Maternal, obstetric and neonatal outcome in multiparous pregnant women with hepatitis C virus infection in an Egyptian rural community

Hepatitis C virus infection is worldwide. The obstetric and perinatal outcome of chronic Hepatitis C virus Infection are variable. Vertical transmission is a serious unsettled problem. Evaluation of risk factors of HCV infection in pregnant women. Identifying the maternal, obstetric, perinatal outcome and the vertical transmission rate. A prospective clinical observational study. The studied groups included 418 pregnant women attending the Obstetric Department, Mansoura University Hospital They were tested for HCV antibodies. Seroposltive cases underwent HCV-RNA. HCV+ve were compared to the HCV-ve group. Risk-factors for HCV Infection were inquired. The maternal and perinatal morbidity together with Apgar scoring were evaluated. The rate of vertical transmission was estimated by measuring HCV antibodies and HCV-RNA in the offsprings of the HCV+ve mothers at labour and seropositive offsprings had repeated HCV-RNA at 3, 6 and 9 months after delivery. 13.16% of the studied cases were seropositive for HCV-ab and 10.05% were HCV-RNA positive. Previous genital mutilation and deliveries by traditional birth attendants were significantly higher in the HCV+ve group. No significant maternal, obstetric and perinatal complications in the diseased group except high rates of miscarriages. No significant clinical differences between the studied groups. However, significant equations in the serum bilirubin, transaminases and alkaline phosphatase and significant lowering of platelet count were found in the HCV +ve group. Vertical transmission rate was high [16.6%]. HCV infection in pregnant Egyptian rural mothers is high. Female genital mutilation and deliveries by traditional birth attendants should be abandoned. HCV antibodies testing in preconception counseling is advisable

Functional status of the thyroid gland in complicated versus uncomplicated pregnancies

Many Adverse pregnancy outcome have been reported in pregnant women with thyroid dysfunction. The prevalence of thyroid dysfunction and its relation to pregnancy outcome had not been studied in our locality. To assess the magnitude of thyroid disorders during pregnancy and their relation to pregnancy outcome. A prospective clinical observational study. Subjects and One-hundred-fifty four, pregnant women attending the Ante-natal Care Unit, Mansoura University Hospital. Clinical examination was undertaken. Laboratory evaluation utilizing the highly sensitive chemiluminscent serum TSH assay was performed, together with estimation of serum total T3 and total T4. Cases with abnormal TSH levels were subjected to free T4 estimation to confirm the state of thyroid dysfunction. Urine examination, blood count, liver function tests, kidney function tests and plasma glucose were carried out. Thyroid and abdominal ultrasound were performed. The studied cases were classified into two groups; group 1; 12 women having different antenatal complications and group II; 42 women having no pregnancy complications. The studied cases were also grouped into rural and urban groups, according to their residence in villages or Mansoura town respectively No hyperthyroid cases were detected in either groups. The clinical manifestations of hypothyroidism were not fulfilled, but utilizing serum TSH and FT4 testing, forty five cases out of the 154 studied cases revealed subclincial hypothyroidism [29.2%] being significantly higher among the complicated pregnancy group [33.9%] than the non complicated group [16.7%] and significantly more frequent among the rural cases than the urban group [p<0.001]. Subclincial hypothyroidism has a tendency to increase with increasing gestational age. The most prevalent complications were severe preeclamptic toxemia in 73.7% and second trimester abortion in 15.8% of cases. Subclinical hypothyroidism is common, especially in rural localities. TSH screening of pregnant women in each trimester is suggested

Accumulation of cadmium and iron in the hydrocele fluid of infertile men with primary varicocele: a possible role in male infertility

Varicoceles are a common cause of male infertility, but despite data from human studies some points of the pathophsiology remains unclear. Seminal plasma cadmium concentrations were found to be increased in infertile men. In addition, increases in blood plasma cadmium concentrations in infertile men have been associated with teratozoospermia. Cadmium contributes to infertility by induction of apoptosis in testicular tissue

Methods: An ejaculate and blood sample were collected immediately before surgery from 45 infertile men with varicocele classified into 3 groups [group 1 included 12 oligospermic, group 2 included 14 asthenospermic and group 3 included 19 oligoasthenospermic men] followed by aspiration of hydrocele fluid from the tunica vaginalis at the time of subinguinal varicocelectomy. Blood samples were collected from 10 healthy fertile men as control group. In each specimen, cadmium and iron levels were determined by atomic absorption spectrophotometer and the effect of hydrocele fluid on the sperm velocity was determined by examining aliquots of sperms suspended in hydrocele fluid compared to those suspended in seminal plasma

Results: The cadmium level was found to be significantly higher in the hydrocele fluid than peripheral blood, while the increase in the iron level was found to be non significant in the 3 patients groups with bilateral varicocele. Hydrocele fluid added to the sperms, initially increased the motility for 10 to 15 minutes then the velocity diminished gradually and eventually all the sperms became immotile in 30 minutes

Conclusions: 1- The hydrocele fluid in patients with varicocele has a deleterious effect on the sperm vitality. 2- The increased cadmium and iron concentrations in the hydrocele fluid are probably drived from the increased transvascular fluid exchange which occurs with varicocele. 3- These metal ions may diffuse from the hydrocele fluid to the sperms during their maturation in the epididymis and induce their acrosomal insufficiency effect

Accumulation of cadmium and iron in the hydrocele fluid of infertile men with primary varicocele; a possible role in male infertility

Varicoceles are a common cause of male infertility, but despite data from human studies the pathophysiology remains unclear. Seminal plasma cadmium concentrations were found to be increased in infertile men. In addition, increases in blood plasma cadmium concentrations in infertile men have been associated with terat-ozoospermia. Cadmium contributes to infertility by induction of apoptosis in testicular tissue. An ejaculate and blood sample were collected immediately before surgery followed by aspiration of hydrocele fluid from the tunica vaginalis at the time of subinguinal varicocelectomy. In each specimen, cadmium and iron levels were determined by atomic absorption and the effect of hydrocele fluid on the sperm velocity was determined by examining aliquots of sperms suspended in hydrocele fluid compared to those suspended in seminal plasma. The cadmium and iron levels were higher in the hydrocele fluid than the peripheral blood in 72% and 46% of patients with bilateral varicocele respectively. Hydrocele fluid added to the sperms, initially increased the motility for 10 to 15 minutes then the velocity diminished gradually and eventually all the sperms became immotile in 30 minutes. 1-The hydrocele fluid in patients with varicocele has a deleterious effect on the sperm vitality. 2- The increased cadmium and iron concentrations in the hydrocele fluid are probably derived from the increased transvascular fluid exchange which occurs with vaticocele. 3- These metal ions may diffuse from the hydrocele fluid to the sperms during their maturation in the epididymis and induce their acrosmal insufficiency effect. 4- Impregnation rate was higher after surgical correction of varicocele and removal of hydrocele fluid in those patients who presented with high preoperative levels of cadmium and iron

Pelvic and peripheral venous insufficiency: different presentation and common pathophysiology

Aim: varicose veins are related to other diseases including varicocele or utero-ovarian varices. On the base of close physio pathologic relationships between varicose veins and gonadal varicosity, we decided to evaluate the features of pelvic venous insufficiency in patients affected by varicose veins

Patients and Methods: seventy patients with different grades of chronic venous insufficiency [CVI] were included in the study. The patients were evaluated pre-operatively by color Doppler for grading of gonadal varicosity and assessment of valvular incompetence in the peripheral veins. Post-operatively, the number of valves in the stripped veins was correlated to the degree of gonadal varicosity

Results: thirty patients were proved to have both peripheral and pelvic venous insufficiency. Higher grades of gonadal varices were associated with lesser number of saphenous values. There was a significant relation between the Doppler grading of venous reflux in gonadal E. peripheral veins

Conclusions: the incidence of varicocele associated with CVI was higher than the incidence of isolated varicocele. The bilateral development of gonadal and peripheral varicosity in female patients refers to mechanical compression followed by axial reflux. The association of lesser number of valves in the saphenous veins with higher grades of varicocele raises the possibility of generalized valvular scarcity as a cause of venous insufficiency

Study of some biochemical assays in serum and ascitic fluid for differentiation between cirrhotic and malignant ascites

The clinical diagnosis of ascites is an easy task but the etiological diagnosis of the type of ascites is occasionally a different problem. Many studies have investigated the possibility of using a single marker to detect cancer in ascitic patients; but no analysis of ascitic fluid including cytology has been shown to be specific and sufficiently sensitive for either hepatic or extrahepatic cancer. To evaluate the role of various biochemical parameters including cholesterol, LDH, total protein, albumin and glucose for the differentiation of cirrhotic ascites from malignancy related ascites, fifty ascitic patients were classified into three main groups: Group I: included 20 patients with cirrhotic ascites. Group II: included 15 ascitic patients with hepatocellular carcinoma on top of liver cirrhosis. Group III: included 15 ascitic patients with extrahepatic malignancy without liver cirrhosis. All patients were subjected to: clinical history and examination, various imaging, routine laboratory investigations, histopathological examination, cytological examination of ascitic fluid, and biochemical analysis of both serum and ascitic fluid. We found that, although cytological examination of ascitic fluid is specific, it is less sensitive than ascitic fluid biochemical analysis in determining the cause of ascites. The accuracy of ascitic fluid cholesterol LDH, SAAG, A/S LDH ratio, A/S cholesterol ratio, A/S protein ratio, AFTp and ascitic/blood glucose ratio in discrimination of exudative malignant ascites from transudative cirrhotic ascites are [91%, 91%, 91%, 86%, 83%, 83%, 80% and 71%] respectively. Ascitic fluid biochemical analysis may be useful than cytological examination in follow-up of cirrhotic ascitic patients aiming to early detection of complication

Hemostatic disturbances in hepatitis B virus infection patients

This study was conducted on 20 patients [14 males and 6 females] with chronic hepatitis B virus infection and their ages ranged between 30-50 years and 10 control males. The aim of this study was to assess the hemostatic abnormalities in chronic hepatitis virus infection. All patients were subjected to full history, clinical examination, abdominal ultrasound and laboratory investigations [CBC, LFTS, HBsAg, PT, APTT and coagulation factors I, II, V, VII, VIII, IX, XI and XII]. The results of this study revealed that higher level of factors VII, VIII and factor XI and decreased level of factors IX and XII reflecting the lesser degree of prolongation in PT and APTT. It was concluded that abnormal hemostasis is a common complication of lever diseases and determination of its underlying pathogenesis is essential foe rational management. Vitamin K coagulation factor IX was diminished