Clinical intervention for maternal near miss cases in El Galaa teaching hospital

Background: Near miss cases share many characteristics with maternal deaths and can directly inform about obstacles that had to be overcome after the onset of an acute complication, hence providing valuable information on obstetric care. This allows for corrective action to be taken on identified problems to reduce related mortality and long-term morbidity

Objective: The purpose of this study was to determine the efficacy of possible interventions [in the form of monthly clinical audit for new near miss cases and feedback strategy] in reducing maternal near miss cases in El Galaa Teaching Hospital in Egypt and improving WHO indicators of maternal health

Methods: The study was conducted over 3 stages: Stage I [Formative Stage]: Is a retrospective study of maternal near miss cases over 1 year period, based on WHO criteria from 1/1/2016 to 1/1/2017. Stage II [Intervention stage]: This incorporated a monthly clinical audit for new near-miss cases and feedback strategy, using WHO case report forms, as well as engagement of opinion leaders for 1 year from 1/1/2017 to 1/1 2018 with 2 to 3 cases discussed monthly. Stage III [Assessment Stage]: Evaluating the clinical performance and frequency of near miss cases after intervention

Results: In this study, the majority of women with potentially life threatening conditions were referred from private obstetrician clinic, private hospitals and Ministry of Health to El Galaa hospital. The majority of Maternal near miss cases [67.9%] gave birth by Caesarean section, this was because of the severity of these patients' obstetric conditions usually requires urgent action. The main life threatening conditions among women in this study were hypertensive disorders of pregnancy 41% [24% Pre-eclampsia, 15% Eclampsia, 2% chronic hypertension]

Conclusion: Our intervention [near miss clinical audit] helped to improve the performance and quality of care provided to women with complications during pregnancy, as reflected on the maternal health outcome indicators. Therefore we recommend incorporating clinical audit process in all health facilities. The Maternal mortality index and Maternal near miss mortality ratio, two of the indicators recommended by WHO, can be used to monitor and assess the performance and health care level. Health managers and policy makers should use maternal health outcome indicators for allocation of resources and prioritization of investments

Comparative study on the effect of factor V leiden and prothrombin gene polymorphism in preeclampsic cases

To identify polymorphism of Factor V Leiden and Prothrombin gene in women suffering from preeclampsia. From 142 pregnant women we identified 92 women suffering from preeclampsia and 50 healthy controls with normal pregnancy matched for age and socioeconomic status, preeclampsic patient classified as mild preeclampsia 42[45.7%] and severe preeclampsia 50[54.3%]. Blood samples were tested for DNA polymorphism affecting thrombophilia Factor V Leiden and Prothrombin gene polymorphism. Heterozygous AG genotype showed a significant high frequency among preeclampsic patients [20.7%] compared to controls [4.0%], [OR 6.2, P= 0.006] regarding to Prothrombin gene but: Factor V Leiden, AG genotype showed [8.7%] of preeclampsic patients which was absent in any of the controls

Comparative study on the effect of C667T and A1298C polymorphism in preeclampsic cases

To identify polymorphism of methylenetetrahydrofolate reductase gene in women suffering from preeclampsia. From 142 pregnant women we identify 92 women suffer from preeclampsia and 50 healthy controls with normal pregnancy matched for age and socioeconomic status, preeclampsic patient classified as mild preeclampsia 42[45.7%] and severe preeclampsia 50[54.3%]. Blood samples were tested for DNA polymorphism affecting thrombophilia methylenetetrahydrofolate reductase C677T and A1298C. Homozygous TT genotype, T allele of C677T polymorphism has a significantly higher frequency among preeclampsic cases compared to healthy controls [OR=21.7, 1.46, respectively]. Thus TT genotype and T allele may be considered as genetic risk factors for preeclampsic cases. On the other hand, non significant association in either genotype among preeclampsic cases compared to controls regarding to A1298C

