Real-World Study on Effectiveness of Insulin Glargine U300 After Oral Antidiabetic Drug Failure in Patients with Type 2 Diabetes in the Gulf Region.

INTRODUCTION: The effectiveness and safety of long-acting insulin glargine U300 (Gla-300), in patients with type 2 diabetes mellitus (T2DM) requiring insulin, has not been reported in the Gulf region. METHODS: Insulin-naïve patients with T2DM, uncontrolled on OADs, and prescribed Gla-300 were followed up in a 12-month prospective observational study. Gla-300 was titrated to glycemic targets. The primary endpoint (achieving glycemic targets) was evaluated at month 6 of treatment. The need for treatment intensification, safety, and patient-reported outcomes (PRO) were also reported. RESULTS: The study included 412 patients (61.7% men; age 52.2 ± 11.1 years and T2DM duration 10.7 ± 6.8 years). Almost 50% were on more than 3 OADs, mostly biguanides, sulfonylureas, and dipeptidyl-peptidase-4 inhibitors. Baseline HbA1c level was 9.2% ± 1.1% and targets were set at 6.9% ± 0.4%. Baseline fasting plasma glucose was 11.5 ± 3.8 mmol/l. Fifty-seven patients (13.8%) achieved glycemic targets at month 6, hindered by baseline HbA1c ≥ 10%, frequent co-morbidities, older age, suburban/rural residence, and full-time employment. Levels of HbA1c dropped progressively by 0.96% ± 0.07% (month 3), 1.29% ± 0.08% (month 6), and 1.76% ± 0.06% (month 12). Gla-300 dose was 17.0 ± 9.0 IU/day at baseline, 24.6 ± 9.6 IU/day at month 3, 28.5 ± 9.9 IU/day at month 6, and 30.7 ± 10.7 IU/day at month 12. Three patients experienced non-severe hypoglycemia and a slight decrease in body weight and PROs improved. CONCLUSIONS: In the Gulf, Gla-300 in patients with T2DM uncontrolled on OADs improved glycemic control, with low rates of hypoglycemia and improved PROs. Gla-300 dose up-titration from baseline to month 6 did not, however, result in a vast proportion of patients achieving their pre-determined HbA1c targets. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03703869.

Solvatochromism of new tetraphenylethene luminogens: integration of aggregation-induced emission and conjugation-induced rigidity for emitting strongly in both solid and solution state.

In this study, we synthesized and characterized four tetraphenylethene (TPE) analogs, investigated their photophysical properties, and conducted quantum chemical calculations. Some molecules exhibited aggregation-induced emission enhancement behavior and showed efficient emission in both solid and solution states. Solvatochromism was observed in particular derivatives, with solvent polarity influencing either a bathochromic or hypsochromic shift, indicating the occurrence of photoinduced intramolecular charge transfer (ICT) processes. Quantum chemical calculations confirmed that variations in molecular packing and rigidity among the TPE analogs contributed to their diverse behavior. The study showcases aggregation in luminophores without significant impact on the excited state and highlights how minor alterations in terminal substituents can lead to unconventional behavior. These findings have implications for the development of luminescent materials. Furthermore, the synthesized compounds exhibited biocompatibility, suggesting their potential for cell imaging applications.

Application of variation theory in STEM education: A comprehensive guideline for STEM teachers.

Incorporating appropriate pedagogical strategies has been instrumental in the development of a favorable learning environment for holistic learning, particularly in Science, Technology, Engineering, and Mathematics (STEM) education. However, there is growing evidence of the need to advance the existing methods, through more robust and comprehensive fieldwork grounded in design study. It has been shown that the lack of guidance in lesson planning using variation theory is also thought to require particular attention, as the accuracy of the student learning relies significantly on the planning of the lesson. However, little research has outlined the strategy to be followed for incorporating variation theory. This article proposes a method of preparing lesson plans to systematically implement the variation theory in STEM classrooms. The method seeks to design and implement current techniques as follows:•According to variation theory, teachers must create the necessary conditions for learning for the students to recognize what they are expected to learn.•To create the necessary conditions for learning, teachers define the key aspects of the topic to be covered and use different patterns of variations in teaching those contents, such as contrast, separation, generalization, and fusion.•Finally, teachers focus on the key aspects one by one or simultaneously to grab students' attention.

Nutritional rehabilitation of malnourished children detected by Screening Tool for Assessment of Malnutrition in Pediatric: Urban versus rural settings.

BACKGROUND: Malnutrition presents a major global health burden. In Egypt, it remains an important issue in children under 5 years especially in rural communities. AIM OF THE STUDY: The aim of the study was to screen 2-5 years old children enrolled from Egyptian hospitals in rural and urban areas for the risk of malnutrition using Screening Tool for Assessment of Malnutrition in Pediatric (STAMP) and to evaluate the effectiveness of nutritional intervention programs. SUBJECTS AND METHODS: This cross-sectional study was conducted on 90 patients recruited from two hospitals in urban and rural Cairo, Dietary history and anthropometric measurements were assessed. Patients at intermediate and severe risk of malnutrition according to STAMP were given tailored nutritional programs. RESULTS: In the rural hospital, 4.4% of the screened children were underweight, 22.2% were marginally underweight, and 73.3% had normal weight. Regarding the urban hospital, 15.6% were marginally underweight, 84.4% had normal weight and no underweight patients. Among the rural group 35.6% were at high risk according to STAMP score results compared to 20% in the urban group. Nevertheless, the only significant differences were the more stunting and higher BMI in rural hospital patients. After nutritional intervention, high-risk category patients decreased in both groups coupled by significant improvement in the anthropometric parameters and nutrition data with no significant differences between them. CONCLUSION: Nutritional education and prompt implementation of nutritional rehabilitation program for malnourished children detected by screening tools result in improvement in their nutritional status disregards their location whether urban or rural.

Endothelial Insulin Resistance Exacerbates Experimental Periodontitis.

Epidemiological studies suggest that the severity of periodontitis is higher in people with diabetes than in healthy individuals. Insulin resistance might play a crucial role in the pathogenesis of multiple diabetic complications and is reportedly induced in the gingiva of rodents with type 2 diabetes; however, the molecular mechanisms underlying the pathogenesis of diabetes-related periodontitis remain unclear. Therefore, we aimed to investigate whether endothelial insulin resistance in the gingiva may contribute to the pathogenesis of periodontitis as well as elucidate its underlying molecular mechanisms. We demonstrated that insulin treatment downregulated lipopolysaccharide (LPS)-induced or tumor necrosis factor α (TNFα)-induced VCAM1 expression in endothelial cells (ECs) via the PI3K/Akt activating pathway, resulting in reduced cellular adhesion between ECs and leukocytes. Hyperglycemia-induced selective insulin resistance in ECs diminished the effect of insulin on LPS- or TNFα-stimulated VCAM1 expression. Vascular endothelial cell-specific insulin receptor knockout (VEIRKO) mice exhibited selective inhibition of the PI3K/Akt pathway in the gingiva and advanced experimental periodontitis-induced alveolar bone loss via upregulation of Vcam1, Tnfα, Mcp-1, Rankl, and neutrophil migration into the gingiva compared with that in the wild-type (WT) mice despite being free from diabetes. We also observed that insulin-mediated activation of FoxO1, a downstream target of Akt, was suppressed in the gingiva of VEIRKO and high-fat diet (HFD)-fed mice, hyperglycemia-treated ECs, and primary ECs from VEIRKO. Further analysis using ECs transfected with intact and mutated FoxO1, with mutations at 3 insulin-mediated phosphorylation sites (T24A, S256D, S316A), suggested that insulin-mediated regulation of VCAM1 expression and cellular adhesion of ECs with leukocytes was attenuated by mutated FoxO1 overexpression. These results suggest that insulin resistance in ECs may contribute to the progression of periodontitis via dysregulated VCAM1 expression and cellular adhesion with leukocytes, resulting from reduced activation of the PI3K/Akt/FoxO1 axis.

Whole-body diffusion-weighted imaging with background body signal suppression and quantitative apparent diffusion coefficient in the detection, staging, and grading of non-Hodgkin lymphoma.

Purpose: Assess reproducibility of detection, staging, and grading of non-Hodgkin lymphoma (NHL) using whole-body diffusion-weighted imaging with background body signal suppression (WB-DWIBS). Material and methods: Thirty NHL patients underwent WB-DWIBS, divided into 2 groups according to staging and grading. Image analysis and apparent diffusion coefficient (ADC) measurement of the largest lymph node in each group were performed by 2 observers. Inter-observer agreement was performed. Results: Overall inter-observer agreement for detection of NHL was excellent (k = 0.843; 92.05%) with excellent inter-observer agreement of nodal disease (cervical, thoracic and abdominal) (k = 0.783, 0.769, and 0.856; 96.67%, 90.0%, and 93.3% respectively), extra-nodal disease (k = 1; 100%), and splenic involvement (k = 0.67; 83.3%). The overall inter-observer agreement of DWIBS in staging of NHL was excellent (k = 0.90; 94.9%) with excellent inter-observer agreement for stage I (k = 0.93; 96.4%), stage II (k = 0.90; 94.8%), stage III (k = 0.89; 94.6%), and stage IV (k = 0.88; 94.0%). There was significant difference between ADC in stage I, II (0.77 ± 0.13, 0.85 ± 0.09 × 10-3 mm2/s), and stage III, IV (0.63 ± 0.08, 0.64 ± 0.11 × 10-3 mm2/s, p < 0.002, < 0.001). Interclass correlation showed almost perfect agreement for ADC measurement in staging and grading groups (r = 0.96 and r = 0.85, respectively, p < 0.001). There was significant difference between ADC in aggressive lymphoma (0.65 ± 0.1, 0.67 ± 0.13 × 10-3 mm2/s) and indolent lymphoma (0.76 ± 0.14, 0.84 ± 0.09 × 10-3 mm2/s, p < 0.028, < 0.001). Conclusion: DWIBS is reproducible for detection and staging of nodal and extra-nodal involvement in patients with NHL. ADC can quantitatively participate in the staging and grading of NHL.

Computed tomography and magnetic resonance imaging of congenital thoracic systemic venous anomalies.

We present the imaging findings of thoracic systemic venous anomalies diagnosed by computed tomography and magnetic resonance imaging. Persistent left superior vena cava is the commonest anomaly of the thoracic systemic veins encountered either incidentally as an isolated finding or associated with congenital heart disease. Inferior vena cava (IVC) interruption with azygos continuation is the second most common anomaly, which may also be isolated or be associated with left isomerism syndrome. The article will also discuss other rarer systemic venous anomalies including retroaortic brachiocephalic vein and IVC drainage into the left atrium. Finally, the impact of pre-procedure reporting of thoracic systemic venous anomalies on the choice of intervention and patient outcome will be addressed.

Solid-State Luminescent Materials Containing Both Indole and Pyrimidine Moieties: Design, Synthesis, and Density Functional Theory Calculations.

Heterocyclic compounds with effective solid-state luminescence offer a wide range of uses. It has been observed that combining pyrimidine and indole moieties in a single molecule can enhance material behavior dramatically. Here, different heterocyclic compounds with indole and pyrimidine moieties have been synthesized effectively, and their structures have been validated using NMR, IR, and mass spectroscopy. The photoluminescence behavior of two substances was investigated in powder form and solutions of varying concentrations. After aggregation, one molecule displayed a redshifted luminescence spectrum, whereas another homolog showed a blueshift. Thus, density functional theory calculations were carried out to establish that introducing a terminal group allows modifying of the luminescence behavior by altering the molecular packing. Because of the non-planarity, intermolecular interactions, and tiny intermolecular distances within the dimers, the materials demonstrated a good emission quantum yield (Φem) in the solid state (ex. 25.6%). At high temperatures, the compounds also demonstrated a stable emission characteristic.

Ultrastable Conjugated Microporous Polymers Containing Benzobisthiadiazole and Pyrene Building Blocks for Energy Storage Applications.

In recent years, conjugated microporous polymers (CMPs) have become important precursors for environmental and energy applications, compared with inorganic electrode materials, due to their ease of preparation, facile charge storage process, π-conjugated structures, relatively high thermal and chemical stability, abundance in nature, and high surface areas. Therefore, in this study, we designed and prepared new benzobisthiadiazole (BBT)-linked CMPs (BBT-CMPs) using a simple Sonogashira couplings reaction by reaction of 4,8-dibromobenzo(1,2-c;4,5-c')bis(1,2,5)thiadiazole (BBT-Br2) with ethynyl derivatives of triphenylamine (TPA-T), pyrene (Py-T), and tetraphenylethene (TPE-T), respectively, to afford TPA-BBT-CMP, Py-BBT-CMP, and TPE-BBT-CMP. The chemical structure and properties of BBT-CMPs such as surface areas, pore size, surface morphologies, and thermal stability using different measurements were discussed in detail. Among the studied BBT-CMPs, we revealed that TPE-BBT-CMP displayed high degradation temperature, up to 340 °C, with high char yield and regular, aggregated sphere based on thermogravimetric analysis (TGA) and scanning electron microscopy (SEM), respectively. Furthermore, the Py-BBT-CMP as organic electrode showed an outstanding specific capacitance of 228 F g-1 and superior capacitance stability of 93.2% (over 2000 cycles). Based on theoretical results, an important role of BBT-CMPs, due to their electronic structure, was revealed to be enhancing the charge storage. Furthermore, all three CMP polymers featured a high conjugation system, leading to improved electron conduction and small bandgaps.

Prevalence of diabetes distress and depression and their association with glycemic control in adolescents with type 1 diabetes in Dubai, United Arab Emirates.

OBJECTIVE: Diabetes distress and depression have been shown to be prevalent among adolescents with type 1 diabetes and screening for these parameters should be a routine part of diabetes care. To assess the prevalence of diabetes distress and depression and their association with glycemic control in a sample of adolescents with type 1 diabetes attending a diabetes center in Dubai, United Arab Emirates. All adolescents aged 13 to 18 years with type 1 diabetes that were seeking treatment at the Dubai Diabetes Center from the period of September 1, 2018 to May 1, 2019. A total of 72 participants completed the study. RESEARCH DESIGN AND METHODS: Adolescents were asked to fill in questionnaires assessing diabetes distress and depression. Multivariate linear regression analysis was used to assess the relationships between the subsets of socio-demographic and clinical characteristics, and the scores of the questionnaires. RESULTS: The mean HbA1c of the study sample was 9.61% [82 mmol/mol] with higher levels found in females as compared with males (p<0.05). Females showed significantly greater levels of distress as compared with males. Although adolescents with HbA1c≥7.5% scored higher for diabetes distress and depression, the difference was not statistically significant to those with an HbA1c of <7.5%. Higher levels of diabetes distress were highly correlated with depressive symptoms, with distress and depression both being significant predictors of one another. CONCLUSIONS: Our results highlight the importance of implementing and sustaining psycho-educational interventions to aid in alleviating diabetes distress and depression in this subgroup of the population.

Effect of Soybean Oil Supplementation on Milk Production, Digestibility, and Metabolism in Dairy Goats under Thermoneutral and Heat Stress Conditions.

In a previous work, we observed that heat-stressed goats suffer reductions in milk yield and its contents of fat and protein. Supplementation with soybean oil (SBO) may be a useful strategy to enhance milk quality. In total, eight multiparous Murciano-Granadina dairy goats (42.8 ± 1.3 kg body weight; 99 ± 1 days of lactation) were used in a replicated 4 × 4 Latin square design with four periods; 21 d each (14 d adaptation, 5 d for measurements and 2 d transition between periods). Goats were allocated to one of four treatments in a 2 × 2 factorial arrangement. Factors were no oil (CON) or 4% of soybean oil (SBO), and controlled thermal neutral (TN; 15 to 20 °C) or heat stress (HS; 12 h/d at 37 °C and 12 h/d at 30 °C) conditions. This resulted in four treatment combinations: TN-CON, TN-SBO, HS-CON, and HS-SBO. Compared to TN, HS goats experienced lower (p < 0.05) feed intake, body weight, N retention, milk yield, and milk protein and lactose contents. However, goats in HS conditions had greater (p < 0.05) digestibility coefficients (+5.1, +5.2, +4.6, +7.0, and +8.9 points for dry matter, organic matter, crude protein, neutral detergent fiber, and acid detergent fiber, respectively) than TN goats. The response to SBO had the same magnitude in TN and HS conditions. Supplementation with SBO had no effects on feed intake, milk yield, or milk protein content. However, SBO supplementation increased (p < 0.05) blood non-esterified fatty acids by 50%, milk fat by 29%, and conjugated linoleic acid by 360%. In conclusion, feeding 4% SBO to dairy goats was a useful strategy to increase milk fat and conjugated linoleic acid without any negative effects on intake, milk yield, or milk protein content. These beneficial effects were obtained regardless goats were in TN or HS conditions.

