Continuing professional development system for health-care professions, Egypt

While the regulatory framework for medical education in Egypt has rapidly evolved, the progress of developing a system for continuing professional development has been slow. In 2018 the government approved legislation establishing a regulatory authority for continuing professional development and added expectations for continuing professional development as a condition of relicensure for physicians in Egypt. The new authority has deployed a provider-accreditation model that sets criteria for educational quality, learning outcomes, independence from industry, and tracking of learners. Only accredited providers can submit continuing professional development accredited activities. Despite regulatory and administrative support there have been several barriers to the implementation of the system including limited availability of funding, lack of suitable training venues and equipment for hands-on training, and resistance from the profession. As of March 2022, 112 continuing professional development providers have achieved accreditation, and deployed 154 accredited continuing professional development activities. The majority of accredited providers were medical associations (64%) and higher education institutions (18%), followed by medical foundations and nongovernmental organizations (13%) and health-care facilities (5%). One electronic learning platform has been accredited. Any entity with commercial interests cannot be accredited as a continuing professional development provider. Funding of continuing professional development activities can be derived from provider budgets, programme registration fees or appropriate sponsors. Funding from industry is limited to unrestricted educational grants. The foundations for an effective continuing professional development system have been established in Egypt with the aim of achieving international recognition.

Microbiological evaluation for antifungal activity of some metal oxides nanofillers incorporated into cold cured soft lining materials: clinical based study / Avaliação microbiológica da atividade antifúngica de algumas nanopartículas de óxidos metálicos incorporadas em materiais de revestimento macio curados a frio: estudo clínico

Objetivo: O objetivo do presente estudo foi avaliar a eficácia da adição de nanopartículas de óxido de zircônio (ZrO2), óxido de titânio (TiO2) e óxido de sílica (SiO2) a um material de revestimento macio curado a frio na adesão de Candida albicans (CA). Material e Método: Cinquenta e quatro pacientes foram selecionados e divididos em três grupos de acordo com a modificação do revestimento com nanopartículas de ZrO2, TiO2 e SiO2 (18 cada). Cada paciente recebeu prótese total maxilar com três cavidades, as cavidades foram revestidas com forro macio curado a frio modificado com diferentes concentrações (0%, 3% e 7%) de nanopartículas de óxido metálico. Nos dias 14 e 28, as trocas foram retiradas do local de realinhamento e imediatamente cultivadas para avaliação fúngica. O número de colônias foi contado, os dados coletados e explorados para normalidade usando o teste de Shapiro-Wilk e a transformação logarítmica da contagem de CA foi realizada. ANOVA para medidas repetidas e de uma via (one-way) foram usados, seguidos por teste de Tukey (HSD). O teste t independente foi usado para comparar as contagens de CA em diferentes períodos. Resultados: A adesão do CA foi significativamente diminuída pela adição de nanopartículas de ZrO2, TiO2 e SiO2 em comparação com o grupo controle, também a cobertura antifúngica aumentou com o aumento da concentração de nanopartículas (p <0,005). A maior contagem de CA foi identificada no grupo SiO2 seguido por ZrO2, enquanto TiO2apresentou a menor contagem de CA (p <0,001). Conclusão: Adição de diferentes nanopartículas; ZrO2, TiO2 e SiO2para revestimento macio curado a frio é um método eficaz para reduzir a adesão de CA (AU)

Objective: The aim of the current study was to evaluate the efficacy of addition of zirconium oxide (ZrO2), titanium oxide (TiO2), and silica oxide (SiO2) nanoparticles to cold-cured soft liner on adhesion of Candida albicans (CA). Material and Methods: Fifty-four patients had been selected and divided into three groups according to the modification of soft liner with ZrO2, TiO2, and SiO2 nanoparticles (18 each of). Each patient received maxillary complete denture having three cavities, the cavities were lined using cold cured soft liner modified with different concentration (0%, 3%, and 7%) of metal oxide nanoparticles. On days 14 and 28, swaps were taken out from relining site and immediately cultured for fungal evaluation. The number of colonies were counted, data collected and explored for normality using Shapiro-Wilk test, logarithmic transformation of CA count was performed. Repeated and one-way ANOVA were used followed by Tukey HSD. Independent-t test used to compare between CA counts at different periods. Results: The CA adhesion was significantly decreased by the addition of ZrO2, TiO2 and SiO2 nanoparticles in comparison with control group, also the antifungal coverage increased with nanoparticles concentration increased (P<0.005). The highest CA count was identified in group SiO2 followed by ZrO2, while TiO2 showed the lowest CA count (P <0.001). Conclusion: Addition of different nanoparticles; ZrO2, TiO2 and SiO2 to cold-cured soft liner is an effective method for reducing CA adhesion. (AU)

Effect of SiO2 and Al2 O3 nanoparticles on wear resistance of PMMA acrylic denture teeth / Efeito das nanopartículas de SiO2 e Al2 O3 na resistência ao desgaste de dentes em acrílico PMMA para prótese

Objetivo: Este estudo teve como objetivo avaliar a resistência ao desgaste de dentes em acrílico para próteses contendo nanopartículas de dióxido de silício (nano-SiO2 ) e dióxido de alumínio (nanoAl2 O3 ). Material e Métodos: O material em polimetilmetacrilato (PMMA) foi utilizado para fabricar 84 amostras (n=10) contendo nano-SiO2 e nano-Al2 O3 nas concentrações 0,1% em peso, 0,3% em peso e 0,5% em peso de pó acrílico. Uma máquina de teste de desgaste de dois corpos e um microscópio digital foram usados para medir as mudanças na perda de peso e rugosidade da superfície, respectivamente. Testes de ANOVA a um fator e testes de comparações múltiplas de Tukey foram utilizados para análise dos dados (α = 0,05). Resultados: O material modificado com nano-SiO2 demonstrou um aumento significativo na perda de peso em comparação com o material acrílico artificial convencional (p ˂ 0,05) enquanto o material modificado com nano-Al2 O3 demonstrou aumento não significativo na perda de peso, exceto no subgrupo 0,5% (p < 0,05). Não há diferenças significativas em relação à alteração da rugosidade após a simulação de desgaste entre todos os grupos testados (p > 0,05). Conclusão: As nanopartículas de nano-Al2 O3 exibem menos efeito negativo que o nanoSiO2 , podendo ser usado com cautela, se necessário. (AU)

Objective: This study aimed to evaluate the wear resistance of acrylic denture teeth containing silicon dioxide (nano-SiO2 ) and aluminum dioxide (nano-Al2 O3 ) nanoparticles. Material and Methods: Poly methyl methacrylate (PMMA) denture tooth material was used to denture tooth material was used to fabricate 84 specimens (n=10) containing nano-SiO2 and nano-Al2 O3 in concentrations 0.1wt%, 0.3wt%, and 0.5wt% of acrylic powder. A two-body wear testing machine and digital microscope were used to measure the changes in weight loss and surface roughness respectively. One-way ANOVA and pair-wise Tukey's post-hoc tests were used for data analysis (α = 0.05). Results: Nano-SiO2 modified teeth material demonstrated a significant increase in weight loss in comparison conventional artificial acrylic teeth material (p ˂ 0.05) while nanoAl2 O3 modified teeth material demonstrated non-significant increase in weight loss except for 0.5% subgroup (p ˂ 0.05). There is no significant differences regarding roughness change after wear simulation among all tested groups (p > 0.05). Conclusion: Nano-Al2 O3 nanoparticles exhibit less negative effect than nano-SiO2 so; it could be used with caution if necessary. (AU)

Integrative herbal treatments of diabetes in Beni Mellal region of Morocco / 中西医结合学报

OBJECTIVES@#Diabetes is one of the most life-threatening chronic metabolic disorders and is considered a global health problem due to its prevalence and incidence. In Morocco, several herbal preparations are utilized to treat this disease. For this reason, the current study aimed to identify and to collect data about the medicinal plants utilized in folk medicine for the treatment of diabetes in the Beni Mellal region of Morocco.@*METHODS@#An ethnobotanical survey was carried out among 400 herbalists, competent villagers and traditional healers from the Beni Mellal region through direct interviews using a semistructured questionnaire.@*RESULTS@#Forty-five medicinal plants belonging to 25 families were identified for their use in diabetes treatment. Interview results showed that the most frequently used plants were Olea europaea, Salvia officinalis, Allium sativum and Trigonella foenum-graecum, with a relative frequency of citation values of 24.3%, 23.0%, 22.5% and 20.5%, respectively. Moreover, in this study, the Fabaceae family was the most commonly reported plant family, and the leaves and roots were the most commonly used parts, for the treatment of diabetes.@*CONCLUSION@#The Beni Mellal region of Morocco has an important floristic biodiversity of plants used to treat diabetes in traditional medicinal practice. This result provides a good database for pharmacological screenings in the search for plant-based antidiabetic medications.

Erratum - Color variation induced by abutments in the superior anterior maxilla: an in vitro study in the pig gingiva

The author names were mistakenly given as Cetik Sibel. It should be corrected as Sibel Cetik. The Journal of Advanced Prosthodontics apologizes to the readers for this error.

Erratum - Color variation induced by abutments in the superior anterior maxilla: an in vitro study in the pig gingiva

The author names were mistakenly given as Cetik Sibel. It should be corrected as Sibel Cetik. The Journal of Advanced Prosthodontics apologizes to the readers for this error.

Color variation induced by abutments in the superior anterior maxilla: an in vitro study in the pig gingiva

PURPOSE: The aim of this work is to evaluate different types of materials used for making implant abutments, by means of an in vitro study and a review of the literature, in order to identify the indications for a better choice of an implant-supported restoration in the anterior section. MATERIALS AND METHODS: 5 implant abutments were tested in a random order in the superior anterior maxilla of pig gingiva (n = 8): titanium dioxide (Nobel Biocare); zirconium dioxide, Standard BO shade (Nobel Biocare, Kloten, Switzerland); zirconium dioxide, Light BI shade (Nobel Biocare); zirconium dioxide, Intense A 3.5 shade (Nobel Biocare); and aluminium oxide. Each abutment was tested for 2 mm and 3 mm thickness. To determine color variation, VITA Easyshade Advance spectrophotometer (Vita Zahnfabrik, Bad Sackingen, Germany) was used. RESULTS: Results showed that the color variation induced by the abutment would be affected by the abutment material and gingival thickness, when the gingival thickness is 2 mm. All materials except zirconium dioxide (Standard shade) caused a visible change of color. Then, as the thickness of the gingiva increased to 3 mm, the color variation was attenuated in a significant manner and became invisible for all types of abutments, except those made of aluminium oxide. CONCLUSION: Zirconium dioxide is the material causing the lowest color variation at 2 mm and at 3 mm, whereas aluminium oxide causes the highest color variation no matter the thickness.

Anti-gliadin Antibodies and Gluten Neuropathies: A Borderline Link.

The aim of this research was to estimate the prevalence of gluten sensitivity in neurologic diseases of unknown etiology and to determine their clinical and biological characteristics in a Moroccan population. Patients and Methods: A prospective case-control study was performed on 60 patients and 57 controls. Patients and controls underwent a screening for IgG and IgA anti-gliadin antibodies (ELISA anti-Gliadin, Orgentec, threshold: 12 IU/ml), and IgA anti-tissue transglutaminase antibodies (ELISA IgA-tGTA, DRG, threshold: 10 IU/m). Results: The median age of patients was 43±13.91 years (ranges: 13-67), versus 39.4±9.12 (ranges: 19-58) for controls. Male to female sexe-ratio was 0.7 for patients vs 2.1 for controls. IgG and/or IgA anti-gliadin antibodies (AGA) were positive in 26.7% of cases (n=16) vs 15.8% (n=9) in controls (p=0.15), while IgA-tTGA was negative in all patients, but positive in 1 control. Positive AGA cases corresponded to peripheral neuropathy (n=4), ataxia (n=3), ischemic stroke (n=3), myopathy (n=2), and 1 case for each of the following conditions: multiple sclerosis, epilepsy, cerebral thrombophlebitis and myelopathy. Among the positive AGA cases, IgA isotype was more prevalent, but IgG AGA titers were higher and clinically more relevant. Conclusion: Gluten Sensitivity is a potential cause of unknown etiological neurologic diseases in young adults, particularly peripheral neuropathy, ataxia and ischemic stroke. AGA testing especially IgG isotype might be a suitable marker to screen for gluten neuropathies.

[Information needs of Moroccan elderly cancer patients]

Background: Announcing cancer to a patient is not a simple task. Usually doctors fail to inform patients about the diagnosis and it is more likely in older people .The need of information in cancerous elderly is not well established. In developed countries, there is evidence that the majority of old patients are demanding exhaustive information about their disease, treatment and prognosis

Aim: In developing countries where social and cultural issues are different, perception of cancer in elderly is not well studied. Therefore we conducted a prospective study on Moroccan elderly cancerous need of information about their disease

Methods: This is a prospective descriptive study, Conducted in the National Institute of Oncology of Morocco, cancerous patients older than 70 were included. A questionnaire was given to participants. Demographics, disease characteristics, social, economical and cultural features were recorded

Results: One hundred and fifty patients responded to the questionnaire. Mean age was 73. 72.7% of patients were diagnosed in advanced stages. Illiteracy was found in 76%. 87.3% of patients did not have health insurance. All patients were Muslim, practicing in 97%. 57% ignored diagnosis. 80% didn't want to know further information about prognosis and treatment side effects. Family protection from information was found in 70%

Conclusion: Moroccan elderly affected with cancer are less demanding of details about their illness.Illiteracy and cultural background may play a major role, Relatives overprotection is also influencing

Rapid Simultaneous detection of AmpC and ESBLs among Enterobacteriaceae using MastD68C detection set and possible therapeutic options

Extended spectrum beta -lactamases [ESBLs] and AmpC beta -lactamases are enzymes produced by a variety of Gram-negative bacteria which confer an increased resistance to commonly used antibiotics and represent a substantial clinical threat. Several phenotypic tests have been recommended for screening and confirmation of ESBL- and AmpC-producing organisms. However, a comprehensive diagnostic algorithm integrating both screening and confirmation has not been established. This study aimed to detect ESBL and/or AmpC production by using MastD68C ESBL and AmpC detection set as a single phenotypic method and to study its sensitivity and specificity comparing to other methods. Evaluate the effect of novel antibiotics namely tigecycline and doripenem, as well as the efficacy of old reviving antibiotics as colistin and temocillin against ESBL- and AmpC-producing Enterobacteriaecae. Hundred Enterobacteriaceae isolates were screened for ESBL production using disc diffusion method and confirmed by combination disc diffusion test. Screening of AmpC production was done by cefoxitin disc test, disc approximation test and confirmation was done by AmpC disc test. Isolates screened positive for ESBL were investigated for their susceptibility to temocillin, tigecycline, colistin and doripenem by E-test. Among the 100 Enterobacteriaceae isolates, 45 were screened positive for ESBL-production using the disc diffusion test and 36 were confirmed by the combination disc test. Nine isolates were screened for AmpCproduction using the cefoxitin disc test and 5 isolates were confirmed as AmpC producers by AmpC disc test. Using MAST D68C set, 35 isolates were ESBL producers, 2 were AmpC producers, one isolate was both ESBL and AmpC producer. All isolates were sensitive to tigecycline and doripenem. Forty-three isolates were sensitive to colistin, while, thirty-seven isolates were sensitive to temocillin. MAST D68C test appears to be a promising way to detect isolates producing ESBL and/or AmpC. Tigecycline, doripenem, temocillin and colistin revealed excellent activity against ESBL- and AmpC- producing Enterobacteriaceae

