Search

Objectives: The objective of this web-based study is to analyze the attributes of bariatric surgery cases ensuing health implications. Additionally, the study seeks to delve into the factors influencing post-bariatric psychological evaluations and the impact of various bariatric surgeries on weight loss and psycho-social assessment scores for patients who had undergone bariatric surgeries within a specific bariatric surgery center in Egypt between January 2017 and January 2024., Methods: An analytical cross-sectional study recruited 411 adults who had undergone different bariatric procedures by the same surgical team. We collected the data using a validated self-administered questionnaire that included the Body Image Scale (BIS), the Rosenberg Self-Esteem Scale (RSES), the quality-of-life score (QOLS), and the modified General Patient Satisfaction Score after Bariatric Surgeries (GSABS)., Results: The most commonly performed bariatric surgery was sleeve gastrectomy (SG), accounting for 82.7% of the procedures. The majority of the patients (78%) were female, with a mean age of 35.8. Among the participants, 32.4% reported experiencing complications, and 21.2% of those individuals were still experiencing complications at the time of assessment. The BIS had a mean score of 16.54 ± 6.27, indicating an average body image perception. The RSES yielded a mean score of 20.11 ± 4.63, indicating average self-esteem, while the GSABS had a mean score of 8.08 ± 2.39, indicating an overall average level of patient satisfaction. No statistically significant differences were found between the various types of bariatric surgeries in terms of total body weight loss percentage, excess body weight loss percentage, or the timing of the intervention. However, increased time intervals from surgeries noted a significant reduction in the BIS., Conclusion: The majority of patients who underwent SG and Roux-en-Y gastric bypass (RYGB) surgeries exhibited high GSABS scores. SG patients also had high BIS scores. However, all other interventions showed normal GSABS and BIS scores. All types of surgeries resulted in normal RSES and QOLS. Furthermore, the BIS score increases with the intervention's recentness, but it significantly decreases after the second-year post-surgery. Conversely, the older the timing of the intervention, the higher the RSES score after surgery., Competing Interests: Declarations. Competing interest: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: Nurses' clinical competence is a significant concern in all healthcare settings due to the necessity of delivering high-quality patient care. Understanding and addressing the factors related to competence are crucial for promoting nurses' clinical competence and ultimately improving patient outcomes. Producing and maintaining a skilled nursing workforce is essential to protect communities., Aim: This study aimed to assess the level of self-evaluated clinical competence and its correlation with demographic and occupational variables among registered nurses employed at selected outpatient clinics in Egypt., Materials and Methods: The study utilized a descriptive cross-sectional design with a self-administered, two-part questionnaire that assessed participants' demographic and occupational variables as well as perceived clinical competence in various healthcare settings. It took place at outpatient clinics of two governmental hospitals and five primary healthcare centers in Mansoura City, Egypt between January, and June 2023. A purposive sample of 450 nurses took part in this study., Results: The average score of nurses' clinical competence was 155.3±7.2 out of 230, indicating a "moderate level". In terms of professional behaviors and general performance, the average score for clinical competence was 48.4±3.6 and 40.7±4.1 respectively. Additionally, the average score for clinical competence regarding core and advanced nursing skills were 43.4±3.0 and 22.8±1.5 respectively. Among the domains of clinical competence, the highest average score was associated with "professional behaviors" as it forms the backbone of nursing practice. There was a highly significant relationship between the average score of clinical competence and the participant's age, sex, level of education, and years of clinical work experience (P<0.001)., Conclusion: Nurses perceived their level of clinical competence as moderate. To enhance nurses' clinical competence, future studies and interventions should focus on promoting supportive work environments, providing ongoing education and training in advanced nursing skills, and the fostering development of critical thinking skills in nurses., Recommendations: Healthcare organizations should implement educational interventions to enhance nurses' clinical competence. These interventions should include continuous professional development opportunities, mentorship programs, inclusive training initiatives, and structured feedback mechanisms. These measures will help nurses stay up-to-date with the latest practices and technologies, create a supportive learning atmosphere, and address the unique needs and challenges faced by nurses of different genders and specialties., Competing Interests: NO authors have competing interests., (Copyright: © 2024 Mohamed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Death certification is a health indicator and a public health surveillance tool. High-quality death certificate ensures reliability of mortality statistics used to direct the arranging of health-related programs and leading assessments of research and proper healthcare outcomes. The World Health Organization (WHO) puts Egypt in the group of 'low quality' death registration data. The aim of this study was to evaluate the impact of composite training and audit intervention on accurate completion of death notification forms (DNFs) in Assiut University Children Hospital (AUCH) that has an average monthly mortality of 120 children's deaths., Methods: A Quasi-experimental study design was conducted among residents of AUCH. The intervention consisted of 1- Preparing training material with basic information on how to report causes of death according to WHO criteria and case scenarios extracted from the medical records of children who died at AUCH, 2- One hundred residents of the AUCH were trained in one day workshops in 4 groups, with a pre-post knowledge assessment questionnaire. 3- A weekly audit of a sample of 10-15 DNFs was done for six months with reporting of findings to quality assurance director of the hospital., Results: Eighty- nine physicians completed the pre-post knowledge assessment with significant increase in knowledge score after the intervention (15.7 ± 3.2 vs. 11.9 ± 2.8). There was a significant decrease in the errors of reporting on the DNFs. The main improvement was in decrease from 90 to 18% in reporting the mechanism of death, and significant decline in writing cause of death in Arabic language only., Conclusion: Accurate reporting of the medical cause of death can be achieved by educational intervention targeting physicians with institutionalizing of audit system for continuous quality improvement., Competing Interests: Declarations. Ethics approval and consent to participate: The current study was conducted following approval from the Institutional Review Board (IRB) of the Faculty of Medicine, Assiut university (IRB No. 04-2023-300340). Administrative approval was obtained from the head of Assiut University children hospital before conducting the study. Participation was voluntary with confidentiality and privacy of all data was assured. Several measures were taken to ensure the protection of privacy during both data collection and analysis. Informed consent was obtained from all resident physicians, clearly outlining our commitment to protecting their privacy. The objective of the training was explained by administering the pretest to the participants to obtain their informed consent. Data was analyzed anonymously where identifiers were removed and during data collection, all data was securely entered in a separate excel sheet, with access limited to authorized research personnel only. Mortality data was handled with particular care: it was isolated from other data and entered in a separate excel sheet, and all analyses were conducted in a secure environment. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are widespread, treatable sexually transmitted infections (STIs) of global significance, affecting millions annually. Left untreated, they pose significant risks, including pelvic inflammatory disease (PID), infertility, and complications during pregnancy. The U.S. Centers for Disease Control recommends annual chlamydial screening for sexually active women to address these risks. Responding to this global challenge, the World Health Organization (WHO) has formulated a global health sector strategy on sexually transmitted infections, outlining priority actions to strengthen STI responses in countries. However, STI epidemiological studies encounter challenges in developing nations like Egypt due to socio-cultural factors, poverty, and limited diagnostic facilities. In Egypt, STI diagnosis primarily relies on clinical presentations, lacking structured screening programs for CT and NG. This study's main objective is to estimate the prevalence of Chlamydial and gonorrheal infections, advocating for supportive STI strategies in Egypt. Additionally, the study aims to provide a foundation for national prevalence estimates of CT and NG infections., Methods: A cross-sectional study encompassed five antenatal clinics in different regions of Egypt. A total of 1040 pregnant women attending these clinics were consecutively sampled. Data collection involved structured questionnaires, and urine samples were subjected to the GeneXpert CT/NG qualitative real-time PCR test., Results: The prevalence of CT infections was 0.29% (95% CI, 0.10-0.86%), with no detected NG infections. The three CT-positive cases were distributed across different recruitment centers, with no statistically significant differences observed between infected and non-infected participants. Notably, 40.3% of recruited women reported gynecological symptoms, primarily discharge. Additionally, 9.6% had undergone previous testing for sexually transmitted infections, with 8.2% receiving positive results., Conclusions: This study provides valuable data on the prevalence of CT and NG infections among pregnant women attending ANC clinics in Egypt. The findings underscore the importance of ongoing surveillance, routine screening, and targeted interventions to ensure the reproductive health and well-being of pregnant women and their infants. Further research is warranted to explore the broader implications of STIs in different populations and to inform evidence-based guidelines for screening and management in diverse settings., Trial Registration: IRB no.: 17,400,017; WHO ERC Protocol Id. A66005., (© 2024. The Author(s).)

