Search Results (269)

Background: Deep vein thrombosis (DVT) is a serious thromboinflammatory complication of acute ischemic stroke (AIS). The true incidence, mechanistic risk factors, and optimal prophylactic strategies remain uncertain, particularly in the era of reperfusion therapy. Methods: This systematic review and meta-analysis (IRIS-DVT) searched PubMed, Embase, Cochrane, Scopus, and Web of Science for studies reporting DVT incidence, risk factors, or prophylaxis in AIS (2004–2025). Random-effects models were used to generate pooled prevalence and effect estimates, and the certainty of evidence was graded using the GRADE framework. Results: Forty-two studies (n = 6,051,729 patients) were included. The pooled prevalence of DVT was 7% (95% CI, 6–9%), approximately seventy-fold higher than in the general population, with wide heterogeneity influenced by screening timing and diagnostic modality. Pathophysiological risk factors included higher stroke severity (NIHSS; SMD 0.41; 95% CI, 0.38–0.43), older age (SMD 0.32; 95% CI, 0.18–0.46), elevated D-dimer (SMD 0.55; 95% CI, 0.38–0.72), female sex (OR 1.33; 95% CI, 1.19–1.50), and malignancy (OR 2.69; 95% CI, 1.56–5.22), supported by moderate-certainty evidence. Respiratory infection and admission hyperglycemia showed weaker, low-certainty associations. Traditional vascular risk factors (hypertension, diabetes, atrial fibrillation, dyslipidemia) were not significantly related to DVT risk. Evidence for prophylaxis with low-molecular-weight heparin, direct oral anticoagulants, or intermittent pneumatic compression was limited and graded very low certainty. Conclusions: DVT complicates approximately one in fourteen AIS cases, reflecting a distinct thromboinflammatory process driven more by acute neurological severity, systemic hypercoagulability, and malignancy than by conventional vascular risk factors. Early systematic screening (≤72 h) and consistent use of mechanical prophylaxis are warranted. Dedicated AIS-specific mechanistic and interventional trials are urgently needed to refine prevention strategies and improve post-stroke outcomes. Full article

Recurrent erysipelas is a common and clinically significant condition that poses challenges for both patients and healthcare systems. Each episode may damage lymphatic vessels, leading to chronic lymphedema, which perpetuates the risk of further relapses. Recurrence rates remain high, ranging from 11% in outpatients during the first year to up to 46% of hospitalized patients within three years. The lower limbs are the most frequent site, although recurrences may also occur in other regions, such as the upper limb after mastectomy with lymph node dissection. This review summarizes current knowledge on risk factors, preventive measures, and chemoprophylaxis in recurrent erysipelas. Modifiable risk factors such as obesity, diabetes, venous insufficiency, tinea pedis, and poor hygiene play an important role, while non-modifiable factors include age, sex, and a history of prior episodes. Non-pharmacological strategies—weight reduction, glycemic control, smoking cessation, compression therapy, and meticulous skin care—form the cornerstone of prevention and may reduce the need for long-term antibiotics. Antibiotic prophylaxis, most commonly with oral penicillin V or intramuscular benzathine penicillin, has been shown to lower recurrence rates. However, efficacy may be reduced in patients with chronic edema or severe obesity. Macrolides serve as alternatives in penicillin-allergic patients, but concerns remain about resistance, adverse effects, and drug–drug interactions. In conclusion, recurrent erysipelas requires a multifaceted approach. While antibiotic prophylaxis is effective, its long-term success depends on simultaneous management of underlying conditions. Further studies are needed to define optimal regimens, treatment duration, and non-antibiotic alternatives. Full article

Oral hygiene protocols and basic oral care (BOC) are paramount for patients undergoing cancer treatment, although based upon limited evidence from clinical trials. There are a range of oral care guidelines proposed in the literature mainly focusing on oral mucositis prevention. This systematic review aimed to define the best procedures and practices in the scope of oral hygiene protocols and BOC interventions for the prevention and/or treatment of oral complications in patients under cancer treatment. This systematic review was conducted according to the PRISMA guidelines, and the methods were previously established and registered in PROSPERO (CRD42022319455). A systematic search was completed in six databases (PubMed, Scopus, Web of Science, LILACS, and the Cochrane Library, and gray literature). Eleven studies were included in the qualitative analysis including non-randomized (n = 1) and randomized clinical trials (n = 6), and cohort studies (n = 4). The included studies showed the effectiveness of soft brushes for daily oral hygiene with topical fluoride, and the use of mouthwashes with 0.12% chlorhexidine, doxepin, and benzydamine and saline solutions, as well as dental scaling/prophylaxis in decreasing the severity of oral toxicities. Although not well-explored by well-designed clinical studies, BOC protocols may be effective in prevention oral toxicities from cancer therapy and are supported in multiple guidelines. This review synthesized available evidence on BOC in head and neck cancer patients, focusing on the effectiveness of hospital-based dental protocols during cancer treatment. Full article

Background: Venous thromboembolism (VTE) is a serious and common complication in cancer patients, and it is the second leading cause of death after cancer itself. Cancer-associated thrombosis (CAT) is an indicator of a poorer prognosis and can lead to treatment delays and increased healthcare costs. This review aims to provide a comprehensive update on the efficacy and safety of tinzaparin in the treatment and prophylaxis of VTE in cancer patients. Methods: This is a narrative review that examines the pharmacological properties of tinzaparin, as well as the results from clinical studies and meta-analyses. It includes a discussion of tinzaparin’s role in special patient populations and its comparison with other anticoagulants. Results: Tinzaparin is a low-molecular-weight heparin (LMWH) that does not accumulate in patients with renal insufficiency, eliminating the need for dose adjustments. Studies have shown that tinzaparin is a safe and effective treatment for CAT, with a favorable safety profile regarding hemorrhagic complications. In the CATCH study, tinzaparin showed a significant reduction in clinically relevant non-major bleeding compared to warfarin. Tinzaparin has also been shown to be more effective than vitamin K antagonists (VKAs) in promoting the recanalization of venous thrombi. A meta-analysis confirmed that tinzaparin was superior to VKAs in preventing VTE recurrence in the long term. Conclusions: While direct oral anticoagulants (DOACs) offer convenience, LMWHs like tinzaparin remain crucial, especially for patients with specific characteristics such as renal insufficiency, complex drug interactions, or a high risk of gastrointestinal bleeding. Tinzaparin’s favorable safety and efficacy, along with its unique pharmacological properties, make it a valuable option for managing VTE in the complex oncology population. Full article

Background: The efficacy of a single oral dose of Ivermectin as prophylaxis for SARS-CoV-2 is uncertain. This trial sought to evaluate the effectiveness of a single oral low dose of Ivermectin to prevent SARS-CoV-2 infection or reduce symptoms if infection did occur. Methods: Asymptomatic community-dwelling adults were enrolled in this study within 72 h of close contact with a case of SARS-CoV-2. Participants were randomised, stratified by vaccination status and exposure site, to a single oral 200 µg/kg dose of Ivermectin or placebo. The primary outcome was conversion to a positive polymerase chain reaction (PCR) or rapid antigen test (RAT) for SARS-CoV-2 within 14 days of close contact. Secondary outcomes were restricted to those who met the primary outcome. They included the following: days alive free of symptoms in the 14 (DAFS1-14) and 28 (DAFS1-28) days following intervention and days from close contact until a positive PCR or RAT for SARS-CoV-2. Results: A total of 536 participants registered for this trial. Of these, 86 met inclusion criteria and were randomised. 68 adhered to the trial protocol and were included in the analysis. A total of 11/36 (Ivermectin arm) and 11/32 (placebo arm) met the primary outcome. After controlling for age and prior SARS-CoV-2 infection, the estimate (95% confidence interval (95% CI)) of the effect of Ivermectin (compared to placebo) on the absolute value of the proportion of participants converting to a positive PCR or RAT was −0.051 (−0.26 to 0.16), p = 0.63. After controlling for prior SARS-CoV-2 infection, age, body mass index, hypertension and lung disease, the average treatment effect (Ivermectin versus placebo) on DAFS1-14 was 2.5 days (95%CI 1.1 to 4.5), p = 0.036, and for DAFS1-28, was 2.3 days (95% CI 0.7 to 3.3), p = 0.35. The mean (standard deviation) number of days from close contact until a positive PCR or RAT was 5.0 (4.1) days for the Ivermectin group versus 2.6 (0.8) days for the placebo group. After controlling for age and prior SARS-CoV-2 infection, the average treatment effect (95%CI), Ivermectin versus placebo, on days from close contact until a positive PCR or RAT was 2.3 days (95% CI 1.1 to 3.4), p = 0.033. Conclusions: We did not demonstrate that a single oral low dose of Ivermectin administered to asymptomatic adults within 72 h of close contact with a case of SARS-CoV-2 prevents conversion to a positive PCR or RAT. However, the trial had a small sample size and does not exclude a clinically meaningful effect of Ivermectin on conversion to a positive PCR or RAT. Amongst those who did convert to a positive PCR or RAT, the use of Ivermectin significantly lengthened the time from close contact to conversion and increased the number of days alive free of symptoms following intervention. Full article

Objectives: Oral isotretinoin remains the most effective therapy for severe acne, but its exceptional efficacy is often accompanied by relatively frequent adverse effects. In this study, we quantified the frequency- and dose-related predictors of clinical and biochemical adverse effects during isotretinoin treatment in routine Polish practice. Methods: The records of 370 patients (mean age: 28 ± 12 years) who began isotretinoin treatment between June 2020 and June 2025 were reviewed. The mean daily isotretinoin and cumulative isotretinoin doses were 23.4 ± 9.1 mg and 88.3 ± 31.5 mg/kg, respectively. The adverse events documented at two-monthly visits were correlated with age and dosing. Lipid, hepatic, thyroid and prolactin panels were compared with age- and sex-matched controls using χ² statistics and odds ratios (ORs). Results: Xerosis (70%), retinoid dermatitis (20%) and cheilitis (15.5%) predominated. Hand eczema rose with higher daily isotretinoin doses (ρ = 0.082; p = 0.037), whereas pruritus declined with greater cumulative isotretinoin exposure (ρ = −0.088; p = 0.037). Retinoid dermatitis was linked to a younger age (ρ = −0.080; p = 0.0286), whereas desquamation increased slightly with age (ρ = +0.083 p = 0.0228). Overall, dyslipidemia was twice as common as in the controls (OR: 2.06; 95% CI: 1.49–2.86; p-value: <0.0001), which was driven by an elevated total cholesterol (OR: 1.93; 95% CI: 1.34–2.77; p-value: 0.0004), LDL (OR: 3.40; 95% CI: 2.26–5.10; p-value: <0.0001) and triglycerides (OR: 1.95; 95% CI: 1.20–3.17; p-value: 0.0062) and decreased HDL (OR: 2.68; 95% CI: 1.75–4.10; p-value: <0.0001). Interestingly, hyperprolactinemia occurred eight-fold more often (OR: 8.42; 95%; 95% CI: 2.97–23.84; p-value: <0.00001). Aminotransferase and TSH elevations were infrequent and statistically non-significant. Conclusions: At moderate cumulative doses, isotretinoin was generally well tolerated; however, clinically relevant lipid and prolactin disturbances were frequent. Routine lipid and endocrine monitoring, early emollient prophylaxis and dose individualization are recommended to ensure safe isotretinoin usage in everyday practice. Full article

Background/Objectives: Chronic endometritis (CE) is a subclinical inflammation of the endometrium that affects female fertility. Although awareness of its impact on reproductive outcomes has increased significantly, clinical management—especially the diagnostic value of hysteroscopy and the effectiveness of perioperative antibiotic prophylaxis in improving fertility—remains unclear. Methods: This retrospective analysis involved 136 infertile women (30–44 years) who underwent diagnostic hysteroscopy between 2022 and 2023 at the Military Institute of Medicine in Warsaw. Women with intrauterine pathologies or other infertility factors were excluded. Hysteroscopic indicators of chronic endometritis (CE) included micropolyps and endometrial hyperemia. Endometrial biopsies were stained with CD138 and CE was diagnosed based on ≥5 plasma cells per 10 high-power fields. A single oral dose of azithromycin was administered post-procedure and pregnancy outcomes were assessed 12 months later. Results: CE was histologically confirmed in 29.2% of patients. The presence of micropolyps demonstrated a strong correlation with CE (p < 0.0001), although CE was also found in 21% of patients with normal hysteroscopic findings. While CE status did not significantly influence pregnancy rates, patients who received azithromycin exhibited a significantly higher conception rate (53% vs. 21%, p = 0.022). Additionally, secondary infertility was associated with higher reproductive success compared to primary infertility (54% vs. 24%, p = 0.022). Conclusions: Micropolyps are a specific hysteroscopic marker of CE. However, histologic inflammation markers may be present even in the absence of abnormal hysteroscopic findings. Furthermore, the routine use of antibiotic prophylaxis is associated with improved reproductive outcomes. Full article

Background: Daily oral preexposure prophylaxis (PrEP) is one strategy employed to decrease HIV transmission among adolescent girls and young women (AGYW). The Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) program, funded by PEPFAR/USAID and implemented by the Project HOPE Namibia (PHN)-led consortium, provided services in the Khomas, Oshikoto, Zambezi, and Oshana regions. This study assessed the one-month PrEP retention rate among AGYW 15–24 and the associated factors. Methods: The program’s target populations for PrEP included AGYW aged 15–24 years who were at substantial risk for HIV, tested HIV-negative, and resided in the regions where the PHN-led consortium was implementing the DREAMS program. Data between 2018 and 2024 were exported from DHIS2 to IBM SPSS version 29 for secondary data analysis. We analyzed the data using Chi-squared tests and binomial and multinomial logistic regression. Results: Among the 17,277 participants newly initiated on oral PrEP and included in this study, only 2466 returned on time for their one-month appointment. The one-month PrEP retention rate among AGYW was 14.3%, 95% CI (13.8–14.8%). The most common reasons for PrEP discontinuation were traveling away from home, not needing PrEP anymore, forgetfulness, and side effects. Participants from Oshakati and Onandjokwe exhibited a higher likelihood of one-month PrEP retention. Additionally, participants who were in the programs for 7–12 months or over 36 months, who attended the safe space HIV prevention sessions, who were unaware of their partners’ HIV status, and who considered themselves at risk of HIV also exhibited a lower likelihood of one-month PrEP retention. In contrast, individuals who had 1–2 children and those who were either pregnant or breastfeeding exhibited a higher likelihood of one-month PrEP retention, (COR) = 1.28, 95% CI (1.15–1.43), and COR = 2.00, 95% CI (1.62–2.46), respectively. Conclusions: Targeted, innovative, and context-specific strategies should be developed to support AGYW in identifying their HIV risk and continuing the use of daily oral PrEP during periods of heightened risk. Additionally, prioritizing the introduction of discreet, long-acting PrEP options that require less frequent administration may better align with their needs and preferences. Full article

Introduction: Anemia, characterized by a reduction in hemoglobin concentration, is a widespread health concern globally, impacting individuals across various demographics. Iron deficiency, often compounded by inadequate folic acid levels, is a primary driver. This review aims to consolidate current evidence and offer a practical recommendation regarding the role of folic acid 1 mg + iron (ferrous sulfate) 90 mg supplementation in both preventing and treating anemia. Objective: We aimed to provide a comprehensive review and recommendation regarding the use of folic acid 1 mg + iron (ferrous sulfate) 90 mg supplementation in the prevention and treatment of anemia in adults, based on current evidence and clinical experience. Methods: A thorough literature review was conducted, encompassing studies, guidelines, and meta-analyses related to iron deficiency, anemia, and folic acid supplementation. This review incorporated data from sources such as the World Health Organization (WHO), the European Hematology Association (EHA), and Cochrane Database. Clinical experience of the authors was also taken into account. Results: Anemia, a prevalent hematological condition, affects a significant portion of the global population. The risk factors for iron deficiency and iron deficiency anemia include age, menstruation, pregnancy, dietary restrictions, chronic diseases, and inflammatory conditions. Accurate diagnosis of anemia involves reticulocyte count, morphological classification, and identification of the underlying etiology. Oral iron salts, particularly ferrous sulfate, are the first-line treatment for uncomplicated iron deficiency anemia, with lower doses or alternate-day dosing improving tolerability. Adequate folic acid availability is crucial for erythropoiesis, and supplementation is safe and enhances treatment response, especially in mixed deficiency anemia. A fixed-dose combination of folic acid 1 mg + iron (ferrous sulfate) 90 mg is effective and well-tolerated for the treatment of iron deficiency anemia, mixed nutritional anemia, and iron deficiency without anemia in adults. Conclusions: Based on extensive scientific evidence and clinical experience, the combination of folic acid 1 mg + iron (ferrous sulfate) 90 mg is a valuable therapeutic option for the prevention and treatment of anemia. This combination should be indicated for iron and folic acid deficiency during pregnancy, lactation, and the postpartum period and for the prophylaxis and treatment of anemia during pregnancy and in adults in general. This approach enables correction of folate deficiencies, optimizing treatment response and ensuring sufficient folic acid levels, particularly in cases of incomplete adherence or missed doses, and is critical during pregnancy to minimize the risk of neural tube defects. Full article

Background/Objectives: Preventive oral health education plays a key role in preparing future healthcare professionals to promote and maintain good oral hygiene. Individually Trained Oral Prophylaxis (iTOP) is a structured, personalized educational program that emphasizes correct brushing techniques and interdental cleaning. This study aimed to evaluate the long-term effectiveness of a single-session iTOP intervention on clinical oral health outcomes among medical and dental students. Methods: A 2-year prospective cohort study included 82 first- and fourth-year medical and dental students at the University of Mostar, Bosnia and Herzegovina. The researchers randomly assigned participants to an iTOP intervention group or a control group. The primary analysis used multivariable linear mixed-effects models for repeated measures, adjusted for study program, academic year, smoking status, and baseline oral-hygiene habits, with effect sizes reported alongside 95% confidence intervals. Clinical periodontal parameters—plaque index, bleeding on probing, and probing depth—were assessed at baseline, three months, and two years. All participants received professional cleaning and oral hygiene kits. Only the intervention group received personalized iTOP training, consisting of a single session with brief reinforcement at the 3-month follow-up. This study was registered at ClinicalTrials.gov (NCT07085013). Results: Seventy-six students completed the follow-up. The iTOP group had significantly lower plaque index and bleeding scores at both follow-up points (p < 0.001) compared to the control group. Baseline differences were observed between subgroups (medical vs. dental; younger vs. older students), but these diminished over time. At the 2-year follow-up, only the plaque index remained significantly improved, while other clinical parameters returned to values comparable to baseline. Conclusions: The iTOP program resulted in significant short-term improvements in oral health among medical and dental students. For sustained long-term outcomes, iTOP or similar structured oral health education programs should be integrated into medical and dental curricula. Enhancing oral health awareness among healthcare providers may ultimately contribute to improved public oral health outcomes. Given the single-center design and the single-session nature of the intervention, the results should be interpreted with caution. Full article

The global fight against HIV/AIDS has been significantly bolstered by the development and implementation of pre-exposure prophylaxis (PrEP), yet innovation in PrEP interventions, improved adherence and greater access are still needed to maximize its benefit. Nonhuman primate (NHP) infection with simian immunodeficiency virus (SIV) has served as an instrumental animal model in advancing HIV PrEP research. This review comprehensively examines the utility of NHP models in evaluating the efficacy, pharmacokinetics, and safety of diverse PrEP strategies, including oral, injectable, implantable, and topical formulations. It discusses the development of diverse challenge models that simulate human transmission routes and the advantages of NHPs in enabling controlled and mechanistically informative studies. It also highlights the successful translation of pivotal NHP studies evaluating tenofovir-based regimens as well the long-acting agents, cabotegravir and lenacapavir, into the clinical settings, emphasizing the consistently high predictive power of the NHP models for the HIV PrEP clinical efficacy. Finally, it underscores the importance of species-specific pharmacologic considerations and the value of NHP data in informing clinical trial design. As the global community strives to end the HIV epidemic as a public health threat in the absence of an efficacious prophylactic vaccine, NHP models make a critical contribution in the development of next-generation HIV prevention tools. Full article

