Main University Hospital Research Articles

The impact of intravenous metoprolol tartrate on mortality rates in patients with septic shock due to ventilator-associated pneumonia: A randomized clinical trial

Background: Septic shock, particularly due to ventilator-associated pneumonia (VAP), is a significant cause of mortality in critically ill patients. Traditional treatments include antimicrobial therapy, fluid resuscitation, and vasopressors. However, recent interest has emerged in using β-blockers to modulate the hyperadrenergic state seen in sepsis. β-blockers, like metoprolol, may improve cardiac efficiency, reduce myocardial oxygen demand, and ultimately enhance patient outcomes. Objective: This study aimed to assess the impact of administering intravenous metoprolol tartrate on the mortality rates of patients with septic shock due to VAP. Methods: This study employed a randomized clinical trial design within the Intensive Care Units of Alexandria Main University Hospital. A cohort of 100 patients diagnosed with septic shock due to ventilator-associated pneumonia (VAP) participated in the trial. Upon achieving hemodynamic stabilization, participants were randomly assigned to either receive standard care alone or standard care supplemented with intravenous metoprolol. Variables of interest included assessing 28-day mortality rates, duration of ICU stay and mechanical ventilation, reliance on intravenous fluids and vasopressors, acid-base balance, lactate levels, inflammatory markers, and mean arterial pressure (MAP). This comprehensive approach aimed to evaluate the impact of metoprolol on critical outcomes in this patient population. Results: The administration of intravenous metoprolol tartrate resulted in significant clinical benefits, including lower 28-day mortality rates (P = 0.013), shortened durations of ICU stay (P < 0.001), and reduced mechanical ventilation periods (P < 0.001). These outcomes were explained by the observed decreased reliance on intravenous fluids and vasopressors (P < 0.001), improved acid-base balance and lactate levels. The rapid reduction of inflammatory markers (P < 0.001) and the sustained improvement of MAP in the metoprolol group compared to the control group further contributed to the explication of these findings. Conclusion: Intravenous metoprolol tartrate effectively controlled inflammation, optimized hemodynamics, and improved patient outcomes compared to standard care, suggesting it as a beneficial adjunct in the management of septic shock. Trial registration: PACTR202404531355476. Keywords: Metoprolol; septic shock; ventilator-associated pneumonia; beta-blockers; mortality.

Comparison of genotypic features between two groups of antibiotic resistant Klebsiella pneumoniae clinical isolates obtained before and after the COVID-19 pandemic from Egypt

Klebsiella pneumoniae is a common pathogen capable of causing a wide range of infections. Antibiotic resistance complicates treatment of these infections significantly. We are comparing resistance levels and genotypes among two collections of K. pneumoniae clinical isolates from Alexandria Main University Hospital (AMUH). We used disc diffusion and Minimum Inhibitory Concentration (MIC) by microbroth dilution to assess resistance levels and performed whole genome sequencing (WGS) to describe multilocus sequence types (MLST) and resistance gene presence. Among a collection of 56 K. pneumoniae clinical isolates (19 from 2019 to 37 from 2021), multidrug resistance (MDR) was 33% and 10%, extended drug resistance (XDR) was 24% and 46% and pan-drug resistance (PDR) was 43% and 43%, respectively. We identified 15 MLST STs including two novel types (ST-6118 and ST-6119 ). ST-101 and ST-383 were common between the two collections; ST-101 was the most common genotype in 2019 (28.6%) and ST-147 was most common in 2021 (25%). Ampicillin/sulbactam, amikacin, cefepime, ceftriaxone and ertapenem MICs were significantly higher in 2021. Prevalence of aph(3’) – Ia, aph(3’)-VI, mphA was significantly higher in 2021. The increasing resistance levels and the persistence of some MDR/XDR genotypes is concerning. Understanding mechanisms of resistance will inform infection control and antimicrobial stewardship plans to prevent evolution and spread of XDR and PDR strains.

Factors affecting time to recovery from diabetic ketoacidosis in adult diabetic patients in Alexandria Main University Hospital

BackgroundDiabetic ketoacidosis (DKA) is a life-threatening condition as a complication of diabetes and represents a significant healthcare global burden. The current study goal was to determine factors affecting time to recovery from DKA in Alexandria Main University Hospital.Patients and methodsOne hundred fifty patients who had been admitted with DKA were included in this study. All patients were managed with hospitalization for IV fluids, continuous intravenous insulin infusion, electrolyte correction, as well as detection and treatment of the predisposing factor until the full resolution of DKA.ResultsMales contributed to 58.7% of the total patients in this study with a mean age of 32.16 ± 15.06 years. DKA mean time of resolution was 18.76 ± 14.07 h. The majority of patients were with T1DM (86%), while T2DM were 14%. Missed insulin dose was the leading precipitating factor (60.7%) followed by infections (38.7%). There was a statistically significant relationship between DKA resolution time with age, time of presentation, type of diabetes, initial pH, initial serum K+ level, initial HCO3− level, initial anion gap, initial base excess, and initial RBS (p value < 0.001).ConclusionDelayed time of resolution from DKA was associated with initial lower pH, initial lower HCO3− level, initial lower base excess level, initial higher anion gap level, type 2 diabetes mellitus, patients on pre-mixed insulin regimen, old patients, delayed time for seeking medical care, and abnormal serum K+ level.

The quality of the electrodiagnostic referral system and the electrodiagnostic patterns in a sample of Egyptian patients

BackgroundElectrodiagnosis is a localizing, diagnostic, and prognostic tool for individuals with suspected neuromuscular diseases. In addition to detailed history taking and thorough clinical examination, correct execution and interpretation of these tests can provide vital insights into the underlying neuromuscular disorders and frequently guide the need for proper management decision. The request for an electrodiagnosis examination should include brief clinical information and a provisional clinical diagnosis; this enhances the efficient easy performance of the test. The current study aims to detect the pattern of neuromuscular diseases in the Alexandria Main University Hospital, Egypt, and to evaluate the quality of the referral system to the electrodiagnosis unit.ResultsThe study included 371 patients, out of which, 65% were referred from the Governmental Specialized Medical Councils and the Neurosurgery department. Although sensory complaints were the main reason for referral, yet 28.8% of patients did not show any electrodiagnosis abnormality. A compatible referral note led to shorter test times and fewer electromyography needle insertions.ConclusionDisorders of the peripheral nerves are the most frequent neuromuscular diseases referred to the electrodiagnosis unit with carpal tunnel syndrome being the most common disorder. A compatible referral letter is necessary when requesting an electrodiagnosis test, to save the physician time and focus on targeted procedures.

Retrospective Study Of The Clinical Characteristics Of Cases With Covid-19

background: COVID-19 pandemic placed immense pressure on health systems. The disease is transmitted by inhalation or contact with infected droplets. The symptoms are usually fever, cough, sore throat, breathlessness, fatigue and malaise. The aim of this study was to determine the clinical characteristics of cases with covid-19. Design: Observational retrospective study was followed in this study. Study setting: This study was conducted at Tanta main university hospital and Itay El-baroud general hospital. Subjects: A purposeful sample of 100 adult isolated patients from the previosly mentioned settings was included in the study. Collection tools: one tool was used to collect data in this study "Covid-19 clinical characteristics assessment sheet" this tool consists of 2 parts: Part (1): Demograhic data of the studied cases with covid-19 Part (2): clinical characteristics of studied cases with covid-19. The results were as follow: the results indicated that around one third of the participants were dead and there was highly significant relationship between hypertension, diabetes mellitus, serum Ferritin level and blood group A and death (p&lt;0.001). ICU admission rate was 71% and 35% of covid-19 cases needed invasive mechanical ventilation. Conclusion: it was concluded that the majority of confirmed covid-19 patients were old males. The highly reported signs and symptoms were fatigue, weakness, anorexia, tachypnea and fever. Hypertension and diabetes mellitus were the most reported comorbid diseases of confirmed covid-19 patients. Recommendations: Generalize the awareness of the most reported clinical characteristics of covid-19 to help health care providers to make the correct initial suspected diagnosis of COVID-19

Prevalence and Risk Factors of Post-intensive Care Syndrome Among Patients in Alexandria Main University Hospital

