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Tuberculosis (TB) is a disease that disproportionately affects the poor. The World Health Organization lists economic factors as one of main barriers to tuberculosis management.This study aimed to estimate the household total catastrophic cost of TB and its determinants among newly diagnosed Egyptian tuberculous patients.This was a cohort prospective study covering 257 TB patients registered in 2019. The patients were followed up bi-monthly until the end of the treatment regimen (4 visits). A standardized questionnaire published by the poverty sub-working group of the Stop TB Partnership was used after minor modification. The following costs were measured: pre-diagnosis, direct and indirect, guardian and coping, as well as annual household income. Catastrophic cost (direct plus indirect) was considered if the total cost of TB treatment exceeded 20% of the household's annual income. Sensitivity analyses were conducted using different thresholds.The incidence of household total catastrophic cost was 24.1%. The mean total cost of TB treatment was US$ 198. Over 50% of the total direct cost was incurred during the pre-diagnosis period. After adjustment for other determinant variables using multivariable logistic regression, we found that age30 years, living in a house with crowding index2, poverty and coping were more likely to cause higher total catastrophic cost.Catastrophic cost was experienced by 1 out of every 4 new TB patients. As the main cost drivers were poverty and coping, the Ministry of Health and Population should be collaborated with Ministry of Finance and NGOs to put a plan of social protection system for poor families with TB patients.التكلفة الإجمالية الباهظة للأسر بسبب السل في مصر: معدل التكلفة الباهظة، ومسببات التكلفة، والآثار المترتبة على السياسات.محسن جاد الله، وجدي أمين، ميرفت راضي.السل مرض يؤثر على الفقراء بدرجة متفاوتة. وترى منظمة الصحة العالمية أن العوامل الاقتصادية أحد العوائق الرئيسية أمام معالجة السل.هدفت هذه الدراسة إلى تقدير التكلفة الإجمالية الباهظة للسل التي تتكبدها الأسرة، والعوامل المحددة لها بين المرضى المصريين المصابين بالسل الذين شخِّصت حالاتهم حديثًا.كانت هذه دراسة استباقية أترابية شملت 257 مريضًا بالسل مُسجَّلًًا في عام 2019. وجرت متابعة المرضى كل شهرين حتى نهاية نظام المعالجة (4 زيارات). واستُخدم استبيان موحد نشره الفريق العامل الفرعي المعني بالفقر التابع لشراكة دحر السل، بعد تعديل طفيف. وقد قِيسَت التكاليف التالية: تكاليف ما قبل التشخيص، والتكاليف المباشرة وغير المباشرة، وتكاليف الوصي والتكيف، فضلًًا عن الدخل السنوي للأسرة المعيشية. وتُعد التكلفة (المباشرة وغير المباشرة) باهظة إذا تجاوزت التكلفة الإجمالية لعلاج السل 20٪ من الدخل السنوي للأسرة. وقد أُجريت تحليلات الحساسية باستخدام عتبات مختلفة.بلغت نسبة تحمل الأسرة لتكلفة باهظة 24.1٪. وبلغ متوسط التكلفة الإجمالية لعلاج السل 198 دولارًا أمريكيًّا. ويُدفَع أكثر من 50٪ من إجمالي التكاليف المباشرة خلال فترة ما قبل التشخيص. وبعد تعديل المتغيرات المحددة الأخرى باستخدام الانحدار اللوجستي المتعدد المتغيرات، وجدنا أن العمر أقل من 30 عامًا، والعيش في منزل ذي مؤشر ازدحام أكثر من 2، والفقر والتكيف كان أكثر عرضة لتحمل تكلفة باهظة أعلى.عانى مريض واحد من كل 4 مرضى جدد من مرض السل من تكلفة باهظة. نظرًا لأن العوامل الرئيسية للتكلفة كانت الفقر والتكيف ، يجب أن تتعاون وزارة الصحة والسكان مع وزارة المالية والمنظمات غير الحكومية لوضع خطة لنظام الحماية الاجتماعية للأسر الفقيرة مع مرضى السل.Coût total des dépenses catastrophiques des ménages liées à la tuberculose en Égypte : incidence, facteurs de coût et implications politiques.La tuberculose est une maladie qui touche les pauvres de manière disproportionnée. En effet, l'Organisation mondiale de la Santé a classé les facteurs économiques parmi les principaux obstacles à la prise en charge de la tuberculose.La présente étude estime le coût total des dépenses catastrophiques des ménages liées à la tuberculose et ses déterminants parmi les patients tuberculeux égyptiens nouvellement diagnostiqués.Il s'agissait d'une étude de cohorte prospective couvrant 257 patients atteints de tuberculose enregistrés en 2019. Les patients ont été suivis deux fois par mois jusqu'à la fin de leur protocole thérapeutique (quatre visites). Un questionnaire standardisé publié par le sous-groupe de travail sur la pauvreté du Partenariat Halte à la tuberculose a été utilisé après quelques modifications mineures. Les coûts suivants ont été mesurés : coûts avant le diagnostic, coûts directs et indirects, coûts pour les personnes qui s'occupent des malades et coûts de l'adaptation à la situation financière ainsi que le revenu annuel du ménage. Les coûts (directs et indirects) étaient considérés comme étant catastrophiques si le coût total du traitement de la tuberculose dépassait 20 % du revenu annuel du ménage. Des analyses de sensibilité ont été effectuées en utilisant différents seuils.L'incidence du coût total des dépenses catastrophiques pour les ménages était de 24,1 %. Le coût total moyen du traitement de la tuberculose était de 198 dollars des États-Unis. Plus de 50 % du coût direct total a été engagé pendant la phase précédant le diagnostic. Après ajustement pour d'autres variables déterminantes à l'aide d'une régression logistique multivariable, nous avons constaté que le fait d'être âgé de moins de 30 ans, de vivre dans une maison dont l'indice de surpeuplement est supérieur à deux, la pauvreté et l'adaptation à la situation financière étaient plus susceptibles de causer un coût catastrophique total plus élevé.Un nouveau patient tuberculeux sur quatre a subi un coût catastrophique. Les principaux facteurs de coût étant la pauvreté et l'adaptation à la situation financière, le ministère de la Santé et de la Population devrait collaborer avec le ministère des Finances et les organisations non gouvernementales (ONG) pour mettre en place un système de protection sociale destiné aux familles pauvres comptant des patients tuberculeux.

