Spanlastics gel-A novel drug carrier for transdermal delivery of glimepiride.

Glimepiride (3rd-generation sulfonylurea) is used for treatment of type 2 diabetes, but its oral administration has been associated with severe gastric disturbances such as nausea, vomiting, heartburn, anorexia, haemolytic anaemia. Accordingly, the transdermal route may represent a potentially suitable alternative. This work investigates the usefulness of a novel drug carrier system for transdermal application. The system investigated were called spanlastics gels and constituted span 60 with edge activator (tween 60 or tween 80). Spanlastics gel has been introduced as a stable form alternative to the liquid formulations of spanlastics. Spanlastics gels were prepared by coacervation phase separation method. Entrapment efficiency and size of spanlastics vesicles produced from the hydration of spanlastics gels were characterised. In vitro release and skin permeation of glimepiride from various spanlastics gel formulations were investigated across mixed cellulose membrane and excised rabbit skin. The obtained results indicated that the maximum entrapment efficiency was 65.36% when the tween 60 content was 30%. The drug release and permeation were increase as the concentration of edge activator increased. Spanlastics gel prepared with Tween 80 at concentration 50% showed higher permeability and flux value (248.69 µg/cm2and 8.31 µg/cm2.h, respectively) through rabbit skin.

Hydrogen alpha laser ablation plasma diagnostics.

Spectral measurements of the H(α) Balmer series line and the continuum radiation are applied to draw inferences of electron density, temperature, and the level of self-absorption in laser ablation of a solid ice target in ambient air. Electron densities of 17 to 3.2×10(24) m(-3) are determined from absolute calibrated emission coefficients for time delays of 100-650 ns after generation of laser plasma using Q-switched Nd:YAG radiation. The corresponding temperatures of 4.5-0.95 eV were evaluated from the absolute spectral radiance of the continuum at the longer wavelengths. The redshifted, Stark-broadened hydrogen alpha line emerges from the continuum radiation after a time delay of 300 ns. The electron densities inferred from power law formulas agree with the values obtained from the plasma emission coefficients.

Systematic review with meta-analysis: comparison between therapeutic regimens for paediatric chronic hepatitis C.

BACKGROUND: To decide when and how to treat children with chronic hepatitis C is an ongoing debate. AIM: To compare the outcomes of therapy for children with chronic hepatitis C. METHODS: An electronic database assessed clinical trials with sustained virological response rates specified by genotype. The data were extracted according to the therapeutic regimen; interferonα±ribavirin and pegylated interferonα±ribavirin. RESULTS: The search sourced 23 peer-reviewed articles which enrolled 934 cases, aged 2-19 years. Sustained virological response rates were significantly higher with the addition of ribavirin to either interferonα or pegylated nterferonα vs. their monotherapies for genotypes 1,2&3 with crude and weighted estimates. The weighted estimate indicated higher sustained virological response rates for those treated with pegylated interferonα+ribavirin vs. interferonα+ribavirin for genotype 1 (50% vs. 40%) and genotypes 2&3 (90% vs. 84%), (odds ratio 1.5, 95% confidence interval 1.2-1.8, and 1.8, 1.2-2.9 respectively). Cases with genotype 4 treated with pegylated interferonα+ribavirin had a lower sustained virological response (41%) vs. genotype 1 (1.4, 1.2-1.8), and vs. genotypes 2&3 (13.5, 10.3-17.9). Some adverse events were significantly higher among cases treated with pegylated interferonα+ribavirin vs. interferonα+ribavirin. CONCLUSIONS: Despite the superiority of pegylated interferonα+ribavirin to interferonα+ribavirin for the treatment of chronic hepatitis C among children, the significant higher adverse events along with the modest outcome for genotypes 1&4 render that regimen a suboptimal therapy. These data indicated the need for the future comparison with clinical trials of direct anti-viral drugs for children with chronic hepatitis C.

