Risk prediction genetic study of non-HLA gene NOD2 three polymorphisms in acute graft versus host disease after allogeneic hematopoietic stem cell transplantation

Background: Graft-versus-host disease [GVHD] has been associated with non- human leukocyte antigen [HLA] gene polymorphisms after allogenic Hematopoietic stem cell transplantation [aHSCT]

Objective: This study aims to investigate the role of three polymorphisms in Nucleotide-binding Oligomerisation Domain [NOD2] gene on the occurrence / severity of acute GVHD among Egyptian population

Methodology: A total of 64 patients and their corresponding donors who underwent aHSCT from HLA-identical matched siblings were genotyped by polymerase chain reaction and restriction fragment length polymorphism [PCR-RFLP]. Results were confirmed by automated laser sequencer

Results: There was highly statistical significant association between NOD2 recipient l007fs allele and higher incidence of aGVHD p= 0.006. There was no significant association between NOD2 donor l007fs allele, G908R allele in donors and recipients, R702W in donors and recipients with incidence and severity of aGVHD

Conclusion: This research an original pilot study to demonstrate that the NOD2 SNP13 [Leu1007fs] is a possible risk factor for aGVHD among Egyptian population

Does anaesthesia in mothers during delivery affect bilirubin levels in their neonates? / 소아과

PURPOSE: This study aimed to assess whether different anesthetic techniques and oxytocin use applied during delivery affect transcutaneous bilirubin levels during the first 24 hours in neonates. METHODS: A total of 1,044 neonates delivered by either caesarian section (C/S) or normal vaginal delivery (NVD) were included in the study. They were classified into 5 groups as follows: group 1: born by C/S using general anesthesia, group 2: C/S using spinal anaesthesia, group 3: C/S using general anesthesia after failed spinal block, group 4: by NVD without anesthesia, and group 5: oxytocin-induced vaginal delivery without anesthesia. Transcutaneous total bilirubin levels (TBLs) were measured during the first 24 hours and on the fifth and eighth days of life and the levels in different groups were compared. RESULTS: The TBLs were significantly higher in neonates delivered by C/S using general anesthesia rather than spinal anesthesia (P < 0.001), and both groups had higher levels than those born by NVD without anesthesia (P≤0.001). However, the group receiving general anesthesia after failed spinal block was found to have the highest bilirubin level. Moreover, TBLs were significantly higher with the use of oxytocin (P≤0.001). CONCLUSIONS: C/S and general anesthesia adversely affect the bilirubin levels in neonates, and the use of oxytocin during vaginal delivery also increases TBLs in neonates.

The effect of intracameral epinephrine on pupil size during phacoemulsification and its postoperative effect on specular findings and macular thickness

ABSTRACT Objective: To evaluate pupillary size and vital signs following intraoperative intracameral adrenaline during phacoemulsification and postoperative effect of on co specular microscopy findings and macular thickness by OCT. Methods: A prospective interventional study carried out from December 2014 to December 2015 on 90 eyes. They were divided randomly into further 6 groups (15 each). The inclusion criteria consisted of no history of ocular pathologic conditions, trauma, previous ocular surgery, or recent ocular medication use. All patients were dilated preoperatively by phenylephrine 10% and operated under local peribulbar anesthesia. Then systemic monitoring regarding (pulse rate, blood pressure) and measurement of the horizontal pupil diameter by a caliper to the nearest 0.25mm pre and post intracameral adrenaline injection. Results: In our study there were great effect for intracameral epinephrine, with concentrations used, in dilatation and maintainance of papillary dilatation, The mean pre intracameral epinephrine was 4.53± 1.27 mm.The mean post epinephrine papillary diameter was 6.46± 1.00 mm. Three cases from group 1/10000 weren't dilated properly. Also three cases from group 1/9000 weren't dilated properly after intracameral epinephrine. Conclusion: Intracameral epinephrine even in higher concentrations is effective in papillary dilatation especially in cases with long duration and poorly dilated cases by usual topical mydriatics.

