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Introduction: Education is a dynamic process that needs periodic refining. The lack of innovative teaching techniques in academics makes medical education inadequate in making a significant stride toward the future. Didactic lectures (DL) have been the gold standard and the most common method of traditional teaching and learning practice. Active learning improves the knowledge-sharing process facilitates the development of analytical approaches to problem-solving and develops critical thinking. This study aims to evaluate the knowledge, obstacles, and options for implementing active learning among current teaching faculties of different affiliations. Methods: A descriptive, cross-sectional study was conducted on August 2022 among seventy-eight study participants. They were instructed to fill in the preformed proforma after obtaining written consent. Statistical analysis was done using SPSS. Results: Fifty-two (66.7 percent) of participants strongly favored that active learning imparts better content knowledge, with forty-six (59 percent) of participants strongly agreeing that lack of insufficient student-teacher interaction is an obstacle for active learning. Forty-four (56.4 percent) participants strongly agreed that group work facilitates active learning. Conclusion: Active learning methods can be implemented in the medical curriculum as medical educators are aware of the challenges and obstacles of this teaching-learning method. It can develop lifelong learning skills among students and teachers. Keywords: Active learning; Didactic learning; Medical education.

Neonatal abstinence syndrome (NAS) refers to a constellation of signs occurring in newborn infants who were exposed to opioids or opiates in utero. These manifestations include poor feeding, gastrointestinal disorders, abnormal sleep patterns, and neurological signs such as jitteriness, tremors, and seizures (1, 2). Myoclonus, jitteriness, and tremors often may be interpreted as seizures and therefore treated as epileptic seizures.Objective: To determine whether seizure like activity observed in infants with NAS correlate with electroencephalogram (EEG) findings.Design/ Method: We reviewed the standard EEG or video electroencephalogram (VEEG) of infants with NAS who were admitted because of seizure-like clinical activity. The exclusion criteria were major neurological anomalies, hypoxic ischemic encephalopathy, metabolic disorders, or with clinical diagnosis other than NAS.Results: Forty neonates met study criteria; 28 had standard EEG recordings and 18 had VEEG. Mean gestational age was 38.5 weeks. The onset of seizure-like clinical activity was as early as day 1 and as late as day 16 of life. The clinical seizure-like activity described at the referring hospital were jerking, rhythmic movement of the extremities, or tremors. Only three (7.5%) neonates had epileptic seizures. There were increased sharp transients in frontal, central, temporal, and or occipital regions. VEEG showed disturbed non-rapid eye movement (REM) sleep with frequent arousal, jittery movements, or sleep myoclonus.Conclusion: Clinical seizure-like activity correlates poorly with epileptic seizures in infants with NAS. In neonates with NAS, a VEEG would be useful to determine if the clinical seizure-like activity is of epileptic origin or not, prior to initiation of anti-seizure medications.

Background and study aims Small bowel arteriovenous malformations (AVMs) pose a bleeding risk and have traditionally been diagnosed by invasive enteroscopic procedures in patients with hereditary hemorrhagic telangiectasia (HHT). Capsule endoscopy (CE) is emerging as a safe and non-invasive alternative for small intestinal evaluation, but its diagnostic yield and utility in diagnosing small bowel AVMs in HHT patients are understudied. The aim of this study was to meta-analyze the utility of CE for diagnosing AVMs in HHT patients. Methods A meta-analysis and systematic review of the literature on CE in HHT patients identified in the PubMed, EMBASE, Scopus, and Cochrane databases from inception to March 2018 were conducted. Summary effects were estimated using a random effects model. Results After applying exclusion criteria, five studies (n = 124 patients) were eligible for meta-analysis. The pooled diagnostic yield for visualization of small bowel AVMs by CE was 77.0 % (95 % CI 65.8 – 85.4 %, P

Dental caries affects around 36% of the world's population and results in the loss of primary teeth in about 530 million youngsters. It is described as the loss of the enamel layer of the tooth by acids generated by the activity of cariogenic bacterium such as Streptococcus mutans on carbohydrates. This study aims to identify bioactive endophytic actinomycetes as an antibacterial agent against S. mutans DSM 20523 and to identify the bioactive endophytic actinomycetes using the 16S rRNA sequencing approach. To determine the percentage zone of inhibition, three endophytes at 10-day-old culture have been streaked onto ISP2. Then, S. mutans was streaked perpendicular to the endophytes. Crude extracts from three endophytes have been prepared by using four different types of media namely Tryptic Soy broth, Kings B, International Streptomyces Project Medium No.1 (ISP1) and Starch Casein broth. These crude extracts proceeded to undergo disk diffusion and MIC assays against S. mutans. All three endophytes from streaked plates with the highest percentage zone of inhibition were identified using the 16S rRNA gene molecular approach for characterisation. Endophytic actinomycetes which were isolated from Hopea ferrea showed potent antibacterial activity against S. mutans. All endophytic actinomycetes isolates from streak plates showed good inhibitory activity against the S. mutans. The highest percentage of inhibition was shown by the PT9-13S2 isolate followed by PT9-8S2 and PT9-13W2. Furthermore, crude extracts of PT9-8S2 and PT9-13W2 (the highest ZOI) from TSB media showed inhibitory activities against S. mutans, from disk diffusion as well as minimum inhibitory assays. From the 16S rRNA molecular approach, endophytic actinomycetes PT9-8S2 was closely related to Streptomyces collinus while PT9-13S2 and PT9-13W2 were closely related to Streptomyces malachitospinus. From this study, endophytic actinomycetes showed a promising source as antibacterial agents against cariogenic bacterium S. mutans which is the main causative agent of dental caries. [ABSTRACT FROM AUTHOR]

Cancer which synonymously known as neoplasia is a genetic disorder of cell growth that is triggered by acquired or less commonly inherited mutations affecting a single cell and its clonal progeny. The aims of this scoping review was to investigate the role of sugar and sugar substitutes in breast, lung, and oral cancers with a hypothesis that sugar promoted carcinogenesis. Three databases (EBSCO, PubMed, and Scopus) were searched from January 2010 to December 2021 to identify the preclinical studies eligible for this scoping review. The review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. A total of 361 articles were reviewed and the qualitative synthesis used 12 of these articles. Based on the qualitative synthesis, four studies reported dietary sugar (glucose-and/or sucrose) induced cancer progression, one study revealed sugar substitute (aspartame) induced cancer proliferation, seven studies reported that sugar substitutes inhibit cancer proliferation, and one study reported that sucrose promotes cancer while xylitol inhibits cancer. In addition., it was reported that D-allose and cisplatin have a synergistic effect in treating cancer. In conclusion, simple sugar intake is associated with an increased risk of carcinogenesis. In contrast, sugar substitutes inhibit cancer cell line progression, subsequently acting as a potential cancer therapy, thus supporting the study's hypothesis. [ABSTRACT FROM AUTHOR]

Vaccinating children with disability in low- and middle-income countries, such as Fiji, is a key priority for equity. This study aimed to understand the social and behavioral drivers of vaccine uptake among children with disability in Fiji, from the perspectives of health, disability, and community stakeholders. Five qualitative focus groups were conducted with 22 stakeholders, including healthcare workers, disability service providers and advocates, and community and faith leaders (female n = 17, 77%). Data were collected and analyzed using reflexive thematic analysis and applied the World Health Organization's Behavioral and Social Drivers of Vaccination framework. Numerous drivers were reported to impact vaccination for children with disability. These included (1) Thinking and feeling: lack of reliable information about vaccine benefits and safety for children with disability; (2) Social processes: disability stigma and discrimination impacted families of children with disability engaging with healthcare services; lack of tailored vaccination communication and engagement strategies; and, need for improved disability and health service collaboration; (3) Motivation: lack of awareness and support for parents of children with disability to have their children vaccinated, and religious beliefs negatively impacted motivation; (4) Practical issues: long waiting times and lack of suitable waiting areas for children with disability; financial and time barriers; and, lack of healthcare worker knowledge and confidence in providing vaccines to children with disability, impacted patient-provider trust. The findings from this study can inform strategic actions to overcome barriers to vaccination for children with disability, including strengthening existing vaccination programs, promoting greater equity in vaccination for children with disability in Fiji. This will reduce the burden of vaccine-preventable diseases in this priority group.

Objective This study aims to explore the associated impairments of cerebral palsy (CP) and their correlates among children with CP in Vietnam.Design Descriptive cross-sectional study using hospital-based surveillance.Setting National Children’s Hospital, Hanoi, Vietnam between June and November 2017.Participants 765 children with CP were recruited.Outcome measures We assessed clinical characteristics of CP, associated impairments (epilepsy, intellectual, visual, hearing, speech impairments) and their correlates. We performed descriptive analyses (median, IQR and proportion). χ2 test and Fisher’s exact test were used for categorical variables. Univariate logistic regression and multivariate logistic regression models were established and associated impairments were included as independent variables.Results The median age of children was 1.7 years (IQR=2.7). Quadriplegia was the predominant subtype (69.5%) and 46.5% were at Gross Motor Function Classification System level IV–V. Of children, 76.3% had ≥one associated impairment, most commonly speech or intellectual impairments (59.1% and 57.8%, respectively). Severity of motor impairment, type of CP, maternal and perinatal factors (eg, gestational age, perinatal asphyxia, timing of injury causing CP) were associated with greater risk of associated impairments.Conclusion Children with CP have a high burden of associated impairments. Findings from our study will inform the development and implementation of appropriate screening and interventions and reduce the long-term adverse effects of these impairments on individuals with CP and their socioeconomic impact.

Background: The epidemiology of cerebral palsy (CP) is poorly described in Ghana. These data are crucial for evidence-based intervention for children with CP in the country. Objectives: We aimed to describe the epidemiology of CP among children in Ghana. Method: We established the first institution-based register of children with CP in Ghana (Ghana CP Register–GCPR). Children with confirmed CP aged 18 years were registered following a detailed neurodevelopmental assessment. Socio-demographics, risk factors, predominant motor type and topography, gross motor function classification system (GMFCS), associated impairments, education and rehabilitation status were documented. Results: Between October 2018 and February 2020, 455 children were registered (mean [standard deviation {s.d.}] age at assessment: 5.9 [4.1] years). Preterm birth and low birthweight were reported in 52.0% and 21.1% children respectively. Most children (79.6%) had a pre- or perinatally acquired CP and the mean (s.d.) age of CP diagnosis was 22.2 (21.6) months. Overall, 55.9% of children had spastic tri- or quadriplegia, 60.5% had GMFCS level III–V and 70.3% had ≥ 1 associated impairment. However, 20.5% had never received rehabilitation services and 69.6% of school-aged children in the GCPR were not enrolled in schools. Conclusion: The study findings indicate a high burden of severe motor and associated impairment among children with CP in Ghana which highlights the need for tailored interventions to improve health and well-being of children with CP in the country. Contribution: The study highlights the need for interventions to improve functional outcome, health and well-being of children with CP in Ghana.

Abstract This protocol presents a comprehensive proposal for the establishment of the Saudi Cerebral Palsy Register (SCPR), a crucial project for investigating and addressing the prevalence, etiology, and management of cerebral palsy (CP) in Saudi Arabia. The SCPR will not only provide a robust database for ongoing research and analysis but will also serve as a platform for investigating the causes of CP, implementing preventative strategies, and improving the quality of care and outcomes for people with CP and their families in Saudi Arabia. Detailed case definitions, inclusion/exclusion criteria, and data collection protocols are discussed to ensure the integrity and comparability of the data. The plan also outlines strategic funding, institutional and government endorsement, sustainability considerations, potential challenges and proposed solutions, and expected outcomes and impact. These include creating research and educational opportunities, fostering regional and international collaborations, and significantly contributing to CP prevention strategies. Overcoming anticipated obstacles, such as stigma, institutional policies, and collaborations, and securing both necessary funding and endorsements are highlighted as critical for the success of the SCPR. The project is not only aligned with promote prevention of health risks, a target of Vision 2030 in Saudi Arabia, but is also expected to have a substantial impact on the health and quality of life of people with CP and their families in Saudi Arabia, serving as inspiration for similar efforts worldwide.

Background/Objectives: Cerebral palsy (CP) affects a substantial number of children, particularly in low- and middle-income countries such as Bangladesh. Maternal health literacy is critical to the health and well-being of children with CP, particularly in low-resource settings. In this study, we sought to assess how the mPower (mother’s power) community-based intervention impacted mothers’ CP-specific knowledge, as well as their utilization of rehabilitation services in rural Bangladesh. Methods: This quasi-experimental study was conducted with a group of mothers of children with CP, formed through the ongoing initiatives of the Bangladesh CP Register in rural Bangladesh. A pre-post-intervention comparison method was used to assess the outcomes of the intervention. Results: Mothers who participated in over two-thirds of the mPower sessions demonstrated a significant increase in CP-related knowledge (75.5% vs. 63.6%, p = 0.04). Additionally, mothers who attended two-thirds of the mPower sessions utilized rehabilitation services more often compared to those who attended fewer sessions (55.3% vs. 22.6%, p < 0.001). Conclusions: The mPower intervention successfully improved health literacy and likely increased rehabilitation service utilization among mothers of children with CP in rural Bangladesh.

Background: Limited knowledge on nutritional epidemiology in Ghanaian children with Cerebral Palsy (CP) necessitates a comprehensive investigation for an improved understanding of malnutrition in this population. Objectives: We aimed to describe the epidemiology of malnutrition among children with CP in Ghana. Methods: The study used data collected as part of the Ghana CP Register (GCPR). The GCPR is an institution-based surveillance of children with CP aged 18 years in Ghana. Between October 2018 and April 2020, N = 455 children with CP were registered. Data were collected on (i) weight, length or height, mid-upper-arm-circumference of children with CP; (ii) socio-demographic characteristics; (iii) motor type and topography, gross motor function classification system level (GMFCS); (iv) associated impairments; (v) educational and rehabilitation status for each child. Descriptive and bivariate analyses were performed. Results: Mean and standard deviation age of the registered children at assessment was 5.9 ± 4.1 years, and 42.1% were female. Two-thirds of the children had ≥ one form of undernutrition (underweight or severely underweight: 38.9%, stunted or severely stunted: 51.2%, thin or severely thin: 23.8%). In the adjusted analysis, low maternal education, GMFCS-IV, speech impairment and epilepsy significantly increased the odds of undernutrition among participating children (aOR: 2.6 [95% CI:1.3–5.4]; 2.2 [95% CI:1.0–4.8]; 2.0 [95% CI:1.1–3.6]; 2.9 [95% CI:1.1–7.5] respectively). Conclusions: The high malnutrition rate indicates an urgent need for nutrition interventions and translational research to improve nutritional status and prevent adverse outcomes among children with CP in Ghana. Contribution: Our study contributes important data and a framework to develop guidelines and evidence-based interventions for children with CP in Ghana.

Summary: Background: Children with disabilities face an increased risk of adverse health outcomes and poor anthropometric deficits, although the focus on them is limited in the South Asian context thus far and need newer and more evidence. This study investigates the effects of disability on adverse health outcomes and anthropometric deficits among 2–4 years aged children in South Asian countries. Methods: We analyzed data from 93,180 children aged 2–4 years across Bangladesh, Nepal, Pakistan, and Afghanistan using Multiple Indicator Cluster Surveys (2017–2023). Disability status was the primary exposure, and outcomes included adverse health outcome (acute respiratory infection, diarrhea, fever), anthropometric deficit (stunting, wasting, underweight), and healthcare service sources during adverse health events (care received from skilled healthcare personnel, care received from non-professional personnel, and care received from health facility workers other than skilled healthcare personnel). Using multilevel and multinomial logistic regression models, we examined associations between exposure and outcome variables, adjusting for covariates. Findings: We found average disability prevalence in South Asia was 8.7% (8.3–9.0; n = 8072), varying from 3.4% (3.0–3.8; n = 446) in Bangladesh to 12.3% (11.4–13.3; n = 1259) in Afghanistan. Common health issues included fever (n = 24,982, 26.8%, 26.2–27.4) and diarrhea (n = 14,081, 15.1%, 14.7–15.6), while prevalent poor anthropometric deficits were stunting (n = 39,766, 42.7%, 42.0–43.3) and underweight (n = 22,390, 24.0%, 23.5–24.5). Children with disability had 1.30 (95% CI: 1.21–1.40) to 1.60 (95% CI: 1.47–1.75) times and 1.17 (95% CI: 1.05–1.29) to 1.39 (95% CI: 1.30–1.48) times higher likelihoods of adverse health outcomes and anthropometric deficits, respectively, with variations observed among countries and different disability types. Individuals with disability were 1.16 (95% CI: 1.00–1.35) to 1.26 (95% CI: 1.01–1.58) times more likely to receive healthcare services from skilled healthcare personnel compared to health facility workers other than skilled healthcare personnel. Interpretation: This study findings emphasizes the need for community-level awareness programs to improve anthropometric well-being and healthcare of the children with disability. Funding: This research did not receive any specific funds.

Abstract The presence of comorbidities among individuals with disabilities worsens their already complex health and social circumstances. This study aims to explore prevalence and patterns of morbidities among persons with disabilities in Bangladesh and identify associated socio-demographic factors. Data from 4270 persons with disability was analysed extracted from the 2021 Bangladesh National Household Survey on Persons with Disability. Outcome variable considered was the occurrence of morbidity among persons with disabilities. Explanatory variables encompassed factors at the individual, household, and community levels. Adjusted and unadjusted multilevel mixed-effects logistic regression model was used to explore association of outcome variable with explanatory variables. We found that approximately half of individuals with disabilities experienced one or more morbidities, with chronic conditions being the most prevalent (44%). Around 42% of total persons with disability were unable to work. Specifically, hypertension (18.3%), diabetes (9.1%), and heart problems (17.1%) were prevalent chronic conditions. The likelihood of experiencing comorbidity was found to be higher among females (aOR 1.3, 95% CI 1.1, 1.7), increase year of education (aOR, 1.1, 95% CI 1.0–1.2), and those from wealthier households (aOR 1.6, 95% CI 1.2, 2.2). This underscores the need for targeted policies and interventions addressing their distinct healthcare needs.

Aim: To determine the antibacterial effect of ethanolic Z. mauritiana leaves extract against Streptococcus mutans, which is known as an aetiological agent in the development of dental caries. Materials and Methods: The plant extracts were prepared using maceration method in 100 % ethanol for 72 hours. The ethanol filtrate was separated and concentrated using a rotary evaporator. Then, the extract was lyophilized using freeze dryer for three days. The antibacterial assay of the leaf extracts was conducted on S. mutans (ATCC 25175) by disc diffusion method, minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC). Results: The results of disc diffusion method were determined by the diameter of zone of inhibition. For 200 mg/mc and 500 mg/mℓ of the ethanolic extract of Ziziphus mauritiana leaf extract the zone of inhibition were 11.67 mm and 13.9 mm respectively. The MIC and MBC value was 3.125 mg/mℓ. Conclusion: The findings from this study suggest that ethanol extracts of Ziziphus mauritiana leaves have the potential to be developed as a therapeutic agent in preventing development of dental caries. [ABSTRACT FROM AUTHOR]

Objective The 2022 Australian winter was the first time that COVID-19, influenza and respiratory syncytial virus (RSV) were circulating in the population together, after two winters of physical distancing, quarantine and borders closed to international travellers. We developed a novel surveillance system to estimate the incidence of COVID-19, influenza and RSV in three regions of Queensland, Australia.Design We implemented a longitudinal testing-based sentinel surveillance programme. Participants were provided with self-collection nasal swabs to be dropped off at a safe location at their workplace each week. Swabs were tested for SARS-CoV-2 by PCR. Symptomatic participants attended COVID-19 respiratory clinics to be tested by multiplex PCR for SARS-CoV-2, influenza A and B and RSV. Rapid antigen test (RAT) results reported by participants were included in the analysis.Setting and participants Between 4 April 2022 and 3 October 2022, 578 adults were recruited via their workplace. Due to rolling recruitment, withdrawals and completion due to positive COVID-19 results, the maximum number enrolled in any week was 423 people.Results A total of 4290 tests were included. Participation rates varied across the period ranging from 25.9% to 72.1% of enrolled participants. The total positivity of COVID-19 was 3.3%, with few influenza or RSV cases detected. Widespread use of RAT may have resulted in few symptomatic participants attending respiratory clinics. The weekly positivity rate of SARS-CoV-2 detected during the programme correlated with the incidence of notified cases in the corresponding communities.Conclusion This testing-based surveillance programme could estimate disease trends and be a useful tool in settings where testing is less common or accessible. Difficulties with recruitment meant the study was underpowered. The frontline sentinel nature of workplaces meant participants were not representative of the general population but were high-risk groups providing early warning of disease.

