hyperresponsiveness, and exacerbation frequency (6, 7). However, the response to these medications is highly variable, particularly when administered at moderate-to-high dosages(8). The variability in response may be attributable to different mechanisms underlying the airway inflammation (9).

Background Pediatric diabetes clinics around the world rapidly adapted care in response to COVID‐19. We explored provider perceptions of care delivery adaptations and challenges for providers and patients across nine international pediatric diabetes clinics. Methods Providers in a quality improvement collaborative completed a questionnaire about clinic adaptations, including roles, care delivery methods, and provider and patient concerns and challenges. We employed a rapid analysis to identify main themes. Results Providers described adaptations within multiple domains of care delivery, including provider roles and workload, clinical encounter and team meeting format, care delivery platforms, self‐management technology education, and patient‐provider data sharing. Providers reported concerns about potential negative impacts on patients from COVID‐19 and the clinical adaptations it required, including fears related to telemedicine efficacy, blood glucose and insulin pump/pen data sharing, and delayed care‐seeking. Particular concern was expressed about already vulnerable patients. Simultaneously, providers reported 'silver linings' of adaptations that they perceived as having potential to inform care and self‐management recommendations going forward, including time‐saving clinic processes, telemedicine, lifestyle changes compelled by COVID‐19, and improvements to family and clinic staff literacy around data sharing. Conclusions Providers across diverse clinical settings reported care delivery adaptations in response to COVID‐19—particularly telemedicine processes—created challenges and opportunities to improve care quality and patient health. To develop quality care during COVID‐19, providers emphasized the importance of generating evidence about which in‐person or telemedicine processes were most beneficial for specific care scenarios, and incorporating the unique care needs of the most vulnerable patients.

Background Omega-3 (n–3) fatty acids have shown benefit in cognitively impaired subjects, but the effect on cognitively healthy older subjects is unclear. Objectives Our aim was to determine if long-term, high-dose ω-3 ethyl esters, EPA (20:5n–3) and DHA (22:6n–3), prevent deterioration of cognitive function in cognitively healthy older adults. Methods A total of 285 subjects with stable coronary artery disease (CAD) on statin treatment were randomly assigned to 3.36 g EPA and DHA or none (control) for 30 mo. Cognitive function was assessed in all 285 subjects at baseline and in 268 and 250 subjects who returned at 12- and 30-mo follow-up, respectively, with neuropsychological testing as a prespecified secondary outcome. A completer's analysis, along with a sensitivity analysis carrying forward the last observation, was performed. Results Over the 30-mo period, subjects randomly assigned to EPA and DHA had significantly better scores than control for verbal fluency, language, and memory (mean: 1.08; 95% CI: 0.25, 1.91; P = 0.011) and 2 tests of visual-motor coordination (mean: −2.95; 95% CI: −5.33, −0.57; P = 0.015 and mean: −9.44; 95% CI: −18.60, −0.30; P = 0.043, respectively). The better scores for EPA and DHA were due to an improvement at 12 mo compared with baseline in verbal fluency, language, and memory (P = 0.047) and 2 tests of visual-motor coordination (P = 0.033 and P < 0.001, respectively), whereas control had no change. Post hoc analyses indicated no difference by age, sex, or diabetes status. Conclusions Cognitively healthy older adults with stable CAD randomly assigned to high-dose EPA and DHA had improved cognitive function over a 30-mo period compared with control. These findings may be especially important for CAD patients because CAD is a risk factor for cognitive decline. This trial was registered at clinicaltrials.gov as NCT01624727.

