Background: A non-optimal resynchronization lead (RL) position is a possible cause of poor CRT response. Objectives: The study aims to test RT3DE value for individual assessment of LV dysynchrony and prospective evaluation of CRT response after RL implantation at the pre-determined SMMD whatever the method of CRT. Methods: Seventeen HF patients were prospectively included in the study. RT3DE data were obtained before and after 1, 3, 6 months of CRT. Time to minimal systolic volume (tmsv) was calculated from the 17 segment model obtaining systolic dyssynchrony index (SDI). Time/volume curves, parametric imaging were applied for pre-implant identification of SMMD and individual assessment of CRT response. Delta-time delay (delta-t) and selective parameters between tmsv of latest and earliest activated segments were calculated. All patients received CRT according to accessibility of SMMD. We used BFRVP in 5 patients with septal SMMD; BVP in 12 patients with LV SMMD. Results: The RL was successfully implanted at the SMMD or nearest segment in 14 (82.4%) initial responders (5 BFRVP, 9 BIVP). Twelve of them were responders after 6 months. CRT response was comparable in BFRVP and BIVP. A moderate correlation between % change of EF and that of SDI (r=-.406), delta-t (-.497) was found. Baseline delta-t showed a stronger correlation with % change of EF(r=-.718**, P= 0.009) than that of SDI (r=-.509, P=0.091). Conclusion: The use of RT3DE for individual assessment of LV mechanical dysynchrony and for optimal RL positioning at the pre-identified SMMD can provide more optimum CRT regardless the method of CRT.

Background: A non-optimal resynchronization lead (RL) position is a possible cause of poor CRT response. Objectives: The study aims to test RT3DE value for individual assessment of LV dysynchrony and prospective evaluation of CRT response after RL implantation at the pre-determined SMMD whatever the method of CRT. Methods: Seventeen HF patients were prospectively included in the study. RT3DE data were obtained before and after 1, 3, 6 months of CRT. Time to minimal systolic volume (tmsv) was calculated from the 17 segment model obtaining systolic dyssynchrony index (SDI). Time/volume curves, parametric imaging were applied for pre-implant identification of SMMD and individual assessment of CRT response. Delta-time delay (delta-t) and selective parameters between tmsv of latest and earliest activated segments were calculated. All patients received CRT according to accessibility of SMMD. We used BFRVP in 5 patients with septal SMMD; BVP in 12 patients with LV SMMD. Results: The RL was successfully implanted at the SMMD or nearest segment in 14 (82.4%) initial responders (5 BFRVP, 9 BIVP). Twelve of them were responders after 6 months. CRT response was comparable in BFRVP and BIVP. A moderate correlation between % change of EF and that of SDI (r=-.406), delta-t (-.497) was found. Baseline delta-t showed a stronger correlation with % change of EF(r=-.718**, P= 0.009) than that of SDI (r=-.509, P=0.091). Conclusion: The use of RT3DE for individual assessment of LV mechanical dysynchrony and for optimal RL positioning at the pre-identified SMMD can provide more optimum CRT regardless the method of CRT.

Rationale: Internal vaginal douching is a common practice among women all over the world specially those in the Middle East and is used for personal hygiene or aesthetic reasons in many countries. The current study aims to investigate the prevalence of this practice in Assiut, Egypt. It also investigated why, and how do women practice internal vaginal douching and the impact of this habit on reproductive health outcome. Methods: A cross sectional observational study conducted in a university hospital in Assiut Egypt. An interview administered questionnaire prepared by the investigators and administered to 620 women by trained clinic nurse. The primary outcome was the percentage of women who gave a history of preterm labor in women performing internal vaginal douching or not. Other outcomes were the types of vaginal infections and other reproductive implications in the ladies performing internal vaginal douching compared with those just using external hygiene. Results: Our participants were predominantly multipara from semi-urban background and middle socioeconomic level. Considering vaginal douching as a religious duty and a kind of personal cleanliness were the most common reasons for women to use internal vaginal douching in 88.9% and 80.6% of the study sample respectively. The incidence of preterm labor (19.2% Vs 11.9% (p=0.048) and PID (13.2% 6.0% p=0.008) were significantly higher in women performing douching compared to those not performing this habit. There were no significant differences between the 2 groups as regard the history of ectopic pregnancy or the mean number of previous abortions. Conclusion: Internal vaginal douching is a prevalent practice in Egypt and has traditional and religious rotes within the community. There are many misbelieves around this habit in Egypt. Internal vaginal douching dose increase the reproductive health hazards especially preterm labor, ectopic pregnancy and pelvic inflammatory disease. Much effort and awareness companies are needed to increase women awareness about health hazards of this incorrect practice and limit its use.

Rationale: Internal vaginal douching is a common practice among women all over the world specially those in the Middle East and is used for personal hygiene or aesthetic reasons in many countries. The current study aims to investigate the prevalence of this practice in Assiut, Egypt. It also investigated why, and how do women practice internal vaginal douching and the impact of this habit on reproductive health outcome. Methods: A cross sectional observational study conducted in a university hospital in Assiut Egypt. An interview administered questionnaire prepared by the investigators and administered to 620 women by trained clinic nurse. The primary outcome was the percentage of women who gave a history of preterm labor in women performing internal vaginal douching or not. Other outcomes were the types of vaginal infections and other reproductive implications in the ladies performing internal vaginal douching compared with those just using external hygiene. Results: Our participants were predominantly multipara from semi-urban background and middle socioeconomic level. Considering vaginal douching as a religious duty and a kind of personal cleanliness were the most common reasons for women to use internal vaginal douching in 88.9% and 80.6% of the study sample respectively. The incidence of preterm labor (19.2% Vs 11.9% (p=0.048) and PID (13.2% 6.0% p=0.008) were significantly higher in women performing douching compared to those not performing this habit. There were no significant differences between the 2 groups as regard the history of ectopic pregnancy or the mean number of previous abortions. Conclusion: Internal vaginal douching is a prevalent practice in Egypt and has traditional and religious rotes within the community. There are many misbelieves around this habit in Egypt. Internal vaginal douching dose increase the reproductive health hazards especially preterm labor, ectopic pregnancy and pelvic inflammatory disease. Much effort and awareness companies are needed to increase women awareness about health hazards of this incorrect practice and limit its use.

