Background: 

The world is facing a terrible challenge to overcome the COVID-19 global outbreak. The spread of COVID-19 pandemic disease has put global health, life and work style, social and economic growth at high risk. The current study was aimed at extracting COVID-19 related information, attitudes and behaviors commitment level from the general population and healthcare workers in the central region of Egypt.

Method: 

A cross-sectional online survey of 1312 Egyptian residents was conducted between 11^th May and 15^th June 2020. A questionnaire containing 28 knowledge and 56 attitude items was completed by all the participants. Stratified random sampling was applied to select the study participants. In this analysis, data was collected using a questionnaire that was developed and validated. The questionnaire included demographic variables and items relating to COVID-19 awareness, attitudes and practices. Descriptive and inferential experiments were carried out.

Results: 

In total, 1312 participants completed the questionnaire; 80.2% of the participants have good knowledge about different modes of transmission of COVID-19, 5.6% obtain their knowledge from WHO website and 60.5% from multiple sources. The results showed positive attitude from the participants towards COVID-19 protective measures as 81.0% wearing masks, 85.2% washing their hands, 76.6% using alcohol and hand gel hygiene, and 64.5% using surface disinfectants.

Conclusion: 

The findings highlight the value of clear communications from health authorities and the government, as well as the need for targeted health education programs to promote awareness, behaviors and practice levels.

Abstract:

Background:

As a result of the availability of high-speed computing devices, disease screening procedures in modern hospitals have significantly improved over the last few decades. As a result of this invention of deep learning procedures (DP), this work implemented modern diagnostic schemes to achieve accurate and fast results when screening patients for diseases with the aid of medical data.

Method:

This study applied pre-trained DP to detect Diabetic Foot Ulcers (DFU) from the test images. This work consists following stages; (i) Resizing, augmenting, and enhancing images, (ii) deep-features mining with a chosen DP, (iii) features reduction using 50% dropout and serial features-fusion, and (iv) Binary-classification through five-fold cross-validation. Two types of disease detection procedures implemented during the investigation: (a) Conventional deep-features and (b) fused deep-features (FD).

Result:

As a result of this study, the FD obtained with VGG16 and ResNet101 enabled 99.5% accuracy in DFU detection using SoftMax classifier.

Conclusion:

This demonstration confirmed that the proposed scheme is effective in detecting DFU from the chosen database.

Background:

The objective of this research endeavor was to assess the effects of rosiglitazone (RSG) and ursolic acid (UA) on hepatic insulin signaling indicators and inflammatory marker concentrations in C57/BL/6J mice that were provided with a high-fat diet (HFD).

Methods:

C57BL/6J mice were fed a HFD for 16 weeks and orally administered UA (5 mg/kg BW), RSG (4 mg/kg BW), and UA (5 mg/kg BW) + RSG (4 mg/kg BW) for the last 6 weeks.

Results:

The HFD groups showed a significant increase in leptin, TNF-α, and IL-6, whereas adiponection level significantly decreased. The expression of insulin signaling markers in the liver also significantly increased in HFD mice.

Conclusions:

Combination treatment improves above said parameters than individual parameters. These data suggest that combination treatment (UA with RSG) has potential benefits for the treatment of HFD-induced insulin resistance, and its effects may be associated with improvements in the inhibition of the expression of inflammatory markers in plasma and liver.

Background:

We conducted a meta-analysis to assess the impact of gastrectomy versus endoscopic submucosal dissection for early stomach cancer.

There are-now-a-variety-of-viewpoints-on-gastrectomy-versus-endoscopic-submucosal-dissection-for-early-stomach-cancer,-and-there-are-not-many-thorough-assessments-that-are-pertinent.

Methods:

A-systematic-literature-search-up-to-July-2022-was-performed-and-2456-related-studies-were-evaluated.-The-chosen-studies-comprised-15461-early-stomach-cancer-subjects-who-participated-in-the-selected-studies'-baseline-trials;-6503-of-them-used-the-endoscopic-submucosal-dissection, while 8958 used gastrectomy. Odds ratio (OR), and mean difference (MD) with 95% confidence intervals (CIs) were calculated to assess the effect of the gastrectomy versus endoscopic submucosal dissection for early stomach cancer by the dichotomous, and contentious methods with a random or fixed effect model.

Results:

The use of endoscopic submucosal dissection resulted in significantly lower 5-year overall survivals (OR, 0.59; 95% CI, 0.45-0.77, p<0.001), lower the 5-year overall survival in propensity score-matched patients (OR, 0.49; 95% CI, 0.41-0.59, p<0.001), higher recurrences (OR, 6.99; 95% CI, 5,03-9.70, p<0.001), and higher synchronous lesion (OR, 7.24; 95% CI, 2.78-18.83, p<0.001), and higher metachronous lesion (OR,10.05; 95% CI, 6.44-15.67, p<0.001) compared to the gastrectomy for early stomach cancer.

However, no significant difference was found between submucosal dissection and gastrectomy for early stomach cancer in recurrence-free survival (OR, 0.74; 95% CI, 0.54-1.00, p=0.05), disease-free survival (OR, 0.43; 95% CI, 0.16-1.16, p=0.10), and disease-specific survival (OR, 1.05; 95% CI, 0.38-2.89, p=0.92).

Conclusions:

The use of endoscopic submucosal dissection resulted in significantly lower 5-year overall survival, lower 5-year overall survival in propensity score-matched patients, higher recurrences, higher-synchronous lesion, and higher metachronous lesion, however, no significant difference was found in recurrence-free survival, disease-free survival, and disease-specific survival compared to the gastrectomy for early stomach cancer. The small number of studies in several comparisons calls for care when analyzing the results.

Background:

A meta-analysis investigation was executed to measure the wound complications (WCs) frequency in minor technique gastrectomy (MTG) compared to open gastrectomy (OG) for gastric cancer (GC).

Methods:

A comprehensive literature inspection till February 2023 was applied and 2078 interrelated investigations were reviewed. The 17 chosen investigations enclosed 12746 individuals with GC were in the chosen investigations' starting point, 3052 of them were utilizing robotic gastrectomy (RG), 6603 of them were utilizing laparoscopic gastrectomy (LG) and 3091 were utilizing OG. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were utilized to compute the value of the WCs frequency in MTG compared to OG for GC by the dichotomous approaches and a fixed or random model.

Results:

No significant difference was found in surgical site wound infection (SSWI) between RG and OG (OR, 1.45; 95% CI, 0.89-2.35, p=0.13), LG and OG (OR, 0.75; 95% CI, 0.47-1.18, p=0.21), and RG and LG (OR, 1.07; 95% CI, 0.72-1.60, p=0.73) in individuals with GC.

Conclusions:

No significant difference was found in SSWI between RG, OG, and LG in individuals with GC. However, care must be exercised when dealing with its values because of the low number of nominated in the meta-analysis and the low sample size of some of the nominated investigations for the meta-analysis.

Background

We performed a meta-analysis to evaluate the effects of neuraxial anesthesia compared to general anesthesia on postoperative results in hip fracture surgery subjects.

Methods

A systematic literature search up to January 2021 was done and 20 studies included 298785 subjects with hip fracture surgery at the start of the study; 80783 of them were under neuraxial anesthesia, and 218002 of them were under general anesthesia. They were reporting relationships between the effects of neuraxial anesthesia compared to general anesthesia in subjects with hip fracture surgery. We calculated the odds ratio (OR) or the mean difference (MD) with 95% confidence intervals (CIs) to assess the effects of neuraxial anesthesia compared to general anesthesia in subjects with hip fracture surgery using the dichotomous or continuous method with a random or fixed-effect model.

Results

Neuraxial anesthesia in subjects with hip fracture surgery was significantly related to lower acute myocardial infarction (OR, 0.73; 95% CI, 0.54-0.99, p=0.04), hypotension (OR, 0.37; 95% CI, 0.20-0.70, p=0.002), and postoperative cognitive dysfunction postoperative 1day (OR, 0.27; 95% CI, 0.17-0.42, p<0.001) compared to general anesthesia.

However, no significant difference was found between neuraxial anesthesia and general anesthesia in subjects with hip fracture surgery in a postoperative cognitive dysfunction postoperative 7days (OR, 0.64; 95% CI, 0.37-1.09, p=0.10), pneumonia (OR, 0.69; 95% CI, 0.29-1.62, p=0.39), length of hospital stay (MD, 0.75; 95% CI, -1.39-2.90, p=0.49),  deep venous thrombosis (OR, 1.21; 95% CI, 0.50-2.95, p=0.68), 30-day mortality (OR, 1.12; 95% CI, 0.53-2.34, p=0.77), blood loss (MD, -57.47; 95% CI, -123.36-8.41, p=0.09), and delirium (OR, 0.98; 95% CI, 0.32-2.49, p=0.96).

Conclusions

Neuraxial anesthesia in subjects with hip fracture surgery may decrease the risk of acute myocardial infarction, hypotension, and postoperative cognitive dysfunction postoperative 1 day compared to general anesthesia. Furthers studies are required to validate these findings.

Background:

We performed a meta-analysis to evaluate the effects of dual antithrombotic treatment (DATT) including direct oral anticoagulants (OAs) versus triple antithrombotic (TAT) with vitamin K antagonist on bleeding and ischemic results in atrial fibrillation (AF) after percutaneous coronary intervention.

Methods:

A systematic literature search up to April 2021 was done and 5 studies included 8019 subjects with AF using antithrombotic treatment after percutaneous coronary intervention at the start of the study; 4325 of them were using DATT and 3694 were using TATs. They were reporting relationships between the effects of DATT including direct OAs versus TAT with vitamin K antagonist on bleeding and ischemic results in AF after percutaneous coronary intervention. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the effects of DATT including direct OAs versus TAT with vitamin K antagonist on bleeding and ischemic results in AF after percutaneous coronary intervention using the dichotomous method with a random or fixed-effect model.

Results:

Dual antithrombotics had significantly lower major bleeding (OR, 0.58; 95% CI, 0.51-0.66, p<0.001), and thrombolysis in myocardial infarction major and minor bleeding (OR, 0.49; 95% CI, 0.36-0.67, p<0.001) compared to TATs in subjects with AF using antithrombotics treatment after percutaneous coronary intervention.

However, antithrombotics had no significantly difference in all-cause mortality (OR, 1.08; 95% CI, 0.88-1.33, p=0.46), cardiovascular mortality (OR, 1.07; 95% CI, 0.83-1.38, p=0.63), myocardial infarction (OR, 1.16; 95% CI, 0.92-1.46, p=0.01), stent thrombosis (OR, 1.42; 95% CI, 0.94-2.12., p=0.09), and stroke (OR, 0.86; 95% CI, 0.59-1.25, p=0.42) compared to TATs in subjects with AF using antithrombotics treatment after percutaneous coronary intervention.

Conclusions:

Dual antithrombotics may have a lower risk of major bleeding, and thrombolysis in myocardial infarction major and minor bleeding compared to TATs in subjects with AF using antithrombotic treatment after percutaneous coronary intervention. However, antithrombotics had no significant difference in all-cause mortality, cardiovascular mortality, myocardial infarction, stent thrombosis, and stroke compared to TATs in subjects with AF using antithrombotics treatment after percutaneous coronary intervention. Furthers studies are required to validate these findings.

Diloxanide furoate (DXF) and Metronidazole (MTZ) are commonly combined as a binary mixture for the treatment of a variety of diseases brought on by bacteria and parasites including amoebiasis and giardiasis. Different analytical methods were established for determination of both DXF and MTZ, However, only one chemometric spectrophotometric method was established for their stability indicating determination which involves problematical steps and specific software program. Herein, double divisor ratio spectra derivative (DDRSD) method is exploited for quantification of DXF and MTZ in presence of DXF-degradation products (FUR and DEG). The recommended DDRSD method is linear over the range of 2–25 and 1–25 µg/mL for DXF and MTZ, correspondingly. Additionally, the suggested method was effectively employed to their pharmaceutical formulations with good findings. Besides, the recommended DDRSD method was validated conforming to ICH guidelines. The introduced DDRSD method is simple, selective, and economic and could be implemented for quality control samples of the studied drugs.

