Contribution of vaginal infection to preterm premature rupture of membrane and adverse pregnancy outcome

Background:Pretermpremature rupture of membranes (PPROM) is the cause of approximately one third of preterm deliveries. Objectives: assess the relation of vaginal infections and their antimicrobial profile with PPROM and pregnancy outcome. Methodology: Case control study of 320 females with PPROM (case) and 320 females with normal pregnancy (control) at 28- 37 weeks of gestation. Vaginal examination, vaginal pH assessment and Whiff test were done. Vaginal swabs were collected and examined microscopically for diagnosis of different vaginal infections. Swabs were cultivated, identification and antimicrobial susceptibility of revealed bacteria were done. Maternal and neonatal outcomes were assessed. Results: Bacterial vaginosis and aerobic vaginitis were identified in 29.1% and 17.3% of all participants respectively. There was statistically significant difference regarding prevalence of different vaginal infections in case and control groups (p < /em><0.001). Aerobic vaginitis and bacterial vaginosis were risk factors for PPROM. Streptococcus agalactiae was the most prevalent organism. Erythromycin and ampicillin were the least effective antibiotics against Gram positive and Gram-negative isolates respectively. There was significant increase of all maternal and fetal adverse outcomes in cases with aerobic vaginitis. Conclusion: Different vaginal infections carry risk of PPROM and adverse maternal and neonatal outcomes. The variation in prevalence of bacterial isolates in different studies and localities notify the lack of standardized treatment for infected mothers. Accurate diagnosis of vaginal infection, precise medical treatment during pregnancy is essential for maintenance of maternal and neonatal health

The Effect of Organizational Structure on the Adoption of Agile Methodologies_A Case Study

This exploratory case study used observations and interviews to investigate how the structure of an organization impacts its ability to adopt agile software development methodologies. It also aimed to identify the agile practices that are perceived as helpful or unhelpful by the individuals practicing them. It examined an organization’s attempt to adopt agile methodologies for the first time in a new software product development project. Twelve employees from different teams working on this project participated in the study. . The participants were asked about their perception of the agile process. They were also asked to identify the various teams with which they regularly interact and to provide examples of the helpful and unhelpful patterns of behavior they exhibit. The findings suggest that the structure of the organization was a major limiting factor that affected its ability to adopt agile methodologies. Agile practices rely on the level of flexibility that an organization can demonstrate. However, the organization attempted to adopt agile practices without redefining the project members’ roles, work processes, or departmental affiliations. Participants perceived many aspects of the agile methods negatively, and various symptoms of a misfit between the existing organizational structure and the requirements of agile methods were observed, including poor communication and multiple conflicts between the different project teams, which caused the project to go over time and over budget. Furthermore, it was observed that the teams struggled to follow the agile practices and found various ways to alter and work around them to fit the existing structure, rather than adhering to them and welcoming the new practices. Several potential areas for future research are identified, including: using longitudinal case studies to examine organizations and the relationships between their members before and after adopting agile methodologies, in order to identify and attribute any observed behavioral patterns to the appropriate cause; examining organizations in which the structure was altered to accommodate agile methodologies; and examining how organizations define the roles of highly specialized employees who possess very specific abilities and must be shared across different development projects

Chest Wall Tumors: A Spectrum of Different Pathologies and Outcomes of Reconstruction Techniques

Background: Chest wall resection and further reconstruction for tumors represent a challenging concept for surgeons. Thanks to the evolving reconstruction techniques, good results were obtained after extensive resection and reconstruction. Patients and methods: This prospective cohort study was conducted at our University Hospitals throughout 5 years. A total of 43 eligible cases with chest wall tumors were included. All cases were subjected to a multidisciplinary team approach, complete history taking, physical examination, radiological evaluation, and biopsy. The details of surgical techniques, complications, and follow up parameters were included. Results: The mean age of the included cases was 29.45 years. We included a total of 24 males (55.8%). Fibromatosis was the commonest encountered pathology (27.9%), followed by chondrosarcoma (25.5%), and osteosarcoma (21%). Regarding the method of reconstruction, polypropylene mesh was used in 46.5% of cases, followed by direct closure (30.2%). Ten cases were managed by Methyl Methacrylate within the proline mesh (23.3%), while superimposed muscle flap was performed in only 2 cases (4.6%). Post-operatively, bleeding was encountered in 5 cases collectively (11.6%), while wound infection occurred in 11.6% of cases. Pulmonary complications included pneumonia (2.3%) and atelectasis (11.6%). Furthermore, chest wall instability was present in (11.6%) of cases. On follow up, recurrence was diagnosed in (9.3%) of cases (n = 4). Conclusion: Surgical intervention is very effective if tailored to every patient as per team paln. A multidisciplinary team approach is extremely important especially if an extensive demolition is required. Indeed, radical wide en-bloc resection can achieve satisfactory results provided that the extent of resection is not influenced by any anticipated reconstruction problems

Effect of maternal dexamethasone administration on daily fetal movement count and its correlation with Doppler studies and cardiotocography

