RESUMEN
The incidence of caesarean section for breech presentation has increased markedly in the last 20 years. A prospective, interventional cohort study was carried out of the success rate of external cephalic version (ECV) and its predictors of as well as its impact on the rate of caesarean section for vaginal breech delivery. All 128 women admitted during the study period to the obstetrics department of a tertiary care military hospital in Taif, Saudi Arabia with breech presentation at term, regardless of age and parity, who accepted ECV were recruited. ECV was successful in 53.9% of the women. Most of the women with successful ECV delivered normally (84.1%) and only 14.5% of them delivered by caesarean section. Conversely, normal vaginal delivery was reported among 8.5% of those who had spontaneous version with failed ECV and approximately two-thirds of them delivered by caesarean section (62.7%). Successful ECV reduced the breech and caesarean section rate.
Asunto(s)
Presentación de Nalgas/prevención & control , Cesárea/estadística & datos numéricos , Versión Fetal/estadística & datos numéricos , Adulto , Estudios de Cohortes , Parto Obstétrico/estadística & datos numéricos , Femenino , Hospitales Militares , Humanos , Embarazo , Estudios Prospectivos , Arabia Saudita , Resultado del TratamientoRESUMEN
Job-related burnout is an occupational hazard for health care professionals. This study aimed to determine the prevalence of burnout and its associated factors among physicians working at primary health care centres in Asir province, Saudi Arabia. In a cross-sectional survey applying the Maslach Burnout Inventory (MBI) with standard cutoffs, 29.5% of respondents reported high emotional exhaustion, 15.7% high depersonalization and 19.7% low personal accomplishment, with 6.3% scoring high in all 3 dimensions. High emotional exhaustion score was associated with younger age, Saudi nationality and salary 15,000-20,000 SR. Physicians who had more working days and those who had longer duration of annual vacation were less likely to report emotional exhaustion. High depersonalization score was associated with Saudi nationality, working for 5-15 years and salary > 20,000 SR. Low personal accomplishment score was associated with younger age, non-Saudi nationality, working for > or =5 years and more annual vacation.
Asunto(s)
Agotamiento Profesional/epidemiología , Despersonalización/psicología , Fatiga/psicología , Médicos de Atención Primaria/psicología , Adulto , Análisis de Varianza , Agotamiento Profesional/etiología , Agotamiento Profesional/psicología , Estudios Transversales , Despersonalización/complicaciones , Fatiga/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Médicos de Atención Primaria/estadística & datos numéricos , Prevalencia , Factores de Riesgo , Arabia Saudita/epidemiología , Encuestas y CuestionariosRESUMEN
The incidence of caesarean section for breech presentation has increased markedty in the last 20 years. A prospective, interventional cohort study was carried out of the success rate of external cephalic version [ECV] and its predictors of as well as its impact on the rate of caesarean section for vaginal breech delivery. All 128 women admitted during the study period to the obstetrics department of a tertiary care military hospital in Taif Saudi Arabia with breech presentation at term, regardless of age and parity, who accepted ECV were recruited ECV was successful in 53.9% of the women. Most of the women with successful ECV delivered normally [84.1%] and only 14.5% of them delivered by caesarean section. Conversely, normal vaginal delivery was reported among 8.5% of those who had spontaneous version with failed ECV and approximately two-thirds of them delivered by caesarean section [62.7%]. Successful ECV reduced the breech and caesarean section rate
Asunto(s)
Presentación de Nalgas , Cesárea , Embarazo , Estudios Prospectivos , Estudios de Cohortes , Parto Obstétrico , Modelos Logísticos , Versión FetalRESUMEN
Job-related burnout is an occupational hazard for health care professionals. This study aimed to determine the prevalence of burnout and its associated factors among physicians working at primary health care centres in Asir province, Saudi Arabia. In a cross-sectional survey applying the Maslach Burnout Inventory [MBI] with standard cutoffs, 29.5% of respondents reported high emotional exhaustion, 15.7% high depersonalization and 19.7% low personal accomplishment, with 6.3% scoring high in all 3 dimensions. High emotional exhaustion score was associated with younger age, Saudi nationality and salary 15 000-20 000 SR. Physicians who had more working days and those who had longer duration of annual vacation were less likely to report emotional exhaustion. High depersonalization score was associated with Saudi nationality, working for 5-15 years and salary > 20 000 SR. Low personal accomplishment score was associated with younger age, non-Saudi nationality, working for >/= 5 years and more annual vacation
