Foley's catheter plus prostaglandin E[2] compared to prostaglandin E[2] alone for induction of labor

To compare the effectiveness of Foley catheter plus prostaglandin E[2] tablets with prostaglandin E[2] tablets alone in cervical ripening and induction of labor. Patients admitted for induction of labor were randomized into 2 groups. Group A received PGE[2] tablets and intracervical Foley catheter. Group B received PGE[2] tablets only. PG tablets were given to a maximum of 2 doses 6 hours apart. All patients had Bishop Score of <5 and no contraindication to vaginal delivery. After 12 hours, Bishop Score was assessed. Patients with favorable cervix [Bishop >/= 7] had artificial rupture of membranes. Syntocinon was started if there are no adequate uterine contractions. 300 patients participated in the study; 150 in each group. Bishop Score after 12hrs was significantly higher in group A compared to group B [7.48 +/- 1.72 Vs 6.09 +/- 1.85, p<0.01] as well as the mean change after 12 hours [3.20 +/- 1.59 Vs 2.37 +/- 1.42, p<0.01]. 14.4% of patients in group A had a Bishop Score of <7 after 12 hours compared to 25% in group B [p<0.05]. The induction to delivery time was significantly less in group A compared to group B [16.81 +/- 3.29 Vs 18.04 +/- 3.53,p<0.01]. Syntocinon was used in 68% of patients of group A compared to 81% of patients of group B [p<0.05]. 74% of group A patients delivered vaginally compared to 70.6% in group B, the difference was insignificant. There was no statistically significant difference regarding the number of C.S. and the number of instrumental deliveries as well. There was no significant difference regarding the incidence of fetal distress, puerperal pyrexia, or uterine hyperstimulation between the 2 groups. The combination of prostaglandin and Foley catheter resulted in better Bishop Score, shorter induction to delivery time, and fewer failed inductions. However, there was no significant effect on vaginal delivery or C.S. rates

Clinical associations of autoantibodies against monomeric C-reactive protein in systemic lupus erythematosus

The aim of this study was to analyze circulating levels of anti-monomeric CRP autoantibodies [anti-mCRP] in serum samples from SLE patients in relation to biochemical and clinical disease activity markers and to identify significant associations between the presence of these antibodies and the relevant clinical manifestations of SLE. Serum levels of IgG anti-mCRP antibodies were detected by enzyme linked immunosorbent assay [ELISA] for sixty patients diagnosed as SLE and met the revised ACR criteria and 30 matched healthy subjects as a control group. Disease activity was evaluated according to the Systemic Lupus Erythematosus Disease Activity Index [SLEDAI] score. Association of anti-mCRP reactivity with clinical features, with other auto-antibodies and with serum concentrations of C3, C4, C1q and CRP were assessed. In this study IgG antibodies to mCRP were found in sera from 65% SLE patients compared to 3.3% healthy controls. In SLE patients positive for IgG anti-mCRP antibodies, there were significantly greater frequency of renal affection [76.9% vs 28.5%, P<0.001], thrombosis /fetal loss [43.5% vs 9.5%, P<0.05], aCL IgG, aCL IgM and LAC positivity [41% vs 14.2%, 25.6% vs 14.2%, 35.8% vs 14.2%, P<0.05] and anti-dsDNA antibodies positivity [69.2% vs 42.8%, P<0.05]. Also, there were lower mean counts o/WBCs, lymphocytes, platelets, lower levels of CRP, C3, C4, C1q and higher mean of SLEDAI score in SLE patients positive to IgG anti-mCRP antibodies. Eight [20.5%] patients with IgG anti-mCRP and 4 [19%] patients without were positive for aPL antibodies without clinical manifestations of antiphospholipid syndrome [APS] [asymptomatic aPL carriers] with insignificant difference between both groups. Also, there were negative correlation between WBCs, lymphocytes, platelets counts, levels of C3, C4 and C1q with serum levels of anti-mCRP antibodies and significant positive correlation between the levels of serum aCL IgG, aCL IgM, anti-dsDNA antibodies and SLEDAI score of disease activity with serum levels of anti-mCRP antibodies. In this study we have demonstrated the high prevalence of anti-mCRP autoantibodies in SLE. Also, observed strong significant association of anti-mCRP reactivity with renal affection and thrombosis and found that the antibody levels were correlated with clinical and laboratory disease activity measures

Circulating levels of endothelin-1 in patients with systemic sclerosis: relationship to specific organs involvement

The aim of this study was to determine the serum levels of endothelin-1 [EN-1] as a marker of endothelial cell activation in patients with systemic sclerosis [SSc] and to investigate its relationship to specific organs involvement. Thirty two female patients diagnosed as SSc were included in this study; all of them met the criteria proposed by the ACR. Serum EN-1 was detected by enzyme linked immunosorbent assay [ELISA] for the patients and 20 matched healthy subjects as a control group. Thorough clinical assessment was performed; high resolution computed tomography [HRCT] scan and scoring was done for patients with pulmonary fibrosis; doppler echocardiography was done to assess pulmonary artery pressure. In this study; there was highly significant increase in the mean titre of EN-1 in SSc patients than in control group [<0.001] and significant increase in diffuse than limited SSc [P<0.05]. Significantly higher levels of Serum EN-1 were found in SSc patients complaining from pulmonary fibrosis, pulmonary and systemic arterial hypertension [P<0.001], higher in patients complaining from sclerodactyly, digital ulcers, cardiac and renal affection and in patients positive either for Anti-TOPO-I antibodies or ACA [P<0.05]. Also, there were significant positive correlation between mean pulmonary artery pressure, mean systemic arterial pressure, levels of serum creatinine, serum urea, 24 hours proteinuria, titre of ANA, anti- TOPO-I antibodies, ACA and HRCT scores with serum levels of EN-1 in SSc patients. Also, there was a significant negative correlation with creatinine clearance. Enothelin-1 through endothelial cell activation has a pathogenic role in SSc that help in evaluation of the clinical severity of scleroderma lung disease, systemic hypertension, cardiac and renal affection. EN-1 may also represent a promising serological parameter for therapeutic consideration; use of endothelin receptor antagonist may be a strategy for reaching clinical improvement

TRUS-aided seminal vesiculography

Male infertility represents a percentage of the many other causes of infertility among couples. Obstructed male reproductive pathway till the prostatic urethra, represents one of the male causes which can be treated in confidence. Introduction of Trans-Rectal Ultrasonography [TRUS] with localization and cannulation of the seminal vesicles added much to the diagnosis of that problem, especially in obstructed cases. Fourteen patients were the material of our study. TRUS with needle insertion followed by fluoroscopic injection of the contrast to the seminal vesicles was performed. The patients attended with a mean age of 30 years, having different complains from painful ejaculation [8], perineal pain [8], infertility [7], and heamospermia [6]. After vesiculography, there were 12 patients having complete opacification of the distal ejaculatory ducts and partial opacification in 2 patients. Delayed complications in the form of epididymitis were seen in one patient

Microalbuminuria, endocrinal metabolic disorders as predictors of hypertension

The present work aimed to study microalbuminuria, endocrinal and metabolic disorders that may predict hypertension. One hundred and thirty subjects were classified into three groups; group I patients with essential hypertension [50 patients], group II normotensive offsprings with family history of hypertension [50 subjects] and group III healthy normotensive subjects [30 subjects]. The study confirmed that many of the components of hypertension syndrome as metabolic abnormalities [increased total cholesterol, LDL-cholesterol, triglycerides and hyperhomocysteinemia], renal abnormalities [microalbuminuria] and endocrinal abnormalities [increased plasma insulin, norepinephrine, renin and endothelin levels] precede the onset of high blood pressure. So, early identification and treatment of them will have a more significant impact on the course of the disease

Sirolimus based therapy in live donor renal transplantation: a prospective randomized study

The present work aimed to study safety and efficacy of sirolimus in combination with either low dose tacrolimus or mycophenolate mofetil in live donor kidney transplant recipients. A total of 80 patients of either sex aging >/18 years with end-stage renal disease who had undergone live donor renal allotransplantation were recruited into the study. They were randomly divided into two groups. Group A patients received sirolimus in dose of 10 mg/day for 3 days after surgery then maintained on 5 mg/day. In addition, they received tacrolimus and steroids. Group B patients received sirolimus in dose of 10 mg/day, mycophenolate mofetil and steroids. All patients were followed up for 12 months clinically and by laboratory, radiologic and histopathologic evaluation. The study showed that excellent one year kidney transplant outcomes can be achieved by sirolimus administration especially with avoidance of calcineurin inhibitors. Longer follow-up is required to study the impact on graft integrity and eventual graft survival and chronic rejection rates

Relationship between microalbuminuria and subclinical cardiac structural changes in isolated systolic hypertension in elderly patients

Isolated systolic hypertension is common in elderly people and accounts for more than 50% of all cases with hypertension above the age of 65 years. Microalbuminuria represents an early marker of cardiac structural damage

The aim of this work: is to study the relationship between micro albuminuria and subclinical cardiac structural changes [septal wall thickness [SWT], left ventricular mass [LVM] and left ventricular mass index [LVMI]] in isolated systolic hypertension in elderly patients

Result: showed significant positive correlation between microalbuminuria and cardiac structural changes [LVMI - P = 0.001, SWT - P = 0.002 and LVM - P = 0.00011]. There was a significant positive correlation between the duration of hypertension and microalbuminuria, LVM [P=0.02] and LVH [P=0.001]. Also, there was a significant positive correlation between age of patients and LVM [P = 0.01] and LVH [P = 0.01]

Conclusion: taken together this study showed that microalbuminuria represents an early marker of crdiac structural changes in isolated systolic hypertension in elderly patients. It is considered one of the new associated risk factors of hypertension. Cardiovascular prognosis depends not only on the blood pressure level but also on hte presence of target organ damage. So we recommend early detection of microalbuminuria in every hypertensive patient as it is an early sign of endothelial dysfunction and damaged blood vessels