Shifting the Scales: Tirzepatide's Breakthrough in Obesity Management.

Obesity is a complex and chronic condition that presents a significant global health challenge, resulting in a wide range of health problems, such as heart disease, stroke, and diabetes, therefore diminishing the overall well-being of numerous individuals. Conventional treatment options often prove inadequate, providing temporary relief and frequent weight regain. However, a promising medication called tirzepatide has emerged and been approved by the FDA as a groundbreaking solution for managing obesity. Through its unique mechanism of action as a glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, as well as its impressive results in clinical trials, tirzepatide has the potential to completely transform the current approach to treating obesity. This editorial provides a quick snap for the clinical implications of tirzepatide, its mechanism of action, effectiveness, safety record, and the challenges it faces, such as insurance coverage and drug shortages. It emphasizes the importance of an integrated treatment approach and highlights the necessity for continuous research and policy backing to enhance accessibility and advance public health outcomes related to weight management.

From Protection to Prevention: Redefining Vaccines in the Context of Antimicrobial Resistance.

Antimicrobial resistance (AMR) poses a significant threat to global health, compromising the effectiveness of treatments and increasing medical risks. In this crisis, the importance of vaccines in reducing AMR is being increasingly acknowledged, although not thoroughly explored. This literature review asserts that vaccines can significantly lessen the occurrence of infections, thereby reducing the need for antibiotics and limiting the emergence of resistance. Vaccines play a crucial role in antimicrobial stewardship programs by preventing diseases that would otherwise necessitate the use of antibiotics. Expanding vaccine coverage supports responsible usage of antimicrobials and aligns with global health priorities to maintain effective medical interventions. This review emphasizes the need for equitable funding and policy support for vaccine initiatives comparable to new antibiotics and diagnostic techniques. Moreover, it calls for more detailed investigations into vaccines' economic and health benefits in managing AMR, highlighting their potential as cost-effective solutions to this urgent health challenge. Through a careful analysis of existing literature, this review highlights the fundamental role of vaccines in transforming the landscape of AMR, shifting the focus from a protective approach to a preventive health strategy.

Aeluropus littoralis stress-associated protein promotes water deficit resilience in engineered durum wheat.

Global climate change-related water deficit negatively affect the growth, development and yield performance of multiple cereal crops, including durum wheat. Therefore, the improvement of water-deficit stress tolerance in durum wheat varieties in arid and semiarid areas has become imperative for food security. Herein, we evaluated the water deficiency resilience potential of two marker-free transgenic durum wheat lines (AlSAP-lines: K9.3 and K21.3) under well-watered and water-deficit stress conditions at both physiological and agronomic levels. These two lines overexpressed the AlSAP gene, isolated from the halophyte grass Aeluropus littoralis, encoding a stress-associated zinc finger protein containing the A20/AN1 domains. Under well-watered conditions, the wild-type (WT) and both AlSAP-lines displayed comparable performance concerning all the evaluated parameters. Ectopic transgene expression exerted no adverse effects on growth and yield performance of the durum wheat plants. Under water-deficit conditions, no significant differences in the plant height, leaf number, spike length, and spikelet number were observed between AlSAP-lines and WT plants. However, compared to WT, the AlSAP-lines exhibited greater dry matter production, greater flag leaf area, improved net photosynthetic rate, stomatal conductance, and water use efficiency. Notably, the AlSAP-lines displayed 25 % higher grain yield (GY) than the WT plants under water-deficit conditions. The RT-qPCR-based selected stress-related gene (TdDREB1, TdLEA, TdAPX1, and TdBlt101-2) expression analyses indicated stress-related genes enhancement in AlSAP-durum wheat plants under both well-watered and water-deficit conditions, potentially related to the water-deficit resilience. Collectively, our findings support that the ectopic AlSAP expression in durum wheat lines enhances water-deficit resilience ability, thereby potentially compensate for the GY loss in arid and semi-arid regions.

Improving Efficiency in Hospital Pharmacy Services: An Integrated Strategy Using the OCTAGON-P Framework and Lean 5S Management Practices.

