Assessing the knowledge, attitude, and practice of frontline physicians in Egyptian university hospitals regarding pharyngitis and acute rheumatic fever: a cross-sectional study that calls for action.

BACKGROUND: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major public health issues. Although the primary and secondary prevention of RHD through appropriate management of bacterial pharyngitis and ARF are well-described in the literature, few studies address the knowledge, attitude, and practice (KAP) of developing countries. We aimed to evaluate the KAP of the frontline physicians in Egyptian university hospitals regarding pharyngitis and ARF. METHODS: We employed a cross-sectional design between September 1st, 2022, and January 31st, 2023 using a self-administered questionnaire in 21 Egyptian universities. The questionnaire was developed based on previous studies and recent guidelines and included four domains: sociodemographic data, knowledge, attitude, and practice regarding pharyngitis and ARF. We utilized both online (Google Forms) and paper surveys. Frontline physicians, including interns, residents, and assistant lecturers, were conveniently invited to participate. Furthermore, with the help of participating phycisians in recruiting their colleagues, we utilized the snowball method. Data were analyzed using IBM SPSS version 27 software. RESULTS: The final analysis included 629 participants, of whom 372 (59.1%) were males and 257 (40.9%) had direct contact with ARF patients. Most participants (61.5%) had a fair knowledge level while 69.5% had a fair level of practice regarding ARF and pharyngitis. Higher satisfactory knowledge levels were noted regarding pharyngitis (17.1% vs. 11.3%; p-value: 0.036) and ARF (26.8% vs. 18%; p-value: 0.008) among physicians dealing directly with ARF cases compared to physicians in departments not dealing directly with ARF cases. Physicians in Cairo region universities had significantly higher levels of satisfactory knowledge about ARF compared to Delta and Upper Egypt region universities (p = 0.014). Delta region universities showed significantly lower levels of practice compared to Cairo and Upper Egypt region universities (p = 0.027). The most frequently recognized barriers against health promotion were low socioeconomic status (90.3%) and lack of adequate public education (85.8%). CONCLUSIONS: Despite the fair knowledge and practice levels towards bacterial pharyngitis and ARF among participants, many gaps were still identified that might contribute to RHD prevalence. Educational interventions should be implemented by updating the local guidelines in Egypt for diagnosis and management based on the most recent guidelines.

Tomographic assessment of bone changes in atrophic maxilla treated by split-crest technique and dental implants with platelet-rich fibrin and NanoBone® versus platelet-rich fibrin alone: Randomized controlled trial.

BACKGROUND: This study evaluated the clinical benefits of adding NanoBone® with split-crest technique and simultaneous implant placement covered with platelet-rich fibrin membrane in horizontally deficient maxillary ridges in terms of crestal and horizontal bone changes and patient morbidity. METHODS: Forty patients indicated for maxillary ridge splitting and simultaneous implant placement were assigned randomly to the study groups: control group (Platelet Rich Fibrin membrane) and test group (Platelet Rich Fibrin membrane + Nanobone®). The Cone Beam Computed Tomography Fusion technique was utilized to assess crestal and horizontal bone changes after five months of the surgical procedure. Patient morbidity was recorded for one week post-surgical. RESULTS: Five months post-surgical, buccal crestal bone resorption was 1.26 ± 0.58 mm for the control group and 1.14 ± 0.63 mm for the test group. Lingual crestal bone resorption was 1.40 ± 0.66 mm for the control group and 1.47 ± 0.68 mm for the test group. Horizontal bone width gain was 1.46 ± 0.44 mm for the control group and 1.29 ± 0.73 mm for the test group. There was no significant statistical difference between study groups regarding crestal and horizontal bone changes and patient morbidity. CONCLUSIONS: The tomographic assessment of NanoBone® addition in this study resulted in no statistically significant difference between study groups regarding crestal and horizontal bone changes and patient morbidity. More randomized controlled clinical trials on gap fill comparing different bone grafting materials versus no grafting should be conducted. GOV REGISTRATION NUMBER: NCT02836678, 13th January 2017.

Comparison of post-auricular and frontal bispectral index values obtained during renal surgeries.

BACKGROUND: The bispectral index (BIS) monitor is one of the EEG-derived monitoring techniques and well-established devices used to measure the depth of anesthesia. This study aimed to assess the agreement of BIS values based on the positions of either post-auricular or frontal sensors in individual patients undergoing renal surgeries while lateral positions at various stages of anesthesia. PATIENTS AND METHODS: 12 patients older than 18 years, ASA I-III patients scheduled for elective renal operations, two BIS were placed on each patient, one on each side of the post-auricular region and one across the forehead, and each sensor was connected to a different BIS monitor. We gathered three pieces of data at each of the six-time points: BIS score, signal quality index (SQI) score calculating the signal's strength and electromyography (EMG) score: before the onset of anesthesia (awake) when the eyelash reflex is lost (LOC), after intubation (intubation), following the initial surgical incision, each 30 min throughout the procedure (maintenance), and at the moment the patient's eyes open naturally after waking up from anesthesia (emergence). RESULTS: The overall BIS value at the frontal position was significantly higher than the post-auricular position (52.5 ± 22.2 and 52.1 ± 22.1, respectively, P = 0.010). On the other hand, the BIS value was comparable between the frontal and post-auricular positions at LOC, intubation, 60, 120, and 80 min and at emergence. A strong link between the two sensor positions, as indicated by the correlation coefficient (r = 0.607, P < 0.001), and the Bland-Altman analysis revealed a small mean difference (-1.8) and a low (9.0/- 12.5) limit of agreement, with just 4.3% of the readings falling outside of it during the anesthetic maintenance period. CONCLUSION: Acceptable variation in BIS data was observed when obtained from the two different sensor positions for clinical usage. The post-auricular BIS sensor system may be a suitable substitute for an impractical frontal setup. PROTOCOL REGISTRATION: The study was registered in clinicaltrials.gov on 11/07/2022 (trial registration number: NCT05451823).

Toward Robust and Unconstrained Full Range of Rotation Head Pose Estimation.

Estimating the head pose of a person is a crucial problem for numerous applications that is yet mainly addressed as a subtask of frontal pose prediction. We present a novel method for unconstrained end-to-end head pose estimation to tackle the challenging task of full range of orientation head pose prediction. We address the issue of ambiguous rotation labels by introducing the rotation matrix formalism for our ground truth data and propose a continuous 6D rotation matrix representation for efficient and robust direct regression. This allows to efficiently learn full rotation appearance and to overcome the limitations of the current state-of-the-art. Together with new accumulated training data that provides full head pose rotation data and a geodesic loss approach for stable learning, we design an advanced model that is able to predict an extended range of head orientations. An extensive evaluation on public datasets demonstrates that our method significantly outperforms other state-of-the-art methods in an efficient and robust manner, while its advanced prediction range allows the expansion of the application area. We open-source our training and testing code along with our trained models: https://github.com/thohemp/6DRepNet360.

A review of visual SLAM for robotics: evolution, properties, and future applications.

Visual simultaneous localization and mapping (V-SLAM) plays a crucial role in the field of robotic systems, especially for interactive and collaborative mobile robots. The growing reliance on robotics has increased complexity in task execution in real-world applications. Consequently, several types of V-SLAM methods have been revealed to facilitate and streamline the functions of robots. This work aims to showcase the latest V-SLAM methodologies, offering clear selection criteria for researchers and developers to choose the right approach for their robotic applications. It chronologically presents the evolution of SLAM methods, highlighting key principles and providing comparative analyses between them. The paper focuses on the integration of the robotic ecosystem with a robot operating system (ROS) as Middleware, explores essential V-SLAM benchmark datasets, and presents demonstrative figures for each method's workflow.

