Death certification status in Eastern Mediterranean Region: A systematic review.

A death certificate is an important public health surveillance tool that affects the quality of morbidity and mortality statistics. This systematic review examines death certification in the Eastern Mediterranean Region, uncovers the methodological qualities of published studies, the common errors committed by certifiers, and physicians' knowledge in filling out death certificates. We searched three databases, finding 19 studies, the majority of which reported errors in the underlying cause of death. Fewer than 25% of physicians reported training on filling out death certificates. Complexity of the cases and lack of training were reported as common difficulties facing physicians leading to errors.

Assessment of cancer-related fatigue among Jordanian patients: a cross-sectional survey.

BACKGROUND: Cancer-related fatigue (CRF) is considered to be one of the most common symptoms reported by cancer patients. However, little information is available regarding the variables associated with CRF among Jordanian patients. AIMS: To assess the prevalence of CRF and explore its predictors among Jordanian patients. METHODS: A cross-sectional survey design was used. FINDINGS: Of the 240 patients surveyed, 210 (87.5%) had fatigue at the time of the survey. The total mean fatigue score was 6.2 (SD=1.7) out of a maximum possible score of 10. The results also showed that being unemployed, with longer hospitalisation, low haemoglobin, and having lung cancer seem to predict higher levels of CRF. CONCLUSION: Several variables and factors associated with CRF were identified. In response to these results, healthcare providers should pay more attention to CRF, which needs to be assessed on a regular basis and to be managed with the available pharmacological and non-pharmacological interventions.

Evidence-based pharmaceutical care: The next chapter in pharmacy practice.

INTRODUCTION: Pharmacy is a very dynamic profession and the role of the pharmacist is improving with the expansion of the scope of services and the introduction of new subspecialties over time. Moving from being medication dispensers to outcome-oriented and patient-focused care providers; pharmacists will carry more responsibility and commitment to improve their knowledge and practice. Being updated and evidence-based is a key tool to achieve effective pharmaceutical care services. The primary purpose of this article is to highlight the concept of "evidence based pharmaceutical care" as professional practice to improve the quality of pharmaceutical care. METHODS: Literature for relevant evidence was searched by Medline (through PubMed), Cochrane library using the keywords: pharmaceutical care, evidence-based and pharmacy practice. Also a manual search through major journals for articles referenced in those located through PubMed was done. RESULTS AND DISCUSSION: There is strong data showing that pharmaceutical care lead to improvement in health outcomes and cost-effective therapy. More efforts, policies and qualified staff are needed to establish the "evidence-based pharmaceutical care" as new daily professional practice. Evidence to support pharmacists in their emerging role as care providers is available to improve the efficacy and quality of pharmaceutical care. Education and specialized training practicing evidence based approach are vital to prepare pharmacists to provide high quality pharmaceutical care. CONCLUSION: As care providers, pharmacists are effective in providing high quality patient care and being members in multidisciplinary clinical teams is needed to give them the opportunity. Evidence based pharmaceutical care is a natural and logical emerging concept in the modern pharmacy practice to achieve high quality and more effective pharmaceutical care but still more efforts and resources are needed to promote new attitude toward more professional career.

Diagnosis, Management And Prevention Of Hepatitis C In Pakistan 2017.

AIMS AND OBJECTIVES: Since the advent of direct acting antiviral agents, there is a revolutionary change in the management of HCV infection. Newer drugs with different mechanism of action are being introduced and are expected to be available in coming few months in Pakistan as well. The main purpose of the guideline is to review and induct the latest research in field of HCV infection in Pakistani perspective so that our healthcare professionals can apply the new recommendations in timely and judicial manner. Target groups of guidelines are general physicians treating hepatitis C, hepatologists and gastroenterologists. Other beneficiaries of these guidelines are public health institutions of Pakistan, which provide free treatment to deserving patients under National Hepatitis Prevention and Control Program and Pakistan Bait-ul- Mal Program. METHODOLOGY: These guidelines are based on the review of National consensus practice guidelines: Diagnosis, Management and Prevention of Hepatitis C Pakistan 2009. Published data in National and International Journals searched with the help of Google search and pub med, and 2015-16 guidelines of HCV by AASLD, EASL, APASL and WHO. Local studies are preferably added with references to enhance the Pakistani perspective. Evidence was also taken from published studies. Recommendations have been based upon evidence from national publications on the subject and scientific presentations at national liver meeting as well from experts' personal experience and opinion.

Role of dissection in light of students' perceptions.

OBJECTIVE: To observe students' perception of gross anatomy dissection. METHODS: The qualitative study comprised second year medical students of Army Medical College, Rawalpindi, and was conducted in July, 2013. Data was collected over three weeks through quota sampling. Focus group discussions were held with four groups having 15 students each.The sessions were audio-recorded which were transcribed and interpreted. RESULTS: On the basis of FGDs, four themes were identified: Prossected specimen as an introductory teaching tool; emotional reaction on specimen handling; practical concerns during specimen handling; and experience of learning anatomy. Trends were identified within these broader themes. CONCLUSION: There were differences in terms of attitudes and dissection hall experiences of medical students connected with the learning.

Presenting clinical symptoms of post-COVID-19 breakthrough infection: Predictors of mortality in a Middle Eastern population.

Objective: Breakthrough COVID-19 infections are common following immunisation with various types of vaccines. The patterns of infections have not been well established. We aimed to analyse the signs and symptoms of post vaccination infections in addition to the need for hospital admission, ER visit and supplemental oxygen in relation to age and gender. Methods: A cross-sectional cohort study was conducted in JUH from March 2021 to August 2022, we interviewed 1479 individuals who are >15 years of age and got a breakthrough infection. The statistical analysis was performed using STATA statistical software. Results: Out of the 1479 cases, 50.2 % and 69.4 % were females and less than 45 years of age respectively. Symptoms of cough, fever and headache were reported by nearly 50 % of the patients, while one-third complained of dyspnoea. We found that participants older than 45 years had worse clinical outcomes (P-value < 0.001). 13 deaths were identified in this study due to breakthrough infection, 92.3 % of them were older than 45 years (P-value < 0.001). Participants ≥45 years who experienced a breakthrough infection of COVID-19 were 0.7 times less likely to be females using adjusted logistic regression. Conclusion: This study indicates that despite more severe symptoms reported in younger patients, the major clinical outcomes were worse among older patients, which makes age a major risk for poor outcomes regardless of symptoms. Thus, older people should be evaluated carefully when presenting with mild symptoms of COVID-19 breakthrough infection. The study also confirms that there is no difference in the incidence of COVID-19 breakthrough infections between males and females. Prospective studies are needed to risk stratify COVID-19 breakthrough infections, which should take into account variants of the virus and comorbidities.

Molecular interaction of di-ester bonded cationic Gemini surfactants with pepsin: in vitro and in silico perspectives.

The implications of surfactant-enzyme/protein interactions in a variety of fields, including biotechnology, cosmetics, paints and pharmaceuticals, have attracted a lot of attention in contemporary studies. Herein, we have employed several in vitro and in silico techniques such as excitation and absorption spectroscopies, circular dichroism and FT-IR spectroscopies, density functional and molecular dynamics simulations to understand the interaction behavior of oxy-diester-based green cationic Gemini surfactants, N1,N1,N14,N14-tetramethyl-2,13-dioxo-N1,N14-dialkyl-3,6,12-tetraoxateradecane-1,14-diaminiumdichloride (abbreviated as Cm-E2O2-Cm, where 'm' stands for alkyl chain length, m = 12 and 14) with one of the main digestive proteins, pepsin. The spectroscopic techniques confirm the static quenching effect of surfactants on pepsin. The calculated physical parameters (Ksv, Kb and ΔG) and their order reveal the distinguished implications for the surfactants' chain lengths. The spontaneity of interaction was also confirmed by negative Gibbs free energy change values. The extrinsic spectroscopic study with pyrene as fluorescence probe, FT-IR and CD techniques indicated a potential conformational change in pepsin induced by the Gemini surfactants. DFT, docking and MD simulations provided the theoretical understanding regarding the quantum mechanical environment, location of binding and stability of the protein-surfactant complexation in energy terms. We believe this study will be a humble addition to our existing knowledge in the field of protein-surfactant interactions.Communicated by Ramaswamy H. Sarma.

Seroprevalence and molecular characterization of Toxoplasma gondii infecting ruminants in the North-West of Egypt.

Toxoplasma gondii is a coccidian parasite known for its heavy toll on people and livestock. It can cause abortion and a variety of congenital diseases. The current study aimed to examine some seroprevalence and molecular attributes of T. gondii obtained from ruminants in the North-West of Egypt. Specimens were random selected from five different locations in Alexandria and Matrouh governorates. A total of 483 blood samples, collected from 96 mixed flocks, were screened for anti-T. gondii IgG antibodies using enzyme-linked immunosorbent assay (ELISA). The seropositive results were then confirmed using polymerase chain reaction (PCR) primers for the B1 and P30 genes. Specific PCR products were selected for sequencing and alignment against the GenBank, where phylogeny has been examined using the maximum likelihood, neighbor-joining, and maximum parsimony in MEGA6. ELISA confirmed the presence of T. gondii in 188 of the investigated samples (38.92%), indicating a higher prevalence in camels (64.51%) and sheep (43.75%) as compared to goats (27.93 %) and cattle (13.46%). PCR confirmed the presence of T. gondii-specific sequences in 159 seropositive specimens, with homology between 98.3 and 100%. The genetic distances between the investigated variants ranged from 0.1 to 0.9, and 7 single nucleotide polymorphisms (SNPs), were identified in the examined T. gondii specimens. The camel T. gondii parasite, isolated from Matrouh, showed a 100% homology with the most dangerous reference strains of T. gondii-RH in the GenBank. Our results showed that B1 and P30-specific PCR could detect T. gondii in blood samples more accurately than ELISA. In addition, the statistical analysis of our data indicated that species, age, sex, and animal location were all risk factors for toxoplasmosis. These findings are likely to boost disease control and help contain the spread of T. gondii infections.

Strain and strain rate echocardiographic imaging predict occurrence of atrial fibrillation in post-coronary artery bypass grafting patients.

BACKGROUND: Atrial fibrillation (AF) occurs very frequently after coronary artery bypass grafting (CABG); it occurs in about 20-edictors can be used for the dedicatio40% of patients. It is associated with several adverse events. This study aimed to extrapolate a predictor for postoperative atrial fibrillation (POAF) occurrence which is reproducible and simple to be a part of routine echocardiography screening before CABG. This study included 89 patients scheduled for isolated coronary artery bypass surgery. History, clinical examination, and complete 2D echocardiography with LA speckle tracking analysis were done preoperatively. Patients were then followed up post-surgery for incidence of AF till discharge from the hospital. The patients were divided into 2 groups according to POAF occurrence. RESULTS: Patients who developed postoperative AF had older age (P = 0.0032) and longer hospital stay (P = 0.021) and higher stroke incidence but statistically non-significant (14.3% vs 3.3%). The POAF patients showed less peak atrial longitudinal strain (PALS) value than non-POAF patients. The left atrial strain rate values showed a significant difference with the lower left atrial systolic strain rate and less negative (higher) early diastolic strain rate and late diastolic strain rate. After multivariate logistic regression analysis, the independent predictors for POAF were PALS (OR 0.770, 95% CI 0.627-0.946), late LA diastolic strain rate (LASRa) (OR 3.476, 95% CI 1.207-12.186), and age (OR 1.181, 95% CI 1.011-1.379). CONCLUSION: Preoperative LA global strain assessed by 2D speckle tracking analysis could be helpful as a predictor for AF post-CABG surgery, and identification of these patients may reduce its morbidity and mortality. The study suggested PALS value less than 29.8 to be a predictor for the occurrence of POAF.

