Viable production of hydrogen and methane from polluted water using eco-friendly plasmonic Pd-TiO2 nanocomposites

Solar-to-fuel conversion is a novel clean energy approach that has gained the interest of many researchers. Solar-driven photocatalysts have become essential to providing valuable fuel gases such as methane and hydrogen. Solar energy has emerged as a renewable, abundant energy source that can efficiently drive photochemical reactions through plasmonic photocatalysis. As a capping agent, orange peel extract was used in this study in a microwave-assisted green method to incorporate titanium dioxide with distinct amounts (3, 5, and 7 wt%) from Pd-plasmonic nanoparticles (2-5 nm). The leading role for plasmonic nanoparticles made from Pd-metal is enhancing the photocatalyst's ability to capture visible light, improving its performance. X-Ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), transmission electron microscopy (TEM), Brunauer, Emmett, and Teller (BET) surface area analysis, and UV-vis DRS analyses have investigated the obtained plasmonic photocatalysts' crystallographic, morphological, and optical characteristics. The UV-vis absorption spectra demonstrated the visible light absorption capacity attributed to the localized surface plasmonic resonance (LSPR) behavior of the newly formed nanoplasmonic photocatalysts. The generated Pd-TiO2 nanomaterials' photocatalytic activity has been examined and evaluated for combustible gas production, including the formation of CH4 and H2 from the photocatalytic degradation of Reactive Yellow 15 (RY) during a deoxygenated photoreaction in a homemade solar photobiogas reactor.

O-285 Artificial intelligence algorithms reach expert-level accuracy in automated grading of blastocyst morphology assessment based on static embryo images and Gardner criteria

Study question

Can artificial intelligence (AI) algorithms reach expert-level accuracy in blastocyst morphology assessment according to Gardner criteria?

Summary answer

The prediction accuracy of the best performing AI algorithm (Deit), outperformed human-level mean accuracies compared to an embryologist majority vote for all Gardner morphological criteria.

What is known already

Routinely, morphological grading of blastocysts is performed visually according to Gardner criteria, which suggest expansion (EXP), quality of inner cell mass (ICM), and trophectoderm (TE) as key parameters to predict treatment outcome. Consequently, blastocyst scoring is prone to inter-and intra-observer variability, which may lead to inconsistencies in selecting blastocysts for transfer. AI-based algorithms may help to improve treatment outcome predictability, as it has been suggested recently. In those studies, parameters such as blastocyst quality or stage were annotated by experts from static or time-lapse-derived blastocyst images, to train AI algorithms, e.g. XCeption or YOLO, and compare them to human annotators.

Study design, size, duration

This retrospective study involves 2,270 images from 837 patients collected over a period of four years in a university IVF clinic.

Participants/materials, setting, methods

All images were annotated by one senior embryologist and divided into a training and a balanced test set. Subsequently, eight embryologists labeled 300 test set images such that every single image was seen by at least four embryologists. Annotators diverging from the ensemble vote for more than one standard deviation were excluded (n = 2) to set the ground truth labels. Finally, three AI architectures (XCeption, Swin, Deit) were trained and evaluated on that particular ground truth.

Main results and the role of chance

Out of nine annotators, labelling accuracy of two embryologists diverged from the consensus vote for more than one standard deviation for at least one of the three Gardner criteria. The consensus vote was built from the remaining seven annotators (mean accuracy EXP 0.81, ICM 0.70, TE 0.67). The Swin architecture outperformed the mean expert accuracy for all three criteria (EXP 0.82, ICM 0.76, TE 0.68), while the Deit and the XCeption architecture outperformed the mean expert accuracy in ICM accuracy (Deit 0.72, XCeption 0.73), and performed equal or worse in EXP and TE accuracy (Deit EXP 0.77, ICM 0.73; XCeption EXP 0.77, TE 0.66). When compared to a recent study conducted on time-lapse imaging data using AI algorithms, all our models outperform the ICM accuracy and achieve comparable TE accuracy. To minimize the role of chance in calculating the models' prediction accuracies, the SWA-Gaussian (SWAG) algorithm was used. SWAG is a method to reflect and calibrate uncertainty representation in Bayesian deep learning. It is based on modelling a Gaussian distribution for each networks' weight and applying it as a posterior over all neural network weights to perform Bayesian model averaging.

Limitations, reasons for caution

To reflect a real IVF lab scenario, embryologists of different origins and levels of experience were involved and no scoring training was offered to the participants. These facts could have potentially negatively affected the degree of consensus, although we excluded two annotators diverging from the mean labeling accuracy.

Wider implications of the findings

In the past, AI algorithms proved to reliably differentiate between good and bad prognosis blastocysts but not necessarily between blastocysts of similar quality. Further AI-supported differentiation on the basis of expansion and cell lineages will facilitate the ranking of blastocysts and would bring automated scoring closer to clinical application.

Trial registration number

Not applicable.

Modulation of host epigenome by coronavirus infections and developing treatment modalities for COVID-19 beyond genetics

The recent Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) outbreak has resulted in coronavirus disease 2019 (COVID-19) pandemic worldwide, affecting millions of lives. Although vaccines are presently made available, and vaccination drive is in progress to immunize a larger population; still the risk of SARS-CoV-2 infection and related mortality is persistent amid threats of the third wave of the ongoing pandemic. In the scenario of unavailability of robust and efficient treatment modalities, it becomes essential to understand the mechanism of action of the virus and deeply study the molecular mechanisms (both at the virus level and the host level) underlying the infection processes. Recent studies have shown that coronaviruses (CoVs) cause-specific epigenetic changes in the host cells to create a conducive microenvironment for replicating, assembling, and spreading. Epigenetic mechanisms can contribute to various aspects of the SARS-CoV-2 multiplication cycle, like expressing cytokine genes, viral receptor ACE2, and implicating different histone modifications. For SARS-CoV-2 infection, viral proteins are physically associated with various host proteins resulting in numerous interactions between epigenetic enzymes (i.e., histone deacetylases, bromodomain-containing proteins). The involvement of epigenetic mechanisms in the virus life cycle and the host immune responses to control infection result in epigenetic factors recognized as emerging prognostic COVID-19 biomarkers and epigenetic modulators as robust therapeutic targets to curb COVID-19. Therefore, this narrative review aimed to summarize and discuss the various epigenetic mechanisms that control gene expression and how these mechanisms are altered in the host cells during coronavirus infection. We also discuss the opportunities to exploit these epigenetic changes as therapeutic targets for SARS-CoV-2 infection. Epigenetic alterations and regulation play a pivotal role at various levels of coronavirus infection: entry, replication/transcription, and the process of maturation of viral proteins. Coronaviruses modulate the host epigenome to escape the host immune mechanisms. Therefore, host epigenetic alterations induced by CoVs can be considered to develop targeted therapies for COVID-19.

Cyclooxygenase-2 expression as a prognostic factor in pediatric classical Hodgkin lymphoma

PURPOSE

Cyclooxygenase-2 (COX-2) is an inflammation-related enzyme that has been shown to have a role in tumor initiation, angiogenesis, and proliferation. It has been demonstrated that COX-2 expression is increased in many tumors and is a negative prognostic parameter. Our objective is to investigate the prognostic value of COX-2 expression in pediatric patients with classical Hodgkin lymphoma (CHL).

METHODS

This was a retrospective analysis in pediatric patients (n = 127) diagnosed with CHL and treated at the pediatric oncology department, National Cancer Institute, Cairo University, January 2005-June 2013. We correlated COX-2 immunostaining in Reed-Sternberg (RS) cells with clinical variables and outcome.

RESULTS

COX-2 was expressed on 38.6% of RS cells. The median follow-up time was 48.4 months (range 4-114 months). The 5-year OS and PFS, in COX-2(+ve) versus COX-2(-ve) was 85.3% versus 96.0% (p = 0.248) and 78.6% versus 84.3% (p = 0.354), respectively. A multivariate analysis showed that COX-2(+ve) was not significantly associated with the 5-year OS (HR = 2.9; 95% CI 0.7-12.4, p = 0.149) or with the 5-year PFS (HR = 1.4; 95% CI 0.6-3.2, p = 0.490). High-risk patients in the COX-2(+ve) group had a significantly lower 5-year OS (p = 0.021). The 5-year PFS was significantly lower in the COX-2(+ve) group with B symptoms (p = 0.023) and bulky disease (p = 0.028). Radiotherapy was given only to high-risk patients; survival was much better in radiation-treated children in both the Cox-2(+ve) and Cox-2(-ve) groups. The magnitude of the radiotherapy effect was also greater in the Cox-2(+ve) group, but this difference was not statistically significant.

CONCLUSION

COX-2 expression showed a tendency to be a poor prognostic factor, but it failed to provide meaningful independent information. Further larger studies are needed to investigate COX-2 as a prognostic factor and potential therapeutic target.

Cairo consensus on the IVF laboratory environment and air quality: report of an expert meeting

This proceedings report presents the outcomes from an international Expert Meeting to establish a consensus on the recommended technical and operational requirements for air quality within modern assisted reproduction technology (ART) laboratories. Topics considered included design and construction of the facility, as well as its heating, ventilation and air conditioning system; control of particulates, micro-organisms (bacteria, fungi and viruses) and volatile organic compounds (VOCs) within critical areas; safe cleaning practices; operational practices to optimize air quality while minimizing physicochemical risks to gametes and embryos (temperature control versus air flow); and appropriate infection-control practices that minimize exposure to VOC. More than 50 consensus points were established under the general headings of assessing site suitability, basic design criteria for new construction, and laboratory commissioning and ongoing VOC management. These consensus points should be considered as aspirational benchmarks for existing ART laboratories, and as guidelines for the construction of new ART laboratories.

Bioprocess enhancement of feather degradation using alkaliphilic microbial mixture

1. The main aim of this work is to develop a robust method to generate a microbial mixture which can successfully degrade poultry feathers to overcome environmental problems. 2. Four different alkaliphilic microbes were isolated and shown to degrade poultry feathers. 3. Two of the isolates were phylogenetically identified as Lysinibacillus and the others were identified as Nocardiopsis and Micrococcus. 4. The best microbial co-culture for white and black feather degradation was optimised for pH, temperature and relative population of the isolates to achieve almost 96% of degradation compared with a maximum of 31% when applying each isolate individually. 5. The maximum activity of keratinase was estimated to be 1.5 U/ml after 3 d for white feathers and 0.6 U/ml after 4 d for black feathers in a basal medium containing feather as the main carbon source. Additionally, non-denaturing polyacrylamide gel electrophoresis showed 4 and 3 protease activity bands for white and black feather, respectively. 6. This study provides a robust method to develop potential new mixtures of microorganisms that are able to degrade both white and black feathers by applying a Central Composite Design.

Gastrointestinal manifestations in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by multisystem involvement, including the gastrointestinal (GI) tract. There is a significant variation in the clinical presentation and severity of GI disorders. When GI symptoms present as the initial manifestation of SLE, there is likely to be a delay in the diagnosis. The cause of these GI manifestations in SLE may be the disease, or the side effects of medications, or infections. In this study we investigated the GI manifestations in a group of SLE patients. Our study was conducted on 40 SLE patients and 30 healthy controls to assess the prevalence of GI symptoms in SLE patients. The prevalence of gastrointestinal manifestations in our study was 42.5%. GI manifestations in our SLE patients were: acute abdominal pain (due to pleurisy and peritonitis), 6%; diffuse abdominal pain, 23.5%; epigastric pain, 29%; epigastric pain with vomiting, 23.5%; epigastric pain with chronic constipation, 6%; chronic constipation, 6%; and diffuse abdominal pain with bleeding per rectum, 6%. In our study, we found a higher incidence of Giardia infestation in SLE patients than in healthy controls, and 10% of these patients were asymptomatic. There was more Giardia infestation in patients with GI symptoms as compared with patients with no GI symptoms, with a P value of 0.009. In our study SLE patients with GI symptoms had a peak systolic velocity (cm/s) with a mean of 108.4 ± 32.1 standard deviation (SD) in the celiac Doppler study. Patients without GI symptoms had a peak systolic velocity with a mean of 111.9 ± 37.7 SD, meaning that our patients mostly had no evidence of celiac trunk stenosis, but there was significant difference between SLE patients without GI symptoms and controls, as the mean was higher in SLE patients than in the controls. Also, the celiac end diastolic velocity was higher in both groups of SLE patients with GI symptoms and those without GI symptoms, compared to controls.

Efficacy of transabdominal sonoelastography in the diagnosis of caesarean section scar endometrioma: A pilot study

Transabdominal sonoelastography (TASE) is a new imaging technique that maps the elastic properties of soft tissue. We evaluated 34, consecutive women with suspected scar endometrioma using standard B-mode ultrasound and elastography. Twenty-three women (23/34) underwent surgical excision and had the diagnosis confirmed by histopathology. All endometriomas (23 patients) in B-mode imaging appeared as hypoechoic masses along the line of a previous caesarean section incision and the outer borders were difficult to define precisely. By TASE, the endometrioma presented a typical blue-green-red appearance and the outer borders were clearly defined. (red and green area corresponds with the central hypoechoic soft areas). Strain ratios varied from 0.02 to 0.75. Real-time TASE is a simple, useful technique in confirming a clinical diagnosis of endometrioma in a caesarean section scar. Compared with B-mode ultrasound, it provides additional, preoperative information about the extent of the lesion that may be helpful to the surgeon.

Conservative management of placenta percreta: a stepwise approach

PURPOSE

To describe a modified surgical approach in the form of stepwise cesarean section in placenta percreta.

METHODS

We conducted a prospective observational study. A total of 71 patients with placenta percreta were subjected to the new stepwise surgical approach and uterine repair at the time of cesarean delivery.

RESULTS

The procedure was successful in controlling the bleeding and preserving the patient's uterus in 65 (91.5%) women. Ten patients (14.1%) had urinary tract complications, nine (90%) were managed during cesarean section and one presented late in the form of vesicouterine fistula.

CONCLUSIONS

A stepwise cesarean section is safe and effective procedure that can be applied in placenta percreta.

Novel modification of B-Lynch uterine compression sutures for management of atonic postpartum hemorrhage: VV uterine compression sutures

AIM

The aim of this study was to demonstrate a novel modification of uterine compression sutures for use in women with primary postpartum hemorrhage and to evaluate its effectiveness.

MATERIAL AND METHODS

This was a prospective observational study. Nineteen patients with atonic postpartum hemorrhage were subjected to the novel VV uterine compression sutures at the time of cesarean delivery.

RESULTS

The procedure was successful in 18 out of 19 women (94.7%) in controlling the bleeding and preserving the patient's uterus. Only one patient required supravaginal hysterectomy.

CONCLUSIONS

VV compression sutures comprise an easy, safe and effective procedure that can be applied in cases of atonic postpartum hemorrhage.

Agreement of histopathological findings of preoperative uterine curettage and hysterectomy specimens: impact of time factor and hormonal therapy

OBJECTIVES

To study the agreement of preoperative curettage and definitive histology after hysterectomy as well as the correlation of time factor and hormonal therapy to this agreement.

METHODS

This retrospective study was done in the Departments of Obstetrics and Gynecology and Pathology, Faculty of Medicine, Mansoura University, Egypt. Pathology reports of patients exposed to dilatation and curettage followed by hysterectomy during the period from May, 2004 to April, 2011 were reviewed.

RESULTS

We reviewed 83 cases who fulfilled the inclusion criteria. There were non-significant differences between findings of D&C and hysterectomy specimens (P = 0.42). The concordance rate between D&C and hysterectomy was 79.5%. One case of endometrial carcinoma (1.2%), one case of simple endometrial hyperplasia, one case of atrophic endometrium, and two cases of endometrial polyp were diagnosed only after hysterectomy (4.8%). Furthermore, histologic examination of hysterectomy specimens confirmed only 8 of 13 cases (61.5%) of endometrial hyperplasia with atypia. No significant correlation of time factor and hormonal therapy to the agreement between findings of D&C and hysterectomy specimens (P = 0.58 & 0.19 respectively).

CONCLUSION

There was no significant difference between preoperative endometrial histology and hysterectomy specimens (P = 0.41).This agreement had not been significantly affected by time interval and hormonal therapy. Future researches with larger number of cases are needed to confirm or disagree with our findings.

Immunohistochemical expression of cyclin A in testicular biopsies of fertile and infertile men: correlation with the morphometry of seminiferous tubules

Cyclin A is a member of the cyclin family of proteins, which are required for both the mitotic and meiotic divisions that characterise spermatogenesis in human and other mammalian species. The data on cyclin A expression in various human spermatogenic disorders and its relationship to the morphology of seminiferous tubules are not well clarified. This study aimed to evaluate the immunohistochemical expression of cyclin A in testicular biopsies of different spermatogenic disorders correlating with the morphology of seminiferous tubules using morphometry tools. Immunohistochemical evaluation of cyclin A was carried out on testicular biopsies obtained from 48 infertile males (nonobstructive azoospermia) and 15 normal subjects together with using semiautomatic morphometric analysis for evaluation of seminiferous tubules. Cyclin A is expressed in 100% of normal and hypospermatogenesis groups and in 80% of maturation arrest group, with complete absence in Sertoli cell only group. In positive cases, cyclin A stained the nuclei of spermatogonia and primary spermatocytes with a higher intensity of expression in normal cases compared with infertile group. Cyclin A expression was significantly associated with the different examined morphometric parameters. Cyclin A is involved in both mitosis and meiosis of human spermatogenesis as it is expressed in spermatogonia and primary spermatocytes. Morphometry of human testis is intimately correlated with the testicular histopathology.

Late post-cesarean surgical complication

AIM

The aim of the study was to clarify the incidence, indication, and management of late surgical intervention following cesarean section (CS) in a tertiary care university hospital.

METHODS

A cohort of 5981 women underwent CS from a group of 24,060 parturients in a retrospective study at a tertiary care university hospital. Surgical intervention after CS in the late postoperative period (after puerperium) was reviewed regarding clinical, operative, and pathological findings.

RESULTS

The CS rate was 24.86%. The incidence of late surgical intervention after CS was 0.40% (24/5981); of these 24 women, 10 (41.67%) were operated for skin lesions, two (8.3%) for urogenital fistula, three (12.5%) for gastrointestinal problems, three (12.5%) for omental masses and six (25%) for pelvic lesions.

CONCLUSION

Although the incidence of surgical intervention after CS in the late postoperative period is low and the outcome is favorable, several measures must be undertaken to reduce late surgical complications.

Is expectant management of early-onset severe preeclampsia worthwhile in low-resource settings?

OBJECTIVE

To evaluate the maternal and perinatal outcome following expectant management of early-onset severe preeclampsia (PE) at a tertiary hospital in Mansoura, Egypt.

METHODS

This prospective, observational study included 211 patients with severe PE, occurring between 24 and 34 weeks of gestation. They were classified according to gestational age on admission into three groups. Group 1 included 61 patients with gestational ages between 24 and 28 weeks. Group 2 (28 to <32 weeks) included 66 patients and group 3 (32-34 weeks) included 84 patients. Outcome measures included prolongation of gestation, and maternal and perinatal complications.

RESULTS

The median overall prolongation of gestation was 12 +/- 6 days. The rate of neonatal survival significantly increased (P < 0.001) from 12/61 (19.7%) in group 1 to 30/66 (45.5%) in group 2 and 67/84 (79.8%) in group 3. There were no maternal mortalities; however, 43 (20.4%) women developed significant morbidities. HELLP syndrome, renal impairment and placental abruption were the main complications.

CONCLUSION

In low-resource settings, expectant management of early-onset severe PE is associated with relatively higher rates of perinatal mortality and maternal morbidity and should be limited to gestational ages between 28 and 34 weeks of gestation.

Paraumbilical hernia repair during cesarean delivery

BACKGROUND AND OBJECTIVES

Pregnant women with paraumbilical hernia usually postpone hernia repair until after delivery, but some patients request that it be done during cesarean delivery. Therefore, we evaluated the outcome of combined cesarean delivery and paraumbilical hernia repair in a prospective study at a tertiary referral university hospital.

PATIENTS AND METHODS

In a prospective study, we compared the outcome of 48 patients undergoing cesarean delivery combined with paraumbilical hernia repair versus 100 low-risk patients undergoing cesarean delivery alone. The main outcome measures were operation time, blood loss, severity of pain, peripartum complications, hospital stay, hernia recurrence, and patient satisfaction.

RESULTS

The combined procedure took significantly longer than cesarean delivery alone (75.2 minutes versus 60.5 minutes, P<.001)). There were no major complications. Wound infection occurred in 6 patients (4.1%). Hospital stay did not differ significantly from those of controls. Pain at the hernia site repair occurred in two patients, and one hernia recurred in the hernia repair group during a mean follow-up period of 22 months (range, 6-36 months). All hernia patients reported that they preferred the combined operation.

CONCLUSIONS

Combined cesarean delivery and paraumbilical hernia repair had the advantage of a single incision, single anesthesia, and a single hospital stay while avoiding re-hospitalization for a separate hernia repair. Our results indicate that the combination approach is safe, effective, and well accepted.

Randomized controlled trial of three doses of letrozole for ovulation induction in patients with unexplained infertility

The aromatase inhibitor letrozole is a novel agent that can be used as an alternative to clomiphene citrate for ovulation induction in patients with unexplained infertility. The dose of letrozole used has varied between studies, and this study aimed to compare the three most commonly used doses: 2.5, 5 and 7.5 mg. A total of 179 patients were randomly recruited in this prospective study with 58, 61 and 60 patients in each dosage group respectively. This study reports a significantly higher (P < 0.05) number of follicles (total, > 14 mm and > or = 18 mm) on the day of administration of human chorionic gonadotrophin in the 7.5 mg group, associated with significantly fewer (P < 0.05) days of stimulation. However the pregnancy and miscarriage rates were similar in the three groups. In conclusion, it seems that the use of higher doses of letrozole offers no advantage in terms of pregnancy rates over the lower (2.5 mg) dose.

Value of estimating intraocular antibody production in diagnosis of typical and atypical lesions of ocular toxoplasmosis

Serum and aqueous humor (AH) samples were collected from 45 patients: 20 with typically active or reactivated retinal lesions of Toxoplasma (Group I), 16 with atypical lesions (Group II) and 9 with old quiescent scars (Group III). Also, serum and AH samples were collected from 10 patients with chronic toxoplasmosis without any ocular manifestation (Group IV). T. gondii specific IgG, IgA and IgM antibodies were measured by ELISA in AH and serum and the intraocular (local) antibody production was determined by calculating Goldman-Witmer coefficient (G.W.C.). IgG antibodies were the only class detected in all sera of patients with ocular and nonocular toxoplasmosis. An intraocular IgG antibody synthesis was confirmed in 95% and 37.5% of patients with typical (Group I) and atypical (Group II) posterior uveitis respectively and in none of either patients with quiescent scars (Group III) or the ophthalmologically free patients (Group IV). As regard the typical active lesions, the sensitivity of the IgG assay (95%) was higher than that of IgA (60%) and IgM (5%) assays. Beside the conclusion that AH analysis to detect local antibody production is more reliable than the estimating of serum antibodies for the diagnosis of ocular toxoplasmosis, the detection of AH specific antibodies in 6 atypical cases, who were treated successfully by antitoxoplasmic therapy, represent a help to increase the number of uveitis cases in which specific treatment can be established.

Day 5 inhibin B levels in a treatment cycle are predictive of IVF outcome

BACKGROUND

Day 5 serum inhibin B during IVF treatment has been investigated as a predictor of outcome.

METHODS

A total of 54 women (< or = 39 years, normal menses and endocrine profiles) were treated with urinary gonadotrophins or recombinant FSH following pituitary down-regulation. Serum day 3 FSH in a preceding cycle was <8.5 IU/l. Plasma inhibin B, inhibin A and estradiol were determined after 4 days of gonadotrophin administration (day 5).

RESULTS

Day 5 inhibin B was the most highly correlated with the number of mature follicles (>14 mm), oocytes retrieved and fertilized. Receiver operating characteristic analysis gave high accuracy for day 5 inhibin B in predicting ovarian response and indicated that a threshold of 400 pg/ml may be helpful in the decision as to whether to continue treatment. Women with <400 pg/ml (n = 16) had lower numbers of follicles, mature follicles, oocytes retrieved, fertilized and cleaved compared with those >400 pg/ml (n = 36) and this threshold gave a positive likelihood ratio of 30, 92.9% sensitivity, 95.0% specificity and 86.7% positive predictive value to detect poor ovarian response. Day 5 inhibin B was the best predictor of pregnancy (no live births and four cycles cancelled, low inhibin group; nine live births and no cancelled cycles, high inhibin group).

CONCLUSIONS

Normogonadotrophic, normogonadal women with day 5 inhibin B <400 pg/ml in down-regulated cycles have a poor response to ovarian stimulation and are less likely to conceive compared with women with higher day 5 inhibin B.

Becoming a doctor

Medical training cannot be equated with merely studying for a degree. It encompasses much more, challenging one's values, self perception and perspective on life itself. During five years at medical school, the individual irreversibly alters to become "a medic", not just "a student of medicine", no matter how much detachment from the course and its associated lifestyle the individual has endeavoured to preserve. In the following article, we intend to explore the different stages of training and discuss how each shapes the student. "Becoming a medic" intellectually, emotionally and spiritually is the inevitable consequence of spending five years at medical school, and the assumption of this role is indeed crucial to survival in medical practice. The importance of bringing our own individual qualities to the profession must, however, not be overlooked. Personal flair and abilities should be nurtured, not suppressed during medical school. A diversity of interests serves both to ease the pressures laid upon us at medical school, and to broaden our characters and deepen our understanding of humanity. Medical students, while necessarily adapting to the role of a doctor, should emerge from their training not as narrow "medics" but as enthusiastic, compassionate people equipped to treat patients to the best of their ability.

Percutaneous endoscopic gastroscopy tube migration: a rare cause of a common surgical problem

Percutaneous endoscopic gastroscopy (PEG) is now the preferred method for long-term enteral nutrition for patients with inadequate oral intake. It is usually replaced by a Foley catheter when it becomes non-functional because of blockage or wear and tear. PEG tube migration is an unusual complication which may not be noticed by the patient or the medical staff and may present as delayed small bowel obstruction. We report on a patient who developed such a complication and the missing PEG tube was replaced by a Foley catheter when it was thought the original tube had fallen out. The use of catheters with an external stop device is recommended to prevent this rare complication.

The effect of gonadotrophins with differing LH/FSH ratios on the secretion of the various species of inhibin in women receiving IVF

We have measured secretory patterns of inhibin A, B, total alpha inhibin, pro-alphaC inhibin and oestradiol in women following pituitary suppression who were randomised into two groups to receive either urinary gonadotrophin (25:75 IU/ampoule of luteinizing hormone (LH) and follicle stimulating hormone (FSH; Normegon; n = 11) or recombinant (r)FSH (75 IU/ampoule of FSH alone, n = 16). The women were of similar age (approximately 33 years) and length of infertility (approximately 4 years) and had a normal endocrine evaluation. Plasma FSH, LH, oestradiol, inhibin A, B, pro-alphaC and total alpha inhibin were measured by immunoassay prior to and following gonadotrophin stimulation. Immunoactive FSH, LH and oestradiol blood concentrations following pituitary down regulation were similar in the two groups being <2.0, <3.6 IU/l and <82 pmol/l respectively. The units of FSH given (2230 versus 2764 IU; Normegon versus rFSH), duration of treatment (9.1 versus 9.4 days) and number of follicles of > or =14mm on the day of human chorionic gonadotrophin (HCG) administration (17 versus 14) were also similar. Inhibin A or B concentrations rose similarly during Normegon or rFSH administration, peaking at days 9-11. Total alpha and pro-alphaC inhibin concentrations were lower (P < 0.05) in the rFSH group during days 10 and 11 of treatment being 18.9 +/- 15.9 ng/ml (Normegon) and 4.6 +/- 2.8 ng/ml (rFSH) for total alpha inhibin and 8.5 +/- 6.8 ng/ml (Normegon) and 2.8 +/- 1.6 ng/ml (rFSH) for pro-alphaC inhibin on day 10. Overall, higher total alpha inhibin concentrations were associated with more mature follicles and oocytes, greater fertilization rates and better quality embryos. We conclude that inhibin A and B secretion was similar in both groups and is primarily controlled by FSH, whereas total alpha inhibin and pro-alphaC increased preferentially in the Normegon group over the rFSH group, indicating that they are, in part, stimulated by LH.

A randomized prospective assessor-blind evaluation of luteinizing hormone dosage and in vitro fertilization outcome

OBJECTIVE

To determine the effect of exogenous LH dosage on IVF outcome.

DESIGN

Single-blinded (assessor-blinded) study with random assignment of treatment groups.

SETTING

Human Assisted Reproduction Unit, Rotunda Hospital, Dublin, Ireland.

PATIENT(S)

Infertile normogonadotropic women undergoing their first cycle of IVF were studied.

INTERVENTION(S)

Patients were randomized to gonadotropin drugs with varying doses of LH per ampule: recombinant FSH containing no LH (group 0, n = 39), urinary FSH containing <1 IU of LH per ampule (group 1, n = 30), hMG containing 25 IU of LH per ampule (group 25, n = 30), and hMG containing 75 IU of LH per ampule (group 75, n = 29). The FSH dose was kept constant at 75 IU per ampule. A long-protocol GnRH-analog regimen was used.

MAIN OUTCOME MEASURE(S)

Dose and duration of gonadotropin stimulation, follicle and oocyte numbers, implantation rate, and pregnancy rate.

RESULT(S)

The median duration of ovarian stimulation; median number of gonadotropin ampules used; serum E2 levels; and numbers of follicles, oocytes, and embryos were similar among the four groups. Median LH levels on the day of hCG administration, however, differed significantly. Live birth rates per cycle differed markedly, but statistical significance was not achieved (23%, 7%, 20%, and 31% for groups 0, 1, 25, and 75, respectively). A significant trend in implantation rates was noted with increasing LH dosage of the urinary preparations (19%, 10%, 18%, and 28% for groups 0, 1, 25, and 75, respectively).

CONCLUSION(S)

In the present study, although the residual endogenous LH after down-regulation was adequate for ovarian response and E2 synthesis, the addition of exogenous LH improved implantation. An FSH/LH ratio of 75/75 IU per ampule appeared to be the optimum dose.

Hepatocellular carcinoma in Mansoura-Egypt: experience of 385 patients at a single center

BACKGROUND/AIMS

Hepatocellular carcinoma is one of the commonest malignancies in the world. The two main etiological factors for hepatocellular carcinoma are cirrhosis and viral hepatitis. Although the first choice of treatment for hepatocellular carcinoma is surgical resection, most of them are unresectable at the time of diagnosis.

METHODOLOGY

From January 1994 to June 1999, 385 patients with hepatocellular carcinoma were presented to the Gastroenterology surgical center, Mansoura University, Egypt and subjected to similar diagnostic process. Forty-five (11.6%) of these patients (34 males and 13 females) with a mean age of 50.9 years (+/- 7.53 years) were subjected to different types of hepatic resection.

RESULTS

The underlying liver pathology was cirrhosis in 85%. Positive virology was found in 82.5% (HCV 61%, HBV 14.5% and combined 7%). The main presentation were asymptomatic in 144 (37.4%) patients, abdominal pain in 92 (23.9%) patients, ascites in 95 (24.6%) patients, jaundice in 53 (14%) patients and upper gastrointestinal hemorrhage in 26 (6.75%) patients. Only 45 (11.6%) were resectable, they were subjected to hepatic resection with operative mortality in 2 cases (4.4%) and with overall mortality in 29 (64.4%) cases after 48 months (32.8 +/- 19 months) of follow-up. The main causes of late mortality were recurrence in 14 (31.1%) cases, hepatic cell failure in 7 (15.5%) cases and other causes in 6 (13.3%).

CONCLUSIONS

Hepatocellular carcinoma is now a common malignancy in Egypt, which usually develops on top of cirrhosis of viral origin in 82%. Hepatic resection is the only method of treatment with a low resectability rate.

Transplacental transmission of hepatitis C virus in HIV-negative mothers

The aim of this work was to evaluate transplacental transmission of hepatitis C virus (HCV) in HIV-negative pregnant women who were HCV-PCR-positive, and also to determine the serotypes of the virus in these cases. Therefore, 767 pregnant women were screened for anti-HCV antibodies, hepatitis B surface antigen (HBsAg) and anti-HIV antibodies. HCV PCR was performed for HCV-positive women. Those who were PCR-positive were tested for anti-HCV IgM. Neonates of PCR-positive mothers were tested for virus transmission by the PCR test. Virus serotyping was done for mothers and neonates. Anti-HCV antibodies were detected in 105 out of 767 (13.7%) pregnant women. PCR was positive in 18 out of 67 HCV-positive women (26.9%). Transplacental transmission occurred in 11.1% of HIV-negative pregnant women. HCV type 4 predominates in Egypt (83.3%). Mothers who are PCR-positive and have high aspartate aminotransferase and positive anti-HCV IgM are most likely to transmit HCV to their babies.

Essential pre-conceptual measures for the female partner before commencing an in vitro fertilisation programme

Two hundred and eighty-one women were checked for the presence of specific pre-conceptual data and their medico-legal implications prior to commencing an in vitro fertilisation (IVF) programme. In only 9.6 per cent were the results of a recent rubella test available in the patients referral notes. Fifty-four per cent were then tested in the unit. Two per cent were found to be not immune. Thirty-six per cent of women needed a cervical smear prior to commencing therapy. No such test had been undertaken previously in 6.7 per cent and 12.7 per cent had abnormal test results. Pre-conceptual intake of folic acid is considered an important preventative measure. The patient uptake rose from 15 per cent to 97 per cent following specific advice.