Objectives: Current diagnostic tests for tuberculosis (TB) in children living in low-endemic countries are limited by low specificity and the inability of the current tests to differentiate between active TB and latent TB infection (LTBI). This study aimed to evaluate the blood IP-10 mRNA expression level to detect LTBI in Egyptian pediatric household contacts (PHC). Methods: TB-specific IP-10 and IFN-γ mRNA levels were assessed by real-time quantitative PCR (RT-qPCR) in 72 Egyptian PHC of active pulmonary TB cases. All study participants were also assessed by Tuberculin Skin Test (TST) and Quantiferon gold in tube (QFN-GIT) assay. Results: IP-10 and IFN-γ mRNA expression levels were significantly higher in PHC with active TB or LTBI than TB negative (p < 0.0001). The level of IP-10 mRNA expression was significantly higher in PHC with active TB than LTBI (p = 0.0008). In contrast, there was no significant differences in the IFN-γ mRNA expression between PHC with active TB compared to LTBI (p = 0.49). The sensitivity and specificity of the IP-10 RT-qPCR were 94.2% and 95.2%, respectively, in PHC with active TB compared to 85.7% and 81.8% in PHC with LTBI. The negative and positive predictive values and accuracy of IP-10 RT-qPCR for distinguishing active TB from LTBI were 85.2%, 58.3%, and 72.6% respectively. Conclusion: Blood IP-10 mRNA expression level may be a potential diagnostic marker to help distinguish active TB from LTBI in PHC.

Objective The novel coronavirus disease 2019 (COVID-19) has made its worldwide spread since its outbreak in December 2019. Limited information is available about the epidemiology and clinical characteristics of COVID-19, especially in Africa and Egypt. Methods We aimed to study the clinical and epidemiological characteristics of COVID-19 in Egyptian children. This is an observational retrospective cohort study performed at two specialized COVID-19 isolation hospitals in Egypt. All admitted COVID-19 pediatric patients between March 20, 2020, and May 1, 2020, were included in the study. Discussion This study included 40 COVID-19 confirmed cases (mean age, 9.4 years), 67.5% were male, 85% were asymptomatic, and 15% had mild symptoms. There were no confirmed severe or critically ill cases among the patients. Conclusion COVID-19 runs in a benign course in Egyptian children with no mortality and no significant morbidity.

Background: During a pandemic, healthcare workers are at high risk of contracting COVID-19. To protect these important individuals, it is highly recommended that they receive the COVID-19 vaccine. Our study focused on evaluating the safety and efficacy of Egypt’s first approved vaccine, the Sinopharm vaccine (BBIBP-CorV), and comparing these findings with other vaccines. Methods: An observational study was conducted in fifteen triage and isolation hospitals, from the 1st of March until the end of September 2021. The study included fully vaccinated and unvaccinated participants, and we measured vaccine effectiveness (using 1-aHR), the incidence rate of severely to critically ill hospitalized cases, COVID-19-related work absenteeism, and the safety of the vaccine as outcomes. Results: Of the 1364 healthcare workers who were interviewed, 1228 agreed to participate. After taking the hazard ratio into account, the vaccine effectiveness was found to be 67% (95% CI, 80–43%) for symptomatic PCR-confirmed cases. The incidence rate ratio for hospitalization was 0.45 (95% CI, 0.15–1.31) in the vaccinated group compared to the unvaccinated group, and there was a significant reduction in absenteeism among the vaccinated group (p < 0.007). Most adverse events were mild and well tolerated. Vaccinated pregnant and lactating mothers did not experience any sentinel adverse events. Conclusion: Our study found that the BBIBP-CorV vaccine was effective in protecting healthcare workers from COVID-19.

OBJECTIVE Health care workers_ the first line army in the current pandemic_ are the most vulnerable group for COVID-19 infection. Vaccination of health care workers is strongly recommended to salvage our army. However, more research is needed to determine the safest and most effective vaccine. In our study, we assessed the safety and effectiveness of the first approved vaccine in Egypt_ the Sinopharm vaccine. DESIGN, SETTING: An ambispective cohort study was conducted in fifteen triage and isolation hospitals, from the 1st of March till the end of September 2021. Participants are either fully vaccinated or unvaccinated. OUTCOMES AND MEASURES: Efficacy outcome to assess vaccine effectiveness, severity outcome to assess incidence rate of hospitalized cases (severe to critically ill) or the COVID-19 related mortality, in addition to the safety of the vaccine. INTERPRETATION: From the selected hospitals, we included 1228 of 1364 interviewed healthcare workers. Vaccine effectiveness was 67% to protect against symptomatic PCR confirmed cases and 46% for total COVID-19 infection after adjusting hazard ratio. Incidence rate ratios of vaccinated to unvaccinated group were 0.39 (95%CI, 0.24–0.65) for PCR confirmed symptomatic case, 0.63 (95%CI, 0.46–0.86) for total COVID-19 infection, 0.45 (95% CI, 0.15–1.31) for hospitalization, 0.71 (95% CI, 0.07– 6.39) for mechanical ventilation and only one COVID-19 death among unvaccinated group. Most adverse events are mild and well-tolerated. Pregnant and lactating vaccinated mothers did not report any sentinel adverse events. CONCLUSION Sinopharm was effective in protecting health care workers from the highly transmissible COVID-19 infection when the predominant Delta variant was ambient.

Background Pulmonary tuberculosis (TB) lesion is acidic, and changing this acidic pH may affect growth of TB bacilli and response to therapy. We aimed to assess the effect of adjuvant inhalation of sodium bicarbonate (SB) 8.4% on clinical, radiological, and microbiological responses in patients with sputum-positive drug-sensitive pulmonary TB. Patients and methods One hundred and three patients with pulmonary TB completed the study, and they were classified into two groups: group I included 55 patients who received standard anti-TB regimen plus SB inhalation, and group II included 48 patients who received anti-TB regimen only. The responses in both groups were evaluated clinically, microbiologically, and radiologically. Results There was no statistically significant difference between both groups in baseline bacillary load, clinical picture, and radiology. Both groups improved clinically 1 month after start of therapy. In group I only, there was a statistically significant improvement in chest radiograph after 1 month (P

Background: The aim of this study is to estimate the budget impact of budesonide/formoterol fixed dose combination (FDC) versus salbutamol, both used as needed, in mild asthma patients, fro...

Background: The rapid worldwide spread of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) or COVID-19 pandemic from its epicentre; Wuhan has led to an epidemiological breakdown. Egypt reported its first COVID-19 case on Feb 14, 20202,3. Thereafter, Egypt scaled-up preventive measures, with a partial lockdown starting on March 25. Several therapeutic agents along with Convalescent Plasma Transfusion are under investigation and data from Convalescent Plasma Transfusions (CPT) have been receiving a lot of attention, after Emergency approvals from the Food and Drug Administration (FDA) suggesting that it may provide a clinical effect in the treatment of SARS-COV-2 Importance: Early and effective treatment of COVID-19 is vital for control of SARS-CoV-2 infection Methods: -Designs: An interventional, single-arm, non-randomized clinical trial conducted in Egypt from April 15 to July 21, 2020. -Settings: This was a multi-centre study conducted in 3 hospitals in Egypt. -Participants: a total of 94 COVID-19 laboratory-confirmed patients using qRT-PCR were enrolled in the study. -Intervention: All patients were administered with two plasma units (each unit is 200cc). The volume of donated plasma was 800cc. -Main Outcome and Measures: Primary measure was the degree of clinical improvement among the COVID-19 patients who received CPT within seven days Results: A total of 94 patients were enrolled who received CPT either within seven days or after seven days of hospitalization. 82 were severely ill, 12 were critically ill. The average age remained 58 years (±SD 15.1 years). Male were 69% and 49% patients got cured while 51% died with CFR 51%. 75% deaths were above 45years of age. The symptoms were dyspnoea (55%), fever (52%), cough (46%), and loss of taste and smell (21%), and cyanosis (15%). The most common co-morbidities among the 60 years age group Hypertension (57%) and Chronic Heart Disease (24%) were reported. CPT within seven days remained significant as compared with the CPT after seven days with the number of days to cure (p=0.007) and ICU stay (P=0.008) among severely ill cured cases. Conclusions: Among patients with COVID-19 and severe or critical illness, the use of CPT along with routine standard therapy resulted in a statistically significant improvement when administered within seven days of hospital admission. However, plasma transfusion, irrespective of days to transfusion may not help treat critically ill patients. The overall mean time to cure in severely ill patients was 15 days if CPT provided within seven days with 65% cure rate. Trial Registration: Clinical Intervention identifier: MOHP_COVID-19_Ver1.1 registered April 2020 Keywords: Covid 19 pandemic, Convalescent plasma, SARS-CoV-2

IntroductionSince the worldwide emergence of the COVID-19, several protocols were used by different healthcare organisations. We evaluated in this study the demographic and clinical characteristics of COVID-19 disease in Egyptian population with special consideration for its mortality predictors.Methodology8162 participants (mean age 48.7±17.3 years,54.5% males) with RT-PCR positive COVID-19 were included. The electronic medical records were reviewed for demographic, clinical, laboratory, and radiologic features. The primary outcome was the in-hospital mortality rate.ResultsThe in-hospital mortality was 11.2%. There was a statistically significant strong association of in-hospital mortality with age >60 years old (OR:4.7; 95% CI 4.1-5.4;p3.1 (OR:6.4; 95% CI 4.4-9.5;P< 0.001), and ground glass opacities (GGOs) in CT chest (OR:3.5; 95% CI 2.84-4.4;PConclusionsThis multicenter, retrospective study ascertained the higher in-hospital mortality rate in Egyptian COVID-19 patients with different comorbidities.

Clinical question What is the role of drugs in preventing covid-19? Why does this matter? There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. Recommendations The second version of this living guideline reiterates the previous strong recommendation against the use of hydroxychloroquine and includes a new conditional recommendation against the use of tixagevimab-cilgavimab in individuals who do not have covid-19. How this guideline was created This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provides methodological support. A living systematic review with network analysis informs the recommendations. An international guideline development group (GDG) of content experts, clinicians, patients, an ethicist and methodologists produces recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Understanding the recommendations The living network meta-analysis informing this guideline included 12 trials (8379 participants) comparing hydroxychloroquine to standard care/placebo, and one trial (5197 participants) comparing tixagevimab-cilgavimab to standard care/placebo. When moving from evidence to the continued strong recommendation against the use of hydroxychloroquine, the GDG emphasised additional evidence suggesting no or little effect on mortality and hospital admission, and an increased risk of adverse effects. For the new conditional recommendation against the use of tixagevimab-cilgavimab, the GDG emphasised in vitro evidence reducing the applicability of available trial data. While trial results demonstrated modest reduction in the occurrence of laboratory confirmed symptomatic covid-19, lack of in vitro neutralisation of new SARS-CoV-2 sub-lineages was considered to have rendered these results obsolete. Updates This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. Readers note This is the second version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19 and living guidance regarding covid-19 related clinical management. When citing this article, please consider adding the update number and date of access for clarity.

Background & Aims: In the midst of this pandemic, planning the prioritization of hospital admissions for patients affected with COVID-19 should be of prime concern, particularly in healthcare settings with limited resources. Thus, in this study, we aimed to develop a novel approach to triage COVID-19 patients and attempt to prioritize their hospital admission using Lung Ultrasonography (LUS). The efficacy of LUS in triaging suspected COVID-19 patients and assessing the severity of COVID-19 pneumonia was evaluated; the findings were then compared with those obtained by chest computed tomography (CT). Method: This multicenter, cross-sectional study comprised 243 COVID-19 patients who presented to the emergency department in 3 major university hospitals in Egypt. LUS was performed by an experienced emergency or chest physician, according to the local protocol of each hospital. Demographic, clinical, and laboratory data were then collected from each patient. Each patient was subjected to chest CT scans and LUS. Results: The mean age of the 243 patients was 46.7 ± 10.4 years. Ground-glass opacity, subpleural consolidation, translobar consolidation, and crazy paving were reported in the chest CT scans of 54.3%, 15.2%, 11.1%, and 8.6% of the patients, respectively. B-line artifacts were observed in 81.1% of the patients (confluent pattern, 18.9%). The LUS findings completely coincided with the CT findings (Kappa agreement value, 0.77) in 197 patients (81.1%) and offered a diagnostic sensitivity of 74%, diagnostic specificity of 97.9%, positive predictive value of 90.2%, and negative predictive value of 93.6% for the COVID-19 patients. Following the addition of O2 saturation to the lung imaging findings, the ultrasound method was able to demonstrate 100% sensitivity and specificity in accurately differentiating between severe and non-severe lung diseases. Conclusion: LUS with oxygen saturation might prove to be effective in prioritizing the hospital admission of COVID-19 patients, particularly in healthcare settings with limited resources.

Background: The prevalence of type 2 diabetes mellitus (DM) is increasing rapidly in Egypt and considered one of the major health problems in the Eastern Mediterranean region. Objectives: To measure the prevalence of diabetes and detect the undiagnosed cases of diabetes mellitus among patient with tuberculosis. Methods: Study Design: Nationwide population-based study. To diagnose DM among TB patients, we used a fasting blood sugar level of ≥ 126 mg/dl and a post-prandial blood glucose test result of ≥ 200 mg/dl. Results: Screening for DM among 1435 TB patients' with no history of DM detected 30 new cases of DM, with a case detection rate of 2.09%. The highest screening yields were among TB patients aged ≥ 40 years, females and those with pulmonary TB. The number needed to screen (NNS) TB patients for detecting one new case of DM was 48 while the lowest values were for older age (NNS=27) and females (NNS=29). Conclusion: Older age and being females and those with pulmonary type of TB were more prone to the double burden of TB and DM. Identifying cases with double burden of diseases will improve the proper management of both diseases and prevent complications. Keywords: Screening test, diabetes mellitus, tuberculosis.