Demaghi, a polyherbal formulation, mitigates aluminum chloride-induced neurological impairment in mice: Insights from phytochemical analysis and behavioral assessment.

Herbal products have been very popular in Pakistan for their curative significance against various disorders. Demaghi (DEMG) is a widely used herbal product claimed to own natural substances having neuroprotective potential. The current study aims to scientifically validate the chemical composition as well as its neuroprotective claims of this widely used herbal tonic. The commercially available Demaghi product was chemically characterized for its phytocomposition. The mice were treated with two doses of Demaghi (DEMG 50 mg and 100 mg/kg/day), and the effects of its prolonged exposure on animal anxiety, memory, and depression were noted through a series of behavioral tests in the AlCl3-induced memory deficient mice model. Besides that, dissected brains were biochemically analyzed for oxidative stress markers and acetylcholinesterase activity, as well as histopathological changes. The study outcomes showed that DEMG (100 mg/kg/day) has prominent anti-anxiety effects, memory-enhancing properties, and anti-depressants effects observed in the AlCl3-induced memory-deficient mice model. Biochemical assays also showed a greater decrease in oxidative stress of tested animals treated with 100 mg/kg/day of DEMG. The histopathological analysis also revealed that administration of DEMG reduced the AlCl3-induced toxicity. UPLC-MS results revealed the presence of many phytoconstituents, which showed to support cholinergic signaling in in-silico studies. The current research validates the neurological benefits of Demaghi for memory-boosting properties. The phytocompounds present in Demaghi exert neuroprotective effects, possibly by enhancing the cholinergic neurotransmission and combating the neurotoxin-induced oxidative stress.

Assessment of 222Rn, 226Ra, 238U, 218Po, and 214Po activity concentrations in the blood samples of workers at selected building material factories in Erbil City.

The objective of this research is to assess the impact of radon concentration on workers at certain construction material industries in Erbil, Kurdistan Region of Iraq. The CR-39 solid-state track detector was used in this experiment to monitor radon levels and their daughters. For this purpose, as a case study group, 70 workers were divided into seven subgroups (gypsum, cement plant, lightweight block, marble, red brick 1, crusher stone, and concrete block 2), and 20 healthy volunteers were selected as a control group. The findings demonstrate that the mean concentrations of radon, radium, uranium, and radon daughters deposited on the detector face (POS) and chamber walls (POW) for the case study group were 9.61 ± 1.52 Bq/m3, 0.33 ± 0.05 Bq/Kg, 5.39 ± 0.86 mBq/Kg, 4 ± 0.63, and 16.62 ± 2.64 mBq/m3, whereas for the control group, they were 3.39 ± 0.58 Bq/m3, 0.117 ± 0.03 Bq/Kg, 1.91 ± 0.32 mBq/Kg, 1.41 ± 0.24, and 5.88 ± 1 mBq/m3, respectively. The statistical analysis revealed that radon, radium, uranium, and POW and POS concentrations were statistically significant (p ≤ 0.001) in the samples for the case study groups of cement, lightweight block, red brick 1, marble, and crusher stone factories in comparison to the control group; however, the results for gypsum and concrete block 2 factories were not statistically significant in comparison to the control group. Intriguingly, the radon levels in every blood sample examined were far lower than the 200 Bq/m3 limit established by the International Atomic Energy Agency. Hence, it may be argued that the blood is devoid of contaminants. These results are crucial for determining whether or not an individual is exposed to substantial quantities of radiation and for demonstrating a link between radon, its daughter, uranium, and the prevalence of cancer among workers in the Kurdish region of Iraq.

Natural radioactivity and radiological risk assessment due to building materials commonly used in Erbil city, Kurdistan region, Iraq.

