A MINI OVERVIEW OF MALARIA IN PREGNANCY.

Human malaria is caused by five species of Plasmodia: P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi. Most infections are due to either P. falciparum or P. vivax, but mixed infections with more than one malarial species also occur. The majority of malaria-related deaths are due to P. falciparum. Generally, the pregnant women are a high risk group, as malaria can be a life threatening infection for both mother and fetus. Risk of stillbirth, spontaneous abortion, and other adverse pregnancy outcomes is increased in the setting of malaria, and pregnant travelers should be advised to defer travel until after delivery whenever feasible.

OCCUPATIONAL, NOSOCOMIAL OR HOSPITAL ACQUIRED TOXOPLASMOSIS.

Toxoplasma gondii is protozoan parasite infects wild and domestic animals including birds, cats, sheep, goats, cattle, pigs and poultry. Cats are the definitive host of Toxoplasma and transmitted to other animals or people. There are three forms of T gondii: the tachyzoite (the rapidly reproducing form), the bradyzoite (a slower reproducing form contained in tissue cysts), and the sporozoite (contained in oocysts). The tachyzoite invade cells in the body where it thep multiplies rapidly and can destroy cells. When the cells die, the tachyzoites are released and infect other cells. For this reason, tachyzoites are seen in many tissues and organs throughout the body that are infected during this acute phase of the disease. This is also called the extraintestinal phase of the infection since it can affect all cells outside the intestines in all infected animals. However, only cats have the. intestinal phase of the infection. Two or three weeks after the first infection, the Toxoplasma divides more slowly and a protective membrane forms around the parasite cells. The cyst containing the parasites is called a zoitocyst and the cells inside the cyst are called bradyzoites. The tissue cysts are formed primarily in brain, eye, heart muscle, and skeletal muscle. Bradyzoites persist in tissues for many years, possibly for the life of the host. In cats, Toxoplasma infects the small intestine lining where they reproduce asexually. After a few days of rapid reproduction the cells transform into a sexual form, combine, and become enclosed in a cyst called an oocyst. Oocysts contain the sporozoite form of the Toxoplasma parasite. Gocysts are found in both wild and domestic cats but not in any other animals or birds.

TRAINING PROGRAM FOR NURSING STAFF REGARDING VIRAL HEMORRHAGIC FEVERS IN A MILITARY HOSPITAL.

Viral hemorrhagic fevers (VHFs) refer to a group of illnesses caused by several distinct families of viruses. In general, the term "viral hemorrhagic fever" is used to describe a severe multisystem syndrome (multisystem in that multiple organ systems in the bpdy are affected). Characteristically, the overall vascular system is damaged, and the body's ability to regulate itself is impaired. These symptoms are often accompanied by hemorrhage (bleeding); however, the bleeding is it rarely life-threatening. While some types of hemorrhagic fever viruses can cause relatively mild illnesses, many of these viruses cause severe, life-threatening disease. The selected disaster diseases for this study included: 1-Crimean-Congo hemorrhagic Fever, 2-Dengue Fever, 3-Ebola Fever, 4-Hem-orrhagic Fever with renal syndrome (HFRS), 5-Hantavirus Pulmonary Syndrome, 6-Lassa Fever, 7-Marburg Fever, 8-Rift Valley Fever and 9-Yellow Fever. The educational training program was given over ten sessions to a group of Staff Nurses. The results showed that the program succeeded in enhancing nurse' knowledge, awareness, responsibility, and obligations toward patients with the Viral Hemorrhagic Fevers The results showed a significant impact of training sessions illuminated in the follow-up test on the knowledge score of nurses in all types of diseases except for the Congo hemorrhagic fever, while, statistical significance varied in some diseases in the study when it comes to the comparison between pretest and post-test. All results confirmed on the positive impact of the training program in enhancing the knowledge of nurses toward VHFs patients and their relevant. There was a significant positive impact of the training sessions on changing the attitude of nurses toward patients with VHFs. This result was confirmed on the collective level since the total scores on tests revealed significant positive impact of the study on changing the attitude of nurses toward relevant patients. The relationship included personal data (age, sex, level of education, & years of experiences) and main variables (knowledge scores & attitude change to patients) with the disease in question. This part revealed a significant relationship between all personal data and total knowledge score among nurses except for the level of education, while all results were insignificant for the relationship between the personal data and the nurses' attitude. Difference between the total nurses' attitude change and the total knowledge scores was significant on the three tests' levels; pre, post, and the follow-up. The overall evaluation showed that six criteria were adopted, regarding the educator, the length of presentations, the evaluation of the studied groups regarding the training facilities, the subject matters, the overall training program, and the importance of diseases in question to their practical working environment. The frequency distribution showed that the educator met nurses' expectations; the material tools were plausible enough to satisfy trainees and presentations were fairly short. But, the training facilities were just excellent by the vast majority of trainees. The entire material met specific needs of relevant health care organizations, but about 43% reported that it was difficult. The vast majority of trainees favored the program under almost all criteria studied in the final questionnaire. Above 50% of trainees were not confident enough toward their ability in applying their knowledge acquired practically. The final evaluation showed that the most important were Rift Valley fever, Ebola fever, Hanta virus pulmonary syndrome, Crimean Congo fever and lastly Dengue fever. Lassa and Marburg fevers were of less interest to nurses.

HUMAN BABESIOSIS: A GENERAL REVIEW WITH SPECIAL REFERENCE TO EGYPT.

Babesiosis is a tick-borne malaria-like illness caused by species of the intra-erythrocytic protozoan Babesia. Humans are opportunistic hosts for Babesia when bitten by nymph or adult ticks. Currently, Babesia infection is transmitted by various tick vectors in Europe, Asia, Africa and the northwestern and northeastern United States. Human babesiosis was first described in 1957 but is now known to have worldwide distribution. The increase in reported cases is likely due to increases in actual incidence as well as increased awareness of the disease. Despite the diagnostic and preventive advances resulting from extensive research and a greater understanding of the disease, babesiosis continues to have significant medical impact as a confounding variable in the diagnosis and treatment of Lyme disease and as a potential threat to the blood supply, especially in the United States. Diagnostic advances, like the development of PCR assays, have resulted in increased sensitivity for detection as well as the discovery and characterization of new babesial species. Further studies using the molecular tools now available and those to be developed will lead to a better understanding of the natural history of these organisms, including the transmission cycle and the, potential role of Babesia parasites themselves as immunomodulAtor. Human babesiosis is usually an asymptomatic infection in healthy individuals. Several patients become symptomatic, and, within these subpopulations, significant morbidity and mortality occur, especially in elderly, immunocompromised, or asplenic patients. It is difficult to diagnose. Although the index of suspicion should be high in rural Babesia endemic areas, patients with babesiosis have few, if any, localizing signs to suggest the disease. Diagnosis confirmation depends on the parasitemia degree, the expertise and well trained laboratory personnel. Most patients infected by B microti who are otherwise healthy appear to have a mild illness and typically recover without specific chemotherapy; however, treatment is recommended for all diagnosed cases to prevent sequelae and potential transmission through blood donation. In addition, patients should be advised to take precautions against tick exposure and to refrain from donating blood until completely cured of babesiosis.

Knowledge and performance regarding management of house dust mites in a military hospital.

House dust mites (HDM) are microscopic arthropods live indoor and/or outdoor inhibited by vertebrates including man. This study improved nurses' knowledge and performance regarding the management of HDM to minimize nosocomial patient's exposure in a Military Hospital. All staff nurses with working experience of at least one year were included (n=60 nurses). Three tools were used for data collection: 1- a self-administered questionnaire sheet to assess subjects sociodemographic data and knowledge regarding management of HDM, 2- an observation check list to evaluate performance as regard environmental care related to HDMs' control, and 3- practical dust collection from indicative areas whenever possible to isolate mites from dust patients' dwelling for identification following standard local and international keys. The results showed that the implementation of educational intervention program led to significant improvement of nurses' knoweledge and performance related to management of HDM post program implementation. This fact was practically approved as some nurse's requested to examine even their own homes. Also, seven species of mites were isolated.

The current status of fleas according to environmental changes in some Governorates in Egypt.

A preliminary survey of domestic rodent and their fleas was carried out in different environmental Governorates (Ismailia, Dakahlia, El-Fayoum, North Sinai and Matrouh), Egypt. Flea index (number of flea/rodent) and percentage frequency of different flea species were recorded in spring (2009- 2010). The main rodent species found were the Norway rat, Rattus norvegicus, the grey-bellied rat, Rattus rattus alexandrinus, the white- bellied rat, Rattus rattus frugivorus, the house mouse, Mus musculus and the spiny mouse Acomys cahirinus. The common flea species attacking rodents were: the oriental rat flea, Xenopsylla cheopis, the mouse flea, Leptopsylla segnis, the dog flea, Ctenocephalides canis and the sticktight flea Echidnophaga gallinacea. The flea index at Ismailia and Matrouh Governorates showed the highest indices (8.93 & 7.68), while El-Fayoum and North Sinai Governorates showed the lowest ones (1.09 & 1.68). Dakhalia showed moderate flea index (4.52). The highest number of fleas was recorded on R. norvegicus lives in places that are easy to dig barrows, which are suitable medium for fleas breeding. The lowest number was recorded on Mus musculus and Acomys cahirinus. The oriental rat flea, Xenopsylla cheopis was the highest frequency distribution for all domestic rodent species, while, the stick-tight flea, Echidnophaga gallinacea was the lowest which recorded at Ismailia and Dakahlia only.