Pregnancy outcome after difficult embryo transfer in IVF-ET cycles

Background: Embryo transfer [ET] is one of the most crucial steps in IVF/ICSI treatment. Although it, apparently, seems simple, it is an integral part of IVF/ICSI and can affect the outcome of the whole treatment cycle. The majority of couples [approximately 80%] who undergo IVF reach the ET stage, yet few pregnancies occur. The pregnancy rate after ET is dependent on multiple factors including embryo quality, endometrial receptivity, and the technique of the ET

Aim of the Work: The aim of the current study is to investigate the clinical and ongoing clinical pregnancy rates in women who experience difficult embryo transfer [ET] after IVF/ICSI cycle

Patients and Methods: This prospective cohort study was conducted at Dar Al-Teb Infertility and IVF Center between January 2017 and January 2018. The study included 417 women planned to undergo ET

Results: The biochemical, clinical and ongoing clinical pregnancy rates were significantly lower in women who had difficult ET when compared to women who had easy ET [ORs 0.5, 95% CI [0.31 to 0.83]; 0.48, 95% CI [0.29 to 0.79]; 0.36, 95% CI [0.21 to 0.62]; respectively]

Conclusion: Difficult ET is associated with significantly reduced biochemical, clinical and ongoing clinical pregnancy rates

Recommendations: ET should be smooth with easy passage of the transfer catheter. Since any uterine manipulation during ET adversely affects IVF results, therefore precaution should be taken to identify possibly difficult ET cases in advance

Combination therapy versus monotherapy for gastroesophageal reflux in children with difficult-to-treat bronchial asthma

Gastroesophageal reflux [GER] is a common disorder in children with bronchial asthma. Difficult-to-treat asthma; It has been identified as a potential trigger, complication and even differential diagnosis for asthma. GERD; Our aim was to find out the efficacy of the combined use of both the proton pump inhibitor esomep-Proton pump inhibitors; razole and the antidopaminergic prokinetic domperidone versus the sole use of esomeprazole in Prokinetics improving asthma severity in children with difficult to treat asthma. Among 178 children with difficult-to-treat asthma, GER was assessed using upper GIT endoscopy. Those who had GER were randomly divided into 2 equal subgroups the first was treated with esomeprazole for 12 weeks while the other was treated with esomeprazole and domperidone for the same period [beside the usual treatment for asthma in both groups]. Childhood-asthma control test [C-ACT], forced expiratory volume in 1st second [FEVj] [% of predicted], peak expiratory flow [PEE] variability, induced sputum substance P [SP] and endoscopic reflux score [ERS] were recorded before and after the treatment. Gastro-esophageal reflux [GER] was observed in about 45% of children with difficult-to-treat asthma. The C-ACT, induced sputum SP, ERS and FEVj showed significant improvement while PEE variability showed no significant changes when comparing combination therapy subgroup [esomeprazole and domperidone] with esomeprazole only subgroup combination of domperidone and esomeprazole was more effective in improving the endoscopic reflux score, childhood-asthma control test [C-ACT] and FEVj [% of predicted] and significantly reduced the sputum SP than the use of esomeprazole only in children with difficult-to-treat asthma

Serum Troponin-I as a prognostic marker in acute exacerbated chronic obstructive pulmonary disease patients

Background: Chronic Obstructive Pulmonary Disease [COPD] is a major cause of chronic morbidity and mortality worldwide. It is the fifth leading cause of death worldwide. The spectrum of cardiovascular complications associated with COPD is clearly broad, right ventricular [RV] dysfunction and pulmonary vascular disease are common in COPD and progress with time. In RV failure, cardiac Troponins [cTn] are suspected to be elevated secondary to RV ischemia or micro infarction

Objective: To evaluate the prognostic value of cardiac Troponin I level in acute exacerbated chronic obstructive pulmonary diseases [AECOPD] and its impact on the hospital outcome in those patients

Patients and methods: This study was performed on 60 patients with AECOPD, admitted at Chest Department and respiratory ICU; Zagazig University hospital. All patients were subjected to: thorough history taking, clinical examination, electrocardiography and echocardiography, arterial blood gas [ABG] analysis, measure forced vital capacity [FVC] and forced expiratory volume in first second [FEV1], serum assay of cTnI level which is considered -ve if <0.01 ng/ml and +ve if >/=0.01 ng/ml

