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A WHO global strategy launched in November 2020 sets out an ambitious pathway towards the worldwide elimination of cervical cancer as a public health problem within the next 100 years. Achieving this goal will require investment in innovative approaches. This review aims to describe integrated approaches that combine human papillomavirus (HPV) vaccination and cervical cancer screening in low- and middle-income countries (LMIC), and their efficacy in increasing uptake of services. A systematic review was conducted analyzing relevant papers from Embase, Medline, CINAHL and CAB Global Health databases, as well as grey literature. Narrative synthesis was performed on the included studies. Meta-analysis was not appropriate due to the heterogeneity and nature of included studies. From 5,278 titles screened, 11 uncontrolled intervention studies from four countries (from Africa and east Asia) were included, all from the past 12 years. Four distinct typologies of integration emerged that either increased awareness of HPV and/or cervical cancer screening, and/or coupled the delivery of HPV vaccination and cervical cancer screening programs. The synthesis of findings suggests that existing HPV vaccination programs can be a useful pathway for educating mothers and other female caregivers about cervical cancer screening; through in person conversations with care providers (preferred) or take-home communications products. Integrated service delivery through outreach and mobile clinics may overcome geographic and economic barriers to access for both HPV vaccination and cervical cancer screening, however these require significant program and system resources. One study promoted HPV vaccination as part of integrated service delivery, but there were no other examples found that examined use of cervical cancer screening platforms to promote or educate on HPV vaccination. This review has demonstrated gaps in published literature on attempts to integrate HPV vaccination and cervical cancer screening. The most promising practices to date seem to relate to integrated health communications for cervical cancer prevention. Future research should further explore the opportunities for integrated health communications to support the efforts towards the new global cervical cancer elimination agenda, and costs and feasibility of integrated service delivery for underserved populations.

Background: Iron deficiency is a frequent and multifac-torial disorder in the career of athletes. Exercise-induceddisturbances in iron homeostasis produce deleterious effectson performance and adaptation to training. Thus, theidentification of strategies that restore or maintain iron home-ostasis in athletes is required.Aim of Study: To determine the relation between regularphysical activity, iron level and hepcidin level as well asinflammatory markers among a sample of Medical Ain ShamsUniversity Students.Subjects and Methods: The current study is a descritptivestudy of 54 students from 200 students that follow regularphysical activity among 1220 Ain Shams Medical Students.Our study group was divided into two groups. Group 1 included23 students with reduced serum iron level. Group 2 included31 students with reduced serum iron level.Results: There was no significant difference observedbetween studied groups regarding BMI, waist circumference,hip circumference and waist hip ratio and the hemoglobinlevel. However serum ferritin and hepcidin were significantlylower in reduced serum iron group than normal serum irongroup. CRP was significantly higher in reduced serum irongroup than normal serum iron group and shows positivecorrelation between with BMI in reduced serum iron whereashepcidin show significant positive correlation between serumhepcidin and waist circumference in reduced serum iron groupas well as significant negative correlation with BMI in controlgroup.Conclusion: The timing of sampling post exercise mayshow the induction of hepcidin response to exercise whichmay show guiding information on exact timing with irontherapy in athletes.

Oral mucositis is a distressing complication of chemotherapy-induced toxicity in cancer patients, it effect on the well-being of patients, demonstrating its negative impact on patients’ quality of life, and may lead to dose reduction among patients. Hence, the present study was conducted to evaluate the effect of educational guidelines on reducing chemotherapy induced oral mucositis based on patients' needs assessment. A quasi-experimental research design (pretest and posttest) has been conducted to achieve the aim of this study. This study was conducted in the inpatients' department at Radiotherapy and Nuclear Medicine Department, affiliated to Ain Shams University. A purposive sample of 70 adult patients was selected based on certain inclusion criteria. A structured interview questionnaire, Oral assessment guide, and Patients' health condition assessment (Patient-related outcomes PROMs) are methods used to collect the data among the studied patients. There was statistically significant improvement in the post-test implementation of educational guidelines as regard patient's mouth care practice with p-value

BACKGROUND The recently developed Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) is originally an English questionnaire targeting the assessment of caries-related quality of life from a child's point of view. AIM This study aimed to translate and adapt CARIES-QC into Arabic language and to test its reliability and validity on Arabic-speaking children. DESIGN A total of 234 children aged 5-16 years answered the translated questionnaire. Internal consistency was measured using Cronbach's alpha; 62 children answered the questionnaire again to evaluate the test-retest reliability by calculating the intraclass correlation coefficient (ICC). Convergent validity was evaluated by correlating question scores with global question scores. Confirmatory factor analysis (CFA) was conducted to evaluate cross-cultural validity. RESULTS Cronbach's alpha of CARIES-QC/A was 0.905. The interitem correlation coefficients of CARIES-QC/A ranged from 0.240 to 0.850. The total ICC score was 0.960. CFA demonstrated acceptable fit to data in the one-factor model. Convergent validity indicated moderate correlation with the global question (rs = 0.740). CONCLUSIONS CARIES-QC/A is a valid and reliable tool that could be used to evaluate oral health-related quality of life in Arabic-speaking children.

