Camel Milk is an Alternative and a Complementary Treatment to the Current Parenteral Insulin Therapy of Insulin-dependent Diabetes Mellitus

The main treatment of insulin-dependent diabetes mellitus (IDDM) is insulin replacement via parenteral routes which is far from satisfactory, because injection is generally a painful procedure, especially when patients need to get the injections throughout their life by 2-3 injections/day. Secondly, many patients have phobia against injections especially children. Thirdly, insulin is expensive to purchase. Fourthly, parenteral insulin is not safe in the long-term of uses as development of anti-insulin antibodies is possible, and fifthly, parenteral insulin is associated with the risk of hypoglycemic events. For those reasons, raw dromedary’s camel milk is an alternative and or complementary to pareneral insulin treatment of IDDM. This paper discusses the chemical constituents and properties of dromedary’s camel milk, recent research about its efficacy in the treatment of IDDM, its role in the restoration of experimentally damaged beta-cells of the pancreas, its role in the improvement of lipid metabolism, body mass index and functions of the kidneys and liver of subjects with IDDM received camel milk. This paper demonstrates that, raw dromedary’s camel milk causes significant reduction in insulin doses in insulin dependent diabetic subjects to obtain glycemic control along with significant hypoglycemic effects. Significant improvement were also observed in HbA1c levels, micro albuminuria, lipid metabolism, BMI, biochemical parameters of the liver and kidney functions of camel milk fed experimental subjects with IDDM. Camel milk works as a regulator of blood sugar in the absence of original insulin, and it seems to work together with the body’s own restorative and regenerative abilities to maintain normal health. Camel milk is well tolerated and its uses are not associated with the risk of hypoglycemic events, and it may be able to eliminate the alloxan and other chemicals’ induced-toxicity on pancreas and on other body’s organs via regenerative effects on damaged cells with unknown mechanism and could be used as an alternative and or a complementary treatment to current IDDM therapy

Medication package inserts’ usefulness for Sudanese pharmacists and patients: pharmacists’ perspective

Background: Written medication information is important to health care professionals and patients, alike. Medication package inserts (PI) can prove useful sources for written medication information for pharmacist and patients. The main objective of this study was to evaluate the knowledge, attitude, and practice of the Sudanese pharmacists toward PIs.Methods: A total of 120 randomly selected Sudanese community and hospital pharmacists, were addressed with a questionnaire of 14 free to answer closed-ended questions.Results: Results showed clear dominance of the young (96.5%), females (63.3%)pharmacists population, whose majority (90.8%) had their undergraduates studies in Sudan. Majority (79.2%) of respondents was keen to read the PIs, and (75.8%)considered them as reliable written medication information sources and references. Correlation between respondents’ reliability and reading of PIs was significant (**p=0.038). How to use medications (95%) their dose (92.5%), and compliance (67.5%), topped the medication information particulars provided by respondents to patients. Drug-interactions and side-effects (36.7%) were downplayed by the respondents. Only a small minority (21.7%) of respondents used to advise patients to read PIs. Majority (85%) of respondents believed that PIs were difficult for patients to understand. Their texts’ language (68.2%), technical terminology (75%) and font size (10%) were cited as main barriers to understandability.Conclusions: To secure usefulness of PIs, they shall be written in lay terminology of patients’ native language. Pharmacists shall seek independent sources of medication information, advice and motivate patients to read PIs and keep them for ongoing reference

The Relationship Between Serum 25 hydroxy Vitamin D Deficiency and Dietary Pattern in Baxshin Hospital, Sulaimani City

Vitamin D is one of the fat-soluble vitamins that have a great role in phosphate and calcium balance and bone structure. To our knowledge, there are limited data on the relation between dietary pattern and serum vitamin d concentration. Therefore, the aim of the current study is find out whether, there are any associations between serum vitamin D and with any specific dietary pattern. A cross sectional study was implemented in Baxshen hospital in order to find the prevalence of vitamin D deficiency and its relation with dietary pattern among healthy participants. 1131 participants were enrolled in the current study male and female with age 18 – 65 years old, living in Sulaimani city and its districts have not used any supplement in the past 6 months before enrolling the study.  Two questionnaires were used for collecting of data, the first one was included demographical data of the participants. Including their age, gender, marital status, educational level, address, and etc. The second one was data on dietary pattern; particularly we focused on some vitamin D dietary sources. A three-day dietary records estimate was taken from the patients and this data were coded and put in dietary software (windiet) and then analyzed. The age of the sample ranged from 18 to 65 years old with the mean of 34.34 years old with a standard deviation of 12.6. One hundred sixty-two (14.3%) of the 1131 participants were female, nine hundred sixty-nine (85.7%) of the participants were male. 65.5 % of them exposure to sun less than 30, 34.5% exposure to sun more than half hour. About 84.6% of participants had severe deficiency of vitamin D and 6.9% of participants had adequate vitamin D. Fish, eggs and yogurt conception was common among those participants whom their serum vitamin D was adequate, in contrary, there were less consumed among those who had vitamin D deficiency.  The percentage of obese (99.8%) was significantly higher than normal weight and overweight among severe deficiency Vitamin D. Furthermore, a highly percentage of adequate was (93.6%) in the normal weight. The mean of vitamin D intake was 761 ± 195.65 IU, in normal weight group, and the mean of vitamin d intake was 125.98 ± 53.15 IU, in obese group. This study has concluded that the reach Dietary sources of vitamin D is not enough to provide the body adequate amount of vitamin D, in addition, Obese and overweight individuals tend to have less serum vitamin D status compared to normal weight individuals and finally recommended daily amount of vitamin d intake should be established for Kurdistan people

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Application of Solid Phase Extraction on Multiwalled Carbon Nanotubes of Some Heavy Metal Ions to Analysis of Skin Whitening Cosmetics Using ICP-AES

A novel and highly sensitive method for the determination of some heavy metals in skin whitening cosmetics creams using multiwalled carbon nanotubes MWCNTs as solid phase extraction sorbent for the preconcentration of these heavy metals prior to their determination by inductively coupled plasma atomic emission spectrometry is described. Different practical parameters have been thoroughly investigated and the optimum experimental conditions were employed. The developed method was then applied for the determination of arsenic, bismuth, cadmium, mercury, lead and titanium in samples of skin whitening cosmetics. The detection limits under these conditions for As, Bi, Cd, Pb, Hg and Ti were 2.4, 4.08, 0.3, 2.1, 1.8, and 1.8 ng&amp;#183;mL&amp;#8722;1, respectively. The relative standard deviations (RSDs) were found to be less than 2.0%. For validation, a certified reference material of NIST SRM 1570a spinach leaves was analyzed and the determined values were in good agreement with the certified values. The recoveries for spiked samples were found to be in the range of 89.6&amp;#8211;104.4%