Oral sildenafil citrate: a potential approach for improvement of endometrial thickness and treatment of unexplained infertility in women.

OBJECTIVE: The study aimed to determine the impact of using sildenafil citrate as an adjuvant with clomiphene citrate (CC) in the treatment of women with unexplained infertility. PATIENTS AND METHODS: 130 women with unexplained infertility were enrolled in a prospective randomized study. After dividing into two groups, all patients received CC 50 mg-BD from the 2nd to the 7th day of the cycle. Oral sildenafil citrate 20 mg was given BD to the study group from the end of menstruation till ovulation. A transvaginal ultrasound was carried out for all patients to assess ovulation, number of follicles, and endometrial thickness (ET). The beta-hCG blood test was used to determine pregnancy two weeks after ovulation followed by an ultrasound to confirm viability. Adverse effects were recorded and miscarriage, ectopic, and multi-fetal pregnancy were followed up for twelve weeks. RESULTS: Median ET in the study group was 8 mm compared to 7 mm in the control group (p<0.01). The number of pregnancies increased in the study group but with no significant difference. The median ET was greater in the study group with an infertility duration of less than 2 years. Headache was the most significant adverse effect in the study group (9.2% vs. 1.5%, p=0.052). CONCLUSIONS: Adding sildenafil citrate to CC is a good choice for overcoming the antiestrogenic action of CC and improving ET in women with unexplained infertility, especially in those with less than 2 years of infertility.

Immunohistochemical assessment of endothelin-1 axis in psoriasis, basal cell carcinoma and squamous cell carcinoma.

AIM: Endothelin-1 is an autocrine growth factor for keratinocytes, an effect controlled by its A and B receptors, with no previous comparison of endothelin axis expression in inflammatory and neoplastic skin diseases showing keratinocyte proliferation. The aim of the study was to investigate endothelin-1 axis expression in skin lesions of psoriasis, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). METHODS: This study included 40 subjects (8 patients with SCC, 12 patients with BCC, 10 patients with psoriasis, and 10 healthy controls). Biopsies from lesional skin of patients and normal skin of controls were examined immunohistochemically for endothelin-1 and its receptors A and B frequency and grade of expression. RESULTS: Endothelin-1 and receptor A were detected in all patients with SCC and psoriasis, with a higher frequency and grade of expression than controls and BCC. The frequency of receptor B expression was significantly lower while higher staining grade was found in BCC (8.3%) rather than other studied groups. CONCLUSION: A comparable higher frequency and grade of expression of endothelin-1 and its receptor A are documented in psoriasis and SCC than in BCC and controls denoting their involvement in keratinocyte proliferation in both diseases. Receptor A is the predominately expressed receptor in psoriasis and SCC.

Can laparoscopic removal of Essure device before embryo transfer correct poor reproductive outcome pattern in IVF? A case report.

OBJECTIVE: This report describes a successful surgical approach to multiple in vitro fertilization (IVF) failures in the setting of hydrosalpinges, which had been previously treated with Essure inserts. MATERIALS AND METHODS: A non-smoking 33-year-old Caucasian G2 P0020 (body mass index: BMI = 22) attended for second opinion. Her history was significant for bilateral hydrosalpinges having been noted on hysterosalpingogram two years earlier. This was managed by hysteroscopic placement of Essure inserts bilaterally. One year later, and now with Essure in situ, the patient completed three IVF cycles elsewhere. Her first and third IVF attempts resulted in biochemical pregnancy, while human chorionic gonadotropin (hCG) was negative after the second cycle. Upon presentation at the authors' center and before beginning a fourth IVF cycle, further testing and surgical removal of the Essure devices was recommended. RESULTS: Repeat hysteroscopy was unremarkable; laparoscopic bilateral salpingectomy and extirpation of Essure implants was accomplished without difficulty. Following menses, the patient initiated IVF with three embryos transferred. At day 60, a single intrauterine pregnancy was identified with positive cardiac activity (rate > 100/min). Her obstetrical course was uneventful; a healthy 4,195 gram male infant was delivered (breech) by Cesarean at 40 weeks' gestation. CONCLUSION: Essure inserts comprise inner fibers of polyethylene terephthalate, a stainless steel coil, and a nickel-titanium coil. The product received FDA approval as a contraceptive in 2002 although its use for hydrosalpinx remains off-label. While successful outcomes with IVF following Essure placement have been reported, this is the first description of pregnancy and delivery from IVF after Essure removal. Essure may be considered for sterilization when laparoscopy is contraindicated, but experience with its use specifically for treating hydrosalpinges before IVF is limited. This observed association between prior poor IVF outcomes and Essure with subsequent delivery after surgical Essure removal is the first of its kind to be reported, and warrants further investigation.

