Colorectal cancer in Egypt

PURPOSE: The aim of this study was to review the age distribution and pathology features of colorectal cancer in Egypt. METHODS: A seven-year review (retrospective in first six years, prospective in the seventh) of all colorectal adenocarcinoma patients (N = 177; 104 males; mean age, 46; range, 19–74 years) presented to the Department of Surgery, Ain Shams University, was performed. Data from three other major hospitals throughout the country were retrieved and compared with Ain Shams data. Retrospective data were retrieved from patients files and surgery and pathology records. Family history of colorectal cancer and other characteristic hereditary nonpolyposis colorectal cancer tumors was obtained prospectively in all patients. RESULTS: According to Ain Shams data, the disease had no predilection to a specific age group. Thirty-eight percent of the tumors occurred in patients aged less than 40 years, and only 15 percent of patients were aged above 60 years. None of the young patients fulfilled the Amsterdam criteria for hereditary nonpolyposis colorectal cancer. Seventy-five percent of tumors occurred in the left side, 3 percent were Dukes A, and 58 percent were Dukes C. Synchronous and metachronous tumors occurred in 2.8 and 4.5 percent of patients, respectively. Adenomas were present in 5.6 percent of patients and bilharziasis in 3.4 percent of resection specimens. Data from different centers were remarkably similar to Ain Shams results. CONCLUSION: Colorectal cancer in Egypt has no age predilection and more than one-third of tumors affects a young population. The high prevalence in young people can neither be explained on a hereditary basis nor can it be attributed to bilharziasis. The disease usually presents at an advanced stage, and predisposing adenomas are rare. Similarity of the data from different centers suggests that this is the picture of colorectal cancer typical of Egypt.     

Clinical Outcomes in Asymptomatic and Symptomatic Atrial Fibrillation Presentations in GARFIELD-AF: Implications for AF Screening

BackgroundAsymptomatic atrial fibrillation is often detected incidentally. Prognosis and optimal therapy for asymptomatic compared with symptomatic atrial fibrillation is uncertain. This study compares clinical characteristics, treatment, and 2-year outcomes of asymptomatic and symptomatic atrial fibrillation presentations.MethodsGlobal Anticoagulant Registry in the Field-Atrial Fibrillation (GARFIELD-AF) is a global, prospective, observational study of newly diagnosed atrial fibrillation with ≥1 stroke risk factors (http://www.clinicaltrials.gov, unique identifier: NCT01090362). Patients were characterized by atrial fibrillation-related symptoms at presentation and the CHA₂DS₂-VASc score. Two-year follow-up recorded anticoagulation patterns (vitamin K antagonist, direct oral anticoagulants, parenteral therapy) and outcomes (stroke/systemic embolism, all-cause mortality, and bleeding).ResultsAt presentation, of 52,032 eligible patients, 25.4% were asymptomatic and 74.6% symptomatic. Asymptomatic patients were slightly older (72 vs 70 years), more often male (64.2% vs 52.9%), and more frequently initiated on anticoagulation ± antiplatelets (69.4% vs 66.0%). No difference in events (adjusted hazard ratios, 95% confidence interval) for nonhemorrhagic stroke/systemic embolism (1.19, 0.97-1.45), all-cause mortality (1.06, 0.94-1.20), or bleeding (1.02, 0.87-1.19) was observed. Anticoagulation was associated with comparable reduction in nonhemorrhagic stroke/systemic embolism (0.59, 0.43–0.82 vs 0.78, 0.65–0.93) and all-cause mortality (0.69, 0.59-0.81 vs 0.77, 0.71-0.85) in asymptomatic versus symptomatic, respectively.ConclusionsMajor outcomes do not differ between asymptomatic and symptomatic atrial fibrillation presentations and are comparably reduced by anticoagulation. Opportunistic screening-detected asymptomatic atrial fibrillation likely has the same prognosis as asymptomatic atrial fibrillation at presentation and likely responds similarly to anticoagulation thromboprophylaxis.     

Implications of Concomitant Tricuspid Regurgitation in Patients Undergoing Transcatheter Aortic Valve Replacement for Degenerated Surgical Aortic Bioprosthesis: Insights From the PARTNER 2 Aortic Valve-in-Valve Registry

Objectives

The aim of this study was to assess the implications of concomitant tricuspid regurgitation (TR) in patients undergoing valve-in-valve (VIV) transcatheter aortic valve replacement.

Morphometric study of foramina transversaria in Jordanian population using cross-sectional computed tomography

Anatomical Science International - Foramina transversaria are bilateral landmarks of human cervical vertebrae. Morphometric analysis of foramina transversaria is valuable in both clinical and...     

Comparison of conventional,photogrammetry, and intraoral scanning accuracy of complete-arch implant impression procedures evaluated with a coordinate measuring machine

Statement of problemConventional implant impressions by using elastomeric impression material have been reported as a more reliable technique for a complete-arch implant record compared with intraoral scanner procedures. Photogrammetry technology may provide a reliable alternative to digital scanning or a conventional impression; however, its accuracy remains unclear.PurposeThe purpose of this in vitro study was to measure and compare the implant abutment replica positions of the definitive cast with the implant abutment replica positions obtained by the conventional technique, photogrammetry, and 2 intraoral scanners.Material and methodsAn edentulous maxillary cast with 6 implant abutment replicas (RC analog for screw-retained abutment straight) was prepared. Three impression techniques were performed: the conventional impression technique (CNV group) by using a custom tray elastomeric impression procedure after splinting the impression copings at room temperature (23°C), photogrammetry (PG group) technology (Icam4D), digital scans by using 2 different IOSs following the manufacturer′s recommended scanning protocol, namely IOS-1 (iTero Element) and IOS-2 (TRIOS 3) groups (n=10). A coordinate measuring machine (CMM Contura G2 10/16/06 RDS) was used to measure the implant abutment replica positions of the definitive casts and to compare the linear discrepancies at the x-, y-, and z-axes and the angular distortion of each implant abutment replica position by using a computer aided-design software program (Geomagic) and the best fit technique. The 3D linear gap discrepancy was calculated. Measurements were repeated 3 times. The Shapiro-Wilk test revealed that the data were not normally distributed; therefore, the Kruskal-Wallis test was used to analyze the data, followed by pairwise Mann-Whitney U tests (α=.05).ResultsSignificant y-axis linear and XY and YZ angular discrepancies were found among the CNV, PG, IOS-1, and IOS-2 groups (P<.05). The PG group obtained a significantly higher distortion on the y-axis and 3D gap compared with all the remaining groups (P=.004). The 3D discrepancy of the CNV group was 11.7 μm, of the IOS-1 group was 18.4 μm, of the IOS-2 was 21.1 μm, and of the PG group was 77.6 μm. In all groups, the interquartile range was higher than the median errors from the discrepancies measured from the definitive cast, indicating that the relative precision was low.ConclusionsThe conventional technique reported the lowest 3D discrepancy for the implant abutment position translation capabilities of all the implant techniques evaluated. The intraoral scanners tested provided no significant differences in linear distortion compared with the conventional method. However, the photogrammetry system tested provided the least accurate values, with the highest 3D discrepancy for the implant abutment positions among all the groups.