Evaluation of the application of DOTS strategy in Gharbia Governorate

Egypt has succeeded in implementing the directly observed treatment, short course [DOTS] strategy nationwide. This strategy involves the direct observation of tuberculous patients during drug intake to ensure that the full treatment course is followed. It has been shown world-wide that patients treated without direct observation have a substanti ally higher risk of adverse outcome than those treated under direct observation. Estimate the risk of Mycobacterium Tuberculosis disease in a trial to reduce its prevalence and evaluating DOTS strategy implementation in Gharbia Governorate to prevent the spread of tuberculosis in the community by early detection of patients with infectious tuberculosis and providing them with effective treatment to ensure a rapid and lasting cure. Diminished development of treatment failure and resistant cases would thus follow as an achievement. This study included 276 tuberculous patients who attented in the last two year 2006, 2007 in Mehalla El Kobra and Tanta chest centers. They were categorized according to their locality arid study year. Their age, sex, site of tuberculosis, the regimen of drug used, were recorded. The treatment outcome of the patient and notification of number of cured, completed treatment, relapsed, treatment failure, transferred and died patients were also thus known. The 276 tuberculous patient, included 101 patients belonging to Mehalla [41 patients in 2006 and 60 patients in 2007] and 175 patients belonging to Tanta [88 patients in 2006 and 87 patients in 2007]. The pulmonary form of the disease represented 77.23% in Mehalla and 76% in Tanta. The remaining were extrapulmonary. In relation to gender there were male predominance 64.36% in Mehalla and 69.71 in Tanta. The difference was statistically insignificant. The percent of treatment success in the form of cured and completed treatment patients were 88.12 in Mehalla and 77.14 in Tanta. The percent of treatment failure were 1.98 in Mehalla and 4.57 in Tanta. The percent of died patient were in 2.97 Mehalla and 5.72 in Tanta. The difference were statistically significant [p<0.05]. cases needs to be improved, so that treatment would be initiated early enough to minimize pre-treatment transmission of infection in the community. The need for interventions aiming at, earlier identification of sources of infection and reducing tuberculosis transmission in the studied communities and in other similar communities, is urgent. However the outcome of successful manangement of the detected cases in the study fulfills the desired international standard in Mehalla and is promising in Tanta, which would satisfy the desired effect of avoiding resistence of the bacillus with its economic, medical and social burden

study on the aetiology of pneumonia in Cairo and Tanta university hospitals: a bacteriologic approach

One hundred and sixty cases of "pneumonia" with proved clinical and radiological evidence from the Chest Departments in Cairo and Tanta University Hospitals during the year 2007, were the subjects of a conventional bacteriologic study having in mind the empirical approach in the antibiotic therapy. They represented 4.06% of the yearly admissions. The major age incidence was 16 year with more sex predilection. 92.5% belonged to CAP [community acquired pneumonia] and only 7.5% to HAP [hospital acquired pneumonia], VAP [ventilator associated pneumonia] being excluded. 80.6% were primary; with no antedating pathology in the patients, while 19.4% were secondary with co-morbidity in such patients; out which malignancy and COPD were the main associations in older age groups and foreign body in younger ages. The causative organisms were bacteriologically identified only in 53.7% of cases. The main organism in the causation of CAP was Streptococcus pneumoniae in 51.7% of the cases, followed by Hemophilus influenzae in 15.5%, while in HAP, 2 major organisms were responsible for the disease; namely Streptococcus pneumoniae and Klebsiella pneumoniae; 33.3% for each, followed by Hemophilus influenzae and Streptococcus pyogenes; 11.1% for each, but the number of cases in HAP is too small to draw valid conclusions. The organism detected, in primary pneumonia was also essentially Streptococcus pneumoniae 57.6%, while in secondary pneumonia the same organism was encountered in only 33.3% of the cases. Concerning the lobar and lobular distribution of the disease the S. pneumoniae was overwhelming in the lobar type: 84.2%, while in the lobular bronchopneumonic type the main organisms, besides S. pneumoniae which was responsible for 22.2% of the cases were S. pyogenes was responsible for one quarter of the cases and H. influenzae which was encountered in 22.2%. Figures for other organisms are detailed in the text with their relation to other parameters of the study

study on the aetiology of pneumonia in Cairo and Tanta university hospitals, a bacteriologic approach

