Dentists' perception of primary health care services in family health and mother and child health clinics in Alexandria, Egypt

This study compared dentists' perceptions of provided services in Family Health [FH] and Mother and Child Health [MCH] clinics. A questionnaire was distributed to 120 dentists in 7 FH and 4 MCH clinics in Alexandria, Egypt in 2012. The questionnaire assessed personal and professional background, perceptions of primary health care [PHC] role, types of services provided, patient recall and referral systems and perception of service quality. The response rate was 100%. More FH dentists perceived their role to include providing care for children and pregnant women. Restorations and scaling were provided by 90% of all dentists. More FH dentists reported providing simple extractions, paediatric extractions and multi-rooted endodontic treatment [P = 0.03, 0.001 and 0.001]. In FH clinics, where the performance-based incentive system was implemented, a greater number of patients was served and there was a shift in the type of services provided although dentists had a less positive perception of quality aspects. Thus, there is a need for the establishment of a mission and clear guidelines for the FH clinics to guide service provision

Effect of malathion on pars distalis of the pituitary gland and the possible protective role of vitamin C in adult female albino rats: a histological, immunohistochemical, and ultrastructural study

Malathion is one of the organophosphorus insecticides that are widely used in agriculture and have been reported to cause multiple organ damage. Vitamin C has been proposed as an antioxidant because it reduces oxidative stress. This work aimed to study the possible histological, immunohistochemical, and ultrastructural changes of gonadotrophs and somatotrophs of the pars distalis of the anterior pituitary gland associated with chronic sublethal malathion administration and assess the possible beneficial role of vitamin C in ameliorating these possible changes. Forty adult female albino rats were divided into four groups. Group I served as the control group. Group II received vitamin C at a dose of 20 mg/100 g/day. Group III animals were treated with malathion at a dose of 100 mg/kg/day. Groups IV animals received vitamin C and then malathion after 2 h at the previous doses. The treatments were given orally to the rats for 2 months. The rats were then sacrificed and specimens from the anterior pituitary gland were taken for light and electron microscopic examination. Light microscopic examination of rats treated with malathion revealed that gonadotrophs exhibited vacuolated degranulated cytoplasm and pyknotic nuclei, whereas somatotrophs appeared shrunken with dense nuclei. Immunohistochemically, there was a decrease in the immunoreactivity of follicle stimulating hormone, luteinizing hormone, and growth hormone-secreting cells. Ultrastructurally, gonadotrophs and somatotrophs showed disintegration of cellular organelles and apoptosis of the nuclei. Coadministration of malathion with vitamin C showed a slight improvement in some gonadotrophs and somatotrophs that looked normal in both light microscopic and electron microscopic examination; however, still others were markedly affected, showing signs of degeneration and apoptosis. The results showed that malathion in chronic doses induces histological, immunohistochemical, and ultrastructural changes in gonadotrophs and somatotrophs because of oxidative stress, and the use of vitamin C partially improves the malathion-induced toxicity

Ophthalmogenetic and epidemiological studies of Egyptian children with mental retardation

Mental retardation [MR] is a congenital or early onset lifelong impairment of cognitive adaptive functioning or daily living skills. It is a serious and lifelong disability that places heavy demands on society and the health system. The prevalence of visual and ocular disorders in children with MR is high and can influence sensory-motor development and learning ability. Assessment of the genetic and epidemiologic aspects of mental retardation and clarifying the ocular and visual problems among mentally disabled children. A cross-sectional hospital based study was conducted, through a period of two years, included 190 children under 18 years of age with mild to profound intellectual disabilities who were diagnosed among 480 cases referred to the Genetic clinic, Research Institute of Ophthalmology for genetic diagnosis and counseling. The definition of MR and the criteria for diagnosis were adopted from the World Health Organization [WHO] classification. The etiology of MR was specified by obtaining information about the personal and family history that included a three generation pedigree analysis, with special attention to the presence of similar cases, thorough clinical examination including complete neurological evaluation, chromosomal and other investigative studies. Ophthalmologic examination included visual acuity testing, ocular motility and examination of the external eye and anterior segment; cycloplegic refraction and fundus examination. One hundred and ninety patients representing 39.6% of the total examined cases in two years were classified etiologically into 6 groups. Specific causes were found in 161 cases [84.7%] and the etiology was unknown in 15.3% of children. Metabolic and chromosomal disorders comprised the most common etiological problems of the examined mentally retarded children in this study. The percentage of mild, moderate, severe and profound MR was 67.5%, 26%, 5.8% and 0.7%, respectively. Family history was positive in 34.7% of patients and autosomal recessive inheritance was the commonest mode of transmission [48.4%] that reflects the high percentage of consanguineous marriages among Egyptians. Microscopically visible chromosomal anomalies of intellectually disabled patients included 25 numerical and 11 structural aberrations. Errors of refraction and strabismus were the most common in children with chromosomal disorders [24.7%] and [28.1%] respectively. While the highest percentage of optic atrophy, retinal dystrophy, microphthalmia, cataract and corneal opacities were diagnosed in children with metabolic disorders representing 76.2%, 93.3%-, 38.5%, 50% and 80% of cases diagnosed in all categories respectively. In this study, metabolic and chromosomal disorders represented the most common etiological problems among the examined mentally retarded children with the highest proportion of specific ocular and visual problems represented among them to the extent that the eye could be considered as a window for their diagnosis. In most cases, diagnosis will assist families in understanding the condition, its prognosis and recurrence risks; more epidemiological studies have to be undertaken to determine the magnitude of the problem and its pattern of distribution in our country. The results also emphasize the need for establishing an efficient system to provide regular ophthalmic care for children with mental retardation

