Cairo University Hospitals Research Articles

Assessing and improving radiation safety in cardiac catheterization: a study from Cairo University Hospital

BackgroundCatheter laboratories are high-radiation exposure environments, especially during X-ray procedures like percutaneous transluminal coronary angioplasty and electrophysiological studies. Radiation exposure poses risks of stochastic (e.g., cancer) and deterministic (e.g., skin changes) effects. This study assessed radiation safety and health practices in a cardiac catheterization unit to optimize radiation safety. A cross-sectional study in Cairo University Hospital (March–September 2019) evaluated 700 patients and healthcare workers. Real-time radiation measurements, educational lectures, and radiation protection measures were implemented in three phases. Data on radiation exposure, procedures, and compliance were collected and analyzed.ResultsThe total procedure time and fluoroscopy time per cardiologist did not significantly differ between phases, but there was a statistically significant reduction in the mean total cumulative radiation doses between Phase I and Phase III for cardiologists (P = 0.013). Among nurses and technicians, there was no significant difference in radiation doses between the two phases. Significant correlations were found between operators' radiation doses, procedure time, and fluoroscopy time. Patients' radiation doses decreased significantly from Phase I to Phase III, with correlations between dose, procedure time, and gender. Compliance with radiation protection measures was suboptimal.ConclusionsCompliance with radiation safety standards in the cardiac catheterization unit at the Cairo University Hospital needs improvement. The study highlights the importance of adhering to radiation safety principles and optimizing protective measures to reduce radiation exposure for both patients and healthcare personnel. Despite low compliance, significant reductions in radiation doses were achieved with increased awareness and adherence to specific protection measures. Future efforts should focus on enhancing radiation safety protocols and organ-specific radiation impact assessments.

The impact of EndoCuff-assisted colonoscopy on the polyp detection rate: A cross-over randomized back-to-back study

Background and study aimsColorectal cancer (CRC) is one of the most common cancers worldwide, and most CRCs develop from polyps with malignant potential. We aimed to study the difference in polyp detection rate between EndoCuff-assisted colonoscopies (EAC) and standard colonoscopy (SC). Patients and methodsThis study was conducted at Cairo University Hospitals on patients referred for screening or diagnostic colonoscopy from July 2018 to August 2020. All included patients underwent back-to-back standard colonoscopy (SC) and ENDOCUFF VISION-assisted colonoscopies (EAC). Results214 patients were included in this study. In comparison between EAC and SC, EAC increased the polyp detection rate (69 (32.24 %) vs. 57(26.64 %) (p < 0.05), EAC increased the detection of diminutive polyps ≤ 5 mm (104 vs. 81) (p < 0.05), and small polyps 6–9 mm (12 vs. 10) while there was no difference in large polyps ≥ 10 mm. EAC increased the adenoma detection rate (ADR) (37 (17.2 %) vs. 32(14.9 %) (p < 0.05). The findings detected by EAC shortened the interval of surveillance determined by SC findings. EndoCuff caused six mucosal erosions (2.8 %) in patients. ConclusionEAC increases the number of detected colonic polyps, primarily small polyps on the left and right sides of the colon.

Incidence and predisposing factors of intraocular Lens tilt following secondary ciliary sulcus implantation in children: An ultrasound biomicroscopic study.

To evaluate the incidence and causes of intraocular lens (IOL) tilt and changes in anterior chamber angle after secondary IOL sulcus implantation following congenital cataract removal. A retrospective observational study was conducted on children who underwent secondary sulcus IOL implantation following pediatric cataract removal in the period from 2017-2020 in Cairo university Hospitals. Children were examined for IOL position, centration, and tilt. Intraocular pressure (IOP) measurement, fundus and gonioscopic examination was performed. Ultrasound biomicroscopy (UBM) was performed on both eyes in children with clinically detected tilt. Ciliary sulcus secondary IOL implantation was performed in 102 eyes (57 children). IOL tilt was detected clinically in 16 eyes of 14 children (15.7%). UBM showed clinically undetected tilt in the fellow eye in additional 4 eyes. The mean angle of tilt was 12.8 ± 3.9° in clinically detected tilt compared to 7.5 ± 1.2° in UBM detected tilt. Mean anterior chamber depth (ACD) was 2.4 ± 0.5 mm IOP was >21 mmHg in 1.9% of eyes. Narrowing of the anterior chamber angle (ACA) after sulcus implantation occurred in 40% of eyes with open angle. Sulcus proliferations and obliterated sulcus were detected in all 20 eyes. Sommering's ring was found in 7 eyes (35%). Axial length, corneal diameter, and presence of persistent fetal vasculature did not affect IOL position. The presence of residual lens matter or an obliterated ciliary sulcus is associated with a higher incidence of IOL malposition following ciliary sulcus implantation.

Prevention of post-spinal anaesthesia hypotension in caesarean delivery using delayed supine positioning - A randomised controlled trial.

Maternal hypotension is a common and dangerous consequence after a subarachnoid block for a caesarean section. Combining pharmacological methods such as norepinephrine infusion, ondansetron and non-pharmacological methods in delayed supine positioning better impacts the maternal haemodynamic profile. The present study assessed the benefits and adverse effects of combining pharmacological and non-pharmacological methods in hypotension prophylaxis. This randomised controlled trial was conducted at Cairo University Hospital's obstetric theatre from January to October 2020. The study included 85 parturients who were randomised to two groups. Group Sitting was left seated for 2 min after injection, and Group Control was made to lie down in the supine position immediately after the subarachnoid block. Both groups received prophylactic intravenous norepinephrine infusion, in addition to an ondansetron bolus, before surgery. Patients' systolic blood pressure (SBP) from intrathecal injection until delivery of the foetus, was documented. The Sitting group's SBP (122 (14) mmHg) till delivery was statistically higher than the Control group's readings (114 (10) mmHg) (P = 0.004). The Sitting group's intraoperative SBP values were often greater than the Control group values. In addition, the Sitting group had a reduced hypotension incidence and a lower rate of ephedrine use than the other group, but bradycardia incidence was comparable between both groups. In elective caesarean delivery, combining pharmacological and non-pharmacological methods achieve better results regarding maternal hypotension, vasopressor consumption, nausea and vomiting, and foetal outcomes.

Evaluation of relationship between TMPRSS2 p.(Val197Met) variant and COVID-19 susceptibility and severity

BackgroundThe World Health Organization (WHO) declared Coronavirus Disease 2019 (COVID-19) a global pandemic on March 11, 2020. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has killed millions of people and had a terrible effect on society. The transmembrane protease serine 2 (TMPRSS2) enzyme is essential in the initial phases of the interplay between the SARSCoV-2 and the host cells by assisting viral entrance.MethodsThis observational case–control study involved 150 participants, 100 adult patients with COVID-19, 50 of whom appeared healthy and had no history of or symptoms of COVID-19 infection when the study was conducted. Between January and April 2022, patients were taken as inpatients in isolation units or through recruitment from the COVID-19 clinic at Kasr Al-Ainy Cairo University Hospitals. According to the National Institutes of Health guidelines (2021), they were categorised into three categories: mild, moderate, and severe. TMPRSS2 p.(Val197Met) variant genotyping was evaluated using TaqMan Real-Time PCR.ResultsThe study showed a substantial difference between the mild and severe COVID-19 patient groups regarding their TMPRSS2 (p.Val197Met) genotypes (P value = 0.046). The C allele was significantly more prevalent in the mild, moderate and severe COVID-19 patient categories (77.8%, 89.7% and 91.7%, respectively) and the control group (80%). Meanwhile, the T allele was more prevalent in the mild (22.2%) and control (20%) groups. There was a statistically significant difference in allelic distribution between the mild and severe groups (P value = 0.034).ConclusionThe study showed a connection between the TMPRSS2 gene variant p.(Val197Met) and the degree of illness. We concluded that the T(mutant) allele was protective against severe COVID-19 because it was linked to lesser disease severity.

Geriatric nutritional risk index and adverse medical outcomes among Egyptian patients admitted to a geriatric hospital: a prospective cohort study

BackgroundElderly are one of the most heterogeneous and vulnerable groups who have a higher risk of nutritional problems. Malnutrition is prevalent among hospitalized elderly but underdiagnosed and almost undistinguishable from the changes in the aging process. The Geriatric Nutritional Risk Index (GNRI) is a tool created to predict nutrition-related complications in hospitalized patients. This study aims to measure the prevalence of nutritional risk using the GNRI among hospitalized elderly Egyptian inpatients and to determine the association between the GNRI and selected adverse clinical outcomes.MethodsA hospital-based prospective cohort study was conducted among 334 elderly patients admitted to a tertiary specialized geriatric university hospital in Cairo, Egypt from August 2021 to June 2022. Within 48 hours after hospital admission, socio-demographic characteristics, blood biomarkers, anthropometric measurements, and nutritional risk assessment by the GNRI score were obtained. Patients were divided into three groups based on their GNRI: high, low, and no nutritional risk (GNRI<92, 92-98, and >98) respectively. Patients were followed up for the occurrence of adverse outcomes during hospital stay (bed sores, Healthcare-Associated Infections (HAIs), hospital Length of Stay (LOS), and hospital mortality) and three months after discharge (non-improvement medical status, appearance of new medical conditions, hospital readmission and 90-day mortality). Multivariable regression and survival analysis were conducted.ResultsThe prevalence of high-nutritional risk was 45.5% (95% CI, 40%–51%). Patients with high risk had significantly longer LOS than those with no risk. The high-nutritional risk was significantly associated with the development of bed sores (Adjusted Odds Ratio (AOR) 4.89; 95% CI, 1.37–17.45), HAIs (AOR: 3.18; 95% CI, 1.48–6.83), and hospital mortality (AOR: 4.41; 95% CI, 1.04–18.59). The overall survival rate was significantly lower among patients with high-nutritional risk compared to those with no risk.ConclusionGNRI is a simple and easily applicable objective nutritional screening tool with high prognostic value in this Egyptian sample of patients. The findings of this study signal the initiation of the application of this tool to all geriatric hospitals in Egypt.

The impact of corona virus disease-2019 (COVID-19) vaccination on patients with systemic rheumatic diseases attending a tertiary care university-based hospital

BackgroundSafety and efficacy of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine among systemic rheumatic diseases (SRDs) remain a serious concern. Aim of the workTo explore different corona virus disease-2019 (COVID-19) vaccine adverse reactions, post-vaccination COVID-19 infection, disease flare and acceptability of vaccine among patients with SRDs. Patients and methodsThis study was conducted on 750 patients with SRDs attending the Rheumatology Department, Cairo University Hospitals (December 2022 – February 2023). All patients were subjected to full clinical history, COVID-19 infection, vaccine history, adverse events, disease flare and assessment of their acceptability to the vaccine. ResultsThe mean age of the patients was 41.6 ± 11.7 years with a female:male 8.4:1 and 52.5 % were educated. 414 (55.2 %) received COVID-19 vaccine. Only 26 (6.3 %) suffered from post-vaccination COVID- 19 infection (one mild attack). The causes for not receiving the vaccine were either due to unacceptability (78.9 %) or doctors’ advice (21.1 %). 64.8 % received inactivated virus vaccines (64.8 %) and 87.9 % received two doses. The commonest local and systemic side effects were pain (73.9 %) and headache (30.2 %). Only four (0.96 %) patients reported disease flare. There was a significant difference between the diagnosis, type of vaccines and some of the adverse effects of the vaccines such as pain (p = 0.019) and fever (p = 0.021), redness (p = 0.007) and swelling (p = 0.013). ConclusionThe efficacy and safety of SARS-CoV-2 vaccine among Egyptian patients with SRDs is confirmed. There were significant differences in certain vaccine side effects especially pain, fever, redness and swelling. Most patients well tolerated the COVID-19 vaccine providing reassurance.

Proportion of Hidden Vertebral Fractures Among Egyptian Males With Fragility Hip Fractures in the Emergency Room of Ain Shams University Hospitals.

Background Fragility fractures are linked to significant costs for society as well as significant pain and suffering, disability, and even death. It is well-recognized that osteoporosis-related fragility fractures raise the risk of subsequent fragility fractures. One of the most frequent osteoporotic fractures brought on by low bone mineral density and other risk factors is vertebral fractures. Considering that most vertebral fractures are asymptomatic and not clinically identified, proactive screening could stop additional impairment. Objective The current study aims to determine the prevalence and risk factors of hidden vertebral fractures in Egyptian males who have fragility hip fractures. Patients and methods A cross-sectional case-control study examining the correlation of risk factors between cases (fragility hip fracture and vertebral fractures) and a control group (fragility hip fracture without vertebral fracture) was carried out from September 2020 to September 2021 on patients visiting the orthopedic emergency department of a university hospital in Cairo, Egypt. Males who presented to the emergency room (ER) with fragility hip fractures and were 40 years of age or older met our inclusion criteria. For every patient who presented with a fragility hip fracture, standard lateral and anteroposterior radiographs of the dorso-lumbar spine were taken. Results A total of 43,935 patients visited the orthopedic emergency room (ER) throughout the study period; 13,034 of those patients were men, accounting for 29.7% of all orthopedic ER visits. Our inclusion criteria for fragility hip fractures were met by 132 male participants. The screening lumbosacral plain X-rays identified 27 (20.5%) of the 132 patients as having concomitant vertebral fractures in addition to the fragility hip fractures. Concomitant hidden vertebral fractures among Egyptian males with other fragility fractures, particularly fragility hip fractures, are predicted by the number of co-morbid diseases, hypertension, and continuous use of steroids and anti-epileptics. Conclusion Most fragility fractures are avoidable. Because one fragility fracture increases the likelihood of others, early detection is crucial. To prevent complications and mortality, it is important to identify and manage individuals who have a fragility hip fracture as they frequently have concurrent hidden vertebral fractures. Predictive risk factors for fragility vertebral fractures include hypertension, the number of concomitant illnesses, and chronic drugs (anti-epileptics and steroids).

Correlation between bispectral index and FOUR score in critically ill patients with traumatic brain injury: A cross-sectional study

ABSTRACT Introduction For neurological testing and monitoring of traumatic brain injury (TBI) patients whose verbal component of the Glasgow Coma Scale (GCS) cannot be assessed, the Full Outline of Unresponsiveness (FOUR) score has been established. In order to determine the degree of awareness in patients with traumatic brain injury, this study will correlate the FOUR score with the bispectral index (BIS) and global consciousness score (GCS). Methods Twenty TBI patients with traumatic brain injury who were hospitalised to the surgical ICU at Cairo University Hospital participated in our prospective observational research. An observer who was blind to the BIS values assessed each of the FOUR scores and GCS (Covidien BIS complete monitoring system, Mansfield, MA, USA). Each patient provided four sets of readings. Spearman’s correlation coefficient was used to perform a correlation between the FOUR score, GCS, and BIS (r). Results There was a significant correlation between BIS and FOUR score (r = 0.854, 95% confidence interval: 0.780–0.904) (P < 0.001). There was also a significant correlation between BIS and GCS (r = 0.864, 95% confidence interval: 0.795–0.911) (P < 0.001). Conclusion There is a strong correlation between FOUR score, GCS, and BIS values in patients with traumatic brain injury. FOUR score seems a reliable alternative for GCS and BIS in the assessment of degree of consciousness, especially in intubated patients.

Clinico-laboratory outcomes of plasma transfusion in the Egyptian’s pediatric intensive care units—a prospective observational study

BackgroundDespite the paucity of data supporting their indications, plasma transfusions (PT) are regularly administered for critically ill patients (CIP) in pediatric intensive care units (PICU). The aim of this study was to identify the actual indications for PT in the Egyptian’s PICUs and determine to what extent it affects the clinic-laboratory outcomes for CIP.MethodsA prospective observational study was conducted for 6 months on 180 CIP in PICUs of Cairo University Hospital who received plasma for at least one time during their length of stay (LOS). Full history, examination, and investigations were obtained from the medical records.ResultsPlasma was transfused in 64.4% of the studied population to support moderate and severe critical illness identified by multiple organ dysfunction score (MODS). Meanwhile, subjective-based physician conceptions accounted for 12.8% of all indications for plasma transfusion. PT in CIP was associated with a significant reduction in platelet count, prothrombin time, partial thromboplastin time, and international normalized ratio with p-value < 0.001, while there was a significant increase in hemoglobin level with p-value < 0.001. A statistically positive correlation exists between the time interval between admission and 1st PT and LOS with a p-value < 0.001 being shorter with earlier transfusion. Of the 180 patients enrolled in this study, seventy patients (38.9%) died, while 110 patients (61.1%) survived. A statistically significant increase in mechanical ventilation (MV) (p = 0.004), total number of PT (p < 0.001), and MODS score (p < 0.001) were recorded in dead CIP compared with survivors.ConclusionModerate and severe critical illness identified by MODS was the most frequent cause for PT in the Egyptian’s PICUs. Early, precise, and objectively based PT has a strong role in improving the outcomes in CIP.

Violence against healthcare workers during the COVID-19 pandemic: a cross-sectional survey at Cairo University Hospital.

Healthcare workers have a significant chance of experiencing violence, with physical violence impacting anywhere from 8 to 38% of healthcare professionals throughout their careers. Besides physical abuse, many healthcare workers are subject to verbal aggression or threats, with patients and visitors being the most frequent sources of such incidents. This research examines the work atmosphere of healthcare professionals at Kasr Al-Aini University Hospital in Cairo, Egypt, during the pandemic. The study aims to evaluate the frequency of violence toward healthcare workers and health professionals training through a cross-sectional survey conducted among them. The research was conducted on Egyptian healthcare workers over 6 months, from November 2020 until the end of January 2021, using convenience sampling in a cross-sectional study. Over half of the respondents reported experiencing violence. Among those who experienced violence, 93% reported verbal aggression, 43% reported physical and verbal abuse, and 59% claimed that violence increased during the pandemic. Additionally, 97% of those who experienced violence reported it occurring within the 4 months following the survey. About 42.5% of the respondents were female, and nearly 65% were over 30. 82% of the respondents did not receive training on handling violence while performing their job. This study highlights the high prevalence of verbal assaults in healthcare settings, primarily by patients' families or acquaintances. Despite reporting such incidents, most respondents did not see any significant government action. Furthermore, the COVID-19 pandemic did not significantly change the frequency of violent incidents, indicating that the root causes of violence are systemic and extend beyond the pandemic. These findings underscore the need for systemic changes in healthcare organizations to address and prevent violence against healthcare workers.

Evaluation of Corneal High Order Aberrations in Post Laser-Assisted in Situ Keratomileusis versus Photorefractive Keratectomy in Myope

Background Aberrations of the eye are the difference between two surfaces: the ideal and the actual wave front. Higher order aberrations are a relatively small component, comprising about 10% of the eye’s total aberrations. High order aberrations increase with age and minor symmetry exists between the right and the left eyes. Aim and objectives To Compare corneal high order aberrations in post laser-assisted in situ keratomileusis with corneal high order aberrations in post Photorefractive keratectomy in myope. Subjects and methods this study was designed as a prospective randomized intervention study that conducted on 40 myopic eyes. The eyes divided into two randomized groups. Group A: 20 myopic eyes corrected with laser-assisted in situ keratomileusis and Group B: 20 myopic eyes corrected with Photorefractive keratectomy. Cases were collected for LASIK and PRK at operative theater in Beni-Suef University Hospital and clear vision laser center in Cairo, from May 2019 till January 2022. Result There was clinically significant difference between pre- and post-operative visual acuity, vertical trefoil and vertical coma of LASIK group and there was clinically significant between pre- and post-operative visual acuity, vertical trefoil and vertical coma of PRK group. But there was no significant difference between LASIK and PRK in visual acuity, spherical aberration, higher order 5 mm and 6 mm, vertical coma and Vertical trefoil. Conclusion There is non-significant increase in higher order aberration and spherical aberration post LASIK and post PRK with lesser amount in PRK.

Effects of core exercises on knee pain, disability, proprioception, and quadriceps strength in patients with knee osteoarthritis: A randomized controlled trial

Aim. This pretest-posttest controlled study investigated the effects of core exercises on knee pain, disability, proprioception, and quadriceps strength in patients with knee osteoarthritis (KOA). Materials and Methods. Eighty patients aged from 40-65 years with mild to moderate KOA were recruited from Cairo University hospitals. They were randomly assigned into two equal groups; group A received core exercises plus conventional exercises and group B received conventional exercises only. Sessions were done 3 times weekly for 4 weeks. Patients were evaluated, pre-and post-treatment, for knee pain (using visual analogue scale), disability (using aggregate locomotor function), proprioception (using inclinometer), and quadriceps strength (using dynamometer). Results. There were no significant differences between groups post-treatment (p-value &gt; 0.05). There was a significant improvement in quadriceps strength in group (A&amp;B) and pain and disability in group (A) post-treatment (p-value &lt; 0.05). Conclusions. Adding core exercises to conventional exercises showed a trend towards significance in reducing pain and disability than conventional exercises alone in KOA. On the other hand, conventional exercises with or without core exercises improved quadriceps strength rather than proprioception. Hence, further studies on a larger sample are promising.

Assessment of CAD/CAM Customized V Pattern Plate Versus Standard Miniplates Fixation in Mandibular Angle Fracture (Randomized Clinical Trial)

BackgroundMandibular angle is the most common site for fractures, accounting for 23–42% of all cases of mandibular fractures. A customized fixation system is designed directly for a specific patient, which reduces the time spent bending and fixing the plate during the operation. This study was designed to assess the effect of CAD/CAM customized V pattern plate versus standard miniplates fixation in mandibular angle fracture.Materials and MethodsThis prospective randomized clinical trial included 26 patients suffering from mandibular angle fracture. Patients were selected from Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University and Ahmed Maher Teaching Hospital. Study group (13) needed open reduction and internal fixation by using CAD/CAM V plate with surgical guide, while control group (13) needed open reduction and internal fixation by using standard superior–inferior miniplate fixation. The patients were then followed up for one year postoperatively.ResultsIt showed that there was a statistical difference between the study group and the control group regarding postoperative pain, occlusion, and maximal interincisal opening (p value < 0.05%). There was no statistical difference (p value > 0.05%) in the postoperative panoramic radiograph that was taken within the postoperative 1st week in both groups, while the increase in mean bone density was statistically significant (p value < 0.05%) from 6 months to one year postoperatively.ConclusionCAD/CAM customized V pattern plate is a suitable plate design because it offers sufficient stability for normal bone healing, the creation of an ideal occlusion, an early return to function, and adequate postoperative radiographic outcomes.Trial RegistrationIt was registered at ClinicalTrials.gov. Registration number: NCT03761524. Registration date: 03.12.2018.

Beneficial role of healthy eating Index-2015 score & physical activity on COVID-19 outcomes

BackgroundNutritional status and physical activity are essential to maintain a strong immune system. No definite pharmacological strategies for Coronavirus disease 2019 treatment are presently available, so natural enhancement of the immune system is in need. Our goal was to assess the correlation of healthy diet and physical activity on COVID-19 disease outcome.MethodsThis cohort study was conducted on 68 adult patients who contracted mild (38) or moderate [30] cases of COVID-19, recruited via a convenience sampling technique from the outpatient clinic, Kasr Al-Aini Faculty of Medicine, Cairo University Hospital. Patients’ Healthy Eating Index (HEI) and degree of physical activity as measured by the Global Physical Activity Questionnaire were evaluated and linked with several inflammatory markers.ResultsMost of patients with mild COVID-19 patients (92.1%) were physically active, compared to only 50% of moderate COVID-19. The total Metabolic Equivalent Task-min/week was positively correlated with the lymphocyte percentage. The median total HEI score was significantly higher in the patients with mild COVID-19 than with moderate COVID. Significant positive correlations observed among the lymphocyte count and total HEI-2015. There was approximately a 64% reduction in the probability of acquiring moderate COVID-19 illness for each unit rise in The HEI.ConclusionHealthier nutrition and Physical activity correlated with reduced COVID-19 disease severity.Trial registrationThe study was registered on clinical trial.gov maintained by the US National Library of Medicine (CinicalTrials.gov identifier = NCT04447144; https://clinicaltrials.gov/) (25/06/2020).

Phenotypic and Genotypic Characterization of AmpC Beta Lactamases in Acinetobacter Species Isolated from Cairo University Hospitals

Phenotypic and Genotypic Characterization of AmpC Beta Lactamases in Acinetobacter Species Isolated from Cairo University Hospitals

Lifestyle determinants as predictor of severity of metabolic associated fatty liver disease (MAFLD)

BackgroundMetabolic-associated fatty liver disease (MAFLD) is a public health issue that can result in liver cirrhosis and its complications.Aim of workAssess the dietary pattern, physical activity, and sleep quality of MAFLD patients.MethodsCross-sectional study of 77 MAFLD patients being present in the outpatient clinic of Endemic Medicine Department at Cairo University Hospital. An interview questionnaire including sociodemographic, medical history, validated food frequency questionnaire (FFQ), Pittsburg Sleep Quality Index (PSQI), and international physical activity questionnaire (IPAQ) were utilized to collect data.ResultsAmong patients, 36%, 34%, and 30% had liver steatosis grades I (mild), II (moderate), and III (severe) respectively. Waist circumference, body mass index (BMI), daily caloric and carbohydrate intake, impaired sleep quality, and low physical activity were significantly linked with steatosis grades. The independent significant predictors for MAFLD severity were waist circumference (P = 0.011, OR 1.119), poor sleep quality (P = 0.038, OR 3.871), habitual sleep efficiency (OR 3.402, 95%CI 1.403–8.252), daytime dysfunction (OR 2.487, 95%CI 1.374–4.501), and physical activity (P = 0.027, OR 4.6).ConclusionWaist circumference, poor sleep quality, habitual sleep efficiency, daytime dysfunction, and low physical activity were the real marked predictors for MAFLD severity.

Relationship between nurses’ emotional intelligence and their perception of patient safety climate

Background Emotional intelligence is regarded as an important characteristic for building stable and healthy emotions among nursing staff that enhances nursing performance, supports the concept of nurse–patient relationship, and encourages the nurses to be more involved in decision making in providing care. Emotional intelligence helps individuals to perform well in risky tasks and could be beneficial for patients under the care of nurses through improving the patient safety climate. Aim The aim was to assess the relationship between nurses’ emotional intelligence and their perception of patient safety climate. Design A descriptive correlational design was used for this study sample. Patients and methods The study was conducted at New Kasr Al-Aini Teaching Hospital, Cairo University Hospital, on a convenience sample of 250 staff nurses. Results The results revealed that the total mean percent of emotional intelligence of nurses was 86.64%, which indicates high level of emotional intelligence, and the total mean score of patient safety climate was 72.33%, which indicates high level of patient safety. In addition, there was a highly statistically significant positive correlation (P=0.00) between emotional intelligence and patient safety climate. Conclusion Nurses had high level of emotional intelligence and patient safety climate. There was a highly statistically significant positive correlation between emotional intelligence and patient safety climate. Recommendation There should be increased staff participation in development and training to emphasize the power of emotional intelligence. The aim should be to improve the level of self-awareness, self-management, social consciousness, and relationship management among nurses to increase emotional intelligence and maintain patient safety climate.

Risk Stratification of Acute Upper Gastrointestinal Bleeding by AIMS65, Rockall, Glasgow Blatchford and Baylor Scores

Abstract Background Upper gastrointestinal bleeding (UGIB) is the most common cause of emergency admission in gastrointestinal disease. Despite the development of endoscopic therapies and pharmacological management, UGIB is still associated with considerable rates of mortality and morbidity, and high medical expenses. Different scoring systems have been suggested for diagnosing these patients. Aim of the Work In this study we aimed to compare the predictive value of three scoring systems Rockall, Glasgow Blatchfors scale (GBS) and AIMS65 in patients with UGIB. Patients and Methods This study was conducted on 120 adult Egyptian patients presented by UGIB at Emergency department of Ain Shams University Hospital in Cairo, Egypt at a period from October 2020 to June 2021. Patients underwent upper endoscopy within first day from an attack of UGIB. AIMS65, GBS, and PRS scores were calculated for each patient. The ability of these scores to predict clinical outcomes was determined. Area under the receiver-operating-characteristics (ROC) curve, sensitivity, specificity, positive and negative predictive values were calculated for rebleeding and mortality. Results GBS was superior to AIMS65, Rockall and Baylor scores in identifying the patients who are likely to need interventional endoscopy "cutoff ≥8.5, sensitivity 80.8%, specificity 54.4%", need blood transfusion "cutoff ≥11.5, sensitivity 54.2%, specificity 90.3%. While AIMS65 score was superior to GBS and other scores in prediction of unfavorable outcomes, namely risk of need for ICU admission "Cutoff ≥1.5, sensitivity 86.4% specificity 96.1%", need for rebleeding in hospital "cutoff ≥1.5, sensitivity 92.7%, specificity 96.2%" and death in hospital "cutoff ≥2.5, sensitivity 90.9%, specificity 98.2%. The reasons for differences in cutoff values compared to previous studies can including ethnicity, UGIB aetiology, period of follow up and number of patients. Conclusion Early risk stratification is recommended in patients presenting with acute UGIB to identify patients at higher risk of bleeding or death and guide management decisions regarding timing of endoscopy, triage to appropriate level of care, and disposition. The optimal cutoff of each scoring system should be specified for different population to maximize the power of identifying UGIB patients at high risk of death.

Comparative study between the outcome of decompressive craniotomy versus craniectomy in the management of acute subdural hematoma

BackgroundAcute Subdural hematoma is a very crucial entity in traumatic brain injury, presented with disabling morbid complications and a high mortality rate; therefore, it is a massive socio-economic burden, leading to either direct or secondary brain injury, as hypoxia.Aim and objectivesComparative study between decompressive craniotomy (DC) and craniectomy in the management of acute subdural and their consequences. Assessing the most effective management protocol for ASDH with the least morbidity, short hospital’ stay and avoidance of re-operation.MethodThe study design is a prospective comparative randomized study, conducted on 30 patients with ASDH operated and managed starting December 2019 inclusive April 2021 at the Neurosurgery Department Cairo University Hospitals. They were divided equally into two groups: 15 had decompressive craniectomy and another 15 cases were operated upon with craniotomy. All patients were diagnosed with traumatic ASDH.ResultsThe mean GCS pre-operative in DC was (9.4) mean with a range from (6 to 13) and the post-operative mean was (11.13) with a range from (4 to 15) compared to the results in the craniotomy group; the pre-operative mean was (9.6) with a range from (6 to 10) and the post-operative GCS mean (11.53) ranging from (6 to 14) that had a P value of 0.69.ConclusionThere is no statistical significance in comparing decompressive craniectomy and craniotomy in dealing with ASDH, yet early time of surgical evacuation and duroplasty have shown to have good prognostic factors.