Perinatal mortality of placenta previa: a 1-year retrospective study

Background: Antepartum haemorrhage is one of the important causes of perinatal mortality and morbidity in India. The increased risk of perinatal morbidity and mortality in placenta praevia is due to preterm birth, low birth weight, birth asphyxia and neonatal sepsis. This is a retrospective study done over a period of 5years to determine the incidence, demographic features, risk factors, obstetric management, maternal mortality and morbidity, and perinatal outcome in women presenting with placenta praevia.Methods: This was a retrospective study done at Nil Ratan Sircar Medical College and Hospital over a period of five years starting from January 2016 to December 2017. Antenatal women with more than 28 weeks of gestational age with a complaint of painless vaginal bleeding or those diagnosed as having placenta praevia on routine ultrasound examination were included in this study and hospitalised.  Among them cases of placenta praevia were 21.Results: There were21 cases of placenta praevia registered amounting to 0.23% incidence. The various antenatal complications seen associated with placenta praevia were severe anaemia (14.28%), coexisting PIH (4.76%), IUD (4.76%), IUGR/Oligohydraminos (4.76%). All the patients in the study had undergone caesarean deliveries. Perinatal morbidity studied as percentage of new-borns requiring resuscitation followed by NICU admission was 33.3%. Among the delivered patients of placenta praevia incidence of perinatal mortality was 23.8%. Prematurity (42.85%) contributed to most cases of perinatal mortality, followed by RDS (14.28%) and asphyxia (14.28%).Conclusions: In this study placenta praevia is seen more commonly in 28-34 weeks of gestation and patients mainly presented with a bout of bleeding eventually had preterm deliveries. Although vaginal deliveries are appropriate in selected cases of placenta paevia liberal use of caesarean section in well-equipped hospitals with availability of blood transfusion services have helped to lower complications.

Role of hypovitaminosis D in the incidence and complications of diabetes mellitus in rats

Background: Diabetes mellitus continues to be a public health concern. Vitamin D had sparked widespread interest in the pathogenesis and prevention of diabetes. The aim of this study was to investigate the effect of vitamin D [deficiency and treatment] with alteration in fasting plasma glucose, insulin resistance in alloxan injected rat

Materials and Methods: The experiment was carried out using 40 male albino rats [Sprague Dawley] weighing 150+/-10g. Animals were randomly divided into three groups; first group fed standard diet as a negative control group. Diabetic group injected subcutaneously by alloxan, and fed on standard diet. The third group fed standard diet without vitamin D for two weeks. After that glucose and insulin were determined in each rat of all groups to insure alteration in fasting plasma glucose, insulin resistance, Homeostasis model assessment insulin resistance [HOMA-IR] was calculated. Then the third group was divided to two subgroups. The first subgroup fed basil diet with required vitamin D; while the second subgroup fed standard diet with double dose vitamin D. At the end experiment [4 weeks], glucose, insulin, lipid profile, liver and renal functions were determined in blood and serum, while [HOMA-IR] and LDL were calculated for normal, diabetic group and both treatment subgroups

Results: Vitamin D deficiency group had the nearest results to the diabetic group injected with alloxan group in: insulin, glucose and HOMA-IR. Other groups had lower level than the other two groups in the same parameter. Our data explained the improvement in glucose level after feeding with vitamin D. Diabetic group injected with alloxan had increased in liver enzymes, renal function and lipid profile compared with other groups and showed variable changes in histopathological examination

Conclusion: Vitamin D deficiency status is associated with a higher risk of type 2 diabetes. Vitamin D improves glucose tolerance and insulin sensitivity. Vitamin D has also been shown to reduce the risk of diabetes associated complications

study of the protective role of dried garlic powder and vitamin C on some toxic effects of aflatoxin B1 in adult albino rats

One of the most important effects of unconditional storage of food and foodstuff is intoxication caused by mycotoxins. Among mycotoxins, aflatoxin B[1] [AFB[1]] which is the most harmful one. In this work, we studied the AFB[1] induced hepatotoxicity and genotoxicity and using of garlic and vitamin C to ameliorate the AFB[1]-induced damage. This study was conducted for 12 weeks on 192 adult albino rats of both sexes, divided into 8 groups, each consisted of 24 rats: group 1 [-ve control group], group II [+ve control group], group III [+ve control group], group IV [garlic group], group V [vitamin C group], group VI [AFB[1] group], group VII [aflatoxin B[1]+garlic] and Group IV [aflatoxin B[1]+ vitamin C]. The first 3 groups were used as control groups and the [-ve] control group "I" used to be compared with other treated groups. After 6 and 12 weeks, 6 rats from each group were anesthetized and blood samples were collected to assess serum aspartate aminotransferase [AST] and serum malondialdehyde, [MDA] levels. Then the rats were sacrificed and liver specimens were obtained to assess the histopathological and immunohistpathological changes using light microscope. After that another 6 rats from each group were used for studying the chromosomal pattern of their bone marrow cells. The results revealed significant histopathological changes in AFB[1] group [VI] when compared with control group [1]. These changes were in form of loss of hepatic architecture, congested central vein, vacuolated cytoplasm, degeneration and necrosis, immunohistopathological changes in form of decreased in the Bcl[2] expression and chromosomal abnormalities in form of chromosomal gaps, breaks, deletions, ring chromosomes, hypoploidy and hyperploidy. These harmful effects were reduced in rats treated by dried garlic powder and vitamin C. It was conlude that AFB[1] caused hepatotoxicity and genotoxicity. Both garlic and vitamin C have significant improvement effects on AFB[1]-induced hepatoxicity and genotoxicity. Effectiveness of vitamin C is better than garlic in protection of liver and bone marrow cells

Prevalence of intestinal parasitosis in a rural population in Egypt, and its relation to socio-demographic characteristics

A cross-sectional study was conducted in a village in Menoufia Governorate, Egypt where the majority of people had individual trenches in the houses for sewage disposal with absence of public sewage system. Out of 2292 stool samples 47.8% had at least a single infection. Multiple infections occurred in 14.9%. Entamoeba histolytica was 20%, E. coli 10%, Giardia lamblia 10%, Ascaris lumbricoides 27.31%, Hymenolepis nana 2.96%, Schistosoma mansoni 2.45% and Ancylostoma duodenale 2.23%. Males were significantly infected with S. mansoni than females. Younger age groups were significantly infected by H. nana than older ones. Working in agriculture was significantly at risk with S. mansoni and A. duodenale infections. On multiple logistic regression analysis; the risk factor most strongly associated with infection was the presence of another infected family member

Role of some mycotoxins in inducing kidney diseases in upper Egypt

Egypt has a climate that favors the growth of fungi specially those producing mycotoxins. Mycotoxins are found all over the world in human food and blood as well as in animal blood and tissues. The most threatening effects are their nephrotoxicity and carcinogenicity. The aim of this study was to identify the role of some mycotoxins namely; ochraloxin A [OTA] and fumonisin B[1] [FB1] in the occurrence of chronic renal disease of unknown aetiology in Upper Egypt. This study was carried out on 134 subjects who were classified as: 47 patients suffered from chronic renal failure of unknown aetiology before dialysis treatment [group A], 35 subjects who were relatives of patients in group A considering that they share them in the same environmental conditions [group B], 28 subjects working in the Middle Egypt Company [MEC] for grinding of cereals as an occupational risk group for exposure to inhalation of mycotoxins [group C] and 24 subjects with normal kidney functions as a control group. They exposed to a detailed history, their occupation, family history and kidney function tests. Indices of early kidney affection and levels of OTA and FB[1] in urine and serum for all subjects in all groups were also done. As regard group A, OTA was significantly increased while FBI was non-significantly increased in both serum and urine of patients compared to control group. There was positive correlation between the levels of OTA in both serum and urine versus the level of blood urea. It was found also that the patients with positive ochratoxicity had mild proteinuria. As regard group B, OTA and FB[1] were detected in urine and plasma, although with levels lower than that in group A but significantly higher than that of controls. As regard group C, OTA was found to be nearly equal to that in controls both in serum and urine which may indicate the low contamination levels of cereals in MEC due to good storage conditions. However, FB[1] was found in serum to be insignificantly higher than that in groups A and controls. Also FB[1] was detected in urine insignificantly lower than that in group A and insignificantly higher than that in controls. Although the results were statistically non significant but may indicate the increased risk of exposure to FB[1] in this group. We concluded that the presence of OTA and FB[1] in serum and urine of our control group may indicate the presence of these two mycotoxins as contaminants in the food in our locality. Also, these toxins may play a role in inducing chronic renal diseases in our locality. We advise a continuous follow up for all subjects exposed to these toxins, giving instructions about ways for protection and treatment as well as good storage for cereals and foods

Effects of occupational exposure to lead and noise on hearing

Noise induced hearing loss is one of the most common and expensive sources of compensated work related health problems in modern industrialized countries. This study was conducted to detect the combined effect of occupational exposure to noise and lead on hearing. An observational analytic comparative approach was selected for this study. The inference population comprised 208 production workers from the Egyptian Copper Works Company in Alexandria, of these workers 51 were exposed to both noise and lead, 54 workers were exposed to noise, 53 workers were exposed to lead, and the rest, 50 workers were not exposed to neither noise or lead. All workers were subjected to a detailed interview, physical examination, otological examination, and auditory evaluation through a pure-tone audiometry, speech audiometry [Speech Reception Threshold [SRT] and Speech Discrimination Score [SDS]%], tympanometry, and auditory brain-stem response audiometry. Moreover, the blood lead level of workers, and workplace noise intensity were measured. Clinical evaluation of workers revealed a significant increase in mean systolic blood pressure among lead exposed and noise exposed workers. Neurological manifestations [tremors, tingling/numbness, reduced visual acuity and headache], urinary troubles, and oral manifestations gingivitis and bleeding gum], were significantly more encountered among lead exposed workers and workers with combined exposure. On assessing the workers' mean hearing threshold of the right ear, it was evident that at low frequencies [250 Hz and 500 Hz] the maximum significant drop was recorded among the workers with combined exposure [30.2 +/- 9.8 dB, 30.2 +/- 9.74 dB respectively], compared to lead exposed workers [29.15 +/- 8.42 dB, 28.49 +/- 6.97 dB respectively], and noise exposed workers [27.68 +/- 6.98 dB, 28.43 +/- 7.57 dB]. On the contrary, at higher frequencies [1 KHz - 8 KHz] the maximum drop was recorded by noise exposed worker. Regarding the left ear, the maximum impairment at low frequencies was observed among lead exposed workers [28.3 +/- 8.08 dB, 28.49 +/- 9.38 dB respectively], but at the higher frequencies a similar pattern to that observed at the right ear was obtained. Noise exposed workers had the most impaired mean SRT [31.48 +/- 8.22 dB], while workers with combined exposure recorded the worst mean SDS% [91.67 +/- 6.06%]. No significant delay was observed in the Auditory Brainstem Response [ABR] audiometry recorded at the latencies I, III, and V and inter-peak latencies; I-III, I-V, and III-V for the studied workers. On calculating the total hearing impairment percent, noise exposure imposed the worst effect on hearing, where both noise exposed workers and workers with combined exposure had the highest mean hearing impairment percent [15.25 +/- 13.61%, 13.22 +/- 13,49% respectively]. Among noise exposed workers, the significant predictors of hearing impairment were the duration of employment and smoking. While, blood lead level and aging were the significant predictors for hearing impairment among workers with combined exposure. Cochlear affection is the main site of lesion in noise and/or lead exposed workers, and the risk of combined exposure to noise and lead imposed on the auditory system sensitivity at the studied levels of exposure is nearly similar to that encountered by noise exposure alone

Prevalence of S. mansoni and intestinal parasites in a rural population in Egypt, and its relation to socio-demographic characteristics

