Mohsen Gadallah

Prevalence of female genital cutting among Egyptian girls

OBJECTIVE Female genital cutting (FGC) is the collective name given to traditional practices that involve partial or total cutting away of the female external genitalia whether for cultural or other non-therapeutic reasons. In Egypt, the result of the Demographic Health Survey in 2000 revealed that 97% of married women included in the survey experienced FGC. The aim of this study is to measure the prevalence of FGC among schoolgirls in Egypt. METHODS Multistage random technique was applied for site selection. First, Egypt was divided into five geographical areas; Greater Cairo, Lower Egypt, Upper Egypt, Sinai and Suez Canal Region. Second, from each governorate, two educational districts were selected randomly (except Luxor). In each of the selected districts, the schools were divided into primary, preparatory and secondary schools. In each education stage, the schools were divided into rural, urban, government and private. The total number of females interviewed was 38,816. FINDINGS The prevalence of FGC among schoolgirls in Egypt was 50.3%. The prevalence of FGC was 46.2% in government urban schools, 9.2% in private urban schools and 61.7% in rural schools. Educational levels of mother and father were negatively associated with FGC (P < 0.001). The mean age of the time of FGC was 10.1 +/- 2.3 years. CONCLUSION FGC prevalence is lowering, yet more active education at the grass-roots level is needed to create change.

Subclinical nephrotoxicity caused by smoking and occupational silica exposure among Egyptian industrial workers

BACKGROUND The aim of the present work was to investigate early signs of subclinical renal alterations due to silica exposure and smoking among non-silicotics and silicotics by measuring urinary indicators of nephrotoxicity. METHODS The subjects comprised 29 non-silicotics (9 non-smokers, 20 smokers), 24 silicotics (9 non-smokers, 15 smokers), and 28 referents (9 non-smokers, 19 smokers). Measured urinary parameters were concentrations of total protein, microalbumin, retinol-binding protein, and activities of N-acetyl-beta-D-glucosaminidase and glutathione S-transferase. In addition, we measured levels of urinary silicon and creatinine. RESULTS Compared with referents, both non-silicotics and silicotics excreted significant high levels of all measured parameters. Smokers in each investigated group also showed increased levels (although not significant) of renal parameters in comparison to corresponding non-smokers. Among non-silicotics, the present results showed that elevation of measured urinary parameters was significantly associated with work duration, while only urinary excretion of glutathione S-transferase was associated with work duration among silicotics. CONCLUSIONS The study confirms that silica may lead to subclinical signs of nephrotoxicity, and that smoking also has a nephrotoxic effect on kidney and is synergistic to nephrotoxicity of silica exposure. Additionally, the study suggests that renal alterations may occur prior to pulmonary involvement.

Relationship of locus of control, psychological distress, and trauma exposure in groups impacted by intense political conflict in Egypt.

INTRODUCTION Social and political instability have become common situations in many parts of the world. Exposure to different types of traumatic circumstances may differentially affect psychological status. OBJECTIVE The aim of this study was to compare the relationship between personal perceptions of control over the events happening in ones life and psychological distress in two groups who experienced physical trauma but differed as to whether the trauma was a result of political upheaval and violence. Views on the extent to which the state was interested in the individual were also assessed. METHODS The sample consisted of 120 patients who were injured in the Cairo epicenter and 120 matched controls from the greater Cairo area whose injuries were from other causes. The Brown Locus of Control Scale and the Symptom Checklist-90-Revised (SCL 90-R) were administered approximately three months after the January 2011 start of the demonstrations and subsequent overthrow of the government. RESULTS The groups did not differ on locus of control. For both groups, externality was associated with greater distress, suggesting a relationship between perceived helplessness in controlling ones life and distress. The Cairo group scored significantly higher than the control group on the SCL 90-R Global Severity Index (GSI) and Positive Symptom Total (PST). Perceptions of state interest in the population were low; overall, 78% viewed the state as having little or no interest in them. Discussion The relationship between exposure intensity and psychological distress is examined. In addition, differences in findings in populations experiencing political chaos compared with other types of disasters are considered. CONCLUSION Beliefs regarding personal control over ones life circumstances are more closely associated with psychological distress than the circumstances in which the trauma occurred.

Effect of silica exposure on urinary excretion of copper and zinc.

Background: Occupational exposure to silica could lead to renal histological alterations in the glomeruli and proximal tubules. We investigated urinary excretion of copper and zinc and its possible relationship to renal alterations and work duration among nonsmoking, silica‐exposed workers. Methods: Thirty‐six control subjects (age, 39.08±6.65 years) and 48 silica‐exposed workers (age, 36.79±7.33 years) were included in the present study. The exposed workers were grouped into workers with <10 years’ work duration (n=9; age, 29.0±1.50 years) and workers with ≥10 years’ work duration (n=39; age, 38.59±6.94 years). Glomerular function was assessed by measuring urinary level of microalbumin, and proximal tubular reabsorption function was assessed by measuring urinary level of &agr;1‐microglobulin. Structural integrity of proximal tubules was studied by measuring urinary activity of cytosolic enzyme glutathione S‐transferase (GST). Also, urinary levels of copper, zinc, and creatinine were measured. Results: All measured urinary parameters were significantly increased among silica‐exposed workers compared with control subjects. A significant correlation was observed between urinary levels of each of copper and zinc with the glomerular and proximal tubular functional and structural urinary parameters as well as work duration. Conclusion: Occupational silica exposure may lead to increased urinary loss of copper and zinc as protein‐metal complex, and the urinary level of these essential trace elements may be a marker for renal dysfunction. The urinary excretion of GST may be a useful marker for proximal tubular injury.

