Determinants of hand hygiene compliance in Egypt: building blocks for a communication strategy

Hand hygiene of health-care staff is one of the most important interventions in reducing transmission of nosocomial infections. This qualitative study aimed to understand the behavioural determinants of hand hygiene in order to develop sustainable interventions to promote hand hygiene in hospitals. Fourteen focus group discussions were conducted with nurses in 2 university hospitals in Egypt. The interviews were tape recorded and transcribed. Thematic analysis was conducted by 2 independent investigators. The findings highlighted that nurses did not perceive the benefits of hand hygiene, and that they linked the need to wash hands to a sense of dirtiness. Knowledge of hand hygiene and related products was limited and preference for water and soap was obvious. Environmental constraints, lack of role models and social control were identified as barriers for compliance with hand hygiene. A multi-faceted hand hygiene strategy was developed based on existing cultural concepts valued by the hospital staff

Metformin improves insulin sensitivity and hyperandrogenemia in Egyptian hirsute patients with polycystic ovary syndrome

PCOS is a heterogeneous clinical syndrome characterized by a spectrum of symptomatology, pathology and laboratory findings. It is now accepted that polycystic ovary syndrome has important long-term health implications, including metabolic disorders and increased risk factors for cardiovascular disease like insulin resistance, abdominal obesity, dyslipidemia, hypertension and markers of abnormal vascular function. The aim of this work was to study the effect of metformin on the clinical, metabolic and endocrine parameters in hirsute women secondary to polycystic ovary syndrome. The study was conducted on 30 Egyptian hirsute patients suffering from polycystic ovary syndrome. Clinical examination included anthropometric measurements [BMI and WHR] and Ferriman and Gallwey scoring for hirsutism. Fasting serum insulin and fasting blood glucose were measured from which insulin resistance [IR] was assessed by HOMA. The glucose to insulin ratio [GIR] was calculated. Lipid profile was estimated. Serum luteinizing hormone [LH] and follicle stimulating hormone [FSH] were estimated in the early follicular phase. Total serum testosterone and sex hormone-binding globulin [SHBG] were measured. Ultrasonographgy was done on the pelvis for examination of the ovaries. The patients were instructed to do diet and physical exercise. They received metformin 1500 mg/day for 6 successive months. Clinical, metabolic and endocrine parameters were reevaluated after the medication. A significant 31% improvement in the frequency of the menstrual cycle was observed. Hirsutism improved by 19%. BMI was reduced by 8%. WHR decreased by 2.3%. Insulin resistance decreased by 54%. Total serum cholesterol, LDL-cholesterol, serum triglyceride and total cholesterol/H DL-cholesterol ratio showed slight decrease [3%, 6%, 9% and 9%, respectively], while HDL-cholesterol showed a slight increase by 7%. Total serum testosterone decreased by 32% and LH/FSH ratio improved by 28%. SHBG levels increased by 9%. There was a positive correlation between BMI and HOMA-IR, serum cholesterol and serum TG. There was a highly significant positive correlation between BMI and FBG as well as fasting serum insulin and HOMA-IR. On the other hand, there was a significant negative correlation between BMI and GIR. A highly significant positive correlation was found between BMI and total cholesterol and TG. Also, there was a significant positive correlation between BMI and total cholesterol/HDL-cholesterol ratio. Again, BMI showed a highly significant positive correlation with LH/FSH ratio. There was a highly significant positive correlation between WHR and the frequency of the menstrual cycle and fasting serum insulin. There was a significant positive correlation between WHR and HOMA-IR, serum total cholesterol and TG. There was a significant negative correlation between WHR and SHBG. HOMA-IR showed a significant positive correlation with GIR. Metformin improves insulin sensitivity and hyperandrogenemia in Egyptian hirsute women with polycystic ovary syndrome. This is associated with improvement in menstrual abnormalities. Metformin has additional benefit in reducing hair growth in Egyptian hirsute young women with polycystic ovary syndrome

Attachment of leishmania major and leishmania infantum in the midgut of their respective sand fly vectors phlebotomus papatasi and phlebotomus langeroni [diptera: psychodidae]

The attachment of Leishmania infantum and Leishmania major in the midgut of experimentally infected Phlebotomus langeroni and Ph-lebotonius papatasi was examined by transmission electron microscopy. Cellular damage in the midgut of infected flies as a byproduct of infection was observed in both species. A difference in the mode of attachment of flagella to the midgut of their respective sand fly vectors suggested higher adaptation between L. major/P. papatasi compared to L. infantum/P. langeroni

Renal replacement therapy and increased risk of cardiovascular disease in El-Minia governorate, Upper Egypt

Introduction: End stage renal disease [ESRD] is one of the main health problems in El Minia Governorate Currently, hemodialysis [HD] represents the main mode for treatment of ESRD in El Minia Governorate. El Minia Governorate consists of 9 districts and total population of 4.6 millions

The aim of this study: Is to describe the prevalence rate and etiology of ESRD in patients under Renal Replacement Therapy [RRT] in El Minia Governorate during the year 2005 and risk factors for cardiovascular disease in this group of patients

Material and Method: Patients of ESRD were interviewed and questionnaires were filled out by the investigators. The questionnaire included personal data, past history of relevant diseases, renal biopsy results, ultrasonography, dialysis frequency, lipid profile, ECG, Echocardiography and other data investigating the cause of ESRD and the causes of death

Results: This study included 614 patients, that is 51% of the estimated total number of patients treated by RRT in El-Minia governorate. The prevalence of ESRD in El- Minia governorate is 260/ per million population [PMP]. Most patients are treated by hemodialysis [HD] [97.2%] while only 2.8% are treated by either peritoneal dialysis or renal transplantation. The etiology of ESRD was unknown in 28% of cases while hypertension was responsible for 20.7% of cases, obstructive uropathy 12.7%, chronic glomerulonephritis 10.4%, analgesic nephropathy 6% chronic pyelonephritis 5.8%, and diabetic nephropathy 5%. Other causes such as gouty nephropathy, collagen diseases, toxaemia of pregnancy and lupus nephritis constituted 7% of cases. The prevalence of ischemic heart disease was 16.5%, congestive heart failure 28% Cerebrovascular accidents 5%, the death rate among HD patients during this year was 210/1000

Recommendation: Education program for nephrologists and practitioners should be strengthened with special emphasis on etiological factors leading to ESRD, blood pressure control with focus on systolic pressure appears to be an important strategy to improve outcomes in HD patients, Attempts to establish a program for renal Transplantation should be encourged

effect of the trematode Echinostoma liei and certain non-vector snails as biocontrol agents against infectivity of Schistosoma mansoni larval stages to their hosts under laboratory conditions

The present investigation was carried out to study the effect of the non-medically important parasite Echinostoma liei in the presence of three non-vector snails [Planorbis planorbis, Melanoides tuberculata and Helisoma duryi] on the infectivity of the larval stages of Schistosoma mansoni to Biomphalaria alexandrina and to albino mice [Mus Musculus].The infection rates of Biomphalaria alexandrina exposed to Schistosoma mansoni miracidia in the presence of Planorbis, Melanoides and Helisoma snails at ratios of 1B: 5 non-vector snails were significantly lower being 62.9%, 46.9% and 44.4% versus to 83.7% in control group. Also, there are reduction in mean total numbers of cercariae/snail and duration of shedding specially in the presence of Planorbis and Helisoma snails, while the prepatent periods were elongated by the presence of Planorbis and Melanoides snails. Snails exposed to Echinostoma liei miracidia showed reduction in infection rates in the presence of the three studied non-vector snails and in duration of shedding by the presence of Melanoides and Helisomd snails. Snails exposed to both parasites showed reduction in the infection rate especially in the presence of Melanoides and Helisoma snails. No Biomphalaria snails were infected with both parasites in the groups maintained with H. duryi at ratios of 1B: 3H and 1B: 5H. The lowest total number of schistosome and echinostome cercariae was in the group of 1B: 3M. The presence of non-vector snails with infected Biomphalaria suppressed the infectivity of schistosome cercariae to the experimental mice

Hepatitis C viraemia and cortisol level in thalassaemic children along with other viraemia risk factors

Hepatitis C virus [HCV] is the major cause of post-transfusion hepatitis world-wide and as thalassaemic patients are exposed to repeated bloodú transfusions, theyú are at' high-risk to get HCV infection. This study aimed at shedding some light on any association between serum cortisol, human immunodeficiency virus [HIV] or Schistosoma mansoni [S. manson i] infections and HCV viraemia in Egyptian thalassaemic children. This study was carried out on 51 thalassaemic children [34> and 17 +], aged 1-14 y attending the Hematology unit. Thirty-eight had been found to be + ve for HCV antibody [Ab], whereas 23 of them had HCV-RNA by reverse transcriptase polymerase chain reaction [RT-PCR]. All children were investigated for complete blood picture, hemoglobin electrophoresis, some liver function tests, HIV infection and serum cortisol level. Most of them tested for infection and S. mansoni serology. HCV -Ab +ve group were associated with blood transfusion >/= 10 units [P < 0.001]. heptomegaly [P < 0.05], hepatic tenderness [P< 0.0001], splenectomy [P < 0.02], elevated ALT [P < 0.01] and decreased serum cortisol [P < 0.000 1]. HCV -viraemia was associated with tender hepatomegaly [P < 0.05] only. Serum cortisol decrease was dependent on multiple blood transfusion rather than on HCV infection, whether associated with viraemia or not, in HCV-Ab the thalassaemic children. We recommend farther study for decrease of serum cortisol in HCV infected thalassaemics and other factors, not tested in the present study, behind HCV viraemia in these patients

Study of nursing student's knowledge about sexuality and sexual health

This study aimed to assess the impact of a teaching unit about sexuality and sexual health on university nursing students. All students enrolled in Maternity and Gynecological Nursing Course were included in this study [n=150]. Two tools were used for data collection: The 1st was a questionnaire to assess student's knowledge about certain areas in sexuality and sexual health e.g. female and male reproductive anatomy and physiology, sexual response cycle, female sexual response and circumcision, male and female sex problems, sex education and menopause. This tool was administered twice, once before the conduction of the teaching unit and the other at its end. The 2nd tool was the teaching unit which stressed the gaps in the student's knowledge as identified by their response in tool 1. The results revealed a general lack of knowledge in almost all the investigated parameters before the teaching unit. However, a significant improvement in student's knowledge' was observed after the teaching unit. This indicated that sex education as well as sexual health should be effectively integrated in the university nursing curriculum

Male psychogenic erectile dysfunction in elder age a myth or truth?

The existing work had investigated the main etiologic aspects in 40 elderly males, aged 56 +/- 5.9 years, suffering from secondary erectile dysfunction. Clinical, psychiatric, neurological, and urological assessments were implemented, and supported by basic assays, blood glucose and lipids, urine analysis, as well as intracavernous prostavasine injection. Cutaneous perception threshold, EMG of bulbocavernous reflex, Doppler ultrasonography, penile branchial index, cavernosometry, and cavernosography were performed for suspected cases. Predominantly psychogenic etiology, mainly depressive disorders according to DSMIII, was identified in 32.5% of cases. Predominantly organic etiology were sized in 27.5% of the study sample. Combined mixed psychogenic and organic etiologies were identified in 10% of cases. Bimixed organic etiologies were noticed in 7.5%, while multifactorial etiological factors were encountered in 22.5% of cases. Different working mechanisms are discussed, and the current work proposed recommendations that might be useful in clinical management of such cases

Neurological dysfunctions among workers exposed to inorganic lead

This study was carried out to detect the electroencephalographic [EEG] changes as well as its pattern and to study the relation between motor conduction and presence of EEG changes among workers exposed to inorganic lead. Twenty workers occupationally exposed to inorganic lead and another twenty workers not exposed to lead were chosen as index and control groups respectively. The following investigations were performed for both groups. haemoglobin [Hb], blood lead [BPb], urine delta aminolevulinic acid [ALA], motor nerve conduction velocity [MNCV] and distal latency [DL] of right radial nerve, and EEG. EEG chages were significantly more among exposed group [5 workers, 25%] than control group [0%]. Left temporal discharge was noticed among the five workers and generalized bilateral epileptic activity among only 2 of them. Among exposed group, no significant differences were seen between exposed workers with and those without EEG changes as regards all investigations. There were insignificant correlations between duration of exposure, BPb, urine ALA, MNCV and DL, and presence of EEG changes among exposed workers

Road traffic injuries admitted to Jubail hospital: a study of site, severity and outcome

The present work showed that road traffic injuries admitted to Jubail Hospital were mainly at the head and neck followed by multiple injuries. Injury severity score proved to be a good predictor to assess outcome of cases but it has to be applied also at pre-hospital level and it has to be tried and tested in other areas of Saudi Arabia. Most of the admitted injured victims suffered from mild to moderate injuries. Age, nationality, victim status proved to be important predictors of injury outcome. Improvement in the emergency medical care system is required with special emphasis on causes of case referrql to other hospitals. Careful supervision of children is required to avoid playing at streets, and use of safety measures inside cars, especially safety belts is highly bene ficial as demonstrated in other studies to lower rates of head and neck injuries

Psychological effects of trace anesthetics on physicians

This study was carried out in Alexandria University Hospital. Thirty four anesthetists were randomly selected and a similar number from the medicine department matched for age were chosen as a control group. A battery of psychological tests were administered to both groups to reveal the effect of exposure to traces of anaesthetic gases on their psychological state. The study showed that the anesthetists [index group] had a higher percent. change of stress test [16.45 +/- 15.435 compared with 7.910 +/- 5.935, t= 3.01], higher staff satisfaction [3.88 +/- 2.508 compared with 2.35 +/- 2.385] t= 2.58 while, they had a lower coronary prone behaviour score [7.29 +/- 3.61 compared with 8.88 +/- 1.62] t= 2.34. Memory, anxiety and job satisfaction scores as well as sociodemographic characteristics did not differ significantly between the two groups

Effect of race upon noise induced hearing pattern

Hearing of 2 groups of workers were compared to study the effect of race on noise induced deafness. The first group consisted of 40 Filipino workers and the other included 40 Indian workers. Matching was done for type of noise dosimetry were done for all workers included in the study. The mean age of workers was 33.87 +/- 4.02 years, while they spent 5.67 +/- 2.24 years exposed to noise which had an average level of 92.85 +/- 6.07 dB. The results indicated that both groups had a similar audiogram pattern for both right and left ears. No significant differences were observed between the 2 groups regarding the level of hearing at the measured frequencies. Both groups showed mild functional loss of hearing with no significant differences of the mean functional hearing loss of Filipinos [4.4017 +/- 4.138%] and Indians [4.4444 +/- 3.999%]

Comparison of hearing effects of different noise patterns

In this study the effects on hearing induced by occupational exposure to continuous noise with added impulses, continuous noise and intermittent noise with varying intensity were compared. Personal noise dosimetry was used to measure the level of noise exposure and pure tone audiometry was utilized to measure hearing threshold. The results indicated that these types of noise produced similar audiographic patterns. Continuous noise with added impulses affected both high and low frequencies of hearing in contrast to the other 2 types which affected mainly the high frequencies. Effects of continuous noise with added impulses appear at a shorter duration of exposure than the other types of noise

Risk of occupational eye injury

Occupational eye injury is one of the common injuries occurring at work. This research used the matched pair case control esign to study 377 pairs of workers. The maximum likelihood estimate of the odds ratio was utilized to statistically evaluate the findings. The results indicated that young age [less than 25 years], inexperience at present work chronic illness, performing unusual tasks and failure to use safety goggles were significant risk factors for occupational eye injury

Relation between personal level of noise exposure and noise induced deafness

This study was formulated to reveal the dose response and dose effect relationship between personal noise dosimetry and occupational noise induced deafness using 2 methods of deafness assessment. The included 368 production workers were from four factories. The selected workers had a mean age of 33.07 +/- 5.99 years, and exposed to noise for a relatively short period, 5.94 +/- 3.96 years. More than 65% of workers suffered from noise deafness using either method. Including level of hearing at 4000 Hz proved to be very beneficial for assessment of the relation between noise level and degree of occupational functional hearing loss. Type of noise, noise peak level, duration of exposure in addition to level of personal noise level proved to be important factors for predicting occupational hearing loss. Dose response relationship curve showed that increased noise level was accompanied by an increased proportion of workers suffering from noise deafness. At noise levels exceeding 100 dB all exposed workers suffered from occupational deafness. Due to the short duration of exposure most of the workers suffered from mild deafness

Accident proneness pattern and effect of nationality

The pattern of accident frequency was studied in a construction company. The accident records of workers for 3 consecutive years were analysed to reveal the shape of accident distribution. It was found that the distribution followed a negative binomial distribution [proneness hypothesis]. The pattern was constant over the three studied years. Significant inter-year correlation was found for the number of accident commited by the worker each year. Classification of workers by nationality after matching for type of work did not affect the accident frequency pattern. No significant differences were found among the mean accident number for Egyptians, Indians or Philipinos.