation of patient symptoms, organism count, patient compliance and cost of treatment were done. Results: The enrolled patients were suffering from lower urinary tract infections; asymptomatic bacteruria (17 cases) or cystitis (83 cases). Ten patients were excluded. The demographic data of included patients were not significant for both groups. Complete relief (100%) of symptoms 5 days after start of treatment was noticed in Fosfomycin group while improvement of symptoms after 5 day-treatment was noticed in 86.49% in Nitofurantoin group (p-value = 0.030). The side effects were recorded in 7 cases (18.42%) in Fosfomycin group compared to (35.14%) with significant A. S. Dawood et al. 533 difference in the reported side effects, (p-value = 0.003). Compliance was 38/38 (100%) in Fosfomycin group compared to 34/37 (91.89%) in Nitro-fuantoin group (p-value = 0.001). Resistance was very minimal in Fosfomy-cin group where 1/38 case (2.63%) reported resistance for treatment compared to 8/37 cases (21.62%) in Nitofurantoin group (p-value = 0.001). Conclusion: Fosfomycin trometamine proved to be safe, effective, and has limited resistance. Moreover higher patient compliance and fewer side effects were recommending Fosfomycin to be a first choice drug for uncomplicated lower urinary tract infections during pregnancy at Tanta University.

Background: Submucous leiomyoma and endometrial polyps are the most challenging causes of heavy menstrual flow (menorrhagia) accompanied with infertility, and other clinical issues. There are different hysteroscopic modalities for management of heavy menstrual flow caused by submucous myomas and polyps including conventional hysteroscopic resectoscopy and a novel, recent uterine hysteroscopic morcellator.

Unintended pregnancy is not only a major health problem, but are also a great social and financial burden on societies and countries. There are about 75 million unwanted pregnancies per year according to WHO statistics. When abortions were included, unintended pregnancies increased to 2.65 million, or 49% of all pregnancies. Counseling prior contraception is a mandatory or a must to prevent these unintended pregnancies and their related risks. Unfortunately counseling is a deficient process in third world countries and usually made by young medical staffs or sometimes by paramedical personnel or not present at all. In this perspective, issues for deficient counseling and how patients select the method of contraception are addressed.

Background: Long Acting Reversible Contraceptives (LARC) had a very high efficacy in lowering unintended pregnancies and their poor health sequalae. Although their reported efficacy, these methods are not widely used among patient’s due to non-awareness and faulty concepts linked to these methods.Methods: This cross-sectional study was conducted to determine the degree of awareness, attitude and preference of LARC by attendants of Tanta University contraceptive clinic in the period from January 1, 2016 to December 31, 2016. All patients were counseled with thorough discussion about LARC methods. The following issues were determined: age, parity, mode of previous delivery, residence, medical diseases, socioeconomic state of family, type of LARC method used, how she know about this method and why she preferred that type.Results: 391 women underwent this study with age range of 21-46 years, and BMI range of 20.46-31.87. LARC were preferred by 72.38% of patients and mainly IUDS (52.94%)...

Hypothesis: bladder pain syndrome (BPS) presents by both urological and gynecological symptoms. The gynecological symptoms include chronic persistent pelvic pain, dyspareunia and decreased libido on the other hand urological symptoms include wide variety of symptoms as bladder discomfort, dysuria, frequency, and urgency. Although, the definition and diagnostic criteria for the condition was established, the pathogenesis, etiology and histologic findings of BPS are still not fully understood and diagnosis is made by exclusion. Review of published data including both gynecological and urological articles focusing on the updates in the diagnostic tests, pathology and the recent therapies. The searched words were bladder pain syndrome, interstitial cystitis and painful bladder. The free full text article found after our search were 454 articles after exclusion of deficient article not covering the whole subject, 91 articles were enough for this work to be completed. From this review, Bl...

Aim: To evaluate and compare the efficacy of methotrexate injection in management of persistent simple ovarian cyst versus the use of transvaginal ultrasound aspiration alone. Patients and Methods: This randomized controlled study was conducted at Tanta University Hospitals in the period from April 1, 2016 to October 31, 2016. Patients were randomly allocated into two groups; each group has 25 patients with benign persistent simple ovarian cyst. Group I: Patients were subjected to transvaginal aspiration of the cyst. Group II: patients were subjected to methotrexate injection inside the cyst. Patients in both group were followed up at 1, 3, 6 months after procedure for the recurrence and occurrence spontaneous pregnancy. Results: The mean age in group I was 28.8 years, and the mean age in group II was 26.52 years with non-significant difference. Also there was non-significant difference between both groups regarding size of the cyst. No case recorded to have a cyst recurrence in group II and four cases in group I within six months with significant difference (P value 0.037), and there was non-significant differences as regard the pregnancy rate and complications. Conclusion: Transvaginal intra-cystic methotrexate injection is a safe and effective choice for management of persistent simple benign ova-rian cyst.