role of uterine artery doppler sonography in predicting pre-eclampsia at 14-20 weeks of gestation

Background: the introduction of Doppler technology has proved the first opportunity for repetitive, noninvasive hemodynamic monitoring in human pregnancy compared to other methods of maternal and fetal monitoring

Aim of the Work: this study aimed to predict usefulness of uterine artery Doppler in predicting pre-eclampsia and to study uterine artery Doppler waveforms at 14-20 weeks of gestation

Patients and Methods: this prospective study was carried out in the Radiodiagnosis Department Ain Shams University. This study included 33 pregnant women [between 14 to 20 weeks of pregnancy]; they were chosen randomly from patients referred from maternal clinics, all were primigravida, single pregnancy during the period from June 2017 to December 2017

Results: regarding our results when RI index was used, sensitivity, specificity were 90.0%, 87.0% and when PI index was used sensitivity, specificity were 60.0%, 87.0%

Conclusion: we can conclude that uterine artery Doppler between 14- 20 weeks of gestation is a simple rapid non-invasive procedure and it can be used as a reliable indicator for prediction of preeclampsia to use it as a screening test

Recommendations: we recommend other studies with a wide scale of population [large number] in more than one center; this will lead to increased surveillance and delivery in a well-equipped setup in high risk detected patient which is necessary to reduce the maternal and fetal complications

Low profile ilizarov frame in correction of varus deformity in patients with adolescent blount's disease

Background: Adolescent Blount disease or late onset tibia vara constitutes the most common cause of pathologic genu varum in late childhood and adolescence. It is a developmental condition characterized by disordered endochondral ossification of the posteromedial part of the proximal tibial physis resulting in multiplanar deformities of the lower limb

Objective: the aim of this work was to evaluate the results of treatment of acute correction of varus deformity in patients with Blount disease by using low profile Ilizarov frame

Patients and Methods: It is a retrospective and a prospective study for 10 patients who had adolescent Blount disease treated by acute correction using low profile Ilizarov frame. We looked principally into the following variables to evaluate the results of the treatment: Deformity correction [expressed as mechanical axis restoration], the average normal values were used as a reference [medial proximal tibial angle, 85-90; posterior proximal tibial angle, 77-84; thigh-foot angle, +10 external rotation]

Results: the patients were 9 boys [90%] and one girl [10%]. The mean age at presentation was 13.60 years, range [ 11- 17 years] , 6 patients [60%] presented with unilateral affections and 4 patients [40%] presented with bilateral affection. Mean preoperative to postoperative changes of MPTA from 74.57 [range 65-80] improved to 89.21 [range 86-95], Mean preoperative to postoperative changes of PPTA from 74.21 [range 66-80] improved to 79.07 [range 77-82] , Mean preoperative to postoperative changes of MAD from 31.14 mm [range 18-45 mm] improved to 3.64 mm [range 0-8 mm]. Mean preoperative to postoperative changes of TFA from -23.57 [range -30 -15] of internal tibial torsion improved to 5.36 [range 0-10] of external tibial torsion

Conclusion: Management of adolescent Blount disease by acute correction strategy using a low profile Ilizarov is a safe technique offering excellent results with low incidence of complications. Low profile Ilizarov is lighter and less bulky so more comfortable for patients than classic Ilizarov external fixation , Acute correction technique can achieve the same result of correction as gradual correction technique in patient with no limb length discrepancy , Acute correction offers a shorter time in frame as compared to gradual correction with fewer follow-up visits and exposure to radiation

Frequency and detection of respiratory syncytial virus pneumonia in children by nested reverse transcriptase polymerase chain reaction

Respiratory syncytial virus [RSV] is one of major causes of viral respiratory tract disease in young children and infants. We aimed to study the frequency of respiratory syncytial virus and its subtypes in pneumonia and bronchopneumonia in pediatric patients less than two years old tested by nested polymerase chain reaction with the evaluation of routinely used methods of diagnosis which are clinical manifestations and chest X-ray. The study included 70 patients exhibited lower respiratory tract symptoms in the form of pneumonia and bronchopneumonia. Their age ranged from two months to eighteen months. All participants were subjected to clinical examination, chest X-ray examination, nasopha-ryngeal aspirate [NPA] samples for microbiological examination and nested reverse transcriptase polymerase chain reaction for diagnosis of respiratory syncytial virus. RSV was highly prevalent infection in our studied patients, as 60 patients [86%] out of 70 were positive. Children from 2-3 months were highly affected [43.3%] and rate of infection decreases with increase of age. RSV infection was statistically significant with some clinical findings and radiological findings. RSV is the most important etiological agent causing pneumonia and bronchopneumonia in infancy. Na-sopharyngeal aspirate is a sensitive method in detecting viral infection during infancy. Nested reverse transcriptase polymerase chain reaction which is rapid and reliable technique may provide important diagnostic information in establishing the etiology and improving management of the patients

