Comparison of Type 2 Diabetes Mellitus Control at Home Healthcare and Hospital Clinic Care at King Salman Armed Forces Hospital (2021-2022): A Retrospective Cohort Study.

BACKGROUND: Home healthcare represents a great necessity for patients with diabetes mellitus (DM). Although there are numerous studies on geriatric diabetic patients, there are few studies on diabetic home care versus hospital care. AIM: This study aimed to compare the effect of home healthcare services to hospital care for controlling type 2 diabetes mellitus (T2DM) at King Salman Armed Forces Hospital, Tabuk, Saudi Arabia. METHODS: This retrospective cohort study included patients with type 2 diabetes mellitus at King Salman Armed Forces Hospital. The home healthcare group included 128 participants who received frequent follow-up visits at home. The hospital care group included 128 participants from the primary care clinic. Glycosylated hemoglobin (HbA1c) was used to measure glycemic control. Logistic regression analysis was done to detect factors related to achieving glycemic control. RESULTS: Home healthcare care had a greater impact on the reduction of baseline glycosylated hemoglobin levels (p=0.0053). The target glycosylated hemoglobin was achieved by patients who received home healthcare (p=0.020). Using the multivariate regression analysis, home healthcare, married patients, those who can do full daily life activities without assistance, and those who were treated with only insulin had significant correlations to meet the target glycosylated hemoglobin level (odds ratio: 0.814, 0.541, 0.448, and 0.144; 95% confidence intervals: 0.72-0.94, 0.30-0.99, 0.31-0.65, and 0.08-0.25, respectively). CONCLUSIONS: Home care strategy for patients suffering from type 2 diabetes mellitus provides better glycemic control compared to hospital care. Home care, marriage, doing full daily activities, and insulin treatment are important factors affecting glycemic control.

Lessons learnt in scaling up evidence-based comprehensive health sector responses addressing female genital mutilation in highly prevalent settings.

Female genital mutilation (FGM) affects over 200 million girls and women. Its health complications include acute and potentially lifelong urogenital, reproductive, physical, mental health complications with estimated health treatment costs of US$1.4 billion per year. Moreover, there is a concerning rise in the trend of FGM medicalisation with almost one in five FGM cases being performed by a health worker.The WHO developed several evidence-based resources to apply a comprehensive health approach to strengthen FGM prevention and care services. However, there has been limited uptake of this comprehensive approach in FGM prevalent settings. To address this, a three-step multicountry participatory process was used to engage health sector players from FGM prevalent settings to develop comprehensive action plans, implement foundational activities and harness the learnings to inform subsequent planning and implementation. Support to adapt evidence-based resources and seed funding were also provided to initiate foundational activities that had potential for scale up.A total of 15 countries participated in this three-step this approach between 2018 and 2022. Ten countries developed comprehensive national action plans and eight WHO resources were adapted for foundational activities.This scale up approach can be strengthened by increasing the frequency of multicountry experience sharing meetings, identifying in-country champions to continuously advocate for FGM integration within (public and private) health services and securing stable funding to implement foundational activities. Documentation of each country's experience as case studies including monitoring and evaluation are essential to expand the learning and quality of the health interventions addressing FGM.

Ranking parameters driving siring success during sperm competition in the North African houbara bustard.

Sperm competition is a powerful force driving the evolution of ejaculate and sperm traits. However, the outcome of sperm competition depends on many traits that extend beyond ejaculate quality. Here, we study male North African houbara bustards (Chlamydotis undulata undulata) competing for egg fertilization, after artificial insemination, with the aim to rank the importance of 14 parameters as drivers of siring success. Using a machine learning approach, we show that traits independent of male quality (i.e., insemination order, delay between insemination and egg laying) are the most important predictors of siring success. Traits describing intrinsic male quality (i.e., number of sperm in the ejaculate, mass motility index) are also positively associated with siring success, but their contribution to explaining the outcome of sperm competition is much lower than for insemination order. Overall, this analysis shows that males mating at the last position in the mating sequence have the best chance to win the competition for egg fertilization. This raises the question of the importance of female behavior as determinant of mating order.

Synthesis, Photophysical Characterization and Evaluation of Biological Properties of C7, a Novel Symmetric Tetra-Imidazolium-Bis-Heterocycle.

