Providing technical assistance: lessons learned from the first three years of the WHO Adolescent and Youth Sexual and Reproductive Health and Rights Technical Assistance Coordination Mechanism.

Young people's sexual and reproductive health (SRH) continues to be a major challenge in low and middle-income countries, with implications for public health now and in the future. Fortunately there is a growing array of evidence-based interventions, and commitments from governments, development partners and donors, to support programmes that aim to improve young people's SRH.However, in some situations, the technical assistance that governments feel that they need to strengthen and implement national policies and strategies, to move from words to action, is not available. The WHO Adolescent and Youth Sexual and Reproductive Health and Rights (AYSRHR) Technical Assistance (TA) Coordination Mechanism was initiated to help fill this technical assistance gap; to respond to TA requests from ministries of health in ways that are timely, efficient, effective and contribute to strengthening capacity.This paper describes the process of developing the Technical Assistance Coordination Mechanism (TA Mechanism) and the outcomes, experiences and lessons learned after three years of working. It triangulates the findings from a preliminary review of the literature and discussions with selected key informants; the outcomes from a series of structured review meetings; and the documented processes and results of the technical assistance provided to countries.The lessons learned focus on three aspects of the TA Mechanism. How it was conceptualized and designed: through listening to people who provide and receive AYSRHR TA and by reviewing and synthesizing past experiences of TA provision. What the TA Mechanism has achieved: a standardized process for TA provision, at different stages for a range of AYSRHR issues in ten countries in three geographic regions. And what worked well and what did not: which common challenges was the TA Mechanism able to address and which ones persisted despite efforts to avoid or resolve them. The paper ends with the implications of the lessons learned for future action.

Assessment of Bacterial Load and Post-Endodontic Pain after One-Visit Root Canal Treatment Using Two Types of Endodontic Access Openings: A Randomized Controlled Clinical Trial.

The need for controlling bacteria and pain during root canal therapy is undeniable. This clinical trial aimed to assess whether there is a difference in colony-forming unit (CFU) reduction after instrumentation and post-endodontic pain after root canal treatment (RCT) using a traditional endodontic cavity (TEC) versus a conservative endodontic cavity (CEC). This clinical study was conducted on 89 patients designated for a single-visit RCT. Patients were allocated randomly (TEC n = 45 and CEC n = 44). The access opening was gained accordingly in each group by a single operator. A pre-instrumentation sample of root canal dentin was collected using an endodontic file; the second sample was collected similarly, right after shaping and cleaning the root canal. The CFU was calculated based on the samples collected. The pain level was recorded preoperatively and at 1, 7, and 21 days postoperatively utilizing a visual analog scale (VAS). There were no statistically significant differences in the CFU reduction between the TEC and CEC groups (p > 0.05). Additionally, there were no statistically significant differences found in postoperative pain levels between the TEC and CEC at 1, 7, and 21 days (p > 0.05). Despite the limitations of this study, both the CEC and TEC demonstrate a decrease in bacteria within the root canals and alleviate postoperative pain with no difference between them.

Xeno-Free 3D Bioprinted Liver Model for Hepatotoxicity Assessment.

Three-dimensional (3D) bioprinting is one of the most promising methodologies that are currently in development for the replacement of animal experiments. Bioprinting and most alternative technologies rely on animal-derived materials, which compromises the intent of animal welfare and results in the generation of chimeric systems of limited value. The current study therefore presents the first bioprinted liver model that is entirely void of animal-derived constituents. Initially, HuH-7 cells underwent adaptation to a chemically defined medium (CDM). The adapted cells exhibited high survival rates (85-92%) after cryopreservation in chemically defined freezing media, comparable to those preserved in standard medium (86-92%). Xeno-free bioink for 3D bioprinting yielded liver models with high relative cell viability (97-101%), akin to a Matrigel-based liver model (83-102%) after 15 days of culture. The established xeno-free model was used for toxicity testing of a marine biotoxin, okadaic acid (OA). In 2D culture, OA toxicity was virtually identical for cells cultured under standard conditions and in CDM. In the xeno-free bioprinted liver model, 3-fold higher concentrations of OA than in the respective monolayer culture were needed to induce cytotoxicity. In conclusion, this study describes for the first time the development of a xeno-free 3D bioprinted liver model and its applicability for research purposes.

Epidemiology of tuberculosis in Saudi Arabia following the implementation of end tuberculosis strategy: Analysis of the surveillance data 2015-2019.

OBJECTIVES: To analyze the evolution of tuberculosis (TB) epidemiology in Saudi Arabia in the 5 years following the implementation of the end-TB Strategy. METHODS: A retrospective analysis of surveillance data, reported by the national tuberculosis control program from 2015-2019, was carried out. The annual incidence and the percentage of yearly changes were calculated and compared to the World Health Organization (WHO) milestones, which anticipate a 4-5% annual decline. Additionally, various other epidemiological indicators of TB were examined. RESULTS: The national TB incidence declined from 10.55% per 100,000 in 2015 to 8.76% per 100,000 in 2019, aligning with the WHO's 2019 milestone estimated between 8.59-8.96% per 100,000. While Makkah Region (40.3%) and Riyadh (24.6%) accounted for the majority of cases, Jazan region consistently exhibited the highest incidence throughout the study period. Demographic features shifted towards a younger age category, male, and native dominance. There was a consistent decrease in resistance and intermediate sensitivity to all first-line anti-TB drugs, associated with a substantial decrease in both polydrug resistance (from 4.7-1.9%; p<0.001) and multidrug resistance (from 4.4-2.4%; p=0.008). CONCLUSION: The figures of TB incidence TB in Saudi Arabia between 2015-2019 has met the WHO end-TB milestones, predicting successful progress toward the 2035 goal.

Pathological assessment and tissue tropism of two different Egyptian infectious bronchitis strains.

Avian infectious bronchitis is one of the most common viral infections in chickens affecting all ages. The tropism of infectious bronchitis virus (IBV) strains became broader and more variable posing major implications for the effective control of IBV infection. In this study, two IBV viruses representing classic and variant strains were inoculated intranasally into day-old SPF chicks (105 EID50/0.2 ml/bird). Clinical signs were observed for 15 days post-infection (DPI). Five chicks from each group were euthanized at 2, 4, 6, 8, 10, 12, and 15 DPI for histopathology and virus antigen detection by IHC and quantitative rRT-PCR. Results revealed that both classic and variant IBV strains induced mild clinical signs with no mortalities and fewer various histopathological lesions in infected SPF chickens. Although the viruses were detected by rRT-PCR up to 12 DPI, the affected tissues showed regeneration after 10 DPI with IHC revealing no IBV antigen. In summary, no differences were found in the behaviour of both IBV isolates in chickens. The broad tissue tropism for both IBV strains as indicated by viral antigen detection in various organs with no clinical or gross lesion suggest that the main cause of death in IBV infection under field conditions occurs as a result of complication with secondary infections rather single IBV infection. Due to positive immunostaining in the bursa, it is thought that IBV infection has immunosuppressive consequences, hence further study is required to validate this impact.

Assessment of healthcare workers' knowledge and attitude on Ebola virus disease in Somalia: a multicenter nationwide survey.

BACKGROUND: In September 2022, a new Ebola outbreak was reported in Uganda, East Africa, and 142 confirmed cases, including 19 Healthcare workers (HCWs) reported. Ebola is not endemic in Somalia, but the country is at a reasonable risk of the virus being introduced due to the direct connection with daily flights from Uganda without border health control and prevention activities. Therefore, evaluating HCWs' Knowledge and attitude is crucial since this is the first time being evaluated in Somalia. The study's objective is to evaluate the HCWs' Knowledge and attitude toward the Ebola virus disease in Somalia. METHOD: An online self-administrated cross-sectional survey was conducted among HCWs (n = 1103) in all six federal member states of Somalia using a validated, reliable, well-structured questionnaire. Data we analyzed using descriptive statistics and Logistic regression were used to determine sociodemographic characteristics associated with poor Knowledge and negative attitude. RESULT: Over one-third (37.3%) of HCWs had poor Knowledge; the mean knowledge score was 7.97 SD ± 2.15. Almost 40.1% of the HCWs had a negative attitude; the mean attitude was 27.81 SD ± 8.06. Low-income HCWs (AOR = 2.06, 95%CI:1.01-4.19), Married HCWs (AOR = 1.39, 95%CI: 1.110-1.963), Midwives (AOR = 2.76, 95%CI: 1.74-4.39), Lab technicians (AOR = 2.43, 95%CI: 1.43-4.14), HCWs work in Jubaland state of Somalia (AOR = 3.69, 95%CI: 2.39-5.70), Galmudug state (AOR = 8.50, 95%CI: 4.59-15.77), Hirshabelle state (AOR = 3.18, 95%CI: 2.15-4.71) were more likely to have poor Knowledge compared to their counterparts. HCWs who work in Hirshabelle state (AOR = 5.44,95%CI: 3.58-8.27), Jubaland state (AOR = 8.47, 95%CI: 4.69-15.29), and Galmudug state (AOR = 4.43, 95%CI: 3.03-6.48) was more likely to have a negative attitude than those working in the Banadir region administration. CONCLUSION: Most Somali healthcare workers showed good Knowledge and a positive attitude toward the Ebola virus. The implementation to enhance Knowledge and attitude must specifically focus on low-income HCWs, Midwives, Lab technicalities, and those who work in Hirshabelle, Jubaland, and Galmudug states of Somalia.

Assessment of Periodontal Health Among Removable and Fixed Partial Denture Wearers in Aseer Region of Saudi Arabia.

BACKGROUND Prosthetic rehabilitation will have harmful effects on periodontal structure if the patient fails to maintain an oral hygiene protocol. This study aimed to evaluate oral hygiene in fixed and removable partial denture wearers in the Aseer Province of Saudi Arabia. MATERIAL AND METHODS This was a cross-sectional study done on 286 prosthesis wearers aged between 25 and 55 years; 142 were men and 144 women. Clinical examination was done using 3 periodontal parameters: plaque index, gingival index, and calculus surface index. RESULTS It was found that 72% and 25% of patients used fixed and removable partial prostheses, respectively. Most patients were in the 45-55 year age group (38.1%), were medically fit (78%), and used toothbrush and paste (70.6%). Most patients were instructed regarding the use of oral hygiene measures for their prostheses (71.3%). However, around half of the study group (52.8%) had odor from their prostheses. Most fixed prostheses were in the posterior teeth (73.2%) and had 3 units or more (58.7%). Removable partial dentures were mostly tooth-tissue supported (74%). A statistically significant difference was found for plaque index and gingival index between natural teeth and abutments in terms of various prosthetic parameters (P£0.001). The higher prevalence of gingival inflammation, plaque, and calculus accumulation in this study may be correlated to improper oral hygiene methods used by patients. CONCLUSIONS It can be concluded that there is a need to reinforce meticulous oral hygiene practices among patients using prosthodontic appliances.

Assessment of tetanus Immunization among healthcare workers in Mogadishu, Somalia.

Tetanus is still a major problem in sub-Saharan African countries. This study aims to evaluate tetanus disease and vaccine awareness among healthcare workers in Mogadishu. This descriptive, cross-sectional study was scheduled for January 2-7, 2022. A questionnaire consisting of 28 questions was applied in a face-to-face manner to 418 healthcare workers. Only health workers aged≥18 living in Mogadishu were included. Questions about sociodemographic characteristics, tetanus disease, and vaccines were developed. 71.1% of the participants were female, 72% were ˂25 years old, 42.6% were nursing students, and 63.2% had a university education. It was observed that 46.9% of the volunteers had an income level of <$250, and 60.8% resided in the city center. 50.5% of the participants received a tetanus vaccine in their childhood. Questions to determine participants' level of knowledge about tetanus and the tetanus vaccine were responded to with an accuracy of between 44 and 77%. Although 38.5% of the participants reported that they were exposed to trauma at least once a day, the rate of those who had three or more doses of the vaccine was only 10.8%. On the other hand, 51.4% reported that they had received training about tetanus and vaccination. There was a significant difference (p < .001) in terms of knowledge level among sociodemographic characteristics. The fear of side effects was the most important reason for not being vaccinated. Healthcare workers in Mogadishu have little awareness of tetanus disease and vaccines. Efforts to improve education and other factors will be sufficient to eliminate the disadvantage brought about by the socio-demographic structure.

How prepared is the world? Identifying weaknesses in existing assessment frameworks for global health security through a One Health approach.

