Tanta University Research Articles

Evaluation of autologus platelet-rich plasma versus silver nitrate in the treatment of cervical erosion

Background Cervical erosion is identified by the existence of columnar cells on the ectocervix rather than on the squamous epithelium. Adolescent age, pregnancy, and hormonal contraception are all causes of erosion. Some doctors think erosion is a typical asymptomatic variation, while others believe it is caused by persistent cervicitis. Metaplastic columnar epithelium may cause a variety of symptoms such as vaginal discharge, leukorrhea, postcoital bleeding, pelvic discomfort, and dyspareunia. Laser ablation, microwave ablation, platelet-rich plasma (PRP) injections, herbal treatments, and cryosurgery have all been reported as therapeutic options. Aim Evaluating the therapeutic effect of applying an autologous PRP in cervical erosion versus chemical cautery with silver nitrate. Patients and methods Randomized controlled clinical study on 100 patients at the outpatient clinic of the Obstetrics and Gynecology Department, Faculty of Medicine, Tanta University Hospitals. A total of 50 patients was assigned as the PRP group), the study group, while the other was the silver nitrate group. Follow-up visits occurred on the 1st, 2nd, 4th, 6th, 8th, 10tht, and 12th week posttreatment for the lesion size changes, symptom relief, postprocedure discomfort, pain, and long-term complications. Results PRP and silver nitrate are now being used to treat symptomatic patients with cervical erosion. Because it resulted in a faster tissue healing time and fewer complications, autologous PRP has the potential to replace alternative unpleasant treatment options such as cautery, with promising results for inflamed and injured cervical tissue with erosion repair. Conclusion PRP shows no immunogenic difficulty or ethical matters as autologous. It stops damage to the cervix and hence prevention from cervical cancer.

Spotlight on some psychiatric aspects of hepatitis-C virus patients

Background Hepatitis C viral infection is one of the most burdensome diseases affecting 2–3% of the world population. At least 50% of patients infected with HCV suffer from one psychiatric illness. Aim The aim was to evaluate some psychiatric aspects and life quality in cirrhotic and noncirrhotic hepatitis-C virus (HCV) cases. Patients and methods A case–control study in the Neuropsychiatry Department and Internal Medicine Department in Tanta University Hospital. Patients were divided into 50 cirrhotic HCV patients (group I), 50 noncirrhotic HCV patients, both were nonmedicated (group II), and 30 healthy controls (group III). We used Child–Turcotte–Pugh, Beck Depression Inventory, Taylor's Manifest Anxiety Scale, Mini-Mental State Examination, and Liver Disease Symptom Index 2. Results Beck Depression Inventory showed a statistically significant higher percentage of mild and moderate depressed patients in patient groups (groups I and II) than the control group (group III), unlike between patient groups. Educational level was found to be significant in comparison between depressed and nondepressed groups. Taylor's Manifest Anxiety Scale showed mild and moderate anxiety high percentage in patient groups (groups I and II) than the control group (group III) and this difference was of statistical significance, unlike between patient groups. Mini-Mental State Examination revealed mild cognitive impairment of high percentage in patient groups (groups I and II) than the control group (group III) and this difference of statistical significance, unlike between patient groups. Liver Disease Symptom Index 2 showed strong affection of health-related quality of life in patient groups. Conclusion Psychiatric disorders can occur frequently in HCV patients, with a higher incidence of depression, anxiety, and cognitive impairment. All these psychiatric disorders were found in both cirrhotic and noncirrhotic patients. Also, health-related quality of life was affected in such patients markedly independent of the stage of liver disease.

Prevalence of iron deficiency in the first trimester in nonanemic pregnant women at Tanta delta of Egypt

Background Throughout gestation, iron requirements increase significantly to support a growing red cell volume, a developing fetus, and a developing placenta, and also any predicted or unplanned blood loss after birth, especially with cesarean delivery. Aim The scope of this study was to evaluate the occurrence of iron deficiency in the first trimester, in nonanemic pregnant women, and its relation to the outcome of pregnancy. Patients and methods This study was conducted on 100 pregnant women in the first trimester attending the Obstetric Department at Tanta University Hospital duration of research from October 2019 to October 2020, 4 ml of venous blood sample was collected, 2 ml was collected on EDTA vacutainers for complete blood picture, the other 2 ml was collected on plain tube for estimation of maternal serum iron, ferritin, centrifugated at high speed of 2000 rpm, and serum was stored at −20°C until analysis. Results This study was done on 100 cases to evaluate the frequency of iron deficiency in the first trimester, in nonanemic pregnant women and its relation on pregnancy. Conclusion Iron deficiency in gestation is indeed a common problem, according to this study, and it is largely linked to greater maternal per-partum morbidity. Pregnant women should really be encouraged to begin antenatal care as soon as possible, so that their hematological status can be adequately optimized through regular oral iron intake and/or parenteral iron supplementation ahead to labor and delivery, avoiding any need for blood transfusion.

POS-598 CLINICAL STUDY EVALUATING IRON STATUS AT END-STAGE RENAL DISEASE PATIENTS ON HEMODIALYSIS

One of the main defects in the diagnosis of iron deficiency in chronic kidney disease patients is the inaccuracy of commonly used tests. Initial studies have shown that the Reticulocyte hemoglobin content (CHr) test is a promising test in improving the diagnosis of iron deficiency. The purpose of this study was to compare the Reticulocyte hemoglobin content (CHr) test with the well-known tests for the diagnosis of iron deficiency, Transferrin saturation (Tsat), ferritin test, and Hemoglobin concentration to determine which is most accurate and effective. A number of participants are 75, all study participants will undergo laboratory tests twice at baseline and end of the study, laboratory tests are: (Tsat, ferritin, CHr, Hb, BUN, creatinine blood test, Blood Urea concentration, ALT, AST, Serum Iron, and TIBC), participants consist of two groups, (Group1) 44 adult patients, with end-stage renal disease on hemodialysis from Kidney Department of Tanta University Teaching Hospitals, (Group 2) 30 adult healthy participants, were randomly selected from the community. Each patient was followed for four months. Patients whose CHr < 29 pg, were given intravenous sacrofer® 100mg, dose/week for 4 months. There was no significant difference between groups in the final mean Transferrin saturation (Tsat) and Serum ferritin test. The mean CHr remained in the targeted range (30.9 ―32.4 pg) throughout the study period in both groups. There are a statistically significant difference means of CHr and Hb for Group 1 at baseline and final P values were 0.0372, <0.0001 respectively. CHr has a lower level of test variability compared to serum ferritin and transferrin saturation. In this study, hemoglobin concentration was taken as the gold standard. CHr had sensitivity 60.87% and specificity 98.02%. Serum iron had sensitivity of 58.70% and specificity of 84.16%, while transferrin (TIBC) had sensitivity of 73.91% and specificity of 55.45. The variability (%CV) of CHr was found to have significantly less variation than the other tests, with a CV of 8.31% compared to hemoglobin concentration 18.99%, TIBC 29.07%, Serum iron 44.41%, transferrin saturation of 46.19% and serum ferritin of 50.67% We have found that, iron deficiency management based on CHr is simple and practical to perform at a little incremental cost. The superior performance of CHr might be explained by a far lower level of test variability compared to serum ferritin and transferrin saturation.

Monopolar microelectrodes versus radiofrequency in posterior cordotomy for bilateral vocal fold paralysis

Background Bilateral abductor vocal fold paralysis (BAVFP) is an uncommon condition with potentially significant negative effects on breathing and quality of life. It presents as one of the most difficult problems for the laryngologist. Located at the crossroads of the airway and food passages, the larynx provides three important functions: airway protection, respiration, and phonation, which are affected by paralysis of one or both vocal folds. Aims The aims of treatment of BAVFP are to provide adequate airway, preservation of voice quality, and laryngeal competence. Patients and methods This is a randomized, prospective clinical trial that was carried out on 20 patients with BAVFP, who were subjected to endoscopic/assisted microscopic posterior cordotomy at the Department of Otorhinolaryngology, Tanta University Hospital. The study was carried out from first February 2019 till April 2020. The patients were allocated into two groups: group A patients were operated with radiofrequency. Group B patients were operated with monopolar microelectrodes. Grade of dyspnea, exercise tolerance test, voice handicap index-10, MD Anderson Dysphagia Inventory, and aspiration were evaluated preoperatively and 2 weeks and 3 months postoperatively. Results Both techniques were successful in postoperative glottic chink, exercise tolerance, dyspnea, and aspiration. There was a significant difference (P=0.007) between group A and group B at 3 months postoperative voice handicap index-10. Conclusion Both techniques could be used as an easy and cheap alternative in performing posterior transverse cordotomy.

Evaluation of post-placental IUD insertion during cesarean section at a Tertiary care Hospital in Egypt

objectives: To evaluate the efficacy of post placental IUD insertion during cesarean section. material and methods: A randomized controlled study was conducted at tertiary care hospital (Tanta University Hospital) in the period from Jan, 1, 2017 to December, 31, 2017.Two groups of patients were selected; each group included 60 patients with desire of birth control. The group I was subjected to post-placental intrauterine device (IUD) insertion and group II was subjected to interval IUD insertion (3 months after cesarean delivery). Both groups were assessed as regard to time of cesarean section (CS), amount of postoperative bleeding, postoperative pain, occurrence of infection, any displacement of IUDs, failure of contraception and patients' satisfaction. Results: The demographic data were comparable in both groups. The duration of cesarean surgery was slightly prolonged in the study group. The infection, puerperal bleeding, and displacement of IUDs were not significantly different in both groups. The discontinuation rate after 6 months was 5.88% in study group compared to 8.33% in the control group. The satisfaction rate in both groups were 90.20%, 91.67% in study and control groups respectively. The expulsion rates were 3.92% and 0.00% in the study and control groups respectively. Pregnancy on top of IUD was 3.92% in study group and 4.17% in control group with p.value =0.949. Conclusion:Post-placental IUD insertion was found to be a sound, safe and effective clinical approach taking advantages of the possible desire of patients for immediate contraception , so achieving the right goal of pregnancy spacing and decreasing unintended pregnancies.

TROP-2: a unique immunohistochemical marker for diagnosis of papillary thyroid carcinoma

Background: Histomorphology remains the gold standard in the diagnosis of thyroid tumors; specifically papillary thyroid carcinoma (PTC). However, equivocal cytohistologic features may be encountered, and warrant special criteria for distinction. Aim: This study aimed to determine the potential use of TROP-2 immunoreactivity in the diagnosis of PTC (in comparison to CK19 immunoreactivity) and its role in the segregation of PTC from non-neoplastic, benign as well as malignant thyroid lesions, and to predict the diagnostic significance of both markers in combination. Material and Methods: The current work was carried out on 249 cases of thyroid lesions, retrieved as paraffin blocks; from the Department of Pathology, Faculty of Medicine, Tanta University. The study was conducted during the period from March 2019 to May 2020. HE TROP-2 showed 100% specificity, 87.78% sensitivity, 100% PPV and 94.47% accuracy, CK19 showed 100% sensitivity, 25.69% specificity. For segregation of PTC, from other (non-neoplastic, benign or malignant) thyroid lesions; TROP-2 showed 87.78% sensitivity, 98.11% specificity, 96.34% PPV, 93.41% NPV and 94.38% accuracy. CK19 showed 100% sensitivity and 100% NPV, yet it had low specificity of 40.25%, a low PPV of 48.65% and low accuracy of 61.85%. The combined usage of both markers didn’t show better results than TROP-2 alone. Conclusions: CK19 exhibits high sensitivity over TROP-2 in PTC diagnosis, however, TROP-2 shows high specificity and better accuracy. The combination of both markers doesn't show remarkable findings than TROP-2 alone.

Corneal endothelial cells changes in different stages of Keratoconus: a multi-Centre clinical study

PurposeTo assess the corneal endothelial cells morphology and count in keratoconus patients and their correlation with different stages of keratoconus.MethodsProspective non randomized multi-centric clinical study included 150 eyes of 150 keratoconus patients. Four centers in Egypt participated in this study included: Departments of Ophthalmology in Alexandria University, Tanta University and Port Said University and Alex I-Care hospital. Pentacam (Wavelight Oculyzer II) and specular microscopy (Tomey EM-3000) were done to all eyes. Keratoconic eyes were classified according to Amsler classification into stage 1, 2 and 3. Stage 1 included 99 eyes, stage 2 included 32 eyes & stage 3 included 19 eyes.ResultsThe mean age of keratoconus patients was 24.07 ± 6.154 years. Forty five cases were males (30%) and 105 cases were females (70%). There was statistically significant difference in endothelial cell density (p < 0.001) and coefficient of variation (p = 0.012) between different stages of keratoconus eyes. Regarding cell surface area, there was statistically significant difference in cell surface area between different stages of keratoconus eyes (p < 0.001). In addition, for cell morphology, there was statistically significant difference between different stages of keratoconus eyes (p < 0.001).ConclusionsQualitative and quantitative structural changes were seen in endothelial cells of keratoconus eyes by using specular microscopy. For stages 1 and 2, keratoconus may not affect the corneal endothelim significantly. The endothelium in stage 3 shows significant changes regarding polymegathism and pleomorphism.

Echocardiographic evaluation of sepsis induced myocardial dysfunction in patients with sepsis or septic shock: a prospective cohort study

Background: Sepsis-induced myocardial dysfunction (SIMD) occurs in 50% of septic patients and is characterized by reduced ejection fraction (EF), cardiac index, impaired contractility, and diastolic dysfunction (DD). In sepsis-induced cardiomyopathy (SICM), EF shows initial significant deterioration on the 1st day, then final improvement at the end of the study. This study evaluated the value of different parameters measured with trans-thoracic echocardiography (TTE) in the diagnosis and prognosis of SIMD in the surgical intensive care unit (SICU).&#x0D; Methodology: This prospective cohort study was conducted on 100 patients, aged from 18 to 50 years admitted to SICU being affected by sepsis or septic shock. TTE parameters [EF, tricuspid annular systolic excursion (TAPSE), inferior vena cava (IVC) diameter, E/A ratio and grading of DD and hemodynamic parameters [mean arterial blood pressure (MAP), heart rate (HR), central venous pressure (CVP)] on admission, three day post-admission and after one week.&#x0D; Results: The mortality rate was 45%. DD was found in 90%. The mortality group had higher DD, higher HR, and lower MAP than the surviving group, with an insignificant difference in LVEF, TAPSE, IVC, and CVP on the 3rd and 7th days. Sepsis-induced cardiomyopathy (SICM) was found in 31% of surviving patients. DD (grade III had the highest mortality followed by grade I then grade II), HR &gt;110 bpm, and MAP &lt; 65mmHg are independent factors that negatively affect the duration of survival significantly.&#x0D; Conclusion: TTE in patients with sepsis or septic shock is vital for diagnosis and prognosis. DD, tachycardia (HR &gt;110 bpm), and hypotension (MAP &lt; 65mmHg) are independent predictors of mortality in those patients. Patients with SICM (little reversible impairment of LV systolic function) had a good prognosis.&#x0D; Keywords: Sepsis Induced Myocardial Dysfunction, Diastolic dysfunction, Sepsis, Septic Shock&#x0D; Preregistration: The study was registered in the Ethical Committee of Faculty of Medicine, Tanta University, Tanta, Egypt (approval number: 31728/08/17)&#x0D; Abbreviations: SIMD–Sepsis-induced myocardial dysfunction; SICM–sepsis-induced cardiomyopathy; TTE– transthoracic echocardiogram. EF–Ejection fraction; DD–diastolic dysfunction; MD–Myocardial dysfunction; TAPSE–tricuspid annular systolic excursion; SICU–surgical intensive care unit&#x0D; Citation: El-Oraby MA, Shaban AES, El-Dada AA, El-Badawy AEH. Echocardiographic evaluation of sepsis induced myocardial dysfunction in patients with sepsis or septic shock: a prospective cohort study. Anaesth pain intensive care 2021;25(2):150-162. DOI: 10.35975/apic.v25i2.1463&#x0D; Received: 6 November 2020, Reviewed: 30 December 2020, Accepted: 3 February 2021

Seeking Medical Care for Urinary Incontinence among Working Women Aged 20-50 Years

Urinary incontinence is a prevalent condition among women and yet still a taboo. Many studies reported low consultation rates for urinary incontinence despite evidence of effective treatment and better management of the condition in primary care. Few researches studies the seeking for medical care among working women with easy access to medical resources. The aim of the present study was to assess the seeking medical care for urinary incontinence among working women aged 20-50 years. Working women aged 20-50 years and attended Obstetrics and Gynecology Department in Tanta University Hospitals for any reason during the year 2005 represented the target population. They were mostly not necessarily ill or asking for treatment. A previously piloted self-completion questionnaire was used to collect the required data and height and weight for the respondents were measured for the body mass index. A total of 149 incontinent women entered the study. Their socio-demographic, obstetric, and incontinence characteristics were revealed. Moderate and sever incontinence were acknowledged by 41.6% of the respondents and 53.7% were bothered by their symptom. Only about one of ten [9.4%] of all women and about two of ten [19.4%] of those reported moderate/severe incontinence had sought for medical care. The age had no effect in willing to seek for medical help [p=0.219]. Perception of the normality of the condition and considering it as not a problem were the main reasons [68.2%] for not seeking for medical care among women with minimal/slight degree of incontinence. Shame from talking to the physician [40%] and having other priorities [34%] were the main barriers for those had moderate/severe incontinence. The difference between the two groups was statistically significant [p=0.001]. Despite the existence of effective interventions for urinary incontinence, many working women at the reproductive age continue to suffer. The extent of the problem revealed to the physicians is like an iceberg. Achieving health gain for this cohort requires a more active approach to counteract the stigma attached to the problem, to inform them the cause and progress of the condition and to ensure that effectiveness of primary care of the problem.

Performance of albumin-bilirubin score in prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding

BackgroundHepatic encephalopathy exacerbates the morbidity, delays hospital discharge, and increases the rate of readmissions of cirrhotic patients, particularly those are admitted by acute variceal bleeding. We evaluated the performance of albumin-bilirubin score in prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding, in comparison to Child-Pugh and MELD scores. This prospective cohort study was conducted on 250 cirrhotic patients who were consecutively presented by acute variceal bleeding in the period from January to December 2020 at Tanta university emergency hospital. Albumin-bilirubin, Child-Pugh, and MELD scores were measured at admission, and then all patients were followed up for 4 weeks after endoscopic bleeding control for possible occurrence of hepatic encephalopathyResultsAlbumin-bilirubin, Child-Pugh, and MELD scores had significant performances in prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding; in this regard, albumin-bilirubin score had the highest accuracy (AUC 0.858, CI 0.802-0.914, sig 0.000) followed by Child-Pugh score (AUC 0.654, CI 0.574–0.735, sig 0.001) and then MELD score (AUC 0.602, CI 0.519–0.686, sig 0.031). The cumulative incidence of hepatic encephalopathy in cirrhotic patients with albumin-bilirubin grade 3 was found to be significantly more than that present in albumin-bilirubin grade 2; most of these hepatic encephalopathy cases occurred in the first 2 weeks of follow-up period.ConclusionsAlbumin-bilirubin score has a significant performance in risk prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding better than Child-Pugh and MELD scores. Albumin-bilirubin grades could be used as a risk stratifying tool to triage cirrhotic patients who will benefit from early discharge after bleeding control and those patients who will benefit from prophylactic measures for hepatic encephalopathy.

Needlescopic Appendectomy in Children and Adolescents Using 14-Gauge Needles: A New Era.

Purpose: We are presenting a very minimally invasive technique for laparoscopic appendectomy (needlescopic appendectomy [NAP]) in children and adolescents using suture grasper device, epidural needle, and homemade isolated long diathermy probe without any conventional laparoscopic instruments. Patients and Methods: NAP was attempted in 48 patients with uncomplicated acute appendicitis at Al-Azhar, Tanta University Hospitals and other allied hospitals during the period from May 2017 to November 2018. The study included patients with acute appendicitis and patients scheduled for interval appendectomy. Exclusion criteria were patients with concealed appendix, patients with appendicular abscess or appendicular mass, patients with acute appendicitis complicated with generalized peritonitis, and patients unfit for laparoscopy. The appendix was brought outside through the umbilical port and the operation was completed extracorporeally. In cases of appendicitis with tethered cecum, the whole procedure was completed intracorporeally. Results: Forty-eight patients with acute uncomplicated appendicitis were treated by NAP. They were 36 males and 12 females with a mean age of 9 ± 3.7 years (range = 4-15 years). Two cases with concealed appendix and one case with appendicular mass were diagnosed during initial laparoscopy and excluded from the study. Thirty-two cases (71.11%) were completed intracorporeally and 13 cases (28.89%) were completed by extracorporeal NAP. The mean operative time was 33.29 ± 3.95 minutes (range = 27-40 minutes) for intracorporeal NAP and 20.9 ± 7.01 minutes (range = 14-40 minutes) for extracorporeal NAP. Degrees of cosmetic satisfaction of the patients and parents were excellent in 93.33% (N = 42/45 patients), and very good in 6.67% (N = 3/45 patients) of patients. Conclusion: NAP using needles only is a new technique that is very minimally invasive, very cheap, safe, reproducible, and easy to be done with outstanding cosmetic results.

Acanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes.

PurposeTo study the predisposing factors, clinical manifestations, and treatment outcome of patients with Acanthamoeba keratitis (AK) at Tanta University’s Ophthalmology Hospital in Tanta, Egypt.MethodsA retrospective study of 42 patients (44 eyes) with Acanthamoeba keratitis who had medical records available for review over 4 years.ResultsForty-four eyes of 42 patients were treated for AK over the study period. In 29 eyes (65.8%), AK was related to contact lens wear. Severe ocular pain was the main presenting symptom in 38 eyes (86.3%). The most common ocular signs were radial perineural corneal infiltrates (65.9%), pseudo-dendrites (43.2%), ring infiltrates (45.5%), and diffuse stromal infiltration (59%). Acanthamoeba was detected by culture, smear, and in-vivo confocal microscopy (IVCM) in 25 eyes (56.8%), while in 19 eyes (43.2%) the diagnosis was based solely on the clinical findings. IVCM was effective in detection of Acanthamoeba in cases with early presentation, while culture was more sensitive in late presentation with corneal melting. The mean duration of treatment was 73.3 ± 23.7 days. Surgical intervention in the form of tectonic grafts or amniotic membrane transplant was required in five cases (11.3%) due to progressive corneal thinning and perforation. Seventeen patients (38.6%) had 0.2 or better final best-corrected visual acuity after treatment.ConclusionThe diagnosis of AK remains a major challenge for most ophthalmologists. Contact lens abuse is the major risk factor. Early diagnosis and appropriate treatment of AK with biocidal agents can improve the final outcome and help avoid surgical intervention. IVCM is an excellent tool for early diagnosis of AK.

Job Stress and Presenteeism Prevalence among Nursing Staff during the Outbreak of Pandemic Coronavirus Disease 2019

Background: Job stress and presenteeism are perplexing issues in the nursing profession during the crisis of COVID-19 pandemic that must receive increasing attention. Aim: It aimed to assess the job stress and presenteeismprevalence, as well as verify the association between two concepts among nursing staff during the outbreak of coronavirus disease 2019. Design: It utilized a descriptive, correlational design. Setting: It was conducted in the Main Tanta University and Emergency Hospitals. Subjects: All nursing staff (503), who had a Diploma, Bachelor of Sciences, or Master of Sciences in nursing. Tools:The questionnaire involved nursing staff’s demographic data, the adapted Extended Nursing Stress Scale, the Presenteeism Prevalence Questionnaire, and the Stanford Presenteeism Scale.Results: The organizational factors were the dominant reasons for presenteeism among nursing staff rather than the personal factors. Workload, inadequate emotional preparation, death and dying, and conflict with supervisors were the most prominent factors for causing stress. Furthermore, there was a positive correlation between job stress factors and nursing staff’s perception of presenteeism. Conclusion: Presenteeism behavior is evidence for organizational risk-taking behavior with diverse implications in the nursing profession, in which the nursing staff perceived a high level of job stress associated with a high prevalence of presenteeism behavior during the coronavirus pandemic. Recommendations: Develop a policy and practices with more guidelines to avoid the vagueness regarding what nursing staff should do while sick. Moreover, promoting the coping strategies and conflict resolution for managing job stress among nursing staff to reduce presenteeism behavior.

Thyroid chondroplastic flap for resection of laryngoceles.

Large and combined laryngoceles usually need an external approach. One difficulty in such approach was the dissection at the paraglottic space. To overcome such difficulty, a thyroid chondroplastic flap approach to the paraglottic space was designed. This study is a case series of thirty consecutive patients (24 men and six women with an average age of 45.6years), having large combined laryngocele resected externally between January 1995 and December 2019) at the department of ORL_HNS Tanta University, Egypt. This approach allowed for excellent exposure of the paraglottic space, facilitating complete resection. Complications included perichondrial tearing in five patients, obstructing hematoma in two patient and minimal edema in four patients. Thyroid chondroplastic flap is an excellent and safe approach for the paraglottic space facilitating complete resection of large laryngoceles.

Acute Pulmonary Embolism at Tanta University Hospital: Single Centre Registry

Background: Pulmonary embolism (PE) is a major cause of morbidity and mortality worldwide, and has significant negative impacts on quality of life, healthcare costs, and longevity. Registries have been created to record ‘real-life’ clinical features and management of patients with PE.&#x0D; Aim: We aimed to describe a comprehensive view of the clinical presentation, demographic data, treatment modalities and short-term outcome at hospital discharge and 3 months after discharge for patients presented with acute pulmonary embolism at Tanta university hospital to improve the level of care of those patients.&#x0D; Methods: This study was conducted on 150 patients with confirmed acute PE presented to Tanta university hospitals. The study duration was 1 year from April 2019 to May 2020.&#x0D; Results: We focused on a group of common risk factors for PE and determined prevelance of each in our enrolled patients, we found increase some risk factors obesity and bed rest &gt; 3 days were the most prevalent risk factors followed by active cancer, estrogen use and lower limb fracture. Symptoms in this study are near to other registries and ESC guidelines 2019 with the commonest symptom was dyspnea and chest pain and the least symptom was hemoptysis. Certain ECG signs more prevalent in our patients and these signs related to RV strain with sinus tachycardia the commonest sign followed by S1Q3T3 sign and the least was right axis deviation.&#x0D; Conclusion: Presence of active cancer and patients with high risk stratification were independent predictors of mortality. Other factors associated with increased mortality were impaired RV systolic function, high PESI score, presence of RBBB in ECG and presence of congestive heart failure. Increased risk of bleeding in male patients with intermediate high or high risk category especially those received UFH and fibrinolytic therapy. Previous history of VTE was independent predictors of VTE recurrence.

Self-Care Practices of Primipara Women Regarding Breast Engorgement

Abstract: Breast engorgement is a painful condition affects postnatal women, and lead to unsuccessful breastfeeding. So, there is urgent need to increase women’s knowledge and to improve their self-care practices regarding breast engorgement. Aim: The present study aimed to assess self-care practices of primipara women regarding breast engorgement. Subjects and method: The study was conducted at postpartum departments, outpatient clinics and Neonatal intensive care units affiliated to Tanta University Hospital, El-Menshawy General Hospital and El-Mabara Hospital, in addition to Maternal and Child Health Centers at Botros and Sager. Convenience sample of 200 women were included in the study. Four tools were used for the collection of data: Tool I: Structured interview schedule, consisted of two parts: Part (1): Socio-demographic data of the women. Part (2): Reproductive history. Tool II: Knowledge of primipara women regarding breast engorgement. Tool III: Self-care practices of primipara women regarding breast engorgement. Tool IV: LATCH Breastfeeding Charting Scale. Results: The study revealed that almost three quarters (77.5%) of women had poor level of knowledge followed by (17.0% and 5.5% respectively) of them had fair and good level of knowledge. The entire of the studied women with breast engorgement had unsatisfactory practices. It also illustrated that, only 27.0% had well breastfeeding. Conclusion: There was poor knowledge, as well as unsatisfactory level of self -care practices regarding breast engorgement among primipara post-natal women. Recommendations: the study recommended developing antenatal classes for all women to increase their knowledge and enhance their self-care practices regarding breast engorgement.

Factors Affecting Nurses’ Experiences Related to Current Handover Process between Emergency Department and In-patient Units

Handover process is fundamental and crucial component of patient safety care. Communication failure constitutes a major source of medical mistakes or sentinel events. So the study aimed to assess factors affecting nurses’ experiences related to current handover process between emergency department and in-patient units.A cross- section, correlational design was used. The study was conducted at Tanta University Emergency Hospital, (60) nurses were included. One Structured Questionnaire was used; including three parts Nursing Satisfaction with Handover, Current Handover Process Quality, and Information Inventory Provided in Current Handover Process. (33.3%) of the nurses reported they rarely had opportunity to ask questions and to clarify information during handover process. (77%) of them were dissatisfied with the current handover process. (30%) reported they experienced error during handover process due to ineffective communication. (45% and 31%) of the nurses viewed that providing accurate and honest information and availability of structured standardized process is important to improve handover process. 49.9% of the nurses viewed they did not provide total information during handover process So, we recommended establishing standardized tools according to ED context and each inpatient unit to optimize the quality of handover process, and conduct training programs to enhance nurses’ satisfaction by helping them to gain knowledge and apply tools to manage the intricate nature of handover process.

Effect of an Educational Program on Gynecological Nurses′ Performance Pre and Post Hysterectomy Surgery

Background: Hysterectomy is the most common gynecological surgical procedure among reproductive age women. The nursing care plan for a woman undergoing hysterectomy should reflect nurse's awareness of the physical care required, as well as her emotional needs and anxiety levels. The aim of this study: was to determine the effect of educational program on gynecological nurses′ performance pre and post hysterectomy surgery. Subjects and method: The study was conducted at the gynaecological inpatient unit of obstetric and gynaecological department at Tanta University Hospital and El-Menshawy Hospital affiliated to Ministry of Health and Population. All nurses (40 nurses) who were working in the previously mentioned settings and provided care to women undergoing hysterectomy were included in the study. Two tools were used for data collection; Tool (I): Structured interview schedule for nurses. Tool (II): An observational checklist for nurse′s performance. Results: The results revealed that majority of the studied nurses had low level of knowledge and unsatisfactory performance regarding hysterectomy preprogram, which significantly improved immediately and one month post program with a significant statistical difference P <0.05. Conclusion and recommendations: The findings of present study revealed that the implementation of the educational program resulted in a significant improvement of nurses’ performance regarding pre and post hysterectomy surgery immediately and one month after program compared to preprogram. Planned sustainable training program to upgrade nurse's skills and knowledge to care for women with hysterectomy.

Training program using the concurrent training to develop some physical and physiological variables for 400 meter hurdles

This research aims at putting a proposed training program using the concurrent training for developing some physical and physiological variables for 400 meter hurdles The researcher used the experimental method using the experimental design of one group of (13) runners under the age of 20 who represented hurdles in the Tanta University national team. The researcher does all the physical and physiological measurements - under consideration- , Arithmetic mean - median - standard deviation - torsional coefficient - simple correlation coefficient of Pearson to calculate stability of tests - statistically significant significance (Z) Mann test to calculate honesty coefficient - test (T) (T.TEST) - percentage of improvement