Objective We aimed to define the epidemiology of COVID-19 outbreaks in aged care facilities (ACFs) during the postvaccine period, including vaccine effectiveness (VE) for this high-risk group.Design Systematic review and meta-analysis.Data sources Ovid Medline, Ovid Embase, Scopus, Web of Science and Cochrane databases were searched through 1 September 2023.Eligibility criteria Any original observational studies and trials reporting data on COVID-19 outbreaks among the partially/fully vaccinated residents from ACFs during or after the worldwide implementation of vaccine roll-out.Data extraction and synthesis We estimated the attack rate, case fatality rate, mortality rate and VE during postvaccine period. Random effect model was adopted for meta-analysis. Quality assessment on all included studies was performed using the Meta Quality Appraisal Tool.Results 38 articles were included from 12 countries reporting 79 outbreaks with 1708 confirmed cases of COVID-19 from 78 ACFs. The pooled attack rate was 28% (95% CI 20% to 37%) among the fully vaccinated residents. Two-thirds (62.5%) of the index cases were unvaccinated healthcare professionals (eg, physicians, nurses) and caregivers. Unvaccinated residents had a significantly higher rates (12%) (95% CI 7% to 19%) of mortality compared with the vaccinated residents (2%) (95% CI% 1 to 4%) and the post-COVID-19 vaccine estimates for case fatality rate (13% vs 23%) and hospitalisation rate (17% vs 37%) were substantially lower. VE in preventing disease among residents in ACFs was 73% (95% CI 49% to 86). Overall, the included studies were heterogeneous in nature, however, the risk of bias was low to moderate.Conclusions Our study reaffirmed the impact of vaccination as a key public health measure to minimise the burden of COVID-19 in ACFs. Facilities with higher crowding indexes should be prioritised for vaccination and should advocate for higher vaccination targets among staff and residents as a critical intervention strategy to minimise disease burden in this vulnerable population.

Introduction Japanese encephalitis virus (JEV) is a mosquito-borne flavivirus that causes encephalitis and other morbidity in Southeast Asia. Since February 2022, geographically dispersed JEV human, animal and vector detections occurred on the Australian mainland for the first time. This study will determine the prevalence of JEV-specific antibodies in human blood with a focus on populations at high risk of JEV exposure and determine risk factors associated with JEV seropositivity by location, age, occupation and other factors.Method Samples are collected using two approaches: from routine blood donors (4153 samples), and active collections targeting high-risk populations (convenience sampling). Consent-based sampling for the latter includes a participant questionnaire on demographic, vaccination and exposure data. Samples are tested for JEV-specific total antibody using a defined epitope-blocking ELISA, and total antibody to Australian endemic flaviviruses Murray Valley encephalitis and Kunjin viruses.Analysis Two analytic approaches will occur: descriptive estimates of seroprevalence and multivariable logistic regression using Bayesian hierarchical models. Descriptive analyses will include unadjusted analysis of raw data with exclusions for JEV-endemic country of birth, travel to JEV-endemic countries, prior JEV-vaccination, and sex-standardised and age-standardised analyses. Multivariable logistic regression will determine which risk factors are associated with JEV seropositivity likely due to recent transmission within Australia and the relative contribution of each factor when accounting for effects within the model.Ethics National Mutual Acceptance ethical approval was obtained from the Sydney Children’s Hospitals Network Human Research Ethics Committee (HREC). Local approvals were planned to be sought in each jurisdiction, as per local ethics processes. Ethical approval was also obtained from the Australian Red Cross Lifeblood HREC.Dissemination Findings will be communicated to participants and their communities, and human and animal health stakeholders and policy-makers iteratively and after final analyses. Understanding human infection rates will inform procurement and targeted allocation of limited JEV vaccine, and public health strategies and communication campaigns, to at-risk populations.

