Challenges in Healthcare Management of Individuals with Special Needs in Malaysia: Perceptions of Caregivers

Aims and Objectives

A "caregiver" is responsible for managing the basic needs of others, including individuals with special needs (IWSNs). Caregivers play an important role in the well-being of IWSNs, though caring can lead to a decline in health and quality of life. This qualitative study aimed to investigate the perceived healthcare challenges faced by caregivers of IWSNs in Malaysia.

Materials and Methods

Thirty-two primary caregivers were interviewed via audio-recorded semistructured focus group discussions to investigate their perceived barriers and challenges in caring for IWSNs. The qualitative data were then analyzed via thematic analysis.

Results

Thirty-two participants took part in a total of nine discussion sessions, where the majority were females (n = 29; 90.63%) and from the Malay race (n = 30; 93.75%). Most of the IWSNs under their care had autism (n = 11; 34.38%) and were between 6 and 10 years of age (n = 13; 40.63%). The main themes identified were related to healthcare services, support systems, caregivers' personal factors, and IWSN issues. Within the healthcare services domain, themes regarding the accessibility and appropriateness of healthcare facilities and the attitudes of staff were uncovered, whereas in the support system domain, themes pertaining to community and peer, family, and governmental support were discussed. In the domain of caregivers' personal factors, themes regarding stress with the burden of care and feelings of guilt were noted, and in the area of IWSN factors, the theme of behavioral difficulties exhibited by IWSNs was discussed.

Conclusion

Primary caregivers in Malaysia face challenges with healthcare facilities and staff, gaining support from the community, family, and government, burning out, and feeling guilty as well as behavior issues of their IWSN. Thus, understanding these challenges is vital in providing healthcare services that cater to not only IWSNs but also their caregivers to ensure the success and well-being of all involved.

Emotional intelligence and academic performance among medical students - a correlational study

OBJECTIVE

Emotional intelligence is the ability to monitor one's emotions and feelings and those of others, to distinguish between them, and to use this information to guide one's thoughts and actions. A growing body of evidence suggests that highly emotionally intelligent student groups have better academic performance, better emotional awareness, and relationship management. We set forward to determine if any such positive relation exists among medical students.

MATERIALS AND METHODS

A descriptive cross-sectional study was conducted on undergraduate medical students of Majmaah University. Convenient sampling was done to enroll the consenting students. A self-administered questionnaire on emotional intelligence was adapted from a model by Paul Mohapel. The questions based on a 5-point Likert scale assessed the four domains of emotional intelligence i.e., emotional awareness, emotional intelligence; demographic details and grade-point averages (GPA) were also collected. The data was tabulated and analyzed using SPSS 22.0 (IBM Corp., Armonk, NY, USA).

RESULTS

Hundred and forty medical undergraduates enrolled in the study with a male-to-female ratio of 1:06. The median semester score was 4.47 (range 1.1-5.8) and the median cumulative score was 4.44 (range 2.8-5.0). The emotional management score was highest among those with a CGPA >4.50 (p=0.048). A significantly higher mean emotional awareness score (p<0.001), social-emotional awareness score (p<0.001), and relationship management score (p=0.030), and the mean EQ total was higher among males than for females (p<0.001). A small but significant correlation was observed and also with EQ total score (r= 0.18, p= 0.032).

CONCLUSIONS

Emotional management affects the academic performance of medical students. There should be more sessions to improve the emotional intelligence of the students so that it can aid in their academic performance.

OC-026 PERFORMING A SLIT ON THE MESH TO ENCIRCLE THE CORD STRUCTURES DURING LAPAROSCOPIC INGUINAL HERNIA REPAIR - A SYSTEMATIC REVIEW AND META-ANALYSIS

Aim

There are several modifications in the technique for the placement of mesh during laparoscopic inguinal hernia repair. The present study aimed to provide stronger evidence in establishing whether the slit mesh technique is superior to the non-slit technique (the most common practice). The primary outcome was recurrence and secondary outcomes were postoperative groin pain, bleeding, seroma formation and duration of surgery.

Material & Methods

Eligible studies had to compare the two methods of mesh placement slit Vs non slit in laparoscopic TEP or TAPP inguinal hernia repair. Databases searched were Embase, Medline, Cochrane collaboration, NICE guidelines search.

The meta-analysis was conducted using Review Manager software 5:4. The outcomes were expressed in odd ratios with their 95% confidence intervals. Where significant heterogeneity existed (I2&gt;75%) a random effects model was used otherwise a fixed effects model was used.

Results

Five studies included, all were single centre studies, 4 retrospective and one prospective observational studies. 1076 patients included, 633 in the slit group and 434 in the non-slit group. The male to female ration was 9:1.

There were 10 (1.5%) recurrences in the slit group compared to 12 (2.5%) in the non-slit group 0.62, 95% CI (0.27–1.41). There was no difference in the incidence of post-operative bleeding (1.21, 95%CI 0.4–3.66), seroma formation (1.5, 95% CI 0.81–2.76), or post-operative neuralgia (0.98, 95%CI 0.11–8.92).

Conclusion

There is no advantage in performing a slit on the mesh to encircle the cord structures during laparoscopic inguinal hernia repair.

Impact of COVID-19 pandemic on quality of partner relationship and sexual activity among COVID positive males: a cross sectional study

OBJECTIVE

Our aim was to assess sexual activity, partner relationships among males who had been infected with COVID-19, to study the impact of COVID-19 infection on partner relationship and to find out the association between partner and sexual relationship during lockdown.

MATERIALS AND METHODS

A cross sectional study was conducted in Saudi Arabia through social media platforms via online questionnaire between December 1, 2020 and January 31, 2021 among 871 participants after a pilot study among 20 participants of which 497 were included in the study. Statistical analysis was conducted using SPSS version 20.0 (IBM Inc., Armonk, NY, USA). Responses were presented as frequencies and percentages and the association was studied using Chi squared test/Fisher's exact test. The value of p ≤ .05 was considered significant.

RESULTS

Out of the total study participants, nearly 85% of them belonged to the age range of 18 to 39 years, more than half of the participants were married. In the six months prior to the study being conducted, 268 respondents (53.9%) did not have sexual relationships. Respondents with positive COVID-19 infection reported that their partner lived with them in the same house during home isolation and was also found to be significantly associated with having intact sexual relationships in the last six months of the lockdown period (p-value < .001). Moreover, respondents who reported having good relationships with their partners during the pandemic were found to be significantly associated with having intact sexual relationships during the pandemic lockdown (p-value < .001).

CONCLUSIONS

Among the COVID-19-positive respondents, sexual activity and partner relationships were largely found to be intact during the pandemic lockdown period.

