Prevalence of Rifampicin resistance tuberculosis among presumptive tuberculosis patients in Egypt-2021: a national health facility-based survey.

BACKGROUND: The magnitude of MDR-TB cases was noticeable in Egypt. However, the last national survey was 11-years ago. The current survey was conducted to determine the prevalence of rifampicin resistance among sputum smear-positive pulmonary tuberculosis patients in Egypt. METHODS: A national health facility-based cross-sectional study was conducted in 14 randomly selected governorates in Egypt between August 2020 and September 2021. All presumptive TB cases, either new or previously treated according to WHO definitions, with no gender, age, or nationality limitations, and provided informed consent were included in the study. Each patient completed a case report form (CRF). The CRF included socio-demographic and clinical data. Sputum samples were collected according to standard techniques and cultured on Lowenstein-Jensen (L-J) medium. Gene X-pert test was carried out first on the samples for simultaneous identification of MTB and rifampicin resistance. The prevalence of RR was calculated using crude, cluster, and weighted methods. Factors associated with RR were analyzed by bivariate and multivariate techniques. RESULTS: Among the total 849 presumptive TB patients enrolled in the study, 710 (83.6%) patients were subjected to Gene X-pert testing (MTB/RIF). The crude prevalence of RR was 3.32% (95% CI: 1.89-4.76%) among the new cases and 9.46% (95% CI: 2.63-16.29%) among the retreated cases with an overall estimate of 3.99%; (95% CI: 2.51-5.47%). By cluster analysis the overall prevalence of RR was 5.01% (95% CI: 2.90-7.13). Factors associated with the prevalence of RR were co-morbidity with bronchial asthma, drug abuse and history of contact with a family member with TB. CONCLUSION: The prevalence of RR among either new or retreated cases TB patients was lower than the previous Egyptian rates in 2010-2012. The strongest predictor associated with RR was comorbidity with bronchial asthma.

Truth-telling in Oncology: Egyptian Patients' Attitudes and Preferences.

OBJECTIVE: Truth-telling in oncology is a major challenge, particularly in the absence of disclosure protocols in Egypt and the lack of Egyptian studies examining patients' preferences regarding cancer disclosure. This study aimed to reveal the preferences of patients seeking care at the National Cancer Institute - Cairo University regarding disclosing cancer diagnosis and the type and amount of information to be told. METHODS: This cross-sectional study was conducted on 200 patients selected consecutively from those attending the outpatient clinics of the National Cancer Institute - Cairo University. Face-to-face interviews were performed with the patients according to a structured questionnaire. The questionnaire consisted of five parts: socio-demographic characteristics, knowledge about cancer disease, attitudes towards cancer disease, experience during the disclosure of the diagnosis, and preferences regarding disclosure of cancer diagnosis. RESULTS: Most patients (89.5%) preferred to know the diagnosis. Of them, 94.4% wished to know from the physician. No agreement was found between most patients' preferences and physicians' practice. On multivariate logistic regression analysis, patients' education was the only significant predictor of the preference to know the diagnosis (OR = 5.298, 95% CI = 1.258 - 22.301, P = 0.023). CONCLUSION: Patients have a great desire to know the diagnosis and other information related to treatment and prognosis.

Emotional distress symptoms and their determinants: screening of non-clinical hospital staff in an Egyptian University hospital.

BACKGROUND: Non-clinical hospital staff were rarely studied despite their potential exposure to workplace stressors. We aimed to measure the prevalence of depression, anxiety, and stress (emotional distress symptoms) and determine their association with perceived job stress level and socioeconomic factors among non-clinical hospital staff. METHODS: This cross-sectional study was conducted in Ain-Shams University Hospitals from March to May 2019. Tools were the Arabic Depression, Anxiety, and Stress Scale-21, Workplace Stress Scale, and Socioeconomic status scale. Independent correlates were determined using multivariable ordinal regression. RESULTS: Out of 462 participants, 72.5% reported receiving insufficient income and 54.8% showed Effort-reward imbalance. Job stress was scored as severe/potentially dangerous by 30.1%. The prevalence of depression, anxiety, and stress were 67.5, 69.0, and 51.7%; and the severe/extremely severe levels were 20.8, 34.6, and 17.6% respectively. Across all the severity levels, the likelihood of depression, anxiety, and stress were progressively higher with more serious levels of income insufficiency [in debt versus able to save, OR:5.82 (95%CI:2.35-14.43), OR:3.84 (95%CI:1.66-8.91), and OR:3.01 (95%CI:1.20-7.55) respectively] and with higher job stress levels. Specifically, the likelihood of depression, anxiety, and stress increased by 74, 56, and 53% respectively with feelings of unpleasant/unsafe work conditions and by 64, 38, and 62% respectively with the presence of work-life conflict; while the likelihood of depression and stress increased by 32 and 33% respectively when there was difficult communication with superiors; and only the likelihood of depression increased by 23% with underutilization of skills. CONCLUSION: Non-clinical hospital staff were commonly affected by emotional distress symptoms with high rates of severe/very severe levels, and they often considered their workplace stress as severe/potentially dangerous. Workplace stress and income insufficiency were strong correlates with emotional distress symptoms. Decreasing work-life conflict, enhancing leadership skills, and mitigation of the economic hardship are needed.

Household catastrophic total cost due to tuberculosis in Egypt: incidence, cost drivers and policy implication.

Background: Tuberculosis (TB) is a disease that disproportionately affects the poor. The World Health Organization lists economic factors as one of main barriers to tuberculosis management. Aims: This study aimed to estimate the household total catastrophic cost of TB and its determinants among newly diagnosed Egyptian tuberculous patients. Methods: This was a cohort prospective study covering 257 TB patients registered in 2019. The patients were followed up bi-monthly until the end of the treatment regimen (4 visits). A standardized questionnaire published by the poverty sub-working group of the Stop TB Partnership was used after minor modification. The following costs were measured: pre-diagnosis, direct and indirect, guardian and coping, as well as annual household income. Catastrophic cost (direct plus indirect) was considered if the total cost of TB treatment exceeded 20% of the household's annual income. Sensitivity analyses were conducted using different thresholds. Results: The incidence of household total catastrophic cost was 24.1%. The mean total cost of TB treatment was US$ 198. Over 50% of the total direct cost was incurred during the pre-diagnosis period. After adjustment for other determinant variables using multivariable logistic regression, we found that age < 30 years, living in a house with crowding index > 2, poverty and coping were more likely to cause higher total catastrophic cost. Conclusions: Catastrophic cost was experienced by 1 out of every 4 new TB patients. As the main cost drivers were poverty and coping, the Ministry of Health and Population should be collaborated with Ministry of Finance and NGOs to put a plan of social protection system for poor families with TB patients.

Assessment of Household Catastrophic Total Cost of Tuberculosis and Its Determinants in Cairo: Prospective Cohort Study.

BACKGROUND: One goal of the End tuberculosis (TB) Strategy is to see no TB-affected households experiencing catastrophic costs. Therefore, it is crucial for TB-elimination programs to identify catastrophic costs and their main drivers in order to establish appropriate health and social measures. This study aimed to measure the percent of catastrophic costs experienced by Egyptian TB patients and to identify its determinants. METHODS: We conducted a prospective cohort study with 151 Egyptian TB patients recruited from two chest dispensaries from the Cairo governate from May 2019 to May 2020. We used a validated World Health Organization TB patient-cost tool to collect data on patients' demographic information, household income, and direct and indirect expense of seeking TB treatment. We considered catastrophic TB costs to be total costs exceeding 20% of the household's annual income. RESULTS: Of the patients, 33% experienced catastrophic costs. The highest proportion of the total came in the pretreatment stage. Being the main breadwinner, experiencing job loss, selling property, and the occurrence of early coronavirus disease 2019 lockdown were independent determinants of the incidence of catastrophic costs. Borrowing money and selling property were the most-often reported coping strategies adopted. CONCLUSION: Despite the availability of free TB care under the Egyptian National TB Program, nearly a third of the TB patients incurred catastrophic costs. Job loss and being the main breadwinner were among the significant predictors of catastrophic costs. Social protection mechanisms, including cash assistance and insurance coverage, are necessary to achieve the goal of the End TB Strategy.

Intracranial haemorrhage associated with Vitamin K deficiency in Egyptian infants.

AIM: Intracranial haemorrhage (ICH) in infancy is a rare life-threatening event. The aim of this review is to highlight the association of ICH and potentially preventable vitamin K deficiency and to describe risk factors, presentation and outcome. METHODS: Original published data on ICH related to vitamin K deficiency during 2008-2012 were extracted from records of participating centres in Egypt (Cairo and Delta region). Full data on 70 infants (0-24 weeks) have been reported in three publications. RESULTS: The first study involved premature infants where ICH was potentially preventable with administration of parenteral vitamin K prophylactic doses to mothers ahead of imminent preterm delivery. The other 2 studies involved term newborns and infants. ICH due to early or classic vitamin K deficiency was reported in nine patients while 44 were due to late vitamin K deficiency. Main risk factors for late onset were exclusive breastfeeding, persistent diarrhoea and/or prolonged antibiotic therapy. CONCLUSION: Vitamin K deficiency bleeding is a relatively frequent problem underlying ICH in infancy. Prophylactic vitamin K to mothers when anticipating preterm labour or a vitamin K boost in exclusively breast-fed infants with prolonged antibiotic usage and, or, persistent diarrhoea might have an impact on prevention and outcome.

Hypertension and associated cardiovascular risk factors among urban slum dwellers in Egypt: a population-based survey.

BACKGROUND: The economic deprivation of most slum inhabitants, and the lack of services and facilities may increase their vulnerability to unhealthy lifestyles and cardiovascular diseases. AIMS: This study aimed to determine the prevalence of modifiable risk factors for cardiovascular diseases in slum residents in Cairo, Egypt and evaluate their association with hypertension. METHODS: A household cluster survey was conducted in Mansheiet Nasser, a large slum area in Cairo. The study included 984 adult participants. The World Health Organization STEPS instrument for noncommunicable disease risk factor surveillance was used to determine the prevalence of smoking, fruit/vegetable consumption, overweight/obesity, physical activity, diabetes and hypertension. RESULTS: Smoking, insufficient fruit/vegetable consumption, low physical activity and diabetes were reported by 43.4%, 92.2%, 98.4% and 8.7% of the sample respectively. The prevalence of hypertension and overweight/obesity were 31.2% and 73.0% respectively. Most of the participants (83.8%) had ≥ 3 cardiovascular risk factors. A significantly higher proportion of men smoked, engaged in less physical activity, had diabetes and had multiple risk factors. Hypertension was significantly associated with age 30-< 50 years (OR = 3.04, 95% CI: 1.66-5.58), age ≥ 50 years (OR = 12.5, 95% CI: 6.71-23.26), overweight (OR = 1.58, 95% CI: 1.0-62.35), obesity (OR = 2.23, 95% CI: 1.49-3.35), low fruit/vegetable consumption (OR = 1.88, 95% CI: 1.02-3.48), and diabetes (OR = 1.77, 95% CI: 1.08-2.92). CONCLUSIONS: Urban slum dwellers in Mansheiet Nasser have an increased vulnerability to cardiovascular diseases compared with the Egyptian population. Measures are needed to improve their lifestyles and reduce their risk of cardiovascular diseases.

Association between hepatitis C infection and cerebro-cardiovascular disease: analysis of a national population-based survey in Egypt.

OBJECTIVES: To examine the association between hepatitis C virus (HCV) infection, cardiovascular risk factors and cerebro-cardiovascular (CCV) disease. METHODS: The source of data was the Egypt Health Issues Survey conducted in 2015. Participants were 11 256 individuals with complete HCV testing, age 25-59 years. Data on demographics, cardiovascular risk factors, CCV disease (myocardial infarction and/or cerebral stroke) and HCV infection were retrieved. Descriptive, bivariate, multivariable logistic regression and sensitivity analyses were performed to determine the independent association of past HCV exposure or chronic infection with diabetes, hypertension and CCV disease. RESULTS: 3.9% of participants were antibody positive/RNA negative and considered to have past HCV exposure; 7.9% had detectable HCV-RNA and were considered to have chronic infection. Participants with negative antibodies and no history of liver disease (n = 9928) were the control group. In addition to the previously known risk factors, multivariable analyses revealed that diabetes was independently associated with past HCV exposure (OR = 1.71, 95% CI: 1.27-2.32) and HCV chronic infection (OR = 1.56, 95% CI: 1.23-1.97), whereas CCV disease was independently associated with past exposure (OR = 2.69, 95% CI: 1.62-4.46) and not with chronic infection. No evidence of an association between hypertension and either HCV status was found. CONCLUSION: The association of both past HCV exposure and chronic infection with diabetes and that of past HCV exposure with CCV disease may suggest targeting HCV-positive reactors for preventive and curative programmes addressing extrahepatic complications.

Screening for diabetes among tuberculosis patients: a nationwide population-based study in Egypt.

BACKGROUND: The prevalence of type 2 diabetes mellitus (DM) is increasing rapidly in Egypt and considered one of the major health problems in the Eastern Mediterranean region. OBJECTIVES: To measure the prevalence of diabetes and detect the undiagnosed cases of diabetes mellitus among patient with tuberculosis. METHODS: Study Design: Nationwide population-based study. To diagnose DM among TB patients, we used a fasting blood sugar level of ≥ 126 mg/dl and a post-prandial blood glucose test result of ≥ 200 mg/dl. RESULTS: Screening for DM among 1435 TB patients' with no history of DM detected 30 new cases of DM, with a case detection rate of 2.09%. The highest screening yields were among TB patients aged ≥ 40 years, females and those with pulmonary TB. The number needed to screen (NNS) TB patients for detecting one new case of DM was 48 while the lowest values were for older age (NNS=27) and females (NNS=29). CONCLUSION: Older age and being females and those with pulmonary type of TB were more prone to the double burden of TB and DM. Identifying cases with double burden of diseases will improve the proper management of both diseases and prevent complications.

Association of rotating night shift with lipid profile among nurses in an Egyptian tertiary university hospital.

The main objective was to identify whether night shift nurses are more prone to dyslipidaemia than day shift nurses. One hundred and fifty female nurses aged 20-49 years were recruited from Ain Shams University Hospitals, Egypt, from January to March 2016: 64 day shift and 86 night shift. Diet type was assessed by interview questionnaire and job satisfaction was assessed using the job satisfaction survey. Triglyceride (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) were measured in all nurses. The predictors of high TG level were ages 30-39 and ≥ 40 years and night shift. The only predictor of high LDL level (> 130 mg/dl) was age ≥ 40 years. An unhealthy diet and night shift were predictors of risky HDL levels. Seventy nurses were unsatisfied with their jobs, and 137 ate a semi-healthy diet. The findings emphasize that night shift nurses are at risk of abnormal lipid profile, therefore an occupational programme to help nurses cope with their employment conditions is necessary.

Association of rotating night shift with lipid profile among nurses in an Egyptian tertiary university hospital

The main objective was to identify whether night shift nurses are more prone to dyslipidaemia than day shift nurses. One hundred and fifty female nurses aged 20-49 years were recruited from Ain Shams University Hospitals, Egypt, from January to March 2016: 64 day shift and 86 night shift. Diet type was assessed by interview questionnaire and job satisfaction was assessed using the job satisfaction survey. Triglyceride [TG], low-density lipoprotein [LDL] and high-density lipoprotein [HDL] were measured in all nurses. The predictors of high TG level were ages 30-39 and >/= 40 years and night shift. The only predictor of high LDL level [> 130 mg/dl] was age >/= 40 years. An unhealthy diet and night shift were predictors of risky HDL levels. Seventy nurses were unsatisfied with their jobs, and 137 ate a semi-healthy diet. The findings emphasize that night shift nurses are at risk of abnormal lipid profile, therefore an occupational programme to help nurses cope with their employment conditions is necessary

L'objectif principal de la présente étude consistait à déterminer si les équipes de nuit d'infirmières sont davantage sujettes à la dyslipidémie que les équipes de jour. Cent cinquante infirmières âgées de 20 à 49 ans ont été recrutées dans le centre hospitalier universitaire d'Ain Shams entre janvier et mars 2016, dont 64 travaillant dans des équipes de jour et 86 dans des équipes de nuit. Le régime alimentaire a été évalué dans un questionnaire d'entrevue, et une enquête sur la satisfaction au travail a été menée. Les triglycérides, les lipoprotéines de basse densité [LDL] et les lipoprotéines de haute densité [HDL] ont été mesurées chez toutes les infirmières. Un âge compris entre 30 et 39 ans, et supérieur ou égal à 40 ans, et le travail de nuit constituaient les facteurs prédictifs d'une élévation du taux de triglycérides. Etre âgé de 40 ans ou plus était le seul facteur prédictif d'un niveau élevé de LDL [supérieur à 130 mg/dl]. Un régime alimentaire malsain et le travail en équipes de nuit constituaient des facteurs prédictifs de taux à risque de HDL. Sept infirmières étaient insatisfaites de leur travail, et 137 avaient des régimes alimentaires partiellement sains. Les résultats mettent en évidence le fait que les infirmières qui travaillent en équipes de nuit ont un risque de présenter un profil lipidique anormal. Un programme de santé au travail est donc nécessaire pour aider les personnels infirmiers à faire face à leurs conditions de travail

The application of Urban Health Equity Assessment and Response Tool to assess health inequity among dwellers of an urban slum area in Giza Governorate, Egypt.

BACKGROUND: The WHO in 2008 developed the Urban Health Equity Assessment and Response Tool. It is a user-friendly guide for stakeholders and decision makers at national and local levels to identify health inequities. Moreover, using such tool will facilitate decisions on viable and effective strategies, interventions, and actions that should be used to reduce health inequities. AIM: To assess the health equity in a disadvantaged district (Gezerit El Warak) located in Giza province, Egypt. MATERIALS AND METHODS: A population-based survey was conducted in the study district. A total of 643 heads of households were interviewed using Urban Health Equity Assessment and Response developed by WHO. Indicators of key health outcomes and major social determinants were calculated and then compared with the corresponding national indicators. RESULTS: The results of social determinants of health showed lower performance than national figures in the core indicators illiteracy (42.5%) and male tobacco smoking (56.0%), whereas good performance was reported for unemployment among adults (2.0%), fully immunized infants (95.1%), and females' overweight (34.5%)/obesity (38.0%). The main problem encountered was the inadequate physical infrastructure, mainly safe drinking water and sewage disposal system. The health outcome indicators revealed higher prevalence of hypertension among both males (20.7%) and females (19.2%). History of diabetes mellitus was markedly higher than the national figures among both males (11.5%) or females (9.6%). CONCLUSION: Compared with the national indicators, the main health determinants with low performance encountered in the study area included the physical infrastructure and high prevalence of male tobacco smoking. Health outcome indicators with low performance were diabetes and hypertension. The response of stakeholders was positive and immediate actions were taken to tackle some of the low-performance indicators.

Clinical characteristics of patients with multiple sclerosis enrolled in a new registry in Egypt.

BACKGROUND: Epidemiological studies of multiple sclerosis (MS) are lacking in Egypt. OBJECTIVE: To study the characteristics of Egyptian patients with multiple sclerosis in a new registry in a major tertiary referral centre in Cairo, Egypt. SUBJECT AND METHODS: Patients were from the project MS database of the Multiple Sclerosis Unit at Ain Shams University Hospitals (N=950). We conducted a detailed medical history and examination including the Expanded Disability Status Scale (EDSS). RESULTS: Females represented 72% of subjects (female: male ratio 2.57:1). The mean age of disease onset was 26.1±7.6 years. Relapsing-remitting MS (RRMS) was the most common presentation (74.6%). Visual or sensory symptoms were the most common at presentation with RRMS, while motor symptoms were the most common presentation in other types of MS. Time to diagnosis was delayed up to 2 years in 27.8% of patients. The mean EDSS score was 3.6±2.1; 55% had EDSS≤3. About half (49%) received a disease-modifying drug. Progressive MS and motor presentation were associated with higher disability. CONCLUSIONS: This is the first documented MS registry from Egypt. The clinical characteristics of MS in Egypt was similar to other Arab countries and western countries. MS is more common among females in Egypt, with RRMS being the most common presentation. Visual symptoms and motor symptoms were the most common presentations in RRMS and progressive MS, respectively. Our findings also highlight the value of establishing registries in Egypt in order to be able to study, prospectively, the clinical course of the disease, the response to various DMD's and the epidemiology of MS in Egypt.

Prognostic factors of treatment among patients with multidrug-resistant tuberculosis in Egypt.

BACKGROUND/PURPOSE: Multidrug-resistant tuberculosis (MDR-TB) represents 5% of TB cases globally. In Egypt, it represents 11.4% of TB cases (2.2% of new and 38.2% of previously treated). Our objectives were to evaluate the treatment outcomes and determine the associated prognostic factors among the first national treatment cohort of MDR-TB from 2006 to 2010. METHODS: All patients diagnosed with MDR-TB from July 2006 to December 2010 who were admitted to Abbassia Chest Hospital, the first Egyptian national center established for MDR-TB treatment, were included. They were followed up clinically, radiologically, and bacteriologically by sputum smear, culture, and drug-susceptibility testing at regular intervals. Individualized treatment regimens were prescribed according to each patient's drug-susceptibility testing and the drug treatment history. Patients received at least five effective drugs. Outcome rates, and crude and adjusted odds ratios of unsuccessful outcomes were calculated. RESULTS: The number of bacteriologically proven MDR-TB patients was 228, of which 225 were pulmonary cases. Half of the cases showed moderate or extensive lung lesions, and 15.8% were diabetics. A total of 158 (119 cured and 39 completed treatment) patients achieved successful outcome (69.3%), 16 (7.1%) failed treatment, 27 (11.8%) were lost to follow up, and 27 (11.8%) died. Predictors of unsuccessful outcome were delay in sputum culture conversion to 2 months or more, moderate or extensive lung lesions, and a history of diabetes. CONCLUSION: A treatment success rate of approximately 69% was achieved with the first national treatment cohort of MDR-TB under the Egyptian program. Predictors of unsuccessful treatment were delayed culture conversion, moderate or extensive lung affection, and diabetes.

Hepatitis C virus acquisition among Egyptians: analysis of a 10-year surveillance of acute hepatitis C.

OBJECTIVE: To identify current risk factors for hepatitis C virus (HCV) acquisition among Egyptians. METHODS: Patients with acute HCV were identified through a surveillance system of acute hepatitis in four fever hospitals in Egypt between 2002 and 2012. Case-control analysis was conducted, cases being incident acute symptomatic HCV and controls being acute hepatitis A identified at the same hospitals. The questionnaire covered iatrogenic, community and household exposures to HCV in the 1-6 months prior to onset of symptoms. Multivariate models were built to identify risk factors associated with HCV acquisition among non-drug users and drug users separately. RESULTS: Among non-drug users, hospital admission was independently associated with acute HCV infection (OR = 4.2, 95% CI = 1.7-10.5). Several iatrogenic procedures, for example admission in a surgery unit, sutures, IV injections and IV infusions, highly correlated with hospital admission, were also associated with acute HCV infection and could have been used in the final model instead of hospital admission. Among drug users, identified risk factors were multiple sexual relations (OR = 4.0, 95% CI = 1.1-14.7), intravenous drug use (OR = 3.9, 95% CI = 1.2-13.0) and shaving at the barbershops (OR = 8.7, 95% CI = 2.4-31.4). Illiteracy and marriage were significant risk factors in both groups. CONCLUSION: Invasive medical procedures are still a major risk for acquiring new HCV infections in Egypt, as is illicit drug use in spreading HCV infection.

Assessment of rheumatoid arthritis patients' adherence to treatment.

BACKGROUND: Reports on adherence among patients with rheumatoid arthritis (RA) in Egypt and the Middle East region are lacking. This study aimed to measure adherence to treatment among a sample of patients with RA at Ain Shams University Rheumatology outpatient clinic and to assess factors affecting it. METHODS: A cross-sectional descriptive study was carried out at the rheumatology outpatient clinic on a sample of 140 patients with RA. An interview questionnaire was used to measure adherence using the 8-item Morisky's scale, factors affecting adherence to treatment like patients satisfaction were assessed using the short form patient satisfaction questionnaire, also patients' knowledge, beliefs and rate of prescription refilling were assessed. Disease Activity Score-28 was used as an objective method to assess RA disease activity. RESULTS: According to Morisky's scale, 90.6% and 9.4% were classified as low and moderately adherent, respectively, none was classified as highly adherent to treatment. Important barriers to adherence reported were fear of side effects, nonavailability of free drugs in hospital pharmacy and cost of medications. Younger patients (P=0.002) and those reporting greater general satisfaction (P=0.02) were more likely to be adherent. In addition, on-time refill rates of medication (P=0.001) and disease activity (P=0.02) were associated with higher adherence scores and thus further validated the results of the adherence questionnaire. CONCLUSIONS: Higher adherence was associated with more positive beliefs on medication, greater satisfaction with health care and less disease activity.

Surveillance of health care-associated infections in a tertiary hospital neonatal intensive care unit in Egypt: 1-year follow-up.

BACKGROUND: Reported rates of neonatal health care-associated infections (HAIs) in neonatal intensive care units (NICUs) have risen rapidly in recent years. Little data are available in Egypt, however. The aim of the present study was to determine the incidence of and risk factors for HAIs in the NICU of Ain Shams University Hospital of Obstetrics and Gynecology. METHODS: A prospective study was carried out on all neonates admitted in the NICU of Ain Shams University Hospital of Obstetrics and Gynecology in 2012. Centers for Disease Control and Prevention criteria were followed for identifying HAIs. RESULTS: A total of 434 neonates were enrolled in the study. The cumulative incidence of HAIs in the NICU was 28%. Bloodstream infections accounted for 85% of HAI episodes; pneumonia, for 10%. The most common organism isolated was Klebsiella spp. The main risk factors identified on multivariable analysis were gestational age <38 weeks (relative risk [RR], 1.63), birth weight <1,500 g (RR, 1.39), mechanical ventilation (RR, 1.74), and surgical procedures (RR, 1.65). The mortality rate attributed to HAIs was 11.75%, and the extra hospital length of stay attributed to HAIs was 8 days. CONCLUSION: The high incidence of HAI identified in the study NICU mandates more vigorous infection control interventions.

Patient safety attitude among health care providers in family health care centers in Cairo governorate.

Two hundred and eighty Health care; physicians, nurses and technicians were included in the study, 133 (47.5) from 6th discrete HCF, 54 (19.3%) from Duwaiqa and 93 (33.2%) from Al Haggana. Ages ranged between 22 and 59 years (35.14 ± 10.13), years of experience in the study group ranged between 1 and 35 years (8.72 ± 8.18) and years of work in group ranged between 1 & 40 years (10.43 ± 8.33). Doctors and nurses were males (72.55%) & females (86%) respectively while technicians were mostly males (60%). The teamwork climate score was 3.98 ± 0.87, 64.0% answered high or very high, 16.4% answered inadequate and 18% had answered few or very few. Safety climate score was 3.61 ± 0.63, 49.28% had high or very high score, 17.14% answered inadequate and 32.15% had answered few or very few. Job satisfaction score was 3.91 ± 0.80, 32.15% had answered few or very few, 17.14% answered inadequate and 49.28% answered high or very high. Stress recognition score was 3.61 ± 0.79, 25% had answered few or very few, 28.6% answered inadequate and 45.7% answered high or very high. Perception of management score was 3.48 ± 0.80, 23.2% had answered few or very few, 17.8% answered inadequate and 57.6% answered high or very high. Working condition score was 3.51 ± 0.84, 46.8% had answered few or very few, 17.1% answered inadequate and 35.7% answered high or very high. A significant difference regarding team work score, safety climate score, perception of management score, working condition score with highest value in doctors and lowest in technicians. On the other hand no significant difference was detected regarding job satisfaction score and stress recognition score. A significant difference regarding team work score, safety climate score and perception of management score with high values among older groups. No significant difference was detected regarding job satisfaction score, stress recognition score and working condition score. Also, a significant difference regarding team work score and safety climate score with higher value in males. Significant difference regarding job satisfaction score and working condition score was detected with higher value in females. No significant difference was detected regarding stress recognition score and perception of management scores.

Seroprevalence of rubella antibodies among adult Egyptian females aged 20-30 years. Is there a need for rubella vaccination?

INTRODUCTION: Egypt adopted a comprehensive strategy to eliminate measles and rubella by conducting a catch up campaign (in 2008) targeting children and young adults in the age group 10-19 years. This study aimed to explore the seroprevalence of rubella among females aged 20 to 30 years in order to provide the Ministry of Health with information to develop future strategies for rubella supplemental immunization activities among women of childbearing age before marriage and conception. METHODS: A total of 339 females in the age group 20 to 30 were selected. The study group comprised women who attended the central laboratory of the Ministry of Health for checking up before travelling abroad as pre-travel requirements for visa application. The collected serum samples were tested for rubella-specific IgG antibodies. RESULTS: The overall prevalence of rubella antibodies in the study group was 88.2%. Around 5.0% of females, who reported that they had been vaccinated, were susceptible to rubella. Age, history of measles, mumps and rubella (MMR) vaccination and past history of rubella infection were considered factors associated with seropositivity for rubella. CONCLUSION: The seroprevalence rate of rubella antibodies among our female study group was considered low.

Relationship of locus of control, psychological distress, and trauma exposure in groups impacted by intense political conflict in Egypt.

INTRODUCTION: Social and political instability have become common situations in many parts of the world. Exposure to different types of traumatic circumstances may differentially affect psychological status. OBJECTIVE: The aim of this study was to compare the relationship between personal perceptions of control over the events happening in one's life and psychological distress in two groups who experienced physical trauma but differed as to whether the trauma was a result of political upheaval and violence. Views on the extent to which the state was interested in the individual were also assessed. METHODS: The sample consisted of 120 patients who were injured in the Cairo epicenter and 120 matched controls from the greater Cairo area whose injuries were from other causes. The Brown Locus of Control Scale and the Symptom Checklist-90-Revised (SCL 90-R) were administered approximately three months after the January 2011 start of the demonstrations and subsequent overthrow of the government. RESULTS: The groups did not differ on locus of control. For both groups, externality was associated with greater distress, suggesting a relationship between perceived helplessness in controlling one's life and distress. The Cairo group scored significantly higher than the control group on the SCL 90-R Global Severity Index (GSI) and Positive Symptom Total (PST). Perceptions of state interest in the population were low; overall, 78% viewed the state as having little or no interest in them. Discussion The relationship between exposure intensity and psychological distress is examined. In addition, differences in findings in populations experiencing political chaos compared with other types of disasters are considered. CONCLUSION: Beliefs regarding personal control over one's life circumstances are more closely associated with psychological distress than the circumstances in which the trauma occurred.