An ethno-botanical study of medicinal plants used for the management of respiratory tract disorders in northern parts of Palestine.

BACKGROUND: The medicinal application of natural plant remedies is well established. These medicinal plants are still in use within the Palestinian community to treat several illnesses. This research is intended to study the use of natural plants to treat different types of respiratory tract disorders. METHOD: This ethno botanical study focused on the medicinal plants that are used to treat respiratory diseases in the northern part of Palestine; Nablus, Tulkarm, Qalqilia, and Jenin. A questionnaire was distributed to 120 respondents. The data obtained included names of the plants used, the parts used, the diseases for which the products were applied, as well as the method of preparation. To evaluate results, percentages (%), Fic (factor of informant consensus), and FL (fidelity-level) were calculated. RESULTS: A total of 120 participants were selected for the final analysis. The highest percentage of herbal use was reported for flu 85.8% (103 participants) followed by cough 83.3%, while the lowest percentage of users was for bronchitis with 54.1%. The study showed that 31 plant species of 19 families were used for respiratory disorders treatment. Six species were from the Lamiaceae family, three species from the Apiaceae family, two species from Amaryllidaceae, Fabaceae, Myrtaceae, Rutaceae and Zingiberaceae, and one plant species for each of the rest of families. Leaves and fruits were the most commonly used parts of plants. Decoction was the method of preparation and was taken as a hot drink. Chamomile, mint, sage, lemon, and ginger were in the recipes for the five respiratory diseases. CONCLUSION: In Palestine, patients with respiratory diseases rely heavily on the use of herbal remedies. Leaves and fruits were the most commonly used plat elements. Age and marriage were significantly associated with the use of botanical remedies. Whereas there was no significant association between the source of information about medicinal plants and the location where medicinal plants were purchased. It is vital to conduct comprehensive clinical investigations and pharmacological assessments of these herbal remedies, in order to identify their efficacy, safety, and toxicity levels.

Investigation of a herpesvirus outbreak in mixed breeds of adult domestic ducks using next generation sequencing.

This report characterizes the first lethal outbreak of Marek's disease on a large farm of mixed-breed adult ducks (>18,000) and identifies the pathogen that resulted in high mortality (35%). Clinical signs included inappetence, respiratory distress, depression, muscle weakness, and ataxia. Post mortem revealed enlarged fragile liver mottled with miliary whitish spots and an enlarged spleen. Histopathology revealed hepatocellular necrosis with eosinophilic intra-nuclear inclusion bodies, necrosis of splenic follicles and degeneration/necrosis of renal tubules. The disease was tentatively diagnosed as a herpesvirus infection, confirmed by virus isolation from the liver. DNA was isolated from 15-year-old archival formalin-fixed tissues from infected ducks and subjected to next generation sequencing (NGS). Despite highly degraded DNA, short stretches of G- and C-rich repeats (TTAGGG and TAACCC) were identified as telomeric repeats frequently found in herpesviruses. Megablast and further investigative bioinformatics identified presence of Marek's disease virus (MDV), a Gallid alphaherpesvirus type 2 (GAHV-2), as the cause of the acute fatal infection. The source of infection may be attributed to a dead migratory flamingo found close to the duck enclosures three days prior to the outbreak; hence, GAHV-2 may also be responsible for the fatal infection of the flamingo accentuated by heat stress. Considering the possible spread of this highly contagious and lethal virus from a flamingo to the ducks, and the increasing zoonosis of animal viruses into humans, such as monkey B alphaherpesvirus transmission from macaques to humans with ~80% fatality, this observation has important ramifications for human health and safety of the poultry industry.

Enhancing Photorealism Enhancement.

We present an approach to enhancing the realism of synthetic images. The images are enhanced by a convolutional network that leverages intermediate representations produced by conventional rendering pipelines. The network is trained via a novel adversarial objective, which provides strong supervision at multiple perceptual levels. We analyze scene layout distributions in commonly used datasets and find that they differ in important ways. We hypothesize that this is one of the causes of strong artifacts that can be observed in the results of many prior methods. To address this we propose a new strategy for sampling image patches during training. We also introduce multiple architectural improvements in the deep network modules used for photorealism enhancement. We confirm the benefits of our contributions in controlled experiments and report substantial gains in stability and realism in comparison to recent image-to-image translation methods and a variety of other baselines.