Asunto(s)
Atención Primaria de Salud , Médicos de Atención Primaria , Factores de Riesgo , Prevalencia , Estudios Transversales , Emociones , Despersonalización , Médicos , Modelos Logísticos , Agotamiento ProfesionalRESUMEN
This cross-sectional study evaluated the immune status of non-vaccinated healthy infants to determine if it is possible to replace both measles vaccine [at 9 months] and measles, mumps and rubella [MMR] vaccine [at 18 months] with a single dose of MMR at 12 months. Serum samples from 566 children in Alexandria, Egypt showed a significant decrease in the seropositive rate to the 3 viral diseases with increasing age, but a significant increase in the seropositive rate among infants who were ranked 1st or 2nd in their family, full-term or born to mothers with no history of hypertension during pregnancy. We recommend administration of the first dose of MMR vaccine between 9 and 12 months of age, and a booster dose of MMR vaccine at 4 years of age
Asunto(s)
Vacuna Antisarampión , Estudios Transversales , Vacuna contra el Sarampión-Parotiditis-Rubéola , Edad GestacionalRESUMEN
This study aimed to estimate the rate of and risk factors for nosocomial pneumonia of patients admitted to hospitals in Taif, Saudi Arabia. A case-control study was conducted of 211 discharged patients with confirmed pneumonia and 633 controls without pneumonia and a review was made of hospital records during 1999-2003. Multiple logistic regression showed that duration of hospital stay, unit of admission, chronic obstructive pulmonary diseases, coma, nasogastric tube, endotracheal tube, debilitating diseases and mechanical ventilation were independently associated with increased risk of pneumonia. The mean incidence of overall nosocomial infection in the period 1999-2003 was 3 per 100 discharged patients, while the mean incidence of nosocomial pneumonia was 0.88.
Asunto(s)
Infección Hospitalaria/epidemiología , Infección Hospitalaria/etiología , Neumonía/epidemiología , Neumonía/etiología , Adolescente , Adulto , Distribución por Edad , Anciano , Análisis de Varianza , Antibacterianos/efectos adversos , Estudios de Casos y Controles , Infección Hospitalaria/prevención & control , Complicaciones de la Diabetes/complicaciones , Femenino , Humanos , Inmunosupresores/efectos adversos , Incidencia , Control de Infecciones , Intubación Gastrointestinal/efectos adversos , Intubación Intratraqueal/efectos adversos , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neumonía/prevención & control , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Respiración Artificial/efectos adversos , Factores de Riesgo , Arabia Saudita/epidemiología , Distribución por SexoRESUMEN
This study aimed to estimate the rate of and risk factors for nosocomial pneumonia of patients admitted to hospitals in Taif, Saudi Arabia. A case-control study was conducted of 211 discharged patients with confirmed pneumonia and 633 controls without pneumonia and a review was made of hospital records during 1999-2003. Multiple logistic regression showed that duration of hospital stay, unit of admission, chronic obstructive pulmonary diseases, coma, nasogastric tube, endotracheal tube, debilitating diseases and mechanical ventilation were independently associated with increased risk of pneumonia. The mean incidence of overall nosocomial infection in the period 1999-2003 was 3 per 100 discharged patients, while the mean incidence of nosocomial pneumonia was 0.88
Asunto(s)
Infección Hospitalaria , Neumonía Asociada al Ventilador , Factores de Riesgo , Estudios de Casos y Controles , Tiempo de Internación , Unidades de Cuidados Intensivos , Intubación Gastrointestinal , Enfermedad Pulmonar Obstructiva Crónica , NeumoníaRESUMEN
This study determined the prevalence and risk factors for flat foot among 18-21-year-old male Saudi Arabian army recruits. Among 2100 military recruits, the prevalence of flat foot was 5.0%. A case-control logistic regression analysis of risk factors (104 cases and 412 controls) showed family history, wearing shoes during childhood, obesity and urban residence were significantly associated with flat foot. No associated complaints were reported among the cases and thus flexible flat foot does not seem to be a cause of any disability.
Asunto(s)
Pie Plano/epidemiología , Pie Plano/etiología , Personal Militar/estadística & datos numéricos , Adolescente , Adulto , Índice de Masa Corporal , Estudios de Casos y Controles , Pie Plano/clasificación , Pie Plano/diagnóstico , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Obesidad/complicaciones , Obesidad/diagnóstico , Linaje , Vigilancia de la Población , Prevalencia , Características de la Residencia , Factores de Riesgo , Arabia Saudita/epidemiología , Zapatos/efectos adversos , Salud UrbanaRESUMEN
This study determined the prevalence and risk factors for flat foot among 18-21 year-old male Saudi Arabian army recruits. Among 2100 military recruits, the prevalence of flat foot was 5.0%. A case-control logistic regression analysis of risk factors [104 cases and 412 controls] showed family history, wearing shoes during childhood, obesity and urban residence were significantly associated with flat foot. No associated complaints were reported among the cases and thus flexible flat foot does not seem to be a cause of any disability
Asunto(s)
Pie Plano , Factores de Riesgo , Prevalencia , Obesidad , ZapatosRESUMEN
PURPOSE: To address the epidemiological characteristics and clinical indices that may predict the prognostic profile of meningitis among children. METHODS: Children admitted to Alexandria fever hospital with clinical diagnosis of meningitis/meningoencephalitis during the period 2002-2003 were recruited for the study. They were subjected to clinical examination as well as CSF bacteriological and serological investigations. RESULTS: Three hundred and ten patients (195 males and 115 females) were included. About 65.2% of them were infected with acute bacterial meningitis (ABM) and 34.8% were infected with aseptic meningitis. In this study, ABM was caused by Haemophilus influenzae (21%), Streptococcus pneumoniae (13.9%), Neisseria meningitidis (14.2%) and other undetermined bacteria (16.1%). ABM showed significant association with age group 1-9 years (66.3%), low socio-economic class (96%), working mother (83.2%), more than two smokers in the family (62.9%) and cold seasons (fall 35.1% and winter 48.5%). Aseptic meningitis showed significant association with age group 3-15 months (100%) and previous immunization (81.5%). The overall case fatality rate was 10.3%; 13.9% for ABM and 3.4% for aseptic meningitis. 7.1% of all survivors developed epileptic attacks. Predictors for death or epilepsy events were high WHO meningitis score (>or=9), decreased CSF glucose level (<10 mg/dL), more smokers in the family, generalised seizures, infancy (<1 year of age) and working mothers. CONCLUSION: This study highlights the importance of several predictors of the outcome of meningitis in children. It is concluded that quick and simple scoring scales, such as the WHO scale, are not only applicable but valuable prognostic tools for meningitis in children.
