The Prevalence and Predictors of Atherosclerotic Coronary Artery Disease in Rheumatic and Non-rheumatic Valvular Heart Disease Patients.

OBJECTIVES: The paradox of concurrent coronary artery disease (CAD) among patients with rheumatic and non-rheumatic valvular heart disease (RVHD; non-RVHD) is unclear. We aimed to evaluate the impact of the RVHD and non-RVHD on the prevalence of CAD and various risk factors, assess the number of diseased coronaries, clinical profile and the possible predictors of CAD in these patients, which may clarify the paradox and provide an insight for the prevention of CAD. METHODS: The records of 106 valvular heart disease patients who had undergone valve replacement surgery at the King Faisal Cardiac Centre from January 2014 to October 2019 were evaluated. The clinical data and established risk factors were compared and logistic regression analyses were performed to identify plausible predictors of CAD. RESULTS: Transthoracic echocardiographic diagnosis of 106 patients confirmed, 43 had RVHD (56.4 ± 8 years), of whom six (13.9%) had CAD with the highest mitral valve regurgitation (p < 0.01), and 63 had non-RVHD (60.0 ± 12 years). Of these, 31 patients showed the highest CAD (49.2%). Single- and triple-vessel disease was most common in RVHD and non-RVHD patients with concurrent CAD (33.3%; 41.9%, respectively), while non-RVHD patients also had quadruple vessel disease. The mean age of the RVHD and non-RVHD patients with coexisting CAD was significantly higher (66.7 ± 5; 66.7 ± 8 years) than those without CAD (46.1 ± 12.0; 54.7 ± 20, respectively). RVHD patients showed a significantly lower prevalence of diabetes, dyslipidaemia, hypertension, inflammatory cells, hepatorenal function markers, ejection fraction, and regional wall motion abnormality compared to RVHD patients with coexisting CAD (p < 0.01). Bivariate analysis indicated white blood cells, monocytes, neutrophils, gamma-glutamyl-transferase (GGT), bilirubin and blood urea nitrogen (BUN) to be significantly lower in RVHD patients. Predictors of high risk of CAD were BUN and hyperlipidaemia for RVHD and BUN, creatinine and GGT for non-RVHD patients. CONCLUSIONS: The prevalence of CAD in Saudi RVHD patients was significantly lower than in the Western countries, whereas non-RVHD was higher. The low prevalence may partly be attributed to age, reduced mitral regurgitation, and low frequency of risk and inflammatory factors.

Acceptability to donate human milk among postnatal mothers at St. Francis hospital Nsambya, Uganda: a mixed method study.

BACKGROUND: The World Health Organization recommends the use of donated human milk (HM) as the second-best option for mothers who are temporarily unable to provide sufficient breast milk to meet the needs of their infants. However, HM donation is yet to become an accepted practice in Uganda. We assessed the level of, and factors associated with acceptability to donate HM among postnatal mothers at St. Francis Hospital Nsambya (SFHN). METHODS: A cross-sectional sequential explanatory mixed method study was conducted between October 2018 and March 2019. A questionnaire on sociodemography, awareness and likely acceptability to donate HM was administered to 410 postnatal mothers at SFHN. Multivariate logistic regression analysis was undertaken to determine factors associated with acceptance of HM donation. Focus Group Discussions (4) and Key Informants Interviews (4) were used to explore factors influencing behaviours to donate human milk. Qualitative data were analysed using a content thematic approach. RESULTS: Overall acceptance of donating the HM was 77.6%, and the significant factors were: willingness to express the HM (AOR 7.5; 95% CI 3.01, 18.68); wet-nursing knowledge (AOR 2.3; 95% CI 1.1, 5.0) and visit to under-5 years' clinic (AOR 21.3; 95% CI 2.3, 196.9). The major themes in relation to accepting to donate HM were wet nursing experience, and confidence in donating the HM, and its perceived effectiveness. There were concerns about the safety and adequacy of HM and fear of transmitting criminal behaviours and mental illness through human milk. CONCLUSIONS: Acceptance to donate HM among postnatal mothers at St. Francis Hospital Nsambya was very high. Willingness to express and store human milk, prior knowledge about wet nursing and a visit to an under-five outpatient clinic were associated with acceptance. Thus, establishing a human milk bank is feasible in the study setting.

Influence of Post Length, Post Material, and Substance Loss on the Fracture Resistance of Endodontically Treated Teeth: A Laboratory Study

PURPOSE: To evaluate the effects of post length, post material, and substance loss on the fracture resistance of endodontically treated mandibular premolars. MATERIALS AND METHODS: A total of 96 extracted human mandibular first premolars were endodontically treated and divided into 12 test groups (n = 8 each) based on the number of residual walls (one/two), post material (glass-fiber/titanium), and post length (5 mm, 7.5 mm, and 10 mm). After luting the posts, specimens received a composite resin core and a crown preparation with a 1.5-mm ferrule. Cast cobalt-chromium crowns were cemented using glass-ionomer cement. After 1,200,000 chewing cycles with a load of 49 N and simultaneous thermocycling (5°C to 55°C), specimens were quasi-statically loaded at 30 degrees to the longitudinal axis of the tooth until fracture. Fracture loads were analyzed using three-way, two-way, and one-way ANOVA (α = .05). Fracture modes were examined under a stereomicroscope (×25 magnification) and recorded. RESULTS: The mean ± SD fracture loads ranged from 642 ± 190 N (one wall, glass fiber, 5 mm) to 1,170 ± 130 N (two walls, titanium, 7.5 mm). The mean fracture load of titanium posts was significantly higher than that of glass-fiber posts (P < .001), and the 7.5-mm post length exhibited significantly higher fracture loads than groups with 5-mm and 10-mm post length (P = .008). CONCLUSIONS: Teeth restored with titanium posts revealed considerably higher fracture resistance than teeth restored with glass-fiber posts, especially if 7.5-mm-length posts were used.

Prevalence and Risk Factors of Home Accidents Among Children Under Five Years of Age in Al-Baha, Saudi Arabia.

INTRODUCTION: Internationally, home accidents are the main cause of preventable debilities and death among children and young persons. Many times, children survive accidents with physical or mental damage that curtails their activities in the long term. The most commonly reported accidental injuries include head injuries, open wounds, and poisoning. This study aims to assess the prevalence and factors associated with home accidents among children under five years old in the Al-Baha region, Saudi Arabia. METHODS: A descriptive cross-sectional study was conducted among the community population in the Al-Baha region, Saudi Arabia, targeting all accessible parents who have children under five years old. A convenience sampling technique was used for sample collection during the period of three months (May 2023 to July 2023), where all accessible parents who fulfilled the inclusion criteria and agreed to participate were invited to fill out the received online study questionnaire. Section 1 covered the participants' demographic data. The second section covered the children's data and the third section included questions about home accident types, frequency, severity, and causes.  Results: The findings showed that 205 (58.2%) study parents reported a history of home accidents among their children. As for accident data, about 122 (59.5%) of the injured children were males. The most reported home accidents among children were fall/impact with hard objects (58.2%), burn (30.7%), asphyxia (27.6%), and poisoning (24.4%). Families with more than seven members and those with four or more siblings significantly experienced higher home accidents than others (p<0.001). CONCLUSION: In conclusion, the current study showed that home accidents among children under five years of age were mainly falls and burns; they were mainly found among male children and children in families with highly educated mothers and many kids. A majority of the reported cases of home accidents were less severe and the hospitalization rates with complications were very few.

Evaluation of Carcass Attributes and Physical, Chemical, and Qualitative Characteristics of Breast Meat of Broiler Chickens Fed on Pulicaria jaubertii Powder.

Pulicaria jaubertii (PJ) is a medicinal plant used as a synthetic antioxidant and as a traditional medicine due to its bioactive compounds. The objective of this study was to investigate the effects of PJ on carcass traits and breast meat quality parameters of broiler chickens. Two hundred and forty male broilers (1 day old) were divided into four groups (0, 3, 6, and 9 g of PJ/kg of basal diet). Performance indicators were evaluated during the feeding stages, and carcass characteristics and physiochemical and qualitative parameters of breast meat were measured at 36 days old. The results showed that PJ improved performance parameters such as weight gain, feed conversion ratio, and production efficiency index (p < 0.05) in the finishing stage. The diets supplemented with PJ were associated with better carcass characteristics (p < 0.05), but some body parts, such as legs (6 and 9 g PJ) and backs (3-9 g PJ) decreased (p < 0.05). Temperature and initial pH were decreased by PJ (p < 0.05). Meat color was not affected by PJ (p > 0.05), although the yellowness and saturation index were lower at 9 g PJ. Total saturated fatty acid content was higher at 3 g PJ, while total polyunsaturated fatty acids and unsaturated to saturated fatty acid ratio were lower at 3 and 6 g PJ (p < 0.05). Total monounsaturated fatty acid content increased at 6 and 9 g PJ. Omega-6 fatty acids and the ratio of omega-6 to omega-3 were lower at 3 g PJ. PJ resulted in higher weight loss on cooking (6 and 9 g PJ) and shear force (3-9 g PJ). In conclusion, PJ had a positive influence on performance, carcass characteristics, and fatty acid profile, and some meat quality traits were generally improved by PJ, but knowledge of its mode of action is still limited and therefore requires further investigation.

Clinical characteristics and outcomes of patients hospitalized with measles during an outbreak in Somalia.

Objectives: Measles is a contagious disease associated with significant morbidity and mortality. This paper describes the clinical characteristics and outcomes of patients hospitalized with measles during an outbreak in Somalia from January 2018 to December 2021. Methods: This retrospective study was conducted at Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital. Children aged 6 months to 17 years who were hospitalized with clinical signs and symptoms of measles and its complications were recruited. Results: In total, 110 participants were enrolled. The median age was 16 [interquartile range (IQR) 12-36] years, and 87 (79.1%) were male. All participants presented with fever, typical measles rash, cough and conjunctivitis, and 43 (39.1%) had received the measles vaccine. Overall, 104 (94.6%) participants were admitted with severe respiratory symptoms, and six (5.4%) were admitted due to poor feeding and/or significant dehydration. Overall, all-cause mortality was 1.8% (n=2). The median duration of hospitalization was longer among participants who died compared with those who survived [11 (IQR 8-14) vs 4 (IQR 2-6) days; P=0.046]. Unvaccinated participants were significantly younger than vaccinated participants [36 (IQR 24-72) vs 12 (IQR 9-16) months; P<0.001]. There was a trend towards higher mortality [0/43 (0%) vs 2/67 (3%); P=0.519] and longer length of hospitalization [3 (IQR 2-6) vs 4 (IQR 3-7) days; P=0.056] among unvaccinated participants compared with vaccinated participants. Both the median total leukocyte count [5.7 (IQR 3.9-8.5) vs 11.6 (IQR 5.9-46.3) x 109/L; P<0.001] and platelet count [239 (IQR 202-358) vs 308 (IQR 239-404) x 109/L; P=0.032] were significantly higher among unvaccinated participants compared with vaccinated participants. However, the median haemoglobin concentration was significantly higher among vaccinated participants compared with unvaccinated participants [11.1 (IQR 9.9-12.3) vs 10.1 (IQR 9.1-11.2) g/dL; P=0.006]. Conclusions: Patients with measles in Somalia have a short hospital stay, low mortality rate and low vaccination rate. Timely vaccination and the need for improved care of patients with measles, particularly vulnerable groups including children and those with undernutrition, are encouraged.

Health Related Quality of Life of Ugandan Children Following Valve Replacement Surgery for Rheumatic Heart Disease.

Background: Valve replacement surgery (VRS) improves clinical outcomes in patients with severe rheumatic heart disease (RHD). However, lifelong anticoagulation and frequent monitoring are required, which potentially impacts health-related quality of life (HRQoL). In this study, we assessed the HRQoL of people with RHD in Uganda following VRS. Methods: This was a hospital-based, cross-sectional study conducted between March and August 2021. Eligible participants were individuals who had VRS before the age of 18 years. The Pediatric Quality of Life Inventory-Cardiac Module (PedsQL-Cardiac module) was used to evaluate HRQoL. A total mean score of ≥ 80% was considered as optimal HRQoL. Results: Of the 83 eligible participants, 52 (60.5%) were female, with a median age of 18 (interquartile range: 14-22) years. Most participants had NYHA I functional status (n = 79, 92%). Most (n = 73, 92.4%) surgeries were performed outside of Uganda, and 61 (72.6%) were single mechanical valve replacement. Almost half (n = 45, 54%) expressed no concern about being on life-long warfarin therapy. However, 24 (29.3%) feared bleeding. The optimal mean score of cardiac-specific HRQoL was achieved in 50 (60.2%) of participants. Factors associated with optimal HRQoL were body mass index (BMI) (adjusted odds ratio (aOR), 1.2, 95% Confidence Interval: 1.1-1.3, p = 0.006), being afraid of bleeding or bruising (aOR: 1.5, 95% CI: 1.21-2.47, p = 0.004), acceptance of having an artificial valve (aOR: 2.7, 95% CI; 1.64-3.81, p < 0.001). Conclusion: HRQoL was optimal in about three in five participants following VRS. Increasing BMI and acceptance of artificial valve were significantly associated with optimal HRQoL.

Lansoprazole attenuates cyclophosphamide-induced cardiopulmonary injury by modulating redox-sensitive pathways and inflammation.

Cyclophosphamide (CPA) is a classical chemotherapeutic drug widely used as an anticancer and immunosuppressive agent. However, it is frequently associated with significant toxicities to the normal cells of different organs, including the lung and heart. Lansoprazole (LPZ), a proton pump inhibitor (PPI), possesses antioxidant and anti-inflammatory properties. The current study investigated how LPZ protects against CPA-induced cardiac and pulmonary damage, focusing on PPARγ, Nrf2, HO-1, cytoglobin, PI3K/AKT, and NF-κB signaling. Animals were randomly assigned into four groups: normal control group (received vehicle), LPZ only group (Rats received LPZ at a dose of 50 mg/kg/day P.O. for 10 days), CPA group (CPA was administered (200 mg/kg) as a single i.p. injection on the 7th day), and cotreatment group (LPZ plus CPA). Histopathological and biochemical analyses were conducted. Our results revealed that LPZ treatment revoked CPA-induced heart and lung histopathological alterations. Also, LPZ potently mitigated CPA-induced cardiac and pulmonary oxidative stress through the activation of PPARγ, Nrf2/HO-1, cytoglobin, and PI3K/AKT signaling pathways. Also, LPZ effectively suppressed inflammatory response as evidenced by down-regulating the inflammatory strategic controller NF-κB, MPO, and pro-inflammatory cytokines. The present findings could provide a mechanistic basis for understanding LPZ's role in CPA-induced cardiopulmonary injury through the alleviation of oxidative stress and inflammatory burden.

Candesartan Protects Against Cadmium-Induced Hepatorenal Syndrome by Affecting Nrf2, NF-κB, Bax/Bcl-2/Cyt-C, and Ang II/Ang 1-7 Signals.

Cadmium (Cd) is a serious pollutant in the environment. Candesartan is an angiotensin II (Ang II) receptor antagonist with promising diverse health benefits. The current study is planned to investigate the hepatorenal protective effects of candesartan against Cd-induced hepatic and renal intoxication. Our results demonstrated that candesartan effectively attenuated Cd-induced hepatorenal intoxication, as evidenced by improving hepatic and renal function biomarkers. Besides, candesartan reversed hepatic and renal histopathological abrasions induced by Cd toxicity. Candesartan antioxidant effect was mediated by Nrf2 activation. Also, candesartan suppressed hepatorenal inflammation by modulating NF-κB/IκB. Moreover, candesartan attenuated Cd hepatorenal apoptosis by upregulating Bcl-2 and downregulating Bax and Cyt-C proteins. Interestingly, these effects are suggested to be an outcome of modulating of Ang II/Ang 1-7 signal. Overall, our findings revealed that candesartan could attenuate Cd-induced hepatorenal intoxication through modulation of Nrf2, NF-κB/IκB, Bax/Bcl-2/Cyt-c, and Ang II/Ang 1-7 signaling pathways.

Adherence to COVID-19 preventive measures in Sub-Saharan Africa during the 1st year of the pandemic: Pooled analysis of the International Citizen Project on COVID-19 (ICPCovid) surveys.

