Background and aim Pelvic congestion syndrome (PCS) is a significant cause of chronic pelvic pain in women of reproductive age, often associated with ovarian vein insufficiency. Traditional management with hormonal therapy or surgery may be invasive. We aimed to evaluate the efficacy and safety of trans-venous coiling (embolization) as a minimally invasive treatment for PCS in an Egyptian cohort. Patients and methods A prospective observational study was conducted at Al-Azhar University Hospital from 2023 to 2024. A total of 20 female patients (mean age: 30.55±6.67 years) with chronic pelvic pain unresponsive to conservative therapy and imaging-confirmed PCS were enrolled. Diagnosis was based on transvaginal ultrasound and computed tomography venography, demonstrating ovarian vein dilation and reflux. All patients underwent trans-venous coiling under fluoroscopic guidance. Technical success, symptom improvement [Visual Analog Scale (VAS)], and complications were assessed. Statistical analysis included descriptive statistics and Paired t -tests for pre and postprocedure VAS scores. Results Technical success, defined as complete occlusion of the target veins, was achieved in 100% of patients. The majority (90%) underwent left ovarian vein embolization, with a mean of 2.3 coils per patient. At 12-month follow-up, 90% of patients reported significant symptom improvement (VAS reduced from 7.4±1.2 to 1.8±0.9, P <0.001). Minor complications included mild contrast reactions (5%) and transient postprocedural pain (10%); no major adverse events or recurrences were observed. Conclusions Trans-venous coiling is a safe and effective treatment for PCS, providing substantial and durable symptom relief with minimal complications.
Background and aim Nasal obstruction has long been related to middle ear (ME) illnesses. Nasal obstruction changes the function of the Eustachian tube and may affect ME pressure. This study aimed to assess the ME function in cases with bilateral complete nasal obstruction not improved with medication. Patients and methods A prospective observational study was conducted among 60 ears of 30 patients with complete bilateral nasal obstruction not improved by medication. The cases were surgically operated on for correction of their nasal occlusion and assessment of ME function before and after 1 and 3 months of operation. The assessment included a tympanogram and audiogram. Results An improvement was found in most cases after three months postoperative, which observed tympanogram type A was observed on Rt and Lt ear (90 and 93.3%) in comparison to tympanogram preoperative, which was type C on Rt and Lt ear (46.7 and 43.3%). Also, assessment of audiogram on Rt ear showed that 90% of cases had normal hearing, and 93.3% of cases showed normal hearing on Lt ear after 3 month postoperative in comparison to assessment of audiogram on Rt and Lt ears showing mid and moderate conductive hearing loss (CHL) about (80, 76.67%), respectively. Conclusion Our outcomes demonstrated that bilateral chronic nasal occlusion is a common reason that has a strong association with Eustachian tube dysfunction, and nasal occlusion operations significantly enhance Eustachian tube function and ME pressure.
Background and aim The rising worldwide incidence of type 2 diabetes mellitus (T2DM) highlights the importance of elucidating its genetic determinants, with particular focus on islet amyloid polypeptide (IAPP) and its impact on β-cell dysfunction. IAPP is co-released with insulin, aggregates into amyloid deposits in T2DM, potentially contributing to β-cell impairment. Genetic variations, such as single-nucleotide polymorphisms in the IAPP gene, may modulate this pathological process. We aimed to evaluate the relationship between the IAPP single-nucleotide polymorphisms rs77397980 and β-cell dysfunction in individuals with T2DM. Patients and methods This case–control study included 150 participants classified into three groups: normal glucose tolerance as a control group, impaired glucose tolerance, and diabetes based on oral glucose tolerance test results. Demographic, metabolic, and genetic data were collected, and rs77397980 was genotyped using real-time PCR. Statistical analysis assessed interactions between genotype and glucose levels on fasting glucose, insulin, and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Results The study showed no significant differences in genotype distribution (TT: 82%, TC: 18%) across groups (P=0.6). While no significant interactions were found in normal glucose tolerance or impaired glucose tolerance groups, diabetic participants with higher glucose levels exhibited lower fasting insulin (P=0.05) and HOMA-IR (P=0.045) in TC carriers compared to TT homozygotes. Conclusion The IAPP rs77397980 TC genotype was associated with lower fasting insulin and HOMA-IR in diabetic individuals with severe hyperglycemia, suggesting a potential protective effect against insulin resistance under high glucose conditions.
