Pattern of Rheumatic Fever in Egyptian Children Younger Than 5 Years.

Aims: Acute rheumatic fever (ARF) is common between 5-15 years, uncommon with different presentation 25 in children below 5 years. The aim of this study is to assess the frequency and characterize the pattern of 26 presentation of rheumatic fever (RF) in Egyptian children younger than 5 years. Study Design: Retrospective study. Place and Duration of the Study: Pediatric department, cardiology division, Cairo University Children’s Hospital, 5 years follow up. Methodology: We retrospectively reviewed the pre-completed data of 766 patients following up in the rheumatic fever clinic. Those with incomplete medical records were excluded. We compared between children younger than 5 years and those who are 5 years or older as regards their demographic data, clinical presentations, laboratory findings and echocardiographic findings. Results: We enrolled 667 patients; 17 of them (2.5%) were younger than 5 years (mean age 3.82± SD 0.393 years). The group of patients younger than 5 years old; included 10 females (58.8%) and 7 males (41.2%). Positive family history was encountered in 6 patients (37.7%). The most common presentations of the younger age group of patients were arthritis in 12 patients (70.5%), followed by carditis in 5 patients (29.4%), chorea in 3 patients (17.6%), and skin manifestations in 2 patients in the form of erythema marginatum (11.7%). Subclinical carditis was more common in younger children than the older group, with more severe valve affection. None of the patients in the younger age group had recurrence of the RF during a period of 5 years follow up while recurrences were encountered in 16 patients (2.5%) of the older age group. Conclusion: ARF can occur in children younger than 5 years. The possibility of rheumatic fever should be adequately investigated in those young children presenting with arthritis, chorea, or skin rash especially in developing countries like Egypt. Echocardiography is an essential tool to diagnose cases with5 subclinical carditis.

Premature and early menopause: risk factors is Jordanian women

To identify risk factors associated with the onset of premature [<40 years] and early [40-45 years] menopause in a sample of Jordanian women. This prospective study was undertaken at Princess Aisha Medical Complex, Amman between August 2007 and February 2008. A total of 1,000 postmenopausal women were included. Factors taken into consideration were age at menarche, age at first delivery, parity, number of miscarriages, history of gynaecological or obstetric surgeries [ovarian, tubal and /or uterine], smoking status and history of premature menopause in first-degree relatives. Out of the 1,000 women, 129 [12.9%] had had menopause before the age of 46 years: 27 [2.7%] before the age of 40 and 102 [10.2%] before the age of 46 years. In these groups, the only statistically significant factor was history of premature menopause in fist-degree relatives. Interestingly, in women who had had menopause after the age of >/= 46 years, the rate of hysterectomies was statistically higher. Early and premature menopause is strongly associated with history of premature menopause first-degree relatives. No other factors studied proved to have any statistical significance

Clinical-pathological feature of primary endometrial cancer patients treated with hysterectomy at King Hussein medical center

To describe the clinical and histopathological features of patients with primary endometrial cancer operated at King Hussein Medical Center the last six years. This retrospective study included cases operated in at King Hussein Medical Center in the period between October 2001 and December 2007. Histopathological data were available for 78 females: however, only 52 patients with primary endometrial cancer were included in this study. Patients with endometrial cancer who were diagnosed after hysteroscopy and endometrial biopsy, and those who had secondary endometrial cancer were excluded from this study. Clinical and histopathological details were collected and analyzed. The sample consisted of 52 females. Age ranged from 14 - 78 years [mean 59.00 +/- 13.35]. The most common presenting symptom was postmenopausal bleeding which occurred in 37 patients [71.2%]. Endometrioid Adenocarcinoma was the predominant histological sub-type, being reported in 34 patients [65.4%], while other types including mixed Mullerian tumors, endometrial stromal sarcoma, clear cell carcinoma, adenosquamous carcinoma, adenocanthoma and papillary serous adenocarcinoma were found among 18 patients [34.6%]. The tumor was confined to the body of the uterus [Stage one] in 30 specimens [57.7%] at the time of surgery. Endometrioid adenocarcinoma of the endometrium is the most common primary endometrial carcinoma operated upon at King Hussein Medical Center. Postmenopausal bleeding was the predominant presenting symptom. Most of the patients were diagnosed early

Residents' perceptions of work environment during their postgraduate medical training in Pakistan.

