Assessment of knowledge, attitudes and practices of expectant mothers in relation to antenatal care in Assiut governorate.

This study aims to assess knowledge, attitudes and practices of expectant mothers in relation to ante-natal care in Assiut and to find out factors affecting their knowledge. Attitudes and practices. The present study was carried out in the ante-natal clinic at Assiut General Hospital and three Maternal and Child Health Centers in Assiut. Fifty women were selected from each of the previously mentioned settings. A specially designed interview sheet was used to collect the necessary data. It was consisted of four parts. The first part included questions related to individual features of women, the second part included questions related to their family features, the third part concerned with previous obstetrical history of women and their acceptance of pregnancy and the fourth part included questions related to knowledge, attitudes and practices of expectant mother in relation to ante-natal care. The findings of the present study revealed that one quarter of the study sample (25.5%) lacked basic and essential knowledge about ante-natal care, most of older women (88.2%) were more likely to have poor knowledge in relation to ante-natal care, the higher educated women (66.7%) were more likely to have good knowledge about ante-natal care compared to 33.5% of lower educated women. It was also observed that the majority of working women (90%) were more likely to have good ante-natal care knowledge compared to housewives (10%). Most of the primigravida women (88.2%) were more likely to have poor knowledge in relation to ante-natal care compared to 11.8% of women whose gravidity was less than 5.

PIP: In Assiut governate, Egypt, interviews were conducted with 200 randomly selected pregnant women attending prenatal clinics at the maternal and child health (MCH) centers in Kolta, Gharb El-Balad, and Arnoub and at Assiut General Hospital to determine their knowledge, attitudes, and practices as they relate to prenatal care. 30.5% reported prenatal care to be important for health promotion for mother and fetus. 20% did not know that prenatal care is important to maternal and fetal well-being. Time of first prenatal visit was for 21% the 1st trimester, for 35% the 2nd trimester, and for 33.5% the 3rd trimester. 34.5% attended 1 prenatal visit each month. 52% had less than 8 visits during their pregnancy. 13.5% had more than 8 visits. 25.5% knew little about the significance of prenatal care. Only 17.5% knew the significance of a well-balanced diet during pregnancy. 42% added some foods to their diet and increased their food intake. 39.5% eliminated fatty, greasy, and highly spiced foods from their diet. 32.5% understood the objectives and reasons for bathing during pregnancy. 50% considered a daily bath to be essential during pregnancy. Only 18% understood the objectives of breast care during pregnancy. 65% did not seek dental care during pregnancy. Factors associated with seeking prenatal care included: younger than 30, higher education, gravidity less than 5 and greater than 0, and working outside the home (p 0.05 for each factor). Recommended ways nurses can encourage pregnant women to seek prenatal care include education via mass media, home visits, improved quality of prenatal care, screening for high-risk women, increased number of MCH centers and prenatal clinics in rural areas, and adequate supply of medication, supplies, and equipment in these facilities.

Case report: inflammatory bronchial flap and 'check valve' bronchial obstruction.

The authors report the case of a patient in whom check valve bronchial obstruction was the result of an inflamed bronchial mucosal flap. Bronchoscopic examination showed that the mucosal flap opened with inspiration and closed with expiration. Protective brush and semiquantitative bronchoalveolar lavage cultures grew Staphylococcus aureus and Pseudomonas spp. An inflammatory mucosal flap and check valve bronchiolar obstruction has been described previously in only one patient and this was on postmortem examination.

Fibroproliferative phase of ARDS. Clinical findings and effects of corticosteroids.

Most patients with adult respiratory distress syndrome (ARDS) survive the initial insult which caused respiratory failure only to succumb later to sepsis caused by nosocomial pneumonia or to pulmonary fibrosis. Clinical criteria and analysis of the tracheal aspirate are notoriously inadequate for establishing a diagnosis of ventilator-associated pneumonia. We implemented a comprehensive diagnostic protocol to determine the cause of sepsis in ARDS patients who had been ventilated for more than three days and who had no bronchoscopic evidence of pneumonia. Nine patients with late ARDS who had fever (89 percent), leukocytosis (89 percent), a new localized infiltrate (78 percent), purulent tracheal secretions (89 percent), low systemic vascular resistance (50 percent), and marked uptake of gallium in the lungs (100 percent) had no source of infection identified. Open-lung biopsy specimens from seven patients showed the fibroproliferative phase of diffuse alveolar damage and confirmed absence of pneumonia. Treatment with prolonged high doses of corticosteroids was associated with a marked and rapid improvement in lung injury score (p less than 0.003 at five days). Our findings indicate that the fibroproliferative process occurring in the lungs of patients with late ARDS gives rise to clinical manifestations identical to those of pneumonia and is potentially responsive to steroid treatment.

Small cell carcinoma of the cervix: a clinical and flow-cytometric study.

The clinical course of 14 patients diagnosed with small cell carcinoma of the cervix (SCC) was reviewed and compared to that of 37 cases of undifferentiated large cell nonkeratonizing carcinoma (LCNK). We observed the following differences between the two: SCC patients had a higher incidence of pelvic wall involvement and distant metastasis; the development of progressive disease was more frequent in SCC than in LCNK patients; median survival time was 9 months in SCC and 40 months in LCNK patients; flow cytometry revealed aneuploidy in all SCC and in 30% of the LCNK patients; the mean DNA index was 2.24 in SCC, significantly higher than in LCNK (1.15). DNA index in cases of SCC was related to survival time. SCC of the cervix is an extremely aggressive tumor, even when compared to other undifferentiated cervical cancers. Aneuploidy is a consistent feature and thus helpful for diagnosis. Due to the wide range of values, the DNA index cannot be used for diagnostic purposes, but it is of prognostic importance in SCC cases.

Significant changes in the distribution of histologic types of lung cancer. A review of 4928 cases.

The histopathologic data for lung carcinoma were reviewed in 4928 patients between 1964 and 1985. The analysis of this data indicates that lung cancer is increasing in our region. Squamous carcinoma remains the most frequent type in men, followed by adenocarcinoma. Small cell carcinoma is the second most frequent type in women, after adenocarcinoma. Small cell carcinoma has increased over the past years and may become the most common type of lung cancer in women, a development that might result in increased numbers of deaths. Lung cancer data must be carefully analyzed in view of the impact on selection of therapy, patient management, and education.

Uterine arteriovenous fistula. A case report.

Arteriovenous malformation of the uterus is rare. It is potentially lethal because profuse, uncontrollable bleeding may occur with diagnostic dilatation and curettage. Several cases of localized uterine arteriovenous malformation have been reported on. The condition should be considered during routine vaginal examination with pulsation and thrill in the vaginal fornices, even if there is a normal menstrual history, as in our patient. In our patient, pathologic examination of the uterus demonstrated for the first time an extensive, diffuse, tortuous arteriovenous anastomosis extending from the upper uterine segment down to the stroma of the exocervix. In such cases a thorough clinical and (if indicated) radiologic evaluation should be done before curettage, or even cone biopsy, to avoid possible massive hemorrhage.

Collagenase activity in rabbit carcinoma: cell source and cell interactions.

Fibroblast-like cells (F-cells) and epithelial-like (E-cells) derived from cultures of rabbit VX-2 carcinoma released collagenase in both active and latent forms in serum-free medium at a level higher than that of normal rabbit fibroblast cultures. The enhanced capacity of the F-cells to release the enzyme, however, continued only for a few passages and then decreased significantly to a low level similar to that of the normal fibroblasts. The enzyme-release by the E-cells continued for a few more passages at a relatively moderate level, higher than that of normal fibroblasts. The release of collagenase in cultures of F-cells was enhanced by the presence of E-cells in mixed cultures as well as by medium conditioned by the E-cells type. Addition of cytochalasin B at 2 micrograms/ml did not significantly effect the enzyme activity released in the cultures. Serum from tumor-bearing rabbits appeared to stimulate the release of enzyme activity in cultures of either cell type.

Separation of VX-2 rabbit carcinoma-derived cells capable of releasing collagenase.

Primary and secondary cultures of VX-2 carcinoma produced high levels of collagenase activity in both active and latent forms in serum-free media. These cultures appeared morphologically heterogeneous in phase-contrast microscopy and revealed the presence of mainly three distinct forms: epithelial-like cells (E cells), fibroblast-like cells (F cells), and large rounded-flat cells which may represent a subclass of the F cells. Cell separation techniques such as brief dispase treatment, Percoll gradient centrifugation, thimerosal treatment, and rabbit serum were used to obtain predominantly one form or the other. The E cells never formed a monolayer but rather grew as limited size clusters of intimately associated cells with large nuclei and often appeared multinucleated. These cells were difficult to maintain in culture or serially passed more than a few times. The F cells, rare in early cultures but having the highest growth potential, appeared in various morphological forms ranging from spindle- to stellate-shaped cells. The cells in their third passage were capable of producing palpable tumors, similar in light and electron microscopic studies to the original tumor from which they were derived, when injected intramuscularly into recipient rabbits and produced specific collagenase activity in active and latent forms in serum-free media. Ultrastructural studies suggested that the E cells were of epithelial origin whereas the F cells were similar to stromal fibroblasts. Cytogenetic studies demonstrated that almost all of the E cells showed both numerical and structural chromosomal changes in a modal number of 54 chromosomes. On the other hand, the major cell population of the F cells resembled normal rabbit fibroblasts; both contained a normal diploid (2n = 44). However, few cells (4-6%) in the F-cell population were hyperdiploid with a modal chromosome number of 54. These cells may represent inadvertent contaminating E cells and account for the apparent limited turmorigenicity observed in early F-cell cultures. The data suggested that the E cells were of tumor origin whereas the majority of the F-cell population appeared to be of host origin. Furthermore, it is suggested that the E cells stimulate tumor-associated stromal cells to produce elevated levels of collagenolytic activity and contribute to collagen degradation during tumor invasion.