Changes in blood and urine parameters among pregnant women during third trimester

Background: During pregnancy, the pregnant lady undergoes significant anatomical and physiological changes in order to nurture and accommodate the developing fetus. These changes begin after conception and affect every organ system in the body.Methods: The study was carried out in the United Arab Emirates - Ajman (Thumbay Hospital) during the period of (March - Jun) in the year of 2018 to estimate HbA1c% levels, hematological blood parameters and urine culture in healthy pregnant women during 3rd trimester. The study was conducted on (108) healthy pregnant women during3rd trimester. Urine culture was performed to detect the growth of bacteria after the culture, gram stain was done to differentiate the bacteria followed by biochemical test to detect the type of bacteria.Results: A total 26 (79%) of patients had normal HbA1c% result while 7(21%) had elevated HbA1c% result. The results of HbA1c% in last trimester mean±SD (range) HbA1c% (n=33) were 5.5±0.52% (111.5±14.8 mg/dL). Also, our results showed strong positive correlation between HbA1% with estimated Average blood glucose (r=0.78, P value=0.00), and weak positive correlation between HbA1 with age (years) (r=0.2, P value=0.02). Bacterial culture showed that two positive results of stenotrophomonas maltophilia was isolated, three cases of Staphylococcus aureus was isolated and three cases of staphylococcus saprophyticus. Hematological profile showed a clinically significant (≤ 0.05) in Hb mean 11.47, P value 0.001, HCT mean, 33.9 P value 0.001 and MCV mean 73.7 value 0.001. No clinically significant (≥ 0.05) in RBCs mean 3.93, P value 0.010, MCH mean 27.3 P value 0.061 and MCHC mean 30.9 P value 0.134.Conclusions: Our study conclude that estimation of HbA1c%, hematological blood parameters and urine culture level in last trimester will be helpful in diagnosis, monitoring and predicting fetal distress.

Comprehensive Drought Analysis Using Statistical and Meteorological Indices Approach: A Case Study of Badin, Sindh

Drought is a global phenomenon that can occur in any ecological zone and render significant damages to both the natural environment and human lives. However, hydro-climatic stresses are growing distinctly in the arid zones across the globe. Literature suggests that the analysis of a long-term data-set could help in strengthening of mitigation planes and rationalization of disaster management policies. Thus, the present study is aimed to analyze the evidence-based historical drought events happened in arid-zone Badin, Pakistan and predict its occurrence and severity for the next 82 years (2018-2099). Drought indices viz standardized precipitation index and reconnaissance drought index have been used to detect the severity of the drought events. Thirty years (1988 to 2017) past data of precipitation and temperature were used to categorize the drought severity and validated against the local data. Climate projections based on RCP 4.5 and 8.5 made at 25x25 km resolution used for future drought analysis. The results demonstrate that the region faced severe to extreme drought in 1990-91 and 2001-04. While, in future 2020-21, 2036-37, 2038-39 would be the extreme driest years under RCP 4.5 and 2029-30, 2089-90 under RCP 8.5. Further insight revealed that the average annual temperature has increased and precipitation has decreased w.r.t the base year 1988. It is concluded that drought detection with SPI and RDI is suitable and drought prediction with the RCP 4.5 and 8.5 could be a better option.

systematic review of the safety of nipple sparing mastectomy

Background: Breast cancer is a complex disease, and local recurrence and cancer-related death is likely multifactorial. Over the past three decades there has been a move towards breast conservation and a focus on aesthetic outcomes while maintaining oncological safety. For some patients, mastectomy is the preferred option. There is growing interest in the potential use of nipple sparing mastectomy [NSM]. However, oncological safety remains unproven, and the benefits and indications have not been clearly identified

Methods: A Systematic search in the scientific database [Medline, EMBASE, Google Scholer and Ovid] from 1980 to 2016 was conducted for all relevant retrospective studies including; randomized controlled trials, cohort studies and case-studies involving women undergoing either NSM were analyzed and included based on the preset inclusion criteria

Results: The search yielded 1193 articles, of which 55 studies with 9053 patients met our selection criteria. After a mean follow up of 41 months [range, 7.1-78 months], the overall pooled locoregional recurrence rate [LRR] was 3.25%, the overall complication rate was 21.8% [1309 of 6003], and the overall incidence of nipple necrosis, either partial or total, was 6.6 % [561 of 8438]. Significant heterogeneity was found among the published studies and patient selection was affected by tumor characteristics

Conclusion: There is growing evidence that NSM has been marked as oncologically safe in women with small, peripherally located tumors, without multicentricity, or when performed as a prophylactic mastectomy. Hence, NSM has been recommended only if carefully selected for a particular group of patients

Noncompaction cardiomyopathy: case presentation with cardiac magnetic resonance imaging findings and literature review

Left ventricular noncompaction cardiomyopathy is a very rare condition, yet believed to be often overlooked. It is thought to be caused by the developmental arrest in embryogenesis and characterized by an increase in the noncompacted, trabeculated myocardium adjacent to compacted myocardium in the left ventricular. The clinical presentations of this type of cardiomyopathy are of variable severity. Echocardiography used to be the diagnostic modality, but recent reports suggest that cardiac magnetic resonance imaging has higher sensitivity and specificity by showing a ratio of the noncompacted myocardium to compacted myocardium of > 2.3

A Missing Correlation between the Number and Type of MEFV Mutations and Severity of Clinical Manifestations in Egyptian Pediatric FMF Patients.

Aims: Previous researches identified the gene for Familial Mediterranean Fever (FMF) and found several different gene mutations that cause this inherited rheumatic disease. The aim of this work is to investigate the correlation between severity of symptoms of FMF and the number and type of MEFV variants, as well as to shed light on the correlation between the genotype and phenotype of Egyptian pediatric FMF patients. Study Design: Retrospective study. Place and Duration of Study: Department of Pediatrics, Kasr El Aini Hospital, Cairo University Medical School, Cairo, Egypt, between January 2012 and February 2013. Methodology: This study involved 35 childhood cases of Egyptian ethnic origin suspected to suffer from FMF. They include 19 males and 16 females of age range between 1-17 years. MEFV mutations in each patient were determined by performing DNA isolation and purification, in vitro amplification (PCR), and reverse hybridization using an FMF StripAssay. Results: Our results revealed 14% homozygous, 34% single heterozygous, 35% compound heterozygous-bi, and 17% compound heterozygous-tri patients. Twelve MEFV mutations were covered where all mutations were concentrated on exons 10 and 2. Severity of clinical manifestations and severity score did not linearly correlate with the number of variants, nor with the type of variant. Conclusion: Our results question the strength of genotype-phenotype correlation in FMF and indicate that MEFV genotypes express much more variable phenotypes than previously suggested. Our results also revealed no association between the number of mutations and severity of clinical manifestations.

Polymerase chain reaction targeting insertion sequence IS6110 for the diagnosis of pulmonary tuberculosis among sudanese children and young adults

This study was carried out in Khartoum State during the period from January 2011 to 1 December 2013 to improve the rate of detection of Mycobacterium tuberculosis [MTB] in children with symptoms of tuberculosis [TB] infection using different conventional and ,: advanced diagnostic techniques. One hundred and ninety-seven specimens of gastric f lavage and sputum were collected from different hospitals in Khartoum State, including | Elbolok Hospital, Jafar Ibn Owf Hospital, Elasha'ab Teaching Hospital, Soba University Hospital and Academy Charity Hospital. ; All children participating in the study were subjected to the Mantoux test after obtaining: appropriate consent injected by 5 tuberculin units of tuberculin purified protein derivative, and the results were recorded after three days. Specimens were decontaminated and inoc-i ulated on Lowenstein-Jensen media according to the modified Petroffs method. Two smears were prepared and stained by Ziehl-Neelsen stain and Auramine fluorescent dye; bacterial DNA was extracted from each specimen by using phenol chloroform method, and then the Polymerase Chain Reaction technique was adopted to detect Insertion Sequence IS6110 gene of MTB in these specimens. This study showed that the positive results for TST, ZN, Auramine, Culture and PCR were 86 [43.7%], 16 [8.1%], 22 [11.2%], 32 [16.2%] and 35[17.8%], respectively. The study concluded that the PCR technique is the most sensitive and specific technique for a quick identification of MTB in gastric lavage and sputum from children who are unable to expectorate a good quality sputum sample or who are diagnosed as negative using conventional diagnostic methods

Cardiac magnetic resonance imaging: a teaching atlas with emphasizing current clinical indications

Cardiovascular magnetic resonance [CMR] is an amazing technology that continues to provide new innovative approaches for evaluating the heart and blood vessels. It can assess cardiac morphology, function, perfusion, viability, coronary and peripheral arteries, and metabolism and tissue characterization. The basic pulse sequences of CMR include; Spin Echo, Gradient echo, and Steady stet free precision. Current clinical indications of CMR are multiple and continuously evolving. CMR often works in complementary fashions to other cardiac imaging techniques or to resolve residual diagnostic dilemma. The purpose of this illustrative review is to review current clinical applications of CMR and to provide physicians and technologists with simple, and regular CMR cases form daily practice. Each case discusses briefly the related clinical history, followed by CMR imaging findings, and simple discussion to highlight the role of CMR in a particular cardiovascular disorder

Total thyroidectomy in treatment of non-malignant goiter: is it worthwhile?

Total thyroidectomy is increasingly being accepted as a treatment of choice for differentiated thyroid cancer. However, because of presumed increased morbidity associated with this procedure, it is still not considered a viable option for management of benign thyroid disorders. To assess the safety and efficacy of total thyroidectomy for management of benign thyroid disorders, we analyzed our data from 100 total thyroidectomies performed for benign thyroid disorders. Demographic details, biochemical findings, indications for operation, specimen weight, and complications were noted. Among these patients, 35 had a toxic goiter and 65 had a non toxic goiter. The mean duration of goiters was 3.8 +/- 3.06 years [3 - 8 years], and the mean weight of the specimens was 85 gm +/- 180 gm. The incidence of permanent hypothyroidism and permanent recurrent laryngeal nerve plasy were 1% in both. According to this study, we can conclude that: total thyroidectomy should be considered as the treatment of choice for multinodular goiter and Graves' disease in a setting of palpable nodule[s] or ophthalmopathy [or both] because reoperation for recurrent goiter in such a setting would be hazardous with distressing complications

Another method for localization of radiolucent urinary stones during ESWL

To study the feasibility and safety of localization of radiolucent urinary stones during ESWL utilising the refluxing intravesically injected contrast medium along indwelling ureteral stents. 2. To identify the optimum volume of contrast medium and the intravesical pressure at which adequate vesicoureteral reflux sufficient for collecting system opacification occurs. 3. To identify criteria by which successful localization can be predicted. With antibacterial prophylaxis, hundred mls. of contrast medium diluted with 500 ml normal saline was infused into the bladder through a Y shaped connection attached to a pre-inserted urethral catheter with the other limb connected to a water manometer for the purpose of continuous intravesical pressure recordings. The amount of infused contrast medium and intravesical pressure at which adequate visualization by fluoroscopy occurred was recorded. Successful stone localization was correlated with the infused contrast medium volume, intravesical pressure, infection, stone location, age, weight, stent duration and fluoroscopy time. Forty six patients were studied. Clear stone localization to facilitate shock targeting was achieved in 37 patients [80%]. This occurred with a mean contrast volume of 300 ml at 20 cm water mean intravesical pressure. Apart from urinary tract infection which was associated with a significantly lower success rate, there were no other criteria by which success can be predicted. There were no significant complications and all visualized stones disintegrated well and were completely cleared at 3 months. The method is safe, easy, repeatable and suitable for targeting radiolucent urinary stones during ESWL in patients with ureteral stents

Impact of thoracoscopic lung biopsy versus per - cutanous CT guided needle biopsy in peripheral lung lesions

To determine the diagnostic yield of the thoracoscopic lung biopsy versus per-cutaneous CT guided needle biopsy in realizing the etiology of peripheral lung lesions, using the spiral CT scan as positioning guidance. The study included 30 patients, with undiagnosed peripheral lung lesions, who were subjected to thorough clinical history and examination, -plain X- ray, routine laboratory investigations, CT chest and CT guided biopsy and thoracoscopy with thoracoscopic lung biopsy. The final diagnosis were 23 malignant lesions and 7 benign lesions. The sensitivity of CT guided biopsy was 78.3% with 100% specificity while the sensitivity of thoracoscopic biopsy was l00% with 100% specificity. The lesion size was a significant factor contributing to diagnostic accuracy of CT guided biopsy. Thoracoscopic biopsy provides higher degree of accuracy for specific benign diagnosis in peripheral pulmonary lesions. Percutaneous transthoracic CT guided needle biopsy is an important scanning tool in diagnosing peripheral pulmonary lesions greater than 2 cm in diameter. Thoracoscopic biopsy is an important tool in diagnosing peripheral pulmonary nodules whether small or large nodules. Thoracoscopy provides higher degree in accuracy for specific benign diagnosis in peripheral pulmonary lesion versus CT guided biopsy. Thoracoscopy provides higher degree of accuracy compared with CT guided biopsy for diagnosis of peripheral pulmonary lesions

Dietary energy intake, energy expenditure and activity pattern among selected rural and urban poor in Bangladesh.

Rural-urban and seasonal differences in energy balance were studied among selected free living subjects, chosen from the poor population groups in Bangladesh. Individual dietary energy intakes were estimated by a combination of 24 hours recall and weighing method. Time allocation to various occupational and non-occupational activities were recorded by observation and questioning, and energy expenditures were calculated by using FAO/WHO/UNU guidelines. The male working adults in both the population groups studied were found to be in negative energy balance in both the seasons observed. In Jan-Feb when employment opportunities for the rural poor were few all age and sex groups were in negative energy balance, and when employment opportunities improved during May-June the situation reversed except for the male working adults. In urban areas, on the other hand, all age and sex groups, except the male working adults were in positive energy balance in both the seasons. Rural children under 10 years, had significantly higher energy expenditure (P < 0.023) than their urban counterparts. Seasonal difference in energy expenditure among the rural male adults is quite high. In the urban group there was no such seasonal difference. Apparently very high rural-urban difference in energy expenditure of the male adults (18-30 y) in season 1 may be attributed to very high energy demanding activities in which the observed subjects in rural areas were engaged during this season. Compared to their urban counterparts rural male adults (18-30 yrs.) were found to be devoted significantly higher time in occupational and heavy household activities.

Comparative study of the hospital stay of some uncomplicated surgical patients in Kasr El Eini hospital and a private hospital

The hospital stay of 115 uncomplicated surgical patients in Kasr El- Aini Hospital and a private hospital was studied in 1992 to get the undue losses of money and medical care in the first group. The differences between the average lengths of hospital stay for cases with simple nodular goiter, oblique hernia and perianal fistula were 10.55, 13.62 and 13.25 days, correspondingly. Knowing that the average daily running costs of a bed in Kasr El-Aini Hospital is about LE 45, the undue lost costs will be 474.75-612.9 and 596.25, correspondingly/each case. The causes of such undue losses may be improper operation schedule, investigations are done on inpatient basis, no proper discharge plan

CA 125, CA 19-9 and CEA in benign gynecologic tumors: Effect of surgery

The present study showed that combining serum essay of CA125, CA19-9 and CEA is useful in the preoperative exclusion of malignancy in patients with ovarian tumors. A leiomyomas were associated with low levels of the 3 tumor markers, elevated levels particularly of serum CA125 may point to adenomyosis in patients with uterine mass. The results showed that the serum levels of the tumor markers were significantly decreased postoperatively. So, it can be safely assumed that the specificity of these tumor markers is not affected by abdominal surgery

Maternal serum levels of alpha-fetoprotein, human placental lactogen and progesterone hormones in normal pregnancy

Alpha-fetoprotein, human placental lactogen and progesterone were determined in the sera of 30 normal pregnant females and 10 healthy non-pregnant controls. Pregnant females were divided into three groups, respectively at different gestational ages of 12, 18 and 36 weeks. Ultrasonography was performed to detect viability and gestational age, as well as to exclude any fetal or placental abnormalities. All pregnant females delivered healthy and normal babies. No case had alpha-fetoprotein maternal value above 2 multiples of the medians [MOM], or below 0.5 MOM. Despite the controversy about the importance of human placental lactogen and progesterone hormones in pregnancy, their assays give-at least-an idea about the competence of the placental compartment

Effect of magnesium sulfate administration on cholinesterase enzyme activity in the sera of patients with severe preeclampsia: is there any lowering effect?

Serum cholinestrase activity was determined using a colorimetric method in 60 females. They were divided into 3 groups, each comprising 20 females. The first group included pregnant females at term with severe preeclampsia. The second group included healthy pregnant females at term. The third group included healthy nonpregnant females. Blood samples were collected from all patients on admission. In the preeclamptic group, second samples were drawn 24 hours after the start of magnesium sulfate therapy. The mean level of serum cholinestrase activities in nonpregnant, preeclamptic and healthy pregnant patients were 2837 +/- 753, 2218 +/- 752 and 1667 +/- 485 units/L respectively. Differences are statistically significant [P < 0.0001]. The enzyme was found to be significantly decreased after the magnesium sulfate administration [1843 +/- 631 units/L] [P < 0.0001]. Our data demonstrated that magnesium has a significant inhibiting effect on serum cholinestrase activity in preeclamptic patients. We conclude that the magnesium inhibiting effect of the already low level of serum cholinestrase activity is responsible for the prolonged duration of action of succinylcholine in preeclamptic patients treated with magnesium sulfate. We believe that both the obstetrician and the anesthesiologist should be aware, alert and cooperative in dealing with these critical cases

Therapeutic serum level of magnesium in patients with severe pre-eclampsia treated with magnesium sulfate

Serum levels of magnesium were determined in 20 healthy nonpregnant females, 20 healthy normotensive pregnant females at term and 20 pregnant females at term with severe preeclampsia. All the preeclamptic patients received a low dosage intramuscular regimen of magnesium sulfate [MgSO[4]] and the serum levels of magnesium were determined again after 24 hours. There was no difference in the baseline values of serum magnesium inthe 3 studied groups. A 6 g loading dose of MgSO[4][3 g I.V. and 3 g I.M.] followed by 3 g/4 hr. I.M. caused maternal serum magnesium concentrations to rise by about 50% from the baseline value of 1.8 mEq/L [2.2 mg/dl] to 2.7 mEq/L [3.3 mg/dl] [P < 0.0001]. Oxytocin used to augment or induce labor in 7 preeclamptic patients had no effect on the serum level of magnesium. The efficiency of our regimen in preventing seizures in cases of severe preeclampsia suggests that the therapeutic level of serum mangesium required to prevent convulsions in preeclampsia may not be as high as previously defined by other investigators. The possibility that a higher dose of MgSO[4], to achieve a higher therapeutic serum level of magnesium, is needed to treat and prevent further seizures in eclampsia is present. Thus, MgSO[4] regimen should be different in the two conditions of similar etiology but with variable severity