Systematic review and meta-analysis of efficacy and safety of combinational therapy with metformin and dipeptidyl peptidase-4 inhibitors

AbstractCombinational therapies are often required in the management of type 2 diabetes mellitus (T2DM). Among the important candidates, dipeptidyl peptidase-4 inhibitors (DPPIs) and metformin combination (DPPI-MET) have shown promising endeavors. In order to examine the efficacy and safety of such a combination therapy in T2DM patients finding inadequate control with metformin, this systematic review and meta-analysis has been conducted. Literature search was made in multiple electronic databases. Inclusion criteria included; RCTs examining the efficacy and safety of DPPI-MET against placebo-MET or MET-only groups of T2DM patients by observing changes in disease endpoints including HbA1c and FPG, and the length of trial be at least 12weeks. Mean differences based meta-analyses were performed and heterogeneity assessment was carried out. Nineteen studies were selected and included in the meta-analyses. DPPI-MET significantly improved all disease endpoints and the difference could be noticed up to 2years in the majority of outcome measures. In comparison with PBO-MET, the DPPI-MET combinational therapy resulted in the percent HbA1c changes from baseline with a mean difference [95% CI] of −0.77 [−0.86, −0.69] in 3-month (P<0.00001), −0.67 [−0.76, −0.59] in 6-month (P<0.00001), −0.67 [−0.88, −0.47] in 1-year (P<0.00001) and −0.36 [−0.53, −0.20] in 2-year trials (P<0.0003). Reduction in body weight and safety profile in the treated and control groups were not different. A combinational therapy with DPPI and metformin significantly improves diabetes clinical indicators and this effect has been observed for up to 2years herein. Safety and tolerability of DPPI-MET combination have been found well-manageable with a very similar adverse event profile in both treated and control groups

The role of nutraceuticals in the management of autism

AbstractAutism and related disorders are increasingly prevalent behavioral syndromes of impaired verbal and nonverbal communication and socialization owing to neurodevelopmental abnormalities. The most recent estimate for the prevalence of autistic disorders is about 1% on a global scale. Etiology of autism is multifactorial and multidimensional that makes therapeutic intervention even harder. Heterogeneity of genetic factors, oxidative stress, autoimmune mechanism, and epigenetic mechanisms complicate the nature of pathogenesis of the disease. Nutraceutical approach to treat this disease is a promising strategy, especially in some areas, it is more attractive than others. This review critically analyzes the roles of vitamins and cofactors, dietary modifications and gut abnormalities, probiotics and prebiotics, phytochemicals, and environmental factors in order to determine the state of evidence in nutraceutical-based autism management practices. This article presents a systematic review of randomized- and placebocontrolled trials to examine the evidence supports the use of autism nutraceu10.1016/j.jsps.2012.10.001ticals. The results will be discussed in the light of all relevant evidence generated from other clinical and exploratory studies

Applications of Fractional Supersaturated Process and Factor Analysis in the Systemic Risks of Financial Fraud

Fraud is defined as an act committed to deceive people and undermine their trust in financial institutions. The effects of fraud in government financial institutions, the private sector, and at the societal level show that it deeply feeds the economy. Objective. This study aims to shed light on the effects of financial fraud, measure its impact, and determine means to control it. Methods and Materials. This study considered a survey and a questionnaire was used to collect primary data. The total number of participants included in the questionnaire was 77. Two methods were used to search for the real effects of financial fraud, measure its impact, and determine the means to control it: factor and regression analyses. The data were analyzed using SPSS version 25.0. Results. The factor analysis results reveal the factors that contributed to the effects of financial fraud from A1 to A15, excluding factors A12 and A13. The regression analysis revealed the elements that contributed to the effects of financial fraud on A2, A5, and A14. Conclusion. Based on the findings of the two methodologies and the similarity in the outcomes of the causal variables, the fundamental and authentic aspects that lead to the effects of financial fraud were identified as A2, A5, and A14

Cardiac Cell Regeneration in Zebrafish A Systematic Review Study.

Objective: This research aims to increase the level and quality of the information acquired from 90 previously conducted studies regarding zebrafish heart regeneration and to summarize the best and latest information as well as the methods gleaned from those studies, which will allow us to determine the best ways to rebuild cardiac tissue in zebrafish. Methods: This study was conducted under the PRISMA guidelines. The search for primary research articles was conducted using PubMed, Web of science, and Mendeley. We used the latest update of Microsoft office Excel, Of the total 1158 results, 1066 were dropped according to the criteria for exclusion. The selected results included previously published and unpublished studies on cardiac cell regeneration in zebrafish from 2012 to 2022. Results: 90 studies met the inclusion criteria. Out of these, 43 used the AR method, 36 used cryoinjury, and 16 used genetic amputation. All methods used were based on selected heart sections, not the whole heart. The primary evaluation technique used in the included studies was histology, either alone or in combination with other methods. Acid Fuchsin Orange G (AFOG), Masson's Trichrome (MT), Hematoxylin/Eosin (HE), immunofluorescence (IF), and in situ hybridization (ISH) were the main histological techniques employed to assess heart regrowth and regeneration. Conclusion: This study may have a risk of bias due to the qualitative and quantitative data that was selected. Further research can help understand and utilize zebrafish regeneration genes in humans

BREASTFEEDING PRACTICE AND MOTHERS AWARENESS AND PRACTICE OF ABSOLUTE BREASTFEEDING IN ARAR, SAUDI ARABIA

Background: Human milk meets all the nutritional requirements of infants for the first 6 months of life, and it is associated with a lower incidence of diarrhea than partial or artificial feeding. The infant should be exclusively breastfed for at least 4 months of life and if possible for 6 months, as recommended by WHO and UNICEF. Objectives: The main objective of this study was to determine the breastfeeding status for children under 24 months in Arar city, and to determine breastfeeding practice in relation to some socidemographic and nutrition related variables. Participants and methods: A cross-sectional study was carried out in Arar city, mothers were selected from the attendees of the female side of 6 randomly selected primary health care centers in the city. They interviewed and filled a questionnaire which included the needed questions. Results: Among the 400 studied children,17.2% got breastfeeding, 41.0% had both breast and artificial feeding while 41.8% depended on artificial feeding only. Absolute breastfeeding in the first 6 months of life was found in 34.7% of infants and in the first 4 months of life was found in 13.8%. Sources of health education of the mothers about absolute breastfeeding period were doctors in 12.1%, health education team of the hospitals in 24.1%, relatives and friends in 11.8%, the media in 3.8% while no health education about absolute breastfeeding period was reported by 48.2% of the studied mothers. The reported causes of artificial feeding was difficulty of breastfeeding during working hours in 41.8%, missing of support in 25.7%, preference of formula milk in 11%, thinking that breastfeeding leads to breast enlargement and redundancy in 8.6% and thinking that breastfeeding leads to obesity of the mothers in 4.5%. No significant relationship between type of child feeding and child age, sex, mother education, mother's working status, father's work or mother age group [P >0.05]. Conclusion: 17.2% got breastfeeding, 41.0% had both breast and artificial feeding while 41.8% depended on artificial feeding only. Absolute breastfeeding in the first 6 months of life was found in 34.7% of infants and in the first 4 months of life was found in 13.8%. With deficiency of exclusive breastfeeding among infants of Arar, Saudi Arabia. Programs promoting exclusive breastfeeding in the first 6 months of age must be conducted to increase mothers’ awareness of the exclusive breastfeeding duration is recommended. Keywords: Breastfeeding; Exclusive breastfeeding; Breastfeeding Practice; Arar, Saudi Arabia

Turnover among foreign nurses in Saudi Arabia

Background: Globally, nursing turnover has become a contemporary concern that significantly influences the financial proficiency of healthcare systems. Not only costs, but healthcare accessibility and quality also reverberate the consequence of the phenomenon.Design and methods:&nbsp; The study explores the factors that attribute to turnover among foreign registered nurses working in Saudi Arabia. A quantitative-based cross-sectional descriptive study design that uses survey data to make statistical inferences about foreign nurse turnover in Saudi Arabia, was conducted to ascertain factors influencing the termination of foreign nurses working with the Ministry of Health (MOH) hospitals.Results: Factors influencing turnover were categorized into 9 dimensions, professional growth and development, leadership style, management, wage and benefits, workload, interpersonal relationship, housing facilities and services, hospital facilities and intent to stay and turn-over intention, of which the professional growth (4.1±0.7) and development had the highest mean agreement scores (4.0±1.1), whereas housing (2.3±1.3) and hospital facilities (2.1±1.0) showed the lowest mean scores.&nbsp;Conclusions: Wage benefits and workload factors were found to be the most significant causes of expatriate nursing turnover, closely followed by inadequate housing and hospital facilities. Recommendations from nursing staff on how to improve retention were also noted

Association Between Voice Handicap Index and Reflux Symptom Index: A cross-sectional study of undiagnosed general and teacher cohorts in Saudi Arabia

Objectives: This study aimed to assess potential associations between self-reported symptoms of laryngopharyngeal reflux (LPR) and voice disorders among two undiagnosed cohorts in Saudi Arabia. Methods: This cross-sectional study was conducted from February to April 2017 in Khobar, Saudi Arabia. Validated Arabic versions of the Reflux Symptom Index (RSI) and 10-item Voice Handicap Index (VHI-10) were distributed to 400 teachers at 13 schools and 300 members of the general population attending an ear, nose and throat clinic in Khobar. Scores of &gt;13 and &gt;11 on the RSI and VHI-10 indicated a potential subjective diagnosis of LPR and voice disorders, respectively. Results: A total of 446 individuals took part in the study, including 260 members of the general population (response rate: 86.7%) and 186 teachers (response rate: 46.5%). The mean age was 32.5 years. In total, 62.2% complained of voice and/or reflux problems, with the remaining 37.8% not reporting/unaware of any problems in this regard. Among the teachers, 30.6% and 18.3% had positive RSI and VHI-10 scores, respectively, while 43.1% and 14.6% of the individuals from the general population had positive RSI and VHI-10 scores, respectively. Overall, VHI-10 scores were significantly associated with RSI scores (P &lt;0.001). Conclusion: A significant association between RSI and VHI-10 scores suggests that there may be an association between LPR and voice disorders. These tools would therefore be a valuable method of monitoring patients; however, they cannot be used to confirm a diagnosis. Thus, more detailed studies are needed to confirm this association using a larger sample size.Keywords: Voice Disorders; Laryngopharyngeal Reflux; Hoarseness; Diagnostic Self Evaluation; School Teachers; Saudi Arabia

Awareness of Dental Interns to Treat Pregnant Patients

BACKGROUND: Pregnancy causes major changes in maternal physiology and metabolism, which may lead to increased susceptibility to oral infection. AIM: Aim of this study is to assess the awareness of dental interns regarding the management of the dental needs of pregnant patients. METHODS: A cross-sectional questionnaire survey was conducted among 188 interns of a private dental college in Saudi Arabia. The questionnaire comprised of 14 knowledge-based questions regarding their training, awareness and practice management of the pregnant patient in dental clinics. Four questions to record and evaluate their training, the number of pregnant patients treated by them and their confidence level in the dental management of the pregnant patient. Excel spreadsheet was used for mathematical calculations. RESULTS: Almost 62% of our participants never treated a pregnant female during their training. About 65% of the interns knew using antibiotics, almost 55% have a clear idea of the safest NSAIDS, and 43% regarded local anaesthesia to be safe when used among pregnant females. Conversely, about 50% of the participants had no clear knowledge of the FDA category of drugs. Only 24% considered dental radiographs to be safe in pregnant patients. 57% thought to postpone the dental treatment in an acute active dental infection in expecting mothers. Results also showed a lack of confidence among interns to provide dental care to gestating female. CONCLUSION: On analysing the results, we found that there is a need to improve the knowledge, awareness and confidence levels among the interns who are the future dentists treating these patients

Injuries type and its relation with Glasgow Coma Scale, injury severity score and blood transfusion in road traffic accident Victims.

Motor Vehicular Accidents claim about 1.2 million lives and injure more than 10 million people annually worldwide. The injuries caused by MVAs can be analyzed based on the type of injury, injury severity score, Glasgow Coma Scale and required blood transfusion. Methodology: A total number of 190 patients were included in this retrospective study from January 01, 2010 to December 31, 2015. The study aimed to determine the correlation between the type of injuries and GCS, ISS, and blood transfusions in the patients suffering from Motor Vehicle Accidents, who were presented to the Emergency Department at the King Khalid Hospital. All the data of the patients fulfilling the inclusion criteria were collected from the database at medical records department of the hospital. Results: Majority of the patients were adults Saudi male. 68.9% of the patients did not sustain shock, and 75.8% of patients did not require a blood transfusion. Patients with head, neck, chest, abdominal, internal organ, pelvic or spinal injuries conferred a statistically significant higher mean ISS. Patients with abdominal or internal organ injuries had a statistically significant higher mean units of blood transfused. GCS was seen to be lower in the head, neck, chest, abdominal, internal organ, spinal and other injuries. Conclusions: The study documents a significant correlation between the type of injury and GCS, ISS, and blood transfusion in victims of road traffic accident. Emergency physician and the caregivers should be more careful about the injuries associated with lower GCS. Patients sustaining injuries of certain parts related to high ISS (i.e., head, chest, abdominal, internal organ, pelvic) should be addressed on priority basis