Hossam E Fadel

Serial noninvasive evaluation of cardiovascular hemodynamics during pregnancy

M-mode echocardiography, in combination with electrocardiography and phonocardiography, has been used to measure pulmonary capillary pressure as well as other cardiac functions. Serial hemodynamic evaluations by use of this technique were performed in seven healthy pregnant women in the recumbent position. Each patient had five studies: four antenatal studies and one postpartum study that served as a control. Mean pulmonary capillary pressure was within normal limits throughout pregnancy and the puerperium. Cardiac output did not increase significantly by the end of the first or second trimester but became elevated by 31% in the early third trimester. This elevation in cardiac output persisted until delivery and resulted from a comparable increase in heart rate. Stroke volume and ejection fraction did not change significantly, while peripheral vascular resistance fell, although not significantly, reaching a nadir at approximately 28 weeks of gestation. Our findings indicate that maternal cardiac output increases due to an increased heart rate and reduced afterload.

Pleural effusions and pulmonary hypoplasia

Nine cases of fetuses with pleural effusions are presented in which the diagnosis was made by ultrasound before the thirtieth week of gestation. A ratio of lung span to hemithorax diameter was calculated and ranged from 0.44 to 0.77 (mean 0.60). At autopsy, pulmonary hypoplasia was confirmed in all cases by criteria based on the ratio of lung weight to total body weight. Because pleural effusions occurring in the midtrimester can be detected and may lead to pulmonary hypoplasia, consideration should be given to definitive in utero therapy when no other major fetal abnormality is detected.

Benign intracranial hypertension in pregnancy: current diagnostic and therapeutic approach.

Four cases of benign intracranial hypertension (BIH) in pregnancy are presented. Literature regarding this rare entity is reviewed. Various diagnostic and therapeutic approaches in the management of BIH are described, with special emphasis on the newer neurodiagnostic and neurosurgical approaches. Guidelines have been suggested in diagnosing and managing this syndrome in pregnancy.

Developments in Stem Cell Research and Therapeutic Cloning: Islamic Ethical Positions, a Review

Stem cell research is very promising. The use of human embryos has been confronted with objections based on ethical and religious positions. The recent production of reprogrammed adult (induced pluripotent) cells does not - in the opinion of scientists - reduce the need to continue human embryonic stem cell research. So the debate continues. Islam always encouraged scientific research, particularly research directed toward finding cures for human disease. Based on the expectation of potential benefits, Islamic teachings permit and support human embryonic stem cell research. The majority of Muslim scholars also support therapeutic cloning. This permissibility is conditional on the use of supernumerary early pre-embryos which are obtained during infertility treatment in vitro fertilization (IVF) clinics. The early pre-embryos are considered in Islamic jurisprudence as worthy of respect but do not have the full sanctity offered to the embryo after implantation in the uterus and especially after ensoulment. In this paper the Islamic positions regarding human embryonic stem cell research and therapeutic cloning are reviewed in some detail, whereas positions in other religious traditions are mentioned only briefly. The status of human embryonic stem cell research and therapeutic cloning in different countries, including the USA and especially in Muslim countries, is discussed.

Minor (glycosylated) hemoglobins in cord blood of infants of normal and diabetic mothers

The levels of minor (glycosylated) hemoglobins in maternal blood during labor and in cord blood at delivery were determined in four groups of women: 20 normal, 22 probably normal, 20 Class A diabetic, and eight overt diabetic women. Maternal HbA, was not significantly increased in the diabetic patients, thereby reflecting adequate metabolic control. In the cord blood, the percentage of the minor hemoglobin HbF1c, which has been shown to be a mixture of acetylated glycosylated HbF, and the ratios HbF1c/HbF and HbA1/hbA were significantly increased in fetuses delivered of diabetic mothers. This supports the view that these fetuses are hyperglycemic in utero. However, there was no correlation between cord blood glycosylated hemoglobins and the birth weight ratio, a sensitive indicator of relative changes in the birth weight.

Mechanism of development of pre-eclampsia linking breathing disorders to endothelial dysfunction

High blood pressure is an important component of pre-eclampsia. The underlying mechanism of development of hypertension in pre-eclampsia is complicated and still remains obscure. Several theories have been advanced including endothelial dysfunction, uteroplacental insufficiency leading to generalized vasoconstriction, increased cardiac output, and sympathetic hyperactivity. Increased blood flow and pressure are thought to lead to capillary dilatation, which damages end-organ sites, leading to hypertension, proteinuria and edema. Additional theories have been put forward based on epidemiological research, implicating immunological and genetic factors. None of these theories have been substantiated. Based on a review of literature this paper postulates that the initiating event for the development of pre-eclampsia is intermittent hypoxia associated with irregular breathing during sleep, hypoapnea, apnea, inadequate respiratory excursions during the waking hours and inadequate cardiopulmonary synchronization (abnormal sympatho-vagal balance).

Effect of maternal-fetal disorders on lung maturation. I: Diabetes mellitus

Amniotic fluid for fetal lung maturity studies was obtained from 287 healthy and 198 diabetic women. Classes of diabetes were as follows: Class A, 111; Class B, 58; Class C, 13; Class D, 11; Class F, 4; and Class R, 1. The regression lines representing the relationship of amniotic fluid lecithin phosphorus concentration to gestational age at amniocentesis in each of the groups of diabetic patients were not statistically different from those of the control subjects. Each of the diabetic patients was then matched with a control subject of the same race, sex of newborn infant, and gestational age at amniocentesis. The regression lines of the nonhypertensive, hypertensive, and all diabetics were not different from those of their respective matched control subjects. Also there was no difference in the proportion of mature lecithin phosphorus concentrations at different weeks between diabetic and normal women. The absence of a significant influence of diabetes on fetal lung maturation is probably due to improvement in diabetic control resulting in normalization of the fetal metabolic environment.

Ethics of Clinical Research: An Islamic Perspective

Medical progress depends on research which has to involve at some point human subjects. The human rights of research subjects must be protected. Ethical principles and guidelines have been developed by international organizations such as the World Medical Association (WMA) and the Council for International Organizations of Medical Sciences (CIOMS). The Islamic Organization for Medical sciences (IOMS), Kuwait, convened a meeting in Cairo, Egypt 2004, and produced a document advancing an Islamic viewpoint on these principles and guidelines. In this paper I discuss all these documents. The guidelines developed by CIOMS are in general agreement with Islamic principles i.e. respect for the person, bringing benefit, avoiding harm, and justice. However some differences exist to which I alluded. I also added some personal opinions. Muslim physicians / scientists should get involved in clinical as well as other medical research. It is farḍ kifāya (collective religious duty). They should be familiar with the ethical principles and guidelines and abide by them in their own research. Also, they should monitor externally sponsored research in their own countries to ensure that thee guidelines are followed. DOI: http://dx.doi.org/10.5915/42-2-5512

The reliability and clinical use of a rapid phosphatidylglycerol assay in normal and diabetic pregnancies

Lecithin phosphorus concentration, the standard fetal lung maturity test in our institution, and phosphatidylglyercol were assayed in 69, 29, and 45 amniotic fluid samples from normal (GI), gestational (GII), and insulin-dependent diabetic (GIII) women by means of thin layer chromatography and Amniostat-FLM, respectively. Lecithin phosphorus concentration greater than or equal to 0.1 mg/dl and positive or strong positive Amniostat-FLM results were considered mature. The results of both assays were concordant in 79% of the samples. The discordance rate was highest in GIII patients. In our experience, respiratory distress syndrome did not develop in neonate infants of diabetic women delivered after a mature lecithin result. With lecithin phosphorus concentration as the reference standard, the predictive value of a mature Amniostat-FLM result was 96.2%, whereas that of an immature result was 58.5%. Respiratory distress syndrome occurred in only two GIII neonates who were delivered within 72 hours of both immature lecithin and Amniostat-FLM results. These findings support the use of Aminostat-FLM as a screening test for fetal lung maturity in both normal and diabetic pregnancies. Additional tests will be necessary to evaluate further fetal lung maturity only if the results are negative.

Indirect antiglobulin test and anti-D prophylaxis in hereditary persistence of fetal hemoglobin.

&NA; The indirect antiglobulin test was used to assess the efficacy of anti‐D prophylaxis in two Rh negative women with hereditary persistence of fetal hemoglobin. Saturation of all D sites by passive antibody should be followed by indirect antiglobulin positivity due to excess administered anti‐D. In hereditary persistence of fetal hemoglobin, all red cells have fetal hemoglobin making the acid elution test (KleihauerBetke smear) to detect feto‐maternal hemorrhage useless. The indirect antiglobulin test is recommended in patients with hereditary persistence of fetal hemoglobin. (Obstet Gynecol 67:13S, 1986)