Homocysteine level as a marker in case of early onset sevre preeclampsia

To determine the association between plasma homocysteine level and early onset severe preeclampsia, and its relevance as a potential marker for predicting preeclampsia. A case control study was conducted on twenty early onset severe preeclamptic pregnant women [group I], and ten normotensive pregnant women as controls [group 11]. The gestational age of both groups ranged between 22 and 26 weeks. Routine laboratory tests, serum creatinine, serum uric acid, platelet count, and plasma homocysteine were measured for both groups. Infirmed consent of the patients was taken. The laboratory findings showed significantly higher mean serum creatinine, serum uric acid, and plasma homocysteine of group [I] compared to the control group [P = 0.00001, P = 0.0000], P = 0.00001 respectively]. However, the mean platelet count of group [I] was significantly lower than that of the control group [P = 0.0000]]. Positive significant correlations were found between plasma homocysteine and systolic blood pressure [r = 0.936, P = 0.001], diastolic blood pressure [r = 0.954, P = 0.001], serum creatinine [r = 0.954, P = 0.001], and serum uric acid [r = 0.963, P = 0.001]. On the other hand, a negative significant correlation was found between homocysteine and platelet count [r = 0.880, P = 0.00]]. Plasma homocysteine concentration is significantly increased in early onset severe preeclampsia and it might contribute in the pathophysiology of the disease. It may be considered as a marker in early onset severe preeclampsia

Gender differences in healthcare-seeking behaviour for urinary incontinence in Alexandria

Urinary incontinence [UI] is a common condition, but previous studies have shown that only about 20% of individuals with UI seek medical care for treatment of their symptoms. The determincnts of treatment seeking are not well understood. Little is known about the effect of gender on health care-seeking behaviors. The objective of this study was to determine gender differentials in factors associated with patients' decisions to seek treatment for urinary incontinence This was a descriptive, hospital based case series study. It was carried out during the first half of the year 2008 in the Urology and Obstetrics and Gynaecology departments of Main University Hospital and El-Shatby University Hospital, Alexandria. As part of purposeful sampling, all participants were selected from the clinic and admission lists. All studied subjects were enrolled by the investigators after signing informed consent and provided they complied with inclusion/exclusion criteria. Data were collected using pre-tested, precoded interview format. In-depth interview was carried out by the investigators themselves to answer the questions because the topic is poorly understood and the research is perception-oriented. We hypothesized that gender differences in treatment seeking for UI would not be explained only by socio-demographic factors, clinical presentation, and symptom impact, but also some important psychosocialfactors of the respondent as well. To test the hypothesis, we developed a multivariate logistic regression modelfor each gender. Information was collected from 353 UI patients out of a total of 374 patients registered in those clinics and admission list during the recruitment period of the study. Thus the response rate was 94.4%. There were 113 [32.0%] males and 240 [68.0%] females. Thus male to female ratio was 1: 2.12. The present study found differences in males and females regarding specific psychosocial factors motivating health care-seeking behaviour. Certain inequality was observed in hospital admission, use of diagnostic procedures, days of hospital stay and surgeries in thai they proved less frequent among women. More women suffered from at least one negative impact on their social lives compared to men. Additionally, the impact of UI on sexual life was not associating with seeking treatment for both men and women. The impact of symptoms on quality of life appears to be the main trigger for seeking help for UI in both men and women. After adjustment for confounders, women's decisions to seek treatment for urinary incontinence were significantly associated with mixed type of UI, severe UI, perceptions about underlying causes of UI, attitude towards health care use, worse social impact score and worse diseasespecific quality of life scores. However, illiteracy and self care practices were adversely affect women's care seeking behavior. In men help-seeking was related to the presence of co-morbid condition, severe UI, associated lower urological complaints, satisfaction with medical care offered, high expectation of benefit from treatment and worse disease-specific quality of life scores. Since the present results revealed gender differences in determinants of UI health care seeking behaviour, strategies to enhance care-seeking for urinary incontinence should consider the role of gender in personal knowledge, needs and behaviors for UI management in adults. Educating physicians and the public about the factors associated with treatment seeking as well as the available treatment options may help women and men to seek and receive more timely care for incontinence symptoms

Needle stick injuries among health care workers of Alexandria University hospitals

