Cytokeratin 13, Cytokeratin 17, and Ki-67 Expression in Human Acquired Cholesteatoma and Their Correlation With Its Destructive Capacity

OBJECTIVES: Cholesteatoma is a nonneoplastic destructive lesion of the temporal bone with debated pathogenesis and bone resorptive mechanism. Both molecular and cellular events chiefly master its activity. Continued research is necessary to clarify factors related to its aggressiveness. We aimed to investigate the expression of Ki-67, cytokeratin 13 (CK13) and cytokeratin 17 (CK17) in acquired nonrecurrent human cholesteatoma and correlate them with its bone destructive capacity. METHODS: A prospective quantitative immunohistochemical study was carried out using fresh acquired cholesteatoma tissues (n=19), collected during cholesteatoma surgery. Deep meatal skin tissues from the same patients were used as control (n=8). Cholesteatoma patients were divided into 2 groups and compared (invasive and noninvasive) according to a grading score for bone resorption based upon clinical, radiologic and intraoperative findings. To our knowledge, the role of CK17 in cholesteatoma aggressiveness was first investigated in this paper. RESULTS: Both Ki-67 and CK17 were significantly overexpressed in cholesteatoma than control tissues (P < 0.001 for both Ki-67 and CK17). In addition, Ki-67 and CK17 were significantly higher in the invasive group than noninvasive group of cholesteatoma (P=0.029, P=0.033, respectively). Furthermore, Ki-67 and CK17 showed a moderate positive correlation with bone erosion scores (r=0.547, P=0.015 and r=0.588, P=0.008, respectively). In terms of CK13, no significant difference was found between cholesteatoma and skin (P=0.766). CONCLUSION: Both Ki-67 and CK17 were overexpressed in cholesteatoma tissue and positively correlated with bone resorption activity. The concept that Ki-67 can be a predictor for aggressiveness of cholesteatoma was supported. In addition, this is the first study demonstrating CK17 as a favoring marker in the aggressiveness of acquired cholesteatoma.

Pathogenesis and Bone Resorption in Acquired Cholesteatoma: Current Knowledge and Future Prospectives

Cholesteatoma is a cystic non tumorous lesion of the temporal bone that has the ability to destroy nearby structures by its power to cause bone resorption and as a result, fatal complications prevail. We aimed to conduct a comprehensive review for pathogenesis of acquired cholesteatoma, bone resorption mechanisms, and offer a future vision of this serious disease. We have reviewed different theories for pathogenesis of acquired cholesteatoma including the most relevant and updated ones with special emphasis on the mechanisms of bone resorption through Medline/PubMed research using the keywords ‘aetiopathogenesis, bone resorption, acquired cholesteatoma, temporal bone, and cytokines.’ In order to strengthen our study, we searched the reference lists of identified reviews. Cholesteatoma is a subject of debate among otolaryngologists since it was prescribed firstly. Over many decades, several theories were postulated for aetiopathogenesis of cholesteatoma with a tendency to follow more than one theory to explain the proper nature of that disease. Until now, the mechanism of bone resorption has yet to be more clarified. In the last century, a leap has occurred in the field of biomolecular cholesteatoma research which improved our knowledge about its pathophysiology and bone destructive mechanism. However, surgery is still the only available treatment. We conclude that discovery of new therapeutic choices for cholesteatoma other than surgery by the use of anti-growth, anti-proliferative, apoptotic agents as well as medications that antagonize osteoclastogenesis should be the main concern in the future clinical and experimental research work. Also, searching for predictors of the aggressiveness of cholesteatoma can affect the timing of intervention and prevent occurrence of complications.

Evaluation of microalbuminuria in patients with systemic sclerosis as an indicator of early renal damage and increased morbidity

Renal involvement and systemic vascular damage have been shown to be significantly affecting prognosis in systemic sclerosis. Microalbuminuria detection in SSc patients as an indicator of early renal involvement and its correlation with various SSc clinical, laboratory parameters and severity of organ systems' damage assessed by Scleroderma Assessment Questionnaire. Forty SSc patients [33 females and 7 males] with mean age of 27.48 +/- 12.56 years and mean disease duration of 6.2 +/- 4.14 years were included. Twenty-four [60%] had lSSc; 13 [32.5%] had dSSc and 3 [7.5%] patients had SSc sine scleroderma. Eight [20%] had microalbuminuria and 9 [22.5%] patients had decreased creatinine clearance. Albumin/creatinine ratio was significantly higher among dSSc patients compared to those with lSSc and SSc sine scleroderma [X[2] = 9.077; p = 0.01]. Albumin/creatinine ratio showed significant positive correlations with telangiectasia [r = 0.322; p = 0.04] and mRodnan's skin score [r = 0.352; p = 0.026] and negative correlations with inter-incisor distance [r = -0.525; p = 0.001] and pleurisy [r = -0.446; p = 0.004]. Albumin/creatinine ratio correlated significantly and positively with IMSS and IDS indices of SAQ [r = 0.378, 0.32; p = 0.016, 0.044, respectively]. SSc patients with microalbuminuria showed significantly higher mean IDS than those without [1.058 vs. 0.631, p = 0.04]. No statistically significant correlations were found between creatinine clearance and the different demographic, clinical features and the indices of SAQ. Microalbuminuria compared to creatinine clearance may be a more sensitive indicator of early renal affection and predictor of increased morbidity

Sonographic, hysteroscopic, and pathologic findings in patients with abnormal uterine bleeding

Abnormal uterine bleeding AUB is the cause of gynecological referral in about 50% of perimenopausal women. The main aim in investigating this condition is to exclude focal, premalignant, or malignant endometrial disease. This is achieved via sonographic, hysteroscopic, and pathologic examinations. To evaluate the sonographic, hysteroscopic, and pathologic findings in women with AUB in a new one stop clinic. Prospective, observational study of 240 premenopausal and 55 postmenopausal consecutive patients with abnormal uterine bleeding. All patients 35 years or more with AUB not related to pregnancy were included. Exclusion criteria included active pelvic infection, severe cardiopulmonary co morbidity, cervical cancer, and initiation of contraception within the last 3 months. All the patients had vaginal sonographic examination, office hysteroscopy, and endometrial biopsy on one stop bases. Diagnostic indices of the different methods. Endometrial biopsy was the gold standard for diagnosing hyperplasia or cancer and combined hysteroscopy and biopsy 'was the gold standard for focal lesion and global endometrial disease. For focal lesion vaginal ultrasound had 42% sensitivity, 87% specificity, 3.2 positive predictive value, and 0.67% negative predictive value. Office hysteroscopy had corresponding figures of 91%, 100%, 91, and 0.09 respectively. Endometrial biopsy had corresponding figures of 17%, 100%, 17, and 0.83 respectively. Office hysteroscopy is the gold standard for diagnosing endometrial focal lesions and combined VUS and EB failed to detect more than 50% of them. This makes that 14% of patients wrongly diagnosed of being free of endometrial focal lesion. So, OH should be included in the initial evaluation of patients with AUB

Study on hymen: morphology, injuries of neonate and knowledge among students of faculty of nursing and education

Hymen is a thin membrane that surrounds the opening to a young Woman's Vagina, can present in different shapes. The most common hymen is shaped like a half moon. This shape allows menstrual blood flow out of girl's vagina [Adams, 2002]. Most Women are born with hymen, a thin piece of skin that partially covers the opening of the vagina [or introitus]. Hymen morphology has a medico-legal importance. Pediatricians are some times confronted with the challenge of documenting evidence of acute or chronic accidental or non accidental trauma to the hymen [Ann Saudi Med, 2001]. Identification of different types and percentage of hymen. Assess Knowledge of students about hymen in both Faculties Nursing and Education in Assiut University and Comparison between student's Knowledge indifferent years the [1st and 4th] years Faculty of Nursing to assess the improvements in their knowledge with program of study. A descriptive, analytic and retrospective design was used for this study The sample of this study was divided into three categories: A total of 220 consecutive girls [210 At birth 36 to 42 weeks of gestation and 10 from 8 to 12 month] were examined at labor ward, to observe hymnal configuration. A total of 20 defloration injuries who were recorded in statistical records from 3 December 2004 up to 3 December 2005. A total of 800 students were recruited for the study included [300 students from 1st year of faculty of Educations] and [500 students include 300 from the 1st year and 200 students from 4th year of faculty of Nursing]. Structured interviewing questionnaires Examination sheet of the hymen [At birth and one year of age] which include Gestational age Age of infant. Shape of hymen. The study result showed that annular configuration is the most common shape [79%] followed by posterior rim [12.7%], sleeve-like, fimbriated and cribiform hymen.-Distribution of defloration injuries who are recorded in statistical record 20 defloration injuries. Results of these students indicated that their mean age was [18.73 +/- 1.42] years. [64%, 55.5%, 50%] of the [1st and 4th grade]students Faculty of Nursing and the students Faculty of Education were residents in rural areas respectively-Regarding to the student's knowledge about the female genital organs, it was found that more than three quarters of the students [83.1%] had correct answer about female genital organs. The source of knowledge about female genital organs and hymen, it was found that [91. 4%] of the students had their knowledge from study books, mass media and teachers few students got their from house and relatives family. The student's knowledge about hymen, it was found that more than three quarters of the students [79.8%] know hymen. Beliefs about hymen, it was found that [72%] of the students defined it a thin membrane allows menstrual blood, [93.4%] that a sign of virginity and more than half of the students [55.5%] that has a different shapes of hymen. The causes of hymen tearing before marriage, it was found that [80.8%] of students mentioned that the main cause of hymen tearing before marriage was masturbation followed by illegal sexual relation, hard sports and [39.4%] by horse riding. Regarding to use of traditional method to rupture hymen in the wedding day, it was found that [100%] of the students didn't agree on use of traditional method to rupture hymen.-Regarding to relation between student's knowledge and parent's education, it was found that when parents were more educated, their daughters were bad information, it seems that education of the parents creates more barriers between their and their daughters, it also indicates that the education of the parents didn't necessarily to improve their knowledge. The comparison between class 1 and 4 of Faculty of Nursing, it was found highly percentage of knowledge about hymen in class 4 more than class 1 of Faculty of Nursing Finally the students need to know more information about hymen [definition, site, morphology, causes of hymen tearing before marriag

Quality of life of diabetic school students with type 1 diabetes mellitus in el behira governorate

Type 1 diabetes is one of the most common pediatric chronic conditions and has potentially life-threatening sequel. It is the most dramatic form of diabetes that has profound effects not only on children and adolescents' physical health but also their mental, emotional, social, and psychological status that in turn can affect one's quality of life. Many studies indicated that enhancing quality of life and well-being is as important as metabolic control and prevention of secondary morbidity. The present study was conducted to identify the quality of life among diabetic school age students in Elbehira governorate. The study was carried out on a sample composed of 300 diabetic students aged 10-15 years enrolled in governmental primary and preparatory schools in Elbehira governorate. The data collection process started from the end of December 2008 to the end of May 2009.Two tools were used to collect necessary information: Student's clinical data structured questionnaire and the generic KINDLR Quality of life Questionnaire.lt was developed by BulUnger and Ravens-Sieberer in 1994 to assess quality of life in chronically ill children including diabetes module. It includes 42 questions and six subscales; physical well being, emotional well being, self esteem, friends, family and school. It was translated into Arabic and used to collect data. The main results obtained from the study revealed that the age of students ranged from 10-15 years with a mean of 12.67 + 1.927. More than half of students [57.0%] were females, while the rest [43.0%] were males. More than half [54.0%] of them were enrolled in preparatory schools, and 46.0% were enrolled in primary schools. Two thirds [33.7%] of them had diabetes from 5-7 years, while 18.0% of them had diabetes for more than 7 years. The majority [83.0%] of them discovered the disease through appearance of clinical manifestation. More than three quarters [78.7%] of the students had poor knowledge about diabetes mellitus, while more than one fifth [20.7%] of them had fair knowledge and the rest of them [0.7%] had good knowledge. More than half [54.7%] of the students had fair self care practices, while more than one fifth [24.0%] of them had good self care practices and the rest [21.3%] of them had poor self care practice. More than two thirds [67.7%] of students had fair quality of life, while, more than one fifth [22.3%] of them had poor quality of life and the rest [10.0%] had good quality of life with a mean of 1.8840.556. Statistically significant relations were found between QOLscores and students' residence, father's education, mothers' education and working condition, crowding index, total self care practices score. No statistically significant relations were found between QOL scores and students' age, sex, scholastic year, birth order, consanguinity of parents, duration after diabetes diagnosis, method of disease discovery, total knowledge score. It can be concluded that type 1 diabetes affects all QOL dimensions, physical, emotional, self esteem, school, family and friends relations

Focus on the synthesis and reactions of some new pyridine carbonitrile derivatives as antimicrobial and antioxidant agents

3-[4-CHLOROPHENYL]-1-[2, 4-dichlorophenyl]-propen-1-one [1] was prepared and reacted with active methylene compound, ethyl cyanoacetate in the presence of ammonium acetate 10 give the corresponding pyridine carbonitrile [2]. The behavior of compound 2 towards phosphorous pentasulfide, phosphorous oxychloride and some acyclic-sugars has been investigated and afforded compounds 3, 4 and 5a-d, respectively. The thioxo-pyridine carbonitrile [3] reacted with different halo compounds namely: methyl iodide, ethyl chloroacetate, some acyclic sugars to afford 6, 7 and 8a-c, respectively. Treatment of compound 3 with acrylonitrile afforded compound 9. Reaction of the thiosulfanyl 6 with hydrazine hydrate gave the hydrazine derivative 10 while reaction of 7 with the same reagents gave the acid hydrazide 11. Also, compound 4 reacted with different nucleophiles to afford compounds 10, 12-14. Condensation of compound 10 with ethyl acetoacetate, acetyl acetone, acetic anhydride, p-chlorobenzaldehyde afforded compounds 15-18, respectively. Moreover, compound 10 reacted with carbon disulfide to afford compound 19. Finally, condensation of compound 10 with aldehydo-sugar namely: D-glucose gave the corresponding acyclic nucleoside 20. Furthermore, biological evaluation of some prepared compounds has been assessed and some of them revealed promising antimicrobial and antioxidant activity

Synthesis and reactions of some pyridopyrimidine and thienopyridine derivatives for antiviral evaluation

Compounds 6-amino-4-[4-chlorophenyl]-2-thien-2-ylpyridine5-carbonitrile [2] and 4-[4-chlorophenyl]-6-thioxo-2-thien-2-yll,6-dihydropyridine-5-carbonitrile [9] were prepaied using 3-[4-chlorophenyl]-l-thien-2-ylpropenone [I] and malononitrile or cyanothioacetamide, respectively. Pyridine derivative 2 was in turn used as a precursor for preparation of some pyridopyrimidine and fused pyridopyrimidine derivatives 3-8. On the other hand, the pyridine derivative 9 was used in preparation of thienopyridine derivatives 10 and 11. Moreover, fusion of compound 11 with excess of benzoyl chloride ' afforded 4-[4-chlorophenyl]-2-phenyl-7-thien-2-yl-3H-pyrido [3,2:4,5] thieno[3,2-d] pyrimidin-4-one [12]

Parathyroid hormone: effects on glucose homeostasis and insulin sensitivity in chronic renal failure patients on regular hemodialysis

To look into the relation between parathyroid hormone and abnormal glucose homeostasis in chronic renal failure patients on regular hemodialysis. 41 subjects, with chronic renal failure, and on regular hemodialysis [28 male, 13 female; age range 19-64 years]. Full history and clinical examination were taken for every patient. In addition, ten age and sex matched healthy persons were selected randomly as control group. Informed consent was obtained. All patients were investigated to determine serum creatinine, calcium, phosphorus, alkaline phosphatase, parathyroid hormone, fasting glucose, and fasting insulin. Homeostasis module assessment of insulin resistance was calculated as a measure of insulin resistance. Homeostasis module assessment of beta cell was calculated as a measure of pancreatic beta cell function. The uremic patients were classified into two groups: group A included 24 patients with plasma parathyroid hormone levels < 450 pg/ml and group B included 17 patients with plasma parathyroid hormone level >450 pg/ml. There is a marked increase in fasting insulin level in all patients versus control associated with increased homeostasis module assessment of insulin resistance, an index for insulin resistance. Significant negative correlation is found between parathyroid hormone and fasting insulin and homeostasis module assessment of insulin resistance in uremic patients. Patients with severe hyperparathyroidism have relatively more impaired pancreatic beta cell function in comparison to those with mild hyperparathyroidism. The pulsed dose of intravenous 1-cholecalciferol is associated with low parathormone level and high serum calcium. Insulin resistance is a constant feature of chronic renal failure patients under hemodialysis therapy, while secondary hyperparathyroidism is linked negatively to beta cell function. Intermittent pulsed intravenous alphacalcidol is an effective method of lowering high serum parathyroid hormone and is associated with improvement of beta cell function without significant effect on insulin resistance

Using blood pressure and urine output as a guide for the duration of magnesium sulphate therapy as a prophylaxis against seizures among patients with severe preeclampsia

To assess whether we can use blood pressure and urine output to adjust the duration at postpartum magnesium sulphate as a prophylaxis against seizures in patients with severe preeclampsia. This is a randomized control single blinded clinical trial held in Suez canal University hospital, Obstetrics and Gynecology Department. The study was carried on 150 of pregnant women attending the emergency delivery ward and are diagnosed as cases of severe preeclampsia distributed in three groups. The first group received magnesium sulphate as a 6 gm intravenous bolus loading dose then 1 gm/hour as a maintenance dose until the delivery time, then the regimen will be continued after delivery spontaneous onset of diuresis and, greater than 50% of the hourly postpartum blood pressures less than 150 mm Hg systolic and, less than 100 mm Hg diastolic [including the hour immediately before medication discontinuation], the second group received magnesium sulphate as a 6 gm intravenous bolus loading dose then 1 gm/hour as a maintenance dose until the delivery time then the regimen continued after delivery until the onset of diuresis only and the third group received a 48 gm of magnesuim sulphate. The results showed that no cases exposed to fits in group 1 and also no cases exposed to fits in group 2;: versus one case [3.3%] exposed to fits in group 3. There was only one as only one case that needed to reinitiate therapy in group 2 versus two cases needed to reinitiate therapy in group which is statistically insignificant. In group 2 there was one case needed to reinitiate therapy, so no effect on blood pressure or the need to reinitiate therapy by increasing the total dose as magnesium sulfate. There were no side effects at all from magnesium sulfate in group 1 and group 2, versus nine cases [30%] suffered from oliguria, two cases [6. 7%] suffered from hyporeflexia and three cases [10%] suffered from arrythmias in group 3. We can depend on diuresis alone as a dependable clinical parameter to withdraw magnesium sulphate safely without giving the patient unnecessary doses of the unsafe magnesium sulfate and without affecting the maternal outcome as no cases had postpartum fits and only one case needed to reinitiate therapy, although depending on diuresis and blood pressure to determine the duration of the therapy carries the same safety margin as diuresis alone and carries no more benefit over diuresis alone as magnesium sulfate not mainly an antihypertensive drug

Synthesis and reactions of 3-aryloxiran-2-y1 pyridin-2-y1 methanone. a novel synthesis of triazolopyrimidines and hexaazafluorenones for biological evaluation

