Activation of coagulation in chronic urticaria in relation to disease severity and activity.

BACKGROUND: The pathogenesis of chronic urticaria is incompletely understood. There is growing interest in the role of the coagulation cascade in chronic urticaria. We aimed to assess the possible activation of the coagulation cascade in chronic spontaneous urticaria (CSU) in relation to disease severity and activity. METHODS: This study was conducted on 30 patients with active CSU and 30 apparently healthy individuals as controls. Patients with acute urticaria, physical urticaria, or any form of urticaria other than spontaneous urticaria were excluded. Plasma levels of D-dimer and activated factor VII (FVIIa) were measured by ELISA at baseline for all recruited patients and controls. In addition, they were measured for CSU patients after complete disease remission. RESULTS: Plasma levels of D-dimer and FVIIa were significantly higher among patients with active CSU than among healthy controls. D-dimer levels were lowest among patients with grade 1 severity and highest among those with grade 4 severity. Factor VIIa levels did not differ significantly according to disease severity grades. After complete disease remission, there was a significant dramatic drop in levels of D-dimer and FVIIa among patients. CONCLUSION: We conclude that activation of the coagulation cascade occurs in CSU, and we demonstrate the novel finding that activated factor VII levels are significantly reduced after medical therapy, confirming the implication of the extrinsic pathway activation in CSU. Future controlled studies may investigate the role of anticoagulant therapy in refractory chronic urticaria.

Monoamine concentrations changes in the PTU-induced hypothyroid rat brain and the ameliorating role of folic acid.

Thyroid hormones are recognized as the key metabolic hormones that play a critical role in the development of central nervous system (CNS) throughout life. The present study was designed to determine the changes in brain monoamine concentrations in 6-n-propyl thiouracil (PTU)-induced hypothyroid rats, in addition to the ameliorating role of folic acid treatment. Fifty male albino rats were equally divided into five groups; first and second groups were the control and folic acid groups, respectively, while the third group was the hypothyroid group in which the rats received PTU in drinking water for 6 weeks. The fourth and fifth groups were co- and post-treated folic acid groups with hypothyroid rats, respectively. Our results revealed that serotonin and norepinephrine concentrations were significantly decreased in the hypothalamus and cortex, while it significantly increased in the hippocampus of hypothyroid rats when compared with control group. Serotonin and norepinephrine concentrations were decreased in hypothalamus and cortex in co- and post-treated folic acid groups with hypothyroid rats, while the concentration of dopamine were significantly increased in the hypothalamus and hippocampus of the hypothyroid rats and co-treated folic acid group with hypothyroid rats. In cortex, the dopamine concentration was significantly increased in hypothyroid rats and post-treated folic acid group with hypothyroid rats, while it significantly decreased in co-treated folic acid group with hypothyroid rats when compared with the control group. Also, our results revealed that, folic acid treatment was better if it is administered as an adjuvant after returning to the euthyroid state by withdrawing PTU from the drinking water.

Prevalence of unmet contraceptive need among Egyptian women: a community-based study.

INTRODUCTION: An estimated 17% of married women in the developing world still have an unmet need for contraception. This study aimed to measure the prevalence and reasons for unmet contraceptive need among married women in the childbearing period in an underprivileged district in Eastern Cairo. METHODS: A cluster survey of 2340 women in the Marg district of Eastern Cairo was performed. Socio-demographic data and data on both past and present contraceptive use were obtained by interview questionnaire. RESULTS: The prevalence of unmet need was 7.4%; 53.4% for limiting and 46.6% for spacing. Experience of side effects from contraceptive use, and fear of side effects, was highly prevalent among women with unmet need. In addition, a large proportion of women with unmet need perceived themselves not to be at risk for conceiving. CONCLUSIONS: A substantial proportion of women in Cairo have unmet contraceptive need. Efficient counseling of women about contraception may help reduce this high prevalence.

Dissection of familial correlations in hepatitis C virus (HCV) seroprevalence suggests intrafamilial viral transmission and genetic predisposition to infection.

