Review on NAD(P)H dehydrogenase quinone 1 (NQO1) pathway.

NQO1 is an enzyme present in humans which is encoded by NQO1 gene. It is a protective antioxidant agent, versatile cytoprotective agent and regulates the oxidative stresses of chromatin binding proteins for DNA damage in cancer cells. The oxidization of cellular pyridine nucleotides causes structural alterations to NQO1 and changes in its capacity to binding of proteins. A strategy based on NQO1 to have protective effect against cancer was developed by organic components to enhance NQO1 expression. The quinone derivative compounds like mitomycin C, RH1, E09 (Apaziquone) and ß-lapachone causes cell death by NQO1 reduction of two electrons. It was also known to be overexpressed in various tumor cells of breast, lung, cervix, pancreas and colon when it was compared with normal cells in humans. The mechanism of NQO1 by the reduction of FAD by NADPH to form FADH2 is by two ways to inhibit cancer cell development such as suppression of carcinogenic metabolic activation and prevention of carcinogen formation. The NQO1 exhibit suppression of chemical-mediated carcinogenesis by various properties of NQO1 which includes, detoxification of quinone scavenger of superoxide anion radical, antioxidant enzyme, protein stabilizer. This review outlines the NQO1 structure, mechanism of action to inhibit the cancer cell, functions of NQO1 against oxidative stress, drugs acting on NQO1 pathways, clinical significance.

Efficacy of Rotary and Hand Instrument in removing Gutta-percha and Sealer from Root Canals of Endodontically Treated Teeth.

AIM: One of the common dental procedures employed these days in patients with irreversible pulpitis is root canal therapy. In retreatment cases, it is necessary for complete removal of obturate gutta-percha (GP) from obturate root canal system. Various methods and techniques are available these days for this purpose. This study was aimed to assess the efficacy of D-RaCe files, ProTaper retreatment files, Mtwo retreatment files, and manual Hedstrom files (H-files) in removing filling materials from the root canals of the endodontically treated teeth. MATERIALS AND METHODS: The present study included comparative evaluation of efficacy of nickel-titanium (NiTi) retreatment instruments and H-files in removing GP and sealer from root canals. All the samples were randomly and broadly divided into four study groups based on the instrumentation technique for removing the root canal fillings. Evaluation of the results was done based on operating time and remaining root canal filling material. Stereomicroscopic evaluation of the samples was done at 8* magnification. RESULTS: All the results were assessed and analyzed by Statistical Package for the Social Sciences (SPSS) software. Least quantity of filling material was left by ProTaper retreatment files. When put together in decreasing order, the efficacy of different study groups, in terms of mean time taken for retreatment, was found to be as follows: D-RaCe > ProTaper Retreatment > Mtwo Retreatment > H-file. CONCLUSION: No single technique can completely remove obturating fillings from the root canals of endodontically treated teeth. However, rotary instruments are better in comparison with hand instruments for removing the GP from obturate root canals. CLINICAL SIGNIFICANCE: ProTaper retreatment files and D-RaCe files are recommended over other instrument systems in terms of quality for managing retreatment root canal cases.

Dapsone for immune thrombocytopenic purpura in children and adults.

Dapsone is one of the second line treatments of immune thrombocytopenic purpura (ITP). Dapsone is cheap and has response rates comparable to other second line treatment options like azathioprine, danazol, cyclophosphamide, cyclosporine, and vincristine. This retrospective analysis includes 38 patients (out of total 313 patients) of ITP treated with dapsone from 2004 to 2012. All male patients were screened for G6PD deficiency before starting dapsone. Out of 38 patients (12 children and 26 adults), one was newly diagnosed ITP, seven were persistent ITP, and 30 were chronic ITP. Five patients had side effects of dapsone; two required discontinuation due to skin rashes. The average dose of dapsone was 1.57 mg/kg/day and time to response was 57 days (19-108 days). The response was irrespective of previous treatments and response to them. The response rate was 48.6% (complete response = 40.5%). Only two adult patients had sustained response (> 6 months) after dapsone discontinuation. There were no predictors identified for dapsone response. Dapsone is a safe and cheap second-line therapy for ITP with a response rate of about 50% (majority being CR). A response to dapsone is slow, sustained, and relapses are uncommon on therapy. Dapsone withdrawal leads to relapse in most of the patients.

Retrograde intrarenal surgery with central neuraxial blockade versus general anesthesia: A systematic review and meta-analysis.

Objective: The aim of the article is to assess the impact of retrograde intrarenal surgery under central neuraxial blockade in comparison to general anesthesia (GA). Material and Methodology: This systematic review was conducted following the guidelines set out by the preferred reporting items for systematic reviews and meta-analyses. We conducted a comprehensive search across major electronic databases, including various types of studies such as descriptive studies and full-text literature, all of which were incorporated into the current review from 2018 to 2023. We involved those studies, which included the comparative study of spinal anesthesia (SA), epidural anesthesia (EA), and combined spinal epidural anesthesia with GA. Result: In our meta-analysis of 12 studies, it was found that anesthesia technique significantly affected operation time, with neuraxial anesthesia (NA) showing a mean difference of -2.28 (95% confidence interval (CI): -3.5 to -1.04, P = 0.003) compared to GA. However, there were no significant differences in rates of stone clearance, 24-h pain scores and length of hospital stay among patients administered with NA or GA for retrograde intrarenal surgery (RIRS). Conclusion: On the basis of the outcomes of study, NA can serve as a viable alternative to GA for RIRS. Our analysis reveals no significant differences in rates of stone clearance, operation duration, 24-h pain scores, complication rates, and length of hospital stay between NA in addition to GA in the context of RIRS. This suggests that given the potential economic advantages, NA might be a preferable choice over GA, contingent on patient preferences, baseline characteristics, and stone burden.

Knowledge of ocular infections among the dental practitioners across India: a cross sectional survey.

BACKGROUND: Ocular issues such as impaired vision, ophthalmia, orbital cellulitis, and blindness are not common with dental infections. However, there is absence of set guidelines in prevention and management of ocular issues arising from dental infections. Hence the knowledge and vantage point of the dentists with respect to ocular complications arising from dental infections was evaluated. OBJECTIVE: This study reviews the knowledge of dentists with association of eye infection due to dental contamination. METHOD: A cross sectional survey using standardized questionnaires were sent suing social media platform among the academicians and practicing dental clinicians. All the questionnaires were content validated by three ophthalmologists. Descriptive statistics was scrutinized and tabulated by employing the Statistical Package for Social Sciences (SPSS), version 17 (SPSS Inc., Chicago IL). Chi square tests was used. RESULTS: About 69.1%(65) and 30.9%( 29) of BDS and MDS grduates have experienced ocular complications because of dental contamination. This distribution showed no statistical significance (p = 0.25). 73.8% (183) and 28.2%( 65) had compliance with the eye protection, 77.7% (160) of BDS graduates and 22.3% (46) of MDS graduates preferred safety eye wear. This distribution showed statistical significance (p = 0.00). About 76.2% (279) of BDS graduates and 23.8%( 67) of MDS graduates faced ocular infections because of different types of splashes which included water, blood and saliva. (p = 0.23) CONCLUSION: This study puts an emphasis on the knowledge assessment among the dental practitioners on the importance of preventive barriers, and how special protective gear is required for doing cases undergoing dental treatment.

Gender Identification by Fingerprint Pattern and Salivary Blood Group Antigen Expression: A Forensic Approach.

Introduction Fingerprints found at the crime scene are important and valuable evidence, as they are unique to every individual. Determining the blood group from the blood samples obtained at the site of the crime helps in identifying a person. However, where blood stains are not available, saliva obtained at the crime site can be used to identify the victim. Since fingerprint patterns and blood groups are unique to every individual and remain unchanged throughout life, the correlation between dermatoglyphics and blood groups can be of use in victim identification. Objectives The present study is conducted with the objective of finding out if there is any association between the distribution of fingerprint patterns and blood groups and if this association is of use in gender identification. Materials and method Fingerprint patterns were determined in 200 (females: n = 152, males: n = 48) dental undergraduate students in the age range of 18 to 24 years. ABO blood grouping was done on saliva by using the absorption-elution method. To determine the accuracy of ABO blood group determination using saliva, it was correlated with the ABO blood grouping in blood.  Observations and result The most common fingerprint pattern was found to be loops (87, 43.50%), followed by whorls (81, 40.50%) and arches (32, 16.00%). The most common blood group was B (68, 34%), followed by O (46, 23%) and A (42, 21%), and the least common was AB (12, 6%). A higher percentage of secretors in saliva was observed in females (130, 86%) than males (38, 79%). The correlation of gender with blood group and fingerprint pattern showed that in males, the most common blood group was B (20, 42%), and the most common fingerprint pattern was whorls (21, 44%). In females, the most common blood group was B (48, 32%), while the most common fingerprint pattern was loop (68, 45%). Conclusion Present study reports an association between blood group and dermatoglyphics, which may help in gender identification. Saliva can be used as a helpful tool in victim identification in cases where blood stains are not available.

Comparison and Evaluation of Fracture Toughness of Milled, 3D-Printed, and Conventional Polymethyl Methacrylate: An In Vitro Study.

Introduction: Dentures aim to replicate natural dentition's esthetics and functions as much as possible. With computer-aided design/computer-aided manufacturing (CAD/CAM) technology, dentistry had a new renaissance with workflow and materials. Aim: The aim is to compare the fracture toughness of the milled, 3D-printed, and conventional polymethyl methacrylate (PMMA) to those processed conventionally. Materials and Methods: 10 CAD MILLED PMMA BLOCKS, 10 3D PRINTED PMMA BLOCKS, and 10 CONVENTIONAL (HEAT CURE) PMMA BLOCKS. Results: A significant difference was seen in the mean flexural module when compared among three study groups as P < 0.05. It was found to be maximum in CAD/CAM PMMA, followed by conventional heat cure and 3D-printed PMMA. Conclusion: Formlabs and Dentca (3D-printed) were significantly weaker in fracture toughness compared to Leucitone 199 (conventional) (P < 0.05). Leucitone 199 (conventional) was significantly weaker in fracture toughness compared to Avadent (CAD CAM) (P < 0.05).

Comparison of Man Hours Utilized for Mandibluar Overdenture Treatment Retained by Single Implant with Bar Fabricated by CAD-CAM Process and Conventional Casting Processs - An Vivo Study.

Introduction: Both the population's average life expectancy and the number of patients without teeth are rising. A 2012 epidemiological survey in India found that 30% of the population is edentulous. The rehabilitation process with a set of removable maxillary and mandibular complete dentures is the standard treatment for patients who are edentulous. This study is the first to incorporate and compare a novel approach to a single implant-retained mandibular overdenture with a bar attachment fabricated by CAD-CAM and a casting process on a single implant in the symphysis region. Method: Five maxillary and mandibular completely edentulous patients were enrolled in the study. Results: Significant difference was seen in the conventional laboratory time and CAD-CAM time as P < 0.05. Conclusion: Compared to the conventional casting process, the single implant-supported bar mandibular overdenture (SISBOD) with a novel bar required fewer man hours and was more convenient.

The Influence of Nickel-Titanium (Ni-Ti) Rotary Instrument Systems on Debris and Smear Layer Formation in Endodontic Procedures: An In Vitro Scanning Electron Microscopy Study.

Background Successful endodontic treatment relies on the effective removal of debris and the prevention of smear layer formation within the root canals. The choice of nickel-titanium (Ni-Ti) rotary instrument systems can significantly impact these outcomes. Aim This study aims to evaluate and compare the debris and smear layer formation in root canals of extracted mandibular second premolar teeth following instrumentation with the ProTaper Universal (Dentsply Sirona, Charlotte, NC) (Group II), Twisted File (Kerr Endodontics, Gilbert, AZ) (Group III), and XP Endo (FKG Dentaire, La Chaux-de-Fonds, Switzerland) (Group IV) Ni-Ti rotary instrument systems. Methods In this in vitro study, 60 extracted mandibular second premolar teeth were randomly divided into four groups, each containing 15 teeth. Group I served as the control with no instrumentation. Groups II, III, and IV were instrumented with the ProTaper Universal rotary file, the Twisted File, and the XP Endo file systems, respectively. Debris and smear layer formation were evaluated through scanning electron microscopy (SEM), and photomicrographs were scored using a standardized index. Results Group II (ProTaper) exhibited the highest mean debris and smear layer scores, with values of 3.50 and 2.70, respectively. Group IV (XP Endo) demonstrated the least debris and smear layer formation, with mean scores of 2.65 and 2.08, respectively. Statistical analysis confirmed significant differences among the groups for both debris and smear layer formation. Conclusion The results highlight the practical importance of selecting appropriate Ni-Ti rotary instrument systems to minimize debris and smear layer formation during endodontic procedures. The XP Endo file system showed promise as a favorable choice in this regard, but further clinical research is needed to validate these findings.

Lesions Misdiagnosed as Endodontic Pathosis: A Narrative Review.

In daily practice, clinicians come across certain radiographic abnormalities which may or may not be asymptomatic. This abstract discusses radiographic abnormalities encountered by clinicians in daily practice, some of which resemble endodontic lesions. Prompt attention is crucial as these lesions can be benign or malignant. The article emphasizes the importance of differential diagnosis for accurate identification of periapical pathosis.

Unveiling an Uncommon Scenario of Co-occurrence of Multiple Odontomes With Impacted Maxillary Lateral Incisor and Canine in a 17-Year-Old Girl: A Unique and Rare Case Report.

This case report presents the enigma of multiple odontomes with overretained deciduous teeth leading to the impaction of permanent successors (22, 23) in an abnormal position in a 17-year-old female patient who reported the chief complaint of maligned teeth. Permanent maxillary canines and lateral incisors are the most common teeth to face the brunt of impaction due to a wide range of etiological factors. It is imperative for a clinician to diagnose cases at an early stage to accelerate the rate of eruption of such teeth. This is especially important in cases where initially the etiology seems to be simple but on careful and judicious evaluation of the case, numerous other etiologies are found to map together for the underlying pathology. This case discusses how the presence of multiple odontomes with delayed exfoliation of deciduous teeth leads to the impaction of a permanent successor. Understanding the underlying pathology is seemingly important to devise intricate treatment mechanics for traction of impacted teeth without taxing anchorage from dental units and taking cognizance of the amount of alveolar bone loss post-removal of multiple odontomes. The appropriate thickness of alveolar bone scaffolding is required for the canine to extrude down, with an adequate band of marginal gingiva encircling the cement-enamel junction of the impacted canine, preventing any kind of fenestration and dehiscence. Hence, meticulous care was taken during surgical exposure and removal of odontomes to preserve an adequate labial cortical plate intact for traction. These excavated tooth-like structures were later subjected to histopathological evaluation, which confirmed the diagnosis of compound odontomes.

Hydrogen energy systems: Technologies, trends, and future prospects.

This review critically examines hydrogen energy systems, highlighting their capacity to transform the global energy framework and mitigate climate change. Hydrogen showcases a high energy density of 120 MJ/kg, providing a robust alternative to fossil fuels. Adoption at scale could decrease global CO2 emissions by up to 830 million tonnes annually. Despite its potential, the expansion of hydrogen technology is curtailed by the inefficiency of current electrolysis methods and high production costs. Presently, electrolysis efficiencies range between 60 % and 80 %, with hydrogen production costs around $5 per kilogram. Strategic advancements are necessary to reduce these costs below $2 per kilogram and push efficiencies above 80 %. Additionally, hydrogen storage poses its own challenges, requiring conditions of up to 700 bar or temperatures below -253 °C. These storage conditions necessitate the development of advanced materials and infrastructure improvements. The findings of this study emphasize the need for comprehensive strategic planning and interdisciplinary efforts to maximize hydrogen's role as a sustainable energy source. Enhancing the economic viability and market integration of hydrogen will depend critically on overcoming these technological and infrastructural challenges, supported by robust regulatory frameworks. This comprehensive approach will ensure that hydrogen energy can significantly contribute to a sustainable and low-carbon future.

Moving beyond traditional macrofaunal community structure studies in the Indian Ocean continental shelf: a research synthesis based on research weaving.

The Indian Ocean (IO) continental shelf characterized by unique oceanographic and meteorological features and extreme habitat is a biodiversity hotspot region. Marine biodiversity provides valuable resources and services, in terms of economy, cultural, science, and education. Unsustainable exploitation and habitat degradation represent the greatest threat to biodiversity. Understanding how these services will change in the future requires knowledge of marine biodiversity. Although macrofaunal biodiversity is critical for the functioning of shelf systems, it has received much less attention, particularly in the IO, mainly due to logistics reasons precluding our ability to predict future changes. Here, we discuss the state of knowledge of macrofaunal ecology, to identify the knowledge gaps, which will allow for setting research priorities. The new framework in research synthesis, research weaving, that combines systematic mapping with bibliometric analysis was applied. The research weaving approach helps illustrate the evolution of research over time and identifies areas of current research interests and the performance of institutions and collaboration patterns. Data retrieved from the Web of Science were analyzed in the R and VOS Viewer software. The results highlight how macrofaunal research in IO is constrained by spatial and temporal scales, with the majority of studies focused on structural patterns. Moreover, most studies were conducted in a few countries (India, Australia, Saudi Arabia, Iran, and South Africa) using different sampling techniques hindering comparison within the IO habitats. Future studies investigating the macrofaunal community using a multidisciplinary approach and scientific collaboration (regional and international) can advance our efforts to close the marine biodiversity knowledge gaps.

