Role of mast cells and T-lymphocytes in pemphigus vulgaris: significance of CD44 and the c-kit gene product (CD117).

Molecular mechanisms underlying the pathophysiology of pemphigus vulgaris are still not clear. We aimed to determine the significance of detecting expression of some antigens that might be pivotal to the process, namely CD44 and CD117, in patients with active pemphigus vulgaris. Seventeen patients with active pemphigus vulgaris and 19 normal healthy controls were included in the study. The immunohistochemical results showed prominent expression of CD44 in 13 of the patients and CD117 in 9 of the patients with new blister formation. CD44 percentage values in peripheral T-lymphocytes were significantly higher in patients than controls, as detected by flow cytometry. In addition, there was a significant increase in a soluble form of c-kit in sera of patients with active pemphigus vulgaris compared to controls.

Role of mast cells and T-lymphocytes in pemphigus vulgaris: significance of CD44 and the c-kit gene product [CD117]

Molecular mechanisms underlying the pathophysiology of pemphigus vulgaris are still not clear. We aimed to determine the significance of detecting expression of some antigens that might be pivotal to the process, namely CD44 and CD117, in patients with active pemphigus vulgaris. Seventeen patients with active pemphigus vulgaris and 19 normal healthy controls were included in the study. The immunohistochemical results showed prominent expression of CD44 in 13 of the patients and CD117 in 9 of the patients with new blister formation. CD44 percentage values in peripheral T-lymphocytes were significantly higher in patients than controls, as detected by flow cytometry. In addition, there was a significant increase in a soluble form of c-kit in sera of patients with active pemphigus vulgaris compared to controls

Hospital morbidity due to post-operative infections in obstetrics & gynecology.

OBJECTIVE: To study the incidence and risk factors for postoperative infection following cesarean sections and major gynecological surgery. METHODS: Postoperative infection was documented in the specified registers in all patients following cesarean sections and major gynecological surgery from January 1997 to December 1998. This study was a part of the prospective analysis of hospital-based morbidity and mortality in the Department of Obstetrics and Gynecology. RESULTS: There were a total of 89 cases of postoperative infections amongst 4,032 patients undergoing major operations giving an overall infection rate of 2.2%. The morbidity due to infections was 3.3% in cesarean sections and 0.9% in major gynecological surgery. Abdominal hysterectomies had a higher infection rate than vaginal surgery. The most common causative organisms isolated were Enterococcus, Staphylococcus and Klebsiella species. CONCLUSION: It was found that vaginal flora was a significant source of contamination during surgery, which could be minimised by local sterilisation methods. The high infective morbidity in abdominal hysterectomies needs further analysis of the risk factors. Infection surveillance with a regular review of antibiotic protocols is recommended.

Indications for blood transfusion in pregnancy with sickle cell disease.

In order to assess the value of prophylactic blood transfusion in the management of pregnant patients with sickle cell disease, a study was conducted on 571 sickle cell disease pregnancies. These patients were divided into 2 groups, one with prophylactic transfusion and the other with restricted transfusion. In spite of the reduction in the incidence of blood transfusion the rate of preterm labour, intrauterine growth retardation, perinatal mortality and maternal mortality were similar in both groups. A restricted blood transfusion policy can be safely followed without compromising fetal or maternal well-being with an additional benefit of reducing the incidence of transfusion related crises and other complications.

Potentially active antimicrobial agents from 2-benzenesulfonyloxyphenyl-3,1-benzoxazine-4-one derivative.

Fourteen of nitrogeneous heterocyclic compounds that accommodate the sulfonate-ester moiety were synthesized through interaction of 2-benzenesulfonylo xyphenyl-3,1-benzoxazine-4-one with some nucleophilic reagents. The assigned structures for the prepared new compounds were confirmed on the basis of elemental and spectral data. Evaluation of the antimicrobial activity of these products, relative to standard antibiotics was tested and discussed.

Synthetic approaches and biological evaluation of some new sulfonate ester-containing quinazoline derivatives as potentially active antimicrobial agents.