Background and aim Striae rubra, or stretch marks, are a common skin problem that affects both sexes, but women are more common to be affected and more self-conscious about stretch marks than men. Striae have a highly difficult expensive therapeutic challenge, so we aimed to evaluate the clinical efficacy and safety of the 577 nm Pro-Yellow laser in the treatment of Stria rubra. Patients and methods In this interventional study, 18 female patients complaining of striae rubera conducted at the outpatient clinic of Al-Azhar University Hospital (Assiut). All the included patients subjected to 577-nm Pro-Yellow Laser for striae rubra were evaluated through physical examination and measurement of lesion width and length. Standardized digital photography was performed before, during, and after treatment sessions. Improvement in stretch marks was assessed using the Manchester Scar Scale at baseline and one month post-treatment. Results There was a statistically significant improvement and decrease in color, finish, contour, distortion, and texture items of Manchester scar scale for assessment of the lesions before and after treatment with P value less than 0.0001. Conclusion The 577-nm Pro-Yellow Laser was an effective therapeutic option for striae rubra. The 577-nm Pro-Yellow Laser resulted in a significant reduction in the width of striae rubra, showed a significant improvement in the dermoscopic and Manchester scar scale. Moreover, the treatment showed high satisfaction and good improvement, assessed by the quartile grading scale.
Background and aim Total knee arthroplasty (TKA) is associated with significant postoperative pain, where an adductor canal block (ACB) addresses anterior pain but spares the posterior knee, which remains a significant pain source. The infiltration between the popliteal artery and the capsule of the knee (IPACK) and sensory posterior articular nerve of the knee (SPANK) blocks are two motor-sparing techniques to manage this posterior pain. We aimed to compare the analgesic efficacy of ultrasound-guided IPACK block versus SPANK block when combined with ACB after TKA. Patients and methods This prospective, randomized, single-blinded study involved 90 patients undergoing elective unilateral TKA under spinal anesthesia, allocated to receive either ACB+IPACK (group I, n=45) or ACB+SPANK (group S, n=45). The primary outcome was the duration of analgesia. Secondary outcomes included pain scores of visual analog scale (VAS), total opioid consumption, time to first rescue analgesia, hemodynamics, and adverse effects. Results Group I demonstrated a significantly longer duration of analgesia (877.44±115.1 vs. 461.96±78.5 min, P<0.001) and time to first rescue analgesia (14.6±1.66 vs. 8.16±1.55 h, P<0.001). Total 24-h nalbuphine consumption was significantly lower in group I (6.76±2.23 vs. 9.87±2.64 mg, P<0.001), with superior pain scores at 8, 12, and 18 h. Conclusion Combining ACB with the IPACK block provides more effective and prolonged postoperative analgesia than ACB with the SPANK block, reducing opioid requirements and improving pain control without increasing side effects.
Background Laparoscopic sleeve gastrectomy (LSG) is a main surgical treatment for morbid obesity. This research evaluates its impact on weight loss, obesity-related comorbidities, and gastric pouch volume dynamics. This study aimed to assess the outcomes of LSG in morbidly obese cases, focusing on comorbidity resolution, weight loss, and changes in gastric volume over 1 year. Patients and methods The research involved 30 morbidly obese cases (BMI above 40 kg/m2 or above 35 kg/m2 with comorbidities) aged 18–60 years, undergoing LSG at Al-Azhar University Hospital. Gastric volume has been assessed using multislice computed tomography (MSCT) at 1 month and 1 year postsurgery. Weight loss and comorbidity outcomes were monitored during monitoring at 1, 3, 6, and 12 months. Results Cases showed significant weight loss, with a mean percentage of excess weight loss increasing from 15.98% at 1 month to 64.01% at 1 year (P<0.001). Comorbidities like osteoarthritis, hypertension, diabetes, and obstructive sleep apnea resolved or enhanced in most cases. Gastric pouch volume increased significantly from 82.93±11.45 ml at 1 month to 175.8±23.68 ml at 1 year (P<0.001). No association has been observed among gastric volume increase and inadequate weight regain or weight loss (P=0.491). Conclusion LSG effectively promotes weight loss and ameliorates obesity-related comorbidities. Gastric dilation occurs as a normal response but does not hinder weight loss outcomes.
Background and aim Physiological significance of the right ventricle (RV) has been underestimated, and its contractile function was hemodynamically insignificant, however, it plays a crucial role in maintaining regular cardiac pumping. We aimed to assess RV systolic function in patients with hypertensive heart failure (HHF) by tissue Doppler and three-dimensional echocardiography (3DE). Patients and methods This observational, cross-sectional study was carried out on 50 patients clinically diagnosed with HHF were included in the study, in whom we assess RV function by tissue doppler and 3DE. Results There was a significant positive correlation between tricuspid annular plane systolic excursion and fractional shortening (r=0.537, P<0.001), right ventricular ejection fraction (r=0.454, P<0.001), right ventricular end-diastolic volume (r=0.278, P=0.050), and right ventricular end-systolic volume (r=0.278, P<0.001). There was a significant negative correlation between tricuspid annular plane systolic excursion and right ventricle dimension (r=−0.295, P=0.037) and RV strain (r=−0.276, P=0.035). Conclusions This study demonstrated that tissue Doppler imaging (TDI)-derived parameters and 3DE measurements are effective in detecting subtle changes in RV function that may not be apparent using conventional echocardiographic techniques. Our findings highlight the clinical significance of evaluating RV function in hypertensive patients, as impaired RV mechanics are associated with worse prognoses and increased morbidity. The combined use of TDI and 3DE allowed for a comprehensive assessment of RV structure and function, enhancing the sensitivity and specificity of RV dysfunction detection. The 3D echocardiographic assessment and TDI revealed that there is statistically significant RV dysfunction in patients with HHF.
Background and aim An Anal fissure is a painful tear, often from constipation or childbirth. In chronic cases, healing is delayed due to muscle spasm. Topical glyceryl trinitrate (GTN) and diltiazem (DTZ) help by relaxing the muscle, with DTZ often performing better. This study aimed to compare the effect of topical DTZ 2% and GTN 0.2% in the treatments of chronic anal fissure. Patients and methods This prospective randomized clinical trial included 80 patients (18–60 years) with chronic anal fissure at Al-Azhar Assiut from November 2023. Patients were randomly separated into two groups: one managed with 2% DTZ ointment, the other with 0.2% GTN ointment. Results Before treatment, the main presenting symptoms were constipation, pain, and bleeding. Posterior fissures were found in 90.1% of patients, with skin tags in 75% and sphincter spasm in 62.5%. At 6 weeks, complete healing occurred in 80% of the DTZ group and 75% of the GTN group (P >0.05). Recurrence rates at 24 weeks were 10% in the DTZ group versus 12.5% in the GTN group. More side effects were reported in the GTN group, notably headache (67.5 vs. 22.5%; P < 0.001). Healing at 8 weeks was comparable (78% DTZ vs. 82.5% GTN; P = 0.775). Pain decreased in both groups with no significant difference throughout follow-up. Conclusion Both DTZ 2% ointment and GTN 0.2% ointment are effective. DTZ showed slightly better healing and fewer headaches, but the difference was not significant.
Background and aim The prevalence of congenital heart disease (CHD) is 3.5–17.5 per 1000 live births. Natriuretic peptides are biologically active molecules secreted by the ventricular musculature in response to volume or pressure overload, causing vasodilation, natriuresis, and diuresis, which leads to improved myocardial relaxation. We aimed to evaluate the diagnostic value and possible correlation of plasma brain natriuretic peptide (BNP) levels with CHD and each of the hemodynamic, ECG, and echocardiographic data in pediatric CHD. Patients and methods This is an observational prospective study carried out on 60 children (40 cases with CHD and 20 controls) with ages between 2 months to 10 years, admitted at Pediatrics Department Al-Azhar University hospital (Assiut) from November 1, 2021 to November 30, 2023. Demographic data, anthropometric measurements, vital signs, and systemic examination were performed on all participants, as well as chest radiograph, ECG, echocardiography, laboratory investigation, and assay of plasma level of BNP. Results Anthropometric measurements were significantly lower in cases of CHD compared to controls (P<0.001). BNP was statistically significantly higher in cases of CHD than in the control group and showed a significant positive correlation with respiratory rate and modified Ross grading and strong negative correlations with age, systolic and diastolic arterial blood pressure, and ejection fraction. BNP at the cutoff point (>7690 pg/ml) showed a sensitivity of 93.3% and specificity of 76%. Conclusion Elevated plasma BNP levels should be considered a significant diagnostic marker in children with CHD, particularly those who developed congestive heart failure; however, BNP proved to be a nonsignificant prognostic factor.
Background and aim Previous studies have established an association between peripheral osteoarthritis and subclinical atherosclerosis; however, the relationship with spondylosis remains insufficiently explored. The objective of this study was to evaluate the link between spondylosis and subclinical atherosclerosis and to examine the possibility of a causal relationship. Patients and methods A cross-sectional study was conducted, enrolled 100 patients with lumbar and/or cervical spondylosis presenting with low back and/or cervical pain. Radiographic evaluation included anteroposterior and lateral views, with spondylosis graded using the Lane index for lumbar and the Kellgren index for cervical involvement. Subclinical atherosclerosis was evaluated through the measurement of carotid intima-media thickness (CIMT) using Doppler ultrasonography. To evaluate the association between spondylosis severity and subclinical atherosclerosis, correlation and regression analyses were applied. Results Subclinical atherosclerosis was identified in 14% of patients. CIMT showed significant correlations with age, cervical pain severity, and the Lane index for lumbar spondylosis (r=0.72, r=0.34, r=0.41; P<0.001). Additional significant correlations were found between CIMT and triglyceride levels, Roland–Morris disability score, and the Kellgren index for cervical spondylosis (r=0.25, r=0.23, r=0.32; P=0.014). Conclusion Severe spondylosis was associated with a higher prevalence of subclinical atherosclerosis, suggesting a potential causal relationship. Validation of these findings requires larger, multicenter studies.
Background and aim Rectal cancer management has evolved significantly with the introduction of laparoscopic surgery. However, the debate continues regarding the oncological adequacy and perioperative outcomes of laparoscopic low anterior resection (LLAR) compared to open low anterior resection (OLAR). This research aimed to compare early results after the operation and oncological adequacy between LLAR and OLAR for rectal cancer. Patients and methods Prospective comparative research has been carried out on forty cases diagnosed with mid or low rectal cancer between January 2023 and January 2025. Cases were equally separated into two groups: LLAR (n=20) and OLAR (n=20). Preoperative preparation, surgical technique, and postoperative care were standardized. Short-term outcomes, including operative time, gastrointestinal recovery, pain, hospital stay, morbidity, and complications, were assessed. Oncological outcomes included margin status, lymph node yield, and recurrence rate. Results LLAR showed a statistically significant advantage in earlier postoperative flatus passage (P=0.02) and a significantly reduced wound infection rate (P=0.006). There was a statistically insignificant variance between the groups with regard to operative time, blood loss during the operation, hospital stay, bowel motion following the operation, or most complications. Oncological outcomes, including circumferential and distal resection margins, number of harvested lymph nodes, overall survival, and disease-free survival, showed insignificant variances among groups. Conclusion LLAR demonstrated favorable short-term outcomes with comparable oncological adequacy to OLAR. These findings support the effectiveness and safety of the laparoscopic approach in rectal cancer surgery, though larger research is recommended to confirm long-term benefits.
