Integrated transmission expansion planning incorporating fault current limiting devices and thyristor-controlled series compensation using meta-heuristic optimization techniques.

Transmission expansion planning (TEP) is a vital process of ensuring power systems' reliable and efficient operation. The optimization of TEP is a complex challenge, necessitating the application of mathematical programming techniques and meta-heuristics. However, selecting the right optimization algorithm is crucial, as each algorithm has its strengths and limitations. Therefore, testing new optimization algorithms is essential to enhance the toolbox of methods. This paper presents a comprehensive study on the application of ten recent meta-heuristic algorithms for solving the TEP problem across three distinct power networks varying in scale. The ten meta-heuristic algorithms considered in this study include Sinh Cosh Optimizer, Walrus Optimizer, Snow Geese Algorithm, Triangulation Topology Aggregation Optimizer, Electric Eel Foraging Optimization, Kepler Optimization Algorithm (KOA), Dung Beetle Optimizer, Sea-Horse Optimizer, Special Relativity Search, and White Shark Optimizer (WSO). Three TEP models incorporating fault current limiters and thyristor-controlled series compensation devices are utilized to evaluate the performance of the meta-heuristic algorithms, each representing a different scale and complexity level. Factors such as convergence speed, solution quality, and scalability are considered in evaluating the algorithms' performance. The results demonstrated that KOA achieved the best performance across all tested systems in terms of solution quality. KOA's average value was 6.8% lower than the second-best algorithm in some case studies. Additionally, the results indicated that WSO required approximately 2-3 times less time than the other algorithms. However, despite WSO's rapid convergence, its average solution value was comparatively higher than that of some other algorithms. In TEP, prioritizing solution quality is paramount over algorithm speed.

ACTION Teens Saudi Arabia: Perceptions, attitudes, motivators, and barriers among adolescents living with obesity, caregivers, and healthcare professionals in Saudi Arabia.

Obesity is predicted to affect approximately one-quarter of children/adolescents in Saudi Arabia by 2030, but there is limited evidence regarding the perceptions, attitudes, behaviours, and barriers to effective obesity care for adolescents living with obesity (ALwO), caregivers of ALwO, and healthcare professionals (HCPs). We report data from 500 ALwO (aged 12-<18 years), 500 caregivers, and 200 HCPs surveyed in Saudi Arabia as part of the global, cross-sectional ACTION Teens study (NCT05013359). Nearly all respondents recognized that obesity has a strong impact on overall health (ALwO 88%; caregivers 85%; HCPs 90%). Most ALwO and caregivers were aware of the ALwO's obesity status (95% and 99%, respectively) and worried about weight impacting the ALwO's future health (both ≥99%), and social media was their most commonly used source of weight-management information (60% and 53%, respectively). Among ALwO and caregivers who had discussed weight with an HCP in the past year, most experienced ≥1 negative feeling following their most recent discussion (61% and 59%, respectively). Although 81% of HCPs felt motivated to help their ALwO patients lose weight, 57% believed weight loss was completely the ALwO's responsibility (compared with only 37% of ALwO and 35% of caregivers). This may reflect the finding that only 24% of HCPs had received advanced training in obesity/weight management after medical school. Overall, while respondents had similar perceptions of the impact of obesity, we found HCPs' attitudes towards weight loss were not aligned with those of ALwO and caregivers, suggesting a need for improved communication and obesity education.

Photodynamic therapy mediated by methylene blue-loaded PEG accelerates skin mouse wound healing: an immune response.