Results: cTnI was positive in 42 AECOPD patients. cTnI positivity was more prominent among patients with very severe exacerbation of COPD and in those with past history of LTOT, MV, ICU admission. Also, cTnI positivity was more in patients admitted to ICU rather than those managed in the ward and among patients who needed MV rather than who did not need it and in patients who failed weaned rather that who succeeded weaned. P-pulmonate, Rt. ventricular strain, high pulmonary artery pressure, hypoxemia and hypercapnia showed a great effect upon cTnI positivity. The duration of hospitalization was longer among cTnI +ve patients than cTnI ?ve ones, Tropinin cutoff value for the prediction of death was >0.055 ng/ml with Sensitivity = 75%, Specificity = 68%

Conclusion: Positive cTnI in AECOPD patients may suggest exacerbation severity and the occurrence of pulmonary hypertension and right ventricular dysfunction. Positive cTnI is considered as good prognostic marker for the possibility of a need for MV and a longer duration of hospitalization. MV may further elevate cTnI in AECOPD patients and with possible weaning failure. Negative cTnI and cTnI

Diagnostic Validity of serum and peritoneal TNF-alpha, high sensitivity CRP and plasma cell-free nuclear DNA [ccf nDNA] as biomarkers of pelvic endometriosis- a case control study

Introduction: Endometriosis is a disease defined by the presence of endometrial glands and stroma located outside the uterine cavity. These ectopic implants can be found throughout the pelvis, on and within the ovaries, abutting the uterine ligaments, occupying the rectovaginal septum, invading the intestinal serosa, and along the parietal peritoneum. Endometrial implantation at distant sites such as the pleura, lung, within surgical scars, and along the diaphragm also has been reported. [1] . It results often in subfertility and pain, occurs mainly in women of reproductive age [16-50 years] and has a progressive character in at least 50%, but the rate and risk factors for progression are unknown. Endometriosis can be classified into four stages: minimal, mild, moderate and severe. The gold standard for the diagnosis of endometriosis is laparoscopic inspection, ideally with histological confirmation. [2], however, is an invasive technique and should be performed only after imaging techniques prove insufficient for confident diagnosis. [3] Lack of a non-invasive diagnostic test contributes to the long delay between onset of symptoms and diagnosis of endometriosis. [2] Additional tools are needed for non-invasive classifications in order to reduce the number of unnecessary laparoscopies without adversely affecting outcomes. Finding specific and more sensitive biomarkers in endometriosis is critical, because endometriosis is usually diagnosed only in advanced stages, and there is a high rate of morbidity for this disease. [4]

Aim of the work: The aim of the current study is to assess the validity of serum and peritoneal high sensitivity CRP and TNF-alpha and plasma cell-free nuclear DNA [ccf nDNA] as biomarkers in early diagnosis of pelvic endometriosis

Methods: This study was conducted at the Obstetrics and Gynecology department, Maternity Hospital, Ain Shams University. This is a case control study of 120 women scheduled for diagnostic laparoscopy. Laparoscopy was indicated in these women whether for various causes of subfertility or for chronic pelvic pain between January 2011 and January 2012. The patients were divided into the following groups: Group I [endometriosis group/ study group] consisted of 80 patients diagnosed to have endometriosis during laparoscopy. Group I cases were subdivided into two subgroups, Group IA: consisted of 34 cases with stage 1or minimal endometriosis and Group IB: consisted of 46 cases with stage 2 or mild endometriosis. Group II [non-endometriosis group/Control group]: consisted of 40 cases with no detected pelvic pathology. During the laparoscopy procedure, both peripheral venous blood and peritoneal samples were withdrawn. Serum and peritoneal levels of high sensitivity CRP and TNF-alpha as well as plasma levels of ccf nDNA were compared in both groups and in early stages [minimal and mild] of endometriosis within the study group

Results: Serum TNF-a, serum hs-CRP and plasma ccf DNA were significantly elevated in cases compared with the control group. They were also elevated in patients with group IA and group IB as compared to control group. However, there was no statistically significant difference between cases and control group as regards peritoneal TNF-a and peritoneal hs-CRP. There was no significant difference between the group IA and group IB as regards all biomarkers

Conclusion: Our results showed that serum TNF-alpha , serum hs-CRP and plasma ccf DNA are highly reliable biomarkers for screening and early diagnosis of endometriosis, but they can not be used to discriminate between stage I and stage II. On the other hand, peritoneal TNF-a and peritonealhs-CRP are non reliable for early diagnosis of endometriosis and can not be used to discriminate between stage I and stage II of endometriosis

impact of repeated thoracentesis on the outcome of chemical pleurodesis in malignant pleural effusion

Repeated thoracentesis may cause pleural inflammation and induce local release of proinfammatory cytokine as tumor necrosis factor-alpha [TNF-alpha] which may subsequently enhance the release of plasminogen activator inhibitor-1 [PAI-1] and lead to fibrin formation in malignant effusion. The presence of fibrin strands after repeated thoracentesis may be of considerable value in predicting the success of subsequent pleurodesis in patients with malignant pleural effusions [MPEs]. So, the aim of this work is to study the impact of repeated thoracentesis on the outcome of chemical pleurodesis in MPE. This is a retrospective study included 116 patients with MPE, they were diagnosed finally by pleural fluid [PF] cytology and/or either computed tomography [CT]-guided biopsy or tissue biopsy [Abram's or thoracoscopic biopsy]. These patients were admitted and subjected to the following: a] Pleural tapping and the aspirated fluid was sent for chemical, cytological and bacteriological examinations for determination of the inclusion criteria, [b] Tube thoracostomy insertion, [c] Pleurodesis, and assessment of the response to pleurodesis was done once after 30 days and another after 60 days. Regarding pleurodesis success or failure in this work, there was statistically highly significant decrease in the duration of chest tube before pleurodesis in patients with successful pleurodesis than that in patients with failed one. But, statistically non-significant decrease was observed in the duration of chest tube after pleurodesis in patients with successful pleurodesis than that in patients with failed one. There was statistically significant negative correlation between the number of pleural fluid [PF] aspiration and the duration of chest tube after pleurodesis and statistically nonsignificant negative correlation between the number of PF aspiration and the duration of chest tube before pleurodesis. Also, to predict the success of the pleurodesis, after 30 days of pleurodesis with cut-point of PF aspiration number >7 times, sensitivity and specificity were 75.3% and 65.7% respectively and after 60 days of pleurodesis, also, at cut-point of PF aspiration number >7 times, sensitivity of 80.3% was higher than that after 30 days of pleurodesis and specificity of 64.4% which was near that after 30 days of pleurodesis. Repeated thoracentesis may be of considerable value in predicting the success of subsequent chemical pleurodesis in MPE. Repeated thoracentesis of MPE >7 times has good sensitivity, but low specificity in predicting success of subsequent chemical pleurodesis. Measurement of PF glucose levels and PF cytology provide information about the outcome of chemical pleurodesis in MPE

Histological study of the effect of induced diabetes on the zona glomerulosa of the adrenal cortex of adult male albino rat

Diabetes is one of the chronic diseases affecting many organs in the body. However, studies concerning its effect on the zona glomenilosa are limited. This work is concerned with studying the histological effects of streptozotocin [STZ]-induced diabetes on the zona glomenilosa of the adrenal gland of adult male albino rats Thirty healthy adult male albino rats were utilized, divided into two groups; Group A: Control and Group B: Experimental group. Rats of experimental group treated with five intra-peritoneal injections of [STZ] with 7-day intervals. The first three doses were 75 mg/kg and the remaining two doses were 150 mg/kg body weight. The control group received only 0.1 ml of 0.1 M citrate buffer, pH 4.4, by the intra-peritoneal route, Thirty days after the detection of the diabetic status, the animals of the two groups were anaesthetized with ether inhalation and the suprarenal glands were removed and processed for light and electron microscopy examination. Plasma level of aldosterone was measured by radioimmunoassay. At light microscopic level, the zona glomerulosa cells of the STZ-induced diabetic rats showed apparent increase in the cytoplasmic vacuolation and pyknotic nuclei. Electron microscopic study of the cells in the previous group revealed degenerative changes in the form of an apparent increase in the number of lipid droplets associated with mitochondrial degeneration. Plasma aldosterone decreased in STZ-induced diabetic rats. The results of this work suggested that streptozotocin induced diabetes changed the ultrastructures of the zona glomerulosa cells which may consequently lead to disturbance of their functions

Renin-angiotensin II -aldosterone axis disturbances in patients with chronic obstructive pulmonary disease

