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Background and Aim: Informal prescribers (IPs) significantly contribute to the development of antimicrobial resistance and in disseminating pathogens from poultry to humans and other animals through the food chain, posing a serious global health threat. Therefore, this study aimed to assess whether the knowledge of IPs has an impact on their attitude and practice toward antimicrobial use, antibiotic residues, and antimicrobial resistance. Materials and Methods: In this cross-sectional study, we conducted a pre-tested and questionnaire-based survey to investigate the knowledge, attitude, and practice of IPs in selected parts of the Mymensingh division, Bangladesh. Then, we used the linear regression model test with R-squared (R2) to measure the association between the study variables. Results: Our investigation revealed that 70% of the IPs knew about antibiotics and 75% had good knowledge about antibiotic resistance, whereas only 50% were aware of withdrawal periods. Informal prescribers also displayed good attitudes toward the use and sale of antibiotics with withdrawal periods and completion of medication (50%). Analysis of their practice on the sale and prescription of antibiotics showed that 70% and 30% of IPs use antibiotics against bacterial infections and other conditions, respectively. Most of them do not consult a veterinarian before selling or prescribing antibiotics, although 80% claim to do so. This is because 75% of IPs gave other options regarding their consultations. However, 95% of IPs uses antibiotics only for therapeutic purposes. Furthermore, only 10% sell antibiotics based on a veterinarian’s recommendation. Approximately 45% of IPs use single antibiotics at a time, while the rest use multiple antibiotics, individually or combined. Approximately 15% use antibiotics monthly, while 85% use them whenever the need arises. The knowledge and attitude of IPs are significantly affected by their age (p ≤ 0.025). The district of domicile also impacted their knowledge. Surprisingly, IPs from Jamalpur had significantly better knowledge compared to those from Mymensingh and Sherpur (p ≤ 0.01). The attitude of IPs from Jamalpur and Netrokona also differed significantly (p ≤ 0.001) from that of Mymensingh and Sherpur. The knowledge of IPs influenced their attitude up to 80.5% (r2 = 0.628) and their practice up to 75.4% (r2 = 0.545). Conclusion: The knowledge of IPs greatly influenced their attitude and practice, while sociodemographics also influenced their knowledge and attitude toward antimicrobial use, antibiotic residues, and antimicrobial resistance.

To illustrate the challenges encountered when gathering rapidly synthesized evidence in response to the coronavirus disease 2019 (COVID-19) pandemic. In this article, we describe the challenges encountered when we performed a systematic literature review (SLR) of randomized controlled trials (RCTs) on the efficacy and safety of treatments for severe COVID-19. The methods of the SLR are described in full, to show the context of our objectives. Then we use the results of the SLR to demonstrate the problems of producing synthesized evidence in this setting. Various challenges were identified during this SLR. These were primarily a result of heterogeneity in the study methodology of eligible studies. Definitions of the patient populations and outcome measurements were highly variable and the majority of studies demonstrated a high risk of bias, preventing quantitative synthesis of the collated evidence. Consolidating evidence from RCTs evaluating COVID-19 interventions was problematic. Guidance is needed for scenarios with high rapid output in primary research. [ABSTRACT FROM AUTHOR]

The study examines the significant factors affecting the capital structure decisions for banks' in MENA region. An unbalanced panel data comprising of 132 banks operating in fifteen different countries of the MENA region from 2012 to 2017, data was extracted from Bank Scope resulting in 891 bank year observations. Macroeconomic indicators and institutional characteristics data has been taken from World Bank and World Bank governance indicators database and financial freedom data has been collected from heritage foundation. We use the two-step system Generalized Method of Moments (GMM) to explore the relationship between dependent and explanatory variables. The regression outcome between profitability and leverage shows a negative and significant relationship. No significant association between tangibility and leverage is found. Earnings volatility is negatively and significantly related to leverage. The relationship between growth and leverage is negative and significant. Macroeconomic indicators GDP growth and inflation show a positive relationship with leverage. Finally, the institutional factors, that is, government effectiveness, political stability, and rule of law have positive association with leverage. The study results will lend a hand to bank managers to make value-maximizing financing decisions to achieve an optimal capital structure. It will also help the policymakers to articulate an effective regulatory framework in the region. As per our knowledge, this is the first study to explore the determining factors of capital structure for banks operating in the MENA region. Moreover, the findings from MENA region banks could also support the comparative study with other regional blocks. [ABSTRACT FROM AUTHOR]

Objective: To develop faculty consensus of orthodontic learning outcomes associated with knowledge and skills of “Treatment” required for undergraduate students. Study Design: Qualitative study Place and Duration of Study: Islamic International Dental College, Islamabad, 15th January, 2016 to 15th March, 2016. Materials and Methods: A Delphi method was used in two rounds to develop consensus by orthodontic faculty from various dental colleges of Pakistan. Learning outcomes related to skills were formulated in the form of a questionnaire and sent to study participants. A five point likert scale was used to obtain perception of dental faculty. Later, a qualitative approach was adopted by giving open ended questions associated with skills required in “Treatment” part of undergraduate orthodontic course. The quantitative data was analyzed by using SPSS version 20. The qualitative data was obtained and analyzed using NVivo version 11. Results: Twenty participants (N= 20) responded with their feedback to closed-ended first questionnaire and sixteen participants responded to the second open-ended questionnaire. Out of the 28 learning objectives, participants achieved consensus on 21 items particularly on knowledge and skills related to treatment planning for mixed dentition in first round. Whereas in second round, out of seven non consensus items, two learning objectives, three dimensional location of maxillary canine and skill in fabrication of functional appliances could not achieve consensus. Conclusion: The orthodontic faculty agreed that undergraduate students must have skills of history taking, oral examination, x-ray, and removable appliances for orthodontic discipline.

Context: There is a growing concern regarding increasing cases of kidney diseases in Jigawa state, with most conditions requiring hemodialysis or other forms of renal replacement therapy. Aim: This study aimed to find the magnitude, distribution, socio-demographic, and other factors associated with hemodialysis in Jigawa state, Northwest Nigeria. Materials and Methods: It was a retrospective multicenter analysis of secondary data from hemodialysis centers of the randomly selected public hospitals in northwest Nigeria. Statistical Analysis: Data were analyzed using IBM SPSS Statistics for Windows, version 22.0, with statistical significance set at P ≤ 0.05. Results: A total of 1,329 patients were enrolled for dialysis in Kano and Jigawa states, between 2019 and 2022, out of which more than one-third (509, 38.3%) were from Jigawa state. Dutse, Jahun, Gumel, and Hadejia local government areas (LGAs) of Jigawa state had 86 (16.8%), 64 (12.6%), 48 (9.4%), and 44 (8.6%) respectively. The respondent's ages ranged from 1 − 100 years with a median age of 48 (interquartile range [IQR] = 31, 60) years. Chronic kidney disease (CKD) was found among 403 (79.2%) patients, acute on chronic kidney disease (AOCCKD) in 87 (17.1%) patients, and acute kidney injury (AKI) in 19 (3.7%) patients. The major risk factors identified were hypertension, diabetes, and chronic glomerulonephritis (CGN) among 329 (64.6%), 69 (13.6%), and 66 (13.0%) patients, respectively. Hypertension was a significantly higher risk factor among patients from Jigawa state compared with other states (46.8%, P < 0.001), hypertensives from Jigawa state were twice more likely to develop kidney disease requiring hemodialysis (adjusted odds ratio [aOR] = 2.2, 95% confidence interval [CI] = 1.7–2.8) compared with non-hypertensive etiologies. Conclusion: The burden of kidney diseases requiring hemodialysis in Jigawa state is high, with hypertension and diabetes being the major risk factors for hemodialysis. The government and other stakeholders should develop strategies for early identification and proper management of the risk factors. [ABSTRACT FROM AUTHOR]

Context: The morbidity and mortality arising from the COVID-19 pandemic in low- and middle-income countries were further worsened by the disruption in health systems and diversion of strained health resources for emergency response. Aim: This study ascertained whether there was an increase in the number of deaths recorded in Kano, Nigeria, during the pandemic, compared to the preceding 3 years and identified the potential causes of these deaths. Materials and Methods: Using a retrospective design, data were collected from a tertiary hospital in Kano from January to June 2020. Data on number and date of deaths, as well as clinical information of the deceased, were retrieved from hospital records. Comparison data were collected on all deaths and admissions in the hospital within a similar period (January–June) of 2017–2019. Results: The age of the deceased ranged from one day to 115 years, with the majority being males (n = 414; 63.2%) and adults (n = 491; 75.0%). The majority did not have history of recent travel (n = 570; 87.0%), contact with COVID-19 suspected cases (n = 622; 95.0%), or confirmed COVID-19 (n = 625; 95.4%). Slightly less than half (n = 262; 46.2%) died within 24h of admission. The majority (n = 452; 79.7%) died within 7 days of admission. The most common cause of death recorded on admission was sepsis (n = 66; 10.1%), while 53 (8.1%) were brought in dead. SARS-CoV-2 infection was the documented cause of death in twelve patients (1.8%). More than half (n = 378; 57.7%) had underlying medical conditions, of which hypertension (n = 172; 45.5%) was the most common. The highest annual average deaths (178) and admissions (2179) were recorded in 2019, while 135 deaths and 1532 admissions were recorded in 2020. Most deaths occurred in April 2020 (208), while the highest number of admissions was recorded in March 2020. Mortality was higher in April of 2020 (14.1%, 95% CI: 12.4%–16.0%) compared to the same month in 2017 (7.6%, 95% CI: 5.9%–9.7%), 2018 (8.4%, 95% CI 7.0%–10.2%), and 2019 (8.5%, 95% CI 7.3–9.8%). Conclusion: In summary, we found excess mortality rates during the COVID-19 pandemic in Kano, Nigeria, consistent with prior studies. [ABSTRACT FROM AUTHOR]

This study examines the effects of shadow banking activities on the financial stability of the Chinese banking system. Moreover, it assesses whether the relation between financial stability and shadow banking activities changes for banks having political connections. The findings suggest a significant positive effect of shadow banking on the credit risk as well as the financial stability of Chinese banks. The growth of shadow banking activities has a significantly positive effect on Chinese commercial banks lowering the default risk and this relationship is incrementally significant for financial institutions having political connections. These findings are robust by controlling for various bank-specific and macroeconomic conditions. [ABSTRACT FROM AUTHOR]

This research aims to evaluate the internal factors influencing the performance of Islamic banks in Pakistan. There are currently five Islamic banks in operation, and data from all five have been used to analyze their performance from 2008 to 2021. The data was collected from the State Bank of Pakistan. To examine financial performance, this study used return on assets (ROA) and returns on equity (ROE) as proxies, and considered both internal attributes (such as liquidity, bank size, asset quality, capital adequacy ratio, operational efficiency, and assets management) and external factors (such as macroeconomic indicators like GDP growth and inflation rate). Ordinary least squares (OLS) estimation is employed to examine the relationship among variables. The estimation findings suggest that all of the internal factors have a strong association with banks' performance. Bank size and asset quality were found to have a positive and significant association with ROA, while asset quality and assets management were associated positively with ROE. Additionally, during the Covid-19 pandemic period, banks' size and liquidity were found to adversely affect ROA of Islamic banks, while operational efficiency had a positive impact. [ABSTRACT FROM AUTHOR]