The role of a specialized urethral catheter in early detection of intra-abdominal hypertension: a case report.

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) impact morbidity and mortality in burn patients, exacerbated by extensive fluid resuscitation required for more than 20% of total body surface area burns. We report a case of a 28-year-old male with severe burns and a TBSA of 49% who presented after a fire incident. The trauma team managed the patient's fluid resuscitation, followed by early burn debridement. A TraumaGuard catheter was used for continuous intra-abdominal pressure (IAP) monitoring. On the second day of admission, a critical IAP of 20 mm Hg was detected, indicative of impending ACS. Immediate intervention with cistracurium and increased sedation reduced the IAP to 9 mm Hg, preventing the progression to ACS. This case demonstrates the importance of routine IAP monitoring in severely burned patients to prevent ACS. Early identification and management of elevated IAP can avert the progression to ACS and reduce the need for more invasive interventions.

Examining Vaccine Hesitancy Among Ghanaian Parents for the R21/Matrix-M Malaria Vaccine.

INTRODUCTION: This study aimed to assess Ghanaian parental attitudes toward a new malaria vaccine, R21/Matrix-M, and its associated determinants. METHOD: A cross-sectional survey was conducted anonymously in July and August 2023 using snowball and convenience sampling techniques, using the Parental Attitude about Children Vaccination Scale. RESULTS: A total of 818 individuals were included, 67.2% were females, their median age was 32 years, and 29.01% were hesitant to vaccinate their children. People living in forests, with younger children, having the youngest child aged 1-3 years, skipping antenatal care or scheduled vaccinations, and not being willing to give the R21/Matrix-M vaccine to children, were vaccine-hesitant. However, healthcare workers, those having a relative who died from malaria, and those who vaccinated their child against malaria were less hesitant. DISCUSSION: A large sector of parents expressed willingness to vaccinate their children against malaria. Addressing parental hesitancy requires intervention programs targeting the identified factors and enhancing parental knowledge.

Adherence to Oral Hormonal Treatment among Breast Cancer Patients in Egypt.

BACKGROUND: Adjuvant endocrine therapy has been shown to improve treatment outcomes in breast cancer patients. However, not all patients can complete their scheduled treatment protocols. The purpose of this study was to evaluate the adherence to oral hormonal therapy among Egyptian breast cancer patients. PATIENTS AND METHODS: A cross-sectional study was conducted at the National Cancer Institute, Breast Cancer Hospital, from February 2022 to May 2022. An interview and a survey were administered to assess the adherence of breast cancer patients to oral hormonal treatment. Adherence was measured using the Morisky Medication Adherence Scale-8 (MMAS-8). RESULTS: The survey was fully completed by 300 patients, of whom 98.3% were females and 1.7% were males. Among the patients, 30% fell into the age group of 40-50 years. Most patients were postmenopausal (90.3%). In terms of education, 18% had a high level of education, while 53.3% were illiterate. Additionally, 50.7% of patients had other chronic diseases. Regarding medication information, 44.7% preferred to receive it from a physician, 27.7% from pharmacists, and 27.7% from both. Proper medication counseling was received by 99.7% of patients. According to the MMAS-8 survey, 40.3% of all patients demonstrated high adherence to their oral hormonal treatment, 32.7% had moderate adherence, and 27% had low adherence. No significant associations were found between adherence levels and subgroups such as gender, age, educational level, duration of endocrine therapy, breast cancer stage, or other co-morbidities. CONCLUSION: This study reveals a substantial level of adherence, both high and moderate, to oral endocrine therapy among breast cancer patients in Egypt. Possible contributing factors include proper medication counseling within the healthcare setting and regular patient follow-up.

Silver nanoparticles versus chitosan nanoparticles effects on demineralized enamel.

BACKGROUND: To compare the impacts of different remineralizing agents on demineralized enamel, we focused on chitosan nanoparticles (ChiNPs) and silver nanoparticles (AgNPs). METHODS: This study was conducted on 40 extracted human premolars with artificially induced demineralization using demineralizing solution. Prior to the beginning of the experimental procedures, the samples were preserved in artificial saliva solution. The nanoparticles were characterized by transmission electron microscopy (TEM) and teeth were divided into four equal groups: Group A was utilized as a control group (no demineralization) and received no treatment. Group B was subjected to demineralization with no treatment. Group C was subjected to demineralization and then treated with ChiNPs. Group D was subjected to demineralization and then treated with AgNPs. The teeth were evaluated for microhardness. The enamel surfaces of all the samples were analysed by scanning electron microscopy (SEM) for morphological changes and energy dispersive X-ray analysis (EDX) for elemental analysis. RESULTS: The third and fourth groups had the highest mean microhardness and calcium (Ca) and phosphorous (P) contents. SEM of these two groups revealed relative restoration of homogenous remineralized enamel surface architecture with minimal micropores. CONCLUSION: Chitosan nanoparticles (NPs) and silver NPs help restore the enamel surface architecture and mineral content. Therefore, chitosan NPs and AgNPs would be beneficial for remineralizing enamel.

Safety and Pharmacokinetics of Casirivimab and Imdevimab (CAS+IMD) in Pediatric Outpatients With COVID-19.

The safety of casirivimab+imdevimab (CAS+IMD) (anti-SARS-CoV-2 monoclonal antibodies [mAbs]) in pediatric outpatients with COVID-19 was evaluated in a randomized, phase 1/2/3 trial. Consistent with adults, CAS+IMD was generally well tolerated with low drug-induced immunogenicity rates. The findings support development of next-generation anti-SARS-CoV-2 mAbs for at-risk pediatric patients.

Cardiovascular disease prevalence and associated factors in a low-resource setting: A multilevel analysis from Somalia's first demographic health survey.

BACKGROUND: Cardiovascular diseases (CVDs) are a leading cause of death globally, with low- and middle-income countries disproportionately affected. Somalia, a nation grappling with persistent humanitarian crises and a rising burden of non-communicable diseases, has limited data on CVD prevalence and its risk factors. This study, the first of its kind in Somalia, leverages data from the inaugural nationally representative demographic health survey to examine the prevalence and associated factors of CVD among Somali adults. METHODS: A cross-sectional analysis was conducted using data from the 2020 Somali Demographic Health Survey, encompassing 5062 participants aged 35 years and older. Multilevel logistic regression was utilized to explore associations between individual-level and community-level factors and CVD prevalence. Individual-level factors included age, sex, marital status, education, wealth, smoking, and khat chewing. Community-level factors encompassed region and type of residence. RESULTS: The prevalence of CVD in Somalia was found to be 7.1%. Community-level factors were significantly associated with CVD prevalence. Residents of Sool region exhibited higher odds of CVD, while those in Banadir region had lower odds. Nomadic communities demonstrated lower CVD risk compared to urban areas. School attendance was marginally associated with CVD risk. After controlling for other factors, sex of the household head remained significant, with females having slightly lower odds of CVD. CONCLUSION: This study underscores the critical influence of community-level factors, particularly region and type of residence, on CVD prevalence in Somalia. The findings highlight the need for targeted interventions that address geographic disparities and promote healthy lifestyles within communities. Future research should delve deeper into the underlying mechanisms of these associations and explore the impact of individual-level factors like school attendance and sex on CVD risk.

Intraperitoneal hepatorenal toxicity of zinc oxide and nickel oxide nanoparticles in rats: a systematic review.

Zinc oxide (ZnO) and nickel oxide (NiO) nanoparticles (NPs) are widely used in various industries due to their distinctive physico-chemical and biological properties. However, concerns have been raised about their potential toxicity in humans. While many studies have reviewed their effects on visceral organs upon ingestion, inhalation, or skin contact, limited reviews are available regarding their adverse consequences on the liver and kidneys resulting from intraperitoneal administration in rats. Hence, this systematic review is the first to uniquely address this issue. A systematic search was performed on PubMed and Google scholar to identify articles that explored the toxic effects of ZnO-NPs and NiO-NPs in rats following intraperitoneal injection. The quality of the articles was assessed using SYCLE's risk of bias tool, leading to the selection of 16 articles; 14 for ZnO-NPs, 1 for NiO-NPs and 1 for both NPs. This review revealed that ZnO-NPs induces an acute toxicity in liver and kidney that is dose dependent. The impairments were marked by changes in organs functional markers, lipid and glucose levels and antioxidant deficiencies and lipid peroxidation. NiO-NPs also showed considerable toxicity, despite the limited studies. Further, variability of physico-chemical properties among studies complicated the toxicity assessment. To conclude, this study provides a novel contribution by summarizing the literature findings that suggest potential adverse intraperitoneal hepatorenal toxic outcomes associated with ZnO-NPs and NiO-NPs. Future research should focus on long-term effects and standardizing protocols to ensure the safe use of ZnO-NPs and NiO-NPs in industrial and clinical practices.

