Chemotherapeutic effect of Ulmus pumila leaves methanolic extract against N-methyl-N-nitrosourea-induced mammary carcinoma in female rats: An in vitro and in vivo study

Searching for a chemopreventive agent is an important approach for breast cancer management. The aim of the study was to evaluate the chemopreventive potential of Ulmus pumila (UP) leaves extract on breast tumorigenesis induced in experimental animals by N-methyl-N-nitrosourea. This target was undertaken through preparing several extracts from the fresh leaves of UP using different solvents against the breast adenocarcinoma cell line (MCF-7). Our in vitro results demonstrated that the methanolic extract of UP (UPME) showed the highest cytotoxic activity against the growth of MCF-7 cells. After determination of UPME safe dose (1/10) of a lethal dose, the in vivo results revealed that UPME treatment significantly decreased the activities of liver enzymes, kidney function, cancer antigen 15-3 (CA 15-3) level, urokinase plasminogen activator, heparanase, basic fibroblast growth factor, B-cell leukemia lymphoma 2, and cyclooxygenase-2. By contrast, total antioxidant capacity (TAC) was increased in therapeutic, protective, and prophylactic groups as compared to the tumor group. These improvements were supported with histopathological changes. These results indicated that the chemotherapeutic potential of UPME through stimulation of apoptosis and the suppression of angiogenesis, proliferation, and metastasis.

Enhancement of disaster management and first aid rules for primary school teachers in Egypt

Background: genuine injuries have been reported at schools. Given that schools might not have any trained healthcare providers; teachers will provide first aid to students

Objective[s]: to assess knowledge and skills regarding first aid and disaster management among primary school teachers, and evaluate the effectiveness of first aid and disaster management training program on knowledge and skills of those teachers

Methods: intervention study, in the form of a training program on 43 teachers from two primary schools in Zagazig district, was performed. Evaluation was done through comparing school teachers' first aid and disaster management knowledge and skills before and after intervention by the use of a questionnaire and an observational checklist

Results: the percent of teachers with satisfactory first aid knowledge increased from 7.0% to 46.5% while for satisfactory practice, the percent increased from 4.7% to 51.2% after intervention. For satisfactory disaster management knowledge, the percent increased from 9.3% to 58.1% while for satisfactory disaster management practice, the percent increased from 2.3% to 23.6% after intervention with a statistically significant difference

Conclusions: first-aid and disaster management training program is an effective tool for improving teachers' knowledge and practice

Recommendation: First aid and disaster management training program should be one of the preplacement and in service training programs for primary school teachers to protect the life of children

CXCR3 renal expression in glomerulonephritis in children: is there a connection with the course of the disease?

Glomerulonephritis [GN] is a common childhood disease that may represent a significant cause of chronic kidney disease at one point of its course. The role of chemokines in glomerulonephritis, has been long anticipated and studied and the possible link between certain chemokines and different renal pathologies, if proved, can pave the road for future use of such markers for early prognosis and possible therapies for this common disease. Objective: in this study, we aimed at detecting CXCR3 in the renal biopsies done for children with glomerulonephritis and to correlate it to the nature of renal pathology and response to therapy. Methods: The glomerular and interstitial expression of CXCR3 in renal biopsies done for 22 patients with glomerulonephritis was studied using immunohistochemical staining. Pathologies already diagnosed in these biopsies were proliferative GN [mesangioproliferative GN, diffuse proliferative GN, focal proliferative GN, IgA nephropathy and crescentic GN] as well as non-proliferative GN [Minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, diffuse mesangial sclerosis and advanced hypertensive nephrosclerosis]. History, clinical findings and laboratory investigations in the initial presentation and at the time of the study were obtained. Results: The degree of glomerular and interstitial CXCR3 expression did not vary with gender, age of presentation, response to steroids, or cumulative doses of steroids. Percentage of strong glomerular CXCR3 expression was much higher in proliferative GN compared to non-proliferative GN although the difference was not statistically significant, percentage of renal dysfunction was more among strong glomerular and mild/moderate interstitial CXCR3 expression with no statistically significant difference from the counterparts. Conclusion: Our study revealed that enhanced CXCR3 renal expression on glomerular and interstitial levels did not affect the response to steroids along the course of the disease and so can probably act as a therapeutic target rather than a prognostic marker

Metabolic Acidosis and Rhabdomyolysis with Metformin overdosage

Metformin is a biguanide oral hypoglycemic agent used as first-line or as a part of multi-drug therapy in the treatment of Type 2 Diabetes Mellitus [DM]. Lactic acidosis is a well-known but relatively uncommon adverse effect of Metformin, especially in patients with co-existing renal failure. There are several case reports of inadvertent or intentional Metformin overdosage resulting in severe metabolic acidosis with hyperlactatemia and often fatal outcome. Continuous hemodiafiltration with other supportive therapies have resulted in successful management of the metabolic derangements and is presently the accepted standard therapy of Metformin intoxication. A twenty-two-year-old female presented with Metformin over-dosage of 50g and developed severe metabolic acidosis and rhabdomyolysis. Metabolic acidosis was prolonged; the pH level was 6.72, bicarbonate level <4 mmol/L and lactate level was more than 25 mmol/L. The patient was managed with crystalloids, bicarbonate infusions and continuous venovenous hemodiafiltration. The blood gas parameters normalized 48 hours after initiation of the treatment. Hemodiafiltration was continued for longer than usual due to the prolonged metabolic acidosis and until the elevated Creatine Kinase [CK] levels returned to normal. She made an uneventful recovery, without residual sequelae

Anticoagulant and antibacterial activities of polysaccharides of red algae Corallina collected from Lebanese coast.

In this work, we studied another species of red algae, Corallina, growing on the Lebanese coast of Batroun. The analysis of trace elements showed that Corallina was rich in K, Ca, Mg, Na, Si, Sr, P and Fe. Corallina was composed of 70.81% of saturated fatty acids, 25.54% of monounsaturated fatty acids and 3.65% of polyunsaturated fatty acids with palmitic acid as the main component. Moreover, the total yield of sulfated galactans and carrageenan was 2.5% and 10%, respectively. Both extracts exhibited anticoagulant effect but sulfated galactans were less potent than carrageenan. Sulfated galactans possessed inhibitory activity as well as bactericidal activity against all Gram-positive strains tested (Enterococcus faecalis ATCC 29212 and Staphylococcus epidermidis CIP 444). But, carrageenan was only able to inhibit the growth of S. epidermidis with a minimal inhibitory concentration (MIC) of 0.325 mg/mL. Furthermore, infrared spectroscopy (IR) revealed that the isolated carrageenan was of Lambda-type. Corallina could therefore be considered as a potential source of bioactive molecules that may be useful for the development of new pharmaceutical agents.

Subchronic toxicity of propyl paraben in adult male rats

In the current study, daily per os administration of propyl paraben [n-propyl-p-hydroxybenzoate] to adult male rats for four consecutive weeks induced severe hepatotoxicity as revealed by the significant elevation in serum marker enzymes along with a significant decrease in serum protein and its fractions. Furthermore, propyl paraben administration disturbed steroid hormones balance by suppressing serum testosterone level, with a concomitant increase in serum estradiol and an ultimate decrease in testosterone/estradiol ratio. Hepatic and testicular toxicity was furtherly attributed to oxidative stress induction, since propyl paraben altered the oxidant/antioxidant balance in both tissues. Signs of toxicity and histopathological changes in the liver and testes were observed by light microscopy of haematoxylin and eosin-stained sections. In conclusion, our data demonstrate the potency of propyl paraben as an endocrine disruptor to induce disturbances in normal steroid balance in adult male rats. In addition, the induced oxidative stress represents a common mechanism of propyl paraben toxicity in hepatic and testicular tissues

Role of calcium in enhancing the activity and thermal stability of a new cationic peroxidase purified from euphorbia tirucalli latex

