Ketamina en dosis bajas con anestesia local reduce la morbilidad postoperatoria de la cirugía del tercer molar: Revisión sistemática y metanálisis.

Objective: This review addresses a clinical research question related to lower third molar surgery (L3MS): does the combination of pre-emptive low-dose ketamine with local anesthesia (KLA) reduce postoperative complications compared with local anesthesia (LA) alone? Material and methods: A systematic literature search was performed to identify eligible articles by electronic searches of PubMed, Cochrane Central Register of Controlled Trials, EBSCO Library, Web of Science and grey literature through June 2019 without data or language restrictions. We analyzed all randomized controlled clinical studies (RCTs) comparing use of KLA with use of LA in L3MS regarding pain, swelling, and trismus outcomes. The quality of evidence was rated according to Cochrane’s tool for assessing risk of bias. Results: Five RCTs encompassing 230 extraction sites (KLA = 115, LA = 115) were included in this study. The standardized mean difference (SMD) with the 95% confidence interval (CI) was used to synthesize the results. The data show that there were significant differences between the two groups in post-operative pain (SMD -1.464, 95% CI -1.683 to -0.949, p= 0.001) and swelling (SMD -0.450, 95% CI -0.758 to -0.142, p= 0.004, all low quality evidence). However, there was no significant difference in the trismus (SMD -0.754, CI -1.487 to -0.022, p = 0.043, very low quality evidence). Conclusion: The combination of pre-emptive low-dose ketamine with LA significantly decreased pain and swelling within the first 24 hours after L3MS compared with the control group.Objetivo: Esta revisión aborda una pregunta de investigación clínica relacionada con la cirugía del tercer molar inferior (L3MS): ¿la combinación de ketamina preventiva en dosis bajas con anestesia local (KLA) reduce las complicaciones postoperatorias en comparación con la anestesia local (AL) sola? Material y Métodos: Se realizó una búsqueda bibliográfica sistemática para identificar artículos elegibles mediante búsquedas electrónicas en PubMed, Registro Cochrane Central de Ensayos Controlados, Biblioteca EBSCO, Web of Science y literatura gris hasta junio de 2019 sin restricciones de datos ni de idioma. Se analizaron todos los estudios clínicos controlados aleatorios (ECA) que compararon el uso de KLA con el uso de LA en L3MS con respecto a los resultados de dolor, hinchazón y trismo. La calidad de la evidencia se clasificó de acuerdo con la herramienta Cochrane para evaluar el riesgo de sesgo. Resultados: Se incluyeron en este estudio cinco ECA que abarcan 230 sitios de extracción (KLA = 115, LA = 115). La diferencia de medias estandarizada (DME) con el intervalo de confianza (IC) del 95% se utilizó para sintetizar los resultados. Los datos muestran que hubo diferencias significativas entre los dos grupos en el dolor posoperatorio (DME -1,464; IC del 95%: -1,683 a -0,949; p= 0,001) e hinchazón (DME -0,450; IC del 95%: -0,758 a -0,142 , p= 0,004, todas las pruebas de baja calidad). Sin embargo, no hubo diferencias significativas en el trismo (DME -0,754; IC: -1,487 a -0,022; p= 0,043, evidencia de muy baja calidad). Conclusión: La combinación de ketamina preventiva en dosis bajas con LA disminuyó significativamente el dolor y la hinchazón dentro de las primeras 24 horas después de la L3MS en comparación con el grupo de control

SERO-EPIDEMIOLOGICAL STUDY OF HEPATITIS B, C, HIV AND TREPONEMA PALLIDUM AMONG BLOOD DONORS IN HODEIDA CITY- YEMEN

Objective: Infections transmitted in blood transfusions are the most significant concern associated with blood donation. The purpose of this study was to establish the current prevalence of hepatitis viruses (B and C), HIV and T. pallidium among blood donors at National Blood Transfusion and Research Center (NBTRC) Hodeida Branch, Hodeida city, Yemen. Methods: Serological markers of HBV, HCV, HIV 1, 2, T. pallidium antibodies were studied in 25446 (males) using commercially available kits, over a period of 3 years from January 2016 to April 2018 at National Blood Transfusion and Research Center (NBTRC) Hodeida Branch , Hodeida city, Yemen. Also, the prevalence of confirmed-positive test results of these infections was evaluated among different ages. Results: The sero-prevalence of HBV, HCV, HIV, T. pallidium infections based on confirmation tests, were 0.74%, 0.19%, 0.38% and 0.18% respectively. The prevalence of HBV was significantly higher in age groups 37-46 years and 47-56 years with significant associated OR equal to 2.3 (p<0.001) and OR=2.7 (p=0.02) respectively. The prevalence of HCV was significantly higher in age groups 47-56 years with significant associated OR equal to 6.5 (p=0.003).  The prevalence of T. pallidium was significantly higher in age group 37-46 years with significant associated OR equal to 3.6 (p<0.001). Conclusion: This study highlights the prevalence of HBV, HCV, HIV, and T. pallidium among different male ages. The prevalence varies from one age group to another, being the lowest among younger and very older age groups. Therefore, extensive recruitment of young donors should help ensure a long-term increase in the blood supply without jeopardizing safety.                            Peer Review History: Received 24 April 2019;   Revised 31 April; Accepted 3 May, Available online 15 May 2019 Academic Editor: Dr. Jennifer Audu-Peter, University of Jos, Nigeria, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency.  Received file:                Reviewer's Comments: Average Peer review marks at initial stage: 6/10 Average Peer review marks at publication stage: 9/10 Reviewer(s) detail: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, [email protected] Dr. Hatem Sameir Abbas, Al-Azhar University, Egypt, [email protected] Similar Articles: PREVALENCE OF HEPATITIS G VIRUS AMONG PATIENTS WITH CHRONIC LIVER DISEASE AND HEALTHY INDIVIDUALS, SANA'A CITY-YEMEN PREVALENCE AND GENOTYPING OF HEPATITIS C VIRUS IN HEMODIALYSIS PATIENTS AND EVALUATION OF HCV-CORE ANTIGEN TEST IN SCREENING PATIENTS FOR DIALYSIS IN SANA'A CITY, YEMEN EXPLOSION OF HEPATITIS B AND C VIRUSES AMONG HEMODIALYSIS PATIENTS AS A RESULT OF HEMODIALYSIS CRISIS IN YEMEN SERUM POSITIVITY OF ANA AND ASMA AMONG KHAT AND NONKHAT CHEWERS AS MARKERS FOR AUTOIMMUNE HEPATITIS TYPE 1 SERO-PREVALENCE OF HEPATITIS C VIRUS AMONG DENTAL CLINIC WORKERS IN SANA’A CITY- YEMEN AND THE RISK FACTORS CONTRIBUTING FOR ITS INFECTION PREVALENCE AND POTENTIAL RISK FACTORS OF HEPATITIS B VIRUS IN A SAMPLE OF CHILDREN IN TWO SELECTED AREAS IN YEME

5G NOMA user grouping using discrete particle swarm optimization approach

Non-orthogonal multiple access (NOMA) technology meets the increasing demand for high-seed cellular networks such as 5G by offering more users to be accommodated at once in accessing the cellular and wireless network. Moreover, the current demand of cellular networks for enhanced user fairness, greater spectrum efficiency and improved sum capacity further increase the need for NOMA improvement. However, the incurred interference in implementing NOMA user grouping constitutes one of the major barriers in achieving high throughput in NOMA systems. Therefore, this paper presents a computationally lower user grouping approach based on discrete particle swarm intelligence in finding the best user-pairing for 5G NOMA networks and beyond. A discrete particle swarm optimization (DPSO) algorithm is designed and proposed as a promising scheme in performing the user-grouping mechanism. The performance of this proposed approach is measured and demonstrated to have comparable result against the existing state-of-the art approach

Impact of Health Insurance on Accessibility of Physical Therapy’s Patients at King Fahd Hospital of the University-AL Khobar

Physiotherapy plays an essential role in modern healthcare delivery as it provides a wide range of non-surgical treatments to treat chronic diseases. Physiotherapy includes many clinical guidelines as treatment and rehabilitation services improve patients' lives. Changes in health insurance policies and coverage affect costs Borne by patients and their families; this can lead to a variety of services and barriers to appropriate healthcare. The study goal is to describe the impact of Health Insurance on Accessibility among Physical Therapy Patients at King Fahd Hospital of the University-AL Khobar to describe the benefits of Health insurance on accessibility among physical therapy patients and to explore the barriers and challenges of Health insurance on accessibility among physical therapy patients.We carried out a descriptive cross-sectional survey design to describe the physical therapy patients' perception toward health insurance accessibility at King Fahd Hospital of the University-AL Khobar. Data were collected on Monday, March 9th, 2021, through self-administered questionnaires that 740 surveys were distributed, and only 544 patients participated in the survey. The data finished collecting on April 1st, 2021. Statistical Package for Social Science (SPSS) was used to analyze the data. Overall, 544 respondents completed the survey. This study clearly shows that access to health care services is a significant concern that accessibility of physical therapy was confirmed by 36.6%. Low accessibility due to the high cost of physical therapy was reported by 36.9% of patients included. Accessibility to physical therapy upon need was not written in a high frequency 30% versus 29.6% as not sure. Accessibility to facilities was highly reported by 29.6%; insurance companies enhancing accessibility to physical therapy was not approved by the majority of the included participants 37.1%. Also, insurance companies offering multiple choices for physical therapy were only agreed on 26.8%. Finally, the quality of service differs based on the facility's nature and was approved by 50.2% of included patients. Direct access to physical therapy is an example of providing an innovative primary care service that is achievable, acceptable to both users and service providers, and health insurance will positively impact access to the healthcare system. However, accessibility is a necessary term that must be taken care of to define the need for healthcare to deliver healthcare services and organizational structures to match the community's needs

Antimicrobial Susceptibility of Klebsiella pneumoniae and Escherichia coli with Extended-Spectrum β-lactamase associated Genes in Hospital Tengku Ampuan Afzan,Kuantan, Pahang

Background: To assess antimicrobial susceptibility of extended-spectrum β-lactamase- (ESBL-) producing Klebsiella pneumoniae and Escherichia coli isolates from Hospital Tengku Ampuan Afzan (HTAA), as well as to identify ESBL genes. Methods: Non-duplicate K. pneumoniae and E. coli isolates were recovered from various clinical samples. Isolates were screened for antimicrobial resistance by disc diffusion method. Isolates resistant to oxyimino-cephalosporins were subjected to phenotypic ESBL production. Detection of resistance genes was then performed using primers specific for ESBL genes(bla CTX-M,bla SHV and bla TEM). Results: Piperacillin/tazobactam and carbapenems remained the active β-lactam antibioti against K. pneumoniae and E. coli. ESBLs were detected among 35.5%(39/110)of K. pneumoniae and 18.8%(28/149)of E. coli isolates. CTX-M β-lactamase was detected in 90% of all ESBL-positive isolates, whereas bla SHV and bla TEM genes were found among 56% and 52% of them, respectively. Twenty-eight percent(28%)of the total ESBL-positive isolates harboured the three ESBL genes, while 50% carried two of the tested ESBL genes. Conclusion ESBLs encoded by at least one ESBL genes are frequently isolated among K. pneumoniae and E. coli in HTAA. The significant proportion rate of the resistant determinants is alarming, thus monitoring their transmission and dissemination is essential to control it at an early phase

Clinical Management in Diagnosis and Treatment of the Iron Deficiency Anemia in Adults: Systemic Review

This study aimed at exploring with a systematic review the clinical management in diagnosis and treatment of the iron deficiency anemia in adults, as the iron deficiency is the most frequent cause of anemia worldwide. And it impairs quality of life, increases asthenia and can lead to clinical worsening of patients. In addition, iron deficiency has a complex mechanism whose pathologic pathway is recently becoming better understood. This review summarizes the current knowledge regarding diagnostic algorithms for iron deficiency anemia. The majority of aetiologies occur in the digestive tract, and justify morphological examination of the gut. First line investigations are upper gastrointestinal endoscopy and colonoscopy, and when negative, the small bowel should be explored; newer tools such as video capsule endoscopy have also been developed. The treatment of iron deficiency is aetiological if possible and iron supplementation whether in oral or in parenteral form.

Boron removal from produce water through adsorption

Boron (B) is essential for the development and functioning of organisms, involving their growth, health, and development of plants, animals, and humans. Nevertheless, the increasing use of boron in various applications has led to environmental problems and health issues. Several separation technologies have been employed to remove boron, and adsorption is one such technology that utilizes adsorbents to address solutions containing extremely low levels of boron. This finding investigates the residual boron from a synthesized solution through adsorption, using CRB05 as the adsorbent. The impact of adsorbent dosage, contact time, boron concentration, and pH on residual boron was examined. The findings indicate that the pH plays a substantial role impact on the residual boron efficiency from all adsorbents. The highest residual of boron was achieved at pH 4.5, adsorbent dosage 1125 mg/L, time 255 minutes, and concentration 1150 mg/L with 98% removal. Adsorption of boron using CRB05 proved to be an effective method for recovering boron from the synthesis solution. The findings of this study enhance our comprehension of the adsorption behavior of CRB05 and provide insights into the optimal operating conditions for efficient boron removal

Integrating Complementary and Alternative Medicine into Family Medicine Practice: Narrative Review

Complementary and Alternative Medicine (CAM) has witnessed a significant surge in usage across various populations and regions in recent decades. This review article delves into the prevalence and patterns of CAM usage, from cancer patients to cultural practices in Saudi Arabia and New Zealand. In Saudi Arabia, CAM practices, especially spiritual ones like prayer and reciting the Quran, are widely adopted, with herbs, honey, and dietary products also being popular. New Zealand healthcare professionals, including general practitioners and midwives, generally hold a positive view towards CAM, with acupuncture being particularly favored. However, concerns about CAM's scientific evidence, safety, and costs persist. In the U.S., while CAM is popular, many family physicians feel inadequately trained to address CAM-related patient queries. In Germany, a significant number of family physicians use CAM in their practices, emphasizing the need for increased CAM education and research. The data underscores the global trend of CAM adoption and the need for its effective integration into mainstream healthcare. Despite its popularity, the integration of CAM in medical education remains limited in many regions, including Saudi Arabia. However, there's a noticeable shift with some medical schools beginning to incorporate CAM into their curriculum. The article underscores the importance of evidence-based practice, education, training, open communication, regulation, interdisciplinary collaboration, a patient-centered approach, thorough documentation, continuous research, cultural sensitivity, and cost-effectiveness evaluation when considering the integration of CAM into mainstream healthcare. The recommendations provided aim to ensure that patients receive holistic care that is both safe and effective. The overarching theme is the need for a balanced, informed, and collaborative approach to integrating CAM into family medicine practice

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI