Antenatal care among Palestine refugees in Jordan: factors associated with UNRWA attendance

Background: Maternal and neonatal mortality is a global issue acknowledged by the Sustainable Development Goals (SDGs). Adequate ante-natal care (ANC) is pivotal to reducing these mortality rates, while understanding why women don’t attend ANC is crucial to addressing the SDGs.

Aims: Using routine primary health care data to determine the factors associated with inadequate attendance by Palestine refugees (PR) to ANC seeking facilities provided by the United Nations Relief and Works agency for Palestine Refugees in the Near East (UNRWA), Jordan.

Methods: A backwards logistic regression model incorporating non-health system factors and health system factors, was performed using UNRWA data.

Results: A younger age of women was associated with inadequate ANC visits (P = 0.0009) in the non-health systems model. For health system factors, pregnancy risk status, having a gynaecologist review and the health centre attended were factors found to be significantly associated with ANC attendance (P < 0.0001).

Conclusions: Understanding the health system factors associated with ANC attendance can lead to changes and improvements in UNRWA’s operational policies

Prevalence of depression and associated factors among elderly Sudanese: a household survey in Khartoum State

We assessed depression among 300 elderly Sudanese [age 60+ years]. We conducted a cross-sectional household survey in 3 localities in Khartoum State. A 2-stage stratified sampling was carried out to select the localities and then the areas using simple random sampling; then systematic random sampling was used to select households. The prevalence of depression was 47.5%. Depression was significantly associated with age [P = 0.002], level of education [P = 0.015], occupation [P < 0.001], the problems of everyday living [P = 0.026], and social problems [P < 0.001]. After controlling for confounders using multiple logistic regression, we found that depression was 4 times greater among the elderly retired compared to the elderly working, 3 times greater among the elderly with social problems and those who were suffering from urine incontinence and 2 times greater among the elderly with living problems

Knowledge and attitudes of population towards HIV/Aids in four states, Sudan

HIV/AIDS is a public health problem in the Sudan. The country is the most severely affected in North Africa and the Middle East with an estimated 500,000 people living with HIV/AIDS. The objectives of the study were to determine knowledge and attitude of the local population in selected states about HIV/ AIDS and to determine the relation between knowledge and attitude towards HIV/AIDS and associated social factors. Design was descriptive, cross-sectional, community- based study conducted in Gezira, Sinnar, River Nile and Northen states. The population was those found in their settings during the visits in April 2009. Both sexes were enrolled and children below the age of 15 years of questionnaire and were analyzed by the computer using SPSS, version 13, soft ware. Knowledge of the population in the selected four states about HIV/AIDS was favorable [73%]. Tolerant attitude towards HIV-infected people was low [40%]. Results showed that males acquired better knowledge than females [76.2% versus 71.8%] but females were more tolerant towards HIV/AIDS than males [42% versus 37.4%]. Results showed that HIV/AIDS Knowledge graduates [92.6%] followed by basic and secondary [76.7%]. Illiterates acquired the least level of knowledge [42.4%]. The study showed that tolerance of population towards PLWHA increased according to the level of education. The university graduated was more tolerant [55.1%] than the basic/secondary [40.5%] and illiterates [21.9%]. It was shown that the single population was more tolerant towards PLWAH, followed by the married, the divorced and the widowed constituting 41.6%, 40.4%, 31.4% and 25% respectively. The study concluded that, level of knowledge was HIV/AIDS of the population in the selected states was good. Level of knowledge among males, the working force and the single population was higher than the females, those without jobs and the married. Level of HIV/AIDS knowledge increased according to the level of education, was higher among university graduates followed by basic / secondary and Illiterates. Attitude of the population in the selected states towards people living with HIV/AIDS "PLWHA" was low, only 40% had more tolerant attitude. Females, the highly educated and the working population were more tolerant towards HIV/AIDS than males, the less educated, and the nonworking population

Condom use among illegal multi-partners females in the Sudan

Professional multi-partners females have relatively high numbers of sexual partners. The prevalence of HIV among multi-partners is high. Illegal multi-partners females probably have the same high risk. To describe baseline indicators of condom use during sexual intercourse among a religiously prohibited, and socially non accepted population which is represented by illegal multipartners females. From Oct 2010 to Dec 2010, we collected data on condom use and sexual habits of 102 illegal multi-partners females, in two cities [Khartoum and Kasala]. Because it is religiously prohibited, and is a social stigma in an Islamic community, access to multi-partners females for research purpose is very difficult in Sudan. Nevertheless, women were recruited as they were seeking care in STIs at dermatology and STIs public clinics in Khartoum and Kassala The median age of female multi-partners was 36 years [range 21-56]. The reported median number of clients was 80 per month [range 4-200 clients]. Vaginal intercourse was most common [98%] and anal intercourse was infrequent [10%]. Of 102 participants, 97 [95%] reported no use of condom with their clients, whereas five women [4.9%] reported irregular use of condom. Of 102 participants only four [3.92%] are ported being tested for HIV infection. Of 102 participants 61/102 [60%] did not have condoms during sexual intercourse, whereas 20 [19.61%] reported resistance of the partners, 15% although they knew the benefit if using condoms, but partners pay more if not use and 5% were indifferent if use or not. Our results confirm that illegal multi-partners females may be at increased risk for HIV infection and so their clients will also be at high risk of contracting HIV. Beside being religiously and legally prohibited and socially unacceptable, this unsafe practice can create a serious health problem

Does postdural puncture headache left untreated lead to subdural hematoma? Case report and review of the literature

The patient was a 39-year-old pregnant woman who was scheduled for cesarean section. Spinal anesthesia was induced using a 26-gauge needle with an atraumatic bevel. Postoperatively, the patient developed cranial subdural hematoma manifesting as severe non-postural headache, associated with right eye tearing, fifth cranial nerve palsy and left hemiparesis. The diagnosis was confirmed by computed tomography scan. The patient was managed by careful neurological follow-up associated with conservative treatment and recovered fully after 12 weeks. Our report reviews the literature on 46 patients who developed a postdural puncture headache complicated by subdural hematoma following spinal or epidural anesthesia. It is possible that postdural puncture headache left untreated may be complicated by the development of subdural hematoma. Patients developing a postdural puncture headache unrelieved by conservative measures, as well as the change from postural to non-postural, require careful follow-up for early diagnosis and management of possible subdural hematoma. [c] 2005 Elsevier Ltd. All rights reserved

Applicability of evidence based medicine in the Sudan

Evidence-based medicine [EBM] is a growing practice in health care that aims to bring and apply the best evidence from medical research outcome to the bedside, clinic and community. Although evidence based medicine is now well recognized and practiced in many developed countries, it is still not well known in medical practices in many other developing countries. The aim of this paper is to clarify the basic concept, methodology, resources of evidence-based medicine, situation, obstacles and its applicability in Sudan

Severe malaria in Sudanese children: clinical aspects and prognosis in hospitalized patients

To assess the epidemiology, clinical presentations, disease management, outcome and risk factors associated with severe malaria in children in four hospitals in Sudan. Follow-up prospective design was used to fulfill the objectives of the study in four hospitals: Omdurman pediatrics hospital, located in the capital [Khartoum] compared to Madani, Gadarif and Sennar hospitals located in other states. Total admission of severe malaria was 543 children representing 21% of all paediatric admissions, and 12% of malaria outpatient cases. Median age of children with severe malaria was 48 months. 93% of children with severe malaria died before the age of 9 years. Case fatality rate was 2.6%. The risk of dying because of delay was four times more than when there was no delay, 95% CI [1.5 - 14.3]. Other risks of death were severe malaria associated with coma, inability to sit or eat and hyperpyrexia. Omdurman hospital in Khartoum State in the capital, had the highest case management performance percentage compared to other regional hospitals. In view of this, it can be argued that deaths due to severe malaria could be reduced by improving health management and planning with the redistribution of resources [including consultants] at the central and regional levels and the conduct of proper training

Angiotensin converting polymorphism in obese patients

Obesity is a complex disorder caused by the interaction of environmental and genetic susceptibility associated with increased risk of morbidity from a variety of disorders. The aim of the present study was to investigate the association between ACE I/D polymorphism and obesity and its contribution to the different risk factors among obese patients which may constitute the basis for strategies to manage this serious problem. Fifty-four male obese patients with BMI >/= 30 kg/m[2] were recruited. Twenty-six healthy men with BMI < 25 kg/m[2] of comparable age were selected as a control group. All patients and controls were subjected to thorough history taking, anthropometric measurements [weight, height, BMI, waist and hip circumference and WHR] and BP measurement. ECG was done. Laboratory investigations included FPG, PPPG, HbA[1c], OGTT, lipid profile and fasting serum insulin. IR was determined by the computer updated 1996 version of HOMA2. ACE I/D polymorphism was determined by PCR. Eighteen and a half percent of obese patients had a family history of CHD and 31.5% were smokers. Nineteen patients were categorized as prehypertensives while 20 had stage 1 or stage 2 hypertension. IHD was diagnosed in five obese patients. Hyperlipidemia, IGT and DM were detected in 61.1%, 50% and 22.2% of obese patients, respectively; 29.6% of patients had grade I obesity, 29.6% had grade II and 40.7% had grade III obesity. Sixty-three percent of patients had a waist circumference> 102 cm and 38.9% had a WHR> 1.0. Obese patients had significantly higher FPG, PPPG, HbA[1c], fasting serum insulin, HOMA2-IR and HOMA2-%B as compared to controls. On the other hand, HOMA2-% S was significantly lower in obese patients. All studied lipid parameters were significantly higher in obese patients except HDL-cholesterol which was significantly lower in obese patients. The distribution of the ACE genotype for obese patients was 38.9%, 46.3% and 14.8%, for the DD, ID and II, respectively. In controls, 34.6% were DD, 46.2% were ID and 19.2% were II genotype. There was no statistically significant difference between obese patients and controls as regards the genotype frequency [Pearson X[2]=0.296; P=0.862]. Relative allele frequencies in both groups were D allele: 0.620 in obese versus 0.577 in controls and I allele: 0.380 versus 0.423, respectively with no statistically significant difference as well. There was a statistically significant difference between the three ACE I/D genotypes of obese patients as regards BMI, waist circumference and WHR. The DD genotype was associated with higher values of these obesity markers. No such differences were observed for control participants. There were no significant differences in age, SBP and DBP among the three ACE genotypes of obese patients. However, there was a tendency towards DD genotype in the older age group and in patients with higher BP. There was no significant difference between DD, ID and II ACE genotypes of obese patients as regards any of the studied metabolic parameters. However, numerically higher values of FPG, PPPG, HbA[1c], fasting serum insulin, HOMA2-IR, serum triglycerides, total cholesterol and LDL-C and lower values of HOMA2-%S and HDL-cholesterol were observed among DD genotypic obese patients. Overall, DD homozygote obese patients showed a tendency for family history of CHD, smoking, abdominal adiposity, hypertension, hyperlipidemia and DM. ACE I/D polymorphism was significantly associated with abdominal adiposity, hyperlipidemia and DM in obese patients when compared with patients having no such risk factors [P=0.021, P=0.049, P=0.045, respectively]. Nine obese patients showed a maximum of five associated risk factors that were added to obesity, while only two obese patients presented with no such associated risk factors at all. Seven of those nine obese patients were DD homozygotes. It was found that the more the number of studied risk factors added to obesity, the more the prevalence of the DD homozygote genotype [LLR=27.153; P=0.002]. The results of the present study could indirectly suggest that the DD genotype contributes a genetic factor for the development of abdominal obesity and that this would predispose obese patients to further risk for development of CHD. ACE inhibitor therapy can induce improvements in atherosclerosis and IR and therefore they are ideal drugs to be used in obese hypertensive patients

Bone metabolism in dialysis patients assessed by biochemical markers and densitometry

A decrease in bone mineral density is common in patients with chronic renal failure. It is also a risk factor for fractures in this population. The aim of the study was to evaluate bone mineral density-BMD and some biochemical markers of bone metabolism in patients on chronic hemodialysis. The study was performed on 50 patients on chronic hemodialysis. Bone mineral density was measured using dual energy x-ray absorptiometry [DEXA] in the distal left forearm. Concentrations of iPTH and carboxy terminal propeptide of type I collagen [PICP] was measured by commercially available Kits. Mean T scores of the distal left forearm were -2.7 +/- 2.2 for men and -2.2 +/- 1.9 for women T scores in the range of osteopenia were present in 30% of patients, and in the osteoporosis range in 54% of patients. Patients with bone mass measurements in the osteoporosis range had significantly increased iPTH levels compared with patients with T scores in the osteopenic/normal range. There was statistically significant negative correlation between BMD T scores and iPTH [r=-0.63, P0.0032] and with PICP [r=-0.820, P=0.0001]. On the basis of our finding we conclude that bone loss is seen in patients on chronic hemodialysis. Bone turnover markers estimated in this population correlated well with BMD measurements at sites of pure cortical bone as the distal radius

Cytokine elimination during continuous hemofiltration. A feasible clinical modality for septic patients

Tumour necrosis factor a [TNF-alpha] and interleukin 6 [IL-6] arc important prognostic markers in intensive care unit [ICU] septic patients. The aim of the study was to determine whether continuous venovenous hemofiltration [CVVH]. using Fresenius hemofilter AV600s, leads to elimination of TNF-alpha and IL-6 in 20 septic patients with multi-organ failure. At the start of hemofiltration [o], 6 and 12 hours the mean afferent plasma concentration +/- SD of TNF-alpha [41.9 +/- 9.56, 30.85 +/- 6.2. 25.5 +/- 5.28 pg/ml] and that of IL-6 [890 +/- 183.96, 635 +/- 149.65, 410 +/- 168.27, pg/ml]. 'the different plasma concentrations were significantly lower than tile corresponding afferent concentrations. TNF-alpha and IL-6 were detectable in the ultra filtrate of all patients. The plasma clearance of TNF-alpha and IL-6 significantly decreased after 12 hours as a result of the adsorptive elimination of the mediators due to progressive membrane saturation. We demonstrated that CVVH could represent an appropriate tool to remove a broad spectrum of proinflammatory mediators, if such removal is required in septic patients

Plasma total homocysteine levels in patients with tType 1 diabetes: effect of chronic cigarette smoking

Aim: The purpose of this study was to compare plasma total homocysteine [tHcy] levels, a recognized cardiovascular risk factor, in non-diabetic subjects and type 1 diabetic patients, and to evaluate whether chronic cigarette smoking had a deleterious effect on plasma tHcy levels in these patients. Subjects and To achieve this aim, plasma tHcy concentrations were measured in 50 young type 1 diabetic patients without clinical evidence of macroangiopathy and in 50 healthy control subjects who were matched for age, sex, BMI and smoking habit. It was found that plasma tHcy levels were significantly higher in type 1 diabetic patients than in control subjects [12.5 +/- 4.9 vs 10.3 +/- 2.3micro mol/l, P<0.01]. Comparing the clinical and biochemical characteristics of diabetic subjects grouped according to smoking status, diabetic smokers had higher levels of plasma triglycerides, but no significant differences were found in age, sex, BMI, total cholesterol, creatinine, glycometabolic control, blood pressure, duration of diabetes, and the presence of chronic microvascular complications. Nevertheless, plasma tHcy levels were markedly elevated in diabetic smokers [by -50%] versus nonsmokers, [15.5 +/- 5.6 vs 10.6 +/- 2.9 micro mol/l, P<0.0001] in a dose-dependent fashion, when subjects were categorized for the number of cigarettes smoked daily. Conclusions: We concluded that chronic cigarette smoking seems to adversely affect plasma tHcy levels in young adults with type 1 diabetes

Matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1, parathyroid hormone related protein and tissue expression of CD44v6 in metastatic breast cancer

Matrix metalloproteinases [MMPs] and their inhibitors [TIMPs] modulate ECM composition and may affect breast cancer invasion and metastases. Bone metastases are a frequent complication of advanced breast cancer. This work investigated the relationship between plasma levels of MMP-9, TIMP1, PTHrP, tissue expression of CD44v6 and the development of nodal and bone metastases in 40 female patients with different stages of breast cancer. The control group comprised 10 females with benign breast lesions. All studied parameters were significantly higher in patients than in controls. Patients with lymph node involvement has significantly higher plasma MMP-9, MMP9/TIMP-1 ratio and CD44c6 expression than those without nodal affection, [p= 0.018, 0.006 and 0.02 respectively]. Higher MMP-9 MMP9/TIMP-1 ratio and PTHrP were found in patients with than those without bone metastases [p = 0.013, 0.01 and 0.0002 respectively]. CD44v6 expression was associated with increased MMP-9 and TIMP-1 levels as well as higher tumour grade. Post-operative MMP-9 was significantly lower than pre-operatively. Our data indicate that increased plasma MMP-9 and MMP-9 / TIMP-1 imbalance may be useful markers for development of nodal and bone meatstases in breast cancer patients and in predicting post-operative recurrence. While CD44v6 is involved in nodal metastases, PTHrP seems to be an important determinant of development of bone secondaries

Acute effects of somatostatin injection on glucorgulation in states of hyperinsulinemia

Aim: Hyperinsulinemia is a constant feature of insulin resistant states. Insulin resistance appears to be a syndrome that is associated with type 2 diabetes mellitus, obesity, hypertension, lipid abnormalities and atherosclerotic cardiovascular disease. This study aimed at studying the effects of insulin suppression in hyperinsulinemic states regarding glucoregulation. Thirty patients were allocated in three groups: GIII: Obese nondiabetic [n =10], GIl: lean essential hypertensive patients [n =10], and Gill: obese type 2 diabetic patients [n =10]; together with 10 normal individuals as control. All cases were subjected to measurement of BMI, blood pressure, serum insulin and whole venous blood glucose fasting and after 60 minutes interval for 3 hours after 100 micro g subcutaneous injection of long acting somatostatin analogue. Fasting hyperinsulinemia was found in 80% of obese non-diabetics; 60% of lean essential hypertensive patients and in 90% of obese type 2 diabetic patients. Hyperinsulinem was positively correlated with the degree of BMI in group I and III. Maximal percentage suppression of insulin Was inversely correlated with BMI in the three different group. Blood glucose levels were significantly elevated in the second and third hours following somatostatin analogue injection in obese nondiabetic and lean hypertensive groups. Meanwhile it decreased significantly during the whole three hours in obese type 2 diabetic patients. Conclusions: One can conclude that suppression insulin by somatostatin analogue has significant effects on glucose regulation in patients with hyperinsulinemia. These effects were of dubious biological importance

Role of the kidney in removing circulating leptin in humans

To assess the role of the kidney in removing circulating leptin in humans by studying the leptin metabolism across the renal bed of normal human kidney and also studying the circulating leptin levels in end stage renal disease [ESRD] patients maintained on hemodialysis [HD]. The study included 14 human subjects with intact renal functions and who were scheduled for elective cardiac catheterization. Aortic, renal vein, peripherial arterial and urine samples were withdrawn from each subject. A separate cohort of 32 patients with ESRD maintained on HD were also included in the study. A blood sample was taken from the arterial limb of the vascular access of each patient before and after the HD session. For all samples, leptin levels were determined by radioimmunoassay [RIA]. In subjects with intact renal functions, plasma leptin concentrations were significantly increased in the aorta than in the renal vein [11.3 +/- 3.1 vs. 10.1 +/- 2.9 ng/ml] indicating net renal leptin uptake [RU]. The calculated RU was 849 +/- 184 ng/min which accounted for 65% of all leptin removed from the circulation. The calculated renal leptin fractional extraction [Fx] was 15.6 +/- 2%. Lineweaver-Burk analysis indicated that RU followed saturation kinetics with an apparent Michaelis-Menten constant of 10.7ng/ml and maximal velocity of 1700 ng/min. Leptin was generally undetectable in urine. In ESRD patients on HD, the peripheral arterial leptin levels standardized for body mass index were increased by fourfold as compared to control subjects with intact renal function. In addition, plasma leptin is not cleared by hemodialysis with a modified cellulose membrane. Human kidney plays a substantial role in leptin removal from the circulation by taking up and degrading the peptide. ESRD patients have higher levels of circulating leptin which are not cleared by hemodialysis using modified cellulose membrane

Zinc levels in short stature

Several studies have reported that zinc deficiency limited the growth in infants and young children. This study has been designed to determine the plasma and hair zinc levels in preadolescent children and adolescents with short stature and to search for an eventual correlation of their levels with insulin-like growth factor 1 [IGF-1] and growth hormone [GH]. Subjects and Methods This study was conducted on forty short stature children with apparent good health and with height measurements below the 3rd percentile for age and sex. They were divided into two groups: preadolescent children [n=20] and adolescents [n=20]. Twenty children of normal growth and of matched age and sex were included as controls. In all studied subjects, plasma GH levels were estimated under basal conditions and after applying two provocative tests [exercise for 20 minutes and clonidine stimulation after 30, 60, 90 and 120 minutes] using radio immunoassay technique [RIA], plasma IGF-I using RIA, plasma and hair zinc using atomic absorption spectrophotometry. revealed that both preadolescent and adolescent subjects had reduced levels of plasma zinc, hair zinc, plasma IGF-1 and plasma GH under basal conditions. After applying the two provocative tests [exercise and clonidine stimulation], preadolescents showed normal GH levels while adolescents were still having reduced GH levels. Plasma zinc levels in the adolescent group showed a significant positive correlation with height measurements and with IGF-1 levels of these subjects. From the results of this work, one can conclude that short stature preadolescent children and adolescents have decreased levels of zinc which could account for the limited growth in these subjects whether through indirect mechanisms or via hormonal mediation specially by lowering the levels of IGF-1

Clinical neurological and CT brain findings in children with beta-thalassemia major

The aim of this work was to study the effect of beta-thalassemia major on the nervous system in children via computed tomography [CT] of the brain and clinical neurological examination. The study included 32 children with beta-thalassemia major [20 males and 12 females] with ages ranged from 6 -15 years [mean age 9.19 +/- 2.5 years]. They were age-matched with 10 apparently healthy control children [6 males and 4 females] with a mean age of 8.9 +/- 3.14 years. The patients were classified into 3 groups: First group consisted of 8 children [5 males and 3 females] with a mean age of 7.57 +/- 1.49 years. The children in this group were included in the study at the time of first diagnosis to have beta-thalassemia major before receiving any medication, blood transfusion or iron chelation therapy. The second group consisted of 12 children [8 males and 4 females] with a mean age of 9 +/- 2.59 years. They were with a known diagnosis of beta-thalassemia major for at least 3 years. They received repeated blood transfusions and regular iron chelation therapy. The third group included 12 children [7 males and 5females] with a mean age of 10.3 +/- 2.57 years. They had the illness since 5 years or more. They received repeated blood transfusions, but on irregular iron-chelation therapy. The patients and controls were subjected to full history taking thorough general and neurological examination and assessment of sera ferritin levels. CT brain was done for the patients only. The following results were obtained: Patients of the first group showed no neurological abnormalities and 4 cases [50%] of them showed mild central atrophy. In the second group 8 patients [66.66%] showed generalized brisky deep reflexes. The same patients showed moderate central atrophy 8patients [66.66%] showed mild cortical atrophy and one case [8.33%] showed moderate cortical atrophy. In the third group 4 patients [33.33%] showed mental dullness [I.Q. 80, 70, 75, 70], 4 patients [33.33%] showed simple inattention to the surrounding stimuli with decrease of spontaneity and exploring. 4 patients [33.33%] showed bilateral, symmetrical sensory hyperesthesia of the distal parts of the extremities i.e sensory polyneuropathy, one of them was diabetic. CT brain of the third group revealed presence of moderate cortical atrophy in 8 cases [66.66%], mild cortical atrophy in 4 cases [33.33%], and mild central atrophy in 8 cases [66.66%]. The degrees of cortical atrophy and central atrophy were independent in the patients. Serum ferritin level showed high significant increase in patients [mean 955.6 +/- 563.99 ng/ml] in comparison with the control group [181 +/- 35.4 ng/ml]. It was as Follows in the 3 groups of patients respectively: 568.75 +/- 92.3 ng/ml., 861.67 +/- 221.15 ng/ml. and 1631.67 +/- 471.99 ng/ml. i.e., it was highest in the third group. We may suggest that there were 3 factors responsible for the above findings in variable degrees: anaemia which might cause some irreversible neurological changes, hemosiderosis and iron-chelation therapy. Hemosiderosis might be incriminated more than the other factors in the pathogenesis of atrophy of cerebral cortex while the white matter of the brain was atrophied more in patients with regular iron-chelation therapy

Properties of processed cheese made from ras and kashkaval cheese manufactured by direct acidification

Twenty one blends of processed cheese differing in their ingredients of hard cheeses were manufactured in the Alexandria National Center pilot plant [FOA]. The effect of using Ras and Kashkaval cheese made by direct acidification on physico chemical, texture, colour, organoleptic and microbiological properties of processed cheese, were studied. Results indicated that: 1. Slight increase in acidity making the mixture easier to melt during cooking. 2. Texture of the processed cheese product would have good spreading properties. 3. The colour of processed cheese was influenced by using hard cheese made by direct acidification specially when kashkaval cheese was used as the main resources of hard cheese. 4. processed cheese of acceptable quality could be obtained by using Ras or kashkaval cheeses prepared by direct acidification

Effect of some protein additives as improvers on physico-chemical, whipping and organoleptic properties of whipped cream

Four sorts of protein [skim milk powder, sodium caseinate, whey protein concentrate and soy protein isolate] at 3 levels of each of them [1, 2 and 3%] were used as improvers for the quality of whipping cream after being tested for the best percentages of sugar stabilizer and emulsifier which give the good platability, physicochemical and whipping characteristics. Using 10% sugar + 0.3% stabilizer and emulsifier [gelatin and mono-and diglycerides] gave the best results for the whipping properties [overrun, foam stability and the time of whipping PH values and viscosity before and after whipping] also, best sensory evaluation. Thus, this treatment was the more preferable than the other treatments and it was, then, applied in all the other experiments. The PH values and viscosity [CP] varied highly significantly [P <0.00] with different sorts of protein additives. Using skim milk powder and sodium caseinate increased the viscosity of whipping cream than the others at all the levels tried. The foaming volume [overrun] varied highly significantly [P <0.00] between sort and level of protein. The highest foam stability was obtained by using either whey protein concentrate or soy protein isolate

Peripheral retina in myopic eyes

The condition of the retinal periphery and degree of myopia and axial length of the myopic eyes [axial myopia] were studied. One hundred and five Egyptian eyes, the degree of myopia varied between -0.5 and -30.0 diopters. Slit lamp and operative microscope biomicroscopy with Goldmann-3 mirror fundus contact lens with scleral depression. Axial length was determined by A-mode ultrasonography. Seventeen types of vitreal and peripheral retinal lesions were found in 85.71%, of which chorio-retinal degenerations [85.71%] were the commonest, followed by cystoid degeneration [83.81%], then pigmentary degeneration and pigment clumps [60%]. Pigmentary degeneration and pigment clumps, paving stone degeneration, vitreous liquefaction, PVD, WWOP, glistening dots, lattice degeneration and retinal breaks; all were significantly increased with the increase in the degree of myopia. Lattice degeneration and its associated lesions as paving stones, WWOP, PVD, retinal holes, glistening dots and pigmentary degenerations were increased by the increase in the anteroposterior diameter [axial myopia] of the globe