The potentials for corporatization of public hospitals: The case of Egypt

With changing health landscape across the globe, increasing burden of chronic diseases, increasing citizens expectations that accompanied by cost limitations, health reform becomes inevitable for Egyptian health system to maximize benefits and overcome challenges. Reform might include healthcare service provision, health policies, workforce planning or public health programs strategies. New Public Management concepts and principles represent the basis for many of reform plans since its emerging in the early 1990s. Many countries have used New Public Management guiding principles to shape its health reform program. Egypt is undergoing a reform plan across the whole sectors through Egypt 2030 plan announced by Ministry of Planning and Administrative reform. The reform plan has identified a set of goals for the health sector to achieve and another set of indicators to measure the progress and level of achievement. This paper presents corporatization of public hospital as a tool that can fit into the new reform program. With the execution of universal health coverage, the autonomy of hospitals will help to achieve the targeted level of performance, efficiency, and quality of services. The main challenge facing implementation is the high percentage of poverty in Egypt and their dependency on the government hospitals to get healthcare services. Transforming these hospitals into revenue generating organization will affect accessibility except there is a social insurance scheme that can protect poor against the commercialization of healthcare services. Research question: is corporatization improving performance, increasing accessibility and enhancing the quality of healthcare services? Methodology: qualitative research where semi-structured interviews were conducted with healthcare professional and system experts locally and globally to get their views on the feasibility of implementation of such reform in Egypt. Conclusion: corporatization of public hospitals in Egypt represents a fair organizational reform strategy for Egyptian health system to increase efficiency and satisfaction. Yet, a rigorous readiness assessment of the system components (regulations, providers, payers, and beneficiaries) should be executed to measure the readiness for implementation

STR-867: FLEXURAL BEHAVIOUR OF REINFORCED SCC BEAMS CONTAINING RECYCLED CRUMB RUBBER

This study aimed to investigate the effect of crumb rubber (CR) on the flexural behavior and cracking characteristics of self-consolidating concrete beams. Four full-scale self-consolidating rubberized concrete (SCRC) beams containing recycled CR particles as a partial replacement for fine aggregate with percentage ranging from 0% to 15% (by volume of sand) were tested. The performance of some design codes was evaluated in predicting the cracking moment and crack widths of the tested beams. The results indicated that increasing the CR content noticeably reduced the compressive strength, tensile strength, and first cracking moment of all SCRC beams. However, up to 15% replacement of CR, the flexural capacity of the tested beams was shown to be slightly decreased. In addition, increasing the CR content appeared to improve the beams’ ductility and limit the flexural crack widths. In general, the results of flexural loading tests indicated a promising potential for using SCRC in structural applications

Transplantation of Bone Marrow-Derived Mesenchymal Stem Cells Preserve the Salivary Glands Structure after Head and Neck Radiation in Rats

BACKGROUND: The salivary glands are one of the radiation sensitive tissues during radiotherapy in the treatment of head and neck cancer. Within the first weeks of radiotherapy, the radiation causes progressive loss of gland function, then continue throughout the later of the patient’s life. AIM: The present work was designed to discover the potential effect of bone marrow-derived mesenchymal stem cells (MSCs) injected locally and in decreasing the unwanted effects of radiation on rats salivary gland. MATERIAL AND METHODS: 6 rats used as the control group (N) and 12 rats had a single radiation dose of 13Gy in the head and neck then, they were equally allocated into two groups: Irradiated only as a group (C), Irradiated then treated with MSCs as a group (S). The animals were euthanised 7 days post radiation. Then, submandibular salivary glands were cut up; the histological examination was done. RESULTS: Histological examination of the treated group(S) shown an apparent improvement in the SG structure and function compared to the irradiated group (C), this improvement represented mainly as preserving acini diameter ( mean diameter in µm group ( C ) 183.1 ± 4.5, in group (S) 356.3 ± 33.5 while, in (N) group 408.9 ± 5.9) and decrease in fibrotic areas in the gland ( mean fibrosis parentage in group ( C ) 26.5 ± 5.9 in (C ) group , in group (S) 11.7 ± 4.13 while in (N) group 0.2 ± 0.31). CONCLUSION: BM-MSCs has revealed to be promising in mitigating the side effects of radiotherapy on salivary glands structure

The effect of albumin administration on renal dysfunction after experimental surgical obstructive jaundice in male rats

AbstractThe aim was to study the influence of albumin supplementation on the changes of the kidney function and structure in cirrhotic rats induced by common bile duct ligation (BDL). Twenty-four male albino rats weighing 200–250g were divided into Group I: 6 rats underwent laparotomy alone, and the bile duct was only dissected from the surrounding tissue; Group II: 6 rats underwent a sham operation and received 2% albumin in their drinking water; Group III: 6 rats were subjected to bile duct ligation only; and Group IV: 6 rats were subjected to bile duct ligation and received a daily albumin 2% in drinking water. All rats were sacrificed after 4 weeks. We measured the liver and kidney functions and oxidative stress markers in the renal tissue and conducted a histological evaluation of the liver and kidney. The liver enzymes were decreased, but there was no significant difference in the bilirubin levels in group IV compared to group III. There was a significant elevation of serum creatinine in group III compared to group II, and serum creatinine was attenuated in group IV. The renal tissue catalase activity and reduced glutathione, as well as the nitric oxide levels, were significantly increased in group IV and were elevated in group III. Histologically, the livers of group IV showed degeneration and inflammatory cell infiltration with regeneration areas in which normal hepatocytes appeared. The kidneys of group IV showed recovery as well as areas of inflammatory cell infiltration. Some tubules appeared with normal epithelial lining. In conclusion, the results suggest that albumin partially improves the renal functions and structures after their disturbances as a result of BDL

Laparoscopic and bacteriologic evidence of bacterial vaginosis in unexplained infertility

Background: Aim of current study was to estimate the prevalence of Bacterial Vaginosis (BV) among women with Unexplained Infertility (UI) and to describe laparoscopic appearances in positive cases.Methods: Design: Prospective randomized comparative diagnostic trial. Setting: Tertiary care referral facility and University hospital. Patients: One hundred and fifty women divided into UI study group A (120 cases) and a control group B (30 cases). Intervention(s): Vaginal and endouterine swabs form two subgroups of the UI group (60 cases each) and vaginal swabs from control group (30 cases). All swabs were tested using Amsel's criteria then cultured. Thereafter, UI group (60 cases) was subjected to diagnostic laparoscopy. Main outcome measure(s):  the prevalence of BV among women with UI and laparoscopic findings among positive cases.Results: In the study group, the number of positive cases of BV confirmed by culture was 51 cases (42.5%) while it was diagnosed in three cases (10%) in group B (P = 0.0001). In group A, BV was diagnosed in 24 and 27 infertile cases with periods of infertility less than and more than 3 years respectively and in 39 patients (32.5%) with recurrent vaginitis without statistically significant difference. There was an insignificant difference in diagnosis of BV whether the site of sample was the posterior fornix of the vagina or the endometrial cavity. Positive laparoscopic findings were reported in 77 patients (64.2%). The most common laparoscopic abnormalities were hyperemic uterus and chronic salpingitis.   Conclusions: BV is frequently implicated in female infertility and it is probably an underestimated cause of UI. There is no extra benefit from using culture instead of Amsel’s criteria for the diagnosis of BV.  No difference in the site of sample taking in diagnosis of BV from posterior vaginal fornix or endometrial cavity.  Laparoscopy is very beneficial in explaining the effect of BV on the upper genital tract

Assessment the Accuracy of Risk Adjustment in Congenital Heart Surgery Score in Congenital Cardiac Centers at Dakahlya Government

Background: There has been massive progress in congenital cardiac surgery outcomes analysis in the last two decades. The RACHS-1 score was developed to adjust for the huge difference in congenital cardiac pathologies when comparing the operative mortality for children undergoing paediatric congenital heart surgery. Methods: This prospective observational study was conducted on all patients undergoing cardiac surgery in all congenital heart surgery centers in Dakahlya Governorate, where we assessed the operative mortality post-surgery and compared it to the RACHS-1 expected mortality to assess the accuracy of using the RACHS-1 to predict mortality in our society. Results: This study included 559 patients in two years period, VSD was the most frequent diagnosis (13.6%), followed by Single ventricle (11.3%), then TOF (10.4%). VSD closure was the most frequent procedure (11.3%), followed by mB-T shunt (8.9%), then TOF repair (8.1%). Day-30 outcome among the studied cases Mortality was uncommon (7.9%), the main cause was heart in aetiology (43.2%). Mortality was significantly highest in HLHS, and then followed by TAPVD. The overall mortality according to each category was 1.2%, 3%, 8.57%, 17.39%, 0% and 57.1% for category 1, 2, 3, 4, 5 and 6. Conclusion: RACHS-1 is an accurate method to predict mortality early post operatively. Ventricular septal defect (VSD) was the most frequent diagnosis. VSD closure was the most frequent procedure, followed by mB-T shunt, then TOF repair, most of them were elective. The most common category of RACHS-1 was 3. HLHS, RACHS≥3, Palliation operation were significant independent factors increase the day-30 mortality

Hormonal, follicular and endometrial dynamics in letrozole-treated versus natural cycles in patients undergoing controlled ovarian stimulation

The objective of this study was to compare letrozole-stimulated cycles to natural cycles in 208 patients undergoing intrauterine insemination (IUI) between July of 2004 and January of 2007. Group I (n = 47) received cycle monitoring only (natural group), Group II (n = 125) received letrozole 2.5 mg/day on cycle days three to seven, and Group III (n = 36) received letrozole 5 mg/day on cycle days three to seven. There were no differences between the groups in endometrial thickness or P4 on the day of hCG. Estradiol levels had higher variation in the second half of the follicular phase in both letrozole-treated groups compared to the control group. Estradiol per preovulatory follicle was similar in both letrozole cycles to that observed in the natural cycles. LH was lower on the day of hCG administration in the letrozole 2.5 mg/day group vs. the natural group. In summary, letrozole results in some minor changes in follicular, hormonal and endometrial dynamics compared to natural cycles. Increased folliculogenesis and pregnancy rates were observed in the letrozole-treated groups compared to the natural group. These findings need to be confirmed in larger, prospective studies

Capacitive sensor based on molecularly imprinted polymers for detection of the insecticide imidacloprid in water

This manuscript reports on the development of a capacitive sensor for the detection of imidacloprid (IMD) in water samples based on molecularly imprinted polymers (MIPs). MIPs used as recognition elements were synthesized via a photo-initiated emulsion polymerization. The particles were carefully washed using a methanol (MeOH) / acetic acid mixture to ensure complete template removal and were then dried. The average size of the obtained particles was less than 1 mu m. The imprinting factor (IF) for IMD was 6 and the selectivity factor (alpha) for acetamiprid, clothianidin, thiacloprid and thiamethoxam were 14.8, 6.8, 7.1 and 8.2, respectively. The particles were immobilized on the surface of a gold electrode by electropolymerization. The immobilized electrode could be spontaneously regenerated using a mixture of MeOH/10 mM of phosphate buffer (pH = 7.2)/triethylamine before each measurement and could be reused for 32 times. This is the first-time that automated regeneration was introduced as part of a sensing platform for IMD detection. The developed sensor was validated by the analysis of artificially spiked water samples. Under the optimal conditions, the linearity was in the range of 5-100 mu M, with a limit of detection (LOD) of 4.61 mu M

Longitudinal changes in peri-papillary retinal nerve fiber layer thickness in patients with unilateral branch retinal vein occlusion

Background: Associations between retinal venous occlusion (RVO), elevated intraocular pressure, and glaucoma have been reported. Further investigations into structural alterations in the fellow eyes of individuals with unilateral RVO have revealed that the peripapillary retinal nerve fiber layer is thinner than in healthy eyes, suggesting that there may be systemic risk factors common to both RVO and glaucoma. We aimed to evaluate changes in peripapillary retinal nerve fiber layer thickness (pRNFLT) among individuals with unilateral branch retinal vein occlusion (BRVO). Methods: This prospective observational study recruited 30 individuals (60 eyes) with newly diagnosed unilateral BRVO and macular edema, and a control group of 30 healthy individuals (30 eyes) with no abnormalities on fundus examination or concurrent systemic comorbidities. After baseline measurements, the participants were reassessed at 6, 12, and 24 months by measuring global and sectoral pRNFLT using spectral-domain optical coherence tomography. Results: The mean age and sex distributions were comparable between the patient and control groups (both P > 0.05). When compared to fellow eyes, global and sectoral pRNFLT in eyes with BRVO were significantly higher at baseline (all P < 0.05). Over time, pRNFLT decreased dramatically, and by the conclusion of the two-year follow-up, there was a significant reduction from baseline in the affected eyes (all P < 0.05). Likewise, affected eyes experienced a significant improvement in best-corrected distance visual acuity and central macular thickness over the two-year follow-up (both P Less than or equal to 0.001). Comparing the global and all-sector pRNFLT of fellow eyes in the patient group with those of normal eyes in the control group, there were no significant differences at any visit, except in the temporal sector, which revealed a significant reduction in pRNFLT at 24 months in the fellow eyes of patients with unilateral BRVO (P = 0.02).   Conclusions: Patients with unilateral BRVO experienced a significant reduction in pRNFLT in the affected eyes and, to a lesser extent, in the fellow eyes, compared with that of the control arm, suggesting that they are prone to retinal nerve fiber layer damage. The reduction in pRNFLT in the normal fellow eyes of patients with BRVO may be attributed to age or concurrent systemic comorbidities. Further studies with long follow-up periods are required to shed light on the etiology of functional and structural changes in both the retinal nerve fiber layer and ganglion cell complex in the normal and affected eyes of patients with unilateral BRVO