Novel nomogram-based integrated gonadotropin therapy individualization in in vitro fertilization/intracytoplasmic sperm injection: A modeling approach / 대한생식의학회지

Objective@#This study aimed to characterize a validated model for predicting oocyte retrieval in controlled ovarian stimulation (COS) and to construct model-based nomograms for assistance in clinical decision-making regarding the gonadotropin protocol and dose. @*Methods@#This observational, retrospective, cohort study included 636 women with primary unexplained infertility and a normal menstrual cycle who were attempting assisted reproductive therapy for the first time. The enrolled women were split into an index group (n=497) for model building and a validation group (n=139). The primary outcome was absolute oocyte count. The dose-response relationship was tested using modified Poisson, negative binomial, hybrid Poisson-Emax, and linear models. The validation group was similarly analyzed, and its results were compared to that of the index group. @*Results@#The Poisson model with the log-link function demonstrated superior predictive performance and precision (Akaike information criterion, 2,704; λ=8.27; relative standard error (λ)=2.02%). The covariate analysis included women’s age (p<0.001), antral follicle count (p<0.001), basal follicle-stimulating hormone level (p<0.001), gonadotropin dose (p=0.042), and protocol type (p=0.002 and p<0.001 for short and antagonist protocols, respectively). The estimates from 500 bootstrap samples were close to those of the original model. The validation group (n=139) showed model assessment metrics comparable to the index model. Based on the fitted model, a static nomogram was built to improve visualization. In addition, a dynamic electronic tool was created for convenience of use. @*Conclusion@#Based on our validated model, nomograms were constructed to help clinicians individualize the stimulation protocol and gonadotropin doses in COS cycles.

Novel nomogram-based integrated gonadotropin therapy individualization in in vitro fertilization/intracytoplasmic sperm injection: A modeling approach / 대한생식의학회지

Objective@#This study aimed to characterize a validated model for predicting oocyte retrieval in controlled ovarian stimulation (COS) and to construct model-based nomograms for assistance in clinical decision-making regarding the gonadotropin protocol and dose. @*Methods@#This observational, retrospective, cohort study included 636 women with primary unexplained infertility and a normal menstrual cycle who were attempting assisted reproductive therapy for the first time. The enrolled women were split into an index group (n=497) for model building and a validation group (n=139). The primary outcome was absolute oocyte count. The dose-response relationship was tested using modified Poisson, negative binomial, hybrid Poisson-Emax, and linear models. The validation group was similarly analyzed, and its results were compared to that of the index group. @*Results@#The Poisson model with the log-link function demonstrated superior predictive performance and precision (Akaike information criterion, 2,704; λ=8.27; relative standard error (λ)=2.02%). The covariate analysis included women’s age (p<0.001), antral follicle count (p<0.001), basal follicle-stimulating hormone level (p<0.001), gonadotropin dose (p=0.042), and protocol type (p=0.002 and p<0.001 for short and antagonist protocols, respectively). The estimates from 500 bootstrap samples were close to those of the original model. The validation group (n=139) showed model assessment metrics comparable to the index model. Based on the fitted model, a static nomogram was built to improve visualization. In addition, a dynamic electronic tool was created for convenience of use. @*Conclusion@#Based on our validated model, nomograms were constructed to help clinicians individualize the stimulation protocol and gonadotropin doses in COS cycles.

Reevaluation of Malaria parasites in El-Fayoum Governorate, Egypt using rapid diagnostic tests [RDTS]