3-aryloxiran-2-y1 pyridin-2-y1 methanones [Ia,b] were prepared according to our pervious workt [1-3], from arylidenepyridin-2-y1-methanone [4-5]. Compounds Ia,b reacted with different amines such as hydrazine hydrate, p-nitrophenyl hydrazine, hydroxyl amine, and thiourea to give pyrazolylpyridine, isoxazolyl pyridine, and pyridinylpytimidine-2-thione compounds Ia,b, IIIa,b, IVa,d, respectively. Compounds IVa,b were alkylated by methyl iodide to give methyl sulfanyl pyrimidine derivatives V[a,b] which were treated with hydrazine hydrate to give pyrimidinyl hydrazine compounds VIa,b The latter compounds reacted with carbon disulfide, ethyl chloroformate, and aromatic aldehyde in different conditions to produce pyridinyltriazolopyrimidinthione, and pyridinyl pyrimidinyl hydrazone, derivatives VIIa,b, VIIIa,b, and IXa,b, respectively. Compounds VIIa,b were treated with ethyl chloroacetate followed by hydrazine hydrate to give pyridinyl triazolopyrimidinyl acetic acid hydrazide compounds XIa,b which cyclized by using phosphorus pentoxide to give pyridinyl hexaazafluorenone derivatives XIIa,b. Compounds IXa,b reacted with thioglycolic acid to give [pyridinylpyrimidinyl amino]-thiazo1idinone derivatives XIIIa,b

Macro- and micromorphology of flacourtia cataphracta roxb cultivated in Egypt: stem, leaf, and stem-bark

The detailed macro-and micromorphological characters of the stems, leaves and stembark of Flacourtia cataphracta Roxb. [Syn. F. jangomas Raeusch] were studied with the aim to find out the diagnostic elements of these organs, which facilitate their identification in both entire and powdered forms

Vascular endothelial growth factor [VEGF]: an association with diabetic microvascular complications

Type 2 diabetes mellitus [DM] and hyperhomocysteinaemia are both associated with premature vascular disease. This study aimed to assess plasma total homocysteine [P tHcy] level in type 2DM and its relation to nephropathy and retinopathy. P tHcy level was estimated in 20 type 2 diabetic patients with retinopathy and microalbuminuria and 20 patients with retinopathy and macroalbuminuria versus 20 type 2 diabetics with no retinopathy nor nephropathy and 20 healthy controls matched for age, sex and race. Other assessment included funduscopic examination, complete urine analysis, estimation of urinary albumin excretion rate, blood urea, serum creatinine, crentinine clearance, fasting plasma glucose, glycosylated haemoglobin [HbA[IC]]. serum lipid profile. as well as ultrasonographic examination of the kidneys and renal arteries. Mean P tHcy concentration was significantly higher in both the albuminuric groups than in normal albuminuric. group and controls, however mean P tHcy was inversely correlated with creatinine clearance versus no correlation with the other studied parameters, and no relation to retinopathy. Creatinine clearance is the only parameter associated with P tHcy, denoting that the degree of renal functional impairment is the determinant of its plasma concentration in patients with type 2 DM

Vascular endotheliaf growtli factor [VEGF]: an association with diabetic microvascular complications

The mediators of diabetic microvascular complications remain largely unknown. As diabetic stinopathy is associated with ischaemic changes followed by neovascularization, a role has been proposed for vascular endothelial growth factor [VEGF] its pathogenesis. Subjects and Serum EGF levels were studied in 55 diabetic patients at ferent stages of their disease and microvascular mplications. It was first noted that ciculating VEGF levels were significantly higher in betic patients [421 +/- 309 pg/ml, mean +/- SD] npared to controls [188 +/- 145 pg/ml], P < 0.05. ther analysis showed VEGF levels to be highest in] etic patients with proliferate retinopathy 1 +/- 376 pg/ml]. The level in those with and without background retinopathy was comparable to that of controls [379 +/- 250 pg/ml]. A significant rise in serum VEGF was also detected in patients with significant proteinuria [662 +/- 276 pg/ml]. The level in those with icroalbuminuria was comparable to that of controls [375 +/- 273 pg/ml]. A positive, albeit weak, correlation was noted between serum VEGF and urinary albumin excretion [r= 0.27, P < 0.05]. This study confirms raised circulating level of VEGF in diabetic patients with advanced microvascular disease [proliferate retinopathy and established nephropathy]

