Structural-Guided Identification of Small Molecule Inhibitor of UHRF1 Methyltransferase Activity.

Ubiquitin-like containing plant homeodomain Ring Finger 1 (UHRF1) protein is recognized as a cell-cycle-regulated multidomain protein. UHRF1 importantly manifests the maintenance of DNA methylation mediated by the interaction between its SRA (SET and RING associated) domain and DNA methyltransferase-1 (DNMT1)-like epigenetic modulators. However, overexpression of UHRF1 epigenetically responds to the aberrant global methylation and promotes tumorigenesis. To date, no potential molecular inhibitor has been studied against the SRA domain. Therefore, this study focused on identifying the active natural drug-like candidates against the SRA domain. A comprehensive set of in silico approaches including molecular docking, molecular dynamics (MD) simulation, and toxicity analysis was performed to identify potential candidates. A dataset of 709 natural compounds was screened through molecular docking where chicoric acid and nystose have been found showing higher binding affinities to the SRA domain. The MD simulations also showed the protein ligand interaction stability of and in silico toxicity analysis has also showed chicoric acid as a safe and nontoxic drug. In addition, chicoric acid possessed a longer interaction time and higher LD50 of 5000 mg/kg. Moreover, the global methylation level (%5 mC) has been assessed after chicoric acid treatment was in the colorectal cancer cell line (HCT116) at different doses. The result showed that 7.5 µM chicoric acid treatment reduced methylation levels significantly. Thus, the study found chicoric acid can become a possible epidrug-like inhibitor against the SRA domain of UHRF1 protein.

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.

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

تقيم هذه الدراسة المعارف والمواقف والممارسات لدى العاملين في الرعاية الصحية تجاه إدارة التخلص من الفضلات في مستشفيات جامعة عين شمس في القاهرة، مصر. وهي دراسة مستعرضة شملت 110 أطباء و 151 ممرضة و 89 من العاملين في خدمة الغرف، إذ أجرت الباحثات معهم مقابلات استخدمن فيها استبيانا مسبق التصميم. واتضح للباحثات أن العاملين في خدمة الغرف أكثر إطلاعا من الأطباء ومن الممرضات على سياسات ونظم التخلص من الفضلات في المستشفى، ولكنهم أقل إطلاعا على تفاصيل نوعية خاصة بذلك. كما أحرز العاملون في خدمة الغرف أعلى الدرجات الإجمالية في المواقف من التخلص من الفضلات من بين الفئات الثلاث. كما كان لدى الممرضات درجات ممارسة مقبولة [84 %]أكثر مما لدى الأطباء [67.3 %][في حين لم تقم الباحثات بتقييم العاملين في خدمة الغرف]. ولم يترافق التدريب ولا فترة العمل ترافقا يعتد به مع الدرجات المحرزة في المعارف والمواقف والممارسات، إلا لدى الممرضات اللاتي لديهن خبرة أطول، واللواتي يغلب أن حصلن على معلومات مقبولة حول التخلص من الفضلات تزيد على ما لدى الممرضات ذوات الخبرة الأقل

ABSTRACT 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.

RÉSUMÉ La présente étude a évalué les connaissances, les attitudes et les pratiques des prestataires de soins de santé au sujet de la gestion des déchets au sein du Centre hospitalier universitaire d'Ain Shams au Caire (Égypte). Dans la présente étude transversale, 110 médecins, 151 infirmières et 89 agents de ménage ont été interrogés à l'aide d'un questionnaire préétabli. Les agents de ménage avaient nettement plus de connaissances que les médecins ou les infirmières sur les politiques et les systèmes d'élimination des déchets à l'hôpital, mais moins de connaissances détaillées spécifiques sur l'élimination. Les agents de ménage ont aussi obtenu les scores généraux les plus élevés des trois groupes pour les attitudes vis-à-vis de l'élimination des déchets. Les infirmières étaient beaucoup plus nombreuses à obtenir des scores satisfaisants pour la pratique (84,0 %) que les médecins (67,3 %) (les agents de ménage n'ont pas été évalués sur ce point). La formation et le nombre d'années d'expérience n'étaient pas significativement associés aux scores pour les connaissances, les attitudes et les pratiques, sauf chez les infirmières qui avaient une expérience professionnelle plus longue. Ces dernières étaient plus susceptibles d'obtenir des scores satisfaisants pour les connaissances sur l'élimination des déchets que les infirmières moins expérimentées.

Comparative study between laparoscopic and open repair of paraumbilical hernia.

UNLABELLED: This randomized prospective study compared the effectiveness of laparoscopic paraumbilical hernioplasty to the conventional open technique. Forty patients with paraumbilical hernia were randomly categorized into 2 equal groups. GL treated by laparoscopic paraumbilical hernioplasty and GO treated by conventional (open) umbilical hernioplasty. The mean length of follow up was 36 months. In GL, mean operative time was 58.1 +/- 15.5 minutes, in GO, it was 42.2 +/- 10.3 minutes (p = 0.0005). Postoperative pain score 6 hours after surgery was 2.95 +/- 1.19 in GL patients as compared to 6.10 +/- 1.74 in GO ones (p < 0.0001). Mean hospitalization time was 1.05 +/- 0.224 days in GL versus 1.25 +/- 0.550 days in G O (p = 0.14). There was one conversion (5%) to the open repair. Postoperative seroma occurred in 2 patients (10%) in GL and 3 patients (15%) in GO. Three patients (15%) in G O developed surgical site infection. Hernia recurrence was not seen in either 2 Groups. Mean patient satisfaction score for GL patients was 7.85 +/- 1.27 versus 6.00 +/- 1.69 for GO patients (p = 0.0004). CONCLUSION: Compared to open repair, laparoscopic repair is technically feasible, safe and effective, with good clinical outcome. It is associated with longer time for surgery but reduced postoperative pain, analgesic requirement, complication and infection rates with earlier return to normal activities.

Epidemiologic pattern of falls among inpatients in Ain Shams University Hospitals in Cairo, Egypt.

BACKGROUND: Patient falls and injuries during hospitalization is a good quality indicator of safety of inpatients. Data on inpatients falls are deficient in Egyptian hospitals. Ain Shams university hospitals do not have any recording system for falls. AIM: This study aimed at estimating the incidence density of falls and describing pattern and risk factors contributing to falls in Ain shams university hospitals. SUBJECTS AND METHODS: A prospective follow up study was conducted on inpatients admitted to Ain Shams university hospitals. Patients were followed up for a maximum of two weeks for the occurrence of fall. An interview questionnaire addressed to in-patients was designed to investigate the incident of fall. Type of fall, provisional cause, consequences, night or day timing of fall, walking condition in hospital and past history of fall were among the factors investigated in the incident of fall. Questionnaire assessing the basic and instrumental daily activities for the elderly (>60 years) was completed. RESULTS: 1779 patients were included in the study in eight different wards with a mean age of 41.8 years. The incidence density of falls was 9 per 1000 patient days. Logistic regression analysis identified male gender, walking difficulties in-hospital and history offalls before hospitalization as independent risk factors for falls among below 60 years patients. CONCLUSION: Incidence of falls is relatively high among the studied university hospitals. Identified risk factors differed among adults compared to elderly. RECOMMENDATIONS: Measuring, monitoring and assessing fall rates are strongly recommended using a valid and reliable tool to improve quality of health services.

Prevalence of unmet contraceptive need among Egyptian women: a community-based study.

INTRODUCTION: An estimated 17% of married women in the developing world still have an unmet need for contraception. This study aimed to measure the prevalence and reasons for unmet contraceptive need among married women in the childbearing period in an underprivileged district in Eastern Cairo. METHODS: A cluster survey of 2340 women in the Marg district of Eastern Cairo was performed. Socio-demographic data and data on both past and present contraceptive use were obtained by interview questionnaire. RESULTS: The prevalence of unmet need was 7.4%; 53.4% for limiting and 46.6% for spacing. Experience of side effects from contraceptive use, and fear of side effects, was highly prevalent among women with unmet need. In addition, a large proportion of women with unmet need perceived themselves not to be at risk for conceiving. CONCLUSIONS: A substantial proportion of women in Cairo have unmet contraceptive need. Efficient counseling of women about contraception may help reduce this high prevalence.

Assessment of knowledge, attitude and practice of hand washing among health care workers in Ain Shams University hospitals in Cairo.

Most nosocomial infections are thought to be transmitted by the hands of health care workers. The aim of this work was to assess the knowledge, attitude and practice of hand washing among health care workers (HCW) in Ain-Shams University hospitals and to investigate the presence of the necessary facilities and supplies required for hand washing (HW) in ten wards. A cross-sectional descriptive and observational study was conducted for six months from June till November 2006. Observation of the HCW for hand washing practice was done at any opportunity of contact with the patients in the different wards by members of the infection control team. Knowledge & attitude of HCW towards hand hygiene was done through self-administered questionnaire to HCW in 10 different departments. The total opportunities observed were 2189 opportunities. Doctors showed a significantly higher compliance (37.5%) than other groups of HCW (P = 0.000), however only 11.6% of the opportunities observed for doctors were done appropriately. The most common type of HW practiced among HCW was the routine HW (64.2%) and the least was the antiseptic HW (3.9%). Having a short contact time and improper drying (23.2%) were the most common errors that lead to inappropriate HW. Most of the wards had available sinks (80%) but none of them had available paper towels. The mean knowledge score was higher in nurses compared to doctors (42.6 +/- 1.7 versus 39.1 +/- 10.5). Most of the nurses (97.3%) believe that administrative orders and continuous observation can improve hand washing practices. Implementation of multifaceted interventional behavioral hand hygiene program with continuous monitoring and performance feedback, increasing the supplies necessary for HW and institutional support are important for improving the compliance of hand hygiene guidelines.

Dissection of familial correlations in hepatitis C virus (HCV) seroprevalence suggests intrafamilial viral transmission and genetic predisposition to infection.

OBJECTIVE: Unsafe injections and transfusions used during treatments are considered to be responsible for many cases of transmission of hepatitis C virus (HCV) in developing countries, but cannot account for a substantial proportion of present infections. The aim of the present work was to investigate familial clustering of HCV infection in a population living in a highly endemic area. DESIGN, SETTING AND PARTICIPANTS: A large seroepidemiological survey was conducted on 3994 subjects (age range, 2-88 years) from 475 familial clusters in an Egyptian rural area. Epidemiological methods appropriate for the analysis of correlated data were used to estimate risk factors and familial dependences for HCV infection. A phylogenetic analysis was conducted to investigate HCV strain similarities within and among families. MAIN OUTCOME MEASURES: HCV familial correlations adjusted for known risk factors, similarities between viral strains. RESULTS: Overall HCV seroprevalence was 12.3%, increasing with age. After adjustment for relevant risk factors, highly significant intrafamilial resemblances in HCV seroprevalence were obtained between father-offspring (odds ratio (OR) = 3.4 (95% confidence interval (CI), 1.8 to 6.2)), mother-offspring (OR = 3.8 (95% CI, 2.5 to 5.8)), and sibling-sibling (OR = 9.3 (95% CI, 4.9 to 17.6)), while a weaker dependence between spouses (OR = 2.2 (95% CI, 1.3 to 3.7)) was observed. Phylogenetic analysis showed greater HCV strain similarity between family members than between unrelated subjects, indicating that correlations can be explained, in part, by familial sources of virus transmission. In addition, refined dissection of correlations between first-degree relatives supported the role of host genes predisposing to HCV infection. CONCLUSIONS: Current HCV infection in endemic countries has a strong familial component explained, at least partly, by specific modes of intrafamilial viral transmission and by genetic predisposition to infection.

Metabolic and cardiovascular risk profiles and hepatitis C virus infection in rural Egypt.

