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BACKGROUND AND OBJECTIVES: The timing of the reinstitution of warfarin after cesarean section (CS) delivery was not adequately addressed in the literature. This study aims to evaluate the risks of early versus late initiation of warfarin post-CS in patients with mechanical heart valves. METHODS: This randomized, open-label cohort study included 114 pregnant women with mechanical heart valves planned to be delivered by CS at or after 28 weeks of gestation. Patients were randomly divided into two groups: Day-2-group, where warfarin was started on day 2, and Day-5-group, where warfarin was started on day 5 after CS. Maternal postoperative bleeding complications, mechanical valve thrombosis, need for blood transfusion or reoperation, and maternal mortality were identified. RESULTS: Ten women (8.8%) had 11 bleeding complications, of whom 2 patients (20%) had intraperitoneal hemorrhage (none in Day-2-group and 2 in Day-5-group), 3 patients (30%) had subcutaneous hematoma (none in Day-2-group and 3 in Day-5-group), and 6 patients (60%) had sub-rectus hematoma (3 in Day-2-group and 3 in Day-5-group). No mechanical valve thrombosis, other thromboembolic events, or in-hospital maternal mortality were reported. CONCLUSION: Despite the small number of events, the bleeding risk was lower in the group with early post-CS warfarin introduction than in the group with late warfarin introduction in patients with prosthetic heart valves. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04855110.

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INTRODUCTION AND HYPOTHESIS: The aim of this study was to evaluate the effectiveness of perineal massage, pelvic floor muscle training (PFMT) and a pelvic floor dysfunction (PFD) prevention educational program in pregnant women above the age of 35 years to prevent perineal tear and episiotomy. METHODS: A randomized parallel assignment study involved two groups of pregnant women at the obstetrics outpatient clinic 4 weeks prior to their due date. The first group (n = 200) was educated to do digital perineal massage and pelvic floor muscle training and received an educational PFD prevention program. The second group (n = 200) received only the prevention education program. Occurrence of perineal laceration was reported at time of delivery as a primary outcome. Statistical analysis was done using the IBM SPSS computer program (Statistical Package for the Social Sciences; IBM Corp, Armonk, NY, USA), release 22 for Microsoft Windows. RESULTS: Delivery was significantly less complicated by perineal tear, episiotomy and postnatal pain in the first than in the second group (p < 0.05). Grades of perineal tear were mostly of first and second degree in the first group compared with the second group. We found a significantly lower need for analgesia and fewer ampoules required during the hospital stay in the first group (p < 0.001, 0.002, respectively). CONCLUSIONS: Performing antenatal digital perineal massage and PFMT in addition to health education is recommended to reduce perineal complications.

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Preeclampsia (PE) is the most common medical complication of pregnancy characterized by hypertension and significant proteinuria after the 20th week of gestation, its prevalence is about 2%-8% of pregnancies. Antihypertensive drugs were found to have an adverse effect to both the mother and the fetus so interest is increased in nonchemical treatment. This study was conducted to compare between the effects of stretching exercises versus autogenic training (AT) on PE. This study was carried out on 40 preeclamptic primiparous women, their gestational age was exceeding 20 weeks. They were randomly divided into two equal groups; group A consisted of 20 women received stretching exercises and group B consisted of 20 women received relaxation training in the form of AT. All patients in both groups A and B received (3 sessions per week for 6 weeks) and received methyldopa as the antihypertensive drug. Evaluation of all patients in both groups A and B was done before and after the treatment program by assessing arterial blood pressure and proteinuria. Results of this study revealed that there is a significant decrease in systolic blood pressure, diastolic blood pressure and proteinuria in both groups A and B after 6 weeks of treatment. There was no significant difference between both groups post-treatment in systolic blood pressure, diastolic blood pressure, and proteinuria. It can be concluded that both stretching exercise and AT were found to be effective nonchemical methods which control the symptoms of PE.

