[Pilot study of antiretroviral therapy in Djibouti]

A cross-sectional survey was conducted among 112 HIV positive patients who had received antiretroviral therapy for > 3 months to assess the efficacy of treatment [viral load < 400 copies/mL]. The median age at enrolment was 36 years, 90% of patients were at the AIDS stage and median CD4 rate was 118/mm[3]. Patients received a combined treatment of 2 NRTI +1 NNRTI [51%], 3 NRTI [45%] and 2 NRTI+1 PI [4%]. Virological efficacy was seen in 74% of the patients, irrespective of the prescribed protocol and the initial clinical and immunological profile. Mean improvements measured were 20% on the Karnofsky index [KI], 2.1 kg/m[2] in body mass index and 82 cells/mm[3] in CD4. The prevalence of side effects was 84%. The predictors for treatment success were quality of care and KI > 70%

[Evaluation of compliance with antiretroviral treatment of HIV patients in Djibouti, 2005]

We determined the rate of compliance with antiretroviral therapy and investigated the factors that influence it among 86 HIV patients. Compliance ratio [number of tablets taken/number prescribed] was assessed by tablet count. The mean ratio of compliance was 92%. By tablet count, 77% of the patients were compliant [compliance ratio >/= 90%]. Non-compliance was significantly associated with side-effects, degree of confidentiality of the care centre and traveling. Compliance correlated significantly with viral load. In multivariate analysis, community support and level of education protected against non-compliance. Patients having already missed a dose and those dissatisfied with confidentiality had a 4 times greater risk of non-compliance

study on demodex folliculorum mite density and immune response in patients with facial dermatoses

In the present study, 40 patients with facial skin lesions and Demodex folliculorum [DF] mite density > 5/cm2 by SSSB were evaluated for their immune response through counting T-cell subsets [CD3-CD4-CD8] and NK cells [CD16] numbers and IgG, M, D concentrations in peripheral blood in relation to DF mite density. They were 26 females and 14 males with overall mean age was 48.57 +/- 15.33 years. A control group of 40 healthy individuals without any skin diseases was enrolled. The mean DF mite density [MD] was 11.82 +/- 3.72/cm2 in patients compareed to 1.77 +/- 2.39 /cm2 and a prevalence of 47.5% in controls. The difference was statistically significant. MD significantly correlated with age both in study and controls, but not with sex. A significant decrease in the absolute numbers of lymphocytes, T-cell subsets and NK cells was found in the study group in comparison with controls. Mean IgM level was significantly higher in patients. No significant correlation was observed between MD and the immune response. So, DF mites modulate the host cellular immune response to their advantage, as T-cell subsets and NK cells seem to be the target of immuno-suppression, favouring dermatosis development

Two different doses of dexamethasone for prevention of postoperative nausea and vomiting in children

Dexamethasone in a dose of 1mg/kg has been proved to be effective in prevention of PONV. Smaller dose [0.5mg/kg] of dexamethasone was applied in the present study. One twenty children, 5-15 years old, scheduled for strabismus surgery, were randomly allocated to 3 groups. Patients in groups A and B received dexamethasone 1mg/kg and 0.5 mg/kg respectively, immediately after induction while group C received saline. Induction with sevoflurane, fentanyl and cistracurium followed by LMA insertion and mechanical ventilation. Incidence and severity of PONV, ondansetrone requirements, duration of stay in PACU and parental satisfaction were recorded for every patient. Statistical analysis was done using Kruskal-Wallis followed by Mann-Whitney U test for non-parametric data and ANOVA for parametric data. There was no significant difference between groups as regard the risk factors for PONV. Incidence of PONV during early [0-6h] postoperative periods was significantly lower in both dexamethasone groups A and B compared with control group C [12.5% and 15% Vs 30% with P value c 0.01]. Incidence of PONV during late postoperative period [6-24 h] was also significantly less in groups A and B compared so group C [7.5% and 12.5% Vs 223% with P value of 0.01 and 0.03 respectively]. Severe PONV [score=3] was found in 23% of patients in groups A and B compared to 7.5% in group C during early post operative period [P value = 0.04] Nausea alone [score=l] was also less in group A and B compared with C [5% and 73% Vs 12.5% with P value of 0.01 and 0.04 respectively] in early postoperative period. Rescue antiemetic drug [ondansetrone] was given to 323% of patients in control group [group C] compared with 123% and 173% in groups A and B with P value of 0.01 and 0.02 respectively. Duration of stay in PACU was significantly shorter in group A and B [128.3[35.7 and 130.6[41.9 min] compared with control group [147.5[33.2min] with P value of 0.02 and 0.03 respectively. Parental satisfaction was also less in control group. We concluded that dexamethasone could decrease PONV and ondansetrone requirements. Smaller dose of dexamethasone [0.5 mg/Kg was as effective as that dose already used by others [1 mg/Kg] especially during early postoperative period

