Search results for: ethnic background

Authors: Vu Hoang Thu Huong

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Background: Surface electrical stimulation (SES) is a popular non-invasive approach that offers a wide range of treatments for many diseases of physical therapy. It involves applying electrical stimulation to the skin via surface electrodes to stimulate nerve fibers. SES was regularly used to treat the back and upper or lower extremities, but it was rarely used to treat the chest and abdomen. SES on the thorax and abdomen should be administered with more attention because crucial organs are under those areas (i.e., heart, lungs, liver, etc.). In these areas, safety precautions are suggested, and some SES applications might even be a contraindication. The fact that physical therapists have less experience with SES in these situations can also be attributed to these. Although a few earlier studies applied it to these settings and discovered hopeful results, none of them highlight the relationship between the intensity of SES and its depth of impact for safety considerations. Objective: To assure feasibility when using SES in these areas, the purpose of this study is to summarize the common location and intensity of those areas that have been conducted in previous studies. Method: A thorough systematic review was conducted to determine the common surface electrode position for the thorax and abdomen areas. The studies with the randomized controlled design were systematically searched using inclusion and exclusion criteria through nine electronic databases, including Pubmed, Scopus, etc., between 1975 and Dec 2021. Results: Thirty-three studies with over 1800 participants and 4 types of SES (TENS, IFC, NMES, and FES) with various categories of department hospitals were found. Following an anterior, lateral, and posterior observation, the particular SES positions found that it concentrated on 6 regions (the thoracic, abdomen, upper lateral, lower lateral, upper back, and lower back regions), and its intensity for each region was also summarized. Conclusion: This systematic review figured out the popular locations of SES in the thorax and abdominal areas as well as a summarized maximum of intensity that was found in previous studies with outstanding outcomes.

Keywords: surface electrical stimulation, electrical stimulation, thoracic, abdomen, abdominal.

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Authors: Ralene Sim, Stefan Mueller, N. Gopalakrishna Iyer, Ngian Chye Tan, Khee Chee Soo, R. Shetty Mahalakshmi, Hiang Khoon Tan

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Background: Regional failure in nasopharyngeal carcinoma (NPC) is managed by salvage treatment in the form of neck dissection. Radical neck dissection (RND) is preferred over modified radical neck dissection (MRND) since it is traditionally believed to offer better long-term disease control. However, with the advent of more advanced imaging modalities like high-resolution Magnetic Resonance Imaging, Computed Tomography, and Positron Emission Tomography-CT scans, earlier detection is achieved. Additionally, concurrent chemotherapy also contributes to reduced tumour burden. Hence, there may be a lesser need for an RND and a greater role for MRND. With this retrospective study, the primary aim is to ascertain whether MRND, as opposed to RND, has similar outcomes and hence, whether there would be more grounds to offer a less aggressive procedure to achieve lower patient morbidity. Methods: This is a retrospective study of 66 NPC patients treated at Singapore General Hospital between 1994 to 2016 for histologically proven regional recurrence, of which 41 patients underwent RND and 25 who underwent MRND, based on surgeon preference. The type of ND performed, primary treatment mode, adjuvant treatment, and pattern of recurrence were reviewed. Overall survival (OS) was calculated using Kaplan-Meier estimate and compared. Results: Overall, the disease parameters such as nodal involvement and extranodal extension were comparable between the two groups. Comparing MRND and RND, the median (IQR) OS is 1.76 (0.58 to 3.49) and 2.41 (0.78 to 4.11) respectively. However, the p-value found is 0.5301 and hence not statistically significant. Conclusion: RND is more aggressive and has been associated with greater morbidity. Hence, with similar outcomes, MRND could be an alternative salvage procedure for regional failure in selected NPC patients, allowing similar salvage rates with lesser mortality and morbidity.

Keywords: nasopharyngeal carcinoma, neck dissection, modified neck dissection, radical neck dissection

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Authors: Sadhana Sharma, Neha Sharma, Hardik Khandelwal, Arti Sharma

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Background: It is widely acknowledged globally that parents must advocate for their children's drug and substance abuse prevention. However, many parents find it difficult to advocate due to systemic and logistical barriers. Alternatives to introducing advocacy, awareness, and support for the prevention of drug and substance abuse to children could occur in schools. However, little research has been conducted on the development of advocates for substance abuse in school settings. Objective: to evaluate the effectiveness of a school-based addiction prevention and control created as part of the Rajasthan Addiction Prevention Project (a partnership between state-community initiative). Methods: We conducted an evaluation in this study to determine the impact of a RAPP on a primary outcome (substance abuse knowledge) and other outcomes (family–school partnership, empowerment, and support). Specifically, between September-December 2022, two schools participated in the intervention group (advocacy training), and two schools participated in the control group (waiting list). The RAPP designed specialised 2-hrs training to equip teachers-parents with the knowledge and skills necessary to advocate for their own children and those of other families. All participants were required to complete a pre- and post-survey. Results: The intervention group established school advocates in schools where trained parents volunteered to lead support groups for high-risk children. Compared to the participants in the wait list control group, those in the intervention group demonstrated greater education knowledge, P = 0.002, and self-mastery, P = 0.04, and decreased family–school partnership quality, P = 0.002.Conclusions: The experimental evaluation of school-based advocacy programme revealed positive effects on substance abuse that persist over time. The approach wa s deemed feasible and acceptable by both parents and the school.

Keywords: prevention, school based, addiction, advocacy

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Authors: Liang-Jen Wang, Sung-Chou Li, Yuan-Ming Yeh, Sheng-Yu Lee, Ho-Chang Kuo, Chia-Yu Yang

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Background: Dysbiosis in the gut microbial community might be involved in the pathophysiology of attention deficit/hyperactivity disorder (ADHD). The fungal component of the gut microbiome, namely the mycobiota, is a hyperdiverse group of multicellular eukaryotes that can influence host intestinal permeability. This study therefore aimed to investigate the impact of fungal mycobiome dysbiosis and intestinal permeability on ADHD. Methods: Faecal samples were collected from 35 children with ADHD and from 35 healthy controls. Total DNA was extracted from the faecal samples, and the internal transcribed spacer (ITS) regions were sequenced using high-throughput next-generation sequencing (NGS). The fungal taxonomic classification was analysed using bioinformatics tools, and the differentially expressed fungal species between the ADHD and healthy control groups were identified. An in vitro permeability assay (Caco-2 cell layer) was used to evaluate the biological effects of fungal dysbiosis on intestinal epithelial barrier function. Results: The β-diversity (the species diversity between two communities), but not α-diversity (the species diversity within a community), reflected the differences in fungal community composition between ADHD and control groups. At the phylum level, the ADHD group displayed a significantly higher abundance of Ascomycota and significantly lower abundance of Basidiomycota than the healthy control group. At the genus level, the abundance of Candida (especially Candida albicans) was significantly increased in ADHD patients compared to the healthy controls. In addition, the in vitro cell assay revealed that C. albicans secretions significantly enhanced the permeability of Caco-2 cells. Conclusions: The current study is the first to explore altered gut mycobiome dysbiosis using the NGS platform in ADHD. The findings from this study indicated that dysbiosis of the fungal mycobiome and intestinal permeability might be associated with susceptibility to ADHD.