Purpose This study aims to evaluate the antimicrobial effects of the cholecalciferol vitamin D3 against Streptococcus sobrinus (Strep. sobrinus) and Streptococcus mutans (Strep. mutans) bacteria in vitro that is considered the main causative bacteria in dental caries development. Materials and Methods The antimicrobial effects of vitamin D3 were evaluated against Strep. sobrinus and Strep mutans using the agar disc diffusion method. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of vitamin D3 were determined using a microdilution method following the guidelines by the Clinical Laboratory Standards Institute (CLSI). Scanning electron microscope (SEM) was used to evaluate the morphological changes of bacterial cells following exposure to vitamin D3. Results Strep. sobrinus was more sensitive to vitamin D3 compared to Strep. mutans bacteria. The MIC values of vitamin D3 against Strep. sobrinus and Strep. mutans were 60 µg/mL and 250 µg/mL respectively whereas the MBC values were 120 µg/mL and 500 µg/mL, respectively. Moreover, significant changes in the bacterial morphology were observed in treated bacterial cells with vitamin D3 as compared to the untreated control bacteria using SEM. Conclusion These findings suggested that vitamin D3 has excellent antimicrobial effects against Strep. sobrinus and Strep. mutans and may be considered as a promising compound in the prevention of dental caries in the future. Further research is recommended to elucidate the mechanism of vitamin D3 on these bacteria. [ABSTRACT FROM AUTHOR]

Introduction Cerebral palsy (CP) is one of the leading causes of childhood disability globally with a high burden in low-income and middle-income countries (LMICs). Preliminary findings from the global LMIC CP Register (GLM CPR) suggest that the majority of CP in LMICs are due to potentially preventable causes. Such data are lacking in the Latin American region. Generating comparable epidemiological data on CP from this region could enable translational research and services towards early diagnosis and early intervention. We aim to establish a Latin American multicountry network and online data repository of CP called Latin American Cerebral Palsy Register (LATAM-CPR).Methods and analysis The LATAM-CPR will be modelled after the GLM CPR and will support new and emerging Latin American CP registers following a harmonised protocol adapted from the GLM CPR and piloted in Argentina (ie, Argentine Register of Cerebral Palsy). Both population-based and institution-based surveillance mechanisms will be adopted for registration of children with CP aged less than 18 years to the participating CP registers. The data collection form of the LATAM-CPR will include risk factors, clinical profile, rehabilitation, socioeconomical status of children with CP. Descriptive data on the epidemiology of CP from each participating country will be reported, country-specific and regional data will be compared.Ethics and dissemination Individual CP registers have applied ethics approval from respective national human research ethics committees (HREC) and/or institutional review boards prior to the establishment and inclusion into the LATAM-CPR. Ethical approval for LATAM-CPR has already been obtained from the HREC in the two countries that started (Argentina and Mexico). Findings will be disseminated and will be made publicly available through peer-reviewed publications, conference presentations and social media communications.

To compare the incidence and outcomes of congenital and neonatal varicella in Australia in the pre-vaccination (1995–1997) and post-vaccination era (after 2005 to November 2020), active prospective national surveillance for congenital varicella syndrome (CVS) and neonatal varicella infection (NVI) was conducted through the Australian Paediatric Surveillance Unit (APSU). Compared with 1995–1997, there was a 91.5% reduction in the incidence of CVS and a 91.3% reduction in the incidence of NVI in 2009–2020. However, almost half of the mothers in 2009–2020 were born overseas and came from countries without a vaccination program. Although there has been a substantial and sustained decrease in the reported incidence of CVS and NVI in Australia since 2006, congenital and neonatal varicella infections persist. Thus, there is an opportunity for targeted screening of varicella in young migrant, asylum seeker and refugee women at risk of varicella infection and prioritisation for vaccination to prevent CVS and NVI.

Introduction Cerebral palsy (CP) is the most common childhood physical disability with rates approximately 50% higher in First Nations Australian children. This study aims to evaluate a culturally-adapted parent-delivered early intervention programme for First Nations Australian infants at high risk of CP (Learning through Everyday Activities with Parents for infants with CP; LEAP-CP).Methods and analysis This study is a randomised assessor masked controlled trial. Infants with birth/postnatal risk factors will be eligible for screening. Infants at high risk of CP (‘absent fidgety’ on General Movements Assessment, and/or ‘suboptimal score’ on the Hammersmith Infant Neurological Examination) aged 12–52 weeks corrected age will be recruited. Infants and their caregivers will be randomised to receive LEAP-CP (intervention) or health advice (comparator). LEAP-CP is a culturally-adapted programme of 30 home visits delivered by a peer trainer (First Nations Community Health Worker); and includes goal-directed active motor/cognitive strategies, CP learning games and caregiver educational modules. The control arm receives a monthly health advice visit, based on the Key Family Practices, WHO. All infants continue to receive standard (mainstream) Care as Usual. Dual child primary outcomes are Peabody Developmental Motor Scales-2 (PDMS-2) and Bayley Scales of Infant Development-III. The primary caregiver outcome is the Depression, Anxiety and Stress Scale. Secondary outcomes include function, goal attainment, vision, nutritional status and emotional availability. Sample size: total of 86 children (43/group) will enable an effect size of 0.65 on the PDMS-2 to be detected (80% power, α=0.05; 10% attrition).Ethics and dissemination Ethics approval through Queensland ethics committees and Aboriginal Controlled Community Health Organisation Research Governance Groups, with families providing written informed consent. Findings will be disseminated with guidance from the Participatory Action Research, in collaboration with First Nations communities; peer-reviewed journal publications and national/international conference presentations.Trial registration number ACTRN12619000969167p.

Acute mesenteric venous thrombosis (MVT) is the rarest cause of acute mesenteric ischaemia, so thrombosis of a variant inferior mesenteric vein (IMV) is especially uncommon in the setting of antiphospholipid syndrome (APS). Here, we present such a case of seronegative APS initially manifesting as an anomalous IMV thrombosis in a 76-year-old woman. Although guidelines support anticoagulation with vitamin K antagonists in these patients, we anticoagulated with rivaroxaban (a direct oral anticoagulant (DOAC)) due to patient preference, which resulted in complete clinical and endoscopic resolution. IMV thrombosis is a rare form of MVT, only two case reports describe successful anticoagulation with DOACs in the setting of MVT and none report APS as an underlying aetiology. Therefore, this case provides the opportunity to review the pathophysiology of MVT, APS and their medical management including current trends in anticoagulation. [ABSTRACT FROM AUTHOR]

Abstract Objective: We report a survey in regional Queensland to understand the reasons for suboptimal uptake of the COVIDSafe app. Methods: A short five‐minute electronic survey disseminated to healthcare professionals, mining groups and school communities in the Central Queensland region. Free text responses and their topics were modelled using natural language processing and a latent Dirichlet model. Results: We received a total of 723 responses; of these, 69% had downloaded the app and 31% had not. The respondents’ reasons for not downloading the app were grouped under four topics: lack of perceived risk of COVID‐19/lack of perceived need and privacy issues; phone‐related issues; tracking and misuse of data; and trust, security and credibility. Among the 472 people who downloaded the app and provided text amenable to text mining, the two topics most commonly listed were: to assist with contact tracing; and to return to normal. Conclusions: This survey of a regional population found that lack of perceived need, concerns around privacy and technical difficulties were the major barriers to users downloading the application. Implications for public health: Health promotion campaigns aimed at increasing the uptake of the COVIDSafe app should focus on promoting how the app will assist with contact tracing to help return to ‘normal’. Additionally, health promotors should address the app's impacts on privacy, people's lack of perceived need for the app and technical barriers.