Childhood autism: knowledge and perception among university students in United Arab Emirates

Background: Adequate knowledge and awareness about childhood autism allows early diagnosis and interventions. The present study was carried out to assess the knowledge and perception of university students about childhood autism.Methods: A cross-sectional study was conducted to evaluate the level of knowledge and awareness about autism spectrum disorder among university students. A total of 400 students were randomly enrolled from five universities. The questionnaire covered the major aspects of autism.Results: Only 300 questionnaires were fully completed giving a response rate of 75%. The majority of respondents agreed that autism is a neuro-developmental disorder with strong genetic basis where family history increases chances of developing autism. They believe that vaccination, poor parenting and environmental factors are not causes of autism. Large numbers of participants were not sure if autism is more common in males than females but agreed that early identification improves the therapeutic outcomes while 44% believed that children can outgrow autism with proper treatment. More than 50% of respondents disagreed to the statements that autistic children are intellectually disabled and all display poor eye contact. Only 20% of students agreed that autistics children have mental disabilities, while about 50% believed that they can live independently.Conclusions: University students seem to hold adequate knowledge about major hallmarks of the disorder. However, more efforts are needed to enhance awareness of not only parents and relatives but also the general public so that they can deal responsibly with identified cases of autistic children

A Case of Immune-Mediated Pneumonitis Associated With Dual Nivolumab and Ipilimumab Immunotherapy Treatment

Nivolumab and ipilimumab are immunotherapy agents used in combination to treat metastatic melanoma and have proven to be efficacious. However, they have been linked to the development of immune-mediated inflammatory processes in various organ systems and tissues, including immune-mediated pneumonitis (IMP). This case report describes a 50-year-old female patient with metastatic melanoma who was treated with nivolumab and ipilimumab therapy and developed IMP as a complication. Despite treatment with steroids and infliximab, the patient\u27s condition worsened, and she passed away due to respiratory compromise. This report emphasizes the potential for serious complications in patients receiving combination immunotherapy and highlights the importance of close monitoring and risk stratification, particularly in patients with underlying lung conditions

Twice-daily insulin glargine for patients with uncontrolled type 2 diabetes mellitus.

Insulin glargine is recombinant human insulin analog that is commonly used in patients with type 2 diabetes as well as those with type 1 diabetes. Pharmacokinetic and pharmacodynamics studies of insulin glargine had shown that it has an onset of action that ranged from 1.2 to 1.8 h while its duration of action is 18 to 26 h. Because of its long duration of action insulin glargine is usually prescribed once daily. However, several reports have shown that the administration of insulin glargine once daily is not enough to achieve adequate glucose control in some patients requiring a twice daily dosing. The first report on using insulin glargine twice daily was published shortly after its availability. It described a patient with type 1 diabetes who had consistently elevated bedtime glucose values on once daily insulin glargine administered in the evening. There was significant improvement in glucose values after changing the frequency of insulin glargine to twice daily as a split dose every 12 h. Albright and colleagues found that twice daily glargine therapy was required in patients with type 1 diabetes who developed morning hypoglycemia and/or afternoon hyperglycemia while on once daily therapy; the twice daily regimen was associated with a significant reduction in HbA1c levels compared to patients who were on once daily therapy

Different percentages of basil seeds (Ocimum basilicium L.) as hydrocolloid in batter coating system: effect on the physicochemical and sensory properties of breaded fish fillets

Basil seed (Ocimum basilicium L.) has the potential to improve the characteristics of food products when added to the batter for coating but the amount could result in different qualities. This study investigates the physicochemical and sensory properties of tilapia fish fillets coated with batter added with different percentages of basil seeds (0%, 3%, 6% & 9%). The viscosity, coating adhesion, cooking yield, frying loss, moisture and fat contents, colour, texture and sensory properties were analyzed. As the basil seeds percentages added increased, the viscosity was improved and strongly correlated with the coating adhesion, cooking yield, frying loss and moisture content. The hardness, chewiness and fracturability of the fish fillet were also improved. The treated samples were darker and redder, which contributed to the golden colour. Panellists rated the crispness and overall acceptability of the treated samples higher than the control (0% of basil seed), while other parameters such as colour, appearance, fishy smell level, taste and juiciness were not different between the control and the treated samples. In conclusion, the quality of the coated fish fillet with added 3% of basil seed to the batter was not much different compared to the control (0%), while, the 9% had negatively influenced the oil adsorption and sensory characteristics of the samples. Therefore, 6% is suggested as the most suitable percentage to be used in the batter

Customers’ Satisfaction Towards 99Speedmart based on Product Quality and Service Quality in Bangsar, Kuala Lumpur

Convenience stores have been providing basic needs for their customers and have become one of the customer’s pleasure to come to shop the essential needs for the household. This study focuses on the customer’s satisfaction towards 99Speedmart by looking into two variables, which are Service Quality (SERVQUAL) and product quality. These two variables are vital to any business as it would affect its loyal customers if any of these did not meet their expectations. A survey was conducted by distributing the adapted questionnaire to 238 respondents that comprise three sections. The data was analysed quantitatively by using SPSS SPSS. It was found that many respondents showed positive results towards 99Speedmart which they are partly agreed that 99Speedmart provides good quality products and services

The Need for Harmonizing Value Added Tax Legislation in Gulf Cooperation Council

The elimination of discriminatory value added tax (VAT) laws on commodities are required for the proper function of the Gulf Cooperation Council (GCC) single market. The proper function of a single market entails the elimination of discriminatory internal VAT regulations of imported goods or services. Hence, the purpose of this study is to empirically examine the need for harmonizing VAT legislation among GCC countries. The data of this study was collected through a variety of sources, including the ministry's website, VAT law for each country, published articles, and other online data sources/websites with regards to VAT. The data were statistically evaluated using Microsoft Excel. The dependent variable in this study is Harmonization. The factors affecting Value Added Tax Legislation are also called independent variables. Through this search, they harmonize VAT legislation in the GCC countries to maximize the effectiveness of tax laws. Thus, such a fact process to be helpful to understand the challenges faced by GCC companies due to discriminatory VAT regulations and double taxation.  There is a need to harmonize VAT legislation in the GCC countries to maximize the effectiveness of tax laws. This study adds value by assessing the present state and the need for harmonizing VAT legislation in the GCC countries. The timely approach of the study will help policymakers, regulators, and practitioners to understand the importance of harmonizing VAT legislation in the GCC

COVID-19 Vaccine Hesitancy among Arab Americans

Background: Coronavirus disease-2019 (COVID-19) vaccines have a significant impact on reducing morbidity and mortality from infection. However, vaccine hesitancy remains an obstacle in combating the pandemic. The Arab American (AA) population is understudied; thus, we aimed to explore COVID-19 attitudes within this community. Methods: This was a cross-sectional study. An anonymous online survey was distributed to members of different AA associations and to the community through the snowball method. Results: A total of 1746 participants completed the survey. A total of 92% of respondents reported having received at least one dose of a COVID-19 vaccine. A total of 73% reported willingness to receive a booster, and 72% plan to give their children the vaccine. On multivariate analysis, respondents were more likely to be vaccine-hesitant if they were hesitant about receiving any vaccine in general. They were less likely to be vaccine-hesitant if they were immigrants, over the age of 40, up to date on their general vaccination and if they believed that COVID-19 vaccines are safe and effective in preventing an infection. The belief that all vaccines are effective at preventing diseases was also associated with lower hesitancy. Conclusions: This sample of AAs have higher vaccination rates and are more willing to vaccinate their children against COVID-19 when compared to the rest of the population. However, a reemergence of hesitancy might be arising towards the boosters

Are children with tuberculosis in Pakistan managed according to National programme policy guidelines? A study from 3 districts in Punjab

<p>Abstract</p> <p>Background</p> <p>The adherence to policies of National TB Control Programme (NTP) to manage a case of tuberculosis (TB) is a fundamental step to have a successful programme in any country. Childhood TB services faces an unmet challenge of case management due to difficulty with diagnosis and relatively new policies. For control of childhood TB in Pakistan, NTP developed and piloted its guidelines in 2006-2007. The objective of this study was to compare the documented case management practices of pediatricians and its impact on the outcome before and after introducing NTP policy guidelines.</p> <p>Findings</p> <p>An audit of case management practices of a historical cohort study was done in children below 15 years who were put on anti-tuberculosis treatment at all nine public hospitals in three districts in province of Punjab. The study period was two years pre-intervention (2004-05) and two years post-intervention (2006-07) after implementation of new NTP policy guidelines for childhood TB. There were 920 childhood TB cases registered during four years, 189 in pre-intervention period and 731 in post-intervention period. The practices changed significantly in post-intervention period for use of tuberculin skin test (63% of pulmonary cases, 19% of extrapulmonary cases and 67% for site unknown), and for the use of chest x-ray (69% of pulmonary cases, 16% of extrapulmonary cases and 74% for site unknown). Diagnostic scores were recorded for only a minority of cases (18%). The proportion of correct drugs pre- and post-intervention remained same. There were unknown treatment outcomes in 38 out of 141 cases (27%) in pre-intervention and in 483 out of 551 cases (87%) post-intervention, all among the 692 cases without documented treatment supporter.</p> <p>Conclusions</p> <p>The study has shown that pediatricians have started following parts of the national policy guidelines for management of childhood TB. The documented use of diagnostic tools is increased but record keeping of case management practices remained inadequate. This seems to increase case finding substantially but the treatment outcomes were poor mainly due to unknown outcomes. Development and implementation of standardized operational tools and regular monitoring system may improve the services.</p

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication