Seroprevalence and risk factors for hepatitis B and C virus infection in Damietta Governorate, Egypt

Hepatitis B and C virus [HBV and HCV] infections remain major public health problems in Egypt and data are needed on risk factors for infection. This study determined the prevalence of anti-HCV and HBV surface antigen seropositivity in Damietta Governorate, Egypt, and evaluated potential risk factors for infection and the impact of HBV vaccination on seroprevalence. A household, cross-sectional study was conducted of 2977 individuals. About 20% were vaccinated against HBV. Only 1.1% were infected with HBV and 9.3% with HCV; both infections coexisted in 12 people [0.4%] [all unvaccinated]. The main risk factors for both HCV and HBV were exposure to dental procedures, surgery, stitches, schistosomiasis treatment and contact with infected person. HBV and HCV prevalences in Damietta were lower than the national rate, likely due to the routine compulsory HBV vaccination in those aged < 19 years. There is a need to educate the general population about HBV and HCV transmission routes and avoidance of risky behaviours

Prevalence and risk factors for spontaneous bacterial pleuritis in cirrhotic patients with hydrothorax

Spontaneous bacterial pleuritis is a high mortality complication in cirrhotic patients with hydrothorax. To investigate the prevalence and risk factors for spontaneous bacterial pleuritis in cirrhotic patients with hydrothorax. Adult inpatients with liver cirrhosis and hydrothorax were enrolled. The severity of liver disease was assessed by the Model for End-Stage Liver Disease [MELD] score. Pleural fluid was analyzed [pH, polymorphonuclear [PMN] leucocyte count, total protein level, lactate dehydro-genase [LDH] level, glucose level, bacterial culture and cytology]. Spontaneous bacterial pleuritis was diagnosed by positive pleural fluid culture or, if negative, a pleural fluid PMN count > 500 cells/microL without radiographic evidence of pneumonia. Out of 98 cirrhotic patients with hydrothorax enrolled in the study; 14 [14.3%] fullfilled the criteria for the diagnosis of spontaneous bacterial pleuritis. Of those 14 patients; 9 were culture positive and 5 were culture negative. The other 84 did not have evidence of spontaneous bacterial pleuritis and were considered to have uncomplicated hydrothorax. Patients with spontaneous bacterial pleuritis had more severe liver diseases [MELD score], and higher rate of associated spontaneous bacterial peritonitis [SBP] and bacteraemia than patients with uncomplicated hydrothorax. Patients with spontaneous bacterial pleuritis had a significantly higher PMN count and a lower protein level in the pleural fluid. The prevalence of spontaneous bacterial pleuritis in the studied group of patients with hepatic hydrothorax was 14.3%. Patients with advanced liver disease, low pleural fluid protein, or SBP are at risk for spontaneous bacterial pleuritis

Stress hyperglycemia and electrolytes disturbances in patients with acute cerebrovascular stroke

Stress hyperglycaemia is a common problem in stroke population. Hyponatremia hypernatremia was reported In 25% and hypohalemia/ hyperhalemia in 27% of patients with acute ischemic and haemorrhagic stroke. The aim of this work was to assess the serum glucose, potassium and sodium levels in patients with acute cerebrovascular stroke and its relationship to the type of stroke, severity and prognosis. Fifty patients with acute cerebrovascular stroke [CVS] were randomly allocated and after CT scan of the brain, they were classified into: Group 1:25 patients with haemorrhagic stroke, Group 11:25 patients with ischemic stroke. All the patients were subjected to standardized clinical assessment, Glasgow coma scale [GCS] and Barthel Index [BI] at time of admission and after one week. Fasting blood sugar, Glycosylated hemoglobin [HbA Ic], serum potassium and sodium were measured at base line. Stress hyperglycemia was detected in 13[76%] of haemorrhagic stroke patients versus 4[24%] of ischemic stroke patients with statistical significant difference, p< 0.05. Hyponatremia was detected in 19[38%] of all stroke cases [11[22%] in haemorrhagic and 8[16%] in ischemic group]. No recorded cases with hypernatremia. Hypokalemia was detected in 4[8%] of all stroke patients [2 in each group]. Hyperkalemia was present in 14[28%] of all stroke patients [8]16%] in haemorrhagic and 6[12%] in ischemic group. There was statistical significant difference within each group as regard GCS1, GCS2, BI1, BI2 between patients with and without stress hyperglycemia and electrolyte disturbance, p<0.05. There was statistical significant difference in mortality rate between patients with and without stress hyperglycemia and electrolyte disturbance, p<0.05. Baseline hyperglycemia and electrolytes disturbances [hyponatremia, hyperkalemia and hypokalemia] are important prognostic factors related to outcome in stroke patients. Haemorrhagic stroke has more poor outcome than ischemic stroke which was related to male gender, smoking, higher BP, more frequent hyperglycemia and electrolytes disturbances. Lastly Ell < 60, GCSl< 8, hyperglycemia > 126, hyperkalemia and hyponatremia are independent predictors of poor outcome in stroke patients

