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Background: Burn is bodily injury resulting from exposure to heat, electricity, or some radiations, marked by varying degrees of skin destruction and hyper anemia often with the formation of watery blisters Aim of study: to assess Nurses' Knowledge, Practice and, Attitude, Regarding Burn Injury Management. Subjects and methods: Descriptive study. The study was conducted at three hospitals (Beni-Suef general hospital, Minia general hospital and, Minia university hospital)first and second hospital affiliated to ministry of health, the third one affiliated to ministry of higher education. Forty nurses where included in the current study sample. Three tools of data collection were used to carry out this study namely, tool 1): Structured Self-Administered Questionnaire that include two parts; part 1): demographic characteristics, and part 2): nurse's knowledge, Tool П-: Nurses’ observational checklists procedure, and Tool IП: Structured nurse's attitude scales. Results: majority of the studied nurses (82.5%) had unsatisfactory knowledge, and, (100%) had unsatisfactory practices and negative attitude regarding burn injury management. Conclusion and recommendations: Most of nurses had shortage knowledge level, poor practice and, negative attitude due to lack of educational program, lack of training and, no update to nurse's performances so, the current study recommended that importance of Provide continuous education and update for nurses regarding evidence based nursing practices about burn patients and, provide sufficient supplies and equipment from hospital administration for nurses to perform their practice in a high quality, safe and in efficient way

AIM: This was a prospective double-blinded randomized comparative study. Several authors have reported the efficacy of platelets derivatives for spinal union. However, the use of PRP and PRF for bone fusion with TLIF has not been fully explored. METHODS: Standard open TLIF surgery was performed on 80 patients, randomized in three groups, TLIF and local bone were used in 40 patients (control group) and TLIF, local bone, and PRP were used in 20 patients (PRP group) and PRF was used in 20 patients (PRF group). Radiological parameters were assessed by X-ray after 3 months post-operative to evaluate the position of the screws and cage migration and by CT scans at 6 months and 12 months postoperatively. Patients, surgeons, and post-surgical analysis were blinded. RESULTS: VAS scores for lower back pain and leg pain were statistically significant between the three groups preoperatively. The VAS scores of back pain improved after 12 months and were statistically significant (p < 0.001) and the VAS score of leg pain improved compared with preoperatively in the three groups during the 6- and 12-month follow-up postoperatively, however, the three groups, VAS scores for leg pain were not significantly different. After 1-year follow-up, significantly more patients achieved definite fusion, when implanted platelets derivatives compared with the control group, but with no significance regarding fusion rates. CONCLUSION: We advocated using platelet derivative as a fusion enhancer modality which is cost and time saving. It appears to be a complementary step that ensures better outcome for the patients.

Early diagnosis is considered important for medical images of breast cancer, the rate of recovery and safety of affected women can be improved. It is also assisting doctors in their daily work by creating algorithms and software to analyze the medical images that can identify early signs of breast cancer. This review presents a comparison has been done in term of accuracy among many techniques used for detecting breast cancer in medical images. Furthermore, this work describes the imaging process, and analyze the advantages and disadvantages of the used techniques for mammography and ultrasound medical images. K-means clustering algorithm has been specifically used to analyze the medical image along with other techniques. The results of the K-means clustering algorithm are discussed and evaluated to show the capacity of this technique in the diagnosis of breast cancer and its reliability to identify a malignant from a benign tumor.

Introduction: Survivors of torture have high rates of mental health problems and can experience a sequela of physical effects with the most common being persistent pain. Similar to survivors of torture, persons that are incarcerated have high rates of mental health problems, persistent pain and pain-related disability.The purpose of this study is to assess the effect of an interdisciplinary group treatment approach, involving psychotherapy and physiotherapy, with survivors of torture whom are incarcerated in a prison in Kurdistan, Iraq. Methods: A parallel group study design was used to compare a treatment group (n=11) and a wait-list control group (n=16). The treatment group participated in an interdisciplinary treatment service for a total of 10 weekly group sessions for each discipline.The primary outcome measures were symptoms of nociplastic pain, anxiety, depression, and PTSD. Secondary outcome measures evaluated physical functioning, sleep quality, and general self-efficacy. Results: A statistically significant reduction in outcome measure scores was seen in all symptoms measured immediately post-treatment. Discussion and Conclusion: These findings suggest that a culturally and contextually appropriate interdisciplinary group treatment intervention for survivors of torture in a prison could be effective for short-term reductions in symptoms of anxiety, depression, PTSD, persistent pain, and function. The study has limitations including a small sample size, lack of long-term outcome measures, and an inability to isolate effect of each component of care. The study does demonstrate the feasibility of implementing research that follows international research standards and practices within under-researched settings and post-conflict areas.

Background: Breast cancer related lymphedema represents a major complication of breast cancer treatment, impacting the quality of life of breast cancer survivors. Patients with lymphedema need to conduct lifelong self care activities to control the progression of swelling, manage lymphedema-associated symptom burden, and minimize long term negative outcomes. Aim: This study aimed to assess knowledge and self care practices of women with breast cancer related lymphedema. Study design: A descriptive study design was utilized to conduct this study. Setting: This study was conducted in the outpatient breast clinic at Oncology Center and Nuclear Medicine, affiliated to Ain Shams University Hospitals. Subjects: A purposive sample of 50 women newly diagnosed with breast cancer related lymphedema, post mastectomy, and treated with radiotherapy. Data collection tools: A structured interview questionnaire for women with breast cancer related lymphedema, and self care practices questionnaire. Results: The mean age of the studied women was 47.71±7.16, and about one fifth of them had satisfactory level of total knowledge regarding breast cancer related lymphedema, also; the minority of them had adequate level of total lymphedema self care practices. Moreover there is statistically significant difference between the self care practices of the studied women and their educational level. Conclusion: The majority of the studied women had unsatisfactory knowledge regarding breast cancer related lymphedema, and almost of them had inadequate lymphedema self care practices. Recommendations: Educational programs about lymphedema and risk reduction methods after the breast surgery are strongly needed. Also, continuous in service educational programs should be held for all the health care team working in breast cancer units. In addition, further researches are recommended to assess barriers to self care among patients with breast cancer related lymphedema.

Background: Subcutaneous enoxaparin administration often causes problems such as pain; bruise and hematoma at the injection sites. In terms of these problems, cold application has been found to have various therapeutic benefits as relieve pain by produce localized anesthetic effect and controls bleeding by causing vasoconstriction. Aim of the study: To investigate the effect of cold application on local problems among patients receiving subcutaneous enoxaparin. Design: Self controlled trial design was utilized. Setting: The study was carried out in general surgery department, orthopedic surgery department, and chest Intensive Care Unit at Beni-seuf University Hospital. Study subjects: A purposive sample of 60 patients was included in the study. Data collection tools: Data were obtained through Patient assessment tool, Bruising Category Scale, Visual Analogue Scale for pain and Hematoma Formation Scale. Results: All studied patients had pain and more than half developed bruise at injection site when they received enoxaparin without cold application but more than three quarter of studied patients had pain and less than one quarter developed bruise when they received injection with cold application. Meanwhile, the majority of the studied patient did not develop hematoma whether cold applied at injection site or not. Conclusion: The pre-injection cold application at enoxaparin injection site was effective in reducing the occurrence of pain and bruising. Moreover, there was statistically significant relation between the patients’ pain intensity, the size of bruising and their demographic characteristics; age and gender. Recommendations: Cold application should be included in standard protocol for the administration of SC enoxaparin and providing on-going and regular in-service educational programs about it for nurses.

Background: The rise of Primary Percutaneous Coronary Intervention (PPCI) procedure as an option for treating Coronary Artery Diseases demands addressing a variety of concerns in the recovery period and afterward including fasting the Ramadan month in the countries with the prevailing Muslim population. Therefore this study aims to assess the ability and the safety of fasting among patients who underwent PPCI within two specified periods.Method: This study was a prospective observational study with a sample size of 200 consecutive patients that have been divided into two groups based on the duration of their last PCI for an attack of Acute Myocardial Infarction (AMI). The patients were admitted to the Causality Department of the Surgical Specialty Hospital-Cardiac Center, Erbil/Iraq. The studied data have been analyzed using the Statistical Package for Social Science version 25 (SPSS), and a P-value of ≤0.05 was considered statistically significant.Results: The proportion of fasting and non-fasting patients showed a significant association with the duration of their last PCI procedure with a P-value of 0.001 as 14% in Group I (patients with less than 6 weeks duration post-PCI) successfully fasted the month while it was 54% in Group II (Patients with more than 6 weeks duration post PCI). Among our findings, there were significant associations with P-values of 0.001 between post-PCI symptoms and Ramadan fasting. In regards to NYHA classifications assessment, Group I had a higher proportion of patients classified as Class III and Class IV compared to Group II with a significant P-value of 0.001 with proportions of class III classification in Group I of 14.3% among fasting, 17.1% among non-fasting, and 58.3% among those who could not continue their fasting while in Group II, the proportions showed 3.7% among fasting, 6.7% among non-fasting, and 0% among those who could not continue their fasting.Conclusion: We discourage fasting among patients who have undergone Percutaneous Coronary Intervention within the first 6 weeks, as well as patients who have NYHA class III and above as they are highly liable for deterioration and can not continue their fasting.

Heart disease is one of the most common causes of death worldwide. Real-time methods for forecasting heart disease from medical data sources that explain a patient's current health status are discussed in this paper. The proposed system's main aim is to find the best data mining algorithm for predicting heart disease with high accuracy. We suggested using Decision Tree (DT), Support Vector Machine (SVM) and Naive Bayes (NB) algorithms. All of these algorithms are classified as supervised learning and work better with training data. The main purpose of using three algorithms is to see which one is the best at predicting heart disease. The result shows that the DT algorithm provides the best accuracy with less training time when compared to SVM and Naive Bayes(NB).

Context: Hepatocellular carcinoma (HCC) is considered one of the most challenging tumors with high incidence, prevalence, and mortality rates. Radiofrequency Ablation (RFA) is one of the emerging therapeutic modalities used for the minimally invasive treatment in the management of early-stage HCC. Aim: This study aimed to assess the effect of self-care guidelines on quality of life for patients with Hepatocellular Carcinoma undergoing Radio Frequency Ablation. Methods: A quasi-experimental design was used to achieve the aim of this study. This study was conducted at the Interventional Radiology Unit, affiliated to Ain Shams University Hospital, on a purposive sample of 50 patients with hepatocellular carcinoma; 25 randomly allocated to the study group, and 25 allocated to the control group. A structured interview questionnaire for patients with hepatocellular carcinoma undergoing radiofrequency ablation was used to collect the study data. It comprises three parts: Sociodemographic characteristic, assessment of patients' medical health, and knowledge about HCC and RFA. The second tool was the quality of life of cancer survivors questionnaire (pre /posttest), and finally, a patient-reported self-care practices assessment checklist (pre /posttests). Results: There were statistically significant differences between the study and control groups regarding their total knowledge about hepatocellular carcinoma and radiofrequency ablation therapy pre and post-implementation of self-care guidelines. There were highly statistically significant differences between both groups regarding the total quality of life, pre and post-implementation of self-care guidelines. In addition, there were highly statistically significant differences regarding total self-care practice, pre, and post-implementation of self-care guidelines. A positive correlation was revealed between total knowledge with total self-care practice and total quality of life (pre/posttest). Also, a significant correlation was revealed between the total quality of life and self-care practices post self-care guidelines implementation at (p

Background: Intensive Care Unit Acquired Muscle Weakness (ICU-AW) is one of the most important complications occurs in the ICU. ICU-AW is a multifactorial syndrome characterized by generalized muscle weakness. Critical care nurses (CCNs) have an important role in the prevention of ICU-AW through increase mobility and applying of range of motion. Design: A descriptive exploratory design was utilized to achieve aim of this study. Aim: This study aimed to assess factors contributing to acquired muscle weakness among critical ill patients. Setting: the study was carried out in intensive care units of Beni–Suef University Hospital. Subjects: A Purposive sample of seventy five patients admitted in the previous mentioned setting. Tools of data collection were consisted of Patient assessment tool, muscle strength scale and indicators to incidence of ICU-AW and factors contributing to ICU-AW assessment tool. Results: revealed that more than half of the studied patients had ICU-AW. The majority of studied patients who had muscle weakness were older than the Non ICU-AW patients. Application of positioning and range of motion exercises were not done in the ICU-AW patients. Administration of corticosteroid and incidence of malnutrition was higher in the ICU-AW patients than the Non ICU-AW patients. There were no statistically significant relation between incidence of ICU-AW and gender, admission medical diagnosis, administration of parenteral nutrition and application of positioning and walking exercises. Conclusion: More than half of studied patients developed ICU-AW. The contributing factors of ICU-AW are patient age, WBCs level, not applying range of motion and chair sitting exercise to ICU patients, administration of corticosteroid and malnutrition. Recommendations: Further researches are recommended to study extensively the effect of nutritional status on incidence of ICU-AW. Also, examine the incidence of ICU-AW in sedated and unconscious patients.

Background: Non-Hodgkin's lymphoma patients undergoing chemotherapy have symptoms that continue to place a significant burden and preventing them from living normally. This requires non-hodgkin's lymphoma patients to engage in a range of self-management actions. The aim of this study was to assess the effect of self-management guidelines on chemotherapy associated symptoms among non-Hodgkin lymphoma patients. Design: A quasi experimental design. Setting: the study was conducted at the hematology unit in Ain Shams University Hospital. Subjects: A purposive sample of 76 adult patients. Data collection tools: Three tools were used in this study, structured interview questionnaire for the non-hodgkin's lymphoma patients undergoing chemotherapy, self-care practices questionnaire, and symptoms experience tools. Results: Regarding total level knowledge, 28.9% of the studied patients had satisfactory level of total knowledge pre implementation of self-management guidelines which improved to 65.8% with a highly significant difference post implementation of self-management guidelines (P≤ 0.001). While 26.3% of the studied patients had satisfactory level of total self-care practices pre implementation of self-management guidelines which improved to 57.9% with a highly significant difference post implementation of self-management guidelines (P≤ 0.001). There was a significant improvement on patients` symptoms experience post implementation of self management guidelines. Conclusion: The implementation of self-management guidelines for patients with non-Hodgkin's lymphoma undergoing chemotherapy has a statistically significant positive effect on their knowledge, self-care practice and associated symptoms which support the stated hypothesis. Recommendation: This study recommends the importance of developing tailored self-management programs for fatigue, nausea, vomiting and oral mucositis to understand and promote chemotherapy associated symptoms self-management in patients with non-hodgkin's lymphoma disease.

Background: Hospital acquired anemia (HAA) is one of the most common intensive care unit (ICU) acquired complications that associated with poor outcomes, increase morbidity and mortality for critically ill patients. Factors contribute to its development include profound loss of RBCs or insufficient RBCs production. Aim of the study: to assess factors contributing to HAA among critical ill patients. Design: A descriptive exploratory design was utilized. Setting: The study was carried in Beni –Suief university hospital inside the critical care units which include; general ICU, cardio care unit (CCU) and chest ICU. Study subjects: purposive sample of 75newly admitted adult critically ill patients to the above mentioned sitting was included in the study. Data collection tools: Data were obtained through patients assessment tool, factors contributing to HAA and indicators of HAA tool. Results: reveals that, nearly one third of studied patients their age were more than or equal fifty years. As regard to gender, the results revealed that, more than half of them were males, nearly one third of anemic patients had HAA in the 5th day from admission to hospital. As well more than three quarter of anemic patients were under feeding and more than one third of them had sepsis, in addition to mean amount of blood loss for anemic patients exceed amount of blood loss for non anemic patients. Conclusion: More than half of studied patients developed HAA during their ICU stay. Even, non-anemic patients were subjected to a decline in their Hb level. As well as, there were statistically significant relation between nutrition deficiency, sepsis, blood loss in ICU and drugs increase RBCs loss factors and occurrence of HAA. Also there were insignificant relation between demographic characteristic of studied patients, their diagnosis on admission to hospital, hemodilution, drugs affect RBCs production and occurrence of HAA. Recommendations: Designing in-service training and educational program for nurses about blood conversation strategies especially prevention of blood loss associated invasive procedure and phlebotomy practice.

Objectives:Patients with impaired renal functions have a variable risk of morbidity and mortality in cardiovascular surgery. Poor outcome was reported among patients who underwent valve surgery. Current study is presumed to compare the early outcomes of patients having different degrees of impaired renal functions and undergoing mitral valve replacement surgery. Methods:135 patients were admitted into the three highly specialized centers in Cairo and Ismailia–Egypt between Dec.2018 and Jan.2020 Preoperative, intraoperative and early post-operative data were recorded. Impairment may present as one of these strata: early reversible (G1-2 included strata 1 & 2 kidney disease patients), moderate G3-4 included strata 3 & 4 kidney disease patients) or advanced irreversible renal damage. (The 5th stratum or G5-KD included end stage renal disease patients undergoing 4-hour hemodialysis sessions, three times a week, with bicarbonate dialysate). We correlated outcome among each stratum with cardiac and renal functions in that stratum. Results:The more is the impairment of renal functions at any peri- operative stage, the longer is the need for prolonged mechanical ventilation and the longer is the hospital stay. We found that levels of serum creatinine were significantly increased postoperatively Also, the more is the reversibility of the renal impairment, even by renal dialysis, the much better is the outcome (P=.0019). We also found insignificant difference between different strata of irreversible renal impairment in the early outcome of the prosthetic mitral valve replacement surgery. The early reversible damage can be repaired peri-operatively. Conclusions:Prosthetic mitral valve replacement among patients with different degrees of impaired renal functions is not only feasible but also it does not seem to add any more deterioration into renal function. Prolonged mechanical ventilation and hospital stay are the only drawbacks of irreversibly impaired renal damage by dialysis or renal transplant.

Diarrheal disease is considered a significant health problem, principally in developing countries as it is one of the leading causes of morbidity and mortality especially in infants. Studies found that STES and EPEC strains are among the most predominant causative agents in acute diarrhea. The aim of the study was to investigate the presence of certain virulence factors and antibiotic resistances of STEC and EPEC originating from infants with diarrhea in Egypt. A total of 200 infants of different ages suffering from diarrhea between August 2017 and February 2019 were registered in this study. Standard cultural and biochemical methods were used to isolate E. coli species while; PCR was applied for the detection of virulence genes (stx1, stx2, eae and pfb A) for STEC and EPEC isolates, respectively. Eighty nine (44.5%) E. coli strains were isolated from 200 stool samples. A total of 40 (44.9%) strains were identified as STEC, and 1(1.12%) strain was atypical EPEC. Fourteen of the STEC serotypes were O157:H7. Susceptibilities of 40 STEC and 1 aEPEC isolates were determined for ten antimicrobial drugs. STEC O157:H7 strains and STEC Non-O157:H7 exhibited the highest resistance against cefazolin and no resistance against imipnem and Amikacin, respectively while, the isolated strain of aEPEC was sensitive to all the studied antibiotics except cefazolin. Results showed that STEC is one of the major causes of diarrhea that showed resistant to commonly used antibiotics so representatives must pay great attention to this matter in order to increase the health of the community.

Tetranychus urticae (Acari: Tetranychidae) infesting many plants but Mentha viridis L., and Mentha piperita L., were low in number of infestation. Therefore the objective of this study was to identify the resistance of M. viridis and M. piperita plants against T. urticae by studying the external shape and internal contents of those plants. For morphological studies, dried leaves were covered with gold utilizing an Edwards Scan coat six sputter-coater. For histological studies, arrangements of Soft Tissue technique were used. For phytochemical studies, the plants were cut, dried and then high performance liquid chromatography (HPLC) was used. While feeding the mites were collected from the area between oily glands, trichomes and respiratory stomata in both mint species. The most important leaf structures in aromatic plants are the oily glands found on the external part of the leaves (both upper and lower epidermis). The number of oil glands in M. viridis leaves was greater than in M. piperita; the trichomes on the epidermis of M. viridis were greater in number than in M. piperita; the spongy mesophyll in M. viridis was much thicker than in M. piperita. The essential oils in the leaves of both mint species contained 71 compounds representing 99.61% of the total oil constituents identified from M. viridis before infestation, and 90.95% after infestation, and about 99.65% from M. piperita before infestation, and 99.98% after infestation.

Background Ischemic heart disease (IHD) is a common cause of death, which encourages us to improve continuously the techniques adopted for coronary artery bypass grafting (CABG). Still the most commonly used graft is saphenous vein harvested by different techniques. Methods This prospective randomized study included 60 patients with IHD in need of CABG classified into two equal groups: group A (saphenous vein harvesting with conventional technique) and group B (saphenous vein harvesting with lens assisted bridging technique [LABT]). We compared the two groups in terms of preoperative, intraoperative and postoperative data then we statistically analysed the findings. Results Our study showed that LABT had significantly less pain, less infection, more cosmetic, less hospital stay with more patient satisfaction and without any additional costs. Conclusions Our study showed that lens assisted bridging vein harvesting was a good substitute for conventional technique.

Objective: This cross-sectional study was conducted from July to November 2015 to estimate the prevalence of anti-toxopalsma antibodies in sheep and goats in El-Gadarif state. Material and methods: A total of 400 serum samples comprising of 200 sheep and 200 goats were collected and tested by Toxo-latex agglutination test and indirect enzyme linked immunosorbent assay (iELISA). Results: The overall sero-prevalence was 52.0% (n=208/400) using Toxo-latex agglutination test and 45.7%(n=42/92) and 27.2%(n=25/92) using iELISA in sheep and goats, respectively. Furthermore, the sero-prevalences among the two investigated species and the two age groups were statistically similar but were different between localities, breeds and sexes. In the univariate analysis, species (P=0.028) and locality (P=0.001) were associated with Toxo-latex agglutination test positive status. Additionally, species (sheep) and locality (Al-Fao, Al-Hawatah, and West El-Gadarif) had increased odds of being Toxo-latex agglutination test positive in the multivariate analysis. Conclusion: It can be concluded that the prevalence of anti-toxopalsma antibodies is relatively high and there was no between-species variation in sero-positivity. These findings warrant further investigations to estimate the burden of the disease and the likelihood of zoonotic transmission. http://doi.org/10.5455/javar.2017.d205 XML PubReader

Introduction: Cerebrovascular Background: Critical care nurses are expertly trained to care for critically ill patients; however, many critical care nurses feel inadequately prepared to provide end of life care to patients in the intensive care unit. The nurses attribute this to lack of support and training on end-of-life care. The study aim was to assess effect of self-learning package (SLP) on critical care nurses' performance regarding care for end of life patient. Methods, Design: To achieve this aim a quasi-experimental design was utilized. Subjects and setting: A convenient sample of 60 nurses was selected from surgical, medical and neurological ICU of Ain-Shams university hospitals. Study results: Regarding demographic characteristics. This study revealed that, 58.3% of the studied subjects were less than 30 years, 83.3% were female, 75.0% were diploma nurses, 46.7% of them had ten or more years of experience, and 81.7% had no training related to end of life care. Regarding knowledge and practice 15.0% & 23.3% respectively of the study subjects had satisfactory knowledge and practice related to care for end of life patient in pre phase, 80.0% & 81.7 % respectively in post implementation of self-learning package and 60.0% &45% had a satisfactory knowledge and practice in follow up phase. While regarding attitude, positive attitude was 5%, 80% and 55% respectively in pre, post and follow up phases Conclusion: The current study concluded that there was highly statistically significant increase of total score of nurses' knowledge, practice and total score of nurse’s attitude pre/post, pre/follow up and post/ follow up phases of SLP implementation. there was statistically significant positive effect for SLP on nurses' knowledge, practice and attitude. Recommendations; conduction of further researches in end of life care to enrich, improve, & update nurse's knowledge, practice and attitude. Periodic in-services education program regarding end of life care and self-learning package to be performed for patients are recommended.

Scientific knowledge has advanced to enable the development of inhaled insulin. It is a form of diabetes medication administered via the pulmonary system that studies have shown to be efficacious in the treatment of both type 1 and type 2 diabetes. Inhaled insulin is a new, safe means to deliver insulin that may increase patient compliance with insulin therapy, helping them to achieve optimal glycemic control and possibly reducing their risk of developing cardiovascular complications. However, diabetes is a chronic illness requiring lifetime intervention. Empowering patients with the knowledge of the diabetes disease process may give them the confidence to be more autonomous in managing their diabetes. HIIP gives nurse practitioners a new option that may improve their patients’ acceptance of insulin therapy, and improve glycemic control.

Context: Exercise interventions are the cornerstone of cardiac rehabilitation. The exercise program consists of respiratory physiotherapy, neck and shoulder exercises, walking, and cycling. The purpose is preventing respiratory complications, neck and shoulder pain, and increasing the physical functional level. Aim: of this study is to evaluate the effect of applying nursing exercise protocol on hemodynamics and functional capacity among post-cardiac surgery patients. Methods: Quasi-experimental research design utilized in the current study. A purposive sample including 60 male and female patients, classified equally into two equal groups; study group (n= 30) and control group (n= 30), collected through 14 months. This study carried out in the inpatient cardiac surgery department and the outpatient cardiac clinic of Cardiothoracic Surgery Hospital at New Minia City. Four tools utilized in collecting data; named Health Assessment Record; Six Minute Walk Distance Test; Modified Medical Research Council Scale (MMRC) for measuring dyspnea; and Nursing Educational Protocol Checklist. Results: Current study findings displayed an improvement of total distance walked among study group compared to control group, it also showed highly statistically significant differences between both groups related to total distance walked after 12th-week post-discharge documented by p-value (0.000). Conclusion: The current study findings concluded that the nursing educational protocol in the form of deep breathing, incentive spirometer; coughing and early ambulation induces a significant improvement in hemodynamic variables and six minute walk distance recommending that hospitals should implement nursing educational protocol as a routine hospital policy among all cardiac surgical patients in all age groups.

Aim of The study to assess the mothers’ knowledge about breast Feeding, bottle Feeding and weaning of their Infants. This study was carried out in all MCH centers at Minia city. Descriptive research design was used to meet the aim of study. A convenient sample included 1000 mothers who were attending MCH centers.A structured interview sheet was developed by the researcher based on review of relevant literature. It included 2 parts: Part I; included sociodemographic characteristics of the mother and child, Part II; included items related to mothers’ knowledge about breast feeding, bottle feeding, and weaning. There were highly statistical significant differences between total knowledge of mother about breast feeding and all her socio-demographic characteristics. There was a positive relationship between maternal education and increased knowledge about infant feeding. Conclusion of this study illustrated that there is a relationship between knowledge of mother about breast feeding, bottle feeding ,and weaning and her socio-demographic characteristics and that there is a relationship between the education of mother with her knowledge about pattern of breast feeding, bottle feeding, and weaning and that there is a relationship between the occupation of mother and knowledge about exclusive breast feeding, duration of exclusive breast feeding. The study recommended that there is a dire need to arrange for health education program sessions for mothers with main emphasis on importance of colostrum’s feeding, exclusive breast feeding & suitable age of starting and complete weaning.

