Treatment outcomes among patients with multi-drug resistant tuberculosis in Abbasia chest Hospital from July 2006 to June 2010

Tuberculosis despite being treatable and preventable disease, it continues to be a major health challenge in many parts of the world. The emergence of drug-resistant tuberculosis has made the current epidemic worse. This retrospective study included 200 MDR-TB patients admitted to Abbassia Chest Hospital in the period between July 2006 and June 2010. Their files had been analyzed including medical history, chest examination and investigations. Drug regimens of resistance used for treatment and the fate of treatment were reported. Patients were 148 males [74%] and 52 females [26%]. Their ages ranged from 15 to 76 years [37.83 +/- 12.78 years]. 81.5% of them lived in rural areas, 2.5% were tobacco smokers and were diabetics. Defaulters were 44.5%, treatment failure patients were 44%, relapse patients were 4%, and new cases constituted 7.5% of the studied patients. Acquired resistance was 92.5% and primary resistance was 7.5%. The duration for sputum conversion ranged from 2 to 9 months [4.19 +/- 1.28 months]. The fate of MDR-TB treatment was favorable outcome in 132 cases [66%] and unfavorable in 68 cases [34%] [28 patients were defaulters [14%], 21 patients died [10.5%] and 19 patients had treatment failure [9.5%]]. The prevalence of defaulter patients was significantly higher among unfavorable outcome patients while the prevalence of treatment failure patients was significantly higher among favorable outcome. Successful treatment could be achieved in 66% of MDR-TB patients treated in Abbassia Chest Hospital between July 2006 and June 2010

Pleurodesis using different agents in malignant pleural effusion

Malignant pleural effusions [MPE] are characterized by rapid reaccumulation, after tapping, and many symptoms related. Pleurodesis, for the management of MPE, is intended to achieve symphysis between parietal and visceral pleura, and to prevent relapse of pleural effusion. Many chemical agents are tried to induce abrasion and damage of the pleural mesothelial layer to achieve this symphysis. The aim of this study is to compare the results of medical pleurodesis, using 4 different chemical agents in these cases, to reach an efficient one with minimal complications. Between July 2010 and July 2012, 40 patients with MPE, divided into 4 groups, underwent medical pleurodesis using 4 chemical agents in comparison: bleomycin, doxycycline, povidone iodine and 5-fluorouracil. Immediately and for 3 months after the procedure, the results of pleurodesis were assessed and the final reported success rates were 70% for bleomycin, 80% for doxycycline and 80% for povidone iodine, while 5 fluorouracil had the lowest success rate [50%] [P-value < 0.05]. Bleomycin, doxycycline and povidone iodine are nearly equally effective and safe pleurodetic agents when used in the optimal dose, while 5-fluorouracil had a much higher failure rate. Although povidone iodine and doxycycline are as effective and safe as bleomycin, they are cheaper alternatives and more available chemical agents for pleurodesis in cases with MPE

Sleep pattern changes in patients with liver cirrhosis

Liver cirrhosis is considered as a major cause of mortality worldwide and is the most common non-neoplastic cause of death among hepatobiliary and digestive diseases. One of the least studied complications of liver cirrhosis is the disturbed sleep pattern, which is being increasingly recognized as a major health problem affecting the quality of life. This study included two groups; the first group consisted of 30 patients diagnosed as liver cirrhosis based on abdominal ultrasound and liver biopsy and the second group consisted of 10 healthy subjects served as controls. ESS was calculated for every patient and all patients were subjected to complete overnight polysomnography to detect sleep disturbances among all participants. Our results showed that cirrhotic patients had ESS, AHI and OSA significantly higher than the control group [16.4 +/- 2.6 vs 11.1 +/- 1.8, P = 0.0001; 10.9 +/- 8.5 vs 2.4 +/- 1.6, P = 0.005 and 3.1 +/- 3.1 vs 1.1 +/- 0.9, P =0.03, respectively]. The percentage of sleep efficiency was significantly lower in cirrhotic patients than the control group [61.9 +/- 12.9 vs 73.1 +/- 7.6 [P = 0.02]]. Also, the percentages of S1, S3-S4 and REM sleep in relation to the total sleep time were significantly higher in the cirrhotic patients than the control group [P = 0.01, 0.02 and 0.06, respectively] while the percentage of S2 was significantly lower [P = 0.02]. Cirrhotic patients of Child class C had ESS, AHI and OSA significantly higher and sleep efficiency significantly lower than cirrhotic patients of classes A and B [P = 0.001 for all]. Cirrhotic patients with tense ascites had ESS, AHI and OSA significantly higher and sleep efficiency lower than patients with mild, moderate, or no ascites. This study revealed that cirrhotic patients had disturbed sleep pattern, correlating with the degree of cirrhosis