Background: Patients with symptoms of obstructive sleep apnea (OSA) present to nearly all physicians irrespective of their specialties. A basic knowledge of OSA is considered essential to identify those patients for appropriate referral and treatment. This study aimed to assess the knowledge and attitude of Sharkia Governorate Critical Care physicians regarding OSA using a standard validated questionnaire. Results: This cross-sectional survey study was performed on a sample of Sharkia Governorate physicians, from all critical care units in tertiary and secondary hospitals including the following specialties: chest, internal medicine, neurology, cardiology, pediatric, and anesthesia. The OSA knowledge and attitudes (OSAKA) questionnaire that consists of 18 knowledge assessment questions and the OSA attitude questionnaire that consists of 6 attitude assessment questions were used. A total of 231, out of 296 invited physicians, completed the given questionnaire with a response rate of 78%. The mean score for knowledge assessment was 10.05 ± 2.3 with a 33.3% adequate response, while the mean score for attitude assessment was 3.75 ± 1.22 with a 59.3% adequate response. The mean OSA knowledge (12.5 ± 2.42) and attitude (5 ± 0.78) scores were highest among chest physicians when compared to physicians from other specialties (p < 0.001). A significant positive correlation between knowledge and attitude scores was found among Sharkia Governorate critical care physicians (r = 0.55, p < 0.001). Conclusions: The level of knowledge of OSA among Sharkia Governorate critical care physicians was far from optimal whereas the attitude regarding OSA was acceptable.

Background. The current global pandemic of COVID-19 is considered a public health emergency. The diagnosis of COVID-19 depends on detection of the viral nucleic acid by real time reverse transcription polymerase chain reaction (RT-PCR). However, false-negative RT-PCR tests are reported and could hinder the control of the pandemic. Chest computed tomography could achieve a more reliable diagnosis and represent a complementary diagnostic tool. Aim. To perform a meta-analysis and systematic review to find out the role of chest computed tomography versus RT-PCR for precise diagnosis of COVID-19 infection. Methods. We searched three electronic databases (PubMed, ScienceDirect, and Scopus) from April 1 to April 20, 2020, to find out articles including the accuracy of chest computed tomography scan versus RT-PCR for diagnosis of SARS-CoV-2 infection. Observational studies, case series, and case reports were included. Results. A total of 238 articles were retrieved from the search strategy. Following screening, 39 articles were chosen for full text assessment and finally 35 articles were included for qualitative and quantitative analysis. Chest computed tomography showed a wide range of sensitivity varied from 12%–100%. Conclusion. Chest computed tomography is playing a key role for diagnosis and detection of COVID-19 infection. Computed tomography image findings may precede the initially positive RT-PCR assay.

Previous studies have shown that environmental exposure to heavy metals has been related to epigenetic changes, such as DNA methylation in receptors involved in pathogenesis of asthma. One of these receptors is beta-2 adrenergic receptor ( ADRB2). We conducted this study to examine the association between blood aluminum concentration, blood ADRB2 5′ untranslated region (5′-UTR) methylation level, and childhood asthma control level. Our results showed a significant positive association between high blood aluminum concentration (odds ratio, 16, 95% confidence interval (CI) [3.57 to 71.76], p < 0.001) and high blood ADRB2 5′-UTR methylation level (odds ratio, 4.75, 95% CI [1.39 to 16.2], p = 0.013), and risk of uncontrolled asthma. Multivariable logistic regression revealed that higher blood aluminum concentration was independently associated with increased risk of uncontrolled bronchial asthma (odds ratio, 9.10, 95% CI [2.38 to 34.85], p = 0.0013], after controlling for age, sex, and blood ADRB2 5′-UTR methylation level. In addition, blood ADRB2 5′-UTR methylation level significantly correlated with whole blood aluminum concentration in asthmatic children ( r = 0.480, p < 0.001). We concluded that increasing blood aluminum concentration is an important independent correlate of risk for uncontrolled bronchial asthma as well as increased blood aluminum concentration caused ADRB2 5′-UTR hyper-methylation with increasing risk of uncontrolled bronchial asthma.

Background: 1, 25-dihydroxy vitamin D3 (VitD3) can improve the effect of allergenspecific immunotherapy (SIT). Few data is available about its role in childhood asthma. Objective: To assess the immunological and clinical efficacy of VitD3 as an adjuvant to allergen specific immunotherapy in pediatric asthma. Methodology: Sixty nine children with atopic asthma were divided into three groups: a group received subcutaneous immunotherapy (SCIT) in combination with VitD3 (n=23), another group received SCIT alone (n=23), and the last group VitD3 alone (n=23). All children were assessed at baseline, and six months for rate of inhaled corticosteroid (ICS) discontinuation, and serum levels of IL-10, and IL-17A. Results: In the SCIT + vitD3, ICS discontinuation rate was higher compared to VitD3 alone group and SCIT alone group at the end of 6th month (P=0.555 and 0.016 respectively). The combined SCIT+ VitD3 group showed significant increase of serum IL-10 level in comparison to SCIT alone group and VitD3 alone group (P=0.000) and significant decrease in serum IL-17A level compared to VitD3 alone group (P= 0.011) Conclusion: VitD3 enhance the clinical and immunological outcomes of SIT in pediatric asthma. Further investigation is needed to evaluate this effect in a larger scale to confirm its role as an adjunct to SIT.

Background: Coronavirus Disease 2019 (COVID-19) is a paramount public health issue. The true statistics about COVID-19 in Egypt are veiled. Aim: To determine the incidence rate of moderate and severe SARS-CoV-2 infection among the patients seeking admission to Zagazig University Hospitals (ZUH), Egypt based on the chest Computed Tomography (CT) COVID-19 Reporting and Data System (CO-RADS) radiological criteria. Methods: All patients aged ≥ 18 years old seeking admission to ZUH between January 1 st and March 31 st , 2021, were eligible for enrollment in the study if they performed non-enhanced chest CT. Assessment of clinical, laboratory, and chest CT CO-RADS radiological criteria for each patient was carried out. The patients were defined to have moderate or severe COVID-19 if they met CO-RADS 4 or 5 radiological criteria, respectively, in association with the clinical and/or laboratory criteria. Results: A total of 5549 subjects were enrolled in the study. The total number of moderate and severe COVID-19 cases diagnosed at ZUH during January 2021 was 434/1827 with a monthly incidence rate of 23.75; 95% CI (21.9-25.8) per 100.000 of the population. The total number of moderate and severe COVID-19 cases during February 2021 was 215/1622 with a monthly incidence rate of 13.25;. During March, the total number of moderate and severe COVID-19 cases was 416/2100 with a monthly incidence rate of 19.8; 95% CI (18.2-21.6). Conclusion: The incidence rate of moderate and severe COVID-19 infection at ZUH is in parallel with the national COVID-19 incidence reports.