Knowledge, attitude and practice of long acting reversible hormonal contraception (LARHC) among women in urban upper Egypt

Background: The current study aims to assess the knowledge, attitude and practice of long acting reversible hormonal contraception (LARHC) among women in urban upper Egypt.Methods: A cross sectional study which included 902 married women, in the reproductive age, attending the outpatient clinics (Gynecology and family planning) of: 1-Assiut University Maternity Hospital, 2- Sohag University Hospital, and 3-Gehina General Hospital (MOH hospital) with current or previous use of any method of LARHC methods. A Questionnaire file was designed to assay knowledge attitude and practice of clients towards contraceptive methods. All data collected from clients reviewed separately to assess knowledge, attitude and practice of women towards contraceptive methods.Results: The most popular contraceptive method is COCs followed by IUD then DMPA. 99% of studied sample heard with good description about different types of LARHC. 54.9% of studied sample most popular/famous LARHC DMPA, most sources of information on LARHC were, Hospital, Relative/friends and health workers. 94.24% of the studied sample were in favor to use of LARHC, 94.2% of them agree to take a space between births, about 55.4% of them were health child and 61% comfortable lifestyle benefit from birth spacing, 33% of studied sample were maternal health, 68% of them were think/prefer to use implants, 64.5% of them didn’t pregnant while breastfeeding. 11% of sample women never used any contraception before and most reasons for not using contraception are fear of side effects, desire for more children, irregular sexual relationship, and husband opposition. Only 16.6 % of studied sample used LARHC before and most of them used DMPA, however 3 women who used DMPA get pregnant while using it.Conclusions: There is a good level of knowledge between upper Egypt women about LARHC methods.

Value of cardiac biomarkers in patients with acute pulmonary embolism

Prognostic stratification of patients with PE is important in management and potentially improve clinical outcome. Cardiac biomarkers are used as an adjunct to clinical and echocardiographic risk stratification in a variety of circumstances, [Creatine-kinase-MB [CK-MB]] and cardiac troponin I [cTnl] are most widely used because of their high sensitivities, and very high specificity of troponin for heart muscle injury. Evidence is mounting that myoglobin's sensitivity for myocardial necrosis combined with its unique release and clearance properties may render it particularly attractive as a risk marker either alone or in combination with other markers. The aim of the current study is to assess the levels of cardiac specific biomarkers in relation to different clinical, ECG and echocardiogrphic findings in patients with acute PE, as well as evaluating the prognostic value of these biomarkers for inhospital mortality and adverse clinical events. This study comprised 40 patients with proved PE [22 males and 18 females], their mean age was 50.05 +/- 13.09 years [range 22-70 years]. The following investigations were performed for all patients; 12-leads ECG, Full echo Doppler study, spiral CT of the chest, and laboratory testing: arterial blood gas, serum myoglobin, serum troponin, total CK and CK-MB, kidney and liver function tests. Significant elevation of CK-MB [> 10 micro/L] was noted only in 7.5% of patients, while cardiac cTnl was elevated [>/= 0.07 ng/ml] in 45% of patients and elevated serum myoglobin was found very early after symptoms [<4 h] in 55% of patients. Elevated serum cTnl and myoglobin were significantly associated with ECG signs of right ventricular strain and echocardiographic evidence of right ventricular dysfunction. The results of the present study demonstrate the prognostic value of cardiac specific biomarkers, cardiac troponin I and myoglobin in acute pulmonary embolism. Thus, the current data combined with the results of previous studies strongly support the integration of troponin and myoglobin testing into the risk stratification and management of patients with established acute PE

Advanced non-small cell lung cancer in elderly patients: the standard every 3-weekly versus weekly paclitaxel with carboplatin

