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Mathematical models are powerful tools to analyze pathogen spread and assess control strategies in healthcare settings. Nevertheless, available models focus on nosocomial transmission through direct contact or aerosols rather than through blood, even though bloodborne pathogens remain a significant source of iatrogenic infectious risk. Herein, we propose an agent-based SEI (Susceptible-Exposed-Infected) model to reproduce the transmission of bloodborne pathogens dynamically within hospitals. This model simulates the dynamics of patients between hospital wards, from admission to discharge, as well as the dynamics of the devices used during at-risk invasive procedures, considering that patient contamination occurs after exposure to a contaminated device. We first illustrate the use of this model through a case study on hepatitis C virus (HCV) in Egypt. Model parameters, such as HCV upon-admission prevalence and transition probabilities between wards or ward-specific probabilities of undergoing different invasive procedures, are informed with data collected in Ain Shams University Hospital in Cairo. Our results suggest a low risk of HCV acquisition for patients hospitalized in this university hospital. However, we show that in a low-resource hospital, frequent device shortages could lead to increased risk. We also find that systematically screening patients in a few selected high-risk wards could significantly reduce this risk. We then further explore potential model applications through a second illustrative case study based on HBV nosocomial transmission in Ethiopia. In the future, this model could be used to predict the potential burden of emerging bloodborne pathogens and help implement effective control strategies in various hospital contexts.

Background Good work boosts mental health, self-esteem, and earnings, while physicians are more likely to experience burnout and dissatisfaction with work-life balance, leading to decreased productivity. This study aimed to identify the factors shaping the relationship between medical staff in academic and clinical departments and to describe the overall working environment. Methods The current study was conducted among demonstrators/residents, assistant lecturers, and lecturers from academic and clinical departments of a tertiary care hospital in Cairo, Egypt. Mixed methods were used. For the quantitative part, a comparative cross-sectional study was conducted on 228 clinical and 89 academic participants. The Doctor-Doctor Relationship and Workplace Environment Evaluation Scale (DDRWEE) was computed using 18 statements with a 3-point Likert scale. For the qualitative part, 16 in-depth interviews were conducted with 8 clinical and 8 academic participants. Results The mean age of academic staff was 32.8 ± 4.5 versus 30.9 ± 4.2 for clinical staff. The factors decreasing the DDRWEE Score were being clinical staff, weak scientific advantages from colleagues, weak practical advantages from seniors, weak ethical advantages from seniors, and thinking of resignation or changing career. For the qualitative part, six themes were generated: Factors affecting relations with colleagues both specifically and generally; Reliability of the statement: “When I become a senior, I will treat juniors the same way I was treated”; Causes of strained relationships between colleagues and reflections from personal experiences; Factors that enhance colleague relationships and reflections from personal experiences; Behavior of colleagues in the department when someone faces accountability: and Qualities of an ideal doctor and suggestions for creating a better doctor-to-doctor work environment. Conclusion The study emphasized the importance of creating a supportive academic and professional environment for medical staff, addressing their practical and emotional needs. This research suggests that while the DDRWEE score has good internal validity, external validation is needed for its wider applicability. Limitations The study’s generalizability to Egyptian physicians is limited due to sample convenience, the need for external validation of the DDRWEE score, and potential reporting bias due to the self-administered questionnaire.

Background: Caesarean section (CS) is a life-saving operation when vaginal delivery is risky to the mother or baby. However, if not medically indicated or performed under suboptimal conditions, it can be harmful and resource-intensive. Aims: To estimate the prevalence of CS in 6 Egyptian governorates and identify possible risk factors (including demographic, social and healthcare services factors) stratified according to geographical areas. Methods: We used secondary data collected from a large survey to investigate the sociodemographic and health indicators of 6 purposefully selected Egyptian governorates with suboptimal health indicators: 3 from Upper Egypt (Sohag, Assiut and Menia) and 3 from Lower Egypt (Sharkia, Beheira and Ismailia). The survey data were gathered using an interview questionnaire that targeted household members. Results: The CS rate was estimated at 55.1% for the 3 years preceding the study, and the highest rate was 67.8% in Behira and the lowest was 49.0% in Assiut. In most governorates, the CS rate was higher in rural than in urban areas, but the difference was not significant. High CS rates were significantly related to higher social class and lower number of children (≤ 3). Conclusion: In the governorates investigated, CS was performed more often, with higher rates than those reported in the 2015 Egypt Health Issue Survey. The adoption of protocols for elective CS should be enforced with a more multisectoral effort. Pregnant women should be well informed of the risks associated with CS and its medical indications.

