Ventilator-Associated Pneumonia: Incidence, Risk Factors and Outcome in Paediatric Intensive Care Units at Cairo University Hospital.

INTRODUCTION: Ventilator-Associated Pneumonia (VAP) is a major cause of hospital morbidity, mortality and increased health care costs. Although the epidemiology, pathogenesis and outcome of VAP are well described in adults; few data exist regarding VAP in paediatric patients, especially in developing countries. AIM: To determine the incidence, risk factors and outcome of VAP in two Paediatric Intensive Care Units (PICUs) at Cairo University Hospital. MATERIALS AND METHODS: A total of 427 patients who received Mechanical Ventilation (MV) were included in this prospective study during the period from September 2014 till September 2015. Patients were observed daily till VAP occurrence, discharge from the unit or death, whichever came first. Demographic, clinical characteristics, laboratory results, radiographic and microbiological reports were recorded for all patients. RESULTS: Nearly 31% patients developed VAP among the entire cohort. The incidence density was 21.3 per 1000 ventilator days. The most frequently isolated organisms from VAP patients were Pseudomonas aeruginosa (47.7%), Acinetobacter (18.2%) and Methicillin-resistant Staphylococcus aureus (MRSA) (14.4%). VAP patients were significantly younger than non-VAP ones. The incidence of VAP in comatose patients and those with MOSF was significantly higher. Prior antibiotic use for > 48 h before MV, supine body positioning and reintubation were significantly associated with VAP. On multiple logistic regression analysis, MOSF; prior antibiotic use > 48h; reintubation; coma; and age remained independent predictors of VAP. Mortality rate among the VAP group was significantly higher compared to the non-VAP one (68.2% vs. 48.5%, p<0.001). Survival curve analysis showed a shorter median survival time in VAP patients. CONCLUSION: Identification of risk factors and outcome of VAP in PICUs may help in reducing the incidence and improving patients' outcomes. The incidence of VAP in this study was relatively high. The most prominent risk factors for occurrence of VAP were MOSF, prior antibiotic use for > 48 h before MV, reintubation, coma and age. Proper use of antibiotics before MV in PICUs is essential. Also, adequate training of nurses and strict supervision of infection control protocols are crucial. Lack of a gold standard for the diagnosis of VAP and difficulty in sampling procedures were among the study limitations.

Health Research and Millennium Development Goals: Identifying the Gap From Public Health Perspective.

Assessing the research output within the universities could provide an effective means for tracking the Millennium Development Goals (MDGs) progress. This analytical database study was designed to assess the trend of research theses conducted by the Public Health Department (PHD), Faculty of Medicine, Cairo University during the period 1990 to 2014 as related to the: MDGS, Faculty and department research priority plans and to identify the discrepancies between researchers' priorities versus national and international research priorities. A manual search of the theses was done at the Postgraduate Library using a specially designed checklist to chart adherence of each thesis to: MDGs, Faculty and department research plans (RPs). The theses' profile showed that the highest research output was for addressing the MDGS followed by the PHD and Faculty RPs. Compliance to MDGs 5 and 6 was obvious, whereas; MDGs 2, 3, and 7 were not represented at all after year 2000. No significant difference was found between PH theses addressing the Faculty RPs and those which were not before and after 2010. A significantly lower percent of PH theses was fulfilling the PHD research priorities compared to those which were not after 2010. This study showed a definite decline in research output tackling the MDGS and PHD research priorities, with a non-significant increase in the production of theses addressing the Faculty RPs. The present study is a practical model for policy makers within the universities to develop and implement a reliable monitoring and evaluation system for assessment of research output.

Assessing the Impact of a Community-Based Health and Nutrition Education on the Management of Diarrhea in an Urban District, Cairo, Egypt.

Diarrhea is considered as a major cause of mortality in children aged less than five years old. This pre/post interventional study was designed to assess maternal knowledge about diarrhea and implement a community-based health and nutrition education messages. The study was held in Al-Darb Al-Ahamar (ADAA) district, Cairo, Egypt and targeted a random sample of 600 mothers having at least one child under-five years old and complained of at least one previous attack of diarrhea. The study was conducted in three phases. The pre-intervention phase included a base line survey for the mothers and training activities for the community health workers (CHWs). Intervention phase included health and nutrition education sessions; performance evaluation for the CHWs during providing the message. In phase three, the mothers had no instructions for 3 months then the post- intervention interview and feedback sessions were conducted. Results showed that knowledge of mothers about diarrhea (etiological factors and preventive measures) had improved significantly after the intervention. During observation CHWs' scored 50% of the required tasks in education and communication skills. In the feedback sessions, all the mothers declared that nutrition education sessions were highly valuable, and asked for on-going support and training programs. The current study found that health and nutrition education sessions were successful in improving mothers' knowledge regarding preventive measures and management of diarrhea. CHWs are effective health education providers especially in household based intervention. Thus, health services should support community based interventions to reinforce mothers' knowledge and practices towards their sick children.

Causes and outcome predictors of traumatic brain injury among emergency admitted pediatric patients at Cairo University Hospitals.

BACKGROUND: Traumatic brain injury (TBI) is a major global public health problem with significant morbidity and mortality, especially among the pediatric age group. Researchers are eager to find new diagnostic tools that might be useful for outcome prediction of pediatric TBI. OBJECTIVE: This study aims to determine the causes of TBI in pediatric patients admitted to the Emergency Hospital at Cairo University, and monitor and evaluate some clinical and laboratory markers for outcome prediction. PATIENTS AND METHODS: A hospital-based prospective study was carried out; all pediatric patients with TBI admitted to the New Emergency Hospital during 6 months (November 2014-April 2015) were enrolled in the study. A total of 67 pediatric patients with TBI were examined and investigated upon admission and followed prospectively till discharge or death. Probing questions were used to collect data on child abuse and neglect. The Glasgow Coma Scale (GCS) was used for clinical assessment, followed by cerebral tomography (computed tomography scan). Routine laboratory investigations, arterial blood gases (pH, PCO2, and HCO3), and coagulopathy tests (prothrombin time, prothrombin concentration, international normalized ratio, and D-dimer) were performed on days 1 and 7. RESULTS: Fall from height, traffic accidents, and direct head trauma represented 38.8, 34.3, and 21% of head trauma etiologies, respectively. Child neglect and abuse was detected in 62.7 and 18% of patients, respectively. Values of GCS at days 1 and 7 were significantly higher among survivors (P<0.001). D-dimer levels on days 1 and 7 were significantly higher among nonsurvivors (P<0.001). Receiver operating characteristics curve analysis showed the discriminative ability of D-dimer level on day 1 in predicting mortality with 89.3% sensitivity and 76.9% specificity. CONCLUSION AND RECOMMENDATIONS: Falls, traffic accidents, and direct head trauma were the most frequent etiologies for TBI in emergency admitted pediatric patients. Child neglect and abuse were the most prominent predisposing factors. GCS and D-dimer were the most important clinical and laboratory markers predicting mortality. Further large-scale studies are needed to determine the prevalence of TBIs and to prove the prognostic role of the D-dimer.

Impact of an infection-control program on nurses' knowledge and attitude in pediatric intensive care units at Cairo University hospitals.

BACKGROUND: Healthcare-associated infection is a prominent problem among patients in pediatric intensive care units (PICU) as it could result in significant morbidity, prolonged hospitalization, and increase in medical care costs. The role of nurses is extremely important in preventing hazards and sequela of healthcare-associated infections. OBJECTIVE: The aim of this study was to assess the effect of a health education program regarding infection-control measures on nurses' knowledge and attitude in PICUs at Cairo University hospitals. PARTICIPANTS AND METHODS: This was a pre-post test interventional study in which a convenient sample of 125 nurses was taken from the nursing staff in different PICUs at Cairo University hospitals. The study took place in three phases. In the first phase, the nursing staff's knowledge, attitude and practice concerning infection-control measures were tested using a self-administered pretested questionnaire and an observation checklist. The second phase included health education sessions in the form of powerpoint and video presentations; and in the third phase the nurses' knowledge and attitude on infection-control measures were reassessed. RESULTS: A significantly higher level of knowledge was revealed in the postintervention phase as compared with the preintervention phase with regards to the types of nosocomial infections (94.4 vs. 76.8%, P<0.001), the at-risk groups for acquiring infection (95.2 vs. 86.4%, P=0.035) and the measures applied to control nosocomial infections (89.6 vs. 68%, P<0.001). Nurses in the postintervention phase had significantly more knowledge about the types of hand washing (99.2 vs. 91.2%, P=0.006). A significantly higher percent of nurses in the postintervention phase knew the importance of avoiding recapping syringes (72.8 vs. 34.4%, P<0.001) and believed that infection-control measures could protect them completely from acquiring infection (79.2 vs. 65.6%, P=0.033). Statistically significant higher total knowledge and attitude scores were revealed in the postintervention phase as compared with the preintervention one (P<0.001). The percentage practice score of observed units was the highest among nurses in the neonatal intensive care unit at the Japanese Hospital (88%), whereas it was the lowest in the emergency pediatric unit (65%). CONCLUSION AND RECOMMENDATIONS: There is scope for improvement in knowledge and attitude after educational program was offered to the nursing staff. Educational training programs should be multidisciplinary interventions in the era of quality control to help healthcare workers realize the importance of basic infection-control measures in reducing pediatric morbidity and mortality and improving the quality of care.