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OBJECTIVE: To evaluate the impact of maternal body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) on labor progress in nulliparous women. METHODS: The present prospective cohort study enrolled primigravidae admitted to Kasr Al Ainy hospital, Cairo University, Egypt, during active labor between February 1, 2016, and February 28, 2017. Patients were classified into three equal groups using their BMI at admission: underweight (<18.5), normal weight (18.5-29.9), and obese (≥30). The primary outcome was the rate of cervical dilatation; secondary outcomes included the duration of the second stage of labor, neonatal delivery weight, and the mode of delivery. RESULTS: Among the 600 primigravidae enrolled (200 in each group), significant differences were recorded in the rates of cervical dilatation (P<0.001), and the duration of the active labor phase (P<0.001) and the whole of labor (P<0.001); in the obese group, the cervical dilatation rate was lowest and the durations of the active phase of labor and the whole of labor were longer. The incidence of intrapartum cesarean delivery (P<0.001) and neonatal delivery weight (P<0.001) also differed between the groups; both were highest in the obese group. CONCLUSIONS: Patterns in labor progress, including cervical dilatation rate and labor duration, differed among patients with different BMI. ClinicalTrials.gov: NCT02686073.

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OBJECTIVES: The primary aim of this study was to test the hypothesis that sexual dysfunction is higher in infertile females in relation to normal healthy women through comparing total and sexual domains scores in both groups. The secondary objectives were: to determine factors affecting occurrence of female sexual dysfunction (FSD) in all sample and to determine factors affecting the different sexual domain scores within the infertile group. STUDY DESIGN: This cross sectional study was done at Cairo University Hospital. 200 infertile and 200 control females were evaluated using the Female Sexual Function Index (FSFI) questionnaire. Total score less than 26.55 signified sexual dysfunction. Husbands were evaluated by Sexual Health Inventory for Men (SHIM) questionnaire. A score less than 22 signified erectile dysfunction (ED). RESULTS: Proportion of females with sexual dysfunction was higher in the infertile versus control group (47% versus 30%, 95%CI for the difference: 8%, 26%, p-value:<0.001). Total, orgasm, satisfaction and pain scores were significantly lower in infertile versus control group (mean±SD: 26.8±3.8 versus 27.9±3.5, p-value: 0.003; 4.2±0.7 versus 4.6±0.6, p-value: 0.01; 4.9±0.5 versus 5.2±0.5, p-value: 0.004 and 3.9±0.9 versus 4.4±0.7, p-value:<0.001 respectively). Husband SHIM erectile score was significantly lower in the infertile group (median score (range): 19 (5, 25) versus 22 (12, 25), p-value: 0.001). After adjustment for 15factors by logistic regression, the odds ratio of having FSD was 2.6 (95%CI: 1.5, 4.5, p-value: 0.001) in the infertile relative to control females. Secondary (versus primary) infertility was negatively correlated with arousal score (B (95%CI): -0.6 (-0.02, -1.2), p-value: 0.003) while duration of infertility was negatively correlated with arousal, satisfaction and pain domains scores (B (95%CI): -0.2 (-0.08, -0.32), p-value: 0.04; -0.2 (-0.1, -0.3), p-value: 0.005; -0.2 (-0.06, -0.34), p-value: 0.03 respectively). CONCLUSION: sexual dysfunction is more prevalent in infertile versus control group. Infertility clinicians should be aware of this problem to assess and treat their patients to improve their quality of life.

