Background In obstetric practice, most allegations against obstetrician–gynecologists relate in some manner to the management of labor and delivery; few solely involve perceived flaws in prenatal or postpartum care. Objective To evaluate the incidence and causes of maternal deaths and to evaluate the role of medical malpractice leading to maternal deaths in Assiut Governorate. Patients and methods Women delivered at Al-Azhar University Hospital during a 6-month period in 2013 and women delivered in the period extending from 2005 to 2010 in Assiut Governorate as documented by the local Medicolegal Department of the Ministry of Justice were the subjects of this study. Results Among 2556 women delivered in a 6-month period, two women died, representing a maternal mortality rate of 0.078% (a maternal mortality ratio of 78/100 000 live birth). Antepartum hemorrhage and postpartum hemorrhage were the reported causes in a case each. We also studied 50 maternal deaths referred to local Medicolegal Department of the Ministry of Justice owing to medicolegal claims. We found that the chronic hypertension was the most commonly reported morbidity (20.0%) followed by severe anemia (18.0%), diabetes mellitus (8.0%), epilepsy (2.0%), and deep vein thrombosis (2.0%). More than two-thirds (68.0%) of them had antenatal care, whereas the remainder (32.0%) did not receive it. Regarding the neonatal outcome in the studied women, we found that in 34 (68.0%) cases, women delivered a live mature baby, whereas in 15 (30.0%) cases, fetal death occurred, and in one (2.0%) case, the delivered newborn was macrosomic. In all cases, there was a civil liability. Negligence was the commonest cause (42.0%) followed by misdiagnosis (30.0%) and delayed treatment (28.0%). Regarding the qualification of the service provider, we noted that those with master qualification came on the top (52.0%) followed by general practitioners (18.0%) and diploma holders (12.0%). In 44.0% of cases, delivery took place in governmental hospital, whereas in 32.0% of cases was in health unit and in 24.0% of cases was in private clinic. In our study, surgical specialties accounted for 31.0% of claims followed by obstetrics (25.0%), anesthesia (17.5%), internal medicine (14.5%), and pediatrics (12.0%). Conclusions In the present study, we reported a maternal mortality rate of 0.078% (maternal mortality ratio of 78/100 000 live birth). With respect to the type of liability in the studied women, we found that in all cases, there was civil liability.

Background Spondylolysis and lytic spondylolisthesis are common orthopedic problems. Nonsurgical methods and physiotherapy always fail. Surgical options include laminectomy (obsolete), noninstrumented fusion, posterolateral fusion (PLF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion, anterior lumber interbody fusion, and other techniques. Most of them are successful, but each has its own advantages and disadvantages. PLIF is a successful method but carries the disadvantage of disruption of the posterior column and leaving the dura uncovered. Aim The aim of the study was to analyze the results of recapping technique and comparing the results with PLF regarding. Surgical time, blood loss, complications, pain relief, and fusion rate were recorded. Patients and methods A comparative study between 15 patients with PLF and 15 patients with recapping PLIF was done. Follow-up and radiograph were done at 2 weeks, 3 months, 6, and 12 months. When pseudoarthrosis was suspected, a computed tomography scan was done (two cases). Results Surgical time and blood loss were more in the recapping groups, in which one case of dural injury was recorded but no cases of pseudoarthrosis. Moreover, two cases of pseudoarthrosis were recorded in the PLF group. Early pain relief was more in the PLF group, but late improvement was similar in both groups. Conclusion Recapping PLIF can restore the three columns of the spine. It provides canal clearance as anterior lumber interbody fusion, carries low risks, and ensures good stability. It also provides wide surface for fusion, with preservation of the important mechanical roles of the posterior structure than do classic PLIF, with superior results of PLF group in the short term but superior results for recapping in the long-term follow-up.

