Age-period-cohort analysis of colorectal cancer mortality in Saudi Arabia from 1990 to 2019

OBJECTIVES

The current study aimed to describe and estimate the independent effects of age, period, and cohort on colorectal cancer (CRC) mortality in Saudi Arabia from 1990 to 2019.

STUDY DESIGN

This was an epidemiological study.

METHODS

Data were obtained from the Global Burden of Disease study 2019. Age-period-cohort modelling was used to compute the net drift, local drift, cross-sectional age curve, longitudinal age curve, and rate ratios (RRs) of period and cohort of CRC mortality in Saudi Arabia.

RESULTS

In 2019, there were 1629 (95% uncertainty interval [UI]: 1263 to 2045) CRC cancer deaths in Saudi Arabia, and the age-standardised mortality rate of CRC was 9.7 (95% UI: 7.8 to 11.6) per 100,000 population. For men, between 1990 and 2019, the total number of CRC deaths increased dramatically from 199 (95% UI: 130 to 286) in 2019 to 942 (95% UI: 725 to 1228). For the period effects, the relative risk (RR) of mortality rate for both sexes followed similar monotonic increase patterns throughout the study period.

CONCLUSIONS

Results from this study highlight a concerning increase in CRC mortality rates in Saudi Arabia from 1990 to 2019, particularly among individuals aged 30-50 years. While mortality rates for men were higher at the start of the study period, more favourable trends for men were seen in the later years of the study period, indicating evolving gender disparities. Establishing evidence-based national screening guidelines and adopting multi-level diagnostics, risk assessment, and population-wide screening, especially for younger populations, is crucial.

Design, synthesis, and evaluation of 4'-phosphonomethoxy pyrimidine ribonucleosides as potential anti-influenza agents

Influenza viruses belong to the Orthomyxoviridae family and cause acute respiratory distress in humans. The developed drug resistance toward existing drugs and the emergence of viral mutants that can escape vaccines mandate the search for novel antiviral drugs. Herein, the synthesis of epimeric 4'-methyl-4'-phosphonomethoxy [4'-C-Me-4'-C-(O-CH₂ P═O)] pyrimidine ribonucleosides, their phosphonothioate [4'-C-Me-4'-C-(O-CH₂ P═S)] derivatives, and their evaluation against an RNA viral panel are described. Selective formation of the α- l-lyxo epimer, [4'-C-(α)-Me-4'-C-(β)-(O-CH₂ -P(═O)(OEt)₂ )] over the β- d-ribo epimer [4'-C-(β)-Me-4'-C-(α)-(O-CH₂ -P(═O)(OEt)₂ )] was explained by DFT equilibrium geometry optimizations studies. Pyrimidine nucleosides having the [4'-C-(α)-Me-4'-C-(β)-(O-CH₂ -P(═O)(OEt)₂ )] framework showed specific activity against influenza A virus. Significant anti-influenza virus A (H1N1 California/07/2009 isolate) was observed with the 4'-C-(α)-Me-4'-C-(β)-O-CH₂ -P(═O)(OEt)₂ -uridine derivative 1 (EC₅₀  = 4.56 mM, SI₅₀  > 56), 4-ethoxy-2-oxo-1(2H)-pyrimidin-1-yl derivative 3 (EC₅₀  = 5.44 mM, SI₅₀  > 43) and the cytidine derivative 2 (EC₅₀  = 0.81 mM, SI₅₀  > 13), respectively. The corresponding thiophosphonates 4'-C-(α)-Me-4'-C-(β)-(O-CH₂ -P( S)(OEt)₂ ) and thionopyrimidine nucleosides were devoid of any antiviral activity. This study shows that the 4'-C-(α)-Me-4'-(β)-O-CH₂ -P(═O)(OEt)₂ ribonucleoside can be further optimized to provide potent antiviral agents.

Autistic traits and obsessive-compulsive personality traits in OCD patients

Background

Studies have reported a high prevalence of autism spectrum disorder in young people with obsessive-compulsive disorder with a negative effect on psychosocial functioning. However, the extent to which autism spectrum disorder and obsessive-compulsive personality disorder traits overlap and by inference, the extent to which these separately classified Diagnostic and Statistical Manual of Mental Disorders disorders five (obsessive-compulsive personality disorder, personality disorder, autism spectrum disorder, neurodevelopmental disorder) may share a nosological relationship has not so far been systematically investigated in clinical samples.

This study is done to detect the frequency of obsessive-compulsive personality traits and autistic traits in a sample of patients with obsessive-compulsive disorder.

Results

Results revealed that younger patients had significantly more severe and extreme obsessive-compulsive disorder scores. Moreover, Structured Clinical Interview for DSM-IV (SCID-II) and Autism Spectrum Quotient analysis revealed that younger patients had a significantly higher prevalence of personality traits and autistic traits respectively. Statistical significance as many patients with severe and extreme Yale-Brown Obsessive-Compulsive Scale showed criteria of obsessive-compulsive personality disorder. No association of statistical significance was found between obsessive-compulsive disorder severity and autistic trait presence. On the contrary, statistical significance was found between autistic traits and obsessive-compulsive personality disorder.

Conclusions

There is the presence of comorbidity of obsessive-compulsive personality traits and autism spectrum traits in obsessive-compulsive disorder patients. Obsessive-compulsive personality traits prevalence in obsessive-compulsive disorder patients was higher than in autistic traits. Several factors of genetic predisposition, environmental factors like education and marital status, employment, and intrinsic factors as age of patients all exhibited a pivotal role in obsessive-compulsive disorder prevalence and severity.

Impact of slaking shale behaviour on damage of engineering structures, Saudi Arabia

Shale slaking has caused problems on infrastructure and buildings in Tabuk City, Saudi Arabia. Most of these problems occur in the form of subsidence, cracking and loss of bearing capacity related to the slaking more than the expansion of clay minerals in shale. The aim of this research is to study the possible causes of such problems in Tabuk districts. The geotechnical properties of Tabuk shale indicate that the shale has a low degree of expansion. X-ray diffraction analysis confirms that kaolinite is the predominant clay mineral, while expansive clay minerals are not present. Based on slake durability index, disintegration ratio and shale rating system, the shale is classified as soil-like with low to medium durability. Scanning electron microscopy results indicate that the development of gypsum crystals could be a crucial factor in the degradation. Pore-air compression and crystal growth or the dissolution of gypsum and halite minerals are significant slaking mechanisms in triggering the disintegration of shale because they disturb the structure and destroy the diagenetic bonds of shale, which reduces the strength. The damage is not related to the expansion of clay minerals within the shale but is significantly influenced by the slaking of shale and its transition from rock-like to soil-like material.

The effect of preoperative oral administration of prednisolone on postoperative pain in patients with symptomatic irreversible pulpitis: a single-centre randomized controlled trial

AIM

This single-centre randomized, double-blind, placebo-controlled clinical trial assessed the effect of a preoperative, single, oral dose of prednisolone on postoperative pain and postoperative analgesic intake in patients with symptomatic, irreversible pulpitis in mandibular molars.

METHODOLOGY

Four hundred participants, randomly assigned to two equal groups, received either 40 mg prednisolone or placebo tablets 30 min before single-visit root canal treatment. Patients recorded their pain level 6, 12 and 24 h after treatment on a 100-mm visual analogue scale. All patients received a sham capsule to take if needed as a postoperative analgesic, and, if the pain persisted, an analgesic was prescribed. The relative risk reduction and 95% confidence intervals (CI) were estimated for binary data. Mann-Whitney U-test was used to compare postoperative pain intensity between groups.

RESULTS

The relative risk reduction in pain incidence was 20.31% (95% CI: 12.03%, 27.82%) at 6 h, 23.39% (95% CI: 14.75%, 31.16%) at 12 h and 28.85% (95% CI: 18.08%, 38.20%) at 24 h. Prednisolone had significantly less post-obturation pain intensity compared to placebo at 6, 12 and 24 h (P < 0.001). The relative risk reduction in sham-capsule intake was 54% (95% CI: 38%, 66%) and of analgesic intake was 55% (95% CI: 3%, 79%). No adverse effects were recorded.

CONCLUSION

Preoperative oral administration of a single dose of 40 mg prednisolone was beneficial to control short-term post-obturation pain after single-visit root canal treatment in patients with symptomatic irreversible pulpitis reducing pain incidence after 24 h by approximately 30% and postoperative analgesic intake by approximately 55%.

Preliminary characterization of human skin microbiome in healthy Egyptian individuals

Human skin is a large, complex ecosystem that harbors diverse microbial communities. The rapid advances in molecular techniques facilitate the exploration of skin associated bacterial populations. The objective of this study was to perform a preliminary characterization of skin associated bacterial populations in Egyptian individuals. Samples were collected from five healthy subjects from two skin sites; Antecubital Fossa (AF) and Popliteal Fossa (PF). Genomic DNA was extracted and used to amplify bacterial 16S rRNA genes which were sequenced on Illumina MiSeq platform. The two sites showed distinct diversity where PF was more diverse than AF. Taxonomic analysis of sequences revealed four main phyla Proteobacteria, Firmicutes, Actinobacteria and Deinococcus-Thermus, with Proteobacteria presenting the highest diversity. Klebsiella, Bacillus, Pseudomonas and Escherichia were the most predominant genera. Our data suggest that environmental factors can shape the composition of the skin microbiome in certain geographical regions. This study presents a new insight for subsequent analyses of human microbiome in Egypt.

Geographic distribution of hematopoietic cancers in the Nile delta of Egypt

BACKGROUND

Previous evidence indicated that incidence rates of non-Hodgkin's lymphoma (NHL) are high in Egypt although little is known about risk factors.

MATERIALS AND METHODS

Using data from the population-based cancer registry of Gharbiah governorate in Egypt, we assessed the 1999-2005 incidence of hematopoietic cancers (HCs) based on the ICD-O3 by age- and sex-specific urban-rural distribution.

RESULTS

NHL showed the highest incidence among all HCs (11.7 per 100 000). Urban incidence of HCs was higher than rural incidence. Incidence rates of Hodgkin's lymphoma (HL) and NHL were high especially among urban males up to the 64-year age category. Rural incidence of HL and NHL was high below age 20. Among the districts of the governorate, we observed NHL incidence pattern similar to that observed for hepatocellular carcinoma because of the possible link to hepatitis C virus for both cancers. Comparison to the published HCs data from Algeria, Cyprus, and Jordan showed the highest NHL rate in Egypt than the other countries in the region.

CONCLUSIONS

Future studies should define the role of environmental exposures in hematopoietic carcinogenesis in this population. In-depth studies should also investigate the role of access to health care in the urban-rural variation of HC distribution in this population.

Urban-rural differences of gynaecological malignancies in Egypt (1999-2002)

OBJECTIVE

In previous studies, we have shown a three to four times higher urban incidence of breast cancer and estrogen receptor-positive breast cancers in the Gharbiah Province of Egypt. We investigated the urban-rural incidence differences of gynaecologic malignancies (uterine, ovarian and cervical cancers) to explore if they show the same trend that we found for breast cancer.

DESIGN

Cancer registry-based incidence comparison.

SETTING

Gharbiah population-based cancer registry (GPCR), Tanta, Egypt.

SAMPLE

All patients with uterine, ovarian and cervical cancer in GPCR from 1999 to 2002.

METHODS

We calculated uterine, ovarian and cervical cancer incidence from 1999 to 2002. For each of the three cancers, we calculated the overall and age-specific rates for the province as a whole, and by urban-rural status, as well as for the eight districts of the province.

RESULTS

Incidence of all three cancer sites was higher in urban than in rural areas. Uterine cancer showed the highest urban-rural incidence rate ratio (IRR = 6.07, 95% CI = 4.17, 8.85). Uterine cancer also showed the highest urban incidence in the oldest age group (70+ age category, IRR = 14.39, 95% CI = 4.24, 48.87) and in developed districts (Tanta, IRR = 4.14, 95% CI = 0.41, 42.04). Incidence rates by groups of cancer sites showed an increasing gradient of urban incidence for cancers related to hormonal aetiology, mainly of the breast and uterus (IRR = 4.96, 95% CI = 2.86, 8.61).

