Ceftazidime-Avibactam plus aztreonam synergistic combination tested against carbapenem-resistant Enterobacterales characterized phenotypically and genotypically: a glimmer of hope

BACKGROUND

Carbapenemase-producing Enterobacterales (CPE) show rapid global dissemination and pose a significant therapeutic challenge. This study aimed to characterize carbapenemase-producing Klebsiella spp. and Escherichia coli (E. coli) phenotypically and genotypically and evaluate the effect of ceftazidime/ avibactam plus aztreonam combination.

METHODS

A total of 219 Klebsiella species and 390 E. coli strains were isolated from clinical samples, in which 80 Klebsiella spp. and 20 E coli isolates were resistant to tested carbapenems (imipenem, ertapenem, meropenem) by disk diffusion/broth dilution method and Vitek-2 compact system. MASTDISCS Combi Carba plus discs and real time PCR were used to determine type of carbapenemase phenotypically and genotypically, respectively. Interestingly, the synergistic effect between ceftazidime-avibactam (E-test) and aztreonam (disc) was tested against the CPE isolates.

RESULTS

Out of the carbapenem-resistant isolates, 76.25% Klebsiella spp. isolates were extensively drug-resistant (XDR) while 18.75% were pan drug-resistant (PDR), and 5% were multidrug-resistant (MDR). Regarding E. coli, 5% were PDR, 20% were MDR and 75% were XDR. More than one carbapenemase gene was detected in 99% of the isolates. In comparison between MAST-Carba plus discs and PCR results, sensitivity and specificity were (85.42-97.92%) in Klebsiella spp., and (69.64-100%) in E. coli, respectively. Moreover, a strong association was detected between both test results among Klebsiella spp. (p < 0.001) and E. coli (p = 0.012) isolates. Finally, ceftazidime-avibactam and aztreonam combination showed a synergistic effect in 98.8% of Klebsiella spp. and 95% of E coli. All 16 PDR isolates showed synergy.

CONCLUSION

This synergistic effect spots the light on new therapeutics for XDR and PDR CPE.

Prevalence of trimethoprim/sulfamethoxazole resistance genes among Stenotrophomonas maltophilia clinical isolates in Egypt

Stenotrophomonas maltophilia is an important multidrug resistant nosocomial pathogen. Trimethoprim/sulfamethoxazole (TMP/SMX) is considered the drug of choice for treatment of S. maltophilia infections, thus emerging resistance to TMP/SMX poses a serious threat. In the present study we aimed to investigate the frequency of TMP/SMX resistance genes (sul1, sul2, dfrA), and to evaluate their relatedness with integron 1 (int1), and insertion sequence common regions (ISCR) among 100 S. maltophilia from different clinical isolates in Egypt. Isolates were identified biochemically and confirmed by VITEK2. Detection of sul1, sul2, and dfrA genes, int1 and ISCR elements was performed by PCR. Among the 16 TMP/SMX resistant isolates, sul1 gene was detected in all of them, and it was associated with int1 gene presence in all resistant isolates. The sul2 gene was detected in 6 out of 16 resistant isolates (37.5%), and only 2 of the 16 resistant isolates (12.5%) harboured dfrA gene. ISCR was detected in 10 of the resistant isolates (62.5%) and in 4 of them it was associated with the presence of sul2 gene. Among the 84 TMP/SMX sensitive isolates, sul1 gene was detected in 15 (17.8%), int1 in 16 (19%) and ISCR in 6 (7.1%). None of the susceptible isolates had sul2 or dfrA genes. These findings point out an increasing frequency of TMP/SMX resistance genes among S. maltophilia clinical isolates in our region, so the adoption of prudent use of S. maltophilia antimicrobial agents and the establishment of a surveillance system are desperately needed.

Data, Social Determinants, and Better Decision-making for Health: the 3-D Commission

More than a decade after the World Health Organization Commission on the Social Determinants of Health (SDoH), it is becoming widely accepted that social and economic factors, including but not limited to education, energy, income, race, ethnicity, and housing, are important drivers of health in populations. Despite this understanding, in most contexts, social determinants are not central to local, national, or global decision-making. Greater clarity in conceptualizing social determinants, and more specificity in measuring them, can move us forward towards better incorporating social determinants in decision-making for health. In this paper, first, we summarize the evolution of the social framing of health. Second, we describe how the social determinants are conceptualized and contextualized differently at the global, national, and local levels. With this, we seek to demonstrate the importance of analyzing and understanding SDoH relative to the contexts in which they are experienced. Third, we problematize the gap in data across contexts on different dimensions of social determinants and describe data that could be curated to better understand the influence of social determinants at the local and national levels. Fourth, we describe the necessity of using data to understand social determinants and inform decision-making to improve health. Our overall goal is to provide a path for our collective understanding of the foundational causes of health, facilitated by advances in data access and quality, and realized through improved decision-making.

Proposal of a Hybrid Optical Double Ring Resonator for Cancer Biosensing

A new design for a silicon-on-insulator (SOI) optical biosensor is proposed in the form of a hybrid double-ring resonator. The proposed device improves the sensitivity by 2.4 times compared with the traditional devices.

Investigation of a dynamic measurement methodology for fast detection of gross defects in regularly distributed nuclear material samples

Non-Destructive Assay (NDA) techniques are widely used to verify Nuclear Materials (NM). Most of these techniques are static ones for which, the measuring device and the assayed samples are located at fixed positions during measurements. While assaying regularly distributed NM, attenuation and screening effects may contribute negatively to the accuracy of the results, especially for relatively high density materials. Another factor that may affect the accuracy is the allowable time of measurement. Detection of gross defects in such materials could be achieved more accurately and much faster by employing dynamic measurements. In this work, an investigation for a proposed Non-Destructive Dynamic (NDD) measuring system is presented. The system is assumed to detect gross defects in nuclear fuel assemblies of EK-10 type more accurately and faster than other traditional systems based on static measurements. Different scenarios were considered and studied using the MCNP5 Code. The results showed that the investigated method could be easily applied to detect gross defects in regularly-distributed NM samples.

Assessment of hepatitis B immunization programme among school students in Qatar

Background

In 2010, Qatar adopted the target of reducing hepatitis B prevalence to < 1% in children by 2015. The World Health Organization Region for the Eastern Mediterranean is identified with intermediate hepatitis B virus (HBV) endemicity, ranging from 2% to 7%. It is estimated that 4.3 million individuals are living with HBV infection in the Region.

Aims

This study was conducted to assess hepatitis B seroprevalence in children, hepatitis B vaccination coverage, potential exposure to risk factors, and knowledge among parents/guardians about hepatitis B infection.

Methods

We carried out this cross-sectional study in Qatar during the academic year 2015/16. Multistage cluster sampling was used to select a nationally representative sample of 2735 grade 1 school students aged ≥ 5 years. Blood was collected by finger prick and tested using the point-of-care test/rapid test. A self-administered, precoded questionnaire was used to assess parent/guardian knowledge about HBV and collect information on the child's HBV vaccination coverage.

Results

All blood samples were HBsAg negative. Qataris had a vaccination card and were totally vaccinated but 17.7% of non-Qataris did not hold a vaccination card and most parents/guardians were not aware of the vaccination status of their children. Children were exposed to various hepatitis B risk practices. Knowledge about hepatitis B among parents/ guardians was low.

Conclusions

Qatar has averted the hepatitis B threat and maintained high vaccination coverage for children.

Measuring Geographic and Wealth Inequalities in Health Distribution as Tools for Identifying Priority Health Inequalities and the Underprivileged Populations

Background

Currently, there is no consensus on standard measure that can be routinely part of the health information systems to alert countries to inequalities in health and identify the priority health inequality conditions.

Objectives

To identify the health inequality measures relevant for assessing geographic and wealth inequalities; use the measures as a demonstration to what can happen in practice to recognize the geographic and wealth-related priority health inequalities within a country; and identify the geographic and wealth underprivileged populations.

Method

Egypt data were used as demonstration. Pearson coefficient of correlation was calculated to compare the various geographic and wealth health inequality measures. T test was used to identify significant correlations. The relevant inequality measures were used to rank geographic and wealth health inequalities and identify the underprivileged populations.

Results

The wealth inequalities in health measured by the concentration index provide a familiar and perform adequately in identifying economic inequalities in health. However, the geographic health inequalities identified by the index of dissimilarity appear to provide a more comprehensive profile of health inequalities within a country.

Conclusion

There is a need for a feasible inequality measure in the health information systems. A country’s geographic health distribution measured by the index of dissimilarity appears to provide a feasible first-step alarm to inform and guide the uptake of equity-sensitive policies.

Enhancing ex vivo expansion of cord blood-derived unrestricted somatic stem cells for clinical applications

OBJECTIVES

To study effects of serum-containing medium (SCM) versus serum-free medium (SFM) and influence of seeding density, on rate of expansion of cord blood (CB) unrestricted somatic stem cells (USSCs), as a prerequisite for evaluating their therapeutic potential in ongoing clinical trials.

MATERIAL AND METHODS

Isolation, propagation and characterization of USSCs from CB samples were performed and followed by their passage 3 culture in SCM and SFM, at cell densities of 5, 50, 500 and 5000 cells/cm(2) .

RESULTS

The cells were CD44(+) , CD90(+) , CD73(+) , CD105(+) , CD34(-) , CD45(-) , and HLA-DR, with Oct4 & Sox2 gene expression; they were differentiated into osteoblasts and adipocytes. USSCs cultured in SCM had significantly higher population doubling levels (P < 0.01) than those cultured in SFM. Those cultured in SCM at 5 cells/cm(2) and those cultured in SFM at 50 cells/cm(2) had significantly higher population doubling (P < 0.01) levels than those cultured at higher cell densities.

CONCLUSIONS

For scaling up of USSCs from 106 (?) to 1012 (?) in 6 weeks, culturing of CB-derived cells of early passage (≤P3) in SCM at low cell seeding density (5 cells/cm(2) ) is suggested for increasing cell count with lower passaging frequency, followed by culture of expanded USSCs at 50 cells/cm(2) in SFM, to avoid undesirable effects of bovine serum in clinical applications.

Primary health care in the Eastern Mediterranean Region: from Alma-Ata to Doha

The celebration in Doha of the 30th anniversary of the Alma-Ata Declaration at the International Conference on Primary Health Care renewed the commitment of the Eastern Mediterranean Region to primary health care as the tool for better health. The principles agreed at Alma-Ata in 1978 apply as much now as they did before. The event provided an opportunity for the Eastern Mediterranean countries to define future directions to steer the health systems to integrate primary health care and harness the intersectoral approach.

Could the employment-based targeting approach serve Egypt in moving towards a social health insurance model?

The current health insurance system in Egypt targets the productive population through an employment-based scheme bounded by a cost ceiling and focusing on curative care. Egypt Social Contract Survey data from 2005 were used to evaluate the impact of the employment-based scheme on health system accessibility and financing. Only 22.8% of the population in the productive age range (19-59 years) benefited from any health insurance scheme. The employment-based scheme covered 39.3% of the working population and was skewed towards urban areas, older people, females and the wealthier. It did not increase service utilization, but reduced out-of-pocket expenditure. Egypt should blend all health insurance schemes and adopt an innovative approach to reach universal coverage.

Impact of a service provider incentive payment scheme on quality of reproductive and child-health services in Egypt

A case-control, quasi-experimental study was designed (post-test only) to investigate the effect of a performance-based incentive payment scheme on behaviours of public-sector service providers in delivering a basic package of maternal and child-health services in Egyptian primary healthcare units. The results showed significant improvements in the quality of family-planning, antenatal care, and child-care services as reported by women seen in clinics where the incentive payment scheme was in operation as measured by various indicators, including both technical and inter-personal communication content. An analysis of characteristics of the service providers and clients found no significant or meaningful differences between the study groups, and the facilities of both the study groups were essentially the same. Some findings are suggestive of other influences on behaviours of the service providers not captured by the data-collection instruments of the study. Subsequent to this study, the payment scheme has been rolled out to other districts in Egypt.

Evaluation of liver biopsy in Egyptian HBeAg-negative chronic hepatitis B patients at initial presentation: implications for therapy

OBJECTIVES

A subgroup of HBeAg-negative chronic hepatitis B (CHB) patients with alanine aminotransferase (ALT) and/or hepatitis B virus (HBV)-DNA levels below the cutoff values of international guidelines may have significant liver disease and miss the opportunity for early treatment. Histopathological changes of HBeAg-negative CHB patients at initial presentation irrespective of HBV-DNA and/or ALT levels to increase the likelihood of patients for treatment are evaluated.

METHODS

CHB patients attending Cairo Liver Center from January 2006 to May 2008 had biochemical, serological, and virological screening as well as liver biopsy that was assessed by Metavir score.

RESULTS

Fifty-two HBeAg-negative CHB patients (46 male and 6 female) with a median age of 37.5 years were included in the study. Significant fibrosis (>or=F2) was found in 26% (5/19) of patients with serum HBV-DNA <2,000 IU/ml, and 53% (21/40) of patients with ALT level <2xULN. Liver biopsy increased candidacy for treatment by nearly 25% before implementation of the recommended lower ALT levels (30 U/l for male and 19 U/l for female patients), and by 21.2% after implementation of the lower ALT level. Implementation of the lower ALT level increased the candidacy of patients for treatment by 4% (two patients), whereas liver biopsy increased eligibility for treatment by 55.8 % (27/49).

CONCLUSIONS

Liver biopsy is more reliable than either ALT or HBV-DNA levels in the decision to treat Egyptian HBeAg-negative CHB patients, even with the implementation of the recommended lower ALT levels.

Hepatocellular carcinoma in Egypt: A single center study over a decade

AIM: To identify the trend, possible risk factors and any pattern change of hepatocellular carcinoma (HCC) in Egypt over a decade.

