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

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

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

Central Venous Oxygen Saturation as a Predictor of the Outcome of Weaning From Mechanical Ventilation

Weaning from mechanical ventilation represents a corner stone of management of critically ill patients. Successful weaning represents a great achievement in patient's critical course in the ICU. This makes the process of weaning one of the most difficult steps in ICU care, for those reason, such a study was done to create a new thinking about the predictors that facilitate patient weaning from mechanical ventilator. The aim of this study is to evaluate the central venous saturation as a predictor of the outcome of weaning from mechanical ventilation. Cohort, unicentric, clinical study research design was utilized in the current study. Sample consists of one hundred and twenty patients over a one year period, all patients passed the first SBT (spontaneous breathing trial) and weaned successfully from mechanical ventilation were extubated after undergoing a two-step weaning protocol (measurements of predictors followed by a T-tube trial). Extubation failure was defined as the need of re-intubation within 48 hrs. The weaning protocol evaluated hemodynamic, ventilation parameters, arterial and venous gases during mechanical ventilation (Immediately before T-tube trial), and at the 30th min of spontaneous breathing trial. Findings of this study show that re-intubation rate was 30%. Analysis by logistic regression revealed that central venous saturation was the only variable able to discriminate outcome of extubation. Reduction of central venous saturation by >5% was an independent predictor of re-intubation, with odds ratio of 52.6 (95% confidence interval =16.34–169.42), a sensitivity of 87%, and a specificity of 90%. Reduction of central venous saturation during spontaneous breathing trial was associated with extubation failure and could reflect the increase of respiratory muscles oxygen consumption. Results of the present study indicated that central venous saturation was an early and independent predictor of extubation failure and may be a valuable accurate parameter to be included in weaning protocols. Keywords: Central Venous Saturation - Mechanical Ventilation - Extubation

Role of Elastic Stable Intramedullary Nailing in Diaphyseal Fractures in Children

Background: All femoral or tibial fractures regardless of associated injuries, intramedullary nailing (IMN) has its more advantages in rapid rehabilitation, good effects on the child and his family and strong fixation. Objective: To assess the role of elastic stable IMN in union of diaphyseal fractures of long bones in children. Patients and Methods: A prospective and retrospective analytical study on ten children with isolated femoral or tibial fractures who were admitted to Orthopedic Department, Zagazig University Hospitals. They were divided equally into group I that included 5 patients with femoral shaft fracture managed with IMN and group II, which included 5 patients with tibial shaft fracture managed with IMN. Their mean age was 4.7 years old. Results: When the groups compared, the spica cast group was found to have a shorter duration of hospital stay compared to elastic nail group. The knee range of motion of the spica cast group was found to be better compared to the elastic nailing group. The elastic nailing group was found to have started walking earlier both with and without support. Patients with intramedullary nailing started to walk with aid after one month and  independently after 2 weeks. Patients with spica cast started to walk with aid after 2 months and independently after 12 weeks. Conclusion: None of the available treatment tools to fix diaphyseal long bones fractures in preschool children is perfect because each method has its own set of complications. However, constitute the motive for developing new techniques or changing the design of currently available devices

Effect of intranasal stem cell administration on the nigrostriatal system in a mouse model of Parkinson's disease

Parkinson's disease (PD) is the second most common neurodegenerative disease worldwide. It affects the locomotor system, leading to a final severe disability through degeneration of dopaminergic neurons. Despite several therapeutic approaches used, no treatment has been proven to be effective; however, cell therapy may be a promising therapeutic method. In addition, the use of the intranasal (IN) route has been advocated for delivering various therapies to the brain. In the present study, the IN route was used for administration of mesenchymal stem cells (MSCs) in a mouse model of PD, with the aim to evaluate IN delivery as an alternative route for cell based therapy administration in PD. The PD model was developed in C57BL/6 mice using intraperitoneal rotenone administration for 60 consecutive days. MSCs were isolated from the mononuclear cell fraction of pooled bone marrow from C57BL/6 mice and incubated with micrometer‑sized iron oxide (MPIO) particles. For IN administration, we used a 20 µl of 5x105 cell suspension. Neurobehavioral assessment of the mice was performed, and after sacrifice, brain sections were stained with Prussian blue to detect the MPIO‑labeled MSCs. In addition, immunohistochemical evaluation was conducted to detect tyrosine hydroxylase (TH) antibodies in the corpus striatum and dopaminergic neurons in the substantia nigra pars compacta (SNpc). The neurobehavioral assessment revealed progressive deterioration in the locomotor functions of the rotenone group, which was improved following MSC administration. Histopathological evaluation of brain sections in the rotenone+MSC group revealed successful delivery of MSCs, evidenced by positive Prussian blue staining. Furthermore, rotenone treatment led to significant decrease in dopaminergic neuron number in SNpc, as well as similar decrease in the corpus striatum fiber density. By contrast, in animals receiving IN administration of MSCs, the degeneration caused by rotenone treatment was significantly counteracted. In conclusion, the present study validated that IN delivery of MSCs may be a potential safe, easy and cheap alternative route for stem cell treatment in neurodegenerative disorder

Association of the serum chemerin level with the development of diabetic retinopathy in patients with type 1 diabetes mellitus

Background: In patients with type 2 diabetes mellitus, the development of diabetic retinopathy (DR) correlates positively with elevated serum chemerin levels. This study was aimed at investigating the probable association between the serum chemerin level and the development of DR in patients with type 1 diabetes mellitus (T1DM). Methods: In this cross-sectional study, we included Egyptians and classified them into four groups: group 1, including healthy individuals; group 2, including patients with T1DM without DR; group 3, including patients with T1DM with non-proliferative DR (NPDR); and group 4, including patients with T1DM with proliferative DR (PDR). The assessment included best-corrected distance visual acuity assessment, slit-lamp biomicroscopy, funduscopy, fundus fluorescein angiography, and macular ocular coherence tomography. Fasting blood samples were obtained from all participants to measure serum chemerin, glycated hemoglobin (HbA1c), total cholesterol, triglyceride, and creatinine levels. Serum chemerin levels were compared among the groups, and their correlations with age, duration of diabetes, HbA1c, total cholesterol, triglyceride, and creatinine levels were analyzed. Results: We recruited 209 participants, including 46 healthy individuals in group 1, 52 patients (T1DM and no DR) in group 2, 61 patients (T1DM and NPDR) in group 3, and 50 patients (T1DM and PDR) in group 4, with comparable mean ages and sex ratios among groups. The diabetes duration, body mass index, HbA1c, total cholesterol, triglyceride, and serum chemerin levels differed significantly among the groups (all P < 0.001), whereas the creatinine level did not (P > 0.05). The serum chemerin level was significantly higher in group 4 than in groups 3 and 2, in group 3 than in group 2, and in groups 3 and 4 than in group 1 (all P < 0.001). However, it was comparable between groups 1 and 2 (P > 0.05). It correlated with the duration of T1DM and HbA1c, total cholesterol, triglyceride, and creatinine levels but not with age. Conclusions: Patients with T1DM with DR showed higher serum chemerin levels than those with T1DM without DR or healthy individuals. Serum chemerin levels were higher in those with PDR than in those with NPDR. Thus, serum chemerin levels are a potential biomarker of the development and severity of DR in patients with T1DM. Nevertheless, future diagnostic accuracy studies are required to confirm these potential applications

An improved indoor positioning based on crowd-sensing data fusion and particle filter

Due to the lack of global positioning system (GPS) signals in some enclosed areas, indoor localization has recently gained significant importance for academics. However, indoor localization has a number of challenges and defects, including accuracy, cost, coverage, and ease of use. This paper explores the integration between the inertial measurement unit (IMU) and Wi-Fi-based received signal strength indicator (RSSI) measurements, demonstrating their combined potential for robust indoor localization. IMUs excel at capturing precise short-term motion dynamics, offering insights into an object’s acceleration and orientation. Conversely, RSSI measurements serve as valuable indicators for relative positioning within indoor environments. By fusing data from these sources, our approach compensates for the inherent weaknesses of each sensor type. To achieve accurate indoor positioning, we employ techniques such as sensor fusion, Wi-Fi fingerprinting, and dead reckoning. Wi-Fi fingerprinting allows us to create a database that maps RSSI measurements to specific locations, while dead reckoning helps mitigate drift and inaccuracies. By combining these methods, we estimate a device’s position with increased precision. Through experimental evaluation, we assess the performance and efficiency of our integrated approach, comparing the estimated path or new location with a predefined reference path. The findings emphasise a significant improvement in accuracy, with the integration of crowd-sensing, particle filtering, and magnetic fingerprinting techniques resulting in a notable increase from 80.49% to 96.32% accuracy

Molecular and serological techniques for the diagnosis of culture negative infective endocarditis in Alexandria Main University Hospital

AbstractBackground and aimCulture-negative infective endocarditis (CNIE) is a diagnostic dilemma. The study was carried out to estimate the prevalence of CNIE among definite IE cases, to describe the epidemiologic and clinical characteristics of CNIE patients and to diagnose the microbial etiology of CNIE using molecular and serological techniques.Subjects and methodsSixty-five definite IE cases were enrolled in a prospective observational study between January and December 2010. CNIE cases were tested by 16SrRNA and seminested PCR for 35 blood samples, serological tests and the study of ten valve tissue specimens.ResultsCNIE constituted 39 (60%) cases. The mean age of CNIE patients was 31years. Male to female ratio was 2.9:1. Healthcare associated IE accounted for 15.4%, native valve IE for 66.7% and intravenous drug abuse for 20.5% of cases. The mitral valve was the most frequently involved (56.4%). Out of 39 CNIE cases, seminested blood PCR detected 12 cases (ten Staphylococci, two Streptococci). Five cases were reactive by serology (three Bartonella, one Coxiella, and one Brucella). Six cases were positive by analysis of valve tissue (three Staphylococci, three Streptococci). The combined results of all diagnostic tools decreased the percentage of non-identified causes of CNIE from 60% to 24.6%.ConclusionsOur data underlined the role of collecting blood culture before starting antibiotics and the role of seminested PCR in the diagnosis of conventional causes of CNIE. The importance of serology to identify non conventional causes was also highlighted

Vegetation Dynamics and Species Diversity in a Saharan Oasis, Egypt

The present study provides an analysis of the floristic composition, habitat types, vegetation structure and species diversity, elucidating the role of the environmental factors that affect species distribution in Kharga Oasis, Western Desert, Egypt. The vegetation was sampled from 89 permanently visited stands in 12 sites situated along N - S line transect across the oasis, and extending for about 185 km to cover as much as possible the physiognomic variation in habitats. Four main habitats were recognized and forming concentric zones (from inside to outside): farmlands and date-palm orchards represent the inner zone, the waste-salinized lands (not saltmarshes) in the middle zone, and the surrounding (bounding) desert in the outer zone. A total of 122 species from 35 families and 102 genera represented the flora of the study area. Poaceae, Asteraceae and Fabaceae were the major families, which constituted 47% of the total flora. Classification using Bray-Curtis cluster analysis produced 4 vegetation groups (A - D); each can be linked to a certain habitat. The arrangement of habitat zones along the first DCA axis can be noticed: outer zone (bounding desert), middle zone (waste-salinized lands) and inner zone (arable lands). On the other hand, farmlands and date-palm orchard groups were separated from each other along the second DCA axis. The relationship between the vegetation and soil variables was studied using Canonical Correspondence Analysis (CCA); it was indicated the most important environmental gradients those control the vegetation composition and the distribution pattern of species in Kharga Oasis, which were mainly related to gradients in soil moisture content and fine fractions. The present situation of Kharga Oasis urges the conservation of some old historic wells and the naturally growing open dom-palm forests before vanishing due to high human activities in the area