Emergence of foot-and-mouth disease virus SAT 2 in Egypt during 2012.

The epidemiology of foot-and-mouth disease (FMD) in North Africa is complicated by the co-circulation of endemic FMD viruses (FMDV), as well as sporadic incursions of exotic viral strains from the Middle East and Sub-Saharan Africa. This report describes the molecular characterization of SAT 2 FMD viruses that have caused widespread field outbreaks of FMD in Egypt during February and March 2012. Phylogenetic analysis showed that viruses from these outbreaks fell into two distinct lineages within the SAT 2 topotype VII, which were distinct from a contemporary SAT 2 lineage of the same toptype from Libya. These were the first FMD outbreaks due to this serotype in Egypt since 1950 and required the development of a tailored real-time reverse-transcription PCR assay that can be used in the laboratory to distinguish FMD viruses of these lineages from other endemic FMD viruses that might be present in North Africa. These data highlight the ease by which FMDV can cross international boundaries and emphasize the importance of deploying systems to continuously monitor the global epidemiology of this disease.

Evaluation of zinc level in skin of patients with necrolytic acral erythema.

BACKGROUND: Necrolytic acral erythema (NAE) is considered a cutaneous sign of hepatitis C virus infection. Its exact pathogenesis is still not fully understood, with some reports about decreased serum zinc levels but none about its level in the skin. OBJECTIVES: To assess skin (lesional and perilesional) and serum zinc levels in patients with NAE and compare them with levels in control subjects. METHODS: Fifteen patients with NAE and 10 healthy controls were included in this study. Assessment of zinc level, in serum by graphite furnace atomic absorption spectrophotometry and in lesional and perilesional skin biopsies by flame atomic absorption spectrometry, was done in all subjects. Re-evaluation of serum and lesional skin zinc level was done after oral zinc treatment. RESULTS: Mean±SD zinc levels were significantly lower in patients (serum 0·44 ± 0·13 mg L(-1) ; lesional skin 42·6 ± 18·9 mg L(-1) ; perilesional skin 32·5 ± 17·2 mg L(-1) ) than controls (serum 1·17 ± 0·29 mg L(-1) ; skin 100·1 ± 2·77 mg L(-1) ), with a positive correlation between lesional and perilesional skin zinc (r = 0·91, P < 0·01). Oral zinc supplementation significantly increased serum and skin zinc levels (by 159% and 4%, respectively; P < 0·05). CONCLUSIONS: NAE is associated with decreased serum and skin zinc levels. Oral zinc supplementation corrects decreased levels of plasma and skin zinc much earlier than the desired clinical benefits appear.

Investigation of self-organizing oscillator networks for use in clustering microarray data.

The self-organizing oscillator network (SOON) is a comparatively new clustering algorithm that does not require the knowledge of the number of clusters. The SOON is distance based, and its clustering behavior is different to density-based algorithms in a number of ways. This paper examines the effect of adjusting the control parameters of the SOON with four different datasets; the first is a (communications) modulation dataset representing one modulation scheme under a variety of noise conditions. This allows the assessment of the behavior of the algorithm with data varying between highly separable and nonseparable cases. The main thrust of this paper is to evaluate its efficacy in biological datasets. The second is taken from microarray experiments on the cell cycle of yeast, while the third and the fourth represent two microarray cancer datasets, i.e., the lymphoma and the liver cancer datasets. The paper demonstrates that the SOON is a viable tool to analyze these problems, and can add many useful insights to the biological data that may not always be available using other clustering methods.

Study on the possible role of heat shock proteins in host resistance to Trichinella spiralis infection in experimental animals.

The expression of heat shock proteins (HSPs) and their immunogenic role in host parasite relationship has been studied in T. spiralis infection in mice. Two groups of infective stage larvae were incubated at 37 degrees C or at 43 degrees C for 3 hours in a nutrient medium. Crude somatic extracts and excretory/secretory (E/S) products were obtained. Quantitative estimation and in vitro translation of mRNA were carried out. Crude somatic extracts, E/S products and in vitro translated proteins were all subjected to SDS-PAGE and immunoelectrophoresis against a monoclonal antibody to HSP70. They were further used to immunize mice which were then infected with T. spiralis. The degree of immunization was assessed by counting adult worms, muscle larvae and estimating total gamma globulins of mice. SDS-PAGE revealed intense peaks of 71 KDa and 81 KDa in all proteins obtained from heat shocked larvae. These proteins have been proved to involve HSP70 as manifested by their strong reactivity with anti-HSP70. In vitro translated products of heat shocked larvae (at 43 degrees C) proved to be strongly immunogenic as evidenced by the lower adult worm, muscle larval counts and higher total gamma globulins in sera of mice in comparison with the control non immunized group as well as to other larval antigens incubated at 37 degrees C. So, exposure to heat, can induce the synthesis of heat shock proteins which can defend the organism against environmental stress. Meanwhile, these heat shock proteins can render the host more refractory to reinfection.

Physico-chemical and technological studies on sugar beet roots.

The morphological and chemical characteristics of ten varieties of sugar beet roots were evaluated during the season of 1996-1997. The best morphological characteristics were found in Top, Ito and Pamela varieties. The highest expected technological yield of sugar was found in Pamela and Top. The chemical constituents of different varieties of sugar-beet roots showed significant differences. The suitability of sugar beet juice for preparing beet syrup as a new product was also evaluated and compared with sugar cane syrup. Purified beet-syrups concentrated under vacuum or under atmospheric pressure showed more stability during storage than sugar cane syrup. The effect of storage conditions (at cold storage and at room temperature) and packaging materials (glass and polyethylene high-density bottles) on properties of beet-syrup and sugar cane syrup were also studied.

Effect of some parasitic infection on neurotransmitters in the brain of experimentally infected mice before and after treatment.

The effects of some parasitic infection (bilharziasis, toxocariasis and trichinosis) on the brain of experimentally infected mice were investigated. Eighty animals were classified into four groups, group I contained five non infected animals as a control group. The other groups each contained twenty-five mice infected with Schistosoma mansoni (group II), Toxocara canis (group III) and Trichinella spiralis (group IV). Each infected group was divided into two subgroups (a,b). Subgroup (a) left untreated and subgroups (b) treated by praziquantel (in group II) and mebendazole (in group III and IV). Histopathological and immunological examination using peroxidase antiperoxidase (PAP) technique and neurotransmitters estimation (nor-epinephrine, dopamine and serotonine) were carried. In the untreated animals, there were mild histopathological changes and mild antigenic deposition in subgroups (IIa and IIIa) and marked changes in subgroup (IVa). There were significant decrease in dopamine in subgroup (IIIa), not improved after treatment (subgroup IIIb) and significant decrease in nor-epinephrine and serotonine in subgroup (IVa) improved after treatment in subgroup (IVb). The neurotransmitters changes may explain the motor, behavioural and emotional changes that occurred with these parasites.

