Sociodemographic and behavioural determinants of early childhood caries knowledge among expectant mothers in Kuwait.

PURPOSE: Early Childhood Caries (ECC) is a highly prevalent disease in Kuwait. It poses health, economic, and social implications affecting patients, their families and communities. ECC awareness campaigns targeting expectant mothers hold a promising potential as primary prevention tools. Understanding the baseline of ECC knowledge (ECC-K) is an important foundational step in planning such interventions. The aim of this study was to assess the level of ECC-K in a sample of expectant mothers, and to identify the sociodemographic and behavioural determinants of that knowledge. METHODS: A multiple-choice questionnaire was distributed to 430 expectant women from one maternity hospital in Kuwait. The questionnaire gathered information on the demographics, ECC-K, and the oral health behaviours of the participants. Bivariate analysis assessed the relationship between ECC-K scores and the different socio-demographic variables and oral health practices of the participants. A multiple linear regression model was developed to identify the predictors of ECC-K scores RESULTS: The response rate was 94% (n = 405). The mean ECC-K score was 6.4 [standard deviation (SD) = 2.5] out of a maximum score of 14. Age, education, number of children, frequency of dental visits, and flossing frequency were significantly associated with ECC-K levels (p < 0.05). CONCLUSIONS: ECC-K among this cohort of expectant mothers was inadequate. Educational interventions are needed to foster better ECC preventive practices.

Oral health practices and knowledge among parents and hired caregivers.

AIM: To investigate the oral healthcare practices and knowledge of parents and nannies in Kuwait. METHODS: A cross-sectional interview-based survey was carried out on parents and nannies to explore their demographics, oral health care practices and knowledge. Independent t-test was used to assess differences in practice and knowledge between parents and nannies. Multiple linear regression compared practice and knowledge of parents and nannies, adjusting for age, time spent in childcare, national origin, education, governorate of residence and number of other children in the household. RESULTS: Three-hundred caregivers were interviewed, parents (N = 146, 49%) and nannies (N = 154, 51%). Parents had a higher mean practice score (parents 3.25, nannies 2.69, p < 0.001), but a similar knowledge score to nannies (parents 38.0, nannies 37.6, p > 0.48). Governorate of residence predicted lower practice scores for parents residing north of the Kuwaiti capital compared to those residing elsewhere (ß = - 0.571, p < 0.05). Education weakly predicted lower practice scores for nannies beyond high school, but better scores for parents with a college degree. Education also predicted higher knowledge scores among nannies with college degrees (ß = 2.249, p = 0.06), but for the lower knowledge scores (ß = - 3.693, p = 0.08) among parents with college degrees. CONCLUSION: Caregivers' oral health practices and knowledge scores were good. However, nannies had poorer child oral healthcare practices. Results highlight the need to involve nannies in child oral healthcare education.

Plasma levels of haemostatic factors in patients with pulmonary embolism on admission and seven months later.

INTRODUCTION: With the exception of D-dimer, not much is known about the plasma levels of haemostatic factors during acute venous thromboembolism (VTE) compared to their basic levels in a stable phase. The goal of this study was to examine how plasma levels of factor V, VIII, XIIIa, von Willebrand factor antigen (vWF:Ag), fibrinogen, thrombomodulin evolve from the point of diagnosis of acute VTE to the end of standard treatment period. METHODS: Sixty-three consecutive patients (mean 57, range 18-86 years, 33 females) with acute pulmonary embolism (PE) were included. Laboratory samples were collected upon arrival (acute phase) and seven months later (stable phase). Fifteen similar aged individuals served as controls. RESULTS: Plasma levels of factor XIIIa (87.5% vs 117.7%, P < .001) and soluble thrombomodulin (36.6 vs 47.5 ng/L, P < .001) were lower, whereas plasma levels of vWF:Ag (2.66 vs 2.01 IU/mL, P < .001) and fibrinogen (4.3 vs 3.9 g/L, P < .05) were higher on admission compared to the stable phase. In the stable phase, vWF:Ag (2.01 vs 1.43 IU/mL, P < .01) and soluble thrombomodulin (47.5 vs 38.0 ng/mL, P < .05), but not FXIIIa levels, were higher in PE patients compared to healthy controls. CONCLUSION: This study confirms the concept of FXIIIa consumption during acute phase of VTE by showing its intraindividual normalization during the follow-up. vWF:Ag, known to be associated with the risk of VTE, was constantly elevated in the majority of the patients. Soluble thrombomodulin levels were lower in acute phase compared to stable phase, a finding which significance needs to be evaluated in the future.

[Epidemiology of the resistance of Mycobacterium tuberculosis to antituberculosis drugs at the main hospital in Dakar, Senegal. A 4-year retrospective study (2000-2003)]. / Épidémiologie de la résistance de Mycobacterium tuberculosis aux antituberculeux à l'hôpital principal de Dakar. Étude rétrospective sur quatre ans (2000-2003).

A retrospective study was carried out from January 2000 to December 2003 to assess the resistance of Mycobacterium tuberculosis to antituberculosis drugs and the impact of this on the treatment result. Two hundred and two patients' files were studied (average age: 36 years; sex-ratio: 1.7). Pulmonary localisation (85.7%) or extrapulmonary localisation (14.3%). HIV status is negative (71.3%), positive (10.8%) or unknown (17.9%). The overall recovery rate is 60.7% (61.4% in HIV-; 46.1% in HIV+), the rate of treatment failure is 2.7% (1.1% in HIV-; 15.4% in HIV+), the death rate due to tuberculosis is 6.3% (2.3% in HIV-; 23.1% in HIV+), and the rate of patients who disappeared from the system is 30.3% (35.2% in HIV-; 14.2% in HIV+). Hepatotoxicity that occurred during treatment is observed in 14.3% of cases (recovery: 56.2%; failure: 6.2%; lost from the system: 18.8%). Eighty-four percent of patients never received antituberculosis treatment (group A) versus 15.8% of patients who had already received one or more antituberculosis drugs (group B). The rates of resistance to isoniazid are 6.4% (A) and 12.5% (B), to rifampicin 1.7% (A) and 12.5% (B), to ethambutol 0.5% (A) and 0% (B), to streptomycin 24.1% (A) and 46.8% (B). The percentage of multiresistant strains is 1% in patients not treated previously and 11% in those who had already received antituberculosis treatment. When the patients are carriers of a strain that is responsive to the treatment administered, the recovery rate is 64.2% versus 46.7% in patients whose strain is resistant to at least one of the treatments administered.

Pinch grafting of chronic leg ulcers: a retrospective analysis of 104 patients with 169 ulcers.

OBJECTIVE: To compare healing rates of inpatients and outpatients with chronic leg ulcers treated with pinch grafting and to define which of these patients would benefit most from the therapy. METHOD: This retrospective analysis reports the healing rates of 104 patients with 169 ulcers treated with pinch grafting during 1997-2007 at the Department of Dermatology, Tampere University Hospital. RESULTS: These relate to 17 outpatients with 18 pinch-grafted ulcers and 95 inpatients with 151 ulcers. Nine ulcers (50%) in the outpatient and 95 (62.9%) in the inpatient group healed completely. Median healing times were five and eight weeks for the outpatient and inpatient groups respectively. For the sample as a whole, 61.5% of the ulcers healed. CONCLUSION: This retrospective study found that pinch grafting is an efficient method of treating chronic leg ulcers, with an overall healing rate over 60%. Patients who complied with compression therapy were most likely to benefit from this therapy.

