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Background: COVID-19 pandemic affected the global population, and infection is a high risk among nurses in the gastrointestinal endoscopy unit. Endoscopy is a diagnostic procedure that involves inserting a flexible fiber-optic tube into the esophagus, stomach, or upper small intestine, depending on the degree of suspected lesions. This study aimed to evaluate the effect of educational guidelines intervention regarding COVID -19 on nurses' knowledge and precautionary practices in gastrointestinal (GIT) endoscopes. Design: A quasi-experimental design was used. Setting: The study was carried out at the gastrointestinal endoscopy unit affiliated with General Portsaid Hospitals (Al-Mabarrah Hospital, Al-Amiri Hospital, Al-Zohour Hospital, Port Fouad Hospital, and Al-Tadamon Hospital). Sample: The study included a convenient sample of all endoscopy nursing personnel (30 nurses). Three tools for data collection: (1) Demographic structured interview sheet, (2) Nurses’ Covid-19 Knowledge Questionnaire, and (3) Nurses’ Covid- 19 Precautionary Practices Checklists. Results: More than one-third of the studied nurses received training courses regarding COVID-19 before. Almost three-quarters of the studied nurses reported that their main source of information about knowledge regarding COVID-19 was doctors. There was an improvement with a highly statistically significant difference between nurse's knowledge regarding COVID -19 pre/post one month of educational intervention (P

Thoracic surgery threatens the integrity of body, such as physical, psychological, social and spiritual aspects and may cause discomfort such as pain response and sleep disturbance. Aim: The study aimed to determine the effect of Benson's relaxation technique on reducing pain intensity, anxiety level and improving sleep quality among patients undergoing thoracic surgery. Design: A quasi experimental research design was utilized. Setting: The study was conducted in thoracic surgery department at Mansoura chest hospital and Mansoura University Hospital- chest department. Subjects: A purposive sample of 160 post thoracic surgery were recruited in this study. Tools: Four tools were used; Tool I: Assessment interview questionnaire sheet includes personal and health relevant data, Tool II: Short Form McGill Pain Questionnaire (SFMPQ), Tool III: Groningen Sleep Quality Scale (GSQS) and Tool V: Hospital Anxiety and Depression Scale (HADS). Results: There was a statistically significant effect of Benson's Relaxation Technique on reducing pain intensity, anxiety level and improving sleep quality among patients undergoing thoracic surgery. Conclusion: The study concluded that, Benson relaxation technique has a positive improvement in level of pain, quality of sleep and anxiety & depression among the study group who applied Benson's relaxation technique. Also, the most common factors that can affect the sleep quality level for those patients is the pain. Recommendation: This study recommended that, the nurses should pay more attention to Benson's relaxation technique as a simple, cheap and effective technique while taking care of post operative patients.

The optimal surgery for operable gastric carcinoma is still controversial. The aim of the current study was to assess the outcomes of D2 compared with D1 gastrectomy. This observational study included 80 patients with operable gastric cancer treated by D2 gastrectomy at Alexandria University Hospital between January 2010 and January 2016. Another 68 patients treated by D1 gastrectomy during the same period were included. Both groups were compared regarding operative mortality, morbidities, tumor recurrence, and 5-year survival rates. D2 gastrectomy had a significantly higher postoperative mortality and morbidity rates compared with D1 group (19.4% and 41.9% versus 6.3% and 18.8%). Mean number of LNs retrieved was statistically increased in D2 compared with D1 group with more frequency of adequate lymphadenectomy (LN retrieved > 15). D2 gastrectomy demonstrated significant lower recurrence and cancer-specific mortality rates compared with D1 group (18.6% and 14.5% versus 34.9% and 30.8%) with no significant difference in DFS and OS rates. Spleen-saving D2 gastrectomy showed no significant difference in early postoperative mortality with significant increase in DFS and OS compared with D1 gastrectomy (78.7% and 82% versus 61.5% and 64.6%). D2 gastrectomy had a lower recurrence and cancer-specific mortality rates than D1 gastrectomy but it had higher postoperative mortality and morbidity rates that resulted in no overall survival benefit of D2 compared with D1 gastrectomy. Spleen-saving D2 gastrectomy can be done safely in selected patients by expert surgeons without increased morbidity and mortality and better survival outcomes.

Introduction The feasibility and efficacy of emergency curative resection of complicated colorectal cancer is still controversial. This prospective study aim was to assess surgical and oncologic outcomes after emergency compared to elective curative resection of colorectal cancer. Methods 60 consecutive patients presented with complicated colorectal cancer managed by emergency surgery were included and compared to another 155 consecutive patients admitted during the same period with uncomplicated colorectal cancer managed by elective surgery. Both groups were compared regarding curative resection rate, early postoperative mortality and morbidity, 3-years tumor recurrence and survival rates. Results Complicated colorectal cancer presented at a more advanced stage with a lower resectability rate and higher postoperative mortality and morbidity rates when compared to uncomplicated ones. Emergency resection of stage I/II colorectal cancer had similar 3-years disease free, overall survival and cancer-specific mortality rates approximating elective. But, emergency resection of stage III tumors had significantly decreased 3-years disease free and overall survival rates although there was no significant increase in cancer specific mortality rate. Conclusions Complicated colonic cancers present at a more advanced stage with a lower resectability rate, and higher postoperative morbidity and mortality rates when compared with uncomplicated ones. In medically fit patients, emergency curative resection of complicated colorectal cancer could be done safely with survival outcomes approximating elective resection of uncomplicated cancer in the same stage if proper oncologic resection done by expert surgeon., Highlights • The feasibility and efficacy of emergency curative resection of complicated colorectal cancer is still controversial. • Most of previous studies were not well designed and included both curative and palliative resection. • This study compared emergency and elective curative resection regarding proper resection, tumor recurrence & survival rate. • This study revealed that emergency curative resection has ‎higher postoperative morbidity and mortality rates. • Proper emergency resection by expert surgeon has similar survival outcomes to elective resection of cancer in same stage.

Background Newborn infants have an increased sensitivity to pain and are more reactive to pain than older children and adults. Nurses play a crucial role in assessing pain, implementing and evaluating interventions to minimize neonatal pain using available resources especially nonpharmacologic techniques. Aim of the study to develop and apply an educational program on pediatric nurses regarding selected nonpharmacologic techniques to relieve pain in neonates. Research design A pre/post quasi-experimental research design was utilized in the present study. The study was carried out at Minia University for Obstetric and Pediatric and General Hospitals at neonatal care units. A convenient sample of 41 nurses was included in this study. Educational program for nurses was done through using the following data collection tools 1) Pre-designed questionnaire sheet, 2) Observation checklists sheet and 3) Educational and training program. Results It was revealed that there was an obvious increase in the total mean scores of knowledge and practice in post and follow up program phase compared with pretest phase, with a very highly significant difference (p Conclusion The education program had a significant impact on pediatric nurses' knowledge and practices regarding selected nonpharmacologic techniques to relieve pain in neonates. Recommendations A continuous training and educational program should be planned and offered on regular basis for nurses regarding nonpharmacologic techniques to relieve pain in neonates.

Background: Kegel exercise role in strengthening the pelvic floor muscle in the treatment of prolapse and urinary incontinence and improve mobility and relieves pain Aim; The study aims to assess the knowledge and attitude and practices of kegel exercise among postnatal women in Al Madinah Al Munawarh, Saudi Arabia. Study design: This study utilized descriptive quantitative cross-sectional study design. Study Setting: The study was conducted of the postnatal ward in Maternity and Children's Hospital in Al Madinah Al Munawarh, Saudi Arabia. From April to December 2019. Sample: the study carried out among 152 of postpartum mothers. Tools that used in this study; Tool I: An interviewer-administered questionnaire in Arabic language was used in this study, it composed of three parts targeting the research objectives. Tool II: was concerned with knowledge of women regarding kegel exercises. Tool III: - concerned two parts: Part one: This part related to women's attitude towards kegel exercises. Part two: This part related to women's practices about kegel exercises. Results: the study found that 44.7% of the sample was in the age group 26-31 years old, 75.0% were multigravida, 85.5% had no miscarriage, 67.1% had vaginal delivery, and 50.0% have 1-3 children. 25% of the sample reported media as their source for information on kegel exercise. 62.7% of the sample had satisfactory knowledge. 72.4% were categorised as having ‘somewhat favourable’ overall attitudes towards kegel exercises. 57%of the mothers have not performed kegel exercise. 38.5% of the participants were correctly practised kegel exercise in sitting or standing position. While 29.7% was correctly practised kegel exercise in lying down position. Conclusion; Women’s knowledge concerning the kegel exercise in the postnatal period is reasonable and their attitude was favourable, but the mothers had the poor practice of kegel exercises. Recommendation; Mothers should be informed and trained to kegel exercises properly by educational courses.

Introduction: Good antenatal care (ANC) reduces maternal and neonatal mortality and improves health outcomes, particularly in low-income countries. World Health Organization recommendation of initiation of antenatal care within the first four months of pregnancy and at least four antenatal care visits during the course of an uncomplicated pregnancy. Inadequate care during this time breaks a critical link in the continuum of care and affects both women and her neonate. Objectives: The aim of the study was to identify effects of antenatal care on maternal and neonatal outcomes in Women Health Hospital Subjects & Method: Three hundred parous women and their neonates conducted a comparative study. They were divided into two groups' according to parity the first group (primipara =150), and the second group (high parity=150) and divided every group into two groups the first was poor antenatal care and other was adequate antenatal care during the period from February 2017 to August 2017 using a stratified sampling. Results: Most of the primipara women had poor antenatal care (88%) but high parity (67.3%). There was the highly significant relationship between two groups. More than half were had poor antenatal care (60.3%) but less than half were adequate antenatal care. The most common complication in primipara group was eclampsia (36.4%) while in high parity group was anemia (14.3%) in poor antenatal care. The most common complication in labor was premature rupture of membrane (19.0% & 14.3%) respectively, in poor antenatal care of two groups. In primipara group, the proportion of low birth weight was 16.0% in poor antenatal care, while stillbirth was (11.0%) inadequate antenatal care also neonatal weight in Kg related to poor antenatal care and adequate antenatal care were (2.636 ± 0.659 & 3.050 ± 0.503) respectively. In high parity group, the proportion of Special Care Baby Units admission was 12.2% in poor antenatal care, while Special Care Baby Unit admission was 11.9% inadequate antenatal care also neonatal weight related to poor antenatal care and adequate antenatal care were (2.973 ± .709 & 3.081 ± 0.643) respectively. Conclusion: Good quality antenatal care promote the health of the mother and decreases the percentage of iron deficiency anemia, gestational hypertension and before term labor and promote maternal outcomes, including a reduced risk of under birth weight, preterm neonates and Special Care Baby Unit admission. Recommendations: the women should have access to good quality antenatal care. Both the woman and the neonatal are at a greater risk during pregnancy and labor. This risk can be reduced with good antenatal care and delivery by trained personnel. And awareness of the adverse impact of high parity on obstetric

Background Neoadjuvant chemotherapy (NAC) has clinically important outcome. Early evaluation of the treatment response is important to avoid unnecessary therapy in non-responders. MRI is the most sensitive imaging for monitoring NAC response. Aim of this study Is to test the ability of DWI to detect early response to NAC. Results The study was performed on 20 patients, proved pathologically to have invasive breast cancer. All patients underwent breast MRI before initiation of NAC, after one cycle and after completion of the NAC protocol. Regarding the mass size, results showed no significant change in maximum mass diameters occur after the 1st NAC cycle. Absolute value of the ADC show increase all along the treatment course which has no significant correlation with the pathological response. The relative increase ADC more than 20% calculated from subtraction of the pre-treatment ADC mean value from that after the first NAC, subdividing the result on the pre-treatment ADC mean value and multiply it by 100 reflected significantly on the pathological response (p value of 0.011). Conclusion ADC value can predict responder from non-responder as early as after the first cycle of chemotherapy.

AIM To compare the effects of renal transplantation on cardiac functions in children and adults. METHODS One hundred and ten patients attending the nephrology outpatient clinic were enrolled in this study and were divided into six groups. The first two groups consisted each of 30 renal transplant patients who had a successful renal transplantation more than six months, but less than one year. Group I were less than 18 years and group II were more than 18 years. The third and fourth groups, each were 20 chronic renal failure patients on regular hemodialysis. Again, group III were less than 18 years and group IV were more than 18 years. Group V and VI (The control Groups) consisted each of 5 subjects below and above 18 years of age, respectively with normal kidney functions. All patients were subjected to history and examination. The kidney functions and the hemoglobin were analyzed. After obtaining informed consent, echocardiography was done to all patients. RESULTS There was a statistically significant improvement (P < 0.0001) in all cardiac parameters. A regression in left ventricular end diastolic volume (LVED) both in children (4.7 ± 0.8 to 4.2 ± 0.5) and in adults (5.9 ± 0.7 to 4.9 ± 0.6) were found. There was a regression in left ventricular end systolic volume (LVES) both in children (3.1 ± 0.6 to 2.4 ± 0.4) and in adults (4.1 ± 0.9 to 3.1 ± 0.5). Fractional shortening improves both in children (32.6 ± 5.3 to 41.7 ± 7.6) and in adults (29.0 ± 6.6 to 36.5 ± 4.1). The improvement in ejection fraction (EF) was higher in children (59.7 ± 7.0 to 71.9 ± 6.1) than in adults (52.0 ± 12.5 to 64.8 ± 5.9). However, this degree of improvement (in children: 12.2 ± 5.1) did not show statistical difference (P-value 0.8), when compared to adults (12.7 ± 9.8). CONCLUSION After renal transplantation cardiac functions and morphology (EF/LVED/LVES) do improve markedly and rapidly in both children and adults.

Physical restraint is a piece of equipment or device that restricts a patient's ability to move. Restraints may keep a patient from getting out of bed or moving arms and legs excessively. The aim of this study was to establish, apply basic guidelines for nurses that dealing with restrained patients and evaluate the effect of physical restraint guidelines on nurse's performance. Methods A Quasi experimental research design was used in this study. Sample all nurses (90) that dealing with physical restraint patients were selected from the Mansoura University Hospitals. Five tools were used for data collection. Results of the present study found that, the mean age of the nurses was 28.73 ± 6.91years. In addition to all of the studied nurses had unsufficient practices score and 84.4% of them had unsufficient knowledge score as pretest, while 78.9% of the subject study had sufficient practice and 94.4% of them had sufficient knowledge after direct implementation physical restraint guidelines, on the other hand on the follow up phase the same study reveled that 63.3% of the nurses had sufficient practice while 76.7% had sufficient knowledge score regarding physical restraint application. The study concluded; there was significantly improvement in nurses’ knowledge and practice concerning to physical restraint application after implementation of physical restraint guidelines.

Background: Umbilical Cord Milking (UCM) is a safe and likely technique for both the mothers and their neonates which improve the neonatal outcomes. The aim of the study was to assess the effects of umbilical cord milking on premature neonates' and mothers' outcomes.Methods: Design: Quasi-experimental research design was utilized. Setting: Emergency and Labor Unit of Women's Health University Hospital and Neonatal Intensive Care Unit (NICU) in Assiut University Children Hospital were the setting which the study was implemented. Subjects: It included 80 mothers and their premature neonates. The subjects were divided randomly into two groups (40 premature neonates who were received the UCM as a study group and 40 premature neonates as a control group who received the Immediate Cord Clamping [ICC]). Tool: One structured interview questionnaire was designed especially for this study. It included two parts: Personal and clinical data of the studied mothers and premature neonates.Results: The Hemoglobin (Hb) level significantly increased in the study group when compared to the control group within 6 hours of birth (12.11 vs. 10.61) and at 36-48 hours after UCM (12.27 vs. 11.32). Also, UCM had significantly improved the need for blood transfusion, death rate, and length of hospital stay among premature neonates in the study group.Conclusions and recommendations: UCM improved preterm neonates' outcomes as increasing Hb level, less need for blood transfusion, and decline incidence of death, lowers length of hospital stay. Recommendations: Increasing awareness of neonatology, pediatric, and obstetric nurses about benefits and technique of UCM through health education program.

Background Women in health care represent an ancient and widespread profession. Violence against women is a pervasive violation of fundamental human rights of women. Pregnancy is a risk factor for increase in violence, especially in health care facilities. Research design A descriptive design was used in this study. Settings The study was conducted at Zagazig University Hospitals. Sample A convenience sample was used, including 231 pregnant health care workers (HCWs). A structured questionnaire sheet was constructed by the researchers to collect data of this study and included four parts. Tools The first part is a structured questionnaire constructed by the investigators to collect the data. The second part is the obstetric history. The third part is the information related to workplace violence assessment. The fourth part included maternal and neonatal assessment sheet. Results More than two-thirds (68.3%) of pregnant HCWs had been exposed to workplace violence. Pregnant HCWs working in most departments experienced violence, with highest frequency observed in the emergency department. Verbal violence (47.2%) was the most common form of violence followed by psychological (30.7%), physical (19.5%), and finally sexual violence (2.6%). Pregnant HCWs faced many maternal and fetal complications, with the complications of first and second stages of labor and fetal distress being 7.8 and 67.1%, respectively. Approximately 43.3% of pregnant HCWs were more likely to deliver by cesarean. However, 37.7% have premature rupture of membrane (PROM), and 27.7% have low-birth-weight, and 20.8% preterm births.. Conclusion Pregnant HCWs face many maternal and fetal complications because of violence, such as abortion, deterioration in the progress of labor, cesarean delivery, fetal distress, PROM, low-birth weight, and preterm birth. Recommendation Special attention should be directed to control violence against pregnant HCWs, especially those who have a history of exposure to violence.

Background and aim: To determine the effect of light therapy (polarized polychromatic non coherent light) on episiotomy in postpartum women Materials and methods: Thirty primiparous female in 1st 24 hours after vaginal delivery with mediolateralepisitomy, their age were ranged from (20-25) years and their body mass index (BMI) not exceeded 30 kg/m². All participants were free from perineal skin diseases, diabetes, hypertension and preeclampsia, they were randomly assigned into 2 equal groups, study group(A): they were treated with general perineal care {in form of debridement, local antimicrobial ointment and betadine applied on the wound surface as well as oral antibiotic and analgesics (morphine)}, in addition to Bioptron light therapy 15 minutes/session, one session /day for 5 consecutive days and control group (B): they were treated immediately after recovery from anesthesia with general perineal care as described for group (A). Assessment of all subjects in both groups (A&B) was carried out before and after the treatment program using Present Pain Intensity (PPi) scale, level of white blood cells and standardized REEDA Scale Results: There was a statistically highly significant decrease (P