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Background: Alzheimer’s disease (AD) is characterized by cholinergic dysfunction, making the inhibition of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) critical for improving cholinergic neurotransmission. However, the development of effective dual inhibitors remains challenging. Objective: This study aims to synthesize and evaluate novel pyridazine-containing compounds as potential dual inhibitors of AChE and BuChE for AD treatment. Methods: Ten novel pyridazine-containing compounds were synthesized and characterized using IR, 1H NMR, and 13C NMR. The inhibitory activities against AChE and BuChE were assessed in vitro, and pharmacokinetic properties were explored through in silico ADME studies. Molecular dynamics simulations were performed for the most active compound. Results: Compound 5 was the most potent inhibitor, with IC50 values of 0.26 µM for AChE and 0.19 µM for BuChE, outperforming rivastigmine and tacrine, and showing competitive results with donepezil. Docking studies revealed a binding affinity of −10.21 kcal/mol to AChE and −13.84 kcal/mol to BuChE, with stable interactions confirmed by molecular dynamics simulations. In silico ADME studies identified favorable pharmacokinetic properties for compounds 5, 8, and 9, with Compound 5 showing the best activity. Conclusions: Compound 5 demonstrates strong potential as a dual cholinesterase inhibitor for Alzheimer’s disease, supported by both in vitro and in silico analyses. These findings provide a basis for further optimization and development of these novel inhibitors.

Rheumatoid arthritis (RA) is a debilitating autoimmune condition characterized by chronic synovitis, joint damage, and inflammation, leading to impaired joint functionality. Existing RA treatments, although effective to some extent, are not without side effects, prompting a search for more potent therapies. Recent research has revealed the critical role of FAS-associated death domain protein (FADD) microvesicular shedding in RA pathogenesis, expanding its scope beyond apoptosis to include inflammatory and immune pathways. This study aimed to investigate the intricate relationship between mi-RNA 128a, autoimmune and inflammatory pathways, and adenosine levels in modulating FADD expression and microvesicular shedding in a Freund’s complete adjuvant (FCA) induced RA rat model and further explore the antirheumatoid potency of trimetazidine (TMZ). The FCA treated model exhibited significantly elevated levels of serum fibrogenic, inflammatory, immunological and rheumatological diagnostic markers, confirming successful RA induction. Our results revealed that the FCA-induced RA model showed a significant reduction in the expression of FADD in paw tissue and increased microvesicular FADD shedding in synovial fluid, which was attributed to the significant increase in the expression of the epigenetic miRNA 128a gene in addition to the downregulation of adenosine levels. These findings were further supported by the significant activation of the TLR4/MYD88 pathway and its downstream inflammatory IkB/NFB markers. Interestingly, TMZ administration significantly improved, with a potency similar to methotrexate (MTX), the deterioration effect of FCA treatment, as evidenced by a significant attenuation of fibrogenic, inflammatory, immunological, and rheumatological markers. Our investigations indicated that TMZ uniquely acted by targeting epigenetic miRNA128a expression and elevating adenosine levels in paw tissue, leading to increased expression of FADD of paw tissue and mitigated FADD microvesicular shedding in synovial fluid. Furthermore, the group treated with TMZ showed significant downregulation of TLR4/MYD88 and their downstream TRAF6, IRAK and NF-kB. Together, our study unveils the significant potential of TMZ as an antirheumatoid candidate, offering anti-inflammatory effects through various mechanisms, including modulation of the FADD-epigenetic regulator mi-RNA 128a, adenosine levels, and the TLR4 signaling pathway in joint tissue, but also attenuation of FADD microvesicular shedding in synovial fluid. These findings further highlight the synergistic administration of TMZ and MTX as a potential approach to reduce adverse effects of MTX while improving therapeutic efficacy.

