Current practice of oral care for hematopoietic stem cell transplant patients: A survey of the eastern Mediterranean blood and marrow transplantation group

Introduction: The oral cavity is one of the most common sites impacted by hematopoietic stem cell transplantation (HSCT) with acute complications including mucositis, bleeding, salivary gland dysfunction, infection, and taste alteration. These complications may result in significant morbidity and can negatively impact outcomes such as length of stay and overall costs. As such, oral care during HSCT for prevention and management of oral toxicities is a standard component of transplant protocols at all centers. The objective of this study was to evaluate the current oral care practices for patients during HSCT at different transplant centers within the Eastern Mediterranean region.Material and methods: An internet-based survey was directed to 30 transplant centers in the Eastern Mediterranean region. The survey included five sections asking questions related to (1) transplant center demographics; (2) current oral care protocol used at the center and type of collaboration (if any) with a dental service; (3) use of standardized oral assessment tools and grading systems for mucositis; (4) consultations for management of oral complications; and (5) oral health needs at each center. Data are presented as averages and percentages.Results: A total of 16 responses from 11 countries were collected and analyzed, indicating a response rate of 53%. Eight centers reported that a dentist was part of the HSCT team, with four reporting oral medicine specialists specifically being part of the team. Almost all centers (15/16; 93%) had an affiliated dental service to facilitate pre-HSCT dental clearance with an established dental clearance protocol at 14 centers (87%). Dental extraction was associated with the highest concern for bleeding and the need for platelet transfusion. With respect to infection risk, antibiotic prophylaxis was considered in the setting of low neutrophil counts with restorative dentistry and extraction. All centers provide daily reinforcement of oral hygiene regimen. The most frequently used mouth oral rinses included sodium bicarbonate (68%) and chlorhexidine gluconate (62%), in addition to ice chips for dry mouth (62%). The most frequently used mucositis assessment tools were the World Health Organization scale (7/16; 43%) and visual analogue scale for pain (6/16; 37%). Mucositis pain was managed with lidocaine solution (68.8%), magic mouth wash (68.8%) and/or systemic pain medications (75%).Conclusions: Scope and implementation of oral care protocols prior to and during HSCT varied between transplant centers. The lack of a universal protocol may contribute to gaps in oral healthcare needs and management for this group of patients. Further dissemination of and education around available oral care guidelines is warranted.Clinical relevance: Considering oral care during HSCT a standard component of transplant protocols, the current study highlights the common oral care practices for patients at centers within the Eastern Mediterranean region

Evaluation of Orthodontic Treatment Need Among Saudi Population: A Cross-Sectional Study

Objective: To assess the orthodontic treatment needs among the Saudi population through a cross-sectional study, providing a comprehensive understanding of the prevalence and factors influencing treatment needs. Methods: This research employs a cross-sectional study design to assess the orthodontic treatment needs among the Saudi population. Cross-sectional studies provide a snapshot of the population at a given point in time and are suitable for determining the prevalence of a specific condition or treatment need in a defined population. Results: The study included 480 participants. The most frequent age among them was 18-28 years (n= 199, 41.5%) followed by 29-239 years (n= 191, 39.8%). The most frequent gender among study participants was Male (n= 297, 61.9%) followed by Female (n= 183, 28.1%). The most frequent nationality among study participants was Saudi (n= 450, 93.8%) followed by non-Saudi (n= 30, 6.3%). Participants were asked if they think they need orthodontics. There were 194 participants not need it (40.4%), followed by 151 maybe with (31.5%), and 135 participants think definitely needed it (28.1%). Conclusion: Study results showed that most of the study participants are from the university according to their educational level. The most common nationality was Saudi. Most of them were male. Most of the participants think they don’t need orthodontics. In addition, most of the study participants had good social connections

A multi-country study on the impact of sex and age on oral features of COVID-19 infection in adolescents and young adults

Background: Oral diseases are features of COVID-19 infection. There is, however, little known about oral diseases associated with COVID-19 in adolescents and young adults (AYA). Therefore, the aim of this study was to assess oral lesions’ association with COVID-19 infection in AYA; and to identify if sex and age will modify these associations. Methodology: Data was collected for this cross-sectional study between August 2020 and January 2021 from 11-to-23 years old participants in 43-countries using an electronic validated questionnaire developed in five languages. Data collected included information on the dependent variables (the presence of oral conditions- gingival inflammation, dry mouth, change in taste and oral ulcers), independent variable (COVID-19 infection) and confounders (age, sex, history of medical problems and parents’ educational level). Multilevel binary logistic regression was used for analysis. Results: Complete data were available for 7164 AYA, with 7.5% reporting a history of COVID-19 infection. A significantly higher percentage of participants with a history of COVID-19 infection than those without COVID-19 infection reported having dry mouth (10.6% vs 7.3%, AOR = 1.31) and taste changes (11.1% vs 2.7%, AOR = 4.11). There was a significant effect modification in the association between COVID-19 infection and the presence of dry mouth and change in taste by age and sex (P = 0.02 and < 0.001). Conclusion: COVID-19 infection was associated with dry mouth and change in taste among AYA and the strength of this association differed by age and sex. These oral conditions may help serve as an index for suspicion of COVID-19 infection in AYA

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

External Data Access and Indexing in a Scalable Big Data Management System

Traditional Database Management Systems (DBMS) offer a long list of quality attributes such as high performance, a flexible query interface, accuracy, reliability and fault tolerance. However, in order for users to get these benefits, they need to first have their data loaded into the system and stored in its storage layer using the system's binary format and utilizing its different data structures. The space requirements and the computational and operational cost of loading data is unjustifiable at times. This cost increases as data becomes larger and larger, especially when existing systems are generating these data continually, e.g., by producing system logs. For these reasons, many existing applications don't use DBMSs at all and instead rely on custom scripts or specialized code that lack the qualities offered by DBMSs. This problem has been acknowledged by many Data Management Systems that also provide ways for users to use their query language to carry out different analysis against data in raw format. However, external data access in most of these systems involves expensive full scan operations, affecting the performance of these DBMSs to a great extent. For this reason, many data management systems provide external data access to facilitate data loading and not for ongoing use for routine data querying and analysis. Recently, several research projects have sought to improve efficiency for external data access using different techniques. Each of these techniques has certain limitations, such as having to change the existing external data or having to write it in the first place through a specialized system, or has resulted in very small performance gains. In AsterixDB, the big data management system developed in UCI, we have designed and implemented a new feature that allows building incrementally refreshable indexes over external data. In this thesis, we explain in detail the different types of external data AsterixDB can access through its adapters. We then explain the semantics and user model associated with the indexing of external data. We follow that with a discussion of the system design for indexing external data and show how the system addresses the different challenges associated with this task. We further provide an evaluation of query performance over external data that resides in Hadoop Distributed File System. We compare AsterixDB's external data access with Hive on the same data files and with the same data after loading it into AsterixDB's internal storage. We show that a user can get competitive performance using AsterixDB without having to first load their data into the system

External Data Access and Indexing in a Scalable Big Data Management System

Traditional Database Management Systems (DBMS) offer a long list of quality attributes such as high performance, a flexible query interface, accuracy, reliability and fault tolerance. However, in order for users to get these benefits, they need to first have their data loaded into the system and stored in its storage layer using the system's binary format and utilizing its different data structures. The space requirements and the computational and operational cost of loading data is unjustifiable at times. This cost increases as data becomes larger and larger, especially when existing systems are generating these data continually, e.g., by producing system logs. For these reasons, many existing applications don't use DBMSs at all and instead rely on custom scripts or specialized code that lack the qualities offered by DBMSs. This problem has been acknowledged by many Data Management Systems that also provide ways for users to use their query language to carry out different analysis against data in raw format. However, external data access in most of these systems involves expensive full scan operations, affecting the performance of these DBMSs to a great extent. For this reason, many data management systems provide external data access to facilitate data loading and not for ongoing use for routine data querying and analysis. Recently, several research projects have sought to improve efficiency for external data access using different techniques. Each of these techniques has certain limitations, such as having to change the existing external data or having to write it in the first place through a specialized system, or has resulted in very small performance gains. In AsterixDB, the big data management system developed in UCI, we have designed and implemented a new feature that allows building incrementally refreshable indexes over external data. In this thesis, we explain in detail the different types of external data AsterixDB can access through its adapters. We then explain the semantics and user model associated with the indexing of external data. We follow that with a discussion of the system design for indexing external data and show how the system addresses the different challenges associated with this task. We further provide an evaluation of query performance over external data that resides in Hadoop Distributed File System. We compare AsterixDB's external data access with Hive on the same data files and with the same data after loading it into AsterixDB's internal storage. We show that a user can get competitive performance using AsterixDB without having to first load their data into the system

Antimicrobial Resistance Awareness, Antibiotics Prescription Errors and Dispensing Patterns by Community Pharmacists in Saudi Arabia

Background: Antibiotic overuse and misuse have greatly facilitated the development of antimicrobial resistance (AMR). The Kingdom of Saudi Arabia is one of the countries that took a strategic approach, beginning with the prohibition of over-the-counter antibiotic dispensing, followed by the implementation of antimicrobial stewardship programs and various educational and awareness governmental activities and plans. However, the status of antibiotic prescriptions and dispensing in Saudi community pharmacies is still unclear. As a result, this study investigates community pharmacists' antibiotic dispensing practices and their knowledge of their role in fighting AMR, in addition to the status of antibiotic prescribing errors by physicians. Method: This is an online-based survey study of 671 participants distributed among community pharmacists of large pharmacy chains throughout the Saudi Arabia. Result: A number of 671 community pharmacists were participated in total, with a response rate of 96.57% (648 responses). The majority of community pharmacists (67%) had a long experience (>5 years) in this field. An antibiotic prescribing error was prevalent, with a mean of 3.32 per month in each pharmacy. Dentists (36.7%) and general practitioners (28.7%) were the most prescribers associated with antibiotic prescription errors. Most community pharmacists had a generally good practice of dispensing antibiotics, accounting for 71.5% of daily antibiotic dispensing. However, more than one-third of those pharmacists (35.2%) agreed on dispensing topical antibiotics without a prescription, based on their evaluation of the case presented in the pharmacy, as the majority of community pharmacists demonstrated a significant understanding of AMR. Conclusion: The current study demonstrated that there is a good antibiotic dispensing practice in the community pharmacies in Saudi Arabia, in addition to a substantial understanding of the community pharmacist’s vital role in fighting AMR. This study could inform decision-makers on antibiotic usage in Saudi community pharmacies to improve the current inappropriate antibiotic use and dispensing situation and, thus, control AMR spread in Saudi Arabia