Diabetic foot ulcers: a review of current management

Diabetic foot ulcers are a serious complication of diabetes mellitus which increases the patient morbidity and also have significant socioeconomic impact. The present review aims to summarize the causes and pathogenesis leading to diabetic foot ulcers, various classification systems and to focus on the current management of this significant and preventable health condition

A Rare Presentation of Lipoma: Case of Preputial Lipoma

Penile lipoma itself is a very rare finding. Over which preputial lipoma is not reported previously so this case of a 33-year-old married male is probably the first documented case of preputial lipoma where it causes sexual dysfunction.

Qualitative behavior of a highly non-linear Cutaneous Leishmania epidemic model under convex incidence rate with real data

In the context of this investigation, we introduce an innovative mathematical model designed to elucidate the intricate dynamics underlying the transmission of Anthroponotic Cutaneous Leishmania. This model offers a comprehensive exploration of the qualitative characteristics associated with the transmission process. Employing the next-generation method, we deduce the threshold value $R_0$ for this model. We rigorously explore both local and global stability conditions in the disease-free scenario, contingent upon $R_0$ being less than unity. Furthermore, we elucidate the global stability at the disease-free equilibrium point by leveraging the Castillo-Chavez method. In contrast, at the endemic equilibrium point, we establish conditions for local and global stability, when $R_0$ exceeds unity. To achieve global stability at the endemic equilibrium, we employ a geometric approach, a Lyapunov theory extension, incorporating a secondary additive compound matrix. Additionally, we conduct sensitivity analysis to assess the impact of various parameters on the threshold number. Employing center manifold theory, we delve into bifurcation analysis. Estimation of parameter values is carried out using least squares curve fitting techniques. Finally, we present a comprehensive discussion with graphical representation of key parameters in the concluding section of the paper

Protocol study: Sexual and reproductive health knowledge, information-seeking behaviour and attitudes among Saudi women: A questionnaire survey of university students

Copyright © 2014 Farih et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background - Sexual and reproductive health (SRH), a basic right for women worldwide, is infrequently researched in countries in the Middle East and North Africa (MENA). No empirical studies of SRH among Saudi women exist. This protocol describes a study to explore the SRH knowledge, information-seeking behaviour and attitudes of Saudi female university students. Methods/Design - This study will administer a questionnaire survey to female students at 13 universities in Riyadh, Saudi Arabia. The questionnaire was developed following a literature search to identify relevant content, with psychometrically tested tools used when available. The content layout and the wording and order of the questions were designed to minimize the risk of bias. The questionnaire has been translated into Arabic and piloted in preparation for administration to the study sample. Ethical approval for the study has been granted (reference no. QMREC2012/54). After questionnaire administration, the data will be collated, analysed and reported anonymously. The findings will be published in compliance with reporting guidelines for survey research. Discussion - This study will be the first to provide fundamental information concerning Saudi females university students SRH knowledge and information needs.King Abdullah Scholarship Program, Saudi Arabi

Patient Satisfaction and Its Predictors in the General Hospitals of Southwest Saudi Arabia: A Cross-sectional Survey

Background: Patient satisfaction occupies a central position in measuring the quality of care as it provides information on the provider's success, meeting the patient’s values and expectations. Hence, it is an essential tool for assessing health services outcomes. This study aimed to assess patients' satisfaction level and factors influencing healthcare quality of general hospitals in the Jazan region, Saudi Arabia (SA). Methods: This observational cross-sectional study was conducted on a sample of 423 patients selected through stratified random sampling from general hospitals of the Jazan region. Results: The overall satisfaction rate among the study participants was 80.9%. Satisfaction with food services was the highest (91.15%) followed by doctor services (81.0%), reception and entry procedures (80%), and nursing services (78.15%). The various aspects of satisfaction with doctors and nurses included the treatment prescribed by physicians, clarity in communication with patients, compassion and providing clear explanation of what they were doing. However, about 27.3% of the patients were dissatisfied with the length of waiting period before seeing a doctor. Binary logistic regression analysis suggested that uneducated patients and patients with secondary school education were more likely to have higher satisfaction level than university-educated patients (OR = 3.40, 95% C.I. [1.56–7.45], p = 0.002), (OR = 2.66, 95% C.I. [1.28–5.55], p = 0.009), and (OR = 2.29, 95% C.I. [1.40–3.73], p = 0.001), respectively. Conclusion: The health services satisfaction level was high in the Jazan population. However, some aspects of dissatisfaction were reported, such as the long waiting period before seeing a doctor. These aspects are recommended to be improved to ensure that the services provided by general hospitals are of high quality

ADAMTS19-associated heart valve defects: Novel genetic variants consolidating a recognizable cardiac phenotype