Objectives: Assessment of the relationship between dietary patterns and menstrual disorders among female medical and paramedical students at Beni-Suef University, Egypt., Methods: Beni-Suef University conducted a cross-sectional analytical questionnaire-based study. Three hundred fifty two female medical and paramedical students agreed to participate in the study. The collected data about demographics, physical activity, menstrual history, and dietary assessment were transferred to SPSS version 26 for statistical analysis. A p value ≤0.05 was considered statistically significant., Results: The prevalence of irregular cycles, heavy blood flow, severe dysmenorrhea, and premenstrual syndrome (PMS) was found to be (21.9 %), (13.1 %), (35.5 %), and (68.9 %), respectively. Poor adherence to the Mediterranean diet (40.1 %) and physical activity (69.9 %) was present. Females with irregular cycles (p=0.472), heavy menstrual blood flow (p=0.007), and severe dysmenorrhea (p=0.029) reported lower adherence to the Mediterranean diet. Mothers' educational level (p=0.034), family income (p=0.005), and family size (p=0.009) were significantly associated with dietary adherence., Conclusions: Poor adherence to regular physical activity and the Mediterranean diet is highly prevalent in our research and is highly associated with menstruation disorders. So, it is critical to support health education programs emphasizing healthy dietary habits and regular physical activity to improve menstrual health and women's quality of life., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Background: Child physical abuse, a type of child maltreatment (CM), poses a significant global public health concern. Nonaccidental fractures and soft tissue injuries, which encompass any action that directly or indirectly harms a child, are the primary indicators of physical abuse in children., Objective: This study aimed to investigate the prevalence, risk factors, and outcomes of accidental and nonaccidental skeletal fractures in a sample of Egyptian children., Methods: A cross-sectional analytical study was conducted between March 2022 and August 2022. A total of 156 children who presented with skeletal injuries and attended Mobarak Central Hospital were enrolled. Patients were subjected to full history taking, complete examination, and investigations. A structured questionnaire was administered to all the legal guardians., Results: Physical abuse was reported in 22.4 % of cases, while medical neglect was reported in 19.9 % of cases. The incidence of physical abuse was notably higher among children whose fathers were smokers and/or drug addicts (p ≤ 0.05). The most common form of physical abuse was hitting (94.3 %). Among skeletal injuries, fractures were predominant (94.3 %), primarily closed fractures associated with contusions. Fractures of the upper limb accounted for the highest incidence (94.3 %) of skeletal injuries, and 60 % of physically abused children experienced moderate-severity injuries., Conclusion: The most common fracture observed in abused children is the upper limb fracture, typically involving a single bone. Clinicians should be more vigilant in suspecting abuse, even in cases where there is an isolated fracture, and advocate for the development of parental training programs., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Psychological stress is a common psychological comorbidity among medical students and worsens their quality of life. Psychological resilience is thought to have a protective role against stress. However, evidence regarding the prevalence of stress and resilience alongside their associated factors is scarce, especially in the Middle East. This is the first multicenter, cross-sectional study to investigate resilience and stress among Egyptian medical students., Methods: The current cross-sectional study was conducted on 2465 university students in seven public universities in Egypt. The universities were selected using the simple randomization method. The data was collected using a self-administered questionnaire consisting of four parts: demographic data, socioeconomic tool represented in the Family Affluence Scale (FAS), the Kessler Psychological Distress Scale (K10), and the Brief Resilience Scale (BRS). Data was analyzed in SPSS version 26 software., Results: The majority of the students were stressed (86.5%), most of whom had severe stress (48.9%). Most of the students had low resilience (49.9%), while only 3.2% had high resilience. In the logistic regression analysis, being a female, living alone, spending long hours on social media, and thinking of suicide or leaving medicine were associated with being stressed and having low resilience. Medical students with low resilience were significantly more liable to stress [Adjusted odds ratio (AOR) = 3.667, confidence interval (CI): 2.709-4.965, P = 0.000], and vice versa [AOR = 3.709, CI: 2.746-5.009, P = 0.000]. Interestingly, high socioeconomic status showed a significant association with high resilience (P = 0.004); nonetheless, it was not associated with stress (P = 0.993). Academic grades were not associated with both the level of stress and resilience. Aging, being in clinical or academic stages, smoking, having a chronic disease, and being financially-supported are neither associated with stress nor resilience., Conclusions: The present study revealed that Egyptian medical students had low resilience and high stress, with a significant relationship between both of them. Further investigations via longitudinal study design to understand the resilience-stress relationship are recommended. Developing and implementing resilience-improving strategies in medical schools is highly recommended to decrease the prevalence of stress and its subsequent burdens., (© 2024. The Author(s).)

In the first phase of its treatment program, Egypt aimed to treat 250,000 people annually until 2020, thereby reducing the number of viremic patients and limiting hepatitis C virus (HCV) transmission. Egypt strives to eradicate HCV and HCV-associated morbidity by 2030. This study aimed to determine the prevalence of HCV infection among end-stage renal disease patients and the reasons for non-treatment among those offered free medication. This multi-center cross-sectional study was conducted during the period from November 2022 to April 2023. The study included 500 patients receiving hemodialysis (HD) sessions on a regular basis for more than three months in Dakahlia Governorate. According to patients` medical history, we found that 23.4% of patients had previous HCV infection. Of these, 12.6% received treatment, and 10.8% did not receive treatment due to a variety of reasons. For instance, some patients were unaware of the drug's availability, five patients (1%) feared side effects, 43 patients (8.6%) did not require treatment, and five patients (1%) had other causes as contraindications of drugs, noncompliance and deterioration of health status. In addition, 20.4% of patients were reported to have fully recovered, while 0.8% had a recurrence. After investigations, 1% of patients had positive hepatitis B surface antigen (HbsAg), 23.4% positive HCV Ab, and 4.2% positive HCV by the polymerase chain reaction. In conclusion, the low prevalence of HCV among HD patients confirms that HCV infection is not currently a significant health concern among patients on maintenance HD., (Copyright© by the Egyptian Association of Immunologists.)

Background: Ramadan fasting is an obligatory religious practice for Muslims. However, research data on the effect of Ramadan on idiopathic intracranial hypertension (IIH) symptoms are lacking. This study aimed to study the effect of Ramadan fasting on the severity of headache and visual symptoms and related quality-of-life activities., Methods: This prospective cohort study targeted females diagnosed with IIH (n = 102) who were eligible to fast for Ramadan in 2023. The patients were recruited from the Neurology Clinic in Beni-Suef University Hospital, Egypt. Body mass index (BMI), monthly headache days and intensity of headache attacks, six-item Headache Impact Test (HIT-6), and the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) scores during Ramadan were compared to those during the (non-fasting) month of Shaaban, the preceding month to Ramadan., Results: There was a significant increase in the BMI of patients with IIH in Ramadan compared to the (non-fasting) month of Shaaban, at a median (interquartile range [IQR]) of 30.5 (26.6-35.8) kg/m 2 and 30.1 (26.6-35.2) kg/m 2 , respectively (p = 0.002). The median (IQR) value of monthly headache days was significantly increased during Ramadan in comparison to the (non-fasting) month of Shaaban, at 20 (11.5-30) vs. 15 (10-25) (p < 0.001). There was a statistically significant worsening in the visual analog scale (VAS) scores (median [IQR] 7 [5-8] vs. 6.5 [5-8]), HIT-6 scores (median [IQR] 61 [58-67] vs. 59 [53-61.5]), and NEI-VFQ-25 total scores (median [IQR] 1312.5 [1238.8-1435] vs 1290 [1165-1417.5]) during Ramadan in comparison to the (non-fasting) month of Shaaban (p < 0.001 for all comparisons). The change in BMI in Ramadan was positively correlated with the change in monthly headache days (r = 0.24, p = 0.014), VAS (r = 0.20, p = 0.043), HIT-6 (r = 0.25, p = 0.010) and NEI-VFQ-25 scores (r = 0.24, p = 0.016)., Conclusion: Ramadan fasting had an aggravating effect on headache, visual symptoms, and related quality-of-life activities, which might be attributed to weight gain during this month. Whether proper nutritional management to prevent weight gain during Ramadan may help mitigate this worsening effect is a mission of future studies., (© 2024 American Headache Society.)

Background: Self-medication (SM) is a rising public health issue, especially in developing countries. It can be associated with various problems such as the delayed seeking of medical advice, drug interactions, and serious events such as antimicrobial drug resistance. We aimed to evaluate the Egyptian general population's knowledge, attitudes, and practices of SM., Methods: We employed a cross-sectional design between February 7th and March 8th, 2023 using a self-administered questionnaire available in Arabic. The questionnaire was developed based on previous studies and included four domains: sociodemographic data, knowledge, attitude, and practice of SM. We utilized both online (Google Forms) and paper surveys, utilizing convenience and snowball sampling methods. Data were analyzed using R Statistical Software (v4.1.3; R Core Team 2022)., Results: 1630 Egyptian individuals (838 females and 792 males) from the seven provinces were enrolled, with a median age of 25 years (IQR: 22-40). Around 55.97% and 48.28% of the participants had good knowledge and favorable attitudes regarding SM respectively, while 62.8% had practiced SM in the previous three months. The most frequently used medications were painkillers (60.74%) followed by antibiotics (32.13%) and antipyretics (28.61%). The pharmacist's recommendation was the source of SM for 53.61% while 31.53% used old medications at home. Most participants (59.08%) practiced SM because they thought they had simple or minor symptoms. The multivariate regression analysis revealed that females had significantly higher knowledge of SM than males (aOR: 2.10; 95%CI: 1.64-2.71; p-value < 0.001), with no significant differences in practice (aOR: 1.24; 95%CI: 0.99 - 1.56; p-value = 0.065). Individuals working or studying in the medical field were significantly more knowledgeable about SM (aOR: 4.30; 95%CI: 3.27-5.69; p-value < 0.001) and more likely to practice SM (aOR: 1.65; 95%CI: 1.26-2.17; p-value < 0.001). The odds of SM decreased with favorable attitudes (aOR: 0.44; 95%CI: 0.36-0.55; p-value < 0.001) while surprisingly, knowledge level was not significantly contributing to SM practice (aOR: 1.15; 95%CI: 0.90-1.48; p-value = 0.268)., Conclusions: SM is prevalent in Egypt, highlighting the importance of raising awareness and encouraging physician consultation as a priority. Governments, healthcare organizations, and educational institutions need to collaborate to provide the necessary support and resources., (© 2024. The Author(s).)

Background: Monkeypox (Mpox) is a re-emerging infectious disease representing a new global challenge. It poses a substantial threat to countries, particularly those with a low number of cases. Due to its popularity as a tourist destination and its proximity to many African refugees, Egypt is potentially at risk of Mpox importation. Therefore, effective disease management necessitates healthcare workers (HCWs) to possess adept knowledge, along with a positive attitude and behavior. The study aimed to assess the knowledge, attitude, and perception of Egyptian HCWs and medical students towards human Mpox., Methods: The present cross-sectional study data was collected from participants between October and December 2022 via a questionnaire. The questionnaire comprised 31 questions in the knowledge section, 11 questions in the attitude section, and 14 in the perception section., Results: The present study involved a total of 1,034 HCWs and medical students. It was found that 55.3% of the participants demonstrated adequate knowledge about Mpox, whereas 44.5% and 39.8% of the respondents exhibited favorable attitudes and perceptions towards the disease, respectively. Binary logistic regression analysis revealed that adequate knowledge was significantly observed in ages older than 40 years ( p < 0.001), married participants ( p < 0.001), and doctors ( p < 0.001). The positive attitude was significantly observed among the male sex ( p = 0.045), urban residents ( p = 0.002), and nurses ( p = 0.002). Conversely, married participants (p = 0.013), doctors ( p < 0.001), and individuals employed in pharmacy and laboratory departments ( p < 0.001) experienced an increase in positive perception., Conclusion: Knowledge, attitude, and perception towards Mpox among Egyptian HCWs and medical students exhibit suboptimal levels. Addressing these gaps is crucial to controlling and effectively preventing disease transmission., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Amer, Nofal, Gebriel, Bedawy, Allam, Khalil, Elahmady, Nofal, Saeed, Shaltout, Behiry, Attia, Bahgat, Ali, Ahmed, Abdelrahman and Hammad.)