The COVID-19 pandemic has exposed faults in the way we assess preparedness and response capacities for public health emergencies. Existing frameworks are limited in scope, and do not sufficiently consider complex social, economic, political, regulatory, and ecological factors. One Health, through its focus on the links among humans, animals, and ecosystems, is a valuable approach through which existing assessment frameworks can be analysed and new ways forward proposed. Although in the past few years advances have been made in assessment tools such as the International Health Regulations Joint External Evaluation, a rapid and radical increase in ambition is required. To sufficiently account for the range of complex systems in which health emergencies occur, assessments should consider how problems are defined across stakeholders and the wider sociopolitical environments in which structures and institutions operate. Current frameworks do little to consider anthropogenic factors in disease emergence or address the full array of health security hazards across the social-ecological system. A complex and interdependent set of challenges threaten human, animal, and ecosystem health, and we cannot afford to overlook important contextual factors, or the determinants of these shared threats. Health security assessment frameworks should therefore ensure that the process undertaken to prioritise and build capacity adheres to core One Health principles and that interventions and outcomes are assessed in terms of added value, trade-offs, and cobenefits across human, animal, and environmental health systems.

Monitoring progress on Antimicrobial Resistance (AMR) response in the World Health Organization African region: Insights from the Tracking AMR Country Self-Assessment Survey (TrACSS) 2021 results for the human health sector.

Antimicrobial resistance (AMR) is a major 21st century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan on AMR (GAP). The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. This was a secondary data analysis of responses from forty-one countries that participated in the 2021 TrACSS. Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. Fifteen 15(37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for human health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanisms in the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical.

Evaluation and Assessment of Community Awareness About Coronary Artery Disease in the Aseer Region.

Background Coronary artery disease (CAD), a severe cardiovascular disorder, still remains the major reason for death among adults. In Saudi Arabia, the most common risk factors noticed were hypertension, diabetes, smoking, and dyslipidemia. To date, various therapies have been used for managing CAD, but primary prevention remains the cornerstone to reducing the incidence of CAD-linked mortality and morbidity. The present research aimed to evaluate public awareness levels about CAD in the Aseer region of Saudi Arabia. Materials and methods A structured questionnaire was used to assess the demographic variables, information regarding risk factors, and knowledge and awareness about CAD. To analyze the knowledge and awareness of the general population regarding CAD, 26 well-constructed questions were framed and asked. General characteristics like knowledge, awareness, risk factors, signs and symptoms, complications, effects, treatment, and prevention of CAD were recorded by asking questions with different options. The data obtained were then subjected to statistical analysis using SPSS version 20.0 software (IBM Corp., Armonk, NY). Results Out of 651 participants, 66.51% were males and 33.48% were females, and 36.40% were aged between 26 and 35 years. Of the participants, 14.13% had a positive family history of CAD, 66.05% had inactive lifestyle habits, and 59.60% did not report any stress. A total of 61.29% were unaware of CAD, but many of them were aware of the risk factors, symptoms, and complications of the disease. A total of 5.529% were suffering from CAD, with a time period of less than one year. Only 1.84% of participants were taking medicines for CAD. Conclusion Our study suggested that the community of the Aseer region of Saudi Arabia has meager knowledge and awareness about CAD. Westernized lifestyles and urbanization have caused poor physical well-being in people, leading to increased risk factors for CAD. Thus, we suggest that different educational public health awareness programs should be implemented by the Ministry of Health, Saudi Arabia to decrease the prevalence of these life-threatening diseases.

Year-Long Assessment of Soil Nematode Diversity and Root Inhibition-Indicator Nematode Genera in Rice Fields.

Soil nematodes contribute to nutrient cycling. This year-long study aimed to investigate the changes in the diversity of soil nematodes during the spring, summer, and winter seasons in rice fields at 24 sites and to determine the indicator nematode genera that inhibit the roots of rice plants. A total of 216 soil samples were collected during three seasons, and the collection of 72 root samples was carried out during rice cropping. Forty-four soil nematode genera were identified. They exhibited significant changers in their abundance, which were dependent on the seasons and on soil characteristics. In particular, the abundance of plant-parasitic nematodes (PPNs) and free-living soil nematodes was 49% and 15% higher during the summer than during the spring and winter seasons, respectively. Soil characteristics, such as soil nitrogen (N) contents, carbon (C) contents, and soil moisture were significantly higher during the summer than in the spring and winter seasons, but soil pH was significantly lower during the summer than in the spring and winter seasons. Moreover, Hirschmanniella,Meloidogyne, and Heterodera emerged as good indicators for rice root inhibition, corroborating the frequency, density, and prominence value of PPNs of the sampled soil and rice roots. This study also indicated that free-living nematode genera, such as Rhabdolaimus, Diplogaster, and Rhabditis, might function as ecological indicators for soil health.

Energy, exergy, environmental impact, and economic analyses of evacuated tube compound parabolic concentrator-powered solar thermal domestic water heating system.

In the reported study, a dynamic analytical model is developed to propose the energy, exergy, environmental impact, and economic analyses of the water heating system at Jaipur (India) with an evacuated tube compound parabolic concentrator field of a total area of 81 m2. Consequently, the model is used to perform parametric studies to report the effect of operating and meteorological parameters on the productivity and performance of the system. Moreover, the system's performance, environmental impact, and economic aspects have been investigated and compared under different meteorological conditions at four different Rajasthan (India) locations using TMY2 weather data files. Results clarified that Jodhpur receives the highest solar radiation intensity from these four locations. The model results were validated with the experimental data, and a good agreement has prevailed. Consequently, the results indicate the highest annual energy and exergy gain for Jodhpur with 79.72 MWh and 9.311 MWh, respectively, followed by Jaisalmer, Barmer, and Jaipur. The economic analysis results clarified that the simple payback period ranged from 4.5 to 4.75 years and the discounted payback period ranged from 6.6 to 7 years based on a 6% discount rate. At the same time, the levelized cost of heating for the given system is around 0.023 $/kWh which is very economical closest to that of CNG as a fuel which costs around 0.059 $/kWh. The internal rate of return is reported to be 16.76, 16.82, 16.77, and 16.75% for Barmer, Jodhpur, Jaipur, and Jaisalmer, respectively, and savings of 74.4, 78.1, 75.4, and 73.8 tonnes of CO2 emission to the environment.

Assessment of Canadian Syncope Risk Score in the prediction of outcomes of patients with syncope at the Emergency Department of Suez Canal University: STROBE compliant.

ABSTRACT: Syncope is a temporary loss of consciousness usually related to insufficient blood flow to the brain. It's also called fainting or "passing out." Syncope is responsible for 3% to 5% of emergency department visits, with a hospitalization rate in about 40% of cases, with an average stay of 5.5 days. The Canadian Syncope Risk Score showed good discrimination and calibration for 30-day risk of serious adverse events after disposition from the emergency department.The aim was to assess Canadian Syncope Risk Score in predicting outcomes and mortality at the emergency department of Suez Canal University Hospitals.A prospective observational cohort study was carried out in emergency department in Suez Canal University Hospital. After approval by the Ethical and Research Committee of Faculty of Medicine, Suez Canal University, 60 patients with syncope attending to emergency department were included to this study. All included participants were assessed by history taking and they also assessed by the Canadian Syncope Risk Score.The Canadian Syncope Risk Score's mean of the study group was 4.9 and the range of the scores was from -2 to 11. The mean of the percentage of risk of serious events at 30 days in the study group was 29.17% and it ranged from 0.7% to 83.6%.There was a statistically significant difference between means Canadian Syncope Risk Score's score regarding complication occurrence. Cases which showed complications had a mean score of 7.33 compared to a mean score of 1.25 in case of no complication occurrence P-value <.001. At a cut-off point of more than 3 for the Canadian Syncope Risk Score's, sensitivity of that score in complication's occurrence prediction was 100% and the specificity was 87.5% P-value <.001.The Canadian Syncope Risk Score's is strong predictor for risk of serious adverse events and a good indicator for admission, with 100% sensitivity and 87.5% specificity at cut off point more than 3.

Life Cycle Assessment of Construction and Demolition Waste Management in Riyadh, Saudi Arabia.

