Shebin El-Kom Teaching Hospital Research Articles

The Assessment of the Diagnostic Accuracy of Bedside Lung Ultrasound in Critically Ill Respiratory Failure Patients

Background: Lung ultrasound is a new diagnostic tool for diagnosis of acute chest conditions. The aim of the current study was to assess the accuracy of lung ultrasound algorithm in intensive care unit (ICU) patients with respiratory failure. Methods: This is a randomized comparative study included 80 patients admitted to the intensive care unit, Shebin El-Kom Teaching Hospital during three years from October 2017- October 2020. The study received the approval of ethical committee of faculty Medicine, Kasr- El-Einy, Cairo University. History, clinical examination, Chest X ray, Computed tomography (CT) chest, lung US, and Echocardiography were done. Results: Ultrasonography (US) showed sensitivity and specificity 100 %, 100% respectively in diagnosis of pneumothorax Regarding pneumonia, sensitivity and specificity of US were (68.2%, 86.2% respectively). Regarding interstitial lung disease (ILD), sensitivity and specificity of US were (55.6%, 98.6%). Additionally, as regard pulmonary edema and pleural effusion, US sensitivity and specificity were (66.7%, 97.4%) and (78.9%, 98.4%) respectively. Conclusion: In comparison with CT scan, bedside lung ultrasonography (LUS) seems to be a valuable substitute in cases where performing CT is problematic. We recommend starting the use of bedside LUS as routine tool to improve the diagnostic accuracy for most of the pulmonary presentations.

Yersinia Infection in Acute Appendicitis in Children in Shebin Elkom Teaching Hospital

Yersinia Infection in Acute Appendicitis in Children in Shebin Elkom Teaching Hospital

Placenta accreta index as a predictor of placental invasion in cases of placenta previa

ObjectiveThis study aims to evaluate the role of the placenta accreta index in predicting placental invasion in patients with placenta previa.Patients and methodsThis study was carried on 60 pregnant women with placenta previa (after 30 weeks gestation). They were recruited from the Obstetrics and Gynecology clinic of Menoufia University hospitals and Shebin El Kom Teaching Hospital in the period from January 2019 to December 2020.ResultsPreterm labor was found in 15 (78.95%) patients in the accreta group and six (14.36%) patients in the nonaccreta group (P = 0.000). Hysterectomy was performed in 14 (73.68%) patients in the accreta group and four (9.76%) patients in the nonaccreta group (P = 0.000). Urological complications occurred in five (26.32%) patients in the accreta group and one (2.44%) patient in the nonaccreta group (P = 0.004). Blood transfusion was needed in 16 (84.21%) patients in the accreta group and seven (17.07%) patients in the nonaccreta group (P = 0.000). ICU transfer was needed in 10 (52.63%) patients in the accreta group and two (4.88%) patients in the nonaccreta group (P = 0.000).ConclusionsBoth grayscale and color Doppler ultrasound were very important in the prenatal diagnosis of placenta accreta to reduce maternal and perinatal mortality and morbidity, but color Doppler had higher sensitivity and specificity. Placenta accreta index score 4 can be used as a predictive cutoff value for prediction of placental invasion in patients with placenta previa. Placenta previa in current pregnancy, previous uterine scar, increased maternal age, number of dilation and curettage and number of pregnancies and labors, and the presence of previous history of placenta previa are all risk factors for placenta accreta, and placenta accreta is associated with increased postoperative morbidity. It is associated with increased blood loss, risk of blood transfusion, ICU admissions, wound sepsis, urological complications, and poor neonatal outcome.