Shaping ability of three thermally treated nickel-titanium systems in S-shaped canals.

This study aimed to compare the shaping ability of ProTaper Next (PTN), HyFlex EDM (HEDM) and One Curve (OC) systems manufactured via different thermal treatment methods in simulated S-shaped canals. Sixty S-shaped canals in clear resin blocks were enlarged to a final apical size of 25 using PTN, HEDM and OC instruments (n = 20 canals/group). Composite images were obtained by superimposing pre- and post-preparation images. The amount of removed resin was measured perpendicularly to the canal surface in 22 points. Prepared canal width and canal transportation at different levels were determined. Canal aberrations were also recorded. Data were statistically analysed using analysis of variance, the Kruskal-Wallis and the chi-square tests at a 0.05 significance level. OC produced the most conservative enlargement and better maintained particularly the apical curvature of the S-shaped canals than HEDM and PTN. OC and HEDM better maintained the canal terminus and coronal curvature than PTN.

Higher stress scores for female medical students measured by the Kessler Psychological Distress Scale (K10) in Pakistan.

The aim of this study was to determine the stress level of medical students and the relationship between stress and academic year. A cross-sectional, descriptive study was conducted at an undergraduate medical school with a five-year curriculum, in Pakistan, from January 2014 to April 2014. Medical students in the first four years were included in the study. The Kessler Psychological Distress Scale (K10), a self-administered questionnaire, was distributed to the students. A total of 445 medical students completed the questionnaire. The average stress score was 19.61 (SD=6.76) with a range from 10 to 43. Stress was experienced by 169 students (41.7%). The scores of female students were higher than scores of males, indicating a higher stress level (P=0.011). The relationship between stress and academic year was insignificant (P=0.392).

Effects of Fasciola gigantica experimental infection on some inorganic elements in the snail host Lymnaea natalensis.

Flame atomic absorption spectrometry was performed to determine the alteration in the concentrations of metallic ion Pb, Zn, K, Na, Fe, Cu and Co in the soft parts of the Lymnaea natalensis snails shedding Fasciola gigantica cercariae and to determine the alteration in the concentration of Ca in the soft parts and shells of the same snails. The Co was found to be present at concentration level below the detection limits of the analytical method used. Regarding detected elements, three elements Zn, K and Cu were found to be present at significantly higher concentrations in cercariae-shedding snails compared with uninfected snails. Two elements, Pb and Na, showed significant decrease in cercariae-shedding snails compared to uninfected ones. The concentration of Fe showed non-significant increase. The results showed significant lowering in the calcium content of the shells and soft parts of cercariae-shedding snails relative to the calcium content in the uninfected ones. The obtained results and the hypothesis of hypercalcification in shells of infected snails were discussed.

Effects of Schistosoma mansoni and Schistosoma haematobium infections on calcium content in their intermediate hosts.

Flame atomic absorption spectrometry was performed to determine the alteration of calcium concentration in the soft parts and shells of Biomphalaria alexandrina and Bulinus truncatus due to the infection with Schistosoma mansoni and S. haematobium, respectively. The results showed significant lowering in the calcium content of the shells of cercariae shedding B. alexandrina and B. truncatus relative to the calcium content in the shells of uninfected ones. In contrast, the calcium content in the soft parts of cercariae shedding snails was higher than in the soft parts of uninfected snails; the differences were statistically significant. Generally, calcium content was significantly higher in the shells than in the soft parts of the snails, regardless infected or uninfected. The results obtained and the hypothesis of hypercalcification in shells of infected snails were discussed.