Impact on core values of family medicine from a 2-year Master's programme in Gezira, Sudan: observational study

Background: Training of family physicians should include not only clinical and procedural skills, but also core values as comprehensive care, continuity of care, leadership and patient-centeredness. The Gezira Family Medicine Project (GFMP) is a 2 years Master’s programme in family medicine in Sudan. We assessed the impact of GFMP on the candidates’ adherence to some core values of family medicine. Methods: This is a prospective study with before-after design based on repeated surveys. We used Patient-Practitioner Orientation Scale (PPOS) to assess physicians’ attitude towards patient-centeredness. Practice based data from individual patients’ consultations and self-assessment methods were used to assess physicians’ adherence to core values. Results: At the end of the programme the candidates (N = 110) were significantly more active in community health promotion (p <  0.001), more confident as a team leader (p = 0.008), and showed increased adherence to national guidelines for managing diabetes (p = 0.017) and hypertension (p = 0.003). The responding candidates had more knowledge about patients’ medical history (p <  0.001), family history (p < 0.001) and family situation (p < 0.001). There were more planned follow up consultations (p < 0.001) and more referrals (p = 0.040). In contrast, results from PPOS showed slightly less orientation towards patient-centeredness (p = 0.007). Conclusions: The GFMP Master’s programme induced a positive change in adherence to several core values of family medicine. The candidates became less patient-centered.publishedVersio

Severe Neonatal Presentation of Progressive Familial Intrahepatic Cholestasis Type 4 in an Omani Infant

Progressive familial intrahepatic cholestasis type 4 (PFIC4) is a relatively newly described autosomal recessive disorder caused by biallelic mutations in the gene encoding tight junction protein 2 (TJP2) which is located in chromosome 9q21. PFIC4 is characterized by cholestasis with or without other extrahepatic manifestations. Bleeding tendency due to vitamin k deficiency is a well-known complication of cholestasis. We present a neonate who presented with cholestasis and multiple intracranial bleeds. He was found to have severe coagulopathy and his genetic work up revealed a homozygous variant mutation in TJP2 gene causing PFIC4. He had persistent cholestasis that necessitated an internal biliary diversion with some clinical improvement. Keywords: Jaundice; Intracranial haemorrhage; Progressive Familial Intrahepatic Cholestasis type 4

OCCURRENCE OF CARBAPENEMASES AND EXTENDED-SPECTRUM Î’ETA-LACTAMASES IN UROPATHOGENIC ENTEROBACTERIACEAE ISOLATED FROM A COMMUNITY SETTING, SETTAT, MOROCCO

Objective: Urinary tract infections (UTIs) are still commonly diagnosed in outpatients as well as in hospitalized patients. In this study, weinvestigated the prevalence and performed molecular characterization of extended-spectrum-β-lactamases (ESBL) and carbapenemases produced byEnterobacteriaceae isolates that cause community UTIs in Settat city, Morocco.Methods: From January 2012 to December 2013, all uropathogenic community Enterobacteriaceae isolates were collected from the microbiologylaboratory of Hassan II Hospital, Settat, Morocco. Antibiotic susceptibility testing was performed as recommended by Clinical and LaboratoryStandard Institute. Phenotypic identification of ESBL and carbapenemase producer isolates was confirmed by the double-disk synergy test and themodified Hodge test, respectively. Molecular characterization of β-lactamase genes was performed using polymerase chain reaction (PCR), followedby sequencing of the obtained products.Results: Among 153 isolates, 31 (20.26%) were multi-drug resistant (MDR). Nine strains (5.88%) were ESBL producers, of which Klebsiellapneumoniae (n=5; 20.83%), Escherichia coli (n=3; 3.15%), and Enterobacter cloacae (n=1; 9.09%) species were identified. The results of ESBLencodinggene detection by sequencing revealed the presence of CTX-M-15 (n=9) in association with other β-lactamase genes such as temoneira 1 (n=8) and sulfhydryl variable 1 (n=5). According to the modified Hodge test and PCR, three isolates (1.96%) were positive carry the blaConclusion: The emergence of MDR uropathogenic Enterobacteriaceae isolates in our community is highly alarming. Strict measures will be required to control the further spread of these uropathogenic isolates. Keywords: Carbapenemase, Enterobacteriaceae, Extended-spectrum-β-lactamases, Moroccan community.OXA-48 gene.Keywords: Carbapenemase, Enterobacteriaceae, Extended-spectrum-β-lactamases, Moroccan community.Objective: Urinary tract infections (UTIs) are still commonly diagnosed in outpatients as well as in hospitalized patients. In this study, we investigatedtheprevalenceandperformedmolecularcharacterizationofextended-spectrum-β-lactamases(ESBL)andcarbapenemasesproducedby Enterobacteriaceae isolates that cause community UTIs in Settat city, Morocco. Methods: From January 2012 to December 2013, all uropathogenic community Enterobacteriaceae isolates were collected from the microbiology laboratory of Hassan II Hospital, Settat, Morocco. Antibiotic susceptibility testing was performed as recommended by Clinical and Laboratory Standard Institute. Phenotypic identification of ESBL and carbapenemase producer isolates was confirmed by the double-disk synergy test and the modified Hodge test, respectively. Molecular characterization of β-lactamase genes was performed using polymerase chain reaction (PCR), followed by sequencing of the obtained products. Results: Among 153 isolates, 31 (20.26%) were multi-drug resistant (MDR). Nine strains (5.88%) were ESBL producers, of which Klebsiella pneumoniae (n=5; 20.83%), Escherichia coli (n=3; 3.15%), and Enterobacter cloacae (n=1; 9.09%) species were identified. The results of ESBL- encodinggenedetectionbysequencingrevealedthepresenceofCTX-M-15(n=9)inassociationwithotherβ-lactamasegenessuchastemoneira1 OXA-48 (n=8) and sulfhydryl variable 1 (n=5). According to the modified Hodge test and PCR, three isolates (1.96%) were positive carry the bla gene.  Conclusion:TheemergenceofMDRuropathogenicEnterobacteriaceaeisolatesinourcommunityishighlyalarming.Strictmeasureswillberequiredto control the further spread of these uropathogenic isolates. Keywords: Carbapenemase, Enterobacteriaceae, Extended-spectrum-β-lactamases, Moroccan community

Multilocus Sequence Typing of Klebsiella Pneumoniae Producing Extended Spectrum Β-Lactamases Isolated From Kurdistan Region, Iraq.

This study was purposed to sequence analysis of ESBLs genotype of K pneumoniae using partial sequence and Multilocus sequence typing (MLST). A total of 275 K. pneumoniae isolatesinvolved three general hospitals in Duhok, Erbil, and Sulymania, from September 2010 to June 2011. The Minimum Inhibitory Concentration (MIC) was measured by Phoenix system that confirmed 187 ESBL producing isolates followed by the Double Disk Synergy Test (DDST). Then, 12 isolates were selectedaccording to sample diversity, high resistancy to β-lactam and cephalosporins and harboring combination of three genes (TEM, SHV, and CTX-M). Partial sequence analysis of TEM; showed two different genotypes regarding blaTEM as 9 isolates (75%) from different samples (wound, sputum and blood) from three provinces harbor TEM-1 gene and 3 isolates (25%) only from urine in three provinces harbor TEM-198 gene. SHV analysis revealed characterization of selected isolates into six different genotypes. The common genotype was blaSHV-11 involved five isolates from sputum and blood in Erbil and Sulymania provinces, and wound in Duhok province. Only one genotype as all 12 isolates (100%) from different samples and different provinces was found harbored CTX-M-15 gene. Multilocus sequence typing (MLST) study performed using seven housekeeping genes (gapA, infB, mdh, pgi, phoE, rpoB and tonB). A total of 8 different sequence types (STs) were identified;ST11 was dominant sequence type, accounting 41.6 %( 5 isolates) and was harboring combination of TEM-1, SHV-11 and CTX-15 genes

Bacteriological and Molecular Characterization of Extended Spectrum Β-Lactamases in Clinical Isolates of Klebsiella Pneumoniae Isolated From Kurdistan Region, Iraq.

A total of 275 clinical isolates of Klebsiella pneumoniae were collected from three general hospitals in Duhok, Erbil, and Sulymania, during the period September 2010 to June 2011. The Minimum Inhibitory Concentration (MIC) of these isolates was measured using the Gram-negative susceptibility card (GNC) of Phoenix system. Only 187 ESBL producing K. pneumoniae isolates were detected by this system. These isolates were confirmed as 100% ESBLs producers by the Double Disk Synergy Test (DDST). All 187 K. pneumoniae isolates were 100% resistant to ampicillin, cefazolin, cefepime, ceftriaxone, cefotaxime, cefuroxime, ceftazidime, and aztreonam. These isolates showed different percentages of resistance 81.8%, 68.5%, 65.8%, 52.4%, 50.3%, 34.2%, 25.2%, and 12.3% towards, ampicillin/sulbactam, gentamicin, trimethoprime-sulfamethoxazole, ciprofloxacin, piperacillin-tazobactam, amikacin, amoxicillin-clavulanate, and levofloxacin respectively.  Molecular characterization by PCR was employed using specific primers for three different ESBLs (TEM, SHV, and CTX-M). Results obtained revealed that SHV-type ESBLs were the most common ESBL occurring in 87% of the isolates with phenotypic evidence of ESBLs production. While those for TEM-type and CTX-M-type were 60% and 58% respectively

Pharmaceutical Equivalence of Some Conventional Carbamazepine Tablets Marketed in Sudan

