Tertiary Trauma Survey: Nurses Performance and Polytrauma Patients’ Outcomes

Context: Tertiary Trauma Survey is an important tool for detecting missed injury, and some trauma units have created their protocol for tertiary trauma surveys to decrease the incidence of missed injuries in trauma patients.Aim: This study aims to assess nurses' performance regarding tertiary Survey and Poly-trauma patients' outcomes.Methods: Descriptive exploratory design was utilized to achieve the aim of the study. A convenient sample of all available nurses (50 nurses) working in the intensive care unit at the emergency hospital affiliated to Ain Shams University Hospitals. A purposeful sample composed of (50) adult patients diagnosed as polytrauma patients was recruited from the same units. Data was obtained through three main tools; Self-administered questionnaire for nurses, nurses practice observational checklist and clinical outcome record for patients. Results: Nurses had an unsatisfactory level of knowledge and practice regarding the tertiary trauma survey (44%&32%, respectively). There was a highly statistically significant positive correlation between the total level of knowledge and practice. There was a difference between injury severity score and laboratory, hemodynamic status, physical assessment, and radiological findings of poly-trauma patients on admission and after 24 hours. Conclusion: Less than half and less than one-third of the nurses under study had an unsatisfactory level of knowledge and practice, respectively, regarding the tertiary trauma survey. There was a highly statistically significant positive correlation between the total level of knowledge and total level practice. Polytrauma patients' outcomes revealed a statistically significant difference between injury severity score, hemodynamic status, physical assessment, and radiological findings in polytrauma patients on admission and after 24 hours. Recommendations: Further research is needed to follow the patients' outcomes and missed injuries. Replication of the current study on a larger probability sample is recommended to achieve generalization of the result. Tailored Training courses are needed for nurses to improve unsatisfactory knowledge and practices regarding tertiary trauma survey- integrated studies with the emergency medical team to communicate patients' outcome research findings

Purification and characterization of phenoloxidase from immunized haemolymph of Schistocerca gregaria

Phenoloxidase (PO) is a key factor in insect immunity. On invasion of microorganisms and pathogens, prophenoloxidase (PPO) changes to its active form, PO. The present study has been conducted to purify and characterize the PO from the haemolymph of desert locust, Schistocerca gregaria (Forskal) following activation of immune system by invasion of bacteria, Bacillus thuringiensis kurstaki (Bt). PO is purified by a combination of ammonium sulfate precipitation, blue sepharose CL-6B and phenyl sepharose CL-4B chromatography yielded a 209.97-fold purity and 54.75% recovery of activity. Sodium dodecyl sulfate (SDS) polyacrylamide gel electrophoresis (PAGE) reveals that the molecular weight of the purified PO is 70.154 kDa. The purified PO is characterized in terms of its biochemical and enzymatic properties by using L-DOPA as a specific substrate. Ca2+ and Cu2+ significantly stimulated PO activity when compared with other metals. The PO reaction was strongly inhibited by phenylthiourea and thiourea, moderately inhibited by ethylene diamine tetractic acid (EDTA) and poorly inhibited by ethylene glycol tetraacetic acid (EGTA) and diethyl dithiocarbamate (DTC). Inhibition of PO showed excellent recovery ability by addition of Ca2+ on EGTA-inhibited enzyme. Therefore, PO is most probably a kind of tyrosinase-type Ca2+-containing metalloenzyme. The content of Ca2+ is higher than other trace metal elements. The reactive intermediates yielded by PO with its specific substrate L-DOPA had a broad-spectrum bactericidal activity against Gram +ve bacteria (Bacillus cereus and Staphylococcus aureus) with a greater degree more than Gram-ve bacteria (Escherichia coli and Pseudomonas aeruginosa). From the present study, PO from S. gregaria is most probably a tyrosinasetype calcium-containing mono-phenoloxidase, which functions not only as a catalytic enzyme in melanin production in locusts, but perhaps also as a humoral factor in host defense via melaninization as in other insects.Key words: Schistocerca gregaria, phenoloxidase, purification

Determination of dimenhydrinate and cinnarizine in combined dosage form in presence of cinnarizine impurity

Three accurate, sensitive and time saving spectrophotometric methods have been developed and validated for determination of mixture of dimenhydrinate (DMH) and cinnarizine (CIN) in presence of cinnarizine impurity (1-(diphenylmethyl)piperazine) (IMP). In method A; dimenhydrinate was determined by measuring 1D amplitudes at 292.0 nm while cinnarizine and its impurity were determined by 1DD method at 256.2 and 219.6 nm, respectively, using standard spectrum of 20 µg/mL of dimenhydrinate as a divisor. Method B depends on dividing spectrum of ternary mixture by standard spectrum of 20 µg/mL of dimenhydrinate and then cinnarizine and its impurity were determined in the obtained ratio spectrum by ratio difference method using the difference between 219.0 and 237.2 nm and between 230.0 and 264.0 nm, respectively. On the other hand dimenhydrinate could be determined by dividing spectrum of ternary mixture by standard spectrum of 20 µg/mL of cinnarizine and then it were determined at the obtained ratio spectrum by ratio difference method using the difference between 216.8 and 232.8 nm. Method C is the mean cantering of ratio spectra method (MCR) where the amplitudes at 234.8, 240.0 and 233.6 nm in the second mean centering ratio spectra were used for determination of dimenhydrinate, cinnarizine and its impurity, respectively. The developed methods were validated according to ICH guidelines regarding good accuracy and precision, and they were successfully applied to pharmaceutical formulation and laboratory prepared mixtures. The results were statistically compared with those obtained by reported method and no significant difference was found

Bipolar sealing devices versus endoscopic vascular staplers during laparoscopic splenectomy in children with benign hematological diseases

Background: Splenectomy, whether open or laparoscopic, is considered a step of management in many children with benign hematological diseases such as immune thrombocytopenia, thalassemia, autoimmune hemolytic anemia, and spherocytosis. The major challenge during laparoscopic splenectomy (LS) is the rich blood supply of the spleen. Many techniques were considered to control the vascular supply of the spleen. Staplers, clips, either titanium or hemoclips, a bipolar sealing device (BSD), or ultrasonic shears were all used to complete LS. We aimed to compare the results of using BSD versus endoscopic staplers for vascular control of the pedicle during LS.Patients and methods: The study was carried out on 30 children with benign hematological diseases who presented to the Pediatric Surgical Unit. They were grouped randomly into two groups: group A and group B. Group A included 15 patients who were subjected to LS in which BSD was used for vascular control, whereas group B included 15 patients subjected to LS in which endoscopic staplers were used for vascular control of the pedicle.Results: The mean age of the children in group A was 9.60 years, whereas the mean age of the children in group B was 10.40 years. In group A, the mean estimated amount of blood loss was 72.27 ml. However, this was 80.67ml in group B. In group A, the mean operative time required was 39.00 min, whereas it was 56.27 min in group B. The indications for splenectomy were thalassemia in 15 cases (seven for group A and eight for group B), idiopathic thrombocytopenic purpura in 13 cases (seven for group A and six for group B), and spherocytosis in two cases (one for each group). The mean splenic size in group A was 10.43 cm, whereas it was 11.73 cm in group B.Conclusion: LS has evolved over the last decade because of the advancements of BSDs and endoscopic staplers. According to our data the use of LigaSure reduces the overall operative time, operative blood loss, and associated complications compared with the use of staplers.Keywords: children, laparoscopic, splenectom

Boosting piezoelectric properties of PVDF nanofibers via embedded graphene oxide nanosheets

Tremendous research efforts have been directed toward developing polymer-based piezoelectric nanogenerators (PENG) in a promising step to investigate self-charging powered systems (SCPSs) and consequently, support the need for flexible, intelligent, and ultra-compact wearable electronic devices. In our work, electrospun polyvinylidene fluoride (PVDF) nanofiber mats were investigated while graphene oxide (GO) was added with different concentrations (from 0 to 3 wt.%). Sonication treatment was introduced for 5 min to GO nanosheets before combined PVDF solution. A comprehensive study was conducted to examine the GO incremental effect. Microstructural and mechanical properties were examined using a scanning electron microscope (SEM) and a texture analyzer. Moreover, piezoelectric properties were assessed via various tests including impulse response, frequency effect, d33 coefficient, charging and discharging analysis, and sawyer tower circuit. Experimental results indicate that incorporation of GO nanosheets enhances piezoelectric properties for all concentrations, which was linked to the increase in β phase inside the nanofibers, which has a significant potential of enhancing nanogenerator performance. PVDF-GO 1.5 wt.% shows a notably higher enhancing effect where the electroactive β-phase and γ-phase are recorded to be boosted to ~ 68.13%, as well as piezoelectric coefficient (d33 ~ 55.57 pC/N). Furthermore, increasing impact force encouraged the output voltage. Also noted that the delivered open circuit voltage is ~ 3671 V/g and the power density is ~ 150 µw/cm2. It was observed that GO of concentration 1.5 wt.% recorded a conversion efficiency of ~ 74.73%. All results are in line, showing better performance for PVDF-GO 1.5 wt.% for almost all concentrations

Spatiotemporal analysis of Highly Pathogenic Avian Influenza (H5N1) outbreaks in poultry in Egypt (2006 to 2017)

BACKGROUND: In Egypt, the highly pathogenic avian influenza (HPAI) subtype H5N1 is endemic and possesses a severe impact on the poultry. To provide a better understanding of the distributional characteristics of HPAI H5N1 outbreaks in Egypt, this study aimed to explore the spatiotemporal pattern and identify clusters of HPAI H5N1 outbreaks in Egypt from 2006 to 2017. RESULTS: The Epidemic curve (EC) was constructed through time series analysis; in which six epidemic waves (EWs) were revealed. Outbreaks mainly started in winter peaked in March and ended in summer. However, newly emerged thermostable clades (2.2.1.1 and 2.2.1.2) during the 4th EW enabled the virus to survive and cause infection in warmer months with a clear alteration in the seasonality of the epidemic cycle in the 5th EW. The endemic situation became more complicated by the emergence of new serotypes. As a result, the EC ended up without any specific pattern since the 6th EW to now. The spatial analysis showed that the highest outbreak density was recorded in the Nile Delta considering it as the ‘Hot spot’ region. By the 6th EW, the outbreak extended to include the Nile valley. From spatiotemporal cluster epidemics, clustering in the Delta was a common feature in all EWs with primary clusters consistently detected in the hot-spot region, but the location and size varied with each EW. The highest Relative Risk (RR) regions in an EW were noticed to contain the primary clusters of the next EW and were found to include stopover sites for migratory wild birds. They were in Fayoum, Dakahlia, Qalyobiya, Sharkia, Kafr_Elsheikh, Giza, Behera, Menia, and BeniSuef governorates. Transmission of HPAI H5N1 occurred from one location to another directly resulted in a series of outbreaks forming neighboring secondary clusters. The absence of geographical borders between the governorates in addition to non-restricted movements of poultry and low vaccination and surveillance coverage contributed to the wider spread of infection all over Egypt and to look like one epidemiological unit. CONCLUSION: Our findings can help in better understanding of the characteristics of HPAI H5N1 outbreaks and the distribution of outbreak risk, which can be used for effective disease control strategies. GRAPHICAL ABSTRACT: [Image: see text

ASSESSMENT EFFECT OF ALOE VERA, AZADIRACHTA INDICA AND MORINGA OLEIFERA AQUEOUS EXTRACTS ON CARBON TETRACHLORIDE-INDUCED HEPATOTOXICITY IN RATS

Objective: This experiment aims to investigate the hepatotherapeutic effect of Aloe vera (AV), Azadirachta indica (N), and Moringa oleifera (MO).Methods: Eighty albino rats have been divided into ten groups. The first group was fed on a basal diet while the second group was administered paraffin (10 ml/kg body weight) through gavage for four days. The third to the tenth groups received (5 ml/kg body weight) CCl4: liquid paraffin (2:1) for three days followed by (10 ml/kg body weight) CCl4: liquid paraffin (2:1) for one day through gavage. Group three kept without any treatment, other groups then received (AV) (60 mg/kg body weight), (MO) (200 mg/kg body weight), (N) (200 mg/kg body weight), bi-extract of (AV+N), bi-extracts of (AV+MO), bi-extract of (MO+N), and tri-extracts of (AV+N+MO) respectively for 36 d. The liver and blood were studied for hepatotoxicity and antioxidant indices.Results: Biochemical and histopathological analysis revealed that CCl4 elevated plasma liver enzymes (aspartate transaminase, alanine aminotransferase, and gamma glutamyl transferase). Carbon tetrachloride also caused an elevation in erythrocyte content of glutathione with a concomitant increase in the plasma malondialdehyde content, along with marked atrophy of hepatocytes. However, these effects were ameliorated by the treatment of rats with the different extracts.Conclusion: Results showed that administration of the aquatic extracts of Aloe vera, Neem, and Moringa (separately/mixedly) played a therapeutic role against CCl4-induced liver damage by improving liver enzyme activities, antioxidant blood parameters, and a liver histopathological picture of intoxicated rats.Keywords: Aloe vera, Azadirachta indica, Moringa oleifera, CCl4 hepatotoxicity, Antioxidant, Rat hepatocyte