Paclitaxel and platinum-based chemotherapy is considered to be a standard approach for locally advanced and metastatic non-small cell lung cancer [NSCLC]. In recent years, paclitaxel on a weekly schedule in combination with carboplatin has been widely used because it is associated with a lower incidence of neuropathy and myelosuppression. Otherwise, only a few studies are available in elderly patients with NSCLC. The aim of our study was to evaluate the efficacy and safety of weekly paclitaxel combined with carboplatin compared with the classic 3-weekly schedule of paclitaxel and carboplatin as initial therapy and the feasibility of subsequent maintenance therapy versus observation in elderly patients with locally advanced [stage IIIB] and metastatic [stage IV] NSCLC. Ninty patients >/=65 years with stage IIIB-IV NSCLC were randomly assigned to one of the following arms: arm1, paclitaxel 90 mg/m[2] weekly for 3 of 4 weeks with carboplatin [area under the curve /[AUC/] =6] on day 1 of each 4 week cycle; and arm 2, paclitaxel 200 mg/m[2] with carboplatin [AUC = 6] on day 1 of each 3-week. After four cycles of chemotherapy, those with objective response or stable disease were randomized to weekly paclitaxel [70 mg/ m[2], 3 of 4 weeks] or observation as maintenance therapy. Primary end point was response while second end points included survival and toxicity. Eighty-six patients were evaluable for response, overall responses were recorded in 42.9% in arm 1 versus 31.8% in arm 2; stable disease was 38.1% in arm 1 versus 27.3% in arm 2 and progressive disease was 19% in arm 1 versus 40.9% in arm 2. The median time to progression and median survival times were 7 months and 10.8 months in arm 1 versus 5.6 months and 9 months in arm 2, respectively. The 1-year survival rates were 47.6% in arm 1 versus 36.4% in arm 2. Grade 3/4 anemia was more common in arm 1 [23.8%] than arm 2 [9.1%]. Grade 3/4 neutropenia and febrile neutropenia occurred in 14.3% and 4.7% in arm 1 versus 22.7% and 9.1% in arm 2. Grade 2/3 neuropathy occurred in 4.7% in arm 1 versus 13.6% in arm 2. Efficacy was similar between the weekly regimen and the standard regimen of carboplatin and paclitaxel for elderly patients with advanced NSCLC and may be advantageous based on its favorable tolerability profile

T helper type 1/T helper type 17-related cytokines in chronic hepatitis C patients before and after interferon and ribavirin therapy

This study examined the T helper [Th] 1/Th17-related cytokines, interferon [IFN]- gamma and interleukin [IL]-17 in the serum of biopsy-proven chronic hepatitis C patients before and after IFN and ribavirin therapy to address whether or not viral clearance is related to Th1/Th17 cytokines. The serum levels of IFN-gamma and IL-17 were assayed by ELISA on 26 patients with chronic hepatitis C virus [HCV] infection before the start and 3 months after treatment with pegylated IFN-alpha plus ribavarin and compared with sera from 15 normal control subjects. IFN- gamma and IL-17 levels are higher in the serum of patients with chronic hepatitis than in normal controls and these elevated levels were not directly correlated [r = -0.01, p = 0.96 for IFN-gamma and r= - 0.08, p= 0.66 for IL-17] to the viremic state of the HCV infection. In contrast to IL-17, IFN-gammas showed significant reduction after 12 weeks of treatment with pegylated IFN plus ribavirin. However, IFN-gamma and IL-17 serum levels were not significantly [p= 0.19 and =0.70, respectively] different among responders are nonresponders for pegylated IFN plus ribavirin therapy. Our finding suggest that the combined treatment with pegylated IFN-alpha and ribavirin downmodulates the secretion of key cytokine IFN-gammas as early as 12 weeks after treatment in infected patients. These findings could encourage new exciting possibilities for immune-based interventions with the aim of restoring functional antiviral T cell responses combined with improved viral clearance

Sequential chemoradiotherapy versus concurrent chemoradiotherapy plus consolidation chemotherapy in unresectable stage III non-small cell lung cancer