Evaluation of intra-articular injection of injectable platelet-rich fibrin, anterior repositioning splint and arthrocentesis in treatment of temporomandibular joint internal derangement.

The current research paper was designed to assess the impact of an intra-articular injection of injectable platelet-rich fibrin (I-PRF) following arthrocentesis and the use of an anterior repositioning splint (ARS) as a proposed treatment approach for addressing symptomatic internal derangement of the temporomandibular joint (TMJ). This study comprised thirty patients who presented with bilateral disc displacement without reduction. The patients were evenly distributed into two groups: Group I underwent treatment involving ARS and arthrocentesis alone, while Group II underwent treatment with ARS, arthrocentesis, and the injection of I-PRF. Clinical assessment of all patients was done postoperatively in the following intervals; first week, first month, third month, and six months for maximum mouth opening (MMO), right and left lateral excursion, and pain score. Magnetic resonance imaging (MRI) assessment for all joints was done at the sixth month postoperatively. Both groups demonstrated improvement in MMO, lateral excursion, and pain. Significant statistical differences were observed in the mean values of MMO and Visual Analogue Scale (VAS), favouring the I-PRF group. MRI postoperatively showed no significant changes in disk position or morphology at the end of the sixth month. Administering an intra-articular I-PRF injection subsequent to arthrocentesis demonstrates effectiveness as a treatment approach for alleviating the signs and symptoms associated with internal derangement of the TMJ.

Association of treatment satisfaction and physician trust with glycemic control among primary care patients with type 2 diabetes in Egypt.

Objectives: To evaluate the association of diabetes treatment satisfaction and trust in family physicians with glycemic control among primary care patients with type 2 diabetes mellitus. Methods: A cross-sectional study on 319 patients with type 2 diabetes mellitus from five primary healthcare centers in Egypt. Data were collected from February to August 2021 using a structured questionnaire that contained six parts: sociodemographic data, disease profile, the Diabetes Treatment Satisfaction Questionnaire (DTSQ), 8-item Morisky Medication Adherence Scale (MMAS-8), self-reported medication knowledge questionnaire (MKQ), and revised healthcare relationship trust scale (HCR). Multiple linear regression analysis was used to assess predictors of treatment satisfaction, physician trust, and HbA1c level. P values less than 0.05 were considered significant. Results: The mean age was 59.66 years (± 7.87 years) and 55.17% were females. Multiple linear regression analysis for predicting HbA1c showed that HbA1c level was lower in patients with higher treatment satisfaction scores (ß = - 0.289, p < 0.001) and higher medication adherence scores (ß = - 0.198, p = 0.001). Treatment satisfaction scores were positively predicted by higher physician trust scores (ß = 0.301, p < 0.001), increased medication adherence scores (ß = 0.160, p = 0.002), and longer duration of diabetes (ß = 0.226, p < 0.001). Positive predictors for physician trust included HbA1c level (ß = 0.141, p = 0.012), medication knowledge (ß = 0.280, p < 0.001), diabetes treatment satisfaction (ß = 0.366, p < 0.001) and medication adherence (ß = 0.146, p = 0.011). Conclusion: Optimizing diabetes treatment satisfaction and physician trust could have favorable associations with medication adherence and medication knowledge with a possible improvement in glycemic control. Family physicians should incorporate patients reported outcomes alongside traditional clinical measures in evaluating diabetes management in primary care.

Impact of aerobic and resistance training on fatigue, quality of life, and physical activity in prostate cancer patients: a systematic review and meta-analysis.

BACKGROUND: Prostate cancer (PCa) is a prevalent cancer with significant morbidity and mortality rates. In most cases, prostate cancer remains asymptomatic until advanced disease manifests with symptoms, such as benign prostate hyperplasia (BPH). Timely detection and better management have improved overall survival in patients with prostate cancer, and fatigue, reduced physical activity, and impaired quality of life (QoL) remain major challenges that impact daily life. OBJECTIVE: This study aimed to systematically review and conduct a meta-analysis to evaluate the impact of aerobic and resistance training on fatigue, quality of life, and physical activity in prostate cancer patients undergoing treatment. MATERIAL METHODS: A comprehensive literature search was conducted using the PubMed, Cochrane Library, and clinicaltrials.gov databases, adhering to the PRISMA guidelines. Twenty studies, involving 1393 participants, were included in the final analysis. The inclusion criteria were Studies that evaluated the effects of exercise interventions relative to passive controls in patients with prostate cancer were included. The primary outcomes of interest were fatigue, QoL, and PA.. Data from eligible studies were extracted, and a meta-analysis was performed using RevMan 5.40. RESULTS: Twenty studies met our inclusion criteria. Data Analysis of the included studies demonstrated a significant improvement in quality of life among prostate cancer patients in the exercise group compared to the control group (SMD=0.20, 95% CI=0.07 to 0.34, P=0.003). However, there was no significant association between exercise and fatigue (SMD=0.07, 95% CI=-0.13, 0.26, P=0.51). Sensitivity analysis did not alter these findings. Regarding physical activity outcomes, the control group exhibited superior performance in the 400-meter walk test (P<0.05). No significant associations were found between exercise and the 6-meter walk test or up-and-go time. CONCLUSION: This systematic review revealed that aerobic and resistance training enhance the quality of life of patients with prostate cancer, although it has a limited impact on fatigue and physical activity levels. These findings advocate a shift in clinical practice and positioning exercise as a core component of comprehensive cancer care. Tailoring exercise regimens according to individual patient needs and treatment stages should become the norm in treatment planning. This approach goes beyond physical wellness and addresses the psychological and emotional facets of cancer management. Moreover, there is an evident need for further research to develop holistic exercise interventions that effectively address the complex dynamics of fatigue, physical activity, and QoL in this patient group.

Grasping knowledge, attitude, and perception towards monkeypox among healthcare workers and medical students: an Egyptian cross-sectional study.

Background: Monkeypox (Mpox) is a re-emerging infectious disease representing a new global challenge. It poses a substantial threat to countries, particularly those with a low number of cases. Due to its popularity as a tourist destination and its proximity to many African refugees, Egypt is potentially at risk of Mpox importation. Therefore, effective disease management necessitates healthcare workers (HCWs) to possess adept knowledge, along with a positive attitude and behavior. The study aimed to assess the knowledge, attitude, and perception of Egyptian HCWs and medical students towards human Mpox. Methods: The present cross-sectional study data was collected from participants between October and December 2022 via a questionnaire. The questionnaire comprised 31 questions in the knowledge section, 11 questions in the attitude section, and 14 in the perception section. Results: The present study involved a total of 1,034 HCWs and medical students. It was found that 55.3% of the participants demonstrated adequate knowledge about Mpox, whereas 44.5% and 39.8% of the respondents exhibited favorable attitudes and perceptions towards the disease, respectively. Binary logistic regression analysis revealed that adequate knowledge was significantly observed in ages older than 40 years (p < 0.001), married participants (p < 0.001), and doctors (p < 0.001). The positive attitude was significantly observed among the male sex (p = 0.045), urban residents (p = 0.002), and nurses (p = 0.002). Conversely, married participants (p = 0.013), doctors (p < 0.001), and individuals employed in pharmacy and laboratory departments (p < 0.001) experienced an increase in positive perception. Conclusion: Knowledge, attitude, and perception towards Mpox among Egyptian HCWs and medical students exhibit suboptimal levels. Addressing these gaps is crucial to controlling and effectively preventing disease transmission.

Evaluating the potential mediating role of ADAMTS13 activity in the relationship between obesity and the severity of COVID-19: A retrospective cohort study.

Obesity and low enzyme A disintegrin and metalloproteinase with thrombospondin type-1 motif-13 (ADAMTS13) activity have been linked to poor coronavirus disease 2019 (COVID-19). Given that obesity may influence ADAMTS13 activity, it is feasible; however, it remains unclear whether ADAMTS13 activity acts as a mediator between obesity and COVID-19 outcomes. We investigated the link between body mass index (BMI) and COVID-19 outcomes, using ADAMTS13 activity as a mediator. ADAMTS13 activity was measured in 86 hospitalized COVID-19 patients. BMI, ADAMTS13 activity, and COVID-19 outcomes were assessed. Obese patients had a high odds ratio for low ADAMTS13 levels. When different levels of ADAMTS13 activity were considered, the severity of COVID-19 in obese patients was 4.5 times that in the normal BMI group. Furthermore, increased coagulopathy indicators correlated with low ADAMTS13 activity. Patients with elevated ALT and AST levels showed a 3 to 4-fold increase in the chances of low ADAMTS13 activity (OR:3.19, 95% CI:1.22-8.90, P = .021; OR:2.17, 95% CI:0.91-5.27, P = .082, respectively). When ADAMTS13 activity was considered, obese patients had greater COVID-19 severity and slower viral clearance than those with normal BMI. Low ADAMTS13 activity and impaired liver function are associated with poor COVID-19 outcomes. These findings encourage researchers to use molecular component identification to study the effects of obesity on the von Willebrand factor (VWF)/ADAMTS13 axis, COVID-19 pathogenesis, and outcomes.

Palliative and Supportive Care for Patients with End-Stage Hepatocellular Carcinoma: Perspectives of Egyptian Domestic Caregivers.

OBJECTIVES: Palliative care is a holistic, patient-centered approach to improving the quality of life for those with terminal diseases and their families. The main objective of the current study was to evaluate the Egyptian domestic caregivers' knowledge, attitudes, and competencies related to palliative and supportive care. METHODS: Three hundred and thirty-five family caregivers in total were recruited. A descriptive research design was used. Four tools were used to collect data; structured interview questionnaire to collect demographic questions, palliative care knowledge questionnaire, Palliative Attitude Scale, and Competence Scale. The study was conducted in oncology outpatient and pain clinics located at the Damietta Cancer Institute in Damietta Governorate, Egypt. RESULTS: Nearly two-thirds of the informal family caregivers are aged between 30-40 years old; 54% are female, and 83% are married. Also, sixty-seven point eight of the informal family caregivers were working (part-time). Furthermore, 65 % of them had insufficient knowledge, 68 % had a positive attitude, and 58% of the informal family caregivers had non-competency skills regarding palliative and supportive care. CONCLUSION: Approximately two-thirds of informal care providers had insufficient total knowledge scores, more than half possessed a positive attitude, and more than half reported non-competency skills regarding palliative care of hepatocellular patients. RECOMMENDATION: It is highly advisable to launch extensive health education programs and campaigns aimed at all of the unpaid informal family careers of patients with serious terminal illnesses, including hepatocellular carcinoma, at various governments with greater sample sizes.

Transcrestal sinus lift with simultaneous implant placement using osseodensification in posterior maxilla with residual bone height of 4-6 mm / Elevação de seio maxilar via crista do rebordo com instalação simultânea de implante utilizando osseodensificador em região posterior de maxila com altura do remanescente ósseo de 4 a 6 mm

Objective: The aim of this study was to evaluate the transcrestal sinus lift using Osseodensification technique with simultaneous implant placement. Material and Methods: In this case series 7 patients who needed implant placement in the atrophic posterior maxilla were enrolled. In all the cases the residual bone height between the sinus floor and the alveolar crest was 4-6 mm. Transcrestal sinus lift was performed using Osseodensification with simultaneous implant placement. Cone-beam computed tomography (CBCT) were obtained immediately postoperative and 6 months after operation. Implant stability using Osstell® were assessed at the time of implant placement and implant exposure (6 months). Results: The results showed that the mean bone height gain was 5.33±0.83mm at 6 months postoperatively. Mean bone density value was 818.43±109.63 HU. Mean ISQ value was 80.00±3.11 at 6 months postoperatively. The duration of surgical procedure (minutes) ranged between 25-38 minutes with an average of 30.86±4.10 minutes. Conclusion: The crestal maxillary sinus floor elevation using Osseodensification technique with simultaneous implant placement provide superior results regarding bone density and implant stability and less duration of surgical procedure. (AU)

Objetivo: O objetivo deste estudo foi avaliar a elevação de seio maxilar via crista do rebordo com a técnica de Osseodensificação com instalação simultânea de implante. Material e Métodos: Nesta série de casos, participaram 7 pacientes que necessitavam de implantes em região posterior de maxila atrófica. Em todos os casos a altura de remanescente ósseo entre o soalho do seio e a crista alveolar estava entre 4 a 6 mm. A elevação de seio maxilar via crista do rebordo foi realizada com osseodensificação com instalação simultânea de implante. As Tomografias Computadorizadas Cone Beam (TCCB) foram obtidas imediatamente após a cirurgia e 6 meses depois. A estabilidade dos implantes utilizando Osstell® foi avaliada no momento da instalação do implante e no momento da reabertura (6 meses). Resultados: Os resultados mostraram que a média de ganho de altura óssea foi de 5.33±0.83mm após 6 meses da cirurgia. A média da densidade óssea foi de 818.43±109.63 HU. A média de ISQ foi de 80.00±3.11 após 6 meses da cirurgia. A duração do procedimento cirúrgico (minutos) foi entre 25 a 38 minutos com uma média de 30.86±4.10 minutos. Conclusão: A elevação do soalho de seio maxilar via crista do rebordo com instalação simultânea de implante utilizando osseodensificador promove resultados superiores em relação à densidade óssea, estabilidade do implante e menor duração do tempo cirúrgico (AU)

SPECIAL ARTICLE COVID-19: Covid-19-Related Acute Invasive Fungal Sinusitis: Clinical Features and Outcomes

Abstract Introduction There is a noticeable increase in the incidence of acute invasive fungal sinusitis which coincides with the ongoing coronavirus pandemic. It is a potentiallylethal fungal infection, with the most common form being the rhino-orbito-cerebral presentation. Objectives The aim of the present study is to discuss the different epidemiological factors, risk factors, clinical presentations and outcomes of acute invasive fungal sinusitis which is noticeably related to the coronavirus disease 2019 (Covid-19) pandemic. Methods The present cross-sectional cohort study included 22 adult patients who presented with Covid-19-related acute invasive fungal sinusitis. The diagnosis of acute invasive fungal sinusitis was confirmed by histopathological biopsy. All data, including demographics, risk factors, clinical findings, different lines of treatment and their outcomes, were recorded and analyzed. Results All patients had diabetes mellitus (100%), and 17 (77.3%) had been submitted to systemic steroids. All patients (100%) had unilateral sinonasal disease. Proptosis was found in 15 patients (68.2%), ophthalmoplegia was observed in 12 patients (54.5%), and intracranial affection occurred in 10 patients (45.5%). A total of 20 patients (90.9%) received liposomal amphotericin B. Surgical debridement was performed in 18 patients (45.5%). Non-septated mycelia was present in 19 biopsies (86.4%), while 3 (13.6%) showed septated mycelia. Total improvement was achieved in 10 patients (45.5%), while the mortality rate was of 27.3% (6 out of 22 participants). Conclusion Diabetes mellitus is the most common preexisting medical condition associated with Covid-19-related acute invasive fungal sinusitis. Systemic corticosteroid therapy is considered a predisposing factor. It is necessary to raise the level of awareness to diagnose this condition, especially in patients with Covid-19 infection or those who have recently recovered from it.