Malaria as a disease has been identified in Egypt since ancient times. Malaria was endemic in almost all parts of the country but prevalence showed a steady decrease by 1990, and regressed in most of the Governorates. Then by the end of 1998 till now Egypt become free from local transmission of malaria. All reported cases were imported mainly from Sudan. However, the outbreak of falciparum [1 case] and vivax [23 cases] that occurred [May 2014] in Aswan Governorate strongly indicated that malaria is reemerging in the country. El-Fayoum should be take special attention, rather than being the last residual focus. The efficient malaria vector A. sergenti, the proven vector A. pharoensis and the suspected vector A. multicolor were encountered. This work reevaluated malaria status by using RDTs in survey and Giemsa stained thick films to confirm positive cases and estimation of parasite rate, formula, densities and species, also to study the ecological and entomological efficacy factors. The result showed that out of 2044 examined persons, 14 [0.68%] were passive cases i.e. attending themselves to El-Fayoum Malaria Units after their return from Sudan. Microscopic examination of their stained thick films obtained from MOH and P shows that 9 [64.2%] out of passive cases were positive 3 of them are P. falciparum [33.3%] and the rest P. vivax 6[66.7%] The species formulas of P. falciparum and P. vivax were 33.3% and 66.7% respectively. Concerning the density class, only one vivax case was of low density class while the other cases were of high density class. All positive cases were males, imported from Sudan and most of them were merchants having trade activities in Sudan. All examined persons during active case detection ACD [1551] and neighborhood of detected cases NOD [479] were malaria negative by rapid diagnostic tests. The areas recording the highest number of imported cases were Abu Shanap, Aboxa [Ballona] and Kafr Aboud [Abshaway Center] but no Anopheline spp larvae were detected. While in Al Nazla A. sergeni and A. multicolor larvae were detected where there was no any imported case or even traveler to Sudan. If the situation is reversed i.e. an imported case inhabit Al Nazla, reemergence of local malaria may start. The situation of Kafr Fazara is greatly changed by using fine sand instead of clay in manufacturing red brick after prevention excavation of land. No imported cases or Anopheline spp larvae were recorded

Detection of fluoroquinolone resistance in mycobacterium tuberculosis clinical isolates as determined by gyrA / B gene mutation by using PCR technique

Fluoroquinolones are broad-spectrum antimicrobial agents that have been used with increasing frequency over the past decade. Fluoroquinolones have in vitro and in vivo activity against Mycobacterium tuberculosis. However, resistance to fluoroquinolones in cases of tuberculosis is not routinely assessed. Mutations in a small region of gyrA, called quinolone resistance-determining region [QRDR] and, less frequently, in gyrB are the primary mechanism of FQ resistance in M. tuberculosis. PCR-based techniques provide new possibilities for the rapid diagnosis of first- and second-line drug resistance. There were 40 consecutive adults, who had culture confirmed pulmonary tuberculosis during the study period. Mutations were observed in the QRDRs of both gyrA and gyrB in 22 isolates [55%]. Only gyrA +ve in 7[17.5%] isolates. Only gyrB +ve in 5[12.5%] isolates. Total gyrA +ve in 29[72.5%] and total gyrB +ve in 28[70%] isolates. Both gyrA and gyrB -ve in 6 [15%]. The incidence of FO-resistant M. tuberculosis is gradually increasing to alarming levels this may be due to wide spread use of this vital groups of drugs in community-acquired pneumonia and urinary tract infections

Antibacterial effectiveness of low energy diode laser irradiation on management of periodontitis in Down syndrome

With the poor oral hygiene exhibited by patients with Down syndrome, the potential for a robust flora arises causing Periodontitis. Along with periodontal disease, the patient population has other medical conditions that limit treatment. This study was conducted to evaluate the antibacterial effectiveness of an 870-nm diode laser on periodontitis in patients with Down syndrome. Thirty five patients with Down syndrome suffering from periodontitis were included in this study and divided into two groups, Group I [25 patients] laser was applied to one half of the mouth and the other half was considered as a control and Group II included [10 patients] basic periodontal treatment was applied to evaluate the systemic effect of laser. Quantification of A. actinomycetemconcomitans, P. Gingivalis and Capnocytophaga were carried out using real-time PCR technique at baseline and at 2 weeks, at 6 weeks and at 12 weeks post periodontal and laser treatment. A. Actinmycetcomitans and P. gingivalis were the most common organisms found in the studied patients and Capnocytophaga was the least common organisms. In group I the quantitative results of A. actinomycetemconcomitans, P. Gingivalis at 2 weeks were significantly lower in both sides of mouth than that of baseline level. After 6 week, it was still significantly lower than that of the baseline in the right side of the mouth, but at 12 weeks no significant difference was observed in both sides. In group II, quantitative results of A. actinomycetemconcomitans, P. Gingivalis at 2 weeks were also significantly lower than that of baseline but not at 6 and at 12 weeks. As regards, Capnocytophaga there was no significant difference at baseline, at 2 weeks, at 6 weeks and at 12 weeks post periodontal and laser treatment in both groups I and II. Scaling and root planning plus laser therapy was better than scaling and root planning alone in the chosen patients and this antibacterial effect continues to be significant up to 6 weeks after therapy. Based upon the results of the study, it was found that Laser therapy could be used for the treatment of periodontitis as a complementary therapy not to replace mechanical intervention