Background and aim Obesity affects over one-third of the global population and is linked to various health problems such as cardiovascular diseases, diabetes, and dyslipidemia. It results from an imbalance between energy intake and expenditure. Bariatric surgery, particularly sleeve gastrectomy (SG) and Roux-en-Y gastric bypass, is the most effective treatment for morbid obesity, offering benefits beyond weight loss, including metabolic improvements. These procedures can also enhance lipid profiles, although nutrient deficiencies may occur, especially with malabsorptive techniques. This study aims to assess the impact of laparoscopic sleeve gastrectomy (LSG) on lipid profiles and calcium metabolism. Results will be compared with international data from various centers. Patients and methods This retrospective analysis included 30 patients admitted to the General Surgery Department at Al-Azhar University Hospital, Assiut, who underwent LSG for the management of morbid obesity between August 2022 and August 2024. Preoperative and postoperative lipid profiles and serum calcium levels were assessed. Results Three months after the procedure, notable improvements were observed in lipid profile parameters. Specifically, total cholesterol, triglycerides, and low-density lipoprotein levels showed significant reductions, while high-density lipoprotein levels demonstrated a significant rise. Conversely, postoperative serum calcium levels showed a significant decline. Conclusion Our retrospective study shows LSG leads to significant weight loss and favorable changes in lipid profile within a short postoperative period. However, it may lead to calcium deficiency due to altered absorption, necessitating supplementation and regular monitoring.
Background and aim Alopecia areata (AA) is a common autoimmune hair loss disorder with heterogeneous severity, distribution, and duration. Pentoxifylline has been utilized in dermatological conditions mostly as an additional treatment, with advantageous benefits. This study aimed to assess the safety and efficacy in clinical settings of intralesional pentoxifylline in treating AA. Patients and methods A prospective clinical study that was conducted on 50 patients diagnosed clinically and dermoscopically with AA. The patients were subjected to Intralesional pentoxifylline injection and had one session every 3 weeks for 12 weeks. Results A significant reduction in dermoscopic features of AA after treatment. Regarding the SALT score, there was a significant reduction before and after treatment. More so, a high satisfaction rate was observed in 27 (54%) patients after the treatment. As regards follow-up data, recurrence and appearance of new lesions were observed in three (6%) and two (4%) of patients, respectively. Moreover, regarding side effects, telangiectasia and atrophy were not observed among patients., On the other hand, transient erythema and pain were observed in some patients. Conclusion Intralesional pentoxifylline is an effective, safe, and well-tolerated method for the treatment of AA with minimal adverse effects and a low recurrence rate.
Background and aim Hepatic ascites usually treated by natriuresis and diuresis. Empagliflozin is a sodium–glucose cotransporter 2 inhibitor which is a novel drug that was designed for management of type II diabetes mellitus by targeting sodium–glucose cotransporter 2 in the kidney, advocating urinary excretion of both sodium and glucose in the urine. We aimed to explore the safety and efficacy of empagliflozin as an auxiliary treatment for ascites in patients with liver cirrhosis Patients and methods A clinical trial was conducted on 104 patients with cirrhotic ascites enrolled in this study treated for 3 months by the standard therapy [salt restriction plus diuretics (spironolactone and frusemide)] then standard therapy plus empagliflozin 10 mg po once for another 3 months abdominal girth and body weight was used a measure of ascites volume. Results Empagliflozin had very good safety profile as regard cirrhotic patients, however there were no statistically significant reduction of abdominal girth and body weight as a measure of ascites volume. Conclusion Empagliflozin was found to be safe and well tolerated in patients with advanced chronic liver disease. Although it appeared to enhance diuresis and facilitate ascites mobilization, these effects did not achieve statistical significance.