Mucoadhesive polymers as efficient drug delivery systems

The drug action can be reinforced as a result of the development of new drug delivery systems. Over the past few decades, mucosa/ drug delivery has received a great deal of attention to improve both the local and systemic drug effects. Drug delivery across the mucosa bypasses the first-pass hepatic metabolism and avoids the degradation caused by the gastrointestinal enzymes. Mucoadhesive dosage forms are designed to enable prolonged retention at the desirable site of action, provide sustained release of drug and thus, lead to an improved bioavailability, as well as therapeutic outcomes. Compared with other mucosa/ rissues, vaginal mucosa/ cavity is more appropriate and attractive for drug delivery. In addition, a prolonged contact of mucoadhesive dosage forms with the vaginal mucosa may be achieved more easily than at other absorption sites like rectum or intestinal mucosa. This review aims to highlight the recent advances in the study of mucoadhesion and mucoadhesive polymers. It provides an overview of the structure of mucosa/ membranes, the mechanism and theories involved in mucoadhesion, and finally it describes briefly the main characteristics and the advantages of vaginal mucoadhesive drug delivery systems compared with other delivery systems

Protective and therapeutic effects of cannabis plant extract on liver cancer induced by dimethylnitrosamine in mice

Hepatocellular carcinomas will emerge as a major form of malignancy in the coming decades. When these tumors are in advanced stages, few therapeutic options are available. Therefore, it is essential to search for new treatment modalities to fight this disease. Evaluate the possible protective and therapeutic effects of Cannabis extract on dimethylnitrosamine [DMNA]-induced hepatocarcinogenicity in mice. Seventy-five male mice were divided into five groups of 15 each: group I mice received corn oil only as the control group; group II mice were injected intraperitoneally with DMNA [10 microg/kg body weight] weekly for 12 weeks; group III mice were pretreated orally with cannabis extract [0.5 ml/kg body weight] every other day for two weeks before the injection of DMNA, and continued until the end of the experiment [12 weeks]; group IV mice were treated orally with cannabis extract every other day simultaneously with DMNA injection and continued until the end of the experiment; group V mice were treated orally with cannabis extract every other day after receiving the last intraperitoneal injection of DMNA. A real time PCR was used to quantify telomerase reverse transcriptase and caspase-8 m-RNA expression level

Protective effect of fish liver oil and propolis on anticonvulsant drugs-induced osteoporosis

Osteoporosis is a major health problem and its prevalence increases the risk of bone fracture. It is classified into primary [postmenopausal or age related] and secondary [related to chronic diseases, drug therapy, or life style]. There is accumulating evidence that patients on antiepileptic drugs [AEDs] are at an increasing risk of developing osteoporosis. The present study aimed at investigating the protective effect of dietary natural products, fish liver oil, and propolis on osteoporosis caused by anticonvulsant drugs. A total of 105 albino rats were used, divided into seven groups of 15 rats each. Group 1 was used as a control group. In group 2, rats were injected intraperitoneally with pilocarpine [300 mg/kg body weight]. The pilocarpine-induced epileptic rats in the other five groups were orally treated with valproate [400 mg/kg body weight], a combination of valproate and fish liver oil [0.4 ml/kg body weight/day], a combination of valproate and propolis [50 mg/kg body weight/ day], fish liver oil, and propolis, respectively. At the end of the experiment [6 months treatment], animals were sacrificed, femur shafts were extracted, decalcified, and processed into paraffin blocks for histopathological and image analysis and morphometric studies. Rats treated with the antiepileptic valproate alone showed a decrease in the thickness of shaft cortical bone, with a marked decrease in the number of osteocytes, increase in Haversian canals, and decrease in bone trabeculae, disruption of normal architecture, and widening of bone marrow spaces compared with the control group. Treatment with the dietary natural products, fish liver oil, and propolis along with the AED valproate might improve histopathological changes and morphometric parameters in bone associated with AED-induced osteoporosis

Multi-drug resistant acinetobacter species as a cause of hospital acquired infections

Acinetobacter baumannii is an important opportunistic pathogen that is rapidly evolving toward multidrug resistance and is involved in various nosocomial infections that are often severe. Carbapenems are considered one of the very few antibiotics left to treat infections caused by this organism. The aim of this work is to study the antibiotic resistance pattern of Acinetobacter species isolated from different sites of nosocomial infections

Patients and Methods: antibiotic resistance pattern for 30 clinical isolates Of Acinetobacter was determined by the Kirby Bauer disk diffusion method Extended spectrum beta lactamase [ESBLs] production was detected by double disc synergy test. Isolates detected to be imipenem resistant were tested for metallo -lactamase [MBL] production by E test

Results: Extended spectrum beta lactamase production is high [19/30] 63.3% among Acinetobacter species. Ten [33.3%] isolates are found to be resistant to imipenem and meropenem by the disk diffusion method and 3/30 [10%] of them are found to be MBLs producers

Conclusion: acinetobacter spp. are resistant to many classes of antibiotics. Production of ESBLs, and MBLs are responsible for the multidrug resistance of these pathogens

Detection of streptococcus pneumonia in middle ear -effusion from patients with otitis media

In spite of the availability of effective antimicrobial therapy, Otitis media with effusion [OME] is still an important infection leading to serious health problems in both children and adults. [Streptococcus pneumonia] S. pneumoniae is one of the most frequently isolated bacteria from middle ear effusion [MEE] samples of OME patients. Since it is fastidious bacteria, various problems may arise in the rapid diagnosis of OME settings. Knowing which bacterium is involved is essential for the prognosis and treatment of otitis media with effusion, as the high frequency of its presentation may be linked to the etiology and/or course of the process in many patients

Objective: the aim of this study was to evaluate the use of nested polymerase chain reaction [PCR] assay for S.pneumonia as a diagnostic tool in patient with OME, and to detect the relation of the organism to other factors contributed to pathogenesis of OME

Subjects and Methods: middle ear fluid samples were aspirated from 34 patients presented with OME. Each sample was subjected to cultivation on selective media, and nested PCR test using specific primers directed to selected pneumolysin gene fragment of S.pneumonia

Results: S.pneumonia was recovered by culture in 4/34 [11.87%] of middle ear fluid samples; 3/4 [75%] from children and ¼ [25%] from Adults. Nested PCR detected S.pneumonia in 11/134 [32.4%] of the samples; 8/11 [72. 7%] were children and 3/11 [27.3%] were adults. All culture positive samples were PCR positive, but 7 [63.6%] of the PCR positive samples were culture negative. There were strong effects of the age, pervious history of acute otitis media, sinusitis and allergic rhinitis. The recovery rate of the organism was [72.7%, 54.5 %, 36.4% and 27.3%] respectively

Conclusion S.pneumonia was detected in high rates in MEE samples. This suggests that it may play a role in the pathogenesis of otitis media with effusion. In addition, PCR was more sensitive compared to culture for detection of S. pneumoniae in MEE samples

Medicolegal significance of diffuse axonal injury [DAI]: a forensic, histopathological and immunohistochemical interpretation

In some head trauma cases, there is no obvious cause of death and no brain lesions detected despite the positive history and the short survival time. This study was conducted to evaluate immune-histochemistry for Beta-Amyliod Precursor Protein [beta-APP] in detection of DAI. It was carried on 50 autopsy cases, 39 males and 11 females, aging between the 2[nd] to the 5[th] decades of life. Survival period was around 3 hours up to 4 weeks. The cause of head injury was determined. Complete autopsy were done. Selected brain sections were prepared for examination with routine hematoxylin and eosin [H and E], special stains Phosphotungstic Acid Hematoxylin [PTAH] stain and beta-APP, Neuro Specific Enulase [NSE], S 100, Synapto- Physin, Glial Fibrillary Acid Protein [GFAP] immunohistochemistry. The brain was assessed grossly at two settings; before its removal from the skull and after 2 weeks of fixation in 10% buffered formalin. The results revealed that, there is no significant difference between age and sex, the causes of head injury were more common due to violent assaults, and motor vehicle accidents. OAI is not always associated with skull fractures. There is a highly significant difference for the presence of intracranial hemorrhage. Both H and E stain and PTAH stain can diagnose brain edema, OAI, as regards axonal swelling and damage after 6 hours post traumatic survival period. In early survival stage, [beta-APP] is highly significant for detection of axonal swelling as early as 3 hours survival period. GFAP stain has highly significant value in detecting the glial cells and gilosois in the late survival stage. The beta-APP is a more sensitive and accurate method for early detection of OAI. It should be considered as an important technique that could provide valuable medico-legal evidences

Neoangiogenesis and ossification in senile calcific aortic valve: a histological and immunohistochemical study

Aortic valve calcification is the most frequent pathological process necessitating surgical aortic valve replacement. It was until recently that the progressive calcification was considered as a degenerative disease with passive calcium deposition on the valve leaflets. This work was designed to elucidate some of the events occurring in senile calcific aortic stenosis. Calcific aortic valve leaflets were obtained from patients presenting with isolated severe senile calcific aortic stenosis admitted for aortic valve replacement. Paraffin sections of calcific aortic valves were examined histologically and immunohistichemically for CD 31 to detect neoangiogenesis and osteopontin [osteoblast marker]. Examination of calcific aortic valves revealed cells having features of osteocytes and positive for osteopontin. Multiple blood vessels were also detected compared to total absence in the normal aortic valves. Inflammatory cellular infiltration and cells having features of chondrocytes were recognizable. CD 31 immunopositivity was detected within the endothelium of the new vessels. There are three major events or phases going on within the senile calcific aortic valves. These are inflammatory cellular infiltration, neovessel formation and endochondral ossification rather than passive deposition of calcium. Hence, treatment should be directed according to the phase

Hepatitis G virus infection in patients with hepatitis C

Hepatitis G virus [HGV] infection is a worldwide health problem causing acute and chronic non A- E hepatitis. Because HGV and hepatitis C virus [HCV] share same modes of transmission, co-infection with the two viruses is not uncommon especially among people at high risk of parenteral infection. The aim of this study was to determine the prevalence of HGV among HCV virus cases, and to determine the degree of concurrent association between HGV and other prevalent infections in Egypt as Schistosoma, and hepatitis B virus [HBV] infections. This study included 100 blood donors attending Alexandria University Blood Bank in EL Shatby, proved to be positive for HCV antibodies by enzyme linked immunosorbant assay [ELISA] technique. Blood samples ,vyere collected and tested for the detection of HBV surface antigen [HBsAg] and Schistosoma antibodies by ELISA technique and HGV RNA by nested polymerase chain reaction [PCR] technique.' Out of 100 anti-HCV positive blood donors, 39[39%] had HGV RNA in their serum, of them 10 [25.6%] were positive for HBsAg, on the other hand 34[87.2%] were positive for Schistosoma antibodies. From this study it could, be concluded that HGV is a common co-infection in HCV cases, however there was no significant statistical relation between the presence of HGV RNA and the presence of HBsAg and /or Schistosoma antibodies. Screening for HGV among blood donors in addition to the routinely screened HBV and HCV may have a beneficial effect in reducing its transmission among the population

Transformation and expression of Na+/H+antiporter vacuolar [AtNHX1] gene in tobacco plants under salt stress

Saline soil is a serious problem worldwide, and it is necessary to improve the salt tolerance of plants to avoid the progressive deterioration of saline soil. Agrobacterium based system was employed to transfer a vacuolar Na[+]/H[+] antiporter [AtNHX1] gene into tobacco leaf discs. Hundred thirty putative transgenic tobacco plants were obtained. The leaf painting assay was applied to select the transformants containing the bar gene [basta herbicide resistance]. In addition, the stable integration of the AtNHX1 gene was confirmed by PCR analysis. The expression of encoding sequence AtNHX1 gene was detected by the accumulation of salt in the transgenic tobacco plants under the salt stress conditions. Transgenic tobacco plants expressing the AtNHX1gene were able to grow in the presence of 150 to 300 mM NaCl and accumulated significantly at high concentrations of sodium ions in the leaves. However, the wild type plants could not tolerate a concentration up to 150 mM NaCl. This remarkable high salt tolerance in transgenic tobacco plants can be helpful in the future for applying important phytoremdiation plants in high saline lands