A nationwide survey to assess COVID-19's impact on health and lifestyle in Saudi Arabia

OBJECTIVE

Since COVID-19 outbreak, there is a lack of extensive literature on the impact of the COVID-19 pandemic on health and lifestyle. The aim of the study was (1) to assess the COVID-19 related knowledge and its socio-demographic correlates in individuals from different parts of Saudi Arabia, (2) to evaluate the health-related impact and lifestyle changes in the Saudi population because of the COVID-19 pandemic, and (3) to determine the perceived importance of future preparedness among residents.

MATERIALS AND METHODS

A cross-sectional study was conducted in different regions of Saudi Arabia from  December 2020 to February 2022. Individuals aged 18 years and above were surveyed from different parts of the county. The questionnaires were made available online, and the participants filled them in. The questionnaires included COVID-19 related knowledge, the assessment of the health impact of COVID-19, perceived importance of future preparation for the pandemic, lifestyles, and demographics. Likert plot, univariate and multivariate logistic regression analyses were done.

RESULTS

A total of 616 respondents were included in the study. The majority of the repondents were female (58.6%).  36% of the respondents considered their knowledge level on the novel coronavirus as very good. 43.5% said their knowledge level on preventing the spread of the novel coronavirus is excellent. Retired people were 84% (aOR 0.16, 95% CI 0.03-0.78) less likely of higher physical activity as compared to working (≥40 hrs/week) professionals. Separated/divorced/widowed and singles were 3.65 times (aOR 3.65, 95% CI 1.34-9.94) and 2.23 times (aOR 2.23, 95% CI 1.28-3.89) more likely of higher screen time as compared to those who were married/cohabitation/common-law.

CONCLUSIONS

Lifestyle in Saudi Arabia has changed significantly due to the COVID-19 pandemic. Healthy habits such as eating at home and cooking at home have increased, while unhealthy habits such as reduced physical activity, screen time have increased.

The relationship of educational environment and preparedness to practice - perceptions of Malaysian dental graduates

Gauging dental graduates' perceptions of their university training and of how it prepares them for professional practice is useful in measuring the quality and adequacy of the curriculum to which they were exposed.

OBJECTIVES

This study aimed to evaluate the perceptions of dental graduates' educational environment as well as preparedness to practice, and how these two components are correlated.

METHODS

A self-administered, validated questionnaire, developed from previous studies, was distributed to dental graduates of a public Malaysian university (n = 178, response rate = 60%) via online and postal surveys. Bivariate analyses were carried out using Spearman's rank-order correlation (Spearman's Rho, significance level p < .01) to determine the correlation between (1) Global Preparedness Score and Global DREEM Score, (2) domains of DREEM Inventory and perceived preparedness, and (3) domains of perceived preparedness and DREEM Score.

RESULTS

The Global Preparedness Score was 191.52, with more than 90% of respondents feeling well prepared in the "General Patient Management," "Drug and Emergency Management" and "Practice Management" domains. The Global DREEM Score was 148.99/200, interpreted as "more positive than negative." The DREEM Inventory domains with the highest and lowest scores were "Students' Academic Self-Perception" (78.03%) and "Students' Social Self-Perception" (71.86%), respectively. A moderate positive correlation was found between Global Preparedness Score and Global DREEM Score (p < .01). In addition, moderate to large positive correlations were noted between perceived preparedness and "Student Perception of Learning," "Student Perception of Atmosphere" and "Student Academic Self-Perception" (p < .01). Moderate positive correlations were also found between the DREEM Score and most domains of perceived preparedness (p < .01).

CONCLUSIONS

The majority of graduates were well prepared to perform in most areas of clinical practice and perceived their overall educational environment as positive. In particular, those who viewed the educational environment in a positive light were also found to possess a good level of preparedness.

Assessment of parent knowledge and perception towards the importance of child immunization in Sudair region, Saudi Arabia

OBJECTIVE

According to WHO, global coverage of immunization was 86% in 2019, which dropped to 83% in 2020. The objective of this study is to assess parental knowledge and identify their perception towards the importance of child immunization. This study has also tried to determine the possible influencing factors for parental decision-making towards child immunization.

PATIENTS AND METHODS

A community-based cross-sectional study was conducted in 2020 in Sudair region of Saudi Arabia. The study was done among parents residing in Sudair region, where the sample was randomly selected based on the household. The sample of 436 was taken using the population proportion formula. Data were collected and analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA). Both the descriptive and inferential statistics were used to draw the results.

RESULTS

In this study the three-fourth (77.1%) of respondents were female and the remaining were male (23%). The majority of the respondent's knowledge was reported to have some form of influence on their idea of immunization followed by Ministry of Health, family members, medical staff, social media and others. A significant association was seen between age, marital status, occupational status and parents' knowledge on the importance of immunization (thinking if all child immunization was important). Association was also seen between parents' perception that immunization causes serious side effects and the age of the respondents.

CONCLUSIONS

The specific programs and bcc materials are needed to enhance the knowledge and perception of individuals regarding the need for complete immunization and also regarding the fact of vaccine-preventable diseases.

Neurological manifestation with special reference to HIV-associated neurocognitive disorder (HAND) among people on anti-retroviral treatment in India

OBJECTIVE

The neurological manifestations and their severity in patients on antiretroviral treatment (ART) are currently unexplained. ‎We aimed at studying the prevalence of HIV Associated Neurological Disorders (HAND) among people on antiretroviral treatment, using the International HIV Dementia Scale (IHDS).

PATIENTS AND METHODS

A predesigned and pretested proforma including the International HIV Dementia Scale (IHDS) was administered to 100 HIV patients attending to ART center of KIMS teaching Hospital (Koppal, Karnataka) from January 2020 to March 2020. The data was analyzed SPSS version 15 software. Descriptive statistics were used for demographic characteristics. The Student's t-test and chi-square test methods were applied to determine the relationship between qualitative characteristics.

RESULTS

The prevalence was found to be 59%. Out of 100, 57 HIV patients scored less than 10 whereas 43 HIV patients scored ≥10 on the IHDS scale. The mean age of the study population was 39.14 ±13.01 years; the total IHDS score was 9.96±1.53 and the CD4 count was 427.91±226.0. This study demonstrated that the patients with CD4 count more than 350 (i.e., 63.60%) had a better IHDS score.

CONCLUSIONS

Neurocognitive disorder was found to be more common than anticipated. All ICTC Centers need to consider assessing HIV-associated neurocognitive disability (HAND), and the International HIV Dementia Scale (IHDS) as one instrument for such assessment.