In vivo effect of [50Hz] magnetic Filed on concentration of trace elements concerned with hemoglobin formation

The present in vivo experiment was designed to establish whether the exposure to 50 Hz magnetic field induces changes in blood and organs store of trace elements concentrations possibly associated with changes in hemoglobin level and induction of anemia. Rats were exposed to a high magnetic field strength of 0.5 T for one hour daily, the experiment was conducted for 30 days. Thirty-six rats were divided into control and magnetic field exposed rats. Iron, copper and zinc concentrations in blood, liver, kidney and spleen were estimated to assess the magnetic field effect on trace element storage in these tissues. MF exposure resulted in a depletion of the organs store of trace elements. A highly significant increase in blood copper and a decrease in zinc and iron levels were detected. A significant decrease was found in the hematological parameters, ceruloplasmin and ferritin [iron metabolism parameters]. The changes observed were associated with anemia during the first 14 days of MF exposure. The magnitude of anemia increased with increasing the exposure time

Some reactions of 3-methyl- 1- phenyl-4- [phenylamino-thiocarbonyl] -2- pyrazolin-5-one

The title compound 1 was prepared via reaction of 3-methyl-1-phenyl-2-pyrazolin-5-one with phenylisothiocyanate. Then, it was converted to pyrazolopyrazole, pyrazolopyrimidine, pyrazolopyridine, and the amino derivatives through reaction with hydrazines, urea, thiourea, malononitrile and aromatic amines. Compound [1] prepared via addition of activated nucleophilic carbon of 3-methyl-1-phenyl-2-pyrazolin-5-one to the electrophilic carbon of phenylisothiocyanate seemed to be suitable to annulation through its reactive center. The reaction of [1] with hydrazine hydrate and phenyl-hydrazine in boiling ethanol gave the pyrazolopyrazole derivatives [2a] and [2b], respectively. The mass spectrum of [2a] showed the parent ion peak at m/z 289 and the following abundant peaks 185, 105, 91, 77, and 51. Structure of [2a] was further established by its reaction with ethyl bromoacetate to give [3]. The latter afforded the hydrazide derivative [4] on reaction with hydrazine hydrate

standard policy of use of WHO partograph in the active management of labor

This study evaluated the introduction of active standard management policy of labor in a large teaching hospital. In the first six months of the study, a partograph without preset lines was used, but acceleration was practiced without standard guidelines [Group I: 636 patients]. In the following six months, the WHO partograph with a present alert and action lines and an active management protocol were used [Group II: 630 patients]. There was a significant reduction of the duration of labor in group II and labors lasting more than 12 hours were reduced from 15% to 4.4% in primigravida and from 6.9% to 1.5% in multipara. The increased use of amniotomy to augment labor in group II led to a significant reduction in the use of oxytocin. The number of instrumental and abdominal deliveries also decreased. The frequency of babies with respiratory depression at birth was also reduced

Reliability of ultrasound in the assessment of cervical incompetence

This study included 40 pregnant women with cervical incompetence and 60 women with normal pregnancy. In normal pregnancy the mean internal os diameter was 11.5 +/- 3.0 mm during the 1st trimester and 14.5 +/- 3.2 mm during the 2nd trimester. In women with cervical incompetence these measurements were 17.9 +/- 3.6 mm during the 1st trimester [P < 0.001] and 20.1 +/- 3.4 mm in the 2nd trimester [P-< 0.001]. When a cut-off point of 15 mm was used as a threshold for diagnosing the condition in the first trimester, it produced a sensitivity of 87.5% and a specificity of 86.7% with a false negative rate of 12.5% and a false positive rate of 13.3%. In the 2nd trimester a threshold of 20 mm produced a sensitivity of 50% and a specificity of 96.7% false negative rate 29.3% and 7.7% false postitive rate. These false rates were higher than could be acceptable as a screening test for cervical incompetence