Orchiepididymitis in the context of multisystem inflammatory syndrome in a child with Covid-19 from Syria: a very rare presentation for SARS-Cov-19 in children.

The coronavirus disease 2019 (COVID-19) is still striking the global population affecting all age groups. So far, many clinical features associated with COVID-19 illness remain under-identified, especially atypical manifestations. It is essential to characterize associated rare symptoms to better recognize complications. As severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes Multisystem Inflammatory Syndrome in children (MIS-C) in severe infection manifesting as a generalized inflammatory reaction and immune response in many body systems, potential involvement of the male urogenital tract by SARS-CoV-2 should be considered. Herein, we report a case of a pediatric patient with orchiepididymitis associated with COVID-19 infection, emphasizing the importance of considering other manifestations such as genital involvement of MIS-C in children with COVID-19 and highlighting the need to monitor the genitourinary function after infection. Therefore, andrological consultation is necessary to evaluate fertility as a long-term follow-up, especially as the effects of SARS-CoV-2 on male reproductive function are still to be thoroughly researched.

Training on the Practical Approach to Lung Health: effect on drug prescribing in PHC settings in Jordan.

This study assessed whether training physicians on the Practical Approach to Lung Health (PAL) reduces drug prescribing and the cost of drugs prescribed to respiratory patients in the primary health care setting. Data were compared before and after training general practitioners on standard guidelines for case management of respiratory conditions in primary care. A total of 56 general practitioners practising in 25 health centres in 3 out of 12 governorates of Jordan participated in both the baseline survey (n = 6260 respiratory patients) and the impact survey (n = 2709 patients). Training in PAL decreased by 12.2% the number of drugs prescribed per patient, increased the prescription of inhaled medications and reduced the mean cost of a drug prescription per patient by 8.7%.

Results of the feasibility test of the Practical Approach to Lung Health in the Syrian Arab Republic.

We assessed implementation of the Practical Approach to Lung Health (PAL) in primary care facilities in the Syrian Arab Republic and its short-term impact on respiratory care in patients aged 5+ years. After training on PAL for 76 general practitioners in 75 health centres, referrals and sputum smear examinations for patients increased. The mean number of drugs prescribed per patient decreased by 14.8% and that of antibiotics by 33.3%, while prescriptions for inhaled medications increased. The mean cost of drug prescriptions fell by 26.2%.

Impact of the uranium (VI) speciation in mineralised urines on its extraction by calix[6]arene bearing hydroxamic groups used in chromatography columns.

Actinides determination in urine samples is part of the analyses performed to monitor internal contamination in case of an accident or a terrorist attack involving nuclear matter. Mineralisation is the first step of any of these analyses. It aims at reducing the sample volume and at destroying all organic compounds present. The mineralisation protocol is usually based on a wet ashing step, followed by actinides co-precipitation and a furnace ashing step, before redissolution and the quantification of the actinides by the appropriate techniques. Amongst the existing methods to perform the actinides co-precipitation, alkali-earth (typically calcium) precipitation is widely used. In the present work, the extraction of uranium(VI), plutonium(IV) and americium(III) from the redissolution solutions (called "mineralised urines") on calix[6]arene columns bearing hydroxamic groups was investigated as such an extraction is a necessary step before their determination by ICP-MS or alpha spectrometry. Difficulties were encountered in the transfer of uranium(VI) from raw to mineralised urines, with yield of transfer ranging between 0% and 85%, compared to about 90% for Pu and Am, depending on the starting raw urines. To understand the origin of such a difficulty, the speciation of uranium (VI) in mineralised urines was investigated by computer simulation using the MEDUSA software and the associated HYDRA database, compiled with recently published data. These calculations showed that the presence of phosphates in the "mineralised urines" leads to the formation of strong uranyl-phosphate complexes (such as UO2HPO4) which compete with the uranium (VI) extraction by the calix[6]arene bearing hydroxamic groups. The extraction constant of uranium (VI) by calix[6]arene bearing hydroxamic groups was determined in a 0.04 mol L(-1) sodium nitrate solution (logK=4.86±0.03) and implemented in an extraction model taking into account the speciation in the aqueous phase. This model allowed to simulate satisfactorily the experimental uranium extraction data and to support the preliminary conclusions about the role of the phosphates present in mineralised urines. These calculations also showed that the phosphate/calcium ratio is a key parameter as far as the efficiency of the uranium (VI) extraction by the calix[6]arene columns is concerned. It predicted that the addition of CaCl2 in mineralised urines would release uranium (VI) from phosphates by forming calcium (II)-phosphate complexes and thus facilitate the uranium (VI) extraction on calix[6]arene columns. These predictions were confirmed experimentally as the addition of 0.1 mol L(-1) CaCl2 to a mineralised urine containing naturally a high concentration of phosphate (typically 0.04 mol L(-1)) significantly increased the percentage of uranium (VI) extraction on the calix[6]arene columns.

Tuberculosis case finding in twenty-two countries of the Eastern Mediterranean Region.

A hypothetical model has been developed to evaluate the efficiency of the case-finding process in 22 countries of the Eastern Mediterranean Region. The model is based on the patient's pathway to care in a stepwise approach from the community to the tuberculosis (TB) management units. Performance was measured using indicators for each of the components of the Stop TB strategy, and a scoring system was developed. The indicators significantly associated with TB case detection were then reported. This tool can assist countries in evaluating the efficiency of their surveillance system in detecting cases.

Induction of labour: how close to the evidence-based guidelines are we?

The aim of this study was to assess the indications and methods used for induction of labour (IOL), to determine whether induction was performed as per local guidelines, to ensure the Royal College of Obstetricians and Gynaecologists/National Institute for Clinical Excellence (RCOG/NICE) guidelines were adhered to within the department and finally, identify areas for improvement in women's care. We retrospectively analysed 95 cases of IOL managed between 1 May and 30 June 2003 at City Hospital, Birmingham, UK. A total of 95 out of 569 (16.7%) deliveries were induced over the period of study. Indications for IOL and their documentation in the case-notes showed 60 - 70% compliance with guidelines. Pre-IOL cervical ripening with prostaglandin E2 (PGE2) was performed in 42 cases out of 65, showing 64.6% compliance with guidelines. All cases who had pre-IOL cervical ripening with PGE2 were closely monitored during ripening, showing 100% compliance. A total of 79 cases out of 95 (83.2%) achieved vaginal delivery. However, eight of those (8.4%) required instrumental delivery. More than 50% of women delivered within 12 h of starting IOL. Five cases (5.3%) had failed IOL. The overall caesarean section (CS) rate was 16.8%. Maternal and fetal complications were relatively uncommon during the study period. Uterine hyperstimulation was reported in only one case (1.1%) in this study. Full compliance with evidence-based guidelines was achieved in some aspects of this audit, while other aspects showed no or little compliance. IOL is an effective and safe intervention in modern obstetric practice. Regardless of cervical status and parity, vaginal delivery can be anticipated in the majority of women undergoing labour induction.

Dental erosion, soft-drink intake, and oral health in young Saudi men, and the development of a system for assessing erosive anterior tooth wear.

The aim of the study was to investigate some aspects of the oral health of male Saudi military inductees with special reference to soft-drink consumption, dental erosion, caries and fluorosis prevalences; a second aim of the study was to develop a system for assessing dental erosion. The material comprised a random selection of 95 individuals with a mean age of 20.9 years (range, 19-25 years). A questionnaire survey was made of each individual's dietary and oral hygiene habits and general and oral health, in addition to clinical, study cast, radiographic, and photographic examinations. The results showed that soft-drink consumption in the sample (x = 247 1/year) far exceeded that found in Western populations and that professional and self-administered dental care were generally scant. Twenty-eight percent of the maxillary anterior teeth showed pronounced dental erosion. Fluorosis was a common finding, and the number of untreated carious cavities was high. DMFT (mean = 10.0; DT = 7.7; MT = 0.5; FT = 1.8) and DMFS (mean = 18.3; DS = 12.6; MS = 2.5; FS = 3.2) were higher than those of comparable Western populations and showed an approximately threefold increase over a period of about 18 years as compared with that previously reported in a similar Saudi sample. In view of the high frequencies of dental erosion, untreated carious cavities, and fluorosis reported here and the strong indication of an increasing caries prevalence, the need for serious recognition of the implications in the planning of future dental health care program is stressed.

Dental erosion associated with soft-drink consumption in young Saudi men.

This study reports on the causative factors of dental erosion in selected high- (n = 19) and low-erosion (n = 19) subgroups of a larger random sample (n = 95) of young male Saudi military inductees. By means of a questionnaire, the role of various possible factors related to oral health in general, and to dental erosion in particular, was assessed for each participant. Clinical examination included recordings of severity of dental erosion and fluorosis, presence of buccal cervical defects and first permanent molar 'cuppings', DMFT and DMFS, visible plaque index, and gingival bleeding index. In addition, bitewing radiographs, study casts, and intraoral color transparencies were obtained for each individual. Logistic regression analysis showed a strong correlation between the presence of dental erosion and a high level of consumption of cola-type soft drinks. Other statistically significant associated factors, although of less predictive strength, were type of cleaning aid and gingival bleeding index. In subgroup comparisons, dental problems (primarily pain), number of buccal cervical defects, and number of missing teeth were significantly greater in the high- than in the low-erosion subgroup.

Training on the Practical Approach to Lung Health: effect on drug prescribing in PHC settings in Jordan

This study assessed whether training physicians on the Practical Approach to Lung Health [PAL] reduces drug prescribing and the cost of drugs prescribed to respiratory patients in the primary health care setting. Data were compared before and after training general practitioners on standard guidelines for case management of respiratory conditions in primary care. A total of 56 general practitioners practising in 25 health centres in 3 out of 12 governorates of Jordan participated in both the baseline survey [n = 6260 respiratory patients] and the impact survey [n = 2709 patients]. Training in PAL decreased by 12.2% the number of drugs prescribed per patient, increased the prescription of inhaled medications and reduced the mean cost of a drug prescription per patient by 8.7%

Results of the feasibility test of the Practical Approach to Lung Health in the Syrian Arab Republic

We assessed implementation of the Practical Approach to Lung Health [PAL] in primary care facilities in the Syrian Arab Republic and its short-term impact on respiratory care in patients aged 5+ years. After training on PAL for 76 general practitioners in 75 health centers, referrals and sputum smear examinations for patients increased. The mean number of drugs prescribed per patient decreased by 14.8% and that of antibiotics by 33.3%, while prescriptions for inhaled medications increased. The mean cost of drug prescriptions fell by 26.2%