Keywords: ADHD, fungus, gut–brain axis, biomarker, child psychiatry

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Authors: Mohammad Ranjbar, Mohammad Bazyar, Blake Angell, Thomas Lung, Yibeltal Assefa

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Background: Current health insurance programs in Iran suffer from low enrolment and are not sufficient to attain the country to universal health coverage (UHC). We hypothesize that improving the enrollment rate and moving towards a more sustainable UHC can be achieved by improving the benefits package and providing new incentives. The objective of this study is to assess public preferences and willingness to pay (WTP) for social health insurance (SHI) in Iran. Methods: A discrete choice experiment (DCE) was conducted in 2021, using a self-administered questionnaire on 500 participants to estimate WTP and determine individual preferences for the SHI in Yazd, Iran. Respondents were presented with an eight-choice set and asked to select their preferred one. In each choice set, scenarios were described by eight attributes with varying levels. The conditional logit regression model was used to analyze the participants' preferences. Willingness to pay for each attribute was also calculated. Results: Most included attributes were significant predictors of the choice of a health insurance package. The maximum coverage of hospitalization costs in the private sector, ancillary services such as glasses, canes, etc., as well as coverage for hospitalization costs in the public sector and drug costs, were the most important determining factors for this choice. Coverage of preventive dental care did not significantly influence respondent choices. Estimating WTP showed that individuals are willing to pay more for higher financial protection, particularly against private sector costs; the WTP to increase the coverage of hospitalization costs in the private sector from 50% to 90% is estimated at 362,068 IR, Rials per month. Conclusion: This study identifies the key factors that the population value with regard to health insurance and the tradeoffs they are willing to make between them. Hospitalization, drugs, and ancillary services were the most important determining factors for their choice. The data suggest that additional resources coming into the Iranian health system might best be prioritized to cover hospitalization and drug costs and those associated with ancillary services.

Keywords: social health insurance, preferences, discrete choice experiment, willingness to pay

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Authors: Eriselda Simoni, Leonard Simoni, Endri Paparisto, Laureta Flaga, Silvana Bara, Edit Xhajanka, Arjan Harxhi

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Background: Some pathologies are encountered more often in HIV/ AIDS, such as those with bacterial, fungal, viral, and neoplastic causes, but what has been more noticeable in recent years is the increased and more aggressive manifestation of periodontal disease and oral caries. Our purpose is to investigate the correlation between the HIV/AIDS stage and CD4 level with oral health, dentition, and periodontal status. Materials and Methods: We conducted a prospective observational study that included 35 patients newly diagnosed with HIV/AIDS and underwent an oral examination at the University Dental Clinic in Tirana, Albania, in the period April - July 2024. This study evaluated the basic demographic, laboratory characteristics, oral hygiene, and the presence of oral lesions. The dentition status was assessed with the values DT (decay teeth), FT (filled teeth), and MT (missing teeth) presented as DMFT. The periodontal status was evaluated through a periodontal probe measuring CPI (community periodontal index) and LOA (loss of attachment) as recommended by the WHO Oral Health Assessment Form 2013. The Pearson Correlation Coefficient (r) was used to evaluate the relationship between levels of CD4+ and DMF, CD4+ and CPI, and CD4+ and LOA. The P value ≤ 0.05 was considered statistically significant. Results: 80% of patients included were males with a mean age of 35.8 years. 8.6% of patients were categorized as HIV stage I, 28.6% as stage II, and 62.8% as HIV stage III/AIDS. The mean level value of CD4+ was 266.2 cells/mm3 and the rapport CD4+/ WBC (White Blood Cells) was 15.7%. Most patients (57.2%) used toothbrushes less than 1 time a day. An important negative correlation was found between CD4+ and dentition and periodontal status. A lower level of CD4+ was correlated with a higher DMFT, CPI, and LOA, respectively coefficient (r) for CD4/DMFT = -0.52, p =0.01, (r) for CD4/CPI= - 0.38, p=0.024 and (r) for CD4/LOA= - 0.37, p=0.029. Conclusions: In our study, it was documented that patients with HIV/AIDS had worse oral health, an important negative correlation between CD4+ and dentition and periodontal status. A lower level of CD4+ was correlated with a worse dentition status (higher DMFT), and poor periodontal health (higher CPI and LOA). The monitoring and treatment of oral pathologies can be important in early HIV/AIDS diagnoses and treatment.

Keywords: HIV/AIDS, oral health, dentition, periodontal

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Authors: Hajar Al Rajaibi, Kawla Al Toubi, Saeed Al Jaadi, Deepali Jaju, Sanjay Jaju

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Background: The available evidence in Oman on lack of physical activity call for immediate intervention. Physical activity counseling by doctors to their patients is influenced by their attitudes and personal physical fitness. To our best knowledge, the physical activity status of Omani medical students has not been addressed before. These future doctors will have a critical role in improving physical activity in patients and thus their overall health. Objective: The aim of the study is to assess the physical activity level, physical fitness level, and attitudes towards physical activity among Sultan Qaboos University senior medical students. Methods: In this cross-sectional study (N=110; males 55), physical activity level was assessed using International Physical Activity Questionnaire (IPAQ ) short form and attitudes towards physical activity using a fifty-four-items Kenyon questionnaire. The physical fitness level was assessed by estimating maximal oxygen uptake (VO₂max) using Chester step test. Results: Female students reported more sitting time more than 7hr/day (85.5%) compared to male students (40%; p < 0.05). The IPAQ revealed moderate level of physical activity in 58% of students. Students showed a high positive attitude towards physical activity for health and fitness and low attitude for physical activity as tension and risk. Both female and male students had a similar level and attitude towards physical activity. Physical fitness level was excellent (VO₂max > 55ml O₂/kg/min) in 11% of students, good (VO₂max>44-54ml O₂/kg/min) in 49% and average to below-average in 40%. Objectively measured physical fitness level, subjectively reported physical activity level or attitudes towards physical activity were not correlated. Conclusion: Omani medical students have a positive attitude towards physical activity but moderate physical activity level. Longer sitting time in females need further evaluation. Efforts are required to understand reasons for present physical activity level and to promote good physical activity among medical students by creating more awareness and facilities.

Keywords: Chester step test, Kenyon scale, medical students, physical activity, physical fitness

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Authors: Isabella Lobo Sasaoka, Felipe Q. da Luz, Zubeyir Salis, Phillipa Hay, Tamiris Gaeta, Paula Costa Teixeira, Táki Cordás, Amanda Sainsbury

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Background: A significant number of people with obesity that seek weight loss treatments experience binge eating episodes. Nonetheless, it is unknown whether binge eating episodes can hinder weight loss outcomes. Objective: To compare weight change in people with or without binge eating submitted to bariatric surgery, pharmacotherapy, nutritional orientation, and/or psychological therapies. Method: We conducted a systematic review with meta-analyses by searching studies in PubMed, American Psychological Association (APA), and Embase. Results: Thirty-four studies were included in our systematic review, and 17 studies were included in the meta-analyses. Overall, we found no significant difference in weight loss between people with or without binge eating submitted to any type of weight loss treatment. Additionally, we found no statistically significant differences in body weight between people with or without binge eating at short and long follow-up assessments following any type of weight loss treatment. We also examined changes in body weight in people with or without binge eating in three additional meta-analyses categorized by the type of weight loss treatment (i.e., behavioural and/or nutritional interventions; bariatric surgery; pharmacotherapy isolated or combined with behavior interventions) and found no difference in weight loss. Eleven out of the 17 studies that were assessed qualitatively (i.e., not included in meta-analyses) did not show differences in weight loss in people with or without binge eating submitted to any type of weight loss treatment. Conclusion: This systematic review with meta-analyses showed no difference in weight loss in people with or without binge eating submitted to a variety of weight loss treatments. Nonetheless, specialized therapies can be required to address eating disorder psychopathology and recurrent binge eating in people with obesity that seek weight loss.

Keywords: obesity, binge eating, weight loss, systematic review, meta-analysis

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Authors: Neera Kapoor

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Background: Knockdown Resistance (KDR) is one of the mechanisms of insecticide resistance in insects caused by the reduced target site sensitivity i.e. voltage gated sodium channel (VGSC) rendering it less sensitive to the toxic effects of DDT and pyrethroids. In this study, we evaluated insecticide susceptibility and its underlying KDR mechanism in eight Ae. aegypti and five Ae. albopictus field populations. Methodology: Field population was collected from four different geographical regions of India covering 18 districts of ten states. For genotyping of twelve KDR alleles in Ae. aegypti field populations, three PCR based assays were used; with DNA sequencing; ASPCR; PCR-RFLP. Genomic DNA was isolated, and three partial domains (II, III, and IV) of VGSC were amplified and sequenced. Results: Molecular screening for common KDR mutations, revealed the presence of five mutations viz. S989P, V1016G, T1520I, F1534C/L. Two novel mutations were observed, first at T1520 (ACC) residue where a C > T substitution at the second position of codon results in amino acid change to Isoleucine (ATC). Second mutation was an alternative point mutation at F1534 (TTC) residue where a substitution of T > C at the first position of codon results in an amino acid change to Leucine (CTC). ASPCRs were not accurate, so three PCR-RFLP assays were developed for genotyping of five KDR alleles in Ae. aegypti; viz. T1520I, F1534C/L. Representative samples of all genotypes (n=200) were sequenced to validate the newly developed PCR based assays for Ae. aegypti. Genotyping results showed that 989P is linked to 1016G and novel mutation 1520I was always found with 1534C allele. Conclusion: Present study confirmed the presence of DDT and pyrethroid resistance among Ae. aegypti populations in India and for the first time reported KDR mutations in this species from India including two novel mutations. Results of present study lead us to infer that, at least five KDR mutations (S989P, V1016G, T1530I, F1534C, and F1534L) can be seen as a potential marker for DDT/pyrethroid resistance.

Keywords: F1534C, F1534L, S989P, T1530I, V1016G

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Authors: Jeremy Attard, Jordan François, Serge Lazzarini, Thierry Masson

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Gauge theories are the natural background for describing geometrically fundamental interactions using principal and associated fiber bundles as dynamical entities. The central notion of these theories is their local gauge symmetry implemented by the local action of a Lie group H. There exist several methods used to reduce the symmetry of a gauge theory, like gauge fixing, bundle reduction theorem or spontaneous symmetry breaking mechanism (SSBM). This paper is a presentation of another method of gauge symmetry reduction, distinct from those three. Given a symmetry group H acting on a fiber bundle and its naturally associated fields (Ehresmann (or Cartan) connection, curvature, matter fields, etc.) there sometimes exists a way to erase (in whole or in part) the H-action by just reconfiguring these fields, i.e. by making a mere change of field variables in order to get new (‘composite‘) fields on which H (in whole or in part) does not act anymore. Two examples: the re-interpretation of the BEHGHK (Higgs) mechanism, on the one hand, and the top-down construction of Tractor and Penrose's Twistor spaces and connections in the framework of conformal Cartan geometry, one the other, will be discussed. They have, of course, nothing to do with each other but the dressing field method can be applied on both to get a new insight. In the first example, it turns out, indeed, that generation of masses in the Standard Model can be separated from the symmetry breaking, the latter being a mere change of field variables, i.e. a dressing. This offers an interpretation in opposition with the one usually found in textbooks. In the second case, the dressing field method applied to the conformal Cartan geometry offer a way of understanding the deep geometric nature of the so-called Tractors and Twistors. The dressing field method, distinct from a gauge transformation (even if it can have apparently the same form), is a systematic way of finding and erasing artificial symmetries of a theory, by a mere change of field variables which redistributes the degrees of freedom of the theories.

Keywords: BEHGHK (Higgs) mechanism, conformal gravity, gauge theory, spontaneous symmetry breaking, symmetry reduction, twistors and tractors

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Authors: Suin Seo, Sung-Il Cho

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Background: The use of mobile apps for smoking cessation has grown exponentially in recent years. Yet, there were limited researches which evaluated the quality of smoking cessation apps to our knowledge. In most cases, a clinical practice guideline which is focused on clinical physician was used as an evaluation tool. Objective: The objective of this study was to develop a user-centered measure for quality of mobile smoking cessation apps. Methods: A literature search was conducted to identify articles containing explicit smoking cessation guideline for smoker published until January 2018. WHO’s guide for tobacco users to quit was adopted for evaluation tool which assesses smoker-oriented contents of smoking cessation apps. Compared to the clinical practice guideline, WHO guideline was designed for smokers (non-specialist). On the basis of existing criteria which was developed based on 2008 clinical practice guideline for Treating Tobacco Use and Dependence, evaluation tool was modified and developed by an expert panel. Results: There were five broad categories of criteria that were identified including five objective quality scales: enhancing motivation, assistance with a planning and making quit attempts, preparation for relapse, self-efficacy, connection to smoking. Enhancing motivation and assistance with planning and making quit attempts were similar to contents of clinical practice guideline, but preparation for relapse, self-efficacy and connection to smoking (environment or habit which reminds of smoking) only existed on WHO guideline. WHO guideline had more user-centered elements than clinical guideline. Especially, self-efficacy is the most important determinant of behavior change in accordance with many health behavior change models. With the WHO guideline, it is now possible to analyze the content of the app in the light of a health participant, not a provider. Conclusion: The WHO guideline evaluation tool is a simple, reliable and smoker-centered tool for assessing the quality of mobile smoking cessation apps. It can also be used to provide a checklist for the development of new high-quality smoking cessation apps.

Keywords: smoking cessation, evaluation, mobile application, WHO, guideline

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Authors: Magdalena Rusady Goey, Gordon Strathdee, Neil Perkins

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Background: Acute lymphoblastic leukaemia (ALL) is the most frequent type of childhood malignancy, accounting for 25% of all cases. TWIST2, a basic helix-loop-helix transcription factor, has been implicated in ALL development. Prior studies found that TWIST2 undergoes epigenetic silencing in more than 50% cases of ALL through promoter hypermethylation and suggested that re-expression of TWIST2 may inhibit cell growth/survival of leukaemia cell lines. TWIST2 has also been implicated as a regulator of NF-kappaB activity, which is constitutively active in leukaemia. Here, we use a lentiviral transductions system to confirm the importance of TWIST2 in controlling leukaemia cell growth and to investigate whether this is achieved through altered regulation of NF-kappaB activity. Method: Re-expression of TWIST2 in leukaemia cell lines was achieved using lentiviral-based transduction. The lentiviral vector also expresses enhanced green fluorescent protein (eGFP), allowing transduced cells to be tracked using flow cytometry. Analysis of apoptosis and cell proliferation were done using annexinV and VPD450 staining, respectively. Result and Discussion: TWIST2-expressing cells were rapidly depleted from a mixed population in ALL cell lines (NALM6 and Reh), indicating that TWIST2 inhibited cell growth/survival of ALL cells. In contrast, myeloid cell lines (HL60 and K562) were comparatively insensitive to TWIST2 re-expression. Analysis of apoptosis and cell proliferation found no significant induction of apoptosis, but did find a rapid induction of proliferation arrest in TWIST2-expressing Reh and NALM6 cells. Initial experiment with NF-kappaB inhibitor demonstrated that inhibition of NF-kappaB has similar impact on cell proliferation in the ALL cell lines, suggesting that TWITST2 may induce cell proliferation arrest through inhibition of NF-kappaB. Conclusion: The results of this study suggest that epigenetic inactivation of TWIST2 in primary ALL leads to increased proliferation, potentially by altering the regulation of NF-kappaB.

Keywords: leukaemia, acute lymphoblastic leukaemia, NF-kappaB, TWIST2, lentivirus

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Authors: Zahra Khodabandeh, Leila Rezaeian, Mohammad Amin Edalatmanesh, Asghar Mogheiseh, Nader Tanideh, Mehdi Dianatpour, Shahrokh Zare, Hossein Bordbar, Neda Baghban, Amin Tamadon

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Background: In-utero xenotransplantation of stem cells in abnormal fetuses effectively treats several genetic illnesses. Objective: The current research aimed to evaluate structural and morphological alterations in the liver of rabbit fetuses following xenotransplantation of human Wharton’s jelly-derived mesenchymal stromal cells (hWJ-MSCs) using a stereological technique. Methods: hWJ-MSCs were isolated from the human umbilical cord, and their authenticity was established by flow cytometry and differentiation. At gestational day 14, the rabbits were anesthetized, and hWJ-MSCs were injected into the uteri of 24 fetuses. Twenty-two fetuses were born successfully. Ten rabbit liver specimens were prepared from injected fetuses, including eight rabbits on day three following birth and two rabbits on the 21st post-natal day. The non-injected fetuses were considered positive controls. The livers of the control and hWJ-MSCs-treated rabbits were fixed, processed, stained, and examined through stereological approaches. Results: In the hWJ-MSCs-treated group, the mean liver weight and volume increased by 42% and 78% compared to the control group. The total volume of the hepatocytes increased by 63% and that of sinusoids by threefold in the treated rabbits. The total volume of the central veins increased by 70%. The total number corresponding to hepatocytes in the experimental group increased by 112% compared to the rabbits in the control. The total volume of the hepatocyte nuclei in the experimental group increased by 117% compared to the rabbits in the control. Conclusion: After xenotransplantation of human MSCs, host tissue microenvironments (here, the rabbit liver) were altered, and these included quantitative factors corresponding to the liver tissue and hepatocyte morphometric indices.

Keywords: xenotransplantation, mesenchymal stromal, stem cell, Wharton ‘s jelly, liver

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Authors: Angkrit Phitchayangkoon, Ar-Aishah Dadeh

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Background: A key aim of triage is to identify the patients with high risk of cardiac arrest because they require intensive monitoring, resuscitation facilities, and early intervention. We aimed to identify the predicting factors such as initial vital signs, serum pH, serum lactate level, initial capillary blood glucose, and Modified Early Warning Score (MEWS) which affect the occurrence of cardiac arrest in an emergency department (ED). Methods: We conducted a retrospective data review of ED patients in an emergency department (ED) from 1 August 2014 to 31 July 2016. Significant variables in univariate analysis were used to create a multivariate analysis. Differentiation of predicting factors between cardiac arrest patient and non-cardiac arrest patients for occurrence of cardiac arrest in an emergency department (ED) was the primary outcome. Results: The data of 527 non-trauma patients with Emergency Severity Index (ESI) 1-3 were collected. The factors found to have a significant association (P < 0.05) in the non-cardiac arrest group versus the cardiac arrest group at the ED were systolic BP (mean [IQR] 135 [114,158] vs 120 [90,140] mmHg), oxygen saturation (mean [IQR] 97 [89,98] vs 82.5 [78,95]%), GCS (mean [IQR] 15 [15,15] vs 11.5 [8.815]), normal sinus rhythm (mean 59.8 vs 30%), sinus tachycardia (mean 46.7 vs 21.7%), pH (mean [IQR] 7.4 [7.3,7.4] vs 7.2 [7,7.3]), serum lactate (mean [IQR] 2 [1.1,4.2] vs 7 [5,10.8]), and MEWS score (mean [IQR] 3 [2,5] vs 5 [3,6]). A multivariate analysis was then performed. After adjusting for multiple factors, ESI level 2 patients were more likely to have cardiac arrest in the ER compared with ESI 1 (odds ratio [OR], 1.66; P < 0.001). Furthermore, ESI 2 patients were more likely than ESI 1 patients to have cardiovascular disease (OR, 1.89; P = 0.01), heart rate < 55 (OR, 6.83; P = 0.18), SBP < 90 (OR, 3.41; P = 0.006), SpO2 < 94 (OR, 4.76; P = 0.012), sinus tachycardia (OR, 4.32; P = 0.002), lactate > 4 (OR, 10.66; P = < 0.001), and MEWS > 4 (OR, 4.86; P = 0.028). These factors remained predictive of cardiac arrest at the ED. Conclusion: The factors related to cardiac arrest in the ED are ESI 1 patients, ESI 2 patients, patients diagnosed with cardiovascular disease, SpO2 < 94, lactate > 4, and a MEWS > 4. These factors can be used as markers in the event of simultaneous arrival of many patients and can help as a pre-state for patients who have a tendency to develop cardiac arrest. The hemodynamic status and vital signs of these patients should be closely monitored. Early detection of potentially critical conditions to prevent critical medical intervention is mandatory.

Keywords: cardiac arrest, predicting factor, emergency department, emergency patient

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Authors: Anne N. Heirman, Lisette van der Molen, Richard Dirven, Gyorgi B. Halmos, Michiel W.M. van den Brekel

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Background: Due to the rising incidence of oropharyngeal squamous cell cancer (OPSCC), many patients are challenged with choosing between transoral(robotic) surgery and radiotherapy, with equal survival and oncological outcomes. Also, functional outcomes are of little difference over the years. With this study, the wants and needs of patients and caregivers are identified to develop a comprehensible patient decision aid (PDA). Methods: The development of this PDA is based on the International Patient Decision Aid Standards criteria. In phase 1, relevant literature was reviewed and compared to current counseling papers. We interviewed ten post-treatment patients and ten doctors from four head and neck centers in the Netherlands, which were transcribed verbatim and analyzed. With these results, the first draft of the PDA was developed. Phase 2 beholds testing the first draft for comprehensibility and usability. Phase 3 beholds testing for feasibility. After this phase, the final version of the PDA was developed. Results: All doctors and patients agreed a PDA was needed. Phase 1 showed that 50% of patients felt well-informed after standard care and 35% missed information about treatment possibilities. Side effects and functional outcomes were rated as the most important for decision-making. With this information, the first version was developed. Doctors and patients stated (phase 2) that they were satisfied with the comprehensibility and usability, but there was too much text. The PDA underwent text reduction revisions and got more graphics. After revisions, all doctors found the PDA feasible and would contribute to regular counseling. Patients were satisfied with the results and wished they would have seen it before their treatment. Conclusion: Decision-making for OPSCC should focus on differences in side-effects and functional outcomes. Patients and doctors found the PDA to be of great value. Future research will explore the benefits of the PDA in clinical practice.

Keywords: head-and-neck oncology, oropharyngeal cancer, patient decision aid, development, shared decision making

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Authors: Beatrice Adeoye

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Background: One of the health challenges developing countries face is air pollution from indoor and outdoor activities. Smoke as a result of cooking, burning wastes and power generators litter the air space on a continual basis due to poverty and governance challenges. The short and long term implications of these actions are enormous and studies have attributed smoke as one of the leading preventable risk factors contributing to global burden of respiratory infections. Design/Methods: The issue at hand therefore includes an exploration of the existing policy frameworks regarding smoke, adherence to international conventions and practices, and more importantly the activities of the government in addressing these issues. Aside this, an understanding of the implications of smoke on peoples’ health and well-being also become crucial. Consequently, this article seeks to interrogate the effect of smoke on the health and well-being of Nigerians and the activities of the policy makers in addressing these challenges. Results (Main Argument): This study reviewed both primary and secondary data on poverty, smoke emission and attendant health risks coupled with existing policies on smoke and air pollution in the country. For instance, over 69% of Nigerians are poor, ranking third in the world; 2.9 billion people live in homes using wood, coal or dung as their primary cooking fuel; equally, 50.6% of Nigerians has no access to regular electricity supply. Further, sustainable policy regarding smoke emission is lacking in the country. This work further submitted that continued low standard of living as a result of governance challenges coupled with a lack of sustainable policy have aggravated the health risks related to smoke in the country. Conclusions: The implication on the health of the children, mothers and vulnerable groups for the future of the country is enormous and may continue if not addressed. Urgent attention therefore needs to be focused on this area considering what this portends for the nation now and in the future.

Keywords: air pollution, indoor, outdoor, respiratory infections

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Authors: Keng H. Kong, Louis C. Tan, Wing L. Aw, Kay Y. Tay

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Background: Fatigue is a common problem in patients with Parkinson's disease, with reported prevalence of up to 70%. Fatigue can be disabling and has adverse effects on patients' quality of life. There is currently no satisfactory treatment of fatigue. Acupuncture is effective in the treatment of fatigue, especially that related to cancer. Its role in Parkinson's disease-related fatigue is uncertain. Aims: To evaluate the clinical efficacy of acupuncture treatment in Parkinson's disease-related fatigue. Hypothesis: We hypothesize that acupuncture is effective in alleviating Parkinson's disease-related fatigue. Design: A single center, randomized, controlled study with two parallel arms. Participants: Forty participants with idiopathic Parkinson's disease will be enrolled. Interventions: Participants will be randomized to receive verum (real) acupuncture or placebo acupuncture. The retractable non-invasive sham needle will be used in the placebo group. The intervention will be administered twice a week for five weeks. Main outcome measures: The primary outcome will be the change in general fatigue score of the multidimensional fatigue inventory at week 5. Secondary outcome measures include other subscales of the multidimensional fatigue inventory, movement disorders society-unified Parkinson's disease rating scale, Parkinson's disease questionnaire-39 and geriatric depression scale. All outcome measures will be assessed at baseline (week 0), completion of intervention (week 5) and 4 weeks after completion of intervention (week 9). Results: To date, 23 participants have been recruited and nine have completed the study. The mean age is 63.5±14.2 years, mean duration of Parkinson’s disease is 6.4±1.8 years and mean MDS-UPDRS score is 8.3±2.8. The mean general fatigue score of the multidimensional fatigue inventory is 13.5±4.6. No significant adverse event related to acupuncture is noted. Potential significance: If the results are as expected, this study will provide preliminary scientific evidence for the efficacy of acupuncture in Parkinson's Disease-related fatigue, and opens the door for a larger multicentre trial to be performed. In the longer term, it may lead to the integration of acupuncture in the care of patients with Parkinson's disease.

Keywords: acupuncture, fatigue, Parkinson's disease, trial

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Authors: Guo Yu, Haoming Ma, Peiru Zhou

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BACKGROUND: In addition to hyperglycemia, hypoglycemia, and glycemic variability, a decrease in the time in the targeted blood glucose range (TIR) may be associated with an increased risk of death for critically ill patients. However, the relationship between the TIR and mortality may be influenced by the presence of diabetes and glycemic variability. METHODS: A total of 998 diabetic and non-diabetic patients with severe diseases in the ICU were selected for this retrospective analysis. The TIR is defined as the percentage of time spent in the target blood glucose range of 3.9–10.0 mmol/L within 24 hours. The relationship between TIR and in-hospital in diabetic and non-diabetic patients was analyzed. The effect of glycemic variability was also analyzed. RESULTS: The binary logistic regression model showed that there was a significant association between the TIR as a continuous variable and the in-hospital death of severely ill non-diabetic patients (OR=0.991, P=0.015). As a classification variable, TIR≥70% was significantly associated with in-hospital death (OR=0.581, P=0.003). Specifically, TIR≥70% was a protective factor for the in-hospital death of severely ill non-diabetic patients. The TIR of severely ill diabetic patients was not significantly associated with in-hospital death; however, glycemic variability was significantly and independently associated with in-hospital death (OR=1.042, P=0.027). Binary logistic regression analysis of comprehensive indices showed that for non-diabetic patients, the C3 index (low TIR & high CV) was a risk factor for increased mortality (OR=1.642, P<0.001). In addition, for diabetic patients, the C3 index was an independent risk factor for death (OR=1.994, P=0.008), and the C4 index (low TIR & low CV) was independently associated with increased survival. CONCLUSIONS: The TIR of non-diabetic patients during ICU hospitalization was associated with in-hospital death even after adjusting for disease severity and glycemic variability. There was no significant association between the TIR and mortality of diabetic patients. However, for both diabetic and non-diabetic critically ill patients, the combined effect of high TIR and low CV was significantly associated with ICU mortality. Diabetic patients seem to have higher blood glucose fluctuations and can tolerate a large TIR range. Both diabetic and non-diabetic critically ill patients should maintain blood glucose levels within the target range to reduce mortality.

Keywords: severe disease, diabetes, blood glucose control, time in targeted blood glucose range, glycemic variability, mortality

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Authors: AliAkbar Hafezi, Jalal Taherian, Jamshid Abedi, Mahsa Elahi, Behnam Kadkhodaei

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Background: Soft tissue sarcomas (STS) are generally treated with a combination of limb preservation surgery and radiation therapy. Today, preoperative radiation therapy is considered for accurate treatment volume and smaller field size. Therefore, this study was performed to compare preoperative with postoperative radiation therapy in patients with extremity STS. Methods: In this non-randomized clinical trial, patients with localized extremity STS referred to the orthopedic clinics in Iran from 2021 to 2023 were studied. Patients were randomly divided into two groups: preoperative and postoperative radiation therapy. The two groups of patients were compared in terms of acute (wound dehiscence and infection) and late (limb edema, subcutaneous fibrosis, and joint stiffness) complications and their severity, as well as local recurrence and other one-year outcomes. Results: A total of 80 patients with localized extremity STS were evaluated in two treatment groups. The groups were matched in terms of age, sex, history of diabetes mellitus, hypertension, smoking, involved side, involved extremity, lesion location, and tumor histopathology. The acute complications of treatment in the two groups of patients did not differ significantly (P > 0.05). Of the late complications, only joint stiffness between the two groups had significant statistical differences (P < 0.001). The severity of all three late complications in the postoperative radiation therapy group was significantly higher (P < 0.05). There was no significant difference between the two groups in terms of the rate of local recurrence of other one-year outcomes (P > 0.05). Conclusion: This study showed that in patients with localized extremity STS, the two therapeutic approaches of adjuvant and neoadjuvant radiation therapy did not differ significantly in terms of local recurrence and distant metastasis during the one-year follow-up period and due to fewer late complications in preoperative radiotherapy group, this treatment approach can be a better choice than postoperative radiation therapy.

Keywords: soft tissue sarcoma, extremity, preoperative radiation therapy, postoperative radiation therapy

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Authors: Junaid Jibran Jawed, Prasanta Saini, Subrata Majumdar

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Background: Leishmania donovani infection causes severe host immune-suppression through the modulation of pathogen recognition receptors. Apart from TLRs (Toll Like Receptor), recent studies focus on the important contribution of NLR (NOD-Like Receptor) family member NOD1 and NOD2 as these receptors are capable of triggering host innate immunity. The aim of this study was to decipher the role of NOD1/NOD2 receptors during experimental visceral leishmaniasis (VL) and the important link between host failure and parasite evasion strategy. Method: The status of NOD1 and NOD2 receptors were analysed in uninfected and infected cells through western blotting and RT-PCR. The active contributions of these receptors in reducing parasite burden were confirmed by siRNA mediated silencing, and over-expression studies and the parasite numbers were calculated through microscopic examination of the Giemsa-stained slides. In-vivo studies were done by using non-toxic dose of Mw (Mycobacterium indicus pranii), Ara-LAM(Arabinoasylated lipoarabinomannan) along with MDP (Muramyl dipeptide) administration. Result: Leishmania donovani infection of the macrophages reduced the expression of NOD2 receptors whereas NOD1 remain unaffected. MDP, a NOD2-ligand, treatment during over-expression of NOD2, reduced the parasite burden effectively which was associated with increased pro-inflammatory cytokine generation and NO production. In experimental mouse model, Ara-LAM treatment increased the expression of NOD2 and in combination with MDP it showed active therapeutic potential against VL and found to be more effective than Mw which was already reported to be involved in NOD2 modulation. Conclusion: This work explores the essential contribution of NOD2 during experimental VL and mechanistic understanding of Ara-LAM + MDP combination therapy to work against this disease and highlighted NOD2 as an essential therapeutic target.

Keywords: Ara-LAM (Arabinoacylated Lipoarabinomannan), NOD2 (nucleotide binding oligomerization receptor 2), MDP (muramyl di peptide), visceral Leishmaniasis

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Authors: Abhisek Dash

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This study had three neural networks, one for number segmentation, one for number detection and one for number recognition all of which are coupled to one another. All networks were trained on the MNIST dataset and were convolutional. It was assumed that the images had lighter background and darker foreground. The segmentation network took 28x28 images as input and had sixteen outputs. Segmentation training starts when a dark pixel is encountered. Taking a window(7x7) over that pixel as focus, the eight neighborhood of the focus was checked for further dark pixels. The segmentation network was then trained to move in those directions which had dark pixels. To this end the segmentation network had 16 outputs. They were arranged as “go east”, ”don’t go east ”, “go south east”, “don’t go south east”, “go south”, “don’t go south” and so on w.r.t focus window. The focus window was resized into a 28x28 image and the network was trained to consider those neighborhoods which had dark pixels. The neighborhoods which had dark pixels were pushed into a queue in a particular order. The neighborhoods were then popped one at a time stitched to the existing partial image of the number one at a time and trained on which neighborhoods to consider when the new partial image was presented. The above process was repeated until the image was fully covered by the 7x7 neighborhoods and there were no more uncovered black pixels. During testing the network scans and looks for the first dark pixel. From here on the network predicts which neighborhoods to consider and segments the image. After this step the group of neighborhoods are passed into the detection network. The detection network took 28x28 images as input and had two outputs denoting whether a number was detected or not. Since the ground truth of the bounds of a number was known during training the detection network outputted in favor of number not found until the bounds were not met and vice versa. The recognition network was a standard CNN that also took 28x28 images and had 10 outputs for recognition of numbers from 0 to 9. This network was activated only when the detection network votes in favor of number detected. The above methodology could segment connected and overlapping numbers. Additionally the recognition unit was only invoked when a number was detected which minimized false positives. It also eliminated the need for rules of thumb as segmentation is learned. The strategy can also be extended to other characters as well.

Keywords: convolutional neural networks, OCR, text detection, text segmentation

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Authors: Rokas Arlauskas, Donatas Austys, Rimantas Stukas

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Background. The World Health Organization recommends to reduce an intake of added sugar. High consumption of sugar and sweets increases the risk of obesity and overweight. The analysis of the body mass index (BMI) data of the adult population of Lithuania shows that only less than half (45.7%) of the total population has a normal body weight (18.5-24.9 BMI), overweight (25.0-29, 9 BMI) more than a third (36.6 percent), obese (>=30.0 BMI) is 15.4 percent population and underweight (<18.5 BMI) has 2.1 percent population. More men than women are obese (16.5% and 14.9%, respectively). In order to achieve this, alternative sweetening methods by using sweeteners might be employed. However, studies show that attitudes and beliefs might act as a barrier for sugar replacement with sweeteners. In Lithuania, there is a lack of studies on consumption of sugar and sweeteners, including attitudes of Lithuanian residents towards them. Therefore the objective of this study was to assess the attitude of Lithuanian adults towards replacement of added sugar with sweeteners. Methods. A representative sample of Lithuanian population of adults aged 18 to 75 years was formed. A total number of 1008 residents participated. Data was collected using a questionnaire. With respect to social and demografic characteristics, distribution of respondents by answering to one question was analysed. Respondents were asked to indicate their likely behaviour in terms of added sugar if they knew that there a healthier than sugar sweetener exists.Results. Every fifth participant (20.7%) indicated no added sugar consumption and no likely use of the healthier sweetener. Every second respondent among added sugar consumers (40.0% of whole sample) indicated that if they knew about existence of a healthier sweetener than sugar, they would try it and, if liked it, would use it instead of sugar. Approximately 35.0% of whole sample would ignore the fact that healthier than sugar sweetener exists and continue to consume sugar regardless of its effects on health. Younger, urban and higher educated respondents were more likely to opt for a healthier sweetener instead of added sugar (respectively, 45.7% vs. 34.4%, 43.3% vs. 31.2%, 47.6% vs. 37.3% of whole sample, p < 0.05). Conclusions. Half of Lithuanian adult consumers of added sugar would try to replace added sugar with healthier sweetener. Such a reasonable attitude was more prevalent among younger, urban and higher educated respondents.

Keywords: added sugar, lithuanian adult population, sweeteners., food

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Authors: Wajeeha Zahid, Shafquat Rozi, Farhan Raza, Masood Kadir

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Background: Dental caries affects the overall health and well-being of children. Findings from various international studies regarding the association of dental caries with asthma are inconsistent. With the increasing burden of caries and childhood asthma, it becomes imperative for an underdeveloped country like Pakistan where resources are limited to identify whether there is a relationship between the two. This study aims to identify an association between dental caries and asthma. Methods: A cross-sectional study was conducted on 544 children aged 12-15 years recruited from five private schools in Karachi. Information on asthma was collected through the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The questionnaire addressed questions regarding child’s demographics, physician diagnoses of asthma, type of medication administered, family history of asthma and allergies, dietary habits and oral hygiene behavior. Dental caries was assessed using DMFT Index (Decayed, Missing, Filled teeth) index The data was analyzed using Cox proportional Hazard algorithm and crude and adjusted prevalence ratios with 95% CI were reported. Results: This study comprises of 306 (56.3%) boys and 238 (43.8%) girls. The mean age of children was 13.2 ± (0.05) years. The total number of children with carious teeth (DMFT > 0) were 166/544 (30.5%), and the decayed component contributed largely (22.8%) to the DMFT score. The prevalence of physician’s diagnosed asthma was 13%. This study identified almost 7% asthmatic children using the internationally validated International Study of Asthma and Allergies in Childhood (ISAAC) tool and 8 children with childhood asthma were identified by parent interviews. Overall prevalence of asthma was 109/544 (20%). The prevalence of caries in asthmatic children was 28.4% as compared to 31% among non-asthmatic children. The adjusted prevalence ratio of dental caries in asthmatic children was 0.8 (95% CI 0.59-1.29). After adjusting for carious food intake, age, oral hygiene index and dentist visit, the association between asthma and dental caries turned out to be non-significant. Conclusion: There was no association between asthma and dental caries among children who participated in this study.

Keywords: asthma, caries, children, school-based

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Authors: Atefeh Abedini, Pegah Soltani, Arda Kiani

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Background: Sarcoidosis and Tuberculosis are both considered granulomatous chronic diseases with some similar pulmonary and extra-pulmonary manifestations. It is hypothesized that given these morphological similarities, the genome of mycobacterium could have an impact on the development of Sarcoidosis. Identifying the potential correlation of these diseases may assist in the management of sarcoidosis. Herein, we aimed to inspect the lymph node biopsy of sarcoidosis patients for the existence of the HSP-65 mycobacterium DNA sequence. Methods: This cross-sectional survey was conducted on 1188 Sarcoidosis patients without active/latent tuberculosis infection who were diagnosed in Masih Daneshvari Hospital in Tehran, Iran, from January 2020 to January 2022. Trans-bronchial needle aspiration (TBNA) was performed due to bilateral hilar lymphadenopathy to take a specimen. Results: The under-evaluated patients were mainly women (N=815 (68.6%)), none-smoker (N=1016 (85.5%)), and middle-aged (50.1 (SD=4.22)) with average angiotensin-converting enzyme (ACE) index of 75.6 (SD=6.42). Dyslipidemias (n=314 (26.4%), Hypertension (n=295 (24.8%)), Diabetes mellitus (n=131 (11.0%)), and chronic heart diseases (n=97 (8.2%)) had the highest prevalence between comorbidities. Skin lesions (n= 655 (55.1%)), ophthalmic (n=341 (28.7%)), and cardiac involvement (n=229 (19.3%)) were obtained as the most common extra-pulmonary characteristics of the patients. Amongst 1188 enrolled patients who were not afflicted with Mycobacterium tuberculosis based on smear/culture essay, clinical symptoms, and Chest x-ray screening, 121 (10.2%) cases had detectable amplified DNA for Mycobacterium Tuberculosis extracted from mediastinal lung lymph nodes. Conclusion: In this survey, the mycobacterium genome was detected in almost 1 per 10 case biopsies of sarcoidosis. The remarkable number of cases (n=1188) evaluated in this study was the strength of this study which supported the hypothesis regarding sarcoidosis and mycobacterium genome correlation. Further investigation, such as case-control surveys, is required to better clarify this association.

Keywords: mycobacterium tuberculosis, sarcoidosis, genome, DNA, trans-bronchial needle aspiration

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Authors: Metrek Almetrek, Naser Alqahtani, Eisa Ghazwani, Mona Asiri, Mohammed Alqahtani, Magboolah Balobaid

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Background: Advocacy of potential for community coalitions to positively address social determinants of health and quality of life, little is known about the views of stakeholders involved in such efforts. This study sought to assess the provinces leaders’ perspectives about social determinants related to the Health Neighborhood Initiative (HNI), a new county effort to support community coalitions. Method and Subjects: We used a descriptive, qualitative study using personal interviews in 2022. We conducted it in the community coalition's “main cities committees” set across service planning areas that serve vulnerable groups located in the seven registered healthy cities to WHO (Abha, Tareeb, Muhayel, Balqarn, Alharajah, Alamwah, and Bisha). We conducted key informant interviews with 76 governmental, profit, non-profit, and community leaders to understand their perspectives about the HNI. As part of a larger project, this study focused on leaders’ views about social determinants of health related to the HNI. All interviews were audio-recorded and transcribed. An inductive approach to coding was used, with text segments grouped by social determinant categories. Results: Provinces leaders described multiple social determinants of health and quality of life that were relevant to the HNI community coalitions: housing and safety, community violence, economic stability, city services coordination and employment and education. Leaders discussed how social determinants were interconnected with each other and the need for efforts to address multiple social determinants simultaneously to effectively improve health and quality of life. Conclusions: Community coalitions have an opportunity to address multiple social determinants of health and quality of life to meet the social needs of vulnerable groups. Future research should examine how community coalitions, like those in the HNI, can actively engage with community members to identify needs and then deliver evidence-based care.

Keywords: social determinants, health and quality of life, vulnerable groups, qualitative research

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Authors: Miriam Colleran, Barbara Sheehy-Skeffington

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Background: To explore if there are unique features in the palliative care needs of patients with intellectual disability that may impact on planning for resource and service provision for them. Aim: The purpose of this practice review is to assess the indications for, numbers of and outcomes of care for adults with intellectual disabilities referred to a specialist palliative care service over a twoyear period. Service utilization aspects considered included the frequency of home visits by a specialist palliative care doctor or clinical nurse specialist and the number of hospice admissions that occurred for the patients. Method: A retrospective review was carried out of persons 18 years and older with intellectual disabilities referred to a specialist palliative care service over a 5-year period from 30.11.3018 to 29.11.2023. A manual review was carried out of the register using key terms, namely, known residential care and community dwelling places of service providers for persons with intellectual disabilities in the area and registered diagnoses in addition to the patients known to the clinicians who had intellectual disabilities. Results: 25 referrals were made to the specialist palliative care service of 23 persons with intellectual disabilities during that time. However, this may be an underestimate. 15 women and 8 men were referred with an age range of 19 to 86 years of age. The majority had a diagnosis of Down’s syndrome or Trisomy 21. 5 patients referred did not have home visits from the specialist palliative care team. A range of 2 to 48 phone calls per person occurred by the specialist palliative care team regarding this cohort of patients. The outcomes for the patients included discharge and death. The majority of patients that died, did so in the community. One person however died in hospital. Another person died in a hospice out of area. Conclusion: Providing specialist palliative care for adults with intellectual disabilities is an important element of palliative care. The dominance of the community as the place of death for these patients and the limited number of patients dying in either hospice or hospital are noteworthy. Further research is necessary and education to inform, support, and empower specialist palliative care professionals in optimizing palliative and end-of-life care for persons with intellectual disabilities and to inform service development and provision.