Adequacy of Informed Consent in Elective Surgical Procedures: A Study in a Navi Mumbai Tertiary Care Centre.

Background Informed consent (IC) is a voluntary authorisation given by a patient or research subject after fully comprehending the risks involved in various procedures and treatments. Though a patient may fulfill all the aspects of consent by completing an informed consent form (ICF), research indicates poor execution of the IC process by ill-informed patients with little comprehension. The present study was done on patients to assess their understanding and involvement in the consenting process, thereby providing insight into the adequacy and sufficiency of the IC process. Materials and methodology Patients undergoing elective surgical procedures were surveyed using a questionnaire to study whether the written informed consent (IC) process was adequately used in elective surgeries and to assess the patient's understanding of the IC and whether the informed consent forms (ICF) used met the ethical and legal standards for this purpose. The questionnaire was administered to the patients by two surveyors. As per the inclusion/exclusion criteria, data was collected from 221 admitted patients who were planned to undergo or recently underwent various elective surgical/operative procedures. Descriptive analysis using frequency and percentages of the positive and negative responses was used to analyse the data. Results In 219 (99%) of the cases, informed consent was taken. Two hundred-eight patients (94.1%) understood the knowledgeable consent information, while 13 (5.9%) did not. Of the total 221 patients, more than 90% of patients were informed about the nature and indication of the surgery. The expected benefits were told to 83.25% of patients, while possible complications of the procedure were reported to 91 patients (41.2%). Of the total, 58.37 % of patients knew the type of anaesthesia used for elective surgery. Two hundred and sixteen (97.73%) patients favoured the informed consent process, and 213 (96.38%) were satisfied with the information provided in the consent form. The education status of the patient varied, with nearly 15.5% being illiterate while 35.3% being educated till high school. Patients undergoing surgical procedures must be explained the nature and indication of the proposed surgical treatment, including its benefits and risks. About 208 (94.1%) of the patients stated that they understood all the information provided in the ICF, and 213 patients (96.3%) were satisfied with it. Most patients (88.7%) exercised autonomy in deciding to undergo surgery. Ninety-seven percent of patients favoured the IC process, of which 38.46% believed informed consent has a medicolegal significance. Conclusion The present study revealed that a better understanding of the informed consent by the patients is a vital component of the process as it helps exercise autonomy in the decision-making process. However, the lack of information in the informed consent forms critically affects the quality and adequacy of the IC, thus posing ethical and legal challenges to genuinely informed consent.

Deciding the Cause of Death in a Victim of a Road Traffic Accident Became Difficult Due to Interventions: A Case Report.

Though uncommon, puncture injury to the heart can occur during cardiac resuscitation and when inserting a lifesaving drug directly into the left ventricle of the heart. Utmost precaution must be taken to avoid damaging the conduction system of the heart, particularly the nodal part, as it can cause cardiogenic shock, arrhythmia, and sudden death. Our index case report describes a 55-year-old male who was fatally injured after being hit by a truck while riding his bike. The autopsy revealed multiple puncture injuries to the atrioventricular node area of the septum, observed on both sides of the interatrial septal wall surface. Histopathological examination also showed subendocardial hemorrhage around the atrioventricular nodal area. The nature of the injuries made identification of the cause of death difficult.

Gunshot Injury to the Face With Atypical Non-linear Bullet Trajectory: A Case Report.

The disruptive effect of firearm missiles on body tissues depends on many factors. However, it mainly relates to the bullet's physical and dynamic properties and tissue-related factors. We encountered an unusual case of a gunshot injury wherein the bullet traversed the neck with an upward and non-linear trajectory with an exit from the contralateral side of the neck without damaging any vital neck organs. A 26-year-old male presented with a gunshot wound to the chin from close range. A bullet entry hole was observed on the right side of the chin, encircled by the abrasion collar, with tattoo marks around the area. The patient was conscious, with normal vital signs and no injury to the cranial nerves or aerodigestive tract. The CT imaging of the patient revealed the injury tract traversing through the muscles of the floor of the mouth to involve the left carotid and left parapharyngeal space, along with the left sternocleidomastoid muscle, with an exit hole below the left mastoid in the posterior triangle of the neck. A bullet usually travels through the body in a straight line or pathway; however, its non-linear trajectories depend on the projectile's dynamics and its interaction with the body tissues. The present case emphasizes understanding wound ballistics to know the erratic bullet trajectories in the victim's body and their interpretation, irrespective of their entry site.

Nanotechnological advancements in the brain tumor therapy: a novel approach.

Nanotechnological advancements over the past few years have led to the development of newer treatment strategies in brain cancer therapy which leads to the establishment of nano oncology. Nanostructures with high specificity, are best suitable to penetrate the blood-brain barrier (BBB). Their desired physicochemical properties, such as small sizes, shape, higher surface area to volume ratio, distinctive structural features, and the possibility to attach various substances on their surface transform them into potential transport carriers able to cross various cellular and tissue barriers, including the BBB. The review emphasizes nanotechnology-based treatment strategies for the exploration of brain tumors and highlights the current progress of different nanomaterials for the effective delivery of drugs for brain tumor therapy.

Evaluation of Salivary Alkaline Phosphatase Levels in Passive Smokers of Different Age Groups.

Background The smoke inhaled by a nonsmoker from the smoldering end of a cigarette is referred to as passive smoke. The nicotine present in smoke is known to cause tissue damage and alter the enzymatic composition of the body. Alkaline phosphatase (ALP) is a group of intracellular hydrolytic enzymes known to partake in cellular metabolism. ALP levels are affected by smoking as well as passive smoking (PS) with a change in the pH of the oral cavity. The association of salivary alkaline phosphatase (S-ALP) levels in different age groups, gender, and times of exposure is not thoroughly explored yet, which was the primary aim of this study. Material and methods A total of 64 samples were collected from passive smokers and non-smokers. Unstimulated saliva (2-2.5 mL) was collected from each subject after obtaining their consent, followed by centrifuging and mixing with ALP reagent in a semi-autoanalyzer to obtain the S-ALP levels. Results Higher S-ALP levels were seen in passive smokers (34.70 IU/L) compared to healthy individuals (12 IU/L), which came to be statistically significant (p<0.01). S-ALP levels, when compared to different age groups and gender, were statistically insignificant (p>0.05). However, higher levels were seen in association with time of exposure in passive smokers where the data was statistically significant (p<0.01), suggesting tissue damage possibly due to oxidative stresses and tissue inflammation on continuous exposure for a minimum of 30-60 minutes daily as per our study. Conclusion Significantly high levels of S-ALP were found in passive smokers in comparison to non-smokers. This suggests that passive smoking has negative effects on the body tissues. Age, gender, and time of exposure of a non-smoker to tobacco smoke can lead to alterations in S-ALP levels. High levels of S-ALP were seen in individuals with prolonged exposure to tobacco smoke on a daily basis. Salivaomics can thus be used as a non-invasive, economical, and accurate alternative in tissue damage diagnosis.

Quality in neonatal mortality audits: Results of pilot study from district of Dhule, Maharashtra.

Introduction: As per WHO guidelines, it is important to have quality among mortality audit documents to improve outcome in health services. Objective: To assess quality of facility-based neonatal mortality audits implementation. Methodology: Mixed-method descriptive analysis was conducted. Totally, 96 death review documents were reviewed. The 25 healthcare workers were interviewed in depth. Observation analysis done for audit meetings using WHO modified checklist for quality in audit toolkit. Results: The observation of audit meetings highlighted that almost half of the members were not communicated regarding vision of audit and framework of audit and review meetings. In quantitative analysis, it was found that secondary care hospitals were not having accuracy and consistency in audit documentation. Conclusion: The quality of neonatal death audit was poor due to challenges faced by the hospitals in creating an enabling atmosphere, which can be overcome by sharing the vision of audit with the whole staff of the hospital. A standard operating procedure for audit committee to be adopted to implement action plans. Commitment, investment, and intentional leadership from everyone, including all healthcare workers, can make these ambitious goals attainable.