METHODS: All HCC patients attending Cairo Liver Center between January 1993 and December 2002, were enrolled in the study. Diagnosis of HCC was based on histopathological examination and/or detection of hepatic focal lesions by two imaging techniques plus α-fetoprotein level above 200 ng/mL. The duration of the study was divided into two periods of 5 years each; period I (1993-1997) and period II (1998-2002). Trend, demographic features of patients (age, gender, and residence), risk factors (HBsAg, HCV-Ab, schistosomiasis and others) and pattern of the focal lesions were compared between the two periods. Logistic regression model was fitted to calculate the adjusted odds ratios for the potential risk factors. The population attributable risk percentage was calculated to estimate the proportion of HCC attributed to hepatitis B and C viral infections.

RESULTS: Over a decade, 1 328 HCC patients out of 22 450 chronic liver disease (CLD) patients were diagnosed with an overall proportion of 5.9%. The annual proportion of HCC showed a significant rising trend from 4.0% in 1993 to 7.2% in 2002 (P = 0.000). A significant increase in male proportion from 82.5% to 87.6% (P = 0.009); M/F from 5:1 to 7:1 and a slight increase of the predominant age group (40-59 years) from 62.6% to 66.8% (P = 0.387) in periods I and II respectively, reflecting a shift to younger age group. In the bivariate analysis, HCC was significantly higher in rural residents, patients with history of schistoso-miasis and/or blood transfusion. Yet, after adjustment, these variables did not have a significant risk for development of HCC. There was a significant decline of HBsAg from 38.6% to 20.5% (P = 0.000), and a slight increase of HCV-Ab from 85.6% to 87.9% in periods I and II respectively. HBV conferred a higher risk to develop HCC more than HCV in period I (OR 1.9 vs 1.6) and period II (OR 2.7 vs 2.0), but the relative contribution of HBV for development of HCC declined in period II compared to period I (PAR% 4.2%, 21.32%). At presentation, diagnostic α-fetoprotein level (≥200 ng/mL) was demonstrated in 15.6% vs 28.9% and small HCC (≤3 cm) represented 14.9% vs 22.7% (P = 0.0002) in periods I and II respectively.

CONCLUSION: Over a decade, there was nearly a twofold increase of the proportion of HCC among CLD patients in Egypt with a significant decline of HBV and slight increase of HCV as risk factors. α-Fetoprotein played a limited role in diagnosis of HCC, compared to imaging techniques. Increased detection of small lesions at presentation reflects increased awareness of the condition.

Causes of death in the Eastern Mediterranean Region during the years 1998-2000

OBJECTIVE

This paper aims to consider the available mortality data as an insight to epitomize the mortality pattern and the main leading causes of death specific to the Easter Mediterranean Region (EMR) in order to set priorities for future research in the region.

METHODS

Data was taken from the last 3 World Health Organization (WHO) mortality statistics. Crude mortality rates were compared between the 6 WHO regions for the years 1998, 1999 and 2000. Proportional mortality and standardized proportional mortality ratios were calculated for the causes of death and types of malignant neoplasm deaths and compared between the EMR and the other regions of the world. Spearman coefficient rank-order correlation was calculated to detect significant correlation between the ranking of the main causes of death in EMR and the 3 basic demographic, socio-economic and health care indicators in the 6 regions of the world.

RESULTS

The results of this study showed that approximately 9 per 1,000 of the world's population die annually. Africa and Europe have the highest mortality rates. The main causes of death worldwide are cardiovascular diseases, infectious or parasitic diseases, malignant neoplasm, infectious respiratory diseases and other respiratory diseases. In EMR, approximately 8 per 1,000 die annually. The causes of death in EMR can be classified into 3 categories. 1) Non-prominent in EMR as compared to other regions of the world. 2) Prominent in EMR and significantly correlated to the basic indicators. 3) Prominent in EMR but not related to the basic indicators. These include deaths due to wars, congenital anomalies, perinatal conditions, genitourinary diseases, endocrine disorders, road traffic accidents, cancer bladder, lymphoma leukemia

CONCLUSION

The results of this study emerged the need for extensive epidemiological studies to investigate thoroughly the main causes of death influencing mortality in EMR, specially that they coincide with the health consequences of depleted uranium. Also, most of these health conditions were previously described among the United States and European veterans who served in the Gulf War.

Maternal factors associated with the duration of breast feeding in Jeddah, Saudi Arabia

Recently, there has been increasing concern about the decline in breast-feeding pattern in developing countries. The objectives of this study were to document the recent breast-feeding trends in Jeddah during the first year of an infant's life and identify the probable maternal risk factors implicated in breast-feeding cessation. Data were collected from six randomly selected primary health care centres in Jeddah City. All married women with an infant </= 12 completed months of age were interviewed, and information on socio-demographic characteristics, breast feeding and contraceptive use were collected. Cox proportional hazard regression model was used to calculate the adjusted odds ratios for the various maternal risk factors related to breast-feeding cessation. A total of 400 women were enrolled in the study. Their mean age at delivery was 28.0 years (SD = 4.1 years). Approximately 40.0% had never attended school, 43.0% had at least five children and 13.8% were smokers. Deliveries by caesarean section were reported by 13.0% of women and contraceptive use by 44.7%, among whom oral contraceptives were the commonest method. Around 94.0% of women ever initially breast fed their infants, and this proportion dropped to 40.0% by the infant's 12th month. Women who delivered by caesarean section (OR = 1.9 [95% CI 1.3, 2.8]P = 0.001) and those who used oral contraceptives (OR = 1.5 [95% CI 1.1, 2.2]P = 0.031) were at higher risk of stopping breast feeding and lower probability of maintaining breast feeding to the 12th month post partum than those who delivered vaginally and did not use oral contraceptives. Breast-feeding practice seems to decline rapidly during the first year of the infant's life. Health care professionals should promote breast-feeding practice as early as the antenatal period. They should also take into consideration the impact of caesarean section deliveries and early oral contraceptive use to avoid their negative impact on breast-feeding practice.

Prevalence of daily breakfast intake, iron deficiency anaemia and awareness of being anaemic among Saudi school students

Iron deficiency anaemia is one of most prevalent nutritional disorders worldwide. It is known to affect the health and cognitive ability of children and adolescents. Studies in Saudi Arabia concentrate only on the population of young children and pregnant females or girls. Studies on the whole school student population is lacking. The objectives of this study were to identify the nutritional habits and the prevalence of anaemia among school students in Jeddah, as well as to recognize the students' awareness of their anaemic nutritional status. Data were collected from a sample of Saudi school children in Jeddah City from 42 boys' and 42 girls' schools during the month of April 2000. Data collection was done by an in-person interview to collect socio-demographic factors, nutritional habits, weight and height. Haemoglobin was measured in a sample of 800 students selected at random from both genders and different age groups. Anaemia was defined according to the new WHO cut-off levels for haemoglobin as: blood haemoglobin <11.5 g/dl for the 5-11 years boys and girls; <12.0 g/dl for 12-14 years boys and girls; <12.0 g/dl for 15+ girls and <13.0 g/dl for 15+ years boys. Proportion and 95% confidence intervals (CI) were calculated and significance was considered when the 95% CI did not overlap. Anaemia was reported among 20.5% of school students. Anaemia was more prevalent among students of at least 12 years as compared to the younger age group. Also, anaemia was more marked among governmental school attendees and those born to low-educated mothers. Menstruating girls were at around double the risk of being anaemic than non-menstruating girls. Anaemia was associated with negative impact on school performance and was more marked among those who failed their exams as compared to students with excellent results. Skipping breakfast was reported by 14.9% of students and this habit did not differ by age, sex, body mass index or social class. Skipping breakfast was more marked among students with poor school performance as compared to those with very good or excellent results. Only 34.1% of anaemic school students were aware of being anaemic. Awareness was nearly equal in all age groups and social classes but girls were more aware of their anaemic status than boys. Iron deficiency anaemia appears to be prevalent among school students. At age 12 years and over, low social class and menstruating girls constitute the high-risk groups. Screening is recommended for high-risk groups and school health programs are crucial to improve students' nutritional habits, knowledge and awareness.

