Antiphospholipid syndrome and second- or third-trimester fetal death: follow-up in the next pregnancy.

OBJECTIVE: To evaluate the efficacy of a uniform management protocol in antiphospholipid-antibody-positive obstetric patients with at least one second- or third-trimester intra-uterine fetal death. STUDY DESIGN: A prospective study of 33 successive pregnancies in antiphospholipid-antibody-positive patients, diagnosed after an intra-uterine fetal death. The management included treatment by a combination of aspirin and low-molecular-weight heparin, and a close follow-up with at least clinical examination, ultrasonography, uterine, and umbilical artery Doppler monthly from the first trimester. In the absence of any anomaly, delivery was induced between 37 and 38 weeks' gestation. RESULTS: In this high risk population, seven recurrences of vascular pathology occurred: five cases of mild, isolated fetal growth retardation and one of preeclampsia associated with fetal growth retardation requiring preterm delivery. Eight patients were delivered before 37 weeks. No recurrence of second- or third-trimester fetal death was observed. Uterine artery Doppler was informative as early as the first trimester (12-15 weeks): a bilateral notch was associated with a lower birthweight (2626+/-688 g versus 3178+/-353 g, respectively, p = 0.01), despite similar gestational age. The negative predictive value of uterine Doppler was more than 92% at 12-15 weeks' gestation and remained high throughout pregnancy. CONCLUSION: Although intra-uterine fetal death is considered at high risk of recurrence in case of antiphospholipid syndrome (APS), a uniform management protocol including aspirin and heparin and close obstetrical follow-up led to a favorable outcome in most cases.

Intestinal parasitic infections in immunosuppressed patients.

Hundred immunosuppressed patients and 50 apparently healthy individuals as control were subjected to stool examination for parasitic infections by the direct smear method and the merthiolate iodine formal-dehyde (MIF) concentration technique. The modified Ziehl-Neelson stain and the aniline carbol methyl violet stain were used to detect Cryptosporidium oocysts. 27 Patients were found positive using the MIF technique while only 13 of them were positive by the direct smear method. Cryptosporidium oocysts were detected in 7 cases using the aniline carbol methl violet stain while only 5 of them were positive by the modified Ziehl-Neelson stain.

Toxoplasma antibodies in clinically suspected cases of toxoplasmosis.

One hundred and seven cases, 35 males and 72 females aging from 3 months to 32 years old were divided into 4 groups: ocular, neurological, cases with abortion and cases having Down's syndrome. 47 apparently healthy individuals were taken as control. All were serologically tested for Toxoplasma antibodies using IFAT and ELSA for detection of IgG. The positive cases as well as cases below one year old were tested by ELISA IgM for the detection of acute or congenital toxoplasmosis. Toxoplasma antibodies (IgG) were found in 28 (26%) and 43 cases (40%) by IFAT and ELISA respectively. ELISA IgM was positive in 12 (20%) out of 60 serum samples. Two cases (11%) among 27 patients below one year old positive. Statistical significance was reported concerning the positive cases in the ocular group as well as patients with abortions. Results revealed that ELISA is more sensitive and specific than IFAT.

Incidence of Toxoplasma and Toxocara antibodies among out-patients in the Ophthalmic Research Institute, Egypt.

Infection by Toxoplasma gondii and Toxocara canis is getting much important nowadays. Both are soil transmitted infections. The present study was planned to detect the incidence of T. gondii and T. canis antibodies among 100 patients attending the outpatient clinics in Research Institutes of Ophthalmology (RIO), whose urine and stool were free from other parasitic stages. Patients were classified into two groups, group I; (70 ocular cases) and group II, (30 non-occular cases). Control group (group III); 30 healthy persons. Sera from all individuals were subjected to IFAT and IHAT to detect Toxoplasma antibodies and IFAT to detect Toxocara antibodies. By using IFAT for Toxoplasma revealed, 25% as a total incidence, 21.4% in group I, 33.3% in group II and 6.6% in group III. While IHAT revealed 51% as a total incidence, 51.4% in group I, 50% in group II and 23.3% in group III. Among group I, retinochoroiditis cases showed the highest incidence and titre. While hydrocephalic cases showed highest incidence and titre in group II. T. canis antibodies revealed 23% as a total incidence, 14.3% in group I, 43.3% in group II and 5% in group III. Cases presented with retinal detachment showed the highest incidence and titre in group I while in group II hepatomegalic cases gave the highest incidence and titre. Concomitant infection of both Toxoplasma and Toxocara was detected in 8% of positive cases.

[Cervical pregnancy: conservative treatment with primary embolization of the uterine arteries. A case report. Review of the literature]. / Grossesse cervicale: traitement conservateur avec embolisation première des pédicules utérins. A propos d'un cas. Revue de la littérature.

Ectopic pregnancies are rarely located in the cervix. In most (50-70%) of the cases, haemostatic hysterectomy is usually performed. We attempted an original approach for ectopic pregnancies located in the cervix which allowed preservation of the uterus. The uterine arteries are embolized before evacuation of the pregnancy and haemostasis of the loge with a balloon probe. In the literature, the incidence has been reported at 1 cases/20,000 births. Past history of curetage is a favouring factor. Echography facilitates diagnosis. When possible, conservative treatment may involve surgery (arterial ligature, endocervical haemostasis), drug therapy (methotrexate) and radiography (arterial embolization).

Study of the present status of filariasis in an endemic area in Giza Governorate, Egypt.

In a trial to throw some light on the present status of Filariasis in Giza Governorate, both human and mosquitoes were surveyed in two endemic areas: Kafr-Ghataty and Azizya. In Kafr-Ghataty the clinical cases detected were very rare (0.77%), while no microfilaraemic cases were obtained. The situation was different in Azizya village, where no clinical cases were detected but microfilaraemic cases were relatively higher (8%). The results of the larval survey, carried out only in Kafr-Ghataty, showed that Culex pipiens larvae were predominant (99.57%). They were found in all the breeding places specially canals and seepages, while Theobaldia longiareolata larvae were rare (0.43%) and present only in wells and cesspits. Regarding the adult mosquitoes survey, Culex pipiens was the only species detected in both areas. The results of dissection of adult female mosquitoes showed that individual dissection failed to detect infection among mosquitoes, in contrast to mass dissection which gave positive results (0.27% in Kafr-Ghataty and 2.2% in Azizya). It was also found that infective mosquitoes were 0% in Kafr-Ghataty and 1.1% in Azizya.

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.

Protein chromatographic study on adult Ascaris lumbricoides, Ascaris vitulorum and Toxocara canis.

Chromatographic analysis using Sephacryl S-300 was done on protein extract of adult Ascaris lumbricoides, A. vitulorum and Toxocara canis worms. Six fractions were separated from both Ascaris species and nine from T. canis. Fractions revealed a variety of molecular weights in relation to the three species of worms that ranged from 6,000-70,000 daltons. Crude extract of T. canis showed cross reaction with both species of Ascaris sera using double gel diffusion, while no reaction was obtained using a partially purified antigen.

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.

Immunodiagnostics of Toxocara canis in suspected ocular and visceral manifestations.

Sera from patients with ocular and visceral manifestations of toxocariasis were tested by precipitin absorption (PAT), counter-immunoelectrophoresis (CIEP), indirect fluorescent antibody (IFAT) and ELISA. The ocular cases revealed a percentage of positivity of 36% by PAT, 0% by CIEP, 32% and 28% by IFAT with embryonated egg (EE) and frozen section antigens (FS) respectively and 40% by ELISA. The visceral cases revealed 44% positively by PAT, 24% by CIEP 52% and 48% by IFAT with EE and FS respectively and 52% by ELISA. Statistical evaluation was done to interpret the results.

Concomitant Toxoplasma and Toxocara infections.

Toxoplasmosis being to a large extent a soil transmitted infection is acquired in the same manner and often at the same time as toxocariasis, the source being concomitantly infected cats. 110 sera of patients suspected of toxoplasmosis and found positive by the indirect fluorescent antibody test (IFAT), were also tested for Toxocara antibodies by the IFAT. Seropositivity was found to be 18.1%. On the other hand, 12 sera from patients presenting with toxocariasis and proved serologically positive, were tested to detect Toxoplasma antibodies and only one was positive (8.3%). Association of antibodies of the two parasites was found in 21 sera (17.2%).

Immunodiagnostics of visceral toxocariasis.

Twenty five suspected cases of visceral toxocariasis and 25 apparently healthy controls, were tested in four serological tests, namely precipitin absorption test (PAT), counter immunoelectrophoresis (CIEP), indirect fluorescent antibody test (IFAT), and enzyme linked immunosorbent assay (ELISA). Adult Toxocara worm antigen was used in PAT & CIEP as saline extract and as frozen sections (FS) in IFAT while the embryonated eggs (EE) were used as saline extract in ELISA and as a whole in IFAT. The percentages of positivity reported were 44% by PAT, 24% with CIEP, 52% with IFAT (EE), 48% with IFAT (FS), and 52% in the ELISA. In the apparently healthy control group, only one subject gave positive result with PAT, and ELISA at titres of 1/16 and 1/64 respectively. The EE antigen proved to be more sensitive than adult worm antigen, where it was used in IFAT & ELISA and gave the highest percentage of positivity and the highest titre (1/256 & 1/4096 respectively). It was noticed that the children below the age of 10 years, were statistically significant (P less than 0.05) by all tests except CIEP.

Diagnosis of ocular and glandular toxoplasmosis using the Indian ink immunoreaction.

The Indian ink immunoreaction (IIR) as a method for diagnosis of Toxoplasma infection has been evaluated. 68 sera from patients with suspected ocular and glandular toxoplasmosis and 30 control sera from normal individuals were tested using both indirect fluorescent antibody test (IFAT) and IIR. The test proved to be specific, simple and rapid especially for screening purposes.