Psychiatric, psychological and behavioral problem in Egyptian and Saudi adolescent orphans: a comparative study

To determine psychiatric, behavioral andpsychological problems in Egyptian and Saudi adolescent living in orphanages in a comparative study. 50 Saudi adolescent orphans [25 boys and 25 girls] and 50 Egyptian adolescent orphans [25 boys and 25 girls], 50 controls Saudi and 50 controls Egyptian psychiatrically free adolescent were also randomly selected. Psychiatric and psychological assessment using: complete psychiatric sheet, psychometry for psychopathy and aggression, ego strength, rigidity, locus of control, and SAKS which included Sexual Deviation, Relation with others, Negative attitude toward institutions, and Abnormal Behaviour. [44%] of girls and [44%] of boys showed Attention Deficit Disorder [ADD]. Also,[40%] of Egyptian boys and girls showed ADD. There was a statistically significant difference between orphans and controls Saudi girls regarding all items of psychological assessment. Orphans and control Saudi boys showed a statistically significant difference for ego strength, psychopathy, sexual deviation, and negative attitude toward home, abnormal behaviour and relation with others. There was a statistically significant difference between orphans and controls Egyptian girls and boys regarding all items of psychological assessment except for locus of control. Egyptian and Saudi orphan boys differed in all items of psychological assessment except for rigidity. Egyptian and Saudi orphan girls differed in for ego strength, sexual deviation, and negative attitude toward home, abnormal behaviour and relation with others. Saudi and Egyptian adolescent orphans showed psychiatric, psychological and behavioural problems, ADHD was the highest psychiatric diagnosis in both Saudi and Egyptian orphans, Orphans had disturbances in ego strength, psychopathy, sexual deviation, locus of control, negative attitude toward others, abnormal behavior and relation with others. There was cultural related difference in psychometric assessment for orphans

Prevalence study of psychiatric morbidity in a sample of adolescents in secondary schools in new Damietta City-Egypt

Few studies have estimated the psychiatric morbidity among adolescents in secondary schools in Egypt. The objectives of this study were to describe such disorders, identify those students with problems, and evaluate the relationship between their problems and some variables related to them. From September 2008 till April 2009. The study was done on 542 students [263 male [48.5%1 and 279 female [51.5%J], age range 15-18 years; those in urban 333 [61.4%] while in rural area 209 [38.61 with exclusion of deaf and blind. The researcher used Child and Adolescent behavior checklist, General health Questionnaire [GHQ], Clinical interview. Students with+ve score on GHQ were clinically interviewed, and the diagnosis of psychiatric disorders were done according to the diagnostic and statistically manual of mental disorder fourth version revised version [DSM IV TR]. About [22%] of Secondary school adolescents suffers from one or more of the psychiatric disorders as follows; Depression 21.4%, ADHD 15.9%, GAD 12.6% Adjustment disorder 12.6%, OCD 9.5%, conduct disorder 6.3%, Oppositional deviant dis. 5.6%, Separation anxiety dis. and Motor tics 4.8%, nocturnal enuresis 3.9%, social phobia 2.7%, no one complained of drug abuse or psychotic dis. The following socio demographic risk factors are statistically correlated to the psychiatric morbidity, age, sex, number of brothers, economic status and place of living. The mental health of Secondary school adolescents should be assessed, as they may be at risk for mental health problems. Preventive and therapeutic interventions are recommended

role of vitamin [E] on the toxic effect of dehydro epiandroestrone on albino rats

Dehydro Epi Androstrone [DHEA] is a steroid hormone produced by the adrenals that serves as a precursor for many steroids hormones. The aim of the work is to study the effects of DHEA on liver, ovary, breast and skin of senile female albino rats and the role of vitamin E, as a protective agent. In the present study, two hundred senile female albino rats were used. They were divided equally into 5 groups, 40 rats each. The first three groups were control group receiving distilled water, com oil and vitamin E, respectively. The last two groups were received maximum therapeutic dose of DHEA and combined DHEA and vitamin E. Twenty rats from each group were sacrificed after 4 months of daily administration of drugs and after 2 months follow up without any drugs [6 months]. Specimens, obtained from liver, ovary, breast and skin, were subjected to histopathological examination and AgNORs histochemical stain where the number of nuclear dots were estimated by computerized Analysis system 200 [CAS 200]. When DHEA was stopped for 2 months, a regression was defected in liver toxic capillaritis [congestion and inflammation], and in glandular hyperplasia of breast tissue, but no regression in hepatocelluar carcinoma and polycystic ovaries. Vitamin E protected the liver against DHEA induced liver toxic capillaritis, glandular hyperplasia of breast tissue but didn't protect against hepatocellular carcinoma or DHEA induced polycystic ovaries. DHEA had real benefit effects on the skin of senile rats which was augmented by co-administration of vitamin E. So the present study recommended the use of DHEA cautiously in people with existing liver disease or family history of breast carcinoma, and the use of vitamin E to women taken DHEA for protection from proliferative changes of breast tissue and for better improvement of senile skin. Also, the present study recommended the use of AGNORs stain as a sensitive indicator for early proliferative changes occur in liver and breast tissues

Treatability of Alexandria wastewater using pure oxygen activated sludge process

Alexandria is the second largest city and main port of Egypt. It lies north west of the Nile Delta. Most of the collected sewage from the city is pumped to two wastewater treatment plants. Both plants are using primary treatment technology and discharge their primary treated effluents into Lake Maryut. Therefore the discharges of these plants have resulted in more deterioration of the lake. In Alexandria, the population growth had also led to an increase in land cost due to rarity of land and expansion of residential areas. Accordingly, a suitable wastewater treatment technique characterized by less land requirement, less sludge production, high efficiency, and lower gaseous emissions should be considered. This study was carried out to investigate the treatability and feasibility of applying pure oxygen activated sludge process compared to air activated sludge process. Two pilot scale activated sludge units with internal solids circulation were used. One of these units was operated with compressed air and the second was operated with pure oxygen gas. The units were fed with the primary settled effluent of the East Treatment Plant. Both units were operated at different sludge ages and detention times. At each condition, both units were evaluated. The results showed that a satisfactory effluent quality could be achieved at sludge age of 6 days and detention time ranging from 5.5 to 9 hours, and at sludge age of 6 days and detention time ranging from 2 to 3 hours for air and pure oxygen activated sludge units, respectively. The pure oxygen system produced better effluent quality at higher Food/Microorganism [FIM] ratio than that of the air unit. Pure oxygen can produce a good settling activated sludge compared with the air activated sludge system. Lower sludge quantities could be obtained for the pure oxygen system compared to the air system operated at the same sludge age. Nitrification occurred in both systems during all the applied operating conditions. The feasibility study showed that pure oxygen system is better than air system in both plants in saving the cost of land required to achieve secondary treatment, and in the cost of sludge thickening. Finally, the study ended by some recommendations which are suitable for Alexandria city

Adverse effects of chronic exposure to ambient benzene on the cochlea-an experimental study

The enrolled animals in this study were conducted to analyses the possible histological changes in the cochlea on chronic exposure to ambient benzene. The studied animals were 50 albino rats which were divided into two groups, benzene and control groups. The first group included 40 rats and subjected to benzene inhalation with the same criteria of its ambient inhalation. The control group was 10 animals which didn't expose to benzene. Two months later, the animals were sacrificed and the cochleae were processed for histopathological study. Degenerative changes of stria vascular [SV] were reported in 30% of animals of benzene group. Also, cloudy swelling of outer hair cells [OHC] in 20% and hydropic degeneration [OHC] in 10% of benzene group were recorded. No histopathological changes were noticed in control group. The changes were attributed to degenerative rather than inflammatory reactions. The possible mechanism of these changes was discussed. It was concluded that chronic exposure to ambient benzene has noxious effect on the cochlea and sensorineural hearing loss may arise and certain recommendations would be suggested