Prevalence and Risk Factors of Post-intensive Care Syndrome Among Patients in Alexandria Main University Hospital

Empowering mind-body wellness: effect of bundling seated exercises and psychoeducational rehabilitation using the teach-back approach on fatigue and coping of women postmastectomy

BackgroundBeing diagnosed with Breast Cancer (BC) is a crisis that throws the patient’s life out of balance. Cancer-related fatigue is a debilitating sign experienced by women during and after BC treatment. Regular physical exercise may help mitigate patients’ fatigue, enhance coping abilities, improve their quality of life, and overall well-being. In parallel, psychological interventions are geared toward normalizing the lived painful experiences among oncology patients.Objectiveto examine the effect of bundling seated exercises and psychoeducational rehabilitation using the teach-back approach on fatigue and coping of women postmastectomy.MethodsA quasi-experimental study was conducted in the Oncology Surgical Department and chemotherapy unit at the Alexandria Main University Hospital, Egypt. A total of 60 women were randomly allocated to either to the study or the control groups. Women in the study group practiced seated exercises and psychological rehabilitation interventions, including mindfulness breathing, problem-solving training, cognitive reframing technique, and thought stopping while the control group received the routine care.ResultsThe study revealed a significant decline in the fatigue mean scores among participants in the intervention group from 136.10 ± 27.76 to 98.43 ± 25.99 (p < 0.001). Similarly, there was a significant decrease in the patients’ mean scores of maladaptive coping, helplessness/ hopelessness (p = 0.014), and anxious preoccupation (p = 0.008). In contrast, there is a noticeable increment in the scores of adaptive coping, such as fighting spirit (p = 0.012), cognitive avoidance (p = 0.002), and fatalism (p = 0.009).ConclusionBundling seated exercises and psychological rehabilitation interventions using the teach-back approach have been proven to be simple and inexpensive non-pharmacological methods of reducing cancer-related fatigue and improving coping skills among women post-mastectomy.Trial registration numberNCT06360276, ClinicalTrails.gov, Retrospectively registered (April 8th, 2024), URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT06360276.

The moderating role of ethical awareness in the relationship between nurses’ artificial intelligence perceptions, attitudes, and innovative work behavior: a cross-sectional study

BackgroundArtificial intelligence is rapidly advancing and being integrated into healthcare, potentially revolutionizing patient care and improving outcomes by leveraging large datasets and complex algorithms.AimInvestigate the moderating role of ethical awareness between nurses’ artificial intelligence perceptions, attitudes, and innovative work behaviors.Design and MethodsA cross-sectional descriptive correlational design adhering to STROBE guidelines. A non-probability convenience sample of 415 Alexandria Main University Hospital nurses was analyzed. Statistical methods included one-way ANOVA, the student t-test, and the Pearson coefficient, with results evaluated for significance at the 5% level and internal consistency assessed via Cronbach’s α. Linear regression assessed the predicting and moderating effect between ethical awareness, nurses’ artificial intelligence perceptions, attitudes, and innovative work behavior. The perceptions of using the Artificial Intelligence Scale, general attitudes towards the Artificial Intelligence Scale, ethical awareness of Using Artificial Intelligence, and the Employee Innovative Behavior Scale were used to respond to the research aim.ResultsThe study revealed that perception of AI use among nurses has a mean score of 50.25 (SD = 3.49), attitudes towards AI have a mean score of 71.40 (SD = 4.98), ethical awareness regarding AI use shows a mean score of 43.85 (SD = 3.39), and nurses innovative behavior exhibits a mean score of 83.63 (SD = 5.22). Attitude and ethical awareness were statistically significant predictors of innovation. Specifically, for every one-unit increase in attitude, innovative work behaviors increase by 1.796 units (p = 0.001), and for every one-unit increase in ethical awareness, innovative work behaviors increase by 2.567 units (p = 0.013). The interaction effects between perception, ethical awareness, attitude, and ethical awareness were also examined. Only the interaction between attitude and ethical awareness was found to be significant (p = 0.002), suggesting that the effect of attitude on innovative work behaviors depends on the level of ethical awareness. In other words, ethical awareness moderates the relationship between attitudes and innovative work behaviors rather than perception and innovation.ConclusionThere is a statistically significant correlation between attitude, ethical awareness, and creativity, highlighting that ethical awareness moderates the relationship between attitudes and innovative work behaviors. These findings emphasize the importance of ethical awareness in fostering positive attitudes towards AI and enhancing innovative practices in nursing, ultimately contributing to nurses’ well-being.

Severity of child neglect among acutely poisoned children in Egypt

Background: Child abuse and neglect pose significant public health challenges, contributing to compromised development and adverse health outcomes. Neglect is the most frequent type of child abuse, presenting substantial challenges for paediatricians. Aims: To identify types of neglect associated with poisoned children, analyse potential risk factors and develop a novel severity scoring system to assess child neglect in Alexandria, Egypt. Methods: Using a simple random sampling technique, with an observational checklist we collected data on children aged 2 months to 17 years admitted for poisoning at the poison centre of Alexandria Main University Hospital from October to December 2022. We analysed the data using SPSS version 20.0 and tested the associations between neglect score and child data, current condition and carer data using the χ2 test, the Monte Carlo simulation and Fisher’s exact P. Results: The study enrolled 147 children, male-to-female ratio 1:1.17. Pesticides were the most common cause of poisoning. Lack of supervision was noted in 83% of cases and the neglect severity score showed that 27.9% of the children experienced severe neglect. There was significant association between severity of neglect and caregiver’s education level and between severity of neglect and child’s residence; severe neglect cases were significantly higher among children whose caregivers had no formal education (70.7%) and among those from rural areas (61%). Conclusion: These findings highlight the critical need to address educational disparities among caregivers and improve supervision for children, especially in rural areas.

Incidence of Pancreatic Leakage in Isolated Biliary Limb Roux-en-Y Reconstruction in Whipple Procedure

Abstract Background Whipple is currently the procedure of choice in the treatment of localized pancreatic cancer. Isolated Roux-en-Y loop pancreaticojejunostomy was proposed as a method of reconstruction following pancreaticoduodenectomy. The idea is to isolate the bile from pancreatic secretions to minimize pancreatic enzyme activation and ultimately pancreatic fistula formation. It was also proposed that if a pancreatic fistula develops, it will be a pure fistula and thereby more benign as opposed to a mixed pancreatic fistula containing bile. Objective To estimate the incidence of pancreatic fistula in patients undergoing isolated Roux-en- Y hepaticojejunostomy reconstruction following pancreaticoduodenectomy. Patients and Methods In this prospective observational study, our aim is to calculate the incidence of post-operative pancreatic fistula in 20 patients that underwent Roux-en-Y isolated biliary limb reconstruction following pancreaticoduodenectomy for the treatment of pancreatic cancer. The study includes patients that underwent this procedure at Ain Shams University Hospitals in the period between January 2021 and July 2022 with a post-operative follow up period of 3 weeks. Patients were diagnosed with pancreatic cancer using MRI or CT scans with some of them also undergoing endoscopic US with biopsy. They were then admitted to one of the two main Ain Shams University Hospitals for pre-operative preparation. Results Our study did no estimate post-operative complications such as delayed gastric emptying and wound infection. Pancreaticoduodenectomy is a major surgery that carries a significant burden in terms of morbidity and mortality. Post-operative pancreatic fistula can be fatal as it can lead to vascular pseudoaneurysms that may fatally rupture. The idea behind using isolated biliary limb roux-en-y reconstruction is to alleviate the morbidity caused by post-operative pancreatic fistula. Conclusion Further comparative studies with a higher number of patients are recommended to assess and compare the value of isolated biliary limb reconstruction when compared to conventional reconstruction.

227 Retrospective Study to Assess Axillary Management and Oncological Outcome After Neoadjuvant Chemotherapy for Patients with Breast Cancer

Abstract Aim Evaluation of the effect of neoadjuvant chemotherapy on axillary nodal status. The secondary objective was to evaluate the percentage of patients who are eligible for SLNB after neoadjuvant chemotherapy. Method This retrospective study was conducted by collecting data during the period from October 2019 to July 2021. The study included 64 patients who had biopsy-proven locally advanced breast cancer with clinically or radiologically positive axillary LNs, had been receiving neoadjuvant chemotherapy at the Clinical Oncology Department, and underwent surgery after neoadjuvant therapy at the surgical oncology unit of Alexandria Main University Hospital. Exclusion criteria were as follows: Patients with early-stage breast cancer, metastatic stage IV breast cancer, unfit/refusing neoadjuvant therapy, aged less than 18 years or more than 75 years or clinically and radiologically negative axilla. Data were collected retrospectively to assess the oncological and surgical outcomes after completing NAC. The files of 450 patients were reviewed, and only 64 patients were eligible patients to be included in our study. Results Complete pathological response (ypT0ypN0) was found in six of the 64 patients in our study. Four patients were triple-negative, and two patients were HER2-enriched biological subtype. One patient was T1, one patient was T2, one patient was T3, and three patients were T4. One patient was N1, four patients were N2, and one patient was N3. Conclusions Post-neoadjuvant ultrasound is essential for assessment of axillary response. Approximately 44.4% of patients with negative post-neoadjuvant axillary ultrasound can avoid unnecessary ALN clearance. Accurate axillary staging is the cornerstone for omission of axillary clearance after neoadjuvant among patients.

L-carnitine: A novel approach in management of acute cholinesterase inhibitor insecticide poisoning.

Cholinesterase inhibitors (ChEIs) insecticide poisoning is a serious global health concern that results in hundreds of thousands of fatalities each year. Although inhibition of the cholinesterase enzyme is the main mechanism of ChEI poisoning, oxidative stress is considered the mechanism underlying the related complications. The study aimed to assess the oxidative status of the patients with ChEI insecticide poisoning and the role of L-carnitine as adjuvant therapy in their management. Human studies on the efficacy and safety of L-carnitine in treating insecticide poisoning are limited despite its growing research interest as a safe antioxidant. This prospective study was conducted on eighty patients with acute ChEIs insecticide poisoning admitted to Alexandria Poison Center, Alexandria Main University Hospital, Egypt. Patients were allocated into two equal groups randomly. The L-carnitine (LC) group received the conventional treatment (atropine & toxogonin) and LC and the standard treatment (ST) group received the standard treatment only. Outcome measures were fatality rate, the total administered dose of atropine & toxogonin, length of hospital stay, and the requirement for ICU admission or mechanical ventilation. The study results revealed that malondialdehyde (MDA) significantly decreased in the LC group. Cholinesterase enzyme levels increased significantly after treatment in the LC group than in the ST group. The LC group needed lower dosages of atropine and toxogonin than the ST group. Also, the LC group showed no need for ICU admission or mechanical ventilation. The study concluded that LC can be considered a promising adjuvant antioxidant treatment in acute ChEIs pesticide poisoning.

Assessment of vitamin d status among egyptian covid-19 patients

BackgroundThe COVID-19 outbreak has increased awareness of vitamin D's (Vit-D) potential advantages for both prevention and treatment. Adequate vitamin D levels are necessary for health of the immune system, which can help with cellular response and protection against the severity of microbial infection.PurposeTo evaluate Vit-D levels and their association with illness severity in Egyptian COVID-19-infected individuals.MethodsThis case–control investigation was performed at the Alexandria Main University Hospital on 80 subjects divided into 2 groups: 40 COVID-19 patients and 40 healthy persons to measure the Vit-D levels of the Egyptian cohort.ResultsThere was a statistically insignificant difference in the Vit-D serum levels of the studied groups (P = 1.000). The age of the Vit-D insufficient patients was significantly higher than that of Vit-D sufficient patients (P = 0.006). There was a statistically insignificant rise in the CRP level in the Vit-D insufficient patients (P = 0.862) compared to patients with sufficient Vit-D. Also, the D-dimer levels in Vit-D-insufficient patients were considerably higher (P = 0.015). Patients with sufficient Vit-D exhibited significantly lower levels of IL-6 than Vit-D insufficient patients. (P = 0.037). Patients in the Vit-D-insufficient subgroup needed substantially more breathing support than those in the Vit-D-sufficient group (P = 0.020).ConclusionAlthough there was no association between both levels of Vit-D and the COVID-19 infection risk, insufficiency of Vit-D was related to more severe infection.

Phenotypic and molecular characterization of extended spectrum- and metallo- beta lactamase producing Pseudomonas aeruginosa clinical isolates from Egypt.

Antimicrobial resistance among Pseudomonas aeruginosa (P. aeruginosa), a leading cause of nosocomial infections worldwide, is escalating. This study investigated the prevalence of extended-spectrum β-lactamases (ESBLs) and metallo-β-lactamases (MBLs) among 104 P. aeruginosa clinical isolates from Alexandria Main University Hospital, Alexandria, Egypt. Antimicrobial susceptibility testing was performed using agar dilution technique, or broth microdilution method in case of colistin. ESBL and MBL prevalence was assessed phenotypically and genotypically using polymerase chain reaction (PCR). The role of plasmids in mediating resistance to extended-spectrum β-lactams was studied via transformation technique using plasmids isolated fromceftazidime-resistant isolates. Antimicrobial susceptibility testing revealed alarming resistance rates to carbapenems, cephalosporins, and fluoroquinolones. Using PCR as the gold standard, phenotypic methods underestimated ESBL production while overestimating MBL production. Eighty-five isolates (81.7%) possessed only ESBL encoding genes, among which 69 isolates harbored a single ESBL gene [blaOXA-10 (n = 67) and blaPER (n = 2)]. Four ESBL-genotype combinations were detected: blaPER + blaOXA-10 (n = 8), blaVEB-1 + blaOXA-10 (n = 6), blaPSE + blaOXA-10 (n = 1), and blaPER + blaVEB-1 + blaOXA-10 (n = 1). Three isolates (2.9%) possessed only the MBL encoding gene blaVIM. Three ESBL + MBL- genotype combinations: blaOXA-10 + blaAIM, blaOXA-10 + blaVIM, and blaPER + blaOXA-10 + blaAIM were detected in 2, 1 and 1 isolate(s), respectively. Five plasmid preparations harboring blaVEB-1 and blaOXA-10 were successfully transformed into chemically competent Escherichia coli DH5α with transformation efficiencies ranging between6.8 × 10 3 and3.7 × 10 4 CFU/μg DNA plasmid. Selected tested transformants were ceftazidime-resistant and harbored plasmids carrying blaOXA-10. The study highlights the importance of the expeditious characterization of ESBLs and MBLs using genotypic methods among P. aeruginosa clinical isolates to hinder the development and dissemination of multidrug resistant strains.

Germline NQO1c.559C&gt;T as a biomarker of genetic susceptibility to immune checkpoint blockade resistance.

8537 Background: Tobacco is the main risk factor for developing lung cancer. Yet, some heavy smokers do not develop cancer while others do at young ages. The study of cancer immunology has led to the surge of immune checkpoint blockade (ICB), which transformed the treatment landscape of cancer pts. NQO1 has been associated with extreme phenotypes of high risk for the development of tobacco-induced NSCLC and with poor survival outcomes for xerographs. Development of biomarkers for ICB has been mainly focused on tumor-related factors while genetic susceptibility of the host has been poorly explored to date and some evidence suggests that genetic dysregulation may enables immune escape. Methods: From June 2016 to January 2023, 326 NSCLC pts from two main University Hospitals of Malaga (Spain) receiving ICB were prospectively enrolled, blood samples were gathered. We selected a representative set of 60 consecutive pts for exome sequencing to characterize the germline contribution to resistance (progression within the first 6 months of treatment). PBMC DNA was extracted and prepared for exome sequencing. Raw sequencing data was processed and aligned to a reference genome using BWA. Base recalibration, germline variant calling and variant filtering was performed through GATK. Survival probabilities were estimated with the Kaplan-Meier method and compared using the log-rank test. We explored the lung cancer related genes among our results. Results: Median age at diagnosis of 64 (54-85). 76,6% were men. 44/60 (73,3%) were adenocarcinoma (ADC), PD-L1≥1% in 55% of patients, 22% shown PD-L≥50%. 78% had advanced disease at diagnosis. 65% received ICB in combination with chemotherapy. We found NQO1c.559C&gt;T in 46,6% of pts (28/60). The variation was not associated with survival outcomes in the multivariant analysis (p&gt;0.05) but with poor OS for non-ADC histology (19.7m vs 6m for mutated and WT, respectively; p&lt;0.01). In addition, we found 26 germline variants associated with OS and PFS, and 52 variants with response to ICB. The variants were missense or involved a stop gain/loss. Conclusions: Exome sequencing analysis of germline variants could be a suitable methodology to identify subrogated biomarkers of immune resistance in NSCLC patients. NQO1c.559C&gt;T might help to identify poor prognosis non-ADC pts in the ICB setting.

Alternations in miR-155 and miR-200 serum levels can serve as biomarkers for COVID-19 in the post-mass vaccination era.

Mass vaccination and natural immunity reduced the severity of COVID-19 cases. SARS-CoV-2 ongoing genome variations imply the use of confirmatory serologic biomarkers besides PCR for reliable diagnosis. MicroRNA molecules are intrinsic components of the innate immune system. The expression of miR155-5p and miR200c-3p was previously correlated with SARS-CoV-2 pathogenesis. This case-control study was conducted during the third peak of the COVID-19 pandemic in Egypt and aimed to calculate the accuracy of miR155-5p and miR200c-3p as biomarkers for COVID-19. Thirty out of 400 COVID-19 patients at a main University hospital in Alexandria were included in the study along with 20 age-matched healthy controls. Plasma samples were collected for total and differential CBC. Relative quantitation of miR155-5p and miR200c-3p expression from WBCs was done by RT-qPCR. The expression of miR155-5p and miR200c-3p was positively correlated and was significantly downregulated in COVID-19 patients compared to the healthy control group (p ˂ 0.005). Both miR155-5p and miR200c-3p were of 76% and 74% accuracy as diagnostic biomarkers of COVID-19, respectively. Regarding the differentiation between mild and moderate cases, their accuracy was 80% and 70%, respectively. miR155-5p and miR200c-3p expression can be used to confirm the diagnosis of COVID-19 and discriminate between mild and moderate cases, with a moderate degree of accuracy.

Decreasing medication errors in Alexandria Main University Hospital Critical Care Unit 3 using sensitization program

ABSTRACT Introduction The occurrence of medication errors in hospital settings presents considerable public health challenges, as they significantly affect patient morbidity and mortality, especially with an increasing frequency in critical care units. Material and methods A prospective before-and-after study conducted in Critical Care Unit 3 at Alexandria Main University Hospital involved 1440 observations of medication errors in 16-bed units over three months, encompassing 181 patients using a checklist. After implementing a sensitization program, a follow-up study was conducted with 1472 observations involving 185 patients over another three months. The comprehensive study focuses on the impact of the sensitization program on medication errors and its reporting, employing a prospective before-after design. Results No statistically significant difference in mortality was observed between Control and Postintervention groups (p = 0.258). Prescription errors accounted for 52.0%, transcription errors 19.2%, dispensing errors 1.2%, preparation errors 13.9%, and administration errors 13.6% of total medication errors. In the Control group, 38.7% experienced at least one medical error, compared to 21.6% in the Postintervention group (p < 0.001). There were 396 medication errors (27.5% of observations) in the Control group versus 250 errors (17.0% of observations) in the Postintervention group (p < 0.001). Errors reporting increased from 3.8% to 30% (p < 0.001). Conclusions The non-technological sensitization program effectively reduced medication errors in our resource-limited unit and improved error reporting.

Risk Assessment Tool of Breast Cancer and Barriers against Breast Self-Examination among Nurses: An Educational Program

Purpose. Breast cancer is considered a huge health problem among women all over the world due to its increased mortality rate. Breast cancer deaths are decreased by 28–34% due to improvement in treatment and early detection. In order to detect breast cancer early and provide the best possible therapy, knowledge and awareness are essential. So, this study aimed to assess risk of breast cancer among nurses, the knowledge and practices of breast self-examination (BSE) and determine its barriers, and implement an educational program for them. Design. A quasiexperimental research design was used. Methods. This study was conducted at two university hospitals (main university hospital and woman’s health hospital). A purposive sample of 280 nurses with age more than thirty-five years were included in the study using three tools, namely, structure interview questionnaire, breast cancer risk assessment tool, and a structured breast cancer knowledge and practice questionnaire. Nurses’ knowledge and practices regarding breast cancer and BSE were first assessed and then they were provided with two educational courses covering theoretical and practical information. One month after the program ended, the nurses’ knowledge and practices were assessed again. Results. About 3.2% of the participants have five years high risk of developing breast cancer according the risk assessment tool, the main barriers of do not do BSE did not find any symptoms and scared from finding any abnormality. There was a significant increase in knowledge and practice of breast self-examination posteducation compared to pre-education (73.2 and 98.2%, respectively). Also, there was a statistically significant difference between pre- and postprogram with a p value of 0.0001. Conclusion. This study concluded that 3.2% of the nurses with high risk of developing breast cancer needed a follow-up; more than half of them do not perform breast self-examination because they think that do not have any symptoms in the breast and the educational program with a significant effect on knowledge and practices of nurses. So, the researchers recommend the nurses need for an empowerment program and support by providing assistance in places of work as done free clinical examination and mammography by female specialist for privacy.

Unraveling the synergy: how organizational intelligence fuel soft skills and nurses’ thriving: a cross-sectional study

AimInvestigate the influence of organizational intelligence on the development of soft skills and the overall thriving of nurses at Alexandria Main University Hospital in Egypt.DesignA cross-sectional descriptive design following STROBE guidelines examined the relationship between organizational intelligence, soft skills, and nurses’ thriving.Methods and toolsData were collected from 740 nurses working across critical care units using structured questionnaires. The questionnaires assessed organizational intelligence, soft skills, and thriving at work. Sociodemographic characteristics, including age, gender, education, and nursing experience, were also collected. Statistical analyses were used to analyze the data, including ANOVA, t-tests, Pearson correlation, and stepwise regression.ResultsThe findings revealed nurses’ positive perceptions of organizational culture and documentation skills. However, areas such as measures and rewards and staff relations and communication indicated opportunities for improvement. Nurses reported high vitality levels but needed more learning opportunities at work. Significant correlations were found between demographic variables, organizational intelligence, soft skills, and thriving. Organizational intelligence demonstrated a robust positive relationship with both soft skills and thriving. Age, gender, education, and experience significantly influenced nurses’ soft skills and thriving.ConclusionThe study highlights the importance of organizational intelligence in enhancing nurses’ professional capabilities and well-being. Addressing demographic factors and fostering a supportive work environment is crucial for optimizing nursing practice and organizational effectiveness.Nursing implicationsInsights from this study can inform targeted interventions and policy decisions to enhance nursing practice, organizational development, and healthcare outcomes in Egypt. Fostering organizational intelligence and soft skills among nurses can improve patient care, increase job satisfaction, and overall organizational success.

Ultrasound-assisted resection of insular gliomas

BackgroundInsular gliomas’ management challenges are attributed to their complex shape, proximity to critical vasculature, and organization. However, cytoreductive surgery's role in maximal extent of resection (EOR) improves survival. Intraoperative ultrasound (IOUS) aids in defining tumor border, detecting residual, and guiding access.AimThe aim of this study was to assess the impact of using intraoperative ultrasound on the extent of resection of insular gliomas, and the postoperative outcomes in a prospective cohort of 20 patients operated at Alexandria main university hospital and followed up for a period of at least 3 months.ResultsThe Near total resection rate was 45% with 70% of patients having no neurological morbidity postoperatively. The median EOR was 81% with a range of 44 to 96%. The mean duration of IOUS setup was 19.6 ± 5.04 min, while the additional resection rate following IOUS assessment for residual tumor was 65% (n = 13). In addition, there was a significant increase in Karnofsky Performance Status (KPS) from the preoperative through to the 90-day follow-up period (p = 0.012). Finally, following multivariate linear regression analysis, the EOR was identified as having a statistically significant correlation with the postoperative KPS (p = 0.004).ConclusionIntraoperative ultrasonography is a valuable modality for strategizing the most efficient route to the tumor, promptly detecting any remaining tumor tissue, and optimizing the extent of resection for insular gliomas, while taking into consideration the phenomenon of brain shift.