Prevalence and topographical characteristics of keratoconus in patients with refractive errors in the Egyptian delta.

PURPOSE: To study the prevalence of keratoconus (KC) and the topographical characteristics of the affected corneas in patients with refractive errors who were seeking refractive surgery in the Egyptian delta. METHODS: A retrospective study covering four and half years (Jan 2012-June 2016) where the topographical data of 8124 participants were obtained from the records of a refractive center in the Nile delta region, Egypt. The diagnosis of KC was based on the Holladay criteria in one or both eyes, using the Pentacam scans, whereas grading of KC was based on the Amsler-Krumeich classification. RESULTS: The prevalence of KC was 1.12% (91/8124 participants) with 95% confidence interval 0.91-1.3. Of all the affected cases, 5 cases (5.5%) had unilateral, and the other 86 cases (94.5%) had bilateral KC. The affected and unaffected subjects did not show any significant difference regarding gender. Sixty-eight (38.4%) eyes had stage 1 KC, 53 eyes (29.9%) had stage 2, 27 eyes (15.3%) had stage 3, and 29 eyes (16.4%) had stage 4 KC. It was most prevalent (1.2%) among cases with astigmatism (P < 0.001). CONCLUSION: Keratoconus was found in 1.12% of patients seeking refractive surgery, with no gender preference. Most cases had bilateral affection. Astigmatism was the most common refractive error to be associated with keratoconus.

The Value of Intermittent Fasting and Low Carbohydrate Diet in Prediabetic Patients for the Prevention of Cardiovascular Diseases. / Papel do Jejum Intermitente e da Dieta Restrita em Carboidratos na Prevenção de Doenças Cardiovasculares em Pacientes Pré-Diabéticos.

BACKGROUND: Prediabetic patients are at increased risk for cardiovascular diseases and the development of microvascular and macrovascular complications. Intermittent fasting (IF) and low-carbohydrate diet (LCD) are promising dietary plans. OBJECTIVES: Our aims to analyze the benefits of IF combined with LCD on microvascular and macrovascular outcomes in prediabetic patients. METHODS: The study included 485 prediabetic patients with no history of cardiovascular diseases divided into group I: (n = 240 patients) who underwent IF (16 h IF 3-4 days per week) combined with LCD (<130 g of carbohydrate per day), and group II: (n = 245 patients) with ad libitum calorie intake. The two groups were followed-up for two years for assessment of micro and macrovascular complications. A p-value < 0.05 was considered statistically significant. RESULT: There was a significant reduction in body weight, body mass index, waist circumference, body fat percentage and glycated hemoglobin in group I. The incidence of progression from prediabetes to diabetes was significantly lower in group I (2.1% vs. 6.9% in group II, p = 0.010). In addition, a significant increase in the incidence of microvascular and macrovascular complications was observed in group II, including retinopathy, neuropathy and unstable angina. Multivariate regression analysis revealed that increased body weight, fasting glucose, glycated hemoglobin and low-density lipoprotein were independent risk factors impacting microvascular and macrovascular outcomes. CONCLUSIONS: In prediabetic patients, IF, combined with LCD, was associated with lower progression to diabetes mellitus and lower incidence of microvascular and macrovascular complications.

FUNDAMENTOS: Pacientes pré-diabéticos têm alto risco de doenças cardiovasculares e complicações microvasculares e macrovasculares. O Jejum Intermitente (JI) e a dieta restrita em carboidratos (dieta low-carb, DLC) são estratégias dietéticas promissoras nesse grupo. OBJETIVOS: Analisar os benefícios da combinação do JI com DLC sobre desfechos microvasculares e macrovasculares em pacientes pré-diabéticos. MÉTODOS: O estudo incluiu 485 pacientes pré-diabéticos sem história de doença cardiovascular. Os pacientes foram divididos em dois grupos: grupo I (n = 240) submetidos ao JI (16 horas de JI, F 3-4 dias por semana) combinado com DLC (<130 g de carboidratos por dia), e grupo II (n = 245) que consumiram alimentos à vontade (grupo controle). Os dois grupos foram acompanhados por dois anos para avaliação de complicações macrovasculares e microvasculares. Um valor p < 0,05 foi considerado estatisticamente significativo. RESULTADOS: Houve uma redução significativa no peso corporal, índice de massa corporal, porcentagem de gordura corporal e hemoglobina glicada no grupo I. A incidência de progressão de pré-diabetes para diabetes foi significativamente menor no grupo I (2,1%) que no grupo II (6,9%) (p = 0,010). Ainda, um aumento significativo na incidência de complicações microvasculares e macrovasculares foi observado no grupo II, incluindo retinopatia, neuropatia e angina instável. A análise de regressão multivariada revelou que peso corporal aumentado, e níveis elevados de glicemia de jejum, hemoglobina glicada e lipoproteína de baixa densidade foram fatores de risco independentes de desfechos microvasculares e macrovasculares. CONCLUSÕES: Em pacientes pré-diabéticos, o JI, combinado com DLC, associou-se com menor progressão para diabetes mellitus e menor incidência de complicações microvasculares e macrovasculares.