OBJECTIVE: Unsafe injections and transfusions used during treatments are considered to be responsible for many cases of transmission of hepatitis C virus (HCV) in developing countries, but cannot account for a substantial proportion of present infections. The aim of the present work was to investigate familial clustering of HCV infection in a population living in a highly endemic area. DESIGN, SETTING AND PARTICIPANTS: A large seroepidemiological survey was conducted on 3994 subjects (age range, 2-88 years) from 475 familial clusters in an Egyptian rural area. Epidemiological methods appropriate for the analysis of correlated data were used to estimate risk factors and familial dependences for HCV infection. A phylogenetic analysis was conducted to investigate HCV strain similarities within and among families. MAIN OUTCOME MEASURES: HCV familial correlations adjusted for known risk factors, similarities between viral strains. RESULTS: Overall HCV seroprevalence was 12.3%, increasing with age. After adjustment for relevant risk factors, highly significant intrafamilial resemblances in HCV seroprevalence were obtained between father-offspring (odds ratio (OR) = 3.4 (95% confidence interval (CI), 1.8 to 6.2)), mother-offspring (OR = 3.8 (95% CI, 2.5 to 5.8)), and sibling-sibling (OR = 9.3 (95% CI, 4.9 to 17.6)), while a weaker dependence between spouses (OR = 2.2 (95% CI, 1.3 to 3.7)) was observed. Phylogenetic analysis showed greater HCV strain similarity between family members than between unrelated subjects, indicating that correlations can be explained, in part, by familial sources of virus transmission. In addition, refined dissection of correlations between first-degree relatives supported the role of host genes predisposing to HCV infection. CONCLUSIONS: Current HCV infection in endemic countries has a strong familial component explained, at least partly, by specific modes of intrafamilial viral transmission and by genetic predisposition to infection.

Accuracy of ultrasound in the diagnosis of nonfunctioning kidneys.

The accuracy and reliability of ultrasound were assessed in 246 patients with 338 radiologically nonfunctioning renal units. The causes of nonfunction included hydronephrosis, pyonephrosis, renal parenchymal disease, renal agenesis, renal neoplasm and polycystic disease. Obstruction was proved in 158 patients, with an accuracy of 98.1 per cent. Retrograde pyelography was avoided. The diagnosis of a small end stage kidney was correct in 42 patients. In 9 patients with a unilateral nonfunctioning kidney less than 9 cm. long a thin coarsely textured cortex with dilatation of 1 or more calices was found. To our knowledge the presence of dilated calices in a small kidney, suggestive of chronic pyelonephritic changes, has not been described previously by ultrasound. Nonvisualization occurred in 16 cases (4.7 per cent) despite the anatomical presence of a kidney. An advanced degree of pyonephrosis with thick inspissated pus sometimes may mimic the ultrasonic appearance of a renal neoplasm.

Ultrasonography and amoebic liver abscesses.

Twenty-four patients were admitted to Kasr-El-Aini Hospital with suspected diagnoses of amoebic liver abscesses. The patients underwent clinical examinations, stool specimen analyses for cysts and trophozoites of Entamoeba histolytica, radiologic examinations, and routine liver function tests. In one patient, a liver scintiscan was obtained. Ultrasonographic examination was performed on all patients using the gray scale imaging technique. In 20 patients, the diagnoses of amoebic liver abscesses were demonstrated by ultrasonographic examination. In 19 patients, amoebic liver abscesses were verified by aspiration biopsies (95%), and one patient had a false-positive result. This false-positive result was due to a degenerated hepatoma, demonstrated by aspiration biopsy. Of the 19 patients, 12 patients (63.12%) had right lobe abscesses and seven (36.89%) had left lobe abscesses. The site, size and nature of the pus contained in the abscess could be determined by ultrasonographic examination and, therefore, helped in the management and technique of the aspiration biopsy. In addition, follow-up data could be more detailed using ultrasonographic examinations. Ultrasonographic examination is a noninvasive, safe, accurate, and rapid method of diagnosis, and is highly recommended as a routing procedure in all cases of suspected amoebic liver abscesses in the pre- and posttreatment stages of the disease. It is also recommended as an indicator of complete cure at follow-up examination.

Sonography of bilharzial masses of the scrotum.

Five patients with bilharzial masses of the spermatic cord were studied. Clinical examination and laboratory tests were performed. Plain radiology was used in 1 case to illustrate the calcified masses. Sonography in these patients gives a characteristic picture, with echogenic multiple masses with posterior shadowing. Operative excision of these masses was performed, and histopathological examination was carried out to verify the diagnosis.

Distal splenorenal shunts (Warren's operation) B-mode and real time ultrasonographic assessment.

B mode and real time ultrasonography have been used in a trial to demonstrate the patency of distal splenorenal shunt done in Warren's operation. Thirty seven patients with portal hypertension, and bleeding oesophageal varices were the subject of this study. Using B-mode ultrasonography in 70% of cases (26 patients), the splenic, left renal vein and the site of anastomosis were demonstrated. In 8% (3 patients), both splenic and left renal veins were seen patent, but the site of anastomosis was not detected. In the remaining 22% (8 patients), neither the left renal vein nor the site of anastomosis could be demonstrated. Using the Real-time two dimensional ultrasound, 9 of the 37 patients were examined. The patency of both veins and the site of the shunt was demonstrated in 90% (8 patients).