Evaluation of the effect of sildenafil citrate in pre-eclampsia

This study was undertaken to evaluate the effect of Sildenafil citrate [Viagra] on clinical course, biochemical parameters as well as Doppler ultrasound indices in cases of mild pregnancy-induced hypertension [PIH] and to evaluate the role of Sildenafil, if any, as a new therapeutic modality in mild PIH. The present study was conducted on 60 mild pre-eclamptic pregnant women; they were divided into 2 groups: Group I: included 40 cases and were subdivided into 2 subgroups: Group I A [20 cases] received 100mg sildenafil citrate in 2 daily divided doses for 1 week Group IB [20 cases] received 100 mg sildenafil citrate in 2 daily divided doses for 2 weeks Group II [control]: included 20 cases and were subjected to placebo [iron preparation] and bed rest for 1 week. Both groups were subjected to clinical, biochemical and Doppler ultrasound to assess the changes in blood pressure, uric acid, serum creatinine, serum proteins, serum albumin, ultrasound assessment of amniotic fluid index [AFI] and Doppler ultrasound indices [RI, Pl, S/D ratio] respectively before and after the treatment. The study revealed that there was significant decrease in systolic and diastolic blood pressure measurements and all Doppler indices after the use of 100 mg sildenafil for 1 week in group I A and a more significant reduction after longer duration of treatment in group IB without significant change of all these parameters in group II that was subjected to placebo and bed rest for 1 week. Such discussion is still controversial; the subject is still open for much future validation on larger study groups. It is too early for such preliminary study to arrive at sharp conclusions regarding the clinical utility of sildenafil for amelioration of pregnancy-induced hypertension. However it is convenient to report that at least in the current series, significant lowering of blood pressure and improvement of blood flow indices by Doppler ultrasound was attained by 100 mg sildenafil citrate- The possibility of cumulative effect is still hopeful based on more marked effect of the drug with longer duration of administration

Morbidity patterns among King Faisal University Students, Al Hassa, Kingdom of Saudi Arabia

To explore the prevalent morbidity problems among students at King Faisal University. To identify the nature of referred cases and assess the efficiency of the referral system. This was a retrospective, records-based descriptive study, involving the examination of the health records of students at King Faisal University, who attended the Medical Center for Primary Health Care services in a five-year period. A pre-tested compilation sheet was used for data collection. Out of 2472 consultations, about 58% of the diagnosed morbidity conditions were of infectious nature, mostly affecting the respiratory [62%], dental [14%], gastrointestinal [7%], and skin infections [5%], with more prevalence among males. The non-infectious morbidity conditions were recorded more among females and included muscle and joints problems [16%], allergic conditions [15%], gastrointestinal [8%], and trauma [5%]. Some of the encountered morbidity demonstrated seasonal variation. Case referrals were about 6%, more in the non-infectious conditions, with a deficient feedback system. Quality improvement of the medical records and the establishment of a proper referral system are necessary. Health education on preventable morbid conditions should be organized and implemented

Treatment outcome of smear positive pulmonary tuberculosis patients

Introduction: The prime goals of tuberculosis treatment are to cure diseased individuals and minimizing transmissibility of Mycobacterium tuberculosis within the community. Tuberculosis treatment imposing many challenges for patients, health care providers and control program and non adherence to this regimen increases the risk of treatment failure, relapse, emergence of drug resistance and prolonged infectivity. Directly observed treatment short course [DOTS] had been evolved as the standard care to improve treatment compliance. Despite the free availability of these medications, many patients are not successfully treated

Objective: To evaluate the treatment outcome among patients with smear positive pulmonary Tuberculosis. To identify factors that may be associated with non-successful treatment

Subjects and Methods: A multi stage sample consisted of about 849 smear positive TB patients new and previously treated pulmonary cases selected from 14 Governorates. They were submitted to sputum culture and sensitivity to determine the pattern of resistance to the first line anti TB drugs. All the included subjects were followed using a special data collection form to determine the treatment outcome among them

Results: Treatment outcome could be reported in 776 patients, successful treatment occurred 87% among new patients vs. 47% in the previously treated group, non-successful treatment in the form of failure [11%], defaults [3.6%], transferred out [4.7%], and death in [3.4%]. Treatment outcome was favorable among females compared to male patients [83.3% vs. 75.5%]. Drug resistance was significantly higher among previously treated males. Successful treatment outcome was dependent on the gender, type of the patients, and the presence of multi-drug resistance using the logistic regression model

Conclusion: Treatment outcome is highly dependent on the pattern of drug resistance, type of the patient, and the gender

Assessment of knowledge and attitude towards tuberculosis among samples Egyptian population

Tuberculosis continues to rank among the world's most serious problems despite unparalleled biomedical achievements of effective chemotherapy. Several factors are responsible for high incidence and prevalence of tuberculosis is underdeveloped and developed countries as cultural-determined beliefs about the knowledge of tuberculosis, failure to adhere to treatment, delay in diagnosis, patients' gender and low level of patient information. Beliefs about tuberculosis and its causes are major influences of people's behavior, understanding such attitudes and beliefs can aid health providers and policy makers in rectification through provision of properly designed educational strategies. Distorted tuberculosis knowledge and beliefs could participate in the patients delay, non-compliance and unfavorable outcome

Objectives: To assess the possible effect of anti tuberculosis health education campaign, and to explore areas of deficiency of tuberculosis knowledge among a sample of Egyptian community

Subjects and Methods: a multistage sampling technique was followed to select a sample of 3800 interviewees in 20 Egyptian Governorates. A questionnaire was designed and field pre-tested before being used in the pre and post assessment. Data collectors were trained on interviewee's selection as well as on the questionnaire

Results: The study demonstrated a possible positive some aspects of knowledge concerning the nature of tuberculosis as an infectious disease which is treatable and curable. About 30% of the included subjects considered TB as malignant tumors, God's punishment or will, related to extra marital sexual activities, and drug addition. Positive changes have been found regarding the ways of how TB is transmitted but still as substantial knowledge deficit on how to prevent infection, early symptoms of the disease and care seeking behavior in case of chest problems. Tuberculosis accompanying stigma is deeply settled and needs multiple educational interventions to ameliorate its effects. The study pointed out the potential role of the private sector, school and institutional curricula in addition to the role of the media in improving the TB knowledge among the population

Conclusions: Proper messages, collaboration between different health sectors and partners with implementation of effective culturally-sensitive educational strategies should be employed to increase TB knowledge regarding the nature of the disease, the early presentation, early diagnosis, and how to ameliorate the accompanying stigma

Chronic diseases detection and follow-up: a primary health care perspective "1[st] stage"

Introduction: In Egypt the Primary health care perspective of chronic diseases remains poorly defined and the distribution as well as the natural histories of many chronic illnesses remains obscure. While progress has been made, in identifying some specific treatment strategies, preventive strategies still lacking behind. Study hypothesis: The prevalence of chronic diseases is under estimated and underserved in rural areas

Aim of the study: Foundation of a Primary Health Care [PHC] model, for detecting, recording and follow-up of chronic diseases in their served communities

Specific Objectives: 1. To determine the prevalence of target chronic diseases [diabetes mellitus I and II, hypertension, end stage renal disease and chronic liver disease in the served rural community. 2. Foundation a database model of chronic disease in PHC setting for further epidemiological studies

Study Design: Intervention operational research

Subject and Methods: Twenty-four Primary Health Care [PHC] units assigned randomly, six representing each of the four studied districts representing the four Governorates assigned for the Health System Upgrading Project II to work in. The principal nurse, Al Raeda Refias within the unit's catchments area and PHC physician were the responsible local personnel. Nurses were subjected for orientation, completing forms and conducting screening test at PHC or home settings for all family members, when an index case is there [previously or newly diagnosed]. Same procedure to be done for suspected or referred cases by El Raedas whom were subjected for more detailed orientation about target diseases, their signs and symptoms. Training concerning how to prepare family lists [suspected cases recorded in different color], referral of suspected member to PHC nurse for screening and to validate the diagnosis by the PHC physician. A simple computerized data base [using Excel] was designed in each PHC and PHC team was trained to implement

Results: The total population surveyed in this study assumed to be 227, 335 individuals. The total number of identified patients with the four assigned diseases was 2135; of which 387 were affected by 2 diseases, and 53 were found to have 3 conditions. The total count of the four target diseases were 2575 conditions [910 diabetes mellitus of both types with a prevalence of 4/1000], 1208 hypertension [5.3/1000], 126 renal failure [0.6/1000] and 331 liver cell failure [1.5/1000]. With the exception of liver disease, female predominated and 70% of patients were illiterate

Conclusion: chronic diseases in rural communities were underestimated; more attention should be given to different aspect of care, regular active screening to trace disease clustering and identification of risk factors, epidemiological features, monitoring and follow-up with suitable curative services