This study aimed at studying the prevalence of noncompliance among diabetic patients in Gharbia governorate in Egypt as well its causes, its effect on glycemic control, and factors affecting it.
There is growing evidence suggesting that because of the alarmingly low rates of compliance, increasing the effectiveness of compliance interventions may have a great impact on the health of the population. Promotion of therapeutic compliance is considered an integral component of patient care. It has been shown that despite effective methods of treatment, many diabetic patients fail to achieve satisfactory glycemic control, which leads to accelerated development of complications and increased mortality.
A total of 339 diabetic patients who fulfilled the inclusion criteria were recruited in the present study. Compliance to treatment was evaluated during patients’ visits to health units in Gharbia governorate. Medication compliance was assessed during a personal interview with each patient using a multiple-choice questionnaire. Blood samples were obtained for measurement of glycated hemoglobin (HbA1c).
In the study population, the compliance rates were observed to be suboptimal. The most important social factors that significantly affected compliance rates included age, income, and educational level. Among the factors that significantly affected compliance rates were duration of treatment, presence of diseases other than diabetes, and the number of prescribed drugs. Another factor that played an important role was diabetes care costs. The most common reasons for low rates of compliance were forgetfulness and high cost of treatment.
An improvement in the compliance level may be achieved through improvement of patients’ economic levels as well as reduction in the cost of medication. The number of drugs and doses should be reduced as much as possible through continuous research involving doctors and pharmaceutical companies.
The aim of this study was to estimate the prevalence of depression, anxiety, and obsessive–compulsive disorders among secondary school students and to assess the comorbidities of these disorders.
Any type of mental illness can have a negative impact on cognitive development and learning and involves a very high cost to both the individual and society. Anxiety and depression can be considered reliable indicators for the assessment of mental illness in a community.
From a total of 83 635 secondary school students in Menoufia Governorate during the academic year 2010–2011, using a multistage random sampling technique, a sample of 1373 students was selected and surveyed from March 2011 to April 2012 by means of the Beck Depression Inventory, 2nd ed., the Costello–Comrey Anxiety Scale, and the Obsessive–Compulsive Disorder Scale, all of which were answered by the participants. Those with scores higher than the cutoff values were interviewed by a psychiatrist for the final clinical diagnosis on the basis of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. criteria.
The prevalence of depressive symptoms was 21.5% for mild, 7.1% for moderate, and 0% for severe depression in this study group. The total prevalence of depressive symptoms was 28.6%, and the prevalence of depressive disorders was 11.3%. The prevalence of anxiety symptoms was 41.2% and that for anxiety disorders was 21%. The prevalence of obsessive–compulsive symptoms was 15.8% and that of obsessive–compulsive disorder was 2.7%. Comorbidities of mental disorders were common.
According to these findings, the high rate of mental disorders among adolescents in our community calls for more attention from the family and educational and health institutes. Comorbidities associated with mental disorders are common. In addition, assessment using screening is recommended.
The aim of this study was to determine the toxic effect of di-n-butylphthalate (DBP) on the testes of developing and adult albino rats and to establish the possible protective role of curcumin.
DBP is an endocrine-disrupting chemical that disrupts the growth of normal male reproductive organs of adult and developing rats after prenatal exposure.
The rats used in this study received DBP alone as well as in combination with curcumin and were subjected to biochemical (measuring the level of testosterone), histological, immunohistochemical, and morphometric (analysis of the mean diameter of the seminiferous tubules) studies.
Administration of DBP to rats at a dose of 500 mg/kg dissolved in 1 ml/kg corn oil by daily gavage significantly reduced (P<0.001) the serum levels of testosterone in developing and adult rats compared with control rats. DBP-treated rats showed marked atrophy of the seminiferous tubules with apoptosis, exfoliation, and abnormal regeneration of the spermatocytes, with a highly significant decrease (P<0.001) in the mean diameter of the seminiferous tubules compared with that in the control and combined DBP and curcumin groups. DBP-induced reproductive toxicity was reversed by the addition of curcumin.
Exposure to DBP led to more pronounced testicular damage and impaired spermatogenesis in prepubertal and adult male rats. These changes can be prevented by addition of curcumin, which induced restoration of spermatogenesis.
The present study was carried out to determine the prevalence of aerobic and anaerobic pathogens in diabetic foot infections (DFIs), detect their susceptibility to different antimicrobial agents, investigate the microbiological profiles of DFIs in relation to different grades of Wagner classification, and assess the risk factors for DFIs.
DFI is the most frequent reason for diabetes-related hospitalization. It develops because of several diabetes-related factors including arterial insufficiency, neuropathy, foot deformities, previous ulcers, previous amputation, and local trauma.
The study was carried out on clinical specimens taken from 100 diabetic patients (50 patients had type I insulin-dependent diabetes mellitus (IDDM) and 50 patients had type II noninsulin-dependent diabetes mellitus (NIDDM) and 50 nondiabetic patients with foot infection during the period from May 2011 to July 2012. The specimens were cultured using aerobic and anaerobic microbiological techniques, and antibiotic susceptibility testing was performed according to the methods recommended by the Clinical and Laboratory Standards Institute (CLSI). Multidrug-resistant organisms were detected including oxacillin-resistant and vancomycin-resistant staphylococci and gram-negative bacilli extended-spectrum beta-lactamase producers.
DFIs were polymicrobial in 76% of cases. Staphylococcus aureus was the most common aerobic isolate (17.6%) (including 74.4% methicillin resistant and 23.1% vancomycin resistant). Peptostreptococcus spp. were the most common anaerobic isolate (39.4%). Extended-spectrum β-lactamase production was detected in 53.4% of Gram-negative bacilli. About 62% of diabetic patients were infected with multidrug-resistant organisms. The risk factors for DFIs were duration of diabetes more than 1 year, random blood sugar of at least 200 mg/dl, trauma, previous ulcer and amputation, and comorbidities related to diabetes.
Imipenem was the most effective drug against all isolates. Effective glycemic control and educating patients on the prophylactic foot care are of key importance for decreasing DFIs.
The study aimed at determining the prevalence of and risk factors for chronic kidney disease (CKD) using microalbuminuria (MA) as a screening test in a rural area in Gharbia Governorate.
CKD is being increasingly recognized as a public health problem. There is still paucity of data on the prevalence of and risk factors for CKD by using MA as a screening test in the Middle East.
A randomly chosen sample of 320 apparently healthy individuals were interviewed in Shennera village in Gharbia Governorate using a structured questionnaire including information about risk factors for MA. They were also subjected to laboratory investigations including analyses of microalbumin, creatinine, and random blood sugar levels and lipid profile.
The mean age of the studied sample was 35.7±13.7 years; 50.9% were male. Only 85% of the sample had sufficient income. The prevalence of MA was 14.4%. The prevalence of CKD (estimated glomerular filtration rate<60 ml/min/1.73 m2+MA) was 15.6%, but those with elevated creatinine levels comprised 2.8% of the studied group. MA showed an increasing trend with age. The prevalence of MA was significantly higher among diabetic patients, hypertensive patients, obese individuals, cardiovascular disease patients, and smokers. The independent predictor variables associated with the presence of MA in a mutually adjusted logistic regression model were diabetes (odds ratio=8.62, 95% confidence interval: 2.62–28.31) and hypertension (odds ratio=4.92, 95% confidence interval: 1.63–14.86).
Screening of MA seemed to be an easy, equally, or even more efficient method for early identification of significant numbers of individuals with CKD compared with other conventional methods, particularly among those with uncontrolled or undetected diseases such as diabetes or hypertension.
The objective of this study was to evaluate the possible role of fibroblast growth factor 23 (FGF23) in the occurrence of left ventricular hypertrophy and vascular calcification in predialysis chronic kidney disease (CKD) patients.
FGF23 is a suggested risk factor for poor outcome of CKD. This raises the possibility that FGF23 is a hormone that controls calcium–phosphorus metabolism and is a real risk factor for cardiovascular mortality and morbidity in predialysis CKD patients.
Thirty predialysis CKD patients with estimated glomerular filtration rate (90≥eGFR>15 ml/min/1.73 m2) by the modification of diet in renal diseases formula were included in this study. Patients were recruited from the Internal Medicine Department, Menoufia University (Egypt). Our controls were 10 individuals with preserved kidney function of more than 90 ml/min/1.73 m2 with normal BUN and creatinine matched by age and sex. Routine and specific investigations (serum FGF23 measurement using ELISA immunoassay, serum intact parathyroid hormone, conventional echocardiography, and lateral abdominal aortic radiograph for calcification) were performed.
The mean log FGF23 level in CKD patients was 2.3±0.6 Ru/ml and was significantly higher than that of control participants, 1.7±0.1 Ru/ml (P<0.001). There was a significant difference between CKD2–3 stage and CKD4 stage in the FGF23 (P<0.05) level but not in serum phosphorus (P>0.05). Left ventricular mass index was correlated positively with log FGF23 (r=0.44, P<0.05) and negatively with eGFR (r=−0.4, P<0.05). Abdominal aortic calcification was correlated positively with age (r=0.55, P<0.001), but had no correlation with FGF23 (r=0.36, P>0.05).
