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IntroductionNeurophobia, defined as a fear or aversion toward neuroscience and clinical neurology study, was first introduced by Dr. Ralph Jozefowicz in 1994. This study aimed to assess the prevalence and contributing factors of neurophobia among clinical-year medical students at Badr University in Cairo (BUC) and Helwan University. Given the high incidence of neurological disorders in Egypt, addressing neurophobia is crucial to encourage medical students to pursue neurology and help meet the country’s growing healthcare needs.MethodsA cross-sectional study was conducted on 1,235 clinical-year medical students from BUC and Helwan University. Quantitative data were collected using the Schon questionnaire and NeuroQ scale. Additionally, focus group discussions (FGDs) involving 62 students provided qualitative insights.ResultsNeurophobia was more prevalent among BUC students (47.7%) compared to Helwan students (26%). Male students reported higher levels of neurophobia, yet expressed greater confidence in neurology than female students. The perceived complexity of neuroanatomy (43.4%), lack of clinical exposure (52.5%), and excessive theoretical content (40.3%) were the main contributing factors. Early clinical exposure and more interactive teaching methods were strongly preferred by the students.ConclusionNeurophobia represents a major educational barrier and contributes to the global shortage of neurologists. A little is known regarding neurophobia among Egyptian medical students. Proposed solutions include adopting active learning strategies and reducing the time gap between neuroscience and neurology to enhance students’ confidence to reduce neurophobia among undergraduates. Yet, more studies are needed to reveal more about neurophobia prevalence, factors, and suggested plans to overcome.

BackgroundAttention-deficit hyperactivity disorder (ADHD) has a high comorbidity with substance use disorders (SUDs). The overlap between ADHD and SUD in both adolescents and adults is one of the areas of increasing clinical and public health interest. The current study aimed to investigate the demographic and clinical characteristics of individuals with ADHD and comorbid SUDs during the adolescence period in comparison with those with ADHD without SUDs. Thirty adolescents aged 13–21 with ADHD, half of them with comorbid SUD, were interviewed using the Kiddie Schedule of affective disorders and schizophrenia. The Arabic version of Conners’Parent Rating Scale, urine screening for substances of abuse and the electronic version of the Continuous performance test-3 (X-version) (CPT3-X) were used to evaluate the adolescents.ResultsSubjects with ADHD and SUD were more likely to be males (86.7%) older than 17 years (73.3%). They showed higher impulsivity and lower vigilance on CPT3-X than those with ADHD alone. The hyperactive/impulsive subtype of ADHD was the most significant variable that predicted comorbid SUD (p = 0.016), followed by comorbid conduct disorder (p = 0.017), then severe degree of ADHD (p = 0.018), and finally commission errors which indicates impulsivity in ADHD patients in CPT3-X (p value 0.029).ConclusionsOlder males with severe ADHD, prominent hyperactive/impulsive symptoms, and comorbid conduct problems are at a specifically high risk to use substances during adolescence. High commission errors and high variability of performance in CPT might also distinguish youth with ADHD + SUD from those with ADHD only. Early intervention programs should be put in place to identify and protect these subjects from substance use in their early years of adolescence.

The study aims at analyzing the epidemiological, clinical and entomological characteristics of Darfur yellow fever epidemic. It is a descriptive, cross-sectional study. According to operational case definition, suspected yellow fever cases are included in case spread sheet with variables like age, sex, locality, occupation, status of vaccination, onset of symptoms, presenting symptoms, date of blood sampling and confirmation of diagnosis either by laboratory results or epidemiological link. Data about important entomological indices were collected by surveys conducted in 17 localities of 3 Darfur states (Central, West and south Darfur). All Darfur states (especially Central Darfur) have been affected by Yellow Fever outbreak. There is a need to review the non-specific case definition of Yellow Fever which seems to overwhelm the system during outbreaks with cases of other endemic diseases. The significant risk factors of this outbreak included male sex, adult age, outdoor occupation and traditional mining. The fatality rate was significantly associated with vaccination status. The highest fatality rate was recorded by children less than 2 years old (42.9%). Generally, increase in certain entomological indices was followed by increase in number of reported cases 7 days later. Central Darfur state was significantly higher in most studied entomological indices.

Background End colostomy rates following colorectal resection vary across institutions in high‐income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left‐sided colorectal resection. Methods This study comprised an analysis of GlobalSurg‐1 and ‐2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left‐sided colorectal resection within discrete 2‐week windows. Countries were grouped into high‐, middle‐ and low‐income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left‐sided colorectal resection were included: 113 (6·9 per cent) from low‐HDI, 254 (15·5 per cent) from middle‐HDI and 1268 (77·6 per cent) from high‐HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low‐ compared with middle‐ and high‐HDI settings. The association with colostomy use in low‐HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left‐sided colorectal resection based on income, which went beyond case mix alone. This secondary analysis of an international prospective multicentre observational study demonstrates significant variation in the proportion of patients receiving an end stoma after left‐sided colorectal resection between high‐ and low–middle‐income countries; this cannot be accounted for by case mix alone. This could relate to unmeasured patient risk characteristics, but may also reflect delayed access to surgical care, lack of equipment for anastomosis formation, or differences in subspecialist colorectal training. Wide variation in stoma rates

IntroductionSurgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings.MethodsA multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI).ResultsOf 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI.ConclusionThe odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.

Aim： Energy-restriction mimetic agents （ERMAs） are small-molecule agents that target various aspects of energy metabolism, which has emerged as a promising approach in cancer therapy. In the current study, we tested the ability of OSU-CGS, a novel ERMA, to tar- get human colorectal cancer （CRC） in vitro. Methods： Two human CRC cell lines （HCT-116 and Caco-2） were tested. Cell viability was assessed using MTT assay. Caspase-3/7 activities were measured using Caspase-GIo 3/7 assay kit. Western blot analysis was used to measure the expression of relevant pro- teins in the cells. Glucose consumption of the cells was detected using glucose uptake cell-based assay kit. Results： OSU-CG5 dose-dependently inhibited HCT-116 and Caco-2 cell proliferation with the ICso values of 3.9 and 4.6 μmol/L, respec- tively, which were 20-25-fold lower than those of resveratrol, a reference ERMA. Both OSU-CG5 （5, 10, and 20 μmol/L） and resvera- trol （50, 100, and 200 μmol/L） dose-dependently increased caspase-3/7 activity and PARP level in the cells. Furthermore, both OSU- CG5 and resveratrol induced dose-dependent energy restriction in the cells： they suppressed glucose uptake and Akt phosphoryla- tion, decreased the levels of p-mTOR and p-pTOS6K, increased the levels of ER stress response proteins GRP78 and GADD153, and increased the level of β-TrCP, which led to the downregulation of cyclin D1 and Spl. Conclusion： OSU-CG5 exhibits promising anti-cancer activity against human CRC cells in vitro, which was, at least in part, due to energy restriction and the consequent induction of ER stress and apoptosis.

Alcohol consumption has been commonly associated with gastric mucosal lesions including gastric ulcer. Diosmin (DIO) is a natural citrus flavone with remarkable antioxidant and anti-inflammatory features that underlay its protection against cardiac, hepatic and renal injuries. However, its impact on gastric ulcer has not yet been elucidated. Thus, the current study aimed to investigate the potential protective effects of DIO against ethanol-induced gastric injury in rats. Pretreatment with DIO (100 mg/kg p.o.) attenuated the severity of ethanol gastric mucosal damage as evidenced by lowering of ulcer index (UI) scores, area of gastric lesions, histopathologic aberrations and leukocyte invasion. These actions were analogous to those exerted by the reference antiulcer sucralfate. DIO suppressed gastric inflammation by curbing of myeloperoxidase (MPO) and tumor necrosis factor-α (TNF-α) levels along with nuclear factor kappa B (NF-κB) p65 expression. It also augmented the anti-inflammatory interleukin-10 (IL-10) levels. Meanwhile, DIO halted gastric oxidative stress via inhibition of lipid peroxides with concomitant enhancement of glutathione (GSH), glutathione peroxidase (GPx) and the total antioxidant capacity (TAC). With respect to gastric mucosal apoptosis, DIO suppressed caspase-3 activity and cytochrome C (Cyt C) with enhancement of the anti-apoptotic B cell lymphoma-2 (Bcl-2) in favor of cell survival. These favorable actions were associated with upregulation of the gastric cytoprotective prostaglandin E2 (PGE2) and nitric oxide (NO). Together, these findings accentuate the gastroprotective actions of DIO in ethanol gastric injury which were mediated via concerted multi-pronged actions, including suppression of gastric inflammation, oxidative stress and apoptosis besides boosting of the antioxidant and the cytoprotective defenses.

Despite its broad applications, cisplatin affords considerable nephro- and hepatotoxicity through triggering inflammatory and oxidative stress cascades. The aim of the current investigation was to study the possible protective effects of tangeretin on cisplatin-induced hepatotoxicity. The impact of tangeretin on cisplatin-evoked hepatic dysfunction and histopathologic changes along with oxidative stress, inflammatory and apoptotic biomarkers were investigated compared to silymarin. Tangeretin pre-treatment significantly improved liver function tests (ALT and AST), inhibited cisplatin-induced lipid profile aberrations (total cholesterol and triglycerides) and diminished histopathologic structural damage in liver tissues. Tangeretin also attenuated cisplatin-induced hepatic inflammatory events as indicated by suppression of tumor necrosis factor-α (TNF-α) and enhancement of interleukin-10 (IL-10). Meanwhile, it lowered malondialdehyde (MDA), nitric oxide (NO) and nuclear factor erythroid 2-related factor 2 (NRF-2) levels with restoration of glutathione (GSH), and glutathione peroxidase (GPx). Regarding mitogen-activated protein kinase (MAPK) pathway, tangeretin attenuated cisplatin-induced increase in phospho-p38, phospho-c-Jun N-terminal kinase (p-JNK) and phospho-extracellular signal-regulated kinase (p-ERK1/2) in liver tissues. In addition, tangeretin downregulated Bax expression with augmentation of Bcl-2 promoting liver cell survival. Our results highlight the protective effects of tangeretin against cisplatin-induced acute hepatic injury via the concerted modulation of inflammation, oxidative stress, MAPKs and apoptotic pathways.

COVID-19 still poses a worldwide health threat due to continuous viral mutations and potential resistance to vaccination. SARS-CoV-2 viral multiplication hindrance by inhibiting the viral main protease (Mpro) deemed propitious. Structure-based virtual screening (SBVS) is a conventional strategy for discovering new inhibitors. Nonetheless, the SBVS efforts against Mpro variants needed to be benchmarked. Herein, in the first stage of the study, we evaluated four docking tools (FRED, PLANTS, AutoDock Vina and CDOCKER) via an in-depth benchmarking approach against SARS-CoV2 Mpro of both the wild type (WTMpro) and the deadly Omicron P132H variant (OMpro). We started by compiling an active dataset of non-covalent small molecule inhibitors of the WTMpro from literature and the COVID-Moonshot database along with generating a high-quality benchmark set via DEKOIS 2.0. pROC-Chemotype plots revealed superior performance for AutoDock Vina against WTMpro, while both FRED and AutoDock Vina demonstrated excellent performance for OMPro. In the second stage, VS was performed on a focused library of 636 compounds transformed from the early-enriched cluster related to perampanel via a scaffold hopping approach. Subsequently, molecular dynamics (MD) simulation and MM GBSA calculations validated the binding potential of the recommended hits against both explored targets. This study provides an example of how to conduct an in-depth benchmarking approach for both WTMPro and OMPro variants and offering an evaluated SBVS protocol for them both.