Hacia la promoción del turismo y los servicios hoteleros para el turismo de orfanatos en Egipto

Orphanage tourism is a sub-sector of volunteer tourism which refers to traveling abroad to "do well" and support others in other communities. Importance: The importance of providing hospitality services to this style is that orphan tourism stems from the desire to have more meaningful and ethical holiday experiences, and the desire to give back to the host communities visited by the tourist. The study aims at developing the level of promoting hospitality services for the Orphanage Tourism and hospitality pattern in Egypt. Study problem: The problem of the study lies in identifying the strengths and weaknesses and identifying the needs towards promoting hospitality services for the Orphanage Tourism and hospitality pattern in Egypt. Methodology: Using the descriptive approach, selecting guests, managers and supervisors of marketing and public relations departments and those who are in direct contact with customers. The total numbers of questionnaires received were 150 questionnaires were distributed to a group of managers and supervisors in 15 five-star hotels as well as 15 tourism companies in the Red Sea region, and among them 120 questionnaires were valid, correctly and ready to be statistically analyzed. Results: There are deficiencies in the hospitality services provided to the Orphanage Tourism and hospitality pattern in the Red Sea region, and they need more attention and care. Lack of tourism awareness of the strengths and weaknesses and identifying the needs for hospitality tourism orphanages in Egypt and the need to pay attention to them .Recommendations: shedding light and spreading tourist awareness of strengths and weaknesses and identifying needs towards promoting tourism and hospitality services for Orphanage Tourism and hospitality pattern in Egypt; Providing an appropriate environment to provide services that meet the needs of tourism and hospitality services for Orphanage Tourism and hospitality pattern to meet their needs and satisfy their desires.El turismo de orfanatos es una subtipología del turismo solidario que se refiere a viajar al extranjero para "hacer el bien" y apoyar a otras comunidades locales. La importancia de brindar servicios de hospitalidad de este estilo radica en que el turismo de orfanatos surja del deseo de tener experiencias vacacionales más significativas y éticas y del deseo de retribuir a las comunidades anfitrionas visitadas por el turista. El estudio tiene como objetivo desarrollar mejores niveles de promoción de los servicios de hospitalidad para el turismo de orfanatos y fijar un patrón de hospitalidad en Egipto. En este etudio se pretende identificar las fortalezas y debilidades e identificar las necesidades de promoción de los servicios de hospitalidad para el turismo de orfanatos en Egipto. Metodología: Se utiliza un enfoque descriptivo y cualitativo a través de la selección actores, gerentes y supervisores cualificados de los departamentos de marketing y relaciones públicas que están en contacto directo con los clientes. El número total de cuestionarios recibidos fue de 150, distribuidos entre un grupo de gerentes y supervisores en 15 hoteles de cinco estrellas, así como de 15 empresas turísticas en la región del Mar Rojo, y entre ellos, 120 cuestionarios fueron válidos, correctos y adecuados para su análisis estadístico. Resultados: Existen deficiencias en los servicios de hospitalidad brindados al turismo de orfanatos y el patrón de hospitalidad en la región del Mar Rojo necesita más atención y cuidado. Además falta conciencia turística sobre las fortalezas y debilidades de esta subtipología turística y de identificación de las necesidades de los orfanatos de turismo hotelero en Egipto. Recomendaciones: arrojar luz y difundir la conciencia turística sobre las fortalezas y debilidades e identificar las necesidades para promover el turismo y los servicios de hospitalidad para el turismo de orfanatos y el patrón de hospitalidad en Egipto; proporcionar un ambiente apropiado para brindar servicios que satisfagan las necesidades de turismo y servicios de hospitalidad relacionados con la visita y ayuda a los orfanatos; y establecer un plan de acción para mejorar la calidad de los servicios relacionados con esta subtipología turística