Needle stick injury has been recognized as one of the occupational hazards which results in transmission of blood borne pathogens. As there was limited data on the national level about these injuries determinants of such injuries are important to investigate and to design effective prevention programs. The purpose of this study was to investigate the prevalence and circumstances of needle stick injuries among heath care personnel working at Alexandria University hospitals. Effectiveness of the existing control measures and practice of standard precautions were also assessed. A cross-sectional survey was carried out among 913 health care workers [HCW] in different clinical departments of the three teaching hospitals from January to December 2007. Data were obtained by an anonymous, self-reporting questionnaire. Health Belief Model [HBM] was used to explain standard precautions practice. Multiple linear regression was performed to predict factors associated with the practice of standard precautions. Of the recruited participants, 70.6% [645/913] had completed the questionnaires. Nurses had the highest response rate [92.5%]. More than two thirds [68.0%, n=438] of participanting HCWs had sustained at least one needle stick injury in the last 12 months. Risk of [Needle Stick Injuries [NSls] was significantly associated with younger age of the participants and fewer years of work experience. More specifically, of all occupational groups, nurses have the highest risk to experience needle stick injuries [62.3%]. Disposable syringes accounted for 38.4% of injuries. Most needle stick injuries [36.5%] occurred at the patient's ward. Evaluating the kind of activity under which the needle stick injury occurred, on average 36.0% of injuries occurred during recapping of a needle especially if this practice was handily done. High risk patients [one with a history of infection with HIV, hepatitis B, hepatitis C, or injection drug use] were involved in 8.2% of injuries. The majority of NSIs [73.1%] occurred at end of the shift. Most health care workers [77.4%] were mentally distressed during their injury. Factors increase possibility of infection transmission were the procedure involving a needle placed directly in patient's vein or artery, exposure to a source patient who had evidence of blood borne infection, low immune status of the HCW [i.e., no vaccination with HBV], deep injury, and lack use of personal protective equipment. A total of 327 respondents [74.7%] did not report the injury to an employee health service. Lack knowledge of appropriate procedure after injury was the most common cited reason for not reporting the injury. The survey revealed that use of preventive measures was inadequate. Only 10.0% of all participant workers knew new needless safety devices. The significant protective factors that decreased the frequency of needle stick injuries were using devices with safety features [OR=0.41], satisfactory adherence of a health care worker to infection control guidelines [OR=0, 42], having training in injection safety and appropriate work practices [OR=0.14], comfortable room temperature during injection [OR=O.32], and availability of written protocol for prompt reporting of such injuries [OR=0.37]. The mean standard precautions practice percent score for the health care workers was 46.32%. In multiple linear regression model, knowledge score of infection transmission [adj beta: 0.18] and the work experience [adj beta: 0.06] were the only significant predictors of standard precautions score. There is a high rate of needlestick injuries in the daily routine of Alexandria teaching hospitals with subsequent risk of infection transimission. Greater collaborative efforts are needed to prevent needlestick injuries. Such efforts are best accomplished through a comprehensive program that addresses all circumstances that contribute to the occurrence of needlestick injuries in health care workers. Critical to this effort is the elimination of needle use where safe and effective alternatives are available and the continuing development, evaluation, and use of needle devices with safety features. All such approaches must include serious initial and ongoing training efforts

Role of antenatal care in toxemia of pregnancy in Alexandria

Pre-cclampsia and eclampsia remain one of the major obstetrical problems in less developed countries. Proper antenatal care [ANC] with regular measurement of blood pressure remains the mainstay of screening for hypertension in pregnancy. The aim of the current study was to identify frequency and characteristics of women with toxemia of pregnancy, assess both the quantitative and qualitative adequacy of antenatal care among cases with toxemia of pregnancy and to evaluate the effect of antenatal care on maternal and perinatal outcome. A cross-sectional case series study design was utilized. The study population was all cases, with confirmed diagnosis of toxemia of pregnancy who were admitted to El-Shatby University hospital during the period from January to May 2005. A structured interviewing schedule was used to collect data on characteristics of cases, maternal and fetal outcome. Site, adequacy and quality of received antenatal care were assessed. Out of total cases [336], 14.29% were diagnosed as mild pre-eclampsia, 83.31% were found to have severe pre-eclampsia while 2.40% were suffering from eclampsia. The severity of the condition was significantly associated with older maternal age, multiple pregnancy, primigravity, nulliparity, low socioeconomic conditions, husband's smoking and excessive caffeine consumption. Three-quarters of eclampsia cases [75.0%] didn't receive antenatal care and 60.0% of severe pre-eclamptics received inadequate antenatal care. The mean percent score of quality care domains of antenatal care content for mild pre-eclamptics was 75.62 +/- 13.80%. This was significantly higher than that for those of severe [59.96 +/- 27.95%] or for eclampsia cases [48.75 +/- 20.04%] where X2 of Kruskal-Wallis=8.316 [F<0.001]. Adverse maternal and fetal outcome occurred in 79.4% of women and 72.3% of babies for those who received poor quality ANC. In conclusion, the complications of pre-eclampsia and eclampsia could be prevented by wide spread use of adequate antenatal care, education and training of primary medical care personnel, prompt diagnosis of high risk patients and timely referral to higher level health care