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This study aimed to assess the biological activities of Tunisian Simmondsia chinensis and characterize their potential bioactive compounds. Different extracts of S. chinensis were tested for their antioxidant, antibacterial, anti α-amylase, and anti-acetylcholinesterase activities through in vitro assays. The methanolic extract exhibited the highest levels of antioxidant activity and total phenolic content (976.03 GAE/g extract) compared to the other extracts. Additionally, it demonstrated a substantial anti-acetylcholinesterase activity (PI= 75%) and potent antibacterial property, particularly against Enterococcus faecalis, Listeria monocytogenes, Bacillus cereus, Bacillus subtilis, and Salmonella enterica. The IC50 values of ethyl acetate and methanolic extracts against α-amylase were 42 μg/mL and 40 μg/mL, respectively, indicating potent anti-diabetic effects. HPLC-ESI-MS/MS analyses identified flavonoids and lignans as the major phenolic compounds in the methanolic extract. To better comprehend the mechanisms behind inhibitory effects on α-amylase and acetylcholinesterase enzymes, a molecular docking study was conducted. Consequently, these findings indicate that S. chinensis is a highly valuable natural resource with potential industrial applications., (© 2024 Wiley‐VCH GmbH.)

In this study, a novel fatty acid anhydride, named phalarisin 1, was successfully isolated from the ethyl acetate extract of Phalaris canariensis growing in Tunisia. The structural characterisation of the compound was achieved through various spectroscopic techniques including FT-IR, 1D and 2D-NMR spectroscopy, as well as acidic hydrolysis analyses. Remarkably, phalarisin exhibited potent antimicrobial properties against a range of pathogens including Micrococcus luteus , Bacillus subtilis , Fusarium oxysporum , and Fusarium phylophylum , with minimum inhibitory concentrations (MICs) ranging from 31.25 to 62.5 μg/mL. To grasp the antimicrobial potential of compound 1, molecular docking studies were performed and they furnished evidence indicating its ability to bind to proteins in bacteria and fungi that are pivotal for drug resistance.

Introduction: The assessment of Volatile Organic Compounds (VOCs) in exhaled breath or sweat represents a potential non-invasive and rapid diagnostic tool for respiratory diseases., Objective: To determine if trained dogs can reliably identify the odour associated with COVID19., Methods: This is a monocentric prospective study carried out in the Emergency Department (ED) of a university hospital fromJulyto November 2021.Axillary sweat samples from all patients were collected bytwo trained health care professionals. The samples were collected in the form of sterile gauze swabs placed under the armpits for at least 4 h for each patient.Then, Tubes wereshiftedto the double-blind dog training centre for VOC detection by two individuals., Results: Dogs were tested using a total of 129 axillary sweat samples; 69 of the 107 patients who tested positive for COVID-19 based on their odours had a positive PCR/Antigen test and 19 of the 22 patients who were tested negative for COVID-19 by the dogs had a negative PCR test. The sniffer dog infection detection method had a sensitivity of 95.83% and a specificity of 33.33%. The PPV was 64.49% and the NPVwas 86.36%. The measurement of the intensity of the connection between the two variables (disease/sign) was very strong ( Q  = 0.84). This link is statistically significant (X 2 = 19.13) with a probability p ≤ 0.001., Conclusion: Overall, the use of trained detection dogs as a screening method for SARS-CoV-2 is an interesting avenue of research that warrants further exploration and validation.

Background: Food-associated antibiotic-resistant bacteria can cause infections that may critically impact human health. The objectives of this study were to determine the microbial contamination level of green leafy vegetables and their antibiotic resistance pattern., Methods: Sixty-three samples of leafy vegetables were collected from Dammam Central Fruit and Vegetables Market from January to June 2023. The vegetables included lettuce (Lactuca sativa), parsley (Petroselinum crispum), and watercress (Nasturtium officinale). Samples were tested by standard microbiological techniques for identification and antibiotic susceptibility testing., Result: Eight types of bacteria belonging to six different genera were detected. Enterobacteriaceae family was represented by four genera: Klebsiella, Proteus, Morganella, and Enterobacter. The other two genera were Pseudomonas and Aeromonas. Enterobacter cloacae was the most abundant organism, followed by Pseudomonas putida and Aeromonas sobria. On the other hand, Morganella morganii, Aeromonas hydrophila, and Proteus mirabilis were the least abundant. The three vegetable types had different levels of bacterial contamination. All isolated organisms were sensitive to penicillin, cephalosporin, aminoglycoside, and fluoroquinolone. However, Klebsiella oxytoca, M. morganii, and K. pneumonia showed resistance to ampicillin. A. hydrophila, Morganella morganii, and E. cloacae showed resistance to amoxicillin. M. morganii and E. cloacae were found to be resistant to cefalotin. Moreover, A. hydrophila, M. morganii, and E. cloacae were resistant to cefoxitin. Again, A. hydrophila was found to be resistant to imipenem. Only M. morganii was resistant to Ciprofloxacin. Two isolates, P. mirabilis and M. morganii were resistant to tigecycline. Another two, M. morganii and P. mirabilis were resistant to Nitrofurantoin. Only M. morganii was found to be resistant to trimethoprim., Conclusion: This study aligns with the broad consensus in the literature about the significance of bacterial contamination in vegetables and the public health implications. The unique focus on antibiotic resistance patterns adds an essential dimension to the existing body of knowledge., (© 2024. The Author(s).)

Heavy metal contamination in seafood is a developing concern due to the potential negative consequences on human health. Egypt's coastal regions are important for seafood production and consumption, making it critical to assess the safety of these aquatic resources. The current study examined toxic metal levels (Hg, Pb, Cd, and AS) in 96 samples of sardine and shrimp from four Egyptian coastal governorates (Alexandria, Kafr El-Sheikh, Damietta, and Port Said) from 2019 to 2021. Inductively coupled plasma-optical emission spectroscopy (ICP-OES) was used to investigate the four hazardous metals. The recovery percentages of the determined metals ranged between 97 % and 99 %. Limits of detection (LOD) and limit of quantification (LOQ) for the determined metals ranged from 0.001 to 0.0077 mg/l and from 0.0035 to 0.026 mg/l, respectively. Mercury (Hg) was not found in any of the samples tested. The concentrations of Pb and Cd in the sardines and shrimp samples were higher in the winter seasons than in the summer seasons. Meanwhile, the difference in seasons had no effect on the concentration of As in the sardines and shrimp samples. The highest concentrations of the other three metals in the sardine and shrimp samples were used to calculate the Estimated Daily Intake (EDI), Target Hazard Quotient (THQ), and Hazard Index (HI). The obtained THQ as well as the HI of Pb, Cd, and As were all less than 1.0 (with the exception of sardine samples from Kafr El-Sheikh Governorate, which recorded 1.262), indicating that there is no significant health risk to the consumer from consuming such sardines and shrimp from these governorates. The effect of different seasons on the concentrations of the metals under study does not have a specific behavior, but varies according to the governorate, the type of sample, and the type of contaminated metal. Due to the high level of contamination with heavy metals in sardine samples collected from Kafr El-Sheikh governorate (TTHQ = 1.26), an environmental study is required to determine the causes of contamination and control them., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Synthetic cannabinoids (SCs) dependence is increasingly prevalent among young individuals globally, with limited understanding of their potential detrimental effects. Therefore, we conducted this comparative study to assess impulsivity and non-suicidal self-harm behavior in patients with SCs dependence., Subjects and Method: We conducted this comparative, case-control study in the outpatient clinics of (Beni-suef University Hospital). We recruited 30 patients with SCs dependence and the 30 healthy subjects as a control group. Psychometric scales, including Addiction Severity Index (ASI), Barratt Impulsivity Scale-11 (BIS-11), Deliberate Self-harm Inventory-Short Version (DSHI), SCID I, SCID II, and drug urine screen, were applied to compare the two study arms., Results: DSHI-s scores were significantly higher between the two study arms (3.23 ± 4.97 vs. 0.0 ± 0.0, p  < 0.001, for cases and controls, respectively). Similarly, the mean ± SD score of the BIS scale was significantly higher in cases 68.13 ± 9.75 compared to the control group (45.67 ± 5.12) with a statistically significant difference ( p  < 0.001). Using the regression analysis, we observed a significant positive linkage between age, duration of substance use, DSHI-s, and the Barratt scale., Conclusion: Patients with synthetic cannabis addiction exhibited more impulsivity and self-harm behaviors compared to healthy controls. The adverse effects of substance use disorder escalated, notably in individuals classified as having severe addiction based on the Addiction Severity Index. Age and length of substance use were found to be potential factors influencing the level of impulsivity and self-harm actions.

Determining the gene expression and serum profile of the indicators linked to clinical endometritis susceptibility in Egyptian buffalo cows was the aim of this investigation. The buffalo cows that were enrolled were divided into two groups: forty infected buffalo cows with clinical endometritis and forty seemingly healthy buffalo cows that served as the control group. For the purposes of gene expression and biochemical analysis, ten milliliters of blood was obtained via jugular venipuncture from each buffalo cow. TLR4 , IL-8 , IL-17 , NFKB , SLCA11A1 , NCF4 , Keap1 , HMOX1 , OXSR1 , ST1P1 , and SERP1 were manifestly expressed at much higher levels in the buffaloes with endometritis. On the other hand, the genes that encode SOD , CAT , NDUFS6 , Nrf2 , and PRDX2 were down-regulated. There was a significant ( p < 0.05) elevation of the serum levels of non-esterified fatty acids (NEFAs), beta hydroxy butyric acid (BHBA), triglycerides (TGs), globulin, creatinine, and cortisol, along with a reduction in the serum levels of glucose, cholesterol, total protein albumin, urea, estrogen (E2), progesterone (P4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroxine (T4), prostaglandin F2 α (PGF2α), calcium, iron, and selenium, in the endometritis group in comparison with the control. However, no significant change was observed in the values of phosphorus, magnesium, copper, or zinc in either group. Within the selective breeding of naturally resistant animals, the variation in the genes under study and the changes in the serum profiles of the indicators under investigation may serve as a reference guide for reducing endometritis in Egyptian buffalo cows.

Background: Evidence supporting the possible causal association of myopericarditis with the coronavirus disease (COVID-19) vaccine has mainly come from case reports. Epidemiological evidence indicating an increased relative risk for myopericarditis after COVID-19 vaccination is lacking. Therefore, this study aimed to identify and assess all confirmed COVID-19 vaccine- related cases of myopericarditis presenting to major cardiac centers in the Eastern Region of Saudi Arabia, before and after the introduction of the COVID-19 vaccine., Methods: According to case definition, the hospital's information system database detected all confirmed cases at two main cardiac centers., Results: Of the 18 confirmed myocarditis and myopericarditis cases detected after the administration of COVID-19 vaccines, three were possibly related to COVID-19 immunization. The first case was of myopericarditis following a third dose of mRNA-1273. The second case was myocarditis, which occurred seven days after the first dose of AstraZeneca. The third case was myocarditis, which occurred 12 days after the third dose of BNT162b2. A cardiologist carefully evaluated the cases using recognized protocols and case definitions to demonstrate a direct relationship with vaccination consequences rather than coincidence., Conclusion: We found no difference in the occurrence of myocarditis and myopericarditis after the COVID-19 vaccine compared with the background rate during a similar period (P = 0.9783). The incidences of myocarditis and myopericarditis following immunization were low. The advantages of the COVID-19 vaccination outweigh the risk of myopericarditis., Competing Interests: The authors declare that they have no competing interests in this work., (© 2024 Al Zahrani et al.)

Abstract: Apocrine hidrocystomas are benign, cystic neoplastic lesions resulting from the apocrine secretory component of the sweat gland. They most commonly occur on the head and neck, with predilection to the periorbital area. Less frequent sites include the axilla, nipple, external auditory canal, foreskin, conjunctiva, lower lip, and fingers, among others. The authors report a unique case of a nail bed hidrocystoma in a 55-year-old woman, a site not previously described., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Background: Earlier reports suggested high rates of antibiotic utilization among COVID-19 patients despite the lack of direct evidence of their activity against viral pathogens. Different trends in antibiotic consumption during 2020 compared to 2019 have been reported., Purpose: The objective of this study is to assess the impact of COVID-19 pandemic on antibiotic consumption in the presence of active Antibiotic Stewardship Program., Methods: This study represented a five years assessment of the consumption of the commonly prescribed antibiotics measured as DDDs/100-Bed Days. We analyzed the data by using nonparametric Friedman and Friedman tests to compare the antibiotic consumption before and during the three subsequent waves of COVID-19., Results: Antibiotic consumption through the DDDs/100-BD has shown reduction in the median of antibiotics consumption of most antibiotics during the period of COVID-19 as compared to the pre-COVID-19 period, which was significant for meropenem and ciprofloxacin, except colomycin that slightly increased. Significant reduction in the consumption of imipenem and meropenem during the second and third waves as compared to the pre-COVID period. Throughout the years, significant reductions were observed between 2018 and 2019 (p=<.001), 2018 and 2020 (p=0.008), and 2018 and 2022 (p=0.002)., Conclusion: The reduction in antibiotic consumption is attributed to the strong influence if the ASP and the reluctance of people to visit hospitals during the COVID-19 pandemic. Other related COVID-19 precautions such as physical distance, good hand hygiene, facemasks, that resulted in the prevention of secondary bacterial infections have contributed to the reduction in antibiotic utilization during the pandemic., Competing Interests: The authors declare that they have no conflicts of interest in this work., (© 2024 Elsafi et al.)

The objective of this study is to assess the effectiveness of different techniques employed in remediating contaminated soil and wastewater ecosystems to ensure the safety of tomato fruits (Solanum lycopersicum L. var. cerasiforme) cultivated in these environments. Three biochemical techniques T1-T3, besides two controls CCU and CCT, were used to remediate contaminated soil ecosystems using rock phosphate, elemental sulfur, bentonite, phosphate-dissolving bacteria, and Thiobacillus sp. The contaminated agricultural drainage water was remediated by a down-flow hanging sponge (DHS) system. Two experiments were conducted: a pot experiment took place in the greenhouse at the National Research Center of Cairo (Egypt) and a field experiment was carried out at the basin site in the village of El-Rahawy, applying the optimal treatment(s) identified from the greenhouse experiment. The health risk assessment for potentially toxic elements (PTEs) in the harvested tomato fruits was conducted by calculating estimated daily intake (EDI) and target risk quotient (THQ) values. Results from the greenhouse experiment indicated the high effectiveness of the DHS technique in remediating El-Rahawy agricultural drainage water. The content of PTEs after remediation was significantly reduced by 100%, 93.3%, 97.8, and 77.8% for cadmium, copper, manganese, and zinc, respectively. The application of treated drainage water in employed reclaimed soil ecosystems led to a remarkable decrease in PTE levels, especially under T3 treatment; the reduction reached 89.4%, 89.5%, and 78.4% for nickel, copper, and zinc, respectively. The bioremediation technique also reduced the content of PTEs in tomato fruits harvested from both greenhouse and field experiments; the cadmium content, for example, was below detection limits in all treatments. The T3 treatment applied in the greenhouse experiment caused the highest percentage decrease among the employed PTEs in tomato fruits grown in the greenhouse. The same trend was also reached in the field experiment. Microbiological analyses of tomato fruits revealed that E. coli, Salmonella, or S. aureus bacteria were identified on tomato fruits harvested from either greenhouses or field experiments, showing that the counted total bacteria were higher under the field experiment compared to the greenhouse experiment. The health risk assessment parameter THQ was below 1.0 for all tested metals under all treatments. This means that no potential health risk is expected from consuming tomato products produced under the different employed remediation treatments. In conclusion, the employed bioremediation techniques successfully reduced the PTE content and microbial load in both soil and drainage water ecosystems and in harvested tomato fruits. Henceforth, no health risks are expected from the consumption of this product., (© 2024. The Author(s).)

Objectives: This randomized clinical trial evaluated and compared the 2-year clinical performance of two ion-releasing bulk-fill composites (Cention N and Surefil One) with that of a conventional bulk-fill resin composite (Powerfil) in Class I and II cavities., Methods: Thirty-two patients, each with 3 Class I and/or Class II cavities under occlusion, were enrolled in this trial. A total of 96 restorations were placed, 32 for each material, as follows: a self-adhesive composite; Surefil-one, alkasite; Cention N, and a bulk-fill resin composite; Powerfil. The restorations were placed by a single operator. Clinical evaluation was performed at baseline (1-week), 6-months, 1-year, and 2-years by two independent examiners using the FDI criteria. Intergroup and intragroup comparisons were analyzed using the Kruskal-Wallis and Friedman Tests. Multiple comparisons between groups were analyzed using the Mann-Whitney and Wilcoxon-rank tests. The level of significance was set at α = 0.05., Results: Twenty-seven patients with a total of 81 restorations were evaluated at the end of the 2-years with 84.35% recall rates. Clinical success rates were 100%, 100%, and 96.3% for Powerfil, Surefil-one, and Cention N, respectively. Cention N showed a statistically significant (p < 0.05) decreased marginal integrity in comparison with resin composite at the 2-year evaluation. No recurrent decay was detected in any restoration., Conclusions: Both ion-releasing bulk-fill composites provided acceptable clinical performance similar to bulk-fill composite in Class I and II restorations over a 2-year period., Clinical Relevance: The results of this trial suggests that there is a promising evidence supporting the use of ion-releasing composites., (© 2024 Wiley Periodicals LLC.)

Objective: To evaluate the effect of various surface coating methods on surface roughness, micromorphological analysis and fluoride release from contemporary resin-modified and conventional glass ionomer restorations., Materials & Methods: A total of 72 permanent human molars were used in this study. The teeth were randomly assigned into 2 groups according to type of restorative materials used; resin modified glass ionomer cement and conventional glass ionomer (SDI Limited. Bayswater Victoria, Australia). Each group was subdivided into 3 subgroups according to the application of coat material; Sub-group1: without application of coat; Sub-group2: manufacturer recommended coat was applied and sub-group3: customized (vaseline) coat was applied. Each group was then subdivided into two divisions according to the time of testing; immediate (after 24 h) and delayed (after 6 months of storage). Three specimens from each sub-group were selected for surface roughness test (AFM) and another 3 specimens for the micromorphological analysis using scanning electron microscope (SEM). For the fluoride release test, a total of 60 cylindrical discs were used (n = 60). The discs were randomly split into 2 groups according to type of restorative materials used (n = 30); resin modified glass ionomer cement and conventional glass ionomer. Each group was subdivided into 3 subgroups (n = 10) according to the application of the coat material; Sub-group1: without application of coat; Sub-group2: with the manufacturer recommended coat and sub-group3: with application of customized (vaseline) coat. Data for each test was then collected, tabulated, were collected, tabulated, and tested for the normality with Shapiro-Wilk test. Based on the outcome of normality test, the significant effects of variables were assessed using appropriate statistical analysis testing methods., Results: Regarding the data obtained from surface roughness test, Shapiro-Wilk test showed normal distribution pattern of all values (p > 0.05). Accordingly, Two-way ANOVA outcome showed that the 'type of restoration' or 'test time' had statistically significant effect on the AFM test (p < 0.05). Regarding Fluoride specific ion electrode test 2-way ANOVA followed by Least Significant Difference (LSD) Post-hoc test revealed significant difference among the groups (p < 0.05). It showed that SDI GIC group after 14 days of measurement had the highest mean of fluoride release (36.38 ± 3.16 PPM) and SDI RMGIC after 30 days of measurement had the second highest mean of fluoride release (43.28 ± 1.89 PPM). Finally, regarding the micromorphological analysis using SEM, a slight difference was observed between the studied groups., Conclusions: Based on the results of this study, various coatings enhance surface roughness in the initial 24 h of restoration insertion. Different coat types seems that have no influence on fluoride release and the micromorphological features of the restoration/dentin interface., (© 2024. The Author(s).)

The study aims to explore bee venom (honey-BV) as a potential natural preservative for "Tallaga" soft cheese. Characterization of the active compounds in honey-BV was conducted via chromatographic analyses. Antimicrobial efficacy against pathogenic bacteria and fungi was evaluated, and minimum inhibitory concentration (MIC) was determined. Subsequently, honey-BV was applied to Tallaga cheese at 15 mg/g concentrations. The main active ingredients identified in bee venom were apamin (2%) and melittin (48.7%). Both concentrations of bee venom (100 and 200 mg/mL) exhibited significant antifungal and antibacterial properties against tested organisms, with MIC values varied from 0.2 to 0.5 mg/mL for bacteria to 3-13 mg/mL for fungi. Application of honey-BV in Tallaga cheese resulted in complete elimination of Staphylococcal populations after 2 weeks of cold storage, with no detectable growth of molds or yeasts throughout the storage period. Additionally, a steady decrease in aerobic plate count was observed over time. In summary, honey-BV holds promise as a natural preservative for soft cheese, however, more investigation is required to optimize the concentration for economic viability, taking into account health benefits and safety considerations., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Objectives: To provide a 3-year follow-up of previously treated patients to assess and compare the periodontal responses and clinical performance of proximal subgingival open sandwich restorations., Materials and Methods: Ninety-five adults participated in the study, with a combined total of 120 compound Class II cavities. These cavities had gingival margins located below the CEJ. Four different restorative materials were used to elevate the dentin/cementum gingival margins of the cavities: resin-modified glass ionomer, glass hybrid, flowable bulk-fill composite, or ion-releasing material, which were then completed with the same overlaying composite. Different periodontal and clinical evaluations, based on the criteria set by the World Dental Federation (FDI) criteria, were performed at different time intervals, including baseline, 6 months, 1, 2, and 3 years., Results: The type of base material did not affect the periodontal evaluations. There were no statistically significant differences between different time intervals or base material groups in any of the evaluated FDI parameters. However, the ion-releasing material scored significantly worse in the radiographic evaluation than any of the other groups., Conclusions: All tested materials are suitable for proximal subgingival open sandwich restorations, as long as the restoration/tooth margin is at least 2-mm away from the bone crest., Clinical Significance: Clinicians can confidently choose any of the tested materials for proximal subgingival open sandwich restorations, as they have shown good outcomes from both periodontal and clinical perspectives., (© 2023 Wiley Periodicals LLC.)

This study aimed to evaluate the periodontal responses of subgingival proximal margins elevated using different restorative materials. A total of 120 proximal cavities with dentin/cementum gingival margins were elevated using one of four materials (resin-modified glass ionomer, glass hybrid, flowable bulk-fill resin composite, or bioactive ionic resin) and completed with the same overlaying resin composite. At 2 weeks (baseline), 6 months, 1 year, and 2 years postrestoration, periodontal parameters and the radiographic distance between the restoration margin and bone crest were evaluated. Appropriate statistical analyses were performed. The values of all periodontal parameters increased with time, although only the increases in Plaque Index and probing depth within each material group were statistically significant. There were no statistically significant differences in any of the periodontal parameters between the different materials within the same evaluation period, nor between different time points or material groups in the radiographic distances. Both glass ionomer-based and resin-based materials were periodontally safe as subgingival open sandwich restorations.

Quinoxaline derivatives are an important class of heterocyclic compounds in which N replaces one or more carbon atoms of the naphthalene ring and exhibit a wide spectrum of biological activities and therapeutic applications. As a result, we were encouraged to explore a new synthetic approach to quinoxaline derivatives. In this work, we synthesized two new derivatives namely, ethyl 4-(2-ethoxy-2-oxoethyl)-3-oxo-3,4-dihydroquinoxaline-2-carboxylate ( 2 ) and 3-oxo-3,4-dihydroquinoxaline-2-carbohydrazide ( 3 ) respectively. Their structures were confirmed by single-crystal X-ray analysis. Hirshfeld surface (HS) analysis is performed to understand the nature and magnitude of intermolecular interactions in the crystal packing. Density functional theory using the wb97xd/def2-TZVP method was chosen to explore their reactivity, electronic stability and optical properties. Charge transfer (CT) and orbital energies were analyzed via natural population analysis (NPA), and frontier molecular orbital (FMO) theory. The calculated excellent static hyperpolarizability (β o ) indicates nonlinear optical (NLO) properties for 2 and 3 . Both compounds show potent activity against c-Jun N-terminal kinases 1 (JNK 1) based on structural activity relationship studies, further subjected to molecular docking, molecular dynamics and ADMET analysis to understand their potential as drug candidates.Communicated by Ramaswamy H. Sarma.