One hundred and sixty [160] cases of "pneumonia" with proved clinical and radiologic evidence from the Chest Departments in Cairo and Tanta University Hospitals during the year 2007, were the subjects of a conventional bacteriologic study having in mind the empirical approach in the antibiotic therapy. They represented 4.06% of the yearly admissions. The major age incidence was 16 year with more male sex predilection. 92.5% belonged to CAP [community acquired pneumonia] and only 7.5% to HAP [hospital acquired pneumonia], VAP [ventilator associated pneumonia] being excluded. 80.6% were primary; with no antedating pathology in the patients, while 19.4% were secondary with comorbidity in such patients; out which malignancy and COPD were the main associations in older age groups and foreign body in younger ages. The causative organisms were bacteriologically identified only in 53.7% of cases. The main organism in the causation of CAP was Streptococcus pneumoniae in 51.7% of the cases, followed by Hemophylus influenzae in 15.5%, while in HAP, 2 major organisms were responsible for the disease; namely Streptococcus pneumoniae and Klebsiella pneumonia; 33.3% for each, followed by Hemophylus influenza and Streptococcus pyogenes; 11.1% for each, but the number of cases in HAP is too small to draw valid conclusions. The organism detected, in primary pneumonia was also essentially Streptococcus pneumoniae 57.6%, while in secondary pneumonia the same organism was encountered in only 33.3% of the cases. Concerning the lobar and lobular distribution of the disease the S. pneumoniae was overwhelming in the lobar type: 84.2%, while in the lobular Bronchopneumonic type the main organisms, besides S. pneumoniae which was responsible for 22.2% of the cases, were Streptococcus pyogenes was responsible for one quarter of the cases and H. influenza which was encountered in 22.2%. Figures for other organisms are detailed in the text with their relation to other parameters of the study

Study of psychological aspects in asthma an Egyptian experience

The problem of psychologic trouble in asthma is frequently overlooked, and needs to be assessed. For this purpose 40 asthmatic patients were investigated. A psychological trouble was found to be present in 55% of them; mostly in the form of anxiety/neurosis [84.6%]. Its proper conventional management, when added to the traditional phamacotherapy, stepped up the outcome of treatment in the particular case: The success, interpreted as relief and control parameters; combined together in the treatment which means controlled or partially controlled, reached 81.8% in these patients. The incidence of "difficult to treat" or uncontrolled cases dropped from 36.4% to 18.2%, when such cases received added psychotherapy. Even the comparison of the overall relief and control of patients revealed significant better outcome, when the proper treatment was applied to either patients with or without psychological trouble; figures being 81.8% and 77.7%, respectively. As a pilot study, this presentation calls for more elaborate study on the subject, with special attention to whether the relationship is a cause and effect one and/or a mere association

Tuberculosis and HIV infection: an egyptian experience

The interval change, in the association of Tuberclosis and H.I.V. infect ion, was studied; clinically, and by radiologic, pathologic, and microbiologic parameters. An immunologic study, for HIV. serology, was also carried out in two stages: The first was a screening phase; by the HIV 1 and 2 ultra-rapid test device [Serum/Plasma] and the second was confirmatory by the Immunocomb II HIV 1 and 2 Bispot. The immunologic study was done for 22 of 121 proved total tuberculous cases. These 22 cases had a high risk for HIV infection. The risk factors included, as examples, behavioral aberrations, encountered in 18.2% and blood transfusion in 59.1% of such high risk cases. Also sexual aberrations, though not reported in the present study, in spite of meticulous inquiry, received proper attention. No HIV. Seropositivity was met with in the present study. Hence the problem is not sizeable, but multicenter studies, in Egypt, are recommended, in order to have a global view of the problem. Also periodic assessment of the problem, is needed in order not to be suddenly faced by its hazards

Trends of ambulatory management of pulmonary tuberculosis: experience in Mehalla El Kobra chest center, Egypt

A major chest center, in Mehalla El Kobra, Egypt, was chosen to carry out the present study. A total of 812558 individuals attended the dispensary during the 25 years covered in the study; starting from 1971 and ending in 2001, inclusive: our of these, 5179 cases were diagnosed as being turberculous: The pulmonary cases were 4831 and the extra-pulmonary were 348. The trend in the incdenee of pulmonary cases was declining, being 99.2%, of all T.B. cases, at the starting year, 1971, while it dropped to 77.1% in the last year, 2001. The analogous figures for extrapulmonary cases are rising i.e. 0.8% and 22.8%, respectively. The positive yield on sputum smear, rose from 12.1% of the pulmonary cases in the year 1977 to 70.4% in the year 2001, Hence there is prompt and active case finding at the center, by sputum microscopy, among the pulmonary T.B. patients. Before the year 1992 short-term therapy was used only in hospitalized and not in ambulatory chest center patients. It was instituted, for some cases together with other cases who received only the old standard treatment in the center, for ambulatory cases in the year, 1992. It was thus decided to further analyze the data of the trends of tuberculosis treatment, in the chest center, starting from this year; 1992 and for the following 10 year; up to 2001; inclusive. The initial number of pulmonary T.B. cases during this period was 946. Their contacts; presenting for examination in the dispensary, were 3942, viz 4.1 contacts for every index case. The overall rate of detection of T.B. among the contacts, was 4.7%. Out of the 946 original pulmonary T.B. cases during the 10 studied years, the outcome of management could be traced in 634 patients; at the time of the study during 2002, i.e. 67%: 40.6% of the traced cases received the older traditional standard therapy, before the nation-wide application of the recent short-term therapy. Thus short-term therapy was prescribed to 59.6% of the whole traced cases. The favourable outcome; namely cured and completed treatment cases, was achieved in 70.6% of those on short-term therapy, while the analogous figure for cases on standard therapy, was 60.6% [p < 0.05]. The analogous figures for unfavourable outcome were 20.3% and 34.1% for short-term and standard therapy cases, respectively [p < 0.05]. Cases referred on their own request, to other centers, for further management were not included. The application of DOTS therapy definitely improved the outcome. The defaulting rate, thanks to DOTS, dropped to 7.6% as whole, when compared to 21.5% in the era before DOTS application [p <0.005]. The same beneficial trend could not be demonstrated, as far as treatment failure is concerned, possibly due to such cases being resistant, which may need DOTS PLUS; as a policy. Such policy is not yet applicable, at the surveyed area. The over-all look is promising and hence perfect combat, on the way of irradication, may be expected and even foreseen, in our local circumstances

Defects in asthma management: a factual clinical Egyptian experience

A factual clinical approach concerning the management of bronchial asthma patients in an Egyptian experience is the main objective of this study in order to disclose any defects and try to amend them. A total of 870 patients were included in this study. Only 750 were analyzed as 120 of them were considered not to be genuine asthmatics and were thus excluded. 41.3% of asthmatic cases were managed by general practitioners [GPs], while 37.6% were managed by chest specialists. Other specialties including pediatricians, general medical physicians and allergy specialists managed 21.1%. In 89.5% of the patients, ventilatory functions were not done. The classification management according to GINA and Egyptian guidelines were not possible in 91.4% and 93.1%, respectively. The main bulk in this defect was among general practitioners [90%], the least was among chest specialists [49.2%]. Other specialists shared in this defect by 87.3%. Non-compliance in the management was essentially in inhalation therapy [40.2%], followed by corticoid therapy [34.89%]. Cost of drugs was prohibiting in 19.2% of cases as an outcome 35.3% of patients could be relieved in their acute episodes, while only 15.5% could achieve control of their disease. All these parameters were also analyzed according to the managing speciality

Study of natural killer cells [NKCs] in pulmonary tuberculosis

This study aimed at evaluation of natural killer [NK] cells in cases of pulmonary tuberculosis using flow cytometry. It comprised 50 subjects divided into two groups. The first group included 40 patients, they were subdivided according to response to antimycobacterial chemotherapy into four subgroups [recently diagnosed [fresh], sputum converters, sputum non-converters [after 8-10 weeks of treatment] and relapsed [or reactivation] subgroups]. Another group included 10 normal persons as a control. On the whole, it was found that the percentage of CD56 [natural killer cells] in relation to total lymphocytes was significantly decreased in pulmonary tuberculosis. This was encountered in all subgroups

Tracing of pulmonary tuberculosis cases among "goza" smokers using mycobacterial phage typing

The present study included 564 patients with chest symptoms belonging to 3 groups: 175 cigarette smokers, 160 "Goza" smokers [Hubble-bubble or water pipe] and 229 non-smokers. The objective was defining any relation between "Goza" smoking and pulmonary tuberculosis, with special utilization of the technique of Mycobaeteriophage typing in this respect. Results refer to a definite statistically significant increased incidence of pulmonary tuberculosis among "Goza" smokers [19.3%], versus cigarette smokers [5.7%] and non-smokers [4.8%]. There was also statistically significant difference in the clinical and radiological aspects between the 3 groups, namely: art increased incidence of haemoptysis [51.6%] and dyspnea [64.5%] in Goza smokers and more far-advanced extent of the disease among them [70.9%]. The resistance pattern of Mycobacteria isolated from tuberculosis "Goza smokers belonging to the same "Goza-smoking session', was the same, in each of 9 "sessions" from which the cases were collected. The same trend was obtained when the phage typing of the bacilli was correlated with the "Goza-smoking session'. The same phage type, was shown, among the patients collected from the particular session e.g. sessions I .2,3 and 4 showed only phage type A in all their tuberculous patients while session 6 showed phage type B. Phage type Ax was isolated only from session 7 and phage type C only from session 9 and phage type I from session 8. It can he concluded that the mass use of one 'Goza" in the concerned "Goza-smoking session', usually in an unwholesome atmosphere among consumers with low apprehension of symptom like cough and expectoration, is a definite risk factor for cross-infection with pulmonary tuberculosis discovered in an advanced stage. So, "Goza" smokers are a high vulnerable group, in this respect, that needs special epidemiological attention as a public health problem

Abdominal aortic aneurysm in complicated and non-complicated hypertensive patients population

Abdominal aortic aneurysm [AAA] is an important cause of preventable death in the elderly. To search for an effective screening framework for the detection of [AAA], prospective screening study involving 200 predominantly elderly patients aged 56 - 75 years by ultrasound for the presence of AAA in 2 phases, in screen I, 110 hypertensive patients [diastolic blood pressure reading> 95 mmHg and systolic blood pressure> 155 mmHg without apparent hypertensive complications] was the only selection criterion, in screen II included 90 hypertensive patients with a systolic blood pressure level higher than 175 mmHg with antihypertensive therapy, and complicated hypertension in the form of cerebral [transient ischemic attacks and/or strokes] cardiovascular [ischemic heart disease, congestive heart failure and claudication]; renal [benign and malignant arteriolar nephrosclerosis and renal failure]; retinal [hypertensive retinopathy and sclerotic changes]. The yield of AAAs in screen I and II was [2.7%] and [13.3%], respectively [P < 0.05]. Of the complications of hypertension, only claudication was independently associated with the presence of AAA [relative risk, 5.6, confidence interval, 1.7 - 18.3, P < 0.005]. Screening for AAA is recommended for elderly patients with claudication. Uncomplicated hypertension by itself is not an indication for screening

Annual tuberculosis infection rate in Kalubyia governorate

Estimation of annual infection rate was done on 2005 primary school children and 1045 students of secondary schools in Qalyoubia governorate. The prevalence of infection at the age 6-12 years in urban area was 17.8% in urban area was 6.7% and in the rural area 6.1%. The prevalence of infection at the age 15-18 years was 17.8% in urban area and 17.5% in rural area. The prevalence of infection among males was higher than that of females. The estimated annual infection rate at the age 6-12 years in urban area was 7.4% and 6.1% for the rural area. In young adults [15-18 years] the rate was 12.9% and 12.6% for the urban and rural area respectively. The higher the risk of becoming infected, the higher the prevalence. This was clear at the age of 15-18 years. The risk was 12.9% and the prevalence was 17.8%

Annual tuberculosis infection rate in Sharkia governorate

Estimation of annual tuberculosis infection rate was done on 2024 children at the age 6-12 years and 980 students at the age 15-18 years in Sharqia governorate. The prevalence of infection at the age 6-12 years in the urban area was 6.3% and 6.8 in the rural areas respectively. The prevalence of infection among males was higher than females. It also increased with age. The estimated annual infection rate at the age 6-12 years in urban areas and 11.8 in the rural area. In young adults 15-18 years it was 11.6% in urban areas and 11.8 in the rural area. There was no difference of statistical significance between the two areas of the study

