Internal Medicine

To assess the impact of a cervical traction maneuver (Amr's maneuver) used in conjunction with active management of the third stage of labor (AMTSL) on the incidence of postpartum hemorrhage (PPH). The present multicenter randomized controlled trial was conducted in Cairo between March 1, 2016, and June 30, 2017. Women aged at least 18 years who had singleton pregnancies and were candidates for vaginal delivery were enrolled. After block randomization, AMTSL was performed for all participants. Following placental delivery, Amr's maneuver using cervical traction for 90 seconds was carried out in the study group. The primary outcome, incidence of PPH (>500 mL blood loss) within 6 hours of delivery, was compared between the study and control groups in an intention-to-treat analysis. There were 852 patients randomized to the study (n=426) and control (n=426) groups. The incidence of PPH was significantly lower in the study group compared with the control group (6 [1.4%] vs 19...

Background: Serum level of cholesterol is one of the most vital risk factors for cardiovascular diseases (CVD). Statins are highly effective drugs for reducing serum cholesterol; hence, preventing coronary heart disease (CHD). Rosuvastatin (Crestor) is one of the most potent and widely prescribed statins. Even though generic statins have been approved based on their bioequivalence with brand-name drugs, there remains considerable concern as regards their effectiveness and safety. Most clinicians and patients welcome the generic drug decreased costs; however, it is indispensable for them that effectiveness and safety are not compromised. Thus, the rationale intended for this study is to compare brand rosuvastatin and generic rosuvastatin as regard their economic impact using a cost-minimization analysis. Methods: This cost-minimization model estimates potential impact of rosuvastatin brand versus generic on the healthcare resource utilization for one-year frame from the payer perspective. The model conforms to real practice of management of hyperlipidemia in Egypt and was validated by experts. Results: The drug costs in the rosuvastatin brand group were 3,155,250 EGP while in the generic group were 2,299,030 EGP. The costs of CVD events in the rosuvastatin brand group were 5,863,558 EGP, while in the generic group were 6,810,180 EGP. The total costs in the rosuvastatin brand group were 9,018,808 EGP, while in the generic group were 9,109,210 EGP with a difference of −100,047 EGP. Conclusions: In conclusion, the real cost of generic treatment is more than that of the brand statin when taking into consideration the cardiovascular events.

Heart failure (HF) is a common cause of cardiovascular mortality and morbidity. Despite advances in treatment, the prognosis remains poor. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors decrease HF events by 27-39% in high-risk patients with type 2 diabetes mellitus (T2DM). Moreover, the DAPA-HF and EMPEROR-Reduced studies randomized patients with HF with reduced ejection fraction (HFrEF) with or without diabetes mellitus to receive guideline-directed medical therapy versus guideline-directed medical therapy plus an SGLT-2 inhibitor. Both studies showed the benefits of SGLT-2 inhibitors. In addition, SGLT-2 inhibitors have shown improvement according to the EMPEROR-Preserved study of HF with preserved ejection fraction (HFpEF). Therefore, a panel of cardiology experts from the Egyptian Atherosclerosis and Vascular Biology Association (EAVA) revised the literature for SGLT-2 inhibitors in HF, along with the recommended indications and contraindications, and this article presents their consensus on the topic. The panel concluded that SGLT-2 inhibitors have significantly benefited patients with chronic HFrEF, as indicated through the DAPA-HF and EMPEROR-Reduced trials. The panel recommended early use of dapagliflozin 10 mg or empagliflozin 10 mg in patients with symptomatic chronic HFrEF, whether diabetic or non-diabetic, to ameliorate HF hospitalization rate, mortality, symptoms, and decline in renal function.

Objective: To measure the impacts of cervical traction on the uterine artery hemodynamics.Methods: This study was a randomized-controlled trial. The primary outcome measure was the uterine artery hemodynamics indices: end diastolic velocity (EDV) and systolic/diastolic velocity ratio (S/D ratio).Main Results: The study was conducted in one institution in Cairo from January-2017 to March-2017 with 12-month follow up period. Both groups were comparable (p-value > 0.05) with regard to the age, BMI, heart rate, blood pressure, gravidity, parity as well as episiotomy. There was no difference (P> 0.05) between the two groups regarding vital signs after the intervention. All the patients tolerated the procedure with mild sedation. PSV, EDV, S/D, PI & RI were comparable between both groups before the intervention. However, PSV, S/D ratio, RI & PI were significantly higher (p-values < 0.001) in the study group than the control group after the intervention. On the other hand, EDV was...