Heat stress affects some physiological and productive variables and alters metabolism in dairy ewes.

Heat stress (HS) has a significant economic impact on the global dairy industry. However, the mechanisms by which HS negatively affects metabolism and milk synthesis in dairy ewes are not well defined. This study evaluated the production and metabolic variables in dairy ewes under controlled HS conditions. Eight Lacaune ewes (75.5 ± 3.2 kg of body weight; 165 ± 4 d of lactation; 2.31 ± 0.04 kg of milk per day) were submitted to thermoneutral (TN) or HS conditions in a crossover design (2 periods, 21 d each, 6-d transition). Conditions (day-night, 12-12 h; relative humidity; temperature-humidity index, THI) were: TN (15-20°C; 50 ± 5%; THI = 59-65) and HS (28-35°C; 45 ± 5%; THI = 75-83). Ewes were fed ad libitum and milked twice daily. Rectal temperature, respiratory rate, feed intake, water consumption, and milk yield were recorded daily. Milk and blood samples were collected weekly. Additionally, TN and HS ewes were exposed to glucose tolerance test, insulin tolerance test, and epinephrine challenge. Heat stress reduced feed intake (-11%), and increased rectal temperature (+0.77°C), respiratory rate (+90 breaths/min), and water consumption (+28%). Despite the reduced feed intake, HS ewes produced similar milk to TN ewes, but their milk contained lower fat (-1.7 points) and protein (-0.86 points). Further, HS milk tended to contain more somatic cells (+0.23 log points). Blood creatinine was greater in HS compared with TN, but no differences in blood glucose, nonesterified fatty acids, or urea were detected. When glucose was infused, TN and HS had similar insulin response, but higher glucose response (+85%) was detected in HS ewes. Epinephrine infusion resulted in lower nonesterified fatty acids response (-215%) in HS than TN ewes. Overall, HS decreased feed intake, but milk production was not affected. Heat stress caused metabolic adaptations that included increased body muscle degradation and reduced adipose tissue mobilization. These adaptations allowed ewes to spare glucose and to avoid reductions in milk yield.

Effects of Cold Exposure on Some Physiological, Productive, and Metabolic Variables in Lactating Dairy Goats.

