Search results for: hyperthermia therapy

Authors: Yuki Matsumoto, Yuma Ishimoto

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Cognitive Behavior Therapy (CBT) with children has shown effective application to various problems such as anxiety and depression. Although there are barriers to access to mental health services including lack of professional services in communities and parental concerns about stigma, school has a significant role to address children’s health problems. Schools are regarded as a suitable arena for prevention and early intervention of mental health problems. In this line, CBT can be adaptable to school education and useful to enhance students’ social and emotional skills. However, Japanese school curriculum is rigorous so as to limit available time for implementation of CBT in schools. This paper describes Brief Cognitive Behavior Therapy (BCBT) with children in a Japanese school setting. The program has been developed in order to facilitate acceptability of CBT in schools and aimed to enhance students’ skills to manage anxiety and difficult behaviors. The present research used a single arm design in which 30 students aged 9-10 years old participated. The authors provided teachers a CBT training workshop (two hours) at two primary schools in Tokyo metropolitan area and recruited participants in the research. A homeroom teacher voluntarily delivered a 6-session BCBT program (15 minutes each) in classroom periods which is called as Kaerinokai, a meeting before leaving school. Students completed a questionnaire sheet at pre- and post-periods under the supervision of the teacher. The sheet included the Spence Child Anxiety Scale (SCAS), the Depression Self-Rating Scale for Children (DSRS), and the Strengths and Difficulties Questionnaire (SDQ). The teacher was asked for feedback after the completion. Significant positive changes were found in the total and five of six sub-scales of the SCAS and the total difficulty scale of the SDQ. However, no significant changes were seen in Physical Injury Fear sub-scale of the SCAS, in the DSRS or the Prosocial sub-scale of the SDQ. The effect sizes are mostly between small and medium. The teacher commented that the program was easy to use and found positive changes in classroom activities and personal relationships. This preliminary research showed the feasibility of the BCBT in a school setting. The results suggest that the BCBT offers effective treatment for reduction in anxiety and in difficult behaviors. There is a good prospect of the BCBT suggesting that BCBT may be easier to be delivered than CBT by Japanese teachers to promote child mental health. The study has limitations including no control group, small sample size, or a short teacher training. Future research should address these limitations.

Keywords: brief cognitive behavior therapy, cognitive behavior therapy, mental health services in schools, teacher training workshop

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Authors: Linda Chularojmontri, Seewaboon Sireeratawong, Suvara Wattanapitayakul

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Terminalia arjuna Roxb. (family Combretaceae) is commonly known as ‘Sa maw thet’ in Thai. The fruit is used in traditional medicine as natural mild laxatives, carminative and expectorant. Aim of the study: This research aims to study the anti-inflammatory, analgesic and antipyretic activities of Terminalia arjuna extract by using animal models in comparison to the reference drugs. Materials and Methods: The anti-inflammatory study was conducted by two experimental animal models namely ethyl phenylpropionate (EPP)-induced ear edema and carrageenan-induced paw edema. The study of analgesic activity used two methods of pain induction including acetic acid and heat-induced pain. In addition, the antipyretic activity study was performed by induced hyperthermia with yeast. Results: The results showed that the oral administration of Terminalia arjuna extract possessed acute anti-inflammatory effect in carrageenan-induced paw edema. Terminalia arjuna extract showed the analgesic activity in acetic acid-induced writhing response and heat-induced pain. This indicates its peripheral effect by inhibiting the biosynthesis and/or release of some pain mediators and some mechanism through Central nervous system. Moreover, Terminalia arjuna extract at the dose of 1000 and 1500 mg/kg body weight showed the antipyretic activity, which might be because of the inhibition of prostaglandins. Conclusion: The findings of this study indicated that the Terminalia arjuna extract possesses the anti-inflammatory, analgesic and antipyretic activities in animals.

Keywords: analgesic activity, anti-inflammatory activity, antipyretic activity, Terminalia arjuna extract

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Authors: Elham Vojoudi, Marzieh Mehrafza, Ahmad Hosseini, Azadeh Raofi, Maryam Najafi

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Premature ovarian failure (POF) has become one of the main causes of infertility in women of childbearing age and the incidence of this disorder is increasing year by year. In these patients, poor ovarian response (POR) to gonadotropins reflects a diminished ovarian reserve (DOR) that gives place to few follicles despite aggressive stimulation. Up to now, egg donation is the only way to resolve infertility problems in POF patients. Therefore, some novel aspects such as activating (Akt signaling pathway) and inhibiting (Hippo-signaling) elements have been identified as IVA procedure that promotes primordial follicle activation. In this study, we used the newly developed technique (combination of in vitro activation of dormant follicles (IVA) and stem cell therapy) to promote ovarian follicle growth much more efficiently than the natural, in vivo process for women with POF. Transplantation of Warton Jelly-MSCs to the ovaries of POF patients rescued overall ovarian function. Participants (10 patients) were followed up monthly for a period of six months by hormonal (AMH, FSH, LH and E2), clinical (resuming menstruation), and US (folliculometry) outcomes after a laparoscopic operation. In summary, IVA/WJ-MSC transplantation may provide an effective treatment for POF.

Keywords: POF, in vitro activation, stem cell therapy, infertility

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Authors: Gadia Duhita, Noorhana, Tjhin Wiguna

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Background: ADHD is the most common behavioural disorder in Indonesia. A stimulant, specifically methylphenidate, has been the first drug of choice for an ADHD treatment more than half a century. During the last decade, non-stimulant therapy (atomoxetine) for ADHD treatment has been developing. Growing evidence of its efficacy and the difference in its side effects profile to stimulant therapy have made methylphenidate’s position as a first line therapy for ADHD in need of re-evaluation. Both methylphenidate and atomoxetine have proven themselves against placebos in reducing core symptoms of ADHD. More recent studies directly compare the efficacy of methylphenidate and atomoxetine. Objective: The objective of this paper is to find out if either methylphenidate or atomoxetine is superior to another. This paper will assess the validity, importance, and applicability of current available evidence which compare the effectivity, efficacy, and safety of methylphenidate to atomoxetine for treatment in children and adolescents with ADHD. Method: The articles were searched for through the PubMed and Cochrane databases with “attention deficit/hyperactivity disorder OR adhd”, “methylphenidate”, and “atomoxetine” as the search keywords. Two articles which were relevant and eligible were chosen by using inclusion and exclusion criterias to be critically appraised. Result: The study by Hazel et al. showed that the efficacy of methylphenidate and atomoxetine are comparable for treatment in child and adolescent ADHD. The result shows 53.6% (95% CI 48.5%-58.4%) of the patient responded to the treatment by atomoxetine and 54.4% (95% CI 47.6%-61.1%) patients responded to methylphenidate, with the difference in proportion of–0.9% (95% CI –9.2%-7.5%). The other study by Hanwella et al. also showed that the efficacy of atomoxetine was not inferior to metilphenidate (SMD = 0.09, 95% CI –0.08-0.26) (Z = 1.06, p = 0.29). However, the sub-group analysis showed that OROS methylphenidate is more effective compared to atomoxetine (SMD = 0.32, 95% CI 0.12-0.53) (Z = 3.05, p < 0.02). Conclusion: The efficacy of methylphenidate and atomoxetine in reducing symptoms of ADHD is comparable. None is proven inferior to another. The choice of pharmacological tratment children and adolescents with ADHD should be made based on contraindication and the side effects profile of each drug.

Keywords: attention deficit/hyperactivity disorder, ADHD, atomoxetine, methylphenidate

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Authors: Parastoo Parhizkar, Jaber Yaghini, Omid Fakheran

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Background: Third molar surgery is often associated with postoperative problems which cause serious impediments on daily activities and quality of life. Steroidal anti-inflammatory drugs may decrease these common post-operative complications. The purpose of this review is evaluating the available evidence regarding the efficacy of corticosteroids used as adjunctive therapy for patients undergoing third molar surgery. Methods: PubMed, Google scholar, Scopus, web of science, clinicaltrials.gov, scirus.com, Cochrane central register for controlled trials, LILACS, OpenGrey, centerwatch, isrctn, who.int and ebsco were searched without restrictions regarding the year of publication. Randomized clinical trials assessing patient-reported outcomes in patients undergoing surgical therapy, were eligible for inclusion. Study quality was assessed using the CONSORT-checklist. No meta-analysis was performed. Results: A total of twelve Randomized Clinical Trials were included in this study. Methylprednisolone and Dexamethasone may decrease postoperative side effects such as pain, trismus and edema. Based on the results both of them could improve patients’ satisfaction, and there is no significant difference between these two types of corticosteroids regarding the patient centered outcomes (p > 0.05). Intralesional and intravenous injection of Dexamethasone showed an equivalent result, with statistically significant better results (P < 0.05) in comparison with the oral treatment. Conclusion: various types of corticosteroids can enhance the patient’s satisfaction following third molar surgery. However, there is no significant difference between Dexamethasone, Prednisolone and Methylprednisolone groups in this regard. Comparing the various administration routs, local injection of Dexamethasone is quite simple, painless and cost-effective adjunctive therapy with better drug efficacy.

Keywords: third molar surgery, corticosteroids, patient-reported outcomes, health related quality of life

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Authors: Lilia Edit Aparicio Pico, Paulo Cesar Coronado Sánchez, Roberto Ferro Escobar

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This paper presents the implementation of telemedicine services for physiotherapy, occupational therapy, and speech therapy rehabilitation, utilizing telebroadcasting of audiovisual content to enhance comprehensive patient recovery in rural areas of San Vicente del Caguán municipality, characterized by high levels of social conflict in Colombia. The region faces challenges such as dysfunctional problems, physical rehabilitation needs, and a high prevalence of hearing diseases, leading to neglect and substandard health services. Limited access to healthcare due to communication barriers and transportation difficulties exacerbates these issues. To address these challenges, a research initiative was undertaken to leverage information and communication technologies (ICTs) to improve healthcare quality and accessibility for this vulnerable population. The primary objective was to develop a tele-rehabilitation system to provide asynchronous online therapies and teleconsultation services for patient follow-up during the recovery process. The project comprises two components: Communication systems and human development. A technological component involving the establishment of a wireless network connecting rural centers and the development of a mobile application for video-based therapy delivery. Communications systems will be provided by a radio link that utilizes internet provided by the Colombian government, located in the municipality of San Vicente del Caguán to connect two rural centers (Pozos and Tres Esquinas) and a mobile application for managing videos for asynchronous broadcasting in sidewalks and patients' homes. This component constitutes an operational model integrating information and telecommunications technologies. The second component involves pedagogical and human development. The primary focus is on the patient, where performance indicators and the efficiency of therapy support were evaluated for the assessment and monitoring of telerehabilitation results in physical, occupational, and speech therapy. They wanted to implement a wireless network to ensure audiovisual content transmission for tele-rehabilitation, design audiovisual content for tele-rehabilitation based on services provided by the ESE Hospital San Rafael in physiotherapy, occupational therapy, and speech therapy, develop a software application for fixed and mobile devices enabling access to tele-rehabilitation audiovisual content for healthcare personnel and patients and finally to evaluate the technological solution's contribution to the ESE Hospital San Rafael community. The research comprised four phases: wireless network implementation, audiovisual content design, software application development, and evaluation of the technological solution's impact. Key findings include the successful implementation of virtual teletherapy, both synchronously and asynchronously, and the assessment of technological performance indicators, patient evolution, timeliness, acceptance, and service quality of tele-rehabilitation therapies. The study demonstrated improved service coverage, increased care supply, enhanced access to timely therapies for patients, and positive acceptance of teletherapy modalities. Additionally, the project generated new knowledge for potential replication in other regions and proposed strategies for short- and medium-term improvement of service quality and care indicators

Keywords: e-health, medical informatics, telemedicine, telerehabilitation, virtual therapy

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Authors: Rui Sang, Fei Deng, Alexander Engel, Ewa M. Goldys, Wei Deng

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In this study, we brought together X-ray induced photodynamic therapy (X-PDT) and chemo-drug (5-FU) for the treatment on colorectal cancer cells. This was achieved by developing a lipid-polymer hybrid nanoparticle delivery system (FA-LPNPs-VP-5-FU). It was prepared by incorporating a photosensitizer (verteporfin), chemotherapy drug (5-FU), and a targeting moiety (folic acid) into one platform. The average size of these nanoparticles was around 100 nm with low polydispersity. When exposed to clinical doses of 4 Gy X-ray radiation, FA-LPNPs-VP-5-FU generated sufficient amounts of reactive oxygen species, triggering the apoptosis and necrosis pathway of cancer cells. Our combined X-PDT and chemo-drug strategy was effective in inhibiting cancer cells’ growth and proliferation. Cell cycle analyses revealed that our treatment induced G2/M and S phase arrest in HCT116 cells. Our results indicate that this combined treatment provides better antitumour effect in colorectal cancer cells than each of these modalities alone. This may offer a novel approach for effective colorectal cancer treatment with reduced off-target effect and drug toxicity.