COVID-19 susceptibility, severity, clinical outcome and Toll-like receptor (7) mRNA expression driven by TLR7 gene polymorphism (rs3853839) in middle-aged individuals without previous comorbidities.

Background: Toll-like receptors are implicated in the pathophysiology of the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory disease (MERS), according to several studies. The whole-genome sequencing of SARS-CoV-2 revealed that the TLR7 gene could be implicated in the virus's pathogenesis since the virus includes ssRNA patterns that could bind to TLR7. Aim: The purpose of this study was to look into the function of the TLR7 (rs3853839) C/G polymorphism and the expression of TLR7 mRNA transcript in the development, severity and progression of COVID-19. Subjects and methods: A case-control study included 285 participants who were divided into two groups: 150 middle-aged people with COVID 19 who had no previous co-morbidities and 135 healthy volunteers who served as controls. TaqMan test was used to genotype the TLR7 (rs3853839) C/G polymorphism, and real-time PCR was used to determine the relative expression of its mRNA transcript. The level of IL-6 in serum was determined using the ELISA method as an indicator of cytokine storm and COVID-19 severity. Results: The GG genotype was shown to be much more common in COVID-19 patients (38.7%) than controls (4.4%), with an OR of 19.86 (95% CI: 7.85; 50.22) and was linked to disease severity and poor clinical outcomes (hospitalization, respiratory failure, cardiac complications, ICU admission and mechanical ventilation).As a result, the G allele was considerably higher in cases (57.0%), while the C allele was significantly higher in controls (p = 0.001). The GG genotype was found to be substantially more common in patients who were severely/critically unwell. TLR7 mRNA expression levels were significantly higher in COVID-19 patients (2.44 ± 0.89) than in controls (1.06 ± 0.46) (p = 0.001). TLR7 mRNA levels were highest in COVID 19 patients with the GG genotype (rs3853839). Patients with the GG genotype had considerably lower WBC counts, but significantly higher serum ferritin, CRP, IL-6 and D dimer levels (P = 0.045, 0.001, 0.023, 0.033, 0.001, respectively). Conclusion: The GG form of the TLR7 SNP (rs3853839) could be a genetic risk factor for COVID-19 infection, severe illness and poor clinical outcome. TLR7 mRNA expression was also elevated in COVID-19 patients who were severely/critically unwell and had a bad outcome, suggesting that they could be used as COVID-19 prognostic biomarkers.

A Simple Scoring Model Predicting the Outcome of COVID-19 Patients: Tanta COVID Score.

BACKGROUND: COVID-19 is a worldwide pandemic with high rates of morbidity and mortality, and an uncertain prognosis leading to an increased risk of infection in health providers and limited hospital care capacities. In this study, we have proposed a predictive, interpretable prognosis scoring system with the use of readily obtained clinical, radiological and laboratory characteristics to accurately predict worsening of the condition and overall survival of patients with COVID-19. METHODS: This is a single-center, observational, prospective, cohort study. A total of 347 patients infected with COVID-19 presenting to the Tanta University Hospital, Egypt, were enrolled in the study, and clinical, radiological and laboratory data were analyzed. Top-ranked variables were identified and selected to be integrated into a Cox regression model, building the scoring system for accurate prediction of the prognosis of patients with COVID-19. RESULTS: The six variables that were finally selected in the scoring system were lymphopenia, serum CRP, ferritin, D-Dimer, radiological CT lung findings and associated chronic debilitating disease. The scoring system discriminated risk groups with either mild disease or severe illness characterized by respiratory distress (and also those with hypoxia and in need for oxygen therapy or mechanical ventilation) or death. The area under the curve to estimate the discrimination performance of the scoring system was more than 90%. CONCLUSION: We proposed a simple and clinically useful predictive scoring model for COVID- 19 patients. However, additional independent validation will be required before the scoring model can be used commonly.

A study of anxiety, depression and stress symptoms among Fayoum medical students during COVID-19 lockdown, Egypt.

BACKGROUND: The widespread pandemic of COVID-19 virus carries not only physical hazards, but also major psychological effects especially among medical students. The aim was to investigate the psychological effects of COVID-19 on medical students and the factors affecting them. The study was carried out with an online questionnaire distributed through Google Forms for medical students at Faculty of Medicine, Egypt. The questionnaire included socio-demographic questions, validated psychometric tools for the assessment of depression, anxiety and stress (Depression Anxiety Stress Scales DASS-21) and the Impact of Event Stress Scale-Revised (IES-R) were applied. RESULTS: The total number of participants was 282 students. Percentage of participants with clinically significant depression was 75.2%, anxiety was 56.4% and stress was 52.9%. Those showed PTSD probability was 54.3%. The multivariate regression analysis revealed that IES remained significantly associated with gender and previous road accidents, depression and anxiety remained significantly associated with personal history of psychiatric illness, while stress remained significantly associated with gender and previous road accidents. CONCLUSIONS: Medical students were highly depressed, anxious and stressed during period of COVID-19 pandemic. Being a female, having previous history of psychiatric illness and previous road accident were highly associated with increasing the psychological impact of COVID-19.