CONCLUSIONS

The higher urban incidence of uterine cancer, coupled with our previous findings of higher incidence of breast cancer and estrogen receptor positive breast cancer in urban areas in this region, may be suggestive of possible higher exposure to environmental estrogenic compounds, such as xenoestrogens, in urban areas.

A Study of Dementia in Home Care Patients in Qatar with the Psychosocial Burden on Caregivers

Dementia is characterized by progressive deterioration of cognitive functions. It places a burden on caregivers and on society,and has been established as one of the major challenges of the present time. A retrospective study of 350 home care patients in Qatar found 50 with dementia for which it assessed various risk factors, co-morbities and the psychosocial burden on the care givers. It was found that the two major types of dementia, Alzheimer's disease and Vascular dementia had equal occurrence amongst home care patients in Qatar, with hypertension and atherosclerosis being the major contributing factors; a family history of dementia played only a minor role. Depression was the main co-morbidity in the patients. The care givers, mostly female, showed no significant psychosocial burden.

A classification of drug substances according to their mechanism of action

Different classification systems for therapeutic agents exist. The most commonly used one is the ATC Code (ATC: Anatomy, Therapeutic properties, Chemical, pharmacological properties). Here, an alternative classification system (TCAT: Target-Chemistry-Anatomy-Therapy) is proposed which refers to the molecular mechanism of action or rather, target. The main subgroups of targets are: enzymes; substrates, metabolies, proteins; receptors; ion channels; transporter molecules and systems; nucleic acids, ribosomes; physicochemical mechanisms; antigen-antibody reactions; unknown targets. This target-oriented approach may be particularly useful in teaching advanced medicinal chemistry.

Evaluation of tumour markers in molar pregnancy

METHODS

Circulating CA 125, CA 19-9, CA 15-3 and carcinoembryonic antigen (CEA) levels were studied in sixty patients with hydatidiform mole and in twenty normal pregnant women of a corresponding duration of pregnancy.

DISCUSSION

Serum levels of CA 125, CA 15-3 and CEA are not affected by molar pregnancy. The mean level of CA 19-9 in maternal serum is significantly lower in cases of molar pregnancy when compared with cases of normal pregnancy. The amnion cell origin of CA 19-9 could explain the statistically significant difference between cases of therapeutic abortion and cases of HM (complete HM lacks amniotic membrane).

Prevalence of hepatitis B infection markers in Lebanese children: the need for an expanded programme on immunization

This multi-centre, cross-sectional study was designed to reveal the present status of hepatitis B infection markers among Lebanese children, and provide recommendations regarding childhood immunization policies. A total of 841 children, aged between 6 months and 6.5 years, were enrolled from Lebanon's five districts. Their sera were tested for hepatitis B surface antigen and hepatitis B core IgG. The overall prevalence of hepatitis B virus infection markers was 0.8% with increasing age-specific rates from 0% at 6 months to 1.3 % at > 5 years. There was no statistically significant association between the presence of hepatitis B markers and family characteristics or risk factors for infection. The highest prevalence rates were among children from Beirut suburbs (2.9 %) and South Lebanon (1.6%). The risk of horizontal transmission of hepatitis B to uninfected children increased substantially after the age of 2 years. An expanded programme on immunization that integrates hepatitisB vaccine during the first year of life is needed.

Anti-fasciola IgG isotypes among patients with fascioliasis before and after treatment

Stool examination using modified Kato thick smear method was performed to detect Fasciola eggs and other parasites. Abdominal pain was the major presenting symptom (83.3%) followed by pallor (71.6%) and fever (16.7%). Anaemia and hepatomegaly were recorded in 70% of patients compared to 25% with splenomegaly. Abdominal ultrasonography revealed hepatomegaly and common bile duct dilatation in 70% of patients. Moreover, 6 cases showed Olympic game rings which is diagnostic. All of patients had positive IgG4 levels, 58 cases were found positive for specific total IgG and IgG1, whereas, only 36 cases had positive IgG2 levels (60%). All negative control group showed no cross reactions. On the other hand, ELISA detecting IgG4 showed the highest specificity (95%), followed by IgG2 (85%) and the least specific test was obtained with detection of IgG (70%) and IgG1 (65%). One week after treatment, 90% of patients were completely cured. One and 3 months after treatment, the cure rate was 83.3%. In completely cured patients, none of anti-Fasciola isotypes was significantly changed.

