Efficacy and Toxicity of Vincristine and CYP3A5 Genetic Polymorphism in Rhabdomyosarcoma Pediatric Egyptian Patients.

BACKGROUND: Rhabdomyosarcoma (RMS) is a rare cancer that develops in soft tissue, particularly skeletal muscle tissue and occasionally hollow organs like the bladder or uterus. Vincristine (VCR) is the main therapy used in treatment of RMS, it is an alkaloid produced from vinca and it is one of the most commonly prescribed drugs in pediatric oncology for the treatment of a number of tumors. The CYP3A5 enzyme is responsible for vincristine metabolism. The effect of CYP3A5 genetic polymorphism on the efficacy and toxicity of VCR on RMS patients still needs further research. METHODS: Genotyping for CYP3A5 SNPs rs776746, rs10264272 and rs41303343 was performed using Taqman Real-Time PCR assays in a retrospective cohort study of 150 RMS pediatric patients treated with vincristine. The relationship between these genotypes and RMS survival was then examined. RESULTS: We found that patients with CYP3A5*3/*3 had the highest incidence of vincristine-induced neuropathy reaching 61.3%. Patients with CYP3A5*1/*3, CYP3A5*3/*6 and the normal metabolizers with CYP3A5*1/*1 had frequencies of 22%, 10.7%, and 4.7%. patients with the lowest frequency of 1.3% were those with the CYP3A5*1/*6 genotype. There was no correlation between the genotypes of CYP3A5*3, CYP3A5*6, CYP3A5*7, and RMS survival. Initial risk, metastasis, response, convulsions, unsteady gait and hepatotoxicity grade had a significant effect on overall survival with p<0.05. CONCLUSION: CYP3A5*1/*1 have less severe vincristine-induced neuropathy than CYP3A5 *1/*3, CYP3A5 *1/*6 and CYP3A5 *3/*3, CYP3A5 *3/*6. There is a significant influence of CYP3A5 mutation on neuropathy grade and assist of ADL as a part of neurotoxicity.

Unidirectional Nano-modulated Binding and Electron Scattering in Epitaxial Borophene.

A complex interplay between the crystal structure and the electron behavior within borophene renders this material an intriguing 2D system, with many of its electronic properties still undiscovered. Experimental insight into those properties is additionally hampered by the limited capabilities of the established synthesis methods, which, in turn, inhibits the realization of potential borophene applications. In this multimethod study, photoemission spectroscopies and scanning probe techniques complemented by theoretical calculations have been used to investigate the electronic characteristics of a high-coverage, single-layer borophene on the Ir(111) substrate. Our results show that the binding of borophene to Ir(111) exhibits pronounced one-dimensional modulation and transforms borophene into a nanograting. The scattering of photoelectrons from this structural grating gives rise to the replication of the electronic bands. In addition, the binding modulation is reflected in the chemical reactivity of borophene and gives rise to its inhomogeneous aging effect. Such aging is easily reset by dissolving boron atoms in iridium at high temperature, followed by their reassembly into a fresh atomically thin borophene mesh. Besides proving electron-grating capabilities of the boron monolayer, our data provide comprehensive insight into the electronic properties of epitaxial borophene which is vital for further examination of other boron systems of reduced dimensionality.

van der Waals 2D transition metal dichalcogenide/organic hybridized heterostructures: recent breakthroughs and emerging prospects of the device.

The near-atomic thickness and organic molecular systems, including organic semiconductors and polymer-enabled hybrid heterostructures, of two-dimensional transition metal dichalcogenides (2D-TMDs) can modulate their optoelectronic and transport properties outstandingly. In this review, the current understanding and mechanism of the most recent and significant breakthrough of novel interlayer exciton emission and its modulation by harnessing the band energy alignment between TMDs and organic semiconductors in a TMD/organic (TMDO) hybrid heterostructure are demonstrated. The review encompasses up-to-date device demonstrations, including field-effect transistors, detectors, phototransistors, and photo-switchable superlattices. An exploration of distinct traits in 2D-TMDs and organic semiconductors delves into the applications of TMDO hybrid heterostructures. This review provides insights into the synthesis of 2D-TMDs and organic layers, covering fabrication techniques and challenges. Band bending and charge transfer via band energy alignment are explored from both structural and molecular orbital perspectives. The progress in emission modulation, including charge transfer, energy transfer, doping, defect healing, and phase engineering, is presented. The recent advancements in 2D-TMDO-based optoelectronic synaptic devices, including various 2D-TMDs and organic materials for neuromorphic applications are discussed. The section assesses their compatibility for synaptic devices, revisits the operating principles, and highlights the recent device demonstrations. Existing challenges and potential solutions are discussed. Finally, the review concludes by outlining the current challenges that span from synthesis intricacies to device applications, and by offering an outlook on the evolving field of emerging TMDO heterostructures.

Current status of African pediatric oncology education efforts aligned with the Global Initiative for Childhood Cancer.

Education of the pediatric oncology workforce is an important pillar of the World Health Organization CureAll technical package. This is not only limited to healthcare workers, but all stakeholders in the childhood cancer management process. It includes governmental structures, academic institutions, parents and communities. This review evaluated the current educational and advocacy training resources available to the childhood cancer community, the contribution of SIOP Africa in the continental educational needs and evaluated future needs to improve the management of pediatric malignancies in reaching the Global Initiative for Childhood Cancer goals. Childhood cancer, unlike adult cancers, has not been prioritized in African cancer control plans nor the teaching and advocacy surrounding pediatric oncology. The availability of formal training programs for pediatric oncologists, pediatric surgeons and radiotherapy specialists are limited to particular countries. In pharmacy and nutritional services, the exposure to pediatric oncology is limited while training in advocacy doesn't exist. Many nonacademic stakeholders are creating the opportunities in Africa to gain experience and train in these various fields, but formal training programs should still be advocated for. LEARNING POINTSThe African continent has various resources to increase the capacity of childhood cancer care stakeholders to increase their knowledge.African pediatric oncology teams rely on a multitude of international sources for training while developing their own.There is a greater need for formal, standardized cancer training especially for pediatric surgeons, radio-oncologists and nurses.Greater inclusion of pathologists, pediatric oncology pharmacists and dieticians into multidisciplinary care and childhood cancer training should be facilitated and resourced.Successful advocacy programs and tool kits exist in parts of Africa, but the training in advocacy is still underdeveloped.

Knowledge, attitudes and practices of Egyptian healthcare professionals toward therapeutic drug monitoring service as a principal component of personalized medicine.

Aim: To assess pharmacists' and physicians' knowledge, attitudes and practices toward therapeutic drug monitoring (TDM) service at the Children's Cancer Hospital Egypt 57357. Materials & methods: This was a single-site cross-sectional study where all practicing pharmacists and physicians were eligible to participate. Results: A statistically significant difference in the knowledge scores between pharmacists and physicians (p = 0.022) was found. In general, attitudes toward TDM among pharmacists and physicians were positive. Regarding practices, pharmacists were more likely than physicians to agree or strongly agree that they have studied some scientific references on TDM (p = 0.034), but more physicians recommend the TDM service (p = 0.046). Conclusion: A multidisciplinary educational program in Egypt for TDM for both medicine and pharmacy staff will improve interprofessional collaboration in the clinical setting, leading to better personalized medication management.

The objective of the present survey was to evaluate the knowledge, attitudes and practices of pharmacists and physicians toward therapeutic drug monitoring (TDM) services at the Children's Cancer Hospital Egypt 57357. TDM is defined as 'measuring the amount of specific drugs in patients' blood to ensure that the concentrations of administered drugs are both effective and safe'. A single-centered study was conducted at the CCHE where all pharmacists and physicians participated. There was a remarkable difference in the knowledge scores between pharmacists and physicians. Generally, both pharmacists and physicians demonstrated positive attitudes toward TDM. In real-life practice, pharmacists were more likely than physicians to agree that they had scientific evidence about TDM. Multidisciplinary educational programs for TDM among physicians and pharmacists would improve interprofessional collaboration for the benefit of patients in Egypt.

Macroscopic Single-Phase Monolayer Borophene on Arbitrary Substrates.

A major challenge in the investigation of all 2D materials is the development of synthesis protocols and tools which would enable their large-scale production and effective manipulation. The same holds for borophene, where experiments are still largely limited to in situ characterizations of small-area samples. In contrast, our work is based on millimeter-sized borophene sheets, synthesized on an Ir(111) surface in ultrahigh vacuum. Besides high-quality macroscopic synthesis, as confirmed by low-energy electron diffraction (LEED) and atomic force microscopy (AFM), we also demonstrate a successful transfer of borophene from Ir to a Si wafer via electrochemical delamination process. Comparative Raman spectroscopy, in combination with the density functional theory (DFT) calculations, proved that borophene's crystal structure has been preserved in the transfer. Our results demonstrate successful growth and manipulation of large-scale, single-layer borophene sheets with minor defects and ambient stability, thus expediting borophene implementation into more complex systems and devices.

Factors hindering the implementation of clinical pharmacy practice in Egyptian hospitals.

Background: The direction toward incorporating clinical pharmacy services is increasing worldwide but there are many barriers that hinder its implementation in many countries. The types of barriers vary among countries according to their culture, population, education & economic status. Objective: This study aims to investigate factors hindering the implementation of clinical pharmacy practice in Egyptian hospitals. Methods: Hundred hospital pharmacists working in various reputable hospitals in Egypt participated in a descriptive cross-sectional survey designed as a questionnaire representing the main factors previously reported in the literature to hinder clinical pharmacy implementation in different countries around the world. Cronbach alpha was calculated to test the reliability of the questionnaire. Likert plot was used to graphically present the participants' responses. Results: The most significant factors that participants reported to hinder the implementation of clinical pharmacy practice in Egyptian hospitals were the lack of clear career path, financial resources, and leadership support. The percentage of participants who agreed that such factors were key players in hindering the implementation of clinical pharmacy practice was 76%, 74%, and 57% respectively. Conclusion: A number of factors were found to impede clinical pharmacy implementation in Egyptian hospitals. Taking corrective measures to resolve such hindrances should ensure proper hospital pharmacy practice and should positively reflect on patient healthcare services provided at the national level.

Utilization of greenhouse effect for the treatment of COVID-19 contaminated disposable waste - A simple technology for developing countries.

Countries with abundant solar radiation have the potential to invest in simple technologies for deactivation of many bacteria and viruses in medical solid waste. In addition to the traditional Infection and Prevention Control (IPC) measures, these simple technologies contribute to better protection of health care workers in countries with compromised solid management schemes. Monitoring of temperature, relative humidity and ultraviolet inside containers soundly designed to collect disposal infectious waste illustrated to deactivate several viruses and bacteria. Casanova et al., 2010, used some surrogate viruses to overcome the challenges of working with SARS-CoV, concluded that by temperature above 40 °C most of viruses become below levels of detection after 90 min. Here we are proposing a model of a simple transparent container almost 200 L in volume that allow solar energy to be accumulated inside. In summer conditions in the testing site, temperature inside the container reached above 50 °C when the ambient air temperature was around 30 °C. The container was built using epoxy glass to guarantee maximum heat penetration. Actual temperature measurement inside the container was measured in real time against ambient air temperature. We present a mathematical model for predication of maximum temperature at different positions inside the container and their relation to different ambient air temperature scenarios. The mathematical formulas used are based on the conservation laws and a good agreement of a full month of field measurements were obtained. Even in winter conditions in many of developing countries air temperature can maintain levels above 20 °C, which will produce temperature around 30 °C and viruses can reach levels below detection limit in maximum 3 h.

Assessment of healthcare professionals' knowledge, attitudes, and perceived challenges of clinical pharmacogenetic testing in Egypt.

Aim: We evaluated healthcare practitioners' perspectives regarding clinical pharmacogenetics in Cairo, Egypt. Materials & methods: We administered a paper-based survey to pharmacists and physicians practicing at Children's Cancer Hospital Egypt. The survey assessed practitioners' knowledge, attitudes, and perspectives about pharmacogenetic testing. Results: The study included 184 respondents (67.9% pharmacists; 32.1% physicians. Overall, the pharmacogenetic knowledge was low (mean = 41.7%) but attitudes toward pharmacogenetic testing and its potential clinical application were generally positive. Pharmacists responded more favorably than physicians to statements attributing the responsibility of applying pharmacogenetics in the clinical setting to their profession. However, several challenges were identified; the most common being: lack of pharmacogenetic knowledge and skill, lack of pharmacogenetic testing devices, and limited funding. Conclusion: Future efforts to promote pharmacogenetic implementation should focus on foundational education, practical training, and exploration of potential funding sources.

Highlights from the 13th African Continental Meeting of the International Society of Paediatric Oncology (SIOP), 6-9 March 2019, Cairo, Egypt.

The 13th African continental meeting of the international society of paediatric oncology, held on 6-9 March 2019 in Cairo, was organised in collaboration with the Children Cancer Hospital (57357) in Egypt and the global parents' organisation (Childhood Cancer International) and supported by a large international faculty. With 629 delegates from 37 countries (24 African), this was the largest forum of healthcare professionals focused on children and young people with cancer in Africa to showcase advances and discuss further improvements. Three targeted workshops, on nursing care, pharmacy and nutrition, attracted large numbers and catalysed new collaborative initiatives in supportive care studies, extended roles for pharmacists in quality control and care delivery and addressed malnutrition concurrently with cancer treatment. The Collaborative Wilms Tumour Africa Project, open in seven sub-Saharan countries, and the trials in Burkitt's lymphoma reported encouraging outcomes with further initiatives in supportive care (the supportive care for children with cancer in Africa project). While acknowledging deficits in radiotherapy provision, available in only 23 of 52 African countries, centres with facilities reported their technical advances that benefit patients. Of great importance for children with brain tumours, who are underdiagnosed in Africa, was the first announcement of African paediatric neuro-oncology society, whose 63 current members aim to tackle the shortage of neurosurgeons through training fellowships, workshops and a dedicated conference. The congress provided the opportunity to discuss how African countries will work with the WHO global initiative aiming to improve childhood cancer survival to 60% in all countries by 2030. This conference report is dedicated to the three Kenyan delegates who died tragically on the Ethiopian Airlines flight ET302 on their way home, full of new ideas and pride in what they had achieved so far. All those who heard their presentations are determined to continue their excellent work to improve cancer care for children in Africa.

Treatment of immunocompromised patients with suspected invasive fungal infections: economic analysis of diagnostic-driven versus empirical strategies in Algeria and Egypt.

Background: Invasive fungal infections (IFIs) in immunocompromised patients are associated with high mortality and treatment costs. Identifying appropriate, cost-effective treatment strategies is crucial to reduce the burden of IFIs. This economic assessment compared strategies for treating immunocompromised patients in Algeria and Egypt.Methods: We developed a decision analytic model incorporating clinical and cost inputs associated with a diagnostic-driven (DD) and standard empirical (SE) strategy. Costs and clinical outcomes were used to calculate incremental cost-effectiveness ratios (ICERs) per death avoided.Results: In both countries, 73.8 (DD) and 125.3 (SE) hypothetical patients per 1,000 received antifungal therapy; 73.8 (DD) and 32.7 (SE) had diagnosed IFIs. Survival at 180 days was similar between DD and SE strategies in Algeria (92.0% vs 91.6%) and Egypt (90.2% vs 90.0%). Total costs per patient were lower with the DD than SE strategy (Algeria: $839 vs $1,591; Egypt: $4,077 vs $4,717). ICERs indicated that the DD compared with SE strategy was associated with better clinical outcomes at a lower overall cost in both countries.Conclusion: Diagnostic-driven compared to empirical therapy may be cost-saving in Algeria and Egypt for the management of immunocompromised patients with persistent neutropenic fever, with no increase in mortality.

International telepharmacy education: another venue to improve cancer care in the developing world.

OBJECTIVE: In developed countries, pharmacists play a crucial role in designing and implementing cancer treatments as part of a multidisciplinary oncology team. However, developing countries have a shortage of pharmacists, and their role is generally limited to dispensing and selling drugs. The aim of this study was to investigate the feasibility of providing clinical pharmacy educational activities via international teleconferencing to improve cancer care in developing countries. MATERIALS AND METHODS: Meticulous preparation and intense promotion of the workshop were done in Egypt before the telepharmacy conferences began. Multiple connectivity tests were performed to resolve technical problems. Nine telepharmacy conferences were delivered during 3-h sessions that were held on three consecutive days. Talks were subsequently made available via Web streaming. Attendees were requested to complete a survey to measure their satisfaction with the sessions. RESULTS: The teleconference was attended by a total of 345 persons, and it was subsequently reviewed online via 456 log-in sessions from 10 countries. Technical issues (e.g., poor auditory quality) were resolved on the first day of the event. The rate of attendees' responses on the survey was 30.1%, and satisfaction with the event was generally good. CONCLUSIONS: Telecommunication is a relatively inexpensive approach that may improve pharmacy practices, especially those used to treat patients with cancer in developing countries. Special attention to patient-based telepharmacy education, including the use of cost-effective technology, should be considered.