Attitudes, Beliefs, and Behaviors of Topical Antibiotic Prescribing among Primary Care Providers in Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: The World Health Organization (WHO) estimates that 20-50% of antibiotics are misused in society. In addition to the development of antimicrobial resistance, topical antibiotics have been associated with adverse effects such as allergic contact dermatitis (ACD) and inadequate wound healing. This study investigated the appropriateness of topical antibiotic prescriptions among primary care providers in Saudi Arabia. METHODS: A cross-sectional survey was conducted among Saudi Arabian primary care providers (physicians (general, family, and internal medicine)) employed in governmental and non-governmental healthcare facilities (primary care centers and outpatient clinics). RESULTS: In total, 222 participants were included in the analysis. A total of 73% agreed that inappropriate topical antibiotic use puts patients at risk, and 43% reported antibiotic resistance in daily practice. Many respondents lacked knowledge of the proper indications for topical antibiotics, and 66.2% attributed this to a lack of updated knowledge, while 45% blamed inadequate supervision. CONCLUSION: Antibiotic prescription patterns deviated from the standards recommended by WHO. This calls for continuous review at all levels of healthcare, providing more physician education and ensuring that antibiotic therapy guidelines are easily accessible and effectively used to avoid the negative consequences of inappropriate antibiotic prescription.

Mechanistic Insights into the Ameliorative Effect of Cichoriin on Diabetic Rats-Assisted with an In Silico Approach.

Type 2 diabetes mellitus is considered to be a substantial socioeconomic burden worldwide on both patients and governments. Coumarins are biomolecules with a diversity of biological activities. The current investigation aimed to explore the ameliorative effects of cichoriin, which is a type of coumarin, on high-fat diet/streptozotocin (HFD/STZ)-induced diabetic rats. METHODS: Rats were allocated into five groups. Group I was considered as the control group, while the other groups were HFD/STZ-induced diabetic rats. Group II was assigned as the diabetic control. Groups III and IV were treated with cichoriin (50 or 100 mg/kg, respectively). Group V received glibenclamide (5 mg/kg) (as a positive control). The blood glucose (BG), serum insulin, triglycerides (TG), total cholesterol (TC), total antioxidant capacity (TAC), catalase, hepatic superoxide dismutase (SOD) and content of malondialdehyde (MDA) were assessed. Histopathological and immunohistochemistry analysis of pancreatic tissue were performed. mRNA and protein expressions of GLUT4, AMPK, and PI3K were estimated. RESULTS: Cichoriin treatment ameliorated HFD/STZ-induced diabetic conditions and mitigated the histopathological characteristics of the pancreas, as well as increasing pancreatic insulin expression. This decreased the levels of BG, TG, TC, and MDA and improved the TAC, catalase and SOD contents. Cichoriin demonstrated upregulation of mRNA and protein expressions of GLUT4, AMPK, and PI3K. The in silico binding of cichoriin with GLUT4, AMPK, and PI3K supported the possible current activities. CONCLUSION: Collectively, this work highlighted the potential role of cichoriin in mitigating HFD/STZ-induced diabetic conditions and showed it to be a valuable product.

Mucopolysaccharidoses diagnosis in the era of enzyme replacement therapy in Egypt.

BACKGROUND: Undegraded glycosaminoglycans (GAGs) induced by deficiency of enzymes are the primary cause of mucopolyscchardoses. Mucopolysacchardoses (MPS) are a group of rare lysosomal storage diseases (LSD). The quantification of a specific enzymatic activity is needed for accurate diagnosis. The objectives of this work were: first, to continue the study of mucopolysacchardoses disease in Egypt after the start of using the enzyme replacement therapy (ERT). Second, to define the commonest types among our population after 18 years experience with the disease. Third, to compare the different MPS types' distribution, diagnosed after the start of the ERT, to identify the impact of using ERT on the number and type of diagnosed patients. METHOD: Urinary GAGs were measured for all referred cases followed by two-dimensional electrophoretic separation for cases with high levels of GAGs; the specific enzyme activity was assayed for each type depending on the abnormal electrophoretic pattern obtained. Clinically suspected cases of Morquio syndrome were directly subjected to measuring the specific enzyme. RESULTS: Out of 1448 suspected cases, 622 (42.9%) MPS patients were diagnosed revealing the following distribution: MPS I (172, 27.7%), MPS II (57, 9.1%), MPS III [(177, 28.5%: 134 type B and 43 types A, C or D)], MPS IVA (124, 19.9%), MPS VI (90, 14.5%) and MPS VII (2, 0.3%). MPS III was the most commonly diagnosed type followed by MPS I and MPS IVA. MPS IVA represented the most common type receiving treatment, followed by MPS I, MPS II and MPS VI. CONCLUSION: The presence of treatment encouraged the affected families and physicians to seek diagnosis. MPS III was the commonest type among our studied group after 7 years of diagnosis, while MPS IVA was the commonest type receiving treatment.

Ultrasound guided lipofilling as a suggested method for implant salvage in implant based breast reconstruction: A case report.

BACKGROUND: Implant based reconstruction is one of the well-established methods to restore shape and volume after total mastectomy. Exposure of an implant is a serious complication that could lead to failure of the whole process of breast reconstruction. There are no uniform guidelines on the management of such complication. Several methods have been described including antibiotic irrigation, implant replacement and flap coverage. This case report describes the use of ultrasound guided lipofilling for implant salvage in case of an exposed non-infected implant. CASE PRESENTATION: A 29-year-old patient with T3N1 post neoadjuvant chemotherapy breast cancer underwent skin sparing mastectomy and immediate subpectoral implant based reconstruction. She presented a week post hospital discharge with an exposed non infected silicone implant. Antibiotic irrigation and secondary sutures were done with satisfactory wound healing within eight days. However, ultrasound examination revealed a sizeable area where the implant was in direct contact with the skin. Utrasound guided lipofilling was done in the same setting as contralateral mastopexy to achieve symmetry. The patient had a smooth postoperative course. She was referred to radiation therapy department where she received adjuvant chest wall irradiation according to her pathological result. Follow up after radiation therapy by clinical and ultrasound examination revealed no implant related complications. CONCLUSION: Lipofilling is a very useful tool that could help in cases of an uninfected exposed implant. It could also be used primarily as an adjunct procedure to implant based reconstruction to optimize the outcome.

Effect of hydrothermal and Ca(OH)2 pretreatments on anaerobic digestion of sugarcane bagasse for biogas production.

The effect of hydrothermal (HTP) and Ca(OH)2 pretreatments on the biogas produced by the anaerobic digestion of sugarcane bagasse (SCB) was studied. HTP, Ca(OH)2 and combination pretreatment had significant effects on hemicellulose and lignin degradation during pretreatment and methane yield through digestion. The highest biogas production observed in combination pretreatment HTP 180 + 8.5% of SCB reached 318 mL/g Volatile Solids (VS), which were 47% higher than the untreated SCB, with the highest methane content 69% and highest lignin degradation 44%. The functional groups and the structural changes in the pretreated SCB have also been analyzed by Fourier Transform Infrared Spectroscopy (FTIR) and Scanning Electron Microscopy (SEM) analysis. Kinetic analysis of methane production potential from SCB was determined to compare ultimate methane yields and kinetic constants. The results of this research contribute useful information to improve the efficiency of anaerobic digestion of SCB by pretreatment.