Production and characterization of novel marine black yeast's exopolysaccharide with potential antiradical and anticancer prospects.

The marine black yeasts are characterized by the production of many novel protective substances. These compounds increase their physiological adaptation to multi-extreme environmental stress. Hence, the exopolysaccharide (EPS) producing marine black yeast SAHE was isolated in this study. It was molecularly identified as Hortaea werneckii (identity 98.5%) through ITS1 and ITS4 gene sequencing analysis. The physicochemical properties of the novel SAHE-EPS were investigated through FTIR, GC-MS, TGA, ESM, and EDX analysis, revealing its heteropolysaccharide nature. SAHE-EPS was found to be thermostable and mainly consists of sucrose, maltose, cellobiose, lactose, and galactose. Furthermore, it exhibited an amorphous texture and irregular porous surface structure. SAHE-EPS showed significant antiradical activity, as demonstrated by the DPPH radical scavenging assay, and the IC50 was recorded to be 984.9 µg/mL. In addition, SAHE-EPS exhibited outstanding anticancer activity toward the A549 human lung cancer cell line (IC50 = 22.9 µg/mL). Conversely, it demonstrates minimal cytotoxicity toward the WI-38 normal lung cell line (IC50 = 203 µg/mL), which implies its safety. This study represents the initial attempt to isolate and characterize the chemical properties of an EPS produced by the marine black yeast H. werneckii as a promising antiradical and anticancer agent.

Perceived barriers and opportunities of providing quality family planning services among Palestinian midwives, physicians and nurses in the West Bank: a qualitative study.

BACKGROUND: Despite advancements in family planning (FP) services, several barriers persist in the Occupied Palestinian territory (oPt), blocking women's access to suitable, high-quality and equitable FP services. The aim of this study was to understand how healthcare providers perceive their abilities, barriers and opportunities in providing good quality FP services. Furthermore, it seeks to explore knowledge and training regarding FP among healthcare providers engaged in providing FP services. METHODS: A qualitative study was undertaken from August to September 2022 in seven Primary Health Care (PHC) clinics distributed in three governorates and operating under the Palestinian Ministry of Health (MoH) in the West Bank. Semi-structured, in-depth face-to-face interviews were conducted with 13 health providers (Physicians, midwives and nurses), using an interview guide in Arabic language. Transcripts were subsequently analyzed using the six phases of reflexive thematic analysis. RESULTS: FP services face various challenges, including shortages in resources such as staff, supplies, infrastructures and FP methods. Midwives possess significant potentials to offer accessible, high-quality, efficient and equitable FP services, yet, their capacities remain underutilized, representing a missed opportunity for a country like Palestine. The study provided a current overview of FP services while illustrating the need for quality FP services and the need for an updated continuous education and training, updated standardized guidelines and protocols and supportive supervision are needed across all levels of healthcare providers. Finally, providers reported a wide range of structural barriers to FP services. CONCLUSIONS: It is crucial to meticulously address both community-related and health system factors to enhance the fulfillment of FP needs and reduce unintended and closely spaced pregnancies. Policymakers should invest in the development of laws and regulations regarding FP services, promoting a comprehensive and holistic approach to FP services. This includes formulating supportive policies, capacity building of human resources and maintaining security of FP commodities.

Optimization of melanin pigment production from the halotolerant black yeast Hortaea werneckii AS1 isolated from solar salter in Alexandria.

BACKGROUND: Melanins are one of the magnificent natural pigments synthesized by a wide range of microorganisms including different species of fungi and bacteria. Marine black yeasts appear to be potential prospects for the synthesis of natural melanin pigment. As a result, the goal of this research was to isolate a marine black yeast melanin-producing strain and improve the culturing conditions in order to maximize the yield of such a valuable pigment. RESULTS: Among five locally isolated black yeast strains, the only one that demonstrated a potent remarkable melanin pigment production was identified using ITS rDNA as Hortaea werneckii AS1. The extracted pigment's physiochemical characterization and analytical investigation with Ultraviolet-Visible (UV) spectrophotometry, Fourier Transform-Infrared spectroscopy (FTIR), and Scanning Electron Microscope (SEM) confirmed its nature as a melanin pigment. The data obtained from the polynomial model's maximum point suggested that CaCl2, 1.125 g/L; trace element, 0.25 ml/L; and a culture volume 225 mL/500 mL at their optimal values were the critical three elements impacting melanin production. In comparison with the baseline settings, the response surface methodology (RSM) optimization approach resulted in a 2.0 - fold improvement in melanin output. CONCLUSIONS: A maximum melanin yield of 0.938 g/L proved the halotolerant H. werneckii AS1 potentiality as a source for natural melanin pigment synthesis 'when compared to some relevant black yeast strains' and hence, facilitating its incorporation in a variety of pharmaceutical and environmental applications.

Exploring the impact of indication on variation in rates of intrapartum caesarean section in six Palestinian hospitals: a prospective cohort study.

BACKGROUND: Caesarean section rates are rising globally. No specific caesarian section rate at either country-level or hospital-level was recommended. In Palestinian government hospitals, nearly one-fourth of all births were caesarean sections, ranging from 14.5 to 35.6%. Our aim was to assess whether variation in odds for intrapartum caesarean section in six Palestinian government hospitals can be explained by differences in indications. METHODS: Data on maternal and fetal health were collected prospectively for all women scheduled for vaginal delivery during the period from 1st March 2015 to 30th November 2016 in six government hospitals in Palestine. Comparisons of proportions in sociodemographic, antenatal obstetric characteristics and indications by the hospital were tested by χ2 test and differences in means by one-way ANOVA analysis. The odds for intrapartum caesarean section were estimated by logistic regression. The amount of explained variance was estimated by Nagelkerke R square. RESULTS: Out of 51,041 women, 4724 (9.3%) underwent intrapartum caesarean section. The prevalence of intrapartum caesarean section varied across hospitals; from 7.6 to 22.1% in nulliparous, and from 5.8 to 14.1% among parous women. The most common indications were fetal distress and failure to progress in nulliparous, and previous caesarean section with an additional obstetric indication among parous women. Adjusted ORs for intrapartum caesarean section among nulliparous women ranged from 0.42 (95% CI 0.31 to 0.57) to 2.41 (95% CI 1.70 to 3.40) compared to the reference hospital, and from 0.50 (95% CI 0.40-0.63) to 2.07 (95% CI 1.61 to 2.67) among parous women. Indications explained 58 and 66% of the variation in intrapartum caesarean section among nulliparous and parous women, respectively. CONCLUSION: The differences in odds for intrapartum caesarean section among hospitals could not be fully explained by differences in indications. Further investigations on provider related factors as well as maternal and fetal outcomes in different hospitals are necessary.

Pharmacokinetics and Pharmacodynamics of 3 Doses of Oral-Mucosal Dexmedetomidine Gel for Sedative Premedication in Women Undergoing Modified Radical Mastectomy for Breast Cancer.

BACKGROUND: Buccal dexmedetomidine (DEX) produces adequate preoperative sedation and anxiolysis when used as a premedication. Formulating the drug as a gel decreases oral losses and improves the absorption of buccal DEX. We compared pharmacokinetic and pharmacodynamic properties of 3 doses of buccal DEX gel formulated in our pharmaceutical laboratory for sedative premedication in women undergoing modified radical mastectomy for breast cancer. METHODS: Thirty-six patients enrolled in 3 groups (n = 12) to receive buccal DEX gel 30 minutes before surgery at 0.5 µg/kg (DEX 0.5 group), 0.75 µg/kg (DEX 0.75 group), or 1 µg/kg (DEX 1 group). Assessments included plasma concentrations of DEX, and pharmacokinetic variables calculated with noncompartmental methods, sedative, hemodynamic and analgesic effects, and adverse effects. RESULTS: The median time to reach peak serum concentration of DEX (Tmax) was significantly shorter in patients who received 1 µg/kg (60 minutes) compared with those who received 0.5 µg/kg (120 minutes; P = .003) and 0.75 µg/kg (120 minutes; P = .004). The median (first quartile-third quartile) peak concentration of DEX (maximum plasma concentration [Cmax]) in plasma was 0.35 ng/mL (0.31-0.49), 0.37 ng/mL (0.34-0.40), and 0.54 ng/mL (0.45-0.61) in DEX 0.5, DEX 0.75, and DEX 1 groups (P = .082). The 3 doses did not produce preoperative sedation. The 1 µg/kg buccal DEX gel produced early postoperative sedation and lower intraoperative and postoperative heart rate values. Postoperative analgesia was evident in the 3 doses in a dose-dependent manner with no adverse effects. CONCLUSIONS: Provided that it is administered 60-120 minutes before surgery, sublingual administration of DEX formulated as an oral-mucosal gel may provide a safe and practical means of sedative premedication in adults.

