Sana'a University

The GPS‐derived velocity field (1988–2005) for the zone of interaction of the Arabian, African (Nubian, Somalian), and Eurasian plates indicates counterclockwise rotation of a broad area of the Earth's surface including the Arabian plate, adjacent parts of the Zagros and central Iran, Turkey, and the Aegean/Peloponnesus relative to Eurasia at rates in the range of 20–30 mm/yr. This relatively rapid motion occurs within the framework of the slow‐moving (∼5 mm/yr relative motions) Eurasian, Nubian, and Somalian plates. The circulatory pattern of motion increases in rate toward the Hellenic trench system. We develop an elastic block model to constrain present‐day plate motions (relative Euler vectors), regional deformation within the interplate zone, and slip rates for major faults. Substantial areas of continental lithosphere within the region of plate interaction show coherent motion with internal deformations below ∼1–2 mm/yr, including central and eastern Anatolia (Turkey), the southwestern Aegean/Peloponnesus, the Lesser Caucasus, and Central Iran. Geodetic slip rates for major block‐bounding structures are mostly comparable to geologic rates estimated for the most recent geological period (∼3–5 Myr). We find that the convergence of Arabia with Eurasia is accommodated in large part by lateral transport within the interior part of the collision zone and lithospheric shortening along the Caucasus and Zagros mountain belts around the periphery of the collision zone. In addition, we find that the principal boundary between the westerly moving Anatolian plate and Arabia (East Anatolian fault) is presently characterized by pure left‐lateral strike slip with no fault‐normal convergence. This implies that “extrusion” is not presently inducing westward motion of Anatolia. On the basis of the observed kinematics, we hypothesize that deformation in the Africa‐Arabia‐Eurasia collision zone is driven in large part by rollback of the subducting African lithosphere beneath the Hellenic and Cyprus trenches aided by slab pull on the southeastern side of the subducting Arabian plate along the Makran subduction zone. We further suggest that the separation of Arabia from Africa is a response to plate motions induced by active subduction.

IMPORTANCE: The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. OBJECTIVE: To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. EVIDENCE REVIEW: The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs). FINDINGS: In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. CONCLUSIONS AND RELEVANCE: The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.

AIMS: Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment. METHODS AND RESULTS: This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen between January 2010 and November 2012. The majority (63.9%) had moderate-to-severe multivalvular disease complicated by congestive heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%). One-quarter of adults and 5.3% of children had decreased left ventricular (LV) systolic function; 23% of adults and 14.1% of children had dilated LVs. Fifty-five percent (n = 1761) of patients were on secondary antibiotic prophylaxis. Oral anti-coagulants were prescribed in 69.5% (n = 946) of patients with mechanical valves (n = 501), AF (n = 397), and high-risk mitral stenosis in sinus rhythm (n = 48). However, only 28.3% (n = 269) had a therapeutic international normalized ratio. Among 1825 women of childbearing age (12-51 years), only 3.6% (n = 65) were on contraception. The utilization of valvuloplasty and valve surgery was higher in upper-middle compared with lower-income countries. CONCLUSION: Rheumatic heart disease patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anti-coagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level.