A cross-sectional study was conducted in a village in Menoufia Governorate in Egypt where the majority of people had individual trenches in the houses for sewage disposal with absence of public sewage system. Out of 2292 stool samples 47.8% had at least a single infection. Multiple infections occurred in 14.9%. Entamoeba histolytica was 20%, E. coli 10%, Giardia lamblia 10%, Ascaris lumbricoides 27.31%, Hymenolepis nana 2.96%, Schistosoma mansoni 2.45% and Ancylostoma duodenale 2.23%. Males were significantly infected with S. mansoni than females. Younger age groups were significantly infected by H. nana than older ones. Working in agriculture was significantly at risk with S. mansoni and A. duodenale infections. On multiple logistic regression analysis, the risk factor most strongly associated with infection was the presence of another infected family member. We recommend screening all family members of positive cases

Hemodialysis in children: safety, efficiency and adequacy

Assessment of dialysis adequacy is a complex issue that remains controversial. Urea kinetic modeling are the most common parameters used, however they are less well studied in pediatric hemodialysis than in adult. This study aimed to evaluate different strategies to obtain optimum dialysis therapy by using different filters and by changing the time of dialysis session. 200 dialysis sessions were performed in patients with ESRD to test adequacy and evaluate patient's safety. Urea kinetic modeling [Kt/V] was used to assess adequacy of dialysis in addition to R [R=Postdialysis urea level/predialysis urea level] and URR [urea reduction ratio= 1 -R]. Monitoring dialysis efficiency by comparing delivered and predicted Kt/V was also done using different filters [polysulfone 0.7m 2, cellulose 0.7m 2, polysulfone 0.4m 2]. The dialysis time was reassessed for patients with frequent complications where smaller filters for longer time were used. Retrospectively, the two sessions per week dialysis program were compared to three sessions per week in relation to adequacy and ultrafiltration. In this study, the relationship between delivered and predicted Kt/V [QE] was close to ideal value of 1. The smaller filters [F3] showed lower dialysis adequacy than accepted [0.85] but the larger filters [F4, CA70] showed accepted dialysis adequacy [1.14 and 1.19] thus smaller filters for longer time were used in patients with frequent complications. The frequency of dialysis sessions 3 times weekly was better than twice weekly because of volume overload complications. Delivered Kt/V were significantly correlated with QE, URR, filter surface area, and dialysis session time. The study concluded that the dialysis should be adjusted to the individual needs of a child as determined not only by the size of the patients or the specifications of the used prescription alone but also by individual variations in dialysis tolerance

Effect of haemofiltration in prevention of contrast induced nephropathy and on acid/base status in predialysis chronic kidney disease patients undergoing cardiac catheterization

High risk renal failure patients have increased risk for contrast nephropathy during coronary angiography despite the use of conventional prophylaxis with intravenous hydration and acetylcysteine. The aim of the study was assess the role of haemo filtration versus conventional prophylaxis in preservation of kidney function and prevention of contrast nephropathy in chronic kidney disease patients undergoing cardiac catheterisation. There was a highly significant reduction in BUN, creatinine, serum uric acid [p<0.001] in haemofiltration group in comparison with baseline and control group till day 4 that was not significant after one week. There was a significantly improving rise in pH and serum HCO[3] level in haemofiltration in haemofiltration group till 24 hours post contrast injection [p<0.001]. Haemofiltration can provide adequate pres ervation of kidney function in high risk renal patients under going cardiac catheterisation. It also achieved proper adjustment of acid/base status in such patients

Hypercoagulable state in children with nephrotic syndrome: a study of some markers of hemostasis activation

