High Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060141320110701Genetic Background of Carbapenem Resistant Acinetobacter baumannii in a Health Care Setting in Alexandria, Egypt3113242016110.21608/jhiph.2011.20161ENAmira AmineMicrobiology Department, High Institute of Public Health, Alexandria University, Alexandria, EgyptWalaa HazzahMicrobiology Department, High Institute of Public Health, Alexandria University, Alexandria, EgyptAsmaa Abou BakrAlexandria Main University HospitalJournal Article20181201<em>Acinetobacter baumannii (A. baumannii</em>) is recognized as a major pathogen causing nosocomial infections, particularly in patients admitted to intensive care units (ICU), and many widespread strains are resistant to almost all antibiotics currently in use<em>. </em>Carbapenemases belonging to molecular class D (OXA enzymes) have emerged globally as the main mechanism responsible for this resistance. This work aimed at detecting the spread of OXA carbapenemases in <em>A. baumannii in ICU patients and to identify</em> the susceptibility patterns of strains to polymyxin E (colistin), polymyxin B, and tigecycline as a promising option for treatment. Twenty seven clinical isolates of <em>A. baumannii</em>, collected from Alexandria Main University Hospital, were included in this study. <em>A. baumannii</em> was isolated from different clinical samples from ICU patients. All 27 isolates were subjected to complete identification and antimicrobial susceptibility testing. The identified carbapenem resistant <em>A</em><em>. baumannii</em> strains were tested for the presence of <em>bla</em> <sub>OXA-23</sub>, <em>bla</em><sub>OXA-24</sub>, <em>bla</em><sub>OXA-58</sub> and <em>bla</em><sub>OXA-51</sub> genes using multiplex PCR assay. Colistin and polymyxin B were found to be active upon the majority of identified resistant <em>A. baumannii</em> strains, where around 70% of the strains were sensitive to both of them, while tigecycline was found to be more effective as 92.5% of strains were sensitive to it. Resistance to carbapenems was mediated by both OXA-51 (100%) and OXA-23 (92.5%) for the tested <em>A. baumannii</em> strains.High Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060141320110701Correlation of Ghrelin, Adiponectin and Leptin to BMI and Treatment Outcome in Breast Cancer Patients3253402016310.21608/jhiph.2011.20163ENEbtsam ZaherDepartment of Radiation Sciences, Medical Research Institute, Alexandria University, Alexandria, EgyptAhmed SaadDepartment of Experimental and Clinical Surgery, Medical Research Institute, Alexandria University, Alexandria, EgyptMostafa Al-NaggarCancer Management and Research Departments, Medical Research Institute, Alexandria University, Alexandria, EgyptJournal Article20181201<strong>Background: </strong>Body mass index (BMI) is an independent prognostic factor for survival in breast cancer patients. Patients with higher BMI were found to have poorer cancer prognosis and lower survival rates. Many factors as ghrelin, adiponectin and leptin, have been implicated in obesity but their correlation with breast carcinogenesis and treatment outcome is still a debate. <strong>Objective: </strong>Toidentify the relation of ghrelin, adiponectin and leptin with BMI in breast cancer patients and their possible role in carcinogenesis and treatment outcome. <strong>Methods: </strong>Sera from 80 breast cancer patients were analyzed. Ghrelin, adiponectin and leptin were assayed by commercial RIA kits, and their levels were correlated with BMI, clinicopathological parameters and relapse-free survival. The median duration of patients' follow-up was 32 months. <strong>Results:</strong> 73.7% of the cohort was overweight/ obese. Compared to breast cancer patients with normal BMI, overweight/obese patients had a significantly higher tumor size and higher histological grade. Overweight/obese patients had higher leptin and lower ghrelin and adiponectin levels. Adiponectin was lower in patients with higher tumor grade and lymph node involvement, while ghrelin decreased with increasing tumor size and histological grade. Only serum ghrelin levels were significantly correlated to better disease-free survival. <strong>Conclusion:</strong> Ghrelin, adiponectin and leptin are significant factors in controlling BMI in breast cancer patients but only ghrelin is a significant predictor of better outcome and recurrence-free survival.High Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060141320110701The Pattern of Menopausal Manifestations in a Group of Egyptian Women3413502016410.21608/jhiph.2011.20164ENFatma Abo-RomiaObstetric and Gynecologic Nursing, Faculty of Nursing, University of Tanta, Tanta, EgyptJournal Article20181201<strong>Background: </strong>Menopausal manifestations are affected by many ethnic, environmental and demographic factors.<strong> Objective: </strong>to describe the pattern of menopausal manifestations in a group of Egyptian women.<strong> Methods: </strong>The present study is a cross-sectional descriptive study. A sample of one hundred menopausal and premenopausal women in Tanta were selected to participate in the study.Based on review of relevant literature, structure interview was used to ask the studied women about their socio demographic characteristics and menopausal manifestations.<strong> Results: </strong>The studied women had a mean age of (45.6 ± 3.4) years, 75 % of them were married. 20% one women were diabetics, 35 % had hypertension and 60% had coronary artery disease. Three women were subjected to hysterectomy or oophrectomy. The age of menopause was 46 years in 52.0 % of menopausal women. The most commonly reported symptom was bone aches (75 %) followed by sleep disturbance (71 %) and feeling anxious or nervous (65 %). <strong>Conclusions: </strong>the studied Egyptian women have a particular pattern that differs from other populations. Musculoskeletal manifestations and sleep disturbances are the most common manifestations in this group of Egyptian menopausal women.High Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060141320110701The Relation Between Perineal Length and Lacerations During Labor3513582016510.21608/jhiph.2011.20165ENFatma Abo-RomiaObstetric and Gynecologic Nursing, Faculty of Nursing, University of Tanta, Tanta, EgyptJournal Article20181201<strong>Background: </strong>Perineal length is thought to affect the risk of perineal lacerations in vaginally delivered women. <strong>Objective: </strong>to investigate the possible role of perineal length as a risk factor for development of perineal lacerations during vaginal delivery.The study was conducted at Elhelal Elahmar hospitals in Alexandria. M<strong>ethods:</strong> A convenience sample ofEighty women with singleton pregnancies who went into spontaneous labor at term during the study period were included in the study.All participants were subjected to general examination, abdominal palpation and vaginal examination was performed to assess cervical effacement/length, dilatation, cervical position, consistency, membranes, liquor, presentation, position, caput, moulding and station. Perineal measurements (to the nearest 0.5 cm) were taken at the beginning of the active phase of labor (effacement of 80-100% and 3-4cm dilatation). The length of the perineum was determined as the distance between the fourchette and center of the anal orifice. <strong>Results: </strong>Comparison between women with perineal length £ 3.5 cm (group I) and those with perineal length > 3.5 cm (group II) revealed that women in GI had significantly longer 2<sup>nd</sup> stage of labor and significantly higher frequency of perineal lacerations. Comparison between those with perineal lacerations (PL) and women without in those who didn't have episiotomy has shown that women with perineal lacerations had significantly longer 2<sup>nd</sup> stage of labor and larger head circumferences of the newborn baby. <strong>Conclusion: </strong>Women with short perineal length are at increased risk of perineal lacerations during vaginal delivery. Other factors associated with increased prevalence of perineal lacerations are prolonged 2<sup>nd</sup> stage of labor and increased neonatal head circumference.High Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060141320110701Rate, Indications and Complications of Caesarean Section at Aljamahiriya Hospital, Benghazi, Libya3593672016610.21608/jhiph.2011.20166ENMusa BusariraDepartment of Obstetrics & Gynecology, Faculty of Medicine, Benghazi, LibyaMilad GahwagiDepartment of Obstetrics & Gynecology, Faculty of Medicine, Benghazi, LibyaNajla AlagurDepartment of Obstetrics & Gynecology, Faculty of Medicine, Benghazi, LibyaJournal Article20181201<strong>Background:</strong> Rates of caesarean section (CS) in developing as well as developed countries have increased beyond World Health Organization (WHO) recommended level of 15% almost doubling in the last decade.<strong> Objective: </strong>To assess the rate, indications and early complications of CS delivery at Aljamahiriya hospital, Benghazi, Libya.<strong> Methods: </strong>A retrospective study involved representative sample of 670 out of 4654 of cases delivered by CS during the year 2009. Data were recorded from the hospital files, and statistical reports of the department of statistics. A predesigned questionnaire was used to collect the data needed for the study including parity, type of CS, indications for emergency and elective CS and early complications that might have led to CS.<strong> Results: </strong>A total of 16109 deliveries were reported in Aljamahiriya hospital during 2009, 4654 of them were delivered by CS constituting 22.4% of total deliveries. The main indications of emergency CS were fetal distress (38.2%) and previous two scars (22%), while in elective CS the main indication was previous scars (50%). The overall rates of early complications were 2.3% for emergency CS and 3.9% for elective ones; wound infection was reported among 1.8% of cases with elective CS, while post partum hemorrhage constituted the most common complication of the emergency CS (1.1%).<strong> Conclusion & Recommendations: </strong>The high and unprecedented increase in CS rates reported in this study may be partly due to CSs that are not medically indicated, and suggest that physician practice patterns and patient preferences should be explored. The present study is the first step to document actual practice. It points out for further in depth studies to explore the medical, environmental and social factors contributing to the high rate of CS. In addition, similar studies should be carried out at other hospitals in Libya. The results should be used by the national health authorities to introduce more evidence based practice and so decrease maternal mortality and morbidity.High Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060141320110701Foot Care Practices among Type 2 Diabetics Attending a Primary Care Military Hospital, Taif, Saudi Arabia3683812016710.21608/jhiph.2011.20167ENSherif OmarTropical Health Department, High Institute of Public Health, University of Alexandria, Egypt
Department of Preventive Medicine, Prince Mansour Military Community Hospital, Taif, Saudi ArabiaAmr SabraTropical Health Department (Primary Health Care Division), High Institute of Public Health, University of Alexandria, EgyptJournal Article20181201<strong>Objective: </strong>To determine foot care practices among type 2 diabetic patients without previous history of foot problems attending primary care clinics in Prince Mansour Military Community Hospital (PMMCH), Taif, Saudi Arabia. <strong>Methods</strong><strong>: </strong>A Cross-sectional descriptivestudy using a convenient non probability sample was done during August and September 2010. 188 type 2 diabetic patients were questioned using a predesigned questionnaire sheet after reviewing their medical files. Collected data included: socio-demographic features, medical condition, diabetes control and foot care practices, which was later judged using a scoring system to show its quality. <strong>Results</strong><strong>: </strong>Among the studied sample: 112/188 (59.6%) were males; mean age was 56.5 years ±14.5 SD. Illiteracy was prevalent in 47.9% of them. Poor glycemic control (HbA<sub>1</sub>c ≥ 7 mmol) was reported in 75% of the patients. Regular foot checkup has never been performed in 30.3% of the sample, 65.4% never seek medical advice for their foot problems, 61.2% never used special medical shoes and 46.3% never checked inside the shoe before wearing it. Using our scoring system, 63.3% of the studied patients were considered poor in their foot care practices. Educational level was the only factor predicting the level of good foot care practices, those with higher level were found to have better practices (OR=2.179, 95% CI=1.074-4.423 and p<0.05).<strong> Conclusion: </strong>Health education programs integrated in comprehensive foot care clinics are crucial to limit foot complications among the growing number of diabetic patients.