Extensive construction augmenting the infrastructure and real estate projects underpin Saudi Arabia's Vision 2030 of sustainable cities. A part of this struggle involves the transformation of the existing infrastructure together with new construction, which generates a large amount of construction and demolition waste (CDW). In the absence of a structured life cycle assessment (LCA) framework, the waste management companies are planning future scenarios (phased expansions of material recovery facilities to improve the recycling rate) primarily on economic grounds. This study assesses the environmental impacts of the existing and planned CDW management practices of the Saudi Investment Recycling Company in Riyadh City by dint of LCA. Impact 2002+ performs life cycle impact assessment of the base case (45% recycling), four treatments (61, 76, 88, and 100% recycling), and zero waste scenarios. The study demonstrates the benefits of current CDW (mixed soil, concrete blocks, clay bricks, glazed tiles, and asphalt) recycling in terms of avoided impacts of non-renewable energy, global warming, carcinogens, non-carcinogens, and respiratory inorganics potentially generated by landfilling. For the treatment scenario of 100% recycling, CDW conversion into a wide range of aggregates (0-50 mm) can replace 10-100% virgin aggregates in backfilling, precast concrete manufacturing, encasements and beddings of water mains and sewers, manholes construction, non-load bearing walls, and farm-to-market roads. To achieve long-term economic and environmental sustainability, municipalities need to improve source segregation, handling, and storage practices to enhance the existing (45%) recycling rate to 100% in the next five years and approach the zero-waste scenario by 2030. The findings of the present study motivate the generators for source reduction as well as encourage the recycling companies and concerned organizations in the continuous performance improvement of the CDW management systems across Saudi Arabia on environmental grounds, as an addition to the perceived economic benefits.

Hispolon-Loaded Liquid Crystalline Nanoparticles: Development, Stability, In Vitro Delivery Profile, and Assessment of Hepatoprotective Activity in Hepatocellular Carcinoma.

The present work describes the development and characterization of liquid crystalline nanoparticles of hispolon (HP-LCNPs) for treating hepatocellular carcinoma. HP-LCNPs were prepared by a top-down method utilizing GMO as the lipid and Pluronic F-127 as the polymeric stabilizer. The prepared formulations (HP1-HP8) were tested for long-term stability, where HP5 showed good stability with a particle size of 172.5 ± 0.3 nm, a polydispersity index (PDI) of 0.38 ± 0.31 nm, a zeta potential of -10.12 mV ± 0.05, an entrapment efficiency of 86.81 ± 2.5%, and a drug loading capacity of 12.51 ± 1.12%. Optical photomicrography and transmission electron microscopy images demonstrated a consistent, low degree of aggregation and a spherical shape of LCNPs. The effect of temperature and pH on the optimized formulation (HP5) indicated good stability at 45 °C and at pH between 2 and 5. In vitro gastrointestinal stability indicated no significant change in the particle size, PDI, and entrapment efficiency of the drug. The drug release study exhibited a biphasic pattern in simulated gastric fluid (pH 1.2) for 2 h and simulated intestinal fluid (pH 7.4) for up to 24 h, while the best fitting of the profile was observed with the Higuchi model, indicating the Fickian diffusion mechanism. The in vivo pharmacokinetic study demonstrated nearly 4.8-fold higher bioavailability from HP5 (AUC: 1774.3 ± 0.41 µg* h/mL) than from the HP suspension (AUC: 369.11 ± 0.11 µg* h/mL). The anticancer activity evaluation revealed a significant improvement in antioxidant parameters and serum hepatic biomarkers (SGOT, SGPT, ALP, total bilirubin, and GGT) in the diethyl nitrosamine-treated group of rats with the optimized LCNP formulation (HP5) vis-à-vis HP suspension.

Arrhythmias in Female Patients: Incidence, Presentation and Management.

There is a growing appreciation for differences in epidemiology, treatment, and outcomes of cardiovascular conditions by sex. Historically, cardiovascular clinical trials have under-represented females, but findings have nonetheless been applied to clinical care in a sex-agnostic manner. Thus, much of the collective knowledge about sex-specific cardiovascular outcomes result from post hoc and secondary analyses. In some cases, these investigations have revealed important sex-based differences with implications for optimizing care for female patients with arrhythmias. This review explores the available evidence related to cardiac arrhythmia care among females, with emphasis on areas in which important sex differences are known or suggested. Considerations related to improving female enrollment in clinical trials as a way to establish more robust clinical evidence for the treatment of females are discussed. Areas of remaining evidence gaps are provided, and recommendations for areas of future research and specific action items are suggested. The overarching goal is to improve appreciation for sex-based differences in cardiac arrhythmia care as 1 component of a comprehensive plan to optimize arrhythmia care for all patients.

In Vitro Assessment of Sealing Ability of Various Materials Used for Repair of Furcal Perforation: A SEM Study.

