Chest Tube Removal: Efficacy of Cold Application and Breathing Exercise on Pain and Anxiety Level

Context: Post-cardiothoracic surgical chest tube removal (CTR) is considered a painful technique and one of the most painful patients' experiences in the intensive care unit. Painkillers are the most prevalent method to relieve the pain, but the patient may not respond well and achieved complete relaxation. Regardless of scientific advances, no efficient action is possessed to decrease pain and anxiety because of it. Aim: This study aimed to investigate the efficacy of cold application and breathing exercises on pain and anxiety levels following chest tube removal.Methods: A quasi-experimental design (one group pre/post-test) was utilized to achieve the aim. This study was conducted in the Intensive Care Unit at the Cardio-Thoracic Academy Affiliated to Ain Shams University Hospital, Cairo. A Purposive sample included 60 patients undergoing cardiothoracic surgical procedures and having at least two chest tubes in place. Data were collected using three tools; a structured interviewing questionnaire, pain intensity assessment visual numeric scale, short-form McGill pain assessment questionnaire, modified comfort scale, and breathing exercise checklist. Results: This study revealed that patients suffer from severe pain before CTR without cold application and breathing exercise (61.7%), or with the application of them (66.7%), the pain level improved during removal as 80% of patients display no pain when using the cold application and breathing exercise that increased to 95% after 10-15 minute of removal compared to 8.3% when cold application and breathing exercise not used. Otherwise, the anxiety level decreased during CTR as 58.3% had mild anxiety level with cold application and breathing exercises compared to 38.3% had a very severe anxiety level. Mild anxiety level increased to 91.7% after 10-15 minutes of CTR compared to 16.7 % when CTR without application. Conclusion: Cold application and breathing exercises are useful for reducing patients' pain and anxiety levels associated with chest tube removal after cardiothoracic surgery. Encouraging critical care nurses to use cold application and breathing exercises as a non- pharmacological pain relief technique during chest tube removal was highly recommended

Corruption Drives the Emergence of Civil Society

Peer punishment of free-riders (defectors) is a key mechanism for promoting cooperation in society. However, it is highly unstable since some cooperators may contribute to a common project but refuse to punish defectors. Centralized sanctioning institutions (for example, tax-funded police and criminal courts) can solve this problem by punishing both defectors and cooperators who refuse to punish. These institutions have been shown to emerge naturally through social learning and then displace all other forms of punishment, including peer punishment. However, this result provokes a number of questions. If centralized sanctioning is so successful, then why do many highly authoritarian states suffer from low levels of cooperation? Why do states with high levels of public good provision tend to rely more on citizen-driven peer punishment? And what happens if centralized institutions can be circumvented by individual acts of bribery? Here, we consider how corruption influences the evolution of cooperation and punishment. Our model shows that the effectiveness of centralized punishment in promoting cooperation breaks down when some actors in the model are allowed to bribe centralized authorities. Counterintuitively, increasing the sanctioning power of the central institution makes things even worse, since this prevents peer punishers from playing a role in maintaining cooperation. As a result, a weaker centralized authority is actually more effective because it allows peer punishment to restore cooperation in the presence of corruption. Our results provide an evolutionary rationale for why public goods provision rarely flourishes in polities that rely only on strong centralized institutions. Instead, cooperation requires both decentralized and centralized enforcement. These results help to explain why citizen participation is a fundamental necessity for policing the commons.Comment: 24 pages, 7 figures (Press embargo in place until publication

Descriptive Epidemiology of Hemophilia and Other Coagulation Disorders in Mansoura, Egypt: Retrospective Analysis.

Hemophilia represent the most severe inherited bleeding disorder (INB), it’s thought to affect inviduals from all geographical areas in equal frequency. In Egypt which has a population of approximately (80million) consanguineous marriage are frequent, therefore autosomal recessive coagulation disorders reach a higher prevalence than in many other countries

The Relationship between Workplace Bullying for Nurses and Leadership Styles

Background: Workplace bullying is a social and organizational problem within the nursing profession; this phenomenon has significant negative effects and is closely associated with leadership styles. Aim: This study aimed to examine the relationship between workplace bullying for nurses and leadership styles. Design: A descriptive correlational design was used in this study. Setting: This study was conducted at El-Obour Hospital for Health Insurance, Kafr El-Sheikh Branch. Sample: Consisted of a representative sample of staff nurses (N=295). Tools: Two tools were used for data collection: The Negative Acts Questionnaire-Revised (NAQ-R) and the Multifactor Leadership Questionnaire (MLQ). Results: (61.7%) of staff nurses were highly exposed to workplace bullying. Also, the most dominant style was laissez-faire leadership, with the highest mean percentage of respondents. There was a statistically significant negative correlation between staff nurses' exposure to workplace bullying and transformational leadership. There was also a statistically significant negative correlation between staff nurses' exposure to workplace bullying and transactional leadership. While, there was a statistically significant positive correlation between staff nurses' exposure to workplace bullying and laissez-faire leadership. Conclusion: There was a statistically significant, negative correlation between staff nurses’ exposure to workplace bullying (r =-0.285, p< 0.001) and leadership styles. Recommendation: Healthcare organizations should suggest policies and rules to prevent bullying and punish bullies. Nurse Managers should encourage staff nurses to report workplace bullying incidents. Further studies: Explore the staff nurses' perceptions about bullying before and after applying a training program about bullying and strategies to deal with it

Real-Time PCR in the early detection of invasive fungal infection in immunodeficient infants and children

Background: Crucial to the diagnosis and effective therapy of invasive fungal infection (IFI) in the immunodeficient is the early identification of the causative agent especially in patients who lack clinical evidence of the disease. The standard methods for the detection of fungi in clinical specimens are direct microscopy and mycological culture. Microscopy often lacks a satisfactory sensitivity, whereas diagnosis by mycological culture often requires a long growth period. Studies have demonstrated the feasibility of detecting molds and yeast in a single reaction using the universal fungal primer. Objective: Evaluation of the role of real-time PCR in the early detection of fungal infection in immunodeficient patients with suspected IFI, who lack clinical evidence of the disease. Methods: This study included 30 immunodeficiency patients suspected of having IFI; 9 with primary and 21 with secondary immunodeficiency. All patients had at least one host factor, but no clinical criteria according to the EORTC-MSG definition of IFI. Twenty seven had fever and 3 had bronchopneumonia, both not responding to broad spectrum antibiotics for 96 hrs. or more. Blood samples were cultured for fungi and were analyzed with real-time PCR using universal fungal primers. For positive samples of fungal infection, aspergillus-specific primers were used for detection of aspergillus. Results: Seventeen patients (56.7%) proved to have IFI. Blood culture detected Candida in 2 patients only, while PCR detected Candida in another 9 and Aspergillus in 6, thus 15/17 patients with IFI (88%) were missed by blood culture. Blood culture for IFI diagnosis had a very low sensitivity (12%) but had a 100% specificity and positive predictive value. The results PCR did not vary with gender, degree of fever, immunodeficiency type, clinical presentation or current intake of antifungal treatment. Patients with proven IFI showed significantly increased CRP levels as compared to those without infection. Conclusion: Real-time PCR proved superior to culture in early diagnosis of IFI in patients with immunodeficiency before the appearance of the characteristic clinical and imaging signs. Reliance on blood culture alone at that stage would result in missing most of the positive cases with consequent delay in the initiation of specific treatment. Keywords: Invasive fungal infection, immunodeficiency, blood culture, real-time PCR, candida, aspergillusEgypt J Pediatr Allergy Immunol 2012;10(2):67-7

Quality of care of Egyptian asthmatic children: Clinicians adherence to asthma guidelines

