Implementation of a mentored professional development programme in laboratory leadership and management in the Middle East and North Africa

Laboratories need leaders who can effectively utilize the laboratories' resources, maximize the laboratories'capacity to detect disease, and advocate for laboratories in a fluctuating health care environment. To address this need, the University of Washington, USA, created the Certificate Program in Laboratory Leadership and Management in partnership with WHO Regional Office for the Eastern Mediterranean, and implemented it with 17 participants and 11 mentors from clinical and public health laboratories in 10 countries [Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, and Yemen] in 2014. Designed to teach leadership and management skills to laboratory supervisors, the programme enabled participants to improve laboratory testing quality and operations. The programme was successful overall, with 80% of participants completing it and making impactful changes in their laboratories. This success is encouraging and could serve as a model to further strengthen laboratory capacity in the Region

Integration of evidence based medicine into the clinical years of a medical curriculum

Teaching Evidence Based Medicine [EBM] helps medical students to develop their decision making skills based on current best evidence, especially when it is taught in a clinical context. Few medical schools integrate Evidence Based Medicine into undergraduate curriculum, and those who do so, do it at the academic years only as a standalone [classroom] teaching but not at the clinical years. The College of Medicine at King Saud bin Abdulaziz University for Health Sciences was established in January 2004. The college adopted a four-year Problem Based Learning web-based curriculum. The objective of this paper is to present our experience in the integration of the EBM in the clinical phase of the medical curriculum. We teach EBM in 3 steps: first step is teaching EBM concepts and principles, second is teaching the appraisal and search skills, and the last step is teaching it in clinical rotations. Teaching EBM at clinical years consists of 4 student-centered tutorials. In conclusion, EBM may be taught in a systematic, patient centered approach at clinical rounds. This paper could serve as a model of Evidence Based Medicine integration into the clinical phase of a medical curriculum

effect officus carica [Fig] fruit on some biochemical parameters in a sample of healthy young male Yemenis

Fig is the Ficus carica, family Moraceae. It is widely produced in the Mediterranean countries particularly Turkey, Greece and Spain. It is mentioned in the traditional Islamic medicine as a remedy for gout and haemorrhoids. This article is performed to study the effect of Figs on the fasting blood sugar, serum cholesterol and serum uric acid in a sample of 14 healthy young male Yemenis. Two clinical trials were performed, in the first trial each volunteer received two placebo tablets daily for 14 days, and in the second trial each volunteer received 100 g of figs daily for 14 days. A washout period of two weeks was kept between the two successive trials. The results showed that figs significantly lowered the fasting blood sugar by 16% and increases serum cholesterol by 22%, while insignificantly increases serum uric acid by 5%. Finally placebo tablets did not change these parameters in the volunteers. The blood sugar lowering-effect of fig may be attributed mainly to its laxative action, and the serum lipid increasing-effect may be attributed to its high content of fixed oil. Fig fruit may have a beneficial effect in patients with diabetes

Gunshot wound injuries to the male external genitalia

To identify the patterns of civilian gunshot wound [GSW] injuries to the male external genitalia, and to present our experience in the management of such injuries. This descriptive study was carried out in the Urology and Nephrology Center, Al-Thawra Modern General and Teaching Hospital, Sanaa, Yemen from June 2005 to April 2008, and included 20 men that presented with GSW injuries to the external genitalia. After clinical and radiological evaluation with retrograde urethrography when indicated, early surgical repair was undertaken for all patients with evident, or suspected deep genito-urinary wounds. The mean age of the patients was 33.2 years. In 15 [75%] patients, injuries were inflicted by high-velocity weapons, and in 5 by low-velocity pistols, and 18 [90%] patients had other associated injuries. The penis was involved alone in 10 [50%], scrotum in 4 [20%], and the penis and scrotum in combination in 6 [30%] patients. In 5 patients, the lesions were superficial. Corporeal injuries were detected in 13 patients, and urethral injuries were detected in 6 patients. In post-repair, mild curvature during erection was experienced by 5 patients, severe angulation by one, and sexual dysfunction by 2 patients. We encountered 9 testicular ruptures, and our testicular salvage rate was 45.5%. Although the dominant inflicting weapons were high-velocity automatic rifles, the severity of injuries and their related outcomes were almost comparable to other low-velocity series. This is possibly due to the primary involvement of nearby bulky muscles in 90% of cases, which may absorb the blasts' effect of the projectiles on the genitalia

Management of penile fractures

To present our experience with surgical and conservative management of penile fracture. This prospective study was carried out in the Urology and Nephrology Center, at Al-Thawra Modern General and Teaching Hospital, Sana'a, Yemen from June 2003 to September 2007, and included 30 patients presenting with penile fracture. Diagnosis was made clinically in all our patients. Six patients with simple fracture were treated conservatively while 24 patients with more severe injuries were operated upon. Patients' ages ranged from 24-52 years [mean 31.3 years], 46.7% of patients were under the age of 30 years and 56.7% were unmarried. Hard manipulation of the erect penis for example during masturbation was the most frequent mechanism of fracture in 53.3% of patients. Solitary tear was found in 22 patients and bilateral corporal tears associated with urethral injury were found in 2 patients. Corporal tears were sutured with synthetic absorbable sutures and urethral injury was repaired primarily. All operated patients described full erection with straight penis except 3 of the 8 patients who were managed by direct longitudinal incision, in whom mild curvature during erection was observed. The conservatively treated patients described satisfactory penile straightness and erection. The optimal functional and cosmetic results are achieved following immediate surgical repair of penis fracture. Good results can also be obtained in some selected patients with conservative management

Applications of the yignalin system for cervical cytological reporting

The Bethesda System [TBS] for reporting the results of cervical cytology was developed as a uniform system of terminology that would provide clear guidance for clinical management. According to TBS, the diagnostic report should include a recommendation for further evaluation when appropriate. The aim of this wok was to use TBS terminology in classification of abnormal cervical Pap smears or with persistent significant inflammatory changes, and correlate the results with the final histopathological findings for optimum evaluation and clinical use. This prospective study was conducted in the Cytocolposcopic Unit of Teaching Laboratories and Outpatient Department of Medical City Teaching Hospital over a period of one year [Sep. 2001- Sep. 2002]. Eighty-three married females were included in the study. A cervical smear was taken followed by a punch biopsy, taken under colposcopic guidness, from the suspicious lesions for histopathological study. All cytological interpretations were reported and categorized according to The Bethesda System [TBS]. The rate of different cytological and histopathological findings and a comparison between the results were estimated by a special statistical analysis. Minimal cytological abnormalities were significantly more common than high-grade squamous intraepithelial lesion/HGSIL [95.5% compared to 4.5% respectively]. Atypical squamous cells of undetermined significance/ASCUS, as a single entity, was the most common cytological abnormality [44.8%], followed by low-grade squamous intraepithelial lesion/LGSIL [41.8%], atypical glandular cells of undetermined significance/AGUS [9%], and then HGSIL [4.5%]. [24.1%] of ASCUS in cytology was associated with underlying CIN [SIL] lesions in: histopathology, out of those, [20.7%] had CIN1/LGSIL and [3.4%] had CINII-III/HGSIL [14.3%] of cases with LGSIL.in cytology had CIN II-III [HGSIL] in histopathology, while HGSILs in cytology were associated with 100% high-grade lesions in histopathology. The most common cytologic diagnoses immediately preceding the discovery of histologic HGSIL were LGSIL [57.1%], ASCUS [14.3%], and then HGSIL [28.6%]. Minimal cytological abnormalities in cervical smears were significantly more common than HGSIL. ASCUS, as a single entity, was the most common cytological abnormality. All cases of HGSIL, in cytology, were found to have the same diagnosis by histopathology. So all cases with HGSIL in cytology should be immediately referred for colposcopy for final diagnosis. On the other hand, cases with minor cytological abnormalities were found to have high-grade lesions in histopathology in only 3.3% of women referred with ASCUS smears, and 14.3% of those with LGSIL smears. The latter finding demonstrates that an adjunctive method like colposcopy or close follow-up [particularly with three-smear follow up] is recommended to rule out high-grade lesions

Diagnostic value of cytology and colposcopy in patients with abnormal cervical pap smears

An optimal cancer detection system for preclinical cervical lesions should combine a cytological examination with a colposcopic follow-up examination. Detection at early pre-invasive stage provides an opportunity for treatment to prevent progression to invasive cancer. The present study aimed at evaluation of cytology, colposcopy, and combined cytology and colposcopy in predicting histopathological diagnosis of cervical intraepithelial neoplasia/squamous intraepithelial lesion [CIN/SIL] or other neoplastic changes in patients with abnormal cervical cytological findings. This prospective study was conducted in the Cyto-colposcopy Unit of Teaching Laboratories and Outpatient Department of Medical City Teaching Hospital over a period of one year [Sep. 2001- Sep. 2002]. Eighty-one married females were included in the study. A cervical smear was taken followed by a colposcopic examination of the cervix and then a punch biopsy was taken from the suspected lesions for histopathological study. Estimation and evaluation of the validity parameters of cytology, colposcopy, and combined cytology and colposcopy were performed using different cutoff points by special statistical analysis. Sensitivity, specificity and accuracy of cytology in the diagnosis of CIN/SIL were 73%, 93.2% and 84.0% respectively. The False- negative rate was 27%. Sensitivity, specificity and accuracy of colposcopy in the diagnosis of CIN were 83.3%, 58.5% and 70.1% respectively choosing doubtful findings as a cut-off point. The combination of cytology and colposcopy gave the following results: sensitivity, specificity and accuracy were 94.6%, 61.4% and 76.5% respectively; the negative predictive value [NPV] was 93.1%. When suspicious colposcopic findings were chosen as the cut-off point, the specificity and the positive predictive value [PPV] were higher at the expense of sensitivity and NPV. The conventional Pap smear, a valuable tool in the evaluation of patients with abnormal cervical cytology, was found to be of relatively low sensitivity in predicting CIN/SIL. Colposcopy is a valuable tool too. However, the validity parameters showed variable figures depending on the different cut-off points applied for the diagnosis of CIN/SIL. The ideal cut-off point was when doubtful and higher-grade colposcopic lesions are considered positive. The combination of cytology and colposcopy resulted in an increased sensitivity and NPV. The specificity could be further increased or improved when the threshold was set to distinguish higher-grade lesions [suspicious lesions] from lesser abnormalities

Evaluation of direct fluorescent monoclonal antibody test for detection of cryptosporidium in diarrhoeic patients

In a trial for evaluation of direct fluorescent monoclonal antibody test [Mab] in diagnosis of cryptosporidiosis, stool of 250 diarrhoeic patients, collected from 150 immunocompetent and 100 immunosuppressed children at different ages, were subjected for both modified Ziehl-Neelsen stain [MZN] and Mab. The obtained data showed that Mab was sensitive, easy and quick to perform in addition to its ability for detection of scanty infection. However, high cost and rapid fading of parasites are its main disadvantages. Although MZN showed less sensitivity to detect Cryptosporidium oocyst, it had the advantage of recognition of other protozoa e.g. G. lamblia. It is concluded that Mab proved to be more superior diagnostic technique, as it could be helpful for epidemiological screening for cryptosporidiosis

Psychiatric and social aspects of poisoning

62 admissions of drug overdose were randomly referred by the Department of Medicine for psychiatric assessment. The majority were young unmarried females attempting suicide as a reaction to social and personal stress. Psychiatric and mental disorders were diagnosed in only 13 cases of which depression was the commonest. Sedatives and Tranquilisers were the drugs most commonly used. This study emphasises the importance of psychiatric assessment in patients with self poisoning to detect those who require psychiatric and social care and calls for actions to minimize drug abuse

Pattern of acute poisoning: a 12 month hospital study

This study was conducted to determine the pattern of acute poisoning in an Iraqi general hospital. Out of a total 8359 medical admissions in one year, 314 patients [3.75%] were admitted on acount of acute poisoning. Self poisoning with drugs was responsible for about 85% of patients compared with about 14% for accidental and about 1% for homicidal poisoning. Benzodiazepine sedatives and hypnotics were found to occupy the leading place among drugs used for self poisoning followed by the analgesic antipyretic group of drugs in the second place. Most patients with self poisoning were young females in the second or third decades of life and some had a previous history of psychiatric illnesses [6%], or previous suicidal attempts [9%]. This study calls for action to introduce appropriate control measures to minimise the possibilities of drug abuse and prevent further increase in the problem of acute poisoning

Studies on the prevalence of hypertension in Iraqi rural and urban communities

A blood pressure study was conducted on samples of Iraqi rural and urban communities. The prevalence of hypertension among the examined population over the age of 15 years was 12.3 and 9.5% for the urban and rural populations respectively. Increase in age and adiposity was accompanied by a progressive rise in the prevalence of hypertension. Only 19.2% of the hypertensives detected were aware of their condition prior to the survey and of those only 37.5% were on regular treatment