Dentists' perception of primary health care services in family health and mother and child health clinics in Alexandria, Egypt

This study compared dentists' perceptions of provided services in Family Health [FH] and Mother and Child Health [MCH] clinics. A questionnaire was distributed to 120 dentists in 7 FH and 4 MCH clinics in Alexandria, Egypt in 2012. The questionnaire assessed personal and professional background, perceptions of primary health care [PHC] role, types of services provided, patient recall and referral systems and perception of service quality. The response rate was 100%. More FH dentists perceived their role to include providing care for children and pregnant women. Restorations and scaling were provided by 90% of all dentists. More FH dentists reported providing simple extractions, paediatric extractions and multi-rooted endodontic treatment [P = 0.03, 0.001 and 0.001]. In FH clinics, where the performance-based incentive system was implemented, a greater number of patients was served and there was a shift in the type of services provided although dentists had a less positive perception of quality aspects. Thus, there is a need for the establishment of a mission and clear guidelines for the FH clinics to guide service provision

Thiobarbituric acid reactive substance [TEARS] a marker of oxidative stress in obstructive sleep apnea

OSA is a common condition that is primarily characterized by intermittent and recurrent pauses in respiration results in multiple cycles of hypoxia/re-oxygenation with an increased production of reactive oxygen species [ROS]. Is to assess TEARS as a marker of oxidative stress in obese patients with and without OSA. Study was performed on 51 obese subjects who had been referred to the Chest Department of Kasr Alaini Hospital with clinical suspicion of OSA in order to perform pol-ysomnography. They were classified into two groups; Cases: consist of 33 obese patients who were diagnosed as obstructive sleep apnea [OSA] and Controls: consist of 18 obese subjects, without OSA as a control group. The two groups were subjected to polysomnograpic study and serum TEARS. There was statistically highly significant increase in Epworth sleepiness scale [ESS] among cases compared to controls. As regards the polysomnographic data, there was statistically highly significant increase in AHI, desaturation index and duration of desaturation < 90% among cases compared to control subjects. While minimal O[2] sat% and average O[2] sat% were lower in cases than in the control subjects this reduction was statistically significant. There was statistically highly significant increase in serum TEARS levels among cases as compared to controls. There was a statistically significant positive correlation between grade of obesity and serum TEARS among studied cases. TERAS could be used as a marker of oxidative stress in OSA

Insulin resistance in obstructive sleep apnea

OSA is a common condition that is characterized by intermittent and recurrent pauses in respiration results in multiple cycles of hypoxia/reoxygenation with an increased production of reactive oxygen species [ROS]. Is to assess serum insulin level and insulin resistance in obese patients with and without OSA. Study was performed on 51 obese subjects who had been referred to the Chest Department of Kasr Alaini Hospital with clinical suspicion of OSA in order to perform polysomnography. They were classified into two groups; cases: consist of 33 obese patients who were diagnosed as obstructive sleep apnea [OSA] and controls: consist of 18 obese subjects, without OSA as a control group. The two groups were subjected to polysomnographic study, serum insulin by ELISA and assessment of insulin resistance by calculation of HOMA index. There was statistically highly significant increase in Epworth sleepiness scale [ESS] among cases compared to controls. As regards the polysomnographic data, there was statistically highly significant increase in AHI, desaturation index and duration of desaturation < 90% among cases compared to control subjects. Regarding minimal O2 sat% and average O[2] sat% were lower in cases than in the control subjects and this reduction was statistically significant. There was statistically highly significant increase in serum insulin, HOMA index among cases as compared to controls. Insulin resistance in OSA is related to sleep associated hypoxemia and hypoxic stress

Clinico-pathological profile of bronchogenic carcinoma cases presented to Chest Department, Cairo University in the last 10 years

Introduction: Lung cancer was the most commonly diagnosed cancer as well as the leading cause of cancer death in males in 2008 globally

Aim of the work: To evaluate the clinico-pathological profile of the bronchogenic carcinoma cases in the Chest Department, Cairo University

