Background Topical Mitomycin-C (MMC) can have a deleterious effect onto corneal endothelium in some ophthalmic surgeries.
Aim To evaluate safety of intraoperative topical MMC in pterygium surgeries ...onto corneal endothelium.
Design Prospective comparative cohort study.
Subjects and methods Forty-six patients were included in this study. Twenty-three patients underwent pterygium surgery with intraoperative MMC application (trial group) and equal number of patients underwent pterygium excision without MMC (control group) at the Suez Canal University Hospital. Corneal endothelial images were acquired with a specular microscope before surgery and at one week, one month, and three months following surgery.
Results Mean preoperative endothelial cell counts were 2364±220 cells/mm2 in the pterygium excision without MMC group and 2411±227 cells/mm2 in the pterygium excision with MMC group (P=0.7). One week, one month and three months after surgery, the pterygium with MMC group showed a statistically insignificant endothelial cell loss (P=0.06) whereas the other group didn't encounter any decrease in ECD (P=0.349), similar insignificant changes were found between the different measurements in the follow-up periods as compared to the preoperative measurements of central corneal thickness (CCT), cellular hexagonality, coefficient of variation and standard deviation of cell area as well as between patients of both groups.
Conclusions A single intraoperative 0.02% MMC topical application using MMC solution-moistened cellulose sponges, onto the scleral bed under the conjunctiva with care not to touch the cornea has not resulted in a statistically-significant deleterious effect onto corneal endothelium.
To evaluate the short-term efficacy of Dutasteride in the management of chronic prostatitis (CP)/chronic pelvic pain syndrome.
A randomized placebo-controlled double-blind study was conducted that ...including 50 patients diagnosed with CP based on the presence of pelvic pain for ≥3 months of the preceding 6 months. Patients were randomized into 2 equal groups to evaluate Dutasteride of 0.5 mg once daily that was given for 3 months compared to a placebo.
Forty-nine patients were evaluated after the follow-up period with no statistically significant difference in the perioperative demographic data. The mean age of the Dutasteride group was 48.3 (range 41–62) compared to a mean age of 46.5 (range 44–60) in the placebo group. There was a highly statistically significant improvement in the Dutasteride group compared to its preoperative parameters and the placebo compared group in the terms of pain, urinary scores, and total National Institutes of Health CP symptom score. Moderate and marked improvement in patients’ symptomatology was seen in 56% of the dutasteride group, while only 8% in the dutasteride group failed to show an improvement with no significant side effects noted in our study.
The short-term outcome of dutasteride therapy showed an improvement in the National Institutes of Health-CP symptom score compared to a placebo in the treatment of category IIIB CP.
NCT04756206.
Background: Vascular malformations are birth defects that happen when different stages of angiogenesis shut down. 44 - 64% of all vascular malformations are venous malformations VMs. Sclerotherapy is ...the first treatment line for VMs. It acts by getting rid of the vascular endothelial cells in the lesion. One of the most common sclerosing agents for VMs is polidocanol, which is a popular counterpart for concentrated ethanol.Aim of the work: This study aims to evaluate the efficacy of Ethanol in comparison to polidocanol foam sclerotherapy in the treatment of venous malformation.Patients and Methods: This prospective interventional study included 20 patients with VM that operated at the department of surgery of Al-Azhar University Hospitals, New Damietta and International Medical Center, Cairo, Egypt from October 2018 to March 2021. Patients were divided into 2 groups. Group A ethanol and Group B Polidocanol.Results: The difference between the 2 groups regarding the demographics, postoperative change of symptoms, degree of satisfaction, and complications, was not significant indicating that polidocanol foam is nearly as effective as ethanol however, it was slightly more tolerated with fewer side effects compared to ethanol.Conclusion: Polidocanol foam is an effective therapeutic option for VM. Although ethanol produces good outcomes with few major side effects, polidocanol has a low chance of damaging adjacent tissue. Polidocanol foam works almost as well as ethanol.
Background
Breast cancer is the most common malignant tumor and the commonest cause of death in female between 35 and 55 years of age. Neoadjuvant chemotherapy (NACT) is used in large scale nowadays ...in management of breast cancer. Recent studies propose that shear wave elastography (SWE) can early predict tumor therapy response during NACT for invasive breast cancer.
Aim of work
To study the ability of SWE to predict pathological complete response (pCR) during NACT as early as first cycle.
Subjects and methods
The study analyzed data of 48 patients breast cancer who were scheduled for receiving NACT before surgery. During treatment, SWE examination was done at first four cycles.
Results
Forty-eight breast cancer cases were included in the study with one hundred and ninety two examinations done. The cutoff point of stiffness ratio percent change post-first cycle in differentiating pCR and npCR groups was − 20% (AUC 0.755, sensitivity 81.8%, specificity 61.5%). The cutoff point of stiffness ratio percent change post-second cycle in differentiating pCR and npCR groups was − 49% (AUC 0.741, sensitivity 72.7%, specificity 76.9%). The stiffness ratio could predict pCR in early cycles of NACT.
Conclusions
US using shear wave elastography is an available, cheap, non-contrast, non-ionizing radiation method that predicts pCR in cases of breast cancer at neoadjuvant setting as early as first cycle.
Background
We recently adapted a guideline for Community-Acquired Pneumonia (CAP) in children to the Egyptian health system. Adaptation of evidence-based clinical practice guidelines to the local ...healthcare context is a valid alternative to de novo development that can upgrade their application without enforcing a major burden on resources. The objective of this manuscript is to elucidate diagnosis, treatment, and prevention of CAP as well as methods used for the adaptation process to produce the 1st National Guideline for Community-Acquired Pneumonia in children in Egypt using Adapted ADAPTE method. The full process was described extensively with all three phases of set up, adaptation, and finalization. An adaptation group and an external review including clinical content experts and methodologists conducted the process.
Results
The authors adapted 10 principal categories of recommendations from three source Clinical Practice Guidelines. Recommendations incorporate; common clinical manifestations, indications for hospitalization and intensive care unit admission, indications for laboratory investigations and radiology in diagnosis, choice of empiric antibiotic therapy in the outpatient and hospitalized children with non-complicated CAP and the duration of therapy, the role of influenza antiviral therapy, follow-up anticipated response to therapy, management of non-responding pneumonia, criteria of safe discharge, and prevention of CAP. Many tools were gathered and established to improve implement ability containing two clinical algorithms for management of non-complicated CAP and for non-responding pneumonia in children, pathway for assessment of severity of CAP in primary care facilities, medication tables, simplified Arabic patient information, PowerPoint slide presentation lecture for management of CAP, and online resources.
Conclusion
The final clinical guideline supports pediatricians and related healthcare workers with evidence-based applicable guidance for managing community-acquired pneumonia in Egypt. This work demonstrated the efficiency of Adapted ADAPTE and highlighted the importance of a cooperative clinical and methodological professional group for adaptation of national guidelines.
ABSTRACT
Background and Aim
Buprenorphine (BUP) maintenance treatment for opioid use disorder (OUD) begins with supervised daily dosing. We estimated the clinical effectiveness of a novel ...incentivised medication adherence and abstinence monitoring protocol in BUP maintenance to enable contingent access to increasing take‐home medication supplies.
Design
Two‐arm, single‐centre, pragmatic, randomised controlled trial of outpatient BUP maintenance, with during‐treatment follow‐ups at 4 weeks, 8 weeks, 12 weeks and 16 weeks.
Setting
Inpatient and outpatient addictions treatment centre in the United Arab Emirates.
Participants
Adults with OUD, voluntarily seeking treatment.
Interventions
The experimental condition was 16 weeks BUP maintenance with incentivised adherence and abstinence monitoring (I‐AAM) giving contingent access to 7‐day, then 14‐day, then 21‐day and 28‐day medication supply. The control, treatment‐as‐usual (TAU) was 16 weeks BUP maintenance, with contingent access to 7‐day then 14‐day supply.
Measurements
The primary outcome was number of negative urine drug screens (UDS) for opioids, with non‐attendance or otherwise missed UDS, imputed as positive for opioids. The secondary outcome was retention in treatment (continuous enrolment to the 16‐week endpoint).
Findings
Of 182 patients screened, 171 were enrolled and 141 were randomly assigned to I‐AAM (70 49.6%) and to TAU (71 50.4%. Follow‐up rates at 4 weeks, 8 weeks, 12 weeks and 16 weeks were 91.4%, 85.7%, 71.0%, 60.0% respectively in I‐AAM and 84.5%, 83.1%, 69.0%, 56.3% in TAU. By intention‐to‐treat, the absolute difference in percentage negative UDS for opioids was 76.7% (SD = 25.0%) in I‐AAM versus 63.5% (SD = 34.7%) in TAU (mean difference = 13.3%; 95% CI = 3.2%–23.3%; Cohen's d = 0.44; 95% CI = 0.10–0.87). In I‐AAM, 40 participants (57.1%) were retained versus 33 (46.4%) in TAU (odds ratio = 1.54; 95% CI = 0.79–2.98).
Conclusions
Buprenorphine maintenance with incentivised therapeutic drug monitoring to enable contingent access to increasing take‐home medication supplies increased abstinence from opioids compared with buprenorphine maintenance treatment‐as‐usual, but it did not appear to increase treatment retention.
Purpose
To compare the safety and efficacy of standard 30 min epithelium‐off cross‐linking (CXL) versus photorefractive keratectomy (PRK) combined with accelerated epithelium‐off cross‐linking (AXL) ...for the treatment of progressive keratoconus (CXL‐Plus).
Methods
This study was a prospective multicentre comparative clinical study. A total of 125 eyes of 75 patients with grade 1 keratoconus and documented progression were divided into two groups. Group A included 58 eyes treated with standard CXL. Group B included 67 eyes treated with combined PRK and AXL. The recorded data included UDVA, CDVA, subjective and objective refraction, keratometry and pachymetry using corneal topographies preoperatively and postoperatively at 3, 6, 12 and 24 months of follow‐up.
Results
In group A, at 24 months of UDVA and CDVA were improved from 1.12 ± 0.38 and 0.58 ± 0.42 to 0.66 ± 0.20 and 0.20 ± 0.12 (LogMAR±SD). The spherical equivalent was reduced from 4.03 ± 1.18 to 1.78 ± 1.04 D. The cylinder reduction was 0.32 ± 0.19 D. In group B, at 24 months of UDVA and CDVA were improved from 1.26 ± 0.52 and 0.68 ± 0.36 to 0.58 ± 0.28 and 0.20 ± 0.16 (LogMAR ± SD). The spherical equivalent was reduced from 4.23 ± 0.95 to 1.92 ± 0.74 D. The cylinder reduction was ±1.76 D.
Conclusion
Surprisingly, standard CXL showed close results to CXL‐Plus at the 24th follow‐up month. Standard CXL acted as a stabilizing procedure associated with a late myopic component reduction. CXL‐Plus acted as a refractive and stabilizing procedure with an early effect on both the myopic and the astigmatic component but no later improvements. Standard CXL seems to be more powerful than AXL in its long‐term effect. Therefore, in the future, we want to test the combination of PRK with standard CXL.
Female sex steroid hormones have a fundamental role in breast cancer. Meanwhile, current evidence supports the contribution of breast cancer stem cells in carcinogenesis, metastasis, and resistance ...to cytotoxic chemotherapy. Nevertheless, the interaction between breast cancer stem cells with sex hormones or key hormonal antagonists remains elusive.
To investigate the effect of diverse sex hormonal stimulation and suppression regimens on the proliferation of a primary human breast cancer cells with stem cell activity.
Cells were exposed to estradiol, progesterone, letrozole, ulipristal acetate, or a combination of ulipristal acetate-letrozole, continually for 6 months. Additionally, nanoparticle-linked letrozole and ulipristal acetate formulations were included in a subsequent short-term exposure study. Phenotypic, pathologic, and functional characteristics of unexposed cells were investigated.
The proliferation of breast cancer cells was comparable among all hormonal stimulation and suppression groups (P = 0.8). In addition, the nanoparticle encapsulated hormonal antagonists were not able to overcome the observed resistance of cells. Cell characterization showed a mesenchymal-like phenotype overexpressing three master pluripotency markers (Oct 4, SOX2, and Nanog), and 92% of cells were expressing ALDH1A1. Notably, the CD44 high/CD24 low cell population presented only 0.97%–5.4% over repeat analyses. Most cells lacked the expression of mesenchymal markers; however, they showed differentiation into osteogenic and adipogenic lineages. Upon transfer to serum-free culture, the long-term maintained mesenchymal-like cancer cells showed remarkable morphologic plasticity as they switched promptly into an epithelial-like phenotype with significant mammosphere formation capacity (P = 0.008).
Breast cancer cells can develop a pluripotent program with enhanced stemness activity that may together contribute to universal resistance to sex hormonal stimulation or deprivation. Isolation and characterization of patient-derived breast cancer stem cells in large clinical studies is therefore crucial to identify new targets for endocrine therapies, potentially directed towards stemness and pluripotency markers. Such direction may help overcoming endocrine resistance and draw attention to breast cancer stem cells’ behaviour under endogenous and exogenous sex hormones throughout a woman’s reproductive life.
Background: Poor adherence to treatment is one of the main challenges to symptom control and preventing recurrence in bipolar disorder (BD). Numerous studies have established an association between ...patients’ poor adherence and an increased risk of recurrence, relapse of the symptoms and admission to hospital. Aim: To study the socio-demographic and clinical factors associated with medication nonadherence in patients with BD who were admitted to the hospital. Setting: The study was conducted at the Institute of Psychiatry, Ain Shams University. Methods: A 1-year longitudinal prospective study of 110 patients, aged 18–60 years, with BD-I. Young Mania Rating Scale, Clinical Global Impression, Global Assessment of Functioning, Sheehan Disability Scale and Insight and Treatment Attitude Questionnaire were applied before and 6 months after discharge. Adherence was measured using the Morisky 8-Item Medication Adherence Scale. Sociodemographic data and level of functioning were studied in relation to adherence. Results: Higher adherence was noticed in female, married and older patients and those with a higher level of education. However, low adherence was more common in male, nonmarried and less educated patients. Follow-up after 6 months revealed that the high adherence group scored the lowest in terms of disability. Meanwhile, the low adherence group scored the highest scores in disability. Conclusion: Several socio-demographic and clinical variables were found to be associated with a low adherence rate to the prescribed medication in patients with BD-I. Age and impaired insight were found to be significant predictive factors for non-adherence.
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