Mortality In Egypt Research Articles

Diagnostic Value of Plasma Methylated Septin 9 in Detection of Hepatocellular Carcinoma in Egyptian Patient with Post Hepatitis C Liver Cirrhosis in Comparison to Serum Level of Alphafeto Protein

Abstract Background Egypt has the highest hepatitis C virus (HCV) prevalence worldwide. Cirrhosis secondary to HCV is associated with the highest annual risk for developing hepatocellular carcinoma. The burden of HCC has been increasing in Egypt with a doubling in the incidence rate in the past 10 years. HCC contributes to 14.8% of all cancer mortality in Egypt. Most HCCs (80%) arise in a cirrhotic liver, a situation where there has been longstanding hepatocyte damage and chronic inflammation leading to fibrosis. Aim of the Work This study aims to evaluate the diagnostic value of plasma mSEPT9 assay in detection of HCC in Egyptian patients with post hepatitis C liver cirrhosis in comparison to serum level of α-fetoprotein (AFP). Patients and Methods This is a prospective case-control study conducted at the Gastroenterology department in Ain Shams University Hospital. The study population consisted of 80 subjects, divided into three groups: 40 patients with hepatocellular carcinoma, 20 patients with liver cirrhosis, and 20 healthy subjects as controls with matched age and gender. Results The study found that hepatocellular carcinoma (HCC) was more frequent in male patients and that the age of HCC patients was statistically significantly higher than patients with cirrhosis and healthy controls. Patients with HCC and cirrhosis had a higher Child Pugh score than healthy controls. Portal hypertension and portal vein thrombosis were more frequent in HCC and cirrhosis patients than in the control group. Liver enzymes were higher in patients with HCC and cirrhosis compared to healthy controls, while hemoglobin and platelet levels were lower in patients with HCC. Hepatitis C antibody and PCR were positive in HCC and cirrhosis patient groups. AFP and Methylated Septin 9 levels were higher in patients with HCC and cirrhosis than in healthy controls, and AFP had better diagnostic accuracy than Methylated Septin 9. Both AFP and Methylated Septin 9 levels were positively correlated with age, Child Score, liver enzymes, and coagulation profile and negatively correlated with platelet count and hemoglobin level. AFP level was positively correlated with the number of focal lesions and liver size. Conclusion This study demonstrated that plasma Methylated Septin 9 can be a promising noninvasive and circulating epigenetic biomarker for HCC diagnosis at the individual level. However, our results showed that AFP was superior than Methylated Septin 9 in the detection of HCC, Methylated Septin 9 has higher Sensitivity. It was suggested that the combination of plasma mSEPT9 and AFP could enhance the sensitivity of Methylated Septin 9 or AFP alone in the diagnosis of HCC. Further comparative studies with larger sample size and longer follow-up are needed to confirm our results and to identify risk factors of adverse events.

EPH135 Years of Life Lost and Productivity Costs Due to Premature Cancer-Related Mortality in Egypt

EPH135 Years of Life Lost and Productivity Costs Due to Premature Cancer-Related Mortality in Egypt

Egyptian Society of Liver Cancer Recommendation Guidelines for the Management of Hepatocellular Carcinoma.

Globally, hepatocellular carcinoma (HCC) is the fourth most common cause of death from cancer. The prevalence of this pathology, which has been on the rise in the last 30 years, has been predicted to continue increasing. HCC is the most common cause of cancer-related morbidity and mortality in Egypt and is also the most common cancer in males. Chronic liver diseases, including chronic hepatitis C, which is a primary health concern in Egypt, are considered major risk factors for HCC. However, HCC surveillance is recommended for patients with chronic hepatitis B virus (HBV) and liver cirrhosis; those above 40 with HBV but without cirrhosis; individuals with hepatitis D co-infection or a family history of HCC; and Nonalcoholic fatty liver disease (NAFLD) patients exhibiting significant fibrosis or cirrhosis. Several international guidelines aid physicians in the management of HCC. However, the availability and cost of diagnostic modalities and treatment options vary from one country to another. Therefore, the current guidelines aim to standardize the management of HCC in Egypt. The recommendations presented in this report represent the current management strategy at HCC treatment centers in Egypt. Recommendations were developed by an expert panel consisting of hepatologists, oncologists, gastroenterologists, surgeons, pathologists, and radiologists working under the umbrella of the Egyptian Society of Liver Cancer. The recommendations, which are based on the currently available local diagnostic aids and treatments in the country, include recommendations for future prospects.

Participation in the National Campaign on Viral Hepatitis C and Non-Communicable Diseases among Administrative Workers of Ain Shams University, Egypt

Background: On the first of October 2018, the Egyptian Ministry of Health and Population (MOHP) launched an initiative; named “100 Million Healthy Lives”, for nationwide screening of hepatitis c virus (HCV) and non-communicable diseases (NCDs). Egypt has the highest prevalence of HCV infection in the world where about 10% of the Egyptian population is affected by the disease. NCDs are the leading cause of mortality in Egypt and account for about 84% of all deaths. This study was conducted to a) Estimate the prevalence of participation in the national campaign on viral hepatitis C and non-communicable diseases among administrative workers in Ain shams University (ASU), b) Estimate the self-reported satisfaction of these participants with the campaign. Subjects and Methods: A cross-sectional study was conducted on 400 administrative workers of ASU faculties between March and August 2019 in Cairo, Egypt. A multistage random sample was done. Results: The study showed that 96% of the study group participated in the campaign. “Evaluating health status” was considered the main reason for participation at 92%, followed by "desire to obtain follow-up card", at 36%. Non-participation rate was about 4% and the main cause of non-participation was “fear of needle prick". About 91% of the participants were satisfied with the provided services. Mass media played a major role in awareness about the campaign for 91% of participants. Conclusions: The majority of the study group participated and was satisfied with the campaign. Mass media played a major role in participant awareness of the campaign.

Dependence Modelling of Lifetimes in Egyptian Families

In this study, we analyse a large sample of Egyptian social pension data which covers, by law, the policyholder’s spouse, children, parents and siblings. This data set uniquely enables the study and comparison of pairwise dependence between multiple familial relationships beyond the well-known husband and wife case. Applying Bayesian Markov Chain Monte Carlo (MCMC) estimation techniques with the two-step inference functions for margins (IFM) method, we model dependence between lifetimes in spousal, parent–child and child–parent relationships, using copulas to capture the strength of association. Dependence is observed to be strongest in child–parent relationships and, in comparison to the high-income countries of data sets previously studied, of lesser significance in the husband and wife case, often referred to as broken-heart syndrome. Given the traditional use of UK mortality tables in the modelling of mortality in Egypt, the findings of this paper will help to inform appropriate mortality assumptions specific to the unique structure of the Egyptian scheme.

Understanding inequities in child mortality in Egypt: Socioeconomic and proximate factors

ABSTRACT While there have been notable advancements in child health in Egypt, disparities in child mortality still exist. Understanding these disparities is crucial to addressing them. The objective of this study is to explore the factors linked to child mortality in Egypt, providing a comprehensive understanding of the disparities in child mortality rates. The study utilises cross-sectional data from Egypt's Demographic and Health Survey (EDHS) in 2014 to examine child mortality. The dataset consists of 15,848 observations from mothers with children born within five years prior to the survey. The choice of explanatory variables was guided by the Mosely and Chen Framework and logistic multivariate regression was used to conduct the analyses. The study finds lower education, early childbearing, insufficient birth spacing, lack of breastfeeding, and absence of improved toilet facilities (proxy for living conditions) were all significantly linked to an increased likelihood of child loss. Additionally, poorer people in rural settings experienced the worst child mortality. The findings align with the World Health Organization's Conceptual Framework for Action on the Social Determinants of Health (CSDH). Recommended policy interventions include targeting women in rural areas, improving living conditions and removing financial/other barriers to accessing care.

Assessment of the serum glucose/potassium GLU/K ratio as a predictor of intermediate syndrome following acute anticholinesterase exposure