Background Cardiac resynchronization therapy (CRT) improves quality of life, exercise tolerance, and myocardial function in a considerable number of patients with heart failure (HF) and left bundle branch block. In addition, CRT decreases HF hospitalizations and overall mortality. However, structural, morbidity, and mortality improvements after CRT rate between 40 and 60%. Objective To compare the role of the cardiac magnetic resonance (CMR) and speckle-tracking echocardiography (STE) in expectation of response to CRT. Patients and methods We investigated the predictors of CRT response using CMR measurement of left ventricular (LV) volumes and function, CMR-derived mechanical dyssynchrony, scar percentage, and its relation to the site of LV lead implantation, in comparison with STE in prediction of CRT outcomes. Results A total of 35 patients with HF planned for CRT were included. Echocardiography was used to define the response to CRT (15% reduction in LV end-systolic volume 6 months after implantation). At follow-up, 18 (51.43%) patients were categorized as responders. Echocardiographic speckle-tracking radial strain analysis showed a significant LV dyssynchrony in responders versus nonresponders (radial mid-anteroseptal and posterior wall delays were 245.1 ms and 80.7 ms, respectively) (P<0.0001). LV radial dyssynchrony, as measured by CMR-feature tracking, was significantly higher in responders versus nonresponders (mean of SDt-16 of radial strain were 232.7 ms vs. 180.4 ms, P<0.0001), and median of radial mid-anteroseptal-to-inferolateral wall delay was 375 vs. 125.4 ms, P<0.0001). Late contrast-enhanced CMR was performed for scar assessment. It was noticed that scar percentage of LV mass was much higher in nonresponders (median 6.2 vs. 0%) (P=0.005). Conclusion CMR imaging offers the unique opportunity to predict the CRT outcomes by measurement of LV volumes, LV mechanical dyssynchrony (that well correlated with that of STE), and the total scar percentage and distribution in a single examination.

Background Prevalence of hyperemesis gravidarum (HG) varies from 0.3 to 1.5% of all live births. The exact cause is not well known and is probably multifactorial. It is the most common cause of hospitalization in the first half of pregnancy and second only to preterm labor for pregnancy overall. The etiology of emesis gravidarum remains unknown, but a number of possible causes have been studied such as endocrinal, immunological, psychological, metabolic, genetic, and even infectious such as Helicobacter pylori infection. Objective To screen for H. pylori serum immunoglobulins in HG in pregnancy. Patients and methods This was a prospective observational cross-sectional study. The study was conducted at Abo Qir General Hospital and Al-Hussein University Hospital. The study was carried on 50 pregnant women who have vomiting sufficiently severe to produce weight loss, dehydration, acidosis from starvation, alkalosis from loss of HCL in vomitus, and hypokalemia (HG). Results Overall, 44% of cases were positive and 56% were negative regarding H. pylori immunoglobulin M. Conclusion We were unable to find an association between H. pylori and HG. We find that only 44% of cases are positive and 56% are negative regarding H. pylori immunoglobulin M, and 92% of cases had +3 ketones, and only 8% have ketones in urine from +1 to +2.

Background Dacryocystorhinostomy (DCR) is an operation that creates a lacrimal drainage pathway into the nasal cavity to facilitate drainage of the previously obstructed excreting system. Objective To compare effectiveness and complications of external and endoscopic DCR for treatment of primary acquired [nasolacrimal duct obstruction (NLDO)]. Patients and methods The present study included 60 patients (38 females and 22 males) aged between 18 and 50 years complaining of epiphora owing to NLDO. Patients were subdivided into two groups: group A included 30 (50%) eyes of 25 patients who were subjected to endoscopic DCR, and group B included 30 (50%) eyes of 27 patients who were subjected to external DCR. Results In this study, the right eye was more commonly affected than left eye. The percentage of right eye affection was 53.3% and left eye affection was 33.3%%. Massive intraoperative bleeding in group A was seen in five (16.5%) cases, whereas in group B, massive intraoperative bleeding was noted in nine (29.7%) cases. The difference was statistically nonsignificant (P=0.617). The successful surgical outcome after 6 months was achieved in 28 (92.4%) of 30 patients for the endoscopic DCR and 26 (85.4%) of 30 patients for external DCR surgery. The difference was not statistically significant (P=0.604). Conclusion DCR is the standard treatment for NLDO. It can be performed by external or endoscopic approach. Both these approaches have minimal complications and comparable surgical outcome. However, endoscopic DCR is a safe, minimally invasive effective day-care technique with good aesthetic results.