Solidification as low cost technology prior to land filling of industrial hazardous waste sludge

The aim of this study is to stabilize and solidify two different treated industrial hazardous waste sludges, which were selected from factories situated close to Alexandria. They were selected to ensure their safe transportation and landfill disposal by reducing their potential leaching of hazardous elements, which represent significant threat to the environment, especially the quality of underground water. The selected waste sludges have been characterized. Ordinary Portland Cement (OPC), Cement Kiln Dust (CKD) from Alexandria Portland Cement Company, and Calcium Sulphate as a by-product from the dye industry were used as potential solidification additives to treat the selected treated waste sludges from tanning and dyes industry. Waste sludges as well as the solidified wastes have been leach-tested, using the General Acid Neutralization Capacity (GANC) procedure. Concentration of concerning metals in the leachates was determined to assess changes in the mobility of major contaminants. The treated tannery waste sludge has an acid neutralization capacity much higher than that of the treated dyes waste sludge. Experiment results demonstrated the industrial waste sludge solidification mix designs, and presented the reduction of contaminant leaching from two types of waste sludges. The main advantages of solidification are that it is simple and low cost processing which includes readily available low cost solidification additives that will convert industrial hazardous waste sludges into inert materials.

Study of the role of parvo virus B19 in arthropathies of Egyptian adult cases

This work was done to assess the relation between HPV B19 infection and arthropathies in Egyptian adults cases. For this purpose 40 rheumatoid arthritis (RA) cases, 10 osteoarthritis cases and 10 systemic lupus erythematosus (SLE) cases were selected to represent different types of arthropathies. The selection of cases was based on clinical diagnosis and laboratory tests (ESR, Hb level, Rose waller, detection of antinuclear antibodies and detection of hidden rheumatoid factor). HPV B19 IgM and IgG were searched for by ELISA test in their sera as indicator of the state of HPV B19 infection. A control group was also included in this study, as 30 healthy persons with no previous complaint of rheumatic symptoms. HPV B19 IgM was detected in 60% of patients with RA, 40% of osteoarthritis cases and None of the SLE cases. Positive cases were more among females with long duration of illness affecting both big and small joints. These results indicated a possible causal association between acute HPV B19 and arthropathy. As regards HPV B19 IgG, it was detected in 57% of RA cases, 60% of osteoarthritis cases and 40% of SLE. The difference in IgG was statistically insignificant from the control group (46.7%). The presence of HPV B19 IgG antibodies indicates previous exposure to the virus but does not indicate its time. Detection of HPV B19 IgM or rising titer of HPV B19 IgG may lead to early diagnosis of HPV B19 arthropathies.

Effect of Norplant implants on the pituitary-adrenal axis function and reserve capacity

The present work investigated the effects of Norplant implants on the pituitary-adrenal function among 15 users of Norplant implants prior to and 6 months after insertion of the implants. Serum cortisol levels and their diurnal variations, ACTH and 24-h urinary 17-ketosteroids, ketogenic steroids, 17-hydroxy steroids, and creatinine, were measured. Also, a dynamic test (the 5-h Synacthen depot = ACTH stimulation test) was done before and 6 months after implants insertion. The 9 a.m. cortisol levels were blunted (within the normal ranges) while the 6 p.m. values were unaltered. The 24-h urinary ketogenic, hydroxy, and ketosteroids were also unchanged after Norplant implants use. The ACTH stimulation test showed a decreased adrenal response which was also within normal ranges. These data should raise the question related to suprarenal response to acute or prolonged stresses, such as surgical operations or shock in women using Norplant implants.

Chlamydial serology among patients with tubal factor infertility and ectopic pregnancy in Alexandria, Egypt

BACKGROUND AND OBJECTIVES

Little is known about the role of Chlamydia trachomatis in the etiology of tubal factor infertility and ectopic pregnancy in Egypt.

