Effect of three modalities on emergence agitation among post-traumatic stress disorder patients undergoing laparoscopy: a randomized controlled study.

BACKGROUND AND AIM: Emergence agitation (EA) after general anesthesia is common in patients with post-traumatic stress disorder (PTSD). Due to the recent worldwide events such as the Covid-19 pandemic and wars, PTSD is not rare. Accordingly, a reliable, cost-effective anesthetic protocol to lower the incidence of EA is crucial. Therefore, we aimed to compare three different interventions for avoiding EA in PTSD patients undergoing gynecological laparoscopic surgery. Participants were divided into four groups: 1: performing pre-operative relaxation techniques (deep breathing exercise and progressive muscle relaxation [PMR]); 2: administrating intra-operative Ketamine; 3: applying both previously mentioned strategies and 4 as controls. METHODS: This study was carried out on 144 adult women scheduled for gynecological laparoscopy, randomly allocated into four groups: three intervention groups and a control group (36 each). Women aged 18-45 years old, with a diagnosis of PTSD were included in the study. Patients with a positive history of major neurological, cardiovascular, metabolic, respiratory, or renal disease were excluded. Any patient who reported the use of psychiatric drugs were also excluded from the study. Data was analyzed using IBM SPSS Statistics software version 26. Kolmogorov- Smirnov was used to verify the normality of the distribution of variables. Odds ratio was calculated to clarify the strength and direction of the association between intervention groups and control. Data was deemed significant at a p-value ≤0.05. RESULTS: Heart rate (HR) and Mean Arterial Blood Pressure (MABP) intra-operative and post-operative till 24 hours were significantly lower in groups 1, 2, and 3 compared to group 4 (p<0.001). There was a significant statistical difference in the intraoperative HR percentage decrease. MABP percentage decrease post-operative was higher in all the intervention groups with no statistically significant difference, except for group 1 compared to group 4, which was statistically significant (12.28 ± 11.77 and 6.10 ± 7.24, p=0.025). Visual Analogue Scale measurements were significantly less in the intervention groups 1, 2, and 3 compared to group 4. On Riker sedation-agitation scores, group 1 was 85 times more likely to be non-agitated (85 (15.938 - 453.307), p<0.001), group 2 was 175 times more likely to be non-agitated (175 (19.932-1536.448), p<0.001) and group 3 was protected against agitation. CONCLUSION: Pre-operative relaxation techniques (breathing exercises and PMR) significantly lowered HR, MABP, VAS score, and EA than controls. These effects were not significantly different from intra-operative ketamine injection or the combination of both (relaxation techniques and ketamine). We recommend routine pre-operative screening for PTSD and the application of relaxation techniques (breathing exercises and PMR) in the pre-operative preparation protocol of PTSD-positive cases as well as routine practical application of preoperative relaxation techniques. Further studies on using pre-operative relaxation techniques in general could be cost-effective.

Is neuregulin-1 (NRG-1) a potential blood biomarker linking depression to obesity? A case-control study.

BACKGROUND AND AIM: No definite biomarker linking depression and obesity has been found yet. Our study aimed to investigate neuregulin-1 (NRG-1) as a potential blood biomarker for this association. METHODS: A case-control study was conducted on 108 obese subjects assigned for laparoscopic sleeve gastrectomy and 100 non-obese controls. Depression was assessed pre- and post-operatively. Serum NRG-1 was measured. RESULTS: Pre-operatively depression was significantly higher among obese compared to non-obese patients. After the operation, 1.9% of the severely depressed subjects reported no depression, while 5.6% became moderately depressed; about 6% of the moderately depressed and 16% of the mildly depressed became not depressed. Serum NRG-1 level was significantly lower among obese and severely depressed compared to the controls. It was negatively correlated to the level of depression pre- and post-operative (r = -0.764 and -0.467 respectively). The sensitivity of serum NRG1 as a predictor for depression pre- and post-operative was 92.45% and 52.94% respectively. Specificity was 69.09% and 79.73% respectively at cut-off values of ≤ 3.5 and ≤ 2.5 ng/ml. CONCLUSION: NRG-1 is a possible biomarker for the diagnosis of depression pre-bariatric surgery and the prediction of its prognosis post-operatively.

Effect of treatment of chronic hepatitis c virus patients with direct-acting anti-retroviral drugs on semen and hormonal parameters.

Objective: Hepatitis C virus (HCV) infection is known to influence the seminal and hormonal parameters of infected men. This study was performed to assess the effects of HCV clearance using direct-acting antiviral (DAA) agents on semen and hormonal parameters. Methods: A total of 50 patients with chronic HCV were enrolled, and conventional semen analysis was performed according to World Health Organization guidelines. Basal levels of total testosterone, free testosterone (FT), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin, and sex hormone-binding globulin (SHBG) were assessed before and 3 months after treatment with DAAs. Results: Following DAA treatment, statistically significant increases were observed in sperm motility and the proportion of grade A sperm. Additionally, the percentage of abnormal forms was significantly decreased after treatment (p=0.000). However, no significant differences were observed in semen volume, concentration, or total sperm count. Sex hormone analysis of patients after DAA treatment revealed significant increases in FT, LH, and FSH levels, along with significant decreases in SHBG, prolactin, and E2 levels. Conclusion: Following HCV clearance, we noted an improvement in sperm motility and an increase in the percentage of sperm with normal morphology. Treatment with DAAs was also associated with increased levels of FT and LH, along with decreased levels of SHBG, prolactin, and E2.

Association Between Type 1 Diabetes Mellitus and Eating Disorders: A Systematic Review and Meta-Analysis.

BACKGROUND: Previous meta-analyses have shown mixed results regarding the association between eating disorders (EDs) and type 1 diabetes mellitus (T1DM). Our paper aimed to analyse different EDs and disordered eating behaviours that may be practiced by patients with T1DM. METHODS: A literature search of PubMed, Scopus and Web of Science was conducted on 17 January 2023, using the key terms "T1DM," "Eating Disorders" and "Bulimia." Only observational controlled studies were included. The Revman software (version 5.4) was used for the analysis. RESULTS: T1DM was associated with increased risk of ED compared with nondiabetic individuals (RR = 2.47, 95% CI = 1.84-3.32, p-value < 0.00001), especially bulimia nervosa (RR = 2.80, 95% CI = 1.18-6.65, p-value = 0.02) and binge eating (RR = 1.53, 95% CI = 1.18-1.98, p-value = 0.001). Our analysis has shown that increased risk of ED among T1DM persisted regardless of the questionnaire used to diagnose ED; DM-validated questionnaires (RR = 2.80, 95% CI = 1.91-4.12, p-value < 0.00001) and generic questionnaires (RR = 2.03, 95% CI = 1.27-3.23, p-value = 0.003). Prevalence of insulin omission/misuse was 10.3%; diabetic females demonstrated a significantly higher risk of insulin omission and insulin misuse than diabetic males. CONCLUSION: Our study establishes a significant and clear connection between EDs and T1DM, particularly bulimia and binge eating, with T1DM. Moreover, female diabetics are at higher risk of insulin misuse/omission. Early proactive screening is essential and tailored; comprehensive interventions combining diabetes and ED components are recommended for this population, with referral to a specialised psychiatrist.

Mental health, risk perception, and coping strategies among healthcare workers in Egypt during the COVID-19 pandemic.

BACKGROUND: Coronavirus disease-19 emerged in December 2019. Healthcare workers were exposed to this highly infectious virus during the pandemic and suffered several social and psychological consequences, such as anxiety, psychological distress, and burnout. OBJECTIVES: To assess the psychological distress, anxiety, depression, coping strategies, risk perception, and attitude toward interprofessional teamwork among Egyptian healthcare workers during the COVID-19 pandemic. METHODS: We conducted a cross-sectional online survey which consisted of five sections. The primary outcomes were anxiety (GAD-7), depression (PHQ-9), risk perception towards COVID-19, interprofessional teamwork attitude, and coping strategies during the Coronavirus disease-19 pandemic. The web-based questionnaire was distributed to Egyptian healthcare workers from the 20th of April 2020 to the 20th of May 2020. A snowball sampling method was used. Regression analysis was conducted to test the relationship between the socioeconomic characteristics and the previously mentioned outcomes. RESULTS: A total of 403 participants responded to the online questionnaire. The majority were females (70.5%) and within the age group of 26-40 years (77.7%), with 2-5 years of work experience (43.2%). Most participants were pharmacists (33%) and physicians (22.1%). Eighty-two participants (21%) reported moderate to severe anxiety, and 79 participants reported (19.4%) moderate to severe depressive symptoms. In the univariate model, the marital status was associated with depression (OR 0.47, 95% CI 0.28-0.78), anxiety (OR 0.52, 95% CI 0.32-0.85), and an attitude toward interprofessional teamwork (ß = -1.96 95% CI -2.72 to -1.2). Providing direct care to the patients was associated with lower anxiety symptoms (AOR 0.256, 95% CI 0.094-0.697). More severe anxiety and depressive symptoms were associated with difficulties in everyday life and the professional work environment (AOR 4.246 and 3.3, P = 0.003 and 0.01, respectively). Availability of mental health facilities at the workplace was associated with a lower risk perception towards COVID-19 (ß = -0.79, 95% CI -1.24 to -0.34) and a more positive attitude towards teamwork (ß = 2.77 95% CI 1.38-4.15). CONCLUSIONS: According to our results, the COVID-19 pandemic was associated with mild anxiety and depression among healthcare workers in Egypt, especially pharmacists and physicians. We recommend more research targeting the mental health of healthcare workers in Egypt. If proven cost-effective and needed, wide-scale mental health screening and public health campaigns can facilitate effective prevention and treatment strategies. In addition, the availability of mental health facilities at the workplace could alleviate some of the risk perception associated with health emergencies and improve interprofessional teamwork.

The relationship between anxiety and irritable bowel syndrome symptoms among females: A cross-sectional study in Egypt.

There is a scarcity of studies focusing on irritable bowel syndrome (IBS) and anxiety in Egypt. Accordingly, our study aimed to assess the association between anxiety and IBS symptomatology among Egyptian females. Three hundred eighty-three females (145 IBS and 238 controls) were included in the study, and data were obtained using structured predesigned questionnaires. IBS and anxiety symptoms were assessed according to the Rome IV criteria and the Arabic version of the beck anxiety inventory, respectively. Both IBS and non-IBS groups showed increased anxiety during the pandemic, without a significant difference between both groups (P value = .657). Higher levels of education were significantly associated with severe anxiety (P value = .031). Multivariate analysis of IBS patients showed that intermediate education was significantly associated with 75% lower odds for increased IBS symptoms compared with illiterate or read-and-write IBS patients [odds ratio (OR): 0.25, 95% confidence interval (CI) 0.06-0.95, P value = .042]. Urban residence was significantly associated with 13.5 times greater odds of increased IBS symptoms, compared with rural residence (OR: 13.48, 95% CI 3.55-51.25, P value < .001). Moreover, patients who lost their job during the pandemic were 12.9 times more likely to have increased symptoms (OR: 12.89, 95% CI 1.84-90.15, P value = 0.01). A unit increase in patients age and beck anxiety inventory score was associated with 68% and 75% greater odds for increased IBS symptoms, respectively (OR: 1.68, 95% CI 1.12-2.53, P value = .012; OR: 1.75, 95% CI 1.08-2.84, P value = .024). Increasing anxiety is associated with increased IBS symptoms. Therefore, IBS patients should be screened for anxiety, and the role of psychiatric management of anxiety in the amelioration of IBS symptoms must be explored.

Association between insomnia and the incidence of myocardial infarction: A systematic review and meta-analysis.

BACKGROUND: Insomnia has been closely associated with cardiovascular disease (CVD) including myocardial infarction (MI). Our study aims to assess the eligibility of insomnia as a potential risk factor for MI. METHODS: PubMed, Scopus, and Web of Science were searched using terms; such as "Insomnia" and "MI." Only observational controlled studies with data on the incidence of MI among insomniacs were included. Revman software version 5.4 was used for the analysis. RESULTS: Our pooled analysis showed a significant association between insomnia and the incidence of MI compared with noninsomniacs (relative risk [RR] = 1.69, 95% confidence interval [CI] = 1.41-2.02, p < .00001). Per sleep duration, we detected the highest association between ≤5 h of sleep, and MI incidence compared to 7-8 h of sleep (RR = 1.56, 95% CI = 1.41-1.73). Disorders of initiating and maintaining sleep were associated with increased MI incidence (RR = 1.13, 95% CI = 1.04-1.23, p = .003). However, subgroup analysis of nonrestorative sleep and daytime dysfunction showed an insignificant association with MI among both groups (RR = 1.06, 95% CI = 0.91-1.23, p = .46). Analysis of age, follow-up duration, sex, and comorbidities showed a significant association in insomniacs. CONCLUSION: Insomnia and ≤5 h of sleep are highly associated with increased incidence of MI; an association comparable to that of other MI risk factors and as such, it should be considered as a risk factor for MI and to be incorporated into MI prevention guidelines.

Impact of COVID-19 on digestive system: prevalence, clinical characteristics, outcome, and relation to the severity of COVID-19.

Background: Coronavirus disease 2019 (COVID-19) is commonly associated with respiratory symptoms. However, gastrointestinal (GI) symptoms are increasingly recognized in COVID-19 patients. The aim is to study the prevalence and features of gastrointestinal manifestations in severe acute respiratory coronavirus 2 (SARS-CoV-2) infected patients and evaluate the outcome among the studied population. Results: We enrolled adult patients with laboratory-confirmed COVID-19 admitted to Ain Shams University designated hospitals, Cairo, Egypt, from March 2021 to June 2021. The patients were assigned to a GI group and a non-GI group based on the presence or absence of one or more digestive symptoms. A total of 300 hospitalized COVID-19 patients were included, of which 104 (34.7%) had one or more digestive symptoms. They were compared with 196 COVID-19 patients without GI symptoms. The most common reported GI symptom was diarrhea (82.7%). GI symptoms' presence was higher in moderate cases. Patients with digestive symptoms presented for care later than those without (7.9±3.8 vs 7.4±7.2 days, P=0.5). Moreover, they have lower mortality, though non-significant (7.7 vs 12.8%, P=0.18). Patients with digestive symptoms had lower total leucocytic count (TLC), neutrophil count, neutrophil to lymphocyte ratio (NLR), platelet count, and higher serum sodium than those without digestive symptoms. Conclusion: GI symptoms are prevalent among COVID-19 patients, and the most common was diarrhea. The presence of GI manifestations was not associated with increased mortality.

Possible Use of miR-223-3p as a Prognostic Marker in Transarterial Chemoembolization Treatment of Hepatocellular Carcinoma Patients.

INTRODUCTION AND OBJECTIVES: Transcatheter chemoembolization (TACE) is the recommended therapy for intermediate stage hepatocellular carcinoma patients. Unfortunately, one of the main reasons for its failure is the emergence of multidrug resistance (MDR). Therefore, this study explored the possibility of using MDR-related miRNA as a response biomarker in HCC patients treated with doxorubicin drug-eluting bead TACE (DEB-TACE). PATIENTS AND METHODS: Quantitative real-time polymerase chain reaction (qRT-PCR) was employed to evaluate the expression level of 14 MDR-related miRNAs in doxorubicin-resistant HepG2 cells (HepG2/Dox) developed by single-dose of doxorubicin mimicking the situation of liver cells surviving TACE. The sera level of miR-223-3p, which was the most significantly downregulated in the HepG2 cells, was determined in 60 primary HCC patients undergoing TACE. Restoring miR-223-3p in HepG2/Dox cell line was achieved by its mimic transfection. Cell sensitivity was measured by SRB assay. Cell apoptosis and doxorubicin uptake were assessed by flow cytometry. The expression of miR-223-3p target protein, P-glycoprotein, was evaluated using qRT-PCR and western blotting. RESULTS: We detected a significant downregulation of circulating miR-223-3p in patients non-responders to TACE treatment compared with responders. The expression of miR-223-3p was markedly decreased in resistant HepG2/Dox cells compared to the parental control. In addition, the expression of miR-223-3p was found to be inversely correlated with P-glycoprotein expression thus confirming the role of miR-223-3p in MDR. Furthermore, overexpression of miR-223-3p suppressed P-glycoprotein which promoted cellular uptake of doxorubicin and increased apoptosis. CONCLUSIONS: Our data suggest a potential role for miR-233-3p as a prognostic as well as a therapeutic target for HCC.

Implications of cigarette smoking on early-onset androgenetic alopecia: A cross-sectional Study.

BACKGROUND: Androgenetic alopecia (AGA) is a condition affecting both males and females. Aims We aimed to assess the demographic and clinical features of early-onset AGA among smokers and nonsmokers and to evaluate whether prevalence of AGA was affected by smoking. PAATIENTS/METHODS: One thousand (1000) healthy males aged between 20 and 35 years not complaining of any local scalp condition and free of any mental illness were recruited for this study and divided into two groups of 500 each based on their smoking attitudes. Androgenetic alopecia was classified according to the Hamilton baldness scale, and trichoscopy was used to confirm the diagnosis of AGA. A designed questionnaire to determine basic physical and smoking habits completed and results was interpreted and analyzed. RESULTS: The majority of smokers (425) had a form of AGA, while only (200) nonsmokers had a degree of AGA (P < .01). Of the smokers group, 235 (47%) had grade III AGA and 120 subjects (24%) had grade IV AGA. In the nonsmokers group, 100 subjects (20%) had grade II AGA and 50 subjects (10%) had either grade III or IV AGA. CONCLUSION: The prevalence of AGA among smokers was statistically higher than among nonsmokers, while severity of AGA was not associated with the intensity of smoking. Nicotine and its derivative cotinine might be responsible for accelerating AGA progress pending further validation.

Radiological Surveillance Post-Curative Colorectal Cancer Resection: Is There a Need for a Targeted Protocol?

Background The frequency of radiological surveillance after curative colorectal cancer resection has long been a controversial issue with the need to balance potential harm from ionizing radiation and the financial burden of intense surveillance against advantages of early detection of recurrent disease. NICE guidelines issued in 2018 suggested having two surveillance computed tomography (CT) scans within three years of surgery without specifying the timing or the interval. Aim To examine whether an evidence-based flexible approach based on individual patients' risk factors can add value to surveillance protocols. Reaching a targeted protocol that can maximize early detection of metastasis without consumption of resources and most important without compromising patient safety. Methodology A retrospective study involving five years of data of patients who underwent curative colorectal cancer resections. Data extracted after patients completed their three-year surveillance CT scans, CT reports retrieved together with post-operative histology reports, and a detailed database was constructed. Results Of 179 patients included, 66 developed recurrence (7 local and 59 distant). Recurrence increased from 23.5% in T1 to 66% in T4 (P=0.0001). The median time to recurrence 23 months in T4 disease compared to 36, 42 and 43 months for stages T1, T2 and T3, respectively (P=0.0001). A similar incremental increase in recurrence noted from 22% in the N0 stage to 73.5% in the N2 stage (P=0.0001); the median time to recurrence of 14 months in N2 patients compared to 45 and 33 months for stages N0 and N1, respectively (P=0.0001). Recurrence correlated well with positive extramural vascular invasion (EMVI) status, (71.7% versus 19.3% P=0.0001) being detected significantly earlier in EMVI positive group at 17 versus 45 months (P=0.0001). Conclusion Flexible protocol for radiological surveillance after curative resection of colorectal cancer, based on known pathological prognostic factors, is likely to be more effective in maximizing resource utilization as well as improving patient outcomes.

MicroRNAs 182 and 375 Sera Expression as Prognostic Biochemical Markers in Breast Cancer.

INTRODUCTION: Breast cancer (BC) is the most common malignancy among women; supporting the need for identification of novel prognostic biomarkers, circulating microRNAs (miRNAs) could serve as such in various cancers. The aim of this study was to explore the association between miRNAs 182 and 375 with BC stages and its receptors, based on their expression using real time PCR. MATERIALS AND METHODS: Detailed medical history was taken and blood samples were withdrawn from 80 female subjects divided over the studied groups. Patients ranged in age from 24 to 80 years and were classified as follows: group I included 10 noncancerous postmenopausal control subjects; group II included 32 postmenopausal patients with BC; group III included 10 noncancerous premenopausal control subjects; group IV included 24 premenopausal patients with BC; and group V included 6 patients with benign breast tumors. RESULTS: miRNA 182 expression was significantly higher in group II, group IV, and group V (3.36 ± 0.14, 2.52 ± 0.34, and 4.93 ± 0.3,9 respectively); miRNA 375 expression was significantly higher in group II, group IV, and group V (4.41 ± 0.40, 3.12 ± 0.35, and 11.28 ± 2.37, respectively) (P < .05). Both miRNAs were significantly associated with each other and with receptors used for the prognosis of BC even after multiple regression analysis. CONCLUSION: Accordingly, miRNAs 182 and 375 could be potential noninvasive markers used for the follow up of BC patients.

Repression of acetaminophen-induced hepatotoxicity by a combination of celastrol and brilliant blue G.

The sterile inflammatory response is an eminent contributor to acetaminophen (APAP)-hepatotoxicity in humans. Recent advances unraveled an axial role of the NLRP3-inflammasome in APAP-post injury inflammation. Nevertheless, the role of signaling events preceded the NLRP3-inflammasome activation, like the transcription factor NF-κB and the purinergic receptor P2X7, is still unclear and needs further elucidation. Here, we investigated the pharmacological inhibition of these upstream signaling molecules by celastrol and brilliant blue G (BBG) (separately or simultaneously) in APAP-hepatotoxicity in mice. The results indicated that both celastrol and BBG pretreatments, especially when combined together, curbed APAP-induced hepatocellular injury (ALT, AST and LDH) and death (necrosis and apoptosis). The underlying mechanisms of protection of such combination against APAP-challenge were attributed to their efficient cooperation in: i) preventing the consumption of hepatic antioxidants (reduced glutathione and superoxide dismutase); ii) limiting the overproduction of lipid peroxidation aldehydes (malondialdehyde and 4-hydroxynonenal) and total nitrate/nitrite products; iii) attenuating the inflammatory cells accumulation in the liver, as evidenced by reducing the number of F4/80 positive cells/field in immunostaining and myeloperoxidase activity; iv) reversing the dysregulation in production of pro-inflammatory (TNF-α, IL-17A and IL-23) and anti-inflammatory (IL-10) cytokines; and v) enhancing the reparative capacity of injured hepatocytes, as demonstrated by increasing the percentage of PCNA positive hepatocytes per field of immunostaining. In conclusion, this murine study elicits a potential clinical applicability and therapeutic utility of celastrol and BBG combination in human cases of APAP-overdose hepatotoxicity.

Associations of depression and neuroticism with smoking behavior and motives among men in rural Qalyubia (Egypt).

PURPOSE: Smoking addiction is influenced by cultural and environmental factors and personality traits. We assessed the associations between neuroticism and depression and smoking behavior and motives among Egyptian adult men in rural Qalyubia Governorate. PATIENTS AND METHODS: Using a cross-sectional design, we administered questionnaires to randomly selected 201, 278, and 120 adult men aged 18 years or above who were never, current, and former smokers, respectively. We used Center for Epidemiologic Studies Short Depression (CES-D) scale, Eysenck Personality Inventory (EPI), Fagerström Test for Nicotine Dependence (FTND), and Wisconsin Inventory of Smoking Dependence Motives scales to assess the associations between neuroticism, depression, and smoking risk. RESULTS: The mean CES-D and EPI scores were significantly higher among current smokers as compared with never smokers (P=0.02 and 0.006, respectively). The greatest risk for ever smoking was observed among those with both neuroticism and depression [adjusted odds ratio (95% confidence interval) were 1.98 (1.23-3.19); 2.56 (1.34-4.88); and 1.82 (1.10-3.03) for ever, former, and current smokers, respectively]. Both CES-D and EPI scores were associated with a variety of smoking motives and with the level of severity or intensity of nicotine dependence on FTND. CONCLUSION AND RECOMMENDATIONS: Neuroticism and depression were associated with smoking behavior and motives among Egyptians, and thus attention should be given to individual needs in designing and implementing smoking cessation interventions.