Alleviating rural poverty in sub-Saharan Africa.

PIP: This analysis of rural poverty and hunger in Africa discusses the intertemporal and cross-sectional dimensions of poverty as an aid to policies and programs to alleviate hunger. Since nutritional adequacy of diets varies according to season, seasonality is an important cause of poverty especially in countries with 1 major harvest. In agricultural communities the wet season brings on food shortages and high prices, requiring assistance programs to concentrate on alleviating hunger at this time of year. Drought places a similar demand on resources. People may be poorer in 1 section of a country than another if they have no access to the existing power system, depriving them of services and assistance. There are forgotten regions of Africa where people are poor due to physical isolation, increasing the risk of drought and impeding emergency relief. Production in these areas may be low because there are no consumer goods to buy with surplus. It is important to identify target groups for financial assistance which will change with time and environmental conditions.^ieng

A clinicoepidemiological study of heart disease in schoolchildren of Menoufia, Egypt.

This study was conducted to determine the prevalence of rheumatic heart disease (RHD) and congenital heart disease (CHD) in primary schoolchildren of Menoufia, Egypt and to study the relationship between these two problems and socioeconomic conditions. A total of 8000 children were screened for cardiac disease in their schools. Children with confirmed RHD and CHD in addition to 200 healthy children (controls) were visited at their homes to assess their social environment and other factors according to a designed questionnaire. We found prevalence rates of 3.4/1000 and 2.6/1000 for the RHD and CHD respectively. The most common cardiac defects were double mitral and pulmonary stenosis in the RHD and CHD groups respectively. Nineteen (39.6%) of the patients were diagnosed for the first time during the study. Penicillin prophylaxis was received by only four (14.8%) of the RHD children and none of the CHD children. The number of other affected siblings, increased multiparity, repeated abortion, and intake of contraceptives by mothers were significantly higher in families of the children with CHD. The proportion of illiterate, unskilled, and heavy smoking fathers was higher in the two patient groups. Family income was lowest in the RHD group, while increased crowding index and low whole social environment were significantly related to both RHD and CHD. Effective programs at the community and health service levels are needed in Menoufia to solve the problem of heart disease in schoolchildren in the immediate future.

Knowledge and attitudes towards premarital counselling and examination.

Premarital counselling and examination have begun to play a very important role in the management of many genetic disorders. 600 villager's knowledge and attitudes toward premarital counselling and examination in Menofia Governorate was studied in order to predict the community acceptance and behaviour toward utilization of such service. The result showed a big lack in knowledge even among educated respondents about the term. The main source of information was mass media followed by medical personnel who should participate more in this service. Most respondents, except unmarried males, have a favourable attitude toward either premarital counselling and examination or consanguinous marriage. This may be related to certain social changes in village life such as declining illiteracy, increased economic pressures, increase number of nuclear families and accordingly delay in beginning a family. It was unlikely that non-contraceptive users would resort to induced abortion rather to use contraceptive methods. Educational programs should be directed toward: (a) unmarried males so that their attitude toward premarital counselling and examination can be changed to correct direction, (b) unmarried females to make consanginous marriage more undesirable, and (c) non-contraceptive users to make them more intended to use safe contraceptive methods than induced abortion.

PIP: Premarital counseling and examination have begun to play a very important role in the management of many genetic disorders. 600 villagers knowledge and attitudes toward premarital counseling and examination in Menofia Governorate, Egypt was studied in order to predict the community acceptance and behavior toward utilization of such service. The results showed a big lack of knowledge even among educated respondents about the term. The main source of information was mass media followed by medical personnel who should be more involved in this service. Most respondents, except those unmarried males, have a favorable attitude toward both premarital counseling and examination of consanguineous marriage. This may be related to certain social changes in village life such as declining illiteracy, increased economic pressures, increase in the number of nuclear families, and a subsequent delay in beginning a family. It was unlikely that noncontraceptive users would resort to induced abortion instead of contraceptive methods. Educational programs should target: unmarried males so that their attitude towards premarital counseling and examination can be altered to change direction; unmarried females in order to deter them from consanguineous marriage; and noncontraceptive users to make them choose safe contraceptive methods rather than induced abortion.

