Factors affecting defaulting from DOTS therapy under the national programme of tuberculosis control in Alexandria, Egypt

This unmatched case-control study aimed to identify factors affecting default from therapy under the national programme of TB control in Alexandria, Egypt. Record reviews and structured interviews were made with 57defaulters and 187 randomly selected controls. Univariate analysis showed 13 out of 54 factors investigated were significantly associated with defaulting and/ after stepwise logistic regression, 5 factors remained in the model: younger age [adjusted OR= 0.16], rural area of residence [OR= 12.9], long waiting times [OR=5.81], poor physician-patient communication [OR= 3.06] and fear of information leakage [OR =3.62]. Reasons cited by defaulters included long distance to the clinic, unsuitable clinic times and long waiting times. The main factors associated with defaulting from the national programme of TB control In Alexandria, Egypt were service-related factors, which are amenable to Improvement

Role of three side support ankle-foot orthosis in improving the balance in children with spastic diplegic cerebral palsy

Cerebral palsy [CP] is a heterogeneous group of permanent, non-progressive motor disorders of movement and posture. Ankle-foot orthoses [AFOs] are frequently prescribed to correct skeletal misalignments in spastic CP. The present study aims to evaluate the effect of the three side support ankle-foot orthosis on standing balance of the spastic diplegic CP children. Thirty spastic diplegic CP children participated in this study from both sexes. They were divided randomly into two age and sex matched groups: [Group I: study group and Group II: control group]. The degree of spasticity was evaluated by passive movement for both limbs, while the child was completely relaxed. The Biodex stability system, was used for the assessment of the dynamic postural control of all diplegic children. Also the system measures the subject's ability to control the platform's angle of tilt. The patient's performance is noted as stability index which represents the variance of the platform displacement in degrees. Every patient in the study group was exercised on three side support ankle-foot orthosis for 30 min, three times weekly, for 6 months, also they received the same therapeutic exercise program which was given to the control group. The results revealed no significant difference as regards the pre-treatment mean values of all stability indices in both the control and the study groups [P < 0.05]. However comparison between post-treatment mean values of all stability indices in both groups showed significant improvement in favor of the study group [p < 0.05]. Uses of the three side support ankle-foot orthosis in addition to physical exercise program is highly useful in rehabilitation of spastic diplegic cerebral palsy children as they enabled them to gain more balance control and postural reactions

Consanguinity and its relevance to clinical genetics

Consanguineous marriages have been practiced since the early existence of modern humans. Until now, consanguinity is widely practiced in several global communities with variable rates. The present study was undertaken to analyze the effect of consanguinity on different types of genetic diseases and child morbidity and mortality. Patients were grouped according to the types of genetic errors into four groups: Group I: Chromosomal and microdeletion syndromes. Group II: Single gene disorders. Group III: Multifactorial disorders. Group IV: Diseases of different etiologies. Consanguineous marriage was highly significant in 54.4% of the studied group compared to 35.3% in the control group [P < 0.05]. Consanguineous marriages were represented in 31.4%, 7.1%, 0.8%, 6%, 9.1% among first cousins, one and a half cousins, double first cousins, second cousins and remote relatives respectively in the studied group. Comparison between genetic diseases with different modes of inheritance showed that recessive and multifactorial disorders had the highest values of consanguinity [78.8%, 69.8%, respectively], while chromosomal disorders had the lowest one [29.1%]. Consanguineous marriage was recorded in 51.5% of our cases with autosomal dominant diseases and in 31% of cases with X linked diseases, all cases of mental retardation [100%] and in 92.6% of patients with limb anomalies [P < 0.001]. Stillbirths, child deaths and recurrent abortions were significantly increased among consanguineous parents [80.6%, 80%, 67%] respectively than among non consanguineous parents. In conclusion, consanguineous marriage is significantly higher in many genetic diseases which suggests that couples may have deleterious lethal genes, inherited from common ancestor and when transmitted to their offsprings, they can lead to prenatal, neonatal, child morbidity or mortality. So public health education and genetic counseling are highly recommended in our community

Juvenile and adult onset systemic lupus erythematosus outcome in Egyptian patients

The aim was to study the outcome characteristics of systemic lupus erythematosus [SLE] in Egyptians according to the age at disease onset and gender. We studied 239 SLE patients [185 adult and 54 Juvenile onset] with a female to male ratio of 9.39-1 and a mean age of 28.23 +/- 8.91 years and disease duration of 5.45 +/- 4.25 years. Full history taking, thorough clinical examination, laboratory and relevant radiological investigations were performed. Disease activity was assessed using SLEDAI and damage by SLICC. Renal biopsies were done in those with renal involvement. The clinical manifestations, disease activity and damage and laboratory investigations of the SLE patients varied according to the age at disease onset and gender. The prevalence of damage was obviously increased in juvenile patients and higher in males. Growth failure, delayed puberty and fibromyalgia were present more in Juvenile-onset patients. Adult onset SLE patients had a significantly higher secondary Sjogren syndrome especially in females. In the present study, there was a 2.5% mortality and the commonly involved kidneys were an important cause of death. Measuring organ damage in SLE is important with special concern to juvenile-onset patients to allow for designing new treatments that improve control of disease activity and minimize the development of irreversible damage. The kidney appeared to be commonly involved, especially in males, indicating the importance of regular screening for early and appropriate management

Risk factors for autism: an Egyptian study

This study has been conducted to determine the possible risk factors of autism. This case control study was conducted at pediatric hospital, Ain Shams University on, 100 autistic patients who were subjected to the followings tools: Confirmation of diagnosis using DSM-IV-TR criteria, IQ assessment using Stanford-Binrent intelligence scale, and assessment of severity of autistic symptoms using childhood autism rating scale [CARS]. Full clinical examination, neurological examination, EEG and audiological assessment were also done. Forty-six percent of our patients with autistic symptoms presented at the age of one and half years and 32% at the age of 2 years. Fifty-five percent of our patients had mild to severe retardation [IQ = 20-70], 36% below average mentality [IQ = 71-89] and 9% with normal mentality [IQ = 90-109]. High maternal age [mother, P35 years] at birth was found in 23% of autistic children in comparison to 9.5% of controls. Also advanced paternal age [father, P35 years] at birth was found in 91% of cases in comparison to 83.5% of control group and the difference was statistically significant. Positive family history was found to be statistically significantly associated with the risk of autism [16% of cases versus 1% of control]. All studied developmental milestones were delayed among autistic children than control group [p= 0.000]. As regards natal factors, a history of low birth weight, delivery by ceserian section were significantly higher among cases than controls. Also postnatal factors as history of hypoxia, resuscitation and history of jaundice were considered significantly risk factors for autism [p=0.000]

Correlation between the RhD genotyping and RhD serotyping in isoimmunized pregnancies

Alloimmunisation was one of the most important causes of perinatal mortality and morbidity by the middle of the last century. The objective of the present study was to investigate the presence of the RHD gene in fetal cells [amniocytes] obtained from amniotic fluid by genotyping to compare it with the RhD serotyping. Also to correlate the presence of RhD gene with the neonatal outcome. This work was carried out at Maternity hospital and Medical Genetics center, while PCR testing was done at the Medical Research center, Faculty of Medicine, Ain Shams University in the period from 2008 to 2010. The present study included recruiting of 20 RhD negative [sensitized to the RhD antigen] pregnant mothers. The entire study group was subjected to complete general, obstetric and a detailed obstetric ultrasonographic examination. Rh typing and indirect Coomb's test were also done. Amniocentesis was performed with a 20-gauge needle under continuous ultrasound guidance. RhD serotyping of the fetuses showed that, 14 fetuses [70%] were positive and six fetuses [30%] were negative. While using RhD gentyping 13 cases [65%] were positive and seven cases [35%] were negative [P value = 0.002]. Among fetuses positive for RhD genotyping six fetuses [46%] had received postnatal treatment, while among fetuses negative for RhD genotyping, neither of them had received postnatal treatment [P value = 0.032], which is statistically significant. From the present study we can conclude that, the identification of an antigen-negative fetus on the basis of the blood group genotype provides significant advantages in managing the pregnancy at risk for HDFN

Ocular features in Egyptian genetically disabled children

Ocular changes in genetically disabled children are great and of special importance. The aim of the present study was to delineate the nature and frequency of ocular defects in genetically disabled children. A cross sectional study was carried out. It included 95 genetically disabled children who were chosen from the medical genetics and ophthalmic departments, Ain-Shams University Hospitals, and examined for any associated ocular abnormalities. Studied patients were divided into six groups [Group I: Chromosomal disorders [Down syndrome], Group II: Genetic syndromes, Group III: Cranial anomalies, Group IV: Inborn errors of metabolism [IEM], Group V: Cerebral palsy, Group VI: Mental retardation]. Anomalies of the eyelids were detected in 63.1% of our patients. They were significantly increased in group I [Chromosomal disorders [Down syndrome]], compared to other groups. Errors of refraction were detected in all Down syndrome patients. On the other hand some ocular findings were present in our Down syndrome patients and not reported in the literature before; these include, lacrimal fistula, lagophthalmos, heterochromia, macrocornea and ectropion in 3.3% of patients, tortous retinal vessels, entropion, and prominent upper punctum in 6.6%, ptosis in 10%, microcornea, absent foveal reflex, and blepharophimosis in 13.3% of our cases. Lacrimal apparatus abnormalities were detected in 11.5% of our patients, the highest frequency was detected among the chromosomal disorder group 27%. Conjunctival and scleral abnormalities were also detected in 10.5% of our patients, where the group of chromosomal disorders had the highest frequency [20%]. Cornea and anterior chamber abnormalities were detected in 30.5%, these abnormalities had the same frequency [33%] in the groups of chromosomal disorders, genetic syndromes and inborn errors of metabolism. Iris and pupil abnormalities were detected in 15.7% of our patients. Lens abnormalities were detected in 10.5% of our patients, where the group of inborn errors of metabolism had the highest frequency [44%]. Ocular musclesand mobility abnormalities were diagnosed in 47.3% of our patients. Fundus examination revealed abnormalities in 34.7% of patients,where the group of cerebral palsy had the highest frequency [50%].Our results emphasize that, the earlier and better the visual sense function, the greater the chance the child will achieve his potential.The ophthalmologist, paediatricians, geneticists must work hand in hand for detection of ocular disorders in genetically disabled children to initiate diagnostic and therapeutic measures to control the disease

Mitochondrial alterations in children with chronic liver disease

Over recent years it has become apparent that the hepatocyte mitochondrion functions both as a cause and as a target of liver injury. Resultant dysfunction of mitochondria yields deficient oxidative phosphorylation, increased generation of reactive oxygen species, impairment of other metabolic pathways and activation of both necrotic and apoptotic pathways of cellular death. Methods: This study was conducted on 26 children and adolescents with chronic liver disease who presented to or were following up in the Pediatric Hepatology Clinic, Children's Hospital, Ain-Shams University. They were divided into three groups according to the aetiology of liver disease [GI= patients with Wilson's disease [WD], GII=patients with chronic hepatitis C, GIII=patients with chronic liver disease other than Wilson's and chronic hepatitis C].Ultrasound-guided gun liver biopsies were performed, under local anaesthesia for all the 26 patients, using a modified 18-gauge truecut needle. Two liver biopsy cores were taken from each patient. One for light and electron microscopic examinations and the other was immediately immersed in liquid nitrogen to be frozen and used for studying mitochondrial DNA deletions by PCR Liver steatosis was higher in the group of patients with Wilson's disease and other liver disease. Electron microscopic examination of the mitochondria revealed significant mitochondrial pleomorphism in patients with Wilson's disease and patients with chronic hepatitis C infection. Enlarged mitochondria were found to be more prevalent among patients with chronic hepatitis C infection. Three of our patients [11.53%] had mitochondrial DNA deletions. We developed scoring system for mitochondrial affection in our patients, 7 patients [32%] were considered to have mild mitochondrial affection, 9 patients [41%] had moderate mitochondrial affection, while 6 patients [27%] had severe mitochondrial affection. Four of the studied patients had no mitochondrial affection. Conclusion: Mitochondria affection is common in chronic liver disease. This mitochondrial affection might be responsible for some of the chronic liver disease manifestation such as easy fatiguability and steatosis

Validation of TIMI and GRACE acute coronary risk scores in Alexandria governorate and their role in the comparison of quality of care between hospitals

Risk stratification in acute coronary syndrome [ACS] aims to identify those patients who might benefit prognostically from further investigation and treatment. In addition, risk stratification models have been used by health authorities and hospitals in quality management activities. The present study aimed at validating the Thrombolysis in Myocardial Infarction [TIMI] and The Global Registry of Acute Coronary Events [GRACE] risk scores for prediction of mortality in patients with ACS in Alexandria governorate. In addition, the study aimed also at using one of the validated risk scores to compare risk adjusted mortality among participating hospitals. The study was conducted at hospitals belonging to 3 different health care organizations in Alexandria. All admitted patients with the diagnosis of ACS throughout a period of 6 months were included in the study [n=606]. Discriminatory capacity and calibration of the TIMI and GRACE risk scores for detection of in-hospital mortality and mortality within six months of index admission were assessed. The study showed that both TIMI and GRACE risk scores had high c statistics of 0.70 or higher. GRACE scores showed equal or higher c statistics than TIMI scores denoting better discriminatory capacity. TIMI risk score showed good calibration while GRACE risk score showed lower calibration capacity with certain patient categories. The GRACE risk score was used to calculate the standardized in-hospital mortality ratio which was higher than 1 for all participating hospitals indicating higher than expected mortality for ACS patients in these hospitals. GRACE risk score showed good discriminatory capacity, suggesting that it is suitable for clinical use among ACS patients in Alexandria governorate. It was recommended to use GRACE risk score for risk adjustment in quality management activities

Genomics in health and disease

Genomics is the study of all person's genes including interactions of those genes with each other and person's environment. Many Factors contribute to human health and disease. Our environment and our biology are two factors that strongly influence our health. For along time, it was believed that disease resulted entirely from our environment or entirely from our biology. Now we are seeing that many human diseases are a result of a complex interaction between our biology and our environment and many other factors. The completion of the Human Genome Project signaled that the genome revolution was here to stay and symbolized its promise that knowing the DNA sequence of our genome and those of hundreds of other organisms would allow us to take on the greatest challenges of human health and alleviate human suffering. The Aim of this review is to discuss the influence of genomics on global health and genetics susceptibility to disease

Improvement of blood utilization at a governmental general hospital in the state of Kuwait

Red blood cells [RBCs] transfusions have saved lives and expedited the recovery of illnesses to millions of patients. However, RBCs transfusions carry high risk of life threatening complications and economic burden. The present study aimed at assessing the appropriateness of RBCs transfusion at one Ministry of Health hospital in Kuwait and to assess the effect of multiple interventions for improving the appropriateness of RBCs utilization. The present study used one group pre-test post-test quasi experimental design. To assess the appropriateness of RBCs transfusions, 185 records were reviewed in each of pre and post intervention phases. Improvement interventions included involvement of hospital administrators and heads of departments, development of the hospital transfusion guidelines, improvement of participant physicians' knowledge, and improvement of blood transfusion documentation. The present study revealed 22.4% reduction in the total number of RBCs transfusions in the post intervention phase as compared to pre intervention phase. However, low rate of appropriateness of RBCs transfusion in pre intervention phase [40.4%] was encountered which was minimally improved to 46.5% following implementation of multiple improvement interventions. Physicians showed very low compliance with completion of the newly introduced blood transfusion request and consent forms. The appropriateness of red blood cells transfusions at the study hospital is low before and after implementation of the improvement interventions. Documentation of blood transfusion is deficient at the study hospital. It is recommended to strengthen the blood transfusion interventions used in the present study and to implement these interventions in Ministry of Health Hospitals in Kuwait to improve the appropriateness of RBCs transfusions

Efficiency use of EM and PGPR inoculation on sugar beet plants under different fertilization levels

The efficiency use of EM [Japanese bio-product] in relation to a local bacterial inoculum [PGPR] in improving sugar beet yield and quality in addition to increase of net profit [L.E./fed] was the aim of the present investigation. Seeds were treated with: 1- EM, [effective microorganisms], 2- Combined inoculum contained Azotobacter chroococcumn and Bacillus megaterium bacteria., PGPR, [biofertilizer prepared in Sakha Agricultural Research Station. Microbiology Lab.], 3- Inoculation with the mixture of the two inoculants. These treatments applied along with 50% or 75% of recommended dose of nitrogen compared to traditional treatment [100%N and P. but not inoculated]. All the treatments inoculated with the PGPR biofertilizer obtained 50% p only. Inoculation of sugar beet seeds with EM or PGPR inoculum alone with 75% N did not give significant effect on most studied parameters. But solitary inoculation with EM or PGPR with 50% N, mostly, had negative effects on the studied characters. The mixed inoculation with EM and PGPR with 75% N and 50% p attained the highest top yield [ton/fed], root yield [ton/fed], root fresh weight [kg/plant], sugar yield [ton/fed], sucrose%, N content and K%, while, P-content, alpha-amino nitrogen, sugar loss to molasses, extractable sugar, extractability and purity percentages were not significantly affected. The treatment of mixed inoculation with 75% N and 50% P, also, attained the highest economic net return [L.E. /fed]. Thus, this treatment is recommended for its beneficial effect on yield, quality and save of mineral fertilizer. According environmental viewpoint, this treatment may saves consumed energy, the matter which leads to decrease of CO[2] emission resulting a positive impact on the environment

