Knowledge, attitudes and practices of health-care personnel towards waste disposal management at Ain Shams university hospitals, Cairo

This study assessed knowledge, attitudes and practices of health-care providers towards waste management at Ain Shams University Hospitals, Cairo, Egypt. In this cross-sectional study 110 physicians, 151 nurses and 89 housekeepers were interviewed using a pre-designed questionnaire. Housekeepers were significantly more knowledgeable than physicians or nurses about hospital policies and systems for waste disposal, but less so about specific details of disposal. Housekeepers also had the highest overall scores for attitudes to waste disposal among the 3 groups. Significantly more nurses had satisfactory practice scores [84.0%] than did physicians [67.3%] [housekeepers were not assessed]. Training and duration of work experience were not significantly associated with knowledge, attitude and practice scores, except for nurses with longer work experience, who were more likely to have satisfactory knowledge about waste disposal than less experienced nurses

Factors affecting defaulting from DOTS therapy under the national programme of tuberculosis control in Alexandria, Egypt

This unmatched case-control study aimed to identify factors affecting default from therapy under the national programme of TB control in Alexandria, Egypt. Record reviews and structured interviews were made with 57defaulters and 187 randomly selected controls. Univariate analysis showed 13 out of 54 factors investigated were significantly associated with defaulting and/ after stepwise logistic regression, 5 factors remained in the model: younger age [adjusted OR= 0.16], rural area of residence [OR= 12.9], long waiting times [OR=5.81], poor physician-patient communication [OR= 3.06] and fear of information leakage [OR =3.62]. Reasons cited by defaulters included long distance to the clinic, unsuitable clinic times and long waiting times. The main factors associated with defaulting from the national programme of TB control In Alexandria, Egypt were service-related factors, which are amenable to Improvement

Serum interleukin-18 levels in patients with systemic lupus erythematosus: relation with disease activity and lupus nephritis

To further investigate the possible role of IL-18 in the pathogenesis of systemic lupus erythematosus [SLE] and development of lupus nephritis [LN], and to explore its relationship with pathological classes of LN, degree of acute renal activity and chronic damage. Forty-one SLE patients with LN, thirty-one lupus non-nephritis patients and fifteen age and sex matched healthy controls were enrolled in this study. SLE patients were subjected to disease activity assessment by SLEDAI, renal disease activity assessment by the Systemic Lupus International Collaborating Clinics [SLICC] Renal Activity Score, laboratory investigations including measurement of serum interleukin-18 using Enzyme Linked Immunosorbent Assay. Renal biopsy was obtained from LN patients and pathological classification was made according to World Health Organization [WHO] criteria. Analysis of activity and chronicity indices was done on these biopsy specimens. Serum levels of IL-18 were significantly higher in patients with LN than lupus non-nephritis patients and healthy controls [p < 0.001]. There were significant correlations between IL-18 and SLEDAI [p = 0.002], proteinuria [p = 0.027], renal activity score [p = 0.003] and activity index [p = 0.039] in patients with LN. There was no significant difference in the serum levels of IL-18 between WHO classes of LN IL-18 appears to have a pathogenic role in the development of SLE and plays a crucial role in triggering inflammation in LN. Serum IL-18 levels could be a useful biomarker to assess the activity of renal disease in SLE

balanced anesthesia with dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery

To evaluate the effect of adding dexmedetomidine to a balanced anesthetic technique on postoperative nausea and vomiting after laparoscopic gynecological surgeries. A prospective double-blind randomized study was designed at Jordan University Hospital, Amman, Jordan between December 2008 and February 2009. Eighty-one female patients in their child-bearing age [17-48 years]; American Society of Anesthesiologists [ASA] clinical status I, who were scheduled for elective diagnostic laparoscopic surgeries under general anesthesia were divided into 2 groups. Group D [n=42] received dexmedetomidine infusion, while group P [n=39] received 0.9% sodium chloride infusion along with the balanced anesthesia. The incidence of early [up to 24 hours] postoperative nausea, vomiting, nausea and vomiting, and the need for postoperative rescue anti-emetic medications were recorded. The total incidence of postoperative nausea and vomiting decreased significantly in group D; 13 out of 42 patients [31%], compared to group P; 23 out of 39 patients [59%], vomiting alone did not significantly change, the incidence of postoperative nausea, and the use of rescue anti-emetic medications were significantly different. A significant drop in overall consumption of fentanyl and sevoflurane was also noted in group D. Combining dexmedetomidine to other anesthetic agents, results in more balanced anesthesia and a significant drop in the incidence of postoperative nausea and vomiting after laparoscopic gynecological surgeries

Safety and experience with awake video-assisted thoracoscopic surgery [VATS] in compromized patients

Background: Video-assisted thoracoscopic surgery [VATS] was implemented as a minimally-invasive technique to reduce tissue trauma. Thoracic epidural anesthesia furtherly-reduces intra-operative metabolic stress, postoperative pain, in addition to supporting awake VATS, by which then completely avoiding the drawbacks of mechanical ventilation and general anesthesia in high-risk patients. In this study we report the safety and experience with using VATS in patients where general anesthesia was deemed unsafe or not suitable. The VATS procedure was done in awake patients utilizing thoracic epidural analgesia and I.V sedation

Methods: In this prospective study twenty five patients underwent VAT surgery for different thoracic pathologies at New Kasr El Aini Teaching Hospital, Cairo University between February 2005 and December 2006. There were 19 male and 6 females ranging in age from 55 to 79 years and their body mass index ranging from 25 to 31. All patients had various co-morbid conditions [hepatic, cardiac, renal and/or respiratory compromise] hence general anesthesia was deemed a hazardous option

Results: Twenty five patients underwent 28 VAT procedures which included pleural biopsy and talc poudrage in 7 patients; bullectomy in 7 patients; pleuropericardial window in 4 patients; lung biopsy in 4 patients; evacuation of clotted hemothorax in 2 patients; and wedge resection of pulmonary nodule in 1 patient. There were no morbidity or mortality related to the procedure. However there were 2 late mortalities which were attributed to the primary disease

Conclusion: Awake video-assisted thoracoscopic procedure was carried out in various thoracic pathologies with technical ease and minimal morbidity and mortality complications. In our experience this procedure is considered soundly-safe particularly in patients athigh risk for general anesthesia

study into the expression of the tumor suppressor gene p53 and the oncogene bcl-2 in human breast cancer

In this study, the protein expression of the mutant tumor suppressor gene p53, and oncogene bcl-2 was evaluated in 50 female breast cancer patients using two different techniques, ELISA and western blotting, the relation between these two techniques in relation to protein expression was detected, and the correlations between the expression of these two proteins and the different prognostic parameters of cancer breast were studied. The mean value of bcl-2 in breast cancer patients was statistically significantly higher than those of normal healthy controls using both ELISA and western blotting techniques. A significant positive correlation was found between bcl-2 and both the tumor size and the stage of the tumor which signifies its important role as a prognostic factor in breast cancer. Also over-expression of mutant p53 was detected using both ELISA and western blotting techniques when compared to the normal healthy controls. The only statistically significant correlation between mutant p53 expression and the different prognostic parameters of breast cancer was found to be between p53 the stage of the tumor. When taking predictive cut off levels of bcl-2 at 75U/ml, and mutant p53 at 2.16U/ml, bcl-2 showed the highest sensitivity, specificity anti diagnostic accuracy of [88%, 90%, and 90%] respectively, while mutant P53 showed its highest sensitivity, specificity and diagnostic accuracy [80%, 100%, and 85.7%] at the chosen cut offs. When done in either abnormal and both abnormal double combinations with the same cut offs, the sensitivity, specificity and diagnostic accuracy in the either abnormal combination have improved than either parameter singly, [92%, 100% and 94.29%] respectively, while in both abnormal combination the sensitivity, specificity, and diagnostic accuracy are [64%, 90% and 71.43] respectively. When studying the correlation between the 2 techniques [ELISA and western blotting] used in determination of bcl-2 and P53 expression in breast cancer patients all samples which showed over-expression for mutant P53 and bcl-2 using ELISA technique, also demonstrated over-expression using western blotting technique. The percent of positive expression the mutant P53 and the bcl-2 proteins were higher [76%] and [88%] respectively using western blotting technique when compared to ELISA technique [70%] and [80%] respectively. The results of both techniques were statistically significantly correlated for both P53 and bcl-2. Although western blotting technique has a higher sensitivity compared to ELISA, it has many disadvantages as cost, reproducibility, time consumption and the requirement for high skills

Chidren with isolated head injury: prognostic value of haemostatic parameters and glasgow coma score

Traumatic brain injury is a common cause of death and disability in children between 1 and 14 years and accounts for up to 70% of all pediatric trauma death. [Ghajar 2000]. Traumatic head injury is graded as mild, moderate or severe on the basis of the level of Consiousness or the Glasscow coma score [GCS], after resuscitation, Mild traumatic brain Injury [GCS 13 - 15], moderate traumatic brain injury [GCS 9-12], severe traumatic brain Injury [GCS 3-8]. [Ghajar 2000]. Coagulopathy after head injury is well described; traumatic brain injury patients are known to develop coagulation abnormalities, the degree of which appears to be an independent predictor of the outcome. [Selladuraui et al., 1997]. So the aim of this work is to study the relation between the coagulation abnormalities and the outcome in comparison to the GCS in the head trama patients under 14 years old. 24 children entered this study with isolated traumatic head injury, computerized tomography C.T., full neurological examination with immediate blood samples for detection of coagulation abnormalities were done. The relation between different haemostatic parameters, GCS, C.T. findings and Glasgow outcome score were measured. The results of this study showed that, the age of the patients had a significant relation to the outcome as 75% of the patients had good outcome and all of them were less than 14 years old. The relation between the Glasgow Come Score GCS and the Glasgow outcome score GOS showed that there was a significant result between them, as patients with head trauma and had a GCS 1 or 2 had good outcome while patients with GCS group 4 had bad outcome, where p was <0.05. Computerized Tomography [CT] findings showed variable relation to the outcome. The coagulation parameters showed that Prothrombin time PT score was significant to the GCS and non-significant to the GOS Partial thromboplastin time PTT score showed non-significant to GCS and GUS. Platelet count score PC showed non significant to GCS and GUS, thrombin clotting time showed significant to GCS as well as GUS, serum fibrinogen fibrin degradation product FDP and disseminated intravascular coagulation scores showed significant GCS as well as GOS. Conclusion of this work is that the FDP, DIC, serum fibrinogen, and thrombin clotting factors were good predictors for the outcome in children with traumatic head injury, the same as for the GCS which is strongly independent prognostic factor for the outcome in children

Significance of circulating intercellular adhesion molecules [sICAM-1] and thrombopoietin [TPO] in hepatitis C vinis related liver cirrhosis

Chronic hepatitis C is a major health problem that causes mortality in the worldwide distribution. The systemic levels of many soluble adhesion molecules and cytokines are altered in autoimmune diseases and liver infection. Among mediators that show altered serum levels are sICAM-1 expressed by immunocompetent cells and thrombopoitin [TPO]. The aim of this study was to evaluate the serum sICAM and TPO and their correlations with clinical and laboratory data in patients with hepatitis C-related cirrhosis. 40 patients with HCV-related cirrhosis and 20 healthy subjects were enrolled in this study. They were subjected to the following investigations: complete blood picture, liver and kidney functions, prothrombin time[PT], abdominal sonography and estimation of serum TPO and sICAM-1. Compared to controls, the patients group showed significant increase in spleen size [P<0.025], portal vein diameter [P<0.0025], ALT, AST, bilirubin, sICAM-1 [P<0.0005], and PT [P<0.05]. However there was significant decrease in serum albumin levels [P<0.01], platelets count [P<0.0005], RBCs count, haemoglobin concentrations [P<0.025] and serum TPO levels [P<0.0025]. The serum creatinine levels and WBCS count showed insignificant changes with control. The serum TPO levels were negatively correlated to ALT [r=-0.97, P<0.0001], PT [r=-0.96, P<0.0001], spleen size [r=-0.95, P<0.0001], and portal vein diameter [r=-0.96, P<0.0001] and positively correlated to platelets [r=0.84, P<0.0005]. While serum sICAM-l were positively correlated to ALT [r=0.99, P<0.0001], PT [r=0.94, P<0.0005], spleen size [r=0.95, P<0.0001], and portal vein diameter [r=0.85, P<0.005] and negatively correlated to platelets count [r=-0.7l, P<0.005]. Our results suggested that impaired synthesis of TPO by cirrhotic liver may contribute to the development of thrombocytopenia and related to liver cirrhosis together with increased splenic sequestration of platelets by the enlarged spleen. So recombinant human TPO should be evaluated in the treatment of thrombocytopenia in HCV-related cirrhosis. In addition, sICAM-1 elevation in plasma of patients suffering from HCV-related cirrhosis was related to the degree of cirrhosis and portal hypertension. So, sICAM-1 may be used as a marker of the disease activity and may provide diagnostic and prognostic information. However this needs to be further studied to detect the cut off level of sICAM-1 in Egyptian HCV-related liver cirrhosis

Assessment of health status of workers in a major waste dumpsite with special emphasis on liver disease

This study was done on 168 male workers, engaged in the whole cycle of solid waste management at Shubramant Dumpsite at Giza Governorate, to assess different health hazards, emphasizing the liver disease. All subjects under the study were subjected to complete clinical assessment, screening by abdominal ultrasonography, serologic tests for HBV and HCV as well as biochemical tests for liver and kidney functions and complete blood picture. Abdominal ultrasonography revealed various abnormalities among 81.6% of the studied workers as follows: Bilharzial [68.45%], bright liver [10.71%], hepatomegaly [8.32%], liver cirrhosis [2.38%] and portal hypertension [1.2%]. Hydronephrosis and hydroureter were elicited in 1.79% of the cases. Anti HCV +ve cases were elicited in 37 workers, while anti HBV +ve cases were elicited only in 9 workers. All laboratory findings and skin diseases encountered were detailed. There was a positive relation between the duration of employment and musculoskeletal and eye complaints as well as ultrasonographic findings, especially the liver. Except for past exposure history, kidney stones, alkaline phosphatase, creatinine, normal and infectious cases of skin, no statistically significant differences were elicited between those exposed directly or indirectly to various hazards of waste among the investigated subjects

Increased production of vascular endothelial growth factor and some other cytokines in serum and ascitic fluid of cirrhotic patients with spontaneous bacterial peritonitis

The aim of this study was to determine serum and ascetic fluid vascular endothelial growth factor [VEGF], tumor necrosis factor- alpha [TNF-alpha], interleukin-6 [IL-6] and endotoxin, in cirrhotic patients and to search for a relationship between them and SBP. This study was performed on 40 cirrhotic patients with SBP, their ages ranged from 35 to 60 years, with mean of 47.5 +/- 11.6 years, 40 cirrhotic patients with non-infected ascites their ages ranged from 22 to 50 years, with mean of 34.5 +/- 6.5 years and 20 healthy control subjects with matched age and sex. From the results obtained it was concluded that VEGF, IL-6, TNF-alpha and endotoxin in the serum and ascetic fluid may become useful markers for diagnosis of SBP and for monitoring the treatment of cirrhotic patients

Effect of oral administeration of molybdenum in rats

At a trial for the assessment of different changes may occur in man by chronic administration of molybdenum, this study was carried to evaluate the toxic effect of long administration of molybdenum on rat's liver, kidney, thyroid gland and testis. The liver enzymatic activities, alkaline phosphatase[ALP], alanine aminotransferase [ALT] and aspartate aminotransferase [AST] were determined in the serum. The toxic effect on kidney was studied through determination of urea, creatinine and uric acid. Also this work evaluated the toxic effect of molybdenum on metabolism and growth by estimation of plasma level of thyroid hormones[T3, T4] and TSH of the pituitary gland. On the other hand the toxic effect was estimated on testis by estimation of testosterone hormone to evaluate its effect on the fertility. The used rats were divided into two groups. The first group[10 rats] served as control were administered orally 1 mI of 0.9%Nacl/day, while the other group [30 rats] were administered orally ammonium molybdate [50 mg/kg/day] for 12 weeks. The group administered ammonium molybdate showed a haematological changes in the form of significant reduction in HB concentration, haematocrit value and erythrocytic count [P<0.01]. Also a significant increase in both total and differential leucocytic count was observed compared to control group. The biochemical study showed a significant elevation in serum level of liver enzymes AST, ALT [P<0.01] and AP [P<0.001] as well as bilirubin [P<0.01]. The kidney function tests showed a significant. increase of blood urea [P<0.0005], serum creatinine [P<0.05] and serum uric acid [P<0.001]. The serum level of thyroid hormones[T3 and T4] and TSH level showed a significant increase [P<0.01], while Testosterone level was significantly decreased [P<0.001] compaired to the control one. The histological examination of the liver revealed hepatic cell degeneration and polymorph-nuclear leucocytic infiltration and increase the collagen fibers around the portal tract .The kidney showed glomerular, tubular degeneration and necrosis. While the Testis showed testicular cell degeneration of Leydig cells and degeneration of basement membrane of seminiferous tubules. It was concluded that prolonged administration of ammoniurn molybdate caused growth retardation, depression action, male infertility, and degenerative changes of kidney, liver and testis

TNF-alpha and homocysteine levels in type 1 diabetes mellitus

The role of homocysteine as an independent risk factor for vascular endothelial damage, and the possible link between homocysteine and tumour necrosis factor-alpha [TNF-alpha] as two synergistic risk factors for beta-cell apoptosis in type 1 diabetes mellitus was studied. Plasma homocysteine levels were significantly elevated in all diabetic patients compared with controls and diabetic patients with vascular complications showed higher elevations. Furthermore, homocysteine levels showed significant positive correlation with the degree of microalbuminuria. TNF-alpha levels were elevated in all diabetic patients compared with controls. These results may have therapeutic implications