Background: Tuberculosis (TB) is a major cause of morbidity and mortality globally. Understanding its epidemiology and burden is critical for targeted interventions., Aim: To highlight the prevalence, incidence and treatment outcomes of TB in Egypt during the last 2 decades., Methods: For this systematic review and meta-analysis, we searched Medline/PubMed, ResearchGate, Google Scholar, and Scopus databases. We searched the local databases for unpublished studies, and the reports of international agencies, applying clear inclusion and exclusion criteria. The search covered prevalence; incidence; treatment outcomes; age, gender and residence of patients; and type of TB. Data were analyzed using STATA version 16.0. Pooled estimates with 95% confidence interval (CI) were calculated using a random effects model. Odds ratio (OR) with 95% CI was used as effect measures for related variables. Heterogeneity across studies was assessed using the I² statistic with sub-group analysis., Results: A total of 23 studies from 22 governorates, out of 27 governorates, involving a 139 597 study population met the eligibility requirements with no publication bias. The pooled prevalence was 8.70 (95% CI: 5.80-12.41, I² = 92.7%) and the pooled incidence was 9.10 (95% CI: 6.65-14.86, I² = 95.5%) per 100 000 population. About 82.6% of cases showed cured/completed treatment, 4.4% failure of treatment, and 3.9% died. In the subgroup analyses, the odds of TB prevalence were higher among males than females (2.05; 95% CI: 1.44-3.28), among those living in rural than in urban areas (1.29; 95% CI: 0.61-1.97), in Upper Egypt and Greater Cairo than in Lower Egypt and Delta Region (1.85; 95% CI: 0.97-4.15). The odds of pulmonary TB prevalence were higher than the extrapulmonary TB (2.43; 95% CI: 1.63-5.71). The odds of the treatment cases who were cured/completed (1.04; 95% CI: 0.96-1.51), failed (1.71; 95% CI: 1.35-2.73), and died (1.12; 95% CI: 0.87-1.60) were higher in Lower Egypt than in Upper Egypt., Conclusion: TB incidence decreased in Egypt over the last two decades, but treatment outcomes were unsatisfactory, with variations across the different regions. To achieve TB eradication in Egypt, efforts should be made to sustain the TB control strategy by improving treatment outcomes and intensifying case finding and surveillance reporting., (Copyright: © Authors 2024; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: Over-prescription of antibiotics contributes to antibiotic resistance, which is a global health threat. Egypt has alarmingly high rates of antibiotic over-prescription for acute upper respiratory tract infections (URIs) in children. To effectively address this issue, it is important to understand the various factors that influence prescription behaviors. The Teixeira antibiotic prescription behavioral model (TAPBM) offers a comprehensive framework through which these factors can be explored. This qualitative study sought to investigate the perspectives of key stakeholders involved in pediatric healthcare in Egypt, with the primary goal of identifying the underlying determinants that contributed to this problem., Methods: This qualitative study was conducted in Assiut City, Egypt, between January and March 2023. Purposive sampling was used to select participants, including consultant pediatricians, supervisors of pediatric training programs, and specialists in infection prevention and control. Thirteen semi-structured in-depth interviews (IDIs) were conducted, audio-recorded, and transcribed. Thematic analysis was performed using MAXQDA 2020 software., Results: Two main themes emerged from the analysis: intrinsic factors related to physicians, extrinsic factors related to patients, and nonphysician factors. Intrinsic factors encompass personal characteristics and attitudes. Prescribing decisions were influenced by factors such as fear of complications, limited follow-up visits, and competition. Knowledge and education also played a significant role. Moreover, diagnostic uncertainty in distinguishing between bacterial and viral infections posed a challenge. Extrinsic factors included patient and caregiver factors, such as parental expectations and demands for antibiotics, driven by the belief that they produced rapid results. Moreover, patients' demographic factors, including socioeconomic status and living conditions, affected their prescribing behavior. Health system-related factors, such as the type of healthcare institution and the absence of formal national guidelines, were identified as influential factors. Additionally, this study highlighted the influence of the pharmaceutical industry. The potential impact of the COVID-19 pandemic on antibiotic prescriptions was addressed., Conclusions: The study highlights the intricate interplay between intrinsic and extrinsic factors that shape antibiotic prescription decisions, underscoring the significance of addressing these factors in mitigating overprescribing., (© 2023. The Author(s).)

Defensive medicine refers to practices motivated mainly by legal rather than medical purposes. Increased healthcare costs, overutilization of medical services, and potential harm to patients from unnecessary procedures are among its drawbacks. We performed this study to assess the prevalence of defensive medicine practices in Egypt and their associations with experiencing malpractice claims and workplace physical violence. We investigated 1797 physicians (68.1% male), with an average age of 36.8 ± 9.1 years, practicing in Egypt between January 14th and February 23rd, 2023. SPSS was used for statistical analysis. The majority reported engaging in defensive medicine practices. Specifically, 89.6% acknowledged avoiding high-risk procedures, 87.8% refrained from treating high-risk patients, 86.8% admitted to making unnecessary referrals, 84.9% acknowledged ordering unnecessary tests, 61.4% reported performing unnecessary procedures, and 56.4% disclosed prescribing unnecessary medications. Obstetricians and surgeons exhibited the highest rates of defensive medicine. Using linear regression analysis adjusted for age and sex, malpractice claims and workplace physical violence were associated with defensive medicine score (zero-100): βs (95% CIs) = 5.05 (3.10, 6.99) and 5.60 (3.50, 7.71), respectively, (p values < 0.001). In conclusion, defensive medicine is deeply ingrained in the clinical routines of Egyptian physicians. Establishing a comprehensive national medical liability framework is required., (© 2023. The Author(s).)

Objective: Assessment of the perceived SA for medical students in Beni-Suef University, Egypt., Methods: An analytical cross-sectional study was conducted over a period of 6 months among medical students at faculty of medicine, Beni-Suef University through an online survey using google form. For data collection, an English validated questionnaire developed in partnership by the International Federation of Medical Students Association (IFMSA) and the Training for Health Equity Network (THEnet) was used., Results: Students' mean SA score was 17.3±7.1. Perceived SA scores ranged from 18 to 26 for 40.9% of participants, while 38.9% of them had scores ranging from (9-17), indicating that the faculty is doing well, However, there is a need to identify areas of weakness and advocate for strategies to improve SA among students. Furthermore, there were statistically significant differences in age, gender, residence, and academic year across students with different scores., Conclusion: Although half of the medical students of Beni-Suef university had acceptable SA, but there are areas for improvement and weakness to fix within the faculty., (© 2023 Walter de Gruyter GmbH, Berlin/Boston.)

Objectives: This study aimed to examine the association between the effect of emotional intelligence on job burn-out and the mediating effect of workplace conflict management among critical care physicians., Design and Setting: A cross-sectional study design was deployed., Participants: The studied sample comprised 144 critical care physicians working at two Egyptian tertiary care public hospitals., Measures: The participants' responses to three questionnaires were studied, including the Maslach Burnout Inventory, the Emotional Intelligence Questionnaire and the Conflict Management Formative Questionnaire, in addition to assessing coenzyme Q10 (CoQ10) levels., Results: Among the anaesthesiologists and critical care specialists examined, burn-out was reported by 63.9% of them. The findings of this study indicated that emotional intelligence played a notable role in predicting job burn-out, with a negative impact. Further analysis revealed that workplace conflict management acted as a mediator between emotional intelligence and the three components of job burn-out. Additionally, age and years of experience were found to have a negative correlation with burn-out and a positive correlation with conflict management. Furthermore, CoQ10 levels showed a negative correlation with burn-out, while displaying positive correlations with emotional intelligence and conflict management., Conclusion: Conflict management acted as a mediator in reducing burn-out by demonstrating a significant negative relationship between emotional intelligence and burn-out. Initial findings indicated that possessing good emotional intelligence and conflict management skills had a positive influence on the immune system, as evidenced by higher CoQ10 levels. However, burn-out had the opposite effect, depleting the body's CoQ10 stores and negatively impacting immune-protective mechanisms. Therefore, it is crucial to implement emotional management educational programmes and update educational policies and pedagogical practices to enhance the emotional capabilities of healthcare providers, especially in demanding fields like critical care, to effectively address conflicts., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The effectiveness of red cell transfusion in a given blood unit that relied on both quantity and quality of donated cells undoubtedly affects prognostic outcomes., Objective: We aimed to determine the frequency of subclinical functional hemoglobin and red cell abnormalities in donated blood of Fayoum University Hospital in Egypt. Additionally, to assess the usefulness of reticulocyte mean hemoglobin content (RET-He) and immature reticulocyte fraction (IRF) as screening measures for such abnormalities., Material and Methods: This cross-sectional study enrolled 200 volunteer blood donors who met the national standard criterion of blood donation. Complete blood count with reticulocyte parameters, serum ferritin, sickling test, G6PD assay, Mentzer index, and naked-eye single tube red cell osmotic fragility test were carried out., Results: Functional red cell abnormalities represented 44 % of this cohort. Out of them, 4.5 % had iron deficiency, 11 % had a positive sickling test, 19 % had G6PD deficiency, and 9.5 % had suspicious thalassemia. The sensitivity and specificity test for RET-He in selective identification of functional hemoglobin abnormalities in donated blood were 83.3 % and 61.2 %, respectively at a cutoff value of 26.9. Though there was no statistically significant effect of RET-He on the selective detection of G6PD deficiency, IRF had a statistically significant high level with a p-value of 0.04., Conclusion: Subclinical functional red cell abnormalities seem to be prevalent among blood donors. Reticulocyte/ erythrocyte indices could be useful screening tools for red cell abnormalities. Further studies are required for assessing the impact of transfusing such abnormalities to neonates and other critical recipients., Competing Interests: Conflict of Interest All authors declare there is no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The complex metabolic profile of tamoxifen anticancer drug and polymorphism in its metabolizing enzymes particularly CYP2D6 contribute to the high-observed inter-individual variability in its main active metabolite endoxifen. Therapeutic drug monitoring of endoxifen may play a key role in optimizing tamoxifen therapy, and control of both adverse effects and cancer recurrence. This pilot study aims to assess the clinical benefits of applying endoxifen measurement during tamoxifen therapy in patients with breast cancer., Methods: Adult premenopausal breast cancer patients ≥ 18 years who received tamoxifen at a fixed dose of 20 mg daily were included. The primary endpoint was to identify the inter-subject variability in serum concentration of the drug and its metabolites especially endoxifen, through fixation of the tamoxifen dose. The secondary endpoint was to check the correlation between endoxifen metabolite concentration and the development of tamoxifen's adverse effects and cancer recurrence., Results: Sixty patients were included in the study with a mean age of 38.4  ±  0.6 years (range: 26-50). The mean concentration of tamoxifen and endoxifen was 181  ±  9.6 ng/mL and 31.49 ng/mL, respectively. The inter-individual variability in concentrations for the drug and its active metabolite as estimated by the coefficient of variation percentage was in 41% and 31%, respectively. Cancer recurrence was observed in a group of patients ( n   =  16) with an average endoxifen level of 24.48 ng/mL. Another group of patients ( n   =  25) developed different tamoxifen adverse effects including hot flashes, vaginal bleeding, endometrial thickness, and ovarian cysts with the average endoxifen level of 38.61 ng/mL. The rest of the patients ( n   =  19) who responded smoothly to the drug with no complications had an average endoxifen level of 31.37 ng/mL. Analysis of variance test showed a significant difference in endoxifen levels between the three groups ( p   =  0.002)., Conclusion: The measurement of the endoxifen active metabolite of tamoxifen in breast cancer patients can help dose optimization in light of the observed wide inter-individual variability in drug fixed-dose related concentration of the metabolite. Monitoring of serum concentration of endoxifen can help to reveal, reduce and control tamoxifen's adverse effects and cancer recurrence., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: The study explores the emergence of COVID-19 pandemic fatigue among well-educated Egyptians measured in terms of their level of adherence toward COVID-19 protective measures along 20 months since the beginning of the pandemic., Setting and Design: A cross-sectional study was conducted in October 2021, using an online questionnaire for well-educated Egyptians in different governorates., Results: A total of 888 participants completed the questionnaire, their mean age was 39 ± 7.2 years and 60% of them were females. There was a strong association between the presence of either behavioral risk factors or chronic conditions and % of infection. The main sources of COVID-19 information were social media, followed by the Egyptian Ministry of health and population and WHO websites. A pandemic fatigue was observed after nearly 7 to 10 months from the pandemic emergence. The participant's age, previous COVID-19 infection, and occupation status were significant predictors for adherence to COVID-19 protective measures. The participants claimed that difficulty in remaining at home, feeling uncomfortable with face masks, the high cost of protective supplies, absence of governmental enforcement, and forgetfulness are the most perceptive barriers hindering their adherence to COVID-19 protective measures. They suggested some strategies for better adherence and reduced pandemic fatigue that includes: the implementation of governmental enforcement measures, including penalties for nonwearing masks, educational health programs, and availability of free protective supplies at the workplace., Conclusions: Pandemic fatigue was observed after 7 to 10 months from the pandemic emergence even though the high education level of the participants., Competing Interests: None

Background: It is crucial to study the public's perceptions and behaviour during a pandemic as this will be the driving force for practicing recommended precautions. The current study aimed to identify perceptions of a group of Egyptian adults to COVID-19 using the Health Belief Model (HBM), to measure self-reported practice of preventive behaviours and to identify influencing factors., Methods: Cross sectional study was used, including Egyptian adults aged 18 + years. A structured anonymous online questionnaire was used including: a demographic section, the modified MERS- CoV Health Belief Model scale after addition of questions related to COVID-19 and questions on preventive behaviours to COVID-19., Results: Of the 532 study participants, 28.6% were males, age ranges (18 to 74 years). There was a statistically significant positive correlation between total practice score and all COVID-19 Health Belief Model constructs total scores except for perceived barriers score showing negative correlation (P value < 0.05). Linear regression analysis showed that older age, male gender and living inside Cairo were associated with lower practice score (P value < 0.01)., Conclusions: Increased perceived susceptibility, perceived benefits, cues to action and perceived self-efficacy scores were associated with higher practice score in the current study. Additionally, results revealed that social media and websites can play an important role in shaping risk perception in the community. Stressing risk perception and efficacy beliefs prevention message can drive people to practice preventive behaviors., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Rationale: GeneXpert MTB/RIF (Mycobacterium tuberculosis/rifampicin) assay is a method for detecting rifampicin resistance (RR-MTB) in suspected samples in less than 2 hours with high sensitivity and specificity yield. This study aimed to use the GeneXpert MTB/RIF assay to determine the frequency of RR-MTB and to study the possible influencing correlates associated with positive results., Subjects and Methods: This is a retrospective cross-sectional study of patients who visited TB clinic in 5 years (2016-2021). According to the data sheet of the patients, all the collected specimens were divided into 2 parts one for diagnosis by Ziehl-Neelsen stain and the other part for GeneXpert analysis. GeneXpert was also used to look for evidence of RR., Results: Out of the 2605 total samples screened, 718 (27.6%) tested positive for MTB on GeneXpert assay; of them 633 (88.4%) were sensitive to Rifampicin, 83 (11.6%) were resistant to Rifampicin and 2 cases were undetermined. Factors contributing to RR-MTB were: smoker/ex-smoker, with 2.5 times more risk (p = 0.013.0, p = 0.001); recurrence cases had a 4-fold increased risk (p < 0.001); patients with very low M. tuberculosis detected on the GeneXpert MTB/RIF test were 8 times more likely to have RR-TB (P = 0.004)., Conclusion: This study disclosed a high-rate MTB in Egyptian probable TB cases. Smoking, recurrence and cases with a very low M. tuberculosis burden noticed on the GeneXpert MTB/RIF test had augmented risk of RR-TB., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2022 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Introduction: Multiple myeloma (MM) is a B-cell lymphoproliferative disease in which the bone marrow microenvironment plays an important role in pathogenesis. The T helper (Th-17) cell plays an important role in the development of cancer by releasing pro-inflammatory cytokines such as IL-17A and IL-17F. Th-17 cells have been studied in a variety of solid tumors, as well as few hematological malignancies, including acute myeloid leukemia, non-Hodgkin lymphoma, and monoclonal gammopathy of unknown significance., Aim: Our study aimed to assess the association between IL-17A polymorphism and MM risk and other MM characteristics in Egyptian patients., Patients & Methods: a prospective study involving 77 patients with MM (mean age 54.6 years; males 53.2%; females 46.8%) and a healthy control group of same age and gender. It was performed at the Mansoura University Oncology Center (OCMU). The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) approach was used to detect IL17A 197 G/A (rs2275913) genotypes in genomic DNA from MM patients and healthy controls., Results: The IL-17A polymorphism may not be associated to myeloma predilection in the Egyptians as a whole. There was also no significant correlation in statistical study between gender and the IL-17A polymorphism. (p 0.14), a number of clinical and laboratory characteristics, including hypercalcemia (p 0.28), hypoalbuminemia (p 0.49), renal impairment (p 0.13), high LDH (p 0.62), osteolytic bone lesions (p 0.26), and pathological fracture (p 0.96), are also present. Nevertheless, no statistically significant difference in the OS of MM patients was detected for the IL-17A polymorphism (p 0.83)., Conclusion: Our research demonstrated that IL-17A polymorphism may not be linked to multiple myeloma susceptibility in our population and did not influence its different clinical and laboratory features. IL-17A polymorphism had no effect on OS in MM patients.

Background: Knowing what to eat and realizing the significance of healthful eating habits are among the important steps to promoting eating behavior. The current study aims to assess the nutrition knowledge (NK) among a convenient sample in four different countries, determine the association between different demographic factors and NK, and investigate the need for future interventions on nutrition in the four selected countries., Methods: A cross-sectional multi-national survey study among a convenient sample of 8,191 subjects from Egypt, Syria, Saudi Arabia, and Jordan who undertook surveys between January 2019 and January 2020. A pre-tested interview questionnaire was utilized for data collection from study participants. It included three sections: i) Sociodemographic characteristics:. ii). Section two included twenty-one questions related to NK.. iii). Section three included one question about NK sources., Results: About three-quarters showed inadequate nutrition knowledge (73.1%). Youth (15-24 yrs.) were more dependent on social media, with 87% using it as a primary source of NK, while adults (≥ 25 yrs.) demonstrated that 43% of them used social media. In contrast, TV was more prominent among them, with participants' characteristics such as living with parents, body mass index, and country of residence showing no association with NK. However, female sex, education, and reading nutrition articles are significantly correlated with adequate knowledge (p < 0.001). Significant predictors of satisfactory knowledge were age, sex, education, living with parents, and reading nutrition articles., Conclusion: The study revealed low levels of NK indicating an urgent need to implement educational programs to promote nutrition knowledge. As NK is a modifiable determinant of diet intake and can positively impact the need for developing strategies in counselling and raising awareness among the general population to improve their health status., (© 2023. The Author(s).)

Background: Lead (Pb) and cadmium (Cd) heavy metals are considered potentially hazardous toxins which cause serious health problems. Many studies reported that the water of Qaroun Lake in Fayoum, Egypt with its fish farms was contaminated with Pb and Cd above permissible levels. However, there is a lack of studies addressing levels of these toxic metals among inhabitants., Objectives: We aimed to evaluate blood levels of Pb and Cd and their potential health risk among inhabitants around Qaroun Lake., Materials and Methods: This case-control study estimated Pb and Cd blood levels among 190 individuals from two destinations (near and far away) of Qaroun Lack using an atomic absorption spectrometer after full history taking and routine checkup investigations; Full blood count, serum ferritin, liver enzyme (ALT), and creatinine levels., Results: There was a significant difference between blood levels of Pb and Cd heavy metals of inhabitants from near and far away Qaroun Lake destinations (p-value < 0.001). The majority of inhabitants around Qaroun Lake had Pb and Cd blood levels above permissible levels (100% and 60% respectively). Critical levels out of them were 12.1% and 30.3% respectively. In comparison to inhabitants faraway Qaroun Lake, three individuals (2.4%) had Cd above the permissible level, while all of them (100%) had Pb level within the permissible level. There were no statistically significant differences between the two sampled populations as regards hemoglobin level, ALT, creatinine, and ferritin serum levels (p-value > 0.05). The difference between studied populations regarding types of anemia was not statistically significant. Subclinical leucopenia was higher in the population near Qaroun Lake when compare to inhabitants far from the lake (13.6% vs. 4.8%, p-value 0.032)., Conclusion: Bio-monitoring of populations exposed to Pb and Cd hazardous substances could help in generating an early warning system to reduce the disease burden associated with their toxicity., (© 2023. The Author(s).)

Introduction: controlling the worldwide pandemic, coronavirus disease (COVID-19), could be impossible due to the hesitancy about the available vaccines and the difficulty to implement strict restrictions. Little information is available about herd immunity in the highly vulnerable region of North East Africa, Egypt. The objective of this study was to assess the seroprevalence of SARS-CoV-2 during the pandemic in one of the highly vulnerable populations in Egypt, the Fayoum district of Fayoum Governorate. Additionally, to assess the predictive value of symptoms and other associated risk factors towards a positive COVID-19 test., Methods: in this cross-sectional community-based pilot study, immunoglobulin G (IgG) antibodies that are specific for the SARS-CoV-2 spike (S1-RBD) protein were tested during the period from February 2021 to July 2021., Results: out of 155 participants, 60.6% were SARS-CoV-2 seropositive. Out of symptomatic and asymptomatic individuals, 76.5% and 56.2% were seropositive, respectively. Surprisingly, only one individual had received the COVID-19 vaccine. Previous history of COVID-19; such as symptoms and gender are statistically significant predictors of high seroconversion independent of age, comorbidities, and level of education., Conclusion: this study which disclosed unexpectedly high SARS-CoV-2 seroconversion among the Egyptians, might provide a clear insight into COVID-19 transmission patterns and state of immunity. Further study with a larger sample size on a large scale is required to represent the whole local population., Competing Interests: All authors declare no competing interests., (Copyright: Salwa Bakr et al.)

Objectives: To assessthe impact of a health educational programme on knowledge and health beliefs of female office workers regarding cervical cancer screening., Method: The quasi-experimental study was conducted at Kafrelsheikh University, Egypt, from March to September 2021, and comprised all female employees at the university regardless of department or professional status. After baseline assessment using a self-designed questionnaire, an educational session was conducted through small focussed groups having 1-5 participants in their own office environments. Post-intervention change in knowledge and beliefs was assessed using the same questionnaire 1 month after the intervention. Data was analysed using SPSS 22., Results: Of the total 492 female employees, 360(73.2%) completed the study. Of them, 256(71.1%) were aged 30-40 years, 283(78.6%) were ever-married, 206(57.2%) were from urban communities, 322(89.4%) had university educational, 280(77.8%) had sufficient income, and 214(59.4%) had high socioeconomic status. The mean totalscores for knowledge and health beliefs increased significantly post-intervention (p<0.0001)., Conclusions: The use of health belief model to change knowledge of and perceptions towards cervical cancer and its screening was found to be effective.

Objectives: The current study aimed to detect the BOS prevalence and determinants among residents working during the second wave of the COVID-19 pandemic in an Egyptian tertiary university referral hospital., Methods: A cross-sectional study evaluating the working period from June to November 2020 during the COVID-19 pandemic second wave, through a five sections questionnaire evaluating: 1 - sociodemographic characteristics, 2 - job characteristics, 3 - negative thoughts related to their job, 4 - resident's health problems, and 5 - evaluating BOS through Maslach Burnout Inventory (MBI) scale (including emotional exhaustion [EE], depersonalization [DP], and personal accomplishment [PA] as subscales)., Results: We included 230 residents with a median age of 27 years. The median MBI sub-scales (IQ Range) values were 30.0 (20, 39), 21.0 (15, 30), and 29.5 (22, 36) for EE, DP, and PA, respectively. About 51.0% and 83.0% of the residents were high in EE and DP, while 8.7% were low in PA. The median EE and DP were higher in younger age (⩽27 years; p  = .002 and .024), males ( p  = .001 and <.001), working >90 hours weekly ( p  = .016 and <.001), exposure to harassment ( p  < .001), and having COVID-19 infection ( p  = .002 and .001). Residents working in surgical departments reported higher DP scores than those in non-surgical departments ( p  = .03). There was a mild positive correlation between working hours per week and the total scores in EE and DP, r  = .24 ( p  < .001) and r  = .23 ( p  = .001) respectively, while it was found to have a negative correlation with the PA ( r  = -.133 and p  = .044)., Conclusions: The BOS is evident and considerably high among the residents working during the COVID-19 pandemic. Younger age, males, working in surgical departments, and those who got COVID-19 infection were most vulnerable.

The perspectives of healthcare professionals on antibiotic stewardship programs (ASPs) should be explored. Any antibiotic stewardship strategy must be individualized based on patient needs, prescription habits, and local resources. The current study aimed to explore the perspectives of healthcare providers on antibiotics stewardship and their awareness of these perspectives. Furthermore, potential barriers to the application of ASPs should be identified and addressed. This exploratory cross-sectional study utilized a qualitative method to evaluate critical care physicians, pediatricians, and clinical pharmacists ( n = 43). The mean age of the physicians was 32 ± 1.5 years. Among them, approximately two-thirds (66%) were women. A thematic content analysis was performed to examine the responses of the participants and to prioritize the recommendations for and barriers to the implementation of ASPs from the perspective of healthcare providers. According to the interviewees, the primary obstacles include lack of time in implementation and monitoring and lack of awareness of the need for ASPs. All respondents recommended the implementation of supervised and continuous trainings. In conclusion, the abovementioned barriers must be adequately addressed to facilitate the implementation of ASPs.

Egypt is the country with the highest known hepatitis C virus (HCV) prevalence worldwide. The origin of gender differences in HCV prevalence is not usually well understood. This systematic review and meta-analysis aimed to review and evaluate the gender differences in HCV infection rates amongst Egyptians. Such data would be important to support prevention and control programs aiming to minimize HCV-related morbidity and mortality. PubMed, Scopus, and Web of Science (WOS) were searched for relevant articles published from 1st January 2011 to 13th December 2021, using the search terms (HCV OR "hepatitis C" OR hepacivirus) AND (prevalence OR seroprevalence OR epidemiology OR incidence OR magnitude). At first, retrieved articles were screened, and then relevant data were extracted and analyzed. Descriptive statistics were used for data analysis. Out of 616 studies from databases, only 30 were included after the full-text screening, with 193,621 included participants: 97,597 male and 96,024 female. The overall seroprevalence of HCV antibodies in all included studies was 0.02 (CI - 0.23 to 0.28), with no significant difference between males and females. However, HCV RNA positivity was significantly more prevalent in males than females in adults and the general population (after excluding high-risk groups). In children, no statistically significant differences between males and females were found in the seroprevalence of HCV antibodies nor in the prevalence of PCR positivity. HCV RNA positivity is significantly higher in males than females in adults, while there are no gender differences in children., (© 2023. The Author(s).)

Background: Poisoning is a major health problem especially in developing countries and leads to high morbidity and mortality., Aim: To identify the profile of acute poisoning in the Toxicology Unit at Tanta University Hospital, Egypt (2017-2021)., Methods: A cross-sectional study using data extracted from medical records from beginning of January 2017 to end of December 2021. Data including demographic data, Glasgow coma scale, type of poisons, manner of poisoning, time of admission and discharge and state at discharge., Results: This study included 9713 cases. Rodenticides represented the most frequent cause of poisoning among both males (30%) and females (27%). Pharmaceutical drugs, CNS abused pharmaceutical drugs, and chemicals represent the most common categories (24%, 22%, and 21%, respectively) among children (up to 12 years). Rodenticides and pharmaceutical drugs represent the highest categories among other age groups. Evening admissions represented 52% of cases. Glasgow coma scale was 15 among 86.3% of cases. Intentional poisoning was more common than accidental poisoning (58.6% and 34.7%, respectively). One half (52.2%) of the admitted cases were discharged within 24 hours of admission and 44.4% of them were discharged after 48-72 hours. Family request was the main reason of discharge of cases (70.3%), 15.7% were improved, 4% died. Mortality by rodenticide was 12.5%., Conclusion: Rodenticides, pharmaceutical and CNS abused pharmaceutical drugs were the most common categories of poisoning. Intentional poisoning was more common than accidental poisoning. Rodenticides were responsible for most deaths., (© 2023. The Author(s).)