Farber disease overlapping with stiff skin syndrome: expanding the spectrum

Farber Disease [MIM 228000][1] is a rare AR disorder first described by Sidney Farber in 1952[2]. Farber disease is usually recognized by the presence of three symptoms: Painful and progressively deformed joints, nodules under the skin and progressive hoarseness. Other organ systems may also be involved. As with most lysosomal storage diseases, the course of Farber's Disease is progressive and death typically occurs in infancy. Stiff skin syndrome [SSS] [MIM% 184900][1] was first described by Esterly and McKusick as a disorder characterized by thickened and indurated skin of the entire body and limitation of joint mobility with flexion contractures. Diagnosis and clarification of overlapping in the clinical presentation of the studied case. Clinical report of an atypically presenting Farber case and analyzing the overlapping manifestations between the two syndromes. Histopathological study was the conclusive diagnostic key in our case. Recognition of atypical or abortive cases is of practical importance as it may affect counseling or therapeutic decision making. Orodental manifestations were not previously considered but they may be of future diagnostic help

Changes in adrenal steroidogenesis in spontaneous bacterial peritonitis and sterile ascites

Adrenal androgens, particularly dehydroepiandrosterone [DHEA], may have important regulatory effects on the immune system in humans. This study measured the changes in adrenal steroidogenesis in 13 non-infected cirrhosis patients with sterile ascites and 13 patients with spontaneous bacterial peritonitis and the relation with circulating interleukin-6 [IL-6] levels. Comparisons were made with 10 healthy age-matched control subjects. The severity of bacterial peritonitis in liver cirrhosis was significantly associated with enhanced serum IL-6 and cortisol levels, and a decrease in serum DHEA sulfate in relation to serum IL-6 concentrations. Careful, long-term studies on DHEA administered to cirrhosis patients are needed to assess its safety in improving a number of pathological conditions that complicate liver cirrhosis

Biological evaluation and study of polysaccharides of Dalbergia sissoo Roxb growing in Egypt

The extracts of Dalbergia sissoo Roxb growing in Egypt, the polysaccharides prepared from leaves, stem and bark and the major constituent in the plant [biochanin A] were subjected to screening of anti-inflammatory, anti-pyretic and analgesic activities adopting new methodology. The anti-tumor, anti-oxidant, and antimicrobial activities of these substances were also examined. Since the polysaccharides prepared from different organs [leaves 2.5%, stem 2.2%, bark 1.2%] possessed anti-inflammatory activities, they were subjected to further phytochemical studies, using paper chromato-graphy and GC/MS analysis. The polysaccharides were heterogeneous in nature and lacked uronic acids. The use of GC/MS to study the monomeric composition of polysaccharides in the acid hydrolysate indicated that the leaf polysaccharides consist mainly of rhamnose [77%] in addition to glucose [23%]. The stem polysaccharide consists of rhamnose [47%], glycerol [46%] and galactose [7%]. The bark polysaccharide consists of rhamnose [18%], fructose [2.5%], glucose [74.5%] and galactose [6%]

Epithelial-mesenchymal interaction in rhino-bronchial remodeling

The clinical phase and outcome of allergic diseases is related to the degree of bronchial and nasal remodeling. The present study aimed at assessing some features of both upper and lower airway remodeling in allergic patients as well as the role of epidermal growth factor and its receptor [EGFR] and transforming growth factor fi [TGF-fi] in this process.Twenty patients with mild persistent asthma according to G1NA guidelines and mild persistent allergic rhinitis [ARIA] were included in the present study. Fibreoptic bronchoscopy was done during stable disease. Forceps biopsy was taken from a segmental bronchus and from the nasal turbinates. The biopsies taken were stained by haematoxylin and eosin [H and E] for histopathologic evaluation and immunohistochemical detection of EGFR and TGF-ft was done.Abnormalities in nasal epithelium [ulceration, atypia, and basement membrane thickening] were detected in 50% of asthmatic patients and abnormalities in bronchial epithelium were detected in 40% of them. EGFR was expressed in all abnormal nasal and bronchial epithelium specimens. TGF-f$ was expressed in 90% of abnormal nasal epithelium and all abnormal bronchial epithelium. Both factors were expressed only in hypertrophied nasal and bronchial mucus glands and some inflammatory cells. They were positively correlated with both nasal and bronchial basement membrane thickness.Remodeling occurs even in mild allergic patients. Epithelial-mesenchymal interaction through EGFR and TGF-/3 release plays a major role in this process

Chelating behaviour of alizarin dyes with divalent metal ions [Mn[2+], Co[2+], Ni[2+], Cu[2+], Zn[2+]]

The physico-chemical characteristics of some new complexes of divalent metal ions such as [Mn[2+], Co[2+], Ni[2+], Cu[2+] and Zn[2+]] with Alizarin [Aliz.] dyes [Aliz. Red S and Aliz. yellow R] have been investigated. A spectrophotometric method has been used to determine the dissociation constants of the dyes as well as the stability constants of their complexes. The order of increasing stability of the formed complexes was found to be Co[2-+] < Zn[2-+]

Oro-dental abnormalities in patients with mental retardation

The present study included 132 cases with mental subnormality. The aim of the present work was to investigate the prevalence of the oral and dental abnormalities in patients with mental retardation and to delineate the most common patterns of presentation associated with oro-dental abnormalities. All patients were subjected to full history taking, thorough oro-dental examination and IQ assessment. Chromosomal studies and metabolic screening were done when needed. It was concluded that oro-dental abnormalities are more frequent in patients with severe or profound mental retardation. The oral region abnormalities represent a major problem in the oral health of patients with mental retardation. Medical dental services and care were recommended for the affected cases, since there is no national oral disease prevalence data for patients with mental retardation and developmental disability

Diagnosis of endometriosis: a second look at the role of biochemical markers

To evaluate the accuracy of 3 markers CA-125, CA 19-9 and CRP in the diagnosis of endometriosis especially in virgins or unmarried women with dysmenorrheal and/or oleic pain. 50 no pregnant female patients in the reproductive age undergoing laparoscopy for infertility and/or chronic pelvic were included. Serum CA-125, CA 19-9 and VRP, were assayed twice; during the 1st 3 days of the menstrual cycle, and 7-10 days later. According to laparoscopic results, the study population was divided into: cases with early endometriosis group [I, 17 cases]; cases with advanced endometriosis included [group II, 19 cases]; cases with non-endometriotic pelvic inflammations/adhesions, [group III, 13 cases]; and cases with normal laparoscopic findings [group IV, II cases]. Serum levels of all markers were higher in endometriosis group compared to non-endometriotic inflammatory lesions and to controls. CA-125 was the most accurate when measured using during menstruation, CA 19-9 was the least accurate, while CRP menstrual/ preovulatory samples ratio was 100% accurate. Measurement of CRP during menstruation and it the revelatory period could provide an accurate marker for the diagnosis of endometriosis especially in airing or unmarried women with early disease

Evaluation of TNF alpha and ILI beta cytokines in hepatocellular carcinoma [HCC] cases

The aim of this study was to estimate the levels of TNF alpha and ILI beta cytokines in 35 HCC patients and ten healthy controls in order to determine the implication of these cytokines in the pathogenesis of such conditions and subsequently establishing a therapeutic scheme. An estimation of serum TNF alpha and ILI beta levels was done using ELISA technique. The results showed a statistical significant elevation of TNF alpha and ILI beta levels in HCC patients when compared with the control group with a positive correlation between these two cytokines. It was recommended to use TNF alpha mutated protein by altering amino acid sequences to modulate affinities to TNF alpha receptors to be active against HCC without severe toxicities

Efect of helicobacter pylori on urea/ammonia ratio in gastric juice and blood ammonia levels in patients with chronie liver diseases

Helicobacter pylori HP has high urease activity which enables it to hydrolyze gastric juice urea produciug ammonia. It has been proposed that infection with HP in patient with advanced liver disease may implicate an increased level of blood ammonia which have a non benign effect in the pathogenesis of hepatic encephalopathy. To investigate this hypothesis, the present work measured the blood ammonia and the urease activity of HP using Urea/ Ammonia ratio [U/A] in gastric juice of patients suffering from chronic liver disease associated with HP infection. Gastric juice aspiration, gastric biopsies and blood samples were taken from 27 patients with chronic liver disease and portal hypertension. Their liver affection was classified into Child A[14], Child B[6] and Child C [7]. The HP was identified using 3 kinds of tests, rapid urease, rapid latex and enzyme Immunoassay tests. The intragastric and blood ammonia levels were measured by an ultraviolet method, gastric urea was determined using an enzymatic method. It was found that all patients harboured HP organism, the ammonia levels correlated with the severity of the liver affection [p<0.01]. Comparing the mean ammonia levels of the severest stage of liver disease [Child C] with the mild stage [Child A], it showed a high significant mean value in both the blood and gastric juice [p<0.01], The moderate stage [Child B] had its mean ammonia values higher than Child A, but it was only the blood level which was significantly higher [p<0.05]. U /A ratio in gastric juice were 1.1, 0.6 and 0.4 in Child A, B and C respectively, showing statistical significant decrease between Child B and C when compared with Child A group [p<0.01]. U/A ratio in gastric juice may be a good indicator of HP infection and related to the Child score. It was concluded that due to HP infection there is an increased urease enzyme production leading to increased ammonia intragastrically. This may have a local damaging effect on the gastric mucosa. There is also an increased absorption and accumulation of ammonia in the blood of patients with chronic liver disease, as a result of liver decompensation. Thus eradication of HP infection in these patients may minimize the development of complications and decrease the incidence of encephalopathy