Background and objectives To investigate changes in retinal vascular plexuses, choriocapillaris, along with microcirculation of optic nerve head (ONH), in patients with type 2 diabetes mellitus without clinically evident retinopathy and healthy controls using optical coherence tomography angiography (OCTA). Patients and methods This is a prospective, cross-sectional observational study that included 20 eyes of normal healthy controls (group 1) and 20 eyes of diabetic patients without clinically evident retinopathy (group 2). All participants underwent OCTA examination (RTVue-XR Avanti; Optovue). Average and parafoveal vessel density in superficial capillary plexus (SCP), deep capillary plexus, choriocapillaris vessel density, foveal avascular zone area and perimeter, and vessel density inside ONH and in peripapillary region were compared between groups. Microaneurysms and capillary nonperfusion were taken into analysis. glycated hemoglobin and serum creatinine were assessed for diabetic patients. Results Group 2 showed statistically significant lower average vessel densities of SCP and deep capillary plexus (P<0.01) and parafoveal vessel density of SCP (P<0.01) compared with group 1. Moreover, there was statistically significant and highly significant difference between group 2 and group 1 regarding tempo-inferior and tempo-superior sectors of peripapillary area (P=0.016 and 0.001, respectively). A statistically significant increase in foveal avascular zone area and perimeter was found in group 2 compared with group 1 (P<0.01). Average vessel density of choriocapillaris had a negative correlation with serum creatinine in group 2 (P<0.05). Microaneurysms and capillary nonperfusion were detected by OCTA in diabetic patients. Conclusion OCTA can identify preclinical diabetic retinopathy before the clinical manifestations appear. It is a promising noninvasive tool for assessing retinal vascular plexuses, choriocapillaris, and ONH microcirculation.

Background Surgical repair of hernia is considered to be one of the most repeatedly conducted operations all over the world. Aim This study has been carried out to obtain well-established information about surgery duration, hospital stay, and short-term and long-term complications, following inguinal or ventral hernia repair using ProGrip meshes. Patients and methods A total of 50 patients with right oblique inguinal hernia (Rt. OIH), left oblique inguinal hernia (Lt. OIH), or paraumbilical hernia and epigastric hernia (PH or EH) ventral hernia were enrolled in this study. Operative repair was performed using self-gripping polyester meshes. Follow-up to compare the anticipated outcomes of these hernia types was done. Results Most of the short-term and long-term complications were found to be low in Rt. OIH, Lt. OIH, and PH or EH ventral hernias. Hospital stay was found to be 1–2 days in all of them. Return to work was 10–14 days. Patient satisfaction was 100% in Rt. OIH, and a little below in other types of hernias. Hematoma was found to be 0–13.3%, seroma in 0–23.3%, pain in 10–30%, wound infection in 0–16.7%, and recurrence 0–10%. Conclusion For the ProGrip meshes, they are recommended to be used in both Rt. OIH and Lt. OIH, as well as EH and PH.