A novel symmetric tetra-imidazolium-bis-heterocycle, called C7, was designed and synthesized in a quick two-step pathway, with the objective to synthesize biologically active supramolecular assembly. The synthesized compound was then analyzed for its photophysical properties, for a potential application in theragnostic (fluorescence) or phototherapy (photodynamic therapy, with the production of reactive oxygen species, such as singlet oxygen 1O2). C7 was thus screened for its biological activity, in particular against important human pathogens of viral origin (respiratory viruses such as adenovirus type 2 and human coronavirus 229E) and of fungal and bacterial origin. The compound showed limited antiviral activity, combined with very good antiproliferative activity against breast cancer, and head and neck squamous cell carcinoma models. Interestingly, the selected compound showed excellent antibacterial activity against a large array of Gram-positive and Gram-negative clinically isolated pathogenic bacteria, with a possible inhibitory mechanism on the bacterial cell wall synthesis studied with electron microscopy and molecular docking tools. Collectively, the newly synthesized compound C7 could be considered as a potential lead for the development of new antibacterial treatment, endowed with basic photophysical properties, opening the door towards the future development of phototherapy approaches.

A single application of chlorhexidine gel reduces gingival inflammation and interleukin 1-ß following one-stage implant placement: A randomized controlled study.

BACKGROUND: Chlorhexidine (CHX) is a broad-spectrum antimicrobial agent commonly used in medicine. Application of (CHX) during abutment connection reduced the bacterial load at the implant-abutment interface. We hypothesize this treatment may consequently reduce peri-implant soft tissue inflammation and marginal bone loss. PURPOSE: To evaluate the effect of a single application of CHX gel inside the dental implant internal hexagon on peri-implant tissue. METHODS: Forty patients were recruited to this randomized, double-blinded, clinical trial. At the time of implant installation, a 4-mm healing abutment was connected to the implant. In the test group, chlorhexidine gel 1% was applied inside the implant hex, whereas control implants did not receive any gel. Clinical and radiographic measurements included soft tissue recession (REC), plaque index (PI), gingival index (GI), plaque index (PI), keratinized mucosa width (KM), probing depth (PD), and a peri-apical parallel x-ray. Peri-implant crevicular fluid (PICF) was collected for cytokine analysis. t-Test was used to compare changes from baseline to 3 months. Mann-Whitney U test and t test were used to compare test and control groups. RESULTS: Twenty patients in the test group and 17 in the control group completed the study. One implant in the control group failed to osteointegrate. There were no significant differences between the control and test groups for REC changes, bone loss, and PD. GI was significantly lower in the test group after 1 week (1.79 ± 0.24 vs 0.75 ± 0.18, respectively) and 3 months (1.18 ± 0.21 vs 0.25 ± 0.12, respectively) although PI was equal. At 3 months, interleukin 1-ß (IL1-ß) was higher in the control group (p < 0.01) and a positive correlation was found between GI and IL1-ß (rs  = 0.60424, p = 0.00032). CONCLUSIONS: Application of chlorhexidine gel reduced inflammation and IL1-ß levels in the peri-implant soft tissue.

Knowledge and attitudes of Lebanese women towards Baby Friendly Hospital Initiative practices.

BACKGROUND: The World Health Organization and United Nations Children's Fund launched the Baby Friendly Hospital Initiative (BFHI) to encourage best infant breastfeeding practices immediately after birth. In Lebanon, few hospitals are currently accredited as Baby Friendly. AIM: To assess the knowledge of Lebanese women of BFHI steps, and to explore their attitudes towards Baby Friendly Hospitals, Skin-to-Skin Contact and Kangaroo Care practices. METHODS: A cross-sectional survey of a random sample of healthy pregnant women from Lebanon's six governorates. RESULTS: The mean (SD) age of the participants (N = 517) was 28.6 (4.7) years. Most participants were unfamiliar with the terms Baby Friendly hospital (93.7%), skin-to-skin contact or kangaroo care (75%), or were inadequately instructed on how to initiate (54.2%) or continue (46.2%) breastfeeding. However, when provided with information about the benefits of BFHI practices, most mothers (> 90%) stated that they would deliver in Baby Friendly hospitals. About 68.4% of mothers refused to give donor human milk to their sick premature infants because of religious beliefs. Knowledge of Baby Friendly hospitals was significantly associated with university education (p = 0.029), higher monthly income (p = 0.042), and previous experiences of skin-to-skin contact (p<0.001), rooming in (p = 0.037), or breastfeeding support (p = 0.036). CONCLUSION: There is a need for national awareness campaigns that address both the numerous advantages of the BFHI practices and Lebanese women's knowledge gaps about these practices. Such knowledge will help scale up the implementation of BFHI practices in hospitals in Lebanon, thus increasing breastfeeding rates and positively impacting the health of infants and mothers.

Molecular Dynamics Simulations of Influenza A Virus NS1 Reveal a Remarkably Stable RNA-Binding Domain Harboring Promising Druggable Pockets.

The non-structural protein NS1 of influenza A viruses is considered to be the major antagonist of the interferon system and antiviral defenses of the cell. It could therefore represent a suitable target for novel antiviral strategies. As a first step towards the identification of small compounds targeting NS1, we here investigated the druggable potential of its RNA-binding domain since this domain is essential to the biological activities of NS1. We explored the flexibility of the full-length protein by running molecular dynamics simulations on one of its published crystal structures. While the RNA-binding domain structure was remarkably stable along the simulations, we identified a flexible site at the two extremities of the "groove" that is delimited by the antiparallel α-helices that make up its RNA-binding interface. This groove region is able to form potential binding pockets, which, in 60% of the conformations, meet the druggability criteria. We characterized these pockets and identified the residues that contribute to their druggability. All the residues involved in the druggable pockets are essential at the same time to the stability of the RNA-binding domain and to the biological activities of NS1. They are also strictly conserved across the large sequence diversity of NS1, emphasizing the robustness of this search towards the identification of broadly active NS1-targeting compounds.

Investigating the Importance of the Pocket-estimation Method in Pocket-based Approaches: An Illustration Using Pocket-ligand Classification.

Small molecules interact with their protein target on surface cavities known as binding pockets. Pocket-based approaches are very useful in all of the phases of drug design. Their first step is estimating the binding pocket based on protein structure. The available pocket-estimation methods produce different pockets for the same target. The aim of this work is to investigate the effects of different pocket-estimation methods on the results of pocket-based approaches. We focused on the effect of three pocket-estimation methods on a pocket-ligand (PL) classification. This pocket-based approach is useful for understanding the correspondence between the pocket and ligand spaces and to develop pharmacological profiling models. We found pocket-estimation methods yield different binding pockets in terms of boundaries and properties. These differences are responsible for the variation in the PL classification results that can have an impact on the detected correspondence between pocket and ligand profiles. Thus, we highlighted the importance of the pocket-estimation method choice in pocket-based approaches.

Global vision of druggability issues: applications and perspectives.

During the preliminary stage of a drug discovery project, the lack of druggability information and poor target selection are the main causes of frequent failures. Elaborating on accurate computational druggability prediction methods is a requirement for prioritizing target selection, designing new drugs and avoiding side effects. In this review, we describe a survey of recently reported druggability prediction methods mainly based on networks, statistical pocket druggability predictions and virtual screening. An application for a frequent mutation of p53 tumor suppressor is presented, illustrating the complementarity of druggability prediction approaches, the remaining challenges and potential new drug development perspectives.

PockDrug-Server: a new web server for predicting pocket druggability on holo and apo proteins.

Predicting protein pocket's ability to bind drug-like molecules with high affinity, i.e. druggability, is of major interest in the target identification phase of drug discovery. Therefore, pocket druggability investigations represent a key step of compound clinical progression projects. Currently computational druggability prediction models are attached to one unique pocket estimation method despite pocket estimation uncertainties. In this paper, we propose 'PockDrug-Server' to predict pocket druggability, efficient on both (i) estimated pockets guided by the ligand proximity (extracted by proximity to a ligand from a holo protein structure) and (ii) estimated pockets based solely on protein structure information (based on amino atoms that form the surface of potential binding cavities). PockDrug-Server provides consistent druggability results using different pocket estimation methods. It is robust with respect to pocket boundary and estimation uncertainties, thus efficient using apo pockets that are challenging to estimate. It clearly distinguishes druggable from less druggable pockets using different estimation methods and outperformed recent druggability models for apo pockets. It can be carried out from one or a set of apo/holo proteins using different pocket estimation methods proposed by our web server or from any pocket previously estimated by the user. PockDrug-Server is publicly available at: http://pockdrug.rpbs.univ-paris-diderot.fr.