Bacteremia after injection sclerotherapy and band ligation for oesophageal varices: a comparative study

A comparative trial was conducted to study the occurrence of bacteremia after oesophageal endoscopic injection sclerotherapy [EIS] and band ligation [EBL] in forty Egyptian patients with portal hypertension. Twenty patients were subjected to EIS and twenty patients underwent EBL The Two groups were well matched as regards clinical, laboratory, ultrasonographic data, endoscopic findings, modified Child's classification and aetiology of portal hypertension. Aerobic and anaerobic blood cultures were done for all patients before, 30 minutes and 24 hours after the procedures. Throat cultures and cultures of the bands used were done before the procedures. The injector and tip of the endoscope were as well cultured before and after the procedure. Serum Interleukin-[6] [IL-[6]] and polymorphnuclear elastase enzyme were also measured before, 30 minutes and 24 hours after the procedures as parameters of infection. Aerobic blood cultures were positive in two [10%] patients of the EIS group. One yielded a coagulase negative Staphylococcus strain after24 hours, and the other yielded Klebsiella pneumoniae after 30 minutes and 24 hours. The two organisms were also isolated from the patients' throats. Patients of the EBL group gave negative results. All anaerobic cultures were negative. IL-[6] and elastase enzyme had increased after both procedures. Mean level of IL-[6] was higher in EIS group than EBL group after 30 minutes and 24 hours. The latter difference was significant. [42.67 +/- 4.88 in EIS vs. 37.09: 1 +/- 5.65 in EBL, p< 0.01]. Mean level of elastase enzyme also showed a significantly higher level in EIS group than EBL group only 24 hours after the procedures [49. 32 +/- 4.74 vs. 44.67:1 +/- 0.52 in both groups respectively, p < 0.01]. These data suggest that the incidence of bacteremia is less common after band ligation than sclerotherapy. Band ligation could be safer than injection sclerotherapy especially in patients with risk of infections

Obstructive jaundice due to schistosomiasis

The patients with obstructive jaundice for whom stenting of the common bile duct failed are reviewed. The causes of failure and surgical treatment are discussed. Schistosomiasis of the gall bladder [GB] and the lymph nodes related to the common bile duct [CBD] leading to related clinical manifestations, are very rare. We report two cases of obstructive jaundice due to chronic schistosomal cholecystitis and schistosomal granulsmatous reaction in the lymph nodes related to the head of the pancreas. They had hepatosplenomegaiy, raised serum bilirubin, especially the direct type, and positive rectal snip for Schistosoma mansoni ova. In case one: Endoscopic retrograde cholangeopancreatography [ERCP] demonstrated remarkable gall bladder distension encroaching on the distal part of the CBD with consequent proximal dilatation of the biliary system. On exploration a hugely dilated GB with dense adhesions between the GB, CBD and duodenum with palpable firm lymph nodes were the cause of obstruction. Cholecystectomy, exploration of CBD and T-tube insertion were done. Tissue examination revealed chronic schistosomal choleystitis with lymphadenitis. In case two: ERCP demonstrated a smooth long segmental filling defect located at the mid coarse of the CBD most probably by an extrinsic compression with normal pancreatic duct. On exploration a well defined rounded mass at the lower end of the CBD related to the head of pancreas was found. The CBD and the GB were dilated. Exploration of the CBD was negative. The mass was excised and the pancreas was biopsied. Histopathological examination proved to be chronic schistosomal lymphadenitis and non-specific pancreatitis. A specific anti-schistosomal treatment [praziquantel] was prescribed in multiple doses with clinical and laboratory improvement of the two patients