A novel protocol for postpartum magnesium sulphate in severe pre-eclampsia: a randomized controlled pilot trial

Objective: Magnesium sulphate is the preferred anticonvulsant used to prevent the development of fits in severe pre-eclampsia; we aim to compare between three different protocols of postpartum magnesium sulphate in the effectiveness of preventing the development of fits in severe pre-eclampsia.

Methods: Double-blind randomized controlled pilot trial, done in Cairo university hospital, Cairo, Egypt during 2013–2014, on 240 women with severe pre-eclampsia. Magnesium sulphate intravenous infusion was given in the postpartum period to all the patients, women were randomly allocated to group I (Single loading dose only), group II (12?h abbreviated protocol) or group III (24?h standard protocol) (n?=?80 in each group).

Results: There were no significant difference between the three groups as regards the incidence of eclampsia, elevated liver enzymes and low platelets syndrome, maternal ICU admission and; however The incidence of flushing was significantly higher in group III than group II and I (24 [30%] versus 12 [15%] versus 4 [5%]; p?<?0.001) respectively.

Conclusion: The pilot study demonstrates that the single-loading dose of postpartum magnesium sulphate is a promising alternative to the standard and the abbreviated protocol in preventing eclampsia; however, a large clinical trial is necessary to prove this.     

Maternal serum interleukin-6 in the management of patients with preterm premature rupture of membranes

Aim: To evaluate the clinical usefulness of maternal serum interleukin-6 for the detection of subclinical chorioamnionitis and in the prediction of the latency period in patients with preterm premature rupture of membrane (PPROM).

Methods: The study group included 60 patients at 24–34 weeks of gestation complaining of PPROM. Laboratory investigations included serial measurements of IL-6, TLC and CRP. Conservative management was carried out till 36 weeks unless delivery was indicated beforehand. The main outcome measures were the latency period and the occurrence of subclinical chorioamnionitis.

Results: The mean gestational age at presentation was 30.9 weeks and 35.2 weeks at delivery. The mean IL-6 level at presentation was 4.7?pg/ml. There was no correlation between IL-6 at presentation and the latency period. In addition, those diagnosed as having subclinical chorioamnionitis by placental histopathology had significantly higher levels of IL-6 at delivery. Taking IL-6 level cutoff point of 8.5?pg/ml, histological chorioamnionitis, RDS and NICU admission were significantly higher above that level while neonatal birth weight, Apgar scores at one and five minutes were significantly lower.

Conclusion: Maternal serum IL-6 at the time of PPROM has no correlation to the latency period while IL-6 levels at the time of delivery have significant correlation to the subclinical chorioamnionitis and neonatal outcome measures.     

Age‐ and gender‐specific reference intervals for serum lipid levels (measured with an Advia 1650 analyzer) in school children

Background: Due to the lack of country‐specific norms in Saudi Arabia, age‐ and gender‐specific lipid reference intervals are needed to be established for Saudi children. Methods: Blood samples were collected from 1168 children aged 6–16 years: 500 boys (43%) and 668 girls (57%), and were analyzed for cholesterol, high‐density lipoprotein (HDL) and low‐density lipoprotein (LDL). Reference intervals were established by calculating the mean and the 2.5th and 97.5th percentiles. Results: There were significant differences between boys at each Tanner stage with respect to cholesterol (P < 0.001); and HDL (P < 0.0001) but not LDL (P < 0.06) among girls. There were significant differences between boys and girls during puberty with respect to cholesterol (P < 0.0001), HDL (P < 0.0001), and LDL (P < 0.001). There was a significant positive correlation between total cholesterol levels, LDL and HDL levels at all Tanner stages in both genders. In girls, the only significant inverse correlation was at stage I (r=?0.243, P= 0.001); there was no significant correlation at other stages. Conclusions: Unlike children in other developing countries, Saudi children do not have lower serum cholesterol than their Western counterparts. These findings reflect changing dietary habits and increasing affluence in Saudi Arabia. These reference intervals may be used to aid in the early assessment of cardiovascular risk in Saudi pediatric populations.     