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Background: Vitiligo is an acquired pigmentary disorder of unknown etiology that affects up to 1% of the general population of all skin types. It is a multifactorial disorder. There are numerous medical and surgical treatments aimed at repigmentation. Microneedling is a minimally invasive procedure that uses fine needles to puncture the epidermis. The indications for microneedling therapy have grown significantly and it is becoming a widely used treatment in Dermatology. Aim of Study: To study the clinical and histological efficacy of combined NB-UVB phototherapy and microneedling versus NB-UVB phototherapy in the treatment of vitiligo. Patients and Methods: Twenty patients were divided into two Groups (A & B), each of 10 patients. Both groups were matched regarding age, sex, skin type and have a depigmented patch at the same corresponding site. Group A was subjected to microneedling with dermapen at one depigmented patch followed by NB-UVB phototherapy sessions twice weekly for three months. Group B was subjected to NB-UVB phototherapy sessions twice weekly for three months. Two Skin biopsies one before and one after the therapy were taken for immunohistochemical examination by HMB 45. Results: The mean percentage of improvement was significantly high in Group A (48.50% ± 26.46) than Group B (20.0% ± 19.58). In Group A 20% showed mild improvement (G1), 20% showed moderate improvement (G2), (40%) showed good improvement (G3) and 20% showed excellent improvement (G4). In Group B 30% showed no improvement, 50% showed mild improvement (G1), 10% showed moderate improvement (G2) and 10% showed good improvement (G3). There was statistically significant difference between both groups (p=0.027*). Immunohistochemical changes revealed marked expression of HMB45 in Group A more than Group B, the mean of color intensity in Group A was 0.05 ±0.04 and a median of 0.03

Climate change and related challenges are affecting all over the world, particularly, African's 2030 path of sustainable development, especially in the desert regions, which include the most vulnerable and vulnerable systems. Climate changes are a natural phenomenon that occurs every several millennia, but increased last years as a result of human activity. It transcends the geographical boundaries of countries and poses a global threat. The steady increase in global surface air temperatures has been confirmed (0.3 and 0.6 oc) over the past 100 years. Any disruption of the Earth's ecosystem in general, increasing average atmospheric temperature, melting of the poles, inundation of island States and deltas, disruption of rainfall patterns, negative impacts on agricultural land productivity, water needs, public health and transmission of epidemic diseases. This review light on scientific concept of climate changes, climate change risks, climate worming and human footprint. Moreover, this review aims to discuss the historical development of international agreements, treaties and protocols that discussed addressing climate change and its current and future effects. Moreover, this review aims to discuss the historical development of international agreements, treaties and protocols that discussed addressing climate change and its current and future effects. Briefly, it summarizes what will happen to the blue planet if the reasons of climate changes continue?

Background: Antimicrobial resistance is one of the most serious public health threats of the twenty-first century, Uropathogenic Escherichia coli (UPEC) are one of the main bacteria causing urinary tract infections (UTIs). The rate of UPEC with high resistance towards antibiotics has increased dramatically in recent years. Objectives: This study aimed to assess the antibiotic resistance pattern of UPEC and to detect the relationship of antibiotic resistance with the presence of efflux pump genes (AcrA-AcrB-TolC). Methodology: This study included 50 UPEC strains, Identification of E.coli by Gram stain, culture and biochemical reactions was done, Antibiotic susceptibility for isolated E.coli strains by vitek system and detection of AcrA-AcrB-TolC genes by conventional PCR among isolated strains were also performed. Results: the prevalence of MDR was 70%,UPEC isolates showed high level of resistance to : ampicillin(94%), nalidixic acid (84%), ticacillin (82%), ciprofloxacin (76%) and trimethoprim/sulfamethoxazole (76%), low level of resistance of UPEC to:gentamicin (34%), amoxicillin/clavulinic acid (28%), ceftazidime (21%), cefoxitin (16%), piperacillin/ tazobactam (8%), tobramycin(2%) and ertapenem (2%) but no resistance to amikacin , imipenem and nitrofurantoin. 50%, 66% and 68% of isolates had genes acrA, acrB and tolC respectively. there was a significant correlation between tol C gene and MDR phenotype. Conclusion: the rate of MDR UPEC is rising, efflux pumps play an important role in mediating antibiotic efflux and increase the rate of antibiotic rasistance. The frequency of tol C gene was significantly higher in MDR than non MDR, while the acr A B level showed non significant variation among MDR and non MDR.

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