Utiity of tests used to diagnose asthma, gastroesophageal reflux and upper airway cough syndrome in patients with chronic cough and normal chest radiography

Despite the clinical significance of cough, research efforts aimed at improving diagnostic capabilities and developing more effective therapeutic agents have been, to date, disappointing in their limited scope and outcomes. Asthma, gastro-oesophageal reflux disease [GERD] and upper airway cough syndrome [UACS] are common causes for chronic cough with a normal chest X-ray [CXR]. To describe the frequency of these three causes in a cohort of outpatients with chronic cough and normal CXR and to identify the diagnostic tests best able to identify the aetiology in the vast majority of cases using the response to specific therapy as a gold standard. Nonsmoking outpatients of both genders who complained of cough for more than 8 weeks and had normal findings on CXR were studied prospectively. All patients were subjected to spirometery [including postbronchodilator reversibility], sinuses CT scan, rhinoscopy, and 24-h esophageal pH monitoring to get "an initial diagnosis". The assumed causes were confirmed by treating them sequentially. "The final diagnosis" depended on a successful response to therapy. Hundred patients were studied: the laboratory tests established initial diagnoses of asthma, UACS, GERD, or various combinations of these in 78 patients, of those; 35 patients [44.9%] had a single cause, 39 patients [50%] had two causes, and 4 patients [5.1%] had all three causes. After treatment of those 78 patients, the final diagnoses were established as follow: 47 patients [60.3%] has a single cause, 28 patients [35.9%] had two causes and 3 patients [3.8%] had all three causes. There was a good agreement between the laboratory tests and the definite causes [agreement in 65 patients [83%] and discrepancy in 13 patients [17%], k > 0.75]. Twelve patients had their diagnoses changed for two causes to a single cause and one patients had the diagnosis changed from three causes to two causes. Asthma, UACS, GERD, or some combination of these represent 78% of the causes of chronic cough in our sample. Therefore, these conditions should be considered first during diagnostic evaluation of patients with chronic cough and normal CXR. Inspite of some discrepancy between initial and final diagnoses, the study identifies the group of diagnostic methods best able to identify the cause in the vast majority of cases of chronic cough including sinuses CT scan, rhinoscopy, pulmonary function tests, and esophageal pH monitoring

Effect of upper limb, lower limb and combined training on exercise performance, quality of life and survival in COPD

Because there are differences between the upper limb [UL] and lower limb [LL] muscles in terms of the morphological and functional adaptations in COPD patients, specific protocols for strength training and endurance should be developed and tested for the corresponding muscle groups. To elucidate the potential effects of unsupported UL and/or LL exercise training in patients with COPD. The 6-min walking distance [6-MWD], unsupported upper limb endurance [UULE] time, St. George's Respiratory questionnaire [SGRQ], BODE index and pulmonary function tests are used as outcome measures. A prospective, randomized controlled study of patients with COPD. Patients were randomly assigned to one of 4 groups, group A received UL training, group B received LL training, group C received both UL and LL training and group D received no training [controls]. Patients in group A, B, and C underwent exercise training 3 times weekly for 8 weeks. The outcome measures were carried out at study entry and after 8 weeks. 78 patients completed the study: 20 patients in group A, 21 in group B, 19 in group C and 18 in group D. Upper limb training significantly increased UULE time without affecting 6-MWD while LL training significantly increased 6-MWD without changing UULE time. Combined UL and LL training significantly increased both UULE time and 6-MWD. Significant reductions in the scores of SGRQ and BODE index were observed in groups A, B and C but not group D [control]. No changes were found in pulmonary function in all groups at the end of the study. In patients with COPD, combined UL and LL training significantly enhanced the exercise tolerance and quality of life and reduced the risk of death [BODE index] without any change in the pulmonary function

Effect of Aspergillus fumigatus sensitization and colonization on lung function and airways inflammation in asthma

The sensitization and exposure to fungal allergens have been reported to be associated with asthma. The importance of Aspergillus fumigatus [AF] sensitization and colonization of the airways in patients with asthma is unclear. To clarify the effect of sensitization and airways colonization of AF on lung function and airways inflammation in asthma. We studied 66 patients with asthma. Patients were classified into two groups according to AF sensitization: [1] AF-sensitized [immediate cutaneous reactivity >3 mm]; and [2] AFnonsensitized. A positive sputum culture for AF confirmed airways colonization by AF. Routine spirometry was performed for all patients. Airways inflammation was assessed by sputum differential inflammatory cell count. Asthma duration was significantly longer in AF-sensitized asthmatics. Significantly higher rates of positive AF-culture were detected in sputum from AF-sensitized asthmatics [63%] in comparison to AF-nonsensitized asthmatics [31%]. FEV1 and FEV1/FVC were more reduced in AF-sensitized asthmatics in comparison to AF-nonsensitized asthmatics. Sputum neutrophils count was significantly higher in AF-sensitized asthmatics in comparison to AF-nonsensitized asthmatics. Sputum eosinophils did not differ between AF-sensitized and AF-nonsensitized asthma groups, concordant with peripheral blood eosinophils, which did not differ significantly between groups. Multilinear regression analysis predicting FEV1% showed that AF sensitization and sputum neutrophil count were the most important predictors of FEV1 [p= 0.016 for both], followed by positive sputum culture for AF and sputum eosinophil count [p= 0.024 and 0.046 respectively]. [p = 0.105]. AF detection in sputum is associated with AF-sensitization, neutrophilic airway inflammation, and reduced lung function. This supports the concept that development of fixed airflow obstruction in asthma is consequent upon the damaging effects of airway colonization with AF

Prognostic value of plasma brain natriuretic peptide in patients with stable chronic obstructive pulmonary disease

Early detection of pulmonary hypertension or cor pulmonale could be beneficial in managing patients with chronic obstructive pulmonary disease [COPD] because the prognosis of these conditions is poor. Plasma brain natriuretic peptide [BNP] levels are elevated in patients with PH secondary to chronic lung diseases. The aim of the present study was to investigate the use of plasma BNP levels as a prognostic marker in patients with stable COPD. Plasma BNP was measured in controls and patients with stable COPD stage II, III and IV [according to the Global Initiative for Chronic Obstructive Lung Disease classification]. Echocardiography, arterial blood gas analysis, and spirometry were also performed for COPD patients. The study included 57 male patients with stable COPD; 19 had stage II COPD, 21 had stage III COPD, and 17 had stage IV COPD. Twenty age-matched healthy male smokers were enrolled as a control group. The plasma BNP levels were significantly higher in COPD patients compared to controls. The plasma BNP levels in COPD patients increased with disease severity. Plasma BNP levels significantly correlated with FEV1%, PaCO2, PaO2 and pulmonary artery systolic pressure. Plasma BNP levels increased significantly with disease severity, progression of chronic respiratory failure, and secondary pulmonary hypertension in patients with stable COPD. These results suggest that plasma BNP can be a useful prognostic marker to monitor COPD progression and identify cases of secondary pulmonary hypertension in patients with stable COPD

Central obesity among adults in Egypt: prevalence and associated morbidity

Through a home-based survey, all people aged 18 years and over [n = 1800] in the catchment areas of 12 primary health care centres in 4 Egyptian governorates were subjected to standardized waist and hip measurements. Central obesity was determined based on the waist circumference [WC] and waist-to-hip ratio [WHR] indicators. The age-adjusted prevalence of central obesity among adults was 24.1% and 28.7% based on the WC and WHR indicators respectively. After adjustment for sex and other confounding factors, WC was significantly associated with the risk of diabetes and hypertension, while WHR was not significantly associated with either diabetes or hypertension. No significant association was seen between body mass index and diabetes or hypertension

Social marketing strategy for promotion of iodized salt in Egypt

Despite the fact that the iodized salt program has been implemented in Egypt since 1996, yet Egypt health Demographic survey [DHS/2001] revealed that household iodized consumption at the national level was only [56%]. One of the main reasons behind such a low figure is lack of consumer awareness. Accordingly the National Nutrition Institute NNI [in collaboration with MOHP /UNICEF Egypt] planned and implemented a marketing strategy to demonstrate its impact in creating consumer demand for use of iodized salt in two Egyptian governorates with the least household consumption levels [Gharbia and Fayoum]. A Qualitative study using focus group discussion technique was carried out followed by development of educational communication materials. Social marketing activities included; advocacy and orientation meetings- local committee formulation- training of community volunteers- two launching meetings for the campaign- promotional communication activities in [schools, health centers, agricultural extension units, religious sites and mass media channels]. Monitoring and evaluation of the social marketing campaign activities was made. A field survey of the iodized salt status at retail and household levels at the end of the campaign showed improvement by almost 1.6 times in Gharbia and 2.5 times in Fayoum. It was concluded that using a social marketing approach for promotion of the iodized salt program is an important and effective strategy, which should be expanded in other Egyptian governorates together with legislation and control of illegal salt availability at market level and increased provision of iodized salt availability for consumer purchase

High dose versus low dose streptokinase infusion in patients with submassive pulmonary embolism and echocardiographic right ventricular dysfunction

Pulmonary embolism [PE] remains a major cause of morbidity and mortality in the general population, the established treatment for PE is anticoagulation. It has previously been demonstrated that thrombolytic therapy can be lifesaving in patients with massive PE [haemodynamic instability and right heart failure]. However, the use of thrombolytic therapy in patients with submassive PE [haemodynamically stable] remains a controversial topic. Recent clinical studies, however, support evidence that thrombolysis may favorably affect the outcomes in a wider spectrum of high risk PE patients presenting with right ventricular dysfunction [RVD] as evidenced by decreased right ventricular end diastolic diameter [RVEDD], disappearance of paradoxical septal motion [PSM], and tricuspid regurge [TR] as well as decrease in the pulmonary artery pressure. The aim of this study was to evaluate the effect high dose streptokinase [SK] in 1 hour versus low dose SK in 24 hours in patients with submassive PE and RVD. The study included 50 patients [25 males and 25 females, mean age 45.5 y] with submassive PE [positive spiral CT chest] and RVD [proved by echocardiography]. Those without contraindications to SK were randomly assigned to receive either high dose [group 1] or low dose [group 2] of SK. Those with contraindication [s] to SK received anticoagulation [group 3]. Echocardiography was done before and 72 h after treatment. Right ventricular dysfunction [RVEDD, PSM, and TR] and mean pulmonary artery pressure [PAP] improved significantly 72 h after treatment in group 1 and 2, while a slight improvement in PAP was observed after treatment in group 3. No significant difference was noticed between group 1 and 2 regarding the effect of treatment on RVD or PAP. No significant difference was found between group 1 and 2 regarding the complications of SK. No significant difference was found between the 3 groups regarding the mortality. These data suggest that SK can rapidly reverse the pulmonary hypertension and RVD in contrast to anticoagulation. Both protocols of SK are equieffective in rapid reversal of RVD and pulmonary hypertension. Both protocols were safe as proved by absence of difference in mortality over anticoagulant group

