Uterine salvage management for atonic postpartum hemorrhage using "modified lynch suture".

BACKGROUND: To assess the effectiveness of the new modified technique in order to control bleeding in women presenting with atonic, flabby uterus compared to the most commonly described technique of classic B-Lynch suture. METHOD: This study included 160 women of uncontrolled atonic postpartum hemorrhage delivered by cesarean section at Ain Shams University Maternity Hospital between January 2013 and October 2015. Participants were randomly assigned following simple randomization procedures (computerized random numbers) and divided into two groups. Group, I (80 patients) operated upon by the modified (new technique) stitch while group II (80 patients) operated upon by the classic technique. The ultimate goals were to stop blood loss after placement of the sutures and avoid life-saving hysterectomy thus preserving the life and fertility of the patient. RESULTS: The modified new technique was done in 80 patients with atonic postpartum hemorrhage and it was found to be superior to the classic technique with a success rate 95 % (4 cases needed hysterectomy as a lifesaving measure) compared to 85 % with the classic technique (in 12 cases, a life-saving hysterectomy was done). CONCLUSIONS: This technique can replace the classic B-lynch in flabby unresponsive atonic uteri as it has 8 shaped placement of the stitch which causes more firm compression on the uterus and simultaneous bilateral uterine artery ligation. This technique was proved valuable and successful in many patients who suffer from uncontrolled massive postpartum hemorrhage (PPH).

Involvement of transposon-like elements in penicillin gene cluster regulation.

Subtelomeric secondary metabolite (SM) gene clusters are frequently surrounded by DNA repeats and transposon-like elements. The Aspergillus nidulans penicillin cluster, 30kb from the telomere of chromosome VI, is bordered by such elements. Deletions of penicillin telomere proximal and distal border regions resulted in decreased penicillin production. A 3.7kb distal region called PbIa, consisting of the putative transposable element DNA-2, was examined further where its replacement by a pyrG marker presented a similar phenotype as loss of the global SM regulator LaeA, resulting in a decrease in penicillin gene expression and product formation. In contrast, placement of the pyrG marker on either side of PbIa had no effect on penicillin synthesis. A requirement for PbIa in penicillin production was also apparent in a histone deacetylase mutant, DeltahdaA, enhanced for penicillin production. Trans-complementation of the PbIa element near and within the terrequinone A cluster on chromosome V did not restore penicillin biosynthesis or increase production of terrequinone A. Taken together, this data provides evidence for transposon involvement in SM cluster regulation.

Real-time nucleic acid sequence-based amplification assay for detection of hepatitis A virus.

A nucleic acid sequence-based amplification (NASBA) assay in combination with a molecular beacon was developed for the real-time detection and quantification of hepatitis A virus (HAV). A 202-bp, highly conserved 5' noncoding region of HAV was targeted. The sensitivity of the real-time NASBA assay was tested with 10-fold dilutions of viral RNA, and a detection limit of 1 PFU was obtained. The specificity of the assay was demonstrated by testing with other environmental pathogens and indicator microorganisms, with only HAV positively identified. When combined with immunomagnetic separation, the NASBA assay successfully detected as few as 10 PFU from seeded lake water samples. Due to its isothermal nature, its speed, and its similar sensitivity compared to the real-time RT-PCR assay, this newly reported real-time NASBA method will have broad applications for the rapid detection of HAV in contaminated food or water.

Combined immunomagnetic separation-molecular beacon-reverse transcription-PCR assay for detection of hepatitis A virus from environmental samples.

In this study, a molecular-beacon-based real-time reverse transcription (RT)-PCR assay was developed to detect the presence of hepatitis A virus (HAV) in environmental samples. A 125-bp, highly conserved 5' noncoding region of HAV was targeted. The sensitivity of the real-time RT-PCR assay was tested with 10-fold dilutions of viral RNA, and a detection limit of 1 PFU was obtained. The specificity of the assay was demonstrated by testing with other environmental pathogens and indicator microorganisms, and only HAV was positively identified. When combined with immunomagnetic separation, the real-time RT-PCR assay successfully detected as few as 20 PFU in seeded groundwater samples. Because of its simplicity and specificity, this assay has broad applications for the rapid detection of HAV in contaminated foods or water.

Penicillin-induced effects on streptomycin uptake and early bactericidal activity differ in viridans group and enterococcal streptococci.

In vitro studies with penicillin and [3H]streptomycin in four strains of streptococci (S. faecalis, S. sanguis, and S. mitis) were performed by simultaneously measuring the rates of bacterial killing and uptake of streptomycin. In S. faecalis, penicillin stimulated streptomycin uptake, as has been shown by Moellering and Weinberg (R. C. Moellering, Jr., and A. N. Weinberg, J. Clin. Invest. 50:2580-2584, 1971). Moreover, the antibiotic combination was associated with an enhanced bactericidal rate which temporally correlated with beta-lactam-induced aminoglycoside uptake. In contrast, in viridans group streptococci (S. sanguis and S. mitis) penicillin had no effect on streptomycin uptake and a minimal effect on bactericidal rate when compared with either drug alone. These data suggested that the stimulation of streptomycin uptake in streptococci by penicillin is strain or species specific and that important differences exist between enterococci and viridans group streptococci regarding the mechanisms of beta-lactam-aminoglycoside potentiation.

Ovarian structure in cases of primary and secondary infertility.

PIP: The present study was carried out to assess the ovarian structure in cases of primary infertility (PI), and secondary infertility (SI). 40 patients were selected from the infertility clinic of Al Azhar University hospital from those suspected to have ovarian abnormalities with history of amenorrhea or oligomenorrhea or those having enlarged ovaries on pelvic examination. Their ages ranged from 17 to 40 years; their husbands were generally in good health and fertile. 28 were suffering from PI and 12 from SI. Ovarian biopsy was taken in 20 patients by laparoscopic technique and 20 patients by wedge resection. At the same time endometrial biopsy was taken with a specimen of cervical mucus and vaginal cells to detect the presence or absence of ovulation. Evidence of recent ovulation was present in 57.1% of the cases of PI and 50% of the cases of SI. However, the ovarian structure was abnormal in 92.9% of the cases of PI and 83.3% of the cases of SI. Polycystic ovary was present in 71.4% of PI cases and in 58.3% of SI cases and was considered the most common ovarian abnormality in both groups, followed by sclerotic ovary, which was detected in 14.3% of PI cases and no SI cases. Other findings in both groups included tubo-ovarian abscess, ovarian fibroma and a serous cystadenoma.^ieng

Histological study of the effects of hycanthone on the frog's ventricle in the presence of a soluble sodium salt of prednisolone hemisuccinate.

The histological picture of the ventricle of frog's heart exposed to the action of Hycanthone in Ringer's solution in concentration of 1:1 was compared with that of the ventricle of frog's heart exposed to Ringer's solution devoid of the drug and with that of frog's heart exposed to Ringer's solution containing Hycanthone in concentration of 1:1 in addition to a soluble sodium salt of prednisolone hemisuccinate in concentration 1:1. It was found that the structure of the ventricle of the heart exposed to the action of Hycanthone in the presence of the soluble sodium salt of prednisolone hemisuccinate was close in pattern to the structure of the ventricle of the heart exposed to Ringer's solution alone, while the ventricle of the heart exposed to Hycanthone alone in Ringer's solution in concentration of 1:1 was different in that the muscle fibres swollen, the cytoplasm was paler with less marked striations, the nuclei were swollen and paler, the epicardial cells were swollen and the connective tissue pattern was distorted. This denoted that the morphological changes that occurred in response to Hycanthone in the presence of the soluble sodium salt of prednisolone hemisuccinate was less marked than those which occurred in its absence.

The effects of dyphylline [7-(2,3-dihydroxypropyl) theophylline] on the toxicity of hycanthone on the frog's heart.

The effects of the topical application of Dyphylline in concentrations of 1.0 mg/1.0 ml and 10 mg/1.0 ml Ringer's solution and 25 mg/1.0 ml, 0.065% NaCl solution (the content of ampoules in clinical use) were investigated on frog's heart in situ. Dyphylline in all of the above concentrations had a stimulatory effect on the frog's heart. Hycanthone methanesulphonate in concentration of 1.0 ml/1.0 ml when topically applied to the frog's heart had a depressant effect on both of the contractility and rhythmicity. The depressant effects of Hycanthone in concentration of 1:1 were compared before and after the topical application of Dyphylline in the above mentioned concentrations. It was found that Dyphylline in concentration of 1.0 mg/1.0 ml could partially antagonize the depressant effect of Hycanthone on the heart rate but not on the force of contraction. Dyphylline in concentration of 10 mg/1.0 ml could partially antagonize the depressant effects of Hycanthone on both of the heart rate and the force of contraction. Dyphylline in concentration of 25 mg/1.0 ml could completely antagonize the depressant effects of hycanthone on both of the heart rate and the force of contraction.