Navigating Uncertainty: The Impact of COVID-19 on Families of Terminally Ill Patients.

Background: The coronavirus disease (COVID-19) pandemic has caused significant global mortality and left a substantial number of bereaved individuals in its wake while reshaping healthcare delivery and profoundly affecting families coping with loss. During the pandemic, public health measures and the fear of getting COVID have reshaped grieving for families, adding emotional layers and complexities. This was further compounded by bereavement challenges, including changes to gatherings that have altered social norms and limited families in honoring loved ones, causing further distressing. Purpose: To elucidate experiences of families who had a hospitalized terminally ill family member during the COVID-19 pandemic and identify themes from the existing literature that can inform clinical practice related to how healthcare providers care for individuals and their families during palliative care going forward. Methods: This scoping review delved into qualitative studies sourced from peer-reviewed literature found in PubMed, CINAHL, and MEDLINE databases. Results: A thorough search yielded 298 articles, of which 10 were included in the present review. Four themes were identified: the importance of communication, the challenges and effects of separation from loved ones, changed rituals and bereavement, and access to services and support. Implications for Practice: The restrictions and fear imposed by the COVID-19 pandemic has significantly altered patient and family care dynamics, disrupting customary face-to-face visits and increasing emotional strain for families, while highlighting the necessity for personalized end-of-life care. Integrating supportive frameworks and utilizing telehealth platforms or hybrid care models will be crucial in addressing the complexities of grief and loss experienced by patients, families, and caregivers during and after the pandemic.

Predictive Factors for Regression versus Progression of Nonevacuated Posttraumatic Acute Extradural Hematoma.

Study Design This study was a retrospective study conducted from October 2020 to October 2022 on 106 posttraumatic patients with acute extradural hematomas (EDHs) who were initially planned for conservative treatment. 74 patients had spontaneous EDH regression (EDHR), while 32 patients developed EDH progression (EDHP) and were shifted for surgery. The two groups were statistically compared regarding the different demographic, clinical, and radiographic factors to identify the significant predictors for regression versus progression of acute posttraumatic EDH. Objectives Conventionally, urgent evacuation is the accepted management for EDH. However, several recent reports have described successful conservative management in selected patients. There are no adequate clues to verify patients who will have spontaneous EDHR from those at risk for EDHP and delayed surgery. The main objective of this study was to identify the significant predictors for possible regression versus progression of acute posttraumatic EDH initially planned for nonsurgical treatment. Materials and Methods A retrospective study conducted over 2 years, included 106 head trauma patients with acute EDH, who were admitted to our department and were initially planned for conservative treatment. Various demographic, clinical, and radiographic factors were analyzed to verify the significant predictors for spontaneous EDHR (EDHR group) versus EDHP and subsequent surgical evacuation (EDHP group). Results The mean age was 20.37 ± 12.712 years and the mean Glasgow Coma Scale score (GCS) was 12.83 ± 2.113. Total 69.8% of patients showed spontaneous EDHR, while 30.2% developed EDHP and were shifted for surgical evacuation. Statistical comparison showed that higher GCS ( p = 0.002), frontal location ( p = 0.022), and concomitant fissure fracture ( p = 0.014) were the significant predictors for EDHR, while younger age ( p = 0.006), persistent nausea/vomiting ( p = 0.046), early computed tomography (CT) after trauma ( p = 0.021), temporal location ( p < 0.001), and coagulopathy ( p = 0.001) were significantly associated with EDHP. Conclusion Patients with traumatic EDH fitting the criteria of initial nonsurgical treatment necessitates 48 hours of close observation and serial CT scans at 6, 12, 24, and 48 hours to confirm the regression or early detect the EDHP. Patients with high GCS, frontal hematomas, and associated fissure fracture are at low risk for EDHP. Increased alertness is mandatory for young age and patients with persistent nausea/vomiting, early CT scan, temporal hematomas, or coagulopathy.

