Salah M. Rasheed

Endometriosis is characterized by the presence of ectopic endometrial tissues. Mechanisms of tissue dissemination in endometriosis may be similar to those involved in tumor metastasis. We hypothesize that dysregulation of kisspeptin (KISS1), a metastasis suppressor in endometrial carcinoma, may contribute to the pathogenesis of endometriosis. In this study, we characterized the immunoreactivity of kisspeptin and its receptor, KISS1R, in eutopic and ectopic endometrial tissue of women with and without endometriosis, in proliferative and secretory menstrual cycle phases. Immunohistochemistry was performed using KISS1 and KISS1R antibodies on samples from women with (n = 35) and without (n = 14) endometriosis. Samples from women with endometriosis included eutopic endometrium (n = 20) samples, superficial endometriotic implants (SUP, n = 10) deep infiltrating endometriotic implants (DIE, n = 15), and ovarian endometriomas (OMA, n = 15). Immunoreactivity was quantified using histoscores. KISS1 and KISS1R immunoreactivity was significantly lower in eutopic endometrial stroma of women with versus without endometriosis, regardless of the menstrual cycle phase (P = 0.001 and P = 0.015 respectively). In endometriotic implants, KISS1 levels were significantly lower in both glandular and stromal components of DIE (P < 0.01) and OMA (P < 0.01) compared to SUP. KISS1R immunoreactivity was lower in the glandular component of OMA (P = 0.035) compared to SUP. KISS1 and KISS1R levels are lower in eutopic endometrial stroma from women with versus without endometriosis, consistent with a role for decreased KISS1 expression in the pathogenesis of endometriosis. As deeply invasive lesions showed lower KISS1 levels than superficial lesions, downregulation of KISS1 levels may contribute to implant invasiveness.

Objective: To evaluate the impact of bilateral internal iliac artery ligation (BIL), bilateral uterine artery ligation (BUAL), step‐wise uterine devascularization (SWUD), and B‐Lynch on infertility, ovarian reserve, and pregnancy outcome.Methods: The study included 168 infertile or pregnant patients—recruited at outpatient clinics in Egypt—who had previously undergone uterine‐sparing surgery (BIL [group I], n = 59; SWUD [group II], n = 65); BUAL [group III], n = 2; and B‐Lynch [group IV], n = 42). One‐way analysis of variance was used to compare the prevalence of infertility, the status of ovarian reserve, and the prevalence and type of relevant maternal and/or fetal obstetric complications between the groups.Results: Groups II and IV had the highest prevalences of infertility. The ovarian reserve was significantly lower in group II. Unexplained infertility was the predominant cause of infertility in group I, anovulation and premature ovarian failure in group II, and endometriosis and intrauterine adhesions in group IV. The frequency of obstetric complications, particularly placenta previa and preterm labor, was high in group IV.Conclusion: Of the 4 procedures, BIL had the least deleterious effect on reproductive performance; SWUD increased the risk of premature ovarian failure, and B‐Lynch increased the risks of endometriosis, intrauterine adhesions, placenta previa, and preterm labor.

Objective: To evaluate maternal, fetal, and neonatal outcomes and their associated risk factors among pregnant women with liver cirrhosis (LC). Methods: A prospective cohort study was conducted at Sohag University Hospital, Egypt, between May 1, 2009, and April 1, 2012. Participants included 129 pregnant women with LC (study group), 647 pregnant women without LC (control group 1), and 853 non‐pregnant women with LC (control group 2). Univariate and multivariate analyses were performed. Results: Maternal, fetal, and neonatal complication rates were significantly higher in the study group than in control group 1 ( P = 0.001 for all complications). The rate of hepatic decompensation (HD) was higher in the study group than in control group 2 (63.6% vs 13.6%; P = 0.001). Maternal mortality was higher in the study group (7.8%) than in either control group 1 (0.2%) or control group 2 (2.5%; P = 0.001). Variceal bleeding during vaginal delivery was the most frequent cause of maternal mortality. Vaginal delivery and increasing gestational age were the key variables affecting the rate of HD ( P = 0.001 for both). Conclusion: The presence of LC during pregnancy was associated with high rates of maternal and neonatal complications. Increasing gestational age and vaginal delivery were the most important risk factors for HD.

To evaluate the rate and pattern of complications associated with use of the Copper T 380A intrauterine device (IUD) among adolescents. A prospective comparative study of women eligible for IUD insertion who attended the family planning clinic of Sohag University Hospital, Egypt, between July 1, 2008 and December 31, 2010. The participants were categorized as adolescents or adults. The Copper T 380A IUD was inserted in all participants and follow-up visits were scheduled at 1, 3, and 6 months. Odds ratio and χ(2) square tests were used to compare the rates of complications at each visit. Of 1512 patients eligible for IUD insertion, 852 met the inclusion criteria: 281 adolescents and 571 adults. The rates of pain, bleeding, displacement, expulsion, and removal of IUDs were significantly higher in adolescents (P<0.05). The rates of these complications were high in adolescents younger than 16 years; the rates then decreased with age and became comparable with the adult rates at 18 years of age. IUD-associated complications were high in adolescents up to the age of 17 years. Our data suggest that adolescents younger than 18 years of age should be counseled carefully before IUD insertion, and examined more frequently to detect displacement or expulsion of the device.

Objective: To estimate the influence of the 2007 criminalization law on the prevalence and yearly incidence of female genital mutilation (FGM) in Upper Egypt and assess the attitudes of both the population and their health providers toward FGM.Methods: Between September 15, 2008, and September 15, 2010, all girls and young women presenting at the Departments of Gynecology and Obstetrics or Pediatrics of Sohag and Qena University Hospitals were invited to answer a questionnaire, which was also presented to their parents. Another questionnaire was presented to all nurses, young physicians, and senior physicians working at either hospital.Results: The prevalence of FGM was 89.2%. The incidence was 9.6% in 2000, began to decrease in 2006, and had reached 7.7% at the end of the study period in 2009 (P = 0.05). In their vast majority, the procedures were performed by general practitioners. In total, 88.2%, 34.3% and 14.9% of nurses, young physicians, and senior physicians, respectively, approved the practice.Conclusion: The incidence of FGM is still very high in Upper Egypt in spite of the criminalization law. While general practitioners perform most procedures, most nurses are in favor of preserving the practice.

To determine the reasons for adolescent pregnancy in Upper Egypt and to evaluate maternal, fetal, and neonatal outcomes. All primigravidae under 30 years of age who attended the labor/delivery ward at Sohag University Hospital, Sohag, Egypt, between December 31, 2005, and December 31, 2009, were invited to participate. Participants were allocated to the study group (up to 19 years of age at first pregnancy) or the control group (20-30 years of age at first pregnancy). Maternal, obstetric, fetal, and neonatal complications were compared between the groups, and adolescent participants completed a questionnaire to identify the reasons for pregnancy. In total, 58.2% had married seeking motherhood. Rates of ectopic pregnancy, pre-eclampsia, eclampsia, premature rupture of membranes, preterm labor, and cesarean were significantly higher among adolescents younger than 15 years of age; the risk then decreased steadily with age and became comparable to the control group after 16 years of age. Adolescent pregnancy increases the risk of ectopic pregnancy, pre-eclampsia, eclampsia, premature rupture of membranes, preterm labor, and cesarean among mothers up to 16 years of age. After 16 years of age, pregnancy is not associated with increased risk of obstetric or neonatal complications.