Background Menorrhagia is menstrual blood loss, which interferes with a woman’s physical, emotional, social, and material quality of life, and which can occur alone or in combination with other symptoms. Ibuprofen is one of the most common NSAIDs used for treatment of heavy menstrual bleeding. Tranexamic acid is the best option for those who experience irregular uterine bleeding and plan to become pregnant in the near future. Objective To evaluate and compare the efficacy of tranexamic acid and ibuprofen in controlling menorrhagia induced by copper T-380A intrauterine device (IUD). Patients and methods This prospective randomized comparative parallel study between tranexamic acid and ibuprofen for treating copper-IUD-induced menorrhagia included 100 women who attend outpatient clinic at Al-Hussein University Hospital from October 2019 to March 2020. Results Mean menstrual days in both group 1 and group 2 decreased significantly from the first month after IUD insertion to 6 months after treatment. Conclusion Tranexamic acid as an antifibrinolytic agent and Ibuprofen as an NSAID, at a dosage of 500 mg capsules of tranexamic acid three times a day and 400-mg tablet of ibuprofen three times a day orally, have the same significant effects on copper T-380A IUD-induced menorrhagia. Their effects are on both the volume of blood loss and the duration of menses.

Objective To assess the efficacy of otoendoscopy in the surgical management of atelectatic ear to improve the clinical and the audiological outcomes. Patients and methods A total of 38 ears in 24 patients with middle ear atelectasis and intact ossicular chain were randomly assigned into two groups: group I (27 ears) underwent endoscopic T-tube insertion and group II (11 ears) underwent endoscopic cartilage tympanoplasty. Assessment of hearing was performed for all cases preoperatively and 3 months postoperatively. Results There is a significant postoperative improvement of air-bone gap averages reported in the two studied groups, with mean hearing gain of 21.67±7.97 dB in group I and 19.72±5.3 dB in group II. Conclusions At 3 months postoperatively, there was a significant statistical difference concerning different audiological parameters among the two groups.

Background Hypotension is the most common serious scenario in patients undergoing cesarean sections under spinal anesthesia. Care bundles have been employed using a set of three to five approaches with the aim to prevent and manage hypotension after spinal anesthesia. This study was conducted to determine the effectiveness of left uterine placement in maternal care bundle for the prevention of spinal anesthesia-induced hypotension in cesarean section. Patients and methods A total of 100 parturients age 25–35 years with American Society of Anesthesia grades I and II, undergoing elective cesarean section under spinal anesthesia, were assigned into two equal groups at random: group A and group B (each group n=50). Both groups were subjected to a bundle of care using 4-mg ondansetron diluted in 10-ml normal saline given slowly intravenous for 5 min before the induction of spinal anesthesia, and spinal anesthesia was initiated using hyperbaric bupivacaine with a constant dose (10 mg), and administration of intravenous ephedrine 9 mg was done after spinal anesthesia had been cited. Group A was subjected to additional parameter in the care bundle, including patient’s suitable position with left displacement of the pregnant uterus. Mean arterial blood pressure (MABP) and heart rate (HR) were recorded every 5 min for 45 min after spinal anesthesia. The total ephedrine and atropine requirements were also determined. Results Both groups showed a nonsignificant difference of the MABP and HR at the baseline measurement values. Follow-up of MABP and HR values every 5 min for 45 min after the onset of spinal anesthesia showed a statistically significant decrease in both groups. Overall consumption of ephedrine and atropine showed statistically significant decrease in group A compared with group B (P<0.001 and 0.01, respectively). By comparing the effect size between both groups using Cohen’s d test regarding MABP, HR measurements, and total dose of ephedrine and atropine, we found that it had a small effect size. Conclusion The application of left uterine placement is an important and effective parameter in a maternal care bundle for decreasing the incidence of postspinal anesthesia hypotension in parturients undergoing elective cesarean section.

Background and aim Atrial fibrillation (AF) is the most common arrhythmia and accounts for one-third of hospitalizations for rhythm disorders in the United States. This increasing burden of AF leads to a higher incidence of stroke. Aim The aim of the study is to assess the risk of thrombogenesis in patients with persistent nonvalvular AF by using transthoracic echocardiogram, transesophageal echocardiogram, and tissue Doppler imaging in relation to the risk of thromboembolism (CHA2DS2-VAS score). Patients and methods Selected 50 patients with persistent AF were included. All patients underwent echocardiography assessment at the echocardiography unit. Results Regarding spontaneous echocardiography contrast, there was a statistically significant difference among the three groups. Regarding left atrial appendage (LAA) thrombus, there was a statistically significant difference among the three groups. Regarding left atial appendage flow velosity (LAAFV), there was an extremely statistically significant difference among the three groups. Regarding left atrial appendage wall velosity (LAAWV) by transthoracic echocardiogram, there was an extremely statistically significant difference among the three groups. Regarding LAAWV by transesophageal echocardiogram, there was an extremely statistically significant difference among the three groups. Conclusion Patients with clinical predictors of high risk included in the CHA2DS2-VASc score were associated with increased incidence of thrombus in the LAA. In patients with nonvalvular AF, the CHA2DS2-VASc score is recommended for assessment of stroke risk. There was a correlation between the development of thromboembolic events and high-risk CHA2DS2-VASc score, as high scores indicate increased thrombogenicity.

Background and aim Early research activities during medical education years are an important factor for attracting a greater number of physicians to careers in research. In the current study, the authors aimed to investigate the interest in research among medical students at the Faculty of Medicine for Girls, Al-Azhar University, Cairo, to explore the factors that contribute to emergence of interest in research and those that contribute to no interest. The authors also aimed to determine factors that prevent those who are interested in research from engaging in research activities. Participants and methods The current study is a cross-sectional one that was carried out on 420 female students who were chosen randomly from all study years. Students responded to a self-administered questionnaire. Statistical analysis Data were analyzed using statistical package for the social sciences program version 16. Testing of the hypothesis was performed at the 95% confidence level, and a P value less than 0.05 was considered significant. Results The authors found that 73.3% of the students were interested in research. A total of 62.9% of the students reported interest in research because they believed that it could be beneficial for their careers; however, the most common reasons for no interest in research was that they were more interested in clinical work (73.6%), while the most commonly cited factor for not being able to engage in research among those who were interested was lack of time (90.3%). Conclusion Despite the high interest in health research, medical students did not report any actual publication of research papers. Consequently, the authors recommend provision of a favorable research environment and assembly of a research team to support students in all steps of their research.

Background One of the commonly performed surgical procedures in general surgical practice is groin hernia repair. Different procedures have been prescribed for hernioplasty either by open or laparoscopic approaches. Tension-free hernioplasty and obliteration of myopectineal orifices necessitate mesh insertion with different methods for its fixation. Chronic groin pain post hernioplasty (either open or laparoscopic) has been considered multifactorial and most of it has been attributed to the method of mesh fixation. Aim This study aims to evaluate the outcome of temporary percutaneous mesh fixation in transabdominal preperitoneal repair (TAPP) using a fascial closure device or straight needle suture. Patients and methods This prospective study was carried out in the Department of General Surgery Al-Hussein Hospital, Al-Azhar University, Cairo, from October 2016 to December 2017, during which 30 patients were subjected to laparoscopic TAPP hernioplasty with percutaneous mesh fixation and followed up for 1 year. A full preoperative assessment was carried out on all patients. TAPP hernioplasty with percutaneous mesh fixation was performed for all patients; postoperative follow-up was performed for detection of early and late postoperative complications. All cases were followed up for 1 year to detect late complications such as chronic pain and recurrence. Results In this study, the mean age of the patients was 39.2 years. The operative time ranged from 50 to 90 min. All patients underwent uneventful TAPP repair for groin hernia; only one patient had port site bleeding, which was properly controlled during surgery. All patients were discharged on the second postoperative day with a mean hospital stay of 1 day and allowed to resume daily activities at mean 7.5 days postoperatively. Pseudohernia developed in 10% of patients without true recurrence. Only one patient developed recurrence 6 months postoperatively. One year postoperatively, none of the patients had persistent pain and there was no other recurrence. Conclusion Temporary percutaneous mesh fixation in TAPP hernioplasty either by fascial closure device or by straight needle suture is sufficient, effective in mesh fixation and reasonable in terms of cost, enabling better availability to all patients, and yielding nearly the same recurrence rate as ordinary TAPP without permanent groin pain.

Purpose We evaluated the clinical and radiological outcome of pure cancellous iliac bone graft for the treatment of scaphoid nonunion. Patients and methods The subjects of this study were 30 patients who had a nonunited scaphoid fracture treated with pure cancellous iliac bone graft and casting between March 2015 and April 2019. The average follow-up period was 9 months. We performed open reduction through the volar approach with impaction of the fracture site with pure nonvascularized cancellous iliac bone graft and scaphoid cast for a period ranging from 1 1/2 to 3 months. Results Bony union was achieved in 29 of 30 patients. Nonunion occurred in only one patient.

Background Traumatic wounds, burns, tumor resections, and tibial fractures frequently lead to exposure of the tibia. Due to limited mobility and a paucity of overlying skin, flap coverage is generally required even for a small defect in the pretibial area. Soft tissue coverage of these defects is a must as any exposed bone that is not covered by vascularized soft tissue is at risk of osteomyelitis, bone necrosis, and sepsis. Objective This study aimed to evaluate the coverage of middle third defects of the leg using an inferiorly based hemigastrocnemius muscle flap. Patients and methods This prospective study was carried out at the Plastic, Reconstructive and Burn Department, Al-Azhar University Hospitals. This study included 20 patients with soft tissue defects at the middle third leg. Results In our study, 90% of the patients underwent reconstruction with a medial head distally based gastrocnemius flap, while the rest, 10%, underwent reconstruction with a lateral head distally based gastrocnemius flap. The majority of our patients, 65%, did not develop any complications. Unfortunately, 10% of the patients developed graft rejection and 10% developed partial flap necrosis, while 5% developed wound infection, 5% developed hematoma and 5% showed delayed graft take; all of these patients were managed early, and in terms of complications, only 5% of the patients had a hypertrophic scar of the donor site and 5% of the patients had hyperkeratosis. Most of our patients, 90%, were satisfied with the results, with only 10% being unsatisfied with the shape of postreconstructive recipient or donor sites. Conclusion The inferiorly based hemigastrocnemius muscle flap based on the vascular bundles between the two heads can be useful for reconstruction of the middle third of the leg. It is a simple technique allowing rapid, durable, and reliable coverage of these defects without sacrificing a nerve or a major vessel to the foot.

Background Numerous methods have been developed for the correction of protruding ears. However, the best technique should be the one that is simple, reliable, and reproducible. Our research aimed to compare Mustarde technique and Stenström technique used in the correction of prominent ears. We included 20 patients who were randomly assigned to Mustarde or Stenström technique. All participants underwent full history collection, general and local examinations, and full investigations. We analyzed the age, sex, surgical technique, follow-up, complications, and results. Aim The aim of this study is to compare between Mustarde and Stenström techniques in the correction of prominent ear. Patients and methods This study included 20 patients with prominent ear, comprising 15 males and five females, attending Al-Azhar University hospitals. The patients were divided into two groups, with each group including 10 patients: creation of antihelix was done in all cases, and conchomastoid sutures were used if needed in some cases. Results According to our results, comparison of these two groups showed that patient satisfaction was high in both groups. In our study, hemorrhage, hematomas, keloid formations, suture extrusion, skin and cartilage infection, skin necrosis, and relapse have not occurred in any of the patients of the two groups. Irregularity in the antihelix was not observed in any patients from group A (Mustarde technique) and observed in one (5%) patient from group B (Stenström technique). Conclusion Minimizing the gap between the ear and the mastoid is the most significant outcome for patients in considering the operation as a success. Mustarde technique was our favorite technique for correction of protruding ear in children with soft or thin cartilage. We also agree that the technique of Stenström was effective in adults with hard or thick cartilage.