Intrafamilial transmission of hepatitis B and C among families of multi-transfused Egyptian children

Several studies have reported clustering of hepatitis B virus [HBV] and hepatitis C virus [HCV] infection in households. We aimed to measure the prevalence of HBV and HCV infections among family members of known HBV and/or HCV positive children, and to identify possible routes of intrafamilial transmission. 68 children with known HBV and/or HCV infections [index cases] were recruited. Blood samples were obtained from 303 of their family members for analysis for hepatitis B surface antigen [HBsAg] and HCV antibodies according to the index case status. A detailed questionnaire was applied to all study participants to investigate possible routes of medical, community and household infection. 2 relatives of the HBV infected index cases were positive for HBsAg [prevalence of 1.3% [21154]]. Both infected subjects were adults, were unvaccinated with HBV vaccine, had previous medical interventions, and had accompanied the index case during hospitalisation. No HBsAg infections were detected among siblings of HBV index cases, all of whom were vaccinated with the HBV vaccine. Prevalence of HCV infection among family members of HCV positive index cases was 9.3% [24/258], higher than the 4.4% [2/45] found among family members of HCV negative index cases. On logistic regression analysis, risk factors for HCV infection were older age, medical interventions, higher crowding index, and exposure to the blood of index cases. Sharing towels, beds, and eating utensils were not found to be associated with HBV or HCV infection. Absence of HBV infection among younger people in this study may be due to their high HBV vaccination coverage. There was a relatively higher prevalence of HCV infection among family members of HCV-infected index cases. Direct exposure to blood of the index case appeared to be the most important route of intrafamilial infection

Single measurement of total serum cholesterol, HDL-C, LDL-C and triglycerides in the second trimester as a predictor of pre-eclampsia in high risk pregnant women

To evaluate the utility of measuring different serum lipids in the second trimester of pregnancy for predicting pre-eclampsia in high risk patients. The study comprised 90 pregnant females with high risk of developing pre-eclampsia. Serum measurements of total cholesterol, HDL-C, LDL-C and triglycerides were taken between 18-24 weeks of gestation. Patients were followed up and divided into 2 groups accordingly. Group I [healthy patients], Group II [patients who develop pre-eclampsia]. Serum triglycerides showed a sensitivity of 100%, a specificity of 100%, a PPV of 100% and a NPV of 100% with a total accuracy of 100%. Total serum cholesterol showed a sensitivity of 88.1%, a specificity of 70.83%, a PPV of 72.55% and a NPV of 87.18% with a total accuracy of 78.89%. HLD-C showed a sensitivity of 74.19%, a specificity of 52.54%, a PPV of 45.1% and a NPV of 79.49% with a total accuracy of 60%. Moreover, LDL-C showed a sensitivity of 100%, a specificity of 44.32%, a PPV of 3.92% and a NPV of 100% with a total accuracy of 45.56% and finally TC/HDL ratio showed a sensitivity of 96.43%, a specificity of 61.29%, a PPV of 52.94% and a NPV of 97.44% with a total accuracy of 72.22%. According to the results of the study, the most accurate predictor for the prediction of pre-eclampsia, was the serum triglycerides level, while Total serum cholesterol and TC/HDL ratio came next in accuracy

comparative study of single dose, double-dose methotrexate and surgical management of ectopic pregnancy regarding safety, efficacy and tubal patency

To evaluate the safety, efficacy of two Meth-otrexate [MTX] regimens for treatment of ectopic pregnancy [EP] and determine the future fertility after medical and surgical management of ectopic pregnancy. 75 cases with EP, 52 were stable and eligible for medical treatment. 24 cases received MTX 50mg/m2, additional dose was given one week later if B-HCG did not decline by 15% between day 4 and 7, while 28 cases received MTX 50mg/m[2] on days 0 and 4, additional doses were given on day 7 and/or on day 11 if HCG levels did not decrease by 15% during the follow-up period. 23 cases underwent surgery. Hysterosalpingogram [HSG] was performed to assess future fertility of patients after receiving treatment for EP. Overall success rate for single-dose and double-dose protocol was 79% and 85.7% respectively. The difference in success rate between the two regimens was most evident at B-HCG concentrations between 2000-5000mIU/mL; 75% for the single dose regimen and 85.7% for the two-dose regimen which favor using the two-dose regimen in this category of patients. Treatment was well tolerated in both groups, most side effects were mild and transient. Regarding future fertility; tubal patency was 94.2% after medical treatment and 82.6% after salpingectomy. The 2-dose protocol is a hybrid between the two previously established protocols; the single dose and the multi-dose MTX. It may optimize the balance between convenience and efficacy. Single-dose regimen is most suitable for low B-HCG <2000mIU/mL mIU/mL, the 2-dose regimen is more suitable for higher B-HCG 2000-5000, while B-HCG >5000mIU/mL has a high failure rate with medical treatment. In a limted number of patients, no safety concerns were noted with either the single-dose or the 2-dose protocols. Medical treatment should be offered to stable patients whenever feasible because it preserves their future fertility meanwhile cost effective

Developmental potential of retrieved oocytes for ICSI: the effect of reducing the LH dose during the stimulation phase of the long agonist protocol

Ovarian stimulation is an integral part of assisted reproductive technologies [ART]. Under physiologic conditions, both follicle-stimulating hormone [FSH] and luteinizing hormone [LH] activity is necessary to guarantee follicle growth and maturation, and hence their developmental potential. To test the effect of reducing the LH content in the ovulation induction for infertile pituitary suppressed females undergoing ICSI on the maturity and developmental potential of the retrieved oocytes. Retrospective randomized study. Private infertility Center. 102 patients were included in the study, which were divided into two groups according to the stimulation protocol used. Group A [n=51] [Long agonist HMG-FSH protocol], and Group B [n=51] [Long agonist HMG only protocol]. Comparison between the two groups included, number of stimulation days, number of oocytes retrieved, maturity of oocytes retrieved, fertilization rate, cleavage rate, Embryo grading, and pregnancy rate. Lowering the LH content in the stimulation phase did have a significant positive effect on the fertilization rate, and an insignificant positive effect on the cleavage rate. Although, lower LH doses resulted in less grade 1 embryos, it resulted in an insignificantly higher pregnancy rate, indicating the higher ability of these embryos to implant

Diagnostic value of serum CA-125, CA 19-9, IL-13 and TNF-alpha in endometriosis and prediction of its severity

Endometriosis is one of the most common benign gynecological disorders affecting more than 10% of women of reproductive age A non-surgical diagnostic approach would be of great benefit to both physicians and women alike. To test the diagnostic potential of serum biochemical markers: CA-125, CA 19-9, IL-13 and TNF-alpha conditions as well as to predict its severity. Cross- sectional study. Obstetric and Gynecology Department, Kasr El-Aini hospital - Cairo University. Ninety one consecutive non-pregnant female patients in the reproductive age undergoing laparoscopy for infertility and/or chronic pelvic pain. Serum biochemical markers: CA-125, CA 19-9, IL-13 and TNF-alpha were measured using specific kits and techniques for each in the 91 patients. According to the results of laparoscopic and histopathological examination the study population were divided into 4 groups: early endometnosis, advanced endometrosis, non-endometriotic pelvic inflammations/adhesions and patients with normal findings respectively. Accuracy of the study markers in differentiating between the various pathological situations was calculated, to predict the specificity of each marker, to distinguish endometriosis from other clinical conditions and to predict its severity. Serum CA 125 in group of patients with early endometriosis [26 patients] showed significant difference when compared to the control group [16 patients]. Also significant difference of serum CA125, CA 19-9 and TNF- between cases of advanced endometriosis [14 patients] compared to PID and control groups, [51 patients]. This same significant difference was also detected with TNF-alpha between group of early endometriosis and compared to PID and control groups. CA 19-9 showed significant difference in its level in group of early endometriosis compared to other groups. After combining cases with endometriosis, the three serum biochemical markers which slowed significant difference when compared to other groups were CA-125, CA 19-9 and TNF-alpha while JL-B showed no significant difference. The accuracy of the serum biochemical markers CA-125, CA 19-9 and TNF-alpha regarding the sensitivity and specificity were 79.962, 75.82 and 93.4 respectively. TNF-alpha is characterized by perfect sensitivity while both CA-125 ed CA 19-9 have perfect specificity. Combining the results of assaying serum TNF-alpha plus any of the other markers CA 125 or CA 19-9 will have 100 accuracy in distinguishing cases with endometriosis from those with non-endometriotic lesions. Only serum level of CA 19-9 can distinguish between cases with early and advanced endometriosis