Colonoscopy screening for colorectal cancer in Egypt: a nationwide cross-sectional study.

BACKGROUND: Current guidelines advocate for colorectal cancer (CRC) screening in adults who are at risk by using direct visualization methods such as colonoscopy. However, in Egypt, there is a paucity of data regarding the current practice of colonoscopy screening. Moreover, more information is needed about the knowledge and attitudes of potential participants regarding the procedure and possible barriers that can limit their participation. METHODS: We conducted a nationwide cross-sectional study using an interview-based survey of patients aged 45 years or above who presented to outpatient clinics of nine university hospitals throughout Egypt. Participants were surveyed to assess their compliance with CRC colonoscopy screening guidelines, their knowledge of and attitude towards colonoscopy screening, and their perspective on potential barriers to colonoscopy screening. RESULTS: A total of 1,453 participants responded to our survey in the nine study centers. Only a minority of participants (2.3%) were referred for CRC screening. Referral rates were higher among those who knew someone with a history of CRC (5.3% vs 1.5%, p < 0.001) or had a discussion with their physician about CRC (25.8% vs 0.7%, p < 0.001). Few responders (3.2%) had good knowledge regarding CRC screening. After introducing the concept of CRC screening to all participants, most patients (66.7%) showed a positive attitude towards having the procedure. Financial burden and fear of results were the two most frequently cited barriers to undergoing CRC screening (81.1%; and 60.1%, respecteively). CONCLUSIONS: Despite the positive attitude, there is insufficient knowledge about CRC screening among eligible participants in Egypt. This has probably contributed to low compliance with current CRC screening guidelines and needs to be addressed at the national level.

The efficacy and safety of Zuranolone for treatment of depression: A systematic review and meta-analysis.

RATIONALE: Zuranolone, a newly FDA-approved synthetic neurosteroid, shows promise in treating depression. OBJECTIVES: Our aim is to evaluate Zuranolone's efficacy and safety in treating depression. METHODS: Five databases were searched until September 2023 for relevant randomized clinical trials evaluating the efficacy and safety of zuranolone. The potential risk of bias in the included trials was evaluated by the Cochrane Risk of Bias II guideline Data were extracted and pooled using Review Manager Software (RevMan 5.3). RESULTS: An analysis of eight studies highlights Zuranolone's efficacy in treating depression compared to placebo across most of the outcomes. Notably, the 30mg and 50mg doses demonstrated significant improvements in reducing HAM-D scores by over 50% within a 15-day follow-up (RR) of 1.46 (95% CI [1.27, 1.68], p < 0.0001) and 1.14 (95% CI [1.01, 1.3], p = 0.04). Additionally, the HAM-D ≤ 7% score analysis revealed significant enhancements with the 30mg dose over both 15-day (RR = 1.82, 95% CI [1.44, 2.31], p < 0.0001) and 45-day (RR = 1.43, 95% CI [1.16, 1.77], p = 0.0008) durations. Adverse Events Drug Discontinuation demonstrated no overall significant difference (OR = 1.33, 95% CI: [0.79, 2.23], p = 0.282). Further, specific adverse events, such as headache, showed no significant overall difference between Zuranolone and placebo (OR = 1.11, 95% CI: [0.84, 1.47], p = 0.47), with dose-dependent analysis revealing less headache in the 30 mg group. CONCLUSION: Zuranolone demonstrates favorable tolerability and safety, particularly at 30mg and 50mg doses after 15 days, suggesting its potential and effective treatment for depression.

Efficacy and safety of glucagon-like peptide 2 in patients with short bowel syndrome: a systematic review and network meta-analysis.

BACKGROUND: Glucagon-like peptide 2 (GLP-2) is a highly conserved enteroendocrine hormone that seems to be a regulator promoting intestinal adaptation. This study aimed to summarize the evidence on the efficacy and safety of exogenous GLP-2 in patients with short bowel syndrome (SBS). METHODS: A database search was performed on PubMed, Web of Science Core Collection, Scopus, Ovid, and the Cochrane Central Register of Controlled Trials in November 2022. Clinical trials on the effect of GLP-2 on patients with SBS were included. The Cochrane Risk of Bias 2 and Risk Of Bias In Non-randomized Studies - of Interventions tools for quality assessment of randomized and nonrandomized trials were used. The extracted data were analyzed qualitatively and quantitatively using a network meta-analysis model. RESULTS: This study included 23 clinical trials with 843 patients. The patients' ages ranged from 4.0 to 62.4 years. The treatment doses were 0.1, 0.05, and 0.025 mg/kg/day for teduglutide; 5 and 10 mg/week for apraglutide, and 0.1, 1, and 10 mg/day for glepaglutide. The treatment duration ranged from 1 to 32 weeks. Regarding citrulline level, 0.1 mg/kg/day of teduglutide had the highest mean difference (MD; 14.77; 95% CI, 10.20-19.33), followed by 0.05 mg/kg/day (13.04; 95% CI, 9.79-16.2) and 0.025 mg/kg/day (7.84; 95% CI, 2.42-13.26) of teduglutide. In addition, the effect estimate showed significant differences between all teduglutide dose groups and the control group. Different doses of glepaglutide were analyzed to assess the effect on alkaline phosphatase (ALP) levels, in which 0.1 mg/day of glepaglutide showed a significantly higher MD (20.71; 95% CI, 2.62-38.80) than 1 mg/day (the reference) and 10 mg/day (8.45; 95% CI, -10.72 to 27.62) of glepaglutide. However, 0.1 vs 10 mg of glepaglutide has an MD of -14.57 (95% CI, -437.24 to 148.11) for the indirect estimate, whereas 10 mg of glepaglutide has an MD of 8.45 (95% CI, -10.72 to 27.62) for the network estimate. Regarding safety outcomes, there was no significant difference among all teduglutide and apraglutide dose groups compared with the control group. Catheter-related bloodstream infection was the most common adverse event reported with the use of apraglutide, teduglutide, and glepaglutide. CONCLUSION: Despite the small number of patients in the included studies and variable follow-up duration, GLP-2 seems to be safe and effective in patients with SBS. GLP-2 showed a positive effect on increasing plasma citrulline level and decreasing ALP level.

Profile and outcomes of acute poisoning in the toxicology treatment and control center at Tanta University Hospital, Egypt.

BACKGROUND: Poisoning is a major health problem especially in developing countries and leads to high morbidity and mortality. AIM: To identify the profile of acute poisoning in the Toxicology Unit at Tanta University Hospital, Egypt (2017-2021). METHODS: A cross-sectional study using data extracted from medical records from beginning of January 2017 to end of December 2021. Data including demographic data, Glasgow coma scale, type of poisons, manner of poisoning, time of admission and discharge and state at discharge. RESULTS: This study included 9713 cases. Rodenticides represented the most frequent cause of poisoning among both males (30%) and females (27%). Pharmaceutical drugs, CNS abused pharmaceutical drugs, and chemicals represent the most common categories (24%, 22%, and 21%, respectively) among children (up to 12 years). Rodenticides and pharmaceutical drugs represent the highest categories among other age groups. Evening admissions represented 52% of cases. Glasgow coma scale was 15 among 86.3% of cases. Intentional poisoning was more common than accidental poisoning (58.6% and 34.7%, respectively). One half (52.2%) of the admitted cases were discharged within 24 hours of admission and 44.4% of them were discharged after 48-72 hours. Family request was the main reason of discharge of cases (70.3%), 15.7% were improved, 4% died. Mortality by rodenticide was 12.5%. CONCLUSION: Rodenticides, pharmaceutical and CNS abused pharmaceutical drugs were the most common categories of poisoning. Intentional poisoning was more common than accidental poisoning. Rodenticides were responsible for most deaths.

Parents' perception of COVID-19 risk of infection and intention to vaccinate their children.

Background: Parent's perception of the COVID-19 vaccines is very important to protect themselves and their children and achieve maximum effect of vaccination programs. Objective: Evaluate the perception and attitude of parents towards COVID-19 risk of infection and intentions to vaccinate their children. Method: Cross-sectional study including 1032 participants who have children aged from 5 to 18 years using a structured questionnaire. Results: Overall, 65.0% of participants or their family members suffered from comorbidities that poses them at risk for COVID-19 infection such as hypertension (25.1%) and diabetes mellitus (16.1%). The prevalence of tobacco smoking in the studied families was 36.9%. Among participants, 40.6% had a family member with history of confirmed COVID-19 infection. Nearly one-half of studied parents (48.2%) reported COVID-19 as a serious infection and the majority were worried about getting a family member infected (86.8%). Among participants 62.0% of male parents and 57.8% of female parents agreed that vaccine information is reliable. Participants reporting safety of COVID-19 vaccination represented 45.3%. If vaccine is available, 40.1% of parents intended to vaccinate their children. The main factors associated with the willingness to vaccinate children were vaccine is not suitable for children under 18 years (OR = 11.508), concern about vaccination safety (OR = 8.678), doubts about reliability of vaccine information (OR = 7.811) and ability of vaccine to prevent infection (OR = 5.766). Conclusion: Our study provides a brief insight about how parents think about COVID-19 vaccines and acceptance to vaccinate their children.

Antecedentes: La percepción de los padres sobre las vacunas contra el COVID-19 es muy importante para protegerse a sí mismos y a sus hijos y lograr el máximo efecto de los programas de vacunación. Objetivo: Evaluar la percepción y actitud de los padres hacia el riesgo de infección por COVID-19 y las intenciones de vacunar a sus hijos. Método: Estudio transversal que incluyó a 1032 participantes que tenían hijos de 5 a 18 años mediante un cuestionario estructurado. Resultados: En general, el 65,0% de los participantes o sus familiares padecieron comorbilidades que los ponen en riesgo de infección por COVID-19, como hipertensión (25,1%) y diabetes mellitus (16,1%). La prevalencia de tabaquismo en las familias estudiadas fue del 36,9%. Entre los participantes, el 40,6% tenía un familiar con antecedentes de infección confirmada por COVID-19. Casi la mitad de los padres estudiados (48,2%) informaron que la COVID-19 era una infección grave y la mayoría estaba preocupada por la posibilidad de que un miembro de la familia se infectara (86,8%). Entre los participantes, el 62,0% de los padres varones y el 57,8% de las mujeres acordaron que la información sobre las vacunas es confiable. Los participantes que informaron sobre la seguridad de la vacunación contra la COVID-19 representaron el 45,3%. Si la vacuna está disponible, el 40,1% de los padres tenía la intención de vacunar a sus hijos. Los principales factores asociados al deseo de vacunar a los niños fueron la vacuna no apta para menores de 18 años (OR = 11.508), preocupación por la seguridad vacunal (OR = 8.678), dudas sobre la confiabilidad de la información vacunal (OR = 7.811) y capacidad de vacuna para prevenir la infección (OR = 5.766). Conclusión: Nuestro estudio proporciona una breve perspectiva sobre cómo piensan los padres sobre las vacunas contra el COVID-19 y la aceptación de vacunar a sus hijos.

The Influence of Surface Texturing of Ceramic and Superhard Cutting Tools on the Machining Process-A Review.

Machining is an indispensable manufacturing process for a wide range of engineering materials, such as metals, ceramics, and composite materials, in which the tool wear is a serious problem, which affects not only the costs and productivity but also the quality of the machined components. Thus, the modification of the cutting tool surface by application of textures on their surfaces is proposed as a very promising method for improving tool life. Surface texturing is a relatively new surface engineering technology, where microscale or nanoscale surface textures are generated on the cutting tool through a variety of techniques in order to improve tribological properties of cutting tool surfaces by reducing the coefficient of friction and increasing wear resistance. In this paper, the studies carried out to date on the texturing of ceramic and superhard cutting tools have been reviewed. Furthermore, the most common methods for creating textures on the surfaces of different materials have been summarized. Moreover, the parameters that are generally used in surface texturing, which should be indicated in all future studies of textured cutting tools in order to have a better understanding of its effects in the cutting process, are described. In addition, this paper proposes a way in which to classify the texture surfaces used in the cutting tools according to their geometric parameters. This paper highlights the effect of ceramic and superhard textured cutting tools in improving the machining performance of difficult-to-cut materials, such as coefficient of friction, tool wear, cutting forces, cutting temperature, and machined workpiece roughness. Finally, a conclusion of the analyzed papers is given.

Elemental and Thermochemical Analyses of Materials after Electrical Discharge Machining in Water: Focus on Ni and Zn.

The mechanism of the material destruction under discharge pulses and material removal mechanism based on the thermochemical nature of the electrical erosion during electrical discharge machining of conductive materials were researched. The experiments were conducted for two structural materials used in the aerospace industry, namely austenite anticorrosion X10CrNiTi18-10 (12kH18N10T) steel and 2024 (D16) duralumin, machined by a brass tool of 0.25 mm in diameter in a deionized water medium. The optimized wire electrical discharge machining factors, measured discharge gaps (recommended offset is 170-175 µm and 195-199 µm, respectively), X-ray photoelectron spectroscopy for both types of materials are reported. Elemental analysis showed the presence of metallic Zn, CuO, iron oxides, chromium oxides, and 58.07% carbides (precipitation and normal atmospheric contamination) for steel and the presence of metallic Zn, CuO, ZnO, aluminum oxide, and 40.37% carbides (contamination) for duralumin. For the first time, calculating the thermochemistry parameters for reactions of Zn(OH)2, ZnO, and NiO formation was produced. The ability of Ni of chrome-nickel steel to interact with Zn of brass electrode was thermochemically proved. The standard enthalpy of the Ni5Zn21 intermetallic compound formation (erosion dust) ΔH0298 is -225.96 kJ/mol; the entropy of the crystalline phase Scint is 424.64 J/(mol·K).

The frequency of low bone mineral density and its associated risk factors in patients with inflammatory bowel diseases.

OBJECTIVE: To detect the frequency and the predictive factors of low bone mineral density in inflammatory bowel disease (IBD) patients, so as to optimize bone mineral density (BMD) monitoring and treatment for those at risk. SUBJECTS AND METHODS: Thirty Asian patients were included in this study and were divided into 18 patients with ulcerative colitis (UC), and 12 patients with Crohn's disease (CD). All patients were diagnosed by colonoscopy and histopathological biopsy and were subjected to routine laboratory investigations in addition to 25 hydroxy vitamin D levels as well as serum calcium, phosphorus and alkaline phosphatise. BMD was measured by using dual-energy X-ray absorptiometry (DEXA) scan at lumbar spine and femoral neck; predictive factors for BMD were analyzed by group comparison and step-wise regression analysis. RESULTS: There was increased frequency of osteoporosis and osteopenia involving the lumbar spine in patients with IBD being more common among CD patients than in the UC group. Positive correlations were found between low BMD measurements and vitamin D levels, body mass index (BMI) (P < 0.001) as well as steroid cumulative dose and duration of therapy (P < 0.001); stepwise regression analysis showed that CD and vitamin D deficiency are predictive factors for both osteoporosis and osteopenia (P = 0.024, P = 0.027, respectively). CONCLUSION: Low BMD was found to be more frequent among patients with CD than UC; in addition CD and vitamin D deficiency act as predictive factors for low BMD. We recommend that calcium and vitamin D should be given to all IBD patients; in addition, bisphosphonate administration should be put into consideration.