Low winter temperatures in some regions have a negative impact on animal performance, behavior, and welfare. The objective of this study was to evaluate some physiological, metabolic, and lactational responses of dairy goats exposed to cold temperatures for 3 weeks. Eight Murciano-Granadina dairy goats (41.8 kg body weight, 70 days in milk, and 2.13 kg/day milk) were used from mid-January to mid-March. Goats were divided into 2 balanced groups and used in a crossover design with 2 treatments in 2 periods (21 days each, 14 days adaptation and 7 days for measurements). After the first period, goats were switched to the opposite treatment. The treatments included 2 different controlled climatic conditions with different temperature-humidity index (THI) values. The treatments were: thermoneutral conditions (TN; 15 to 20 °C, 45% humidity, THI = 58 to 65), and cold temperature (CT; -3 to 6 °C, 63% humidity, THI = 33 to 46). Goats were fed ad libitum a total mixed ration (70% forage and 30% concentrate) and water was freely available. Goats were milked at 0800 and 1700 h. Dry matter intake, water consumption, rectal temperature, and respiratory rate were recorded daily (days 15 to 21). Body weight was recorded at the start and end of each period. Milk samples for composition were collected on 2 consecutive days (days 20 and 21). Insulin, glucose, non-esterified fatty acids (NEFA), ß-hydroxybutyrate (BHB), cholesterol, and triglycerides were measured in blood on d 21. Compared to TN goats, CT goats had similar feed intake, but lower water consumption (-22 ± 3%), respiratory rate (-5 ± 0.8 breaths/min), and rectal temperature (-0.71 ± 0.26 °C). Milk yield decreased by 13 ± 3% in CT goats, but their milk contained more fat (+13 ± 4%) and protein (+14 ± 5%), and consequently the energy-corrected milk did not vary between TN and CT goats. The CT goats lost 0.64 kg of body weight, whereas TN goats gained 2.54 kg in 21 days. Blood insulin and cholesterol levels were not affected by CT. However, values of blood glucose, NEFA, hematocrit, and hemoglobin increased or tended to increase by CT, whereas BHB and triglycerides decreased. Overall, CT goats produced less but concentrated milk compared to TN goats. Despite similar feed intake and blood insulin levels CT goats had increased blood glucose and NEFA levels. The tendency of increased blood NEFA indicates that CT goats mobilized body fat reserves to cover the extra energy needed for heat production under cold conditions.

Milk Production and Energetic Metabolism of Heat-Stressed Dairy Goats Supplemented with Propylene Glycol.

Heat-stressed dairy animals increase their reliance on glucose. This elevated glucose demand is partially met by increasing the conversion of glucogenic amino acids (AA) in the liver. Propylene glycol (PG) is a glucogenic precursor and was not tested in dairy goats under thermoneutral (TN) and heat stress (HS) conditions simultaneously. We hypothesize that if HS-goats are fed with PG, they would get more glucose and consequently spare more glucogenic AA for milk protein synthesis rather than gluconeogenesis. Eight multiparous dairy goats (40.8 ± 1.1 kg body weight; 84 ± 1 days in milk) were used in a replicated 4 × 4 Latin square design of 4 periods; 21 d each (14 d adaptation, 5 d for measurements, and 2 d of transition). Goats were allocated to one of 4 treatments in a 2 × 2 factorial arrangement. Factors were control (CO) without PG or 5% of PG, and thermoneutral (TN; 15 to 20 °C) or heat stress (HS; 12 h/d at 37 °C and 12 h/d at 30 °C) conditions. Feed intake, rectal temperature, respiratory rate, milk yield, milk composition, and blood metabolites were measured. Compared to TN, HS goats had lower (p < 0.01) feed intake (-34%), fat-corrected milk (-15%), and milk fat (-15%). Heat-stressed goats also tended (p < 0.10) to produce milk with lower protein (-11%) and lactose (-4%) contents. Propylene glycol increased blood glucose (+7%; p < 0.05), blood insulin (+37%; p < 0.10), and body weight gain (+68%; p < 0.05), but decreased feed intake (-9%; p < 0.10) and milk fat content (-23%; p < 0.01). Furthermore, blood non-esterified fatty acids (-49%) and ß-hydroxybutyrate (-32%) decreased (p < 0.05) by PG. In conclusion, supplementation of heat-stressed dairy goats with propylene glycol caused milk fat depression syndrome, but reduced body weight loss that is typically observed under HS conditions. Supplementation with lower doses of PG would avoid the reduced feed intake and milk fat depression, but this should be tested.

Sensing solutions for improving the performance, health and wellbeing of small ruminants.

Diversity of production systems and specific socio-economic barriers are key reasons explaining why the implementation of new technologies in small ruminants, despite being needed and beneficial for farmers, is harder than in other livestock species. There are, however, helpful peculiarities where small ruminants are concerned: the compulsory use of electronic identification created a unique scenario in Europe in which all small ruminant breeding stock became searchable by appropriate sensing solutions, and the largest small ruminant population in the world is located in Asia, close to the areas producing new technologies. Notwithstanding, only a few research initiatives and literature reviews have addressed the development of new technologies in small ruminants. This Research Reflection focuses on small ruminants (with emphasis on dairy goats and sheep) and reviews in a non-exhaustive way the basic concepts, the currently available sensor solutions and the structure and elements needed for the implementation of sensor-based husbandry decision support. Finally, some examples of results obtained using several sensor solutions adapted from large animals or newly developed for small ruminants are discussed. Significant room for improvement is recognized and a large number of multiple-sensor solutions are expected to be developed in the relatively near future.

The first 2 months of the SARS-CoV-2 epidemic in Yemen: Analysis of the surveillance data.

INTRODUCTION: Yemen was one of the last countries in the world to declare the first case of the pandemic, on 10 April 2020. Fear and concerns of catastrophic outcomes of the epidemic in Yemen were immediately raised, as the country is facing a complex humanitarian crisis. The purpose of this report is to describe the epidemiological situation in Yemen during the first 2 months of the SARS-CoV-2 epidemic. METHODS: We analyzed the epidemiological data from 18 February to 05 June 2020, including the 2 months before the confirmation of the first case. We included in our analysis the data from 10 out of 23 governorates of Yemen, located in southern and eastern part of the country. RESULTS: A total of 469 laboratory confirmed, 552 probable and 55 suspected cases with onset of symptoms between 18 February and 5 June 2020 were reported through the surveillance system. The median age among confirmed cases was 46 years (range: 1-90 years), and 75% of the confirmed cases were male. A total of 111 deaths were reported among those with confirmed infection. The mean age among those who died was 53 years (range: 14-88 years), with 63% of deaths (n = 70) occurring in individuals under the age 60 years. A total of 268 individuals with confirmed SARS-CoV-2 infection were hospitalized (57%), among whom there were 95 in-hospital deaths. CONCLUSIONS: The surveillance strategy implemented in the first 2 months of the SARS CoV 2 in the southern and eastern governorates of Yemen, captured mainly severe cases. The mild and moderate cases were not self-reported to the health facilities and surveillance system due to limited resources, stigma, and other barriers. The mortality appeared to be higher in individuals aged under 60 years, and most fatalities occurred in individuals who were in critical condition when they reached the health facilities. It is unclear whether the presence of other acute comorbidities contributed to the high death rate among SARS-CoV-2 cases. The findings only include the southern and eastern part of the country, which is home to 31% of the total population of Yemen, as the data from the northern part of the country was inaccessible for analysis. This makes our results not generalizable to the rest of the country.

Outcome of Undergraduate Medical Education using Medical Simulation according to Students' Feedback.

OBJECTIVES: This study aimed to determine students' overall satisfaction with clinical simulation sessions and compare the satisfaction levels of obstetrics/gynaecology (OBGYN) students (group one) and internal medicine students (group two). METHODS: This study was conducted from January to June 2019 at the Arabian Gulf University, Manama, Bahrain. Students from year five were included and offered sessions that used simulations to support clinical skill development. Data were collected using a five-point Likert scale (i.e. strongly agree, agree, neutral, disagree, strongly disagree) via feedback forms. RESULTS: A total of 150 students were included in this study (response rate: 99.07%). In groups of seven, the students attended five cycles of simulations with two sessions per cycle in each specialty over six months. The mean percentage of responses of "strongly agree" and "agree" was 97.8 ± 2.3% in group one and 95.7 ± 2.7% in group two. The satisfaction scores of group one were higher than those from group two for all statements. Significant differences were found between groups one and two in their responses to the statement of whether the simulation session was relevant to clinical practice (100% versus 92.9%; P <0.001) and whether the debriefing session was useful (98.1% versus 94.8%; P = 0.015). CONCLUSION: Students indicated high satisfaction after attending the simulation sessions; however, OBGYN students were more satisfied compared to those studying internal medicine.

The application of omics in ruminant production: a review in the tropical and sub-tropical animal production context.