Anti-cyclic citrullinated peptide antibodies as a discriminating marker between rheumatoid arthritis and chronic hepatitis C-related polyarthropathy

Articular involvement is a frequent extrahepatic manifestation of hepatitis C virus infection. The distinction between HCV-related polyarthropathy and true RA may be very difficult especially with recent onset RA before articular damage and erosions develop. To assess the diagnostic utility of anti-CCP antibodies and compare it with that of rheumatoid factor in distinguishing between rheumatoid arthritis and HCV related polyarthropathy. Anti-CCP antibodies and RF were determined in the sera of 30 patients with RA and 22 patients with HCV-related polyarthropathy. Anti-CCP antibodies were positive in 83.3% of patients with RA and in 4.5% in patients with HCV and polyarthropathy. RF was positive in 90% of RA patients and in 81.1% of HCV patients with polyarthropathy. The anti-CCP antibodies showed higher specificity for RA compared to RF [95.4% Vs 18.2%]. However the sensitivity of anti-CCP was comparable to that of RF [83.3% Vs 90%]. Anti-CCP antibodies are reliable laboratory markers to differentiate between RA and HCV-related polyarthropathy

Study of fasting plasma ghrelin hormone in obese non diabetic and obese type 2 diabetic patients

Obesity is a multifactorial syndrome characterized by an excessive adipose tissue accumulation. The aim of our work was to study the possible role of ghrelin hormone in the pathogenesis of obesity in obese non diabetic and obese type 2 diabetic patients. The study was conducted on 45 adult subjects. The studied subjects were subdivided into three groups: Group I includes 15 obese type 2 diabetic patients, Group II includes 15 simple obese non diabetic patients and Group III includes 15 normal subjects with normal BMI as a control group. All subjects were subjected to full history taking, clinical examination, routine investigations, fasting blood glucose, HbA 1c, fasting insulin, insulin resistance estimated by HOMA-IR and fasting plasma ghrelin. There was a significant decrease regarding fasting plasma ghrelin hormone in obese [either type 2 diabetic or non diabetic] than the control group p>0.05. However, ghrelin hormone was more decreased in obese type 2 diabetic than obese non diabetic. There was negative correlation between fasting plasma ghrelin hormone and both of fasting insulin hormone, fasting blood glucose and insulin resistance estimated by HOMA-IR. Also, there was negative correlation between fasting plasma ghrelin hormone and BMI, weight, waist circumference and waist hip ratio. Fasting plasma ghrelin was decreased in obese subjects and seemed to be a down-regulation in human obesity and this may be a consequence of elevated insulin

Randomized, clinical trial of ligasure haemorhoidectomy versus conventional "ferguson" haemorhoidectomy

To compare outcome of Ligasure and Ferguson" haemorhoidectomy. Eighty patients with grade III and IV haemorhoids were prospectively randomized and underwent either Ligasureor "Ferguson" haemorhoidectomy. We documented preoperative data, perioperative, [operative time and blood loss], postoperative, [pain score, analgesia, morbidity, hospital stay, healing time, anorectal manometery and patient satisfaction over 6 months]. Ligasure group achieved a significant reduction in operative time, blood loss [each, P=0.001], pain score, analgesics at 1st, 3rd, 7th day, 2nd week [all, P<0.05], hospital stay and healing time [each, P<0.05]. Postoperative morbidity between both groups was significant. Manometeric changes [postoperative versus preoperative] were insignificant in Ligasure group [P>0.05], but in conventional group postoperative pressures were lower, resting [P,0.0001], squeeze [P,0.001]. Also better 3rd month satisfaction was noticed in Ligasure group, p, 0.03. Ligasure haemorhoidectomy is superior to conventional haemorhoidectomy. Ligasure patients gain short term benefits: Reduced postoperative pain, wound healing time and better satisfaction. Cost remains the most important point against LVSS

Hiatal hernia and peptic stricture: the most common complications after corrosive oesophageal stricture

To study the radiological appearances and possible complications in corrosive oesophageal stricture. 15 patients diagnosed as post corrosive upper GI injury are included in this study. Diagnostic studies were barium swallow examinations, either performed by the conventional method or by the recent digital method. The films of patients were studied for corrosive stricture sites, length and the presence of complications including hiatal hernia and peptic strictures. The patients had an age range of 4-50 years with a mean of 29.36 +/- 14.66 yrs. All patients were complaining of dysphagia. Heart burn was the complaint in 46.6% of patients, reflux was noted radiologically in 66% of cases. Short [less than 3 cm] and long strictures occurred with equal frequency, while annular stricture were uncommon. The most common site for stricture was the middle third of the thoracic oesophagus [60%]. Simultaneous gastric narrowing occurred in only 13.4% of cases. Complications of oesophageal strictures or its treatment by dilatation included FB impaction [6.7%], partial perforation [26.8%], malignancy [6.7%], hiatal hernia [93.3%] and peptic stricture [20%]. Hiatal hernia was the most common complication of corrosive oesophageal stricture and consequently peptic strictures were also common. In these patients reflux symptoms were masked by the dominant complaint of dysphagia due to the original stricture. In patients with corrosive oesophageal stricture treatment of GORD should be immediately initiated whenever hiatal hernia and reflux symptoms are observed. This strategy would diminish the possibility of peptic stricture, possibly dysplasia and carcinoma

Serum and synovial fluid tgf-beta-1 in ankylosing spondylitis patients

Hypothesis: This study was carried out to estimate the level of TGF-beta-1 in both the serum and synovial fluids of patients with AS and to asses the potential usefulness of its measurement as a marker of the clinical features, disease activity, and radiographic grading of sacroiliitis

Methodology: Enzyme linked immunoassay was used to quantify TGF-beta-1 in 20 AS patients and 20 healthy individuals. All patients were subjected to clinical examination. The Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] was used to measure the disease activity. Analysis of the type and frequency of abnormalities of the sacroiliac joints in our AS patients was performed by computed tomography [CT]

Results: The level of serum TGF-beta-1 was significantly elevated [p<0.001] in AS patients than in controls. TGF-beta-1 concentrations in the synovial fluid were 5 fold higher than in the corresponding serum samples indicating intra-articular production. Also, there were significant correlations between both serum and synovial TGF-beta-1 and BASDAI and radiographic grading of sacroiliitis

Conclusion: These results support the hypothesis that TGF-beta-1 has a role in the pathogenesis of AS. Measurement of TGF-beta-1 either in the serum or in the synovialfluid, was found to be a useful marker that reflected both disease activity and radiographic grading of sacroiliitis. Longitudinal studies are required to evaluate the role of TGF-beta-1 in protection against ankylosis of the spine. It might also have a role in the future of therapy in patients with spinal involvement in AS

Nitrous oxide in isufflation does not increase the incidence of gas embolism during laparoscopic cholecystectomy: detection by transoesaphageal echocardiograply

In a prospective randomized clinical trial, 24 patients with ASA score I or II were scheduled for laparoscopic cholecystectomy. They were divided into two equal groups, where either carbon dioxide [CO2] or nitrous oxide [N2O] was used for pneumoperitoneum. Standard general anesthesia was used in all cases. Transesophageal echocardiography [TEE] probe was introduced to monitor gas embolism [GE] events. The procedure was divided into four operative stages [T1 = insufflation, T2 = dissection of cystic duct and artery, T3 = gallbladder bed dissection and T4 = extraction and desufflation]. For each stage, the number and score [from 1-3] of gas embolism episodes were recorded. In addition, heart rate [HR], mean arterial blood pressure [MAP], saturation of oxygen [SaO2] and end-tidal CO2 [ET CO2] were recorded immediately after induction [baseline], during insufflation and every ten minutes of the procedure. The study concluded that during laparoscopic cholecystectomy, insufflating gas does not increase the incidence of GE events compared with CO2. On the contrary, N2O exhibits slightly less GE events in some of the operative stages. The stage of insufflation predisposes to more GE events than the rest of the operation. Most of the GE events are associated with some rate of gas flow into the peritoneal cavity, whatever the type of gas is. Therefore, more cautions must be taken into consideration whenever there is active gas flow into the peritoneal cavity for the risk of GE