Background and aim High-resolution computed tomography (HRCT) offers a more detailed anatomical assessment than the Chest radiography (CXR) in the diagnosis of chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the influence of HRCT in refining the diagnosis and management of COPD patients. Patients and methods This study included 50 COPD patients. All patients underwent thorough clinical assessment, spirometry, CXR, and HRCT. HRCT findings were analyzed for emphysema, bronchial wall thickening, bronchiectasis, air trapping, and co-existing pathologies, and compared with CXR findings. Results The study included 45 males and five females, with a mean age of 63.32±10.45 years. Spirometry revealed various degrees of obstruction, with forced expiratory volume in 1 second (FEV1)% ranging from 12 to 75%. While CXR detected abnormalities in most patients (e.g. hyperinflation, increased bronchovascular markings), HRCT provided significantly more detailed information. HRCT identified emphysema in 72% of patients (centrilobular 46%, panlobular 26%), bronchial wall thickening in 90%, and bronchiectasis in 34%. Notably, HRCT revealed significant air trapping in 84%, cystic lung disease in 24%, and pulmonary nodules in 16%. HRCT also detected co-existing pathologies such as interstitial lung disease in 10% and pleural effusion in 6%. A statistically significant relationship was found between HRCT findings and CXR findings for consolidation or effusion (P=0.001). Conclusion HRCT plays a valuable role in the comprehensive evaluation of COPD patients, offering superior anatomical detail compared with CXR. It is instrumental in detecting subtle parenchymal changes, airway abnormalities, and co-existing conditions that influence diagnosis and guide appropriate management, thereby improving patient outcomes.
Background and aim Helicobacter pylori infection is a prevalent chronic bacterial infection in the world, involving approximately half of the world population. We aimed to evaluate and compare the efficacy and safety of vonoprazan (VPZ) versus omeprazole when used in a nonbismuth quadruple regimen for H. pylori eradication. Patients and methods In this prospective, open-label, randomized controlled trial, 200 individuals with dyspeptic symptoms and confirmed H. pylori infection were included from the outpatient clinic of the Hepatology and Gastroenterology Department at Al-Azhar Assiut University Hospital. Participants were randomized into two groups: group I (n=100) received clarithromycin 500 mg twice daily, amoxicillin 1000 mg twice daily, nitazoxanide 500 mg twice daily, and omeprazole 40 mg twice daily for 14 days. Group II (n=100) received the same antibiotic regimen combined with VPZ 20 mg twice daily for 14 days. Results The overall eradication rate was 85%, with a statistically significant difference between the two groups (P=0.001). The VPZ-based regimen achieved a 94% eradication rate, significantly higher than the 76% noted with the omeprazole-based regimen. Conclusion VPZ-based therapy exhibited superior efficacy in eradicating H. pylori compared with omeprazole, with eradication rates of 94 versus 76%, respectively. The findings suggest that VPZ-based nonbismuth quadruple therapy is a safe, well-tolerated, and highly effective treatment option, offering improved success rates over traditional omeprazole-based regimens.
Background and aim Stress urinary incontinence (SUI) results from pelvic floor muscle weakening, often postchildbirth. Fractional carbon dioxide (CO2) laser therapy and platelet-rich plasma (PRP) show promise for tissue regeneration, with lasers stimulating collagen remodeling and PRP enhancing healing. This study evaluates the efficacy and safety of their combined use in managing SUI and its impact on sexual function. Our aim is to assess the effectiveness and safety of transvaginal CO2 laser and PRP in female SUI patients. Patients and methods This prospective observational study was conducted at Al-Zahra University Hospital and a private center from May 2022 until study completion. Thirty women diagnosed with SUI via the International Consultation on Incontinence Questionnaire − Urinary Incontinence Questionnaire underwent two cycles of CO2 laser and PRP therapy at baseline (T1) and 6 months (T2). Primary outcomes included SUI symptom improvement and urodynamic parameters. Secondary outcomes assessed sexual function via the female sexual function index. Results Thirty women with SUI were enrolled. From T1 to T2, 86.8% (26/30) reported symptom improvement (P<0.001). Significant improvements were observed in urodynamic parameters (P<0.001), except for maximum cystometric capacity (P=0.70). Female sexual function index scores also showed notable enhancement. Conclusion Transvaginal CO2 laser therapy combined with PRP appears to be a safe, minimally invasive alternative to surgery for SUI treatment, with the added benefit of improving sexual function.
