El-Demerdash Hospital Research Articles

Flexible Ureteroscopy with Laser Lithotripsy versus Extracorporeal Shock Wave Lithotripsy in Management of Ureteric Stones in Pediatric Age Group

Background: pediatric stone disease is one of the most common urological issues in pediatric urology practice. The incidence of urinary stone disease is increasing in children in last decades. Aim of the Work: determination of the efficacy and outcome of flexible ureteroscopy using holmium Yttrium aluminium garne laser lithotripsy and compare its results with that of Extracorporeal shock wave lithotripsy EWSL in management of ureteric stones in pediatric age group. Patients and Methods: this study included 40 patients in pediatric age group. Complaining of upper ureteric stones less than (1cm). Patients underwent either ESWL or Flexible Ureteroscopy randomly according to 1: 1 ratio. The procedures were done at Eldemerdash hospital and National Institute of Urology and Nephrology. The patients were divided into two groups. Group A: Patients undergone extracorporeal shock wave lithotripsy (ESWL). Group B: Patients received flexible ureteroscopy and laser lithotripsy. Results: there was no statistically significant difference found between the two studied groups regarding age, sex, size and BMI, and stone free rate. Also there was highly statistically significant difference as regard hospital stay. The SWL group required a shorter period of hospitalization and there was highly statistically significant difference between the two groups regarding duration of the procedure which is more prolonged in flexible group. Conclusion: flexible URS lithotripsy and laser are considered a safe, highly efficient, minimally invasive, and reproducible surgery technique -with a higher stone free rates and less postoperative complications, after a single procedure, when compared to ESWL- for management of upper ureteric calculi in children after failure of ESWL.

Role of Diffusion Weighted Magnetic Resonance Imaging (DW-MRI) in Assessment of Urinary Bladder Carcinoma

Background: bladder cancer is the fourth most common cancer in males and the tenth most common cancer in females. Urinary bladder cancer occurs three to four times more frequently in men than in women and has a high recurrence rate, necessitating long-term surveillance after initial therapy. Patients with bladder cancer survive longer than those with most other common cancers. For the radiological evaluation of the urinary bladder and prostate gland, magnetic resonance imaging (MRI) is a valuable imaging modality due to high tissue contrast, multiplanar imaging capabilities, and the possibility of tissue characterization. Diffusion-weighted imaging (DWI) has emerged as a diagnostic technique in the evaluation of various abdominal lesions. Aim of the Work: to evaluate the role of diffusion weighted magnetic resonance imaging (MRI-DWI) in the diagnosis of urinary bladder carcinoma, with pathological diagnosis was taken as the reference. Patients and Methods: this is a retrospective study that included 20 patients in whom bladder cancer had been suspected either clinically or by U/S and confirmed by biopsy and 20 patients in whom bladder cancer had been not suspected and MRI was done because of other pelvic diseases as a control group. The study was conducted in El-Demerdash hospital. The patients will be referred to the radiology department from the urology department for further MRI evaluation with DWIs. Results: in this study, 20 patients suspected to have bladder cancer were scheduled for MR imaging. All patients were scheduled for different MR sequences including T2WIs, DWIs and post contrast T1WIs. Regarding the detection of urinary bladder carcinoma the sensitivity, specificity, and accuracy for differentiating superficial from invasive tumors using T2 images alone and combined use of T2 and DW images were 62.5%, 66.7%, 63.2% and 100%, 100%, 100% respectively. The sensitivity, specificity, and accuracy for differentiating superficial from invasive tumors using post contrast MR images alone and combined use of post contrast MR images and DW images were 92.3%, 100%, 93.3% and 100%, 100%, 100% respectively. Conclusion: we assume that DW-MRI is a safe and confident method in detection and local staging of urinary bladder carcinoma. In addition, DW images may predict the histological grade of the tumor. Hence DWI may be added to routine imaging protocols of urinary bladder tumors.

Role of Diffusion Weighted Magnetic Resonance Imaging (DW-MRI) in Assessment of Urinary Bladder Carcinoma

Background: bladder cancer is the fourth most common cancer in males and the tenth most common cancer in females. Urinary bladder cancer occurs three to four times more frequently in men than in women and has a high recurrence rate, necessitating long-term surveillance after initial therapy. Patients with bladder cancer survive longer than those with most other common cancers. For the radiological evaluation of the urinary bladder and prostate gland, magnetic resonance imaging (MRI) is a valuable imaging modality due to high tissue contrast, multiplanar imaging capabilities, and the possibility of tissue characterization. Diffusion-weighted imaging (DWI) has emerged as a diagnostic technique in the evaluation of various abdominal lesions. Aim of the Work: to evaluate the role of diffusion weighted magnetic resonance imaging (MRI-DWI) in the diagnosis of urinary bladder carcinoma, with pathological diagnosis was taken as the reference. Patients and Methods: this is a retrospective study that included 20 patients in whom bladder cancer had been suspected either clinically or by U/S and confirmed by biopsy and 20 patients in whom bladder cancer had been not suspected and MRI was done because of other pelvic diseases as a control group. The study was conducted in El-Demerdash hospital. The patients will be referred to the radiology department from the urology department for further MRI evaluation with DWIs. Results: in this study, 20 patients suspected to have bladder cancer were scheduled for MR imaging. All patients were scheduled for different MR sequences including T2WIs, DWIs and post contrast T1WIs. Regarding the detection of urinary bladder carcinoma the sensitivity, specificity, and accuracy for differentiating superficial from invasive tumors using T2 images alone and combined use of T2 and DW images were 62.5%, 66.7%, 63.2% and 100%, 100%, 100% respectively. The sensitivity, specificity, and accuracy for differentiating superficial from invasive tumors using post contrast MR images alone and combined use of post contrast MR images and DW images were 92.3%, 100%, 93.3% and 100%, 100%, 100% respectively. Conclusion: we assume that DW-MRI is a safe and confident method in detection and local staging of urinary bladder carcinoma. In addition, DW images may predict the histological grade of the tumor. Hence DWI may be added to routine imaging protocols of urinary bladder tumors.

Flexible Ureteroscopy with Laser Lithotripsy versus Extracorporeal Shock Wave Lithotripsy in Management of Ureteric Stones in Pediatric Age Group

Background: pediatric stone disease is one of the most common urological issues in pediatric urology practice. The incidence of urinary stone disease is increasing in children in last decades. Aim of the Work: determination of the efficacy and outcome of flexible ureteroscopy using holmium Yttrium aluminium garne laser lithotripsy and compare its results with that of Extracorporeal shock wave lithotripsy EWSL in management of ureteric stones in pediatric age group. Patients and Methods: this study included 40 patients in pediatric age group. Complaining of upper ureteric stones less than (1cm). Patients underwent either ESWL or Flexible Ureteroscopy randomly according to 1: 1 ratio. The procedures were done at Eldemerdash hospital and National Institute of Urology and Nephrology. The patients were divided into two groups. Group A: Patients undergone extracorporeal shock wave lithotripsy (ESWL). Group B: Patients received flexible ureteroscopy and laser lithotripsy. Results: there was no statistically significant difference found between the two studied groups regarding age, sex, size and BMI, and stone free rate. Also there was highly statistically significant difference as regard hospital stay. The SWL group required a shorter period of hospitalization and there was highly statistically significant difference between the two groups regarding duration of the procedure which is more prolonged in flexible group. Conclusion: flexible URS lithotripsy and laser are considered a safe, highly efficient, minimally invasive, and reproducible surgery technique -with a higher stone free rates and less postoperative complications, after a single procedure, when compared to ESWL- for management of upper ureteric calculi in children after failure of ESWL.