Stakeholders' Perception of the Palestinian Health Workforce Accreditation and Regulation System: A Focus on Conceptualization, Influencing Factors and Barriers, and the Way Forward.

The Health Workforce Accreditation and Regulation (HWAR) is a key function of the health system and is the subject of increasing global attention. This study provides an assessment of the factors affecting the Palestinian HWAR system, identifies existing gaps and offers actionable improvement solutions. Data were collected during October and November 2019 in twenty-two semi-structured in-depth interviews conducted with experts, academics, leaders, and policymakers purposely selected from government, academia, and non-governmental organizations. The overall perceptions towards HWAR were inconsistent. The absence of a consolidated HWAR system has led to a lack of communication between actors. Environmental factors also affect HWAR in Palestine. The study highlighted the consensus on addressing further development of HWAR and the subsequent advantages of this enhancement. The current HWAR practices were found to be based on personal initiatives rather than on a systematic evidence-based approach. The need to strengthen law enforcement was raised by numerous participants. Additional challenges were identified, including the lack of knowledge exchange and salary adjustments. HWAR in Palestine needs to be strengthened on the national, institutional, and individual levels through clear and standardized operating processes. All relevant stakeholders should work together through an integrated national accreditation and regulation system.

Management of patients presenting to the emergency department with sudden onset severe headache: systematic review of diagnostic accuracy studies.

OBJECTIVE: Advances in imaging technologies have precipitated uncertainty and inconsistency in the management of neurologically intact patients presenting to the Emergency Department (ED) with non-traumatic sudden onset severe headache with a clinical suspicion of subarachnoid haemorrhage (SAH). The objective of this systematic review was to evaluate diagnostic strategies in these patients. METHODS: Studies assessing any decision rule or diagnostic test for evaluating neurologically intact adults with a severe headache, reaching maximum intensity within 1 hour, were eligible. Eighteen databases (including MEDLINE and Embase) were searched. Quality was assessed using QUADAS-2. Where appropriate, hierarchical bivariate meta-analysis was used to synthesise diagnostic accuracy results. RESULTS: Thirty-seven studies were included. Eight studies assessing the Ottawa SAH clinical decision rule were pooled; sensitivity 99.5% (95% CI 90.8 to 100), specificity 24% (95% CI 15.5 to 34.4). Four studies assessing CT within 6 hours of headache onset were pooled; sensitivity 98.7% (95% CI 96.5 to 100), specificity 100% (95% CI 99.7 to 100). The sensitivity of CT beyond 6 hours was considerably lower (≤90%; 2 studies). Three studies assessing lumbar puncture (LP; spectrophotometric analysis) following negative CT were pooled; sensitivity 100% (95% CI 100 to 100), specificity 95% (95% CI 86.0 to 98.5). CONCLUSION: The Ottawa SAH Rule rules out further investigation in only a small proportion of patients. CT undertaken within 6 hours (with expertise of a neuroradiologist or radiologist who routinely interprets brain images) is highly accurate and likely to be sufficient to rule out SAH; CT beyond 6 hours is much less sensitive. The CT-LP pathway is highly sensitive for detecting SAH and some alternative diagnoses, although LP results in some false positive results.

Non-urgent emergency department attendances in children: a retrospective observational analysis.

INTRODUCTION: A significant proportion of ED attendances in children may be non-urgent attendances (NUAs), which could be better managed elsewhere. This study aimed to quantify NUAs and urgent attendances (UAs) in children to ED and determine which children present in this way and when. METHODS: Dataset extracted from the CUREd research database containing linked data on the provision of care in Yorkshire and Humber. Analysis focused on children's ED attendances (April 2014-March 2017). Summary statistics and odds ratios (OR) comparing NUAs and UAs were examined by: age, mode and time of arrival and deprivation alongside comparing summary statistics for waiting, treatment and total department times. RESULTS: NUAs were more likely in younger children: OR for NUA in children aged 1-4 years, 0.82 (95% CI: 0.80 to 0.83), age 15 years, 0.39 (95% CI: 0.38 to 0.40), when compared with those under 1 year. NUAs were more likely to arrive out of hours (OOHs) compared with in hours: OR 1.19 (95% CI 1.18 to 1.20), and OOHs arrivals were less common in older children compared with those under 1 year: age 1-4 years, 0.87 (95% CI: 0.84 to 0.89) age 15 years, 0.66 (95% CI: 0.63 to 0.69). NUAs also spent less total time in the ED, with a median (IQR) of 98 min (60-147) compared with 127 min (80-185) for UAs. CONCLUSION: A substantial proportion of ED attendances in children are NUAs. Our data suggest there are particular groups of children for whom targeted interventions would be most beneficial. Children under 5 years would be such a group, particularly in providing accessible, timely care outside of usual community care opening hours.

Effect of Low-dose ColchiciNe on the InciDence of Atrial Fibrillation in Open Heart Surgery Patients: END-AF Low Dose Trial.

BACKGROUND: Studies using 1 mg of colchicine to prevent postoperative atrial fibrillation (POAF) reported conflicting results. Moreover, colchicine was associated with significant gastrointestinal (GI) side effects. This study examined whether low-dose colchicine effectively prevents POAF and whether low-dose therapy is associated with lower rates of colchicine-induced GI side effects. METHODS: In this prospective, randomized, double-blind, placebo-controlled study, consecutive adult patients admitted for elective cardiac surgeries randomly received a 1-mg dose of colchicine (n = 81) or placebo (n = 71) orally 12 to 24 hours before surgery followed by a daily dose of 0.5 mg until hospital discharge. The primary efficacy endpoint was the development of at least one episode of POAF of ≥5 minutes. The primary safety endpoint was the development of adverse events, especially diarrhea. RESULTS: The in-hospital mortality rate was 3.9%. POAF occurred in 13 patients (16.1%) in the colchicine group and 13 patients (18.3%) in the placebo group (odds ratio 0.85 [95% Confidence Interval = 0.37-1.99]). Diarrhea occurred in two patients in each group and necessitated treatment discontinuation in one patient in each group. CONCLUSION: Low-dose colchicine did not prevent POAF in patients undergoing cardiac surgery. These results should be interpreted cautiously because of the small sample size and early study termination.ClinicalTrials.gov Unique Identifier number: NCT03015831.

Lingual schwannoma in an adolescent girl- A diagnostic challenge.

Shwannoma, a benign neurogenic neoplasm consisting of schwann cells is a slow growing solitarily found pathology. We present a case of shwannoma in a 14 year old girl and its identifying features which can be a diagnostic challenge owing to its similarity with many lesions. The patient visited our center with a nodular growth on her tongue. Transoral excision was performed and pathologic examination confirmed the diagnosis of schwannoma.

Phylogenetic analysis of Salmonella species isolated from cows, buffaloes, and humans based on gyrB gene sequences.

This study aimed to investigate the role of dairy cows and buffaloes as reservoirs of nontyphoidal salmonelloses (NTS), to reveal the occurrence of NTS among dairy workers and children with acute diarrhea and to study the gyrB gene phylogenetic relations of the obtained Salmonella strains, 300 samples were chosen randomly from clinically infected animals, including 100 feces and 50 raw milk from buffaloes and cows. Five hundred samples were chosen randomly from healthy animals, including 150 feces and 100 raw milk from buffaloes and cows. A total of 160 stool samples were randomly chosen from healthy workers (60) and children with acute diarrhea (100). Salmonella species were isolated from the examined samples and identified by polymerase chain reaction. Sequencing and phylogenetic analyses of gyrB gene were also performed. S. enteritidis and S.typhimurium were isolated from 0.5% (2/400) of the cows and buffaloes, respectively. Dairy workers were found to be at greater risk of exposure to Salmonella infection (5%) than children (1%). S. enteritidis was isolated from 1.7% (1/60) of dairy workers. S. typhimurium was isolated from 3.33% (2/60) and 1% (1/100) of dairy workers and children, respectively. Phylogenetic analysis of Salmonella species gyrB gene sequences from both animals and humans falls inside one clade, and all of them were closely related to each other with less significant genetic distance (99.9:100). In conclusion, cows and buffaloes act as reservoirs of Salmonella infection in dairy farms in Egypt and contribute a risk of zoonotic transmission to human.

