Lumbar kinematics, functional disability and fear avoidance beliefs among adults with nonspecific chronic low back pain

Objectives: This study aimed to examine correlations between lumbar kinematics, functional disability and fear avoidance beliefs among adults with nonspecific chronic low back pain [LBP]

Methods: This crosssectional study was conducted between March and December 2014. A total of 32 adults diagnosed with nonspecific chronic LBP were recruited from outpatients attending either an orthopaedic clinic at a university hospital or a private physiotherapy clinic in Malaysia. Lumbar kinematics were measured using sensors attached at the first lumbar [L1] and second sacral [S2] vertebrae levels. The Oswestry Disability Index [ODI] and Fear-Avoidance Beliefs Questionnaire [FABQ] were used to assess degree of functional disability and fear avoidance beliefs, respectively

Results: For maximum range of motion, positive correlations were observed between ODI scores and right lateral flexion and right rotation [P = 0.01 each], although there was a negative correlation with left rotation [P = 0.03]. With maximum angular velocity, ODI scores were positively correlated with right and left lateral flexion L1 [P = 0.01 and <0.01, respectively] but negatively correlated with left lateral flexion L2 [P = 0.04]. Regarding minimum angular velocity, ODI scores were positively correlated with left lateral flexion S2 [P <0.01] but negatively correlated with right and left lateral flexion L1 [P = 0.02 each], right rotation L1 [P = 0.02] and left rotation S2 [P = 0.01]. No significant correlations were found between lumbar kinematics and FABQ scores

Conclusion: These findings suggest that certain lumbar kinematic parameters are correlated with functional disability, but not with fear avoidance beliefs

disintegrin and metalloproteinase 33 [ADAM33] gene polymorphism association with asthma in Egyptian children

A disintegrin and metalloproteinase-encoding gene [ADAM33], was recently identified as an asthma susceptibility gene. ADAM33 protein is expressed in smooth muscle cells of bronchi and pulmonary fibroblasts, playing a major role in airway remodeling. Earlier studies, have mostly confirmed a link between ADAM33 and asthma as well as bronchial hyperresponsiveness. This work studied a group of Egyptian asthmatic children for 3 ADAM33 single nucleotide polymorphisms [SNPs], previously identified as putative risk alleles: T1 G > A[rs2280091], T2 A > G[rs2280090], V4 G > C[rs2787094] using Polymerase Chain Reaction - restriction fragment length polymorphism [PCRRFLP] with emphasis on their relation to clinical [severity, smoking, family history, and atopic manifestations] and laboratory data [Ig Immunoglobulin E [Ig E] level and absolute eosinophilia] and pulmonary functions. Sixty [3-12 years old] asthmatic children and 32 matched controls were recruited. The genotype distribution for the SNPs showed no significant difference between the patients and the controls. A higher frequency of the [AA] genotype of T1 polymorphism was found in controls [75%] than in patients [41%], while the [AG] variant was higher in cases [46.6%] than in controls [21.9%] but with no statistically significant difference. Also the [GG] genotype was higher in cases [11.6%] than in controls [3.1%] but with no statistical significance. The allelic frequencies of T1 showed a higher [A] allele in controls [85.93%] than cases [65%] and higher [G] allele in cases [35%] than controls [14.06%], showing a high significant difference. No correlation was found between [T1, T2, and V4] and the demographic, clinical and laboratory parameters, except SNP T1 showing a positive correlation with Ig E level, and SNP V4 showing a positive correlation with passive smoking as a precipitating factor and borderline significance with absolute eosinophilia. In conclusion, no significant association was detected between these SNPs and asthma susceptibility in this study

Study of the relation between quality of inpatient care and early readmission for diabetic patients at a hospital in the Eastern province of Saudi Arabia

Readmission of diabetic patients after discharge from hospital has potential value as a quality of care indicator. This retrospective cohort and case-control study aimed to determine the readmission rate for diabetic patients within 28 days after discharge and the association between quality of inpatient care and unplanned readmission. An audit of records was conducted in a hospital in the Eastern province of Saudi Arabia during 2000-2008. The rate of unplanned readmission of patients originally admitted with diabetes mellitus [n = 1125] was 5.2%. Comparison of data from readmitted patients [n = 62] and a sample of non re admitted patients [n = 62] showed that adherence by health care providers to American Diabetes Association guidelines for admission work-up [OR 0.91, 95% Cl: 0.85-0.99] and readiness for discharge criteria [OR 0.89, 95% Cl: 0.84-0.95] were significantly more likely to decrease the risk of readmission within 28 days

The Outcome of the Seminal Fluid Parameters Collected via Coitus Interruptus versus Masturbation

A one year study was carried out to determine the outcome of the seminal fluid parameters collected via masturbation and coitus interruptus in 151 patients who were undergoing intrauterine insemination (IUI) and patients who came for seminal analysis. There were no statistically significant differences in terms of volume, concentration, progressive motility and normal morphology from specimens collected via coitus interruptus compared to specimens collected via masturbation. Pregnancy outcomes were also comparable.

Diagnostic significance of atypical category in the voided urine samples: a retrospective study in a tertiary care center

Voided urine samples continue to play an important role in the surveillance of urothelial malignancy and also as a screening mode for high risk patients. In some cases, it is difficult to reliably distinguish changes induced by inflammation, stone or other reactive condition from neoplasm, and these cases are categorized as atypical. The aim of our study is to evaluate the prevalence and the significance of atypical diagnosis in the voided urine samples and also to identify the cytomorphologic features that are seen more frequently in the atypical malignant urine samples. All voided urine cytology samples with a diagnosis of atypical urothelial cells, between the period of 2000 and 2009, were obtained from the cytology database. Only those cases with histologic follow-up were included in the study. The cytology and the histology slides were retrieved and reviewed. The following parameters were evaluated: cellularity, cell clusters, nuclear membrane irregularities, hyperchromasia and India-ink type nuclei, the presence of spindle cells and the cytoplasmic characteristics. Out of 72 voided urine samples included in the study, 49 cases [68%] had a positive histologic diagnosis of urothelial malignancy in the follow-up histology; of these [55%] were high-grade urothelial carcinoma. Increased cellularity, papillary cell clusters, nuclear membrane irregularity, hyperchromasia and India-ink type nuclei were observed more frequently in the atypical malignant urine samples, while cytoplasmic vacuolization were seen more in the negative reactive urine samples. The atypical category diagnosis is associated with a significant proportion of urothelial carcinoma. It should be used by the pathologist to convey concern to the clinician in difficult cases that may require close follow-up

Quality of life of patients with oral and pharyngeal malignancies

The target population was cases of oral and pharyngeal cancer in Alexandria and El Behira regions. Data were collected through all accessible archives. Data about quality of life [QoL] were collected through interviewing 171 subjects using the Arabic version of "Functional Living Interview Questionnaire for Cancer" [FLIC]. It consists of 22 items translated into Arabic language, and was checked for reliability and validity. Only 12 questions were found suitable for use after testing the questionnaire. Responses are coded on a 7 point Likert scale. Questions included pain, psychic stress, and ability to work and do household activities. The initial scale's structure identified a two-factor model: functional including 6 questions, and psychological including 6 questions. The grand total score was calculated as the sum of responses to the 12 items. The total score of the scale range is 12 to 84 points. The median was used for demarcation between what was considered as "good" response, and what was considered as "poor" QoL. Quality of life displayed higher "good" frequencies among those 30-60 years old. Males, and rural cases expressed better QoL than females and urban. Married were of better QoL compared to single patients. The educated showed higher frequency of "good" compared to un-educated. Employees and professionals reported better QoL. Stage categories showed significant indirect correlation with QoL scores. The best QoL according to total or psychological mean scores was recorded for pharyngeal-otherwise [pharyngeal of a mysterious origin] or lip cases, while the worst were for the floor of the mouth. Lip cases showed the best QoL scores through the functional domain. According to treatment; surgery showed the best QoL, while chemotherapy showed the worst. When it came to chronic irradiation complications; those without complications expressed the best QoL. All those treatment complications showed significant associations with dichotomous leveling of QoL. Logistic regression showed that stage, late surgical complications, and response to treatment were the most important predictors of QoL

Squamous cell carcinoma of the breast

Pure primary squamous cell carcinoma of the breast is a rare disease, thus strict criteria should be applied when making such a diagnosis. Breast abscesses are a common presentation. We report a case of primary SCC of the breast in a 69-year-old woman in which the initial clinical impression was a breast abscess. She had an incision and drainage, and cytological and histological examination revealed squamous cell carcinoma. A secondary source was excluded and the patient underwent mastectomy, which was followed by a local recurrence in 4 months

Taurine protects transplanted liver against ischemia-reperfusion injury

Although liver transplantation as a treatment of end-stage liver disease has developed rapidly, the problem of ischemia-reperfusion injury [I/RI] to the liver graft remains an obstacle. After I/R, Kupffer cells were activated and generate reactive oxygen species [ROS] which play a central role in the pathogenesis of rejection. Taurine is a cysteine derivative known as being a conjugate to primary bile acids; besides oxidative regulation functions, it is supposed to have protective efficacy on ischemia reperfusion liver damage and its anti-hepatic injury may be mainly related to inhibiting lipid peroxides formation, regulating cellular calcium homeostasis and stabilizing biological membrane. To evaluate the effect of taurine injection before liver transplantation on the oxidant [MDA] /antioxidant [reduced glutathione and glutathione peroxidase] status, activation of Kupffer cell [tumor necrosis factor-alpha] and cell apoptosis [expression of hypoxia inducible factor-1 alpha [HIF-1 alpha] and caspase-3]. Forty patients undergoing liver transplantation were divided into two groups: Group I: Taurine group [n=20] were given [1 gm taurine intravenous bolus to the donor 30 min before hepatectomy and another 1 gm to recipient 15 min before graft reperfusion] .Group II: saline control group [n= 20] were given physiological saline of the same volume as taurine group. Liver biopsy was taken before the end of operation for the mRNA expression of HIF-1 alpha and caspase-3. Blood samples were taken from each participant at the beginning of the operation [T[0]], clamping of portal vein [T[1]], 1 h and 3 h after portal vein reperfusion [T[2] and T[3], respectively]. Serum levels of aspartate aminotransferase [AST], alanine aminotransferase [ALT], tumor necrosis factor-alpha [TNF- alpha], malondialdehyde [MDA], reduced glutathione [GSH] and whole blood glutathione peroxidase activity [GPx] were analyzed. TNF-alpha and MDA levels were significantly increased at T[1], significantly peaked at 1 h after reperfusion [T[2]] and significantly decline after 3h [T[3]]. However, this elevation of TNF-alpha and MDA levels were significantly higher in saline group compared to taurine group. On the other hand, the level of GSH and the activity of GPx were significantly higher in the taurine group than in the control group. HIF-1 alpha and caspase-3 mRNA were highly expressed in control group more than taurine group. Taurine can protect the liver against ischemia-reperfusion injury by downregulation of HIF-1alpha, caspase-3, decreasing the production of TNF-alpha and improvement of hepatic antioxidant capacity

Genetic polymorphisms of DNA repair gene XRCC1 and susceptibility to acute leukemia

Defective DNA repair has been reported to be a risk factor for various malignancies. Polymorphisms of DNA repair genes could alter protein structure and may impair DNA repair capacity. Genetic polymorphisms of XRCC1 gene could lead to defective base excision repair [BER] pathway resulting in impaired DNA repair capacity and increased risk of acute leukemia. To determine the possible effect of XRCC1 gene polymorphisms 194Arg to Trp and 399Arg to Gin on the risk of development of acute leukemia in a group of Egyptian patients. The study was also extended to evaluate the association between these polymorphisms and disease outcome. Polymorphisms of XRCC1 codon 194 [Arg to Trp] and codon 399 [Arg to Gin] were genotyped in 35 patients with acute lymphoblastic leukemia [ALL], 35 patients with acute myeloid leukemia [AML] and 70 healthy controls using polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP] method. Individuals with heterozygous XRCC1 194 Arg/Trp variant demonstrated a significant increased risk of AML than controls [Odds Ratio [OR] 3.5, 95% confidence interval [CI], 1.3-9.5]. The frequency of homozygous XRCC1 399 Gin/Gin variant was statistically higher in ALL patients than controls [OR 3.69, 95% CI, 1.19-11.4]. Stratification for sex with regard to codon 194Trp carriers showed that males had 3.2-fold increased risk of ALL than females with borderline significance. In case of codon 399Gln polymorphism, a highly significant risk of ALL among females was observed with 7.5-fold increased risk. The frequency of XRCC1 haplotype A [399Gln carriers and 194Trp carriers] was significantly higher in both ALL and AML patients than controls [OR5.2, 95% CI, 1.6-16.7, p-value <0.01 for ALL] [OR 3.2, 95% CI, 0.9-11.1, p-value=0.055 for AML]. The polymorphic variant of XRCC1 194Trp has a significant unfavorable effect on disease outcome among ALL and AML patients [p-value 0.002 and 0.05 respectively]. Acute lymophoblastic leukemia patients carrying the 399Gln allele experienced a significant unfavorable outcome than ALL patients carrying the wild-type allele [p-value<0.01]. An increased risk of AML among carriers of XRCC1 194Trp and an increased risk of ALL among patients with XRCC1 399Gln variant genotypes were observed. Combined presence of XRCC1 194Trp and 399Gln variants [haplotype A] had significantly higher risk of both ALL and AML. The polymorphic variants of XRCC1 codons 194 and 399 had significant unfavorable effect on disease outcome of both AML and ALL

Monocytes expressing tissue factor as a diagnostic marker for neonatal sepsis

In neonatal sepsis, several clinical and laboratory parameters have been proposed for its diagnosis, however, with variable sensitivity and specificity. The bacterial products in sepsis including endotoxin induce the production of proinflammatory cytokines that evoke the expression of tissue factor [TF] on monocytes and endothelial cells. To estimate the percentage of monocytes expressing tissue factor [TF%] by flowcytometry in patients with neonatal sepsis and to delineate its significance to diagnose neonatal sepsis. Twenty-seven neonates with neonatal sepsis and positive blood culture were recruited and evaluated clinically for their risk factors. Laboratory investigations including complete blood picture, C-reactive protein [CRP] and estimation of the monocytes TF expression by flowcytometry were done. Twenty-four normal newborns were included as a control for the laboratory data. The monocytes expressing TF% of the studied patients was significantly higher than that of the controls, p-value = 0.0001. The level of TF% was significantly influenced positively by premature rupture of membrane [PROM], Multiplicity, WBC count, staff/segment ratio, CRP and negatively by gestalional age, body weight, and platelet count. The sensitivity and overall accuracy of the TF% were higher than those of the staff/segment ratio and the WBC count for diagnosing neonatal sepsis. The areas under the receiver operating characteristic curve [AUC] of TF%, staff/segment ratio and WBC count were 0.84, 0.79 and 0.60 respectively, 95% confidence interval]. The monocytes expressing TF% is a promising diagnostic and prognostic marker of infection in neonatal sepsis with high sensitivity and overall accuracy. Adding the estimation of monocytes expressing TF% to the sepsis screen may improve the diagnosis of neonatal sepsis

Ultrastructure of the camel's pulmonary alveoli with special reference to the air-blood barrier [with 7 figures]

The present study was conducted to characterize the cellular population lining the alveoli of the camel's lung. It focused on the ultrastructural findings and their reflection on the physiological role in gas exchange and transcytosis through the air-blood barrier [ABB]. It was carried on adult camel using electron microscope. Ultrastructural examination revealed that the pulmonary alveoli were lined with a continuous epithelium comprising two major cell types; the predominant, attenuated pneumocyte type I and the less popular, irregularly cuboidal pneumocyte type II. Two 'forms of fibroblasts were distinguished; the most remarkable feature of the first form was its well-developed and abundant rough endoplasmic reticulum. The second form was characterized by large, irregular, dark stained nucleus and little amount of cytoplasm. The most obvious feature of endothelial cells was the concentration of small vesicles [pinocytotic vesicles] adjacent to the endothelial cell membranes. They were circumscribed by a continuous basal lamina. Along the same endothelial cell, two cytoplasmic zones were existing; a thin cytoplasmic area containing few or no plasmalemmal vesicles [avesicular area] and another thicker cytoplasmic area with numerous plasmalemmal vesicles and endocytotic pits [vesicular area]

study of Helicobacter pylon in dyspeptic patients with and without decompanseated liver disease

