Scanning electron microscopy and histopathological study of the effect of estriol on the endometrium of women using long acting injectable contraceptives with irregular uterine bleeding

Hormonal contraceptives are female sex steroids, synthetic estrogen and synthetic progesterone [pro gestin], or pro gestin only. They can be administered in the form of oral contraceptives "OC", implants, and injectables. A large part of the modem medical research has focused on studying the effect of different forms of the hormonal contraception on the human endometrium whether by the conventional dilatation and curettage or by outpatient pipelle to study the endometrial histopathological changes either by light microscope or scanning electron microscope; and to correlate the findings detected by both modalities, in order to develop an effective method for diagnosis and treatment of different forms of eridometrial pathology. The aim of the present study was to evaluate the effect of estrogen treatment on the endometrium of women using pogestational injectable contraceptive [Depo-provera] [R]and complaining of irregular uterine bleeding using: Clinical assessment, transvaginal ultrasound and studying endometrial samples by: The ordinary light microscope and the scanning electron microscope. In this study 30 women using depo provera as a contraceptive method and all of them complaining of irregular uterine bleeding were randomly categorized into 2 groups; group A included 15 cases who received estriolfor 3 months, and group B included 15 cases who received Diosmine for the same period. Both groups were subjected to endometrial sampling by an out patient pippelle before and after treatments then the endometrial tissues were examined by the ordinary light microscope and the scanning electron microscope, results were then tabulated and statistically analyzed using the standard statistical tests. Microscopic examination of-the endometrial biopsies from all women receiving depot inedroxyprogesterone acetate revealed variable degrees of endo, netrial atrophy. The glandular architecture was cystic in cases and budded in the others. The glands were lined by mitotically inactive bland-looking cuboidal or flattened cells with rare pseudostratfication. The glands were embedded' in a mitotically inactive spindled stroma that exhibited varying degrees of collagenation. The ratio of glands to stroma was near one with predominant stroma. in many foci. Microscopic examination of the endometrial biopsies of the 15 patients that received Diosmine for 3 months didn't reveal any proliferative change in 12 of them and only weak prohferative changes were noted in 3 of them. All atrophic endometria examined with the SEM revealed inconsistency in cell size and shape, cellular loss and separation, infrequency of ciliated cells and absence of uterodomes. Epithelial surface was usually flattened, with cells often displaying raised cell borders; Microvillous cells were thinly populated with very low, blebbed microvilli. Afew to moderate number of glands with large openings were observed. Pitted cells were observed in 2 of the specimens that were treated with Diosmine. Number of injections and time lapse since the last injection had a role in the endometrial changes but age, gravidity and parity had no role. Depotmedroxyprogesterone acetate [DMPA] is one of the most effective hormonal iontraceptive methods used by women in reproductive age to prevent pregnancy. Discontinuation of DMPA is mainly due to menstrual irregularities including unpredictable bleeding or spotting; this bleeding is mainly due to endometrial atrophy. Estriol is considered the friendly estrogen and can he used in treatment of vaginal bleeding during DMPA use by changing the endometrium front vrophic to prolfirative so it causes building up of a new endometrium without evident side effects Endometriutn either under effect of DMPA or estriol is easy to be studied by combined scanning electron microscopy and ordinary light microscopy cfter endometrial sampling by outpatient pipelle

[Early onset non-affective psychosis: clinical and developmental perspectives]

Childhood psychosis is a rare disorder with much controversy between studies investigating its clinical features and premorbid function. Data concerning early onset non-affective psychosis is still lacking. The aim of this study was to describe socio-demographic data, early development, pre-morbid function and clinical characteristics of children presenting with early onset non-affective psychosis. Forty two Saudi patients with child and adolescent onset psychosis diagnosed according to DSM-IV criteria were assessed using Schedule for Affective Disorders and Schizophrenia for School Aged Children Present and Lifetime Version [K-SADS-PL] and positive and negative symptom scale [PANSS]. Developmental aspects and premorbid function were assessed by General Developmental Scale [GDS], Childhood Behavioral Scale [CBS] and Premorbid Adjustment Scale [PAS]. All data were subjected to statistical analysis. The sample included 27 patients diagnosed with schizophrenia, 10 with psychotic disorder not otherwise specified and 5 with acute psychotic episode. 61.9% of the sample had gradual onset and 38.1% had acute onset. The mean age of onset was 12.3 +/- 3.8. Negative symptoms were more manifested than positive symptoms among the whole sample. The most frequently reported positive symptoms were hallucinations [95.2%]. Physiological disturbances were relatively common as disturbed sleep [81%], appetite disturbances [28.6%] and impaired sphincter control [14.3%]. All schizophrenic and non-schizophrenic children were similar in having impairment in early development and premorbid functions that were significantly correlated with more negative symptoms and younger age of onset. The developmental and premorbid impairments are more emphasized in children with early onset non-affective psychosis and significantly influence the clinical presentation

Diagnostic utility of viral load and biochemical markers in chronic hepatitis C viral infection associated with hepatic fibrosis

The role of liver biopsy in management of patients with chronic hepatitis C is currently being depated. A liver biopsy is most often preserved for those considering treatment in order to assess the grade and stage of hepatitis. Several non invasive markers of hepatic fibrosis have been evaluated for their ability to assess liver histology. The aim of this study is to assess the degree of hepatic fibrosis as evaluated by liver biopsy and ultrasonography in relation to serum HCV-RNA viral load, routine biochemical and haemotological markers. The study was carried out during the period 2005-2006 it included 20 chronic HCV out patient who attended the Out Clinic of Hepatology Unit Faculty of Medicine and Medical Research Institute Alexandria University. Patients were clinically evaluated and tested for the presence of anti-HCV by ELISA, HCV-RNA by quantitative Real Time PCR. A panel of routine biochemical tests includes [ALT, AST, GGT, serum albumin, serum cholesterol, prothrombin activity and platelet count was carried out. Core liver biopsies were taken from all 20 patients under U/S guidance. This study shows 11 [55%] out of 20 chronic HCV patients has no significant fibrosis by Metavir staging [F0-F2].while the remaining 9 [45%] had significant fibrosis [F3-F4] The viral load did not correlate with the degree of liver fibrosis. Platelets and albumin were significantly associated with the presence of significant fibrosis 90% of the HCV patients with no significant fibrosis and prothrombin activity act >/= 80%. A platelet count below 150x109/L was associated with significant fibrosis while or platelet count more than 150x109 does not exclude its presence. By using the APRI index [AST/platelet] all patients with significant fibrosis have a score less than one while a score more than 2 is associated with significant fibrosis. A score less than 2 in the API [Age/platelets] was favor of the absence of significant fibrosis while the score of 6 was associated with significant fibrosis by using Forns index 88.9% of patients with significant fibrosis has a cut-off value higher than 2 while all patients with no significant fibrosis has a cut-off value less than 6.9. By using [ALT/AST] ratio 72% of patients with no significant fibrosis had a ratio less than one. Our results confirm the NIH consensus status of 2002 had no single non invasive test or panel of serological markers can provide an accurate assessment of the intermediate stage of liver fibrosis indicating that non invasive tests could not replace the information provided by liver biopsy

effect of some stress conditions on reproduction in tilapia nilotica

Nineteen mature male and female Tilapia nilotica were kept under natural environmental conditions in November 1991. They were classified into three groups. The first group was maintained in aquaria with one liter of water for each cm. of fish length under natural conditions of temperature and photo-period and fed once daily at a ratio of 1% of the body weight. The second group was fasted for 6 days. The third groups was kept with average of one liter of water/2.5 cm of fish length. Plasma samples as well as samples from the testes and ovaries for histological examination were taken after 3 and 6 days. The obtained results indicated a high significant decrease in plasma testosterone in the fasted group after 3 days which returned to the control levels after 6 days, while in the overcrowded group, testosterone showed no significant change from the control values. The histological studie of the testes showed no noticeable changes of both seminferous tubules or interstitial cells neither in the fasted nor in the overcrowded group. Estradiol -17 beta in the plasma of the fasted female Tilapia nilotica showed a significant decrease after 3 and 6 days, while its levels in the overcrowded females showed a significant increase after 3 days then declined after 6 days. Plasma progesterone revealed no detectable changes from the control group both in fasted and overcrowded group. The histological findings revealed that, in the ovaries of 3 days fasted females, the oocytes of early and late-perinucleous [stages 1 and II] were more than the vitellogenic stage [stage IV, V, VI]. While, in the ovaries of 6 days fasted females, the vitellogenic stages were predominated. In ovaries of both 3 and 6 days fasted females there were few atretic or empty follicles to be seen. The ovary of the 3 days overcrowded females was nearly similar to that of the control, but the number of the atretic follicles was more than that of control. After 6 days overcrowding, there was increase in vitellogenic stages. In addition there was a few number of empty or atretic follicles