Specialization preference and attitude of medical students in Cairo within the primary health care context.

This cross-sectional study investigates specialization preference of medical students in Cairo, Ain Shams and El-Azhar Medical Schools using a stratified systematic random sample of 428 students and house officers (199 females and 229 males). They represent 5% of all second, fifth year students and house officers from all three universities. In addition 31 female students of El-Azhar were followed up to the final year and house officer year. The aim of the study is to compare students specialization preference with PHC needs. The questionnaire used comprised besides demographic data like age, sex, origin, maternal and paternal education and occupation also factors influencing the specialization preference like motive for choosing medical education, lecturer's personality, subject content, future location and setting intention. The distribution of specialization preference was found significantly different with educational year, sex, maternal education and occupation, father's occupation, socioeconomic standard, reason for choosing medical study and content attraction of the subject. Major subjects like surgery, medicine and gynaecology and obstetric were preferred significantly more by males, students with non-medical fathers, of lower SES, those who choose medicine for prestige and help of people, and who were attracted by the content of subject, while vis versa for pediatric and other specializations like cardiology, ophthalmology, clinical pathology and psychiatry among others. The follow-up study indicated that female students of El-Azhar tended to gynaecology and obstetric (from 32.3% to 42.1%) orienting themselves toward community needs being themselves to 34.1% from rural areas. The multiple regression analysis indicated that the best subset of variables influencing specialization preference are SES, maternal education, study reason, father occupation, sex, future setting and location. Students preferences are far from the PHC needs.

Satisfaction of mothers by nursing care provided to their sick children in ambulatory health care centers.

The aim of the study was to measure satisfaction of mothers attending health units with their ambulatory children. A random sample of 150 mothers was included in the study from 3 ambulatory care units in Ismailia. The indirect method of measuring satisfaction was used through identification of mothers pre-visit expectations and measuring the post visit fulfillment by technical quality of nursing care. The percentage of expectation fulfillment reflected the degree of satisfaction. The mother's responses were validated by observers opinion to the same service provided. The results of the study revealed that respondent scores indicated a weak satisfaction with most of nursing care services such as taking temperature, weighing the child and carrying physicians orders. The results also revealed that aspects related to nurse's advice and guidance to mothers regarding child's condition, elicited high level of unsatisfaction.

Assessment of knowledge, attitudes and practices of expectant mothers in relation to antenatal care in Assiut governorate.

This study aims to assess knowledge, attitudes and practices of expectant mothers in relation to ante-natal care in Assiut and to find out factors affecting their knowledge. Attitudes and practices. The present study was carried out in the ante-natal clinic at Assiut General Hospital and three Maternal and Child Health Centers in Assiut. Fifty women were selected from each of the previously mentioned settings. A specially designed interview sheet was used to collect the necessary data. It was consisted of four parts. The first part included questions related to individual features of women, the second part included questions related to their family features, the third part concerned with previous obstetrical history of women and their acceptance of pregnancy and the fourth part included questions related to knowledge, attitudes and practices of expectant mother in relation to ante-natal care. The findings of the present study revealed that one quarter of the study sample (25.5%) lacked basic and essential knowledge about ante-natal care, most of older women (88.2%) were more likely to have poor knowledge in relation to ante-natal care, the higher educated women (66.7%) were more likely to have good knowledge about ante-natal care compared to 33.5% of lower educated women. It was also observed that the majority of working women (90%) were more likely to have good ante-natal care knowledge compared to housewives (10%). Most of the primigravida women (88.2%) were more likely to have poor knowledge in relation to ante-natal care compared to 11.8% of women whose gravidity was less than 5.

PIP: In Assiut governate, Egypt, interviews were conducted with 200 randomly selected pregnant women attending prenatal clinics at the maternal and child health (MCH) centers in Kolta, Gharb El-Balad, and Arnoub and at Assiut General Hospital to determine their knowledge, attitudes, and practices as they relate to prenatal care. 30.5% reported prenatal care to be important for health promotion for mother and fetus. 20% did not know that prenatal care is important to maternal and fetal well-being. Time of first prenatal visit was for 21% the 1st trimester, for 35% the 2nd trimester, and for 33.5% the 3rd trimester. 34.5% attended 1 prenatal visit each month. 52% had less than 8 visits during their pregnancy. 13.5% had more than 8 visits. 25.5% knew little about the significance of prenatal care. Only 17.5% knew the significance of a well-balanced diet during pregnancy. 42% added some foods to their diet and increased their food intake. 39.5% eliminated fatty, greasy, and highly spiced foods from their diet. 32.5% understood the objectives and reasons for bathing during pregnancy. 50% considered a daily bath to be essential during pregnancy. Only 18% understood the objectives of breast care during pregnancy. 65% did not seek dental care during pregnancy. Factors associated with seeking prenatal care included: younger than 30, higher education, gravidity less than 5 and greater than 0, and working outside the home (p 0.05 for each factor). Recommended ways nurses can encourage pregnant women to seek prenatal care include education via mass media, home visits, improved quality of prenatal care, screening for high-risk women, increased number of MCH centers and prenatal clinics in rural areas, and adequate supply of medication, supplies, and equipment in these facilities.

A prospective study of morbidity pattern and nutritional status of a group of healthy newborns during their first year of life in a rural area near Alexandria.

The present work was planned to study morbidity pattern and nutritional status of a group of healthy new borns in a rural area near Alexandria (Abbis II, VIII villages) through a prospective follow up approach. Eighty two infants were followed up for 12 months. Each infant was subjected to 15 visits within the first year of life. Morbidity was recorded either from mother's history, records from rural health centres or detected by the researcher and expressed as morbidity risk exposures based on a tested scoring system. Anthropometric standards issued by WHO were used to classify the children's length for age, weight for age and weight for length in terms of a cut off point of 2 SD below the median of that of the reference. Gomez classification was used to diagnose undernutrition and Waterlow system was used to diagnose growth stunting. Socioeconomic status of infants' families was also assessed. Results indicated a high prevalence of morbidity risk exposure, growth retardation and under nutrition with a tendency for gradual increase towards the end of the follow up. The results also proved that diarrheal diseases were still the most common illness among infants followed by respiratory tract infections. Investigation of the effects of socioeconomic status on morbidity risk exposure proved its significance at the end of the follow up. The results also illustrated a significant effect of morbidity risk exposure on the nutritional status at the end of the first year.

PIP: Health workers visited 82 healthy newborns in 2 villages near Alexandria, Egypt 15 times during their 1st year of life. The morbidity pattern, the nutritional status, and the morbidity pattern's effect on the nutritional status of the infants were studied. At the end of 1 year, 40.24% of the children had diarrhea. The mean annual number of diarrheal episodes was 4.3%. Poor environmental sanitation and the presence of animals and birds in and around the infants homes probably contributed to the high prevalence of diarrhea. 35.37% had either an upper or lower respiratory tract infection at the end of follow up. The mean annual number of respiratory infections stood at 2.2. Skin disease was the 3rd most common disease during the 1st year particularly during the 1st 3 quarters (14.13%, 12.36%, and 11.91%). Eye disease especially conjunctivitis were the 4th most common diseases among these children, especially during the 3rd quarter (13.10). The only infectious disease was measles which afflicted only 3.66% of the infants. None of the infants from high middle socioeconomic households were considered at high morbidity risk exposure. Almost all (93.33%) of these infants were at low morbidity and low average risk exposures. 24.39% of infants from low socioeconomic households were at high morbidity risk exposure, however. The percentage of infants growing normally decreased over time. For example, at the 1st quarter, 91.3% grew normally and by the 4th quarter this decreased to 57.32%. By 1 year almost 1.5 were either stunted or wasted and 3.66% were both stunted and wasted. an association existed between morbidity and nutritional status of the infants. Children with high morbidity scores were also the children suffering from the most severe malnutrition. Health workers should encourage mothers to use child health services at the rural health centers. They also should use growth charts to monitor infant and child growth.

Study of tetanus neonatorum in Tanta Fever Hospital, 1988-1989.

Neonatal tetanus (NT) is the most under-reported fatal infectious disease. Ministry of Health statistics in Egypt reflect only 10% of NT cases. This study aims at evaluating the effect of the campaign to immunize pregnant women against tetanus in Gharbia governorate in Egypt. In this report it is shown that NT admission decreased sharply in 1989, compared to the previous years, and that the severity of the disease was also less. The value of a sentinel site is also demonstrated. To eliminate NT, however, educational programmes and better perinatal care are needed in addition to vaccination.

An outbreak of typhoid fever resistant to chloramphenicol and other drugs in Gharbeya Governorate in Egypt.

An outbreak of Typhoid fever (TF) occurred in Gharbeya Governorate in Egypt during November and December 1990. Ninety children with mean age of 9.64 +/- 3.67 years and 43 adults with mean age 22.51 +/- 5.36 years were treated in Tanta fever hospital (TFH) during this outbreak. Resistance of TF during the outbreak to the usual antibiotics given in TFH was the main feature of the outbreak, including resistance to chloramphenicol, co-trimoxazole, ampicillin, tetracycline, and gentamycin. Such resistance was detected in vitro as well as in vivo. Sensitivity was present in vitro and in vivo to ofloxacin (OF) and cefotaxime. The clinical response of OF was 96 per cent in children and 82 per cent in adults. No significant difference in side effects was detected in children treated with OF and those treated with other drugs after 6 months follow up.

Metabolic effects of some antibilharzial drugs inhibition of citrate oxidation by Bilharcid.

Bilharcid inhibited citrate oxidation and the inhibition was decreased by time. The inhibition is not restored or reduced by increasing citrate concentration. NAD stimulated citrate oxidation in the presence of Bilharcid. Cysteine slightly stimulated citrate oxidation, while ATP had no effect. Addition of citrate before Bilharcid protected the enzyme against the inhibitory action of the drug.

Metabolic effects of some antibilharzial drugs: inhibition of NAD-linked substrate oxidation in rat liver by bilharcid.

BILHARCID inhibited malate and pyruvate oxidation. The degree of inhibition reached 50% when the concentration of Bilharcid was 10(-3) M. The mechanisms of the inhibitory action of the drug are discussed with reference to the effects of both adenine and pyridine nucleotides on the activity of the oxidoreductase enzymes.

Metabolic effects of some antibilharzial drugs. Studies on the inhibitory action of "bilharcid" on succinate oxidation in normal rat liver.

THE INHIBITION of succinate oxidation by Piperazine diantimonyl tartarate (Bilharcid) could be in part attributed to accumulation of oxaloacetate. This is discussed with reference to the effect of ATP, glutamate and cysteine on the reversal of the inhibitory action, of the drug on succinate oxidation.

Metabolic effects of some antibilharzial drugs. Comparative study on the effect of tartar-emetic and piperazine hexahydrate on the activity of some oxidoreductase enzymes of the rat livers.

IN THIS INVESTIGATION, the effects of the examined antibilharzial agents are as follows: Bilharcid and tartar-emetic similarly affected succinate oxidation. 50% inhibition could be obtained at a concentration of 10(-3) of both drugs. Malate oxidation was differently affected by the drugs. Bilharcid and tartar-emetic at a concentration of 10(-3) M induced 50% and 70% inhibition respectively, while tartar-emetic stimulated malate oxidation if added in a concentration of 10(-5) M. Pyruvate oxidation was affected in the same manner and to the same extent as malate oxidation. Citrate oxidation was slightly inhibited by Bilharcid and tartar-emetic. 10% and 30% inhibition could be obtained if the concentration was 10(-3) M of both drugs respectively. Bilharcid had a biphasic effect on citrate oxidation. Stimulation could be observed at low concentrations (up to 10(-8) M and inhibition at higher ones (up to 10(-3) M. Piperazine hexahydrate was nearly without effect on the rate of oxidation of the four mentioned substrates.

Interrelationships between anemia and fertility patterns in rural Egyptian women.

PIP: This study investigates the relation of malnutrition as indexed by hemoglobin levels and anthropometry and the fertility of Egyptian rural women. 357 married women in 2 villages in Beheira governorate, aged 15-45 were interviewed. 40.9% were in the optimum childbearing age (20-30 years); mean age was 30.5 years. Mean duration of married life was 10.96 years. The frequency distribution curve of hemoglobin of the group was shifted to the left, indicating a high prevalence of anemia. Mean body weight ranged between 62-64 kg, mean height between 158-63 cm, and mean body index between 2.31-2.85. Weight percentiles and degree of anemia shared a bimodal distribution, while the weight for height percentiles and degree of anemia showed a normal distribution with a shift to the left indicating prevalence of underweight for height. The group had an average of 3.6 previous pregnancies; the highest average was 6.7 attained at the age of 40-45 years. Mean pregnancy interval was 2.14 years; number of live births was an average of 3.27; abortion experiences on the average was 0.22; mean stillbirths was 0.07; highest average child losses was for ages 40-45, 0.75; average number of living children 2.8; and mean reproductive activity increased with increase in years of married life. Anemia tends to reduce fertility at all ages with the mean parity higher in the total normal group (3.44) than in the anemic (3.27). Mean family size was also higher in the normal (3.18) than anemic (2.7) groups. In anemic women percentages of live births was 97.7% compared with 94.4% in the normal group, pregnancy wastage was 10.1% compared to 4% in the normal group and total child losses was 11.3% compared to 10.8% in the normal group. The differences are not considered to be statistically significant. The data indicated that interaction between nutritional states, environmental conditions, and fertility performance is the major determinant of human reproduction.^ieng

Breast feeding and infant growth, a follow-up study in Menoufia, Egypt.

PIP: Staff from a maternal and child health (MCH) center in urban Shebeen El Kom and from an MCH center in rural Om-khnan in Menoufia Governate, Egypt followed 200 newborn infants for 6 months. The mean birth weight stood at 3.3 kg, mean birth length 50.2 cm, mean head circumference at birth 34.5 cm, and the mean mid arm circumference at birth 10.2 cm. Infants which were exclusively breast fed lost 14 percentiles of weight for age from birth-6 months while those which were exclusively formula fed lost 18 percentiles. On the other hand, those which received solid food in addition to breast milk gained 24 percentiles. Similarly, exclusively breast fed infants lost 6 percentiles of length for age and exclusively formula fed infants lost 8 percentiles. Infants which breast fed and had solid food supplements gained 14 percentiles. In addition, breast fed infants regardless of solid food supplementation maintained their percentiles for age for head circumference while formula fed infants lost 8 percentiles. The reduced growth velocity in formula fed infants may be due to dilutions of formula and an increased incidence of infections, especially gastroenteritis. After 3-4 months of lactation, the breast milk yield fell in the mothers who exclusively breast fed their infants which may have caused a reduction in growth velocity. No group of infants experienced an increase in protein energy malnutrition. Even though there was a reduced growth velocity in these infants, research shows that breast fed infants maintain a better health status and have fewer infections than nonexclusively breast fed infants. In fact, no evidence exists that shows more rapid growth of normal neonates to be desirable.^ieng