<i>Rhizopus oryzae</i>Retro-Orbital Abscess: Comparison of Spores and Hyphae Antifungal Susceptibility and Clinical Outcome

Rhizopus is fungus of the order Mucorales, responsible for invasive diseases called mucormycosis. The correct identification of these fungi is one of the main questions raised in the literature since the diagnosis is not simple, being the necessary detection in biopsies of infected tissues and isolation of the microorganism for identification by morphological and molecular methods. In vitro susceptibility testing results are not fully clear since there are reports showing that in vitro resistance does not always mean therapeutic failure. This paper describes a case of rhino-orbito-cerebral mucormycosis in a patient with alcoholic chronic pancreatitis and secondary mellitus diabetes involving microbiological diagnostic, antifungal susceptibility tests for conidia and hypha and clinical correlation. The causative agent was identified by morphological characteristics and DNA sequencing. Minimal Inhibitory Concentration (MIC) for amphotericin B (AMB), itraconazole (ITZ) and terbinafine (TERB) was determined by broth microdilution method. Standardization of the dynamic growth evaluation patterns using the automated system BCT (BioCell-Tracer?) was obtained allowing to determining hyphae growth control and evaluating the effect of different concentrations of amphotericin B, itraconazole and terbinafine directly on growing hyphae. The fractional inhibitory concentration (FIC) for the combination of the two antifungals that the patient received at the same time, terbinafine and itraconazole, was also determined trying to correlate with clinical outcome. Strains isolated of retro-orbital abscess were identified as Rhizopus oryzae. MIC results (MIC) testing conidia showed high sensibility to amphotericin B and itraconazole in comparison to the obtained for terbinafine. The tests in the automated system BCT using hyphae showed sensibility to all tested antifungal agents and the FIC results for combination in vitro between terbinafine and itraconazole showed synergism consistent with the therapeutic success obtained for the patient who received initial treatment with amphotericin B followed for maintenance treatment with the combination itraconazole and

Surrogate Role of CD85k on Monocytic Lineage Involved Leukemogenesis Biology and Clinical Aspect

Background: Unique receptor involved in leukemogenesis is CD85k;an immuneglobulin receptor for immune tolerance, CD36 is glycoprotein mediates cellular adhesion and metastatic spread, CD14, CD15 considered common monocytic markers. Aims: to investigate CD85k with monocytic lineage involved leukemia (MLIL) markers in leukemia pathogenesis and clinical presentation. Patients and Methods: 47 patients (32 diagnosed acute myeloid leukemia (AML);15 non-malignant hematological disease as a control), were included, aged from 2 to 80 years, all subjected to peripheral blood (P.Bl) and bone marrow (B.M) examination, immunophenotyping (IPT) using FASC Canto four color flow cytometer (FCM) Becton Dickenson (BD) USA, for CD13, CD33, MPO, HLA-DR, CD34, CD38, CD117, CD14, CD15 and CD36 the Mo Abs supplied by B.D Bioscience, and anti CD85k Mo Abs by Aveda de Coimbra Flamenco, reference No. 1399990130. Results: Frequency of CD85k is 19/32 (59.37%) of AML;14/14 (M4/M5) 100% positive CD85k, insignificant correlations of CD85k to sex, lymphadenopathy or organomegaly, platelets count and P.Bl blast (P > 0.05), significant to age 50,000 × 109/l, Hb 0.05). Conclusion: Although CD85k is MLIL associated marker, it is not correlated with other MLIL markers with frequency 100% in MLIL and 59.37% in AML, age predisposition is <35 years with no sex variation, significant correlation to progenitor and myeloid markers, it’s a crucial role in leukemogenesis biology, not in clinical presentations, considered good follow up predictor MLIL marker.

Correction of Factitious Hyperkalemia in Hemolysed Specimens from Adult Emergency Department Using the Beckman Coulter Unicell DxC 880i Analyzer Derived Factor

Hemolysis in ED （emergency department） patients is common due to difficult blood draws. Values of serum potassium （K＋） become falsely elevated secondary to release of intracellular contents. Objective： The aim of the study was to establish a correction factor for factitious elevated K＋ in samples for de adult ED. Methods： We used samples from 125 adult ED patients, in which the 2nd sample was drawn due to hemolysis of the first tube. Results： Firstly, we derived a correction factor expressing an increase in potassium concentration in 0.21 mmol/L （95% confidence interval, 0.17-0.24 mmol/L with p 〈 0.01） for each hemolysis index increment. Conclusions： A reliable correction factor for factitious hyperkalemia in a clinical relevant range exists.