Background Hospital pharmacy departments have a critical role in the healthcare system, as they aim to provide excellent patient services while also ensuring cost-effectiveness. Lean methodologies are well-known for improving efficiency and quality in various industries, but their impact on healthcare, particularly in hospital pharmacy settings, has not been thoroughly investigated. Aim This quality improvement (QI) study aimed to assess the impact of implementing the sort, set in order, shine, standardize, and sustain (5S) methodology using the innovative orientation, coordination, training, awareness, governance, observation, normalization, and promotion (OCTAGON-P) framework on the operations of Mediclinic Parkview Hospital (MPAR) Pharmacy in Dubai, UAE. Methods The QI project spanned a period of six weeks, from December 18th, 2023, to January 28th, 2024. Throughout this period, a new novel OCTAGON-P framework's eight crucial elements were methodically integrated. Simultaneously, an extensive preparation process encompassing the five stages of the 5S method was carried out. Results The findings indicated a notable enhancement in organization, orderliness, cleanliness, medication storage, and workspace standardization. The significant improvement of 217% in terms of organization highlighted the effectiveness of resource arrangement. The orderliness of the workspace saw an increase of 800%, indicating a transformation in the systematic organization. Additionally, cleanliness improved by 138%, demonstrating a significant advancement in maintaining a spotless environment. The standardization of processes experienced a boost of 300%, reflecting a solidified approach to consistent operational methods. These refinements resulted in an overall improvement of 90% from the initial baseline of 20% on the 5S checklist scores. Efficiency gains were observed, with outpatient medication retrieval times reduced by 50%, inpatient times by 40%, emergency prescription serving by 16.7%, and pediatric prescription serving by 11%. The inpatient medication return process saw a 67% improvement. Patient counseling time increased by 23.3%, indicating a more patient-centered approach. Prescription verification and medication expiry checks increased by 50% and 200%, respectively, enhancing the quality of care. Inventory management efficiency improved by 36%, and medication label printing time decreased by 70% with the additional label printers. Installing extra medication label printers was done through the OCTAGON-P framework, specifically in the "orientation" and "coordination" phases. These two initial phases focused on leadership's 5S orientation, management support, and securing additional resources. Therefore, the OCTAGON-P framework provided a structured approach that promoted continuous improvement and sustained lean practices. Conclusion This research study presented the remarkable effectiveness of the OCTAGON-P framework in structurally implementing the 5S methodology into hospital pharmacy operations. The findings underscored the potential of lean 5S to enhance and optimize operational efficiency and overall quality within the critical environment of hospital pharmacy settings. Consequently, these improvements can conclusively result in the provision of superior and enhanced patient care, which is truly fundamental and central to the mission and objectives of any healthcare institution.

Enhancing Hospital Pharmacy Operations Through Lean and Six Sigma Strategies: A Systematic Review.

Hospital pharmacies are integral to the healthcare system, and evaluating the factors influencing their efficiency and service standards is imperative. This analysis offers global insights to assist in developing strategies for future enhancements. The objective is to identify the optimal Lean Six Sigma methodologies to improve workflow and quality of hospital pharmacy services. A strategic search, aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, encompassed an extensive range of academic databases, including Scopus, PubMed/Medline, Web of Science, and other sources for relevant studies published from 2009 to 2023. The focus was on management tactics and those examining outcomes, prioritizing publications reflecting pharmacy operations management's state. The quality of the selected articles was assessed, and the results were combined and analyzed. The search yielded 1,447 studies, of which 73 met the inclusion criteria. The systematic review found a low to moderate overall risk of bias. The number of publications rose during the coronavirus disease (COVID-19) outbreak. Among studies, research output in the United States of America represented 26% of the total. Other countries such as Indonesia, Spain, Canada, China, Saudi Arabia, the United Arab Emirates, and the United Kingdom also made significant contributions. Each country accounted for 12%, 8%, 7%, 5%, 5%, 5%, and 5%, respectively. The pharmacy journals led with 26 publications, and healthcare/medical with 14. The quality category came next with 12 articles, while seven journals represented engineering. Studies used empirical and observational methods, focusing on practice quality enhancement. The process control plan had 26 instances, and the define, measure, analyze, improve, and control (DMAIC) was identified 13 times. The sort, set in order, shine, standardize, and sustain (5S) ranked third, totaling seven occurrences. Failure mode and effects analysis (FMEA) and root cause analysis were moderately utilized, with six and four instances, respectively. Poka-Yoke (mistake-proofing measures) and value stream mapping were each counted three times. Quality improvement and workflow optimization dominated managerial strategies in 22 (30.14%) studies each, followed by technology integration in 15 (20.55%). Cost, patient care, and staffing each featured in three (4.11%) studies, while two (2.74%) focused on inventory management. One (1.37%) study each highlighted continuing education, collaboration, and policy changes. Analysis of the 73 studies on Lean and Six Sigma in hospital pharmacy operations showed significant impacts, with 26% of studies reporting decreased medication turnaround time, 15% showing process efficiency improvements, and 11% each for enhanced inventory management and bottleneck/failure mode reduction. Additionally, 9% of studies observed decreased medication errors, 8% noted increased satisfaction and cost savings, 6% identified enhancements in clinical activities, 3% improved prescription accuracy, 2% reduced workflow interruptions, and 1% reported increased knowledge. Also, this study has identified key strategies for service delivery improvement and the importance of quality practices and lean leadership. To the best of the author's knowledge, this research is believed to be the first in-depth analysis of Lean and Six Sigma in the hospital pharmacy domain, spanning 15 years from 2009 to 2023.

