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

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

Ultrasound-Guided Versus Palpation-Guided Techniques to Achieve Vascular Access in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Pediatric heart surgery is a vital therapeutic option for congenital heart disease, which is one of the most prevalent causes of death in children. Arterial cannulation (AC) and central venous catheter (CVC) are required in pediatric cardiac surgery for continuous monitoring of the central venous pressure (CVP), replacement of fluid or blood products, close hemodynamic monitoring, and frequent sampling for arterial blood gases (ABG). A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) retrieved from PubMed, Embase Cochrane, Scopus, and WOS until February 2024. Risk ratio (RR) was used to report dichotomous outcomes, and mean difference (MD) was used to report continuous outcomes, both with a 95% confidence interval (CI) using the random-effects model. Thirteen RCTs with 1060 children were included. Regarding arterial cannulation, the ultrasound-guided technique (US) was associated with a statistically significant increase in successful cannulation [RR: 1.31 with 95% CI (1.10, 1.56), P < 0.0001], and first-attempt success [RR: 1.88 with 95% CI (1.35, 2.63), P < 0.0001]. However, US was not associated with any statistically significant difference in venous cannulation in both outcomes with [RR: 1.13 with 95% CI (0.98, 1.30), P = 0.10], [RR: 1.53 with 95% CI (0.86, 2.71), P = 0.15] respectively. Moreover, US was associated with a statistically significant decrease in the number of attempts either in arterial cannulation with [MD: - 0.73 with 95% CI (- 1.00, - 0.46), P < 0.0001] or in venous cannulation with [MD: - 1.34 with 95% CI (- 2.55, - 0.12), P = 0.03], and the time of attempted cannulation also either in arterial cannulation with [MD: - 2.27 with 95% CI (- 3.38, - 1.16), P < 0.0001] or in venous cannulation with [MD: - 4.13 with 95% CI (- 7.06, - 1.19), P < 0.0001]. US guidance improves successful cannulation rates and first-attempt success in arterial access and reduces the number of attempts and procedural time for arterial and venous access. It was also associated with a lower incidence of complications and procedure failure, particularly in arterial access. However, it was associated with a higher incidence of venous puncture.

Knowledge, attitude, and practice of Egyptian medical students towards healthcare workers' recommended vaccines: a nationwide cross-sectional survey.

BACKGROUND: Vaccination of healthcare workers (HCWs) is pivotal in decreasing the incidence of contagious infections in hospital settings. In this study, we assessed the knowledge, attitude, and practice regarding HCWs' recommended vaccines among medical students and interns in Egypt. METHODS: A multicenter, cross-sectional study was conducted using a structured, pilot-tested, and self-administered questionnaire among Egyptian medical students and interns. We invited 1332 participants to our survey using a systematic random sampling that included participants across nine medical schools in Egypt during the 2021-2022 academic year. RESULTS: Out of 1332 participants, 1141 completed our questionnaire with a response rate of 85.7%. Overall, 43% of the participants had intermediate knowledge (knew 2-3 HCWs' recommended vaccines). Furthermore, 36.7% had received a booster dose of at least one of the HCWs' recommended vaccines over the last 10 years, with only 6.1% having received all recommended vaccines. Hepatitis B vaccine was the most widely known (71%) and received (66.7%). Interns were more likely to know, receive, and recommend HCWs' recommended vaccines. The majority (> 90%) agreed that vaccination is beneficial and safe, with a median score of eight (interquartile range [IQR: Q25-Q75]: 7-9) out of ten for vaccine efficacy and eight (IQR: 7-8) for safety. However, the median score for hesitancy was five (IQR: 2-7). The most common influential and limiting factors for vaccination were scientific facts (60.1%) and fear of vaccine side effects (44.9%). CONCLUSION: Although medical students in Egypt have good knowledge of and attitudes towards vaccination, there is a gap in their practices. Interventions are needed to improve vaccination uptake among medical students in Egypt.

Network meta-analysis of randomized controlled trials comparing the effectiveness of different treatments in reducing amniocentesis-associated pain and anxiety.

OBJECTIVE: This network meta-analysis compared different methods to determine which is most efficient at lowering pain and anxiety in women undergoing amniocentesis. METHOD: We looked through all published randomized controlled trials in the databases PubMed, Scopus, Web of Science, Cochrane, and EM base. Anxiety and pain were the predominant results. We used the R software version 4.2.1 to analyze the data. RESULTS: We included a total of 20 studies, with sample sizes ranging from 60 to 570. Virtual reality was the most effective strategy for lowering pain during AC [MD = -1.30, 95% CI (-2.11, -0.49)]. In addition, paracetamol use was the most successful approach for lowering pain following AC [MD = -1.68, 95% CI (-1.99, -1.37)]. The use of H7 acupressure, however, was the strategy that significantly reduced anxiety following AC [SMD = -15.46, 95% CI (-17.77, -13.15)]. CONCLUSION: The most effective method for reducing pain is the combination of virtual reality with paracetamol. Whereas, the most effective way to reduce anxiety is to combine an ice gel pack with H7 acupressure before applying AC.

Continuous saline bladder irrigation after blue light transurethral resection of bladder tumor increases recurrence-free survival in low- to intermediate-risk non-muscle invasive bladder cancer.

OBJECTIVES: To evaluate the efficacy of Continuous Saline Bladder Irrigation (CSBI) after blue light transurethral resection of bladder tumor (TURBT) to prevent recurrence of low- to intermediate-risk Non-Muscle Invasive Bladder Cancer (NMIBC). PATIENTS AND METHODS: We conducted a retrospective study including patients with low- to intermediate-risk NMIBC who underwent TURBT in two urological centers between January 2017 and December 2018. Each TURBT was performed using blue light after intravesical instillation of hexaminolaevulinic acid. The experimental group included patients who received CSBI while the control group included patients without CSBI. When practice, CSBI was started immediately after the surgery and was interrupted 24 hours thereafter. Low-risk NMIBC had a surveillance while intermediate NMIBC had 8 adjuvant endovesical instillations of Mitomycin. The primary endpoint was bladder tumor recurrence free-survival which was defined as the time between the initial TURBT and the date of TURBT for bladder recurrence. RESULTS: A total of 167 patients (median age: 71 years) were included: 20% female, 15% low-risk, 85% intermediate-risk NMIBC. CSBI was performed in 95 cases (57%). No complication related to irrigation was reported. Bladder recurrence was observed in 55 cases (32.9%): 22 (23.1%) in the CSBI group vs. 33 (45.8%) in the control group (P=0.002). Multivariate stepwise logistic regression analysis with backward selection revealed that CSBI (HR 0.47 [0.27-0.81]; P=0.006) and MMC (HR 0.55 [0.31-0.95]; P=0.034) were significantly associated with reduced risk of bladder recurrence. CONCLUSIONS: Continuous saline bladder irrigation reduced the risk of bladder recurrence after blue light TURBT in patients with low- to intermediate-risk NMIBC while being safe. Prospective randomized study is needed to confirm these results. LEVEL OF EVIDENCE: 3.

Single use and reusable flexible ureteroscopies for the treatment of urinary stones: A comparative study of perioperative complications.

OBJECTIVE: To compare the perioperative complications of patients who underwent flexible ureteroscopy (fURS) for the treatment of urinary stones according to the type of ureteroscope used, single-use (suURS) or reusable (rURS) flexible ureteroscope. PATIENTS AND METHODS: A retrospective and single-center study was conducted between January 2017 and May 2019, including all fURS performed for nephrolithiasis management. During the study period, 5rURS and 1suURS (UscopePU3022™) were available. The primary endpoint was the occurrence of 30-days postoperative complications, especially infectious complications, classified according to Clavien-Dindo grading system. RESULTS: Overall, 322 consecutive fURS were included corresponding to 186 rURS (57.8%) and 136 suURS (42.2%). Respectively in rURS and suURS groups, the median (IQR) age was 57 (45-65) vs. 57 (44-66) years (P=0.75), 83 (44.6%) vs. 63 (46.3%) female were included (P=0.82), and median (IQR) Charlson score was 2 (1-3) vs. 2 (0-3) (P=0.15). Fifty-one patients (15.8%) developed postoperative complications, 28 patients (15%) in rURS group and 23 patients (17.6%) in suURS group (P=0.64). Most of them (n=47, 92.1% of overall complications) were minor (Clavien I-II). Occurrence of urinary tract infection in suURS group (n=13; 9.5%) was equally comparable with rURS group (n=10; 5.4%), P=0.15. CONCLUSIONS: Our data suggests that suURS represents a safe alternative to rURS. Compared to reusable devices, UscopePU3022™ use was associated with a similar complication rates, however, did not decrease the occurrence of infectious events. LEVEL OF EVIDENCE: 3.