BCG Infection after Bladder Cancer Treatment—3 Clinical Case Reports

Immunotherapy with Bacillus Calmette-Guérin (BCG) to treat non-muscle invasive bladder cancer has become an effective and superior alternative to chemotherapy. Intravesical treatment with BCG appears to be relatively safe;however, occasionally BCG infection complicates such treatment. In the present work we describe three patients in whom BCG infection occurred after intravesical BCG therapy. All patients had positive urine culture forMycobacterium tuberculosis complex, using AccuProbe culture identification and then Genotype Mycobacterium MTBC test identified Mycobacterium bovis BCG. The diagnosis is difficult and microbiologic study is usually negative, so high index of suspicion is essential.

Nutritional Supplement Ocoxin® Combined with Gemcitabine-Based Chemotherapy in Patients with Advanced Pancreatic Adenocarcinoma

Background: the quality of life (QoL) of patients with pancreatic ductal adenocarcinoma (PDAC), with its limited survival, can be affected by chemotherapy-induced toxicity. The main objective was to evaluate the effect of introducing ocoxin oral solution (OOS) in combination with standard therapy on quality of life. Methods: Thirty patients were enrolled in an exploratory, prospective, single-centre clinical trial in the oncology department of “Hermanos Ameijeiras” University Hospital in Havana, Cuba. Quality of life was measured using the EORTC QLQ-C30 questionnaire and toxicity was assessed using the NCI-CTC-AE classification version 5.0. Results: There was stability in the scores over time for overall QoL and the functional scale criteria, while in terms of symptoms, fatigue, pain and loss of appetite were reduced. No grade 3 - 4 adverse events (AEs) were recorded, and only 14.9% of toxicities were classified as grade 2, and these were considered to be unrelated to OOS. Biochemical and nutritional parameters were normalised at 12 months compared to the baseline values. Conclusions: This clinical study is the first report of the use of OOS in patients with advanced pancreatic cancer, and demonstrates that it is able to maintain optimal quality of life with reduced severity of toxicity during and after combination treatment with gemcitabine-based chemotherapy.

Relationship between vitamin D and IL-23,IL-17 and macrophage chemoattractant protein-1 as markers of fibrosis in hepatitis C virus Egyptians

AIM: To assess vitamin D in hepatitis C patients and its relationship to interleukin (IL)-23, IL-17, and macrophage chemoattractant protein-1 (MCP-1). METHODS: The study was conducted on 50 Egyptian hepatitis C virus (HCV) genotype number IV-infected patients and 25 age- and gender-matched healthy subjects. Venous blood samples were obtained. Samples were allowed to clot and sera were separated by centrifugation and stored at -20?°C. A 25 hydroxy vitamin D assay was carried out using solid phase RIA. A 1,25 dihydroxy vitamin D assay was carried out using a commercial kit purchased from Incstar Corporation. IL-17 and -23 and MCP-1 were assayed by an enzyme immunoassay. Quantitative and qualitative polymerase chain reaction for HCV virus were done by TaqMan technology. Only HCV genotype IV-infected subjects were included in the study. The mean ± SD were determined, a t-test for comparison of means of different parameters was used. Correlation analysis was done using Pearson’s correlation. Differences among different groups were determined using the Kruskal-Wallis test. RESULTS: The mean vitamin D level in HCV patients (group?I) was 15 ± 5.2 ng/mL while in control (group II) was 39.7 ± 10.8. For active vitamin D in group?I?as 16.6 ± 4.8 ng/mL while in group II was 41.9 ± 7.9. IL-23 was 154 ± 97.8 in group?I?and 6.7 ± 2.17 in group II. IL-17 was 70.7 ± 72.5 in cases and 1.2 ± 0.4 in control. MCP-1 was 1582 ± 794.4 in group?I?and 216.1 ± 5.38 in group II. Vitamin D deficiency affected 72% of HCV-infected patients and 0% of the control group. Vitamin D insufficiency existed in 28% of HCV-infected patients and 12% of the control group. One hundred percent of the cirrhotic patients and 40% of non cirrhotic HCV-infected patients had vitamin D deficiency. IL-23, IL-17, and MCP-1 were markedly increased in HCV-infected patients in comparison to controls.A significant negative correlation between vitamin D and IL-17 and -23 and MCP-1 was detected. HCV-infected males and females showed no differences with respect to viral load, vitamin D levels, IL-17, IL-23 and MCP-1. The viral load was negatively correlated with vitamin D and active vitamin D (P = 0.0001 and P = 0.001, respectively), while positively correlated with IL-23, IL-17, and MCP-1. We classified the patients according to sonar findings into four groups. Group?Ia with bright hepatomegaly and included 14 patients. Group?Ib with perihepatic fibrosis and included 11 patients. Group?Ic with liver cirrhosis and included 11 patients. Group?Id with hepatocellular carcinoma (HCC) and included 14 patients. Vitamin D and active vitamin D were shown to be lower in cirrhotic patients and much lower in patients with HCC, and this difference was highly significant (P = 0.0001). IL-17 and -23 and MCP-1 were higher in advanced liver disease) and the differences were highly significant (P = 0.0001). CONCLUSION: Whether the deficiency of vitamin D is related to HCV-induced chronic liver disease or predisposing factor for higher viral load is a matter of debate.

Helicobacter pylori may be an initiating factor in newly diagnosed ulcerative colitis patients: A pilot study

AIM To directly visualize Helicobacter pylori(H. pylori) by the highly sensitive and specific technique of immunohistochemical staining in colonic tissue from patients newly diagnosed with ulcerative colitis(UC).METHODS Colonoscopic biopsies from thirty patients with newly diagnosed UC and thirty controls were stained with Giemsa stain and immunohistochemical stain for detection of H. pylori in the colonic tissue. Results were confirmed by testing H. pylori Ag in the stool then infected patients were randomized to receive either anti H. pylori treatment or placebo.RESULTS Twelve/30(40%) of the UC patients were positive for H. pylori by Giemsa, and 17/30(56.6%) by immunohistochemistry stain. Among the control group 4/30(13.3%) and 6/30(20 %) were positive for H. pylori by Giemsa and immunohistochemistry staining respectively. H. pylori was significantly higher in UC than in controls(P = 0.04 and 0.007). All Giemsa positive patients and controls were positive by immunohistochemical stain. Four cases of the control group positive for H. pylori also showed microscopic features consistent with early UC.CONCLUSION H. pylori can be detected in colonic mucosa of patients with UC and patients with histological superficial ulcerations and mild infiltration consistent with early UC. There seems to be an association between UC and presence of H. pylori in the colonic tissue. Whether this is a causal relationship or not remains to be discovered.

Circulating tumor and cancer stem cells in hepatitis C virusassociated liver disease

AIM: To assess the role of circulating tumor cells (CTCs) and cancer stem cells (CSCs) in hepatitis C virus (HCV)-associated liver disease.

Beta-endorphin in serum and seminal plasma in infertile men

Aim： To access beta-endorphin levels in serum as well as seminal plasma in different infertile male groups. Methods： Beta-endorphin was estimated in the serum and seminal plasma by enzyme-linked immunosorbent assay （ELISA） method in 80 infertile men equally divided into four groups： non-obstructive azoospermia （NOA）, obstructive azoospermia （OA）, congenital bilateral absent vas deferens （CBVAD） and asthenozoospermia. The results were compared to those of 20 normozoospermic proven fertile men. Results： There was a decrease in the mean levels of betaendorphin in the seminal plasma of all successive infertile groups （mean ± SD： NOA 51.30 ± 27.37, OA 51.88 ± 9.47, CBAVD 20.36 ± 13.39, asthenozoospermia 49.26 ± 12.49 pg/mL, respectively） compared to the normozoospermic fertile control （87.23 ± 29.55 pg/mL）. This relation was not present in mean serum level of beta-endorphin between four infertile groups （51.09 ± 14.71, 49.76 ± 12.4, 33.96 ± 7.2, 69.1 ± 16.57 pg/mL, respectively） and the fertile control group （49.26 ± 31.32 pg/mL）. The CBVAD group showed the lowest seminal plasma mean level of beta-endorphin. Testicular contribution of seminal beta-endorphin was estimated to be approximately 40%. Seminal beta-endorphin showed significant correlation with the sperm concentration （r = 0.699, P = 0.0188） and nonsignificant correlation with its serum level （r = 0.375, P = 0.185） or with the sperm motility percentage （r = 0.470, P = 0.899）. Conclusion： The estimation of beta-endorphin alone is not conclusive to evaluate male reproduction as there are many other opiates acting at the hypothalamic pituitary gonadal axis.