Reactivation of cytomegalovirus in a patient with stevens-johnson syndrome-toxic epidermal necrolysis

Stevens-Johnson syndrome [SJS] and toxic epidermal necrolysis [TEN] are severe adverse cutaneous reactions to drugs. We describe the case of a 19 year old patient with SJS/TEN overlap syndrome, who developed severe interstitial pneumonia after she had received antiepileptic drugs. A cytomegalovirus infection was diagnosed by Real Time Polymerase Chain Reaction [RTPCR] detection on Bronchoalveolar lavage. Based on observations on biological data, temporal relationship, and clinical features, it could be inferred that the reactivation of cytomegalovirus with viral replication can predispose a person to TEN-SJS. We discuss here, in the light of the current literature, the probable association between drug-induced SJS-TEN and fulminant reactivation of cytomegalovirus

Acupuncture and transcutaneous electrical nerve stimulation versus occlusal splint therapy in the management of temporomandibular pain dysfunction syndrome

The aim of this study was to evaluate the acupuncture therapy as well as the transcutaneous electrical nerve stimulation [TENS] versus the occlusal splint therapy in the management of temporomandibular disorders [TMDs]. According to the treatment regimen, the selected patients were divided into four groups, each comprising eight patients. Group I and IV received acupuncture and occlusal splint therapies respectively as sole mode of treatment, while group II and III received combination therapy of acupuncture of TENS with splint therapy alternatively. Both subjective and objective evaluations were carried out for each patient at the pre-treatment stage and on regular recall visits up to nine months from the end of treatment. The results of this study showed a varying degree of success of the selected treatment approaches between the four groups being in favor to the combination therapy

Effect of the bucco-lingual psition of artificial psterior teeth on the denture supporting bone of the edentulous patient

To improve the complete denture quality, the bucco-lingual position of the artificial posterior teeth has to be determined in relation to the shape of the residual alveolar ridges and their relationship. The arrangement of posterior artificial teeth should be considered not only for the denture stability but also to avoid the high pressure on supporting structures. A two dimensional finite element method program was developed to investigate the statics for the contour of the complete denture and residual ridge to investigate the effect of the position of artificial posterior teeth under vertical occlusal force on the denture supporting bone

Multiplicity of Schistosoma mansoni infection changed the activity of ATPases and the levels of free radical in the liver of male mice

The present study was carried out to investigate the influence of Schistosoma mansoni infection on the levels of thiobarbituric acid- reactive substances [TBARS] as free radicals and on the activity of Na+, K+ -ATPase and Ca+2, Mg+2 -ATPase in the livers and brains of male mice after 33 days of infection with 60, 120, 180 and 300 cercariae/mouse. The study showed that the levels of free radicals increased with increasing the intensity of S. mansoni infection. There was a correlation between the increment of free radical levels and the inhibition of different types of ATPase activity of S. mansoni-infected mice. In addition, this study also provided a new possible mechanism of liver damage caused by schistosome through induction of free radical levels. The results demonstrated that the activity of ATPase decreased and the level of free radicals [TBARS] increased at all levels of S. mansoni infection. The deleterious effect of free radicals on the liver and other possible organs could be increased, especially at higher intensity of S. mansoni infection. These alterations might be one of the factors associated with the etiology of liver damage, which are commonly encountered in schistosomal patients

new analgesia protocol for cataract surgery

Our objective was to describe the safety and efficacy of a new analgesia protocol that enables the surgeon to maintain control over an alert patient experiencing seemingly painless ambulatory cataract surgery, while eliminating the risks and side effects associated with general, local, and intracameral anesthesia. This study was carried out on two thousands cataract surgery cases. This technique produces profound ocular analgesia, avoiding any undesired sedative effects, using very low-dose, titrated, intravenous alfentanil. Complete control of the uncooperative patient, including lid squeezing and ocular and genera! body movements, is obtained whenever necessary using very low-dose, titrated, intravenous propofol. Success was defined as surgery completed in a controlled manner without the need to convert to general, local, or intracameral anesthesia and the patent's experience being perceived as pain free. One thousand nine hundred ninety-five [99.75%] of the cases were successful without ever deviating from the protocol. This analgesia protocol offers advantages for cataract surgery. It virtually eliminates the morbidity of cataract surgery associated with other anesthesia techniques while providing excellent and reliable control with minimal side effects. It allows for an immediate postoperative recovery with instantaneous vision restoration. These patients are generally awake, alert, and retain their protective reflexes

Australia antigen and anti-australia antibody in lymphomas, leukemias and breast cancer

The sera of 90 lymphoma and 60 leukemic patients were studied for the presence of either HBsAg or anti-HBs using counter-electrophoresis. In addition, the study included 40 breast cancer patients and 20 normal healthy subjects as controls. The findings indicated a close and specific association between hepatitis B infection and leukemia. The frequency of exposure in leukemia patients was 17% compared to 5% in the other groups. Acute leukemia cases with positive HBsAg or anti-HBs reactions indicated a group with very bad prognosis. The causal relationship of hepatitis B virus to certain types of leukemias was discussed

phase II study of vindesine in patients with hodgkin's disease, lymphoma, and breast cancer

Seventy-four patients with Hodgkin's disease, lymphomas, and breast cancer were treated with vindesine 3 mg - 3.5mg/ m/[2]/week iv. Complete, partial and mixed responses were encountered in 16 of 26 patients with Hodgkins disease, in 9 of 24 lymphoma patients, and partial response in 4 of 24 breast cancer patients. Mild to moderate degree of peripheral neuropathy was encountered in 46 patients. Mild leucopenia was seen in 12 patients. It is concluded that vindesine is efficacious in Hodgkin's disease and lymphomas, and is recommended for combination chemotherapy regimes

Effect of combination chemotherapy on the clinical response of malignant lymphoma

This study included 56 patients with advanced stages of malignant lymphoma: 36 NHL, and 20 HD. The most common pathological subtypes were diffuse poorly differentiated lymphocytic in NHL and mixed cellularity in HD, both of which are known to be of unfavorable prognosis. Conventional combination chemotherapy produced nearly the same CR rate in both HD [57%] and NHL [50%], whereas the <> chemotherapy was more effective in HD [CR rate with MOPP-6 = 71.4%] and less effective in NHL [CR rate with CHOP= 40%, and CHOP-L 33.3%]. Although <> combinations were known to be better for clearing the disease, additional toxicities of these combinations apparently resulted in disturbing the patient-tumor relationship. This might explain the poorer response of NHL patients who received the aggressive combinations

Effect of diabetes mellitus on topographic changes in structure supporting maxillary complete denture

Several studies have been carried out on the histologic and mophologic changes in the structure supporting complete dentures. Nothing was reported in the literature about the effects of Diabetes Mellitus on the morphology of the structures supporting complete dentures. The aim of this work was to study the topographic changes in the denture bearing area in non-diabetic and diabetic patients. The results showed that complete dentures caused reduction in the heights of the ridges in diabetic and non-diabetic patients. However, than reduction in heights of the ridges in diabetic group was greater thar. that in the non-diabetic group. More reduction in the heights of the ridges took place in the premolar and first molar rather than in the second molar regions