Keywords: about intellectual disability, palliative care

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Authors: Husain Rajib, T. H. Sheikh, D. G. Jewel

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Background: Amblyopia is a frequent cause of monocular blindness in children. It can be unilateral or bilateral reduction of best corrected visual acuity associated with decrement in visual processing, accomodation, motility, spatial perception or spatial projection. Anisometropia is an important risk factor for amblyopia that develops when unequal refractive error causes the image to be blurred in the critical developmental period and central inhibition of the visual signal originating from the affected eye associated with significant visual problems including anisokonia, strabismus, and reduced stereopsis. Methods: It is a prospective hospital based study of newly diagnosed of amblyopia seen at the pediatric clinic of Chittagong Eye Infirmary & Training Complex. There were 50 anisometropic amblyopia subjects were examined & questionnaire was piloted. Included were all patients diagnosed with refractive amblyopia between 3 to 13 years, without previous amblyopia treatment, and whose parents were interested to participate in the study. Patients diagnosed with strabismic amblyopia were excluded. Patients were first corrected with the best correction for a month. When the VA in the amblyopic eye did not improve over month, then occlusion treatment was started. Occlusion was done daily for 6-8 hours (full time) together with vision therapy. The occlusion was carried out for 3 months. Results: In this study about 8% subjects had anisometropia from myopia, 18% from hyperopia, 74% from astigmatism. The initial mean visual acuity was 0.74 ± 0.39 Log MAR and after intervention of amblyopia therapy with active vision therapy mean visual acuity was 0.34 ± 0.26 Log MAR. About 94% of subjects were improving at least two lines. The depth of amblyopia associated with type of anisometropic refractive error and magnitude of Anisometropia (p<0.005). By doing this study 10% mild amblyopia, 64% moderate and 26% severe amblyopia were found. Binocular function also decreases with magnitude of Anisometropia. Conclusion: Anisometropic amblyopia is a most important factor in pediatric age group because it can lead to visual impairment. Occlusion therapy with at least one instructed hour of active visual activity practiced out of school hours was effective in anisometropic amblyopes who were diagnosed at the age of 8 years and older, and the patients complied well with the treatment.

Keywords: refractive error, anisometropia, amblyopia, strabismic amblyopia

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Authors: Mohamed M. Mashaly, Ahmed M. F. El Shiwi

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Background: Shoulder impingement syndrome is an encroachment of subacromial tissues, rotator cuff, subacromial bursa, and the long head of the biceps tendon, as a result of narrowing of the subacromial space. Activities requiring repetitive or sustained use of the arms over head often predispose the rotator cuff tendon to injury. Purpose: To compare between Combined effect therapeutic exercises and Shockwave therapy versus therapeutic exercises and phonophoresis in the treatment of shoulder impingement syndrome. Methods: Thirty patients diagnosed as shoulder impingement syndrome stage II Neer classification due to mechanical causes. Patients were randomly distributed into two equal groups. The first group consisted of 15 patients with a mean age of (45.46+8.64) received therapeutic exercises (stretching exercise of posterior shoulder capsule and strengthening exercises of shoulder muscles) and shockwave therapy (6000 shocks, 2000/session, 3 sessions, 2 weeks apart, 0.22mJ/mm^2) years. The second group consisted of 15 patients with a mean age of 46.26 (+ 8.05) received same therapeutic exercises and phonophoresis (3 times per week, each other day, for 4 consecutive weeks). Patients were evaluated pretreatment and post treatment for shoulder pain severity, shoulder functional disability, shoulder flexion, abduction and internal rotation motions. Results: Patients of both groups showed significant improvement in all the measured variables. In between groups difference the shock wave group showed a significant improvement in all measured variables than phonophoresis group. Interpretation/Conclusion: Combined effect of therapeutic exercises and shock wave were more effective than therapeutic exercises and phonophoresis on decreasing shoulder pain severity, shoulder functional disability, increasing in shoulder flexion, abduction, internal rotation in patients with shoulder impingement syndrome.

Keywords: shoulder impingement syndrome, therapeutic exercises, shockwave, phonophoresis

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Authors: Mikael Soini, Kari Björn

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Metropolia University of Applied Sciences (MUAS) Information and Communication Technology (ICT) Degree Programme provides full-time Bachelor-level undergraduate studies. ICT Degree Programme has seven different major options; this paper focuses on Health Technology. In Health Technology, a significant curriculum change in 2014 enabled transition from fragmented curriculum including dozens of courses to a new integrated curriculum built around three 30 ECTS themes. This paper focuses especially on the second theme called Customer Oriented Software Applications. From students’ point of view, the goal of this theme is to get familiar with existing health related ICT solutions and systems, understand business around health technology, recognize social and healthcare operating principles and services, and identify customers and users and their special needs and perspectives. This also acts as a background for health related web application development. Built web application is tested, developed and evaluated with real users utilizing versatile user centred development methods. This paper presents experiences obtained from the first implementation of Customer Oriented Software Applications theme. Student feedback was gathered with two questionnaires, one in the middle of the theme and other at the end of the theme. Questionnaires had qualitative and quantitative parts. Similar questionnaire was implemented in the first theme; this paper evaluates how the theme-based integrated curriculum has progressed in Health Technology major by comparing results between theme 1 and 2. In general, students were satisfied for the implementation, timing and synchronization of the courses, and the amount of work. However there is still room for development. Student feedback and teachers’ observations have been and will be used to develop the content and operating principles of the themes and whole curriculum.

Keywords: engineering education, integrated curriculum, learning and teaching methods, learning experience

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Authors: Abanda Wilfred Chick

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Background: According to World Health Organization (WHO), the role of Information and Communication Technologies (ICT) in health sectors of developing nations has been demonstrated to have had a great improvement of fifty percent reduction in mortality and or twenty-five-fifty percent increase in productivity. The objective of this study was to assess the use of information and communication technologies in enhancing health care delivery for Human Immunodeficiency Virus (HIV) patients in Bamenda Health District. Methods: This was a descriptive-analytical cross-sectional study in which 388 participants were consecutively selected amongst health personnel and HIV patients from public and private health institutions involved in Human Immunodeficiency Virus management. Data on socio-demographic variables, the use of information and communication technologies tools, and associated challenges were collected using structured questionnaires. Descriptive statistics with a ninety-five percent confidence interval were used to summarize findings, while Cramer’s V test, logistic regression, and Chi-square test were used to measure the association between variables, Epi info version7.2, MS Excel, and SPSS version 25.0 were utilized for data entry and statistical analysis respectively. Results: Of the participants, one-quarter were health personnel, and three-quarters were HIV patients. For both groups of participants, there was a significant relationship between the use of ICT and demographic information such as level of education, marital status, and age (p<0.05). For the impediments to using ICT tools, a greater proportion identified the high cost of airtime or internet bundles, followed by an average proportion that indicated inadequate training on ICT tools; for health personnel, the majority said inadequate training on ICT tools/applications and half said unavailability of electricity. Conclusion: Not up to half of the HIV patients effectively make use of ICT tools/applications to receive health care. Of health personnel, three quarters use ICTs, and only one quarter effectively use mobile phones and one-third of computers, respectively, to render care to HIV patients.

Keywords: ICT tools, HIV patients, health personnel, health care delivery

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