A new cationic peroxidase from Euphorbi and firucalli [pencil cactus] latex was purified to homogeneity using benzene fractionation, gel filtration and cation-exchange chromatography. The purified enzyme was found to be monomeric with a molecular weight of 44 kDa as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis [SDS-PAGE]. The purified enzyme had a broad specificity towards some phenolic substrates in the order of 2,2'-azino-bis [3-ethylbenzothiazoline-6-sulfonicacid] [ABTS] > guaiacol > 0-phenylenediamine > 4-aminoantipyrene, whereas no affinity towards ascorbic acid and o-dianisidine was recorded. The enzyme had pH and temperature optima at 7.0 and 40°C, respectively. Study of kinetic parameters demonstrated that ABTS had the highest affinity towards ELP, where K[m], F[max] and V[ms]/K[m] values were 0.503 mM, 500 U/assay and 994.04 U/mM, respectively. ELP was stable from 10°C up to 60°C and lost about 70% of its activity at 70°C. The thermal inactivation profile of ELP in absence of Ca[2+] is biphasic and characterized by a rapid decline in activity on exposure to heat, followed by a more gradual decrease in activity on continued exposure. However, the purified enzyme exhibited increased thermal stability in the presence of calcium ions. Furthermore, the activity of purified enzyme was enhanced by 550% in the presence of 15 mM CaCl[2], suggesting a pivotal role for Ca[2+] in conferring structural stability to the heme environment and in retaining the active site of ELP. Most of the examined metal ions [except for Ca and Mg] and compounds had differential inhibitory effects on ELP activity. In conclusion, a locally available plant [Euphorbia tirucalli] could be a potential candidate source for peroxidase, the most widely used enzyme in industrial and biomedical applications. In addition, calcium was found to be essential for enhancing enzymatic activity and thermal stability of the purified Euphorbia tirucalli latex peroxidase

Patterns of drug resistance in case of smear positive pulmonary tuberculosis in Giza and Cairo governorate

Pulmonary tuberculosis is a major cause of morbidity and mortality World Wide, resulting in the greatest number of deaths due to any other single infectious agent. Drug resistance threatens global tuberculosis control efforts. Multi drug resistance means drug resistance to at least rifampicin and isoniazid. One hundred and nineteen sputum and culture positive patients underwent drug susceptibility to the first line drugs [Isoniazid, Rifampicin, Streptomycin and Ethambutol]. 79/119 patients in addition underwent drug susceptibility to Pyrizinamide, Ofloxacin, Amikacin and Levofloxacin. The susceptibility test shows that 35/119 patients [29.4%] were sensitive to all the tested drugs. 84/119 of the included patients [70.6%] showed drug resistance to at least one of the first line drugs by different patterns. 29/119 patients were diagnosed as MDR cases with a percent of 31% [resistant to both INH and Rifampcin]. This study shows increase incidence of resistance to first line drugs as well as increase incidence of MDR

Biochemical evaluation of chitosan in rats fed high fat-high carbohydrate- diet

This study was designed to evaluate the potential of chitosan at a dosage of 27, 180 and 270 mg/Kg b.w, which equivalent to 300, 2000 and 3000 mg/day human age recommended doses, respectively in rats fed high fat-high carbohydrate [HFHC]- diet for six weeks. The obtained results demonstrated that HFHC-fed rats displayed a significant increase in blood glucose, serum lipid profile, atherogenic index, ALT, AST, ALP, total bilirubin, malondialdehyde, urea, creatinine and uric acid compared to the normal control rats. However, the concomitant administration of chitosan with HFHC-diet for 8 weeks led to a dose-dependant improvement in these pathological changes. The low and medium doses of chitosan were exhibited mild to moderate effects. Only a dose of 270 mg chitosan /Kg b.w was able to maintain these changes at near normal levels and demonstrated its hypolipidaemic and hypoglycaemic activities

Cytotoxicity and oxidative stress of arsenic and the possible ameliorative effect of Coriandrum Sativum L. in albino rats

