Ultrasonographic wall thickness measurement of the upper and lower uterine segments in the prediction of the progress of preterm labour.

OBJECTIVE: To assess the role of ultrasonographic measurement of the upper and lower uterine segments wall thickness in predicting the progress of preterm labour in patients presenting with preterm labour pains. STUDY DESIGN: Fifty pregnant women presenting at Obstetrics Department - Suez Canal University, Egypt with regular lower abdominal pains and diagnosed as having preterm labour were enrolled in the study. MATERIALS AND METHODS: Measurements of the upper and lower uterine segments wall thickness by transabdominal ultrasonography in-between contractions and with full bladder were taken. The upper/lower uterine wall thickness ratio was calculated and correlated to the progress of the preterm labour and to the response to tocolytics. RESULTS: The ultrasonographic upper/lower uterine wall thickness ratio was directly related to the progress of preterm delivery (PTD). The change in this ratio is correlated inversely with the response to tocolysis. Using the ROC curve, when the upper/lower uterine wall thickness ratio was ≤ 1.26 the sensitivity was 94.74 and the specificity was 100.00, and when the ratio was ≤ 1.52 the sensitivity was 100.00 and the specificity was 83.33. CONCLUSIONS: These data may serve as a baseline ultrasonographic reference values for further studies in prediction the progress of preterm labour in patients presenting with preterm labour pains.

Clinical relevance of cyclooxygenase-2 and matrix metalloproteinases (MMP-2 and MT1-MMP) in human breast cancer tissue.

Breast cancer (BC) is the most common neoplasm among women in most developed countries, including Egypt. Elevated levels of certain proteins in human BC are associated with unfavorable prognosis and progressive stages of the disease. The aim of our study was to evaluate the protein expression profile and prognostic significance of cyclooxygenase-2 (COX-2), matrix metalloproteinase-2 (MMP-2), MMP-9 and membrane type 1-MMP (MT1-MMP) and their interaction in operable BC patients. The protein expression of COX-2, MMP-2 and MT1-MMP were evaluated by western blot technique, whereas enzymatic activity of MMP-2 and MMP-9 was determined by zymography in 47 breast cancer patients as well as normal adjacent tissues. Also, the correlation between these proteins and age, tumor size, LN stage, TNM stage, estrogen receptor, progesterone receptor, disease-free survival, and overall survival (OS) has been investigated. As compared to adjacent normal tissues, COX-2, MMP-2 and MT1-MMP were over-expressed in 43, 64, and 60 % of tumor tissues, respectively. In the same pattern, the activity of MMP-2 (62 %) and MMP-9 (45 %) was elevated in BC tissues. Multivariate analysis showed a positive correlation between the protein expression of COX-2, MMP-2, and MT1-MMP and the activity of MMP-2 and MMP-9 in BC patients. However, the enzymatic activity showed no correlation with clinicopathological features. This study confirms the preclinical evidence that COX-2 increased the expression of MT1-MMP, which in turn activates MMP-2. The lack of correlation with clinicopathological features, OS or disease-free survival ascertains the complexity of tumor progression and metastasis with many pro- and counter regulatory factors.

Trachoma and blindness in the Nile Delta: current patterns and projections for the future in the rural Egyptian population.

A population based survey of trachoma and blindness was conducted in a rural Nile Delta hamlet. Trachoma remains hyperendemic in this region. Active trachoma was common among preschool children; over half had moderate to severe disease. Of residents 25 years old 90% had substantial conjunctival scarring. Severe conjunctival scarring was commoner among women (84%) than men (58%), and three-quarters of older women had trichiasis/entropion compared with 57% of older men. Males and females had equivalent age specific rates of inflammatory disease. Blindness was associated with old age; 17% of residents aged 50 and over were blind. Estimates of blindness based on this survey and other surveys in Egypt indicate that blindness is still a serious public health problem in rural Egypt. The number of blind persons in Egypt will increase from an estimated 420,000 in 1980 to 868,000 by the year 2020. The current crude blindness rate of 1.8% is expected to increase to 2.3% in the year 2000 and to 3.2% in 2020.

Nonculture methods for diagnosing chlamydial infection in patients with trachoma: a clue to the pathogenesis of the disease?

We studied five different tests for diagnosing conjunctival Chlamydia trachomatis infection in specimens obtained from 100 children with moderate-to-severe trachoma. The tests were Giemsa stain, isolation in cell culture, direct fluorescein-conjugated monoclonal antibody, enzyme immunoassay, and a DNA probe. The Giemsa stain was least sensitive at 29%. The other tests gave essentially equivalent performances: sensitivity ranged from 73% to 84% and specificity from 93% to 100%. Seven of the 45 positive specimens were only positive in cell culture, whereas 11 of the 45 were negative in culture but positive in at least two nonculture tests. We speculate that these discordant results actually reflect the biologic status of the chlamydial infection. There appears to be a stage in the infection where chlamydial antigens and nucleic acids can be detected in the absence of infectivity. This stage of infection may contribute to the pathogenesis of trachoma by providing a source of sensitizing antigen.

Beta-human chorionic gonadotrophin levels before and after the development of pre-eclampsia.

Maternal serum levels of beta-human chorionic gonadotrophin (beta-hCG) concentrations were significantly higher in 41 primigravid patients with proteinuric pre-eclampsia compared with those in 41 primigravid normotensive women matched for age and gestation. beta-hCG was also measured in serial serum samples obtained from 13 women who had a high weight-gain between 20 and 30 weeks of pregnancy. Seven of these pregnancies were subsequently complicated with pre-eclampsia while the remaining six continued to be normotensive; beta-hCG levels were found to rise before the clinical signs of pre-eclampsia appeared.