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Background: Access to medicine is crucial for the effective functioning of healthcare systems. A robust regulatory framework is necessary to ensure the safety, effectiveness, and availability. However, weak regulatory frameworks persist in many low- and middle-income countries, leasing to the circulation of falsified and substandard medicines as well as anti-competitive restrictions on registering poor-quality medicines, which poses a significant public health threat. This study evaluated the evolution of Zanzibar's medicine regulatory system over the past two decades and identified the key factors contributing to its success by elaborating on the Zanzibar Food and Drug Agency, seeking the expertise of regional, continental, and global experts to assess its regulatory capacity and maturity level. Methods: This study was conducted at the Zanzibar Food and Drug Agency (ZFDA) in Unguja, Zanzibar, using a retrospective cross-sectional review and qualitative approach. It thoroughly reviewed relevant regulatory documents, including Acts, policies, guidelines, and assessment reports. Data were collected using a standardised checklist and analysed to uncover patterns and insights regarding the evolution of Zanzibar's medicine regulatory system. Results: This study revealed substantial legal provisions, organisational development, strategic planning, and resource allocation improvements. Notable achievements include establishing a structured organisational framework, developing a comprehensive strategic plan, and implementing a Quality Management System (ISO 9001:2015 certified). The ZFDA also addressed human resource limitations by creating job descriptions and a staff scheme of service, enhancing financial resources through revised fee regulations and government support, and improving infrastructure with new office and laboratory facilities. Conclusion: Zanzibar's medicine regulations have evolved significantly, with marked regulatory capacity and infrastructure improvements. Future efforts should address the remaining challenges and foster collaboration with regional and international bodies to ensure the continued evolution and effectiveness of Zanzibar's medicine regulatory framework. [ABSTRACT FROM AUTHOR]

Background: Human biomonitoring is crucial for regulatory toxicology, yet data on biomarker concentrations in the UAE are lacking. This study addresses this gap by analyzing urinary concentrations of 16 metals in UAE young adults, assessing correlations with personal characteristics, dietary patterns, and lifestyle habits. Methods: A cross-sectional pilot study was conducted among 144 randomly selected young adults (71 males and 73 females) from Sharjah, UAE, between January and March 2023. Participants provided urine samples, which were analyzed for 16 heavy metals using ICP-OES, and completed detailed questionnaires covering sociodemographic factors, lifestyle, and dietary habits. Descriptive statistics were used to summarize participant characteristics, and linear regression analysis was applied to explore associations between metal concentrations and factors such as gender, dietary habits, and exposure to environmental risks. Non-parametric tests, including the Mann-Whitney test, were used to assess differences by gender. Statistical significance was set at p < 0.05. Ethical approval was obtained, and informed consent was secured before participation Results: Significant findings include dietary influences on metal exposure, with rice consumption linked to higher metal concentrations. Sex differences were significant, with females showing elevated levels of arsenic, lead, and cadmium. Lifestyle factors, such as smoking and incense use, were correlated with increased barium and boron levels. Conclusion: This study highlights the significant role of dietary habits, especially the consumption of rice, in metal exposure among young adults in Sharjah. The findings highlight the urgent need for comprehensive human biomonitoring to understand environmental exposures and reform public health policies. The gender-specific differences in metal distribution suggest the necessity for targeted public health strategies. The study, however, is limited by its cross-sectional nature and the focus on a specific geographic area, warranting further research for broader generalizability. Future investigations, particularly on the impact of incense exposure on metal levels, are essential for developing comprehensive health interventions and preventive strategies in the UAE. [ABSTRACT FROM AUTHOR]

To provide an overview of the I‐CAH Registry. Following the successful roll‐out of the I‐DSD Registry in the 2000s, it was felt that there was a need for a registry for congenital adrenal hyperplasia (CAH) and this was launched in 2014 as a dedicated module within the original registry. In addition to supporting and promoting research, the I‐CAH Registry acts as an international tool for benchmarking of clinical care and it does this through the collection of standardised data for specific projects. Surveillance of novel therapies in the field of CAH can also be achieved via global collaborations. Its robust governance ensures adherence to the international standards for rare disease registries. Rare disease registries such as the I‐CAH Registry are important tools for all stakeholders involved in the care of people with CAH. [ABSTRACT FROM AUTHOR]

Background It is unclear whether targeted monitoring of acute adrenal insufficiency (AI) related adverse events (AE) such as sick day episodes (SDEs) and hospitalization rate in congenital adrenal hyperplasia (CAH) is associated with a change in the occurrence of these events. Aim Study temporal trends of AI related AE in the I-CAH Registry. Methods In 2022, data on the occurrence of AI-related AE in children aged <18 years with 21-hydroxylase deficiency CAH were compared to data collected in 2019. Results In 2022, a total of 513 children from 38 centers in 21 countries with a median of 8 children (range 1-58) per center had 2470 visits evaluated over a 3-year period (2019-2022). The median SDE per patient year in 2022 was 0 (0-2.5) compared to 0.3 (0-6) in 2019 (P =.01). Despite adjustment for age, CAH phenotype and duration of study period, a difference in SDE rate was still apparent between the 2 cohorts. Of the 38 centers in the 2022 cohort, 21 had also participated in 2019 and a reduction in SDE rate was noted in 13 (62%), an increase was noted in 3 (14%), and in 5 (24%) the rate remained the same. Of the 474 SDEs reported in the 2022 cohort, 103 (22%) led to hospitalization compared to 299 of 1099 SDEs (27%) in the 2019 cohort (P =.02). Conclusion The I-CAH Registry can be used for targeted monitoring of important clinical benchmarks in CAH. However, changes in reported benchmarks need careful interpretation and longer-term monitoring. [ABSTRACT FROM AUTHOR]

The Centers for Disease Control and Prevention (CDC) define child maltreatment as any act or series of actions, whether through commission or omission, by a caregiver that poses a threat to or harms a child. Child neglect is generally characterized by a continuing failure to fulfill a child's basic physical and/or psychological needs, which can significantly impair the child's development or health. Specifically, dental neglect refers to the willful neglect by a caregiver or legal guardian to prevent the onset of oral diseases and the failure to seek necessary treatment to maintain proper oral health, functionality and freedom from pain and infection. Child maltreatment can be classified into several categories, which may occur independently or in combination. These categories include physical abuse, sexual abuse, emotional or psychological abuse and neglect, physical neglect, human trafficking, medical care and Munchausen syndrome by proxy. Child abuse and neglect are critical issues that extend beyond social contexts to significantly impact healthcare professionals who may encounter abused children. With over half of trauma cases occurring in the head and neck area, dental professionals are uniquely positioned to offer vital insights into instances of abuse and are essential in identifying oral signs indicative of neglect. This makes the detection and reporting of abuse not only a moral duty but also a legal obligation. This review focuses on assessing perioral and intraoral injuries, bite marks, infections, diseases and psychological distress that might indicate potential child abuse or neglect. Additionally, it notes that oral health problems may also be associated with victims of human trafficking. [ABSTRACT FROM AUTHOR]

The breakthrough of the Covid-19 pandemic has not only caused significant disruption across numerous industries globally but also marked a surge in digital transformation within the financial sector through the adoption of FinTech. The pandemic was exceptional for the FinTech sector as it developed and accelerated the adoption of FinTech firms. This study examines the impact of Covid-19 on FinTech firms' dividend policy by applying logistic regression models. The sample includes 171 FinTech firms listed in The STOXX Global FinTech Index from 2014 to 2021. The findings reveal that FinTech firms tend to increase or maintain their dividend payments rather than omit them during Covid-19 to convey positive signals to the market. [ABSTRACT FROM AUTHOR]

Salbutamol, a commonly used bronchodilator for managing asthma and other respiratory conditions, can increase blood glucose levels by stimulating glycogenolysis and gluconeogenesis, exacerbating hyperglycemia and raising the risk of diabetic ketoacidosis (DKA). We present a case of a 13-year-old boy with mild asthma who developed DKA after ingesting a salbutamol solution. He presented classic symptoms of DKA, including tachycardia, tachypnea, hypotension, and laboratory findings consistent with metabolic acidosis, hyperglycemia, and electrolyte imbalances. He received supportive care, including fluids, insulin, and close monitoring and showed gradual improvement. He was discharged in good condition with appropriate follow-up instructions. This case stresses the need to recognize salbutamol toxicity as a potential cause of DKA. Healthcare providers should be cautious and avoid unnecessary bronchodilator therapy for patients with metabolic acidosis and breathing difficulties. Patients and caregivers should also be educated about the risks of using salbutamol and the importance of following prescribed dosages. [ABSTRACT FROM AUTHOR]

Background: In England, court‐based mental health liaison and diversion (L&D) services work across courts and police stations to support those with severe mental illness and other vulnerabilities. However, the evidence around how such services support those with neurodevelopmental disorders (NDs) is limited. Aims: This study aimed to evaluate, through the lens of court and clinical staff, the introduction of a L&D service for defendants with NDs, designed to complement the existing L&D service. Methods: A realist evaluation was undertaken involving multiple agencies based within an inner‐city Magistrates' Court in London, England. We developed a logic model based on the initial programme theory focusing on component parts of the new enhanced service, specifically training, screening, signposting and interventions. We conducted semi‐structured interviews with the court staff, judiciary and clinicians from the L&D service. Results: The L&D service for defendants with NDs was successful in identifying and supporting the needs of those defendants. Benefits of this service included knowledge sharing, awareness raising and promoting good practice such as making reasonable adjustments. However, there were challenges for the court practitioners and clinicians in finding and accessing local specialist community services. Conclusion: A L&D service developed for defendants with NDs is feasible and beneficial to staff and clinicians who worked in the court setting leading to good practice being in place for the defendants. Going forward, a local care pathway would need to be agreed between commissioners and stakeholders including the judiciary to ensure timely and equitable access to local services by both defendants and practitioners working across diversion services for individuals with NDs. [ABSTRACT FROM AUTHOR]