PURPOSE: Conventional approaches for enhancing wound healing may not always yield satisfactory results. Instead, we test the effectiveness of a newly developed photodynamic therapy (PDT) that uses methylene blue (MB) loaded with polyethylene glycol (PEG) (MB-PEG) hydrogel to accelerate wound healing process in mice. METHODS: A dorsal skin incision with 6 mm punch which topically subjected to MB-PEG hydrogel and a low-level laser light of red light to assess the regeneration process of wounded skin. A total of 63 adult male CD1 mice divided into normal group (no treatment) and other wound groups received different treatments of laser (650 ± 5 nm and power intensity of 180 mW/cm2), MB-PEG, or PDT (MB-PEG followed by laser). The wound healing parameters were investigated by histological examination of the skin and measuring of proinflammatory cytokines at the early stage (48 h) and a late one on day 21. RESULTS: at 48 h, the score of tissue granulation, inflammation, and angiogenesis process were markedly improved in wounded groups that received MB + PEG combined with laser compared to the group treated with laser alone. On day 21, a significant improvement of the inflammation was detected in the group treated with MB + PEG plus laser compared to the other groups. At 48 h, the upregulated serum levels of tumor necrosis factor (TNF)-α and interleukin (IL)-1ß in the wound group were significantly (P < 0.001) reduced in the group treated with MB + PEG combined with laser. CONCLUSION: MB-PEG based hydrogel improves and accelerates wound closure in the context of laser compared to either single treatment.

Geometrical Characteristics of Grade III Arteriovenous Malformations That Contribute to Better Outcomes in Endovascular Treatment.

BACKGROUND: Grade III brain arteriovenous malformation (AVM) is a distinct subgroup of AVMs that encompasses multiple subtypes according to the Spetzler-Martin classification. METHODS: This retrospective study included 61 patients with grade III AVM who underwent embolization between 2010 and 2022. The study analyzed the angioarchitecture of the AVM nidus and evaluated the outcomes of the embolization procedures. RESULTS: There were 29 patients (47.5%) with subtype S1E1V1, 20 patients (32.8%) with subtype S2E1V0, and 12 patients (19.7%) with subtype S2E0V1. The rate of complete occlusion in all patients was 47.5% (29 patients). The rate of complete occlusion was higher in cases with a compact nidus (P < 0.001). Several parameters were associated with occlusion of the AVM nidus, including ≤3 arterial feeders (P = 0.017) and presentation with hemorrhage (P = 0.007), with the majority of patients with a compact nidus presenting with hemorrhage. Other factors associated with compact geometry were the presence of a single deep vein, ≤3 arterial feeders, ≤2 superficial draining veins, and an AVM nidus size ≤3 cm. CONCLUSIONS: The compact nature of grade III AVM is a crucial predictor for the success of embolization. Several characteristics associated with a compact nidus, such as presentation with hemorrhage and a lower number of arterial feeders, have a significantly higher closure rate. Other factors, such as a single deep draining vein, reduced superficial venous drainage, and small size, show a strong association with complete obliteration.

The prognostic role of urea-to-creatinine ratio in patients with acute heart failure syndrome: a case-control study.

BACKGROUND: Recent research has shown that the blood urea/creatinine ratio (BUN/Cr) rather than BUN or Cr alone can predict the prognosis of individuals with acute heart failure (AHF). The objective of this study was to estimate the urea-to creatinine serum ratio (BUN/Cr) in patients with acute decompensated heart failure (ADHF) and correlate the results with patient outcome, length of hospitalization, and mortality. RESULTS: Sixty ADHF patients were included and categorized into four groups; Group I: non-AKI with low BUN/Cr (n = 25); Group II: non-AKI with high BUN/Cr (n = 5); Group III: AKI with low BUN/Cr (n = 14); Group IV: AKI with high BUN/Cr (n = 16). Regarding urea and BUN levels, the first reading showed a considerable rise in urea and BUN levels in groups III and IV compared to group 1 and in group IV compared to groups I and III. Similar results were recorded in the second and third readings. Regarding the BUN/Cr ratio, the three readings revealed a significant elevation in group IV compared to groups I and II and in group IV compared to group III. Mortality was significantly higher in group IV compared to group I. Additionally, MACE was significantly more frequent in group IV compared to groups I and III. Multivariable logistic regression analysis revealed that hypertension, creatinine, and BUN were independent predictors of AKI. CONCLUSIONS: BUN/Cr may predict prognosis in AHF patients since AHF with an elevated BUN/Cr is associated with a higher death rate.