Effects of long-term dehydration on oxidative stress, apoptotic markers and neuropeptides in the gastric mucosa of the dromedary camel.

We investigated the effects of 20 days of dehydration and 20 days of dehydration followed by 72 h of rehydration on the gastric mucosa of the one-humped dromedary camel. The parameters addressed include biomarkers of oxidative stress, apoptosis, gastric epithelial histology, gastric neuropeptides, and their receptors. Nineteen clinically healthy, 4-5 year-old male dromedary camels were divided into three groups (five control camels, eight dehydrated for 20 days, six dehydrated for 20 days and then rehydrated for 72 h). Dehydration affected the oxidative stress biomarkers causing a significant increase in malondialdehyde, glutathione, nitric oxide, and catalase values compared with controls. Also the results revealed that dehydration caused different size cellular vacuoles and focal necrosis in the gastric mucosa. Rehydration for 72 h resulted in improvement in some parameters but was not enough to fully abolish the effect of dehydration. Dehydration caused significant increase in apoptotic markers; tumor necrosis factor α, caspases 8 and 3, BcL-x1 and TGFß whereas caspase 9, p53, Beclin 1, and PARP1 showed no significant change between the three groups indicating that apoptosis was initiated by the extrinsic pathway. Also there were significant increases in prostaglandin E2 receptors and somatostatin in plasma and gastric epithelium homogenate, and a significant decrease in cholecystokinin-8 receptors. A significant decrease of hydrogen potassium ATPase enzyme activity was also observed. Pepsinogen C was not affected by dehydration. It is concluded that long-term dehydration induces oxidative stress and apoptosis in camel gastric mucosa and that camels adjust gastric functions during dehydration towards water economy. More than 72 h are needed before all the effects of dehydration are reversed by rehydration.

Contribution of public places in proliferation of dengue vectors in Penang Island, Malaysia

Objective: To determine abundance, distribution and diversity of potential breeding container habitats of the dengue vectors in public places including schools, restaurants, mosques and parks in southwest areas of Penang Island, Malaysia. Methods: Premises at restaurants, schools, parks and mosques were surveyed simulta-neously and inspected visually for container habitats and production of immature mosquitoes from March 2015 to March 2016. Abundance (mean ± SE) of breeding containers between sites was compared using One-way ANOVA. Independent sample t-test was used to compare total number of Aedes albopictus (Ae. albopictus) and Aedes aegypti (Ae. aegypti) surveyed. Results: The surveyed locations yielded a total of 3741 breeding containers and 19537 immature mosquitoes from four areas. Concurrent artificial and natural containers pro-duced 78.4%immature Ae. albopictus and 6.3%Ae. aegypti mosquitoes in wet season, with 14.2% Ae. albopictus and 1.1% Ae. aegypti mosquitoes in dry season. Artificial containers accounted for 98.1% of the total containers recorded, with restaurants being the most productive locations (8012) and schools being the least productive (2234). Conclusions: It was concluded that public places are good sources of potential container habitats of Aedes mosquitoes in Penang Island, Malaysia and Ae. albopictus has exclu-sively replaced the home-grown Ae. aegypti even in urban areas. Therefore, treatment of artificial containers in such locations is critical in Aedes mosquito control campaigns during dengue outbreaks.

Qatari women living with cardiovascular diseases-challenges and opportunities to engage in healthy lifestyles.

In Qatar, cardiovascular diseases are the leading causes of morbidity and mortality. Cardiovascular diseases can be prevented and controlled by modifying lifestyle risk behaviors. In this qualitative study, we investigate ways to increase participation in physical activity, and to promote a healthy diet, and nonsmoking behavior in Qatari women. Individual in-depth interviews were conducted with 50 Arabic women. Participation in physical activity, observing a healthy diet, and abstinence from smoking are desirable lifestyle practices among Qatari women. Social support networks, cultural values, religion, changing sociodemographic and economic conditions, heart disease, and a harsh climate affect the ability of these women to pursue a healthy lifestyle.

A Comparative Study of the Microleakage of Resilon/Epiphany and Gutta-Percha/AH-Plus Obturating Systems.

INTRODUCTION: The aim of the present study was to investigate and compare the apical sealing ability of Resilon/Epiphany-filled root canals with those that were obturated with gutta-percha/AH-Plus endodontic sealer. MATERIALS AND METHODS: A total of 60 extracted human single-rooted teeth were selected; 25 teeth for each test group and five for each control group. After conducting conventional endodontic treatment, the teeth were immersed in physiologic saline solution for thirty days, and subsequently sealed and stored in methylene blue dye solution for seven days. The teeth were sectioned to evaluate the linear apical leakage using a stereoscopic microscope. The data were statistically analyzed by non-parametric Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The results showed significant differences between the two groups of endodontic sealers (P<0.001). CONCLUSION: Within the limitation of the present in vitro study, Resilon/Epiphany sealer had better apical sealing ability than gutta-percha/AH-Plus sealer.

Accurate sperm morphology assessment predicts sperm function.

Sperm morphology has been associated with in vitro as well as in vivo fertilisation. The study aimed to evaluate the possible relation between the percentage of spermatozoa with normal morphology and the following sperm functional assays: (i) zona-induced acrosome reaction (ZIAR); (ii) DNA integrity; (iii) chromatin condensation; (iv) sperm apoptosis; and (v) fertilisation rates. Regression analysis was employed to calculate the association between morphology and different functional tests. Normal sperm morphology correlated significantly with the percentages of live acrosome-reacted spermatozoa in the ZIAR (r = 0.518; P < 0.0001; n = 92), DNA integrity (r = -0.515; P = 0.0018; n = 34), CMA(3) -positive spermatozoa (r = -0.745; P < 0.0001; n = 92), sperm apoptosis (r = -0.395; P = 0.0206; n = 34) and necrosis (r = -0.545; P = 0.0009; n = 34). Negative correlations existed between for the acrosome reaction, and DNA integrity, while negative associations were recorded with the percentages of CMA(3) -positive spermatozoa, apoptotic and necrotic spermatozoa. Sperm morphology is related to sperm dysfunction such as poor chromatin condensation, acrosome reaction and DNA integrity. Negative and significant correlations existed between normal sperm morphology and chromatin condensation, the percentage of spermatozoa with abnormal DNA and spermatozoa with apoptotic activity. The authors do not regard sperm morphology as the only test for the diagnosis of male fertility, but sperm morphology can serve as a valuable indicator of underlying dysfunction.

Unusual developing sites of dengue vectors and potential epidemiological implications

Objective: To identify the unusual breeding sites of two dengue vectors, i.e. Aedes albopictus (Ae. albopictus) and Aedes aegypti (Ae. aegypti). Methods: During the second half of 2010, we performed an occasional survey in rural (Teluk Tempoyak) and urban (Gelugor) areas of Penang Island, Malaysia, to identify cryptic breeding sites. Results: In the rural area, we found heterogeneous immature stages of Ae. albopictus in the water bowl of an encaged bird. We also observed Ae. aegypti eggs deposited in the flush tank of a toilet in the urban area. Conclusions:It can be concluded that both breeding patterns can increase contact with hosts (humans and birds) and presumably population densities of Ae. albopictus and Ae. aegypti, thereby potentially boosting the risks for spread and transmission of arboviral diseases.

Pilot study on relation of the periapical status and quality of endodontic treatment in an adult Sudanese population

The purpose of the present cross-sectional pilot study was to evaluate the influence of the quality of root canal fillings and coronal restorations on the periradicular status of these teeth. Seventy adult patients attended the Conservative dentistry clinic (Faculty of Dentistry, University of Khartoum), seeking routine dental care (not emergency care) were included. Patients were examined and the coronal restoration status was scored according to a modification of Ryge’s criteria for marginal adaptation. The quality of the root filling was assessed radiographically for length and homogeneity. The periapical status was categorized on the basis of presence or absence of signs of apical periodontitis (AP). The relationship between coronal status, quality of root filling and periapical health was determined statistically using Χ2 test. Thirtyfour teeth (48.57%) showed signs of AP. The combination of adequate coronal restoration and adequate root filling resulted in significantly reduced incidence of apical periodontist of 12.5% compared to 76.47% presence of AP when both parameters scored as inadequate. There was statistically significant relation between the quality of the treatment and the periapical status (p = 0.001). The incidence of AP in root-filled teeth was high. The importance of a good coronal restoration and an adequate root filling should be stressed as they both influence the periapical health.

Things that go bump ... bump ... bump: an analysis of injuries from falling down stairs in children based at Sheffield Children's Hospital.

BACKGROUND: Falls down stairs are a common presentation to the paediatric emergency department. The pattern of injury associated with this mechanism of injury has not been described for the UK population. A retrospective analysis of attendances to the Emergency Department of Sheffield Children's Hospital was carried out. RESULTS: Overall 90% (216/239) of patients sustained one or more injuries; 69% (165/239) sustained minor head and facial injuries; 12% (29/239) sustained minor soft tissue injuries of other regions; 10% (23/239) had limb fractures, of which 60% (14/23) were of the upper limb (nine clavicle fractures, one supracondylar fracture of the elbow and four wrist fractures) and 40% (9/23) were of the lower limb (four femoral fractures and five tibial fractures). Two per cent (5/239) had skull fractures (all were in the group of children dropped while being carried on the stairs). Injuries to more than one body part occurred in only 3% (8/239) of cases. DISCUSSION: The results suggest that children who fall down the stairs are mainly toddlers and in general sustain only minor injuries, the commonest being a minor head injury. Severe truncal and extremity injuries or injuries involving multiple body regions should provoke further questioning looking for evidence of non-accidental injury. There is no correlation between the number of stairs fallen down and the likelihood or severity of injury. CONCLUSION: Infants who fall down stairs with their carer or are dropped while being carried down stairs require an especially close evaluation.

Myocardial dysfunction in malnourished children.

BACKGROUND: Malnourished children suffer several alterations in body composition that could produce cardiac abnormalities. AIM: The aim of the present study was to detect the frequency of myocardial damage in malnourished children as shown by echocardiography and cardiac troponin T (cTnT) level. METHODS: Forty-five malnourished infants and young children (mean±SD of age was 11.24 ±7.88 months) were matched with 25 apparently healthy controls (mean±SD of age was 10.78±6.29 months). Blood sample was taken for complete blood picture, liver and kidney function tests, serum sodium, potassium, calcium levels and cTnT. All the malnourished children were subjected to echocardiographic evaluation. RESULTS: Malnourished children showed a significantly lower left ventricular (LV) mass than the control group. The LV systolic functions were significantly impaired in patients with severe malnutrition. The cTnT level was higher than the upper reference limits in 11 (24.44%) of the studied malnourished children and all of them had a severe degree of malnutrition. The cTnT level was significantly higher in patients with anemia, sepsis and electrolyte abnormalities and it correlated negatively with LV ejection fraction (EF). Six of the studied children with high cTnT levels (54.5%) died within 21 days of treatment while only one case (2.9%) with normal level of cTnT died within the same period. CONCLUSIONS: LV mass is reduced in malnourished children. Children with severe malnutrition have a significant decrease in LV systolic functions. Elevated cTnT levels in malnourished children has both diagnostic and prognostic significance for cardiomyocyte damage.