H1N1 influenza A. Preliminary evaluation in hospitalized patients in a secondary care facility in Saudi Arabia

To assess the epidemiologic and clinical manifestations of the first wave of H1N1 influenza A patients. This study is a retrospective chart review of all patients admitted in King Saud Medical Complex, Riyadh, Kingdom of Saudi Arabia, from 22nd May to 31st August 2009, with a proven diagnosis of H1N1 influenza A. Only patients with a positive nasopharyngeal swab were included, and excluded when the swab was negative. Charts were then analyzed for epidemiological and clinical data. A total of 153 patients with proven H1N1 infection were admitted, with a predominance of male patients [108 [71%]]. Most patients were Saudis [111 [73%]], with 83 males [75%], and 28 females [25%]. The mean age was 25 years [standard deviation; 9.45 years], and median age was 24 years. The most common symptoms in order of frequency were; fever [143 patients], cough [126 patients], sore throat [70 patients], headache [18 patients], shortness of breath [17 patients], myalgia [11 patients], diarrhea [9 patients], and vomiting [7 patients]. Average duration of symptoms before admission was 3.55 days, and the average time of hospitalization was 4.8 days. Full recovery was obtained in 150 patients. Death occurred in 3 patients. True to its designation as a pandemic, H1N1 influenza A, has reached Saudi Arabia and poses a risk to the young population without immunity, and those with co-morbid disease, particularly of the lungs [bronchial asthma], and the pregnant. Despite its virulence in infecting people, deaths are far less than anticipated for such a novel virus. Social distancing can be recommended. However, further observation has to continue to substantiate these tentative preliminary findings

Haemolytic anaemia after ABO-mismatched living-donor kidney transplantation

ABO.mismatched transplants are used frequently. Acquired haemolytic anaemia have been reported after ABO mismatched transplantation. Among 214 ABO.unmatched living-donor kidney transplants tS, 10 cases with cyclosporine based therapy developed haemolysis All studied patients had pre-transplant non specific blood transfusion and received kidneys from one haplotype HLA mismatched living donors. There were 164 males and 50 females. while the mean age was 30.41 years. CsA was stopped in patients treated with triple Immunosuppression while the patients received Pred-CsA were switched to conventional immunosuppression 6 patients were transfused with washed O cells and no plasma exchange was required. The prognosis was excellent in 9 patient, and one died from severe haemolysis. The haemolytic anaemia was more frequent among blood group A recipients [60% of our cases] and more severe among recipients with blood group B. Univariate analysis demonstrated significant impact for recipient age. donor sex, number of pretransplant blood transfusions. primary immunosuppression, time to onset of diuresis, recipient and donor blood groups. On the other hand, multivariate analysis restricted the significance to blood group of donor and recipient. time to onset of diuresis and primary immunosuppression. ABO unmatched kindray transplantation had no impact on patient survival, mean while the graft survival appeared to be better among unmatched ABO group in comparison to the same blood group recipients

comparative study on the effect of PGE1 and PGE2 on the pregnant uterus of mice

Using the pregnant uterus of mice, the effect of dinoprostone [PG E2] and misoprostol [PG E1] on uterine activity was compared. Both PG E1 and PG E2 were able to increase the uterine resting tone and amplitude of contractions. However, PG E1 caused magnification of the normal configuration of the wave of uterine contraction together with moderate increase of resting tone, while PG E2 caused initially a sharp increase in the tone with a sustained contraction showing only minimal oscillations. Both PG E1 and PG E2 were found to be effective in stimulating uterine activity. At the same time, PG E1 did induce a more physiological type of contraction that may be safer for labor induction than that produced by PG E2. Furthermore, the effect of both drugs was antagonized by the beta 2 sympathomimetric albuterol. The results indicated that beta 2 agonists could be used to stop uterine hypertonicity or to postpone uterine activity till the cervix is sufficiently ripened to minimize the effect of these contractions on both mother and fetus

Intrapleural bleomycin in malignant pleural effusion

This study included twenty patients with malignant pleural effusion, proved with fluid cytology and/or pleural biopsy. The primary tumour was lung cancer in 8 cases, lymphoma in 2 cases, breast in 6 cases, ovary in one case and the primary site was undefined in 3 cases. A tube drainage over 24 hours was performed followed by introduction into the pleural cavity of 100 ml saline containing 90 mg bleomycin and the tube was clamped for 24 hours before drainage of the residual fluid. The response rate was achieved by serial follow-up X ray chest and ultrasound examination to detect the amount of pleural effusion. It was defined as no recurrence of effusion or asymptomatic recurrence of effusion not requiring aspiration for greater than 30 days. The overall response rate was 70 percent. The side effects were pain in8 cases [40 percent], fever in 6 cases [30 percent] and gastrointestinal symptoms in 4 cases [20 percent]. It is concluded that tube drainages with local application of bleomycin is an effective and safe method in the control of rapid recurrent malignant pleural effusion