The Efficacy and Safety of Ivabradine in Arrhythmias: A Systematic Review

Background: Treating arrhythmia adequately is crucial to prevent cardiac morbidity and mortality. Previous studies report that ivabradine may increase the risk of atrial fibrillation; however, emerging evidence shows that the drug may have beneficial effect in treatment of arrhythmia. Purpose: The present research explored the clinical evidence regarding the clinical efficacy and safety of ivabradine to treat arrhythmias. Method: A comprehensive literature search was conducted using MEDLINE, EMBASE, Scopus, Google Scholar and Web of Science databases. Full text articles that report on the use of ivabradine in human subjects with arrhythmia are included. Studies not written in English language and those not published in the period between 2016 and May 2021 were excluded. Results and discussion: Eight articles were included in the current review after screening a total of 1100 articles. The studies depicted that ivabradine is effective in improving ventricular rate, heart rate, and sinus rhythm in atrial fibrillation and has limited or no side effects. In addition, the findings indicate that combining ivabradine with other medications is more effective for improving the ventricular rate and maintain sinus rhythm than when used alone. Conclusion: Ivabradine alone or in combination with other medications can therefore be used as a potential treatment for arrhythmias. (AU)

An Analysis of the Literature and a Case Study on the Successful Surgical Treatment of a Crohn's Patient Using a Kono-S Anastomosis.

Background: Crohn's disease (CD) is a chronic inflammatory bowel disease affecting the gastrointestinal tract. Treatment involves immunosuppression, and surgical intervention is sometimes necessary for patients who do not respond to medical treatment. However, recurrence of the disease is a common complication after surgery. Aim: This case report focuses on a patient with CD who underwent ileocecal resection with Kono-S anastomosis, a surgical technique aimed at reducing recurrence rates. Case description: A 43-year-old male with a known history of CD for 13 years presented with recurring moderate-to-severe lower abdominal pain associated with belching, nausea, subjective fever, and sweats. The patient was on infliximab and azathioprine. Investigations confirmed irregular skip mural thickening of ileal loops with significant luminal narrowing along with stenotic fibrostrictures of the ileum, and mild bilateral sacroiliitis. The patient was treated surgically with an ileocecal resection and a Kono-S anastomosis operation. This case report highlights the advantages and disadvantages of the Kono-S anastomosis technique in treating patients with recurrent CD. Clinical significance: Kono-S anastomosis demonstrates a relative safety profile and carries several potential benefits. However, its wider adoption is limited due to insufficient familiarity among surgeons and the possibility of complications. Nevertheless, embracing Kono-S as the standard anastomosis method holds the promise of significant advantages for individuals with CD. Conclusion: This case report highlights the potential benefits of Kono-S anastomosis in reducing CD recurrence and provides valuable insights for further research and clinical practice. How to cite this article: Saeed M, Algahiny AT, Elmitwalli OSMMS, et al. An Analysis of the Literature and a Case Study on the Successful Surgical Treatment of a Crohn's Patient Using a Kono-S Anastomosis. Euroasian J Hepato-Gastroenterol 2023;13(1):36-39.

Economic Reliable Arthroscopic Technique for Reduction and Fixation of Acute Acromioclavicular Joint Dislocation.

Separation of the acromioclavicular joint (ACJ) is a common orthopaedic injury among athletes involved in contact sports and victims of motor vehicle accidents. ACJ disruptions are common in athletes. Treatment is guided by the level of injury; grade 1 and 2 injuries are managed nonoperatively. Grades 4-6 are managed operatively, whereas grade 3 is an area of controversy. Several operative techniques have been described to restore anatomy and function. We present a technique that's safe, economic, and reliable in the management of acute ACJ dislocation. It allows intra-articular glenohumeral assessment and relies on a coracoclavicular sling. This is an arthroscopic-assisted technique. It entails a small transverse or vertical incision over distal clavicle 2 cm away from ACJ, which enables us to reduce the ACJ and maintain reduction with a k-wire, checked by the C-arm. Diagnostic shoulder arthroscopy is then performed to assess the glenohumeral joint. The rotator interval is liberated and the coracoid base is exposed, and PROLENE sutures are then passed anterior to the clavicle medial and lateral to the coracoid. It is the used to shuttle polyester tape and ultrabraid as a sling under the coracoid. A tunnel is then made in the clavicle, then one end of suture is passed through the tunnel whereas the other end remains anterior. Several knots are made to ensure it is secured, then the deltotrapezial fascia is closed as a separate layer.

