Poultry rearing and slaughtering practices in rural Egypt: an exploration of risk factors for H5N1 virus human transmission.

BACKGROUND: Highly pathogenic avian influenza (H5N1) virus continues to cause infections in Egypt. This study describes the practices associated with raising and slaughtering household poultry to identify risk factors for H5N1 infection and reasons for non-compliance with preventive measures. METHODS: An investigation was conducted of 56 households with household flocks (19 households with human H5N1 cases, 19 with poultry H5N1 cases, and 18 with no reported poultry or human H5N1 cases). Data were collected via structured observations and in-depth interviews. RESULTS: Half of the households kept at least some free-range poultry and mixed at least some different species of poultry as it was considered beneficial for the poultry. Feeding and cleaning practices exposed children to contact with poultry; slaughtering contaminated homes; use of personal protective barriers was not a norm; waste management exposed the communities to slaughtering waste and dead chickens; and reporting of sick and dead poultry was not a practice. Only minor changes in poultry-handling took place following H5N1 virus outbreaks. DISCUSSION: H5N1 virus prevention in Egypt represents both an epidemiological and socio-cultural challenge. Traditional poultry-rearing practices that likely increase exposures to H5N1-infected poultry are common throughout Egypt. Despite education campaigns following sporadic H5N1 outbreaks, no differences in these practices could be detected between households with previous H5N1 human or poultry cases and those households with any previous experience with H5N1. Development of H5N1 infection-related education campaign strategies should focus on perceptions underlying traditional practices in order to tailor public awareness messages that are meaningful for communities

Relevance of posterior malleolar fracture fixation to ankle syndesmotic reduction, a comparative study

Background: Appropriate distal tibiofibular syndesmotic reduction is crucial to restore ankle stability, guard against future arthrosis with worse functional outcome. Optimal technique for syndesmotic reduction has been a matter of debate. This study aimed at radiological evaluation of syndesmotic integrity following two methods of reduction (posterior malleolar fixation and trans-syndesmotic screw fixation), additionally, correlating the posterior malleolus size to the radiological results of both techniques.Methods: Syndesmotic integrity was compared after each technique as per translational and rotational fibular positions. Utilizing, preoperative and postoperative computed tomography scans of injured ankle, the fibular antero-posterior and Medio-lateral translation distances were measured. Additionally, the fibular rotation angle was calibrated. Incidence of inadequate reduction in each group was reported. Preoperative and postoperative radiological findings were compared and correlated to posterior malleolus size in relation to tibial articular distance.Results: A significant difference between both techniques was noted in term of fibular rotation. In patients with PM ˂ 10% of tibial articular surface, a significant difference was obvious in postoperative AP-translational and rotational findings between both techniques. Overall malreduction incidence rate of 68.9% was reported in this study, with 84.7% rate in patients managed with SS-fixation, whilst 51.2% rate in those managed via PM-fixation.Conclusions: Posterior malleolar fixation could limit syndesmotic malreduction risk whatsoever it’s size. Approaching CT reference values for syndesmotic reduction might benefit preoperative planning and detect intraoperative malreduction. Further future clinical studies correlating these findings to clinical outcome would be more helpful

Bullets over ballots: Islamist groups, the state and electoral violence in Egypt and Morocco

This article is concerned with state-sponsored electoral violence in liberalized autocracies. The first section of the paper identifies a number of variables that can help explain the decision calculus of authoritarian incumbents to deploy force against strong electoral challengers. The second section then examines these propositions with reference to Egypt and Morocco. Drawing on recent parliamentary elections in both countries the article questions why, despite facing the challenge of political Islam, the two regimes differed so markedly in their willingness to manipulate the polls by recourse to violence. Whilst the Egyptian authorities decided to abrogate all pretence of peaceful elections in favour of violent repression against the Muslim Brotherhood candidates and sympathizers, no such tactics were deployed by the ruling elite in Morocco. We suggest that three principal factors influenced the regimes' response to this electoral challenge: (1) the centrality of the elected institution to authoritarian survival; (2) the availability of alternative electioneering tools; and (3) the anticipated response of the international community. The article concludes by suggesting that in order to understand better when and how states deploy violence in elections, we need to focus on a more complex set of factors rather than simply on the electoral potency of key opposition challengers or the authoritarian nature of the state

The Use of Ceramic Waste Powder (CWP) in Making Eco-Friendly Concretes

The global production of ceramic waste powder (CWP), which is produced during the final polishing process of ceramic tiles, exceeds 22 billion tons. The disposal of CWP in landfills will cause significant environmental problems (i.e., soil, air, and groundwater pollution). CWP is characterized by its chemical composition that is mainly composed of silica (SiO2) and alumina (Al2O3). Both minerals represent more than 80% of the CWP composition. CWP has potentials to be used as an ingredient to partially or entirely replacing Portland cement to make eco-friendly concretes. This chapter summarizes the effect of using CWP in making eco-friendly concretes, with a particular focus on using CWP as a partial cement replacement in conventional-vibrated concrete (CVC) and self-compacting concrete (SCC), and the production of zero-cement alkali-activated concrete (AAC)

