Sperm membrane lipid liposomes can evoke an effective immune response against encapsulated antigen in BALB/c mice.

In an earlier study, we provided strong evidence that liposomes made of sperm membrane lipids (spermatosomes) can deliver entrapped molecules to the cytosol of target cells. Now we have evaluated the immunological behavior of spermatosome-encapsulated soluble antigen ovalbumin (OVA) in BALB/c mice. Spermatosome-mediated antigen delivery can affect both cytosolic and endosomal antigen-processing pathways, simultaneously, leading to the generation of CD4+ T-helper and CD8+ cytotoxic T-cell responses. Isotype studies revealed that immunization with spermatosome-encapsulated OVA elicits mainly IgG2a and IgG1 subclasses of antibodies. A potential vaccine candidate should impart long-lasting protection against infection; to this end, immunization with spermatosome-encapsulated OVA resulted in expression of CD44 and CD62L cell-surface markers on T cells, suggestive of a desirable memory response. We conclude that spermatosome encapsulation is a useful strategy for vaccine production, because it enhances the immunological activity of the encapsulated antigen.

Abdominal myomectomy versus abdominal hysterectomy for symptomatic and big uterine fibroids.

OBJECTIVE: To compare abdominal myomectomy with abdominal hysterectomy in women with big and symptomatic uterine fibroids. METHODS: The hospital records at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia were reviewed to identify women who underwent abdominal myomectomy or abdominal hysterectomy between 1989 and 1999. Inclusion criteria were the presence of symptoms and size of the uterus equaling that of 12 weeks gestation or more. Women who underwent myomectomy as a treatment of infertility were excluded. RESULTS: During the study period, 111 women met the inclusion criteria. Thirty-eight women underwent abdominal myomectomy and 73 women underwent abdominal hysterectomy. Forty women were excluded because of myomectomy for infertility. Abdominal myomectomy was successfully performed in all women for whom it was scheduled. Hysterectomy, internal iliac ligation, or other procedures were not necessary to control the bleeding. The primary indication for myomectomy was abnormal vaginal bleeding in 23 women and pelviabdominal mass in 15 women compared to 6 women and 67 women in the hysterectomy group. There were statistically significant differences in the mean age and parity (p value 0.01 and <0.001) between women who underwent abdominal myomectomy and abdominal hysterectomy. The uterine size clinically (mean +/- standard deviation), size of largest myoma by ultrasonography, and from histopathology reports were 15.4 +/- 3.8, 11.8 +/- 2.8, and 13.6 +/- 3.2 compared to 17.9 +/- 4.4, 16.9 +/- 4.2, and 13.8 +/- 3.7 (p values not statistically significant). Similarly, there were no statistically significant differences in the pre- and postoperative hemoglobin, estimated blood loss, rate of blood transfusion, operative time, and numbers of days in hospital. CONCLUSION: Abdominal myomectomy for big and symptomatic uterine fibroids carries similar risks to abdominal hysterectomy.

Laparoscopic methotrexate instillation in unruptured tubal pregnancy--is it worthwhile?

This study documents the success rate and risks of laparoscopic local injection of methotrexate in the unruptured tubal pregnancy. This was a prospective study conducted in two centres, King Abdulaziz University Hospital and Dr Erfan & Bagedo Hospital, Jeddah, Saudi Arabia. Twenty-one patients with an intact tubal pregnancy were selected for laparoscopic local treatment with the use of a single injection of 12.5 mg of methotrexate into the ectopic site at the time of diagnostic laparoscopy. In 80.9% (17 patients), serum beta-hCG level decreased to the nonpregnant level with no further intervention and the patients recovered without any serious side effect. In 19.9% (four patients) mini-laparotomy was indicated because of a rising beta-hCG. Local methotrexate therapy in an early intact tubal ectopic at the time of laparoscopy is a possible alternative to surgery in selected cases. It also has some advantage over systemic (intramuscular) methotrexate as it avoids potentially serious side effects.

Screening for gestational diabetes mellitus in pregnant females.

OBJECTIVES: To evaluate the applicability of the 50-g glucose challenge test as a screening test for gestational diabetes mellitus in relation to pregnancy outcomes. METHODS: A prospective study was conducted on 818 Saudi pregnant females who were randomly recruited from the Antenatal Clinics at King Abdulaziz University Hospital and New Jeddah Clinic Hospital, Jeddah. All females underwent a 50-g glucose challenge test between 24-28 weeks gestation. A result for 50-g glucose challenge test was considered positive at > 7.2 mmol/L and the female was asked to undergo a 100-g oral glucose tolerance test. The diagnosis of gestational diabetes mellitus was carried out according to the National Diabetes Data Group criteria. RESULTS: A total of 289 females exhibited plasma glucose level > 7.2 mmol/L following the 50-g glucose challenge test. Of the 289 females enrolled for the 100-g oral glucose tolerance test, 102 were diagnosed to have gestational diabetes mellitus (positive oral glucose tolerance test) and 187 were considered oral glucose tolerance test negative according to the National Diabetes Data Group diagnostic criteria. This gave a prevalence of gestational diabetes mellitus of 12.5%. Gestational diabetes mellitus females were significantly older in age, heavier in weight, with higher gravidity, greater percentage of operative deliveries and still-births, and heavier fetal birth weight as compared with the non-gestational diabetes mellitus group (P<0.05 in each case). The maximum sensitivity and specificity of the 50-g glucose challenge test were found to be at plasma glucose value of 7.8 mmol/L post the 50g glucose load. The sensitivity and specificity of this value was 88% and 84%, with a positive predictive value of 82%. To determine whether the values of plasma glucose after a 50-g glucose load were detecting abnormalities similar to those detected according to that of oral glucose tolerance test; the values obtained one-hour post the 50-g glucose challenge test were compared with zero-, one-, 2- and 3-hour values and also the area under the curve in the 100-g oral glucose tolerance test. Plasma glucose post the 50-g glucose challenge test showed marked correlation with oral glucose tolerance test results. This was mostly occurring at the one- and 2-hour oral glucose tolerance test values and was stronger in the gestational diabetes mellitus group and in both the gestational diabetes mellitus plus negative oral glucose tolerance test combined, than in the negative oral glucose tolerance test group on its own. CONCLUSION: It is concluded that plasma glucose level measured one-hour post a 50-g glucose challenge test at 24-28 weeks of gestation with a cut-off value of 7.8 mmol/L is a reliable screening test for gestational diabetes mellitus in the local population studied. This test offers the best combination of ease and economy of use and reproducibility in screening for gestational diabetes mellitus.

Round spermatid separation and in-vitro maturation.

OBJECTIVE: To combine 2 methods; spermatid isolation and in-vitro maturation to improve their quality and enhance their ability of fertilization. METHODS: A discontinuous Percoll gradient was used to separate immature germ cells. Co-culture with Vero cells was attempted to convert round spermatids into more mature forms. In total 87 spermatids were studied. RESULTS: Of a final number of 77 round spermatids only 12 (15.5%) showed a certain degree of maturation in 3 out of 7 patients (42%). Of those 12 maturing spermatids, only 4 developed to an early elongated spermatid stage Sc1, but without flagella. CONCLUSION: Considering the limited in-vitro round spermatid maturation achieved in this study, the low fertilization and pregnancy rate with spermatids in general and round spermatids in particular, further refinements of this technology have to be achieved before its regular implementation in routine clinical practice is justifiable.

Vibroacoustic stimulation - does it really help?

One of the major objectives of perinatal medicine is to look for better means of testing for fetal well-being in utero. This prospectively study measured the antenatal fetal heart rate changes in response to fetal acoustic stimulation using artificial electronic larynx (Model 5C) in two groups of patients. In Group A, consisting of 80 low risk patients selected from the antenatal clinic, the acoustic stimulation resulted in a good response with no perinatal death. In Group B, consisting of 80 high risk patients, only 15 patients (18.7%) showed no response. In these 15 patients, there were two stillbirths and two neonatal deaths. Thirteen of these 15 patients were small for gestational age compared to only eight out of 61 who showed good response to the stimulus. This difference and the findins are statistically significant.