Distributed intelligence involving a large number of smart sensors and edge computing are highly demanded under the backdrop of increasing cyber‐physical interactive applications including internet of things. Here, the progresses on ferroelectric materials and their enabled devices promising energy autonomous sensors and smart systems are reviewed, starting with an analysis on the basic characteristics of ferroelectrics, including high dielectric permittivity, switchable spontaneous polarization, piezoelectric, pyroelectric, and bulk photovoltaic effects. As sensors, ferroelectrics can directly convert the stimuli to signals without requiring external power supply in principle. As energy transducers, ferroelectrics can harvest multiple forms of energy with high reliability and durability. As capacitors, ferroelectrics can directly store electrical charges with high power and ability of pulse‐mode signal generation. Nonvolatile memories derived from ferroelectrics are able to realize digital processors and systems with ultralow power consumption, sustainable operation with intermittent power supply, and neuromorphic computing. An emphasis is made on the utilization of the multiple extraordinary functionalities of ferroelectrics to enable material‐critical device innovations. The ferroelectric characteristics and synergistic functionality combinations are invaluable for realizing distributed sensors and smart systems with energy autonomy., Ferroelectric materials possess extraordinary multiple signal or energy conversion and storage functions, including high dielectric permittivity, switchable spontaneous polarization, piezoelectric, pyroelectric, and bulk photovoltaic effects. The characteristics of ferroelectrics, and the synergized combinations of their multiple functionalities are invaluable for realizing distributed wireless sensors and smart systems with energy autonomy.

Background Timely diagnosis and early initiation of life-saving antiretroviral therapy are critical factors in preventing mortality among HIV-infected infants. However, resource-limited settings experience numerous challenges associated with centralised laboratory-based testing, including low rates of testing, complex sample referral pathways and unacceptably long turnaround times for results. Point-of-care (POC) HIV testing for HIV-exposed infants can enable same-day communication of results and early treatment initiation for HIV-infected infants. However, complex operational issues and service integration can limit utility and must be well understood prior to implementation. We explored and documented the challenges and enabling factors in implementing the POC Xpert® HIV-1 Qual test (Cepheid, Sunnyvale, CA, USA) for early infant diagnosis (EID) as part of routine services in four public hospitals in Myanmar. Methods This sub-study was part of a randomised controlled stepped-wedge trial (Australian and New Zealand Clinical Trials Registry, number 12616000734460) designed to investigate the impact of POC testing for EID in Myanmar and Papua New Guinea. Infants recruited during the intervention phase underwent POC testing at the participating hospitals as part of routine care. Semi-structured interviews with 23 caregivers, 12 healthcare providers and 10 key informants were used to explore experiences of POC-EID testing. The research team and hospital staff documented and discussed implementation challenges throughout the study. Results Overall, caregivers and healthcare workers were satisfied with the short turnaround time of the POC test. Occasional delays in POC testing were mostly attributable to late receipt of samples by laboratory technicians and communication constraints among healthcare staff. Hospital staff valued technical assistance from the research group and the National Health Laboratory. Despite staff shortages and infrastructure challenges such as unreliable electricity supply and cramped space, healthcare workers and caregivers found the implementation of the POC test to be feasible at pilot sites. Conclusions As plans for national scale-up evolve, there needs to be a continual focus on staff training, communication pathways and infrastructure. Other models of care, such as allowing non-laboratory-trained personnel to perform POC testing, and cost effectiveness should also be evaluated.

Aim to investigate for the first time whether the regenerative approach can be used to rehabilitate a case with regional odontodysplasia (ROD). ROD is a rare, localized developmental anomaly of the dental tissues. Moreover, we review the various treatment protocols for ROD and compare them to the suggested regenerative protocol. Case report A 22-year-old female patient diagnosed with ROD in the upper left quadrant was presented to our clinic. Initially, the affected teeth were extracted and three implants were inserted. A combination of autologous bone marrow mononuclear cells (BMMNCs) seeded on a collagen sponge, nanohydroxyapatite, and autologous platelet-rich fibrin (PRF) was used to enhance bone regeneration in the defective area and around the inserted implants. After 9 months, bone regeneration and successful osteointegration around the inserted implants were achieved, permitting the insertion of a fourth implant. After an additional six months, a final fixed restoration was constructed. Conclusion The suggested regenerative approach provides a better treatment option for ROD patients to regenerate the lost bone, rehabilitate aesthetics, and restore normal function.

IntroductionEarly infant diagnosis (EID) of HIV and timely initiation of antiretroviral therapy can significantly reduce morbidity and mortality among HIV-positive infants. Access to EID is limited in many low-income and middle-income settings, particularly those in which standard care involves dried blood spots (DBS) sent to centralised laboratories, such as in Papua New Guinea (PNG). We conducted a qualitative exploration of the feasibility and acceptability of implementing a point-of-care (POC) EID test (Xpert HIV-1 Qualitative assay) among health workers and key stakeholders working within the prevention of mother-to-child transmission of HIV (PMTCT) programme in PNG.MethodsThis qualitative substudy was conducted as part of a pragmatic trial to investigate the effectiveness of the Xpert HIV-1 Qualitative test for EID in PNG and Myanmar. Semistructured interviews were undertaken with 5 health workers and 13 key informants to explore current services, experiences of EID testing, perspectives on the Xpert test and the feasibility of integrating and scaling up POC EID in PNG. Coding was undertaken using inductive and deductive approaches, drawing on existing acceptability and feasibility frameworks.ResultsHealth workers and key informants (N=18) felt EID at POC was feasible to implement and beneficial to HIV-exposed infants and their families, staff and the PMTCT programme more broadly. All study participants highlighted starting HIV-positive infants on treatment immediately as the main advantage of POC EID compared with standard care DBS testing. Health workers identified insufficient resources to follow up infants and caregivers and space constraints in hospitals as barriers to implementation. Participants emphasised the importance of adequate human resources, ongoing training and support, appropriate coordination and a sustainable supply of consumables to ensure effective scale-up of the test throughout PNG.ConclusionsImplementation of POC EID in a low HIV prevalence setting such as PNG is likely to be both feasible and beneficial with careful planning and adequate resources.Trial registration number12616000734460.

Background: Colistin is the last choice for serious infections caused by multidrug-resistant Gram negative bacteria and one of the prominent causes for spreading the resistance is Plasmid-borne Mobile Colistin Resistance (mcr). Broth microdilution method (BMD) is the reference tool for Colistin MIC determination, but it has many obstacles, so commercial BMD methods had been developed that are more user-friendly than the reference method and (Liofilchem ® ComASPTM) is one of them, which we used to determine Colistin MIC in this study. Objective: to detect Colistin resistant gram negative bacilli by ComASPTM Colistin (formerly Sensi Test™Colistin) among Intensive Care Unit (ICU) patients admitted to Ain Shams university hospitals and to Screen the presence of mcr-1 gene by Polymerase Chain Reaction (PCR) in Colistin resistant isolates. Methodology: This Observational cross-sectional study was performed in the Medical Microbiology and Immunology Department, Faculty of Medicine, Ain Shams University between June 2019 to November 2019. One hundred isolates of Gram negative bacilli were obtained from patients admitted at different Intensive Care units of Ain Shams University Hospitals. Full identification was done by conventional microbiological methods, Then MIC was measured for all isolated organisms by using commercial BMD ComASPTM colistin, PCR was done for Colistin resistant isolates to detect mcr-1 gene. Results: 60% of the Gram negative bacilli (GNB) isolates were K.pneumoniea.Colistin resistance was 14% among 100 (GNB), 35.7% of these Colistin resistant were K.pneumoniea obtained from urine samples. Prevalence of mcr-1 gene was 7.1%. Conclusion: Commercial BMD ComASPTM Colistin is simple and uncomplicated method for detection Colistin susceptibility.

We report two unrelated boys with frontonasal dysplasias type-2 (FND-2) who shared an identical novel homozygous ALX4 mutation c.291delG (p.Q98Sfs*83). Both patients presented with a large skull defect but one had bilateral parietal meningocele-like cysts that lie along with the bony defect and increased in size with age. Scalp alopecia, hypertelorism, and clefted alae nasi were also detected in both of them. Furthermore, impalpable gonads were noted, being unilateral in one and bilateral in the other. Neuroimaging showed small dysplastic occipital lobes with dysgyria and midline subarachnoid cyst. Additional dysplastic corpus callosum and small cerebellar vermis were observed in one patient. Parietal foramina were noted in the parents of one patient. Our findings highlight the dosage effect of ALX4 and underscore the challenges of prenatal genetic counseling. Further, the indirect role of ALX4 in the development of the occipital lobe and posterior fossa is discussed.

Background: The public consciousness towards anesthesiologist and anesthesia is limited even in urban population. Our cross-sectional analysis highlights this lack of public awareness and discusses possible remedies to overcome these limitations. Materials and Methods: Surgical outpatient department was screened for 6 months period in King Abdulaziz Hospital. A questionnaire divided into three parts (awareness about anesthesiologist, consent, present surgical experience) was filled out for each patient. The patients on the basis of their answers were classified as aware or unaware, furthermore, source of patient data was analyzed. Results: Even with an exceptionally low threshold, only 44.86% of population could be categorized as aware, and commonest source of their information was not anesthesiologist but surgeon (56%). 89.7% patients were not aware of contents of pre-operative consent they had signed and further, only 21.4% were aware of anesthesia-related issues. Pain was reported as the most mutual pre-operative fear and post-operative patient concern. 40.2% patients due to lack of pre-operative counseling were not able to recognize the type of anesthesia and thought they had received both general anesthesia and spinal anesthesia. Finally, after explaining the role of anesthesia for surgery, 98.1% patients presented desire to meet the anesthesiologist before if they were to be operated in future. Conclusion: The awareness about anesthesia is particularly low likely due to low knowledge rates and lack of pre-operative counseling by anesthesiologist. Both patient and anesthesiologist should understand the significance of consent, as it is not only a legal binding but can eliminate pre-operative factitious fears of patients and can improve patient satisfaction towards surgery.

Over the past 30 years, stem cell technologies matured from an attractive option to investigate neurodegenerative diseases to a possible paradigm shift in their treatment through the development of cell-based regenerative medicine (CRM). Implantable cell replacement therapies promise to completely restore function of neural structures possibly changing how we currently perceive the onset of these conditions. One of the major clinical hurdles facing the routine implementation of stem cell therapy is the limited and inconsistent benefit observed thus far. While unclear, numerous pre-clinical and a handful of clinical cell fate imaging studies point to poor cell retention and survival. Coupling the need to better understand these mechanisms while providing scalable approaches to monitor these treatments in both pre-clinical and clinical scenarios, we show a proof of concept bioimpedance electronic platform for the Agile development of smart and mobile biomedical applications like neural implants or highly portable monitoring devices.

BackgroundThe majority of HIV infection among children occurs through mother-to-child transmission. HIV exposed infants are recommended to have virological testing at birth or 4-6 weeks of age but challenges with centralized laboratory-based testing in Myanmar result in low testing rates and delays in result communication and treatment initiation. Decentralized point-of-care (POC) testing when integrated in prevention of mother-to-child transmission of HIV (PMTCT) services, can be an alternative to increase coverage of early infant diagnosis (EID) and timely engagement in HIV treatment and care.AimThis paper aims to explore experiences of caregivers of HIV-exposed infants enrolled in the PMTCT program in Myanmar and the perceived acceptability of point-of-care EID testing compared to conventional centralised laboratory-based testing.MethodsThis is a sub-study of the cluster randomised controlled stepped-wedge trial (Trial registration number: ACTRN12616000734460) that assessed the impact of near POC EID testing using Xpert HIV-1 Qual assay in four public hospitals in Myanmar. Caregivers of infants who were enrolled in the intervention phase of the main study, had been tested with both Xpert and standard of care tests and had received the results were eligible for this qualitative study. Semi-structured interviews were conducted with 23 caregivers. Interviews were audio recorded, transcribed verbatim and translated into English. Thematic data analysis was undertaken using NVivo 12 Software (QSR International).ResultsThe majority of caregivers were satisfied with the quality of care provided by PMTCT services. However, they encountered social and financial access barriers to attend the PMTCT clinic regularly. Mothers had concerns about community stigma from the disclosure of their HIV status and the potential consequences for their infants. While medical care at the PMTCT clinics was free, caregivers sometimes experienced financial difficulties associated with out-of-pocket expenses for childbirth and transportation. Some caregivers had to choose not to attend work (impacting their income) or the adult antiretroviral clinic in order to attend the paediatric PMTCT clinic appointment. The acceptability of the Xpert testing process was high among the caregiver participants and more than half received the Xpert result on the same day as testing. Short turnaround time of the near POC EID testing enabled the caregivers to find out their infants' HIV status quicker, thereby shortening the stressful waiting time for results.ConclusionOur study identified important access challenges facing caregivers of HIV exposed infants and high acceptability of near POC EID testing. Improving the retention rate in the PMTCT and EID programs necessitates careful attention of program managers and policy makers to these challenges, and POC EID represents a potential solution.

Purpose: The aim of this article was to study the clinical and social outcomes of health care transition among Asian adolescents and young adults with HIV (AYHIV). Methods: AYHIV who transferred from a pediatric to an adult clinic within the past year across five sites in Malaysia, Thailand, and Vietnam had clinical and laboratory evaluations and completed questionnaires about their health, socioeconomic factors, and transition experiences. Multiple logistic regression was used to assess associations with HIV viremia. Results: Of 93 AYHIV enrolled between June 2016 and April 2017, 56% were female, 87% acquired HIV through perinatal exposure, median age was 20 years (interquartile range [IQR] 18.5–21). Two-thirds were in a formal education program, 43% were employed, 43% of females and 35% of males were sexually active. Median lifetime antiretroviral therapy duration was 6.2 years (IQR 3.3–10.7); 45% had received second-line therapy. Median CD4 was 601 cells/mm 3 (IQR 477–800); 82% had HIV-RNA

Over the past 30 years, stem cell technologies matured from an attractive option to investigate neurodegenerative diseases to a possible paradigm shift in their treatment through the development of cell-based regenerative medicine (CRM). Implantable cell replacement therapies promise to completely restore function of neural structures possibly changing how we currently perceive the onset of these conditions. One of the major clinical hurdles facing the routine implementation of stem cell therapy is the limited and inconsistent benefit observed thus far. While unclear, numerous pre-clinical and a handful of clinical cell fate imaging studies point to poor cell retention and survival. Coupling the need to better understand these mechanisms while providing scalable approaches to monitor these treatments in both pre-clinical and clinical scenarios, we show a proof of concept bioimpedance electronic platform for the Agile development of smart and mobile biomedical applications like neural implants or highly portable monitoring devices.

Background Children and adolescents with HL have excellent long-term survival exceeding 95% after combined modality treatment. However, about 20% will either relapse or have PRF. Salvage HDCT followed by AHSCT is considered to be the preferential treatment. Objective To describe the outcome (OS and EFS) and prognostic factors in pediatric patients with relapsed or refractory HL (r/rHL) who underwent AHSCT. Methods We retrospectively included 43 pediatric patients with r/rHL who underwent AHSCT from July 1, 2007, till December 31, 2016, at the Children's Cancer Hospital of Egypt. MAC regimen given was CMV. Results Of the whole cohort, 88.4% of patients achieved CR, while 11.6% had a positive PET scan prior to transplantation. The 3-year OS and EFS were 85% and 70.6%, respectively. The 3-year OS for patients > 10 years was 94% versus 65.5% for patients 10 years of age or younger (P = 0.046). There is strong tendency toward better 3-year OS for patients with negative PET scan as compared to those with positive PET scan before AHSCT, 89.4% vs 60%, respectively (P = 0.059). This tendency is also applicable when looking at the 3-year EFS for the two groups, 78.3% vs 40%, respectively (P = 0.069). Conclusion Poor predictors of OS were younger age and positive PET scan before AHSCT. The latter, along with single modality treatment before AHSCT, were poor predictors of EFS.

Measuring CD4 counts remains an important component of HIV care. The Visitect CD4 is the first instrument-free low-cost point-of-care CD4 test with results interpreted visually after 40 min, providing a result of ≥350 CD4 cells/mm3., Measuring CD4 counts remains an important component of HIV care. The Visitect CD4 is the first instrument-free low-cost point-of-care CD4 test with results interpreted visually after 40 min, providing a result of ≥350 CD4 cells/mm3. The field performance and diagnostic accuracy of the test was assessed among HIV-infected pregnant women in South Africa. A nurse performed testing at the point-of-care using both venous and finger-prick blood, and a counselor and laboratory staff tested venous blood in the clinic laboratory (four Visitect CD4 tests/participant). Performance was compared to the mean CD4 count from duplicate flow cytometry tests on venous blood (FACSCalibur Trucount). In 2017, 156 patients were enrolled, providing a total of 624 Visitect CD4 tests (468 venous and 156 finger-prick samples). Of 624 tests, 28 (4.5%) were inconclusive. Generalized linear mixed modeling showed better performance of the test on venous blood (sensitivity = 81.7%; 95% confidence interval [CI] = 72.3 to 91.1]; specificity = 82.6%, 95% CI = 77.1 to 88.1) than on finger-prick specimens (sensitivity = 60.7%; 95% CI = 45.0 to 76.3; specificity = 89.5%, 95% CI = 83.2 to 95.8; P = 0.001). No difference in performance was detected by cadre of health worker (P = 0.113) or between point-of-care versus laboratory-based testing (P = 0.108). Adequate performance of Visitect CD4 with different operators and at the point of care, with no need of electricity or instrument, shows the potential utility of this device, especially for facilitating decentralization of CD4 testing services in rural areas.

Background Current point-of-care tests (POCT) for syphilis, based on the detection of Treponema pallidum (TP) total antibodies, have limited capacity in distinguishing between active and past/treated syphilis. We report the development and early evaluation of a new prototype POCT based on the detection of TP-IgA antibodies, a novel biomarker for active syphilis. Methods The TP-IgA POCT (index test) was developed in response to the World Health Organisation (WHO) target product profile (TPP) for a POCT for confirmatory syphilis testing. Two sub-studies were conducted consecutively using 458 pre-characterised stored plasma samples in China (sub-study one, addressing the criteria for the WHO TPP), and 503 venous blood samples collected from pregnant/postpartum women in South Africa (sub-study two, addressing potential clinical utility). Performance of the index test was assessed against standard laboratory-based serology using a combination of treponemal (TPHA) and non-treponemal (rapid plasma reagin [RPR]) tests. Findings In sub-study one, the index test demonstrated 96·1% (95%CI=91·7%-98·5%) sensitivity and 84·7% (95%CI=80·15–88·6%) specificity for identification of active syphilis (TPHA positive, RPR positive). It correctly identified 71% (107/150) samples of past-treated syphilis (TPHA positive, RPR negative). In sub-study two, the index test achieved 100% (95%CI=59%-100%) sensitivity for active syphilis and correctly identified all nine women with past syphilis. Interpretation The TP-IgA POCT has met the WHO TPP for a POCT for diagnosis of active syphilis and demonstrated its potential utility in a clinical setting. Future studies are warranted to evaluate field performance of the final manufactured test. Funding Saving Lives at Birth: Grand Challenge for Development, Thrasher Research Fund, and the Victorian Government Operational Infrastructure Scheme.

Background Persistent infection with high-risk types of human papillomavirus (HPV) is the preeminent factor driving the development of cervical cancer. There are large gaps in knowledge about both the role of pregnancy in the natural history of HPV infection and the impact of HPV on pregnancy outcomes. Methods This single-site prospective cohort substudy, nested within an international multisite randomized controlled trial, assessed prevalence, incident cases, and persistence of type-specific HPV infection, and the association between persistence of high-risk HPV infection with pregnancy outcomes among HIV-infected pregnant women in Kenya, including HIV transmission to infants. Type-specific HPV was assessed using a line probe assay in pregnancy and again at 3 months after delivery. HIV status of children was determined using polymerase chain reaction at 6 weeks. Results In total, 84.1% (206/245) of women had a high-risk HPV infection at enrollment. Three quarters (157/206) of these infections persisted postpartum. Persistence of HPV16 and/or HPV18 types was observed in more than half (53.4%; 39/73) of women with this infection at enrollment. Almost two-thirds had an incident high-risk HPV infection postpartum, which was not present in pregnancy (62.5%), most commonly HPV52 (19.0%). After adjustments, no association was detected between persistent high-risk HPV and preterm birth. All mothers of the 7 cases of infant HIV infection had persistent high-risk HPV infection (P = 0.044). Conclusions High levels of high-risk HPV infection and type-specific persistence were documented, heightening the urgency of mass role out of HPV vaccination. The association between HPV persistence and HIV transmission is a novel finding, warranting further study.

Background Accurate measurement of CD4 cell counts remains an important tenet of clinical care for people living with HIV. We assessed an instrument-free point-of-care CD4 test (VISITECT® CD4) based on a lateral flow principle, which gives visual results after 40 min. The test involves five steps and categorises CD4 counts as above or below 350 cells/μL. As one component of a performance evaluation of the test, this qualitative study explored the views of healthcare workers in a large women and children’s hospital on the acceptability and feasibility of the test. Methods Perspectives on the VISITECT® CD4 test were elicited through in-depth interviews with eight healthcare workers involved in the performance evaluation at an antenatal care facility in Johannesburg, South Africa. Audio recordings were transcribed in full and analysed thematically. Results Healthcare providers recognised the on-going relevance of CD4 testing. All eight perceived the VISITECT® CD4 test to be predominantly user-friendly, although some felt that the need for precision and optimal concentration in performing test procedures made it more challenging to use. The greatest strength of the test was perceived to be its quick turn-around of results. There were mixed views on the semi-quantitative nature of the test results and how best to integrate this test into existing health services. Participants believed that patients in this setting would likely accept the test, given their general familiarity with other point-of-care tests. Conclusions Overall, the VISITECT® CD4 test was acceptable to healthcare workers and those interviewed were supportive of scale-up and implementation in other antenatal care settings. Both health workers and patients will need to be oriented to the semi-quantitative nature of the test and how to interpret the results of tests. Electronic supplementary material The online version of this article (10.1186/s12913-019-3948-x) contains supplementary material, which is available to authorized users.

Objectives: To primarily assess documentation during in-hospital cardiopulmonary arrest resuscitation and to secondarily observe cardiopulmonary resuscitation event and outcome variables. Methods: A retrospective review of 360 code blue forms and medical records at King Fahad General Hospital, King Abdulaziz General Hospital (Almahjar), and Althghar Hospital in Jeddah was performed between 2015 to 2016. Results: Survival to discharge rates and neurological outcomes were not documented at all. Other undocumented variables include gender 9 (2.5%), nationality 12 (3.3%), code blue announcement time 130 (36%), initial rhythm 10 (2.8%), time to airway placement 154 (57.2%), time to cardiology arrival 181 (50.27%), and time to anesthesia arrival 145 (40.27%). Conclusion: We strongly recommend the use of standardized cardiopulmonary arrest sheets among all hospitals and follow up of neurological outcomes and survival to discharge as outcome variables. Saudi Med J 2018; Vol. 39 (3): 261-266 doi: 10.15537/smj.2018.3.21885 How to cite this article: Bakhsh AA, Bakhsh AR, Karamelahi ZA, Bakhsh AA, Alzahrani AM, Alsharif LM, et al. Communicating resuscitation. The importance of documentation in cardiac arrest. Saudi Med J . 2018 Mar;39(3):261-266. doi: 10.15537/smj.2018.3.21885.

Background: Considerable research indicates that experiencing acute kidney injury (AKI) during hospitalization from sepsis increases patients' risk of death, but few data exist on whether preexisting renal disease, irrespective of the need for dialysis, also increases mortality. Objectives: The objectives of this study were to identify if preexisting renal disease alters outcomes in patients admitted to a Saudi Arabian, tertiary-care intensive care unit (ICU) for septic shock. Materials and Methods: All patients ≥14 years old admitted to the ICU for septic shock from December 2015 to January 2017 were enrolled prospectively and followed for a minimum of 30 days or until death or hospital discharge. Patients with versus without preexisting renal disease were compared regarding demographic and baseline clinical characteristics, details of their infection and treatment, and outcomes. Results: Among 161 patients (mean age: 61.6; male:female = 1:1), 33 had some documented, preexisting renal disease, among whom 17 required regular dialysis. Among the 128 without preexisting renal disease, 66 (52%) died in hospital, versus 11 of 17 (65%) and 9 of 16 (56%) with kidney disease requiring and not requiring dialysis, respectively. Both the presence of renal dysfunction and the development of new-onset AKI were borderline linked to increased, inhospital mortality (P = 0.051 and 0.080, respectively). However, the presence of preexisting renal disease, with or without the need for dialysis, was nonsignificantly (P = 0.58) linked to increased, inhospital mortality. Conclusions: In our sample of 161 patients with septic shock, the presence of preexisting renal disease was not associated with increased mortality, but new-onset AKI and the presence of renal dysfunction in the ICU both were associated with increased mortality.

Background In Myanmar, postpartum haemorrhage is the leading cause of maternal mortality and contributes to around 30% of all maternal deaths. The World Health Organization recommends training and supporting auxiliary midwives to administer oral misoprostol for prevention of postpartum haemorrhage in resource-limited settings. However, use of misoprostol by auxiliary midwives has not formally been approved in Myanmar. Our study aimed to explore community and provider perspectives on the roles of auxiliary midwives and community-level provision of oral misoprostol by auxiliary midwives. Methods A qualitative inquiry was conducted in Ngape Township, Myanmar. A total of 15 focus group discussions with midwives, auxiliary midwives, community members and mothers with children under the age of three were conducted. Ten key informant interviews were performed with national, district and township level health planners and implementers of maternal and child health services. All audio recordings were transcribed verbatim in Myanmar language. Transcripts of focus group discussions were fully translated into English before coding, while key informants’ data were coded in Myanmar language. Thematic analysis was done using ATLAS.ti software. Results Home births are common and auxiliary midwives were perceived as an essential care provider during childbirth in hard-to-reach areas. Main reasons provided were that auxiliary midwives are more accessible than midwives, live in the hard-to-reach areas, and are integrated in the community and well connected with midwives. Auxiliary midwives generally reported that their training involved instruction on active management of the third stage of labour, including use of misoprostol, but not all auxiliary midwives reported using misoprostol in practice. Supportive reasons for task-shifting administration of oral misoprostol to auxiliary midwives included discussions around the good relationship and trust between auxiliary midwives and midwives, whereby midwives felt confident distributing misoprostol to auxiliary midwives. However, the lack of clear government-level written permission to distribute the drug was perceived as a barrier to task shifting. Conclusion This study highlights the acceptability of misoprostol use by auxiliary midwives to prevent postpartum haemorrhage, and findings suggest that it should be considered as a promising intervention for task shifting in Myanmar. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1324-6) contains supplementary material, which is available to authorized users.

ObjectiveThis study assessed the potential operational feasibility and acceptability of a heat-stable, inhaled oxytocin (IOT) product for community-based prevention of postpartum haemorrhage in Myanmar.MethodsA qualitative inquiry was conducted between June 2015 and February 2016 through focus group discussions and in-depth interviews. Research was conducted in South Dagon township (urban setting) and in Ngape and Thanlyin townships (rural settings) in Myanmar. Eleven focus group discussions and 16 in-depth interviews were conducted with mothers, healthcare providers and other key informants. All audio recordings were transcribed verbatim in Myanmar language and were translated into English. Thematic content analysis was done using NVivo software.ResultsFuture introduction of an IOT product for community-based services was found to be acceptable among mothers and healthcare providers and would be feasible for use by lower cadres of healthcare providers, even in remote settings. Responses from healthcare providers and community members highlighted that midwives and volunteer auxiliary midwives would be key advocates for promoting community acceptance of the product. Healthcare providers perceived the ease of use and lack of dependence on cold storage as the main enablers for IOT compared with the current gold standard oxytocin injection. A single-use disposable device with clear pictorial instructions and a price that would be affordable by the poorest communities was suggested. Appropriate training was also said to be essential for the future induction of the product into community settings.ConclusionIn Myanmar, where home births are common, access to cold storage and skilled personnel who are able to deliver injectable oxytocin is limited. Among community members and healthcare providers, IOT was perceived to be an acceptable and feasible intervention for use by lower cadres of healthcare workers, and thus may be an alternative solution for the prevention of postpartum haemorrhage in community-based settings in the future.

Background Oxytocin is the gold standard drug for the prevention of postpartum haemorrhage, but limitations in cold chain systems in resource-constrained settings can severely compromise the quality of oxytocin product available in these environments. This study investigated the perspectives and practices of stakeholders in low and lower-middle income countries towards oxytocin, its storage requirements and associated barriers, and the quality of product available. Methods Qualitative inquiries were undertaken in Ethiopia, India and Myanmar, where data was collected through Focus Group Discussions (FGDs) and In-Depth Interviews (IDIs). A total of 12 FGDs and 106 IDIs were conducted with 158 healthcare providers (pharmacists, midwives, nurses, doctors and obstetricians) and 40 key informants (supply chain experts, program managers and policy-makers). Direct observations of oxytocin storage practices and cold chain resources were conducted at 51 healthcare facilities. Verbatim transcripts of FGDs and IDIs were translated to English and analysed according to a thematic content analysis framework. Findings Stakeholder awareness of oxytocin heat sensitivity and the requirement for cold storage of the drug was widespread in Ethiopia but more limited in Myanmar and India. A consistent finding across all study regions was the significant barriers to maintaining a consistent cold chain, with the lack of refrigeration facilities and unreliability of electricity cited as major challenges. Perceptions of compromised oxytocin quality were expressed by some stakeholders in each country. Conclusion Knowledge of the heat sensitivity of oxytocin and the potential impacts of inconsistent cold storage on product quality is not widespread amongst healthcare providers, policy makers and supply chain experts in Myanmar, Ethiopia and India. Targeted training and advocacy messages are warranted to emphasise the importance of cold storage to maintain oxytocin quality.

Background:Papillon-Lefèvre syndrome (PLS) is considered a rare syndrome, which is characterized by the presence of palmar-plantar hyperkeratosis and aggressively progressing periodontitis that finally leads to premature loss of both deciduous and permanent teeth.Case report:A four-year-old Egyptian boy presented with a maternal complaint that her child suffers from early loss of many teeth, presence of loose teeth along with an asymptomatic swelling related to the upper anterior area. The patient was diagnosed with PLS. A symptomatic management and prevention program was followed and the swelling was excised; afterwards diagnosed as peripheral ossifying fibroma.Conclusion:Early recognition and intervention for patients with PLS is essential to avoid the threat of being edentulous if left unmanaged.

Objective A noninvasive tool that allows individuals to be monitored who are at risk of developing a malignancy is an unmet need. Such a test would need to consist of a molecular signature that allows for gradual judgment to assess the efficacy of preventive strategies. Here we performed a proof-of-principle study to test whether a DNA methylation (DNAme) signature in fluid collected from the vagina is able to identify women with cervical or endometrial cancer. Materials and methods DNA from vaginal fluid samples from 111 women (30, 8, 73 with endometrial cancer, cervical cancer, and benign gynecological conditions, respectively) were analyzed for DNAme using the Illumina 450k DNA methylation bead array assay, which allows the assessment of DNAme at more than 480.000 CpG sites. We developed a cervical and an endometrial cancer DNAme signature by comparing normal and cancerous cervical and endometrial samples from the publicly available The Cancer Genome Atlas data and developed deviation scores to assess the potential of discriminating cancer from a control sample using a vaginal fluid DNAme signature. Results More than 60% of variations in DNAme in our vaginal fluid cannot be explained by those clinical or technical factors that we were aware of. Both the cervical and the endometrial cancer DNAme signature resulted in receiver operating characteristic area under the curve between 0.75 and 0.83 to discriminate controls and the cancers for which the signature has been designed for. Conclusions Whole DNAme signatures based on array technologies in body fluids are able to discriminate cancer cases from controls.

Electrically conductive glass-like carbon structures can be obtained from a polymer template through a pyrolysis process. These structures can be used as electrodes for bio sensing applications such as electrochemical evaluation of cell adhesion and proliferation. This study focuses on the optimization of two dimensional (2D) pyrolytic carbon microelectrodes with the carbon MEMS (C-MEMS) process using the negative epoxy photoresist SU-8. Different electrochemical microchips with carbon working (WE) and counter electrode (CE) were fabricated. More specifically, pyrolysis process was optimized to decrease the resistivity of the resulting carbon material and improve the performance in cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). Finally, EIS was used to monitor adhesion and proliferation of HeLa cells.