Menstruation among adolescent school girls

This work was carried out to study the characteristics and problems of the menstrual cycle among adolescent schoolgirls, the knowledge of girls about different aspects of menstruation and to assess the practicing of menstrual hygienic measures in relation to their knowledge. The study was carried out on 210 postmenarcheal schoolgirls aged 13-16 years [104 preparatory school girls and 106 secondary school girls] as a random sample from one preparatory and one secondary school at El-Mahalla El-Kobra City, Gharbia Governorate during the scholastic year 1999-2000. The average menarcheal age was 12.63. +/- 0.99 years. The mean duration of menstrual blood flow was 4.74 +/- 1 .60 days. Most of the studied girls [60%] had menstrual cycle of normal length [28-32 days]. Only 36.67% of the studied girls menstruating blood in average amount. Most of the studied girls menstruating regularly [87.14%]. Nearly two thirds of the studied girls suffered from premenstrual symptoms [66.24%], with significant higher percent among secondary school girls than preparatory ones [72.64% and 57.69% respectively]. Vulvitis was detected among 15.24% of the studied girls during the period of the study with no significant difference between preparatory and secondary schoolgirls. The most frequent premenstrual symptoms among the studied girls were abdominal cramps, impaired concentration, headache, mood changes and low work performance with significant difference between them. Abdominal cramps and low work performance were more frequent among preparatory school girls than secondary school girls. Some premenstrual symptoms, were more frequent among secondary school girls than preparatory ones as headache, mastalgia, backache, fatigue and behavioral changes. The menstrual gynecological problems were detected among 88.10% of the studied girls, with no significant difference between preparatory and secondary schoolgirls. The most frequent menstrual problem was dysmenorrhea [75.71%], with higher percent among preparatory than secondary schoolgirls [81 .73% and 69.8 1% respectively]. Heavy menstrual bleeding represented 47.62%. followed by hypomenorrhea [14.29%] and polymenorrhea [7.62%]. Menstruation was a leading cause to other non-gynecological problems including: decreased daily activities, impaired school performance and school absentism, with no significant difference between preparatory and secondary school girls. 37.03% of the studied girls had correct knowledge, 30.11% had false knowledge and 32.86% had no information about menstruation. The pattern of distribution of' knowledge as being good or unsatisfactory was significantly different between preparatory and secondary schoolgirls regarding good knowledge about; premenstrual symptoms, changes that occur differences regarding their knowledge about menstrual hygiene, Statistically, there were significant differences between correct and bad practice of hygienic measures among the studied girls on the light of their knowledge regarding; perineal hygiene, use of chemicals during perineal wash, frequency of changing pads during menstruation, sanitary disposal of pads, and bathing during menstruation [with higher percents of good knowledge and correct practice among secondary schoolgirls than preparatory ones]. 84.29% of the studied girls depended on a single source of information about menstruation. The highest percent of the studied girls depended on their mothers as a source of information [51.43%]. The level of education among parents of the studied girls denoted that their reproductive knowledge was not sufficient as a source of information and they must be indulged in the programs of reproductive health education for the benefit of their daughters. The occupation of parents and their economic standard may have a role as a barrier for good practice of hygienic measures inspite of the good knowledge among their girls. The findings of the present study point to the need for early school-based reproductive health education programs, incorporating correct information on reproductive biology and the subsequent prevention of reproductive ill health. The reproductive education programs designed for schoolgirls must be based upon their true knowledge at different education grades, putting in consideration the role of their curriculum

Is serum antioxidant vitamins A, E and C and trace metals zinc and sellenium have aprotective effect on the occurrence of hepatocellular carcinoma among cases of liver cirrhosis?

Chronic hepatitis is a relevant clinical problem due to mainly evolution to cirrhosis and its life threatening complications. Liver cirrhosis is associated with decreased activity of the antioxidant enzymes as well as many antioxidant micronutrients and vitamins. The high susceptibility of those patients to develop hepatocellular carcinoma [HCC] may be a consequence of superimposed oxidative stress due to lack of defensive mechanisms in cirrhotic patients. The present study aimed to assess the serum levels of antioxidant vitamins A, E and C and micronutrient trace elements zinc and selenium among cases of HCC and cases of liver cirrhosis, to assess the prooxidant antioxidant status in comparison with normal subjects. It was carried out on 26 cases of liver cirrhosis, 26 cases of HCC on top of liver cirrhosis and 26 normal subjects. The study was conducted at the Tropical Medicine Department, Tanta University Hospital, during the year, 1998. According to viral etiology among the studied cases, HCV was detected in 80.77% of cirrhotic patients and 76.92% of HCC cases. HBV was detected in 19.23% of cirrhotic cases and 23.08% of HCC cases. The mixed HBV and HCV caused 15.38% of cirrhotic patients and a same percent of HCC cases. Serum and liver tissue levels of vitamins A and E showed significant depletion among cases of HCC and liver cirrhosis in comparison to normal subjects. This depletion was significantly more marked among cases of HCC than cases of liver cirrhosis. Serum level of vitamin C showed the same pattern. Also, serum and liver tissue levels of trace metals zinc and selenium showed significant decrease among cases of HCC and liver cirrhosis than the control subjects and this decrease was significantly more marked among cases of HCC. Among cases of HCC, the decrease in serum levels of selenium and vitamin A was significantly correlated with the decrease in the corresponding concentrations in liver tissue, while the decrease in serum levels of vitamin E and zinc showed no significant correlation with that in liver tissue. Among cases of liver cirrhosis and normal subjects, there was no significant correlation between serum and liver tissue levels of vitamins A and E and trace elements zinc and selenium. Malondialdehyde [MDA], which is considered as a reflection of the prooxidant status in cells showed significant elevation in serum of cases with liver cirrhosis in comparison to normal subjects. This elevation was significantly higher among cases of HCC. Elevation of serum levels of MDA was significantly correlated with the reduction in serum levels of vitamins A, E and C and that of zinc among cases of HCC, while this correlation was not significant among cases of liver cirrhosis and normal subjects. This denotes the importance of establishment of preventive measures for viral hepatitis, proper treatment of chronic liver cirrhosis and the importance of preventive dietary approach for the cases of chronic hepatitis and liver cirrhosis as risk group for HCC

Serum copper /zinc [cu/zn] ratio as an early detector of heptocellular carcinoma among cases of liver cirrhosis

The present study aimed to assess the role of serum copper/zinc [Cu/Zn] ratio as an early detector of hepatocellular carcinoma [HCC] in cases of liver cirrhosis and for screening cases of HCC as a biomarker for cancer. It was carried out on 26 cases of liver cirrhosis, 26 cases of HCC on top of liver cirrhosis and 26 normal subjects. The study was conducted at the Tropical Medicine Department, Tanta University Hospital, during the year 1998. The viral etiology among the studied cases was as the following: HCV was detected in 80.77% of cirrhotic patients and 76.92% of HCC cases. HBV was detected in 19.23% of cirrhotic cases and 23.08% of HCC cases. The mixed HBV and HCV caused 15.38% of cirrhotic patients and a same percent of HCC cases. The mean serum level of copper was significantly increased among cases of HCC [113.77 +/- 26.96 mg/dl] than that among cases of liver cirrhosis, which was also significantly higher than that of the controls [89.38 +/- 24.34 mg/dl and 70.38 +/- 19.01 mg/dl respectively]. The mean serum level of zinc showed significant depletion among cases of HCC than that of cirrhotic patients, which was also significantly lower than that of the controls [154.42 +/- 28.86 mg/dl, 180.46 +/- 18.23 and 497 +/- 140.79 respectively], denoting disturbance in trace metals in serum of patients with liver cirrhosis, which may be a cause of neoplastic changes. The mean serum Cu/Zn ratio was significantly higher among cases of HCC than that among cases of liver cirrhosis and the controls [0.76 +/- 0.22, 0.50 +/- 0.17 and 0.15 +/- 0.01 respectively]. Serum alpha-fetoprotein [AFP] among cases of HCC [901.15 +/- 386.46 ng/ml] showed significant elevation than that among cases of liver cirrhosis [70.81 +/- 49.68 ng/ml], which was also significantly higher than that among the controls [10 +/- 2.55 ng/ml]. Elevation in serum levels of AFP was significantly correlated with the elevation in the corresponding serum Cu/Zn ratio among cases of HCC [r = 0.78] and cases of liver cirrhosis [r = 0.65] and this correlation help studying changes in trace metals as biomarkers of cancer. Serum levels of AFP and Cu/Zn ratio were not significantly correlated among the controls [r =0.15]. At a cutoff value of 146 mg/dl serum copper, the maximum cirrhotic patients range, showed sensitivity of 19.23%, specificity of 92.31%, positive predictive value [PPV] 71.43% and negative predictive value [NPN] 52.17%, referring to the high predictive value of serum copper in diagnosis of HCC among cases of liver cirrhosis. At a cutoff value of 0.90 serum Cu/Zn ratio, the maximum range of the Cu/Zn ratio among cirrhotic patients, it showed sensitivity of 23.08%, specificity of 96.15%, PPV of 85.71% and NPV of 55.56% in detection of HCC among cases of liver cirrhosis. At a cutoff value of 500 ng/ml serum alpha-fetoprotein, as a definite diagnostic level of cancer, it showed a sensitivity of 92.31%, specificity of 100%, PPV of 100% and NPV of 92.86%. With respect to the highest range of Cu/Zn ratio among the studied cases of HCC, the cut off value of 220 ng/ml serum alpha-fetoprotein showed a sensitivity of 100%, specificity of 96.15%, PPV of 96.30% and NPV was 100% in diagnosing HCC among cases of liver cirrhosis, denoting that the assessment of Cu/Zn ratio may increase the ability of AFP in diagnosing HCC among cases of chronic hepatitis and liver cirrhosis. This denotes the importance of developing a variety of screening protocols to detect hepatocellular carcinoma [HCC] early in patients with hepatitis B surface antigenemia or chronic hepatitis C and patients with liver cirrhosis [as a risk group for HCC] such as serum copper and Cu/Zn ratio, as being available to many laboratories, inexpensive, not time consuming and non-invasive. Also, attention must be paid to excess intake of zinc as diets or supplements for those patients as a preventive measure for HCC

Patient education as a mean to reduce hospital stress among hospitalized children

Hospitalization whether elective planned or as a result of an emergency or trauma is stressful for children of all ages and their families as children might be subjected to various routines and invasive procedures possibly even surgery. This study was carried out on 140 children aged 6 - 12 years who were admitted to the Pediatric Department at Tanta University Hospital due to medical problems, excluding comatosed, mentally ill or critically ill children. Of them, 70 children were studied as a study group who received the routine hospital care in addition to education as a preparation to hospital experience during hospitalization. The other 70 children were matched for socio-demographic characters and the nature of diseases at admission to hospital to be studied as controls. They received the routine hospital care but not educated for preparation to hospital experience. Both groups were compared regarding level of anxiety, level of depression, improvement of health status at discharge from the hospital and follow up after discharge at the outpatient clinic, to study the effect of patient education on reducing hospital stress and improvement of outcome of applied hospital care. All the studied children suffered from chronic illnesses, with highest percent cases of cardiac diseases, followed by renal diseases, respiratory diseases, blood disorders, neurological disorders and other diseases as severe malnutrition with superimposed infection. Most of the studied children were hospitalized for more than two weeks. The hospitalized child patient education was conducted individually for each child in the study group during the period of hospitalization. Out of the study group, 82.86% were positive to anxiety with different levels compared to 81.43% among the controls at admission to hospital, with no significant difference. Among the frequent causes of anxiety among the study and control groups were; bad health status, expected decreased school achievement, bad physical symptoms as headache, blurred vision, deceased body weight, loss of appetite and being away from school friends. Out of the study group, 92.86% were positive to depression with different levels at admission to hospital compared to 88.57% among the controls, with no significant difference. Among the frequent causes of depression among the studied children were; social problems especially social isolation, regression in school, sense of being less and different from other peers, sense of pain, sadness and passive trend toward self body. All these items showed more significant decrease among the educated group than among the non-educated children of different diseases as detected at discharge from the hospital. The results showed that the child education during hospitalization had a significant effect in reducing the anxiety and depression state [or reduction in hospital stress], that may play a role in improving the health status of the educated diseased children more than non-educated ones with better response to continue follow up at the outpatient clinic to complete treatment if needed

Medicolegal and epidemiological aspects of nosocomial infection in Tanta University Hosital

