Impact of donor and recipient sex on outcomes of HLA-identical sibling allogeneic hematopoietic stem cell transplantation

Hematopoietic cell transplantation [HCT] is well established as therapy for hematologic malignancies as well as many non-malignant disorders. Donor selection is an important way to decrease the risks after HSCS and is therefore a key component of the clinical practice of transplantation. There are many criteria proved or hypothesized to affect outcomes after SCT and one of these, sex is the most controversial. Some investigators have found an increased risk of acute or chronic graft-versus-host disease [GVHD] associated with donor sex. Transplantation of stem cells from a female donor to a male recipient is a special circumstance in which donor T cells specific for minor H antigens, encoded by genes on the recipient Y-chromosome that are polymorphic to their X-chromosome homologues, may make a contribution to GVHD and GVL activity. Investigate the effect of donor and recipient sex mismatch on outcomes of HLA-identical sibling allogeneic stem cell transplantation. This study was carried on 82 patients selected from patients who had underwent a myelo-ablative preparative regimen for a hematologic malignancy and received HSC transplant from an HLA-identical sibling being divided into 2 groups: 1st one with a female donor to a male recipient and 2nd one include otherwise. Both groups will be subjected to HLA tissue typing, CBC, Bone marrow aspirate evaluation, PT and PTT, blood culture when needed, SGPT, SGOT, ALP, blood urea, s.creatinine, urine analysis, pulmonary function tests, chest x-ray, echocardiography ECG, CMV-, EBV-, VZV-, Toxoplasma- antibodies [IgG, IgM], HBs-Ag, HBs-Ab, and HCV-Ab. After variables controlling for patient and donor, there was an increased risk of acute GVHD in patients who received grafts from female donor being 18% for patients receiving grafts from female compared with 8% for recipients of male grafts. Donor sex was also an important influence on risk of developing chronic GVHD with cumulative incidences of chronic GVHD 9.7% for patients receiving transplants from male donors grafts compared to 24.3% for recipients of female donor grafts. We found that male recipients of grafts from female donors had a significantly higher probability for acute and chronic GVHD than male recipients with male donors or female recipients with female donors and despite the beneficial GVL effect observed in male recipients with female donors, these patients had significantly reduced survival compared with all patient/donor sex combinations, suggesting that other variables, particularly GVHD, contribute to transplantation-related mortality

Maternal serum biochemical markers as a predictor for adverse pregnancy outcome

To establish reference values of assaying some maternal serum biochemical markers, namely; MSAFP. MSHCG, uE3 and PAPP-A: at 10-20 weeks gestation; among healthy pregnant women and observe the relationship of such markers to predict adverse pregnancy outcome. This is a prospective randomized controlled study conducted in the Obstetrics and Gynecology Departments at AL-Azhar and Cairo University Hospitals during a period of two and half years starting January 2003. Three hundreds healthy pregnant women from those attending the antenatal clinics were participated in this study. Their age ranged between 20-38 years. They all had a spontaneous pregnancy in singleton with gestational age of 10-20 weeks gestation at the time of study. This was confirmed by ultrasonic scanning. Pregnancy outcomes were obtained for all women. The incidence of adverse pregnancy outcome namely: miscarnage, preterm delivery, intrauterine growth restriction [IUGR], intrauterine fetal death [IUFD]. pregnancy induced hypertension [PIH] and congenital malformation were evaluated. Blood samples were withdrawn and sera were separated for estimation of levels of maternal serum alpha fetoprotein [MSAFP], unconjugated estriol [uE3], free 3-human chorionic gonadotropin [beta-hCG] and pregnancy associated plasma protein-A [PAPP-A]; using time resolved flouroi mmunoassay technique. Our study showed, unexplained significant elevations of MSAFP and serum 3hCG levels with adverse pregnancy outcome [miscarriage, preterm delivery, IUGR, IUFD]. Low unconjugated estriol levels, was associated with adverse pregnancy outcome except for preterm delivery. Maternal serum levels of PAPP-A were found to be significantly decreased in all adverse pregnancy outcome except in PIH. Combinations of maternal serum markers for prediction of adverse pregnancy outcome were compared. Increased maternal serum AFP and 3hCG were significant only for miscarriage and preterm delivery, whereas increased MSAFP and decreased uE, was significant for all adverse pregnancy outcome except for preterm delivery. Increased levels of MSAFP and decreased levels of PAPP-A was only significant with PIH. Whereas increased levels of beta hCG with decreased uE3 levels was significant for all adverse pregnancy outcome except for preterm delivery and PIH. The combination of increased beta hCG levels and PAPP-A were not significant correlated to adverse pregnancy outcomes. combined maternal serum four markers can be used not only for the detection of fetal structural and chromosomal anomalies but also for early prediction and detection of high risk pregnancies

Cartilaginous sddle-nose deformity, the"umbrella technique", a new foundation technique for correcting the deformity

The saddle-nose deformity has always been an enormous challenge for rhinoplasty surgeons. The predominant cause has progressed from disease to trauma to now surgery, whereas the treatment has shifted from complex flap reconstructions to restoration of septal support [1] In modern era, major contributions have come from Sheen and Sheen[2], Mayers [3], Tardy et al. [4], and Gunter et al. [5] The most common combination is an initial nasal trauma followed by extensive surgical treatment. One important observation is that there are very few "pure" saddle-nose deformities, either etiologically or surgically. Therefore, one must be prepared to use a component approach to each defect and design an individualized operative solution for each case. As a consequence of the virous abnormalities involved in complex saddle-nose deformities, several structures of the nose need to be corrected, resulting in an intricate surgical procedure. To improve practicality of the complex surgical procedure, Rettinger [6], has divided the course of surgery into 3 separate reconstructive steps, offering the surgeon a standardized technical principle. In the current study, a new technique has been used to correct post operative and traumatic cartilaginous saddle 11 nose deformity " the umbrella technique ". Autogenous cartilage graft material [septal or conchal] has been used to regain septal support which was compromised sutured to butterfly camouflaging graft dorsally at the area of saddling and columellar strut is used. Forty two patients with post operative or traumatic cartilaginous saddle- nose deformity underwent correction of their deformity using this technique. 17 patients were male and 25 were female. They were followed up for 12-18 months. Additional surgical procedures were nasal septum correction, additional nasal tip graft, osteotomy, correction of deformed nasal alae, and correction of vestibular stenosis

Evaluation of the effect of four maternal positions on the duration of the second stage in nulliparous women

For centuries, there has been controversy around whether being.upright [standing, sitting, birthing stools, chairs, squatting] or lying down [supine, left lateral, lithotomy] have advantages for women delivering their babies To assess the benefits and risks of the use of different positions during the second stage of labor. The primary outcome was the duration of the second stage. Secondary outcomes were incidence of operative delivery, incidence of perineal and vaginal tears, estimated blood loss during the third stage and Apgar score This prospective randomized study was carried out at the Department of Obstetrics and Gynecology of the Shatby Maternity University Teaching Hospital in Alexandria, Egypt between 1998 and 2002. The study was carried out on 2080 nulliparous women who reached the second stage of labor with alive, full term, singleton fetus presenting with cephalic vertex presentation and with estimated average fetal weight. Women with medical or obstetric risk factors were excluded. Five hundred and twenty cases were randomly allocated into one of 4 groups. Group I cases used squatting position and group II cases used sitting position. Standing and lithotomy positions were the positions taken by cases in groups III and IV respectively There was no significant difference between groups concerning gestational age, estimated fetal weight by ultrasonography, head station and uterine activity. The shortest mean duration of the second stage was observed among cases in group I [30 [6 minutes] while the longest duration was observed among cases in group IV [100 [25 minutes]. In group II the second stage lasted 60 [15 minutes while in group III the second stage lasted 40 [12 minutes. A statistically significant decrease for the use of medical analgesia [p=0.0001] and oxytocin [p=0.0001] [was observed in women using the upright birth position. A significantly lower rate of operative delivery was detected in women who delivered in an upright position [groups I, II, III] compared with women delivering in lithotomy position [group 1V] [p=0.0001]. The frequency of perineal tears, and vaginal and labial trauma did not differ between the four groups [p>0.05]. When analyzing maternal blood loss in the third stage, no significant differences between all groups were found [p>0.05]. No differences in APGAR score <7 at 1 and 5 minutes or cord pH <7.1 were observed [p>0.05] between groups Maternal position during the second stage of labor definitely affects the duration of the second stage. Upright posture [squatting, standing, and sitting] were associated with shorter duration of the second stage in comparison to lying down [lithotomy position]. Also upright posture was associated with lower incidence of operative delivery

number needed to treat and time to relinquish oxytocin. A randomized clinical trail

To evaluate the use of oral misoprostol for cervical ripening and labor induction in term pregnancy with intact and ruptured membranes, we selected two hundred primigravidae at term admitted to El Shatby maternity hospital fulfilling our selection criteria. All subjects were randomly assigned to receive either 100ug misoprostol orally that was repeated every 4 hours till adequate contraction pattern occured or to receive 2 mIU/minute of oxytocin that was increased at 30 minutes interval till adequate contraction pattern was achieved. The mean induction-delivery time was significantly shorter in the misoprostol group, [t=12.36, 4.69 and 6.067 for all women, women with intact membranes and women with premature rupture of membranes respectively]. The percentage of normal vaginal delivery was significantly higher in the misoprostol group, [X2 =10.6, 2.915 and 10.0 respectively]. The duration of the 3rd stage was significantly shorter for the misoprostol group, [t = 4.26, 2.019 and 0.928 respectively]. There was no significant difference between the two studied groups as regards abnormal fetal heart rate, the occurrence of hypertonus, the percentage of retained placenta and the occurrence of post-partum hemorrhage. Apgar score and neonatal admition to neonatal intensive care unit were not significantly different between the two studied groups. Oral misoprostol is superior over oxytocin in labor acceleration in both women with intact or rupture membranes

Bilateral panuveitis as a presentation of the sero-negative stage of HIV infection

We described the clinical picture of the eyes together with the laboratory findings of an African adolescent during the sero-negative stage of HIV infection who presented clinically with bilateral panuveitis with mild reaction in both the anterior chamber and vitreous. The fundus showed plaques that could be cotton-wool spots and pigmentary changes. Based on the presence of eosinophilia, a drop T-helper / T-suppressor together with a drop of B-cell total number, absent delayed hypersensitivity together with multiple opportunistic infections in the form of toxoplasmosis, the case was diagnosed as acquired immune deficiency [AIDS]. The patient was sero - negative at presentation, but sero-conversion occurred five months later. The importance of antigen detection in cases of suspected immunodeficiency is emphasized