A Chicken Production Intervention and Additional Nutrition Behavior Change Component Increased Child Growth in Ethiopia: A Cluster-Randomized Trial.

BACKGROUND: Chicken production in the context of nutrition-sensitive agriculture may benefit child nutrition in low-income settings. OBJECTIVES: This study evaluated effects of 1) a chicken production intervention [African Chicken Genetic Gains (ACGG)], and 2) the ACGG intervention with nutrition-sensitive behavior change communication (BCC) [ACGG + Agriculture to Nutrition (ATONU)], on child nutrition and health outcomes and hypothesized intermediaries. METHODS: Forty ACGG villages received 25 genetically improved chickens and basic husbandry guidance; of these, 20 ACGG + ATONU villages in addition received a nutrition-sensitive behavior change and homegardening intervention; 20 control clusters received no intervention. We assessed effects of the interventions on height-for-age z scores (HAZ), weight-for-age z scores (WAZ), and weight-for-height z scores (WHZ) at 9 (midline) and 18 mo (endline) through unadjusted and adjusted ordinary least squares (OLS) regressions. We examined the interventions' effects on hypothesized intermediaries including egg production and consumption, dietary diversity, women's empowerment, income, child morbidities, anemia, and chicken management practices through OLS and log binomial models. RESULTS: Data included 829 children aged 0-36 mo at baseline. ACGG + ATONU children had higher midline HAZ [mean difference (MD): 0.28; 95% CI: 0.02, 0.54] than controls. The ACGG group had higher HAZ (MD: 0.28; 95% CI: 0.05, 0.50) and higher WAZ (MD: 0.18; 95% CI: 0.01, 0.36) at endline than controls; after adjusting for potential baseline imbalance, effects were similar but not statistically significant. At endline, differences in ACGG + ATONU children's HAZ and WAZ compared with controls were similar in magnitude to those of ACGG, but not statistically significant. There were no differences in anthropometry between the intervention groups. ACGG + ATONU children had higher dietary diversity and egg consumption than ACGG children at endline. Both interventions showed improvements in chicken management practices. The interventions did not increase anemia, diarrhea, fever, or vomiting, and the ACGG + ATONU group at midline showed reduced risk of fever. CONCLUSIONS: A chicken production intervention with or without nutrition-sensitive BCC may have benefited child nutrition and did not increase morbidity.This trial was registered at clinicaltrials.gov as NCT03152227.

Effects of selenium on oxidative damage and antioxidant enzymes of eukaryotic cells: wine Saccharomyces cerevisiae.

AIM: To clarify the effects of selenium (Se), parameters related to oxidative issues, as well as the antioxidant response were investigated on an autochthonous wine yeast strain. METHODS AND RESULTS: Antioxidant enzyme activity, gel electrophoresis, Western blot and MDA level were used to investigate the effects of different concentration of Se in wine yeast. We found that Se is able to affect the enzymatic activities of catalase (CAT), glutathione peroxidase (GPx) and superoxide dismutase (SOD). An increase in lipid peroxidation was observed in a dose-dependent manner of (Se), thus, indicating the occurrence of cell membrane damage. Additionally, Se induced post-translational oxidative modifications of proteins, especially oxidation of thiol groups (both reversible and irreversible) and protein carbonylation (irreversible oxidation). CONCLUSION: These results obtained could further the understanding the effect of different concentration of Se in wine yeast strain with which Se affect the enzymatic activities and induces some post-translational modifications of proteins. SIGNIFICANCE AND IMPACT OF THE STUDY: The understanding of mechanisms regulating the response of wine yeast to Se is important for future work using selenized yeast as enriched Se supplements in human nutrition.

Ovarian masses in pediatric patients: a multicenter study of 98 surgical cases in Tunisia.

Ovarian masses requiring surgical intervention are uncommon in the pediatric population. Our aim is to report results of a multicentric Tunisian study concerning the clinical practice and the management of pediatric ovarian masses and to identify the factors that are associated with ovarian preservation. Between January 2000 and December 2015, 98 pediatric patients (<14 years) were surgically treated for ovarian masses at the five pediatric surgery departments in Tunisia. Ninety-eight patients were included in this study. The mean age of the patients at time of surgery was 8.46 ± 4.87 years. Sixty-three ovarian masses (64.3%) were non-neoplastic lesions, 24 (24.5%) were benign tumors, and 11 (11.2%) were malignant neoplasms. Conservative surgery (ovarian-preserving surgery) was successfully performed in 72.4% of the benign lesions, whereas only three patients (27.3%) with malignant tumors underwent ovary-sparing tumor resection (p < .001). The mean diameter of the tumors in the patients who underwent oophorectomy was significantly larger than that in the patients who underwent conservative surgery (7.8 ± 3.9 cm vs. 5.7 ± 2.9 cm, respectively, p = .001). In our study, the risk factors for oophorectomy were a malignant pathology and large tumor size. In accordance with the Gynecologic Cancer Intergroup consensus, we recommend that surgical management of ovarian masses in children should be based on ovarian-preserving surgery.

Aminophylline infusion for status asthmaticus in the pediatric critical care unit setting is independently associated with increased length of stay and time for symptom improvement.

INTRODUCTION: The role of aminophylline in the treatment of severe acute asthma in the pediatric critical care unit (PCCU) is not clear. We sought to examine the association of aminophylline treatment with PCCU length of stay and time to symptom improvement. MATERIAL AND METHODS: Patients with severe acute asthma who were admitted to our PCCU and received aminophylline infusion were retrospectively compared with similar patients who did not receive aminophylline. The primary outcome measure was functional length of stay (i.e. time to which patients could be transferred to a general pediatric ward bed). A secondary outcome was time to symptom improvement. RESULTS: Adjusted functional length of stay was longer for subjects who received aminophylline (n = 49) than for the patients who did not (n = 47) (hazard ratio 0.396, p < 0.001), as well as the time for symptom improvement (hazard ratio 0.359, p < 0.001). In the group of subjects receiving aminophylline, those with a serum theophylline level ≥ 10 mcg/ml (therapeutic) (n = 31) had longer functional length of stay (hazard ratio 0.457, p = 0.0225) and time to symptom improvement (hazard ratio 0.403, p = 0.0085) than those with levels < 10 mcg/ml (sub-therapeutic) (n = 18). CONCLUSIONS: The addition of aminophylline to therapy with corticosteroids and inhaled ß-agonists was associated with statistically and clinically significant increases in functional length of stay and time to symptom improvement in the PCCU. This potential morbidity supports the National Asthma Education and Prevention Program guideline proscribing aminophylline use in acute asthma.

Response surface optimization of a single-step castor oil-based biodiesel production process using a stator-rotor hydrodynamic cavitation reactor.

In order to combat environmental pollution and the depletion of non-renewable fuels, feasible, eco-friendly, and sustainable biodiesel production from non-edible oil crops must be augmented. This study is the first to intensify biodiesel production from castor oil using a self-manufactured cylindrical stator-rotor hydrodynamic cavitation reactor. In order to model and optimize the biodiesel yield, a response surface methodology based on a 1/2 fraction-three-level face center composite design of three levels and five experimental factors was used. The predicted ideal operating parameters were found to be 52.51°C, 1164.8 rpm rotor speed, 27.43 min, 8.4:1 methanol-to-oil molar ratio, and 0.89% KOH concentration. That yielded 95.51% biodiesel with a 99% fatty acid methyl ester content. It recorded a relatively low energy consumption and high cavitation yield of 6.09 × 105 J and 12 × 10-3 g/J, respectively. The generated biodiesel and bio-/petro-diesel blends had good fuel qualities that were on par with global norms and commercially available Egyptian petro-diesel. The preliminary cost analysis assured the feasibility of the applied process.

Distribution, characterization and chemical management of noxious shrub weed (Dichapetalum stuhlmannii Engl) in cashew in southeastern Tanzania.

Weeds are among the limiting factors that influence low production of economically important crops including cashew (Anacardium occidental L.). Shrub weeds attribute to inter-competition for resources, hinder harvesting and ultimately reduce cashew yields in Tanzania. The current study determined the distribution, characteristics and chemical control option of Dichapetalum Engl in Lindi and Mtwara regions, Southeastern Tanzania. The distribution study involved a survey for weed presence along the areas of Lindi and Mtwara regions. The characterization included distilling, and assessing the growth and development properties of shrub weed. Chemical herbicides; glyphosate 480g. ai/l, 2, 4 D - Dichlorirophenoxyacetic 720g. ai/l, triclopyr 160g a.i./l and 1:1 mixture of glyphosate 480g a.i./l plus triclopyr 160g a.i./L at 15, 20 and 25 mls of formulated product/L of water per 4 m2 were tested on tender, mature and blooming growth stages of D. Stuhlmannii and three spraying frequencies. Findings revealed that the D.stuhlmannii, is a widely distributed shrub weed in Lindi and Mtwara regions. The weed was characterized with three main growth stages of seedling, mature and blooming with a long tap root and evergreen throughout the wet and dry seasons. The tested herbicides revealed the potential suppression of D. Stuhlmannii growth. Glyphosate and a mixture of glyphosate + triclopyr at 15 ml/L outperformed triclopyr and 2, 4 D across all the growth stages. Double spraying of glyphosate and its mixture bettered frequencies of triclopyr and 2, 4 D. The delayed regrowth of suppressed shrub weed took 90-120 days after application of herbicides. The current study recommends for single or double applications of glyphosate herbicides at 15 ml/L or 10,700 ml/ha on tender or mature D. Stuhlmannii in cashew farms. Further studies on the economic feasibility and effect on the microbiota of applied fungicides are required.

A Study on the Potential of Valorizing Sargassum latifolium into Biofuels and Sustainable Value-Added Products.

To increase the limited commercial utility and lessen the negative environmental effects of the massive growth of brown macroalgae, this work illustrates the feasibility of valorizing the invasively proliferated Sargassum latifolium into different value-added products. The proximate analysis recommends its applicability as a solid biofuel with a sufficient calorific value (14.82 ± 0.5 MJ/kg). It contains 6.00 ± 0.07% N + P2O5 + K2O and 29.61 ± 0.05% organic C. Its nutritional analysis proved notable carbohydrate, ash, protein, and fiber contents with a rational amount of lipid and a considerable amount of beneficial macronutrients and micronutrients, with a low concentration of undesirable heavy metals. That recommends its application in the organic fertilizer, food, medicine, and animal fodder industries. A proposed eco-friendly sequential integrated process valorized its biomass into 77.6 ± 0.5 mg/g chlorophyll, 180 ± 0.5 mg/g carotenoids, 5.86 ± 0.5 mg/g fucoxanthin, 0.93 ± 0.5 mg/g ß-carotene, 21.97 ± 0.5% (w/w) alginate, and 16.40 ± 0.5% (w/w) cellulose, with different industrial and bioprocess applications. Furthermore, Aspergillus galapagensis SBWF1, Mucor hiemalis SBWF2, and Penicillium oxalicum SBWF3 (GenBank accession numbers OR636487, OR636488, and OR636489) have been isolated from its fresh biomass. Those showed wide versatility for hydrolyzing and saccharifying its polysaccharides. A Gram-negative Stutzerimonas stutzeri SBB1(GenBank accession number OR764547) has also been isolated with good capabilities to ferment the produced pentoses, hexoses, and mannitol from the fungal saccharification, yielding 0.25 ± 0.014, 0.26 ± 0.018, and 0.37 ± 0.020 g ethanol/g algal biomass, respectively. Furthermore, in a pioneering step for valuing the suggested sequential biomass hydrolysis and bioethanol fermentation processes, the spent waste S. latifolium disposed of from the saccharification process has been valorized into C-dots with potent biocidal activity against pathogenic microorganisms.

Enhancing physical characteristics and antibacterial efficacy of chitosan through investigation of microwave-assisted chemically formulated chitosan-coated ZnO and chitosan/ZnO physical composite.

This study investigates the creation and analysis of chitosan-zinc oxide (CS-ZnO) nanocomposites, exploring their effectiveness in inhibiting bacteria. Two synthesis approaches, physical and chemical, were utilized. The CS-ZnO nanocomposites demonstrated strong antibacterial properties, especially against Staphylococcus aureus, a Gram-positive bacterium. Chemically synthesized nanocomposites (CZ10 and CZ100) exhibited larger inhibition zones (16.4 mm and 18.7 mm) compared to physically prepared CS-Z5 and CS-Z20 (12.2 mm and 13.8 mm) against Staphylococcus aureus. Moreover, CZ nanocomposites displayed enhanced thermal stability, with decomposition temperatures of 281°C and 290°C, surpassing CS-Z5 and CS-Z20 (260°C and 258°C). The residual mass percentages at 800°C were significantly higher for CZ10 and CZ100 (58% and 61%) than for CS-Z5 and CS-Z20 (36% and 34%). UV-Visible spectroscopy revealed reduced band gaps in the CS-ZnO nanocomposites, indicating improved light absorption. Transmission electron microscopy (TEM) confirmed uniform dispersion of ZnO nanoparticles within the chitosan matrix. In conclusion, this research underscores the impressive antimicrobial potential of CS-ZnO nanocomposites, especially against Gram-positive bacteria, and highlights their enhanced thermal stability. These findings hold promise for diverse applications in industries such as medicine, pharmaceuticals, and materials science, contributing to the development of sustainable materials with robust antimicrobial properties.

