Helicobacter pylori infection and hyperemesis gravidarum: possible causal relationship with evaluation of a new immunoassay in stool compared with standard diagnostic techniques

The aim of the present study was to investigate any possible association between infection with Helicobacter pylori [H. pylori] and hyperemesis gravidarum [HG]. Moreover; evaluation of different methods used in the diagnosis of H. pylori during pregnancy aiming to present a simple non-invasive and reliable method. 68 pregnant women with hyperemesis gravidarum and 72 control pregnant women were enrolled in the study. All participants were examined both for H. pylori serum immunoglobulin G antibodies [HpIgG Ab], showing chronic infection, and H. pylori stool antigens [HpSA], and showing active gastrointestinal colonization. Serologically positive H. pylori infection was detected in 59 [86.8%] subjects of the hyperemesis gravidarum group and in 32 [44.4%] of the controls [P<0.01]. HpSA was detected in 45.6% of patients with hyperemesis gravidarum, whereas only 5.6% of patients in the control group were positive for this specific antigen [P<0.001]. The new stool immunoassay test had a sensitivity of 96% [95% confidence interval 90.6% to 100%], specificity of 93% [85.1% to 99.5%], positive predictive value of 92%, and negative predictive value of 96%. In conclusion, this study supports the studies suggesting an association between H. pylori and HG. Infection with H. pylori should be kept in mind in cases of HG in pregnant women. The findings of the current study have, also, demonstrated that HpSA as a relatively simple, inexpensive and time saving noninvasive test is a reliable method for detection of active H. pylori infections in pregnant women with hyperemesis gravidarum. This stool immunoassay represents a new, accurate, and non-invasive method for H pylori infection that overcomes the limitations of existing tests

Estrogen-lowering medical treatment after laparoscopic surgery for symptomatic endometriosis stage III-IV: is it of value?

In order to decrease endometriosis recurrence after surgical therapy, it has been proposed to use a post-surgical estrogen-lowering medical treatment. The aim of the present study was to evaluate the efficacy of a post-operative regimen of GnRH analogue and danazol in women underwent laparoscopic conservative surgery for endometriosis stage III-IV .This was studied in a randomized trial in which no post-surgical therapy was compared with a protocol consisting of a 3 months of GnRH analogue and danazol. The primary objective was to assess whether this surgical/medical combined approach could produce a significantly longer relief of pain symptoms. The between-group differences in both objective disease recurrence and pregnancy rates among women wanting children were also evaluated. All patients conservatively operated at laparoscopy for stage III-IV endometriosis from March 2004 to May 2006 were requested to enter the study. Patients who underwent surgery for recurrent endometriosis were excluded from the study, as well as patients who had taken hormonal therapies before laparoscopy. A total of 134 women were randomized, by computer-generated list/ after laparoscopic conservative surgery for symptomatic endometriosis stage III-IV to three groups: Group I [n 44]; receive monthly i.m. injections of gonadotropin-releasing hormone [GnRH] analogue, leuprolide acetate depot [3.75 mg] for 3 months. Group II [n 45]: Postoperative treatment with danazol 600 mg daily for 3 months. Group III [n - 45]: Subjected to an expectant management, All patients were regularly followed up every 3 months for at least one year for evaluation of pain symptoms, fertility and objective disease recurrence. During the follow-up period, which lasts for at least 12 months, five [35.7%] of the 14 women who wanted children and who were allocated the GnRH analogue, five [33.3%] of the 15 women in the danazol group/ and six [40%] of the 15 given no treatment became pregnant [not significant]. Moderate/severe pelvic pain recurred during the follow-up in 10 [23%] of the 44 women with pelvic pain allocated the GnRH analogue, 10 [22.2%] of the 45 women given postoperative danazol/ and 11 [24%] of the 45 allocated no. Treatment Four women [9%] treated with GnRH analogue, five [11%] allocated to danazol treatment and four [9%] who received no treatment had objective disease recurrence as demonstrated by gynecological examination and/or pelvic ultrasonography [not significant]. This study does not support the routine post-operative use of a 3 month course of GnRH analogue or danazol after laparoscopic surgery for stage III-IV endometriosis with respect to postoperative expectant management

Passive smoking and pregnancy outcome: Is there any harm?

Adverse health effects of exposure to environmental tobacco smoke [ETS] among non-smokers have been studied occasionally in developing countries. The aim of this work is to study the effects of exposure to ETS on the maternal and fetal outcome in pregnancy. 282 nulliparous pregnant women with singleton pregnancy from Department of Obstetrics and Gynaecology, Tanta University Hospital, were included in this prospective study. A pre-designed structured questionnaire was used to record the details of exposure to ETS at home or at work place. The maternal and fetal variables were compared among those who were exposed to ETS vs. not exposed. Unpaired Student t-test was used for the comparison of continuous variables and Fisher's Exact test was used for categorical variables. Multiple logistic regression analysis was performed after including all variables found to have significant differences on univariate analysis. Of the 282 women studied, 169 [59.9%] reported exposure to ETS from the husband and other family members or at work place [Passive smokers], and 113 [40.1%] did not have any exposure to tobacco smoke [Control group]. In the mothers exposed to ETS, there was a significantly higher incidence of pre-term birth [24.3% vs. 15.9%; p<0.05] and small-for-gestation babies [31.4% vs.16.8%; p<0.001] as compared to unexposed mothers. The mean birth weight of the babies born to the mothers exposed to ETS was 230 g less than that of babies in the unexposed group [2550 +/- 0.479 g vs. 2780 +/- 0.563 g respectively, p=0.016].The multiple logistic regression analyses showed that ETS exposure during pregnancy was significantly associated with a higher risk of small-for-gestation babies [OR 2.3; 95% CI: 1.1-4.6]. In conclusion, this prospective study links passive smoking during pregnancy to more than two-fold higher risk of small-for-gestation baby even after adjusting for all possible confounders. The incidence of preterm labor and anemia were, also, higher among pregnant women exposed to ETS