Assessment of tibolone effects on menopausal symptoms and cardiovascular markers

To assess Tibolone effects on menopausal symptoms, lipid profile, serum homocysteine levels, and C-reactive protein. Fifty two healthy post menopausal women, who had been menopausal for at least one year, were recruited in this prospective randomized controlled clinical trial. They were randomly assigned into two groups. The first group received 2.5mg Tibolone tablet [Livial] for 6 month was referred to as "Tibolone group'. The second group received placebo treatment for 6 month and was referred to as "Control group. Menopausal symptoms were assessed upon enrollment and after 6 months using the Greene climacteric scale. All women had an assay of total cholesterol, triglyceride, LDL cholesterol, HDL cholesterol, CRP, and serum homocysteine levels upon enrollment and after 6 months. After 6 months, Tibolone reduced significantly the Greene climacteric scale [median score=10, with score range=2-25] compared to the control group [median score=15, with score range=4-48. p=0.0013]. In the Tibolone group, there was significant decrease in the scale after 6 months compared to baseline. After 6 months, there was no significant difference between the 2 groups regarding the cholesterol, triglycerides, and LDL cholesterol levels. However, there was significant drop in the HDL cholesterol in the Tibolone group compared to the control group [63.33 +/- 15.41 Vs 75.80 +/- 21.11, p=0.016]. By applying the paired t-test and comparing the lipid profile values in the Tibolone group, there was a significant reduction in total cholesterol, triglyceride, and HDL levels after 6 months. There was no significant reduction in LDL cholesterol level. At baseline, there was no significant difference in the homocysteine level between the 2 groups. After 6 months, there was still no significant difference between the 2 groups. Within the Tibolone group, there was a 5.1% reduction in the serum Homocysteine level after 6 months compared to baseline, however, this was also non significant. After 6 months, CRP was significantly higher in the tibolone group compared to the control group [1.99 +/- 0.73 Vs 1.52 +/- 0.76, p<0.05]. Within the tibolone group there was significant rise in CRP level after 6 months. Tibolone is effective in controlling menopausal symptoms. Tibolone had favorable effect on total cholesterol and triglyceride levels, however, it reduced HDL. Tibolone had no effect on homocysteine levels, It was associated with a rise in CRP levels. Further long term clinical trials are needed to verify the cardiovascular effects of tiblone

Correlating brain stem auditory evoked potentials measurement to clinical and neurophysiological findings in patients with diabetes mellitus

Diabetes mellitus is a multisystem metabolic disorder. One of its rarely probed complications is brainstem dysfunction. We investigated brainstem auditory evoked potential studies [BAEPs] in diabetic patients, as well as its to microangiopathy. The study was conducted on 40 [type 1 and type 2] diabetic patients, calssified into: group [< 5 years duration of illness] and group 11 [> 5 years duration of illness]. The patients were examined clinically and neurologically. Neurophysiological tests in the form of: BAEPs, nerve conduction studies and flash electroretinography were performed to all patients. Urine analysis, instantaneous random blood sugar and funduscopy were also performed for patients. The BAEPs patients' results were compared to those of 30 normal subjects. Wave V absolute latency, III-V IPL and I-V IPL were positively correlated with the patients' age. Latency of wave III and V/I amplitude ratio were significantly higher in male patients. Tinnitus was associated with statistically significant increase in wave V latency, III-V IPL and I-V IPL. The same finding was reported in the 21 patients who showed evidence of nerve conduction abnormalities during nerve conduction studies. Retinal changes detected by fundus examination and abnormal F-ERG was associated with statistically significant increase in wave III latency. Brainstem dysfunction occurs early in the course of diabetes [type I and III similarly] and it is further affected by its duration. BAEP studies will be of help in detecting early subclinical central nervous system involvement in diabetic patients

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

Health promotion in primary health care: a model for youth friendly services

The potential role of primary health care [PHC] as a unique setting for health promotion is becoming more recognized. Despite claims to promote health, most health care organizations in Egypt do so within the narrow definition of health. Global concern is growing about the health status of young females. Health services, although available, lack comprehensiveness that addresses the needs of this still shadowed sector of the population. In an attempt to make one of the PHC facilities be more "Youth Friendly", an integrated interventional approach for health promotion, with coordinated efforts from relevant stakeholders, was conducted in a rural PHC facility of Upper Egypt and the community within its catchments area. Targeted young females were initially defined and characterized through an interview based household survey. A total study sample of 671 females aged 12-20 years was included. Health and health care problems were identified through different qualitative and quantitative techniques. This was followed by a sequence of training courses for all the PHC providers, with community and local authority mobilization, and health education sessions for the targeted young females. Results of the study revealed marked community-level improvements and collaboration. At the PHC level, modifications in the organization of the delivery system, by arranging for convenient times to accommodate females were established. In addition, the designed card system enabled documentation of health education and counseling sessions needed by each female. The performance of the healthcare team was progressively improved through training. Significant rising means of knowledge and performance post- training scores were found for various priority topics, with p-values <0.001. At the individual young females' level, there were marked improvements in the utilization of the PHC services, where 62% of the studied group visited the centre more than 12 times during the 6-months post-intervention. This study highlights the strong belief that with changes in the way healthcare is organized, delivered and financed, new practice models beyond the level of the individual could be innovated to provide a holistic approach of health promotion for populations especially the non-regular PHC users

Myocardial performance in hydroxyurea versus transfusion treated sickle cell disease pediatric cases

Sickle cell disease [SCD] is associated with many cardiac abnormalities including increase cardiac output, pulmonary hypertension [PH] and myocardial perfusion abnormalities. Hydroxyurea [HU] is considered to be the most successful drug therapy for severe sickle cell disease. The objective is to study the echocardiographic cardiac abnormalities in patients with SCD on HU therapy comparing them with those on isolated blood transfusion regimen. Descriptive cross sectional case study was conducted on 29 cases of SCD on transfusion regimen [16 cases] and on HU therapy [13 cases]. Doppler echocardiographic assessment of left ventricular systolic and diastolic function, calculation of myocardial performance index [MPI] and left ventricular mass were done to all patients. Right ventricular MPI was higher in HU treated group with difference approaching significance [p = 0.06]. No significant correlation between HU dose and duration and left ventricular systolic or diastolic function, right ventricular diastolic function, or pulmonary artery pressure [PAP]. PH was present in 55% of SCD. No significant difference in PAP between HU and transfusion treated groups. Negative significant correlation between left ventricular deceleration time and estimated systolic pulmonary artery pressure [r=-0.37 p =0.04]. No deleterious echocardiographically detected cardiac effects were observed in HU treated SCD patients. HU had no effect on PH

Nutritional assessment of hospitalized patients and its impact on morbidity, mortality and length of stay

To asses the nutritional status of hospitalized patients in the Internal Medicine Department of Kasr Al-Aini Hospitals and its repercussion on mortality, morbidity and the length of hospital stay. In a prospective way, 177 adult patients admitted to the units of Internal Medicine Department of Kasr Al-Aini Hospitals from December 2004 to March 2006 were evaluated by using the Subjective Global Assessment [SGA]. Patients were followed to determine length of hospital stay, complications and in-hospital mortality. The sample consisted of 100 men and 77 women. The mean age was 53 year, with a standard deviation of 14 years, with 33.9% of patients [n=60] were over 60 years. Most patients, 74% [n=131], were from rural areas. A total of 87.6% of patients [n=155] were admitted to general wards and 12.4% [n=22] to the ICU. According to the SGA, 41.8%] [n=74] of patients had moderate malnutrition or were at risk of malnutrition and there were no severely malnourished patients. Men were at increased risk of being malnourished compared with women [p<0.05]. A tendency to malnutrition was observed in older individuals, especially in those 60 years and older [p<0.001]. According to univariate analysis, complications were significantly more frequent among those at risk of malnutrition than among the well nourished as there was 61 patients from group 2 [82.4%] versus 32% [n=33] incidence of complication in group 1 [p>0.001, Relative Risk RR=2.58 and Attributable Risk AR=50.4%]. Overall mortality was 15.3% [n=27] of which 11.9% belonged to group 2 [n=21] and only 3.4% [n=6] belonged to group 1 [p<0.001] and the median length of hospital stay was 19 days [range 6-39 days]. The hospital stay in group 2 was 25 days +/- 14 [Mean +/- SD] Vs 14 days +/- 8 [Mean +/- SD] in group 1 [p<0.001]. Malnutrition is frequent in hospitalized patients in Internal Medicine department on admission, and it is an independent risk factor for morbidity, mortality, and prolongs the length of hospitalization. Efforts should be made to quickly assess the nutritional status of these patients and early start of nutritional intervention should be done