This study aimed to investigate the potential use of okra and psyllium mucilage as co-carrier wall materials with whey protein and gum Arabic polymers for encapsulation of fenugreek oil to mask its undesirable flavor and promote their health benefits. Particle size, zeta potential, encapsulation efficiency, morphological properties and fatty acid profiles of crude and encapsulated oils were examined using zeta-sizer, SEM and GC-MS techniques. Crude and encapsulated fenugreek oils were added as functional ingredients during production of pan bread and biscuits. The quality characteristics (baking quality, color and organoleptic properties) of bread and biscuits as well as microbiological properties of bred samples were evaluated. Results showed that the forming microcapsules had sphere particles with the size of 5.05 and 31.64 μm for okra and pysillium mucilage, respectively and had smooth continuous surfaces with no holes or fractures. Fatty acids analysis showed that fenugreek oil is superior functional edible oil, rich in unsaturated fatty acids. The organoleptic properties of products were improved when fat replaced with encapsulated fenugreek oil with okra or psyllium mucilage. Likewise, encapsulated fenugreek oil showed antimicrobial activity in bread samples during storage period. On contrary, Bread and biscuits incorporated with crude fenugreek oil gained the lowest scores for all organoleptic parameters. Regarding these results, encapsulated fenugreek oil presents good fat alternatives in dough formulations with acceptable technological, sensory and antimicrobial properties. However, further investigations still needed regarding the biological activity of encapsulated fenugreek oil and its utilization as a food supplement in other food products., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Ltd.)

Objective: The objectives of this study are to identify the prevalence and the factors behind overweight and obesity among the healthcare profession's students., Methods: A well-structured and validated questionnaire was distributed to a heterogeneous purposive sample of the healthcare profession's students in Saudi Arabia., Results: About 21.0% and 15.5% were overweight and obese, respectively. The average knowledge score was 70.6% and increased with age and among obese participants. The average attitude score was 74.8% with no variation within age, body mass index (BMI), and gender. The average practice score was only 36.7%. There was a significant variation of the practice within the different age groups (P = 0.021). There was a significant association between the participant's knowledge and attitude, and practice., Conclusion: The average practice score was poor. Despite their good knowledge and positive attitude, the students are exposed to heavy junk food marketing, which encourages overconsumption by instilling positive emotional associations with the junk food. They are mostly physically inactive, anxious and sleep deprived, which can lead to poor eating habits. For this group, various strategies and motivators will likely be needed., Competing Interests: The authors report no commercial or financial relationship that might be seen as creating a conflict of interest throughout the research’s conduct for this work., (© 2024 Elsafi et al.)

Background: In Pakistan, where the burden of communicable diseases remains high, the private sector accounts for 62% of health care provision., Aim: To describe the role of the private sector in communicable disease management in Pakistan and inform a more effective engagement towards achieving Universal Health Coverage., Methods: We searched the literature and available documents on policies, regulations and experiences in private health sector engagement in Pakistan. We interviewed policy level experts regarding the formulation of national health policies and plans and a sample of private providers using a structured questionnaire to assess their awareness of and engagement in communicable disease programmes., Results: Published reports described initiatives to engage the private sector in improving coverage for a package of care and programme-specific initiatives. Pakistan did not have a national policy for structural engagement, and regulations were limited. Policy level experts interviewed perceived the private sector as market-driven and poorly regulated. Thirty-nine percent of private sector providers interviewed were aware or had been trained in procedures or guidelines, and 23% of them had had their performance monitored by government., Conclusion: We recommend that the Ministry of Health provide overall vision for the operations of the public and private health sectors so that both sectors can complement each other towards the achievement of Universal Health Coverage, including for communicable diseases., (Copyright: © Authors 2024; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: The prevalence of heart failure (HF) is increasing among young adults in the United States with pervasive racial and ethnic differences in this population., Objective: To evaluate contemporary associations between race and ethnicity, clinical comorbidities, and outcomes among young to middle-aged adults with HF., Methods: A retrospective analysis was performed using the National Health and Nutrition Examination Survey. All participants with a self-report of HF aged 20-64 years from 2005 to 2018 were included and stratified by race and ethnicity [non-Hispanic (NH) Whites, NH Blacks, and Hispanics]. Data on baseline characteristics including age, sex, marital status, citizenship, education level, body mass index, insurance, waist circumference, cigarette smoking, marijuana use, and relevant clinical comorbidities were included. Weighted logistic regression was performed to estimate adjusted odds ratios (aOR) to determine the association of race and ethnicity with HF. Cox proportional-hazards models were used to assess the association of race and ethnicity with all-cause and cardiac mortality., Results: A total of 1,940,447 young to middle-aged adults had self-reported HF between 2005 and 2018, of whom 61% were NH White, 40% were NH Black, and 22% were Hispanic. When compared with NH White adults, NH Black adults had higher odds of HF adjusted for age, sex, insurance status, marital status, education level, citizenship status, and clinical comorbidities (adjusted aOR 2.63, 95% CI: 1.71-4.05, p  < 0.001). There was no significant difference in the odds of HF between Hispanic and NH White adults (aOR 1.18, 95% CI: 0.64-2.18, p  = 0.585). NH Black adults had higher mean systolic and diastolic blood pressure, and a comparable or lower burden of cardiovascular and non-cardiovascular clinical comorbidities compared with NH White and Hispanic adults. No statistical significance was noted by race and ethnicity for all-cause and cardiac mortality during a follow-up of 5 years., Conclusion: NH Black young to middle-aged adults were more likely to have HF which may be related to higher blood pressure given the largely similar burden of clinically relevant comorbidities compared with other racial and ethnic groups.

This study aimed to evaluate the annual occupational radiation exposure of technologists during PET/CT imaging in 2020 and 2021. Eleven nuclear medicine technologists were monitored at the PET/CT department. The personal dose equivalents (PDEs) for staff members, measured in terms of Hp (10) and Hp (0.07), were assessed annually, considering both deep and surface doses. PDEs were quantified using a thermoluminescent detector (LiF:Mg:Ti)). The average and range of PDEs and extremity doses (mSv) for the technologists were as follows: 4.5 (0.1-13.4) for Hp (10), 4.63 (0.1-13.9) for Hp (0.07), and 2.5 (0.2-17.5) for extremity, respectively. The results indicated that staff members are exposed to high-energy gamma rays while preparing radiopharmaceuticals, injections, and image acquisition. Therefore, proper handling of radiopharmaceuticals and patient management during the acquisition of parameters are crucial for maintaining the occupational dose within the defined limit., Competing Interests: Declaration of competing interest All authors declare that there is no conflict of Interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Candida glabrata is a commensal yeast of the gastrointestinal tract and skin of humans. However, it causes opportunistic infections in immunocompromised patients, and is the second most common Candida pathogen causing bloodstream infections. Although there are many studies on the epidemiology of C. glabrata infections, the fine- and large-scale geographical nature of C. glabrata remain incompletely understood. Here we investigated both the fine- and large-scale population structure of C. glabrata through genome sequencing of 80 clinical isolates obtained from six tertiary hospitals in Qatar and by comparing with global collections. Our fine-scale analyses revealed high genetic diversity within the Qatari population of C. glabrata and identified signatures of recombination, inbreeding and clonal expansion within and between hospitals, including evidence for nosocomial transmission among coronavirus disease 2019 (COVID-19) patients. In addition to signatures of recombination at the population level, both MATa and MATα alleles were detected in most hospitals, indicating the potential for sexual reproduction in clinical environments. Comparisons with global samples showed that the Qatari C. glabrata population was very similar to those from other parts of the world, consistent with the significant role of recent anthropogenic activities in shaping its population structure. Genome-wide association studies identified both known and novel genomic variants associated with reduced susceptibilities to fluconazole, 5-flucytosine and echinocandins. Together, our genomic analyses revealed the diversity, transmission patterns and antifungal drug resistance mechanisms of C. glabrata in Qatar as well as the relationships between Qatari isolates and those from other parts of the world.

Competing Interests: Competing interests: None declared.

Background: Many countries in the Eastern Mediterranean Region (EMR) have developed packages of services for achieving Universal Health Coverage (UHC), however, policymakers, especially in resource-constrained countries, still face challenges in delivering equitable, efficient and sustainable health services., Aims: To provide guidance for EMR countries and develop packages of services for UHC., Methods: We used information gathered from narrative reviews, national experiences and expert consultations to develop step-by-step guidance for the development of national packages of services for the achievement of UHC by countries in the EMR., Results: The processes used to develop packages of services varied between EMR countries and these processes may not have involved all relevant stakeholders. We highlight in this paper the iterative processes, including several phases and steps, to be used by EMR countries for developing packages of services for UHC. These processes also make provision for continuous monitoring and revision to make necessary improvements as morbidity patterns evolve., Conclusion: Developing a package of services for the achievement of UHC is a significant milestone for EMR countries and it is central to shaping the healthcare system for effective delivery of services., (Copyright: © Authors 2023; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Due to the extended localized fluoroscopy, many radiographic exposures, and multiple procedures that might result in tissue reaction, patients and personnel received a significant radiation dose during interventional cardiology (IR) procedures. This study aims to calculate the radiation risk and assess patient and staff effective doses during IC procedures. Thirty-two patients underwent a Cath lab treatment in total. Ten Cath lab personnel, including six nurses, two cardiologists, and two X-ray technologists. Optical stimulating-luminescent dosimeters (OSL) (Al2O3:C) calibrated for this purpose were used to monitor both occupational and ambient doses. Using an automated OSL reader, these badges were scanned. The Air Kerma (mGy) and Kerma Area Products (KAP, mGy.cm 2 ) have a mean and standard deviation (SD) of 371 ± 132 and 26052, respectively. The average personal dose equivalent (mSv) and its range for cardiologists, nurses and X ray technologists were 1.11 ± 0.21 (0.96-1.26), 0.84 ± 0.11 (0.68-1.16), and 0.68 ± 0.014 (0.12-0.13), respectively. The current study findings showed that the annual effective dose for cardiologists, nurses, and X-ray technologists was lesser than the yearly occupational dose limit of 20 mSv recommended by national and international guidelines. The patients' doses are comparable with some previously published studies and below the tissue reaction limits., Competing Interests: Declaration of competing interest All authors declare that there is no conflict of Interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Spondylarthritis (SpA) is an umbrella term that encompasses a wide range of rheumatological disorders. Several studies demonstrated that SpA is associated with increased healthcare resource utilization (HCRU) and a lower health-related quality of life (HRQoL). This review aimed to summarize the current literature regarding the multidimensional impact of SpA on HRQoL and HCRU in Saudi Arabia and explore the correlation of the extent of severity of SpA with HRQoL and HCRU. Although the prevalence of SpA varies across different populations and is correlated with HLA-B27 prevalence, the magnitude of SpA in the Saudi population has not been extensively evaluated. Few studies have investigated the impact of SpA on HRQoL and HCRU in Saudi Arabia and the Middle East. There is a need to study the cost-effectiveness of various SpA treatment strategies, including biologic disease-modifying anti-rheumatic drugs (bDMARDs), to prioritize healthcare spending in the Saudi healthcare system. Data on SpA in Saudi Arabia and the Middle East region are mainly based on expert views, with few population-based studies compared to other regions. Therefore, there is an imperative need to develop high-quality, national-level epidemiological studies that assess the following: (1) more accurate estimates of the current prevalence of SpA in Saudi Arabia, including the prevalence of axial SpA and psoriatic arthritis; (2) the phenotypes/clinical characteristics of SpA, including disease severity and extra-articular involvement; (3) the impact of SpA on the HRQoL of the patients and the factors that can predict the extent of impaired HRQoL in such population, which can represent the first step in developing psychological interventions that should be personalized to this patient population; (4) the impact of implementing formal assessment of disease activity on the management of the patients and, subsequently, their HRQoL; and (5) the HCRU and costs for patients with SpA, and how treatment patterns can affect this cost., Competing Interests: Dr Hanan Al Rayes is a speaker, moderator, and/or advisory board member for AbbVie, Eli Lilly, Janssen, novartis and Pfizer. Mohamed Bedaiwi does not have any relevant disclosures for this article, Hany Salah, Tharwat Hamad and Mohab Soliman are full-time employees of AbbVie Biopharmaceuticals GmbH and may hold stocks or stock options., (© 2023 Al Rayes et al.)

Introduction: The benchmarking for medication incidents rate is not regarded as a recognized key performance measure or indicator in national or international organizations. The absence of benchmarking the medication incidents results in the loss of a self-governing perception of how well we performed compared to other peers., Methodology and Settings: This 600-bed tertiary, Joint Commission International (JCI) accredited hospital retrospective analysis looked at all medication management-related events from January-2018 to December-2021. The study design follows descriptive, cross-sectional, retrospective prevalence research., Results: The rate of medication incidents that resulted in harm declined from Q3-2019 to Q4-2021. A significant increase in Pharmacy interventions/clarifications was recorded. Additionally, a significant increase in incidents reported with no-harm coupled with a significant reduction in incidences of serious events from 2019 to 2020. Finally, no-harm events were significantly reduced from 2020 to 2021., Discussion: The Pharmacy's study analyzed every medication incident documented from 2019 to 2021. 99.7% of reported incidents were classified as no-harm (near misses). There was an exponential decrease from Q1-2020 to Q1-202. A significant increase in incidents fell in the category of (near misses) with no-harm and a significant reduction in serious events. Pharmacy interventions/clarifications saw a massive increase and impact from Q3-2018 to Q2-2019, compared to the same period in 2018. By preventing medical incidents, benchmarking, and analyzing incidents and the reporting system, the use of information technology could dramatically reduce the rate of drug incidents., Conclusion: This study found that benchmarking medication incidents is valuable, as it can help identify areas where improvements can be made, implement strategies to improve safety, and track progress over time. The benchmark was recommended to be below 100 incidents for every 10,000 prescriptions/orders processed, and for E-I categories, below one incident for every 10,000 prescriptions/orders processed. This will help develop a worldwide standard with an absolved culture with non-punitive consequences., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Published by Elsevier B.V. on behalf of King Saud University.)

Background: The timely abortion of status epilepticus (SE) is essential to avoid brain damage and long-term neurodevelopmental sequalae. However, available anti-seizure treatments fail to abort SE in 30% of children. Given the role of the tropomyosin-related kinase B (TrkB) receptor in hyperexcitability, we investigated if TrkB blockade with lestaurtinib (CEP-701) enhances the response of SE to a standard treatment protocol and reduces SE-related brain injury., Methods: SE was induced with intra-amygdalar kainic acid in postnatal day 45 rats under continuous electroencephalogram (EEG). Fifteen min post-SE onset, rats received intraperitoneal (i.p.) CEP-701 (KCEP group) or its vehicle (KV group). Controls received CEP-701 or its vehicle following intra-amygdalar saline. All groups received two i.p. doses of diazepam, followed by i.p. levetiracetam at 15 min intervals post-SE onset. Hippocampal TrkB dimer to monomer ratios were assessed by immunoblot 24 hr post-SE, along with neuronal densities and glial fibrillary acid protein (GFAP) levels., Results: SE duration was 50% shorter in the KCEP group compared to KV (p < 0.05). Compared to controls, SE induced a 1.5-fold increase in TrkB dimerization in KV rats (p < 0.05), but not in KCEP rats which were comparable to controls (p > 0.05). The KCEP group had lower GFAP levels than KV (p < 0.05), and both were higher than controls (p < 0.05). KCEP and KV rats had comparable hippocampal neuronal densities (p > 0.05), and both were lower than controls (p < 0.05)., Conclusions: Given its established human safety, CEP-701 is a promising adjuvant drug for the timely abortion of SE and the attenuation of SE-related brain injury., Competing Interests: Declaration of Competing Interest None of the authors has any conflict of interest to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Pharmacy automation and robotics implementation are essential aspects of healthcare facilities. It streamlines the medication dispensing process and significantly reduces medication errors. However, implementing automation and robotics in pharmacies comes with its challenges. We aim to detect and rectify potential dangers in the pharmacy workflow by utilizing the Failure Mode and Effects Analysis (FMEA) methodology; this is expected to augment performance and increase profitability., Materials and Methods: In this study, we conducted an FMEA analysis using a qualitative approach to identify the challenges experienced during pharmacy automation and robotics implementation in a Joint Commission International (JCI) accredited hospital in the Arabian Gulf area. The pharmacy processes and procedures were mapped in a Flow chart to visualize the pharmacy workflow, including highlighting the risks that were found. Then these risks were arranged as Potential failure modes and added to the table as 9 main points for each RPNs were calculated, and then the 9 points were prioritized for the action plans., Results: Via applying traditional Risk Priority Number (RPN) FMEA, the Pharmacy board identified the process stages marked risky failure modes through several FMEAs, calculating the total RPNs at the implementation phase. It revealed several challenges, including staff training, technical issues, and inadequate communication. Furthermore, the study resulted in corrective and intervention steps., Conclusion: Pharmacy automation and robotics implementation is a complex process that requires proper planning, preparation, and execution. The FMEA approach effectively identifies potential problems and evaluates their impact on the pharmacy system. Nine major failure modes appeared to be risky stages with high RPN scores. Therefore, multiple interventions were done during the implementation to enhance the knowledge of challenges faced during the implementation of the automation process and solve it. Future studies should address the identified challenges and develop strategies to mitigate them., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