Response of faba bean plant to inoculation with heavy metals tolerant rhizobium leguminosarum biovar viceae and/or phosphate-dissolving bacteria

Many isolates of R. Ieguminosarum biovar viceae [8 isolates] and phosphate-dissolving [6 isolates] bacteria were isolated from soils irrigated with polluted sewage water with high concentrations of heavy metals [El-Gabal El-Asfar and El-Hamoul regions] and others irrigated with clean water [El-Riad region]. These isolates were evaluated for their tolerance to high concentrations of mixed Pb, Cd and Ni. High tolerant bacterial isolates were selected for inoculation of faba bean plants under gradient concentrations of these heavy metals mixture, in the greenhouse. Rhizobia and phosphate-dissolving bacterial isolates varied in their ability to tolerate high concentrations of heavy metals in YMA medium. Isolates from highly polluted soils revealed higher tolerance to YMA medium heavy metals than those isolated from clean soils collected from El-Riad region. Sandy soil washed with 0.1 N HCl were enriched with different concentrations of heavy metals mixture, i.e. Pb, Cd and Ni and sowed with faba bean seeds. The seedlings were inoculated with the rhizobial isolates. The isolates of RH6 and RH8 showed the highest records of plant dry weight [g], number and dry weight of nodules/plant, and N%. Phosphate-dissolving isolates varied for their tolerance to heavy metal pollution in nutrient broth medium. The isolates of B4 and B6 were the most tolerant and gave highest alkaline phosphatase activity [15.15 and 13.45, mg/g/h]. Results indicated that combined inoculation with RH8+B6 increased faba bean yield components especially seeds over uninoculated N-fertilized control. N and P concentrations in seeds were, also, increased but, heavy metal concentrations decreased. Thus, inoculation of faba bean plants with heavy metal tolerant S. Ieguminosarum biovar viceae and phosphate-dissolving bacteria is recommended to apply in heavy metals polluted soils

possible role for gastroprotectives on aspirin-induced gastric ulcer in rats

Gastric ulcer is a discontinuity in the gastric mucosa that occurs due to imbalance between gastric mucosal protective factors and aggressive factors. The Aim of the present work was to test and compare the protective effects of an antisecretory H2 receptor blocker; ranitidine and other recently suggested gastroprotective drugs: L-arginine; a precursor of NO, zinc sulfate; an anti-inflammatory antioxidant agent and pioglitazone; a PPAR-gamma agonist, on a rat model of aspirin induced gastric ulcer. Acute gastric lesion was induced in rats by a single oral dose of aspirin 300mg/ kg body weight. L-arginine 200mg / kg b. wt, zinc sulfate 80 mg/ kg b. wt, and pioglitazone 10 mg / kg b. wt. were given alone and in combination with ranitidine 50 mg / kg b. wt for 3 days before induction of gastric lesion. Aspirin induced a significant increase in gastric mucosal lesion score and free and total gastric hydrochloric acid with a significant decrease in gastric nitric oxide and mucin levels as compared to normal group. A significant increase in gastric malondialdhyde and decrease in reduced glutathione as compared to normal group. L-arginine, zinc sulfate, and pioglitazone produced improvement of most of the measured parameters as compared to non-treated group. Combination of L-arginine and ranitidine was superior in prophylaxis against aspirin-induced gastric ulcer when compared to the effects of each drug used individually, and the other studied combinations. The role of HCl and NO seems more important in the pathogenesis of aspirin induced gastric ulcer, as evidenced by the better protective effects of combination of ranitidine and L-arginine in comparison to the ranitidine with either zinc sulfate or pioglitazone

Parathyroid hormone [PTH] and markers of calcium metabolism in children with congestive heart failure

