Aim: To examine the effects of an interventional programme about preeclampsia on high-risk preeclampsia Jordanian women's awareness and pregnancy outcomes. Background: Preeclampsia is a leading cause of maternal death and illness globally, and has a high rate in Jordan compared to other countries. Increasing preeclampsia awareness is recommended to prevent its serious complications. Methods: A randomized controlled trial was conducted at a public hospital in Jordan. A consecutive sample of 113 pregnant high-risk preeclampsia women was recruited and divided randomly into interventional and control groups. A questionnaire comprising seven terms on demographics and 51 questions assessing women's awareness on preeclampsia was used. The intervention group received a 2h educational programme about preeclampsia with self-monitoring of blood pressure and urine protein and routine care, while the control group received a 2-h educational programme relevant to urinary tract infection and received routine care. A pretest was carried out at baseline and 2 weeks after the intervention, a post-test was performed for the two groups. Results: The results revealed a significant difference in mean scores for awareness of preeclampsia in the interventional group compared to the control group after conducting the education programme. A significant difference was also found between both groups in terms of Apgar scores at 1st min and 5th min and mean diastolic BP. Conclusion and implications for nursing, health and education policy: Preeclampsia educational programme is effective in improving preeclampsia awareness and some pregnancy outcomes. Midwifery and nursing educators are highly encouraged to train midwives and nurses to be effective health professionals. Health educational programmes need to be designed by professionals based on an updated evidence and women's needs. It is of importance that these programmes focus on involving women in their health care by selfmonitoring and providing women with the necessary resources to improve pregnancy outcomes.

Background Qatar is located on the north-eastern coast of the Arabian Peninsula. Qatari natives account for less than 15% of the population while the largest migrant group comprising 60% derives from South Asia. Despite projections that stroke burden in Qatar will increase with population ageing, epidemiological studies focusing on stroke in Qatar are relatively scarce. Method We reviewed the available epidemiological publications relating to Qatar. In addition, we have added to this knowledge by incorporating Qatari data from the on-going Bio-Repository of DNA in Stroke, an independent multinational database of stroke patients. Results Qatar has low reported incidence and mortality rates of 58 and 9.17 per 100,000 per year, respectively, which may be explained by its middle-aged migrant worker majority population. Correspondingly, South Asian migrants in Qatar suffered younger strokes than Qatari natives (48.7 vs 63.4 years, P < 0.001). Among the most common risk factors identified in stroke patients were hypertension (77.9%), diabetes (43.8%) and hypercholesterolemia (28.5%). Ischaemic stroke was the most frequent subtype amongst migrant South Asians (71.1%). The majority of stroke cases had computed tomography and/or magnetic resonance imaging scans, but only 11.1% of ischaemic strokes were thrombolysed. Qataris on one-year follow up were more often found to have died (6.5% vs 0.3%) and had further stroke/transient ischaemic attack events (17.4% vs 6.4%, P = 0.009) compared to South Asians. Conclusion The burden of stroke is increasing in Qatar, and considerable disparities are observed between the native and migrant populations which likely will require different approaches to management by its healthcare system.

Background/Aims: Congenital Adrenal Hyperplasia (CAH) patients are at higher risk of systemic hypertension secondary to high steroid dose therapy. Our aim was to look for early cardiovascular changes in young CAH patients, by the analysis of BP levels and echocardiographic parameters. We aimed also to investigate the possible risk factors that may contribute to such effects. Methods: We evaluated blood pressure measurements (using international percentiles) and echocardiography in 53 CAH pediatric patients. Thirty healthy age and sex matched children were included as controls. Results: It was found that 10(18.9%) patients had elevated BP and 23(43.4%) patients had hypertension. Out of those hypertensive patients, 7 (13.2%) patients had systolic hypertension, 3 (5.6%) patients had diastolic hypertension, and 13 (24.5%) patients had combined systolic and diastolic hypertension. BP levels of CAH cases were positively correlated with Hydrocortisone doses (r=0.14, P value=0.038) and negatively correlated with 17-OH-progesterone levels (r=-0.15, P value=0.023). Our patients had myocardial hypertrophy with increased left ventricular wall thickness, greater mean LVM and LVMI. Age and hypertension were predictors of LV hypertrophy. Conclusions: The present study showed that a considerable portion of CAH patients had hypertension. Their BP levels were influenced by Glucocorticoids (GCs) doses.

SummaryIn a randomised, double-blind study, the effect of addition of I mg of diamorphine to 4 ml of 0.5% bupivacaine for spinal anaesthesia was studied in two groups each of 30 patients presenting for either transurethral genito-urinary surgery, or for lower limb arterial surgery or inguinal herniorrhaphy. Addition of 1 mg diamorphine to intrathecal 0.5% bupivacaine produced a prolonged and satisfactory analgesia in more than half the patients undergoing lower limb arterial or inguinal surgery. and the analgesic requirements of ihe remainder during the first postoperative 24 h were much less than those who received bupivacaine alone. In the urological surgery set there were no signijicant darerences between the group who received bupivacaine and diamophine, and the group who received bupivacaine alone. The mixture of diamorphine I mg in 4 ml0.5% bupivacaine was slightly less hypobaric (0.9981 at 37°C) than bupivacaine alone.Key words Anaesthetic techniques, regional; spinal. Anaesthetics, local; bupivacaine. Analgesics; diamorphine.Aqueous solutions of bupivacaine hydrochloride (0.5%) are essentially isobaric (sp. gr. I .004 at 20°C; 0.997 at 37°C) when mixed with cerebrospinal fluid to provide spinal subarachnoid anaesthesia for surgery of the lower limbs and for transurethral procedures 111. A volume of 4 ml of such a solution injected into the subarachnoid space at the level of L3-4 seldom causes an extensive sensory or autonomic nervous blockade, and the duration of analgesia is about 2.5-3 h [I]. Diamorphine (diacetyl morphine) may also be injected intrathecally to provide prolonged postoperative analgesia devoid of autonomic blockade. Because diamorphine is highly lipid soluble, high drug concentrations are not maintained in the mobile cerebrospinal fluid (CSF) phase to diffuse rostrally and cause ventilatory depression [2]. One of us (C.P-R.), has used for many years, empirically but successfully, a mixture of 1 mg diamorphine dissolved in 0.5% bupivacaine to provide spinal anaesthesia and excellent postoperative pain relief, for patients undergoing lower limb arterial surgery.Diamorphine (1 mg of anhydrous powder) when dissolved into 4 ml of isobaric bupivacaine 0.5% should in theory increase the density and baricity of bupivacaine to some extent. which might affect the spread of analgesia subsequently. To test this hypothesis, we determined the density and baricity of bupivacaine 0.5% with and without the addition of 1 mg diamorphine in 4 ml of solution. We also compared, in two randomised double-blind studies, the spread and duration of analgesia provided by intrathecal bupivacaine 0.5% with diamorphine, to that produccd by bupivacaine alone. Patients and methodsTwo parallel studies were undertaken, the first involving 30 patients (Set VG) presenting for elective vascular or general surgery of the groin and lower limbs; the second involving 30 patients (Set CU) presenting for elective transurethral procedures of the bladder and the prostate gland (Table I). The studies were approved by the district et...