Severe cutaneous adverse drug reactions: Incidence, clinical patterns, causative drugs and modalities of treatment in Assiut University Hospital, Upper Egypt.

Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and overlap SJS/TEN are life-threatening diseases that are most frequently caused by drugs. Much debate remains about the role of systemic corticosteroids (SCs) in their treatment. Our aim to determine the incidence, causative drugs, the role and side effects of SCs in severe cutaneous adverse reactions (SCARs), in Assiut University Hospital (AUH). Patients This study was conducted in Department of Dermatology at AUH, from 2012 to 2017. All patients with SJS, overlap SJS/TEN and TEN admitted during this period were included in the study. Eighty-three patients with SCARs were included in this study. The most common type was SJS (67.5%). The incidence ranged from 1.7% in 2012 to 7.7% in 2017. Carbamazepine, valproic acid, lamotrigine, diclofenac sodium, and flucloxacillin-amoxicillin were the most common causative drugs. The most common side effects of SCs were peptic ulcer (55.5%) and hypertension (51.8%). The mortality rate in patients treated with SCs was 100% in TEN, 33.3% in overlap SJS/TEN and 16.3% in SJS. The patients of SCARs must be aware of the causative drugs and must never be re-administered. SCs in treatment of SCARs may increase the complications and the mortality rate.

Impact of animated instruction on tablets and hands-on training in applying bimanual perineal support on episiotomy rates: an intervention study.

INTRODUCTION AND HYPOTHESIS: In Palestine, episiotomy is frequently used among primiparous women.This study assesses the effect of training birth attendants in applying bimanual perineal support during delivery by either animated instruction on tablets or hands-on training on episiotomy rates among primiparous women. METHODS: An interventional cohort study was performed from 15 October 2015 to 31 January 2017, including all primiparous women with singletons and noninstrumental vaginal deliveries at six Palestinian hospitals. Intervention 1 (animated instructions on tablets) was conducted in Hospitals 1, 2, 3, and 4. Intervention 2 (bedside hands-on training) was applied in Hospitals 1 and 2 only. Hospitals 5 and 6 did not receive interventions. Differences in episiotomy rates in intervention and nonintervention hospitals were assessed before and after the interventions and presented as p values using chi-square test, and odds ratios (OR) with 95% confidence intervals (CI). Differences in the demographic and obstetric characteristics were presented as p values using the Kruskal-Wallis test. RESULTS: Of 46,709 women, 12,841 were included. The overall episiotomy rate in the intervention hospitals did not change significantly after intervention 1, from 63.1 to 62.1% (OR = 0.96, 95% CI 0.84-1.08), but did so after intervention 2, from 61.1 to 38.1% (OR = 0.39, 95% CI 0.33-0.47). Rates after Intervention 2 changed from 65.0 to 47.3% (OR = 0.52, 95% CI 0.40-0.67) in Hospital 1 and from 39.4 to 25.1% (OR = 0.49, 95% CI 0.35-0.68) in Hospital 2. CONCLUSIONS: Hands-on training of bimanual perineal support during delivery of primiparous women was significantly more effective in reducing episiotomy rates than animated instruction videos alone.

Impact of electronic and blended learning programs for manual perineal support on incidence of obstetric anal sphincter injuries: a prospective interventional study.

BACKGROUND: Obstetric anal sphincter injuries (OASIS) are associated with anal incontinence, dyspareunia and perineal pain. Bimanual perineal support technique (bPST) prevents OASIS. The aim of this study was to assess the effect of two different bPST training-methods on OASIS incidence. METHODS: This is a prospective-interventional quality improvement study conducted in two Palestinian maternity units between June 1 2015 and December 31 2016. Women having spontaneous or operative vaginal-delivery at ≥24 gestational-weeks or a birthweight of ≥1000 g (n = 1694) were recruited and examined vaginally and rectally immediately after vaginal birth by a trained assessor. Data on baseline OASIS incidence were collected during Phase-1 of the study. Subsequently, birth attendants in both maternity units were trained in bPST using two training modalities. A self-directed electronic-learning (e-learning) using an animated video was launched in phase-2 followed by a blended learning method (the animated e-learning video+ structured face-to-face training) in phase-3. OASIS incidence was monitored during phases-2 and 3. Variations in OASIS incidence between the three phases were assessed using Pearson-χ2-test (or Fisher's-Exact-test). The impact of each training-method on OASIS incidence was assessed using logistic-regression analysis. RESULTS: A total of 1694 women were included; 376 in phase-1, 626 in phase-2 and 692 in phase-3. Compared to Phase-1, OASIS incidence was reduced by 45% (12.2 to 6.7%, aOR: 0.56, CI; 0.35-0.91, p = 0.018) and 74% (12.2 to 3.2%, aOR, 0.29, CI; 0.17-0.50, p < 0.001) in phases-2 and 3, respectively. There was also a significant reduction in OASIS incidence by 52% from phase-2 to phase-3 (6.7% (42/626) to 3.2% (22/692), p = 0.003). These reductions reached statistical significance among parous-women only (aOR: 0.18, CI; 0.07-0.49, p = 0.001) after the first training method tested in phase-2. However, the reduction was significant among both primiparous (aOR: 0.39, CI; 0.21-0.74, p = 0.004) and parous-women (aOR: 0.11, CI; 0.04-0.32, p < 0.001) after implementing the blended learning method in phase-3. CONCLUSION: The animated e-learning video had a positive impact on reducing OASIS incidence. However, this reduction was enhanced by the use of a blended learning program combining both e- learning and face-to-face training modalities. STUDY REGISTRATION NUMBER: ClinicalTrialo.gov identifier: NCT02427854 , date: 28 April 2015.

Building a research registry for studying birth complications and outcomes in six Palestinian governmental hospitals.

BACKGROUND: Electronic-health (e-health) provides opportunities for quality improvement of healthcare, but implementation in low and middle income countries is still limited. Our aim was to describe the implementation of a registration (case record form; CRF) for obstetric interventions and childbirth events using e-health in a prospective birth cohort study in Palestine. We also report the completeness and the reliability of the data. METHODS: Data on maternal and fetal health was collected prospectively for all women admitted to give birth during the period from 1st March 2015 to 31st December 2015 in three governmental hospitals in Gaza and three in the West Bank. Essential indicators were noted in a case registration form (CRF) and subsequently entered into the District Health Information Software 2 (DHIS 2) system. Completeness of registered cases was checked against the monthly hospital birth registries. Reliability (correct information) of DHIS2 registration and entry were checked for 22 selected variables, collected during the first 10 months. In the West Bank, a comparison between our data registration and entry and data obtained from the Ministry of Health patient electronic records was conducted in the three hospitals. RESULTS: According to the hospital birth registries, a total of 34,482 births occurred in the six hospitals during the study period. Data on the mothers and children registered on CRF was almost complete in two hospitals (100% and 99.9%); in the other hospitals the completeness ranged from 72.1% to 98.7%. Eighty birth events were audited for 22 variables in the three hospitals in the West Bank. Out of 1760 registrations in each hospital, the rates of correct data registration ranged from 81% to 93.2% and data entry ranged from 84.5% to 93.1%. CONCLUSIONS: The registered and entered data on birth events in six hospitals was almost complete in five out of six hospitals. The collected data is considered reliable for research purposes.