Coronary revascularization in the elderly with stable angina

A proportion of elderly with coronary artery disease is rapidly growing. They have more severe coronary artery disease, therefore, derive more benefit fi＇om revascularization and have a greater need for it. The elderly is a heterogeneous group, but compared to the younger cohort, the choice of the optimal revascularization method is much more complicated among them. In recent decades, results has improved dramatically both in surgery and percutaneous coronary intervention （PCI）, even in very old persons. Despite the lack of evidence in elderly, it is obvious, that coronary artery bypass surgery （CABG） has a more pronounced effect on long-term survival in price of more strokes, while PCI is certainly less invasive. Age itself is not a criterion for the selection of treatment strategy, but the elderly are often more interested in quality of life and personal independence instead of longevity. This article discusses the factors that influence the choice of the revascularization method in the elderly with stable angina and presents a complex algorithm for making an individual risk-benefit profile. As a consequence the features of CABG and PCI in elderly patients are exposed. Emphasis is centered on the frailty and non-medical factors, including psychosocial, as essential components in making the decision of what strategy to choose. Good communication with the patients and giving them unbiased information is encouraged.

The Diagnostic and Prognostic Value of Serum Procalcitonin among Ventilator Associated Pneumonia Patients

Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results: There was a highly statistically significant difference (p value 0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p 0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p = 0.449), CRIP (R = 0.403) and SOFA (R = 0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings.

Distribution of HBV genotypes among HBV carriers in Benin:phylogenetic analysis and virological characteristics of HBV genotype E

AIM: To determine the distribution of Hepatitis B virus (HBV) genotypes in Benin, and to clarify the virological characteristics of the dominant genotype.METHODS: Among 500 blood donors in Benin, 21 HBsAg-positive donors were enrolled in the study. HBV genotypes were determined by enzyme immunoassay and restriction fragment length polymorphism. Complete genome sequences were determined by PCR and direct sequencing.RESULTS: HBV genotype E (HBV/E) was detected in 20/21 (95.2%), and HBV/A in 1/21 (4.8%). From the age-specific prevalence of HBeAg to anti-HBe seroconversion (SC) in 19 HBV/E subjects, SC was estimated to occur frequently in late teens in HBV/E.The comparison of four complete HBV/E genomes from HBeAg-positive subjects in this study and five HBV/E sequences recruited from the database revealed that HBV/E was distributed throughout West Africa with very low genetic divers ity (nucleotide homology 96.7-99.2%).Based on the sequences in the basic core promoter (BCP)to precore region of the nine HBV/E isolates compared to those of the other genotypes, a nucleotide substitution in the BCP, G1757A, was observed in HBV/E.CONCLUSION: HBV/E is predominant in the Republic of Benin, and SC is estimated to occur in late teens in HBV/E. The specific nucleotide substitution G1757A in BCP, which might influence the virological characteristics,is observed in HBV/E.

Molecular study of astrovirus, adenovirus and norovirus in community acquired diarrhea in children: One Egyptian center study

Objective: To determine the prevalence of astrovirus, norovirus, adenovirus in children below five years old with diarrhea by multiplex reverse transcriptase polymerase chain reaction(RT-PCR) along with rotavirus antigen detection by enzyme linked immunosorbant assay.Methods: The study was conducted on children below five years old complaining of acute diarrhea. The study included stool examination by molecular method for detection of norovirus, adenovirus and astrovirus by multiplex RT-PCR. Rotavirus antigen was detected in the stool by enzyme linked immunosorbant assay.Results: The study included 100 children below 5 years old with acute diarrhea.Multiplex RT-PCR was positive in 34% of the children. The most frequently detected virus was rotavirus(44%), followed by norovirus(30%), adenovirus(20%) and astrovirus(14%). The clinical symptoms were more significantly associated with viral diarrhea such as fever(P = 0.03), bloody diarrhea(P = 0.025), vomiting(P = 0.000 1) and watery diarrheas(P = 0.05). The frequency of diarrhea with viral pathogen was significantly presented in winter season(39.7%). There were significant frequencies of norovirus and adenovirus in age ranging 1–2 years old(P = 0.04, P = 0.01 respectively).Conclusions: The present study spotlights on the prevalence of viral pathogens as an important etiology in diarrhea in children below five years old. Astrovirus, norovirus and adenovirus are common along with rotavirus in this group of patients. Multiplex PCR leads to improve the laboratory diagnosis of these viruses along with antigen detection method. Further longitudinal studies are required to evaluate the epidemiological data associated with these viruses and for proper management of such drastic infection.

Quantitative multiparametric magnetic resonance imaging can aid non-alcoholic steatohepatitis diagnosis in a Japanese cohort

BACKGROUND Non-invasive assessment of non-alcoholic steatohepatitis(NASH)is increasing in desirability due to the invasive nature and costs associated with the current form of assessment;liver biopsy.Quantitative multiparametric magnetic resonance imaging(mpMRI)to measure liver fat(proton density fat fraction)and fibroinflammatory disease[iron-corrected T1(cT1)],as well as elastography techniques[vibration-controlled transient elastography(VCTE)liver stiffness measure],magnetic resonance elastography(MRE)and 2D Shear-Wave elastography(SWE)to measure stiffness and fat(controlled attenuated parameter,CAP)are emerging alternatives which could be utilised as safe surrogates to liver biopsy.AIM To evaluate the agreement of non-invasive imaging modalities with liver biopsy,and their subsequent diagnostic accuracy for identifying NASH patients.METHODS From January 2019 to February 2020,Japanese patients suspected of NASH were recruited onto a prospective,observational study and were screened using noninvasive imaging techniques;mpMRI with LiverMultiScan®,VCTE,MRE and 2DSWE.Patients were subsequently biopsied,and samples were scored by three independent pathologists.The diagnostic performances of the non-invasive imaging modalities were assessed using area under receiver operating characteristic curve(AUC)with the median of the histology scores as the gold standard diagnoses.Concordance between all three independent pathologists was further explored using Krippendorff’s alpha(a)from weighted kappa statistics.RESULTS N=145 patients with mean age of 60(SD:13 years.),39%females,and 40%with body mass index≥30 kg/m2 were included in the analysis.For identifying patients with NASH,MR liver fat and cT1 were the strongest performing individual measures(AUC:0.80 and 0.75 respectively),and the mpMRI metrics combined(cT1 and MR liver fat)were the overall best non-invasive test(AUC:0.83).For identifying fibrosis≥1,MRE performed best(AUC:0.97),compared to VCTE-liver stiffness measure(AUC:0.94)and 2D-SWE(AUC:0.94).For assessment of steatosis≥1,MR liver fat was the best performing non-invasive test(AUC:0.92),compared to controlled attenuated parameter(AUC:0.75).Assessment of the agreement between pathologists showed that concordance was best for steatosis(a=0.58),moderate for ballooning(a=0.40)and fibrosis(a=0.40),and worst for lobular inflammation(a=0.11).CONCLUSION Quantitative mpMRI is an effective alternative to liver biopsy for diagnosing NASH and non-alcoholic fatty liver,and thus may offer clinical utility in patient management.