Predictors of placental abruption during expectant management of premature preterm rupture of membranes

ObjectiveTo predict the risk factors of placental abruption during expectant management of preterm rupture of membranes.BackgroundA frequency of abruption of 4.0%–6.8% has been reported in patients with preterm premature rupture of membranes (PPROM). Antepartum vaginal bleeding occurs during the period of expectant management, the associated risk of developing placental abruption is high. It may be possible to approximate the risk for placental abruption based on these simple prepregnancy risk factors.Patients and methodsAn observational study was conducted on 100 pregnant women. The patients were randomly selected from those attending labor ward at Menoufia University Hospital and Shebin EL-Kom Teaching Hospital. All women included in this study are with PPROM, divided into group I that included 79 without placental abruption and group II included 21 with placental abruption. Full analysis of detailed history and examination and primarily samples are taken during the study period from January 2019 to December 2020.ResultsThere were statistically significant differences among patients with placental abruption than those without placental abruption regarding antepartum or intrapartum fetal distress requiring urgent cesarean section and gestational age. The majority of patients with placental abruption had gestational age more than 32 weeks (P < 0.05). Most of the patients with placental abruption had latency to its occurrence more than 48 h since the time of admission with PPROM with a percentage of 85.71%.ConclusionPlacental abruption is a complex disease. Although several risk factors are known, the etiopathogenesis is not fully understood and its occurrence often remained unpredictable or unpreventable. Placental abruption was absent in 79% of our patients.

Association of maternal serum lipids levels at late gestation with large for gestational age and neonatal macrosomia in nondiabetic women

ObjectivesTo evaluate the relationship between maternal serum lipids at late gestation in nondiabetic women and the risk of large for gestational age (LGA) and neonatal macrosomia.BackgroundLGA is defined as an infant with a birth weight greater than the 90th percentile for the given week of pregnancy. Maternal dyslipidemia can also induce excessive fetal growth by changes in lipid metabolism during pregnancy.Patients and methodsA prospective observational study was conducted on 161 pregnant women aged 20–35 years recruited from the Department of Obstetrics and Gynecology of Menoufia University Hospital and Shebin El-Kom Teaching Hospital from January 2020 till December 2020. The patients included in the study were singleton live pregnancy, pregnant at 37–42 gestational weeks, and naturally conceived. For all patients, detailed history taking, including family history of diabetes mellitus among first-degree relatives, complete clinical examination, and measurements of maternal lipid profile, including total cholesterol, triglyceride (TG), high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol (LDL-C), and fasting blood sugar and 2 h postprandial blood sugar, were done. Obstetric ultrasound was performed to assess fetal growth. Accordingly, patients were classified into three groups as follows: group 1, normal group; group 2, LGA; and group 3, LGA and neonatal macrosomia.ResultsOur results reported that cholesterol level, TG, LDL levels, and fasting blood sugar level were significantly higher in the LGA group when compared with the normal group. These significant higher levels were consistent between the neonatal macrosomic group and the normal group, with the exception of LDL level, which showed a nonsignificant difference. A cutoff level of cholesterol more than 214 has a sensitivity of 93.8%, a specificity of 82.2%, and an accuracy of 85%, whereas a cutoff level of TG more than 244 has a sensitivity of 96.6%, a specificity of 55.3%, and an accuracy of 63%.ConclusionsElevated TG and cholesterol at late gestation are independent predictors for LGA and neonatal macrosomia in nondiabetic pregnant women.

Evaluation the role of conventional and Xpert MTB/RIF assays as point-of-care tests of Mycobacterium tuberculosis infections, especially during the COVID-19 pandemic in Menoufia, Egypt

