Assiut Women's Health Hospital Research Articles

Concerns about data integrity across 263 papers by one author

Comprehensive investigation of published work by authors suspected of academic misconduct can reveal further concerns. We aimed to test for data integrity concerns in papers published by an author with eight retracted articles. We investigated the integrity of all papers reporting on prospective clinical studies by this author. We assessed the feasibility of study methods, baseline characteristics, and outcomes. We plotted the author's clinical research activity over time. We conducted pairwise comparisons of text, tables, and figures to identify duplicate publications, and checked for consistency between conference abstracts, interim analyses, trial registrations, and final papers. Where indicated, we recalculated p-values from the reported summary statistics. We identified 263 papers claiming to have enrolled 74,667 participants between January 2009 and July 2022, 190 (72%) of which reported on studies that recruited from the Assiut Women's Health Hospital in Assiut, Egypt. The number of active studies per month was greatest between 2016 and 2019, with 88 ongoing studies in May 2017. We found evidence of data integrity concerns in 130 (49%) papers, 43 (33%) of which contained concerns sufficient to suggest that they could not be based on data reliably collected from human participants. Our investigation finds evidence of widespread integrity concerns in the collected work of one author. We recommend that the involved journals collaborate in a formal investigation.

Developing and Implementing Nursing Care Protocol Regarding Management of Postpartum Hemorrhage

Background: Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality in developingcountries. PPH is defined as any blood loss >500 ml following vaginal delivery and >1000 ml after cesarean section.It can also be defined as fall in hematocrit >10% or blood loss >15% of total blood volume, or 10% measured perpartum decline in hemoglobin levels. Aim of the study: the aim of this quasi-experimental study was to evaluate theeffect of Developing and implementing Nursing Care protocol regarding management of postpartum hemorrhage onPatients outcomes and complications. Setting: This study was conducted at Assiut Women's Health Hospital,postpartum unit .Sample: Purposive sample with a total of 140 Postpartum Hemorrhage patients was recruited,divided into two groups (control and study) 70 patients for each group Result: this study found that a significantdifference between the routine and designed protocol in nursing management of postpartum hemorrhage . thesefindings show that the patient outcomes improved in study cases when compared with control cases which appearedin stop of bleeding 95.7% in study group, 82.8% in control group and conscious level 87.1%in study group,78.6 incontrol group with normal conscious level Conclusion: This research concluded that nursing care protocol waseffective in reducing postpartum hemorrhage outcome and complications. Recommendations: clearly writtenPostpartum Hemorrhage management protocol, adapted for a particular hospital, should be developed and used inclinical practice.

The effect of pregnancy on female sexual function: a cross-sectional study

Objective The current study aims to evaluate the effect of pregnancy in its different trimesters on the female sexual function. A cross-sectional study was conducted at Assiut University Hospital, Assiut, Egypt. Patients and methods We included consecutive healthy sexually active pregnant women aged between 18 and 40 years who had attended the antenatal care clinic of Assiut Women Health Hospital between June 2014 and May 2015. We used the Arabic version of the female sexual function index (FSFI) in the interview to evaluate the sexual functions or problems during the past month. The cutoff score used to indicate sexual dysfunction was 28.1. Results A total of 600 healthy sexually active women were enrolled in this study: 300 women with uncomplicated pregnancy and 300 nonpregnant women. The percentage of women having total female sexual dysfunction during pregnancy was 63.3% compared with 61.2% of nonpregnant women. The percentage of women having total female sexual dysfunction was 70, 44, and 72% in the first, second, and third trimesters, respectively. The second trimester women had the highest total FSFI score, which was not significantly different from the total FSFI score in nonpregnant women (P = 0.922). Conclusion The current study reports no differences in the prevalence and indices of sexual function between pregnant and nonpregnant women. However, the second trimester represents the peak of sexual function throughout pregnancy, and the problem of sexual dysfunction is the highest during the third trimester.

Effect of Cesarean Section on Demand on the phenomena of Increasing Cesarean Section Rate at Women's Health Hospital

Abstract Aims of the study were to determine the hospital based rate of C.S at Assiut Women's Health Hospital and assess the effect of C.S on demand on increasing C.S rate. Setting: This study was conducted at Assiut Women's Health Hospital, postpartum unit .Sample: A convenience sample (1500) of all postpartum women who had C.S during a three months period. Design: A cross –sectional descriptive study design was used in this study. Results: Cesarean section rate in hospital was 47.3% at 2016 and cesarean section on demand accounts for about 5.5% of the rate of C.S and in the present study findings. Conclusion: C.S which was done on maternal demand was accounted for 5.5%, as it might increase the rate of hospital based rate of C.S. Recommendations: Implementation of counseling sessions for pregnant women to improve awareness of vaginal delivery benefits, indications for C.S and the consequences of performing an elective or an unnecessary C.S.