FGF23 could be an early risk factor for the occurrence of left ventricular hypertrophy even before an increase in serum phosphorus in predialysis CKD patients.
To detect the expression of the PASD1 gene in acute myeloid leukemia (AML) patients and its relation to clinical features and complete remission of AML.
AML is a heterogeneous disease with variable clinical outcomes. PASD1 [Per ARNT Sim (PAS) Domain containing protein 1] can stimulate autologous T-cell responses, and it is therefore considered to be a potential immunotherapeutic target for the treatment of various malignancies, including AML.
The study was carried out on 60 AML patients (group I) and 30 healthy controls (group II). Reverse transcriptase PCR analysis of the PASD1 gene was carried out for all patients and controls.
PASD1 was expressed in 12 (20%) AML patients, but was not expressed in any of the 30 controls. PASD1 expression was associated more with patients below 45 years (66.7% of the PASD1-positive patients were <45 years old compared with 29.2% of the PASD1-negative patients). No significant correlation was found between PASD1 gene positivity and any of the clinical and hematological variables of AML, except for less incidence of fever at presentation. PASD1-positive patients achieved more complete remission (66.7%) compared with PASD1-negative patients (35.4%) (P<0.05).
PASD1 is an attractive leukemia-associated antigen. Its expression was associated with young age and favorable outcome. However, further studies are required, with standardization of the age, clinical, and cytogenetic and molecular genetic prognostic markers, to confirm the prognostic value of PASD1 gene expression in AML, to assess its correlation with clinical features of AML patients, and to investigate its role in minimal residual disease detection and immunotherapy of AML.
The aim of this work was to study some of the health disorders resulting from occupational exposure to mercury among workers in a fluorescent lamp factory.
With the fast market growth of fluorescent lamps, the associated emissions and risk of mercury, which is an essential component in all types of fluorescent lamps, have received increasing public attention worldwide. Low doses of mercury exert toxicity on various human organs, including the central nervous, renal, respiratory, reproduction, immune, cardiovascular, skin, and motor systems.
A cross-sectional study was carried out on 138 workers in a fluorescent lamp factory and a nonoccupationally exposed group of 151 individuals. An environmental study of mercury and noise levels was carried out. Neurobehavioral tests, spirometric measurements, and audiometric examination were performed. Urinary mercury level was also measured for all participants.
In the exposed group, the mean value of urinary mercury level (µg/g creatinine) was significantly increased among those who showed behavioral changes and hearing loss or had other manifestations related to mercury toxicity. With increasing duration of employment in years or with increasing urinary mercury level, the performance of neurobehavioral test battery and spirometric measurements deteriorated. Prominent symptoms among mercury-exposed workers included tremors, emotional lability, memory changes, neuromuscular changes, and performance deficits in tests of cognitive and/or motor functions.
The neurobehavioral test battery must be used to study subclinical central nervous system dysfunction because of mercury toxicity, especially to evaluate the severity of the effects of mercury in epidemiological studies. This study also reinforces the need for effective preventive programs at fluorescent lamp industry workplaces, especially in developing countries with the most unhygienic ill-ventilated conditions.
The aim of this work was to study the effect of garlic on the lipid profile of hypercholesterolemic rats and investigate the vascular reactivity to norepinephrine and acetylcholine in hypercholesterolemic rats treated with garlic in-vitro experiments.
Hypercholesterolemia is considered an important risk factor for the development of atherosclerosis; currently, there is a major trend to use herbal remedies for the treatment and prevention of hypercholesterolemia and garlic is used for this purpose.
Forty male rats were divided into the following four groups of 10 animals each: (i) normal diet-fed animals (control), (ii) hypercholesterolemic animals, (iii) hypercholesterolemic garlic-treated animals, and (iv) hypercholesterolemic garlic-prophylactic animals. The animals were fed a standard food preparation enriched with 2% cholesterol for 2 months and soya bean oil. Thirty days after beginning the experiment, garlic was administered in the hypercholesterolemic garlic-treated group whereas in the hypercholesterolemic garlic-prophylactic group garlic was administered from the start till the end of the experiment. At the end of the experiment, a blood sample was drawn from each rat to determine total cholesterol and to separate the lipoproteins; also, a segment of the thoracic aorta was removed to study endothelial function (vascular reactivity).
Garlic reduced the total serum cholesterol levels and low-density lipoprotein-cholesterol levels significantly. Endothelium-dependent relaxation was significantly greater in the treated and prophylactic group compared with that in the hypercholesterolemic group.
Garlic played a significant role in prophylaxis and treatment of hypercholesterolemia and improvement of endothelial dysfunction.