<p>Abstract</p> <p>Background</p> <p>Despite the development and dissemination of guidelines for the diagnosis and management of asthma, a gap remains between current recommendations and actual practice.</p> <p>Objectives</p> <p>To assess the physicians attitude towards asthma guidelines and their adherence to its recommendations.</p> <p>Methods</p> <p>Three hundred and fifty two clinicians (101 General practitioners, 131 pediatric specialists, 35 pediatric consultants and 85 doctors did not report the qualification) engaged in direct childhood asthma care in Cairo, Egypt were subjected to a self-administered questionnaire with 35 questions of which most were multiple choices, aiming at assessment of three important aspects about the involved physicians; physician's knowledge, practice and attitude. 165 of the clinicians were working in governmental hospitals, 68 clinicians work in private clinics and 119 clinicians work in both.</p> <p>Results</p> <p>Agreement with asthma guidelines was present in 76.2% of the studied physicians, however those who not in agreement with the guidelines claimed that this was mainly due to patient factors, firstly the poor socioeconomic standard of the patient (18.1%) and secondly due to poor patient compliance (16%). Poor knowledge was found in 28.5%, poor practice was found in 43.6% and poor attitude was found in 14.4% of the studied physicians. There was positive highly significant correlation between qualification and knowledge, (p < 0.01), positive highly significant correlation between qualification and practice, (p < 0.01), and positive highly significant correlation between qualification and attitude, (p < 0.01).</p> <p>Conclusion</p> <p>The attitude of the studied physicians revealed agreement of their majority with the guidelines, while the disagreement was mainly explained by the poor socioeconomic standard of the patients. The degree of poor practice is more marked than that of poor knowledge or poor attitude reflecting resources limitations and applications obstacles in the physician's practice.</p

Chiral Capillary Electrokinetic Chromatography: Principle and Applications, Detection and Identification, Design of Experiment, and Exploration of Chiral Recognition Using Molecular Modeling

This work reviews the literature of chiral capillary electrokinetic chromatography from January 2016 to March 2021. This is done to explore the state-of-the-art approach and recent developments carried out in this field. The separation principle of the technique is described and supported with simple graphical illustrations, showing migration under normal and reversed polarity modes of the separation voltage. The most relevant applications of the technique for enantioseparation of drugs and other enantiomeric molecules in different fields using chiral selectors in single, dual, or multiple systems are highlighted. Measures to improve the detection sensitivity of chiral capillary electrokinetic chromatography with UV detector are discussed, and the alternative aspects are explored, besides special emphases to hyphenation compatibility to mass spectrometry. Partial filling and counter migration techniques are described. Indirect identification of the separated enantiomers and the determination of enantiomeric migration order are mentioned. The application of Quality by Design principles to facilitate method development, optimization, and validation is presented. The elucidation and explanation of chiral recognition in molecular bases are discussed with special focus on the role of molecular modeling

In vitro and in vivo hepatoprotective activity of extracts of aerial parts of Bidens pilosa L (Asteraceae)

Purpose: To investigate the protective effects of aqueous and methanol extracts of Bidens pilosa using various in vivo and in vitro models of hepatic injury.Methods: One kilogram of the aerial parts of Bidens pilosa was used to prepare 80 % methanol and aqueous extracts of the plant (500 g for each extract). The total phenolic content (TPC), total flavonoid content (TFC), and antioxidant activity of both extracts were evaluated. The hepatoprotective activity of these extracts in carbon tetrachloride (CCl4, 0.1 %) and D-galactosamine (700 mg/kg)-induced liver injury, respectively, was investigated in mice. Paracetamol-induced liver injury was used as in vitro reference standard.Results: TPC and TFC of methanol extract were higher than those of the aqueous extract. The combination of methanol extract and silymarin showed the highest antioxidant activity. In vivo administration of CCl4 and D-galactosamine significantly increased the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP), but decreased the total protein, albumin and glutathione (GSH) contents of liver. Co-administration of the extracts (50 mg/kg) and silymarin (100 mg/kg) effectively countered the effects of CCl4 and Dgalactosamine, while also exerting their antioxidant properties. Both methanol and aqueous extracts showed hepatoprotective activity in paracetamol-induced cytotoxicity in primary cultures of rat hepatocytes.Conclusion: Bidens pilosa possesses significant in vivo and in vitro hepatoprotective activity in mice and may be therapeutically useful as a protective agent in acute liver injury.Keywords: Bidens pilosa, D-galactosamine, Carbon tetrachloride, Paracetamol, Liver injury, Hepatoprotective, Antioxidant, Silymarin, Hepatocyte

The role of self-esteem and self-efficacy in women empowerment in the Kingdom of Saudi Arabia: A cross-sectional study