To evaluate the efficacy and toxicity of concurrent/consolidation chemoradiotherapy versus sequential chemoradiotherapy in unresectable stage III non-small cell lung cancer [NSCLC]. Between January 2003 and April 2006 thirty-two patients with stage III unresectable NSCLC were randomly assigned to one of the two treatment arms. In the sequential arm, patients received induction chemotherapy with docetaxel [75 mg/m[2]] repeated every 3 weeks for 3 cycles, followed by thoracic radiotherapy at a dose of 61Gy in 33 fractions over 6.5 weeks. In the concurrent/ consolidation arm, the same radiotherapy was started on day 2 with two concurrent cycles of cisplatin 50 mg/m2 on days 1, 8, 29, and 36; etoposide 50 mg/m2 on days 1 through 5 and 29 through 33. Then these patients received consolidation therapy with docetaxel started 4-6 weeks after concurrent chemoradiotherapy, repeated every 3 weeks for 3 cycles at a dose of 75 mg/m[2]. The overall response rate was higher in concurrent/consolidation arm [62.5%] than in sequential arm [43.7%], [P=0.03]. The median survival was 19 months in concurrent/ consolidation arm and 13.6 months in the sequential arm, [P=0.001]. The 2- year survival rate was better in concurrent/ consolidation arm [43.7%] than in the sequential arm [25%], [P=0.03]. Median progression-free survival was longer in concurrent/consolidation arm [11.9 months] than in sequential arm [8 months], [P=0.07]. The major and most frequent toxicity was neutropenia, which was 43.7% in concurrent/consolidation arm versus 56.2% in sequential arm, [P=0.09]. However, esophageal toxicity [>/= grade 3] was relatively higher in concurrent/consolidation arm 18.7% versus 6.2% in sequential arm, [P= 0.05]. Brain metastasis was the most common site of distant failure in both treatment arms. Locoregional failure was more frequent in sequential arm [37.5%] than in concurrent/consolidation arm [18.7%], [P=0.04]. Consolidation docetaxel after concurrent cisplatin/ etoposide with radiotherapy in stage III NSCLC was feasible, tolerable and can be safely administered with relatively low incidence of radiation esophagitis. In addition, treatment outcomes compared favorably with the sequential chemoradiotherapy

Intima-media thickness of the common carotid artery in rheumatoid arthritis patients

To measure the intima-media thickness [IMT] of the common carotid artery [as an index of subclinical atherosclerosis] and to evaluate the factors associated with arterial wall thickness in RA patients. We used an accurate and reliable imaging technique, high-resolution B-mode ultrasound, to compare common carotid artery [CCA] intima-media wall thickness [IMT] in 40 RA patients and 40 controls. The apparently healthy subjects were comparable with the RA patients as regards the risk factors for atherosclerosis, including age, sex, menopause status, body mass index [BMI], blood pressure, and serum lipid levels. We investigated the association between [IMT] of the [CCA] in RA and clinical and therapeutic variables. The mean level of IMT of the CCA showed a statistically highly significant increase [p<0.001] in RA patients as compared to controls. There were statistically significant correlations [p<0.05] between IMT of the CCA in RA and disease related variables; duration of morning stiffness, articular index, grip strength, ESR, hemoglobin level, pain severity and rheumatoid factor. Highly statistically significant correlations [p<0.001] were found in relation to age, disease duration, spread severity index, Larsen score, HAQ and CRP. Insignificant correlations [p>0.05] were found between IMT of the CCA in RA patients and sex, B.M.I, systolic and diastolic blood pressure, lipid profile and drug treatment. RA patients exhibited greater thickness of the common carotid artery than healthy controls, so RA patients have an ultrasonic marker of early atherosclerosis. The age, disease duration, disease activity and severity, decreased physical activity, but not therapeutic variables, were associated with the increased arterial wall thickness

Detection of carotid atherosclerosis in systemic lupus erythematosus and its relation to risk factors

To detect early atherosclerotic changes in SLE patients and to evaluate its relation to traditional cardiovascular risk factors and lupus-related factors. Forty female SLE patients were included in this study. Their age ranged from 20 to 63 years. All of them were subjected to full history taking, thorough clinical examination, laboratory investigations, disease activity assessment using SLE Disease Activity Index [SLEDAI] and assessment of SLE-related disease damage according to the Systemic Lupus International Collaborating Clinics [SLICC] damage index. Intima-media thickness [IMT] and carotid plaques were measured with carotid B-mode ultrasound. Risk factors associated with carotid plaques and IMT were determined. They included traditional cardiovascular risk factors, SLE-related disease factors and inflammation markers. Eighteen patients out of the 40 [45%] had plaques. Those patients were statistically significantly [p<0.05] older and had higher systolic and diastolic blood pressure, greater body mass index, higher levels of total cholesterol, low-density lipoprotein [LDL] cholesterol, fibrinogen and C-reactive protein [CRP] than patients without plaques. The patients with plaques had a statistically significant [p<0.05] longer disease duration, higher SLICC damage score and longer duration of prednisone use than those without plaques. The mean level of IMT of the CCA showed a statistically significant increase [P < 0.05] in SLE patients as compared to controls. The IMT was statistically highly significantly [p<0.001] as correlated with the age, CRP, and SLICC damage index. The prevalence of the plaques in the studied SLE patients was 45%. There were statistically significant differences between the patients with and those without plaques regarding disease-related factors [disease duration, SLICC damage score and duration of prednisone use] and inflammation markers [fibrinogen and C-reactive protein]. IMT of the CCA showed a statistically significant increase [P < 0.05] in SLE patients as compared to controls. The IMT was statistically highly significantly correlated with SLICC damage index. These findings show that SLE-related disease factors and inflammation markers are associated with carotid atherosclerosis in the SLE patients. SLE patients at risk of atherosclerosis should be examined by high resolution ultrasonography for identification of early stage atherosclerosis. Also, dampening of the inflammatory activity has a favorable impact on the progression of atherosclerosis in SLE patients

Associations between specific antinuclear antibodies, detected by line immunoassay, and clinical features of patients with systemic lupus erythematosus

Autoantibodies are an integral part of the process of classifying, detecting, and, at least in some cases, mediating autoimmune diseases. The antinuclear antibody is not just one antibody but, actually, many different antibodies associated with a variety of diseases and disease manifestations. Antinuclear antibodies [ANA], anti-Sm, or anti-dsDNA antibodies are part of the American College of Rheumatology criteria [ACR] for SLE. Specific reactivities are associated with distinct clinical features of SLE. To study associations between antinuclear antibodies [ANA] detected by Line Immunoassay and signs/symptoms in patients with systemic lupus erythematosus [SLE]. A total of 38 unselected consecutive patients, diagnosed as having SLE and attending the rheumatology and nephrology units, Suez Canal University Hospital, were included in this study. The patients met the American College of Rheumatology [ACR] revised criteria for classification of SLE. ANA profiles were determined by line immunoassay and by indirect immunofluorescence on Crithidia luciliae. An extensive list of signs/symptoms was evaluated. ANA were found by indirect immunofluorescence [IIF] in 36/38 [95%] patients. The frequencies of the specific reactivities were: anti-dsDNA 60%, anti-SmB 35%, anti-SmD 25%, anti-RNP-C 25%, anti-Ro60 15%, anti-SSB 15%, anti-RNP-A 10%, antiRibosomal P 10%, anti-Ro52 5%, anti Cenp-B 5%, anti Scl-70 2.6%, and anti-Histones 60%. Cutaneous manifestations were associated with anti-SSB, Ro52, Ribosomal P, anti-dsDNA and histones. Raynaud's phenomenon was associated with Ro52 and 60, histones and RNP-C. Xerostomia was associated with Ro52 and 60 as well as Cenp-B. Renal manifestations were associated with RNP-A, Ro52, Ro60 and dsDNA. By using a sensitive and specific multiparameter assay like LIA for identifying antinuclear reactivities, we could confirm some of the previously reported associations of antibodies with clinical symptoms of SLE. We also found several new associations meriting further study

Assessment of thyroid status in children with type 1 diabetes mellitus in Ismailia

Diabetes mellitus is defined as a syndrome of disturbed energy homeostasis caused by deficiency of insulin or its action and resulting in abnormal metabolism of carbohydrate, protein and fat. It is the most common endocrine disorder in childhood and adolescence with important consequence on emotional development. Type I diabetes is frequently associated with autoimmune diseases, such as hyperthyroidism, Hashimoto thyroiditis, pernicious anemia, Addison disease, vitiligo, hypoparathyroidism, and myasthenia gravis, thyroid autoimmunity is a remarkably frequent concomitant of type 1 diabetes in childhood. Genetic susceptibility to autoantibody formation in association with autoimmune thyroid diseases [AITD] and type 1 diabetes mellitus has been described with varying frequencies. So the present study is designed to assess thyroid autoimmunity and dysfunction in children with type 1 diabetes mellitus and recognition of possible risk factors. This study is a descriptive study carried out on 64 children with type 1 diabetes mellitus aged 2-18 yr. complete history, physical examination and laboratory testing were done for diabetic children as follows: age and sex, history of diabetes mellitus: duration, complications, and therapy, history suggestive of autoimmune disease: vitiligo, Addison's disease, pernicious anemia, celiac disease and others, family history :paternal consanguinity, history of diabetes mellitus and other endocrinopathy, history of autoimmune diseases, history of thyroid dysfunction and symptoms of hypothyroidism or symptoms of hyperthyroidism. Assessment of thyroid autoantibodies by indirect fluorescent antibody technique [IFA], free T4 and TSH assay were done. Thyroid autoimmunity was detected in 10.9% of diabetic patients [7 patients]. In seven diabetic children, thyroid antibodies levels were elevated on one occasion, whereas 57 patients were antibodies-negative during observation period. In conclusion, these data support and extend the previous findings documenting the high prevalence of thyroid autoimmunity in children and adolescent screened for autoimmune with type 1 diabetes. Also these data support the recommendation for regular testing of thyroid auto antibodies and thyroid hormones

Increased circulating Fe[epsilon] RII-bearing b-lymphocytes and serum levels of IL-4 in non - autoreactive chronic idiopathic urticaria

The exact pathophysiology of chronic idiopathic urticaria [CIU] is not well understood. The concept of autoreactivity has evolved to explain the disease in up to 50% of cases, while the search for other mechanisms is still needed to explain the disease, at least among the remaining subpopulation of non-autoreactive CIU. Therefore, we thought to investigate some aspects of the IgE-dependent, lymphocyte-mediated late-phase response [LPR] of anaphylaxis. We searched for percentages of Fc[epsilon]RII-bearing [CD23[+]] B and T lymphocytes and correlated this with total IgE serum levels, IL-4 serum levels and the disease severity scores. Twenty-five patients with non-autoreactive CIU and ten healthy control subjects participated in this study. CD23[+] B- and T-cells were assessed by flow cytometry, total IgE serum levels were estimated by enzyme linked fluorescent assay [ELFA], IL-4 serum levels were estimated by Enzyme Amplified Sensitivity Immunoassay [EASIA], while disease severity was determined by a daily self-assessment urticaria activity and itching score. Our results showed that the mean values for percentages of CD23[+] B-cells [6.7 +/- 2.3%], total IgE serum levels [139.6 +/- 103.9 micro g/dl] and IL-4 serum levels [18.3 +/- 14.7ng/ml] for patients were statistically significant [p=0.002, 0.013 and 0.008, respectively], when compared with the corresponding values for controls [4.0 +/- 1.7%, 51.5 +/- 25.1 micro g/dl, and 5.1 +/- 4.1ng/ml, respectively], while the difference between the mean percentage of CD23[+] T-cells for patients [2.8 +/- 2%] and that for controls [2.1 +/- 0.6%] was nonsignificant [p=0.267]. Strong positive correlations were detected between percentages of CD23[+] B-cells and severity scores [r= 0.678, p= 0.0001], total IgE serum levels [r= 0.756, p= 0.0001] and IL-4 serum levels [r= 0.709, p= 0.0001], while no correlation was detected between CD23[+] B-cells and CD23[+]T-cells [r= 0.188, p= 0.368]. It is concluded, that CD23[+] B-cells, regulated by IL-4, may contribute in the pathogenesis of non-autoreactive CIU, by producing high levels of IgE and possibly lymphokines, while CD23[+] T-cells may be involved in early antigen recognition. This may have a future therapeutic ramification in this distinct subset of CIU by targeting low-affinity IgE receptors

Assessment of single shot ethanol injection in treatment of HCC

The purpose of this work was to study the efficiency of percutaneous single shot ethanol injection [PEI] in the treatment of hepatocellular carcinoma [HCC] under general anesthesia. Twenty-three patients having 29 nodules of HCC were included in this study. They were followed up periodically for 18 months. Lesions were not more than 3 in number and the size of each nodule did not exceed 5 cm. The patients were divided into 2 groups according to Child classification A or B, respectively. Single shot US guided PEI of the tumors was done under general anesthesia [Deprivan]. The end point was complete opacification of the tumor. Measurement of serum alpha fetoprotein [AFP], prothrombin time and concentration [PT and PC] and alkaline phosphatase was done before and after PEI. Power duplex imaging [PDI], contrast enhanced CT and FNAB were also done before and after PEI to assess the vascularity and viability of the tumor, hence the therapeutic effect of single shot PEI. Fine needle aspiration biopsy [FNAB] was done few weeks after the procedure to confirm the tumor death. The study concluded that PEI is an effective and cheap non surgical method of treatment of small HCC that could be done in a single session under general anesthesia