Plasma visfatin concentrations in polycystic ovary syndrome: relationships with indices of insulin resistance and hyperandrogenism

Visfatin, a protein secreted by adipose tissue, is suggested play a role in pathogenesis of insulin resistance. In polycystic ovary syndrome [PCOS], insulin resistance might be involved in the development of endocrine and metabolic abnormalities. The aim of the study was to measure plasma visfatin levels in PCOS women and to assess the relationship between plasma visfatin concentration and indices of insulin resistance and markers of hyperandrogenism in PCOS patients. A total of 50 women were studied. Twenty five women had PCOS, and the remaining 25 were healthy women with regular menstrual cycles who served as control subjects. Blood samples were collected between the 3 rd and the 5 th days of a menstrual cycle in the control group and 3-5 days after a spontaneous menses, or independent of cycle phase in the presence of amenorrhea in the PCOS group for estimation of insulin, glucose, lipid parameters, sex-hormone and visfatin levels. Plasma visfatin concentrations were significantly higher in the PCOS group [72.94 +/- 33.3ng/ml] than in the control group [54.69 +/- 3l.5ng/ml] [p= 0.039]. The PCOS group had higher insulin resistance [HOMA-lR] [3.12 +/- 0.98] in comparison to the control group [2.27 +/- 0. 68] [p=0.017]. In the PCOS group, plasma visfatin levels were found to be positively correlated with BMI and waist circumference, HOMA-lR as well as with free androgen index, and negatively correlated with LH, total testosterone and sex hormone-binding globulin[SHBG] levels. In the whole study group, plasma vislatin levels was positively correlated with BMI and waist circumference, FSH and SHBG levels as well as with free androgen index, and negatively correlated with LH, total testosterone values. Visfatin levels are increased in women with PCOS compared to healthy controls. Visfatin is associated with insulin resistance in PCOS patients. Positive correlation found between visfatin and free androgen index in PCOS patients

Serum heat shoch protein 70 levels in pre-eclampsia and adverse pregnancy outcomes

Heat shock protein 70 [Hsp 70], a marker of cellular stress, was suggested to be elevated in pregnancies complicated by pre-eclampsia. Adverse pregnancy outcomes [APOs] are a group of common obstetric diseases and many studies have been conducted in an effort to clarify their risk factors It is well known that these risk factors can induce the synthesis of a group of highly conserved proteins, called heat shock proteins [Hsps]. The aim of the study was to measure serum heat shock protein [Hsp]70 in mothers with pre-eclampsia and adverse pregnancy outcomes [APOs] and to evaluate whether it can be applied as a useful indicator for the development of these conditions. Eighty pregnant women were included in this study [20 pre-eclamptic women, 20 women with threatened preterm labor, 20 women with intrauterine growth restriction and 20 healthy women with non-complicated pregnancy]. After obtaining informed consent, serum samples were collected from all participants to measure Hsp70 levels. The levels of Hsp 70 were measured using enzyme-linked immunosorbent assay. Measurement of serum Hsp 70 levels showed statistically higher values among pre-eclamptic patients compared to preterm, Intrauterine growth restriction [IUGR] and control groups [24.6 +/- 12.7 ng/ml, 15.l +/- 5.4 ng/ml, 14.3 +/- 6.1 ng/ml, 11 .7 +/- 4.9 ng/ml respectively, p

Serum adiponectin levels in coronary artery disease

Coronary artery disease [CAD] refers to a lack of oxygen due to inadequate perfusion of the myocardium, which causes an imbalance between oxygen supply and demand. Many generalized or systemic risk factors predispose to development of atherosclerosis. Atherosclerosis of the coronary arteries commonly causes acute coronary syndromes. Adiponectin is one of the adipokines secreted by adipocytes. Adiponectin may play anti-atherogenic and anti-inflammatory roles. The aim of this study is to investigate whether concentrations of serum adiponectin constitute a significant coronary risk factor. Serum adiponectin was measured in 50 patients with CAD and in 20 control subjects. Patients were divided into three groups according to condition type: Acute myocardial infarction [AMI] group [n=20], unstable angina pectoris [UAP] group [n=15], and stable angina pectoris [SAP] group [n=15]. Serum concentrations of adiponectin in patients with CAD were significantly lower than in control subjects [p<0.000]. There was a significant negative correlation between adiponectin and triglyceride and significant positive correlation with HDL in patients. The findings suggest that measurement of serum concentrations of adiponectin may become a predictor risk factor for CAD and may be related to the development of acute coronary syndromes

Role of maternal plasma procalcitonin levels in the prediction of subclinical infection in patients with preterm premature rupture of membranes

To compare maternal plasma procalcitonin [PCT] concentrations in cases of preterm premature rupture of membranes [pPROM] and premature rupture of membranes [PROM] at term, and to determine whether these concentrations are of value in the diagnosis of pPROM cases suspected of subclinical intrauterine infection or in the prediction of the pPROM-to-delivery interval. A total of 90 women with singleton pregnancies were enrolled in this study, 25 patients with pPROM, 25 with PROM at term, 20 healthy women at preterm gestation, and 20 healthy women at term were included. In pPROM group, analysis of PCT concentrations with reference to serum leucocytosis, serum C-reactive protein levels, as well as to the presence/absence of neonatal congenital infection or histological chorioamnionitis was carried out. The outcomes of pPROM cases were also recorded with reference to pPROM-to-delivery interval. PCT concentrations in pPROM and PROM at term cases were significantly higher than in healthy controls in approximate gestational age [40.84 +/- 11.64, 9.19 +/- 4.81 [pPROM, PROM at term cases], 3.33 +/- 1.40, 2.41 +/- 0.91 [preterm and term healthy controls], respectively, p<0.001]. In pPROM group, no significant correlation was observed between PCT and leucocytosis [p=0.458] or C-reactive protein [p=0.188]. Also no statistically significant difference was found between PCT concentrations in patients who gave birth to newborns with and without congenital infection, and in patients with and without histological chorioamnionitis [p=0.591, 0.091 respectively]. The accuracy of procalcitonin determinations were poor. The value of maternal plasma PCT determinations in the diagnosis of pPROM cases suspected of intra-amniotic infection, as well as for the prediction of pPROM-to-delivery interval, newborn's infection or histological chorioamnionitis is unsatisfactory. However, PCT concentrations are elevated, both in patients with preterm and term PROMs in comparison to healthy pregnant mothers, and therefore further evaluations are necessary to establish the role and relative contribution of PCT levels in the prediction of subclinical intrauterine infection in pPROM cases

Predicting preterm delivery in asymptomatic pregnant women with prior preterm delivery by measurement of cervical length, fetal fibronectin and phosphorylated insulin-like growth factor-binding protein-1

To evaluate the accuracy of cervical length measurement in combination with assessment of fetal fibronectin [FFN] and phosphorylated insulin-like growth factor-binding protein-1 [phIGFBP-1] in cervico-vaginal secretions as a predictor of preterm delivery in asymptomatic pregnant women with a history of preterm birth. 91 singleton pregnant mothers [between 22-24 weeks of gestation] with previous history of one or more unexplained preterm birth were included in the study. For all participants transvaginal sonographic measurement of cervical length was carried out together with qualitative assay of fetal fibronectin and quantitative measurement of phosphorylated insulin-like growth factor binding protein-1 in cervico-vaginal secretions. The primary outcome of the study was delivery before completed 37 weeks of gestation. There was a significant association between cervical length and the occurrence of preterm delivery [p=0.002], cervical length was 23.12 +/- 8.5mm in 33 cases who experienced preterm delivery compared to 29.34 +/- 9.4mm in 58 cases who delivered at term. Regarding fetal fibronectin assay in cervico-vaginal secretions, no statistically significant difference was found between those who delivered preterm and those who had term delivery [p=0.972]. Measurement of phosphorylated insulin-like growth factor-binding protein-1 [phIGFBP-1] in cervico-vaginal secretions showed statistically significant difference among patients who delivered preterm compared to those who did not [p=0.007]. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for cervical length, phIGFBP-1, and for their combination, and our results demonstrated high sensitivity, specificity, positive and negative predictive values for the combined method compared with either method alone. Both cervical length and phIGFBP-1 measurement in cervico-vaginal secretions at 22-24 weeks are likely to be useful in predicting preterm delivery in asymptomatic women with a history of preterm birth and their combination increased their sensitivity, specificity, positive and negative predictive values as predictors