Range of factors in the reduction of hyperhydricity associated with in vitro shoots of Salvia santolinifolia Bioss

Hyperhydricity is a serious physiological disorder and affects In vitro propagation of many plants and as well of Salvia santolinifolia. The donor material to initiate the in vitro culture was the callus taken from the in vitro shoots produced on Murashig and Skoogs (MS) medium at 4.0 mg/l BA. This callus formed numerous hyperhydric shoots on culturing upon the medium of the same composition. The aim was to systematically evaluate the effect of cytokinins (Benzyladnine (BA) and N6-(-2-isopentenyl) adenine (2iP), culture vessels magnitude, medium solidification, source of nitrogen and calcium chloride for the alleviation of hyperhydricity. In the tissue cultures of S. santolinifolia BA and 2iP induced severe hyperhydricity, when other factors i.e. culture vessels magnitude and a suitable concentration of agar, ammonium nitrate (NH4NO3), potassium nitrate (KNO3) & calcium chloride (CaCl2.2H2O) were not optimized. After 30 days' culture, we observed 83.82% hyperhydric shoots at increased level (1.5 mg/l 2iP) and 81.59% at decreased levels (1.0 mg/l 2iP). On the other hand, hyperhydricity percentage at decreased (0.4%) and at increased (0.8%) levels of agar were 72.37% and 39.08%, respectively. MS medium modification with NH4NO3 (412 mg/l), KNO3 (475 mg/l) and CaCl2.2H2O (880 mg/l) was found the best medium to reduced hyperhydricity (23.6%).

Association of indoor air pollution on cognitive dysfunction among elderly

OBJECTIVE

Cognitive dysfunction among the elderly is a devastating condition preceded by accumulation of neuropathology leading to accelerated cognitive decline. Many epidemiologic studies have reported the relation between indoor air pollution exposure and cognitive impairment. To clarify the nature of the association, a comprehensive systematic review and meta-analysis were performed.

MATERIALS AND METHODS

The analysis included all observational studies, including cross-sectional studies, prospective and retrospective cohort studies. Experimental studies, randomized controlled trials (RCTs), and controlled clinical trials were excluded. Studies on the relationships of indoor air pollution and cognition published before 30 April 2021 which are peer-reviewed scientific publications available in English were included after performing a structured literature search through electronic databases, including PubMed, Embase, Cochrane Library, and clinical trial.gov. A total of 146 articles were collected, and after screening thoroughly only, 9 studies were selected. Meta-analysis for the final set of selected studies was performed using the R software.

RESULTS

The quality of all the studies was adequate as almost all reported an association between at least one pollutant and cognitive dysfunction. However, relatively few studies considered outcomes that provide the most substantial evidence for a causal effect. In total, 5 studies have reported on cognitive function. The pooled mean of cognitive function was 12.16 (95% CI: 10.73 to 13.58). However, the heterogeneity was very high (I2=100%; chi-square test for heterogeneity = p<0.001). We used a modified JBI structured risk of the bias assessment tool, and it was minimal among the included studies as most of the studies have followed a random sampling method and explicitly mention it in their methods.

CONCLUSIONS

Exposure to indoor air pollution through fuels used for cooking and heating was significantly associated with cognitive dysfunction among elderly women. Given the limitations, a more extensive meta-analysis and longitudinal studies are recommended to investigate the biological mechanism behind the impact of indoor air pollution on cognitive health.

"LONG COVID": an insight

We aimed this systematic review to analyze and review the currently available published literature related to long COVID, understanding its pattern, and predicting the long-term effects on survivors. We thoroughly searched the databases for relevant articles till May 2021. The research articles that met our inclusion and exclusion criteria were assessed and reviewed by two independent researchers. After preliminary screening of the identified articles through title and abstract, 249 were selected. Consequently, 167 full-text articles were assessed and reviewed based on our inclusion criteria and thus 20 articles were regarded as eligible and analyzed in the present analysis. All the studies included adult population aged between 18 and above 60 years. The median length of hospital stay of the COVID-19 patients during the acute infection phase ranged from 8 days to 17 days. The most common prevalent long-term symptoms in COVID-19 patients included persistent fatigue and dyspnea in almost all of the studies. Other reported common symptoms included: shortness of breath, cough, joint pain, chest pain or tightness, headache, loss of smell/taste, sore throat, diarrhea, loss of memory, depression, anxiety. Associated cardiovascular events included arrhythmias, palpitations and hypotension, increased HR, venous thromboembolic diseases, myocarditis, and acute/decompensated heart failure as well. Among neurological manifestations headache, peripheral neuropathy symptoms, memory issues, concentration, and sleep disorders were most commonly observed with varying frequencies. Mental health issues affecting mental abilities, mood fluctuations namely anxiety and depression, and sleep disorders were commonly seen. Further, diarrhea, vomiting, digestive disorders, and Loss of appetite or weight loss are common gastrointestinal manifestations. Therefore, appropriate clinical evaluation is required in long COVID cases which in turn may help us to identify the risk factors, etiology, and to my help, we treat them early with appropriate management strategies.

Biodiversity of orb-web spiders (family: araneidae) of buner valley, Pakistan

The present research was carried out to explore the spider fauna of Buner valley with taxonomic study from February 2018 to January 2019. For this purpose samples were collected, four times at each month from 4 tehsils: Daggar, Gagra, Mandan and Totalai. Two methods were used, hand picking and sweep net for collection of samples. During day and night, three habitats, arid area, agriculture land and building area were search for collection. A total of 534 samples of spider were collected from four sampling sites, in which 379 were belonging to family Araniedae. After confirmation, the identified species were belonging to 8 genera (Neoscona, Argiope, Cyclosa, Araneus, Cyrtophora, Larinia, Erivoxia and Poltys) and 19 species. 18 of them were identified to specie level while a single specie to its generic level. The genus Neoscona was the dominant genus 26.31% having 5 species while the genus Argiope 21.05% is the second dominant having 4 species followed by Cyclosa 15.78% having 3 species followed by Cyrtophora and Araneus 10.52% having two species both. The Poltys and Larinia 5.26% are the rarest genera represent single-single specie both. Statistical analysis show that specie richness (D) = 5.77, Simpson index (1-D) = 0.87, Shannon index (H) = 2.33. Diversity of spiders was evenly distributed and calculated Evenness value was H/InS = 0.5408. There is also few atypical species and Fisher alpha estimate high value (Fisher α) = 4.42. Chao-1 estimated we have reported 22 species.

Comparative brain analysis of wild and hatchery reared Mahseer (Tor putitora) relative to their body weight and length

The present study was aimed at comparing the brain size of mahseer (Tor putitora) in relation to their body weight and standard length, to investigate the potential impact of rearing environment on brain development in fish. The weight of the brain and three of its subdivisions cerebellum (CB), optic tectum (OT), and telencephalon (TC) were measured for both wild and hatchery-reared fish. The data was analysed using multiple analysis of covariance (MANCOVA), analysis of covariance (ANCOVA), and discriminate function analysis (DFA). We found the fish reared under hatchery conditions exhibit smaller brain size related to body weight, when compared to the wild ones. A significant (p<0.5) difference was observed in the length of CB and OT concerning the standard body length while no significant difference was found in TC of the fish from both the origins. The results of the current study highlight a logical assumption that neural deficiency affects the behaviour of fish, that's why the captive-reared fish show maladaptive response and face fitness decline when released to the natural environment for wild stock enhancement. The current study concluded that hatchery-reared fish exhibit variations in gross brain morphology as compared to their wild counterpart.

