Letrozole versus combined clomiphene citrate plus metformin as a first line treatment in women with polycystic ovarian syndrome: a prospective randomized trial

To compare the effect of letrozole to combined clomiphene citrate plus metformin as a first-line treatment to induce ovulation in women with polycystic ovarian syndrome [PCO]. In the present prospective randomised trial, 200 infertile women with PCOS were equally randomised to receive letrozole 2.5 mg for ,five days [days 3-7 of the cycle] or clomiphene citrate [CC]100 mg for five days [days 3-7 of the cycle] plus metformin 1500 mg daily for three treatment cycles. Human chroinic gonadotropine injection [HCG] was given when at least one follicle 18 mm present. The 3-month rate of ovulation, pregnancy and abortion were evaluated. The groups were similar with regard the baseline clinical characteristics and hormonal profiles. The ovulation rate was higher in the letrozole group [76.5% versus 71.6%] but without significant difference and the endometrial thickness at day of HCG was significantly higher in the letrozole group [8.6 mm versus 7.4 mm]. Letrozole shows higher pregnancy rate [45.7% versus 39.2%] and lower rate of abortion [10.8% versus 18.2%] but with no significance. The rate of multiple pregnancy was significantly higher in the CC metformin group 12.1% versus no case in the letrozole group letrozole is a suitable alternative first-line ovulation inducing drug in PCO

Randomized study comparing the effect of hydroxyethyl starch HES 130/0.4, hes 200/0.5 and modified fluid gelatin for perioperative volume replacement in thoracic surgery: guided by transesophageal doppler

Plasma volume expansion is of great importance during major surgery. To achieve this goal, colloids may be preferred to crystalloids, as they more effectively increase blood volume and consequently, cardiac output. The aim of this study was to assess whether using the new hydroxyethyl starch with a lower molecular weight [HES 130/0.4] will be as effective as standard HES 200/0.5 and Gelatin in restoring the hemodynamics guided by trans-esophageal doppler moniter [EDM]. Sixty adult patients scheduled for major thoracic surgery were randomized to receive either 6% HES BO/0.4 [HES 130/0.4 group] or 3% modified fluid gelatin [Gelatin group] or 6% HES 200/0.5 [HES 200/0.5 group] as their colloid during the intraoperative period. The maximum dosage of all colloids was 33 ml/kg. Each group has 20 patients. Hemodynamic data and Doppler derived measurements; Cardiac index [Cl], Systolic flow time corrected for heart rate [FTc] and Stroke Volume Index [SVI] were recorded serially at 5 time points during the operation. Laboratory Measurements were recorded at baseline and every day postoperative for five days. The mean volume of gelatin 3% given was significantly more than the amount of HES 130/0.4 and HES 200/0.5 given [p < 0.05]. Volume of colloids infused in HES 130/0.4 was higher than HES 200/0.5 without statistical significance. Doppler derived measurements were comparable in all groups throughout the whole procedure. Platelet count was significantly lower in the Gelatin group in comparison to the other HES groups in the five PODs [p < 0.05]. The two HES treated groups were comparable to each other. INR was significantly higher for Gelatin group in comparison to HES 130/0.4 group in the second and third PODs [p <0.05] but in comparison to HES 200/0.5 group the higher level did not reach statistically significance. Serum creatinine was significantly higher and Creatinine clearance was significantly lower in the Gelatin than in the HES-treated patients on the first and second PODs [p =0.004] with no difference between the two starches. The new HES 130/0.4 were as effective as HES 200/0.5 and modified fluid gelatin in intravascular volume expansion in major thoracic surgery. Also administration of the new HES 130/0.4 has more favorable effect on hemostasis and on renal and platelet than Gelatin

Laryngeal cancer: sociodemographic, life style and clinical risk factors among patients underwent total laryngectomy

Laryngeal cancer [LC] is an important health problem. It is one of the most common respiratory cancers. The prevalence of this cancer is increasing all over the world. The aim of the present study is to determine the clinical features of the laryngeal cancer patients underwent total laryngectomty [TL]; to define the characteristic features of surgery in these patients; and to define the life style, health behavioral, sociodemographic and clinical risk factors of the patients. A total of 90 laryngeal cancer patients and a control group of the same number were enrolled in the study. A case-control, hospital based study design was used. The most important clinical features of the studied laryngeal cancer cases underwent TL were; most lesions site was glottis [56.7%], presented with hoarseness of voice [85.6%] and most of the patients were in stage III [63.3%]. Also, the most important characteristics of the surgery in these cases were 64.4% had TL and primary tracheoesophageal puncture, 88.9% underwent thyroidectomy and 25.6% had preoperative tracheostomy. The +ve reflux symptoms index was significant clinical risk factor [OR=6.77]. Factory worker occupation was significant risk factor [OR=4.65]. The most important sociodemographic risk factors for laryngeal cancer were male sex, urban residence, old age, low social level and low occupational level [ORs= 52.59, 2.43, 2.43, 1.99 and 1.97; respectively]. Further, the most important significant health behavioral risk factors were cigarette smoking, goza smoking and no healthy food intake [ORs= 4.44, 4.25 and 2.74; respectively]. Population based studies are needed in different areas in Egypt and on large numbers of patients to understand the full epidemiology of the laryngeal cancer and quality of life of these patients

Relationship between organizational culture and ethics work satisfaction among baccalaureate nurses at main Assiut University Hospital

There is an important ethical aspect to any organizational culture and depending on the nature of the culture different ethical standards may guide the behavior of organization members, each culture has somewhat different potential for supporting a healthy, successful organization and has different impact on the satisfaction and careers of employees. This study was conducted with the aim of identify the relationship between the organizational culture and ethics work satisfaction. Subjects of this study included all nurses who have Baccalaureate degree [no. 110] working in the Main Assiut University Hospital. They classified into [97 head nurses] and [13 supervisors]]. Tools used in data collection include three tools Socio-demographic Data Sheet, Organizational Culture questionnaire developed by [Daft, 2000] and modified by the researcher, which profiling three types of culture: strong, medium, and weak. Ethics work satisfaction questionnaire was developed by Joint Commission on Accreditation of Health care Organizations [1994] and Hinshow [1987]. It divided into two factors: organizational ethics [7 items]and personnel ethics [9 items].The response for both tools will be measured on five point likert scale that ranged from [5] strongly agree to [1] strongly disagree. Work Variable Questionnaire divided into three parts as regard to the organizational support [6 items] was developed by Marques and Huston, [2006], recommendation [7 items], and retention [9 items] developed by Mohamed, [2001] response will be measured on [3] for agree, [2] for not decided, and [1] for disagree. The result revealed that there were a positive statistically significant correlation between strong culture and personnel ethics [r= -453, P<0.05]. While, strong positive statistically significant correlation was found between medium type of organizational culture and personnel ethics items [r=354, 415, statistically significant at p<0.01]. Additionally, as regard weak type of organizational culture there was a positive statistically significant correlation with personnel ethics items [r=982, p<0.05]. On the light of the study findings the researcher recommended that: Instituting an ethics committee made up of interdisciplinary representative from nursing, medicine, administration, these committees provide guidance to patients and their families as well as the health care team, provide ongoing support to nurses through feedback and positive reinforcement and positive environment or culture, Give opportunities to nurses to participate in choosing topics which needed to improve their abilities and needs, Provide safety measures to protect health care providers from occupational health hazard

Blood levels of nitric oxide and endothelin-1 during normal menstrual cycle

Nitric oxide [NO] is a free radical gas synthesized from L-arginine by a class of specific enzymes known as NO synthases, and inducible NO synthase isoforms. Nitric oxide synthase activity has been identified in the human uterus and has been thoroughly studied in pregnant women. All three NO synthase isoforms are thought to play an important role in the maintenance of uterine quiescence during gestation, and inducible NO synthase is involved in the induction of cervical ripening before labour. However, few studies have examined the role of NO in the normal menstrual cycle. Endonthelin-1 [ET-1] might play a role in endometrial bleeding and /or repair, as previously reported. In the present study, the serum levels of NO, estradiol [E2] and plasma levels of ET-1 were measured in menstrual follicular and luteal phases of the menstrual cycle to evaluate their role in menstrual cycle. This study included twenty unmarried females with regular menstrual cycles ranging from 27 to 30 days. The levels of serum E[2] and plasma ET-1 were measured by ELISA, and the serum NO were estimated by chemical method. Our results showed that serum levels of E[2] were significantly increased during luteal phase compared with menstrual and follicular phases, whereas plasma levels of ET-1 were significantly higher during menstrual phase compared with follicular and luteal phases of the menstrual cycle. Serum levels of NO did not show significant change during the three phases of the cycle. ET-1 levels were negatively correlated with E[2] while no significant correlation between ET-1 and NO and between NO and E[2]. It can be concluded that ET-1 may play an important role in menstruation and E2 inhibits secretion of ET-1. While NO shows no relation to ET-1 and E[2]

Role of serum interleukin-6 and osteocalcin in prediction of bone loss in postmenopausal women

Osteoporosis is defined as a reduction of bone mass density or the presence of fragility fracture. This reduction in bone tissue is accompanied by deterioration in the architecture of the skeleton, leading to a markedly increased risk of fracture. Interleukin-6 [IL-6] and osteocalcin have been associated with the risk of chronic disease such as osteoporosis. In this study, we assessed the relationships between interleukin-6 and osteocalcin in the prediction of postmenopausal osteoporosis. The study included 80 women whose age ranged from 18 to 80 years and were classified into the following four groups according to the duration of menopause: Control group, this group comprised 20 premenopausal healthy females, they had regular menstrual cycles. Group I [Post Menopausal Patients], this group comprised 20 patients of osteoporosis, with menopause less than 5 years. Group II [Post Menopausal Patients], this group comprised 20 patients of osteoporosis, with menopause from 5-10 years. Group III [Post Menopausal Patients], this group comprised 20 patients of osteoporosis, with menopause more than 10 years. Patients of group I showed a significant increase of both IL6 [p<0.05] and osteocalcin [p<0.001] compared to control group. On the other hand, patients of both group II and III showed non significant change of interleukin-6 while a highly significant increase of osteocalcin [p<0.001], as compared to control group. We concluded that interleukin-6 appears to be a potent osteotropic factors that may play an important role in prediction of bone loss in early menopause as it is easy to measure and can be measured routinely. We recommend for the investigation on role of interleukin-6 in pathophysiology of bone loss

Epidemiology and cost of haemodialysis in Jordan

To assess the epidemiology and burden of haemodialysis in Jordan, all patients on haemodialysis [1711 patients] were surveyed during September/October 2003. Mean age was 48.9 years, 56% were male, 86.8% were unemployed and 92% were poor. Mean distance to the haemodialysis service was 13.6 km. Annual hepatitis B and C seroconversion for patients negative before dialysis was 0.34% and 2.6% respectively. Prevalence of haemodialysis was 312 per million population; the incidence in 2002 was 111 per million population. Fatality rate at 1 year was 20%. Diabetes mellitus was the leading cause of haemodialysis, 29.2% of cases. Total estimated cost of haemodialysis in 2003 was US$ 29.7 million

Diabetes mellitus: the leading cause of haemodialysis in Jordan

This study aimed to define the role of diabetes mellitus as a cause of end-stage renal disease requiring haemodialysis in Jordan, and to compare diabetic and nondiabetic patients. All patients on haemodialysis in Jordan at the time of the survey in 2003 [n = 1711] were personally interviewed and additional data were obtained from medical records. Diabetes mellitus was the most common cause of end-stage renal disease [29.2% of cases]. The mean age of patients was higher in diabetics [57.5 years, standard deviation [SD] 12.3] than nondiabetics [45.4 years, SD 17.1]. Duration on haemodialysis was significantly shorter in diabetics compared to nondiabetic patients

Combined duplex ultrasound assessment of peak systolic velocity and waveform acceleration in the penile flaccid state in patients with erectile dysfunction

Duplex ultrasonography in conjunction with intracorporeal injection of vasoactive agent such as papaverine and prostaglandine El is a widely spread method in diagnosis of various type of impotence. However, many searshes accused it as invasive and time consuming method of diagnosis. In addition, it is not the accurate method to diagnose the extent of affection of the penile vascularity in arteriogenic impotence. Our study was performed trying to find if the simple assessment of penile vasculature in the flaccid state can be accurate or not and if there is another confirming parameter that serve assessment of the patients without the invasiveness of the intracorporeal injection of vasoactive agents with its complications

Results and risk factors of mitral valve reoperation

To assess the results and risk factors of mitral valve re-operations 50 patients were operated upon at El Hussein University Hospital during the period from January 1998 to June 2003. The patients are fully investigated. It was found that age, EF, ACT, CBP were independent variables of the survival of the patients. As regard the clinical improvement, 16 [32.0%] patients were in class II preoperatively; postoperatively there were 8 of them [16.0%] in class II and 8[16.0%] patients in class III, postoperatively. Nine patients were in class III, postoperatively 8 of them [16.0%] were in class I and 1 [2.0%] patient was in class II. Eight patients were in class IV, postoperatively, 4 of them [8.0%] were in class I and 4 [8.0%] were in class II. One patient was in class I preoperatively and became in the same class postoperatively. As regard the mortality, preoperatively there were 16 patients [32.0%] in class II. All of them survived the operation. Fourteen patients [28.0%] were in class III, 4 of them [8.0%] died. Sixteen patients [32.0%] were in class IV preoperatively, 7 of them [14.0%] died. Four patients [8.0%] were in class V, 3 patients [6.0%] died postoperatively. As regard hepatic dysfunction, 28 patients [56.0%] were associated with hepatic dysfunction preoperatively, half of them died postoperatively, [14 patients: 28.0%] while only 3 patients [6.0%] died from 22 patients [44.0%] presented with preoperative normal liver function. Preoperative PVE was associated highest mortality, staph: 3 patients [6.0%], strept: 2 patients [4.0%], eandida: 2 patients [4.0%], crypt: 1 patient [2.0%], pseudo: I patients [2.0%]. As regard the cardioplogia, sixteen patients [32.0%] were given crystalloid cardioplegia, 7 patients of them [14.0%] survived and 9 patients [18.0%] died. Thirty four patients [68.0%] were given blood cartioplegia, 26 patients of them [52.0%] survived and 8 patients [16.0%] died. As regard arrhythmia, 20 patients [40.0%] were in sinus rhythm preoperatively, 5 patients [10.0%] of them died postoperatively, while 30 patients [60.0%] had AF, 12 patients [24.0%] died. Sex: 23 patients [46.0%] were males, 10 patients of them [20.0%] died, while female patients were 27 [54.0%], seven of them [14.0%] died, Toxemia: sixteen patients [32.0%] were in toxemia preoperatively, 10 patients of them [20.0%] died postoperatively while 34 [68.0%] presented without toxemia 7 patients of them [14.0%] died. First operations: patients with previous DVR were 9 patients [18.0%] 5 of them [10.0%] died postoperatively; 1 patient [2.0%] with previous DVR and. De Vaga died; 9 patients [18.0%] with previous MVR and De Vaga, 3 patients [6.0%] of them died; 31 patients [62.0%] with previous MVR, 8 patients of them [18.0%] died postoperatively. Mitral valve redo is challenging procedure. Several risk factors affecting the survival of the patients such as gender, previous clinical stage, arrhythmia, PVE. valve thrombosis, paravalvular teak, hepatic and renal dysfunction, type of cardioplegia, toxemia, low Co, type of previous procedure, ascending aorta versus femoral cannulation

Role of surgical correction of aortic coarctation on hypertension in adults

To diagnose the impact of surgical intervention on systolic hypertension, a retrospective study reviewed 14 adults with a mean age of 27.3 +/- 6.2 years who underwent coarctation repair at Al-Azhar University Hospital between 1995 and 2002. All patients were hypertensive [mean systolic blood pressure 169.3 +/- 21.4 mmHg, range 140 to 220 mmHg] and 9 patients [64.2%] were on a regimen of at least one hypertensive medication at the time of surgical interference. All patients underwent cardiac catheterization and the mean peak systolic gradient across the coarctation was 57.9 +/- 24.4 mmHg [range 25 to 120 mmHg]. Operative procedures included resection of the coarctation segment with an interposition of tube graft [3 patients], resection and end-to-end anastomosis [2 patients], a bypass graft [6 patients] and patch angioplasty [3 patients]. There was no hospital mortality or late morbidity. Early and intermediate follow up was available at a mean of 2.5 +/- 2 years [range 1 to 6 years]. At last follow-up, the peak systolic gradient between the upper and lower body was trivial. All patients had significant improvement in systolic blood pressure compared with preoperative values, specially older patients requiring medication

Effect of aortic valve replacement on the severity of associated mitral valve incompetence

The study included 80 patients divided into three groups according to the severity of MVI [trivial, mild and moderate]. All the studied patients had no obvious organic MV lesions and underwent mechanical aortic valve replacement. Pre- and postoperative echo evaluated severity of MVI, mitral annular area and LV EDD, ESD. There was marked improvement in the clinical status after AVR in 78 [97.5%] patients. There was a general improvement in the seventy of MVI. In univariate analysis, there was no significant statistical effect in correlation of the changes in the severity of MVI to the studied variables as age, mitral annular area and LV dimensions. However, there was a significant statistical change in the mitral annular area in all studied groups from pre- to postoperative measures. At the last period of follow up there was improvement in the left ventricular dimensions, but was not significant statistically from pre- to postoperative measurements, especially in LVEDD. There was no incidence of valve thrombosis or endocarditis

Use of echocardiography and scintigraphy in assessment of coronary artery disease [comparative study]

The aim of the study was to perform a comparative study between dipyridamole Technetium Tc-99m sestamibi single photon emission computed tomographic scintigraphy [DMIBI] and dobutamine-atropine stress echocardiography [DASE] in assessment of coronary artery disease [CAD] in correlation to the coronary angiography. The study included 62 patients 43 males and 19 females [mean age: 60 +/- 11 years]. All patients underwent multistage DASE, DMIBI and coronary angiography over one month's time. These procedures were performed according to standard techniques and analysed in comparative issue for the sensitivity and their specificity in assessment of CAD. The study revealed 10 patients with three-vessel disease, 11 patients with 2 and 20 patients with single vessel disease. The other 21 patients had insignificant coronary disease for intervention. DASE and DMIBI were similarly sensitive [87% and 80% respectively] for the detection of CAD. However. DASE was more specific [91% vs. 73%, p<0.01]. Detection of Multiple wall motion abnormalities and perfusion defects were similar in both tests [72% vs. 66% respectively]. However, DASE was more specific than DMIBI [95% vs. 76% respectively p<0.01]. DASE and DMIBI were moderately concordant for the detection and extent of CAD [p<0.0001] but fairly concordant [p<0.001] in the detection of type abnormalities [normal, fixed, ischaemic or mixed]. DASE and DMIBI were comparable tests for the detection of CAD. Both were sensitive for the detection of CAD and moderately sensitive for the detection of the extent of the disease. However, DASE was more specific than DMIBI particularly in multi-vessels disease

Magnesium sulphate and zinc sulphate status in patients with chronic mild to moderate asthma

The mechanism of magnesium proposed effect on asthma is unknown, but may involve a direct action on bronchial smooth muscle, producing airway dilatation. It was found that magnesium sulphate and zinc sulphate relaxed the contracted bronchial smooth muscle in a concentration-dependent manner. The current study was done to evaluate serum and RBCs level of magnesium in asthmatic and healthy subjects, to assess the effect of B[2] agonists on blood magnesium level and to assess the possible role of magnesium sulphate and zinc sulphate in stable mild to moderate asthmatic patients. Sixty subjects were included, 20 apparently healthy and 40 mild to moderate asthmatics who were subgrouped into two groups: 2a who received intravenous magnesium sulphate for 5 days and group 2b who received oral zinc sulphate for 5days. Serum magnesium was non significantly decreased in asthmatics when compared to normal control subjects, while RBCs content was significantly decreased in asthmatics when compared to controls. It was concluded that RBCs magnesium level is significantly decreased while serum magnesium is trivially decreased in asthmatics. Serum IgE and blood eosinophils are increased in asthmatics and pulmonary functions relate inversely to both of them. Salbutamol decreases significantly the serum and RBCs magnesium levels in asthmatics while non significantly decreases them in healthy subjects. Magnesium sulphate may play a role in management of stable mild to moderate asthma while zinc sulphate has no role in the setting of chronic mild to moderate asthma

surgery for ascending aortic aneurysm

From January 1991 through June 1994, 16 patients underwent surgery for ascending aortic aneurysm. There were 14 men and 2 women with an average age of 42 years. The etiology of these aneurysms were syphilitic [one patient], mycotic complicating early prosthetic valve endocarditis [PVE] [one patient], type A aortic dissection [4 patients], atherosclerotic [2 patients], annuloaortic ectasia [4 patients] and Marfan's syndrome [4 patients]. All patients except one, had severe aortic insufficiency. According to the underlying pathology, different surgical techniques were used

Effect of sternotomy on haemodynamic data in patients undergoing aortic or mitral valve replacement using two different narcotic analgesic

This study included 30 adult patients allocated into 2 groups of 15 patients each receiving either fentanyl 50 ug/kg or sufentanil 10 ug/kg for induction of anesthesia. Hemodynamic parameters including 2 categories, direct HR-SABP-MABP-RAP-MPAP-PCWP-CO, derived: CI-SVI-SVR-PVR-LVSWI, were made before, after induction and after sternotomy. After induction there was a significant decrease of SABP, MABP, HR, CO, SVR, CI and SVI but the decrease was greater with the sufentantil group. Sufentanil could prevent the hypertension and the tachycardia due to sternotomy, more than fentanyl suggesting the superiority of sufentanil or over fentanyl as an anesthetic for cardiac surgery