Introduction: While most governments instituted several interventions to stall the spread of COVID-19, little is known regarding the continued observance of the non-pharmaceutical COVID-19 preventive measures particularly in Sub-Saharan Africa (SSA). We investigated adherence to these preventive measures during the initial 6 months of the COVID-19 outbreak in some SSA countries. Methods: Between March and August 2020, the International Citizen Project on COVID-19 consortium (www.icpcovid.com) conducted online surveys in six SSA countries: Benin, Cameroon, Democratic Republic of Congo, Mozambique, Somalia, and Uganda. A five-point individual adherence score was constituted by scoring respondents' observance of the following measures: mask use, physical distancing, hand hygiene, coughing hygiene, and avoiding to touch one's face. Community behaviors (going to public places, traveling during the pandemic) were also assessed. Data were analyzed in two time periods: Period 1 (March-May) and Period 2 (June-August). Results: Responses from 26,678 respondents were analyzed (mean age: 31.0 ± 11.1 years; 54.1% males). Mean individual adherence score decreased from 3.80 ± 1.37 during Period 1, to 3.57 ± 1.43 during Period 2; p < 0.001. At the community level, public events/places were significantly more attended with increased travels during Period 2 compared to Period 1 (p < 0.001). Using linear mixed models, predictors of increased individual adherence included: higher age (Coef = 0.005; 95% CI: 0.003-0.007), female gender (Coef = 0.071; 95% CI: 0.039-0.104), higher educational level (Coef = 0.999; 95% CI: 0.885-1.113), and working in the healthcare sector (Coef = 0.418; 95% CI: 0.380-0.456). Conclusion: Decreasing adherence to non-pharmaceutical measures over time constitutes a risk for the persistence of COVID-19 in SSA. Younger persons and those with lower education levels constitute target groups for improving adherence to such measures.

Interactive effect of elevated CO2 and drought on physiological traits of Datura stramonium.

Rising atmospheric CO2 concentrations are known to influence the response of many plants under drought. This paper aimed to measure the leaf gas exchange, water use efficiency, carboxylation efficiency, and photosystem II (PS II) activity of Datura stramonium under progressive drought conditions, along with ambient conditions of 400 ppm (aCO2) and elevated conditions of 700 ppm (eCO2). Plants of D. stramonium were grown at 400 ppm and 700 ppm under 100 and 60% field capacity in a laboratory growth chamber. For 10 days at two-day intervals, photosynthesis rate, stomatal conductance, transpiration rate, intercellular CO2 concentration, water use efficiency, intrinsic water use efficiency, instantaneous carboxylation efficiency, PSII activity, electron transport rate, and photochemical quenching were measured. While drought stress had generally negative effects on the aforementioned physiological traits of D. stramonium, it was found that eCO2 concentration mitigated the adverse effects of drought and most of the physiological parameters were sustained with increasing drought duration when compared to that with aCO2. D. stramonium, which was grown under drought conditions, was re-watered on day 8 and indicated a partial recovery in all the parameters except maximum fluorescence, with this recovery being higher with eCO2 compared to aCO2. These results suggest that elevated CO2 mitigates the adverse growth effects of drought, thereby enhancing the adaptive mechanism of this weed by improving its water use efficiency. It is concluded that this weed has the potential to take advantage of climate change by increasing its competitiveness with other plants in drought-prone areas, suggesting that it could expand into new localities.

Nanoformulated Recombinant Human Myelin Basic Protein and Rituximab Modulate Neuronal Perturbations in Experimental Autoimmune Encephalomyelitis in Mice.

