Effect of Single- versus Double-Layer Uterine Closure during Caesarean Section on Niche Formation and Menstrual Irregularity

Background: The myometrium at the location of the CS (caesarean section) scars, also known as residual myometrium thickness (RMT), is larger after a double-layer uterine closure procedure than following a single-layer one. It may lessen the formation of a niche that is the myometrium’s disruption at the location of the scar of the uterus. Gynecological manifestations, obstetric problems in a future pregnancy and birth, and maybe subfertility are linked to thin RMT and a niche. Objective: To ascertain if double-layer unlocked closure of the uterus is better than single-layer one in terms of post-menstrual spotting and niche development following a first CS. Patients and Methods: In this randomized clinical study, 287 patients were evaluated for qualifying. Of all eligible individuals, 57 patients were excluded from the study based on the inclusion criteria. Results: The variation in ages, gestational age, body mass index (BMI), and cesarean section indications between the two assigned groups is statistically insignificant. However, postmenstrual spotting was statistically significantly more common in single-layer group compared to in double-group. The current study revealed ultrasound findings suggestive of niche formation was statistically significantly more common in single-layer group compared to in double-layer group. Conclusion: As evident from the current study, it demonstrates the advantages of double-layer unlocked closure of the uterus over single-layer one in terms of post-menstrual spotting and niche development following first-time cs. Thus, we deduced that fewer niches are formed, and fewer menstrual spotting occurs in the presence of double unlocked layers closure. To ascertain the impact of uterus closure method on post-operative niche development and the risk of obstetrics and gynaecological problems, further prospective trials with extended follow-up periods are required.

Avian influenza virus surveillance in migratory birds in Egypt revealed a novel reassortant H6N2 subtype

Background:Avian influenza viruses(AIVs)have been identified from more than 100 different species of wild birds around the globe.Wild migratory birds can act as potential spreaders for AIVs to domestic birds between different countries.Egypt is situated on important migratory flyways for wild birds between different continents.While much is known about circulation of zoonotic potential H5N1 and H9N2 AIVs in domestic poultry in Egypt,little is known about the pivotal role of migratory birds in the maintenance and transmission of the viruses in Egypt.Methods:Targeted AIV surveillance has been conducted in 2017 in different wetlands areas in Northern and Eastern Egypt.Results:AIV of subtype H5 was detected in two bird species.In addition,a novel reassortant strain of the H6N2 subtype was identified which reveals the continuous risk of new influenza virus(es)introduction into Egypt.This novel virus possesses a reassortant pattern originating from different AIV gene pools.Conclusions:Intervention control strategies should be performed to minimize the possible contact of domestic birds with wild birds to lower the risk of virus transmission at this interface.In addition,constant monitoring of AIVs in migratory birds is essential in the early detection of influenza virus introduction into Egypt.