Helicobacter pylori infection was investigated by two different methods, microscopically and biochemically in 200 dyespeptic patients [149 male and 51 female] aged from 40-70 years. All patients divided into two groups, the first one as control group [100] and without liver cell failure, the second studied group [100] as diseased group with liver cell failure. Helicobacter pylori infection was diagnosed in 54% in the first group and 78% in the second group. The Helicobacter pylori prevalence in the second group of liver cell failure was significantly higher than in the first control group and was not correlate to the sex difference, etiology of the liver cell failure, child classification or any endoscopic finding of gastroduodenal mucosal lesion. In both groups Helicobacter pylori infection was significantly higher in patients over 40

Randomized controlled trial to enhance psychosocial adjustment of asthmatic childern

The aim of the present study was to evaluate the effect of a psychosocial patient education program on the psychological adjustment of asthmatic children between 11 and 18 years old. One hundred children attending the outpatient health insurance clinic were randomly selected and randomized to experimental and control groups. Children's asthma knowledge, self-esteem, asthma severity and psychological adjustment were assessed for both groups before and after the intervention. An intervention program was developed and introduced to the experimental group. The program consisted of sixteen sessions of Information giving and cognitive-behavioral strategies for the children. The results revealed significant differences in the mean percentage change of the intervention and control groups regarding self-esteem, knowledge and asthma severity [Z=2.83, Z=4.75 and Z=2.24 respectively, P< 0.05]. Statistical significant differences were found between the mean percentage change of the intervention and control groups regarding, dependency, hostility, productivity and withdrawal domains as well as the total PARS Ill score. In conclusion, the study demonstrated positive effect of the intervention in promoting the adjustment of asthmatic children. It is suggested that similar interventions can be directed to children with any chronic illness and can be implemented in a variety of pediatric settings

Homocysteine assay in patients with acute myocardial infarction and those at risk for coronary heart disease

It was suggested that homocysteine oxidation products as hydrogen peroxide, superoxide anion radical and other reactive oxygen species are injurious to vascular endothelium and so increased total homocysteine was considered as independent risk factor for cardiovascular diseases. To study homocysteine level in patients with AMI and those with DM and HTN - as established risk factors for coronary heart disease - in comparison to healthy controls this study was planned. This study included 11 patients with recent AMI, 14 with systemic HTN, 15 diabetics [type2] and 10 healthy controls .All of comparable age and sex. Homocysteine level was measured by ELISA in the blood of all groups. Simultaneous assay for serum B12 and folic acid was also done by radioimmunoassay technique. The study revealed a highly significant increase in the homocysteine level between each of the diseased groups [AMI 14.3 +/- 2. 7umol/L; HTN 14.7 +/- 3.3 umol/L and 16.5 +/- 1.7 umol/L for the diabetic group] versus 9.8 +/- 1.9 umol/ L for the control group [p < 0.05 between each of the diseased groups and the control]. No Significant decrease in the serum level of folic acid nor that of B12 in any of the diseased groups versus the control group was also noticed [p> 0.5]. Homocysteine is a clear risk factor for coronary heart disease. As no difference in homocysteine level between those with AMI and those at risk so homocysteine is only a risk factor not acute phase reactant in acute injury. High homocysteine level in the blood is highly suggested new member in the metabolic syndrome. Still folic acid as well as B12 supplements could be recommended in hyperhomocysteinemia whatever their serum level

Comparative long term results of first line surgical therapies for bulbar and posterior urethral strictures

We present our long term comparative results in the management of buldar and posterior urethral strictures using various first line surgical techniques. From January 1983 to January 2000 and with a mean follow-up of 58 months and a median of 34 months, 120 males with bulbar and posterior urethral strictures were managed in our tertiary care hospital. Only first line; therapies, selected by the respective treating urologist, were included in order to assess their efficacy and cost benefit value. Results of endoscopic management of bulbar strictures were correlated to ecology, the length of the stricture and previous urethrotomies. Optical urethrotomy was successful in 40% of the patients. However, when the stricture was short less than 2cm with no history of previous urethrotomy, the relapse rate was only 33%. Holmium laser urethrotomy was successful 60% of selected cases. Perineal and transpubic urethroplasties were highly successful in the management of bulbo-membranous and membranous strictures, with a success rate of 85% and 88% respectively, There was no difference in surgical results according to the etiology of the stricture. Optical and internal urethrotomy and Holmium - YAG laser urethrotomy are highly successful as first line therapies for short [less than 2cm] bulbar urethral stictures with no previous urethrotomies. They may also be indicated in older people with one failed internal urethrotomy. Perineal and transpubic urethroplasties are the gold standards for the management of bulbar, bulbo-membranous and membranous strictures. Treatment should be tailored to each individual case for optimal results

Gastric pedicle tube in reconstruction of gastrointestinal continuity after total laryngopharyngectomy

Gastric pedicle tube placed retrostrenally was performed to reconstruct gastro- intestinal continuity after laryngopharyngectomy in 11 patients [7 males and 4 females] aged from 50 to 67 years, with a mean age of 56 +/- 0.4 referred to hospital in the period from January 1999 to December 2000. These patients had extensive pyriform fossa tumors in five patients, posterior pharyngeal wall tumor in three patients and localized postcricoid tumor in three patients. A reconstruction of the gastro-intestinal tract was done in the same sitting after excision of the tumor by ENT surgeons. The postoperative complications were pneumothorax in two patients, cervical fistula in three patients, which closed spontaneously after 2-3 weeks and two patients suffered from stenosis of cervical anastomosis, but responding to intermittent dilatation. Two patients died from severe chest infection during the postoperative period. Temporary gastrotomy was done for all patients to be used for feeding during the postoperative period removed after complete healing of the anastomosis. Apart from two patients who died during the postoperative period, the remaining patients were discharged from the hospital in a fair general condition. They were subjected to regular follow up

Feeding gastrostomy: surgical or endoscopic ? a prospective study

This study compared operative gastrostomy [OG] [performed by surgeons] with percutaneous endoscopic gastrostomy [PEG] [performed by physician endoscopists] in a prospective randomized fashion to determine whether one technique was superior. PEG [Sachs-Vine] and OG [Stamm] were done using local anesthesia. Patients were assessed for complications, mortality, tube Junction, and cost Groups were equally matched for indications and underlying disease. Fifty-seven had OG and 64 had attempted PEG. Complications occurred in 26% of OG patients and 9% died. Complications occurred in 25% of PEG patients and 12% died. Tube feeding was initiated in both groups within a mean of 29 [24 to 72] hours of the gastrostomy placement OG costed 1675 and PEG 979 local currency units to perform. We conclude that, there is no difference between OG [using local, anesthesia] and PEG with regard to morbidity, mortality, or tube Junction. The endoscopic technique does appear to have economic advantage

Ultrastructural mucosal changes in patients with ulcerative colitis

The present study included 15 patients with ulcerative colitis in various degrees of severity [mild, moderate and severe] and 5 healthy individuals as a control group to assess the ultrascructural changes of the mucosa in ulcerative colitis patients. Full length colonoscopic examination was done to all patients. Mucosal biopsies were taken from the inflamed mucosa and processed for histological and electron microscopic examination. These biopsies were compared with similarly processed ones from controls. The study showed the presence of ultrastructural mucosal changes in ulcerative colitis patents in the form of mitochondrial swelling, lack of microvilli, multiple secondary lysosomes, swollen goblet cells, peripheral condensation of nuclear chromatin, loss of tight junction and infiltration of the inflamed mucosa and epithelium with eosinophils. These changes were more frequent as the disease increases in severity. Dysplasia - like changes such as indentation of the nucleus, peripheral condensation of chromatin and flattening of cells were demonstrated in only two patients with severe and long-term U.C. The control biopsies appeared to be ultrastructurally normal. In conclusion, ulcerative colitis is associated with many ultrastructural mucosal Changes which are more frequent as the disease increases [progresses] in severity. These changes may be involved in the pathogenesis of ulcerative colitis and its related neoplasia

Evaluation of ethnic root factors and distorted dietary habits in the differential occurrence of coronary heart disease nowadays

A dietary environmental and socioeconomic study in five different populations was investigated for the differential incidence of coronary heart disease [CHD], with special emphasis on the ethnic roots and distorted dietary habits [Matha et al., 1991 and Mukhtar, 1995], as followed [3 Indians, 6 Arabians, 8 Turkish, 6 Zulu and one Scandinavian]. An assessment of postprandial dyslipidemia following a standardized fatty test meal [Yamazaki et aI., 1987 and Mensink, 1990] was done including plasma levels of cholesterol, triglycerides, HDL and LDL. The latters were specially expressed as LDL/HDL ratio which was significantly higher among Indian, Arabian and Turkish as compared with Zulu and Belgium ethnic roots