Background and aim Helicobacter pylori (H. pylori) is a spiral-shaped gram-negative bacterium that colonizes the intestines, This work aimed to evaluate Vonoprazan’s and Omeprazole’s clinical effectiveness and safety in a high-dose amoxicillin dual regimen for the treatment of H. pylori infection. Patients and methods In this prospective superiority parallel open-label randomized controlled trial, 100 patients with dyspeptic symptoms who tested positive for an H. pylori infection by stool antigen test (SAT) were included in the study at Al-Azhar-Assiut University Hospital. Patients were divided into two groups at random using a 1:1 allocation ratio in parallel. Group 1 (Omeprazole-based high-dose amoxicillin dual therapy (DT)) (n=50): Patients were treated with amoxicillin1000 mg t.i.d and omeprazole 40 mg t.i.d for 14 days and group 2 (Vonoprazan based high dose amoxicillin DT) (n=50): Patients were treated, amoxicillin 1000 mg t.i.d and Vonoprazan 20 mg b.i.d for 14 days. Results Intention to treat (ITT) and per protocol (PP) analyses of the eradication rates by SAT were (90% and 93.75%, respectively) in vonoprazan group compared to (74% by ITT analysis and 78.72% by PP analysis) in omeprazole group and ITT analysis and PP analysis were significantly higher in group 2 than group 1 (P value <0.05). Conclusions DT based on vonoprazan is a safe and effective alternative for the eradication of H. pylori infection in regions with high antibiotic resistance, as it is characterized by high symptom relief rates, excellent compliance, and a reduction in antibiotic consumption. Place of the study: Hepatology, Gastroenterology, and Infectious diseases, Al-Azhar University, Assiut, Egypt
Background and aim Cesarean section is the surgical delivery of a baby through incisions in the uterus and abdomen. Its rate has steadily elevated and is now the most frequent surgery globally. This study aimed to assess the safety (for both fetus and mother) and effectiveness of vacuum-assisted Cesarean delivery. Patients and methods This randomized controlled investigation involved 60 women having cesarean section at Al-Azhar University Hospital, Assiut (October 2023–January 2025). They have been separated into group A (30 cases with vacuum extraction) and group B (30 cases with manual extraction) of the nonengaged head of the fetus. Results A statistically insignificant variance was observed among the vacuum extraction and manual extraction groups regarding gestational age, parity, birth weight, and APGAR scores at 1 and 5 min. In the vacuum extraction group, the number of pulls ranged from 1 to 3, with 13.3% experiencing cup detachment and a 6.7% failure rate. Neonatal outcomes, including NICU admission, need for resuscitation (13.3 vs. 16.7%), and incidence of cephalohematoma (6.7 vs. 0%), showed insignificant differences between groups. Maternal outcomes revealed a significantly shorter incision length in the vacuum extraction group (9.0±1.3 vs. 12.8±2.1 cm). In contrast, postpartum hemorrhage, blood loss, extension of uterine incision angles, head extraction time, and U-D interval showed insignificant differences. Conclusion Vacuum extraction significantly reduced incision length compared with manual extraction, with no significant differences in neonatal outcomes or maternal complications.
Background and aim Helicobacter pylori infection is a common infection that produces multiple intestinal and extraintestinal diseases, and the overall eradication rate is less than desirable. The suboptimal acid suppression had an important role in reducing the eradication rate. Our study aimed to compare the potent acid suppressor (Vonoprazan)versus pantoprazole in the eradication of H. pylori. Patients and methods A randomized clinical trial was conducted on 100 patients infected with H. pylori and divided into two equal groups: group 1 treated with levofloxacin-based triple therapy and proton-pump inhibitor, while group 2 treated with levofloxacin-based triple therapy and Vonoprazan. Results The eradication rate was significantly higher in Vonoprazan-containing regimens (92%) than proton-pump inhibitor with a 76% eradication rate, while there were no significant side effects between the two groups. Conclusion Vonoprazan-based therapy is a safe, well-tolerated, promising and effective treatment option for H. pylori eradication, offering a higher success rate compared to pantoprazole-based regimens.
