Comparison between temporal versus nasal anterior transposition of the inferior oblique muscle for management of dissociated vertical deviation with inferior oblique over action: two years follow up

Background: anterior nasal transposition [ANT] is a relatively new procedure which can be used to eliminate inferior oblique over action. An advantage of this procedure over temporal anterior transposition is that it avoids ante-elevation syndrome

Objective: to compare anterior temporal transposition [ATIO] of the inferior oblique muscles versus anterior nasal transposition [ANT] in management dissociated vertical deviation [DVD] with inferior oblique muscle over action [IOOA]

Patients and Methods: The study included 50 eyes of 28 patients with DVD of at least 10 prism dioptres Ä in the eye involved. The patients were divided into two groups. Group A [25 eyes of 15 patients] managed by temporal anterior transposition [ATIO] of the inferior oblique muscles and Group B [25 eyes of 13 patients] managed by nasal anterior transposition [ANT] of the inferior oblique muscles. All patients were followed for at least 24 months postoperatively. The size of preoperative and postoperative angle of DVD, grade of IOOA preoperative and postoperative, need for repeated surgeries and complications were recorded and evaluated

Results: In group A the mean DVD angle was decreased in primary positions from 21.11+/-4.32 Delta to 9.5 +/- 4.7 Delta [P<0.001] and from 19.5 +/- 4.6 Delta to 5.51 +/- 2.65 Delta [P<0.001] in group B mean IOOA grade was decreased from +2.0 +/- 0.7 to +0.18 +/- 0.4 in group A [P<0.001] and from +2.5 +/- 0.7 to +0.1+/-0.5 [P<0.001] in group B. In group B, two patients developed hypotropia of 5 and 6 PD. Persistent IOOA [+1] was observed postoperatively in two eyes in each group. Limited elevations in abduction developed in 3 patients in group A, the incidence of recurrence rate after 24 months was 2 eyes 10% in group A and one eye 5% in group B

Conclusion: Anterior transpositions either temporal or nasal of the inferior oblique muscles are safe and effective in management of DVD with inferior oblique muscle over action. Anterior nasal transposition [ANT] is more effective in correction of DVD with less incidence of antielevation syndrome and recurrence of DVD, however may induce persistent hypotropia

Predictive value of maternal hormonal serum level of inhibin a in case of threatened abortion

Threatened abortion is the commonest complication in pregnancy, it is defined as vaginal bleeding with or without menstrual like cramps in the first 20 weeks of pregnancy. No history of passage of tissue or rupture of membrane is present and ultrasound demonstrates an intrauterine sac with fetal cardiac activity. The early and accurate prediction of unsuccessful pregnancy in this situation should lead to appropriate treatment without unnecessary delay, but still there is no efhctive marker to predict in advance the outcome of threatened abortion. Inhibin A concentration rises and falls during the menstrual cycle. The lowest level is during the early and late days of the cycle and peaks during midcyles coincident with LH surge and midlureal period [being twofold higher than the first]. its level is higher in pregnant women than in non pregnant, and increases throughout pregnancy until delivery. in the early weeks of gestation, the corpus luteum is the principal source of inhibin but about the eighth week, it is excreted from the fetoplacental unit, immediately after delivery it's level decreases sharply. Th aim of the present research was to study the possible role of inhibin A in predicting pregnancy outcome in women with threatened abortion. This study included fifty pregnant women at 8 and 10 weeks gestational age, they were divided into: Groujy I [studied group] including 30 pregnant women with threatened abortion. Group II [control group] including 20 healthy not complaining pregnant women matched with the studied group. All of them were subjected to the following: Complete history taking, general clinical examination; obstetric examination; routine laboratory investigations; ultrasound examination for detection of fetal viability and fetal parameters; maternal blood samples were collected for determination of the quantitative measurement of inhibin A and follow up of cases till reaching 20 weeks of gestational age. The studied groups were further subdivided according to the outcome of pregnancy into: Group A [threatened abortion and fluting pregnancies] n 15; group B [threatened abortion bui ongoing pregnancies] n 15. The results of the study were analysed statistically, and we found that; there was a significant decrease in the levels of inhibin A in cases of threatened abortion [group I] compared with the control group. Much more significant lower levels of inhibin A were Jbund in cases of threatened abortion and failing pregnancies [group A] compared with the cases of threatened abortion but ongoing pregnancies [group B]. The cutoff value of inhibin A was measured, using the receiving operator curve [Roc curve], it was 268.9 pg/mI with a sensitivity of 82.5% and a specificity of 90.1% at8 weeks, while it was 395.5 pg/mI with a sensitivity of 85.5% undo specificity of 90.5% at 10 weeks. From our study we concluded that, finding an abnormal low level of inhibin A in pregnant fimale with threatened abortion can predict poor pregnancy outcome. The expanding knowledge of the role of inhibins since the development of specific and sensitive assays has opened the field for their potential uses in clinical practice. Examining the role of inhib ins and other biochemical markers in early pregnancy ftzilure will lead to an improved understanding of the mechanism behind it and will aid in selection of patients in whom expectant management is appropriate

child labor legislations and it's implementation in urban governorates in Egypt 2001

1- Almost all working children had no employment card with child's photo, no list for their names, ages and date of starting work that should be existed in a visible place in the workshop. 2- Only 33% of the working children are working on average from one to six hours per day and 67% are working seven hours or more per day, which reaches sometimes around 12 hours per day. 3- It means that there are great variations between the legal working hours and the actual one revealed by this study. It seems that the law is violated, or even faraway beyond those who work in establishments. 4- Moreover, about 76% of the working children had work after 6 P.M. and around 35% of them had rest time less than 60 minutes per day. 5- About 98% of the working children are receiving their wages by themselves. 6- Regrinding health conditions in establishments, the study showed that, medical care of the working children is very low. Since most of them reported that no medical certificate granted that the child is free from diseases and capable for work was asked, nor there regular check-up. 7- About 69% of the working children reported that they had no glass of milk during the period of work

possible cytoprotective role of L-arginine and misoprostol in some radiocontrast media induced toxicity

Despite recent medical progress in supportive medical therapy, the frequency of hospital aquired acute renal failure has increased in recent years.Of the multiple etiologies which can cause such renal impairment, radiocontrast media are recorded to be the third common cause of hospital aquired acute renal failure.In attempts to minimize the radiocontrast induced nephrotoxicity, L-arginine and misoprostol were used as cytoprotective agents against such toxicity. This study was conducted on 180 adult male albino rats. They were classified into: negative control group I distilled water group II, gum acacia group III, L-arginine group IV, misoprostol groupV, diatrizoate group VI, iopromide group VII, L-arginine and diatrizoate group VIII, misoprostol and diatrizoate group IX, L-arginine and iopromide group X, misoprostol and i opromid group Xl, gentamicin group XII, gentamicin and diatnzoate group XIII, gentamicin and iopromide grou XIV, gentamicin, L-arginine and diatrizoate group XV, gentamicin, misoprostol and diatrizoate group XVl, gentamicin, L-arginine and iopromide group XVll. The last group was gentamicin, misoprostol and iopromide group XVIII. At the end of the experimental period the animals were sacrificed, BUN and serum creatinine and urinary beta2 microglobulin and gamma glutamyl transpeptidase [GGT] analyses as well as histopathological examination of the kidney sections were carried out. The results revealed that in groups VI and VII there was significant increase in BUN, serum creatinine, urinary beta2 microglobulin and GGT with degeneradive changes in the proximal convoluted tubules in comparison with group I. These changes were more observed in group VI than in group VII.While in group XIII, there was marked increase in BUN and serum creatinine with aggravation in the renal histopathological changes in comparison with group XII. Moreover misoprostol appeared more effective than L-arginine in nephroprotection when it was given five days before the radiocontrast media either in groups with health kidney [VIII, IX, X and XI] or groups with compromized kidney [XV, XVI, XVII and XIII]

Hypertension care in al Asyah primary health care center, al Qassim, Saudi Arabia: an audit of structure, process, and outcome

Objectives: the objective of this study is to assess the quality of hypertension care in Al-Asyah primary health cares [PHC] center, Al Qassim Region, Saudi Arabia through an auditing of structure, process, and outcome

Subjects and methods: all files of registered hypertensive patients in the PHC center were reviewed as recommended by WHO, National Quality Assurance protocol, protocol of management of hypertension and criteria in the Sixth report of Joint National Committee on detection, evaluation and treatment of high blood pressure [JNCVI], to evaluate the structure, process, and outcome of hypertension care

Result: all hypertensive patients registered in Al Asyah PHC center [201 patients] were included in this study. The prevalence of HTN among adults [

Conclusion: this study proves that all essential resources needed for hypertension care are available, but the results of process and outcome indicators show the need for the improvement of the referral system as well as good continuous constant health education programs to encourage the patients, their families and the community to observe more healthy lifestyles

Audit of structure, process, and outcome of diabetic care at Al Asyah primary health care center, Qassim region, Saudi Arabia

Objective: to assess the quality of diabetic care in Al-Asyah primary health care [PHC] center, Qassim region, KSA, through an auditing of structure, process, and Outcome

Methodology: the files of all registered diabetic patients in this PHC center were reviewed. The indicators for structure were evaluated according to the National Quality Assurance protocol and manual of chronic diseases, and those for process were assessed by a modified scoring system. The outcome indicators were evaluated using the recommendations of American Diabetic Association [ADA] 2002

Result: dietician, diabetic educator and Hb A1C, HDL level, LDL level were the most common non available resources. Out of 4628 patients registered in this PHC center, only 159 patients had diabetes. The prevalence of diabetes among registered adults aged 15 years and above was 5.8% and this increased with age. The patients were mostly Saudi [96.2%] and married [75.5%]. They included 83 females [52.2%]. The mean age was 56 years. Most of the patients were Type 2 [95.6%] and most were diagnosed at the PHC center [94.3%]. The mean duration of the diabetes since diagnosis was 6.4 years. All checked process items showed high percentages of coverage [73% and above] except for the examination of the fundus, and the measurement of the triglyceride levels. Results showed that most of the samples were obese or overweight [49.7% and 32.7% respectively]. While 21.4% had good diabetic control, 42.8% had poor diabetic control. Patient compliance to appointment was good [98.1%], and 13% of the diabetic patients had at least one reported complication

Conclusion: this study proves that some essential resources needed for diabetic care were inadequate. Provision of these resources is essential for the improvement of the quality of health care for diabetic patients. Also, there is a need to improve the referral system and establish an appropriate health education program to encourage patients, their families and the community to follow a more healthy life-style

Different techniques of nucleus delivery in extracapsular cataract extraction

This study aimed to evaluate different techniques performed for nucleus delivery in planned extracapsular cataract extraction [ECCE]. ECCE with or without posterior chamber IOL was performed in 60 eyes of 50 patients. Patients were divided into 3 groups according to the technique of nucleus delivery. Each group included 20 eyes. In the first group the nucleus was delivered by bimanual pressure at 6 o'clock and 12 o'clock. In the second group the nucleus was delivered by Simcoe loop and in the third group the nucleus was delivered by pressure on the sclera at 12 o'clock after closed hydrodissection technique. Nucleus delivery was classified into easy, difficult or failed when the surgeon shifted to another technique to deliver the nucleus. In the first group, difficult expression of lens nucleus occurred in 3 cases and failed expression in 3 cases. Zonular rupture and vitreous loss occured in 2 cases, we recommend to avoid this technique in cases with weak zonule and in cases with old age and high myopia. In the second group difficult nucleus delivery occurred in 4 cases. This technique needs more surgical skill and is better avoided in young patients. In the third group difficult nucleus delivery occurred in 3 cases and failed nucleus delivery in 3 cases. This technique must be avoided in Morgagnian cataract and in soft eyes

Newly discovered cases of pulmonary tuberculosis in Cairo during the year 1987

Then were 3633 Newly discovered Tuberculous cases attending Abbassia Chest Hospital and different chest dispensaries in Cairo during the year 1987. Incidence rate among population in Cairo was [0.06%]. Incidence in males 65.4% was higher than females [34.6%]. Highest occurance of disease was among those ranging between 12 - 35 years of age. Cough was the most frequent symptom. Positive sputum for acid fast bacilli occured in 80.2% of cases. Bronchogenic Tuberculosis had highest percentage being 74. 7%. Cases with Diabetic history were 3.8%. Tuberculin test was positive in 94.0% of cases and 13.1% had history of contact