Tanta University Research Articles

Zinc Supplementation in Preterm Neonates with Jaundice: Is it Beneficial?

Neonatal jaundice is a common neonatal disease that has adverse effects on neonates, especially preterm neonates, when indirect bilirubin level is adequately high to pass the blood-brain barrier, causing bilirubin encephalopathy or kernicterus. This study aimed to investigate the value of zinc (Zn) supplementation in preterm neonates with jaundice and whether it will be beneficial. A prospective randomized clinical trial, with the identification number TCTR20200504007, was conducted at Tanta University Hospital from July 2016 to March 2018 on 200 preterm neonates with jaundice. The studied neonates were divided into two groups: group 1, which received Zn and phototherapy, and group 2, which received phototherapy only and did not receive Zn. In group 1, 100 preterm neonates with jaundice received Zn as 0.6 mL (cm3) of zinc origin/kg/day orally through the oro-nasogastric tube divided into two doses (every 12 h), which was equal to 1.2 mg elemental zinc/kg/day orally for 10 days. There was no significant difference in serum bilirubin level between the two groups on the 2nd, 4th, and 6th days of admission, while the serum bilirubin level was significantly decreased in group 1 compared with that in group 2 only on the 8th, 9th, and 10th days of admission. The p-- values were 0.045*, 0.027*, and 0.004*, respectively. Zn administration to preterm neonates with jaundice was found to be beneficial in decreasing serum bilirubin level. Zn supplementation should be provided to preterm neonates with jaundice.

Relationship between hyperemesis gravidarum and Helicobacter pylori infection at Tanta University Hospitals

Background Hyperemesis gravidarum (HEG) is persistent nausea and vomiting affecting the general condition of pregnant females. Hyperemesis requiring admission occurs in 0.3–2% of pregnancies. The exact cause is unknown, but there are hypotheses involving hormonal factors and Helicobacter pylori infection. Also, increased serum levels of steroids and hcG changes the gastrointestinal tract; besides, altered immunity during pregnancy activates H. pylori infection. H. pylori is a common bacterial infection that causes active chronic gastritis up to ulceration. Aim This study aims to investigate the association between HEG and H. pylori infection. Patients and methods Our study was conducted on 100 pregnant women between 6 and 14 weeks of gestation, grouped as 50 women with HEG and 50 not suffering from HEG. Patients were investigated for routine investigations as complete blood count, liver, and renal functions. Specific investigations were carried out to determine the serum level of H. pylori IgG antibody by the ELISA method. Results In this study, 30 (60%) patients in the HEG group had H. pylori infection and only five (10%) patients in the control group (P<0.001), indicating a strong association between H. pylori and HEG. There was no significant statistical difference between the two groups regarding age, education, residence, socioeconomic level, gravidity, parity, and gestational age. Conclusions A strong association was found between H. pylori and HEG. So, when a pregnant patient complains of HEG, we should test for H. pylori seropositivity and if seropositive we give the patient triple therapy to eradicate H. pylori infection.

Beta-Tricalcium Phosphate and Concentrated Growth Factors in Treatment of Intra-bony Defect Randomized Clinical Trial (RCT)

This study was designed to assess the efficacy of biodegradable gelatin / Beta-tricalcium phosphate sponge socked in concentrated growth factors (CGF) in treating periodontal intra-bony defects, as compared with biodegradable gelatin /beta-tricalcium phosphate sponges alone. Materials and Methods: Twenty intra-bony defects ≥4 mm and pocket depth (PD) ≥5 mm in 20 patients were selected from the outpatient clinic of Oral Periodontology Clinic, Faculty of Dentistry, Tanta University to join in this study. Patients were randomly allocated into two groups 10 patients each. Group I was treated by surgery plus biodegradable gelatin /beta-tricalcium phosphate sponges, (control group). Group II was treated by gelatin/beta-tricalcium phosphate sponges socked in CGF. Bleeding on probing (BOP), PD, and clinical attachment level (CAL) were measured at baseline, 3, and 6months periods. Cone beam radiographs were taken at baseline, and 6 months after surgery evaluating the area of the defect (AD) and bone density (BD). Results: Both groups showed significant improvement in clinical parameters (P≤0.05). There were statistically significant differences in all investigated parameters between the two groups at 3 and 6 months in favor of group II, except for CAL there was no significant difference between them at 6 months. A significant decrease of DA and increase in BD at 6 months was noted for both groups with significant differences between them in favor of group II (P<0.05). Conclusion: Using a biodegradable gelatin/β-TCP socked in CGF could enhance the outcome of periodontal regeneration, as evidenced by improved bone density and reduction in the defect area.

MRI and ultrasonography in the evaluation of causes of shoulder pain

Background The shoulder is a complex joint that is essential for daily activities. Shoulder pain is a common musculoskeletal complaint. Shoulder ultrasound (US) is one of the best imaging techniques for the evaluation of shoulder pain. MRI is a powerful tool in the diagnosis of causes of shoulder pain because it is noninvasive and it provides good evaluation of the soft tissue, labrum, and bones. Aim The aim of our study was to evaluate the role of MRI and US in the diagnosis of the etiology of shoulder pain. Patients and methods This study was performed on 30 patients complaining of shoulder pain referred to the Radiodiagnosis Department at Tanta University Hospitals for performing shoulder US and MRI. Results The most common cause of shoulder pain in this study was rotator cuff muscle injury especially supraspinatus muscle. There was good agreement between US and MRI in the diagnosis of rotator cuff muscle lesions with kappa test=0.734, while there was no agreement between US and MRI in the diagnosis of labral tears with kappa test=0, and in cases with bony lesions the agreement between US and MRI was moderate with kappa test=0.420. Conclusion US is an effective imaging modality in evaluating patients with shoulder pain. US is the modality of first choice for the evaluation of rotator cuff tears. MRI is superior to US in the assessment of correct site and the extent of rotator cuff muscle tear and in evaluating bony and labral lesions.

Transvaginal ultrasound evaluation of uterine scar in pregnant women with a previous cesarean section

Background Many studies have shown that the thickness of the lower uterine segment (LUS) is correlated to the risk of uterine scar dehiscence. Transvaginal sonography (TV US) has been used to predict uterine dehiscence by measuring the LUS thickness near term. Aims In this study, the main aim was to assess the thickness of the LUS and determine its integrity in pregnant women at term with previous cesarean section (CS) through TV US. Patients and methods The study involved 200 pregnant females at term (gestational age between 36 and 38 weeks) with a history of one previous CS, who were attending the Gynecology and Obstetrics Department at Tanta University Hospital. The study started from January 2019 till September 2020. Results There was highly significant correlation between LUS thickness measured by TV US, scar shape, and continuity with intraoperative findings as categorized into four grades (r=−0.783 and P=0.000). The cutoff value was 2.3 mm; at this thickness the risk of dehiscence increased, with a sensitivity of 94.1%, specificity of 96.4%, and an accuracy of 95% (area under the curve=0.935). Conclusion TV US is a reliable method for the assessment of the risk of uterine rupture by measuring the LUS thickness in women with previous CS. The cutoff value is 2.3 mm with a sensitivity of 94.1% and specificity of 96.4%. Accuracy was 95%.

Effectiveness of meperidine, nalbuphine, and paracetamol in labor analgesia at Tanta University Hospitals

Background Pain during the first stage of labor is visceral pain that originates in the uterus and cervix, and it is produced by uterine muscle hypoxia, lactic acidosis, distention of the lower uterine segment, stretching of the ligaments, and pressure on the bony pelvis. It is mediated through the afferent nerve supply of the uterus through the sympathetic nerve, which finally reaches the thoracic and lumbar segments of the spinal cord. Aim The aim of this study is to test and compare the efficacy of intravenous injection of meperidine, nalbuphine, and paracetamol infusion in intrapartum analgesia. Patients and methods This prospective randomized comparative study was conducted in the Department of Obstetrics and Gynecology at Tanta University Hospitals from August 2018 till January 2020. Results The use of paracetamol as an analgesic in the first stage of labor showed a significant decrease between paracetamol and the groups of pethidine and nalbuphine as regards the potency of analgesia. However, the duration of labor was significantly shortened with paracetamol than pethidine and nalbuphine. The maternal, neonatal, and fetal side effects were more with opioids (pethidine and nalbuphine) than paracetamol. Conclusion Parenteral opioids (pethidine and nalbuphine) have nonsignificant difference in effectiveness in intrapartum analgesia. However, they are more effective than paracetamol for pain relief and maternal satisfaction during the first stage of labor.

The Doppler velocimetry of ductus venosus in fetuses with cardiac defects during pregnancy

Background Fetal medicine researches were directed to replace the invasive screening tests done at the first and early second trimesters such as cardiovascular status and amniocentesis to discover fetal anomalies, especially cardiac malformations with noninvasive ultrasonic markers such as ductus venosus Doppler. It is associated with cardiac defects. It is the main concern of fetal medicine researches nowadays to improve neonatal outcome. It leads to abnormal heart rhythm or abnormal heart muscle, in which the heart fails to contract normally. Aims We aim to study ductus venosus Doppler and pulsatility index (PI) of veins in fetuses with cardiac malformations to improve fetal and neonatal outcome. Patients and methods This study includes 50 pregnant females attending Tanta University Hospital. This study was carried on during the period from May 2019 to July 2020. Some cases were excluded: who had twin pregnancy. Results There is a correlation between abnormal PI and occurrence of congenital heart disease, especially the major types. As regards A wave, we found that it is present in 17 (34%) of 50 cases and 11 of them had normal PI. It is absent in 33 (66%) of cases. This study concluded that in chromosomally normal fetuses, assessment of ductus venosus could improve the predictive capacity for major cardiac defect. Conclusions DV Doppler is a very important scan in pregnancy. PI is very important as first-trimester sonographic marker for fetal congenital heart diseases and in prediction of neonatal outcome.

EFFECT OF EDUCATIONAL PROGRAM ON NURSES’ PERFORMANCE FOR CHILDREN WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA

Introduction: Idiopathic Thrombocytopenic Purpura is an autoimmune blood disorder associated with decrease platelets level less than normal, which may result in bleeding occurrence. The actual cause is unknown. It may be progressive if untreated, but may remit spontaneously for several years. The aim of this study was to evaluate the effect of health educational program on nurses’ performance for children with Idiopathic-Thrombocytopenic-Purpura. Methods: The study was Quasi- experimental research design used for 50 nurses working at Pediatric Hematology Unit of Tanta University Hospital and Pediatric Hematology Unit of Al- Mabra Tanta Hospital. Two Tools were used to collect required data: structured interview schedule to collect biosocial data of nurses and observational check list regarding nursing practice. Results: The present study-represented that, three quarter of nurses had poor-knowledge and all of them had unsatisfactory level of practice before the-educational-program-implementation. While immediately and after one month from the implementation of the program the total-scores-of-nurses' knowledge and practice improved. Conclusion: There was a-significant improvement in nursing knowledge and practice in relation to nursing care for children with Idiopathic-Thrombocytopenic-Purpura. Recommendations: In-service-training program should be conducted periodically for nurses' teaching the basic knowledge and clinical skills.

High Abdominal Perfusion Pressure Using Umbilical Cord Flap in the Management of Gastroschisis.

Background: Gastroschisis management remains a controversy. Most surgeons prefer reduction and fascial closure. Others advise staged reduction to avoid a sudden rise in intra-abdominal pressure (IAP). This study aims to evaluate the feasibility of using the umbilical cord as a flap (without skin on the top) for tension-free repair of gastroschisis.Methods: In a prospective study of neonates with gastroschisis repaired between January 2018 to October 2020 in Tanta University Hospital, we used the umbilical cord as a flap after the evacuation of all its blood vessels and suturing the edges of the cord with the skin edges of the defect. They were guided by monitoring abdominal perfusion pressure (APP), peak inspiratory pressure (PIP), central venous pressure (CVP), and urine output during 24 and 48 h postoperatively. The umbilical cord flap is used for tension-free closure of gastroschisis if PIP > 24 mmHg, IAP > 20 cmH2O (15 mmHg), APP <50 mmHg, and CVP > 15cmH2O.Results: In 20 cases that had gastroschisis with a median age of 24 h, we applied the umbilical cord flap in all cases and then purse string (Prolene Zero) with daily tightening till complete closure in seven cases, secondary suturing after 10 days in four cases, and leaving skin creeping until complete closure in nine cases. During the trials of closure, the range of APP was 49–52 mmHg. The range of IAP (IVP) was 15–20 cmH2O (11–15 mmHg), the range of PIP was 22–25 cmH2O, the range of CVP was 13–15 cmH2O, and the range of urine output was 1–1.5 ml/kg/h.Conclusion: The umbilical cord flap is an easy, feasible, and cheap method for tension-free closure of gastroschisis with limiting the PIP ≤ 24 mmHg, IAP ≤ 20 cmH2O (15 mmHg), APP > 50 mmHg, and CVP ≤ 15cmH2O.

Tubular PDA versus other PDA types: Challenging device choice for transcatheter closure

BackgroundTubular-shaped (type C) PDA poses a significant challenge for the interventionist. ObjectivesThe aim was to assess the safety and effectiveness of different devices for transcatheter closure of tubular PDA. MethodsA retrospective study was performed on all patients who underwent transcatheter closure of PDA at both Cairo and Tanta University Pediatric and Cardiology Departments during the period of 5 years. ResultsThe study included 326 patients aged 7 to 156 months. Twenty-five patients had type C PDA (7.7%). Tubular PDAs with a diameter 1.6-3 mm (5 patients) were closed by an Amplatzer duct occluder (ADO) II and coils, while those 3.1-5 mm in diameter (13 patients) were closed by either an oversized ADOI or an Amplatzer vascular plug (AVP) II. The Amplatzer atrial and ventricular septal devices were used only for 5 patients with type C PDAs. Complete closure was achieved in 76% of type C patients and increased to 96% after one month compared to 74.4% with an increase to 95.3% after one month in patients with other PDA types. ConclusionsDifferent devices can be used successfully to close tubular PDAs in infants and children. AVP II may be a reasonable option in cases with a relatively narrow diameter.

Nursing Work Team Effectiveness and Organizational Commitment among Intensive Care Units Staff Nurses: The Pathway for Enhancement

Background: Nursing teamwork effectiveness is a vital aspect of the functioning of any hospital and a basic structural component of hospitals’ design. Effective nursing teamwork can be predicted as one of the effectively adopted of the health services and associated with organizational commitment. Aim of the study: Determine the relation between nursing work team effectiveness and organizational commitment among intensive care units staff nurses. Subjects and Method: Research design: A descriptive correlational research design was utilized in this study. Setting: Tanta University Main Hospital in all intensive care units. Subjects: A convenience sample including all staff nurses no (332) working in previous setting. Tools of data collection: Two tools were used. Tool I: Nursing Work Team Effectiveness Structured Questionnaire that included two parts. Part 1 concerned with socio demographic data, part2 included eight dimensions of team effectiveness. Tool II: Organizational Commitment Scale that used to assess staff nurses organizational commitment. Results: Slightly less than half 45.36% of staff nurses have moderate level of total team effectiveness. More than half 62.58% of staff nurses had moderate level of organizational commitment. There is positive significant correlation between total team effectiveness and total organizational commitment between staff nurses p < 0.001.Conclusion:Staff nurses had moderate level of work team effectiveness and also organizational commitment. Nursing teamwork effectiveness has a positive influence on organizational commitment. Recommendation: Adjust hospital policies to focus hospital systems and structures on team–based rather than hierarchical. Creating continuous assessment and evaluation of team effectiveness to determine which dimensions of team effectiveness need to be improved.

Practice of Nurses Caring for Patients with Accidental Chest Trauma during Emergency Period: Effect of Educational Guidelines

Background: chest trauma is a common cause of mortality, major disability, and the leading cause of death from physical trauma after head and spinal cord injury. Aim: This study aimed to evaluate the effect of educational guidelines on nurses' practice level in caring patients with accidental chest trauma during emergency period. Study design: A quasi- experimental research design on one group with pre and post-test was utilized in this study. Setting: The study was conducted in the emergency department affiliated to Tanta University Emergency Hospital. Subjects: A convenience sample of all available nurses (60) who are working in emergency department(ER), and caring patients with accidental chest trauma affiliated to Tanta University Emergency Hospital, from both sex, different age and agree to participate in the study .Data collection tools:1. Nurses' demographic characteristic .2.Nurses' Observational checklist. Results: The present study revealed that there was a highly statistically significant difference between level of nurses' practice pre, post implementation of the educational guidelines. There were significant correlation between nurses educational level and their level of practice post implementation of the educational guidelines with (P value= 0.001. Conclusion: The implementation of the educational guidelines has a positive effect on nurses' practice level in caring of patients with accidental chest trauma during emergency period throughout the program phases. These findings support the research hypothesis. Recommendations: Regular continuous educational program plan about nursing care of patients with accidental chest trauma during emergency period to nurses working in emergency department at least every six months for enhancing nurses' practice to achieve high quality of care. Importance of presence of protocol related to nursing care of patients with accidental chest trauma during emergency period.

IN ROAD TRAFFIC ACCIDENTS, ARE THE PATTERN, SEVERITY, AND OUTCOME OF DRIVERS’ INJURIES AFFECTED BY MARIJUANA ABUSE?

Introduction: Road traffic accidents (RTAs) represent a leading contributor to the global disease burden. Drivers involved in some RTAs were found to be under the influence of different drugs. Marijuana effects on driving risks are not thoroughly understood. The study aimed to compare the pattern, severity, and clinical outcome of injuries between marijuana-smoking drivers and non-drugged drivers in RTAs. Patients and Methods: This prospective, comparative study was carried out on 78 drivers admitted to the emergency department, Tanta University Emergency Hospital during the period from the start of January to the end of December 2018. All drivers were subjected to history taking, clinical examination, assessment of injury severity score (ISS) and revised trauma score (RTS), and detection of tetrahydrocannabinol (THC) in urine. Results: Thirty-six drivers tested positive for THC with a median level of 314.6 ng/ml. There was a lack of significant association between marijuana smoking and the site of injuries. The marijuana-positive group had a significantly higher frequency of skull fractures, ruptured spleen, intraperitoneal hemorrhage, and abrasions on the body surface when compared to the marijuana-negative group. The median ISS was non-significantly higher, and the mortality was significantly higher in the marijuana-positive group. The THC level correlated significantly and strongly with both ISS and RTS. A significantly higher median THC level was detected in non-survivors compared to survivors. Conclusion: It could be concluded that Marijuana smoking is associated with an increased mortality rate in victims of RTAs. There are strong correlations between THC level and both ISS and RTS, suggesting a dose-dependent effect of marijuana smoking.

External Jugular Venous Pressure versus Central Venous Pressure Measurement as a Clinical Predictor among Critically Ill Mechanically Ventilated Patients

Background: Continuous changes in central venous pressure monitoring among critically ill patients was allied to fluid response. External jugular venous pressure may be a reliable estimation method to central venous pressure and have the advantages of being less invasive. Setting: This study was conducted at the anesthesia Intensive Care Unit at Emergency Hospital affiliated to Tanta University Hospitals, Egypt. The aim of the study was to estimate external jugular venous pressure versus central venous pressure measurement as a clinical predictor among critically ill mechanically ventilated patients Method: A prospective comparative study design was utilized in the current study. A purposive sample of 30 adults mechanically ventilated patients was included in this study. Two tools were utilized to collect data: Tool (I): Mechanically ventilated patient assessment and Tool II: Central venous pressure and External jugular venous pressure assessment. Results: It was observed that there was a highly positive and significant correlation between central venous pressure and external jugular venous pressure reading r= 0.813 and p=0,000. Conclusions: External jugular venous pressure measurement represented a real value of central venous pressure. A positive statistical correlation between central venous pressure and external jugular venous pressure measurements seems to be a reliable method to differentiate mechanically ventilated patients with high or low central venous pressure monitoring. Recommendations: Measurement of external jugular venous pressure should be integrated within the critically ill patient's routine care Measurement. Also Measuring central venous pressure may be replaced with external jugularvenous pressure (EJVP) when indicated. Further studies will be needed to confirm reliability of the EJVP on a larger probability sample.

