Statistico epidemiological study of changes in the vaginal flora of contraceptive pill users in Alexandria.

PIP: A stratified random sample of 1000 women with proportionate allocation according to district of residence was taken from normal females living in Alexandria, Egypt, and attending family planning centers in order to understand social-pathological changes in the vaginal flora of oral contraceptive (OC) users. Cases were examined over 18 months, and all cases were given a combined OC. Bacteriology and pH changes in vaginal flora were determined after 18 months. Results of the bacteriological examination revealed a positive correlation between those having a vaginal discharge and pH above 5, mixed infection, and illiteracy. As the duration of pill use increased, so did the incidence of monilla, staphylococcus aureus, anaerobic streptococci, gram negative bacilli, trichomonas vaginalis, and hemophilus vaginalis, whereas lactobacilli decreased. Duration of pill use also corresponded to increase in vaginal pH. Longer duration of OC use, practice of bad hygiene, and illiteracy were factors associated with an alkaline pH, changed pattern of vaginal flora, and greater susceptibility to infection by staph aureus and E. coli.^ieng

Noninvasive breast carcinoma: results of a national survey by the American College of Surgeons.

This study evaluates the data of noninvasive (in situ) lobular (ISLC) and ductal (ISDC) carcinoma, collected from 498 hospitals in a National Breast Cancer Survey, carried out by the American College of Surgeons in 1978. ISLC and ISDC were identified in 323 (3.2%) of 10,054 female patients with lobular and ductal carcinoma, of the total of 23,972 patients with histologically proven breast cancer surveyed (1.4%). The frequency of ISLC was significantly higher (18.5%) than ISDC (2.1%) suggesting a less agressive nature of ISLC, with a slower progression to invasion than ISDC. There was a different age distribution of ISLC and ISDC: about 80% of ISLC and 50% of ISDC were diagnosed in patients who were less than 54 years old, and the incidence showed a marked decrease in the older age groups in ISLC, whereas the incidence remained high in the following decade in ISDC. In this series there was a distinctly better five-year cure rate in the patients with ISLC (83.5%) than in the patients with ISDC (68.8%), in spite of the fact that radical surgery was performed more frequently in ISDC (67.8%) than ISLC (36.3%). The recurrence rate was five times higher (10.5%) in ISDC than in ISLC (2.5%). In black patients the recurrence rate (21.3%) was significantly higher in ISDC than in white patients (9.3%). In the present study there were no statistically significant differences in the five-year cure and recurrence rate in patients with noninvasive carcinoma, treated by more conservative procedures (72.9% and 8.5%) and those treated by more extensive surgeries (76.2% and 7.7%). The results of this study suggests that the biologic behavior of ISLC and ISDC may be different with regard to their propensity to invade and their overall prognosis. In contrast, the infiltrative form of lobular and ductal carcinoma, were found to have the same prognosis, regardless of the type of operative procedure performed.

Management and survival of female breast cancer: results of a national survey by the American College of Surgeons.

This is a resume of a Breast Cancer Survey carried out by the American College of Surgeons in 1978. Four hundred and ninety-eight hospitals in 47 states, Washington, D.C., and Puerto Rico participated, contributing a total of 24,136 female patients with histologically confirmed breast cancer. In these patients, five-year cure rates were 60.5% for clinically localized disease and 33.9% for regional disease. Five-year survival rates were 72.8% for localized disease and 49.1% for regional disease. From the 1960's into the early 1970's, there was a gradual shift away from radical mastectomy towards so-called modified radical mastectomy. In a group of patients treated by either radical or modified mastectomies, the axillary nodal status, size of the tumor, and location of the tumor were examined in relation to the prognosis. In the study of number of metastatic nodes in the axilla, there were reduced cure and survival rates in patients with one or more positive nodes as compared to those with negative axillary nodes. With the increase in the number of positive nodes, there was a continuing associated decline in survival and cure. The clinical size of the tumor also correlated well to the prognosis. With the increase in the size of the tumor, there was a gradual increase in the probability of axillary nodal involvement. However, in the group of patients with tumor size smaller than 1 cm, axillary metastasis occurred in 25%. When the axillary nodes were involved, the cure rate in those patients was not significantly better than the rates for those with larger primary tumors in this study. Tumors located in the medial half of the breast were associated with a slightly lower cure rate than those in the lateral half. Young women under 35 years of age had poorer survival and cure rates, although in women 35-44 years of age, the five-year results were comparable to the older group of patients. In blacks, breast cancer was diagnosed in a relatively more advanced stage than in whites. Survival and cure rates were generally lower for blacks, and such lower rates seem to be associated with the relatively advanced stage of the disease.

