Does delayed phase imaging in CT angiography provide additional information in patients with suspected active bleeding?

PURPOSE

We hypothesize that delayed phase imaging does not provide additional diagnostic information in patients who undergo multi-phasic CTA for suspected active bleeding.

METHODS

Data on patients who underwent multiphasic CTA (pre-contrast, arterial, porto-venous, and delayed phases) for suspected acute bleed were retrospectively collected between January 2019 and November 2021. CTA images were reviewed by a general radiologist, an interventional radiologist, and a body imaging radiologist independently. Each reader evaluated if delayed phase images provided additional information that would change the final impression of the CTA report. Additional information regarding bleeding location, time needed for delayed image acquisition, and radiation exposure were also obtained.

RESULTS

A total of 104 patients with CTAs were analyzed with an average age of 58 years ± 22. Studies rated with absent additional findings on delayed images were 102 (98.1%) by the interventional radiologist, 101 (97.1%) by the body imaging radiologist, and 100 (96.1%) by the general radiologist with percent agreement of 96.15% (kappa 0.54, p < 0.001). All the findings were characterized as unlikely to be clinically significant. Mean time added to complete a delayed phase images was 3.61 ± 3.4 min. The average CT dose length product (DLP) for the total exam was 3621.78 ± 2129.57 mGy.cm with delayed acquisition adding a mean DLP of 847.75 ± 508.8 mGy.cm.

CONCLUSION

Delayed phase imaging does not provide significant additional diagnostic information in evaluating patients with suspected active bleeding but is associated with increased examination time and radiation exposure.

Influence of maternal characteristics and infant feeding patterns on infant growth from birth till 18 months: The MISC study

BACKGROUND

The growth and development of infants during the first 1000 days of life are crucial for their health.

OBJECTIVES

This study aims to assess the impact of maternal characteristics and infant feeding patterns on infant growth from birth to 18 months.

METHODS

Data were derived from the 2-year perspective Mother Infant Study Cohort (MISC) study which included six visits from the third trimester of pregnancy until 18 months postpartum. A convenient sample of 256 pregnant women aged 19-40 years was recruited from Sharjah, Dubai and Ajman in the United Arab Emirates.

RESULTS

Amongst mothers' characteristics, Arab nationality, pre-pregnancy overweight/obesity, higher gestational weight gain and lower physical activity were found to increase the likelihood of infants being overweight at 6, 12 and 18 months. Exclusive breastfeeding was positively correlated with reduced odds of the infant being overweight at 18 months (aOR = 0.31, 95% CI: 0.12-0.81). Breastfeeding for up to 6 months and the introduction of solid foods after 6 months was associated with reduced odds of the infant being overweight at 12 months old (aOR = 4, 95% CI: 1.1-14.6; aOR = 2.97, 95% CI: 1.09-8.08, respectively).

CONCLUSION

The findings spotlight the influence of maternal characteristics and infant feeding on infant growth. This asserts the need for evidence-based programmes targeting mothers to promote optimal feeding practices and foster healthy child growth.

Beyond pillbox: a national cross-sectional study on the attitudes, practices, and knowledge of community pharmacists regarding complementary and alternative medicine

BACKGROUND

While community pharmacists are uniquely positioned to promote the safe and effective use of complementary and alternative medicine, their potential role remains largely untapped. The objective of this study was to assess the knowledge, attitudes, and practices related to complementary and alternative medicine products among community pharmacists in the United Arab Emirates and explore the correlates of knowledge in the study sample.

METHODS

Using a stratified random sampling frame, a national survey of community pharmacists was conducted in the United Arab Emirates. In a face-to-face interaction, participants completed a multi-component questionnaire consisting of four sections: sociodemographic and general characteristics; knowledge of complementary and alternative medicine products and usage; attitudes towards complementary and alternative medicine and practices related to complementary and alternative medicine. Based on participants' answers, scores were calculated with higher scores indicating more positive knowledge, attitudes, and practices.

RESULTS

373 community pharmacists participated in the study (response rate: 83%). For the knowledge questions, more than 50% of community pharmacists correctly answered the functions of complementary and alternative medicine, however lower percentages were noted for the side effects and drug interactions questions. Most community pharmacists had positive attitudes towards complementary and alternative medicine, except for particular aspects such as efficacy, where 40% agreed that complementary and alternative medicine is only effective in treating minor complaints. As for practices, while more than 70% of participants counseled patients on complementary and alternative medicine use, only 47% reported the toxic effects when encountered. Multiple linear regressions showed that community pharmacists working in independent pharmacies, those with fewer years of experience, and those who did not receive complementary and alternative medicine education during their academic degree had lower knowledge scores (p < 0.05).

CONCLUSIONS

The findings of this study showed that community pharmacists in the United Arab Emirates have good knowledge of complementary and alternative medicine functions and generally positive attitudes and practices, with few gaps identified in each. Together, these findings provide critical evidence for the development of targeted interventions to promote the role of community pharmacists towards safe and effective complementary and alternative medicine use in the country.

Patterns of cannabis use, perception of harm, and perceived impact of legislative change in an online sample of young adults from Lebanon: insight on recreational users versus dual motive users

BACKGROUND

Lebanon remains as one of the major sources of cannabis worldwide. In 2020, its government passed a legislation enabling the cultivation of local medicinal cannabis. This first study following the legislative change examines the overlapping use of cannabis for recreational/medicinal purposes and characteristics of the distinct cannabis user types.

METHODS

A total of 1230 young adults (18-24 years) filled an anonymous online survey in early 2020.

RESULTS

Young adults in the sample were distributed as follows: 33% 18-20 years; 60% males; 94% Lebanese; 75% students; and 89% living with family. The older young adults (21-24), males, those employed, living with non-family members, and who perceived themselves as being a little/lot richer than most were statistically significantly more present in the cannabis user subtypes (recreational only or recreational/medicinal) than non-cannabis users. When dual recreational/medicinal users are compared to recreational users only, the latter seemed to have a more conservative profile of behaviours, attitudes, and perceptions and acts of harm. The prevalence ratio comparing the prevalence of users supporting consuming cannabis "once or twice" in dual motive users vs. recreational users only was 1.13 for "once or twice", 1.25 for "occasionally", 1.64 for "regularly", and 2.4 for "daily". Any other illicit drug use was reported by 1% of the non-cannabis users, 36% of the recreational users only, and 58% of the recreational/medicinal users (p-value < 0.01). Similarly, any prescription drug use was reported by 3% of the non-cannabis users, 16% of the recreational users only, and 28% of both recreational/medicinal users (p-value < 0.01).

CONCLUSION

The interface between recreational and medicinal cannabis use is complex. Dual motive users may warrant special attention as a subpopulation of cannabis users. This is relevant to contexts experiencing medicinal cannabis legislation changes, such as Lebanon, as policymakers and implementers should be sensitized to the emerging evidence for more data-informed policy changes.

Sustainable diets among youth: Validity and reliability of a questionnaire assessing knowledge, attitudes, practices, and willingness to change

BACKGROUND

In light of the global commitment to promoting sustainable dietary choices and the pivotal role of young adults in the adoption of these choices, it is paramount to understand their perspectives of healthy and sustainable diets. The present study aimed to investigate the validity and reliability of a questionnaire examining the knowledge, attitudes, practices, and willingness to change regarding sustainable diets among young adults in the United Arab Emirates (UAE).

METHODS

Male and female students attending University of Sharjah, UAE (n = 436), completed an online questionnaire consisting of four sections: knowledge, attitudes, practices, and willingness to change with regard to sustainable diets. Of the participants, 106 completed the questionnaire a second time, 1 month later. Factor analysis (FA) (both exploratory and confirmatory), Cronbach-α, interitem correlations, and intra class correlation (ICC) coefficients were used in the data analysis.

RESULTS

Exploratory FA revealed four factors corresponding to the components of the questionnaire. Results of the confirmatory FA indicated a good fit: the χ2 df ratio was < 5 (2.3), root mean squared error of approximation was < 0.08 (0.048) and the comparative fit index was above 0.9 (0.901). Cronbach α and interitem correlations were: knowledge: 0.57 and 0.21; attitude: 0.70 and 0.28; practices: 0.76 and 0.39; willingness to change: 0.69 and 0.27. The ICC coefficients, assessing the reliability of the questionnaire, ranged between 0.48 and 0.92 for the various items.

CONCLUSIONS

The developed questionnaire is a valid and reliable tool that could be used to identify the gaps and opportunities for the development of evidence-based interventions aiming to enhance the uptake of sustainable diets among young adults.

Evaluation of the effectiveness of sleep hygiene education and FITBIT devices on quality of sleep and psychological worry: a pilot quasi-experimental study among first-year college students

Background

College students report disturbed sleep patterns that can negatively impact their wellbeing and academic performance.

Objectives

This study examined the effect of a 4-week sleep hygiene program that included sleep education and actigraph sleep trackers (FITBITs) on improving sleep quality and reducing psychological worry without control group.

Design settings and participants

A pilot quasi-experimental design, participants were randomly selected medical and health sciences from a university students in the United-Arab-Emirates.

Methods

Students were asked to wear FITBITs and log their daily sleep data and completed the Pittsburgh Sleep Quality Index (PSQI) and Penn State Worry Questionnaire (PSWQ). Extensive sleep hygiene education was delivered via lectures, a WhatsApp group, and the Blackboard platform. In total, 50 students completed pre-and post-assessments and returned FITBIT data.

Results

There was a significant difference in the prevalence of good sleep postintervention compared with pre-intervention (46% vs. 28%; p = 0.0126). The mean PSQI score was significantly lower post-intervention compared with pre-intervention (6.17 ± 3.16 vs. 7.12.87; p = 0.04, Cohen's d 0.33). After the intervention, subjective sleep quality, sleep latency, and daytime dysfunction were significantly improved compared with pre-intervention (p < 0.05). In addition, FITBIT data showed total sleep time and the number of restless episodes per night were significantly improved postintervention compared with pre-intervention (p = 0.013). The mean PSWQ score significantly decreased from pre-intervention to p = 0.049, Cohen' d = 0.25. The correlation between PSQI and PSWQ scores was significant post-intervention (β = 0.40, p = 0.02).

Conclusion

Our results may inform university educational policy and curricular reform to incorporate sleep hygiene awareness programs to empower students and improve their sleep habits.

Adherence to the Mediterranean diet and its association with environmental footprints among women of childbearing age in the United Arab Emirates

PURPOSE

To examine the association of adherence to the Mediterranean Diet (MD) with Environmental Footprints (EFPs) among women of childbearing age in the United Arab Emirates (UAE).

METHODS

Data belonging to a nationally representative sample of 482 women (19-50 years) were derived from a previous survey in the UAE. In face-to-face interviews, participants completed questionnaires addressing sociodemographic, physical activity, and dietary intake characteristics; the latter assessed using a multiple pass 24-h recall. The composite Mediterranean (c-MED) index was used to examine the adherence to the MD. Metrics for the EFPs (water use, energy use, and GHG emissions) were calculated using Life Cycle Analyses. Descriptive statistics and linear regressions were used in data analysis.

RESULTS

In the study sample, the distribution of the c-MED scores was skewed to the right, indicating a low adherence to the MD. The lowest contributions to the total c-MED score were observed for legumes (2.9%) and olive oil (1.8%). The EFPs associated with food consumption per 1000 kcal were: water use: 1256.89 ± 544.95 L/day; energy use: 18.01 ± 7.85 MJ/day, and GHG: 2.46 ± 1.46 kg CO_{2 eq}/day. After adjustment for age, energy intake, and potential confounders, being adherent to the MD was associated with 540.57 [95% CI (- 726.6; - 354.54)] units decrease in water use and 0.94 units decrease in GHG emissions [95% CI (- 1.45; - 0.43)].

CONCLUSIONS

The findings of this study revealed an inverse association between adherence to the MD and EFPs. As such, the MD may represent a promising dietary strategy to improve health outcomes and reduce the environmental impact. Public health programs addressing the low adherence to the MD among women of childbearing age in the UAE are warranted.

Prenatal breastfeeding knowledge, attitude and intention, and their associations with feeding practices during the first six months of life: a cohort study in Lebanon and Qatar

Background

Prenatal knowledge, attitude, and intention related to breastfeeding are postulated as important modulators of feeding practices. Using data from the Mother and Infant Nutritional Assessment (MINA) study, a three year cohort conducted in Lebanon and Qatar, this study aimed to characterize breastfeeding practices during the first six months postnatally and examine their associations with prenatal breastfeeding knowledge, attitude, exposure, and intention.

Methods

Pregnant women during their first trimester were recruited from primary healthcare centers in Beirut and Doha. Data collection was conducted in 2015 − 2018. Participants were followed-up until the child was twoyears old. Exposure, knowledge, attitude, and intentions regarding breastfeeding were assessed during the third trimester of pregnancy (n = 230), using validated questionnaires and scales. Breastfeeding practices were evaluated at four months (n = 185) and six months (n = 151) postpartum. Early initiation of breastfeeding was defined as putting the infant to the breast within one hour of birth, and exclusive breastfeeding (EBF) as feeding exclusively with breast milk.

Results

Breastfeeding practices were as follows: ever breastfeeding: 95.8%; early initiation of breastfeeding: 72.8%; breastfeeding at four and six months: 70.3% and 62.3%; EBF at four and six months: 35.7% and 18.5%. Over 95% of participants had high breastfeeding exposure, and 68.8% had strong / very strong intentions to breastfeed. Only 25% had very good knowledge, and 9.2% reported positive/strong positive attitude towards breastfeeding. After adjustment, high exposure was associated with greater odds of breastfeeding initiation (OR 10.1: 95% CI 1.25, 80.65). Both positive attitude towards breastfeeding and strong intention to breastfeed were associated with EBF at four months (OR 2.51; 95% CI 1.02, 6.16 and OR 4.0; 95% CI 1.67, 9.6), breastfeeding at four months (OR 2.92: 95% CI 1.29, 6.62 and OR 5.00: 95% CI 2.25, 11.1), and breastfeeding at six months (OR 3.74: 95% CI 1.24, 11.32 and OR 8.29: 95% CI 2.9, 23.68).

Conclusions

Findings of this study documented suboptimal knowledge and attitude towards breastfeeding and showed that prior exposure, a positive attitude, and a strong intention to breastfeed prenatally were significant predictors of breastfeeding practices postnatally. This highlights the need to develop specific interventions and policies aimed at improving breastfeeding attitudes and creating an enabling environment that supports women throughout their breastfeeding journey.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00456-x.

Synthesis, characterization, anti-microbial and cytotoxic applications of zinc(II) complexes

ABSTRACT. In the present research, three zinc(II) complexes were synthesized using 3-(3-fluorophenyl)-2-methylacrylic acid (HL), 1,10-phenanthroline and 2,2'-pyridine as ligands. The composition, structural confirmation, coordination way of ligand and assignment of geometry to the complexes were made by different analytical tools like elemental analysis, FTIR and 1H-NMR. The ligand 3-(3-fluorophenyl)-2-methylacrylate appeared to coordinate the metal (Zn) atom via COO- moiety in all of the complexes (1-3) while 1,10-phenanthroline and 2,2'-pyridine co-ordinated to Zn(II) atom through N-donor sites in complexes 2 and 3, respectively. The complex 1 showed four while 2 and 3 showed six co-ordinated geometry. The synthesized complexes were evaluated for antimicrobial and cytotoxic activities. The obtained results showed that complexes are active against microbial agents and exhibited significant cytotoxicity.                     KEY WORDS: Co-coordination, Geometry, Zinc(II) complexes, Biological activity   Bull. Chem. Soc. Ethiop. 2021, 35(2), 287-299. DOI: https://dx.doi.org/10.4314/bcse.v35i2.6

High association of COVID-19 severity with poor gut health score in Lebanese patients

Background

Coronavirus disease 2019 (COVID-19) has affected millions of lives globally. However, the disease has presented more extreme challenges for developing countries that are experiencing economic crises. Studies on COVID-19 symptoms and gut health are scarce and have not fully analyzed possible associations between gut health and disease pathophysiology. Therefore, this study aimed to demonstrate a potential association between gut health and COVID-19 severity in the Lebanese community, which has been experiencing a severe economic crisis.

Methods

This cross-sectional study investigated SARS-CoV-2 PCR-positive Lebanese patients. Participants were interviewed and gut health, COVID-19 symptoms, and different metrics were analyzed using simple and multiple logistic regression models.

Results

Analysis of the data showed that 25% of participants were asymptomatic, while an equal proportion experienced severe symptoms, including dyspnea (22.7%), oxygen need (7.5%), and hospitalization (3.1%). The mean age of the participants was 38.3 ±0.8 years, and the majority were males (63.9%), married (68.2%), and currently employed (66.7%). A negative correlation was found between gut health score and COVID-19 symptoms (Kendall’s tau-b = -0.153, P = 0.004); indicating that low gut health was associated with more severe COVID-19 cases. Additionally, participants who reported unhealthy food intake were more likely to experience severe symptoms (Kendall’s tau-b = 0.118, P = 0.049). When all items were taken into consideration, multiple ordinal logistic regression models showed a significant association between COVID-19 symptoms and each of the following variables: working status, flu-like illness episodes, and gut health score. COVID-19 severe symptoms were more common among patients having poor gut health scores (OR:1.31, 95%CI:1.07–1.61; P = 0.008), experiencing more than one episode of flu-like illness per year (OR:2.85, 95%CI:1.58–5.15; P = 0.001), and owning a job (OR:2.00, 95%CI:1.1–3.65; P = 0.023).

Conclusions

To our knowledge, this is the first study that showed the impact of gut health and exposure to respiratory viruses on COVID-19 severity in Lebanon. These findings can facilitate combating the pandemic in Lebanon.

Impact of Ramadan Fasting on Dietary Intakes Among Healthy Adults: A Year-Round Comparative Study

Religious rituals are considered among the principle factors that impact dietary behaviors and food selections. The main objective of this study is to characterize food intake among Lebanese adults observant of the fasting month of Ramadan and compare it to their intake of the rest of the year. During a year-round study, including the month of Ramadan, Lebanese adults (n = 62), completed multiple (9 to 13) 24-h dietary recalls. Information about sociodemographic and lifestyle characteristics was also obtained. Dietary intake was examined using food groups as well as energy, macro, and micronutrient consumption. Significant differences in dietary intakes were observed for 12 of the 19 food groups (expressed as a percent of total energy) during Ramadan as compared to the rest of the year. More specifically, the intakes of cereals, cereal-based products, pasta, eggs, nuts and seeds, milk and dairy, and fats and oils were lower, while vegetables, dried fruit, Arabic sweets, cakes and pastries, and sugar-sweetened-beverages intakes were higher during Ramadan as compared to the remainder of the year (p < 0.05). Such differences in food groups' intakes were reflected in nutrients intakes, including carbohydrates, cholesterol, calcium, beta-carotene, vitamin C, folate, and magnesium. The findings of this study highlighted major differences in dietary intakes between the fasting month as compared to the rest of the year. With the large number of adults who observe fasting during Ramadan, the particularities of dietary intake during Ramadan ought to be considered in the development of context and culture-specific dietary recommendations.

Dietary Patterns and Their Associations With the FTO and FGF21 Gene Variants Among Emirati Adults

Purpose: To examine the dietary patterns and their associations with the FTO and FGF21 gene variants among Emirati adults. Methods: Using a cross-sectional design, healthy adult male and female Emiratis (n = 194) were recruited from primary health care centers in Sharjah, UAE. Participants completed a 61-item semi-quantitative food frequency questionnaire. In addition, a saliva sample was obtained for the genetic analysis. Genotyping was performed for FTOrs9939609(A>T), FTOrs9930506(A>G), FGF21 rs838133 (A > G), and FGF21 rs838145 (A > G). Dietary patterns were derived using the principal component analysis. Logistic regression analyses were used to examine the association of dietary patterns with genetic variants. Results: Three dietary patterns were identified: "Western": consisting of fast food, sweets, and processed meat; "Traditional Emirati" rich in vegetables, traditional Emirati-mixed-dishes and whole dairy; while whole grains, low-fat dairy, and bulgur were components of the "Prudent" pattern. Subjects carrying the A allele of the FTO rs9939609 were 2.41 times more likely to adhere to the Western pattern compared to subjects with genotype TT (OR:2.41; 95%CI:1.05-5.50). Compared with subjects with A/A, those carrying the G allele of the FTO rs9930506 were more likely to follow a Western diet (OR: 2.19; 95%CI: 1.00-4.97). Participants carrying the risk allele (A) of the FGF21 rs838133 were twice more likely to adhere to the Traditional pattern as compared to subjects with genotype GG (OR: 1.9, 95%CI: 1.01-3.57). Conclusions: The findings of this study suggested associations among specific FTO and FGF21 gene variants with dietary patterns among Emirati adults. These findings could be used to inform evidence-based targeted nutrition preventive recommendations, especially those aiming to limit intake of western type foods.