Combining Genetic and Phenotypic Analyses for Detecting Bread Wheat Genotypes of Drought Tolerance through Multivariate Analysis Techniques.

Successfully promoting drought tolerance in wheat genotypes will require several procedures, such as field experimentations, measuring relevant traits, using analysis tools of high precision and efficiency, and taking a complementary approach that combines analyses of phenotyping and genotyping at once. The aim of this study is to assess the genetic diversity of 60 genotypes using SSR (simple sequence repeat) markers collected from several regions of the world and select 13 of them as more genetically diverse to be re-evaluated under field conditions to study drought stress by estimating 30 agro-physio-biochemical traits. Genetic parameters and multivariate analysis were used to compare genotype traits and identify which traits are increasingly efficient at detecting wheat genotypes of drought tolerance. Hierarchical cluster (HC) analysis of SSR markers divided the genotypes into five main categories of drought tolerance: four high tolerant (HT), eight tolerant (T), nine moderate tolerant (MT), six sensitive (S), and 33 high sensitive (HS). Six traits exhibit a combination of high heritability (>60%) and genetic gain (>20%). Analyses of principal components and stepwise multiple linear regression together identified nine traits (grain yield, flag leaf area, stomatal conductance, plant height, relative turgidity, glycine betaine, polyphenol oxidase, chlorophyll content, and grain-filling duration) as a screening tool that effectively detects the variation among the 13 genotypes used. HC analysis of the nine traits divided genotypes into three main categories: T, MT, and S, representing three, five, and five genotypes, respectively, and were completely identical in linear discriminant analysis. But in the case of SSR markers, they were classified into three main categories: T, MT, and S, representing five, three, and five genotypes, respectively, which are both significantly correlated as per the Mantel test. The SSR markers were associated with nine traits, which are considered an assistance tool in the selection process for drought tolerance. So, this study is useful and has successfully detected several agro-physio-biochemical traits, associated SSR markers, and some drought-tolerant genotypes, coupled with our knowledge of the phenotypic and genotypic basis of wheat genotypes.

A Preliminary Checklist (METRICS) to Standardize the Design and Reporting of Studies on Generative Artificial Intelligence-Based Models in Health Care Education and Practice: Development Study Involving a Literature Review.

BACKGROUND: Adherence to evidence-based practice is indispensable in health care. Recently, the utility of generative artificial intelligence (AI) models in health care has been evaluated extensively. However, the lack of consensus guidelines on the design and reporting of findings of these studies poses a challenge for the interpretation and synthesis of evidence. OBJECTIVE: This study aimed to develop a preliminary checklist to standardize the reporting of generative AI-based studies in health care education and practice. METHODS: A literature review was conducted in Scopus, PubMed, and Google Scholar. Published records with "ChatGPT," "Bing," or "Bard" in the title were retrieved. Careful examination of the methodologies employed in the included records was conducted to identify the common pertinent themes and the possible gaps in reporting. A panel discussion was held to establish a unified and thorough checklist for the reporting of AI studies in health care. The finalized checklist was used to evaluate the included records by 2 independent raters. Cohen κ was used as the method to evaluate the interrater reliability. RESULTS: The final data set that formed the basis for pertinent theme identification and analysis comprised a total of 34 records. The finalized checklist included 9 pertinent themes collectively referred to as METRICS (Model, Evaluation, Timing, Range/Randomization, Individual factors, Count, and Specificity of prompts and language). Their details are as follows: (1) Model used and its exact settings; (2) Evaluation approach for the generated content; (3) Timing of testing the model; (4) Transparency of the data source; (5) Range of tested topics; (6) Randomization of selecting the queries; (7) Individual factors in selecting the queries and interrater reliability; (8) Count of queries executed to test the model; and (9) Specificity of the prompts and language used. The overall mean METRICS score was 3.0 (SD 0.58). The tested METRICS score was acceptable, with the range of Cohen κ of 0.558 to 0.962 (P<.001 for the 9 tested items). With classification per item, the highest average METRICS score was recorded for the "Model" item, followed by the "Specificity" item, while the lowest scores were recorded for the "Randomization" item (classified as suboptimal) and "Individual factors" item (classified as satisfactory). CONCLUSIONS: The METRICS checklist can facilitate the design of studies guiding researchers toward best practices in reporting results. The findings highlight the need for standardized reporting algorithms for generative AI-based studies in health care, considering the variability observed in methodologies and reporting. The proposed METRICS checklist could be a preliminary helpful base to establish a universally accepted approach to standardize the design and reporting of generative AI-based studies in health care, which is a swiftly evolving research topic.

Improving Antimicrobial Stewardship Program Using the Lean Six Sigma Methodology: A Descriptive Study from Mediclinic Welcare Hospital in Dubai, the UAE.

BACKGROUND: Antimicrobial resistance (AMR) is one of the key challenges in healthcare, and effective antimicrobial stewardship programs (ASPs) can play a vital role to control it. The aim of the current study was to assess the impact of the Lean Six Sigma (LSS) methodology on a hospital-wide ASP. METHODS: This retrospective descriptive study was conducted at Mediclinic Welcare Hospital (MWEL), Dubai, the United Arab Emirates (UAE). The critical-to-quality (CTQs) data were collected pre/post interventions, including leadership support, guideline implementation, and audits. The study focused on inpatients who received antimicrobials from January 2021 to July 2022, analyzing ASP metrics (utilization, processes, and outcome measures). RESULTS: The ASP improvements led to an 81.7% decrease in hospital's parenteral antimicrobial expenses from January 2021 to July 2022, and a 54.2% reduction in antimicrobial usage while maintaining clinical outcomes. The average defined daily dose per 100 bed-days drop of 12.5% further demonstrated this positive trend. The intervention was not accompanied by higher nosocomial infection rates, longer stays, or mortality. Additionally, intervention led to better compliance with surgical prophylaxis bundles, antimicrobial protocols, hand hygiene and other ASP CTQ metrics. CONCLUSIONS AND RECOMMENDATIONS: This study emphasized the significance of implementing the LSS methodology in addressing process variations, enhancing ASP outcomes, and reducing antimicrobial use. These findings can inform health policymakers to improve future ASP outcomes. Additionally, sustainability through continuous monitoring and ongoing education initiatives should be considered to ensure the long-term success of these improvements.

Pilot Testing of a Tool to Standardize the Assessment of the Quality of Health Information Generated by Artificial Intelligence-Based Models.

Background Artificial intelligence (AI)-based conversational models, such as Chat Generative Pre-trained Transformer (ChatGPT), Microsoft Bing, and Google Bard, have emerged as valuable sources of health information for lay individuals. However, the accuracy of the information provided by these AI models remains a significant concern. This pilot study aimed to test a new tool with key themes for inclusion as follows: Completeness of content, Lack of false information in the content, Evidence supporting the content, Appropriateness of the content, and Relevance, referred to as "CLEAR", designed to assess the quality of health information delivered by AI-based models. Methods Tool development involved a literature review on health information quality, followed by the initial establishment of the CLEAR tool, which comprised five items that aimed to assess the following: completeness, lack of false information, evidence support, appropriateness, and relevance. Each item was scored on a five-point Likert scale from excellent to poor. Content validity was checked by expert review. Pilot testing involved 32 healthcare professionals using the CLEAR tool to assess content on eight different health topics deliberately designed with varying qualities. The internal consistency was checked with Cronbach's alpha (α). Feedback from the pilot test resulted in language modifications to improve the clarity of the items. The final CLEAR tool was used to assess the quality of health information generated by four distinct AI models on five health topics. The AI models were ChatGPT 3.5, ChatGPT 4, Microsoft Bing, and Google Bard, and the content generated was scored by two independent raters with Cohen's kappa (κ) for inter-rater agreement. Results The final five CLEAR items were: (1) Is the content sufficient?; (2) Is the content accurate?; (3) Is the content evidence-based?; (4) Is the content clear, concise, and easy to understand?; and (5) Is the content free from irrelevant information? Pilot testing on the eight health topics revealed acceptable internal consistency with a Cronbach's α range of 0.669-0.981. The use of the final CLEAR tool yielded the following average scores: Microsoft Bing (mean=24.4±0.42), ChatGPT-4 (mean=23.6±0.96), Google Bard (mean=21.2±1.79), and ChatGPT-3.5 (mean=20.6±5.20). The inter-rater agreement revealed the following Cohen κ values: for ChatGPT-3.5 (κ=0.875, P<.001), ChatGPT-4 (κ=0.780, P<.001), Microsoft Bing (κ=0.348, P=.037), and Google Bard (κ=.749, P<.001). Conclusions The CLEAR tool is a brief yet helpful tool that can aid in standardizing testing of the quality of health information generated by AI-based models. Future studies are recommended to validate the utility of the CLEAR tool in the quality assessment of AI-generated health-related content using a larger sample across various complex health topics.

