Contrast echocardiogram in diagnosing rare type of persistent left superior vena cava.

We report a rare case of persistent left superior vena cava (PLSVC) with direct drainage into the left atrium in a 3-yearsold boy who had been electively admitted for hypospadias repair, when he was noticed to have finger clubbing and mild hypoxia but was otherwise asymptomatic. The diagnosis of PLSVC can be made without an invasive tool as direct drainage of PLSVC into the left atrium be visualised using transthoracic echocardiography (TTE) by injecting agitated saline into the left arm.

Study of the relation between quality of inpatient care and early readmission for diabetic patients at a hospital in the Eastern province of Saudi Arabia.

Readmission of diabetic patients after discharge from hospital has potential value as a quality of care indicator. This retrospective cohort and case-control study aimed to determine the readmission rate for diabetic patients within 28 days after discharge and the association between quality of inpatient care and unplanned readmission. An audit of records was conducted in a hospital in the Eastern province of Saudi Arabia during 2000-2008. The rate of unplanned readmission of patients originally admitted with diabetes mellitus (n = 1125) was 5.2%. Comparison of data from readmitted patients (n = 62) and a sample of nonreadmitted patients (n = 62) showed that adherence by health care providers to American Diabetes Association guidelines for admission work-up (OR 0.91, 95% CI: 0.85-0.99) and readiness for discharge criteria (OR 0.89, 95% CI: 0.84-0.95) were significantly more likely to decrease the risk of readmission within 28 days.

Study of the relation between quality of inpatient care and early readmission for diabetic patients at a hospital in the Eastern province of Saudi Arabia

Readmission of diabetic patients after discharge from hospital has potential value as a quality of care indicator. This retrospective cohort and case-control study aimed to determine the readmission rate for diabetic patients within 28 days after discharge and the association between quality of inpatient care and unplanned readmission. An audit of records was conducted in a hospital in the Eastern province of Saudi Arabia during 2000-2008. The rate of unplanned readmission of patients originally admitted with diabetes mellitus [n = 1125] was 5.2%. Comparison of data from readmitted patients [n = 62] and a sample of non re admitted patients [n = 62] showed that adherence by health care providers to American Diabetes Association guidelines for admission work-up [OR 0.91, 95% Cl: 0.85-0.99] and readiness for discharge criteria [OR 0.89, 95% Cl: 0.84-0.95] were significantly more likely to decrease the risk of readmission within 28 days

Congenital heart disease among school children in Alexandria, Egypt: an overview on prevalence and relative frequencies.

A study was undertaken to determine the prevalence and relative frequencies of congenital heart diseases diagnosed by echocardiography among school children in Alexandria, Egypt. The study was conducted during a 1-year period (1 May 1995-1 May 1996) at the Students' Health Insurance Hospital, which is a referral center for all health insurance units, providing an echocardiography service. The prevalence of congenital heart diseases (CHD) among school children accounted for 1.01/1,000. There was a male predominance in cases of pulmonary stenosis and single ventricle, while in cases of patent ductus arteriosus, mitral valve prolapse, and partial atrioventricular canal there was a female predominance. The commonest cardiac defects were ventricular septal defects, pulmonary stenosis, and atrial septal defects. Pulmonary stenosis ranked the second commonest defect and is a peculiar finding in our Egyptian population. The mere presence of these cardiac defects in school children is an indicator of the poor quality of care provided to this growing childhood population.

Thoracolumbar fracture--dislocation results of surgical treatment.

Fifteen cases of unstable fracture-dislocation of the thoracolumbar spine have been treated by open reduction, short segment transpedicular fixation and fusion in Universiti Unit, Kuala Lumpur Hospital from January 1994 until December 1997. Twelve male and three female patients were injured; their age ranged from 18 to 45 years. Five fracture-dislocations occurred in the lower thoracic spine (T8 to T11), eight at the thoracolumbar junction (T12 to L2) and two in the lumbar spine (L3 to L5). All the patients had neurological deficit. Seven patients with incomplete or cauda equina lesions regained some neural function, while all eight with complete lesions remained unchanged. Ten of the fifteen cases were grossly unstable and translated beyond 50% of the width of the spinal column. At the time of follow up (more than one year in all patients), no loss of reduction or of fixation was noted in any patient. Solid fusion was achieved in all patients. The advantages of this method of treatment include stable fixation, with maintenance of sagittal and coronal spinal alignments, to allow early rehabilitation.

Risk factors for congenital heart diseases in Alexandria, Egypt.

A matched case control study has been conducted in the children's hospitals in Alexandria, Egypt, during 2 years-period, aiming at investigating the risk factors for the occurrence of congenital heart diseases. Our results showed that the significant risk factors for developing any type of congenital heart disease and ventricular septal defects were: older paternal age at birth, positive consanguinity, positive family history, female sex hormones, irradiation, hazardous maternal occupation, diabetes mellitus and suburban or rural residence. However, some environmental/teratogenic factors were not implicated in the etiology of atrial septal defects or pulmonary stenosis. These findings strongly suggest that environmental factors vary according to the specific type of congenital heart disease. This study emphasizes on the need to instruct the public about the importance of pre-marital counseling and the deleterious effects of various teratogens in the environment.