Parathyroid hormone [PTH] regulates the content of calcium and exerts an effect on myocardial function. Abnormal secretion of PTH has been sporadically reported to be associated with depressed mechanical performance of the heart muscle. The aim of this study is to evaluate parathyroid function in patients with CHF due to dilated cardiomyopathy [DCM], measuring some different parameters of calcium metabolism This work was carried on 30 cases [20 males and 10 females] with congestive heart failure [CHF] having a mean age of 6.69 +/- 3.94 years. They were recruited from Cardiomyopathy Clinic at Cairo University Children Hospital [Abou El Riche], All our patients were subjected to full history taking, general examination and echo-cardiographic examinations. Thirty normal healthy children of matched age and sex were included to serve as control. Cases were further classified into[i] Decompensated HF[n=18] [NYHA III, IV] who were admitted to in patient units and[ii] Compensated HF[n=12] [NYHA II]. The following laboratory parameters were measured and compared. Osteocalcin[OC] and Parathyroid hormone[PTH], in addition to total serum calcium, phosphorus, creatinine, urea, alkaline phosphatase, sodium and potassium. The results of our work revealed statistically significant lower serum calcium, higher serum phosphorus levels and lower serum osteocalcin in DCM cases compared to controls [p=0.0001,0.002 and 0.0001 respectively].There was no statistically significant difference between cases and controls regarding serum PTH. l.e. normal PTH, however the calcium is depressed in DCM. Parathyroid hormone level was normal in patients with CHF, however three cases of the decompenstated group showed non-significant elevated levels. Significant hypocalcaemia, hyperphosphatemia and reduction in serum OC levels were noted in our CHF patients. Further studies of these factorscontributing to the associated morbidity of patients with decompensated CHF-should be well traced

Factors associated with hospitalization for type2 diabetic patients at a teaching hospital in Saudi Arabia

Increasing prevalence of diabetes all over the world intensifies the demand for health care services, and particularly for inpatient care. The present study aims at identifying factors associated with hospitalization for patients with type 2 diabetes mellitus at a teaching hospital in Saudi Arabia. To achieve the objectives of the study, comparison was made between hospitalized and non-hospitalized type 2 diabetic patients using a retrospective case-control design. Four categories of factors namely, socio-demographic, outpatient clinic, clinical and quality indicators were investigated to elicit their relation with hospitalization among type 2 diabetes patients. Univariate analysis and stepwise multiple regression analysis were employed. Hospitalization was found to be independently associated with male gender, frequent visitors of outpatient clinics other than diabetes clinic, patients with nephropathy and patients with HbA1c >/= 7%. Limited number of cases and controls received the recommended ambulatory care for diabetes patients as evidenced by the marked low level of process of care indicators for diabetes patients. Conclusions and recommendations: Hospitalization was related to a limited number of factors many of which require better ambulatory care at outpatient clinics of the study hospital. It was recommended to continuously monitor the identified significant variables using the hospital electronic medical record system in order to target those patients at high risk for hospitalization

Determinants of healthcare utilization and cost among privately insured families in Saudi Arabia

The kingdom of Saudi Arabia is currently restructuring its healthcare system through implementing a number of strategies among which the introduction of insurance coverage for both foreign workers and citizens. The aim of the present study is to assess factors that affect utilization and cost of health services among a group of privately insured families in Saudi Arabia. A six month administrative claims database of employees and their dependents from three different companies covered by a major insurance company was utilized to collect demographic enrollment characteristics, service utilization and services costs. The unit of analysis of the present study was families rather than individuals with a total of 131 families included in the analysis. The study revealed that those covered by the highest class of coverage provided by the insurance company [class VIP and A] had more utilization and higher mean charges per family compared to those covered by class B or C. The study also found that middle aged and older families had more utilization and average charges per family compared to younger families. Families in which women were the primary insured had both lower use and lower average charges. Finally family size seemed not related to any pattern of medical care use. Families with lower insurance class coverage, and families in which women are the primary insured showed lower utilization pattern, but families with older individuals had more utilization. Additional studies are need for a more comprehensive understanding of utilization pattern by the insured population in Saudi Arabia

Effectiveness of home blood glucose monitoring on controlling type II diabetes mellitus in two university hospitals, Riyadh

Home glucose monitoring is an opportunity for patients with type II diabetes to control their own blood glucose and health, testing blood glucose at home helps to prevent the immediate and potentially serious consequences of very high or very low blood glucose levels. This study aimed at ascertaining diabetic patients performance of home blood glucose monitoring [SMBG], its perceived benefits, and its effectiveness in controlling type II diabetes mellitus. A cross sectional study was conducted on a 300 type II diabetic patients who follow up in the diabetes clinics at two university hospitals in Riyadh, Saudi Arabia. Data were collected through a structured interview questionnaire and records review. Out of the total 300 diabetic patients, 145 [48.3%] use SMBG and 51.7% of them used it according to the doctors advice, and 52.4% of them checked it by themselves. Only 55.2% received education about use SMBG. Educational level and employment were significantly related to SMBG. Most of the patients [66.3%] who had SMBG presented with normal HbA1c range [OR=4.86, 95% Cl= 2.37-10.28]. The study provide a proof supporting effectiveness of SMBG for diabetic patients, however, it recommends to launch further in depth research to provide evidence about the effectiveness of self-monitoring and identify patients who might derive most benefit from different froms of blood glucose monitoring

Identification of drug cost reduction opportunities in a university hospital in Saudi Arabia

Expenditure on medications represents significant proportion of the total hospital budget. Establishing an effective drug cost management program is a priority area for hospitals that must begin with determining the current costs and pattern of use of medications. The aim of the present study is to determine the cost and pattern of drug utilization at the study hospital in order to identify cost reduction opportunities. A descriptive retrospective design was used to examine the cost and pattern of drug utilization for all admissions during the period from: 1[st] January 2006 to 30[th] June 2006 in an university hospital in Eastern Saudi Arabis. Electronic patient data as well as manual drug cost data were obtained and merged to create the analysis database. The study revealed that the total drug cost at the study hospital was SR 11, 823, 666.9 [mean per admission=SR 2123.5 and median per admission=SR 357.3] during the study period. Antibiotics were responsible for 35.8% of the total inpatient drug costs followed by blood products which accounted for 20.6% of the total inpatient drug costs. Further investigation of both groups revealed that the combination of piperacillin and tazobactam represented 4.5% of prescribed drugs and accounted for almost half of the inpatient ntbiotic costs [SR 2, 064, 916.8] and 17.4% of the total hospital's inpatient drug costs. Human alumin and intravenous immunoglobulin were responsible for the majority of cost of blood products. Piperacillin and tazobactam, human albumin, and intravenous immunoglobulin other than Rho [D] immunoglobulin are responsible for high percentage of drug expenditure at the study hospital while being prescribed to a limited number of patients. Designing a drug cost management program to target these three drugs will increase the likelihood of achieving significant cost reduction

Impact of helicobacter pylori infection on circulating interleukin-1beta [IL-1BETA] in gastroduodenal disorders

Helicobacter pylori [H. pylori] infection in characterized by marked changes in cytokine production, resulting from the immune response to infection. The H. pylori-associated diseases present with manifestations varying from mild non-ulcer dyspepsia or peptic ulcer disease [PUD] to gastric cancer. Study the effect of H. pylori infection on circulating serum levels of IL-1beta in some gastroduodenal disorders. According to upper gastrointestinal [GI] tract symptoms, upper GI endoscopy [including gastric pH measurement, ultra-rapid urease test-for the diagnosis of H-pylori infection, and biopsy], and histo-pathological examination, 80 patient with gastroduodenal disorders [20 gastric ulcer, 20 duodenal ulcer, 10 gastritis, 10 duodenitis and 20 gastric cancer] were studied. In addition, 10 apparently healthy subjects served as a control group. Circulating serum IL-1beta levels were determined for all subjects, by ELISA. The majority of gastroduodenal disorders studied had evidence of H. pylori infection and significantly higher serum IL-1beta than control subjects, being more in gastric disorders [gastritis, cancer and ulcer]. Gastric pH was significantly higher in patients with gastric disorders [gastric cancer, gastric ulcer and gastritis]. IL-1beta correlates positively with H. pylori infection in patients with duodenal ulcer and gastric ulcer. Meanwhile, it correlates negatively with gastric pH, in patients with gastric ulcer. Gastric pH and serum IL-1beta are significantly higher in cancer patients than in non-cancer patients. On other hand, H. pylori infection is detected more significantly in non-cancer patients. The mean serum IL-1beta was found to be significantly higher in patients with positive H. pylori infection than in those negative for H. pylori infection. IL-1beta is in an important pro-inflammatory cytokine with profound effects. Its acid inhibitory properties uniquely qualify it as a major player in the host's response to H. pylori infection and the diseases associated with it