Should all patients with unexplained paroxysmal palpitations undergo diagnostic electrophysiologic study [EPS]

This study was performed on 40 patients for the evaluation of palpitations. There were 17 patients with inappropriate sinus tachycardia diagnosed with an elevated resting heart rate and an exaggerated heart rate response to exercise in the absence of organic illness, they were excluded from the study. The other 23 patients [16 females and 7 males] were diagnosed as paroxysmal unexplained palpitations. All patients had careful history taking, cardiac exam and baseline labs including complete blood count and thyroid functions. Also, they had regular 12-lead ECG, echocardiography, 24-Holter monitoring and exercise test. All patients underwent baseline electrophysiologic studies in a drug- free state of anti- arrhythmic medicine. Atrial and ventricular stimulation protocol using up to three extrastimuli was done as well as using Isuprel infusion if no tachycardia was induced at baseline. The study concluded that palpitation is a common symptom that needs a careful work-up to assess the etiological diagnosis. Electrophysiological studies in these patients have a low yield and should be only considered in patients with documented sustained arrhythmia or highly suspicious for rhythm disorder

Thyroid carcinoma in thyrotoxic patients treated surgery

The incidence of thyroid carcinomas in a series of 78 patients seen for thyrotoxicosis of any etiology was reported in this study. Surgical treatment for thyrotoxicosis was selected as the treatment of choice in 78 patients [25 with toxic diffuse goiter, 48 with toxic nodular goiter and 5 patients with toxic adenoma]. Thyroid cancer was found in six patients for a total incidence of 7.69% [one patient had toxic diffuse goiter with a percentage of incidence of 4% which was follicular carcinoma and 4 patients had toxic nodular goiter with a percentage of incidence of 8.3% and all had papillary carcinoma]. When a nodule was present in a toxic diffuse goiter, the possibility to face with malignant lesion reached 16.66% of the cases [one out of 6 cases]

Assessment of diagnostic potential of office mini-hysteroscopy in gynecologial diagnosis

To evaluate feasibility of diagnostic office mini-hysteroscopy for gynecological diagnosis. One hundred and fifty patients with different gynecologic problems were examined by transvaginal sonography [TVS]. An informed consent was obtained for examination by office mini-hysteroscopy; a Wolf rigid 2.7 mm hysteroscope was utilized. Endometrial biopsy was taken with vacuum aspiration curette in cases of abnormal uterine bleeding. The study revealed that TVS had sensitivity of 47.3% and specificity 67.2% as compared to 98.7% and 100% respectively for office hysteroscopy in the diagnosis of the whole study cases. In abnormal uterine bleeding, the diagnostic accuracy of office hysteroscopy showed 97% sensitivity and 100% specificity. Mini-hysteroscopic diagnosis of intra-uterine lesions was 100% sensitive and 100% specific. Office mini-hysteroscopy is an accurate, reliable and fast method for evaluation of intra-uterine pathology with minimal morbidity and high patient acceptance. It should be considered an indispensable modality for routine investigation in gynecologic diagnosis

Laparoscopic versus conventional surgical treatment of genuine urinary stress incontinence

To compare laparoscopic versus the classical open colposuspension in surgical treatment of GSI. The study was conducted on 20 patients diagnosed to have GSI. P re-operative evaluation entailed stress test, Q-tip test and urodynamic study including combined cystometry and pressure flow study. Ten cases were subject to laparoscopic Burch colposuspension using non-absorbable suture between Cooper's ligament and vaginal vault. Ten cases were subjected to classical open Burch procedure. Post-operative evaluation was done. Clinical and urodynamic tests were rechecked one month after surgery. Operating time was significantly longer in laparoscopic group [3.25 hours] as compared to open group [1.25 hours]. One case of bladder perforation was recognized intraoperatively in laparoscopic group. Analgesic requirement was significantly less in laparoscopy cases. Hospital stay was found to be significantly shorter in laparoscopic group [4.8 days] than in open group [8.1 days]. Two cases of wound infection were reported in cases of open group. Urodynamic studies revealed comparable results in both groups one month after operation, all in favour of restoration of normal continence. One case [10%] of recurrence was found in each group. Laparoscopic Burch colposuspension is a safe and effective procedure for GSJ. Laparoscopic approach provides better visibility, more precise haemostasis, less post-operative discomfort, quicker recovery and shorter hospital stay

