Postprandial hyperinsulinaemia and growth of human hepatocellular carcinoma

Human liver cirrhosis is commonly associated with increased fasting and glucose induced insulin concetrations. The main cause of impaired glucose metabolism in chronic liver disease is a reduced insulin action. Patients with chronic liver disease complicated with human hepatocellular carcinoma [HHC] frequently have impaired glucose metabolism. Aim: To investigate the effect of augmentation of postprandial hyperinsulinaemia on the growth of hepatocellular carcinoma. Patients and methods: The growth rate of 60 small hepatocellular carcinomas [diameter 140 days, n=30]. Fasting plasma insulin concentration and area under the plasma curve [AUCins] of oral glucose tolerance test [10.3[6.3] mirco U/ml and 265 [159] mirco U/ml/h, respectively; [mean [SD] in the rapid growth group were significantly higher than those in the slow growth group [7.7[4.5] mirco U/ml/h and 153 [145] mirco U/ml/h], respectively] [p= 0.031, and 0.0005], respectively. In contrast, Fasting plasma glucose concentration and area under the plasma glucose curve [AUCglu] in the rapid growth group were significantly lower than those in the slow growth group [p=0.0002 and p=0.001, respectively]. Initial tumor size was significantly higher in rapid growth than in the slow growth with p=0.01. Univariate and multivariate analyses of logisitic regression models demonstrated that AUCins was a significant factor contributing to the growth rate of HCC [p=0.001 and p=0.015, respectively]. Conclusions: The real time ultrasonography appears to offer a simple, safe, and noninvasive method of monitoring the growth rate of hepatocellular carcinoma. The postprandial hyperinsulinaemia is significantly correlated with the rapid growth of human hepatocellular carcinoma; accordingly octreotide[long acting somatostatin analogue] can be used in the treatment of inoperable hepatocellular carcinoma

Adult depression in Alexandria Egypt, 1998

The objectives of this population based study were to quantify the prevalence of depression among adults in Alexandria, to identify some of its determinants as well as to reveal gender differences in its presentation. 300 adults were surveyed in their households [10 from each of 30 clusters of the governorate]. The self administered Beck's inventory for usage in primary care settings was used for identifying the depression state. The prevalence rate was 11% with a non significant higher proportion among males. Mean age of depressed subjects was higher than the free Age interval with highest percentage of cases was 50-60 years. Epidemiologic variables that were found to be significantly associated with a higher rate of the condition were being divorced or widowed, a positive recent history of stressful life events and having a positive personal history of psychological troubles. On the other hand, examined factors like financial state, working status and whether the person is a bread earner or dependent in the family had no association with the state of depression. Male cases were younger than female ones they also had a higher mean score on the depression scale. The genders differed significantly in scores of psychopathological parameters related to hopelessness, low self esteem, loss of sexual interest, loss of pleasure, guilt, self reproach and suicidal ideation. The authors recommend active case finding for depression at the primary care level, instituting counseling services for marriage and family relations, intensifying mass media health education directed to mechanisms of coping with life stresses and restudying the gender differences in epidemiology of depression in a large scale community research

conformity of physicians' performance with the national guidelines of the Egyptian family planning program

Data on adequacy of physicians' performance at family planning clinics in Alexandria is contained in this report. An observational check list was used for monitoring the daily performance of 35 physicians working in the 12 family planning clinics of Alexandria. Clients were intrauterine device users in their initial visits to the clinics. The whole care process was divided into five areas covering interpersonal communication and technical aspects. The percentage score [physicians' performance index] was calculated for total, area and sub-areas of care. The collective performance index combines indices of physicians in both types of facilities together. Fifty percent value of physician performance index was taken as the cut-off point between lower unacceptable performance and higher acceptable one. The collective total performance index was unacceptable [49.37 +/- 8.24] denoting considerable deviation from standards of adequate care. Areas of care related to examination and history taking tasks had the most deficient collective physician performance index [6.72 +/- 6.64 and 25.56 +/- 13.03 respectively]. Negligence of these two areas skips the two basic rationales for right choice of the contraceptive method. The collective performance index for communication was just above the acceptable value [51.20 +/- 13.37]. The two areas with highest performance index were infection control and intrauterine device insertion [63.36 +/- 10.79 and 65.66 +/- 12.08 respectively]. This is an indication of the technical orientation of physicians leaving the total program concepts like informed decision and continuation inadequately implemented. Performance index of physicians in specialized clinics was repeatedly found to be significantly higher than those of integrated clinics in all areas of care. In area of communication, the performance index in specialized clinics was acceptable in contrast to that in integrated ones. However, the performance index in the two types of clinics were found together in either the acceptable or the unacceptable range in all other areas. This may reflect the existence of a dominant atmosphere that enhances or weakens the performance in different areas of care and the priority of importance given to these areas

epidemiological study on hepatitis A cases admitted to Alexandria Fever Hospital

This study was conducted on 160 clinically diagnosed cases of hepatitis A at the Fever Hospital in Alexandria. The present findings revealed that 25% of cases of hepatitis A had their residence in El Montazah district which is a newly inhabited area of Alexandria which probably reflect the ease of communicability of hepatitis A in this area. Three results point to the possibility of clinical misdiagnosis of the type of hepatitis I. The mean age of cases was older than expected for hepatitis A [mean=24.63 +/- 14.36 years] 2. The onset was gradual in 22.5% of cases in contrast to the sudden onset described in the identification of hepatitis A[3]. Fever was reported by only 43.75% of patients. This study concluded that further study is needed in El Montazah area to preclude the causes of clustering of cases from this area. It also recommends serological differentiation of the type of viral hepatitis at fever hospital in order to guard against the possibility of chronic carriage of hepatitis B to pass undiagnosed