Meningococcal vaccination and travel health in Hajj pilgrims – A study of pilgrims to Mecca, Saudi Arabia

Background: Hajj brings millions of pilgrims from different countries into a confined place. A number of outbreaks of meningococcal disease have been reported after the Hajj. All pilgrims are required to receive a quadrivalent meningococcal vaccine at least 10 days before the Hajj. They are also advised to follow travel health advice to reduce the risk of acquiring infections. We conducted a study to investigate the association between time of meningococcal vaccination and carriage of Neisseria meningitidis pathogenic serogroups A, C, W, and Y. Patterns of health problems encountered by pilgrims and preventive measures adopted during the Hajj were also investigated. Methods: A cross-sectional oropharyngeal carriage survey was conducted in 2973 Hajj pilgrims in 2017. A two stage sampling method was used to select departing flights. An electronic data collection tool (‘Open Data Kit’ (ODK)), was used to gather demographic, health and exposure data through questionnaires. Real-time polymerase chain reaction (rt-PCR) was used to identify N. meningitidis and serogroups. Results: The overall prevalence of N. meningitidis carriage was 4·6%. Meningococcal carriage of pathogenic serogroups A, C, W, and Y was not significantly associated with time of vaccination. A total 22·58 % were likely unvaccinated against meningococcal disease. 38.7% reported symptoms of upper respiratory tract infections and 5.4% of travel 4 diarrhoea. Compliance with facemask use was 50.2%. Changing facemask every 4 hours was found to be a significant protective factor for URTI’s. No significant association was found between having a chronic disease and seeking pre-travel advice. Conclusion: Whilst this study did not find any association between timing of meningococcal vaccination and carriage of N. meningitidis, it did highlight the issue of unvaccinated pilgrims and a need to strengthen compliance with the current vaccination policy. Early pre-travel health advice should continue to be enforced

The morphometric anatomy and clinical importance of the radial artery

Background: The radial forearm flap (RFF), including the radial artery and venous components, is used for hand reconstruction surgery. Updating the knowledge of the vascular anatomy in the forearm and associated flaps, such as the RFF, is useful in bringing innovations into reconstructive surgery. This study aimed to describe the morphometric anatomy of the radial artery (RA) and the associated RFF in human cadavers. Materials and methods: A total of 16 forearms from 8 human cadavers were dissected. The group consisted of 5 men and 3 women with a mean age at death of 59.05 ± 14.06 years. The inclusion criteria consisted of no history of trauma or surgery; thus, only apparently normal cadavers were included. The measurement of the following parameters was performed on these human cadavers: the mean diameter of the RA, the length of the RA, the average diameter of the cephalic vein, the length of the pedicle of the flap, and the average area of the radial forearm flap. Results: In males, the mean diameter of the radial artery at the wrist was 2.58 ± 1.1 mm. In females, the mean diameter of the radial artery was 2.60 ± 0.99 mm, and the mean length of the radial artery was 20.55 ± 1.7 cm. The average diameter of the cephalic vein was 1.8 ± 0.8 mm. The length of the pedicle of the flap was 8.88 ± 1.6 cm. The average area of the radial forearm flap was 5 X 7 cm2. Conclusions: This study demonstrates the morphometric anatomy of the RA and lateral forearm radial artery flaps in human cadavers, which could be useful in improving the success rate during transradial coronary interventions and performing complex hand injuries

Measurement of healthcare quality : a mixed-methods comparative study of accredited and non-accredited hospitals in Saudi Arabia

Saudi Arabia was one of the first countries in the middle east to adopt an accreditation programme in its healthcare sector in forming the Central Board of Accreditation for Healthcare Institutions (CBAHI) in 2005. Even though accreditation has implied positive effects on quality of healthcare, as addressed in the literature, the literature search revealed a dearth of published studies concerned with the relationship between accreditation and improved quality of healthcare in Saudi Arabia. The main aim of this research was to examine any potential differences in the quality of care provided by accredited and non-accredited Ministry of Health hospitals in Saudi Arabia. A mixed-method approach was adopted with the intention of gathering both quantitative and qualitative data to answer the research objectives. Quantitative data was collected through extraction from the reports on quality of care indicators provided by the participating Ministry of Health hospitals. Qualitative data incorporated social and behavioural thinking regarding the quality of accredited and non-accredited hospitals. Qualitative data was collected through semi-structured interviews with senior hospital management of a selection of Ministry of Health hospitals. A total of 88 MoH hospitals provided data, of which 46 were accredited and 42 were non-accredited. When quality of care indicators were compared between accredited and non-accredited hospitals, a significant difference was found in 12 separate quality of care indicators. The significant difference was that, the indicators in the accredited hospitals had a higher score, which showed that the quality of care in non-accredited hospitals was better. Three themes emerged from the interview data: knowledge, practice, and attitude, with findings showing a similarity of perspective towards quality from both accredited and non-accredited hospital staff. Non-accredited hospital staff had a different attitude towards quality than accredited hospital staff. Conclusion: This study clearly demonstrated the superiority of non-accredited hospitals in the overall results of the indicators under study. Moreover, the behaviour and attitude of the employee demonstrate that some of the hospitals members are not able to strike a balance between their basic duties as healthcare practitioners and their participation in quality initiatives

A Comparative Study on the Flexural Behaviour of Rubberized and Hybrid Rubberized Reinforced Concrete Beams

This paper aims to investigate the flexural behaviour of the rubberized and hybrid rubberized reinforced concrete beams. A total of fourteen beams, 150×200 mm in cross-section with 1000 mm in length, were subject to a laboratory test over an effective span of 900 mm. The sand river aggregate was replaced by 10%, 12.5%, and 15% of crumb rubber (volume).   The hybrid structure contained two double layers: 1) rubberized reinforcement concrete at the top layer of the beam and 2) reinforcement concrete at the bottom layer of the concrete beam. The static responses by the flexural test of all the beams were evaluated in terms of their fresh properties, failure patterns, total energy, flexural strength, stiffness, and ultimate deflection, modulus of rupture, strain capacity, and ductility index. The results showed that there were improvements when the hybrid beams were used in most cases such as failure pattern, ultimate load, stiffness, modulus of rupture, and stress. The rubberized concrete beams showed improvements in the strain capacity as illustrated in strain gauges and stress-strain curves, toughness, ultimate deflection, and ductility index. The findings of the study revealed an improved performance with the use of the hybrid beams. This has resulted in the implementation of innovative civil engineering applications in the engineering sustainable structures

Physiologically-based pharmacokinetic modeling for single and multiple dosing regimens of ceftriaxone in healthy and chronic kidney disease populations: a tool for model-informed precision dosing

Introduction: Ceftriaxone is one of commonly prescribed beta-lactam antibiotics with several label and off-label clinical indications. A high fraction of administered dose of ceftriaxone is excreted renally in an unchanged form, and it may accumulate significantly in patients with impaired renal functions, which may lead to toxicity.Methods: In this study, we employed a physiologically-based pharmacokinetic (PBPK) modeling, as a tool for precision dosing, to predict the biological exposure of ceftriaxone in a virtually-constructed healthy and chronic kidney disease patient populations, with subsequent dosing optimizations. We started developing the model by integrating the physicochemical properties of the drug with biological system information in a PBPK software platform. A PBPK model in an adult healthy population was developed and evaluated visually and numerically with respect to experimental pharmacokinetic data. The model performance was evaluated based on the fold error criteria of the predicted and reported values for different pharmacokinetic parameters. Then, the model was applied to predict drug exposure in CKD patient populations with various degrees of severity.Results: The developed PBPK model was able to precisely describe the pharmacokinetic behavior of ceftriaxone in adult healthy population and in mild, moderate, and severe CKD patient populations. Decreasing the dose by approximately 25% in mild and 50% in moderate to severe renal disease provided a comparable exposure to the healthy population. Based on the simulation of multiple dosing regimens in severe CKD population, it has been found that accumulation of 2 g every 24 h is lower than the accumulation of 1 g every 12 h dosing regimen.Discussion: In this study, the observed concentration time profiles and pharmacokinetic parameters for ceftriaxone were successfully reproduced by the developed PBPK model and it has been shown that PBPK modeling can be used as a tool for precision dosing to suggest treatment regimens in population with renal impairment

A Fully Guided Sequential Template Immediate Loading Protocol for Dual-Arch Implant Surgery

Lamia Alruhailie,1,* Aliyaa Zaidan,2,* Abeer Alasmari,2,* Ossama Raffa1,* 1Department of Prosthodontics, King Abdulaziz Medical City, Jeddah, Saudi Arabia; 2Department of Periodontics, King Abdulaziz Medical City, Jeddah, Saudi Arabia*These authors contributed equally to this workCorrespondence: Ossama Raffa, Department of Prosthodontics, King Abdulaziz Medical City, Jeddah, Saudi Arabia, Tel +966543322668, Email [email protected]: A method is described for designing, fabricating and implementing sequential template immediate loading protocols for dual arch implant therapy. A 41-year-old medically-free patient with terminal dentition was treated following stackable guide loading protocols for maxillary and mandibular arches. Implants were placed following extractions and immediately loaded with full arch fixed prostheses. Healing was uneventful and all implants integrated successfully. Special consideration was given to the design and clinical challenges when implementing stackable guide protocols for dual arch implant therapy.Keywords: prosthodontics, implants, digital dentistry, stackable guide

The Prevalence of Obesity among School Students and its Relation to Dietary and Physical Habits

BACKGROUND: Recent studies suggest that unhealthy food practices and lack of exercise are the main cause of the progressive increase in the obesity prevalence. AIM: We aim to assess the prevalence of obesity among school students and its relationship to dietary and physical habits. METHODS: A cross-sectional study from 18 intermediate and high schools located in Taif, Saudi Arabia, between April 2014 and June 2015. We excluded any student with a psychological disease or chronic diseases. We calculated the body mass index (BMI) of students by measuring their height and weight. Dietary, physical, sleep habits, and socioeconomic status were assessed. RESULTS: A total of 2943 students participated with a mean age of 15.4 ± 1.7 years. The majority of these were boys and attending government schools with a mean BMI 22.7 ± 8.6 kg/m2. Overall, 13.6% were overweight and 12.8% were obese. One-third of students report a sedentary lifestyle. Compared to girls, boys were more likely to have lower BMI (p < 0.001), be overweight (p < 0.001), exercise for >300 min/week (p < 0.001), own electronic devices other than smartphone (p < 0.001), use the electronic devices <3 h/day (p = 0.007), eat their meals with their family (p < 0.001), eat fruits and vegetables daily (p < 0.05), exercise for >300 min/week (p < 0.001), and walk to and from school at least once weekly (p < 0.001). CONCLUSION: A quarter of the students were either overweight or obese. Girls were more likely to be obese with less favorable socioeconomic, media consumption, dietary, and physical profiles

Clinically relevant enhancement of human sperm motility using compounds with reported phosphodiesterase inhibitor activity

STUDY QUESTION: Can we identify compound(s) with reported phosphodiesterase inhibitor (PDEI) activity that could be added to human spermatozoa in vitro to enhance their motility without compromising other sperm functions? SUMMARY ANSWER: We have identified several compounds that produce robust and effective stimulation of sperm motility and, importantly, have a positive response on patient samples. WHAT IS KNOWN ALREADY: For >20 years, the use of non-selective PDEIs, such as pentoxifylline, has been known to influence the motility of human spermatozoa; however, conflicting results have been obtained. It is now clear that human sperm express several different phosphodiesterases and these are compartmentalized at different regions of the cells. By using type-specific PDEIs, differential modulation of sperm motility may be achieved without adversely affecting other functions such as the acrosome reaction (AR). STUDY DESIGN, SIZE, DURATION: This was a basic medical research study examining sperm samples from normozoospermic donors and subfertile patients attending the Assisted Conception Unit (ACU), Ninewells Hospital Dundee for diagnostic semen analysis, IVF and ICSI. Phase 1 screened 43 commercially available compounds with reported PDEI activity to identify lead compounds that stimulate sperm motility. Samples were exposed (20 min) to three concentrations (1, 10 and 100 µM) of compound, and selected candidates (n = 6) progressed to Phase 2, which provided a more comprehensive assessment using a battery of in vitro sperm function tests.  PARTICIPANTS/MATERIALS, SETTING, METHODS: All healthy donors and subfertile patients were recruited at the Medical Research Institute, University of Dundee and ACU, Ninewells Hospital Dundee (ethical approval 08/S1402/6). In Phase 1, poor motility cells recovered from the 40% interface of the discontinuous density gradient were used as surrogates for patient samples. Pooled samples from three to four different donors were utilized in order to reduce variability and increase the number of cells available for simultaneous examination of multiple compounds. During Phase 2 testing, semen samples from 23 patients attending for either routine diagnostic andrology assessment or IVF/ICSI were prepared and exposed to selected compounds. Additionally, 48 aliquots of prepared samples, surplus to clinical use, were examined from IVF (n = 32) and ICSI (n = 16) patients to further determine the effects of selected compounds under clinical conditions of treatment. Effects of compounds on sperm motility were assessed by computer-assisted sperm analysis. A modified Kremer test using methyl cellulose was used to assess sperm functional ability to penetrate into viscous media. Sperm acrosome integrity and induction of apoptosis were assessed using the acrosomal content marker PSA-FITC and annexin V kit, respectively. MAIN RESULTS AND THE ROLE OF CHANCE: In Phase 1, six compounds were found to have a strong effect on poor motility samples with a magnitude of response of ≥60% increase in percentage total motility. Under capacitating and non-capacitating conditions, these compounds significantly (P ≤ 0.05) increased the percentage of total and progressive motility. Furthermore, these compounds enhanced penetration into a cervical mucus substitute (P ≤ 0.05). Finally, the AR was not significantly induced and these compounds did not significantly increase the externalization of phosphatidylserine (P = 0.6, respectively). In general, the six compounds maintained the stimulation of motility over long periods of time (180 min) and their effects were still observed after their removal. In examinations of clinical samples, there was a general observation of a more significant stimulation of sperm motility in samples with lower baseline motility. In ICSI samples, compounds #26, #37 and #38 were the most effective at significantly increasing total motility (88, 81 and 79% of samples, respectively) and progressive motility (94, 93 and 81% of samples, respectively). In conclusion, using a two-phased drug discovery screening approach including the examination of clinical samples, 3/43 compounds were identified as promising candidates for further study. LIMITATIONS, REASONS FOR CAUTION: This is an in vitro study and caution must be taken when extrapolating the results. Data for patients were from one assessment and thus the robustness of responses needs to be established. The n values for ICSI samples were relatively small. WIDER IMPLICATIONS OF THE FINDINGS: We have systematically screened and identified several compounds that have robust and effective stimulation (i.e. functional significance with longevity and no toxicity) of total and progressive motility under clinical conditions of treatment. These compounds could be clinical candidates with possibilities in terms of assisted reproductive technology options for current or future patients affected by asthenozoospermia or oligoasthenozoospermia

Development of certain novel N-(2-(2-(2-oxoindolin-3-ylidene)hydrazinecarbonyl)phenyl)-benzamides and 3-(2-oxoindolin-3-ylideneamino)-2-substituted quinazolin-4(3H)-ones as CFM-1 analogs: design, synthesis, QSAR analysis and anticancer activity.

The reaction of N-(2-(hydrazinecarbonyl)aryl)benzamides 2a, b with indoline-2,3-diones 4ae in acidified ethanolic solution furnished the corresponding N-(2-(2-(2-oxoindolin-3-ylidene)hydrazinecarbonyl)phenyl)benzamides 5aj, respectively. Furthermore, 3-(2-oxoindolin-3-ylideneamino)-2-substituted quinazolin-4(3H)-ones 6aj were prepared by the reaction of 3-amino-2-arylquinazolin-4(3H)-one 3a, b with 4ae. Six derivatives of the twenty newly synthesized compounds showed remarkable antitumor activity against most of the tested cell lines, Daoy, UW228-2, Huh-7, Hela and MDA-MB231. Although these six compounds were more potent than the standard drug (CFM-1), indeed compounds 5b, 5d and 6b were the best candidates with IC50 values in the range 1.866.87, 4.4210.89 and 1.468.60 μg/ml and percentage inhibition in the range 77.188.7, 59.4184.8 and 75.488.0%, respectively. QSAR analyses on the current series of derivatives also have been performed for all five cancer cell lines and thus 10 statistically significant models were developed and internally cross validated