SUMMARYTrauma victims are at high risk of development of inadequate tissue oxygenation, anaerobic metabolism and tissue acidosis. This will lead to multiple organ dysfunction syndrome or death. To maximize chances for survival, treatment priorities must focus on rapid resuscitation and rapid hemostasis.The aim of the work is a comparison between the usage of normalization of each of cardiac index (CI) [one of the global tissue oxygenation indices] and gastric intramucosal pH (pHi) [one of the regional tissue perfusion indices] as resuscitation end point to find out which one is the best for providing better outcome in mechanical trauma adult shocked patients.Physiologically, respiratory gas transport is the amount of O2 transported to tissues and the amount of CO2 that removed by blood.Oxygen transport system involves four components. These are (1) whole blood oxygen content (CaO2), (2) oxygen delivery (DO2), (3) oxygen uptake (VO2), and (4) oxygen extraction ratio.Carbon dioxide transport system includes diffusion of CO2 out of the tissue cells to blood, and transported to alveoli as plasma protein combined CO2 (7%), Hgb.CO­2 (23%) and HCO3- (70%).Proper tissue oxygenation is essential for normal cell function. It needs continuous adequate O2 supply to tissue cells. Adequate O2 supply to tissue needs (1) normal O2 balance (i.e. VO2 = MRO2), (2) absence of both oxygen deficit, oxygen debt, and (3) flow independent O2 consumption.Global tissue hypoxia develops when systemic O2 delivery is insufficient to meet O2 demand of the tissues. Regional tissue hypoxia develops when regional O2 delivery is insufficient e.g. gastrointestinal tract hypoxia when O2 supply by splanchnic circulation became insufficient.Shock is a life-threatening disturbance of hemodynamics that results in failure to maintain adequate perfusion (oxygenation) of vital organs. The varieties of circulatory shock are the following; (1) hypovolemic (hemorrhagic), (2) cardiogenic and (3) distributive.The hypovolemic (hemorrhagic) shock is due to external or internal hemorrhage with consequence hypovolemia and its related manifestations (decreased venous return, decreased cardiac output, decreased blood pressure, … etc.).The stages of hemorrhagic shock are three; (1) compensated, (2) uncompensated, and (3) irreversible. According to the volume, the lost blood is classified into 4 classes; class I (up to 750 ml of blood volume lost), class II (750-1500 ml of blood volume lost), class III (1500-2000 ml of blood volume lost) and class IV (³ 2000 ml of blood volume lost).Evaluation of hypovolemic shocked patients include; (1) history (type of trauma, associated diseases, concurrent drugs … etc.), (2) physical examination (consciousness, airway, hemodynamic .. etc), (3) laboratory studies (CBC, electrolytes, glucose level, kidney functions, coagulation profile … etc), (4) imaging studies (X-ray, chest, pelvis and long bone and scan of the skull and cervical vertebral column).Treatment of hemorrhagic shocked patient includes; (1) prehospital care as splitting of fractures, cervical spine immobilization rapid transport of the patient and initiate appropriate treatment in the field. (2) Emergency department care which has three goals; (a) maximization of oxygen delivery, (b) control of further blood loss and (c) fluid resuscitation.Cardiogenic shock is the inability of the heart to generate sufficient output to maintain adequate tissue perfusion. It is due to heart failure which is precipitated by variety of the diseases as vulvular heart disease, cardiomyopathy, cardiac tamponade, acute myocardial infarction etc.Cardiogenic shock is manifested by low blood pressure, tachycardia, pallor, low pulse pressure, increased central venous pressure...etc. Management of cardiogenic shock includes oxygen, nitroglycerine, asprine, morphine and intravenous fluid administration, sometimes intra-aortic balloon pump needed.Distributive shock is insufficient tissue perfusion especially for vital organs due to blood volume shift from central core organs to the massively dilated peripheral vascular beds especially venous blood vessel.According to the causes of distributive shock, there are 3 varieties. These are (i) neurogenic, (ii) septic, and (iii) anaphylactic and anaphylactoid.Shock in trauma patients is mainly due to hemorrhage but also there are many other causes as cardiac tamponade, tension pneumothorax spinal cord injury etc.Assessment of tissue perfusion give us an idea about DO2/VO2. This assessment may be global or regional.The methods of assessment of global tissue perfusion (oxygenation) include heart rate, blood pressure, respiratory rate, capillary refill, shock index, SVO2, ETCO2, serum lactate, base deficit, and cardiac output measurement.The methods of