Plastic use for food and drinks and related knowledge, attitudes, and practices among a sample of Egyptians.

Introduction: Plastic is extensively used in everyday life, particularly for food and beverage containers. The inappropriate use of these containers may lead to the leaching of various chemicals from plastic, such as bisphenol A, phthalate, and styrene, which cause numerous adverse health effects. This study aimed to assess the knowledge, attitudes, and practices toward using plastic for food and drinks among a sample of the Egyptian population. Materials and methods: A questionnaire was designed based on scientific literature to assess sociodemographic data, knowledge, attitudes, and practices toward the use of plastic for food and drinks. A total of 639 participants were recruited by employing the convenience sampling technique. Results: More than half of the participants (347, 54%) had poor knowledge scores. Personal experiences, social media, and web pages represented the most common knowledge sources. A comparison between plastic-related knowledge scores and the studied sociodemographic characteristics revealed statistically significant differences in age, gender, education, marital status, residence, working, and socioeconomic standard. A good attitude was reported by the majority (515, 80.6%) of participants. The majority (493, 77.2%) were occasional and frequent plastic users and the practice scores were significantly associated with age, education, residence, and socioeconomic standard. Higher educational level, gender (women), and rural residence were predictors of good participants knowledge, while lower socioeconomic status and urban residence were predictors of bad participants practice in a multivariate logistic regression analysis. Conclusion: The observed unsatisfactory knowledge and practice scores vs. the high attitude indicates a knowledge gap that can help direct future improvements. We call for public awareness programs about safe plastic use and the related health hazards of plastic chemicals. We also stress upon the urgent need for a collaboration between health authorities and the plastic and food industry to guarantee that information about proper plastic use is conveyed to consumers.

COVID-19 prevention and rehabilitation related knowledge and practices among Egyptian post-COVID-19 patients.

BACKGROUND: Even with the mild form of COVID-19, people need to practice the proper preventive measures to achieve health, safety and control spread of infection. Few studies assessed sound disinfection and rehabilitative knowledge. This study aims to assess the self-reported, knowledge of specific disinfection measures among post-recovery COVID-19 patients and identifying the most requested knowledge items regarding the prevention and post COVID rehabilitation measures. METHODS: This is an exploratory cross-sectional study using an electronically open survey. A pre-tested e-questionnaire was employed for data assembling. The sample size was calculated and a total of 417 people completed the questionnaire. Knowledge score was calculated for preventive and disinfection measures during and after COVID 19 infection. It comprised three sections: socio-demographics, study participants' knowledge regarding precautions, disinfection, and rehabilitation measures, as well as sources of knowledge about COVID-19. RESULTS: All participants infected with COVID-19 (82%) reported self-isolation for ten days after confirming the infection, with only 18% required hospitalization. Regarding the information needed by the participants, the highest requests were for the rehabilitation information after COVID-19 and preventive measures. Females under 30 years old and those with a college education or higher were significantly more likely to request rehabilitation information after COVID-19 (P-value 0.05). Nevertheless, males were significantly more interested in information regarding preventive measures; They were over 30 years old and had education below university (P-value 0.05). Participants (above 30 years old) had significantly higher knowledge of preventive and disinfection measures during and after COVID-19 infection (P = 0.030). CONCLUSION: After the COVID-19 experience, most participants demonstrated a great desire for rehabilitation information and proper preventive measures. This paves the way for delivering self-management and rehabilitation knowledge and emphasizing the significance of various prevention modalities.

Exploration of the nutrition knowledge among general population: multi-national study in Arab countries.