Role of pectoral fascia removal in modified radical mastectomy

Pectoral fascia may act as a protective layer against harmful effects of radiotherapy [fibrosis]. Moreover, dissection of pectoral fascia from its muscle may contribute to much seroma formation. So, this study comes to evaluate the relation between pathological parameters of primary tumour and pectoral fascia1 invasion. Fifty patients submitted to this study where the primary tumour, axillary lymph nodes and pectoral fascia were histopathologically studied. The results showed presence of a good relation between the distance of the primary tumour and pectoral fascia invasion. There was also a good relation between pectoral fascia invasion and axillary lymph nodes infiltration. So, it was advised to remove pectoral fascia when the distance between it and primary tumour is less than 1 cm. Also, it should be removed when there is an axillary lymph node invasion irrespective of their numbers. Otherwise, preservation of pectoral fascia is advised

Solidification as low cost technology prior to land filling of industrial hazardous waste sludge

The aim of this study was to stabilize and solidify two different treated industrial hazardous waste sludges which were selected from factories situated close to Alexandria. They were selected to ensure their safe transportation and landfill disposal by reducing their potential leaching of hazardous elements which represent significant threat to the environment, especially the quality of underground water. The selected waste sludges have been characterized. Ordinary Portland cement [OPC] and cement kiln dust [CKD] from Alexandria Portland Cement Company and calcium sulfate as a by-product from the dye industry were used as potential solidification additives to treat the selected treated waste sludges from tanning and dyes industry. Waste sludges as well as the solidified wastes have been leach-tested using the general acid neutralization capacity [GANG] procedure. Concentration of concerning metals in the leachates was determined to assess the changes in the mobility of major contaminants. The main advantages of solidification are being simple and low cost process which includes readily available low cost solidification additives that convert the industrial hazardous waste sludges into inert materials

possible role of gastrin in cholelithiasis in cirrhotics

The present study was conducted to find out the relation between gastrin hormone level and the prevalence of gallbladder stones in cirrhotic patients. Eighty five patients with liver cirrhosis and 20 individuals as a control were included in the study. Fasting serum gastrin was estimated and abdominal ultrasonography were done for the patients and the individuals whereas guided liver biopsies were done for the patients. The study showed higher prevalence of gallbladder stones among patients [31.7%], compared to the control [0%]. The study showed a significant increase in serum gastrin level in patients compared with control, moreover, the study showed that serum gastrin levels among patients with gallbladder stones had statistically significant higher levels compared with the serum gastrin among patients having no gallstones. From the present study it can be concluded that gastrin hormone elevation can be a contributing factor for the pathogenesis of gallbladder stones in cirrhotic patients

Efficiency of cattle manure composting at farms in one of the Delta villages, Egypt

The present study aimed at evaluating the physicochemical stabilization and the pathogenic and entomolyic destruction of the composted manure. A representative sample of fifteen piles representing different durations was selected. Most of the studied pile dimensions were not optimum, time allowed for fermentation was not enough to stabilize it and none of the piles surveyed had undergone turning. The presence of poor conditions of fermentation would not allow the temperature to build up and hasten the decomposition. The slightly alkaline medium is extremely useful in the application on acidic soils. The high values proved the ineffectiveness of the fermentation process. Heavy metals were present in very small concentrations. The presence of high values of total and fecal coliforms indicated that none of the piles was stabilized. The presence of larvae house and blow flies indicated that the materials undergone fermentation were a good media for flies breeding. The isolation of parasites in 90% of the piles means that the temperature did not increase to a degree enough to kill various parasitic stages. For proper manure management, local farmers should be instructed to follow systematic operating practices with emphasis on producing a high quality and pathogen free compost