This study included 50 children with nephrotic syndrome; 28 were in relapse [group I] and 22 were in therapy withdrawal after successful remission [group II]. Twenty healthy children were included as controls. Thrombin antithrombin complex [TAT], fibrin monomer [FM], plasma fibrinogen, alpha-2-antiplasmin [alpha-2AP] tests and platelet counts were performed to detect the coagulation anomalies that are suggestive of a hypercoagulable state in the nephrotic cases. Serum albumin, total cholesterol and triglycerides levels were also determined. In conclusion, data suggested the presence of a prethrombotic state in the nephrotic cases, particularly in the relapse group. Elevated TAT, FM as well as fibrinogen and platelet count seem to be reliable indicators of this prethrombotic state. A significant reduction in the anti-fibrinolytic marker alpha-2AP was detected in the plasma of relapsing nephrotic cases

Sepsis following premature rupture of membranes in Minoufiya neonatal intensive care unit

Premature rupture of amniotic membranes [PROM] is one of the serious complications of pregnancy, a relationship exists between prolonged PROM, chonoamnionitis and neonatal sepsis. The purpose of the present work was to identify percentage and risk factors for neonatal sepsis following PROM and to study the relationship between bacterial flora of women in labor [with and without rupture of membranes] and the results of blood culture of their septic neonates. Our study was carried on 100 neonates and their mothers. High vaginal, endocervical and anorectal swabs for bacterial culture were done to all mothers with or without PROM. Neonates were examined and investigated for sepsis diagnosis, in the first 72 hours after delivery. The incidence of neonatal sepsis following PROM in the present work was 25%. The most commonly isolated organism from the septic neonates was E-coli followed by Klebsiella while the least common organisms were Enterobacter and Diphteroid. The surface swabs of the babies matched with blood culture for the neonates irrespective of the condition of fetal membranes with no significant difference between neonates with PROM and without PROM. The mother lower genital tract swabs matched with blood cultured from the neonates with a significant difference between cases with PROM and without PROM. Prematurity was the major risk factor for early onset neonatal sepsis following PROM in our study. The mortality rates in septic neonates with PROM was 60% while that of neonates with sepsis without PROM was 37.5%. The prolonged duration of PROM offers time for the ascent of bacteria resulting in early onset neonatal sepsis especially in the presence of other risk factors for neonatal sepsis such as, prematurity and low apgar score. And the bacteria found in blood cultures of neonates with early onset sepsis following PROM are usually the same that found in the genital tract of their mothers

Endoscopic management of ureteroceles in children

Treatment of ureteroceles in children varies according to the anatomicopathological form and the-choice of the surgical team. This study tries to determine the exact value of the endoscopic management of ureteroceles in children. In our study we treated 11 ureteroceles in 10 children by endoscopic incision, 7 of them were intravesical ureteroceles [4 single system and 3 duplex system] and 4 were duplex system ectopic ureteroceles. The procedure consists of a tiny transversal incision at the lower and median aspects of the ureteroceles. In our study the dilation of the upper tract disappeared or decreased in all cases of intravesical ureteroceles and in half the cases of ectopic ureteroceles. The incision of the ureterocele led to a vesicoureteral reflux in the associated ureter in 6 cases 54.5% [43% of the intravesical ureteroceles, 75% of the ectopic ureteroceles]. Following endoscopic treatment, no further surgery was required in 5 of the 7 cases with intravesical ureteroceles [71.5%], while every case of ectopc ureterocele needed a further operation [lower tract surgery in 3 cases and upper tract surgery in 1 case]. Endoscopic incision of ureteroceles is a simple and quick procedure which allows obstruction to be removed and the dilation of the upper tract and its corresponding kidney function to be improved, particularly in the neonate. The endoscopic management of ureteroceles may in itself suffice, without necessity of further surgery. These favorable results can more readily be seen in cases of intravesical ureterocele than in those of ectopic ureterocele

relationship between Schwann cells and endoneurial macrophages after sciatic nerve crush injury