This work has been carried out in order to investigate the possible ameliorative effect of Coriander in arsenic - induced toxicity in albino rats. 2,3 Dimercaptosuccinic acid [DMSA] was used as chelating agent. To achieve this purpose, 60 adult albino rats were used and randomly divided into equal 5 groups [12 rats each]. Group 1 served as negative control, group 2 received daily 100 ppm of sodium arsenite in drinking water, group 3 rats received daily oral dose of sod. arsenite and Coriander seeds extract [CSE] [1 g/kg body weight]., group 4 rats received sod. arsenite and oral dose of DMSA [0.05 g/ kg b.w] for 5 days lasted. Group 5 rats received sod. arsenite, Coriander seeds extract [CSE] and DMSA for 5 days lasted. The experiment lasted for 8 weeks and blood samples were withdrawn 4 and 8 weeks after induction of toxicity and different treatments. The antioxidant potential was carried out using the methanolic extract of Coriander seeds. Reducing power assay and Diphenyl picrylhydrazyl [DPPH] radical scavenging assay methods proved the antioxidant potency of CSE. In-vivo studies using the different biochemical techniques and antioxidant parameters proved that sodium arsenite caused a significant increase in all parameters concerned the liver toxicity while treatment of CSE or DMSA caused an ameliorative effect on this toxicity. Induction of hepatotoxicity by arsenite together with CSE and DMSA proved the synergistic effects of these chelating agents on arsenite toxicity

Fine needle aspiration cytology in the evaluation of lymphoid lesions: a retrospective study of the utility of flow cytometry in conjunction with morphology

Fine needle aspiration [FNA] cytology, in conjunction with flow cytometry, is now widely used as a reliable and accurate method for the assessment of various lymphoid lesions, especially for lesions situated in odd locations where obtaining biopsy and monitoring for recurrence in previously diagnosed cases of lymphoma are difficult. The objective of this study was to determine the utility of FNA and immunophenotyping in the assessment of lymphoid lesions, and to find whether flow cytometry is more useful in the evaluation and subclassification of the small cell morphology group of lymphomas than in the large cell morphology group of lymphomas. Retrospective analysis of patients diagnosed with lymphoma over at a 5-year period. All 175 FNA cases were followed carefully either clinically or histologically for at least 5 years. We compared the utility of flow cytometry in the diagnosis of small cell morphology lymphomas to large cell morphology lymphomas. Flow cytometry was performed on 72 of 175 [41%] of FNA specimens clinically suspicious of lymphoma. The excisional follow-up biopsy was obtained in 78 of 175 [44.5%] cases. Based on cytomorphologic evaluation, 82 cases [47%] were considered negative, 34 cases [19%] were considered atypical, 32 cases [18%] were positive for NHL-small cell morphology, 21 cases [12%] were positive for non-Hodgkin lymphoma [NHL]-large cell morphology, 3 cases [2%] were positive for NHL, and 3 cases [2%] were nondiagnostic. Immunophenotyping utilizing flow cytometry was the diagnostic parameter in 28 of 32 cases [88%] of the NHL-small cell morphology group and in 11 of 24 cases [46%] of the NHL-large cell morphology/Hodgkin lymphoma group. Immunophenotyping by flow cytometry is more essential for the accurate evaluation and classification of small cell morphology than large cell morphology lymphoid lesions in FNA cytology

role of ureteral stents for all ureteroneocystostomies in kidney transplants

As the routine use of ureteral stents [US] remain controversial. A recent met-analysis of ureteral stenting concluded that the routine use of US resulted in improved outcomes. In contrast, the indiscriminate use of US can lead to adverse complications. To better define this question, we reviewed our single center experience in which US were placed selectively. 301 patients were eligible to be enrolled. 55 living donor and 246 deceased-donor charts were analyzed for donor and recipient clinical characteristics, immunosuppressive therapy and outcomes. 28 US were placed for either small bladder capacity [n=7], unhealthy appearing bladder tissue [n=8] or for an uncertain vascular supply to the ureter [n=13]. Patients with US did not develop urinary leaks, 8 [28%] developed complications including obstruction, encrustation, and urinary tract infections. 12 [4.3%] non-stented patients developed a clinically significant urinary leak. Risk factors for urinary leaks included dual and en-bloc pediatric donor kidney transplants, extended criteria donors and the use of single U stitch technique for ureteral anastomoses. Our results demonstrate that the majority of patients can be successfully transplanted without the routine use of US. Selective use of US should be reserved for high-risk situations

Cardioprotective activity of polysaccharopeptides extracted from pleurotus ostreatus mycelium in a doxorubicin-rat model

The present study was undertaken to investigate the possible abatement of doxorubicin-induced cardiomyopathy in the rat by polysaccharopeptides extracted from the culture broth of Pleurotus ostreatus mycelium. It was found that polysaccharopeptides given as protection before doxorubicin intoxication normalized the levels of serum total creatine kinase, aspartate aminotransferase and lactate dehydrogenase activities, in addition to malondialdehyde, reduced glutathione, as well as superoxide dismutase and catalase activities in the heart tissue. Nitric oxide and tumor necrosis factor-alpha concentrations were persistently reduced in the heart tissue, while interferon-gamma concentration was insignificantly changed, compared to controls. Light microscopic examination of haematoxylin and eosin-stained sections of the left ventricles showed normal structure of the cardiac myocytes, except for a slight but significant decrease in their thickness, compared to controls. Pretreatment with mycelial polysaccharopeptides provided a potential protective effect against doxorubicin-induced oxidative stress in rats

Tyrosinemia type 1: clinical and biochemical analysis of cases with poor treatment outcome

Tyrosinemia Type I [TT1] is a metabolic disorder with impaired activity of fumarylacetoacetate hydrolase enzyme. The causes of death are liver failure, pseudo porphyric crisis and hepatocarcinoma. The treatment is based on diet restriction, liver transplantation and the NTBC. Aim: To review the clinical presentation, biochemical analysis and expose the causes of failure of treatment in 3 patients with TT1. By studying the clinical and biochemical data of 3 dead patients with TT1 [part of the total 15 patients with the same diagnosis], during [October 2001 to October 2009].The diagnosis was established by high tyrosin in the blood and succinylacetone in the urine. Monitoring was based on the combination of liver imaging, and alpha feto protein as tumor marker. Two patients were treated by NTBC and diet restriction [patients 1 and 2] while the 3rd patient was treated by diet restriction only. Overall survival rate was 80% [85.7% in those treated by NTBC]. The age at onset was respectively 8, 5 and 1.5 months .The age at diagnosis was 40, 6 and 6 months. All three patients were presented with severe liver failure. [PT ranged from 21% to 24%], patient 1 was treated with NTBC for 4 months and died after 2 months of stopping NTBC. The second patient did not respond to NTBC and died after 5 months of treatment. The third patient died after 2 months of treatment. A. Poor prognosis in patient 1 and 2 could be explained by [1] The dose was less than 2mg/kg/d [2] Late diagnosis in patient 1. [3] Difficulty of management and monitoring. B. Poor prognosis in patient 3 was on diet restriction as in the literature. C. Slow decrease of alpha feto protein can explain the possibility of hepatocarcinoma in patient 1 and 2 but the duration of the treatment was short to conclude, the increase in patient 3 is well known as a part of hepatocarcinoma mechanism. [1] Early diagnosis and starting NTBC with diet restriction give good prognosis. [2] Starting neonatal metabolic screening

Opportunistic parasitic infections among immunocompromised Egyptian patients

The commonest opportunistic parasites causing morbidity and/or mortality in the immuno-compromised subjects are mainly the gastro-intestinal ones. This study clarified the prevalence of the opportunistic parasites among a group of immuno-compromised patients selected from Al Azhar University Hospitals. One hundred immune compromised patients [GI] were divided into GIa: 40 malignancy patients. GIb: 30 with diabetes mellitus. GIc: 30 with chronic renal failure. GII: included 20 cross-matched healthy subjects as controls. Sheets were filled out on each subject including all personal and medical history. Both groups were subjected to stool and blood examinations for parasites. The results showed opportunistic parasites in 30% of patients and in 10% of healthy controls. The highest group had parasitosis was patients suffering from malignancy [18%]. The patients suffering from chronic renal failure or from diabetes mellitus were equally affected [6% each group]. There was significant relation between malignant patients and diabetic or chronic renal failure ones, but without significant relation between diabetic and chronic renal failure patients. Giardia lamblia was the most common parasite found in the patients [10%] of which 5% were among patients suffering from malignancy. Others were Cryptospotidim parvum [7%] Cyclospora cayetanensis [3%] and Microsporidia species [2%]. Mixed infection was detected in 2 cases that had C. parvum and Cyclospora. But, neither Isospora belli nor Strongyloides stercoralis were detected. Also, ELISA showed antibodies against Toxoplasma gondii in sex patients but none against Leishmania d. infantum

Myringoplasty [Risk factors and the effect of post operative follow up on the outcome of success rate in Erbil / Kurdistan of Iraq]

The presence of a perforated tympanic membrane with intermittent discharge and hearing loss of conductive type are the indication for myringoplasty. The purpose of this study was to determine risk factors in candidates for myringoplasty and to evaluate the post operative myringoplasty success rate results in our local region in Erbil/Kurdistan, Iraq. The second objective is to appraise and assess the effect of close observation and post operative treatment and follow up on this result, to increase the success rate. A prospective study, randomly taken 68 patients with unilateral perforated tympanic membrane, who are candidates for myringoplasty; patients of different age groups ranging [16 -55] years old, of different gender 30 males and 38 females having dry unilateral perforated tympanic membrane of more than 3 months, underwent myringoplasty [underlay] between may 2006 and April 2009 at Rizgary teaching hospital. Measurement of the post operative results and outcome were depend on the take rate and the hearing level at the last follow up visit in different time postoperatively and with dry clean non infected operated ear. Small, dry posterior perforation, with postauricular approach in well pneumatized mastoid and in well educated non-smoker patient with close observation post-operatively using BIPP has better success rate. The success rate increased from 72% in the 1st postoperative visit to 88% in the last postoperative visit. To increase the success rate, its necessary to determine the factors that affect the success rate preoperatively, also close observation with meticulous toilet of the operated ear post-operatively using BIPP is necessary to increase the success rate

Community and hospital acquired infection of methicillin-resistant staphylococcus aureus [MRSA] in Erbil city

Methicillin-resistant Staphylococcus aureus [MRSA] is one of the most frequently isolated pathogens in both community and hospitals, and associated with high morbidity and mortality rates with rapid development of resistance. The methicillin -resistance occurs due to the presence of PBP2a of the bacterial cell wall, which has low affinity for beta-lactam antibiotics. MRSA are often multi-resistant to both beta-lactams and non-beta -lactams antibiotics. The study was documented the occurrence of community and hospital acquired MRSA infections. The clinical specimens were collected from patients at three teaching hospitals in Erbil city. All Staphylococcus aureus were identified as MRSA by detection of PBP2a. Out of 377 Staphylococcus aureus isolated, 30.24% were MRSA. The wound was the most common infection site for both community and hospital acquired MRSA. Statistically the patients with hospital acquired MRSA were older than the community acquired MRSA. MRSA is one of the most common causes of serious infection in community and hospital settings. The most common site infected by MRSA is the surgical wound infection

Prophylactic and curative effects of oat bran [Avena sativa] against hyperlipidaemia in albino rats

The aim of this study was to evaluate the hypolipidaemic effect of oat bran in albino rats. To achieve this goal, two main experiments included 56 female Swiss rats were conducted. The first was Prophylactic experiment comprised of 24 rats in three groups as follows: Group 1: negative control, fed on normal diet, Group 2: positive control received hyperlipidaemic diet [HL-D] and Group 3: received daily HL-D along with oat bran at a dose of 2.70 g kg[-1] b.w. for 8 weeks. The second was Curative experiment comprised of 32 rats. Eight rats served as negative control [Group 1], and the other rats were subjected to the induction of experimental hyperlipidaemia for 4 weeks. Then the hyperlipidaemic rats were divided randomly into equal three groups as follows: Group 2: Hyperlipidaemic rats served as positive control for 4 weeks. Group 3: Hyperlipidaemic rats received oat bran at a daily dose of 2.70 g kg[-1] b.w. for 4 weeks Group 4: Hyperlipidaemic rats received a daily p.o dose of 3.6 mg kg[-1] b.w of simvastatin as reference drug for the same period. The results revealed that HLD supplementation increased plasma lipid profile [triglycerides, total cholesterol [T.C] and LDL], risk ratio [T.C/HDL and LDL/HDL], liver cholesterol, serum enzymes [aspartate aminotransferase [AST], alanine aminotransferase [ALT] and alkaline phosphatase [ALP]]. However, a daily administration of oat bran with HL-D was significantly able to suppress the lipotropic effects of HL-D in plasma and liver in both experiments. This study concluded that oat bran supplemented diet is an effective hypolipidaemic agent

Assessment of patient satisfaction towards primary health care facilities - a survey study in Sharkia Governorate

Patient satisfaction is an important tool that measure performance of health care providers. To assess patient satisfaction towards Primary Care in Sharkia Governorate in 2009, and to detect causes of patient dissatisfaction. This study was carried out on 893 patients from 18 Primary Health Care Facilities in Sharkia. Data were collected through interview sheet including seven domains of patient satisfaction: reception service, doctors' and nurses' performance, accessibility in time and place, health environment and patients' rights. Responses were put in Likert Scale from excellent to poor, then satisfaction level was classified into: unsatisfied, partially satisfied and strongly satisfied. Pareto analysis for causes of dissatisfaction was done. The majority of patients were satisfied with accessibility of facilities in time 96.98% and place [98.54%], short waiting time [97.98%]. 73.46% of patients were satisfied with doctors' performance and 60.36% with nurses' performance. 33.26% of patients reported drugs unavailability, 25.87% were dissatisfied with the inadequacy of laboratory capabilities. Pareto analysis revealed that causes of dissatisfaction were deficiency in: information given to patients, bio-psychosocial approach, co-ordination between drugs, shared management, examination, follow-up, health education, referral, drugs, cleanliness, nurses' skills, and investigations. Most of patients were satisfied with accessibility of PHC facilities in time and place, short waiting time, cost of tickets, preventive services and staff performance. Most of patient dissatisfaction [80%] resulted from only 8 of studied causes regarding doctors' performance and only 7 of studied causes of nurses' performance, and health care environment

Treatment of hypertension in acute ischemic stroke

There has been substantial controversy regarding treatment of blood pressure in the management of acute ischemic stroke. Non-Uniformity of study design and reporting makes it difficult to draw conclusions from previous data. When to treat hypertension in the acute setting is one of the unsettled questions yet. To study stroke outcome in relation to treatment of hypertension in the management of acute ischemic stroke and its impact on the cardiovascular system. This was a prospective study in which all admitted patients for acute ischemic stroke within 24 hours throughout the year 2006 were included. The severity of the stroke was based on the National Institutes of Health Stroke Scale [NIHSS]. The 2005 AHA/ASA guidelines in the management of acute ischemic stroke were followed. We also followed the same guidelines in the treatment of hypertension in adults with acute ischemic stroke in the first 24 hours. However, patients who continued to have hypertension grade II and III after the first 24 hours were also treated. A total of 356 patients were initially included and managed in the acute phase. Only 241 completed the study and attended the clinics for their follow up assessment at 3 months. The majority were males [76%], preexisting hypertension was found in 68.9% and most of the patients had hypertension on admission [87.5%]. In 223 patients [92.53%] no antihypertensive medication was given in the 1[st] 24 hours. In 134 patients [55.6%] the blood pressure continued to be on the hypertensive side after the first 24 hours and they received antihypertensive medications. The 223 patients [92.53%] who did not receive antihypertensive treatment achieved 57.1%, 78.09% and 73.87% of the total reduction in SBP, DBP and MBP respectively at the end of the 1[st] 24 hours. All cardiac complications [ten patients, 4.15%] were reported in the first 24 hours only. The mean NIHSS score on admission was 22.98 +/- 10.38, while the mean score at the 3[rd] month was 9.4 +/- 6.5. The differences were highly significant [p<0.0001]. When the stepwise regression analysis was used, only the increase in stroke severity at the onset [p<0.0001], followed by the decrease in SBP at the 3[rd] day [p<0.001] and lastly the increase in SBP on admission [p<0.05] were predictive for poor stroke outcome. Introducing antihypertensive medications after the first 24 hours of acute ischemic stroke in patients who continued to have hypertension grade II and III has no negative impact on stroke outcome and limits the cardiovascular complications