Distribution of commensal rodents in some shops of three districts in Malakand region, Pakistan

Using wire mesh live traps distribution pattern of the Rattus rattus and Mus musculus in different shops of three districts of Malakand region, Pakistan were recorded from September 2014 to October 2015. Over all 103 rodents (Rattus rattus 86 and Mus musculus 17) were caught during in 0.04 trap success (2448 trap nights). Regression of daily captures on cumulative captures revealed an estimate of 103 rodents from all the sampled structures with an average of 3.55 rodents per shop. R. rattus; 83.4% of captures were numerically dominant in almost all types of shops sampled, and were significantly different than Mus musculus; 16.5% of captures. Both species were found together in some shops while they were mostly trapped from the separate shops. Male rodents outnumbered the females.

Oral health education in the undergraduate nursing curriculum of Australian and Malaysian institutions

INTRODUCTION

A high degree of training is necessary to prepare student nurses for their roles as oral healthcare partners that can promote a holistic approach to health in the community. This study aims to determine the extent of oral health education in Australian and Malaysian nursing institutions, as well as investigate educators' perceptions of education and practice in this area of care.

METHODOLOGY

An audio-recorded, semi-structured qualitative phone interview was conducted with the heads of 42 nursing schools across Australia (n = 35) and Malaysia (n = 7) during the 2015 academic year. Qualitative data were analysed via thematic analysis. Quantitative data, wherever appropriate, were measured for frequencies.

RESULTS

The response rate was 34.2% (n = 12) and 71.4% (n = 5) for the Australian and Malaysian subjects, respectively. Findings revealed that although all the nursing schools measured provided didactic and clinical training in oral health, curriculum content, expected learning outcomes, amount of clinical exposure and assessment approach lacked consistency. Most nursing educators across both countries perceived an overloaded curriculum as a barrier to providing oral health education. Whilst educators demonstrated their support for training in this area of care, they expressed the need for an established national guideline that highlights the educational requirement for future nurses in oral health maintenance and their scope of practice.

CONCLUSION

This study provides valuable information for further developing oral health education for nurses, to improve their competency and ultimately the health of the communities that they will serve.

Cutaneous leishmaniasis-Awareness, knowledge and practices among general population in rural and urban areas in Malakand region, Pakistan

Malakand region is an endemic area for cutaneous leishmaniasis (CL). However, there are limited number of studies of this disease in Pakistan. Therefore, a study was conducted to understand the level of awareness attitude and practice among the residents of Makaland towards CL and the disease vectors. This study adopted a cross-sectional approach with a total of 400 respondents (n=93 rural and n= 307 urban). Overall, the population in Malakand region (61.2%) were well-informed in the role of sand fly in transmitting diseases, but most lack knowledge on the vector's behavior and almost a quarter (24.5%) were unable to provide knowledge on proper control measures. Alarmingly, the practice and attitudes of the general population was not satisfactory as close to half (49.8%) of the population did adopt any control method. This study calls for increase in awareness through health education campaign to reduce the risk of cutaneous leishmaniasis outbreaks in the future.

Perceptions of oral health education and practice among nursing students in Malaysia and Australia

OBJECTIVE

Representing the largest proportion of healthcare workers, nurses play a significant role in oral health (OH) maintenance as part of a larger effort to promote holistic patient care. The study aims to determine nursing students' perceptions of OH education and practice in Malaysian and Australian nursing schools.

MATERIALS AND METHODS

A self-administered questionnaire (content- and face-validated) survey was undertaken, classroom style, amongst final-year nursing students from selected Malaysian (n = 122, Response rate=97.6%) and Australian (n = 299, Response rate=54.7%) institutions. Quantitative data were analysed via Statistical Package for Social Science software (Chi-square and Fisher's exact tests, p ≤ 0.01).

RESULTS

Significantly more Malaysian nursing students, compared to those in Australia, reported having encountered patients with OH issues (98.4% vs. 82.9%), namely halitosis (87.7% vs. 62.2%), oral ulcers (63.1% vs. 41.1%), oral/dental trauma (36.9% vs. 21.1%) and caries in children (28.7% vs. 7.7%). Less than half of Malaysian and Australian nursing students reported that they received adequate OH training (48.4% vs. 36.6%, p ≤ 0.01), especially in detecting oral cancer (18.0.0% vs. 22.6%, p ≤ 0.01) and preventing oral diseases (46.7% vs. 41.7%, p ≤ 0.01). Students in both countries demonstrated positive attitudes and believed in their role in OH care. Most students agreed that they should receive training in OH, especially in smoking cessation and providing OH care for patients with special needs. They also opined that a standardized evidence-based oral hygiene protocol is needed.

CONCLUSION

Support for education and practice in this area of patient care suggested positive implications for further development of nurses' roles in OH promotion and management.

Extramural Oral Health Educational Program Involving Individuals With Disabilities: Impact on Dental Students' Professionalism

Context

Oral health inequalities experienced by patients, including people with disabilities (PWD), have been related to dentists' lack of professionalism and inadequate experience in managing patients with special needs.

Aims

This study investigated the impact of an extramural program involving PWD on dental students' professionalism and students' perception of training in managing patients with special needs.

Materials and Methods

A group of 165 undergraduate dental students (year 1 to year 5) participated in a voluntary program, involving 124 visually impaired children, at a special education school in Kuala Lumpur, Malaysia. A dedicated module in oral health was developed by specialists in special care dentistry, pedodontics, and medical sciences. Dental students then participated in a semi-structured focus group interview survey to discuss perceptions of their learning experiences. Qualitative data were analyzed via thematic analysis.

Results

The program had positive impact on various aspects categorized into four major domains: professional knowledge (e.g., understanding of oral-systemic-social-environmental health interaction and understanding of disability), professional skills (e.g., communication and organizational skills), professional behavior (e.g., empathy and teamwork), and value-added learning (e.g., photography and information technology skills). Students showed improved willingness to manage, and comfort in managing PWD, and expressed support for future educational programs involving this patient cohort.

Conclusion

Improved knowledge, skills, attitudes, and personal values, as well as support for future programs, indicate the positive impact of extramural educational activities involving PWD in developing professionalism in patient care, while providing an opportunity for students to be exposed to managing patients with special needs.

