Microbial resistance in patients with urinary tract infections in Al-Mukalla, Yemen

Background: Urinary tract infection (UTI) is an aggravating and common problem in human at sometimes during their life and may give more complications.Objective: To project antimicrobial resistance in patients with UTI as a wide problem among cases referred to the National Center of Public Health Laboratories in Ibn-Sina Teaching Hospital in Al- Mukalla, Hadhramout Governorate in Yemen.Materials and methods: From 290 cases referred from Ibn-Sina Teaching Hospital outpatients, urine samples were tested and reported in the National Center for Public Health Laboratories at the period from 2003 to 2006. Data were obtained from the records of the center (for urine examination, culture and sensitivity test) and analyzed.Results: Among 290 cases, 147(50.7%) were suffering from urinary tract infection. E. coli, which is the normal intestinal flora, was the most common isolate 52 (35.4%). E. coli showed high resistance against quinolones (84.6%) and penicillin (78.8%) and there was no resistance against macrolides. Conclusion: Microbial resistance strains were high, which may be due to the abuse of antibiotics.Keywords: Hadhramout, E. coli, macrolides, quinolones

Procedures for the Investigation of Dimension Stone Resources: The Suitability of Jibal Aja and Jabal Salma Plutons, Near Hail, Saudi Arabia

This thesis describes a new set of procedures for evaluating dimension stone potential. It focuses on the granitic rocks of the Arabian Shield. In particular, two sites near Hail have been assessed in detail. Site 1 is in the Jibal Aja batholith, and site 2 is in the Jabal Salma pluton. Conventional investigation methods -- desk study, field and laboratory measurement -- have been applied, along with an analysis of satellite imagery. A key element in the new set of procedures is the use of Landsat (Thematic Mapper) data in the form of false-colour, CRC images. Many aspects of the sites which are related to the suitability of the materials for dimension stone can be recognized via the Landsat images; these include rock type, state of alteration and staining, rock colour, rock-unit contact conditions, and distribution of weathering. A new method of predicting in-situ block sizes has been developed which takes its input from conventional scanline data. From all of the geotechnical information collected, and the engineering geological maps which have been constructed, summary maps are prepared showing the distribution of potential dimension stone resources in the two test sites. Large potential reserves (>10

The assessment of pulpal blood flow using laser Doppler flowmetry

Aims: The overall aim of this work was to study the use of Laser Doppler flowmetry for the assessment of the dental pulp in permanent teeth. The thesis is presented as four distinct studies; 1) A systematic review was carried out to assess the published evidence on the use of laser Doppler flowmetry in the assessment of the pulp status of permanent teeth, 2) A cross-sectional survey was carried out in order to understand the use of dental pulp tests by paediatric dentists and general dental practitioners in children with dental trauma in the United Kingdom, 3) The first clinical study aimed to assess whether laser Doppler flowmetry was more accurate than the conventional pulp sensibility tests (Electric pulp test and ethyl chloride) in assessing the pulp status of permanent anterior teeth in children, and 4) The second clinical study aimed to prospectively monitor pulp sensibility/vitality of traumatised teeth using laser Doppler flowmetry, electric pulp testing and ethyl chloride, and to prospectively investigate the accuracy of each test. Methods: Systematic review: A systematic literature search, using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, www.clinicaltrials.gov and www.controlled-trials.com, in addition to citation and manual reference list searches, was conducted up to 15th January 2018. A risk of bias assessment was performed using the quality assessment for diagnostic accuracy studies tool (QUADAS-2) with all steps performed independently by two reviewers. Survey: A cross-sectional study utilising an 18-item questionnaire that was developed using the Bristol Online Survey (BOS) tool and circulated electronically to the members of the British Society of Paediatric Dentistry between June and August 2017. Clinical study 1: A cross-sectional cohort diagnostic accuracy study with randomisation was carried out in 8-16-year-old children. Participants had one maxillary central or lateral incisor with either a completed root canal treatment or pulp extirpation and a contra-lateral tooth with vital pulp. The outcome measures included the cut-off threshold for LDF and the sensitivity, specificity and predictive values as well as the repeatability of each test. The Receiver Operating Characteristic (ROC) curve and the contingency 2X2 table were used for analysis. Kappa scores were used to assess the repeatability of EPT and ethyl chloride while inter-class correlation was used for LDF. Clinical study 2: Children who sustained dental trauma to an anterior permanent tooth with uncertain pulp vitality requiring monitoring for a minimum of 12 months were included in the study. Recordings of dental pulp tests were carried out at baseline and at the end of the follow-up period. Results Systematic review: Only four studies all with a high risk of bias were included in the final systematic review for analysis. Laser Doppler flowmetry was reported to be more accurate in differentiating between teeth with normal pulps and pulp necrosis with a sensitivity of (81.8-100%) and specificity of 100 % in comparison to other vitality tests such as pulp oximetry (sensitivity = 81.3 %, specificity = 94.9 % ) and sensibility tests such as electric pulp testing (EPT) (sensitivity = 63.3 – 91.5 %, specificity = 88 – 100 %). Survey: One hundred and forty-one respondents, both, paediatric dental specialists (56%) and GDPs (44%) were included in the analysis. Almost all specialists (93.7%) reported using sensibility tests routinely in comparison to 80.6% of GDPs. Child perception and cooperation were the most commonly reported barriers. GDPs mainly used cold testing, while specialists used cold and electric pulp tests equally. Inconsistencies in recording as well as documentation the results varied among respondents. Only a few specialists reported having some experience in using laser Doppler flowmetry. Clinical study 1: There was a significant difference between the Flux values for teeth with vital and non-vital pulps. The best cut–off ratio for LDF was 0.6 yielding a sensitivity of 54 % and a specificity of 32 % which were lower than the values of electric pulp test (Sensitivity = 83.8 – 94.6 %, Specificity = 89.2 – 97.6 %) and ethyl chloride (Sensitivity = 81.1 – 91.9 %, Specificity = 73 – 81.1 %). The repeatability of LDF, EPT and ethyl chloride were 0.85, 0.86 and 0.81, respectively. Clinical study 2: The study included a convenience sample size of 15 participants with a mean age of 10.7 years (SD=1.66), age range 8-14 years. The mean follow-up period was 7.29 months (SD 1.9) with a range of 6-12 months. All traumatised teeth remained vital at the end of follow-up except one tooth. The specificity of LDF at baseline was 80% compared to 66.6% and 60-73.3% for EPT and ethyl chloride, respectively. At the end of the follow-up period, LDF showed lower specificity (71.4 %) than EPT (78.5 – 85.7 %) and ethyl chloride (71.4 – 78.5 %). Conclusion: Despite the high reported sensitivity and specificity of laser Doppler flowmetry in the systematic review, these data were found to be based on studies with a high level of bias and serious shortfalls in study designs. The survey of specialists and GDP’s showed that the use of pulp sensibility tests was relatively high amongst respondents while those of vitality tests were very low. Barriers and inconsistencies in the technique and recording of the results of sensibility tests were evident. The frequency and timing of using sensibility tests in line with international guidelines were stressed. The use of standardised techniques involving methods considered to improve reliability was highlighted. The results of the clinical studies showed that there was a high probability of false results when using LDF in assessing the pulp blood flow/pulp vitality. LDF was unable to differentiate between teeth with vital and non-vital pulps in children between the ages of 8-16 years with an acceptable level of confidence in the first clinical study. Within the limitations of the second clinical study, LDF showed better specificity than both EPT and ethyl chloride in predicting the outcome of the pulp at baseline but less at the end of follow-up. Due to the small sample size and relatively short follow-up period, the results of the second clinical study have been interpreted with caution. Therefore, the published data on the accuracy of LDF can not be accepted as they are based on studies with unacceptable flaws in study design. Our studies have shown that not only the use of LDF or even the experience of clinicians with its use is extremely low, but also its specificity and sensitivity were of a level which is unacceptable for recommending its meaningful clinical use

Estimating Dengue Transmission Intensity from Case-Notification Data from Multiple Countries

Despite being the most widely distributed mosquito-borne viral infection, estimates of dengue transmission intensity and associated burden remain ambiguous. With advances in the development of novel control measures, obtaining robust estimates of average dengue transmission intensity is key for assessing the burden of disease and the likely impact of interventions.We estimated the force of infection (λ) and corresponding basic reproduction numbers (R0) by fitting catalytic models to age-stratified incidence data identified from the literature. We compared estimates derived from incidence and seroprevalence data and assessed the level of under-reporting of dengue disease. In addition, we estimated the relative contribution of primary to quaternary infections to the observed burden of dengue disease incidence. The majority of R0 estimates ranged from one to five and the force of infection estimates from incidence data were consistent with those previously estimated from seroprevalence data. The baseline reporting rate (or the probability of detecting a secondary infection) was generally low (<25%) and varied within and between countries.As expected, estimates varied widely across and within countries, highlighting the spatio-temporally heterogeneous nature of dengue transmission. Although seroprevalence data provide the maximum information, the incidence models presented in this paper provide a method for estimating dengue transmission intensity from age-stratified incidence data, which will be an important consideration in areas where seroprevalence data are not available

Alternative epidemic indicators for COVID-19 in three settings with incomplete death registration systems

Not all COVID-19 deaths are officially reported, and particularly in low-income and humanitarian settings, the magnitude of reporting gaps remains sparsely characterized. Alternative data sources, including burial site worker reports, satellite imagery of cemeteries, and social media-conducted surveys of infection may offer solutions. By merging these data with independently conducted, representative serological studies within a mathematical modeling framework, we aim to better understand the range of underreporting using examples from three major cities: Addis Ababa (Ethiopia), Aden (Yemen), and Khartoum (Sudan) during 2020. We estimate that 69 to 100%, 0.8 to 8.0%, and 3.0 to 6.0% of COVID-19 deaths were reported in each setting, respectively. In future epidemics, and in settings where vital registration systems are limited, using multiple alternative data sources could provide critically needed, improved estimates of epidemic impact. However, ultimately, these systems are needed to ensure that, in contrast to COVID-19, the impact of future pandemics or other drivers of mortality is reported and understood worldwide

The diagnostic accuracy of laser Doppler flowmetry in assessing pulp blood flow in permanent teeth: A systematic review

Background/Aim Pulp necrosis is a frequent complication following dental trauma. The diagnosis of the state of the dental pulp can be challenging as most commonly used diagnostic tools are subjective and rely on a response from the patient, potentially making their use unreliable, especially in the child population. The aim of the study was to systematically review the evidence on the use of laser Doppler flowmetry in the assessment of the pulp status of permanent teeth compared to other sensibility and/or vitality tests. Methods A systematic literature search, using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, www.clinicaltrials.gov and www.controlled-trials.com, in addition to citation and manual reference list searches, was conducted up to 15th January 2018. A risk of bias assessment was performed using the quality assessment for diagnostic accuracy studies tool (QUADAS‐2) with all steps performed independently by two reviewers. Results Four studies with a high risk of bias were included in the final analysis. Laser Doppler flowmetry was reported to be more accurate in differentiating between teeth with normal pulps and pulp necrosis with a sensitivity of (81.8‐100%) and specificity of 100% in comparison to other vitality tests such as pulp oximetry (sensitivity = 81.3%, specificity = 94.9%) and sensibility tests such as electric pulp testing (sensitivity = 63.3 – 91.5%, specificity = 88 – 100%). Conclusion Despite the higher reported sensitivity and specificity of laser Doppler flowmetry in assessing pulp blood flow, these data are based on studies with a high level of bias and serious shortfalls in study designs. More research is needed to study the effect of different laser Doppler flowmetry's parameters on its diagnostic accuracy and the true cut‐off ratios over which a tooth could be diagnosed as having a normal pulp