Patients and methods: Retrospective study was carried out in the Chest Department, Cairo University, in which four hundred and four confirmed cases of bronchogenic carcinoma were admitted during July 2002 till July 2012. Data regarding demographics, smoking, histology, clinical presentation, radiographic findings are reported

Results: Our study included 404 confirmed cases of bronchogenic carcinoma. Male to female ratio was 4.6:1. The highest incidence was in the sixth and seventh decades of life [63.6%]. Smoking was found to be the main risk factor in 75.7% of patients. Cough was the most common symptom found in 347 patients [85.9%], followed by dyspnea in 276 patients [68.3%]. Most common radiological finding was mass lesion [49.8%]. Majority of cases were diagnosed by bronchoscopy [68.1%]. Four types of bronchogenic carcinoma were found: squamous cell carcinoma 37.4% adenocarcinoma 29.5%, small cell carcinoma 14.9%, large cell carcinoma 7.2% and undifferentiated carcinoma 11.1%. In females, adenocarcinoma was the predominant cell type [54.2%] while in males, squamous cell carcinoma was the predominant cell type [42.5%]

Conclusion: Bronchogenic carcinoma is more frequent beyond the middle age. Smoking is still the major risk factor. Adenocarcinoma is more common in females and was the most frequent tumor in non-smokers, while in males, squamous cell carcinoma is still the predominant cell type

Purification and characterization of camel liver L-asparaginase

L-asparaginase from camel liver was isolated and purified by heat denaturation followed by QAE-Sephadex A-50 column chromatography and SP-Sepharose column chromatography. The purified camel liver L-asparaginase had a molecular weight of 180 kDa [consistent with a homotetramer] and a pI value of 8.6. The enzyme was thermostable with relative structure rigidity and an optimum temperature at 65°C. It had a pH optimum at 9.6 and was stable for storage at 4°C in the refrigerator for 7 days

Expression of recombinant escherichia coli L-asparaginase II, purification and characterization

L-Asparaginase [ASNase] is an anti-cancer [[antineoplastic] or [cytotoxic]] chemotherapy drug that is used for the treatment of acute lymphoblastic leukemia [ALL]. An efficient and economical scheme was developed for over expression and rapid purification of the Escherichia coli enzyme. The gene encoding for the Escherichia coli L-asparaginase was PCR-amplified and cloned in pGEX-4Tl expression vector. The recombinant L-asparaginase was purified to homogeneity by affinity chromatography on glutathione Sepharose column. The recombinant enzyme had an apparent MW of 152 kDa and a K[m] value of 12.5 microM for the main physiological substrate L-asparagine. The pI value was 5.6 while the turnover number [catalytic constant] was 1 x 10[2] s[-1] and the K[cat]/K[m] value [specificity constant] was 0.8 x 10[7] M[-1]s[-1]

Identification and evaluation of antigenic epitopes of total soluble extract and adult worm vomit for immunodiagnosis of human fascioliasis

Fascioliasis is an important worldwide herbivores infection with increasing evidence of prevalence as a human disease. There is an important necessity to develop sensitive and specific diagnostic tools for early treatment and to avoid complications. This study is directed to identify, characterize and evaluate the immunodiagnostic potential of the total soluble extract [TSE] and the adult worm vomit [AWV] antigens of worm using immunoblotting of total IgG and IgG4. Sixty individuals, 29 positive for fascioliasis by IHAT [Group I], 15 positive for other parasitic infections [Group II] and 16 normal controls [Group III], were included. Both TSE and AWV antigens were analyzed by SDS-PAGE. All sera were immunoblotted against the two antigens using total IgG and IgG4. Total IgG immunoblotting using TSE antigen at 62 kDa gave sensitivity, specificity, positive value predictive [PVP] and accuracy of 72.5%, 100%, 100% and 82.2%, respectively. These values were 62.5%, 100%, 100% and 81.2%, respectively with AWV antigen at 56 kDa. IgG4 immunoblotting using TSE antigen gave sensitivity, specificity, PVP and accuracy of 100%, 93.3%, 96.6% and 97.8%, respectively at 60 kDa, while AWV antigen gave no reaction with IgG4 antibody. Total IgG immunoblotting using TSE antigen at 62 kDa and AWV antigen at 56 kDa proved to be valuable as diagnostic tests for human fascioliasis

Tissue factor, tissue factor pathway inhibitor and factor VII activity in cardiovascular complicated type 2 diabetes mellitus

Tissue factor [TF] is the main initiator of the extrinsic coagulation pathway through factor VII [FVII] activation, which is physiologically inhibited by tissue factor pathway inhibitor [TFPI]. Alteration of this pathway has been described in Type 2 diabetes mellitus [T2DM]. The aim of this study is to assess TF and TFPI plasma levels and FVII coagulant activity [FVIIa] in T2DM in relation to cardiothrombotic disease and their correlation to metabolic and clinical behavior of the patients. The study was conducted on 80 T2DM patients divided to accordingly; groupI: 40 patients without a history or clinically detected heart disease, and groupII: 40 patients with a history of myocardial infarction compared to 30 controls. The patients were recruited from Ain Shams University diabetes clinic from September 2007 to February 2009 after informed consent was obtained. Peripheral blood samples were taken for measurement of plasma TF and TFPI levels using ELISA technique and quantitative FVIIa using FVII deficient plasma. Plasma levels of TF, TFPI and FVIIa were significantly higher in T2DM patients compared to the controls [p<0.001]. TF [236.50 +/- 79.23]and TFPI [242.33 +/- 85.84]were significantly higher in group II, compared to group I [150.33 +/- 81.16], [152.8 +/- 82.46], [p<0.001]. TF and TFPI were significantly correlated to body mass index and glycemic control. Also, TF and TFPI were significantly higher in hypertensives [p=0.001] and dyslipidemics [p=0.006] but not in smokers [p=0.64], [p=0.11] respectively. There was a correlation between high TF, TFPI plasma levels, FVIIa activity and cardiothrombotic complications in T2DM especially in the presence of high risk factors such as poor glycemic control, dyslipidemia and obesity. Future target therapy against TF may be beneficial for T2DM patients

Angiotensin converting enzyme [ACE] l/D gene polymorphism in children with idiopathic nephrotic syndrome

Various genetic markers have been studied to predict susceptibility and course of nephrotic syndrome. The Angiotensin-converting enzyme [ACE] gene carries insertion [I] and deletion [D]polymorphism within its intron 16. The presence of D-allele in the ACE gene has been reported as a probable genetic risk factor for idiopathic nephrotic syndrome [INS] and may be also related to poor responsiveness to steroids which is the single most important clinical parameter in determining the course of the disease. The aim is to determine the distribution of the ACE gene insertion/deletion [l/D] polymorphism, and its effect on clinical, laboratory, histological findings and therapeutic response in childhood INS. Fifty one nephrotic syndrome patients [35 males and 16 females] were enrolled in the study. All patients received oral steroids as in initial therapy for their nephrotic syndrome. The pattern of response to steroid therapy was determined and patients divided into 2 groups: steroid sensitive [SS] and non-steroid sensitive [non-SS]. The non-SS group was further divided into steroid dependent [SD] and steroid resistant [SR] patients. Clinical, laboratory and histological features were determined. Fifty unrelated healthy adults were recruited as controls. The genotypes for ACE l/D polymorphism were analyzed by using a PCR based method. Twenty patients were SS and 31 were non-SS, of the non-SS group, 18 were SD and 13 were SR. The presence of hypertension at presentation was significantly related to steroid unresponsiveness. Among the SS group the frequencies of the Ii, ID, and DD genotypes of the ACE gene were 20%[n=4], 65%[n=13] and 15%[n=3], respectively, while the frequencies among the Non-SS group were 19.4%[n=6], 74.2%[n=23] and 6.5%[n=2], respectively. The differences between the two groups were statistically insignificant [Chi square=0.59]. The corresponding incidence for control was 12%, 68% and 10% respectively. The differences between controls versus the entire patient group, the SS group and the non-SS group were not statistically significant [p value>0.05 in all]. The frequency of D+genotype was 80%[n=16] in the SS group compared to 80.6%[n=25] in the Non-SS group, the difference between the two groups was statistically insignificant [Fisher's exact=1]. The pattern of the ACE gene polymorphism showed insignificant correlation with age of onset of the disease, hypertension at presentation, stability of renal functions and renal biopsy results. The current study on Egyptian children with INS reveals no association between ACE gene l/D polymorphism and clinical, histological findings, steroid responsiveness, or progression of the disease These results are at variance with reports from other parts of the world suggesting that the impact of ACE gene polymorphism on pediatric INS is likely to be influenced by the ethnic origin. Results of this study revealed an association between hypertension at presentation and non-responsiveness to steroid. Patients with steroid non responsiveness were more liable to develop impaired renal function

Combined general anesthesia and peribulbar block with ropivacaine and colonidine in patients undergoing retinal detachment surgery

The aim of this study was to evaluate the effects of peribulbar injection of 1% ropivacaine and hyaluronidase with 0.5 microg/kg clonidine combined with GA on the occurrence of oculocardiac reflex, IOP, surgical bleeding, postoperative pain, and occurrence of postoperative nausea and vomiting [PONV]. We enrolled 60 patients scheduled for primary retinal detachment surgery. They randomly allocated to one of two groups to receive either GA plus PB block by 1% ropivacaine and hyaluronidase 16 lU/mL with clonidine in a dose of 0.5 micro g/kg [PB group, n= 30] or GA alone [control group, n = 30]. In the PB group, the incidence of oculocardiac reflex was decreased; intraocular pressure and surgical bleeding were reduced. Immediate postoperative pain scores were lower, and the time of administration of the first postoperative analgesic was longer. Both the number of patients who required an analgesic supplement and the total amount of additional analgesic requested were smaller in the PB group. The two groups were similar with respect to the incidence of postoperative nausea and vomiting. PB block combined with GA was superior to GA alone for retinal detachment surgery with scleral buckling, resulting in less intraoperative bleeding and less incidence of intraoperative occurrence of oculocardiac reflex and also improving postoperative analgesia

Central corneal thickness [CCT] as an additional parameter to monitor childhood glaucomas after glaucoma surgery

The purpose of this study was to investigate the role of CCT as an additional parameter to monitor childhood glaucomas after glaucoma surgery. This study included postoperative 18 eyes of 10 children [8 with bilateral glaucoma and 2 with unilateral glaucoma], All children were operated with one surgeon and with one technique which was combined trabeculotomy-trabeculectomy [CTT] with mitomycin C [MMC] 0.3 mg/ml. IOP and CCT were evaluated 1-3 weeks post-operatively. Overestimation of IOP was found in 13 out of 18 eyes [72,2%] included in the study, 2 eyes with aniridia, 2 eyes with aphakia and 9 eyes with residual clouding of the cornea post-operatively. Underestimation was found in 3 out of 18 eyes [16.7%] of the study all of them had clear cornea post-operatively while no changes of IOP according to corneal thickness was found in 2 out of 18 eyes [11.1%]. From the results of this study we can conclude that central corneal thickness measurement should be considered as an additional parameter when evaluating IOP in congenital glaucoma

Matrix metalloproteinase-1 in camel liver tissues: isolation, purification and some characterization

Matrix metalloproteinases [MMPs] constitute a multigene family of over 25 secreted and cell surface enzymes that process or degrade numerous pericellular substrates. Their targets include other proteinases, clotting factors, cell surface receptors, and virtually all structural extracellular matrix proteins The MMPs play a vital role in cellular functions as cell proliferation, tissue development, wound healing and tissue repair. In this study, a trial was carried out to isolate matrix metalloproteinase-l [MMP-1: collagenase, EC 3.4.24.7] from camel liver tissues [CaInelus dromedarius] in a small scale purification technique using ammonium sulphate fractionation, gel filtration on Sephadex G-100 and Bio-Gel A-1.5m column chromatographies. The homogeneity of the purified preparation was judged by polyacrylamide gel electrophoresis [PAGE] in the presence and absence of SDS and beta-mercaptoethanol. The enzyme is heterodimer and the molecular weight [M[r]] of the two subunits are 67 and 30 kDa, while that of the native enzyme is 97 kDa. The optimum temperature was in the range of 30-40°C EDTA was more potent inhibitor than DTT for enzyme activity

endothelial nitric oxide synthase gene intron 4 polymorphism in Egyptian patients with end-stage renal disease