Recently, ADAMTS19 was identified as a novel causative gene for autosomal recessive heart valve disease (HVD), affecting mainly the aortic and pulmonary valves. Exome sequencing and data repository (CentoMD) analyses were performed to identify patients with ADAMTS19 variants (two families). A third family was recognized based on cardiac phenotypic similarities and SNP array homozygosity. Three novel loss of function (LoF) variants were identified in six patients from three families. Clinically, all patients presented anomalies of the aortic/pulmonary valves, which included thickening of valve leaflets, stenosis and insufficiency. Three patients had (recurrent) subaortic membrane, suggesting that ADAMTS19 is the first gene identified related to discrete subaortic stenosis. One case presented a bi-commissural pulmonary valve. All patients displayed some degree of atrioventricular valve insufficiency. Other cardiac anomalies included atrial/ventricular septal defects, persistent ductus arteriosus, and mild dilated ascending aorta. Our findings confirm that biallelic LoF variants in ADAMTS19 are causative of a specific and recognizable cardiac phenotype. We recommend considering ADAMTS19 genetic testing in all patients with multiple semilunar valve abnormalities, particularly in the presence of subaortic membrane. ADAMTS19 screening in patients with semilunar valve abnormalities is needed to estimate the frequency of the HVD related phenotype, which might be not so rare

IL-11 Induces NLRP3 Inflammasome Activation in Monocytes and Inflammatory Cell Migration to the Central Nervous System

The objective of this study is to examine IL-11-induced mechanisms of inflammatory cell migration to the central nervous system (CNS). We report that IL-11 is produced at highest frequency by myeloid cells among the peripheral blood mononuclear cell (PBMC) subsets. Patients with relapsing-remitting multiple sclerosis (RRMS) have an increased frequency of IL-11+ monocytes, IL-11+ and IL-11R+ CD4+ lymphocytes, and IL-11R+ neutrophils in comparison to matched healthy controls. IL-11+ and granulocyte-macrophage colony-stimulating factor (GM-CSF)+ monocytes, CD4+ lymphocytes, and neutrophils accumulate in the cerebrospinal fluid (CSF). The effect of IL-11 in-vitro stimulation, examined using single-cell RNA sequencing, revealed the highest number of differentially expressed genes in classical monocytes, including up-regulated NFKB1, NLRP3, and IL1B. All CD4+ cell subsets had increased expression of S100A8/9 alarmin genes involved in NLRP3 inflammasome activation. In IL-11R+-sorted cells from the CSF, classical and intermediate monocytes significantly up-regulated the expression of multiple NLRP3 inflammasome-related genes, including complement, IL18, and migratory genes (VEGFA/B) in comparison to blood-derived cells. Therapeutic targeting of this pathway with αIL-11 mAb in mice with RR experimental autoimmune encephalomyelitis (EAE) decreased clinical scores, CNS inflammatory infiltrates, and demyelination. αIL-11 mAb treatment decreased the numbers of NFκBp65+, NLRP3+, and IL-1β+ monocytes in the CNS of mice with EAE. The results suggest that IL-11/IL-11R signaling in monocytes represents a therapeutic target in RRMS

Ongoing strategies to improve antimicrobial utilization in hospitals across the Middle East and North Africa (MENA) : findings and implications

Antimicrobial resistance (AMR) is an increasing global concern, increasing costs, morbidity, and mortality. National action plans (NAPs) to minimize AMR are one of several global and national initiatives to slow down rising AMR rates. NAPs are also helping key stakeholders understand current antimicrobial utilization patterns and resistance rates. The Middle East is no exception with high AMR rates. Antibiotic point prevalence surveys (PPS) provide a better understanding of existing antimicrobial consumption trends in hospitals, and assist with the subsequent imple-mentation of antimicrobial stewardship programs (ASPs). These are important NAP activities. We examined current hospital consumption trends across the Middle East along with documented ASPs. A narrative assessment of 24 PPS studies in the Region found that, on average, more than 50% of in-patients received antibiotics, with Jordan having the highest rate at 98.1%. Published studies ranged in size from single to 18 hospitals. The most prescribed antibiotics were ceftriax-one, metronidazole, and penicillin. In addition, significant postoperative antibiotic prescribing lasting up to five days or longer was common to avoid surgical site infections. These findings have resulted in a variety of suggested short-, medium-, and long-term actions among key stakehold-ers, including governments and healthcare workers, to improve and sustain future antibiotic prescribing in order to decrease AMR throughout the Middle East

Emerging Themes and Future Directions of Multi-Sector Nexus Research and Implementation

Water, energy, and food are all essential components of human societies. Collectively, their respective resource systems are interconnected in what is called the “nexus”. There is growing consensus that a holistic understanding of the interdependencies and trade-offs between these sectors and other related systems is critical to solving many of the global challenges they present. While nexus research has grown exponentially since 2011, there is no unified, overarching approach, and the implementation of concepts remains hampered by the lack of clear case studies. Here, we present the results of a collaborative thought exercise involving 75 scientists and summarize them into 10 key recommendations covering: the most critical nexus issues of today, emerging themes, and where future efforts should be directed. We conclude that a nexus community of practice to promote open communication among researchers, to maintain and share standardized datasets, and to develop applied case studies will facilitate transparent comparisons of models and encourage the adoption of nexus approaches in practice