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BackgroundThere is a growing body of evidence regarding eHealth interventions that target substance use disorders. Development and funding decisions in this area have been challenging, due to a lack of understanding of what parts of an intervention work in which context. ObjectiveWe conducted a realist review of the literature on electronic cognitive behavioral therapy (eCBT) programs for substance use with the goal of answering the following realist question: “How do different eCBT interventions for substance use interact with different contexts to produce certain outcomes?” MethodsA literature search of published and gray literature on eHealth programs targeting substance use was conducted. After data extraction, in order to conduct a feasible realist review in a timely manner, the scope had to be refined further and, ultimately, only included literature focusing on eCBT programs targeting substance use. We synthesized the available evidence from the literature into Context-Mechanism-Outcome configurations (CMOcs) in order to better understand when and how programs work. ResultsA total of 54 papers reporting on 24 programs were reviewed. Our final results identified eight CMOcs from five unique programs that met criteria for relevance and rigor. ConclusionsFive strategies that may be applied to future eCBT programs for substance use are discussed; these strategies may contribute to a better understanding of mechanisms and, ultimately, may help design more effective solutions in the future. Future research on eCBT programs should try to understand the mechanisms of program strategies and how they lead to outcomes in different contexts.

BackgroundEgypt is a country of nearly 100 million citizens, and there are less than 1000 registered psychiatrists. The mental health care system is under resourced and nearly inaccessible for the majority of the population. In addition, youth under the age of 25 years represent 50% of Egyptian citizens; however, there are no specific services addressing their unique needs. How can the needs of the largest population in the Middle East be effectively addressed? Is a web-based framework an option for Egyptian psychiatrists to serve the population? ObjectiveThe aims of this study were to better understand the opinions of psychiatrists on the current state of mental health care services in Egypt and their current knowledge on electronic mental health (EMH); assess the attitudes of Egyptian psychiatrists toward web-based interventions and telemedicine for mental health; and identify perceived advantages and barriers of EMH development in Egypt. MethodsA cross-sectional survey was conducted online among 640 Egyptian psychiatrists. It included a total of 36 items within a set of 16 questions asking about EMH literacy, integrating EMH into the mental health care system, and the perceived priorities and barriers of EMH. The sampling was supported by Tanta University, a large academic institution close to Cairo. Statistical analysis was performed using SPSS 25 (IBM Corp). Descriptive statistics, the chi-square test, the independent sample t test, and analysis of variance were applied. ResultsA total of 188 participants responded (response rate of 29.4%), of which 54.2% (102/188) were female and 54.3% (102/188) were between 30 and 45 years old. Less than half of the participants thought that the current health care system was efficient for adults (69/155, 44.4%), and even less thought it was efficient for youth (44/155, 28.3%). Almost all participants agreed that EMH would be beneficial for patient care (147/155, 94.8%) and that integrating EMH into the current health care system would be a good idea (118/155, 76.2%). The highest rated utility of web-based solutions was documentation, followed by psychoeducation and communication with professionals. The main advantages were to improve access to care in rural areas of the country and its convenience. ConclusionsThere is scarcity of mental health resources in Egypt. Egyptian psychiatrists are interested in EMH and believe web-based platforms can become part of the solution for the Egyptian mental health care system.

Abstract Background Benign paroxysmal positional vertigo (BPPV) is the most frequent vestibular disorder with significant morbidity, psychosocial impact, and medical costs. This multi-center study work aimed to review BPPV clinical features, treatment, and outcomes. Methods After a detailed history, clinical examination, audiological assessment, and position provocation tests to diagnose BPPV type, the suitable repositioning maneuver was done. BPPV was diagnosed according to the criteria developed for this study through piloting and validation in a specialized dizziness clinic. The main outcome measures were patient demographics, comorbidities, canal involvement, response to treatment, and incidence of recurrence. Results Within included 114 patients, the affected canal was 93% posterior semicircular canal, 3.5% horizontal semicircular canal, and 3.5% anterior semicircular canal. The response after repositioning maneuver was (86%) after one session and 100% after the second session. Conclusion Meticulous BBPV assessment with choosing appropriated provocation test help to diagnose and identify the type of BPPV and so applying appropriated suitable repositioning maneuver.

Granite rocks are currently one of the foremost raw materials that can be used for various economic purposes such as ornamentation and building materials, because they do not possess radioactive concentrations and have good physical and mechanical properties. The granite rocks of north Um Taghir are connected to neoproterozoic rocks and integrated to the north Arabian-Nubian Shield (ANS), which lies in Northeast Africa. Inductively coupled plasma mass spectrometry (ICP-MS) and X-ray fluorescence analysis, concurrent to some statistical analysis, have been carried for major oxides and some trace elements to extract much fundamental information by following certain mathematical methods. The exposed granite rock units in north Um Taghir are classified into four rock units represented by tonalite, granodiorite, monzogranite, and alkali-feldspar granite which are cut by different types of dikes. The magma of tonalite and granodiorite is low-to-medium K calc-alkaline affinity, while the magma of monzogranite and alkali-feldspar granite is medium-to-high K calc-alkaline affinity, and of metaluminous to peraluminous nature. Granite rocks show a slightly depletion of fractionated patterns from light rare earth elements (LREEs) to heavy rare earth elements (HREEs) with slightly positive to negative Eu anomalies from tonalite to monzogranite and alkali-feldspar granites. The statistical criteria have been achieved to explore the significant differences of radiological hazard parameters among samples. It is obvious that there is no homogeneity among samples; furthermore, in Kruskal–Wallis test, Mann–Whitney test, and Pearson correlation coefficient, it can be noticed that there are significant differences between each pair of samples: tonalite, monzogranite; tonalite, alkali-feldspar granite; granodiorite, monzogranite; and granodiorite, alkali-feldspar granite. There is a strong direct relationship among granodiorite and both tonalite and alkali-feldspar granite, and among alkali-feldspar granite and tonalite and granodiorite. There is a strong inverse relationship among monzogranite and tonalite, granodiorite, and alkali-feldspar granite. As stated by all results, it can be mentioned that the granite rocks have a worthy result of mechanical and physical properties. So that they can be used for various economic purposes.

Background: Neuroinflammation pathways have been associated with the development of major depressive disorders (MDD). The anti-inflammatory characteristics of statins have been demonstrated to have significance in the pathophysiology of depression. Aim: To investigate the mechanistic pathways of high dose atorvastatin in MDD. Patients and methods: This trial included 60 patients with MDD who met the eligibility requirements. Two groups of patients (n = 30) were recruited by selecting patients from the Psychiatry Department. Group 1 received 20 mg of fluoxetine plus a placebo once daily. Group 2 received fluoxetine and atorvastatin (80 mg) once daily. All patients were assessed by a psychiatrist using the Hamilton Depression Rating Scale (HDRS). A HDRS score of ≤7 indicates remission or partial remission [HDRS<17 and>7]. Response was defined as ≥ 50% drop in the HDRS score. The serum concentrations of nucleotide-binding domain, leucine-richcontaining family, pyrin domain-containing-3 (NLRP-3), interleukin-6 (IL-6), adenosine monophosphate activated protein kinase (AMPK), and signal transducer and activator of transcription factor-3 (STAT-3) were measured. Results: The atorvastatin group showed a significant reduction in the levels of all measured markers along with a statistical increase in the levels of AMPK when compared to the fluoxetine group. The atorvastatin group displayed a significant decrease in HDRS when compared to its baseline and the fluoxetine group. The response rate and partial remission were higher in the atorvastatin group than fluoxetine (p = 0.03, and p = 0.005), respectively. Conclusion: These results imply that atorvastatin at high doses may be a promising adjuvant therapy for MDD patients by altering the signaling pathways for AMPK/ NLRP3 and IL-6/STAT-3. [ABSTRACT FROM AUTHOR]

The hallmark of neglected Ischemic Priapism is increasing tissue necrosis and hypoxia due to blocked venous outflow caused by unrelieved tissue pressure inside a confined compartment. inside six hours of start, irreversible changes to corporal tissue take place because of RIP, which causes time-dependent alterations inside the corpora cavernosa. While 50% of patients can maintain their erectile function if their priapism is treated within 24 hours, the maintenance of erectile function and the response rate to distal shunt procedures progressively decrease as priapism lengthens. Guidelines2022 from the American Urological Association state that once more conservative methods have failed, a distal penile shunt surgery is usually part of the management of neglected Ischemic Priapism. Distal shunts, such as intracavernosal tunneling, have poor results for protracted ischemic priapism, with just 30% of priapic episodes lasting more than 48 hours successfully treated. Penoscrotal corporal decompression (PSD) is a simple technique in the management of neglected Ischemic Priapismwith fewer complications & less cost with the restoration of erectile function than other techniques. PSD has favorable results in maintaining adequate sexual function as If PSD does not produce a long-lasting new shunt from the corpora cavernosa to the glans or spongiosum, there may be a greater chance of restoring physiological erectile function. [ABSTRACT FROM AUTHOR]

Background: Neuroinflammation pathways have been associated with the development of major depressive disorders (MDD). The anti-inflammatory characteristics of statins have been demonstrated to have significance in the pathophysiology of depression. Aim: To investigate the mechanistic pathways of high dose atorvastatin in MDD. Patients and methods: This trial included 60 patients with MDD who met the eligibility requirements. Two groups of patients (n = 30) were recruited by selecting patients from the Psychiatry Department. Group 1 received 20 mg of fluoxetine plus a placebo once daily. Group 2 received fluoxetine and atorvastatin (80 mg) once daily. All patients were assessed by a psychiatrist using the Hamilton Depression Rating Scale (HDRS). A HDRS score of =7 indicates remission or partial remission [HDRS<17 and>7]. Response was defined as = 50% drop in the HDRS score. The serum concentrations of nucleotide-binding domain, leucine-richcontaining family, pyrin domain-containing-3 (NLRP-3), interleukin-6 (IL-6), adenosine monophosphate activated protein kinase (AMPK), and signal transducer and activator of transcription factor-3 (STAT-3) were measured. Results: The atorvastatin group showed a significant reduction in the levels of all measured markers along with a statistical increase in the levels of AMPK when compared to the fluoxetine group. The atorvastatin group displayed a significant decrease in HDRS when compared to its baseline and the fluoxetine group. The response rate and partial remission were higher in the atorvastatin group than fluoxetine (p = 0.03, and p = 0.005), respectively. Conclusion: These results imply that atorvastatin at high doses may be a promising adjuvant therapy for MDD patients by altering the signaling pathways for AMPK/NLRP3 and IL-6/STAT-3. [ABSTRACT FROM AUTHOR]

to compare the results of using Dapoxetine and HA (hyaluronic acid) gel injection by Five puncture technique in the treatment of premature ejaculation (PE). 100 sexually active heterosexuals circumcised males with lifelong PE were included in the study. Group A patients were treated with on-demand Dapoxetine, while group B was treated with HA gel glans penis injection using a five-puncture technique. Both groups were evaluated at 1st,3rd and 6th months post-treatment using IELT. There were no significant differences between both groups regarding patient demographic. Mean pretreatment IELT in groups A and B were 45.82 ± 7.44 and 46.18 ± 7.82 receptively. There was no significant difference between both groups. After treatment, both groups show significant ILET improvement during the 1st,3rd, and 6th months follow-up with a P value < 0.001. However, when comparing the improvement of ILET in group A (Dapoxetine) and group B (HA injection), there were high significance differences in favor of group B in the 1st,3rd, and 6th-month follow-up. Although both treatment modalities have improved IELT and premature ejaculation, but HA injection with five punctures technique was significantly better than oral Dapoxetine with self-limited side effects. [ABSTRACT FROM AUTHOR]

Purpose of Review: We performed recent literature review with the aim to address the updates in diagnosis and management of interstitial cystitis/bladder pain syndrome (IC/BPS). Recent Findings: There are multiple recently published studies that collectively lead to an organized stepwise plan for diagnosis and management of IC/BPS. Summary: IC/BPS is a common health condition that can be managed efficiently if the appropriate steps are taken in diagnosis and management. [ABSTRACT FROM AUTHOR]

Background: Emerging evidence suggests that positive impacts can be generated when digital health interventions are designed to be responsive to the cultural and socioeconomic context of their intended audiences. Objective: This narrative review aims to synthesize the literature about the cultural adaptation of digital health interventions. It examines how concepts of culture and context feature in design and development processes, including the methods, models, and content of these interventions, with the aim of helping researchers to make informed decisions about how to approach cultural adaptation in digital health. Methods: Literature searches for this narrative review were conducted across 4 databases. Following full-text article screening by 2 authors, 16 studies of interventions predominantly focused on the self-management of health were selected based on their detailed focus on the process of cultural adaptation. Key considerations for cultural adaptation were identified and synthesized through a qualitative narrative approach, enabling an integrative and in-depth understanding of cultural adaptation. Results: The literature demonstrates varying approaches and levels of cultural adaptation across stages of intervention development, involving considerations such as the research ethos orienting researchers, the methodologies and models used, and the resultant content adaptations. In relation to the latter, culturally appropriate and accessible user interface design and translation can be seen as particularly important in shaping the level of adaptation. Conclusions: Optimizing cultural adaptation involves linking culture with other contextual factors such as economic conditions and social systems to ensure accessibility and the sustained use of digital health interventions. Culturally humble approaches that use the involvement of a broad range of participants, experts, and other stakeholders are demonstrated to spark vital insights for content development, implementation, and evaluation. [ABSTRACT FROM AUTHOR]