BackgroundThe widespread use of anticholinesterase-containing pesticides accounts for the considerable morbidity and mortality in Egypt and worldwide. AimFew studies have investigated the predictors of intermediate syndrome (IMS). Therefore, in this study, we assessed the adequacy of the serum glucose/potassium (GLU/K) ratio as an early reliable tool to predict IMS incidence following intoxication with acute anticholinesterase compounds. MethodsA prospective cross-sectional study was conducted among patients who presented to Tanta University Poison Control Center, Egypt, and were diagnosed with acute anticholinesterase intoxication between January and August, 2021. Patients were categorized based on the primary outcome into IMS (+) and IMS (−) groups. ResultsOverall, 243 patients were included, among whom 44 (18.1%) had IMS as the complication. Younger individuals with age ranging between 18 and < 25 years constituted the main exposed age category in both groups. Vomiting and abdominal colic were the most commonly noted complaints in the included patients (94.2% and 63.8% of patients, respectively). The delay, length of hospital stay, mean blood pressure, O2 saturation, Glasgow Coma Scale score, random blood glucose level, K concentration, GLU/K ratio, and dose of atropine administered were significant IMS predictors on an individual basis, and the GLU/K ratio was the most significant IMS predictor. At a cutoff value of > 41.07%, the GLU/K ratio could significantly predict IMS (areas under the curves = 0.971, p < 0.001) with 93% accuracy, 93.2% sensitivity, and 93% specificity. ConclusionAlthough the clear pathophysiology of IMS remains to be elucidated, our results provide insight into the significant contribution of neurological affection, apart from the well-known direct toxic effect on muscles. Moreover, we demonstrated a significant association between the development of IMS and severity of organophosphorus compounds’ exposure. Physicians should be vigilant to detect IMS early upon admission using the GLU/K ratio, which is a useful early IMS predictor.

The Impact of Comorbidities on COVID-19 Severity and Mortality in Egypt

Background Older persons and people of any age with certain underlying comorbidities such as diabetes mellitus, cardiovascular disease, lung disease, kidney disease, liver disease, and cancer are at a higher risk of severe disease course and death if they become infected with COVID-19. Identifying at-risk groups and risk factors for COVID-19 severity and mortality is important for guiding the efficient and appropriate prevention and management of patients with COVID-19. Objective This study aimed at describing the demographics and epidemiologic characteristics of confirmed COVID-19 cases in Egypt and determining the impact of different comorbidities on patients’ outcomes. Methods The data of all confirmed COVID-19 patients admitted to 408 governmental hospitals all over Egypt from February to May 2020 were collected retrospectively from the National Egyptian Disease Surveillance System. The cases were confirmed using RT-PCR. Results Overall, 28,415 patients (55% male and 45% female) were identified. Their median age was 44 years. Of those, 743 (2.6%) were admitted to ICU, 408 (1.4%) required ventilator, and 1045 (3.7%) died. Of the 21,617 (76.1%) patients with completed data, 4687 (21.7%) had comorbidities. Overall, 11.8% had diabetes, 5.3% cardiovascular disease, and 4.3% chronic obstructive pulmonary disease. Those who had 1 comorbidity were more likely to die (odds ratio 2.83), were admitted to ICU (odds ratio 6.36), and needed a ventilator (odds ratio 5.95) compared to patients with no comorbidities. Having multiple comorbidities increased the risk of mortality (odds ratio 3.53), ICU admission (odds ratio 8.62), and requiring a ventilator (odds ratio 9.06). Conclusions COVID-19 patients with comorbidities had a higher risk of disease severity and mortality. Multiple comorbidities further increase the risk to a higher extent. All necessary precautions should be taken for patients with comorbidities to avoid COVID-19 infection in order to prevent the worst prognosis.

Values of Application of Three Delays Model to Maternal Mortality Scenarios at Sohag Univeristy Hospital Bidirectional Cohort Study

Background: Maternal mortality in Egypt is still relatively high so measuring maternal mortality and identifying its causes is essential and should be calculated regularly for the purpose of planning, monitoring and evaluation of provided maternal health care. Objective: Identifying the circumstances and causes of maternal mortality. Patient and method: Data were collected from records of patients who were presented to and delivered at Sohag University Hospital in the period between 2017 and 2019. Only cases of maternal mortality were included in this study. In our study we found 20 maternal deaths occurred at our hospital between 2017 and 2019. Results: In our study the most frequent one was the 1st delay that occurred in 10 women followed by 2nd delay in 4 women then combination of 1st and third in about 3 women and combination of 1st and 2nd in 2 cases and delay 2 in 1 case. Our study showed that the first cause of death was preeclampsia/eclampsia 55% followed by obstetric hemorrhage (placenta previa, postpartum hemorrhage, rupture uterus) 35%, caesarean section complications 5% and lastly medical condition associated with pregnancy 5%. Conclusions: This study showed that the first delay is the most important delay in Sohag, especially in rural areas, and the most important cause of death was preeclampsia and ignorance about its complications which was due to lack of antenatal care.

Malpractice as a Leading Cause to Maternal Mortality in Egypt: A Postmortem Statistical Study

Background: Maternal deaths are quite common tragic event in developing countries where the main sourceof information on the causes of maternal death is clinical records and autopsies. Knowledge about the causesof these deaths are scarce in Egypt. Efforts to reduce maternal mortality in Egypt are mostly not driven byevidence. This autopsy study was performed to assess the cause of maternal mortality including malpractice,thus providing information which plays an important role in improving clinical practice in Egypt.Methods: A retrospective, descriptive study was conducted at the Egyptian Forensic Authority (EFMA) ina 5-years perios between January 2008 and December 2012 to investigate maternal mortality cases allegedto be due to malpractice.Results:. The total number of maternal deaths was 114 cases. The majority of cases (n=90, 79.0%) werenegative concerning malpractice. Twenty-four deaths (21%) can be attributed to malpractice; 16 due tosurgeon faults and 8 anesthesia-related deaths. The main cause of death was obstetric hemorrhage (n=46)followed by respiratory failure (n=30). Out of the 24 cases, 19 were proved to be due to negligence inthe form of late intervention, improper preparation, unmanaged complication and unauthorized place ofmanagement.Conclusion: Malpractice causes nearly one-fifth of alleged maternal deaths; the most frequenct type ofwhich is negligence. Surgeon errors were double anesthesia related deaths. Hemorrhage was the mostcommon cause of death in malpractice as well as incidental deaths. Quality of obstetric care in Egypt needsfurther improvement in the aspects of health facilities and care providers.

Evaluation of Severity of Poisoning Exposures among Patients Presented to Poison Control Center, Ain Shams University Hospitals, Egypt during 2019

Background: Poisoning exposure continues to be an important public health concern in many developing countries and a major cause of morbidity and mortality in Egypt. The information released by the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH) is mostly a trigger for increasing hazards challenging the community. Aim: To evaluate severity of poisoning exposures among patients presented to PCC-ASUH during year 2019. Methods: A retrospective study involved patients presented to the PCC-ASUH with history of poisoning during 2019. Results: This study included 21,492 patients. The majority of poisoning incidents were at the age group of 15 – 25 years (34%) and females outnumbered males (54.8% versus 45.2%). Route of poisoning was mostly oral (89.1%). Most poison exposures were suicidal (51.5%). Drug poisoning constituted the majority of cases (59.5%). Centrally acting drugs were the commonest drugs (18%) and household chemicals were the commonly used poisons (13.4%). Poisoning severity score was mild in 79.4% of cases, moderate in 14.4% and severe in 6.2% of cases. Mortality rate was 0.66%. Higher PSS was associated with prolonged hospital stay and death. Conclusion: Poisoning is more common in young and middle-aged people. Ingestion was the main route of poisoning and suicidal poisoning predominated. Corrosives and detergents were the most commonly involved toxic substances while centrally acting drugs topped the list of drug poisoning. Higher PSS was associated with prolonged hospital stay and death. Recommendations: Poisoning severity score is a simple tool for better poisoning assessment. Strict regulations are needed to control medication marketing.

Identifying of HBV DNA in liver tissues of chronic hepatitis and hepatocellular carcinoma to study the Hepatitis B virus silent infection in Egyptian patients

Hepatitis B virus (HBV) infection comprises one of the most frequent causes of adult morbidity and mortality in Egypt. The presence of HBV genomes in the absence of HBV surface antigen (HBsAg) individuals is referred to as occult HBV infection. This study aimed to detect HBV integration in HBsAg negative chronic hepatitis and hepatocellular carcinoma (HCC) cases by extraction of DNA from tissue and serum of chronic hepatitis and HCC cases to find out the silent HBV infection. Subjects and Methods: Seventy-three patients divided into three groups; group I: included fifty-two sera samples for hepatocellular carcinoma (HCC) patients with negative HBsAg and positive HBcAb; of which fourteen liver tissues samples were taken (group I). Nine chronic hepatitis patients with negative HBsAg and positive HBcAb (group II) were studied in both liver tissue and serum sample. Twelve chronic hepatitis patients with positive HBsAg and positive HBcAb were included as a control group. DNA from those groups has been separated from tissue sections that have been mounted on glass slides. Results: The present study showed that 1/52 (1.9%) of the patients with HCC were positive for HBV DNA in the serum while all the 52 HCC patients were negative for HBV DNA in the liver tissue. Conclusion: The present showed that 1/52 (1.9%) of the patients with HCC were positive for HBV DNA in the serum. The explanation for this is the low endemicity of HBV infection in Egypt which differ HBV DNA detection process.

Key risk factors, farming practices and economic losses associated with tilapia mortality in Egypt

Egypt is the topmost aquaculture producer in Africa and the third largest tilapia producer globally. Nile tilapia in particular is the cornerstone of fish farming in Egypt. Recently, fish farms have experienced unusual tilapia mortality during summer season, threatening further growth of the sector. In order to understand risk factors, a questionnaire based cross-sectional study was conducted using tilapia epidemiology and health economics online survey tools. We surveyed 113 tilapia farms in four of the largest tilapia producer governorates (Kafr El Sheikh, Beheira, Sharqia, Faiyum) and one governorate with less farming activity (Minya). Farming practices, biosecurity measures and estimated losses were also assessed. Results indicate that a combination of risk factors contributed to the observed mortality events. We observed significant correlation between water source (surface and irrigation canals) and both occurrence and level of unusual mortality events (p < .001). Similarly, higher average water temperature, salinity, and polyculture of tilapia with wild sourced mullet favored the occurrence of unusual mortality (p < .001). Unusual mortality level was higher with low inclusion of tilapia in polyculture settings compared to other species (p = .014). Average fish weight at mortality peaks also contributed to mortality level (p = .029). Farming practices that affected mortality incidences included sharing of equipment between farms (p < .001). The overall losses from unusual mortality were estimated at about 11,304,400 EGP (around 720,000 USD). Results of this study indicate further studies are needed to understand better the interactions between necessary pathogens and component (risk factors) causes for tilapia mortalities in Egypt.

Diagnostic utility of serum dipeptidyl peptidase (DPP- IV) /CD26 as a serum marker in Egyptian patients with colorectal cancer

ABSTRACT Background Colorectal cancer (CRC) is considered a major cause of morbidity and mortality in Egypt. Colonoscopy is the standard for detection of lesions. The combination of screening methods is effective. Decrease and loss of DPP-IV/CD26 expression and activity are found in microenvironments of specific tumors which are related to impaired immune functions. Aim of the work To study sCD26 as a noninvasive test in Egyptian patients with CRC as well as their correlation to CEA, CA 19–9 & other -biochemical parameters and determine the possibility to use it as a diagnostic tool for CRC. Patients and methods This study included 40 patients divided into two groups: group I: comprised 20 patients with CRC, group II: comprised 20 patients with other colorectal disease together with 20 healthy control. Results There was highly significant decrease in sCD26 in group I in comparison to group II and III. CD26 at cutoff 4.69 mg/mL, its sensitivity was 85% and its specificity was 87.5%. Conclusion CD26 is involved in the pathogenesis of colorectal diseases; sCD26 is diminished in CRC patients suggesting the potential utility of a sCD26 for diagnosis

Fractional Optimal Control with Fish Consumption to Prevent the Risk of Coronary Heart Disease

According to the World Health Organization (WHO), Chronic Heart Disease (CHD) is one of the greatest defies currently confronting humankind which is sweeping the whole globe, with an expanding trend in developing countries. In this paper, a mathematical model (MM) was proposed to study the connection between fish consumption and CHD mortality in Egypt, by considering a system of ordinary differential equations (ODEs) involving time-fractional derivative (FD). We considered here the study on Egypt for the ease of obtaining real data, but the method and approach adopted here is not limited to Egypt only and can be applied to any country in the world with the information of the real data related to the subject of the study. Additionally, the control function which represents the metabolic and the behavioural risk factors of CHD that help to reduce the number of mortality due to CHD is incorporated in the proposed MM. A fractional optimal control problem (FOCP) with a proposed control is formulated and studied theoretically using the Pontryagin maximum principle, to minimize the susceptible population and also to decrease the mortality rate of CHD. Moreover, firstly we discussed the positivity and boundedness of solutions; then, the model equilibria are determined and their local stability analysis was investigated; furthermore, we use the improved forward-backward sweep method (FBSM) based on the predictor-corrector method (PCM) in order to obtain the solution of proposed FOCP. In addition, some numerical simulations were performed to show the effect of the proposed optimal control (OC) besides the impact of fish consumption on the mortality of CHD.

Combretastatin A-4 disodium phosphate and low dose gamma irradiation suppress hepatocellular carcinoma by downregulating ROCK1 and VEGF gene expression.

Hepatocellular carcinoma (HCC) is a tough opponent. HCC contributes to 14.8% of all cancer mortality in Egypt. There are many choices for management of HCC; however tumor relapse has been reported in animal and clinical studies. This study was conducted to investigate the impact of low dose γ-irradiation (LDR) and combretastatin A-4 disodium phosphate (CA-4DP) on HCC recurrence. HCC was induced in male Wistar albino rats by oral administration of N-nitrosodiethylamine (NDEA) for 17 weeks. We evaluated the expression of the endothelial cell marker (CD31) by immunostaining. Expression of Rho Associated Coiled-Coil Containing Protein Kinase 1(ROCK1) and Vascular endothelial growth factor (VEGF) expression was assessed by real-time PCR after (6, 24 and 48 h). Our results showed that expression of CD31 and gene expression of ROCK1 and VEGF was significantly repressed at all-time intervals by combination therapy ofLDR and CA-4DP as compared with untreated NDEA/HCC group and NDEA/HCC groups treated with either LDR or CA-4DP alone, (P < 0.05). Our study demonstrated the additive effect of LDR in combination with CA-4DP in suppression of HCC.

Transmissibility and mortality trends of COVID-19 epidemic in Egypt

ABSTRACT Background: Since identification of the first case on Feb. 14, Egypt had implemented several control measures. This research aimed at study the time trend of the transmissibility and mortality of COVID 19 in Egypt. Methods: Published data on daily reported cases and deaths since the start of the epidemic till week 19 were used. We estimated the basic reproductive number (R0) during the early phase of the epidemic using the simple exponential growth method (SEG) and time dependent method (TD). Then we estimated time varying effective reproductive number (Re) after implementation of the control measures by applying the TD method. Moreover, the trend in the Case Fatality Rate (CFR) throughout the study period was studied. Results: With SEG method, R0 was found to be 2.26 (2.15–2.38) and 2.58 (2.43–2.72) for infectious period of 8 and 10 days, respectively. While by the TD method, R0 was estimated to be 2.34 (95% CrI: 2.05–2.64) and 3.01 (95% CrI: 2.64–3.40) for mean ± SD of SI equals 5.8 ± 2.6 and 7.5 ± 3.4, respectively. With TD method, Re decreased from the initial value of R0 to reach 1.30 (95% crI: 1.17–1.45) in week 7. After that Re values fluctuated closely around 1. CFR reached its peak (7.7%) on April 12 then it decreased to its lowest value (3.4%) after two months before increasing slightly again to (4.1%) in the last days. Conclusion and recommendation: The initial Basic reproductive number was high in Egypt. Effective reproductive number dropped after control measures till fluctuating around one. CFR also declined over time but slight increase in the last days was observed. After relaxation of the control measures, we recommend the instantaneous monitoring of the transmissibility and mortality in Egypt.

PCV69 COST EFFECTIVENESS ANALYSIS OF TICAGRELOR VERSUS CLOPIDOGREL IN STEMI PATIENTS FROM NATIONAL HEART INSTITUTE PERSPECTIVE IN EGYPT

Acute coronary syndromes (ACS) are a major cause of morbidity and mortality in Egypt. Early diagnosis and prompt, effective therapy are essential to reverse ischemia, restore normal coronary blood flow, and limit myocardial damage .The main objective is to compare costs and outcomes associated with the use of Ticagrelor versus Clopidogrel in patients with STEMI following PCI from NHI perspective in Egypt. A cost utility study is adopted, The model design adopted was a combination of one-year decision tree followed by a long-term Markov model to ensure that all major clinical and resource generating events that a patient may experience throughout the course of their remaining life are captured . The clinical evidence was taken from PLATO-STEMI sub study , acquisition cost of drugs, monitoring cost and cost associated with each health state is collected from NHI and MOH hospitals in financial fiscal year 2019. Utilities were captured from published studies for the same target population . A discount rate of 3.5% is used for both cost &QALY, DSA and PSA were conducted. Ticagrelor over 25 year time horizon provides an incremental health gain of 16.87 QALYs compared with Clopidogrel, at an incremental cost of 243,499 EGP resulting in an ICER of 14,433 EGP/QALY. The result was below the accepted willingness to pay threshold of Egypt which is equal 86000 EGP/QALY. The costs associated with the MI health state in the first year of clopidogrel arm had the great impact on the results of the study based on the results of DSA, the results of PSA revealed from the cost-effectiveness acceptability curve that at a willingness to pay of 86000EGP per QALY, the probability of Ticagrelor being cost-effective is 100%. Ticagrelor revealed to be a cost effective treatment option for STEMI patients following PCI compared to Clopidogrel intervention from NHI perspective in Egypt.

KNOWLEDGE AND PRACTICE OF FOOT CARE IN PATIENTS WITH TYPE 1 AND 2 DIABETES AT NATIONAL INSTITUTE OF DIABETES AND ENDOCRINOLOGY IN CAIRO

Diabetes mellitus is one of the most common chronic diseases worldwide. It is one of the sixth leading causes of death in the United States. Egypt reported at least 8.6 million adults with diabetes which was the eleventh most important cause of premature mortality in Egypt. People with diabetes may develop several different foot problems as a result of nerve damage. Diabetic foot adds to economic burden due to huge expenditure on treatment, loss of productivity, frequent recurrence of the problem, and high rate of amputation. Establishing adequate knowledge and practice regarding diabetic foot care will reduce the threat of diabetic foot complications and ultimately amputation. Aim: The study determines levels of knowledge towards foot care and practices in type 1 diabetes (T1D) and type 2 diabetes (T2D). Setting: National Institute of Diabetes and Endocrinology in Cairo. Sample: About 541 patients (250 T1D and 291 T2D) was selected. Research design: Comparative descriptive exploratory design was utilized. Results: Highly significant differences were found between both groups regarding knowledge of diabetic foot care. Highly significant association was found between both groups in relation to foot care measures, no significant association between both groups as regards to levels of knowledge. A highly statistically significant association was found between the mean of knowledge scores and other variables and also with practice scores. Conclusion: Patients are aware of their disease and had desirable knowledge and poor practice of foot care. Strategies to expand a nationwide network of diabetes centers with implementation of primary prevention programs regarding foot care needed.

Genetic Variants of CYP2R1 Are Key Regulators of Serum Vitamin D Levels and Incidence of Myocardial Infarction in Middle-Aged Egyptians.

Myocardial Infarction (MI) is one of the leading causes of morbidity and mortality in Egypt and worldwide. Vitamin D deficiency has long been linked to incidence of cardiovascular diseases. Several factors were reported to contribute to serum vitamin D level including exposure to sunlight. However, genetic variations in the vitamin D metabolic pathways have also been considered as strong determinants of vitamin D levels. CYP2R1 is the major 25-hydroxylase enzyme that is responsible for the 1st activation step of vitamin D. to investigate the contribution of polymorphisms in CYP2R1 gene to vitamin D deficiency and incidence of MI in Egyptians. The study included 323 subjects; 185 MI patients and 138 healthy controls. Serum 25OHD3, 25OHD2 and total 25OHD levels were measured using LC-MS/MS. SNPs rs2060793 and rs1993116 were determined by polymerase chain reaction - restriction fragment length polymorphism (PCRRFLP) which is considered one of the most commonly used techniques in genotyping. SNP rs10766197 was detected using TaqMan allele discrimination assay. Serum 25OHD3, 25OHD2 and total 25OHD levels were found to be significantly lower in MI patients than controls. The three studied SNPs were associated with significantly different total 25OHD levels and their genotype distributions differed significantly between MI patients and controls where the high risk genotypes were AG/AA for rs2060793, AG/GG for rs1993116 and AG/AA for rs10766197. Additionally, the concurrent presence of high risk genotypes of the three studied SNPs rendered those individuals at extremely higher risk for MI than each individual SNP (OR 14.1, 95% CI (3.1-64.7), p-value = < 0.0001). Genetic variants of CYP2R1 are key determinants of serum 25OHD levels and are highly associated with MI risk.