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PURPOSE: To determine the sonographic criteria for diagnosis of fetal intracranial hemorrhage (ICH), using both gray scale ultrasound, and tomographic ultrasound imaging (TUI). MATERIALS AND METHODS: A prospective multicenter study, recruiting patients at risk of fetal ICH over four years. All cases with fetal ICH had serial ultrasound assessments, including TUI, fetal and postnatal MRIs. RESULTS: Twenty-one patients were diagnosed with fetal ICH, two cases had extracerebral (subdural) hemorrhage, 16 cases had intracerebral (intraventricular) hemorrhage and three cases had combined hemorrhage. The mean gestational age at which they were diagnosed was 29.8 ± 5.2 weeks. Seventy-six percent of cases had no identifiable risk factors. IUGR was associated with 57.9% of cases. Using grey scale ultrasound, we demonstrated clear cut sonographic criteria for diagnosis of fetal ICH. TUI enabled us to detect some midline cerebral lesions not detected by grey scale 2D ultrasound alone. Fetal and postnatal MRI confirmed those findings. CONCLUSION: Ultrasonography can be used in the detection, classification and monitoring the progression of various types of ICH. TUI is an additional diagnostic tool that might help to detect the exact size, and extent of those lesions. Fetal MRI is not superior, but might aid in the diagnosis.

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BACKGROUND: Heparin has been shown to modify fundamental biologic processes ranging from blood coagulation and cell proliferation to fibrogenesis and asthma. The goal of this study was to identify specific or broad biologic responses of the rat lung to intratracheal instillation of heparin by targeted proteomic analysis. METHODS: Rats were given either aerosolized 500 microg heparin in 250 microl saline or saline alone. Lungs were harvested at 0, 24, or 96 hours post-treatment and isolated proteins analyzed by two-dimensional gel electrophoresis. Proteins which increased and decreased significantly in treated groups above controls were then selected for identification by mass spectrometry. RESULTS: Although heparin treatments resulted in a general reduction in cytosolic protein expression, there were significant increases within members of discrete groups of proteins. At 24 hours, proteins which function in cytoskeletal organization and in calcium signaling were up-regulated between 2- and 27-fold above baseline and untreated controls. Increased proteins include annexins V and VI, septin 2, capping G protein, actin-related protein 3, moesin, RhoGDP dissociation inhibitor, and calcyclin. A group of proteins relating to immune response and tumor suppressor function were either up-regulated (tumor suppressor p30/hyaluronic acid binding protein-1, Parkinson disease protein 7, proteosome 28 subunit/interferon-gamma inducible protein, and proteosome subunit macropain alpha-1) or strongly down-regulated (transgelin). At 96 hours, most proteins that had increased at 24 hours remained elevated but to a much lesser degree. CONCLUSION: These cumulative observations demonstrate that whole lung heparin treatment results in significant up-regulation of selected groups of proteins, primarily those related to cytoskeletal reorganization and immune function, which may prove to be relevant biomarkers useful in analysis of lung exposures/treatments as well as in system biology studies.

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Multiple prior studies have identified aldehyde dehydrogenases (ALDH) that are capable of oxidizing retinal to retinoic acid. In this study, we test the hypothesis that the accumulation of intracellular retinoic acid may lead to the suppression of ALDH expression and thus increase cytotoxicity to 4-hydroperoxycyclophosphamide (4-HC) in vitro. Mainly A549, but also other lung cancer cell lines, were used in our experiments, with the former having high levels of two ALDH isozymes expressed. Dose-response and time-course experiments were performed by incubating the cells with all-trans retinoic acid (ATRA) as well as other commercially available retinoids. The results show that incubation of A549 cells with any of the retinoids at pharmacologic doses for > or =48 h results in a significant decrease in ALDH-1A1 and ALDH-3A1 enzyme activity and protein levels but not the corresponding mRNAs. Such a decrease in ALDH activity was seen in all cell lines tested and results in a significant increase in toxicity of 4-HC and acetaldehyde, both of which are substrates for the enzymes. Prior incubation with ATRA also results in increased cytotoxicity, although to a lesser degree, of phenylketophosphamide and melphalan, neither of which is a substrate for ALDHs. These results suggest a post-translational mechanism through which retinoids decrease both ALDH expression, which results in increased cytotoxicity of 4-HC and acetaldehyde, although other previously described effects of these retinoids may contribute to the slight increase in cytotoxicity seen with other chemotherapy agents. These results may have clinical implications in regard to the use of retinoids in lung cancer prevention and treatment.

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