Time parameters in continuous versus pulsed ultrasound phacoemulsification: a comparative study

To compare the effective phaco time, nuclear removal time as well as total surgery time when using continuous versus pulsed ultrasound in cataract removal by phacoemulsification. A non randomized comparative study that included 106 eye of 106 patients who suffered from vision impairing cataract and were scheduled for cataract removal by coaxial phacoemulsification. Patients were subdivided into two groups; Group A [55 eyes] in which continuous mode was used and group B [51 eyes] in which the pulsed mode was used. Both were further subdivided into 5 subgroups according to LOGS III nuclear grading system. All patients had standard phacoemulsification with IOL implantation. There was no statistically significant difference between both groups as regards the nuclear removal time and the total surgery time. Effective phacoemulsification time [EPT] showed statistically significant difference between both groups in cases of cataract with nucleus grade 5 [p value -0.000]. It is advisable to use the pulse mode in cases of hard nuclei. These methods of power modulation aim at reduction of energy production with corneal protection and better visual outcome

Serological detection of Toxoplasma gondii in chronic renal failure patients and renal transplant recipients

Toxoplasma gondii antibodies were detected in 78 patients with renal disease by ELISA. Patients were classified according to the renal status; chronic renal failure patients not on haemodialysis [G1=19], chronic renal failure patients on regular haemodialysis [G2=30], renal transplant recipient [G3=29] and 13 normal controls. Anti-Toxoplasma IgG and IgM antibodies were 36.8% and 10.5% in renal failure patients not on haemodialysis, 56.7% and 16.7% in patients on regular haemodialysis and 69% and 24.1% in renal transplant recipients versus 23.1% and 0% in controls with statistical significant difference for Toxoplasma IgG antibodies only. Anti-Toxoplasma IgG antibodies levels of G3 were lower than that of Gl. It was observed that the more the exposure to dialysis, the more the risk of toxoplasmosis. It was found that 85.71% of renal transplant recipient seropositive cases for anti-Toxoplasma IgM antibodies were detected in one year post-transplantation and 14.28% of cases after the first year of transplantation

Risk factors predisposing to toxoplasmosis in chronic renal failure patients and renal transplant recipients

This work evaluated risk factors predisposing to toxoplasmosis in chronic renal failure patients and renal transplant recipients. The present study included 91 cases classified according to their renal status into four groups; control group, renal failure patients not on haemodialysis, renal failure patients on regular haemodialysis and renal transplant recipients group. The age groups [<20] and [30-] had the highest positivity for anti-Toxoplasrna IgG and IgM antibodies in comparison to the other age groups. The results showed no sex difference in positivity rate for anti-Toxoplasma IgG and IgM in groups. There was no significant difference between groups regarding risk factors for contracting toxoplasmosis, clinical presentation suggestive of toxoplasmosis and diabetes mellitus. There was significant difference between all groups as regarding intake of immunosuppressiye drugs and blood transfusion

Comparison of different methods to diagnose pneumocystis jiroveci pneumonia in children with haematological malignancies

Giemsa stain and PCR [single and nested PCR] were compared to a direct immunofluorescence assay [IFA] for the detection of Pneumocystis jiroveci in immuno-compromised patients with haematological malignancies, suspected of having P. jiroveci pneumonia. A total of 50 specimens [3 bronchoalveolar lavages [BAL], 16 sputum samples and 31 nasopharyngeal aspirate samples] were obtained from the Paediatric Oncology Unit of Kasr El-Aini Oncology Centre, Faculty of Medicine, Cairo University. Direct immunofluorescence [the gold standard] could detect 4 positive cases. Giemsa stain could only detect one positive case, being 25% sensitive and 100% specific. Single PCR could detect 3 positive cases, being 75% sensitive and 100% specific. Nested PCR could detect 36 positive cases, being 100% sensitive and 19.2% specific. We conclude that whenever possible, BAL samples should be obtained, for the diagnosis of P. jiroveci pneumonia [PJP]. Diagnosis of PJP should best be performed by IF or single PCR, especially if non-invasive samples are used. Nested PCR is recommended for detection of P. jiroveci in all immunosuppressed asymptomatic patients to identify a group of patients at high risk of developing PJP in the future, for whom proper chemoprophylaxis against P. jiroveci may be beneficial