BACKGROUND: Knowing what to eat and realizing the significance of healthful eating habits are among the important steps to promoting eating behavior. The current study aims to assess the nutrition knowledge (NK) among a convenient sample in four different countries, determine the association between different demographic factors and NK, and investigate the need for future interventions on nutrition in the four selected countries. METHODS: A cross-sectional multi-national survey study among a convenient sample of 8,191 subjects from Egypt, Syria, Saudi Arabia, and Jordan who undertook surveys between January 2019 and January 2020. A pre-tested interview questionnaire was utilized for data collection from study participants. It included three sections: i) Sociodemographic characteristics:. ii). Section two included twenty-one questions related to NK.. iii). Section three included one question about NK sources. RESULTS: About three-quarters showed inadequate nutrition knowledge (73.1%). Youth (15-24 yrs.) were more dependent on social media, with 87% using it as a primary source of NK, while adults (≥ 25 yrs.) demonstrated that 43% of them used social media. In contrast, TV was more prominent among them, with participants' characteristics such as living with parents, body mass index, and country of residence showing no association with NK. However, female sex, education, and reading nutrition articles are significantly correlated with adequate knowledge (p < 0.001). Significant predictors of satisfactory knowledge were age, sex, education, living with parents, and reading nutrition articles. CONCLUSION: The study revealed low levels of NK indicating an urgent need to implement educational programs to promote nutrition knowledge. As NK is a modifiable determinant of diet intake and can positively impact the need for developing strategies in counselling and raising awareness among the general population to improve their health status.

Social and self-stigma during COVID-19 pandemic: Egyptians' perspectives.

BACKGROUND: Social stigma associated with infectious diseases existed throughout the history of pandemics due to fears of contagion and death. This study aims to assess social and self-stigma resulting from COVID-19 infection and other associated factors in Egypt during the pandemic. METHODS: A cross-sectional study was conducted on 533 adult Egyptians via an online questionnaire. The questionnaire included social stigma toward current and recovered COVID-19 patients and the negative self-image of being a COVID-19 patient. RESULTS: The mean calculated overall COVID-19-related stigma score for the studied sample was 4.7±3.1. The highest reported stigma category was mild stigma: Social stigma towards current COVID-19 patients (88.2%), Social stigma toward recovered COVID-19 patients (64.2%), Negative self-image for being a COVID-19 patient; perceived self-stigma (71.6%) and total stigma score (88.2%) respectively. The overall stigma score was negatively associated with a higher level of education and getting information from healthcare workers and positively associated with getting information from social networks. CONCLUSION: Social and self-stigma related to COVID-19 infection was mild from the Egyptian perspective but found in a large proportion of the population and mainly affected by getting information from healthcare workers or through social media and being more among those with lower education levels. The study recommends more legislative control on social media for disseminating health-related information and conducting awareness campaigns to counteract these adverse effects.

Barriers to adequate nutrition care for child malnutrition in a low-resource setting: Perspectives of health care providers.

Introduction: Several studies in developing countries found that more need-based training is required for health care providers (HCPs) in child malnutrition management. Methods: An exploratory cross-sectional study was conducted to explore barriers to providing adequate nutrition care as perceived by the healthcare providers (HCPs) in the child malnutrition clinic at a Children's University Hospital in Egypt. Participants were selected using the purposive sampling technique. Five out of seven HCPs in the clinic were included (two male physicians, one female physician, and two female nurses). Qualitative data were collected through in-depth interviews. The interview guide consisted of semi-structured open-ended questions. Quantitative data were the resulting scores from the scoring system used to assess the understandability and actionability of the patient education materials (PEMs) that are available in the clinic. The Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) for the scoring. Statistical analysis: The thematic content analysis technique was employed for qualitative data. The percent score was generated for the PEM actionability and understandability for quantitative data. Results: Most common child malnutrition conditions encountered by HCPs were nutritional deficiencies. Barriers to the delivery of adequate nutrition care to children were physician-centered: limited nutrition education in the medical school, health system-centered: an insufficient number of HCPs, lack of nutritional supplements, lack of patient education materials (PEMs) that suit the characteristics of the served community, lack of updated standard of practice (SOP) and guidelines, inadequate nutrition training of HCPs, and insufficient time for each patient, and caregivers-centered: the low socioeconomic status and false cultural, nutritional beliefs. Conclusion: There are different barriers to adequate nutrition care for child malnutrition in low-resource healthcare settings. Mainly nutritional deficiencies. Most of the barriers were health system-related in the form of insufficient resources (shortage of workforce; concerning the high caseload, nutritional supplements, and PEMs) and inadequate management of resources (lack of skill-based training, lack of updated SOP and guidelines, and lack of properly designed PEMs that facilitate communication with the target caregivers).

Perspectives on Antibiotic Stewardship Programs among Health Care Providers at Two University Hospitals in Egypt.

The perspectives of healthcare professionals on antibiotic stewardship programs (ASPs) should be explored. Any antibiotic stewardship strategy must be individualized based on patient needs, prescription habits, and local resources. The current study aimed to explore the perspectives of healthcare providers on antibiotics stewardship and their awareness of these perspectives. Furthermore, potential barriers to the application of ASPs should be identified and addressed. This exploratory cross-sectional study utilized a qualitative method to evaluate critical care physicians, pediatricians, and clinical pharmacists (n = 43). The mean age of the physicians was 32 ± 1.5 years. Among them, approximately two-thirds (66%) were women. A thematic content analysis was performed to examine the responses of the participants and to prioritize the recommendations for and barriers to the implementation of ASPs from the perspective of healthcare providers. According to the interviewees, the primary obstacles include lack of time in implementation and monitoring and lack of awareness of the need for ASPs. All respondents recommended the implementation of supervised and continuous trainings. In conclusion, the abovementioned barriers must be adequately addressed to facilitate the implementation of ASPs.

Prevalence, characteristics, and factors associated with caffeine-withdrawal headache during the first day of Ramadan.

BACKGROUND: Data regarding prevalence, characteristics, and factors associated with caffeine-withdrawal headache are lacking. This work aimed to study the prevalence of caffeine-withdrawal headache among caffeine consumers during Ramadan's first day and describe its characteristics and associated factors. METHODS: This analytical cross-sectional study targeted 755 caffeine consumers eligible to fast on the first day of Ramadan. Two methodological approaches were followed: an online open survey and a face-to-face interview. Using an adjusted form of food frequency questionnaire, eligible participants were requested to report their intake of caffeine-containing products during the last week of Shaaban month, the month preceding Ramadan. RESULTS: The prevalence of caffeine-withdrawal headache on the first day of Ramadan was 419 (55.5%), with 95% confidence interval (CI; 51.9-59.0%). The headache in the majority of the participants was throbbing in character (249/419, 59.4%), diffuse (146/419, 34.8%), and moderate in intensity (227/419, 54.2%). Participants who developed caffeine-withdrawal headache had significantly higher body mass index (27.2 ± 5.1 vs. 26.3 ± 5 [mean ± standard deviation], p-value = 0.012), daily caffeine intake, mg (316 [185.2-537.8] vs. 144.4 [60.0-312.4] [median interquartile range (IQR)], p-value < 0.001), and caffeine intake mg/kg body weight (4.7 [2.6-7.2] vs. 1.9 [0.8-4.4] [median (IQR)], p-value < 0.001) than participants who did not develop it. Mild, moderate, and severe caffeine use disorder were found to have adjusted associations with developing caffeine-withdrawal headache. They increased the odds of headache by 5.3 (95% CI = 3.40-8.3), 10.2 (95% CI = 5.9-17.5), and 15.5 (95% CI = 9.0-26.8) times, respectively. The optimal cut-off value of daily caffeine intake/Kg body weight was determined at 1.97 mg/kg with an area under the curve of 0.722 and sensitivity and specificity of 85.1% and 50.2%, respectively. CONCLUSION: Daily caffeine intake/kg body weight and caffeine use disorder are significantly associated with a caffeine-withdrawal headache.

Climate change-related knowledge and attitudes among a sample of the general population in Egypt.

Introduction: Identifying the public awareness and risk perception regarding climate change, are fundamental preliminary steps in determining gaps and paving the way for awareness campaigns that address climate change causes and counteraction mitigation measures. However, few studies were conducted in Egypt; thus, the researchers conducted the current cross-sectional study among a sample of the Egyptian population to identify general knowledge and perception about climate change and its effects, as well as attitudes toward mitigation measures. Methods: An exploratory population-based electronic-open survey, was conducted among 527 members of the general population between January and April 2022, using a convenience sampling technique. A pre-tested 2-page (screen) electronic included three sections: sociodemographic characteristics, global warming/climate change-related knowledge, and attitude toward climate change mitigation. Results: The average global warming knowledge score was 12 ± 3. More than 70% (71.1%) of the participants were knowledgeable (percentage score >70%). Approximately half of the enrolled participants (48.2%) agreed that everyone is vulnerable to the effects of global warming/climate change. More than three-quarters (78.3%) of the participants agreed that carbon emissions from vehicles and industrial methane emissions were the first factors that contributed to climate change, followed by the ozone holes (731%). Global warming/climate change-related knowledge was statistically higher in participants aged of >30 years, married participants, urban residents, highly educated individuals, and employed individuals (p-value ≤ 0.05). Approximately 80% of the participants agreed that responding to the questionnaire drew their attention to the topic of climate change and its effects. More than two-thirds of those polled agreed that increasing public transportation use could help mitigate the effects of climate change/global warming, followed by the materials used and the direction of construction. Conclusion: More than two-thirds of the participants were knowledgeable regarding climate change. Social media and the internet were the main sources of information. However, participants need to get the information in a different way that could help in changing their attitude positively toward the issue of climate change mitigation. The current study recommends the need for various initiatives that work should be launched.

Perceived stigma and healthcare services in healthcare settings among people living with HIV in Egypt: a qualitative study.

BACKGROUND: The researchers conducted the current study to explore the perspectives of people living with HIV (PLHIV) on HIV-related discrimination and the delivery of healthcare services in healthcare settings. METHODS: An exploratory study using a qualitative approach was conducted among 46 PLHIV who were seeking HIV counselling and treatment from two HIV centres in the Cairo governorate using a purposive sampling technique. RESULTS: A thematic content analysis was used to examine the responses. Participants had a combination of positive and negative experiences. Some participants reported staff acceptance and friendliness towards HIV-positive patients on antiretroviral treatment. Most interviewees observed that staff took extra precautions when treating or caring for them. The majority stated that counselling about the effects of the treatment was inadequate and that testing was either too far from their homes or at overcrowded centres with long waiting times. All the interviewees recommended ongoing communication and HIV counselling skills for healthcare providers who are in contact with HIV patients. CONCLUSION: Most of the study participants were not satisfied with HIV services in the participating centres, as well as experiencing stigma. More investment in enhancing the quality of HIV service delivery and reinforcement of health worker competencies, mainly in HIV counselling, may improve satisfaction, bearing in mind HIV-related stigma in the centres involved.

Adjustment of family planning service statistics reports to support decision-making at central and governorate level, Egypt.

BACKGROUND: The Ministry of Health and Population (MOHP)-Family Planning Sector (FPS) has a strong management information system (MIS) that allows the flow of data from MOHP-FP clinics, health districts, and governorates up to the central level. Yet, family planning (FP) quarterly reports issued at the central level are presented as database/spreadsheet software documents. These data are not used to provide indicators or information that aid in decision-making or the tracking of FP services over time. The objective of the study is to organize data in the database, develop key performance indicators, and design FP reports and policy briefs. METHODS: The study is operations research that is driven by published data derived from MOHP-FP sector-head, and 2014 service statistics quarterly hardcopy reports. The information was entered into an excel program, and 15 key performance indicators (KPIs) were calculated and used to rank Egypt's 27 governorates. We developed an annual FP report form, settled tables, and colored graphs that are liable to rank the governorates from best to least favorable. RESULTS: The quarterly data sheets issued by the MOHP-FP sector were organized for the quarters, and one annual sheet was developed with the organization of Egypt's Governorates into 4 specific regions, with each governorate having a fixed position in all reports. The key performance indicators were as follows: percent of clients aged 35 and up; percent of clients with fewer than three children; proportion of current FP users by method; percent of clients reported as first-time clients; percent of clients defined as new clients (non-FP users and FP discontinuers); and contraceptive coverage rate, i.e., percent coverage of married women of reproductive age with dispensed FP methods expressed as couple years. CONCLUSION: MOHP-FP sector service statistics data could be used for the development of fifteen key performance indicators. Having those indicators at governorate, district, and central levels in quarterly and annual reports and their communication with decision-makers at all levels and their tracking overtime will guide them to timely decision-making for improving performance in FP services at all levels.

Violence and sociodemographic related factors among a sample of Egyptian women during the COVID-19 pandemic.

BACKGROUND: Violence against women is a worldwide problem that affects different social and economic classes, and this violence has almost increased with pandemics as the COVID-19 pandemic. The present survey aimed to assess the prevalence of violence against women in Egypt during the COVID-19 pandemic and to identify the relationship between sociodemographic factors and violence exposure. A total of 509 women were recruited using a self-completion e-form questionnaire. RESULTS: The prevalence of violence experienced by women was (43.8%); the most common type was the emotional representing (96.0%) of exposed women, while sexual violence was the least common (13.5%). Violence exposure was affected significantly by residence governorates, husbands' working status, reduced husbands' working hours, and history of violence exposure. CONCLUSIONS: Violence against women in Egypt was increased during the COVID-19 pandemic, which raises the need for a strong and urgent anti-violence program to control this problem.

Assessment of knowledge, attitudes, and precautionary actions against COVID-19 among medical students in Egypt.

BACKGROUND: The COVID-19 pandemic has become a significant public health threat. Therefore, the purpose of this survey was to assess knowledge, attitudes, and precautionary measures related to COVID-19 among college students. METHODS: A convenient sample of 3263 volunteers responded to a self-administered electronic questionnaire during the period from October to December 2020. The knowledge, attitude, and practice (KAP) score level was calculated with a range of 0-34 points. RESULTS: The mean age of the participants was 21 (+/-1.2) years, 69% were female, and 60.3% were urban. The majority of respondents received information about COVID-19 symptoms (93.9%), how to protect yourself (92.5%), and how it is transmitted (86.8%). The most cited sources of information were social media (75.7%), and the most credible were government websites and international organizations. More than half (65%) expressed concern regarding contracting COVID-19, and 89.2% believed that COVID-19 is a dangerous infection due to the rapid spread of the virus. The mean total KAP score was 26.1 (+/-4.2), which differed significantly between gender groups and residential areas. Logistic regression analysis showed that volunteers with good knowledge were 1.3 and 1.0 times more willing to volunteer and maintain a physical distance than those with less knowledge. Female students were 40% less likely to volunteer than males, yet they were 1.8 times more cautious about practicing protective measures such as washing their hands with soap and water than male students. Classifying the COVID-19 pandemic as a serious infection, urban communities have twice been careful to wear masks outdoors and maintain a social distance of at least 2 m from one another compared to rural inhabitants. CONCLUSION: The current survey revealed that medical students have good knowledge regarding COVID-19, a positive attitude towards the use of protective measures, which were necessary to limit the spread of the disease. However, improvement is still required, and community education should occur as usual with a commitment to utilizing all the strategies that can support knowledge to improve and change attitudes as well as practices of the population.

A Modified Delphi Study for the Development of a Leadership Curriculum for Pediatric Oncology.

BACKGROUND: The broader construct of participatory system-wide leadership has not been highlighted in the pediatric oncology domain, although these skills are teachable. The researchers conducted the current study to develop a leadership competency curriculum for pediatric oncologists in Egypt. METHODS: The study was carried out in three phases: (1) Conducting a literature review for the years 2013-2018 to identify the initial competencies of pediatric oncology leadership (2) Holding a meeting with a superior reference panel (SRP) to get a consensus on the initial list of competencies, and (3) Conducting a two-round modified Delphi survey. RESULTS: Seventy-five invitees from 12 countries completed the first round (R1) of the survey. Of the 75 respondents to R1, 69 completed round 2 (R2) (92%). In R1, 73 competency items were surveyed for relevance to include in a pediatric oncology leader role curriculum. Thirty-seven items were judged for inclusion, while 36 items were judged for exclusion. In R2, the 37 competencies relevant for inclusion were presented in which participants were asked to check them as either IN or OUT. Finally, 17 competencies remained. CONCLUSION: The process resulted in 17 pediatric oncology leader role competencies. CONCLUSION: This final set of 17 competency items is considered as an important step towards reducing the variability in pediatric oncology education and practice that currently exists in Egypt. This is the initial step towards developing a learning and assessment toolkit for this imperative area of research and practice. 
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Asymptomatic SARS-CoV-2 infection among healthcare workers in a non-COVID-19 teaching university hospital.

BACKGROUND: During the COVID-19 pandemic, most of the published reports on COVID-19 emphasized that health care workers (HCWs) get infected more than the general population representing one of the most vulnerable groups. However, that the real percentage of HCWs infected by SARS-CoV-2 in Egypt remains unknown. The researchers conducted the current study to assess seroprevalence of SARS-CoV-2 IgG among HCWs working in a hospital with no SARS-CoV-2 patients, and to identify the potential factors associated with SARS-CoV-2 IgG seropositivity. DESIGN AND METHODS: The current study is a cross-sectional study carried out among 455 HCWs at Cairo University Hospital. The researchers administered a questionnaire shortly before the SARS-CoV-2 rapid test is performed using closed-ended question format to obtain information on demographic data of the study participants including age, sex, specialty, clinical information including questions about medical conditions, and. history of previous exposure with a confirmed or suspected case of COVID-19, and history of COVID-19- compatible symptoms during the previous 14 days (cough, sore throat, runny nose, fatigue, shortness of breath, fever, headache, vomiting, diarrhea, anosmia, ageusia, and chills). RESULTS: We screened 455 HCWs for SARS-CoV-2 antibodies, 31.4% were in the high-risk group, and 68.6% in the low-risk group. The overall IgG seroprevalence was 36 (7.9%) (95% CI 5.8 to 10.8). The IgG seroprevalence was significantly higher in low-risk group 11% (35/312) versus high-risk group 0.7% (1/143), p<0.001. CONCLUSIONS: Low seropositivity rates for SARS-CoV-2 among HCWs is suggestive of lack of immunity and we are still far from herd immunity.

COVID-19 Pandemic Preparedness in Egypt's Teaching Hospitals: A Needs Assessment Study.

INTRODUCTION: Regular collection and monitoring of data describing the dynamics of the utilization of healthcare services, especially in teaching hospitals (TH), which provide model quality medical services, are critical for COVID-19 pandemic preparedness. METHODS: The researchers analyzed data and information derived from service statistics reports from June 1st to July 15th, 2020 in terms of hospital resources, as well as utilization patterns of beds, ICU, and ventilators, for 11 screening hospitals affiliated with the General Organization of Teaching Hospitals and institutes in Egypt assigned by the Ministry of Health and Population to provide medical care for COVID-19 patients. Hospital indicators in terms of COVID-19 screening services, as well as utilization patterns of inpatient beds, ICU beds, and ventilators were computed. RESULTS: A total of 78,869 non-medical personnel and 2,176 medical personnel were presented with COVID-19 triage symptoms. Investigations conducted in the targeted 11 hospitals delineated that 22.2% of non-medical personnel and 27.9% of medical personnel were COVID-19 PCR-confirmed cases. The inpatient bed occupancy rate was 70% for non-medical patients and 67% for medical staff patients. For ICU, the bed occupancy rate was 92 % for non-medical patients and 88% for medical patients. Among the confirmed cases, 38% of medical patients utilized a ventilator vs. 36% of medical personnel cases. Hospital ranking according to utilization pattern among non-medical personnel, Hospital H ranked first in terms of the high load of screening services. Hospital C ranked first regarding the number of confirmed cases, whereas Hospital D ranked first for high ICU utilization among all teaching hospital ICU cases. With respect to medical personnel, Hospital G ranked first for the high load of screening services for the total studied cases. Hospital G ranked first for the number of confirmed cases. Hospital B ranked first regarding high ICU utilization among all teaching hospital ICU cases. CONCLUSION: Teaching hospitals have demonstrated preparedness for the COVID-19 pandemic by maintaining an inpatient bed occupancy rate of 70% or less and ventilator utilization at <40% of confirmed cases. However, the ICU bed occupancy rate was more than 90% indicating a shortage of resources. In addition, there is variance across hospitals regarding caseload for resource reallocation decisions.

Impact of implementation of a modified World Health Organization multimodal hand hygiene strategy in a university teaching hospital.

BACKGROUND: Although educational programs could enhance knowledge, practices, and compliance with hand hygiene (HH) for health care workers, the researches focusing on effective methods for educating and increasing the compliance with HH practices are scanty. Consequently, the researchers conducted the present study to assess HH-related knowledge, attitude, and compliance rate after the implementation of a modified version of the World Health Organization (WHO) multimodal strategy was written in the background. METHODS: A pretest-posttest quasiexperimental study was conducted in a university hospital in Cairo among 84 nurses. The study consisted of 4 phases: baseline assessment, intervention, postintervention assessment, and follow-up phase. The intervention (HH-campaign) consisted of 4 components: infrastructure change, training/education of health care workers, posting visual reminders, and development of institutional safety climate "hand hygiene champions." RESULTS: HH compliance rate significantly increased from 28% before the intervention to 50% after the intervention and 58% after the follow-up period (P < .001). The knowledge score and the attitude score significantly improved before and after the intervention (P < .001). The use of alcohol handrub significantly increased from 9.5% before the intervention to 65% after the intervention and 76% after the follow-up period. CONCLUSIONS: Implementation of a modified version of the World Health Organization multimodal strategy successfully doubled HH compliance rates. Tackling a social way of thinking together with regular frequent training and follow-up are essential to sustain adherence to safe HH practices.

Assessment of nutritional status and disease activity level in Systemic Lupus Erythematosus patients at a tertiary care hospital / Evaluación del estado nutricional y el nivel de actividad de la enfermedad en pacientes con lupus eritematoso sistémico en un hospital de atención terciaria

ABSTRACT Introduction: Nutritional status and unhealthy dietary habits may have an influence on Systemic Lupus Erythematosus (SLE) course and activity. Objectives: This work aimed to determine the nutritional status and dietary intake of SLE patients and its relation to disease activity. Material and methods: Sixty-five SLE patients were recruited from Kasr Alainy outpatient clinic from October 2017 to December 2017 in a cross-sectional study. Data were collected using a structured interview questionnaire including inquiry about the socioeconomic status, nutritional status using anthropometric measurements, semi-quantitative food frequency questionnaires (FFQ), and hemoglobin level measurement. Disease activity level was assessed using SLE disease activity index (SLE-DAI). Results: The median age of the enrolled female patients was 30.0 (24.0-37.0), with median disease duration of 3.0 years (1.0-9.0). BMI assessment revealed that more than three quarters of SLE patients were overweight and obese. The semi-quantitative FFQ revealed a decreased consumption of fresh fruit, vegetables, milk and other dairy products and an increased intake of fats and oils. Disease activity (SLE-DAI) correlated with increased BMI (r = 0.299, p = 0.016), body weight (r = 0.276, p = 0.026), and disease duration (r = 0.246, p = 0.049). Conclusions: Inadequate nutrient intake and the high percentage of overweight and obesity among SLE patients with excessive consumption of lipids and low intake of fibers were revealed. Also, disease activity (SLE-DAI) correlated with increased BMI.

RESUMEN Introducción: El estado nutricional y los hábitos alimenticios poco saludables pueden influir en el curso y la actividad del lupus eritematoso sistémico (LES). Objetivos: Este trabajo tuvo como objetivo determinar el estado nutricional y la ingesta dietética de los pacientes con LES y su relación con la actividad de la enfermedad. Material y métodos: Se reclutaron 65 pacientes con LES de la clínica ambulatoria de Kasr Alainy desde octubre de 2017 hasta diciembre de 2017 en un estudio transversal. Los datos se recopilaron mediante un cuestionario de entrevista estructurada que incluía una investigación sobre el estado socioeconómico, el estado nutricional mediante mediciones antropométricas, los cuestionarios de frecuencia de alimentos semicuantitativos (FFQ) y la medición del nivel de hemoglobina. El nivel de actividad de la enfermedad se evaluó utilizando el índice de actividad de la enfermedad del LES (LES-DAI). Resultados: La mediana de edad de las pacientes reclutadas fue de 30,0 (24,0-37,0) años, con una duración media de la enfermedad de 3,0 años (1,0-9,0). La evaluación del índice de masa corporal (IMC) reveló que más de las tres cuartas partes de las pacientes con LES tenían sobrepeso y eran obesas. La FFQ semicuantitativa reveló una disminución del consumo de frutas frescas, verduras, leche y otros productos lácteos, y una mayor ingesta de grasas y aceites. El índice del LES-DAI se correlacionó con un aumento del IMC (r= 0,299; p = 0,016), peso corporal (r = 0,276; p = 0,026) y duración de la enfermedad (r = 0,246; p = 0,049). Conclusiones: Se reveló una ingesta inadecuada de nutrientes y el alto porcentaje de sobrepeso y obesidad entre los pacientes con LES con un consumo excesivo de lípidos y una baja ingesta de fibras. Además, la actividad de la enfermedad (LES-DAI) se correlacionó con un aumento del IMC.

Diagnostic indicator of acute lung injury for pediatric critically ill patients at a tertiary pediatric hospital.

Early identification of acute lung injury (ALI) in pediatric patients at risk of mortality is important for improving outcome.Assessment of soluble form of receptor for advanced glycation end products (sRAGE) as a valid biomarker for diagnosis of ALI among critically ill, pediatric patients in addition to correlating levels of sRAGE and different outcomes of those patients.A Hospital-based case-control study was conducted in pediatric intensive care units (PICUs) at Cairo University Hospital, along a period of 6 months. Total of 68 pediatric patients following inclusion criteria were classified into: patients with ALI; with both ALI and sepsis; with sepsis and control patients. They were prospectively followed and their laboratory and immunological workup (at days 1 and 9) was done to measure serum sRAGE levels and detect (sRAGE) genotypes.The age of the included children ranged from 8 to 84 months. Plasma level of sRAGE was significantly higher in plasma from patients with ALI regardless of associated sepsis. Plasma sRAGE levels were positively correlated with lung injury score. When assessing sRAGE genotypes, TA and TT genotypes were significant in most of the ALI with and without sepsis patients.Monitoring levels of sRAGE and genotypes can significantly affect the survival of ALI children.

Infection with gram-negative bacteria among children in a tertiary pediatric hospital in Egypt.

BACKGROUND: Patients in pediatric intensive care units (PICUs) are susceptible to infections with gram-negative bacteria (GNB). METHODS: A prospective observational study was conducted in 2 PICUs at Cairo University Hospitals to determine the incidence and outcome of GNB infections over 1 year. Variables of interest included age, gender, isolated organism, susceptibility to antibiotics, and final outcome. RESULTS: During the study period, 1420 patients were admitted to the PICU; of these, 291 developed GNB infections. The median age of the studied GNB patients was 50 months (interquartile range [IQR], 22-80 months). The mortality rate was 37.1%. Organisms were isolated from blood in the majority (86.6%) of patients, with Klebsiella (36.0%) being the most frequently isolated organism. Among patients with GNB infection, 235 patients, one had a multidrug-resistant (MDR) infection. The length of hospital stay was statistically significantly longer in the MDR group (25 days; IQR, 20-30) than in the non-MDR group (15 days; IQR, 10-20) (P < .01). Mortality was similar in both groups (37.4% vs 35.7% in the MDR and non-MDR groups, respectively; P = .88). CONCLUSION: This study highlights high rates of pediatric MDR-GNB infections and emphasizes the need for a continuous surveillance system in the management of these critically ill children.

Perceived Risk of Cervical Cancer and Barriers to Screening among Secondary School Female Teachers in Al Hassa, Saudi Arabia

Background: No previous studies had addressed the perceived risk of cervical cancer (CC) and its influence on screening practices and perceived barriers in Saudi Arabia. Methods: This cross-sectional study was conducted on 506 randomly selected Saudi female secondary school teachers in Al Hassa, Saudi Arabia to assess their level of knowledge about risk factors and signs of CC in relation to perceived risk and to characterize CC screening compliance using a self-administered questionnaire. Results: Of the included female Saudi teachers, 65.4% and 63.4% were considered less-knowledgeable about CC risk factors and early signs and symptoms respectively. Only 17.2% reported being previously examined for CC. The majority of participants perceived themselves to be at an average or below average risk of CC. Residing in urban areas was the strongest predictor of CC screening (Odds ratio 'OR'= 3.39; 95% confidence intervals 'CI= 1.76-6.46; P=0.001). Awareness of risk factors was significantly associated with higher awareness of signs of CC (OR 2.5; 95% CI=, P=0.001). Exploratory factor analysis showed that personal fears (of screening being embarrassing) was the major factor that hindered CC screening with a high loading eigenvalue of 4.392, explaining 30.8% of the barriers toward utilization, followed by health care related factors. Conclusion: Secondary school teachers in Al Hassa, Saudi Arabia showed low perceived risk, poor awareness about risk factors, signs and symptoms of CC and limited uptake of screening practices. This underlines the need for education programs on CC targeting this group.