Maternal Obesity and the Risk of Selected Foetal Abnormalities (Neural Tube Defects and Orofacial Clefts) In Malaysia: A Retrospective Observational Study

Background: Clomiphene citrate (CC) is first choice as an ovulation-stimulating drug in polycystic ovarian syndrome. Anovulation problems could occur in some patients presenting with CC resistance. In PCOS patients, very high levels of AMH were observed. The role of anti-Müllerian hormone (AMH) in the prediction of ovarian response to CC in women with the polycystic ovarian syndrome (PCOS) is investigated in this study. Objective: To assess the predictive value of Anti Mullerian hormone (AMH) in Clomiphene citrate response in patients with polycystic ovary syndrome. Methods: This cross-sectional study was conducted at Tanta University Hospitals, Egypt. The study included 120 anovulatory PCOS women who underwent ovarian stimulation with clomiphene citrate. Day 3 measurement of AMH concentrations was done. Results: Cycles with poor response had significantly (p&lt;0.0001) higher basal serum AMH concentration compared to that of cycles with normal response. AMH area under receiver operating characteristic curve (ROCAUC) 0.88; (p&lt;0.001) and 0.81; (p&lt;0.007) respectively. Using a cut-off level of 6.3 ng/ml, the good response rate was significantly (p &lt; .001) higher in cycles with lower AMH (&lt;6.3 ng/ml) compared to that in those with AMH (&gt; = 6.3) ng/ml. Conclusion: AMH levels could predict the ovarian response to clomiphene citrate in PCO women.

Outcomes of transecting urethroplasty in management of different types of bulbar urethral strictures: single center experience

Background: The study aimed to evaluate the outcomes of transecting bulbar urethroplasty techniques used for management of bulbar urethral stricture as regards the success rate and sexual dysfunction.Methods: Our study was a prospective study and it was carried out at urology department Tanta university, Egypt. The study was approved our ethical committee and an informed consent was obtained from all participants. Thirty patients underwent transecting urethroplasty either excision and primary anastomosis (EPA) or augmented anastomotic urethroplasty. Assessment of the sexual function by sexual health inventory for men (SHIM) questionnaire and postoperatively. Retrograde urethrogram (RGU) and micturating cystourethrogram (MCUG) were performed by an experienced urological surgeon.Results: The age of studied patients ranged from 15-72 years with a mean of 41±13.87. The length of stricture ranged from 2-3 cm with a mean of 2.57±0.38. The stricture was non obliterative in 13 patients (43.3%), obliterative in 4 patients (13.3%) and near obliterative in 13 patients (43.3%). Anastomotic urethroplasty was carried out in 20 out of 30 patients (66.7%) and augmented anastomotic urethroplasty was carried out in 10 out of 30 patients (33.3%). The success rate was 90%. As regard erectile dysfunction, 5 patients reported erectile dysfunction (16.7%).Conclusions: Anastomotic urethroplasty of short segment bulbar strictures continues to have excellent success rates and durability, but some patients who undergo anastomotic urethroplasty experience de novo sexual dysfunction.

Clinical and Laboratory Predictors for ICU Admission ‎among COVID-19 Infected Egyptian Patients, A ‎multi-Center Study ‎

Background and study aim: The incremental global spread of the SARS-CoV-2 virus imposes an enormous burden ‎on medical health systems. We focused on determining the predictors for the COVID-‎‎19 patient's course of illness and what level of care will be actually needed at hospital ‎admission‎‎. Patients and Methods: ‎‎‎170 symptomatic COVID-19 Egyptian patients were gleaned from August 2020 to ‎January 2021, were categorized into a group that managed at home or ward admitted ‎and a group that necessitated ICU hospitalization at Tanta University or Kafr El-sheikh ‎University isolation hospitals. Each patient's demographics, clinical, laboratory, and ‎radiological data were gathered and several classification strategies were applied. The ‎variables that predicted the severity of disease and ICU admission were established via ‎logistic regression. The area under the receiver operating characteristic curve was used ‎to assess performance‎‎.‎ Results: The top risk variables predicting ICU admission were blood oxygen saturation ‎‎(P 4 and oxygen saturation ≤90 with an AUC of 0.850 (95% CI [0.795 ‎‎– 0.905]) and 0.800 (95% CI [0.735 – 0.865]), respectively‎. Conclusion: Fatigue, myalgia, oxygen saturation, pulse, respiratory rates, ferritin, and C- reactive ‎protein may prove useful for physicians to distinguish which COVID-19 patients will ‎be required to be managed critically at hospital admission‎‎‎‎‎‎.

Comparative study between the therapeutic effect of Remdesivir versus Hydroxychloroquine in Covid-19 hospitalized patients.

Background: Up till now, no evidence based studies have recommended specific therapeutic modality to treat corona virus disease-19 (COVID-19). Many regimens were tested since the outbreak has started. Among commonly tested drugs are Hydroxychloroquine, an antimalarial agent, which was proposed based on its anti-inflammatory as well as antiviral effects and Remdesivir, an antiviral that showed invivo and invitro activity against the formerly known corona-viruses The Food & Drug Administration (FDA) approved using Remdesivir in the treatment of severe cases of COVID-19. Objectives: To evaluate the effectiveness of Remdesivir versus Hydroxychloroquine against SARS-CoV-2 in terms of infectivity period in hospitalized COVID-19 patients. Methods: Fifty patients that were clinically diagnosed with Covid-19 admitted to Tanta University Isolation Hospital from June - September, 2020 were included in this study and divided into 2 groups. Group I had Hydroxychloroquine as the main therapeutic agent in their treatment regimen, while group II had the antiviral Remdesivir instead. Laboratory testing involved nasopharyngeal swabbing which was transported immediately to Tanta University Hospital laboratory for Real-time PCR. Results: There was a significant better outcome and shorter infectivity period in group 2 who received the antiviral Remdesivir. Conclusions: Remdesivir showed significant better outcome in COVID-19 hospitalized patients, as it reduced period needed for clinical improvement while administration of Hydroxychloroquine was not associated with better outcome or increased risk to the patients.

The Role of Certain Congenital Infections in Aplastic Anemia and Prognostic Value of Fetal Hemoglobin as a Follow-Up Marker

Background: TORCH infection has a role in aplastic anemia (AA). Fetal hemoglobin may be high in certain acquired hematological conditions such as aplastic anemia. We conducted this study to evaluate the correlation between certain congenital infections and severity of aplastic anemia and to study fetal Hb as a follow up marker during treatment of aplastic anemia. The aim of study was to correlation between certain congenital infection and severity of aplastic anemia and to study of hemoglobin F (HbF) as a follow up marker during treatment of aplastic anemia.&#x0D; Methods: Our prospective study was conducted on 20 children aged up to 18 years diagnosed with aplastic anemia following either bone marrow aspiration or biopsy that proves bone marrow hypocellularity with absence infiltrative BM disease or inherited BM disease recruited from Pediatric Hematology-Oncology Unit of Tanta University Hospital. Patients were classified according to level of HbF in to high HbF group and normal HbF group.&#x0D; Results: TORCH infections were detected in certain numbers of patients . HbF decreased in high HbF group after treatment. There was significant increase in CBC parameters in high HbF group than normal HbF group after treatment. There was insignificant decrease in mortality in high HbF group than normal HbF group. Mild to moderate cases were significantly higher with TORCH IgM +ve cases&#x0D; Conclusions: Acquired AA is associated with TORCH infection. In treated cases of AA, improvement of hematological parameters is associated with high HbF and from these results, it can be used as a prognostic marker to monitor the successful response of these cases to the used line of treatment.

Effect of Educational Program on Knowledge and Uses of Social Network Sites of Faculty of Nursing Students at Tanta University

Background: Now a day, social network sites among students become most common. There are different and more advancing types of social network sites and have greater impact on the way the people use of it and have remained major public health issues throughout the whole world. The aim of the study was to evaluate the effect of an educational program on knowledge and uses of social network of students on faculty of nursing at Tanta University. Subjects and Method: A quasi-experimental research design was utilized in this study and it was carried out at Faculty of Nursing, Tanta University. Subjects: The total studied sample was 79 students. Tools of the study: Two tools were used for data collection; tool I: Structured interview schedule consisted of three parts. Tool II: uses of social network sites, this tool was taken and adapted from the instrument developed by Gupta and Bashir in 2018. Results: Total knowledge and uses scores were significantly improved from preprogram to three months after program application for the studied sample, where the mean of total knowledge score increased from 9.25 pre program to 13.39 three months post program and the mean of total uses score increased from 31.47 pre program to 38.54 three months post program Conclusion: The levels of knowledge and uses of the studied sample toward social network were improved after implementation of the educational program. Recommendation: Conducting lectures, workshops and campaigns to raise awareness about correct and accurate information of social network sites and its uses among other students and all community groups.