Identification of Wheat Ideotype under Multiple Abiotic Stresses and Complex Environmental Interplays by Multivariate Analysis Techniques.

Multiple abiotic stresses negatively impact wheat production all over the world. We need to increase productivity by 60% to provide food security to the world population of 9.6 billion by 2050; it is surely time to develop stress-tolerant genotypes with a thorough comprehension of the genetic basis and the plant's capacity to tolerate these stresses and complex environmental reactions. To approach these goals, we used multivariate analysis techniques, the additive main effects and multiplicative interaction (AMMI) model for prediction, linear discriminant analysis (LDA) to enhance the reliability of the classification, multi-trait genotype-ideotype distance index (MGIDI) to detect the ideotype, and the weighted average of absolute scores (WAASB) index to recognize genotypes with stability that are highly productive. Six tolerance multi-indices were used to test twenty wheat genotypes grown under multiple abiotic stresses. The AMMI model showed varying differences with performance indices, which disagreed with the trait and genotype differences used. The G01, G12, G16, and G02 were selected as the appropriate and stable genotypes using the MGIDI with the six tolerance multi-indices. The biplot features the genotypes (G01, G03, G11, G16, G17, G18, and G20) that were most stable and had high tolerance across the environments. The pooled analyses (LDA, MGIDI, and WAASB) showed genotype G01 as the most stable candidate. The genotype (G01) is considered a novel genetic resource for improving productivity and stabilizing wheat programs under multiple abiotic stresses. Hence, these techniques, if used in an integrated manner, strongly support the plant breeders in multi-environment trials.

The Role of Psychological Factors and Vaccine Conspiracy Beliefs in Influenza Vaccine Hesitancy and Uptake among Jordanian Healthcare Workers during the COVID-19 Pandemic.

Vaccination to prevent influenza virus infection and to lessen its severity is recommended among healthcare workers (HCWs). Health professionals have a higher risk of exposure to viruses and could transmit the influenza virus to vulnerable patients who are prone to severe disease and mortality. The aim of the current study was to evaluate the levels of influenza vaccine acceptance and uptake as well as its determinants, among Jordanian HCWs over the last influenza season of 2021/2022. This study was based on a self-administered electronic survey that was distributed in March 2022. Psychological determinants of influenza vaccine acceptance and vaccine conspiracy beliefs were assessed using the previously validated 5C scale questionnaire (confidence, complacency, constraints, calculation and collective responsibility) and the vaccine conspiracy beliefs scale. The study sample comprised a total of 1218 HCWs: nurses (n = 412, 33.8%), physicians (n = 367, 30.1%), medical technicians (n = 182, 14.9%), pharmacists (n = 161, 13.2%) and dentists (n = 87, 7.1%), among others. About two-thirds of the study sample expressed willingness to receive influenza vaccination if provided free of charge (n = 807, 66.3%), whereas less than one-third were willing to pay for the vaccine (n = 388, 31.9%). The self-reported uptake of the influenza vaccine in the last influenza season was 62.8%. The following factors were significantly associated with higher acceptance of influenza vaccination if provided freely, as opposed to vaccine hesitancy/rejection: male sex; physicians and dentists among HCW categories; higher confidence and collective responsibility; and lower complacency, constraints and calculation. Higher influenza vaccine uptake was significantly correlated with nurses and physicians among HCW categories, older age, a higher monthly income, higher confidence and collective responsibility, lower complacency and constraints and lower embrace of general vaccine conspiracy beliefs. The results of the current study can provide helpful clues to improve influenza vaccine coverage among HCWs in Jordan. Consequently, this can help to protect vulnerable patient groups and reserve valuable resources in healthcare settings. Psychological determinants appeared to be the most significant factors for vaccine acceptance and uptake, whereas the embrace of general vaccine conspiracy beliefs was associated with lower rates of influenza vaccine uptake, which should be considered in educational and interventional measures aiming to promote influenza vaccination.

A Global Map of COVID-19 Vaccine Acceptance Rates per Country: An Updated Concise Narrative Review.

The delay or refusal of vaccination, which defines vaccine hesitancy, is a major challenge to successful control of COVID-19 epidemic. The huge number of publications addressing COVID-19 vaccine hesitancy necessitates periodic review to provide a concise summary of COVID-19 vaccine acceptance rates worldwide. In the current narrative review, data on COVID-19 vaccine acceptance rates were retrieved from surveys in 114 countries/territories. In East and Southern Africa (n = 9), the highest COVID-19 vaccine acceptance rate was reported in Ethiopia (92%), while the lowest rate was reported in Zimbabwe (50%). In West/Central Africa (n = 13), the highest rate was reported in Niger (93%), while the lowest rate was reported in Cameroon (15%). In Asia and the Pacific (n = 16), the highest rates were reported in Nepal and Vietnam (97%), while the lowest rate was reported in Hong Kong (42%). In Eastern Europe/Central Asia (n = 7), the highest rates were reported in Montenegro (69%) and Kazakhstan (64%), while the lowest rate was reported in Russia (30%). In Latin America and the Caribbean (n = 20), the highest rate was reported in Mexico (88%), while the lowest rate was reported in Haiti (43%). In the Middle East/North Africa (MENA, n = 22), the highest rate was reported in Tunisia (92%), while the lowest rate was reported in Iraq (13%). In Western/Central Europe and North America (n = 27), the highest rates were reported in Canada (91%) and Norway (89%), while the lowest rates were reported in Cyprus and Portugal (35%). COVID-19 vaccine acceptance rates ≥60% were seen in 72/114 countries/territories, compared to 42 countries/territories with rates between 13% and 59%. The phenomenon of COVID-19 vaccine hesitancy appeared more pronounced in the MENA, Europe and Central Asia, and Western/Central Africa. More studies are recommended in Africa, Eastern Europe and Central Asia to address intentions of the general public to get COVID-19 vaccination.

Human albumin solution utilization patterns prior and during COVID-19 pandemic in United Arab Emirates: Time to develop and implement national guidelines on prescription and utilization.

The human albumin solution (HAS) has limited but important indications in clinical practices. However, the inappropriate use of HAS can be costly. Thus, it is imperative to establish a practical protocol to use albumin products and rationalize its usage. The aim of this study was to identify HAS utilization patterns in a multi-specialty private hospital in Dubai, United Arab Emirates (UAE), before and during the COVID-19 pandemic. In addition, the objective was to demonstrate the importance of reconsidering the prescribing strategies for HAS administration. All data on 20% HAS administration in Mediclinic Welcare Hospital (MWEL) were retrieved between January 2019 and May 2021, including the total quantities administered and data on primary diagnosis. A total of 579 patient admissions with various diagnoses were included in this study. Our data suggested that the percentage of clinically indicated 20% HAS administrations decreased from 13.0% in the pre-COVID-19 phase to 1.5% in the COVID-19 phase (p<0.001). An increase in the administration of 20% HAS not backed by agreed clinical evidence followed the increase in new number of COVID-19 cases in the UAE. Our study suggests a large proportion of administered HAS, that drastically increased during COVID-19 with lack of evidence of its benefit. This study can be helpful to refine the institutional guidelines of HAS use, and frequent audits and interactive educational interventions are recommended to tackle this issue. In turn, the refinement of HAS administration guidelines could help to reduce the unjustified cost of inappropriate HAS use.

Combining Genetic and Multidimensional Analyses to Identify Interpretive Traits Related to Water Shortage Tolerance as an Indirect Selection Tool for Detecting Genotypes of Drought Tolerance in Wheat Breeding.

Water shortages have direct adverse effects on wheat productivity and growth worldwide, vertically and horizontally. Productivity may be promoted using water shortage-tolerant wheat genotypes. High-throughput tools have supported plant breeders in increasing the rate of stability of the genetic gain of interpretive traits for wheat productivity through multidimensional technical methods. We used 27 agrophysiological interpretive traits for grain yield (GY) of 25 bread wheat genotypes under water shortage stress conditions for two seasons. Genetic parameters and multidimensional analyses were used to identify genetic and phenotypic variations of the wheat genotypes used, combining these strategies effectively to achieve a balance. Considerable high genotypic variations were observed for 27 traits. Eleven interpretive traits related to GY had combined high heritability (h2 > 60%) and genetic gain (>20%), compared to GY, which showed moderate values both for heritability (57.60%) and genetic gain (16.89%). It was determined that six out of eleven traits (dry leaf weight (DLW), canopy temperature (CT), relative water content (RWC), flag leaf area (FLA), green leaves area (GLA) and leaf area index (LAI)) loaded the highest onto PC1 and PC2 (with scores of >0.27), and five of them had a positive trend with GY, while the CT trait had a negative correlation determined by principal component analysis (PCA). Genetic parameters and multidimensional analyses (PCA, stepwise regression, and path coefficient) showed that CT, RWC, GLA, and LAI were the most important interpretive traits for GY. Selection based on these four interpretive traits might improve genetic gain for GY in environments that are vulnerable to water shortages. The membership index and clustering analysis based on these four traits were significantly correlated, with some deviation, and classified genotypes into five groups. Highly tolerant, tolerant, intermediate, sensitive and highly sensitive clusters represented six, eight, two, three and six genotypes, respectively. The conclusions drawn from the membership index and clustering analysis, signifying that there were clear separations between the water shortage tolerance groups, were confirmed through discriminant analysis. MANOVA indicated that there were considerable variations between the five water shortage tolerance groups. The tolerated genotypes (DHL02, DHL30, DHL26, Misr1, Pavone-76 and DHL08) can be recommended as interesting new genetic sources for water shortage-tolerant wheat breeding programs.

Studies on saccharide benzimidazoles: 2-(ß-D-gulofuranosyl)benzimidazole and 2-(ß-D-glucofuranosyl)benzimidazole C-nucleoside analogs; synthesis, anomeric configuration and antifouling potency.

A series of acyclic 2-(D-gulo-) and 2-(D-gluco-)benzimidazole C-nucloside analogs have been prepared by condensation of o-phenylenediamine dihydrochloride derivatives with D-gulonic acid-γ-lactone and D-gluconic acid-γ-lactone, separately. Acid catalyzed dehydrative cyclization of the acyclic benzimidazole C-nucleoside afforded the corresponding 2-(ß-D-gulo-) and 2-(ß-D-gluco-)furanosyl benzimidazole C-nucleoside analogs. The structure and the anomeric configuration of C-nucleoside analogs obtained were determined by periodate oxidation, 1H NMR, UV and circular dichroism (CD) spectroscopy. The antifouling property of C-nucleoside analogs has been studied using antibacterial biofilm test. 2-(D-gulo-) and 2-(D-gluco-)benzimidazole analogs were useful for inhibiting marine bacterial growth and did not cause any bad effect to the surrounding seawater.

Synthesis of compounds having antimicrobial activity from alginate.

Compounds having antimicrobial activity were synthesized from sodium alginate, the main constituent of brown algae. Sodium alginate was oxidized with sodium periodate to get alginate dialdehyde (ADA). FTIR spectrum of the ADA gave very small peak characteristic for aldehyde groups at 1720 cm-1, indicating that the aldehyde group is masked somehow. It may be hydrated, involving at hemiacetal formation or hemialdol, similar to cellulose dialdehyde. Two methods were used for the condensation of ADA with o-phenylenediamine analogs to obtain the final products. The first method was stirring at room temperature and the second method was heating in microwave. The microwave method gave higher yield and shorter reaction time than the other method. The condensation reaction is considered as a shiff-base formation and the proposed mechanism was suggested. The condensation products were characterized by FTIR and UV spectra. The antimicrobial potency for five of these products in addition to the used alginate and to the precursor amines was evaluated against four pathogenic fungi and six pathogenic bacteria species.

Efficient 1,3,4-Thiadiazole-4,5-dihydropyridazin-3(2H)-ones as Antimicrobial Agents.

A set of novel series of 1,3,4-thiadiazolyl-sulfanyl-4,5-dihydropyridazin-3(2H)-ones with anticipated antimicrobial activity has been synthesized. The synthetic protocol of the targeted compounds was accomplished by treating ß-aroylacrylic acid 1 with 5-amino-1,3,4-thiadiazole-2-thiol (2) to afford the thia-Michael adduct 3. Afterwards, the obtained thia-Michael adduct 3 was cyclized to 4,5-dihydropyridazin-3(2H)-ones 4a-d and the non-cyclized product hydrazone 5 by using different hydrazines. Moreover, adduct 3 was reacted with esters like diethyl malonate and ethyl acetoacetate affording 1,3,4-thiadiazolobutanamides 6a, b. Furthermore, the concurrent reaction of later butamides 6a, b with the hydrazine derivatives furnished thiadiazolopyridazin-3(2H)-ones 7a-d, 8, and butanoic acid 9.

Homo-C-nucleoside analogs IV. Synthesis of 4-(2,5-anhydro-D-altro-pentitol-1-yl)-2-phenyl-2H-1,2,3-triazole homo-C-nucleoside. CD assignment of the absolute configuration of the carbon bridge.

Dehydrative cyclization of 4-(D-altro-pentitol-1-yl)2-phenyl-2H-1,2,3-triazole in basic medium with one moler equivalent of p-toluene sulfonyl chloride in pyridine solution gave the homo-C-nucleoside 4-(2,5-anhydro-D-altro-1-yl)-2-phenyl-2H-1,2,3-triazole. The structure and anomeric configuration was determined by acylation, nuclear magnetic resonance (NMR), and mass spectroscopy. The stereochemistry at the carbon bridge of homo-C-nucleoside 2-phenyl-2H-1,2,3-triazoles was determined by circular dichroism (CD) spectroscopy.

Surgical experience in the rehabilitation and reimplantation of disconnected pulmonary arteries and its effectiveness in restoring pulmonary haemodynamics and function.

OBJECTIVES: We established a policy to restore disconnected pulmonary arteries (PAs), regardless of aetiology or cardiac pathology, using a protocol-based strategy. There are conflicting reports of the need to restore disconnected PA especially if severely hypoplastic with some groups advocating surgical repair of cardiac defects to single lung with moderate to high risk. METHODS: All patients referred to our PA reconstruction programme (2007-14) with complete separation of one branch PA were included. Our surgical strategy was based on the size of the PA. In patients with mild or no PA hypoplasia, we performed single-stage implantation of the disconnected PA and repair of intracardiac defects. Two-stage approach was used in patients with severe PA hypoplasia where the disconnected PA was retrieved inside the lung then connected to the aorta with a shunt to promote growth. After 6-12 months, the PA was implanted with simultaneous repair of intracardiac defects. RESULTS: Twenty patients were included (age range = 1 week to 8 years). Aetiologies were ductal origin of distal PA in 13 patients and iatrogenic in 7 patients. Group 1 (isolated lesion) consisted of 8 patients who presented with severe pulmonary hypertension. Group 2 consisted of 12 patients with associated intracardiac defects and was subdivided into Group 2a (biventricular hearts) 8 patients and Group 2b (univentricular hearts) 4 patients. Single-stage repair was achieved in 10 patients. Direct tissue-to-tissue connection was achieved in 18 (90%) patients. The follow-up was 100% complete (median = 53.8 months). All patients are alive and asymptomatic. Implanted PAs are patent with good growth demonstrated on serial echocardiography. Only two PAs required balloon dilatation for moderate restenosis at the anastomosis. No surgical reintervention was needed. All Group 1 patients had complete resolution of the pulmonary hypertension. Lung perfusion scans showed increased uptake (24-53% of the total uptake). CONCLUSIONS: Our study demonstrated that, in paediatric age group, disconnected PAs can be restored with low risk and excellent outcomes even in patients with severely hypoplastic PA. Strategies to repair intracardiac defects to a single lung might not be the optimal approach.

Assessment of serum level of interleukin-1b and interleukin-12 in leprosy: impact of previous Bacillus Calmitte Guerin vaccination.

Macrophages play an important role in attempt to eliminate mycobacteria, via production of cytokines, including interleukin-1, and interleukin-12. Bacillus Calmitte Guerin (BCG) vaccination, known to induce interleukin-1ß in tuberculosis, was originally aimed at tuberculosis control, but it showed efficacy against leprosy. Our aim was to estimate serum levels of interleukin-1ß and interleukin-12, in leprosy, and to assess the impact of previous BCG vaccination on their levels. Serum interleukin-1ß and interleukin-12 p70 were estimated in 43 leprotic patients and 43 controls by enzyme-linked immunosorbent assay. Patients were grouped according to presence or absence of reactions, as well as bacillary load. Serum interleukin-1ß was significantly higher in patients as compared to controls (p = 0.047), and was significantly different in patients' groups (p = 0.036); with significantly higher level in multibacillary patients, both non reactional and with erythema nodosum leprosum, compared with paucibacillary/non reactional patients (p = 0.012 and 0.049 respectively). A statistically significant higher interleukin-1ß was found in BCG vaccinated paucibacillary patients as compared to unvaccinated patients (p = 0.031). Significantly elevated interleukin-12 was present in patients as compared to controls (p < 0.001), with no statistically significant difference comparing patients' groups. BCG vaccination showed stimulatory effect on monocytes only in the immunocompetent paucibacillary leprosy patients, as evidenced by higher Interleukin-1ß in this group. Interleukin-1ß was shown to have a pro-inflammatory role in multibacillary patients with or without erythema nodosum leprosum. Targeting interleukin-1ß may be promising to control episodic refractory erythema nodosum leprosum. Interleukin-12 may be a general marker of active Mycobacterium leprae infection.