Background: Decreased fetal movements is a frequent reason for unplanned consultations through the third trimester ranging between 4% and 16% in various populations it is often a sign of fetal compromise and associated with severe outcomes such as fetal growth restriction, preterm birth and fetal death therefore it is important to question the effect of maternal dexamethasone administration for fetal well-being and its relation on decreased fetal movement which is detected by Doppler studies and cardiotocography. Methods: The current study was performed on 220 pregnant women with gestational age between 28-34 weeks who received antenatal dexamethasone at Ain Shams university hospitals.Results: Regarding fetal movements, there was significant decrease in fetal movement at the 24th hour (Day 2) after 1st and 2nd doses of dexamethasone then re-increased at 48th hour and 72nd hour but still significantly lower than baseline.Conclusions: Administration of dexamethasone had no harmful effects on the fetuses or the mothers, except for a transient decrease of fetal movements in only after 24 hours of the first dose.

COVID-19 associated mucormycosis and diabetes mellitus: An exploratory study

Background:Mucormycosis has abruptly increased in Egypt during the third wave of COVID-19 especially in patients with diabetes mellitus (DM). The aim of this study was to investigate the risk factors, clinical presentation and outcome of mucormycosis in COVID-19 patients with diabetes. Methods: Prospective cohort study was conducted on 72 COVID-19 patients with DM presented with mucormycosis at intensive care units and Ear, Nose, and Throat Department of Zagazig University Hospitals over a period of three months from May 2021 to August 2021. All participants were submitted to history taking, examination, laboratory investigation, radiological and histopathology and culture testing. Results: Post COVID-19 new-onset diabetes mellitus (NOD) was detected in 40% of studied patients. 72.2% of patients had poorly controlled diabetes. Majority of studied patients presented by rhino-orbital mucormycosis (90.3%) and about 86% of them were operated. Hundred percent of patients gave history of antibiotic use and also nearly 99.0% of them received corticosteroids, while only 1.4% of them received tocilizumab. There was statistically significant association between operated patients, hemoglobin (HB) level, lymphocyte count, neutrophil-lymphocyte ratio (NLR), and CRP level with disease prognosis. Conclusions: Poorly controlled DM and steroid use are the most important risk for post COVID-19 mucormycosis. Early surgical intervention carried better disease outcome

The inclusion of children with special educational needs in mainstream schools in Egypt

Following an interpretive-constructivist research approach, this study aimed to explore the complexity of the inclusion of children with special educational needs (SEN) in mainstream schools in the Egyptian context, with a particular focus on teachers’ attitudes towards this process. Specifically, the study aimed to investigate a) Egyptian teachers’ understanding of and attitudes towards inclusive education; b) the influences and experiences that shaped their attitudes; c) teachers’ perceptions about barriers to inclusive education; d) teachers’ perceptions about the changes required to put inclusion into practice in Egypt. A further significant aim of the study was to generate some insights from the findings which could be useful to understand inclusion policy in Egypt and to improve future planning and implementation. The study adopted a multi-method design incorporating both quantitative and qualitative methods (questionnaire and interviews) for data collection in two phases. In phase one, 285 Egyptian teachers were selected randomly and responded to the questionnaire. In phase two, twelve teachers with diverse experiences were chosen purposely for conducting the interviews. Data were analyzed both quantitatively and qualitatively. The findings of the study suggest that Egyptian teachers tend to hold mildly favourable to favourable attitudes towards inclusion. However, uncertainty and concerns were also expressed about the lack of support, resources, training, time, curriculum and pedagogy, collaboration and social attitudes and beliefs about disability. Therefore, teachers in the current study supported the inclusion of certain categories of children with SEN rather than adopting a zero-rejection model of inclusion. Also, the participating teachers adopted an interactive approach in their understanding of disability, which recognizes the interplay between the within-child factors and the environmental factors. Also, one of the main findings in the current study was teachers’ conceptualization of children with SEN as different, regardless of their attitudes towards the inclusion process. Additionally, the findings showed that most teachers adopted a socio-cultural-religious discourse in their understanding of inclusion and disability; a discourse embedded in their religious commitment or at least in their interpretations of the religious values and principles. This discourse supports the calls for considering inclusion and SEN within a cultural model that takes into account the common values about disability in any given context which consequently will affect the educational provision in that context. 6 The findings also indicated that positive teaching experience and in-service training played a role in shaping positive attitudes. Moreover, the findings showed the significant role that the socio-cultural multilayered contexts played in shaping teachers’ conceptualizations of inclusion and disability and their attitudes towards inclusion. The findings also showed that barriers to inclusion can be categorized into four categories: structural-organizational, personal, interpersonal and socio-cultural barriers. All types of barriers were shown to be related, and they interacted together to affect teachers’ understanding of and attitudes towards inclusion and the way inclusive practices can be developed. Finally, teachers suggested several strategies like, building teachers’ commitment, developing national inclusive educational policy and overcoming all the structural-organizational and the cultural barriers in order to put inclusion into practice. Additionally, the study has challenged the traditional and reductionist assumptions of change in the case of inclusion which is based mainly on providing resources. The study argued that unless educational change is tactically directed to the questioning of exclusionary thinking, inclusion will continue to constitute a rhetorical apparition within mainstream settings, with dreadful consequences for the education and welfare of disabled children. Finally, the study ended with utilising its findings with the help of the previous literature to suggest some theoretical implications for developing the theory of inclusion and SEN/disability and attitudes, and providing a set of recommendations for policy, curriculum and pedagogy, teacher education and methodology. Areas for further research investigations are also suggested

Percutaneous drainage of delayed post-cardiac surgery pericardial effusion

Background: Pericardial effusion and tamponade are common following valve surgery. The optimal treatment of symptomatic pericardial effusions remains controversial. The objective of this study was to present our experience in non-surgical management of delayed postoperative pericardial effusion. Methods: This retrospective study was conducted on 64 patients who had delayed pericardial effusion after cardiac surgery from 2016 to 2020. Eight patients were excluded due to the presence of inaccessible posterior or clotted pericardial effusion and were managed surgically, and 56 patients had percutaneous drainage of the pericardial fluid and were included in the analysis. Results: The mean age was 46.84±11.67 years (range: 22- 68 years), and 46.43% were females. The patients had coronary artery bypass grafting (n= 9), Aortic valve replacements  (n= 13), Mitral valve surgery (n= 21), double valve replacements (n= 8) and  combined procedures (n= 5).  All patients complained of varying degrees of exertional dyspnea. There were statistically significant differences between INR in different cardiac surgeries. Mean INR following mitral valve replacement (4.72±0.63) was significantly higher than in aortic valve replacement patients (3.32±0.34; p<0.001) and aortic valve patients (1.76±0.24; p<0.001). Fifteen patients (26.78%) had a large pericardial effusion. Successful drainage was achieved in all cases. Complications were pneumothorax (n= 2, 3.57%), recurrent effusions (n= 4, 7.14%), arrhythmias (n= 7, 12.5%), myocardial punctures (n= 2, 3.57%) and no mortality was reported. Conclusions: percutaneous drainage of postoperative pericardial effusion under radiological guidance is generally safe. Pericardial effusion is common after mitral valve surgery, which could be related to higher INR in these patients

The effect of food elimination and probiotic supplementation in asthmatic children with food allergy

Background: Both bronchial asthma and food allergy are comorbidities of increase prevalence and growing concern worldwide. Objectives: to detect the prevalence of food allergy in children with bronchial asthma, the effect of food elimination and probiotic supplementation on the clinical outcome of asthma and the quality of life (QOL). Methods: This randomized controlled trial included 226 children aged from 4 to 18, suffering from bronchial asthma, 88 of whom had associated food allergy. Patients who suffered food allergy as diagnosed by history, prick to prick test food elimination and oral food challenge test, were randomly divided into four groups, each comprised 22 children. Group (1): received pharmacological treatment only, group (2): received pharmacological treatment and probiotic supplementation, group (3): practiced food elimination and received pharmacotherapy, and Group (4): practiced food elimination and received probiotic supplementation and pharmacological therapy. For patients in all groups, grading of asthma severity, measurement of total IgE and Pediatric Asthma quality of life questionnaire (PAQLQ) were performed before and after 6 months at the end of the study. Results: There were significant statistical improvements of severity of asthma, total serum IgE level and QOL for all groups before and after intervention. The best outcome was achieved in children who practiced avoidance of food allergen(s) and took probiotic supplementation in addition to the pharmacological therapy (p <0.001). Conclusion: Diagnosis of food allergy in asthmatic children is mandatory and combining pharmacological therapy, avoidance of the offended food allergen and intake of probiotics are encourage

The association between helicobacter pylori infection and hyperemesis gravidarum

Background: Hyperemesis gravidarum (HG), a disorder characterized by ongoing severe nausea and vomiting with resulting ketosis, affects 0.3–2% of women during pregnancy. Helicobacter pylori (H. pylori) infection is one of the most common and endemic human infections worldwide, causing a number of very common and important gastrointestinal problems.Objective: We aimed to find the association between H. pylori infection and hyperemesis gravidarum.Patients and Methods: This prospective case control study was conducted at Manshiet El-Bakry General Hospital from October 2020 till June 2021 and performed on 32 patients who had a clinical diagnosis of hyperemesis gravidarum in the first trimester and 32 normal pregnant women who served as control groupResults: Our results revealed that Helicobacter pylori stool antigen was significantly more frequent in hyperemesis gravidarum group.Conclusion: As evident from the current study, there was a strong association between H. pylori infection and HG, allowing us to conclude that H. pylori should, therefore, be considered as one of the risk factors of HG pointing to H. pylori as one contributing factor of this complication of pregnancy. H. pylori testing should be included in investigations of HG, especially when the condition does not respond to treatment and in cases continuing past the first trimester. Appropriate therapeutic non-teratogenic regimens for eradication of H. pylori could be considered to relieve the symptoms of HG in some intractable cases