Assessment of health-care workers' attitudes, knowledge, and skills in the care of critically ill Muslim children in New York.

OBJECTIVES: Pediatric health-care workers often care for families of minority religious backgrounds, but little is known about their perspective in providing culturally and spiritually appropriate care for Muslim patients. We aimed to (1) characterize the attitudes, knowledge, and skills of health-care workers in the care of critically ill Muslim children and (2) evaluate preferences for different educational interventions to improve care of critically ill Muslim children. METHODS: We administered a single-center, cross-sectional, 33-question, electronic survey of interdisciplinary health-care workers in a large pediatric intensive care unit in New York City to characterize their attitudes, knowledge, and skills in caring for critically ill Muslim children. RESULTS: Of 413 health-care workers surveyed, there were 109 (26%) respondents. Participants responded correctly to 51.7 ± 22.2% (mean ± SD) and 69.2 ± 20.6% of background knowledge and clinical skills questions, respectively. Only 29.8% of participants perceived adequate institutional resources to provide culturally competent care to Muslim patients and their families. Participants identified end-of-life care (47.5%) and bioethical concerns (45%) as needed areas for additional institutional resources. When asked about support to aid in caring for Muslim patients, 43.4% of participants requested a team of Muslim health-care workers to provide guidance. Participants most often requested video-based training modules (32.5%) and written materials (30%) as potential educational interventions. SIGNIFICANCE OF RESULTS: We identify gaps in health-care worker knowledge and skills in the care of the critically ill Muslim child. We also describe possible areas for intervention to facilitate culturally and spiritually appropriate care delivery to Muslim children and families.

Supplementary Feeding of Moderately Wasted Children in Sierra Leone Reduces Severe Acute Malnutrition and Death When Compared with Nutrition Counseling: A Retrospective Cohort Study.

BACKGROUND: There is uncertainty about whether children with moderate wasting should receive supplementary feeding. OBJECTIVES: We examined whether supplementary feeding compared with counseling alone in children with moderate wasting prevented progression to severe acute malnutrition (SAM) or death. METHODS: This was a retrospective, dual-cohort study in which 1791 children with moderate wasting were drawn from 2 prior randomized controlled trials that took place in the same location in rural Sierra Leone. A total of 1077 children received supplementary feeding, whereas 714 children received counseling alone. Children in both cohorts were followed for ≥24 wk from enrollment. The primary outcome was time to SAM or death using Kaplan-Meier analysis. Secondary outcomes included time to death as well as proportions of children with healthy midupper arm circumference (MUAC), moderate wasting, SAM, or death at 6, 12, and 24 wk from enrollment. RESULTS: Children who received supplementary feeding were less likely to develop SAM or die across the entire follow-up period (HR: 0.53; 95% CI: 0.44, 0.65; P < 0.001). Time to event for death alone also revealed a lower risk for children who received supplementary feeding (HR: 0.52; 95% CI: 0.28, 0.94; P = 0.03). Children who received supplementary feeding were more likely to have a healthy MUAC at 6 wk (RR: 2.0; 95% CI: 1.7, 2.2) and 12 wk (RR: 1.3; 95% CI: 1.2, 1.5), were less likely to develop SAM at 6 (RR: 0.7; 95% CI: 0.6, 0.9), 12 (RR: 0.5; 95% CI: 0.3, 0.8), and 24 wk (RR: 0.2; 95% CI: 0.1, 0.5), and had higher rates of gain in weight and MUAC at 6 and 12 wk. CONCLUSIONS: Supplementary feeding of children with moderate wasting reduces risk of SAM and death across 24 wk of follow-up.

Supplementary Feeding of Moderately Wasted Children in Sierra Leone Reduces Severe Acute Malnutrition and Death When Compared with Nutrition Counseling: A Retrospective Cohort Study.

BACKGROUND: There is uncertainty about whether children with moderate wasting should receive supplementary feeding. OBJECTIVES: We examined whether supplementary feeding compared with counseling alone in children with moderate wasting prevented progression to severe acute malnutrition (SAM) or death. METHODS: This was a retrospective, dual-cohort study in which 1791 children with moderate wasting were drawn from 2 prior randomized controlled trials that took place in the same location in rural Sierra Leone. A total of 1077 children received supplementary feeding, whereas 714 children received counseling alone. Children in both cohorts were followed for ≥24 wk from enrollment. The primary outcome was time to SAM or death using Kaplan-Meier analysis. Secondary outcomes included time to death as well as proportions of children with healthy midupper arm circumference (MUAC), moderate wasting, SAM, or death at 6, 12, and 24 wk from enrollment. RESULTS: Children who received supplementary feeding were less likely to develop SAM or die across the entire follow-up period (HR: 0.53; 95% CI: 0.44, 0.65; P < 0.001). Time to event for death alone also revealed a lower risk for children who received supplementary feeding (HR: 0.52; 95% CI: 0.28, 0.94; P = 0.03). Children who received supplementary feeding were more likely to have a healthy MUAC at 6 wk (RR: 2.0; 95% CI: 1.7, 2.2) and 12 wk (RR: 1.3; 95% CI: 1.2, 1.5), were less likely to develop SAM at 6 (RR: 0.7; 95% CI: 0.6, 0.9), 12 (RR: 0.5; 95% CI: 0.3, 0.8), and 24 wk (RR: 0.2; 95% CI: 0.1, 0.5), and had higher rates of gain in weight and MUAC at 6 and 12 wk. CONCLUSIONS: Supplementary feeding of children with moderate wasting reduces risk of SAM and death across 24 wk of follow-up.

Pharmacokinetics of Midazolam in preterm neonates with an insight in brain Tissue: A PBPK approach.

Physiological maturity is a gradual process taking place throughout infancy and childhood. Though for years anatomical growth has been the basis for dose calculation in pediatric population, physiological immaturity can-not be overlooked especially in neonates. The potential difference in physiology can significantly affect the outcomes of treatment and may result in under dosing or over-dosage. For many ethical and logistic constrains, carrying out pharmacokinetic studies of pharmacological agents in neonatal population remains a challenging task and such data is therefore, insufficient. This work presents Physiologically Based Pharmacokinetic modeling approach to predict the disposition of IV Midazolam in preterm neonates of different gestational ages, validated by the experimental studies. Furthermore, midazolam concentration in brain tissue of these neonates- the major site of its action- has been noted. The predicted and observed plasma pharmacokinetic parameters are comparable. This article demonstrates the usefulness of in-silico approach for finding out the PK parameters in neonates which may aid in deciding the frequency of drug administration in this population.

Scanning electron microscopy (SEM) and atomic absorption spectroscopic evaluation of Raphanus sativus L. seeds grown in Pakistan.

Raphanus sativus L. (Brassicacae) possesses numerous health benefits due to presence of a host of secondary metabolites in its various parts. The present study investigated the nutritive value of Raphanus sativus (RS) seeds and seed oil. Proximate and physico chemical analysis were carried out by official AOAC (Association of Official Analytical Chemists) and AOCS (American oil chemist society) methods. Scanning electron microscopy (SEM) together with energy dispersive X-ray spectroscopy (EDS) described the surface morphology along with atomic elemental composition of the sample. Mineral contents were evaluated by Atomic absorption spectroscopy. Moisture content was 8.67±0.08% whereas protein, crude fiber, crude fat, carbohydrates, total ash values were reported as 20.13±0.15%, 7.86±0.15%, 32.27±0.25%, 27.32±0.85%, 3.75±0.02% respectively. EDS determined carbon, oxygen, magnesium, sulfur and potassium in seeds. All physico-chemical properties varied insignificantly for the two extraction methods, except for acid value and unsaponifiable matter, which were higher for Soxhlet's extracted oil than cold pressed oil. The mineral composition revealed potassium in the highest concentrations in seeds and seed oil i.e.1660.65±69.26 ppm and 47.80 ± 7.02 ppm respectively. The study suggested that the seed and seed oil could be a potential source of naturally originated raw material for the nutritive and pharmaceutical aid.

Mycobacterium tuberculosis is protected from NADPH oxidase and LC3-associated phagocytosis by the LCP protein CpsA.

Mycobacterium tuberculosis' success as a pathogen comes from its ability to evade degradation by macrophages. Normally macrophages clear microorganisms that activate pathogen-recognition receptors (PRRs) through a lysosomal-trafficking pathway called "LC3-associated phagocytosis" (LAP). Although Mtuberculosis activates numerous PRRs, for reasons that are poorly understood LAP does not substantially contribute to Mtuberculosis control. LAP depends upon reactive oxygen species (ROS) generated by NADPH oxidase, but Mtuberculosis fails to generate a robust oxidative response. Here, we show that CpsA, a LytR-CpsA-Psr (LCP) domain-containing protein, is required for Mtuberculosis to evade killing by NADPH oxidase and LAP. Unlike phagosomes containing wild-type bacilli, phagosomes containing the ΔcpsA mutant recruited NADPH oxidase, produced ROS, associated with LC3, and matured into antibacterial lysosomes. Moreover, CpsA was sufficient to impair NADPH oxidase recruitment to fungal particles that are normally cleared by LAP. Intracellular survival of the ΔcpsA mutant was largely restored in macrophages missing LAP components (Nox2, Rubicon, Beclin, Atg5, Atg7, or Atg16L1) but not in macrophages defective in a related, canonical autophagy pathway (Atg14, Ulk1, or cGAS). The ΔcpsA mutant was highly impaired in vivo, and its growth was partially restored in mice deficient in NADPH oxidase, Atg5, or Atg7, demonstrating that CpsA makes a significant contribution to the resistance of Mtuberculosis to NADPH oxidase and LC3 trafficking in vivo. Overall, our findings reveal an essential role of CpsA in innate immune evasion and suggest that LCP proteins have functions beyond their previously known role in cell-wall metabolism.

Synthesis, characterization and SEM studies of novel 1-indanyl isoniazid and hydrazide Schiff base derivatives as new anti-tubercular agents.

The aim of study was to synthesize 1-indanyl isoniazid and sixteen other hydrazide Schiff base derivatives from 1-indanone. All synthesized derivatives were screened for the inhibitory activity against Mycobacterium tuberculosis on three Mycobacterial strains ATCC H37Rv, known INH-sensitive (INH-S) and INH-resistant strains (INH-R) by proportion method. The derivatives were characterized using different spectroscopic techniques such as UV-Visible, FTIR, 1H NMR, and HREIMS. In addition, to gain more insight into morphology of the structures, Scanning electron microscopy (SEM) was also performed. The results revealed that 1-indanyl isoniazid derivative (UN-1) exhibited more potent and high anti-mycobacterial activity against both INH-sensitive and INH-resistant strains of Mycobacterium tuberculosis when compared to standard anti-tubercular drug isoniazid which might be a novel isoniazid derivative as a new anti-tubercular agent.

Electron ionization gas chromatography-mass spectrometry (ei-gc-ms) analysis of extracted oil from Tribulus terrestris seeds.

The fine powdered form T. terrestris seeds, was extracted with n-hexane by soxhlet apparatus. The aim of the study was to analyze the T. terrestris seed oil (sample-A) by electron ionization Gas Chromatography-Mass Spectrometry (EI-GC-MS) using full scan method within mass range from 40-700 charge to mass ratio (m/z). Out of 102 compounds (1A-102A) 11 compounds (30A, 32A, 37A, 45A, 47A, 48A, 49A, 64A, 83A, 101A and 102A) could not be identified and 91 were identified by classical interpretation of the mass spectrum and by using NIST14 library with match factor > 95 of mass spectrums. While among the 91 identified compounds 18 were found common therefore finally 73 compounds were identified in the present EI-GC-MS analysis of sample-A.

Chemical analysis of Dalbergia sissoo (Roxb.) pod oil by (GC-MS) / GC-FID and evaluation of antioxidant potential.

Dalbergia sissoo (Roxb.) is one of the important plant species having extensive commercial and medicinal uses. The current study aims to assess the chemical constituents in pod oil of Dalbergia sissoo (Roxb.) by using two spectroscopic techniques i.e. GC-FID (Gas Chromatography Flame Ionization Detection) and GC-MS (Gas Chromatography Mass Spectroscopy). In GC-FID technique, nine fatty acids were identified with their respective composition, capric acid (1) (1.496%) lauric acid (2) (5.695%), myristic acid (3) (4.925%), palmitic acid (4) (10.130%), palmitoleic acid (5) (2.166%), stearic acid (6) (2.862%), oleic acid (7) (10.232%), linoleic acid (8) (22.350%) and behenic acid (9) (9.283%). In second technique, i.e. GC-MS, a series of hydrocarbons (10-37) along with two triterpenoids (38-39) were found in pod oil of the plant used. Important structure indices such as Iodine value and Saponification values were also determined. These findings can be helpful to understand the important medicinal and commercial aspects of seeds oil of the plant, like fuel value, degree of unsaturation and oxidative stability. Antioxidant testing (DPPH-Radical Scavenging Assay) was also performed on pods oil but no any significant activity was found.

In vitro Spectroscopic studies on drug interaction of cefpodoxime proxetil and H2 receptor blockers.

One of the relatively advance 3rd generation cephalosporins, cefpodoxime proxetil, is being used all-around. Generally, these are used for the cure of infections allied to urinary and respiratory tract. These cephalosporins have showed a remarkable in vitro activity against many strains of bacteria which are resistant to other orally used active medicinal substances. It is the first oral 3rd generation cephalosporin to be used in the cure of skin infections. The practice of H2 receptor antagonists, concerning lots of treatments recommended in patients with different types of ulcers and allergic urticarial condition, is raising hazards of unwanted secondary outcomes and drug interactions. Learning of in-vitro interaction between cefpodoxime poxetil and H2 blockers (Ranitidine, Famotidine and Cimetidine) were examined applying UV/Visible spectrophotometry and Infrared spectrometry. In the existence of H2 receptor blockers, the cefpodoxime proxetil availability was found to be decreased in vitro only under specific conditions. Furthermore, complexes of Cefpodoxime proxetil-H2 receptor antagonists were manufactured approving the interaction of these drugs. Finally, the above mentioned spectrophotometric techniques were employed to examine the complexes formed (Cefpodoxime proxetil-cimetidine, cefpodoxime proxetil-famotidine and cefpodoxime proxetil-ranitidine).

Development and validation of RP-HPLC method for simultaneous determination of cefpodoxime proxetil and H2 receptor antagonists in pharmaceutical dosage forms.

A new method on RP-HPLC is devised and validated, as per ICH guidelines, for the synchronous estimation of cefpodoxime proxetil and H2-receptor antagonits that are Cimetidine, Famotidine and Ranitidine. The method is simple, accurate, expeditious, reproducible, robust and precise. Chromatography was done on a C18 (250 x 4.6mm) column with methanol: water as mobile phae in the ratio of 70:30 (v/v), pumped at a flow rate of 1ml/min and pH was maintained using 85% ortho-phosphoric acid at 3. The λ max 240 nm was preferred for UV detection. A good linear relationship was attained, over the concentration ranges of 20-70 µg/ml and 5-30µg/ml, for cefpodoxime proxetil and H2 blockers respectively, with a correlation coefficient of R= 0.9987 to 0.9992. The method was validated and found precised (i.e. intra day and interday analysis) with RSD <2%. LOD and LOQ observations were under 0.4806 to 2.6069µg/ml which proved the method to be sensitive. The method provided satisfactory results of robustness and reproducibility, when validated and applied successfully for analysis of dosage forms.

Thiosemicarbazone and thiazolylhydrazones of 1-indanone: As a new class of nonacidic anti-inflammatory and antiplatelet aggregation agents.

This research based on the anti-inflammatory and antiplatelet aggregation properties of some new thiazolyl hydrazone derivatives of 1-indanone. In this regard a thiosemicabazone and twelve thiazolyl derivatives of 1-indanone have been synthesized. Out of these synthetic compounds seven derivatives 1-3, 6, 11-13 exhibited varying degree of anti-inflammatory action with IC50 esteems going from 5.1±1.3 - 78.8±4.6µM/mL. Compound 1 (IC50 =5.1±1.9µM) displayed potent result than standard ibuprofen (IC50 = 11.2±1.9 µM). In antiplatelet aggregation assay, five compounds 1, 5, 6, 8 and 11 were observed to be dynamic with IC50 esteems observed in the range of 38.34-255.7±4.1µM, wher eas, aspirin (IC50 = 30.3±2.6 µM) was used as standard. However, compound 11 was found to be good active for both anti-inflammatory and antiplatelet aggregation activities (IC50 = 13.9±4.9µg/mL) (IC50 = 38.60±3.1µM), respectively.

Development and validation of HPLC method for the determination of Candesartan in human plasma.

Candesartan (CAN), an ARB-blocker, antihypertensive, was analyzed in human plasma by a simple, accurate and precise RP-HPLC (reverse phase-High performance liquid chromatography assay method which was then validated for its accuracy, specificity and precision. The mobile phase has a constitution of acetone, diethylamine and distilled water, while Phosphoric acid was used to adjust the pH to 2.5±0.1. This mobile phase was run at 1.1ml/min and the fluorescence wavelength was set to 392 nm. A C-18 HPLC, column particle size (5 µm) Mediterranean Sea ® L x 1.D. 25cm x 4.6 mm (Supelcosil) , with auto sampler injection volume of 30µl ,an internal standard Valsartan was utilized for chromatographic detection. Candesartan took a retention time of 6±0.5 minutes. This method was validated by the parameters of selectivity, accuracy, precision, repeatability, reproducibility, recovery, linearity and stability. Candesartan's calibration curves were found to be linear in the range of 200ng/ml to 3.125ng/ml and the coefficient of determination (r2) was found to be 0.99. Analytical recovery obtained was above 88%. Hence, this method has been found to be useful for determining Candesartan in plasma.

The personal and workplace characteristics of uninsured expatriate males in Saudi Arabia.

BACKGROUND: A major concern by the health decision makers in Gulf Cooperative Council (GCC) countries is the burden of financing healthcare. While other GCC countries have been examining different options, Saudi Arabia has endeavoured to reform its private healthcare system and control expatriate access to government resources through the provision of Compulsory Employment-Based Health Insurance (CEBHI). The objective of this research was to investigate, in a natural setting, the characteristics of uninsured expatriates based on their personal and workplace characteristics. METHODS: Using a cross-sectional survey, data were collected from a sample of 4,575 male expatriate employees using a multi-stage stratified cluster sampling technique. Descriptive statistics were used to summarize all variables, and the dependent variable was tabulated by access to health insurance and tested using Chi-square. Logistic analysis was performed, guided by the conceptual model. RESULTS: Of survey respondents, 30% were either uninsured or not yet enrolled in a health insurance scheme, 79.4% of these uninsured expatriates did not have valid reasons for being uninsured, with Iqama renewal accounting for 20.6% of the uninsured. The study found both personal and workplace characteristics were important factors influencing health insurance status. Compared with single expatriates, married expatriates (accompanied by their families) are 30% less likely to be uninsured. Moreover, workers occupying technical jobs requiring high school level of education or above were two-thirds more likely to be insured compared to unskilled workers. With regard to firm size, respondents employed in large companies (more than 50 employees) are more likely to be insured compared to those employed in small companies (less than ten employees). In relation to business type, the study found that compared to workers from the agricultural sector, industrial/manufacturing, construction and trading sectors, workers were, respectively, 76%, 85%, and 60% less likely to be uninsured. CONCLUSION: Although the CEBHI is mandatory, this study found that the characteristics of uninsured expatriates, in respect of their personal and workplace characteristics have similarities with the uninsured from other private employment-sponsored health insurance schemes. Other factors influencing access to health insurance, besides employee and workplace characteristics, include the development and extent of the country's insurance industry.

Bile acids and bile alcohols from Muraenesox bagio, Pomadasys argenteus and Lobeo rohita.

Gallbladders bile of three well known commercial fish of South Asia region named Muraenesox bagio (locally called bam), Pomadasys argenteus (dother) and Lobeo rohita (rohu) were analysed on GC-MS, after derivatising the bile alcohols and bile acids as trimethylsilyl ether and trimethylsilyl-methyl ester, respectively. Cholic acid (1) and chenodeoxycholic acid (2) were found as major bile acids in all three species. Major bile alcohol in these fish was cholesterol (4), which was not detected in freshwater specie (L. rohita). M. bagio was also found to contain 3αα,7α,12α-trihydroxy-23-cholesten-26-oic acid (3). Other bile acids and bile alcohols identified in L. rohita were allo deoxycholic acid (5), 12-oxo-3α-hydroxycholanic acid (6), 3α,7α,12α-trihydroxy-24-cholesten-26-oic acid (7), 5α- and 5ß-anhydrocyprinol (8 and 9, respectively) and 5ß-homocholane-3α,7α,12α-25-tetrol (10). Besides acting as emulsifying agent in the digestion process, in non-mammalian vertebrates, e.g., fish, reptiles, etc. the analytical and elucidative studies on the bile contents disclose the diversity in metabolic pathways of cholesterol and indicate the existence of molecular evolution in the basic C27 skeleton of cholesterol.

Medium optimization for the production of amylase by Bacillus subtilis RM16 in Shake-flask fermentation.

This study was carried out in shaking incubator and covers the optimization of culture conditions of Bacillus subtilis for the maximum production of amylase. Optimal activity was found to be 350 U ml(-1) when soluble starch was used as a substrate. Parameters taken into consideration to observe their effect on the optimum production of amylase include incubation time, incubation temperature, pH, inoculum size, carbon source, nitrogen source and metallic ions. All parameters were monitored in order to obtain high level of the enzyme units in cell-free broth. The established optimized conditions for Bacillus subtiliss train RM16 were found to be: incubation time 24 hours, temperature 40°C and pH 8.0. Inoculum size was 5%, starch (1%) as a carbon source while yeast extract (1.5%) as a nitrogen source. Magnesium ions (0.1%) exerted maximum stimulating effect for the production of amylase which can be further used at large scale applications.

Analyses of bile from gallbladders of Arius platystomus, Arius tenuispinis, Pomadasys commersonni and Kishinoella tonggol.

Bile from gallbladders of Arius platystomus (Singhara), Arius tenuispinis (Khagga), Pomadasys commersonni (Holoola) and Kishinoella tonggol (Dawan) were derivatised and analysed by GC-MS for identification of bile acids and bile alcohols. Cholic acid and Chenodeoxycholic acid were found as major bile acids in Arius platystomus, Arius tenuispinis and Pomadasys commersonni. Other bile acids identified in Arius platystomus were allochenodeoxycholic acid, allodeoxycholic acid, 3α,7α,12α-trihydroxy-24-methyl-5ß-cholestane-26-oic acid, and 3α,7α,12α, 24-tetrahydroxy-5α-cholestane-26-oic acid. Cholesterol was found as major bile alcohol in Arius platystomus, Arius tenuispinis and Pomadasys commersonni. Cholic acid was the major bile acid identified in the bile of Kishinoella tonggol while other bile acids included 3α,7α,12α-tridydroxy-5α-cholestanoic acid and 3α,7α,12α-tridydroxy-5ß-cholestanoic acid. Bile alcohol 5ß-cyprinol was present in significant amounts with 5ß-cholestane-3α,7α,12α,24-tetrol being the other contributors in the bile of Kishinoella tonggol.

Diagnostics for schistosomiasis in Africa and Arabia: a review of present options in control and future needs for elimination.

Within the World Health Organization 2012-2020 roadmap for control and elimination of schistosomiasis, the scale-up of mass drug administration with praziquantel is set to change the epidemiological landscape across Africa and Arabia. Central in measuring progress is renewed emphasis upon diagnostics which operate at individual, community and environmental levels by assessing reductions in disease, infections and parasite transmission. However, a fundamental tension is revealed between levels for present diagnostic tools, and methods applied in control settings are not necessarily adequate for application in elimination scenarios. Indeed navigating the transition from control to elimination needs careful consideration and planning. In the present context of control, we review current options for diagnosis of schistosomiasis at different levels, highlighting several strengths and weaknesses therein. Future challenges in elimination are raised and we propose that more cost-effective diagnostics and clinical staging algorithms are needed. Using the Kingdom of Saudi Arabia as a contemporary example, embedding new diagnostic methods within the primary care health system is discussed with reference to both urogenital and intestinal schistosomiasis.

Financing healthcare in Gulf Cooperation Council countries: a focus on Saudi Arabia.

BACKGROUND: This paper presents an analysis of the main characteristics of the Gulf Cooperation Council's (GCC) health financing systems and draws similarities and differences between GCC countries and other high-income and low-income countries, in order to provide recommendations for healthcare policy makers. The paper also illustrates some financial implications of the recent implementation of the Compulsory Employment-based Health Insurance (CEBHI) system in Saudi Arabia. METHODS: Employing a descriptive framework for the country-level analysis of healthcare financing arrangements, we compared expenditure data on healthcare from GCC and other developing and developed countries, mostly using secondary data from the World Health Organization health expenditure database. The analysis was supported by a review of related literature. RESULTS: There are three significant characteristics affecting healthcare financing in GCC countries: (i) large expatriate populations relative to the national population, which leads GCC countries to use different strategies to control expatriate healthcare expenditure; (ii) substantial government revenue, with correspondingly high government expenditure on healthcare services in GCC countries; and (iii) underdeveloped healthcare systems, with some GCC countries' healthcare indicators falling below those of upper-middle-income countries. CONCLUSION: Reforming the mode of health financing is vital to achieving equitable and efficient healthcare services. Such reform could assist GCC countries in improving their healthcare indicators and bring about a reduction in out-of-pocket payments for healthcare.

Annona squamosa Linn: cytotoxic activity found in leaf extract against human tumor cell lines.

Cancer is a common cause of death in human populations. Surgery, chemotherapy and radiotherapy still remain the corner stone of treatment. However, herbal medicines are gaining popularity on account of their lesser harmful side effects on non-targeted human cells and biological environment. Annona squamosa Linn is a common delicious edible fruit and its leaf have been used for the treatment in various types of diseases. The objective of present study is to determine the anticancer potential of the organic and aqueous extracts of leaf of Annona squamosa L. MTT (3-(4, 5-dimethylthiazole-2yl)-2, 5-biphenyl tetrazolium bromide) assay against hepatocellular carcinoma cell line BEL-7404, lung cancer line H460, human epidermoid carcinoma cell line KB-3-1, prostatic cancer cell line DU145, breast carcinoma cell line MDA-MB-435, and colon cancer cell line HCT-116 Human primary embryonic kidney cell line HEK293 as control were used for the study. The crude extract (Zcd) and Ethyl acetate extract (ZE) were found significant anticancer activity only on human epidermoid carcinoma cell line KB-3-1 and colon cancer cell line HCT-116.