Echocardiographic profile of rheumatic heart disease at a tertiary cardiac centre

Rheumatic Heart Disease [RHD] continues to be a major public health problem in developing countries like Pakistan. Objective of this cross sectional-analytical study was to analyze the severity of valvular lesions on echocardiography in patients pre-diagnosed with RHD. The transthoracic echocardiographic records of RHD patients from 2004 to 2008 were retrospectively reviewed for type and degree of valvular involvement according to AHA/ACC guidelines. A total of 13, 414 patients [7, 219 Males [53.8%], 6, 195 Females[46.2%]] ranging from 11 to 90 years with a mean age of 42.33 +/- 18.976 were studied. On echocardiography, 7, 500 [56%] had mitral regurgitation [8.8% severe MR], 6, 449 [48.2%] had tricuspid regurgitation [7.1% severe TR] and 5, 550 [41.4%] had aortic regurgitation [8.8% severe MR], 6, 449 [48.2%] had tricuspid regurgitation [7.1% severe TR] and 5, 550 [41.4$] had aortic regurgitation [4.8% severe AR]. MS was detected in 2, 729 [20.3%] patients [15.3% severe MS], AS in 102 [0.8%] and TS in 31 [0.2%] patients. Mixed mitral valve disease was seen in 3, 185 [23.7%], mixed aortic valve disease in 222 [1.7%] and mixed tricuspid valve disease in 47 [0.4%] patients. All three valves were involved in 2, 826 [21.06%] patients, combination of mitral and aortic valves in 3, 103 [23.13%], mitral and tricuspid in 3, 784 [28.2%], and mitral only in 3, 701 [27.59%] patients. There was some mitral valve abnormality in all patients. Mitral valve was most commonly affected, while regurgitant lesions were more common than stenotic lesions, and most severe in younger patients. All valvular lesions had almost an equal distribution among the sexes, except aortic regurgitation, which was more common in females. Therefore, echocardiography should be done routinely for patients with RHD, focusing on younger population, to facilitate diagnosis and definitive treatment before complications set in

Novel tetrahydronaphthyl thiazole derivatives of anticipated anticancer activity

A new series of some new N-arylidene-4-[1,2,3,4-tetrahydr onaphthalene-6-yl]thiazol-2-amine Schiff bases Il cyclized either by thioglycolic acid or thiosalicylic acid afforded thiazolidinone and benzothiazine derivatives III and IV, respectively. Also, amine I condensed with alpha-halocarbonyl compounds to give the corresponding amino derivatives V. Cyclocondcnsation of the chloroacetamido derivative Vd gave the pyrazine, quinoxaline, benzoxazine and chlorobenzoxazine derivatives VI-VIIIb, respectively. Compounds IIc, III, Vb, VI are evaluated as anticancer agents in human liver carcinoma cell line [HePG2] and breast carcinoma cell line [MCF7] and showed promising activities against these two cell lines

Nutrition capacity development in the middle East and North Africa

The Middle East and North African Nutrition Capacity Development Initiative started in July 2004 as a component of a global initiative spearheaded by UNU and IUNS for development of human and institutional capacity in nutrition. The Middle East and North Africa Nutrition Association [MENANA] was established as an affiliated body to IUNS and took responsibility for identifying core areas for nutrition capacity building in the region. The members adopted a "new conceptual framework for planning nutrition capacity development activities within a comprehensive ten-year plan of action, using a new Conceptual Framework and Guideline for Nutrition Capacity Development Planning developed by Dr. Gohar for use by the MENANA members. A future vision for food security was agreed upon, supported by a prioritized plan of action. The member found that Regional research capacity needs strengthening to address the role of nutrition in prevention of diet related diseases and combating .malnutrition, including micronutrient deficiencies. Mapping research centers in the region was the first task decided to be undertaken by MENANA. Nutrition training to strengthen regional skills of nutritionists has been planned. Nutrition academic education and accreditation of dieticians was discussed, and a regional accreditation examination for dietitians established by MENANA. In the area of nutrition advocacy/education communication, a steering committee was established to organize workshops to enhance regional advocacy. Nutrition networking was planned to strengthen regional inter-country collaboration and cooperation for nutrition capacity building. The selected priorities were supported by the establishment of a regional Nutrition Capacity Building website to include a database of nutritionists in the region, their affiliations and field of interest. A matrix of selected, simple and sensitive nutrition status indicators was planned to be published in the website for the purpose of monitoring regional nutrition status. The website will also provide information services to nutrition professionals in the region and will be linked to important updated nutrition information