Background and objective: The goal of this study was to determine the association of complete left bundle branch block (LBBB), site , severity & risk factors of coronary artery disease (CAD). Complete Left bundle branch block increases the risk of cardiac mortality, and prognosis is primarily determined by the underlying CAD. Because the presence of complete LBBB makes the noninvasive identification of CAD less informative, patients with complete LBBB often are referred for coronary angiography to assess the presence and severity of CAD. Methods: A total of 150 consecutive patients with complete LBBB admitted to the coronary care unit were enrolled from the age of 27 to 81 years with the mean age of 59.32 ± 10.5. Male 84 (56%), Female (44%). History, basal investigations echocardiography and virology screen were performed. Coronary angiography has been done for all patients for different reasons of presentation. Results: Critical CAD 70 (46.7%), Left ventricular systolic dysfunction (LVSD) 50 (33.3%). Hypertension found in 83 (55.3%), diabetes mellitus (DM) in 44 (30%), DM& left ventricular systolic dysfunction(LVSD) were more associated with critical CAD. Conclusion: In our study complete LBBB was more common among hypertensive patients. In DM patients was associated with severe CAD. With Left anterior descending artery being the most common artery involved.

Background: The Western-style diet is characterised by the high intake of energy- -dense foods. Consumption of either high-fructose diet or saturated fat resulted in the development of metabolic syndrome. Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome. Many researchers studied the effect of high-fat diet (HFD), high-fructose diet (HFruD) and high-fructose high-fat diet (HFHF) on the liver. The missing data are the comparison effect of these groups i.e. are effects of the HFHF diet on the liver more pronounced? So, this study was designed to compare the metabolic and histopathological effect of the HFD, HFruD, and HFHF on the liver. The proposed underlying mechanisms involved in these changes were also studied. Materials and methods: Twenty four rats were divided into four groups: con- trol, HFD, HFruD, and HFHF. Food was offered for 6 weeks. Biochemical, light microscopic, immunohistochemical (Inducible nitric oxide synthase [iNOS] and alpha-smooth muscle actin [ α -SMA]), real-time polymerase chain reaction (gene expression of TNF- α , interleukin-6, Bax, BCL-2, and caspase 3), histomorphometric analysis and oxidative/antioxidative markers (thiobarbituric acid reactive substances [TBARS], malondialdehyde [MDA]/glutathione [GSH] and superoxide dismutase [SOD]) were done. Results: The HFD, HFruD and HFHF groups developed a cluster of liver disorders; steatosis, necrosis, inflammation, apoptosis, ballooning degeneration and cytopla- smic vacuolations. Internal metabolic impairments include elevated serum levels of glucose, triglycerides, low density lipoprotein and decreased serum levels of high density lipoprotein and albumin. The immunoreaction of the α -SMA and iNOS was strong in these groups. The oxidant markers (MDA and TBARS) were elevated, while the antioxidant markers (SOD and GSH) were decreased. The area per cent of collagen, inflammatory markers, caspase 3 and Bax were elevated, while the BCL-2/Bax ratio was decreased. The decrease in PAS, antioxidant markers and the elevation of the α -SMA, iNOS, inflammatory and oxidant markers were obvious in the HFHF when compared to that of the other groups. Conclusions: High-fat diet, HFruD, and HFHF developed morphologic hepatic changes ranging from steatosis to necrosis and inflammation, besides the deve- lopment of internal metabolic impairments. The chief factors of hepatic injury were fat accumulation in the hepatocytes, oxidative stress and highly elevated iNOS. Compared to the other groups, HFHF’s effect was more prominent.

The present work aimed to investigate the cellular and immunochemical pattern of T cells population in biopsy material from chronic schistosomiasis haematobium Egyptian patients complicated with bladder cancer. Digital real-time quantitative photocytometry was applied to auto-analyze 29 stained tissue sections from cases and 17 controls using STAT4, GATA3, FOXP3, and CD8 markers specific for Th1, Th2, T regulatory, and T cytotoxic cells, respectively. Area percentage showed significant high level of GATA, followed by FOXP3 and low level of both STAT and CD8 was reported. Tissue samples from five healthy bladder tissues showed significant lower optical density (OD) values. Tissue samples from 12 non-bilharzial bladder cancers showed variable OD values, reflecting wide disparity in the control group. Our results hypothesized an exclusive pattern of T population in long standing complicated schistosomiasis haematobium. Our cases were poorly controlled by unbalanced Th1/Th2 in which Th2 was dominated. FOXP3 increased significantly, however, failed to downregulate Th2, instead, the relation between Th1 and T cytotoxic was forcibly limited by the high level of FOXP3, resulting in loss of their power in defending the host against both parasite and carcinogenic changes. These results provide more clarification for the immune evasion process played by the parasite and tumor cells under the supervision of T regulatory cells. Additionally a critical role of FOXP3 is suggested in manipulating STAT4 and CD8 in favor of malignant transformation in this life-threatening parasite.

Classically presenting with multiple or single peripheral cytopenias of variable severity, the myelodysplastic syndromes may occasionally present with bizarre manifestations that confuse the clinical picture and result in significant delays in making the correct diagnosis. We describe the case of an elderly male patient whose presentation with prolonged unexplained fever coupled with cutaneous, pulmonary and other systemic features of inflammation was finally diagnosed as having a primary myelodysplastic syndrome with associated vasculitis after a delay of 4 years., GMS German Medical Science; 9:Doc27; ISSN 1612-3174

Background and aim: Patients' satisfaction has been used as a significant indicator of quality services provided by health care personnel. Consequently, the most important predictor of patients, overall satisfaction with hospital care is particularly related to their satisfaction with nursing care. Because nurses comprise the majority of health care providers. The aim of the current study is to assess the patients‘ satisfaction toward nursing care provided in medical and surgical units in Mosul city hospitals. Materials and method: A descriptive study represented in a purposive sample consisted of 1000 patients, the study was carried out at three different hospitals include Ibn Sina, Al Jumhory and Al Salam teaching hospitals. The study was conducted at medical and surgical Units; the data were collected through the use of constructing a questionnaire which consists of two parts, demographic characteristics and patients' satisfaction toward nursing care. Content validity was determined by presenting the questionnaire to a panel of 17 experts. The data were analyzed through the application of descriptive statisticas and inferential statistical analysis. Results: Results of the current study revealed that more than half of patients were male 569(56.9%). The most of patients was married 785(78.5%).The majority of patients were from rural 562(56.2%), additionally, the male more satisfied than female and surgical patients‘ satisfaction more than medical patients. the old age satisfaction more than another age groups, such as the lower level education high satisfied, the married patients more satisfied from other, the unemployed patients more satisfaction, the patients had not previous hospitalization more satisfaction. The patients are more satisfaction toward nursing skills from other domains. While there were a statistical significant difference between patient satisfaction toward nursing care provided and patients characteristics. Conclusion: The current study concluded that patients were satisfied to nursing care Recommendation: the study recommended that further studies should be conducted concerning patients satisfaction with nursing care provided in all hospitals. Keywords: Patients satisfaction, Assessment, Nursing care.

Background: Invasive ventilation is a common practice in intensive care units (ICUs). Once a patient is intubated, maintenance of the endotracheal tube placement is essential. When the ETT is not secured effectively, even basic nursing management can cause tube slippage which is a major factor in causing airway trauma. Aim of the study: This study was aimed at comparing the effectiveness of three endotracheal tube securement techniques (Twill, Adhesive and Simple bow) on endotracheal tube slippage, external jugular venous pressure measurement, oral mucosa and facial skin integrity, pain intensity and on patient satisfaction after the fixation method. Subjects and methods: A randomized clinical trial was conducted at the intensive care units in Ain Shams University Specialized Hospital. It included a sample of 90 patients, randomly allocated to the three equal groups: Twill, Adhesive and Simple bow groups, 30 subjects for each. The tools used for data collection included demographic and clinical data sheet, the time profile of ETT fixation method sheet and scales for endotracheal tube (ETT) slippage, external jugular venous pressure (EJVP) measurement, oral assessment guide (OAG) for oral mucosa, Facial Skin Integrity, pain intensity and patient satisfaction procedure scale. The study maneuvers were applied according to the group. Results: Both ETT slippage and EJVP were measured at 15, 30, 60 and 120 min post fixation method. At 120 min, 73% of patients in the Twill group had no slippage compared to Simple bow (50%) and (36%) in Adhesive groups. However, at 30 min post fixation method 90% of patients in the Twill group had normal EJVP measurement compared to Simple bow and Adhesive groups (70% and 57%, respectively), with a statistically significant difference between the three groups. At 60 min, only 10% of patients in the Twill group had high EJVP compared to Simple bow (37%) and Adhesive groups (47%) with a statistically significant difference among them. As well, at 120 min post fixation method, most patients in the Twill group (97%) had normal EJVP measurement, compared to the Adhesive (60%) and Simple bow (57%) groups. Oral mucosa and facial skin integrity assessment was done for all patients in the three study groups at 2, 6, 12, and at 24 h post fixation method. For oral mucosa at 24 h post fixation method, 80% of patients in the Twill group had healthy oral mucosa compared to Simple bow and Adhesive groups (47% and 37%, respectively), with a statistically significant difference between the three groups (P = 0.07). For facial skin integrity, at 6 h, no one of patients in the Twill and Simple bow groups had severe facial skin reaction compared to patients in the Adhesive group (7%) and the difference was statistically significant, (P = 0.01). As well, a statistically significant difference was revealed among the three groups, at 12 and 24 h post fixation method, (P = 0.04 and 0.02, respectively). The Twill technique had the shortest time taken for application and removal of securement method than other groups. Additionally, the Twill group had the lowest scores of pain at all three assessment times (5, 10 and 20 min), whereas those in the Adhesive group had the highest scores. All these differences were statistically significant, (P