Calcium channel α2δ1 subunit as a novel biomarker for diagnosis of hepatocellular carcinoma

Objective:Hepatocellular carcinoma(HCC)is the fifth most common malignancy worldwide.The identification of new simple,inexpensive and highly accurate markers for HCC diagnosis and screening is needed.This case-control study evaluates the role of annexin A2 and voltage-gated calcium channelsα2δ1 subunit as serum biomarkers for HCC diagnosis.Methods:The study comprised three groups:group 1,50 patients with an initial diagnosis of HCC associated with chronic hepatitis C virus infection;group 2,25 patients diagnosed with chronic hepatitis C virus infection and cirrhosis without any evidence of HCC;and group 3,15 healthy controls.All participants were subjected to clinical and laboratory investigations,and radiological scanning.The serum levels of alpha-fetoprotein(AFP),annexin A2,and theα2δ1 subunit were evaluated by using ELISA technique.Results:The serum levels of annexin A2 significantly increased in patients with HCC(10.4±2.5 ng/m L;P<0.001)or with cirrhosis(9.31±1.8 ng/m L;P<0.001)comparing to that of healthy controls(0.296±0.09 ng/m L).However,there was no significant difference in serum annexin A2 levels in patients with HCC comparing to those with cirrhosis.Serumα2δ1 subunit significantly increased in patients with HCC(20.12±3.7 ng/m L)comparing to that in patients with cirrhosis(10.41±3.4 ng/m L,P<0.001)and healthy controls(10.2±2.9 ng/m L,P<0.001).Conclusions:The serumα2δ1 subunit may function as a new biomarker for HCC diagnosis.Conversely,serum annexin A2 has low diagnostic value as an HCC marker,especially in patients with underlying cirrhosis.

Safety and efficacy of Hansenula-derived PEGylated-interferon alpha-2a and ribavirin combination in chronic hepatitis C Egyptian children

AIM: To investigate the safety and efficacy of a Hansenula-derived PEGylated (polyethylene glycol) interferon (IFN)-alpha-2a (Reiferon Retard) plus ribavirin customized regimen in treatment-na&#x000ef;ve and previously treated (non-responders and relapsers) Egyptian children with chronic hepatitis C infection.

Macrophage Inflammatory Protein-1 Beta (MIP-1<i>β</i>) and Platelet Indices as Predictors of Spontaneous Bacterial Peritonitis<br>—MIP, MPV and PDW in SBP

Background/Aims: The objective of this study is to measure macrophage inflammatory protein one beta (MIP-1β), mean platelet volume (MPV) and platelet distribution width (PDW) to evaluate their usefulness in the diagnosis of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. Materials and Methods: This study comprised 41 cirrhotic patients with ascites. MPV, PDW and MIP-1β were measured in serum and ascitic fluid. Results: A significant increase MPV, PDW, C-reactive Protein (CRP) and white blood cell was observed in SBP group compared to non SBP (P ≤ 0.001, P = 0 β was significantly in-creased in ascitic fluid in patients with SBP versus non SBP (P ≤ 0.001). At cutoff value of 8.3 fl MPV had 85.7% sensitivity and 75% specificity (AUC = 0.876) for diagnosis of SBP. At cutoff value of 15.4 PDW had 90.4% sensitivity and 55% specificity (AUC = 0.762). At cutoff value of 121.9 pg/ml MIP-1β in ascitic fluid had 76.1% sensitivity and 100% specificity (AUC = 0.881) for detecting SBP. Conclusion: MIP-1β and platelet indices are useful marker in the diagnosis of SBP in cirrhotic patients. Combined measurement of MIP-1β in serum and ascitic fluid had 100% sensitivity and specificity for diagnosis of SBP.

The Study of Vaginal Fluid Urea, Creatinine, B-HCG and Placental Alpha-1 Microglobulin in Diagnosis of Premature Rupture of Membranes