Consumer perceptions and constraints regarding iron deficiency anemia and flour fortification using focos group discussion technique

Bread is staple food and also sacral food item in the Egyptian diet. Any Change in its content or characteristics may be a very sensitive issue. Therefore consumer perceptions toward fortification of baladi bread with iron must be carefully taken into consideration. Consumer perceptions regarding anemia and fortification were investigated using focus group discussion technique. Eleven focus groups were conducted in Fayoum among different target groups [university students "males, females and mixed", physicians, nurses, teachers "males and females" NGO's leaders, illiterate housewives and consumer protection committee]. The discussion included, their perceptions towards nutritional disorders, priority of iron deficiency anemia and its impact on health, methods of prevention and flour fortification with iron alone versus iron plus vitamins and mineral. The main results of the discussion were as follows: Some consumers believed that anemia doesn't affect more than l0%of the population while others thought that around 70% of the population mainly the poor or rural residents are affected.-The impact of anemia on health varies according to the gender of consumer target groups female consumers stressed the importance of its impact an beauty while male consumers stressed the importance of its impact on power and reproduction. The majority of the target groups supported flour fortification with iron as a cheap and easily administered method for prevention of iron deficiency anemia. Nevertheless this support was given with some suspicion toward iron [perceived as a chemical product added to their sacred bread]. The main perceptions varied from suspect of harmful effects on health, suspected changes in loaf characteristics, or suspicions toward the efficacy of quality assurance techniques. Almost the consumers refuse to give a new name to the fortified bread but they did prefer the use of iron plus vitamins and minerals. The consumers appreciated that the government has taken their views and perceptions into consideration

Social marketing strategy for promotion of iodized salt in Egypt

Despite the fact that the iodized salt program has been implemented in Egypt since 1996, yet Egypt health Demographic survey [DHS/2001] revealed that household iodized consumption at the national level was only [56%]. One of the main reasons behind such a low figure is lack of consumer awareness. Accordingly the National Nutrition Institute NNI [in collaboration with MOHP /UNICEF Egypt] planned and implemented a marketing strategy to demonstrate its impact in creating consumer demand for use of iodized salt in two Egyptian governorates with the least household consumption levels [Gharbia and Fayoum]. A Qualitative study using focus group discussion technique was carried out followed by development of educational communication materials. Social marketing activities included; advocacy and orientation meetings- local committee formulation- training of community volunteers- two launching meetings for the campaign- promotional communication activities in [schools, health centers, agricultural extension units, religious sites and mass media channels]. Monitoring and evaluation of the social marketing campaign activities was made. A field survey of the iodized salt status at retail and household levels at the end of the campaign showed improvement by almost 1.6 times in Gharbia and 2.5 times in Fayoum. It was concluded that using a social marketing approach for promotion of the iodized salt program is an important and effective strategy, which should be expanded in other Egyptian governorates together with legislation and control of illegal salt availability at market level and increased provision of iodized salt availability for consumer purchase

Social marketing campaign for school-based Iron supplementation program

Social marketing was used for a non compulsory short-term iron supplementation trial conducted in two preparatory schools [boys and girls] in Giza Governorate. The iron supplement of 120 mg elemental iron plus 30mg Vit. C /week, was given in form of biweekly doses over eight week's period [Feb.-April,2000], after broad spectrum anti-helmintic treatment. The iron supplement was delivered by two different systems: 4 weeks by Nutrition Institute staff [as model], and 4 weeks by teaching staff. Advocacy staff meeting at district level, meetings with schoolteachers and parents councils, letter to parents, hot-telephone line for inquiries, and health talks using school media and student health groups were the main social marketing activities. Quantitative and qualitative evaluation was made for the prevalence of anemia, coverage of target groups and their compliance to iron supplements. Social marketing activities commenced from the start had created awareness, built trust and confidence among the concerned parties; educational staff, parents, and children and gained support for the program. This led to high coverage [97%] of children participated in the trial; compliance of schoolchildren to biweekly iron supplements reach 82.2% of planned tablets, with significantly more compliance for boys than girls [86.9% Vs. 79.3%]. The school-based delivery for iron tablets is feasible and more sustainable through well-trained and approachable staff. Finally the initial level of anemia [12.81%] was decreased by almost 20% at the end of the trial period. Further study is needed to scale-up iron supplements program for preparatory schoolchildren as a preventive measure against iron deficiency anemia

Effect of nutrition and social factors on menarcheal age among Egyptian adolescent girls

The aim of this study was to determine the nutritional and social factors affecting age at menarche. In a cross sectional analytical study, 2021 adolescent girls aged [11-18 years] were surveyed in six different governorates. Age at menarche was estimated by the recall method and given by the study participants. A questionnaire was designed to collect information about education of girls, family size, number of rooms, parent's education and occupation. Anthropometric measures [weights and heights] were done. Food intake was determined by using 24 hours recall method. Adolescent girls were grouped into three levels according to social characteristics regarding the education and occupation of their parents. Crowdness index was calculated by dividing the family members over the number of rooms. Weights and heights were computed in accordance with age and compared with WHO [1995] percentiles of BMI/age. It was found that 67.2% of the sample had commenced menarche. The mean age for girls at menarche was 12.9 +/- 1.3 years. Among the non menstruating girls 13.1%were under weights. While among the menstruating 19.4%were over weights and 10% obese. The mean percentile of body mass index/age was significantly higher among the menstruating girls [p=0.00].Girls with high level of education commenced menses significantly earlier.[p=0.00] Family size,crowdness index, social levels showed no significant differences between pre and postmenarcheal girls. The total caloric intake and total protein intake were consumed by a higher percentage among girls who experienced menses though not significant. Intake of Micronutrients, retinol, iron and calcium were below the reference values by all girls suspecting under nutrition problems namely vit A deficiency, calcium deficiency problems and iron deficiency anemia. The mean age of menarche in Egypt is [12.9 +/- 1.3] years. Better nutrition on a balanced diet, girls education are important predictors for age at menarche

Prevalence of antibodies to hepatitis C virus in hemodialysis patients and renal transplant recipients

This work was carried out to study the prevalence of hepatitis. C virus [HCV] infection, its associated risk factors and Possible routes of transmission in hemodialysis patients and renal transplant recipients. Ninety five patients and 15 normal controls were included in this Study. Patients were Classified into 3 groups: Group I [64 hemodialysis Patients], Group II [16 renal transplant recipients] and Group III [15 patients with chronic renal insufficiency on Conservative treatments] Each individual was subjected to full clinical examination, estimation of serum alanine aminotransferase [ALT], testing for antibodies to hepatitis C virus [anti-HCV], screening for hepatitis B surface antigen [HBsAg], antibodies to hepatitis B surface antigen [anti-HBs] and/or antigen [anti-NBC] by modified ELISA technique. Anti-HCV was found in 87.5% of hemodialysis patients, 81.25% of renal transplant patients, 53.3% of the conservative group and in 13.3% of the control group. There was a significant correlation between the presence of anti-HCV and the duration on dialysis in groups I and II [p < 0.05], while no significant correlation was detected between HCV positive cases and the number of units of transfused blood in groups I and II [p > 0.05]. Serum ALT was elevated in patients with HCV infection but there was no significant correlation between the presence of anti-HCV and elevated ALT level among the examined groups of patients [p > 0.05]. The prevalence of HCV infection was not correlated with the duration of renal transplantation and the type of immunosuppressive therapy [p > 0.05]. Coinfection with HBV and HCV could occur, as previous infection with HBV was demonstrated Anti-NBC was found in 51.8%, 66.7%, 37.5% of anti.-HCV positive patients in groups I, II; III respectively. Anti-HBs was detected in 24.1% and 15.4% of anti-HCV positive in groups I and II.HBsAg was found only in 4.7% of anti-HCV Positive hemodialysis