Perception of Special Needs Dentistry education and practice amongst Australian dental auxiliary students

INTRODUCTION

The role of dental auxiliaries in collaborative care of patients with special needs is compelling. This study was undertaken to investigate the perceptions of Special Needs Dentistry (SND) education and practice amongst students enrolled in Australian programmes in dental auxiliary, namely dental hygiene, dental therapy and oral health therapy (DH/DT/OHT).

MATERIALS AND METHODS

All Australian institutions offering DH/DT/OHT programmes (n = 14) were invited to participate in a self-administered questionnaire survey, conducted online, involving students across all academic years. Twelve institutions agreed to participate, but only five institutions were included in the final analysis, with a student response rate of 31.1%. Answers to open-ended questions were coded and grouped for measurement of frequencies. Quantitative data were analysed via chi-squared and Fisher's exact tests (significance taken as P < .05).

RESULTS

The majority of students could not define SND (87.0%) were not aware of the existence of this specialty (53.5%) and did not have clinical experience treating patients with special needs (68.9%). Nevertheless, they felt comfortable and positive about treating these patients independently. Most agreed that they should receive clinical and didactic education in SND, with many of them expressing interest in pursuing a specialty training in this field.

CONCLUSION

DH/DT/OHT students' comfort levels, positive attitudes and supportiveness for SND suggested positive implications for these practitioners to partake in multidisciplinary management of patients with special needs, thus indicating the need for standardised training requirements and practice guidelines in this area of care.

Educating medical students in oral health care: current curriculum and future needs of institutions in Malaysia and Australia

Poor oral health has been associated with compromised general health and quality of life. To promote comprehensive patient management, the role of medical professionals in oral health maintenance is compelling, thus indicating the need for educational preparation in this area of practice. This study aimed to determine the extent of training in oral health in Malaysian and Australian medical schools. An audio-recorded semi-structured phone interview involving Academic Programme Directors in Malaysian (n = 9, response rate=81.8%) and Australian (n = 7, response rate = 35.0%) medical schools was conducted during the 2014/2015 and 2014 academic years, respectively. Qualitative data was analysed via thematic analysis, involving coding and grouping into emerging themes. Quantitative data were measured for frequencies. It was found that medical schools in Malaysia and Australia offered limited teaching of various oral health-related components that were mostly integrated throughout the curriculum, in the absence of structured learning objectives, teaching methodologies and assessment approaches. Barriers to providing oral health education included having insufficient expertise and overloaded curriculum. As medical educators demonstrated support for oral health education, collaboration amongst various stakeholders is integral to developing a well-structured curriculum and practice guidelines on oral health management involving medical professionals.

Association between body mass index, diet and dental caries in Grade 6 boys in Medina, Saudi Arabia

The prevalence of obesity is increasing in Saudi Arabia and although caries is associated with obesity, this association has not been investigated in Medina. This study aimed to determine the association between dental caries, body mass index (BMI) and dietary habits of 12-year-old boys from four geographically distinct schools in Medina. Mean BMI was 22.17 kg/m² (± 5.15); 41% had normal BMI, 25% were overweight and 30% were obese. The mean Decayed, Missing and Filled Teeth (DMFT) score was 1.46 (± 2.04). Those in the normal BMI range had a significantly higher prevalence of caries (57%) and DMFT score (1.92) compared with the overweight and obese groups (P < 0.05). These differences remained significant after controlling for possible confounders via linear regression. Mean BMI was significantly lower in boys with severe compared with mild or no caries. Normal and underweight participants had an almost 2 times greater risk of developing caries compared with their overweight and obese counterparts. The children had poor dietary habits and there were no significant associations between dietary variables and caries.

Alpha-Glucosidase Enzyme Biosensor for the Electrochemical Measurement of Antidiabetic Potential of Medicinal Plants

A biosensor for measuring the antidiabetic potential of medicinal plants was developed by covalent immobilization of α-glucosidase (AG) enzyme onto amine-functionalized multi-walled carbon nanotubes (MWCNTs-NH2). The immobilized enzyme was entrapped in freeze-thawed polyvinyl alcohol (PVA) together with p-nitrophenyl-α-D-glucopyranoside (PNPG) on the screen-printed carbon electrode at low pH to prevent the premature reaction between PNPG and AG enzyme. The enzymatic reaction within the biosensor is inhibited by bioactive compounds in the medicinal plant extracts. The capability of medicinal plants to inhibit the AG enzyme on the electrode correlates to the potential of the medicinal plants to inhibit the production of glucose from the carbohydrate in the human body. Thus, the inhibition indicates the antidiabetic potential of the medicinal plants. The performance of the biosensor was evaluated to measure the antidiabetic potential of three medicinal plants such as Tebengau (Ehretis laevis), Cemumar (Micromelum pubescens), and Kedondong (Spondias dulcis) and acarbose (commercial antidiabetic drug) via cyclic voltammetry, amperometry, and spectrophotometry. The cyclic voltammetry (CV) response for the inhibition of the AG enzyme activity by Tebengau plant extracts showed a linear relation in the range from 0.423-8.29 μA, and the inhibition detection limit was 0.253 μA. The biosensor exhibited good sensitivity (0.422 μA/mg Tebengau plant extracts) and rapid response (22 s). The biosensor retains approximately 82.16 % of its initial activity even after 30 days of storage at 4 °C.

Role of metabolic phenotyping in understanding obesity and related conditions in Gulf Co-operation Council countries

Obesity is a major health concern in the Middle East and the incidence is rising in all sections of the population. Efforts to control obesity through diet and lifestyle interventions, and by surgical means, have had limited effect, and the gene-environment interactions underpinning the development of obesity and related pathologies such as metabolic syndrome, cardiovascular disease and certain cancers are poorly defined. Lifestyle, genetics, inflammation and the interaction between the intestinal bacteria and host metabolism have all been implicated in creating an obesogenic environment. We summarize the role of metabolic and microbial phenotyping in understanding the aetiopathogenesis of obesity and in characterizing the metabolic responses to surgical and non-surgical interventions, and explore the potential for clinical translation of this approach.

Natural products are the future of anticancer therapy: Preclinical and clinical advancements of Viscum album phytometabolites

Cancer is a multifaceted and genomically complex disease. Research over the years has gradually provided a near complete resolution of cancer landscape and it is now known that genetic/epigenetic mutations, inactivation of tumor suppressors, Overexpression of oncogenes, spatio-temporally dysregulated intracellular signaling cascades, epithelial to mesenchymal transition (EMT), metastasis and loss of apoptosis are some of the most extensively studied biological mechanisms that underpin cancer development and progression. Increasingly it is being realized that current therapeutic interventions are becoming ineffective because of tumor heterogeneity and rapidly developing resistance against drugs. Considerable biological activities exerted by bioactive ingredients isolated from natural sources have revolutionized the field of natural product chemistry and rapid developments in preclinical studies are encouraging. Viscum album has emerged as a deeply studied natural source with substantial and multifaceted biological activities. In this review we have attempted to provide recent breakthroughs in existing scientific literature with emphasis on targeting of protein network in cancer cells. We partition this review into different sections, highlighting latest information from cell culture studies, preclinical and clinically oriented studies. We summarized how bioactive ingredients of Viscum album modulated extrinsic and intrinsic pathways in cancer cells. However, surprisingly, none of the study reported stimulatory effects on TRAIL receptors. The review provided in-depth analysis of how Viscum album modulated Endoplasmic Reticulum Stress in cancer cells and how bioactive chemicals tactfully targeted cytoskeletal machinery in cancer cells as evidenced by cell culture studies. It is noteworthy that Viscum album has entered into various phases of clinical trials, however, there are still knowledge gaps in our understanding regarding how various bioactive constituents of Viscum album modulate intracellular signaling cascades in cancer. Better and deeper comprehension oncogenic signaling cascades will prove to be helful in getting a step closer to individualized medicine.

Special needs dentistry: perception, attitudes and educational experience of Malaysian dental students

A compromised oral health condition amongst patients with special health care needs (SHCN) has been associated with the reluctance and shortage of skills of dental professionals in managing such patients. Lack of training and experience at the undergraduate level are reported barriers to the provision of care for this patient cohort. Undergraduate education therefore, plays an important role in producing professionals with the knowledge, skills and positive attitude in treating patients with SHCN. This study aims to determine the level of knowledge, comfort and attitudes of Malaysian undergraduate dental students towards caring for patients with SHCN, as well as their perception on education in this field. A self-administered questionnaire was administered in the classroom style to final year undergraduate dental students in Malaysian public dental schools. Most students were aware of Special Needs Dentistry (SND) as a specialty after being informed by academic staff. The majority of the students demonstrated poor knowledge in defining SND and felt uncomfortable providing care for such patients. They perceived their undergraduate training in SND as inadequate with most students agreeing that they should receive didactic and clinical training at undergraduate level. A high percentage of students also expressed interest in pursuing postgraduate education in this area of dentistry despite the lack of educational exposure during undergraduate years. The study supports a need for educational reform to formulate a curriculum that is more patient-centred, with earlier clinical exposure in various clinical settings for students to treat patients with special health care needs, applying the concept of holistic care in a variable clinical condition.

Oral health status of 12-year-old male schoolchildren in Medina, Saudi Arabia

Studies from Saudi Arabia have reported that the prevalence of dental caries among children is relatively high compared with other developing countries The aim was to determine the oral hygiene status and significant caries (SiC) index of 12-year-old males in Medina . In a cross-sectional, analytical study 360 students participated from 4 boys' schools. Dental caries, plaque, gingivitis, fluorosis and malocclusion were recorded using standard methods and indices. The mean DMFT score was 1.53 (SD 1.88). Caries prevalence was low (57.2%) but the mean SiC index was relatively high [3.63 (SD 1.66)]. The prevalences of plaque and gingivitis were high (82.8% and 70.8% respectively). Lower molars had the highest rate of caries. No children presented with dental fluorosis and 82.5% had a class I jaw relationship. Oral hygiene awareness programmes at schools, together with brushing and flossing programmes, are recommended in order to maintain and improve the oral health of young children in Medina.

Undergraduate education in special needs dentistry in Malaysian and Australian dental schools

Meeting the oral health care needs of the growing population of people with special health care needs (SHCN) starts with dental students' acquisition of sound knowledge and development of clinical competence at the predoctoral level. The aim of this study was to review the level of undergraduate education in Special Needs Dentistry (SND) in Malaysian and Australian dental schools. The deans of all six Malaysian public dental schools and eight of nine Australian dental schools participated in a postal survey on current undergraduate didactic and clinical training in SND at their institutions. The results showed the number of dental schools in Malaysia with teaching in SND as a specific discipline was relatively low compared to that of Australia. However, a high percentage of Malaysian and Australian dental schools reported incorporating teaching of SND into pediatric dentistry (83.3 percent vs. 75 percent), oral medicine/oral pathology (66.7 percent vs. 75 percent), and oral surgery (66.7 percent vs. 25 percent). Most respondents said their school delivered SND clinical training in dental school clinics, hospital-based settings, and residential aged care facilities. Respondents in both countries viewed lack of faculty expertise as the greatest barrier to providing SND education. The study provides valuable information that can direct SND curriculum development in the two countries.

Angiomyofibroblastoma of the vulva: report of a rare distinct entity

Angiomyofibroblastoma is a rare benign mesenchymal tumor of lower female genital tract. It has characteristic histomorphology and shows myofibroblastic differentiation. Clinically it is imperative to differentiate angiomyofibroblastoma from other mesenchymal tumors of this region especially aggressive angiomyxoma which is locally infiltrative and needs long term followup. We report clinical, histological, and immunohistochemical features of a case of angiomyofibroblastoma and discuss relevant points regarding histogenesis and biological behaviour. We stress the need to recognize this tumor on clinicopathologic basis to avoid any potential therapeutic implications.

Intravenous leiomyomatosis of the uterus

Intravenous leiomyomatosis (IVL) is a rare neoplasm characterized by nodular masses of histologically benign looking smooth muscle cells growing within uterine or extrauterine venous system.The exact etiology is unclear and benign histological appearance of neoplastic smooth muscles can be deceptive since IVL might behave in a malignant fashion. Total abdominal hysterectomy and excision of any extrauterine tumor if technically feasible is the cornerstone of treatment. We report clinical, histological, and immunohistochemical features of a uterine IVL in a 48 year old lady who presented with menorrhagia. We also elaborate etiopathogenesis and conclude that knowledge about IVL is essential as it must be differentiated from malignant tumors to prevent overtreatment. Long term follow up is recommended in such cases.

A new record of Fannia pusio (Wiedemann) (Diptera:Fanniidae) from Malaysia

Fannia pusio (Wiedemann) (Diptera: Fanniidae) is newly recorded from Malaysia. This record is based on 1male symbol 1female symbol from Sarawak, east Malaysia and 1male symbol 2female symbol from Selangor, peninsular Malaysia. It is included in the pusio group of Fannia wherein are included Fannia femoralis (Stein), Fannia howardi Malloch, Fannia trimaculata (Stein), Fannia leucosticta (Meigen) and Fannia punctiventris Malloch. The male of Fannia pusio is differentiated from other members of the group by the following features: hind femur with a swelling bearing a number of setae that are usually curled at tip; squamae creamy; tergite 1+2 broadly grey dusted at sides.

Epidemiological and etiological study of oral submucous fibrosis among gutkha chewers of Patna, Bihar, India

An etiological and epidemiological study of oral submucous fibrosis (OSMF) has been done in Patna, Bihar. Total 157 cases of OSMF and 135 control subjects were selected for study in the period of 2002-2004. It was observed that Male:Female ratio was 2.7:1. The youngest case of OSMF was 11 year old and the oldest one was 54 years of age. Maximum number of cases were belonging to 21-40 years of age and they were belonging to low or middle socioeconomic class. Most of the OSMF cases used heavy spices and chillies, where as control mild spices and chillies. Gutkha was the most commonly used by the OSMF cases only 3 per cent did not use any gutkha or other areca nut product where as 80 per cent control did not have any chewing habit. The OSMF cases used gutkha and other products 2-10 pouches per day and kept in the mouth for 2-10 minutes and they were using since 2-4 years. Most of the OSMF cases kept gutkha in the buccal vestibule or they chewed and swallowed it, only a small number of patients chewed and spitted it out. It was also observed that OSMF developed on one side of the buccal vestibule where they kept the chew and other side was normal.

Prevalence of seromarkers of HBV and HCV among blood donors in eastern Saudi Arabia, 1998-2001

The prevalence of serological markers of HBV and HCV were determined for blood donors in eastern Saudi Arabia. Between 1998 and 2001, 13,443 donors (10,778 Saudi and 2665 non-Saudi), were screened for HBsAg, anti-HBc Ab, and anti-HCV Ab using commercial kits. There was a steady decrease in the HBsAg (2.58 and 1.67%), anti-HBc rates (15.32 and 9.15%), and anti-HCV (1.04 and 0.59%) rates between 1998 and 2001, respectively. However, there was a marked difference between Saudi and non-Saudi donors with regard to anti-HBc (P < 0.001) and anti-HCV (P < 0.01), but not HBsAg prevalence rates in the same time period.

Influence of storage environment, surface coating, and individual shrink wrapping on quality assurance of guava (Psidium guajava) fruits

Guava (Psidium guajava) fruits of cv. L-49 with individual shrink wrapping using 9 micro LLDPE film could be successfully stored up to 12 days at ambient and 18 days in evaporative cool chamber with negligible loss in vitamin C content. The untreated fruits lose 25-30% of ascorbic acid within 1 week after harvest. Delay in senescence and metabolic activities as supported by less changes in soluble solids, sugars, acidity, respiration, and ethylene evaluation rate was also observed in individual shrink wrapped fruits in cool chamber. The spoilage of fruits by Fusarium rots was significantly less in cool chamber in individually shrink wrapped fruits followed by Sta-fresh treatment. Sta-fresh was more effective in cool chamber than ambient. Individually stored wrapped fruits scored a better value of sensory score than Sta-fresh under both the storage condition.

Polyphasic taxonomy of symbiotic rhizobia from wild leguminous plants growing in Egypt

About 20 strains of rhizobia from wild legumes were characterized based on numerical analysis of phenotypic characteristics, nodulating ability, fatty acid methyl esters (FAME) and SDS-PAGE profiles of whole cell proteins. FAME analysis revealed that palmitic (16:0), stearic (18:0) and arachidonic (20:0) were detected in most of wild-legume rhizobia, the latter being uncommon in fatty acid profiles of Rhizobium and Sinorhizobium. Numerical analysis of FAME classified strains of wild-legume rhizobia into 9 clusters and one heterogeneous group. There was both agreement and disagreement with the clustering data based on phenotypic analysis and FAME analysis. Four strains were grouped together in the same cluster based on both methods. However, 4 another strains, which were placed in one cluster of phenotypic analysis, were distributed in several clusters after FAME analysis. SDS-PAGE of whole-cell proteins revealed that the rhizobial strains exhibited protein profiles with peptide bands ranging from 5-19 band per profile and showed molar mass of 110-183 kDa. As in the case of FAME analysis, numerical analysis of protein bands was compared with clustering of phenotypic analysis. Agreement of the two methods was obvious when clustering some strains but conflicted in the classification of some other strains. However, integration of the three methods could be the basis of a polyphasic taxonomy. The twenty strains of wild-legume rhizobia were finally classified as follows: 12 strains related to Rhizobium leguminosarum, 5 strains related to Sinorhizobium meliloti and 3 strains to Rhizobium spp. Rhizobia nodulating wild herb legumes are among indigenous strains nodulating crop legumes in cultivated as well as noncultivated lands.

Frequency of ABO blood groups in the Eastern region of Saudi Arabia

OBJECTIVE

To document the frequency of the ABO and Rhesus blood groups in Saudi male donors, and to compare our results with the results of other studies in the Kingdom and elsewhere.

METHODS

This study included a total of 57396 male potential blood donors; 19496 blood donors between the years 1985-1989 (referred to as first period of study) and 37700 blood donors between the years 1995-1999 (2nd period). The blood donors were Saudis, coming to donate blood for various reasons to the Blood Bank Department of King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia. ABO and Rhesus blood groups from 200 Saudi females were also determined. The frequency of ABO blood groups and Rhesus status were calculated separately.

RESULTS

Our results revealed the most common blood group was O, (52%) during the first period of study and likewise the most common blood group (51%) during the 2nd period. The lowest blood group frequency was AB (4%) and (4%) during the first and 2nd period. Rhesus positive blood donors comprised 93% and Rhesus-negative donors were 7% during the first period, while they amounted to 91.5% and 8% during the 2nd period. Overall frequency of ABO and Rhesus blood groups during the 2 periods were the following: O-positive 48% and 46%; A-positive 24% and 24.5%; B-positive, 17% and 17%; AB positive 4% and 4%; O negative 4% and 5%; A negative 2% and 2%; B-negative 1% and 2%; and AB negative, 0.23% and 0.32%. Comparison of our results with the other studies from the Kingdom and other nationalities is also presented.

CONCLUSION

Our results show that the most frequent blood group in Saudis is O-positive. Blood group A is observed at a lower frequency relative to values from Western populations, whereas a significant increase in blood group B combined with a slight increase in blood group AB was recorded. Knowledge of the frequencies of the different blood groups in Saudi Arabia is very important for Blood Banks and transfusion service policies. Knowledge of blood group phenotype distribution is also important for clinical studies (for example disease association), as well as for population studies.

Alkaloids from Haplophyllum tuberculatum

Two new alkaloids, haplotubinone (3) and haplotubine (4), were isolated from the aerial parts of Haplophyllum tuberculatum together with the known lignan diphyllin. The structures of the new alkaloids were established by spectroscopic methods in conjunction with X-ray crystallographic analysis of 3. In addition, the amide N-(2-phenylethyl)-benzamide has been identified in this source for the first time.

