Medhat M. Anwar

Oral or vaginal misoprostol for induction of labor

Objective: To compare vaginal versus oral misoprostol for induction of labor. Method: Induction of labor was carried out in 40 women near term in two equal and randomized groups (according to a computer generated table) using misoprostol. Group I received vaginal misoprostol (100 μg) every 3 h while group II patients were given the same dose via the oral route. The dose was doubled if no response was detected under continuous cardiotocographic (CTG) tracings. Result: The vaginal route of administration induced a higher success rate in a shorter time interval using a lower dose but was associated with more abnormal FHR patterns and instances of uterine hyperstimulation. Conclusion: It is recommended to use the vaginal approach with cardiotocographic monitoring.

Plasma miR-22-3p, miR-642b-3p and miR-885-5p as diagnostic biomarkers for pancreatic cancer

BackgroundDiagnosis of pancreatic cancer (PC) by using sensitive and specific biomarkers is considered necessary. MiRNAs are master regulators of gene expression and several biological processes, and they are dysregulated in various cancers, where they play a vital role in either cancer progression or suppression. So, this study was designed to investigate the role of plasma miR-22-3p, miR-642b-3p and miR-885-5p expression as possible diagnostic markers in PC patients as compared to serum CA19-9. In addition, the correlation of those miRNAs and CA19-9 with clinical characteristics of PC patients was analyzed.MethodsThe expression levels of selected miRNAs and serum CA19-9 concentration were determined for 35 patients with PDAC and 15 healthy controls by quantitative real-time RT-PCR and electro-chemiluminescence immune assay, respectively. The sensitivities of miRNAs as biomarkers of PC were evaluated and compared with CA19-9 using a receiver operating characteristic analysis.ResultsThe levels of three miRNAs (miR-22-3p, miR-642b-3p and miR-885-5p) and CA19-9 were significantly higher in PC patients, even those with early-stage disease (IB and IIB), than in healthy control. Both miRNAs and CA19-9 were associated with tumor stage. The high sensitivities of the three selected miRNAs and CA19-9 were observed.ConclusionThe measurement of miR-22-3p, miR-642b-3p and miR-885-5p may prove to have clinical utility in diagnosis of PC. Those miRNAs are ideal early biomarkers for PC diagnosis. So, they can effectively be used with serum CA19-9 for PC screening in early tumor stage.

Cell-free DNA concentration and integrity as a screening tool for cancer.

AIM OF THE STUDY This study aims to evaluate cell-free DNA (CFDNA) concentration and integrity in patients with malignant and nonmalignant diseases and in controls to investigate their value as a screening test for cancer, and to correlate them with clinicopathological parameters of cancer patients. MATERIALS AND METHODS The study included three groups; group I: 120 cancer patients, group II: 120 patients with benign diseases and group III: 120 normal healthy volunteers as control. One plasma sample was collected from each subject. CFDNA was purified from the plasma then its concentration was measured and integrity was assessed by PCR amplification of 100, 200, 400, and 800 bp bands. RESULTS There was a highly significant difference in CFDNA levels between cancer group and each of benign and control groups. AUC of ROC curve for cancer group versus normal and benign groups were 0.962 and 0.895, which indicated the efficiency of CFDNA as a marker of cancer. As for integrity, normal and benign subjects showed only two bands at 100 and 200 bp, while all cancer patients demonstrated the 400 bp band and 78% of them had the 800 bp whose presence correlated with vascular invasion. CONCLUSION The combined use of CFDNA concentration and integrity is a candidate for a universal screening test of cancer. Upon setting suitable boundaries for the test it might be applied to identify cancer patients, particularly among subjects with predisposing factors. Being less expensive, CFDNA concentration could be applied for mass screening and for patients with values overlapping those of normal and benign subjects, the use of the more expensive, yet more specific, integrity test is suggested.

Cervical prostaglandin injection: a novel method of administration for ripening the cervix and induction of labor

Twenty pregnant women with ⩾36 weeks gestation and Bishop score of ⩽4 were subjected to either intracervical injection of PGE2 (0.25 mg) every 4 h to ripen the cervix and induce labor (study group n = 10) or injection of only the diluent (control group n = 10). PGE2 cases showed significant increase in Bishop score and were successfully induced. The mean induction‐establishment and induction‐delivery intervals were 4.3 ± 0.1 min and 6.07 ± 1.7 h, respectively. The control group showed no response. PGE2 cervical injection is a safe and effective method for cervical ripening and labor induction.

Value of circulating DNA concentration and integrity as a screening test for detection of cancer in an Egyptian cohort

Abstract Background Cell-free DNA (CFDNA) is extracellular nucleic acids found in cell-free plasma/serum of humans. This study aims to quantitatively measure CFDNA concentration and integrity in patients with malignant and non-malignant diseases and in healthy controls to investigate their value as a screening test for cancer, and then to correlate them with the clinicopathological parameters of cancer patients. Aim This study included 145 subjects divided into three groups; group I: 83 patients with different types of cancer, group II: 30 patients with benign diseases and group III: 30 normal healthy volunteers as control. One plasma sample was collected from each subject. CFDNA was extracted from plasma and its concentration was measured using Quant-iT™ PicoGreen dsDNA Assay Kit, then CFDNA integrity was detected by conventional PCR for 100, 200, 400 and 800 bp. Results Results revealed that there was a highly significant difference in the mean level of CFDNA between the cancer group and each of the benign and control groups. AUC of ROC curve for cancer group versus normal and benign groups were 0.968 and 0.928, which indicated the efficiency of CFDNA as a marker for cancer. As for CFDNA integrity, normal and benign subjects showed only two bands at 100 and 200 bp, while all cancer patients demonstrated the 100, 200 and 400 bp bands and 78% of cancer patients had the 800 bp whose presence was statistically correlated with vascular invasion. Conclusion Subjects with CFDNA ⩽100 ng/μl would be cancer-free; subjects with CFDNA value ⩾600 ng/μl could be diagnosed as cancer patients, while those with CFDNA between 100 and 600 ng/μl will need DNA integrity to identify non-cancer from cancer patients. Thus plasma CFDNA in combination with DNA integrity could be used as a screening test for cancer detection.

Changes in the circulating levels of hemoglobin, hematocrit, serum iron and total iron binding capacity after four methods of surgical tubal sterilization

One‐hundred women requesting voluntary surgical sterilization were included and enrolled into four groups (each n = 25). Four sterilization modalities were used namely: Falope ring, electrocoagulation, clip and Pomeroy ligation. The circulating levels of hemoglobin, hematocrit, serum iron and total iron binding capacity were studied before sterilization and at 3, 6 and 12 months thereafter. No significant changes were observed at 3 and 6 months post‐sterilization. At 12 months a significant increase in the hemoglobin and serum iron was observed with a significant decrease in total iron binding capacity. Falope ring, clip and Pomeroy ligation were of a higher rank in this context versus electrocoagulation.

Comparison of one-stage endoscopic retrograde cholangiopancreatography and cholecystectomy versus two-stage endoscopic retrograde cholangiopancreatography and cholecystectomy for treatment of cholelithiasis with choledocholithiasis

Introduction The optimal management of symptomatic or suspected common bile duct (CBD) stone continues to be controversial despite the fact that laparoscopic cholecystectomy (LC) has turned out to be the standard method for gallbladder removal and despite innovations in endoscopy and laparoscopic surgery. Aim The aim of this study was to compare the two-stage intervention [endoscopic retrograde cholangiopancreatography (ERCP) under total intravenous anesthesia followed by interval LC] with the one-stage intervention (ERCP combined with LC) in terms of feasibility, safety, effectiveness, and hospital stay. Patients and methods Eighty patients admitted to the Medical Research Institute, University of Alexandria, during the interval between January 2012 and January 2013, diagnosed as having cholelithiasis with choledocholithiasis proven by laboratory and radiological investigations (abdominal ultrasonography and/or MRCP), were studied prospectively, and they were classified into two equal groups: group A, in which a two-stage procedure was performed; and group B, in which a one-stage procedure was performed. Data were recorded, including patients’ demographic, endoscopic, and operative details, success rate, postoperative complication (ERCP and LC), overall operative time, and length of hospital stay. Results The operative time was significantly lower in the two-stage group (group A). There were no statistically significant differences between both groups as regards CBD stone retrieval, morbidity rates, or the mean hospital stay. Conclusion Taking in consideration that our results showed no statistical difference between the two groups, there is still no gold standard of care for patients having chronic calcular cholecystitis and CBD stones. We prefer separating the two procedures in our routine practice.