Prevalence of carbapenem resistance among multidrug-resistant Gram-negative uropathogens

Multidrug-resistant (MDR) uropathogens have become a public health threat, especially in developing countries. Carbapenems are a class of antimicrobial agents often reserved for infections caused by MDR microorganisms. The aim of this study was to determine the prevalence and genotypic basis of plasmid-mediated carbapenem resistance among MDR uropathogens from one of the major clinical settings in Cairo, Egypt. A total of 150 bacterial isolates from patients suffering from urinary tract infections were collected from the Microbiology lab of El-Demerdash Hospital, Cairo, Egypt. All isolates were identified using standard methods. Antimicrobial susceptibility testing was carried out by Kirby Bauer's disk diffusion method following the CLSI guidelines. Plasmids were extracted from MDR uropathogens that also showed carbapenem resistance to be used as templates for PCR amplification. The resulting amplicons were subjected to DNA sequencing. The extracted plasmids were also transformed into Escherichia coli DH5α to compare the phenotypic resistance of the transformants with that of the clinical isolates from which the plasmids were extracted. Of the 150 collected isolates, 116 (77.3%) were Gram-negative, 51 of which (44%) were MDR. Carbapenem resistance was observed in 16/51 (31.4%) of the MDR isolates, 12 of which harbored plasmids. The blaOXA gene was detected in the plasmids of only 9 MDR carbapenem-resistant isolates. From this study, it can be concluded that Gram-negative uropathogens show high rates of multidrug-resistance. The prevalence of MDR uropathogens that are also carbapenem-resistant has increased greatly over the past few years, and this resistance can be easily acquired by horizontal transfer.

Role of Diffusion Weighted MRI in Diagnosis of Cervical Cancer

Background: Diffusion weighted magnetic resonance imaging (DW-MRI) is a functional, non-invasive imaging technique which generates tissue contrast from differences in mobility of water molecules that occurs during an MR pulse sequence. Information regarding the integrity of cellular membranes and tissue cellularity can be obtained, so that DW-MRI can now be included in routine patient assessment. Aim of the Work: The aim of this study is to evaluate the role of DW-MRI in the diagnosis of cervical carcinoma, withpathological diagnosis was taken as the reference. Patients and Methods: This is a retrospective study that included 20 patients in whom cervical cancer had been suspected clinically or by transvaginal ultrasound (U/S) and the control group consisted of 20 patients in whom cervical cancer had not been suspected and MRI was performed because of other Pelvic diseases. The study was conducted in El-Demerdash Hospital. The patients were referred from the Gynecology Department to the Radiology Department (Women’s imaging unit) for further MRI assessment with diffusion weighted images (DWIs). Results: Lesions in all cases show restricted diffusion, however on apparent diffusion coefficient (ADC) map, only one case showed high signal proved to be chronic cervicitis on histopathology. Also, the mean ADC values for malignant lesions were (0.82 x10-3 mm2/sec), while the mean ADC value in the control group was (1.58x10–3 mm2/sec). Therefore, ADC value of (1.04 x10-3 mm2/sec) is a cut off between normal cervical tissue and malignant cervical lesion by sensitivity 95% and specificity 95 %. DWIs had elicited the same accuracy to Dynamic contrast-enhanced (DCE) sequences (95%) when added to the non-contrast MRI in the estimation of cancer cervix. Conclusion: Our results proved that (DW–MRI) was significantly beneficial in terms of diagnostic performance that increases the radiologist’s confidence in image interpretation. So, it implies a non-invasive technique which can be used especially if contrast intake is avoided as in pregnancy. Thus, we suggest that DWI should be included in the routine pelvic MRI protocol. The ADC value in case of cervical carcinoma was significantly lower than in the normal cervical tissue. The ADC threshold of (1.04 x10-3 mm2/sec) was a cut off value, which was detected when differentiating between cancer-affected and non-affected cervical tissues