Comparison between body mass index, triceps skin fold thickness and mid-arm muscle circumference in Saudi adolescents

INTRODUCTION

Adolescence is an important period in an individualâs life. Overweight and obesity are fraught with several health problems even later in life. The objective of this study was to estimate the overweight, obesity, body fat and muscle content of Saudi adolescents as compared to a recognized reference population.

SUBJECTS AND METHODS

Data were collected from a sample of Saudi adolescents in Jeddah from 42 boys' and 42 girls' schools during the month of April 2000. Data collection was done by personal interviews to collect sociodemographic factors and by direct measurement of weight, height, triceps skin fold thickness (TSF) and mid-arm circumference (MAC). The 50th, 85th, and 95th percentiles (P50, P85 and P95) for body mass index (BMI) and triceps skin fold thickness (TSF) were taken, then the 50th, 90th, and 95th percentiles (P50, P90 and P95) for the mid-arm muscle circumference (MAMC) were calculated. These measurements were compared with corresponding values of the National Health and Nutrition Examination Survey I (NHANES I).

RESULTS

The P85 and P95 for BMI and TSF were higher for Saudi adolescents than the NHANES I and the difference was wider for P95. Conversely, there was a lower MAMC at P90 and P95 than the NHANES I reference population curves. The lower MAMC curves were less marked in girls than in boys. On the other hand, Saudi boys and girls showed on average similar body mass index indicated by BMI at P50, which was misleading, since those adolescents showing similar body mass index had more fatness than the average reference population indicated by TSF at P50, and less muscularity on average than reference population indicated by MAMC at P50.

CONCLUSION

Overweight and obesity with increased body fat content and decreased body muscle content appear to be widespread among Saudi adolescents even among those adolescents showing average body mass index. Public health interventions are required to improve quality of food, encourage physical activity and exercise, as well as correct the perception of appropriate body stature.

Perception of body weight among saudi school children

OBJECTIVES

The objectives of this study were to explore the perception of body weight among students in schools in Jeddah City and identify the main determinants of self-perceived obesity, weight management goals and practices.

MATERIAL AND METHODS

Data were collected from a sample of Saudi school children of 42 boys' and 42 girls' schools in Jeddah city during the month of April 2000. Personal interviews were conducted to collect data on socio-demographic factors, food choices, perception of body weight, weight management goals and weight management practices, as well as the actual measurement of weight and height. Students were asked about their perception of their body weight [responses included: very underweight (thin), slightly underweight, about right weight, slightly overweight and grossly overweight (obese)]. Proportion, prevalence and 95% confidence intervals were calculated. Multiple logistic regression models were fitted to calculate the adjusted odds ratio (OR) for an attempt to lose weight and weight management practices.

RESULTS

The distribution of self-perception of body size was nearly similar to the measured body mass index (BMI) classification except for the overweight students, where 21.3% perceived themselves, as slightly overweight and 5.5% as very overweight although 13.4% were actually overweight and 13.5% were obese by BMI standards. Approximately half the students took at least 3 pieces of fruit or fruit juice servings, and a third ate at least 4 vegetable servings per day. A third of the students managed to lose weight. This coincides with the proportion of those actually overweight and obese. Around 28.0% of the students ate less food, fat or calories, 31.0% took exercise and 17.6% were engaged in vigorous exercise to lose weight or prevent weight gain. Staying for at least 24 hours without food which is a potentially harmful means of weight control was practiced by 10.0% of students. Females were less likely than males to be overweight and obese but more likely to perceive themselves as grossly overweight and more likely to try to lose weight. Factors associated with efforts to lose weight by eating less fat or fewer calories were older age, high social class, being actually obese and perceiving oneself as being obese. Staying for at least 24 hours without eating was mainly practiced by females, older age groups, and the actually obese. Exercise was done mainly by the older age groups, those with educated and highly educated mothers, obese and perceiving oneself as being obese. Vigorous exercise was mainly performed by males, younger age groups, taking < 3 pieces of fruit or fruit juice servings per day, eating < 4 vegetable servings per day, and those perceiving themselves as obese.

CONCLUSION

Overweight and obesity are prevalent among our youth and not all obese have a correct image of their body size. Highly recommended are intervention programs of education on nutrition starting in childhood through school age to promote and ensure healthy food choices, improve student's awareness of ideal body size and clinical obesity, encourage physical exercise but discourage potentially harmful weight control measures.

Radiological study of exposure levels in El Maghara underground coal mine

Coal is largely composed of organic matter, but it is the inorganic matter in coal minerals and trace elements that have been cited as possible causes of health, environmental and technological problems associated with the use of coal. Some trace elements in coal are naturally radioactive. These radioactive elements include uranium (U), thorium (Th) and their numerous decay products, including radium (Ra) and radon (Rn). Although these elements are less chemically toxic than other coal constituents, such as arsenic, selenium or mercury, questions have been raised concerning the possible risk from radiation. In order to accurately address these questions and to predict the mobility of radioactive elements during the coal fuel cycle, it is important to determine the specific activity, distribution and form of radioactive elements in coal. The assessment of the radiation exposure from coal burning is critically dependent on the specific activity of radioactive elements in coal and in the fly ash that remains after combustion. The El-Maghara coal mine is the only producing coal mine in Egypt. It is located in the middle of the Sinai desert about 250 km north-east of Cairo, where a coal-fired power plant is intended to be built. In this study, a pre-operational radiological baseline of the site and the occupational radiation exposures due to radon progeny in the mine were determined. The specific activities of 226Ra, 232Th and 40K in soil and coal dust samples collected along the main gallery ranges were found to be 6-22.9, 9.6-47.3 and 77-489 Bq kg-1, respectively. Soil samples collected around the mine showed concentrations of 226Ra, 232Th and 40K in the ranges 2.7-20.2, 3.2-12.6 and 14.6-201 Bq kg-1, respectively. All of the mean values of radon progeny were lower than the action levels for working places recommended in the International Commission on Radiological Protection (ICRP) 65.

Uranium bioassay and radioactive dust measurements at some uranium processing sites in Egypt--health effects

The safety of radiation workers in the uranium mining industry requires close and continuous monitoring of their working conditions. In this study, external radiation surveillance, radioactive dust monitoring and the bioassay of uranium were carried out in some processing sites. As dust represents one of the most important sources of radiation exposure in mills and mines, dust monitoring and bioassays were performed for a sample of workers on the production lines. The concentration of uranium in air ranged from 22.6 x 10(-7) to 11.1 x 10(-5) Bq cm-3, and the exposure levels ranged from 1 to 80 microSv h-1. Laser fluorimetric determination of uranium in urine samples showed concentrations in the range 8.4-29.2 micrograms L-1. Renal function parameters, such as serum creatinine and urea, and hematological parameters were determined in an attempt to correlate them with radiation exposure and the health status of the workers. Urine specimens collected from workers at the ore crushing and separation site showed elevated concentrations of uranium (up to 29.2 micrograms L-1) and a strong correlation between these concentrations and the registered serum creatinine. The mean uranium excretion in the investigated group was more than 20 times the occupational exposure decision level for urine uranium of 0.8 microgram L-1.

Validity of self-reported weight and height among Saudi school children and adolescents

OBJECTIVE

To explore the relationship between self-reported weight and height to actual weight and height in a cross-sectional representative sample of school students in Jeddah City, Kingdom of Saudi Arabia and its relation to selected socio-economic and socio-demographic factors. Also to evaluate the validity of self-reported weight and height measurements.

METHODS

Data was collected from a sample of Saudi school students in Jeddah City, KSA from 42 boys' schools and 42 girls' schools during the month of April 2000. Data collection was carried out by an in-person interview to collect sociodemographic and self-reported weight and height, as well as, actual measurement of weight and height. Body mass index was classified according to age and genders into underweight (<15th percentile), normal weight (>=15th percentile to <85th percentile), overweight (>=85th percentile to <95th percentile) and obesity (>=95th percentile). Validity of self-reported obesity, as compared to measured body mass index, was assessed.

RESULTS

A total of 2,860 Saudi school students were enrolled in the study with an age range from 9 to 21 years (mean=13.9, standard deviation=2.8). Overweight was reported in 13.4% and obesity in 13.5% of school students. Overweight and obesity were more marked among those of at least 13 years of age, male of high social class and students with highly educated mothers. Slightly above half of the school children were unaware of their weight and height giving an unknown body mass index in approximately 60% of cases. Among the remaining 40% who reported their weight and height, underestimation of weight was around 2.7 kg and was mainly among girls, in 16-21 year old group, high socio-economic class and born from educated mothers. Overestimation of height by 4 cm was reported mainly among the overweight, obese, girls, those with at least 16 years of age. Sensitivity of determining obesity by reported weight and height was low especially among girls and those of at least 16-years of age while specificity was more among boys than girls and improved by increase in age.

CONCLUSION

Our results display the inaccuracy of self-reported weight and height in tracking obesity in our youth population. These results also emphasize the need for community and school based programs for preventing and reducing obesity in school age through improving the nutritional status awareness, diet habits and life style in order to ensure health and longevity.

Depleted uranium: an overview of its properties and health effects

There has been much debate about the use of depleted uranium in the Gulf War and its health effects on United States and European war veterans. However, studies on the impact of this radioactive substance on the residents of the surrounding Gulf region are far from adequate. Depleted uranium introduces large quantities of radioactive material that is hazardous to biological organisms, continues to decay for millennia and is able to travel tens of kilometres in air. If depleted uranium were used in the Gulf War, its impact on the health of people in the area would have been considerable. This review of depleted uranium-its origin, properties, uses and effects on the human environment and health-aims to trigger further research on this subject.

Radiochemical neutron activation analysis of total trace tin and determination of its differentiated compounds in aquatic biota

The optimization of extraction and determination of trace tin using radiochemical neutron activation analysis (RNAA) in selected aquatic specimen (algae, fish, mussels) is described. Neutron activation analysis (NAA) using the induced 117mSn (13.6 days) or 113Sn (115 day) nuclides is in principle a sensitive method for determination of total trace tin. However, due to the high contents of arsenic (As) in most marine matrices, neutron irradiation induces high levels of 76As (26.3 h) in comparison to weak 117mSn activities. Selective removal of As by absorption on Acidic Aluminum Oxide (AAO) would be advantageous and reduce the activities required to be handled during tin purification. It was found that perchloric acid medium is the best eluent for separating Sn from As, whereas sulfuric acid and a mixture of the two were not as effective. The standard radiochemical separation procedure based on solvent extraction and purification of tin iodide in toluene from sulfuric acid-potassium iodide (KI) medium with recoveries ranging between 90%–95% is applied. Interferences from the 47Ca/47Sc decay and 199Au with similar gamma energies were effectively removed by the liquid/liquid separation. Comparing the total tin content in freeze-dried samples with the total organotin content in fresh samples shows that the drying process has changed the tin species pattern of the material. The total butyltin content represents 60% and 90% of the total tin content in eel-pout and bream muscles, while it represents about 76%–83% and 58%–88% in mussels and algae, respectively.

Depleted uranium: an overview of its properties and health effects

There has been much debate about the use of depleted uranium in the Gulf War and its health effects on United States and European war veterans. However, studies on the impact of this radioactive substance on the residents of the surrounding Gulf region are far from adequate. Depleted uranium introduces large quantities of radioactive material that is hazardous to biological organisms, continues to decay for millennia and is able to travel tens of kilometres in air. If depleted uranium were used in the Gulf War, its impact on the health of people in the area would have been considerable. This review of depleted uranium--its origin, properties, uses and effects on the human environment and health--aims to trigger further research on this subject.

Experience with the objective structured examination as a tool for students' assessment in the Department of Community Medicine and Primary Health Care in a university [corrected] in Western Saudi Arabia

OBJECTIVE

The objectives of this study were to 1. assess the knowledge and attitude of the 5th year female medical students towards the objective structured examination in general and in Community Medicine in particular prior to the exam, 2. Detect any change in students' knowledge and attitude after passing the exam, 3. Identify the students' evaluation for future objective structured examination in Community Medicine and Primary Health Care and 4. Compare the students' performance in the objective structured examination in Community Medicine and Primary Health Care to the results of multiple choice questions evaluation in the department.

METHODS

There were 2 data sets, the first was collected by self-administered pre and post-objective structured examination questionnaires from all female medical students in the 5th year during the academic year 1996-1997 and the 2nd was copied from the students' results for objective structured examination and multiple choice questions in the department of Community Medicine and Primary Health Care during same academic year.

RESULTS

All the 34 5th year female medical students were enrolled in the study. Most of them reported that they did not receive enough information prior to the objective structured examination and most of their knowledge came from side chats with friends or staff members which was confirmed by their weak knowledge and negative attitude towards the objective structured examination prior to the exam. After setting the objective structured examination, students' knowledge and attitude towards objective structured examination markedly improved and the majority displayed its advantage as an assessment tool and were convinced of its suitability for medical practice in general and community medicine in particular. Most students believed that objective structured examination in Community Medicine and Primary Health Care met their expectations and recommended it for the coming years. Also, students stated the negative and positive aspects that should be considered for future assessments. Moreover, the multiple choice questions were nearly similar and there was a significant correlation between both scores.

CONCLUSION

The 5th year female medical students did not receive enough information and training on the objective structured examination which influenced their attitude prior to the exam. However, most of them showed a positive attitude after the experience and their marks in the objective structured examination were comparable to their marks in the multiple choice questions. The objective structured examination is a popular method of assessment in medical practice worldwide. The decision to discontinue its use after only one year did not allow space of time for evaluation of its appropriateness as an assessment tool. More research is recommended to study the main causes that lead to disregarding this type of medical assessment in the College of Medicine at King Abdulaziz University.

An epidemiological study of childhood disability in Jeddah, Saudi Arabia

Childhood disability is a major health problem that is pronounced in developing countries. The objectives of this study were to identify the maternal risk factors present in our society and their impact on acquiring a disabled child. Data were collected from the six governmental rehabilitation institutes and a sample of normal non-disabled school children in Jeddah City. Information on sociodemographic factors and maternal risk factors was collected by in-person interview and copied from the children's institute records. Logistic regression models were fitted to calculate the adjusted odds ratios in order to demonstrate the impact for the various maternal risk factors on having a disabled child. Our results have shown that certain modifiable maternal risk factors affecting child health still exist in our community, such as early and late-age marriage and childbearing, as well as low education, unemployment, multiparity and consanguineous marriages. All these risks were shown to put the mother at higher risk of having an auditory disabled child. Also, older-age childbearing (> or = 30 years), low education level and multiparity were the maternal risk factors identified that influenced the risk of visual disability in children. Similar maternal risk factors, in addition to unemployment, were more observed among mothers of mentally disabled children. A huge effort is required to discourage the potential risk factors in our community that influence child health.

Infant mortality in Arab countries: sociodemographic, perinatal and economic factors

The infant mortality rates for 1978 and 1998 of 16 Arab countries in the Eastern Mediterranean region were studied. The data were extracted from World Health Organization and United Nations Children’s Fund sources. The impact of demographic, social, perinatal care and economic indicators on infant mortality rates in 1998 was studied using Spearman rank coefficient to detect significant correlations. All countries, except Iraq, showed a sharp decline in rates from 1978 to 1998. Infant mortality rates were directly related to population size, annual total births, low birth weight and maternal mortality ratios. Also, infant mortality rates were inversely related to literacy status of both sexes, annual gross national product per capita and access to safe drinking-water and adequate sanitation facilities.

Infant mortality in Arab countries: sociodemographic, perinatal and economic factors

The infant mortality rates for 1978 and 1998 of 16 Arab countries in the Eastern Mediterranean region were studied. The data were extracted from World Health Organization and United Nations Children's Fund sources. The impact of demographic, social, perinatal care and economic indicators on infant mortality rates in 1998 was studied using Spearman rank coefficient to detect significant correlations. All countries, except Iraq, showed a sharp decline in rates from 1978 to 1998. Infant mortality rates were directly related to population size, annual total births, low birth weight and maternal mortality ratios. Also, infant mortality rates were inversely related to literacy status of both sexes, annual gross national product per capita and access to safe drinking-water and adequate sanitation facilities.

Characteristics of NORM in the oil industry from eastern and western deserts of Egypt

Naturally occurring radionuclides (NORs) from the 232Th- and 238U-series, which are omnipresent in the earth's crust, can be concentrated by technical activities, particularly those involving natural resources. Although, a great deal of work has been done in the field of radiation protection and remedial action on uranium and other mines, recent concern has been devoted to the hazard arising from naturally occurring radioactive materials (NORM) in oil and gas facilities. NORM wastes associated with oil and gas operations from scale deposits, separated sludge and water at different oil fields in the eastern and western deserts were investigated. Concentrations of the uranium, thorium, and potassium (40K) series have been determined from high-resolution gamma-ray spectrometry. Total uranium content of samples was determined using laser fluorimetry. The levels of radioactivity were mainly due to enhanced levels of dissolved radium ions. Only minute quantities of uranium and thorium were present. The disequilibrium factor for 238U/226Ra has been determined.

Going beyond the curriculum to promote medical education and practice in Saudi Arabia

The foundation of health starts as early as undergraduate medical education. Medical education in the Kingdom has always been successful in promoting the medical profession and population health. The current issue in the Kingdom is quality assurance in all organizations including the health field. Thus emerges the value of evaluating the efficiency and effectiveness of the current system in meeting health needs and expectations. The aim of this paper was to analyze the current situation in order to design a frame for the direction of promotion of medical education and practice that best meets health needs and expectations. In fact, medical practice is a multidisciplinary process that is showing continuously changing theories. It has a broad scope of serving the whole community and improving the quality of life of all population categories. The huge quantity of information, needed to be retained by medical professionals, necessitates the move away from traditional methods of education to more practical and comprehensive programs of study. Most of the recent reform in medical education, in the Kingdom, has focused on curriculum and disregarded the education process. The requisite for the education process is a complete model of community-based health care, education and research. This study proposes a design aiming to enhance medical education and promote the medical profession, through developing the quality of medical professionals, that will foster growth of their activity and productivity, moving them into the community where clinical practice and experience are more relevant to the true health situation.

A non-comparative descriptive study of the risk factors for childhood disability, and the rehabilitation services in jeddah, saudi arabia

OBJECTIVES

Identify the possible risk factors in our community that may influence having a disabled child, and identify the rehabilitation services available to disabled children.

METHODS

Data were collected from six rehabilitation institutes for auditory, visual and mental disabilities in Jeddah City during April 1999. Complete data available on sociodemographic and medical risk factors were extracted from the institutes' files. Personal interviews with the disabled were conducted to confirm information on the services offered to them.

RESULTS

Certain modifiable risk factors affecting child health, such as early and late marriages and childbearing, illiteracy, unemployment, high parity and consanguineous marriages still exist in our community. Occupational hazards were also detected among military workers and working women. Disabilities related to perinatal health with antenatal, natal and postnatal components were also observed. According to resources available, various rehabilitation services are offered to disabled children.

CONCLUSION

The need for intervention in two areas of health is crucial. The first is the prevention of future disabilities through continuous research, modification of unfavorable habits and the strengthening of the quality of perinatal care. The second is the improvement of rehabilitation services in order to raise the quality of life of the handicapped.

Prevalence and epidemiological features of hepatocellular carcinoma in Egypt-a single center experience

Background: The studies carried out on hepatocellular carcinoma (HCC) are scarce in Egypt. Nevertheless, they presumed an upward trend for HCC among chronic liver disease (CLD) patients. The objectives of this research were to determine the trend of HCC, the possible risk factors implicated in its development and the population attributable risk of HCVAb and HBsAg positivity for HCC. Methods: Medical records of all patients attending Cairo Liver Center during the years 1992-1995 were reviewed to determine the sociodemographic characteristics, HCVAb, HBsAg and HCC status. Prospectively, 200 HCC cases' stored sera as well as 120 healthy control were tested for aflatoxin B(1) quantitatively and qualitatively. Results: HCC accounted for 4.7% (321/6850) of CLD patients included in the study. HCVAb positive cases were strikingly high (71.1%) and HBsAg positive cases were reported in 22.4% of patients. There was an annual significant rise of HCC ranging from 3.6% in 1992 to 5.3% in 1995. HCC was significantly more prevalent among old age groups (60 years) than younger age groups. The impact of gender and past history of schistosomiasis on HCC was not proved by this study. HCVAb and HBsAg positivity were the two significant independent risk factors for HCC. The population attributable risk percent has shown that HCC cases attributed to HCVAb positivity accounted for 51.1%; while HBsAg positivity only explained 21.3% of cases. Aflatoxin B(1) was detected in 17% of HCC cases compared to 9.4% of healthy control. Risk ratio=2(95%). Conclusion: HCC is showing an increasing trend among our patients. Its development is mainly due to high rates of HCVAb and HBsAg positivity. HBsAg positive patients were at double risk to develop HCC and HCVAb positive patients were at 1.6 more risk. The high prevalence of HCVAb positivity renders its contribution to the development of HCC over seven-fold higher than HBsAg positivity. Short and long term health strategies are crucial to prevent and control HCC in Egypt.

Effect of maternal education on the rate of childhood handicap

OBJECTIVE

The objectives of this study were to determine the relation between maternal education and various maternal risk factors, identify the impact of maternal education on the risk of childhood handicap and estimate the proportion of childhood handicap that can be prevented by maternal education.

METHODS

Data was collected from all married women attending the two major maternity and child hospitals in Jeddah during April 1999. Women with at least one living child were interviewed for sociodemographic factors and having at least one handicapped child. The risk of having a handicapped child and the population attributable risk percent were calculated.

RESULTS

Some potential risk factors are dominant in our society as approximately 30% of women did not attend school and 84% did not work. Consanguineous marriages accounted for about 43%. Pre-marriage counseling was limited as only 10% of women counseled before marriage. The proportion of unemployment and consanguineous marriages decreased significantly by increase in maternal education level. Conversely, the proportion of women reporting pre-marriage counseling increased significantly by increase in maternal education level. Approximately, 7% of women reported having at least one handicapped child. The risk of having a handicapped child showed a significant sharp decline with increase in maternal education level. At least 25% of childhood handicap can be prevented by achieving female primary education and up to half of cases can be prevented if mothers finish their intermediate education.

CONCLUSION

Female education plays a major role in child health. The results of this study suggest investment in female education, which would have substantial positive effects in reducing incidence of childhood handicap in Jeddah.

Cumulative impact of early maternal marital age during the childbearing period

Early marriage of girls, close to age of menarche, is a widespread practice in Arab countries. Knowledge on the cumulative effect of early maternal marriage on maternal and infant health during the childbearing period is insufficient. The objectives of this study were to estimate the prevalence of early maternal marriage in Jeddah, identify its relation with other maternal risk factors, and investigate the cumulative impact of early maternal marriage on subsequent maternal health and pregnancy outcomes throughout the reproductive period. Data were collected from six randomly selected primary health care units in Jeddah City. Married women with an infant < or = 12 completed months of age were interviewed and information on sociodemographic characteristics, maternal health and previous pregnancy outcomes were collected. Early marriage of girls before the age of 16 years accounted for 26.5% of the study population and was reported by a third of mothers currently below the age of 20 years. Illiterate mothers, housewives, multiparae, smokers and those married to a relative reported the highest proportion of marriages before their sixteenth birthday. Those who married before the age of 16 were at about double the risk of developing chronic diseases and experiencing miscarriage, stillbirths and infant deaths. These results suggest that early maternal marriage still exists in our community and is intimately related to other maternal risk factors. Maternal marriage < 16 years appears to be fraught with insecurities for the mother and infant throughout the whole length of the childbearing period and not merely the first pregnancy. Thus, even if culture norms claim early marriage of girls, it should be discouraged before the age of 16 years. Moreover, it is recommended that future research on maternal and infant health considers the cumulative effect of the various risk factors during the whole reproductive period and not only a single pregnancy outcome.

Rift valley fever

Rift Valley fever is a viral disease that affects domestic animals and humans. In humans, Rift Valley fever causes a flu-like disease but occasionally leads to high morbidity and mortality. The disease is generally known in the African continent. However, cases started to appear in Saudi Arabia and Yemen. The objective of this review is to give a general briefing about the epidemiology, ecology and management of the disease.

Hypercholesterolemia and 5-year risk of development of coronary heart disease among university and school workers in Jeddah, Saudi Arabia

BACKGROUND

A study was performed among university and school employees as a step in detecting the prevalence of coronary heart disease (CHD) risk factors among school and university staff and the relation of the various risk factors to hypercholesterolemia and to predict the 5-years probability of development of CHD.

METHODS

All university staff and a sample of school workers in Jeddah were included in the study. Data were collected by interview and self-administered questionnaires, as well as by direct observation and measurement of weight, height, blood pressure, and total blood cholesterol. Logistic regression analysis was performed to identify the impact of various risk factors on hypercholesterolemia. The 5-year risk of development of CHD was calculated to identify the proportion at highest risk.

RESULTS

Some CHD risk factors were detected among the participants as 18.8% were current cigarette smokers, around half were classified as overweight, and 19.9% were classified as hypertensive. Hypercholesterolemia was present in 10.1% and was significantly related to older age (40 years and over) and place of work. The estimated risk of CHD in the coming half-decade for those classified in the fifth quintile was 0.068. The Q(5)/Q(1) ratio has shown that those classified in the fifth quintile were at 3.6 times more risk of developing CHD in the coming 5 years than those classified in the first quintile.

CONCLUSION

CHD risk factors are becoming prevalent in our society. The risk of development of CHD in the coming decades is not trivial. Short- and long-term health strategies are recommended to decrease the risk of CHD and improve the quality of life.

Pathogenicity of a low-virulence duck virus enteritis isolate with apparent immunosuppressive ability

Duck enteritis virus (DEV) was isolated from commercial 2-to-6-wk-old white Pekin ducks experiencing 25%-30% mortality and high morbidity. Secondary infections with Pasteurella multocida, Riemerella anatipestifer, and Escherichia coli were frequently seen in affected ducks. The isolated virus was identical to the prototype DEV by virus neutralization test but differed from the classic DEV by causing lymphoid organ atrophy and inconsistent hemorrhagic lesions in the intestinal annular bands. Attempts to reproduce the disease in white Pekin ducks were unsuccessful until the virulence of the virus was increased by three passages in Muscovy ducklings. Significant thymic atrophy (P < or = 0.001) was detected during the first 10 days postinfection (DPI), but thymus size returned to normal by 17-24 DPI. However, bursal atrophy increased significantly (P < or = 0.001) from 4 DPI until the end of the experiment (39 DPI). Reduction in body weight was significant (P < or = 0.05) between 4 and 6 DPI. There was massive depletion of thymic and bursal lymphocytes with lymphoid necrosis in the thymus, bursa, spleen, and Harderian gland. Eosinophilic intranuclear inclusions were observed in thymus, bursa, spleen, esophagus, cloaca, liver, conjunctiva, and Harderian gland. Occasional intracytoplasmic inclusions were also found scattered in the epithelial cells of conjunctiva, esophagus, bursa of Fabricius, and cloaca. Virus was recovered from experimentally infected ducks from thymus, bursa, spleen, liver, kidneys, trigeminal ganglion, and cloaca during the first 10 days of infection. These findings suggest that a low-virulent DEV can cause a massive lymphoid atrophy and can sustain immunosuppression as noted by the secondary bacterial infection.

Early teenage marriage and subsequent pregnancy outcome

The relationship between marriage before 16 years and pregnancy outcome throughout the childbearing period was examined. Participants included all married women attending six randomly selected primary health care units in Jeddah with at least one infant and complete medical files. Early teenage marriage was found for 27.2% of women. Most of these were illiterate [57.1%], housewives [92.4%]and grand multiparae [66.7%]. They were at twice the risk of spontaneous abortion, four times the risk of combined fetal death and infant mortality, and twice the risk of losing pregnancies any time during their childbearing years. They remained at high risk of poor pregnancy outcome throughout their reproductive lives. Despite tradition, marriage should be discouraged before 16 years

Early teenage marriage and subsequent pregnancy outcome

The relationship between marriage before 16 years and pregnancy outcome throughout the childbearing period was examined. Participants included all married women attending six randomly selected primary health care units in Jeddah with at least one infant and complete medical files. Early teenage marriage was found for 27.2% of women. Most of these were illiterate (57.1%), housewives (92.4%) and grand multiparae (66.7%). They were at twice the risk of spontaneous abortion, four times the risk of combined fetal death and infant mortality, and twice the risk of losing pregnancies any time during their childbearing years. They remained at high risk of poor pregnancy outcome throughout their reproductive lives. Despite tradition, marriage should be discouraged before 16 years.

Hepatitis C infection among drug addicts

Full text is available as a scanned copy of the original print version.

Combination treatment of interferon alpha-2b and ribavirin in comparison to interferon monotherapy in treatment of chronic hepatitis C genotype 4 patients

BACKGROUND AND AIM

Treatment of chronic hepatitis C patients, infected with genotype 4 with interferon-alpha yielded a limited response. Our aim was to compare the efficacy of interferon-alpha alone and in combination with ribavirin in chronic hepatitis C patients infected with genotype 4.

PATIENTS

Fifty-two chronic hepatitis C patients (all males) infected with genotype 4, who had not received interferon, were randomized into 2 equal comparable groups.

METHODS

Group I received interferon alpha-2b "Schering Plough" 3 MU, tiw combined with ribavirin (1000 mg/day). Group II received interferon alpha-2b alone in the same dose. Both groups were evaluated monthly, at the end of 24 weeks of treatment and 24 weeks later. Two patients were dropped from group I and one patient from group II.

RESULTS

Biochemical response: at the end of treatment, a return to normal of ALT was obtained in 16/24 (66.7%) patients on combination therapy vs 8/25 (32%) patients on interferon alone (p = 0.0152). At the end of follow-up, a sustained response was achieved in 10/24 (41.7%) patients on combination therapy vs 4/25 (16%) patients on interferon (p = 0.0468). Virologic response: at the end of treatment, the rates of virological response were higher in the patients on combination therapy 9/24 (37.5%) than in those on interferon 4/25 (16%) (p = 0.0380). At the end of follow-up, loss of serum HCV RNA was reported in 5/24 (20.8%) patients on combination therapy vs 2/25 (8%) patients on interferon (p = 0.1916). Histologic response: mild histologic improvement was shown by a decrease in the inflammatory score, which was highest in patients in the combination group.

CONCLUSIONS

In chronic hepatitis C patients infected with genotype 4, combination therapy with interferon-alpha and ribavirin was more effective than treatment with interferon monotherapy. At the end of the follow-up, about 50% of patients in both groups were still viraemic though their ALT remained normal.

Distribution pattern of 90Sr and 137Cs in the Nile delta and the adjacent regions after Chernobyl accident

Strontium and cesium contents in surface soil samples across the Nile Delta and the north coast of Egypt after the Chernobyl accident have been investigated. The concentration of 137Cs and 90Sr was determined using a high resolution gamma spectrometer based on hyperpure germanium detector (HPGe) and a liquid scintillation counter (LSC) respectively. 90Sr was determined through its decay product 90Y using Cerenkov counting. The determination of 90Sr was based on tributylphosphate (TBP) extraction of yttrium from nitric acid extract of ashed samples. The radioactivity of soils ranged between 18.5 and 2175 Bq/m2 with a mean of 652 Bq/m2 and 234 and 3129 Bq/m2 with a mean of 760 Bq/m2 for 137Cs and 90Sr respectively. An estimated absorbed dose equivalent due to the measured deposit of 137Cs was found to be 0.062 murem/h.

Detection of duck enteritis virus by polymerase chain reaction

Duck enteritis virus (DEV), a herpesvirus, is the causative agent of duck viral enteritis in free-flying, feral, and domesticated members of the Anatidae family. HindIII-digested DEV DNA was cloned into the plasmid pBluescript, and a 1.95-kb fragment was sequenced. This fragment codes for the 3' region of the DEV homologues of varicella-zoster virus (VZV) open reading frame (ORF) UL6 and the 5' region of VZV UL7. Alignment of the putative peptide fragments for DEV UL6 and UL7 showed a 64% and 37% identity with VZV UL6 and UL7, respectively. Primers located in the highly conserved domain of the UL6 gene were used for a polymerase chain reaction (PCR) assay, which was able to amplify DEV DNA. The PCR assay also amplified DEV DNA from the original outbreak samples and/or after passage in Muscovy duck embryos.

Distribution pattern of organotin compounds at different trophic levels of aquatic ecosystems

Organotin compounds including methyl- and butyltin species were determined in selected aquatic specimens (fish muscles, fish liver, mussels, algae) as well as in sediment and water from the mud flats of the German North Sea and the River Elbe. The concentration of tributyltin (TBT) ranged between 27-202 ng/g (fresh mass) in fish muscles, 54-223 ng/g (fresh mass) in fish liver, 10-25 ng/g (fresh mass) in common mussels and 42-97 ng/g (fresh mass) in bladderwrack. The concentration of total organotin compounds (mono-, di-, and trimethyltin + mono-, di-, and tributyltin) in water samples along the River Elbe up to the Elbe estuary ranged between 30-96 ng/l. Retrospective investigation of butylin compounds in mussel samples from the North Sea was performed by the analysis of cryogenically stored samples from 1985. A comparison of the results with that in muscles from 1993 shows that the total tin content and the TBT content decreased from 1985-1993 by a factor of 3.5 and 6.5, respectively. In addition estimated bioconcentration factors (BCF) for organotin compounds in samples from different trophic levels are presented.

Comparison between antigen-capture ELISA and conventional methods used for titration of infectious bursal disease virus

Two antigen-capture enzyme-linked immunosorbent assays (polyclonal and monoclonal AC-ELISAs) were developed and evaluated for titration of infectious bursal disease viruses (IBDVs) propagated in different host systems, namely BGM-70 continuous cell line, primary chicken embryo fibroblast cells, and chicken bursa of Fabricius. The polyclonal system was more sensitive (P < 0.05) than the monoclonal system but both were specific as indicated by the negative results obtained with three non-IBDVs. The results revealed that the conventional systems used for titration of IBDVs (cell cultures and embryonating chicken eggs) were more sensitive than the polyclonal AC-ELISA.