AIM: The aim of the current in vitro research was to evaluate the sealing capacity of three different agents employed for the repair of perforations at the furcation area. MATERIALS AND METHODS: Recently 60 extracted human mandibular permanent molars having well apart plus fully formed roots, and intact furcation were chosen. The 60 samples were allocated at random to three groups of 20 samples: Group I: Furcation perforation repair by means of mineral trioxide aggregate (MTA)-Angelus, Group II: Furcal perforation repair using Biodentine, Group III: Furcal perforation repair by EndoSequence. The specimens were subjected to sectioning with a hard tissue microtome and the sectioned parts of the samples were then examined. The specimens were subjected to gold sputtering and visualizing beneath scanning electron microscope (SEM) at 2000× magnification for assessing the sealing capacity of the agents. RESULTS: The highest sealing capacity was noted with the use of Biodentine at 0.96 ± 0.10, in pursuit by EndoSequence use at 1.18 ± 0.14 and MTA-Angelus use at 1.74 ± 0.08. The disparity amid the three groups was statistically significant with p < 0.001. CONCLUSION: In conclusion, it may be inferred that Biodentine exhibited the finest sealing capacity than EndoSequence and MTA- Angelus. It may thus be given consideration as a substance of preference for the repair of furcal perforation. CLINICAL SIGNIFICANCE: Using biologically compatible substances may be suggested to amend perforations thereby decreasing the occurrence of inflammatory response in the neighboring tissues. The sealing capacity is a significant feature in supporting the result of a root canal treatment of a tooth.

Assessment of Children's Oral Health-Related Knowledge and Self-Efficacy in Expectant Mothers of Najran, Saudi Arabia

Abstract Objective: To assess the knowledge of pregnant women regarding their child's oral health. Material and Methods: A questionnaire was developed and the 1st section comprised sociodemographic variables. The second section contained questions about the eruption of teeth, fluoride importance, cariogenic food, and dental visits. The questionnaire was shared electronically via a link to the receptionist of the gynaecologist at different health centres of Najran to be filled by expectant mothers. The convenient sampling method was used to collect the responses. Data were presented using descriptive statistics. Results: A total of 572 pregnant women participated in this survey. Three hundred and fifteen (55.1%) knew that 1st primary tooth erupts at the age of 6 months. The majority of the respondents (n=332) agreed that toothbrushes and toothpaste could be used to clean a child's teeth; only 5.4%, 10%, and 24.5% preferred miswak, mouthwash, and toothbrush, respectively. Participants were well familiar with cariogenic food and occasionally allowed their children to take it. They have enough knowledge about fluoride toothpaste, but they were not familiar with the benefits of fluoride varnish. Almost 50% of the respondents agreed that the child should visit the dentist within six months, and 27.4% said they should visit the dentist whenever there is a problem. Conclusion: Almost 50% of participants showed a positive attitude towards most questions. However, there is a need to improve their behaviour and knowledge about many aspects of dental care.

Optimizing gentamicin dosing in different pediatric age groups using population pharmacokinetics and Monte Carlo simulation.

INTRODUCTION: The use of once daily dosing of aminoglycosides in pediatrics is increasing but studies on dose optimization targeting the pediatric population are limited. This study aimed to derive a population pharmacokinetic model of gentamicin and apply it to design optimal dosing regimens in pediatrics. METHODS: Population pharmacokinetics of gentamicin in pediatrics was described from a retrospective chart review of plasma gentamicin concentration data (peak/ trough levels) of pediatric patients (1 month - 12 years), admitted to non-critically ill pediatrics. Monte Carlo simulations were performed on the resulting pharmacokinetic model to assess the probability of achieving a Cmax/MIC target of 10 mg/L over a range of gentamicin MICs of 0.5-2 mg/L and once daily gentamicin dosing regimens. RESULTS: A two-compartment model with additive residual error best described the model with weight incorporated as a significant covariate for both clearance and volume of distribution. Monte Carlo simulations demonstrated a good probability of target attainment even at a MIC of 2 mg/L, where neonates required doses of 6-7 mg/kg/day and older pediatrics required lower daily doses of 4-5 mg/kg/day while maintaining trough gentamicin concentration below the toxicity limit of 1 mg/L. CONCLUSION: Once daily dosing is a reasonable option in pediatrics that allows target attainment while maintaining trough gentamicin level below the limits of toxicity.