PRESCRIPTION PATTERN OF ANTIMICROBIAL AGENTS AMONG DENTAL PRACTITIONERS IN A TERTIARY CARE CENTRE IN NORTH INDIA

Objective:The purpose of the study was to find out the pattern of antimicrobial prescription among dental practitioners in a tertiary care centre in North India. Methods:100 prescriptions of the patients attending the various dental outpatient departments of Ziauddin Ahmed Dental College, Aligarh Muslim University were collected and tabulated between January 2016 to June 2016. An observational study was done on the obtained prescriptions on various aspects like dental pathology for which antimicrobial were prescribed, antimicrobial agents used for management of acute and chronic conditions along with their dose and duration. Compliance of the patients during therapy and  adverse effects associated with the regimen was also taken into consideration and the final data was expressed as counts and percentages.Results: Out of a total of 100 patients 54 (54.0%) were males while females were numbered as 46 (42.0%) with maximum distribution of the patients between 31-40 years. On analysis the most commonly presented dental condition for which antimicrobials were prescribed were Acute/Chronic periodontitis (48%), Acute/Chronic gingivitis (32%), Caries (11%), Post RCT (4%), Pericoronitis (3%), Oral trauma (1%) and other condition (1%). For the management of above conditions  antimicrobials were the most extensively used agents which were prescribed for only 3-5 days which may not be sufficient, followed by analgesics and antimicrobial mouthwashes. Among the antimicrobials used, most frequently used agents were Amoxycillin (50%) followed by Ornidazole (21%), Ofloxacin (20%), Doxycycline (16%), Cefixime (9%) and Ciprofloxacin (3%) used either alone or in combination for the management of acute and chronic conditions. Only two patients were advised for culture & sensitivity tests prior to antimicrobial therapy because of non compliance of patients. Majority (74%) of patients completed the prescribed regimen of antimicrobials while 7 patients reported adverse drug reactions(ADRs), among which most common  were nausea and vomiting.Conclusions: In our study we found that the periodontal diseases were the most frequently reported conditions followed by acute/chronic gingivitis for which antimicrobials were prescribed while Amoxycillin and Ornidazole were the most commonly used antimicrobials for the management of various acute and chronic dental conditions, but were prescribed without culture & sensitivity in most cases. 7% patients reported ADRs. To conclude appropriate measures are to be promoted for rational prescribing and ADR reporting.Keywords: Amoxicillin, Dental, Antimicrobials, infections, Prescription pattern

Carbohydrates and lipids metabolic enzymes inhibitory, antioxidant, antimicrobial and cytotoxic potentials of Anchusa ovata Lehm. from Palestine

Introduction: Throughout history, therapeutically active plant products have received substantial attention due to their valuable role in the discoveries of specific medications. The aim of this study was to assess, for the first time, the antimicrobial, antioxidant, antilipase, anti-α-amylase and cytotoxic properties of four fractions derived from Anchusa ovata Lehm. (AO) leaves. Methods: Antioxidant, antilipase and anti-amylase potentials of (AO) were established using DPPH (1,1-diphenyl- 2-picrylhydrazyl), p-nitrophenyl butyrate and dinitro-salicylic acid procedures, respectively, while antimicrobial activity was conducted using broth microdilution assay against eight Gram-positive, Gram-negative bacterial strains in addition to one fungal strain. Moreover, the MTS [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)- 2-(4-sulfophenyl)-2H-tetrazolium] cytotoxic assay was utilized against cervical cancer cells (HeLa). Results: The methanol fraction of AO showed potential antioxidant, antilipase, and α-amylase inhibitory activities with IC50 values of 9.55 ± 0.13, 53.7 ± 0.41 and 16.55 ± 1.84 μg/ml, respectively compared with the positive controls Trolox, Orlistat and Acarbose that had IC50 values of 3.23 ± 0.92, 12.3 ± 0.35 and 28.18 ± 1.22 μg/ml, respectively. Moreover, the hexane, acetone, and methanol fractions had wide ranges of antimicrobial potential. In addition, the cytotoxic activity outcomes which showed the best activity was for the aqueous followed by acetone, hexane and methanol fractions with IC50 values of 1.04, 2.72, 3.96 and 17.67 mg/ ml, respectively. Conclusion: Our data demonstrate a wide range of biological characteristics for each AO plant fraction. This profiling information about the methanol fraction provided important data for further research and pharmaceutical applications.The authors would like to acknowledge the Faculty of Medicine and Health Sciences at An-Najah National University for facilitating the accomplishment of the current study

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

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

Does open reduction internal fixation using a volar locking plate and closed reduction percutaneous pinning using K wires provide similar functional and radiological outcomes for unstable distal radius fractures?

Background: Distal radius fractures (DRFs) are a common orthopedic injury, with open reduction internal fixation (ORIF) and closed reduction percutaneous pinning (CRPP) being the two most frequently used methods for treating unstable DRFs. The optimal treatment approach for DRFs is still a matter of debate. Therefore, this retrospective analysis aimed to compare the functional and radiological outcomes of ORIF and CRPP to determine the most effective approach for treating unstable DRFs. Material and Methods: A total of 89 patients were included in this retrospective study; 34 underwent CRPP and 55 underwent ORIF (61 males and 28 females, mean age: 35.5). Radiographic measurements of radial inclination, radial height, and volar tilt, as well as patient-rated wrist evaluation (PRWE) scores for pain and function, were used to evaluate the functional and radiological outcomes during the final follow-up period, ranging from 1 to 4 years. Results: There were significant improvements in the radiographic measurements for both groups, indicating a good reduction. However, the two fixation methods had no significant difference in radiographic measurements during the entire follow-up period. Regarding PRWE scores, there was a significant difference between the two groups, with patients in the CRPP group reporting better wrist function and less pain. Conclusions: Both CRPP and ORIF are effective methods for treating unstable DRFs. Achieving an acceptable reduction did not correlate with better pain management, function, or the ability to carry out day-to-day activities. However, patients treated with CRPP had better wrist function and less pain during follow-up. Radiographic measurements did not differ significantly between the two groups. Clinicians should consider closed-reduction percutaneous pinning as a viable and effective treatment option for distal radius fractures, particularly when optimal wrist function and pain management are important considerations

The impact of calculating ROX index in delaying intubation with COVID-19 patients at King Abdullah medical city

Background: HFNC is a respiratory mask that covers the nose like an oxygen mask, with the addition of nasal prongs to deliver extra oxygen. At 12 hours, a ROX score above or equal to 4.88 predicts a decreased probability of progressing to mechanical ventilation. Objective: The aim of this study was to evaluate using a high-flow nasal cannula as a potential predictor of delaying intubation. In doing this, the study also sought to verify whether the ROX index accurately predicts HFNC failure for COVID-19 patients treated in the intensive care unit (ICU). Method: Using retrospective observational analysis of prospectively collected data and the study population of patients in the ICUs at KAMC, the study collects and analyzes data using SPSS. Results: P values that are < 0.05 show that the mean differences are statistically significant, and this is seen on days 1-1, day 1-2, day2-1, day 2-2, day 3-1, day 3-2, day 4-2, day 10-1, and day 10-2. This suggests that ROX index can be used in intubation prediction with COVID-19 patients who have respiratory failure type I that received HFNC therapy.&nbsp

Sun-Exposed versus Sun-Protected Cutaneous Basal Cell Carcinoma: Clinico-Pathological Profile and p16 Immunostaining

Introduction: Although widespread, BCC is still relatively poorly understood in regards to pathogenesis and prognosis, particularly the lesions formed on anatomical sites away from sun exposure. With the aim of deepening our understanding of the pathogenesis and clinico-pathological correlations of BCCs, we conducted this study. Methods: Tissue blocks and data of 52 Egyptian patients diagnosed with BCC were retrieved for clinical information and inclusion criteria, then re-examined histologically; p16 immunostaining was carried out and evaluated for analysis and comparison between the two groups, i.e., sun-exposed and sun-protected. Results: Sex, age, clinical suspicion, tumor size, recurrence status, and histologic variants did not show a significant difference between the sun-protected and sun-exposed groups; however, the mean ages recorded were 67.2 vs. 62.7 for the sun-protected and sun-exposed groups, respectively. A total of 52% of BCCs were positive for p16. The sun-protected lesions showed p16 positivity in 61% of cases, whereas 49% of the sun-exposed lesions were positive with no significant difference. There was a significant difference in p16 expression between the recurrent and non-recurrent lesions. Conclusions: A significant difference was seen in the case of cancer recurrence, where all the recurrent BCCs in this study demonstrated negative p16 immunostaining of the primary lesions; however, the positively stained cases in total were 52% of BCCs. The mean patient age of the sun-protected group was much higher than in previous peer studies. We assume that the biological, prognostic, and clinical aspects of p16 protein expression in BCCs are still far from being clearly understood. Further studies are highly recommended, with more focus on its role in the pathogenesis and the prognostic factors

A multinational cross-sectional study on the awareness and concerns of healthcare providers toward monkeypox and the promotion of the monkeypox vaccination

BackgroundThe aim of this study was to explore potential healthcare workers' (HCWs) concerns about the monkeypox virus in order to create practical solutions to manage this disease.MethodsOnline cross-sectional research was conducted in 11 Arabic countries (Egypt, Saudi Arabia, Yemen, Syria, Libya, Algeria, Tunisia, Iraq, Palestine, Jordan, and Sudan) from 2 August 2022 to 28 December 2022.ResultsApproximately 82% of respondents felt the need to acquire further information. The acceptability of the vaccine against monkeypox has been indicated by more than half of the participants (54.5%). Furthermore, we state that 45% of the participants are knowledgeable about the monkeypox virus, and 53.1% of the participants have never been affected with COVID-19 before are more worried about COVID-19 than about monkeypox. Participants diagnosed with COVID-19 were 0.63 times less likely to worry about monkeypox than those who were not diagnosed with COVID-19. A greater willingness to get the monkeypox vaccination was seen among the age group 21–30 years (42.4%) compared to the other age groups.ConclusionMost healthcare professionals have a moderate knowledge of the monkeypox virus. Furthermore, they demonstrated a low willingness to get the vaccination against the monkeypox virus