Moataz M. Abdel-Fattah

Consanguinity and advanced maternal age as risk factors for reproductive losses in Alexandria, Egypt

Background: Consanguinity has been a long-standing social habit among Egyptians. Estimates of consanguinity ratios in different parts of Egypt ranged from 29 to 50%. This study aimed at delineating the role of consanguinity and advanced maternal age on reproductive losses in Alexandria, Egypt. Methods: A case-control study, on 730 couples with history of reproductive losses and 2081 normal couples, was done during the period October, 1998 until August, 2000. Results: Of the 730 couples with reproductive losses, consanguinity frequency was 68.8% with 56.2% first cousins. Prenatal loss and infant deaths were highly encountered among consanguineous marriages (p < 0.0001). In a multivariate logistic regression analysis, consanguinity between couples increased the relative risk of repeated abortion (OR: 3.95; 95% CI: 3.04–5.14), stillbirths (OR: 10.6; 95% CI: 6.7–17.0), neonatal death (OR: 17.2; 95% CI: 10.8–27.3), post-neonatal death (OR: 14.5; 95% CI: 10.6–19.9) and total reproductive losses (OR: 8.3; 95% CI: 6.9–10.1). A positive association was found between advanced maternal age and repeated abortion (OR: 3.19; 95% CI: 2.04–4.97) as well as total reproductive losses (OR: 2.37; 95% CI: 1.74–3.2). Conclusion: This study, the largest-reported case-control study on reproductive losses in Alexandria, strongly suggests that consanguinity may play a major role in the high rates of prenatal and infant mortality while advanced maternal age has a significant role in the causation of repeated abortion, and they must be taken into account for genetic counseling in Egypt. Because of the possibility of controlling, the study gives clear indications for prevention.

Acute respiratory tract infections among Hajj medical mission personnel, Saudi Arabia

Summary Objectives To estimate the prevalence of acute respiratory tract infections (ARI) among 250 personnel serving in a Hajj medical mission, Al-Hada and Taif Armed Forces Hospitals, during the 2005 season and to determine the effectiveness of protective measures, including influenza vaccination, for these infections. Methods This was a nested case-control study. A questionnaire was distributed to the study cohort two weeks after the Hajj period and was self-administered by all recruited subjects. In addition, the medical records of study subjects were reviewed at Al-Hada Hospital for the same period in order to document ARI. Results The attack rate for ARI among study subjects during Hajj season or within two weeks of returning was 25.6% (64/250). Logistic regression analysis of factors related to acquiring ARI revealed that contact with pilgrims imposed an extremely high risk of infection (adjusted OR 13.2, 95% CI 1.5–117.6). Moreover, non-use of alcohol-based hand disinfection carried a more than 8-fold risk of acquiring ARI compared to those who always used alcohol for hand disinfection (adjusted OR 8.4, 95% CI 2.2–32.2). Smoking was also a predictor of ARI in our cohort and influenza vaccination was associated with a 30% reduction in ARI compared to unvaccinated subjects, although this finding was not statistically significant. Unexpectedly, the logistic regression model showed that Saudi nationals were three times more likely to acquire ARI than non-Saudis (adjusted OR 3.1, 95% CI 1.2–8.4). Conclusions The common practice among pilgrims and medical personnel of using surgical facemasks to protect themselves against ARI should be discontinued and regular use of alcohol-based hand scrubs should be more vigorously encouraged. Further research is needed to evaluate the protective value of N95 facemasks against ARI during the Hajj period.

Risk Factors for Lower Limb Complications in Diabetic Patients

Diabetic lower extremity complications may be influenced by a number of factors, including those related to the interaction between patients and the health-care system. Our objective is to identify risk factors for the development of lower limb complications, by looking for classical clinical variables and those related to quality of care. A case-control study was carried out between December 1993 and June 1994 by interviewing 348 patients with lower-limb diabetic complications and 1050 controls enrolled from 35 diabetes outpatient clinics and 49 general practitioners offices in Italy. Among sociodemographic characteristics associated with increased risk of lower limb complications were male gender [odds ratio (OR) = 2.5, confidence interval (CI) 1.6-3.9], age between 50 and 70 years as opposed to younger than 50 (OR = 3.6, CI 2.1-6.3) and being single as opposed to married (OR = 1.4, CI 1.1-1.8). Among clinical variables, treatment with insulin for IDDM and NIDDM patients was an important predictor of lower extremity complications compared to NIDDM patients not being treated with insulin. Cardio-cerebrovascular disease and presence of diabetic neuropathy were associated with a higher risk of being a case (OR = 1.4, CI 1.2-1.8 and OR = 3.0, CI 2.1-4.2, respectively). Patients who needed help to reach the health facility before the onset of the complications and those who did not attend health facilities regularly were more liable to develop complications (OR = 1.5, CI 1.1-2.2 and OR = 2.0, CI 1.3-3.0, respectively). Patients who had never received educational intervention had a threefold risk of being a case as compared to those who received health information regularly. The study identifies factors most likely to be related to adverse outcome and permits to discriminate between avoidable and unavoidable factors.

Health care for diabetic patients in developing countries: a case from Egypt.

The aim of this was to evaluate the pattern of care for diabetic patients in Alexandria as a model from a developing country. It is a cross-sectional multi-centric. One thousand diabetic patients who had diabetes for no less than one year were randomly selected from 14 out-patient clinics and diabetic centres. Results showed that monitoring of the glycaemic state was based, almost entirely upon fasting blood glucose levels, with only a small minority (4%) having HbA measurements. During the previous 12 months, an electrocardiogram had not been performed in 26% of the subjects studies and the fundus was not examined in 38%. Twenty nine percent did not receive neurological examination, and feet were not inspected in 24%. Testing for albuminuria, serum creatinine, blood cholesterol, and triglycerides was performed only in 34%, 37%, 36% and 32% respectively. Patients habits in seeking care revealed that 78% regularly attended the medical centre for follow up, 64% followed dietetic instructions, and 89% were compliant with prescribed therapy. Only 8% did self examination of blood glucose and 26% checked glucose in urine by themselves. Generally, the pattern of care provided for health insured diabetic patients is better than that received by non-health-insured cases. It is concluded that in Egypt the quality of diabetes care differs in many aspects from the recommended standards and that structural as well as organisational improvements are urgently needed, particularly to guarantee adequate care to non-health insured patients.

Association of glycosylated haemoglobin level and diabetes mellitus duration with the severity of coronary artery disease

Diabetes mellitus (DM) is known to cause microvascular and possibly macrovascular complications. This study was performed to find the association between glycosylated haemoglobin (HbA1C) level and the severity of coronary artery disease. One hundred and ten consecutive patients admitted to hospital with acute myocardial infarction were studied. Seventy-eight patients (70.9%) had DM, 73 (93.58%) had HbA1C > 7%, 52 (47.3%) were hypertensive, 19 (17.3%) had a history of smoking and 37 (33.6%) had raised cholesterol. Coronary angiography was carried out in 87 (79.1%) patients and the severity of disease was assessed using the Gensini score. The mean Gensini score was 53.36±36.94 and the mean HbA1C was 8.4±2.39%. There was a significant association between Gensini score and DM (p=0.003) and between Gensini score and hypertension (p=0.018). HbA1C (r=0.427, p=0.001) and duration of DM (r=0.362, p=0.004) had a positive linear correlation with the Gensini score. Multiple regression analysis showed HbA1C to be an independent factor that influenced the Gensini score (p=0.021).

Non-Hodgkin's lymphomas in Alexandria, Egypt; incidence rates and trend study (1995-2004).

During the past decades, the incidence of the most common non-Hodgkins lymphomas has increased dramatically worldwide. In Egypt, it is the fifth most common cancer in both the sexes. The purpose of this study is to study the problem of non-Hodgkins lymphomas in Alexandria, Egypt: incidence rates and trend. The method employed was record reviewing for estimation of the annual incidence rates of non-Hodgkins lymphoma and their trends. The general incidence rate of non-Hodgkins lymphoma was 5.90 in 1995 and reached 8.99 in 2004, with a peak (9.40) in the year 2002. The male incidence of non-Hodgkins lymphoma demonstrated an obvious rise from 1995 to 1998, with a slowing from 1999 to 2002, followed by another evident rise from 2003. Women showed an increase in non-Hodgkins lymphoma incidence rates from 1995 to 2000, then a decline afterwards, till 2004. As regards the population from 15 to 60 years old, there was a rise through the period from 1994 to 1999, then a drop from 2000 to 2004. In the elderly group, the incidence rate was doubled during the 10 years (from 13.36/100 000 in 1995 to 26.65 in 2004). The incidence of non-Hodgkins lymphoma increased steadily from 1995 to 2004 in Alexandria, particularly in the elderly population. The importance of developing additional strategies for screening and prevention of non-Hodgkins lymphoma, in this group, on the basis of epidemiological evidences is warranted.

Epidemiologic Study of Nosocomial Urinary Tract Infections in Saudi Military Hospitals

A case-control study of patients with and without confirmed UTI was performed to identify risk factors for nosocomial UTI. Duration of hospitalization, unit of admission, history of diabetes mellitus or debilitating diseases, and duration and number of urinary catheters were independently associated with increased risk of nosocomial UTIs.

Pattern of disability among patients attending Taif Rehabilitation Center, Saudi Arabia.

Purpose. Despite the growing awareness of the community about the economic, psychological and medical impact of disability, limited research has been carried out to determine the pattern of disabilities in Saudi Arabia. Methods. This is a cross-sectional study of hospital records of patients who were admitted to Armed Forces Rehabilitation Center, Taif, Saudi Arabia, during the period from 1999 – 2005. A total of 850 patient records were reviewed. Data were collected on age, sex, nationality, data of admission and discharge and type of disability. Univariate and multivariate logistic regression analyses were performed to determine predictors of long stay at the hospital. Results. Trauma as an etiology of disability was more common than non-traumatic incidents among male and middle age patients (16 – 45 years). Traumatic accidents mostly result in quadriplegia (72.8%). Male, single, less than 45 years old, patients with traumatic accidents and patients with paralytic types of disability were significantly more likely to stay longer at the hospital (≥6 months). Conclusions. The home care program should be expanded to minimize duration of stay at the rehabilitation centers with lower cost as well as health education of the public would help in encouraging disabled patients to adapt to daily life activities.

Major birth defects among infants with Down's syndrome in Alexandria, Egypt (1995-2000).

A case-control study of 514 infants with confirmed Downs syndrome (DS) was carried out during the period 1 July 1995-30 June 2000 to investigate the risk factors for the occurrence of congenital anomalies among DS cases. Our results showed that the significant risk factors for developing any type of congenital anomalies among DS were: parental consanguinity, grand-maternal consanguinity, use of antibiotics, use of oral contraceptive pills, diabetes mellitus, and maternal fever. The interaction between trisomy 21 genes and consanguinity and/or environmental factors can increase the risk of several additional birth defects.