Spatial-temporal variability in under-canopy soil fertility and nutritional contents of cashew trees in Makonde Plateau of southeastern Tanzania.

This study was conducted out to evaluate the soil fertility in under the cashew tree canopy and nutritional contents of cashew trees on the Makonde Plateau in southeast Tanzania. Seven villages were included, all of which were geographically close to one another yet had the same agro-ecology. The cashew plant samples were taken above the same longitudinal segment as the soil samples, which were taken in under canopies of cashew trees. Nitrogen, Phosphorus, Potassium, Magnesium, Calcium, and micro nutrients (Iron, Zinc, Sodium, and Copper) were all examined in the samples. However, soils were analysed for Organic Carbon, Organic Matter, and pH with soil samples taken at two different depths of 0-30 cm and 30-50 cm, these tests were conducted during the wet and dry seasons. The results confirmed that Calcium, Magnesium, Sodium, and Iron varied significantly with soil depth, as well as with soil depth, seasons, and their interactions, for Organic Carbon and Organic Matter. During the wet season, Nitrogen, Phosphorus, and Zinc concentrations in cashew trees were all statistically higher. Nitrogen and Phosphorus were significantly strong and positively (r = 0.95) correlated in cashew plants with respect to all other nutrients, suggesting synergistic effects. These results imply that macro nutrients including Nitrogen, Phosphorus, Potassium, Magnesium, and Calcium, and micronutrients such as Iron, Zinc, Sodium and Copper limit cashew production in the research area. It is necessary to determine site-specific recommendations and dosages for these nutrients.

Efficacy and safety of baricitinib in treatment of systemic lupus erythematosus: a systematic review and meta-analysis.

BACKGROUND: SLE is an autoimmune disease marked by broad immunological dysregulation and multi-system inflammation. Baricitinib is one of the novel treatments for SLE. We conducted this meta-analysis to evaluate its safety and effectiveness in treating SLE. METHOD: We looked for all published randomized controlled trials in PubMed, Scopus, Web of Science, and Cochrane and included all RCTs comparing baricitinib and placebo in the treatment of SLE. Review Manager 5.4 program was used for data analysis. RESULTS: Three trials with a total of 1849 individuals were included. Participants in the baricitinib group were significantly more likely to attain SRI-4 response than those in the placebo group [RR = 1.11, 95% CI (1.02, 1.21), P = 0.01]. Additionally, baricitinib performed better than the placebo in terms of reduction of ≥ 4 points from baseline in SLEDAI-2 K score [RR = 1.13, 95% CI (1.04, 1.22), P = 0.004]. In terms of SLEDAI-2 K remission of arthritis or rash, baricitinib was also superior to placebo [RR = 1.08, 95% CI (1.00, 1.17), P = 0.04]. Treatment-emergent adverse events did not differ significantly [RR = 1.01, 95% CI (0.97, 1.05), P = 0.61]. CONCLUSION: Baricitinib is potentially safe and effective in the treatment of SLE. It has successfully met the study's primary endpoint and some secondary endpoints highlighting its potential to improve the outcomes of SLE. Despite achieving an SRI-4 response, glucocorticoids sparing and some other secondary outcomes weren't reached by baricitinib.

Cardiac surgery in East Africa: a profile of cases and referral to physiotherapy.