Role of Magnetic Resonance Imaging in Evaluation of Anterior Knee Pain

Background: the term “anterior knee pain” is often used interchangeably with “Patellofemoral pain syndrome PFPS” or “runner’s knee”. PFPS can be defined as anterior knee pain involving the patella and retinaculum. Aim of the Work: to highlight the role of magnetic resonance imaging (MRI) in the diagnosis and grading of the most common causes of anterior knee pain. Patients and Methods: this study included fifty patients, their ages range between 10-60 years (average age 27 years). All presented with anterior knee pain (AKP) and were referred to the Radiology Department of El-Demerdash Hospital for MRI examination after orthopedic consultation.Results: the role of MRI in the diagnosis and grading of the most common causes of anterior knee pain have been shown in this study. These causes have been classified in to five disease categories; Patellar abnormalities represented most of them (64% of the sample size) and they included chondromalacia patella, patellar instability, transient patellar dislocation and painful bipartite patella. Hoffa’s diseases represented 12% of the sample size and they included Hoffa impingement syndrome and Hoffa fibrotic bands. Patellar tendon disorders represented 6 % of the sample size and they included Patellar Tendinopathy and Osgood Schlatter Disease. Quadriceps tendon disorders represented 4% of the sample size and they included Quadriceps Tendinopathy. Other causes represented 14% of the sample size and they included torn anterior horn of the lateral meniscus and cartilage injuries. Conclusion: many factors may cause anterior knee pain. MRI is generally safe, non-ionizing, non-invasive and valuable imaging technique which has been proven to be the modality of choice for establishing an accurate diagnosis of different knee pathologies that cause anterior knee pain in different age groups. It also allows to know the extent, severity, grades and types of the lesions, what will be necessary to decide appropriate treatment. Recommendations: further studies on a larger scale of patients are needed to confirm the results obtained by this work.

Screening of Oropharyngeal Dysphagia in Patients with Diabetes Mellitus in El-Demerdash Hospital

AbstractBackground: Diabetes mellitus is a systemic endocrinal disease that results either from deficiency of insulin hormone (type 1) or from insulin resistance or both (type 2). Literature is scarce related to dysphagia with diabetes. This complaint is expressed by some patients and needs to be explored. A-EAT-10 is a questionnaire that explores the presence of dysphagia symptoms among patients.Aim: The aim of this work is to screen Egyptian diabetic patients (type 1 and type 2) in El-Demerdash Hospital for oropharyngeal dysphagia using the validated Arabic version of Eating Assessment Tool (A-EAT-10) questionnaire to explore the degree of such symptom among them.Study Design: This was a cross-sectional study conducted to screen the diabetic patients (of both type 1 and type 2) in El-Demerdash Hospital for oropharyngeal dysphagia.Patients and Methods: 200 Egyptian adult diabetic pa-tients, aged 18y.1m.1d-59y.12m.31d, were included in this study. The participants were selected upon certain inclusion and exclusion criteria. The inclusion criteria were diabetic patients of type 1 and/or type 2. The exclusion criteria were any past or present history of disorders that might cause oropharyngeal dysphagia. Patients were asked to complete the Arabic version of the Eating Assessment Tool-10 (A-EAT-10) questionnaire. It is formed of 10 questions, and used to detect the presence of dysphagia complaints among patients and how it affects them.Results: The increase in age and having a female gender were considered of high risk for dysphagia among diabetic patients participating in this study. The commonest symptom among diabetic patients who complained from dysphagia was “I cough when I eat”. There is no relation between the type or duration of diabetes mellitus and the presence of oropha-ryngeal dysphagia.Conclusion: The present study showed that diabetic patients may encounter swallowing problems. The A-EAT 10 is an easy method that can be used for screening of swallowing difficulty.

Role of MRI in Postoperative Assessment and Detection of Recurrence in Cancer Rectum

Background: rectal cancer constitutes about one third of all gastrointestinal tumor. High resolution MRI plays a pivotal role in the post-operative follow up and also plays an important role in detection of recurrence. It is the best modality to assess the relations of the rectal tumor and the potential circumferential resection margin (CRM). Therefore it is currently considered the method of choice for local staging of rectal cancer and follows up after total mesorectal excision (TME) and detection of residual or recurrent cancer. Objective: the purpose of this study was to assess the accuracy of MRI in the postoperative assessment rectal carcinoma and detection of recurrence. Subjects and methods: twenty patients with pathologically proven rectal carcinoma underwent pelvic MRI examination. Results: this study was conducted on twenty patients (13 male and 7 female) who underwent surgical excision of pathologically proven cancer rectum. Patients were selected from outpatient’s clinic and Department of Surgery at the El-Demerdash Hospital. The patient’s age ranges from 32 to 75 years old. Conclusion: MRI of rectal cancer was accurate for post-operative assessment and had high sensitivity with specificity in the detection of recurrence.

Pattern and Outcomes of Head Injuries in Egypt: A Study of the Egyptian Revolution

Like many other traumas, head injuries is a growing health problem and is attributed to deaths among the young and productive population. The intention of this study was to compare the difference in the pattern and outcome of head injuries between year 2010 versus 2011. A retrospective comparative study carried out based upon data collected from medical records of patient with head injuries admitted to emergency room, El-Demerdash, Ain Shams University Hospitals starting from January 2010 to December 2011. Socio-demographic, full history, clinical examination and criteria of severity were collected from the sheets for the study. During the study period, the total number of head injured cases received by EL-Demerdash hospital was 1020; 407 in 2010 and 613 in 2011. Due to in-completed sheets 206 of the head injured patients were discarded from the study, 72 in 2010 and 134 in 2011, out of the 134 cases 69 were head gunshots. So the actual numbers of cases subjected to this study were 335 cases in 2010 and 479 in 2011. The male percentage was higher than female in both years. In 2011, the mean age was 24.63 ± 19.19. In 2010, Post-concussion state was in 82.4% of patients, while poly-trauma were present in only 17.6% and no cases of head gunshot were present. In 2011, poly-trauma were 53.03%, while post-concussion were present in 34.86% and head gunshots in 12.11% of cases. In 2010, fall 37.6% followed by motor car accidents (28.4%).

Correlation between stuttering severity and pragmatic development in Egyptian children who stutter

BackgroundFew studies have been carried out concerning the relation between stuttering behaviors and language pragmatics in children who stutter (CWS). The correlation between stuttering severity and pragmatic development in CWS is scarce in the literature so far.AimThis research aimed to study the relationship between stuttering severity and pragmatic language development in the Egyptian Arabic-speaking CWS.Patients and methodsThis study is an analytical cross-sectional study carried out at the Phoniatrics Clinics of El-Demerdash Hospital (Ain Shams University) and El-Zahraa Hospital (Al Azhar University). A total of 60 Egyptian CWS in the age range between 4 years 1 day and 9 years 11 months 31 days were selected conveniently based on inclusion and exclusion criteria. Selected children underwent the Ain Shams assessment protocol for fluency disorders, including assessment of stuttering severity by Bloodstein (BLS) classification and the Stuttering Severity Instrument for Children and Adults – Arabic version (ASSI). The standardized Egyptian Arabic Pragmatic Language Test has been used to assess the pragmatic language development.Pearson’s correlation coefficient has been used to correlate the total pragmatic language age and degree of stuttering severity by BLS classification and the ASSI.ResultsUpon application of the Egyptian Arabic Pragmatic Language Test, all the participating children had no pragmatic language delay. They had scores either at and/or above their fifth percentiles in all the test items except in the paralinguistic aspect. There was no statistically significant correlation between grades of BLS classification or ASSI and the total pragmatic language age.ConclusionCWS had no pragmatic language delay except in the paralinguistic aspects.

Effect of Educational Guidelines for Prevention of Immobilization Complications on Caregivers' Performance and Patients' Functional Condition

Long immobilization periods lead to overall complication and have been associated with poor functional outcomes. The aim of this study was to evaluate the effect of educational guidelines for prevention of immobilization complications on caregivers' performance and patients' functional condition. Quazi experimental design was utilized for conducting the study. Two purposive samples of 45 immobilized patients and their caregivers from orthopedic wards in El demerdash hospital, Cairo, Egypt, were randomly divided into study and control groups. Data were collected through; Self-Administered Structured Questionnaire to assess demographic characteristics and knowledge. Observational checklist also used to assess caregivers' practice. PULSUSE profile used to assess patients' functional condition. Results: There was statistically significant improvement of caregivers' knowledge and practice regarding prevention of immobilization complications and improvement of patients' functional condition in the study group after implementation of educational guidelines when compared to the control group. Conclusion: Educational guidelines improve the caregivers' knowledge and practice regarding prevention of immobilization complication. Recommendations: It is suggested to apply these educational guidelines on the caregivers of immobilized patients and to replicate the study on a larger study sample in different settings to generalize the results.

Malignant Breast Tumors : Role of MRI in Predicting Histopathological Grading

Introduction: Magnetic Resonance Imaging (MRI) is an established supplemental technique to mammography and ultrasonography for evaluation of breast lesions. Diffusion-weighted MR imaging (DWI) has recently been integrated into the standard breast MRI in addition to images obtained from dynamic contrast enhanced MRI. DWI is quantified using the Apparent Diffusion Coefficient (ADC) value which is the measurement of the mean diffusivity of water in tissues along three orthogonal directions. Aim of the Work: The aim of this study was to investigate the relationship between DWI findings (represented by ADC values) and the dynamic contrast enhanced MRI findings (including functional parameters and morphological criteria) with the histopathological grade of malignant breast tumors. Methodology: 25 Patients (age >30 years) were enrolled in this study. All patients were referred either from the screening clinic or the outpatient clinic of Eldemerdash Hospital with clinically suspicious findings and the abnormality was detected by mammography and/or ultrasound. Included masses are those with BI-RADS 5 category on imaging, with no previous biopsy or treatment. There was no knowledge about the histopathological diagnosis at the time of initial evaluation. Exclusion criteria were breast masses with diagnosed or proved benign features. All patients were scheduled for dynamic MRI with diffusion weighted imaging in addition to the conventional MR imaging. Results: Histopathological analysis revealed all 25 lesions to be invasive ductal carcinomas not otherwise specified. Grading of included carcinomas was as follows: 3 lesions (12.0%) were grade I, 14 lesions (56.0%) were grade II and 8 lesions (32.0%) were grade III. Conclusion: That makes DWI the best non-invasive tool available to predict grades of breast carcinoma. However, further larger and more detailed studies are still needed to fully understand the role MR imaging in distinguishing different histological grades of breast cancer.

The Role of Diffusion Weighted MRI in the Differentiation between Benign and Malignant Hepatic Focal Lesion

Background: early detection and diagnosis of hepatic focal lesions are an important step in clinical work, which would allow effective surgical or mini-invasive therapy. With the advances in magnetic resonance imaging (MR) technology, diffusion-weighted magnetic resonance imaging (DWI) is now widely used as a standard imaging sequence in clinical work and shows its potential benefit in evaluation of the focal hepatic lesions. Aim of the work: the use of MR Diffusion imaging with both low and high B values to detect and differentiate between benign and malignant hepatic focal lesion. Methodology: the present study included 30 patients. They were El-Demerdash hospital patients with hepatic focal lesions. Patients underwent US or CT before MR examination. Results: thirty patients were included in this study, 20 males and 10 females. The patient’s age was ranging from 33 to 60 years. There were 24 primary hepatic focal lesions, (36.7% HCC, 3.3% focal nodular hyperplasia, 3.3% cysts, 13.3% hemangiomas, 6.7% cholangiocarcinoma, 16.7% regeneration nodule) and 6 metastatic lesions. Conclusion: we hope to use DWI to be helpful in the characterization of focal liver lesions, especially if the lesions show non classic appearance of contrast enhancement in Triphasic CT study and in patients with renal insufficiency with inability to use contrast enhancement. Recommendations: in our opinion, DWI is a useful adjunct to routine liver imaging (i.e. used as an additional sequence to the standard protocol study and not as a unique imaging series); it is fast, requires no intravenous contrast and is non-invasive. The radiologist has to be aware of the potential pitfalls and limitations of the technique. In patients who cannot receive gadolinium-based contrast agents, DW MR imaging has the potential to be a reasonable alternative technique to contrast-enhanced imaging. We suggest the following strategy for evaluating DWI features of FLLs. We believe that most of the FLLs can be practically classified as benign or malignant by using this scheme.

Neoadjuvent Radiotherapy: Health Education and Quality of Life for Patients with Rectal Cancer