Positive Effect of Helicobacter pylori Treatment on Outcome of Patients With Chronic Spontaneous Urticaria.

OBJECTIVES: The association between Helicobacter pylori and chronic spontaneous urticaria (CSU) is controversial. Therefore, we aimed to directly diagnose H pylori by polymerase chain reaction (PCR) in gastric tissue from patients with CSU and to investigate the association between H pylori eradication therapy and CSU remission. METHODS: Twenty-seven of 72 patients with CSU who were positive for H pylori stool antigen and PCR in gastric biopsy specimens were randomized to receive either anti-H pylori treatment or placebo. RESULTS: Patients with H pylori were found to have significantly lower hemoglobin concentrations with microcytic hypochromic anemia and a significantly higher occurrence of dyspepsia symptoms. All H pylori-treated patients (except two) showed significant improvement of the urticaria itching and red wheals after 2 weeks of therapy compared with the placebo group (P < .001). The response rate to treatment was 85.7% (12 patients; 95% confidence interval, 64.3%-100.0%). The two patients who failed to eradicate H pylori had an H pylori strain resistant to amoxicillin. CONCLUSIONS: An association was observed between CSU and presence of H pylori infection in the gastric tissue. Whether this is a causal relationship or not remains to be discovered, but treatment of H pylori can significantly improve the symptoms of CSU.

Papel do Jejum Intermitente e da Dieta Restrita em Carboidratos na Prevenção de Doenças Cardiovasculares em Pacientes Pré-Diabéticos / The Value of Intermittent Fasting and Low Carbohydrate Diet in Prediabetic Patients for the Prevention of Cardiovascular Diseases

Resumo Fundamentos: Pacientes pré-diabéticos têm alto risco de doenças cardiovasculares e complicações microvasculares e macrovasculares. O Jejum Intermitente (JI) e a dieta restrita em carboidratos (dieta low-carb, DLC) são estratégias dietéticas promissoras nesse grupo. Objetivos: Analisar os benefícios da combinação do JI com DLC sobre desfechos microvasculares e macrovasculares em pacientes pré-diabéticos. Métodos: O estudo incluiu 485 pacientes pré-diabéticos sem história de doença cardiovascular. Os pacientes foram divididos em dois grupos: grupo I (n = 240) submetidos ao JI (16 horas de JI, F 3-4 dias por semana) combinado com DLC (<130 g de carboidratos por dia), e grupo II (n = 245) que consumiram alimentos à vontade (grupo controle). Os dois grupos foram acompanhados por dois anos para avaliação de complicações macrovasculares e microvasculares. Um valor p < 0,05 foi considerado estatisticamente significativo. Resultados: Houve uma redução significativa no peso corporal, índice de massa corporal, porcentagem de gordura corporal e hemoglobina glicada no grupo I. A incidência de progressão de pré-diabetes para diabetes foi significativamente menor no grupo I (2,1%) que no grupo II (6,9%) (p = 0,010). Ainda, um aumento significativo na incidência de complicações microvasculares e macrovasculares foi observado no grupo II, incluindo retinopatia, neuropatia e angina instável. A análise de regressão multivariada revelou que peso corporal aumentado, e níveis elevados de glicemia de jejum, hemoglobina glicada e lipoproteína de baixa densidade foram fatores de risco independentes de desfechos microvasculares e macrovasculares. Conclusões: Em pacientes pré-diabéticos, o JI, combinado com DLC, associou-se com menor progressão para diabetes mellitus e menor incidência de complicações microvasculares e macrovasculares.

Abstract Background: Prediabetic patients are at increased risk for cardiovascular diseases and the development of microvascular and macrovascular complications. Intermittent fasting (IF) and low-carbohydrate diet (LCD) are promising dietary plans. Objectives: Our aims to analyze the benefits of IF combined with LCD on microvascular and macrovascular outcomes in prediabetic patients. Methods: The study included 485 prediabetic patients with no history of cardiovascular diseases divided into group I: (n = 240 patients) who underwent IF (16 h IF 3-4 days per week) combined with LCD (<130 g of carbohydrate per day), and group II: (n = 245 patients) with ad libitum calorie intake. The two groups were followed-up for two years for assessment of micro and macrovascular complications. A p-value < 0.05 was considered statistically significant. Result: There was a significant reduction in body weight, body mass index, waist circumference, body fat percentage and glycated hemoglobin in group I. The incidence of progression from prediabetes to diabetes was significantly lower in group I (2.1% vs. 6.9% in group II, p = 0.010). In addition, a significant increase in the incidence of microvascular and macrovascular complications was observed in group II, including retinopathy, neuropathy and unstable angina. Multivariate regression analysis revealed that increased body weight, fasting glucose, glycated hemoglobin and low-density lipoprotein were independent risk factors impacting microvascular and macrovascular outcomes. Conclusions: In prediabetic patients, IF, combined with LCD, was associated with lower progression to diabetes mellitus and lower incidence of microvascular and macrovascular complications.