Role of western blotting in serological diagnosis of helicobacter pylori infection

Background: Helicobacter pylori [H.pylori ] is the key pathogen for gastroduodenal diseases. The clinical outcome of H.pylori infection is influenced by the presence of strain-specific virulence factors that are usually detected by the presence of specific anti-H.pylori antibodies in serum. Apart from the detection of these antibodies by enzyme-linked immunosorbent assay [ELISA], it is desirable to obtain additional information concerning the presence of certain virulence factors of H.pylori that could be detected by immunoblot analysis

Objective: the aim of this work was to evaluate if blotting can replace the need for invasive endoscopy for diagnosis of virulent H.pylori infection , compare between it and ELISA as serodiagnostic test, and to focus on identifying factors and markers that define high-risk patients in whom H.pylori infection needs to be eradicated

Subjects and Methods: 19 dyspeptic patients were subjected to upper gastrointestinal endoscopy to obtain antral biopsy, direct urease test and culture of biopsy on specific media . Sera were obtained from the patients for IgG examination by ELISA and western blotting

Results: Western blotting was more sensitive [100%] than ELISA [sensitivity 81.8%], but specificity was the same for both [87.5%]. Only western blotting was able to detect antibodies to virulence antigens especially cytotoxin associated antigen [CagA] and vacuolating cytotoxin antigen [VacA]

Conclusion: Western blotting is a highly sensitive noninvasive test to diagnose toxigenic H.pylori infection. So that unnecessary gastroscopy and treatment can be avoided

Evaluation of heat shock protein 70 in psoriasis

Psoriasis is a common chronic, relapsing, noninfectious inflammatory skin disease. The concept that psoriasis has a genetic basis has been accepted for many years and it is commonly thought of as a complex trait. Heat shock proteins [HSPs] are group of proteins whose expression is increased when the cells are exposed to elevated temperature or other stress.These proteins can be induced by a range of cellular stressors including increased temperature, oxidative stress and nutritional deficiencies. Hsps have been proposed to play an important role in the pathogenesis of psoriasis. The aim of this work is to detect the expression of HSP70 in psoriasis and its correlation to the disease severity and to review potential role of HSP70 in pathogenesis and therapy of psoriasis. Skin biopsies were taken from 20 patients with different severity of untreated chronic plaque-type psoriasis and from 20 healthy volunteers. Antibodies to HSP70 were analyzed immunohistochemically. Immunoreactivity intensity distribution index [IRIDI] scores including the proportion of immunoreactive cells and their staining intensity were calculated in the basal, suprabasal, superficial as well as the whole epidermal layers of patients and controls. Results of our study revealed that differential and total IRIDI scores for HSP70 expression showed highly significant higher values in psoriatic patients compared to controls. Statistical differences were found between the different groups of patients; according to their disease severity and controls. Positive correlations also existed between IRIDI scores of patients and disease severity. Our study provides further evidence on the importance of Hsp70 in the pathogenesis of psoriasis and shows increased Hsp70 expression in psoriatic epidermis correlated to increased severity of psoriasis. To our knowledge no previous studies made correlation with HSP70 expression in psoriasis and disease severity. Finally, we are looking forwards to the application of a new therapy that targets Hsp70 or its receptor CD91 and helps in treatment of psoriasis

the therapeutic index better with paclitaxel plus carboplatin than with paclitaxel plus cisplatin in initial treatment of advanced ovarian cancer?

Retrospective analysis and comparison of the side effects, efficacy and feasibility of cisplatin and carboplatin each in combination with paclitaxel as front-line therapy in advanced epithelial ovarian cancer. Between January 2001 and January 2006, 39 patients with advanced epithelial ovarian cancer were allocated to receive paclitaxel 175mg/m[2] intravenously as a 3-hour infusion followed by either cisplatin 75mg/m[2] or carboplalin [area under the plasma concentration-time curve of 5] both on day [1]. The schedule was repeated every 3 weeks for at least six cycles to the majority of the patients. The primary endpoint was the proportion of patients without progression at 2 years. Secondary endpoints included toxicity, tolerability, response to treatment, and overall and progression-free survival time. Kaplan-Meier method estimated overall and time to disease progression. Log rank test compared survival curves with p value 230 had 92.3% sensitivity and 100% specificity [p=<0.001] and tumor size at start of chemotherapy had 96.3% sensitivity and 100% specificity [p<0.001]. The 2-years progression-free survival [PFS] of all patients was 39.4% and the median time to disease progression was 23.3 months. While the median overall survival time of all patients was 37.5 months and the 2-years overall survival [OAS] was 62.9%. The 2-years PFS and OAS were 35.2% and 44.4%, respectively, for TC arm compared with 44.4% and 83.3%, respectively, for paclitaxel-cisplatin [TP] arm. The relative risk [RR] of progression for patients with incomplete response was 6.9 [95%- CI, 2.052 to 23.11] and the RR of death for TC arm was 6.3 [95% CI, 1.7 to 9.0]. The small number of patients entered onto the study caused wide CI around the hazards ratio for RR of death with delayed treatment [hazards ratio, 4.0; 95% CI, 1.7 to 23.3] and did not allow conclusions about efficacy. Age >60 [p=0.05], stage IIIB, IIIC and IV disease [p=0.02], and delayed treatment [0.001] had statistically significant adverse effect on the OAS, while response to chemotherapy [p=0.03] had statistically significant effect on prolonging the OAS. Presence of residual disease >1cm had borderline significance [p=0.06] on the OAS. However elevated level of CA[125] >230, tumor grade, pathological subtype, Karnofsky performance status [KPS] had no statistically significant effect on the OAS [all p=NS]. Univariate analysis of factors that might affect PFS showed that patients with a residual tumor of less than 1cm before chemotherapy [p=0.0003], KPS [p=0.0268], FIGO stage II or IIIa [p=0.0018], had statistically significant longer PFS while CA125 >230 [p=0.0012] and incomplete response [p=0.002] had a significant adverse impact on PFS. In patients with advanced ovarian cancer, a chemotherapy regimen consisting of TC results in less toxicity, is easier to administer, and has similar median time to disease progression [23.3 months], when compared with TP regimen, however a longer follow-up is required for a definitive statement on survival

Efficacy of acupressure on pain intensity during first stage of labor

Pain management may actually help to shorten labor and secure natural delivery. Safe and painless labor is a dream for the future rather than a reality today. This study aimed to explore the efficacy of acupressure on pain intensity during the first stage of labor. The study was conducted on 120 parturient attending in two hospitals in Tanta city, where 60 women were chosen from each setting. Four tools were used [1] a specially designed interview schedule was used to collect basic data such as general characteristics, medical history, women's experience of pain and their expectations about labor pain. [2] Physiological and behavioral responses to pain sheet: Physiological responses to pain including: vital signs, gastrointestinal tract responses and skin responses. Behavioral responses to pain were measured using a modified Chamber Price Pain Rating Scale which includes posture, gross motor activity, facial expression and verbalization. [3] A modified version of "Johansson Pain-o-meter" for measuring the intensity of sensory and affective components of pain. It is composed of 11 affective and 12 sensory pain word descriptors. [4] Visual Analogue Scale. The results revealed that the application of acupressure to women during the first stage of labor was related to their physiological responses to pain. In addition, it was showed that both those who received the acupressure and those who did not receive it had an increase in their blood pressure. Regarding pulse rate it was observed that three nursing intervention had led to a decrease in it among the laboring women within the experimental groups. As regards the respiratory rate, the present study showed that the application of acupressure was related to its increase. In addition, a decrease of nausea and vomiting was seen after the application of acupressure. Physiologically, the activity of the sympathetic nervous system is expected to increase in response to labor pain, resulting in pallor and diaphoresis. The study revealed a change in the behavioral response to labor pain after the application of acupressure. In addition, acupressure is sign significantly related to an increase in assuming a guarded position, and decrease in frowning and grimacing, groaning, moaning, crying out, decrease in quality and intensity of labor pain. The mean score of labor pain had been reduced after acupressure application