Primary and Secondary Breast Sarcoma: Clinical and Pathological Characteristics, Prognostic Factors, and Nomograms for Predicting Survival.

BACKGROUND: Breast sarcoma is one of the rare types of breast tumors with different features and outcomes compared to carcinoma. Our study aims to describe the clinical and pathological characteristics of primary breast sarcoma (PBS) and secondary breast sarcoma (SBS) along with determining prognostic factors and developing nomograms for predicting survival. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) Program, female patients diagnosed with breast sarcoma between 1975 and 2016 were identified. Cox regression was used to evaluate the association between survival and clinical features. RESULTS: Out of 1334 included patients, 816 had PBS and 518 had SBS. PBS had a significantly better overall survival than SBS with median survival months of 107 for PBS and 45 for SBS. The primary tumor site did not have a significant impact on the survival of SBS. Cox regression showed worse survival of PBS patients who were > 60 years (HR 3.04, 95% CI 2.46-3.74) and had tumor size > 50 mm (HR 2.01, 95% CI 1.61-2.51). Being not married was associated with worse survival of PBS (HR 1.29, 95% CI 1.06-1.56) and SBS (HR 1.50, 95% CI 1.19-1.90). Surgery was associated with better survival of PBS (HR 0.60, 95% CI 0.42-0.85) and SBS (HR 0.46, 95% CI 0.31-0.68). The C-indexes of created nomograms were 0.73 for PBS and 0.69 for SBS. CONCLUSION: Age and size were the most important prognostic factors for the survival. Surgery was associated with better survival. However, radiation and chemotherapy did not show significant improvement in survival.

Psoriasis: is it a risk factor for cardiovascular diseases?

BACKGROUND/OBJECTIVES: Psoriasis, newly considered as a systemic inflammatory condition, has a high prevalence of cardiovascular diseases (CVDs), including atherosclerosis and myocardial infarction. Measurement of carotid artery intima-media thickness (C-IMT) represents a noninvasive diagnostic tool for predicting cardiovascular disorders. We aimed to determine if psoriatic patients have an increased risk for the development of cardiovascular disorders by assessment of the presence of subclinical atherosclerosis in psoriasis patients. METHODS: Forty adult psoriatic patients and 40 matched healthy controls were selected in this study. All participants were subjected to full history, examination, assessment of the severity of psoriasis using psoriasis area and severity index (PASI) score, measuring serum lipid profile (cholesterol, low density lipoprotein (LDL) and triglycerides) and C-IMT. RESULTS: Psoriatic patients showed significantly higher serum lipid profile findings and C-IMT. There was a positive statistically significant correlation between C-IMT and each of age of the patients (r = 0.760, p<.001) and severity of psoriasis (PASI score). CONCLUSIONS: There is increased susceptibility to CVDs in psoriatic patients represented by increased incidence of subclinical atherosclerosis and dyslipidemia in our patients.

Endoscopic Transcortical-Transventricular Approach in Treating Third Ventricular Craniopharyngiomas-Case Series With Technical Note and Literature Review.

BACKGROUND: A paradigm shift toward less radicality in the treatment of craniopharyngioma (CP) has increasingly gained recognition. In selected patients, a less invasive approach aiming at cyst decompression may be suitable. OBJECTIVE: To present our experience with the endoscopic transcortical-transventricular approach (ETTA) for the treatment of CP located in the third ventricle, describe our surgical technique, and explore the results reported in the literature. METHODS: Data for third ventricular CPs treated using ETTA in 2 tertiary medical centers between 2006 and 2020 were retrospectively reviewed. Cystic, mixed lesion, new, and recurrent cases were included. ETTA aimed at cyst fenestration, subtotal or partial tumor resection, managing the hydrocephalus, or a combination of these modalities. Fractionated radiotherapy (RT) was performed (54 Gy in 30 fractions). RESULTS: The described approach was performed in 13 patients with a mean age of 30.2 years. Tumor excision was attempted in 10 patients. Cystic fenestration alone was conducted in 3 patients, followed by intracystic catheter implantation in 2 patients. Permanent diabetes insipidus developed in 3 patients, and 1 patient experienced a surgical site infection. The recurrence rate for ETTA + RT (pre-ETTA in 33.3%) was 2/9 (22.2%) after a mean follow-up of 21.3 months. Four patients did not undergo RT after ETTA, and all these patients experienced recurrences after a mean follow-up of 15.5 months. Hydrocephalus resolved in all 6 patients who presented with accompanying hydrocephalus. CONCLUSION: ETTA combined with adjuvant RT is a safe and effective option in the management of cystic or predominantly cystic CP extending into the third ventricle. This procedure also effectively treats the accompanying hydrocephalus.

Comparative 16S Metabarcoding of Nile Tilapia Gut Microbiota from the Northern Lakes of Egypt.

Nile tilapia, Oreochromis niloticus, is the principal fish bred in Egypt. A pilot study was designed to analyze the bacterial composition of the Nile tilapia fish guts from two saltwater lakes in Northern Egypt. Fish samples were obtained from two Delta lakes: Manzala (ML) and Borollus (BL). DNA was extracted, and the bacterial communities in the stomach content were classified (down to the species level) using the 16S rRNA-based analysis. From the two metagenomics libraries in this study, 1,426,740 reads of the amplicon sequence corresponding to 508 total taxonomic operational units were recorded. The most prevalent bacterial phyla were Proteobacteria, Firmicutes, Actinobacteria, and Synergistetes in all samples. Some of the strains identified belong to classes of pathogenic zoonotic bacteria. A notable difference was observed between gut bacteria of Nile tilapia fish obtained from BL and ML. There is a remarkable indication that Nile tilapia fish living in BL is heavily burdened with pathogenic microbes most remarkably those involved with methylation of mercury and its accumulation in fish organs. These pathogenic microbes could have clinical implications and correlated with many diseases. This result was also consistent with the metagenomic data's functional prediction that indicated that Nile tilapia species harboring these two Egyptian northern lakes may be exposed to numerous anthropogenic pollutants. The findings show that the host environment has a significant impact on the composition of its microbiota. The first step towards exploring the better management of this profit-making fish is recognizing the structure of the microbiome.

High-risk human papillomavirus enhances the expression of COX-2 VEGF, EGFR, ProEx-C, and TERT proteins in human papillomavirus-related multiphenotypic sinonasal carcinoma through activation of PI3K/Akt, pRb, and TERT signalling pathways.

Human papillomavirus (HPV)-related multiphenotypic sinonasal carcinoma (HMSC) is a new type of sinonasal tumour that frequently drops out of accurate diagnosis. Human papillomavirus related multiphenotypic sinonasal carcinoma was previously known as HPV-related sinonasal carcinoma with adenoid cystic characteristics, and it is connected to high-risk HPV (HR-HPV) strains whose prognosis is unknown. We aim to evaluate PI3K/Akt, pRb, and h telomerase reverse transcriptase (TERT) signalling pathway activation through the expression of proteins cyclooxygenase-2 (COX-2), vascular endothelial growth factor (VEGF), ProEx-C, and TERT and their prognostic and clinicopathological value in HMSC patients. Sections of the 40 paraffin blocks of HMSC were recovered, and all samples were evaluated for the presence of a cocktail of HR-HPV, and the absence of MYB, NFIB, and MYBL1 fusions using fluorescence in situ hybridization; the presence of myoepithelial markers; S100, actin; the presence of squamous differentiation markers; calponin, p40, and p63 using PCR-based assays; and COX-2,VEGF, ProEx-C, and TERT using immunohistochemical staining. All patients were monitored for around 54 months, until death, or the last known surviving data (range 20-60 months). A statistically significant relationship exists between COX-2 expression was significantly related to the old age group, tumour extent, relapse, mortality, and poor DFS; (p = 0.001), (p = 0.01), (p = 0.002), and (p = 0.035), respectively. While VEGF, ProEx-C, and TERT expression with the old age group, tumour extent, lymph node metastasis, advancedstaging, relapse, mortality, poor disease free survival (DFS), and overall survival (p = 0.001). Human papillomavirus-related multiphenotypic sinonasal carcinoma is a unique sinonasal neoplasm with a strong link to HR-HPV strains. Expression of COX-2, VEGF, EGFR, ProEx-C, TERT was linked to poor prognosis, survival, and aggressive malignant behaviours such as proliferation, local recurrence, and lymph node metastasis, making them novel beneficial biomarkers and targeted therapies for HMSC patients.

Retrospective analysis of nontraumatic subdural hematoma incidence and outcomes in Egyptian patients with end-stage renal disease on hemodialysis.

BACKGROUND: The incidence of subdural hematoma (SDH) in chronic maintenance hemodialysis (CMH) patients may change over time, along with the evolving characteristics of the underlying populations. METHODS: We conducted a retrospective, single-center study at Cairo University hospitals, assessing the incidence, associated risk factors, and outcomes of nontraumatic SDH in CMH patients between January 2006 and January 2019. RESULTS: Out of 1217 CMH patients, nontraumatic SDH was diagnosed in 41 (3.37%) during the study, increasing with the enrollees' age but stable over the observation period and translating into an annual incidence rate of 28 per 1000 patients per year. SDH patients were likely to use central venous catheters, reported pruritis and history of bone fractures, and had higher phosphorus, parathyroid hormone, and alkaline phosphatase values (p < 0.001); however, there was no association with atrial fibrillation or use of anticoagulants. In the SDH cohort (n = 41), six patients did not need surgical intervention and 13 patients died before becoming surgically fit for intervention; mortality correlated with ischemic heart disease (p = 0.033) and the presence of atrial fibrillation or chronic anticoagulation with warfarin (p < 0.0001 for both), among others. Twenty-two patients received surgical operations and of these 2 died postoperatively; overall patient mortality was 12/41 (29.27%) at 30 days and 15/41 (36.59%) at 1 year. CONCLUSION: Our study demonstrated a striking enrichment for underlying comorbidities in those patients developing SDH and a high risk of immediate mortality. The benefit of chronic anticoagulation therapy should be carefully weighed against the risk of CNS bleed in MHD patients.

A parasitological survey of zoonotic cestodes carried by house rats in Aswan, Egypt, reveals cryptic diversity at the molecular level.

BACKGROUND AND AIM: Some rat cestodes are zoonotic and are capable of parasitizing humans and animals, raising serious concerns regarding human and veterinary health. The study aimed to determine the prevalence and risk factors for cestodes in Egyptian house rats and to characterize the cestodes molecularly. MATERIALS AND METHODS: The current survey examined 115 house rats (Rattus rattus) in two cities (Edfu and Aswan) in Egypt's Aswan Governorate for cestode infection using integrated molecular approaches (polymerase chain reaction, sequencing, and phylogenetic analysis) and morphological/morphometrical approaches. RESULTS: The cestodes identified in this study exhibited the typical morphological characteristics of Hymenolepis diminuta (Rudolphi, 1819), Hymenolepis nana (Siebold, 1852) (from rat intestine), and Hydatigera taeniaeformis (from rat liver). The species prevalence rates from these three studies were reported to be 8.7%, 10.4%, and 20.9%, respectively. The ribosomal DNA (ITS1, 18S, and complete ITS) sequences revealed that the hymenolepid sequences were highly distinct but were related to other sequences in the GenBank database, with some sequences showing high similarities to those of H. nana and H. diminuta. In addition, the H. taeniaeformis sequences (ITS2 and mitochondrial cytochrome c oxidase subunit 1 [mtCOX1]) obtained in this study were highly similar to some Taenia taeniaeformis GenBank sequences. The constructed phylogram revealed that the hymenolepidid tapeworms examined in this study were classified into four major branches (the majority of which were hybrids of the two species) and belonged to the genus Hymenolepis. In addition, the phylogram of H. taeniaeformis assigned this species to T. taeniaeformis. CONCLUSION: When typical hymenolepid morphology is combined with molecular and phylogenetic divergence, it may indicate the existence of possible cryptic species. In addition, on the basis of the phylogenetic analysis, genetic diversity within T. taeniaeformis may exist as determined by comparing the metacestode mtCOX1 sequences. The current study presents the prevalence values of zoonotic cestodes and contributes to the body of knowledge, including identification keys and the use of molecular tools for species confirmation.