background: Muscle-invasive bladder cancer is common in Egypt. Trimodality chemoradiation post transurethral resection of bladder tumor proved high benefits. Our aim is to show our institute's experience in using gemcitabine concurrent with radiotherapy post-TURB in an old frail group of patients diagnosed with MIBC regarding efficacy and tolerability.Aim of work:to show the safety and efficacy of using low-dose weekly gemcitabine as a radiosensitizer concurrent with radiotherapy post-TURBT in an old frail group of patients diagnosed with MIBC and unfit for radical surgery. Methods: This prospective study included 47 patients diagnosed with de novo MIBC in the period between October 2016 and October 2020. Patients who qualified underwent maximal TURBT followed by radiation therapy with 65 GY in two phases concomitant weekly gemcitabine (100 mg/m2). Results: The median age was 65.9 years. Males were more common (80.9%) than females. The Median follow-up was 24 months. A complete response was achieved in 34 patients (72.3%). Salvage cystectomy was done for 3 patients who did not achieve CR. chemotherapy was given to another 5 patients of those who did not achieve CR (gemcitabine plus cisplatin/carboplatin). While 5 patients refused any further treatment, only for follow-up regimens. Survival: Median PFS and OS were 40 months and 42 months, respectively. Threeyear progression-free survival (PFS) and overall survival (OS) were 66.6% and 75.4%, respectively. Conclusions: Chemoradiation with low dose Gemcitabine is well tolerated and effective post-TURT. It provides an alternative organ-preserving strategy in invasive TCC for old fragile patients. [ABSTRACT FROM AUTHOR]

Objectives: In 2019, the Insititue for Health Metrics and Evaluation reported that 16% of life lost were attributed to mental health. As a result, global shortage of psychiatrists is a pressing issue due to the increasing burden of mental illness. In 2016, a mere 5% of US medical students chose psychiatry as a career, a trend mirrored in Germany and Italy. As the medical students of 2016 have graduated or transitioned into residency in 2023, their attitudes towards psychiatry could have contributed to today's shortage of psychiatrists. The global mental health burden has only been exacerbated by the COVID-19 pandemic. This study explores the attitudes of German and Italian medical students towards psychiatry, their career aspirations, and the influence of factors such as personal experience and education on their interest in the field. Methods: A cross-sectional survey was conducted among 799 medical students in two European countries in 2016. Participants answered questions about their attitudes towards psychiatry, their psychiatric education, and personal experiences. Inferential analyses were performed using chi-square tests and a significance level of 0.05. Results: The number of years in medical school, personal experiences, and perceived quality of education significantly affected specialty choice and ranking of psychiatry compared to other specialties. Internships, psychiatric placements, and views on psychiatric instructors also played a significant role in choosing psychiatry as a career. Conclusions: Assessing medical students' attitudes towards psychiatry and the factors that influence their career choices, such as psychiatric education and personal experiences, can inform changes to attract students to the field. Addressing the worldwide shortage of psychiatrists is crucial to reduce the burden of mental health and substance use disorders. [ABSTRACT FROM AUTHOR]

This document is a corrigendum for an article titled "Effect of a high dose atorvastatin as added-on therapy on symptoms and serum AMPK/NLRP3 inflammasome and IL-6/STAT3 axes in patients with major depressive disorder: randomized controlled clinical study." The corrigendum addresses an error in the affiliation of one of the authors, Manal A. Hamouda. The correct affiliation should be "Department of Clinical Pharmacy, Faculty of Pharmacy, Menoufia University, Shebin El-Kom, Menoufia, Egypt." The authors apologize for the error and state that it does not affect the scientific conclusions of the article. [Extracted from the article]

Objective: The objective of this study is to compare the outcome of percutaneous nephrostomy by ultrasound (US) versus fluoroscopy including access time, volume of anesthesia required, success rate, and complications. Methods: One hundred patients were enrolled in a prospective randomized study. Patients were divided into two groups, 50 cases each. Comparing the two groups was done regarding the need for dye, radiation effect, time taken, trial number, rate of complication, volume of anesthesia, and success rate. Results: Patient demographics were comparable between both groups with no statistically significant difference. According to the modified Clavien-Dindo classification, the complications were Grade I (pain and mild hematuria) in each group. Procedural pain was present in 41 (82%) patients in Group I and in 48 (96%) patients in Group II. It was treated in both groups with a simple analgesic. Mild hematuria was present in 5 (10%) patients in the US group and 13 (26%) in the fluoroscopic group and treated by hemostatic drugs only. There was a statistically significant difference between both groups regarding the volume of required local anesthesia, the trial numbers, the puncture numbers, bleeding, extravasation, and change in the hemoglobin level. Conclusion: US percutaneous renal access is a safe and effective modality with a high success rate, less operative time, and complication rate. However, a minimum of 50 cases with some pelvicalyceal system dilation may be preliminary requisites to achieve good orientation and competence in achieving safe US percutaneous renal access for future endourological procedures. [ABSTRACT FROM AUTHOR]

To assess safety and efficacy of hyaluronic acid (HA) gel injection in glans penis for treatment of premature ejaculation (PE) using our new five puncture technique. This is a prospective, non-randomized clinical trial on HA gel injection in glans penis for all patients with lifelong PE; all patients were circumcised having heterosexual normal marital life and sexually active. Patients with history of ejaculatory medication use within the previous 3 months, psychiatric disorders, erectile dysfunction, lower urinary tract symptoms (LUTS) due to prostatitis and acquired PE were excluded from the study. A local anesthetic was applied to the skin of glans penis for 30 minutes before the injection of 2 ml HA in glans penis via 30-gauge needle using our new Five-puncture technique. Intra-vaginal ejaculatory latency time (IELT) was measured at 1, 3, 6 and 12 months after injection. Thirty patients completed our study follow up schedule. Mean age of the patients was 41.72 ± 8.50, while mean age of female partner was 37.23 ± 8.54 years. IELT was highly significantly increased (P-value < 0.001) after HA gel injection from baseline, which was in maximum 37.83 ± 11.01 sec at baseline to 323.03 ± 42.06, 281.07 ± 41.05, 241.03 ± 43.09 and 235.6 ± 41.87 sec after 1, 3, 6 and 12 months, respectively, after injection. Three patients complained from discomfort at the site of injection, two from bullae formation at the site of injection and one from ecchymosis, and all resolved spontaneously after 1 week to 10 days after injection. HA gel injection in glans penis using our new five-puncture technique is a safe and effective method that ensures a modest long-term significant increase in IELT and improves ejaculatory control. [ABSTRACT FROM AUTHOR]

Introduction: In Egypt, bladder cancer (BC) represents about 8.7% of cancers in both sexes. In Egyptian men, it accounts for over 30% of all cancers, which makes it the second most frequent cancer. The standard curative treatment for patients with muscle-invasive bladder cancer (MIBC) has been radical cystectomy (RC) with urinary diversion and pelvic lymphadenectomy. Concomitant chemoradiation therapy (CCRT) in MIBC appears to produce results that are comparable to those of RC. Material and methods: Between January 2018 and March 2021, 34 BCdiagnosed patients, who refused RC, were enrolled. They received transurethral resection of the bladder tumour (TURBT) followed by 3 cycles of neoadjuvant chemotherapy (NACT) with gemcitabine, cisplatin, and CCRT. Concomitant chemoradiation therapy with cisplatin, as a chemosensitizer, was administered to patients who experienced a complete response (CR) and a partial response (PR) ≥ 50%. Results: Following NACT, CCRT was given to 27 patients (79.45%) who had either a PR > 50% or CR. Seven patients (20.5%) showed PR below 50%, stable disease, or progressive disease; 4 of them underwent RC followed by postoperative radiation. The average follow-up period was 46 months (range: 6-52 months). Twenty-three patients (67.6%) were still alive at the last check-up. Disease-free survival and 3-year overall survival were 70.8% and 65.1%, respectively. Conclusions: Bladder preservation provides survival rates comparable to those of MIBC patients, but with a higher quality of life. The findings show good survival rates without metastasis; nevertheless, more multicentre trials with larger sample sizes and longer follow-up periods are required to confirm these findings. [ABSTRACT FROM AUTHOR]