Asunto(s)
Haemophilus influenzae/aislamiento & purificación , Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/epidemiología , Enfermedad Aguda , Adolescente , Factores de Edad , Biomarcadores/líquido cefalorraquídeo , Niño , Preescolar , Egipto , Epilepsia/etiología , Femenino , Glucosa/líquido cefalorraquídeo , Hospitales Urbanos , Humanos , Lactante , Masculino , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/microbiología , Neisseria meningitidis/aislamiento & purificación , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Estaciones del Año , Clase Social , Streptococcus pneumoniae/aislamiento & purificación , Mujeres TrabajadorasRESUMEN
The tropical parasite Schistosoma mansoni causes granulomatous inflammation after its eggs lodge in hepatic portal capillaries. In vitro studies indicate that the host's response involves the production of reactive oxygen species, although whether this occurs in vivo at the site of the infection is unknown. The role of oxidative processes in mice infected with S. mansoni was investigated in the current study using the antioxidant melatonin. In Experiment 1, the survival rate of infected mice with and without daily melatonin (10 mg/kg) administration was determined. After 56 d, 25 of 25 infected mice that were diluent treated had died. In contrast, 22 or 25 infected mice (88%) given melatonin were still alive at 56 d. Of these 22 surviving mice, melatonin injections were continued in 11 while the 11 others were switched to diluent. Within 10 d, 11 of 11 diluent-injected mice that were infected with S. mansoni were dead while 6 of 11 melatonin-treated mice survived. In Experiment 2, S. mansoni-infected mice were treated for 30 d with either melatonin or diluent. Uninfected, untreated mice served as controls. In these mice, the levels of lipid peroxidation (LPO) products, vitamin E, nitric oxide (NO), glutathione (GSH), and superoxide dismutase (SOD) activity in the liver, kidney, and spleen were measured. In the serum, cholesterol levels and liver damage (alkaline phosphatase (ALP), aspartate transaminases (AST), total protein, and albumin) were monitored. In addition, peroxynitrite anion (ONOO(-)) in the liver and kidney and inducible nitric oxide synthase (iNOS) in the spleen were immunocytochemically localized. Also, histopathological changes in the liver, kidney, and spleen were examined. The results documented increased LPO and NO levels and decreased vitamin E, GSH, and SOD activity in the liver, kidney, and spleen of S. mansoni-infected mice. Also, there was an increase in serum cholesterol and evidence of liver damage in the infected mice. Immunohistochemical results indicated positive staining of ONOO(-) in the liver and kidney and positive iNOS staining in the spleen of S. mansoni-infected mice. Histopathological observations revealed granuloma formation in the liver with eosinophil infiltration, a large number of megakaryocytes in the spleen, and degeneration with necrotic cells in some tubules of the kidney cortex in the infected mice. Melatonin administration after S. mansoni infection prevented most of the previously described changes. These results suggest that oxidative processes occur at the site of inflammation and are involved in the damaging effects of schistosomiasis and indicate that free radicals may be a major component of the disease. Likewise, melatonin, presumably due to its antioxidant and free radical scavenging activity, is highly protective against the pathological changes associated with schistosomiasis.
Asunto(s)
Melatonina/farmacología , Schistosoma mansoni/patogenicidad , Fosfatasa Alcalina/metabolismo , Animales , Antioxidantes/farmacología , Radicales Libres , Glutatión/metabolismo , Inmunohistoquímica , Riñón/metabolismo , Riñón/parasitología , Peroxidación de Lípido , Masculino , Megacariocitos/metabolismo , Melatonina/metabolismo , Ratones , Óxido Nítrico/metabolismo , Óxido Nítrico Sintasa/metabolismo , Óxido Nítrico Sintasa de Tipo II , Estrés Oxidativo , Bazo/citología , Bazo/parasitología , Superóxido Dismutasa/metabolismo , Factores de Tiempo , Distribución Tisular , Vitamina E/metabolismoRESUMEN
To determine if the cell mediated immunity, induced by T-helper type-1 lymphocytes (Th1) response, during schistosomiasis mansoni has the potential to protect against infection, intensities of infections and re-infections, reflected in the egg count were followed up to 20 months among 119 individuals aged 5-22 years (Ys) with different number of previous infections whose yearly levels and pattern of water contact were similar. They were classified into 5 groups. Delayed hypersensitivity skin tests (DHT) to adult schistosome excretory-secretary antigens (ESAgs) and anti-schistosomula (ESAgs) isotypes were measured on detecting re-infection. The group with a mean age of (8.6 +/- 2.6 Ys) and infected less than 5 times showed only 6.5 percentage reduction of the egg count (PREC) and low cellular and humoral responses. Th1-associated cellular (DHT) and antibody responses (IgG2, IgG3) to the five infections were significantly higher in the (13.5 +/- 1.4 Ys) than in (18 +/- 2.2 Ys) age group. This was reflected in significant difference in PREC; being 41.5% among the first and 13.5% among the second. Th2-associated antibody responses (IgG1, IgG4, IgE) went on rising as patients allowed for age and number of infections increased over 5, being significantly higher in the (19 +/- 1.8 Ys) than in (14 +/- 1.1 Ys) age groups with PREC 45.5% and 12.9% respectively. These results imply a substantial protective role for cell mediated immunity in the pre-puberty stage and provide evidence that Th1-based vaccination strategy can work if augmented.