Effect of mercury vapour exposure on urinary excretion of calcium, zinc and copper: relationship to alterations in functional and structural integrity of the kidney.

Background: The kidney has a remarkable capacity to concentrate mercury (Hg) and as such is a primary target organ when exposure to Hg occurs, and it is also an organ for Hg excretion. Objective: The present work aims to investigate the effect of occupational Hg vapour exposure on the urinary excretion of calcium (Ca), zinc (Zn) and copper (Cu), and the possible association of this excretion to work duration as well as renal alterations. Methods: 83 non-smoker participants (36 referents, age: 35.69 / 9.5 years; 27 Hg vapour-exposed workers with 5 / 10 years work duration, age: 33.09 / 5.1 years; and 20 Hg vapour-exposed workers with] / 11 years work duration, age: 39.509 / 8.50 years) were included in the present study. Urinary levels of microalbumin (U-Malb) and retinol-binding protein (U-RBP) as well as cytosolic glutathione S-transferase activity (U-GST) were measured to assess the glomerular and proximal tubular reabsorption functions as well as structural integrity of proximal tubules; respectively. In addition, blood Hg (B-Hg), serum levels of Hg (S-Hg) and Ca (S-Ca), and urinary levels of Hg (U-Hg), Ca (U-Ca), Zn (U-Zn), Cu (U-Cu) and creatinine (U-cr) were estimated. Results: In comparison to referents, all investigated parameters showed significant increase (except S-Ca and U-Zn/U-Cu ratio that significantly decreased among the workers as one group, S-Ca and U-Zn/U-Cu ratio that significantly and nonsignificantly decreased; respectively among workers with 5 / 10 years work duration, S-Ca and U-Zn/U-Cu ratio that significantly decreased among workers with] / 11 years work duration). In addition, B-Hg was nonsignificantly increased and S-Ca was significantly decreased; also, both U-Hg and U-Zn/U-Cu were nonsignificantly decreased among workers with] / 11 years work duration in comparison to those with 5 / 10 years work duration. Also, each of U-Hg, U-Ca, U-Zn and U-Cu was related to one another, while each of U-Ca, U-Zn and U-Cu was related to each of U-Malb, U-RBP and U-GST (except U-Zn was not related to U-GST). Conclusion: Hg vapour exposure leads to renal alterations which may parallel the change in proteinuria and enzymuria as well as the increased loss in urine of each of Ca, Zn and Cu. The urinary assessment of these metals may be used as a good indicator for renal dysfunction.

Prognostic factors of treatment among patients with multidrug-resistant tuberculosis in Egypt

BACKGROUND/PURPOSE Multidrug-resistant tuberculosis (MDR-TB) represents 5% of TB cases globally. In Egypt, it represents 11.4% of TB cases (2.2% of new and 38.2% of previously treated). Our objectives were to evaluate the treatment outcomes and determine the associated prognostic factors among the first national treatment cohort of MDR-TB from 2006 to 2010. METHODS All patients diagnosed with MDR-TB from July 2006 to December 2010 who were admitted to Abbassia Chest Hospital, the first Egyptian national center established for MDR-TB treatment, were included. They were followed up clinically, radiologically, and bacteriologically by sputum smear, culture, and drug-susceptibility testing at regular intervals. Individualized treatment regimens were prescribed according to each patients drug-susceptibility testing and the drug treatment history. Patients received at least five effective drugs. Outcome rates, and crude and adjusted odds ratios of unsuccessful outcomes were calculated. RESULTS The number of bacteriologically proven MDR-TB patients was 228, of which 225 were pulmonary cases. Half of the cases showed moderate or extensive lung lesions, and 15.8% were diabetics. A total of 158 (119 cured and 39 completed treatment) patients achieved successful outcome (69.3%), 16 (7.1%) failed treatment, 27 (11.8%) were lost to follow up, and 27 (11.8%) died. Predictors of unsuccessful outcome were delay in sputum culture conversion to 2 months or more, moderate or extensive lung lesions, and a history of diabetes. CONCLUSION A treatment success rate of approximately 69% was achieved with the first national treatment cohort of MDR-TB under the Egyptian program. Predictors of unsuccessful treatment were delayed culture conversion, moderate or extensive lung affection, and diabetes.