African agriculture is largely traditional--characterized by a large number of smallholdings of no more than one ha per household. Crop production takes place under extremely variable agro-ecological conditions, with annual rainfall ranging from 250 to 750 mm in the Sahel in the northwest and in the semi-arid east and south, to 1500 to 4000 mm in the forest zones in the central west. Farmers often select well-adapted, stable crop varieties, and cropping systems are such that two or more crops are grown in the same field at the same time. These diverse traditional systems enhance natural enemy abundance and generally keep pest numbers at low levels. Pest management practice in traditional agriculture is a built-in process in the overall crop production system rather than a separate well-defined activity. Increased population pressure and the resulting demand for increased crop production in Africa have necessitated agricultural expansion with the concomitant decline in the overall biodiversity. Increases in plant material movement in turn facilitated the accidental introduction of foreign pests. At present about two dozen arthropod pests, both introduced and native, are recognized as one of the major constraints to agricultural production and productivity in Africa. Although yield losses of 0% to 100% have been observed on-station, the economic significance of the majority of pests under farmers' production conditions is not adequately understood. Economic and social constraints have kept pesticide use in Africa the lowest among all the world regions. The bulk of pesticides are applied mostly against pests of commercial crops such as cotton, vegetables, coffee, and cocoa, and to some extent for combating outbreaks of migratory pests such as the locusts. The majority of African farmers still rely on indigenous pest management approaches to manage pest problems, although many government extension programs encourage the use of pesticides. The current pest management research activities carried out by national or international agricultural research programs in Africa focus on classical biological control and host plant resistance breeding. With the exception of classical biological control of the cassava mealybug, research results have not been widely adopted. This could be due to African farmers facing heterogeneous conditions, not needing fixed prescriptions or one ideal variety but a number of options and genotypes to choose from. Indigenous pest management knowledge is site-specific and should be the basis for developing integrated pest management (IPM) techniques. Farmers often lack the biological and ecological information necessary to develop better pest management through experimentation. Formal research should be instrumental in providing the input necessary to facilitate participatory technology development such as that done by Farmer Field Schools, an approach now emerging in different parts of Africa.

The COVID-19 pandemic has tremendously increased the production and sales of disinfectants. This study aimed to systematically review and analyze the efficacy and safety of chlorine dioxide as a disinfectant. The literature relating to the use of chlorine dioxide as a disinfectant was systematically reviewed in January 2021 using databases such as PubMed, Science Direct, and Google Scholar. Inclusion criteria were studies that investigated the use of chlorine dioxide to assess the efficacy, safety, and impact of chlorine dioxide as a disinfectant. Out of the 33 included studies, 14 studies focused on the disinfectant efficacy of chlorine dioxide, 8 studies expounded on the safety and toxicity in humans and animals, and 15 studies discussed the impact, such as water treatment disinfection using chlorine dioxide. Chlorine dioxide is a safe and effective disinfectant, even at concentrations as low as 20 to 30 mg/L. Moreover, the efficacy of chlorine dioxide is mostly independent of pH. Chlorine dioxide can be effectively used to disinfect drinking water without much alteration of palatability and can also be used to destroy pathogenic microbes, including viruses, bacteria, and fungi from vegetables and fruits. Our review confirms that chlorine dioxide is effective against the resistant Mycobacterium , H1N1, and other influenza viruses. Studies generally support the use of chlorine dioxide as a disinfectant. The concentration deemed safe for usage still needs to be determined on a case-by-case basis.

BACKGROUND: For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. METHODS: The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. FINDINGS: Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). INTERPRETATION: Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. FUNDING: Gates Foundation and Bloomberg Philanthropies.

<p style="text-align: justify;"><strong>Objective:</strong> The study is to evaluate Yemeni medical and pharmacy students&rsquo; knowledge and attitude regarding generic medicines. <strong>Method:</strong> A cross-sectional survey was used to collect data from final-year medical and pharmacy students at six public and private universities in Yemen. The questionnaire was distributed among the students through their course coordinators. Students were clearly informed about the objective of the study and their written consents were taken before the survey. The responses were entered in SPSS, and descriptive and inferential analyses were carried out. <strong>Results:</strong> The response rate was 60.1%. Overall the half of participants&rsquo; perception regarding generic medicine was positive. Perceptions of pharmacy students&rsquo; regarding generic medicines were better than those of the medical students. <strong>Conclusion:</strong> The present study concluded that both studied groups had insufficient knowledge about quality, safety and bioequivalence of generic medicines. The medical students showed poorer knowledge than pharmacy students which need to give more attention from educators regarding the use of generic medicines. <p style="text-align: justify;"><strong>Key words:</strong> Generic drugs, Medical students, Perception, Pharmacy students, Yemen.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

Purpose This study aims to explore patients’ knowledge and beliefs toward generic medicines and identify the factors affecting their beliefs toward them in Yemen. Patients and methods A cross-sectional study was conducted from April 1 to July 1, 2016. A self-administered questionnaire was distributed to 590 adult patients in Sana’a. The data were analyzed using Statistical Package for the Social Sciences® (IBM SPSS) version 26 for Windows. Results Overall, 370 patients participated in this study. The study identified that a majority of the respondents did not know the similarities and differences between generic and branded medication and had negative beliefs toward generic medication. The study identified the factors contributing to the patients’ beliefs toward generic medication. Conclusion Yemeni patients had poor knowledge and negative beliefs toward generic medication. Educational programs provided to patients and healthcare professionals regarding generic medication can improve patients’ knowledge and correct their beliefs in this regard.

Oxygen-isotope ratios of a stalagmite from Socotra Island in the Indian Ocean provide a record of changes in monsoon precipitation and climate for the time period from 42 to 55 thousand years before the present. The pattern of precipitation bears a striking resemblance to the oxygen-isotope record from Greenland ice cores, with increased tropical precipitation associated with warm periods in the high northern latitudes. The largest change, at the onset of interstadial 12, occurred very rapidly, in about 25 years. The chronology of the events found in our record requires a reevaluation of previously published time scales for climate events during this period.

Background Treatment of multi-drug resistant tuberculosis (MDR-TB) for a prolonged period with comparatively less effective and more toxic second-line anti-TB drugs is associated with greater incidence of adverse events. Study aim This study aimed to evaluate the frequency and factors associated with occurrence of adverse events among patients with MDR-TB attending the Bahawal Victoria Hospital, Bahawalpur, Pakistan. Study design This retrospective study included all patients with MDR-TB who were registered and treated at the study site between June 2014 and December 2016 and had their treatment outcomes available at the time of data collection (i.e., November 2018). Measures and outcomes The Electronic Nominal Record System (ERNS) records, medical charts of patients, and laboratory reports were reviewed to obtain the data. Adverse events were reported as per the standard criteria recommended by the WHO. Multivariate binary logistic regression was used to find the independent factors associated with the occurrence of adverse events. Results A total of 179 patients with MDR-TB were included in the final analysis. Out of these, 114 (63.7%) patients experienced at least one adverse event during the course of their treatment. Depression was the most common adverse events (33%), followed by nausea and vomiting (27.4%) and arthralgia (27.4%). The factors associated with the occurrence of adverse events included presence of comorbidity (adjusted odds ratio [ AOR ] 2.951; 95% CI 1.423, 6.118) and being employed ( AOR 3.445; 95% CI 1.188, 9.993). Conclusion Adverse events were prevalent in this cohort, however, resolved with the effective management approaches. Patients with identified factors for occurrence of adverse events need special attention and enhanced clinical management.

Studies on the possible association between bacteria and oral squamous cell carcinoma (OSCC) remain inconclusive, largely due to methodological variations/limitations. The objective of this study was to characterize the species composition as well as functional potential of the bacteriome associated with OSCC. DNA obtained from 20 fresh OSCC biopsies (cases) and 20 deep-epithelium swabs (matched control subjects) was sequenced for the V1-V3 region using Illumina's 2 × 300 bp chemistry. High quality, non-chimeric merged reads were classified to species level using a prioritized BLASTN-algorithm. Downstream analyses were performed using QIIME, PICRUSt, and LEfSe. Fusobacterium nucleatum subsp. polymorphum was the most significantly overrepresented species in the tumors followed by Pseudomonas aeruginosa and Campylobacter sp. Oral taxon 44, while Streptococcus mitis, Rothia mucilaginosa and Haemophilus parainfluenzae were the most significantly abundant in the controls. Functional prediction showed that genes involved in bacterial mobility, flagellar assembly, bacterial chemotaxis and LPS synthesis were enriched in the tumors while those responsible for DNA repair and combination, purine metabolism, phenylalanine, tyrosine and tryptophan biosynthesis, ribosome biogenesis and glycolysis/gluconeogenesis were significantly associated with the controls. This is the first epidemiological evidence for association of F. nucleatum and P. aeruginosa with OSCC. Functionally, an "inflammatory bacteriome" is enriched in OSSC.

Objectives: This study was aimed to explore the knowledge and beliefs of patients in Ibb, Yemen, regarding generic medicines and identify factors affecting their use of these medicines. Methods: A mixed qualitative and quantitative study was conducted between Jan 1 and Mar 31, 2017 in Ibb, Yemen. A total of 310 patients participated in this study. The questionnaire used for data collection comprised of two sections. The first section covered participants' demographic information and contained six questions addressing patients' ability to differentiate between generic and brand-name medications. The second section comprises 15 items regarding patients' beliefs about generic medicines, answered using a five-point Likert scale. Additionally, seven patients were interviewed using a semi-structured interview guide to explore further the factors affecting their generic medicine use. Results: Only 17.4% of patients knew the difference between generic and brand-name medicines. Approximately 59 (19%) patients believed that generic medicines' efficacy was the same as that of brand-name medicines, while 42 (13.5%) believed that generic medicines took longer to take effect. The vast majority of patients (252) (81.3%) believed that generic medicines were appropriate for less serious medical conditions. Only 84 patients (27.1%) believed that generic medications were the same as brand-name ones. Furthermore, the majority of patients held negative beliefs about generic medicines. The study also found that the price of medicines, physicians' recommendations, and pharmacy dispensers contributed to patients' use of generic medications. Conclusion: This study found that Yemen patients have insufficient knowledge of and negative beliefs about generic medicines. Special oriented and well-designed programs to educate and improve patients and healthcare professionals' understanding and beliefs about generic medicines are urgently needed.

Background: Lack of adherence to anti-diabetic medications use is linked with suboptimal glycemic control which in turn leads to increase rate of diabetic complications. The adherence to anti-diabetic medications among adult diabetic patients in Sana'a city has not been yet evaluated.&#x0D; Objective: This study, therefore, assessed the extent to which diabetic patients are adherent to their antidiabetic medications and explored the factors underlying such adherence attitude in Sana’a City, Yemen.&#x0D; Methods: A cross-sectional method was conducted among a sample of 365 diabetic patients attending public and private hospitals from March to April 2017 in Sana'a City-Yemen. Random patients were selected and data regarding their treatment adherence were obtained using a questionnaire. Adherence to diabetes medications was measured using medication adherence index followed by structured interviews. Descriptive analysis was used to compare between different groups of diabetic patients. Bivariate analyses were conducted to evaluate the associations between clinical variables.&#x0D; Results: The cross-sectional study included 365 patients (263 males; 102 females). A high level of medication adherence rate to anti-diabetic drugs in the present study was (70%). The adherence rate was not similar in both genders where males were more adherent than females. The most common reason for non-adherence was forgetfulness (n= 67; 61%). While the lowest factor for non-adherence was associated with ineffective (n= 7; 6%). Adherence was strongly associated with diabetes duration, monthly income, blood sugar monitoring, communication with physician, and patient’s knowledge regarding importance of medication use (p &lt;0.05).&#x0D; Conclusions: The degree of adherence in patients with diabetes in Sana’a to anti-diabetic medication was shown to be mostly suboptimal. The medication adherence levels are still crucial strategy for optimal treatment against diabetes. However, additional studies on strategies to improve adherence rate and health care should be carried out in the future.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Abstract AimsThe aim of this study was to describe the dispensing errors that occurred during the dispensing process in selected hospital pharmacies in Sana’a, Yemen; and to describe their types and causes.MethodologyA prospective study was carried out in selected hospital pharmacies in Yemen over 40 days using a validated tool. ResultsA total of 9000 dispensed prescriptions were evaluated for the dispensing errors and 2.13 % dispensing errors were identified. Wrong dosage form (134/192); wrong strength (24/192); wrong drug (18/192); wrong quantity, wrong instructions written and drug available in the pharmacy but not given were (6/192) and dispense the expired drugs (3/192) were the reported dispensing errors in this study. Poor handwriting, similar drug names, similar drug packaging, fatigue, heavy work, workforce issues, and poor communication were the most common reported causes of dispensing errors. ConclusionThe prevalence of dispensing errors in this study was 2.13%. Pharmacists can play an important role in the improving the safety of medicines. Study of the dispensing errors incidence in national wide, it's types and causes of dispensing errors are very important and highly recommended. Study the impact of different interventions to improve dispensing quality, reducing and preventing dispensing errors are strongly recommended.

BACKGROUND: In war-torn Yemen, reports of confirmed cholera started in late September, 2016. The disease continues to plague Yemen today in what has become the largest documented cholera epidemic of modern times. We aimed to describe the key epidemiological features of this epidemic, including the drivers of cholera transmission during the outbreak. METHODS: . Finally, we estimated the association between rainfall and the daily cholera incidence during the increasing phase of the second epidemic wave by fitting a spatiotemporal regression model. FINDINGS: of more than 2 in 13 of 23 governorates. Microbiological analyses suggested that the same Vibrio cholerae O1 Ogawa strain circulated in both waves. We found a positive, non-linear, association between weekly rainfall and suspected cholera incidence in the following 10 days; the relative risk of cholera after a weekly rainfall of 25 mm was 1·42 (95% CI 1·31-1·55) compared with a week without rain. INTERPRETATION: Our analysis suggests that the small first cholera epidemic wave seeded cholera across Yemen during the dry season. When the rains returned in April, 2017, they triggered widespread cholera transmission that led to the large second wave. These results suggest that cholera could resurge during the ongoing 2018 rainy season if transmission remains active. Therefore, health authorities and partners should immediately enhance current control efforts to mitigate the risk of a new cholera epidemic wave in Yemen. FUNDING: Health Authorities of Yemen, WHO, and Médecins Sans Frontières.

BACKGROUND: Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. METHODS: GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. FINDINGS: The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. INTERPRETATION: We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. FUNDING: Gates Foundation.

Low-power wide-area network (LPWAN) technologies play a pivotal role in IoT applications, owing to their capability to meet the key IoT requirements (e.g., long range, low cost, small data volumes, massive device number, and low energy consumption). Between all obtainable LPWAN technologies, long-range wide-area network (LoRaWAN) technology has attracted much interest from both industry and academia due to networking autonomous architecture and an open standard specification. This paper presents a comparative review of five selected driving LPWAN technologies, including NB-IoT, SigFox, Telensa, Ingenu (RPMA), and LoRa/LoRaWAN. The comparison shows that LoRa/LoRaWAN and SigFox surpass other technologies in terms of device lifetime, network capacity, adaptive data rate, and cost. In contrast, NB-IoT technology excels in latency and quality of service. Furthermore, we present a technical overview of LoRa/LoRaWAN technology by considering its main features, opportunities, and open issues. We also compare the most important simulation tools for investigating and analyzing LoRa/LoRaWAN network performance that has been developed recently. Then, we introduce a comparative evaluation of LoRa simulators to highlight their features. Furthermore, we classify the recent efforts to improve LoRa/LoRaWAN performance in terms of energy consumption, pure data extraction rate, network scalability, network coverage, quality of service, and security. Finally, although we focus more on LoRa/LoRaWAN issues and solutions, we introduce guidance and directions for future research on LPWAN technologies.

&lt;p class="Abstract"&gt;&lt;span lang="EN-GB"&gt;In this competitive scenario of the educational system, the higher education institutes use data mining tools and techniques for academic improvement of the student performance and to prevent drop out. The authors collected data from three colleges of Assam, India. The data consists of socio-economic, demographic as well as academic information of three hundred students with twenty-four attributes. Four classification methods, the J48, PART, Random Forest and Bayes Network Classifiers were used. The data mining tool used was WEKA. The high influential attributes were selected using the tool. The internal assessment attribute in the continuous evaluation process makes the highest impact in the final semester results of the students in our dataset. The results showed that random forest outperforms the other classifiers based on accuracy and classifier errors. Apriori algorithm was also used to find the association rule mining among all the attributes and the best rules were also displayed.&lt;em&gt;&lt;/em&gt;&lt;/span&gt;&lt;/p&gt;