Worldwide Assessment of Low- and Middle-Income Countries' Regulatory Preparedness to Approve Medical Products During Public Health Emergencies.

Background: Regulatory preparedness for public health emergencies is critical. However, responses to past emergencies, such as the 2009 H1N1 influenza pandemic and medical product shortages, have revealed sizable gaps in countries' regulatory capacity and preparedness. A systematic analysis of the regulatory preparedness of countries around the world has not yet been performed. The purpose of this study was to analyze and document the current regulatory preparedness status, highlight the related gaps and challenges in order to propose strategic, harmonized, and sustainable regulatory solutions to improve future responses to public health emergencies. Methods: From 2016 to 2020, we used the World Health Organization (WHO)'s Global Benchmarking Tool (GBT), a standardized instrument for identifying national regulatory authorities' strengths and gaps, to analyze the regulatory preparedness of 84 Member States, 95% of which were low- or middle-income countries. We analyzed whether participating Member States had not implemented, displayed ongoing implementation, had partially implemented, or had fully implemented 10 of the GBT's 268 sub-indicators most relevant to regulatory preparedness for public health emergencies. Findings: Only 10 Member States (12%) that underwent benchmarking had fully implemented all 10 sub-indicators related to regulatory preparedness for public health emergencies; 34 (40%) had fully implemented ≥50% of the emergency sub-indicators, and 20 (24%) had not fully implemented any of the sub-indicators. With regard to individual sub-indicators, regulatory preparedness ranged from 19 Member States (23%) fully implementing reliance on clinical trial decisions of others to 45 (59%) fully implementing legal provisions to fast-track (or expedite) marketing authorization applications. Interpretation: Many WHO Member States have limited regulatory preparedness for a public health emergency. Strengthening regulatory systems and promoting Good Regulatory Practices and reliance in these countries, to enable efficient response to emergencies, should be a global health priority.

Scanning Electron Microscopic Findings on Respiratory Organs of Some Naturally Infected Dromedary Camels with the Lineage-B of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Saudi Arabia-2018.

The currently known animal reservoir for MERS-CoV is the dromedary camel. The clinical pattern of the MERS-CoV field infection in dromedary camels is not yet fully studied well. Some pathological changes and the detection of the MERS-CoV antigens by immunohistochemistry have been recently reported. However, the nature of these changes by the scanning electron microscope (SEM) was not revealed. The objective of this study was to document some changes in the respiratory organs induced by the natural MERS-CoV infection using the SEM. We previously identified three positive animals naturally infected with MERS-CoV and two other negative animals. Previous pathological studies on the positive animals showed varying degrees of alterations. MERS-CoV-S and MERS-CoV-Nc proteins were detected in the organs of positive animals. In the current study, we used the same tissues and sections for the SEM examination. We established a histopathology lesion scoring system by the SEM for the nasal turbinate and trachea. Our results showed various degrees of involvement per animal. The main observed characteristic findings are massive ciliary loss, ciliary disorientation, and goblet cell hyperplasia, especially in the respiratory organs, particularly the nasal turbinate and trachea in some animals. The lungs of some affected animals showed signs of marked interstitial pneumonia with damage to the alveolar walls. The partial MERS-CoV-S gene sequencing from the nasal swabs of some dromedary camels admitted to this slaughterhouse confirms the circulating strains belong to clade-B of MERS-CoV. These results confirm the respiratory tropism of the virus and the detection of the virus in the nasal cavity. Further studies are needed to explore the pathological alterations induced by MERS-CoV infection in various body organs of the MERS-CoV naturally infected dromedary camels.

Serological and Molecular Characterization of Mycobacterium avium Subsp. paratuberculosis (MAP) from Sheep, Goats, Cattle and Camels in the Eastern Province, Saudi Arabia.