assessment of regional perfusion (oxygenation) depend on the body system to be assessed. GIT perfusion is assessted by gastric tonometry and sublingual tonometry. Skeletal muscle perfusion is assessed by near infrared spectroscopy (NIRS). Cerebral tissue oxygenation is assessed by electron paramagnetic resonance oxymetry. Urinary bladder perfusion is assessed by fiberoptic multisensor probe.Trauma is structural, physiological, or psychological changes due to subjection of the body to one or more of inflecting causes of trauma.The causes of trauma are classified intro: (a) iatrogenic as injury of any organ during surgery, rib fracture during CPR and (b) non-iatrogenic as mechanical (blunt and sharp), thermal, barometric … etc.The mechanisms of mechanical trauma depends on the inflecting cause. Blunt object produces trauma by one of the following mechanisms; (i) compression, (ii) shear and (iii) over pressure. Sharp object produced trauma by separating and crushing the tissues along its passage in the tissues.The commonest blunt trauma are: (I) Closed vehicular collision; (a) front impact collisions (as stearing wheal syndrome, windscreen syndrome and dashboard syndrome), (b) lateral impact collisions, (c) rear impact collisions, (d) rotational collision and (e) rollover, (II) Open vehicular collisions, (III) Falls from a height and (IV) Pedstrian collisions.The commonest sharp trauma are; (i) stap wound and (ii) missile wounds.Trauma either accidental or surgical results in alternation of nearly all physiologic systems. Stimuli that initiate the physiologic response to trauma are acute blood loss, shock, hypoxia, acidosis and hypothermia. The mediators of the responses to trauma are sympathoadrenal axis, hypothalamic-pitutary-adrenal axis, antidiuretic hormone, rennin and angiotensin, endogenous opioid, locally produced mediators, and toxic free radicals.Physiologic response to trauma includes psychologic changes, altered vital sings, edema, impaired oxygen transport, altered metabolism, altered coagulation and altered immunity.Assessment and management of trauma patients includes, preparation, triage, primary survey (ABCDES), resuscitation, adjuncts to primary survey and resuscitation secondary survey, adjuncts to secondary survey, continued post resuscitation monitoring and re-evaluation and definitive care.Complications of trauma patients are bleeding and coagulopathy, cardiovascular failure, respiratory failure, embolism, acute renal failure, dysfunction of immune system, sepsis and multiple system organ failure. Psychatric complication, mortality and economic complications.Scoring systems to evaluate trauma patient are divided into physiological, anatomical and combined. Physiological scoring systems are trauma score for adult, trauma score for children, age specific pediatric trauma score for children, Glasgow coma scale for adult, Glasgow coma scale for children and APACHE score. The anatomical scoring systems include abbreviated injury score, injury severity score. The combined physiological and anatomical scoring systems include, trauma injury severity score, trauma index score and circulation, respiration, abdomen, thorax, motor and speech score.Anesthetic management of trauma patient included preoperative evaluation and preparation, establishment of the suitable anesthesia and postoperative care. Preoperative evaluation and preparation include; (i) pre-anesthetic history (of the scene of the accident, pre existing diseases, previous operation, allergy and drug therapy), (ii) physical exmaination with concentration on the state of respiration, circulation and nervous system, and signs of difficulties of intubation, pneumothorax, myocardial contusion, and pericardial tamponade,(iii) investigations to evaluate acid base and electrolytes status beside ECG and X ray for chest and cervical spines.General anesthesia is the technique of choice for patients with multiple injuries. All patients are considered to have full stomach. So in cooperative patients the best way to protect airway is by awake intubation. In uncooperative patient intubation after rapid sequence induction of general anesthesia in the best, provided that the facilities to avoid aspiration are available.The best drug for maintenance of general anesthesia are narcotic analgesics, low concentration of volatile anesthetics and muscle relaxant with no cardiovascular side effects as pipecuronium. During operation, crystalloid, colloid and blood can be given. Monitoring of HR, rhythm, BP, ETCO2, temperature, urine output, intravascular volume status is essential. Postoperatively, extubation of trauma patients following emergency surgery should be delayed until the patient has recovered gag and cough reflexes to protect airway. Critical care unit