Production, Characterization and Valuable Applications of Exopolysaccharides from Marine Bacillus subtilis SH1.

Exopolysaccharides (EPSs) are high molecular weight polymers consisting of different sugar residues they are preferable for replacing synthetic polymers as they are degradable and nontoxic. Many microorganisms possess the ability to synthesize and excrete exopolysaccharides with novel chemical compositions, properties and structures to have potential applications in different fields. The present study attempt to optimize the production of EPS by marine Bacillus subtilis SH1 in addition to characterization and investigation of different valuable applications. Effect of medium type, incubation period and pH were studied using the one factor at a time experiments. It was shown that the highest productivity (24 gl-1) of exopolysaccharides was recorded by using yeast malt glucose medium with pH 9 at the fourth day of incubation. Experimental design using Response Surface Methodology (RSM) was applied to optimize various nutrients at different concentrations. The finalized optimized medium contained (gl-1) glucose (5), peptone (2.5), yeast extract (4.5) and malt extract (4.5) increased the production of EPS to 33.8 gl-1 with1.4 fold increase compared to the basal medium. Chemical characterization of the extracted EPS showed that, FTIR spectra exhibited bands at various regions. Moreover, HPLC chromatogram indicated that the EPS was a heteropolysaccharide consisting of maltose and rhamnose. The study was extended to evaluate the potentiality of the extracted polysaccharides in different medical applications. Results concluded that, EPS exhibited antibacterial activity against Aeromonas hydrophila, Pseudomonas aeruginosa and Streptococcus faecalis and the highest antibacterial activity (7.8, 9 and 10.4 AU/ml) was against S. faecalis at 50, 100 and 200 mg/ml respectively. The EPS exhibited various degree of antitumor effect toward the tested cell lines (MCF-7, HCT-116 and HepG2). In addition, EPS exhibited antiviral activity at 500 µg/ml. The antioxidant capacity increased with increasing the concentration of the sample. Scanning electron microscopic analysis showed that EPS had compact film-like structure, which could make it a useful in the future applications as in preparing plasticized film.

Respiratory and physical ailments correlated with occupational exposure among welders in Pakistan.

Disruption of normal respiratory function is associated with occupational disorders. Exposure to welding fumes on long term basis affects the lung function of the workers and prompts allergic responses. Therefore, the aim of the study was to manifest the association of exposure to welding fumes and respiratory complications with reference to the undermining of normal lung function and respiratory symptoms. A cross sectional study was conducted in different areas of Lahore in 2016. A comparison was made among welders on the basis of lung function and other physical ailments. Questionnaire survey was performed along with the computation of lung function by using spirometer. Data was statistically analyzed by using analysis of variance (ANOVA). The study confirmed a statistically highly significant decline in FVC, FEV1, FEF 25-75%, PEFR and FEV1/FVC ratio among different types of welders. The current study expressed that occupational exposure to welding fumes can considerably distress the lung function. The application of preventive measures is required to solve the health related questions for welders.

Presentation and outcome of Middle East respiratory syndrome in Saudi intensive care unit patients.

BACKGROUND: Middle East respiratory syndrome coronavirus infection is associated with high mortality rates but limited clinical data have been reported. We describe the clinical features and outcomes of patients admitted to an intensive care unit (ICU) with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. METHODS: Retrospective analysis of data from all adult (>18 years old) patients admitted to our 20-bed mixed ICU with Middle East respiratory syndrome coronavirus infection between October 1, 2012 and May 31, 2014. Diagnosis was confirmed in all patients using real-time reverse transcription polymerase chain reaction on respiratory samples. RESULTS: During the observation period, 31 patients were admitted with MERS-CoV infection (mean age 59 ± 20 years, 22 [71 %] males). Cough and tachypnea were reported in all patients; 22 (77.4 %) patients had bilateral pulmonary infiltrates. Invasive mechanical ventilation was applied in 27 (87.1 %) and vasopressor therapy in 25 (80.6 %) patients during the intensive care unit stay. Twenty-three (74.2 %) patients died in the ICU. Nonsurvivors were older, had greater APACHE II and SOFA scores on admission, and were more likely to have received invasive mechanical ventilation and vasopressor therapy. After adjustment for the severity of illness and the degree of organ dysfunction, the need for vasopressors was an independent risk factor for death in the ICU (odds ratio = 18.33, 95 % confidence interval: 1.11-302.1, P = 0.04). CONCLUSIONS: MERS-CoV infection requiring admission to the ICU is associated with high morbidity and mortality. The need for vasopressor therapy is the main risk factor for death in these patients.

A cross sectional study of maternal 'near-miss' cases in major public hospitals in Egypt, Lebanon, Palestine and Syria.

BACKGROUND: The maternal near-miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health. We report findings from the formative stage of a World Health Organization (WHO) funded implementation research study that was undertaken to collect primary data at the facility level on the prevalence, characteristics, and management of maternal near-miss cases in four major public referral hospitals - one each in Egypt, Lebanon, Palestine and Syria. METHODS: We conducted a cross sectional study of maternal near-miss cases in the four contexts beginning in 2011, where we collected data on severe maternal morbidity in the four study hospitals, using the WHO form (Individual Form HRP A65661). In each hospital, a research team including trained hospital healthcare providers carried out the data collection. RESULTS: A total of 9,063 live birth deliveries were reported during the data collection period across the four settings, with a total of 77 cases of severe maternal outcomes (71 maternal near-miss cases and 6 maternal deaths). Higher indices for the maternal mortality index were found in both Al Galaa hospital, in Egypt (8.6%) and Dar Al Tawleed hospital in Syria (14.3%), being large referral hospitals, compared to Ramallah hospital in Palestine and Rafik Hariri University hospital in Lebanon. Compared to the WHO's Multicountry Survey using the same data collection tool, our study's mortality indices are higher than the index of 5.6% among countries with a moderate maternal mortality ratio in the WHO Survey. Overall, haemorrhage-related complications were the most frequent conditions among maternal near-miss cases across the four study hospitals. In all hospitals, coagulation dysfunctions (76.1%) were the most prevalent dysfunction among maternal near-miss cases, followed by cardiovascular dysfunctions. The coverage of key evidence-based interventions among women experiencing a near-miss was either universal or very high in the study hospitals. CONCLUSIONS: Findings from this formative stage confirmed the need for quality improvement interventions. The high reported coverage of the main clinical interventions in the study hospitals would appear to be in contradiction with the above findings as the level of coverage of key evidence-based interventions was high.

Barriers to Elderly Health Care in the Occupied Palestinian Territories.

This study examined different barriers to the access and utilization of primary health care services by the elderly in the occupied Palestinians territories. We collected quantitative data from a larger convenience sample of a national survey of 1299 persons in the occupied Palestinian territories (oPt) that examined the effects of Israel's colonization and its effects on health care delivery between October 2021 and February 2022. The research tool was based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questionnaire. The data was obtained from 76 elderly participants with a mean age of 68.33 years standard deviation (SD = 7.09 years). The majority (75%) reported having at least one chronic health issue and having limited access to health care. They had all finished at least six years of education. The participants claimed having health insurance, while 47.4 percent reported paying for out-of-pocket expenses and medical care was a burden. Access and affordability of health care was a problem for 70 percent of participants. Older persons and their families face access to care issues created by political, geographic, and economic barriers. Poor incomes, war-like conditions, a weak health care system, and a lack of comprehensive care delivery all impact their health.

Ultramicroscopic organization of the exterior olfactory organ in Anguilla vulgaris in relation to its spawning migration.