A Case Report of Type B Aortic Dissection With Ruptured False Lumen.

Aortic dissection is a critical condition characterized by an intimal tear in the aortic wall, leading to the formation of a false lumen. We present a case of a 54-year-old male with chronic type B aortic dissection and hypertension who presented with acute tearing left back pain. Initial evaluation revealed elevated blood pressure and subtle laboratory abnormalities. Imaging confirmed a Stanford type B aortic dissection with an intramural hematoma and contained rupture of the false lumen. Despite initial stabilization efforts, the patient deteriorated rapidly and succumbed. This case highlights the critical importance of early diagnosis.

Global and regional cardiac magnetic resonance feature tracking left ventricular strain analysis in assessing early myocardial disease in ß thalassemia major patients.

BACKGROUND: Cardiac magnetic resonance imaging (CMR) is the modality of choice for quantification of myocardial iron overload in ß-thalassemia major patients using the T2* sequence. CMR feature tracking (FT) is a recent magnetic resonance imaging tool that gives an idea about myocardial fibers deformation; thus, it can detect early impairment in myocardial function even before the reduction in ejection fraction. METHODS: This study aims to assess the ability of left ventricular CMR-FT in the early detection of systolic dysfunction in ß thalassemia major patients and to correlate it with the degree of myocardial iron overload measured by CMR T2*. This prospective study enrolled 57 ß thalassemia major patients who received long-term blood transfusion and 20 healthy controls. CMR was used to evaluate left ventricular volumes, ejection fraction, and the amount of myocardial T2*. A two-dimensional left ventricular FT analysis was performed. Both global and segmental left ventricular strain values were obtained. RESULTS: The mean global circumferential strain (GCS) and global radial strain (GRS) values were significantly lower in patients compared to control (P = 0.002 and P = 0.006, respectively). No correlation was found between T2* values and ejection fraction; however, there was a significant correlation between T2* values and GCS and GRS (P = 0.012 and P = 0.025, respectively) in thalassemia patients. Regional strain revealed significantly lower values of GCS and GRS in basal regions compared to apical ones (P = 0.000). CONCLUSIONS: Our study revealed that CMR-FT can play a role in the early detection of systolic impairment in thalassemia patients.

Factors influencing pregnancy loss between days 30 and 70 in a single cattle herd: A comprehensive analysis of sire, cow, and other contributing factors.

This retrospective study utilized a mixed-effects logistic model analysis to investigate variables associated with the probability of pregnancy loss (PL) between days 30 and 70 in a dataset comprising 9507 pregnancies from a single cattle herd over 10 years. The model incorporated fixed-effect variables including cow breed (Holstein, Crossbred, and Brown Swiss), parity (1st, 2nd, 3rd, and 4th or more), insemination seasons, insemination number (≤3 vs >3), estrus nature (spontaneous vs synchronized), postpartum problems, sire breed (Holstein, Fleckvieh, Brown Swiss, and Montbéliarde), zygote genotypic (pure vs crossbred), days in milk (DIM) at insemination, actual 305-day milk yield, and sire conception rate. Additionally, random effects included sire (n = 129), cow (n = 3463), and production years (n = 10). The results revealed that cows inseminated with Brown Swiss sires or sires with lower initial conception rates had higher PL rates. Biparous cows, cows with lower 305-day milk yield, cows inseminated later in DIM, cows receiving the 4th or subsequent insemination, and cows inseminated during winter or autumn had lower PL rates. The estrus type and zygote genotype did not significantly impact PL. The random effects of cow, sire, and production years were estimated at 0.230, 0.054, and 0.112, respectively. In conclusion, the study findings suggested that improving management practices for high-yielding cows, cows in early lactation stages, and cows exposed to thermal stress conditions, along with utilizing Brown Swiss cows and sires with high initial conception rates per insemination, could potentially decrease overall PL rates on the farm. Nonetheless, the results did not support the use of Crossbred cows, sires from different breeds, or specific sires to mitigate PL rates on the farm.

