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Abstract Background Minimally invasive dentistry is now becoming the forefront of restorative dentistry, involving less traumatic treatment protocols, conservation of tooth structure and surrounding tissues, enhancing the long-term survivability of treated teeth, and improving the overall quality of life for patients. Objective The current case report was conducted to evaluate acquiring deep subgingival interproximal carious lesions by the mean of thermacut bur gingivectomy, in terms of patient satisfaction through pain evaluation, Bleeding on Probing, Pocket Depth, Crestal Bone Level evaluation, and restoration evaluation using modified USPHS criteria. Material and methods A patient with a deep proximal cavity in the posterior tooth was thoroughly examined and underwent Thermacut Bur Gingivectomy (TBG) after caries removal followed by direct resin composite restoration of the prepared cavity. Patient Satisfaction using a Visual Analogue Scale (VAS) as a primary outcome. Bleeding on Probing (BoP), Probing Depth (PD), and Crestal Bone Level (CBL) as secondary outcomes, and Marginal Integrity using Modified USPHS Criteria as a tertiary outcome, were evaluated at the baseline, immediate post-operative, 6 month, 12 month and 22 month follow-up intervals. Results Thermacut bur gingivectomy revealed minimal immediate post-operative pain, minimal time-consuming procedure, minimal (BoP), appropriate (PD) and no need for extra specialty involvement in the treatment of deep interproximal carious lesions in addition to preservation of the alveolar bone crest with excellent restoration margin at different time intervals. Conclusions Thermacut bur gingivectomy can be considered a valid treatment for managing of deep subgingival interproximal carious lesions in vital teeth. Thermacut bur gingivectomy can be introduced as an easy technique for clinicians in the management of deep subgingival interproximal carious lesions, without the need to refer patients to periodontists and without the need for special devices.

Abstract Background Disparities in vaccination coverage exist in Somalia with Internally Displaced Persons (IDPs) being among the groups with the lowest coverage. We implemented an adapted Participatory Learning and Action (PLA) intervention, which focused on routine vaccinations among displaced populations living in Mogadishu IDP camps. The intervention was successful in improving maternal knowledge and vaccination coverage but unsuccessful in improving timely vaccination. We conducted a qualitative study to understand this result and analyze the multi-level barriers to routine childhood immunization uptake. Method In this qualitative study we used observation data from 40 PLA group discussions with female caregivers and purposively sampled nine vaccination service providers and six policy makers for interview. We also reviewed national-level vaccine policy documents and assessed the quality of health facilities in the study area. We used the socioecological framework to structure our analysis and analyzed the data in NVivo. Results The barriers to childhood vaccination among IDPs at the individual level were fear due to lack of knowledge, mistrust of vaccines, concerns about side effects and misinformation; opportunity costs; and costs of transportation. At the interpersonal level, family members played an important role as did the extent of decision-making autonomy. Community factors such as cultural practices, gender roles, and household evictions influenced vaccination. Organizational issues at health facilities such as waiting times, vaccine stock-outs, distance to the facility, language differences, and hesitancy of health workers to open multi-dose vials affected vaccination. At the policy level, confusion about the eligible age for routine vaccination and age restrictions for catch-up vaccination and certain antigens such as BCG were important barriers. Conclusion Complex and interrelated factors affect childhood vaccination uptake among IDPs in Somalia. Interventions that address multiple barriers simultaneously will have the greatest impact given the complex nature of vulnerabilities in this population. There is a need to strengthen the health system and connect it with existing community structures to increase demand for services. Our research highlights the importance of formative research before implementing interventions. Further research on the integration of health service strengthening with PLA to improve childhood vaccination among IDPs is recommended. Trial registration number ISRCTN-83,172,390. Date of registration: 03/08/2021.