Introduction: Identifying the public awareness and risk perception regarding climate change, are fundamental preliminary steps in determining gaps and paving the way for awareness campaigns that address climate change causes and counteraction mitigation measures. However, few studies were conducted in Egypt; thus, the researchers conducted the current cross-sectional study among a sample of the Egyptian population to identify general knowledge and perception about climate change and its effects, as well as attitudes toward mitigation measures., Methods: An exploratory population-based electronic-open survey, was conducted among 527 members of the general population between January and April 2022, using a convenience sampling technique. A pre-tested 2-page (screen) electronic included three sections: sociodemographic characteristics, global warming/climate change-related knowledge, and attitude toward climate change mitigation., Results: The average global warming knowledge score was 12 ± 3. More than 70% (71.1%) of the participants were knowledgeable (percentage score >70%). Approximately half of the enrolled participants (48.2%) agreed that everyone is vulnerable to the effects of global warming/climate change. More than three-quarters (78.3%) of the participants agreed that carbon emissions from vehicles and industrial methane emissions were the first factors that contributed to climate change, followed by the ozone holes (731%). Global warming/climate change-related knowledge was statistically higher in participants aged of >30 years, married participants, urban residents, highly educated individuals, and employed individuals ( p -value ≤ 0.05). Approximately 80% of the participants agreed that responding to the questionnaire drew their attention to the topic of climate change and its effects. More than two-thirds of those polled agreed that increasing public transportation use could help mitigate the effects of climate change/global warming, followed by the materials used and the direction of construction., Conclusion: More than two-thirds of the participants were knowledgeable regarding climate change. Social media and the internet were the main sources of information. However, participants need to get the information in a different way that could help in changing their attitude positively toward the issue of climate change mitigation. The current study recommends the need for various initiatives that work should be launched., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Salem, Hegazy, Thabet Mohammed, Mahrous Hassan, Saad Abdou and Zein.)

Background: Coronavirus disease 2019 (COVID-19) infection is considered a serious highly infectious disease caused by severe acute respiratory syndrome coronavirus 2, resulting in more than 6.27 million deaths worldwide., Aim of the Study: The study aimed to compare clinical characteristics and laboratory findings of COVID-19 patients with complications and without complications and discriminate the important risk factors for the complications and deaths., Subjects and Methods: This cross-sectional study included 75 confirmed COVID-19 positive patients; out of which 49 were severely-ill cases. Analysis of all patients' clinical and laboratory information on admission including serum ferritin, thrombotic activity (d-dimer), lactate dehydrogenase (LDH), C-reactive protein (CRP), creatinine, aspartate aminotransferase, and alanine aminotransferase were done., Results: Lymphopenia, tachycardia, tachypnea, elevated CRP, d-dimer, serum ferritin, LDH, and decreased SpO 2 were significantly associated with complicated cases (p < .05 for all). By using multivariate logistic regression analysis models, elevated serum ferritin and tachycardia were significantly correlated with the increased odds of complicated COVID-19 cases (odds ratio [confidence interval 95%] = 10.42 [2.32-46.89] and 8.01 [1.17-55.99]; respectively) (p = .002 and .007, respectively)., Conclusion: Lymphocytopenia, d-dimer, LDH, and CRP levels, which were significantly linked to the severity of COVID-19, were the prognostic biomarkers to predict the disease severity., (© 2022 The Authors. Immunity, Inflammation and Disease published by John Wiley & Sons Ltd.)

Until 2018, Egypt had the highest prevalence of hepatitis C virus (HCV) infection globally, affecting approximately 7% of the population. Despite efforts in diagnosis and treatment since 2006, nearly 2 million individuals with chronic HCV infection had yet to be diagnosed as of early 2018. In December, 2018, a mass HCV screening campaign for adolescents aged 15-18 years was initiated. Among 3 024 325 adolescents screened, the HCV antibody seroprevalence was 11 477 (0·38%), of whom 8187 (78·7%) were HCV RNA-positive. Sustained virological response 12 weeks after completion of treatment (SVR12) was attained by 7327 (99·6%) adolescents with a fixed-dose combination of generic ledipasvir 90 mg plus sofosbuvir 400 mg. Although mass screening in this age group might not be regularly adopted by many health systems and its cost-effectiveness might be lower than the screening of adults and high-risk groups (eg, patients on haemodialysis, people who inject drugs), breaking the chain of transmission in younger populations should lead to a reduction in HCV incidence and complications, and hasten the elimination of the disease., Competing Interests: Declaration of interests MHE-S reports a grant from Gilead Sciences, outside of the submitted work. All other authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Suicide attempts by self-poisoning have become a critical health problem. This study aimed to investigate the trend, incidence, and the associated risk factors of suicide attempts by self-poisoning. A total of 7398 Egyptian patients were analyzed. The trend of suicide attempts by self-poisoning was analyzed using 6745 patients over four registry years from January 1, 2016, to January 1, 2020. Then, the associated risk factors behind attempted suicide by self-poisoning from January 1, 2019, to January 1, 2020, were assessed using 2523 suicide attempters by self-poisoning, 201 fatalities by self-poisoning, and another 653 survivors of accidental poisoning. Results showed a rising trend of suicide attempts by self-poisoning over the studied years. The incidence of suicide attempts through deliberate self-poisoning represented 26.63/1,000 (CI95%: 25.63-27.86) to the admitted patients and 26.10/100,000 (CI95%: 25.10-27.14) to the regional population. The death rate due to suicide attempts by self-poisoning was 2.08/100,000 (1.90-2.49). The case fatality rate and the proportionate mortality rate for suicide by self-poisoning were 7.38% (CI95%: 6.45-8.42) and 14.11% (CI95%: 12.4-16.0) respectively. Multivariate analysis revealed that attempted suicide by self-poisoning was predicted among patients aged <25 or 25-40 years old (OR = 27.49, CI95%: 15.28-49.64 and OR = 59.42, CI95%: 32.76-107.77 respectively), those of low or moderate socioeconomic status (OR = 35.03, CI95%: 21.32-57.56 and OR = 14.11, CI95%: 10.86-18.43 respectively), students (OR = 2.91, CI95%: 1.57-5.43) and those living in rural residency (OR = 4.12, CI95%: 3.27-5.19). Suicide attempts by self-poisoning exhibited an incremental rise across time which raises a serious concern. Efforts should be directed to overcome the mentioned risk factors triggering suicide attempts by self-poisoning., Competing Interests: The authors have declared that no competing interests exist.

Objectives: This study aimed to investigate the technostress creators and outcomes among University medical and nursing faculties and students as direct effects of the remote working environment during the COVID-19 pandemic., Background: Due to the current COVID-19 pandemic, shifting to virtual learning that implies utilizing the information and communication technologies (ICTs) is urgent. Technostress is a problem commonly arising in the virtual working environments and it occurs due to misfitting and maladaptation between the individual and the changeable requirements of ICTs., Methods: A multicenter cross-sectional study was conducted in medicine and nursing colleges of 5 Egyptian universities and included both staff members and students. The data were collected through personal interviews, from January to May 2021. All the participants took a four-part questionnaire that asked about personal and demographic data, technostress creators, job or study, and technical characteristics and technostress outcomes (burnout, strain, and work engagement). Furthermore, participants' blood cortisol and co-enzyme Q10 (CoQ10) levels were tested in a random sample of the students and medical staff., Results: A total of 3,582 respondents participated in the study, 1,056 staff members and 2,526 students where 33.3% of the staff members and 7.6% of students reported high technostress. Among staff members, total technostress score significantly predicted Cortisol level (β = 2.98, CI 95%: 0.13-5.83), CoQ10(β = -6.54, CI 95%: [(-8.52)-(-4.56), strain (β = 1.20, CI 95%: 0.93-1.47), burnout (β = 0.73, CI 95%: 0.48-0.97) and engagement (β = -0.44, CI 95%: [(-0.77)-(-0.11)]) whereas among students, total technostress score significantly predicted cortisol level (β = 6.64, CI 95%: 2.78-10.49), strain (β = 1.25, CI 95%: 0.72-1.77), and burnout (β = 0.70, CI 95%: 0.37-1.04). Among staff members and students, technology characteristics were significantly positive predictors to technostress while job characteristics were significantly negative predictors to technostress., Conclusion: The Egyptian medical staff members and students reported moderate-to-high technostress which was associated with high burnout, strain, and cortisol level; moreover, high technostress was associated with low-work engagement and low CoQ10 enzyme. This study highlighted the need to establish psychological support programs for staff members and students during the COVID-19 pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kasemy, Sharif, Barakat, Abdelmohsen, Hassan, Hegazy, Sharfeldin, El-Ma'doul, Alsawy, Abo Shereda and Abdelwanees.)

Background: This study investigates different barriers preventing a cohort of Egyptian HIV/HCV coinfected patients from accessing HCV treatment, despite being available and free of charge, aiming to improve the long-term outcomes of coinfected patients and decreasing their liver-related morbidity and mortality., Methods: This study included HIV patients who were referred to Kasr Alainy Viral Hepatitis Center to receive HCV treatment and who had to continue pretreatment assessment in order to receive direct acting antiviral agents free of charge. Patients who did not attend within 90 d were questioned via a telephone interview. Questions addressed sociodemographic status, HIV status and the main barriers to accessing healthcare., Results: Overall, 474 HIV/HCV coinfected patients were eligible for HCV treatment and 223 (47.1%) patients did not complete work-up for HCV treatment. Fear of community stigma concerning HIV/HCV was the most important barrier to compliance with treatment (73.3%), followed by lack of a supportive work environment and employment opportunities (51.5%), whereas 39.3% stopped follow-up due to the lack of integrated services in the healthcare facility., Conclusions: Managing HCV in HCV/HIV coinfected patients still represents a major challenge, not only for healthcare providers, but also at a community level, to improve community awareness and manage the major obstacle facing those patients regarding community stigma., (© The Author(s) 2021. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: Although cervical cancer is potentially preventable, lack of knowledge and poor attitude among healthcare professionals toward cervical cancer screening and Human Papilloma Virus (HPV) vaccination can result in underutilization of these preventive strategies. Then, the objective of this study was to assess the knowledge, attitude, and practice of cervical cancer and its prevention through Pap test screening and HPV vaccination among obstetricians and gynecologists (Ob-Gyns)., Methods: A cross-sectional study was conducted on 250 Egyptian attendees of a national Ob-Gyns professional conference. Data collection was performed using a pre-designed self-administered questionnaire, which tested participants' knowledge, attitude, and practices related to cervical cancer, Pap test screening, and HPV vaccination., Results: The study included 41.2% Ob-Gyns specialists and 37.6% of consultants from secondary and tertiary care hospitals or centers. About 45% of participants had poor-to-fair knowledge, 57% had negative-to-fair positive attitudes toward cervical cancer screening and HPV vaccination, and 44% had ever-performed Pap test, while 45% of participants had ever-prescribed the HPV vaccine to their patients. Physicians' knowledge and attitude were significantly associated with their age, professional level, work experience, and place of work. Although performing cervical cancer screening was significantly more common among older, more experienced, and highly professional participants, HPV vaccine prescription was associated with young, less experienced participants at lower educational and professional levels., Conclusion: Ob-Gyns had poor-to-fair knowledge, Attitude, and practices related to cervical cancer, Pap test screening, and HPV vaccination., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Safe and effective vaccines became an important preventive tool against novel corona virus disease infection. Physicians were prioritized for early vaccination since they are at higher risk for contagion of the infection and they might affect the general populations' uptake of the vaccine. This study aimed to examine the acceptability of COVID-19 vaccines and the underpinnings of reluctance to uptake the vaccine among working physicians in Egypt. A cross-sectional study was conducted for 3 months, recruiting 1268 physicians using a snowballing random sampling technique. A self-administered electronic questionnaire was deployed to collect related data. Of participants, 24% expressed their acceptance towards COVID-19 vaccines, 39% would wait for further review, while 36.7% did not agree to get vaccinated. Findings revealed that 22% of them were vaccinated and the significant determinants of unacceptability included age, gender, higher educational attainments, prior infection, lack of direct patients' contact, and working in rural health facilities (p < 0.05). The most common reasons beyond their reluctance were fear of the vaccines' adverse effects and the short duration of its clinical trials (60% and 49.5%). Physicians had a low intention to receive COVID-19 vaccines particularly between females, senior staff, and those who had a low self-perceived risk for the infection. Integrated approaches should be designed to address concerns and factors associated with vaccine unacceptability to reduce vaccination reluctance between physicians, hence the general population., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Health care-associated infections are reported among the top causes of hospital deaths worldwide. Their prevention is a first priority for patient safety in acute care hospitals. Education and training is recommended as a core component for effective infection prevention and control programs. This study aimed to assess the effect of an infection control training course on the knowledge and practices of medical interns in a large academic hospital in Egypt. The study included 268 medical interns who were getting their practical training at Tanta University Hospitals, Egypt during the study period. Knowledge and practices regarding infection control measures were assessed using a predesigned questionnaire sheet and an observational checklist before and after intervention by infection control training course based on Egyptian national guide for infection control. The data have been analyzed through the application of descriptive frequency, percentages, mean of scores, and the inferential analysis that includes paired t test and Monte Carlo test. The level of statistical significance was adopted at p≤0.05. There was a statistically significant (p < 0.0001) increase in total knowledge score (65.4±13.9 versus 80.2 ±13.2) and total practices score (65±11.3 versus 108±7.9) of infection control measures among studied participants before intervention compared with after intervention. A significant strong positive correlation was detected (r= 0.8, p= 0.0001) between total knowledge and practice scores after intervention by training course. There is a strong positive correlation between knowledge and practices so intervention by infection control training course using teaching multimedia and role play significantly improves the knowledge and practice levels of the studied medical interns., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Drug abuse is a global challenge with harmful effects on health, wealth and wellbeing of nations. University students report more habitual use of marijuana, cocaine, hallucinogens and illicit drugs than noncollege students report., Aims: To identify the prevalence of tobacco use, alcohol and drug abuse and to identify some factors associated with drug abuse., Methods: A cross-sectional study recruiting 2552 students from all faculties hosted by Kafr El-Sheikh University during the academic year 2018-2019. Data were collected using a structured self-administered questionnaire., Results: The prevalence of current drug abuse was 8.9% for cigarette smoking, followed by tranquilizers (4.3%), hashish (3.6%), alcohol (2.7%), bhang (1.4%) and tramadol (1.0%). Men reported significantly greater use of cigarettes, alcohol, tramadol, hashish and bhang than women. Students of practical colleges were found to smoke cigarettes and abuse hashish significantly more than their peers in other colleges. Risk factors associated with drug abuse were mainly related to gender and college type., Conclusion: There is a need to design and implement programmes to raise awareness and provide supportive services for prevention and management of drug abuse among university students tailored according to their needs., (Copyright © World Health Organization (WHO) 2022. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Introduction: Regular collection and monitoring of data describing the dynamics of the utilization of healthcare services, especially in teaching hospitals (TH), which provide model quality medical services, are critical for COVID-19 pandemic preparedness., Methods: The researchers analyzed data and information derived from service statistics reports from June 1st to July 15th, 2020 in terms of hospital resources, as well as utilization patterns of beds, ICU, and ventilators, for 11 screening hospitals affiliated with the General Organization of Teaching Hospitals and institutes in Egypt assigned by the Ministry of Health and Population to provide medical care for COVID-19 patients. Hospital indicators in terms of COVID-19 screening services, as well as utilization patterns of inpatient beds, ICU beds, and ventilators were computed., Results: A total of 78,869 non-medical personnel and 2,176 medical personnel were presented with COVID-19 triage symptoms. Investigations conducted in the targeted 11 hospitals delineated that 22.2% of non-medical personnel and 27.9% of medical personnel were COVID-19 PCR-confirmed cases. The inpatient bed occupancy rate was 70% for non-medical patients and 67% for medical staff patients. For ICU, the bed occupancy rate was 92 % for non-medical patients and 88% for medical patients. Among the confirmed cases, 38% of medical patients utilized a ventilator vs. 36% of medical personnel cases. Hospital ranking according to utilization pattern among non-medical personnel, Hospital H ranked first in terms of the high load of screening services. Hospital C ranked first regarding the number of confirmed cases, whereas Hospital D ranked first for high ICU utilization among all teaching hospital ICU cases. With respect to medical personnel, Hospital G ranked first for the high load of screening services for the total studied cases. Hospital G ranked first for the number of confirmed cases. Hospital B ranked first regarding high ICU utilization among all teaching hospital ICU cases., Conclusion: Teaching hospitals have demonstrated preparedness for the COVID-19 pandemic by maintaining an inpatient bed occupancy rate of 70% or less and ventilator utilization at <40% of confirmed cases. However, the ICU bed occupancy rate was more than 90% indicating a shortage of resources. In addition, there is variance across hospitals regarding caseload for resource reallocation decisions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Abd El Ghaffar, Salem, Al Soda, Abd El Razik, Tahoon, Tahoon, Eysa, Hegazy, Eleraky, Eltayar, Eldarandly and Omran.)

Global surveys have highlighted rise in consumption of cannabinoids among residents of both developed and developing countries. Cannabinoids cause severe damage to the cardiovascular, nervous, respiratory, and renal systems, and have been linked with several deaths. Despite these adverse health effects, the use of cannabinoids has rapidly increased. This work seeks to estimate the prevalence of cannabinoid abuse among Egyptian university students and explore the associated risk factors. A cross-sectional study was carried out over 3 months (1st of July-1st of October 2020) and included 2380 students. Participants were subjected to a pre-designed self-administered questionnaire that included demographic data, Addiction Severity Index, and Depression Anxiety Stress Scale. Among the participating students, 4.9% of them reported cannabinoid abuse and 41% reported smoking cigarettes. The most used substances were hashish (96.5%), Strox (41.3%), Bhang (34.4%), voodoo (34.4%), and Tramadol (31.1%). Gender and social status were also significantly related to rates of substances abuse; most illicit drug users were males (93.1%), and the majority was of low (41.3%) or moderate (50.8%) socioeconomic status. The most significant risk factors associated with substance use were positive history of family conflict (OR=6.48; CI95%: 5.08-8.64, p<0.001), encouragement by peers (OR=2.95; CI95%: 1.73-5.05, p<0.001), male gender (OR=5.46; CI95%: 2.40-12.44, p=0.001), positive history of child abuse (OR=2.85; CI95%: 1.96-3.04, p=0.001), having a stay-at-home mother (OR= 1.56, CI95%: 1.19-2.04, p=0.001), living in an urban area (OR=2.22; CI95%: 1.53-5.0, p=0.002), and positive family history of substance use (OR=1.98; CI95%: 1.48-2.08, p=0.045). This study emphasizes the possible significant rise in substance use among university students. Awareness campaigns should target both students and student families., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Egypt has a shortage of physicians despite thousands of medical students graduating annually., Aims: This study aimed to explore the reasons for Egyptian medical students and young physicians wanting to emigrate., Methods: This cross-sectional study, conducted from February to April 2019, included 711 fifth- and sixth-year medical students and 174 residents from two medical faculties in Egypt, Tanta and Kafrelshiekh. A questionnaire was used to collect data on sociodemographic factors, desire to emigrate and motives for wanting to emigrate., Results: Most participant (89.4%) wanted to emigrate, and thought their salary was not compatible with their working hours or risks. About half the participants (52.8%) worked part-time in private hospitals. Only 4.9% of participants felt appreciated by the country. Most participants (75.9%) were not satisfied with their relationship with patients and 40.2% were not satisfied with their relationship with colleagues. Verbal abuse was reported by 55.5% of participants and physical assaults by 35.4%. Most participants who wanted to emigrate (85.1%) said they would change their minds if improvements were made in the health sector. Residents generally had less negative attitudes to workplace and professional factors than students., Conclusion: Physicians emigrate to seek better work and financial incentives. A retention policy needs to be developed to prevent Egyptian physicians from emigrating., (Copyright © World Health Organization (WHO) 2021. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Objective: To study Ramadan's effect on migraine from the start to the end of the month and the tolerability of patients with migraine to fasting., Background: Fasting is a well-known trigger for migraine. Whether this effect on migraine is the same throughout the whole month, or whether it varies from the first to the last days of the month, has not been studied yet., Methods: A prospective cohort observational study was carried out on persons with migraine who fasted from 24 April to 23 May during Ramadan 2020. Each patient was asked to fill out their headache diary starting from Shaaban (the month before Ramadan) to the end of Ramadan. The Ramadan diary was divided by 10 days each, by which the patient was asked to accurately describe their migraine attacks in terms of frequency, duration, and intensity by using the Visual Analog Scale. Migraine attacks during the first day of fasting were assessed separately., Results: A total of 292 known persons with migraine from Egypt completed the study. Their median age was 33 years; 72/292 (24.7%) were male, and 220/292 (75.3%) were female. About 126/236 (53.4%) of the patients had migraine attacks on Ramadan's first day, most of them during fasting. The frequency of migraine attacks was significantly increased in Ramadan (median 4, interquartile range [IQR] 2-7) compared with Shaaban (median 3, IQR 1-6), p = 0.009. The number of attacks was significantly reduced in both the second (median 1, IQR 0-2.25) and the third 10 days of Ramadan (median 1, IQR 1-3) compared with the first 10 days (median 3, IQR 1-5) (p < 0.001 for each)., Conclusion: Ramadan's potential exacerbating effect on the frequency of migraine attacks should be discussed with patients with migraine. This effect appears to be limited to the first 10 days of Ramadan and then subsides with successive days of fasting., (© 2021 American Headache Society.)

