Evaluation of Metabolic Syndrome in Primary Health Care

Background: Metabolic syndrome includes atherogenic dyslipidemia, obesity, hypertension, hyperglycemia, andinsulin resistance. This complex of metabolic abnormalities is a risk factor for DM2, stroke, adverse cardiacevents, and hepatic necrosis. In the last few years, studies showed a significant high prevalence of this syndromeamong Saudi males. Central visceral adiposity is thought to be the primary trigger of most pathogenic eventsinvolved in the advent of the syndrome. Objectives: In this paper, our aim is to discuss metabolic syndrome, itsdefinitions, pathophysiology, diagnosis, screening, and the management done for such patients in general withspecial focus to primary healthcare. Methodology: PubMed database was used for articles selection. Conclusion:The syndrome is linked with significant impacts on the patient health; as a result, the health care providers shallbe alarmed on how to screen, diagnose and manage such disease. Prevention of childhood obesity is criticalthrough screening and early diagnosis to save major burden and prevent future complications. Thus, nowadays,the new trend is towards incorporating screening of this syndrome in primary health care centers.

The effect of Niclosamide in acetic acid induce colitis: an experimental study

Ulcerative colitis is an idiopathic chronic inflammatory disease of the colon for which a lot of treatment modalities are present. However, significant side effects are associated with them, and there is a need for a search for other tretment options. This study was aimed to assess the contribution of niclosamide in experimentally established colitis in rats. Animals were categorized into 5 groups; the control group undergoes no induction of UC, colitis group in which UC was induced, and animals receive no treatment, the niclosamide group that received niclosamide and sulfasalazine group that received sulfasalazine. Each group was composed of 10 animals. After the completion of a one-month period of the experiment animals were sacrificed and the following meausres were done: the weight of the colon, determination of the area of mucosal damage by mm2, histological scoring after hematoxylin and eosin stain together with MAC score and immunohistochemistry of IL-6, TNF-alpha, MPO, MDA, CD62, and ICAM1. The results of the current study revealed that Nicosamide was able to reduce the area of mucosal damage, colon weight, histological and Mac scores and immunohistochemical scores of inflammatory and oxidative markers, significantly when contrasted to a group of colitis (P< 0.05). It has been concluded that Niclosamide was proved to have a significant effect as an adjuvant mode of therapy for colitis through its, anti-inflamatory and anti-oxidant effects (AU)

Unilateral maxillary distomolar with multiple abnormalities in a young patient: A rare case report with mini systemic review

Supernumerary teeth are those teeth present in addition to the normal number of teeth and are mostfrequently seen in the maxillary incisors and molar regions. In the molar regions, supernumerary teethare divided into two types depending on their location: distomolars and paramolars. Distomolarsusually occur in the form of a fourth molar distal to the third molar. Distomolars are a developmentalanomaly and have been argued to arise from a combination of genetic and environmental factors.Therefore, distomolar management should be part of a comprehensive treatment plan. This articlepresents a case report of an unusual occurrence of a rare unilateral distomolar in the right of themaxilla with multiple abnormalities in a 21-year old healthy subject. In addition, a mini literaturereview includes the definition, types, prevalence, classification, etiology, complications, diagnosis,and therapeutic strategies, which may be adopted in the occurrence of distomolars.

Diagnosis and management of systematic lupus erythematosus [SLE]

Background: Systemic lupus erythematosus [SLE] is the prototypic multisystem autoimmune disorder with a wide range of clinical presentations impacting almost all organs and tissues, such extreme heterogeneity suggests that SLE represents a syndrome rather than a single disease

Although the precise etiologic mechanism is unknown, genetic, hormonal, and environmental factors, as well as immune abnormalities, have been detected. Associations between lupus onset and age, sex, geography, and race have also been established

Aim of the work: This review will focus on advances in the diagnosis and management of SLE. Conclusion: The diagnosis of SLE must be based on the proper constellation of clinical findings and laboratory evidence. Management of this disease should be individualized and should include both pharmacological and non-pharmacological modalities for symptom relief and resolution as well as improved quality of life

Evaluation of tuberculosis public health surveillance, Al-Madinah province, Kingdom of Saudi Arabia, 2012

The objective of the study is to evaluate the quality of the data, the sensitivity of the surveillance, and the completeness of identification and investigation of tuberculosis [TB] patient's contacts. The study covered the TB surveillance program in Al-Madinah province in 2011. First, we reviewed all the notifications, treatment cards, and register books, as well as monthly and quarterly reports, for completeness and accuracy of data. Then, we searched for the missed cases that were not reported. Finally, we reviewed all the patients' household contacts' reports to assess the degree of completion of identification and investigation. There were 444 cases detected during the study period; only 200 cases were reported. The sensitivity of the TB surveillance system was 45%. Among the 200 reported cases, the results revealed high completeness rates for demographic and disease data and low completeness rates for the test result fields. The contact identification and investigation showed that 34.4% of smear-positive cases' contacts were not identified. Only 67% of identified contacts were investigated. The review of hospital records and lab registers showed that 244 cases were not reported. In conclusion, the TB surveillance system has several areas that need improvement

A brief review on medicinal plant Tagetes erecta Linn.

Medicinal plants, its derivatives and characterized secondary metabolites are widely used for medicinal purposes, are becoming popular all over the world as a natural alternative to synthetically produced chemicals both in Traditional and Allopathic system of medicine. The beneficial effect of herbal medicine typically result from the combination of secondary metabolites produced in the herbs such as glycosides, alkaloids, flavonoids, tannins, gums etc. There is a need for the documentation of research work carried out on these herbs, hence forth timely review on the herb Tagetes erecta Linn. Methodology used in the review is based on the published original research articles through exhaustive search through scientific databases; Saudi Digital Library, Pubmed, and Science Direct etc. Reviewed parameters are ethonomedicinal uses chemical constituents and pharmacological and non Pharmacological studies on medicinal plant Tagetes erecta Linn.

A Novel Transglutaminase-1 Missense Mutation in a Palestinian Family with Autosomal Recessive Congenital Ichthyosis: A Case Report.

This work presents the molecular genetics investigation of a male neonate referred to our genetics laboratory with the diagnosis of classical lamellar ichthyosis (one form of autosomal recessive congenital ichthyosis). The neonate was born as a "collodion-baby" and he is the product of a maternal first cousin marriage. DNA sequencing of the coding exons of transglutiminase-1 (TGM1) gene revealed a novel missense (c.A1621C) mutation in exon 11. The mutation altered codon 541 from ACC into CCC thus changing the amino acid threonine into proline (p.T541P) and was predicted to be pathogenic. The presence of the mutation in both parents in heterozygous form and in the patient in homozygous form was further confirmed by PCR-restriction fragment length polymorphism (PCR-RFLP) designed specifically for the identified mutation. It is concluded that the T541P mutation is the cause of the congenital ichthyosis in the presented case and the parents were advised to undergo a PGD-IVF for embryo selection prior to their next pregnancy.

Comparative study in neonates with septicemia using meropenem versus ceftriaxone Plus vacomycin

Neonatal septicemia is an important cause of mortality in both developed and developing countries. The type and pattern of organisms that cause neonatal sepsis changes over time. In addition the causative organisms have developed increased drug resistance for the last two decades. To compare the effectiveness and tolerability of two different antibiotic regimens in the initial treatment of suspected neonatal septicemia. This is a controlled clinical trial on 80 neonates with a presumptive diagnosis of septicemia who were admitted to the children welfare teaching hospital of Baghdad from August 2010 to March 2011.Both early onset sepsis and late onset sepsis were included in this study. The diagnosis of probable sepsis was based on the presence of a repertoire of clinical symptoms and signs. Initial tests performed included complete blood count, CRP, and blood cultures. Neonates were randomly divided into two groups of forty neonates per each. The first group was given meropenem of 30mg/kg /dose every 12 hours, while the second group was treated by a combination of ceftriaxone 50mg/kg/dose every 12 hours plus vancomycin of 15mg/kg/dose every 12 hours. The duration of treatment was 7-14 days. The patients variables in the two treatment groups at entry were comparable. The most prevalent clinical features were reluctance to feed [83.75%], lethargy[70%], pallor [47.5%], irritability [38.75%], and hypothermia[32.5%]. Of the 80 neonates, 81.25% had positive CRP, 58.75% had abnormal WBC count[<5000 /mm[3] or > 20000/mm[3]], and 48.75% had positive blood culture for bacteria. Staphylococcus coagulase negative accounted for 28.2% of the total isolates followed by E coli [23%], Klebsiella pneumonia [20.5%], pseudomonas aeruginosa [17.9%], streptococcus [7.7%], and staphylococcus aureus [2.5%]. The overall responses to treatment was significantly higher P<0.05 in the meropenem group with a cure rate of 87.5% versus 67.5% in vancomycin plus ceftriaxone. Neonates with early onset sepsis showed a significantly higher success rate [p<0.05] with meropenem than with ceftriaxone plus vancomycin [the cure rate 93.1% versus 60%]While there were no differences between the two treatment group regarding late onset sepsis 72.2% versus 80%. The most effective antibiotic for early onset sepsis in this study was meropenem, while it had equal effectiveness with the combination of ceftriaxone plus vancomycin against late onset sepsis

