Readiness for self-directed learning among first year Saudi medical students: a descriptive study

The objectives of the present study was to explore the readiness for Self Directed Learning [SDL] among first year Saudi Medical students enrolled at King Saud University [KSU] and Princess NourahBintAbdulrahman University [PNU] in Saudi Arabia. First year medical students were invited to participate in a descriptive cross sectional study design. Data were collected using a Self -Directed Learner Readiness Scale [SDLRS] which is a self assessment tool aimed to assess three main components: self-management, desire for learning and self control. The students responded to each item of the SDLRS on a 5-point Likert scale. Data were analyzed using SPSS, mean, median and total scores were calculated and were compared among student's groups. The mean score for the desire of learning was the highest [4.08 +/- 0.5] of all the three components of the SDLRS followed by self-control [3.9 +/- 0.9], while the least mean score was for self-management [3.7 +/- 0.5]. Overall, differences between student's groups were not statistically significant. The present study revealed that the overall SDL readiness of participants was good, students were highly motivated for self-learning and had the ability for self-control. However, they need assistance to improve their self-management skills

Evaluation of infections related to the different types of dialysis accesses in patients with end stage renal disease

Introduction: Infection is considered a common life threating complication of vascular access and causing morbidity, access failure, and it is the second leading cause of death after cardiovascular event. It accounts approximately 15% to 36% of morbidity and mortality [Jacob, 2011]. Peritonitis, subcutaneous tunnel and exit site infection are the most common complication in Continuous Ambulatory Peritoneal Dialysis [CAPD] patients and accounts for 18% of mortality [Johnson DW, 2009]

Aim of the work:1. To identify the most common pathogenic microorganisms in different types of dialysis accesses in suspected patients in hemodialysis and patients screened for Tenckhoff catheter infection in CA PD. 2. Common risk factors responsible for infection, 3. Most common sensitive antibiotic, and,.4. Strategy for management and prevention of infection in the dialysis units of Assiut governorate, Egypt

Material and methods: A total 88 patients with End Stage Renal Disease on regular dialysis. Divided into two main groups: Group [A]: 63 patients on hemodialysis with suspected infected vascular accesses. They were sub-divided into: 27 patients with Permanent accesses including [15 patients with AV fistula and 12 patients with tunneled catheters], and 36 patients with suspected infected temporary catheters including 12 patients for each of jugular, subclavian and femoral catheters in the dialysis unit in Assiut university hospital. Group [B]: 25 patients on Continuous Ambulatory Peritoneal Dialysis [CA PD] screened for Tenckhoff catheter infection in dialysis unit of Alexandria Students Hospital

Results: the positive cultures form colonized permanent accesses were 100% in AV fistula and 58.3% :n tunneled, regarding to CVCs, positive cultures were 75% in suhclavian, 83.3% in jugular and 100% in femoral so femoral vein catheters were the highest frequency of colonization, while in CAPD patients, the frequency of colonization were 12%.the most frequent organisms in the colonized permanent accesses and temporary non tunneled catheters were mixed infections [53.3% in AV fistuIa,.57.1% in tunneled, 60% in jugular and 75% in femoral, while the most common organism in subclavian was non- pathogenic staphylococci by 55.6%, and in CAPD patients, 100% of positive cultures were staphylococcus aureus. Our results demonstrate that, Vancomycin was the most sensitive antibiotic by 93.3% in arterio-venous fistula, 100% in tunneled, 75% in subclavian, 93.8% in Jugular and 87.5% in femoral catheter infections

Conclusion: Mixed infection with non- pathogenic staphylococci and candida were the most frequent pathogens in our centers, most sensitive antibiotics were Vancomcin, Amikacin, Niturofurantoin, and this should be combined with systemic antifungal

Protective Effects of Estradiol on Myocardial Contractile Function Following Hemorrhagic Shock and Resuscitation in Rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hemorrhagic shock (HS) results in myocardial contractile dysfunction. Studies showed that 17β-estradiol protects the myocardium against contractile dysfunction. The study investigated the cardioprotective effects of treatment with 17β-estradiol before resuscitation following 1 h of HS and resuscitation.</p><p><b>METHODS</b>Male Sprague-Dawley rats were assigned to 2 sets of experimental protocols: Ex vivo and in vivo treatment and resuscitation. Each set had three experimental groups (n = 6 per group): Normotensive (N), HS and resuscitation (HS-R) and HS rats treated with 17β-estradiol (E) and resuscitated (HS-E-R). Rats were hemorrhaged over 60-min to reach a mean arterial blood pressure of 40 mmHg. In the ex vivo group, hearts were resuscitated by perfusion in the Langendorff system. In the 17β-estradiol treated group, 17β-estradiol 280 µg/kg was added for thefirst 5 min. Cardiac function was measured. Left ventricular generated pressure (LVGP) and +dP/dt were calculated. In the in vivo group, rats were treated with 17β-estradiol 280 µg/kg s.c. after 60-min HS. Resuscitation was performed in vivo by the reinfusion of the shed blood for 30-min to restore normotension.</p><p><b>RESULTS</b>Treatment with 17β-estradiol before resuscitation in ex vivo treated and resuscitated isolated hearts and in the in vivo treated and resuscitated rats following HS improved myocardial contractile function. In the in vivo treated group, LVGP and +dP/dt max were significantly higher in 17β-estradiol treated rats compared to the untreated group (LVGP 136.40 ± 6.61 compared to 47.58 ± 17.55, and +dP/dt 661.85 ± 49.88 compared to 88.18 ± 0.85). Treatment with 17β-estradiol improved LVGP following HS.</p><p><b>CONCLUSIONS</b>The results indicate that treatment with 17β-estradiol before resuscitation following HS protects the myocardium against dysfunction.</p>

Perception of stress and coping strategies by medical students at King Saud University, Riyadh, Saudi Arabia

Medical students face a number of stressors, which affect their academic performance and quality of life. Previous research has shown that coping strategies decrease the level of stress among medical students. The aim of this study was to evaluate the presence of stress and the strategies for coping perceived by medical students. In a cross-sectional study, 319 first-year medical students at King Saud University College of Medicine, Riyadh, Kingdom of Saudi Arabia [188 males and 131 females], were invited to fill in a self-administered questionnaire on the last day of the 2012-2013 academic year. The response rate was 45.5%. The questionnaire comprised 22 items on stress factors and 17 items on coping strategies. The responses were measured quantitatively on a five-point Likert scale. The response rate was 45.5% [145 of 319 students]. The stress factors identified by students were lack of time, excessive subject content, tests, demanding too much of themselves, too many extracurricular activities, competitiveness and family problems. The coping strategies were: respecting one's limits, setting priorities, avoiding comparisons and participating in leisure activities [cinema, reading, sports, meeting friends and family]. The prevalence of perceived stress among medical students was high. This might affect not only their academic performance but also all aspects of health and life. There is a wide range of strategies for coping with stress, and student councils could play an important role in helping students cope with stress.

Nucleoside transport inhibitor, dipyridamole, induced myocardial protection following hemorrhagic shock in ex vivo perfused rat hearts

Successful protection against post-resuscitation myocardial injury is not available for trauma patients. Whereas intensive improvement in resuscitation strategies reduce myocardial injury, death among trauma patients are among the highest in the world due to myocardial dysfunction and multiple organ failure. Dipyridamole is a nucleoside transport inhibitor. Recent studies have shown that elevation of serum adenosine caused by dipyridamole improve cardiac function. The purpose of the present study was to examine the myocardial protective effects of dipyridamole therapy following 1 h of hemorrhagic shock. Sprague-Dawley rats were used. The study consisted of three phases: Phase I to examine the direct effects of dipyridamole on myocardial function by perfusion of the isolated hearts with Krebs Henseleit buffer [KHB] + dipyridamole on the Langendorff apparatus. Phase II examined the protective effects of dipyridamole following 60 min of hemorrhagic shock [HS] by ex vivo treatment with dipyridimole 20 micro g/L for 5 min followed by resuscitation with KHB for 55 min. Phase III: 60 min HS followed by in vivo treatment by injecting 1 ml of [20 micro g/L] dipyridamole intra-arterially, and resuscitation for 30 min. Myocardial protection was assessed by measuring left ventricular generated pressure [LVGP] and end diastolic pressures [LVEDP]. During ex vivo resuscitation, hearts from dipyridamole treated animals had significantly higher LVGP, and significantly lower LVEDP versus controls. Dipyridamole therapy produces protection against post-resuscitation myocardial injury in rats

Myocardial protection by Ethyl-isopropyl amiloride, a specific NA[+] -H[+] exchange inhibitor, following hemorrhagic shock

Hemorrhagic shock and resuscitation is well known to result in myocardial dysfunction and injury. Stimulation of the Na[+] -H[+] exchanger plays an important role in the pathway of myocardial injury. The purpose of the present study was to examine the protective effects of blocking the cardiac Na[+] -H[+] exchange, using 100mM ethyl-isopropyl amiloride [EIPA], a specific Na[+] -H[+] exchanger blocker, on myocardial contractile function on ex vivo resuscitation of isolated rat heart following one hour of hemorrhagic shock. Sprague- Dawley rats were assigned to hemorrhage, hemorrhage + EIPA, sham hemorrhage and sham hemorrhage + EIPA groups. Rats were hemorrhaged for one hour. Hearts were harvested and ex vivo treated and resuscitated by perfused in the Langendorff System. Myocardial function was determined. The results showed that inhibition of the Na[+] -H[+] exchanger using EIPA improved the post-resuscitation myocardial contractile function. Blocking the Na[+] -H[+] exchanger using 100mM EIPA following 60 minutes of hemorrhagic shock improved myocardial function

Resuscitation with adenosine retains cardiomyocyte structure following hemorrhagic shock in rats

Successful treatment of hemorrhage patients requires restoration of normal cardiac function following resuscitation. However, many interventions used to attempt to restore cardiac function may cause additional myocardial injury, cardiac dysfunction and failure. The purpose of this study was to examine the ability of therapeutic intervention using adenosine to protect the heart from contractile dysfunction and post-resuscitation injury following hemorrhagic shock. Male Sprague- Dawley rats were divided into 3 groups: 1] in vivo hemorrhagic shock [1 hour] followed by in vitro treatment with adenosine and ex vivo resuscitation using the Langendorff apparatus [60 minutes], 2] in vivo hemorrhagic shock [1 hour] followed by in vivo treatment with 20 mirco M adenosine and resuscitation [30 minutes] and then ex vivo perfusion [60 minutes] and 3] in vivo hemorrhagic shock [2 hours] followed by in vivo treatment with 20 mircoM adenosine and resuscitation [30 minutes] and then ex vivo perfusion [60 minutes]. Arterial. The results showed that blood samples were collected for measurements of TNF- treatment with adenosine before resuscitation from hemorrhagic shock significantly improved left ventricular contractile function compared to the untreated resuscitated group. Treatment with adenosine also decreased the inflammatory response to shock by lowering the levels of TNF. In conclusion, treatment with adenosine before resuscitation of hemorrhagic shock protected the heart from post-resuscitation myocardial dysfunction and injury in rats

Health services utilization pattern in relation to health care rights and quality perception: an example from rural Giza

Providing relevant policy makers with the necessary information in developing strategies to steer up the choices of communities to different health sectors. To identify health care quality dimensions steering up/ limiting the choices towards different health sectors. And, to probe the issue of rights and empowerment in health care. a descriptive community based exploratory study. It was a policy oriented research where the principles of health systems research [HSR] were followed. One of the villages in Giza, Rural Upper Egypt. Quantitative data was obtained by secondary analysis of the data of a mother household survey. It focused all married wives in the reproductive age 15- 49 year old and their husbands who sought preventive/curative health services in the year before data collection. They totaled 211 couples of different ages and social levels. Qualitative data was obtained from the director general of the quality sector - MOHP, the actively working personnel in the relevant rural primary health care unit, and subgroups of the selected husbands and wives. In depth interviews and focus group discussions were used. The study rural couples considered the private sector to be the best in responding to their priority expectations. It was the heaviest in utilization although too costly to the low social classed. The selected subgroups of the study couples had variable views and attitudes with regard to the different quality dimension in health care. They perceived the need for improving the quality of health care but were not clear about their health care rights or how to obtain the desired changes. The lowest social class studied anal participants had the most limited span of choices to health sectors. They voiced basic needs with the fewest or no quality expectations. Quality perceptions by the health care consumers influence their choice of the health care facility to be sought. Widening the span of health sectors to be sought requires a scientific well prepared strategic micro-planning. Focus groups offered important, information on quality and breadth of health care delivery and should be part of quality monitoring activities. To empower health care consumers to call for their rights, multidisciplinary, slowly but surely efforts from the health, information, education and political disciplines are recommended

Effects of cardiac Na[+]- H[+] exchange blockade on myocardial contractile function during hemorrhagic shock

Myocardial contractile dysfunction has been described following hemorrhagic shock. While the Na [+]-H[+] exchanger is well known to be a major regulator of intracellular pH. its role in hemorrhagic shock remains unclear. However, there has been intensive research investigating the myocardial protective role of several Na[+]-H[+] exchangers in ischemia-reperfusion, which is similar to hemorrhagic shock as both result in extracellular acidosis. The purpose of the present study was to examine the effects of blocking the cardiac Na[+]-H[+] exchanger, using 100 micro M. amiloride, on myocardial contractile function after ex vivo perfusion of isolated rat heart following one hour of hemorrhagic shock. Anesthetized male Sprague-Dawley rats were assigned to either hemorrhagic treated or untreated groups, or a similar time-matched control group [n=6 per group]. Rats were hemorrhaged using a reservoir model. Arterial blood pressure was monitored for one hour, and maintained at a mean arterial blood pressure of 40 mm Hg, via an intra-arterial catheter inserted into the left carotid artery. Two arterial blood samples were taken, one at baseline and another at 60 minutes of hemorrhage. These blood samples were analyzed for pH and lactate levels. Hearts were harvested and perfused either with a balanced salt solution for 60 minutes or a solution containing 100 micro M amiloride. Myocardial function was determined with a balloon- tipped catheter inserted into the left ventricle via the mitral valve. Indices of left ventricular function were measured, including left ventricular end diastolic pressure [LVEDP], left ventricular peak systolic pressure [LVPSP], coronary perfusion pressure [Pp] and left ventricular balloon volume [BV]. The left ventricular +/- dP/dt, which is the left ventricular index of contractility, was calculated. Left ventricular compliance [C] was also calculated. The results showed that inhibition of the Na[+]-H[+] exchanger for 5 minutes of ex vivo perfusion of the isolated hearts following hemorrhagic shock, improved myocardial contractile function as compared to the hemorrhage untreated hearts. The results also showed that hemorrhagic shock decreased myocardial contractile function as compared to controls. Blocking the Na[+]-H[+] exchanger for a short period on ex vivo perfusion of isolated hearts has a protective effect on myocardial contractile function. Further research is needed to investigate the exact mechanism of protection using more specific Na[+]-H[+] exchanger inhibitors

Assessment of the quality of life in children and adolescents with rheumatic fever and rheumatic heart diseases

Introduction: The severity of chronic health condition refers to the impact on a child's physical, intellectual, psychological and social functioning. Long term illness affects the functioning of both children and families

Study Objective: Assessment of the quality of life in children and adolescents with rheumatic fever and rheumatic heart diseases by measuring the essential life spheres "physical, emotional, social and school functioning as well as general well being"

Subjects: Cases [100] were randomly assigned among patients attending outpatient pediatric and cardiac clinic and inpatient hospitalized patients in 2 hospitals [Abo El Rish pediatric university hospital - El Mokatum hospital "Health Insurance Organization". Control [120] matched age and sex patients attending same hospital for mild ailments

Methods: A case-control study conducted during later ½ of the scholastic year [2000/2001]. Patients and controls, were interviewed for completion of 2 pre-prepared and pre-tested questionnaire forms [1- Pediatric Quality of life inventory. 2- A designed questionnaire medical history of patients]

Results: There was a statistical difference between cases and controls for al aspects of quality of life, school absenteeism was found to be the most significant variable related to impaired quality of life. The estimated total disability days for the studied cases due to school absenteeism was 116.76 days per year for the 100 studied cases with a mean 116.8+/-108.2 day per student. Parent education and regular intake of long acting penicillin were found positively affecting the quality of life