Researchers around the world are working at record speed to find the best ways to treat and prevent coronavirus disease 2019 (COVID-19). This study aimed to evaluate the efficacy of ivermectin for the treatment of hospitalized mild to moderate COVID-19 infected patients. This was a randomized open-label controlled study that included 164 patients with COVID-19. Patients were randomized into two groups where Group 1 (Ivermectin group) included patients who received ivermectin 12 mg once daily for 3 days with standard care and Group 2 (control group) included patients who received standard protocol of treatment alone for 14 days. The main outcomes were mortality, the length of hospital stay, and the need for mechanical ventilation. All patients were followed up for 1 month. Overall, 82 individuals were randomized to receive ivermectin plus standard of care and 82 to receive standard of care alone. Patients in the ivermectin group had a shorter length of hospital stay (8.82 ± 4.94 days) than the control group (10.97 ± 5.28 days), but this was not statistically significant (p = 0.085). Three patients (3.7%) in each group required mechanical ventilation (p = 1.00). The death rate was three patients in the ivermectin group (3.7%) versus four patients (4.9%) in the control group without any significant difference between the two groups (p = 1.00). Although there was no statistically significant difference in any endpoints by ivermectin doses (12 mg/day for 3 days); there was an observed trend to reducing hospital stay in the ivermectin-treated group., (© 2021 Wiley Periodicals LLC.)

Background: The COVID-19 pandemic has become a significant public health threat. Therefore, the purpose of this survey was to assess knowledge, attitudes, and precautionary measures related to COVID-19 among college students., Methods: A convenient sample of 3263 volunteers responded to a self-administered electronic questionnaire during the period from October to December 2020. The knowledge, attitude, and practice (KAP) score level was calculated with a range of 0-34 points., Results: The mean age of the participants was 21 (+/-1.2) years, 69% were female, and 60.3% were urban. The majority of respondents received information about COVID-19 symptoms (93.9%), how to protect yourself (92.5%), and how it is transmitted (86.8%). The most cited sources of information were social media (75.7%), and the most credible were government websites and international organizations. More than half (65%) expressed concern regarding contracting COVID-19, and 89.2% believed that COVID-19 is a dangerous infection due to the rapid spread of the virus. The mean total KAP score was 26.1 (+/-4.2), which differed significantly between gender groups and residential areas. Logistic regression analysis showed that volunteers with good knowledge were 1.3 and 1.0 times more willing to volunteer and maintain a physical distance than those with less knowledge. Female students were 40% less likely to volunteer than males, yet they were 1.8 times more cautious about practicing protective measures such as washing their hands with soap and water than male students. Classifying the COVID-19 pandemic as a serious infection, urban communities have twice been careful to wear masks outdoors and maintain a social distance of at least 2 m from one another compared to rural inhabitants., Conclusion: The current survey revealed that medical students have good knowledge regarding COVID-19, a positive attitude towards the use of protective measures, which were necessary to limit the spread of the disease. However, improvement is still required, and community education should occur as usual with a commitment to utilizing all the strategies that can support knowledge to improve and change attitudes as well as practices of the population., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Headache is considered one of the most frequent neurological manifestations of coronavirus disease 2019 (COVID-19). This work aimed to identify the relative frequency of COVID-19-related headache and to clarify the impact of clinical, laboratory findings of COVID-19 infection on headache occurrence and its response to analgesics., Design: Cross-sectional study., Setting: Recovered COVID-19 patients., Subjects: In total, 782 patients with a confirmed diagnosis of COVID-19 infection., Methods: Clinical, laboratory, and imaging data were obtained from the hospital medical records. Regarding patients who developed COVID-19 related headache, a trained neurologist performed an analysis of headache and its response to analgesics., Results: The relative frequency of COVID-19 related headache among our sample was 55.1% with 95% confidence interval (CI) (.516-.586) for the estimated population prevalence. Female gender, malignancy, primary headache, fever, dehydration, lower levels of hemoglobin and platelets and higher levels of neutrophil/lymphocyte ratio (NLR) and CRP were significantly associated with COVID-19 related headache. Multivariate analysis revealed that female gender, fever, dehydration, primary headache, high NLR, and decreased platelet count were independent predictors of headache occurrence. By evaluating headache response to analgesics, old age, diabetes, hypertension, primary headache, severe COVID-19, steroid intake, higher CRP and ferritin and lower hemoglobin levels were associated with poor response to analgesics. Multivariate analysis revealed that primary headache, steroids intake, moderate and severe COVID-19 were independent predictors of non-response to analgesics., Discussion: Headache occurs in 55.1% of patients with COVID-19. Female gender, fever, dehydration, primary headache, high NLR, and decreased platelet count are considered independent predictors of COVID-19 related headache., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Ivermectin is an FDA-approved broad-spectrum anti-parasitic agent that has been shown to inhibit SARS-CoV-2 replication in vitro ., Objective: We aimed to assess the therapeutic efficacy of ivermectin mucoadhesive nanosuspension intranasal spray in treatment of patients with mild COVID-19., Methods: This clinical trial included 114 patients diagnosed as mild COVID-19. Patients were divided randomly into two age and sex-matched groups; group A comprising 57 patients received ivermectin nanosuspension nasal spray twice daily plus the Egyptian protocol of treatment for mild COVID-19 and group B comprising 57 patients received the Egyptian protocol for mild COVID-19 only. Evaluation of the patients was performed depending on improvement of presenting manifestations, negativity of two consecutive pharyngeal swabs for the COVID-19 nucleic acid via rRT-PCR and assessments of hematological and biochemical parameters in the form of complete blood counts, C-reactive protein, serum ferritin and d-dimer which were performed at presentation and 7 days later., Results: Of the included patients confirmed with mild COVID-19, 82 were males (71.9%) and 32 females (28.1%) with mean age 45.1 ± 18.9. In group A, 54 patients (94.7%) achieved 2 consecutive negative PCR nasopharyngeal swabs in comparison to 43 patients (75.4%) in group B with P = 0.004. The durations of fever, cough, dyspnea and anosmia were significantly shorter in group A than group B, without significant difference regarding the duration of gastrointestinal symptoms. Duration taken for nasopharyngeal swab to be negative was significantly shorter in group A than in group B (8.3± 2.8 days versus 12.9 ± 4.3 days; P = 0.0001)., Conclusion: Local use of ivermectin mucoadhesive nanosuspension nasal spray is safe and effective in treatment of patients with mild COVID-19 with rapid viral clearance and shortening the anosmia duration., Clinicaltrialsgov Identifier: NCT04716569; https://clinicaltrials.gov/ct2/show/NCT04716569., Competing Interests: No potential conflicts of interest between authors to be declare., (© 2021 Aref et al.)

Purpose: This study aimed to assess the factors affecting the prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Upper Egypt., Materials and Methods: In this cross-sectional study, the following data were retrieved from the hospital records of 632 injured patients between 1/1/2018 and 31/3/2018: age, sex, residence, means of transportation to the hospital, prehospital time delay, consciousness level on admission, source of injury, and type of worst injury., Results: The prehospital time delay (>one hour) of the injured patients was positively associated with age >60 years and rural residence but inversely associated with consciousness level with odds ratios (95% confidence intervals) of 5.14 (2.26-11.68), 3.49 (2.22-5.48), and 0.56 (0.32-0.96), respectively., Conclusion: The prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Egypt was associated with old age, rural residence, and consciousness level., Competing Interests: The authors have declared that no competing interests exist.

Objectives: The aims of the study were to explore the contraceptive practices of married adolescent girls in rural Upper Egypt and identify the determinants of their ever use of modern contraception., Methods: The study was a household survey of 729 married adolescent girls in 23 villages of two governorates in Upper Egypt. Listing and enumeration of all households in the selected villages were performed prior to data collection, to recruit married adolescent girls below 20 years of age. The girls were interviewed using a structured questionnaire., Results: Only 6% of married adolescent girls were using a modern contraceptive method; 10.6% had ever used a modern contraceptive method, mostly a short-acting method. Considerable proportions of participants believed that using contraception would reduce a woman's fertility and that women should not delay their first pregnancy (34% and 54.3%, respectively); only 50.2% believed that contraception could be used for birth spacing. Predictors of the ever use of a modern method of contraception among married adolescent girls were: accepting that contraception could be used for birth spacing (B = 1.82, p  < .001), older age (B = 0.42, p  < .01), better reproductive health knowledge (B = 0.23, p  < .05) and sharing in contraceptive decision making (B = 0.55, p  < .05)., Conclusion: Married adolescent girls' current use and ever use of modern contraception were very low in rural Upper Egypt. Changing the social norms to create the desire to delay first childbirth, improving adolescent girls' reproductive health knowledge, correcting myths about contraception and building girls' agency to use contraception may increase their contraceptive use.