Background: A significant increase in cardiac surgery has been observed globally, with prolonged length of stay (LOS) still prevalent due to post-operative complications. Physiotherapy pre and post cardiac surgery is known to reduce these complications and LOS, however cases referred for physiotherapy is unknown. Objective: The study aimed to describe the profile and pre- and post-operative referrals to physiotherapy of patients admitted to the cardiothoracic unit at a selected hospital in Tanzania over a four-year period. Method: Descriptive, retrospective design. A data extraction sheet was used to capture demographic, cardiac disease, ICU and hospital LOS, post-operative complications and physiotherapy referral data of all patients ≥18 years of age. Results: 105 cardiac surgeries were performed. Patients' mean age was 30.6 years (SD=10.48) and 54.3% (n=57/105) were female. Cardiac surgeries performed declined from 48.6% (n=51/105) in 2010 to 10.5% (n=11/105) in 2013. Cardiac arrest (33%, n=7/21), pneumonia (19%, n=4/21) and lung collapse (4.8%, n=1/21) were the notable documented post-operative complications. ICU mortality was highest (72,7%, n=8/11). Only 1% (n=1/105) of cases were referred pre-operatively versus 77.7% (n=80/103) post-operatively for physiotherapy. Conclusion: Cardiac surgeries were reduced annually but the post-operative complications need to be reduced. Pre-operative physiotherapy referral may reduce pneumonia and lung collapse following cardiac surgery.

A modeling approach toward oil spill management along the Eastern Mediterranean.

This paper examines the temporal and spatial distributions of the largest oil spill along the Eastern Mediterranean and explores management options (boom deployment and fuel upgrade) to reduce potential adverse impacts on the marine environment from similar accidents. For this purpose, the trajectory and weathering of the ~18,000 tons of heavy fuel oil spilled from the Jiyeh thermal power plant were simulated along the coast of Lebanon using the 3D MEDSLIK model, supported with sea water sampling and analysis and field measurements. The base simulation of the spill under existing conditions at the time of occurrence defined the temporal distribution over 90 days of oil spilled in terms of percentage of oil on the surface or evaporated (13.1%), dispersed in the water column or landed on the coast (86.9% landed of which 30.1% were potentially releasable). The spatial distribution defined shoreline stretches with high risk of exposure (located 35 km north of the source and stretching for more than 150 km with medium to low risk exposure). Parametric analysis revealed a relatively higher sensitivity to the drift factor, the current depth, and the time of spill parameters. Deployment of booms reduced shorelines exposure by ~95% in comparison to baseline conditions, and medium or light brands increased evaporation by ~22-42% and reduced oil reaching the coast by ~37-57% in comparison to heavy fuel oil.

[Comparative characterization of skin lesions observed in the three endemic varieties of cutaneous leishmaniasis in Tunisia]. / Caractérisation comparative des trois formes de leishmaniose cutanée endémiques en Tunisie.

BACKGROUND: The recent spread in the geographical distribution of the three forms of cutaneous leishmaniasis (CL) endemic in Tunisia has resulted in the coexistence of more than one species of Leishmania (L.) in some foci, rendering characterization on the basis of geographical criteria alone more difficult. The aim of the study was to establish clinical criteria associated with these noso-geographic forms, namely sporadic CL (SCL) due to L. infantum, zoonotic CL (ZCL) due to L. major and chronic CL (CCL) due to L. tropica. PATIENTS AND METHODS: One hundred and twelve patients with biologically confirmed CL were involved in the study. Leishmania species was systematically identified by iso-enzyme analysis and/or PCR-RFLP. Details of the number, the location, the morphological aspect and the month of outbreak of the lesions were noted for each patient. RESULTS: SCL lesions appeared later than ZCL lesions (53.8% of cases appeared from December onwards vs. 23.6%, P<0.001). ZCL lesions were often multiple (75%) and situated on the limbs (84.7%, P<0.001), whereas SCL lesions were single (92.3%, P<0.001) and located on the face (84.6%, P<0.001). CCL lesions were also single (78.6%) and located on the face (71.4%). The classical ulcerous presentation with scabs was mainly observed in ZCL patients (69.4%) and the erythematous presentation was described more frequently in SCL patients (75%; P<0.001). CONCLUSION: The number, site, morphological aspect and month of outbreak of lesions could be considered as useful criteria that help differentiate between the three noso-geographical forms of CL prevailing in Tunisia. Such characterization is useful for the individual management of patients and for optimizing the combat against the disease.

[Ileocecal ameboma: a case diagnosed by pathology and molecular biology]. / Amoebome iléocaecal: un cas diagnostique par l'anatomie pathologique et la biologie moléculaire.

Colonic ameboma is a rare benign inflammatory tumor due to the infection by Entamoeba histolytica and poses frequently the problem of colon cancer. We report a case of a 52 year-old patient who presented a cecal amoeboma revealed by a painful mass in the right iliac fossa. Radiologic and endoscopic examinations depicted a parietal thickening of the right colon and the cecum. A presumptive diagnosis of colon cancer was firstly discussed. Confirmation of ameboma was made on pathological examination, PCR and serology.