Assessment of autonomic nervous system in non-pregnant, pregnant and pre-eclampsia patients

During pregnancy, there are remarkable changes in the circulation. Blood pressure and vascular resistance are increased in woman with pre-eclampsia, the blood volume is smaller, and blood pressure and heart rate responses to various provocations are changed compared with those of normotensive pregnant women. Autonomic nervous system [ANS] functions were investigated in women subdivided into three groups [non-pregnant, pregnant, pre-eclampsia]. Cardiovagal arch functions was assisted by spontaneous heart rate and blood pressure variabilities, deep breathing test and valsalva maneuver. Evaluation of adrenergic vasomotor response to posture and Cold stress test [CST] and evaluation of Heart Rate Variability was done. All the tests were done at 30-38 weeks of gestation. There was high significant difference between normal pregnancy group and pre-eclampsia groups in heart rate [HR], systolic blood pressure [SBP] and diastolic blood pressure [DBP]. There was no significant difference between groups in oxygen [O[2]] saturation. As for skin temperature, there was significant decrease in pre-eclampsia reading than the pregnant group. As regard baroreflex function, there was an increase in heart rate with deep inspiration and decrease in heart rate with expiration with no statistical difference between groups as regard the mean heart rate for three groups [p>0.05]. However, the% of change of maximal heart rate response to deep breathing was diminished [17.93%] than non pregnant [48.7%] and the maximal heart rate response to deep breathing was diminished in cases of pre-eclampsia [3.65%] than normal group. The difference between groups was highly significant in lowest heart rate and blood pressure with valsalva maneuver. There was decrease in valsalva ratio in pregnant groups than in non pregnant group but the valsalva ratio was decreased in pre-eclampsia group more than normal pregnant group. The decrease in blood pressure during strain was more marked in normal groups than PIH group. There was increase in heart rate and systolic and diastolic blood pressure during cold stress test and decrease in O[2] saturation and skin temperature in all groups with significant difference between groups in HR, SBP, DBP and skin temp 20 minutes after CST [there was delayed recovery pre-eclampsia group]. As regard HR variability; increase in HR in pre-eclampsia than normal groups in pregnant and non-pregnant. There was increase in HR in the two pregnant groups with significant difference in pregnant than in non pregnant women [p<0.01]. There was reduced HR variability [NN, SD and rMSSD] during pregnancy than in non-pregnant women [p<0.01]. During pregnancy changes in the ANS occur. Normal pregnancy is associated with significant decrease in baroreflex gain as compared with non pregnant state and this decrease in baroreflex gain is even more pronounced in subjects with hypertensive disorders with pregnancy. ANS evaluation can predict abnormal changes in the circulatory system and therefore, early detection can be important to reduce or prevent hemodynamic instability during regional or general anesthesia. Impairment of autonomic nervous system functions may be the cause of pre-eclampsia

Engaging undergraduate medical students in health research: students perceptions and attitudes, and evaluation of a training workshop on research methodology

Study objectives: As a preliminary step before incorporating basics of health research methodology and students' research projects, in medical curricula of Alexandria Faculty of Medicine, the present study was conducted to [1] explore students' perceptions of engaging undergraduate medical students in research, and to [2] evaluate a training workshop on Health Research Methodology. In phase 1, an anonymous questionnaire was administered to a random sample of 644 3rd, 4th, 5th and 6th years' students, Alexandria Faculty of Medicine. Students showed high levels of interest in research, and positive attitudes towards integrating research activities into undergraduate medical curricula. However, a considerable proportion of students were not fully aware of the benefits of engaging undergraduate students in research. Students believed that the main problems facing students' research are: curriculum overload, time restriction, inadequate training in research, lack of staff guidance and cooperation, lack of interest and motivation, and lack of incentives. Several solutions were suggested by students to increase their motivation and engagement in research activities. These included: decreasing the curriculum overload, more training workshops on research methodology, integration of research methodology into undergraduate curriculum, engaging students in mentored research projects, more staff guidance and cooperation, and the incorporation of research activities to be a part of students' final assessment. Students, as young promising researchers, need to be encouraged and awarded. Others suggested increasing funds to support students' research projects, training on data processing, analysis and interpretation, and applying innovative teaching methods that stimulate active learning and critical thinking. Other suggestions included: establishment of a mentored 'Student Research Committee', 'Student Research Journal' and organization of 'Student Conferences' with the subsequent publication of their research papers. In phase 2, a total of 27 students attended a one-day training workshop on research methodology. Students showed high levels of satisfaction and gain from the workshop. The great majority regarded it as valuable, enjoyable experience, providing them with both research skills and sensitization to the benefits of undergraduate medical students' engagement in research activities, as well as its crucial importance to their future medical practice. At our medical school, we believe that medical students are becoming more enthusiastic about getting involved in research, which is encouraging. Given the right amount of support, medical students' interest in research can be successfully nurtured

effects of levonorgestrel releasing intrauterine device on menstrual bleeding pattern, endometrial thickness and uterine vasculature

The study aimed to evaluate the effect of the levonorgestrel releasing intrauterine device [LNG-IUD] on menstrual bleeding pattern, endometrial thickness and uterine vasculature. The study was a prospective controlled study evaluating the effects of LNG-IUD compared with the copper intrauterine device [IUD]. Twenty women carrying LNG-IUS [group I] were compared with thirty women carrying copper IUD in a control group [group II]. Clinical measures of menstrual bleeding, endometrial thickness and Doppler flow of the cervical branch of the uterine artery and spiral artery were evaluated and compared between the two groups. Doppler flow in the cervical branch of the uterine artery did not reveal any changes between the groups I, II [resistance index 0.59 +/- 0.08 and 0.6 +/- 0.09 respectively]. Endometrial thickness was significantly thinner in group I compared with group II [3.9 +/- 1.21 and 7.5 +/- 2.94mm respectively]. Subendometrial flow in the spiral artery was detected in six women only of group I [30%] and in all women of group II [100%]. The present study offers explanation for the change of the menstrual bleeding pattern [specially amenorrhea and oligomenorrhoea] in LNG-IUD users, i.e. a local progestational effect on the endometrium with no change in the uterine vasculature. This adds to the therapeutic value of the device and would lessen the discontinuation rate specially if properly addressed to women in the pre-contraceptive examination

Sublingual misopristol: a possible route for induction of medical evacuation in early pregnancy loss

Misoprostol is effective for cervical priming prior to suction evacuation in first trimester pregnancy termination. The drug is increasingly used to treat women who have a failed pregnancy in the first trimester. However, little is known about the efficacy, safety and acceptability of the drug when used through the sublingual route. A sublingual misoprostol-alone regimen was used in 30 women for induction of medical evacuation for cases of early first trimester pregnancy loss [an embryonic pregnancy, missed abortion and incomplete abortion] up to 9 weeks gestation. The women included in the study were given 600-micro g misoprostol sublingually every 4h for 3 doses then every 6h for two doses [for a maximum of five doses]. The efficacy and acceptability of this regimen were studied. The overall complete evacuation rate was 80%. The complete evacuation rate for women with gestational age 7-9 weeks was 80.95% and that for women with a gestational age of

Morphofunctional characteristics of the interatrial septum in cardiac diseases transesophageal echocardiographic study

Both the morphology and the functions of the interatrial septum in different clinical situations have been addressed only in a few studies, where the attention has been focused particularly on its congenital abnormalities. Our purpose was to study whether the changes of thickness and thinning of the interatrial septum may be related to the age, left atrial dimension and left ventricular functions. So we studied these changes using the transesophageal echocardiography in [60] patients of four groups of cardiovascular discuses. These groups were: Group I: Ischemic heart disease 20 patients. Group II: Dilated cardiomyopathy 20 patients. Group III: Hypertension with stroke 8 patients. Group IV: Corpulmonale 12 patients. All the patients were subjected to thorough clinical examination, 12 leads resting electrocardiography, chest X-ray postero-anterior view and echocardiography in which we made both transthoracic and esophageal approach for each patients. The interatrial septum thinning was calculated as the difference between the thickness of the IAS at atrial systolic phase and the thickness of the IAS at end-ventricular systolic phase. The value was expressed also as percentage of thinning at the end of ventricylar systolic phase. The IAS thickness increases with the age while there is no significant increase in thinning and thinning percentage. The IAS thickness increases in patients of left ventricular dysfunction e.g. [dilated cardiomyopathy, ischemic heart diseases, and hypertensive patients] also it increases in patients of corpulmonale. There is a negative correlation between the IAS thickness and the left atrial dimension, but there is a positive correlation between the IAS thinning and IAS thinning percentage with the left atrial dimension. Patients with prolonged deceleration time of E and isovolumic relaxation time and decreased E/A with or without lower ejection fraction and fractional shortening had less IAS thinning%. On the other hand, patients with shorter deceleration time of E and isovolumic relaxation time and increased E/A with or without lower ejection fraction and fractional shortening had a comparable IAS thinning%.

Functioning adrenal gland tumors study of seven cases

This study was a retrospective analysis of seven patients with adrenal gland tumors. Patients with pheochromocytoma presented mainly with headache, persistent hypertension with paroxysmal severe attacks. Three patients with adrenal cortical adenoma presented mainly with trunkal obesity and mild hypertension, the remaining patient was a child with virilizing manifestations. Different methods of investigations were done that included estimation of catecholamines and cortisol levels in blood. Unilateral flank approach with resection of the last rib was done in all patients. The tumor was resected with the least possible manipulations after ligation of the adrenal vessels. Postoperative improvement was noticed in all patients where there was marked sustained reduction in blood pressure in cases of pheochromocytoma, and manifest reduction in body weight and blood pressure in patients with cortical adenoma showed marked amelioration of the virilizing features

Bladder mucosal graft technique for hypospadias repair, study of 24 cases

The use of bladder mucosa for repair of proximal hypospadias offers several advantages. Twenty-four children suffering from proximal hypospadias, their ages ranged from 4 to 12 years, were included in the study. The repair was completely successful in 18 patients without minor or major complications. However, 2 children developed fistula at the site of the anastomosis and were in need for further closure. Three children developed meatal sticking and stenosis, two of them responded to regular meatal dilation and the 3rd was in need for meatoplasty. One child developed extensive infection and complete wound disruption that was in need for refashioning

Influence of the ionic form of mineral salts on growth of faba bean and rhizobium leguminosarum

A pot experiment was performed to study the nodulation and growth of Faba bean plants [Vicia faba cultivar Giza 2] [2 months age] in an alluvial clay soil [pH 7.9] as affected by the anionic and cationic component of inorganic salts, i.e. Chlorides, carbonates, and sulphates of Na, K, Ca, and Mg. Each was added at a single concentration 20 meq 100 g-1 soil. Tolerance of Rhizobium leguminosarum biovar viceae [Strain F-15] grown on pure culture medium salinized with the same salts was also tested. Salts applied were generally inhibitory to both the macro-and micro-symbionts. Number and characteristics of plant-root nodules, dry weight of plants [Shoots and roots], N content in plants, and bacterial colony count were decreased. Chlorides reduced these parameters to the greatest degree, while sulfate exhibited the lowest effect. Sodium among cations, showed the greatest inhibition, whereas Mg++ was the least detrmintal; K+ and Ca++ occupied intermediate positions. Formation of effective nodules on roots of the plants grown in the salinized soil was very poor, but R. Leguminosarum showed possible tolerance when grown on salinized pure culture medium