GOAL OF THIS STUDY

To assess the association between past chlamydial infection, tubal factor infertility, and ectopic pregnancy in an Egyptian population.

STUDY DESIGN

This report consists of two concurrent case-control studies. First, 51 patients with tubal factor infertility were compared with 48 healthy subjects who did not have tubal factor infertility and 53 pregnant subject subjects. Second, 66 patients with ectopic pregnancy were compared with 51 pregnant control subjects.

RESULTS

Geometric mean titers for Chlamydia trachomatis were higher among patients with tubal factor infertility and ectopic pregnancy, and they were more likely to have high antichlamydial titers (> or = 1:128 immunoglobulin G). Serum titer was significantly correlated with histologic evidence of salpingitis among the patients with an ectopic pregnancy.

CONCLUSION

Our findings, similar to those from Western societies, suggest that among Egyptian women, prior chlamydial infection is associated with an increased risk of tubal factor infertility and possibly ectopic pregnancy.

Chlamydial serologic characteristics among intrauterine contraceptive device users: does copper inhibit chlamydial infection in the female genital tract?

OBJECTIVE

Our objective was to assess the association between copper intrauterine contraceptive device use and the level of antichlamydial antibodies.

STUDY DESIGN

Fifty-four women (29 with history of ectopic pregnancy, 2 with non-tubal factor infertility, 1 with tubal factor infertility, and 22 with intact intrauterine pregnancies) with current or prior intrauterine contraceptive device use were compared with 60 prenatal control subjects with respect to antichlamydial antibodies.

RESULTS

When the intrauterine contraceptive device user group was subdivided into copper users and Lippes Loop device users, a significantly lower geometric mean serum antibody titer among copper intrauterine contraceptive device users was detected. The odds ratio estimates for past chlamydial exposure (> or = 1:64 immunoglobulin G, > or = 1:128 immunoglobulin G) in users of noncopper versus copper intrauterine contraceptive devices were 9.1 (95% confidence interval 1.9 to 43.0) and 10.5 (95% confidence interval 1.5 to 71.8), respectively.

CONCLUSIONS

The lower geometric mean serum antibody titer of antichlamydial antibody among copper versus Lippes Loop device users and the large association measured between past chlamydial infection and noncopper intrauterine contraceptive device use suggest that copper may have a protective effect against Chlamydia trachomatis infection or a suppressive effect on development of antichlamydial antibodies.

Advanced breast cancer in Egyptian women: clinical features and response to endocrine therapy. The Anglo-Egyptian Health Agreement Collaborative Study

Response to endocrine therapy and its relationship to the clinical features of the disease were studied in 84 Egyptian patients with inoperable, locally advanced or metastatic breast cancer. Twenty-four premenopausal patients were treated by oophorectomy with or without concurrent prednisolone. Only one of 20 evaluable patients achieved an objective response. Median time to progression for premenopausal patients was 3 months. Sixty postmenopausal patients received tamoxifen 10 mg twice daily either alone or with prednisolone. Fourteen of 57 (25%) evaluable patients achieved an objective response (four complete remission, 10 partial remission). Median duration of response was 13 months and median time to progression for all postmenopausal patients was 5 months (range 1-30 months). The outcome for postmenopausal patients was similar to that found in a parallel study at Guy's Hospital, London. The response rate for premenopausal Egyptian patients was, however, disappointing and lends support to the claim that breast cancer in Egyptian women is particularly aggressive.

Postmenopausal endometrial patterns and serum estradiol concentrations

Eighty postmenopausal women were subjected to endometrial biopsy. Inadequate biopsy was recorded in 30 cases. In the remaining cases (n = 50) the correlation between endometrial patterns and serum estradiol (E2) was performed. These cases were presenting with uterine bleeding (n = 38) or minor gynecological symptoms (n = 12). Proliferative endometrium was the predominant endometrial pattern whereas endometrial malignancy was only present in 15.8% of the bleeding cases. Serum E2 was significantly elevated in cases having malignant endometrium or adenomatous hyperplasia compared to cases having other endometrial patterns. Serum E2 measurement is recommended as a simple screening test for the detection of postmenopausal endometrial hyperplasia and/or malignancy.