Background: Transient intraocular pressure (IOP) elevations frequently occur after cataract surgery and may raise concerns, especially in patients susceptible to glaucomatous damage or pressure-related complications. These IOP spikes have also been linked to postoperative discomfort and headache. Oral acetazolamide is often used prophylactically, despite its known systemic side effects. Objectives: To evaluate the clinical benefit of routine prophylactic oral acetazolamide in reducing IOP after uncomplicated phacoemulsification performed with an anterior chamber maintainer (ACM). Methods: In this retrospective case–control study, 196 eyes from 196 patients were included. All underwent standard phacoemulsification with an ACM. Patients either received oral acetazolamide postoperatively (n = 98) or no IOP-lowering medication (n = 98). IOP was measured preoperatively, and on postoperative days one and seven. Results: On day one, mean IOP was 14.0 ± 3.8 mmHg in the acetazolamide group versus 15.4 ± 3.8 mmHg in controls (p < 0.005). By day seven, IOP was identical in both groups (13.5 mmHg), with no statistically significant difference (p = 0.95). No participant in either group reported headache or serious adverse effects, though 10% in the acetazolamide group experienced mild, transient systemic symptoms. Conclusions: In low-risk patients undergoing uneventful cataract surgery with ACM, routine use of oral acetazolamide yields only a modest, short-lived IOP reduction without evident clinical benefit. Its use may be unnecessary in this setting, though targeted prophylaxis could be considered for high-risk individuals. Full article

Periodontal disease is a prevalent condition in companion animals. It is crucial to prevent the plaque and bacteria on tooth surfaces to avoid gingivitis and the more harmful periodontitis. The aim of the present study was to assess the impact of MLS laser treatment on the bacterial load by analyzing the gingival swabs of a total of 16 owned dogs with no history of dental disease that were selected from a cohort of patients admitted for plaque removal and dental hygiene procedures. Following each dental hygiene session, each dog received a single MLS laser therapy treatment (808–905 nm diode laser, frequency 36 Hz, and fluence 0.16 J/cm²). Swabs were collected from the two upper premolars before and after the laser treatment. These were submitted for mesophilic bacteria counts, and microbiological analysis was conducted on 10 positive cultures to evaluate the changes in the oral bacterial microbiota. MLS laser therapy statistically significantly reduced the mesophilic bacteria count by 1 log, with higher pre-laser treatment counts (n = 0.44; 5.77 ± 0.21 95%CI) in comparison to post-laser treatment counts (n = 0.73; 4.80 ± 0.346 95%CI). The MLS laser therapy was found to reduce the bacterial load in 80% of the subjects (p < 0.05). No significant differences pre- and post-laser treatment were observed in the bacteria species isolated from the microbiological cultures. MLS laser therapy appears to be a useful, non-invasive method for reducing the bacterial load in the treatment and prophylaxis of periodontal disease in dogs. Full article

The Sultanate of Oman boasts remarkable biodiversity, exemplified by such species as the Arabian leopard (Panthera pardus nimr) and the Arabian oryx (Oryx leucoryx), national symbols that highlight the extensive conservation efforts required to protect the country’s natural heritage. During decades, Omani authorities have taken significant measures to safeguard wildlife and preserve the natural environment. A sanctuary dedicated to the reintroduction of the Arabian Oryx, after extinction in nature in 1972, was established in 1980 in the Al Wusta Governorate under the patronage of the Royal Diwan and currently administrated by the recently established Environment Authority. During the almost 40 years since the reintroduction and the creation of the sanctuary, the oryx population has grown slowly but constantly. In 2021, the sanctuary hosted 738 oryx, allowing the start of the reintroduction of the species into the natural environment. Small groups of animals were released into the wild in selected areas. No animal health adverse events were recorded, and mortality was generally due to injuries received as a consequence of fighting, in particular during mating season. Standard veterinary care, including control of internal and external parasites, was regularly provided. In some occasions, immunization against certain diseases, such as clostridial infections, pasteurellosis, or mycoplasmosis, was also applied. In 2023, an FMD outbreak in cattle reported in Dhofar, about 500 km from the Al Wusta sanctuary, motivated specific prophylactic actions to prevent the risk of diffusion to oryx. From December 2023 to January 2024, an immunization program was undertaken using an FMD vaccine against serotypes A, O, and SAT 1, mostly in male oryx, while pregnant oryx were avoided for abortion risk due to handling. The following year, in January 2025, a severe outbreak occurred in oryx herds held in the sanctuary. The rapid onset and the spread of clinical symptoms among animals (100% morbidity in the second day after the first appearance of signs in some individuals) were suggestive of a highly contagious disease. The animals suffered from severe depression and inappetence, rapidly followed by abundant salivation, erosions of the oral mucosa and tongue, and diarrhea, with a short course characterized by prostration and death of the animal in the most severe cases. Therapeutical attempts (administration of antibiotics and rehydration) were mostly ineffective. Laboratory investigations (ELISA and PCR) ruled out contagious bovine pleuropneumonia (CBPP), Johne’s disease and Peste des petits ruminants (PPR). Both serology and antigen detection showed positiveness to foot-and-mouth disease (FMD). Out of a total population of 669 present in the sanctuary at the beginning of the outbreak, 226 (33.78%) oryx died. Despite the vaccinal status, the 38.49% of dead animals resulted being vaccinated against FMD. Taking into account the incalculable value of the species, the outbreak represented a very dangerous event that risked wiping out the decades of conservation efforts. Therefore, all the available means, such as accrued biosecurity and adequate prophylaxis, should be implemented to prevent the recurrence of such health risks. The delicate equilibrium of wild fauna in Oman requires study and support for an effective protection, in line with the national plan “Vision 2040”, targeting the inclusion of the Sultanate within the 20 best virtuous countries for wildlife protection. Full article

Background/Objectives: Single-dose pre-operative antibiotic prophylaxis for cardiac-device implantation is recommended but extending antibiotic prophylaxis is common. Locally, 50–60% of patients had extended prophylaxis after pacemaker insertion or generator change. Our antimicrobial stewardship programme (ASP) incorporated behavioural change strategies in implementing a multi-pronged intervention bundle to address this and evaluated its effectiveness and safety. Methods: This single-centre, retrospective cohort study included patients aged 21 years old or older, undergoing uncomplicated pacemaker insertion or generator change at Singapore General Hospital (SGH) from October 2022 to March 2025. To improve antibiotic use, ASP interventions incorporating behaviour change strategies were implemented, namely (1) data-driven feedback, (2) targeted education, (3) identification and engagement of ASP champion, and (4) clinical pathway revision. Results: There were 779 patients evaluated; 380 (48.8%) received standard prophylaxis while 399 (51.2%) received extended prophylaxis with oral antibiotics (mean duration, 3.3 ± 0.8 days). Following ASP interventions, the practice of extended prophylaxis declined significantly from 43.8% to 24.0% (p < 0.01). The incidence of surgical site infections was low and similar in both groups (0.8%, p = 1.000); all infections were superficial. There was also significant reduction in the proportion of patients on all antibiotics from 20.7% to 16.3% (p < 0.01). Identification and engagement of ASP champion proved pivotal in changing prescribing behaviour through peer influence and credibility. Conclusions: The bundled ASP interventions, incorporating behavioural change strategies, have effectively and safely reduced the use of extended prophylaxis post-cardiac device implantation. Behavioural change interventions are essential to achieve sustained stewardship success. Full article