Assessment of knowledge, attitude and practice of hand washing among health care workers in Ain Shams University hospitals in Cairo

Most nosocomial infections are thought to be transmitted by the hands of health care workers. The aim of this work was to assess the knowledge, attitude and practice of hand washing among health care workers (HCW) in Ain-Shams University hospitals and to investigate the presence of the necessary facilities and supplies required for hand washing (HW) in ten wards. A cross- sectional descriptive and observational study was conducted for six months from June till November 2006. Observation of the HCW for hand washing practice was done at any opportunity of contact with the patients in the different wards by members of the infection control team. Knowledge & attitude of HCW towards hand hygiene was done through self-administered questionnaire to HCW in 10 different departments. The total opportunities observed were 2189 opportunities. Doctors showed a signifi- cantly higher compliance (37.5%) than other groups of HCW (P = 0.000), however only 11.6% of the opportunities observed for doctors were done appropriately. The most common type of HW practiced among HCW was the routine HW (64.2%) and the least was the antiseptic HW (3.9%). Having a short contact time and improper drying (23.2%) were the most common errors that lead to inappropriate HW. Most of the wards had available sinks (80%) but none of them had available paper towels. The mean knowledge score was higher in nurses compared to doc- tors (42.6 ± 11.7 versus 39.1 ± 10.5). Most of the nurses (97.3%) believe that administrative orders and continuous observation can improve hand washing practices. Implementation of mul- tifaceted interventional behavioral hand hygiene program with continuous monitoring and performance feedback, increasing the supplies necessary for HW and institutional support are impor- tant for improving the compliance of hand hygiene guidelines

Transcriptome-wide analysis reveals different categories of response to a standardised immune challenge in a wild rodent

Individuals vary in their immune response and, as a result, some are more susceptible to infectious disease than others. Little is known about the nature of this individual variation in natural populations, or which components of immune pathways are most responsible, but defining this underlying landscape of variation is an essential first step to understanding the drivers of this variation and, ultimately, predicting the outcome of infection. We describe transcriptome-wide variation in response to a standardised immune challenge in wild field voles. We find that markers can be categorised into a limited number of types. For the majority of markers, the response of an individual is dependent on its baseline expression level, with significant enrichment in this category for conventional immune pathways. Another, moderately sized, category contains markers for which the responses of different individuals are also variable but independent of their baseline expression levels. This category lacks any enrichment for conventional immune pathways. We further identify markers which display particularly high individual variability in response, and could be used as markers of immune response in larger studies. Our work shows how a standardised challenge performed on a natural population can reveal the patterns of natural variation in immune response

New approximations for the cone of copositive matrices and its dual

We provide convergent hierarchies for the cone C of copositive matrices and its dual, the cone of completely positive matrices. In both cases the corresponding hierarchy consists of nested spectrahedra and provide outer (resp. inner) approximations for C (resp. for its dual), thus complementing previous inner (resp. outer) approximations for C (for the dual). In particular, both inner and outer approximations have a very simple interpretation. Finally, extension to K-copositivity and K-complete positivity for a closed convex cone K, is straightforward.Comment: 8

Correlation of magnetic resonance imaging findings with arthroscopy in the evaluation of rotator cuff pathology

Objective: The purpose of this study was to compare the accuracy of magnetic resonance imaging in clinically diagnosed rotator cuff disease based upon the radiologist’s interpretation with actual intraoperative arthroscopic findings being used as the reference standard in a Kenyan outpatient practice.Design: This was a retrospective cohort study.Setting: The study was carried out at Plaza Advanced Imaging Centre over a period of one year from December 2011 to November 2012.Methods: Using the University of Nairobi and Kenyatta National Hospital Ethics Committee approved protocol medical records of thirty four randomly selected consecutive patients with shoulder pain were evaluated. The records of these patients were reviewed to determine the demographics, radiologists MRI interpretations, and the surgeon’s operative findings.Results: Thirty four (79%) patients out of the targeted sample size of 43 were successfully evaluated with an aim of establishing the accuracy and sensitivity of MRI in the diagnosis of rotator cuff pathology in relation to arthroscopic findings. Twenty one (62%) of the patients were male, while the female patientss were 13 (38%).Conclusions: In the present study the sensitivity of MRI in diagnosing of rotator cuff pathology was low but the specificity was high. This means that MRI missed a number of lesions, but of those that were picked the specificity was high. Given the relatively low sensitivity findings of the study compared to previous studies done elsewhere there is need to have a trained dedicated musculoskeletal radiologist. However, there exists a significant correlation between the diagnoses made under MRI and arthroscopy.Results from this study will serve as a useful guide to orthopaedic surgeons in planning the management pathway for patients with rotator cuff pathology and will also highlight areas in need of improving interpretation skills and imaging protocols for radiologists in the country

Epidemiologic pattern of falls among inpatients in Ain Shams University Hospitals in Cairo, Egypt

Background. Patient falls and injuries during hospitalization is a good quality indicator of safety of inpatients. Data on inpatients falls are deficient in Egyptian hospitals. Ain Shams university hospitals do not have any recording system for falls. Aim. This study aimed at estimating the incidence density of falls and describing pattern and risk factors contributing to falls in Ain shams university hospitals. Subjects and methods. A prospective follow up study was conducted on inpatients admitted to Ain Shams university hospitals. Patients were followed up for a maximum of two weeks for the occurrence of fall. An interview questionnaire addressed to in-patients was designed to investigate the incident of fall. Type of fall, provisional cause, consequences, night or day timing of fall, walking condition in hospital and past history of fall were among the factors investigated in the incident of fall. Questionnaire assessing the basic and instrumental daily activities for the elderly (? 60 years) was completed. Results. 1779 patients were included in the study in eight different wards with a mean age of 41.8 years. The incidence density of falls was 9 per 1000 patient days. Logistic regression analysis identified male gender, walking difficulties in-hospital and history of falls before hospitalization as independent risk factors for falls among below 60 years patients. Conclusion. Incidence of falls is relatively high among the studied university hospitals. Identified risk factors differed among adults compared to elderly. Recommendations. Measuring, monitoring and assessing fall rates are strongly recommended using a valid and reliable tool to improve quality of health services

Endolysosomal targeting of a clinical chlorin photosensitiser for light-triggered delivery of nano-sized medicines

A major problem with many promising nano-sized biotherapeutics including macromolecules is that owing to their size they are subject to cellular uptake via endocytosis, and become entrapped and then degraded within endolysosomes, which can significantly impair their therapeutic efficacy. Photochemical internalisation (PCI) is a technique for inducing cytosolic release of the entrapped agents that harnesses sub-lethal photodynamic therapy (PDT) using a photosensitiser that localises in endolysosomal membranes. Using light to trigger reactive oxygen species-mediated rupture of the photosensitised endolysosomal membranes, the spatio-temporal selectivity of PCI then enables cytosolic release of the agents at the selected time after administration so that they can reach their intracellular targets. However, conventional photosensitisers used clinically for PDT are ineffective for photochemical internalisation owing to their sub-optimal intracellular localisation. In this work we demonstrate that such a photosensitiser, chlorin e6, can be repurposed for PCI by conjugating the chlorin to a cell penetrating peptide, using bioorthogonal ligation chemistry. The peptide conjugation enables targeting of endosomal membranes so that light-triggered cytosolic release of an entrapped nano-sized cytotoxin can be achieved with consequent improvement in cytotoxicity. The photoproperties of the chlorin moiety are also conserved, with comparable singlet oxygen quantum yields found to the free chlorin

Flexible synthesis of cationic peptide-porphyrin derivatives for light-triggered drug delivery and photodynamic therapy

Efficient syntheses of cell-penetrating peptide-porphyrin conjugates are described using a variety of bioconjugation chemistries. This provides a flexible means to convert essentially hydrophobic tetrapyrolle photosensitisers into amphiphilic derivatives which are well-suited for use in light-triggered drug delivery by photochemical internalisation (PCI) and targeted photodynamic therapy (PDT)

Measuring health inequality among children in developing countries: does the choice of the indicator of economic status matter?

Background Currently, poor-rich inequalities in health in developing countries receive a lot of attention from both researchers and policy makers. Since measuring economic status in developing countries is often problematic, different indicators of wealth are used in different studies. Until now, there is a lack of evidence on the extent to which the use of different measures of economic status affects the observed magnitude of health inequalities. Methods This paper provides this empirical evidence for 10 developing countries, using the Demographic and Health Surveys data-set. We compared the World Bank asset index to three alternative wealth indices, all based on household assets. Under-5 mortality and measles immunisation coverage were the health outcomes studied. Poor-rich inequalities in under-5 mortality and measles immunisation coverage were measured using the Relative Index of Inequality. Results Comparing the World Bank index to the alternative indices, we found that (1) the relative position of households in the national wealth hierarchy varied to an important extent with the asset index used, (2) observed poor-rich inequalities in under-5 mortality and immunisation coverage often changed, in some cases to an important extent, and that (3) the size and direction of this change varied per country, index, and health indicator. Conclusion Researchers and policy makers should be aware that the choice of the measure of economic status influences the observed magnitude of health inequalities, and that differences in health inequalities between countries or time periods, may be an artefact of different wealth measures used

A candidate tolerance gene identified in a natural population of field voles (Microtus agrestis)

The animal immune response has hitherto been viewed primarily in the context of resistance only. However, individuals, can also employ a tolerance strategy to maintain good health in the face of on-going infection. To shed light on the genetic and physiological basis of tolerance, we use a natural population of field voles, Microtus agrestis, to search for an association between the expression of the transcription factor Gata3, previously identified as a marker of tolerance in this system, and polymorphism in 84 immune and non-immune genes. Our results show clear evidence for an association between Gata3 expression and polymorphism in the Fcer1a gene, with the explanatory power of this polymorphism being comparable to that of other non-genetic variables previously identified as important predictors of Gata3 expression. We also uncover the possible mechanism behind this association using an existing protein-protein interaction network for the mouse model rodent, Mus musculus, which we validate using our own expression network for M. agrestis. Our results suggest that the polymorphism in question may be working at the transcriptional level, leading to changes in the expression of the Th2-related genes, Tyrosine-protein kinase BTK and Tyrosine-protein kinase TXK, and hence potentially altering the strength of the Th2 response, of which Gata3 is a mediator. We believe our work has implications for both treatment and control of infectious disease

Scattering theory with finite-gap backgrounds: Transformation operators and characteristic properties of scattering data

We develop direct and inverse scattering theory for Jacobi operators (doubly infinite second order difference operators) with steplike coefficients which are asymptotically close to different finite-gap quasi-periodic coefficients on different sides. We give necessary and sufficient conditions for the scattering data in the case of perturbations with finite second (or higher) moment.Comment: 23 page