BackgroundTuberculosis (TB) is a destructive pulmonary disease, which was the most fatal infectious disease in the world for many years before the COVID-19 outbreak. During pandemic, COVID-19 was the main concern in every clinic and there were overlapping respiratory diseases resulting in delaying of the diagnosis and treatment of TB. Xpert MTB/RIF assay and Ziehl–Neelsen (ZN) stain are the most commonly used point-of-care test (POCT) assays for TB that were endorsed by WHO allowing a quick treatment turnaround time of a few minutes or hours, hence avoiding patient loss to follow-up. The aim of the study was to evaluate the role of Xpert MTB/RIF as a POCT for early, rapid, and accurate diagnosis of pulmonary and extrapulmonary TB during the COVID-19 pandemic and its role for exclusion of non-mycobacterial TB infections and to evaluate the proportion of patients with active pulmonary TB among COVID-19 patients and to study the difference of some inflammatory markers between patients with COVID-19, patients with pulmonary TB, and patients infected by both TB and COVID-19.Patients and methodsThis study was conducted from February 2018 to December 2021 (including the peak period of COVID-19 on 835 suspected TB patients (629 + 206 suspected COVID-19 patients six of them were proved pulmonary TB). Patients were from Shebin El-Kom Teaching Hospital and Chest hospital, Menoufiya). All 835 (pulmonary and extrapulmonary samples) patients were tested by gene Xpert MTB/RIF including 441 of them tested by ZN only. For detection of sensitivity, specificity positive predictive value (PPV), negative predictive value (NPV), and accuracy we selected 103 samples who were tested by the three methods (gene Xpert MTB/RIF, ZN staining, and culture on LJ media). For studying the difference of some inflammatory markers between patients with COVID-19, patients with pulmonary TB, and patients infected by both TB and COVID-19, 206 patients who were suspected of comorbid TB and COVID-19 during the pandemic were divided into three groups: group I positive for TB and COVID-19 (N = 6), group II positive COVID-19 only (N = 100), and group III were positive pulmonary TB only (N = 50) (NB: 50 patients were excluded due to incomplete data). Blood samples were taken for complete blood count, erythrocyte sedimentation rate, malondialdehyde, interleukin-6, C-reactive protein, D-dimer, ferritin, lactate dehydrogenase, calprotectin, and procalcitonin. Nasal swabs were needed for confirmation of COVID-19 by PCR.ResultsCompared with culture as a gold standard, sensitivity, specificity, PPV, and NPV for ZN smear were 77.1, 100, 100, and 53.8%, respectively. As regards the results of XPERT MTB/RIF assay, from the 103 samples examined, 89 (86%) were positive and 14 (14%) were negative. Eight false-positive results were recorded, compared with culture. The sensitivity was 98.8%, specificity was 61.9%, PPV was 91%, and NPV was 92.8%. There was a significant increase within groups in MDA, procalcitonin, ESR, and calprotectin with P value of 0.22, 0.015, 0.000, and 0.009, respectively.ConclusionXpert MTB/RIF as POCT for TB diagnosis is more sensitive and specific than traditional methods of diagnosis using ZN to overcome the challenges with weak testing infrastructure especially during the COVID-19 pandemic. Serum calprotectin was significantly increased in the COVID-19 group compared with the TB group C-reactive protein, which was significantly increased in the TB group compared with COVID-19 group.

Coronavirus disease 2019 and diabetes mellitus

IntroductionIn late 2019, a new virus severe acute respiratory syndrome coronavirus-2, which causes a new serious disease called coronavirus disease 2019 (COVID-19), spread quickly all over the world. Many complications of diabetes mellitus (DM) such as microvascular and macrovascular complications increase the risk for COVID-19-related severity and mortality.ObjectiveTo assess the effect of DM on outcome and severity of COVID-19.Patients and methodsThis work was a retrospective observation that included confirmed COVID-19-infected patients (PCR positive for COVID-19) who were admitted to Shebin El-Kom Teaching Hospital, Menoufia, Egypt, from March 2021 to March 2022. Laboratory investigations such as age, sex, and sings of severity of COVID-19 were studied. In this study, patients were divided into three main groups as follows: group 1 diabetic patients had known DM, group 2 (hyperglycemic group) patients were without past history of DM but were known to have hyperglycemia with COVID-19, and group 3 (control) had normal blood glucose.ResultsA total of 300 patients were divided into diabetic and hyperglycemic groups and were compared with the control group. It was found that diabetic and hyperglycemic groups were significantly associated with severe and critical disease, long hospital stay, increased number of admissions in critical care unit, increased number of patients under mechanical ventilation, and increased mortality rate from COVID-19 compared with the control group.ConclusionsPatients with DM are more liable for severe acute respiratory syndrome coronavirus-2 infection, ICU admission, and increase in the rate of death. In addition, new hyperglycemia, even without history of DM, increased the severity of COVID-19 infection. Special care should be given for diabetic patients. Therefore, glucose monitoring and tight control of blood glucose are essential for all.

Impact of Enhanced Recovery Pathway Application Outcomes on Nurses and Women Undergoing Cesarean Section

Enhanced recovery after surgery is a standardized, multidisciplinary approach for caring patients with a goal of decreasing length of hospital stay and care without negatively affecting patient outcomes. Aim: to investigate the impact of enhanced recovery pathway application outcomes on nurses and women undergoing cesarean section. Design: A quasi experimental (pre-posttest for maternity nurses and study/control groups for women undergoing cesarean section) design was utilized in this study. Settings: This study was conducted at the obstetrics departments affiliated to University Hospital and Shebin El-Kom teaching hospital, Menoufia Governorate, Egypt. Sample: A convenient sample of 50 maternity nurses worked in the previous settings and a purposive sample of 250 cesarean delivery women were recruited in this study. Instruments: for collecting data; a structured interviewing questionnaire, knowledge assessment & an observational checklist for the nurses, knowledge assessment instrument, an observational checklist and numeric pain intensity scale for the mothers were used. Results: There was an increase in total knowledge and practice scores of the maternity nurses regarding the enhanced recovery pathway application. Also, its application following CS had an effect on relieving the women’s postoperative problems especially pain than those who received the routine hospitals nursing care only.Conclusion: application of enhanced recovery pathway significantly reduces the postoperative complications especially pain, length of hospital stay, and improves the maternity nurses' knowledge and practice scores post caesarean . Recommendation: Enhanced recovery pathway should be applied during cesarean section operations to improve the patients' outcomes and reduce the postoperative complications

ASSESSMENT OF PERINATAL OUTCOME AFTER USING NIFEDIPINE VERSUS PLACEBO IN THE TREATMENT OF PRETERM PRELABOR RUPTURE OF MEMBRANES (Randomized controlled study)

Background: Preterm birth is the most common cause of neonatal morbidity and mortality worldwide and accounts for approximately 75% of all neonatal deaths and 50% of childhood neurological morbidities. Around one-third of preterm deliveries start with preterm pre-labor rupture of membranes (PPROM). Objective: To assess the value of Nifedipine to change the perinatal outcome in cases of preterm pre-labor rupture of membranes. Patients and methods: This was a randomized, controlled study that included and followed 200 pregnant women. One hundred pregnant women were recruited in the Nifedipine group in addition to 100 pregnant women were recruited as a control group from Obstetric Department of Shebin El Kom Teaching Hospital during the period form to 2017-2019. Results: In this randomized clinical trial among women with PPROM without contractions, we found no significant differences between treatment with nifedipine or placebo in terms of perinatal outcomes and prolongation of pregnancy. Conclusion: On perinatal outcomes or prolongation of pregnancy in women with PPROM without contractions.

Evaluation of MicroRNA-122 as A Non-invasive Diagnostic Biomarker For Non-Alcoholic Fatty Liver Disease and NASH related Cirrhosis

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. NAFLD is considered to represent the hepatic manifestation of metabolic syndrome. NAFLD was traditionally considered as a relatively benign liver disease. However, some patients with NAFLD progress to liver fibrosis, cirrhosis and hepatocellular carcinoma 8-13. Therefore, the precise diagnosis and staging of NAFLD patients is clinically important. Liver biopsy is the gold standard for the evaluation of NAFLD patients in terms of staging. However, liver biopsy is an invasive technique, and the identification of noninvasive biomarkers is required. Objective To assess the value of MicroRNA-122 as a non-invasive biomarker for diagnosis of NAFLD and NASH related Cirrhosis. Patients and Methods In the present study, we assess the value of MicroRNA-122 as a noninvasive biomarker for diagnosis of NAFLD and NASH related Cirrhosis. Gastroenterology and Hepatology outpatient clinic at: Ain Shams University Hospitals, Shebin El-Kom Teaching Hospital, Kafr Elsheikh University Hospitals. Clinical Pathology department at Faculty of Medicine, Ain Shams University. Results Patients with NASH had higher NAFLD score than patients with NAFLD than normal control. Patients with NASH had significantly higher frequency of upregulated miRNA-22. Patients with NASH had higher miRNA 122 expression than normal controls and patients with NAFLD. Likewise, patients with NAFLD had higher miRNA 122 expression than normal controls. The miRNA 122 was a significant discriminator of NAFLD and NASH with a sensitivity of 75% and specificity of 82% for NAFLD and a sensitivity of 91% and specificity of 86% for the NASH. Conclusion miRNA-122 is a sensitive and specific biomarker in the early detection of NAFLD and NASH as they are linked to the lipid metabolism reducing the need for liver biopsy. NAFLD fibrosis score had high sensitivity in differentiating the NAFLD groups from the control group and in differentiating the steatosis group from the NASH group. Serum levels of miRNA-122 were positively correlated with BMI, ALT and AST.

Evaluation of MicroRNA-122 as A Non-invasive Diagnostic Biomarker For Non-Alcoholic Fatty Liver Disease and NASH related Cirrhosis

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. NAFLD is considered to represent the hepatic manifestation of metabolic syndrome. NAFLD was traditionally considered as a relatively benign liver disease. However, some patients with NAFLD progress to liver fibrosis, cirrhosis and hepatocellular carcinoma 8-13. Therefore, the precise diagnosis and staging of NAFLD patients is clinically important. Liver biopsy is the gold standard for the evaluation of NAFLD patients in terms of staging. However, liver biopsy is an invasive technique, and the identification of noninvasive biomarkers is required. Objective To assess the value of MicroRNA-122 as a non-invasive biomarker for diagnosis of NAFLD and NASH related Cirrhosis. Patients and Methods In the present study, we assess the value of MicroRNA-122 as a noninvasive biomarker for diagnosis of NAFLD and NASH related Cirrhosis. Gastroenterology and Hepatology outpatient clinic at: Ain Shams University Hospitals, Shebin El-Kom Teaching Hospital, Kafr Elsheikh University Hospitals. Clinical Pathology department at Faculty of Medicine, Ain Shams University. Results Patients with NASH had higher NAFLD score than patients with NAFLD than normal control. Patients with NASH had significantly higher frequency of upregulated miRNA-22. Patients with NASH had higher miRNA 122 expression than normal controls and patients with NAFLD. Likewise, patients with NAFLD had higher miRNA 122 expression than normal controls. The miRNA 122 was a significant discriminator of NAFLD and NASH with a sensitivity of 75% and specificity of 82% for NAFLD and a sensitivity of 91% and specificity of 86% for the NASH. Conclusion miRNA-122 is a sensitive and specific biomarker in the early detection of NAFLD and NASH as they are linked to the lipid metabolism reducing the need for liver biopsy. NAFLD fibrosis score had high sensitivity in differentiating the NAFLD groups from the control group and in differentiating the steatosis group from the NASH group. Serum levels of miRNA-122 were positively correlated with BMI, ALT and AST.

Cervical Length as a Predictor of Success of Induction of Labor

Background: Vaginal delivery is the most important event occurring in women’s life. It carries many risks of significant concerns to the physicians. Predicting the chances of vaginal delivery is of paramount concern for the pregnant woman. Antenatal cervical length measurement has paramount importance in the prediction of labor. Objective: This study aimed to study the role of cervical length in prediction of success of induction of labor in term pregnancy. Patients and Methods: A prospective study where 140 pregnant women undergoing induction of labor for various indications were included, the cases were recruited from Obstetric Department of Shebin El-Kom Teaching Hospital in the period from October 2019 to December 2020. Results: Methods of induction was misoprostol in (75) females and amniotomy with oxytocin in (65) females. 97 Females were delivered by simple vaginal delivery, 79 females were delivered within 24 hours of induction, 18 females were delivered after 24 hours, and 43 females were delivered by caesarian section (C.S.). Indications of C.S. were mainly due to failed induction and fetal distress. Conclusions: We concluded that successful induction of labor was correlated significantly with detection of insulin-like growth factor-binding protein 1 (iGFBP-1) in cervical secretions and measurement of cervical length by transvaginal ultrasound (TVUS), IGFBP-1 detection by Actim Partus test is simple, easy bed side test that can predict successful induction of labor and measurement of cervical length by TVUS is a good predictor factor for successful induction of labor.

Different Modalities of Flap Coverage of Achilles Tendon Region Defects: Functional and Aesthetic Outcomes

Abstract Background: In the decision-making process toward covering various Achilles' tendon region, knowledge about patient related outcomes after surgery and rehabilitation is important. Therefore, we aimed to present an overview of outcomes and select the most appropriate flaps used for covering soft tissue defects over Achilles' tendon region. Aim of Study: Study aimed to analyse and determine the suitable reconstructive surgical options for Achilles' tendon coverage and to evaluate the clinical, functional and aesthetic outcomes. Patients and Methods: Between September 2017 and December 2019, 25 patients with skin loss over Achilles' tendon region were admitted to Menoufia University Hospital and Shebin-Elkom Teaching Hospital. The soft tissue defects ranged from 3x2 to 16x12 cm. Six types of flaps were used for the coverage of concomitant skin defects. Results: There was no complete flap loss and all flaps survived. Lateral supra malleolar flap (28%) was used in seven patients, distally based peroneus brevis muscle flap (16%) in four patients, posterior tibial artery perforator flap (24%) in six patients, peroneal artery perforator flap (4%) in one patient, reversed sural artery flap (24%) in six patients, and free latissimus dorsi musculocutaneous flap (4%) in one patient. Two patients were subjected to debridement and covered with split thickness skin graft (STSG). One patient suffered from chronic ulcer formation which was covered with lateral supra malleolar artery flap. The algorithm of one-stage reconstruction was established, according to the defect size of skin. Conclusion: Perforator flaps, lateral supra malleolar artery flap, and the distally based peroneus brevis muscle flap were a suitable option for coverage of small to intermediate sized defects; reversed sural artery flap is best for coverage of moderate to large size defects and free flaps are the best choices for complex wide reconstructions.

Effect of Implementing Clinical Pathway among Pregnant Women with Pyelonephritis on Childbirth and Neonatal Outcome

Aim of this study to determine the effect of implementing clinical pathway among pregnant Women with pyelonephritis on childbirth and neonatal outcomes. Design: A quasi –experimental design. Setting: The study was conducted at outpatient’s clinic of obstetric department at Shebin EL-Kom Teaching Hospital, Menoufia University hospital at Shebin EL-Kom. Subjects: Convenient sample was used all stuff nurses in the obstetric department (20 nurses) as well as 50 pregnant mothers will selected and divided into two equal groups; intervention group (25mothers who received clinical pathway during second trimester of pregnancy) and control group (25 mothers who not received clinical pathway). Instruments: interviewing questionnaire for pregnant mothers, & nurses and Observation checklist of neonatal outcomes. Results: The study revealed that there was highly significant improvement in women knowledge after implementing clinical pathway, there was significant improvement in nurse’s knowledge, childbirth, and neonatal outcomes. Conclusion: There was significant improvement was obvious among women relief of their reported symptoms and their knowledge about pyelonephritis and measures to relieve it. Recommendations: Improve the quality of health care provided through routine screening of pregnant women and applying workshops for nurses to improve their knowledge about pyelonephritis during pregnancy.

Sexually transmitted diseases knowledge among andrology clinic attendants in Menoufia University and Shebin El-Kom Teaching Hospitals

Objective The aim was to assess knowledge regarding sexually transmitted diseases (STDs) among attendants in Dermatology and Andrology Clinics in Menoufia University Hospital and Shebin El-Kom Teaching Hospital. Background Knowledge of STDs and their complications is important for adequate prevention and treatment, as people who do not know the symptoms may fail to recognize their need and so may not seek help. Patients and methods A case–control study was conducted. Cases were patients who were diagnosed to have current symptomatic STDs. Control group was selected from attendants of both clinics, who were not complaining of any symptoms of STDs. Control group was age and sex matched. The selected sample with the help of the researcher was interviewed using predesigned questionnaire asking about different types of STDs, the causative agents, transmission routes, protective measures, symptoms, and complications of STDs. Results More than half of the studied group (∼64.5%) had satisfactory level of knowledge about STDs. Most of them, ∼84.2%, were from the control group, and only ∼4.2% represented the cases. Proper knowledge about STDs was statistically significant higher in the control group than the case group in STD knowledge parameters (types, complications, symptoms, the causative organisms, the routes of transmission, and the effect of contraceptive pills or condom on the presence of STDs). There was a highly statistically significant relation between the level of knowledge and presence of STDs. Moreover, there was a significant relation between participant education and level of knowledge about STDs. Conclusion The level of STD knowledge is satisfactory among the control group more than the cases. There is a highly statistically significant relation between level of knowledge and presence of STDs. There is a significant relation between participant higher level of education and level of STD knowledge.

EFFECT OF CLINICAL PATHWAY OF POSTOPERATIVE NURSING CAREON IMPROVING POSTOPERATIVE OUTCOMES FOR WOMEN UNDERGOING HYSTERECTOMY

Background: Utilization of a multidisciplinary clinical pathway during care of women undergoing hysterectomy is considered to be more effective during women' management than routine hospital care.Aim: This study was conducted to investigate the effect of clinical pathway of postoperative nursing care on improving postoperative outcomesfor women undergoing hysterectomy. Design: A quasi experimental design (study and control group). Settings: The gynecology and obstetrics departments at two hospitals affiliated to University Hospital and Shebin El-Kom teaching hospital, Menoufia Governorate. Subjects: 100 women who are undergoing hysterectomywere selected. Tools: three instruments were used for data collection;a structured interviewing, numeric pain intensity scaleandpatient satisfaction record.Results: The current study shows that women underwent hysterectomy in the study group were significantly more likely to experience less mean pain score, lesser need for analgesiaand Significant differences in the length of stay were observed compared to those in the control group.Significant differences in the early oral intake, postoperative bowel mobility and need to antiemetic drugswere observed between the study and the control groups. Concerning women’s satisfaction related to the care provided,the score given was mostly satisfied and neutral. Conclusion: application of clinical pathway improving postoperative pain successfully, short length of stay postoperative outcomes related to early ambulation, early oral intake, and bowel mobility, hours to remove catheters and drains and patient satisfaction. Recommendation: Sit is recommended to generalize application of clinical pathways in other clinical areas to improve patient outcomes and reduce postoperative complications.

Awareness of Nursing Staff and Patients Regarding Hospitals Accreditation

Hospital accreditation is considered as an intervention performed to support patient safety and ensure high quality healthcare. Purpose: To assess the level of awareness of nursing staff and patients regarding hospital accreditation and determine the differences between the nursing staff awareness and patientsꞌ awareness regarding hospital accreditation. Design: Descriptive comparative design was utilized in this study. Setting: The study was conducted at ICU, surgical and medical departments at Menoufia University Hospitals, Shebin E Kom Teaching Hospital, National liver Institute and El Helal hospital. Sampling: A simple random sample of 448 staff nurses, 52 head nurses and 221 patients were included to participate in the study .Instruments: Nursing staff awareness and patientsꞌ awareness questionnaire. Results: the nursing staff had a moderate level of perception regarding hospital accreditation in El Helal Governmental hospital (81%) and in National Liver Hospital (NLI)(60.4%), On the other hand, nursing staff in Shebin El-kom Teaching Hospital (STH) and Menoufia University Hospitals(MUH) had a low level of perception . The nursing staff in all hospitals had not satisfied knowledge level and low level of awareness about hospital accreditation. Also, Patients in El Helal hospital had higher level of awareness and perception concerning than patients in Menoufia University hospital, Shebin El- Kom Teaching hospital and National Liver Institute. El Helal patients had satisfied level of knowledge of hospital accreditation, while patients in National Liver Hospital (NLI), Shebin El-Kom Teaching Hospital (STH) and Menoufia University Hospitals (MUH) had not satisfied level of knowledge in hospital accreditation. Conclusion: In the light of the present study results, the studied sample of the nursing staff had moderate level of perception of hospital accreditation in El Helal Governmental hospital and in National Liver Hospital (NLI).On the other hand, nursing staff in Shebin El-kom Teaching Hospital (STH) and Menoufia University Hospitals (MUH) had low level of perception and awareness of hospital accreditation. The patients in El Helal Governmental hospital had a moderate level of awareness, while patients in National Liver Hospital, Shebin El-Kom Teaching Hospital and Menoufia University Hospitals had a low level of awareness regarding hospital accreditation. Recommendations: Healthcare organizations should develop awareness regarding hospital accreditation among nurses by integrating this concept into its core values and strategic management.

Maternal Serum C-Reactive Protein for Prediction of Maternal and Perinatal Morbidity in Premature Rupture of Membranes

Background: Premature rupture of membranes (PROM) is defined as spontaneous rupture of membranes before the onset of uterine contraction. If the rupture of the membranes occurs after 28 weeks but before 37 weeks of gestation it is termed as PPROM (Preterm Premature Rupture of Membranes). Objective: To assess the role of the C- reactive protein (CRP) as a reliable predictor of chorioamnionitis in premature rupture of membranes (PROM). Patients and methods: This is an observational prospective study that was conducted on 120 pregnant women admitted to Menoufia University Hospitals and Shebin EL-Kom Teaching Hospital during the period from October 2019 till December 2020. Results: CRP level has sensitivity and specificity of (87.5% and 88.7%) respectively, at cutoff value >13 with area under curve of 0.915 with accuracy of 76.3% as the diagnostic tool in PPROM cases with histological chorioamnionitis (HCA). Also, C-reactive protein was significantly positively correlated with placental examination HCA, offensive discharge, ESR at 2nd hour, and TLC (p 0.05). Conclusion: CRP has a role for detection of maternal and perinatal morbidity with accuracy about 76% and can be used as an early predictor for morbidity in pregnant women with PPROM. Pregnant women with PPROM who had CRP level ≤13 mg/l should have expectant management if there are no other contraindications and those have CRP level >13 mg/l; termination of pregnancy should be taken in consideration in presence of signs of clinical chorioamnionitis.

Servant Leadership and Meaningful Work' Roles on Staff nurses’ Creativity and Sustainable Development Behavior

Background: In a healthcare organization, servant leadership can fulfill nurses’ needs effectually through prioritizing their career growth and development which may facilitate the creation of creative behavior, motivation, innovation, and satisfaction, besides facilitating sustainable behavior of them in the workplace. Aim: To investigate the relationship between servant leadership and its’ role on staff nurses’ creativity and sustainable development behavior. Setting: The study was implemented at neurology, cardiology, emergency and critical, pediatric, inpatients clinics, and medical departments, and intensive care units (ICUs) of Shebin El-Kom Teaching Hospital, Menoufia Governorate. Subjects: A simple random sample (428) of staff nurses with a minimum of one year of experience. Tools: Three tools were used; Servant Leadership Assessment Instrument; Employee Creativity Scale, and Sustainable Development Behavior Scale. Results: Staff nurse’s response to total levels of servant leadership, creativity, and sustainable development behavior were all at a moderate level. Conclusion: There was a highly statistically significant positive correlation between servant leadership and its’ role on staff nurses’ creativity and sustainable development behavior. Recommendations: Conducting an educational intervention programs about servant leadership to allow a healthy working environment.

Nurse manager’s meaningful recognition program: Its relation to staff nurses’ sense of coherence and self-efficacy during COVID-19 pandemic

Meaningful recognition from nurse managers is considered a powerful tool for improving staff nurses’ psychological capital to deal effectively with stressful challenges they are exposed to during the COVID-19 pandemic through raising their sense of coherence (SOC) and improving their self-efficacy. Aim: This study aimed to assess the effect of nurse managers’ meaningful recognition program on staff nurses’ sense of coherence and self-efficacy. Design: A quasi-experimental, one-group (pretest-posttest) research design was used. Setting: This study was conducted at Shebin El Kom Teaching Hospital, Menoufia Governorate, Egypt. Sample: A purposive sample of 35 nurse managers and 50 staff nurses. Data collection tools: Three tools were used; Recognition Behavior Questionnaire, General Self-efficacy Likert Scale, and Sense of Coherence Scale (SOC), in addition to demographic characteristics. Results: There was a highly statistically significant improvement of the total recognition behavior of nurse managers and its subscales as reported by staff nurses after implementation of the program and on follow up than before (P