accurate specific marker for type 2 DM

Target-tissue resistance to insulin characterizes type 2 diabetes mellitus. Resistin is produced and released from adipose tissue to serve endocrine functions likely involved in insulin resistance. Studies showed that resistin serum levels increase with obesity. The aim of the study is estimate and evaluates the current evidence of serum resistin in obese patients with type 2 diabetes and clarify its relation to glycemic control. The present study included 60 females obese patients who had type II diabetes, compared with 20 non-diabetic obese persons as control. The following parameters were done for every subject participating in the study: Fasting and postprandial blood glucose, lipid profile, serum insulin, serum resistin and calculation of HOMA-IR. There were highly significant increases in serum resistin, serum insulin and HOMA-IR in diabetic patients compared to control subjects. There were significant positive correlations between serum resistin and waist circumference, fasting and postprandial blood glucose, serum total cholesterol, serum LDL, serum insulin and HOMA-IR. This study suggests that resistin may have a role in obesity as well as in altering glucose metabolism leading to the progression of T2D. Further studies of the roles of resistin will shed new light on prevention and treatment of T2D and open a new field for the development of new drugs to improve insulin resistance

Serum resistin as a predictor of ovarian response to clomiphene therapy in PCOS infertile patients

To measure serum resistin levels on day 3-6 of the menstrual cycle of infertile women with Polycystic ovary syndrome [PCOS] undergoing induction of ovulation using clomiphene citrate [CC] to ascertain whether these levels could allow us to predict the ovarian response to CC in those patients. 40 women with the diagnosis of infertility due to polycystic ovary syndrome [PCOS], were included in the study. Participants were included after fulfilling the Rotterdam criteria, 2004. All included participants were investigated by measuring body mass index [BMI], serum follicle stimulating hormone [FSH], serum luteinizing hormone [LH], serum fasting glucose, serum fasting insulin, fasting glucose-to-insulin ratio and serum resistin levels. Participants were treated with clomiphene citrate protocol to induce ovulation. Clomiphene was started as 100mg/day [2 tablets of 50mg] at day 2 for 5 consecutive days for 3 cycles. Ovulation was assessed by midluteal serum progesterone measurement combined with transvaginal sonographic monitoring of follicle growth until the appearance of a preo-vulatory follicle [mean diameter, >/= 18mm] and subsequent follicle rupture. According to the final ovarian response [which is the primary outcome], the study participants were divided into proper response group [ovulation has occurred at least once under treatment during the treatment period] and poor response group [ovulation has never occurred during the 3 study cycles]. Serum resistin was compared between the 2 outcome groups to test its relation to ovarian response. No significant correlation was found between the 2 outcome groups [proper and poor responders] regarding body mass index [BMI], 28.76 +/- 4.86, 29.13 +/- 5.09 respectively, p=0.817. Similarly no statistically significant difference was found between the 2 outcome groups regarding serum LH, FSH, total testosterone levels [p=0.437, 0.327, 0.672 respectively]. Serum fasting glucose, fasting insulin, fasting glucose-to-insulin ratio were not statistically significant when compared between the outcome groups [p=0.456, 0.108, 0.191 respectively]. Serum resistin levels in women who succeeded to ovulate and those who failed to ovulate under clomiphene therapy were not statistically significant when compared between both groups [22.16 +/- 21.6, 24.37 +/- 22.9, respectively, p=0.757]. However, serum resistin levels were positively correlated to serum total testosterone, fasting serum glucose and insulin levels [p=0.008, 0.024, 0.011 respectively]. Serum resistin is likely not a predictor for ovarian response in infertile women with PCOS undergoing induction of ovulation using CC