Correlation of fibronectin distribution in chronic maxillary sinusitis with histopathological and bacteriological findings

In 40 patients their ages ranged from 18 - 40 years with clinically and radiologically proved chronic maxillary sinusitis [CMS], we investigated them for the significance of fibronectin [Fn] distribution in antral mucosa and its correlation with bacteriological and histopathological findings.We obtained bacterial growth in 60% of our series which was polymicrobial including anaerobes [41.66%] mixed [33.34%] and aerobes [25%]. Failure to obtain bacterial growth in 40% of cases does not indicate absence of the disease which may be confirmed by Fn distribution and histopathological findings. It was also confirmed that no rule could be given to the type of histological pattern in relation to specific pathogen. According to the type and amount of cellular infiltration the CMS was divided into 4 categories; plasmalymphocytic, eosinophilic, mixed and hypocellular.Also according to the course of the disease the CMS was classified into fibrotic sinusits which needs no treatment and evolutive sinusitis with acitve inflammatory reaction which may be managed depending upon the type of cellular infiltration and amount of mucosal damage.As for Fn distribution, it was proved to be found on surface epithelium, intracellular, basement membrane, periglandular, apical cell glandular, perivascular and stromal areas in different combinations. While it was present on surface epithelium in cases of gram - positive bacteria and to lesser extent in mixed types but it was absent in cases of gram - negative bacteria. It was proved that total amount of Fn was more in gram positive bacteria than in gram -negative bacteria and in aerobes more than cases of anaerobes. Correlation between Fn distribution in CMS in relation to histopathological and bacteriological findings may be of special values as follows: 1. Presence of interacellular Fn, and on the surface epithelium, indicates the presence of tissue damage and type of bacteria even with negative bacterial growth. 2. Metaplasia is a risky sign in CMS but with reasonable amount of Fn we may predict less risky prognosis. 3-Fn is usually present in pre-fibrotic stage and its amount may represent a good clue to prediction the healing process .4. Absence of Fn on surface epithelium, while the pathogen was gram- positive bacteria may indicate aeration defect of the antrum, and suggesting the line of treatment .Biopsy is mandatory in this study which may be a limiting factors, but it allows the recongnition, and categorization of the disease and gives valuble diagnostic and prognostic data on studing Fn distribution and histopathological pattern in CMS in relation to histological and bacteriological findings may be a suitable parameter for proposed a universal treatment proctocol

Radiologic and histopathologic study of the uterine vasculature in cases of dysfunctional uterine bleeding

Transcervical phlebography was done in [50] patients with perimenopausal dysfunctional uterine bleeding [the study group] and [20] patients with genital prolapse [the control group]. All the patients were admitted for hysterectomy either abdominally in cases of the study group or vaginally with repair in the controls. Ovarian with broad ligamentary varicosity was more detected among the study cases than in the controls, [20 cases: 40% vs, 3 cases 15%]. After the operation of hysterectomy, each uterus was examined pathologically for the endometrial pattern and its vasculature. Regarding the endometrial pattern the secretory endometrium wax only found in the control cases while the adenomatous hyperplasia was only detected in the study cases. More atherosclerotic changes and calcification were detected in the uterine blood vessels of the study patients than in the controls while the endometrial venous sinuses were only found in the patients with uterine bleeding

Basal narcosis: a thchnique for culdoscopy in an awkward position

Culdoscopy was performed for 249 cases underbasal narcosis. This technique was used to achieve analgesia and sedation in a patient who has to be conscious and aware to be put in an awkward knee-chest position. This method was compared with other techniques used which included general, local or regional blocks. The results and side effects were discussed