Background The incidence of osteoporosis in children has increased dramatically during the last decade. This has been attributed to better survival rates of children living with chronic disorders, the increased use of medications known to have a negative impact on the children’s bones, and the increased preference for indoor activities and sedentary life in healthy children. Recent advances in pediatric osteoporosis definition, along with a lack of management recommendations or national consensus on its diagnosis and treatment, have led to a wide range of approaches being implemented to manage this illness. The aim of this work was to develop an optimal evidence-based consensus, target-oriented, on-steered therapeutic approach for children with osteoporosis. Based on 15 key clinical questions, a qualitative literature evaluation was conducted to provide evidence-based recommendations for the treatment of pediatric osteoporosis. An expert panel of 14 pediatric osteoporosis specialists conducted a Delphi survey. The level of evidence for each element was assessed using the Oxford Centre for Evidence-based Medicine (CEBM) System, when available, and/or based on the expert panel’s personal experience. All recommendations with an agreement rate of 75% or higher were included. Results Thirty-six recommendations, categorized into 13 domains, had evidence 4 or 5 and consequently were included in the Delphi survey. This was assessed online and a response rate of 82.4% was achieved. Delphi 2 round revealed that all the recommendations achieved 75% or more level of agreement and therefore have been accepted and included in this management recommendations. Based on that an algorithm showing an approach to pediatric osteoporosis management and maintenance of therapy has been developed. Conclusion For the management of children with osteoporosis, consulting a pediatric bone specialist is strongly advised, either by referral or by advice. This is extremely relevant because children are uniquely capable of recovering spontaneously or with the assistance of medication. This includes also vertebral fractures reshaping. Consequently, there is a huge opportunity to improve bone mass accretion and thus musculoskeletal health in children with osteoporosis.

After the key clinical questions were identified by the core team, a systematic review of the published research was carried out focusing on variable capillaroscopic techniques, definitions, and characteristics, including capillary density (number of capillaries),capillary morphology (shape of each capillary), capillary dimensions (width of apical, arterial, and venous limb of the capillary), and the presence of hemorrhages. Following the core team's identification of the key questions, a dedicated team conducted a systematic review of studies, focusing on the most appropriate NFC techniques, capillaroscopic characteristics and definitions, scoring systems, and image acquisition and interpretation reliability, as well as reporting. By screening the titles and abstracts, 1,281 were ruled out (duplicate studies, studies that did not match the study design of interest, studies that did not examine the patient of interest or did not report the outcome measures of interest). [...]18 studies that were relevant were included in the complete article review (Figure 1).

IgA vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, is the most common cause of systemic vasculitis in childhood. Given its potential life-threatening systemic complications, early and accurate diagnosis as well as management of IgAV represent a major challenge for health care professionals. This study was carried out to attain an evidence-based expert consensus on a treat-to-target management approach for IgAV using Delphi technique. The preliminary scientific committee identified a total of 16 key clinical questions according to the patient, intervention, comparison, and outcomes (PICO) approach. An evidence-based, systematic, literature review was conducted to compile evidence for the IgAV management. The core leadership team identified researchers and clinicians with expertise in IgAV management in Egypt upon which experts were gathered from different governorates and health centers across Egypt. Delphi process was implemented (two rounds) to reach a consensus. An online questionnaire was sent to expert panel (n = 26) who participated in the two rounds. After completing round 2, a total of 20 recommendation items, categorized into two sections were obtained. Agreement with the recommendations (rank 7–9) ranged from 91.7–100%. Consensus was reached (i.e. ⩾75% of respondents strongly agreed or agreed) on the wording of all the 20 clinical standards identified by the scientific committee. Algorithms for the diagnosis and management have been suggested. This was an expert, consensus recommendations for the diagnosis and treatment of IgAV and IgA vasculitic nephritis, based on best available evidence and expert opinion. The guideline presented a strategy of care with a pathway to achieve a state of remission as early as possible. Plain Language Summary Given its potential life-threatening systemic complications, early and accurate diagnosis of immunoglobulin A vasculitis represents a major challenge for health care professionals. This work provided cornerstone principles for the management of the condition. Adopting PICO approach and implementing Delphi process a consensus was reached on evidence-based treat-to-target treatment recommendations. This will endorse enhancement and consistency of care of this cohort of patients in standard practice.

Background Inflammation plays a significant role in the development of major depression and bipolar disorders. This research examines albumin as a potential inflammatory biomarker in these conditions to detect its involvement and explore the connection between serum albumin levels and mood disorders during acute phases in a sample of Egyptian psychiatric patients. Objective To determine serum albumin levels in patients with major depressive disorder (MDD) and bipolar affective disorder (BAD) and healthy control; and identify the correlation between serum albumin levels and the severity of symptoms in both conditions. Patients and methods The study is a case control comparative study; the sample was comprised of 50 patients diagnosed with MDD and 50 with BAD, all of whom were experiencing acute episodes at the time of recruitment. Additionally, 50 healthy individuals were selected as the control group. Diagnosis was conducted using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), while symptom severity was assessed using the Beck Depression Inventory II (BDI-II) and the Young Mania Rating Scale (Y-MRS). Blood samples were collected to measure serum albumin levels, and the correlation between albumin levels and the scores from these assessment scales was analyzed. Results The study revealed no statistically significant difference in the serum albumin level in the 3 study groups. However, the correlation coefficient between serum albumin and YMR (Young Mania Rating) score in bipolar patients is − 0.637, while the correlation coefficient between serum albumin and BDI (Beck Depression Inventory) score in major depression patients is − 0.929, both with P -values of less than 0.001, indicating statistical significance. In addition, there is a significant inverse correlation with the age of onset of symptoms of both patients’ groups, suggesting that late age at onset is associated with lower serum albumin levels. Moreover, serum albumin levels vary significantly by age group only in the major depression group, with higher levels observed in the 18–30 years age group compared to older age groups. Conclusion Serum albumin levels did not differ among the MDD, BD, and control groups. However, a notable negative correlation was observed between serum albumin levels and symptom severity in both MDD and BD patients. Further larger controlled studies are required to investigate the potential of serum albumin as a biomarker for assessing the severity of mood disorders.

Background The aim of this work is to set up the standards for performing musculoskeletal ultrasound scans and reporting as an additional procedure in the rheumatology setting. We used two rounds of the Delphi approach to get the consensus on a musculoskeletal ultrasound reporting. Results Fifteen expert panels had completed the two rounds of surveys. After the end of round two, eighteen recommendations distributed upon eight domains were released. The percentage of the agreement on the recommendations was 93.3 to 100 %. All eighteen key questions were answered at the end of the second round with agreement. Conclusion A musculoskeletal ultrasound report template has been developed by this study, based on outcomes of a Delphi process, by an international participants’ panel. All domains met the 80% voting threshold set in this work. The reporting template can be used for both clinical research as well as standard practice to provide guidance and standardize the musculoskeletal ultrasound reporting.

Background Transition of care means the process of educating and empowering adolescents and young adults to take an active role in their own healthcare, develop decision-making skills, and eventually transition from paediatric to adult healthcare providers. Most people do not switch doctors until they are young adults, but it can be beneficial to start preparing children earlier. We aimed to develop a specific toolkit tailored to paediatric and adult rheumatologists to assist them in transitioning of care of young people with juvenile onset rheumatic musculoskeletal diseases from the paediatric to adult rheumatology care. Results The expert panel was confined to an online survey ( n  = 18), all the experts completed the two rounds. At the conclusion of round 2, a total of 10 points were gathered. The range of respondents (ranks 7–9) who agreed with the recommendations was 88.9 to 100%. All 10 clinical standards identified by the scientific committee were written in the same way. Based on the answers to the structured key questions and the literature review, a structured template was developed presenting transition of care integrated pathway. Conclusion The developed rheumatology-specific guideline offers adolescents and young adults a focussed, multidisciplinary transition of care approach with equity of access, quality of care and flexibility and set up standards for transitional care for young adults with juvenile rheumatological diseases.

BackgroundThe prevalence of sarcopenia with osteoporosis results in a higher risk of falling and fractures. It was noted that patients who had completed their planned 5-year denosumab therapy course as treatment for these conditions started to sustain falls.PurposeTo assess (a) whether denosumab has a unique dual effect on both bone and muscle in comparison to other anti-resorptive agents and (b) its effectiveness in the follow-up period post-treatment completion compared to other anti-resorptive agents.MethodOne hundred thirty-five patients diagnosed to have postmenopausal/senile osteoporosis and who were prescribed denosumab were compared to a control group of 272 patients stratified into 2 subgroups – 136 prescribed alendronate and 136 prescribed zoledronate. All patients were assessed for: BMD (DXA), falls risk (FRAS), fracture risk (FRAX), and sarcopenia measures. All were re-assessed after 5 years of denosumab/alendronate therapy and 3 years of zoledronate and 1 year after stopping the osteoporosis therapy.ResultsNo significant baseline demographic differences between the 3 groups. On completion of the 5-year denosumab therapy, there was significant decrease in falls risk (P = 0.001) and significant improvements in all sarcopenia measures (P = 0.01). One-year post-discontinuation of denosumab, a significant worsening of both falls risk and sarcopenia measures (P = 0.01) noticed.ConclusionDenosumab displayed positive impact and significant improvements in BMD and sarcopenia measures. It also enhanced multidirectional agility as depicted by Timed Up and Go (TUG). Collectively, this would explain the reduction of falls risk which got worse on stopping the medication.Key points• The coexistence of osteoporosis and sarcopenia has been recently considered in some groups as a syndrome termed 'osteosarcopenia'.• Bone and muscle closely interact with each other not only anatomically, but also at the chemical and metabolic levels.• Denosumab displayed positive impact and significant improvements in all sarcopenia measures, and enhanced multidirectional agility with consequent reduction in falls risk.• Denosumab can be considered as a first osteoporosis therapeutic option in this group of patients presenting with osteosarcopenia manifestations.