Radiometric monitoring of construction materials is required for estimating the interior and exterior exposure to ionizing radiation emitted by terrestrial radioactive elements in building materials. Using gamma-ray spectroscopy, the activity concentrations of 226Ra, 232Th, and 40 K in fifty-two samples from eighteen different building materials commonly used in Erbil city, Kurdistan region, Iraq, were evaluated to assess possible radioactive dangers to human health. The activity concentrations of 226Ra, 232Th and 40 K ranged from 1 ± 0.1 (gypsum board) to 130 ± 11 (granite), 1.3 ± 0.2 (gypsum) to 66 ± 8 (ceramic sample), and 18.74 ± 4 (gypsum) to 1061.708 ± 40 (granite) with an average of 28 ± 5, 20.7 ± 4, and 340.8 ± 18 (average ± standard deviation), respectively. Radiological indicators (activity concentration index, alpha and gamma index, hazard indices, interior absorbed gamma dose rate and the corresponding yearly effective dosage rate, and excess lifetime cancer risk) were computed to assess the health risks associated with these building materials. Consideration was given to the indoor annual effective dosage for common construction materials, the radon surface expiration rate, and the indoor radon concentration. The mean values of activity concentration were then inputted into the RESRAD-BUILD computer software to calculate a resident's long-term radiation exposure. The dosages were measured over a range of 0 to 70 years. From 0 to 30 years, there was a significant change in dosages; however, from 30 to 70 years, the dosages were reasonably consistent. This research demonstrates that granite samples are not safe for dwellings with poor ventilation (especially those without windows). In general, other investigated construction materials in the buildings are deemed safe for the population, since the computed values for these parameters fall within the well-being restrictions or criterion values.

Real-time artificial intelligence based health monitoring, diagnosing and environmental control system for COVID-19 patients.

By upgrading medical facilities with internet of things (IoT), early researchers have produced positive results. Isolated COVID-19 patients in remote areas, where patients are not able to approach a doctor for the detection of routine parameters, are now getting feasible. The doctors and families will be able to track the patient's health outside of the hospital utilizing sensors, cloud storage, data transmission, and IoT mobile applications. The main purpose of the proposed research-based project is to develop a remote health surveillance system utilizing local sensors. The proposed system also provides GSM messages, live location, and send email to the doctor during emergency conditions. Based on artificial intelligence (AI), a feedback action is taken in case of the absence of a doctor, where an automatic injection system injects the dose into the patient's body during an emergency. The significant parameters catering to our project are limited to ECG monitoring, SpO2 level detection, body temperature, and pulse rate measurement. Some parameters will be remotely shown to the doctor via the Blynk application in case of any abrupt change in the parameters. If the doctor is not available, the IoT system will send the location to the emergency team and relatives. In severe conditions, an AI-based system will analyze the parameters and injects the dose.

Gender Differences in Smoking Attitude among Saudi Medical Students.

BACKGROUND: Smoking is a growing public health problem throughout the world. However, the attitude of males and females toward smoking may differ. Therefore, this study examines gender differences in smoking behavior and attitude among Saudi medical students. METHODS: From January 2020 to August 2020, a snowball cross-sectional online survey was conducted in five major regions of Saudi Arabia. Medical students (18 years or older) were invited to respond to the questionnaire. RESULTS: Out of the 421 respondents, 255 (60.6%) were female, 243 (57.7%) were between 18 and-24-year-old, and 164 (39%) were from the Eastern Province. The overall prevalence of smoking was 25.4% and was higher among males than females [(44% and 13.3%, respectively), P < 0.001]. However, there was no significant difference in the mean score of the overall attitude towards smoking between males and females [(3.02±0.44 and 3.00±0.34), respectively, P=0.64]. However, more female students believed e-cigarettes were harmful to health than male students [(4.19±1.04 and 4.45±0.9), respectively, P=0.002]. CONCLUSION: The study showed that male students smoke more than female students, and there were no significant differences in the overall attitudes score towards smoking. Therefore, campaigns are needed to decrease smoking rate, especially among male students.

Cost-efficient service selection and execution and blockchain-enabled serverless network for internet of medical things.

These days, healthcare applications on the Internet of Medical Things (IoMT) network have been growing to deal with different diseases via different sensors. These healthcare sensors are connecting to the various healthcare fog servers. The hospitals are geographically distributed and offer different services to the patients from any ubiquitous network. However, due to the full offloading of data to the insecure servers, two main challenges exist in the IoMT network. (i) Data security of workflows healthcare applications between different fog healthcare nodes. (ii) The cost-efficient and QoS efficient scheduling of healthcare applications in the IoMT system. This paper devises the Cost-Efficient Service Selection and Execution and Blockchain-Enabled Serverless Network for Internet of Medical Things system. The goal is to choose cost-efficient services and schedule all tasks based on their QoS and minimum execution cost. Simulation results show that the proposed outperform all existing schemes regarding data security, validation by 10%, and cost of application execution by 33% in IoMT.

Variations in perceived stress among Syrian refugee parents resettled through different sponsorship programs in Canada.

BACKGROUND: Little is known about the perceived stress level of Syrian Refugee (SR) parents residing in Canada specifically in relation to different sponsorship programs. This study aims to assess the relationship between the different sponsorship programs [Government-Assisted Refugees (GAR), Privately Sponsored Refugees (PSR) and Blended Visa Office-Referred refugees (BVOR)] and perceived stress among SR parents, with at least one child under the age of four, who resettled in the Greater Toronto area after 2015. METHODS: A convenience sample of 155 Syrian Refugee (SR) parents was recruited. Perceived levels of stress were measured using the Perceived Stress Scale (PSS-10). Multiple linear regression analysis was performed to assess the independent relation between several types of sponsorship programs and PSS adjusting for demographic, economic and social factors. RESULTS: The overall average PSS score was found to be 12.5 ± 7.2 with BVORs presenting the highest level of moderate stress when compared to GARs and PSRs (75.0% compared to 39.5% and 35.2% respectively). Multivariate analysis showed that the mean PSS was significantly higher among BVORs when compared with GARs (Adj ß = 4.8; 95% CI 0.4, 9.2). No significant difference in PSS levels was reported when PSRs were compered to GARs. Increased PSS scores were found to be associated with worse family functioning (Adj ß = 4.2; 95% CI 1.0, 7.4), while decreased PSS scores were associated with increased age (Adj ß = -0.4; 95% CI -0.6, -0.1). CONCLUSION: A better understanding of the various underlying factors associated with elevated stress is essential for improving the quality of life for SRs in Canada. Results of the study may help tailor more effective preventative measures or government interventions dedicated to reducing stress levels among this population.

Antifouling paint biocides (Irgarol 1051 and diuron) in the selected ports of Peninsular Malaysia: occurrence, seasonal variation, and ecological risk assessment.

Irgarol 1051 and diuron are photosystem II inhibitors in agricultural activities and antifouling paints in the shipping sector. This study focused on three major ports (western, southern, and eastern) surrounding Peninsular Malaysia to construct the distribution of both biocides on the basis of the seasonal and geographical changes. Surface seawater samples were collected from November 2011 to April 2012 and pretreated using the solid-phase extraction technique followed by quantification with GC-MS and LC-MS-MS for Irgarol 1051 and diuron, respectively. Generally, the distribution of Irgarol 1051 was lowest during November 2011 and highest during April 2012, and similar patterns were observed at all ports, whereas the distribution of diuron was rather vague. The increasing pattern of Irgarol 1051 from time to time is probably related to its accumulation in the seawater as a result of its half-life and consistent utilization. On the basis of the discriminant analysis, the temporal distribution of Irgarol 1051 varied at Klang North Port, Klang South Port, and Pasir Gudang Port, whereas diuron was temporally varied only at Kemaman Port. Furthermore, Irgarol 1051 was spatially varied during November 2011, whereas diuron did not show any significant changes throughout all sampling periods. Ecological risk assessment exhibited a high risk for diuron and Irgarol 1051, but Irgarol 1051 should be of greater concern because of its higher risk compared to that of diuron. Thus, it is recommended that the current Malaysian guidelines and regulations of biocide application should be reevaluated and improved to protect the ecosystem, as well as to prevent ecological risks to the aquatic environment.

Impact of the Low-Price Medicine Policy on Medicine Supply in China: An Interrupted Time-Series Analysis.

