Evaluation of anatomical and functional results of overlapping anal sphincter repair with or without the injection of bone marrow aspirate concentrate: a case-control study.

AIM: Overlapping anal sphincter repair (OASR) is used for treatment of faecal incontinence due to an external anal sphincter (EAS) defect; however, it is not the optimal treatment as its functional results tend to deteriorate significantly with time. The present study aimed to evaluate the effect of local injection of bone marrow aspirate concentrate (BMAC) on the outcome of OASR. METHOD: We compared a prospective group of 20 patients with EAS defect who were managed with OASR and BMAC injection (group I) with a historical control group of an equal number of patients managed with OASR alone (group II). Patients were assessed preoperatively and during follow-up by the Wexner continence score and endoanal ultrasound. The primary end-points were the improvement of the continence level measured by the Wexner score and the residual EAS defect size measured by endoanal ultrasound. RESULTS: At the end of follow-up, group I had significantly lower mean postoperative Wexner score (5.4 ± 7.6 vs 10.6 ± 7.4; P = 0.03) and smaller EAS defect percentage (12.2 ± 17.5 vs 18.3 ± 18.9). These findings were statistically significant in patients with a small preoperative EAS defect equal to or less than one-third of the anal circumference. Patients with larger preoperative EAS did not show a significant improvement of the continence level after repair in either group. CONCLUSION: Augmenting OASR with local injection of BMAC in patients with faecal incontinence caused by an EAS defect, particularly a smaller defect, can improve both functional and anatomical outcomes of OASR.

Reproductive tract infections among married women in Upper Egypt.

In a house-to-house survey using cluster sampling, 1344 married women from urban and rural areas of Upper Egypt (Minia, Assiut and Sohag) were interviewed and examined to study the magnitude and determinants of reproductive tract infections. Overall prevalence was found to be 52.8%, with the most prevalent forms being Candida albicans (28.0%), Trichomonas vaginalis (8.7%), Aspergillus species (7.4%), streptococci (4.6%) and Chlamydia trachomatis (4.2%). Multivariate analysis identified certain groups of women at high risk of developing reproductive tract infections (those currently using an intrauterine device, those who regularly practised internal vaginal washing). Discriminant analysis showed that symptoms were of low discriminating value. There is a great need to increase community and women's understanding of reproductive tract infections.

Reproductive tract infections among married women in Upper Egypt

In a house-to-house survey using cluster sampling, 1344 married women from urban and rural areas of Upper Egypt [Minia, Assiut and Sohag] were interviewed and examined to study the magnitude and determinants of reproductive tract infections. Overall prevalence was found to be 52.8%, with the most prevalent forms being Candida albicans [28.0%], Trichomonas vaginalis [8.7%], Aspergillus species [7.4%], streptococci [4.6%] and Chlamydia trachomatis [4.2%]. Multivariate analysis identified certain groups of women at high risk of developing reproductive tract infections [those currently using an intrauterine device, those who regularly practised internal vaginal washing]. Discriminant analysis showed that symptoms were of low discriminating value. There is a great need to increase community and women's understanding of reproductive tract infections

Deleterious effects of khat addiction on semen parameters and sperm ultrastructure.

The semen parameters and sperm ultrastructural morphology have been described in semen samples from two groups of Yemeni subjects. The first 'exposed' group comprised 65 khat addicts, while the second control group included 50 non-khat addict subjects. The mean age was 39.94 +/- 13.85 and 35.72 +/- 11.35 years in the exposed and control groups respectively, without a significant difference. The mean duration of khat addiction among the addicts was 25.34 +/- 12.96 years (range 6.00-48.00). Statistically significant differences were detected between the semen parameters of the two groups. Such parameters, including semen volume, sperm count, sperm motility, motility index and percentage of normal spermatozoa, were lower among addicts. Significant negative correlation was also found between the duration of khat consumption and all semen parameters (r ranged from -0.30 to -0.74). At the transmission electron microscopy level, a counting system was incorporated to compare the numbers of normal spermatozoa with deformed and dead spermatozoa in ultrathin plastic sections. The total mean percentage of deformed spermatozoa was approximately 65%. Different patterns of sperm deformation were demonstrated, and included both the head and flagella in complete spermatozoa, aflagellate heads, headless flagella and multiple heads and flagella. Deformed heads showed aberrated nuclei with immature nuclear chromatin and polymorphic intranuclear inclusions; these were associated with acrosomal defects. The deformed flagella demonstrated numeric aberrations of the axonemal 9 + 2 configuration and structural defects of their associated elements. Persistent cytoplasmic droplets were observed frequently. This study has shown for the first time the deleterious effects of khat addiction on semen parameters in general and sperm morphology in particular of all addicts, especially those who have consumed khat for longer periods of time.