Nosocomial infection [NCI] is considered a major problem of continuous forensic and public health interest. This study aimed at studying the magnitude of nosocomial infections [NCIs] at Tanta University Hospitals and some medicolegal and epidemiological aspects of this problem. A prospective surveillance was conducted to all admitted patients [8427] at the main six wards, at Tanta University Hospitals, during the first 6 months of the year 1998 for detecting cases of NCIs. Bacteriological examination was conducted to 480 patients of NCIs to isolate the causative organisms. All the detected cases were followed up to study mortality. 1535 cases of NCIs were detected out of 8427 patients admitted to the studied six wards during the 6 months period of the study, with a rate of 18.22%. The highest age group of affected male and female patients was 20 - < 30 years, followed by those aged 50 - < 60 years and children aged 1 - < 10 years. Males were significantly more affected than females with male/female ratio 1.06/1. The highest rate among male cases was in the intensive care unit [ICU] [28.37%], urology ward [26.20%] and pediatric ward [20.67%]. Among female cases, the highest rate was in the urology ward [44.94%], burn ward [31.71%] and both ICU and surgery wards in equal percents [25%]. Wound sepsis was the most frequent NCIs [48.14%]. Of them 75.64% were post-operative; especially in surgery and the obstetric and gynecology wards. The non post-operative wound sepsis represented 24.36% of all cases of wound sepsis. The most frequent NCIs in urology department were; UTIs [40.93%], and surgical procedures [31.63%], in the ICU were; cellulitis [27.27%] and both enteritis and pneumonia in equal percents [22.73%], in burn ward was only wound sepsis and in pediatric ward were; enteritis [33.21%], upper respiratory infections [27.86%] and UTIs [12.5%]. Gram -ve bacteria and Staphylococcus aureus were the commonest causative organisms [38.13% and 33.33% respectively]. Gram -ve bacilli were the causative organisms in about half of all NCIs in urology patients [49.67%], while Staphylococcus aureus was the most common causative organism in obstetric and gynecology department [52.20%]. Out of 1535 [total cases of NCIs], 102 [6.64%] patients died from nosocomial bacteremia [blood stream infection] and the main cause was respiratory infections [41.20%]. The dead cases represented the highest percents out of cases in the burn ward [68.18%], ICU [45.45%] and urology ward [10.23%]. The dead cases represented 6.72% in surgery ward, 4.11% in pediatric ward and 2.72% in the obstetric and gynecology ward. Dead cases represented the highest percents among male patients aged 10-< 20 years [11.86%] and elder patients 60-70 years [11.27%] Among female cases of NCIs, dead cases represented the highest percents among those aged 10 - < 20 years [10.98%] and 40 - < 50 years [8.47%]. The percent of deaths among male cases of NCIs was higher than female ones [7.47% and 5.77% respectively], with no significant difference. The highest frequency of antibiotic usage was reported for patients in the ICU [36.41%], followed by those in pediatric ward [26.80%] and urology ward [26.10%] The medical records in different wards were not properly written especially as regard history of previous diseases or previous hospitalization. Negligence was present in recording NCIs in the patients files and discharge abstract. There was a delay in performing laboratory procedures [especially microbiological]. So, proper recording of discharge diagnosis including complications of medical care is essential for accurate evaluation of care. Establishment of an infection control unit, for registration, prevention and control of NCIs in different wards at Tanta University Hospitals was recommended

Human fascioliasis: prevalence and early detection in Seiger, Tanta city, Gharbia governorate

The study of the prevalence of fascioliasis in Egypt is critical for the effective prevention of this disease. The study was carried out in Seiger, a district of Tanta City. Gharbia Governorate. A random sample of 943 [39.44%] of 2391 total population of school children aged 6-15 years was examined for parasitic infection, out of them 332 [35.2%] were suffering from parasitic infection. Of the 943 school children 26 [2.75%] cases were positive for Fasciola gigantica. It was diagnosed by repeated stool analysis in 15 cases, but 26 cases were diagnosed by serologic immunodiffusion test, denoting the importance of serodiagnosis in survey studies for fascioliasis and early detection of infection before excretion of Fasciola ova in patients' stools. The cases of fascioliasis were significantly related to environmental conditions and human dietary habits of using stagnant water canal in washing raw vegetables, the presence of Lymnaea cailliaudi snails, rearing Fasciola infected sheep and cows in houses and the presence of animal shelters nearby the source of water. The clinical findings among cases of fascioliasis were; gastrointestinal symptoms [dyspepsia. anorexia, diarrhea and vomiting] in all cases, right upper quadrant abdominal pain in 92.30% of cases, headache and dizziness in 46.15%, fever in 53.85% and enlarged liver was found in 26.92% of cases. The significant laboratory findings among cases of fascioliasis were low mean blood Hb [7 19 +/- 2.01 mg/dl], high mean W.B.C. count [18.418 +/- 5.529/c.mm]. high mean blood Hb [7.19 +/- 2.01 mg/dl], high mean W.B.C. count [18.418 +/- 5.529/c.mm], high mean blood eosinophilic count [38.33%+24.64] and highly positive immunodiffusion test. These data reflect the role of clinical examination and laboratory investigation of routine school health care in early detection of fascioliasis and orienting the responsible health personnel regarding this. Also, the role of health education to prevent filthy habits under certain risky environmental conditions for fascioliasis. Regarding the treatment of Fasciola gigantica, results showed that, praziquantel in a dose of 75 mg/kg/day for 10 days was effective in 86.71% of treated cases, but praziquantel in the same dose plus metronidazole 50 mg/kg/day for 21 days was effective in the treatment of all studied cases of fascioliasis