To study the possible disturbances of renin-angiotensin II Aldosterone system [RAAS] in chronic obstructive pulmonary disease [COPD] patients, this work was conducted. It included 45 COPD and 10 healthy control volunteers. Both plasma renin activity [PRA] and plasma aldosterone [PA] were measured in patients and controls by radioimmunoassay [RIA] and the results were plotted against clinical and functional data as well as serum and urinary electrolytes. In COPD patients, PRA and PA levels [means +/- SD were 4.4 +/- 1.16 ng/ml/h and 132 +/- 44pg/ml us 1.2 +/- 0.26 ng/ml/h. and 65 +/- 3pg/ml respectively, were significantly higher than those of controls, and positively correlated with each other. There was no effect of sex, body weight or age on the RAAS, while a significant positive correlation between smoking and PRA was found. Greater RAAS stimulation was observed in the presence of peripheral edema and with advancement of hypercapnia, hypoxemia and airway obstruction. Inability to excrete sodium, in urine was the most prominent electrolyte disturbance in advanced COPD. Mechanical ventilation was associated with further stimulation of RAAS. In conclusion, RAAS is frequently stimulated in COPD patients especially in advanced stages of the disease, leading to a state of secondary hyperaldosteronism of the hyperreninemic type that may contribute to sodium retention and edema formation. Hypercapnia and, to lesser degree, hypoxemia may be the most accused predisposing factors for RAAS stimulation

prostaglandin E1, analogue [misoprostol] versus oxytocin in labor induction

Sixty-five patients with an indication for induction of labor were randomly assigned to induction with intravaginal misoprostol or IV oxytocin infusion. In the latter group, prostaglandin E2 vaginal tablets were used prior to infusion if necessary. Among 65 patients evaluated, 33 were assigned to the misoprostol group and 32 to the oxytocin group. PGE2 vaginal tablets were needed in 12 patients in the oxytocin group with unfavorable cervix. Uterine tachysystole occurred more frequently in the misoprostol group [33.3%] than the oxytocin group [15.6%]. However, no statistically significant differences were noted between the two groups regarding mode of delivery and neonatal or maternal adverse outcome. The induction to delivery interval was significantly short in the misoprostol group [10.2 versus 16.3 hours]. In 68% of patients in the misoprostol group, only one intravaginal dose was required for successful labor induction

Lower-lung field tuberculosis in Riyadh Saudi Arabia

One hundred forty four patients were found to have lower lung field tuberculosis in a study of 1400 cases of pulmonary tuberculosis. This represents 10.3% of the total admissions over a period of four years. Lower lung field tuberculosis is more common in females. 26.4% of the patients had previous antituberculous treatment. Sputum conversion took 40.4% days. Average hospital stay was 50 days. Hemoptysis was found in 45.8% of cases and diabetes mellitus was discovered in 13.2%. Chest x-ray studies showed right lung involvement in 46.5% of cases, bilateral involvement in 28.5% and left lung involvement in 25% of cases. A cavitary lesion was found in 49.3%

Study of serum calcium level in active pulmonary tuberculosis

In a study of 227 patients with active pulmonary tuberculosis, hypercalcemia was found in 59 [26%]. It was detected in 46 patients and developed in 13 patients 4 to 6 weeks after the start of antituberculous chemotherapy. The mean [ +/- SD] serum calcium level in those was 2.78 [ +/- 0.137] mmol/L. The majority of cases [67.6%] had a mild rise in the calcium level that remained below 2.8% mmol/L but 30% had a level that ranged between 2.8 and 3 mmol/L. Only 2.4% had serum level higher than 3.0 mmol/L, which could explain the predominant absence of hypercalcemia-related symptoms. Hypercalcemia was more common in patients older than 50 years [P < 0.05], but this did not correlate with the extent of the tuberculosis shown on radiological evaluation. Spontaneous return to normocalcemia occurred in all 40 patients who underwent serial assessments of their serum calcium concentration, 6 to 8 weeks after the start of chemotherapy. Saudi Arabia is known to have a high prevalence of vitamin D deficiency, but none of our patients were immobilized or had received vitamin D supplements or multivitamins. This supports the view that vitamin D intake does not play a major role in inducing hypercalcemia in cases of active pulmonary tuberculosis, as has been suspected

Pulmonary function tests in normal school children in Riyadh, Saudi Arabia

Pulmonary function tests were done in normal Saudi Children [215 boys, 130 girls] ranging in age from 6 to 17 years. The children were selected at random from various primary and secondary schools in Riyadh, Kingdom of Saudi Arabia. The variables measured were vital capacity [VC], forced vital capacity [FVC], forced expiratory volume in the first second [FEV[1]], FEV[1]/FVC%, and forced expiratory flow between 25 and 75% of FVC [FEF 25 - 75%]. In general, the values were higher in boys than in girls of the same age VC was consistently lower than FVC in both sexes. With the exception of FEV[1]/FVC%, all variables showed good correlations with age, height, and weight. The FVC and FEV[1] values in our study were lower than those reported for Jordanian children. Prediction formulas for each variable were determined