[Relationship between body image and eating disorders]

Adolescents face special problems which are less common during childhood. Their self image that is influenced by their body changes during this period could cause eating disorders. The aim of present study was undertaken to asses the relationship between body image and eating disorders among female students in Kerman's high schools. Using a correlational study design, 650 female students drawn from high schools were selected. Data were collected through demographic, eating disorders and body image questionnaires. Data was analyzed using Central and distributional indices, T-test, one-way analysis of variance, linear and logistic regression. Total mean score of body image was 64.02%. The highest scores belonged to the upper part of body such as hair, ears, hands and chest. 6.3% of students had eating disorder, consisting of 1.7% anorexia nervosa, 1.7% bulimia nervosa and 2.9% eating disorder not otherwise specified. Comparison of body image score and type of eating disorders showed significant differences except for anorexia nervosa. Linear regression and logistic regression showed a two-directional relationship between eating disorder variables and body image score. Only BMI was predictive factor for probability of eating disorders [P=0.02]. The relationship between body image and eating disorder is two-directional. Therefore, observing the symptoms of one disorder suggests the probability of the presence of the other one. So educating people like parents and teachers and caregivers by community health nurse regarding nutritional problems can be effective in early diagnosing and identifying such disorders

[Effectiveness of designed health education package on healthy behaviors of patients with tuberculosis at Pasteur Institute of Iran]

Tuberculosis [TB] is the most common infectious disease. It causes more than 2 millions deaths annually around the world. The aim of this study was to investigate the effectiveness of designed health education package on healthy behaviors of patients with tuberculosis at Pasteur Institute of Iran. This research was a quasi-experimental study that was carried out on 31 smear positive patients who referred to Pasteur Institute in 2004. Questionnaire and self report checklist were used to collect the required data. The educational needs were recognized and then the health educational package was designed. After that, the questionnaire and checklist filled out and educational package was performed for 8 weeks. The effect of training was evaluated by post-test after two months and the obtained results compared with the results of pretest. The main data was analyzed by analysis of variance, paired T-test and Pearson correlation coefficient tests in order to evaluate the effectiveness of intervention on knowledge, attitude and behavior of the patients before and after the intervention. The average age in study group was 33.71 years old [SD=13.68] and the sex frequency was 54.8 for males and 45.2 for females. There was a significant correlation between the change of attitude and the previous family history of TB [P<0/001]. However, there was no significant correlation among the past jail and the previous tobacco use with the patient.s knowledge, attitude and practice. Analysis of the data, before and after the educational package intervention showed a significant difference among knowledge, attitude and practice before and after education [p<0/001]. Health education has an important role in improving knowledge, positive attitude and adopting healthy behaviors in the patients with Tuberculosis

Comparative study of laparoscopic versus open cholecystectomy

To compare our results of Laparoscopic Cholecystectomy with Open Cholecystectomy regarding case selection, technical difficulties, duration of surgery, operative complications, post operative complications, post operative hospital stay, morbidity and mortality, patient's attitude after operation, operative expenses, total expenses and general impression in the society. Comparative study carried out from January 2002 to December 2005. Department of Surgery, surgical 'D' Ward, Khyber Teaching Hospital, Peshawar. This study was conducted on two hundreds patients, one hundred patients were submitted to Laparoscopic Cholecystectomy and the other hundred to traditional Open Cholecystectomy. These patients were admitted in our unit through Out-door department or in emergency as acute cholecystitis. All patients were thoroughly assessed and necessary investigations carried out. After consent all patients were operated on the next operation list. The patients were randomly assigned to either one of the procedures. There was no significant difference in the selection of patients in the two groups. No mortality was seen in both the groups, but complications were more in the open procedure than the laparoscopic one. There isles pain, less hospitalization, early mobilization and early return to work in the laparoscopic surgery. Laparoscopic Cholecystectomy is a superior procedure in comparison to Open Cholecystectomy as regards to the results. Hence it is recommended as the first choice operation

Clinical presentations, diagnosis and pattern of intestinal tuberculosis our experience, Nishtar hospital Multan, Pakistan

To discuss clinical presentations, diagnosis and pattern of intestinal tuberculosis of the patients presenting in surgical department. Design. Retrospective study. Place and duration of study. Nishtar Hospital Multan, Pakistan during the period of January 2002 to August 2004. Patients and methods. 109 diagnosed cases of intestinal tuberculosis were included in this study. Patients with intercurrent illness and patients proved to have other diagnosis after full work up were excluded from the study. A detailed history and full physical examination of all patients was recorded. Later on various investigations, operative findings were also noted. Results. The ages of patients were in range of 12-54 years. Male to female ratio was approximately 1:2. Clinical presentation was quite variable ranging from abdominal pain present in 100 patients [91.74%] to weight loss noted in 54 patients [49.54%]. Endoscopic biopsy and PCR analysis were most useful in diagnosing intestinal tuberculosis in elective ca ses. Strictures of the small bowel were commonest pattern noted. Past history of pulmonary tuberculosis was present in 8 patients [7.33%] while 18 patients [16.51%] had previous history of intestinal tuberculosis. 35 patients [32.11%] had positive family history of tuberculosis. 18.34% of the patients had secondary tuberculosis. Conclusion. Intestinal tuberculosis is a common disease in third decade in the developing countries. Females are more affected than males. Primary tuberculosis is more common than secondary tuberculosis. Intestinal tuberculosis may present with a variety of abdominal symptoms and signs. Endoscopy and PCR analysis can be considered as reliable investigation in elective cases. Strictures, mass abdomen and intestinal perforation are the most common pattern observed

Thrombotic thrombocytopenic purpura [TTP], successfully treated with plasma exchange

We report a case of a middle aged woman who developed TTP, was diagnosed on the basis of classical pentad of clinical features. She underwent 5 sessions of plasma exchange and was successfully treated with it. She did not develop any recurrence for a period of last 5 months. Thrombotic thrombocytopenic purpura [TTP] is a hematologic emergency. It is a multisystem disease that can cause rapid deterioration of the patient's neurologic, renal, and hematologic status. TTP is an uncommon disease with a high mortality if misdiagnosed or untreated. Early diagnosis and aggressive treatment by therapeutic plasma exchange are necessary to reduce the risk of a fatal outcome

Rapid assessment of cataract surgical services in age group 50 years and above in lower DIR district Malakand, Pakistan

To assess the rapid assessment of cataract blindness and surgical services in age group 50 years and above. Design: A cross-sectional survey. Place and Duration of Study: This survey was conducted in District Lower Dir, Malakand Division, NWFP, Pakistan, from March 9-23, 2003. Patients and A community-based survey was carried out with systematic cluster random sampling. The survey was preceded by a pilot study in which the proforma and operational methods were field-tested and refined. One thousand, one hundred and fifty eligible adults of 50 years and older were selected by systematic random sampling from the whole lower Dir district of Malakand, Pakistan. A total of 1076 subjects [93.6%] were examined. The visual acuity of each eye was assessed using tumble Snellen's E Card method at 6 and 3 meters. Any subject having visual acuity <3/60 with or without obvious lens opacity or with aphakia [removal of lens] or pseudophakia [removal of cataract lens and implantation of artificial lens] was examined in detail. The surgical services were assessed by measuring the prevalence of pseudophakia, surgical outcome of visual acuity and also the effect of place of surgery on outcome. Prevalence of total bilateral blindness was 2.6%, and unilateral blindness 2.46%.Total prevalence of aphakia was 2.4%, which was almost equal in both sexes, male 2.3% and female 2.4%. Prevalence of unilateral aphakia was 0.3% in females being slightly higher than males, 0.16%.The prevalence of bilateral aphakia was 2.2% and 2% in males and females respectively. Prevalence of total pseudophakic eyes was 2.74%. Surgical outcome showed good, borderline and poor visual acuity of 40.5%, 22% and 14.3% respectively. Surgical outcome was also seemed to be better in private hospitals as compared to field camps. It is concluded that to reduce the prevalence of blindness there was a need to improve the quality of services in mobile camps and fixed facilities. At the same time the visual outcome of surgery could be improved by expanding the number of Intraocular lens procedures and routine monitoring of cataract outcome

Pattern of eye diseases in children of 5-15 years at Bazzertaline area [South Karachi] Pakistan

To assess the prevalence and pattern of eye diseases in children aged 5-15 years. Population based cross-sectional survey. Bazzertaline area of Karachi [South] from July to August, 2003. A community-based survey was carried out at the Bazzertaline Area, South Karachi, Pakistan on 5110 children 5-15 years of age. The socioeconomic status of the area was low, with many living below the poverty line. The survey used the WHO definitions of visual impairment as criteria for classification. St and ard Snell's literate and illiterate charts were used for assessing the visual acuity. An anterior segment examination with a torch light and loupe was carried out and the posterior segment examined with a direct ophthalmoscope, initially without pupil dilation. Suspected cases of amblyopia, albinism, traumatic cataract and squint, etc. were examined with pupil dilatation. Refractive error of 2% was found to be the primary ocular morbidity, followed by conjunctivitis 1.2%, and squint was found as third ocular morbidity with the prevalence of 0.6%. Those diseases that were less than 0.5% included unilateral amblyopia, corneal ulcer/opacity, cataract, aphakia, trauma, blepharitis, albinism, stye, chalazion and unilateral/bilateral blindness. Bilateral blindness was present in 2.7/1000 children, the major causes being cataract and corneal diseases. Low vision was found in 2.2%, the leading cause being uncorrected refractive error. Visual acuity according to 2.42%. Gender showed higher visual impairment in girls as compared to boys 1.72%. Only one case of vitamin-A deficiency was seen. Provision of spectacles would address the most commonly found problem of uncorrected refractive error. Lack of trained personnel and facilities for low vision services in addition to lack of advocacy and awareness in the community contribute to the pattern of eye disease in the area

Evaluation of different modalities for surgical management of renal stones

There is no single method suitable for the removal of all renal stones. The goal of surgical stone management is to achieve maximal stone clearance with minimal morbidity to the patient. The aim of the work is to evaluate different modalities as extracorporeal shock wave lithotripsy [ESWL], percutaneous nephrolithotomy [PNL] and open stone surgery [OSS] in the management of renal stones in patients attending our department in one year. This study was conducted on 200 patients with renal calculi. The patients were divided into three groups: group A [100 patients] underwent ESWL, group B [50 patients] had PNL and group C [50 patients] had OSS. They were completely evaluated by histor, physical examination, laboratory and radiological investigation. Patients were evaluated postoperatively by KUB, US and urinalysis at 1 day, 2 week up to 3 months. Comparing the results in the three groups revealed that the total stone free rate [SFR] in them is nearly equal 90%, 88% and 88% in group A, B and C respectively. On the other hand comparing the results in the three groups in relation to the stone characteristics [burden, number and fresh or recurrent] revealed that the SFR in them is nearly equal in single and small burden stone either fresh or recurrent. While with multiple and large stone burden [> 3 cm] PNL gives the best results [72.2 - 87.5%] especially with recurrent cases as a monotherapy, followed by open surgery [66.6- 80%] especially with fresh cases, then ESWL as it gives the least SFR [33.3-60%]. Stones less than 1 cm, ESWL is usually the primary approach. For stones between 1 - 2 cm, ESWL is still the first-line treatment unless factors of stone composition, location, or renal anatomy shift the balance toward more invasive but definitive treatment modalities [PNL or OSS]. Stones > 2 cm should primarily be treated by PNL, unless specific indications for OSS are present. Stones >3cm, multiple or staghorn better managed by sandwich technique [PNL and ESWL]

clinicoepidemiological study of snakebite in Multan

Objective: To know the epidemiological characteristics of snakebite in and around Multan and to highlight various patterns of toxicity in sufferers of snake`s envenomation

Design: Descriptive, observational study

Place and duration of study: This study was conducted at Medical Unit-IV, Nishtar Hospital, Multan during the year 2002-2003

Patients and Methods: One hundred victims of snakebite from seven various districts around Multan, who were brought to Nishtar Hospital, Multan, irrespective of age, sex and previous medical therapy were included in this study. All victims of snakebite were examined and investigated to know the various patterns of toxicity

Results: Most of the victims [78%] were found to be sufferers of toxic bite, affected mostly on lower limbs [62%] and during night time [52%] of summer season. Hemotoxic snakes were the most common type of snakes [52%] causing envenomations. 90% patients recovered completely and a death rate of 6% and disability rate of 4% was observed

Conclusion: Morbidity and mortality from snakebite can be reduced by proper health education of the farmers, regarding importance of footwear and potential hazards of snakebite

Determination of cultural conditions for the production of rhamnolipid biosurfactant by pseudomonas aeruginosa RB 28

The ability of [20] bacterial isolates of the genus Pseudomonas isolates was tested to produce biosurfactant using crude oil as carbon source. P.aeruginosa RB28 was selected for its high ability to produce biosurfactant. The optimal conditions for production of biosurfactant from RB 28 strain were studied, the results showed that sunflower oil [4%], urea [6g/l], Mg[++] [0.5g/I], Fe[++] [0.008 g/1], Ca[++] [0.05g/l], pH 7.0 and temperature between 30-34 °C after 60 hours of incubation. The maximum production of rharnnolipid [7g/l] was obtained after using these optimum conditions

Comparison of the growth standards between Saudi and American children aged 0-5 years

To compare the national growth monitoring data with the National Centre for Health Statistics [NCHS] growth standards, which is currently used in the Kingdom of Saudi Arabia [KSA]. A cross sectional study following World Health Organization criteria in determining sample size was adopted, whereby 24,000 children from 5 regions were selected to be the desired sample. One hundred and two Primary Health Care centers were also selected randomly from the 5 regions, from where the sample was drawn. A special questionnaire was designed for the data collection. A pilot study was carried out to test the study instruments. Weight, height and head circumference were measured by standard procedures. This data was compared with the National Centre for Health Statistics [NCHS] data. The total number of children examined was 23,821, 11,913 boys and 11,908 girls, they were drawn from 102 health centers selected randomly. Comparing different percentiles for Saudi and NCHS data, there was a significant difference between the Saudi and American children. In order to ensure a correct follow up for our children in KSA, the national figures are more appropriate to follow than the NCHS data

Cardiovascular disease predictors in relation to smoking in egyptian men

The influence of smoking on novel CHD predictors such as serum albumin, bilirubin, lipid peroxides and free fatty acid [FFA] pattern, in addition to traditional predictors such as blood pressure, body mass index [BMI], serum total cholesterol, triacylglycerols, high density lipoprotein cholesterol [HDL-C] and iron between smokers and non smokers was compared. The prevalence of cardiac arrhythmias was higher in smokers than in non smokers. Both of BMI and blood pressure were not significantly changed between groups. Biochemical parameters revealed an extreme increase of serum lipid peroxides, triacylglycerols and total cholesterol/HDL-C ratio in smokers relative to non smokers. Smokers had severely reduced HDL-C levels and slightly decreased total cholesterol/total bilirubin ratio as compared to those of non smokers. Serum albumin and iron levels showed nonsignificant changes between both groups. FFA pattern demonstrated a marked reduction in oleic acid level and a significant increase in erucic acid concentration in smokers regarding to those of non smokers. Each of palmitic, stearic and arachidonic acids decreased in smokers than in non smokers. The percentages of decrease were 28.9%, 20.1% and 30.6%, respectively. Younger smokers had extremely higher levels of serum lipid peroxides, total cholesterol, triacylglycerols and total cholesterol/HDL-C ratio than their age matched controls. Serum HDL-C concentration was severely reduced in younger smokers as compared with their corresponding controls. Older smokers showed a significant decrease in HDL-C level and a marked increase in its ratio with cholesterol regarding to non smokers had the same age

Qualitative and Quantitative coronary angiogra-ply in patients with st segment elevation myocardial infarction versus patients with non- st segment elevation M.I.

This study was carried out at Nasser Institute Hospital during the period from October 1997 to August 1999. The aim of this work was to identify if there is a significant difference between ST segment elevation myocardial infarction [STEMI] and non-ST segment elevation myocardial infarction [NSTEMI] as regards risk factor distribution, cardiac enzymes elevation, echocardiographic examination and quantitative coronary angiographic parameters. Forty patients with acute myocardial infarction were studied, 20 were diagnosed as STEMI [group 1] and the other 20 patients were diagnosed as NSTEMI [group 2] on the basis of electrocardiographic analysis. Every patient was submitted to full medical history, thorough clinical examination and measurement of cardiac enzymes including CPK, LDH, CK-Mb fraction. Resting electrocardiography, echocardiography and coronary angiograms were performed. The results of this work showed that patients with NSTEMI had a statistically significant more prevalent history of myocardial ischemia or infarction [40% versus 5% in patients with STEMI]. Also, a statistically significant lower level of cardiac enzymes and a statistically significant less occurrence of regional wall motion abnormalities were detected. On the other hand, risk factors [age, sex, smoking, hypertension, diabetes mellitus and hyperlipidaemia], left ventricular function, fractional shortening and all QCA parameters showed no statistically significant difference between both groups

Procalcitonin as a diagnostic marker of infection: comparison with c reactive protein and leucocyte count

Procalcitonin has been recently advocated as a marker of bacterial infection. Because of its shorter half-life and earlier ascent it offers advantages over C-reactive protein [CRP] This study aims to evaluate diagnostic markers of infection, comparing procalcitonin with more conventionally used markers of infection as C-reactive protein and leucocyte count in critically ill children admitted to hospital. A prospective observational study was performed during which plasma procalcitonin, serum C reactive protein, and leucocyte count were measured in 58 infants and children [mean age 23.6 months] on admission to hospital Patients were classified as follows: 12 patients with generalized bacterial infection and septic shock, 13 patients with viral infection; 13 patients with localized bacterial infection; and 20 non-infected controls. Optimum sensitivity, specificity, predictive values, and area under the receiver operating characteristic [ROC] curve were evaluated. Admission procalcitonin was significantly higher in children with generalized bacterial sepsis [median 115.2; range 98.4-224.07ng/ml], compared with localized bacterial infection [77.45; 54.5-112.7ng/ml], viral infection [35.6; 17.9-57.2 ng/ml], and controls [2.07; 0-5.01 ng/ml]. Comparing systemic bacterial infection with other groups of patients, area under the ROC curve was 0.984 for procalcitonin [95% CI; 0.878-0.993], 0.856 for C reactive protein [95% CI; 0.704-0.948], and 0.878 for leucocyte count [95% CI; 0.731-0.961]. Cut off concentrations of procalcitonin for optimum prediction generalized bacterial sepsis were > 96.6 ng/ml and C reactive protein > 24 mg/dl. A procalcitonin concentration > 57.0 ng/ml identified all patients with bacterial infection or generalized bacterial sepsis. Plasma procalcitonin concentration is a better diagnostic marker of bacterial infection than C reactive protein or leucocyte count in critically ill children. A procalcitonin concentration of >96.6 ng/ml might be useful in differentiating severe bacterial disease in infants and children

Mutational analysis of the high affinity immunoglobulin E receptor beta chain gene in Egyptian asthmatic children

Asthma results when genetically predisposed individuals are exposed to certain environmental factors. It has been suggested that particular mutations in the beta chain of the high-affinity IgE receptor [FCepsilonRI-beta] gene may alter the function of the receptor and predisposes to asthma through atopy. This study was undertaken to determine whether the I181L and V183L allels were associated with the prevalence or clinical severity of asthma in Egyptian children. We used amplification refractory mutation system-polymerase chain reaction [ARMS-PCR] to screen atopy [n=36] and nonatopic [n=29] asthmatics and control group [n=21] for the I181L and V183L alleles. There was a significant difference in the frequency of I181L between atopic asthmatics [26%] and nonatopic asthmatics [7%] [P=0.003], and between the atopic group and control group [5%] [P=0.003]. In the atopic asthmatics, we also found that the prevalence of I181L mutation was significantly increased in children with moderate and severe disease compared to mild asthmatics [P<0.001]. However, in all subjects studied, V183L mutation was not detected. These data suggest that I181L allele acts as an allergic asthma susceptibility and disease modifying gene and may serve as a clinically useful marker of asthma severity

Integrating maternal and child health with primary health care in Saudi Arabia

Integration is an important tool for successful implementation of components of a comprehensive health programme. We describe strategies adopted to integrate the Saudi maternal and child health [MCH] activities with other primary health care [PHC] components in order to achieve optimal quality care. Achieving such integration was one of the specific objectives of the MCH programme. Besides training MCH workers, other important tools of MCH/PHC integration included: organization, supervision, continuing education, data management and health systems research. The strengths and weaknesses of integration are discussed while the opportunities, limitations and implications are reviewed

Myocardial perfusion imaging for the identification of silent myocardial ischemia in patients with proven coronary artery disease

This study was carried out on 183 patients with positive myocardial perfusion test to assess the incidence of silent ischemia among patients with documented coronary disease and to clarify whether factors such as age, sex, risk factors, medications, prior infarction may influence the occurrence of exercise induced silent ischemia. No chest pain during exercise was documented in >5% of the patients. Moreover, age, medications, previous infarction did not affect the incidence of pain significantly. It was concluded that coronary artery disease without chest pain during exercise testing had a similar extent of abnormally perfused myocardium

Fetal echocardiography with high risk pregnancy

Fetal hearts of 20 pregnant women with insulin dependent diabetes, 20 with hypertension and 20 with rheumatic heart disease as well as ten normal controls were studied by echocardiography. It was found that fetuses of diabetic, hypertensive and rheumatic mothers had smaller end diastolic, end systolic left ventricular dimensions, interventricular septal thickness, left ventricular wall thickness, aortic root diameter and left atrial diameter. No congenital malformations were detected. A screening of high risk pregnant female was recommended to adjust the time and place of labor in order to minimize the incidence of morbidity and mortality

Setting the scene for an ARI control programme: is it worthwhile in Saudi Arabia?

Baseline data on acute respiratory infections [ARI] were collected by a survey questionnaire distributed to physicians of 10% of the health centres randomly selected from each of the five provinces of Saudi Arabia. The physicians estimated that ARI was the cause of sickness in 50% of ill children < 5 years in 1995. None of the physicians had had any training in ARI and they were not aware of any national protocol or programme. Physicians' responses indicated an over-use of antibiotics and diagnostic procedures. A national protocol for diagnosis and treatment of ARI has been prepared and distributed and leaders of primary health care and 55 national trainers have been trained