Rationale: Internal vaginal douching is a common practice among women all over the world specially those in the Middle East and is used for personal hygiene or aesthetic reasons in many countries. The current study aims to investigate the prevalence of this practice in Assiut, Egypt. It also investigated why, and how do women practice internal vaginal douching and the impact of this habit on reproductive health outcome. Methods: A cross sectional observational study conducted in a university hospital in Assiut Egypt. An interview administered questionnaire prepared by the investigators and administered to 620 women by trained clinic nurse. The primary outcome was the percentage of women who gave a history of preterm labor in women performing internal vaginal douching or not. Other outcomes were the types of vaginal infections and other reproductive implications in the ladies performing internal vaginal douching compared with those just using external hygiene. Results: Our participants were predominantly multipara from semi-urban background and middle socioeconomic level. Considering vaginal douching as a religious duty and a kind of personal cleanliness were the most common reasons for women to use internal vaginal douching in 88.9% and 80.6% of the study sample respectively. The incidence of preterm labor (19.2% Vs 11.9% (p=0.048) and PID (13.2% 6.0% p=0.008) were significantly higher in women performing douching compared to those not performing this habit. There were no significant differences between the 2 groups as regard the history of ectopic pregnancy or the mean number of previous abortions. Conclusion: Internal vaginal douching is a prevalent practice in Egypt and has traditional and religious rotes within the community. There are many misbelieves around this habit in Egypt. Internal vaginal douching dose increase the reproductive health hazards especially preterm labor, ectopic pregnancy and pelvic inflammatory disease. Much effort and awareness companies are needed to increase women awareness about health hazards of this incorrect practice and limit its use.

Objective: Use of ultrasound imaging to characterize the patterns of placental separation during active management of the third stage of labour(AMTSL) to explain the effect of different components on the mechanism of placental separation. Methods: 150 women admitted in labour who are nulliparous, gestational age from 37 to 40 weeks,singleton pregnancy,cephalic presentation and delivered vaginally will be randomized into three groups for management of the third stage; 50 women will be managed with full package of the active management of the third stage [10 IU of oxytocin are given IM after delivery of the baby, delayed cord clamping and controlled cord traction will be done when the uterus contracted]. 50 women will be managed using a simplified package(uterotonic after delivery of the baby, delayed cord clamping, no controlled cord traction) 50 women will be managed physiologically(no uterotonic, no controlled cord traction) Continuous real time ultrasonographic examination will be done …. Results: This an ongoing study .The outcomes of the study will be:………

Objective: Use of ultrasound imaging to characterize the patterns of placental separation during active management of the third stage of labour(AMTSL) to explain the effect of different components on the mechanism of placental separation. Methods: 150 women admitted in labour who are nulliparous, gestational age from 37 to 40 weeks,singleton pregnancy,cephalic presentation and delivered vaginally will be randomized into three groups for management of the third stage; 50 women will be managed with full package of the active management of the third stage [10 IU of oxytocin are given IM after delivery of the baby, delayed cord clamping and controlled cord traction will be done when the uterus contracted]. 50 women will be managed using a simplified package(uterotonic after delivery of the baby, delayed cord clamping, no controlled cord traction) 50 women will be managed physiologically(no uterotonic, no controlled cord traction) Continuous real time ultrasonographic examination will be done …. Results: This an ongoing study .The outcomes of the study will be:………

Aim: To compare different outcomes of vitrification and slow freezing of isolated pre-antral follicles and to evaluate different cryo-devices vitrification of isolated follicles. Methods: pre-antral follicles were isolated from mouse ovaries and cryopreserved using vitrification and slow freezing. A preliminary was carried out to select the optimal cryo-devices vitrification of isolated follicles. A total of 414 follicles were randomly distributed among four groups: control (CT) fresh (n=100) , nylon mesh (n=96) , electron microscopy grid (n=120) , and micro-capillary tips (n=116) . Subsequetly, a total of 979 follicles were randomly assigned to three different group: CT fresh (n=256), vitrification (n=399) and Slow freezing (n=324). CT and cryopreserved/thawed follicles were cultured in vitro and examined daily for development . final maturation was triggered with human chorionic gonadotrophin and rates of oocyte maturation were calculated. The Ultra-structure of cryopreserved / thwed follicles was studied using electron microscopy. Meiotic spindle presence and organization in mature oocytes were examined using the oosight imaging system. Result: Micro-capillary tips resulted in poor immediate post-warming survival but no differences were observed in the subsequent in vitro development characteristics between different cryo-devices. Nylon mesh proved to be the easiest carrier, particularly when large numbers of follicles at the end of the culture period (P 0.0001) However all other outcome measures were comparable between both techniques. Conclusions: Isolated follicles were more vulnerable to cryodamage after slow freezing as compared to vitrification