Ahmed Khalil,1 Asmaa Mohamed,1 Manasik Hassan,2 Samar Magboul,2 Hossamaldein Ali,1 Ahmed Salah Elmasoudi,1 Khaled Ellithy,3 Mohammad Qusad,2 Abdulla Alhothi,2 Eman Al Maslamani,4 Mohammed Al Amri,5 Ashraf Soliman5 1Section of Pediatric Clinical Pharmacy, Pharmacy Department, Hamad General Hospital, Doha, Qatar; 2Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha, Qatar; 3Section of Pediatric Intensive Care Unit, Department of Pediatrics, Hamad General Hospital, Doha, Qatar; 4Section of Infectious Diseases, Department of Pediatrics, Sidra Medicine, Doha, Qatar; 5Department of Pediatrics, Hamad General Hospital, Doha, QatarCorrespondence: Ahmed Khalil, Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha, 3050, Qatar, Tel +974 55078679, Email akhalil7@hamad.qaIntroduction: While most children experience mild coronavirus disease 2019 (COVID-19) infections, a minority of cases progress to severe or critical illness. This study aimed to assess the efficacy and safety of Remdesivir (RDV) therapy in children with moderate to severe COVID-19, enhancing clinical decision-making and expanding our understanding of antiviral treatments for pediatric patients.Methods: The study included 60 patients, 38 receiving RDV treatment and 22 serving as the control group. Data was collected retrospectively from January 2021 to January 2022 through electronic hospital records.Results: Regarding the main clinical symptoms reported, most patients experienced Upper Respiratory Tract Infections (93.3%), indicating respiratory involvement. Additional symptoms included Central Nervous System (11.7%) and Gastrointestinal (10.0%). Among the 38 cases in the RDV group included in the study, the adverse effects associated with using RDV: Hypoalbuminemia in 19 cases (50.0%) and anemia in 18 cases (47.4%), making them the most common adverse effects. Only one case in the RDV group experienced non-RDV-related death with a different clinical diagnosis. The results showed that RDV treatment was well-tolerated in pediatric patients, with no significant differences in hospital stay and oxygen treatment compared to the control group with P values (0.2, 0.18), respectively.Conclusion: The outcomes indicate that Remdesivir may represent a safe and therapeutic choice for children with coronavirus disease 2019 (COVID-19).Keywords: COVID-19, remdesivir, RDV, efficacy, safety, SARS-CoV-2

In this paper, the effects of hydrostatic stress on the magnetic properties of Mn-Zn power ferrites are discussed. Ring cores were embedded in cement and the curing process gradually exerted pressure on the core. A novel testing method was developed to continuously measure the power losses and the magnetic susceptibility in dependence on magnetic excitation at a fixed frequency and room temperature with a vector network analyzer. After 450 h, a maximum compressive stress of 120 MPa was reached. Power loss up to 300% was observed, while magnetic susceptibility dropped by 35%. The magneto-mechanical effect on core losses was simulated with the Hodgdon–Esguerra hysteresis model, showing excellent agreement with tested results, which allows us to predict the behavior of ferrite tiles embedded in load-bearing surfaces for wireless power transfer (WPT) applications. [ABSTRACT FROM AUTHOR]

Background/aim The tongue squamous cell carcinoma (TSCC) is considered one of the primary causes of death worldwide. Despite the presence of different therapeutic modalities, scientists always search for natural products that have an anticancer effect. Apricot oil extract has anticancerous effect, but its use is limited due to its toxic systemic effect. In this study, we aimed to investigate the anticancer effect of apricot oil extract locally applied on induced TSCC. Material and methods Thirty rats were divided into three groups, group I was the control group, group II received 7, 12 Dimethylbenz[a]anthracene (DMBA) topically and group III received apricot oil extract alternative with Dimethylbenz[a]anthracene topically. After killing the rats, tongues were dissected and were prepared for histological and immunohistochemical assessment. Results Group II developed TSCC with features of malignancy while group III showed hyperplastic epithelium which was dysplastic and started invasion in few cases. Immunohistochemically, group II showed a strong positive expression of Ki-67 and matrix mettaloprotinase 9 compared with group III. Statistical analysis showed that group II was significantly the highest in Ki-67 and matrix mettaloprotinase 9 expression. Conclusions From the results obtained, we can conclude that apricot oil has potent anticarcinogenic effect and that using it topically may be an alternative to systemic use.

Abstract Background One of the major threats to human health is malignancy. Treatment regimens usually followed by either chemo or radiotherapy have a wide range of collateral unwanted side effects. Scientists seek alternatives with less or no adverse consequences. Nutraceuticals possess disease-modifying implications in medicine related to Alzheimer’s, cardiovascular, Parkinson’s diseases and malignancy. Apricot oil extract is one such nutraceutical. Its active component is amygdalin, known also as vitamin B.17 or laetrile. It is found in a wide range of vegetable species. Amygdalin is found in high concentration in the kernels of rosaceous fruits such as bitter nuts and apricot kernels. Amygdalin is an aromatic cyanogenic component with a glycoside group. It has a diverse effect on different systems and organs of the body. Recently, it has shown an anticancer potential as it can decompose carcinogenic elements found in the body and kill malignant cells, so it results in cancer growth inhibition. There is a great debate related to the cyanide toxicity of amygdalin. The presented study aims to evaluate apricot oil extract’s impact on squamous cell carcinoma of the tongue, HNO97, while testing its safety on non-tumorigenic oral epithelial cells. Results HNO97 cell line viability was markedly decreased. This may be induced by the upregulation of autophagy, apoptosis enhancement as well as cell cycle arrest. Cancer cell migration was also decreased. Apricot oil caused no significant inhibition of normal OEC viability in low doses. Conclusions Apricot oil extract from apricot kernel had a notably antitumorigenic impact on oral cancer cells. It may be later subjected to pre- as well as clinical trials.

Background: In March 2020, the World Health Organization (WHO) declared Severe Acute Respiratory Syndrome Coronavirus 2 (SARS2-CoV-2) as global pandemic. This health crisis has overwhelmed the healthcare system, leading to unprecedented morbidity and mortality rates. During this pandemic, pharmacies tried to maintain their services either through remote services or face-to-face dispensing and consultation. Objectives: This study aimed to share the strategies and plans adopted by the pharmaceutical services department to maintain the healthcare services during the SARS2-CoV-2 crisis and evaluate the patient's perspective. Methods: A cross-sectional analytical survey was conducted among patients/patient relatives who attended King Hamad University Hospital (KHUH) outpatient pharmacies in the Kingdom of Bahrain between February 2021 and May 2021. Patients have two options: either to submit the survey online through barcode scanning or to fill it as a physical paper and submit it to the pharmacy staff (Online-based and paper-based). A total of 641 responses were received. Hospital applied safety logistics to ensure staff and patient safety. Results: Post-hoc analysis revealed that patients aged between 20 and 39 years had less agreement than patients ≤ 19 years old in terms of preferring to continue the same services after the pandemic (p = 0.009). More level of understanding of pharmacy services was seen among patients with higher educational levels compared to elementary and secondary levels in cases of services related to adverse events (p = 0.038) and wrong/missed medication rectification (p = 0.018). Unemployed patients were more in agreement than employed ones regarding continuing the same procedure after the pandemic, services related to wrong/missed medication rectification, and safety while staying in the pharmacy waiting area. Conclusion: Most patients were satisfied with the face-to-face counseling, pharmacy-adapted strategies, and services during the SARS2-CoV-2 pandemic. Face-to-face service during the pandemic was equally comfortable across all age groups and gender.

Introduction: The benchmarking for medication incidents rate is not regarded as a recognized key performance measure or indicator in national or international organizations. The absence of benchmarking the medication incidents results in the loss of a self-governing perception of how well we performed compared to other peers. Methodology and settings: This 600-bed tertiary, Joint Commission International (JCI) accredited hospital retrospective analysis looked at all medication management-related events from January-2018 to December-2021. The study design follows descriptive, cross-sectional, retrospective prevalence research. Results: The rate of medication incidents that resulted in harm declined from Q3-2019 to Q4-2021. A significant increase in Pharmacy interventions/clarifications was recorded. Additionally, a significant increase in incidents reported with no-harm coupled with a significant reduction in incidences of serious events from 2019 to 2020. Finally, no-harm events were significantly reduced from 2020 to 2021. Discussion: The Pharmacy's study analyzed every medication incident documented from 2019 to 2021. 99.7% of reported incidents were classified as no-harm (near misses). There was an exponential decrease from Q1-2020 to Q1-202. A significant increase in incidents fell in the category of (near misses) with no-harm and a significant reduction in serious events. Pharmacy interventions/clarifications saw a massive increase and impact from Q3-2018 to Q2-2019, compared to the same period in 2018. By preventing medical incidents, benchmarking, and analyzing incidents and the reporting system, the use of information technology could dramatically reduce the rate of drug incidents. Conclusion: This study found that benchmarking medication incidents is valuable, as it can help identify areas where improvements can be made, implement strategies to improve safety, and track progress over time. The benchmark was recommended to be below 100 incidents for every 10,000 prescriptions/orders processed, and for E-I categories, below one incident for every 10,000 prescriptions/orders processed. This will help develop a worldwide standard with an absolved culture with non-punitive consequences.

