Transverse Cerebellar Diameter as a Sonographic Parameter for Estimating Gestational Age: an Experience From Yemeni Population

@#Introduction: Estimation of gestational age (GA) is clinically crucial for managing pregnancy and assessing the foetal anatomy, growth and development. Transverse cerebellar diameter (TCD) has been reported as an accurate tool for dating the pregnancy. This study aimed to determine the accuracy of foetal TCD for dating the pregnancy and to construct a reference chart for GA of Yemeni foetuses. Methods: We conducted this prospective cross-sectional study among 400 Yemeni pregnant women between 18 and 40 weeks of gestation provided that they were with known last menstrual period and singleton normal pregnancies. Sonographic TCDs were measured for each foetus. The mean TCD was measured for gestational weeks separately, and a polynomial regression model was then used to predict the GA by TCD. Results: There was a robust correlation between GA and TCD (r = 0.995, p <0.001). The coefficient of determination was 0.989, which indicates that the TCD explains 98.9% of GA change. Conclusion: TCD is an accurate tool to estimate the GA in second and third trimesters, including final weeks, among Yemeni pregnant women as in developed countries. The narrow range between the 5% and 95% percentiles is a significant indication of the accuracy of the TCD in estimating the GA. Therefore, clinicians are recommended to use TCD for estimating the GA and should be trained on measuring it accurately.

Serum survivin and tp53 gene expression in children with acute lymphoblastic leukemia

The aim of this study was to detect the prognostic significance of survivin level and the expression of total p53 in acute lymphoblastic leukemia [ALL] and its correlation to patients' outcome. Sixty two children newly diagnosed with acute lymphoblastic leukemia were treated with chemotherapy and followed up for 2 years or until death. Twenty apparently healthy volunteers with matched age and sex were taken as control. Survivin protein was measured by quantitative sandwich enzyme immunoassay and total human p53 was measured by Flow cytometry in peripheral blood at diagnosis and at complete remission. A highly significant elevation [P<0.0001] was found in survivin protein and total p53 levels in acute lymphoblastic leukemia children patients at diagnosis compared to controls. At complete remission a significant decrease of the two indices were found in ALL patients compared to those at diagnosis [P<0.000l]. Survivin protein and total p53 was significantly higher in non-survived compared to survived group [P<0.0001 and /M].016, respectively]. A positive correlation was found between survivin level and total human p53 level in children with ALL 0-0.501 and P<0.0001]. survivin protein is related to anti-apoptotic proteins and its high expression lead to unsuccessful treatment of ALL. Survivin and TP53 are new prognostic tools in ALL, independent of age and sex

C-reactive protein as a predictor of adverse outcome in patients with acute coronary syndrome

The acute-phase reactant C-reactive protein [CRP] has been shown to reflect systemic and vascular inflammation and to predict future cardiovascular events. The objective of this study was to evaluate the prognostic value of CRP in predicting cardiovascular outcome in patients presenting with acute coronary syndromes. This prospective, single-centered study was carried out by the Department of Pathology in collaboration with the Department of Cardiology, Bolan Medical College Complex Quetta, Balochistan, Pakistan from January 2009 to December 2009. We studied 963 consecutive patients presenting with chest pain to Accident and Emergency Department. Patients were divided into four groups. Group-1 comprised patients with unstable angina; group-2 included patients with acute ST elevation myocardial infarction [STEMI]; group-3 comprised patients with Non-ST elevation myocardial infarction [Non-STEMI] and group-4 was the control group. All four groups were followed-up for 90 days for occurrence of cardiovascular events. The CRP was elevated [>3 mg/L] among 27.6% patients in Group-1; 70.9% in group- 2; 77.9% in group-3 and 5.3% in the control group. Among cases with elevated CRP, 92.1% had a cardiac event compared to 34.3% among patients with CRP œ3 mg/L [P < 0.0001]. The mortality was significantly higher [P < 0.0001] in group-2 [8.9%] and group-3 [11.9%] as compared to group-1 [2.1%]. There was no cardiac event or mortality in Group-4. Elevated CRP is a predictor of adverse outcome in patients with acute coronary syndromes and helps in identifying patients who may be at risk of cardiovascular complications

Apolipoprotein E4 effect on development and cognitive function in giardia-infected children

Parasitic infections can seriously affect child development and cognition while the treatment is easy and cheap. To elucidate apolipoprotein [ApoE] and neurodevelopment in children with Giardiasis and the role of ApoE isoforms in childhood cognition and infant development. The present study was performed on 75 Giardia-infected patients [1-9 years] and 45 healthy children control group of similar age and sex.They were subjected to anthropometric measurements. cognitive functioning. developmental assessments and determination of ApoE allelic forms. ApoE genotypes frequency distribution in the studied children was 6. 8, 4, 42, 27 and 33 for E2/2, E2/3. E2/4, E3/3. E3/4 and [4/4, respectively. There were no significant differences regarding demographic and anthropometric measurements as well as cognitive function between ApoE4 carrier and non carrier in children above 4 years; but their scores of performance, part of the intelligence test, and of the frill scale IQs proved to be at the lower normal level. Meanwhile, highly significant differences were observed between ApoE4 carrier and minim carrier regarding developmental assay in children below 4 years. The ApoE4 isoforms have a protective role on cognitive development in children below 4 years sufferring from sole Giartia infection. So, children with ApoE4 negative genotypes should be notified for their susceptibility to cognitive impairment after diarrhea in early infancy and childhood and are advised for careful follow up

Some studies on Avian Influenza in Egypt I. Experimental trial for evaluation of humoral immunity of vaccinated chickens and ducks with different commercial Avian Influenza vaccines

In experimental study to evaluate the L potency of 6 types of inactivated [Avian influenza vaccines] [one H5N1 and five H5N2] administered at 7 days old chickens as well as to evaluate the potency of 2 types of inactivated Al-vaccines [one H5N1 and one 115N2] administered at 7 days old ducklings with full dose [0.5 cm s/c]. The results revealed that these vaccines were different; all gave mean Haemagglutination inhibition titer varied from 2 to 5.9 log 2 along 5weeks post vaccination using homologous and heterologous antigens. These results declared that once vaccination not enough for the protection HI level against the circulating challenge viruses

Some studies on Avian Influenza in Egypt IL Screening on Avian Influenza infection in some chicken flocks

During the period 2006 to 2009, a total of 1096 blood samples from 92 chicken flocks [21 of breeder flocks,63 of commercial layer flocks and 8 broiler flocks], were collected from different govemorates [Giza, Qalubia, Sharkia and Dakahlia] and tested for determination of hemagglutinationinhibition [HI] titers against Avian Influenza [Al]. All of the surveyed farms applied blind vaccination programs without serological estimation to MDA and actively acquired humoral immune response to determine timing of priming or boosting[s]. HI titer equal to or less than 2 was detected in 76 flocks [82.6%], and there were 16 flocks [17.4%] showed low antibody titer [<4 log2]. The results indicated that MDA persisted for 28 days duration after hatchling and these MDA may interfere with early vaccination [less than 2 weeks of age]. Early vaccinations within first week of age, with full vaccine dose, were frequently and blindly applied due to panic of AT. The results of evaluation of such flocks at marketing age [30. 42 days] revealed suboptimal HI titer. For the control of avian influenza, a rapid diagnosis by detecting the causative virus and identifying its subtype is essential. A rapid diagnosis kit for identification of AT by rapid antigen kits [Type A and H5 kit] was used for detection of AIV in three hundred samples, positive samples were 67, [22.33%]. Out of 82 samples from Qalubia, positive samples were 18, [21.95%], samples from Giza were 56, positive samples 11 were positive, [19.64%], 13/68 samples from Dakahlia were positive [19.11%] and 2 5/94 samples from Sharkia were positive [26.59%]

Role of leptin in patients with chronic idiopathic thrombocytopenic purpura [ITP]

Leptin hormone, synthesized by the adipose tissue, binds with a receptor member of the class I cytokine receptor family. It plays a role in the pathogenesis of several autoimmune diseases. Idiopathic thrombocytopenic purpura [ITP] constitutes the prototype of autoimmune diseases characterized by the production of the autoantibodies against platelet antigens, resulting in enhanced destruction of the platelets by macrophages. Recently, more evidences have been found related to the effects of hormones on the immune system, including their effect on autoimmunity. The aim of this study was to evaluate serum leptin level in patients with chronic ITP in order to determine the role of leptin in the pathogenesis of ITP. This study comprised 40 patients with chronic ITP and 20 healthy controls of similar age, sex and body mass index [BMI]. Serum leptin level was measured by enzyme amplified sensitivity immunoassay [EASIA]. It was found that, the mean serum leptin level in patients with ITP was significantly higher [P<0.001] than in healthy controls. Furthermore, the positivity of platelet-associated antibodies [PAIgG] and platelet count was significantly different between leptin-positive [level greater than mean of control value + 2SD] and leptin-negative patients. From the present study we can conclude that leptin might play an important role in the pathogenesis of ITP

Serum leptin, insulin resistance and soft tissue composition by dual energy X-ray absorptiometry in obese children

This work aimed to study serum leptin and insulin resistance in obese children and their relation to body composition by DEXA and various measurements of obesity. Thirty-three obese subjects body mass index [BMI] > 95th centile, were enrolled in this study [12 males and 21 females]. Their age ranged from 4 years to 15 years [mean 9.4 +/- 2.93]. Sixteen healthy age- and sex- matched Egyptian children were taken as controls. Obese children and the control group were subjected to thorough anthropometric measurements, estimation of BMI and weight% to ideal weight for height, DEXA study for body composition, serum Ieptin by ELISA and serum insulin [ELISA], blood glucose fasting and postprandial to assess insulin resistance. Insulin resistance index. IRP=Fasting Glucose x Fasting Insulin / 22.5. The study showed that obese children had significantly higher BMI and weight% to ideal weight for height compared to controls. Percent total body fat by DEXA was significantly higher in obese children compared to the controls [49.47 +/- 6.12 vs 19.85 +/- 5.06] [P< 0.0001] and arm fat percent in obese children was 52.92 +/- 8.46 vs. 16.84 +/- 4.6 in controls [P< 0.0001]. Also significantly higher trunk fat/lower limb fat by DE][A was detected [1.21 +/- 0.2 vs 0.81 +/- 0.07, P<0.0001]. IRI in obese children was 68.5 +/- 26.8 vs 19.74 +/- 4.8 in controls [P<0.0001] and serum leptin was higher in obese compared to nonobese children [40.71 +/- 22.73 vs. 10.38 +/- 16.08, P<0.001]. Serum leptin and IRI showed a significant correlation with BMI, weight% to ideal weight for height,% total body fat by DEXA and% arm fat. Moreover, a significant correlation was obtained between IRI and serum leptin [P<0.001]. Obesity is associated with insulin resistance and high serum leptin level, which denote serum leptin resistance. Both are correlated with BMI, weight% to ideal weight for height,% total body fat by DEXA and% arm fat by DEXA

Plasma pharmacokinetics of morphine after epidural and intermuscular administration in children

Morphine concentrations were measured by high performance liquidchromatography with electrochemical detector in plasma of children injectedprior to the operation of hypospadias repair, with morphine sulfate eitherepidurally [50 ug/kg] or intramuscularly [0.1 mg/kg]. After administration,plasma morphine levels began to rise until reached its maximum value after 10min. While in intramuscular administration, the maximum plasma morphinelevels occurred after 5 min. post-injection and a similar disappearance ofplasma morphine was observed and extended for more than 240 min. In a comparison, there is significant decrease in maximum plasma morphine concentration [Cp max], absorption rate constant [Ka], volume of distribution [Vd] and terminal half-life [t 1/2] for children epidurally administered less than intramuscularly administered, while a high significant elevation of timemaximum concentration [t max] was observed in the former route. These datademonstrated the analgesic effectiveness of epidural morphine as compared withintramuscular morphine