Assessment of knowledge, attitude and behavior towards antibiotic use in primary health care patients in Fayoum Governorate, Egypt

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Medical students’ attitudes towards patient-centered care, Fayoum Medical School, Egypt

Background: Patient-centered care has been considered the foundation of healthcare quality and the core competency of the doctor-patient relationship.Aims: To assess the attitudes of medical students toward a patient-centered approach and identify the predictors of patient-centeredness scores.Methods: A cross-sectional study was carried out in Fayoum Medical School/Egypt using a validated Arabic version of the Patient-Practitioner Orientation Scale (PPOS).Results: The total PPOS score showed variable score as the grades move up. The total PPOS ranged from 0.05 to 4.39 with an average score of (2.71 ± 0.66) for the entire sample. The sharing and caring subscale score ranged from 0.56 to 4.44 and 0.44 to 5.33 with an average score of (2.33 ± 0.49) and (3.09 ± 0.92) respectively.Conclusion: Medical students had low patient-centered attitude. Medical curricula should be redesigned, and medical students may also benefit from engagement in patient healthcare service

Epidemiology of Hepatocellular Carcinoma in Fayoum Governorate-EgyptEpidemiology of Hepatocellular Carcinoma in Fayoum Governorate-Egypt

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide, and the burden is expected to increase in coming years. HCC has become the second most prevalent cancer among men in Egypt. This study aimed to estimate the prevalence; identify the risk factors and detect clinical features of HCC in Fayoum governorate. The study was a descriptive cross-sectional study with a convenient sample conducted at Tropical & Hepatology Medicine Department in Fayoum University Teaching Hospital. An interview structured questionnaire was used; thorough clinical examination with biochemical and serological investigation. The majority of cases came from rural area, farmers constituted 39.3% of cases. More than 90% of cases suffering from hepatic cirrhosis and more than half of cases having Bilhariziasis. Hepatitis C was the main aetiology 79.8%, followed by hepatitis B 15.4%. Most of focal lesions were in right lobe 57.1% and in the form of single lesion 57.1%. AFP was found to be a weak diagnostic predictor with low sensitivity. HCC was multifactorial pathogenesis with many risk factors (cirrhosis, HCV and schistosomiasis). HBV infection has a declining role in hepatocarcinogenesis. Proper surveillance program is needed for early detection and diagnosis of HC

Jaccoud’s arthropathy in patients with systemic lupus erythematosus: One centre study

Jaccoud’s arthropathy (JA) is a chronic, deforming, non-erosive arthropathy occurring in a subset of patients with systemic lupus erythematosus (SLE). In this research we aimed to evaluate clinical and immunological features in patients with SLE complicated by JA. Eighty seven consecutive SLE patients with a history of arthritis were included in the present study. These patients were subdivided according to “Jaccoud’s arthropathy index” as follows: non-deforming arthropathy, mild deforming and definite Jaccoud. Demographic data, disease activity and disability were recorded. Rheumatoid factor (RF), anti-cardiolipin antibodies (ACL), antiSSA/Ro, and anti SSB/La antibodies, were assessed in all patients. We found clinical deforming arthropathy in 12 patients, among whom seven had definite JA. Both the mean duration of the disease and of arthritis were longer in the JA group compared to the non-deforming arthropathy group. JA patients presented a trend toward a lower quality of life. The prevalence of Sicca syndrome (SS) and antiphospholipid syndrome were significantly higher in the JA group than in the patients with non-deforming arthropathy (p = 0.011 and 0.012, respectively). ACL and RF were more frequent among patients with JA (p = 0.013 and 0.036; respectively). These data suggest that JA is not rare and represents a subset of SLE with specific clinical and serological features. Future studies are needed to reveal the pathogenesis, the genetic association, the prevention, the stabilization and the appropriate cure for these patients

NT-proBNP as Early Marker of Subclinical Late Cardiotoxicity after Doxorubicin Therapy and Mediastinal Irradiation in Childhood Cancer Survivors

Background. Childhood cancer survivors treated with anthracyclines and mediastinal irradiation are at risk for late onset cardiotoxicity. Aims of the Study. To assess the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) as early predictors of late onset cardiotoxicity in asymptomatic survivors of childhood cancer treated with doxorubicin with or without mediastinal irradiation. Methods. A cross-sectional study on 58 asymptomatic survivors of childhood cancer who received doxorubicin in their treatment protocols and 32 asymptomatic Hodgkin’s lymphoma survivors who received anthracycline and mediastinal irradiation. Levels of NT-proBNP, TDI, and conventional echocardiography were determined. Results. Thirty percent of survivors had abnormal NT-proBNP levels. It was significantly related to age at diagnosis, duration of follow-up, and cumulative dose of doxorubicin. TDI detected myocardial affection in 20% more than conventional echocardiography. Furthermore, abnormalities in TDI and NT-pro-BNP levels were more common in Hodgkin lymphoma survivors receiving both chemotherapy and radiotherapy. Conclusions. TDI could detect early cardiac dysfunction even in those with normal conventional echocardiography. Measurement of NT-proBNP represents an interesting strategy for detecting subclinical cardiotoxicity. We recommend prospective and multicenter studies to validate the role of NT-proBNP as an early marker for late onset doxorubicin-induced cardiotoxicity

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically