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Background: Calcitonin-gene-related peptide (CGRP) and CGRP receptors are expressed in trigeminal nerve cells, and treatments targeting CGRP are effective in migraines. For headaches that do not respond to pharmacological treatment, minimally invasive techniques such as greater-occipital-nerve block (GONB) can help relieve the pain and reduce the frequency of headaches. Our study assessed the efficacy of ultrasound-guided greater-occipital-nerve block (USgGONB) in chronic migraines (CM) and its relationship to serum CGRP levels. Methods: Forty chronic migraineurs who underwent bilateral USgGONB using 40 mg triamcinolone and 1 mL lidocaine were recruited and interictal serum CGRP samples were collected immediately before and one month after GONB. The clinical response was evaluated using headache diaries before and one month after USgGONB. The patient response was determined after USgGONB according to the reduction in headache days as a good responder (>50% reduction), poor responder (<50%) or non-responder. Results: Monthly headache days after GONB showed a significant reduction (median, 10 days; range, 8–14.7) compared to before the block (median, 18 days; range, 17–22; p < 0.001). Across all patients, interictal serum CGRP levels after USgGONB were significantly lower than before the block (median, 40 pg/mL (range, 25–60) vs. 145 pg/mL (range, 60–380) (p = 0.001). The pre-treatment interictal CGRP levels showed a significant difference (p = 0.003), as their levels in non-responders (median, 310 pg/mL; interquartile range, 262–350) were significantly higher than those seen in responders, whether poor responders (median, 135 pg/mL; interquartile range, 100–200 pg/mL) or good responders (median, 140 pg/mL; interquartile range, 80–150 pg/mL). Conclusion: the study showed the beneficial effect of USgGONB in chronic migraines that was associated with lowering interictal CGRP levels, implying a potential role for CGRP in the mechanism of action of GONB in CM, and the interictal CGRP level may be used as a predictor for the response to GONB.

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Background Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. GDM is characterized by insulin resistance or decreased glucose tolerance, which increases throughout pregnancy Objective To compare mode of delivery in women with gestational diabetes, treated by insulin versus metformin. Patients and Methods The current study was conducted in Ain Shams University Maternity Hospital in the period between August 2016 and August 2018. A total of 124 women were included in the study. Results Our study compared mode of delivery in women with gestational diabetes, treated by metformin versus insulin. Our study found that the incidence of cesarean section was statistically significantly higher in the insulin group compared to the metformin group. Fasting glucose levels were statistically significantly lower in the metformin group compared to the insulin group, albeit with minor clinical relevance. No statistically significant differences in postprandial glucose levels or glycosylated hemoglobin were found between the two groups.

Background Preeclampsia is a common complication of pregnancy and remains a common cause of maternal and fetal mortality. The clinical symptoms of preeclampsia are caused by widespread endothelial dysfunction suggested to be a part of an exaggerated maternal inflammatory response to pregnancy. Since preeclampsia is associated with widespread endothelial dysfunction, proposed to be provoked by an increased maternal systemic inflammatory response, the maternal plasma level of SAA might be expected to be increased when compared to normal pregnancy levels. The maternal plasma level of SAA in normal pregnancy could differ from non-pregnant level due to increased hormone levels, increased adipose tissue and\or secondary to modifications of inflammatory response in normal pregnancy. Aims The aim of our study is to estimate the relation between serum amyloid A in pregnant women and preeclampsia. Methodology the study conducted this case control study in the emergency room of Ain Shams University Maternity Hospital starting from April 2018 on women with preeclampsia to estimate serum amyloid A in pregnant women with preeclampsia. Members of the control group are healthy, non-smoker pregnant women who had an uncomplicated antenatal course and all arterial blood pressure measurements were normal. Results The current study was conducted in Ain Shams University Maternity Hospital in the period between January 2017 and August 2018. A total of 75 women were included in the study. The process of recruitment and handling the study population during the course of the study is shown in the flow diagram (figure 1). In order to avoid any confounding effect for a possible subclinical ongoing pathophysiological process, four women with preeclampsia lacking severe features were excluded following the development of severe features shortly after measurement of serum amyloid A level. Conclusion Our data sustain the limited number of studies investigating the SAA levels in both preeclamptic and healthy pregnant women, in which it was hard to reach a consensus regarding the association between SAA levels and preeclampsia. Taken in consideration that an elevated plasma level of SAA in preeclamptic women should be considered pathologic, we believe that the response of relationship between the preeclampsia and SAA levels could be caused by an inflammatory condition associated with preeclampsia. Also, serum amyloid A can be used to discriminate between mild preeclampsia cases and controls and as discriminate between severe preeclampsia cases and controls. Recommendation We recommended further investigation on large sample size for the elucidation of the role of SAA in pre-eclampsia neonatal outcome and the possibility of these biochemical factors to be novel markers of such disorders in pregnant women.