Factors influencing parental consent for participation in clinical research involving their children in Egypt

Factors affecting parents' decision to involve their children in clinical research have not been studied in all cultural backgrounds. We aimed to explore the attitudes and beliefs influencing parents' decision to involve their children in clinical research in Mansoura, Egypt. Of 523 families approached, 357 filled the questionnaire. Only 98 [27.5%] parents consented to involve their child in clinical research. The children of consenters were significantly older than refusers: 8.6 [SD 7.2] versus 2.6 [SD 1.2] years. Factors favouring consent were: research of benefit to child [84.7%], enough explanation about the benefits [40.8%] and to learn more about child's condition [29.6%]. Factors favouring refusal were: use of new drugs or vaccines [89.6%] and invasive procedures [84.2%]. Parents' rate of consent was positively correlated with the research being non-invasive and the belief that research was of benefit to their child and negatively correlated with belief that refusal may negatively affect the care provided to their child

Women health in Saudi Arabia: a review of non-communicable diseases and their risk factors

This is a review of the changing pattern of chronic diseases among women in the Kingdom of Saudi Arabia [KSA]. Data from national surveys conducted in KSA, whose results were published between 1996 and 2011 were used. The results showed that over a period of ten years the prevalence of obesity increased in Saudi women from 23.6% to 44.0% and in men from 14.2% to 26.2%; self-reported physical inactivity worsened in both women [from 84.7% to 98.1%] and men [from 43.3% to 93.9%]; prevalence of smoking in women increased [from 0.9% to 7.6%], while it declined in men [from 21.0% to 18.7%]. The prevalence of metabolic syndrome was significantly greater in women than men [42.0% versus 37.2%; p < 0.01]. In conclusion, Saudi women are potentially at a greater risk than a decade ago to develop cardiovascular diseases and diabetes mellitus, with a notable increase in obesity compared to men

using of lucilia cuprina maggots in the treatment of diabetic foot wounds

In the present study, Lucilia cuprina maggots were used for the treatment of diabetic foot wounds. An artificial wound was made in diabetic foot of rabbit. The maggots were sterilized arid put directly on the wound after dressing the wound without using any antibiotics. Several cycles of maggots were put on the wound. The present results showed that the treatment of the diabetic foot was observed after 13 days. After this period the wound was completely healed and become free of microbial contamination. The new tissues were observed to close the wound

Repellent effect of lagenaria siceraria extracts against culex pipiens

Ethanolic, acetone and petroleum ether extracts from leaves and stems of Lagenaria siceraria [Cucurbitaceae] were screened for their repellency effect against Culex pipiens L. mosquito. The repellent action of the present plant extracts were varied depending on the plant parts and the dose of extract. The petroleum ether extract of leaves showed the same repellency percent [100%] of commercial formulation, N. N.'diethyl toulamide [DEBT] at the higher dose [3.33 mg/cm[2]], while petroleum ether extract from stems exhibiting the repellent action [89.6%] at the same dose, respectively. Ethanolic extracts of leaves and stems exhibited the lowest repellent activity as it recorded [81.3% and 69.1%] at [6.67 mg/cm[2]], respectively. Results of this study may contribute to design an alternative way to control mosquitoes currently based on applications of synthetic insecticides. These extracts could be developed commercially as an effective personal protection measure against mosquito bites and thus to control diseases caused by mosquito-borne pathogens

Effects of midgut bacteria and two protease inhibitors on the reproductive potential and midgut enzymes of culex pipiens infected with wuchereria bancrofti

Laboratory investigations were carried out to asses the effect of some proteases inhibitors on the reproductive potential of Culex pipiens females resulted from larvae treated with different protease inhibitors. The fecundity and engorgement of symbiotic and aposymbiotic C. pipiens females were significantly reduced. The blood meal digestion period increased significantly. On the other hand, enzyme band with molecular weight of 40 KDa which may be cysteine protease was detected in untreated symbiotic and aposymbiotic female midguts. The results may explain that the absence of this enzyme bands in treated female midguts may be due to the inhibition caused by [E-64] a cysteine protease inhibitor

Effects of midgut bacteria and two protease inhibitors on the transmission of wuchereria bancrofti by the mosquito vector, culex pipiens

Laboratory investigations were carried out to study the effect of two protease inhibitors on the transmission of W. bancrofti filarial by Culex pipiens and to study the susceptibility interaction between filaria and protease inhibitors. The results obtained revealed that, infection rates were variable among untreated and treated symbiotic and aposymbiotic Cx. pipiens females resulted from third instar larvae treated with E-64 and EDTA. The survival rate was variable among untreated and treated symbiotic and aposymbiotic females resulted from third instar larvae treated with E-64 and EDTA. Protease inhibitor [E-64] caused inhibition of the parasite development and transmission by means of ceasing catalytic activity- responsible for parasite migration-caused by parasitic larval stages inside the mosquito vector

Eosinophilic cationic protein: is it useful in assessing control of childhood asthma?

This study evaluated peripheral eosinophil and serum eosinophilic cationic protein [s-ECP] levels as markers of asthma control. A total of 38 children with asthma [16 controlled and 22 partially controlled] were compared with 16 age- and sex-matched healthy children. Total asthma cases had higher eosinophil counts and s-ECP levels than healthy children and partially controlled asthmatics had significantly higher levels of both markers than controlled asthmatics. Controlled asthma cases showed non-significant changes in both parameters versus healthy children. A negative correlation was noted between degree of asthma control and both eosinophil counts and s-ECP levels [r = -0.60 and -0.75 respectively]. s-ECP as well as peripheral eosinophil count may be helpful in the assessment of asthma control

Steroid and azathioprine versus steroid, cyclosporine, and azathioprine therapies in primary haplo-identical living donor kidney transplantation Twenty-year experience

Achievements in short-term graft survival since the introduction of cyclosporine has not been matched by improvement in long-term graft function, and chronic allograft nephropathy remains the second commonest cause of graft attrition over time. We aimed to evaluate the long-term results of conventional immunosuppression by steroid and azathioprine in comparison with cyclosporine-based triple therapy in living donor kidney transplants. We evaluated the long-term follow-up data of 369 living related kidney transplant recipients that were on prednisolone-azathioprine immunosuppressive therapy [group 1] or triple therapy by prednisolone, cyclosporine, and azathioprine [group 2]. All recipients were followed-up for more than 10 years [mean, 240 +/- 12 months]. Comparative analyses included patient and graft survival rates, condition at last follow-up, graft rejection, and graft function. There were 130 patients in group 1 and 239 in group 2. The overall frequency of acute rejection episodes was not significantly different between the two groups. However, the proportion of patients with chronic allograft nephropathy was significantly higher in group 2 [21% versus 35%, P = .001]. Graft survival rates were 85.3% versus 92.4% at 1 year, 69.9% versus 71.9% at 5 years, and 52.5% versus 50.8% at 10 years in groups 1 and 2, respectively [P = .03]. The two groups were comparable regarding posttransplant malignancies, diabetes mellitus, serious bacterial infections, and hepatic diseases. However, hypertensive patients were significantly more frequent in group 2. Chronic allograft nephropathy was significantly higher in patients receiving cyclosporine, possibly due to the risk of drug-induced nephrotoxicity, glomerular disease recurrence, and hypertension. Nowadays, it is possible to achieve excellent calcineurin inhibitors-free regimen using newer maintenance immunosuppressive agents

Medicolegal aspects of maternal deaths of obstetrical origin

Understanding the extent of maternal deaths especially those due to medicolegal causes as homicide, suicide, accidents, illegal abortion and medical malpractice in women of childbearing age, may lead to improved identification of preventable problems that contribute to maternal morbidity and mortality. Maternal death due to unnatural [medicolegal] causes i.e. deaths due to violence, sudden and unexpected deaths, deaths due to medical malpractice and, in particular, those due to trauma- are increasing and forming the main causes of the maternal deaths. Maternal deaths due to natural causes i.e. direct or indirect obstetrical causes are decreasing nowadays, as a result of rapid progress in the methods of diagnosis and treatment of the various medical conditions affecting women during pregnancy, delivery and puerperium. Medical malpractice represented an important cause of the maternal deaths, especially with the development of the medical care standards. Because of this, if an accident happens the obstetrician more than any other doctor perhaps can find himself in the courts. To avoid this he has to know very well the causes of maternal mortality in order to avoid them as far as possible

Coronary artery bypass grafting on beating heart. does it provide superior myocardial preservation than conventional technique?

