Prevalence characteristics of COPD in never smokers

Chronic obstructive pulmonary disease [COPD] is currently the 4th leading cause of death all over the world. Smoking is by far the most important documented [and preventable] cause for COPD. However, COPD can still be recorded among a good percentage of non smoker patients, due to other different causes. This study was performed in the Chest Department, Menoufiya University, in the period from April 2009 to August 2011, on randomly selected 300 COPD patients, 230 patients [76.66%] were men and 70 patients [23.34%] were women. The mean age of the patients was 60.7 +/- 5.35 years [range 42-83 years], and all patients were diagnosed as having COPD [FEV1/FVC < 70%], with the use of spirometry [prebronchodilator and postbronchodilator inhalation], according to the GOLD criteria. For each patient, the personal history [including his or her education level], smoking history, health status, and exposure to risk factors for COPD, were assessed according to a prewritten questionnaire. Out of the 300 COPD patients included in this study, 120 [40%] were never smokers and 180 [60%] were ever smokers. Women made up 41.7% of the never smokers [50 of 120] and 11% of the ever smokers [20 of 180]. Never smokers were significantly older than smokers [65.08 +/- 5.03 years vs 56.33 +/- 5.67 years [P < 0.001]] and were more likely to be women [41.7% vs 11% [P < 0.001]]. Never smokers made up to 40% [120/300] of all COPD cases: 78% [70/90] of all GOLD stage II cases, 45.5% [50/110] of all GOLD stage III cases. Among never smokers, 58.3% [70/120] fulfilled the criteria for GOLD stage II and 41.7% [50/120] fulfilled the criteria for GOLD stage III and no patients fulfilled the criteria of either GOLD stage I or GOLD stage IV. Never smokers were shown to have more occupational exposure to organic and inorganic dust and irritant gases at work place [41.7% [50/120] vs 27.7% [50/180], P < 0.05], more biomass exposure [41.7% [50/120] vs 0% [0/180], P < 0.001], less education [41.7% [50/120] vs 72.2% [130/180], P < 0.001], more exposure to passive smoking [75% [90/120] vs 22.2% [40/180], P < 0.001]. When compared with never smoker patients with moderate COPD [GOLD stage II], never smokers with severe COPD [GOLD stage III] were older in age [70.6 +/- 2.44 years vs 61.14 +/- 1.25 years, P < 0.001], have a higher female percentage [60% vs 28.6%, P < 0.001], lower BMI [21.2 +/- 0.76 vs 26.14 +/- 2.43, P < 0.001], more occupational exposure [27.5 +/- 2.56 years vs 13.33 +/- 2.39 years, P < 0.001], more biomass exposure [35 +/- 4.15 years vs 20 +/- 10 years, P < 0.001], less education [0% vs 71.4 educated, P < 0.001], more exposure to passive smoking [29 +/- 2.02 years vs 13.75 +/- 4.19 years, P < 0.001]. This study revealed that never smokers constitute a significant proportion of the Egyptian COPD patients. When dealing with COPD management, clinicians must be oriented with the different risk factors, other than tobacco smoke, that play a key role in the development and pathogenesis of COPD, because despite smoking is the most important risk factor, its absence doesn't exclude COPD diagnosis

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

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