Indirect Health Effects of COVID-19: Unhealthy Lifestyle Behaviors during the Lockdown in the United Arab Emirates

Background: Lockdown measures were implemented in many countries to limit the spread of the COVID-19 pandemic. However, such restrictions could precipitate unintended negative consequences on lifestyle behaviors. The main objective of this study was to investigate the prevalence and determinants of unhealthy behavior changes during the COVID-19 lockdown among residents of the United Arab Emirates (UAE). Methods: A cross-sectional web-based survey of adults residing in the UAE was carried out during lockdown (n = 2060). Using a multi-component questionnaire, the collected data included questions regarding the following lifestyle changes: Increased dietary intake, increased weight, decreased physical activity, decreased sleep, and increased smoking. An unhealthy lifestyle change score was calculated based on the number of unhealthy lifestyle changes each participant reported. In addition, sociodemographic and living conditions information was collected. Descriptive statistics as well as simple and multiple linear regression analyses were used to examine the prevalence and determinants of the unhealthy lifestyle changes considered in this study. Results: Among the unhealthy lifestyle changes examined, increased food intake was the most common (31.8%), followed by decreased physical activity (30%), increased weight (29.4%), decreased sleep (20.8%), and increased smoking (21%). In addition to identifying the correlates of each of the aforementioned lifestyle changes, the results of the multiple regression linear analyses revealed the following correlates for the overall unhealthy lifestyle change score: females (β = 0.32, CI: 0.22; 0.42), living in an apartment (β = 0.12, CI: 0.003; 0.23) and being overweight/obese (β = 0.24, CI: 0.15; 0.32) had higher scores, while older adults (>40 years) had lower scores (β = -0.23, CI: -0.34; -0.12). Conclusions: The COVID-19 lockdown has resulted in a high prevalence of unhealthy lifestyle behaviors and practices among UAE residents. The findings of this study provided the evidence base for officials to design interventions targeting high-risk groups and aiming to improve healthy lifestyle factors among residents during the pandemic.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Evaluation of Biting Force of New Design of Extracoronal Castable Precision Attachment versus Conventional Partial Denture for Treatment of Unilateral Mandibular Distal Extension Area: A Randomized Controlled Trial

PURPOSE: The aim of this study was to evaluate biting force of patients with unilateral mandibular distal extension area treated with two different designs of the removable partial denture (RPD), conventional RPD, and new design of extracoronal castable precision attachment (OT Unilateral attachment). MATERIALS AND METHODS: This study was conducted on 16 patients with unilateral mandibular distal extension area with the second premolar is the last abutment teeth. The patients were divided into two equal groups, Group I received conventional RPD, which provides cross arch stabilization and a double Aker clasp was fabricated. Group II received new design of extracoronal castable precision attachment (OT Unilateral attachment). Evaluation of biting force by loadstar sensor, patients of both groups were evaluated at the time of prosthesis insertion, 3, 6, and 1 year later. Statistical analysis performing one-way analysis of variance followed by Tukey’s post hoc test to compare between all follow-up periods within each group, comparison between two groups regarding each follow-up period was performed by independent t-test. RESULTS: Both treatments yielded better after-treatment summary when compared with the baseline; however, better results were obtained and showed a statistically significant increase in Group II (OT unilateral design), especially after 3, 6 months, and 1 year later. CONCLUSION: From the results of this study, it was concluded that: It is preferable to use the new design of extracoronal castable precision attachment (OT unilateral) being simpler, more comfortable to the patients and give high masticatory efficiency in the form of biting force than conventional RPD.  

Exploration of a New Source of Sustainable Nanomaterial from the Koh-e-Suleiman Mountain Range of Pakistan for Industrial Applications

The present study aimed to explore a new source of montmorillonite and to develop an extraction and purification protocol for its isolation from raw clay samples acquired from the Koh-e-Suleiman mountain range in Pakistan. The process involved the collection of raw clay from the source, identification and quantification of montmorillonite. Granulometric extraction and purification protocols increased the montmorillonite content from 21.8-25.1% in the raw clay to 90.1-93.9% after small-scale extraction and 85.33-89.33% on a larger scale. A techno-economic analysis highlighted the practicality and economic benefits of large-scale extraction for industrial applications. This study highlights the existence of a substantial new source of this valuable clay which is currently used across multiple industries including construction, pottery making, pharmaceuticals, cosmetics and engineering. It is intuitively expected that the large-scale extraction of the material will improve the economic condition of the region by providing employment opportunities to locals and may be a valuable resource for export.

Correction to: Determination of the Genetic and Synergistic Suppression of a Methoxyfenozide-Resistant Strain of the House Fly Musca domestica L. (Diptera: Muscidae)

Due to an unfortunate turn of events, the surname of the last author appeared incorrectly in the original publication as the name should have read Binyameen.