should be reserved for the unstable trauma patient for monitoring, mechanical ventilation, fluid administration, warming, nutritional support and laboratory investigations.This study was carried out in the emergency room, operating room and surgical intensive care unit, of Zagazig University Hospital, under the supervision of Anesthesiology Department, after approval of the local ethics committee.It is a prospective randomized clinical study that was carried upon 40 decompensated hemorrhagic shocked patients of both sex who exposed to mechanical blunt trauma patients. The volume of blood loss of these patients was of class III or IV. Their age were ranged from 20-50 years old and their body weights were ranged from 70-80 kgThe exclusion criteria were head trauma, and any patient with evidence of hepatic, renal, respiratory or cardiac problems.On admission rapid assessment of patient’s airway, breathing, circulation (HR, blood pressure), conscious level by GCS were done. Also for every patients at least 2 wide pore peripheral I.V lines (16 gauge) were inserted for administration of drugs and resuscitative fluids.After that these patients were transported to the operating room where all patients were intubated under general anesthesia for the intended surgical procedure. Then nasogastric or orogastric tonometric catheter was inserted and the non-invasive cardiac output sensor was connected between enotracheal tube and breathing circuit. Central venous catheter for monitoring of intravascular volume and for withdrawal of blood samples and intra-arterial line for arterial blood samples were inserted too.General anesthesia was inducted by rapid sequence intravenous administration of sleep dose of kelamine HCl and suxamethonium 1 mg/kg and was maintained by incremental doses of ketamine if patient is hypotensive or inhalational with low concentration of Halothane and fentanyl 0.1 mg/h. if blood pressure is accepted. Pancronium 0.04 mg/kg/h. intravenous was used to assess mechanical ventilation by 100% O2 during surgery.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYThere is growing interest in QT dispersion as a marker for arrhythmia potential being a marker of inhomogenicity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia and infarction, and levels are higher in patients with ventricular arrhythmias. This study was performed to assess QT dispersion in patients with acute myocardial infarction treated with thrombolytic therapy with successful reperfusion versus those who treated with thrombolytic therapy with failed reperfusion and those who treated with conventional therapy and to correlate between QT dispersion and the complicating serious ventricular arrhythmias following acute myocardial infarction. And it is also performed to assess the influence of age, sex, obesity, smoking, diabetes mellitus, hypertension and site of infarction on QT dispersion. The study included 100 patients with recent acute myocardial infarction and they are classified to 3 groups:Group 1: 30 patients who received streptokinase with successful reperfusion.Group 2: 30 patients who received streptokinase with failed reperfusion.Group 3: 40 patients who did not receive streptokinase (control group).Every patient was subjected to full history taking and thorough clinical examination. Analysis of serum electrolytes (Na, K and ca) was done and cases showing abnormal results were excluded. Serum CPK was checked on admission, after 6 hours, after 12 hours and after 24 hours after onset of thrombolytic therapy. ECG was done for every patient on admission, two hours post thrombolytic therapy and predischarge in groups I and 2. In group 3, ECG was done on admission and predischarge.The study concluded that:1- There is a statistically significant reduction in QT dispersion in patients who received thrombolytic therapy with successful reperfusion versus those who received thrombolytic therapy with failed reperfusion and those who did not receive thrombolytic therapy.2- There is a reduction in the incidence of ventricular arrhythmias in patients with successful reperfusion therapy associated with the reduction in the QT dispersion. So, reduction of QT dispersion may be a mechanism of benefit of thrombolytic therapy.3- QT dispersion is increased after myocardial infarction and levels are higher in patients with ventricular arrhythmias.4- QT dispersion is influenced by hypertension, diabetes mellitus, age and site of infarction ,as it is increased in patients with hypertension, diabetes mellitus, age less than 50 years and with anterior than inferior infarction.The study recommended the following:1- Whenever not contraindicated, thrombolytic therapy should be administered as early as possible in cases with AMI.2- QT dispersion can predict the potential for ventricular arrhythmias in patients with AMI.3- Future studies are needed to confirm the value of QT dispersion in risk stratification after AMI.SUMMARYب) المقابلة مع القائمين بالخدمة الصحية:كان معظم مقدمي الخدمة الصحية ذو سنوات خبرة( أكثر من 6 سنوات) وذلك بنسبة أعلى بالوحدات التي تطبق هذا النظام. وكذلك بالنسبة إلى الدورات التدريبية (100%) مقارنة بالوحدات التي لا تطبق هذا النظام(71.4%). كما كان لا يوجد أطباء أخصائيين بالوحدات التي لا تطبق نظام المنهجية.كان معظم القائمين بالخدمة الصحية بالوحدات التي تطبق نظام المنهجية راضين عن معدل التردد على الوحدة مقارنة بالوحدات الأخرى.و كانت أهم الأسباب لانخفاض التردد هي على الوحدات التي لا تطبق هذا النظام من وجهة نظرهم هي الفقر وبعد المسافة. أما بالنسبة للوحدات التي تطبق هذا النظام فكان عدم العلم بوجود الخدمة.وأيضا كان القائمين بالخدمة الصحية بالوحدات التي تطبق نظام المنهجية راضيين تماما عن مكان الوحدة, توفر المعدات الطبية, مستوى الخدمة الصحية بالوحدة وكذلك التعاون مع أفراد المجتمع الذي توجد به الوحدة مقارنة بالوحدات التي لا تطبق هذا النظام.وقد كانت معظم مطالب القائمين بالخدمة الصحية بالوحدات التي لا تطبق نظام المنهجية هي تطوير وتجديد المباني, توفير وسائل المواصلات والاتصالات وكذلك توفير المعدات الطبية. أما بالنسبة للوحدات الأخرى فكان زيادة عدد الممرضات. وقد كان زيادة كمية الأدوية وتنوعها مطلب عام في جميع الوحدات الصحية.وقد أشاد جميع القائمين بالخدمة الصحية في الوحدات التي تطبق منهجية حل المشكلات الصحية بفعالية هذا النظام وأوصوا بتطبيقيه في جميع الوحدات الصحية الريفية بجميع أنحاء مصر.خامسا-السجلات الطبية:كانت السجلات الطبية دقيقة, واضحة وكاملة البيانات في معظم الوحدات الصحية, كذلك طريقة الاحتفاظ بالسجلات كانت مناسبة بالوحدات التي تطبق منهجية هذا النظام مقارنة بالوحدات الأخرى.*الأمهات:- متابعة الحوامل كانت تعتبر مرضية في كل الوحدات ماعدا وحدة ” قرملة” خلال عام 2003.- لم تسجل حالات حمل خطر في وحدة” ميت معلا ” خلال السنوات التي خضعت للدراسة.- كانت أكثر حالات الأنيميا في الحوامل في وحدة” فراشة” وذلك خلال عام 2003, بينما كانت الأكثر في وحدة” قرملة” خلال الستة اشهر الأولى من عام 2004.- كانت أعلى نسبة متابعة للحوامل بتطعيم التيتانوس في وحدة ”بنى عياض” خلال عام 2003, بينما كانت الأعلى في وحدة” قرملة” خلال الستة اشهر الأولى من عام 2004.* الأطفال:- كان أعلى تردد للأطفال الرضع في وحدة” بنى عياض”, وللأطفال قبل سن المدرسة في وحدة” قرملة” وذلك خلال السنوات التي خضعت للدراسة.- كانت تغطية التطعيمات 100% في كل الوحدات.- لم تسجل حالات نقص الوزن بين الأطفال في الوحدات التي لا تطبق منهجية حل المشكلات الصحية خلال السنوات التي خضعت للدراسة.- كانت أكثر حالات الأنيميا في الأطفال قبل سن المدرسة في وحدة” قرملة” وذلك خلال السنوات التي خضعت للدراسة.* تنظيم الأسرة:- كان أعلى معدل للتردد على خدمة تنظيم الأسرة في وحدة” قرملة” خلال السنوات التي خضعت للدراسة, كانت أكثر الوسائل المستخدمة هي الحقن وذلك في جميع الوحدات, واقل الوسائل استخداما كانت اللولب في الوحدات التي تطبق نظام المنهجية و الواقي الذكرى في الوحدات الأخرى وذلك خلال عام 2003, والواقي الذكرى في جميع الوحدات خلال الستة اشهر الأولى من عام 2004.- كل المجتمعات التابعة للوحدات كانت مجتمعات انتقالية( معدل الزيادة الطبيعية بين 1.5-2.5) وذلك خلال عام 2003 بينما كانت متوازنة(معدل الزيادة الطبيعية اقل من 1.5) خلال الستة اشهر الأولى من عام 2004., وقد تم تسجيل وفيات الأمهات في وحدة” قرملة” فقط خلال عام 2003, وفى جميع الوحدات التي تطبق المنهجية خلال الستة اشهر الأولى من عام 2004. تم تسجيل وفيات الأطفال الرضع في وحدة” فراشة” خلال السنوات التي خضعت للدراسة.وأخيرا توصى الدراسة بضرورة:1- تطبيق نظام منهجية حل المشكلات الصحية في جميع الوحدات الصحية الريفية بمحافظة الشرقية لتحسين المهارات الإدارية لمقدمي الخدمة الصحية.2- زيادة أعداد وخبرات القائمين بالخدمة الصحية.3- وجود طبيبة لأمراض النسا والولادة.4- التدريب المستمر لتحسين المهارات التشخيصية والعلاجية و إعطاء الاهتمام للتاريخ المرضى, الكشف العام و أهمية المتابعة للمرضى.5- زيادة كمية ونوعية الأدوية في جميع الوحدات الصحية.6- بالنسبة للوحدات التي لا تطبق منهجية حل المشكلات الصحية: تجديد مباني الوحدات, توفير المعدات الطبية الحديثة, وجود أخصائيين و التدريب المستمر على المهارات التواصلية مع الآخرين.Based on the (PHC) principals and approaches the district team problem solving (DTPS) approach has been developed, which is an effective tool for strengthening management i.e. improving performance of the health services at the district level.DTPS aims to strengthen the health system infra structure and provides sustainable quality of health care for all users to ensure health promotion and control of health problems common to individuals, families, and communities.A comparative cross sectional study was carried out at rural districts in El-Sharkia Governorate. Two rural health units applying the DTPS were chosen randomly [related to Belbes (namely Qeremlah) and Abu Kabeer (namely Bane- Ayadd) health district] versus other two units at the same district not applying this system [Met-Mealla(at Belbes) and Farasha (at Abu Kaber)] and making a comparison between them as regarding maternal and child health(MCH) and family planning (FP) using rapid health appraisal.This study was conducted to detect the effect of application of DTPS on the health service. The practical part of the study consumed six months from the 1st of March to the end of August 2004.The data were collected through: assessment of work condition and structure of the studied health units using a questionnaire sheet, assess consumer satisfaction and opinion of house hold non users using questionnaire. Assess the performance of health care providers through chick list, with making interview with them and reviewing the available medical records as regarding MCH and FP with calculation of some selected indices.1) Structure of units:The units applying DTPS have a suitable site, sanitary environment, well equipped laboratories, available and complete equipments as regard MCH,FP unlike other group of units.2) Consumers of the health services:Most of consumers were from the same village, non workers, having working husbands. Illiteracy represents minimal percentage in units applying DTPS compared with other group of units.The unit was the 1st choice for consumers in units applying DTPS versus other group of units where other places were the 1st choices. Child immunization was the most service used and Antenatal care was the least used in both groups of units. Repeated visits (5th or more) were more in units applying DTPS than other group of units.The units applying DTPS were more accessible by majority of consumers compared to other group of units.The availability of doctor was stated by (46%) in units applying DTPS opposite to (40%) in other group of units. And the majority preferring female doctor in all units.Examination time was satisfactory for (55.5%) of consumers in applying DTPS opposite to (40%) of them in other group of units. Also the behavior of clerks and nurses was more satisfactory in this group of units.Higher percentage of consumers in units applying DTPS show overall satisfaction, satisfaction about waiting place than consumer in other group of units.The high educational group of consumers and those from other villages were the least satisfied especially in units not applying DTPS.The highest percentage of satisfied consumers was with repeated visits (5 times or more) in units applying DTPS.The most common needs for consumer in both groups of units were availability of drugs, followed by availability of female doctor.Renovation and cleaning of buildings, improving waiting places, availability of modern medical equipments and availability of doctor or presence of specialist are needed by consumers in units not applying DTPS with higher percentage than other group of units.3) House holds nonusers:Most of house holds don’t use the unit service because of their non satisfaction about it (Building condition, equipments and physician’s availability) and its long distance from their residence. With higher percentage among units not applying DTPS.Most of them (in areas served by units not applying DTPS) asked for improving units structure through availability of drugs, renovation of buildings, presence of specialist, and modern medical equipments . As regard process; increase examination time.4) Health care providers:1-performance:There was marked significant difference between health care providers in both group of units as regard their communication with patients as higher percentage was noticed in units applying DTPS (except for advices for follow up which have low percentage in both groups of units).2-interview with health care providers:In units applying DTPS there was higher percentage of health care providers with years of experience more than 6 years. Training courses were taken by all of health care providers (100%) in units applying DTPS, opposite to (71.4%) in other group of units. Nevertheless, no specialists were present in units not applying DTPS.Majority of health care providers in units applying DTPS thought that the attendance was satisfactory ,compared with the other group of units, The main causes of low attendance in units not applying DTPS were poverty and long distance, while in units applying DTPS were absence of knowledge about service.The health care providers of units applying DTPS were completely satisfied about the site of units, availability of medical equipments, level of health service and community participation compared to other group of units.Most of those in units not applying DTPS asked for renovation of buildings, availability of means of transportations, communications (telephone), and modern medical equipments. While, most of health care providers in units applying DTPS asked for increasing number of nurses. All health care providers in both groups of units asked for increasing drugs.All health care providers in units applying DTPS found it an effective approach and they advice by its application allover Egypt.5) Medical records:The units applying DTPS had accurate, clear, complete recorded data and suitable record keeping when compared with other groups of units.A) Maternal:-Antenatal coverage was considered satisfactory in years under study in all units except unit Qeremlah in year 2003.- No cases of high risk pregnancy were found in unit Met- Mealla in the years under study.- Anemia in pregnancy was highest in unit Farasha in year 2003, while was highest in unit Qeremlah in first six months of year 2004.- Tetanus toxoid coverage was highest in unit Bany – Ayadd in year 2003, while was highest in unit Qeremlah in first six months of year 2004.B) Children- Attendance rate for infants was highest in unit Bany – Ayadd. And for preschool children in unit Qeremlah in the years under study.- Vaccination coverage was 100% in all studied units.- No under weight was present in units not applying DTPS in years under study.- Anemia in preschool children was highest in unit Qeremlah in years under study.C) Family Planning:- Attendance rate in FP was highest in unit Qeremlah in years under study most commonest used method was injections in all studied units and the lowest was loop in units applying DTPS and male condom in units not applying DTPS in year 2003 and condom in both groups of units in 1st six months of year 2004.All communities related to the units were transitional communities in year 2003and balanced in 1st six months of year 2004. Maternal mortality rate was recorded only in unit Qeremlah at year 2003, while in 1st six months of year2004 it was recorded only in units applying DTPS .Infant mortality rate was highest in unit Farasha in years under study.Conclusion• The units applying DTPS have suitable accessible site, sanitary surrounding environment, well equipped laboratories, available and complete equipments as regard MCH, FP unlike other group of units.• The unit was the 1st choice in for consumers in units applying DTPS.• Examination time and the behavior of nurses and clerks were satisfactory for higher percentage of consumers in units applying DTPS opposite to other group of units.• Higher percentage of consumers in units applying DTPS show overall satisfaction, satisfaction about waiting place than consumer in other group of units.• The consumers from other villages were least satisfied in units not applying DTPS.• Renovation and cleaning of buildings, improving waiting places, availability of modern medical equipments, availability of doctor, presence of specialist and increase means of transportation to the units all are demands of consumers and households in units not applying DTPS with higher percentage than other group of units.• The most common cause of non using units’ service was lack of satisfaction about the service in all studied units due to their non satisfaction about it (Building condition, equipments and physician’s availability) and its long distance from their residence with higher percentage among units not applying DTPS.• There was marked difference between health care providers in both groups of units in communication with patients with higher percentage in units applying DTPS. (Except for advices for follow up which have low percentage in both groups of units).• The health care providers of units applying DTPS were completely satisfied about the attendance rate, site of units, availability of medical equipments, level of health service and community participation compared to other group of units.• Most of those in units not applying DTPS asked for renovation of buildings, availability of means of transportations, communications(telephone), and modern medical equipments• All health care providers in units applying DTPS found it an effective approach and they advice by its application allover Egypt.• The units applying DTPS had accurate, clear, complete recorded data and suitable record keeping when compared with other groups of units.RecommendationsBased on the result of present study, the following recommendations are suggested:1-Application of DTPS in all rural health units in Egypt to improve administrative skills of health care providers.2-Increasing number and qualifications of health care providers.3- Presence of female doctor especially for gynecology.4-Continuous training courses to improve diagnostic skills of health care providers (with special attention to past history, general examination and importance for follow up.)5-Increase quantity and quality of drugs in all primary health care units.6-For units not applying DTPS in this study: development of buildings, provide these units by essential medical equipments, specialists and continuous training on communication skills.