Colonoscopy screening for colorectal cancer in Egypt: a nationwide cross-sectional study

BACKGROUND

Current guidelines advocate for colorectal cancer (CRC) screening in adults who are at risk by using direct visualization methods such as colonoscopy. However, in Egypt, there is a paucity of data regarding the current practice of colonoscopy screening. Moreover, more information is needed about the knowledge and attitudes of potential participants regarding the procedure and possible barriers that can limit their participation.

METHODS

We conducted a nationwide cross-sectional study using an interview-based survey of patients aged 45 years or above who presented to outpatient clinics of nine university hospitals throughout Egypt. Participants were surveyed to assess their compliance with CRC colonoscopy screening guidelines, their knowledge of and attitude towards colonoscopy screening, and their perspective on potential barriers to colonoscopy screening.

RESULTS

A total of 1,453 participants responded to our survey in the nine study centers. Only a minority of participants (2.3%) were referred for CRC screening. Referral rates were higher among those who knew someone with a history of CRC (5.3% vs 1.5%, p < 0.001) or had a discussion with their physician about CRC (25.8% vs 0.7%, p < 0.001). Few responders (3.2%) had good knowledge regarding CRC screening. After introducing the concept of CRC screening to all participants, most patients (66.7%) showed a positive attitude towards having the procedure. Financial burden and fear of results were the two most frequently cited barriers to undergoing CRC screening (81.1%; and 60.1%, respecteively).

CONCLUSIONS

Despite the positive attitude, there is insufficient knowledge about CRC screening among eligible participants in Egypt. This has probably contributed to low compliance with current CRC screening guidelines and needs to be addressed at the national level.

Total hip replacements following acetabular fractures. 7 to 15 years clinical and radiological results

This study is reporting the long term clinical and radiographic results of a group of 45 patients who underwent total hip arthroplasty following acetabular fractures. The study included 39 males and 6 females. The age of the patients ranged from 32 to 61 with a mean of 46.4 years. The indication for surgery was secondary osteoarthritis in 35 patients and avascular necrosis of the femoral head in the remaining ten. The follow up period ranged from 7 to 15 years with a median of 10.3 years. Uncemented total hip prostheses were used in 37 cases while 8 cases had hybrid prostheses with cemented cups and uncemented stems. Thirty patients (66.7%) needed autogenous acetabular bone grafting. There has been a statistically significant improvement from a preoperative mean Oxford hip score of 16 to a postoperative mean score of 39.8 (p < 0.001). At the end of follow up, two cases had revision for cup loosening. The complications included one case of transient sciatic nerve palsy, and two cases of heterotopic ossification. Currently, total hip replacement remains the best option for end stage post traumatic arthritis. There are technical challenges associated with this replacement surgery which the surgeon should be aware of.

Total hip replacements following acetabular fractures. 7 to 15 years clinical and radiological results

This study is reporting the long term clinical and radiographic results of a group of 45 patients who underwent total hip arthroplasty following acetabular fractures. The study included 39 males and 6 females. The age of the patients ranged from 32 to 61 with a mean of 46.4 years. The indication for surgery was secondary osteoarthritis in 35 patients and avascular necrosis of the femoral head in the remaining ten. The follow up period ranged from 7 to 15 years with a median of 10.3 years. Uncemented total hip prostheses were used in 37 cases while 8 cases had hybrid prostheses with cemented cups and uncemented stems. Thirty patients (66.7%) needed autogenous acetabular bone grafting. There has been a statistically significant improvement from a preoperative mean Oxford hip score of 16 to a postoperative mean score of 39.8 (p < 0.001). At the end of follow up, two cases had revision for cup loosening. The complications included one case of transient sciatic nerve palsy, and two cases of heterotopic ossification. Currently, total hip replacement remains the best option for end stage post traumatic arthritis. There are technical challenges associated with this replacement surgery which the surgeon should be aware of.

Value of electroencephalographic monitoring in newborns with hypoxic-ischemic encephalopathy treated with hypothermia

BACKGROUND

The values of electroencephalography (EEG) in neonatal hypoxic-ischemic encephalopathy (HIE) during therapeutic hypothermia (TH) are still uncertain.

AIMS

The aim of this study is to detect EEG background, the prevalence of seizures during cooling, and to determine different EEG patterns that can predict brain injury in magnetic resonance imaging (MRI).

PATIENTS AND METHODS

Thirty-nine newborns with HIE were subjected to TH. Continuous monitoring by video-EEG was carried out throughout cooling and during rewarming. MRI was done for all newborns after rewarming. The predictive value of EEG background for MRI brain injury was evaluated at 6-h intervals during cooling and rewarming.

RESULTS

At all-time intervals, normal EEG was associated with no or mild MRI brain injury. At the beginning of cooling, normal background was more predictive of a favorable MRI outcome than at later time points. After 24 h of monitoring, diffuse burst suppression and depressed patterns had the greatest prognostic value. In most patients, a discontinuous pattern was not associated with poor prognosis. Thirty-one percent developed electrical seizures, and 8% developed status epilepticus. Seizures were subclinical in 42%. There is a significant association between duration of seizure patterns detected on the EEG and severity of brain injury on MRI.

CONCLUSIONS

Continuous EEG monitoring in newborns with HIE under cooling has a prognostic value about early MRI brain injury and identifies electrographic seizures, approximately 50% of which are subclinical. Treatment of clinical and subclinical seizure results in a reduction of the total duration of seizure pattern supports the hypothesis that subclinical seizures should be treated.

Heart-type fatty acid-binding protein as a predictor of cardiac ischemia in intractable seizures in children

BACKGROUND

Children with intractable epilepsy have chronic dysfunction of the autonomic nervous system causing myocardial ischemia. Heart-type fatty acid-binding protein (H-FABP) is a sensitive biomarker for myocardial ischemia.

AIMS

We aimed to evaluate serum levels of H-FABP during seizures compared to their interictal levels and healthy controls and changes in heart rate (HR) and HR variability (HRV) in epileptic children with intractable seizures.

MATERIALS AND METHODS

We included 30 epileptic seizures in 25 children with intractable epilepsy and 30 matched controls. They were subjected to video-electroencephalography monitoring simultaneously with Holter electrocardiogram and measurement of H-FABP.

RESULTS

Mean serum levels of H-FABP were increased significantly in patients either in the ictal or interictal periods compared to that in the controls (P < 0.001 and P< 0.01, respectively). There is no significant difference in serum levels of the H-FABP in the ictal and interictal periods. The basal time domain measures of HRV were significantly lower in the patient group compared to the control group.

CONCLUSION

H-FABP might suggest a degree of myocardial ischemia in intractable epilepsy. HRV is impaired in patients with refractory seizures.

An explosively driven high-power microwave pulsed power system

The increased popularity of high power microwave systems and the various sources to drive them is the motivation behind the work to be presented. A stand-alone, self-contained explosively driven high power microwave pulsed power system has been designed, built, and tested at Texas Tech University's Center for Pulsed Power and Power Electronics. The system integrates four different sub-units that are composed of a battery driven prime power source utilizing capacitive energy storage, a dual stage helical flux compression generator as the main energy amplification device, an integrated power conditioning system with inductive energy storage including a fast opening electro-explosive switch, and a triode reflex geometry virtual cathode oscillator as the microwave radiating source. This system has displayed a measured electrical source power level of over 5 GW and peak radiated microwaves of about 200 MW. It is contained within a 15 cm diameter housing and measures 2 m in length, giving a housing volume of slightly less than 39 l. The system and its sub-components have been extensively studied, both as integrated and individual units, to further expand on components behavior and operation physics. This report will serve as a detailed design overview of each of the four subcomponents and provide detailed analysis of the overall system performance and benchmarks.

A stability-indicating first-derivative spectrophotometric assay of acetazolamide and its use in dissolution and kinetic studies

A simple, rapid, stability-indicating first-derivative spectrophotometric assay procedure for the determination of the degradation products of acetazolamide is described. The dissolution and kinetics of drug degradation in aqueous buffered solutions were studied using the proposed method. Acetazolamide solution exhibited optimum stability at pH 4. The influences of temperature and sonic energy on the degradation of acetazolamide in 0.01 M NaOH solution were also studied. The results showed first-order reaction kinetics, with a degradation rate constant and degradation half-life of 3.51 x 10(-3) day-1 and 8.23 days, respectively.

Spectrophotometric determination of cimetidine in the presence of its acid-induced degradation products

Cimetidine has been determined in the presence of its acid-induced degradation products using a second derivative (D2-) spectrophotometric method (method I) or a colorimetric method (method II). The former is based on D2-value measurement at 216 nm, whilst the latter depends on charge-transfer complexation with dichlorophenol-indophenol. The two methods are proved to be stability indicating, since plots of log C% versus time were linear. The application to cimetidine determination in tablets and ampoules gave good results.

Determination of isothipendyl or dimethothiazine with their sulphoxides using third- and fourth-derivatives spectroscopy on a diode-array spectrophotometer

Third- and fourth-derivative spectrophotometry (3D + 4D), with a diode-array spectrophotometer, has been used for the assay of mixtures of each of isothipendyl hydrochloride (I) and its sulphoxide (II) or dimethothiazine mesylate (III) and its sulphoxide (IV). The parent compounds have been determined by measuring the 3D at 256 nm, 246-256 nm and 256-264 nm and 4D at 250 nm for (I) and 3D at 255 nm or 283 nm and 4D at 257 nm for (III). The sulphoxides have been assayed by measuring the 3D at 285-290 nm and 4D 285-290 nm for (II) and 3D at 305 nm and 4D at 303-310 nm for (IV). Beer's law is obeyed and the detection limits for the proposed 3D and 4D has been calculated. The recovery of these drugs and their sulphoxides in laboratory-made mixture and dosage forms has been reported.

Derivative spectrophotometric determination of clotrimazole in single formulations and in combination with other drugs

First (D1) and second (D2) derivative spectrophotometric methods are presented for the determination of clotrimazole after its acid hydrolysis. Mixtures of clotrimazole with azidamfenicol and dexamethasone have been assayed using D2 measurement at 302 nm after acid hydrolysis for clotrimazole, D1 measurement at 288 nm for azidamfenicol, and D1 measurement at 436 nm after reaction with phenylhydrazinium sulfate for dexamethasone. Reproducible results with relative standard deviations of less than 2% are obtained. The proposed method has been successfully applied to the analysis of creams, topical solutions, and vaginal tablets.

Second derivative spectrophotometric determination of acetaminophen and phenacetin in presence of their degradation products

A rapid and accurate method for determining acetaminophen and phenacetin in presence of their degradation products is presented. Solutions of these drugs in 0.1N HCl were analyzed by measuring their second derivative spectral response at 295 nm where the degradation products do not interfere. The mean percent recoveries for mixtures of acetaminophen and/or phenacetin with the corresponding degradation products were 100.2 +/- 0.6 and 100.6 +/- 1.1, respectively. The method can be used for assessing the stability of the 2 drugs. The proposed method is also applied to the determination of acetaminophen in tablets and syrups.

Determination of ethinyloestradiol in the presence of norethisterone by derivative-difference spectrophotometry

A simple and direct method for the determination of ethinyloestradiol as a minor component in the presence of norethisterone and in oral contraceptive tablets is presented. The method is based on measuring the signal intensity, d delta A/d lambda and d2 delta A/d lambda 2, of the generated first and second derivative spectra of the delta-absorbance curves obtained by measuring solutions in methanol and methanol-sodium hydroxide at certain wavelengths. The method has been applied to the determination of ethinyloestradiol in oral contraceptive tablets, with a coefficient of variation of less than 2%.

Detection of some alkaloids on thin layer chromatograms using pi-acceptors

The reactions of chloranil, fluoranil, 2,5 dichlorobenzoquinone and chloranilic acid with some alkaloids on thin layer chromatograms were examined with a view to determine their suitability as visualizing agents. Chloranil and 2,5 dichlorobenzoquinone (each 0.5% w/v in dioxan) were found to be most suitable as they gave coloured reaction products with many alkaloids.

Bromination methods for determination of phenylephrine hydrochloride in nose drops, salicylamide in tablets, and tetracycline hydrochloride in capsules

Two methods, kinetic and titrimetric, based on an electrophilic substitution reaction with bromine, are described for the assay of phenylephrine hydrochloride in nose drops, salicylamide in tablets, and tetracycline hydrochloride in capsules. The kinetic method depends on the linear relationship between concentration of the drug (microgram/mL) and time (s) for nuclear monobromination, indicated by bleaching of the methyl orange acid color. The titrimetric method is based on addition of excess of bromate-bromide with subsequent determination of excess bromine by an iodide-thiosulfate procedure. This method is also used to count the number of bromine atoms necessary for the electrophilic substitution reaction. Preservatives or tablet-capsule bases do not interfere in either method. Recoveries of drugs added to laboratory-prepared samples were good. As indicated by the F-test, the methods are equally reproducible.

