Lactoferrin plus health education versus total dose infusion (TDI) of low-molecular weight (LMW) iron dextran for treating iron deficiency anemia (IDA) in pregnancy: a randomized controlled trial.

BACKGROUND: Iron deficiency anemia (IDA) is one of the most common medical disorder disturbing pregnancies particularly in low resources countries, and contributes significantly to morbidities and mortalities. Thus, early diagnosis and prompt management of IDA is highly recommended. AIM: To Test the efficacy and safety of oral lactoferrin plus health education provided by a nurse versus total dose infusion (TDI) of low-molecular weight (LMW) iron dextran for treating IDA in the second and third trimester of pregnancy. DESIGN: A prospective interventional, randomized, parallel-group, single-center longitudinal study. SETTING: Woman's Health Assiut University Hospital, Assiut, Egypt, at the outpatient clinic and inpatient unit. It comprised 120 cases divided into two groups as pineapple flavored lactoferrin oral sachets 100 mg twice daily with health education (group A) and TDI of LMW iron dextran (group B). MAIN OUTCOME MEASURES: The primary efficacy parameter was clinical improvement and the amount of increase in hemoglobin concentration by 4 weeks after therapy, secondary outcome measures included measurement of the rest of RBC, and iron indices, the adverse effects related to iron therapy and the patient compliance to the treatment. RESULTS: There was insignificant difference between both groups regarding sociodemographic data, parity and mean gestational age. Both groups showed a significant clinical improvement of anemia 4 weeks post-therapy. There was no statistically significant difference in mean Hb level improvement in both groups after 1 month of therapy. However, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) improved significantly more in group B than A while iron indices (serum iron and serum ferritin) were significantly more in group A than group B. CONCLUSIONS: Pineapple flavored lactoferrin oral sachets plus health education can be widely used as an alternative to TDI iron dextran supplementation due to clinical as well as laboratory improvement of IDA during pregnancy after 1 month of treatment. Proper health education of the pregnant women with nurse recommendations of balanced diet containing good sources of iron would increase awareness of pregnant women and help eradicate IDA with its serious sequel during pregnancy.

Total dose iron dextran infusion versus oral iron for treating iron deficiency anemia in pregnant women: a randomized controlled trial.

STUDY OBJECTIVE: To test safety, efficacy, and cost-effectiveness of total dose infusion (TDI) of low molecular weight (LMW) iron dextran for treatment of iron deficiency anemia (IDA) during pregnancy in comparison to oral ferrous fumarate. DESIGN: Prospective interventional randomized controlled trial (RCT). Design classification. Canadian Task Force II3. SETTING: Antenatal clinic and causality unit of a tertiary care referral facility and University Hospital. PATIENTS: A total 66 anemic pregnant women (hemoglobin level between 7-10 g/dl). INTERVENTION: Administration of a LMW iron dextran as a TDI (group A) or Oral iron ferrous fumarate 60 mg elemental iron three times daily (group B) followed by remeasurement of hemoglobin after 4 weeks. MEASURES AND MAIN RESULTS: The main outcome measure was clinical and laboratory improvement of anemia after 4 weeks of starting the therapy. Both groups showed a significant clinical improvement of anemia 4 weeks post-therapy. However, the first improvement of symptoms was significantly faster in group A. Complete blood count (CBC) as well as all iron indices were improved in both groups after 4 weeks of therapy, but were significantly better in group A than B. Side effects in group B were mainly gastrointestinal (GIT) while one case of mild hypersensitivity to TDI and another one case of local reaction at the site of injection were reported in group A. CONCLUSIONS: It is concluded that despite being equally effective in improving both clinical and laboratory evidence of IDA, TDI allows iron restoration with a single dose faster than oral iron therapy with a reasonable safety profile. It is a good example of office one-stop therapy. Nevertheless, noninvasive selfusage at home is a clear advantage of the cheaper oral iron therapy which makes it the first choice for treating IDA in the second and third trimesters of pregnancy in tolerable cases.

Assessment of Aquaflor(®) , copper sulphate and potassium permanganate for control of Aeromonas hydrophila and Flavobacterium columnare infection in sunshine bass, Morone chrysops female × Morone saxatilis male.

Two experiments were conducted to test the effectiveness of different therapeutants against a mixed infection of Aeromonas hydrophila and Flavobacterium columnare in sunshine bass. Experiment 1 evaluated copper sulphate, florfenicol-medicated feed and potassium permanganate (KMnO(4) ) against a natural mixed infection. Experiment 2 further evaluated copper sulphate as a treatment to control an experimental mixed infection. In experiment 1, naturally infected untreated fish had the lowest final survival per cent, at 71%, while florfenicol-medicated feed at 15mgkg(-1) body weight for 10days or copper sulphate at 2.1mgL(-1) (1% of the total alkalinity) for 24h produced the highest final survivals, at 90% and 88%, respectively. The final survival of the naturally infected fish administered florfenicol-medicated feed was significantly different (P<0.1) from the untreated fish. The survival curves for the florfenicol and the copper sulphate at 2.1mgL(-1) were significantly improved from the untreated fish. In experiment 2, fish were challenged by waterborne exposure to A. hydrophila and F. columnare and either not treated or treated with copper sulphate at 2.1mgL(-1) . At the end of experiment 2, the per cent survival of the challenged fish treated with copper sulphate (99%) was significantly higher (P<0.05) than the non-treated (61%). The results illustrate clear benefit of florfenicol and copper sulphate against a mixed infection of A. hydrophila and F. columnare.

Prevalence of HBV and HCV infection among multi-transfused Egyptian thalassemic patients.

BACKGROUND AND OBJECTIVES: Though regular blood transfusion improves the overall survival of patients with ß-thalassemia, it carries a definite risk of infection with blood-borne viruses. The present study was carried out to estimate the real frequency of hepatitis B virus (HBV) and hepatitis C virus (HCV) among Egyptian ß-thalassemic patients, and determine the infection-associated risk factors in these patients. DESIGN AND SETTING: A prospective study conducted in a university hospital from January 2009 to January 2010. PATIENTS AND METHODS: Two hundred patients with ß-thalassemia major were enrolled in this study. Using enzyme-linked immunoabsorbent assay (ELISA), their sera were tested for hepatitis B surface antigen (HBsAg), antibody to hepatitis C core antigen (anti-HBc), and HCV antibody (HCV Ab). The positive HCV Ab results were confirmed by second-generation recombinant immunoblot assay (RIBA). RESULTS: The study sample consisted of 111 males and 89 females, with a median age of 13 years. Eighty-one (40.5%) patients were HCV Ab positive by ELISA and 39 (19.5) were anti-HCV positive by RIBA; 58 (29.0%) were HBsAg positive and 13 (6.5%) were anti-HBC positive. Older age, an increased number of transfusion units, and HBsAg seropositivity were significantly associated with a higher prevalence of HCV and HBV. CONCLUSION: The prevalence of HCV and HBV infections are very high among Egyptian ß-thalassemic patients, which calls for a critical look into the prevailing transfusion practices and adoption of stricter donor selection criteria to decrease the incidence rate of both HCV and HBV infections effectively. Furthermore, there is a compressing need for the use of more specific and sensitive methods for HCV testing in Mansoura university hospitals.

Post-burn breast deformity: various corrective techniques.

Burns of the front of the chest and abdomen and sometimes the front of the neck and axilla, mostly caused by flame in domestic accidents, are very common in Egypt. If deep, these burns can produce breast deformity in females either in childhood or in adolescence. This work considers 74 female breasts in 55 patients who had post-burn breast deformities due to accidents in childhood or early adulthood. The patients' median age was 21 years (range, 13 to 42 years). The cause was scalding in 18 patients and flame in 37. The following conditions were found: upward contracture in 26 breasts (35%), 21 patients; downward contracture in 32 breasts (43%), 25 patients; and loss or distortion of the nipple/areola complex in 16 breasts (22%), 9 patients. Surgical correction included: Z-plasty, scar revision, scar excision and reconstruction by local flap or skin graft, and use of tissue expanders. Adequate projection of the reconstructed breast with the creation of a normal-looking inframammary fold was obtained. There were no major complications. Two patients had partial skin loss of the split-thickness graft, and partial loss of edges of the areola occurred in three cases. The burns thus caused various degrees of breast deformity and the corrective surgery varied accordingly. It is concluded that in such cases the general rules of scar revision have to be applied, correcting the contracture by Z-plasty or else by a local flap, if available, or by a split-thickness graft if the surrounding area is affected by post-burn scarring or if a large defect appears after complete release. Tissue expanders play a role in some if the scar area is surrounded by normal healthy tissue.

Evaluation of diquat against an acute experimental infection of Flavobacterium columnare in channel catfish, Ictalurus punctatus (Rafinesque).

A trial was performed to evaluate the efficacy of diquat (6,7-dihydrodipyrido[1,2-a:2',1'-c]pyrazinediium dibromide) against an acute experimental infection of Flavobacterium columnare in channel catfish, Ictalurus punctatus. Diquat is an Environmental Protection Agency-approved herbicide and has the potential to be legally and practically used against columnaris. Channel catfish were challenged, by cutaneous abrasion, and waterborne exposure to F. columnare and treated once at 22-h post-challenge with 2.5, 5.0, 10.0 and 15 mg L(-1) of diquat active ingredient for 6 h. At the conclusion of the trial, 21-day post-challenge, diquat at 5.0, 10.0 and 15 mg L(-1) significantly (P < 0.05) reduced the mortality of infected fish from 95% in the challenged non-treated fish to 68%, 59% and 49%, respectively. In vitro, the minimum inhibitory concentration (MIC) of 23 isolates of F. columnare was assayed. The majority of the isolates had an MIC value of 5 microg mL(-1) (15 of the 23 isolates). Infected fish exhibited acute clinical signs similar to a natural infection. The skin had severe ulcerative necrotizing dermatitis and the muscles had severe necrotizing myositis. The gills had severe multifocal necrotizing branchitis. The results demonstrate that diquat would reduce mortalities caused by an acute columnaris infection.

Evaluation of potassium permanganate against an experimental subacute infection of Flavobacterium columnare in channel catfish, Ictalurus punctatus (Rafinesque).

An experiment was performed to evaluate the efficacy of potassium permanganate (KMnO4) as a prophylactic and therapeutic treatment of an experimental subacute infection of Flavobacterium columnare in channel catfish, Ictalurus punctatus. Fish were cutaneously abraded and divided into five treatment groups: (i) challenged by waterborne exposure to F. columnare and not treated with KMnO4 (positive control), (ii) challenged and simultaneously treated with KMnO4, (iii) challenged and treated with KMnO4 at 1, 6 and 9 days post-challenge, (iv) not challenged and treated with KMnO4 at 1, 6 and 9 days post-challenge (first negative control) and (v) not challenged and not treated (second negative control). The dosing of KMnO4 was 2.0 mg L(-1) above the potassium permanganate demand for 2 h duration. The survival of the group challenged and simultaneously treated with KMnO4 (99%) was significantly higher than the positive control (78%) and was not significantly different from the negative control groups. The challenged fish treated with KMnO4 post-challenge had 7% higher survival than the positive control (85% compared with 78%), but that difference was not statistically significant. The results demonstrate that KMnO4 has a clear prophylactic value but probably a marginal therapeutic value once the infection has established.

Cervical priming prior to operative hysteroscopy: a randomized comparison of laminaria versus misoprostol.

BACKGROUND: We aimed to compare efficacy of intravaginal misoprostol versus endocervical laminaria tents prior to operative hysteroscopy in selected cases. METHODS: A total of 144 patients with diagnosed intrauterine lesions scheduled for operative hysteroscopy were randomly allocated to two groups according to method of cervical priming prior to the procedure. Misoprostol 200 microg was inserted into the posterior fornix of the vagina for patients in group A (n=72), while laminaria tents were inserted intracervically in group B patients (n=72). RESULTS: Both methods were effective for cervical dilatation with a mean cervical diameter of 7.5+/-1.2 and 7.6+/-1.2 mm respectively. There was no significant difference in the mean cervical diameter or the time required for cervical dilatation (51.6 versus 51.4 s respectively). In contrast, there was a significant difference between the groups with respect to the insertion difficulty and in doctors' and patients' assessments of the procedure. CONCLUSIONS: Both misoprostol and laminaria were equally effective in inducing proper cervical priming prior to operative hysteroscopy with minimal time of cervical dilatation. Nevertheless, misoprostol may be superior due to easy application, reduced cost, and patient convenience and acceptability.

Effect of food preservatives on mother rats and survival of their offspring.

This work aimed to investigate the effect of food preservatives (sodium benzoate and sodium nitrite) on biochemical aspects of mother rats and survival of their offspring. Fifty pregnant albino rats (Sprague Dauley strain) were divided into 5 groups (10 rats each) and kept individually in wire cages. The first group was fed standard diet free from any additives (control group). The second and third groups were fed standard diet with added acceptable and high doses of sodium benzoate as a preservative. The fourth and fifth groups were fed on standard diet containing sodium nitrite at the same levels like that for benzoate in the second and the third groups. Animals were fed ad libitum during pregnancy. After delivery, the pups were measured anthropometrically (weight and length) and the mothers were sacrificed and their blood samples were taken from the hepatic portal vain. Serum was separated and subjected to biochemical analysis. The results indicated that sodium nitrite intake was associated with a significantly decreased food intake and lowered hemoglobin and hematocrit values (p<0.01 each) while their serum AST and ALP showed significantly higher values (p<0.01). Mothers receiving high dose of benzoate had significantly high ALT values (p<0.01). Both levels of benzoate and nitrite were shown to induce decrease in serum bilirubin and increased serum urea, while the high and acceptable doses of benzoate induced higher values of serum uric acid (p<0.01 and p<0.05, respectively), but did not induce a significant increase in serum creatinine. Pregnant rats which received acceptable and high doses of nitrite showed an increased mortality rate of their pups. The mean weight and length of live pups were lowered by food preservatives compared with controls.

Ovarioscopy, a technique to determine the nature of cystic ovarian tumors.

STUDY OBJECTIVE: To test the value of ovarioscopy as an additional step in the diagnostic work-up of probably benign cystic ovarian tumors before laparoscopic intervention, and to compare its diagnostic accuracy with that of transvaginal ultrasonography (TVUS) and tumor markers. DESIGN: Cross-sectional study (Canadian Task Force classification II-2). SETTING: Gynecologic endoscopy unit at a university hospital. PATIENTS: Sixty-eight women with unilateral or bilateral ovarian cystic swellings without clinical, sonographic, or laparoscopic suspicion of malignancy. INTERVENTION: Preoperatively, TVUS and tumor markers were estimated. Intraoperative endocystic ovarioscopic visualization ovarioscopy and ovarioscopy-guided biopsy were done before laparoscopy. MEASUREMENTS AND MAIN RESULTS: Ovarioscopy had the highest specificity for detecting benign ovarian cysts (98%) compared with (72.6%) and (72%) for tumor markers and TVUS, respectively. Its positive predictive value was 50% compared with 5% and 6% for tumor markers and TVUS, respectively. Its findings agreed with the histopathologic diagnosis in 39 patients (57%, p = 0.000, k = 0.85). CONCLUSION: Ovarioscopy is a simple, rapid maneuver that should precede laparoscopic ovarian cystectomy. It is superior to tumor markers and TVUS for predicting the benign nature of ovarian cysts.

Comparison of transvaginal ultrasonography and vaginal sonohysterography in the detection of endometrial polyps.

BACKGROUND: The diagnostic accuracy of transvaginal ultrasonography and vaginal sonohysterography in detecting endometrial polyps in women suffering abnormal uterine bleeding are compared. METHODS: One hundred and six patients suffering from menometrorrhagia were studied. To detect whether there was endometrial polyp or not, these patients were subjected to transvaginal ultrasonographic examination as well as to sonohysterography. The final diagnosis was established by diagnostic hysteroscopy and its guided biopsy. RESULTS: Transvaginal ultrasonography resulted in false positive and false negative rates of 25% and 36.2% respectively while the figures with sonohysterography were 5.4% and 8% respectively. Combining both techniques further improved such rates to 2.9% and 2.8% respectively but not significantly (p>0.1). The sensitivity and specificity were 64.5%, 75.5% for transvaginal ultrasonography, and 93.1%, 93.9% for sonohysterography (significantly higher: p<0.001). CONCLUSIONS: Sonohysterography is significantly more accurate than transvaginal ultrasonography in the detection of endometrial polyps in cases with abnormal uterine bleeding. Combining both techniques did not significantly improve the diagnostic accuracy. Sonohysterography is an accurate and cost effective method which requires a little skill.

Hysteroscopic myometrial biopsy in unexplained abnormal uterine bleeding.

OBJECTIVES: To define the value of hysteroscopic myometrial biopsy in unexplained abnormal uterine bleeding not responding to hormonal treatment and to compare two hysteroscopic biopsy techniques. DESIGN: A prospective cross-sectional comparative study. SETTING: Gynecologic Endoscopy Unit, Assiut University Hospital, Egypt. PATIENTS: It comprised 99 patients with abnormal uterine bleeding who underwent transvaginal ultrasonography, endometrial biopsy and diagnostic hysteroscopy, which revealed no local lesions. INTERVENTIONS: Operative hysteroscopy was performed for 62 of them (group A). Hysteroscopic myometrial biopsies were taken using rigid biopsy forceps and the resectoscope successively guided by the previous ultrasonography of the myometrium. Thirty-seven patients (group B) underwent total abdominal hysterectomy followed by multiple full-thickness myometrial biopsies of the specimens. RESULTS: Pathologic myometrium was diagnosed in 12 (19%), 27 (43%) and 21 (56.5%) biopsies taken with the rigid biopsy forceps and the resectoscope (group A) and full-thickness biopsies (group B) respectively. Thirty biopsies (48%) taken with the rigid biopsy forceps were inadequate for proper histopathologic assessment while thermal effect was excessive in only four biopsies (6%) taken with the resectoscope. Honeycomb sonographic appearance was specific in prediction of adenomyosis. CONCLUSIONS: Resectoscopic myometrial biopsy can explain the cause of persistent abnormal uterine bleeding in about 43% of cases. Myometrial biopsy using the rigid biopsy forceps is inadequate and is not recommended.

Screening sonohysterography in infertility.

This prospective comparative study was carried out to assess the value of sonohysterography (SHG) in evaluating both the endometrial cavity and tubal patency in infertile patients and to compare its results with hysterosalpingography (HSG), diagnostic hysteroscopy and laparoscopic chromopertubation. It comprised 84 infertile women who were examined using SHG the day before combined diagnostic laparoscopy and hysteroscopy. Eighty-three patients had had HSG within 6 months. As regards the appearance of the endometrial cavity, the results of SHG agreed with hysteroscopy in 72.2% (k = 0.31) while HSG agreed with hysteroscopy in 75.6% (k = 0.39) of cases. The appearance of the right and left tubes using SHG agreed with laparoscopy in 72.4% (k = 0.16) and 60.5% (k = 0.13), respectively, while HSG agreed with laparoscopy in 94% (k = 0.52) and 90.4% (k = 0. 51), respectively. However, when the appearance of fluid in DP was considered as an indirect indicator of patency of at least one tube at SHG, the agreement with laparoscopy rised to 88.1% (k = 0.24) and 85.7% (k = 0.18) for both tubes respectively. In conclusion, SHG is similar to HSG as regards the appearance of the endometrial cavity but it is inferior to it for evaluating tubal factor. The implication of SHG in the infertility work-up as a simple and fast procedure can minimize costs and abuses of sophisticated techniques particularly in the developing countries with limited resources.

Laparoscopic evidence of upper genital schistosomiasis.

This prospective study aimed at estimating the proportion of upper genital schistosomiasis in patients submitted to video-assisted laparoscopy and to describe carefully the bilharzial lesions seen at laparoscopy. Four hundred and thirty-four patients submitted to videolaparoscopy were included in this study. The pelvis was carefully explored for evidence of recent or old upper genital tract chronic inflammation. Suspicious areas like nodules, masses, vascular lesions, adhesions, pathologic tubes or ovarian cysts were biopsied. Positive cases of schistosomiasis were submitted to a thorough immunological evaluation. Diagnostic laparoscopy was carried out in 185 cases while the remaining patients required operative intervention. Biopsy was taken from 128 cases (29.8%) which revealed schistosomiasis in four cases only (0.9%) who demonstrated high titre of antibodies against Schistosoma haematobium . Despite being a rare disease, upper genital schistosomiasis should be considered as a possible cause in all cases of adhesions, tubal, peritoneal or ovarian lesions, if the patient comes from an endemic area.

Child maltreatment: international perspectives.

The purpose of this literature review was to explore definitions, incidence, and management of child maltreatment across cultures. Articles written in the English language published from 1962 to 1991 were reviewed to answer the following questions: (1) What role does cross-cultural variability play in defining child maltreatment? (2) What is the incidence of maltreatment in developed and developing countries across continents? (3) What measures have been instituted by countries to prevent and manage child maltreatment? Cross-cultural information was found to be limited. Child rearing attitudes had an impact on the identification, prevention, and management of maltreatment across nations.

PIP: This literature review relied on data from a MEDLINE search of articles on child abuse published in English from 1962 to August 1991. The literature was examined to determine 1) the role of cross-cultural variability in defining child maltreatment, 2) the incidence of maltreatment in developed and developing countries across continents, and 3) the measures instituted to prevent and manage child abuse. In Africa, information was available for Nigeria and Tunisia. In Asia, data were available Hong Kong, Japan, Jordan, Korea, and the Philippines. Reports from the Australian region covered New South Wales, South Australia and New Zealand, and Victoria. Data from Europe related to France, Great Britain, and The Netherlands. Scandinavia was represented by studies from Denmark, Finland, and Sweden. Canada and the US each yielded studies, and South America was represented in this review by Brazil. The authors concluded that awareness of child maltreatment varies from society to society but more and more countries are becoming concerned about this phenomenon. Data on incidence of child abuse are lacking in many countries, but many researchers in diverse cultures are attempting to fill in the gap. Prevention and management strategies are as diverse as the countries which generate them. Thus, cultural attitudes and behaviors impact on the identification, prevention, and management of maltreatment. Comparable cross-cultural definitions of child maltreatment are needed, with the parameters of acceptable behavior drawn. Criteria for determining the occurrence of child abuse must also be determined.