Quality of care of children with chronic diseases in Alexandria, Egypt: the models of asthma, type I diabetes, epilepsy, and rheumatic heart disease. Egyptian-Italian Collaborative Group on Pediatric Chronic Diseases.

OBJECTIVES: To evaluate the quality of care delivered to children suffering from index chronic diseases using specific indicators of health care delivery and to study the predictors of suboptimal quality of care (SQC) and its outcome on children. DESIGN: Over a 9-month period, guidelines for optimal care were formulated. A specific questionnaire for every studied chronic disease was prepared in collaboration with the clinicians in charge of the diseased children (66% pediatricians and pediatric specialists and 34% adult specialists). The clinicians were asked to write the details of daily practice, ie, how these children were managed on a routine basis as well as in an emergency situation. A cross-sectional study was conducted over a 4-month period and included 953 children suffering from bronchial asthma (BA), childhood epilepsy (CE), type I diabetes mellitus (IDDM), and rheumatic heart disease (RHD). A systematic random sample of children was selected from children visiting the ambulatory settings of all children's hospitals. Every fourth child was selected on 2 randomly chosen days each week, while all diseased children admitted in the hospital settings of the children's hospitals during the study were included. A general form describing the impact of the diseases on the child was prepared. A network of clinicians was created in all children's hospitals; seminars were held during which the content validity of the questionnaire was tested. Items were evaluated for their internal consistency using the Cronbach alpha. According to the degree of adherence to the recent therapeutic guidelines concerning selected indicators of the quality of care specific to every disease, children were categorized as receiving optimal quality of care or SQC. These indicators were: the use of inhaled bronchodilators in acute asthmatic attacks in mild asthma and the use of the prophylactic drugs (inhaled sodium cromoglycate or inhaled beclomethasone) in moderate to severe chronic BA in between acute asthmatic attacks; compliance with antiepileptic drugs in epileptic children; regular performance of self-monitoring of blood glucose and/or urine testing in diabetic children; and compliance with prophylactic antibiotics in children suffering from RHD. The records of the outpatient clinics for ambulatory and hospitalized cases were reviewed to assess the degree of compliance with the prescribed management before the index visit. Sociodemographic characteristics and health care system-related predictors of SQC were analyzed via stepwise logistic regression analysis. The impact of illness on the child was assessed by 7 items which were: dependence on parents in domestic activities, level of activity compared with peers, mood compared with peers, level of socializing, degree of discomfort attributable to illness, level of physical disadvantage, and urinary incontinence. Factor analysis with Varimax rotation was performed on items related to the impact of illness. Parental satisfaction with care was rated as excellent, very good, fair, or poor. Information on school outcome was obtained by asking the caretakers whether the child was able to attend school regularly despite his sickness. Scholastic achievement was also rated as excellent, very good, good, and acceptable. Parents were asked whether the child had ever repeated a grade because of his sickness. SETTING: Ambulatory and hospital settings of all children's hospitals in Alexandria, Egypt. RESULTS: Only 52% of mild asthmatics were given inhaled bronchodilators during acute attacks and 6.84% of moderate to severe asthmatics were taking prophylactic drugs (inhaled sodium cromoglycate and/or inhaled beclomethasone) between acute attacks. Similarly, only 53 of 134 (39.6%) of diabetic children were regularly performing self-monitoring of blood glucose and/or urine testing. In contrast, in epileptic children, 121 of 173 (69.9%) were judged as being compliant by their managing clinicians and more than two