BACKGROUND AND AIMS: To investigate the relationship between lipid profiles and diabetes with past and chronic hepatitis C virus (HCV) infection among village residents of Egypt. PATIENTS AND METHODS: Fasting lipids and glucose profiles were compared among adults never infected with HCV (negative HCV antibodies), infected in the past (positive HCV antibodies and negative HCV RNA) and chronically infected (positive HCV antibodies and HCV RNA). RESULTS: Of the 765 participants, 456 (59.6%) were female, and median age was 40 (range 25-88) years. Chronic HCV infection was present in 113 (14.8%) and past infection in 67 (8.8%). After adjustment for age and sex, participants with chronic HCV infection had lower plasma low density lipoproteins (LDL) cholesterol and triglyceride levels compared with those never infected (age and sex adjusted differences (95% CI) were -19.0 (-26.3 to -11.7) mg/dl and -26.2 (-39.0 to -13.3) mg/dl, respectively). In contrast, participants with cleared HCV infection had higher triglyceride levels compared with those never infected (age and sex adjusted difference (95% CI) was +16.0 (0.03 to 31.9) mg/dl). In multivariate analysis, participants with chronic HCV infection were more likely to have diabetes (OR 3.05, 95% CI 1.19 to 7.81) compared with those never infected, independent of LDL cholesterol levels. CONCLUSION: In conclusion, this community based study has shown that in a single population, chronic HCV infection is associated with glucose intolerance and, despite that, a favourable lipid pattern. An intriguing finding was the high triglyceride levels observed among participants with past infection, suggesting that elevated triglycerides at the time of acute infection may facilitate viral clearance.

Higher clearance of hepatitis C virus infection in females compared with males.

BACKGROUND AND AIMS: According to the literature, 14-46% of subjects clear hepatitis C virus (HCV) from blood after infection. Controversy exists about sex differences in HCV clearance rates. PATIENTS AND METHODS: We compared HCV clearance in males and females using data from a large population based study on HCV infection in Egypt. Definitions used in the paper were: cleared HCV infection (positive HCV antibody and negative HCV RNA test results) and chronic HCV infection (positive HCV antibody and positive HCV RNA test results). The study sample included 4720 village residents aged 18-65 years recruited through home based visits (n = 2425) or voluntary screening (n = 2295). RESULTS: Overall, HCV antibody prevalence was 910/4720 (19.3% (95% confidence interval 18.2-20.4)). Of those with HCV antibodies (n = 910), 61.5% had chronic HCV infection. Compared with males, females were more likely to have cleared the virus (44.6% v 33.7%, respectively; p = 0.001). Control for age, schistosomiasis history, iatrogenic exposures, and sexual exposure to HCV did not alter the positive association between female sex and viral clearance. CONCLUSION: This study provides strong evidence in favour of a higher HCV clearance rate in females compared with males.

Sudden arrhythmia death syndrome: importance of the long QT syndrome.

In approximately 5 percent of sudden cardiac deaths, no demonstrable anatomic abnormality is found. Some cases are caused by sudden arrhythmia death syndrome. A prolonged QT interval is a common thread among the various entities associated with sudden arrhythmia death syndrome. A number of drugs are known to cause QT prolongation (e.g., terfenadine), as are hypokalemia, hypomagnesemia, myocarditis, and endocrine and nutritional disorders. Recently, attention has focused on a group of inherited gene mutations in cardiac ion channels that cause long QT syndrome and carry an increased risk for sudden death. Some of the highest rates of inherited long QT syndrome occur in Southeast Asian and Pacific Rim countries. The median age of persons who die of long QT syndrome is 32 years; men are predominately affected. In addition to a prolonged QT interval, which occurs in some but not all persons with long QT syndrome, another characteristic electrocardiographic abnormality is the so-called Brugada sign (an upward deflection of the terminal portion of the QRS complex). Most cardiac events are precipitated by vigorous exercise or emotional stress, but they also can occur during sleep. Torsades de pointes and ventricular fibrillation are the usual fatal arrhythmias. Long QT syndrome should be suspected in patients with recurrent syncope during exertion and those with family histories of sudden, unexpected death. Unfortunately, not all persons with long QT syndrome have premonitory symptoms or identifiable electrocardiographic abnormalities, and they may first present with sudden death. Beta blockers, potassium supplements, and implantable defibrillators have been used for treatment of long QT syndrome. Identifying the specific gene mutation in a given patient with long QT syndrome can help guide prophylactic therapy.

Accident prevention program in a glass factory in Shoubra El Khema district.