Utility of chloranil in assay of naphazoline, clemizole, penicillin G sodium, and piperazine

A simple and sensitive spectrophotometric method is described for the assay of naphazoline, clemizole, penicillin G sodium, and piperazine. The method was based on the formation of a charge transfer complex between these drugs as n-donors and chloranil, the pi-acceptor. Conformity to Beer's law enabled the assay of dosage forms of these drugs. Compared with official methods, the results obtained were of equal accuracy. A more detailed investigation of th naphazoline-chloranil complex was made with respect to its composition, association constant, and free energy change.

Colorimetric acetaminophen determination in pharmaceutical formulations

Different approaches for the colorimetric determination of acetaminophen, based on its coupling with diazotized o-nitroaniline, are described. Copper(II) chelation with the coupled compound makes the method highly selective. Sensitivity is increased when the acetaminophen assay is carried out indirectly through the determination of the chelate's copper content. Optimum conditions for performing the different approaches are described. The stoichiometric balance for the reactants in the coupled compound and chelate is determined. The degree of dissociation and the instability constant are computed. The rectilinear relationship between the absorbance of the different products and the concentration of acetaminophen allows for its determination in different pharmaceutical formulations. Compared with the official method, the proposed methods give more accurate results.

Spectrophotometric determination of tolbutamide, thiamine hydrochloride, and pyridoxine hydrochloride in combination products

The first derivative curve is used for tolbutamide determination in unit-dose tablets and in combination products. The absorbance contribution from tablet excipient and coexisting components, thiamine and pyridoxine, is thereby nullified. The interference from tolbutamide during thiamine and pyridoxine determination is eliminated by solvent extraction and pH-induced differential spectrophotometry. Thiamine is measured at the isosbestic point of pyridoxine. The latter is determined by the differential absorbance measurement at two wavelengths with the consequent computation of the delta absorbance value.

Spectrophotometric determination of acetaminophen in tablets, sirups, and suppositories

A differential spectrophotometric method and Glenn's method of orthogonal function are described for the assay of acetaminophen in tablets, sirups, and suppositories. Interference from excipients in the formulations is thereby avoided. Accuracy of the analyses is greater with the proposed methods than with the British Pharmacopoeia method.

Spectrophotometric determination of tolbutamide in tablets

Two spectrophotometric methods, Glenn's method of orthogonal function and the basic dye method, are described for determing tolbutamide in tablets without interference from the tablet excipients. In Glenn's method, the absorbance of tolbutamide in 95% ethanol is measured in the vicinity of 250--270 nm at 4 nm intervals and the p2 coefficient is calculated. The coefficient is linearly related to concentration within a range of 0.1--0.4 mg/mL. Tolbutamide gives a complex of a ratio 1:1 with basic dye Brilliant Cresyl Blue (BCB) or Safranin T (ST). The complex is easily extracted with chloroform. The absorbance of the chloroform extract is measured against either a blank or reference experiment. The latter is obtained by using a specific concentration of tolbutamide: 0.4 mg/mL in tolbutamide-BCB or 0.024 mg/mL in tolbutamide-ST. The ST complex method is more sensitive compared with the other methods. When the t-test is applied, the results of the proposed methods are more accurate than those of the traditional ultraviolet spectrophotometric method.

Spectrophotometric determination of theophylline formulations

Minophylline (theophylline ethanoate of piperazine) and aminophylline (theophylline ethylenediamine) were determined spectrophotometrically in dosage forms without interference from excipients and/or preservatives. A mixture of minophylline, in about 30-fold concentration, with phenobarbital was assayed for both components with good accuracy and high reproducibility.

pH-induced difference spectrophotometric assay of acetazolamide, hydrochlorothiazide, and furosemide

On the basis of pH-induced spectral changes for acetazolamide, hydrochlorothiazide, and furosemide, 3 different spectrophotometric methods are described. The methods were successfully applied to the assay of these drugs in different pharmaceutical formulations (tablets and ampoules). The accuracy of the analysis is increased by using the suggested methods as compared with conventional spectrophotometry.