Effect of oral ketoprofen on pain perception during copper IUD insertion among parous women: A randomized double-blind controlled trial

Abstract Objective The study aims to evaluate the analgesic effect of oral ketoprofen prior to copper intrauterine device (IUD) insertion on pain perception during the insertion procedure. Study design: A randomized double-blind controlled trial (Clinical Trials. Gov: NCT02905058). Setting: Assiut Women's Health Hospital, Assiut, Egypt. Materials and methods The current study was conducted in the Family Planning Outpatient Clinic of a tertiary university hospital between October 2016 and February 2017. Parous women eligible for Copper IUD insertion were recruited and randomized in a 1:1 ratio to oral ketoprofen 150 mg or placebo tablets. The participants were asked to take 1 tablet of the study medications one hour before IUD insertion. The primary outcome was the difference in pain scores during the IUD insertion using a 10-cm Visual Analogue Scale (VAS). We considered a 1.5 cm difference in VAS scores between study groups as clinically significant. Results One hundred forty women were enrolled (n = 70 in each group). ketoprofen significantly has lower mean pain score during all steps of IUD insertion with p Conclusion This study depicts that the use of 150 mg oral ketoprofen prior to IUD insertion in parous women reduces the pain perception and increases the satisfaction of women with this highly effective long acting contraceptive method.

The Effect of Ibuprofen on Women with Copper Intrauterine Device-Associated Heavy Menstrual Bleeding: A Prospective Cohort Study

Objective: The current study aims to evaluate the effect of ibuprofen on women with heavy menstrual bleeding associated with copper intrauterine devices (CuIUDs). Study design: A prospective cohort study conducted at Assiut Woman's Health Hospital, Egypt, from October 2015 to September 2016 included women complaining of heavy menstrual bleeding with Cu-IUDs. Eligible women received 1200 mg ibuprofen per day for 5 days starting from the first day of menses for three consecutive cycles. The primary outcome was the clinical response of ibuprofen. The secondary outcomes included the observation of its effect on uterine blood flow and the patient's quality of life. Multiple logistic regression was conducted to identify the potential predictors for responsiveness to ibuprofen. Results: One hundred three patients (80.5%) showed response to ibuprofen after three months of treatment. There was a significant decrease in the mean number of bleeding days and sanitary pads after ibuprofen treatment (p=.000). The uterine blood flow was decreased obviously after 3 months following the treatment (p=.000). The bleeding days, uterine volume and uterine pulsatility index were significant predictors for responsiveness to ibuprofen after 3 months of use (p=.003, p=.04, p=.002; respectively). Conclusion: Ibuprofen can effectively decrease the menstrual bleeding associated with Cu-IUDs. This effect may be secondary to the decrease in the uterine blood flow. Satisfactory response to ibuprofen could be anticipated in women with fewer bleeding days, smaller uterine volume and higher uterine pulsatility index at the beginning of treatment.

Preoperative evaluation of patients with ovarian masses using the risk of malignancy index 4 model

Objective: To evaluate the performance of the RMI 4 in discriminating benign from malignant ovarian masses. Study Design: Cross-sectional study. Setting: Assiut Women Health Hospital- Egypt. Materials and methods: This was an observational cross-sectional study involving 91 patients at Women's Health Hospital, Assiut University, Egypt during the period between January, 2016 and January, 2017. Women with ovarian masses planned for surgical management were recruited from the outpatient gynecology clinic of the hospital. Risk of malignancy index (RMI 4) was calculated for all study participants. Biopsies obtained from the ovarian masses after surgical intervention were sent to the pathology lab for histopathological examination. The histopathologic diagnosis of the ovarian masses is considered the gold standard for diagnosis. Results: The mean age of patients in the benign group was 34.83±16.28 years versus 43.43±15.91 in the malignant group. There were 12 postmenopausal patients (15.6%) in the benign group versus 4 postmenopausal patients (28.6%) in the malignant group (p=0.0001). An ultrasound score of 4 was recorded in 85.7% of patients in the malignant group versus only 6.5% in the benign group (p=0.0001). Additionally, tumor size ≥ 7 cm was observed in 85.7% of patients in the malignant group versus 55.8% in the benign group (p=0.0001). The mean value of CA-125 was significantly higher in malignant group than the benign group (142.09±41.50 versus 54.51±32.86 ml, respectively) with p=0.01. RMI 4 had a sensitivity of 75%, specificity of 97.3%, PPV of 85.7%, NPV of 94.8 % and an overall accuracy of 93.4%. Conclusions: RMI 4 is a simple and reliable tool in the primary evaluation of patients with ovarian masses. It can further be used to discriminate benign from malignant ovarian masses with high sensitivity and accuracy.

Role of Th-1 cell cytokines, leukemia inhibitory factor and hoxA genes in women with recurrent pregnancy loss

Abstract Objective Immunological problems have been identified as a potential cause of recurrent pregnancy loss (RPL). The aim of this study was to investigate the effect of Th-1 cell cytokines, leukemia inhibitory factor and hoxA genes in women with RPL. Materials & methods A prospective, case-control study conducted in Assiut Women Health Hospital, Egypt included 37 women presented with a history of RPL. Samples of uterine flush and endometrial biopsy were taken during the implantation window from those confirmed as not pregnant. Cytokine (LIF and Th1 induced) levels were measured by ELISA, while hox A10 and hox A11 gene expression was evaluated by Taq-man Real Time PCR. Results Higher cytokine mean levels were seen in the RPL group when compared to the control group (TNF-α and LIF cytokines, p ≤ 0.001; INF-γ and IL2 cytokines, p ≤ 0.01). The opposite was true with regards to gene expression, with lower means in both sets found in the RPL group ( hox A11, p ≤ 0.000). A statistically significant positive correlation between INF-γ and TNF-α, hox A10 and hox A11, as well as between LIF and hox A11 was demonstrated. Conclusion This study suggests that women with a history of RPL can have abnormal cytokine and gene expression even when not pregnant. Our findings can be a basis for providing of future successful immunological therapy for women with RPL.

Premature ovarian failure/dysfunction following surgical treatment of polycystic ovarian syndrome: A case series

Abstract Polycystic ovarian syndrome (PCOS) is one of the most common causes of infertility in women. Surgical treatment of PCOS, either by the antiquated wedge resection or ovarian drilling, is one of the commonly used lines in developing countries due to its low-cost. Premature ovarian failure and diminished ovarian reserve are serious complications of the surgical treatment but no published reports sufficiently highlighted these hazards. In this case series, we report on twenty one women aged between 19–39 years, presented to Infertility Clinic, Assiut Women Health Hospital with ovarian dysfunction, diagnosed within 6–36 months after surgical management of PCOS. Nineteen of them had laparoscopic bilateral ovarian drilling using electrocauterization, and the last two had bilateral wedge resection of the ovaries through minilaparotomy. Accurate and documented diagnosis of PCOS, appropriate surgical training, adjusted thermal injury and adjusted number of punctures are essential for the avoidance of excessive damage to the ovaries. Under treatment (failure of drilling) is much better than premature ovarian failure or diminishing ovarian reserve.

The maternal and neonatal outcomes of teenage pregnancy in a tertiary university hospital in Egypt

Aim: To highlight the grave complications among teenage mothers in Assiut Woman's Health Hospital compared with the adult mothers. Methods: This study was a prospective case control study, conducted at the Labor Ward of Assiut Woman's Health Hospital from 1st of January 2016 to 30th of June 2016. We included teenage pregnant women (13-19 completed years at delivery) as case and adult mothers (20-29 years) formed the control group. The primary outcome of the study is the rate of pregnancy complications among teenage mothers. Results: Obstetric complications were higher among the teenage mothers (p=0.0001). The teenage mothers had a higher proportion of normal vaginal delivery (p=0.005). The adult mothers reported a higher rate of elective cesarean section (CS) and operative vaginal delivery (p=0.0001, p=0.002; respectively). The infants of teenage mothers tended to have a lower birth weight and Apgar score than the adult ones. Conclusion: This study clearly states that the teenage mothers and their infants were more liable to complications during pregnancy and labor compared to adult mothers.

Effects of irregular antenatal care attendance in primiparas on the perinatal outcomes: a cross sectional study

Aim: Antenatal care (ANC) is a key strategy for reducing maternal and neonatal morbidity and mortality rates because adequate utilization of antenatal health care services is associated with improved maternal and neonatal health outcomes. The current study aims to identify the factors causing lack of regular attendance at ANC clinics in primiparas and to determine the effects of lack of antenatal care on perinatal outcomes. Methods: A cross sectional study was carried out at Assiut Women's Health Hospital, Egypt between October 2015 and September 2016. Estimated sample size of 516 primiparous women were divided into two groups according to number of attendance to ANC clinics; women who came four visits or more were considered regular and those who came to less than four visits were considered irregular. Data was collected via a structured interview questionnaire that included personal data, obstetrical, data about current pregnancy and labor. The researcher interviewed the women within 24 hours postpartum. Results: The majority of the study sample (74.8%) had regular ANC visits while only (25.2%) had <4 antenatal visits. Financial problems (44.6%) or lack of awareness about the importance of ANC (20%) were the most common reasons for irregular ANC visits. The incidence of preeclampsia and eclampsia is significantly higher in the irregular attendants (p=0.000). Similarly, preterm birth, stillbirth and low birth weight were significantly more common among irregular attendants (p=0000). Conclusion: Women with irregular antenatal care attendance are much more prone to pregnancy complications such as preeclampsia, eclampsia and anemia besides higher adverse birth outcomes including preterm birth, low birth weight and stillbirth.

Vaginal misoprostol prior to intrauterine device insertion in women delivered only by elective cesarean section: a randomized double-blind clinical trial

ObjectiveThe current study aims to evaluate if vaginal misoprostol (400 mcg) administered prior to intrauterine device (IUD) insertion increases the ease and success of insertion among women who had delivered only by elective cesarean delivery (CD). Study designThe current study was a randomized, double-blind, placebo-controlled trial conducted in Assiut Women's Health Hospital, Egypt, between the 1st of April 2015 and the 31st of March 2016 and included women who delivered only by elective CD. One hundred forty women were randomized into two groups; misoprostol group received two misoprostol 400-mcg tablets vaginally, and placebo group received two placebo tablets 3 h before a copper T380A IUD insertion. The primary outcome measure was the difference in the ease of insertion score using a 10-cm visual analog scale between both groups with 0=very easy insertion, and 10=terribly difficult insertion. ResultsThe ease of insertion score was lower in the misoprostol group (2.2±0.5 vs. 4.2±0.5, p=.0001) with higher number of successful IUD insertions than the placebo group (69 [98.6%] vs. 61 [87.1%], p=.009). The mean pain score reported by the women was lower in misoprostol group (2.7±0.6 vs. 4.3±0.8) with higher level of satisfaction from the whole procedure (8.9±0.4 vs. 7.9±0.2) with p=.001 for both. ConclusionsMisoprostol 400 mcg vaginally prior to IUD insertion eases and increase the success of insertion with reduction of pain among women who had delivered only by elective CD. ImplicationsThe use of vaginal misoprostol before IUD insertion in women who had never delivered vaginally before may increase the ease and success of insertion. Moreover, it may reduce the pain felt by women during the procedure.

Effect of Educational Nursing Program on Nurses’ Awareness About Cervical Cancer at Assiut Women's Health Hospital

Background: Worldwide, cervical cancer is the third most common type of cancer in women, it is claims the life of almost half a million women worldwide each year. Aim: To assess the effect of educational program on nurse’s awareness about cervical cancer. Subject and method: A quiz experimental study design was used in this study, the sample included all nurses working in the Assiut Women's Health Hospital, they were 66 nurse. Pre and post test done to evaluate nurse’s awareness about cervical cancer based on evaluation of nurses knowledge and attitude about cervical cancer .Results: The majority of the sample lived in rural area and had a diploma degree in nursing. The mean age of nurses were 29.3±9.6year, near to three-quarter of nurses had adequate knowledge about cervical cancer and more than two-thirds of them had positive attitude toward Pap smear as a screening test after implementation of the educational program, also it was observed a statistical significant relation for nurse’s knowledge in pre and post test. Conclusion: There was an improvement in nurses’ level of knowledge and their attitude become positive toward cervical cancer screening. Recommendations: Provide educational program about cervical cancer and its preventive measurements for nurse in all areas that provide maternity services.

Effect of cervical lidocaine–prilocaine cream on pain perception during copper T380A intrauterine device insertion among parous women: A randomized double-blind controlled trial

ObjectiveThe objective was to investigate the analgesic effect of cervical lidocaine–prilocaine (LP) cream in alleviating pain during copper T380A intrauterine device (IUD) insertion among parous women. Study designWe conducted a randomized, double-blind, placebo-controlled trial at Assiut Women's Health Hospital, Egypt, from October 2015 to April 2016 of parous women desiring copper IUD insertion. We randomized the subjects in a 1:1 ratio to LP cream or placebo. Seven minutes prior to IUD insertion, women received 2 ml of LP cream or placebo to the anterior cervical lip, followed by 2 ml placed in the cervical canal using a Q-tip applicator. The study end point was the subjects' self-reported pain using a 10-cm visual analog scale (VAS) during cervical tenaculum placement, sound insertion, IUD insertion and 5 min postprocedure. We considered a 2-cm difference in VAS scores between study groups as clinically significant. Also, the difference in the ease of insertion score using a 10-cm VAS with 0=very easy insertion and 10=terribly difficult insertion was assessed. ResultsThe study included 120 women (n=60 in each group). LP cream reduces the median VAS pain scores during tenaculum placement (2 vs. 4), sound insertion (3 vs. 6) and IUD insertion (3 vs. 6.5) with p=.0001 at all steps. A lower ease of insertion score was also determined among LP women (2.5±0.98 vs. 4.5±2.7, p=.001). Participants reported no side effects. ConclusionsUse of cervical LP cream prior to copper T380A IUD insertion may alleviate the IUD insertion pain among parous women. ImplicationsCervical LP cream could be effective as an analgesic prior to copper T380A IUD insertion with no side effects. Further studies are needed to assess the women's satisfaction from lying with a speculum in place for 7 min while waiting for the cream to be effective.

Low-Molecular-Weight Heparin for the Treatment of Unexplained Recurrent Miscarriage With Negative Antiphospholipid Antibodies: A Randomized Controlled Trial.

Recurrent miscarriage (RM) is one of the most common clinical problems in reproduction with no definite cause in about 50% of the cases. The study aims to evaluate the effect of low-molecular-weight heparin (LMWH) in the treatment of women with RM negatively tested for antiphospholipid antibodies (APAs). An open-labeled registered randomized controlled study (NCT 01608347) included women who attended the outpatient clinic in Assiut Women Health Hospital and Nag-Hamady Central Hospital, Egypt, with 3 or more unexplained RM. Eligible participants were randomly assigned into 2 groups. The study group included 150 patients receiving LMWH (Tinzaparin sodium 4500 IU) subcutaneous daily injection with 500 µg folic acid once daily orally started once positive pregnancy test till the 20th week of gestation. The control group included 150 patients receiving the same dose of folic acid alone. The primary outcome of the study was the rate of continuation of a viable pregnancy after 20 weeks of gestation. There was no significant difference between both groups as regards age, parity, or number of previous miscarriages. There was a significant increase in women who continued their pregnancy beyond 20 weeks in the study group compared to the control group (73.3% vs 48%, respectively; P = .002). The take-home baby rate was also significantly higher in the LMWH group compared to the control group ( P = .001). Early start of LMWH decreases the incidence of miscarriage in the first 20 weeks of pregnancy in women with unexplained RM negative for APAs.

Once Daily In-Situ Forming Versus Twice-Daily Conventional Metronidazole Vaginal Gels for Treatment of Bacterial Vaginosis: A Randomized Controlled Trial

Once Daily In-Situ Forming Versus Twice-Daily Conventional Metronidazole Vaginal Gels for Treatment of Bacterial Vaginosis: A Randomized Controlled Trial Background: Bacterial vaginosis (BV) is one of the most common infections in childbearing age. Aim: To compare the efficacy of metronidazole (once-daily 0.8% MTZ in situ gel) versus twice-daily conventional MTZ vaginal gel in the treatment of bacterial vaginosis (BV). Material and methods: All patients who presented to Assiut Women Health Hospital- Egypt with symptoms suggestive of BV were counseled to participate in the study. One hundred-four eligible participants were randomly assigned to either MTZ in situ gel or a conventional vaginal gel. All participants were followed-up twice after one and 4 weeks of the beginning of treatment to ensure cure of infection and any side-effects. Results: Demographic criteria of the participants were matched in both groups. The cure rate after one week from the treatment was 74.5% in the in situ gel group and 63.8% in the conventional vaginal gel group (P=0.252), while after 4 weeks, the cure rate showed significant difference in the in situ gel group as compared to the conventional vaginal gel group (66.7%) and (40.4%), respectively (P=0.009). Conclusion: Once daily in situ MTZ gel (0.8%) is more effective than twice-daily conventional gel after four weeks of treatment with nearly same side effects. These findings confirm the use of this novel and efficient modality of long-term treatment of BV.