Keywords: pdt, targeted lipid-polymer nanoparticles, verteporfin, colorectal cancer

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Authors: Nantale Prossy Nabatte, Josephat Nyagero, Elizabeth Kemigisha

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Background: Human Papilloma Virus (HPV) is a prevalent sexually transmitted infection (STI) in the world. It is important to screen for HPV so that women found positive receive early treatment to prevent the development of cervical cancer. The broad aim of the research was to explore the types, occurrence, and associated correlates of HPV infection by genotyping Human papillomavirus among a cohort of WLHIV attending an antiretroviral therapy clinic in Mukono, Uganda. Methods: A cross-sectional study was used to collect data for socio-demographic, sexual practices, and medical history factors associated with HPV genotypes using a pretested interview guide subjected to 342 WLHIV. The respondents’ results for HPV genotypes were obtained retrospectively from respective laboratory records. Data was entered in Epidata v4.6 and analysed using STATA V14. The prevalence of hr-HPV was estimated as a proportion of the entire sample size. Analysis for the correlates of hr-HPV infection was done using a modified Poisson regression model. Results: Slightly more than a half of respondents were aged below 35 years (56.7%), married (52.6%), and with a primary level of education (51.2%). The prevalence of hr-HPV was 39.8% at a 95% confidence interval (CI: 34.40- 44.78). The hr-HPV was higher among those between 30-34 years of age (n= 41, 30.2%) than those between the age of 45-49 years (n=16, 11.8%). In terms of associated correlates, age 45-49 years (aPR: 1.95, 95% CI: 1.41- 2.69), being married (aPR: 1.30, 95% CI: 1.00, 1.69), use of condoms (aPR: 1.31, 95% CI: 1.00 -1.71) and age of sexual debut (aPR: 1.42, 95% CI: 1.08-1.87) were significantly associated with Human papillomavirus genotypes. Conclusion and Recommendation: The prevalence of hr-HPV infection was high, indicative of a risk to the health of WLHIV in Mukono, Uganda, and worldwide at large. The correlates are age 45-49 years, being married, use of condoms, and age of sexual debut. Based on the results, it is recommended that the implementing teams in such projects put more emphasis on the diagnosis of hr-HPV infection and monitoring the treatment. More research is required to determine the effect of ART therapy on hr-HPV persistence.

Keywords: human papillomavirus genotypes, and their correlates, among women living with HIV, attending antiretroviral clinic

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Authors: Merrylord Harb-Azar

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Traditionally, PTSD treatment has involved trauma-focused cognitive behaviour therapy (TF CBT) to consolidate traumatic memories. A piloted integrated treatment of TF CBT and eye movement desensitisation reprocessing therapy (EMDR) of eight phases will fasten the rate memory is being consolidated and enhance cognitive functioning in patients with PTSD. Patients spend a considerable amount of time in treatment managing their traumas experienced firsthand, or from aversive details ranging from war, assaults, accidents, abuse, hostage related, riots, or natural disasters. The time spent in treatment or as inpatient affects overall quality of life, relationships, cognitive functioning, and overall sense of identity. EMDR is being offered twice a week in conjunction with the standard prolonged exposure as an inpatient in a private hospital. Prolonged exposure for up to 5 hours per day elicits the affect response required for EMDR sessions in the afternoon to unlock unprocessed memories and facilitate consolidation in the amygdala and hippocampus. Results are indicating faster consolidation of memories, reduction in symptoms in a shorter period of time, reduction in admission time, which is enhancing the quality of life and relationships, and improved cognition. The impact of events scale (IES) results demonstrate a significant reduction in symptoms, trauma symptoms inventory (TSI), and posttraumatic stressor disorder check list (PCL) that demonstrates large effect sizes to date. An integrated treatment approach for PTSD achieves a faster resolution of memories, improves cognition, and reduces the amount of time spent in therapy.

Keywords: EMDR enhances cognitive functioning, faster consolidation of trauma memory, integrated treatment of TF CBT and EMDR, reduction in inpatient admission time

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Authors: Hendra Wibowo, Suprayitno Wardoyo, Dhama Shinta

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Introduction: Pediatric pulmonary tuberculosis (TB) incidence was increasing, with many undetected cases. In complicated TB, treatment should consist of returning pulmonary function, preventing further complications, and eliminating bacteria. Complicated TB management was still controversial, and surgery was one of the treatments that should be evaluated in accordance with its role in the treatment of complicated TB. Method: This study was an evidence-based case report. The database used for the literature search were Cochrane, Medline, Proquest, and ScienceDirect. Keywords for the search were ‘primary pulmonary tuberculosis’, ‘surgery’, ‘lung resection’, and ‘children’. Inclusion criteria were studies in English or Indonesian, with children under 18 years old as subject, and full-text articles available. The assessment was done according to Oxford Centre for evidence-based medicine 2011. Results: Six cohort studies were analyzed. Surgery was indicated for patients with complicated TB that were unresponsive towards treatment. It should be noted that the experiments were done before the standard WHO antituberculosis therapy was applied; thus, the result may be different from the current application. Conclusion: Currently, there was no guideline on pulmonary resection. However, surgery yielded better mortality and morbidity in children with complicated pulmonary TB.

Keywords: pediatric, pulmonary, surgery, therapy, tuberculosis

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Authors: M. Owlia, M. H. Azarsa, M. Khabbazan, A. Mirbagheri

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Proprioceptive neuromuscular facilitation exercises are a series of stretching techniques that are commonly used in rehabilitation and exercise therapy. Assessment of these exercises for true maneuvering requires extensive experience in this field and could not be down with patients themselves. In this paper, we developed software that uses Microsoft Kinect sensor, a spherical color marker, and real-time image processing methods to evaluate patient’s performance in generating true patterns of movements. The software also provides the patient with a visual feedback by showing his/her avatar in a Virtual Reality environment along with the correct path of moving hand, wrist and marker. Primary results during PNF exercise therapy of a patient in a room environment shows the ability of the system to identify any deviation of maneuvering path and direction of the hand from the one that has been performed by an expert physician.

Keywords: image processing, Microsoft Kinect, proprioceptive neuromuscular facilitation, upper extremities assessment, virtual reality

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Authors: Rona Lee Suelo-Calanao, Mahmoud Loubani

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Objective: Sternal wound infection (SWI) following cardiac operation has a significant impact on patient morbidity and mortality. It also contributes to longer hospital stays and increased treatment costs. SWI management is mainly focused on treatment rather than prevention. This study looks at the effect of closed incision negative pressure therapy (ciNPT) dressing to help reduce the incidence of superficial SWI in high-risk patients after cardiac surgery. The ciNPT dressing was evaluated at 3 cardiac hospitals in the United Kingdom". Methods: All patients who had cardiac surgery from 2013 to 2021 were included in the study. The patients were classed as high risk if they have two or more of the recognised risk factors: obesity, age above 80 years old, diabetes, and chronic obstructive pulmonary disease. Patients receiving standard dressing (SD) and patients using ciNPT were propensity matched, and the Fisher’s exact test (two-tailed) and unpaired T-test were used to analyse categorical and continuous data, respectively. Results: There were 766 matched cases in each group. Total SWI incidences are lower in the ciNPT group compared to the SD group (43 (5.6%) vs 119 (15.5%), P=0.0001). There are fewer deep sternal wound infections (14(1.8%) vs. 31(4.04%), p=0.0149) and fewer superficial infections (29(3.7%) vs. 88 (11.4%), p=0.0001) in the ciNPT group compared to the SD group. However, the ciNPT group showed a longer average length of stay (11.23 ± 13 days versus 9.66 ± 10 days; p=0.0083) and higher mean logistic EuroSCORE (11.143 ± 13 versus 8.094 ± 11; p=0.0001). Conclusion: Utilization of ciNPT as an approach to help reduce the incidence of superficial and deep SWI may be effective in high-risk patients requiring cardiac surgery.

Keywords: closed incision negative pressure therapy, surgical wound infection, cardiac surgery complication, high risk cardiac patients

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Authors: Shweta Jha, Nandita Chaube

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The concept of self has a major role to play in the study of personality which drives the current study in its present form. This is a case of Miss S, a 17-year-old Hindu, currently in eleventh standard, with no family history of mental illness but with a past history of inability to manage relationships, multiple emotional and sexual relationships, repeated self harming behaviour, and sexual abuse over a period of 2 months at the age of 10 years. She comes with a psychiatric history of one episode of dissociative fall followed by a stressful event which left the patient with many psychological disturbances matching the criterion of Cluster B and C traits. Current episode precipitated due to the relationship failure, predisposing factor is her personality traits, and poor social and family support. Considering the patient’s aspiration for positivity and demand of the therapy, ventilation sessions were carried out which made her capable of understanding and dealing with her negative emotions, also strengthened mother child bond, helped her maintain meaningful and healthy relationships, also helped her increase her problem solving ability and adaptive coping skills making her feel more positive and acceptable towards herself, family members and others.

Keywords: cluster B and C traits, personality, therapy, self

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Authors: Aakriti Lohiya

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This study examines the commonly recognised childhood trauma that can have a significant and enduring effect on a person's cognitive and psychological health. The purpose of this study was to look at the intricate interactions that exist between negative self-identity, cognitive distortions, and early trauma. For the study, a sample of (200 women were taken, who were socially active) was gathered. Standardised measures were utilised to evaluate the participants' experiences of childhood trauma, and validated psychological tools were employed to assess negative self-identity and cognitive distortions. The links and predicting correlations between childhood trauma, negative self-identity, and cognitive distortions were investigated using statistical techniques, such as correlation analysis and multiple regression modelling. The results demonstrated that there is no correlation between the degree of early trauma and the emergence of a negative self-identity and cognitive distortions. It examines whether cognitive distortion and events in childhood have any relationship with negative self-identity using various scales. Participants completed the Childhood Trauma Questionnaire, which assessed retrospective accounts of childhood trauma; the Cognitive Distortions Scale, which measured internal attributions and perceptions of controllability; and the attachment style questionnaire, which assessed the attachment attribute of their daily life, which will lead negative. The implications for therapy were also considered.

Keywords: cognitive distortion, therapy, childhood trauma, attachment

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Authors: Muhammad Mustafa Jafar, Syed Ashar Mahfooz, Muhammad Ejaz Saleem, Muhammad Asif Raza, Asghar Abbas, Rao Zahid Abbas, Muhammad Kasib Khan, Hafiz Muhammad Ishaq

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The Babesia gradually attained resistance against the synthetic medicines. To overcome the drug resistance, herbal therapy has gained more attention as compared to allopathic therapy. Peganumharmala (harmal) is a plant which has shown effective results against various protozoal diseases. Therefore, the present study was planned to monitor the efficacy of Peganumharmala (aqueous extract) against Babesiosis in cattle. For this purpose, a total of forty (n=40) infected animals were randomly divided into four equal groups (A, B, C, and D). Group A was treated with aqueous extract of Peganum harmala at 7.5 mg/kg, group B at 10 mg/kg and group C at 12.5 mg/kg of body weight. Group D served as a control group (normal). It was observed that there was a stabilization in hematological parameters (white and red blood cells, hemoglobin and Packed cell volume) in infected animals treated with Peganum harmala at different doses. Results of this study hence indicated that Peganum harmala extract at 12.5mg/kg BW is more effective against Babesiosis than lower doses.

Keywords: Babesiosis, cattle, control, Peganum harmala

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Authors: Adelson G. Guillarte, M. D., Noel J. Belonguel, Jarungchai Anton S. Vatanagul

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Patients with malignant middle cerebral infarction (MCA) (with massive brain swelling and herniation) were reported to have a mortality rate of 80% even with the appropriate conservative medical therapy. European Trials (DECIMAL, DESTINY I, and II, HAMLET) showed significant improvement in mortality and functional outcome with hemicraniectomy. No known published local studies in the region, thus a local study is vital. This is a single center, retrospective, descriptive, cross-sectional, chart review study which includes ≥18 year-old patients with malignant MCA infarction, who underwent hemicraniectomy, and those who were given conservative medical therapy alone, from January 2008 to December 2012 at Perpetual Succour Hospital. Excluded were patients whose charts are with insufficient data, prior MCA stroke, with concomitant intracerebral hemorrhage and with other serious medical conditions or terminal illnesses. Minimum of 32 populations were needed. Data were presented in mean, standard deviation, frequency and percentage distribution. Man n Whitney U test and Chi Square test were used. P-values lesser than 0.05 alpha were considered statistically significant. A total of 672 stroke patients were admitted. 34 patients pass the inclusion criteria. 9 underwent hemicraniectomy and 25 were treated by conservative medical therapy alone. Although not statistically significant (64% vs 33%, p=0.112) there were more patients noted improved in the conservative treatment group. Meanwhile, the Hemicraniectomy group have increased percentage of mortality (67%) (p=0.112). There was a decreasing trend in the average NIHSS score in both groups from admission to post-op 7 days (p=0.198, p=0.78). A bigger multicenter prospective study is recommended to control inherent biases and limitations of a retrospective and smaller study.

Keywords: cerebral infarct, hemicraniectomy, ischemic stroke, malignant middle cerebral artery (MCA) infarct

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Authors: S. AlBustan, B. AlGhannam

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This oral presentation discusses a proposal for a study that evaluates the usability of an evidence based application named ProxTalker App. The significance of this study will inform administration and faculty staff at the Department of Communication Sciences Disorders (CDS), College of Life Sciences, Kuwait University whether the app is a suitable tool to use for CDS students. A case study will be used involving a sample of CDS students taking practicum and internship courses during the academic year 2018/2019. The study will follow a process used by previous study. The process of calculating SUS is well documented and will be followed. ProxTalker App is an alternative and augmentative tool that speech language pathologist (SLP) can use to customize boards for their clients. SLPs can customize different boards using this app for various activities. A board can be created by the SLP to improve and support receptive and expressive language. Using technology to support therapy can aid SLPs to integrate this ProxTalker App as part of their clients therapy. Supported tools, games and motivation are some advantages of incorporating apps during therapy sessions. A quantitative methodology will be used. It involves the utilization of a standard tool that was the was adapted to the Arabic language to accommodate native Arabic language users. The tool that will be utilized in this research is the Arabic Standard Usability Scale (A-SUS) questionnaire which is an adoption of System Usability Scale (SUS). Standard usability questionnaires are reliable, valid and their process is properly documented. This study builds upon the development of A-SUS, which is a psychometrically evaluated questionnaire that targets Arabic native speakers. Results of the usability will give preliminary indication of whether the ProxTalker App under investigation is appropriate to be integrated within the practicum and internship curriculum of CDS. The results of this study will inform the CDS department of this specific app is an appropriate tool to be used for our specific students within our environment because usability depends on the product, environment, and users.

Keywords: A-SUS, communication disorders practicum, evidence based app, Standard Usability Scale

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Authors: Fakhr Eddin Alnaal, Angela Dahdal, Duaa Aladib, Sabeen Ibrahim, Ibrahim Ghoraibi, Bissan Ahmed

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Dementia is one of the diseases which had several stages and Alzheimer’s term was selected in respect for the first doctor Alzheimer who defined the first symptoms of this diseases in a woman whom was well treated by him. The fact that this is a type of a silent disease on which you have a long-term process of neurological degradation and suddenly gives symptoms which are most often irreversible, on clinical level likely we can consider it as a malignancy, one in terms of that it is sudden shocking irreversible and on the level of behavior and some mortality beside the lack of early detection tools for diagnosis. Therefore, the goal of our project is to test the concept of the ability of Statin in prevention of such disease and we investigated that both on experimental level and most importantly on clinical one, the clinical part was performed in a recognized house of aged people who had accidently a high cholesterol and were for years given Statin to treat that elevation, however after the symptoms of Alzheimer’s appeared and when diagnosed, they were well treated and rapidly recovered compared to Alzheimer’s patients in the same house who did not receive Statin had a mild improvement in their symptoms after the therapy, on the other hand we confirmed such observation by a well-organized experimental work.

Keywords: Alzheimer's, dementia, silent disease, statin

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Authors: Zenah Gheblawi, Susan Armijo-Olivo, Elisa B. Pelai, Vaishali Sharma, Musa Tashfeen, Angela Fung, Francisca Claveria

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Due to physiological differences between men and women, pain is experienced differently between the two sexes. Chronic pain disorders, notably temporomandibular disorders (TMDs), disproportionately affect women in diagnosis, and pain severity in opposition of their male counterparts. TMDs are a type of musculoskeletal disorder that target the masticatory muscles, temporalis muscle, and temporomandibular joints, causing considerable orofacial pain which can usually be referred to the neck and back. Therapeutic methods are scarce, and are not TMD-centered, with the latest research suggesting that subjects with chronic musculoskeletal pain disorders have abnormal alterations in the grey matter of their brains which can be remedied with exercise, and thus, decreasing the pain experienced. The aim of the study is to investigate the effects of exercise therapy in TMD female patients experiencing chronic jaw pain and to assess the consequential effects on brain activity. In a randomized controlled trial, the effectiveness of an exercise program to improve brain alterations and clinical outcomes in women with TMD pain will be tested. Women with chronic TMD pain will be randomized to either an intervention arm or a placebo control group. Women in the intervention arm will receive 8 weeks of progressive exercise of motor control training using visual feedback (MCTF) of the cervical muscles, twice per week. Women in the placebo arm will receive innocuous transcutaneous electrical nerve stimulation during 8 weeks as well. The primary outcomes will be changes in 1) pain, measured with the Visual Analogue Scale, 2) brain structure and networks, measured by fractional anisotropy (brain structure) and the blood-oxygen level dependent signal (brain networks). Outcomes will be measured at baseline, after 8 weeks of treatment, and 4 months after treatment ends and will determine effectiveness of MCTF in managing TMD, through improved clinical outcomes. Results will directly inform and guide clinicians in prescribing more effective interventions for women with TMD. This study is underway, and no results are available at this point. The results of this study will have substantial implications on the advancement in understanding the scope of plasticity the brain has in regards with pain, and how it can be used to improve the treatment and pain of women with TMD, and more generally, other musculoskeletal disorders.

Keywords: exercise therapy, musculoskeletal disorders, physical therapy, rehabilitation, tempomandibular disorders

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Authors: Brian M. Mehling, Louis Quartararo, Marine Manvelyan, Paul Wang, Dong-Cheng Wu

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Numerous investigations suggest that Mesenchymal Stem Cells (MSCs) in general represent a valuable tool for therapy of symptoms related to chronic inflammatory diseases. Blue Horizon Stem Cell Therapy Program is a leading provider of adult and children’s stem cell therapies. Uniquely we have safely and efficiently treated more than 600 patients with documenting each procedure. The purpose of our study is primarily to monitor the immune response in order to validate the safety of intravenous infusion of human umbilical cord blood derived MSCs (UC-MSCs), and secondly, to evaluate effects on biomarkers associated with chronic inflammation. Nine patients were treated for conditions associated with chronic inflammation and for the purpose of anti-aging. They have been given one intravenous infusion of UC-MSCs. Our study of blood test markers of 9 patients with chronic inflammation before and within three months after MSCs treatment demonstrates that there is no significant changes and MSCs treatment was safe for the patients. Analysis of different indicators of chronic inflammation and aging included in initial, 24-hours, two weeks and three months protocols showed that stem cell treatment was safe for the patients; there were no adverse reactions. Moreover data from follow up protocols demonstrates significant improvement in energy level, hair, nails growth and skin conditions. Intravenously administered UC-MSCs were safe and effective in the improvement of symptoms related to chronic inflammation. Further close monitoring and inclusion of more patients are necessary to fully characterize the advantages of UC-MSCs application in treatment of symptoms related to chronic inflammation.