Evaluation of two cultural media (CPLM & TYM) for isolation and maintenance of Trichomonas vaginalis stocks in the laboratory.

Five hundreds vaginal discharge specimens were inoculated simultaneously in 2 axenic culture media (CPLM & TYM), in order to compare their ability to isolate and to maintain the growth of T. vaginalis in the laboratory. While both media were found to be equally good in detecting the organisms in vaginal discharges, yet, T. vaginalis stocks were maintained for a longer time in TYM medium (one year), than in the CPLM medium (2 weeks). The yields of the parasites with different inocula subcultured and after different incubation periods were counted in the TYM medium.

Endoscopic diagnosis of gastric varices.

In this retrospective study, the presence and appearance of gastric varices were analyzed among patients presenting at Kasr El Aini Hospital with variceal bleeding during the period from 1984 to 1989. Two groups of patients were studied. The first group included 970 patients with documented variceal bleeding with no history of sclerotherapy. Of these patients 6.7%, had concomitant gastric varices, and 27.1% had direct gastric extension of esophageal varices (mostly of grade 3). Gastric varices alone, without esophageal varices, were found in five cases (0.5%). The second group was a subgroup, and included 376 patients who underwent complete sclerotherapeutic eradication of varices restricted to the esophagus and were without gastric varices at the first presentation. Eleven of these patients (2.9%) developed secondary gastric varices. There was no correlation between the risk of bleeding from primary gastric varices (seen at the first presentation) and the grade of the esophageal varices. There were more bleeding episodes from large gastric varices (35.4% for the cauliflower and 16.9% for the cystic forms) than from the small varices, i.e. ruga-like and network-like gastric varices. The study also shows that the secondary development of gastric varices after endoscopic variceal sclerotherapy is a rare event, and that there was no risk of bleeding from the secondary gastric varices. Patients with esophageal varices with gastric extension had a small risk of bleeding from their gastric varices (5.2%).

Characterization of Egyptian isolates of Trichomonas vaginalis I. Isoenzyme patterns.

Three T. vaginalis isolates from Egypt were compared for their isoenzyme electrophoretic patterns on cellulose acetate. The enzymes studied were: glucose-6-dehydrogenase (G6PD); malate dehydrogenase (MDH); phosphoglucomutase (PGM); glucose phosphate isomerase (GPI); malic enzyme (ME); hexokinase (HK) and lactate dehydrogenase (LDH). The three isolates shared the same isoenzyme banding patterns of MDH; GPI; HK and LDH. Two of these isolates were similar in their banding patterns of G6PD, PGM and different from those of the third isolate. The latter was similar to one of the two isolates and different from the other in the ME isoenzyme patterns.

Characterization of Egyptian isolates of Trichomonas vaginalis: I. Serotyping.

Antitrichomonal hyperimmune sera against T. vaginalis stocks isolated from Egyptian female patients were employed for serological differentiation of somatic and soluble antigens in the Ouchterlony gel double immunodiffusion technique. It was concluded that soluble trichomonal antigens present in association with living flagellates are stock--specific reacting with some, but not all the antitrichomonal hyperimmune sera, while those present in association with dead parasites are common antigens reacting with all the sera. Three stocks, E1, E2 and E3 could be differentiated into two strains using their stock--specific antigens. The somatic antigens of six trichomonal stocks reacted with all the hyperimmune sera denoting common antigenic make up.

The immune defensive mechanism in parasitic infection with eosinophilia.

This study was attempted to assess the extent of stimulation of the immune system in some patients suffering from parasitic infection with eosinophilia. Eighty-eight cases were selected, they included 10 apparently healthy, 10 suffering from different atopic disorders associated with eosinophilia and free from parasitic infections and 68 patients suffering from different parasitic infections associated with marked eosinophilia. The results showed a highly significant increase in the absolute eosinophil count in the atopic group while the parasitized group showed a moderate increase. The IgE serum level was increased in both atopic and parasitized groups. The cellular immunity expressed by phagocytic power of neutrophils was more depressed in parasitized than atopic group.

