Pathologic Pattern of Invasive Bladder Carcinoma: Impact of Bilharziasis

Objective: To describe the pathologic pattern of invasive bladder carcinoma in cystectomy specimens in relation to bilharziasis. Patients and Methods: Between April 2002 and October 2006; 148 consecutive patients with invasive bladder cancer were subjected to radical cystectomy and orthotopic sigmoid bladder substitution at Al-Azhar Urology Department; Cairo; Egypt. A retrospective computerized data- base analysis of the pathologic features of the cystectomy specimens was done focusing on the impact of bilharziasis on the pathology of bladder carcinoma. The tumor cell type; stage; grade and gross features in addition to lymph node involvement were particularly noted. Results: Bilharzial bladder pathology (lesions or ova) was present in 105 (70.9) of 148 cystectomy specimens. Tumor histology included transitional cell carcinoma (TCC) in 84 (56.7); squamous cell carcinoma (SCC) in 51 (34.5); adenocarcinoma in 9 (6.1) and anaplastic tumor in 4 (2.7) of these specimens. Most tumors associated with bilharziasis were bulky and appeared fungating or ulcerative. The pathologic tumor stage was pT2 in 23; pT3 in 70.9and pT4a involving the prostate or seminal vesicles in 6.1. None of these pT4a tumors were SCC. The tumor grade was described as low grade in 72 (48.6) and high grade in 76 (51.4) specimens. Regional lymph node involvement was detected in 31 (20.9) specimens irrespective of bilharzial infestation. Conclusion: Invasive bladder carcinoma associated with bilharzial pathology is mainly stage pT3; low-grade SCC and commonly appears as an ulcerative; bulky; fungating or verrucous mass. On the other hand; bladder carcinoma not associated with bilharziasis is mainly high-grade TCC and commonly appears as nodular or fungating lesions. Positive surgical margin and lymph node involvement are unrelated to bilharzial infestation

The National Congenital Anomalies Register in the United Arab Emirates.

The National Congenital Anomalies Register is a population-based register covering all births in the United Arab Emirates. We evaluated the progress of the register and determined the prevalence of congenital anomalies (CAs) and associated maternal and neonatal risk factors. Total prevalence of CAs for 1999-2001 was 7.89/1000, 10.95/1000 and 7.92/1000 for live births, stillbirths and total births respectively. Rates were comparable to international rates for all districts except Dubai, Fujairah and Ras Al Khaimah. According to the International classification of diseases, the cardiovascular system was the most affected followed by CAs of chromosomal origin and the musculo-skeletal system. Birth defects were more common with older maternal age, grand multiparity, male babies, low-birth-weight babies and premature babies.

The National Congenital Anomalies Register in the United Arab Emirates

The National Congenital Anomalies Register is a population-based register covering all births in the United Arab Emirates. We evaluated the progress of the register and determined the prevalence of congenital anomalies [CAs] and associated maternal and neonatal risk factors. Total prevalence of CAs for 1999-2001 was 7.89/1000, 10.95/1000 and 7.92/1000 for live births, stillbirths and total births respectively. Rates were comparable to international rates for all districts except Dubai, Fujairah and Ras Al Khaimah. According to the International classification of diseases, the cardiovascular system was the most affected followed by CAs of chromosomal and the musculo-skeletal system. Birth defects were more common with older maternal age, gr and multiparity, male babies, low-birth-weight babies and premature babies

Iodine deficiency disorders among school children in upper Egypt: an epidemiologic study.

Iodine deficiency disorders (IDD) are the world's single most significant cause of preventable brain damage and mental retardation. Data regarding IDD in upper Egypt are scarce and even lacking. The aim of the present work was to study the prevalence of IDD and some potential risk factors in upper Egypt. Using a two-stage cluster sampling technique, 6750 school children aged 8-10 years were screened for IDD through clinical examination of the thyroid gland and determination of urinary iodine, from three governorates in upper Egypt, namely Al-Minya (population of 3.3 million), Assyut (population of 2.9 million), and Suhag (population of 3.1 million). Iodine was determined in samples of soil and drinking water. Overall, the prevalence rate of goitre was 34.6 per cent. The median urinary iodine level for children with goitre was 5.04 micrograms/dl compared to 14.81 micrograms/dl among children free of goitre. Multiple logistic regression analysis showed that certain groups of school children were much more likely to develop goitre. They included females (OR = 3.07, 95 per cent CI = 2.78-3.39), children in households where drinking water had an iodine content of less than 0.5 microgram/100 ml (OR = 3.44, 95 per cent CI = 3.09-3.89), and children living in places where soil content of iodine was less than 0.2 microgram/100 g (OR = 2.67, 95 per cent CI = 2.30-3.10). We conclude that IDD is a severe public health problem in upper Egypt. The present situation in upper Egypt necessitates an urgent intervention programme.

Bacteriologic potability of the drinking water in a diarrhea hyperendemic area in southwestern Saudi Arabia.

High prevalence of diarrhea was reported among people living in a semiurban community in Shebaa area in Southwestern Saudi Arabia. This was in comparison to prevalence in a nearby urban community in Abha, the capital city of The Southwestern Region of Saudi Arabia. Contamination of the desalinated water, commonly used for drinking, was one possible hypothesis for occurrence of this diarrhea problem. The objective of the present study was to test bacteriological potability of desalinated water in both Shebaa and Abha areas and to determine whether any contamination occurred during transportation from water distribution stations to houses or during storage in house reservoirs. Water samples were collected and analyzed by the Presumptive Coliform Test from a sample of water tankers transporting water and from tap water originating from house reservoirs in a sample of houses in the two areas. Source of drinking water was recorded for each of such houses. Of 117 water samples from 39 tankers transporting water, only one sample was positive bacteriologically and non-potable (potability = 99%). Whereas among 201 tap water samples from a random sample of houses, 26.4% showed contamination. Bacteriological non-potability was found in a significantly higher proportion of houses in Shebaa area (38.4%) than in Abha city (7.9%), (p<0.001). Also, desalinated water was used for drinking significantly more in Shebaa than in Abha (p<0.001). It is concluded that transportation of the desalinated water by water tankers has not significantly contributed to its contamination. Such contamination rather obviously occurred during storage in house reservoirs, and was possibly implicated, at least partly, in the increased prevalence of diarrhea in Shebaa.

Hyperendemicity of diarrhea in a valley area, Asir Region, southwestern Saudi Arabia.

A random sample of 781 subjects living around a valley in Shebaa area, southwestern Saudi Arabia, and 1284 subjects from the rest of Shebaa, along with a sample of 1095 from a nearby urban community in Abha city have been studied following a notification of a suggestive increase of diarrhea in the valley. This was to determine whether the prevalence of diarrhea was high in the valley and to formulate hypotheses about possible implicated factors. The family head was interviewed about episodes of diarrhea among family members during the 2-week period preceding the interview, about source of drinking water, and about some demographic variables. Observations were made and data were collected on presence and frequency of flies in the house, methods of excreta and refuse disposal, valley and wells water, and the nearby agricultural farms. The 2-week diarrhea episode rate per subject was significantly (p<0.0001) highest in the valley (0.20), was 0.09 in the rest of Shebaa, and was lowest in the urban community area. (0.05). The rate decreased by age (p<0.001) and increased by frequency of flies in the house (p<0.0001), particularly in the valley. Drinking only from the desalinated water was associated with diarrhea episode rate of 0.12 as compared to 0.05 for drinking only from bottled water or from any other combination of sources (p<0.01). The valley and wells water was grossly polluted and was regularly used for irrigating and washing fresh fruits and vegetables from nearby farms. Hypotheses for the factors possibly contributing to this hyperendemicity of diarrhea in the valley include inadequate excreta and refuse disposal, contamination of the valley and wells water, contamination of the desalinated water during transportation or storage and abundance of flies.

A method for adjusting the international growth curves for local use in the assessment of nutritional status of Saudi pre-school children.