Rocuronium versus succinylcholine for rapid sequence induction of anesthesia in elective cesarean section

This study was conducted on forty parturient women undergoing elective cesarean section under general anesthesia to evaluate the onset and tracheal intubation condition together with the fetal and maternal impacts of rocuronium and succinylcholine for rapid sequence induction. The parturient women were randomly allocated into two groups [20 women each] according to the neuromuscular blocker used, group A [0.6mg/kg rocuronium] and group B [Img/kg succinylcholine]. After pre-oxygenation, rapid sequence induction was performed with thiopental sodium 4-6mg/kg followed by either rocuronium or succinylcholine according to the group. Neuromuscular transmittion was assessed using electromyographic response to train of four stimulation of the ulnar nerve at the wrist every 10 seconds. The time to the beginning of depression of Tl amplitude [lag time] and the time to maximum depression of Tl [onset time] were compared in the two groups. They were [25.2 +/- 2.7], [71.7 +/- 2.7] seconds for group [A] and [22.4+2.2], [50.6 +/- 8.2] seconds for group [B] respectively. There were statistically significant difference between the two groups as regard lag time and onset time [P<0.05, P<0.01 respectively]: As regard, the. intubation conditions, there was no statistically significant difference between the two groups. There is statistically significant difference as regard maternal heart rate or mean blood pressure between the two groups [P<0.01, P<0.05 respectively]. As regard Apgar score, there was no statistically significant difference between the groups. It can be concluded that rocuronium provide good intubating conditions comparable to those of succinylcholine and is suitable for rapid sequence intubation when succinylcholine is contraindicated. It is also safe for both the mother and the foetus. List of abbreviations: NMB: Neuromuscular blocker EMG: Electromyography MMG: Mechanomyography

Extracorporeal shock wave lithotripsy for lower pole nephrolithiasis: Efficacy and variables that influence treatment outcome

We evaluated the efficacy of Extracorporeal Shock Wave Lithotripsy [ESWL] for treatment of lower pole caliceal stones. The study attempts to identify the relationship between the radiographic anatomy of the lower pole and the outcome of ESWL treatment for a solitary lower pole caliceal stones to help in selecting patients that are likely to benefit from that treatment. A total of 100 patients with solitary lower pole calculi [less than 2 cm.] underwent ESWL monotherapy using the Dornier Lithotriptor S machine. Pretreatment intravenous urography [IVU] was done to determine the stone size and lower pole measurements which include; the lower pole infundibular length. The lower pole infundibular width and the lower pole infundibulopelvic angle. Clinical and radiographic follow-up was done every month for 6 months after ESWL treatment. Sixty-four patients [64%] were stone-free 6 months after starting ESWL treatment, eighteen patients [18%] showed improvement as decreased stone size and another eighteen patients [18%] failed ESWL treatment. Significant variables that influenced treatment outcome include, stone size and type: the number of ESWL sessions and the radiographic anatomy of the lower pole. A short and broad lower pole infundibulum were very important favorable factors that improved the stone clearance after ESWL. Also a wide infundibulopelvic angle significantly improves the stone free rate after ESWL.ESWL is the initial treatment of choice for lower pole calculi smaller than 2cm. The spatial anatomy of the lower pole as defined by the lower pole infundibulopelvic angle, infundibular length and infundibular width, has a significant role in stone free rates after ESWL

Direct versus nonrefluxing ureteroileal anastomosis in ileal neobladder

Does the theoretical benefit of reflux prevention in low-pressure bladder substitutions outweigh the potentially high rate of anastomotic stricture? Over 6 years, 120 renal units in 60 patients were reimplanted in orthotopic ileal neobladder following radical cystectomy. They were classified into 3 groups: 60 renal units were reimplanted by direct end to side technique, 30 units by extramural serous lined technique and 30units by Le Duc technique. Pre and postoperative bacteriologic study, blood chemistry, IVU, renal isotope scanning and postoperative micturating pouchogram were done in all cases after 3, 6months and then annually for 6-60months [mean, 36months].The following data were recorded in the 3 groups respectively: Rate of anastomotic stricture; 1.66%, 13.33% and 26.66%. Reflux; 15%, 3.33% and 6.66%.Upper tract dilation; 11.66%, 13.33% and 30%.Significant decrease in GFR; 11.66%, 13.33% and 30%.Azotemia; 3.33%, 6.66% and 13.33%. Asymptomatic bacteriurea; 26.66%, 20% and 20%.Pyelonephritis; 6.66%, 6.66% and 10%.Upper tract stone formation; 1.66%, zero and 3.33%. Nonrefluxing methods of ureteroileal anastomosis resulted in statistically significant higher rate of anastomotic stricture and upper tract dilation than direct end to side anastomosis. This is a high cost for any theoretical benefits of preventing pyelonephritis, azotemia or stone formation. In low-pressure bladder substitutions, direct ureteroileal anastomosis may be the technique of choice as it preserves kidney function and morphology, simple and time saving technique

Demand and supply of doctors and dentists in Bahrain, 1998-2005

We examined the supply and demand of medical doctors and dentists in Bahrain. Demand for physicians and dentists was based on the objective of having a physician-to-population ratio of 1:650, and a dentist-to-population ratio of 1:5000. Analysis of the current workforce and projected graduates in the period 1998-2005 indicated that the supply of Bahraini medical doctors and dentists until the year 2005 will not be sufficient to meet the projected demand in these categories. By the year 2005, Bahraini doctors and dentists will provide 82.5% and 75.9% of medical and dental demands respectively. The remaining 17.2% of physicians and 24.1% of dentists will have to be recruited from abroad. Thus, the prospect of oversupply of Bahrainis among these categories until the year 2005 is highly unlikely

effect of premedication with H2 receptor antaconists on thermoregulation of body temperature during general anesthesia

This study was conducted on 60 patients undergoing open abdominal surgery under general anesthesia to evaluate the effect of premedication with H2 antagonists on thermoregulation. The patients were randomly allocated into three groups, each group consisted of 20 patients according to the premedication given. The first group was given a placebo [control group], the second group was given famotidine 40 mg tablet and the third group was given ranitidine 150 mg tablet at 1 hour before anesthesia. Induction of anesthesia was done by 1-2 ug/kg fentanyl, 5-7 mg/kg thiopental and endotracheal intubation was facilitated by vecuronium bromide 0.1 mg/kg. Anesthesia was maintained by nitrous oxide 66% in oxygen and isoflurane 0.6% to 0.8%. Nasopharyngeal temperature [core temp], forearm temperature and index finger temperature, hemodynamic parameters [heart rate and mean arterial blood pressure] were measured before induction [baseline], then every 15 minutes till the end of surgery. The results demonstrated that famotidine has central thermoregulatory inhibitory effect that augments core hypothermia and decrease vasoconstriction threshold

Gamma irradiation of Egyptian cobra [Naja haje] venom

The aim of the present study was to prepare an effective and safe toxoid for the Egyptian Cobra [Naja haje] Venom by gamma irradiation. The effects of gamma irradiation [0.1-10 M rad] on the toxicity, as well as the antigen antibody complex formation reactivity was described. It appears from the results that the lethality of Naja haje venom irradiated in the dry form was not affected up to a dose of 10 M rad [100 KGy]. On the other hand the venom irradiated in the aqueous solution form showed a decrease in its lethality, and this was proportionately related to the dose of irradiation, while the ability of the venom antigens to react with its corresponding antibodies was retained up to irradiation dose of 5 M rad. The results of double immunodiffusion of non irradiated and the different dose levels of gamma irradiated venom [0.1-5 M rad] against a commercial Egyptian poly valent antivenin, all showed similar patterns the four visible lines obtained in the immunodiffusion reactions were identical and joined smoothly at the corners, indicating that there was no change in antigenic reactivity with antibodies determinants

Corrosion resistance of soda lime silica glass bottles manufactured in Egypt

The different types of bottles manufactured at El-Nasr Glass and Crystal Co., Mostorod Factory, were tested to determine their class according to the USP. The corrosion resistance of such bottles towards the attack of water, HCl, NaOH and methyl and ethyl alcohols at different temperatures and times was also studied. The results obtained showed that amber glass bottles belong to class III, whereas, green and colorless bottles belong to the NP class according to the USP. The difference in their corrosion resistance was related to the lower alkali content of amber bottles compared to colorless and green bottles. The results of the effects of the different aqueous solutions, as well as temperature and time of attack, were similar to that published on glasses of similar chemical composition

Helicobacter pylori: comparison between histologic and serologic diagnosis among patients with gastric dyspepsia

