Awareness of hypertension guidelines among family physicians in primary health care

Background: Only 14% of patients on treatment achieve the recommended blood pressure target. Guidelines aim to assist clinicians in the management of patients with hypertension.Objectives: The primary purpose of the study was to survey family physicians(FPs) in Kuwait about their awareness, and to understand better their reasons for not implementing specific guidance within the WHO/ISH guidelines.Methods: This study is a cross-sectional survey that was carried out in the five health regions of Kuwait. All PHC physicians who were currently working as FPs were asked to participate in the study. Data were collected using a structured questionnaire of clinically oriented questions formulated on the basis of the 1999 World Health Organization/International Society of Hypertension (WHO/ISH), as standard reference.Results: The study revealed that 49.1% and 42.1% of FPs were very familiar or somewhat familiar with the guidelines respectively, 92.1% were in agreement, and 79.8% indicated that they always or usually follow these guidelines when treating patients. Regarding the correct choice of the guideline statements, only 8.8% of the FPs choose correctly less than ten of the 20 statements, 64% choose 10 to less than 15, and only 27.2% choose > 15 statements. When asked about perceived patient barriers to blood pressure control, 84.0% of the respondents ranked overcrowded clinics as important or most important barrier to blood pressure control while, 87.4% considered lack of patient knowledge as important or most important barrier. Non availability of the drugs in the clinic was considered by 88.4% of the physicians, and poor adherence to antihypertensive drugs by 90.1%.Conclusion: There is a need to establish nationwide educational and quality monitoring programs to facilitate the correct implementation of hypertension guidelines in PHC clinical practices in Kuwait.Keywords:  Family physicians; Awareness; Hypertension; Guideline

Penile Epidermal Inclusion Cyst

We report a case of epidermal inclusion cyst in a 32-year-old male. This was a complication of circumcision that was neglected over years to form stones and urethrocutaneous fistula. Complete excision of the cyst and repair of the fistula were performed successfully. Histopathological examination confirmed our diagnosis

The Attenuation Capability ofSelected Steel Alloys for Nuclear Reactor Applications

Neutronsand gamma ray attenuation of different steel grades (SS304, SS304L, SS316L, SS430, a modified high manganese-nitrogen austenitic stainless steel, and developed cobalt-free Maraging steel) was measured to study their capability to be used as nuclear reactor materials. The hardness and microstructure of the studied steel alloys were carried out using Vickers hardness and optical microscope respectively.Neutron and gamma rays measurements were carried out using a narrow beam transmissions geometry method. Measurements and calculations of gamma ray attenuation coefficients were carried out at energies 238.63, 338.28, 583.19, 911.2, 968.97, 1173.23, 1332.49, and 2614.51 keV. The transmitted gamma rays were detected by the Hyper Pure Germanium detector (HPGe), while, the neutron flux emitted from 241Am-Be neutron source was used to measure the neutron removal cross section for both slow and total neutrons. The transmitted beam of neutrons was measured under a good geometric conditions using 3He counter.A good agreement between experimental data of mass attenuation coefficients and theoretical results calculated by the WinXcom computer program (version 3.1) was obtained

Twin pregnancy with complete hydatidiform mole and coexisting fetus following ovulation induction with a non-prescribed clomiphene citrate regimen: a case report

<p>Abstract</p> <p>Introduction</p> <p>Twin pregnancy with complete hydatidiform mole represents a very rare obstetric problem. Management of such cases is always problematic because the possibility of fetal survival should always be weighed against the risk of complications of molar pregnancy.</p> <p>Case presentation</p> <p>A 34-year-old Caucasian woman presented to our center with mild vaginal bleeding. Our patient was 16 weeks pregnant after a seven-year period of primary infertility. She became pregnant following a non-prescribed regimen of clomiphene citrate extending from the second day to the 13th day of her last cycle. A transabdominal ultrasound examination revealed a twin pregnancy with complete hydatidiform mole and a coexisting fetus. Serum β human chorionic gonadotropin was falsely low as identified by serial dilution of the sample (the 'hook effect'). Our patient refused termination of pregnancy and she was hospitalized for strict observation and follow-up. Unfortunately, she developed an attack of severe vaginal bleeding and a hysterotomy was performed. The fetus died shortly after birth.</p> <p>Conclusions</p> <p>Twin pregnancy with complete hydatidiform mole represents a matter of controversy. We suggest that conservation should always be considered whenever tertiary care services and strict observation are available.</p

The use of visual methods to explore how children construct and assign meaning to the ''self'' within two urban communities in the Western Cape, South Africa

This study aimed to explore how children construct and assign meaning to the ''self'' within two urban communities of Cape Town in South Africa. Using a child participation methodological framework data were collected using Photovoice and community maps with 54 participants between the ages of 9 and 12. Feelings of safety, social connectedness, and children's spaces were found to be central to the ways in which the participants constructed and assigned meaning to the ''self.'' The study provides implications for intervention programmes aimed at improving children's well-being to be inclusive of activities aimed at improving children's self-concept, including the construction of safe spaces for children to play, learn, and form meaningful relationships

A comparative study of the antimicrobial and antioxidant activities of Inonotus hispidus fruit and their mycelia extracts

Inonotus hispidus (Bull.) P. Karst. has been used as traditional medicine for the treatment of dyspepsia, cancer, and diabetes. Numerous studies have confirmed the antimicrobial, antiviral, antioxidant, anti-inflammatory, immunomodulatory, antiproliferative and cytotoxic biological activities of extracts from this species. The purpose of this study was a comparative analysis of the antioxidant and the antimicrobial activities of methanol extracts from fruit and liquid-cultured mycelia. Four compounds (N-butylbenzenesulfonamide, lauramidopropyl betaine, 3,5-di-tert-butyl-4-hydroxybenzaldehyde, and uplandicine), determined by hybrid HRMS, were found only in mycelia culture extracts. Free radical scavenging, measured by DPPH assay on methanol extracts, showed an activity of about 17.2% and 22.1% of Trolox in fruiting bodies and mycelia, respectively. The I. hispidus methanol extracts from fruit and mycelia culture were found to have varying degrees of antibacterial and antifungal effects against the pathogenic microorganisms tested (minimum inhibitory concentration from 0.17 to 2.56 μg mL−1)

Prevalence of Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma in Upper Egypt

<p>Abstract</p> <p>Background</p> <p>Pseudoexfoliation (PXF) is a recognized risk factor for developing cataract, glaucoma and lens dislocation. PXF is also associated with increased risk of complications during cataract surgery due to poor mydriasis and zonular weakness. The aim of this study is to report the prevalence of pseudoexfoliation among Upper Egyptians attending the ophthalmology clinic of Assiut University Hospital.</p> <p>Methodology</p> <p>A retrospective, chart review study conducted in the period from February 2002 to August 2009. A total of 7738 patients aged 40 years or older attending the general ophthalmic clinics were included in this study. A detailed evaluation including ophthalmic and general history, slit lamp biomicroscopy, intraocular pressure measurement, gonioscopy and dilated eye examination were performed. Patients with pseudoexfoliative material on the anterior lens surface and ⁄ or the pupillary margin in either or both eyes were labeled as having PXF.</p> <p>Results</p> <p>Out of the 7738 patients included, three hundred twenty (4.14%) subjects had PXF. Mean age of PXF group was 68.15 years (SD 8.16, range 40-92 years). PXF was bilateral in 82.2% of cases. It was significantly associated with cataract, glaucoma and hearing loss. Of the PXF patients, 65% had cataract, 30.3% had glaucoma and 8.1% had hearing loss.</p> <p>Conclusion</p> <p>Pseudoexfoliation appears to be a common disorder in older individuals in Upper Egypt.</p

Bioactive substances of cyanobacteria and microalgae: Sources, metabolism, and anticancer

Cyanobacteria and microalgae contain various phytochemicals, including bioactive components in the form of secondary metabolites, namely flavonoids, phenolic acids, terpenoids, and tannins, with remarkable anticancer effects. This review highlights the recent advances in bioactive compounds, with potential anticancer activity, produced by cyanobacteria and microalgae. Previous in vitro investigations showed that many of these bioactive compounds exhibit potent effects against different human cancer types, such as leukemia and breast cancers. Multiple mechanisms implicated in the antitumor effect of these compounds were elucidated, including their ability to target cellular, subcellular, and molecular checkpoints linked to cancer development and promotion. Recent findings have highlighted various mechanisms of action of bioactive compounds produced by cyanobacteria and microalgae, including induction of autophagy and apoptosis, inhibition of telomerase and protein kinases, as well as modulation of epigenetic modifications. In vivo investigations have demonstrated a potent anti-angiogenesis effect on solid tumors, as well as a reduction in tumor volume. Some of these compounds were examined in clinical investigations for certain types of cancers, making them potent candidates/scaffolds for antitumor drug development

Efficacy and Safety of Artemether in the Treatment of Chronic Fascioliasis in Egypt: Exploratory Phase-2 Trials

Fasciola hepatica and F. gigantica are two liver flukes that parasitize herbivorous large size mammals (e.g., sheep and cattle), as well as humans. A single drug is available to treat infections with Fasciola flukes, namely, triclabendazole. Recently, laboratory studies and clinical trials in sheep and humans suffering from acute fascioliasis have shown that artesunate and artemether (drugs that are widely used against malaria) also show activity against fascioliasis. Hence, we were motivated to assess the efficacy and safety of oral artemether in patients with chronic Fasciola infections. The study was carried out in Egypt and artemether administered according to two different malaria treatment regimens. Cure rates observed with 6×80 mg and 3×200 mg artemether were 35% and 6%, respectively. In addition, high efficacy was observed when triclabendazole, the current drug of choice against human fascioliasis, was administered to patients remaining Fasciola positive following artemether treatment. Concluding, monotherapy with artemether does not represent an alternative to triclabendazole against fascioliasis, but its role in combination chemotherapy regimen remains to be investigated