Twenty eight male albino rats aged 6-8 weeks [weighed 300g to 350g] were used in this study: Twenty animals were used for the ultrastuctural study while eight animals were used for the ferritin intravenous injection study. The animals of the ultrastuctural study were divided into two groups; the experimental group [16 rats] and the control group [4 rats]. The left sciatic nerves of the experimental rats were subjected to crush injury while the right and left sciatic nerves of the other 4 rats were used as a control.The animals of the ferritin intravenous injection study were divided into the experimental group [4 rats] and the control group [4 rats]. The left sciatic nerves of the experimental rats were subjected to crush injury. After one week, ferritin was injected intravenously through the vein of the rat tail. The control 4 rats were intravenously injected with ferritin without crush injury and used as a control group.The ultrastractural study of the crushed sciatic nerves showed that nerve fibres could be classified into three main categories. These are the regenerating, recovering and degenerating nerve fibres. The regenerating myelinated and recovering nerve fibres were surrounded by endoneurial macrophages, fibroblasts and collagen fibrils. The cytoplasm of the Schwann cells of the recovering nerve fibres contained large fat globules. They also showed increased pinocytotic vesicles in their cytoplasmic membranes and basal laminae. Macrophages sent their processes to be in close contact to the basal laminae of Schwann cells of the regenerating nerve fibres. Most of the regenerating unmyelinated nerve fibres were not surrounded by the endoneurial macrophages. Active mitosis of the Schwann cells was recorded during the first four weeks after the crush injury.Ferritin intravenous injection study showed that after crush injury, ferritin particles did not cross the cytoplasmic membrane of the Schwann cells indicating that fat cells inside them were of endogenous origin.It could be concluded that there are three types of nerve fibres after peripheral nerve crush injury. They are the regenerating, the recovering and degenerating nerve fibres. The presence of macrophages, fibroblasts and collagen bundles around the nerve fibres could be an indication to its viability. Macrophages might play a role in promoting the Schwann cells for myelin formation and possibly for active mitosis. The myelin carried by the endoneurial macrophages is probably the wasted myelin

influence of smoking habits and menopause on the blood lead level in relation to its effect on some body systems

In this study, blood samples were obtained from 300 adult men and women who had no occupational exposure to lead. One hundred and fifty men were subdivided into three equal groups, each of 50, to assess the influence of smoking on blood lead level: The first group was nonsmokers acted as a control group, the second group involved smokers with mean consumption <20 cigarettes daily and the third group involved smokers men with mean consumption >20 cigarettes daily. The duration of smoking averaged 3-5 years in both groups. In a separate analysis, 150 women were subdivided into three equal groups, each of 50, to assess the influence of menopause on blood lead level: The first group was premenopausal women as a control group, the second group was recent menopausal women [less than four years] and the third group was postmenopausal women more than four years

Cisplatin induced toxicity and the modulating effect of antioxidants

This study was conducted on 120 albino rats divided into 8 equal groups. The study showed that group V [cisplatin group] caused highly significant increases in blood urea nitrogen [BUN], serum creatinine, total cholesterol, triglycerides, total bilirubin, direct bilirubin, alkaline phosphatase, serum glutamic pyruvic transaminase [SGPT], serum glutamic oxaloacetic transaminase [SGOT] together with highly significant reductions in serum electrolytes [serum calcium, Ca, serum potassium, K and serum sodium, Na], total proteins and albumin. Histopathological examination of kidney in group V showed tubular necrosis, focal cytoplasmic vacuolation and interstitial hemorrhages. Histopathological examination of liver in group V showed cloudy swelling of hepatocyte and sinusoidal dilatation

Ultrasonographic evaluation of gastric tumors

The usefulness of ultrasonography [US] in the evaluation of gastric neoplasms was assessed in 30 patients. Gastric masses were identified in 27 cases and missed in three patients. Lymphadenopathy was seen 25 cases. Liver Lymphadenopathy were detected in 18 cases and missed in a single case that was not detected with either ultrasound or computed tomography. Gastric outlet encroachment was seen in seven cases, pancreatic invasion in three, local hepatic extension in two and splenic invasion in one case. Ascites was identified in nine cases, peritoneal seedling in three cases and vascular involvement in two cases. The findings were confirmed by surgery and other imaging modalities including computed tomography. The study showed that ultrasound is an effective tool in the identification, assessment and preoperative evaluation of gastric neoplasms