To compare myocardial injury caused by 3 commonly used methods for coronary artery bypass grafting [CABG]. A prospective randomized study conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. The study started in February 2003 and concluded in April 2004 after including 45 patients [15 patients in each of 3 sub-groups] who fulfilled the inclusion and exclusion criteria. The subgroups included coronary artery bypass surgery performed by: a] conventional technique, b] off-pump technique, and c] on-pump beating-heart techniques. All patients had similar operative risk profiles. Their ages were 70 years or less with an ejection fraction of 30-50%. The creatine kinase, myocardial band [CKMB] levels were determined 2 hours after arrival from the operating room then, at 4 hours, 6 hours, and 12 hours. The comparison of creatine phosphokinase and CKMB levels was carried out using analysis of variance with repeated measures. The p-values were used to evaluate the significance of differences. The pre-operative characteristics including age, gender, ethnic origin, diabetes mellitus, hypertension, and left ventricular function, were similar in the 3 groups. All groups had a median number of 3 bypass grafts. The stay in the intensive care unit and the duration of inotropes were shortest in the off-pump group, but the difference was not significant. There was a peak of CKMB levels at 6 hours in all groups. The trend of CKMB level showed significantly higher values in the conventional CABG group as compared with the other 2 groups. This study indicates that the off-pump technique provides better myocardial preservation than other methods

Comparison of neurological outcomes in patients undergoing conventional coronary artery bypass grafting, on-pump beating heart coronary bypass, and off-pump coronary bypass

To study the differences in the prevalence of neurological complications following coronary artery bypass [CAB] carried out by conventional, on-pump beating and off-pump techniques. A retrospective analysis of all isolated coronary bypass operations [n=127] performed in King Fahad Cardiac Center, Riyadh over a period of one year starting from January 2005. Out of 127 patients, 73 underwent conventional CAB graft [CABG], 33 patents on-pump beating heart coronary bypass, and 21 had off pump coronary bypass grafting [OPCAB]. All patients had preoperative carotid scans and those who developed neurological complications underwent CT-brain and expert neuro-psychiatric assessment. Preoperative characteristics of patients in all 3 groups were similar. The bypass times in the conventional CABG group were significantly longer than the on-pump beating group. The maximum number of grafts was in the on-pump beating group, followed by the conventional CABG, and the least in the OPCAB group. Seven out of 73 cases in the conventional bypass group developed neurological events of various severities. Only one out of 33 patients developed acute confusional state in the on-pump beating group and no neurological events were noticed in 21 patients operated by the OPCAB technique. Low ejection fraction, preoperative congestive cardiac failure, non-elective surgery and preoperative catastrophic state were found to be significant risk factors independent of the bypass technique. This study shows no significant difference in the prevalence of neurological complications among different types of bypass surgery in our institution. There was a trend towards less neurological outcomes in the OPCAB and on-pump beating groups

Treatment of Graves' hyperthyroidism - prognostic factors for outcome

To determine whether clinical and biochemical features of Graves' disease at presentation predict response to medical and radioiodine treatment. We carried out a retrospective 10-year study of 194 consecutive Saudi subjects with Graves' disease who were treated with antithyroid drugs, radioiodine therapy, or both, between January 1995 and December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia. At diagnosis, the mean age was 32 +/- 0.9 years. Only 26% of patients had successful outcome after a course of antithyroid medication. None of the clinical or biochemical factors were associated with a favorable outcome of antithyroid treatment. One dose of radioiodine [13-15 mCi [481-555 MBq]] cured hyperthyroidism in 83% of patients. Presence of ophthalmopathy at presentation was shown to be a significant contributing factor to failure to respond to a single dose of radioiodine [odds ratio, 6.4; 95% CI, 1.51-24.4; p<0.01]. Failure of radioiodine treatment was also associated with higher serum free T3 concentration at presentation [p=0.003]. In patients with Graves' hyperthyroidism, radioiodine treatment is associated with higher success rate than antithyroid drugs. A dose of 13-15 mCi [481-555 MBq] seems to be practical and effective, and should be considered as first line therapy. Patients with high free T3 concentration and, those with ophthalmopathy at presentation were more likely to fail radioiodine treatment. A higher dose of radioiodine may be advisable in such patients

Bone mineral density and bone scintigraphy in adult Saudi female patients with osteomalacia

This prospective study was conducted to demonstrate the role of bone mineral density [BMD] and bone scan in the management of adult Saudi female patients with established diagnosis of osteomalacia. Bone scan using Tc99m methylene diphosphonate [MDP] and BMD of the lumbar spine and femoral neck using dual x-ray absorptiometry [DXA] were performed at the time of diagnosis 6 months and one year after therapy in 96 Saudi female patients attending the metabolic bone disease clinic at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, between January 1997 through to June 1999, aged between 20 and 73-years [mean 42 years]. Alkaline phosphatase, calcium and inorganic phosphorus were measured for all patients before and after treatment. 25 Hydroxy Vitamin D was only measured with the first BMD measurements. The bone profile showed typical biochemical abnormalities of osteomalacia. The bone scan showed feature of "superscan" in all patients and "pseudofractures" in 43 patients. Bone mineral density measurements were compared with that of normal Saudi subjects matched for age and sex. The BMD was significantly low at diagnosis and showed significant improvement after therapy. The improvement of bone density in response to therapy was more evident in lumbar spine than in femoral neck bone. Our results showed that BMD in adult Saudi female patients with osteomalacia was markedly affected probably due to specific constitutional and environmental factors [inadequate exercise, lack of sun exposure and lack of intake of milk and dairy products]. In addition, lumbar BMD and serum calcium appeared to be better markers to monitor therapy. Bone scan helped in demonstrating disease activity, the presence of pseudofractures