Purpose: To evaluate and compare the reliability, accuracy and the cost benefit ratio of vaginal washing fluid urea, creatinine, Beta Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) for diagnosis of premature rupture of membranes (PROM). Material and Methods: A diagnostic study conducted on 70 patients. The patients were divided into three groups: Group A (n = 25): (Confirmed PROM group) patients who were either in labor or not in labor, Gestational age was from 24 weeks onwards and fulfilled the following criteria and/or two of these criteria with low AFI positive pooling, positive nitrazine paper test, positive fern test. Group B (n = 25): (Suspected PROM group) patients who fulfilled the following criteria: Patients with fluid leakage complaint with negative pooling and/or negative nitrazine paper test and/or negative fern test. Group C (n = 25): (Control group with no PROM) patients that were admitted to prenatal clinic for their regular prenatal control visit with 24 - 42 weeks of gestational age without any complaint or complication and with negative pooling, negative nitrazine paper test and/or negative fern test. The vaginal washing fluid urea, creatinine, Beta-Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) were determined for diagnosis of premature rupture of membranes (PROM). Results: PAMG-1 detection in cervico vaginal discharge was a very good test for diagnosis of PROM with high sensitivity, specificity, positive predictive value, negative predictive value, accuracy and P-value (96%, 100%, 100%, 95.84%, 97.78% and <0.0001 respectively). Urea and Creatinine is the second option in diagnosis of PROM with high sensitivity, and specificity after PAMG-1 with a privilege of low cost than PAMG-1. Furthermore they were more accurate than β-HCG. Conclusion: Detection of PAMG-1 in cervico vaginal discharge is promising in diagnosis of PROM & especially in those cases of suspected PROM and it should be done as a worse trial in every case of suspected PROM. Urea and Creatinine is the second option in diagnosis of PROM with high sensitivity, and specificity after PAMG-1 with a privilege of low cost than PAMG-1. Also they were more accurate than β-HCG and they can be used if PAMG-1 is not available for detection of doubtful PROM cases.

Prevalence of Maternal Anemia in Pregnancy: The Effect of Maternal Hemoglobin Level on Pregnancy and Neonatal Outcome

Objective: The aim of our study is to assess the prevalence of anemia in pregnant women, and to evaluate the effect of severity of anemia on maternal and perinatal outcome. Methods: This retrospective cohort study was conducted at the Department of Obstetrics and Gynecology from hospital records. Study population of all pregnant women who had delivered in our hospital after twenty weeks gestation between July 2014 and December 2016. Results: A total of 2654 pregnant women fulfilled the inclusion criteria, 42% were anemic, 83.3% mild anemia group (I) which represents the majority of patients and 16.7% moderate to severe anemia group (II). The majority of cases were due to iron deficiency anemia 92.8%, while 7.2% were due to sickle cell trait, B-thalassemia intermedia, and other causes. The incidence of postpartum hemorrhage, cesarean delivery, and infections was significantly higher in group II compared to group I (5.4%, 40.3%, 3.8% Vs, 2.9%, 31.0%, 2.0%;p = 0.007, 0.041, 0.043 respectively). Low Apgar score, preterm labor, and low birth weight babies were significantly higher in group II compared to group I (11.8%, 12.9%, 11.3% Vs 8.7%, 9.0%, 7.4%;p = 0.034, 0.046, 0.032). Conclusions: This study clarified that anemia is prevalent among pregnant women particularly mild anemia. Early diagnosis and treatment from first trimester has an essential role in managing maternal anemia and it reflects directly on the perinatal outcome. Prematurity, low birth weight infants, and postpartum hemorrhage are the commonest maternal and neonatal complications.

Ability of Comprehensive Geriatric Assessment to Detect Frailty

Background and Aim of the Work: Frailty is a state of reduced physiological reserve associated with increased susceptibility to disability. It is associated with a high morbidity and mortality. This work assessed the ability of comprehensive geriatric assessment to detect frailty in elderly patients. Subjects and Methods: A total number of 104 elderly patients (above 60 years old) were included in this study and they were subjected to a comprehensive geriatric assessment (CGA) including: (history and full clinical examination, Mini mental status examination (MMSE), Geriatric depression scale (GDS), Activities of daily living (ADL), Instrumental activities of daily living (IADL). The patients were divided into frail and non-frail groups using Fried’s criteria as applied by Avila-Funes et al., 2008, each group included 52 patients. Results: There were no significant differences between the two groups regarding age gender or smoking habits. But there was higher percentage of ADL, IADL dependence in addition to higher incidence of depression and cognitive impairment among frail cases. Conclusion: Comprehensive geriatric assessment can be used to detect frailty and its associated impairment and comorbidities.