ABSTRACT
Because of the associated morbidity, mortality and the cost to societies, hypertension is an important public health challenge being the most common worldwide disease-affecting human. To study the clinical characteristics, therapeutic regimens, compliance with treatment, risk factors and target organ damage of hypertensive patients among people > 35 years old. A cross sectional study; conducted in Sohag city; it involved 520 patients; males [45.7%] and females [54.3%]. Their ages were 35 to 85 years. Hypertension presented more between non-smokers [72.55%], females [54.3%], educated patients [50.99%] and patients with low SES [54.9%]. ECG of hypertensive patients showed that ischemia presented in [51.63%] of patients, while their laboratory investigations showed that hyperglycemia presented in [28.7%], anemia in [18.3%], high serum creatinine level presented in [8.49%] and proteinuria in [10.45%] of patient. Adequate BP control was found to be achieved in [49.67%]; older patients had lower adequacy of BP control in spite of the extensive use of multiple-drug therapy and of appropriate drug choice. This is probably due to high prevalence of a difficult to control form of hypertension and poor compliance with the multiple-drug regimen. Most hypertensive patients had more than one coexistent CV risk factor. Aging, being a female [54.3%], diabetes, family history of hypertension [28.7%], smoking [27.45%], family history of coronary heart disease [25.4%], and obesity [10%] were of the contributing risk factors .About 72% had target organ damage. Heart involvement was the most frequent finding [63.39%]; coronary heart disease was the most common heart damage [51.63%]. ACE-inhibitors were prescribed in [58.16%]; mostly capotril and zestril. Beta-blockers were used in [34.64%] of the patients, Ateno is the drug mostly used in this group. Monotherapy was prescribed for [41.17%] only of the patients. Fortunately [75.81%] of patients showed regular use of their drug regimens. It was observed that [49.67%] only of patients had their condition under control, the number of drugs was inversely related to BP control. Hypertensive patients in Sohag city had a profile of high CV risks, target organs damage and poor blood pressure control particularly in the elderly. Great efforts towards improving the compliance of both service providers with guidelines and patients with treatment must be done. A multidisciplinary approach for routine clinical check up, follow-up, training, prescribing simple once-daily regimens and encourage life style modifications; all to optimize patient outcomes and prevent disease
ABSTRACT
Studies performed to date on the prevalence of gallstones in chronic renal failure [CRF] on haemodialysis [HD] have given contradictory results. to evaluate the frequency and percentage of gallstones and its main associated risk factors in a group of Egyptian haemodialysis patients. The study included 147 patients with CRF on HD randomly selected from Assiut and Sohag University renal dialysis units in Upper Egypt [102 males, 45 females]. The screening protocol included complete medical history, female parity, as well as, use of estrogen therapy by females. History of diabetes mellitus and duration of haemodialysis were also recorded. Body mass index [BMI] was calculated and a number of biochemical parameters [total cholesterol and triglycerides, serum calcium, phosphorus and uric acid] were estimated in fasting serum. An ultrasound scan of the gall bladder and biliary tract was performed with a 3.5 MHz linear probe after at least 12 h fasting. In addition, the prevalence of gallstones in the general population of the same geographical region was calculated after revising available data in ultrasonography reports. The mean age of CRF patients was 43 +/- 14.2 years and mean duration of dialysis was 30 +/- 30.5 months. Gallstones were diagnosed in 22.4% of HD patients and this was mildly significantly higher in women than men [31.1% in women vs 18.6% in men, P=0.05] and this percentage was significantly higher than that of the general population in the same geograbical region [1.6% of the total examined] [P=0.001]. The percentage of gallstones didnt increase significantly with increasing age or duration of dialysis. We noticed an insignificantly raised risk for gallstones with use of estrogen by females, diabetes mellitus and smoking in males [OR=3.2, 1.6, 1.2 respectively; P >0.05 for all of them]. No significant difference was noted between CRF patients with and without gallstones in the studied biochemical parameters except for mean serum calcium that was significantly higher in patients with gallstones [9.8 +/- 1.3 vs 8.1 +/- 1.1; P=0.04]. The percentage of gallstones in a group of Egyptian patients on HD is higher than that of the general population of the same area. Apart from female sex, the traditional risk factors associated with gallstones in the non-uraemic general population appear not to play a significant role in gallstone formation in HD patients. Estrogen use in females, presence of diabetes mellitus and smoking in males, have insignificantly raised the risk for gallstones in these patients. Changes in serum calcium appear to play a role. Our results suggest that other factors inherent to kidney pathology may contribute to this high percentage of gallstones in CRF patients on haemodialysis