Background: Pharmacy automation and robotics implementation are essential aspects of healthcare facilities. It streamlines the medication dispensing process and significantly reduces medication errors. However, implementing automation and robotics in pharmacies comes with its challenges. We aim to detect and rectify potential dangers in the pharmacy workflow by utilizing the Failure Mode and Effects Analysis (FMEA) methodology; this is expected to augment performance and increase profitability. Materials and methods: In this study, we conducted an FMEA analysis using a qualitative approach to identify the challenges experienced during pharmacy automation and robotics implementation in a Joint Commission International (JCI) accredited hospital in the Arabian Gulf area. The pharmacy processes and procedures were mapped in a Flow chart to visualize the pharmacy workflow, including highlighting the risks that were found. Then these risks were arranged as Potential failure modes and added to the table as 9 main points for each RPNs were calculated, and then the 9 points were prioritized for the action plans. Results: Via applying traditional Risk Priority Number (RPN) FMEA, the Pharmacy board identified the process stages marked risky failure modes through several FMEAs, calculating the total RPNs at the implementation phase. It revealed several challenges, including staff training, technical issues, and inadequate communication. Furthermore, the study resulted in corrective and intervention steps. Conclusion: Pharmacy automation and robotics implementation is a complex process that requires proper planning, preparation, and execution. The FMEA approach effectively identifies potential problems and evaluates their impact on the pharmacy system. Nine major failure modes appeared to be risky stages with high RPN scores. Therefore, multiple interventions were done during the implementation to enhance the knowledge of challenges faced during the implementation of the automation process and solve it. Future studies should address the identified challenges and develop strategies to mitigate them.

Photovoltaic (PV) systems are becoming essential to our energy landscape as renewable energy sources become more widely integrated into power networks. Preserving grid stability, especially during voltage sags, is one of the significant difficulties confronting the implementation of these technologies. This attribute is referred to as low-voltage ride-through (LVRT). To overcome this issue, adopting a Proportional-Integral (PI) controller, a control system standard, is proving to be an efficient solution. This paper provides a unique algorithm-based approach of the Marine Predator Algorithm (MPA) for optimized tuning of the used PI controller, mainly focusing on inverter control, to improve the LVRT of the grid, leading to improvements in the overshoot, undershoot, settling time, and steady-state response of the system. The fitness function is optimized using the MPA to determine the settings of the PI controller. This process helps to optimally design the controllers optimally, thus improving the inverter control and performance and enhancing the system’s LVRT capability. The methodology is tested in case of a 3L-G fault. To test its validity, the proposed approach is compared with rival standard optimization-based PI controllers, namely Grey Wolf Optimization and Particle Swarm Optimization. The comparison shows that the used algorithm provides better results with a higher convergence rate with overshoot ranging from 14% to 40% less in the case of DC-Link Voltage and active power and also settling times in the case of MPA being less than PSO and GWO by 0.76 to 0.95 s.

Abstract Background Oral potentially malignant lesions (OPML) are suspicious lesions that may turn into malignancy according to the degree of dysplasia. Early diagnosis of these lesions allows their treatment before malignant transformation. Saliva is a liquid biopsy that can be obtained easily from the patient and assessed for biomarkers expression. Our study aimed to investigate the possibility of using salivary and serum TNF-α and Ki-67 in early detection of OPML. Patients with OPML were selected according to histopathological evaluation of the suspected lesions. The lesions were stained immunohistochemically by tumor necrosis factor alpha (TNF-α) and Ki-67. Saliva and blood samples were collected from the patients for detecting the expression of the markers by ELISA. Results The level of TNF-α and Ki-67 was higher in patients with OPML than healthy individuals regarding both saliva and serum. TNF-α was significantly higher in saliva than in serum unlike Ki-67 which was insignificantly higher in saliva than in serum. The OPML show negative expression of TNF-α in OPML immunohistochemically unlike Ki-67 which show intense positive expression in OPML immunohistochemically. Conclusions Saliva can be used as an early noninvasive biomarker detector depending on selecting the appropriate salivary biomarker. Salivary TNF-α can be used in early diagnosis of OPML.

Abstract Background Treating cancer is challenging for both the patient and the physician. This may be explained by the fact that treatment regimens rely on either chemotherapy alone or a combination with radiotherapy. Both modalities have damaging side effects that add to the patient suffer. This inconvenience from the patient part has led scientists to search for discovering new era in cancer management. Plant extracts have proved to be beneficial in many medical fields. Not surprisingly, tumor prevention and therapy is one of these bright fields. Rosmarinus Officinalis has attracted many researchers due to its diverse pharmaceutical capabilities. New drug delivery systems must be set to overcome biomedical as well as biophysical barriers. Nanoformulation of therapeutic agents may help bypassing these burdens. The aim of the present study was to investigate the role of rosemary extract (RE) loaded on chitosan nanoparticles as a cancer treatment modality. Synthesis of nanoparticles encapsulating rosemary extract was performed with subsequent characterization by electron microscopy. Assessment of their effect on OSCC cell line (Hep-2) regarding cell cytotoxicity and impact on cell cycle and apoptotic pathway as well as intracellular ROS quantification was performed. Results RE nanoparticles were found to be cytotoxic to Hep-2 cells in a dose-dependent manner. They induced apoptotic changes as well as cell cycle arrest at G2/M phase. They enhanced ROS expression in cancer cells. Autophagosomes appeared in treated cells. Conclusion Finally, it could be concluded that RE nanoparticles may be a new candidate in the field of cancer management, mainly oral cancer.

Background: Alzheimer's disease (AD) is characterized by cholinergic dysfunction, making the inhibition of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) critical for improving cholinergic neurotransmission. However, the development of effective dual inhibitors remains challenging. Objective: This study aims to synthesize and evaluate novel pyridazine-containing compounds as potential dual inhibitors of AChE and BuChE for AD treatment. Methods: Ten novel pyridazine-containing compounds were synthesized and characterized using IR, 1H NMR, and 13C NMR. The inhibitory activities against AChE and BuChE were assessed in vitro, and pharmacokinetic properties were explored through in silico ADME studies. Molecular dynamics simulations were performed for the most active compound. Results: Compound 5 was the most potent inhibitor, with IC50 values of 0.26 µM for AChE and 0.19 µM for BuChE, outperforming rivastigmine and tacrine, and showing competitive results with donepezil. Docking studies revealed a binding affinity of −10.21 kcal/mol to AChE and −13.84 kcal/mol to BuChE, with stable interactions confirmed by molecular dynamics simulations. In silico ADME studies identified favorable pharmacokinetic properties for compounds 5, 8, and 9, with Compound 5 showing the best activity. Conclusions: Compound 5 demonstrates strong potential as a dual cholinesterase inhibitor for Alzheimer's disease, supported by both in vitro and in silico analyses. These findings provide a basis for further optimization and development of these novel inhibitors. [ABSTRACT FROM AUTHOR]

Background/aim The diagnosis of breast cancer depends mainly on mammography or histopathology, but recently, salivary biomarkers have proved to be a promising tool as a noninvasive diagnostic technique. Cancer antigen (CA)15-3 is a widely used prognostic serum breast cancer biomarker. Cytokines have been used as biomarkers in research for prognosis and have been related with symptoms and adverse outcomes in breast cancer. The present study aimed to assess the accuracy of CA15-3 and interleukin (IL)-1β expression in saliva versus serum of patients with breast cancer. Patients and methods This study enrolled 26 patients with breast cancer from El Demerdash Hospital, Cairo, Egypt. In addition, 16 healthy individuals served as a control group. Saliva and blood samples were collected from all participants. Saliva was collected in the morning at least 2 h after the last intake of food. CA15-3 and IL-1β expressions were measured in saliva and serum using the enzyme-linked immunosorbent assay technique. Results The present results indicated that there were significant differences (P

Abstract Our patient is a 3‐week‐old female neonate, presented with complaints of low‐grade fever and a congested nose for one day. Eventually, she developed progressive desaturation, hypotension, and poor perfusion due to severe pulmonary hemorrhage. Then, she developed cardiac arrest and was declared dead.

(1) Background: During 2019, the COVID-19 pandemic was threatening healthcare services and workers, and acquiring immunity was an option to stop or limit the burden of this pandemic. Herd immunity was a top priority worldwide as the virus was spreading rapidly. It was estimated that 67% of the total global population should be immunized against COVID-19 to achieve herd immunity. The aim of the current study is to investigate different perceptions of healthcare workers in the Kingdom of Bahrain and Egypt using an online survey in an attempt to evaluate their awareness and concerns regarding new variants and booster doses. (2) Methods: This study conducted a survey on healthcare workers in the Kingdom of Bahrain and Egypt about their perception and concerns on the COVID-19 vaccines. (3) Results: The study found that out of 389 healthcare workers 46.1% of the physicians were not willing to take the booster doses (p = 0.004). Physicians also did not support taking the COVID-19 vaccine as an annual vaccine (p = 0.04). Furthermore, to assess the association between the type of vaccine taken with the willingness of taking a booster vaccine, healthcare workers beliefs on vaccine effectiveness (p = 0.001), suspension or contact with patients (p = 0.000), and infection after COVID-19 vaccination (p = 0.016) were significant. (4) Conclusion: Knowledge about vaccine accreditation and regulation should be dispersed more widely to ensure that the population has a positive perception on vaccine safety and effectiveness.

Objective: This randomized controlled clinical trial compared the clinical efficacy of self‐adhesive bulk‐fill Surefil One with a traditional bulk‐fill composite in class II restorations. Materials and Methods: Sixty‐four direct class II composite restorations were categorized into two groups. Group I, control group (n = 32): cavities were restored by Filtek One bulk‐fill composite with Scotchbond Universal (SBU) adhesive in self‐etch mode, Group II, test group (n = 32): cavities were restored by Surefil One self‐adhesive bulk‐fill composite. The study involved a follow‐up period of 1 year, during which restorations were assessed at baseline (BL), 6 months, and 12 months using Federation Dentaire Internationale (FDI) criteria. Data analysis was performed using nonparametric tests. A comparison of restoration characteristics was performed utilizing the chi‐square test (X2). The significance level was set at 0.05. Results: Filtek One and Surefil One bulk‐fill composites revealed clinically acceptable FDI scores over 12‐month recalls. Thirty‐two patients (64 restorations) were available for all follow‐up visits; 100% of the restorations survived. For esthetic properties, Filtek One was far better than Surefil One at all time points. However, in terms of functional and biological properties, both restorations demonstrated comparable performances. Conclusions: Filtek One bulk‐fill restorations were superior in terms of surface luster, surface staining, color match, and translucency, but Surefil One restorations performed well and were similar to Filtek One restorations; however, additional advancements and research are needed to obtain better esthetics. Furthermore, longitudinal studies with extended follow‐up periods are needed to assess the clinical potential of both materials. Clinical Significance: Both Filtek One and Surefil One met the FDI criteria, with Filtek One demonstrating superior esthetic and functional qualities and similar performance regarding biological criteria. Both innovative restorative materials show potential for clinical use. Trial registered on ClinicalTrials.gov under registration number; NCT06120868:07/11/2023. [ABSTRACT FROM AUTHOR]

Convection across circular concentric gaps between cylinders is crucial in industrial applications, including electronic cooling, heat exchangers, and solar collectors. The effect of longitudinal and annular grooves on the outside surface of the inside tube on natural convective heat transmission in enclosure concentric circular annulus is experimentally investigated in the present work. Twin pairs of circular aluminum cylinders with the same radius ratio, length, and surface area were examined. Each one consists of two concentric circular cylinders. To maintain a steady heat flux, the inside cylinder of each pair has an electrical heater connected. The results indicate that the increases in the Nusselt number of around 25%, 43%, 67%, 123%, 142%, 157%, and 172% are seen for groove depths of 0.05 cm, 0.10 cm, 0.15 cm, 0.20 cm, 0.25 cm, 0.3 cm, 0.35 cm, and 0.4 cm. In addition, increasing the depth of the longitudinal groove raises the Nusselt number by roughly 33%, 51%, 79%, 99%, 136%, 153%, 173%, and 184%. The longitudinal grooves with a depth of 4.0 mm enable a 38% increase in free convection over prior research. An annular groove of 4.0 mm depth increases free convection by 36%. Furthermore, a further advancement over earlier research is attributable to the extensive surface contact area of the inner cylinder made possible by longitudinal or annular grooves. [ABSTRACT FROM AUTHOR]

