High Institute of Public Health, Alexandria University
Journal of High Institute of Public Health
2357-0601
2357-061X
44
1
2014
04
01
Prevalence and Determinants of Glucose Abnormalities among Patients with Chronic Liver Disease in Alexandria, Egypt
1
7
EN
Iman
Wahdan
Department of Epidemiology, High Institute of Public Health, Alexandria University, Egypt
Marwa
Madkour
Department of Clinical and Experimental Internal Medicine, Medical Research Institute, Alexandria University, Egypt
Nessrin
El-Nimr
0000-0003-1976-4847
Department of Epidemiology, High Institute of Public Health, Alexandria University, Egypt
dr.elnimr@gmail.com
10.21608/jhiph.2014.20335
Background: The term Chronic liver disease (CLD) encompasses a large number of conditions existing on a<br />continuum between hepatitis infection and cirrhosis. Chronic hepatitis C infection was found to be associated with<br />diabetes mellitus (DM) with a significantly higher prevalence than the prevalence in the general population.<br />Objectives: The aim of the present study was to assess the prevalence and determinants of glucose abnormalities<br />among patients with CLD in Alexandria, Egypt.<br />Methods: Over a period of two years, 264 consecutive patients with CLD referred to the Hepatology and<br />Gastroenterology Unit, Medical Research Institute, Alexandria University were enrolled in the study. Personal,<br />demographic and medical histories were obtained by interviewing each patient and reviewing his/her records. Clinical<br />examination for each patient was also performed. Complete blood picture, fasting blood glucose level and lipid<br />profile, liver profile and imaging were recorded. Serological and/or immunological markers identifying the etiology of<br />CLD were also recorded.<br />Results: The prevalence of glucose abnormalities among hepatitis C positive patients was higher than that among<br />patients with other CLD (39.2% versus 21.7% respectively), with a statistically significant difference. Three<br />independent risk factors were found to be significantly affecting the prevalence of glucose abnormalities among CLD<br />patients; namely etiology of liver disease, presence of fatty liver and total cholesterol level.<br />Conclusion: The present study indicates a high prevalence of DM in patients with CLD in Alexandria. It is therefore<br />imperative that patients with CLD especially chronic hepatitis C patients be screened periodically for glucose<br />intolerance.
Chronic liver disease,Diabetes mellitus,impaired fasting glucose,hepatitis C
https://jhiphalexu.journals.ekb.eg/article_20335.html
https://jhiphalexu.journals.ekb.eg/article_20335_0de2424879e9231bad60e387cd8ce593.pdf
High Institute of Public Health, Alexandria University
Journal of High Institute of Public Health
2357-0601
2357-061X
44
1
2014
04
01
Ventilator Associated Pneumonia: Incidence and Risk Factors in a University Hospital
8
12
EN
Basem
Salama
Community Medicine Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt
rehabnaeem-4111@hotmail.com
Ahmed
Elgaml
Clinical Pathology Department, Cairo Faculty of Medicine, Al-Azhar University, Egypt
Ismail
Alwakil
Chest Department, Cairo Faculty of Medicine, Al-Azhar University, Egypt
Mohamed
Elsayed
Anaesthesiology Department, Cairo Faculty of Medicine, Al-Azhar University, Egypt
Saad
Elsheref
Internal Medicine Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt
10.21608/jhiph.2014.20336
Background: Ventilator associated pneumonia (VAP) is a type of nosocomial pneumonia associated<br />with increased morbidity and mortality. Awareness about the risk factors can be used to implement<br />simple and effective preventive measures.<br />Objectives: To determine the factors associated with development of VAP and its microbial profile<br />among patients admitted to ICUs.<br />Methods: A nested case-cohort study was conducted at Al-Hussein university hospital in Cairo city,<br />Egypt for a period of 6 months from the 1st of March 2013 to the end of August 2013. Patients who<br />were on mechanical ventilation (MV) for more than 48 hours were monitored at frequent intervals for<br />development of VAP. Samples obtained by endotracheal aspiration were ccultured on Blood agar -<br />Chocolate agar - MacConkey agar, plates of which were incubated at 37c for 24 hours. The isolated<br />organism was identified by morphological and biochemical identification.<br />Results: Of the 73 samples which were taken from endotracheal tubes of the patients, 42 cases were<br />diagnosed as VAP with an incidence rate of 57.5%. Early onset VAP occurred in 36 (85.7%), while<br />late onset VAP was observed in the remaining 6 patients(14.3%). Escherichia coli (40.5%) followed<br />by Klebsiella pneumoniae (23.8%) were the most commonly isolated pathogens. Univariate analysis<br />showed that the duration of MV and ICU stay, re-intubation, supine head position, impaired<br />consciousness, steroids use and H2 blocker use were the risk factors associated with VAP (p < 0.05).<br />Logistic regression revealed duration of MV as an independent risk factor for VAP.<br />Conclusion: The incidence of ventilator pneumonia is high in our study. VAP was significantly<br />related to duration of MV and ICU stay, re-intubation, supine head position, impaired consciousness,<br />steroids use and H2 blocker use.
Ventilator-Associated Pneumonia (VAP),Intensive Care Unit,Incidence,risk factors
https://jhiphalexu.journals.ekb.eg/article_20336.html
https://jhiphalexu.journals.ekb.eg/article_20336_312a77d248773c3138bf633b075d033b.pdf
High Institute of Public Health, Alexandria University
Journal of High Institute of Public Health
2357-0601
2357-061X
44
1
2014
04
01
Impact of Accreditation on the Information Management System in Primary Health Care Units in El-Behera Governorate, Egypt
13
20
EN
Samaa
Zenhom
Department of health management, planning and policy, High Institute of Public Health Alexandria University
Noha
Saleh
0000-0002-9615-6119
Department of biostatistics, High Institute of Public Health Alexandria University
noha_saleh2004@yahoo.com
Amira
Elaraby
Quality specialist at Ministry of Health, Alexandria, Egypt
10.21608/jhiph.2014.20337
Background: Accreditation is one of increasingly employed method for promoting quality at the<br />primary health care units (PHC). It is a self-assessment and external peer reviewed process used by<br />healthcare organizations to assess their level of performance accurately in relation to the established<br />standards and to implement ways to improve the healthcare system continuously.<br />Objectives: The aim of this study is to assess the impact of accreditation on compliance with<br />information management system standards in El-Behera PHC units.<br />Methods: A cross-sectional study was carried out in primary health care facilities in El-Behera<br />Governorate. The study population included PHC units participating in accreditation and PHC units<br />not participating in accreditation selected via a two stage stratified random sampling technique. The<br />data were collected using a checklist developed in concordance with the Egyptian accreditation<br />standards for primary health care facilities 2005 for areas related to the information management<br />system. Accreditation standards were scored on a scale of 0-3 (score 3 given for fully met, 2 for<br />acceptable partially met, 1 for unacceptable partially met and 0 for not met). An average percentage<br />score was calculated (standards average percentage score = total facility score/ Target score X 100).<br />Results: The overall average score percentage for standard is significantly (p< 0.05) higher in<br />accredited units than non-accredited ones (64.5 ± 17.9 versus 39.3 ± 13.6 respectively). The lowest<br />mean score percent in accredited PHC units was demonstrated in almost two standards namely<br />accuracy of medical records and verification of implementation (57.8±9.9 and 55.6±12.5 respectively).<br />Conclusion: There was a significant impact of primary health units' accreditation on the health<br />information management system. However, those accredited units still not reach the desired level in<br />standards regarding accuracy of medical records and verification of implementation.
Accreditation Egyptian standards,Health information management,primary health care
https://jhiphalexu.journals.ekb.eg/article_20337.html
https://jhiphalexu.journals.ekb.eg/article_20337_c7be2eac5a3ed78cfbf670fcdeea9a00.pdf
High Institute of Public Health, Alexandria University
Journal of High Institute of Public Health
2357-0601
2357-061X
44
1
2014
04
01
Methotrexate and Misoprostol against Misoprostol Alone for Early Medical Abortion: Comparative Study
21
24
EN
Engy
Taher
Obstetric and Gynecology Department. Faculty of medicine, Alexandria University. Egypt
marwamokhtar2008@yahoo.com
Manal
Swelam
Obstetric and Gynecology Department. Faculty of medicine, Alexandria University. Egypt
Amr
Mansy
Obstetric and Gynecology Department. Faculty of medicine, Alexandria University. Egypt
Marwa
Elgammal
Obstetric and Gynecology Department. Faculty of medicine, Alexandria University. Egypt
10.21608/jhiph.2014.20338
Background: Vaginal mifepristone oral misoprostol have proven to be highly effective medical<br />abortion methods and are used widely in in modern countries.<br />Objectives: The objective of this study is to compare the efficacy for two medical abortion regimens<br />used in one clinic setting misoprostol alone, intramuscular methotrexate and vaginal misoprostol.<br />Methods: An intervention study was conducted on a total of 100 randomly selected women with<br />gestations of first-trimester pregnancy, who sought a missed abortion. Study population was assigned<br />as two groups, the first was subjected to vaginal administration of Misoprostol and the second was<br />subjected to IM injection of methotrexate and self-administration of vaginal misoprostol After 72h.<br />All patients were followed up for recording any side effects of the drugs, progress of abortion & if<br />there was any need for surgical interference [manual vacuum aspiration (MVA) or dilatation and<br />curettage<br />Results: Success rate of the methotrexate regimen was 80% and did not differ significantly from the<br />misoprostol regimen that had success rate of 84%.<br />Conclusions: In this real-use setting, the use of misoprostol in combination with methotrexate or<br />alone for the missed abortion termination are both safe and effective methods without serious side<br />effects.
Methotrexate,misoprostol,Pregnancy,Abortion
https://jhiphalexu.journals.ekb.eg/article_20338.html
https://jhiphalexu.journals.ekb.eg/article_20338_93d0814fd20be39f3fb7a16eb0448590.pdf
High Institute of Public Health, Alexandria University
Journal of High Institute of Public Health
2357-0601
2357-061X
44
1
2014
04
01
Prevalence and Risk Factors for Musculoskeletal Complaints among Dental Practitioners in Alexandria, Egypt
25
32
EN
Mervat
El Dalatony
Department of Public Health and Community Medicine, Faculty of Medicine, Menoufiya University, Egypt
Eman
Salem
Department of Public Health and Community Medicine, Faculty of Medicine, Menoufiya University, Egypt
Hanan
Diab
Department of infection prevention and control, Faculty of Dentistry, Alexandria University, Egypt
10.21608/jhiph.2014.20354
Background: Musculoskeletal complaints represent a significant occupational health issue in<br />dentistry. In Egypt, data about the prevalence and risk factors of this problem are scarce so far.<br />Objectives: To investigate the prevalence of musculoskeletal complaints among dental practitioners<br />and assess the risk factors of these complaints among dentists.<br />Methods: Cross-sectional was used for implementation of the study. Data were collected using Nordic<br />standard questionnaire and demographics questionnaire which were filled out by 200 dental<br />practitioners in their offices in public dental centers in Alexandria, Egypt.<br />Results: A large percent of dentists (72.0%) reported musculoskeletal symptoms in at least one site<br />during the past 12 months. The most commonly affected sites were low back (52.0%), upper back<br />(44.0%), ankles and feet (30.0%) and knees (29.5%). A significant difference was observed between<br />dental specialists regarding neck pain only as it was more prevalent among periodontics (40.9%)<br />followed by prosthodontics (36.4%).A significant association was found between Musculoskeletal<br />Disorders (MSDs) and duration of work ≤ 10 years (P=0.005). In addition, non-prolonged sitting was<br />significantly associated with MSDs (P=0.026). Sick leaves from 1-7 days due to MSDs were reported<br />by more than half (54.0%) of the practitioners who complained of MSD in the last twelve months.<br />Conclusions: A high prevalence of MSD symptoms exists among dental practitioners in Alexandria,<br />Egypt, which affects the daily practice of nearly half of them. Lower and upper back pain symptoms<br />were particularly common. Therefore, it is recommended that an appropriate training program be<br />implemented to improve dentists’ awareness regarding musculoskeletal symptoms and their<br />prevention.
Dental practitioners,Musculoskeletal disorders,risk factors,Nordic standardized questionnaire,Egypt
https://jhiphalexu.journals.ekb.eg/article_20354.html
https://jhiphalexu.journals.ekb.eg/article_20354_37e7d29041241e2e13d29f3f25b609c1.pdf
High Institute of Public Health, Alexandria University
Journal of High Institute of Public Health
2357-0601
2357-061X
44
1
2014
04
01
Interferon Gamma Release Assays (IGRA) in the Diagnosis of Active Pulmonary Tuberculosis
33
40
EN
Mona
EL-Deeb
Chemical Pathology Department, Medical Research Institute, Alexandria University, Egypt
mona_moh_eldeeb@yahoo.com
Hatem
EL Malwany
Chest Diseases Department, Faculty of Medicine, Alexandria University, Egypt
Yehia
Khalil
Chest Diseases Department, Faculty of Medicine, Alexandria University, Egypt
Saher
Mourad
Chest Diseases Department, Faculty of Medicine, Alexandria University, Egypt
10.21608/jhiph.2014.20355
Background: Tuberculosis is one of the deadliest diseases over the world. Diagnosis of pulmonary TB<br />depends on combination various parameters. IGRA measure T cell release of IFN-γ in response to M.TB<br />antigen. WHO policy statement as on IGRA use in low and middle income countries is not established<br />yet. Objective: The present study aimed to compare between tuberculin skin test (TST) and interferon<br />gamma release assay (IGRA) in the diagnosis of active tuberculosis infection and study the effect of 3<br />months of first line anti-TB therapy on the positivity of the IGRA test.<br />Methods: 40 Egyptian patients were included in the study, and assigned as two groups; Group I<br />comprised 20 patients with negative sputum for AFB by Ziehl-Neelsen stains with positive sputum<br />culture for M.TB and Group II included 20 patients with positive sputum and Ziehl-Neelsen for AFB<br />before and after 3 months of first line of anti-TB therapy. All patients were subjected to full history<br />taking, clinical examination, X- ray chest, lab investigations, ESR measurements, microbiological tests<br />and ELISA measurement of Quantiferon-TB Gold.<br />Results: Lower significant values were found in group II after treatment than before treatment regarding<br />clinical parameters and 1st and 2nd hours ESR. IGRA test and TST showed sensitivity (91.18%, 76.4%),<br />specificity (83.33%, 66.67%), positive predictive value (96.88%, 92.86%), negative predictive value<br />(62.5%, 33.3%) and accuracy of (90%, 75%) respectively. IGRA results had no statistical significant<br />differences between the studied groups with poor agreement with TST ((κ) = 0.025).<br />Conclusion: IGRAS test had high sensitivity and specificity in diagnosis of active TB. More studies are<br />needed to evaluate the effect of anti-TB therapy on IGRA level.
Interferon gamma release assays (IGRA),tuberculosis (TB),tuberculin skin test (TST)
https://jhiphalexu.journals.ekb.eg/article_20355.html
https://jhiphalexu.journals.ekb.eg/article_20355_c472ddfa349676321d4696c49ed7d328.pdf
High Institute of Public Health, Alexandria University
Journal of High Institute of Public Health
2357-0601
2357-061X
44
1
2014
04
01
Impact of Balance Disorders on the Health Outcomes of Elderly People in Damanhur- Egypt
41
47
EN
Samia
Khattab Abd El-Rahman
Gerontological Nursing, Faculty of Nursing, Damanhur University, Egypt
samia_khattab@hotmail.com
10.21608/jhiph.2014.20356
Background: Balance disorders are a major cause of falls and the most common geriatric syndromes<br />threatening the independence and affecting the health outcome of elderly people and it reduced level<br />of function.<br />Objective: The study aimed to assess the effects of balance disorders on health outcomes of elderly<br />people. A cross-sectional study was conducted and comprised 114 elderly (60 years and above) from<br />the elderly home, Damanhur. Their demographic characteristics, balance measurements and health<br />outcomes have been evaluated. Data was collected according to the Arabic version of 12-item short<br />form of health outcomes. The Berg Balance Scale (BBS) was used to evaluate balance. The Timed<br />Up and Go (TUG) test was used to measure basic functional mobility. Flexibility was assessed by a<br />sit and reach test, to determine the level of fear of falling in daily life by the visual analogue scale<br />(VAS) was used.<br />Results: One-third of the participants (33.3%) had a history of falls once or more. The most reported<br />morbidities were hypertension and diabetes mellitus (43.9% and 26.3%, respectively).The BBS<br />scores were significantly associated with physical and social health domains, (r = 0.625,p=0.042, and<br />r =0.19, p =0.048).While it was negatively correlated with the psychological health domain (r = -<br />0.16,p =0.087). A positive correlation was observed between the health outcome (SF-12 scores) and<br />BBS, flexibility (r =0.016, 0.082, and 0.119).Whereas, fear of falling was negatively associated with<br />all measured parameters except the flexibility (r = 0.063). The majority of the participants, (80.7%)<br />had moderate health-related quality of life.<br />Conclusion: The assessment of falling risks and body balance of the elderly in elderly homes will<br />guide the implementation of suitable intervention programs to improve body balance, reduce falling<br />and its consequences among elderly.
Balance impairments,health outputs,(BBS) Berg Balance Scale,elderly home,Egypt
https://jhiphalexu.journals.ekb.eg/article_20356.html
https://jhiphalexu.journals.ekb.eg/article_20356_f58db39ded331defdecc3e06e91b260c.pdf
High Institute of Public Health, Alexandria University
Journal of High Institute of Public Health
2357-0601
2357-061X
44
1
2014
04
01
Chromohystroscopy after Failed Intracytoplasmic Sperm Injection (ICSI)
48
52
EN
Emadeldin
Khalifa
Department of Obstetric and gynecology, Faculty of medicine, Alexandria University.
alzahraa_yehia@yahoo.com
Mohamed
Al Samrah
Department of Obstetric and gynecology, Faculty of medicine, Alexandria University.
Tamer
Mahmoud
Department of Obstetric and gynecology, Faculty of medicine, Alexandria University.
Noha
Abdeen
Department of Obstetric and gynecology, Faculty of medicine, Alexandria University.
10.21608/jhiph.2014.20358
Background: Intra cytoplasmic sperm injection (ICSI), is a procedure adopted<br />worldwide as the ultimate micro-assisted fertilization approach due to its clinical<br />success.<br />Objectives: The objective of this study was to assess the value of using Chromohystroscopy modality in<br />infertility workup after failed ICSI procedures in evaluating uterine receptivity and detect any signs of chronic<br />endometritis by a less invasive method.<br />Methods: prospective cohort study. A total of 50infertile patients recruited from the infertility clinic in El-Shatby<br />University Hospital, Faculty of Medicine, Alexandria University. Cases were allocated into two groups. The first<br />group includes cases that had a failed trial of intracytoplasmic sperm injection. The second group includes control<br />cases from patients seeking for fertility treatment with no previous history of intracytoplasmic sperm injection<br />and with no history of anatomic uterine abnormalities. The selected sample size was found to be 50 women, and<br />were randomly selected and allocated in two groups each group was 25 women after fulfilling the inclusion<br />criteria.<br />Results: There was a statically significant increase in the incidence of endometritis among the study group 68%<br />in comparison to 16% in the control group.<br />Conclusions: In this study.Endometrial dyeing with methylene blue at hysteroscopy improves the detection of<br />chronic endometritis.
Chromohystroscopy,Intra cytoplasmic sperm injection (ICSI)
https://jhiphalexu.journals.ekb.eg/article_20358.html
https://jhiphalexu.journals.ekb.eg/article_20358_589a53944fc84fe365fa98b6c7b2e37d.pdf
High Institute of Public Health, Alexandria University
Journal of High Institute of Public Health
2357-0601
2357-061X
44
1
2014
04
01
Decision Making Performance Process among Head Nurses
53
60
EN
Fouada
Shaaban
Nursing services Administration, Faculty of Nursing, Tanta University
Safaa
Zahran
Nursing services Administration, Faculty of Nursing, Tanta University
safaa.zahran@yahoo.com
Mona
Mohamed
Nursing services Administration, Faculty of Nursing, Tanta University
10.21608/jhiph.2014.20359
Background: Decisions play important roles as they determine both organizational and managerial activities. It is the key part of head nurses' activities. Decisions are made at every level of nursing management to ensure that the nursing department goals are achieved. Objectives: The study aimed to assess the decision making performance process among head nurses. Methods: The study was conducted at El-Menshawi and El-Mahala General Hospitals which are affiliated to the Ministry of Health and Population. Study subject included all (95) head nurses working at the assigned hospitals. Decision Making Analysis of Areas and Activities Questionnaire and Decision Making Rating Scale for head nurses were used as tools for data collection. Results: More than one third of head nurses propose the budget of nursing department imposed on them and make decision in concerning the needed qualifications of nursing personnel on each unit in conjunction with the chief. Seventy percentages of head nurses at El-Mahala General Hospital had high levels in the decision making process. More than half at El-Mahala hospital had moderate levels in the strategy of decision making performance process. Conclusion: head nurses fulfilled the areas and activities of decision making process but a lot of decisions making is done with the chief either with or without subordinating opinions. Establishing training programs is recommended to help head nurses and subordinate staff in making effective decision, developing the budget of nursing unit and improving standard of care activities.
Decision Making,head nurse,performance,decision making process
https://jhiphalexu.journals.ekb.eg/article_20359.html
https://jhiphalexu.journals.ekb.eg/article_20359_e5d45c0dcfc9a452affdaf51bcadb4f1.pdf