Role of medical thoracoscopy in the diagnosis of pleural malignancies

A malignant pleural effusion is diagnosed by finding exfoliated malignant cells in pleural fluid or by demonstrating these cells in pleural tissues obtained by closed pleural biopsy, thoracoscopy, or thoracotomy. Precise diagnosis is mandatory as different tumors have different managements. Unlike thoracocentesis and closed pleural biopsy [CPB]; medical thoracoscopy [MT] permits biopsy with direct visualization of the pleural surfaces. The aim of this study was to evaluate of the role of MT in the diagnosis of pleural malignancies in 2 situations: the 1[st] situation; patients with exudative pleural effusion [EPE], in whom thoracocentesis and CPB have failed to establish a diagnosis [15 patients; group I], the 2[nd] situation; patients with EPE, in whom these procedures have established a diagnosis of pleural malignancies [15 patients; group II]. Among the 15 patients of group I; MT established a diagnosis in 14 patients [93%]. Malignancy was the main diagnosis detectable on thoracoscopy; 9 of 15 patients [60%] proved to have pleural malignancies; five patients [33%] proved to have non-malignant conditions after thoracoscopy, MT failed to establish the diagnosis in one patient [7%] [non-specific pleurisy]. Out of the 15 patients in group II, MT confirmed the diagnosis established by thoracocentesis and CPB in 12 cases [80%] and corrected the diagnosis in 3 cases [20%]; a malignant mesothelioma [MM] was corrected to adenocarcinoma, an adenocarcinoma was corrected to MM, and an adenocarcinoma was corrected to squamous cell carcinoma. Few minor complications were reported in five patients [16.7%] including empyema, residual pneumothorax, subcutaneous emphysema and tumor implantation at the site of MT. No bleeding or mortality was reported. In conclusion, MT under local anesthesia and conscious sedation is a safe procedure and could be applied to a variety of indications especially when a pleural malignancy is suspected. Moreover, MT asserts its usefulness in modifying the diagnosis of prior malignancy and to overcome the problem in the distinction between MM and adenocarcinoma thus saving the patients from unnecessary thoracotomy especially in inoperable cases

Morbidity and mortality of low-birth-weight infants in Egypt

Low birth weight is one of the major determinants of neonatal survival and postneonatal morbidity. This study assessed the morbidity and mortality of low-birth-weight [LBW] infants during the first 3 months. Data were collected for 6701 live births. All singleton liveborn LBW infants as well as a comparison group of normal-birth-weight [NBW] infants were followed up for 3 months. Data were collected on weight, morbidity and mortality using a structured questionnaire. Admission to neonatal intensive care unit and mortality were more frequent in LBW [31.6%, 2.0%] than NBW infants [2.0%, 0.2%]. They also had increased risk of neonatal jaundice at 1 month, an increased risk of growth retardation and a much higher risk of mortality

Anaemia among schoolchildren in Qena Governorate, Upper Egypt

A study was carried out during January/February 2001 in Deshna and Armant Districts of Qena Governorate, Upper Egypt, to establish the prevalence of anaemia among schoolchildren aged 6 to 11 years and define appropriate control interventions in the area. Haemoglobin levels were measured directly in schools using a portable spectrophotometer. The mean [SD] level of haemoglobin in 1844 schoolchildren in 37 schools was 12.79 [1.15] g/dL. Only 12% of children were below the WHO cut-off for anaemia for this age group [< 11.5 g/dL] and no cases of severe anaemia [< 7.0 g/dL] were detected. The low prevalence of mild to moderate anaemia indicates that mass iron supplementation is not justifiable, but routine monitoring of haemoglobin levels should be part of the public health activities in the schools

Reduction of chemically induced hepatitis in rats by adenosine

The protective effect of adenosine [1 mg/kg LP.] in hepatitis induced experimentally in rats with dgalactosamine [800 mg/kg LP.] was assessed. The degree of protection was determined biochemically by measuring AST, ALT and bilirubin in addition to hepatic nitric oxide, and by histo-pathological examination of liver. In d-galactosamine induced hepatitis in rats, there were significant elevation of ALT, AST, bilirubin and NO2 and NO3 in addition to foci of necrosis and infiltration of lymphocytes in hepatic lobules and portal tracts. In rats treated with adenosine [1 mg/kg LP.] there were significant reduction of ALT, AST, bilirubin and NO2 and NO3 in addition to more or less normal histological picture of liver. In conclusion, these findings revealed that adenosine had a protective anti-inflammatory effect on liver and this effect may be due to a reduction of hepatic nitric oxide

