Association of Electronic Cigarette Usage with the Subsequent Initiation of Combustible Cigarette Smoking among Dental Students in Riyadh, Saudi Arabia: A Longitudinal Study.

The use of electronic cigarettes, or "e-cigarettes", among youths has sparked worries about the possibility of nicotine dependence as a serious public health issue. Dental practitioners play a critical role in helping their patients quit smoking. Dental schools across the globe have policies encouraging their students to help patients quit smoking. Current research, however, indicates that a significant portion of dental students smoke combustible cigarettes and use e-cigarettes. According to studies, using e-cigarettes has resulted in the subsequent initiation of combustible cigarette smoking among its users. The aim of this study was to determine the association between the use of electronic cigarettes and the subsequent initiation of combustible cigarette smoking among dental students who were not attitudinally susceptible to smoking combustible cigarettes. A longitudinal cohort study was conducted among 121 study participants who were never combustible cigarette users and were attitudinally non-susceptible to smoking at baseline. At baseline, 66 (54.6%) study participants were categorized as e-cigarette users who were attitudinally non-susceptible to combustible cigarette smoking, and 55 (45.4%) study participants were categorized as non-users who were attitudinally non-susceptible to combustible cigarette smoking. The initiation of combustible cigarette smoking was assessed at 6- and 12-month intervals. Binomial regression analysis of the outcome at the end of one-year follow-up, when analyzed with independent variables, revealed a significant influence of e-cigarette use on taking up combustible cigarette smoking [Relative Risk: 9.395; 95% CI: 3.03-29.04]. Chi-squared analysis of independent variables revealed e-cigarette use to be significantly associated with fathers' education level (p = 0.00), parental cigarette smoking status (p = 0.00), cigarette smoking among friends (p = 0.00), and family income (p = 0.00). E-cigarette users are more likely to believe it to be healthier (p = 0.00) than combustible smoking. In the present study, e-cigarette usage demonstrated a significant influence on taking up combustible cigarette smoking among its users. Educational institutions should implement stringent policies and regulations to prevent health professionals from using these products.

Baseline Assessment of Health Research Systems in Saudi Arabia: Harnessing Efforts and Mobilizing Actions.

Major transformations are taking place in the Kingdom of Saudi Arabia (KSA) to achieve the 2030 vision for the health sector. A key component in strengthening the health system is a strong research governance strategy that can support the decision-making process by providing timely and accurate evidence that reflects local context and needs. This paper sought to better understand governance structures and policies for health research systems and support clusters so that they function effectively. This paper outlines the findings of an in-depth baseline assessment of existing health research efforts, activities, and plans of eight research clusters in the KSA and identifies key gaps and strengths in health research governance and capabilities. A cross-sectional design was used to survey research clusters in KSA. A six-part survey was developed to better understand the research clusters' health research governance and capacities. The survey was sent to all KSA clusters and was completed in a group setting during meetings. Findings clearly show strong efforts to support research governance initiatives in health clusters in KSA. While some clusters are more advanced than others, there are plenty of opportunities to share knowledge and combine efforts to help achieve the goals set out for KSA health transformation. This baseline assessment also reflects the first attempt of its kind to understand the KSA experience and provide much-needed lessons on country-wide efforts to support the health system given the trickling effect of this sector on all others, enhancing and advancing national growth.

Cytotoxic cardiac glycosides from the fruit (pods) of Adenium obesum (Forssk.) Roem. & Schult.

Phytochemical investigation of methanolic extract of Adenium obesum led to the isolation of 42 (1-42) compounds belongs to cardiac glycosides, triterpenoids and steroids. The chemical structures of isolated compounds were elucidated by spectral techniques UV, IR, NMR and FAB MS. The cardiac glycosides were tested against three human cell lines, 3T3 (normal cells), HeLa (Human cervical cancer cell lines) and PC-3 (Human prostate cancer cell lines). The cardiac glycoside, honghelin (4), obeside B (5) and obeside C (6) showed significant effects against cell lines Hela, 3T3 and PC-3 compared to standard drug doxorubicin. Compounds 4, 5 and 6 exhibited very low IC50 (µM) against the PC3 human cell line. 4 and 6 also showed least IC50 against the HeLa human cell lines as compared to the standard drug doxorubicin whereas these three compounds showed effect on 3T3 cell line with high IC50 values compared to drug cycloheximide.

Safety and Effectiveness of Sodium Stibogluconate and Paromomycin Combination for the Treatment of Visceral Leishmaniasis in Eastern Africa: Results from a Pharmacovigilance Programme.

INTRODUCTION: In 2010, WHO recommended a new first-line treatment for visceral leishmaniasis (VL) in Eastern Africa. The new treatment, a combination of intravenous (IV) or intramuscular (IM) sodium stibogluconate (SSG) and IM paromomycin (PM) was an improvement over SSG monotherapy, the previous first-line VL treatment in the region. To monitor the new treatment's safety and effectiveness in routine clinical practice a pharmacovigilance (PV) programme was developed. METHODS: A prospective PV cohort was developed. Regulatory approval was obtained in Sudan, Kenya, Uganda and Ethiopia. Twelve sentinel sites sponsored by the Ministries of Health, Médecins Sans Frontières (MSF) and Drugs for Neglected Diseases initiative (DNDi) participated. VL patients treated using the new treatment were consented and included in a common registry that collected demographics, baseline clinical characteristics, adverse events, serious adverse events and treatment outcomes. Six-monthly periodic safety update reports (PSUR) were prepared and reviewed by a PV steering committee. RESULTS: Overall 3126 patients were enrolled: 1962 (62.7%) from Sudan, 652 (20.9%) from Kenya, 322 (10.3%) from Ethiopia and 190 (6.1%) from Uganda. Patients were mostly male children (68.1%, median age 11 years) with primary VL (97.8%). SSG-PM initial cure rate was 95.1%; no geographical differences were noted. HIV/VL co-infected patients and patients older than 50 years had initial cure rates of 56 and 81.4%, respectively, while 1063 (34%) patients had at least one adverse event (AE) during treatment and 1.92% (n = 60) had a serious adverse event (SAE) with a mortality of 1.0% (n = 32). There were no serious unexpected adverse drug reactions. CONCLUSIONS: This first regional PV programme in VL supports SSG-PM combination as first-line treatment for primary VL in Eastern Africa. SSG-PM was effective and safe except in HIV/VL co-infected or older patients. Active PV surveillance of targeted safety, effectiveness and key VL outcomes such us VL relapse, PKDL and HIV/VL co-infection should continue and PV data integrated to national and WHO PV databases.

New dammarane and ursane-type triterpenoids from the flower of Ixora coccinea Linn.

Two new esters of dammarane triterpenoids ixorene isovalerate (1), ixorene 3',8'-dimethyloctanoate (2) and a new ursane-type triterpenoids Ixoroid acid (3) were isolated from the methanolic extract of flowers of Ixora coccinea Linn., along with the three known constituents. The structures of compounds 1 and 3 were elucidated on the basis of extensive 1D,2D NMR studies and mass spectrometry as 17ß-dammara-12,20-diene-3ß-isovelarate and 3ß-hydroxy-18ß-urs-12ene-29ß-oic acid, respectively, whereas 2 was identified as 17ß-dammara-12,20-diene-3ß-3',8'-dimethyloctanoate through (1)H NMR and mass spectral data. Compounds 1, 2, 4 and 5 were evaluated for their in vitro cytotoxic activity, which exhibited weak activity against the 3T3, PC3 and HeLa cell lines with the IC50 value >30 µM. Antioxidant results of 1 - 5 revealed that only compound 5 showed antioxidant activity in DPPH radical scavenging inhibition with the IC50 1.31 × 10(- 6) ± 0.005 µm mL(- 1). Both activities are the first records of these isolated compounds from the flowers of Ixora coccinea Linn.

Mycetoma of the hand.

OBJECTIVE: To describe the incidence and radiographic signs of hand infection in mycetoma. METHODS: A retrospective review was carried out from the radiographic records of 516 confirmed cases of mycetoma seen between January 1994 and October 2002 at the referred outpatient clinic of the Mycetoma Research Center, Soba Teaching Hospital, Khartoum University, Khartoum, Sudan. RESULTS: The hands were involved in 24 (4.6%) of the 516 patients. The wrist was involved in 9 (1.7%). Total involvement of the hand and wrist together was 33 (6.4%) of the 516 patients. Radiographic signs included fanning of the metacarpals, bone erosions, sclerosis, periostitis and soft tissue swelling. The most common sign was soft tissue swelling in 29 (88%) while bones were involved in 15 (45%) of the 33 patients. CONCLUSION: Hand infection in this series is less than previous reports. A wide range of radiographic signs is reported in hand mycetoma. This is the first detailed report of the radiographic findings in mycetoma of the hand. Early detection of mycetoma infection is important to avoid the need for amputation if diagnosis is delayed.