Aim: This study aimed to evaluate the effects of health education on quality of life for patients with rectal cancer undergoing neoadjuvant radiotherapy. Methods: A quasi experimental design was used for the conduction of this study in the Radiotherapy and Nuclear Medicine Department and Surgical Outpatients` Clinics at El Demerdash Hospital affiliated to Ain Shams University Hospitals . A purposive sample composed of 70 adult curative patients from both sexes with rectal cancer undergoing radiotherapy were recruited from the above mentioned settings. Tools: (1) Patients' interviewing questionnaire to assess knowledge of patients about radiotherapy sessions (pre/post health education ). (2) Quality of Life Scale to assess the impact of radiotherapy on the following dimensions: physical, psychological, social and spiritual (pre/post health education ). 3) An observation checklist to evaluate the practice of patients as regards radiotherapy sessions (pre/post health education ). (4) Psychometric assessment: Pain, anxiety and fatigue levels (pre/post health education). Results: There were statistical significant differences between pre/post health education program as regards studied patients` knowledge, practice and quality of life domains , whereas more improvement was noticed post program. Moreover, significant reduction was indicated in the anxiety, pain and fatigue levels post health education program, added to an obvious improvement post radiotherapy sessions. Conclusion: Overall, the study has indicated that health education program had a positive effect on the improvement of quality of life for patients with rectal cancer undergoing radiotherapy, which is attributable to better effect of patients` condition . Recommendations: Further studies should be done to assess the long term success of radiotherapy and follow - up patients` quality of life.

Emergence of Multidrug-Resistant New Delhi Metallo-β-Lactamase-1-Producing Klebsiella pneumoniae in Egypt.

Despite expansion of the New Delhi metallo-β-lactamase-1 (NDM-1) worldwide, the incident of outbreaks regarding Egypt is still uncommon. In this survey, we denounce the emanation of multidrug-resistant NDM-1-producing Klebsiella pneumoniae in Egypt. We have reclaimed 46 unrepeatable carbapenem-resistant K. pneumoniae isolates at El-demerdash hospital, Ain Shams University, Cairo, Egypt. All the isolates showed a decreased sensitivity to imipenem and meropenem via the disc diffusion method. Among the isolates, 10 were proven as NDM-1 producers by utilizing the phenotypic methods (modified Hodge test and EDTA synergistic test) and specific PCR detection of NDM-1 encoding gene, blaNDM-1. The isolates hosting the blaNDM-1 showed an elevated resistance to several classes of β-lactam and non β-lactam antibiotics. All blaNDM-1-harboring isolates have showed positivity for one or more other plasmid-mediated bla genes; in addition, the isolates carried class 1 integron. Enterobacterial repetitive intergenic consensus (ERIC)-PCR results revealed that majority of the isolates, including the NDM-1 producers, are unrelated to each other. This highlights the danger of horizontal transfer of plasmids encoding for such carbapenemases, including NDM-1, between the isolates of K. pneumoniae. In summary, this study has confirmed the incidence of blaNDM-1 together with other bla genes among the K. pneumoniae isolates in Egypt. Control and prevention of infection can be achieved through early detection of resistance genes among bacterial isolates; through limiting the dispersal of these organisms.

USE OF PERSONAL PROTECTIVE DEVICES AMONG HEALTH CARE WORKERS IN A TEACHING HOSPITAL IN CAIRO, EGYPT.

Introduction: Personal protective equipment (PPE) provide a physical barrier between the user and micro-organisms by preventing micro-organisms from contaminating the mucous membranes, airways, skin, clothing, hair and shoes of health care workers. Aim of the work: To describe the practice of nurses and physicians as regards usage of PPE and identify the factors affecting their adherence to using these equipment. Materials and Methods: A cross sectional study among health care workers at El-Demerdash hospital (a teaching hospital in Cairo, Egypt). The study included (269) physicians (from demonstrators to professors) and (331) nurses. Participants answered a questionnaire which included items on socio-demographic and occupational characteristics, questions on practice, attitude of health care workers regarding the usage of personal protective equipments. A health education poster was prepared and used by researchers to transmit a message on the importance of using personal protective equipments among health care workers through face to face interviews. Results: It was found that the independent predictors of adherence among physicians were dealing with a patient known to have a blood borne disease, availability of PPE, senior example and past experience. While in nurses the independent predictors were also dealing with patients known to have a blood borne disease, availability of PPE together with no time to use PPE and training on a clear hospital policy. Conclusion: Increasing the awareness of health care workers about the importance of adherence to usage of PPE is very important and will help in reducing transmission of infection to them. Protection of health care workers from acquisition of infectious diseases can be achieved by compliance to established infection control guidelines including rigorous infection control practices, perspective instructions for the use of PPE and post exposure antiviral prophylaxis

Monthly sulphadoxine-pyrimethamine combinatiled study at the jos universon versus daily proguanil for malaria chemoprophylaxis in sickle cell disease: A randomized controlity teaching hospital

Background Gallstones remain one of the commonest surgical problems in the developed world, and despite major therapeutic advances in recent years, there has been no progress in the prevention of gallstone development, and it may lead to serious complications that may affect patients’ quality of life. Laparoscopic cholecystectomy currently is accepted as the gold standard treatment of gallstones. The advantages of such a surgical approach have been reported by a number of authors, showing both the positive effect of this method on the postoperative quality of life of the patients and its optimal short-term and long-term results. Objective To assess the safety and efficacy of ultrasonic energy as a single alternative tool in the dissection of the gallbladder during laparoscopic cholecystectomy. Patients and methods This is a prospective study that included 60 patients with gallbladder stones who were operated upon for laparoscopic cholecystectomy over 1 year starting from August 2016 till August 2017. Approval from the Ethical Committee of Faculty of Medicine, Ain Shams University, was obtained before commencement of this study. The patients upon whom the study was based were operated on in El Demerdash Hospital and Ain Shams University Specialized Hospital. Results A total of 60 patients were included in this study. Group A included 30 patients for whom laparoscopic cholecystectomy had been done using a harmonic scalpel. Group B included 30 patient for whom laparoscopic cholecystectomy had been done using electrocautery tools (hook, grasper, and scissors) and surgical clips. For both groups, data were collected and analyzed: demographic data (sex, age, BMI, comorbidities, and previous surgeries). Conclusion The main advantages of ultrasonic dissection include the following: (a) utilization of a single instrument for both dissection of the gallbladder and dissection of the artery and dust, (b) shorter operating time, and (c) improved laparoscopic view and possibly a reduction of postoperative pain. The main disadvantage of ultrasonic dissection is instrument cost, which is particularly high if the surgical unit is equipped with reusable instruments.

Executive Dysfunction and Diabetes Mellitus among Elderly Patients at El-demerdash Hospital

Executive Dysfunction and Diabetes Mellitus among Elderly Patients at El-demerdash Hospital

USE OF ABBREVIATIONS IN MEDICAL PRACTICE IN A UNIVERSITY HOSPITAL IN EGYPT

Background: Regardless of their convenience, medical abbreviations have been responsible for serious errors and deaths. Look-alike abbreviations or symbols, throughout the healthcare literature, are widespread examples of common errors. These problems involve numbers as well as letters. Objectives: To identify used abbreviations in medical records in surgical departments in El-demerdash hospital and to assess comprehension level of abbreviations written in medical records by medical and paramedical staff. Material and methods: A cross sectional study was done to review 400 medical records in surgical departments in El-demerdash hospital for identification of used abbreviations. Three hundred healthcare professionals in Eldemerdash hospital were inquired to identify the meaning of the top (5%) frequently used abbreviations in a self-administered questionnaire. Results: More than 900 different abbreviations were identified in the studied sample. Most of them (56%)were used in documenting history and physical examination followed by lab report (20.6%).When medical dictionary was used to identify meaning of the most frequently used abbreviations (top 10%) only (18.4%) of these abbreviations were identified. Meanings of abbreviations were obtained from five general surgery consultants. There were different abbreviations used for a single meaning and different meanings given to a single abbreviation. The factors that significantly affected the number of used abbreviations were length of stay, condition at discharge and department where the patient was staying. The most frequently used abbreviations (top5%) were circulated in a questionnaire to assess the comprehension of these abbreviations among El-demerdash staff. In general, there was poor understanding of the abbreviations used in medical records. Only 3 out of 34 abbreviations were interpreted correctly by more than (50%) of the study sample. Paramedical staff showed lower comprehension level than medical staff. Other factors significantly affected comprehension level of abbreviations include years of experience and last certificate obtained by the participant. Conclusion: The study showed that medical abbreviations are widely used in a non-standardized way in medical records of Eldemerdash hospital. The majority of healthcare professionals had poor understanding of commonly used abbreviations which affects communication during patient care and may lead to medical errors.