Cost-effectiveness analysis of serological prenatal screening for pregnant women in King Abdulaziz University Hospital: a single-center retrospective study

Background: Congenital primary infections with Toxoplasma gondii, cytomegalovirus (CMV), Epstein–Bar virus (EBV), rubella, and hepatitis B virus (HBV) are viral infections transmitted transplacentally through the blood to the fetus and can be life-threatening. Therefore, we aimed to determine the prevalence of these infections and assess the cost-effectiveness of blood tests among pregnant women with positive serologies.Methods: This retrospective review was conducted among pregnant women with positive prenatal screening serology test results between January 2013 to July 2018. A p-value of <0.05 was used to calculate statistical significance.Results: Overall, 9095 pregnant women delivered in the last 5 years. Of these, 97 had positive prenatal screening serology and were enrolled in our study. Of 97, 61 (62.9%) were Saudis and 36 (37.1%) non-Saudis. The prevalence rates of rubella, CMV, EBV, and HBV were 78.35%, 59.79%, 14.43%, and 5.15%, respectively. Additionally, 44 of 97 women developed undesired antepartum outcomes, whereas 47 had adverse neonatal outcomes. CMV, HBV, and rubella were significantly associated with adverse pregnancy outcomes (P<0.005). During the study period, USD 1460228.27 was spent to screen 9095 pregnant women and USD 15573.68 to diagnose 97 pregnant women with positive serology.Conclusions: Because infections with toxoplasma, CMV, EBV, rubella, and HBV can cause serious risk to the mother and fetus during pregnancy. Thus, setting new hospital policies regarding early screening for high-risk pregnancies and early detection of these infections during prenatal visits are inevitable to avoid undesired outcomes.

Colorimetric determination of certain antifungals in pure forms and in their pharmaceutical formulations

An accurate and sensitive visible spectrophotometric method was developed and validated for the analysis of five antifungal drugs namely; clotrimazole, fluconazole, ketoconazole, miconazole nitrate and tolnaftate in pure as well as in their pharmaceutical dosage forms. This method was based on condensation of any of the cited drug with saturated solution of citric acid in anhydrous acetic anhydride in boiling water bath for about 20–30 min. The produced color was measured spectrophotometrically at 535 nm, after dilution with absolute ethanol. All variables affecting reaction conditions were optimized and the regression analysis of Beer's plots showed good correlation coefficients [0.9996 - 0.9999] for the previously mentioned drugs in a general concentration range of 0.8–7 microg ml-1 with overall limits of detection and quantitation in the following ranges: 0.039–0.26 microg ml-1 and 0.13–0.87 microg ml-1 , respectively. The proposed method has been applied successfully for the analysis of bulk drugs and their dosage forms such as topical powder and solution, oral and vaginal tablets, and topical creams. Overall percentage recoveries in the average range: 94.14–99.02% was obtained with considerable accuracy upon analysis of these dosage forms by the proposed method. No interference could be detected from betamethasone or dexamethosane, encountered excipients and additives. The obtained results have been compared with those obtained from reported and / or official method[s] and proper F- and t- values were observed; indicate no significance difference between the results of the proposed and reported methods. The good percentage recoveries and proper statistical data proved the efficiency of the proposed method for the analysis of the cited drugs in their commercial dosage forms with quite satisfactory precision

Clinical value of total HCV core antigen detection and quantification

Recently, the availability of total HCV core antigen assay in peripheral blood gains more interest in clinical evaluation of HCV patients. The aims of the present study were to assess the value of total HCV core antigen as a marker of viral replication, to determine the sensitivity of core antigen assay relative to molecular biology technique and to study the clinical value of HCV core antigen in relation to interferon-based treatment. This study included 150 patients sero-positive for antibodies to HCV. Viral load was assessed by both HCV RNA quantitative assay [bDNA] and HCV core antigen quantitative immunoassay [Ortho trak-C assay]. Spearman rank correlation coefficient was used to determine significant correlations among parameters. Of the 150 studied patients, 128 [85%] were positive to HCV RNA assay [bDNA] and 22 [15%] were negative. Have the 128 patients tested positive for HCV RNA, 125 patients tested positive by HCV core antigen assay with a sensitivity of 98%. All patients tested negative for HCV RNA assay [bDNA] gave negative results by HCV core antigen assay with a specificity of 100%. In the 125 patients that were positive in both assays, HCV RNA and total HCV core antigen were significantly related [r = 0.984; p< 0.001]. The relationship between HCV RNA in IU/ml and total HCV core antigen in pg/ml was given by the following equation: Log HCV core antigen = 0.649 x Log HCV RNA - 2.018. It was found that 1 core pg/ml is equivalent to approximately 8000 HCV RNA IU/ml in clinical samples of the studied patients. The correlation between HCV RNA IU/ml and HCV core antigen pg/ml varied around this average ratio when individual samples were considered, with the majority of the ratios lying between 5000 and 13000 HCV RNA IU/ml per core pg/ml. To evaluate the clinical use of total HCV core antigen quantification in the pretreatment assessment and in monitoring the response; to interferon therapy, sera from ten patients who were treated with a combination therapy of interferon alpha-2a and ribavirin had been studied. Serum samples were collected at baseline, 12 weeks after initiating therapy and at the end of treatment to be tested by both assays. There were significant correlations between log HCV RNA titer [IU/ml] and log HCV core antigen [pg/ml] [r = 0.693. 1.0 and 1.0 for the three comparisons respectively; p< 0.031. 0.003. and 0.017 respectively]. A weak relation had been found between necro-inflammatory changes in liver biopsy and viral load assessed by both assays. No relation could be found with the stage of liver fibrosis. In conclusion, the HCV core antigen assay can be used in confirming HCV infection when antibodies have been detected, in screening of patients, and in monitoring therapeutic interventions

Endoscopic band ligation for treatment of bleeding dieulafoy's lesions in the upper gastrointestinal tract

Dieulafoy's lesion [DL] is an underdiagnosed cause of acute and/or recurrent gastrointestinal bleeding. This study was conducted to evaluate the efficacy and safety of endoscopic band ligation [EBL] in the treatment of patients with bleeding DL in the upper gastrointestinal tract. Out of 2380 patients who had emergency endoscopic examinations for upper GI bleeding, ten patients [8 were males and 2 were females] had DL and were treated by EBL. Mean age was 54.6 years. All patients presented with acute gastrointestinal bleeding [hematemesis, melena or both]. Emergency endoscopy and endoscopic therapy were performed in all patients using EBL. Initial hemostasis was achieved after a single banding session using one elastic band in 9 of the 10 patients [90%] with bleeding DL. The remaining patient [10%], with actively bleeding esophageal DL had recurrent bleeding 24 hours later which was successfully controlled by another banding session. In all patients [100%], no further bleeding developed during the outpatient follow-up [6 months]. No serious complications [deep ulcers or perforations] were observed in any of the treated patients. In conclusion, these results confirm the efficacy and safety of this new modality in the endoscopic management of a rare but life-threatening cause of upper gastrointestinal hemorrhage

Plasma and hepatic tissue endothelin-1 levels in cirrhotic patients with and without bleeding varices

Bleeding from varices is the most lethal event in cirrhotic patients. Bleeding esophageal varices contributed to 51.6% of causes of upper gastrointestinal hemorrhage among Egyptians. The potent vasoconstrictive peptide, endothelin [ET] has been suggested to contribute to the pathogenesis of portal hypertension. So, the present study was designed to determine levels of both circulating ET-1 and hepatic tissue ET-1 in cirrhotic patients with and without bleeding varices. Patients suffering from liver cirrhosis, portal hypertension and upper gastrointestinal bleeding due to esophageal and/or gastric varices were included in the study. Patients who had liver cirrhosis but had never bled before were studied as a comparative group. All patients were classifed according to modified Child's classification. Esophago-gastro-dudenoscopy was done to all patients. Liver biopsy was done whenever possible. Material was divided for both histopathological examinations [using hematoxin and eosin stain] and detection of hepatic tissue ET-1. ELIZA determined plasma and tissue ET-1. Seventy-five subjects were included in this study [fifty bleeders from varices and 15 non-bleeders]. Age of patients ranged between 28 and 67 years with a mean of 45.1 +/- 8.5 years. Fifty-two were males and thirteen were females. Ten healthy controls with a mean age of 41.6 +/- 13.8 years had also been studied. They were 8 males and 2 females. There was a statistically significant increase in the level of plasma ET-1 in bleeder group [12.90 +/- 5.51] when compared to the non-bleeder group [7.50 +/- 2.52] [p< 0.05]. In the same time, there was a statistically significant increase in the level of hepatic tissue ET-1 in bleeder group [77.6 +/-14.03] when compared to the non-bleeder group [52 +/-10.56] [p< 0.05]. Plasma endothelin-1 level showed significant correlation with parameters of hepatic function. In conclusion, results demonstrated that plasma and hepatic tissue ET-1 might play an important role in the genesis of bleeding varices seen in advanced liver cirrhosis and portal hypertension