Injectable in situ forming controlled release implant composed of a poly-ether-ester-carbonate and applications in the field of chemotherapy

Polymeric controlled delivery systems hold great promise in the field of modern medicine. Such technology has already been converted into commercially viable products in a myriad of fields. Chemotherapy is an example of such an area where constant efficacious levels of drug can greatly enhance clinical outcomes. The key to designing such therapies is the preparation of the proper delivery system. To this end, a series of bioresorbable polyether-ester-carbonate copolymers have been developed, which when combined with a diluent, are capable injection into the body and consistently forming a drug delivery depot. The study delineated here aimed at producing a more effective treatment of a common drug, paclitaxel, using the polymeric carrier. The polymer carrier system exhibited controlled release of paclitaxel both in vitro and in vivo. Drug concentrations were analyzed by high performance liquid chromatography and apoptotic activity was confirmed through flow cytometry. Relevant success was exhibited by the regression of tumor size following a multiple injection treatment regimen in a murine xenograft model. This multiple injection treatment shows promising results when compared to the traditional paclitaxel paradigm of a single injection for a period of 3 weeks.     

Anti-cardiolipin and anti-beta 2-glycoprotein I antibodies in celiac disease

Aims

To determine the frequency of anti-cardiolipin (aCL) and anti-β2-glycoprotein I antibodies (aβ2GPI) in celiac disease (CD) patients.

Patients and methods

Sixty-three untreated CD patients and 40 healthy blood donors (HBD) were studied. IgG, IgA and IgM aCL and aβ2GPI were detected by Elisa.

Results

The frequency of antiphospholipid antibodies (aPL) (aCL and/or aβ2GPI) was significantly higher in CD patients (12 out of 63) than in HBD (two out of 40) (19% vs 5%, P = 0.04). Six CD patients out of 63 (9.5%) and one HBD out of 40 (2.5%) had aCL. Ten CD patients (15.9%) and two HBD (5%) had aβ2GPI. Only aβ2GPI-IgA was significantly more frequent in CD patients than in HBD (14.3% vs 2.5%, P = 0.048). In CD patients, aβ2GPI-IgA (nine out of 63) was significantly more frequent (14.3%) than aβ2GPI-IgG (1.6%) and IgM (1.6%) (P = 0.008). In CD patients, the frequency of aCL-IgA and IgM was 6.3% (four out of 63) and aCL-IgG were not detected. Simultaneous presence of positive antibodies was found in four CD patients: one patient had four aPL, one had three aPL and two had two aPL. The four patients who had aCL-IgA had also aβ2GPI-IgA and three of them had a titer higher than 50 units. Among nine patients with aβ2GPI-IgA, four had a titer higher than 100 units. The highest titers were found in adults.

Conclusions

aPL and particularly aβ2GPI-IgA are frequent in CD. The significance of these antibodies has to be determined.     

Alteration of Glial Fibrillary Acidic Proteins Immunoreactivity in Astrocytes of the Spinal Cord Diabetic Rats

Diabetes affects retinal and nervous glial cells, especially the astrocytes. A key indicator of this response is the alteration in the level of intermediate filament glial fibrillary acidic protein (GFAP) and number of GFAP‐immunoreactive astrocytes. To date, no study has investigated the effect of diabetes on the distribution of GFAP‐immunoreactive astrocytes in the spinal cord. Therefore, the present study investigated the effect of diabetes on the number of GFAP‐immunoreactive astrocytes in the gray matter of the spinal cord of streptozotocin‐induced diabetic Wistar rats. Animals were divided into six groups (n = 7); 6 weeks and 12 weeks diabetic duration groups and their respective age‐matched normal control and sham control groups. Our results demonstrated a significant (P < 0.001) decrease in the number of GFAP‐immunoreactive astrocytes in different areas of the spinal cord sections of the 6 weeks and 12 weeks long diabetic rats when compared with the spinal cord of normal and sham control groups of comparable age. The mean percentage in total number of GFAP‐immunoreactive astrocytes in the whole gray matter areas of the spinal cord of the 6 and 12 weeks diabetic groups were approximately 28% and 41% less than control groups. Furthermore, the 12 weeks diabetic group showed a significant (P < 0.001) reduction in the number of GFAP‐immunoreactive astrocytes when compared with the 6 weeks diabetic animals. These results suggest that the induction of diabetes is associated with a reduction in GFAP‐positive astrocytes in the spinal cord, which may affect the functional support and role of astrocytic cells in the nervous tissue. This in turn may contribute to the pathological changes associated with diabetic state in the central nervous system. Anat Rec, 291:390–399, 2008. © 2008 Wiley‐Liss, Inc.     

Using distraction forces to drive an autodistractor during limb lengthening

Distraction osteogenesis can result in high forces developing in the limb. To determine and control the distraction forces (DF), a motorized distractor driven by feedback from DF was developed and used to lengthen the tibiae of 6 sheep undergoing distraction osteogenesis. The forces were measured continually, and, in 4 of the sheep, a force threshold was set, above which an increase in rate was initiated. The rate kept increasing to a set limit if forces remained above the threshold; otherwise, the rate was decreased. Radiographs were acquired biweekly, and muscle samples were analyzed from both the operated and contralateral limbs upon termination of the experiment. Results demonstrated a drop in DF associated with increased lengthening rate, attributed to separation of the callus as indicated by radiography. Histological evidence of muscle damage generally correlated with higher DF levels. There was a significant decrease in muscle fiber diameter in lengthened relative to contralateral limbs. Collectively, the results demonstrated the use of a force-driven distraction system and support the need for considering force data in regulating distraction rates to achieve optimal clinical outcomes.     

Decision support system for the detection and grading of hard exudates from color fundus photographs

Diabetic retinopathy is a major cause of blindness, and its earliest signs include damage to the blood vessels and the formation of lesions in the retina. Automated detection and grading of hard exudates from the color fundus image is a critical step in the automated screening system for diabetic retinopathy. We propose novel methods for the detection and grading of hard exudates and the main retinal structures. For exudate detection, a novel approach based on coarse-to-fine strategy and a new image-splitting method are proposed with overall sensitivity of 93.2% and positive predictive value of 83.7% at the pixel level. The average sensitivity of the blood vessel detection is 85%, and the success rate of fovea localization is 100%. For exudate grading, a polar fovea coordinate system is adopted in accordance with medical criteria. Because of its competitive performance and ability to deal efficiently with images of variable quality, the proposed technique offers promising and efficient performance as part of an automated screening system for diabetic retinopathy.     

High Grade Gynecomastia: Surgical Correction and Potential Impact on Erectile Function

IntroductionGynecomastia denotes benign enlargement of the male breast. It is a common belief that gynecomastia is stigmatizing and may frequently cause social embarrassment and psychological stress. It is possible that this may reflect on erectile function of the afflicted. High grade gynecomastia requires radical breast tissue excision and skin reduction ending up in aesthetically unappealing scars.AimThe purpose of this study is to evaluate the reduction mammaplasty using no vertical scar technique in males with high grade gynecomastia; as regards technical refinements and outcome in the hope of providing a cosmetically appealing solution to this condition. This study also reports on the effect of high grade gynecomastia on erectile function, as well as the effect of surgery.MethodsFifteen male patients with gynecomastia underwent breast reduction using the “no vertical scar reduction mammaplasty.” Erectile function was evaluated before and after surgery.Main Outcome MeasuresSurgical outcome and erectile function.ResultsAll patients but one were satisfied with the outcome. Complications were minimal and manageable. Eleven out of 15 patients had a preoperative International Index of Erectile Function (IIEF) score less than 20 denoting erectile dysfunction. All but one (n = 10) showed improvement in their IIEF score following surgery. The difference between pre-operative IIEF (average 17.8) and postoperative (average 23.5) was statistically significant.ConclusionsThe “no vertical scar reduction mammaplasty” is a reliable technique in cases with gynecomastia and significant ptosis. It has the added benefits of avoiding the vertical scar, hiding the transverse scar in the shadow of the inferior aspect of the breast, with minimal complications. Gynecomastia as a condition causing a feminized outlook may have a negative impact on self confidence and body image. We suggest that this may have a potential negative effect on erectile function, that can be improved by adequate surgical correction. El Noamani S, Thabet AM, Enab AA, Shaeer O, and El-Sadat A. High grade gynecomastia: Surgical correction and potential impact on erectile function.     

Induced Microphase Separation in Hybrid Composite Polymer Electrolytes Based on Poly(acrylonitrile‐r‐butadienes) and Ionic Liquids

Novel hybrid, composite polymer electrolytes (HCPEs) based on poly(acrylonitrile‐r‐butadiene) (PAN‐r‐PB), CN‐modified silica nanoparticles (CN‐MSNs), Li triflate, and ionic liquids (ILs) are synthesized. Using a combination of methods, it is demonstrated that these materials segregate into PAN‐rich and PB‐rich phases, the behavior of which changes depending on the IL type. The incorporation of ILs containing hexyl and octyl substituents at the imidazolium rings leads to a higher mobility of the PB‐rich phase and a decrease of the density of the neighboring PAN‐rich phase, allowing an improvement of the Li ion conductivity. However, with an increase of the substituent length from decyl to dodecyl, ordering of the hydrophobic tails in the PB‐rich phase leads to both stiffening of the latter and corresponding ordering of the ionic pairs of ILs, resulting in a decreased conductivity. The results of this work are broadly applicable for controlling the structure and properties of polymeric materials exhibiting microphase segregation.