Conclusion: Rheumatic fever and rheumatic heart diseases are chronic conditions affecting negatively all aspects of quality of life of the diseased children. So management of these diseases should include assessment of quality of life of patients. Adherence to regular long acting penicillin and strategies for application of standardized regimen program are recommended

ND - YAG laser treatment of haemangiomas in children

Management of 30 cases of mixed hemangiomas in the head and neck with Nd-YAG laser was presented. All cases were investigated using computerized axial tomography and CT scanning for the detection of any deep vascular connections. Nd-YAG 1064 nm was applied with a power ranging from 12 to 16 W and exposure duration from l to 2 sec. The follow-up period for any recurrence or incomplete healing was done. Although the treatment with Nd-YAG laser resulted in scarring, this was accepted by the patients as it was less risky and much easier than other surgical procedures. Technique, post treatment care and follow up results were presented in details

Study of time and geographical patterns of schistosomiasis in Minia and Qualubia governorates

This work aimed at studying time and geographical patterns of schistosomiasis Minia and Qualubia governorates during the last ten years. The data available at Ministry of Health [MOH] for the two governorates were manipulated. Moving average was used to clarify the real peaks or drops in prevalence by smoothing of curve. Results showed a gradual decrease overall trend of S. heamatobium prevalence overtime in Minia governorate with a peak in 1989. However, the prevalence goes up and down with peak in winter months. Epidemic-logic trend of schistosomiasis prevalence in Qualubia governorate showed low fluctuating prevalence with more or les stationary course allover the studied period [1987-1991] with the characteristic peak at early 1989. However, the manoni/haematobium ratio varied greatly between different districts

Health status and service needs of the elderly [60 years and over]

The main health problems were disorders of gastrointestinal and locomotor systems together with impaired vision. Chest diseases were significant problem for males. Diabetes mellitus and heart diseases were present in less than 15% of the studied elderly. Urine screening revealed the presence of blood, protein, leukocytes and nitrites in 55.9, 49, 26 and 11.8% of elderly respectively. Moreover, urine testing identified glucosuria in 11 elderly with negative history of diabetes. The study suggests some strategies to meet health and social needs of elderly

Assessment of the nutritional status in elderly persons [60 years and over]

Results showed insignificant changes of anthropometric measurements with aging and identified deficiency of vitamins A, C, niacin and calcium in 24 hours dietary recall. The median nutrient intake exceeded the standard daily allowances for vitamins B1, B2, iron and protein. It is recommended, for optimal diet of the elderly, to ensure daily consumption of vegetables, fruits and milk. Gastrointestinal troubles which form the major feeding problem have to be properly managed to allow adequate feeding

Evaluation of toxoplasmosis as a risk factor in abortion

The E.L.I.S.A. test was performed to detect specific antitoxoplasma IgG and IgM among 465 pregnant women in Macca, Saud Arabia. The study included cases who had normal pregnancies and those who had present or past history of abortion. No statistical variation was detected among the two groups. This high prevalence rate of latent infection associated with low risk factor suggested the development of solid immunity against reactivation and subsequent abortion

Effect of inbreeding on the outcome of pregnancy and prereproductive mortality

This study was based on the hypothesis that inbreeding might affect pregnancy outcome and pre-reproductive mortality. The material was 479 mothers attending one of Giza MCH centers for antenatal care. They showed inbreeding ratio of 34.7%. For the outcome of past pregnancies, 52.4% of mothers experienced unfavourable outcome which was significantly related to the degree of consanguinity [P < 0.05]. The estimated relative risk [ERR], by the form of unfavourable outcome of pregnancy in the first cousin marriages was 1.1 for abortion, 2 for stillbirths, 2.7 for neonatal deaths and, 3 for congenital anomalies. however, the reported incidence for the corresponding unfavourable outcome were not significantly different from consanguinous and non-consanguinous marriages. On the other hand postneonatal to below 20 years deaths of first cousin marriages were significantly different from the non-consanguinous [P < 0.01]