effect of integrating short messaging services' reminders with electronic medical records on non-attendance rates

To measure the effect of integrating short messaging service [SMS] reminders with an electronic medical record [EMR] system on non-attendance rates in outpatient clinics in a Saudi hospital. Pre- and post- observational studies were conducted at King Abdulaziz Medical City and National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia from January 2010 and March 2010. Data collected from 16 out-patient clinics included the number of non-attended appointments at the clinics in a 3-month period [March-May] in 2 consecutive years: pre-implementation of SMS appointment reminders in 2008 and post-implementation in 2009. The mean non-attendance rates for the 16 outpatient clinics during 2008 were 23.9% [SD 0.0578] and for 2009 were 19.8% [SD 0.0386] with a 4.1% [p<0.001, T-value = 4.81] reduction rate. Integrating SMS reminders with EMR systems showed a positive effect on the reduction of the non-attended appointments at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia

Changes in personality and mood profile of women with toxoplasmosis

Acquired T. gondii infection of immunocompetent patients may cause central nervous system manifestations [Gullain-Bare syndrome or brain abscess] and may be associated with psychiatric manifestation. Iraq is highly endemic with T. gondii, however, publications on psychiatric manifestation of T. gondii infection are scarce. To demonstrate psychiatric manifestations in women with Toxoplasmosis. A total of 68 toxoplasma positive pregnant women and 68 toxoplasma negative pregnant women were included in this study. It was conducted for the period of 5[th] Aug. 2008 to 28[th] Feb. 2009. ELISA was used to diagnose T. gondii. Questionnaire was used to diagnose personality type and depression was used. The diagnosis was according to ICD[10] and DSM-IV. Rates of pseudpsychopathic and limbic personality epilepsy syndrome were significantly high among toxoplasmosis positive pregnant women. Significant high rate of depression was associated with acquired T. gonii infection. These findings might provide evidence supporting role of T. gondii infection in the onset of some behavioral disorders

Jaundice among pregnant women in ALexandria-Egypt: a describtive study

To describe causes, sociodemographic characteristics, and prevalence and some factors that could participate in the occurrence of jaundice during pregnancy in Alexandria - Egypt. A descriptive study started January 2005 for one year duration, included 20 cases [all cases admitted to Alexandria Fever Hospital and Shatby University Hospital for Obstetrics and Gynecology with the clinical and laboratory diagnosis of jaundice]. Questionnaire sheet administered through an interview with each patient includes demographic data, known risk factors, and medical history. Full clinical and obstetric examination was done, with an ultra-sound review, estimation of serum ALT, AST, alkaline phosphatase, bilirubin [total and direct], and serological screening against virus hepatitis A, B, C and E. Most cases [n=17] were admitted to the Fever Hospital. Of them; 11 cases [55%] were due to HAV infection, 5 cases resulted from other virus hepatitis. Remaining 4 cases were due to conditions related to pregnancy. Age between 20 and 30 represented 80% of cases. Low social score accounts for 70% of cases. Only 7 cases presented during the l trimester. Most cases got no previous history of jaundice [95%]; only 4 cases got family history of jaundice. The majority of cases [65%] reported one or more virus known hepatitis risk actors; suffers anaemia [55%], hepatomegaly [90%], and got abnormal levels in blood chemistry. The study is an update in current causes, demographic pattern, and risk factors associated with clinical jaundice during pregnancy. It documents that many factors are implicated in the causation of this relatively uncommon clinical condition

Missed breast carcinoma; why and how to avoid?

Despite the advances in mammography techniques, it still has a number of limitations. It is estimated that about 10 to 25% of lesions are overlooked in mammograms out of which about two thirds are detected retrospectively by radiologists and oncologists. Causes of missed breast cancer on mammography can be secondary to many factors including those related to the patient [whether inherent or acquired], the nature of the malignant mass itself, poor mammographic techniques, provider factors or interpretive skills of radiologists and oncologists [including perception and interpretation errors]. The aim of this study is to investigate the aforementioned factors hindering early breast cancer detection and in turn lowering mammographic sensitivity and to outline the major guidelines to overcome these factors aiming to an optimum mammographic examination and interpretation by radiologists and oncologists. We conducted this multicenter study over a two-year interval. We included 152 histopathologicaly proven breast carcinomas that were initially missed on mammography. The cases were subjected to mammography, complementary US, MRI and digital mammography in some cases and all cases were histopathologically proven either by FNAB, CNB or open biopsy. Revision of the pathological specimens of these 152 cases revealed 121 infiltrating ductal carcinomas, 2 lobular, 4 mucinous, 14 inflammatory carcinomas, 6 carcinomas in situ [3 of which were intracystic], 2 intraductal papillary carcinomas and 3 cases with Paget's disease of the nipple. In analyzing the causes responsible for misdiagnosis of these carcinomas we classified them into 4 causative factors; patient, tumor, technical or provider factors. Tumor factors were the most commonly encountered, accounting for 44.1%, while provider factors were the least commonly encountered in 14.5%. Carcinomas were detected using several individual or combined complementary techniques. These techniques mainly included double reading, additional mammography views, ultrasound and MRI examinations. Forty four carcinomas were detected on double and re-reading by more experienced radiologists. Additional mammographic views were recommended in 35 [23%] cases. Complementary ultrasound examination was performed for all 152 cases [100%] and showed a higher sensitivity than mammography in carcinoma detection. It was diagnostic in 138 [90.8%] cases only. In the remaining 14 cases, further MRI and biopsy were performed. Why can breast carcinoma be missed? Four main factors are responsible for missing a carcinoma: [1] Patient factors [Inherently dense breasts or acquired dense breasts]. [2] Tumor factors [subtle carcinoma, masked carcinoma, multifocal carcinoma and multicentric carcinoma]. [3] Technical factors [bad exposure factors, malpositioned breasts and bad processing quality]. [4] Provider factors [bad perception and misinterpretation]. How to avoid missing a breast carcinoma? Review clinical data and use US and other adjunct techniques as MRI and biopsy to assess a palpable or mammographically detected mass. Be strict about positioning and technical factors. Try to optimize image quality. Be alert to subtle features of breast cancers. Always consider the well defined carcinoma. Compare current images with multiple prior studies to look for subtle increases in lesion size. Look for other lesions when one abnormality is seen. Judge a lesion by its most malignant features. Double reading and the use of computer aided diagnosis [CAD] and finally FFDM [Full Field Digital Mammography]. Close cooperation between the oncologist, radiologist and pathologist is essential to avoid missing any case of breast carcinoma

Endoscopic fulguration versus surgical repair of vesico-uterine fistula

Although surgical correction of vesico-uterine fistulae gives good results, endoscopic fulguration is a new trend for treatment of these cases. These two modalities were compared. Six cases of vesico- uterine fistula caused by bladder injury at cesarean section [4 cases] and by rupture uterus and bladder after obstructed labor [2 cases]. Three cases were treated by endoscopic fulguration, after 6 months follow up, 2 cases have been small and just admitting the 6 ch. fulguration electrode, but the third case showed vaginal leakage immediately after removal of the urethral catheter 6 weeks after fulguration, this case had a giant fistula. Three cases were treated abdominally via transabdominal transperitoneal route and omental flap. All these cases were completely cured. Treatment of small vesico- uterine fistula by endoscopic fulguration is recommended, because of its simplicity and low morbidity. However, large fistulae are preferably treated surgically

Stereological and ultrastructural study of seminiferous tubules in normal testes and in patients with varicocele

Testicular biopsies from fertile men and patients with varicocele were evaluated and examined by using the recent stereological technique and electron microscope. This study quantitated the seminiferous epithelium using the stereological methods. The numerical density of the germ cells was generally reduced in patients with varicocele when compared with that in the normal fertile men. However such reduction was not associated with a similar change in the supporting Sertoli cells. Moreover, the different ratios between various germ cells and Sertoli cells were statistically reduced in varicocele group. The seminiferous tubules were examined by light and electron microscope. The tissue architecture of the tubules in varicocele patients ranged from mild to severely altered. In affected tubules, spermatid nuclear and acrosomal morpology was abnormal. Sloughing of the individual germ cells as well as the vacuolization and degeneration of the Sertoli cell cytoplasm were evindent. Furthermore, Sertoli-spermatid junctional complexes appeared to be structurally abnormal, whereas Sertoli-Sertoli junctional cornplexes appeared to be structurally intact. On the basis of the results in this work, the Sertoli cell is, in fact, the primary intratubular site of alteration in varicocele patients leading secondarily to sloughing and spermatogenic disruption