Labdane diterpenes from Otostegia fruticosa

The new labdane diterpenes otostegin A (2), otostegin B (6) and 15-epi-otostegin B (7) were isolated from the aerial parts of Otostegia. fruticosa, besides the previously known labdanes preleoheterin (1), leoheterin (3), leopersin C and 15-epi-leopersin C (4, 5), ballonigrin (9) and vulgarol (11), along with the iridoid glucoside 8-O-acetylharpagide (10). The structure elucidation of all the isolated compounds was based on their spectral data and chemical derivatization.

Butyrate and glucose metabolism by colonocytes in experimental colitis in mice

BACKGROUND/AIMS

Impaired colonocyte metabolism of butyrate has been implicated in the aetiopathogenesis of ulcerative colitis. Colonocyte butyrate metabolism was investigated in experimental colitis in mice.

METHODS

Colitis was induced in Swiss outbred white mice by oral administration of 4% dextran sulphate sodium (DSS). Colonocytes isolated from colitic and normal control mice were incubated with [(14)C]butyrate or glucose, and production of (14)CO(2), as well as of intermediate metabolites (acetoacetate, beta-hydroxybutyrate and lactate), was measured. The effect of different substrate concentrations on oxidation was also examined.

RESULTS

Butyrate oxidation (micromol/h per mg protein; mean (SEM)) was significantly reduced in DSS colitis, values on day 7 of DSS administration being 0.177 (0.007) compared with 0.406 (0.035) for control animals (p<0.001). Glucose oxidation (micromol/h per mg protein; mean (SEM)) on day 7 of DSS administration was significantly higher than in controls (0.06 (0.006) v 0.027 (0.004), p<0.001). Production of beta-hydroxybutyrate was decreased and production of lactate increased in DSS colitis compared with controls. Increasing butyrate concentration from 10 to 80 mM enhanced oxidation in DSS colitis (0.036 (0.002) to 0.285 (0.040), p<0.001), although it continued to remain lower than in controls. Surface and crypt epithelial cells showed similar ratios of butyrate to glucose oxidation. When 1 mM DSS was added to normal colonocytes in vitro, it did not alter butyrate oxidation. The initial histological lesion of DSS administration was very patchy and involved crypt cells. Abnormal butyrate oxidation became apparent only after six days of DSS administration, at which time histological abnormalities were more widespread.

CONCLUSIONS

Colonocyte metabolism of butyrate, but not of glucose, is impaired in DSS colitis, and may be important in pathophysiology. Histological abnormalities preceded measurable defects in butyrate oxidation.

New products from the reactions of artemisinin with ammonia and amines

Reaction of artemisinin (1) with ammonia, methylamine, dimethylamine, and allylamine afforded five unexpected products 2-6, in addition to the previously reported compounds 7-12. The identities of the new compounds were established from their spectral data, by chemical derivatization and by comparison with published reports. The stereochemistries of compounds 5 and 6 were confirmed by single-crystal X-ray analysis.

Prevalence of antibodies against the hepatitis C virus among voluntary blood donors at a makkah hospital

One thousand four hundred and thirty nine voluntary blood donors attending the blood transfusion department at Al Noor Specialist Hospital, Makkah were screened for antibodies against hepatitis C virus (anti-HCV) by second generation enzyme linked immunosorbant assay (ELISA). A total of 52 donors (3.6%) were anti-HCV positive. Anti-HCV was detected in 1.7% of the Saudi donors as compared to 6.9% among Non-Saudi donors. Scrutiny of the data revealed a higher rate of anti-HCV in the age-group of above 40 years than in the other age groups. Further, when Non-Saudi blood donors were analysed according to their nationalities, Egyptian donors showed a prevalence of 27.2% of anti-HCV followed by Pakistanis (1.9%), Bangladeshis (1.9%), Yemenis (1.5%) and other nationalities (0.5%). When blood samples from 92 patients on maintenance hemodialysis were tested for anti-HCV, 75 (81.5%) patients were found positive for anti-HCV. We conclude that the prevalence of anti-HCV among blood donors in the Makkah region of Saudi Arabia is high and routine screening for anti-HCV should be conducted for all blood donors before they are accepted for donation.

A situation analysis of public family planning service delivery in pakistan

A nationally representative sample of 8 percent of the Government of Pakistan's primary family planning service facilities, the Family Welfare Centres (FWC), was carried out at the request of the Ministry of Population Welfare in mid-1992. The "situation analysis" approach used involved: 1) observation and inventory of services, facilities, supplies and record keeping reviews; 2) observation of interaction between service providers and FP clients at FWC's; 3) interviews with service providers; and 4) exit interviews with FP clients after service provision. This one-day on-site observation by teams of three interviewers provided a unique overview and baseline assessment of the availability of services, the staff functioning and the quality of service. Significant findings include a low caseload, inadequacies of facilities, some stockouts, lack of educational materials, insufficient outreach, unnecessary medical and social barriers to providing contraception as well as in some cases insufficient information to clients about contraindications to contraceptive usage and possible side-effects. The need to bolster in-service training and supervision is emphasized.

Multifocal Langerhans cell histiocytosis of the jaws: a case report

Langerhans cell histiocytosis is an uncommon disease that includes a spectrum of disorders in which there is an abnormal proliferation of Langerhans cells. This article describes a case of a benign form of multifocal Langerhans cell histiocytosis of the maxilla and mandible. The patient was followed for a period of 2 1/2 years, during which time there was spontaneous remission of some of the lesions.

Hürthle cell lesions in thyroid neoplasms

A study of nine cases of Hürthle cell lesions of the thyroid seen in a period of five years at Al-Adan Hospital, Kuwait, is presented. Chart review of physician's contact, patient follow-up and histopathological review showed two cases (22%) were due to Hürthle cell hyperplasia only, and seven (78%) were Hürthle cell tumours, of which Hürthle cell carcinoma was seen in three cases (33%) and Hürthle cell adenoma in four (44%). Of the four cases with adenoma, three (33%) had solitary lesions and one had an associated papillary carcinoma. The extent of primary surgical treatment did not affect the prognosis of adenoma. It is suggested that lobectomy with isthmectomy should be sufficient treatment for Hürthle cell adenoma, while more radical surgery should be reserved for cases with accepted malignant criteria.

Saudi folk medicine: phytochemical and antimicrobial screening

Plants of 25 families, encompassing 30 species were selected on the basis of their folklore uses and literature data for the present screening. Besides phytochemical screening the plant extracts were prepared and tested for their antimicrobial activity. The result of the testing showed that about 77% of these plants exhibited some level of antibacterial activity. The most common chemical constituents found in these plants were sterols and/or triterpenes, falvonoids, alkaloids and tannins. Volatile oils, volatile bases, saponins, coumarins, anthraquinones and cardiac glycosides were also detected.