Clinical and experimental evaluation of some unwanted effects of sodium valproate

The aim of the present work was to evaluate some side effects induced by sodium valproate in epileptic patients. Moreover, to study the effect of the drug on brain chemical neurotransmitters, namely GABA and 5-HT: to confirm its anticonvulsant effect and to exptain some of its side effects. This study was carried out in 2 parts: clinical and experimental. The clinical part was done by clinical evaluation of side effects of sodium valproate on 40 epileptic patients receiving it for at least 3 months. Liver function tests and serum prolactin level were also done before and after treatment. The experimental part was carried out on 30 rats receiving the same drug, and another 30 rats as a control group. Measurements of GABA and 5-HT in different brain areas in both groups was done. Liver biopsy was taken also from both groups and examined under light microscope. The results of the study revealed that side effects appeared in 35% of patients. Weight gain [in 15%], increased appetite, gastrointestinal disturbances and tremors were the commonest side effects. But sedation, headache and skin rashes were less common. The effect of sodium valproate on hepatic enzymes showed significant [P /= 0.05] on serum prolactin level. Moreover, sodium valproate significantly elevates GABA in different areas of brain, and 5-HT in cerebral cortex and midbrain. There was significant reduction of 5-HT level [P

Serum immunoglobulin level in Egyptian male schizophrenics under chlorpromazine treatment

This work was carried out to study serum immunoglobulin [Ig] levels in chronic Egyptian schizophrenics and the possible effects of chlorpromazine [CPZ] medication on them. Results of the present work revealed that there was significant elevation [P <0.05] of serum IgM, IgG, and IgA in schizophrenics compared with control healthy group. Moreover, in schizophrenics under CPZ treatment there was significant rise [P <0.05] in serum IgG, IgM and IgA compared with control healthy group, but IgM level was significantly elevated [P <0.05] compared with schizophrenic group. In addition, there were nonsignificant differences [P> 0.05] in serum albumin or total protein. In conclusion, increased Ig levels may suggest that schizophrenia might be caused by viral infections or may be an autoimmune disease. Moreover, stimulation of immune system by CPZ may explain the resistance of schizophrenics to CPZ treatment. It can be recommended that patient who develop an increase in serum IgM while on CPZ be switched to other type of antipsychotic medications

Effect of guanfacine on kidney, heart and GABA level in DOCA and salt hypertensive rats

Experimental hypertension, was induced in rats by intramuscular injection of desoxycorticosterone [DOCA] in a dose of 50 mg/kg body weight/week for six weeks, in addition to salt in drinking water. Guanfacine was given to normotensive and hypertensive rats intraperitoneally in a daily dose of 0.09 and 0.18 mg/kg body weight for 30 days. Induction. of hypertension resulted in significant reduction in the neurotransmitter gamma aminobutyric acid [GABA] concentration in the brain, hypertrophy of the cardiac muscle and nephrosclerosis with impaired renal function. However, these histophathological and biochemical changes were paradoxically decreased after giving guarifacine in a daily dose of 0.09 mg/kg body weight for 30 days, as a result of marked decrease of blood pressure. The hypertensive rats treated with 0.18 mg/kg body weight of guanfacine for 30 days showed marked increase in the incidence and severity of cardiac and renal histopathological changes, due to the combined toxic effect of guanfacine and hypertension. The increased GABA concentration in the brain and the reduction in blood pressure after giving the drug were more significant with the low dose. In normotensive groups, rats treated with guanfacine in a daily dose of 0.18mg/kg body weight for 30 days showed moderate renal toxicity, while no biochemical or histopathological changes were observed with 0.09 mg/kg body weight of guanfacine. The two doses of guanfacine induced insignificant changes in both blood pressure and GABA concentration in the brain as compared to control non-treatment rats. Thuse law dose of guanfacine is considered more effective and safe and so it is superior to high dose in the ambulatory treatment of hypertension

Child survival project - healthy mother healthy child project: evaluation and plans

An analysis of child mortality causes showed that the great majority of deaths could have been prevented by the use of the appropriate methods for the control or the eradication of causal factors. On the other hand, maternal health is critical not only to women but to children's health. Therefore in Egypt, The Ministry of Health and Population exerted tremendous efforts in this field and through The Child Survival Project the goal of improving the health of infants, children and women in childbearing age was set by aiming to achieve large reductions in mortality and morbidity rates throughout the promotion of safe motherhood and children's health. The major contributions of the project was evident in the following through the CSP [to be sustained within the objectives of the new project Healthy Mother / Healthy Child]: - Reductions in infant, child and maternal morbidity and mortality rates. - Improved performance of primary health care system for all components. - Developing a plan for sustainability of CSP activities and decentralization of some aspects of the administrative and financial management. - Focus training on practical problem solving, management, team building and leadership skills of all components plus specific objectives for each. - Establishing a FETP that is concerned with training the MOH epidemiologists. - A mass media campaign program targeting community awareness and participation. - Finalizing the CSP curriculum and manual for medical schools for full cooperation

Field epidemiology training programme in the Ministry of Health and Population: activities and future plans

In 1993, officials in the Child Survival Project in the Preventive Sector of the Ministry of Health and Population [MOH] agreed to implement a Field Epidemiology Training Programme [FETP] in collaboration with the Health Office of the U.S. Agency for International Development and the U.S. Centres for Disease Control and Prevention [CDC]. Similar to programmes in Saudi Arabia, Indonesia, Mexico, Peru, Columbia, Spain, Thailand and other countries, the Egyptian FETP is based on the two year CDC EIS training programme for public health professionals. Each year, 6 to 8 physicians are enrolled in the FETP-Egypt, receive 3 months of lectures in public health, epidemiology, biostatistics and computer-related subjects by MOH officials, professors from Schools of Public Health and a full-time CDC advisor, then complete 21 months of supervised field work on important public health issues. To date, staff and trainees have worked on many topics, including: case-control studies of Rift Valley Fever, conducting active surveillance to evaluate the completeness of suspected poliomyelitis reporting [26 governorates], assessing public health impact of flash floods in Assiut and Sohag, established a national sentinel hospital surveillance for acute hepatitis, completed case-control studies of neonatal tetanus, evaluated TT vaccine efficacy, conducted cluster surveys of the health status of families with children under 5, and most recently have worked to determine the cause of an outbreak of lead toxicity in a village in Aswan Governorate. Recently, the FETP and the High Institute of Public Health [HIPH] opened discussions about establishing a Masters Degree in Applied Epidemiology as an integral part of the FETP training. In the past year, MOH officials from several other countries have expressed interest in a regional FETP and if this concept were approved, the FETP model could be an important step towards encouraging the routine application of epidemiologic principles to improve the public's health in the Middle East Region

study of the effect of sodium valproates on brain neurotransmitters GABA and 5HT and its teratogenic effect an experimental study

White albino rats were given sodium valproates 400mg / kgm / day for 21 days in males and till 20th day of gestation in females compared to other group of rats didn't receive any drug. The effect of the drug on rats showed significant elevation of GABA concentrations in all tested brain areas and 5HT in cerebral cortex and midbrain, while reduced 5HT in thalamus and hypothalamus. Maternal adminstration of Sodium Valproates induced non Significant change in the number of resorption and live fetuses, as well as number of implantation. Fetuses revealed spina bifida [30%], absence of angle of mandible and ossific centers in upper and lower limbs [15%] and short neck [15%]. Side effects of sodium Valproates such as sedation and weight gain could be attributed to increase of GABA concentration, whereas increased appetite may be due to decreased 5HT in hypothalamus. The anticonvulsant effect of Sodium Valproates could be due to such increase of GABA and to some extent incease of 5HT