Objectives: Sorafenib is the standard first-line treatment for HCC. No sufficient data exists regarding its efficacy in the Egyptian population being a costly medication that is not endorsed by insurance and hence is not used in most institutions. This study aimed to evaluate the overall survival [OS], progression-free survival [PFS] and quality of life [QOL] of Egyptian HCC patients receiving sorafenib versus supportive care. Design: A Prospective cohort observational study. Setting: Electricity Hospital, Medical Oncology Department-Ain Shams University, and Nasser Institute for Research and Treatment, Egypt Subjects: Fifty-five patients with HCC were eligible for enrolment in the trial. Eligible HCC patients were stratified into one of two groups based on institutions’ protocols for HCC treatment. Group (1) received supportive care [n= 20] and Group (2) received sorafenib [n=35]; the patients follow up were continued for one year after diagnosis. Main outcome measures: Patients’ survival, PFS, and QOL. Results: The one-year survival rates were 0.0% and 75.5% [p= 0.008] for group (1) versus group (2), respectively. The median PFS was 5 months and 12 months for group (1) versus group (2), respectively [p= 0.008]. The QOL of the sorafenib group was better than the supportive care group [p = 0.047]. The most common side effects with sorafenib were diarrhoea [42.8%] and hand-foot syndrome [34.2%]. In the sorafenib group, 48.57 % of the patients were requiring dose reduction. Conclusion: Sorafenib was an effective first-line therapy in Egyptian HCC patients with a superior QOL, OS and PFS than those receiving supportive care.

Abstract Background The conflict in Syria has required humanitarian agencies to implement primary-level services for non-communicable diseases (NCDs) in Jordan, given the high NCD burden amongst Syrian refugees; and to integrate mental health and psychosocial support into NCD services given their comorbidity and treatment interactions. However, no studies have explored the mental health needs of Syrian NCD patients. This paper aims to examine the interaction between physical and mental health of patients with NCDs at a Médecins Sans Frontières (MSF) clinic in Irbid, Jordan, in the context of social suffering. Methods This qualitative study involved sixteen semi-structured interviews with Syrian refugee and Jordanian patients and two focus groups with Syrian refugees attending MSF’s NCD services in Irbid, and eighteen semi-structured interviews with MSF clinical, managerial and administrative staff. These were conducted by research staff in August 2017 in Irbid, Amman and via Skype. Thematic analysis was used. Results Respondents describe immense suffering and clearly perceived the interconnectedness of their physical wellbeing, mental health and social circumstances, in keeping with Kleinman’s theory of social suffering. There was a ‘disconnect’ between staff and patients’ perceptions of the potential role of the NCD and mental health service in alleviating this suffering. Possible explanations identified included respondent’s low expectations of the ability of the service to impact on the root causes of their suffering, normalisation of distress, the prevailing biomedical view of mental ill-health among national clinicians and patients, and humanitarian actors’ own cultural standpoints. Conclusion Syrian and Jordanian NCD patients recognise the psychological dimensions of their illness but may not utilize clinic-based humanitarian mental health and psychosocial support services. Humanitarian agencies must engage with NCD patients to elicit their needs and design culturally relevant services.

Background: There are an estimated 55 million internally displaced persons (IDPs) globally. IDPs commonly have worse health outcomes than host populations and other forcibly displaced populations such as refugees. Official development assistance (ODA) is a major source of the global financial response for health in low- and middle-income countries (LMICs), including for populations affected by armed conflict and forced displacement. Analysis of ODA supports efforts to improve donor accountability, transparency and the equitable use of ODA. The aim of this study is to examine international donor support and responsiveness to IDP health needs through analysis of ODA disbursements to LMICs between 2010 and 2019. Methods: ODA disbursement data to LMICs from 2010 to 2019 were extracted from the Creditor Reporting System (CRS) database and analysed with Stata software using a combination of: (i) text searching for IDP and refugee related terms; and (ii) relevant health and humanitarian CRS purpose codes. Descriptive analysis was used to examine patterns of ODA disbursement, and nonlinear least squared regression analysis was used to examine responsiveness of ODA disbursement to recipient country IDP population size and health system capacity and health characteristics. Findings: The study highlighted declining per IDP capita health ODA from USD 5.34 in 2010 to USD 3.72 in 2019 (with annual average decline of -38% from the 2010 baseline). In contrast, health ODA for refugees in LMICs increased from USD 18.55 in 2010 to USD 23.31 in 2019 (with an annual average increase of +14%). Certain health topics for IDPs received very low ODA, with only 0.44% of IDP health ODA disbursed for non-communicable diseases (including mental health). There was also weak evidence of IDP health ODA being related to recipient country IDP population size, and health system capacity and health characteristics. The paper highlights the need for increased investment by donors in IDP health ODA and to ensure that it is responsive to their health needs.

Background: Hypofractionated radiotherapy in early breast cancer yields equivalent or better outcome in terms of efficacy, toxicity, cosmesis and cost-effectiveness. However, its role in node-positive breast cancer is less clear. Aim: To compare between adjuvant conventional and hypofractionated radiotherapy in node-positive breast cancer. Methods: Prospective pilot study of 66 node-positive breast cancer patients recruited over 1 year in a single institution. Patients were randomized to receive adjuvant conventional radiotherapy 200 cGy x 25 fractions with 200 cGy x 5 fractions boost to the tumor bed in case of breast conservation (control arm) or hypofractionated radiotherapy 266 cGy x 16 fractions with 266 cGy x 4 fractions boost to the tumor bed in case of breast conservation (intervention arm). The end points were disease-free survival, cosmetic outcome, ipsilateral arm lymphedema and acute skin reactions. Results: Disease-free survival did not differ significantly between the two treatment arms (p = 0.6) and the 2-year disease-free survival rate was 87% and 89% in the hypofractionated and conventional arms. The rate of excellent/good cosmetic score was higher in the hypofractionated arm than the conventional as rated by patients (71% vs. 46%, p = 0.182) and physicians (29% vs. 8%, p = 0.32). Hypofractionation, when compared to conventional fractionation, was associated with less arm lymphedema (22% vs. 40%, p = 0.149), dry desquamation (28% vs. 53%, p = 0.04), skin darkness (0% vs. 15%, p = 0.054) and wet desquamation (16% vs. 21%, p = 0.601). Conclusion: Hypofractionated adjuvant radiotherapy in node-positive breast cancer patients is equivalent to conventional fractionation as regards disease-free survival, cosmetic outcome and arm lymphedema with less early skin reactions.

Introduction: Many risk factors have been reported to increase mortality among burn patients. Previously, a higher mortality incidence was reported in acute burn patients infected with multidrug-resistant organisms (MDROs) when compared to patients infected with non-MDROs. However, considering this as an independent risk factor for mortality in acute burn patients is not yet confirmed. Methods: We conducted an observational retrospective study in Qatar. We included adult patients admitted to the surgical intensive care unit (ICU) between January 2015 and December 2017 with burn injuries involving either at least 15% of the total body surface area (TBSA) or less than 15% with facial involvement. All patients developed infection with a positive culture of either MDRO or non-MDRO. The primary outcome was in-hospital mortality. Other outcomes included days of mechanical ventilation, ICU, length of stay in hospital, and requirement of vasoactive agents. Results: Fifty-eight patients were included in the final analysis: 33 patients in the MDRO group and 25 patients in the non-MDRO group. Six patients (18.2%) died in the MDRO group versus four patients (16%) in the non-MDRO group ( P = 1). No significant difference was observed between the two groups with regard to the ICU length of stay. However, there was a trend towards increased median length of stay in hospital in the MDRO group: 62 days versus 45 days in the non-MDRO group ( P = 0.057). No significant differences were observed in the other outcomes. Conclusion: In severely burned patients, infection with MDRO was not associated with increased mortality. There was a trend towards increased hospitalisation in MDRO-infected patients. Further studies with a larger sample size are needed to confirm these results. Lay Summary Many factors affect mortality in burn patients admitted to the intensive care unit, such as age, total body surface area involved in the injury, and others. In this retrospective study, we evaluated whether wound infection with a bacterial organism resistant to multiple classes of antibiotics (multidrug-resistant) is considered an independent risk factor for mortality in critically ill burn patients. We included 58 patients requiring intensive care admission with burn injuries involving 15% or more of the total body surface area or less than 15% but with facial involvement. A total of 33 patients were infected with multidrug-resistant organisms (MDROs) and 25 patients with non-MDROs. Six patients (18.2%) from the MDRO group died versus four (16%) in the non-MDRO group. The MDRO group required a longer stay in hospital and an average of one more day on a mechanical ventilator. We concluded that wound infection with MDROs might not increase mortality when compared to wound infection with non-MDROs, although other studies with a larger number of patients involved need to be conducted to validate these results.