Egypt’s competitiveness: empirical examination of the relationship between destination attributes, tourist satisfaction and behavioral intentions among hotel guests

Purpose – The main objective of this study is to use the destination competitiveness model to examine guest satisfaction regarding the different attributes of Egypt within the scope of North African tourist destinations. Design – Both qualitative and quantitative methods were used for data collection in the research. Methodology/approach – The current study applied a self-administered questionnaire targeting visitors of Sharm El Sheikh- 4 and 5 star hotels, which included eight constructs designed to measure tourists’ satisfaction with different competitiveness attributes of Egypt as a tourist destination. Data was collected through a convenience sample of 243 tourists who visited at least two Egyptian tourist destinations. Findings – Results of the study revealed that the physiography and climate of Egypt were perceived to be the most important satisfying attributes. In addition, the availability of a diverse range of activities during tourists’ visit was perceived as the least satisfying attribute. The findings also highlight the importance of Egypt’s historical, cultural, and natural attractions towards the positive satisfaction of visitors, the relationship between the country’s core and supporting attributes, the low affectivity of Egypt’s touristic brand, the global media’s overreaction to safety and security issues in Egypt, and Sharm El Sheikh’s image as a destination of good value. Finally, tourists overall satisfaction was found to be positively predicting both tourists\u27 re-purchase and intention to recommend Egypt to other tourists. Originality of the research – With not enough previous research attempting to discern the effect of Egypt’s destination attributes on tourists satisfaction, this work behaves as a gateway for a large range of future research concerning Egypt’s competitiveness

Knowledge, Attitude and Practice of Diabetic Patients (Type II) Regarding Life Style Modification at Qena University Hospital in (Upper Egypt)

Diabetes mellitus (DM) is a metabolic disorder of multiple etiological factors characterized by chronic hyperglycemia with disturbance of carbohydrate, fat  and  protein metabolism which resulted from either insufficient Insulin secretion, resistance to the action of Insulin or both .The purpose of this study was to assess Knowledge, attitude and practice of diabetic patients ( type II)  regarding life style modification. A descriptive study was conducted using a structured questionnaire amongst 150 type II diabetic patients seen at the diabetic clinic at Qena University Hospital in( UpperEgypt) from the first of June (2015) to the end of August (2015). Socio-demographic characteristics of the participants were obtained and their knowledge, attitude and practice regarding lifestyle modification were assessed. Results showed that more than three quarter of the participants had poor knowledge regarding the benefits of exercise and weight loss ,while 84% had poor knowledge regarding a healthy diet. About the practice, participants showed poor practice to life style modification. Nevertheless, our patients had positive attitude toward healthy lifestyle habits which could potentially be harnessed and translated into healthy lifestyle practices. A Life style modification has important roles in management and prevention of many chronic diseases like (type II) DM. It was recommended that implementation of health education programs about life style modification importance of physical exercise and weight loss, fast food, smoking and drinking (alcohol) to the general society should be by the responsible body. Medical nutrition intervention program should be implemented with a multidisciplinary team (nurses, doctors, dietician, pharmacists…) Keywords: Diabetes Mellitus (type II) - knowledge, attitude, practice and life style modificatio

Asymmetric impacts of oil price shocks on government expenditures: Evidence from Saudi Arabia

This paper investigates the effect of oil price shocks on government expenditures on the health and education sectors in Saudi Arabia. Using a quarterly dataset 1990Q1–2017Q2 and employing a non-linear autoregressive distributed lag (NARDL) model, our research shows evidence of a non-linear relationship between oil prices and government expenditures in Saudi Arabia, where a negative oil price shock would have a statistically significant different impact in the long run compared to a positive shock. We build upon our empirical findings and draw some policy recommendations for Vision 2030 of Saudi Arabia

Prevalence and Antibiogram of Escherichia coli isolates recovered from bovine milk

Antimicrobial resistance is considered a major threat facing humanity. It doesn’t only affect public health, but also causes great losses in the dairy industry. Mastitis is a major threat to the dairy industry. The aim of this study was to monitor the antimicrobial resistance of Escherichia coli (E. coli) collected from raw milk of both healthy and mastitis cows and buffaloes in Egypt. In total, 450 milk samples were collected and examined in the period from 2018 to 2021. The samples were collected from healthy cows and buffaloes (30, 58), suffering from clinical mastitis (139, 223) respectively. E. coli was isolated from 33 mastitis milk samples (9.1%) and from 3 (3.4%) normal milk samples. The antibiotic susceptibility testing was performed using the disc diffusion method (Kirby-Bauer method). E. coli isolated from mastitis milk samples showed resistance to amoxicillin-clavulanic acid (75.8%), ceftazidime (75.8%), colistin (69.8%), ampicillin (39.4%), imipenem (24.2%), trimethoprim-sulfamethoxazole (24.2%), aztreonam (15.2%), cefotaxime (15.2%), tetracycline (15.2%), ciprofloxacin (12.2%), chloramphenicol (6%), and gentamicin (3%). E. coli isolated from normal milk samples showed resistance to ampicillin, and imipenem (66.7%), each, and amoxicillin-clavulanic acid, tetracycline, and trimethoprim-sulfamethoxazole (33.3%), each. The Extended Spectrum -Lactamases test (ESBL) performed on the E. coli isolates showed positive results in 9% of mastitis milk samples, but no results in normal milk samples. Out of 36 E. coli isolates, 34 possessed the ampC gene, but blaTEM and blaSHV were detected in 5 isolates with percentages of 94%, 1.4%, and 1.4%, respectively, while BlaIPM and Sul1 were found in one isolate (2.7%), for each

AM-1241 CB2 Receptor Agonist Attenuates Inflammation, Apoptosis and Stimulate Progenitor Cells in Bile Duct Ligated Rats

BACKGROUND: The cannabinoid receptor 2 (CB2) plays a pleiotropic role in the innate immunity and is considered a crucial mediator of liver disease. Cannabinoid CB2 receptor activation has been reported to attenuate liver fibrosis in CCl4 exposed mice and also plays a potential role in liver regeneration in a mouse model of I/R and protection against alcohol-induced liver injury. AIM: In this study, we investigated the impact of CB2 receptors on the antifibrotic and regenerative process associated with cholestatic liver injury. METHODS: Twenty-six rats had bile duct ligation co-treated with silymarin and AM1241 for 3 consecutive weeks. Serum hepatotoxicity markers were determined, and histopathological evaluation was performed. RESULTS: Following bile duct ligation (BDL) for 3 weeks, there was increased aminotransferase levels, marked inflammatory infiltration and hepatocyte apoptosis with induced oxidative stress, as reflected by increased lipid peroxidation. Conversely, following treatment with the CB2 agonist, AM-1241, BDL rats displayed a reduction in liver injury and attenuation of fibrosis as reflected by expression of hydroxyproline and α-smooth muscle actin. AM1241 treatment also significantly attenuated lipid peroxidation end-products, p53-dependent apoptosis and also attenuated inflammatory process by stimulating IL-10 production. Moreover, AM1241 treated rats were associated with significant expression of hepatic progenitor/oval cell markers. CONCLUSION: In conclusion, this study points out that CB2 receptors reduce liver injury and promote liver regeneration via distinct mechanisms including IL-10 dependent inhibition of inflammation, reduction of p53-reliant apoptosis and through stimulation of oval/progenitor cells. These results suggest that CB2 agonists display potent hepatoregenrative properties, in addition to their antifibrogenic effects

Correlation between platelet count and outcome of chronic HCV patients treated with direct-acting antivirals

Background: Egypt has the highest prevalence of chronic hepatitis C virus (HCV) infection. The direct acting anti-virus (DAAs) are available, with a reported 95% sustained virological response after treatment for 12 weeks (12w-SVR). Objectives: The current study aimed to assess the correlation between platelet count and the DAAs therapy outcome in chronic HCV (CHC) patients. Patients and methods: three hundred CHC patients, Child–Pugh grade A, both naïve and treatment experienced patients were enrolled in this study, from outpatient Clinic, Department of Gastroenterology, Hepatology and Tropical medicine, Qena university hospital, Qena, Egypt, treated with DAAs for 12 weeks, either dual or triple therapy, according to criteria recommended by the national committee for chronic viral hepatitis (NCCVH). Patients categorized into three groups: (1) Group I (non-thrombocytopenic group): included 100 CHC patients with platelet count ≥ 150 (109/L); (2) Group II (mild thrombocytopenic group): included 100 CHC patients with platelet count 100-149 (109/L); (3) Group III (moderate thrombocytopenia): included 100 CHC patients with platelet count 50–99 (109/L). Results: The Overall CHC patient's mean age were (48.2 ± 11), 226 (75.33%) were males and 74 (24.67%) were females. 97.6% (293/300)of CHC patients attainedSVR; 97 % in (Group I), and 98 % in both (Group II), and (Group III), after 12 weeks DAAs therapy with no significant difference between groups. Conclusion: both DAAs treatment modalities were efficient in the eradication of HCV; however, thrombocytopenia in CHC patients does not affect the DAAs therapy outcome

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020