Extensive renal destruction due to severe emphysematous pyelonephritis

Emphysematous pyelonephritis [EPN] is a severe necrotizing infection of the kidney characterized by the presence of gas in renal parenchyma, collecting system or perinephric tissue. It can be life threatening if not recognized and treated promptly. We have reported the case of a 56-year-old woman with a previous history of diabetes mellitus, who was suffering from left-sided flank pain and fever. Diagnosis workup revealed an extensive destruction of the left kidney secondary to an EPN. We opted for a left nephrectomy and intravenous antibiotics. The immediate postoperative course was uncomplicated but the patient developed a chronic renal failure within 1 year

Behavioral Pattern of Menopausal Nigeria Women

Context : Menopause is one area that has been shrouded in myths and taboos and the way women perceive menopause depends largely on the social belief about menopause in their society. Objective : The aims of this study are to assess how women perceived the physical changes during menopause; what the social as well as the individual adjustment practice to menopausal changes might be. Materials and Methods : Qualitative focal group study among women aged 40 years and above where eight to ten volunteers formed a group. Six sessions were held for different focal group; each lasting 1-2 h. A tape recorder and a notepad were used to record the discussions. Opinions of the women were sought on socio-cultural differences in the perception of aging; perception of menstruation; perceived causes and consequences of menopause; sexual intercourse after menopause; social support networks for menopausal women; and types of care and treatment for women in menopause. Results: The participants in the FGDs used various phrases to describe menopause in local term; while some of the participants attributed disease to be a cause of menopause; others believed that it be could be caused by witchcraft or sorcery. However; younger and old women whose menstrual flow stops prematurely seek assistance; often from traditional or spiritual healers. Conclusion: This study reveals the poor menopausal knowledge among the study group with more than half of the respondents having negative attitude towards menopause in addition to mixed feelings about religious obligation and cohabitation

Tuberculous arthritis revisited as a forgotten cause of monoarticular arthritis

Tuberculosis [TB] continues to be a major concern for health care workers. The number of reported cases of extrapulmonary tuberculosis, particularly osteoarticular tuberculosis, is increasing. This fact is attributed to different factors such as underestimating the disease and difficulty in diagnosis, which requires tissue sampling and can lead to a delay in the diagnosis, and can result in significant morbidity and mortality. The aim of this study was to highlight the difficulties and delay in diagnosis of articular tuberculosis, raising the need to create awareness about the importance of early diagnosis to avoid major complications of joint destruction. Retrospective review of patients presenting to a tertiary care center between 2003 and 2009. We reviewed cases who presented with monoarticular joint pain and swelling that failed to respond to treatment elsewhere and were eventually diagnosed as having articular tuberculosis. We collected the demographic data, history, data on clinical examination and the relevant laboratory investigations, in addition to the data on radiological studies. All patients were treated medically with antituberculosis chemotherapy and surgically according to the severity of joint destruction. Thirteen patients had a mean age was 40 years [range, 17-70 years]. The average delay in diagnosis was 2 years. Only 1 patient had pulmonary TB. The hip, knee and elbow were the most common joints involved. Bacteriology was positive in 69% of the cases; and histopathology, in 92%. Fifteen percent of the patients had arthrodesis. None showed recurrence after follow-up of 4 years. A high level of clinical suspicion is essential for early diagnosis and treatment of osteoarticular TB to reduce its significant morbidity

clinical profile of infections in childhood primary nephrotic syndrome

To study the clinical profile of infections in a primary nephritic syndrome. We conducted a retrospective analysis of infections in 98 consecutive children [males 65, females 33] with primary nephrotic syndrome, who satisfied the International Study of Kidney Disease in Children criteria. Their mean age at onset of symptoms was 55 +/- 3.4 months [range: 6 months to 17 years]. The mean duration of follow-up was 38 +/- 3.4 months [range: 12 to 60 months]. A total of 379 episodes of infection were observed in 87 of the 98 children. There was no relationship between age, sex, and severity or frequency of infections. The most common infections were upper respiratory tract infection [30.64%], gastroenteritis [11.08%], urinary tract infection [9.50%], and peritonitis [5.54%]. Other infections included multiple warts, polyoma virus nephropathy, and pneumococcal appendicitis, which were not previously reported. Nephrotic children may get a variety of bacterial and viral infections

Amulets, bands and other traditional applications seen among emergency and neonatal pediatric admissions in a tertiary centre, Nigeria

This study aims to investigate the types and indications of amulets, bands and traditional applications among pediatric emergencies and neonatal admissions into the Federal Medical Centre, Bida, Nigeria. This was a cross-sectional study conducted between January and July, 2008. Children admitted into the emergency and neonatal units of the institution with traditional applications were recruited. Information on demography, time the application was introduced, the reason, cost implication and belief about the efficacy were obtained using a semi-structured questionnaire. Socio-Economic Class was defined using the Oyedeji Classification. The study was based at Federal Medical Centre, Bida and consisted of 666 children admitted into the hospital via the Emergency pediatric and the Neonatal Unit, with a seven-month period prevalence of 11.4% [76 patients]. Of the 76 cases screened for the use traditional applications, only 64 [84.2%] were recruited, the remaining did not agree to participate in the study. The mean age was 493.1 +/- 528.5 days. The study group included 37 males and 27 females [sex ratio 1.4:1] aged 11 days to 2920 days. The applications used included neck band [54.7%], ankle band [15.6%] and head paste [15.6%]. Reasons for the applications included prevention of childhood illnesses [17.2%], sutures closure [15.6%], as well as warding off evil spirits and convulsions [12.5%]. The socio-economic classification was I [1.6%], II [7.8%], III [15.6%], IV [45.3%], and V [29.7%]. Sixty [93.0%] parents believed the applications cannot be used with conventional medicine, while 53.1% of the participants, obtained them free of charge. The use of traditional applications, often for preventive purposes, is common among pediatric patients, especially of low socio-economic classifications. The majority of users considered them incompatible with simultaneous conventional medical care. This has adverse implications for time to presentation for conventional care and treatment outcomes. Promotive and preventive healthcare interventions are needed to reverse this trend. Future broad-based research is warranted

microorganism and underlying urological anomalies causing the urinary tract infection in the children attended the pediatric surgery clinic at the maternity and child teaching hospital Al Qadisiya, Iraq

Urinary tract infections [UTI] are among the most common infections in children. UTI related morbidity remains high despite the use of numerous effective antibacterial agents. The aim of this study was to determine how many patients had underlying urological abnormalities, the specific type of abnormality, and the microorganism causing the UTI in the patients with or without urological anomalies. The sample of this study was conducted in the pediatric surgery unit at The maternity and Children Teaching Hospital, Al-Qadisiya, Iraq and from the 1[st] of august 2005 to the end of July 2008, all the patients presenting with UTI to the outpatient clinic or to the surgical ward were investigated prospectively. There were 78 [70.9%] girls and 32 [29%] boys, 19 [17.2%] were between 0-1 year, 68 [61.8%] were at an age between 1-5 years, and 23 [20.9%] were more than 5 years of age. Forty seven [42.7%] of these patients had abnormal urological findings. Of 78 girls, 31 [39.7%] had urological abnormalities. Sixteen children had VUR as an only abnormality. The distribution of abnormalities showed some changes by age and sex. Bacteriuria [>10[5] bacteria per milliliter of urine] was found in 44 [40%] of patients. The most common bacterial agent of urinary infections was E. coli [61.3%] of total isolates in both sexes; it was the most common pathogen among all patients [those with urological abnormalities and those without]. There was no difference in the distribution of microorganisms in patients with and without urological anomalies. The diagnosis of UTI in young children is important as it is a marker for urinary tract abnormalities. A child with a suspected UTI should have a urine culture and colony count performed in order to identify organisms for confirmation of diagnosis and recommend prompt treatment to reduce UTI related morbidity and mortality in children

Pediatric surgery in Al-Qadisiya: report of rare cases

The aim of this paper is to report 3 rare pediatric surgery cases observed in Al-Qadisiyia: 1. A rare atypical parasitic rachiopagus parasitic twin, 2. Urethral diverticula and anterior urethral valves 3. Inguinal hernia with a persistent Mullerian duct syndrome and transverse testicular ectopia

Review for urolithiasis in patients attending the pediatric surgery unit at Al Qadisiya governorate -Iraq

Pediatric urolithiasis is an uncommon occurrence in developed countries, with a prevalence of l%-5% accounting for about 1 in 1000 pediatric hospital admissions in North America. Though a rare pathology, there is a high degree of morbidity associated with pediatric urolithiasis. To report the pattern and the outcome of to treatment modality [open surgery] in children with urinary stone disease. This study was conducted in the pediatric surgery unit at the maternity and Qicld Teaching hospital in Al-Qadisiya governorate-lraq during the period from the 1st of January 2005 to the end of December 2008, a total of 46 patients, admitted through this single unit, were included in this study and prospectively reviewed. 46 children with urolithiasis were observed 34 [73.9%] were males and 12 [26%] were females male to female ratio was 2.8:1. Their ages ranged from 6 months to 14 years with a mean age of 5.5 years. Pediatric patients with stones present in a manner similar to adults. Primary care physicians need to be highly suspicious of stone disease in a patient presenting with flank or abdominal pain and gastrointestinal symptoms. Pyelolithotomy was done in 22 patients [47.8%] and ureterolithotomy in 7 patients [15.2%]. Pyelonephrolithotomy, extended pyelolithotomy with pyeloplasty were performed in 3 cases [6.2%] each being in one case. Traditional open surgery may be preferred treatment for pediatric urolithiasis in expert hands with excellent stone clearance and minimal complications

Results of primary total hip replacement with special attention to technical difficulties encountered in a cohort of Saudi patients

To illustrate our experience and the difficulty faced in primary total hip replacement [THR] in Saudi patient population. We retrospectively reviewed our database between February 2002 to December 2007 for primary THR cases at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia and identified 58 hips [54 patients]. Patients data were collected from patient's medical records, clinical examination, and x-ray films. Operative reports were examined for the difficulty encountered during surgery and was classified into femoral, acetabular, soft tissue and combined difficulties. Patients follow up was a minimum of 2 years. The indication of surgery was posttraumatic arthritis in 50%, sickle cell anemia related avascular necrosis in 16.6%, primary osteoarthritis in 9.2%, idiopathic avascular necrosis in 9.2%, rheumatoid arthritis in 7.4%, and other indications were 14.7%. The femoral obstacles included narrow femoral canal in 27.7% and proximally migrated femur in 5.5%. Acetabular obstacles included protrusio acetabuli in 14.8% and structural posterior acetabular bone defect in 5.5%. Soft tissue obstacles included tight capsule in 14.8% and muscle contracture in 11.1%.Our Saudi patient population has shown different pathology of their hip disease in which most of the hips being posttraumatic as compared to series published in the west. We advised those who intend to tackle THR in this population to perform extensive preoperative planning in order to be able to anticipate the difficulty demonstrated by our experience

Strongyloides stercoralis hyperinfection after corticosteroid therapy: a report of two cases

Two cases of strongyloides stercoralis hyperinfection are described. Both patients were expatriates from the Indian subcontinent, and reported the use of corticosteroids. The first patient presented with severe pulmonary disease that necessitated respiratory support, followed by acute abdomen and intestinal obstruction and he succumbed to these diseases. The second patient also presented with acute pulmonary disease, which responded to antihelmintic treatment and supportive care; however, he died later due to his primary disease. The clinical features of S stercoralis hyperinfection are nonspecific; therefore, a high index of suspicion is required for early diagnosis and to start appropriate therapy. Because of the seriousness of the disease and the associated high mortality we suggest screening for s stercoralis in patients from endemic areas who will be taking immunosuppressive therapy

Elevated IgE and Atopy among Asthmatic and Non-Asthmatic Children in Northern Jordan

The aim of this study is to explore the rates of elevated total IgE levels and sensitization among asthmatic and non-asthmatic children visiting the clinic in one of the main Children Hospital in northern Jordan. A total of 177 children aged between 1 month and 16 years were classified into 3 groups: Outpatients without any symptoms of atopic diseases [n=82], Asthmatics [n=50] and a control group [n=45]. Serum IgE levels were measured in addition to IgE antibodies against panels of inhalant and food allergens for samples with total lgE above 200 IU/ml. The highest mean value for total IgE [737.9 IU/ml] was in the asthmatic children above the age of 10 years. The rates of high total IgE [above 200 IU/ml] was 44% in asthmatic, 23.2% in outpatient and 13.3% in control children. Twenty one out of the 22 [95.5%] samples of asthmatic children showed reactivity to at least one tested allergen. In this group, sensitization to domestic house dust mites [Dermatophygoides pteronyssinus] was the most prevalent [70%]. For the other groups, 55.5% of subjects were sensitized to mixed grass pollen. Regarding food allergens, the highest percentage of children was sensitized to carrot followed by wheat flour. IgE antibodies specific to food allergens predominate in younger ages whereas IgE to both aero and food allergen groups was noticed in older ages. High levels of IgE were recorded among Jordanian children visiting a pediatric clinic with the highest sensitization among asthmatics being to house dust mites