Asunto(s)
Envejecimiento/inmunología , Formación de Anticuerpos/inmunología , Inmunidad Celular/inmunología , Pubertad/fisiología , Esquistosomiasis mansoni/inmunología , Adolescente , Adulto , Animales , Anticuerpos Antihelmínticos/aislamiento & purificación , Niño , Preescolar , Egipto , Heces/parasitología , Femenino , Humanos , Masculino , Recuento de Huevos de Parásitos , Schistosoma mansoni/inmunologíaRESUMEN
BACKGROUND: Consanguinity has been a long-standing social habit among Egyptians. Estimates of consanguinity ratios in different parts of Egypt ranged from 29 to 50%. This study aimed at delineating the role of consanguinity and advanced maternal age on reproductive losses in Alexandria, Egypt. METHODS: A case-control study, on 730 couples with history of reproductive losses and 2,081 normal couples, was done during the period October, 1998 until August, 2000. RESULTS: Of the 730 couples with reproductive losses, consanguinity frequency was 68.8% with 56.2% first cousins. Prenatal loss and infant deaths were highly encountered among consanguineous marriages (p < 0.0001). In a multivariate logistic regression analysis, consanguinity between couples increased the relative risk of repeated abortion (OR: 3.95; 95% CI: 3.04-5.14), stillbirths (OR: 10.6; 95% CI: 6.7-17.0), neonatal death (OR: 17.2; 95% CI: 10.8-27.3), post-neonatal death (OR: 14.5; 95% CI: 10.6-19.9) and total reproductive losses (OR: 8.3; 95% CI: 6.9-10.1). A positive association was found between advanced maternal age and repeated abortion (OR: 3.19; 95% CI: 2.04-4.97) as well as total reproductive losses (OR: 2.37; 95% CI: 1.74-3.2). CONCLUSION: This study, the largest-reported case-control study on reproductive losses in Alexandria, strongly suggests that consanguinity may play a major role in the high rates of prenatal and infant mortality while advanced maternal age has a significant role in the causation of repeated abortion, and they must be taken into account for genetic counseling in Egypt. Because of the possibility of controlling, the study gives clear indications for prevention.
Asunto(s)
Consanguinidad , Muerte Fetal/etiología , Edad Materna , Embarazo de Alto Riesgo , Adulto , Estudios de Casos y Controles , Egipto/epidemiología , Femenino , Muerte Fetal/epidemiología , Muerte Fetal/genética , Asesoramiento Genético/métodos , Humanos , Mortalidad Infantil , Recién Nacido , Modelos Logísticos , Masculino , Persona de Mediana EdadRESUMEN
ELISA test was used to measure both of low- and high-avidity specific IgG against soluble S. mansoni egg antigen, to differentiate between S. mansoni experimentally infected mice with recent and chronic infection. Mice were infected with 100 S. mansoni cercariae and serum samples were obtained and tested 4, 6, 8, 10, 12, 14 and 16 weeks after infection. The results showed that there was a statistically significant difference between low- and high-avidity specific IgG in experimentally infected mice at 4, 6, 8, and 10 weeks after infection (recent infection). On the other hand, no difference was found in those with chronic infection (12, 14 and 16 weeks after infection). From these results it was concluded that the comparison of low- and high-avidity specific IgG levels was able to differentiate between recent and chronic experimentally infected mice with S. mansoni.