Nuchal cord: impact of umbilical artery Doppler indices on intrapartum and neonatal outcomes: a prospective cohort study.

Background/objective: The purpose of this study is to investigate the use of a more biologic parameter for evaluation of the effect of nuchal cord tightness; the study of blood flow in the umbilical arteries of nuchal cord using Doppler ultrasonography. Methods: This prospective cohort study was conducted at Ain Shams University Maternity Hospital, Cairo, Egypt in the period between August 2015 and August 2017. Hundred primigravidas were recruited with nuchal cord diagnosed by Doppler ultrasonography; whereas the rest of the study population was included in the "Control group". Doppler velocimetry study was then performed on a free-floating loop of the umbilical cord and Doppler indices were calculated. Both groups were followed up during labor: intrapartum events, mode of delivery, and neonatal outcome were recorded. Results: Intrapartum fetal heart rate abnormalities were significantly more common in the nuchal cord group compared to the control group. The overall cardiotocography category was significantly more commonly reflecting abnormal fetal heart rate patterns in the nuchal cord group compared to the control group with 46.74% of the nuchal group patients falling within the "suspicious - pathological - need urgent intervention" categories. Intervention rate was significantly higher in the nuchal cord group than the control group (33.69 versus 21.84%). Moreover, incidence of intrapartum fetal heart rate abnormalities and intervention rate were significantly higher in the nuchal cord with abnormal Doppler subgroup compared to both nuchal cord with normal Doppler subgroup and the control group; with a calculated number needed to harm of 2.11. Conclusions: In view of these results, it might be concluded that umbilical cord tightness affecting fetal hemodynamics (expressed by changes in umbilical artery Doppler) might be a determinate factor affecting the intrapartum course.

Health in Khulais villages, Saudi Arabia. An educational project.

A field work project was conducted in Khulais villages by the Department of Community Medicine, Riyadh Faculty of Medicine, in February 1977. The project involved jointly Riyadh University and the Saudi Arabian Ministry of Health, as well as other organizations. Over a 10-day period, twenty-five students of the fourth-year medical class under the supervision of seven members of the staff studied health problems and rendered selected health services to the community. Project activities included a study of a sample of 280 schoolchildren by clinical examination, anthropometric measurement and selected laboratory investigations; a house-to-house survey; a study of the epidemiology of schistosomiasis and malaria; immunization of pre-school children; a health education programme and an evaluation of the health centre's activities. The main objective was to give the students an appreciation of the need for team-work in approaching community health and help to cultivate their interest in community medicine as an applied discipline.

Some blood genetic markers of selected tribes in Western Saudi Arabia.

A total of 292 randomly selected subjects belonging to two indigenous Arab tribes (Harbi and Ghamid) and two immigrant tribes (Mograbi and Mowallad), residents in Western Saudi Arabia, have been tested for genetic variants of six blood groups, four serum proteins, and five red cell enzyme systems. The distribution of the polymorphic systems was different between indigenous and immigrant tribes, and the present Arab population shows a considerable degree of admixture from the surrounding countries, in particular Africa.

Haemoglobin and erythrocytic glucose-6-phosphate dehydrogenase variants among selected tribes in Western Saudi Arabia.

638 subjects from six tribes in Western Saudi Arabia were tested for haemoglobin and G-6-PD variants. In the bedouins of Harbi and Sahafi tribes there was no sickling but a low frequency of both G-6-PD deficiency (1.7%) and the Gd A+ variant (1.7%) in Harbi. In Mograbi and Mowallad tribes who immigrated recently from Africa, the frequency of Hb S was 4.1 and 3.5%, G-6-PD deficiency 7.5 and 8.5% and the Gd A+ variant 15.1 and 8.5% respectively, which are higher than in bedouins. In Ghamid tribe 4% had Hb S and there was a low frequency of both G-6-PD deficiency (4.8%) and Gd A+ variant (1.6%). However a new B slow variant is common among the Ghamid (16.1%). Hb S frequency in Zahran tribe was 2.6%. Six of the 12 g-6-PD deficient (screening) were found to be positive on starch gel electrophoresis.

Cardiac arrest after intravenous chloroquine injection.

In cases of severe malaria chloroquine phosphate is frequently given--diluted or undiluted--by the intravenous route. It is known that cardiac arrhythmias and hypotension may complicate such therapy, but cardiac arrest is not a well recognised hazard. In this report we describe such a tragic complication, and advocate that undiluted chloroquine should not be administered intravenously in severely ill patients since such patients usually have associated electrolyte disturbances which may render the heart vulnerable to toxic drugs. Chloroquine may be given diluted in normal saline infused over several hours with a close watch over the blood pressure.

Hycanthone therapy in selected patients with S. mansoni and S. haematobium infections in the Sudan.

The results of a clinical trial of hycanthone in 601 selected Sudanese patients with S. mansoni and S. haematobium infections are reported. Hycanthone was given as a single intramuscular injection at a dose of 3.0 mg per kilogramme body weight. The commonest side effects were nausea and vomiting which occurred in 35 per cent and 32 per cent respectively. No incidence of acute hepatic damage and no deaths were encountered. About one third of patients reported for follow-up. Cure rate for S. mansoni was 90 per cent at 6 weeks of treatment and 97 per cent at three months and six months, while for S. haematobium infection it was 82 per cent at 6 weeks and 91 per cent at 3 months and 6 months. A significant reduction in egg excretion was achieved in those who were not cured.