Teenage pregnancy: are teenagers a high risk group?

OBJECTIVES: To study health profile of pregnant teenagers and their pattern of utilization of primary health care services in comparison with pregnant women aged 20-35 years in Abha, Saudi Arabia. STUDY DESIGN: A cohort of 1938 Saudi pregnant women (214 teenagers less than 20 years and 1724 aged 20-35 years) was selected by stratified random sampling technique. They were screened for anemia and hypertension using WHO criteria and followed until delivery to observe the method of delivery. RESULTS: The prevalence of anemia (9.6% and 12.0%, respectively) and hypertension (1.1% and 3.5%, respectively) was not significantly different among primigravida of both age groups. The same trend was observed among multigravida. Follow-up showed that the rate of abnormal deliveries among primigravida of both groups was not significantly different, and even lower among multigravida teenagers. Pregnant women in both groups had similar average prenatal visits (6.6 +/- 1.1 and 6.7 +/- 1.2 respectively, P < 0.05) and the majority contacted the primary health care center early in pregnancy (87.4% and 88.9%, respectively, P < 0.05). CONCLUSION: These results indicate that pregnant teenagers are not a high risk group if good prenatal care is provided.

PIP: Teenage pregnancy has been shown to be associated with an increase in obstetric complications. In particular, gestation associated hypertension and anemia were found more frequently among these young women. The authors screened 1938 pregnant Saudi women for anemia and hypertension using WHO criteria and followed them until delivery to observe the method of delivery in the study of whether or not pregnant women younger than 20 years old are at greater risk of obstetric complications than pregnant women aged 20-35 years. The women were selected by stratified random sampling technique from Abha, Saudi Arabia. 214 were younger than 20 years old, while the rest were aged 20-35. Among primigravida pregnant women younger than 20 years old, 9.6% were anemic and 1.1% suffered hypertension. Among primigravida pregnant women aged 20-35 years old, 12.0% were anemic and 3.5% suffered hypertension. These differences in rates between age groups are not significant. The same trend was observed for multigravida women. Furthermore, the rate of abnormal deliveries among primigravida of both groups was not significantly different, and even lower among multigravida teens. Pregnant women in both age groups made, on average, 6.6-6.8 prenatal visits, while 87.4% and 88.9%, respectively, contacted the primary health care center early in pregnancy. It may be concluded from these findings that pregnant teens do not constitute a high-risk group if good prenatal care is provided.

Anemia among pregnant women in the Asir region, Saudi Arabia: an epidemiologic study.

A cross sectional study was conducted during August 1992, on a representative sample of 6,539 pregnant women attending 69 primary health care centers in the Asir region, southwestern Saudi Arabia for the assessment of their hemoglobin level. The overall prevalence of anemia (Hb < 11 g/dl) was found to be 31.9%. It was found that the prevalence was affected by age (37.3% among those who were less than 20 years old), parity (34.9% among those who had 7 and more deliveries), inter-pregnancy spacing (35.2% among those whose birth spacing was less than 1 year), gestational age, and education (35.1% among illiterates). Health education programs at primary health care level in the region should be revised to stress the importance of balanced diet, compliance with iron medication and sufficient spacing between subsequent pregnancies.

Altitude and socio-biological determinants of pregnancy-associated hypertension.

OBJECTIVES: To study the prevalence of gestation-associated hypertension and to determine the effect of altitude and related socio-biological factors. METHODS: A stratified random sample of 3988 pregnant women living at high altitude and 2744 at sea level in the Asir region, Saudi Arabia was interviewed for socio-biological conditions and examined for blood pressure, proteinuria and body mass. RESULTS: An overall prevalence of 2.4% was found. Certain groups of pregnant women are at high risk of developing hypertension. They include women who are over 40 years, high multipara, having short inter-pregnancy spacing, are overweight, are illiterate and those living at high altitude. Multivariate analysis showed that high altitude is a strong risk factor (adjusted odds ratio (OR), 1.879; 95% confidence interval (CI), 1.123-2.819) and cannot be masked when other variables are controlled. CONCLUSIONS: Special health education and more frequent screening programs at primary health care level should be given to pregnant women living at high altitude.