Background: Carbamazepine (CBZ) is commonly used in the treatment and control of epilepsy, seizures, and neuropathic pain. Due to its limited water solubility, CBZ have slow and variable&nbsp;absorption following oral administration. Effective CBZ plasma levels&nbsp;are achieved through multiple-dose administration of conventional CBZ tablets&nbsp; which may result in serious side effects because of its narrow therapeutic index and toxicity levels.&nbsp;Objectives: This work aimed at&nbsp;comparing four commercial brands of CBZ tablets (A, B, C and D) manufactured by multinational and national companies including the originator (A) through evaluation of their pharmaceutical equivalence using pharmacoepial and nonpharmacoepial standard tests. Methods: Model-independent approach was used for determination of dissolution efficiency (% D.E) and fit factors. &nbsp;Difference&nbsp;between brands was demonstrated through analysis of difference (f1) and similarity (f2) data. In addition various quality tests including weight variation, thickness, diameter, hardness, friability and disintegration time were carried out. Results: The study revealed that all brands complied with the USP specifications regarding weight variation, friability disintegration and drug content. The amount of drug released within 45 minutes were found satisfactory and ranged from 83.44% to 94.5%.&nbsp;Although clear differences in release profiles exist, all&nbsp;brands released about 90% of the labeled CBZ within 30 minutes which can satisfy the patient need.&nbsp;Only brand B failed to pass the nonpharmacoepial hardness test. Conclusion: Selected brands of CBZ tablets complied with all required pharmacoepial quality specifications

HPLC/ESI-MS Characterization of Phenolic Compounds from Cnicus benedictus L. Roots: A Study of Antioxidant, Antibacterial, Anti-Inflammatory, and Anti-Alzheimer's Activity.

peer reviewedThe phenolic composition of Cnicus benedictus roots from four Algerian regions was investigated. Extractions were performed in both hydro-methanolic (30 : 70, v/v) and hydro-ethanolic (30 : 70, v/v) solvents. Their efficiency was determined in terms of the qualitative and quantitative composition in phenolic compounds by HPLC-LC/MS of the different extracts isolated from C. Benedictus roots. Cnicus benedictus roots extract have been characterized by high content of phenolic compounds, where the trans chalcone, 2,3-dihydro flavone, 3-hydroxy flavone and cinnamic acid constitute the major components, in addition to fourteen minor acidic compounds and flavonoids as rutin. The hydro-methanolic extract was the richest in phenolic compounds yield from C benedictus. On the other hand, hydro methanolic (30 : 70, v/v) and hydro ethanolic (30 : 70, v/v) extracts exhibited a high anti-inflammatory activity by in vitro 5-lipoxygenase inhibitory activity (IC50 : 6.05±94.16 μg/mL) as well as by in silico docking according two methods. Likewise, anti-Alzheimer activity of extracts was confirmed by this last technique taking into account the major compounds identified. Antibacterial tests revealed interesting results compared to amoxicillin for the different regions studied with a high content in trans chalcone and 3-hydroxy Flavone

Knowledge, attitude, and practice of exclusive breastfeeding among mothers of childbearing age

BackgroundThe American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding (EBF) for up to 6 months. Despite the importance of breast milk, EBF is far less prevalent in Nigeria than is recommended for developing countries. Worse still, the odds of EBF practice are very low in rural communities. Hence, the aim of this study was to assess the knowledge, attitude, and practice of EBF as well as identify the factors associated with EBF practice among mothers of childbearing age in Chamo town, Jigawa State, Nigeria.MethodsThe study is a cross-sectional design using a questionnaire to assess the required information. The methodology involved the use of simple random sampling to select mothers of reproductive age from Chamo town, which is a rural community located in Jigawa State, Nigeria. A semi-structured questionnaire was used to assess the mother’s knowledge, attitude, and practices regarding EBF. Simple and multiple logistic regression analyses were performed to determine the factors associated with the practice of EBF.ResultsA total of 400 mothers between the ages of 18 and 41 took part in the study. More than half of the participants (57.8%) were between the ages of 26 and 33 and had a primary level of education (30.5%). Only 26.8% of the respondents practice EBF. Those with a tertiary education (AOR = 10.00, p &lt; 0.001), civil servants (AOR = 12.51, p &lt; 0.001), those aware of EBF (AOR = 3.65, p = 0.002), those with correct EBF knowledge (AOR = 4.61, p &lt; 0.001), those with a positive attitude toward EBF demand (AOR = 0.51, p = 0.050), and those who received encouragement from their community (AOR = 9.87, p &lt; 0.001) were more likely to practice EBF.ConclusionThe findings of the study revealed that the majority of the respondents’ knowledge, attitude, and practice of EBF were minimal. This shows the need to step up efforts to educate mothers about the advantages of EBF for both their own health and that of their children while they are in the hospital recovering from childbirth

BLOOM: A 176B-Parameter Open-Access Multilingual Language Model

Large language models (LLMs) have been shown to be able to perform new tasks based on a few demonstrations or natural language instructions. While these capabilities have led to widespread adoption, most LLMs are developed by resource-rich organizations and are frequently kept from the public. As a step towards democratizing this powerful technology, we present BLOOM, a 176B-parameter open-access language model designed and built thanks to a collaboration of hundreds of researchers. BLOOM is a decoder-only Transformer language model that was trained on the ROOTS corpus, a dataset comprising hundreds of sources in 46 natural and 13 programming languages (59 in total). We find that BLOOM achieves competitive performance on a wide variety of benchmarks, with stronger results after undergoing multitask prompted finetuning. To facilitate future research and applications using LLMs, we publicly release our models and code under the Responsible AI License