BACKGROUND: In Pakistan, there is a lack of information about the work environment of residency programs. This lack is a major impediment in their improvement. One of the approaches for improvement in these programs can be directed through the residents' own perception of their working conditions. Therefore, we collected data which would reflect working conditions of residents. AIM: To assess the perceived status of "work environment" in different specialities. MATERIALS AND METHODS: A cross-sectional survey was conducted in four teaching hospitals of Karachi from July 1999 to January 2000. Residents from selected programs were grouped into four broad groups: specialist, medical, surgical and multidisciplinary. Responses of residents were obtained on a Likert scale of 0 to 4. Indices were formed for two components of work environment: academic and mistreatment. STATISTICAL ANALYSIS: Differences between residents' groups were assessed through analysis of variance (ANOVA) at 5% significance. RESULTS: A total of 341 registered residents responded (response rate: 75%). Surgical residents were working more than 80 h/week and this was more than the other three groups. Medical residents were spending the highest actual time on research and teaching activities (10% and 14%, respectively). Academic index score was highest for surgical group (15.81, SD = 4.69) and lowest for multidisciplinary group (11.82, SD = 4.80). Medical group had the highest perceived mistreatment index score (5.56, SD = 4.57). CONCLUSIONS: In a study of work environment of residency programs, differential impact was found for the four groups on work environment perceptions. Most of the residents recognized undergraduate teaching, grand rounds, patient rounds and seminars or workshops as contributing to their academic learning. Reporting of sexual harassment was low, indicating either underreporting or cultural dynamics of our setting.

A matched case-control study of risk factors for neonatal tetanus in Karachi, Pakistan.

BACKGROUND: Previous studies have identified various risk factors for neonatal tetanus (NNT) in rural areas of Pakistan. The present matched case control study was conducted to further evaluate these risk factors in an urban setting. AIM: The study was carried out to identify risk factors for NNT in Karachi. MATERIALS AND METHODS: Patients of NNT (n = 125) diagnosed from January 1998 to February 2001 were recruited through a surveillance system of Expanded Programme on Immunization (EPI). Two neighbourhood controls (n = 250) were matched for each case for gender and date of birth of the case. STATISTICAL ANALYSIS: Conditional logistic regression was performed to assess the independent effect of factors associated with NNT. RESULTS: The final multivariable model identified subsequent application of substances on the umbilical cord (adjusted matched odds ratio [adj. mOR] = 5.1 [2.7-9.7]), home delivery (adj. mOR = 1.8; 95% CI: 1.1- 3.1) and illiterate mother (adj. mOR = 1.6; 95% CI: 1.0- 2.0) as risk factors for NNT after adjusting for other variables in the model. Population attributable risk per cent (PAR %) for subsequent cord application was 69% and PAR % for home delivery was 31%. CONCLUSION: Health planners, while formulating control strategies through immunization programmes should also take into account the impact of post-delivery practices, such as 'subsequent cord application' along with pre-delivery practices. Health awareness regarding appropriate post-delivery practices should be promoted and counselling of pregnant women for giving preference to health care setting for delivery is also crucial.

Factors influencing the selection of surgical specialty among Pakistani medical graduates.

CONTEXT: The delineation between selection of surgery and non-surgery residency programmes could provide a pragmatic view of the influences on medical graduates' careers. This would also help coordinators and educators of residency programmes in surgery to further understand the dynamics of specialty selection. AIMS: To identify the different factors that influence the graduates to select surgical specialties in Pakistan. SETTINGS AND DESIGNS: A cross-sectional survey was conducted in 4 teaching hospitals of Karachi between July 1999 and January 2001. SUBJECTS AND METHODS: A total of 455 residents in 1-5 years of residency programmes were contacted. Three hundred and forty-one residents consented to the interview. Residents who were registered both with the College of Physicians and Surgeons of Pakistan (CPSP) and the Post Graduate Medical Education (PGME) office of the selected hospitals were included in this study. STATISTICAL METHOD USED: Logistic regression analysis. RESULTS: Final multivariate analysis identified 4 factors that remained significantly associated with the selection of surgical specialty: deriving gratification from direct patient care (adjusted odds ratio [aOR] = 5.79; 95% confidence interval [CI]: 1.24, 26.99), procedure-based medical practice (aOR = 2.85; 95% CI: 1.23, 6.61), nature of clinical problems (aOR = 3.39; 95% CI: 1.47, 7.84), and lack of consideration of stress during professional work (aOR = 2.27, 95%CI: 1.25, 4.13). CONCLUSIONS: Direct patient care is perceived to be an integral part of surgery residency and immediate patient outcome is a positive influence in selecting surgical specialty. The inclination towards surgery appeared to be determined by the type of procedures and technical skills involved in its practice. The nature of clinical problems is an important determinant of the choice of specialty. Stress was not perceived to be an important influencing factor for those who decided to select surgical specialties.