Comparison between PCR and mycoplasma duo kit culture system for the detection of mycoplasma hominis and ureaplasma urealyticum in cervicovaginal secretions

Molecular methods are the gold standard for diagnosis of Mycoplasma, due to the difficulty of culture isolation and variability of antibody response to serologic assays. This study aimed at comparing the results of a commercially available culture system for Mycoplasma hominis [M. hominis] and Ureaplasma to the results of the detection using PCR amplification. A total of 160 endo-cervical swabs have been collected "2 swabs from each of 40 infertile females undergoing intra-cytoplasmic sperm injection "ICSI", as well as from the control group which included 40 multiparous women". All samples were subjected to isolation and identification of urogenital mycoplasmas [Bio-Rad,USA] and PCR amplification using specific primers for M. hominis and Ureaplasma urealyticum [U. urealyticum]. PCR revealed 7 cases and 2 controls were positive to M. hominis, while 12 cases and 16 controls were positive to U. urealyticum. The Duo kit revealed 9 cases and 2 controls were positive to M. hominis while 14 cases and 16 controls were positive to U. urealyticum. The sensitivity of Duo kit in relation to PCR was 89.47% and the specificity was 90.48. This work confirms the reliability of Mycoplasma Duo kit culture system for diagnosis of genitourinary colonization of the female genital system with M. hominis or U. urealyticum. Besides, higher sensitivity than the PCR was reported

Homocysteine level as a marker in case of early onset sevre preeclampsia

To determine the association between plasma homocysteine level and early onset severe preeclampsia, and its relevance as a potential marker for predicting preeclampsia. A case control study was conducted on twenty early onset severe preeclamptic pregnant women [group I], and ten normotensive pregnant women as controls [group 11]. The gestational age of both groups ranged between 22 and 26 weeks. Routine laboratory tests, serum creatinine, serum uric acid, platelet count, and plasma homocysteine were measured for both groups. Infirmed consent of the patients was taken. The laboratory findings showed significantly higher mean serum creatinine, serum uric acid, and plasma homocysteine of group [I] compared to the control group [P = 0.00001, P = 0.0000], P = 0.00001 respectively]. However, the mean platelet count of group [I] was significantly lower than that of the control group [P = 0.0000]]. Positive significant correlations were found between plasma homocysteine and systolic blood pressure [r = 0.936, P = 0.001], diastolic blood pressure [r = 0.954, P = 0.001], serum creatinine [r = 0.954, P = 0.001], and serum uric acid [r = 0.963, P = 0.001]. On the other hand, a negative significant correlation was found between homocysteine and platelet count [r = 0.880, P = 0.00]]. Plasma homocysteine concentration is significantly increased in early onset severe preeclampsia and it might contribute in the pathophysiology of the disease. It may be considered as a marker in early onset severe preeclampsia

effect of tympanic membrane perforation on real-ear to coupler difference acoustic transform function

Real-Ear-to Coupler Difference [RECD] is the difference in decibels, as a function of frequency, between the SPL at a specified measurement point in the ear canal and the SPL in a 2cc coupler, for a specified input signal. We investigated the effects of tympanic membrane perforation on the RECD. RECD was obtained using an insertion gain analyzer for 24 adult patients with dry tympanic membrane perforation [group 1] [31 ears] and 20 healthy adult control subjects [group 2] [40 ears]. Cases showed moderate conductive hearing loss in their mean hearing threshold level. There was no statistically significant difference between both anterior and posterior locations as regards the degree of hearing loss or as regards the RECD. There was a statistically significant difference of RECD at frequencies 250Hz, 500Hz and 750Hz, between both groups. The RECD was 3 to 6dB lower in group 1 than in group 2. There was a statistically significant difference on comparing RECD at frequencies 250Hz, 500Hz, 750Hz and l000Hz in right ears, and at frequencies: 250Hz and 500Hz and 750Hz in the left ears of both groups. In group 1, there was no statistically significant difference of RECD values at different frequencies between right and left sided perforations and there was no statistically significant difference of RECD values at different frequencies between both genders except at 1500Hz. There was no statistically significant correlation between the RECD and the age of the patients or their air-bone gap. RECD in patients with tympanic membrane perforation is lower than normal at frequencies [250Hz-750Hz]. We recommend that this discrepancy should be compensated for if average normal RECD are used in the preselection of target and gain to avoid under-amplification at lower frequencies. However, the large inter-subject variation strongly suggests the need for individual RECD measurements whenever possible in fitting aids for patients having tympanic membrane perforations

Comparison of auditory steady state response among normal hearers and patients with different degrees of sensorineural hearing loss

50 adult subjects [100 ears], with a mean age of 33.47 years +/- 10.53 ranging from 18 to 70 years, were enrolled in this study. Ears were divided into 7 groups according to the degree of hearing obtained by pure tone audiometry [PTA]. Auditory steady state response [ASSR] was done for all groups by means of the MASTER biologic. To study the ASSR among normal individuals and patients with different degrees of sensorineural hearing loss [SNHL] and find out the ASSR and behavioural threshold difference in these groups. There was no statistically significant difference among the groups as regards age or gender [p>0.05]. There was a statistically significant difference [p<0.05] among the groups as regards the mean PTA-ASSR hearing threshold difference at all frequencies. The difference decreased as the degree of hearing loss increased [the mean hearing threshold level obtained by ASSR approaches that obtained by PTA] at severer degrees of SNHL [at groups 5, 6 and 7]. The behavioural thresholds obtained by PTA and physiologic thresholds obtained by ASSR were highly correlated. The relationships were described by the following equations: Average PTA = -25.76 + [1.11 x Average ASSR] and according to the frequencies, at 500 Hz: PTA= -22.77 + [1.02xASSR]; at 1000 Hz: PTA= -21.30 + [1.03xASSR]; at 2000 Hz: PTA= -14.58 + [0.99xASSR] and at 4000 Hz: PTA= -14.50 + [0.98xASSR]. ASSR threshold does not reflect the PTA threshold reliably in normal hearers and in milder degrees of SNHL. And ASSR threshold reflects PTA threshold more reliably at severer degrees of SNHL especially at mid frequencies [1000 and 2000 Hz]. So we recommend using ASSR as an additional objective method in estimating the behavioural threshold at moderately severe, severe and profound SNHL with attention in estimating the hearing threshold by ASSR in normal hearing and in slight, mild and moderate degrees of SNHL

Ghrelin in polycystic ovarian syndrome with and without diabetes mellitus in Egyptian population

Background and aim: Ghrelin is a 28 amino acid peptide, which is primarily produced by the stomach. Ghrelin is a strong secretagogue of growth hormone [GH]. The polycystic ovary syndrome [PCOS] is traditionally characterized by chronic anovulation, functional hyperandrogenism. Obesity of the central type and Insulin Resistance [IR] arc highly associated with the syndrome, predisposing women with PCOS to the development of glucose intolerance and, ultimately, type 2 diabetes mellitus. In the current study, we investigated fasting plasma ghrelin levels in a group of patients with PCOS, with and without type 2 DM, and compared with an age matched control group

Results: Fasting plasma Ghrelin was significantly lower in PCOS patients than in control groups

Conclusion: In our study, fasting plasma ghrelin levels were significantly lower in PCOS groups as compared to the control group, Decreased plasma Ghrelin levels correlated significantly with Insulin resistance in the patients groups

Screening of hepatitis b virus in shatby maternity university hospital

Objective: The present work was carried out to detect the prevalence of hepatitis B virus both in nonpregnant as well as in pregnant females and their neonates in Shatby Maternity University Hospital

Methods: The study was conducted on two thousand women admitted to Shatby Maternity University Hospital in the period from May 2004 to August 2005. The non-pregnant population included one thousandfemales scheduled for a variety of elective gynecological procedures including conventional and endoscopic surgery. The pregnant female sample included one thousand women admitted for both vaginal and operative delivery as well as their neonates

Results: The overall prevalence of HBV in the studied sample was 5.2%. In the nonpregnant group, 4.6% of the cases tested positive for HBsAg including 30.4% of the positive samples found positive for HBeAg. The pregnant female group showed a 5.8% prevalence of the virus with 27.5% of the positive samples testing positive for HBeAg. Umbilical cord blood samples testing of the HBsAg positive cases documented that 51.7% of their neonates were HBsAg positive. Moreover, 87.5% of the HBeAg positive cases showed matemo-fetal transmission as compared to 38.1% among the HBeAg negative group

Conclusion: Hepatitis B virus is a major global health problem contributing in substantial morbidity and mortality. Health professionals in the Maternity healthcare setting are consideredfrontline healthcare providers since they carry out infection control as an integral part of patient care on day-to-day basis. They are more likely associated with increased risk of not only acquiring but also of transmitting HBV infection to patients. Perinatal transmission is another important aspect of the problem. Development of clear hospital policies regarding infection control, compulsory vaccination of healthcare personnel, and preoperative routine patient testing are important measures to con rol the spread of the infection. Moreover, all pregnant women should undergo routine testing for HBV during prenatal visits, with hepatitis B immunoglobulin and vaccine provided to infants of HBsAg positive mothers

Rising ratio of matrix metalloprotenase 9/ tissue inhibitor metalloproteinase 1 in trachoalveoilar fluid: a predictor for development of chronic lung disease in ventilated preterm neonates

Bronchopulmonary dysplasia [BPD] or chronic lung disease [CLD] is a disorder of lung injury and repair originally ascribed to positive pressure mechanical ventilation and oxygen toxicity. Matrix metalloproteinases [MMPs] including MMP9 act in remodeling and destruction of extracelluar lung matrix and basement membranes. Tissue inhibitor metalloproteinase 1 [TIMP1] is the specific tissue inhibitor of MMP9. Imbalance in the level of MMP9 relative to its inhibitor TIMP1 has been implicated in matrix disruption and remodeling with further development of [CLD]. to study the value of rising ratio MMP9/ TIMP1 in serial TAF samples in prediction of CLD in neonates needing mechanical ventilation for a long duration. A prospective study conducted on 48 preterm neonates having respiratory distress syndrome [RDS] recruited from NICU of Kasr El Eini Hospital. They were all receiving mechanical ventilation. Their mean gestational age [GA] was 32.03 +/- 1.07 weeks and mean birth weight [BW] was 1118 +/- 93.38 gm. They were subjected to 3 serial tracheal aspirate fluid collections [TAF] during the routine tracheal lavage. 1st sample was collected during the 1st 24 hours of life, 2nd sample during the period from the 8th to the 11th day postnatal and the 3rd sample during the period from the 12th to the 16th day postnatal. Levels of MMP9 and TIMP1, were measured using ELISA technique. Ratio MMP9/TIMP1 was calculated. Patients who completed the 3 serial samples were subdivided into 2 groups: Group I: including patients who developed CLD and Group II including patients who did not develop CLD. Ratio of MMP9/TIMP1 was compared in the 3 serial samples in both groups. 18 neonates died before they completed the 3 successive samples and were excluded from the final analysis of the study. The results of the present study showed that MMP9/TIMP1 ratio was rising over the 3 successive samples in CLD group. In 1st sample ratio in CLD group was 3.6 +/- 0.92 versus 3.32 +/- 0.8 in no CLD group P Value 0.426 non significant but ratio rises in 2nd samples to reach 5.12 +/- 1.44 in CLD group versus 3.30 +/- 0.82 in no CLD group p value 0.002 highly significant. In the 3rd sample the ratio rises more to be 6.50 +/- 1.79 in CLD group versus 3.09 +/- 0.78 in no CLD group P Value 0.001 very highly significant. A rising ratio MMP9/ TIMP1 in TAF in early life might be of use as a predictor for the development of CLD in ventilated neonates. Supplementation of tissue inhibitor [TIMP1] when available could be an effective strategy in the prophylaxis and treatment of CLD

Management of premature rupture of the membrane [PROM] in Shatby Maternity University Hospital as compared to evidence-based management

The study was undertaken to assess current obstetric practices of both diagnosis and management of premature rupture of membrane at Shatby Maternity Hospital in Alexandria as compared to evidence-based obstetric practices. A cross sectional approach was used to assess 200 women having PROM where: I- Practices of diagnosis were assessed including history of gush of water, bleeding, smoking and recurrence of rupture of membranes in the previous deliveries, also the mode of examination were assessed including using dry clean sterile speculum, regional swab as well as the use of ultrasound for the diagnosis. II- The practices of clinical management were assessed in all cases where antibiotics, tocolytic and/or corticosteroids were taken or not. The mode of delivery whether expectant or active one were assessed also the foetal outcome of delivery in the term of Apgar score were assessed. Shatby Maternity Hospital in Alexandria is the largest and main obstetric hospital, with nearly 15,000 admissions per year and 9,000 deliveries. A questionnaire was done the morning following delivery and before discharge. Data obtained from cases themself, files and attending obstetricians were assessed; where 98% of cases were complaining of gush of water and 58% of them had a history of recurrent PROM. Almost all cases were subjected to ultrasound examination which is the main tool of diagnosis, during the clinical management antibiotics, tocolytics and corticosteroids were taken 90%, 40% and 54% respectively, most of cases were subjected to induction of labour [70%] failed, only in 20% of cases. Only 2% of newly born were admitted to neonatal unit suffering from infection and prematurity. It seems that current practices of diagnosis and management of PROM at Shatby Maternity University Hospital are not that far of the evidence-based practice, some modifications, when applied can make such practices up to the evidence based practice

Serine proteases in female serum, new markers in polycystic ovary syndrome

Prostatic Specific Antigen [PSA] is present in very low concentration in female sera., but it can be measured with high sensitivity assays. Polycystic ovary syndrome [PCOS] is a disorder characterized by hyperandrogenism and chronic anovulation. Serum Testosterone is increased in PCOS patients. Women with higher levels of androgen may have higher levels of PSA compared with women with normal levels of androgen. Hirsutism represents a state of androgen excess in women. Women with PCOS usually suffer from hyperandrogenism and were selected to test the hypothesis in this study. Twenty five PCOS females were investigated for the level of PSA in their sera, using chemillurninescent technique. PSA level was found to be higher than normal, and correlated with testosterone levels. Our data suggest that measurement of this serine protease in serum may aid in the diagnosis of PCOS patients

dimensional ultrasound evaluation of the uterine cavity before and after myomectomy in cases of multiple fibroids

The aim of this work was to evaluate the role of three - dimensional [3D] transvaginal ultrasonography [TVS] of the uterine body and cavity in cases of multiple myomas going to do myomectomy and its impact on the integrity of the cavity after myomectomy. The present study was carried on 42 patients with multiple fibroids planned for myomectomy. They were divided into two groups; 16 patients [group I] were examined before and within three months after myomectomy by transabdominal, conventional 2D and 3D TVS in multiplanar mode at the coronal view. 26 patients [group 2] who did myomectomies within three months were examined by 3D ultrasound only after the operation. In both groups, the uterus was evaluated for size, shape of the cavity, presence of intrauterine adhesions and any submucous myomas or polyps. The results of the present study showed that the two groups were comparable as regards the age, gravidity, parity and number of myomas diagnosed preoperatively [p>0.05]. Intraoperatively, fibroids were pure interstitial in 75% of patients in group [1] and 80.77% of patients in group [2], however, fibroids were combined submucous and interstitial in 25% and 19.23% of patients in group 1 and 2 respectively with insignificant difference between both groups [P > 0.05]. The uterine cavity was opened in 31.25% and 15.38% of patients of group 1 and 2 with significant difference between the two groups, [p<0.05]. Postoperatively, 3D TVS revealed normal uterine cavity in all patients of group 1 [100%] and in 88.5% of patients in group 2 with insignificant differences between the two groups, p> 0.05. Three patients in group 2 [11.5%] showed abnormal coronal view in multiplanar mode of 3D scan. Two patients showed intrauterine adhesions with cavity distortion in one of them. One patient showed missed submucous fibroid. Preoperative evaluation of the uterine cavity with 3D TVS in patients planed for myomectomy allows better identification of the position of the uterine fibroids, thus, providing surgeons with guidelines for easy removal of the fibroids and avoid distortion of the uterine cavity when it is opened. Also, postoperative 3D evaluation allows early postoperative diagnosis and management of operative complications and insures an intact uterine cavity for subsequent spontaneous pregnancy or pregnancy following assisted reproductive technology [ART]

helicobacter pylori contribute to infertility?

Helicobacter Pylori is one of the important causes of chronic gastritis. It has also been implicated in extragastric disorders, such as skin diseases of autoimmune nature, vascular disorders and platelet disorders. The most acceptable hypothesis is the existence of mimicry between H Pylori antigens and cells of different host tissues. The prevalence of H Pylori infection among Egyptians is very high. The possibility of involvement of H Pylori in the pathogenesis of infertility is intriguing. H Pylori usually lasts for the patient's entire life. This may boost autoimmune reactions. Mimicry has been shown between human beta-tubulin protein [present in spermatozoa] and H Pylori flagellin, Cag A and Vac A. Antibodies to these antigens cross reacted with human spermatozoa. Our study was conducted on 30 males complaining from infertility problem, 10 healthy fertile controls were included. CASA was performed, together with H Pylori IgA antibodies in seminal fluid. There was a high prevalence of H Pylori IgA antibodies in seminal plasma of patients complaining of infertility and having asthenospermia as compared to the fertile control group