The study aimed to explore the role of self-esteem and self-efficacy in women empowerment among academic and administrative staff at Saudi universities. A cross-sectional design was carried out at 15 governmental universities. A&nbsp; multistage cluster sampling technique was used to select 5587 participants. Multiple linear regression was used to analyze the predictive relation. Data collection included socio-demographic variables, Rosenberg self-esteem scale, general self-efficacy scale, and women empowerment scale. The results indicated that study participants' self-esteem was equally distributed between moderate (49.8%) and high (50.2%). Also, 66.9% of the participants had high self-efficacy, and 86.8% had high total women's empowerment. Regression coefficient showed that self-esteem (B=0.521, b=0.127, t=13.785 and p&lt;0.001) and self-efficacy (B=2.388, b=0.702, t=76.049 and p&lt;0.001) are important predictors of the total women empowerment. However, self-efficacy was observed to be the most dominant predictor (t=76.049). The total model summary shows that 73.4% of the women empowerment level can be predicted through self-esteem and self-efficacy. The study results can be used as a base to build women empowerment programs in the Kingdom of Saudi Arabia (KSA) and help to achieve the 2030 KSA vision regarding women empowerment. Keywords: Self-esteem, self-efficacy, women empowerment, 2030 KSA vision L'étude visait à explorer le rôle de l'estime de soi et de l'efficacité personnelle dans l'autonomisation des femmes parmi le personnelacadémique et administratif des universités saoudiennes. Une conception transversale a été réalisée dans 15 universités gouvernementales. Une technique d'échantillonnage en grappes à plusieurs degrés a été utilisée pour sélectionner 5587 participants.Une régression linéaire multiple a été utilisée pour analyser la relation prédictive. La collecte de données comprenait des variablessociodémographiques, une échelle d'estime de soi de Rosenberg, une échelle d'auto-efficacité générale et une échelle d'autonomisation des femmes. Les résultats ont indiqué que l'estime de soi des participants à l'étude était également répartie entremodérée (49,8%) et élevée (50,2%). En outre, 66,9% des participants avaient une auto-efficacité élevée et 86,8% avaient une forteautonomisation totale des femmes. Le coefficient de régression a montré que l'estime de soi (B = 0,521, b = 0,127, t = 13,785 et p&lt;0,001) et l'auto-efficacité (B = 2,388, b = 0,702, t = 76,049 et p &lt;0,001) sont des prédicteurs importants du l'autonomisation totaledes femmes. Cependant, l'auto-efficacité a été observée comme le prédicteur le plus dominant (t = 76,049). Le résumé total dumodèle montre que 73,4% du niveau d'autonomisation des femmes peut être prédit grâce à l'estime de soi et à l'auto-efficacité. Lesrésultats de l'étude peuvent être utilisés comme base pour élaborer des programmes d'autonomisation des femmes dans le Royaumed'Arabie saoudite (KSA) et aider à réaliser la vision 2030 de la KSA concernant l'autonomisation des femmes. Mots-clés: Estime de soi, efficacité personnelle, autonomisation des femmes, vision 2030 KS

Study The Response of Two Faba Bean Cultivars to Mineral and Bio-Phosphorus Fertilization

Reliance on vegetable protein sources has become an urgent necessity in Egypt due to the high prices of animal protein sources. This research was conducted to study the effect of different rates of mineral phosphate fertilizer with some phosphorous bio-fertilizers (Phosphorine and Microbene) on the productivity and quality of two faba bean cultivars Giza 843 and Masr3 in 2018/2019 and 2019/2020 winter seasons. The results revealed that a significant improvement could be found for most studied traits by the application of 30 kg P2O5/fad of phosphate fertilizer. Moreover, Phosphorine as a bio-fertilizer exhibited a significant enhancement on all studied traits, except shelling% and straw yield in the second season. The cultivars exerted different responses to the rates of phosphate fertilization for plant height, shelling% and protein content in the 2018/2019 season; number of branches/plant and 100 seed weight in the 2019/2020 season; as well as a noticeable response in seed and straw yields/fad, husk, and protein percentages in the two seasons. The interaction between cultivars and bio-fertilizers was significant for seeds protein and carbohydrates content in the 2019/2020 season. Furthermore, phosphate fertilizer rates and bi-fertilizers interaction gave a significant influence on seed yield/fad in both seasons and straw yield/fad in the first season. The second order interaction i.e., cultivars × phosphate × bio-fertilizers possessed a significant effect for seed and straw yields/fad, where the highest seed and straw yields were obtained from Masr1 cultivar when received 30 kg P2O5/fad and inoculated with Phosphorine biofertilizer in both seasons