Prenatal diagnosis of fetal hypertrophic cardiomyopathy in diabetic mothers using 5d fetal echocardiography

Background: Diabetes mellitus is a common condition, affecting approximately 7% of pregnant women. Appropriate management has reduced morbidity and mortality. Diabetes mellitus in pregnancy can cause many problems for the fetus as significant congenital disorders, risk of premature delivery and increased prenatal morbidity and mortality. In addition, it causes neonatal hypoglycemia, macrosomia and transient hypertrophic cardiomyopathy HCM [observed in up to 35% of fetuses]. Fetal Intelligent Navigation Echocardiography [FINE] is a novel method for visualization of standard fetal echocardiography views from volume datasets obtained with spatiotemporal image correlation [STIC].This method can simplify examination of the fetal heart and reduce operator dependency

Objectives: The aim of this study was to investigate the utility of 5D fetal echocardiography in the prenatal diagnosis of fetal hypertrophic cardiomyopathy in healthy mothers, controlled diabetic mothers and uncontrolled diabetic mothers

Patients and Methods: Cross sectional observational study was conducted at Ain Shams University Maternity Hospital at the ultrasound fetal special care unit, Study duration: September 2017- July 2018. This study was conducted on healthy and diabetic pregnant women divided into 3 groups Sampling Method: This study included 111 pregnant women between the 28th and 36th weeks of gestation. After approval of the Local Institutional Review Board, the study was explained and an informed written consent was obtained from all participants. This study included 3 groups of pregnant women which were: Group A: Control group which consist of 37 healthy non-diabetic pregnant women, group B: Controlled group which consist of 37 diabetic pregnant women with good glycemic control, group C: Uncontrolled group which consist of 37 diabetic pregnant women with poor glycemic control

Results: The current study showed that, as regards the thickness of the interventricular septum IVS, there were significant differences between the three groups. The mean IVS thickness in Group A was 0.38+/-0.05 cm; in Group B, it was 0.44+/-0.05cm and in Group C, it was 0.57+/-0.08cm. In a similar study, compared the IVS thickness between GDM, DM type 2 and DM type 1,showed that the mean fetal IVS thickness was 3.73 + 0.84 mm in the DM type1 group; 4.08 + 0.75 mm in the GDM group; and 3.99 + 0.59 mm in the DM type 2 group and found that there was a statistically significant difference between HbA1c and IVS thickness in the DM type1 group only P=0.013.But in the GDM group [P=0.723] and the DM type2 group [P=0.380], there were no significant differences

Conclusion: Infants of diabetic mothers are prone to have multiple problems during the neonatal period which makes them a very high risk infant. These neonates must be screened for any associated congenital anomalies and metabolic abnormalities. Hypertrophic cardiomyopathy of IDM have good prognosis and this cardiomyopathy is reversible in nature but these neonates requires close monitoring and regular follow-up and early intrauterine detection

Chronic diseases and outcome in critically ill elderly admitted to ICU

Background: Elderly patients are a significant and increasing proportion of ICU patients. With advancing age, the comorbidities critically ill elderly patients have substantial mortality. The early recognition of patients at high risk of mortality is needed to plan care in advance and to control healthcare costs

Aim: To find out the relation between chronic diseases and outcome in critically ill elderly admitted to ICU

Study design: A prospective study

Participants: seventy elderly patients aged 60 years and above

Method: This study was performed in Geriatric ICU in Ain Shams University Hospitals including 70 critically ill elderly patients admitted for 24 hours or more. Each patient was subjected to on admission clinical assessment including detailed history taking, in addition to laboratory investigations

Results: The results of our study showed that ischemic heart disease was the only chronic diseases that had significant statistical effect on mortality in critically ill elderly admitted to ICU with p. value= 0.002

Conclusion: In the current study we found that mortality was associated with history of ischemic heart disease

Value of proton magnetic resonance spectroscopy of brain to study the cerebral metabolic abnormalities in COPD: Initial experience

Chronic obstructive pulmonary disease [COPD] patients were found to have cerebral metabolic abnormalities. Proton magnetic resonance spectroscopy [1H MRS] is a sensitive technique that detects metabolic changes of the brain. To study the cerebral metabolic changes in COPD patients using 1H MRS. This study was carried-out on twenty symptomatic COPD patients [16 male and 4 female] and age matched group of 20 healthy controls [11 male and 19 female]. Pulmonary function tests, respiratory muscle strength, resting arterial blood gases, and 1H MRS of the brain were carried out on all subjects. The parieto-temporal and occipital regions were localized for 1H MRS. The metabolic ratios of 7V-acetyl aspartate to creatine [NAA/Cr] and choline to creatine [Cho/Cr] were calculated by the single voxel technique. In comparison with healthy control subjects, the mean values of Cho/Cr in COPD patients were lower in parietotemporal and occipital areas [0.99 +/- 0.21 vs. 1.10 +/- 0.31; P = 0.22] [0.81 +/- 0.26 vs. 0.88 +/- 0.21; P = 0.37], respectively while, the mean values of NAA/ Cr in COPD patients were higher in both parieto-temporal and occipital areas of the brain [1.82 +/- 0.35 vs. 1.68 +/- 0.22; P = 0.14] [1.59 +/- 0.31 vs. 1.39 +/- 0.39; P = 0.08], respectively. In COPD patients, significant positive correlations were observed between maximal expiratory pressure [MEP] and NAA/Cr in parieto-temporal area of the brain. The cerebral metabolites, arterial blood gases, respiratory muscle strength, and pulmonary function tests are altered in symptomatic COPD patients. 1H MRS is a non invasive technique that detects cerebral metabolic changes in COPD patients

Study of intercellular adhesion molecule-I in patients with liver cirrhosis and chronic hepatitis: association with disease severity and activity

This study was carried out in Benha University hospital on 20 patients with liver cirrhosis [Group I], 25 patients with chronic hepatitis [Group II] and 20 healthy controls. Thorough history and clinical examination was done to all subjects. Abdominal ultrasonography and the following laboratory investigations were performed to every subject: AST, ALT, serum albumin, serum bilirubin, Prothrombin time [PT], HCV Ab, HBs Ag, HBc Ab [IgG]. HBe Ab and serum level of intercellular adhesion molecule- 1 "sICAM- 1". Liver biopsy was done to patients only. Assessment of disease severity was judged by Child-Pugh classification. Assessment of disease activity was done by histopathological staging and by ALT and AST levels. Our work showed that serum level of sICAM- 1 was significantly high in both patient groups compared to controls, and this elevation was attributed to both increased hepatic production and defective hepatic clearance. The serum level of sICAM-1 correlated significantly with both disease severity and activity. Our study showed that serum level of sICAM-1 can be used as a screening non-invasive test with high specificity [100%] and sensitivity [94.6%] to detect patients with chronic liver diseases. On the other hand we failed to find a significant difference in the serum level of sICAM-1 between the two patient groups. Therefore, serum level of sICAM-1 has a poor diagnostic value with low specificity [78.6%] and sensitivity [43.5%] to differentiate patients with chronic hepatitis from patients with cirrhosis

early prenatal development of the human gonads

Twenty four human embryos and foetuses of normal appearance were collected and used. Their ages were estimated, approximately in weeks, which divided into 7 groups included the 5, 6, 7, 8, 9, 28, 36th, weeks. The specimens were fixed immediately in 10% formal saline. The paraffin sections were stained with haematoxylin and eiosin and toulidine blue stains to be examined by light microscope and photomicrographed.The results of the present study confirmed the extragonadal origin of the primordial germ cells from the wall of the definitive yolk sac. Their local migration through the dorsal mesentery was observed, but most of them were seen carried by the blood stream through the vitelline veins to the posterior cardinal veins to reach and populate the gonadal rudiment, in the [5th] week embryo, where they settled among the undifferentiated mesenchymal cells underneath the single layered, cuboidal cells of coelomic epithelium which just, began their mitotic activity, In the 6th week embryo, the gonads enlarged and bulged into the coelomic cavity. The coelomic epithelial cells were proliferating into several cellular arrays forming the primitive tunica albuginea containing scatterd [still migrating] large size primordial germ cells, which became clumped with some of these epithelial cells, as presertoli cells, to form the primitive sex cords. In the 7th week embroys, some gonads were differentiated as testis by acquiring certain features included Ihe separation of the coelomic epithelium into a single layer of flattened cells, as well as the more elongation and branching of the primitive sex cords. Meanwhile, other gonads that do not show similar changes were considered as undifferentiated ovaries in female embryos. By the 8th week some cells from the primitive sex cords were segregated and spreaded to the surrounding interstitial blastoma. They were supposed to develop into the secreting "Leydig cells". By the 9th week the sex cords were more elongated and extended towards the mesonephric duct by solid cellular cords of the rete testis. By the 36th week, the testes were enlarged and reached to the scrotum.The fibrous tunica albugina was developed. The seminiferous cords were more thick and convoluted with narrow slit like lumena. The intenstitial blastema had wide fibrous stroma with scattered collections of intersititial cells between the seminiferous cords. The epididymis was more elongated and convoluted.The ovaries in the 28th week foetus were covered by a very attenuated single epithelial layer without tunica albugina. The cortex was fomed of fibrous spaces contained the oocyte surrounded by the follicular cells while the medulla was formed of fibrous stroma rich in blood vessels