Frequency and risk factors of hepatotoxicity of anti Tuberculous drugs

Hepatotoxicity is reported in patients using first-line anti-tuberculous drugs regimen, among them 6-12% die. Identifying the risk factors for developing hepatotoxicity would probably reduce morbidity and mortality associated with T.B management. To study the frequency and risk factors of hepatotoxic reactions in patients receiving firat-line anti-tuberculous drugs. In addition to determine the relation between acetylator phenotype and anti-tuberculous drug hepatotoxicity. Seventy seven patients consecutively presenting to Suez Chest Hospital with active T.B diseases [WHO criteria], who were eligible for anti- tuberculous regimens [WHO guidelines] were included. Child B or C cirrhotic patients or Child A with liver enzymes exceeding double the normal were excluded in addition patients suffering from chronic renal or cardiac disease, hypersensitivity to anti-tuberculous drugs or receiving potentially hepatotoxic medications for other reasons were also excluded. 1-Rate of hepatotoxic reactions according to the diagnostic criteria. 2- Rates of fast and slow acetylator phenotypes. 3- Rate of risk factors among patients with hepatotoxicity versus patients without hepatotoxicity. Hepatotoxic reactions have been diagnosed in seven [9.1%] patients. By univariate analysis, age over 60 years [p = 0.02], alcoholism [p = 0.02], extra-pulmonary tuberculosis [p = 0.02] and severe forms of tuberculosis [p = 0.03] were statistically significant risk factors. Fifty eight [75.3%] of the study sample were slow acetylators, while 8 [10.4%] were fast acetylators. Three out of the eight [37.5%] of fast acetylators and only [6.9%] of the slow acetylators developed hepatotoxicity [p = 0.03]. Logistic regression models showed that fast acetylator phenotype was the only significant [p = 0.04] risk factor for early hepatotoxicity. Alcoholism [p = 0.01] was a significant risk factor for late hepatotoxicity. Hepatotoxic reactions among patients receiving anti-tuberculous drugs remain a considerable problem. Two patterns of liver injury can be observed. The first occurs earlier and is associated with fast acetylator phenotype. The second occurs later and is associated with alcoholism and HCV infection

Risk factors of stone recurrence in idiopathic renal calculi

Recurrent kidney stone [RKS] is a long-term problem causing a significant morbidity. The study was conducted to determine the rate of recurrence of calcium oxalate [Ca-Ox] kidney stones at 5 years after the first symptomatic stone, and to identify the risk factors of stone recurrence and their predictive values. The study included 233 patients with idiopathic Ca-Ox kidney stones. Medical History abbreviated food frequency questionnaire, and laboratory investigations were used to collect the data. The relative risk and 95% confidence interval of stone recurrence for each hypothesized risk factor was determined. Multivariate analysis using logistic regression [LR] was used to identify the significant risk factors and their negative and positive predictive values. The overall rate of recurrence was 61.8%. Young agent the first stone episode, male sex, positive family history [FH] and low fluid and high protein intake were found to be significant risk factors of stone recurrence. No significant differences were identified between recurrent and first stone formers for any of the laboratory measurements. The positive and negative predictive values of a model containing the significant risk factors were 78.3% and 54.4% respectively, with an overall prediction of 69.1%. Ca-Ox kidney stones have a high rate of recurrence. Fluid and protein intake appears to play an important role in kidney stone recurrence. We cannot, identify a good predictive model for stone recurrence so, we recommend pursuing diagnostic and therapeutic approaches for all first-stone formers

Risk factors of micro-albuminuria in patients with non-insulin dependent diabetes mellitus

Micro-albuminuria is an indicator of early diabetic nephropathy [DN]. The trends towards increased end stage renal disease [ESRD] secondary to DN are expected to contiue in developing countries. An understanding of the risk factors, which lead to the development of micro-albuminuria in non-insulin dependent diabetes mellitus [NIDDM], is required to develop strategies for primary prevention of DN. A case-control design was used to determine the risk factors of early DN in 184 patients with NLDDM [48 with micro-albuminuria and 136 with normo-albuminuria]. We defined micro-albuminuria where the ratio of urine albumin in micrograms [mcg] urine creatinine in milligrams [mg] was in the range of 17-299 for males and 25-299 for females. The glycosylated hemoglobin [HbAlc] of >/= 8.1%. was used to define the poor glycemic control. Patients were examined for retinopathy, peripheral neuropathy, coronary artery disease [CAD] and peripheral vascular disease [PVD]. We measured fasting serum triglyceride, cholesterol, low-density lipoprotein [LDL], high-density lipoprotein [HDL], lipoprotein [a] [Lp[a]], C-peptide of insulin, transforming growth factor beta [TGF beta] and e-selectin. HbAlc, duration of diabetes mellitus, systolic blood pressure [SBP], diastolic blood pressure [DBP] and serum C-peptide of insulin, triglyceride, LDL and Lp[a] were positively correlated with micro-albuminuria, while HDL was inversely correlated with it. The TGF beta and e-selectin did not significantly correlated with micro-albuminuria [P>0,05]. After adjustments for the effects of covariates with logistic regression [LR] analysis, the odds ratio [OR] and 95% confidence interval [CI] of micro-albuminuria for the potential risk factors were estimated, LR revealed a significant association between micro-albuminuria and male gender [OR = 5.1], poor glycemic control [OR = 4.7], young age at onset of diabetes [OR = 4.1], dyslipidemia [OR = 3.8], hypertension [OR = 3.1], and the longer duration of diabetes mellitus [OR=2.6]. Male gender, poor glycemic control, young age at onset of diabetes, long duration of diabetes, hypertension and disturbed lipid profile especially triglyceride, LDL and Lp[a] are significant risk factors for development of DN. The possible mediators of progression of nephropathy [serum TGF beta, e-selectin and insulin] are not found to be significant markers of micro-albuminuria stage of DN

Quantitative assessment of the risk of urinary schistosomiasis and other potential risk factor for bladder cancer in Egypt

A case-control study was conducted to assess magnitude of the risk of urinary schistosomiasis and other possible risk factors for squamous and transitional cell types of bladder cancer [BC] in Egypt. Cases included 301 patients who were recruited from National Institute of Cancer at Cairo presenting with an early stage of BC; 148 with squamous cell carcinoma [SCC] and 153 patients with transitional cell carcinoma [TCC]. A definitive diagnosis of BC and its cell type was based on histopathological examination of biopsy. Controls included 154 subjects admitted for surgery other than cancer. Urinalysis and ultrasound examinations were used to exclude controls with evidence of lesions suspicious of BC. Both cases and controls were interviewed using a structured risk-assessment questionnaire. The collected data included age, gender, diagnosis of urinary schistosomiasis, and urinary stones, smoking status, exposure to pesticides, and petrochemical products. Resuits of the bivariate analysis, showed increased significant risks for both types of BC with age >/= 50 years, male sex, urinary schistosomiasis, urinary stones and exposure to pesticides. To measure the adjusted OR and 95% confidence limits [CL] of each risk factor, stepwise logistic regression [LR] was computed to control for effects of the confounding variables. The main results of LR analysis were: 1- Elevated significant risk for SCC with urinary schistosomiasis [OR: 2.5, CL: 1.5-4.1], and urinary stones [OR: 2.2, CL: 1.1-4.2]. 2- Elevated risk for TCC with age of snore man 50 years [OR: 5.3, CL: 3.1-9.0], and urinary schistosomiasis [OR: 2.5, CL: 1.4-4.2]. 3- Increased risks for SCC and TCC, albeit non-significant on exposure to pesticides [OR: 2.0, CL: 0.9-4.8 for SCC], and [OR: 1.5 CL: 0.6-3.8 for TCC]. 4- Non-significant increased risk for SCC and TCC with cigarette smoking. Urinary schistosomiasis is a significant risk factor for SCC and TCC and its risk is almost unaffected by other confounding variables. Albeit statisticallt non-significant, the environmental and occupational factors are associated with high risk for BC

Prevalence of urinary stone disease among Suez canal population

A random sample of 3400 persons above 10 years of age was selected. The diagnosis of urinary stone disease was done on the basis of: 1- history of spontaneous passage of stone or surgical removal of a stone or radiological evidence of a stone in a validated interviewing questionnaire and 2-abdominal ultrasonography's findings in individuals with a history of renal calico and hematuria. We could interview and examine 3171 [93.3%] out of the scheduled 3400 individuals. 188 persons were diagnosed as patients having urinary stone disease i.e. The prevalence rate of the disease is 5.9%. The prevalence varies from region to region [it is as high as 9.3% in rural Ismailia and is as low as 2.9% in Suez City. There is significant increase in prevalence of the disease among males and the male: female ratio was 3:1. The 3rd, 4th and 5th decades of life are the main age groups affected

new concept in the treatment of periapical lesions using honey

Thirty periapical lesions were divided into two similar groups. In the first group, the lesions were irrigated via the root canal with 70% diluted pure honey for three successive times every 48 hours. In the second group, normal saline was used for this purpose. Surgical removal of the lesions for histopathological examination were made at 2, 4, 6, 8, and 12 weeks following the last irrigation in both groups. The results revealed that the honey treated lesions exhibited marked and rapid healing than the normal saline treated lesions. This finding encourages the use of honey in the treatment of periapical leions and open a way for using honey in other oral surgical procedures

Some factors affecting the use of governmental health services in rural area

The study was conducted on 298 families in Defra Village, Gharbia Governarate, Egypt in a period of 6 months. The aim of the work is study of Family's choice of health services and some factors affecting the suitable choice of health services among the rural population. The majority of families [57.4%] used home care during minor illness. Pharmacists and traditional healers were used mainly during minor and chronic illness. The main use of combined health unit was mainly during chronic illness [54.7%] because it is the Less expensive and more accessible health service. Most families [55.7%] used the governmental hospitals in Tanta City or private physicians in severe illness to gain good quality of health services. Suitable choice of health services was significantly found among the educated parents, high income families and families having children less than 5 years