The demand for animal products (e.g. dairy and beef) in tropical regions is expected to increase in parallel with the public demand for sustainable practices, due to factors such as population growth and climate change. The necessity to increase animal production output must be achieved with better management and production technologies. For this to happen, novel research methodologies, animal selection and postgenomic tools play a pivotal role. Indeed, improving breeder selection programs, the quality of meat and dairy products as well as animal health will contribute to higher sustainability and productivity. This would surely benefit regions where resource quality and quantity are increasingly unstable, and research is still very incipient, which is the case of many regions in the tropics. The purpose of this review is to demonstrate how omics-based approaches play a major role in animal science, particularly concerning ruminant production systems and research associated to the tropics and developing countries. SIGNIFICANCE: Environmental conditions in the tropics make livestock production harder, compared to temperate regions. Due to global warming, the sustainability of livestock production will become increasingly problematic. The use of novel omics technologies could generate useful information to understand adaptation mechanisms of resilient breeds and/or species. The application of omics to tropical animal production is still residual in the currently available literature. With this review, we aim to summarize the most notable results in the field whilst encouraging further research to deal with the future challenges that animal production in the tropics will need to face.

Milk yield, milk composition, and milk metabolomics of dairy goats intramammary-challenged with lipopolysaccharide under heat stress conditions.

Heat stress and mastitis are major economic issues in dairy production. The objective was to test whether goat's mammary gland immune response to E. coli lipopolysaccharide (LPS) could be conditioned by heat stress (HS). Changes in milk composition and milk metabolomics were evaluated after the administration of LPS in mammary glands of dairy goats under thermal-neutral (TN; n = 4; 15 to 20 °C; 40 to 45% humidity) or HS (n = 4; 35 °C day, 28 °C night; 40% humidity) conditions. Milk metabolomics were evaluated using 1H nuclear magnetic resonance spectroscopy, and multivariate analyses were carried out. Heat stress reduced feed intake and milk yield by 28 and 21%, respectively. Mammary treatment with LPS resulted in febrile response that was detectable in TN goats, but was masked by elevated body temperature due to heat load in HS goats. Additionally, LPS increased milk protein and decreased milk lactose, with more marked changes in HS goats. The recruitment of somatic cells in milk after LPS treatment was delayed by HS. Milk metabolomics revealed that citrate increased by HS, whereas choline, phosphocholine, N-acetylcarbohydrates, lactate, and ß-hydroxybutyrate could be considered as putative markers of inflammation with different pattern according to the ambient temperature (i.e. TN vs. HS). In conclusion, changes in milk somatic cells and milk metabolomics indicated that heat stress affected the mammary immune response to simulated infection, which could make dairy animals more vulnerable to mastitis.

Prenatal heat stress effects on gestation and postnatal behavior in kid goats.

Consequences of heat stress during pregnancy can affect the normal development of the offspring. In the present experiment, 30 Murciano-Granadina dairy goats (41.8 ± 5.7 kg) were exposed to 2 thermal environments varying in temperature-humidity index (THI) from 12 days before mating to 45 days of gestation. The environmental conditions were: gestation under thermal-neutral (TN; THI = 71 ± 3); and gestation under heat stress (HS; THI = 85 ± 3) conditions. At 27 ± 4 days old, female kids exposed to in utero TN (IUTN; n = 16) or in utero HS (IUHS; n = 10) were subjected to 2 tests: arena test (AT) and novel object test (NOT), the latter was repeated at 3 months of age. Additionally, 8 months after birth, a subset of IUTH and IUHS growing goats (n = 8 each; 16.8 ± 3.4 kg BW) were exposed to 2 environmental conditions in 2 consecutive periods: a basal thermal-neutral period (THI = 72 ± 3) for 7 days, and a heat-stress period (THI = 87 ± 2) for 21 days. In both periods, feeding, resting, posture, and thermally-associated behaviors were recorded. The gestation length was shortened by 3 days in GHS goats. In the AT, IUHS kids showed a lower number of sniffs (P < 0.01) compared to IUTN. In the NOT, IUHS kids also tended to show a lower number of sniffs (P = 0.09). During heat exposure, IUTN and IUHS growing goats spent more time resting and exhibited more heat-stress related behaviors such as panting and drinking (P < 0.001); however, no differences were observed between both groups. In conclusion, heat stress during the first third of pregnancy shortened gestation length and influenced the exploratory behavior of the kids in the early life. However, behavior responses to heat stress during the adulthood were not affected by the in utero thermal treatment.