Quality of documentation of electronic medical information systems at primary health care units in Alexandria, Egypt

Limited data are available about the implementation of electronic records systems in primary care in developing countries. The present study aimed to assess the quality of documentation in the electronic medical records at primary health care units in Alexandria, Egypt and to elicit physician's feedback on barriers and facilitators to the system. Data were collected at 7 units selected randomly from each administrative region and in each unit 50 paper-based records and their corresponding e-records were randomly selected for patients who visited the unit in the first 3 months of 2011. Administrative data were almost complete in both paper and e-records, but the completeness of clinical data varied between 60.0% and 100.0% across different units and types of record. The accuracy rate of the main diagnosis in e-records compared with paper-based records ranged between 44.0% and 82.0%. High workload and system complexity were the most frequently mentioned barriers to implementation of the e-records system

Histological study of the effect of exogenous glucocorticoids on the testis of prepubertal albino rat

Corticosteroids are potent medications that have been extensively used to treat many inflammatory and autoimmune conditions. To study the histological changes that may occur in the prepubertal albino rat testis after administration of dexamethasone and to investigate the possibility of recovery of testis after drug stoppage. Thirty prepubertal male albino rats were used and divided into three equal groups. Group I [control] and group II [dexamethasone-treated] that were injected daily intraperitonealy by dexamethasone [7mg/kg body weight] for 2 weeks. Group III [recovery] were injected daily intraperitonealy with the same dose of dexamethasone for 2 weeks as group II, then left untreated for further 2 weeks. At the time of sacrifice, the testes of all groups were dissected out, processed and stained with H and E. Semithin sections were stained with toluidine blue and ultrathin sections were examined by electron microscope. Histological examination of dexamethasone-treated rats revealed changes in most of the seminiferous tubules. They had lost the normal distribution of their epithelial lining with appearance of several layers of dark type spermatogonia. They were ensheathed by irregular basement membrane. Ultrastructurally, spermatogonia had small irregular nuclei with condensation of heterochromatin and their cytoplasm contained few mitochondria. Some primary spermatocytes showed clumps of heterochromatin in their nuclei and their cytoplasm contained few mitochondria. Other cells were apoptotic. Multiple Sertoli cells appeared with indented nuclei and peripheral marginated heterochromatin. Their cytoplasm showed mitochondria with disrupted cristae. Leydig cells appeared with irregular shaped nuclei, contained large heterochromatic masses and their cytoplasm had some electron dense bodies of variable sizes and shapes. The testis of recovery group contained distorted seminiferous tubules with no return to the normal histological structure. The present work showed that dexamethasone injection for 2 weeks produced destructive effects on the structure of prepubertal albino rat testes. Also, this work showed incomplete recovery of these effects after drug stoppage. In clinical practice, therapeutic doses of dexamethasone and periods of administrations must be carefully adjusted specially in younger ages

Genetic fingerprints of some bacillus spp. isolates gathered from different locations at Saudi Arabia

Twelve Bacillus spp. isolates gathered from different locations at Saudi Arabia were fingerprinted by random amplified polymorphic DNA [RAPD] markers. The results revealed high levels of polymorphism among the studied isolates. Of many 10-mer random primers screened, five gave distinct and reproducible polymorphic DNA amplification patterns. The primers are A3, B6, B10, B11 and C12. The number of the generated bands was primer and genotype dependent. A total of 36 amplified polymorphic DNA bands were generated across the studied isolates with 9 bands being unique. All primers gave a number of unique bands that used for discrimination of some isolates. No primer was able to generate a unique banding pattern for all the studied isolates. However, combinations of all data derived from the RAPD profiles generated by the five utilized primers produced a unique fingerprint for each isolate. Similarity coefficients among the studied isolates were estimated after pooling all the gained data. The levels of similarity between the studied isolates showed low values. It reached the highest value of 0.938 between the two isolates N2 and M2, while the minimum value was 0.118 recorded between the two isolates M1 and W1. The generated dendrogram clustered the three isolates E1, N2 and M2 together and located W1 in a separate cluster

Genetic fingerprinting and relationships of some corynebacterium isolates based on DNA polymorphism

Genetic differences and relationships among six Corynebacterium isolates of different geographic origin from Saudi Arabia were studied based on RAPD-PCR polymorphism. In this analysis many random 10-mer primers were screened, but only five primers [A3, A11, B10, B11 and Z6] were able to generate repeatable and informative products among the DNA samples of the studied bacterial isolates. A total of 47 polymorphic bands were generated by the five primers [100% polymorphism]. Of these bands 23 were scored as unique polymorphic bands. The two primers A11 and B10 were found to be the most effective ones in generating unique bands. The former primer generated 8 unique bands in six isolates while the latter primer produced six unique bands in four isolates. In addition, the most pronounced non unique bands categorized the studied isolates into many class patterns. Combination of all data provides a considerable potentiality for discriminating each Corynebacterium isolate by one or more unique bands or a group of combined class patterns. RAPD data were combined together and used to estimate similarity coefficients and to construct a dendrogram that estimates the relationships among the studied Corynebacterium isolates. The similarity coefficient values varied from zero to 0.44% indicating considerable variability within the studied isolates Based on this dendrogram the studied isolates were separated into two main groups. Such clustering in most cases was well correlated to the geographic collection sites

Verification of subclinical atherosclerosis by carotid doppler ultrasonography in behcet disease patients

Behcets disease [BD], is a unique systemic vasculitis, which affects almost all types and sizes of blood vessels. Although the exact pathogenesis of BD remains unclear, small vessel vasculitis accounts for a considerable portion of the pathogenic processes in BD. In addition, large venous or arterial lesions can occur in BD patients and vascular involvement may be seen in 25%. Vasculitis makes the prognosis of BD severe. Doppler ultrasonography may show carotid intima-media thickness [IMT] associated with atherosclerosis in BD which is an endothelial cell dysfunction [ECD] parameter and may partially explain the observed cardiovascular morbidity and mortality. The aim of the present work is to study the use of Doppler ultrasonography in the assessment of the carotid artery involvement regarding the IMT and plaque formation in patients with BD. Correlation with disease activity, clinical manifestations and laboratory investigations were considered. Assessment of the lipid profile of the patients and correlation with the findings of the Doppler ultrasonography was considered. Twenty patients, 15 males and 5 females, suffering from BD satisfying the new set of diagnostic criteria published by the International Study Group for Behcet's Disease in 1990, were included in the present study. They were recruited from the Rheumatology and Rehabilitation department as well as the outpatient clinic, Cairo University hospitals. Patients were taken consecutively, with a mean age of 36.75 +/- 8.57 years [ranged from 22 to 54 years] and mean disease duration of 9.23 +/- 5.83 years [range 1.5 to 20 years]. Twenty age and sex matched healthy volunteers served as controls with a mean age of 34.5 +/- 4.24 years were also included in the present study. Subjects with diabetes mellitus, hypertension or evidence of myocardial infarction were excluded from the study. Full history taking and clinical examination of all patients and investigations including lipid profile were performed for the control and the patients. Medications received by the patients were considered and patients receiving corticosteroids for management of their disease were not excluded. Disease activity was assessed using the Behcets disease current activity form [BDCAF] score. Carotid artery ultrasound scan for the right and left common carotid arteries, carotid bulb and the first 1.5 cm of the internal and external carotid arteries was carried out in the radiodiagnosis department, Cairo University. The IMT of the carotid artery was measured in both patients and control by ultrasonography. The age at disease onset was 27.53 +/- 6.46 years. Six of the patients were smokers. There was no significant correlation between the dose of corticosteroids or colchicine used by the BD patients and the IMT of the carotid artery. However, the dose of steroids significantly positively correlated with the level of low density lipoprotein [LDL] [p = 0.013]. The mean IMT of both right and left carotid arteries in the BD patients was 0.64 +/- 0.32 mm [0.68 +/- 0.38 mm and 0.6 +/- 0.24mm for the right and left IMT respectively]. The IMT of BD patients was significantly different from that in the control subjects [0.42 +/- 0.13 mm] [p = 0.003]. There was no significant difference between smoker and non smoker patients [p = 0.1]. Furthermore, there was no significant correlation between the IMT with the disease duration or BMI [p = 0.46 and 0.3 respectively].The IMT of the carotid artery showed a significant positive correlation with the urea level [p = 0.009] and creatinine [p = 0.013]. There was a tendancy towards a positive correlation between the IMT and the cholesterol level and a negative one with the HDL, however, there was a significant positive correlation with the serum triglycerides [p = 0.03]. There were positive sonographic findings in 3 out of 20 BD patients [15%] compared to the control [0%]. The three patients were two males who had autoimmune hepatitis and one female with HCV positive hepatomegaly. Atherosclerotic plaque was present in two. There was a significant positive correlation between the IMT of the carotid artery and the BDCAF score in BD patients [r = 0.481, p = 0.016]. The score significantly negatively correlated with the platelet count [p = 0.002] while there was no correlation with the cholesterol, triglycerides, low or high density lipoprotein. On comparing the IMT in BD patients according to the presence and absence of arthritis, CNS or eye involvement, there was no significant difference. One can conclude that there is a morphologic evidence of subclinical atherosclerosis in patients with BD. IMT was associated with triglycerides as well as urea and creatinine levels denoting that the renal function forms a possible risk of CVD in BD. The BDCAF is an easy tool that may significantly reflect the cardiovascular involvement in BD patients and may be important for clinical management

Application of real time - PCR for identification of sheep poxvirus, camel poxvirus and contagious ecthyma virus isolates

Recently, attention has been directed toward the application of Real time - PCR assays as a rapid and accurate tools for identification of Capripox, Parapox and Orthopox viruses that cause devastating diseases in farm animals in the Kingdom of Saudi Arabia. SYBR Green [Real time n PCR assays with primer pairs; Capri - Ks.1 of Capripoxviruses, 045 Orf of Parapoxviruses and Q Orf of Pan-parapoxviruses were adopted on a panel of Saudi field isolates and reference strains of sheep and goat poxviruses, camel poxvirus, reference strains of Lumpy skin disease and vaccinia viruses, and Saudi field isolates of contagious ecthyma [Orf] virus. Capri n KS.1 primer set succeeded to amplify all test DNAs of sheep and goat pox, Camel pox, Lumpy skin disease and vaccinia viruses. With melting curve analysis, temperature of melting [Tm] scored by sheep and goat poxvirus, camel pox virus isolates and their reference strains were relatively identical [between 81.1 and 81.8OC], while Tm scored by Lumpy skin disease virus and vaccinia virus were 82.1 and 83.2OC respectively. No amplification was detected from DNAs of Orf virus isolates tested by Capri - KS.1 primers. However, the Orf virus isolates were fairly equivalent amplified with both of 045 Orf primer set [mean Tm score 92.5°C] and Q Orf primer set [mean Tm score 84°C], as well as with TaqMan Real time - PCR in the presence of TaqMan probe and Q Orf primer set. Otherwise, occasional nonspecific amplification of some isolates and strains of Capripox and Orthopox viruses were detected by too late cycle of amplification [> 35 cycle] with 045 Orf and Q Orf primer sets

Detection and characterization of foot and mouth disease virus, serotype a in Saudi Arabia in 2005

After elapsing of 10 years on the last recorded cases of Foot and Mouth disease [FMD] caused by the virus of serotype A in Saudi Arabia in 1995, new cases of FMD virus, serotype A were diagnosed in two traditional cattle herds in Al-Hota province, 150 Km south of Riyadh. Clinical signs of fever, vesicular stomatitis and coronitis, with morbidity rate of approximately 90% were reported. FMDV, serotype [A] isolates were identified by indirect sandwich ELISA. Vaccine matching tests [virus neutralization and ELISA], amplification and sequencing of the VP1 of the isolates revealed that the isolates were antigenically closely related with A Saudi 95, A 4164 and A22 Iraq 24/64 strains, and genetically identical with isolates of A Iran 2005. Fortunately one of these strains [A22 Iraq 24/64] is already incorporated in polyvalent FMD-vaccine formula in Saudi Arabia

