EGYPTIAN EOSINOPHILIC AND INFECTIOUS MENINGOENCEPHA- LITIS AND THEIR IMPACT ON PSYCHOLOGICAL ASPECTS.

Meningoencephalitis is an acute inflammation of the brain and spinal cord & their covering protective membranes. Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency. The commonest symptoms of meningitis are headache and neck stiffness associated with fever, confusion or altered consciousness, vomiting, and an inability to tolerate light (photophobia) or loud noises (phonophobia). Children often exhibit only nonspecific symptoms, such as irritability and drowsiness. If a rash is present, it may indicate a particular cause of meningitis; for instance, meningitis caused by meningococcal bacteria may be accompanied by a characteristic rash. A broad variety of allergic, infectious, neoplastic, and idiopathic diseases are associated with increased blood and/or tissue eosinophilia and range in severity from self-limited conditions to life-threatening disorders. Although accepted upper limits of normal blood eosinophil numbers vary somewhat, a value above 600 eosinophils /microL of blood is abnormal in the vast majority of cases. Generally speaking, there are several possible causes of eosinophils in the CSF; undoubtedly parasitic infection is one of the main causes.

MONITORING THE VIRAL LOAD IN HIV PATIENTS UNDER ANTI-RETROVIRAL THERAPY (ART).

Viral load monitoring is an important factor in managing HIV disease. Antiretroviral therapy is the recommended treatment for HIV patients, and the goal therapy is achieving viral suppression and reducing viral load below the level of detection. Viral load is an important parameter used to monitor the progression of HIV and critically regarding treatment decision. The results of present study revealed that there were statistical significant differences between patients maintained on treatment (GA) and patients without treatment (GB) regarding the viral load, and clearly indicated that adherence to ART playing a role in suppression the viral load supporting the immune system of HIV infected patients. The success of ART for someone living with HIV depends on, starting the treatment at the right time, choosing the right combination of (ART) and monitoring the effectiveness of the treatment through monitoring the vilral load.

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.

A TRAINING PROGRAM FOR NURSING STAFF ON HEALTH HAZARDS OF CHEMICAL INSECTICIDES EXPOSURE IN A PRACTICAL FIELD.

UNLABELLED: An insecticide is an agent used against insects, ticks, mites and other animals affecting human welfare. Exposure to Insecticides is one of the most important occupational risks among staff worker in Military camp, veterinary medicine, industry and household as well as schools and hospitals. This study Aimed to improve nursing staff knowledge regarding adverse health effects of chemical insecticides exposure in a military field. SETTING: The study was conducted in one of the Main Military Hospital. RESEARCH DESIGN: was used a quasi-experimental research design to conduct this study. SUBJECT: all nursing staff who work in a Military Hospital (n=55) who accept to participate in the research study. RESULTS: A significant improvement in the Nurses' Total knowledge score was found in post-test as compared to that in pre-test. All nurses obtained a satisfactory level of knowledge after the 1st & 2nd post-tests; all of them evaluate the program in relation to trainees' exnectations as "excellent".

Lassa fever or lassa hemorrhagic fever risk to humans from rodent-borne zoonoses.

Viral hemorrhagic fevers (VHFs) typically manifest as rapidly progressing acute febrile syndromes with profound hemorrhagic manifestations and very high fatality rates. Lassa fever, an acute hemorrhagic fever characterized by fever, muscle aches, sore throat, nausea, vomiting, diarrhea and chest and abdominal pain. Rodents are important reservoirs of rodent-borne zoonosis worldwide. Transmission rodents to humans occur by aerosol spread, either from the genus Mastomys rodents' excreta (multimammate rat) or through the close contact with infected patients (nosocomial infection). Other rodents of the genera Rattus, Mus, Lemniscomys, and Praomys are incriminated rodents hosts. Now one may ask do the rodents' ectoparasites play a role in Lassa virus zoonotic transmission. This paper summarized the update knowledge on LHV; hopping it might be useful to the clinicians, nursing staff, laboratories' personals as well as those concerned zoonoses from rodents and rodent control.

THE ARTHROPOD-BORNE ONCHOCERCIASIS: IS IT DESERVED TO BE NEGLECTED?.

Onchocerciasis a filarial parasitic nematode, also known as river blindness and Robles disease, is a neglected tropical disease infecting more than 18 million people mainly in sub-Saharan of Africa, the Middle East, South and Central America and many other countries. Disease infectivity initiates from Onchocerca volvulus (Filarioidea: Onchocercidae) transmitted by the blackfly, Simulium sp. which introduces the infective stage larva with its saliva into the skin. Within human body, adult females (macrofilaria) produce thousands of larvae (microfilariae) which migrate in skin and eye. Infection results in severe visual impairment or blindness for about 2 million, as being the world's second-leading cause of blindness after trachoma, as well as skin onchocercomata.

Selected infectious disease disasters for nursing staff training at Egyptian Eastern Border.

Infectious disease disasters are events that involve a biological agent, disease and that result in mass casualties, such as a bioterrorism attack, an emerging outbreak of infectious disease; all disasters pose a risk of infection transmission. But, infectious disease disasters pose the great-risk to illness or death from an infectious disease. This study raised the awareness and improved knowledge by educational program for Military Nursing Staff on selected infectious disease disasters acquired at Egyptian Eastern Border. The selected arthropod-borne diseases were Anthrax, Tick borne relapsing, Louse borne replasing fever and liver fluke; Clonorchis sinensis. An interventional study was used, for 125 staff nurse who accepted to participate. The tools dealt with four questionnaires: (1) Some sociodemographic characteristics data (2) Educational needs assessment a structured questionnaire. (3) Knowledge test (pre/post-test) and (4) Participants' reactions questionnaire. The results showed that educational intervention significantly improvements the nursing staff knowledge, which were achieved at the immediate post intervention phase, and retained via three months post-test phase. In the service training programs about infectious disease disasters at Egyptian Eastern Border must be established and continued on regular basis. This would improve their knowledge about the epidemiology of these infectious disease disasters.

Botulism as a food poisoning: what is it?

Botulism is a rare but potentially life-threatening neuroparalytic syndrome resulting from the action of a neurotoxin elaborated by the microorganism Clostridium botulinum. This disease has a lengthy history; the first investigation of botulism occurred in the 1820s with a case report on hundreds of patients with "sausage poisoning" in a southern German town. Several decades later in Belgium, the association was demonstrated between a neuromuscular paralysis and ham infected by a spore forming bacillus that was isolated from the ham. The organism was named Bacillus botulinus after the Latin word for sausage, botulus.

Hydrocarbon insecticides: their risks for environment and human health.

Insecticides are used to control diseases spread by arthropods, but theys vary greatly in toxicity. Toxicity depends on the chemical and physical properties of a substance, and may be defined as the quality of being poisonous or harmful to animals or plants. Poisons have many different modes of action, but in general cause biochemical changes which interfere with normal body functions. Toxicity can be either acute or chronic. Acute toxicity is the ability of a substance to cause harmful effects which develop rapidly following absorption, i.e. a few hours or a day. Chronic toxicity is the ability of a substance to cause adverse health effects resulting from long-term exposure to a substance. There is a great range in the toxicity of insecticides to humans. The relative hazard of an insecticide is dependent upon the toxicity of the pesticide, the dose received and the length of time exposed. A hazard can be defined as a source of danger. The great majority of insecticides are poisonous to man and his beneficial insects and animals and are carcinogenic agents particularly, the halogenated hydrocarbons containing benzene ring.

An interventional program for nursing staff on selected mass gathering infectious diseases at Hajj.

This work improved military nursing staff knowledge on selected mass gathering infectious diseases at Hajj. The results showed that only (20%) of the participating nurses attended training program about health hazard during pilgrim. But only (40.0%) of them found the training programs were specific to nurses. Majority found the program useful (70.0%), and the average duration of this training program in weeks was 3.5+1.1. There was significant improvement P = < 0.001, of correct knowledge about meningitis regarding causes, organisms, mode of spread, people at risk, transmission, prevention and treatment, the highest improvement was in causes of meningitis the lowest was in adult vaccination. 25% of participants had adequate knowledge (> 60% from total score) in pre-test 93% in post-test 72% after 3 month with significant difference among tests regarding adequate knowledge. There was significant improvement of correct knowledge P = <0.001 about seasonal influenza and respiratory diseases during pilgrim, the highest improvement was in influenza vaccine strains the lowest was in antiviral drugs. 23% of nurses had adequate knowledge (> 60% from total score) in pre-test 94% in post-test 66% after 3 month with significant difference among tests regarding adequate knowledge. There was significant improvement P = < 0.001 of correct knowledge about gastrointestinal diseases and food poisoning during pilgrim among nurses at military hospital, the highest improvement was in risk factors of food poisoning the lowest was in what GE patient should do. 22% of participants had adequate knowledge (> 60% from total score) in pre-test 91% in post-test 58% after 3 month with significant difference among tests regarding adequate knowledge. There was significant improvement P = < 0.001 of correct knowledge about heat exhaustion during pilgrim among nurses at military hospital, the highest improvement was in non-communicable diseases the lowest was in sun stroke prevention. 27% of participant had adequate knowledge (> 60% from total score) in the pre-test 94% in the post-test 74% after 3 month with significant difference among pre, post and FU regarding adequate knowledge. Also, there were significant improvement P = < 0.001 of correct knowledge about hypertension, dengue fever, skin scalding & others diseases during pilgrim among nurses at military hospital, the highest improvement was in skin scalding prevention the lowest was in first aid bag. 28% of participant had adequate knowledge (> 60% from total score) in the pre-test 92% in the post-test 61% after 3 month with significant difference among pre, post and FU regarding adequate knowledge. There was a significant difference between total knowledge score according to education, and work experience (P > 0.05). in the pre, post and after 3 month in age and in all intervention time in department the highest was ICU then ward then operation room.

African trypanosomiasis with special reference to Egyptian Trypanosoma evansi: is it a neglected zoonosis?

Trypanosomes (including humans) are blood and sometimes tissue parasites of the order Kinetoplastida, family Trypanosomatidae, genus Trypanosoma, principally transmitted by biting insects where most of them undergo a biological cycle. They are divided into Stercoraria with the posterior station inoculation, including T. cruzi, both an extra- and intracellular parasite that causes Chagas disease, a major human disease affecting 15 million people and threatening 100 million people in Latin America, and the Salivaria with the anterior station inoculation, mainly African livestock pathogenic trypanosomes, including the agents of sleeping sickness, a major human disease affecting around half a million people and threatening 60 million people in Africa. Now, T. evansi was reported in man is it required to investigate its zoonotic potential?

Management of hearing impairment in children.

Hearing loss in children is often a silent and hidden handicap. Children with hearing loss frequently appear to be normal, and often their handicaps are not apparent. Hearing loss that is undetected and untreated can result in speech, language, and cognitive delays. Early identification and intervention with hearing inquired child improve language, communication, and cognitive skills. Sudden or progressive sensorineural hearing loss accompanied by dizziness following barotrauma should prompt consideration of traumatic perilymph fistula. Early surgical exploration is recommended to improve hearing and vestibular symptoms.

Infection control to avoid surgical site infection.

Infection control is a discipline that applies epidemiologic and scientific principles and statistical analysis to prevent or reduce rates of nosocomial infections. Effective infection control programs proved to reduce the rates of nosocomial infections and to be cost-effective. It is a key component of the broader discipline of hospital epidemiology. As an example, the anesthesia team acts every day in a highly complex and high risk environment for the transmission of pathogenic organisms and induction of infectious complication. In order to achieve the main goal of preventing or reducing the risk of hospital-acquired infections, a hospital epidemiology program should have the following oversight functions and responsibilities: Surveillance, either hospital-wide or targeted Education about prevention of infections. Outbreak investigations cleaning, disinfection and sterilization of equipments and disposal of infectious waste hospital employee health, specifically after exposure to either blood-borne or respiratory pathogens, Review of antibiotic utilization and its relationship to local antibiotic resistance patterns, Prevention of infections due to percutaneous intravascular devices. Development of infection control policies and procedures oversight on the use of new products that directly or indirectly relate to the risk of nosocomial infections.

Mosquito vectors of infectious diseases: are they neglected health disaster in Egypt?

In spite of the great technological progress achieved worldwide, still arthropod borne infectious diseases is a puzzle disturbing the health authorities. Among these arthropods, mosquitoes from medical, veterinary and economic point of view top all groups. They are estimated to transmit disease to more than 700 million people annually worldwide mainly in Africa, South America, Central America, Mexico and much of Asia with millions of deaths. In Europe, Russia, Greenland, Canada, the United States, Australia, New Zealand, Japan and other temperate and developed countries, mosquito bites are now mostly an irritating nuisance; but still cause some deaths each year. Mosquito-borne diseases include Malaria, West Nile Virus, Elephantiasis, Rift Valley Fever, Dengue Fever, Yellow Fever and Dog Heartworm....etc. Apart from diseases transmission, mosquitoes can make human life miserable. The successful long term mosquito control requires the ecological and biological knowledge of where and how they develop. The importance of mosquitoes is given herein to clarify the problem and to think together what one must do?

Arsenic pesticides and environmental pollution: exposure, poisoning, hazards and recommendations.

Arsenic is a metalloid element. Acute high-dose exposure to arsenic can cause severe systemic toxicity and death. Lower dose chronic arsenic exposure can result in subacute toxicity that can include peripheral sensorimotor neuropathy, skin eruptions, and hepatotoxicity. Long-term effects of arsenic exposure include an in Due to the physiologic effects of the arsenic on all body systems, thus, chronic arsenic-poisoned patient is a major nursing challenge. The critical care nurse provides valuable assessment and interventions that prevent major multisystem complications from arsenic toxicity.

The mosquito borne West Nile virus infection: is it threating to Egypt or a neglected endemic disease?

West Nile virus (WNV) is a mosquito-borne zoonotic arbovirus belonging to the genus Flavivirus in the family Flaviviridae. The virus is found in temperate and tropical regions worldwide, but first identified in the West Nile sub-region in the East African nation of Uganda in 1937. Prior to the mid-1990s WNV infection was sporadically and considered a minor risk for humans, until an outbreak in Algeria in 1994, with cases of WNV-caused encephalitis, and the first large outbreak in Romania in 1996; with a high number of cases with neuroinvasive disease. WNV has now spread globally to Europe beyond the Mediterranean Basin and the United States, is now considered to be an endemic pathogen in worldwide especially in Africa The WNV transmission is mainly b y v a rious mosquitoes species, also tickswere incriminated The birds especially passerines are the most commonly infected animal and serving as the prime reservoir host In Egypt more than 110 mosquito species and subspecies and more than 32 genera of ticks were identified. Besides, not less than 150 species of migratory birds visit Egypt annually in addition to 350 resident ones. This review provided an overview of the current understanding flaviviruses mainly WNFV. Primary care physician and senior nurse should be able to include the disaster diseases in differential diagnosis of various clinical conditions. They should take a thorough history to request specific dependable laboratory test(s) as soon as possible, and positive patient should be transferred to the fever hospital.

The infantile visceral leishmaniasis: could it attack Egyptian north coastal region again?

Visceral leishmaniasis is caused by three species of the L. donovani complex: L. donovani, L. infantum, and L. chagasi. Infections with these organisms are often asymptomatic or very mild, but in a minority of individuals there is progression to severe symptomatic disease. This is associated with spread of the infection throughout the reticuloendothelial system. L. infantum typically affect children below the age of 5 years. However, IVL can also occur in immunosuppressed adults, such as transplant recipients and patients receiving immunosuppressive chemotherapy or patients suffering from chronic intestinal schistosomiasis. IVL was encountered in Al-Agamy, Alexandria on 1983 with Phlebotomus langeroni. This vector is still abundant with low density away from Al-Agamy. Urbanization of the north coastal area in the vicinity of Alexandria changes the ecological status but how does it affect the behavior of sandflies; mainly the IVL vector Phlebotomus langeroni? Many employees and their families return home from Libya with fever with or without other accompanying symptoms. Fever can be a manifestation of a minor, self-limited process or can herald a progressive, life-threatening illness. The detection of Phlebotomus langeroni in El-Hamam City, Sedi Barany City, and Matrooh City and the abundance P. papatasii in these three cities in addition to Al Agamy must be taken into consideration of the Public Health Authority.

Is plague a problem in the Egyptians returning back from Libya?

Many employees return home with fever with or without other accompanying symptoms. Fever can be a manifestation of a minor, self-limited process or can herald a progressive, life-threatening illness. The assessment of this group is often hampered by the clinician's lack of familiarity with the types of infections that the patient may have encountered while traveling. The evaluation of such patients should focus on: What infections are possible given where the patient has lived or traveled and the time when exposures may have occurred? Which of these infections is more probable given the patient's clinical findings and potential exposures? Which of these infections is treatable or transmissible or both? On the other hand, the outbreak of plague at the Libyan-Egyptian borders and the high density rodents and their ecto-parasitic fleas in many Egyptian governorates should be embarked a control program to rodents and fleas and to raise the awareness of the concerned authorizes.

The tick-borne Crimean-Congo hemorrhagic fever in Africa, Asia, Europe, and America: what about Egypt?

Globally, the recognized number of distinct and epidemiologically important diseases transmitted by ticks has increased considerably during the last 4 decades. Crimean-Congo haemorrhagic fever (CCHF) is a tick-borne disease caused by an arbovirus, which was first recognized during a large outbreak among agricultural workers in the mid-1940s in the Crimean Peninsula. Humans become infected through the bites of ticks, by contact with haemorrhage from nose, mouth, gums, vagina, and injection sites of a CCHF patient during the acute phase or follow-up, or by contact with blood or tissues from viremic livestock. This paper reported three human Crimean-Congo haemorrhagic fever cases, one in Almaza fever hospital and two in Gharbia Governorate. No doubt, distribution of tick-vector (Hyalomma spp.) worldwide including Egypt and presence of CCHF in regional countries must be considered by the Health and Veterinary Authorities.

Human pediculosis: a critical health problem and what about nursing policy?

Lice infestation on the human body (also known as pediculosis) is very common. Cases number in the hundreds of millions worldwide. Three distinct presentations of lice infection exist and each is caused by a unique parasite. Head lice (Pediculus humanus capitis) is by far and away the most common infestation and favors no particular socioeconomic group. A genetically close "cousin," Pediculus humanus corporis, is responsible for body lice and is more commonly associated with poverty, overcrowding, and poor hygiene. Pubic lice (crabs) are caused by Pthirus pubis and is transmitted by intimate and/or sexual contact. No doubt, human lice infestation is an increasing problem worldwide, Apart from being an irritating and a shaming human ecto-parasite, they transmit serious infectious diseases; epidemic or classical typhus, epidemic relapsing fever as well as Trench fever. Eradication of lice infestation prevents transmission of infectious diseases. People who live and work in close proximity to louse-infested individuals may secondarily acquire lice even if they regularly wash their clothes and have good hygiene. Thus, all louse-infested persons and workers in close contact with such persons should periodically inspected and use long-acting safe insecticides. Human lice can be treated with agents such as DDT, malathion, and lindane, but reports of resistance to one or more of them have recently appeared. Pyrethroid permethrin when applied as a dust or spray to clothing or bedding is highly effective against lice and is the delousing agent of choice. Fabric treated with permethrin retains toxicity to lice even after 20 washings, thereby offering significant long-term passive protection against epidemic typhus. Itching may continue even after all lice are destroyed. This happens because of a lingering allergic reactionto their bites. Over-the-counter cortisone (corticosteroid) creams or calamine lotion may help.