Objectives: The primary objective of the study was to assess the impact of the Low-Price Medicine Policy (LPMP) on the supply of low-price medicines (LPMs) in China. The secondary objective of the study was to describe the supply situation of LPMs from 2005 to 2018. Methods: The LPMP was launched in the third quarter of 2014 (2014Q3). An interrupted time series analysis was used to evaluate the impact of LPMP on the supply of LPMs in China. Ordinary least squares and Poisson regression models were utilized to estimate the effect of LPMP on LPMs' supply growth rate and the number of supplied LPMs. All the LPMs were divided into two subgroups: intermittent supply and continuous supply. The trend and level changes of the quarterly average growth rate and number of quarterly supplies for different LPM groups were analyzed from 2005 to 2018. Findings: For the quarterly average growth rate, before the intervention, a significant increasing trend was observed in the total group and the continuous supply subgroup; after the introduction of LPMP, the increasing trend was ceased and a significant decrease in the trend and level was noted for both the total group (trend coefficient: ß 3 = -0.0132, p < 0.01; level coefficient: ß 2 = -0.1510, p < 0.05) and the continuous supply subgroup (trend coefficient: ß 3 = -0.0133, p < 0.01; level coefficient: ß 2 = -0.1520, p < 0.05); whereas it had no significant effect for intermittent supply subgroup. For the number of quarterly supplies, after the intervention of LPMP, decline of the supply number was observed (trend coefficient: ß 3 = -0.0027, p < 0.001; level coefficient: ß 2 = -0.0584, p < 0.001); whereas the LPMP was associated with an upward trend and level (trend coefficient: ß 3 = 0.0715, p < 0.001; level coefficient: ß 2 = 0.174) for the intermittent supply subgroup. Conclusion: For most of the LPMs, LPMP did not meet the goal of stimulating LPM production. However, for severely shortage medicines (the intermittent supply subgroup), the effect of LPMP was positive. Comprehensive policies rather than just deregulating medicine price should be introduced to alleviate the situation of medicine shortage in China.

Comparative Physicochemical Evaluation of Starch Extracted from Pearl millet seeds grown in Sudan as a Pharmaceutical Excipient against Maize and Potato Starch, using Paracetamol as a model drug.

OBJECTIVES: The aim of the current study was to compare the physicochemical and disintegrant properties of pearl millet starch with other starches using paracetamol as model drug. METHODOLOGY: Determination of percentage yield, Physicochemical, micrometrics characteristics of starch/granules, drug excipients compatibility studies and evaluation of prepared paracetamol tablets were measured using official techniques. RESULTS: The yield of the millet starch ranged from 30 to 40%. Moisture content 8.77%, pH 5.7, Swelling capacity 1.2, Hydration capacity 1.748, Moisture uptake 11.8%, Amylose 24.6%, with poor flowability and compressibility. No significant difference in hardness, friability% & disintegration times for formulations containing millet starch to that containing potato and maize starch (P>0.05). CONCLUSION: From the study, Millet seeds locally cultivated in Sudan gave a high yield of starch, has same physicochemical properties as maize and potato starch so can be used as an alternative to those starches.

Internet non-use among Canadian indigenous older adults: Aboriginal Peoples Survey (APS).

BACKGROUND: Older adults benefit considerably from Internet use, as it can improve their overall health and quality of life, for example through accessing healthcare services and reducing social isolation. The aim of this study is to assess the prevalence and characteristics of Indigenous older adults in Canada who do not use the Internet. METHODS: The Aboriginal Peoples Survey (APS) 2017 was used and analysis was restricted to those above 65 years of age. The main outcome variable was non-use of the internet in a typical month. Multivariable logistic regression was conducted to assess the relationship between each of the sociodemographic, socioeconomic, lifestyle and health factors and internet non-use. RESULTS: The prevalence of Indigenous older adults who reported never using the Internet in a typical month was 33.6% with the highest prevalence reported by residents of the Canadian territories while the lowest prevalence was reported in British Columbia. After adjustment, results indicated that older age (OR = 4.02, 95% CI 3.54-4.57 comparing 80+ to 65-69 years of age), being a male (OR = 1.52, 95% CI 1.41-1.63), married (OR = 1.34, 95% CI 1.25-1.44), and living in rural areas (OR = 1.95, 95% CI 1.79-2.13) increased the odds of not using the Internet. First Nation individuals and those who have a strong sense of belonging to the Indigenous identity were more likely to not use the Internet compared to their counterparts. In addition, those who were less educated (OR = 8.74, 95% CI 7.03-1 0.87 comparing less than secondary education to Bachelor's Degree and above), unemployed (OR = 1.41, 95% CI 1.26-1.57), smoked cigarettes, used marijuana and those with lower self-perceived mental health and unmet health needs were at increased odds of Internet non-use compared to their counterparts. CONCLUSIONS: Findings from this study show that a large proportion of the Indigenous older adults in Canada do not use the internet. It is necessary to address Indigenous communities' lack of internet access and to create interventions that are consistent with Indigenous values, traditions, and goals.

Impact of National Drug Pricing Policy 2018 on access to medicines in Lahore division, Pakistan: a pre-post survey study using WHO/HAI methodology.

OBJECTIVE: To evaluate the impact of new National Drug Pricing Policy (NDPP) 2018 on access to medicines in terms of prices, availability and affordability. DESIGN: Two cross-sectional surveys were undertaken before and after the launch of NDPP 2018, using a modified WHO/Health Action International (WHO/HAI) methodology. SETTING: Four districts of Lahore division, Pakistan. PARTICIPANTS: 16 public sector hospitals and 16 private sector retail pharmacies. MEASURES: The pre and post survey data on prices and availability of lowest price generics (LPGs) and originator brands (OBs) of 50 medicines were obtained by visiting the same public and private sector health facilities (n=32). Out of 50, 46 surveyed medicines were from the National Essential Medicines List. Inflation-adjusted median unit prices (MUPs) and median price ratios (MPRs) from 2019 were used for price comparison. Affordability was calculated in terms of number of days' wages required to get a standard treatment by the lowest paid unskilled government worker. RESULTS: The overall mean percent availabilities remained poor in both years, that is, far less than 80%. In the public sector, the mean percent availability of OBs improved from 6.8% to 33.1%, whereas, in the case of LPGs, it was reduced from 35.1% to 9%. In the private sector, the mean percent availability of both OBs and LPGs demonstrated slight improvements in 2019, that is, 55.0%-58.3% and 20.3%-32.3%. The adjusted MUPs and MPRs of OBs significantly increased by a median of 4.29% (Wilcoxon test p=0.001, p=0.0001), whereas the adjusted MUPs and MPRs of LPGs increased by a median of 15.7% (p=0.002, p=0.0002). Overall, the affordability of many medicines for common ailments was reduced significantly in 2019. CONCLUSIONS: The availability of medicines slightly improved, except in the case of LPGs, which was reduced in the public sector. The implementation of NDPP 2018 led to increase in drug prices, making the standard treatment for some of the most prevalent ailments unaffordable. So verily, the drug pricing policy must be reviewed to ensure access to essential medicines.

Assessment of Hospital Rooming-in Practice in Abu Dhabi, United Arab Emirates: A Cross-Sectional Multi-Center Study.

The World Health Organization (WHO) recommends rooming-in to reduce infant mortality rates. Little research has been done to assess practices such as rooming-in and its relation to breastfeeding in the United Arab Emirates (UAE). The aim of this study was to examine the prevalence of rooming-in during hospital stay among mothers with infants six months old and below, in addition to other associated factors in Abu Dhabi, UAE. This study utilized a sub-sample extracted from a dataset based on a convenience sample of mothers who were recruited from governmental maternal and child health centers as well as from the community. The purpose of the original research was to evaluate infant and young children's feeding practices. A pre-tested questionnaire was used during interviews with mothers once ethical clearance was in place. Multivariable logistic regression was conducted to describe the results. The original sample included 1822 participants, of which 804 infants met the inclusion criteria. The mean age for mothers and infants was 30.3 years and 3.5 months, respectively. The rate of rooming-in during hospital stay was 97.5%. Multivariable logistic regression analysis indicated factors associated with not rooming-in were low maternal age (Adjusted Odds Ratios (AOR) = 1.15, 95% confidence interval (CI): 1.03, 1.30), low gestational age (GA) (AOR = 1.90, 95% CI: 1.52, 2.36), abnormal pre-pregnancy body mass index (BMI) (AOR = 3.77, 95 % CI: 1.22, 11.76), and delayed initiation of breastfeeding (AOR = 4.47, 95 % CI: 1.08, 18.48). In the context of the high rate of rooming-in revealed in this study, there should be a focus on those groups who do not room-in (i.e., younger women and those with babies of a younger gestational age). Rooming-in practice provides self-confidence in taking care of a baby, knowledge about breastfeeding, and stimulates early-phase lactation.

Evaluation of Disaster Medicine Preparedness among Healthcare Profession Students: A Cross-Sectional Study in Pakistan.

Background: Disasters are devastating incidents, especially when occurring suddenly and causing damage, great loss of life, or suffering. Disasters can affect health and the social and economic development of a nation. The article analyzes the knowledge (K), attitude (A), and readiness to practice (rP) of healthcare professional students in universities in Pakistan. Methods: We carried out a cross-sectional study using a pretested and validated self-administered disaster medicine and preparedness questionnaire. The study recruited 310 students. Responses were scored and categorized as high (75th quartile), moderate (75-25th quartiles), and low (25th quartile). Independent t-test, one-way ANOVA, Pearson correlation, and regression analyses were performed at an alpha level of 0.05. Results: The study found that most of the students had moderate knowledge, attitude, readiness to practice, and total KArP scores. All K, A, and rP scores were significantly correlated with overall KArP scores. Knowledge and attitude factors were significant predictors of readiness to practice. Conclusions: We strongly believe that educators and health policymakers should build a strong curriculum in disaster medicine management and preparedness to prepare competent future healthcare professionals for the nation.

Prevalence and Factors Associated with Visiting the Dentist Only for Emergency Care Among Indigenous People in Ontario.

Ontario has the largest Indigenous population in Canada. This study aims to examine the prevalence and factors associated with poor dental care use amongst the Indigenous in Ontario. Data from the 2014 cycle of the Canadian Community Health Survey was used. The main outcome was defined as visiting the dentist only for emergency care. Stepwise multivariable logistic regression was performed to assess the association between socio-demographic, socio-economic, and the health related factors and emergency dental care use. 28% of the participants reported visiting the dentist only for emergencies. First Nations people were at increased odds of having poor dental care (OR 2.01, CI 1.12-3.95). Additionally, being male, a smoker, having fair/poor health and lacking dental insurance puts the Indigenous Ontarians at increased odds of having the outcome. Improvements to the current social benefit programs could help better cater to the needs of this population.

Access to Essential Cardiovascular Medicines in Pakistan: A National Survey on the Availability, Price, and Affordability, Using WHO/HAI Methodology.

Objective: This national survey was aimed at measuring the access to cardiovascular disease (CVD) medicines in terms of their availability, price, and affordability in Pakistan. This was done by using the standard WHO/Health Action International (HAI) methodology. Methods: The price and availability data for 18 CVD medicines were collected from public sector hospitals (n = 40) and private sector retail pharmacies (n = 40) in eight cities of Pakistan. The outcome measures were availability (calculated as percentage of health facilities stocked with listed medicines), medicine price to the international reference price ratio (i.e., median price ratio (MPR)), and affordability (calculated as number of days' wages (NDWs) of the lowest paid unskilled government worker required to afford one-month treatment of a chronic disease). The affordability of standard treatment in Pakistan with four CVD drugs was compared with data from six other low and middle income countries (LMICs) using HAI database. Findings: The mean percent availability of CVD medicines was significantly low (p < 0.001) in the public sector as compared to the private sector, that is, 25.5% vs. 54.6% for originator brands (OBs) and 30.4% vs. 34.9% for lowest price generics (LPGs), respectively. For all OBs and LPGs, the inflation-adjusted mean MPR was 2.72 and 1, respectively. CVD medicines were found to be unaffordable with average NDWs of 6.4 and 2.2 for OBs and LPGs, respectively, that is, NDWs of more than 1. In international comparison with countries such as Sudan, Lebanon, Egypt, India, Afghanistan, and China, the affordability of standard treatment with selected CVD medicines (atenolol, amlodipine, captopril, and simvastatin) in Pakistan was found to be low. Overall, all four OBs and three out of four LPGs of selected CVD drugs were found unaffordable in Pakistan. Conclusion: This data indicated that the availability of selected CVD medicines was low in both public and private sector medicine outlets. Both OBs and LPGs were found unaffordable in the private sector, necessitating the redressal of pricing policies, structuring, and their implementation.

Skill and knowledge retention after training in cardiopulmonary ultrasound in Ghana: an impact assessment of bedside ultrasound training in a resource-limited setting.

OBJECTIVE: Brief training courses in bedside ultrasound are commonly done by visiting faculty in low-income and middle-income countries, and positive short-term effects have been reported. Long-term outcomes are poorly understood. We held a training course on a cardiopulmonary ultrasound (CPUS) protocol over two separate 10-day periods in 2016. In 2017, 9-11 months after the initial training, we assessed skill and knowledge retention as well as perceived impact on local practice. METHODS: A written test using six clinical vignettes and an observed structured clinical examination were used to assess theoretical knowledge and practical skills. Additionally, in-person interviews and a written survey were completed with the physicians who had participated in the initial training. RESULTS: All 20 participants passed the written and clinical examination. The median follow-up test score was 10 out of 12, compared with a median score of 12 on a test completed immediately after the initial training. Physicians identified the ability to narrow their differential diagnosis and to initiate critical interventions earlier than without ultrasound as a key benefit of the CPUS training. They rated the cardiac, abdominal and inferior vena cava components of the CPUS protocol as most relevant to their everyday practice. CONCLUSION: Long-term ultrasound knowledge and skill retention was high after a brief and intensive training intervention at an academic tertiary hospital in Ghana. Clinicians reported improvements in patient care and local practice patterns.

Direct and indirect cost of diabetes care among patients with type 2 diabetes in private clinics: a multicenter study in Punjab, Pakistan.

BACKGROUND: Diabetes mellitus (DM) has a very high prevalence and poses a huge financial encumbrance on patients. This study aimed to evaluate the cost of diabetes care among patients with type 2 diabetes in private clinics of southern Punjab, Pakistan. RESEARCH DESIGN AND METHODS: This was a descriptive, cross-sectional, prevalence-based, cost-of-illness (COI) study conducted in six private clinics of southern Punjab from July to September 2016, using a pretested questionnaire. Study participants were recruited using a random selection method. Continuous variables, including direct and indirect costs, were summarized using descriptive statistics. Inferential statistics were also used to analyze the correlation between the variables and cost. RESULTS: The mean annual direct cost per patient with diabetes was estimated to be 332 USD. Medications accounted for the largest share (60.4%) of this cost. Age, locality, high socioeconomic status, and prolonged disease duration were significantly associated with the direct costs of illness (p < 0.05). Moreover, 19% of total earnings among very low-income patients were spent on diabetes care. CONCLUSIONS: A substantial proportion of patients' income is spent on diabetes care in Punjab. Our findings support the substantial individual and societal burden caused by diabetes.

Development of a novel and cost-effective redox sensor for voltammetric determination of pantoprazole sodium during pharmacokinetic studies.

A pencil graphite electrode modified with poly (bromocresol green (BCG)) was prepared by electro-polymerization process for the determination of pantoprazole sodium. The surface morphology and structure of poly (BCG) film were characterized by scanning electron microscopy and Fourier transform infrared spectroscopy. The determination of pantoprazole sodium in Britton-Robinson buffer (pH 7.0) was carried out by square wave adsorptive stripping voltammetric technique. Under optimum conditions, the linear response of the peak with concentration of the cited drug was in the range of 6.6-360 × 10-8 M with limit of detection of 2.2 × 10-8 M. Moreover, the poly (BCG)-modified electrode has been successfully applied to determine pantoprazole sodium in tablets, vials and during pharmacokinetic studies.

Sonographic Evaluation of Internal Jugular Vein Diameter and Cross-sectional Area Measurements in Correlation with Left Ventricular End Diastolic Area as a Tool for Perioperative Assessment of Volume Status in Pediatric Patients Undergoing Cardiac Surgery.

AIM: The aim of this study is to compare the ultrasound estimation of the cross-sectional area (CSA) and diameter of internal jugular vein (IJV) with left ventricular end diastolic area (LVEDA) for the assessment of intravascular volume in pediatric patients during cardiac surgery. PATIENTS AND METHODS: The CSA and diameter of the left IJV were defined, using ultrasound machine, and compared with LVEDA, estimated by transesophageal echo, in four times intervals (immediately after induction [T1], before the start of cardiopulmonary bypass [CPB] [T2], immediately after weaning of CPB [T3], and at the end of surgery before transfer to the Intensive Care Unit [T4]) as a tool for intravascular volume assessment in 16 pediatric patients undergoing cardiac surgery. RESULTS: There was a poor correlation between IJV CSA and diameter with LVEDA. r values were 0.158, 0.265, 0.449, and 0.201 at the four time intervals (T1, T2, T3, and T4), respectively. CONCLUSION: Estimation of the CSA and diameter of the left IJV using ultrasound is not reliable and cannot be used alone to decide further management.