Several sulfonate ester-containing quinazolinone derivatives that are substituted with, isolated or fused, aryl, hetaryl or hetarylphenyl ring systems were synthesized with a view to evaluate their efficacy as new bactericidal and/or fungicidal agents. Synthesis of these products involved prior preparation of the 2-[4'-(benzenesulfonyloxy)phenyl]-3,1- 4(H)-benzoxazin-4-one derivative (2) and subsequent reaction with several nitrogen nucleophiles. The structure of these products were established from elemental and spectral analyses. Most of the prepared compounds showed high antimicrobial activity, comparable to standard chemotherapeutic agents, when screened against different microorganisms.

Pregnancy in sickle cell disease in Bahrain.

OBJECTIVE: To review the maternal and fetal complications in pregnant women with sickle cell disease and to compare their pregnancy outcome with those of controls. DESIGN: A case-control study. SETTING: Ministry of Health hospitals in Bahrain. SUBJECTS: 147 pregnancies in 140 women with sickle cell disease and 294 controls matched for age and parity. MAIN OUTCOME MEASURES: The characteristics of women who had crises, the frequency of the crises, hypertensive disorders of pregnancy, infection, diabetes, perinatal mortality and the delivery statistics in the index and control women. RESULTS: Maternal mortality was 1.4% and perinatal mortality was 73.3/1000 total births in women with sickle cell disease, there were no maternal deaths and the perinatal mortality was 6.8/1000 births in the control group. Anaemia was treated by blood transfusion in 47% of women with sickle cell disease and, of these, 39% had a crisis that appeared to have been precipitated by the transfusion in the absence of any other predisposing factors. The presence of raised HbF did not decrease the number of crises but reduced their severity. CONCLUSION: Pregnancy in women with sickle cell disease should be monitored very closely as it constitutes a high risk to both the mother and the baby.

Effect of Altoside (ZR-515) on oxygen consumption, carbon dioxide out put and carbohydrate content of organophosphorus resistant strain of Musca domestica.

The effect of applying JHA ZR-515 at a concentration of 50 microliter/liter water in the larval rearing medium from the first larval instar on oxygen consumption, carbon dioxide out put and total carbohydrates was studied. The oxygen consumed by the pupae previously treated as larvae with ZR-515 was decreased and no adult could emerge. The carbon dioxide out put seems to follow a more or less the pattern of oxygen consumption. The concentration of total carbohydrate content in one day old pupae previously treated as larvae was significantly lower than normals. In three days old there was a marked significant increase and in five days old, the carbohydrate content was significantly higher than controls.

Incidence and severity of gestational diabetes in Bahrain and Australia.

The incidence and severity of gestational diabetes in a series of 5,199 predominantly Arab patients in Bahrain, and 2,643 of mixed racial origin in Australia were studied. The incidence of gestational diabetes in Bahrain (5.4%) was less than in Australia (7.2%) but the more severe degrees were 3 times more common in Bahrain (p less than 0.001). The incidence of gestational diabetes was significantly increased with increasing maternal age and parity. A notable difference between the 2 populations occurred in the groups weighing less than 70 kg. Although Bahrain had a higher proportion of patients weighing less than 70 kg (64.7% versus 55.9%; p less than 0.001) there was a significantly higher incidence of gestational diabetes in this group in the Australian series (13.9% versus 3.7%, p less than 0.001). Postnatal testing of 165 gestational diabetics in Bahrain and 194 in Australia indicated that although the severe degrees of glucose intolerance were more likely to persist postnatally, it was impossible to predict in the individual patient the change in glucose tolerance that would occur after delivery. All gestational diabetics should therefore have a postnatal glucose tolerance test.

Perinatal mortality in Bahrain.

A review of 583 perinatal deaths at the Ministry of Health hospitals in Bahrain, during the years 1985-1987 revealed a perinatal mortality rate of 19.6 per 1,000 total births. Lethal congenital malformations accounted for 145 (24.9%) deaths. Of the 438 normally formed infants there were 42.2% antepartum, 115 (26.3%) intrapartum and 138 (31.5%) early neonatal deaths; in 82.7% of cases the death was considered to be unavoidable. The population of Bahrain for 1986 according to the Central Statistics Organization (1) was 435,065, the majority of which was served by the Ministry of Health Maternity Service with approximately 10,000 deliveries per annum. The Ministry of Health provides maternity services through one main maternity hospital and 2 peripheral hospitals with consultant obstetric care. In addition to these, there are 3 maternity units run by midwives. High risk cases are usually delivered in the main hospital as there is a neonatal intensive care unit attached to it. The latter also acts as a referral centre for all sick babies in Bahrain. An analysis of the causes of perinatal deaths is an effective way of assessing the efficiency of maternity services. The objective of this study was to identify and improve the various factors influencing perinatal mortality in Bahrain.

PIP: In Bahrain, the Ministry of Health (MOH) medical facilities, which included 1 main maternity hospital, 2 peripheral hospitals, and 3 maternity units under the direction of midwives, reported 29,644 births during January 1985-December 1987. 355 of these were stillbirth and 228 infants died within the 1st week which made up a perinatal mortality rate of 19.6/1000 births. The leading causes of perinatal deaths included, in descending order, low birth weight, mainly due to prematurity (29.3%); congenital malformations (24.9%); mechanical problems, especially cord complications (12%), antepartum hemorrhage, most caused by abruptio placentae (9.1%), and preeclampsia (9.1%). Of the 438 normally formed infants that died, 185 (42.2%) of these were antepartum, 115 (26.3%) intrapartum, and 138 (31.5%) postpartum. 45 (10%) of the normally formed infants that died weighed above the 10th percentile for their gestational age and there were no maternal complications. The researchers classified 101 of all the infant deaths (17.3%) as avoidable perinatal deaths--70% due to poor patient compliance, 28% due to medical mismanagement, and 2% due to a combination of these factors. The MOH must emphasize health education and regular prenatal visits for pregnant mothers. Health practitioners need to reevaluate present prenatal and intrapartum clinical methods and to routinely screen for diabetes and other possible high risk factors.

Maternal mortality in Bahrain with special reference to sickle cell disease.

The maternal mortality in Bahrain during the 10-year period, 1977-1986, was 33.9 per 100,000 livebirths; the second 5-year period showed a significant reduction (26.9) compared to the first 5-year period (42.3). Haemorrhage, pulmonary embolism, hypertensive diseases of pregnancy and infection were the main causes of maternal mortality. Sickle cell disease was found to be an underlying cause in about one third of the maternal deaths. Avoidable factors were present in 38% of the cases, the majority being due to the failure of the patients to seek medical care or follow medical advice. Health education, premarital counselling and family planning were identified as significant factors in reducing the maternal mortality rate.

PIP: There were 37 maternal deaths among the 109,221 livebirths registered during the period 1977-86 in Bahrain, Arabian Gulf. The maternal mortality rate was 33.9/100,000 for the 10-year study period; however, disaggregation reveals a decline in this rate from 42.3/100,000 in 1977-81 to 26.9/100,000 in 1982-86. This decline presumably reflects streamlining of the Ministry of Health's maternity services, including a central maternity hospital with all modern facilities that serves as a referral center for all of Bahrain, 2 peripheral hospitals with provision for blood transfusion and surgical deliveries, and 3 maternity units managed by fully qualified midwives. About 80% of deliveries are covered by these maternity services; only 2.5% of deliveries occur in the home. Despite this highly developed maternity care system, 18 of the maternal deaths were due to direct obstetric cause: hemorrhage, 7; pre-eclampsia and eclampsia, 5; abortion septicemia, 2; bowel perforation during cesarean section, 1; thromboembolism, 2; and amniotic fluid embolism, 1. The causes of the 19 indirect maternal deaths were: pulmonary embolism, 5; infection, 7; cardiac failure, 2; cerebrovascular accident, 2; pulmonary hypertension, 1; and uncertain, 2. Of interest is the finding that sickle cell disease was the underlying cause of maternal death in 12 of the 37 deaths in this series. Sickle cell disease was implicated in 3 of the deaths from hemorrhage, all 5 deaths from pulmonary embolism, 2 deaths from septicemia, and the 2 cases of cardiac failure. In this series, 50% of the patients with sickle cell disease had thromboembolic crises following treatment of anemia with packed cell transfusion. Blood transfusion, especially of packed cells, should be given with caution to these patients since it may precipitate vaso-occlusive crisis by increasing blood viscosity. Since sickle cell disease represents a high risk during pregnancy in this Arab population, such patients should have frequent prenatal check-ups and deliver in a well-equipped hospital.