Activities of antioxidant enzymes in bronchial asthma

This work was designed to study the activity of antioxidant enzymes [superoxide dismutase [SOD], glutathione peroxidase [GPX] and glutathione reductase [GR]] in human erythrocytes of blood samples. A total of 24 nonsmoker asthmatic patients and 12 nonsmoker healthy control subjects [their ages ranged 25-65 years] was investigated. The antioxidant enzymes [SOD, GPX and GR] levels were assayed by an automated method. The results showed that there was a non significant decrease in SOD and GPX activities, while GR was reduced significantly in the asthmatic patients when compared with the controls

comparative-study on enzymatic changes in the serum and synovial fluid at early post-mortem period

In this study, postmortem blood and synovial fluid samples were taken from 50 cadavers, from Zeinhom's mortuary. Their medico-legal reports were revised thoroughly to obtain the precise time of death. Serum and synovial fluid samples were analyzed and the levels of the following enzymes were estimated. Alkaline phosphatase [Alk. Ph], Aspartate aminotransferase [AST] Alanine aminotransferse [ALT] and Lactate dehydrogenaze [LDH]. Postmortem serum and synovial fluid samples were grouped according to postmortem interval [the time of samples withdrawal in the first twelve hours ostmortem]. This study showed that the values of Alk. Ph. AST, ALT and LDH increased progressively until 12 hours P.M. It was observed that, there was no significant difference between the mean enzyme levels in the serum and synovial fluid. It is suggested that the mean enzyme levels in the synovial fluid can be used to predict their levels in the serum with much reliability. Moreover, synovial fluid can be easily obtained and does not generate cosmetic problems. It is concluded that synovial fluid analysis can provide useful information in autopsy cases in which suitable blood or urine specimens can not be obtained

Laparoscopic cholecystectomy with selective pre-operative endoscopic cholangiography and sphincterotomy, a safe combination

One hundred and twenty four patients with symptomatic gall bladder stones underwent elective laparoscopic cholecystectomy over a period of three years. They have been successfully and safely performed without operative cholangiography for one hundred and twenty one patients [97.6%]. Pre-operative endoscopic retrograde cholangiogram was performed for fourteen patients suspected to have choledocholithiasis on clinical grounds. Ten of them were found to have common bile duct stones. Endoscopic sphincterotomy was done for these ten patients and all stones were cleared. For one month follow up after discharge, no complications were seen and none has come back with late complications thereafter. Laparoscopic cholecystectomy with endoscopic retrograde cholangiogram and sphincterotomy was safe and effective with good cosmotic result and fast recovery. There was no need to perform operative chorangiogrom and exploration of common bile duct

Laparoscopic versus conventional appendicectomy for appendicitis

Seventy one patients with acute as well as recurrent subacute appendicitis were scheduled for laparoscopic appendicectomy [LA]. One was converted to open surgery [1.4%] and five had concomitant laparoscopic procedures. The remaining 65 cases were compared with 176 conventional appendicectomies [CA] done during the same time interval. LA took a significantly longer time in the operating theatre, 81.4 minutes versus 52.9 minutes for CA. Less than three days hospitalizations was encountered in 78.5% of LA and in 30.11% of CA cases [p <0.001], less than two days in 15.4% and 3.41% respectively [p <0.025%]. Return to normal activity averaged 10 days for LA and 14.4 days for CA [p <0.001]. Complications were less for LA [7.7% than for CA [13.1%], yet the difference is insignificant [p <0.05]. The cosmetic appearance was most satisfactory for the LA patients. Laparoscopic appendicectomy is a safe operation that has the advantages of lasser hospitalization, early return to work and better cosmetic results

Carbohydrate changes of pea seedlings as affected by growth regulators and humid cold storage of pea seeds

The results of this investigation revealed that cold storage of pea seeds, under different moisture levels, slightly increased their carbohydrate content [in terms of mg per 1 g dry weight]. At the early stages of germination [3-day age] there was no significant effect on the total carbohydrate content of the cotyledons, though 30% moisture treatment tended to reduce starch content whereas, that of the radicle was remarkably low. After 7 days of germination, a drop in total carbohydrates of the whole seedlings of all treatments was obvious, compared with 3-day old stage. This may be due to continued metabolic activities leading to growth. After 15 days from sowing GA3 at 10% moisture seemed to cause a drop in the carbohydrate content of the plant organs and whole seedlings. At 50% moisture, GA3 increased the carbohydrate content of roots and leaves above the controls