Virus de l'hepatite C et hepatopathies chroniques a Dakar : etude cas-temoins

En Afrique noire; la place de l'infection par le virus de l'hepatite C (VHC) dans la survenue des hepatopathies chroniques reste discutee; en particulier au Senegal ou la prevalence du VHC est moderee. C'est pourquoi une etude cas-temoins a ete menee a l'Hopital Principal de Dakar; en 1995; incluant 73 malades et 73 temoins. Les malades etaient repartis en 2 hepatites chroniques; 25 cirrhoses et 46 carcinomes hepatocellulaires. Les malades et les temoins ont fait l'objet d'etude serologique vis-a-vis du VHC (test ELISA de depistage; test ELISA de 3e generation en cas de positivite; puis confirmation par immunoblot) avec determination du serotype du VHC par methode immunoenzymatique; une recherche d'infection par le virus de l'hepatite B et une recherche d'anticorps anti-delta ont complete l'etude. Seulement 2 malades etaient porteurs d'anticorps anti-VHC (3 p. 100) et la serologie etait douteuse chez 2 autres ; le serotype 2 a ete mis en evidence chez l'un de ces malades ; aucun temoin n'etait positif vis-a-vis du VHC. Cinquante-quatre malades (74 p. 100) et 15 temoins (21 p. 100) etaient porteurs de l'antigene HBs parmi lesquels 13 malades (24 p. 100) et 1 temoin (7 p. 100) etaient porteurs d'anticorps anti-delta. Cette etude montre le role actuellement negligeable du VHC dans la survenue des hepatopathies chroniques en milieu hospitalier au Senegal et confirme le role predominant du virus de l'hepatite B et aggravant du virus de l'hepatite delta. Ces resultats sont confrontes aux donnees de la litterature concernant les pays d'Afrique noire. Au Senegal; l'impact du VHC parait inferieur a celui qui est oberve en Afrique centrale

[Diffuse interstitial lung disease and connective tissue diseases: study of seven cases in Dakar]. / Les pneumopathies interstitielles diffuses non specifiques au cours des connectivites: à propos de 7 observations à Dakar.

INTRODUCTION: The diagnosis of diffuse interstitial lung disease non specific in connective tissue disease is difficult because of many differential diagnoses. Lung involvement can affect functional or vital prognosis. We report 7 cases. CASES: We collected data from 60 years old mean patients. Pulmonary localisation was diagnosed after 19 years of evolution of the auto-immune disease. Discovering circumstances were dyspnea and chronic cough. The radiographic and scannographic signs were diffuse because of long diagnosis delay. The underlying auto immune disease was scleroderma, rheumatoid arthritis, Sjögren's syndrome, ankylosing spondylitis, Sharp's syndrome, and multiple autoimmune syndrome. The main treatment was corticosteroids and respiratory physiotherapy. CONCLUSION: Throughout these 7 cases we discuss clinical, radiological and evolutive aspects and we focus on the need of early diagnosis for a better prognosis.

[Empiric antituberculous therapy in patients with unexplained exsudative pleural effusion. Is it valid in Senegal?]. / Le traitement antituberculeux présomptif est-il licite dans la pleurésie lymphocytaire exsudative inexpliquée au Sénégal?

AIM: Pleural biopsy and adenosine deaminase activity are not available at our center and the treatment begins without substantiation diagnosis in patients with tuberculous pleural effusion (PE). METHODS: In order to evaluate the validity of an empiric antituberculous therapy in exsudative PE with high prevalence of lymphocytes, we conducted a retrospective study during 1 year. Patient was enrolled if no signs of tuberculous infection, pneumonia or cancer were present. RESULTS: During 1 year, 38 patients were enrolled (23 males, mean age=36 years). PE was major (> 2/3 of the lung) in 14 cases, moderate (between 1/3 and 2/3) In 18 cases and minor (<1/3) in 6 cases. Tuberculous contagion was observed in 10 patients. Tuberculinic test was positive in all patients (12-24 mm). Clinical and radiological cure was obtained in 37 cases, except 1 patient who died from acute heart failure. No recurrence of PE was observed after 1 year follow-up. CONCLUSION: In our endemic areas, empiric antituberculous treatment seems to be an effective strategy in patients with exsudative PE.

[Lung cancer in Senegal]. / Le cancer bronchique au Sénégal.

In Africa the incidence of lung cancer is rising rapidly. The purpose of this prospective study was to analyze clinical, therapeutic, and prognostic features of lung cancer patients treated at the Principal Hospital in Dakar between 2002 and 2007. A total of 72 cases were compiled over the 5-year study period. In 88% of cases the patient was a male smoker with a mean age of 59.2 years. Histological samples were obtained in 79.1% of cases by bronchial fibroscopy (n=33), CT-guided transthoracic needle biopsy (n=17), or from a metastatic site (n=7). The histological diagnosis was squamous cell carcinoma in 23 cases, adenocarcinoma in 14, large-cell carcinoma in 17, small-cell lung cancer in 2, and bronchiolo-alveolar cancer in 1. Tumor staging demonstrated grades I-II in 6 cases, grade II in 17, and grade IV in 49. Symptomatic management was performed in 68% of patients. In the remaining cases management consisted of chemotherapy in 22 cases, radiotherapy for pain relief in 5, and surgery in 1. Ten patients were lost from follow-up. Median survival was 7 or 3 months depending on whether or not chemotherapy was performed. The much higher rate of histological diagnosis than in the sub-region is due mainly to the availability of trained personnel with access to bronchial endoscopy and CT-scan needle biopsy since September 2003. Administration of cytotoxins is feasible but the cost is excessive due to the lack of universal health care coverage: two-thirds of cases were abandoned whereas chemotherapy significantly improved median survival by 4 months (p < 0.0001). Prognosis of the disease is poor because management is undertaken at an advanced stage. Lung cancer is a health issue in Dakar, Senegal. It is urgent to develop therapeutic standards adapted to the African socio-economic setting as well as an anti-tobacco prevention policy.

Le cancer bronchique au Senegal

En Afrique; l'incidence du cancer bronchique (CB) est en forte progression. Nous avons realise une analyse prospective des caracteristiques cliniques; therapeutiques et evolutives des CB observes a l'Hopital Principal de Dakar entre 2002 et 2007. En 5 ans; 72 cas ont ete colliges. Dans 88des cas; il s'agit d'un fumeur de sexe masculin; age en moyenne de 59;2 ans. L'histologie est obtenue dans 79;1des cas apres fibroscopie bronchique (n=33); ponction transthoracique scano-guidee (n=17) ou a partir d'un site metastatique (n=7). Il s'agit de 23 carcinomes epidermoides; 14 adenocarcinomes; 17 carcinomes a grandes cellules; 2 CB a petites cellules; 1 cancer bronchiolo-alveolaire. Ces tumeurs se repartissent en 6 stades I-II; 17 stades III et 49 stades IV. La prise en charge est symptomatique pour 68des malades ; dans les autres cas; elle associe : chimiotherapie (n=22); radiotherapie antalgique (n=5); chirurgie (n=1). Dix patients sont perdus de vue. La survie mediane est de 7 mois ou de 3 mois; selon qu'une chimiotherapie est administree ou non. Le taux de confirmation histologique largement superieur aux donnees dans la sous-region illustre l'apport d'une unite d'endoscopie bronchique entrainee et l'acces a la ponction scanno-guidee depuis septembre 2003. L'administration de cytotoxiques est possible mais trop couteuse faute de couverture sociale generalisee : 2/3 des indications sont abandonnees alors que la chimiotherapie ameliore significativement la surviemediane de 4 mois (p0;0001). Le pronostic reste severe car la maladie est prise en charge a un stade avance. Le CB est une realite a Dakar. Il est desormais urgent de promouvoir des standards therapeutiques adaptes au contexte socio-economique africain; et une politique de prevention du tabagisme

[An unusual mediastinal opacity]. / Une opacité médiastinale inhabituelle.

A 36-year old immunocompetent male from Senegal with an uneventful history was admitted for exploration of a bullous collection in the posterior mediastinum. Multifocal tuberculosis was diagnosed. Computed tomography-guided drainage removed 600 cc of caseum. The diagnosis as rupture of intrathoracic Pott's abscess complicated by a probably esophageal fistula. The clinical course was rapidly favorable with later development of mediastinal fibrosis. This uncommon case illustrates the contribution of interventional radiology recently developed in the Principal Hospital in Dakar, Senegal.

[Exercise-induced dyspnea and hilar enlargement]. / Dyspnée d'effort et gros hiles.

We report the case of a 46-year-old man with an uneventful history who was hospitalized for suspected pulmonary embolism. The chest x-ray did not reveal any parenchymatous anomaly but disclosed pseudo-tumoral enlargement of the pulmonary arteries. There was no right ventricular overload at cardiac echography and the pulmonary arterial pressure was normal. Helicoidal angioscan demonstrated aneurismal dilatation of the both pulmonary arteries, complicated by a thrombus on the right. Outcome was favorable with anticoagulation. After ruling out acquired aneurysm, the diagnosis retained was idiopathic aneurysm of the pulmonary arteries.