Evaluation of the health service performance in outpatient clinics in Zagazig University

Many illnessess now can be treated on an ambulatory base [outpatient care] due to the shortage of hospital beds and escalation in operating expenses for inpatient care. The objective of this study is to evaluate the health service performance in Outpatient Clinics in Zagazig, University Hospitals for the sake of promotion of health services in these clinics. This work was done at the Pediatric and Gynecologic Outpatient Clinics, Zagazig University Hospitals. The health care - providers [physician number 37] and a random sample of 800 consumers of both studied clinics, were included in the present study The performance of the health service was evaluated by assessment of structure, care process, and outcome of care of the studied clinics.The work conditions of the studied outpatient clinics were satisfactory in general, but that for site, area and artificial ventilation of the Gynecologic clinic were inadequate. Lavatones and booklets were not adequate in both clinics while posters were not available in Gynecologic clinic The required medical equipments were available in Pediatric [35%] and Gynecologic clinics [73.9%], while non medical ones represented 62.5% and 68.7% of the required items respectively. Drugs availability was not satisfactory [at both studied clinics] according to both providors and consumers oponion. One record was present at each clinic in which recorded data were inaccurate and incomplete. Functional analysis of physicians showed that their performance was generally satisfactory except for completing ticket data and supervising subordinates. About case management, there was deficiency in communication skills [e.g. welcoming of the patient] versus manual skills [e, g.local examination] Consumer study revealed that rural residence and lower levels of education were significantly associated with higher degree of satisfaction. But consumers of both studied clinics were generally satisfied with service offered except for waiting time at Pediatric clinic. Institution of a quality assurance program to monitor the health service performance at the outpatient clinics on a regular basis is highly recommended

Epidemiology of acute leukemia in Iraqi children

An epidemiologic study was conducted on 277 patients with acute leukemias. The study revealed that 87% had acute lympboctic leukemia [ALL] and 13% acute nonlymphoctic leukemia [ANLL]. According to FAB.- classification of cell morphology for ALL, L1 represented 67%, L2: 26%, and L3:7%. The peak age incidence was 2-6 years, with 60% boys and 40% girls. 80% were from low socio-economic class. A seasonal clustering was observed, a low incidence of Rh-blood group was enocountered in our patients. Down's syndrome represented only 1% of the total cases with ALL. 90% of the pregnant mothers With a child suffering from ALL delivered a baby of the same sex of the affected child. For ANLL 72% of them were boys. From this study, for ALL the age, sex, and different types of leukemias are similar to that abroad. The higher incidence of L2 and L3, with a majority from, low socioeconomic class and seasonal clustering are significant findings in this study, a newborn sib of the same sex of the affected child a unique observation

Red cell deformability versus capillary diameter in diabetic foot

21 patients complaining of diabetes mellitus complicated by diabetic foot, mainly gangrene [15 subjects] and diabetic ulcer [six subjects] were selected. 25 patients served as control for RBCs deformability and five control subjects for measuring capillary diameters. A full clinical examination, urine analysis for sugar and fasting blood sugar were estimated to them. A full histopathological examination was done including measurement of capillary diameters using morphometric eye lens and ordinary light microscope. The longitudinal and transverse diameters were measured and the mean capillary diameter was calculated in five high power field in every section. RBCs deformability test was carried out and the RBCs flow time was measured. The mean capillary diameter for diabetics was significantly lower than that for controls and the red blood cell flow time was also significantly longer. There were no significant changes in capillary diameter and red cell flow time in both NIDD and IDD. The capillary diameter and RBCs deformability were inversly proportionate with the duration of the disease. Endothelial swelling as well as endothelial proliferation were noticed in 78.94%, 100% showed thickened basement membrane. So in diabetes more rigid red cells and increased viscosity at low shear rate are likely to promote stasis in the capillaries and postcapillary venules, sites where the very rarly vascular lesions in diabetes characteristically occur