Incidence and risk factors associated with the patency of ductus arteriosus in preterm infants with respiratory distress syndrome in Kuwait

Patent ductus arteriosus [PDA] is considered to be an important cause of morbidity and mortality among preterm infants. The aim of this study is to determine the incidence of PDA in ventilated preterm infants with respiratory distress syndrome [RDS] and to evaluate the role of some antenatal risk factors on its occurrence in our population. The case records of the preterm infants of <34 weeks gestational age, who were ventilated for RDS at the neonatal intensive care unit of Maternity Hospital, Safat, Kuwait, between March 1998 and February 1999, were reviewed. Diagnosis of PDA was based on echocardiographic findings. The association between the risk factors chosen and the PDA was also evaluated. A total of 101 infants whose gestational ages ranged between 25-33 weeks, and birth weights between 685-1580 grams were included. Fifty-four had a significant PDA [53.4%]. Maternal diabetes and antepartum hemorrhage [APH], birth weights, gestational ages, multiplicity and gender of the infants were found to be related to the incidence of PDA. The incidence of PDA in our ventilated preterm infants with RDS is similar to those reported from other neonatal units outside Kuwait. There are some factors that may identify babies, who are prone to develop PDA, which need to be confirmed by further prospective studies using a larger population

Effect of midgut bacteria of Culex pipiens L. on digestion and reproduction

An investigation was carried out to evaluate the influence of symbiotic bacteria associated with Culex pipiens L. on preoviposition and blood meal digestion periods, and reproductive potential [fecundity and fertility]. Aposymbiotic females were obtained by feeding the normal females on 10% sucrose solution mixed with antibiotic [Tarivid] for three days before feeding them on normal blood meals from a pigeon host. A total of 4 genera were previously isolated from the midgut of C. pipiens. These genera were; Bacillus, Streptococcus, Staphylococcus and Salmonella and Shigella. It seems that the period of blood meal digestion preceded the pre-oviposition period of both bacterial free females and bacterial free females treated with one of the aforementioned bacteria. In addition, it is obviously clear that, the presence of the two bacterial genera; Bacillus and Staphylococcus in the midgut of C. pipiens is essential for normal and high fecundity. Generally, it is evident that the symbionts [gut bacteria] are essential for the completion of embryonic development

Effect of lead toxicity on ultrastructure of bowman's capsule of adult rats

This study was designed to evaluate the lead induced toxic effects on the ultrastructure of adult rat Bowman's capsule, and comprised 18 rats. The animals were divided into two equal groups, [n=9]: control group given pure distilled water and study group given a 0.13% lead acetate solution in drinking water. After 8 weeks exposure, rats were sacrificed and their kidneys were removed and a small piece of renal cortex was fixed and sections were prepared for electron microscopic examination. The parietal cells of Bowman's capsule of the experimenatal group showed signs of damage to nucleus and organelles, with abundance of cytoplasmic vacuoles and phagolysosomes. We can conclude that exposure to lead can induce damage to the parietal cells of Bowman's capsule in rats

Toxic effects of subchronic exposure to malathion on liver and kidney: a possible preventive role of L-ascorbic acid and soyabean

The study comprised 150 male albino rats divided into 5 groups [n=30] according to diet regimen used: control group [normal diet], malathion group [1 mg malathion dissolved in 100ml of water was added to the diet], vitamin C group [L-ascorbic acid in a dose of 200mg/kg]. Soya group [Soya bean powder in a dose of 40 gm/kg], and combination group. Ten rats were sacrificed at 2, 4, and 6 weeks after the start of diet regimen. Blood samples were collected via cardiac puncture, then animals were sacrificed and liver and kidneys were removed for histopathologic examination. Blood samples were examined for serum levels of alanine aminotransferase [ALT], alkaline phosphatase [alk. Ph], g-glutamyl transferase [GGT], creatinine and lipid peroxides [LP]. There was a significant [P<0.05] increase of serum ALT, alk. Ph, and GGT in group II compared to the other groups, at 2, 4 and 6-wks, with a significant [P<0.05] increase at 4 and 6 weeks compared to levels detected at 2-wks. Group V showed the least affection of liver function tests despite being significantly [P<0.05] increased compared to control group. L-ascorbic acid and Soya bean separately, induced significant [P<0.05] decrease in enzyme levels compared to group II, but significantly [P<0.05] increased compared to group I. Serum creatinine showed a significant [P<0.05] increase in group II compared to the other groups. However, the addition of either or both L-ascorbic acid and Soya bean to malathion contaminated diet significantly [P<0.05] attenuated the deleterious effects of malathion on serum creatinine. There was significant [P<0.05] increase of serum LP in group II compared to the other groups at 2, 4 and 6 weeks, with a significant increase [P<0.05] of serum LP at 4- and 6-wks compared to levels detected at 2-wks. However, there was a non-significant difference between groups III-V, despite the significantly [P<0.05] increased levels in groups III and IV compared to the control levels. In liver specimens, increased lymphocytic infiltration and mild cellular vaculation were found in 4-wks specimens. In 6-wks specimens, there was abundant lymphocytic infiltration, and appearance of scattered masses of necrotic areas. Kidney specimens showed mild lymphocytic infiltration and hemorrhagic spots, and intense lymphocytic infiltration, intense hemorrhage and areas of necrosis in 4 and 6 weeks specimens, respectively. Changes were more evident in group II specimens, fiowever, group V rats showed least changes that appeared only in 6-wks specimens. We can conclude that the subchronic exposure to malathion induces toxic effects on liver and kidney via initiation and maintenance of lipid peroxidation, an event that can partly prevented by coadministration of ascorbic acid and Soya bean

Primary hyperparathyroidism and pregnancy

The coexistence of primary hyper-parathyroidism and pregnancy is very rare worldwide. It carries serious complications to the mother and fetus, therefore, early diagnosis and management is of paramount importance. Over a period of 16 years from 1982-1997, 24 patients with primary hyperparathyroidism were identified from the central diagnostic index data base of King Khalid University Hospital. Out of these, only 3 women with primary hyperparathyroidism complicating pregnancy were identified. All 3 women were in the fourth decade. Two of them had coexisting vitamin D deficiency with initially normal serum calcium and were misdiagnosed as cases of osteomalacia while the third had very high serum calcium on first presentation. A single parathyroid adenoma was identified in all 3 patients with 2 undergoing surgical removal of the adenoma. The third patient unfortunately had an abortion. The babies of the first 2 patients were born healthy with no complications. Primary hyperparathyridism, even though rare in pregnancy, carries risks to the mother and fetus and therefore early screening for asymptomatic hyper-parathyroidism in all women of childbearing age and in the early antenatal period of pregnant women is recommended

Primary hyperparathyroidism: King Khaled University Hospital experience

This study was conducted to examine the prevalence, mode of presentation and management of primary hyperparathyroidism in one of the major hospitals in Saudi Arabia. Patients and This was a retrospective analysis of 24 cases of primary hyperparathyroidism, comprising 21 females and three males, who were seen at King Khalid University Hospital over a period of 16 years from 1982 until December 1997. The prevalence of the disease was estimated to be 11.34 per 100,000 hospital population. The majority of the patients presented with musculoskeletal complaints [62%-67%] and/or renal complications [58%]. Hypercalcemia was seen in 92% of the cases. Serum PTH was available for 21 patients and 20 had significantly elevated levels. Fifty% of the patients had features of hyperparathyroid bone disease on plain x-ray, while 79% showed osteopenia of the femoral neck on dual x-ray absorptiometry, and almost all the patients had lumbar osteopenia. Fifty% of the patients had features of metabolic bone disease on bone scan. Thalliumtechnetium subtraction studies proved to be the most reliable tool, with 83% sensitivity, followed by ultrasound scan of the neck, with a sensitivity of 55%. CT scan of the neck was attempted in only seven patients [29%], with a sensitivity of 86%. Twenty-one patients [87.5%] underwent surgical exploration and removal of the parathyroid adenoma. Single parathyroid adenoma was identified in 85% of the cases, 5% had multiple adenomas, and 5% had hyperplasia of the parathyroid gland. Our results showed that primary hyperparathyroidism is not a rare disease in Saudi Arabia. It has a tendency for late presentation with complications. We believe that routine screening for calcium and early identification of such cases are warranted to reduce the morbidity of this easily treatable disorder