Morbidity, mortality, and short term outcome of very low birth weight infants at Ahmadi hospital, Kuwait

Objective: To determine the morbidity, mortality and outcome for VLBW <1500 grams Kuwaiti infants admitted to the Neonatal Intensive Care Unit, at Ahmadi Hospital, Kuwait Oil Company, Kuwait. Study Design: It is a retrospective record review of all inborn Kuwaiti neonates with birth weight <1500 grams between December 1999 and November 2009. Results: One hundred sixty six VLBW infants were included in the study. Eighty-two percent of them were born before 32 weeks and 67.5% were less than 1000 grams. Survival rate was 87.3%. More boys died than girls and 90% of those who died were born before 32 weeks of gestation and < 1000 grams. Respiratory distress syndrome was the commonest morbidity and affected 64.5% of the infants and was more common in boys than girls. During hospital stay other common morbidities were diagnosed and included hyperbilirubinemia, chronic lung disease, patent ductusarteriosus, intra-ventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, and sepsis. During a 2-year follow up period 27.1%, 13.8%, and 11.4% of our survivors suffered from wheezy chest, gastro-esophageal reflux disease GERD, and cerebral palsy respectively. Our survivors, in spite of their catch up growth during infancy, continued to lag in their physical growth at 2 years of corrected age compared to normal birth weight full term infants.Conclusion: We conclude that inspite of the accepted rate of survival among this high risk population, still the incidence of morbidities remains unchanged over the past 2 decades which requires determining, disseminating, and applying best practices using therapies currently available, and also identifying new strategies and interventions

Estrogen recceptor-beta in cancer prostate: clincal and immunohistochemical study

The role of estrogen and its receptors in the etiology and progression of prostate cancer [PC] is poorly understood. This study was designed to determine the patterns of estrogen receptor-beta [ER-beta] expression in malignant human prostate and its association with the clinical outcome. Fifty radical prostatectomy specimens from patients with clinically localized PC were assessed for ER-beta expression using immunohistochemistry [IHC]. Out of the 50 cancer specimens, only 8/50 [16%] were ER-beta positive. Statistically, the ER-beta presence in PC specimens was studied in relation to the different prognostic variables. The ER-beta positivity was statistically significant in association with the prostate gland-confined tumor [p=0.4794], the seminal gland invasion [p=0.0001], pelvic lymph node metastasis [p=0.0080] and Gleason grade [p=0.0044]. The disease relapse was significant in association with the ER-beta immuno-positivity [p=0.1179]. On the other hand there was no significant association with prostatic specific antigen [PSA] level and surgical margins invasion [p=0.9746 and 0.9017 respectively]. We demonstrated that the ER-beta expression in prostate cancer is associated with higher Gleason grade tumours and with higher metastatic potential. The ER-beta could be one of the key processes leading to uncontrolled growth of prostate epithelial cells

Myoview [technetium-99m tetrofosmine] scintigraphy of parathyroid gland in primary hyperparathyroidism

Minimal surgical techniques are increasingly used to remove parathyroid adenomas. Such surgery depends on accurate preoperative localization of the parathyroid swelling. The preoperative accuracy of Tc-99m tetrofosmin was evaluated in 45 patients presented with primary hyperparathyroidism and compared with ultrasonography and Tc-99m pertechnetate studies / Thallium-201 [Tc-O[4]/TL-20I] subtraction. The overall sensitivity of Tc-99m tetrofosmin was 88.8% for double phase study and 91.1% for dual tracer subtraction and that for Tc-99mO[4]/TL-201 subtraction was 80% and US was 73.3% with high significant difference. High reliability and accuracy of Tc-99m tetrofosmin in pre-operative localization of parathyroid adenoma

Apoptosis suppressing protein Bcl-2 expression in rheumatoid synovium

It has been suggested that defective apoptosis plays a role in the development of autoimmune. The aim of this study is to investigate the apoptosis suppressing protein Bcl-2 in the rheumatoid synovum. Twenty synovium biopsy specimens were studied histopathologically and immuno-histochemically. Positive immunoreactivity was observed in 16 cases [80%] the infiltrated lymphocytes and in 11 cases [55%] in the lymphoid follicles, while, in 8 cases [40%] deep synovial fibroblasts showed marked Bcl-2 positively. The superficial synovial cell lining was only positive in 5 cases [25%].The apoptotic process is suppressed in rheumatoid arthritis as triggered by Bcl-2 oncoprotein. The defective control of apoptosis. [programmed cell death] as well excessive proliferation may he of central importance in the pathogenesis of rheumatoid arthritis

Study of some adolescents health problems and application of educational program among adolescents students in Sharkia govemorate-Egypt

Adolescence is a difficult and dangerous period of transition from childhood to adulthood. This population segment is exposed to a variety of health problems including; iron deficiency anemia, obesity, and dental caries, under nutrition, smoking, substance abuse and psychological problems. Objectives: This study is conducted to assess some of adolescents health problems and to explore their underlying factors. Also, it assesses the impact of an applied educational program for the most feasible problem. The study is composed of two phases, the first one is a cross sectional study that is conducted on a suitable sample size of preparatory, secondary school and university adolescents during the academic year 2004-2005. A multistage sampling technique is used for sample selection. A self-administered questionnaire is used to collect the following data; sociodemographic, dietary history, some lifestyle factors and depressionanxiety scale. Clinical examination, anthropomctric measurements and some laboratory tests arc done for the students. The second phase is an intervention one that is conducted after data collection, analysis and prioritization of health problems. Parasitic infection took the first priority to be solved, and the infected students are divided into intervention and control groups. A self-administered questionnaire is used to assess knowledge and practice of both groups regarding parasitic infection. The intervention group is subjected to medical treatment and an educational program while the control one is subjected to medical treatment only. After 2 months all participants are asked to complete the same questionnaire and stool analysis is done for them. The first phase of study showed many health problems among the studies adolescents, which are in sequence; dental caries, anaemia, parasitic infection, obesity, underweight, smoking, anxiety and depression. It was found that dental caries, anaemia, parasitic infection, underweight and depression were significantly associated with rural adolescents belonging to low social class. While, obesity and smoking were significantly associated with urban ones belonging to high social class. Anemia, obesity, anxiety and depression were more prevalent among females, while underweight and smoking were more among males. The problem of obesity was associated with those taking snacks and four meals or more, and not practicing exercise regularly. However, underweight was associated with those were taking less number of meals not and were not taking snacks. Finally, anxiety and depression, both were associated with smoking and absence of qxercise practice. The second phase showed reduction in the percentage of students who were infected by parasitic infection in both control and intervention groups with significant reduction in the intervention group reflecting the great impact of the educational program. The adolescents are exposed to some health problems and by assessing their knowledge about parasitic infestation, it was found to be relatively deficient. So, the study recommended a regular health appraisal for early detection, management in addition to application of a sustained health education program aiming to improve their knowledge, attitude and practice regarding the common health problems

Petrophysical facies discrimination of Miocene calcareous sandstones, Wadi Feiran, Sinai, Egypt

Systematic petrophysical studies were carried out on some calcareous sandstone samples selected from Gebel Hadahid area, Wadi Feiran, south west Sinai,. The studied rock samples are belonging to the Lower Miocene [Rudeis Formation, 338.8 m] which conformably overlies the Nukhul Formation and unconformably underlies Quaternary gravels and sands, The Lower Miocene rocks of the studied area are composed mainly of sandstones intercalated with shale beds and few sandy limestone intercalations at the base. The studied samples were deposited in a fluviatile and mixed Aeolian-fluviatile environment. The storage capacity of the studied rocks was diminished by cementation, mostly by calcite cementation, and rarely by hematite or silica cement. The collected samples were subjected to comprehensive systematic petrophysical investigations including measuring of the bulk density, the porosity, permeability, irreducible water saturation, electric tortuosity of channels, apparent electric resistivity of samples saturated with NaCl solution at three successive concentrations [6, 60 and 120 kppm], and the true electric resistivity. The petrophysical analysis enabled distinguishing three pelrophysical facies. The lower and middle facies [lower and middle parts of Rudeis Formation] have good storage capacity properties due to their high porosity and permeability values, whereas the third facies [topmost parts of Rudeis Formation] has fair storage capacity properties

role of magnetic resonance sialography in assessment of duct system in salivary glands diseases

We evaluated in this study the diagnostic accuracy of MR Sialography in assessment of duct system in salivary gland diseases. This study was conducted on twenty patients. Magnetic Resonance imaging of the major salivary glands using conventional T1 and T2 weighted sequences, with addition of a heavily T2 weighted RARE [Rapid Acquisition with Relaxation Enhancement] MR sialography sequence was performed for all patients supplemented by conventional sialography and plain x-ray examination of the salivary glands. This study included twenty patients of different ages of both sexes, their ages were ranging from 4-80 years, complaining of pain and swelling at the regions of the salivary glands There were six neoplastic lesions, six inflammatory lesions, six sialolithiasis with and without associated sialadenitis, and two cases of non-neoplastic non-inflammatory lesions [sialosis]. Heavily T2-weighted MR sialographic imaging was able to delineate ductal anatomy and pathological changes as dilatation and displacement of the duct system of the examined major salivary glands in all cases. Combining such sialographic sequence with conventional MR sequences [T1 W and T2 W images] promise to be an ideal apprehensive imaging modality for evaluation of major salivary glands diseases

Soluble adhesion molecules in juvenile idiopathic arthritis: relation to activity and clinical subtype

The present research aimed to evaluate serum Adhesion Molecules [AMs] in patients with Juvenile Idiopathic Arthritis [JIA] to correlate their values with disease activity in different clinical subtypes. Serum levels of some soluble AMs [E-selectin, sICAM 1 and sVCAM 1] wereassayed by ELISA in 37 patients with JIA both during activity and after remission. Other activity parameters like sedimentation rate and leukocytic counts were tested as well. Twentyhealthy children of matched age and sex were taken as control. Serum E-selectin was found significantly higher in JIA compared to control [in all subtypes across all disease stages], with significant drop after remission, yet not reached the normal values. These changes were more evident in systemic JIA compared to other subtypes. Serum ICAM 1 and VCAM 1 showed the same changes in relation to control and to the disease activity. We can conclude that systemic JIA is associated with higher levels of soluble AMs thus explaining the perpetual inflammatory process and hence the remissions and exacerbations which are usually associated with higher morbidity in systemic JIA than in the other subtypes. We recommend following JIA patients until laboratory remission [normalization of serum AMs] to correlate AMs levels to clinical course aiming to put forward a therapeutic plan

Urinary abnormalities in asymptomatic primary school Egyptian children

To detect the prevalence of asymptomatic urinary abnormalities in primary school Egyptian children, 1670 healthy children from Dakahila governorate were screed for hematuria and proteinuria using dipstick method. They were 910 males and 760 females. At the first screening, 22 children [1.3%] had urinary abnormalities however only 12 [0.72%] out of them had urinary abnormalities at the second screening. Out of children who had urinary abnormalities, six [0.36%] had isolated hematuria [IH], two [0.12%] had isolated proteinuria [IP] and four [0.24%] had combined hematuria and proteinuria [CHP], Renal biopsy was performed on four children [two had CHP, one had IH and the other had IP]. PSAGN was identified in three children of those who had lH. While the other two had hypercalciuria and renal stone and no abnormality was detected in the sixth child. One of IP children had orthostatic proteinuria while the other had focal segmental glomerulosclerosus. The pattem of renal diseases in CHP children was PSAGN in two, diffuse mesangial proliferation in one and IgA nephropathy in the other. In conclusion, asymptomatic urinary abnormalities are not present in considerable percentage among primary school children in our locality. PSAGN is the leading cause for these abnormalities. Only three children have evidence of chronic kidney disease which raises the issue of considering the cost-benefit ratio before the national implementation of the urine screening program