This study aimed to compare between the histologic and the serologic diagnosis of H. pylori as an etiologic agent in patients with gastric dyspepsia. 60 symptomatic patients with dyspepsia underwent gastroscopy and multiple antral biopsies were taken and stained with modified Gram stain and examined histologically for H. pylori identification. The commonest gastroscopic findings were gastritis in 28 patients [46.6%] and duodenal ulcer in 14 patients [23.3%]. H. pylori was identified by histopathology in 36 patients [60%]. IgG to H. pylori using ELISA test was examined for all patients as well as for age and sex matched 60 control subjects. Seropositivity was found in 39 patients [65%] of cases and in 20 subjects [33.3%] of control with significant statistical difference between two groups [X2= 12.4, p <0.001]. Serologic diagnosis can be relied upon in the diagnosis of gastric infection by H. pylori, with sensitivity [97.2%] and specificity [83.3%] compared to histologic diagnosis

Eye injuries in Bahrain, retrospective study of cases admitted to hospital, 1988-1992

Eye injuries constitute an important cause of morbidity in Bahrain. A retrospective study was conducted to examine eye injuries that required hospital admission during 1988-1992. The objective of the study was to describe the profile of severe eye injuries requiring admission to the hospital. The total number of patients evaluated was 489, 90.4% of whom were males and 9.6% females. Children under 20 year of age constituted 41.3% of total cases, males accounting for 85.1% and females 14.9%. Thirty-eight% of all injuries were related to occupational exposure, particularly among industrial and construction workers; 14.6% of all cases resulted in blindness of severe visual impairment, while 28.6% of cases with ruptured globes had a similar outcome. Adequate preventive measures to minimize the risk of ocular injuries among the population at risk are warranted; these should address safety in the home, playground and work environment

Clinical picture of pearl tumour like lesion of the anterior chamber

Sixty eight patients with pearl tumor like lesion were examined in the Outpatient Clinic of Assiut University Hospital through a period of five years. The lesion appeared as a white nodule [mass] varying in size, shape and site. Past history of trauma was positive in small number of cases. The clinical picture was similar to iridocyclitis. In spite of doing all the available investigations the principle cause of the lesion is still unknown

Histopathology and cytology of anterior chamber pearl tumour like lesion

Cytological examination of an aspirate from 23 eyes affected with pearl tumor like lesion was performed and histopathological examination of 11 tissue samples excised from eyes with healed lesion with its attacked iris were studied. The cytological picture revealed the presence of lymphocytes, polymorphonuclear leucocytes, pus cells, RBCs and plasma cells. The excised tissue samples showed the picture of chronic non granulomatous iritis

Management of health tumour like lesion of the anterior chamber

Medical treatment by steroids, systemic and topical, was used in 68 patients suffering from pearl tumor like lesion. Disappearance of the lesion occurred only in 3 eyes. Aspiration of the lesion was employed in 23 eyes, in 14 of them the lesion disappeared, in 5 eyes it was followed by a membrane like sheet on the anterior iris surface. In 3 eyes, it was very difficult to aspirate the mass. Excision of the residual membrane was performed in 8 eyes with a good results and minimal complications. Destruction by YAG laser was done in four eyes, one of them had recurrence and mild iritis was noticed in most of cases

Recovery of the third and sixth cranial nerves plasy

Twenty three patients with extraocular muscle palsy of unknown etiology were followed up for at least three years, eleven patients had third nerve paralysis and twelve had sixth nerve paralysis. In cases with third nerve palsy complete function recovery occurred in six patients and partial improvement in three patients, while in cases with sixth nerve palsy five patients had complete recovery and two had partial improvement

Carvotacetone derivatives and thiophene-acetylenes from sphaeranthus napierae

Three carvotacetones and two thiophene-acetylenes were isolated from the aerial parts of Sphaeranthus napierae Ross-Craig. Their structures were elucidated by spectroscopic analysis

Evaluation of results of combined reconstruction of anterior cruciate ligament using iliotibial tract and semitendinosus tendon

38 patients underwent combined intra and extra-articular reconstruction of ACL using the iliotibial tract and semitendinosus tendon according to Zarins-Rowe technique [l4]. The age ranged from 19 to 41 years [average 22.5 yrs]. Results of surgery were evaluated 2-5 years post-surgery. Satisfactory result was obtained in 34 patients [89.5%]. Four patients were unsatisfied because of persistance of preoperative disability [two patients 5.3%], more than 10 flexing deformity [two patient 5.3%]. This combined reconstruction in addition to reefing the postero-medial and postero-lateral capsules, offered enhanced stability without compromising the extensor mechanism or sacrificing structurally important tissues