Needlestick injuries among health care workers of University of Alexandria hospitals

The aims of tiis cross-sectiona sffi and circumstances of needlestick injury [NSI] among heath care workers at University of Alexandria teaching hospitals and to assess the effectiveness of the existing control measures and standard precautions Data were obtained by anonymous, self-reporting questionnaire from 645 staff in 2007. Around two-thirds of workers [67.9%] had suffered at least 1 NSI in the last 12 months. High-risk patients [with history of HIV, hepatitis B virus or, hepatitis C virus infection or injecting drug use] were involved in 8.2% of injuries. On evaluating the effectiveness j of existing control measures, significant were: using devices with safety features [OR 0.41], adherence to infection control guidelines [OR 0.42] tranining in injection safety [OR 0.14], comfortable room temperature [OR 0.32] and availability of a written protocol for prompt reporting [OR 0.37]

Gender differences in factors associated with patients' decisions to seek treatment for urinary incontinence in Alexandria, Egypt

The objective of this descriptive, hospital-based comparative cross-sectional survey was to determine gender differences in factors associated with patients' decisions to seek treatment for urinary incontinence [Ul]. Using an interview questionnaire, data were collected from 353 patients attending clinics at hospitals in Alexandria, Egypt. There were differences between males and females regarding specific psychosocial factors motivating health care seeking behaviour. Women had fewer hospital admissions and hospital days and less use of diagnostic procedures and surgery. More women suffered from at least one negative impact on their social lives compared to men. The impact of symptoms on quality of life appeared to be the main trigger for seeking help for Ul in both men and women

Kinetic studies and thermodynamic treatments of substituent effect of the alkaline hydrolysis of acetoxybenzenes and acetoxynaphthalenes

The kinetics of the alkaline hydrolysis of acetoxybenzene, 1,4-diacetoxybenzene, l-acetoxynaphthalene, 1,4-diacetoxynaphthalene and 1,5-diacetoxynaphthalene have been studied in 50% [v/v] dioxane-water. Analysis of the data showed that an increase in the rate was found to be dependent on the position of the acetoxy group. Also, the presence of oxo-group caused an inhibition in the rate to a great extent either in the naphthalene or benzene compounds. The various thermodynamic parameters were deduced. A linear free energy relationship was observed for such substituted acetoxynaphthalene where a good correlation between log k vs. deltaij was observed. Also, the effect of bromo-substitution on the rate of hydrolysis of 2-acetoxynanphthalene has been studied

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

Spectral studies on some pyrimidine derivatives

The electronic absorption spectra of 2-[2'-Thiopyrimidine]-5-nitro-pyridine [I], 1[2'-Thiopyrimidine]-2, 4-dinitrobenzene [II] 2-[2'-Thiopyrimidine]-1, 3, 5-trinitrobenzene [III] and 3-[[2'-Thiopyrimidine] methyl] benzoic acid [IV] were measured in a series of fifteen different solvents. The solvent effects induced spectral shifts in the different peak locations have been analyzed as a function of different solute-solvent interaction mechanisms. Ground state properties of optimum molecular geometries, singlet-singlet electronic transitions have been calculated using the AM1, PM3, ZINDO/S and ab initio/3-21G methods

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

Electronic spectral properties of quinoxalinones and thioquinoxalinones in different solvents

The electronic absorption spectra of 3-benzyl-1H- quinoxalin-2- one and 3-benzyl-1H-quinoxalin-2-thione in solvents of different polarity were analyzed by the multiple regression technique using the equation psi = a[0] + a[1]x[1] + a[2]x[2] + a[3]x[3] +.... The constants a[1], a[2], a[3], ' are the different regression coefficients and the constant a[0] is the regression intercept. The x[1], x[2], x[3], ' are different solvent polarity parameters. The multiple regression coefficients [MRC] were also calculated. The values of the acid dissociation constants of both compounds were determined

Kinetics of the reaction of 2-chloro-3,5-dinitro-pyridine with aniline in hydroxylic solvents

The rates of aromatic nucleophilic substitution [ANS] reactions are notably affected by the solvent polarity such as substrate or intermediate[s] solvent interactions[1-3], the non-specific coulombic, inductive and dispersion interactions, specific hydrogen bond, electron pair donor [EPD], electron pair acceptor [EPA] and solvophobic interactions[4]. It has been found that the reaction of nitroaryl halides with amines in hydroxylic solvents was inversely proportional to the hydrogen bond donating [HBD] ability of the solvent[5]. Moreover, the reaction rate in these hydroxylic solvents was found to be smaller than that in aprotic solvents, which suggests that inter-and intramolecular bond interactions, in the pure solvent and between the solvent and the amine, are relevant in determining the reaction rates[6]. The object of this work was to supplement a systematic study of the hydroxylic solvents influence on the reaction rate of 2-chloro-3,5-dinitropyridine with aniline as a simple model in heterocyclic rings of the ANS [Aromatic nucleophulic substitution] reaction. Also, it is of interest to correlate the kinetic data with E[T[30]] values on rates the preferential solvation in order to evaluate its influence

Management of premature rupture of the membrane [PROM] in Shatby Maternity University Hospital as compared to evidence-based management

The study was undertaken to assess current obstetric practices of both diagnosis and management of premature rupture of membrane at Shatby Maternity Hospital in Alexandria as compared to evidence-based obstetric practices. A cross sectional approach was used to assess 200 women having PROM where: I- Practices of diagnosis were assessed including history of gush of water, bleeding, smoking and recurrence of rupture of membranes in the previous deliveries, also the mode of examination were assessed including using dry clean sterile speculum, regional swab as well as the use of ultrasound for the diagnosis. II- The practices of clinical management were assessed in all cases where antibiotics, tocolytic and/or corticosteroids were taken or not. The mode of delivery whether expectant or active one were assessed also the foetal outcome of delivery in the term of Apgar score were assessed. Shatby Maternity Hospital in Alexandria is the largest and main obstetric hospital, with nearly 15,000 admissions per year and 9,000 deliveries. A questionnaire was done the morning following delivery and before discharge. Data obtained from cases themself, files and attending obstetricians were assessed; where 98% of cases were complaining of gush of water and 58% of them had a history of recurrent PROM. Almost all cases were subjected to ultrasound examination which is the main tool of diagnosis, during the clinical management antibiotics, tocolytics and corticosteroids were taken 90%, 40% and 54% respectively, most of cases were subjected to induction of labour [70%] failed, only in 20% of cases. Only 2% of newly born were admitted to neonatal unit suffering from infection and prematurity. It seems that current practices of diagnosis and management of PROM at Shatby Maternity University Hospital are not that far of the evidence-based practice, some modifications, when applied can make such practices up to the evidence based practice

Estrogen receptor beta gene polymorphism and endometrial inadequacy

To correlate four estrogen receptor beta polymorphisms to endometrial thickness. 24 patients with consistently thin endometrium, in natural and stimulated cycles undergoing controlled ovarian hyper stimulation for ICSI for various indications and 50 control subjects with normal endometrium undergoing COH for ICSI for male factor infertility. Sonographic evaluation of endometrium, PCR on peripheral blood leucocytes using specific primers to detect the determined four polymorphisms, as well as hormone values in COH cycles and ICSI outcome, are recorded. The deletion polymorphism was not found in either groups. The second polymorphism [P846] was significantly more commonly detected in cases of normal endometrium [50% versus 8% in cases with thin endometrium]. The third polymorphism [P1082] was not found in control group and only one case [4%] with thin endometrium and this was not significant. The last silent polymorphism [P1421] was found in 8% of cases and surprisingly all subjects of control group and this was statistically highly significant. The presence of certain ER beta polymorphisms correlate with good endometrial thickness

P300 auditory event-related potential for the diagnosis of subclinical hepatic encephalopathy and prediction of overt encephalopathy in cirrhotic children

Subclinical hepatic encephalopathy [SHE] has been recognized in patients with cirrhosis, irrespective of its etiology. It is of special clinical relevance to identify this condition and to assess its progression to overt encephalopathy. This study was conducted [I] to evaluate the diagnostic usefulness of auditory P3ERP in the detection of SHE in cirrhotic children, to compare it with that of an EEG and a standard psychometric test, and [ii] to examine the clinical progression of SHE to overt HE during follow up. Thirty-four non-encephalopathic cirrhotic children [19M and 15F, mean age 9.84 +/- 3.13 yr] were studied using auditory P300 event related potential [P3ERP], EEG and the number connection test [NCT]. Cut off values for abnormalities in the tests were developed from 45 ages matched controls. Patients were followed regularly for the development of overt HE and the precipitating factors were noted. P3ERP latencies [342.0 +/- 29.4 ms vs. 296.4 +/- 28. 5ms] and NCT time [62.6 +/- 31.3s vs. 43.8 +/- 15.2s] were significantly prolonged in cirrhotics compared to controls. 16 [47%] children had SHE based on at least one abnormal test result. P3ERP detected SHE in maximum number of patients [30%] followed by EEG [23.5%] and NCT [17.6%]. About 55% of patients with SHE progressed to overt SHE within a mean duration of 4 months. Multivariate analysis showed that abnormality on P3ERP and EEG as well as prior episode of HE, occurrence of G.I bleed, dehydration and infection had significantly higher risk for development of overt HE. P3ERP method was more sensitive in detection of SHE in cirrhotic children. Abnormal P3ERP and EEG along with the precipitating factors were significantly associated with development of overt HE

Gall bladder sludge and stones in multitransfused Egyptian thalassaemic patients

One hundred Egyptian beta-thalassaemic patients on a long-term transfusion/chelation programme were evaluated for the prevalence of all bladder sludge and stones and the associated risk factors. Fifty healthy individuals served as controls. Abdominal ultrasonography revealed that 14% of the thalassaemic patients had gall bladder sludge or stones [6% stones and 8% sludge]. The thalassaemic patients with this complication were older, had a higher prevalence of gall bladder symptoms, higher levels of pretransfusion haemoglobin, larger amounts of transfused red cells, and more were regularly transfused. Multiple logistic regression analysis revealed that the presence that gall bladder symptoms and the amount of transfused red cells were the only significant predictors of the occurrence of gall bladder sludge or stones

genetic epidemiological study of malformations at birth in Egypt

A total of 3000 consecutive neonates delivered in a maternity hospital in Giza, Egypt, were subjected to full clinical and genetic evaluation. Social data included parental consanguinity and social class. The prevalence of malformations in the 3000 hospital live births and stillbirths was 3.17%. Malformed neonates [95] were classified into 13 groups according to the system affected using World Health Organization classification of congenital malformations. The most common anomalies were: central nervous system [29.5%], musculoskeletal system [20.0%] and genetic syndromes [13.7%]. Parental consanguinity was found in 31.79% of all cases and in 55.0% of malformed cases, thus illustrating the deleterious effects of consanguinity

Reversibility of mitral regurgitation following rheumatic fever: clinical profile and echocardiographic evaluation

The clinical disappearance of the murmur of rheumatic mitral regurgitation after a period of time has been documented by many researchers. However no studies have related the disappearance of the murmur with the functional or anatomical state of the mitral valve. This study was done to elucidate the mitral valve status using Doppler and color coded echocardiography among those children who have lost their apical pansystolic murmur on auscultation following.a documented attack of rheumatic fever. The study sample consisted of 51 patients including 31 patients in whom the murmur has disappeared [group I], and 20.patients with persistent isolated isolated mitral regurgitation [group II]. Patients of group I had significantly lower grades of murmur intensity, lower incidence of cardiomegaly, and had no heart failure in the initial attack. They were compliant with prophylaxis and had less recurrences than patients of group II. The murmur disappeared in patients of group I from ' to 14 years after the initial attack. Echocardiography revealed that such patients had a normal mitral valve apparatus, and a normal heart size and function. Only5patients of this group had a significant regurgitant jet demonstrated by colour Doppler. We conclude that recovery of the mitral valve and return of cardiac functions to normal is possible in patients inaudible mild regurgitation. Patients who have lost their murmur maybe allowed to exercise freely, yet penicillin prophylaxix should not be discontinued

Genetic markers in coronary heart disease

Coronary heart disease [CHD] was found to aggregate in families. So the present study aimed at studying certain genetic markers [lipoproteins, ABO blood groups and dermatoglyphics], in a group of 60 patients with CHD and a control group to detect any significant association between such genetics markers in this disorder. This can throw light on its genetics. The study revealed significant and marked association of CHD with low alpha-lipoprotein, high pre-beta and beta-lipoproteins. No significant association was detected with ABO phenotypes. Definite significant association was also detected between CHD and certain dermatoglyphics phenotypes including FTP, T-D count and palm patterns. These significant associations of CHD and these genetic markers which are genetically determined denoted strongly genetic etiology or at least genetic predisposition of CHD. Detection of such genetic markers may help in determination of risky individuals in population and families of CHD patients. This can help in prevention by proper genetic counseling