Determination of the Genetic and Synergistic Suppression of a Methoxyfenozide-Resistant Strain of the House Fly Musca domestica L. (Diptera: Muscidae)

Musca domestica Linnaeus (house fly, Diptera: Muscidae) is a major veterinary and medical important pest all over the world. These flies have ability to develop resistance to insecticides. The present trial was performed to discover the inheritance mode (autosomal, dominance, number of genes involved) and preliminary mechanism of methoxyfenozide resistance in order to provide basic information necessary to develop resistance management strategy for this pest. A strain of M. domestica (MXY-SEL) was exposed to methoxyfenozide for 44 generations which developed a 5253.90-fold level of resistance to methoxyfenozide. The overlapping fiducial limits of LC₅₀ values of the reciprocal crosses, F₁ (MXY-SEL ♂ × Susceptible ♀) and F₁^† (MXY-SEL ♀ × Susceptible ♂), suggest that inheritance of methoxyfenozide resistance was an autosomal and likely completely dominant trait (D_LC = 0.93 and 0.94 for F₁ and F₁^†, respectively). Backcrosses of the F₁ with the parental MXY-SEL or Susceptible population predict a polygenic mode of inheritance. Piperonyl butoxide significantly altered the LC₅₀ values, suggesting enhanced detoxification by cytochrome P450-dependent monooxygenases is a major mechanism of resistance to methoxyfenozide in the MXY-SEL strain. The estimated realized heritability was 0.07 for methoxyfenozide. These results would be helpful for the better management of M. domestica.

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

BACKGROUND

The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications.

METHODS

ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery.

RESULTS

The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784.

CONCLUSIONS

This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.

CLINICAL TRIAL REGISTRATION

NCT03044899.

Synthesis of geopolymer-supported zeolites via robust one-step method and their adsorption potential

The present study proposes a robust one-step hydrothermal treatment method for synthesis of high strength geopolymer-supported zeolites utilizing industrial by-products (fly ash and blast furnace slag), which can be potentially used as bulk-type solid adsorbents. The results revealed that the geopolymer-supported zeolites, possessing distinct strengths, zeolite phases (Na-P1, Na-chabazite, and analcime) and pore features depending on the mix design and synthesis conditions, can be easily synthesized employing the proposed one-step method. The geopolymer-supported zeolites exhibited the characteristics of mesoporous materials which are typically desired for commercial adsorbents. The maximum adsorption capacity for Pb²⁺ was found to be about 37.9 mg/g which is relatively higher than the other bulk-type adsorbents reported for Pb²⁺ to date. Since industrial by-products are used for synthesis of these materials, it will help in reducing the environmental hazards associated with the permanent disposal of such by-products, with an added advantage that these bulk-type solid adsorbents can be easily retrieved after use unlike granular adsorbents.

Polymeric Based Therapeutic Delivery Systems Prepared Using Electrohydrodynamic Processes

The development of therapeutic dosage (e.g. pharmaceutical) systems is an ongoing process which, in recent times has incorporated several emerging disciplines and themes at timely intervals. While the concepts surrounding dosage forms have developed and evolved, many polymeric excipients remain as the preferred choice of materials over existing counterparts, serving functions as matrix materials, coatings and providing other specific functional properties (e.g. adhesion, controlled release and mechanical properties). There have been, however, developments in the deployment of synthetic polymeric materials (e.g. polycaprolactone, poly lactic co-glycolic acid) when compared to naturally occurring materials (e.g. lactose, gelatin). Advances in pharmaceutical process technologies have also provided novel engineering platforms to develop a host of exciting structure based materials ranging from the nanometer to the macro scales. Some of these structure enabling technologies include spray drying, super critical processing, microfluidics and even wet chemical methods. More recently electrohydrodynamic (EHDA) engineering methods have emerged as robust technologies offering potential to fabricate a plethora of generic structures (e.g. particles, fibres, bubbles and pre-determined patterns) on a broad scale range. This review focuses on key developments using various EHDA technologies for the pharmaceutical and biomaterial remits when selecting synthetic and/or naturally occurring polymers as pharmaceutical (and therapeutic) excipients. In addition, the underlying EHDA process principles are discussed along with key parameters and variables (both materials and engineering). EHDA technologies are operational at ambient conditions and recent developments have also demonstrated their viability for large scale production. These are promising technologies which have potential in established (e.g. films, dressings and microparticles) and emerging scientific themes (e.g. nanomedicines and tissue engineering).

Stability of Field-Selected Resistance to Conventional and Newer Chemistry Insecticides in the House Fly, Musca domestica L. (Diptera: Muscidae)

The house fly, Musca domestica L. (Diptera: Muscidae), is a pest of livestock and has the ability to develop resistance to different insecticides. We assessed the fluctuations in seasonal stability of house fly resistance to insecticides from poultry facility populations in Pakistan. House fly populations were collected from poultry facilities located at Khanewal, Punjab, Pakistan in three seasons (July, November, and March) to investigate the fluctuations in their resistance to conventional (organophosphate, pyrethroid) and novel chemistry (spinosyn, oxadiazine, neonicotinoid) insecticides. Laboratory bioassays were performed using the feeding method of mixing insecticide concentrations with 20% sugar solutions, and cotton pads dipped in insecticide solutions were provided to tested adult flies. Bioassay results showed that all house fly populations had varying degrees of susceptibility to tested insecticides. Comparisons between populations at different seasons showed a significant fluctuation in susceptibility to organophosphate, pyrethroid, spinosyn, oxadiazine, and neonicotinoid insecticides. Highest resistant levels were found for organophosphate when compared with other tested insecticides. The resistance to conventional insecticides decreased significantly in March compared with July and November, while resistance to oxadiazine and avermectins decreased significantly in November. However, resistance to spinosad and imidacloprid remained stable throughout the seasons. All conventional and novel chemistry insecticides were significantly correlated with each other in all tested seasons except nitenpyram/lambda-cyhalothrin and nitenpyram/imidacloprid. Our data suggests that the variation in house fly resistance among seasons could be due to fitness costs or to the cessation of selection pressure in the off-season. These results have significant implications for the use of insecticides in house fly management.

Fitness cost and realized heritability of resistance to spinosad in Chrysoperla carnea (Neuroptera: Chrysopidae)

The common green lacewing Chrysoperla carnea is a key biological control agent employed in integrated pest management (IPM) programs for managing various insect pests. Spinosad is used for the management of pests in ornamental plants, fruit trees, vegetable and field crops all over the world, including Pakistan. A field-collected population of C. carnea was selected with spinosad and fitness costs and realized heritability were investigated. After selection for five generations, C. carnea developed 12.65- and 73.37-fold resistance to spinosad compared to the field and UNSEL populations. The resistant population had a relative fitness of 1.47, with substantially higher emergence rate of healthy adults, fecundity and hatchability and shorter larval duration, pupal duration, and development time as compared to a susceptible laboratory population. Mean relative growth rate of larvae, intrinsic rate of natural population increase and biotic potential was higher for the spinosad-selected population compared to the susceptible laboratory population. Chrysoperla species are known to show resistance to insecticides which makes the predator compatible with most IPM systems. The realized heritability (h 2) value of spinosad resistance was 0.37 in spinosad-selected population of C. carnea.

Phylogenetic relationships between Mediterranean and middle-Asian wild species of the genus Hordeum L. as revealed by biochemical and molecular markers

The phylogenetic relationships of 60 accessions of the genus Hordeum (29 Mediterranean and 20 middle-Asian wild accessions, together with nine American accessions and two of unknown origin), representing together nine species, were investigated by AFLP markers. Three hundred sixty six AFLP fragments were used for studying the molecular genetic diversity among the studied species, 339 out of them were polymorphic. Forty seven protein bands were obtained from the water soluble and the water insoluble seed storage protein by SDS-PAGE electrophoresis of 18 accessions representing nine species (two accessions/species). One band was common to all species and the other 46 bands were polymorphic. The phylogenetic tree deduced from AFLP analysis is concordant to a large extent with that deduced from seed storage protein. Highly significant cophenetic correlation coefficient was obtained between both AFLP (0.96) and seed storage protein (0.89) indicating the reliability of the results. The studied taxa were clustered according to their genome type. All Mediterranean and middle-Asian wild accessions could be integrated into the existing phylogenetic scheme.

A new seed-train expansion method for recombinant mammalian cell lines

A new approach has been developed and used to minimize the timeand more carefully monitor and control the seed-train expansionprocess of recombinant mammalian cell lines. The process uses 50or 100 ml cryo-bags that contain frozen cells at high cell densities of 20 x 10(6) ml(-1) (100 ml bags) or 40 x 10(6) cells ml(-1) (50 ml bags). The frozen bag cell suspension is thawed and transferred directly into a bioreactorthat has been modified such that pH, DO and temperature can becontrolled at the initial volume of two liters (the working volume eventually increases to 12 l). The successful use of thesecryo-bags and the modified ;inoculation' bioreactor to initiate anew seed train expansion of rBHK or rCHO cells is described herein. The interval between cell thawing and the accumulation ofsufficient cell mass to inoculate a production reactor is reducedby at least 25 to 30 days compared to the conventional method that begins with the thaw of 1-2 ml cryo-vials. This ;one-step'technology leads to a much more consistent scale-up by reducingmanual operations and avoiding subjective decisions during the scale-up phase. The cell metabolic rates and product integritywere similar to the control experiments. Furthermore, it was found that it is not necessary to include a wash step to removeDMSO prior to the inoculation.

Effects of dietary chromium chloride, nicotinic acid and copper sulphate on meat of broilers

1. Combinations of chromium and copper were added to the diet to assess their effects on broiler meat characteristics. 2. For this purpose 175 one-day-old broiler chicks were divided into 7 equal groups and were given treatment feeds containing copper sulphate, chromium chloride and nicotinic acid in different combinations. 3. The study was carried out for 5 weeks and samples were collected at the end of 15, 29 and 35 d of treatment and at 42 d after a withdrawal period of one week. 4. Cholesterol content had decreased significantly in breast meat at d 29 in all treatment groups. In thigh meat, it decreased significantly at d 29 in groups receiving two concentrations of chromium + two concentrations of copper. Cholesterol content remained lower even after withholding the treatment for one week. 5. Crude fat content decreased significantly in breast meat in all treatment groups. In thigh meat, at d 29, a significant reduction in crude fat was observed only in birds receiving low chromium and high copper. 6. Crude protein at d 29 increased significantly in breast meat of birds receiving low chromium and high copper, and low or high chromium, while it decreased significantly in treatment groups after withholding the treatment. In thigh meat, at d 29, it increased significantly in treatment groups but decreased significantly after withholding the treatment. 7. It was concluded that chromium and copper, along with nicotinic acid, have modulating effects on broiler meat under tropical conditions.

Entrance surface doses to patients undergoing selected diagnostic X-ray examinations in Sudan

The aim of the study was to evaluate the entrance surface doses (ESDs) to patients undergoing selected diagnostic X-ray examinations in major Sudanese hospitals. ESD per examination was estimated from X-ray tube output parameters in four hospitals comprising eight X-ray units and a sample of 346 radiographs. Hospital mean ESDs estimated range from 0.17 to 0.27 mGy for chest AP, 1.04-2.26 mGy for Skull AP/PA, 0.83-1.32 mGy for Skull LAT, 1.31-1.89 mGy for Pelvis AP, 1.46-3.33 mGy for Lumbar Spine AP and 2.9-9.9 mGy for Lumbar Spine LAT. With exception of chest PA examination at two hospitals, mean ESDs were found to be within the established international reference doses. The results are useful to national and professional organisations and can be used as a baseline upon which future dose measurements may be compared.

Suppression of experimental autoimmune neuritis by ABR-215062 is associated with altered Th1/Th2 balance and inhibited migration of inflammatory cells into the peripheral nerve tissue

The therapeutic effects of ABR-215062, which is a new immunoregulator derived from Linomide, have been evaluated in experimental autoimmune neuritis (EAN), a CD4(+) T cell-mediated animal model of Guillain-Barré syndrome in man. In previous studies, we reported that Linomide suppressed the clinical EAN and myelin antigen-reactive T and B cell responses. Here EAN induced in Lewis rats by inoculation with peripheral nerve myelin P0 protein peptide 180-199 and Freund's complete adjuvant was strongly suppressed by ABR-215062 administered daily subcutaneously from the day of inoculation. ABR-215062 dose-dependently reduced the incidence of EAN, ameliorated clinical signs and inhibited P0 peptide 180-199-specific T cell responses as well as also the decreased inflammation and demyelination in the peripheral nerves. The suppression of clinical EAN was associated with inhibition of the inflammatory cytokines IFN-gamma and TNF-alpha, as well as the enhancement of anti-inflammatory cytokine IL-4 in lymph node cells and periphery nerve tissues, respectively, in a dose-dependent manner. These effects indicate that ABR-215062 may mediate its effects by regulation of Th1/Th2 cytokine balance and suggest that ABR-215062 is potentially a new chemical entity for effective treatment of autoimmune diseases.

Assessment of radioactivity and the associated hazards in local and imported cement types used in Sudan

Activity concentration of 232Th, 226Ra and 40K in local (Atbra and Rabak) and imported cement types (Jordanian, Indonesian and Seabulk) has been measured using high-resolution gamma-spectrometry. The average values obtained for 232Th, 226Ra and 40K activity concentrations in different cements are lower than the corresponding global values reported in UNSCEAR publications. The radium-equivalent activity (Raeq) of the samples was calculated and compared with similar data reported in the literature. The comparison has revealed that Raeq values obtained fall far below the criterion limit specified for building materials. The potential radiological hazard of the different samples was estimated using different approaches: representative level index and annual dose limit (dose due to gamma radiation inside the room and inhalation of radon). The estimated representative level index for all the samples is less than unity (the upper limit) indicating that the associated gamma radiation level is low. The annual dose limit falls within 0.19 to 0.30 mSv, which is an order of magnitude below the criterion limit specified for building materials in the literature.

Protective effect of Rolipram in experimental autoimmune neuritis: protection is associated with down-regulation of IFN-gamma and inflammatory chemokines as well as up-regulation of IL-4 in peripheral nervous system

Rolipram, a phosphodiesterase type 4 inhibitor, is reported to have anti-inflammatory effects. It can markedly downregulate antigen-driven T cell proliferation and suppress TNF-(alpha and TNF-beta production in vitro and in vivo, which have led to its use in the treatment of a number of autoimmune disorders including experimental autoimmune encephalomyelitis (EAE) and experimental autoimmune neuritis (EAN). EAN is a CD4+ T cell-mediated demyelinating autoimmune disease of peripheral nervous system (PNS) that represents an animal model for the study of the immunopathogenesis and immunotherapy of Guillain-Barré syndrome (GBS) in human. In the previous study, we reported that suppression of EAN by Rolipram was associated with down-regulated myelin antigen-induced T cell responses as well as downregulated IFN-gamma and TNF-alpha production. Here we report that EAN induced in Lewis rats by inoculation with the PNS P2 protein peptide 57-81 and Freund's complete adjuvant (FCA), was strongly suppressed by Rolipram administered twice daily intraperitoneally from day 9 post immunization (p.i.), i.e. after onset of clinical EAN to day 18 p.i. This clinical effect was associated with dose-dependent down-regulated production of IFN-gamma and the chemokines macrophage inflammatory protein-1 alpha (MIP-1 alpha, MIP-2 and monocyte chemotactic protein-1(MCP-1) as well as up-regulated IL-4 production in sciatic nerve sections from Rolipram-treated EAN rats at maximum of clinical EAN, i.e. on day 14 p.i.. These findings suggest that Rolipram may be useful in certain T cell-dependent autoimmune diseases and inflammatory neuropathies. These observations call for further studies on the potential role of Rolipram in the treatment of autoimmune diseases.