Role of MDCT in detection of ventricular dysfunction and pulmonary obstruction index in patients with acute pulmonary embolism

To retrospectively quantity right ventricular dysfunction [RVD] and the pulmonary artery obstruction index in MDCT on the basis of various criteria proposed in the literature and to assess the predictive value of these CT parameters for mortality it has been compared to the echocardiographic assessments. In a retrospective study we reviewed 80 patients where there primary clinical and laboratory diagosis are suggestive of Pulmonary embolism [in Erfan and Baghdo hospital], 20 patient were negative on CT Study while 60 patient were positive [25 men, 35 women; mean age +/- standard deviation 50 years +/- 16] with proved PE, by dectection of the extent of RVD by quantifying the ratio of the right ventricle to left ventricle short-axis diameters [RV/LV] and tile pulmonary artery to ascending aorta diameters, the shape of the interventricular septum, and the extent of obstruction to the pulmonary artery circulation on MDCT. Regression analysts was used to correlate these parameters with the echocardiography and patient outcome. CT signs of RVD [RV/LV ratio, >1.0] were seen in 35 patients [58.3%] in the follow-up, 5 patients died of PE. Both the obstruction index and RV/LV ratio were shown to be significant risk factors for mortality [p=.01 and .03, respectively]. No relationship was found for the ratio of the pulmonary artery to ascending aorta diameters [p= .99] or for the shape of the interventricular septum [p= .30]. The positive predictive value for PE-related mortality with an RV/LV ratio greater than 1.0 was 10.1%. The negative predictive value for an uneventful outcome with an RV/LV ratio of 1.0 or less was 100%. There was a 14 -fold increased risk of dying of PE for patients with an obstruction index of 40% or higher. The Measurement of RVD and pulmonary vascular obstruction index evaluated with MDCT CT at baseline, help predict the prognosis during follow-up

Transconjunctival oozing and point leak of aqueous humor from filtering bleb after trabeuclectomy

To estimate the prevalence and identify factors related to late-onset transconjunctival aqueous oozing and point leak from functioning blebs after trabculectomy with 5-flurouracil [5-Fu] or mitomycin C. Two hundred seven consecutive patients [207 eyes] with functional blebs were examined. The seidel test was performed with extended observation up to 15 seconds. Oozing was identified as transonjunctival aqueous egress without interruption of the conjunctival tissue or aqueous stream on the bleb wall. Logistic regression analyses of oozing and point leak in 168 eyes with an avascular area were performed using independent variables, including age, glaucoma diagnosis, prior incisional surgery, antimetabolite use, concurrent cataract surgery, postoperative follow-up period, intraocular pressure [IOP], concurrent glaucoma therapy, bleb size, and avascualr area size. Of 207 eyes, 27 eyes [13%] had oozing and 6 eyes [2.8%] had point leak. Intraocualr pressure was significantly lower and an avascualr area was more frequent in eyes with oozing or leak than in eyes without [P < .00 1]. Logistic regression analysis revealed that oozing was significantly more common after use of 5-FU than mitomycin C, whereas point leak was associated with a larger avascular area. After tabeculectomy with antimetabolites, transconjunctival oozing is much more frequent than point leak. Oozing was significantly associated with the use of 5-FU and point leak with a larger avascualr area in the bleb