Hybrid nanoparticles combining nanoselenium-mediated Carica papaya extract and trimethyl chitosan for combating clinical multidrug-resistant bacteria.

Multidrug-resistant bacterial infections pose a significant threat to human health, prompting the exploration of innovative solutions. In this study, a new series of antibacterial hybrid nanoparticles (HNPs) were developed. The HNPs are based on a combination of selenium nanoparticles (SeNPs), synthesized using Carica papaya leaf extract, and chitosan (CS/SeHNPs) or trimethyl chitosan (TMC/SeHNPs), respectively. Comprehensive characterization using UV-Vis, FTIR, XRD, SEM-EDX, DLS, TEM, and DSC confirmed the structure and properties of the developed HNPs. SeNPs, CS/SeHNPs, and TMC/SeHNPs showed average hydrodynamic size of 78.8, 91.3, and 122 nm, and zeta potentials of -6.35 mV, +32.8 mV, and +54.8 mV, respectively. Biological assessments were conducted, including antibacterial and antibiofilm assays against clinical strains (E. coli, S. aureus, and K. pneumoniae), along with antioxidant activity. TMC/SeHNPs demonstrated superior performance compared to SeNPs and CS/SeHNPs with the lowest minimum inhibition concentrations (MIC) against S. aureus and K. pneumoniae (3.9 µg/mL) and 62.5 µg/mL against E. coli in addition to robust antibiofilm activity. Furthermore, the TMC/SeHNPs exhibited potent DPPH free radical scavenging ability and demonstrated good biocompatibility, as evidenced by cell viability assays on HFB4 cells. Overall, TMC/SeHNPs emerged as promising candidates in nanomedicine, offering high antioxidant, antibacterial, and antibiofilm activities alongside excellent biocompatibility.

The symptoms evolution of long COVID­19 (SE-LC19): a new patient-reported content valid instrument.

BACKGROUND: The field of long COVID research is rapidly evolving, however, tools to assess and monitor symptoms and recovery of the disease are limited. The objective of the present study was to develop a new patient-reported outcomes instrument, the Symptoms Evolution of Long COVID­19 (SE-LC19), and establish its content validity. METHODS: The 40-item SE-LC19 instrument was developed based on patient-relevant empirical evidence from scientific literature and clinical guidelines that reported symptoms specific to long COVID. A 2-part mixed-method approach was employed. Part 1: Qualitative interviews with a purposive sample of 41 patients with confirmed long COVID were conducted for the content validation of SE-LC19. During cognitive debriefing interviews, patients were asked to describe their understanding of the instrument's instructions, specific symptoms, response options, and recall period to ensure its relevance and comprehensiveness. Five clinicians of different medical specialties who regularly treated patients with long COVID were also interviewed to obtain their clinical expert opinions on SE-LC19. Part 2: Exploratory Rasch Measurement Theory (RMT) analysis was conducted to evaluate the psychometric properties of the SE-LC19 data collected during the interviews. RESULTS: Overall, patients reported that the instructions, questions, recall period, and response options for SE-LC19 were comprehensive and relevant. Minor conceptual gaps reported by patients captured nuances in the experience of some symptoms that could be considered in future studies. Some patients suggested a revision of the recall period from 24 h to 7 days to be able to capture more symptoms given the waxing and waning nature of some symptoms. Clinicians found the instrument comprehensive with minimal suggestions regarding its content. Exploratory RMT analyses provided evidence that the SE-LC19 questionnaire performed as intended. CONCLUSION: The present mixed-methods study in patients with confirmed long COVID supports the content validity and applicability of the SE-LC19 instrument to evaluate the symptoms of patients with long COVID. Further research is warranted to explore the psychometric properties of the instrument and refine a meaningful and robust patient-relevant endpoint for use in different settings such as clinical trials and clinical practice to track the onset, severity, and recovery of long COVID.

Atypical Choroid Plexus Tumor of the Cauda Equina With Metastases to the Spinal Cord and Brain.