Introduction: Rituximab (RTX) and recombinant human myelin basic protein (rhMBP) were proven to be effective in ameliorating the symptoms of multiple sclerosis (MS). In this study, a nanoformulation containing rhMBP with RTX on its surface (Nano-rhMBP-RTX) was prepared and investigated in comparison with other treatment groups to determine its potential neuro-protective effects on C57BL/6 mice after inducing experimental autoimmune encephalomyelitis (EAE). Methods: EAE was induced in the corresponding mice by injecting 100 µL of an emulsion containing complete Freund's adjuvant (CFA) and myelin oligodendrocyte glycoprotein (MOG). The subjects were weighed, scored and subjected to behavioural tests. After reaching a clinical score of 3, various treatments were given to corresponding EAE-induced and non-induced groups including rhMBP, RTX, empty nanoparticle prepared by poly (lactide-co-glycolide) (PLGA) or the prepared nanoformulation (Nano-rhMBP-RTX). At the end of the study, biochemical parameters were also determined as interferon-γ (IFN-γ), myeloperoxidase (MPO), interleukin-10 (IL-10), interleukin-4 (IL-4), tumor necrosis factor alpha (TNF-α), nuclear factor kappa B (NF-kB), brain derived neurotrophic factor (BDNF), 2', 3' cyclic nucleotide 3' phosphodiesterase (CNP) and transforming growth factor beta (TGF-ß) along with some histopathological analyses. Results: The results of the Nano-rhMBP-RTX group showed promising outcomes in terms of reducing the clinical scores, improving the behavioural responses associated with improved histopathological findings. Elevation in the levels of IL-4, CNP and TGF-ß was also noticed along with marked decline in the levels of NF-kB and TNF-α. Conclusion: Nano-rhMBP-RTX treated group ameliorated the adverse effects induced in the EAE model. The effectiveness of this formulation was demonstrated by the normalization of EAE-induced behavioral changes and aberrant levels of specific biochemical markers as well as reduced damage of hippocampal tissues and retaining higher levels of myelination.

Cardiovascular risk factors and clinical outcomes of patients hospitalized with COVID-19 pneumonia in Somalia.

Background: Coronavirus disease-2019 (COVID-19) is a potentially life-threatening illness with no established treatment. Cardiovascular risk factors (CRFs) exacerbate COVID-19 morbidity and mortality. Objective: To determine the prevalence of CRF and clinical outcomes of patients hospitalized with COVID-19 in a tertiary hospital in Somalia. Methods: We reviewed the medical records of patients aged 18 years or older with a real-time polymerase chain reaction (RT-PCR)-confirmed COVID-19 hospitalized at the De Martino Hospital in Mogadishu, Somalia, between March and July 2020. Results: We enrolled 230 participants; 159 (69.1%) males, median age was 56 (41-66) years. In-hospital mortality was 19.6% (n = 45); 77.8% in the intensive care unit (ICU) compared with 22.2%, in the general wards (p < 0.001). Age ⩾ 40 years [odds ratio (OR): 3.6, 95% confidence interval (CI): 1.2-10.6, p = 0.020], chronic heart disease (OR: 9.3, 95% CI: 2.2-38.9, p = 0.002), and diabetes mellitus (OR: 3.2, 95% CI: 1.6-6.2, p < 0.001) were associated with increased odds of mortality. Forty-three (18.7%) participants required ICU admission. Age ⩾ 40 years (OR: 7.5, 95% CI: 1.7-32.1, p = 0.007), diabetes mellitus (OR: 3.2, 95% CI: 1.6-6.3, p < 0.001), and hypertension (OR: 2.5, 95% CI: 1.2-5.2, p = 0.014) were associated with ICU admission. For every additional CRF, the odds of admission into the ICU increased threefold (OR: 2.7, 95% CI: 1.2-5.2, p < 0.001), while the odds of dying increased twofold (OR: 2.1, 95% CI: 1.3-3.2, p < 0.001). Conclusions: We report a very high prevalence of CRF among patients hospitalized with COVID-19 in Somalia. Mortality rates were unacceptably high, particularly among those with advanced age, underlying chronic heart disease, and diabetes.

Clinicopathological characteristics and outcomes of eosinophilic cystitis: A retrospective study.

BACKGROUND: Eosinophilic cystitis (EC) is a rare inflammatory urinary bladder disorder whose etiology, pathogenesis, and treatment are unknown. The work aims to evaluate the clinical manifestations, cystoscopic characteristics, pathological features, treatment, and clinical outcome of EC patients. MATERIALS AND METHODS: The clinical records and histopathology material of 22 patients diagnosed as EC during ten years were reviewed and analyzed for patient's age, sex, clinical data, cystoscopic features, biopsy procedures, treatment plan, follow-up, and prognosis. Frequencies, normality tests, descriptive statistics, and correlations were run. RESULTS: The mean age of patients was 46.5 + 17 years, 12 females and 10 males. Regarding the patient's complaints, dysuria was the most frequent main symptom, followed by hematuria. On cystoscopic examination, bladder mass was seen in 54.5% of patients. Six patients (27.3%) were associated with different allergic diseases; however peripheral eosinophilia was shown in two patients (9.1%). All cases revealed predominance of eosinophilic infiltration on microscopic examination. The most commonly used medications were corticosteroids for 72.7% of patients with tapering dose giving a significant improvement with a recorded recurrence in one patient after 12 months from the first lesion. CONCLUSIONS: No specific clinical presentation for EC patients and histopathology is the standard diagnostic tool. Medical treatment including corticosteroids was the first line with good prognosis, although recurrence remains a possibility which emphasizes the importance of patients' follow-up.

COVID-19 Vaccine Acceptability and Adherence to Preventive Measures in Somalia: Results of an Online Survey.

Most countries are currently gravitating towards vaccination as mainstay strategy to quell COVID-19 transmission. Between December 2020 and January 2021, we conducted a follow-up online survey in Somalia to monitor adherence to COVID-19 preventive measures, and COVID-19 vaccine acceptability and reasons for vaccine hesitancy. Adherence was measured via a composite adherence score based on four measures (physical distancing, face mask use, hand hygiene, and mouth covering when coughing/sneezing). We analyzed 4543 responses (mean age: 23.5 ± 6.4 years, 62.4% males). The mean adherence score during this survey was lower than the score during a similar survey in April 2020. A total of 76.8% of respondents were willing to receive the COVID-19 vaccine. Flu-like symptoms were more frequently reported in the current survey compared to previous surveys. Multiple logistic regression showed that participants who experienced flu-like symptoms, those in the healthcare sector, and those with higher adherence scores had higher odds for vaccine acceptability while being a female reduced the willingness to be vaccinated. In conclusion, our data suggest that the decreasing adherence to COVID-19 preventive measures may have caused increased flu-like symptoms over time. COVID-19 vaccine acceptance in Somalia is relatively high but could be improved by addressing factors that contribute to vaccine hesitancy.

Influence of Post Length, Post Material, and Substance Loss on the Fracture Resistance of Endodontically Treated Teeth. A Laboratory Study.

PURPOSE: To evaluate the effects of post length, post material, and substance loss on the fracture resistance of endodontically treated mandibular premolars. MATERIALS AND METHODS: A total of 96 extracted human mandibular first premolars were endodontically treated and divided into 12 test groups (n = 8 each) based on the number of residual walls (one/two), post material (glass-fiber/titanium), and post length (5 mm, 7.5 mm, and 10 mm). After luting the posts, specimens received a composite resin core and a crown preparation with a 1.5-mm ferrule. Cast cobalt-chromium crowns were cemented using glass-ionomer cement. After 1,200,000 chewing cycles with a load of 49 N and simultaneous thermocycling (5°C to 55°C), specimens were quasi-statically loaded at 30 degrees to the longitudinal axis of the tooth until fracture. Fracture loads were analyzed using three-way, two-way, and one-way analysis of variance (α = .05). Fracture modes were examined under a stereomicroscope (×25) and recorded. RESULTS: Fracture loads ranged from 642 ± 190 N (one wall, glass fiber, 5 mm) to 1,170 ± 130 (two walls, titanium, 7.5 mm). The mean fracture load of titanium posts was significantly higher than that of glass-fiber posts (P < .001), and the 7.5-mm post length exhibited significantly higher fracture loads than groups with 5-mm and 10-mm post length (P = .008). CONCLUSION: Teeth restored with titanium posts revealed considerably higher fracture resistance than teeth restored with glass-fiber posts, especially if 7.5-mm-length posts were used.

Hyaluronic Acid Conjugated Metformin-Phospholipid Sonocomplex: A Biphasic Complexation Approach to Correct Hypoxic Tumour Microenvironment.