Coronavirus disease 2019 (COVID-19); caused by the novel coronavirus (SARS-CoV-2) is the talk of everyone all over the world in 2020 since it has been considered as a public health emergency of international concern by WHO in 30^th January, 2020. COVID-19 is a highly transmittable disease with different symptoms which can vary from mild to severe and life threatening. Scientists all over the world are working on finding a treatment or vaccine for this disease. All of these studies are currently not finished yet during writing this review. However, in this review a summary about the current status of these studies is given. This summary includes medicinal plants and natural products, antivirals like remdesivir, favipiravir, oseltamivir and nelfinavir as well as other miscellaneous drugs like chloroquine, hydroxychloroquine and ivermectin which showed promising results in treating COVID-19. In conclusion, the review recommends conducting further investigations worldwide and reporting them in peer-reviewed publications to aid in improving the drugs’ dosing regimens and clinical studies.

Background

Most patients infected with COVID-19 experienced cold-like symptoms. Some other patients developed more serious symptoms such as pneumonia. N-Acetylcysteine ​​(NAC) is known to be effective against acute respiratory distress syndrome (ARDS) due to its anti-inflammatory and antioxidant properties. The effect of NAC on hospitalized COVID-19 patients was unknown. Therefore, this meta-analysis aimed to establish a relationship between the effects of NAC and non-NAC protocols in inpatients with COVID-19.

Method

By March 2022, a systemic review was conducted to assess the effects of NAC and non-NAC in inpatients with COVID-19. The clinical trials were identified in 20553 subjects admitted with COVID-19 at baseline. 2909 was treated with NAC and 17644 was treated without NAC. This study attempts to compare the effects of NAC and non-NAC in COVID-19 patients hospitalized with pneumonia. Statistical analysis uses the dichotomous method as a tool for odds ratio (OR) at  95% confidence interval (CI) to assess the effectiveness of NAC and non-NAC in COVID-19 patients hospitalized with pneumonia in random or fixed-effect model.

Results

Patients managed with NAC had fewer days in the ICU (OR, 2.79; 95% CI, -1.11-6.69, p = 0.16), lower mortality (OR, 0.69; 95% CI, 0.40-1.20, p = 0.19), and fewer number needed mechanical ventilation (OR, 0.74; 95% CI, 0.25-2.21, p = 0.59) compared with non-NAC in COVID-19 subjects hospitalized with pneumonia.

Conclusion

NAC has decreased the days stayed in the ICU, number of deaths, and number of patients needed mechanical ventilation in COVID-19 hospitalized with pneumonia, although, this difference was insignificant. Further studies are required that could affect the level of significance.

Background: Measurement of educated people knowledge about COVID-19 is important to enhance health measures to reduce the rate of infection. Also, knowing the most usable source of data for the public is important point for enhancing the public awareness about the disease. Hence, this study aimed to evaluate the awareness and the practices related to COVID-19 among educated people.

Methods: 360 participant received a questionnaire that was divided into several parts aimed at collecting data about participant awareness regarding COVID-19. Data collected using a designed questionnaire; to evaluate the knowledge related to COVID-19. The questionnaire was classified into 6 parts covering all aspects of COVID-19 awareness data. The first part was to evaluate the respondent’s general knowledge [6 items]; the second was to evaluate symptoms knowledge [1 item]; the third was to evaluate transmission knowledge [2 items]; the fourth was to evaluate preventive knowledge [4 items]; the fifth was to evaluate treatment knowledge [2 items] and the sixth was indicted the main source of gathering information about the disease [1 item].

Results: A total of 360 participants participated, 91% of them know the main clinical symptoms of COVID-19. 86% believed that following preventive measures (the etiquette of sneezing, coughing, personal hygiene or wearing a mask) reduce infection transmission. More than 90 % of participants used the social media for gathering information about the disease, while highly educated (Master and PhD holders) used the published articles as a source for their knowledge, however they represent a few percent of the participant.

Conclusion: Overall, the study participants had good knowledge about COVID-19, however, more efforts are needed to maximize the awareness of the public. Further clinical study is required to evaluate the effect of such good knowledge on decreasing the infection rate.

Background: The objective of this study was to compare the cost of outpatient ferric carboxymaltose (FCM; Ferinject®) versus Iron sucrose complex (ISC; Ferosac®), two prevalent intravenous iron therapy used in the treatment of iron-deficiency anemia (IDA) in the Kingdom of Saudi Arabia (KSA) from a tertiary care hospital perspective.

Methods: A retrospective study was performed for all patients who were administered FCM in the outpatient clinical setting at Prince Sultan Military Medical City from January 1, 2019, until December 31, 2019. The descriptive data was analyzed using Microsoft Excel 2019 (Microsoft Corporation, Redmond, WA, USA). The total cost of treatment reflected the cost of drugs, the cost of disposables for each infusion, drug monitoring costs during infusion, the cost of productivity loss, and patient traveling cost.

Result: Overall, 993 patients with IDA, treated with FCM in 1,688 outpatient visits were recruited in the study. In the outpatient setting, the per annum cost of treatment was SAR 1,434,092.50 with FCM treatment and SAR 1,715,299.70 with ISC treatment, with a corresponding saving of 16.4% (SAR 281,207.20) with FCM. The cost savings with FCM treatment can be attributed to the reduced frequency of patient visits and corresponding reduction in drug monitoring costs (SAR 266,995.20;77.3%), loss of productivity per year (SAR 163,550.20; 77.3%), and cost of transportation per year (SAR 573,920.00; 77.3%).

Conclusion: The use of FCM, as opposed to ISC resulted in a reduced number of iron infusions (4.4 visits for ISC as compared to one visit for FCM), accompanied by a reduction in the total cost. FCM may represent a cost-saving option compared with the existing alternative therapy used for the management of IDA in KSA.

Background: The aim is to present an electronic CPR calculator combined with CDSS (clinical decision support system) as a safer and faster method for CPR calculation than manual calculation.

Methods: A group of 70 nurses were randomly selected to calculate a CPR card and then enter the patient data into the CPR calculator. The time needed to complete the calculations and the time needed to enter patient information into the CPR calculator were measured. In addition, the number of medication calculation errors were recorded.

Result: The time to finish the CPR card manually was 00:08:31 minutes and the time to generate the CPR card electronically was 00:01:15. The number of nurses who made errors in manual calculation was 23, the total number of errors was 101. There were no errors with the calculator.

Conclusion: The CPR calculator has provided an accurate (with no errors) and faster way to generate CPR cards compared to the manual method.

The COVID-19 pandemic showed us that the world should have a proper protocol for the handling of such pandemics. A similar severe coronavirus pandemic occurs in 1918 (The spinach flu pandemic) and took two years to finish. Both pandemics took a lot of lives.

The 1918 Spanish flu pandemic was prevented with lower healthcare facilities. The main prevention method was social distancing. The effect of this social distancing was obvious when it was broken in Denver, the USA with its double-humped mortality curve of the Spanish flu pandemic in 1918. Even though this pandemic is also a coronavirus pandemic but some differences were observed in COVID-19. This commentary was to discuss the situation that occurs in COVID-19 and compare it to the Spanish flu pandemic in 1918 to reach a protocol for handling any possible upcoming coronavirus pandemics.

Background

We conducted a meta-analysis to assess the eosinophil counts in the small intestine and colon of children without obvious gastrointestinal disease.

There are now a variety of viewpoints on eosinophil counts in the small intestine and colon of children without obvious gastrointestinal disease, and there are not many thorough assessments that are pertinent.

Methods

A systematic literature search up to July 2022 was performed and 2378 related studies were evaluated. The chosen studies comprised 1800 children without obvious gastrointestinal disease participated in the selected studies' baseline trials; 607 of them were colonic eosinophilia, while 1193 were normal. Odds ratio (OR), and mean difference (MD) with 95% confidence intervals (CIs) were calculated to assess the eosinophil counts in the small intestine and colon of children without obvious gastrointestinal disease by the dichotomous, and contentious methods with a random or fixed effect model.

Results

The colonic eosinophilia resulted in significantly higher cell counts in the duodenum and terminal ileum (MD, 9.66; 95% CI, 6.50-12.81, p<0.001) compared to the normal for children without obvious gastrointestinal disease.

However, no significant difference was found between colonic eosinophilia and normal for children without obvious gastrointestinal disease in cell counts in the large intestine and the rectum (MD, 13.25; 95% CI, 0.17-26.33, p=0.05).

Conclusions

The colonic eosinophilia resulted-in-significantly-higher-cell-counts-in-the-duodenum-and-terminal-ileum,-however,-no-significant-difference-was-found-in-cell-counts-in-the-large-intestine-and-the rectum compared to the normal for children without obvious gastrointestinal disease. The small sample size of 8 studies out of 15 and the small number of studies in certain comparisons calls for care when analyzing the results.