We report a case of a 57-year-old man with a tumor arising from the cauda equina with spinal cord and intracranial metastases in the basal cisterns and along the cranial nerves. He presented with severe lower back pain and mild gait imbalance. His imaging revealed a large mass in the lumbosacral region with involvement of the cauda equina, intradural extramedullary enhancing metastases in the thoracic spinal canal, and intracranial metastases in the suprasellar cistern and along both trigeminal and facial/vestibulocochlear nerve complexes. Pathological examination of the resected thoracic spinal cord mass showed an atypical papillary proliferation with moderate nuclear pleomorphism and rare mitotic figures. While the morphologic and immunophenotypic features were consistent with the diagnosis of a choroid plexus tumor, the atypical location for this entity required the exclusion of other epithelioid tumors with papillary architecture. Additional immunohistochemical markers were used to exclude a metastatic adenocarcinoma, a papillary variant of a meningioma, and a papillary variant of an ependymoma. Ultimately, methylation-based tumor profiling determined that the methylation class was a match for "plexus tumor" resulting in the integrated diagnosis of the tumor with features of choroid plexus papilloma. This is a unique presentation for both the location and the metastatic spread. The methylation profile was instrumental in establishing this diagnosis.

Comparison of Adiposomal Lipids between Obese and Non-Obese Individuals.

Our recent findings revealed that human adipose tissues (AT)-derived extracellular vesicles (adiposomes) vary in cargo among obese and lean individuals. The main objective of this study was to investigate the adiposomal lipid profiles and their correlation with cardiometabolic risk factors. AT samples were collected from obese subjects and lean controls and analyzed for their characteristics and lipid content. In addition, we measured the correlation between adiposomal lipid profiles and body composition, glucose and lipid metabolic profiles, brachial artery vasoreactivity, AT arteriolar flow-induced dilation, and circulating markers such as IL-6, C-reactive protein, and nitric oxide (NO). Compared to lean controls, adiposomes isolated from obese subjects were higher in number after normalization to AT volume. The two major lipid classes differentially expressed were lysophosphatidylcholine/phosphatidylcholine (LPC/PC) and ceramides (Cer). All lipids in the LPC/PC class were several-fold lower in adiposomes from obese subjects compared to lean controls, on top of which were PC 18:2, PC 18:1, and PC 36:3. Most ceramides were markedly upregulated in the obese group, especially Cer d37:0, Cer d18:0, and Cer d39:0. Regression analyses revealed associations between adiposomal lipid profiles and several cardiometabolic risk factors such as body mass index (BMI), fat percentage, insulin resistance, arteriolar and brachial artery vasoreactivity, NO bioavailability, and high-density lipoproteins (HDL-C). We conclude that the ability of adiposomes from obese subjects to disrupt cardiometabolic function could be partly attributed to the dysregulated lipid cargo.

Is There any Benefit of Addition of Neo-Adjuvant Chemotherapy (FOLFOX4) to Standard Preoperative Treatment of Rectal Cancer? A Randomized Clinical Trial.

BACKGROUND: Total neoadjuvant therapy (TNT) before surgical intervention represents a unique therapeutic approach for the management of locally advanced rectal cancer (LARC) and has witnessed a notable rise in utilization within recent years. However, the efficacy and safety of this treatment remain subjects of ongoing debate and investigation. This randomized controlled trial aimed to evaluate the potential impact of administering induction chemotherapy (IC) before the conventional neoadjuvant concomitant chemoradiotherapy (nCRT) in LARC patients. MATERIALS & METHODS: patients with resectable stage II-III LARC were randomly allocated to receive either biweekly 6 cycles of FOLFOX4 regimen as IC followed by CRT and total mesorectal excision (TME) (experimental group) or nCRT followed by TME (control group). The primary endpoint was the rate of pathological complete response (pCR). The secondary endpoints encompassed the evaluation of treatment-related adverse events as well as the assessment of survival outcomes. RESULTS: 67 patients were enrolled in this study (32 in the experimental group and 35 in the control group). The median age of the patients was 45 years. Stage IIIB was observed in 46.3% of the patients. The patients who underwent induction chemotherapy demonstrated a notably higher rate of achieving pCR in comparison to the control group (28.1% vs 8.6%; P=0.001). There were no statistically significant differences observed in terms of their toxicity profile and survival outcomes. CONCLUSIONS: Implementation of induction chemotherapy utilizing the FOLFOX4 regimen has demonstrated a notable enhancement in the rate of pathological complete response. However, this improvement does not appear to translate into significant advancements in overall survival outcomes.

Hemospray® (hemostatic powder TC-325) as monotherapy for acute gastrointestinal bleeding: a multicenter prospective study.

Background: Hemostatic powders are used as second-line treatment in acute gastrointestinal (GI) bleeding (AGIB). Increasing evidence supports the use of TC-325 as monotherapy in specific scenarios. This prospective, multicenter study evaluated the performance of TC-325 as monotherapy for AGIB. Methods: Eighteen centers across Europe and USA contributed to a registry between 2016 and 2022. Adults with AGIB were eligible, unless TC-325 was part of combined hemostasis. The primary endpoint was immediate hemostasis. Secondary outcomes were rebleeding and mortality. Associations with risk factors were investigated (statistical significance at P≤0.05). Results: One hundred ninety patients were included (age 51-81 years, male: female 2:1), with peptic ulcer (n=48), upper GI malignancy (n=79), post-endoscopic treatment hemorrhage (n=37), and lower GI lesions (n=26). The primary outcome was recorded in 96.3% (95% confidence interval [CI]: 92.6-98.5) with rebleeding in 17.4% (95%CI 11.9-24.1); 9.9% (95%CI 5.8-15.6) died within 7 days, and 21.7% (95%CI 15.6-28.9) within 30 days. Regarding peptic ulcer, immediate hemostasis was achieved in 88% (95%CI 75-95), while 26% (95%CI 13-43) rebled. Higher ASA score was associated with mortality (OR 23.5, 95%CI 1.60-345; P=0.02). Immediate hemostasis was achieved in 100% of cases with malignancy and post-intervention bleeding, with rebleeding in 17% and 3.1%, respectively. Twenty-six patients received TC-325 for lower GI bleeding, and in all but one the primary outcome was achieved. Conclusions: TC-325 monotherapy is safe and effective, especially in malignancy or post-endoscopic intervention bleeding. In patients with peptic ulcer, it could be helpful when the primary treatment is unfeasible, as bridge to definite therapy.

From Drug Discovery to Drug Approval: A Comprehensive Review of the Pharmacogenomics Status Quo with a Special Focus on Egypt.

Pharmacogenomics (PGx) is the hope for the full optimization of drug therapy while minimizing the accompanying adverse drug events that cost billions of dollars annually. Since years before the century, it has been known that inter-individual variations contribute to differences in specific drug responses. It is the bridge to what is well-known today as "personalized medicine". Addressing the drug's pharmacokinetics and pharmacodynamics is one of the features of this science, owing to patient characteristics that vary on so many occasions. Mainly in the liver parenchymal cells, intricate interactions between the drug molecules and enzymes family of so-called "Cytochrome P450" occur which hugely affects how the body will react to the drug in terms of metabolism, efficacy, and safety. Single nucleotide polymorphisms, once validated for a transparent and credible clinical utility, can be used to guide and ensure the succession of the pharmacotherapy plan. Novel tools of pharmacoeconomics science are utilized extensively to assess cost-effective pharmacogenes preceding the translation to the bedside. Drug development and discovery incorporate a drug-gene perspective and save more resources. Regulations and laws shaping the clinical PGx practice can be misconceived; however, these pre-/post approval processes ensure the product's safety and efficacy. National and international regulatory agencies seek guidance on maintaining conduct in PGx practice. In this patient-centric era, social and legal considerations manifest in a way that makes them unavoidable, involving patients and other stakeholders in a deliberate journey toward utmost patient well-being. In this comprehensive review, we contemporarily addressed the scientific leaps in PGx, along with various challenges that face the proper implementation of personalized medicine in Egypt. These informative insights were drawn to serve what the Egyptian population, in particular, would benefit from in terms of knowledge and know-how while maintaining the latest global trends. Moreover, this review is the first to discuss various modalities and challenges faced in Egypt regarding PGx, which we believe could be used as a pilot piece of literature for future studies locally, regionally, and internationally.