The Degree to Which Elementary Stage Arabic Teachers in Kuwait Implement Remedial Procedures of Reading Weakness

هدفت الدراسة إلى الكشف عن درجة تطبيق معلمات اللغة العربية في المرحلة الابتدائية بدولة الكويت الإجراءات العلاجية للضعف القرائي، وما إذا كان ذلك يختلف باختلاف متغيري المؤهل العلمي، وعدد سنوات الخبرة. ولتحقيق أهداف الدراسة، أعد الباحثان مقياسا لدرجة تطبيق الإجراءات العلاجية للضعف القرائي تكون من (30) فقرة موزعة بالتساوي إلى ثلاثة مجالات: إجراءات التدريس الفردي، وإجراءات تكييف المواد القرائية والتقويم، وإجراءات دعم أجواء الغرفة الصفية والتعاون، طبق على (303) من معلمات اللغة العربية في المرحلة الابتدائية في محافظة الجهراء بدولة الكويت. أظهرت نتائج الدراسة أن درجة تطبيق معلمات اللغة العربية الإجراءات العلاجية للضعف القرائي مرتفعة؛ إذ جاء مجال دعم أجواء الغرفة الصفية والتعاون في المرتبة الأولى بدرجة مرتفعة، تلاه مجال إجراءات التدريس الفردي بدرجة مرتفعة، وأخيرا مجال تكييف المواد القرائية والتقويم بدرجة متوسطة. وأظهرت النتائج أيضا وجود اختلاف دال إحصائيا في درجة تطبيق المعلمات الإجراءات العلاجية للضعف القرائي تبعا لمتغيري المؤهل العلمي لصالح الدراسات العليا، وعدد سنوات الخبرة لصالح (10) سنوات فأكثر.The study aimed at revealing the degree to which Arabic teachers in the primary stage in Kuwait implement remedial procedures of reading weakness, and whether there were statistically significant differences in the degree of their implementing due to the variables of qualification, and years of teaching experience. To achieve the aims of the study, the researcher prepared reading weakness remedial procedures scale consisted of (30) items equally distributed into three domains: individual teaching, adapting reading materials and assessment, and support the classroom atmosphere and cooperation procedures. The sample of the study consisted of (303) primary school Arabic female teachers in Jahra Governorate. The results of the study showed that the degree of implementing Arabic language female teachers’ remedial procedures of reading weakness was high; The support for the classroom atmosphere and cooperation domain firstly ranked with a high degree, followed by individual teaching procedures domain with a high degree, and lastly, adapting reading materials and assessment domain with moderate degree. The results also showed that there was a statistically significant difference in the degree of implementing remedial procedures due to the qualification variable in the favor of higher studies, and to the variable number of years of teaching experience in the favor of (10) years and more. In light of these results, the researcher recommends teachers to use multi-sensory instruction in teaching reading to the students with reading weakness.&nbsp

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

A Glance at the Development and Patent Literature of Tecovirimat: The First-in-Class Therapy for Emerging Monkeypox Outbreak

Monkeypox disease (MPX) is currently considered a global threat after COVID-19. European Medicines Agency (EMA) approved Tecovirimat in capsule dosage form (200 mg) as the first treatment for MPX in January 2022. This article highlights Tecovirimat&rsquo;s development and patent literature review and is believed to benefit the scientists working on developing MPX treatments. The literature for Tecovirimat was gathered from the website of SIGA Technologies (developer of Tecovirimat), regulatory agencies (EMA, United States Food and Drug Administration (USFDA), and Health Canada), PubMed, and freely accessible clinical/patent databases. Tecovirimat was first recognized as an anti-orthopoxvirus molecule in 2002 and developed by SIGA Technologies. The USFDA and Health Canada have also recently approved Tecovirimat to treat smallpox in 2018 and 2021, respectively. The efficacy of Tecovirimat was verified in infected non-human primates (monkeys) and rabbits under the USFDA&rsquo;s Animal Rule. Most clinical studies have been done on Tecovirimat&rsquo;s safety and pharmacokinetic parameters. The patent literature has revealed inventions related to the capsule, injection, suspension, crystalline forms, amorphous form, and drug combinations (Tecovirimat + cidofovir) and process for preparing Tecovirimat. The authors foresee the off-label use of Tecovirimat in the USA and Canada for MPX and other orthopoxvirus infections. The authors also trust that there is immense scope for developing new Tecovirimat-based treatments (new drug combinations with other antivirals) for orthopoxvirus and other viral diseases. Drug interaction studies and drug resistance studies on Tecovirimat are also recommended. Tecovirimat is believed to handle the current MPX outbreak and is a new hope of biosecurity against smallpox or orthopoxvirus-related bioterrorism attack

PREVALENCE AND CAUSES OF RECURRENT PEPTIC ULCER

Background:Peptic ulcer disease (PUD) is a common disease of the gastrointestinal tract characterized by mucosal damage due to the secretion of pepsin and gastric acid. The current study aimed to determine the prevalence and causes of recurrent peptic ulcer. Methods:The current study adopted an exploratory study design in order to determine the prevalence and causes for recurrent peptic ulcer disease in individuals and predict an outcome. The participants for the current study were individuals belonging to the age group 18-75. This age group is chosen as the major influence of peptic ulcer disease is observed within this group.For the current study, questionnaire was adopted for data collection, which was also categorized as a study tool. Results:Study included 589 participants. It is noticed that most of participants (n= 530, 90.1%) strongly agree that they visit the doctor periodically to check on their health. Previous item has the highest rank followed by participants follow smoking lifestyle (n= 526, 89.4%). On the other hand, the least rank item on which participants strongly disagreed was participants suffered from soreness or bleeding from their stomach (n= 249, 42.4%). This gives a prevalence of 42.4% of peptic ulcer disease among study participants. Conclusion:Peptic ulcer illness burdens health care systems, which urge for adequate treatment to limit recurrence and effects. H. pylori, smoking, and aspirin usage are risk factors for 5-year peptic ulcer recurrence. Long-term PUD hazards include smoking and aspirin. Avoiding risk factors reduced the recurrence rate of H. pylori eradication, acid suppression medication, and surgery. This shows how eliminating risk factors may enhance long-term performance. Proper PUD treatment requires multicenter research to prevent recurrence and repercussions