Drug utilisation patterns and factors influencing prescribing choice of antidiabetic drugs among patients with type 2 diabetes mellitus in Scotland, 2010-2020 : a population-based, multi-study project

Introduction: Multiple pharmacological treatment options are currently available for managing type 2 diabetes mellitus (T2DM) with variable safety and extra-glycaemic profiles. However, clinical guidelines mostly do not have a clear treatment algorithm for the optimal selection of antidiabetic drugs (ADDs) as alternative first-line and add-on therapy. Methods: This thesis comprised multiple studies. First, a systematic review and meta-analyses (SRMA) of observational studies investigating factors associated with prescribing ADDs was conducted to identify the gap in this area of research. Second, retrospective cohort studies were performed using linked routinely collected data of patients with T2DM who received ADD between Jan/2010 and Dec/2020 to describe the ADD prescribing patterns and factors influencing ADD prescribing/selection at drug initiation and first-intensification. Data were analysed using descriptive statistics and multinominal logistic regression as appropriate. Results: The identified factors in the SRMA were mapped into four categories; demographic, socioeconomic, clinical, and prescriber factors. Patient age, sex, baseline HbA1c, body mass index (BMI), and kidney problems were the most frequently studied factors. Between 2010 and 2019, 145909 new ADD users with T2DM were identified in Scotland, with around 91% (N=132382) of patients receiving a single ADD. Of those, metformin was the most often prescribed monotherapy (89.7%). Of 145909 new ADD users, 50731 patients were started on metformin (N=46730) or SU (N=4001) monotherapy and intensified with additional ADD(s) between Jan/2010 and Dec/2020. Most initial-metformin (98.4%) and initial-SU users (97.3%) were intensified with single ADD. SU (48.3%) was the most common first intensifying monotherapy after initial metformin but was replaced by SGLT2-I in 2019. Metformin was the most frequently added monotherapy to initial SU (75%). Nevertheless, there was a significant increase in prescribing newer antidiabetic classes (SGLT2-I, DPP4-I), opposite to older ones (SU, insulin, thiazolidinedione). Moreover, multiple clinical (e.g., HbA1c, BMI, etc.) and non-clinical (e.g., age, sex) factors were associated with ADD selection, yet the extent and direction of association varied by antidiabetic class. Conclusions: An overall increase in prescribing newer antidiabetic classes compared to older ones was observed. Some identified factors associated with the prescribing choice were consistent with the variability in drug characteristics, but others (particularly baseline cardiovascular disease) showed inconsistent results.Introduction: Multiple pharmacological treatment options are currently available for managing type 2 diabetes mellitus (T2DM) with variable safety and extra-glycaemic profiles. However, clinical guidelines mostly do not have a clear treatment algorithm for the optimal selection of antidiabetic drugs (ADDs) as alternative first-line and add-on therapy. Methods: This thesis comprised multiple studies. First, a systematic review and meta-analyses (SRMA) of observational studies investigating factors associated with prescribing ADDs was conducted to identify the gap in this area of research. Second, retrospective cohort studies were performed using linked routinely collected data of patients with T2DM who received ADD between Jan/2010 and Dec/2020 to describe the ADD prescribing patterns and factors influencing ADD prescribing/selection at drug initiation and first-intensification. Data were analysed using descriptive statistics and multinominal logistic regression as appropriate. Results: The identified factors in the SRMA were mapped into four categories; demographic, socioeconomic, clinical, and prescriber factors. Patient age, sex, baseline HbA1c, body mass index (BMI), and kidney problems were the most frequently studied factors. Between 2010 and 2019, 145909 new ADD users with T2DM were identified in Scotland, with around 91% (N=132382) of patients receiving a single ADD. Of those, metformin was the most often prescribed monotherapy (89.7%). Of 145909 new ADD users, 50731 patients were started on metformin (N=46730) or SU (N=4001) monotherapy and intensified with additional ADD(s) between Jan/2010 and Dec/2020. Most initial-metformin (98.4%) and initial-SU users (97.3%) were intensified with single ADD. SU (48.3%) was the most common first intensifying monotherapy after initial metformin but was replaced by SGLT2-I in 2019. Metformin was the most frequently added monotherapy to initial SU (75%). Nevertheless, there was a significant increase in prescribing newer antidiabetic classes (SGLT2-I, DPP4-I), opposite to older ones (SU, insulin, thiazolidinedione). Moreover, multiple clinical (e.g., HbA1c, BMI, etc.) and non-clinical (e.g., age, sex) factors were associated with ADD selection, yet the extent and direction of association varied by antidiabetic class. Conclusions: An overall increase in prescribing newer antidiabetic classes compared to older ones was observed. Some identified factors associated with the prescribing choice were consistent with the variability in drug characteristics, but others (particularly baseline cardiovascular disease) showed inconsistent results

Comparative effectiveness and safety of first-line systemic anti-cancer treatments of metastatic colorectal cancer : a systematic review and meta-analysis

Background: metastatic colorectal cancer (mCRC) is characterised by multiple treatment strategies. Randomised clinical trials are not always aligned with the clinical practice, and greater use of realworld (RW) studies has been suggested to inform health care decisions by providing results that reflect RW practice. The purpose of this systematic review and meta-analysis was to provide a synthesis of the available RW evidence on the effectiveness and safety of first-line systemic anti-cancer therapies (SACTs) in patients with mCRC. Methods: relevant databases were searched from inception until July 2021. Inclusion criteria were observational studies; published in English; patients ≥ 18 years; mCRC; first-line SACT for treatment of mCRC. No restrictions were placed on the country of publication. The effectiveness outcomes included overall survival (OS), the primary outcome, and progression-free survival (PFS). Safety was assessed by the occurrence of grade 3 or 4 adverse effects based on the national cancer institute common terminology criteria for adverse events (NCI CTCAE). The results were synthesised using a randomeffect meta-analysis model based on Hazard ratio and 95% confidence interval (95% CI) for survival outcomes, while risk ratio and 95% CI was used for safety outcome. Subgroup analysis was performed to explore differences between different treatment strategies. Heterogeneity was assessed using I2. Results: The search strategy identified 5662 studies, of which 31 met the inclusion criteria and were included in the overall survival meta-analysis. The pooled hazard ratio for overall survival, including all SACTs, was 1.19 (1.1-1.29). The overall heterogeneity of included studies was 76.6%. Subgroup analysis identified a significant difference between different treatment comparisons (p =0.01). The pooled overall survival was significant for chemotherapy only versus Bevacizumab+ chemotherapy (pooled estimate: 1.15 (1.05-1.26). For PFS, 20 studies were included in the meta-analysis. The pooled hazard ratio, including all SACTs, was 1.19 (1.08- 1.3), with an overall heterogeneity of the included studies was 64.4%. subgroup analysis showed a significant difference between different comparisons (p=0.001). the pooled PFS was significant for: (1) chemotherapy only versus bevacizumab+ chemotherapy (pooled estimate: 1.36 (1.05-1.26) and (2) bevacizumab+ irinotecan-based chemotherapy versus bevacizumab+ oxaliplatinbased chemotherapy (pooled estimate: 1.22 (1.07-1.38). For the safety outcomes, 14 studies were included in the meta-analysis. The pooled relative risk of haematological and non-haematological toxicities was 1.25 (0.89-1.76) and 1.03 (0.73-1.46), respectively, with no statistically significant difference between different treatment strategies for the haematological toxicities (p > 0.05). However, the pooled estimate for non-haematological toxicities was significant for two subgroups (1) bevacizumab+ XELIRI versus bevacizumab+ FOLFIRI (pooled estimate 1.66 (1.03-2.7). and bevacizumab+ FOLFOXIRI versus bevacizumab+ XELOXIRI (pooled estimate: 3.5 (1.9-6.4). Conclusion: The results indicated a survival benefit for bevacizumab with additional nonhaematological toxicities for several combinations involving bevacizumab used in first-line settings of mCRC treatment. Although the survival benefit may appear clinically modest, bevacizumab offers hope for increased survival for patients with mCRC

Patterns of initial and first-intensifying antidiabetic drug utilization among patients with type 2 diabetes mellitus in Scotland, 2010-2020: A retrospective population-based cohort study : a retrospective population-based cohort study

To evaluate the utilization and prescribing patterns of antidiabetic drugs (ADDs) for patients with type 2 diabetes mellitus (T2DM) at treatment initiation and first intensification. A retrospective cohort study was performed using linked routinely collected data of patients with T2DM who received ADDs between January 2010 and December 2020 in Scotland. The prescribing patterns were quantified using frequency/percentages, absolute/relative change, and trend tests. Overall, 145 909 new ADD users were identified, with approximately 91% (N = 132 382) of patients receiving a single ADD at first treatment initiation. Metformin was the most often prescribed monotherapy (N = 118 737, 89.69%). A total of 50 731 patients (39.40%) who were started on metformin (N = 46 730/118 737, 39.36%) or sulphonylurea (SU; N = 4001/10 029, 39.89%) monotherapy had their treatment intensified with one or more additional ADD. Most initial-metformin (45 963/46 730; 98.36%) and initial-SU users (3894/4001; 97.33%) who added further drugs were intensified with single ADDs. SUs (22 197/45 963; 48.29%) were the most common first-intensifying monotherapy after initial metformin use, but these were replaced by sodium-glucose cotransporter-2 (SGLT2) inhibitors in 2019 (SGLT2 inhibitors: 2039/6065, 33.62% vs. SUs: 1924/6065, 31.72%). Metformin was the most frequently added monotherapy to initial SU use (2924/3894, 75.09%). Although the majority of patients received a single ADD, the use of combination therapy significantly increased over time. Nevertheless, there was a significant increasing trend towards prescribing the newer ADD classes (SGLT2 inhibitors, dipeptidyl peptidase-4 inhibitors) as monotherapy or in combination compared with the older ones (SUs, insulin, thiazolidinediones) at both drug initiation and first intensification. An overall increasing trend in prescribing the newer ADD classes compared to older ADDs was observed. However, metformin remained the most commonly prescribed first-line ADD, while SGLT2 inhibitors replaced SUs as the most common add-on therapy to initial metformin use in 2019. [Abstract copyright: © 2024 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

Evaluating the Quality of Learning Disabilities Program

الملخص: هدفت هذه الدراسة الوصفية إلى تقويم جودة برنامج صعوبات التعلم بمدارس التعليم الأساسي من وجهة نظر المعلمين في سلطنة عُمان، وبأسلوب العينة المٌتيسرة استجابت 277 معلمة من مختلف محافظات سلطنة عُمان على مقياس تألف من 83 مؤشراً موزعاً على ستة معايير متعلقة بفلسفة البرنامج، والبيئة التعليمية، والعاملون في البرنامج، والبرنامج التربوي الفردي، والدمج والخدمات الانتقالية، ومشاركة الأسرة. وأشارت النتائج إلى أنّ توافر معايير الجودة في البرنامج تراوحت بين المتوسطة والعالية؛ إذ حصل معيار البيئة التعليمية ومعيار فلسفة البرنامج على درجة عالية، بينما حصلت معايير العاملون في البرنامج، والدمج والخدمات الانتقالية، والبرنامج التربوي الفردي، ومشاركة الأسرة على درجة متوسطة. كما أشارت النتائج إلى وجود فروق ذات دلالة إحصائية تبعاً لمُتغيري المؤهل العلمي وسنوات الخبرة التدريسية.  وبناءً على هذه النتائج أوصى الباحثون بأن تتبنى وزارة التربية والتعليم العُمانية المعايير والمؤشرات الواردة بهذه الدراسة.Abstract: The purpose of this descriptive study was to evaluate the quality of the learning disabilities program (LDP) in the basic education schools as perceived by teachers of LDP in the Sultanate of Oman. A convenience sample of 277 teachers was selected from Omani governorates. A scale of 83 indicators was developed and distributed to teachers. These indicators included six standards related to program philosophy, educational environment, program staff, individualized education program, transitional services, and family involvement. The results indicated that the availability of quality standards in LDP ranged from a moderate to a high level. The indicators of the educational environment standard and the program philosophy standard achieved a high level. While the indicators of program staff standard, transitional services standard, individualized education program standard, and family involvement achieved an average level. The results also revealed that there were statistically significant differences due to the educational qualifications and teaching experience of LDP teachers. Based on these results, the researchers recommended that the Omani Ministry of Education adopt the indicators and standards that have been developed in this study

Monkeypox and oral lesions associated with its occurrence: a systematic review and meta-analysis [version 2; peer review: 1 approved, 2 approved with reservations]

Background A zoonotic, double-stranded DNA virus belonging to the genus Orthopoxvirus, the mpox virus (MPXV) is most common in tropical regions of Central and West Africa. The frequency of monkeypox (mpox) cases, however, has sharply climbed globally since May 2022. Objectives To establish the threat of mpox in terms of the oral lesions caused in sufferers. Materials and methods After a thorough study of the literature identified in the PubMed, Web of Science, and Cochrane library databases using the PRISMA framework, 103 papers were found. Using inclusion and exclusion criteria, we chose research that was relevant for our review before shortlisting 14 papers that conformed to the review's guidelines. Results In the 14 selected studies, it was found that oral lesions were among the first clinical signs of a mpox affliction, with ulcers on the dorsal surface of tongue lips being the most common areas affected. Conclusion The rarely observed oral lesions of mpox infection may help in the diagnosis and management of this condition. It is critical to keep in mind that recognising and detecting oral lesions in mpox patients opens the door to more research and efficient patient management

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

Bioactive injectable mucoadhesive thermosensitive natural polymeric hydrogels for oral bone and periodontal regeneration

Periodontitis is an inflammation-related condition, caused by an infectious microbiome and host defense that causes damage to periodontium. The natural processes of the mouth, like saliva production and eating, significantly diminish therapeutic medication residency in the region of periodontal disease. Furthermore, the complexity and diversity of pathological mechanisms make successful periodontitis treatment challenging. As a result, developing enhanced local drug delivery technologies and logical therapy procedures provides the foundation for effective periodontitis treatment. Being biocompatible, biodegradable, and easily administered to the periodontal tissues, hydrogels have sparked substantial an intense curiosity in the discipline of periodontal therapy. The primary objective of hydrogel research has changed in recent years to intelligent thermosensitive hydrogels, that involve local adjustable sol-gel transformations and regulate medication release in reaction to temperature, we present a thorough introduction to the creation and efficient construction of new intelligent thermosensitive hydrogels for periodontal regeneration. We also address cutting-edge smart hydrogel treatment options based on periodontitis pathophysiology. Furthermore, the problems and prospective study objectives are reviewed, with a focus on establishing effective hydrogel delivery methods and prospective clinical applications

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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Characterization of wollastonite-based glass ceramic from clamshell and sodium lime silica bottles

Wollastonite glass-ceramics have been fabricated in this work using clamshell (CS) and soda lime silicate (SLS) glass waste. The samples were prepared using a meltquenching technique based on the chemical formula [(CS)x(SLS)100-x] with x = 10, 20, 30, 40, and 50. The samples were sintered at 600, 700 and 1000°C.The literature has not reported the utilization of CS and the SLS glass waste in the fabrication of wollastonite based glass ceramics. The CS is chosen as a source of CaO and the SLS glass waste provides the required SiO2, and these wastes are expected to provide another alternative means of managing the disposed of SLS glass and CS wastes in the metropolitan cities around the world. Hence, the objectives of this research were to fabricate a series of wollastonite glass-ceramics from clamshell and SLS glass waste and to study both the clamshell concentration and sintering temperature effects on the physical and structural properties of the materials. To achieve the research objectives, measurements and characterizations such as density, linear shrinkage, X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, scanning electron microscopy (SEM), and energy dispersion X-ray fluorescence (EDX) analysis of the prepared samples were carried out. The density values and linear shrinkage mostly increased with the concentration of CS in the materials and sintering temperature where the density is 28.4 g/cm3 and the linear is 7.11 mm. This increment is probably associated with structural changes leading to more interstitial space as shown by SEM micrograph structures. The XRD results showed the presence of peaks of wollastonite, cristobalite, augite, diopside and quartz phases. The XR results show that after the sintering at 600°C, the sample was still in the amorphous phase, the increased in the sintering temperature to 700°C the peaks were found through increasing the sintering temperature to 1000°C the phase appeared. The wollastonite intensity increases when sintering temperature increases. The elemental EDX analysis of the green and sintered samples at 600°C, 700°C and 1000°C revealed the presence of carbon (C), oxygen (O), sodium (Na), silicon (Si) and calcium (Ca). The FTIR analysis of the samples showed mainly the absorptions due to the vibrations of Si–O–Si linkages, symmetric Si–O and bond bending of Si–O–Si, symmetric stretching vibrations of O–Si–O bending, and Ca–O stretching modes. The sintering temperature and clamshell concentration both have structural and physical effects on the material as revealed in FTIR spectra, that was clear when they obtained the bond of calcium groups and the bond of silicon groups