Stunting is a major risk factor for overweight: results from national surveys in 5 Arab countries.

We analysed data on overweight and stunting from large national surveys performed between 2001 and 2004 in 5 Arab countries (Djibouti, Libyan Arab Jamahiriya, Morocco, Syrian Arab Republic and Yemen). Overweight and stunting were defined according to new WHO growth standards. Overweight ranged from 8.9% in Yemen to 20.2% in Syrian Arab Republic. The risk ratio (RR) for overweight in stunted children ranged from 2.14 in Djibouti to 3.85 in Libyan Arab Jamahiriya. RR ranged from 0.76 in mildly stunted children of Yemen to 7.15 in severely stunted children in Libyan Arab Jamahiriya. Etiological fraction in the population ranged from 7.49% to 69.76%.

The use of body mass index for measurement of fat mass in children is highly dependant on abdominal fat.

We examined the relationship between body fat and body mass index (BMI) in a multiethnic population of obese children. BMI z-scores were compared to DEXA measures of whole body composition and regional fat distribution. Fat mass index (FMI) was best predicted by the equation: 1/[(0.159- 0.013 x percentile of total abdominal fat)- (0.01 x BMI z-score)], where percentile of abdominal fat ranges from 1 to 5. Predicted FMI had high agreement with FMI measured by DEXA. There were no detectable differences in this relation between different ethnic groups. Both BMI and abdominal fat should be used as a proxy to determine adiposity.

The use of body mass index for measurement of fat mass in children is highly dependant on abdominal fat

We examined the relationship between body fat and body mass index [BMI] in a multiethnic population of obese children. BMI z-scores were compared to DEXA measures of whole body composition and regional fat distribution. Fat mass index [FMI] was best predicted by the equation: 1/[[0.159 - 0.013 x percentile of total abdominal fat] - [0.01 x BMI z-score]], where percentile of abdominal fat ranges from 1 to 5. Predicted FMI had high agreement with FMI measured by DEXA. There were no detectable differences in this relation between different ethnic groups. Both BMI and abdominal fat should be used as a proxy to determine adiposity

Stunting is a major risk factor for overweight: results from national surveys in 5 Arab countries

We analysed data on overweight and stunting from large national surveys performed between 2001 and 2004 in 5 Arab countries [Djibouti, Libyan Arab Jamahiriya, Morocco, Syrian Arab Republic and Yemen]. Overweight and stunting were defined according to new WHO growth standards. Overweight ranged from 8.9% in Yemen to 20.2% in Syrian Arab Republic. The risk ratio [RR] for overweight in stunted children ranged from 2.14 in Djibouti to 3.85 in Libyan Arab Jamahiriya. RR ranged from 0.76 in mildly stunted children of Yemen to 7.15 in severely stunted children in Libyan Arab Jamahiriya. Etiological fraction in the population ranged from 7.49% to 69.76%

Essential concepts in modern health services.

Health services have the functions to define community health problems, to identify unmet needs and survey the resources to meet them, to establish SMART objectives, and to project administrative actions to accomplish the purpose of proposed action programs. For maximum efficacy, health systems should rely on newer approaches of management as management-by-objectives, risk-management, and performance management with full and equal participation from professionals and consumers. The public should be well informed about their needs and what is expected from them to improve their health. Inefficient use of budget allocated to health services should be prevented by tools like performance management and clinical governance. Data processed to information and intelligence is needed to deal with changing disease patterns and to encourage policies that could manage with the complex feedback system of health. e-health solutions should be instituted to increase effectiveness and improve efficiency and informing human resources and populations. Suitable legislations should be introduced including those that ensure coordination between different sectors. Competent workforce should be given the opportunity to receive lifetime appropriate adequate training. External continuous evaluation using appropriate indicators is vital. Actions should be done both inside and outside the health sector to monitor changes and overcome constraints.

Libyan National Health Services The Need to Move to Management-by-Objectives.

In the last four decades, there has been a substantial horizontal expansion of health services in Libya. This resulted in improvement in morbidity and mortality, in particularly those related to infectious disease. However, measures such as the national performance gap indicator reveal an underperforming health system. In this article, we discuss aspects related to the Libyan health system and its current status including areas of weakness. Overcoming current failures and further improvement are unlikely to occur spontaneously without proper planning. Defining community health problems, identifying unmet needs, surveying resources to meet them, establishing SMART (specific, measurable, achievable, and realistic and time specific) objectives, and projecting administrative action to accomplish the proposed programs, are a must. The health system should rely on newer approaches such as management-by-objectives and risk-management rather than the prevailing crisis-management attitude.

The French Health Care System; What can We Learn?

All public systems look for the best organizational structure to funnel part of their national income into healthcare services. Appropriate policies may differ widely across country settings. Most healthcare systems fall under one of two broad categories, either Bismark or Beveridge systems. There is no simple ideal model for the organization of health services, but most healthcare systems that follow the Beveridge healthcare model are poor performers. The Libyan Health system is a low responsive, inefficient and underperforming system that lacks goals and/or SMART. (Specific, Measurable, Achievable, Realistic, Time specific) objectives. A look at different organization models in the world would reinforce efforts to reorganize and improve the performance of the Libyan National Healthcare services. The French Health Care System (FHCS) ranked first according to the WHO and the European Health Consumer Powerhouse. The FHCS was described to have a technically efficient, generous healthcare system that provides the best overall health care. This makes the FHCS a practical model of organization having many of the essential aspects of a modern national health service. In this review, we describe the main features of the FHCS, current challenges and future trends with particular attention paid to aspects that could be of importance to the Libyan Healthcare System.

Nutritional Status of Under-Five Children in Libya : a National Population-Based Survey

Aim: To describe the nutritional status of children under-five years of age in Libya. Population and methods: A secondary analysis of data of 5348 children taken from a national representative; two-stage; cluster-sample survey that was performed in 1995. Results: Prevalence rates of underweight; wasting; stunting; and overweight were determined using standard definitions in reference to newly established WHO growth charts. The study revealed that 4.3of children were underweight; 3.7wasted; 20.7stunted; and 16.2overweight. Seventy percent of children had normal weight. Undernutrition was more likely to be found in males; in rural areas; and in under- privileged groups. Overweight was more likely found in urban; privileged groups. Wasting was more common in arid regions; stunting was more common in mountainous regions of Al- Akhdar; Al-Gharbi; and in Sirt. Al-Akhdar had the highest prevalence of overweight. Conclusion: The country had a low prevalence of underweight and wasting; moderate prevalence of stunting; and high prevalence of overweight. The country is in the early stages of transition with evidence of dual-burden in some regions. Similar surveys are needed to verify secular trends of these nutritional problems; particularly overweight

Nutritional Status of Under-five Children in Libya: a National Population-based Survey

Aim: To describe the nutritional status of children under-five years of age in Libya. Population and methods: A secondary analysis of data of 5348 children taken from a national representative; two-stage; cluster-sample survey that was performed in 1995. Results: Prevalence rates of underweight; wasting; stunting; and overweight were determined using standard definitions in reference to newly established WHO growth charts. The study revealed that 4.3of children were underweight; 3.7wasted; 20.7stunted; and 16.2overweight. Seventy percent of children had normal weight. Undernutrition was more likely to be found in males; in rural areas; and in underprivileged groups. Overweight was more likely found in urban; privileged groups. Wasting was more common in arid regions; stunting was more common in mountainous regions of Al-Akhdar; Al-Gharbi; and in Sirt. Al-Akhdar had the highest prevalence of overweight.Conclusion: The country had a low prevalence of underweight and wasting; moderate prevalence of stunting; and high prevalence of overweight. The country is in the early stages of transition with evidence of dual-burden in some regions. Similar surveys are needed to verify secular trends of these nutritional problems; particularly overweight

Human bone marrow-derived mesenchymal stem cells.

Mesenchymal stem cells (MSCs) have elicited a great clinical interest, particularly in the areas of regenerative medicine and induction of tolerance in allogeneic transplantation. Previous reports demonstrated the feasibility of transplanting MSCs, which generates new prospects in cellular therapy. Recently, injection of MSCs induced remission of steroid-resistant acute graft-versus-host disease (GVHD). This review summarizes the knowledge and possible future clinical uses of MSCs.

Systems of analysis of posterior capsule opacification.

This paper demonstrates the wide variety of systems for the analysis of posterior capsular opacification (PCO). No single system has been proved to be a gold standard and it is difficult to comment on the advantages of one system over another with the limited current knowledge on the effects of PCO on vision. There are few studies that actually compare the different systems of analysis. Researchers must ensure that the systems they use for PCO analysis are objective and must give maximum consideration to ensuring potential systematic errors are reduced to a minimum. Further research is required into how the various types and locations of PCO affect vision and how well different systems of analysis perform.

Comparison of two fast strategies, SITA Fast and TOP, for the assessment of visual fields in glaucoma patients.

PURPOSE: To compare two fast threshold strategies of visual field assessment; SITA Fast (HSF) and Tendency Orientated Perimetry (TOP), in detecting visual field loss in patients with glaucoma. METHODS: Seventy-six glaucoma, ocular hypertensive and normal patients had HSF and TOP performed in random order. Quantitative comparisons for the global visual field indices - mean deviation and defect (MD) for HSF and TOP, and pattern standard deviation (PSD) for HSF and loss variance (LV) for TOP - were made using correlation coefficients. Humphrey global parameters were converted to Octopus equivalents, and method comparison analysis was used to determine agreement between the two strategies. Test duration times were compared using t-test. Sensitivity and specificity for these two algorithms were determined according to predetermined criteria. RESULTS: High correlation coefficient values were obtained for MD measurements between HSF and TOP ( r=-0.89, P<0.0005) and for PSD (HSF) and LV (TOP) ( r=0.88, P<0.0005). Following conversion of HSF values to Octopus equivalents the TOP strategy estimated MD to be greater and LV to be less than HSF values, the difference increasing as the magnitude of the defect increased. The mean test duration time was 4.04 (0.87) min for HSF and 2.38 (0.34) min for TOP ( P<0.0005). Sensitivity of diagnostic criteria ranged from 86.4% to 89.2% for HSF and from 84.7% to 85.2% for TOP. Specificity ranged from 80.0% to 93.8% for HSF and from 76.5% to 86.7% for TOP. CONCLUSION: There was a high correlation between the HSF and TOP strategies for measurements of global indices. However, the TOP strategy tended to underestimate focal visual field loss compared with SITA Fast. The TOP strategy was faster than SITA Fast. The sensitivity and specificity of the two algorithms were similar. This study establishes the ability of these fast strategies to successfully assess visual fields in glaucoma patients with perimetric experience.

Bilateral panuveitis: a possible association with Kikuchi-Fujimoto disease.

PURPOSE: To report a case of necrotizing lymphadenitis caused by Kikuchi-Fujimoto disease, which developed bilateral panuveitis. METHODS: A 16-year-old Chinese female with histologically proven Kikuchi-Fujimoto disease developed bilateral panuveitis 2 years after the onset of lymphadenopathy. RESULTS: Bilateral panuveitis was successfully treated with topical steroid. Serologic investigations were positive for Epstein-Barr virus antibodies and antinuclear antibodies, but no evidence of systemic disease or other causes of ocular inflammation was found. CONCLUSION: Kikuchi-Fujimoto disease may be associated with intraocular inflammation.

Marginal keratitis: an uncommon form of topical dorzolamide allergy.

PURPOSE: To report a case of marginal keratitis resulting from topical dorzolamide hypersensitivity. METHOD: Case report. RESULTS: A 68-year-old woman presented with bilateral marginal keratitis 2 weeks after commencing bilateral topical dorzolamide. One week after discontinuation of topical dorzolamide, the patient was asymptomatic with complete resolution of corneal infiltrates. CONCLUSIONS: Topical dorzolamide may cause a hypersensitivity reaction in the form of marginal keratitis. Discontinuation of the offending medication should result in complete resolution.

Evidence of cognitive visual problems in children with hydrocephalus: a structured clinical history-taking strategy.

Damage to the occipital cortex in children can result in many complex disorders of cognitive visual function. A series of clinical questions, developed from the specific problems of a cohort of children with cortical visual impairment, was asked of the parents of 200 children with no history of cerebral pathology, aged 5 to 12 years. One hundred and ninety-two parents gave reliable consistent responses. The results show a progressive improvement in performance with age, culminating in few 11- and 12-year olds having frequent problems, apart from 8% having frequent difficulty with orientation in new surroundings and 2% having problems with simultaneous perception tasks. The parents of 52 children (aged 5 to 17 years) with shunted hydrocephalus were then asked the same set of questions. Evidence of cognitive visual problems was identified in 27 of these children of whom 16 manifested multiple difficulties. The disabilities identified by our study comprised problems with: shape recognition, simultaneous perception, perception of movement, colour perception, orientation, object recognition, and face recognition. The range, nature, and combinations of these disorders are presented in this paper.