Association of pleural effusion with different types of liver cirrhosis

The frequency of pleural effusion was studied in 450 patients with different types of liver cirrhosis. They comprised 322 males in the age from 15-60 years and 128 females from 13-50 years. The overall frequency of effusion among these patients was 13.33 percent. Out of the 60 patient with proved pleural effusion it was found to be right in 58.33 percent, left sided in 8.33 percent and bilateral in 33.34 percent. The effusion was found to be mostly a serous transudate [85 percent], an exudate in 6.67 percent and haemorrhagic in 8.33 percent, out of the 5 patients with left sided effusion 3 [60 percent] proved to be tuberculous and 2 [40 percent] were found to be of malignant etiology. Serous transudate was detected in right sided and bilateral effusions only and is considered to be originating from the ascitic fluid either through transdiaphragmatic lymphatics or via diaphragmatic defects. The frequency of effusion was highest in patients with advanced cirrhosis as it was 21.16 percent in stage C, 8.26 percent in stage B and nil in stage A. It is clear that, left sided, exudative or haemorrhagic effusion in cirrhotics need extensive investigations to find out the cause since most of these will be found to have specific etiology rather than cirrhosis per se

study of urinary hydroxyproline [HOP] and alpha antitrypsin in patients with lung cancer and chronic obstructive bronchitis

The urinary Hop was measured for 15 patients with bronchial carcinoma, 18 patients with chronic obstructive bronchitis, 15 healthy smokers and 15 healthy non-smokers. There was a significant increase in the level of urinary HOP in patients with chronic obstructive bronchitis. The increase was correlated with the duration of the disease and the degree of air flow limitaion, whereas it did not correlate significantly with the smoking index. Urinary HOP was variably increased in different types of lung cancer with the highest level in small cell carcinoma

Athlete lung: a pilot study on the changes in ventilatory functions of football players

22 football players were subjected to ventilatory function tests in 2 stages of game performance : preseason and midseason. In every stage the function was assessed pregame immediate post and during recovery until pregame level was regained. Results speak of significant improvement of vital capacity, M.V.V., oxygen consumption, oxygen pulse, and respiratory equivalent in mid-season than preseason values. The recovery was also significantly more efficient in the midseason than in the preseason stages. The term [athlete lung] is forwarded to coin such physiologic changes related to the stepping up of physical fitness of sportsmen as a function of training

Ventilatory dysfunction in bilharzial patients with special reference to bronchospirometry

Twenty-sixpatientswithevidenceof urinary and intestinal bilharziasis were the subject of this study.Their bilharzial affection was in various stages of pathologic implication whereby the cases were subdivided into four groups according to the severity of affection. The standard spirometric ventilatory functions showed combined restrictive and obstructive ventilatorydysfunction. Bronchospirometry showed significant reduction of the oxygen uptake and vital capacity particularly in groups III and IV. The right lung was affected more than the left but still had the higher value. The ventilatory equivalent increased with the increase in the severity of the disease; it was more obvious again in the right lung. The minute ventilation showed insignificant decrease with the progress of the disease,there was negative correlation between the presence of the clinical manifestation of pulmonary hypertension, oxygen uptake and vital capacity

Spirometric and alpha 1- antitrypsin studies in goza and cigarette smokers

One hundred subjects were studied to throw light on the effect of smoking on serum level of alpha-1-antitrypsinandventilatory function. The results showed that there was highly significant reduction in serum level of alpha-1-antitrypsin of smokers and ex- smokers compared with non-smokers. This reduction increased with the progression of smoking index. There was marked decrease of serum level of alpha-1-antitrypsin in smokers of both cigarettes and Goza than those of either cigarettes or Goza only, but the meanserum alpha-1-antitrypsin level is nearly equal in smokers of cigarettes only and smokers of Goza only. As regard the ventilatory function, 40.9% of smokers and 88.9% of ex-smokers showed FVC% <80 compared with 28.6% of non smokers. 89% of smokers and all ex-smokers had FEV1% <80 versus 28.6% in non smokers. 85.8% of smokers and all ex-smokers had MVV% <80 versus 47.7% in non smokers. Also, there was prolongation of the total expiratory time in smokers and ex-smokers and strangely enough this prolongation was more in ex-smokers than smokers.The severity of the ventilatory dysfunction was inversely proportional to serum alpha-1-antitrypsin level