Genetic diversity in Egyptian buffalo using microsatellite markers

Three bovine microsatellite markers named: ETH02; CSSM060 and BM1706 were used to study the genetic diversity in six Egyptian buffalo populations. The total number of animals sampled were 92, and collected from Alexandria, Kafr El-Sheikh, Great Cairo, Menofya, Al-Minya and Qina. All markers showed polymorphism with a total number of alleles 12 for each of ETH02, and BM1706 and 13 for CSSM060. Heterozygosity and Wright's F-statistics [F[IS], and F[ST]] were calculated to determine the genetic variation in these populations. High values of observed heterozygosities were noticed in all populations. The lowest heterozygosity was 0.846 observed in Qina for the microsatellite BM1706, in contrast to heterozygosity 1.00 observed in many populations, especially for the microsatellite ETH02. All the F[Is] values were below zero, indicating the absence of inbreeding within the populations under study. Depending on the genetic distances, a dendrogram showing the genetic relationship among the different populations was prepared. High values of the average gene diversity were noticed, for all markers and all populations, ranging from 0.795 to 0.904 with an overall mean of 0.867. Values of gene flow or migration between populations were high, meaning that migration and admixture could have taken place between these populations. It is concluded that the Egyptian buffaloes belong to one breed

Anatomical study on the correlation between lip prints and dermatoglyphic pattern on finger tips

Dermatoglyphics and Lip prints have been proved to be ectodermal in origin, completely developed by the end of the fourth month of foetal life and remained unchanged throughout the whole person's life. The correlation between finger and lip print patterns was studied, where it was carried out on six hundred Upper Egyptians [three hundred males and three hundred females,]. Fingerprints were taken by the inked method, whereas, lip prints were taken by two methods; smearing lips with lip-stick and photography by close up camera to focus on lips only. The present work showed that, the complex fingerprint patterns tend to occur in the individuals who have complex up print patterns and the simple fingerprints tend to occur in the individuals who have simple lip print patterns. Furthermore, the complex patterns in one hand are present in the individuals who have complex patterns in the other hand, and the simple patterns in one hand are present in the individuals who have simple patterns in the other hand. In conclusion, the results of the present work may participate in the fields of forensic medicine as a method of personal identification, anthropology and the studies of the genetic diseases

Intracameral air injection for acute hydrops in keratoconus

To evaluate the efficacy and safety of intracameral air injection in treating acute hydrops in Keratoconus. Twenty one [21 patients] with acute hydrops secondary to keratoconus. Nine eyes [nine patients] with acute hydrops in keratoconus were treated with intracameral injection of 0.1 ml filtered air. Additional 0.1 ml filtered air was injected if corneal edema persisted when air disappeared from the anterior chamber. Twelve eyes [12 patients] with acute hydrops, that received no therapy or conventional therapy not likely to shorten the duration of hydrops served as controls. Main outcome measures: The period of persistence of comeal edema, the interval between the onset of acute hydrops, and the time when the eye could begin to wear a hard-contact lens, and best spectacle corrected and hard-contact lens-corrected visual acuity after corneal edema subsided were used as criteria to evaluate any differences between the two groups. The average period of persistence of corneal edema was 22.1 +/- 8.0 days [ +/- SD] in the intracameral air injection group and 67.6 +/- 35.7 days in the control group [P =.0009]. The average interval between the onset of acute hydrops and the time when the eye could begin to wear a hard- contact lens, 32.8 +/- 5.7 days in the air injection group and 129.8 +/- 75.7 days in the control group [P =.0056]. The best-corrected visual acuity after corneal edema subsided was similar between the two groups. Intracameral air injection induced no complications. The results suggest that the intracameral air injection is a safe and useful therapy to shorten the period of corneal edema in acute hydrops secondary to kerateconus

[Antimicrobial property of choloroformic extract of garlic [allicin] on intramacrophages brucella melitensis [rev 1] and brucella abortus [S19]]

Introduction: The most important virulence factor of Brucella is related to its capability of intraphagocytic survival. Brucella with this ability, causes persistant infection in host. Garlic extract, because of has organosulfur compounds such as allicin, has antimicrobial activity. The aim of this study was to investigate the effect of garlic choloroformic extract on intramacrophage Brucella spp

Material and Methods: In this study, garlic choloroform was extracted and the quantity of allicin calculated with HPLC; then effect of the extract on intramacrophage survival of B. melitensis Rev1 and B. abortus S19 was studied on cell culture of mouse peritoneal macrophages

Results: Results indicated that the extract was effective and eradicated intramacrophage Brucella in 1:40 [equal to 439 microgram per ml allicin], 1:80 [equal to 218 microgram per ml allicin] and 1:160 [equal to 128 microgram per ml allicin] extract dilutions after 24 hours

Conclusion: Attention must be paid to antimicrobial effect of garlic on intramacrophage Brucella which, seems to be useful in treatment of brucellosis

[Study effect of garlic choloroformic extract [Allicin] on physiology and morphology of brucella]

Brucella under effects of agents such as penicillin, glycin and some hormones could convert to L-form. L-forms are possible during disease or latent brucellosis and interfering in renew relapsing disease. Garlic is a medicine plant that allicin the most important antimicrobial, is its compound. In this study after garlic choloroformic extract prepared and quantity of allicin calculated MIC and MBC for two strains [B.melitensis Rev1 and B.abortus S19] was calculated. Effect of extract on Brucella morphology in subMIC concentrations effect of time and temperature on extract activity and antimicrobial effect of extract with sucrose were studied. Results indicated that antimicrobial effect of allicin is temperature independent and showing its effect on bacteria in two hours. Also L-forms were not isolated in subMIC concentrations

Comparison of pressure lowering effect of latanoprost and a combination of timolol - pilocarpine eye drops in patients insufficiently controlled with B adrenergic antagonists

To compare the effect pressure [IOP] of latanoprost monotherapy and timololpilocarpine in patients with glaucoma or oclular hypertension with inadequately controlled IOP on topical B adrenergic antagonists. This was randomized, observer masked, 6 weeks study performed on 112 patients with glaucoma or ocular hypertension and IOP of at least 22 mmHg on treatment with timolol 0.5 percent twice daily of at least 21 days. The patients were randomized into two parallel groups: either to latanoprost 0.005 percent once daily or to combination of timolol pilocarpine. Changes in mean diurnal IOP from baseline to the 6 week visit were determined. Switching from timolol 0.5 percent to latanoprost 0:005 percent once daily caused a statistically significant reduction in mean IOP [P < 0.001], and switching from timolol to timolol-pilocarpine twice daily caused a statistically significant reduction in mean diurnal IOP [P < 0.001].Latanoprost monotherapy was at least as effective as combination of timolol-pilocarpine twice daily treatment in reducing IOP in patients not adequately controlled on B adrenergic antagonists

study on the effects of prenatal administration of valproic and [Depakine] on the lumbosacral region of the newly born mice

The present study aimed to demonstrate the embryotoxicity of valproic acid [depakine] [VPA] on the lumbosacral region and to determine the period[s] of susceptibility to produce its hazards. A total number of 40 newly born mice was used. They were divided into a control and three experimental groups. The experimental mothers were injected with 400 mg/kg body weight of sodium valproate three times daily at the 8th, 9th and 10th day of gestation, one day each group. Both control and experimental groups were examined for any external abnormality. The specimens were decalcified, cut at 10 microns thickness and stained by hematoxylin and eosin. Staining of the newly born mice was processed for alizarin red stain. From the results obtained it was concluded that, when VPA must be used during pregnancy, it should be used with strict medical supervision and after closure of the posterior neuropore

study on the postnatal development of the articular cartilage of the knee joint of the albino rat

The postnatal development of the articular cartilage of the femur was studied. A total number of 35 albino rats [Wister strain] was used in this study. The animals were divided into seven groups: Newborn, seven days, ten days, fourteen days, twenty-one days, one month and three months. The study revealed that the immature articular cartilage appeared at the age of twenty-one days in the form of three zones; superficial, intermediate and deep. The mature articular cartilage appeared at the age of three months and consisted of four zones; superficial, intermediate, radial and calcified. The tide mark separated the superficial three zones from the fourth one