Searching for optimal serum marker for early prediction of gestational diabetes

To examine which serum marker [sex hormone binding globulin [SHBG], C-reactive protein [CRP], insulin. glucose] is accurate in early predicting the occurrence of GDM. One hundred and fifty six pregnant mothers high risk to develop gestational diabetes mellitus [GDM] were included in the study. When GDM was excluded at hooking setting [using OGTT], mothers are candidate for assaying fasting and non fasting sex hormone binding globulin [SHBO], fasting and non fasting quantitative C-reactive protein [CRP] and fasting insulin levels [from the same blood samples withdrawn during performing the OGTT], OGTT was repeated at 28 weeks and 36 weeks of gestation to diagnose GDM. According to the results of follow up OGTT, participant were divided into cases who developed GDM and those who did not develop GDM to assess the accuracy of each of the studied markers in predicting the occurrence of 0DM in high risk mothers. Sex hormone binding globulin levels [fasting and non fasting] were significantly lower among women who subsequently developed GDM compared with the control group [[276.9 +/- 78.7nmol/L vs 322.4 +/- 71.6nmol/L, P=0.001], [261.5 +/- 66.7 nmol/L vs 299 +/- 59.7 nmol/L, P0.00l] respectively]. No difference was detected in C-reactive protein levels [fasting and non lasting] [P=0.33, 0.349], fasting insulin [P0.082], lasting glucose levels [P=0.119], between the study group who subsequently developed GDM and the control group. SHBG can he used as an early marker to identify the group at highest risk for subsequent GDM allowing earlier intervention and possible benefits to the mothers and their offspring

Prediction of pre-eclampsia and neonatal outcome by the combined use of early second trimester maternal serum homocysteine and uterine artery doppler velocimetry

To evaluate the value of combining early second trimester maternal serum homocysteine and uterine artery doppler velocimetry in the prediction of pregnancies that subsequently develop pre-eclampsia as well as neonatal outcome. This prospective observational study was conducted on eighty seven pregnant mothers [in their 16-19 gestational weeks] at risk to develop pre-eclampsia. All enrolled women should have one or more risk factors to develop pre-eclampsia. Mothers with medical disorders during the current pregnancy were excluded. All participants were investigated with maternal serum homocysteine assay and Doppler analysis of both uterine arteries. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for homocysteine levels, uterine artery resistance index, diastolic notch [unilateral, bilateral], and for the combination of both homocysteine levels and uterine artery Doppler studies. Pre-eclampsia had occurred in 28 out of the 87 participants [32.18%] of whom 17 cases were diagnosed as mild pre-eclampsia [19.54%] and 11 were diagnosed as severe disease [12.64%]. The mean +/- SD of uterine RI for all cases who developed severe pre-eclampsia was 0.62 +/- 0.09 while it was 0.58 +/- 0.06 in those who did not develop the disease all over their pregnancies and the difference was statistically significant [p=0.016]. Early diastolic notch was detected in 11 out of the 28 mothers who developed pre-eclampsia [39.29%; 5 unilateral and 6 bilateral] versus 4 out of the 59 women who passed uncomplicated pregnancies [6.78%; 2 unilateral and 2 bilateral]. This revealed a statistically significant different [p=0.001]. Serum levels of homocysteine was also significantly higher in cases who developed pre-eclampsia than controls. The median [range] of serum homocysteine in mothers who developed pre-eclampsia [mild and severe disease] was 6.24 [1.9 - 23.4] micro mol/l while in women passed uncomplicated pregnancy it was 5.1 [1.6-19.9] micro mol/l [p=0.024]. Out of all delivered neonates of preeclampsia mothers [31 neonates from 28 mothers], 9 neonates were classified to have poor prognosis [29.03%] all of them were from severe preeclamptic mothers. No early neonatal deaths were recorded. This prospective study confirms the value of combining early second trimester maternal serum homocysteine and uterine artery Doppler velocimetry in the prediction of pregnancies that subsequently develop pre-eclampsia as well as neonatal outcome

endothelial nitric oxide synthase gene intron 4 polymorphism in Egyptian patients with end-stage renal disease

Nitric oxide [NO] synthesized by endothelial cell NO synthase [ecNOS] is a potent regulator of intrarenal haemodynamics. A polymorphism in intron 4 of the ecNOS gene is a candidate gene in renal diseases. The aim of this work is to study the gene polymorphism of ecNOS intron 4 in patients with end-stage renal failure and compared it with that of healthy subjects. The study was performed on 40 patients with end stage renal disease [ESRD] patients on regular hemodialysis, and was classified into 2 groups: Group I ESRD patients with diabetic nephropathy [10 patients] and group II includes 30 patients with ESRD due to different etiologies [all causes except diabetic nephropathy], and group III 15 apparently healthy subjects as control group. ecNOS genotypes were determined using polymerase chain reaction. The results showed that two alleles of ecNOS intron 4, labeled a and b could be detected. The frequencies of aa, ba, bb genotypes were 5% [2/40], 12.5% [5/40] 82.5% [33/40] in all the patients, 3.3% [1/30], 13.3% [4/30], 83.3% [25/30] in-group II patients, and 10% [1/10], 10% [1/10] 80% [8/10] in group I patients respectively, and in the control group all were bb100% [15/15]. There is significant difference in the frequencies of ecNOS genotypes between all ESRD patients and the control group [OR 1.423; 95% CI 1.253-1.615, p<0.01]. Compared with controls; the group I patients had much higher frequency of the ecNOS 4a allele than in-group II patients [OR 2.765, 1.556, 95% CI 1.891-4.042, 1.423-1.615, p<0.001, p<0.01] respectively. There was a significantly higher frequency of the ecNOS 4a allele among ESRD patients both diabetic and non-diabetic than in control subjects. This suggests that the ecNOS gene polymorphism in intron 4 appears to be prognostic of renal failure and the ecNOS gene polymorphism in intron 4 is a useful parameter for studying the relationship between NO and the progression of renal failure. This suggests that the ecNOS gene polymorphism might be associated with an increased risk of chronic renal failure

Serum interleukin 8 concentrations in obese subjects with and without impaired glucose tolerance

Interleukin 8 [IL-8] is a cytokine with atherogenic properties. Studies revealed that it is produced and secreted by human adipocytes. The aim of the present study is to evaluate serum IL-8 concentrations in obese subjects with normal glucose tolerance [NGT] and in obese subjects with impaired glucose tolerance [IGT] in fasting state and after oral glucose tolerance test [OGTT] and to find any relation between serum IL-8 and BMI, WHR and glucose level. A total of 60 subjects with marked overweight or obesity [BMI >27.8kg/m[2]], without previously diagnosed disturbances of glucose tolerance, were included in the present study. They were divided into two groups. Group I included 30 subjects with NGT [13 men and 17 women] and group 2 included 30 subjects with IGT [11 men and 19 women]. 25 sex and age-matched healthy lean volunteers were included as control group. In the fasting state, there was no significant difference in fasting serum IL- 8 concentrations between group I and group II. However, fasting serum IL-8 level was significantly higher in both groups in relation to control lean group [p<0.05 and <0.05 respectively]. After OGTT, serum IL-8 level showed no significant differences in lean group [p>0.05] and a highly significant increase in-group I and II [p<0.001]. There was a highly significant increase in serum level of IL-8 after OGTT in-group I and II in relation to control group [p< 0. 01 and <0.001 respectively]. There was also a highly significant increase in serum level of IL-8 in-group II when compared with group I [p<0.01]. In both groups fasting serum IL-8 was related to BMI [group I, r=0.919, p<0.00l; group 2, r=0.843, p<0.001], and also to WHR [group I, r=0.758, p<0.01; group II, r=0.641, p<0.05]. There were no significant correlations between fasting serum IL-8 and plasma glucose level in studied groups. Serum IL-8 concentrations after OGTT were positively related to post load glucose level [r= 0.83, p< 0.001], in group II, but not in group I. We conclude that fasting serum IL-8 levels are increased in obese subjects with normal and impaired glucose tolerance, and are related to BMI and WHR after OGTT, serum IL-8 levels are related to glucose level in obese subjects with IGT. It is possible that an increase in circulating serum IL-8 level might be one of the factors linking obesity and prediabetic stage with greater cardiovascular risk

Serum levels of IL-1 beta and IL-6 in HCV infected patients as markers for liver disease progression

In this study, we aimed to characterize serum cytokine levels of interleukin-1 Beta [IL-1beta] and interleukin -6 [IL-6] in HCV infected patients and in patients with hepatocellular carcinoma [HCC] in comparison to control group and their possible use as markers of disease progression. Sixty Patients were divided into three groups: Group I: included 20 HCV infected patients without cirrhotic changes. Group II: included 20 HCV infected patients with liver cirrhosis [LC]. Group III: included 20 HCV infected patients with HCC and 20 apparently healthy subjects as control group. All patients and control group were subjected to biochemical and serological tests, anti HCV, HCV [RT-PCR] and cytokines measurements of serum IL-1 beta and serum IL-6 levels. Showed a high statistically significant elevated serum IL-6 and IL-1 beta levels in patients with chronic HCV infection in comparison to control group. Highly statistically elevated levels of IL-6 and IL-1 beta in liver cirrhosis and higher levels were found in HCC group in comparison to control group. The levels of II-6 and IL-1 beta increased significantly in HCV infected patients as the disease progress. Serum IL-1 beta, and IL-6 levels are elevated in patients with hepatitis C-related liver diseases, especially in LC and HCC patients. Their levels reflect hepatic dysfunction better than liver inflammation parameters; accordingly, we may use serum IL 1 beta and IL-6 as markers for Liver disease progression in HCV-infected patients instead of invasive techniques

Health related quality of life among Egyptian patients on hemodialysis

The present research was carried out to evaluate the physical [PCS] and mental [MCS] component summary scales in hemodialysis patients as compared to healthy subjects at a baseline and two years later. 130 patients on hemodialysis [mean age 40.6 +/- 8.1 years] were enrolled in the study between February 2003 to February 2005. The short-form with 36 [SF-36] questionnaire was given every 6 months to hemodialysis patients. Results were compared to the general population and changes in QoL over time were determined. Mean PCS was 34 +/- 15.46 and mean MCS was 38.80 +/- 15.17 compared to the general population there were significant decline in PCS and MCS at baseline and two years later. There was no significant correlation between causes of End-Stage Renal Disease [ESRD] and Quality of Life [QoL], except for diabetes mellitus as regard MCS. High levels of serum albumin and hemoglobin was associated with highly significant quality of life. Serum albumin was a good predictor for quality of life in this study. Adequacy of dialysis treatment in hemodialysis patients was determined by serum albumin, hematocrit, KT/V and Urea Reduction Ratio [URR]. Present results showed the negative impact that ESRD and hemodialysis treatment have on self-assessed physical and mental health and it is important to treat all factors that induce hypoalbuminemia as well as anaemia

Antiphospholipid antibodies in Egyptian patients with chronic renal failure

The objectives of present research was to detect the incidence of antiphospholipid antibodies among Egyptian patients with chronic renal failure and its relation to their clinical manifestation and vascular access thrombosis. This study including 80 patients with chronic renal disease divided into two groups. Group A, forty patients with impaired renal function and group B, forty patients in chronic renal failure on hemodialysis. In addition to 10 age and sex matched subjects as a control group. All of them were subjected to clinical examination and laboratory investigation including antiphospholipid antibodies. Lupus anticoagulant was present in 21.25%, aCL IgM in 18.75% while aCL IgG in 11.25% of whole chronic renal disease patients. There was higher incidence of antiphospholipid antibodies in-group B end stage renal failure on hemodialysis [28/40[70%]] compared to group A of renal impairment [25/40[62.5%]]. Also there was insignificant relationship between antiphospholipid antibodies and age, kidney function or liver function tests. There is increase of antiphospholipid antibodies among patients with chronic renal failure with great liability for thrombosis of vascular access. Also patients with positive LA have a great possibility to be hypertensive. HCV infection in hemodialysis group may be the cause of increased incidence of antibodies. Antiphospholipid antibody profile should be done for patients with recurrent thrombosis of vascular shunt, as it is the main cause of hospitalization of dialysis patients

Independent, non-traditional risk factors for cardiovascular events and atherothrombosis in chronic kidney disease and in hemodialysis-dependent patients

This study aimed at evaluating the role of the emerging non-traditional risk factors, their impact on Cardiovascular Disease [CVD] prediction-together with traditional RFs-in Chronic Kidney Disease [CKD] and end-stage renal disease [ESRD] patients. Total homocysteine [tHcy], plasma fibrinogen [Fbg], plasma factor VII activity [FVIIc], anaemia [HCT] and C-reactive protein [CRP], were studied in 37 Egyptian patients classified into chronic kidney disease group [10 cases] and hemodialysis [HD] group [27 cases] in addition to 10 healthy age and sex-matched controls. This study showed that tHcy, fbg CRP and FVIIc demonstrated highly significant increase in the total patient group and in the HD group compared to the normal controls. These values showed a progressive increase with the disease approaching hemodialysis dependence. Among the 37 patients, 21 showed evidence of ischemic heart disease [IHD]. A statistically significant elevation of the previous factors was found in IHD when compared to non-ischemic group of patients. Multivariante analysis showed CRP as the most predictive risk factor for CVE in CKD and ESRD patients. Therefore, it was concluded that the emerging non-traditional factors studied could explain to a great extent-together with traditional RFs- the high rate of CVD in these patients and that CRP is the most fulfilling for being recommended in clinical practice. Alterations of these factors will aid prevention of coronary heart disease [CHD], thus benefiting the patient from risk factor modification

Purohit technique of vaginal hysterectomy in nulliparous women: is it a matter waste of time?

To ease intraoperative access to parauterine space at vaginal hysterectomy, we choose the purohit technique of vaginal hysterectomy using a right angle forceps, electrocautery and 10 mm telescope with light source, to evaluate the role of parity. The study comprised a total of 30 women without prolapse who requested hysterectomy for different benign diseases of the uterus between April 2001 and March 2003. They were grouped to two distinct groups according to parity; group 1 [G1] 14 nuillparous and group 2 [G2] 16 parous women. Exclusion criteria included uterine size above 16 weeks, known pelvic endometriosis and early stages of organ confined malignancy. We compared vaginal hysterectomy success, failure and safety according to parity. Safety was measured from intra and postoperative complications, duration of operation and hospital stay. The overall complication rate showed no significant difference between the two groups as regard to intraoperative and postoperative complications. The mean operative time was significantly longer in nulliparous group [99 SD +/- 55.6 vs 72 SD +/- 32.8 minutes, p<0.05]. However the mean hospital stay showed no significant difference between the two groups [in nulliparous group 6.42 +/- 4.52 and 6.22 +/- 3.92 in parous groups]. The success rate was 85.7% [12/14] in nulliparous group and 87.5% [14/16] in parous group. So, it could be concluded that, using this technique nulliparity was not an obstacle to the vaginal route and, purohit technique of vaginal hysterectomy is not a waste of time in nulliparous women

Reliability of combined hysteroscopy and laparoscopy for management of cornual ectopic pregnancy

Active surgical treatment in the form of hysteroscopy under laparoscopic control was carried out on 15 women with diagnosed cornual ectopic pregnancy over 3 years period. The mean age of the patients was 26.2 years and most of cases were suffering from acute abdomen and vaginal bleeding after a period of amenorrhoea. Transvaginal ultrasound examination revealed an empty uterus, gestational sac separated <1cm from the most lateral edge of the uterine cavity and thin myometrial layer surrounding the sac. Color Doppler mapping of cornual region showed a vascular ring at the periphery. Serial beta hCG quantitative levels were static. General physical and abdominal examinations as well as laboratory profile of all cases were within normal. Patients were scheduled for operation within hours from their attendance, in all cases hysteroscopic management was done by using a small suction cannula for complete removal of the conceptus, avoiding the need for forceps or curette. Performing the procedure under laparoscopic control and injecting vasopressin minimised the risks of bleeding and rupture. The average operation time was 60 minutes and hospital stay ranged from [1-2] days. All patients tolerated the surgical procedure without complication. Based on the preceding results it would appear that this procedure is expeditious and showed immediate evidence of success or failure

Second -trimester placental and renal 3 D sonographic volumetry, a predictor of neonatal outcome in normal and complicated pregnancy with PIH, PET and IUGR

A prospective study evaluated the significance of second Trimester 3D sonographic placental and renal volumetric measurements in the prediction of fetal outcome in normal pregnancy and pregnancy complicated with PET and IUGR to determine their mutual relationship. A total of thirty five pregnant women were recruited from the antenatal clinic of Al Zahraa and Bab El Sharia University hospitals, during the first half of their pregnancies, with singleton pregnancies who fulfilled the study criteria and progressed to delivery. Placental and renal volumes, and fetal anthropometry [biparietal diameter, head and abdominal circumferences, and femoral length] were measured sonographically at 14, 17, 20 weeks and the patients were followed until delivery The main outcome measures were infant birth and placental weights, crown-heel length, head, chest and abdominal circumferences at birth. Measurements of Placental and renal volumes in the second trimester were positively associated with all birth measurements. Among the fetal measurements at 14 and 17 weeks, head circumference was the strongest predictor of birth weight, but at 20 weeks abdominal circumference was the strongest. However at each age, placental volume was the strongest determination of birth weight. There was also significant difference between second trimester placental and renal volumes in patients who subsequently developed pregnancy induced hypertension, PET. And IUGR in reralation to control group with normal pregnancy [P<0.01]

Sterile water for pain relief in labour why not?

Ninety pregnant women were included in this study and randomly assigned to one of three groups: Group one received four injections of 0.5 mL sterile water intracutaneously [number = 30], group two received four injections of 0.5 mL sterile water subcutaneously [number = 30] and group three received four injections of 0.5 mL isotonic saline subcutaneously [number = 30]. The injections were given [Michaelis, rhomboid] during contraction, while the woman simultaneously breathed nitrous oxide and oxygen. Labor pain was measured by visual analogue scale [VAS] pain score just before injection and 2, 10, 45 and 90 minutes after treatment. The median VAS pain score for labor pain was significantly lower compared with initial values in the two active groups and compared with saline at 10 and 45 minutes after treatment. No significant differences in analgesic effect or pain experienced during administration were found between the two active groups. The new subcutaneous method of administering sterile water as well as the earlier described intracutaneous injection method were effective for the relief of pain in labor

Effect of vaginal delivery on anal morphology revealed by anal endosonography

This study included 37 women [mean age of 29.8 years ranged 23-40 years], 20 of them were parous and 17 were nulliparous. For all women, anal endosonography was performed using Kretz Combison 311. Anal canal structures were measured at three levels; high, mid and low. Of the 20 parous women, three had anterior external sphincter defects and 17 had no endosonographic evidence of an anal canal sphincter scar and these women were compared with 17 nulliparous ones. A full set of endosonographic measurements was obtained. There was no significant difference between parous and nulliparous women with respect to subepithelial or internal sphincter thickness at any level. The longitudinal muscle was significantly thicker at both proximal and mid canal levels. Distal anal canal external sphincter was significantly greater in parous women when compared with the nulliparous ones. The anterior ring was significantly thinner in parous women when compared with nulliparous ones. It appeared that vaginal delivery caused change in anal canal anatomy