Pulmonary compliance in smokers with special reference to goza smoking

As a material for this work 150 males were studied. 120 of them were smokers and 30 were non-smokers controls. They were studied through the following methods: a] careful history taking and thorough clinical examination. b] radiologic study. c] spirometry. d] static pulmonary compliance measurements. From this work it can be concluded that: 1- smoking is associated with reduction of the pulmonary compliance in subjects with normal ventilatory function [the mean values of pulmonary compliance in smokers and non-smokers were 0.028 L/CmH[2]O/L V.C. and 0.037 L/CmH[2]O/L.V.C. respectively]. The pulmonary compliance is correlated with the subjects, total consumption of cigarettes, goza and both cigarettes and goza together. Its values differ according to the type of smoking, it has the lowest values in goza smokers [0.043 +/- 0.015] and the highest values in both cigarette and goza consumers [0.062 +/- 0.025]. In cigarette smokers its values occupied intermediate position [0.045 +/- 0.015 L/CmH[2]O/L. V.C.]. 2- Reversed relationship was found between the pulmonary compliance and each of MBC% and FEV% in all subjects of the study while a direct relationship was found between the pulmonary compliance and FVC in subjects with normal ventilatory function. 3- The subjects of total consumption of each of cigarettes, goza and both cigarettes and goza were found to be directly related to the severity of dyspnea and reversely related to each of FEV% and MBC%

Spirometric and arterial blood gas studies in restrictive lung diseases with special reference to the effect of physiotherapy

Thirty-six patients of pulmonary fibrosis were studied including twelve cases in each of the three groups; post-tuberculous pulmonary fibrosis, pulmonary fibrosis as a result of bronchiectasis and idiopathic pulmonary fibrosis. Twenty-four of these patients [eight in each group] received in addition to drug therapy physical treatment mainly in the form of breathing exercise every other day for two months to assess the effect of physical treatment on the ventilatory pulmonary functions and arterial blood gasses of those patients which were done before and after the physiotherapy period. On comparing the changes of FVC% of patients who had received physical treatment with that of patients who had not received physical treatment, the difference of the changes ofthe FVC% was statistically insignificant. On comparing the results of analysis of arterial blood gases [PaO2 and PaCo2] before and after physical treatment, no significant improvement was observed in all cases except in the arterial oxygen tension of patients with post-tuberculous pulmonary fibrosis who received physical treatment, they showed significant increases in PaO2. Chest physical treatment [mainly in the form of breathingexercises]showedinsignificantimprovement of the ventilatory pulmonary functions and arterial blood gases of patients with pulmonary fibrosiscaused bypulmonary tuberculosis, bronchiectasis or of idiopathic type; but in such chronic disease with long duration dramatic improvements would not be anticipated and prolongation of the period of chest physical therapy might show a more beneficial effect on the ventilatory pulmonary functions and arterial blood gasses of such cases

Correlation of the rise in serum acid phosphatase with the degree of hyperglycaemia and vasculopathy in diabetic patients

Serum acid phosphatase and oral glucose tolerance test [OGTT] have been determined in thirty one diabetic patients [thirteen males and eighteen females], and ten normal subjects [five males and five females]. In male patients, the prostatic fraction of the enzyme has also been determined, in addition to the total enzyme activity. In the diabetic patients there is a significant increase in serum acid phosphatase. In male patients the increase was due to rise of the non prostatic fraction of the enzyme. The diabetics were classified into four groups according to the fasting blood glucose level: the first having a fasting level below 100 mg%, the second from 100-200 mg%, the third from 200-300 mg% and the fourth above 300 mg%. no positive correlation were found between the rise in serum acid phosphatase and the extent of impairment in glucose tolerance. Further classification of the diabetic patients was done according to presence or absence of diabetic vasculopathy. Serum acid phosphatase was significantly elevated in patients with vasculopathy, but in the other group without vasculopathy the enzyme level was not different from the normal control. It was concluded that the principle factor underlying rise of the serum acid phosphatase in diabetic patients is the presence of vasculopathy rather than the severity of glucose intolerance