PURPOSE: Development of hyaluronic acid conjugated metformin-phospholipid sonocomplexes (HA-MPS), a biphasic complexation product compiled for enhancing both the lipophilicity and targeting potential of Metformin (MET) to CD44 receptors on pancreatic cancer. METHODS: MET was chemically conjugated to hyaluronic acid (HA) via amide coupling reaction. Then, the HA conjugated MET was physically conjugated to Lipoid™S100 via ultrasound irradiation. A combined D-optimal design was implemented to statistically optimize formulation variables. The HA-MPS were characterized through solubility studies, partition coefficient, drug content uniformity, particle size and zeta potential. The optimized HA-MPS was tested via proton nuclear magnetic resonance, infrared spectroscopy to elucidate the nature of physicochemical interactions in the complex which was further scrutinized on molecular level via molecular docking and dynamic simulation. RESULTS: The solubility and partition studies showed a lipophilicity enhancement up to 67 folds as they adopted inverted micelles configuration based on the packing parameter hypothesis. The optimized HA-MPS showed 11.5 folds lower IC50, extra 25% reduction in oxygen consumption rate, better reduction in hypoxia-inducible factor and reactive oxygen species in MiaPaCa-2 cells. CONCLUSION: These results proved better internalization of MET which was reflected by abolishing hypoxic tumour microenvironment, a mainstay toward a normoxic and less resistant pancreatic cancer.

COVID-19 in Somalia: Adherence to Preventive Measures and Evolution of the Disease Burden.

Following the COVID-19 outbreak in Somalia, strict preventive measures were implemented by the government. We assessed adherence to the government recommendations via two consecutive online cross-sectional surveys between April and July 2020. A five-point adherence score was constructed based on self-reported observance of five preventive measures (physical distancing, face mask use, hand hygiene, mouth covering when coughing/sneezing, and avoidance of touching the face). 4124 and 4703 responses were analyzed during the first and second survey, respectively. The mean adherence score decreased from 3.54 ± 1.5 in the first survey to 3.40 ± 1.6 during the second survey; p < 0.001. More participants experienced at least one flu-like symptom during the second survey (38.2%) compared to the first (16.2%); however, the proportion of positive COVID-19 tests in the first (26.9%) and second survey (26.5%) was similar. The ordinal logistic regression model identified the following predictors for high adherence scores: female gender (odds ratio (OR) = 1.715 (1.581-1.861), p < 0.001); being a healthcare worker/student (OR = 2.180 (2.000-2.377), p < 0.001); obtaining COVID-19 information from official sources (OR = 1.460 (1.341-1.589), p < 0.001); and having postgraduate education (OR = 1.679 (1.220-2.307), p < 0.001). Conversely, obtaining COVID-19 information from social media and residing in urban settings were associated with lower adherence. Targeted and context-specific adaptations of the COVID-19 response may be required in Somalia.

Buccinator Re-Repair (Bs + Re: IVVP): A Combined Procedure to Maximize the Palate Form and Function in Difficult VPI Cases.

OBJECTIVES: To assess the outcome of a modified buccinator flaps' palatal lengthening combined with radical intravelar veloplasty (Bs + Re: IVVP) for the management of postpalatoplasty velopharyngeal incompetence and report the functional and structural changes occurring in the palate. DESIGN: Prospective cohort study of consecutive cleft patients presenting with velopharyngeal incompetence and managed by buccinator re-repair procedure. Blind assessment of randomized recordings of speech and evaluation of velar form and function with nasoendoscopy and lateral videofluoroscopy were done. Patients' demographic data were also collected. PATIENTS: Among 30 consecutive cases who had Bs + Re: IVVP, 24 had adequate pre- and postoperative records of speech outcome data. SETTING: Multidisciplinary cleft team in a tertiary referral center. RESULTS: There were significant improvements in hypernasality, nasal emission, facial grimace and weak consonants, and overall intelligibility of speech. Endoscopy and lateral videofluoroscopy showed significant improvement in total and functional velar length, closure ratio, velopharyngeal gap at closure, palatal thickness, palatal convexity, and mobility. Regarding the procedure complications, no flap ischemia, fistula, or obstructive sleep apnea reported, but there were one cheek hematoma and two minor oral mucosal dehiscence which healed spontaneously. CONCLUSIONS: Buccinator re-repair (Bs + Re: IVVP) has been shown to be an effective and safe procedure in treating difficult postpalatoplasty velopharyngeal incompetence. It was also shown that it is still a physiological nonobstructive procedure with low morbidity.