Parasitic infections associated with malignancy and leprosy.

Results of parasitic infections, as revealed by urine and stool examination was significant (P less than 0.05) in 43.3% of patients suffering from different malignant diseases and non significant (P greater than 0.05) in 29.3% of leprosy patients compared to 22% in control subjects. The most prevalent parasites were E. histolytica and G. lamblia. Cryptosporidium occysts were not detected. By stool examination and culture, S. stercoralis larvae were detected only in the malignancy group. The most common parasites occurring concomitantly were A. duodenale and S. stercoralis. By the IFAT, strongyloidiasis gave significantly higher positive results in the malignancy group than in the leprosy and control groups. IFAT for toxocariasis, showed highly significant positivity in the leprosy group and significantly positivity in the malignancy group. For toxoplasmosis, it showed highly significant positive results in both leprosy and malignancy groups. Eosinophilia was significantly more prominent among malignancy patients and insignificant among those with leprosy. Parasitic infection detected by urine and stool examination among patients with eosinophilia was found in 76% of the malignancy patients and in 66.7% of the leprosy patients.

Parasitic infections associated with mental retardation in Egypt.

Examination of 150 mentally retarded patients for parasitic infections by urine and stool analysis revealed that 115 (76.67%) were positive. The most prevalent parasites found were T. trichiura in 56%, A. lumbricoides in 40.6% and A. duodenale in 21.33%. Double infection was present in 30.67%, triple infection in 15.33% and quadriple infection in 6%. Eosinophilia was detected in 91 (64.08%) of 142 examined cases, all were suffering from intestinal parasites. S. stercoralis was present in 11.33% by stool examination and culture and in 24 (60%) out of 40 examined cases by the IFAT. Toxocara antibodies were present in 38 (56.72%) out of 67 examined cases by the IFAT. Toxoplasma antibodies were present in 106 (74.65%) out of 142 examined cases by the IFAT.

Experimental trichinosis: effect of immunosuppression on the host-parasite system.

Experimental trichinosis in immunocompetent verus immunosuppressed albino rats was studied over a period of two months. The immunosuppressed ones showed significant delay in expulsion of adult worms, significant increase in the yield of muscle larvae, lower IFA titres and delayed encystation of muscle larvae with mild cellular infiltration. Specific antigen deposits detected in the muscles and different tissues of the immunosuppressed rats indicated augmentation of circulating antigens. In both groups, the liver, kidney, lung, brain and testes showed nonspecific pathological changes but larvae were never detected in examined sections. Incidentally, on the 14th post-infection day, two immunocompetent rats were found pregnant, and near-full-term embryos showed more deposition of Trichinella antigens in most of their tissues indicating placental passage of circulating antigens. This study indicates that in patients receiving immunosuppressive drugs, possible exposure to T. spiralis infection will result in severe manifestations or complications.

Effect of Hymenolepis nana on the mouse ileal mucosal cells: histochemical studies.

Histochemical studies of the ileal mucosal cells of mice experimentally infected with H. nana revealed definite increase in mucous secretions indicating increased activity of the goblet cells in response to mucosal irritation. The activity of acid phosphatase was also increased representing a sort of defence mechanism against the attached worms. The activities of ATP-ase and NADH diaphorase enzymes were decreased indicating disturbance in the metabolic and transport processes and in the absorptive function of the intestinal epithelial cells.

A study of adhesive organelles of Giardia intestinalis.

This study revealed that the adhesive disc of Giardia lamblia trophozoite has different forms. The anterior limitation of the ventrolateral flange to the adhesive disc and its flexibility suggests its participation in the mechanism of attachment of the trophozoite. Normal intestinal crypts promote attachment of Giardia trophozoite by providing a passive mechanical barrier against the main peristaltic flow. The mechanism of attachment is described in details.