BACKGROUND: An accident can be defined as an unplanned event that results in or suggests the possibility of personal injury, property damage production interruption diminished health or environmental damage. The accidents have a cost impact on the employees and the company itself. OBJECTIVE: This intervention study was carried out to decrease the accident rate in a glass factory in Shoubra El-Khema district. METHODS: A glass factory in Shoubra El-Khema was selected to implement an intervention program. The program was done through three phases. 1. A preliminary interview questionnaire. 2. Seminars of health education were done to all workers and managers with availability of health education posters, establishment of accident committee and a new reporting system, contract with a housekeeping company was done and also training of some leaders. 3. Concurrent and final evaluation of the program was done. RESULTS: The incidence rate, frequency and severity rate of accidents were decreased at the end of the year after the intervention program. The differences were statistically significant. The opinions of the workers and managers about the different causes of accidents were changed. The belief of the workers and managers about efficiency of health educatio program was changed. Some leaders were trained on skills of health education. Modification of reporting and notification system was done. CONCLUSION: This intervention study succeeded in decreasing accidents rates and increasing the awareness of the managers to decrease accident rates. The beliefs and thoughts o both workers and managers became near to each other. The production loss due to days lost by accidents was reduced. RECOMMENDATIONS: Upgrading process in the factory are recommended to eliminate the hazards at source. Sustaining and continuation of the established preventive program should be done. Trying to apply the program in similar factories is also recommended.

ECHOCARDIOGRAPHIC ABNORMALITIES OF THE MITRAL VALVE ASSOCIATED WITH A LARGE PERICARDIAL EFFUSION.

Features of mitral stenosis and systolic anterior motion of the mitral valve were observed on the echocardiogram of a patient with a large posterior pericardial effusion. The abnormal findings disappeared with resolution of the fluid. Because pericardial effusion may result in the echocardiographic alteration of cardiac structures, repeat study is necessary after the effusion has cleared.

EXERCISE TESTING AND LEFT MAIN CORONARY ARTERY DISEASE: EXPERIENCE WITH 57 PATIENTS.

Results of multistage treadmill tests (TMT) of 57 patients with critical stenosis (>/= 50%) of the left main coronary artery were analyzed. Additional disease was present in the major vessel in three patients (5%), two vessels in 18 patients (32%), and three vessels in 35 patients (61%). The TMT was negative for ischemia in only two patients (4%), positive in 51 (89%), and undetermined in 4 (7%). TMT was strongly positive (>/= 2 mm ST segment depression) in 40 patients (70%), and in 11 (19%) of these, ST depression was >/= 3 mm. Hypotension with exercise was rare and was encountered in only one patient. Arrhythmias were induced with exercise in six patients (10%) and resulted in premature termination of TMT in four. TMT was terminated due to early ST segment depression in 40 patients (70%), in 17 (30%) without chest pain-an unusual finding. Exercise was limited to stage I (Bruce protocol) in 16 (28%), stage II in 26 (46%), stage III in ten (17%), and stage IV in five (9%). Mean exercise tolerance was 298 +/- 22 seconds (SEM). Maximum heart rate (HR) achieved was 76 +/- 2% of their maximal predicted values. Peak double product (systolic BP x HR) was 20490 +/- 830. The data suggest that the TMT is rarely negative in the presence of LM lesions. An early strongly positive response with or without pain should lead one to suspect LM disease. Exercise-induced hypotension is rare. Limited exercise tolerance and/or early ST segment depression in stages I and II of TMT seem to be predictive of the severity of LM lesions.

SILENT MYOCARDIAL INFARCTION WITH POSTERIOR INFERIOR PSEUDOANEURYSM OF THE LEFT VENTRICLE PRESENTING AS A POSTERIOR LUNG MASS.

An asymptomatic 62-year-old man developed a density in his left lower hemithorax in the retrocardiac position on chest roentgenogram, which was discovered during a routine evaluation. This was diagnosed in another hospital as a lung tumor, for which he underwent an exploratory left thoracotomy. This case points out the difficulty in the diagnosis of retrocardiac masses and suggests that echocardiography and cardiac angiography should be accomplished before attempting needle aspiration or an open lung biopsy. The absence of a history of myocardial infarction and classical clinical indications of ventricular aneurysms such as electrocardiographic changes, arrhythmias, and congestive heart failure does not exclude a true aneurysm or pseudoaneurysm of the left ventricle.