Keywords: chronic inflammatory diseases, intravenous infusion, stem cell therapy, umbilical cord blood derived mesenchymal stem cells (UC-MSCs)

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Authors: Ramona-Niculina Jurcau, Ioana-Marieta Jurcau, Dong Hun Kwak, Nicolae-Alexandru Colceriu

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Background: Stress management (SM) is a topic of great academic interest and equally a task to accomplish. In addition, it is recognized the beneficial role of unconventional therapies (UCT) in stress modulation. Aims: The aim was to evaluate medical (MS) versus non-medical students’ (NMS) opinions about academic stress management (ASM) using UCT. Methods: MS (n=103, third year males and females) and NMS (n=112, males and females, from humanities faculties, different years of study), out of their academic program, voluntarily answered to a questionnaire concerning: a) Classification of the four most important academic stress factors; b) The extent to which their daily life influences academic stress; c) The most important SM methods they know; d) Which of these methods they are applying; e) the UCT they know or about which they have heard; f) Which of these they know to have stress modulation effects; g) Which of these UCT, participants are using or would like to use for modulating stress; and if participants use UTC for their own choose or following a specialist consultation in those therapies (SCT); h) If they heard about the following UCT and what opinion they have (using visual analogue scale) about their use (following CST) for the ASM: Phytotherapy (PT), apitherapy (AT), homeopathy (H), ayurvedic medicine (AM), traditional Chinese medicine (TCM), music therapy (MT), color therapy (CT), forest therapy (FT). Results: Among the four most important academic stress factors, for MS more than for NMS, are: busy schedule, large amount of information taught; high level of performance required, reduced time for relaxing. The most important methods for SM that MS and NMS know, hierarchically are: listen to music, meeting friends, playing sport, hiking, sleep, regularly breaks, seeing positive side, faith; of which, NMS more than MS, are partially applying to themselves. UCT about which MS and less NMS have heard, are phytotherapy, apitherapy, acupuncture, reiki. Of these UTC, participants know to have stress modulation effects: some plants, bee’s products and music; they use or would like to use for ASM (the majority without SCT) certain teas, honey and music. Most of MS and only some NMS heard about PT, AT, TCM, MT and much less about H, AM, CT, TT. NMS more than MS, would use these UCT, following CST. Conclusions: 1) Academic stress is similarly reflected in MS and NMS opinions. 2) MS and NMS apply similar but very few UCT for stress modulation. 3) Information that MS and NMS have about UCT and their ASM application is reduced. 4) It is remarkable that MS and especially NMS, are open to UCT use for ASM, following an SCT.

Keywords: academic stress, stress management, stress modulation, medical students, non-medical students, unconventional therapies

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Authors: M. Kuzhko, M. Gumeniuk, D. Butov, T. Tlustova, O. Denysov, T. Sprynsian

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Abstract: The objective of this work was to study the efficacy and safety of inhaled nebulized chemotherapy in the treatment of patients with newly diagnosed pulmonary tuberculosis in comparison with standard antimycobacterial therapy. Materials and methods: The study involved 68 patients aged between 20 and 70 years with newly diagnosed pulmonary tuberculosis. Patients were allocated to two groups. The first (main, n=21) group of patients received standard chemotherapy and further 0.15 g of isoniazid and rifampicin 0.15 g inhaled through a nebulizer, also they received salmeterol 50 mcg + fluticasone propionate 250 mcg at 2 breaths twice a day for 2 months. The second (control, n=47) group of patients received standard chemotherapy, consisting of orally administered isoniazid (0.3 g), rifampicin (0.6 g), pyrazinamide (2 g), ethambutol (1.2 g) with a dose reduction after the intensive phase of the therapy. The anti-TB drugs were procured through the Ukraine’s centralized national supply system. Results: Intoxication symptoms in the first group reduced following 1.39±0.18 months, whereas in the second group, intoxication symptoms reduced following 2.7±0.1 months, p<.001. Moreover, respiratory symptoms regression in the first group was observed following 1.6±0.2 months, whereas in the second group – following 2.5±0.2 months, p<0.05. Bacillary excretion period evaluated within 1 month was reduced, as it was shown by 66.6±10.5% in the main group compared to 27.6±6.5%, p<0.05, in the control group. In addition, period of cavities healing was reduced to 2.9±0.2 months in the main group compared to 3.7±0.1 months, p<0.05, in the control group. Residual radiological lung damage findings (large residual changes) were observed in 22 (23.8±9.5 %) patients of the main group versus 24 (51.0±7.2 %) patients in the control group, p<0.05. After completion of treatment scar stenosis of the bronchi II-III art. diagnosed in 3 (14.2±7.8%) patients in main group and 17 (68.0±6.8%) - control group, p<0.05. The duration of hospital treatment was 2.4±0.4 months in main group and 4.1±0.4 months in control group, p<0.05. Conclusion: Administration of of inhaled nebulized chemotherapy in patients with newly diagnosed pulmonary tuberculosis resulted in a comparatively quick reduction of disease manifestation.

Keywords: inhaled nebulized chemotherapy, pulmonary tuberculosis, tuberculosis, treatment of tuberculosis

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Authors: Linneth Nkateko Mabila, Patrick Hulisani Demana, Tebogo Maria Mothiba

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Background: Sustaining adherence to antiretroviral therapy (ART) over the long term by people, especially children living with Human-Immunodeficiency Virus (HIV), requires accurate and consistent monitoring, and this is a particular challenge for countries in sub-Saharan Africa. However, the regularity and punctuality in monthly antiretroviral treatment collections indicate medication adherence to a certain extent since it has been revealed to be a significant determinant of the outcome of ART. Aim: This study assessed and described the pattern of monthly antiretroviral treatment collections among a cohort of virally unsuppressed HIV-positive children initiated and managed on ART in the rural public clinics of Mopani District, Limpopo, and explored the nurses' perceptions and views of the findings. Methods: A facility-based mixed-methods study was conducted to assess the honoring of scheduled monthly treatment collection practices by a cohort of HIV-positive children under 15 years initiated and managed on ART by Nurse Initiated Management of Antiretroviral Treatment (NIMART)-trained professional nurses (PNs) from 01 January 2015 to 31 December 2015 in public PHC clinics of Mopani District Municipality. This was followed by the exploration of the nurses' perceptions and views regarding this issue to share their experiences and knowledge acquired through managing these children on ART. Results: From a total of 7105 analysable visits, only 44% (3134) were honored as scheduled, with 40% (2828) of children presenting to the clinics after the scheduled appointment date – they missed their appointments, and 11% (768) of treatment collections that took place before the scheduled appointment date. This finding was further confirmed by 90% (97) of the nurses, who reported that they have children who miss scheduled appointments in their public clinics. The primary reasons for children missing appointments were related to caregivers' forgetfulness and conflict between the school schedule and the dates of clinic visits. Conclusion: We confirmed a high prevalence of non-adherence to scheduled monthly ART collections and the existence of health system, social, and caregiver-related factors that threaten treatment adherence and proper clinical outcomes. These findings suggest an urgent need for intervention since non-adherence to ARV therapy can be life-threatening to the child and poses the danger of reduced life expectancy.

Keywords: antiretroviral therapy (art), nimart, virally unsuppressed children, missed appointments

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Authors: Raju Singh, Shikha Singh

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This article is note for managing Autistic Child during the Corona time line. It becomes very critical for the primary caregiver as corona pandemic poses new challenges and completely variety of threats to line of treatment, growth, socialization, mental health for children with autism spectrum disorder (ASD), and, so for the family of the children. It is a highly distressful situation, where the line of treatment has shrunken, physical contact has reduced and therapies footprints reduced in several parts of the world. As children with ASD already face socialization challenges, isolation rules imposed by individuals (or social groups), government agencies have only made the situation worse for the children with ASD and their family. This note will try to touch the basics on understanding the ASD and related development disorders, challenges, impact, and suggest approaches to deal with such situation. This document also covers data analysis, deep dive into the increasing impact of ASD on children. This document can also act as a baseline for many researchers, psychiatrists, psychologists, therapists to view the problem statement and measure its impact.

Keywords: autism spectrum disorder, mental health, applied behavior therapy, occupational therapy, social anxiety

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Authors: Abdelhadi Adam Salih Denei

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Silver nanoparticles (AgNPs) have been used in cancer therapy, and the area of nanomedicine has made unheard-of strides in recent years. A thorough summary of the development and assessment of AgNPs for their possible use in the fight against cancer is the goal of this review. Targeted delivery methods have been designed to optimise therapeutic efficacy by using AgNPs' distinct physicochemical features, such as their size, shape, and surface chemistry. Firstly, the study provides an overview of the several synthesis routes—both chemical and green—that are used to create AgNPs. Natural extracts and biomolecules are used in green synthesis techniques, which are becoming more and more popular since they are biocompatible and environmentally benign. It is next described how synthesis factors affect the physicochemical properties of AgNPs, emphasising how crucial it is to modify these parameters for particular therapeutic uses. An extensive analysis is conducted on the anticancer potential of AgNPs, emphasising their capacity to trigger apoptosis, impede angiogenesis, and alter cellular signalling pathways. The analysis also investigates the potential benefits of combining AgNPs with currently used cancer treatment techniques, including radiation and chemotherapy. AgNPs' safety profile for use in clinical settings is clarified by a comprehensive evaluation of their cytotoxicity and biocompatibility.

Keywords: silver nanoparticles, cancer, nanocarrier system, targeted delivery

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Authors: Michael Vieth, Aric Schadler, Hubert Ballard, J. A. Bauer, Pratibha Thakkar

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Introduction: Congenital diaphragmatic hernia (CDH) is a condition characterized by the herniation of abdominal contents into the thoracic cavity requiring postnatal surgical repair. Previous literature suggests improved CDH outcomes at high-volume regional referral centers compared to low-volume centers. The purpose of this study was to examine CDH outcomes at Kentucky Children’s Hospital (KCH), a low-volume center, compared to the Congenital Diaphragmatic Hernia Study Group (CDHSG). Methods: A retrospective chart review was performed at KCH from 2007-2019 for neonates with CDH, and then subdivided into two cohorts: those requiring ECMO therapy and those not requiring ECMO therapy. Basic demographic data and measures of mortality and morbidity including ventilator days and length of stay were compared to the CDHSG. Measures of morbidity for the ECMO cohort including duration of ECMO, clinical bleeding, intracranial hemorrhage, sepsis, need for continuous renal replacement therapy (CRRT), need for sildenafil at discharge, timing of surgical repair, and total ventilator days were collected. Statistical analysis was performed using IBM SPSS Statistics version 28. One-sample t-tests and one-sample Wilcoxon Signed Rank test were utilized as appropriate.Results: There were a total of 27 neonatal patients with CDH at KCH from 2007-2019; 9 of the 27 required ECMO therapy. The birth weight and gestational age were similar between KCH and the CDHSG (2.99 kg vs 2.92 kg, p =0.655; 37.0 weeks vs 37.4 weeks, p =0.51). About half of the patients were inborn in both cohorts (52% vs 56%, p =0.676). KCH cohort had significantly more Caucasian patients (96% vs 55%, p=<0.001). Unadjusted mortality was similar in both groups (KCH 70% vs CDHSG 72%, p =0.857). Using ECMO utilization (KCH 78% vs CDHSG 52%, p =0.118) and need for surgical repair (KCH 95% vs CDHSG 85%, p =0.060) as proxy for severity, both groups’ mortality were comparable. No significant difference was noted for pulmonary outcomes such as average ventilator days (KCH 43.2 vs. CDHSG 17.3, p =0.078) and home oxygen dependency (KCH 44% vs. CDHSG 24%, p =0.108). Average length of hospital stay for patients treated at KCH was similar to CDHSG (64.4 vs 49.2, p=1.000). Conclusion: Our study demonstrates that outcome in CDH patients is independent of center’s case volume status. Management of CDH with a standardized approach in a low-volume center can yield similar outcomes. This data supports the treatment of patients with CDH at low-volume centers as opposed to transferring to higher-volume centers.

Keywords: ECMO, case volume, congenital diaphragmatic hernia, congenital diaphragmatic hernia study group, neonate

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Authors: Nagwa E. Abd Elazim, Maha S. El-naggar, Rania H. Mohamed, Sara M. Awad

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Background: Radiodermatitis is a common side effect of radiation therapy for breast cancer. However, there is no current consensus about effective standard therapy for the prevention and management of radiation dermatitis. Topical ectoine has demonstrated efficacy in the treatment of atopic dermatitis owing to its anti-inflammatory activity. Objective: To evaluate the efficacy of topical ectoine in comparison to traditional topical dexpanthenol treatment in the management of acute radiodermatitis in breast cancer patients undergoing adjuvant radiotherapy. Methods: Fifty patients were randomized to use either dexpanthenol 0.5% cream (25 patients), or ectoin 7% cream (25 patients), applied twice daily to the irradiated area during the radiation period and continued for 2 weeks after cessation of radiotherapy. Assessment of radiation skin toxicity using Common Terminology Criteria of Adverse Events (CTCAE) v4.0, radiation-associated symptoms, and adverse events were undertaken weekly during radiotherapy and 2 weeks after the end of radiotherapy. Results: Topical ectoine showed some clinical benefit over dexpanthenol, as shown by delayed time to onset (at week 3 versus week 2, respectively) and larger number of patients who reached grade 0 at the end of treatment (64% vs. 48%, respectively). The clinical symptoms of pain (p = 0.003) and itching (p = 0.001) attributable to radiation were less pronounced with ectoine than with dexpanthenol. Burning and hyperpigmentation were the most common side effects with ectoine. However, no significant difference between dexpanthenol and ectoine treatments was found in any of the side effects (p = 0.1). Conclusion: Ectoin was overall more effective in improving radiation dermatitis than topical dexpanthenol in breast cancer patients. Ectoin could be proposed as a preventive or curative treatment for patients undergoing postoperative irradiation for breast cancer. Further clinical studies with a larger number of patients are recommended for the confirmation of these preliminary results.

Keywords: breast cancer, dexapanthenol, ectoin, radiation dermatitis

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Authors: Chairun Wiedyaningsih, Sri Suryawati, Yati Soenarto, Muhammad Hakimi

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Background: Many drugs used in paediatrics are not commercially available in suitable dosage forms. Therefore, the drugs often prescribed in extemporaneous compounding dosage form. Compounding can pose health risks include poor quality and unsafe products. Studies of compounding dosage form have primarily focused on prescription profiles, reasons of prescribing never be explored. Objectives: The study was conducted to identify factors influencing physicians’ decision to prescribe extemporaneous compounding dosage form for paediatric outpatients. Setting: Daerah Istimewa Yogyakarta (DIY) province, Indonesia. Method: Qualitative semi-structured interviews were conducted with 15 general physicians and 7 paediatricians to identify the reason of prescribing extemporaneous compounding dosage form. The interviews were transcribed and analysed using thematic analysis. Results: Factors underlying prescribing of compounding could be categorized to therapy, healthcare system, patient and past experience. The primary reasons of therapy factors were limited availability of drug compositions, dosages or formulas specific for children. Beliefs in efficacy of the compounding forms were higher when the drugs used primarily to overcome complex cases. Physicians did not concern about compounding form containing several active substances because manufactured syrups may also contain several active substances. Although medicines were available in manufactured syrups, limited institutional budget was healthcare system factor of compounding prescribing. The prescribing factors related to patients include easy to use, efficient and lower price. The prescribing factors related to past experience were physicians’ beliefs to the progress of patient's health status. Conclusions: Compounding was prescribed based on therapy-related factors, healthcare system factors, patient factors and past experience.

Keywords: compounding dosage form, interview, physician, prescription

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Authors: Carlos M. Goncalves, Luisa Duarte, Teresa Cartaxo

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The aim of this work was to understand the reasons behind the underutilization of electroconvulsive therapy (ECT) in the younger population and raise possible solutions. We conducted a non-systematic review of literature throughout a search on PubMed, using the terms ‘children’, ‘adolescents’ and ‘electroconvulsive’, ‘therapy’. Candidate articles written in languages other than English were excluded. Articles were selected according to title and/or abstract’s content relevance, resulting in a total of 5 articles. ECT is a recognized effective treatment in adults for several psychiatric conditions. As in adults, ECT in children and adolescents is proven most beneficial in the treatment of severe mood disorders, catatonia, and, to a lesser extent, schizophrenia. ECT in adults has also been used to treat autism’s self-injurious behaviours, Tourette’s syndrome and resistant first-episode schizophrenia disorder. Despite growing evidence on its safety and effectiveness in children and adolescents, like those found in adults, ECT remains a controversial and underused treatment in patients this age, even when it is clearly indicated. There are various possible reasons to this; limited awareness among professionals (lack of knowledge and experience among child psychiatrists), stigmatic public opinion (despite positive feedback from patients and families, there is an unfavourable and inaccurate representation in the media, contributing to a negative public opinion), legal restrictions and ethical controversies (restrictive regulations such as a minimum age for administration), lack of randomized trials (the currently available studies are retrospective, with small size samples, and most of the publications are either case reports or case series). This shows the need to raise awareness and knowledge, not only for mental health professionals, but also to the general population, through the media, regarding indications, methods and safety of ECT in order to provide reliable information to the patient and families. Large-scale longitudinal studies are also useful to further demonstrate the efficacy and safety of ECT and can aid in the formulation of algorithms and guidelines as without these changes, the availability of ECT to the younger population will remain restricted by regulations and social stigma. In conclusion, these results highlight that lack of adequate knowledge and accurate information are the most important factors behind the underutilization of ECT in younger population. Mental healthcare professionals occupy a cornerstone position; if data is given by a well-informed healthcare professional instead of the media, general population (including patients and their families) will probably regard the procedure in a more favourable way. So, the starting point should be to improve health care professional’s knowledge and experience on this choice of treatment.

Keywords: adolescents, children, electroconvulsive, therapy

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Authors: Mahnoor Khan, Bashir Ahmad, Khizar Hayat, Saad Ahmad Khan, Laiba Ahmad, Shumaila Bashir, Abid Ali Khan

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The objective of this study was to synthesize the smallest possible size of ZnO NPs using a modified wet chemical synthesis method and to prepare core shell using polyethylene glycol (PEG) as shell material. Advanced and sophisticated techniques were used to confirm the synthesis, size, and shape of these NPs. Rounded, clustered NPs of size 5.343 nm were formed. Both the plain and core shell NPs were tested against MDR bacteria (E. cloacae, E. amnigenus, Shigella, S. odorifacae, Citrobacter, and E. coli). Both of the NPs showed excellent antibacterial properties, whereas E. cloacae showed maximum zone of inhibition of 16 mm, 27 mm, and 32 mm for 500 μg/ml, 1000 μg/ml, and 1500 μg/ml, respectively for plain ZnO NPs and 18 mm, 28 mm and 35 mm for 500 μg/ml, 1000 μg/ml and 1500 μg/ml for core shell NPs. These NPs were also biocompatible on human red blood cells showing little hemolysis of only 4% for 70 μg/ml for plain NPs and 1.5% for 70 μg/ml for core shell NPs. Core shell NPs were highly biocompatible because of the PEG. Their therapeutic effect as photosensitizers in photodynamic therapy (PDT) for cancer treatment was also monitored. The cytotoxicity of ZnO and PEG-ZnO was evaluated using MTT assay. Our results demonstrated that these NPs could generate ROS inside tumor cells after irradiation which in turn initiates an apoptotic pathway leading to cell death hence proving to be an effective candidate for PDT.

Keywords: ZnO, hemolysis, cytotoxiciy assay, photodynamic therapy, antibacterial

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