Abductive machine learning for modeling and predicting the educational score in school health surveys.

The use of modern abductive machine learning techniques is described for modeling and predicting outcome parameters in terms of input parameters in medical survey data. The AIM (Abductory Induction Mechanism) abductive network machine-learning tool is used to model the educational score in a health survey of 2,720 Albanian primary school children. Data included the child's age, gender, vision, nourishment, parasite infection, family size, parents' education, and educational score. Models synthesized by training on just 100 cases predict the educational score output for the remaining 2,620 cases with 100% accuracy. Simple models represented as analytical functions highlight global relationships and trends in the survey population. Models generated are quite robust, with no change in the basic model structure for a 10-fold increase in the size of the training set. Compared to other statistical and neural network approaches, AIM provides faster and highly automated model synthesis, requiring little or no user intervention.

Modeling and forecasting monthly patient volume at a primary health care clinic using univariate time-series analysis.

Two univariate time-series analysis methods have been used to model and forecast the monthly patient volume at the family and community medicine primary health care clinic of King Faisal University, Al-Khobar, Saudi Arabia. Models were based on nine years of data and forecasts made for 2 years. The optimum ARIMA model selected is an autoregressive model of the fourth order operating on the data after differencing twice at the nonseasonal level and once at the seasonal level. It gives mean and maximum absolute percentage errors of 1.86 and 4.23%, respectively, over the forecasting interval. A much simpler method based on extrapolating the growth curve of the annual means of the patient volume using a polynomial fit gives the better figures of 0.55 and 1.17%, respectively. This is due to the fairly regular nature of the data and the lack of strong random components that require ARIMA processes for modeling.

[Medical practice with regard to physicians' mistakes and disease complications].

This study gives a historical background on regulations implemented by Islamic scholars to codify medical practice, and highlights the advance of science and technology in the modern era and the need for physicians (along with science and technology) to adhere to religious values. It discusses physicians' responsibilities, the issue of malpractice, and the difference between malpractice and complications. Recommendations are proposed to implement medical ethics in the curriculum of medical colleges around the Islamic world and to promote the role of medical religious committees in Islamic world as is being done in Saudi Arabia.

Tumor necrosis factor (TNF alpha) in lymphadenopathy and bone marrow involvement: histopathological and serological study.

Serum samples were collected from 40 patients with enlarged lymph nodes. Lymph node and bone marrow biopsies were performed and processed as usual. Tumor necrosis factor-alpha (TNF alpha) was determined in the sera by factor test human TNF alpha ELISA kit. Histopathological studies of lymph node and bone marrow biopsies were evaluated. The data obtained from this study showed that bone marrow was involved in only 5 patients and their TNF showed the lowest level in this study with a mean level 50 pg/ml. The highest level of TNF occurred in cases with granulomatous lymphadenitis (124 pg/ml) followed by reactive lymphadenitis (105 pg/ml). It can be considered that TNF reflects the immune status of the patient and its study in the serum can be of help in evaluating the progress of the disease. An extended study is need to evaluate the role of TNF-alpha as a prognostic marker in malignancy.

Extruded and protruded lumbar discs: combined clinical, histopathological, histochemical, immunopathological, histochemical, immunopathological and ultrastructural studies.

A total number of selected 252 patients with prolapsed lumbar intervertebral discs (92 extruded and 160 protruded) were operated upon in Neurosurgery Department Zagazig University Hospital during the period extended from January, 1988, to October 1990. In this study we reviewed their clinical and operative data. Surgical biopsies were taken from randomly selected 120 patients of them (50 extruded and 70 protruded discs) and were subjected to histopathological, histochemical and immunopathological studies. Ultrastructural study was performed for randomly selected 14 cases (7 extruded and 7 protruded discs). The results were compared with 7 normal intervertebral discs obtained from these studies showed that there were no differences between extruded and protruded discs at the histochemical level. Cell mediated immunity could be added as a factor in the pathogenesis of the degenerative process that lead to disc prolapse (in 20% of cases with extruded discs and 57.1% of cases with protruded discs). At the ultrastructural level 85.3% of extruded discs were prolapsed nucleus pulposus while 14.7% were prolapsed annulus fibrosus alone or with nucleus pulposus. All protruded discs were prolapsed annulus fibrosus with nucleus pulposus. These findings may have an impact on the management of this common problem.

Effect of parasite screening on refugee health.

Intestinal parasitic infections among refugees have been perceived as a public health problem for decades. A control program strategy to reduce morbidity and eventually transmission of intestinal parasites was initiated in 1993 by Mercy International (MI) for a group of Somalia refugee and has been implemented successfully. The management of the program operating within a comprehensive health care project and the control activities has been performed through the existing health facilities. This project was based on the "Comprehensive Health Care Approach" concept and applied to a collection of 10,000 Somali refugees. A project, which could be further, developed and modified for other similar situations. The strategy adopted was based on periodic chemotherapy of schoolchildren, intense health education in close collaboration with the local community leaders. An overall reduction in prevalence of intestinal parasitic infections of 53% was one of the targets achieved through this effort after three years of activities. 92% and 62% reduced the intensity of Ascaris lumbricoides and Trichuris trichiura infection, respectively. This approach in concert with the political commitment and limited operational costs is a warranty for the future sustainability of the control activities. Future control strategies are tailored to the results of evaluation surveys and are targeted to the identified high-risk areas. This project can be seen as a model in other refugee situation with the use of limited local resources.

A village seizes the reins of health care.

The setting-based approach to health promotion and education has been adopted in an Albanian village. The project requires a high degree of self-determination and self-help. External support comes from the International Islamic Relief Organization. Encouraging progress is being made as villagers acquire a wide range of skills, connected not only with the provision of care but also with such matters as fund-raising, health education and relations with public and private bodies.

PIP: A model health promotion project organized by the International Islamic Relief Organization in an Albanian village demonstrates the significance of the principles of self-help and community participation. The first step in the process was a mass meeting where villagers identified their problems and needs and volunteered for committees and working teams. To obtain in-depth data on social, personal, and health characteristics, 115 of the village's 284 households were randomly selected for interviews with the female head. Priorities were selected on the basis of the following criteria: probability of excellent results, effect on the maximum number of villagers, prevention of future health problems, cost-effectiveness, fulfillment of perceived community needs, and potential for community planning and implementation. Endemic goiter, childhood diarrhea, and unsanitary refuse disposal were selected. Community leaders and working teams then created an intervention program and defined aims, indicators, instruments, and roles. Participants were provided with computer training, and electronic media were used to present ways of dealing with common health problems. To date, villagers have made improvements in the local school, established a room for oral rehydration therapy, obtained iodine tablets and iodized salt from the Ministry of Health and some nongovernmental organizations, and constructed special sites for the burning of refuse. As a result of this project, villagers have developed skills in organizing, supervision, education, and fund raising and have learned how to approach nongovernmental organizations and government agencies for support. The self-reliance that has emerged as a result is expected to provide a sound basis for sustaining the projects even after external agents depart.

An acute case of infantile visceral leishmaniasis histopathological and histochemical studies.

Some histopathological and histochemical studies were carried out on the intestines of an acute case of infantile visceral leishmaniasis. Macrophages-carrying amastigotes were seen mainly in the villous tips, mucin secretion inside the mucosal cells was mild, deposits of collagen and fibrin in the lamina propria were marked and the argentaffin cells were partially lost. The whole results were discussed.

Diagnostic value of DNA content in keratosis and adult papilloma of the larynx.

Nuclear DNA content of laryngeal epithelial cells in smears was carried out by DNA cytometry with automatic microscope and T.V. image analysis system in 6 adult papilloma and 10 keratosis of the larynx patients. The method had high degree of precision confirmed by whole tissue biopsy and serial sections. The method is non invasive and allows fair diagnosis of suspicious and early malignant cases.

Evaluation of Antenatal Referrals from Health Centres to the Maternity and Children's Hospital in Dammam city, Saudi Arabia.

OBJECTIVE: To evaluate antenatal referral rates from Primary Health Care (PHC) centres to the Maternity and Children's Hospital in Dammam and factors affecting it. METHODOLOGY: Four randomly Selected Primary Health Care Centres in Dammam city. A sample of 135 pregnant women referred to the hospital (cases) and 135pregnant women not referred (controls) were randomly selected. A double phase sampling scheme was adopted. Questionnaires regarding the characteristics of the general practitioners (GPs) were distributed to those GPs caring for antenatal patients in the 4 health centres. RESULTS: There was a variation in the referral rates of the five generalpractitioners from 11.5 to 21.2 per 100 antenatal consultation. It was found thatS certain characteristics of the GPs had an important influence on the referral rates. High risk factors in pregnancy were present in some of the controls but they were not referred. CONCLUSION #ENTITYSTARTX00026; RECOMMENDATIONS: There is a variation in the referral rates between the GPs. There is a need to monitor and improve the quality of the antenatal care and the referral process. Better training of the GPs and implementing shared obstetric care is recommended.

Modeling obesity using abductive networks.

This paper investigates the use of abductive-network machine learning for modeling and predicting outcome parameters in terms of input parameters in medical survey data. Here we consider modeling obesity as represented by the waist-to-hip ratio (WHR) risk factor to investigate the influence of various parameters. The same approach would be useful in predicting values of clinical parameters that are difficult or expensive to measure from others that are more readily available. The AIM abductive network machine learning tool was used to model the WHR from 13 other health parameters. Survey data were collected for a randomly selected sample of 1100 persons aged 20 yr and over attending nine primary health care centers at Al-Khobar, Saudi Arabia. Models were synthesized by training on a randomly selected set of 800 cases, using both continuous and categorical representations of the parameters, and evaluated by predicting the WHR value for the remaining 300 cases. Models for WHR as a continuous variable predict the actual values within an error of 7.5% at the 90% confidence limits. Categorical models predict the correct logical value of WHR with an error in only 2 of the 300 evaluation cases. Analytical relationships derived from simple categorical models explain global observations on the total survey population to an accuracy as high as 99%. Simple continuous models represented as analytical functions highlight global relationships and trends. Results confirm the strong correlation between WHR and diastolic blood pressure, cholesterol level, and family history of obesity. Compared to other statistical and neural network approaches, AIM abductive networks provide faster and more automated model synthesis. A review is given of other areas where the proposed modeling approach can be useful in clinical practice.

Evaluation of T cells, B cells and Ig. in tissues of human cutaneous leishmaniasis.

Cutaneous leishmaniasis (CL) is a granulomatous skin disease. The healing of the CL. lesions is attributed to the delayed immunity developed against the amastigotes of the parasite. However, in some cases in spite of the development of strong delayed hypersensitivity CL. lesions failed to heal. In this paper, it was intended to assess the role of immunity in the lesions of human cutaneous leishmaniasis. The results showed that the helper cells predominated the suppressor ones, the mean percentage of B lymphocytes was 25 and the immunoglobulins particularly the IgG were demonstrated by being positively stained. On the other hand, the complement (C3) was within the normal range.

Lymphatic leishmaniasis. An adult case without visceral involvement from Sharkia Governorate, Egypt.

Lymphatic leishmaniasis was reported as an indigenous infection in a 30 year old male from Abo Hamad, Sharkia, Egypt. Cervical lymphadenopathy was the only clinical sign and no visceral involvement. Diagnosis was based on histopathological examination of needle biopsied material. The patient was successfully treated with sodium stibogluconate as shown clinically and parasitologically. It was concluded that lymphatic leishmaniasis should be in mind when dealing with lymphanopathy of unknown aetiology.

Cutaneous leishmaniasis as a possible predisposing factor for skin malignancy.

This paper reports a 13 year old Yemenian boy with cutaneous leishmaniasis (CL.). The histopathological picture of the CL lesions showed marked dysplasia indicating premalignancy. The possibility that CL as one of the predisposing factors for skin malignancy was discussed.

Knowledge, attitude and practice (kap) of primary health care physicians and nurses towards hypertension: a study from dammam, saudi arabia.

OBJECTIVE: To evaluate the quality of management of hypertensive patients attending Primary Health Care Center (PHC) in Dammam city and to determine factors that possibly affect it. DESIGN: A cross sectional study and direct interview. SETTING: Dammam city. SUBJECTS: All doctors and nurses from a randomly selected sample of Primary Health Care Centers during April 1994. MAIN MEASURES: Measuring the knowledge, attitude and practice of doctors and nurses about hypertension management. RESULTS: Hypertension is regarded as an important health problem in Saudi Arabia in the opinion of majority of doctors (80'0) and nurses (69%). Almost half of the doctors and nurses believe that nurses are sufficiently qualified to measure blood pressure of patients. Most of the doctors (96.7%) and nurses (86%) depend merely on face-to-face education of patients Thirty percent of doctors and 34% of nurses think that the care for hypertensive patients in their Primary Health Care Centers is inadequate. CONCLUSIONS AND RECOMMENDATIONS: Offering on job training of both physicians and nurses on hypertension management. Producing a well planned protocol on the national level. Implementing a total quality management and medical audit system to PHC centers.

Histopathological studies on detrusor muscle in schistosomiasis haematobium patients with poor bladder contractility.

The electron microscopic structure of the detrusor muscle in schistosomiasis patients with poor bladder contractility as evaluated by urodynamic measures had been compared with normal detrusor muscle from non-schistosomiasis patients. In the patients with poor bladder contractility the detrusor was formed of muscle fibers which were smaller in size, widely separated by collagen and showed degenerative changes and hyalinosis. No evidence of smooth muscle hyperplasia, mitosis or fibroblastic proliferation was seen. This pathological changes in the bladder of schistosomiasis patients may explain the cause of poor contractility.

Immunological pattern in Syrian golden hamsters experimentally infected with Schistosoma mansoni and Leishmania d. infantum.

The immunoglobulins (IgG, IgM, IgE, & IgA) and the complements (C3 & C4) were studied in hamsters as result of a single infection (S. mansoni or L.d. infantum) and as concomitant infection (L.d. infantum on top of S. mansoni). The immunological pattern showed profound IgG and IgA increase in the concomitant group than either infection alone. Also, concomitant infection induced more IgE increase than either infection alone. On the other hand, C3 and C4 showed more decrease in concomitant infection. The whole results were discussed.

Cutaneous leishmaniasis and basal cell carcinoma in a patient from Al Baha, Saudi Arabia.

While cutaneous leishmaniasis (CL) is a protozoal parasite of the skin, basal cell carcinoma (BCC) is a malignant tumour of the skin. In this paper, we report the identification of cutaneous leishmaniasis and basal cell carcinoma in one patient, in the same site and same lesion. This raised the possibility that CL is a predisposing factor for BCC.

Vascular changes in cutaneous leishmaniasis.

Fifty cases of proven human cutaneous leishmaniasis were histopathologically studied. In twenty biopsies the picture was vascular alternations with or without fibrinoid necrosis and fibrin thrombi in both arteries and veins within the area of the inflammation in the lesions. Hyalinosis and intimal proliferation were also seen. On the other hand, immunoperoxidase staining of CL. lesions showed IgG and IgA within the endothelial cells, in the media and the perivascular space of the diseased vessels. It seems that the formation of immune complexes in the infected skin was responsible for the vascular changes.

Schistosomiasis associated bladder carcinoma expression of cytokeratin.

Twenty patients with bladder carcinoma (14 transitional cell carcinoma and six squamous cell carcinoma) and ten controls of (four with bilharzial lesions, three without and three with metaplasia and dysplasia) were subjected to immunocytochemical and immunohistochemical studies. Bladder and urine samples examination were carried out with the high molecular weight cytokeratin and broad spectrum keratin antibodies using peroxidase anti-peroxidase. Cytokeratins of high molecular weight were expressed in all squamous cancer while broad spectrum keratin was positive in 83.3%. The transitional cell carcinoma was positive in 50% with both cytokeratin and broad spectrum keratin. Urine shedded were positive in 83.3% and 66.7% of squamous cell carcinoma with high molecular weight cytokeratin and broad spectrum keratin respectively. However, each of them was positive in 50% of transitional carcinoma, and negative with non-malignant cases except with metaplasia and dysplasia.