Socioenvironmental predictors of abortion and stillbirths in an industrial community in Egypt.

Air pollution is considered to be one of the overgrowing problems of cosmopolitan distribution, due to marked progress in industrialization. The applied epidemiological and environmental studies related to reproductive health in the community, are considered as the main principles for comprehensive health development in industrial cities. The present study focused on the role of air pollution on the occurrence of abortion and stillbirths among married fertile women during the childbearing age (15-50 years) in two industrial areas, namely Helwan in Cairo Governorate and Tenth of Ramadan City in Sharqyia Governorate. A cross-sectional epidemiological study based on community background was implemented in the two studied areas. The unit of observation was the family including married fertile women based on specific inclusion criteria. Cluster sampling procedure was used in which the unit of sampling was the household, selected within a radius of not less than five Kilometers around the factories. Using Epi-info program, the total sample size in the two studied areas was 1934 women. The interview questionnaire was the tool adopted for data collection, which includes gynecological and obstetric data related to reproductive health. The socio-economic status of studied women was determined using scoring system that includes the education and occupation of both couples. The environmental study was carried-out in the two areas in order to assess the levels of air pollutants and their chemical nature. Data management using Logistic regression analysis was done to determine the effect of independent variables, such as socioeconomic factor, exposure to air pollutants on the occurrence of abortion and stillbirths as examples of reproductive health problems. The mean age of the studied women was 33.8+/-8.8 years in Helwan and 28.1+/-6.5 years in Tenth of Ramadan. Also the study showed significant differences in both the socioeconomic status, smoking inside houses and parity between the studied women in Helwan and Tenth of Ramadan City. The overall prevalence of abortion and stillbirths among women in the studied areas were 29.2% and 4.5%, respectively. However, the prevalence of such reproductive health hazards among women in Helwan was significantly higher than in Tenth of Ramadan City. Also the results of environmental study indicated that Helwan has higher mean values of total dust count, suspended and respirable dust concentrations as well as lead concentration in the ambient air than in Tenth of Ramadan City. The Logistic regression analysis showed that the respirable dust concentration in the air and smoking inside houses are the significant independent factors for the occurrence of abortion. Moreover, Lead concentration in the air and women education is the main predictors of both abortion and stillbirths. Accordingly, the Egyptian authorities should attempt to improve air quality in urban industrial communities to promote reproductive health and prevent woman' s health hazards.

Some epidemiological aspects of patients with end stage renal diseases.

This study was carried out to describe End Stage Renal Disease (ESRD) among Egyptian patients and to identify the possible risk factors of their disease. A case-control study was conducted with 2 control groups (patient or hospital control group and normal community control group) compared with ESRD cases on haemodialysis. The study revealed that hypertension, followed by obstructive uropathy, are the leading causes of ESRD. Conducting the multiple logistic regression analysis, the following factors were found to act independently as risk factors for ESRD, in that order of importance: past history of hypertension, family history of renal failure, past history of renal pain, smoking, urban origin of birth, past history of renal or urinary stones, past history of schistosomiasis, the presence of a near-by residential factory and past history of frequent hospitalization. A quality of life score has been invented. Women experienced a bad quality of life in relation to men and the score correlated positively with age. A number of recommendations have been generated.

Evaluation of expanded program on immunization during the first year of life in Abu Dhabi.

This study was intended to highlight the program of vaccination in the first year of life against the Expanded Program on Immunization (EPI)-target diseases and to determine the trend of these diseases in Abu Dhabi during 1984-1989. The data were collected from annual reports of Ministry of Health. This retrospective study pointed out to the following results: (1) The average vaccination coverage (percent) during the first year of life against EPI-Target diseases increased gradually during 1984, 1986, 1987, 1988, 1989. (2) The vaccination coverage (percent) during the first year of life using BCG and measles vaccines are increased significantly (p < 0.001) during 1985-1989 compared with 1984. (3) The vaccination coverage (percent) during the first year of life using OPV and DPT at the third dose are increased significantly (p < 0.05) during 1987-1989 compared with 1984. (4) The reported cases of measles and its incidence rate consequently decreased during 1988-1989 compared with 1987 and the differences are statistically significant (p < 0.001). The reported cases of diphtheria and its incidence rate show significant increase (p < 0.01) during 1988 compared with 1984. Other EPI target diseases do not show any statistically significant difference (p > 0.05) during 1985-1989 compared with 1984. Based on this study it can be concluded that with increase in average vaccination coverage (percent) from 58.5% in 1984 to 82.9% in 1989, the number of reported cases of EPI target diseases decreased.

Chromosomal aberrations and micronucleus frequency in nurses occupationally exposed to cytotoxic drugs.

In this study, we evaluated the effect of low level occupational exposure of nurses in a medical oncology unit in Cairo, Egypt, to anticancer drugs. Twenty nurses who constantly handled these drugs and 20 controls, matched according to age and sex, were examined. Metaphase chromosomes were studied. Percentages of metaphases with chromosomal aberrations were significantly higher (P < 0.001) in the exposed group (6.1 +/- 2.7) versus the controls (2.6 +/- 1.6). The detected chromosomal aberrations were in the form of chromatid gaps, chromatid breaks and acentric fragments. Micronucleated peripheral blood lymphocytes were also analyzed in cytochalasin B treated binucleated lymphocytes. There was significant increase in cells with micronuclei (P < 0.001) in nurses (10.05 +/- 4.71) in comparison to the matched control (5.42 +/- 2.22) (P < 0.001). Nurses exposed to the cytotoxic drugs for > or = 48 months showed a slightly higher frequency of cells with chromosomal aberrations as well as micronucleated cells than those exposed for < 48 months, but these differences were not statistically significant (P > 0.05).

Risk factors of gallstone disease in a sample of patients in Benha City.

This study included one hundred cases of gallstone disease diagnosed by ultrasonography and a similar group of matched controls chosen from Benha University and General Hospitals. Both cases and controls were subjected to a specially designed questionnaire, clinical examination, anthropometric measurements, ultrasonography and laboratory investigations to find out some risk factors that may contribute to the development of gallstone disease. Females constituted the majority of cases (87%) while males were a minority (13%). In both sexes, the highest percentages of cases were among patients aged fifty years or more (53.8% and 33.3% for males and females respectively). Bad dietary habits including increased consumption of animal fats and frequent use of snacks between meals, obesity as indicated by body mass index and body fat percent, positive family history of gallstones and liver cirrhosis were found to be significant risk factors in the predisposition to gallstones in the present study. On the other hand, factors suggesting hormonal role in the pathogenesis of gallstones such as age of menarche, duration of menstrual life, age at first pregnancy, multiparity and duration of contraceptive pills use did not show any significant difference between female cases and controls.

A comparative study of blood retinol and selenium in minor lower urinary lesions. A case control study.

A case control study was done at Ain Shams University Hospital. Eligibility criteria were put to select cases from the clinics of urosurgery department and a control group from the clinics of surgery departments. The study was conducted in the period form 1st of February till 1st of June 1992. Both cases and control groups were subjected to an interview questionnaire, clinical examination and laboratory investigation to estimate the serum levels of retinol and selenium. Serum retinol and selenium were significantly lower among cases than among control group (p < 0.05 and p < 0.0001 respectively). Moreover, it was found that cases who lived in lower Egypt, belonged to lower socioeconomic class, smoked cigarettes and with current urinary tract infections had mean value of serum retinol significantly lower than the control group (p < 0.05). There was a significant difference in the mean blood selenium between cases and control groups who lived in Cairo (p < 0.001).

Hepatitis B infection in Sana'a City, Republic of Yemen. Prevalence among pregnant women and materno-foetal transmission.

A cross-sectional study was carried out on 130 pregnant women, chosen randomly from those admitted to the labour ward of Al-Thawra general hospital in Sana'a City, Republic of Yemen. This study was conducted to determine the prevalence of HBsAg among pregnant women and estimate the maternofoetal transmission. The prevalence of HBsAg among studied women was 15.4%, however, 6.9% showed inconclusive positive results. The materno-foetal transmission was documented in 50% of positive HBsAg women. Hepatitis B infection among studied women was usually acquired after 20 years of age. Logistic regression model with stepwise forward selection, demonstrated that maternal age, past history of blood transfusion and abortions were contributing factors for +ve HBsAg maternal status, while parity and past history of abortions were contributing factors in materno-foetal transmission.

A 5 1/2 year experience with the St. Jude Medical cardiac valve prosthesis. Early and late results of 737 valve replacements in 671 patients.

Between June 12, 1978, and June 12, 1983, 737 St. Jude Medical valves were implanted in 671 patients (431 males, 240 females) ranging in age from 9 months to 82 years (mean 55 years); 16 of these patients (2.3%) were less than or equal to 15 years and 82 (12.2%) were greater than or equal to 70 years. Associated procedures were performed in 28.2% of the 500 aortic valve replacements, 13.3% of the 105 mitral valve replacements, and 10.6% of the 66 double mitral and aortic valve replacements. Hospital mortality (less than or equal to 30 days) was 3.6% (18/500 patients) for aortic, 4.7% (5/105 patients) for mitral, and 0% for double valve replacement. Only one of these 23 hospital deaths was possibly valve-related. Complete follow-up was achieved during December, 1983, and January, 1984, to provide a minimum follow-up of 6 months. Follow-up has been 100% for a total of 1,619 patient-years, with a mean follow-up of 2 1/2 years. There were 41 late deaths (6.1%): 30 in the aortic group, eight in the mitral group, and three in the double valve replacement group. Fourteen (34.2%) of these late deaths have been considered valve-related. At 5 1/2 years, the actuarial survival rate, hospital mortality excluded, is 91% for aortic, 90% for mitral, and 95% for double valve replacement. Functional improvement of these patients is quite satisfactory: Preoperatively, 60.3% were in Class III or IV of the New York Heart Association, whereas postoperatively, 99.5% of the patients are in Class I or II. As 78 patients (65 aortic, 10 mitral, and three double valve replacement) did not receive anticoagulation therapy for a total period of 84 patient-years, the incidence of valve thrombosis, systemic embolism, and sudden or suspicious deaths in this group was compared with that in a group of 630 patients (including 60 patients from the first group who were given anticoagulants afterwards) subjected to long-term anticoagulation for a total period of 1,535 patient-years. A significantly higher incidence of valve thrombosis and systemic embolism was observed in the absence of anticoagulation. Anticoagulant-related complications occurred in 10 patients, with an incidence of 0.65/100 patient-years. On the basis of this 5 1/2 years of experience, the St. Jude Medical valve appears to be an excellent mechanical prosthesis for cardiac valve replacement, in terms of hemodynamic performance and low thrombogenicity, in patients receiving anticoagulants.

Plasma albumin, parasitic infection and pubertal development in Egyptian boys.

Pubertal stage was assessed in 453 Egyptian boys aged from nine to 17 years. Weights and albumin concentrations were measured and parasites identified from stool samples. The mean age to reach each stage of puberty was significantly delayed in the presence of low albumin levels and parasites. The magnitude of the delay was greater for genital stage 2 than for later stages. Weight was also lower in children with reduced albumin concentration or parasites. Among children of the same age, weight and albumin were positively correlated (P less than 0.001), suggesting that albumin status is involved in the timing of puberty.

Sexual maturation and growth pattern in Egyptian boys.

The mean ages of attainment of successive stages of puberty were estimated in a cross-sectional sample of 453 Egyptian schoolboys from a semi-urban area of Cairo, ranging in age from 9 to 17 years. The stages of puberty were as defined by Tanner (1962). The mean age of onset of puberty (stage 2) was 11.1 years, assessed either by genitalia or by pubic hair. Stage 5 occurred at 16.2 years, again both for genitalia and pubic hair. The time interval between these ages, 5.1 years, was 2 years longer than for British or Chinese boys. There was a highly significant effect of social class on the mean ages of attainment, and the heights and weights of the boys were also related to social class, the class 1 boys being taller and heavier than Tanner's British boys.