Nitric oxide [NO] synthesized by endothelial cell NO synthase [ecNOS] is a potent regulator of intrarenal haemodynamics. A polymorphism in intron 4 of the ecNOS gene is a candidate gene in renal diseases. The aim of this work is to study the gene polymorphism of ecNOS intron 4 in patients with end-stage renal failure and compared it with that of healthy subjects. The study was performed on 40 patients with end stage renal disease [ESRD] patients on regular hemodialysis, and was classified into 2 groups: Group I ESRD patients with diabetic nephropathy [10 patients] and group II includes 30 patients with ESRD due to different etiologies [all causes except diabetic nephropathy], and group III 15 apparently healthy subjects as control group. ecNOS genotypes were determined using polymerase chain reaction. The results showed that two alleles of ecNOS intron 4, labeled a and b could be detected. The frequencies of aa, ba, bb genotypes were 5% [2/40], 12.5% [5/40] 82.5% [33/40] in all the patients, 3.3% [1/30], 13.3% [4/30], 83.3% [25/30] in-group II patients, and 10% [1/10], 10% [1/10] 80% [8/10] in group I patients respectively, and in the control group all were bb100% [15/15]. There is significant difference in the frequencies of ecNOS genotypes between all ESRD patients and the control group [OR 1.423; 95% CI 1.253-1.615, p<0.01]. Compared with controls; the group I patients had much higher frequency of the ecNOS 4a allele than in-group II patients [OR 2.765, 1.556, 95% CI 1.891-4.042, 1.423-1.615, p<0.001, p<0.01] respectively. There was a significantly higher frequency of the ecNOS 4a allele among ESRD patients both diabetic and non-diabetic than in control subjects. This suggests that the ecNOS gene polymorphism in intron 4 appears to be prognostic of renal failure and the ecNOS gene polymorphism in intron 4 is a useful parameter for studying the relationship between NO and the progression of renal failure. This suggests that the ecNOS gene polymorphism might be associated with an increased risk of chronic renal failure

[Cardiac hydatidosis revealed by tamponnade - about a case]

The hydatid cyst of heart is rare Its clinical presentation is not specific Its complications are serious The authors report an original observation in a 85 year old who presented with tamponnade The diagnosis is posed by scan This observation underlines the rare cardiac involvement, the seventy of the complications and the limits of the echocardiography like diagnostic means

effect of vitamin E administration on cisplatin-induced oxidative and histopathological damage of kidney, liver and lens tissues in albino rats

Cisplatin is one of the most active cytotoxic agents in the treatment of cancer but its clinical use is associated with toxicity. The present study evaluated biochemically and histologically the effect of vitamin E as a line of prevention of cisplatin toxicity in rats. Its was carried out on 90 adult male albino rats divided into 6 groups each contains 15 rats, the first group was used as-ve control, the second group received distilled water 1ml/animal intraperitoneally [IP], the third group received corn oil 0.25 ml/animal orally,the fourth group received vitamin E 100 mg/kg orally. Animals of groups II, III and IV served as +ve controls. The fifth group received cisplatin 5 mg/kg IP and the sixth group received vitamin E 100 mg/kg orally 24 hours prior to IP cisplatin 5 mg/kg. After 7 days of treatment, rats were sacrificed,then Malondialdehyde [MDA], reduced glutathione and glutathione perioxidase were measured in kidney, liver and lens tissues. Also kidney, liver and lens tissues were prepared for light microscopic examination. The results revealed significant increase in kidney, liver and lens MDA levels in rats treated with cisplatin in comparison to the-ve control group. Reduced glutathione and glutathione perioxidase levels in kidney, liver and lens were significantly lower in cisplatin group than in the-ve control group. Histopathological examination revealed renal and liver necrosis and cataract changes in cisplatin treated rats. The increased MDA levels, the decreased antioxidant enzymes and histopathological damage in the kidney, liver and lens of rats administered cisplatin were significantly improved with vitamin E administration. So, it is concluded that, vitamin E may play a role in preventing cisplatin induced nephrotoxicity, hepatotoxicity and cataract formation in cancer patients

Role of mismatch repair genes [h MLHI, h PMS1, h PMS2, GTBP/h MSH6, h MSH2] in the pathogenesis of hepatocellular carcinoma

DNA mismatch repair [MMR] is an important mechanism involved in maintaining fidelity of genomic DNA. Abnormalities in at least one of five MMR genes are implicated in the development of many cancers and the associated micro satellite instability [MSI]. By using a newly developed multiplex reverse transcription -PCR assay, the expression of the five known MMR [hMLH1, hPMS1, hPMS2, GTBP/hMSH6, hMSH2] were evaluated in 33 human HCC cases as well as 16 cases from the normal distant hepatic tissue samples [NDHT] were also evaluated. Twenty- five of them were associated with HCV infection. This was done in an attempt to determine the role of MMR genes in the development of HCC. The beta actin gene was used as an internal control for RNA degradation and DNA contamination and as well as a reference for quantifying the levels of their transcription. Out of the 33 studied HCC cases, 30 cases [90.9%] showed reduction in the expression of one or more of the 5 studied MMR genes. Reduced expression of hMSH2 was found in [71.9%], hMLH1 [53.3%], GTBP [51.1%], hPMS2 [33.3%] and hPMSI [6%]. Correlation analysis showed a strong significant correlation [P= 0.0069] between reduced expression of hPMS2 and GTBP [P=0.0034] as well as hPMS2 and non-cirrhosis [P=0.0197]. Chi-square analysis showed a significant correlation between reduced expression of hMLHl and grade II. On the other hand, 57.1%, 50%, 20%, 18.8% and 6% of the NDHT showed reduced expression of hMSH2, hMLHI, GTBP, hPMS2 and hPMSI respectively. Multivariate analysis showed significant correlation between HCC and hMSH2 [P= 0.008], hMLH1 [P=0.001] and GTBP [P=0.032], also between hPMS2, GTBP and HCC infected with HCV cases [P< 0.001, 0.002]. It could finally be concluded that reduced expression of hPMS2 is likely associated with growth advantage and stimulates proliferation changes that have encouraged malignant development in non- cirrhotic HCV infected patients via acquisition of more genetic damage and the MMR defects that occur at an early stage of hepatocarcinogenesis

Urinary thromboxane B2: a new predicting marker for acute myocardial infarction in subjects with risk factors

The authors evaluated the possible significant role of urinary TXB2 as a new predicting marker of Acute Myocardial Infarction [AMI] in high-risk subjects. Eighty persons were submitted to this study and divided into three groups, the control group [n = 20], the high risk group [n = 30] and the AMI group [n =30]. all persons subjected to clinical and laboratory evaluation: Cardiac enzymes, Myoglobin, Lipid profiles, Pyruvate Kinase and urinary TXB2 level. A high significant elevation of Cardiac enzymes, Myoglobin and Pyruvate Kinase was observed in AMI group only. Urinary TXB2 in risk group was highly significant elevated while in AMI group was non significant increased compared to control group the Urinary TXB2 could be used as a good predicting marker for probability of AMI in patients who had one or more of the AMI risk factors

use of non ceramic hydroxyapatite in mastoid cavity obliteration and posterior canal wall reconstruction

Despite the higher security [concerning cholesteatoma recurrence using the open cavity procedure, yet such technique represents some disadvantages including: lifelong care for the cavity, often discharging granulations, and vestibular vertigo due to the lack of labyrinthine protection. Most of these disadvantages can be avoided by mastoid cavity obliteration, which involves different materials described in literature. In this study we used non ceramic bioactive Hydroxyapatite micro granules [Osteo Graf / LD-300] with polycaboxylic acid to form a paste for mastoid cavity obliteration. In addition, we placed a conchal cartilage graft to replace the deep part of posterior canal wall, which acted as a support for the filling material and separated the middle ear cavity from the obliterated attic. Also temporal fascia grafting to repair the tympanic memberane was done. Such technique helped in a later second ossiculoplasty procedure to improve hearing in such patients. Our technique was assessed for its validity to obtain a permanent stable bony mastoid obliteration and secondary hearing gain reconstructive procedures; our assessment was clinical, radiological, and audiological. Our use of bony obliteration. The latter statement is true, as only expensive serial contrast enhanced MRI studies are needed for the detection of such recurrence when soft tissue is used for mastoid cavity obliteration

Depressive symptoms in patients with allergic rhinitis, correlation to severity and response to treatment

Symptomatic allergic rhinitis has been associated with variable degrees of depressive symptoms, the degree of which is directly related to the severity of symptoms and the response to treatment. In this study we aimed to assess the depressive symptom score in allergic rhinitis patients and its affection by response to treatment. In this study we aimed to compare the results between the male and female populations. The study included 60 patients in 2 groups, one received full treatment course for allergy, and the second received only a placebo. We used the SNOT for assessment of nasal symptoms, and the Beck Scale for assessment of the depressive symptoms. The over all results showed that a degree of depression is present in most patients with allergic rhinitis, the severity of which is directly related to the severity of allergic symptoms, and improves with the reduction of allergic symptoms. Lack of improvement or poor response to treatment exacerbates the depressive status. with a more severe affection and increased liability in female population than in the male one

Assessment of fetal kidney dimensions in Sharkia Governorate: Ultrasonographic study

The fetal kidney can be shown in utero using ultrasonography. Major renal congenital anomalies are diagnosed with ultrasound. By 20 weeks of gestation, one or both fetal kidneys can be identified in 90% of pregnant women. The aim of this study is to evaluate the dimensions of the normal fetal kidneys by ultrasonography in Sharkia Governorate to get a standard sonographic chart which can be considered as a reference for the clinicians in this field. One hundred pregnant women were selected from those attending the antenatal clinics of Zagazig University Hospital, their ages ranged 22-32 years with singleton pregnancies in the third trimester. All patients were subjected to medical, obstetric histories, general and local examination. Complete blood count, urine analysis and random blood sugar were also evaluated. The cases were divided into 5 gestational age groups [20 women each] and all were subjected to ultrasound examination to estimate the biparietal diameter, femur length, abdominal circumference and fetal kidney measurements [length, breadth, anteroposterior diameter and volume]. In some cases where right and left fetal kidneys were imaged adequately and measured, average measures were obtained because no significant difference between both sides were recorded. The mean fetal kidney dimensions [length, breadth, antero-posterior diameter and volume] increased progressively throughout the third trimester with progress of gestational age. At 28 weeks of gestation, the perinephric fat was little and the central sinus appeared as a sonolucent slit within the central portion of the kidney. At 32 weeks, corticomedullary differentiation was observed with the appearance of hypo-echoic medullary pyramids. At 38 weeks, an echogenic rim was observed and made the kidney easily delineated from surrounding tissues, and the surface lobulation increased. At full term, the fetal kidney showed marked surface lobulation, corticomeduIlary differentiation, prominent central sinus and good identification of the adrenal glands. In conclusion,The fetal kidney could be properly imaged and visualized at the third trimester. No significant difference could be detected between the dimensions of both right and left kidneys. All kidney dimensions increased with the progress of gestational age throughout the third trimester and both kidney length and volume had the most significant correlation with gestational age. The development of surface lobulation, corticomedullary differentiation and the central sinus of the fetal kidney and the identified adrenal glands, all became more prominent with progress of gestational age