Surveillance of health care–associated infections in a tertiary hospital neonatal intensive care unit in Egypt: 1-year follow-up

BACKGROUND Reported rates of neonatal health care-associated infections (HAIs) in neonatal intensive care units (NICUs) have risen rapidly in recent years. Little data are available in Egypt, however. The aim of the present study was to determine the incidence of and risk factors for HAIs in the NICU of Ain Shams University Hospital of Obstetrics and Gynecology. METHODS A prospective study was carried out on all neonates admitted in the NICU of Ain Shams University Hospital of Obstetrics and Gynecology in 2012. Centers for Disease Control and Prevention criteria were followed for identifying HAIs. RESULTS A total of 434 neonates were enrolled in the study. The cumulative incidence of HAIs in the NICU was 28%. Bloodstream infections accounted for 85% of HAI episodes; pneumonia, for 10%. The most common organism isolated was Klebsiella spp. The main risk factors identified on multivariable analysis were gestational age <38 weeks (relative risk [RR], 1.63), birth weight <1,500 g (RR, 1.39), mechanical ventilation (RR, 1.74), and surgical procedures (RR, 1.65). The mortality rate attributed to HAIs was 11.75%, and the extra hospital length of stay attributed to HAIs was 8 days. CONCLUSION The high incidence of HAI identified in the study NICU mandates more vigorous infection control interventions.

Clinical characteristics of patients with multiple sclerosis enrolled in a new registry in Egypt

BACKGROUND Epidemiological studies of multiple sclerosis (MS) are lacking in Egypt. OBJECTIVE To study the characteristics of Egyptian patients with multiple sclerosis in a new registry in a major tertiary referral centre in Cairo, Egypt. SUBJECT AND METHODS Patients were from the project MS database of the Multiple Sclerosis Unit at Ain Shams University Hospitals (N=950). We conducted a detailed medical history and examination including the Expanded Disability Status Scale (EDSS). RESULTS Females represented 72% of subjects (female: male ratio 2.57:1). The mean age of disease onset was 26.1±7.6 years. Relapsing-remitting MS (RRMS) was the most common presentation (74.6%). Visual or sensory symptoms were the most common at presentation with RRMS, while motor symptoms were the most common presentation in other types of MS. Time to diagnosis was delayed up to 2 years in 27.8% of patients. The mean EDSS score was 3.6±2.1; 55% had EDSS≤3. About half (49%) received a disease-modifying drug. Progressive MS and motor presentation were associated with higher disability. CONCLUSIONS This is the first documented MS registry from Egypt. The clinical characteristics of MS in Egypt was similar to other Arab countries and western countries. MS is more common among females in Egypt, with RRMS being the most common presentation. Visual symptoms and motor symptoms were the most common presentations in RRMS and progressive MS, respectively. Our findings also highlight the value of establishing registries in Egypt in order to be able to study, prospectively, the clinical course of the disease, the response to various DMDs and the epidemiology of MS in Egypt.

Association between hepatitis C infection and cerebro-cardiovascular disease: analysis of a national population-based survey in Egypt

To examine the association between hepatitis C virus (HCV) infection, cardiovascular risk factors and cerebro‐cardiovascular (CCV) disease.

Hypertension and associated cardiovascular risk factors among urban slum dwellers in Egypt: a population-based survey

Background The economic deprivation of most slum inhabitants, and the lack of services and facilities may increase their vulnerability to unhealthy lifestyles and cardiovascular diseases. Aims This study aimed to determine the prevalence of modifiable risk factors for cardiovascular diseases in slum residents in Cairo, Egypt and evaluate their association with hypertension. Methods A household cluster survey was conducted in Mansheiet Nasser, a large slum area in Cairo. The study included 984 adult participants. The World Health Organization STEPS instrument for noncommunicable disease risk factor surveillance was used to determine the prevalence of smoking, fruit/vegetable consumption, overweight/obesity, physical activity, diabetes and hypertension. Results Smoking, insufficient fruit/vegetable consumption, low physical activity and diabetes were reported by 43.4%, 92.2%, 98.4% and 8.7% of the sample respectively. The prevalence of hypertension and overweight/obesity were 31.2% and 73.0% respectively. Most of the participants (83.8%) had ≥ 3 cardiovascular risk factors. A significantly higher proportion of men smoked, engaged in less physical activity, had diabetes and had multiple risk factors. Hypertension was significantly associated with age 30-< 50 years (OR = 3.04, 95% CI: 1.66-5.58), age ≥ 50 years (OR = 12.5, 95% CI: 6.71-23.26), overweight (OR = 1.58, 95% CI: 1.0-62.35), obesity (OR = 2.23, 95% CI: 1.49-3.35), low fruit/vegetable consumption (OR = 1.88, 95% CI: 1.02-3.48), and diabetes (OR = 1.77, 95% CI: 1.08-2.92). Conclusions Urban slum dwellers in Mansheiet Nasser have an increased vulnerability to cardiovascular diseases compared with the Egyptian population. Measures are needed to improve their lifestyles and reduce their risk of cardiovascular diseases.