Study of the role of parvo virus B19 in arthropathies of Egyptian adult cases

This work was done to assess the relation between HPV B19 infection and arthropathies in Egyptian adults cases. For this purpose 40 rheumatoid arthritis (RA) cases, 10 osteoarthritis cases and 10 systemic lupus erythematosus (SLE) cases were selected to represent different types of arthropathies. The selection of cases was based on clinical diagnosis and laboratory tests (ESR, Hb level, Rose waller, detection of antinuclear antibodies and detection of hidden rheumatoid factor). HPV B19 IgM and IgG were searched for by ELISA test in their sera as indicator of the state of HPV B19 infection. A control group was also included in this study, as 30 healthy persons with no previous complaint of rheumatic symptoms. HPV B19 IgM was detected in 60% of patients with RA, 40% of osteoarthritis cases and None of the SLE cases. Positive cases were more among females with long duration of illness affecting both big and small joints. These results indicated a possible causal association between acute HPV B19 and arthropathy. As regards HPV B19 IgG, it was detected in 57% of RA cases, 60% of osteoarthritis cases and 40% of SLE. The difference in IgG was statistically insignificant from the control group (46.7%). The presence of HPV B19 IgG antibodies indicates previous exposure to the virus but does not indicate its time. Detection of HPV B19 IgM or rising titer of HPV B19 IgG may lead to early diagnosis of HPV B19 arthropathies.

Effect of Norplant implants on the pituitary-adrenal axis function and reserve capacity

The present work investigated the effects of Norplant implants on the pituitary-adrenal function among 15 users of Norplant implants prior to and 6 months after insertion of the implants. Serum cortisol levels and their diurnal variations, ACTH and 24-h urinary 17-ketosteroids, ketogenic steroids, 17-hydroxy steroids, and creatinine, were measured. Also, a dynamic test (the 5-h Synacthen depot = ACTH stimulation test) was done before and 6 months after implants insertion. The 9 a.m. cortisol levels were blunted (within the normal ranges) while the 6 p.m. values were unaltered. The 24-h urinary ketogenic, hydroxy, and ketosteroids were also unchanged after Norplant implants use. The ACTH stimulation test showed a decreased adrenal response which was also within normal ranges. These data should raise the question related to suprarenal response to acute or prolonged stresses, such as surgical operations or shock in women using Norplant implants.

Chlamydial serology among patients with tubal factor infertility and ectopic pregnancy in Alexandria, Egypt

BACKGROUND AND OBJECTIVES

Little is known about the role of Chlamydia trachomatis in the etiology of tubal factor infertility and ectopic pregnancy in Egypt.

GOAL OF THIS STUDY

To assess the association between past chlamydial infection, tubal factor infertility, and ectopic pregnancy in an Egyptian population.

STUDY DESIGN

This report consists of two concurrent case-control studies. First, 51 patients with tubal factor infertility were compared with 48 healthy subjects who did not have tubal factor infertility and 53 pregnant subject subjects. Second, 66 patients with ectopic pregnancy were compared with 51 pregnant control subjects.

RESULTS

Geometric mean titers for Chlamydia trachomatis were higher among patients with tubal factor infertility and ectopic pregnancy, and they were more likely to have high antichlamydial titers (> or = 1:128 immunoglobulin G). Serum titer was significantly correlated with histologic evidence of salpingitis among the patients with an ectopic pregnancy.

CONCLUSION

Our findings, similar to those from Western societies, suggest that among Egyptian women, prior chlamydial infection is associated with an increased risk of tubal factor infertility and possibly ectopic pregnancy.

Chlamydial serologic characteristics among intrauterine contraceptive device users: does copper inhibit chlamydial infection in the female genital tract?

OBJECTIVE

Our objective was to assess the association between copper intrauterine contraceptive device use and the level of antichlamydial antibodies.

STUDY DESIGN

Fifty-four women (29 with history of ectopic pregnancy, 2 with non-tubal factor infertility, 1 with tubal factor infertility, and 22 with intact intrauterine pregnancies) with current or prior intrauterine contraceptive device use were compared with 60 prenatal control subjects with respect to antichlamydial antibodies.

RESULTS

When the intrauterine contraceptive device user group was subdivided into copper users and Lippes Loop device users, a significantly lower geometric mean serum antibody titer among copper intrauterine contraceptive device users was detected. The odds ratio estimates for past chlamydial exposure (> or = 1:64 immunoglobulin G, > or = 1:128 immunoglobulin G) in users of noncopper versus copper intrauterine contraceptive devices were 9.1 (95% confidence interval 1.9 to 43.0) and 10.5 (95% confidence interval 1.5 to 71.8), respectively.

CONCLUSIONS

The lower geometric mean serum antibody titer of antichlamydial antibody among copper versus Lippes Loop device users and the large association measured between past chlamydial infection and noncopper intrauterine contraceptive device use suggest that copper may have a protective effect against Chlamydia trachomatis infection or a suppressive effect on development of antichlamydial antibodies.

Advanced breast cancer in Egyptian women: clinical features and response to endocrine therapy. The Anglo-Egyptian Health Agreement Collaborative Study

Response to endocrine therapy and its relationship to the clinical features of the disease were studied in 84 Egyptian patients with inoperable, locally advanced or metastatic breast cancer. Twenty-four premenopausal patients were treated by oophorectomy with or without concurrent prednisolone. Only one of 20 evaluable patients achieved an objective response. Median time to progression for premenopausal patients was 3 months. Sixty postmenopausal patients received tamoxifen 10 mg twice daily either alone or with prednisolone. Fourteen of 57 (25%) evaluable patients achieved an objective response (four complete remission, 10 partial remission). Median duration of response was 13 months and median time to progression for all postmenopausal patients was 5 months (range 1-30 months). The outcome for postmenopausal patients was similar to that found in a parallel study at Guy's Hospital, London. The response rate for premenopausal Egyptian patients was, however, disappointing and lends support to the claim that breast cancer in Egyptian women is particularly aggressive.

Postmenopausal endometrial patterns and serum estradiol concentrations

Eighty postmenopausal women were subjected to endometrial biopsy. Inadequate biopsy was recorded in 30 cases. In the remaining cases (n = 50) the correlation between endometrial patterns and serum estradiol (E2) was performed. These cases were presenting with uterine bleeding (n = 38) or minor gynecological symptoms (n = 12). Proliferative endometrium was the predominant endometrial pattern whereas endometrial malignancy was only present in 15.8% of the bleeding cases. Serum E2 was significantly elevated in cases having malignant endometrium or adenomatous hyperplasia compared to cases having other endometrial patterns. Serum E2 measurement is recommended as a simple screening test for the detection of postmenopausal endometrial hyperplasia and/or malignancy.

Clinical and immunological results of segmental splenectomy in schistosomiasis

We evaluated segmental splenectomy in 51 patients who required splenectomy to relieve the symptoms of schistosomal splenomegaly, and compared their course with that of 44 patients who underwent total splenectomy in an unrandomized study. We describe a minor modification of our initial technique. Patients having segmental splenectomy had a similar postoperative course to those having total splenectomy. Conversion of a segmental to a total splenectomy was required in two cases due to technical faults. No regrowth of the spleen has occurred in up to 4 years of observation. We noted an increased percentage of T lymphocytes with an increased ratio of T helper to T suppressor cells in patients having segmental splenectomy. Our cumulative experience supports adoption and wider evaluation of segmental splenectomy in schistosomiasis.

Epithelial antigens in malignant mixed Müllerian tumours of endometrium

Immunohistochemical staining of formalin fixed paraffin sections with the mouse monoclonal antibodies E29 and CAM 5.2 effectively distinguish epithelium (antigen positive) from stroma (antigen negative) in normal endometrium. These antibodies were used as epithelial markers in the study of eight malignant mixed Müllerian tumours (MMT) of endometrium and gave normal reactions with well differentiated neoplastic glands; in contrast, negative or very weak staining was observed in poorly differentiated epithelial cells, present in large numbers in three cases. Abnormal antigen-containing cells were observed in the stroma of seven MMT. In some cases these are probably due to stromal invasion by malignant epithelium but in others they may represent an early stage of epithelial differentiation in mesenchymal cells of the malignant stroma.

Effect of some xenobiotics on kynurenine hydrolase and kynurenine aminotransferase of mouse liver

The effects of some xenobiotics on the activity of the B6-dependent kynurenine hydrolase (KH) and kynurenine aminotransferase (KATE) in mouse liver, were investigated. Polychlorinated biphenyl (Aroclor 1254) (400mg/kg/day x4) markedly decreased the activity of both enzymes. Benzo(a)pyrene (BP) and 3-methylcholanthrene (3-MC) (40mg/Kg/day x1) as well as phenobarbital (PB) (75mg/kg/day x3) did not alter the activity of KH, while that of KATE was mildy reduced. The response of the two enzymes to treatment with chlorpromazine (CPZ) (5mg/Kg/day x5) were opposite with marked elevation of KH and inhibition of KATE activities. Treatment with B-naphthoflavone (B-NF) (80mg/Kg/day x2), Pyrazole (200mg/Kg/day x1) or indole (400mg/kg/day x1) produce no change in the activity of either enzyme. It, seems therefore, that Aroclor (1254) and chlorpromazine may cause disordered kynurenine metabolism through alterations in the activities of its metabolizing enzymes. This, in turn, might affect nicotinamide adenine dinucleotide biosynthesis and/or the accumulation of some tryptophan metabolites suspected of being carcinogenic or co-carcinogenic.

Long-term treatment of essential hypertension with Nadolol and Hydrochlorothiazide: a two-year follow-up

After 3 weeks of placebo administration, thirty-two mildly or moderately hypertensive patients were treated with hydrochlorothiazide (HCZ) for 3 weeks, then with HCZ plus nadolol, a new beta-adrenergic blocker, for 2 years. The dose of HCZ was 50 mg once daily for all except two patients, who received 50 mg twice a day. The dose of nadolol ranged from 40 mg to 240 mg, once daily. The average supine blood pressure decreased from 182/110 mm Hg at the end of the placebo period to 170/104 mm Hg at the end of treatment with HCZ alone. Nadolol was added to the regimen, and the average supine blood pressure decreased further to 132/88 mm Hg at the end of 3 months of combined therapy. It remained essentially unchanged for the duration of the 2-year study, and no increases in the dosage of either drug were needed. Side-effects were mild, and none required a change in dosage. A once-daily dose of nadolol combined with HCZ appears to be safe and effective therapy for the long-term treatment of mild or moderate essential hypertension.

Control of essential hypertension with captopril, an angiotensin converting enzyme inhibitor

1 Captopril, an orally active angiotensin converting enzyme inhibitor, was compared with hydrochlorothiazide (HCT) in the treatment of mild and moderate essential hypertension. 2 Twenty outpatients received no antihypertensive therapy for 2 weeks, after which they were given placebo for 8 weeks. Since their diastolic blood pressure remained above 100 mm Hg, they were then randomized to receive either captopril (twelve patients) or HCT (eight patients) for a 4-week titration period. If the supine diastolic blood pressure (SDBP) was normalized, (less than or equal to 90 mm Hg) by the end of titration period, the established regimen was continued for an 8-week maintenance period; if not, the alternate drug was added in increasing doses for up to 4 weeks and the combined therapy was maintained for the remaining 4 weeks. 3 After the first 4 weeks of therapy, both groups showed a statistically significant decrease in both systolic and diastolic blood pressure. Normalization of SDBP occurred in 75% of patients treated with captopril alone, and the addition of HCT produced normalization in the remainder. HCT alone resulted in normalization of SDBP in 50% of patients and the blood pressure of the remaining patients was normalized after the addition of captopril. 4 Captopril given orally, either alone or in conjunction with HCT, is an effective agent for the control of mild and moderate essential hypertension. 5 In our series the main side effects encountered were vertigo and dizziness, transient eosinophilia, a rise of BUN and or/a rise of SGPT or SGOT.

Nadolol and propranolol in the treatment of hypertension: a double-blind comparison

Nadolol and propranolol were compared in seventy-five hypertensive patients in a double-blind randomized study conducted at Ain-Shams Hospital. After an initial wash-out period of 5 weeks, including 3 weeks of placebo administration, forty-five patients were given nadolol once daily and thirty patients received propranolol four times per day for 12 weeks, followed by a tapering-off period of 2 weeks. Both beta-blocking agents were effective in controlling hypertension with final daily doses ranging from 80 to 320 mg. Of statistical significance, however, were the better responses of supine systolic blood pressure elicited by nadolol. The only adverse reactions that occurred in this series were slight weight gains in two patients treated with nadolol and moderate dizziness in one patient treated with propranolol. Nadolol was proved to be a safe antihypertensive drug, at least comparable to propranolol in efficacy, with the advantages of a once-daily dose and a lack of direct depressant action on the heart.

Intramuscular 16-phenoxy PGE2 ester for pregnancy termination

A new PGE2 derivative (16-phenoxy PGE2 methyl sulfonylamide sulprostone) was administered by the i.m. route to 48 women pregnancy in any of the three trimesters. The indications for pregnancy interruption were either serious medical problems in intact pregnancies (21 cases) or due to fetal death in utero (27 cases). Single doses of 500 micrograms were repeated every 4 hours in the former group or every 6 hours in the latter category for a maximum period of 24 hours. The treatment was successful in 81% of intact pregnancies and in 92.6% of fetal death cases with an overall mean induction interval of 12.9 hours. More than half the subjects did not experience any side effects apart from mild or moderate uterine colics. An overall mean of 1.4 episodes of vomiting or diarrhoea per induction trial was quite acceptable from the clinical point of view. The absence of serious complications in the group of critically sick women speaks in favor of the relative safety of the drug.

Long-term treatment of essential hypertension using nadolol and hydrochlorothiazide combined

1 The stepped care approach for the treatment of hypertension was adopted in a study at Ain Shams Hospital using hydrochlorothiazide (HCT) and a new beta-blocker, nadolol. Sixty mild to moderately hypertensive patients were studied for 20 weeks (2 weeks no antihypertendive the therapy, 3 weeks placebo, 3 weeks HCT, 4 weeks nadolol + HCT dose titration and 8 weeks nadolol + HCT maintenance). The dose of HCT was 50 mg once daily throughout the study except for six patients who had their HCT dose increased to 100 mg daily during maintenance. The dose of nadolol ranged from 40-240 mg daily. 2 No patient on HCT monotherapy achieved full control of his supine diastolic blood pressure (SDBP less than 90 mm Hg). On combined therapy, 55 patients (91.7%) showed a full response, whereas the remaining five patients a good or adequate response. 3 Thirty-two of these patients agreed to continue in the study for a further 21 months (totalling 2 yr of therapy). To date, 15 of them have completed a total of 10 months, 7 have completed 11 months and 10 have completed 12 months. The delta percentage decrease in supine BP continued to be 28.0 and 19.5 for systolic and diastolic BPs respectively. 4 No significant changes in funduscopies, chest X-rays, ECGs, or full laboratory investigations were noted. A few side-effects of mild nature occurred. None necessitated discontinuation of therapy. 5 Combined therapy with nadolol and HCT is a safe and effective method of controlling hypertension over extended periods.

Early pregnancy interruption by 15 (S) 15 methyl prostaglandin F2alpha methyl ester

Suppositories of 15-methyl PGF2alpha methyl ester in triglyceride were administered vaginally to 75 women in whom 31 to 49 days had elapsed since their last menstrual period. Three or four suppositories of 0.5, 1.0, or 1.5 mg were given at intervals of 3 hours. Pregnancy was later confirmed in 63 of the women. In the pregnant women vaginal bleeding usually started 3 to 6 hours after the initiation of therapy and continued for 10 to 14 days. Patients were followed for 2 to 4 weeks with serial measurement of serum progesterone and hCG. There were no failures in the trial, but in 2 cases the treatment resulted in incomplete abortion. In 2 other patients curettage was performed due to prolonged bleeding, but histologic examination revealed no remaining signs of pregnancy. Gastrointestinal side effects were well within acceptable limits, and no serious complications occurred. Clinical signs of pelvic inflammatory disease were not found. The vaginal use of 15-methyl PGF2alpha methyl ester seems promising as a reliable outpatient nonsurgical self-administered procedure for termination of early pregnancy.

Vaginally administered 16, 16-dimethyl-PGE2 for the induction of midtrimester abortion

Thirty patients in the 13th-20th week of gestation underwent therapeutic abortion utilizing vaginally administered 16, 16-dimethyl-PGE2 (free acid) suppositories. The first 15 patients obtained individual doses in the range of 400-1200 mug given every three hours (mean total dose 4.2 mg). In the following 15 patients a fixed dose schedule was used (800 mug followed by 1000 mug every three hours; mean total dose 5.3 mg). All but one of the 30 patients aborted. The mean induction-abortion interval for all patients was 16.8 +/- 6.9 hours (mean +/- S.D.) With the fixed dose regime the success rate was 100% and the induction-abortion interval 16.0 +/- 5.9 hours. Because gastro-intestinal side effects were minimal, neither anti-emetic nor anti-diarrheic medication was required. A slight elevation of temperature was noted in five patients. The uterine response to the vaginal administration of this compound was characterized by a gradual increase in uterine tonus followed by sustained stimulation. The results are interpreted to suggest that the vaginal administration of 16, 16-dimethyl-PGE2 is a useful alternate method for the induction of second trimester abortion. Moreover, this compound seems to cause fewer gastro-intestinal side effects than other prostaglandins administered by the vaginal route at our department.