The objective of this study was firstly to assess the demineralization inhibitory effect of ion-releasing restorations in enamel adjacent to restoration using a biofilm caries model and secondly to compare the effect to that in a chemical caries model. Fifty-six bovine incisors were filled with either Surefil one (SuO), Cention N (CN) (both ion-releasing materials), Ketac-Molar (GIC) or Powerfill resin composite (RC). The restored teeth were then randomly divided into 2 groups according to the used caries model (biofilm or chemical caries model). The micro-computed tomography (MicroCt) and optical coherence tomography (OCT) outcome measures used to evaluate demineralization inhibition effects were lesion depth, LD and increase in OCT integrated reflectivity, Δ IR , at five different depths. It was observed that all outcome measures of CN were statistically the same as those of GIC and conversely with those of RC. This was also the case for SuO except for LD , which was statistically the same as RC. When comparing the two caries models, LD of the biofilm model was statistically deeper ( p < 0.05) than the chemical model for all four materials. In conclusion, CN and SuO have similar demineralization inhibitory effects as GIC, and the biofilm caries model is more discriminatory in differentiating demineralization inhibitory effects of ion-releasing restorative material.

Sulfur dioxide emissions from fossil fuel combustion have been known to cause detrimental health and environmental effects. The currently used hydrodesulfurization (HDS) method employed by refineries has several drawbacks, such as excessive hydrogen consumption, high energy demand, and inability to remove complex organosulfur compounds, which have limited its ability to produce ultralow sulfur diesel (ULSD) at reasonable operating and capital costs. Ionic liquids (ILs) have been widely studied for their potential to replace conventional HDS. However, while their success has been demonstrated at the laboratory level, studies on industrial-scale feasibility and their integration into process simulators such as Aspen Plus are limited. In this work, 26 commercially available ILs have been screened using COSMO-based models and Aspen Plus for the desulfurization of diesel fuel and several possible process configurations have been examined. In particular, the challenge of ionic liquid regeneration, which has largely been ignored in the literature, has also been addressed and several potential regeneration methods have been proposed including extractive regeneration (E-RE) and stripping regeneration using nitrogen and air as stripping media (S-RE). The results indicate that, among the 26 ILs studied, 1-butyl-3-methylimidazolium thiocyanate is the most promising as a solvent for extractive desulfurization (EDS), E-RE, and S-RE. E-RE was found to be more effective for the removal of dibenzothiophene (DBT), while S-RE is more suited to the removal of thiophene and benzothiophene (BT). As a result, an optimized diesel desulfurization process using 1-butyl-3-methylimidazolium thiocyanate has been proposed that achieves ULSD with <10 ppm total sulfur in simulation studies, with complete recycling of the IL and minimal loss of the model diesel., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Objectives: During the COVID-19 pandemic in Qatar, many patients who were severely ill were colonized and infected by Candida auris, an invasive multidrug-resistant yeast pathogen that spreads through nosocomial transmission within healthcare facilities. Here, we investigated the molecular epidemiology of these C. auris isolates and the mechanisms associated with antifungal drug resistance., Methods: Whole genomes of 76 clinical C. auris isolates, including 65 from patients with COVID-19 collected from March 2020 to June 2021, from nine major hospitals were sequenced on Illumina NextSeq. Single nucleotide polymorphisms were used to determine their epidemiological patterns and mechanisms for antifungal resistance. The data were compared with those published prior to the COVID-19 pandemic from 2018 to 2020 in Qatar., Results: Genomic analysis revealed low genetic variability among the isolates from patients with and without COVID-19, confirming a clonal outbreak and ongoing dissemination of C. auris among various healthcare facilities. Based on antifungal susceptibility profiles, more than 70% (22/28) of isolates were resistant to both fluconazole and amphotericin B. Variant analysis revealed the presence of multi-antifungal resistant isolates with prominent amino acid substitutions: Y132F in ERG11 and V704L in CDR1 linked to reduced azole susceptibility and the emergence of echinocandin resistance samples bearing mutations in FKS1 in comparison with pre-COVID-19 pandemic samples. One sample (CAS109) was resistant to three classes of antifungal drugs with a unique premature stop codon in ERG3 and novel mutations in CDR2, which may be associated with elevated amphotericin B and azole resistance., Discussion: Candida auris isolates from patients with COVID-19 and from most patient samples without COVID-19 in Qatar were highly clonal. The data demonstrated the emergence of multidrug-resistant strains that carry novel mutations linked to enhanced resistance to azoles, echinocandins, and amphotericin B. Understanding the epidemiology and drug resistance will inform the infection control strategy and drug therapy., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Cryptococcus-associated immune reconstitution inflammatory syndrome (C-IRIS) is a condition frequently occurring in immunocompromised patients receiving antiretroviral therapy. C-IRIS patients exhibit many critical symptoms, including pulmonary distress, potentially complicating the progression and recovery from this condition. Here, utilizing our previously established mouse model of unmasking C-IRIS (CnH99 preinfection and adoptive transfer of CD4 + T cells), we demonstrated that pulmonary dysfunction associated with the C-IRIS condition in mice could be attributed to the infiltration of CD4 + T cells into the brain via the CCL8-CCR5 axis, which triggers the nucleus tractus solitarius (NTS) neuronal damage and neuronal disconnection via upregulated ephrin B3 and semaphorin 6B in CD4 + T cells. Our findings provide unique insight into the mechanism behind pulmonary dysfunction in C-IRIS and nominate potential therapeutic targets for treatment., (© 2023. The Author(s).)

The extent of the SARS-CoV-2 circulation and the COVID-19 epidemic in Tunisia three months after virus circulation was unknown. The aim of this study was to determine the extent of SARS-CoV-2 infection among household contacts of confirmed COVID-19 cases living in Hot spot areas of Great Tunis, Tunisia by estimating the seroprevalence of antibodies anti SARS-CoV-2 and to identify factors associated to seroprevalence at the first stage of the pandemic in order to guide decision making and to constitute a baseline for further longitudinal analysis of protective immunity to SARS-CoV-2. The National Observatory of New and Emerging Diseases (ONMNE), Ministry of Health Tunisia (MoH), with the support of the Office of the World Health Organization Representative in Tunisia and the WHO Regional Office for the Eastern Mediterranean (EMRO)), conducted a household cross-sectional survey on April 2020 in Great Tunis (Tunis, Ariana, Manouba and Ben Arous). The study was based on the WHO seroepidemiological investigation protocol for SARS-CoV-2 infection. SARS-CoV-2 specific antibodies (IgG and IgM) were qualitatively detected using a lateral immunoassay that detect SARS-CoV-2 nucleocapsid protein and administered by the interviewers. The included subjects were confirmed COVID-19 cases and their households contacts resided in hot spot areas (cumulative incidence rate ≥ 10 cases/100,000 inhabitants) of Great Tunis. Results: In total, 1165 subjects were enrolled: 116 confirmed COVID-19 cases (43 active cases and 73 convalescents cases) and 1049 household contacts resided in 291 households. The median age of participants was 39.0 with 31 years' interquartile range (Min = 8 months; Max = 96 years). The sex ratio (M/F) was 0.98. Twenty-nine per cent of participants resided in Tunis. The global crude seroprevalence among household contacts was 2.5% (26/1049); 95% CI 1.6-3.6%, 4.8%; 95% CI 2.3-8.7% in Ariana governorate and 0.3%; 95% CI 0.01%-1.8% in Manouba governorate. In multivariate analysis, the associated factors independently related to seroprevalence were age ≥25 years (aOR = 5.1; 95% CI 1.2-22.0), history of travel outside Tunisia since January 2020 (aOR = 4.6; 95% CI 1.7-12.9), symptomatic illness in the previous four months (aOR = 3.5; 95% CI 1.4-9.0) and governorate of residence ( p = 0.02). The low seroprevalence estimated among household contacts in Great Tunis reflect the effect of public health measures early taken (national lockdown, borders closed, remote work), the respect of non-pharmaceutical interventions and the efficacy of COVID-19 contact-tracing and case management at the first stage of the pandemic in Tunisia.

(1) Background: During 2019, the COVID-19 pandemic was threatening healthcare services and workers, and acquiring immunity was an option to stop or limit the burden of this pandemic. Herd immunity was a top priority worldwide as the virus was spreading rapidly. It was estimated that 67% of the total global population should be immunized against COVID-19 to achieve herd immunity. The aim of the current study is to investigate different perceptions of healthcare workers in the Kingdom of Bahrain and Egypt using an online survey in an attempt to evaluate their awareness and concerns regarding new variants and booster doses. (2) Methods: This study conducted a survey on healthcare workers in the Kingdom of Bahrain and Egypt about their perception and concerns on the COVID-19 vaccines. (3) Results: The study found that out of 389 healthcare workers 46.1% of the physicians were not willing to take the booster doses ( p = 0.004). Physicians also did not support taking the COVID-19 vaccine as an annual vaccine ( p = 0.04). Furthermore, to assess the association between the type of vaccine taken with the willingness of taking a booster vaccine, healthcare workers beliefs on vaccine effectiveness ( p = 0.001), suspension or contact with patients ( p = 0.000), and infection after COVID-19 vaccination ( p = 0.016) were significant. (4) Conclusion: Knowledge about vaccine accreditation and regulation should be dispersed more widely to ensure that the population has a positive perception on vaccine safety and effectiveness.

Background: The outbreak has harmed patients with multiple comorbidities and chronic conditions. The pandemic's psychological impact is thought to change their routine of seeking medical care. Research Question or Hypothesis: During COVID-19, patients with chronic conditions may experience anxiety, depression, and stress, and their pattern of seeking medical care may change., Materials and Methods: In May 2021, a cross-sectional, web-based study of patients with chronic diseases was conducted. Eligible patients (1036) were assessed for psychological disorders, primarily depression, stress, and anxiety, using the DASS-21 scale, and their pattern of receiving medical care during COVID-19., Results: During the pandemic, 52.5% of the patients with chronic diseases were depressed, 57.9% were anxious, and 35.6% were stressed. Patients with chronic diseases who had moderate to severe depression (34.9% versus 45.1%, p = 0.001), moderate to severe anxiety (43.6% versus 53.8%, p = 0.001), or moderate to severe stress (14.9% versus 34.8%, p = 0.001) were significantly more likely to have no follow-up for their chronic conditions., Conclusions: Patients with chronic conditions experienced significant anxiety, depression, and stress during COVID-19, which changed their pattern of seeking medical care, and the majority of them did not receive follow-up for their chronic conditions.

Breast cancer is a common malignancy for females (25% of female cancers) and also has low incidence in males. It was estimated that 1% of all breast malignancies occur in males with mortality rate about 20%, with annual increase in incidence. Risk factors include age, family history, exposure to ionizing radiation and high estrogen and low of androgens hormones level. Diagnosis and screening are challenging due to limiting effectiveness of breast cancer screening. Therefore, patients may expose to ionizing radiation that may contribute in breast cancer incidence in males. In literature, limited studies were published regarding radiation exposure for males during mammography. The objective of this research is to quantify patient doses during male mammogram and to estimate the projected radiogenic risk during the procedure. In total, 42 male patients were undergone mammogram for breast cancer diagnosis during two consecutive years. The mean and range of patient age (years) is 45 (23-80). The mean and standard deviation (SD) of the peak tube potential and tube current time product are 28.64 ± 2. and 149 ± 35.1, respectively. The mean, and range of patients' entrance surface air kerma (ESAK, mGy) per single breast procedure was 5.3 (0.47-27.5). Male patient's received comparable radiation dose per mammogram compared to female procedures. With increasing incidence of male breast cancer, proper guidelines are necessary for the mammographic procedure are necessary to reduce unnecessary radiation doses and radiogenic risk., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Professional divers are exposed to unique multifactorial hazards in their working environment and adverse cardiovascular effects such as ischemia, arrhythmia, stroke, and death are associated with professional diving. Cardiovascular events are aggravated by diving-induced oxidative stress and account for one-fourth of diving fatalities. This study aimed to measure oxidative and cardiovascular stress in a group of professional divers in Alexandria, Egypt using a panel of biomarkers. A comparative cross-sectional study was conducted between June 2017 and May 2018 at the General Naval Hospital in Alexandria. A total of 50 professional divers and a comparison group of 50 marine seafarers sharing similar maritime environments were enrolled in the study. Participants were clinically evaluated by electrocardiography (ECG) and plasma measurement of trace metals (Fe + , Cu + , and Zn + ), electrolytes (Na + , K + , Ca + ), and oxidative stress biomarkers (OSBMs; MDA, TAS, GST, GSH, GR, GPx, SOD, and CAT). Significant ECG abnormalities including short corrected QT interval, sinus bradycardia, left ventricular hypertrophy, early repolarization, first-degree heart block, and intraventricular conduction defect were identified among divers. Biochemical analyses revealed high mean levels of FBG [89.0 ± 12.46 vs. 100.5 ± 29.03 mg/dl], LDH-C [41.46 ± 4.01 vs. 39.34 ± 4.34 mg/dl], electrolyte imbalance [higher Na + (9.44 ± 0.52 vs. 9.19 ± 0.60 mmol/L), and lower Ca + (141.72 ± 3.53 and 143.26 ± 3.99 mmol/L)], disturbed trace metals [Fe + and Zn + (101.1 ± 38.17 vs. 147.6 ± 38.08 and 85.52 ± 27.37 vs. 116.6 ± 21.95 µm/dl, respectively), higher Cu+ (271.3 ± 75.01 vs. 100.8 ± 30.20 µm/dl)], and higher OSBMs (high MDA and reduced CAT, GPx, GSH, GR, and GST enzyme levels) among professional divers compared to the marine seafarers ( t -test p  < 0.05). Oxidative stress and trace metal imbalance are associated with the pathophysiology of cardiovascular disease; this association, together with electrophysiological changes of ECG may serve as biomarkers for cardiovascular risk assessment in diver periodic medical examinations.

Occupational radiation exposure can occur due to various human activities, including the use of radiation in medicine. Occupationally exposed personnel surpassing 7.4 millions, and respresent the biggest single group of employees who are exposed to artificial radiation sources at work. This study compares the occupational radiation dose levels for 145 workers in four different hospitals located in the Aseer region in Saudi Arabia. The occupational exposure was quantified using thermoluminescence dosimeters (TLD-100). The levels of annual occupational exposures in targeted hospitals were calculated and compared with the levels of the international atomic energy agency (IAEA) Safety Standards. An average yearly cumulative dose for the two consecutive years. The average, highest and lowest resulted occupational doses under examination in this work is 1.42, 3.9 mSv and 0.72 for workers in various diagnostic radiology procedures. The resulted annual effective dose were within the IAEA approved yearly dose limit for occupational exposure of workers over 18, which is 20 mSv. Staff should be monitored on a regular basis, according to current practice, because their annual exposure may surpass 15% of the annual effective doses., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: This paper provides a systematic review of evidence of government purchase of health services from private providers through stand-alone contracting-out (CO) initiatives and CO insurance schemes (CO-I) on health service utilisation in Eastern Mediterranean Region (EMR) to inform universal health coverage 2030 strategies., Design: Systematic review., Data Sources: Electronic search of published and grey literature on Cochrane Central Register of Controlled Trials, PubMed, CINHAL, Google Scholar and web, including websites of ministries of health from January 2010 to November 2021., Eligibility Criteria: Randomised controlled trials, quasi-experimental studies, time series, before-after and endline with comparison group reporting quantitative utilisation of data across 16 low-income and middle-income states of EMR. Search was limited to publications in English or English translation., Data Extraction and Synthesis: We planned for meta-analysis, but due to limited data and heterogeneous outcomes, descriptive analysis was performed., Results: Several initiatives were identified but only 128 studies were eligible for full-text screening and 17 met the inclusion criteria. These included CO (n=9), CO-I (n=3) and a combination of both (n=5) across seven countries. Eight studies assessed interventions at national level and nine at subnational level. Seven studies reported on purchasing arrangements with non-governmental organisations, 10 on private hospitals and clinics. Impact on outpatient curative care utilisation was seen in both CO and CO-I, positive evidence of improved maternity care service volumes was seen mainly from CO interventions and less reported from CO-I, whereas data on child health service volume was only available for CO and indicated negative impact on service volumes. The studies also suggest pro-poor effect for CO initiatives, whereas there was scarce data for CO-I., Conclusion: Purchasing involving stand-alone CO and CO-I interventions in EMR positively impact general curative care utilisation, but lacks conclusive evidence for other services. Policy attention is needed for embedded evaluations within programmes, standardised outcome metrics and disaggregated utilisation data., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

There seem to currently be no therapeutic medications found for the severe coronavirus infection in 2019 (COVID-19). In light of this, it has been hypothesized that the immunomodulatory treatment known as tocilizumab can lessen the inflammatory response that occurs in the respiratory system, speed up the process of clinical benefit, lower the risk of death, and avert the need for ventilators. This randomized controlled trial (RCT) studied patients with a proven infection of SARS-CoV-2 and hyperinflammatory reactions. The inclusion criteria included fever (body temperature > 38 °C), pulmonary infiltrates, or supplemental oxygen. The patients received either conventional treatment with one dose of either tocilizumab (8 mg per kilogram of body weight) or conventional treatment only. The subjects were randomized to receive either treatment with a 1:1 ratio. A time-to-event test was conducted to determine the time to intubation or death. There was an insignificant difference between the investigated groups regarding the time to death, time to mechanical ventilation, and percentage of deaths. The conventional group's median (IQR) hospital length of stay was 4 (3-6) days, whereas the tocilizumab therapy group was 7 (4.75-10) days. There was a substantial difference in the mechanical ventilation rates in both groups, which were 17 (34%) and 28 (56%), respectively. In hospitalized patients with severe illness and COVID-19, tocilizumab was ineffective in preventing intubation or death. Trials must be larger, however, in order to exclude the potential benefits or harms.

This Article Is Part of the Research Topic: 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict.', Problem: Many countries lacked rapid and nimble data systems to track health service capacities to respond to COVID-19. They struggled to assess and monitor rapidly evolving service disruptions, health workforce capacities, health products availability, community needs and perspectives, and mitigation responses to maintain essential health services., Method: Building on established methodologies, the World Health Organization developed a suite of methods and tools to support countries to rapidly fill data gaps and guide decision-making during COVID-19. The tools included: (1) a national "pulse" survey on service disruptions and bottlenecks; (2) a phone-based facility survey on frontline service capacities; and (3) a phone-based community survey on demand-side challenges and health needs., Use: Three national pulse surveys revealed persisting service disruptions throughout 2020-2021 (97 countries responded to all three rounds). Results guided mitigation strategies and operational plans at country level, and informed investments and delivery of essential supplies at global level. Facility and community surveys in 22 countries found similar disruptions and limited frontline service capacities at a more granular level. Findings informed key actions to improve service delivery and responsiveness from local to national levels., Lessons Learned: The rapid key informant surveys provided a low-resource way to collect action-oriented health services data to inform response and recovery from local to global levels. The approach fostered country ownership, stronger data capacities, and integration into operational planning. The surveys are being evaluated to inform integration into country data systems to bolster routine health services monitoring and serve as health services alert functions for the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Rivas-Morello, Horemans, Viswanathan, Taylor, Blanchard, Karamagi, Droti, Titi-Ofei, Nikiema, Traore, Kipruto, del Riego, Houghton, Salah, Alasfoor, Doctor, Tahirukaj, Tille, Zapata and O'Neill.)

Most overweight individuals do not develop diabetes due to compensatory islet responses to restore glucose homeostasis. Therefore, regulatory pathways that promote β cell compensation are potential targets for treatment of diabetes. The transient receptor potential cation channel subfamily M member 7 protein (TRPM7), harboring a cation channel and a serine/threonine kinase, has been implicated in controlling cell growth and proliferation. Here, we report that selective deletion of Trpm7 in β cells disrupted insulin secretion and led to progressive glucose intolerance. We indicate that the diminished insulinotropic response in β cell-specific Trpm7-knockout mice was caused by decreased insulin production because of impaired enzymatic activity of this protein. Accordingly, high-fat-fed mice with a genetic loss of TRPM7 kinase activity displayed a marked glucose intolerance accompanied by hyperglycemia. These detrimental glucoregulatory effects were engendered by reduced compensatory β cell responses because of mitigated protein kinase B (AKT)/ERK signaling. Collectively, our data identify TRPM7 kinase as a potentially novel regulator of insulin synthesis, β cell dynamics, and glucose homeostasis under obesogenic diet.

Purpose: To evaluate the bonding interface and the remineralization potential of a bioactive restorative material on demineralized dentin compared to a conventional bulk-fill resin composite restoration., Methods: Twelve caries-free human molars were used in this study. Specimens were randomly divided into two groups according to the type of restorative material used (n=12); an injectable resin-modified glass-ionomer restorative [Activa BioActive-Restorative (ABR) ] and a bulk-fill composite [3M Filtek One Bulk Fill Restorative, (BFC) ]. Each restored specimen was sectioned in two semi-equal halves along the long axis of the teeth perpendicular to the resin dentin interface with a water-cooled diamond disk at low speed. The restoration-dentin interfaces were scanned under SEM to observe micromorphological analysis; then an elemental analysis of the interface was performed using an energy dispersive X-ray (EDX) spectroscopy., Results: Quantitative data were described using median (minimum and maximum) after testing normality using the Shapiro-Wilk test. Mann-Whitney U test was used to compare the BFC and ABR. Higher mean values of Ca were identified and related to the ABR material, which provided more Ca ions than BFC. The comparison of Ca and P between materials showed a significant difference in the amount of Ca provided by ABR versus BFC. ABR restorations presented a thicker, and superior remineralization interface compared to the bulk-fill resin composite., Clinical Significance: Activa BioActive Restorative restorations presented a thicker and superior remineralization interface compared to the bulk-fill resin composite., Competing Interests: The authors declared no conflict of interest. This work received no outside funding., (Copyright©American Journal of Dentistry.)

This study compared the periodontopathic bacterial adhesion to four restorative materials used for deep margin elevation at 2, 24, and 48-h after incubation. Discs were produced from four restorative materials: resin modified glass ionomer, glass hybrid, flowable bulk fill resin composite, and bioactive ionic resin. Root dentin was used as control. Specimens were coated with saliva and used to culture a biofilm comprised of three strains of periodontopathic bacteria; Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans. Bacterial adherence was assessed by colony count assay, crystal violet staining, and visualized using confocal laser scanning microscopy. Data were analyzed by two-way ANOVA followed by Tukey's post hoc tests. The adhesion values for the control specimens were significantly higher than for other materials, while those for the flowable bulk fill were significantly lower than for any other material within all evaluation assays. The 2-h incubation period showed the lowest adhesion values regardless of the group. The 48-h adhesion values were higher than the 24-h results in all groups except the flowable bulk fill. Microscopic imaging partially supported the findings of the measurements. In terms of periodontopathic bacterial adhesion, the tested flowable bulk fill may be preferable for subgingival use over other tested materials., (© 2022 Scandinavian Division of the International Association for Dental Research. Published by John Wiley & Sons Ltd.)

In comparison to adults and paediatric are more sensitive to ionizing radiation exposure. Computed tomography (CT) is now the dominant source of medical radiologic tests for patients, accounting for more than 70% of total doses to the general public. Paediatric CT brain scans (with and without contrast) are routinely performed for a variety of clinical reasons. As a result, this parameter must be calculated in order to determine relative radiation risk. The goal of this study is to assess the radiation risk to children during CT brain diagnostic procedures. Three hundred fifty three child patients' radiation risk doses were assessed over the course of a year. The mean and ranged of the children's radiation doses were 40.6 ± 8.8 (27.8-45.8) CTDIvol (mGy) and 850 ± 230 (568.1-1126.4) DLP (mGy.cm) for the brain with contrast medium. For CT brain without contrast, the patients' doses were 40.9 ± 9.4 (14.27-64.07) CTDIvol (mGy), and 866.1 ± 289.3 (203.6-2484.9) DLP (mGy.cm). The characteristics related to the radiation dose were retrieved from the scan protocol generated by the CT system by the participating physicians after each procedure. Furthermore, optimizing the CT acquisition parameter is critical for increasing the benefit while lowering the procedure's radiogenic risk. The patients' radiation dose is comparable with the most previously published studies and international diagnostic reference levels (DRLs). Radiation dose optimization is recommended due to high sensitivity of the paediatric patients to ionizing radiation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)