The aim of this study is to illustrate a method for adjusting the internationally used National Center for Health Statistics (NCHS) growth curves for local use in the assessment of nutritional status of Saudi children. All children 1-60 months in three semiurban-rural communities in Asir region, Saudi Arabia (N = 1168) were subjected to weight and height (or length) measurements. These measurements were individually compared with those of the NCHS reference population. The distribution of the study population was found to be significantly shifted to the left of the normal distribution for reference population on the percentile growth curves (P < 0.001). This denoted the inappropriateness of the NCHS reference standards for local use. Accordingly, the lower limits for the expected normal on the growth curves has been shifted from the 3rd percentile line to -3 standard deviation line, to be suitable for the Saudi children. This led to 70% & 56% reductions in the estimation of undernutrition, based on wt/age and ht/age indicators respectively. It is recommended that this adjustment be supported by other studies locally and in other developing countries.

Prevalence and health-care features of hyperglycemia in semiurban-rural communities in southern Saudi Arabia.

OBJECTIVE: To determine the prevalence of hyperglycemia in semiurban-rural Saudi Arabian communities and to assess some of its important health-care related aspects. RESEARCH DESIGN AND METHODS: A cluster of 12 villages near the city of Abha, the capital of the southern region in Saudi Arabia, with a total population of 2150 (290 families) has been included in this study. The family head was interviewed about diagnosed diabetes among family members. Also, the capillary blood glucose level was measured in subjects greater than or equal to 10 yr (the target population, n = 1419) with a reflectance meter after 2-h fasting after the main midday meal. RESULTS: The 87% of the target population who responded for screening showed a prevalence of 4.6% of diabetes, which was higher among men (5.5%, age adjusted, P less than 0.05) than among women (3.6%). Estimates were based on 57 cases ascertained by positive history of the disease (n = 49) or blood glucose level greater than 11.1 mM (200 mg/dl) without previous diagnosis of diabetes (n = 8). The prevalence of impaired glucose tolerance (blood glucose between 7.8 (140 mg/dl) and 11.0 mM (199 mg/dl) with no history of diabetes) was 3.7%, being higher among women than among men (P less than 0.01). Eighty-eight percent of the previously diagnosed cases were receiving treatment at the time of screening. However, in only 12.2% of those receiving treatment was glucose found to be controlled (level less than 7.8 mM [140 mg/dl]). CONCLUSIONS: Diabetes frequency in this Saudi community is relatively high. There is a pressing need to promote public awareness about the disease and to improve the competency of the health-care team for achieving better control and early detection of the disease.

Evaluation of the use of the reflectance meter by several operators in field screening for diabetes mellitus.

The performance of reflectance meters for measuring blood glucose concentrations was evaluated in other studies previously and was found to be satisfactory. In the present study, we have evaluated the reliability of one brand of such meters (Glucometer II), when used by several operators, for blood glucose measurements during an epidemiological survey. We have compared the results obtained by the meter with those obtained by a standard hospital laboratory procedure for the same samples. A high and statistically significant degree of correlation (r = 0.901) was observed between the two groups of measurements. The linear regression equation was Y = 0.9X + 13.4. We conclude that the Glucometer II is an accurate and practical instrument even when used by several operators in epidemiological surveys provided that adequate training is given to those operators prior to using the instrument. This is important since the use of reflectance meters in epidemiological surveys is becoming increasingly widespread especially in the third world countries.

Intestinal parasitic infections in schoolchildren of Abha (Asir), Saudi Arabia.

Stool specimens from 1282 children between the age of 5 and 13 years attending 10 primary schools for boys in the city of Abha, southwestern Saudi Arabia, were examined for the presence of intestinal parasites. Of these, 313, (24.4%) were found infected with one or more species of 11 intestinal protozoa and helminths. The most common pathogenic protozoa being Giardia lamblia (10.9%) followed by Entamoeba histolytica (4.1%). The nonpathogenic protozoan, Entamoeba coli had the highest prevalence rate (11.3%) in the children's stools. Hymenolepis nana was the commonest intestinal helminth (3.0%). Other intestinal helminths, including Ascaris lumbricoides, Trichuris trichiura. Schistosoma mansoni, Dicrocoelium dendriticum were detected to a lesser extent. The distribution of the common intestinal infections among the children surveyed were also analysed according to age, nationality and multiplicity of infection. Prevalence of E. histolytica was found to increase with age whereas Giardia infections were less common among older children. This pair of parasite species were strongly associated. Yemeni children had consistently the highest prevalence of infection with protozoa and helminths, followed by Saudi and non-Saudi children.

Teething pattern and prevalence of dental caries.

A cross-sectional study was conducted on the children of 146 randomly selected families in Abha, Saudi Arabia. Counting of teeth and examination for caries teeth of children under 12 years of age were done by family visits. The results showed that no child developed teeth before 5 months. By 12 months there were on an average 3.3 teeth erupted per child, and by three years 18.8 teeth. At 12 years of age there were 24.4 teeth per child as compared to 28 in other countries. The DMF (decayed, missing and filled) index of children increased from 1.8 at the age of 4 to 5.1 at 7 and 5.2 at 10 years of age. The rate of caries teeth was higher than that in Australia, Great Britain, USA, India, China and Sudan. Further investigations on causes of high rate of caries teeth are recommended.

Factors influencing development of caries teeth.

A cross sectional study was conducted on the children of 146 randomly selected urban families of Abha, Saudi Arabia, to find out the common factors associated with caries teeth. The factors considered for association were per capita monthly income, sources of drinking water, consumption of soft drinks, daily brushing of teeth, daily consumption of candy, and the education levels of mothers. All children up to 12 years of age were examined by visiting their families. The results showed that the per capita monthly income, sources of drinking water and habit of drinking soft drinks had no significant relation with the prevalence rates of caries teeth in children. But the habit of nonbrushing of teeth daily, daily consumption of candies, and low or no education of mothers had significant association with the presence of caries teeth. Adequate health education of children about the ill effects of these practices and raising the educational levels of mothers and prospective mothers may contribute towards achieving dental health by the year 2000 as targetted by the World Health Organization.

Health services utilization patterns of two urban communities in Abha, Saudi Arabia.

A 20% random sample of 146 families including 942 individuals was selected from two urban communities in Abha City in Saudi Arabia in order to assess the pattern of health services utilization. The information was obtained from the heads of families through interviews using a structured questionnaire. Health "wants" of the people to improve health services were also determined. Of all the health problems encountered in the sample, 84% received health services from the Primary Health Care Center (PHCC) and from the hospital out-patient department. Seventy percent of the deliveries were conducted at the hospital, and the average hospital stay for a delivery was 2.9 days. The overall annual hospitalization rate for the population under study was 89 per 1,000 population, with an average hospitalization period of 7.5 days per case. Deliveries constituted the leading cause for hospitalization. Only 52% of the deliveries received postnatal care, mostly in the hospital, whereas 88 per cent of the pregnancies received antenatal care, mainly in the PHCC. The outreach services of the PHCC were very deficient and lacked the basic elements of preventive services. The role of the hospital and PHCC should be adjusted to meet the health needs of the people, and the people's health "wants" which reflect their sociocultural background should be given attention in health planning.

Health services utilization and cost in Ismailia, Egypt.

A pilot study has been undertaken to assess the utilization patterns of health services and to estimate the expenditure on health care in the Governorate of Ismailia, Egypt. A stratified random sample of 89 households (576 individuals), along with 5 pharmacies, 4 primary health care units (PHCUs) and 10 traditional health workers (THWs) has been selected and studied using personal interviews. PHCUs are facilities affiliated with the Governorate Health Directorate and provide free public primary health care services. They include rural health units, rural hospitals and urban health centres. THWs are individuals with informal training and experience in medical care, and officially unrecognized, but provide some primary health care services to the people. They include traditional midwives (TMs) and traditional healers (THs). The estimated average annual per capita expenditure on health care was L.E. 9.2 (Egyptian L.E. approximately or equal to US$ 1.25). The per capita cost of medication (L.E. 3.5) was double the cost of physicians' fees (L.E. 1.77). An annual rate of hospital admission of 24.3 per 1000 population at an average cost of L.E. 10.5 per case admitted was incurred by the sample. There is evidence that the PHCUs have not been utilized efficiently and there was some degree of dissatisfaction with their services. The households relied more on private physicians as their first contact for seeking help for health problems. The majority utilized TMs for care of delivery despite the shortcomings in their training and supervision. Eighty per cent of the mothers in the sample have had no ante-natal care during pregnancy despite the availability of such care in the PHCUs. Possible reasons for these underutilization patterns of the PHCUs have been discussed, and major approaches for increasing the efficiency and utilization of the health services have been proposed. THWs should be officially recognized by health authorities, should be properly trained and supervised, and their services should be fully integrated with the community health care programmes. Also, programmes for proper administration, organization and supervision of the PHCUs and programmes. Also, programmes for proper administration, organization and supervision of the PHCUs and programmes for developing health manpower responsive to community health needs should be planned and implemented. Finally, a flexible system to compensate fairly physicians and staff of the PHCUs and to allow reasonable chance for physicians for private practice must be established.(ABSTRACT TRUNCATED AT 400 WORDS)

The water factor and mortality from ischemic heart disease: a review and possible explanations for inconsistent findings with additional data from Manitoba.

The question of the relationship between water hardness and mortality from cardiovascular diseases is far from being settled. Marked discrepancies in the results of various studies in this area exist and there is a great need for closer examination of the reliability of measuring water hardness and other water characteristics. There is also a need for standardizing these measurements and for accounting for certain important questions in designing studies of this nature. This article reviews the results of various studies on the "water factor," points out their discrepancies, presents additional evidence from the Province of Manitoba against the "water factor;" and explains possible sources for discrepancies in the findings of various studies. Based on the evidence so far available, it is too early to universally accept the "water story" and to make recommendations for discouraging the softening of hard water as a measure for preventing cardiovascular disease mortality.

Prognostic factors in the survival of 1,484 stroke cases observed for 30 to 48 months. I. Diagnostic types and descriptive variables.

Survival and factors affecting survival were studied in 1,484 new cases of acute definite stroke occurring between Jan 1, 1970, and June 30, 1971, in Manitoba. The 962 infarctions, 279 hemorrhages, and 243 unidentified strokes were ascertained from hospital claim reports. Personal, clinical, and laboratory data were collected from hospital medical records, death certificates, and autopsy reports. Cases were followed up until Dec 31, 1973, to determine survival. Survival was significantly better in infarction than in hemorrhage, in subarachnoid hemorrhage than in intracerebral hemorrhage, in men than in women, in the young than in the old, in the married than in the single, in hemorrhage cases from rural areas than from urban areas, and in those discharged home than in those transferred to long-term care hospitals. These data may help in predicting the outcome of stroke and in planning for more efficient care.

Herpesvirus infection and cervical anaplasia: a seroepidemiological study.

In a cohort of 23,146 pregnant females followed for 37-56 months subsequent to collection of prenatal sera, 57 cases of carcinoma of the cervix were encountered. Three controls were selected for each case from the residual cohort matched to cases for age, residence, number of prior cytology smears taken, and the data of entry to the study. The antibody activity to herpesvirus type 1 and type 2 was examined by the indirect hemagglutination test. The proportion of cases positive for HSV-2 infection was greater than that of the controls; however, the difference was not significant at the 5% level. The relative risk value for the association between HSV-2 infection and carcinoma of the cervix was found to be 2.33. The geometric mean titers of IHAT revealed that the cases of cervical cancer had a higher titer than the controls with respect to HSV-1 as well as HSV-2 antibodies. A sufficiently longer follow-up, yielding a larger sample size, is desired to assess the specific role of HSV-2 infection in development of cervical anaplasia.