Background: Catadromous fishes have well-developed elongated olfactory organs with numerous lamellae and different types of receptor neurons related to their breeding migration. Aim: The current study showed how the olfactory system adapted to the catadromous life. Our work declared the need of the migratory fishes for the sense of smell that is exhibited by a higher number of the olfactory lamellae and the receptor neuron verification in the olfactory epithelium. Methods: Ten specimens of fully grown, but pre-matured, silver eels of Anguilla vulgaris were captured at the outlet of Edco Lake, overlooking the Mediterranean Sea, east of Alexandria. Olfactory rosettes were dissected and fixed for scanning electron microscope (SEM) and transmission electron microscope (TEM). Results: Our study gave a morphological description of the olfactory system of A. vulgaris. At the ultrastructural level using SEM and TEM, one olfactory rosette was provided with 90-100 flat radial olfactory lamellae. The nasal configuration allowed water to enter and exit, transferring odorant molecules to olfactory receptor cells which comprise long cylindrical ciliated and microvillous receptors as well as rod-tipped cells. These cells are bipolar neurons with upward dendritic knobs. The olfactory epithelia also include crypt receptor cells. Interestingly, the olfactory neurons are delimited by nonsensory supporting cells, including long motile kinocilia and sustentacular supporting cells beside mucus secretory goblet cells and ionocytes or labyrinth cells that contribute to the olfaction process. Conclusion: Olfaction is crucial in all vertebrates, including fishes as it involves reproduction, parental, feeding, defensive, schooling, and migration behaviors. Here, A. vulgaris is an excellent model for catadromous fishes. It has a well-developed olfactory organ to cope with the dramatic climate change, habitat loss, water pollution, and altered ocean currents effect during their catadromous life for reproduction.

Foodborne botulism outbreak with potential new management options.

OBJECTIVES: To shed some light on a potential therapeutic modality that may facilitate resolution of botulism symptoms, namely 3,4-diaminopyridine (3,4-DAP). METHODS: In Riyadh, Saudi Arabia, we recently encountered a foodborne botulism outbreak that, luckily, was discovered early. In Prince Sultan Military Medical city, we admitted, during a period of approximately 3 weeks, 15 probable cases, 2 of which were excluded due to more likely alternative diagnoses. We report in this case series 13 highly suspected cases of botulism that we encountered during the outbreak. RESULTS: A total of 12 out of 13 patients required intensive care unit (ICU) admission, one of which required intubation. Symptoms included cranial nerve palsies, gastrointestinal symptoms, limb and respiratory muscle weakness. Patients showed clinical improvement when received botulinum antitoxin and 3,4-DAP if given early in the course of the disease. CONCLUSION: Early admisntration of 3,4-DAP may facilitate recovery and prevent disease progression. Larger prospective trials should be carried out to confirm that.

Variation in Anti-inflammatory, Anti-arthritic, and Antimicrobial Activities of Different Extracts of Common Egyptian Seaweeds with an Emphasis on Their Phytochemical and Heavy Metal Contents.

The anti-inflammatory, anti-arthritic, and antimicrobial activities of some common Egyptian seaweeds in addition to their phytochemical and heavy metal contents were investigated. Phytochemical screening of the seaweed extracts showed the presence of different primary and secondary metabolites with different concentrations according to their species and the used solvent. The ethanolic extract of Colpmenia sinuosa (CSBE2) exhibited the maximum anti-inflammatory and anti-arthritic activity at 1000 µg/ml concentration compared to other seaweed extracts. The dichloromethane extract of Corallina officinalis (CORM) exerted the highest antimicrobial activity with an average inhibition zone diameter (AV) = 15.29 mm and activity index (AI) = 1.53 and with the highest antagonistic activity against Escherichia coli (28 mm). It is followed by Ulva linza ethanolic extract (ULGE2) which recorded (AV) of 14.71 mm and (AI) of 1.30 with the highest antifungal activity against Candida albicans (30 mm). The collected seaweeds would therefore be a very promising source for treating inflammatory, arthritic, and microbial diseases. Moreover, the investigated seaweeds showed variable concentrations of heavy metals among various species. The mean concentrations of the heavy metals took the following order: Fe > Zn > Mn > Ba > Cu > As > Cr > Ni > Pb > V > Cd > Se > Co > Mo. Based on the permissible limits set by the WHO and CEVA, Pb and Ni in the studied seaweeds were found to be within the permissible limits, whereas Cd and Zn contents were at the borderline. Significant correlations were observed between studied parameters. The estimated daily intakes for most heavy metals were lower than the recommended daily intakes.

Experiences of Palestinian patients with hospital services: a mixed-methods study.

BACKGROUND: This study aimed at assessing patient experiences with hospital services and key factors associated with better experiences. METHODS: The study design is cross-sectional supported by qualitative interviews. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was used as data collection instrument. A convenience sample of 391 volunteers aged ≥18 years participated in this study. Qualitative interviews were conducted with patients and healthcare providers to further enrich and explain the quantitative results. RESULTS: The average age of the sample was 41.34, SD (16.4), range (18-87). Females represented 61.9% of the whole sample. Almost 75% were from the West Bank and 25% from the Gaza Strip. The majority of respondents reported that doctors and nurses were respectful, listened to them and explained clearly to them always or most of the time. Only 29.4% of respondents were given written information about the symptoms they may have after discharge from the hospital. Factors that were independently associated with higher scores on the HCAHPS scale were; being females (coef: 0.87, 95% CI: 0.157 to 1.587, p=0.017), being healthy (coef: -1.58, 95% CI: -2.458 to -0.706, p=0.000), being with high financial status (coef: 1.51, 95% CI: 0.437 to 2.582, p=0.006), being from Gaza (coef: 1.45, 95% CI: 0.484 to 2.408, p=0.003) and who visited hospitals outside of Palestine (coef: 3.37, 95% CI: 1.812 to 4.934, p=0.000). Overcrowding, weak organisational and management processes, and inadequate supply of goods, medicines, and equipment were reported factors impeding quality services via in-depth interviews. CONCLUSIONS: The overall hospital experiences of Palestinian patients were moderate but varied significantly based on patients' factors such as sex, health status, financial status and residency as well as by hospital type. Hospitals in Palestine should invest more in improving their services including communications with patients, the hospital environment and communication with patients.

Menstrual health and hygiene among young Palestinian female university students in the West Bank: a cross-sectional study.

OBJECTIVE: We investigated some aspects of menstrual health and hygiene among young female students at Birzeit University in the West Bank of the occupied Palestinian territory. DESIGN: Cross-sectional study in a large central university. PARTICIPANTS: Out of a total of 8473 eligible female students, a calculated sample size of 400 students aged between 16 and 27 years was obtained.SettingLarge central university, West Bank, occupied Palestinian territory (oPt). MEASURES: An anonymous structured international research instrument consisting of 39 questions based on the Menstrual Health Questionnaire, in addition to few questions relevant to the context, was administered. RESULTS: 30.5% of participants were not informed about menstruation before menarche, and 65.3% reported that they were not ready when they got their first period. The highest reported source of information regarding menstruation was family (74.1%), followed by school (69.3%). About 66% of respondents reported that they need more information on various topics of menstruation. The most common type of menstrual hygiene products used were single-use pads (86%), followed by toilet paper (13%), nappies (10%) and reusable cloths (6%). Of the total 400 students, 14.5% reported that menstrual hygiene products are expensive, and 15.3% reported that they always/sometimes had to use menstrual products that they do not like because they are cheaper. Most (71.9%) of the respondents reported that they used menstrual products for longer time than recommended due to inadequate washing facilities at the university campus. CONCLUSIONS: The findings provide useful evidence on the lack and the need for menstrual-related information for female university students, inadequate infrastructure to help them manage their menstruation with dignity and pointed to some menstrual poverty in accessing menstrual products. A national intervention programme is needed to increase awareness regarding menstrual health and hygiene among women in local communities and female teachers in schools and universities to enable them to disseminate information to and meet the practical needs of girls at home, at school and at the university.