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Medication administration errors (MAEs) are the most common and significant type of medication errors worldwide. This study aims to assess the prevalence, types, and severity of MAEs. Furthermore, this study attempts to determine the factors associated with the occurrence of MAEs.This cross-sectional study was conducted over a three-month interval in the internal medicine ward of a tertiary teaching hospital in Jordan. During the study period, 13 nurses were observed while they were preparing and administering medications using a direct disguised observation method. All the recorded observations about the preparation and administration were compared with the physician's orders in the medications' records to identify any possible MAEs.Having observed a total of 1,012 opportunities for errors, 910 MAEs were identified. Among these 910 errors, adherence errors were found to be the most frequent type (n = 364, 35.9%), followed by incorrect drug preparation (n = 247, 24.4%). None of the MAEs revealed any serious harm to patients or contributed to prolonged hospitalization. Antimicrobial drugs (n = 210, 23.0%) was the most common class associated with MAEs, followed by the class of cardiovascular (n = 157, 17.2%) medicines. Results have shown that the occurrence of MAEs was significantly higher in the non-intravenous medications in comparison to the intravenous medications (While this study revealed a high rate of MAEs, all the identified errors did not cause harm to the patients. Continuous awareness and education campaigns targeting the nurses about the importance of proper and safe drug administration are highly recommended.أخطاء إعطاء الدواء هي من بين أكثر أنواع الأخطاء الدوائية شيوعا وأهمية في جميع أنحاء العالم. هدفت هذه الدراسة إلى تقييم انتشار أخطاء إعطاء الدواء وأنواعها وشدتها، وتحديد العوامل المرتبطة بحدوث مثل هذه الأخطاء.أجريت هذه الدراسة المقطعية على مدى ثلاثة أشهر في جناح الطب الباطني في مستشفى تعليمي ثلاثي في الأردن. خلال فترة الدراسة، تمت ملاحظة ما مجموعه 13 ممرضة أثناء تحضير الأدوية وإعطائها باستخدام طريقة الملاحظة المقنعة المباشرة. تمت مقارنة جميع الملاحظات المسجلة المتعلقة بالتحضير والإدارة مع أوامر الطبيب في سجل الأدوية لتحديد أي أخطاء محتملة.لوحظ ما مجموعه 1012 فرصة للأخطاء، وتم تحديد 910 خطأ في إعطاء الأدوية. من بين هذه الأخطاء البالغ عددها 910، كانت أخطاء الالتزام هي النوع الأكثر شيوعا (العدد 364 ، 35.9٪)، يليها تحضير دواء غير صحيح (العدد 247، 24.4٪). لم يسفر أي من أخطاء إعطاء الأدوية عن ضرر جسيم للمرضى أو ساهم في البقاء في المستشفى لفترات طويلة. كانت الأدوية المضادة للميكروبات (العدد 210 ، 23.0٪) هي الفئة الأكثر شيوعا المرتبطة بـأخطاء إعطاء الأدوية، تليها أدوية أمراض القلب والأوعية الدموية (العدد 157 ، 17.2٪). أظهرت النتائج أن حدوث أخطاء إعطاء الأدوية كان أعلى بشكل ملحوظ في الأدوية غير الوريدية مقارنة بالأدوية الوريدية (القيمة الاحتمالية أقل من 0.001).كشفت هذه الدراسة عن وجود معدل مرتفع من أخطاء إعطاء الأدوية. على الرغم من أن جميع الأخطاء التي تم تحديدها لم تسبب أي ضرر للمرضى، إلا أن الأخطاء كانت موجودة دائما. يوصى بشدة بحملات التوعية والتثقيف المستمرة للممرضين والممرضات حول أهمية الإدارة السليمة والآمنة للأدوية.

Significance\ud \ud Communicating in ways that motivate engagement in social distancing remains a critical global public health priority during the COVID-19 pandemic. This study tested motivational qualities of messages about social distancing (those that promoted choice and agency vs. those that were forceful and shaming) in 25,718 people in 89 countries. The autonomy-supportive message decreased feelings of defying social distancing recommendations relative to the controlling message, and the controlling message increased controlled motivation, a less effective form of motivation, relative to no message. Message type did not impact intentions to socially distance, but people’s existing motivations were related to intentions. Findings were generalizable across a geographically diverse sample and may inform public health communication strategies in this and future global health emergencies.\ud \ud \ud \ud Abstract\ud \ud Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges.

Community pharmacists (CPs) are among the frontline healthcare providers who have been exposed to a high risk of being infected with SARS-CoV-2 during the pandemic. Unfortunately, there have been limited studies in the Middle East that provide an occupational risk analysis among CPs. Therefore, this study aims to evaluate the risk of COVID-19 exposure among Middle Eastern CPs and to identify the infection predictors.A cross-sectional survey was conducted using an online, self-administered questionnaire that was distributed to CPs across KSA, Lebanon, and Jordan between November and December 2020. The bivariate logistic regression test was used to analyse the predictors associated with COVID-19.CPs were more susceptible to acquiring SARS-CoV-2 than the general public (12.9% vs. 1.5%). The significant predictors of infection included a family member with confirmed COVID-19 infection, age40 years, encountering patients in pharmacy without a protective glass-barrier, and contact with confirmed COVID-19 patients or colleagues with confirmed COVID-19 during practice. Additionally, the mean level of the respondents' expected rate of infection was 3.27 ± 1.04 (out of 5). This level was significantly higher among female pharmacists and Lebanese pharmacists.This study demonstrates that CPs are at a higher risk of acquiring COVID-19 compared with the general public. This is attributed to several occupational factors that increase the risk of exposure to COVID-19. Therefore, healthcare authorities are advised to enforce strict occupational guidelines for CPs.إن صيادلة المجتمع من ضمن مقدمي الرعاية الصحية العاملين في الخطوط الأمامية والمعرضين لخطر كبير للإصابة بفيروس كورونا المستجد أثناء الجائحة. ومن الملاحظ أن دراسات تحليل المخاطر المهنية الخاصة بصيادلة المجتمع في الشرق الأوسط محدودة. لذلك فقد هدفت هذه الدراسة إلى تقييم مخاطر تعرض هؤلاء الصيادلة لفيروس كورونا المستجد وعوامل التنبؤ بالإصابة بالعدوى.تم إجراء مسح مقطعي باستخدام استبانة عبر الإنترنت يتم تعبئتها ذاتيا وتم توزيعها على صيادلة المجتمع في المملكة العربية السعودية ولبنان والأردن خلال شهري نوفمبر وديسمبر 2020. وتم استخدام اختبار الانحدار اللوجستي ثنائي المتغير لتحليل المتنبئات المرتبطة بفيروس كورونا المستجد.كان صيادلة المجتمع أكثر عرضة للإصابة بعدوى فيروس كورونا المستجد من عامة المجتمع (١٢.٩٪ مقابل ١.٥٪). وكانت المؤشرات المهمة للعدوى هي وجود أحد أفراد العائلة مصابا بالعدوى، وكون السن أقل من ٤٠ عاما، ومقابلة المصابين في الصيدلية دون حاجز زجاجي واق، والاحتكاك بمصابين بالعدوى أثناء ممارسة المهنة، ووجود زميل مصاب. بالإضافة إلى ذلك، كان معدل توقع الإصابة بالعدوى لدى الصيادلة ٣.٢٧± ١.٠٤(من ٥). وكان المستوى أعلى بشكل ملحوظ بين الصيادلة الإناث والصيادلة اللبنانيين.أظهرت هذه الدراسة أن صيادلة المجتمع أكثر عرضة للإصابة بعدوى فيروس كورونا المستجد مقارنة بعامة المجتمع. ويعزى ذلك إلى عدة عوامل مهنية تزيد من خطر تعرضهم للفيروس. لذلك فإنه ينبغي للجهات الصحية المسؤولة أن تضع ضوابط توجيهية مهنية صارمة لصيادلة المجتمع مع مراقبة تطبيقها عن كثب.

Background COVID-19 is a pacing pandemic that affected health systems, economy, and social life in the whole world. Currently, there is no treatment for it, but the world is in a race that yielded, in a relatively short time than usual, several approved, promising vaccines in the middle of a storm of debates because of the speed of their production and approval. Objective This study assessed the willingness of Middle Eastern Arab publics to receive COVID-19 vaccines and investigated the factors behind any reluctance to receive them. Methods A self-administered questionnaire was distributed through social media applications in four Arab countries (Jordan, Saudi Arabia, Lebanon, and Iraq). Participants’ demographics, medical history, their experience with COVID-19, and their willingness to receive the available vaccines were obtained and analyzed. Results A total of 2,925 completed forms were included. Only 25% of the participants were willing to receive a vaccine while 33% were hesitant. Iraqis were the most willing to receive it while Jordanians were the least (35% and 17% of each country, respectively). Interestingly, 60% of the acceptors were ready to pay for the vaccine if not covered by governments. It was also found that American vaccines were preffered by 50% of the acceptors. However, 30% of acceptors were unsure of which vaccine is the best and 11% stated that any vaccine is good. Social media were the major source of information about COVID-19 and its vaccines. Finally, predictors of acceptance of the vaccines included living in Saudi Arabia and Iraq, being unmarried, having monthly income > $1,000, holding a medical degree, having high fear from COVID-19, feeling of being at risk of getting infected with COVID-19, and previous reception of influenza vaccine, whereas predictors of refusal included female sex and previous infection with COVID-19. Conclusion Middle Eastern Arabs are less likely to accept receiving the COVID-19 vaccines compared with non-Arabs. Health authorities in these countries are advised to intensify their awareness-raising activities about the vaccines while ensuring fair distribution of them.

Long noncoding RNAs (lncRNAs) have been recently recognized as key players of gene expression in cerebral pathogenesis. Thus, their potential use in stroke diagnosis, prognosis, and therapy is actively pursued. Due to the complexity of the disease, identifying stroke-specific lncRNAs remains a challenge. This study investigated the expression of lncRNAs HIF1A-AS2 and LINK-A, and their target gene hypoxia-inducible factor-1 (HIF-1) in Egyptian stroke patients. It also aimed to determine the molecular mechanism implicated in the disease. A total of 75 stroke patients were divided into three clinical subgroups, besides 25 healthy controls of age-matched and sex-matched. Remarkable upregulation of lncRNA HIF1A-AS2 and HIF1-α along with a downregulation of lncRNA LINK-A was noticed in all stroke groups relative to controls. Serum levels of phosphatidylinositol 3-kinase (PI3K), phosphorylated-Akt (p-Akt), vascular endothelial growth factor (VEGF), and angiopoietin-1 (ANG1) as well as their receptors, malondialdehyde (MDA), and total antioxidant capacity (TAC) were significantly increased, whereas brain-derived neurotrophic factor (BDNF) levels were significantly decreased particularly in hemorrhagic stroke versus ischemic groups. Eventually, these findings support the role of lncRNAs HIF1A-AS2 and LINK-A as well as HIF1-α in activation of angiogenesis, neovascularization, and better prognosis of stroke, especially the hemorrhagic type.

In dental accident cases the incidence of root fractures in permanent teeth are just 0.5-7% of the cases. Root fractures in the middle third are more frequently involved than the apical third fracture. Since their management may require an interdisciplinary/multidisciplinary approach to care, root fractures are clinically challenging. Thus, to ensure a good treatment plan and, therefore, the best possible prognosis, a clinician must strive for the right diagnosis of root fractures and have detailed knowledge of various therapeutic approaches. The present case highlights the use of the glass fiber post in the upper left lateral incisor, which is endodontically treated, demonstrating a complicated horizontal root fracture in the middle third of the root, stabilizing the fractured root fragments and monitoring the patient for one year, showing a well preserved assembly of the root fragments and the post. Keywords: Glass Fiber Post, Root Fracture, Horizontal Root Fracture.

Introduction: Immunohistochemistry plays an important but limited role in the diagnosis of primary bone tumors. Sometimes it is very difficult to differentiate osteosarcomas histologically from other tumors with similar morphology but with different malignant potential and treatment protocol. The correct diagnosis of OSA relies on identification of osteoid production by malignant cells which can be detected by the use of osteonectin. Materials and Methods: The present study was carried out on 200 patients of benign and malignant lesions of bone. After a detailed clinical history and local examination, paraffin section of resected specimens were studied by hematoxylin and eosin and immunohistochemical stain, osteonectin and matrix was graded on a four-tiered grading system with statistical analysis of osteonectin positivity in osteogenic bone tumours and tumour-like lesions. Results: Benign and malignant tumours accounted for 74.6% and 25.0% of the total cases. Osteoid production were seen in 36 cases (100.0%) of osteosarcomas, followed by fibrous dysplasia in 18 cases (100.0%) and osteoid osteoma in 10 cases (100.0%). Both polygonal and spindle shaped tumour cells in osteosarcoma showed Grade 4 positivity with osteonectin. Fibroblastic variant of osteosarcoma showed diffuse (Grade 4) and focal strong staining (Grade 2) alternating with negative areas. Chondroblastic variant of osteosarcoma showed Grade 4+ immunoreactivity in conventional osteosarcoma like areas, whereas chondrocyte- like tumour cells surrounded by chondro-osteoid –like matrix showed well- defined osteonectin staining. Conclusions: Osteonectin is a helpful osteogenic marker for establishing the diagnosis of osteoblastic origin of a tumour that produce no or scarcely any matrix. Keywords: Bone Tumors, Immunohistochemistry, Osteonectin.

Purpose The development and production of novel vaccine to prevent COVID-19 is an international imperative to human lives. For that purpose, clinical trials have to be carried out as per international ethical standards. The current study was undertaken to examine the willingness to participate in COVID-19 vaccine clinical trials and to determine factors that might affect their decision to participate. Patients and Methods A cross-sectional survey study was carried out among the public in Jordan. During the study period, a convenience sample of adults (aged 18 years or above) were asked to participate via an online self-administered survey that was designed to evaluate the willingness to participate in COVID-19 vaccine clinical trials and to determine factors affecting their decision to participate. Results Results showed that, among participants (n=1,287), 36.1% reported to be willing to participate in clinical trials of the vaccine. Additionally, a lower percentage (18.1%) were willing to allow their children to participate. Motivators that encourage participation were the desire to return to normal life (73.2%), followed by the desire to help in finding a treatment for COVID-19 infection (68.1%). Barriers towards the participation were not wanting to be challenged by the virus (54.7%), fear (40.7%), lack of time (40.4%), and mistrust in pharmaceutical companies (38.9%). Finally, results showed that higher educational level was associated with lower willingness to participate (P=0.001), whereas having a previous participation in clinical studies is associated with a significantly higher willingness to participate in COVID-19 vaccine clinical trials (P

This research aimed to investigate the impact of smartphone advergames characteristics on purchasing intentions. Four dimensions were considered (irritation, entertainment, credibility, and informativeness). To achieve this aim, the researchers developed a model based on literature reviews and previous studies; a self-administrated questionnaire was designed and distributed over a convenience sample. The researchers used a quantitative method and a descriptive-analytical approach; the study sample consisted of 600 consumers, and 519 questionnaires were returned with an 86.5% response rate. Various statistical methods, including descriptive, simple linear regression, were used to analyze the data and test the hypotheses. This research’s key findings were that there is a statistically direct impact of irritation, entertainment, credibility, and informativeness on consumers’ purchasing intentions. Moreover, there is a mediating role of game involvement between advergames and consumers’ purchasing intentions. Hence, many Jordanian companies can use smartphone mobile advertising to increase sales and create product brand image among consumers. Smartphone advergaming provides numerous opportunities and challenges for advertisers in the current dynamic business environment. AcknowledgmentThe authors are grateful to the Middle East University, Amman, Jordan, for the full financial support granted to this research project.

Background Pediatric pharmaceutical care is a new concept in the pharmacy profession. In Jordan, the knowledge of pediatric pharmaceutical care is limited, which may have negative consequences on pediatric pharmaceutical care and treatment efficacy and safety. Objectives The main objective of the present study is to assess parental needs for pediatric pharmaceutical care services and explore their current experiences of pharmaceutical services provided to their children. Setting Parental Facebook Groups in Jordan. Methods A descriptive, cross-sectional survey was designed and distributed online via Social Media networks, mainly Facebook. The validated survey contained 4 main sections addressing different themes related to pediatric pharmaceutical care services including: (1) parental perception of pediatric pharmaceutical care services. (2) Parental needs, wants, and expectations from the pharmacist when providing care to their children. (3) Parental awareness about pediatric pharmaceutical care, and parental satisfaction with current pediatric pharmaceutical care. Respondents who agreed to complete the survey signed and electronic informed consent form to access it. Main outcome measure The main outcomes measure was parental need for pediatric pharmaceutical care services. Results A total of 1104 respondents took part in the study. Of those 71% were female and 44% were 31-40 years old. The majority of respondents (78%) were not familiar with the pediatric pharmaceutical care term. The calculated overall mean perception score was 63.4%. The majority of respondents (89%) reported to need pediatric pharmaceutical care and the mean need score was 71.7%. Only 10.5% agreed/strongly agreed that their children were offered good pediatric pharmaceutical care services and respondents has a total mean satisfaction score of 65.7%. Conclusion The majority of the respondents reported that they need pharmaceutical care services for their children. Pharmacists in Jordan have to develop their role to incorporate pediatric pharmaceutical care services in their practice.

Objectives: To evaluate the role of angiogenesis by the assessment of mean vessel density and to quantify angiogenesis as an important variable in different benign and premalignant endometrial lesions. Materials and Methods: Endometrial biopsies and hysterectomy specimens were examined to evaluate and define any correlation between angiogenesis and different phases and premalignant diseased states of the endometrium. Microvessel counts were performed by examining the microvessels thoroughly in terms of count, morphology and density after staining the tissues by hematoxylin & eosin stain, reticulin stain and immunostain CD 34. Results: A total of 381cases of benign and premalignant endometrial lesions were included in the study. In 135 cases of simple hyperplasias, Microvessel Density (MVD) ranged from 2.4 - 6.7 and Mean MVD was 4.71 on H&E stain and MVD ranged from 2.8 - 8.3 with Mean MVD of 5.39 on reticulin stain. In 105 cases of complex hyperplasias, MVD ranged from 2.3 - 7.0 and Mean MVD was 4.93 on H &E satin and MVD ranged from 3.1-7.7 with Mean MVD of 5.68 on reticulin stain. In 67 cases of atypical hyperplasias, inbudding and outpouching of the glandular epithelium together with multilayering was appreciated with MVD from 4.5 - 8.8 and Mean MVD of 6.31 on H &E stain and MVD of 5.5 - 9.4 with Mean MVD of 7.19 on reticulin stain. A statistically significant difference was noted in all categories except in between simple and complex hyperplasia where the difference was not statistically significant. The role of angiogenesis becomes more significant with increasing severity of lesion, both in terms of hyperplasia and atypia when compared to normal endometrium. Although angiogenesis can be detected on immunostain more easily, it can be illustrated well by H and E or Reticulin stain. Conclusions: Role of angiogenesis becomes more significant with increasing severity of lesion, both in terms of hyperplasia and atypia when compared to normal endometrium. Although an

Background Tuberculosis remains a major health problem in the less developed nations and is now a major health problem in developed countries, owing to the emergence of human immunodeficiency virus (HIV) infection and (AIDS). However, despite the availability of effective chemotherapy, patient noncompliance with regimens is the most common reason for therapeutic failures. The aim of this study is to describe the cytological features of drug defaulters on lymph node fine-needle aspiration cytology (FNAC). Objective Due to the common problem of drug defaulters in developing countries like India, we had carried out a study to see the cytological features of drug defaulters on FNAC of the lymph node. Method Three hundred fifty tuberculosis cases, diagnosed based on Mantoux (Mx) test, acid-fast bacilli and/or culture, were followed up for drug compliance by cervical lymph node FNAC. Result Forty cases were found to be drug defaulters on detailed and meticulous follow-up. These patients were found to have splintered epithelioid cell granuloma with some viable epithelioid cells enmeshed in fibrous tissue elements. Other findings were degenerating epithelioid cells with or without surrounding eosinophilic infiltration and leaching of the degenerating lymphoid and epithelioid cells. Conclusion Lymph node FNAC can be used to identify tubercular drug defaulters, which may be time consuming and/or expensive by culture or other ancillary means.

Introduction. Primary extrahepatic hydatid cysts are rare, and primary splenic hydatid cysts even rarer. Splenic hydatidosis constitutes 2% to 3.5% of all hydatid cysts. Aim. To present a case report of splenic hydatidosis with abdominal pain. Description of the case. We report here a case of isolated splenic hydatid cysts in a 23 year old female, who presented with dull dragging pain in the left hypochondrium. Diagnosis was made on computed tomography imaging of the abdomen and microscopic examination of the laminated hydatid cyst wall and supplemented with positive enzyme linked immunosorbent assay for hydatid antibodies. Conclusion. The incidence of splenic involvement by hydatid cysts is very low. Man is an accidental intermediate host, as entry of the larval forms into humans represents an end stage in its life cycle. Until recently the gold standard treatment for splenic hydatidosis was splenectomy, as medical therapy seems to be ineffective. However, the last two decades have shown a tendency towards splenic conservative surgery in suitable cases, to reduce opportunistic post splenectomy infection.

Neurofibromas of salivary gland are very rare and account for only 0.4% of all salivary gland neoplasms. Plexiform type of neurofibromas are predominantly seen in a scenario of neurofibromatosis-1 (NF-1) association, but solitary plexiform neurofibroma has also been occasionally reported. We present a report of this variant in a 17-year-old male who is presented with a slow-growing painless swelling in the right preauricular region for 8-month duration. Microscopic examination revealed multiple cell types including Schwann cells, perineurial cells, axons, lymphocytes, mast cells, and endoneurial fibroblasts. Immunostaining with S100 confirmed the neural origin. How to cite this article: Qadri S, Rabindranath D, Quadri S, et al. Facial Plexiform Neurofibroma as an Intraparotid Nodule: A Rare Case Presentation. Int J Otorhinolaryngol Clin 2020;12(1):8–10.

Objective In Jordan, research ethics have been subject to increasingly formal regulations and structuring. Recently the Ministry of Higher Education and Research Published the National Research Code of Ethics. However, little is known about the awareness of pharmacology researchers of this code and the extent of its applicability to their research. Methods Purposeful sampling through institutions’ websites was used to identify staff members with excellent profiles from 20 Faculties of Pharmacy in Jordan. After obtaining the required approvals, in-depth interviews were conducted, recorded, transcribed, and analyzed using NVivo 11 Software. The interviews followed a previously prepared and validated interview guide that covered various aspects of education, research, and training. Key findings Eighteen members of staff agreed to take part in the study. Qualitative analysis revealed three main themes each concerning respondents’ awareness of the National Code of Research Ethics in Jordan. The emerging themes were: the lack of awareness regarding the code of ethics, the need for clear guidelines for pharmacology research in Jordan, and the need for further workshops and training courses for pharmacology researchers. Conclusion This study highlights a lack of awareness regarding the presence of the National Research Ethics Code among pharmacology researchers in Jordan. This might have negative implications on medical research. It was thought that the code of ethics should be incorporated in postgraduate pharmacy education, training courses for pharmacy researchers, and workshops for pharmacy academic staff., Awareness, National Research Ethics Code, Qualitative Study, Pharmacology, Pharmacy Researchers

Papillary lesions of the breast include a broad spectrum of entities, many of which pose a diagnostic challenge for the pathologist. Papillary Carcinoma is a rare malignancy of the breast accounting for 0.5- 2% of all breast carcinomas. It occurs more frequently in post-menopausal women over the age of 60. The most common presentation is a painless, mobile mass with bloody nipple discharge. Mammography typically shows a large circumscribed mass with an irregular or nodular contour.We present a case of a 42-year-old-woman with a painless lump in the right breast for 11 months, diagnosed as encapsulated papillary carcinoma of breast with in-situ component. Keywords: Breast, Encapsulated papillary carcinoma, Histopathology.

Scrotal calcinosis is a rare benign disease, which presents as multiple, painless, hard nodular growth in the scrotum without any systemic metabolic disorder. Histologic features of the lesion are extensive dermal deposits of calcium, with associated lympho-histiocytic aggregates and focal foreign body giant cell reaction. The pathogenetic mechanisms could be either purely idiopathic or any form of dystrophic calcification of the lining epithelial cysts or any inflammatory process with subsequent rupture, calcification and obliteration of the cyst wall. We present a rare case report of a 23-year-old male, who presented to the general surgery clinic with complaints of multiple, firm to hard scrotal swellings for the last 6 months. Microscopic examination of the excised growth showed multiple cysts with foci of normal and inflamed lining, with luminal calcific material with foci of ‘naked’ calcium deposits in the dermis. Biochemical tests showed normal values of serum calcium and phosphorus levels in our patient. Keywords: Scrotum, Biochemical, Calcinosis, Histopathology.

Pregabalin is an anticonvulsant that has an abuse potential. The aim of this study was to investigate abuse/misuse of pregabalin in Jordan from the perspective of community pharmacists. A cross-sectional survey using a structured questionnaire was delivered to a sample of community pharmacies. Self-reported method was used to fill the surveys. A total of 151/205 questionnaires were completed (response rate = 74.1%). A total of 132 respondents (87.4%) reported cases of pregabalin abuse in their pharmacies. Less than half of the respondents (n = 69; 45.7%) indicated that pregabalin requests were, in most of the cases, not accompanied by prescriptions. More than half of the sample (55.8%) noticed an increased pattern of pregabalin abuse/misuse during the last six months. The study underscored the need for regulatory efforts and pharmacovigilance to manage pregabalin abuse, along with a pharmacist and patient education at a community pharmacy level.

Aims of the study This study aims to determine females' views, experiences and attitudes regarding the caesarean section (CS) and to explore the factors that increase the prevalence of CS in Jordan. Design This is a cross-sectional study using a questionnaire that was distributed electronically through social media websites. Study participants included 1005 females with a history of at least one CS. Awareness, experiences about CS, complications and reasons for performing CS were investigated. Settings The participants were recruited from all Jordan cities by social media and emails. Findings Most of the respondents stated that the source of their knowledge about CS was from the internet (36.2%) followed by family and friends (31.6%). The majority of respondents were satisfied with their CS experience (72.8%). More than half of the participants (56.9%) reported that CS carries no risk for infants. About 53% of respondents stated that the most common reason leading women to choose to give birth via CS is the fear of labour pain. However, the majority of the respondents disagree with performing CS under maternal request (59.2%). Conclusions and implications This study indicated that Jordanian females do not have reliable sources of information about CS. This leads to lower awareness of CS and its complications, and, as expected, CS is more likely to be performed by privately insured women.

Background Investigating temperament has been a multi-subject exercise that attempts to determine the contribution of temperament to additional measurable phenomena like behavior. The existing research not only evaluates temperament as a variable with the ability to influence additional characteristics but has included interventions that can result in adapted outcomes. Develop an Arabic translation of the Infant Characteristics Questionnaire (ICQ). Purpose Examine the psychometric properties of the translation and establish modified criteria for evaluating the questionnaire. Methods Cross sectional design was used. Translation of the ICQ was achieved through translation/back translation. The population that used the ICQ translation on convenience sample of 40 Arabic-speaking women with children between the ages of 3–12‐months old; this same group also completed a demographic survey. Results The internal consistency of the translated instrument was almost equivalent to or higher than the reported from the United States (US) review. The alpha coefficients calculated from subscales varied between .47 and .87. Conclusion This research study described the translation of the ICQ into the Arabic language for use in the research and clinical setting. The ICQ is a useful tool for evaluating infant difficulty by describing and summarizing parents’ ratings., Highlights • In nursing for infants, the parent-child, is very significant and is often understood as bilateral, correlative and interdependent. • Infant temperament is described as regularities in responding to different situations, and reflect a infant's behavioral characteristics. • The information gathered from infant-temperament questionnaires can help health care professionals inform parents of interventions for improving infant temperament.

The Center for Disease Control and Prevention and the World Health Organization issued a practical approach and Global Action Plan to control the threatening emerging antibacterial resistance. One of the main basis of this plan is the Antimicrobial Stewardship Program (ASPs). This study aimed to evaluate community pharmacists’ awareness and perception towards antimicrobial resistance and ASPs in Jordan. Thus, a qualitative study was conducted through in-depth interviews with twenty community pharmacists. Convienience sampling was used in the study. Qualitative analysis of the data yielded four themes and eleven sub-themes. All the respondents showed good understanding about the causes of antimicrobial resistance. The most important causes reported by them was the non-restricted prescription of antimicrobials. Most of the pharmacists believed that they are competent to provide ASPs, however, they believed that there are several barriers against the implementation of ASPs in community pharmacies in Jordan. Barriers demonstrated by the pharmacists, including organizational obstacles, resources obstacles, and personal obstacles. As a conclusion, this study revealed several barriers against the implementation of ASPs in community pharmacies in Jordan. Incorporating ASPs in the community pharmacy settings requires proper pharmacist training, several academic disciplines team efforts, and good pharmacy practice of antimicrobial guidelines.

Background and aim Tamoxifen (TAM) therapy has been associated with fatty liver diseases. Recently, multiple reports have also shown that TAM is related to cognitive impairment in patients with breast cancer. Luteolin, a natural flavonoid, has been traditionally used to treat various inflammatory disorders, such as chronic liver diseases, cognitive impairments, and cancers. This study aimed to evaluate the potential protective effects of luteolin against the cognitive defects and liver steatosis induced by TAM in rats. Experimental approach The diseased group was subcutaneously (s.c) injected with TAM at a dose of 1 mg/kg daily for 7 days. The cotreated groups were given luteolin via oral gavage at a dose of 20 or 40 mg/kg concomitantly with s.c injection of TAM at a dose of 1 mg/kg for 7 days. All the groups were subjected to behavioral tests 24 h after the last TAM injection. Then, the rats were sacrificed 3 days after the last TAM injection. Results Luteolin cotreatment significantly alleviated the behavioral defects in rats with TAM-induced cognitive impairment. This finding was supported by the reversal of neurodegeneration in the cortex and in the hippocampal regions of the brain. Furthermore, luteolin attenuated hepatic steatosis and decreased the levels of serum aminotransferases and hypertriglyceridemia. As an anti-inflammatory agent, luteolin cotreatment similarly decreased the levels of hepatic inflammatory markers and increased the levels of hepatic β-catenin in TAM-induced fatty liver. Conclusions Luteolin improved the TAM-induced cognitive impairment and hepatic steatosis in rats by alleviating inflammation and modulating hepatic β-catenin levels.

BACKGROUND: Community pharmacists play a pivotal role in healthcare worldwide Their role became more critical during the COVID-19 pandemic This study aims to investigate the community pharmacists' preparedness and responses to the COVID-19 pandemic, and how efficiently they were prepared to contain and prevent the spread of infection METHODS: An online questionnaire was distributed to community pharmacists in Saudi Arabia, Lebanon, and Jordan through social media platforms A scoring system was developed to measure their level of adherence to the preventive measures of the global infection RESULTS: The total included responses were 800 Around 44% of the pharmacists reported spending less than 15 minutes/day reading about COVID-19 updates Although more than half of them were reviewing official sites, 73% of them were also retrieving information through non-official channels Additionally, almost 35% of them were directly contacting customers without physical barriers, 81% reported encountering infected customers, and 12% wore the same facial masks for more than a day Moreover, 58% of the pharmacies reported the absence of door signs requesting infected customers to declare the infection, 43% of the pharmacies were not limiting the number of simultaneous customers, and 70% were not measuring customers' temperatures prior to entry Collectively, the mean total score of applied protective measures was 10 12 ± 2 77 (out of 17) CONCLUSION: The level of preparedness of the community pharmacies in these three Middle Eastern countries was not adequate for facing the COVID-19 pandemic Health authorities in these countries should closely monitor their adherence to the protective guidelines

Adiponectin is essential for the regulation of tissue substrate utilization and systemic insulin sensitivity. Clinical studies have suggested a positive association of circulating adiponectin with healthspan and lifespan. However, the direct effects of adiponectin on promoting healthspan and lifespan remain unexplored. Here, we are using an adiponectin null mouse and a transgenic adiponectin overexpression model. We directly assessed the effects of circulating adiponectin on the aging process and found that adiponectin null mice display exacerbated age-related glucose and lipid metabolism disorders. Moreover, adiponectin null mice have a significantly shortened lifespan on both chow and high-fat diet (HFD). In contrast, a transgenic mouse model with elevated circulating adiponectin levels has a dramatically improved systemic insulin sensitivity, reduced age-related tissue inflammation and fibrosis, and a prolonged healthspan and median lifespan. These results support a role of adiponectin as an essential regulator for healthspan and lifespan.

BACKGROUND: COVID-19 is a pandemic disease with a significant threat to public health. Public knowledge and perceptions significance in tackling pandemics have been evidenced in the previous research. This study aimed to explore public perceptions about pharmacists' educational and prescribing role, and the medication delivery service provided during COVID-19 outbreak. METHOD: A cross-sectional study was conducted among the general population of Jordan using a convenient sampling technique for ten days (15-25 May 2020). Data was collected from 578 participants who agreed to fill the questionnaire, which was distributed online. The questionnaire items were piloted using face validity and reliability. RESULT: Participants showed a positive perception about the impact of pharmacists and pharmacy services provided during COVID-19 outbreak. More than half of the participants (61.1%) believed that pharmacists could prescribe over the counter medications, and only 15.7% believed that pharmacists could prescribe both over the counter and prescribed medications. Linear regression was performed to assess the factors that affect the participants' perception of pharmacists' prescribing and educational role and delivering medication during COVID-19. Females have lower perception scores towards medication delivery services compared to males (P-value= 0.008). However, male participants, those aged less than 50 years, those with postgraduate degrees, and those from non-medical profession showed a significantly higher perception score towards the impact of pharmacists and pharmacy services provided during COVID-19 outbreak compared to others (P-value

AIMS OF THE STUDY The purpose of this study was to assess pharmacists' knowledge and attitude towards early detection of colorectal cancer (CRC) in Jordan and to explore potential predictor variables of such knowledge and attitude. METHODS USED TO CONDUCT THE STUDY An electronic, self-reported questionnaire was used to collect data about demographics, knowledge and attitude regarding early detection of CRC. Both content and face validity were tested in a panel of experts. The participants' responses were analysed using descriptive statistics and multiple linear regressions. RESULTS OF THE STUDY The 352 pharmacists (78% females, 94% Jordanian) had a median age of 28 years and graduated mostly (83%) from public universities. Surprisingly, 90% were not able to identify carcinoembryonic antigen (CEA) as a non-accurate diagnostic method and almost one-third did not identify the correct screening tests. On a scale of 5, the majority of participants (59%) had moderate knowledge scores (3 or 4) in case scenarios. The median knowledge Percent of Maximum Possible (POMP) score was 67% and higher scores were associated with more years since graduation, pharmacists with MSc degree and higher, working in urban areas, studying oncology course and received oncology training (P

Adiponectin is essential for the regulation of tissue substrate utilization and systemic insulin sensitivity. Clinical studies have suggested a positive association of circulating adiponectin with healthspan and lifespan. However, the direct effects of adiponectin on promoting healthspan and lifespan remain unexplored. Here, we are using an adiponectin null mouse and a transgenic adiponectin overexpression model. We directly assessed the effects of circulating adiponectin on the aging process and found that adiponectin null mice display exacerbated age-related glucose and lipid metabolism disorders. Moreover, adiponectin null mice have a significantly shortened lifespan on both chow and high-fat diet. In contrast, a transgenic mouse model with elevated circulating adiponectin levels has a dramatically improved systemic insulin sensitivity, reduced age-related tissue inflammation and fibrosis, and a prolonged healthspan and median lifespan. These results support a role of adiponectin as an essential regulator for healthspan and lifespan.

Current guidelines emphasize the use of 100% oxygen during cardiopulmonary resuscitation after cardiac arrest. When patients are ventilated for variable periods after return of spontaneous circulation (ROSC), hyperoxia causes increased morbidity and mortality by overproduction of reactive oxygen species. Various patient, volunteer, and animal studies have shown the harmful effects of hyperoxia. This mini-review article aims to expand the potential clinical spectrum of hyperoxia on individual organ systems leading to organ dysfunction. A framework to achieve and maintain normoxia after ROSC is proposed. Despite the harmful considerations of hyperoxia in critically ill patients, additional safety studies including dose-effect, level and onset of the reactive oxygen species effect, and safe hyperoxia applicability period after ROSC, need to be performed in various animal and human models to further elucidate the role of oxygen therapy after cardiac arrest.

OBJECTIVES: The present study aimed to exploring community pharmacists' willingness and readiness to test for COVID-19 in Jordan. METHODS: Purposeful sampling was used to identify a list of 30 community pharmacies, which were approached to participate in the study. Twenty interviews were needed to reach data saturation. In-depth interviews were conducted, recorded, transcribed, and analysed using NVivo 11 Software. Interviews followed a previously prepared and validated 10-item interview guide. The interview guide discussed pharmacists' willingness and readiness to test for COVID-19. RESULTS: Twenty community pharmacists were interviewed for the purpose of the present study. Interviews took place during April 2020 and the mean interview duration was 23.30 minutes. Respondents had a mean age of 36.4 years and a mean experience of 8.8 years. The majority were female (70%) and 50% held a BSc in Pharmacy. Regarding respondents' willingness to test for COVID-19 emerging themes were helping other healthcare professional, willingness to contribute to official efforts in fighting COVID-19, acting as an accessible testing cite, willingness to carry out home testing. Regarding respondents' readiness to test for COVID-19 emerging themes were Pharmacists lack basic testing skills, pharmacies are not ready to preform tests and the need for training and certifying. CONCLUSION: Jordanian pharmacists are willing to test patients for COVID-19 in community pharmacies, however, they thought they are not ready enough to undergo such tests and needed extra training and better safety precautions.

Wireless Fidelity (Wi-Fi) network is created on the IEEE 802.11 standard. Connections for local devices in homes and business arenas are provided by Wi-Fi units. With the growing demand as well as penetration of wireless services, the wireless networks users now assume Quality of Service (QoS) besides performances comparable to what is accessible from secure networks. In this paper, OPNET Modeler is used as module and for the simulation of a fiber optic-based Wi-Fi network within a fixed local area network. The aim of this paper is to evaluate their Quality of service (QoS) performances in terms of Wi-Fi voice-packet delay and End-to-End for both Wi-Fi base fiber and Wi-Fi base line. Many scenarios, with same Physical and MAC parameters, have many subnet networks are implementing with fiber optics baseline in addition to Wi-Fi baseline, were created in the network OPNET simulation tool for obtaining the results. The results of simulation reveal that base line demonstrated more delay than base fiber.

Background The 2019 Coronavirus infection (COVID-19) caused by a novel strain of coronavirus was detected in China in December 2019, and declared a public health emergency of international concern on January 30, 2020. Community pharmacists have an important role in supporting the local health emergency preparedness and response arrangements. Objectives To investigate pharmacists and pharmacy students’ awareness and source of their information regard the management of the coronavirus pandemic, and their perspective of their role during this emergent situation. Methods This descriptive cross-sectional online survey study was conducted in Jordan during the COVID-19 outbreak (from 15 to 30 March 2020). A validated online questionnaire addressing participants' current awareness about epidemics/pandemics and COVID-19, source of information and their perspectives of their role. Data were analyzed using statistical package for social science (SPSS). Results Participants (n = 726) had a mean age of 26.9 (8.0) years with 71.9% females. Pharmacy students made 35.3% of the sample while the rest were pharmacists. Only 54.3% of participants believed that they got enough education about epidemics/pandemics, and 94.6% of them follow on the latest coronavirus updates on treatments, and that is mainly from the media (59.5%) followed by the World Health Organization reports (58.7%) and then the published researches (57%). Awareness score (out of 20) of pharmacists (n = 470) was significantly higher (p

Objective The objective of the present study was to explore the barriers and supporting factors for adherence among HIV patients and to explore their needs for pharmaceutical care services. Methods This study utilizes in-depth interviews with HIV patients. Out of 50 patients approached, a total of 30 patients agreed to participate in the study. The researchers used a predesigned topic guide. The interview guide included two parts; the first one focused on the assessment of HIV patients' adherence to their treatment. The second part focused on patients' need for pharmaceutical care services. Results Three main themes emerged from the interviews. Those included patient-related factors, medication-related factors and Healthcare professional related factors. This study found that a number of barriers that decreased adherence in HIV patients included stigmatisation, fear from disclosure, dosage form of the drug, adverse events and poor cooperation from healthcare professionals. On the other side supporting factors included family and friends support, electronic mobile reminders, feeling responsible to raising children, religious beliefs and feeling improvement while using therapy. Furthermore, the study illustrated that HIV patients need to have a specialist pharmacist in their healthcare team who delivers specialised pharmaceutical care services which may increase patients' adherence. Conclusions The current study reveals a margin for medication adherence improvement in HIV patients. Patients in this study demonstrated the need for a pharmaceutical care. Future disease management and clinical pharmacy services programs should address the current study findings in order to improve the health service for HIV patients.

Background: There is an unmet need to develop therapeutic interventions directed at the neurodegeneration that underlies progression in multiple sclerosis. High-dose, pharmaceutical-grade biotin (MD1003) might enhance neuronal and oligodendrocyte energetics, resulting in improved cell function, repair, or survival. The MS-SPI randomised, double-blind, placebo-controlled study found that MD1003 improved disability outcomes over 12 months in patients with progressive multiple sclerosis. The SPI2 study was designed to assess the safety and efficacy of MD1003 in progressive forms of multiple sclerosis in a larger, more representative patient cohort. Methods: SPI2 was a randomised, double-blind, parallel-group, placebo-controlled trial done at 90 academic and community multiple sclerosis clinics across 13 countries. Patients were aged 18-65 years, had a diagnosis of primary or secondary progressive multiple sclerosis fulfilling the revised International Panel criteria and Lublin criteria, a Kurtzke pyramidal functional subscore of at least 2 (defined as minimal disability), an expanded disability status scale (EDSS) score of 3·5-6·5, a timed 25-foot walk (TW25) of less than 40 s, evidence of clinical disability progression, and no relapses in the 2 years before enrolment. Concomitant disease-modifying therapies were allowed. Patients were randomly assigned (1:1) by an independent statistician using an interactive web response system, with stratification by study site and disease history, to receive MD1003 (oral biotin 100 mg three times daily) or placebo. Participants, investigators, and assessors were masked to treatment assignment. The primary endpoint was a composite of the proportion of participants with confirmed improvement in EDSS or TW25 at month 12, confirmed at month 15, versus baseline. The primary endpoint was assessed in the intention-to-treat analysis set, after all participants completed the month 15 visit. Safety analyses included all participants who received at least one dose of MD1003. This trial is registered with ClinicalTrials.gov (NCT02936037) and the EudraCT database (2016-000700-29). Findings: From Feb 22, 2017, to June 8, 2018, 642 participants were randomly assigned MD1003 (n=326) or placebo (n=316). The double-blind, placebo-controlled phase of the study ended when the primary endpoint for the last-entered participant was assessed on Nov 15, 2019. The mean time in the placebo-controlled phase was 20·1 months (SD 5·3; range 15-27). For the primary outcome, 39 (12%) of 326 patients in the MD1003 group compared with 29 (9%) of 316 in the placebo group improved at month 12, with confirmation at month 15 (odds ratio 1·35 [95% CI 0·81-2·26]). Treatment-emergent adverse events occurred in 277 (84%) of 331 participants in the MD1003 group and in 264 (85%) of 311 in the placebo group. 87 (26%) of 331 participants in the MD1003 group and 82 (26%) of 311 participants in the placebo group had at least one serious treatment-emergent adverse event. One (

Objectives: This study aimed to describe the effect of using an innovative teaching strategy using a video tutorial on enhancing students’ knowledge about medication reconciliation, and skills in identifying medication discrepancies. Methods: This is a one group pre-post interventional study that was conducted at the School of Pharmacy at Applied Science Private University. Sixty pharmacy students were invited to attend an educational sessions that involve watching a 6-minutes video tutorial. The first two levels of the Kirkpatrick’s Model were used to evaluate the effectiveness of this training tool. Level 1 (Reaction) was assessed using a satisfaction questionnaire, while level 2 (Learning) was assessed using two criteria: 1) student acquired knowledge about medication reconciliation using a questionnaire and a knowledge score out of 13 was calculated for each student, and 2) student acquired skills in identifying medication discrepancies using a virtual case scenario. If the student was able to identify any of the four impeded discrepancies he/she rewarded 1 point for each identified discrepancy, but if they identified any incorrect discrepancy they scored a negative point. Results: Among the 60 students who registered to participate in the study, 49 attended the educational training (response rate 81.6%). The majority of them (n=44, 89.8%) were satisfied with the training process. Before the video tutorial, students showed an overall low knowledge score [4.08/13.0, SD 1.81], and low ability to identify discrepancies [0.72 identified discrepancies out of 4.0, SD 1.1]. Following the video tutorial, the overall knowledge score was improved (p

Background Fat grafting has been used extensively in plastic surgery in the past two decades. Here, the authors report the retrospective comparison of patients who underwent fractionated fat injection to blend the lid-cheek junction with those who had regular fat injection. Methods After obtaining institutional review board approval, a retrospective review of patients who underwent lower blepharoplasty with fractionated fat injection for blending the lid-cheek junction from January of 2014 through October of 2015 was performed. The results were compared to those of lower blepharoplasty patients who did not have fractionated fat injected before January of 2014. Twelve prospectively selected patients underwent histopathologic and gene expression comparisons. Results A comparison of complications between the two groups revealed no significant differences. Furthermore, there was no significant difference between the two groups for sequelae of fractionated fat injection and regular fat injection. The gene expression analysis of the fractionated and regular fat did not show any difference between undifferentiated and differentiated cells. In addition, Oil Red O staining of the fractionated and regular fat after differentiation showed that cells from both fat groups differentiated equally well. Conclusions Fractionated fat injection appears to be a safe addition in blending the lid-cheek junction in the five-step lower blepharoplasty. There is no fat nodule formation with injection of fractionated fat injection compared with injection of regular fat performed superficially in the tear trough area. Contrary to what has previously been shown, the presence of viable cells in fractionated fat was noted. Clinical question/level of evidence Therapeutic, III.

Pathologic expansion of white adipose tissue (WAT) in obesity is characterized by adipocyte hypertrophy, inflammation, and fibrosis; however, factors triggering this maladaptive remodeling are largely unknown. Here, we test the hypothesis that the potential to recruit new adipocytes from Pdgfrβ+ preadipocytes determines visceral WAT health in obesity. We manipulate levels of Pparg, the master regulator of adipogenesis, in Pdgfrβ+ precursors of adult mice. Increasing the adipogenic capacity of Pdgfrβ+ precursors through Pparg overexpression results in healthy visceral WAT expansion in obesity and adiponectin-dependent improvements in glucose homeostasis. Loss of mural cell Pparg triggers pathologic visceral WAT expansion upon high-fat diet feeding. Moreover, the ability of the TZD class of anti-diabetic drugs to promote healthy visceral WAT remodeling is dependent on mural cell Pparg. These data highlight the protective effects of de novo visceral adipocyte differentiation in these settings, and suggest Pdgfrβ+ adipocyte precursors as targets for therapeutic intervention in diabetes.

Introduction In Jordan, there is a remarkable lack of public awareness about probiotics and available guidance on their use. This study was designed to evaluate Jordanians’ awareness and perception about probiotics and their willingness to use these nutritional supplements as a part of their daily diet. Methods This cross-sectional survey was conducted among the Jordanian public. During the study period, participants were invited to fill -out an electronic-based questionnaire. Results A total of 508 people agreed to participate in the study. Among them, 64.0% (n = 325) reported that they were willing to take probiotics. Only 17.1% of the surveyed participants (n = 90) knew that probiotics were not dead microorganisms. Only 55.0% of participants (n = 279) believed that consumption of probiotics were safe to consume. In addition, 75.0% (n = 381) believed that community pharmacists had a limited role in improving public knowledge about probiotics. Regression analysis showed that participants with higher income (>500 JD/month) and those who had medical degrees had greater knowledge about probiotics compared to others (P Conclusion This study demonstrated that there is inadequate knowledge about probiotics and their potential use. More effort is needed to provide more information about the benefits of probiotics. Greater knowledge could be achieved by encouraging medical doctors and pharmacists to inform the public about probiotics.

AIM/HYPOTHESIS: Adiponectin (APN), a circulating hormone secreted by mature adipocytes, has been extensively studied because it has beneficial metabolic effects. While many studies have focused on the congenital loss of APN and its effects on systemic body glucose and lipid metabolism, little is known about the effects triggered by acute loss of APN in the adult mouse. We anticipated that genetically induced acute depletion of APN in adult mice would have a more profound effect on systemic metabolic health than congenital deletion of Adipoq, the gene encoding APN, with its associated potential for adaptive responses that may mask the phenotypes. METHODS: Mice carrying loxP-flanked regions of Adipoq were generated and bred to the Adipoq (APN) promoter-driven reverse tetracycline-controlled transactivator (rtTA) (APN-rtTA) gene and a tet-responsive Cre line (TRE-Cre) to achieve acute depletion of APN. Upon acute removal of APN in adult mice, systemic glucose and lipid homeostasis were assessed under basal and insulinopenic conditions. RESULTS: The acute depletion of APN results in more severe systemic insulin resistance and hyperlipidaemia than in mice with congenital loss of APN. Furthermore, the acute depletion of APN in adult mice results in a much more dramatic reduction in survival rate, with 50% of inducible knockouts dying in the first 5 days under insulinopenic conditions compared with 0% of congenital Adipoq knockout mice under similar conditions. CONCLUSIONS/INTERPRETATION: Acute systemic removal of APN results in a much more negative metabolic phenotype compared with congenital knockout of Adipoq. Specifically, our data demonstrate that acute depletion of APN is especially detrimental to lipid homeostasis, both under basal and insulinopenic conditions. This suggests that compensatory mechanisms exist in congenital knockout mice that offset some of the metabolic actions covered by APN.

Background: The revised Bethesda System of reporting Pap smears in addition to defining the diagnostic categories also develops criteria for determining the adequacy and quality of Pap smears. Methods: The present retrospective and prospective study was conducted in department of pathology after approval from institutional ethics committee which included retrospective cases from 2007 to 2009 and prospective cases from 2010 to 2011. Prospective cervical smears were stained by using Papanicolaou stain. After staining, slides were mounted, screened and reported by two consultant pathologists by both Conventional system and the 2001 Bethesda system. Smears which were already reported by the Conventional system were also reviewed retrospectively by the 2001 Bethesda system. Cytohistopathologic correlation was done wherever available. Result: Results on adequacy of the specimens showed 98.0% smears as satisfactory and 2.0% were found to be unsatisfactory for evaluation. Pap smear reporting by both the systems showed similar number of cases with inflammatory findings. 18.3% premalignant lesions were reported by the Conventional system but it was significantly higher (31.8%) when reviewed by the Bethesda system. Numbers of malignant lesions were found similar by both systems i.e. 3.6%. Conclusion: Reporting should be done by the Bethesda System as it improves producibility and helps in diagnose of various intraepithelial lesions and invasive lesions at an early stage and helps to manage them properly. DOI: 10.21276/APALM.987

Indole-3-carbinol (I3C) is a natural agent found in high amounts in cruciferous vegetables and is also available as dietary supplements. It is considered as a promising agent for the ongoing medical research due to its possible antioxidant, anti-inflammatory, anti-tumor, antiapoptotic and anti-atherogenic properties. Recent studies are directed towards assessment of the possible effects of I3C on various body organs including the heart, liver, kidney and the endocrine system. This mini-review sheds light on the different properties of I3C that make it a promising therapeutic agent for a wide variety of human diseases including cancer.

A year old male presented to the orthopaedics out patients clinic with a months history of progressive pain and swelling in the left shoulder without fever night sweats cough weight loss headache and altered sensorium with no meningeal signs He had no medical history of diabetes chronic renal disease tuberculosis alcoholism leukaemia lymphoma AIDS Hodgkin rsquo s disease corticosteroid intake or any organ transplantation A preoperative blood count liver and renal function blood sugar levels and tumor markers were all normal Serological tests were negative for HIV and Hepatitis X ray revealed multiple lytic lesion over the clavicle and proximal humerus with fracture On MRI scan multiple ring enhancing lesions depicting solid cryptococcoma were observed in the brain parenchyma Biopsy from the bone and culture revealed cryptococcal infection He was treated with surgical debridement combined with antifungal therapy for weeks After months of follow up the fracture healed well with no evidence of recurrence

Graphene, a member of the carbon family, is the strongest, stiffest, and thinnest known material, with a thickness of 10 nm. It has emerged as engineered nanomaterials and nanomedicines in dentistry with promising results. Usually produced employing Hummers method, graphene possesses excellent physiomechanical properties, electrical conductivity, stability, biocompatibility, and biodegradability. Owing to their interactions with dental pulp stem cells, they have been functionalized with many scaffolds in regenerative dentistry, to upregulate the odontogenic and osteogenic genes. This emerging science of graphene-based materials has also been used for the debridement of root canals. Their unique property of antibiofilm and antiadhesiveness has been used to prevent dental caries and erosions. In addition, they have been incorporated into various biomaterials to enhance their original properties, like in glass ionomers, biodentine, and in bleaching agents like hydrogen peroxide. Depending on their concentration and time of exposure to the substrate, graphene and their derivatives can be effective antibacterial agents. This updated review provides useful information on the promising introduction of graphene in the field of conservative dentistry and endodontics.