Emergency head CT scan ordering and yield: a Malaysian experience

The aims of this study were to determine the emergency brain CT scan ordering rate in our emergency department and its positive yield rate; identify significant clinical factors as predictors for scan yield; and evaluate the need for a CT scanner in the emergency department and implementation of guidelines for emergency brain CT scan. This was retrospective study. The study was carried out in UKM hospital, Malaysia from the 1st of January to the 31st of December 2003. The study included all emergency brain CT scans done to 1,687 patients who visited the emergency department of the hospital. Of these patients, 1,088 samples with complete and clear clinical data were studied. The medical records were reviewed retrospectively for selecting these samples. Samples were grouped into trauma and non-trauma. The ordering rate and positive yield rate were calculated and clinical predictors for positive yield were analyzed using Chi-square test. From the total 59,575 patients who visited the emergency department, head CT scan was likely to be helpful in 1,687 patients. A head CT study was requested for these patients. This resulted in an ordering rate of 2.83%. Of the 1,088 samples reviewed, 716 scans showed positive findings, giving the overall scan yield of 65.8%. Non-trauma vases had significant higher scan yield [70.5%]. Age >55 years was noted to have higher risk of positive scans in both groups, especially those presented with seizures. Other significant factors were dysarthria, limb weakness and facial asymmetry in non-trauma cases [all p< 0.05]. The 2.83% ordering rate with 65.8% scan yield signifies the fact that emergency physicians in the study do not order unnecessary CT scan of the head. These findings were noteworthy and might suggest that we revise the request criteria for head CT. however, validated and locally applied CT scan guidelines should be developed and used in order to further enhance its cost-effectiveness in developing countries where resources are limited but its benefits in current and future settings can well be foreseen

Evaluation of the nutrition status of locomotors handicaps in Jeddah

Less information is available on the nutritional status of disabled children in developing countries, the work aimed to assess the nutritional status of I's handicaps. The studied sample included one hundred forty four handicaps aged 2-23 years; the demographic data, anthropometric measurements and dietary information were collected. The results revealed that the mean weight and height for age groups l-<4y, 4-<7y and7-lly were normal. About a half of sample [47.2%] were illiterate. 34.7% from parent were consanguineous, while 100% of handicap's mother did not receive any drugs during pregnancy, for 47.2% of children the impairment occrued after delivery. The handicaps aged l-<3y take adequate energy and fat, [1542kcal/d, 37.3g/d respectively], but low consumption from iron [5.2mg/d]. While the children aged 4->7y consumed enough amount from all nutrient except energy, protein and vt. A, but children aged 7->11y also consumed enough amount from all nutrient except protein and vt. C, the male aged 11-<15y consumed low energy, fat vt. A and C [1187kcal, 39.5g, 220.5 micro, 18.2mg respectively], but the females in the same age intake adequate amount from all nutrients. The male aged 15-<19y intake a low vt. A [208.4 micro g] and C [31.5mg]. Male aged 19-23y consumed inadequate amount from energy, fat, vt. A and C and calcium 1819.2kcal, 36.9g, 96.5 micro g, 57.3mg and 192.3mg respectively while the female in the same age consumed adequate amount from all nutrient except iron which is 10.4mg/d. The results clear that food intake was imbalanced there fore, they needed much attention to improve their diet and having important way to develop eating practices by using special tools, cooking method to suitable their ability for Chewing and swallowing

Assessment of nutritional status of obesity- women

Diet is becoming an increasingly important determinate of body weight in any community. The variations in body mass index are partly variation by energy intake; whereas regional variations in obesity are related to the educational level of the populatipn. The aim of this study was evaluation the nutrition status and nutrition pattern of obese women. The results reveled that the mean of weight and the height for all sample was 68.8kg +/- 17.3 and 155cm +/- 9.5 respectively, 50.4% of the participant reported that doing the housekeeping activity without servant, while the high percent showed in women with overweigh and obese women don't doing physical activity 55.2% and 57.4% rerpectively. 47.9% from all sample eat three meals per day, while 37.8% eat the breakfast meal and 29.4% did not eat breakfast, but 62.9% from the participant consider that the breakfast meal not important, while 42.3% from the overweigh women did not eat the breakfast because they make a diet to loss weight. 47.1% and 47.0% eat light food and fatty food outside the home respectively. The obese women take a large amount from the energy, protein and fat [2323.38kcal, 93.67g and 82.12g] respectively, and both of women who have overweigh and obesity showed high percent for excess amount from RDA for energy, protein, fat and carbohydrate. Both of obese women and women who have overweigh take high energy from fat. Statistical there was a significant different p<0.05 between the level of education and overweigh and obesity, while a significant different p<0.01 between work and level of income with overweigh and obesity

Maternal serum biochemical markers as a predictor for adverse pregnancy outcome

To establish reference values of assaying some maternal serum biochemical markers, namely; MSAFP. MSHCG, uE3 and PAPP-A: at 10-20 weeks gestation; among healthy pregnant women and observe the relationship of such markers to predict adverse pregnancy outcome. This is a prospective randomized controlled study conducted in the Obstetrics and Gynecology Departments at AL-Azhar and Cairo University Hospitals during a period of two and half years starting January 2003. Three hundreds healthy pregnant women from those attending the antenatal clinics were participated in this study. Their age ranged between 20-38 years. They all had a spontaneous pregnancy in singleton with gestational age of 10-20 weeks gestation at the time of study. This was confirmed by ultrasonic scanning. Pregnancy outcomes were obtained for all women. The incidence of adverse pregnancy outcome namely: miscarnage, preterm delivery, intrauterine growth restriction [IUGR], intrauterine fetal death [IUFD]. pregnancy induced hypertension [PIH] and congenital malformation were evaluated. Blood samples were withdrawn and sera were separated for estimation of levels of maternal serum alpha fetoprotein [MSAFP], unconjugated estriol [uE3], free 3-human chorionic gonadotropin [beta-hCG] and pregnancy associated plasma protein-A [PAPP-A]; using time resolved flouroi mmunoassay technique. Our study showed, unexplained significant elevations of MSAFP and serum 3hCG levels with adverse pregnancy outcome [miscarriage, preterm delivery, IUGR, IUFD]. Low unconjugated estriol levels, was associated with adverse pregnancy outcome except for preterm delivery. Maternal serum levels of PAPP-A were found to be significantly decreased in all adverse pregnancy outcome except in PIH. Combinations of maternal serum markers for prediction of adverse pregnancy outcome were compared. Increased maternal serum AFP and 3hCG were significant only for miscarriage and preterm delivery, whereas increased MSAFP and decreased uE, was significant for all adverse pregnancy outcome except for preterm delivery. Increased levels of MSAFP and decreased levels of PAPP-A was only significant with PIH. Whereas increased levels of beta hCG with decreased uE3 levels was significant for all adverse pregnancy outcome except for preterm delivery and PIH. The combination of increased beta hCG levels and PAPP-A were not significant correlated to adverse pregnancy outcomes. combined maternal serum four markers can be used not only for the detection of fetal structural and chromosomal anomalies but also for early prediction and detection of high risk pregnancies

Bone turnover markers in infertile women and patients with endometriosis under gonadotropin releasing hormone agonist [GnRH-a] and with add-back therapy

Gonadotropin releasing hormone agonist [GnRH-a] induces an acute reversible inhibition of ovarian function with an increase in bone turnover and significant bone loss. This study was conducted to evaluate the bone turnover in women under single and multiple injections of GnRH-a and also to determine the role of add-back therapy on bone turnover. Patients and The present study was designed to include 80 female patients under single injection [40 cases] and multiple injections [40 cases] of long acting GnRH-a with and without add back therapy [add back therapy was nasal salmon calcitonin 200 I.U daily supplement of 1gm calcium daily]. Biochemical bone turnover markers [serum calcium, phosphorus, alkaline phosphatase, osteocalcin and urinary deoxypyridinoline] were estimated. Determination of serum calcium and phosphorus showed no significant differences after two weeks, three months and six months of GnRH-a therapy. Serum alkaline phosphatase level was of no significant difference after two weeks and also after three and six months in the groups with add-back therapy. But after three and six months in the groups without using add-back therapy, it was significantly elevated. Serum osteocalcin and urinary deoxypyridinoline showed no significant changes after two weeks, three and six months of GnRH-a therapy with add-back therapy. But these markers were significantly increased after three and six months in group under GnRH-a therapy without use add-back therapy. A routine survey for females under GnRH-a therapy is recommended to identify subjects of. accelerated bone loss. Such survey should include serum osteocalcin and urinary deoxypyridinoline as these methods are reliable markers of bone turnover. Add-back therapy proved to be an effective measure against the induced bone loss during GnRH-a therapy

role of complete cervical laminectomy in the surgical treatment of advanced spondylotic radiculomyelopathy

This is a retrospective study of 20 patients with severe cervical spondylotic radiculomyelopathy. The routine radiological investigation are CT scan with contrast and NMR imaging. The radiological findings in cases of spondylotic radiculomyelopathy of various stages and degrees fall into three groups. Group A, the axial views show an anterior central or paracentral circumscribed lesion indenting and deforming the cord surface obliterating the subarachnoid space only at the site of compression. The sagittal views confirm these findings. Group B, the axial views demonstrate a linear diffuse lesion either or both anterior and posterior to the cord. The latter is deformed and flattened towards the coronal plane. The surrounding subarachnoid space is thinned, irregular or obliterated all around it. The sagittal views show hour glass indentations of the cord. Group C, the axial views and also the sagittal views show a combination of the aforementioned data