Preeclamptic toxemia in chlamydia pneumoniae seropositive pregnant women

Women who develop preeclampsia may have an intense inflammatory response which may be caused by a concurrent or preceding inflammatory stimulus such as infection. This study was conducted to test the hypothesis that there is an association between Chlarnydia pneumoniae [C.pneumoniae] immunoglobulin [Ig] G seropositivity and development of preeclampsia in pregnant women. A prospective observational study was carried out on 355 healthy pregnant women attending the outpatient clinic at Ain Shams University Maternity Hospital. All women were normotensive primigravidae after 20 weeks of gestation. A single venous blood sample was collected from each of these women and tested for the presence of C.pneumoniae specific IgG antibodies using microimmunofluorescence technique [MIF]. Subsequently, women were classified as either seropositive or seronegative. Women in both groups were followed-up to detect the development of preeclampsia. A total of 248 women continued follow-up till delivery and were enrolled in the study. Seropositive group had a higher incidence of development of preeclampsia; 10% [11 cases developed preeclampsia of 107 seropositive women], compared to seronegative group; 2.8% [4 cases of 141,] and this difference was statistically significant using Chi-square test [p<0.05]. The longitudinal data of this study suggest a possible association between C.pneurnoniae seropositivity and preeclampsia and also support the evidence on infection hypothesis for the development of preeclampsia

Laparoscopic versus open retroperitoneal bilateral varix ligation for obese patients presenting with primary sub-fertility: a randomized comparative study

Objectives: To compare the outcome of laparoscopic versus open varicocelectomy in sub-fertile obese men presenting with bilateral testicular varicoceles

Materials and Methods Forty obese [body mass index > 30] primary sub-fertile males with bilateral varicoceles were selected for this study and randomly subjected to either laparoscopic varicocelectomy [Goup I, n=20] or high retroperitoneal open ligation [Group II, n=20]. Semen analysis was performed preoperatively and three months or more postoperatively. Scrotal duplex was done for each case preoperatively and 6 months post-operatively

Results: The average operative time in Group I and Group II was tilde 77.3 minutes and tilde 58 minutes, respectively [P< 0.05]. Analgesia requirements were significantly less in the laparoscopic group. Only one patient of Group I developed subcutaneous haematoma, while in Group II three developed wound infections and six patients developed wound seroma. The average hospital stay of the patients of Groups I and II was 8.4 hours and 52 hours, respectively [P< 0.05]. The patients of Group II returned to their usual daily activities after an average of 5.3 days, while the patients of Group II needed an average of 8.4 days [P< 0.05]. Hydrocele occurred in none of the patients of Group I and in three patients [15. 7%] of Group II [P<0.05]. Recurrence of the varicocele occurred in none of the patients of Group I, but in three patients [15.7%] of Group II [P< 0.05]. The semen parameters improved after surgery in both groups. The mean improvement in sperm concentration was tilde 32.5 million sperm/ml in Group I and tilde 25 million sperm/ml in Group II [p>0.05]. The mean improvement in the total sperm count was tilde 96 million sperms in Group I and tilde 92 million sperms in Group II [p>0.05]. The mean percentage of improvement in sperm motility was tilde 16.5% in Group I and 14.1% in Group II [p< 0.05]. The mean decrease in the percentage of abnormal forms was tilde 20% in Group I and tilde 5.5% in Group II [p< 0.05]. Moreover, the quality of motility [grades] improved significantly after laparoscopic varix ligation, to a higher extent than after open surgery

Conclusion: The laparoscopic approach is an excellent option for varix ligation in obese patients. Morbidity is less and convalescence is shorter compared to open surgery. A particular advantage of laparoscopy over conventional surgery is the possibility of treatment of bilateral varicoceles through the usual three laparoscopic ports. In this study, improvement in some semen parameters was significantly better following laparoscopic varix ligation. This may be explained by the better view and magnification offered by laparoscopy

Comparative study of different diagnostic modalities of m. tuberculosis and evaluation of rifampicin resistant strains using line probe assay versus conventional proportional method

Tuberculosis remains a major health problem around the world being responsible for 3 million deaths each year. The spread of TB is expected to worsen as infection with multi-drug resistance M. tuberculosis isolates [MDR-M] increases in many countries. Rifampicin is an important component of effective multi-drug therapies of TB. Thus, Rif-resistance means that short course therapy is no longer an option and those second-line drug susceptibilities are required in order to make an informed choice for alternative therapy. Furthermore, resistance to Rif serves as a useful surrogate marker for the detection of MDR isolates. The aim of this study is to shed some light on the line probe assay [LiPA] in comparison to the conventional proportion method for detecting Rif susceptibility genotype and phenotype of M. tuberculosis clinical isolates. This study was conducted on 154 patients with age ranged from 18 to 72 years who were divided into 2 groups. The first group included 130 cases [80 males and 50 females] suspected of having pulmonary TB, and the second group included 24 cases [18 males and 6 females] suspected of having extrapulmonary TB. All cases were subjected to tuberculin skin test. The clinical specimens were collected according to the site of presenting symptoms. At least 3 successive samples of sputum, urine and stool were collected for each case. Contaminated specimens [98 sputum, 13 bronchial lavage, 7 urine and one stool samples] were subjected to a digestion-decontamination procedure. Aseptically collected specimens [13 peritoneal aspirate, 19 pleural aspirate, one fallopian tube and 2 lymph node samples]. All used for smear staining with Kinyoun's stain and culture. Mycobacterial isolates on L-J slants were biochemically typed by niacin accumulation, nitrate reduction and heat stable catalase test. The susceptibility of M. tuberculosis to Rif was performed using both the proportion method on MB7H10 agar and LiPA using LiPA Rif TB strips. The distribution of tuberculous patients according to clinical specimens among all cases showed that 98 sputum samples revealed 26 positive culturers. Two sputum samples were positive by stained smear after processing but negative by either direct smear or culture. The overall positivity of sputum samples were 28 specimens. One positive culture/negative Kinyoun's stain was recovered from fallopian tube specimen. Tuberculin skin test revealed positive induration diameter in 28 [96.6%] out of 29 tuberculous patients, whereas the tuberculin skin test was positive in 78 [62.4%] out of 125 negative smear/culture cases. Direct Kinyoun's stain showed positive smear in 15 out of 154 specimens, which were also positive by L-J culture. Also 12 positive cultures were recovered from the 139 negative direct smears. The sensitivity and specificity of direct Kinyoun's stain versus L-J culture were 55.6% and 100% respectively, and the negative and positive predictive values were 91.4% and 100% respectively. Stained smears after processing revealed positive smear in 22 out of 119 patients, of which 20 were positive by L-J culture. However 6 positive cultures were recovered from 97 negative smears. Its sensitivity and specificity versus L-J culture were 76.9% and 97.8% respectively, and the positive and negative predictive values were 90.9% and 93.8% respectively. There was a statistically significant difference in comparing direct Kinyoun's smear and Kinyoun's smear after processing of the 115 contaminated specimens. The results of mycobacterial biochemical reactions revealed 24 M. tuberculosis and 3 mycobacteria other than tuberculosis [MOTT] isolates. As regard Rif-susceptibility testing of the 24 M. tuberculosis isolates, 8[33.3%] isolates were Rif-resistant and 16 [66.7%] were Rif sensitive by the proportion method, whereas 6[25%] isolates were Rif resistant and 18 [75%] were Rif-sensitive by LiPA. The type of rpoB gene mutations in the 6 Rif-resistant M. tuberculosis isolates by LiPA showed that the most frequently detected mutations were H526Y [57.1%] and S531L [28.6%] and H526D 14.3%. One strain showed double mutations atH526Y and S531L. It is concluded that LiPA is a simple technique which provides clear results requiring only a basic knowledge of molecular technique

Chlamydial infection in IUD users

The objective of this study was to evaluate the prevalence and incidence of Chlamydia trachomatis [Ct] infection among Egyptian women asking for IUD as a method of contraception and to investigate the impact of infection on the restoration of fertility following IUD removal. A longitudinal study was done on 61 primiparous women, in whom a TCu380A IUD was applied 6-8 weeks after delivery. High prevalence and incidence rates of Ct infection were detected. There was no significant difference in signs and symptoms in TCu380A IUD users with a positive DIF test compared with those with negative test. There was no single woman developed pelvic inflammatory disease [PID]. Screening for cervical Ct infection at IUD insertion along with an early antibiotic therapy in positive cases prevented the negative influences on fertility restoration following IUD removal