Role of apoptosis and fas expression in premature rupture of membranes

To examine the degree of apoptosis [programmed cell death] and to evaluate Fas [a cell surface receptor] receptor expressmon in human fetal membranes associated with premature rupture of membrane [PROM] as compared with normal pregnancies. Fetal membranes from 60 pregnancies were included in the study. Forty of 60 pregnancies had PROM. Twenty pregnancies with intact membranes served as controls. Chorioamniotic membrane biopsies were taken from the rupture site and periphery of the rupture site. In the control group, membrane biopsies were taken from the artificial rupture site, cervical pole of the membranes close1to the edge of the placenta. Samples were fixed in neutral buffered formalin and processed for paraffin embedded tissue. Sections were prepared for morphometric measurement and immunohistochemistry evaluation using Fas receptor expression. Patients with PROM showed reduction of the chorionic thickness [P<0.001] while decidual thickness showed non-significant difference versus control group [p>0.13]. Apoptotic cells were detected predominantly in the chorioaznniotic membrane, including the trophoblastic layer, and decidua. There was a statistically significant difference between the apoptotis [represented by Fas expression] of the PROM and control groups in both the rupture and peripheral sites [P<0.05]. Of the 40 cases that could be evaluated after immunohistochemical staining, Fas expression of the amniotic epithelial cells was observed in 40% of control cases and in 60% of cases with PROM. Fas expression was noticed to be increased in association with PROM group [p=0.0001] as well as with reduction of the chorionic thickness [p=0.001]. Negative Fas expression was noticed to be associated with increased thickness of the. chorionic layer. Fas receptor mediated apoptosis-has a role.in premature rupture of fetal membranes

diagnostic value of Von Willibrand factor and circulating adhesion molecules in arteriopathic vascular patients: Relationship to lipid profile and risk factors

The present study was conducted on a group of seldom arteriopathic hyperlipidemic patients to investigate the availability of adhesion molecules measurement [ICAM-1, E-selectin] as well as vWF as markers of endothelial dysfunction, assisting in diagnosis or as indicators of disease progression. This study included 73 hyperlipidemic patients [43 males and 30 females] suffering from arterial occlusive disease. They were subdivided into group I [25 patients with mild hypercholesterolemia, group II [28 patients with severe hypercholesterolemia and group III [20 patients with hypercholesterolemia]. Control group consisted of 20 apparently healthy normolipidemic subjects, age and gender matching. Both patients and controls were subjected to the laboratory investigations [total cholesterol [TC], LDL-C, HDL-C, triglycerides, soluble intracellular adhesion molecule-1 [sICAM-1], soluble endothelial leukocyte adhesion molecule [sELAMs-sE-selectin] and von Willebrand factor [vWF]]. The level of sICAM-1, E-selectin and vWF were significantly higher in group with mild or severe hypercholesterolemia while the increase was nonsignificant in hypertriglyceridemia as regards ICAM-1 and E-selectin compared with the control group. The correlation between vWF and TC, LDL-C, sICAM or sE-selectin were significant, while sICAM showed significant correlation with only LDL-C. sE-selectin had no correlation with the lipid profile parameter. These results support the suggestion that vWF could serve as a marker of diagnosis, prognosis and follow-up of disease severity, while E-selectin is an indicator of early endothelial cell disturbance. sICAM could be also taken as an evidence of the atherosclerotic process. Hypertriglyceridemia seemed to be noninjurious to the endothelial wall

Metformin versus laparoscopic ovarian drilling in the treatment of clomiphene-citrate resistant patients with polycystic ovary syndrome

To evaluate the efficacy of metformin as compared with laparoscopic ovarian drilling in the treatment of clomiphene citrate resistant women with polycystic ovary syndrome. A prospective comparative study. A total of 100 infertile, clomiphene citrate resistant women with polycystic ovary syndrome, aged 20 - 34 years, euthyroid, with normal prolactin level were evaluated prospectively during the period between March 2000 and June 2002. Patients were divided into two groups. Group 1 includes 50 patients who received metformin tablet 500 mg three times daily throughout the cycle. Group 2 includes 50 patients who underwent laparoscopic ovarian drilling. Clinical and menstrual characteristics in addition to the hormonal profile were evaluated before and after the treatment for 6 months. There were no significant differences between the two groups as regards age, body weight, duration of infertility and serum hormone levels [androgens, gonadotrophins, insulin] before admission to the study. A significant improvement was achieved in both groups as regards the regularity of menstrual cycles, reduction in the serum levels of testosterone, androstenedione, LH/FSH ratio, ovulation and pregnancy rates were observed after the treatment. But there were no significant differences between the metformin group as compared with the drilling group as regards the ovulation rate [80% vs. 84%] and pregnancy rate [32% vs. 30%] respectively. Clomiphene citrate resistant patients with polycystic ovary syndrome can be treated effectively either by metformin or by laparoscopic ovarian drilling. A Significant improvement was achieved as regards regulation of menstrual cycles and the rates of ovulation and pregnancy most probably due to the significant decrease in the levels of androgens and leutinizing hormone post-laparoscopic ovarian drilling in addition to the decrease in the fasting insulin level post-metformin therapy

Procalcitonin: an early marker of neonatal sepsis after premature rupture of membranes

In order to assess the predictive value of procalcitonin [PCT] in the early diagnosis and management of neonatal sepsis following premature rupture of membranes [PROM], cord blood procalcitonin [PCT] was evaluated by radioimmunoassay in addition to complete blood count, C- reactive protein [CRP] and blood cultures in 80 newborn infants following PROM of >/24 hours and in 20 healthy comparable controls. Then, a clinical follow up of all cases was done during the neonatal period for the diagnosis of any manifestations and outcomes of infection. A highly significant mean cord blood level of PCT was detected in PROM group compared with the controls. PCT levels were positively correlated with the hematologic score for sepsis and with CRP levels. Moreover, newborns with proven infection [positive blood cultures] showed a significant higher mean PCT level than those with negative cultures and the level was markedly increased in non- survivors compared with the survivors indicating its value as both diagnostic and prognostic test. Higher sensitivity [100%] and specificity [75%] of PCT to sepsis were noted when compared with other indicators of infection; namely, hematologic score and CRP