Abstract Background The global freshwater shortage is an important issue threatening the sustainable development of agriculture and food security. A field study was conducted in two seasons, i.e., 2019 and 2020, in the newly reclaimed land at Village 8, El-Minia Governorate, Egypt, to evaluate maize crop response to three irrigation levels (IL1 = 80, IL2 = 70, and IL3 = 60% of the crop evapotranspiration “ETc”), three plant densities (PD1 = 17.500, PD2 = 23.333, and PD3 = 35.000 plants fed−1), and three antitranspirants treatments (An1 = control, An2 = kaolin at 6%, and An3 = chitosan at 150 L fed−1). The experiment was designed as a randomized complete block design (RCBD) using a split plot in strips. Results Results revealed that the irrigated maize plants with IL1 (80% of ETc) recorded the maximum values for all traits such as vegetative growth, phenology, and yield and its attributes in both seasons. The heaviest value of grain yield (3.15 and 3.10 tonnes fed−1, where 1 feddan = 0.42 hectare) was realized from IL1 treatment in the 1st and 2nd seasons, respectively. Plant density of 35.000 plants fed−1 (PD3) produced the greatest values of leaf area index (6.70 and 6.85), more days to 50% for each of tasseling (62.16 and 61.99 days), and silking (63.63 and 63.73 days), heaviest grain yield (3.11 and 3.16 ton fed−1) and greater water use efficiency WUE (1.46 and 1.48 kg m−3) in both seasons, respectively. Conclusions Foliar spraying with antitranspirants, i.e., kaolin at 6%, led to a tremendous impact on all studied traits by alleviating the water stress and reducing the rate of transpiration. The effect of second-order interaction among IL1 × PD3 × An3 indicated a significant increase in grain yield by 69.91% as compared with the interaction of IL3 × PD1 × An1 in the 2020 season only. CS 10 single-cross maize realized the highest productivity and most efficient use of available resources via using a sowing density of 35.000 plant fed−1, foliar spraying with kaolin at 6%, and irrigation level (80% of ETc) under El-Minia conditions.

BackgroundCash transfer programmes are increasingly used in humanitarian contexts to help address people's needs across multiple sectors. However, their impact on the key objectives of reducing malnutrition and excess mortality remains unclear. mHealth interventions show great promise in many areas of public health, but evidence for their impact on reducing the risk factors for malnutrition is uncertain. We therefore implemented a trial to determine the impacts of 2 interventions in a protracted humanitarian context, a cash transfer conditionality and mHealth audio messages.Methods and findingsA 2 × 2 factorial cluster-randomised trial was implemented in camps for internally displaced people (IDP) near Mogadishu, Somalia, starting in January 2019. The main study outcomes were assessed at midline and endline and included coverage of measles vaccination and the pentavalent immunisation series, timely vaccination, caregiver's health knowledge, and child diet diversity. Twenty-three clusters (camps) were randomised to receive or not receive conditional cash transfers (CCTs) and an mHealth intervention, and 1,430 households were followed up over 9 months. All camps received cash transfers made at emergency humanitarian level (US$70/household/month) for 3 months followed by a further 6 months at a safety net level (US$35). To be eligible to receive cash, households in camps receiving CCT were required to take their children 85%). We conducted intention-to-treat analysis. During the humanitarian intervention phase, the CCT improved coverage of measles vaccination (MCV1) from 39.2% to 77.5% (aOR 11.7, 95% CI [5.2, 26.1]; p < 0.001) and completion of the pentavalent series from 44.2% to 77.5% (aOR 8.9, 95% CI [2.6, 29.8]; p = < 0.001). By the end of the safety net phase, coverage remained elevated from baseline at 82.2% and 86.8%, respectively (aOR 28.2, 95% CI [13.9, 57.0]; p < 0.001 and aOR 33.8, 95% CI [11.0, 103.4]; p < 0.001). However, adherence to timely vaccination did not improve. There was no change in the incidence of mortality, acute malnutrition, diarrhoea, or measles infection over the 9 months of follow-up. Although there was no evidence that mHealth increased Mother's knowledge score (aOR 1.32, 95% CI [0.25, 7.11]; p = 0.746) household dietary diversity increased from a mean of 7.0 to 9.4 (aOR 3.75, 95% CI [2.04, 6.88]; p < 0.001). However, this was not reflected by a significant increase in child diet diversity score, which changed from 3.19 to 3.63 (aOR 2.1, 95% CI [1.0, 4.6]; p = 0.05). The intervention did not improve measles vaccination, pentavalent series completion, or timely vaccination, and there was no change in the incidence of acute malnutrition, diarrhoea, measles infection, exclusive breastfeeding, or child mortality. No significant interactions between the interventions were found. Study limitations included the limited time available to develop and test the mHealth audio messages and the necessity to conduct multiple statistical tests due to the complexity of the study design.ConclusionsA carefully designed conditionality can help achieve important public health benefits in humanitarian cash transfer programmes by substantially increasing the uptake of child vaccination services and, potentially, other life-saving interventions. While mHealth audio messages increased household diet diversity, they failed to achieve any reductions in child morbidity, malnutrition, or mortality.Trial registrationISRCTN ISRCTN24757827. Registered November 5, 2018.

The effect of including lemongrass extract powder (LGEP) as a phytogenic herbal extract supplementation for growing rabbits on productive performance, nutrient digestibility, blood parameters and carcase characteristics were evaluated. One hundred twenty unsexed V-Line rabbits, with 35 days age and 802 ± 47 g weight, were used. Rabbits were divided equally into four treatments to be fed on basal diet as a control diet without lemongrass inclusion (LGEP0) or with the inclusion of LGEP at 2 g (LGEP2), 4 g (LGEP4) or 6 g (LGEP6) per kg diet. Feeding LGEP did not significantly affect final body weight, weekly weight gains, feed consumption or feed conversion ratio. Moreover, no significant effect of supplementing rabbit diets with LGEP was observed on all apparent nutrient digestibility. The LGEP4 treatment decreased (P

Abstract Background High levels of inflammatory markers such as C-reactive protein (CRP) and interleukin (IL)-6 are associated with worse outcome after ischemic stroke. Objectives To study whether the level of IL-6 following ischemic stroke is related to the severity of stroke, infarct volume, stroke subtype, and its impact on stroke outcome. Materials and methods A total of 90 patients of acute ischemic stroke were enrolled with calculation of infarct volume in MRI brain, and serum IL-6 samples were obtained within 24 h and also after 3 months from stroke onset. NIHSS and MRS were done at stroke onset and after 3 months. Results The mean value of IL-6 was higher among patients with small vessel occlusion (8.47 pg/ml) with a significant positive correlation between IL-6 and National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (MRS) after 3 months. IL-6 was significantly higher in patients with recurrence with a cutoff IL-6 value above which recurrence is anticipated which is 7.75 pg/ml. Conclusion Our study concluded that inflammation has an important role in the pathogenesis of acute ischemic stroke particularly small vessel occlusion and it provided evidence that IL-6 contributes to the determination of clinical outcome of acute ischemic stroke and prediction of recurrence.

Background Forced evictions are common in conflict-affected settings. More than 500 internally displaced persons (IDPs) are evicted daily in Mogadishu. Context specific research is necessary to inform responsive humanitarian interventions and to monitor the effective- ness of these interventions on IDPs health. Objective This study explored the causes of forced evictions and their health impacts among IDPs in southern Somalia. Methods We used a qualitative approach, conducting 20 semi-structured interviews, six key informant interviews and four focus group discussions. We used maximum variation sampling to include a wide range of participants and used the framework approach and Nvivo software to analyse the data. Results In this context, landlords often rented land without proper tenure agreements, resulting in risk of forced evictions. Informal tenure agreements led to fluctuations in rent, and IDPs were evicted because tenancy laws were inadequate and failed to protect their rights. IDP settlements often increased the value of land by clearing scrub, and landlords often sought to profit from this by evicting IDPs at short notice if a buyer was found for the land. The effect of eviction on an already marginalised population was wide ranging, increasing their exposure to violence, loss of assets, sexual assault, disruption of livelihoods, loss of social networks, and family separation. Evicted IDPs reported health issues such as diarrhoea, malaria, pneumonia, measles and skin infections, as well as stress, anxiety, psychological distress and trauma. Conclusion Forced evictions remain one of the biggest challenges for IDPs as they exacerbate existing vulnerabilities. Prioritizing implementation of legal protection for IDP tenure rights is necessary to prevent unlawful evictions of IDPs. Humanitarian agencies should aim to respond more effectively to protect evictees and provide support to prevent poor health outcomes. Further quantitative research is needed to examine the relationship between forced evictions and health outcomes.

The present study examines the legal system of a one-person company in Saudi law; this system is considered as a new legal approach in the Saudi economy. Under the new Commercial Companies Law of 2015, the Saudi legislator ratified for one person (natural or legal), the establishment of a company in two forms: the Limited Liability Partnership Company and Joint Stock Company. The adoption of the Saudi legislator for the legal system of a one person is in line with the vision the Kingdom of Saudi Arabia that aims to engage the private sector in the national economy due to it is role as main supporter. The ratification for the establish of a one-person company is considered as a strong incentive for the business sector for a number of reasons such as the determination of the responsibility of the partner by monitoring the capital of the company without exceeding its liability for its debts for the personal finance. The establishment of a one-person company is considered as an exception to the principle that reflected in Article 2 of the Companies Law. The study investigates the nature of the one-person company besides its distinctive characteristics and economic importance, which makes the Saudi legislator to ratify the establishment of the two forms companies on the exceptional legal bases. Finally, the study reveals the means of establishing a one-person company and the mechanisms of its management.

Abstract Background In acute ischemic stroke, collateral circulation plays an important role in maintaining blood flow to the tissue that is at risk of progressing into ischemia, and in increasing the successful recanalization rate without hemorrhagic transformation. Objectives To compare between collaterals in patients with extracranial carotid stenosis alone and in patients having both extracranial and intracranial carotid stenosis and therefore the difference in prognosis between them. Materials and methods A total of 30 patients of acute ischemic stroke were enrolled. The extracranial part of the carotid artery was assessed with color-coded duplex. Transcranial color-coded duplex was done to assess cerebral hemodynamics and collaterals to differentiate between extracranial significant carotid stenosis alone versus combined extra- and intracranial significant carotid stenosis. Results Out of 15 patients with significant extracranial stenosis, 3 of them obtained reversed flow in the ophthalmic artery and 3 patients of them showed change of flow in the anterior cerebral artery(ACA), whereas the other 15 patients of combined stenosis did not show any reversed blood flow in the same arteries which considered nonsignificant. The residual deficit of patients with extracranial stenosis alone was better when compared to that of the other group. Conclusion Our study concluded that transcranial duplex provides useful information about cerebral reserve and status of collaterals which show nonsignificant difference between two studied groups regarding intracranial collaterals. Furthermore, patients with combined extra- and intracranial stenosis were found to have more deficit and worse prognosis than patients with internal carotid stenosis only.

Background: Minimally invasive dentistry is now becoming the forefront of restorative dentistry, involving less traumatic treatment protocols, conservation of tooth structure and surrounding tissues, enhancing the long-term survivability of treated teeth, and improving the overall quality of life for patients. Objective: The current case report was conducted to evaluate acquiring deep subgingival interproximal carious lesions by the mean of thermacut bur gingivectomy, in terms of patient satisfaction through pain evaluation, Bleeding on Probing, Pocket Depth, Crestal Bone Level evaluation, and restoration evaluation using modified USPHS criteria. Material and methods: A patient with a deep proximal cavity in the posterior tooth was thoroughly examined and underwent Thermacut Bur Gingivectomy (TBG) after caries removal followed by direct resin composite restoration of the prepared cavity. Patient Satisfaction using a Visual Analogue Scale (VAS) as a primary outcome. Bleeding on Probing (BoP), Probing Depth (PD), and Crestal Bone Level (CBL) as secondary outcomes, and Marginal Integrity using Modified USPHS Criteria as a tertiary outcome, were evaluated at the baseline, immediate post-operative, 6 month, 12 month and 22 month follow-up intervals. Results: Thermacut bur gingivectomy revealed minimal immediate post-operative pain, minimal time-consuming procedure, minimal (BoP), appropriate (PD) and no need for extra specialty involvement in the treatment of deep interproximal carious lesions in addition to preservation of the alveolar bone crest with excellent restoration margin at different time intervals. Conclusions: Thermacut bur gingivectomy can be considered a valid treatment for managing of deep subgingival interproximal carious lesions in vital teeth. Thermacut bur gingivectomy can be introduced as an easy technique for clinicians in the management of deep subgingival interproximal carious lesions, without the need to refer patients to periodontists and without the need for special devices. [ABSTRACT FROM AUTHOR]