Asymptomatic bacteriuria among primary school children in Dakahlia governorate

Nine hundred and sixty primary school children from Dakahlia governorate were screened for asymptomatic bacteriuria [ABU]. The prevalence of ABU was found to be 4.1%. ABU was more predominant [P 0.001] in children from rural areas [5.9%] than in those coming from urban areas [1.5%]. Females had significantly [P<0.0001] higher ABU prevalence [6.5%] than males [1.6%]. There was no difference in the prevalence of bacteriuria between younger children and older ones. From the total bacterial isolates E-Coli were the most common bacteria 2.6%, followed by Enterobius faocalls 1.8%, Klebsiolla pneumonia 0.4%, then coagulase negative staphylococci 0.3%. In conclusion, ABU is not a common finding in primary school children in our locality. It is more common in girls and in those coming from rural areas. E-CoIi is the most common isolated bacteria

Role of tissue factor pathway inhibitor [TFPI] As A predictor of disseminated intravascular coagulation [DIC] among children with sepsis syndrome

This prospective study aimed at evaluation of the role of tissue factor pathway inhibitor [TFPI] as a predictor of disseminated intravascular coagulation [DIC] among patients with sepsis who were admitted to the PlCU at Alexandria University Children's Hospital over a period of 15 month starting from September 2002. Study subjects comprised 20 children with suspected or. Pre-DIC, 10 children with overt DIC and 10 healthy children served as a control group. Both patients and control groups were evaluated for platelet count, prothrombin activity, aPTT, plasma fibrinogen, AT III %, FDPs, and TFPI. These hemostatic parameters were followed every other day for patients with pre-DIC, while performed once for overt DIC and control groups. Pre-DIC patients with good outcome showed increase in their prothrombin activity, AT III, fibrinogen; decrease in FDPs and slight decrease in aPTT. On the contrary, poor outcome was associated with further decrease in prothrombin activity, AT Ill, fibrinogen, and increase in FDPs, and slight decrease in aPTT. TFPI increased in both survivors and no survivors; however, the final figure was higher in the survivors. TFPI it] patients with overt DIC showed higher significant values in the survivors compared to no survivors

Conclusion: increased level of TFPI in DIC reflect the depletion of the endothelial cell bound TFPl pool with loss of endothelial protective effect. Its therapeutic use in sepsis is based on this concept; TFPI could be used in following the patients with DIC, however, its high cost limit ifs use as a prognostic parameter in DIC

Arabic A series charts for the partially sighted persons

Vision charts that are constructed to estimate V.A. in partially sighted personse are multiple. Keeler "A" series charts for far and near are produced in English language and they predict the magnification required for these patients. In that paper, we have made use of Emarah visin chart and "A" series chart to have far chart and another near chart in Arabic language for the subnormal vision patients

Reduction of intraocular pressure by intranasal nitroglycerine used to ameliorate the pressor response to laryngoscopy and intubation

Twenty health adult patients undergoing non-opthalmic operation, classified into two groups, were studied to evaluate the effect of intranasal nitroglycerine [NTG] used to ameliorate the pressor responses to laryngoscopy and intubation, on the intraocular pressure [IOP]. 1.5ml of nitroglycerine solution, prepared locally, were instilled in each nostril of patients of group II before induction of anaesthesia while patients of group I received nothing. Heart rate [HR], mean arterial blood pressure [MABP] and [IOP] were measured before premedication, after premedication [by diazepam and atropine], after induction by thiopentone Na, after muscle relaxation [by atracurium] then 1 minute, 2 minutes and 5 minutes after laryngoscopy and intubationin in both groups. It was found that intranasal NTG produced insignificant changes in HR, MABP, and IOP below its preoperative value in patients of group II compared to patients of group I. It is therefore, recommended to use NTG especially in hypertensive patients where ophthalmic operations are to be done, especially if no increase in IOP is desired. Intranasal route of NTG administration is reliable especially when the intravenous or oral route is difficult

newly proposed Arabic near vision chart

Since Snellen's principle for measuring the visual acuity for far, challanging ideas were proposed for a scientific principle to measure the acuity for near. The Snellen's principle has never been applied for near vision charts. Instead, the point system was adopted officially by the British ophthalmic society since 1955. Every ophthalmic community has adopted a written chart in its own language. The Parinaud chart in French has been calibrated to give the corresponding to the far visual acuity. We tried to design a chart in Arabic based on the print system of 0.35 mm [The smallest print size and its multitudes] written in a simple, unpredictable way with no political, religious or social inclinations. We have chosen the type of writing, the most commonly read [EI-Bagdadi method]