Screening for diabetes among tuberculosis patients: a nationwide population-based study in Egypt

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

A Nonlinear Goal Programming Model for University Admission Capacity Planning with Modified Differential Evolution Algorithm

This paper proposes a nonlinear Goal Programming Model (GPM) for solving the problem of admission capacity planning in academic universities. Many factors of university admission capacity planning have been taken into consideration among which are number of admitted students in the past years, total population in the country, number of graduates from secondary schools, desired ratios of specific specialties, faculty-to-students ratio, and the past number of graduates. The proposed model is general and has been tested at King Abdulaziz University (KAU) in the Kingdom of Saudi Arabia, where the work aims to achieve the key objectives of a five-year development plan in addition to a 25-year future plan (AAFAQ) for universities education in the Kingdom. Based on the results of this test, the proposed GPM with a modified differential evolution algorithm has approved an ability to solve general admission capacity planning problem in terms of high quality, rapid convergence speed, efficiency, and robustness

A living WHO guideline on drugs for covid-19

CITATION: Agarwal, A. et al. 2022. A living WHO guideline on drugs for covid-19. British Medical Journal, 370. doi:10.1136/bmj.m3379The original publication is available at https://jcp.bmj.com/This living guideline by Arnav Agarwal and colleagues (BMJ 2020;370:m3379, doi:10.1136/bmj.m3379) was last updated on 22 April 2022, but the infographic contained two dosing errors: the dose of ritonavir with renal failure should have read 100 mg, not 50 mg; and the suggested regimen for remdesivir should have been 3 days, not 5-10 days. The infographic has now been corrected.Publishers versio

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease

The recommendations listed in this document are, whenever possible, evidence based. An extensive evidence review was conducted as the document was compiled through December 2008. Repeated literature searches were performed by the guideline development staff and writing committee members as new issues were considered. New clinical trials published in peer-reviewed journals and articles through December 2011 were also reviewed and incorporated when relevant. Furthermore, because of the extended development time period for this guideline, peer review comments indicated that the sections focused on imaging technologies required additional updating, which occurred during 2011. Therefore, the evidence review for the imaging sections includes published literature through December 2011

Prevalence of Rifampicin resistance tuberculosis among presumptive tuberculosis patients in Egypt-2021: a national health facility-based survey

Abstract Background The magnitude of MDR-TB cases was noticeable in Egypt. However, the last national survey was 11-years ago. The current survey was conducted to determine the prevalence of rifampicin resistance among sputum smear-positive pulmonary tuberculosis patients in Egypt. Methods A national health facility-based cross-sectional study was conducted in 14 randomly selected governorates in Egypt between August 2020 and September 2021. All presumptive TB cases, either new or previously treated according to WHO definitions, with no gender, age, or nationality limitations, and provided informed consent were included in the study. Each patient completed a case report form (CRF). The CRF included socio-demographic and clinical data. Sputum samples were collected according to standard techniques and cultured on Lowenstein-Jensen (L-J) medium. Gene X-pert test was carried out first on the samples for simultaneous identification of MTB and rifampicin resistance. The prevalence of RR was calculated using crude, cluster, and weighted methods. Factors associated with RR were analyzed by bivariate and multivariate techniques. Results Among the total 849 presumptive TB patients enrolled in the study, 710 (83.6%) patients were subjected to Gene X-pert testing (MTB/RIF). The crude prevalence of RR was 3.32% (95% CI: 1.89–4.76%) among the new cases and 9.46% (95% CI: 2.63–16.29%) among the retreated cases with an overall estimate of 3.99%; (95% CI: 2.51–5.47%). By cluster analysis the overall prevalence of RR was 5.01% (95% CI: 2.90–7.13). Factors associated with the prevalence of RR were co-morbidity with bronchial asthma, drug abuse and history of contact with a family member with TB. Conclusion The prevalence of RR among either new or retreated cases TB patients was lower than the previous Egyptian rates in 2010–2012. The strongest predictor associated with RR was comorbidity with bronchial asthma

Effect of training and smoking status of physicians on smoking cessation practices in Egypt

Introduction Tobacco smoke contains a deadly mix of chemicals. Training in smoking cessation (SC) increases physician success in helping patients quit smoking. This study aims to assess physicians’ practices and attitudes about SC counselling and to find the effect of training and smoking status of physicians on them. Patients and methods Self-administered questionnaires were distributed among physicians targeting socio-demographic data, physicians’ attitude, and practices regarding SC interventions. Results The study included 1020 physicians distributed over 11 of 27 Egyptian governorates. The mean age of the study participants was 40.02±11.5 years. Current smoking frequency among the study participants was 16%. Only 53.9% of the participants received training on SC. Trained and nonsmoking physicians revealed better SC practices than their counterparts. Conclusions Training has an evident influence on SC practices. On the contrary, smoking has less evident effect on counselling practices. It is therefore important to adopt a national strategy to ensure that all health care providers receive training in SC counselling in at least one phase of their clinical practice

Evaluation of Conjunctival Autografting Augmented with Mitomycin C Application versus Ologen Implantation in the Surgical Treatment of Recurrent Pterygium

Objectives. To evaluate the safety and efficacy of augmenting conjunctival autografting with intraoperative mitomycin C (MMC) application versus Ologen implantation in the management of recurrent pterygium. Materials and Methods. This prospective randomised study included 63 eyes of 63 patients, with recurrent nasal pterygium, who presented to the outpatient clinic of Menoufia University Hospital in Shebin El Kom and Manshiet Soltan from January 2016 to December 2019. Patients were randomly enrolled into two groups. Group A included 32 eyes of 32 patients who underwent conjunctival autografting augmented with the topical application of MMC (0.2 mg/mL), and group B included 31 eyes of 31 patients who underwent conjunctival autografting augmented with Ologen implantation. All the patients underwent follow-up examinations for a period of 24 months. During each visit, a complete ophthalmic examination was performed. Pterygium regrowth of 1 mm or more, over the cornea, was considered a recurrence. Results. In the MMC group, no recurrence was reported during the 24-month follow-up period. In the Ologen implantation group, recurrence was reported in 2 (8%) eyes. The time interval from surgery to recurrence was 5 months in one case and 8 months in the other. No other serious postoperative complications were reported, and there was no statistically significant difference between the groups in this regard. Conclusion. Ologen implantation with conjunctival autografting shows promising results in the surgical management of recurrent pterygium with mild non-vision-threatening postoperative complications comparable to that of MMC application with conjunctival autografting. Registration number: ClinicalTrials.govNCT04419038

Intra-articular versus intravenous magnesium-sulfate as adjuvant to femoral nerve block in arthroscopic knee sur

Background: The combined use of intra-articular (IA) or intravenous (IV) magnesium-sulfate (mgso4) with femoral nerve block might be associated with additive effects on the duration and quality of postoperative analgesia in arthroscopic knee surgery. Patients and methods: This randomized controlled double-blind study included 90 patients. Femoral nerve block was performed in all patients using 20 ml 0.25% bupivacaine before induction of general anesthesia. At the end of surgery patients were randomly allocated into: Group-IA (intra-articular 1 g MgSO4 in 20 ml), Group-IV (intravenous 1 g MgSO4 in 20 ml), and Group-P (20 ml intra-articular and 20 ml intravenous normal saline). 20 ml normal saline was given IV in IA group and IA in IV group. Visual analogue pain score (VAS) at rest, with movement, time to first postoperative rescue analgesia, total postoperative diclofenac consumption, and the number of meperidine rescue doses during the first 24 h postoperatively were measured. Results: Pain scores were comparable in the three groups at 2 and 4 h and were significantly higher in the control group at 6 h and over 24 h. Group IA had the lowest pain scores. Duration of analgesia was significantly higher [11.6 (4.5) h] in IA group compared to [7.5 (3.6) h] in IV group and [5.2 (2.3) h] in control group (p < 0.01). Total Diclofenac over 24 h was significantly lower in IA group [73.8 (50.9) mg] versus [138.4 (51.6) mg] in IV group and [186.0 (43.9) mg] in the control group (p < 0.01). Conclusion: The combined use of femoral nerve block with IA or IV MgSO4 is associated with significant reduction of the intensity and duration of postoperative pain and postoperative analgesic requirements in patients undergoing arthroscopic knee surgery with the IA MgSO4 being superior to IV route of administration

A Nonlinear Goal Programming Model for University Admission Capacity Planning with Modified Differential Evolution Algorithm

This paper proposes a nonlinear Goal Programming Model (GPM) for solving the problem of admission capacity planning in academic universities. Many factors of university admission capacity planning have been taken into consideration among which are number of admitted students in the past years, total population in the country, number of graduates from secondary schools, desired ratios of specific specialties, faculty-to-students ratio, and the past number of graduates. The proposed model is general and has been tested at King Abdulaziz University (KAU) in the Kingdom of Saudi Arabia, where the work aims to achieve the key objectives of a five-year development plan in addition to a 25-year future plan (AAFAQ) for universities education in the Kingdom. Based on the results of this test, the proposed GPM with a modified differential evolution algorithm has approved an ability to solve general admission capacity planning problem in terms of high quality, rapid convergence speed, efficiency, and robustness

A living WHO guideline on drugs to prevent covid-19

Clinical question: What is the role of drugs in preventing covid-19? WHY DOES THIS MATTER?: There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19.Recommendation: The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty).How this guideline was created: This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Understanding the new recommendation: The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19.Updates: This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline.Readers note: This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity