THE ROLE OF LINGO-1 AND MYELIN BASIC PROTEIN MRNAS IN CENTRAL REMYELINATION IN ETHIDIUM BROMIDE-INDUCED DEMYELINATION IN RATS

Objective: The study aimed to assess the possible role of quercetin, pioglitazone, metformin, and dapagliflozin in the enhancement of remyelination process after ethidium bromide (EB)-induced demyelination. Methods: The study was conducted on 60 male Wister rats (250–300 g), randomly divided into sham-operated group and five demyelination groups (each of 10 rats) which subjected to intrapontine stereotaxic injection of EB (10 μl of 0.1% EB) to induce demyelination. Then, randomly subdivided into: EB control group: Rats were treated with normal saline, quercetin-treated group (50 mg/kg/day), pioglitazone-treated group (10 mg/kg/day), metformin-treated group (500 mg/kg/day), and dapagliflozin-treated group (10 mg/kg/day). Behavioral tests (beam balance, foot fault, rotarod, and inverted screen) were conducted for all groups as well as biochemical analysis of LINGO-1 and myelin basic protein (MBP) mRNAs and histological examination of pontine tissues. Results: The EB control group showed deterioration of motor performance on behavioral tests. Degenerative changes were observed in pontine tissue on histological examination together with upregulation of LINGO-1 protein and downregulation of MBP level. While the treated groups after EB demyelination showed significant improvement in motor performance and decreased degenerated neurons in histological examination with upregulation of MBP level and downregulation of LINGO-1 protein level. Conclusion: Quercetin, metformin, dapagliflozin, and pioglitazone showed neuroprotective effect and enhancement of remyelination process

Barriers, challenges and way forward for implementation of person centered care model of patient and physician consultation: a survey of patients’ perspective from Eastern Mediterranean countries

Background: Person-Centered Care (PCC) is now considered a mandatory approach in Patient-Physician consultation. The aim of the study was to identify patients’ perception regarding barriers and possible remedies for implementation of PCC in Eastern Mediterranean Region (EMR). Methods: A cross-sectional multi-country study was conducted in six countries of EMR during May 2014 to October 2014. Expert Family Physicians from each country were identified and asked to participate in the study. The Family Physicians then recruited Patients from their own clinics (\u3e18 years). Data analysis was performed on SPSS 19 and results are reported in the form of proportions, odds ratios and 95% confidence intervals. Results: A total of 234 patients were recruited, 60.6% were aged between 20 to 30 years and 36.3% of them were males. 56% of the patients preferred Person-Centered Care model for patient-physician consultation. The major barriers identified by patients in its implementing were; time constraints (73.9%, OR: 1.5; 95% CI: 0.86-2.78), doctors desire to control patient (OR: 2.6; 95% CI: 1.55-4.49), cultural and religious reasons (52.1%), increased cost (50.9%). Patients responded that increased cost related to Person-Centered Care practice would be acceptable (58.1%), if increase proved to be in the interest of better health and care outcomes (40.6%). Conclusion: Person-Centered Care (PCC) is associated with significant barriers in its implementation in Eastern Mediterranean Region. These barriers can be overcome in the interest of better health and care related outcomes

Health promotion, disease prevention and periodic health checks: perceptions and practice among family physicians in Eastern Mediterranean region

Introduction: The aim of this study was to identify the current practices and perceptions of family physicians regarding health promotion, disease prevention including periodic screening and health checks in Eastern Mediterranean Region. Methods: A multi-country cross-sectional study was conducted in six countries of EMR, from September 2014 to March 2015. Family Physicians who were currently practicing in different countries of EMR were invited to participate in the study through email. A pre-tested structured questionnaire was used for data collection. Data was entered and analyzed on SPSS 19 and logistic regression analysis was performed. Results: A total of 100 physicians’ data was included in the final analysis. The majority were female physicians (76%): 63% were 25 to 35 years of age. Approximately 53% of Family physicians always recommend periodic screening and health checks to their patients. The common screening question asked to patients in medical history was related to their blood pressure (86%). Almost all (99%) of the Family physicians believe they should conduct periodic health checks. Those who had postgraduate training in Family Medicine (OR: 0.5; 95% CI: 0.39-1.67) and attended CME sessions regularly (OR: 0.11; 95% CI: 0.01-0.93), are more likely to recommend periodic screening and health checks to their patients. Conclusion: Periodic screening and health check is an important strategy to prevent disease and maintain health. It is an underutilized practice and a great need exists for its implementation in family practice

Herd Immunity against Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 10 Communities, Qatar.

We investigated what proportion of the population acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and whether the herd immunity threshold has been reached in 10 communities in Qatar. The study included 4,970 participants during June 21-September 9, 2020. Antibodies against SARS-CoV-2 were detected by using an electrochemiluminescence immunoassay. Seropositivity ranged from 54.9% (95% CI 50.2%-59.4%) to 83.8% (95% CI 79.1%-87.7%) across communities and showed a pooled mean of 66.1% (95% CI 61.5%-70.6%). A range of other epidemiologic measures indicated that active infection is rare, with limited if any sustainable infection transmission for clusters to occur. Only 5 infections were ever severe and 1 was critical in these young communities; infection severity rate of 0.2% (95% CI 0.1%-0.4%). Specific communities in Qatar have or nearly reached herd immunity for SARS-CoV-2 infection: 65%-70% of the population has been infected

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Blood pressure control, lifestyle and disease awareness of Saudi hypertensive patients

Mortality and morbidity from hypertension have reached epidemic proportion worldwide. It has been estimated that 874 million adults globally have systolic blood pressure (SBP) of 140 mm Hg or higher. A recent study from Saudi Arabia found 15.2% of adult Saudis were hypertensive of whom 57.8% unaware of this diagnosis. We aim to evaluate the lifestyle advices given to Saudi hypertensive patients, their current lifestyle to determine the effects of these factors on their BP control. Nonrandom convenience sampling of Saudi patients followed up in the clinic by cross-sectional questionnaire. Their BP, blood sugar, and other anthropometric data were measured and provided self-filled questionnaire. Of all participants, 148 known hypertensives on treatment were included in the study with a mean age of 45.7 ± 29.0 years. The mean SBP and diastolic BP were 134.7 ± 21.4 and 85.0 ± 18.9 mm Hg, respectively. The overall awareness score was 77.5% with the highest awareness score for “BP can be controlled by proper management” (93.2%) and the lowest score given for “BP is not affected by alcohol consumption” (63.4%). We found significantly lower mean SBP in those with higher awareness in five of the nine awareness areas inquired. We believe that educating hypertensive patients about their diseases and lifestyle advices has a significant impact on disease control and well-being

Awareness of Libyan students and academic staff members of nanotechnology

At the present time, nanotechnology is involved in every aspect of scientific life and its applications are being integrated into the economy, industry, trade and medicine. The world will require a skilled work force of more than two million nanotechnologists by 2015. The rapid advance in all fields of nanotechnology has led to integrate nanotechnology courses in high schools, institutes and university curricula all over the world. However, nanotechnology has not as, yet been integrated within the Libyan curricula at any level. Thus, this study focuses and explores the awareness of the academic staff and students in Tripoli (Alfateh) University about nanotechnology and nanoscience. Moreover their readiness to integrate the basics and applications into Libyan education curricula. The results show that education level and work place have an effect on the knowledge of the participants on nanotechnology, where about 65% of PhD degree holders knew about nanotechnology and were keen to learn and integrate this technology in the education system. Around 40 % of the participants' information about Nanotechnology were gained from the internet while only 17% had obtained information from their own readings. The majority of the participants (60%) supported the idea of introducing nanotechnology studies to the curricula at pre-graduate stage. However, 29% believed that it should be integrated only in postgraduate studies, and only a few of the participants (11.3%) advised that a continuing education program would be the proper way to study nanotechnology. This study showed that relatively little awareness about nanotechnology is seen among Libyan staff members and students. However, the majority of the participants have realized the importance of the field of nanotechnology and its application, and were eager to learn more about this advanced technology. Based on the preliminary study regarding the opinion and readiness of participants of the current study, it is believed that the integration of nanotechnology and nanosciences in Libyan curricula at different levels of education is an inevitable step to meet the very rapid advances in the field of nanotechnology and its application

Attitude towards hpv vaccination and the intention to get vaccinated among female university students in health schools in jordan

Cervical cancer is a leading cause of morbidity and mortality in women worldwide. The availability of prophylactic vaccines for high-risk types of human papillomavirus (HPV) infection represents an important advancement in the prevention of cervical cancer. In Jordan, the availability of the HPV vaccination is restricted to individuals who are willing to pay. The aim of the current study was to evaluate the willingness and attitude of female university students in health schools/faculties in Jordan to get HPV vaccination and their knowledge about the virus. A self-administered online questionnaire was distributed in October 2021, which comprised 27 items to evaluate HPV knowledge, history of HPV vaccination, intentions to get the HPV vaccine, and the reason(s) behind vaccine refusal for those who rejected vaccination. The study sample comprised 836 participants: medical students (39.7%), pharmacy students (26.0%), dental students (21.2%), and nursing students (13.2%). Only 524 participants had heard of HPV prior to the study (62.7%), of which 48.7% knew about the availability of HPV vaccines. The lowest level of HPV knowledge was observed among nursing students. Only 19/524 students reported a history of HPV vaccination (3.6%). The overall willingness to receive HPV vaccination if provided freely was 75.0%, while only 16.0% were willing to pay for the vaccine. The most common reason for HPV vaccine rejection was the perceived low risk to get HPV infection. Significantly higher intentions to get HPV vaccination were found among older participants and medical students. The embrace of vaccine conspiracy beliefs was associated with a significantly less willingness to get the HPV vaccination (p < 0.001). Dependence on the internet/social media as the source of HPV knowledge was associated with a significantly lower intention to get HPV vaccination (p = 0.002). The coverage of the HPV vaccination among female university students in health schools in Jordan appeared extremely low; however, three-fourths of the students who had heard of HPV were willing to receive the HPV vaccination if provided freely. Complacency appeared as a major factor for HPV vaccine rejection. Increasing the levels of knowledge and awareness of HPV infection and its association with cervical cancer through reliable sources is recommended. This can be helpful for the individual benefit of the students besides the potentially positive role they can play in community education. Countering vaccine conspiracy beliefs with proper education and awareness programs can be helpful to appraise the role of HPV vaccines in cancer prevention