First versus second trimester mean platelet volume and uric acid for prediction of preeclampsia in women at moderate and low risk

Objective: To determine if second trimester mean platelet volume (MPV) and serum uric acid are reasonable predictors of preeclampsia (PE) or not, in patients at moderate and low risk. Methods: This prospective study was conducted on 9522 women at low or moderate risk for developing PE who underwent dual measurements of MPV and serum uric acid at late first trimester (10–12 weeks) and at second trimester (18–20 weeks) and subsequently divided into two groups; PE group (n = 286) who later developed PE and non-PE group (n = 9236). Test validity of MPV and serum uric acid was the primary outcome measure. Data were collected and analyzed. Results: Second trimester MPV is a good predictor for development of PE at a cutoff value of 9.55 fL with area under the curve (AUC) of 0.86, sensitivity of 95.2%, specificity of 66.7%, positive predictive value (PPV) of 87%, negative predictive value (NPV) of 85.7%, and accuracy of 86.7%. Second trimester serum uric acid is a good predictor for development of PE at a cutoff value of 7.35 mg/dL, with AUC of 0.85, sensitivity of 95.2%, specificity of 55.6%, PPV of 83.3%, NPV of 83.3%, and accuracy of 83.3%. Combination of both tests has a sensitivity of 100%, specificity of 22.2%, PPV of 75%, NPV of 100%, and accuracy of 76.7%. Conclusion: Second trimester MPV and serum uric acid alone or in combination could be used as a useful biochemical markers for prediction of PE based on their validity, simplicity, and availability.     

Oral ivermectin for head lice: a comparison with 0.5 % topical malathion lotion

Background: Reports of treatment failure of head lice have become increasingly common. Oral ivermectin has been proposed as a potential alternative for the treatment of head lice infestation. The aim of this study was to compare the efficacy of oral ivermectin with topical malathion lotion in the treatment of head lice. Patients and methods: Eighty apparently healthy children with head lice infestation were randomly assigned to 2 groups, with 40 patients in each. The first group received oral ivermectin as a single dose of 200 μg/kg and the second group received single topical application of malathion lotion 0.5 %. Follow up visits were done at days 8, 15 and 29. A second dose of either drug was given at day 8 in case of treatment failure. Results: After a single dose, complete cure was achieved in 77.5 % and 87.5 % of ivermectin and malathion groups respectively. After the second dose for nonresponders, the cure rate increased to 92.5 % in the ivermectin group and 95 % in the malathion group. No major adverse effects were observed in either group. Conclusions: Oral ivermectin is a promising effective approach for the treatment of head lice and could be an ideal substitute for conventional pediculicides.     

Treatment of Common and Plane Warts in Children with Topical Viable Bacillus Calmette‐Guerin

Abstract: Treatment of verrucae in children is difficult and may be painful using traditional methods, especially if they are multiple or on the face. The objective of the current study was to evaluate the efficacy and safety of topical application of viable Bacillus Calmette‐Guérin (BCG) in a paste formula as a new immunotherapeutic modality in the treatment of common and plane warts in children. The present study included 80 children with common and plane warts at different sites on the body. They were divided into two groups. Group A (40 patients) received topical viable BCG and group B (40 patients) received topical saline as control. All patients and controls had received a previous vaccination of BCG. BCG was applied once weekly for six consecutive weeks. Patients who had partial or no response received another course of treatment for another 6 weeks. Follow‐up was at 6 months to detect any recurrences. A highly significant difference was found between the therapeutic response of common and plane warts to BCG and saline (placebo) (p < 0.001). Complete response was achieved in 65% of children with common warts and 45% of patients with plane warts. No response was detected in the control group. No recurrences or side effects were observed in the BCG group. Topical immunotherapeutic BCG is a new, effective, safe treatment option for children with common and plane warts.     

Statistical analysis of referrals by general practitioner at Health Insurance Organization clinics in Alexandria

Referral of patients generates significant economic costs for both physician fees and diagnostic tests. Variation in referral rates between general practices and between individual GPs has long been the focus of attention for policy makers. The present study aimed to analyze the referrals by General Practitioners (GP) at Health Insurance Organization (HIO) clinics in Alexandria. The study was conducted at 18 Health Insurance Organization (HIO) comprehensive clinics in Alexandria, distributed in the 6 districts of Alexandria HIO. Retrospective analysis of records and cross sectional interview to 180 GPs were carried out. Male GPs comprised 82.2% of the sample. On the average, GPs received 6.6 +/- 4.5 patients per working hour. Over the year 2002, 8.4% of consultations were referred to specialists, 5.4% referred to laboratory and only 0.09% were referred to hospital. The highest percent of referrals from GP to specialist were directed to internal medicine followed by orthopedics, general surgery, E.N.T, dermatology, neuropsychiatry, chest then urology clinics. Referral rate from GPs to specialists was found to have a 6.6-fold variation among clinics, and a 54.8-fold variation among individual GPs. Moreover, there was no homogeneity in variations in referral rates of clinics within 3 of the 6 districts. Using multiple regression analysis, the only significant factor was the indirect relation with workload. Comparison of referral rates of GPs with the limits set by HIO (8-17%) revealed that, 48.9% of GPs were within limits, 37.2% were lower and 13.9% were higher than limits. GPs who had diploma or master were average referrers in 51.5%, low referrers in 30.3% and high referrers in 18.2%, compared to 45.6%, 50.6% and only 3.8%, respectively for those with bachelor degree; the difference was statistically significant.     

The value of neurophysiological and imaging studies in predicting outcome in the surgical treatment of cervical radiculopathy

It is not always easy to predict the degree of symptomatic improvement to be expected in a patient undergoing surgery for cervical disc herniation and radiculopathy. Here we investigate whether preoperative electromyography (EMG) can help select those most likely to benefit from intervention. We prospectively evaluated 20 patients whose required operative level was unclear after clinical examination and MRI scan alone. The surgical procedures was anterior cervical interbody fusion with the AcroMed^® carbon fibre cage. Clinical assessment employed using validated scoring systems (Prolo functional and economic scoring system). Patients underwent MRI preoperatively, and were assessed pre and postoperatively with neurophysiological studies (NPS) including nerve conduction studies and concentric needle EMG. Patients with preoperative evidence of cervical nerve root involvement on EMG (group A, n = 8) had better outcome (P = 0.001) following discectomy and anterior fusion than patients who had no evidence of nerve root damage on EMG (group B, n = 12). Prolo mean score ± SEM for group A was 7.375 ± 0.3750 and for group B was 5.583 ±  0.2876. Thus, NPS are a valuable tool in selecting patients in this subgroup for cervical surgery.     

Malnutrition among pre-school children in Alexandria, Egypt

The study was conducted in Alexandria, Egypt, to assess the current status of malnutrition among 1,217 pre-school children aged 6-71 months. A two-stage cluster-sampling technique was used for selecting the sample. Data on sociodemographic and environmental characteristics of the family, morbidity profiles, and breast-feeding patterns were collected from mothers of the children. Anthropometric measurements were performed, and the prevalence of malnutrition was assessed using three indicators, such as stunting, under-weight, and wasting, following the WHO guidelines and cut-off points. Simple and multiple regression analyses were done for examining the factors associated with the occurrence of malnutrition using principal component factor analysis with varimax rotation. Stunting, under-weight, and wasting were observed in 15%, 7.3%, and 3.6% of the children respectively. High-socioeconomic condition was associated with low prevalence of stunting and underweight (OR = 0.67, confidence interval (CI) = 0.55-0.8 and OR = 0.75, CI = 0.58-0.96 respectively). Good environmental condition was associated with a lower stunting rate (OR = 0.83, CI = 0.72-0.96). Increased age of child and living in a non-squatter area were associated with wasting (OR = 1.02, CI = 1.001-1.03 and OR = 0.38, CI = 0.15-0.97 respectively). Interventions to improve socioeconomic and environmental situations are recommended to reduce the already low level of protein-energy malnutrition further.