Effect of low-energy laser application in the treatment of denture-induced mucosal lesions.

STATEMENT OF PROBLEM: Mucosal inflammation under dentures causes problems for prosthodontists and patients. PURPOSE OF STUDY: This study evaluated the effectiveness of a low-energy laser used in the treatment of denture-induced mucosal lesions in comparison with other conventional methods. MATERIAL AND METHODS: Eighteen men were selected and divided into three groups of six according to the treatment applied: denture removal, relined dentures with temporary tissue treatment, and application of laser irradiation for the lesions while continuing to wear the dentures. Oral hygiene and nutrition were maintained during the study. Clinical, histologic, and densitometric assessments were used to evaluate the three treatment methods. RESULTS: The results revealed that lesions in the group treated with laser irradiation were clinically superior in healing when compared with the other groups. Histologic evidence of the therapeutic effect of lasers in healing denture-induced mucosal lesions was demonstrated. Densitometric evaluation showed an increase in the optical density of alveolar bone underneath the irradiated lesions compared with untreated lesions. CONCLUSION: These findings suggest the effect of therapeutic laser treatment on both soft tissue and bone with subsequent improvement of denture foundation after treatment of denture-induced mucosal lesions.

Patient satisfaction with hospital services: determinants and level in a hospital in Kuwait.

The present study used a well-tested patient satisfaction measuring instrument to identify the determinants of the level of overall satisfaction with hospital services, and to examine the level of satisfaction with attributes of 7 specific dimensions of hospital services. Using multiple regression analysis, it was found that out of 12 patient characteristics, age was the most important determinant of overall satisfaction, followed by gender. Perceived health status, clinical department, and expectations about the quality of services before admission were also significant but less important determinants of overall satisfaction. Marital status, level of education, nationality, and previous hospitalization in the study hospital, in Kuwait, or in a western country hospital, all had no significant effect on overall satisfaction. Concerning the effect of satisfaction with specific dimensions of hospital services on overall satisfaction, it was found that satisfaction with physicians was the most important determinant of overall satisfaction, followed by satisfaction with housekeeping and with nurses. Satisfaction with hospital environment and facilities and with admission process were also significant but less important determinants of overall satisfaction, while satisfaction with food and radiology services did not affect overall satisfaction. The level of overall satisfaction as well as satisfaction with specific dimensions of hospital services were quite high. Physicians' care was the most favorably rated dimension, followed by admission process and housekeeping, while nursing care was the least favorably rated dimension. Among the attributes of physicians' and nurses' care, technical care and courtesy were the most favorably rated items; while communication, particularly imparting of information, was the least favorably rated aspect. Several attributes of the hospital environment and facilities and of the food services were found to be dissatisfying to patients.

Patient satisfaction with hospital services: development and testing of a measuring instrument.

The present study was undertaken with the aim of developing and testing an instrument that could be used to measure patient satisfaction with hospital services in Kuwait. The instrument, which comprised 57 items, and measured satisfaction with 7 specific dimensions of hospital services, was administered to 493 patients using the interview technique. Statistical analysis showed that the instrument yields good response variability. Reliability of the instrument, measured in terms of the internal consistency coefficient alpha, exceeded the acceptable criterion level, the coefficients ranging between 0.73 and 0.86. Evidence of the construct validity of the instrument was found in significant positive correlation between the dimension specific satisfaction scale scores and scores for allegiance scale and for overall rating of quality of hospital services. Construct validity was further supported by convergent discriminant analysis, which showed that correlations between items of all 7 scales and their total scale scores were greater than correlations between scale items and the total scores of scales they do not represent. Analysis of an open-ended question about dissatisfying aspects of hospital services not included on the interview was undertaken to examine the instrument's content validity. Results indicated that patients identified 11 items, 8 of which were identified more than once, and 2 of which were not classifiable to the 7 dimensions assessed by the instrument. It was suggested to add the 8 items that were identified more than once, and to reassess the reliability and validity of the revised instrument. Assessment of the test-retest reliability, by comparing scale scores over time, was also suggested.

Enzyme-linked immunosorbent assay (ELISA) in the diagnosis of active pulmonary tuberculosis.

This study evaluates the sensitivity and specificity of an enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies against Mycobacterium tuberculosis antigen. Twenty seven of the 35 patients with pulmonary tuberculosis had positive serology with an antibody titre of 10 nineteen of them had positive serology with an antibody titre of 100. All the 27 patients with positive serology were either smear or culture positive or both. Twenty six of the 35 control group had negative serology and 9 had positive serology with an antibody titre of 10. The test has a sensitivity of 77.14% and a specificity of 74.29%.

Advanced nasopharyngeal carcinoma: radiation treatment and chemotherapy approaches, and life table survival results.

Induction combination chemotherapy and radiotherapy was tried in 50 patients with T3-T4 nasopharyngeal carcinoma. The results were compared to another matching group of 50 patients given radical radiotherapy. The study showed preliminary improvement of local control rates of the tumour in patients treated by combination chemotherapy with radiation. The actuarial method of survival computation was applied, also the variance and standard error of the four years survival rates for both treatment groups was computed. Comparison of the survival rates showed no significant difference between group I (received combined chemo and radiotherapy) and group II (Radiation therapy) throughout the observation period.