The objectives of the present study were to characterize Mycobacterium avium subsp. paratuberculosis (MAP) infection using serological and molecular tools and investigate the distribution and molecular characterization of MAP strains (cattle (C) and sheep (S) types) in sheep, goat, cattle, and camel herds in Eastern Province, Saudi Arabia. Serum and fecal samples were collected from all animals aged >2 years old in 31 herds (sheep = 8, goats = 6, cattle = 8 and camels = 9) from January to December 2019. Serum samples were tested by ELISA for the detection of MAP antibodies. Fecal samples were tested by PCR for the detection of MAP IS900 gene and the identification of MAP strains. MAP antibodies were detected in 19 (61.3%) herds. At the animal level, antibodies against MAP were detected in 43 (19.5%) sheep, 21 (17.1%) goats, 13 (19.7%) cattle and 22 (9.1%) camels. The IS900 gene of MAP was detected in 23 (74.2%) herds and was directly amplified from fecal samples of 59 (26.8%) sheep, 34 (27.6%) goats, 20 (30.3%) cattle and 36 (15.0%) camels. The S-type was the most prevalent MAP type identified in 15 herds, and all were identified as type-I, while the C-type was identified in only 8 herds. The IS900 sequences revealed genetic differences among the MAP isolates recovered from sheep, goats, cattle and camels. Results from the present study show that MAP was prevalent and confirm the distribution of different MAP strains in sheep, goat, cattle and camel herds in Eastern Province, Saudi Arabia.

Endoscopic endonasal skull base surgery during the COVID-19 pandemic: A developing country perspective.

BACKGROUND: Although primarily a respiratory disorder, the coronavirus pandemic has paralyzed almost all aspects of health-care delivery. Emergency procedures are likely continuing in most countries, however, some of them raises certain concerns to the surgeons such as the endoscopic endonasal skull base surgeries. The aim of this study is to present the current situation from a developing country perspective in dealing with such cases at the time of the COVID-19 pandemic. METHODS: A cross-sectional analytical survey was distributed among neurosurgeons who performed emergency surgeries during the COVID-19 pandemic in Cairo, Egypt, between May 8, 2020, and June 7, 2020. The survey entailed patients' information (demographics, preoperative screening, and postoperative COVID-19 symptoms), surgical team information (demographics and postoperative COVID-19 symptoms), and operative information (personal protective equipment [PPE] utilization and basal craniectomy). RESULTS: Our survey was completed on June 7, 2020 (16 completed, 100% response rate). The patients were screened for COVID-19 preoperatively through complete blood cell (CBC) (100%), computed tomography (CT) chest (68.8%), chest examination (50%), C-reactive protein (CRP) (50%), and serological testing (6.3%). Only 18.8% of the surgical team utilized N95 mask and goggles, 12.5% utilized face shield, and none used PAPRs. Regarding the basal craniectomy, 81.3% used Kerrison Rongeur and chisel, 25% used a high-speed drill, and 6.3% used a mucosal shaver. None of the patients developed any COVID-19 symptoms during the first 3 weeks postsurgery and one of the surgeons developed high fever with negative nasopharyngeal swabs. CONCLUSION: In developing countries with limited resources, preoperative screening using chest examination, CBC, and CT chest might be sufficient to replace Reverse transcription polymerase chain reaction. Developing countries require adequate support with screening tests, PPE, and critical care equipment such as ventilators.

The World Health Organization Global Benchmarking Tool an Instrument to Strengthen Medical Products Regulation and Promote Universal Health Coverage.

National regulatory authorities (NRAs) are the gatekeepers of the supply chain of medical products, and they have a mandate to ensure the quality, safety and efficacy of medicines, vaccines, blood, and blood products, medical devices, including diagnostics and traditional, or herbal medicines. However, the majority of the world's regulators are still struggling to reach a level of maturity, whereby they have a stable, well-functioning and integrated regulatory system. The World Health Organization (WHO) has developed a Global Benchmarking Tool (GBT) as part of its five-step capacity building program to assist NRAs, using the tool, they can benchmark their own strengths and areas of weakness, and then engage in a formal benchmarking process together with WHO and international experts in order to formulate an effective and workable institutional development plan. The GBT is comprehensive across the entire product life cycle and allows benchmarking to be customized to the needs of the NRA. It has evolved from decades of experience using a variety of benchmarking tools, within WHO and other stakeholder organizations. By the end of December 2019, 26 countries had undergone formal benchmarking, and a further 54 countries had used the GBT to conduct self-benchmarking exercises assisted by WHO.