Assessment of level of serum cardiac troponin T in neonates with respiratory distress syndrome

Background: One of the most prevalent reasons for admission to neonatal intensive care units (NICUs) is respiratory distress syndrome (RDs). When myocardial cells are damaged, cardiac troponin I (cTnT) is released as a biomarker of myocardial damage, which is very specific and sensitive.Objective: To determine the level of cTnT in preterm infants who have respiratory distress syndrome as a marker of cardiac dysfunction.Patients and Methods: This study was carried as a case-control trial on forty preterm infants, 20 patients of respiratory distress syndrome at neonatal intensive care unit as a group I, 20 apparently healthy newborns as a control group. Serum cardiac troponin T level sample was taken on the 3rd day of delivery.Results: A statistically significant difference in blood troponin was found between the groups tested, with a negative connection between serum troponin and gestational age, length, and APGAR scores at the first and fifth minutes of life. Respiratory rate and serum troponin were found to have a statistically significant connection. Any one of the echocardiographic measures had a statistically significant positive connection with serum troponin. Serum troponin was able to diagnose respiratory distress syndrome with cutoff ≥ 93.5 ng/mL with the area under the curve, Positive predictive value: 83.33% Positive predictive value: 83.33% Negative predictive value: 100 percent Accuracy: 90%.Conclusion: Cardiac troponin T can be used to detect cardiac dysfunction in ill newborns, especially in centers that do not have in-house echocardiography

Role of diffusion-weighted magnetic resonance (MR) imaging in differentiation between graves' disease and painless thyroiditis

Background: To assess the role of diffusion-weighted MR imaging in differentiation between Graves' disease and painless thyroiditis. Material/Methods: A prospective study was conducted among 37 consecutive patients with untreated thyrotoxicosis (25 female and 12 male; mean age of 44 years) and 15 age- and sex-matched controls. Diffusion-weighted MR imaging of the thyroid gland was performed in patients and controls. The apparent diffusion coefficient (ADC) value of the thyroid gland was calculated and correlated with Tc-99m uptake and thyroid function tests of the patients. Results: There was a significant difference in the ADC value of the thyroid gland between patients and the control group (P=0.001). The mean ADC value of the thyroid gland in Graves' disease was 2.03±0.28×10-3 mm2/sec, and in patients with painless thyroiditis 1.46±0.22×10-3 mm2/sec, respectively. There was a significant difference in the ADC values between Graves' disease and painless thyroiditis (P=0.001). When the ADC value of 1.45×10-3 mm2/sec was used as a threshold value for differentiating Graves' disease from painless thyroiditis, the best result was obtained with area under the curve of 0.934, accuracy of 83.8%, sensitivity of 95.8%, and specificity of 61.5%. The mean ADC value of the thyroid gland in patients positively correlated with serum TRAb and Tc-99m uptake (r=0.57, P=0.001 and r=0.74, P=0.001, respectively). Conclusions: We concluded that ADC values of the thyroid gland can be used to differentiate Graves' disease from painless thyroiditis in patients with untreated thyrotoxicosis

A Study Comparing the Effectiveness of Hamstring Tendon Graft Versus Quadriceps Tendon Graft in Press Fit Anterior Cruciate Ligament Reconstruction

Background: Press fit ACL reconstruction is a surgical procedure used to repair a torn anterior cruciate ligament (ACL) in the knee. During press fit ACL reconstruction, a graft is used to replace the torn ACL. The graft can be harvested from various sources, such as the patient's own hamstring tendons or patellar tendon, or from a donor. The graft is then inserted into tunnels created in the femur and tibia bone. The term "press fit" refers to the technique used to secure the graft within these bone tunnels. Instead of using screws or other fixation devices, press fit ACL reconstruction relies on tight fitting of the graft within the tunnels. Objective: This study aimed to compare the subjective, objective, and radiological results of press fit anterior cruciate ligament (ACL) reconstruction using hamstring tendon graft versus quadriceps tendon graft. Methods: A total of 50 patients with complete ACL tears underwent press fit ACL reconstruction between March 2016 and June 2019. Among them, 25 patients received a hamstring tendon graft, and another 25 patients received a quadriceps tendon graft. Results: The study demonstrated favorable outcomes of press fit ACL reconstruction, with improvements observed in all 50 patients when comparing postoperative to preoperative parameters. The results also showed comparable outcomes between the quadriceps and hamstring groups in terms of subjective, objective, and radiological measures. Conclusion: The press fit technique for ACL reconstruction is a successful method of graft fixation that offers advantages such as fewer complications, lower cost, and easier revision compared to other commonly used techniques

Pandemic (H1N1) 2009 and Hajj Pilgrims Who Received Predeparture Vaccination, Egypt

In Egypt, vaccination against pandemic (H1N1) 2009 virus was required of pilgrims departing for the 2009 Hajj. A survey of 551 pilgrims as they returned to Egypt found 542 (98.1% [weighted]) reported receiving the vaccine; 6 (1.0% [weighted]) were infected with influenza virus A (H3N2) but none with pandemic (H1N1) 2009 virus

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication