An Unusually Massive Hemorrhagic Superficial Infrapatellar Bursa Excised in a One-stage Procedure: Case Report.

Introduction: Superficial infrapatellar bursitis may be traumatic, inflammatory, or infectious. It rarely attains massive dimensions. Open excision can be performed as a one-stage or a two-stage procedure, and endoscopy can be an alternative. We report a chronic, unusually massive, hemorrhagic infrapatellar bursa which we resected totally in a single stage procedure with no significant complications. Case Report: A 65-year-old male farmer presented with a chronic massive swelling in front of the right knee which first appeared 4 years earlier and had no effect on his general condition. The mass was excised in a one-stage procedure and it was found to be a hemorrhagic bursitis. The wound healed uneventfully and, on follow-up 7 weeks later, the patient was able to perform full flexion and extension of the knee. Conclusion: Two-stage procedures for excision are effective, but one-stage procedures are equally effective in chronic cases, provided the dissection is performed meticulously and atraumatically.

Critical Analysis and Optimization of Stoichiometric Ratio of Drug-Coformer on Cocrystal Design: Molecular Docking, In Vitro and In Vivo Assessment.

In this present research, an attempt has been made to address the influence of drug-coformer stoichiometric ratio on cocrystal design and its impact on improvement of solubility and dissolution, as well as bioavailability of poorly soluble telmisartan. The chemistry behind cocrystallization and the optimization of drug-coformer molar ratio were explored by the molecular docking approach, and theoretical were implemented practically to solve the solubility as well as bioavailability related issues of telmisartan. A new multicomponent solid form, i.e., cocrystal, was fabricated using different molar ratios of telmisartan and maleic acid, and characterized by SEM, DSC and XRD studies. The molecular docking study suggested that specific molar ratios of drug-coformer can successfully cluster with each other and form a specific geometry with favourable energy conformation to form cocrystals. Synthesized telmisartan-maleic acid cocrystals showed remarkable improvement in solubility and dissolution of telmisartan by 9.08-fold and 3.11-fold, respectively. A SEM study revealed the formation of cocrystals of telmisartan when treated with maleic acid. DSC and XRD studies also confirmed the conversion of crystalline telmisartan into its cocrystal state upon treating with maleic acid. Preclinical investigation revealed significant improvement in the efficacy of optimized cocrystals in terms of plasma drug concentration, indicating enhanced bioavailability through improved solubility as well as dissolution of telmisartan cocrystals. The present research concluded that molecular docking is an important path in selecting an appropriate stoichiometric ratio of telmisartan: maleic acid to form cocrystals and improve the solubility, dissolution, and bioavailability of poorly soluble telmisartan.

Impacts of supplemental Ginkgo biloba oil on broilers' growth, blood indices, intestinal and hepatic morphology and expression of growth-related genes.

The current work examined the impact of Ginkgo biloba oil (GBO) on growth performance, some biochemical parameters, intestinal and hepatic morphology, economic efficiency and expression of some growth-related genes in broiler chickens. A total of 135 chicks (Cobb 500) were allotted into three groups with 3 replications (15 birds/replicate). The experimental groups included: G1 (control), G2 and G3 were supplemented with GBO in the drinking water (0.25 and 0.5 cm/L), respectively. The GBO was added to the drinking water only for 3 successive weeks. Compared to the other groups, supplementation with 0.25 cm/L GBO significantly (P ≤ 0.05) increased final body weight, overall weight gain, feed intake and water consumption. When 0.25 cm GBO/L was added, that group significantly differed in intestinal villus length (P ≤ 0.05). Birds received 0.25 cm GBO/L had significantly greater blood total albumin and total protein concentrations (P ≤ 0.05), while birds given 0.5 cm GBO/L had higher serum cholesterol and LDL concentrations (P ≤ 0.05). The cost parameters were significantly higher (P ≤ 0.05) in the 0.25 cm GBO/L supplemented group, which exhibited higher total return and net profit. The addition of 0.25 cm GBO/L resulted in higher expression of antioxidant enzymes and insulin-like growth factor while inhibiting the expression of Myostatin in muscles (P < 0.05) compared to the control and those received 0.5 cm GBO/L. In conclusion, broiler chickens that received 0.25 cm GBO/L for 3 consecutive days per week had better performance, intestinal morphology, profitability, and antioxidant status than the control birds.

Characterization and Biodegradation of Phenol by Pseudomonas aeruginosa and Klebsiella variicola Strains Isolated from Sewage Sludge and Their Effect on Soybean Seeds Germination.

Phenols are very soluble in water; as a result, they can pollute a massive volume of fresh water, wastewater, groundwater, oceans, and soil, negatively affecting plant germination and animal and human health. For the detoxification and bioremediation of phenol in wastewater, phenol biodegradation using novel bacteria isolated from sewage sludge was investigated. Twenty samples from sewage sludge (SS) were collected, and bacteria in SS contents were cultured in the mineral salt agar (MSA) containing phenol (500 mg/L). Twenty colonies (S1 up to S20) were recovered from all the tested SS samples. The characteristics of three bacterial properties, 16S rDNA sequencing, similarities, GenBank accession number, and phylogenetic analysis showed that strains S3, S10, and S18 were Pseudomonas aeruginosa, Klebsiella pneumoniae, and Klebsiella variicola, respectively. P. aeruginosa, K. pneumoniae, and K. variicola were able to degrade 1000 mg/L phenol in the mineral salt medium. The bacterial strains from sewage sludge were efficient in removing 71.70 and 74.67% of phenol at 1000 mg/L within three days and could tolerate high phenol concentrations (2000 mg/L). The findings showed that P. aeruginosa, K. pneumoniae, and K. variicola could potentially treat phenolic water. All soybean and faba bean seeds were germinated after being treated with 250, 500, 750, and 1000 mg/L phenol in a mineral salt medium inoculated with these strains. The highest maximum phenol removal and detoxification rates were P. aeruginosa and K. variicola. These strains may help decompose and detoxify phenol from industrial wastewater with high phenol levels and bioremediating phenol-contaminated soils.

Impact of Positive Culture Reports of E. coli or MSSA on De-Escalation of Antibiotic Use in a Teaching Hospital in Pakistan and the Implications.

Background: Antibiotic de-escalation is a key element of antimicrobial stewardship programs that restrict the spread and emergence of resistance. This study was performed to evaluate the impact of positive culture sensitivity reports of E. coli or Methicillin sensitive Staphylococcus aureus (MSSA) on de-escalation of antibiotic therapy. Methods: This prospective observational study was performed on 256 infected patients. The samples were obtained principally from the pus of infected sites for the identification of pathogens and culture-sensitivity testing. The data were collected from patient medical files, which included their demographic data, sample type, causative microbe and antimicrobial treatment as empiric or definitive treatment based on cultures. Data were analyzed using SPSS. Results: Of 256 isolated microbes, 138 (53.9%) were MSSA and 118 were E. coli (46.1%). MSSA showed 100% sensitivity to cefoxitin, oxacillin, vancomycin, fosfomycin, colistin and more than 90% to linezolid (95.3%), tigecycline (93.1%), chloramphenicol (92.2%) and amikacin (90.2%). E. coli showed 100% sensitivity to only fosfomycin and more than 90% to colistin (96.7%), polymyxin-B (95.1%) and tigecycline (92.9%). The high use of cefoperazone+sulbactam (151), amikacin (149), ceftriaxone (33), metronidazole (30) and piperacillin + tazobactam (22) was seen with empiric prescribing. Following susceptibility testing, the most common antibiotics prescribed for E. coli were meropenem IV (34), amikacin (34), ciprofloxacin (29) and cefoperazone+sulbactam (25). For MSSA cases, linezolid (48), clindamycin (30), cefoperazone+ sulbactam IV (16) and amikacin (15) was used commonly. Overall, there was 23% reduction in antibiotic use in case of E. coli and 43% reduction in MSSA cases. Conclusion: Culture sensitivity reports helped in the de-escalation of antimicrobial therapy, reducing the prescribing of especially broad-spectrum antibiotics. Consequently, it is recommended that local hospital guidelines be developed based on local antimicrobial susceptibility patterns while preventing the unnecessary use of broad-spectrum antibiotics for empiric treatment.

Increased Levels of Autoantibodies against ROS-Modified Proteins in Depressed Individuals with Decrease in Antibodies against SARS-CoV-2 Antigen (S1-RBD).

Coronavirus 2019 (COVID-19) disease management is highly dependent on the immune status of the infected individual. An increase in the incidence of depression has been observed during the ongoing COVID-19 pandemic. Autoantibodies against in vitro reactive oxygen species (ROS) modified BSA and Lys as well as antibodies against receptor binding domain subunit S1 (S1-RBD) (S1-RBD-Abs) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were estimated using direct binding and competition ELISA. Serum samples were also tested for fasting blood glucose (FBG), malondialdehyde (MDA), carbonyl content (CC), interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α). Significant structural changes were observed in ROS modified BSA and Lys. Female depressed subjects who were also smokers (F-D-S) showed the highest levels of oxidative stress (MDA and CC levels). Similarly, increased levels of autoantibodies against ROS modified proteins were detected in F-D-S subjects, in males who were depressed and in smokers (M-D-S) compared to the other subjects from the rest of the groups. However, contrary to this observation, levels of S1-RBD-Abs were found to be lowest in the F-D-S and M-D-S groups. During the pandemic, large numbers of individuals have experienced depression, which may induce excessive oxidative stress, causing modifications in circulatory proteins. Thus, the formation of neo-antigens is induced, which lead to the generation of autoantibodies. The concomitant effect of increased autoantibodies with elevated levels of IFN-γ and TNF-α possibly tilt the immune balance toward autoantibody generation rather than the formation of S1-RBD-Abs. Thus, it is important to identify individuals who are at risk of depression to determine immune status and facilitate the better management of COVID-19.

Seroprevalence of Anti-S1-RBD Antibodies in Pre-pandemic and Pandemic Subjects From Hail Region, KSA.

Background: Two years into the pandemic, yet the threat of new SARS-CoV-2 variants continues to loom large. Sustained efforts are required to fully understand the infection in asymptomatic individuals and those with complications. Identification, containment, care, and preventative strategies rely on understanding the varied humoral immune responses. Methods: An in-house ELISA was developed and standardized to screen for serum IgG antibodies against the SARS-CoV-2 S1-RBD protein as an antigen. This study aims to investigate the seroprevalence of serum antibodies against S1-RBD antigen in pre-pandemic (n = 120) and during the early pandemic period (n = 120) in subjects from the Hail region, KSA and to correlate it with clinical and demographic factors. Results: Samples collected from both male (n = 60) and female (n = 60) subjects during the pandemic in the age groups of 20-40 (0.31 ± 0.029 and 0.29 ± 0.024, respectively) and 41-60 years (0.35 ± 0.026 and 0.30 ± 0.025, respectively) showed significantly higher levels of serum antibodies against S-RBD antigen than the age-matched pre-pandemic samples [male (n = 60) and female (n = 60)]. Pandemic subjects exhibited significantly (p < 0.01) higher inhibition (80-88%) than age-matched pre-pandemic subjects (32-39%). Antibodies against S1-RBD antigen were detected in approximately 10% of the total pre-pandemic population (males and females). However, subjects > 60 years did not show antibodies. Conclusion: Antibody levels increased in samples collected during the pandemic, even though these subjects were not clinically COVID-19 positive. A small number of pre-pandemic subjects showed serum antibodies, suggesting prior exposure to other coronaviruses in the region. With dwindling neutralizing antibody levels and reduced vaccine efficacy against newer variants, it remains crucial to develop better assays for surveillance, management, and future research.

Tolmetin Sodium Fast Dissolving Tablets for Rheumatoid Arthritis Treatment: Preparation and Optimization Using Box-Behnken Design and Response Surface Methodology.

Tolmetin sodium (TLM) is a non-steroidal anti-inflammatory drug (NSAIDs). TLM is used to treat inflammation, skeletal muscle injuries, and discomfort associated with bone disorders. Because of the delayed absorption from the gastro intestinal tract (GIT), the currently available TLM dosage forms have a rather protracted start to the effect, according to pharmacokinetic studies. The aim of this study was to create a combination for TLM fast dissolving tablets (TLM-FDT) that would boost the drug's bioavailability by increasing pre-gastric absorption. The TLM-FDTs were developed using a Box-Behnken experimental design with varied doses of crospovidone (CP), croscarmellose sodium (CCS) as super-disintegrants, and camphor as a sublimating agent. In addition, the current study used response surface approach to explore the influence of various formulation and process factors on tablet qualities in order to verify an optimized TLM-FDTs formulation. The optimized TLM-FDTs formula was subsequently evaluated for its in vivo anti-inflammatory activity. TLM-FDTs have good friability, disintegration time, drug release, and wetting time, as well as fast disintegration and dissolution behavior. Significant increase in drug bioavailability and reliable anti-inflammatory efficacy were also observed, as evidenced by considerable reductions in paw thickness in rats following carrageenan-induced rat paw edema. For optimizing and analyzing the effect of super-disintegrants and sublimating agents in the TLM-FDTs formula, the three-factor, three-level full factorial design is a suitable tool. TLM-FDTs are a possible drug delivery system for enhancing TLM bioavailability and could be used to treat rheumatoid arthritis.

Aescin Protects against Experimental Benign Prostatic Hyperplasia and Preserves Prostate Histomorphology in Rats via Suppression of Inflammatory Cytokines and COX-2.

BACKGROUND: Benign prostatic hyperplasia (BPH) is the most common urogenital condition in aging males, while inflammation and tissue proliferation constitute the main pathophysiological factors. The adverse effects of currently available BPH medications limit patient compliance. We tested the protective effect of aescin against the development of BPH in rats. METHODS: A total of 18 male Wistar rats were divided into 3 groups: control (sesame oil 1 mL/kg, s.c.); BPH (testosterone oenanthate 3 mg/kg, s.c., in sesame oil), and BPH-aescin rats (testosterone oenanthate 3 mg/kg, s.c. + aescin 10 mg/kg/day, p.o.). All treatments continued for 4 weeks. Serum and prostatic samples were harvested for biochemical and histopathological examination. RESULTS: Induction of BPH by testosterone increased the prostate weight and prostate weight index, serum testosterone, prostate expression of inflammatory (IL-1ß, TNF-α, and COX-2), and proliferative markers (PCNA and TGF-ß1). Concurrent treatment with aescin decreased the testosterone-induced increase in prostatic IL-1ß, TNF-α, and COX-2 expression by 47.9%, 71.2%, and 64.4%, respectively. Moreover, aescin reduced the prostatic proliferation markers TGF-ß1 and PCNA by 58.3% and 71.9%, respectively, and normalized the prostate weight. CONCLUSION: The results of this study showed, for the first time, that aescin protected against the development of experimental BPH in rats via its anti-inflammatory and antiproliferative effects. These findings warrant further studies to clinically repurpose aescin in the management of BPH.

Point Prevalence Survey of Antimicrobial Use during the COVID-19 Pandemic among Different Hospitals in Pakistan: Findings and Implications.

The COVID-19 pandemic has significantly influenced antimicrobial use in hospitals, raising concerns regarding increased antimicrobial resistance (AMR) through their overuse. The objective of this study was to assess patterns of antimicrobial prescribing during the current COVID-19 pandemic among hospitals in Pakistan, including the prevalence of COVID-19. A point prevalence survey (PPS) was performed among 11 different hospitals from November 2020 to January 2021. The study included all hospitalized patients receiving an antibiotic on the day of the PPS. The Global-PPS web-based application was used for data entry and analysis. Out of 1024 hospitalized patients, 662 (64.64%) received antimicrobials. The top three most common indications for antimicrobial use were pneumonia (13.3%), central nervous system infections (10.4%) and gastrointestinal indications (10.4%). Ceftriaxone (26.6%), metronidazole (9.7%) and vancomycin (7.9%) were the top three most commonly prescribed antimicrobials among surveyed patients, with the majority of antibiotics administered empirically (97.9%). Most antimicrobials for surgical prophylaxis were given for more than one day, which is a concern. Overall, a high percentage of antimicrobial use, including broad-spectrums, was seen among the different hospitals in Pakistan during the current COVID-19 pandemic. Multifaceted interventions are needed to enhance rational antimicrobial prescribing including limiting their prescribing post-operatively for surgical prophylaxis.

Effect of Imipenem and Amikacin Combination against Multi-Drug Resistant Pseudomonas aeruginosa.

Pseudomonas aeruginosa is an opportunistic nosocomial pathogen associated with high morbidity and mortality rates. Combination of antibiotics has been found to combat multi-drug resistant or extensively drug resistance P. aeruginosa. In this study we investigate the in vitro and in vivo effect of amikacin and imipenem combination against resistant P. aeruginosa. The checkerboard technique and time-killing curve have been performed for in vitro studies showed synergistic effect for combination. A peritonitis mouse model has been used for evaluation of the therapeutic efficacy of this combination which confirmed this synergistic effect. The in vitro and in vivo techniques showed synergistic interaction between tested drugs with fractional inhibitory concentration indices (FICIs) of ≤0.5. Conventional PCR and quantitative real-time PCR techniques were used in molecular detection of bla IMP and aac(6')-Ib as 35.5% and 42.2% of P. aeruginosa harbored bla IMP and aac(6')-Ib respectively. Drug combination viewed statistically significant reduction in bacterial counts (p value < 0.5). The lowest bla IMP and aac(6')-Ib expression was observed after treatment with 0.25 MIC of imipenem + 0.5 MIC of amikacin. Morphological changes in P. aeruginosa isolates were detected by scanning electron microscope (SEM) showing cell shrinkage and disruption in the outer membrane of P. aeruginosa that were more prominent with combination therapy than with monotherapy.

Biosynthesis and Anti-Mycotoxigenic Activity of Zingiber officinale Roscoe-Derived Metal Nanoparticles.

Mycotoxigenic fungi have attracted special attention due to their threat to food security and toxicity to human health. Aqueous extract of Zingiber officinale Roscoe was used as reducing and capping agent for the synthesis of silver (AgNPs), copper (CuNPs), and zinc oxide (ZnONPs) nanoparticles. UV-Visible spectra of the AgNPs, CuNPs, and ZnONPs showed absorption peaks at λmax 416 nm, 472 nm, and 372 nm, respectively. Zeta potential of AgNPs, CuNPs, and ZnONPs were -30.9, -30.4 and -18.4 mV, respectively. ZnONPs showed the highest activity against Aspergillus awamori ZUJQ 965830.1 (ZOI 20.9 mm and MIC 24.7 µg/mL). TEM micrographs of ZnONPs-treated A. awamori showed cracks and pits in the cell wall, liquefaction of the cytoplasmic content, making it less electron-dense. The sporulation and ochratoxin A production of A. awamori was inhibited by ZnONPs in a concentration-dependent pattern. The inhibition percentage of OTA were 45.6, 84.78 and 95.65% for 10, 15, 20 of ZnONPs/mL, respectively.

Poloxamer-188 and d-α-Tocopheryl Polyethylene Glycol Succinate (TPGS-1000) Mixed Micelles Integrated Orodispersible Sublingual Films to Improve Oral Bioavailability of Ebastine; In Vitro and In Vivo Characterization.

Orodispersible sublingual films (OSFs) composed of hydrophilic polymers were loaded with poloxamer-188 and d-α-tocopheryl polyethylene glycol succinate (TPGS-1000) mixed micelles to improve the oral bioavailability of a poorly soluble drug, ebastine (EBT). Mixed micelles formed by thin-film hydration method were incorporated into orodispersible sublingual film, consisting of HPMC and glycerol, using solvent casting technique. The mixed micelles and films were thoroughly evaluated for physicochemical characterization (size, polydispersity index, zeta potential, entrapment efficiency, thickness, weight, surface pH studies, disintegration time, swelling indices, mechanical properties, FTIR, PXRD, DSC, SEM, AFM, in vitro drug release, in vivo bioavailability, and toxicological studies). The results showed that the average particle size of mixed micelles was 73 nm. The mean zeta potential and PDI of the optimal mixed micelles formulation were -26 mV and 0.16, respectively. Furthermore, the maximum entrapment efficiency 82% was attained. The film's disintegration time was in the range of 28 to 102 s in aqueous media. The integrity of micelles was not affected upon incorporation in films. Importantly, the micelles-loaded films revealed rapid absorption, high permeability, and increased bioavailability of EBT as compared to the pure drug. The existence of ebastine loaded mixed micelles in the films enhanced the bioavailability about 2.18 folds as compared to pure drug. Further, the results evidently established in-vitro and in-vivo performance of bioavailability enhancement, biocompatibility, and good safety profile of micelles-loaded orodispersible EBT films. Finally, it was concluded that film loaded with poloxamer-188/TPGS-1000 mixed micelles could be an effective carrier system for enhancing the bioavailability of ebastine.

Thoracic fluid content: a novel parameter for predicting failed weaning from mechanical ventilation.

BACKGROUND: Weaning of patients from the mechanical ventilation remains one of the critical decisions in intensive care unit. This study aimed to evaluate the accuracy of thoracic fluid content (TFC) as a predictor of weaning outcome. METHODS: An observational cohort study included 64 critically ill surgical patients who were eligible for extubation. Before initiating the spontaneous breathing trial, the TFC was measured using the electrical cardiometry technology. Patients were followed up after extubation and divided into successful weaning group and failed weaning group. Both groups were compared according to respiratory and cardiovascular parameters. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of TFC to predict weaning outcome. RESULTS: The number of successfully weaned patients was 41/64 (64%). Twenty (31%) patients had impaired cardiac contractility, and of them, 13/20 (64%) patients were successfully extubated. Both groups, successful weaning group and failed weaning group, were comparable in most of baseline characteristics; however, the TFC was significantly higher in the failed weaning group compared to the successful weaning group. The area under the ROC curves (AUCs) showed moderate predictive ability for the TFC in predicting weaning failure (AUC [95% confidence interval] 0.69 [0.57-0.8], cutoff value > 50 kΩ-1), while the predictive ability of TFC was excellent in the subgroup of patients with ejection fraction < 40% (AUC [95% confidence interval 0.93 [0.72-1], cutoff value > 50 kΩ-1). CONCLUSIONS: Thoracic fluid content showed moderate ability for predicting weaning outcome in surgical critically ill patients. However, in the subgroup of patients with ejection fraction less than 40%, TFC above 50 kΩ-1 has an excellent ability to predict weaning failure.

Patient Satisfaction and Their Willingness to Pay for a Pharmacist Counseling Session in Hospital and Community Pharmacies in Saudi Healthcare Settings.

OBJECTIVE: Patient satisfaction is an indicator for quality of healthcare service and is sometimes linked to patients' willingness to pay. Willingness to pay is an economic method for estimating patient's inclination for a service in monetary terms. This study assessed satisfaction of patients from pharmacist counseling service and estimated their willing to pay for the same. METHODS: A month-long survey was conducted in community and hospital pharmacies located in Khobar, Dammam, and Qatif cities of Saudi Arabia, using Arabic version of Patient Satisfaction Feedback (PSF) questionnaire that measured satisfaction with counseling as well as willingness-to-pay. Convenient sampling method was used, and sample size was calculated based on power analysis. Data was analyzed through SPSS version 23. Chi-square (χ2) test and logistic regression analyses were conducted to report associations between variables and, determinants of satisfaction as well as willingness to pay respectively. The study was approved by concerned ethical committee (IRB-2019-05-020). RESULTS: Patients (n = 531) with previous counseling experience were more likely to be satisfied [adjusted odds ratio (AOR) 5.2, p < 0.05]. Patients were more willing to pay if, they had an income above SAR 10,000 i.e., USD 2666.5 (AOR 1.78, p < 0.05), were satisfied with counseling time duration (AOR 4.5) and, were able to get counseling without difficulty (AOR 2.1, p < 0.05). Patients were more likely to be satisfied and were willing to pay if, they received required knowledge/information completely (AOR 2.5, 3.7, and p < 0.05) and found pharmacist helpful (AOR 1, 4.5, and p < 0.05). Most patients (43.9%) were satisfied with pharmacist counseling and average satisfaction rating was 7.87 ± 1.99/10. CONCLUSION: Patients considered counseling as an important service and were satisfied from it. Less than a third of patients were willing to pay for the service. Knowledge and helpfulness of pharmacist were identified as two major determinants that could not only satisfy and but also promote willingness to pay for the service. A pharmacist with skills in pharmaceutical care and counseling could be useful in promoting the service and making it profitable for pharmacy business.

Assessment of Medication Adherence in Saudi Patients With Type II Diabetes Mellitus in Khobar City, Saudi Arabia.

Objective: Medication adherence is defined as taking medications as advised and prescribed by health care professionals for stated duration. Diabetes mellitus (DM) is one of the most common chronic illnesses in Saudi Arabia. This study aimed to document medication adherence in Saudi patients with type 2 diabetes. Methods: A quantitative cross-sectional study was conducted in Saudi out-patients with type 2 DM in the city of Khobar, Saudi Arabia. The study used the General Medication Adherence Scale (GMAS) to document medication adherence in this population. Data was analyzed through SPSS version 23. Study was ethically approved. Results: Data was collected from 212 patients. Few patients (35.8%) had high adherence to anti diabetic medications. The correlation between HbA1c level and adherence score was negative and significantly strong (ρ = -0.413, p < 0.0001). Most patients (N = 126, 59.4%) modified their medication therapy during month of Ramadan and on Eid occassion. Education level was not a determinant of adherence in this population. Conclusion: This study highlighted that medication adherence is influenced by religious and social factors. Patient counseling is required to improve patient beliefs and increase awareness of adhering to prescribed anti diabetic pharmacotherapy. A pharmacist can play constructive role of a disease educator and patient counselor.

Reliability of focused cardiac ultrasound performed by first-year internal medicine residents at a community hospital after a short training.

The use of bedside ultrasound over the past few decades has created a new wave of options for visualizing pathological processes allowing for faster and better detection of disease. We aimed to evaluate the reliability of focused cardiac ultrasound (FCU) performed by first-year internal medicine residents at a community hospital after a short period of training. They received a two-hour lecture and initially performed a supervised FCU followed by ten unsupervised/independent FCUs each. The four parameters that were assessed were left systolic ventricular function, right systolic ventricular function, presence of pericardial effusion, and presence of IVC dilation. Interpretation and analysis of ultrasound images were then carried out by both the residents and an attending physician with expertise in FCU analysis and interpretation. Cohen's Kappa values were obtained comparing the results found by the interns versus the attending. Our findings indicate that more training is required for reliable analysis of FCU by first-year medical residents. Our results also emphasize the need to carefully evaluate the medical residents' FCU skills after the training.

Associated Antenatal Health Risk Factors with Incidence of Toxoplasmosis in Egyptian Pregnant Women.

BACKGROUND AND OBJECTIVE: The major maternal toxoplasmosis infection during pregnancy is regularly related to trans-placental transmission to the embryo and newly-borne child. This cross-section study was performed to investigate the prevalence of toxoplasmosis among pregnant women attending antennal health centers. MATERIALS AND METHODS: The IgM antibodies against Toxoplasma were quantitatively determined by commercially available kits, while IgG antibodies and avidity (AV) of Toxoplasma gondii-specific IgG antibodies were quantitatively determined by using of conventional ELISA. RESULTS: The overall seroprevalence of T. gondii IgM among the investigated pregnant women was much higher than toxoplasma IgG with low IgG avidity representing acute infection with possibility of risk to the mother, embryo and newly-borne child. Results also showed that highest Toxoplasma prevalence was among pregnant women with history of intake of immunosuppressive drugs and abortion, having cats and animals in their households and in the 1st and 2nd trimesters. CONCLUSION: The high infection prevalence of T. gondii among the Egyptian pregnant women in Giza governorate revealed the risk of premature termination of pregnancy due to exposure of T. gondii infection.

Pre-harvest application of calcium chloride and chitosan on fruit quality and storability of 'Early Swelling' peach during cold storage / Efeito da aplicação pré-colheita de cloreto de cálcio e quitosano na qualidade e no armazenamento de frutos de pessegueiro da variedade 'Early Swelling' durante o armazenamento a frio

ABSTRACT Studies related with the storage of peach fruits have received great relevance in Egypt. In this study, the effect of pre-harvest sprays of calcium chloride and chitosan, separately and in combination, on quality attributes and storability of peach fruits stored at 0±1 °C was studied. 'Early Swelling' peach trees were sprayed twice with 1% or 2% calcium chloride. The first spraying was at pea stage, while the second one was performed at 10 days before harvesting. Chitosan sprays were performed at 0.5 or 1%, alone or in combination with 1 and 2% calcium chloride, at 10 days before harvesting. Untreated trees served as control. Fruits were harvested at maturity stage, then packaged and stored at 0±1 °C and 85-90% of relative humidity. Fruit physical and chemical properties were evaluated at 7-day intervals. Results showed that pre-harvest application with 2% CaCl2+1% chitosan was most effective in minimizing weight loss (%) and decay (%), as well as in maintaining maximum firmness and lengthening shelf life. Fruit color was not affected by any of the treatments, while untreated fruits and calcium chloride treatment alone, at both applied concentrations, maintained higher total soluble solids (TSS, %), total phenolic content, and lower titratable acidity percentage.

RESUMO Estudos relacionados ao armazenamento de pêssego tem sido considerado de grande relevância no Egito. Neste estudo, o efeito da pulverização pré-colheita com cloereto de calico e quitosano, isoladamente ou em conjunto, na qualidade e na capacidade de armazenamento de frutos de pessegueiro armazenados a 0±1 °C foi avaliada. Frutos da variedade 'Early Swelling' foram tratados com 1,0 ou 2,0% de cloreto de cálcio. O primeiro tratamento foi aplicado num estado precoce de formação do fruto enquanto o segundo foi aplicado 10 dias antes da colheita. Quitosano foi aplicado nas concentrações de 0,5 ou 1,0%, isoladamente ou em combinação com 1,0% ou 2,0% de cloreto de cálcio também 10 dias antes da colheita. Árvores não tratadas serviram como controle. Os frutos foram colhidos quando maduros, empacotados e mantidos a 0±1 °C e sob condições de humidade relativa de 85-90%. Propriedades físicas e químicas dos frutos foram avaliadas em intervalos de 7 dias. Os resultados mostraram que a aplicação de 2% CaCl2 + 1% quitosano foi a mais eficaz em minimizar a perda de peso (%) e a senescência (%), bem como na manutenção da rigidez e aumento do período de vida em prateleira. A cor dos frutos não foi afectada por nenhum dos tratamentos enquanto frutos não tratados e cloreto de cálcio isoladamente, em ambas as concentrações, mantiveram um elevado teor de sólidos solúveis totais (TSS, %), elevado teor de fenóis e reduzida percentagem de acidez de titulação.

The common zoonotic protozoal diseases causing abortion.

Toxoplasmosis, neosporosis, sarcosporidiosis (sarcocystosis) and trypanosomiasis are the common zoonotic protozoal diseases causing abortion which caused by single-celled protozoan parasites; Toxoplasma gondii, Neospora caninum, Sarcocystis spp and Trypanosoma evansi, respectively. Toxoplasmosis is generally considered the most important disease that causing abortion of both pregnant women and different female animals throughout the world, about third of human being population had antibodies against T. gondii. The infection can pass via placenta, causing encephalitis, chorio-retinitis, mental retardation and loss of vision in congenitally-infected children and stillbirth or mummification of the aborted fetuses of livestock. Neosporosis is recognized as a major cause of serious abortion in varieties of wild and domestic animals around the world particularly cattle, the disease cause serious economic losses among dairy and beef cattle due to decrease in milk and meat production. While unlike toxoplasmosis, neosporosis is not recognized as a human pathogen and evidence to date shows that neosporosis is only detected by serology in the human population. Sarcosporidiosis also can cause abortion in animals particularly cattle, buffaloes and sheep with acute infection through high dose of infection with sarcocysts. On the other hand, humans have been reported as final and intermediate host for sarcosporidiosis but not represent a serious health problem. Trypanosomiasis by T. evansi cause dangerous infection among domestic animals in tropical and subtropical areas. Several cases of abortion had been recorded in cattle and buffaloes infected with T. evansi while, a single case of human infection was reported in India. Trichomoniasis and babesiosis abortion occurs with non-zoonotic Trichomonas and Babesia species while the zoonotic species had not been incriminated in induction of abortion in both animals and man. The current review article concluded that there is still need of wide scope for evaluation of the zoonotic impact and control of these diseases.