Search results for: oral disease

Authors: Nuchanat Handumrongkul Danaya Darnsawasdi, Anantachai Aeka

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To be a model for performing oral presentations by the tour guides, this research has been conducted. In order to develop French language teaching and studying for tourism, its purpose is to analyze the content used by tour guides. The study employed audio recordings of these presentations as an interview method in authentic situations, having four guides as respondents and information providers. The data was analyzed through content analysis. The results found that the tour guides described eight important items by giving more importance to details at Wat Phra Kaew or the Temple of the Emerald Buddha than at the palaces. They preferred the buildings upon the upper terrace, Buddhist cosmology, the decoration techniques, the royal chapel, the mural paintings, Thai offerings to Buddha images, palaces with architectural features and functions including royal ceremonies and others. This information represents the Thai characteristics of each building and other related content. The findings were used as a manual for guides for how to describe a tourist attraction, especially the temple and other related cultural topics of interest.

Keywords: guide, guide presentation, Grand Palace, Buddhist cosmology

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Authors: Made Rahayu Putri Saron, Mochamad Nizar Palefi Ma’ady

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Communication skills are important in everyday life, communication can be done verbally in the form of oral or written and nonverbal in the form of expressions or body movements. Good communication should be able to provide information clearly, and there is feedback from the speaker and listener. However, it is often found that the information conveyed is not clear, and there is no feedback from the listeners, so it cannot be ensured that the communication is effective and understandable. The speaker's understanding of the topic is one of the supporting factors for the listener to be able to accept the meaning of the conversation. However, based on the results of the literature review, it found that the influence factors of person speaking style are as follows: (i) environmental conditions; (ii) voice, articulation, and accent; (iii) gender; (iv) personality; (v) speech disorders (Dysarthria); when speaking also have an important influence on speaker’s speaking style. It can be concluded the factors that support understanding and comfort of the listener are dependent on the nature of the speaker (environmental conditions, voice, gender, personality) or also it the speaker have speech disorders.

Keywords: listener, public speaking, speaking style, understanding, and comfortable factor

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Authors: Marie-Helena Docherty, Sion Edryd Williams

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The prevalence of diabetes mellitus is increasing worldwide. In Sub-Saharan Africa, type 2 diabetes represents over 90% of all types of diabetes with the number of diabetic patients expected to rise. This represents a huge economic burden in an area already contending with high rates of other significant diseases, including the highest worldwide prevalence of HIV. Diabetic complications considerably impact on morbidity and mortality. The epidemiological data for the region quotes high rates of retinopathy (7-63%), neuropathy (27-66%) and microalbuminuria (10-83%). It is therefore imperative that diabetic screening programmes are established. It is recognised that in many parts of the developing world the implementation and management of such programmes is limited by a lack of available resources. The International Diabetes Federation produced guidelines in 2012 taking these limitations into account suggesting that all diabetic patients should have access to basic screening. These guidelines are consistent with the national diabetic guidelines produced by the Lesotho Medical Council. However, diabetic care in Lesotho is delivered at the local level, with variable levels of quality. A cross sectional study was performed in the outpatient department of Maluti Hospital in Mapoteng, Lesotho, a busy rural hospital in the Berea district. Demographic data on gender, age and modality of treatment were collected over a six-week time period. Information regarding 3 basic screening parameters was obtained. These parameters included eye screening (defined as a documented ophthalmology review within the last 12 months), foot screening (defined as a documented foot health assessment by any health care professional within the last 12 months) and secondary prevention (defined as a documented blood pressure and lipid profile reading within the last 12 months). These parameters were selected on the basis of the absolute minimum level of resources in Maluti Hospital. Renal screening was excluded, as the hospital does not have access to reliable renal profile checks or urinalysis. There is however a fully functioning on-site ophthalmology department run by a senior ophthalmologist with the ability to provide retinal photography, retinal surgery and photocoagulation therapy. Data was collected on 183 type 2 diabetics. 112 patients were male and 71 were female. The average age was 43 years. 4 patients were diet controlled, 140 patients were on oral hypoglycaemic agents (metformin and/or glibenclamide), and 39 patients were on a combination of insulin and oral hypoglycaemics. In the preceding 12 months, 5 patients had undergone eye screening (3%), 24 patients had undergone foot screening (13%), and 31 patients had lipid profile testing (17%). All patients had a documented blood pressure reading (100%). Our results show that screening is poorly performed in the basic indicators suggested by the IDF and the Lesotho Medical Council. On the basis of these results, a screening programme was developed using the mnemonic SaFE; secondary prevention, foot and eye care. This is simple, memorable and transferable between healthcare professionals. In the future, the expectation would be to expand upon this current programme to include renal screening, and to further develop screening pertaining to secondary prevention.

Keywords: Africa, complications, rural, screening

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Authors: Omur Sercan Oral

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In this paper, the individual and social conflicts are examined with a sociological perspective during the social process of Macondo described in the post-modern book of Gabriel Garcia Marquez, One Hundred Years of Solitude. More specifically, the theme of the solitude of individuals who choose to be isolated and who are isolated is studied within the context of the suicide of Emile Durkheim. As a self-reflective product of individuals in the result-based process, both economically and socially founded in the text, solitude reflects the ultimate process of separation from society. In this sense, the various and multiplying layers of the collective codes of Macondo as microcosm and their interactions with the individuals are examined in this paper under the roof of suicide in the sociological concept. The attempts to explain the reasons, shift, and its reflections on individuals are carried out to cross the lines of one discipline. In doing that, the ideas of Durkheim, Foucault, Weber, and Clausewitz, to some extent, are planted explicitly and implicitly throughout the paper.

Keywords: Durkheim’s concept of suicide, solitude theme in Marquez, collective consciousness, isolation from society, subjectivity

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Authors: Antonia Egli, Theo Lynn, Pierangelo Rosati, Gary Sinclair

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The World Health Organization (WHO) defines vaccine hesitancy as the postponement or complete denial of vaccines and estimates a direct linkage to approximately 1.5 million avoidable deaths annually. This figure is not immune to public health developments, as has become evident since the global spread of COVID-19 from Wuhan, China in early 2020. Since then, the proliferation of influential, but oftentimes inaccurate, outdated, incomplete, or false vaccine-related information on social media has impacted hesitancy levels to a degree described by the WHO as an infodemic. The COVID-19 pandemic and related vaccine hesitancy levels have in 2022 resulted in the largest drop in childhood vaccinations of the 21st century, while the prevalence of online stigma towards vaccine hesitant consumers continues to grow. Simultaneously, a second disease has risen to global importance: Monkeypox is an infection originating from west and central Africa and, due to racially motivated online hate, was in August 2022 set to be renamed by the WHO. To better understand public reactions towards two viral infections that became global threats to public health no two years apart, this research examines user replies to threads published by the WHO on Twitter. Replies to two Tweets from the @WHO account declaring COVID-19 and Monkeypox as ‘public health emergencies of international concern’ on January 30, 2020, and July 23, 2022, are gathered using the Twitter application programming interface and user mention timeline endpoint. Research methodology is unique in its analysis of stigmatizing, racist, and hateful content shared on social media within the vaccine discourse over the course of two disease outbreaks. Three distinct analyses are conducted to provide insight into (i) the most prevalent topics and sub-topics among user reactions, (ii) changes in sentiment towards the spread of the two diseases, and (iii) the presence of stigma, racism, and online hate. Findings indicate an increase in hesitancy to accept further vaccines and social distancing measures, the presence of stigmatizing content aimed primarily at anti-vaccine cohorts and racially motivated abusive messages, and a prevalent fatigue towards disease-related news overall. This research provides value to non-profit organizations or government agencies associated with vaccines and vaccination programs in emphasizing the need for public health communication fitted to consumers' vaccine sentiments, levels of health information literacy, and degrees of trust towards public health institutions. Considering the importance of addressing fears among the vaccine hesitant, findings also illustrate the risk of alienation through stigmatization, lead future research in probing the relatively underexamined field of online, vaccine-related stigma, and discuss the potential effects of stigma towards vaccine hesitant Twitter users in their decisions to vaccinate.

Keywords: social marketing, social media, public health communication, vaccines

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Authors: Sephora Jose

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Caste slavery was an exploitative human transactional system that prevailed in Kerala, the south-western state of India, till the late nineteenth century. In this particular system, more than ten untouchable/Dalit caste groups had been enslaved and transacted. Mainstream historiographies have subsumed caste slavery under caste servitude covering up the transactional aspect of the practice. However, there are communities in Kerala like Prathyaksha Raksha Daiva Sabha (The Divine Church of Visible Salvation) and Deva Jana Samajam (The Society of God’s People), who claim to be the descendants of the caste slaves. Being spiritual organizations, they engage with the historical reality of slavery through Dalit theology. Their theology is articulated through their oral narratives, including songs, stories, myths, and other cultural productions. This study seeks to understand how the descendants of slave castes in Kerala attempt alternative historiography through Dalit theology articulated in their cultural productions collected over fieldwork.

Keywords: caste slavery, Dalit theology, Dravidians, Deva Jana Samajam, Prathyaksha Raksha Daiva Sabha

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Authors: Kenichi Yamahara, Makiko Ohshima, Shunsuke Ohnishi, Hidetoshi Tsuda, Akihiko Taguchi, Toshihiro Soma, Hiroyasu Ogawa, Jun Yoshimatsu, Tomoaki Ikeda

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We have previously reported the therapeutic potential of rat fetal membrane(FM)-derived mesenchymal stem cells (MSCs) using various rat models including hindlimb ischemia, autoimmune myocarditis, glomerulonephritis, renal ischemia-reperfusion injury, and myocardial infarction. In this study, 1) we isolated and characterized MSCs from human amnion and chorion; 2) we examined their differences in the expression profile of growth factors and cytokines; and 3) we investigated the therapeutic potential and difference of these MSCs using murine hindlimb ischemia and acute graft-versus-host disease (GVHD) models. Isolated MSCs from both amnion and chorion layers of FM showed similar morphological appearance, multipotency, and cell-surface antigen expression. Conditioned media obtained from amnion- and chorion-derived MSCs inhibited cell death caused by serum starvation or hypoxia in endothelial cells and cardiomyocytes. Amnion and chorion MSCs secreted significant amounts of angiogenic factors including HGF, IGF-1, VEGF, and bFGF, although differences in the cellular expression profile of these soluble factors were observed. Transplantation of human amnion or chorion MSCs significantly increased blood flow and capillary density in a murine hindlimb ischemia model. In addition, compared to human chorion MSCs, human amnion MSCs markedly reduced T-lymphocyte proliferation with the enhanced secretion of PGE2, and improved the pathological situation of a mouse model of GVHD disease. Our results highlight that human amnionand chorion-derived MSCs, which showed differences in their soluble factor secretion and angiogenic/immuno-suppressive function, could be ideal cell sources for regenerative medicine.

Keywords: amnion, chorion, fetal membrane, mesenchymal stem cells

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Authors: Gehan Hussein, Hala Agha, Rasha Abdelraof, Marina George, Antoine Fakhri

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Background: β-Thalassemia major (TM) and sickle cell disease (SCD) are inherited hemoglobin disorders resulting in chronic hemolytic anemia. Cardiovascular involvement is an important cause of morbidity and mortality in these groups of patients. The narrow border is between overt myocardial dysfunction and clinically silent left ventricular (LV) and / or right ventricular (RV) dysfunction in those patients. 3 D Speckle tracking echocardiography (3D STE) is a novel method for the detection of subclinical myocardial involvement. We aimed to study myocardial affection in SCD and TM using 3D STE, comparing it with conventional echocardiography, correlate it with serum ferritin level and lactate dehydrogenase (LDH). Methodology: Thirty SCD and thirty β TM patients, age range 4-18 years, were compared to 30 healthy age and sex matched control group. Cases were subjected to clinical examination, laboratory measurement of hemoglobin level, serum ferritin, and LDH. Transthoracic color Doppler echocardiography, 3D STE, tissue Doppler echocardiography, and aortic speckle tracking were performed. Results: significant reduction in global longitudinal strain (GLS), global circumferential strain (GCS), and global area strain (GAS) in SCD and TM than control (P value <0.001) there was significantly lower aortic speckle tracking in patients with TM and SCD than control (P value< 0.001). LDH was significantly higher in SCD than both TM and control and it correlated significantly positive mitral inflow E, (p value:0.022 and 0.072. r: 0.416 and -0.333 respectively) lateral E/E’ (p value.<0.001and 0.818. r. 0.618 and -0. 044.respectively) and septal E/E’ (p value 0.007 and 0.753& r value 0.485 and -0.060 respectively) in SCD but not TM and significant negative correlation between LDH and aortic root speckle tracking (value 0.681& r. -0.078.). The potential diagnostic accuracy of LDH in predicting vascular dysfunction as represented by aortic root GCS with a sensitivity 74% and aortic root GCS was predictive of LV dysfunction in SCD patients with sensitivity 100% Conclusion: 3D STE LV and RV systolic dysfunction in spite of their normal values by conventional echocardiography. SCD showed significantly lower right ventricular dysfunction and aortic root GCS than TM and control. LDH can be used to screen patients for cardiac dysfunction in SCD, not in TM

Keywords: thalassemia major, sickle cell disease, 3d speckle tracking echocardiography, LDH

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Authors: Izabela P. Vatanabe, Rafaela Peron, Patricia Manzine, Marcia R. Cominetti

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Introduction: Considering the increase in life expectancy of world population, there is an emerging concern in health services to allocate better care and care to elderly, through promotion, prevention and treatment of health. It has been observed that frailty syndrome is prevalent in elderly people worldwide and this complex and heterogeneous clinical syndrome consist of the presence of physical frailty associated with cognitive dysfunction, though in absence of dementia. This can be characterized by exhaustion, unintentional weight loss, decreased walking speed, weakness and low level of physical activity, in addition, each of these symptoms may be a predictor of adverse outcomes such as hospitalization, falls, functional decline, institutionalization, and death. Cognitive frailty is a recent concept in literature, which is defined as the presence of physical frailty associated with mild cognitive impairment (MCI) however in absence of dementia. This new concept has been considered as a subtype of frailty, which along with aging process and its interaction with physical frailty, accelerates functional declines and can result in poor quality of life of the elderly. MCI represents a risk factor for Alzheimer's disease (AD) in view of high conversion rate for this disease. Comorbidities and physical frailty are frequently found in AD patients and are closely related to heterogeneity and clinical manifestations of the disease. The decreased platelets ADAM10 levels in AD patients, compared to cognitively healthy subjects, matched by sex, age and education. Objective: Based on these previous results, this study aims to evaluate whether ADAM10 platelet levels of could act as a biomarker of cognitive frailty. Methods: The study was approved by Ethics Committee of Federal University of São Carlos (UFSCar) and conducted in the municipality of São Carlos, headquarters of Federal University of São Carlos (UFSCar). Biological samples of subjects were collected, analyzed and then stored in a biorepository. ADAM10 platelet levels were analyzed by western blotting technique in subjects with MCI and compared to subjects without cognitive impairment, both with and without presence of frailty. Statistical tests of association, regression and diagnostic accuracy were performed. Results: The results have shown that ADAM10/β-actin ratio is decreased in elderly individuals with cognitive frailty compared to non-frail and cognitively healthy controls. Previous studies performed by this research group, already mentioned above, demonstrated that this reduction is still higher in AD patients. Therefore, the ADAM10/β-actin ratio appears to be a potential biomarker for cognitive frailty. The results bring important contributions to an accurate diagnosis of cognitive frailty from the perspective of ADAM10 as a biomarker for this condition, however, more experiments are being conducted, using a high number of subjects, and will help to understand the role of ADAM10 as biomarker of cognitive frailty and contribute to the implementation of tools that work in the diagnosis of cognitive frailty. Such tools can be used in public policies for the diagnosis of cognitive frailty in the elderly, resulting in a more adequate planning for health teams and better quality of life for the elderly.

Keywords: ADAM10, biomarkers, cognitive frailty, elderly

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Authors: Muhammad Fayyaz Nazir, Ellen Wayenberg, Shahzadaah Faahed Qureshi

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Introduction: The study is based on the Contextual Interaction Theory (CIT) constructs to explore the role of policy actors in implementing the COVID-19 Disease Prevention and Control (DP&C) Policy. The study analyzes the role of healthcare workers' contextual factors, such as cognition, motives, and resources, and their interactions in implementing Social Distancing (SD). In this way, we test a two actors policy implementation theory, i.e., the CIT in a three-actor context. Methods: Data was collected through document analysis and semi-structured interviews. For a qualitative study design, interviews were conducted with questions on cognition, motives, and resources from the healthcare workers involved in implementing SD in the local context in Multan – Pakistan. The possible interactions resulting from contextual factors of the policy actors – healthcare workers were identified through framework analysis protocol guided by CIT and supported by trustworthiness criterion and data saturation. Results: This inquiry resulted in theory application, addition, and enrichment. The theoretical application in the three actor's contexts illustrates the different levels of motives, cognition, and resources of healthcare workers – senior administrators, managers, and healthcare professionals. The senior administrators working in National Command and Operations Center (NCOC), Provincial Technical Committees (PTCs), and Districts Covid Teams (DCTs) were playing their role with high motivation. They were fully informed about the policy and moderately resourceful. The policy implementors: healthcare managers working on implementing the SD within their respective hospitals were playing their role with high motivation and were fully informed about the policy. However, they lacked the required resources to implement SD. The target medical and allied healthcare professionals were moderately motivated but lack of resources and information. The interaction resulted in cooperation and the need for learning to manage the future healthcare crisis. However, the lack of resources created opposition to the implementation of SD. Objectives of the Study: The study aimed to apply a two actors theory in a multi actors context. We take this as an opportunity to qualitatively test the theory in a novel situation of the Covid-19 pandemic and make way for its quantitative application by designing a survey instrument so that implementation researchers can apply CIT through multivariate analyses or higher-order statistical modeling. Conclusion: Applying two actors' implementation theory in exploring a complex case of healthcare intervention in three actors context is a unique work that has never been done before, up to the best of our knowledge. So, the work will contribute to the policy implementation studies by applying, extending, and enriching an implementation theory in a novel case of the Covi-19 pandemic, ultimately fulfilling the gap in implementation literature. Policy institutions and other low or middle-income countries can learn from this research and improve SD implementation by working on the variables with weak significance levels.

Keywords: COVID-19, disease prevention and control policy, implementation, policy actors, social distancing

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Authors: Edidiong Ekefre

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The Nigerian civil war was one of the foremost postcolonial conflicts in West Africa that attracted a serious humanitarian problem due to an unprecedented refugee crisis that affected the Biafran region. Due to its geographical location, the Nigerian government used blockades and starvation as a weapon of war against the Biafran. Faced with strong opposition from the Nigerian government, most humanitarian organizations withdrew their support from Biafra, whose death toll was rapidly growing daily due to starvation, malnutrition, and chronic ailment. Thus, the Catholic Church, a major Christian denomination in Biafra, had to see it as its religious obligation to support the humanitarian needs of the Biafrans. Thus, applying oral history methods with archival research, this paper examines the humanitarian activities of the Catholic Church in the Nigerian civil war. It contends that the Catholic Church was a key player in the humanitarian aspect of the Nigerian civil war. The paper concludes that faith-based humanitarian intervention in the Biafran refugee crisis was essential for the survival of the Biafran war-stricken women and children.

Keywords: refugee crisis, humanitarian intervention, Caritas International, blockades, airlifts, starvation

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Authors: Oral S. Saulters, Shanon D. Goldberg, Wendy A. Staples, Ellena I. Martinez, Lorie M. Sanchez, Diego E. Archuleta, Deborah L. Williams, Scot D. Johnson

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To address an important set of unverified field conditions, the Los Alamos National Laboratory Waste Compliance and Tracking System (WCATS) Wall-to-Wall Team performed an unprecedented and advanced inventory. This reconciliation involved confirmation analysis for approximately 5850 hazardous, low-level, mixed low-level, and transuranic waste containers located in more than 200 staging and storage areas across 33 technical areas. The interdisciplinary team scoped, planned, and developed the multidimensional assessments. Through coordination with cross-functional site hosts, they were able to verify and validate data while resolving discrepancies identified in WCATS. The results were extraordinary with an updated inventory, tailored outreach, more cohesive communications, and timely closed-loop feedback.

Keywords: circular economy, environmental performance data, social-ecological-technological systems, waste management

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Authors: Vishvas N. Patel, Mehul Chorawala

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Currently, according to the authors best knowledge there are less effective therapeutic agents to limit intestinal mucosa damage associated with inflammatory bowel disease (IBD). Clinical studies have shown beneficial effects of several probiotics in patients of IBD. Probiotics are live organisms; confer a health benefit to the host by modulating immunoinflammation and oxidative stress. Although probiotics in murine and human improve disease severity, very little is known about the specific contribution of cell wall contents of probiotics in IBD. Herein, we investigated the ameliorative potential of cell wall contents of Lactobacillus casei (LC) in lipopolysaccharide (LPS)-induced murine colitis. Methods: Colitis was induced in LPS-sensitized rats by intracolonic instillation of LPS (50 µg/rat) for consecutive 14 days. Concurrently, cell wall contents isolated from 103, 106 and 109 CFU of LC was given subcutaneously to each rat for 21 days, considering sulfasalazine (100 mg/kg, p.o.) as standard. The severity of colitis was assessed by body weight loss, food intake, stool consistency, rectal bleeding, colon weight/length, spleen weight and histological analysis. Colonic inflammatory markers (myeloperoxidase (MPO) activity, C-reactive protein and proinflammatory cytokines) and oxidative stress markers (malondialdehyde, reduced glutathione and nitric oxide) were also assayed. Results: Cell wall contents of isolated from 106 and 109 CFU of LC significantly improved the severity of colitis by reducing body weight loss and diarrhea & bleeding incidence, improving food intake, colon weight/length, spleen weight and microscopic damage to the colonic mucosa. The treatment also reduced levels of inflammatory and oxidative stress markers and boosted antioxidant molecule. However, cell wall contents of isolated from 103 were ineffective. Conclusion: In conclusion, cell wall contents of LC attenuate LPS-induced colitis by modulating immuno-inflammation and oxidative stress.

Keywords: probiotics, Lactobacillus casei, immuno-inflammation, oxidative stress, lipopolysaccharide, colitis

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Authors: Daniel Aberdam

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Haploinsufficiency of PAX6 in humans is the main cause of congenital aniridia, a rare eye disease characterized by reduced visual acuity. Patients have also progressive disorders including cataract, glaucoma and corneal abnormalities making their condition very challenging to manage. Aniridia-related keratopathy (ARK), caused by a combination of factors including limbal stem-cell deficiency, impaired healing response, abnormal differentiation, and infiltration of conjunctival cells onto the corneal surface, affects up to 95% of patients. It usually begins in the first decade of life resulting in recurrent corneal erosions, sub-epithelial fibrosis with corneal decompensation and opacification. Unfortunately, current treatment options for aniridia patients are currently limited. Although animal models partially recapitulate this disease, there is no in vitro cellular model of AKT needed for drug/therapeutic tools screening and validation. We used genome editing (CRISPR/Cas9 technology) to introduce a nonsense mutation found in patients into one allele of the PAX6 gene into limbal stem cells. Resulting mutated clones, expressing half of the amount of PAX6 protein and thus representative of haploinsufficiency were further characterized. Sequencing analysis showed that no off-target mutations were induced. The mutated cells displayed reduced cell proliferation and cell migration but enhanced cell adhesion. Known PAX6 targets expression was also reduced. Remarkably, addition of soluble recombinant PAX6 protein into the culture medium was sufficient to activate endogenous PAX6 gene and, as a consequence, rescue the phenotype. It strongly suggests that our in vitro model recapitulates well the epithelial defect and becomes a powerful tool to identify drugs that could rescue the corneal defect in patients. Furthermore, we demonstrate that the homeotic transcription factor Pax6 is able to be uptake naturally by recipient cells to function into the nucleus.

Keywords: Pax6, crispr/cas9, limbal stem cells, aniridia, gene therapy

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Authors: Pei-Shan Liang

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Objective: This article explores the nursing experience of caring for a patient with terminal gastric cancer complicated by an abdominal aortic aneurysm. The patient experienced physical discomfort due to the disease, initially unable to accept the situation, leading to anxiety, and eventually accepting the need for surgery. Methods: The nursing period was from June 6 to June 10, 2024. Through observation, direct care, conversations, and physical assessments, and using Gordon's eleven functional health patterns for a one-on-one holistic assessment, interdisciplinary team meetings were held with the critical care team and family. Three nursing health issues were identified: pain related to the disease and invasive procedures, anxiety related to uncertainty about disease recovery, and decreased cardiac tissue perfusion related to hemodynamic instability. Results: Open communication techniques and empathetic care were employed to establish a trusting nurse-patient relationship, and patient-centered nursing interventions were developed. Pain was assessed using a 10-point pain scale, and pain medications were adjusted by a pharmacist. Initially, Fentanyl 500mcg with pump run at 1ml/hr was administered, later changed to Ultracet 37.5mg/325mg, 1 tablet every 6 hours orally, reducing the pain score to 3. Lavender aromatherapy and listening to crystal music were used as distractions to alleviate pain, allowing the patient to sleep uninterrupted for at least 7 hours. The patient was encouraged to express feelings and fears through LINE messages or drawings, and a psychologist was invited to provide support. Family members were present at least twice a day for over an hour each time, reducing psychological distress and uncertainty about the prognosis. According to the Beck Anxiety Inventory, the anxiety score dropped from 17 (moderate anxiety) to 6 (no anxiety). Focused nursing care was implemented with close monitoring of vital signs maintaining systolic blood pressure between 112-118 mmHg to ensure adequate myocardial perfusion. The patient was encouraged to get out of bed for postoperative rehabilitation and to strengthen cardiopulmonary function. A chest X-ray showed no abnormalities, and breathing was smooth with Triflow use, maintaining at least 5 seconds with 2 balls four times a day, and SpO2 >96%. Conclusion: The care process highlighted the importance of addressing psychological care in addition to maintaining life when the patient’s condition changes. The presence of family often provided the greatest source of comfort for the patient, helping to reduce anxiety and pain. Nurses must play multiple roles, including advocate, coordinator, educator, and consultant, using various communication techniques and fostering hope by listening to and accepting the patient’s emotional responses. It is hoped that this report will provide a reference for clinical nursing staff and contribute to improving the quality of care.

Keywords: intensive care, gastric cancer, aortic aneurysm, quality of care

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Authors: Christabel Ihedike, John Mooney, Monica Price

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Summary: This study aims to critically evaluate effect of photochemical smog on respiratory health in Nigeria. Cohort of chronic obstructive pulmonary disease (COPD) patients was recruited from two large hospitals in Abuja Nigeria. Respiratory health questionnaires, daily diaries, dyspnoea scale and lung function measurement were used to obtain health data and investigate the relationship with air quality data (principally ozone, NOx and particulate pollution). Concentrations of air pollutants were higher than WHO and Nigerian air quality standard. The result suggests a correlation between measured air quality and exacerbation of respiratory illness. Introduction: Photochemical smog is a significant health challenge in most cities and its effect on respiratory health is well acknowledged. This type of pollution is most harmful to the elderly, children and those with underlying respiratory disease. This study aims to investigate impact of increasing temperature and photo-chemically generated secondary air pollutants on respiratory health in Abuja Nigeria. Method and Result: Health data was collected using spirometry to measure lung function on routine attendance at the clinic, daily diaries kept by patients and information obtained using respiratory questionnaire. Questionnaire responses (obtained using an adapted and internally validated version of St George’s Hospital Respiratory Questionnaire), shows that ‘time of wheeze’ showed an association with participants activities: 30% had worse wheeze in the morning: 10% cannot shop, 15% take long-time to get washed, 25% walk slower, 15% if hurry have to stop and 5% cannot take-bath. There was also a decrease in Forced expiratory volume in the first second and Forced Vital Capacity, and daily change in the afternoon–morning may be associated with the concentration level of pollutants. Also, dyspnoea symptoms recorded that 60% of patients were on grade 3, 25% grade 2 and 15% grade 1. Daily frequency of the number of patients in the cohort that cough /brought sputum is 78%. Air pollution in the city is higher than Nigerian and WHO standards with NOx and PM10 concentrations of 693.59ug/m-3 and 748ugm-3 being measured respectively. The result shows that air pollution may increase occurrence and exacerbation of respiratory disease. Conclusion: High temperature and local climatic conditions in urban Nigeria encourages formation of Ozone, the major constituent of photochemical smog, resulting also in the formation of secondary air pollutants associated with health challenges. In this study we confirm the likely potency of the pattern of secondary air pollution in exacerbating COPD symptoms in vulnerable patient group in urban Nigeria. There is need for better regulation and measures to reduce ozone, particularly when local climatic conditions favour development of photochemical smog in such settings. Climate change and likely increasing temperatures add impetus and urgency for better air quality standards and measures (traffic-restrictions and emissions standards) in developing world settings such as Nigeria.

Keywords: Abuja-Nigeria, effect, photochemical smog, respiratory health

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Authors: Zakia Fatima, Liu Lu, Donghao Li

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The analysis of biological fluid metabolites holds significant importance in various areas, such as medical research, food science, and public health. Investigating the levels and distribution of nutrients and their metabolites in biological samples allows researchers and healthcare professionals to determine nutritional status, find hypovitaminosis or hypervitaminosis, and monitor the effectiveness of interventions such as dietary supplementation. Moreover, analysis of nutrient metabolites provides insight into their metabolism, bioavailability, and physiological processes, aiding in the clarification of their health roles. Hence, the exploration of a distinct, efficient, eco-friendly, and simpler methodology is of great importance to evaluate the metabolic content of complex biological samples. In this work, a green and rapid analytical method based on an automated online two-dimensional microscale carbon fiber/activated carbon fiber fractionation system and time-of-flight mass spectrometry (2DμCFs-TOF-MS) was used to evaluate metabolites of urine samples after oral administration of food supplements. The automated 2DμCFs instrument consisted of a microcolumn system with bare carbon fibers and modified carbon fiber coatings. Carbon fibers and modified carbon fibers exhibit different surface characteristics and retain different compounds accordingly. Three kinds of mobile-phase solvents were used to elute the compounds of varied chemical heterogeneities. The 2DμCFs separation system has the ability to effectively separate different compounds based on their polarity and solubility characteristics. No complicated sample preparation method was used prior to analysis, which makes the strategy more eco-friendly, practical, and faster than traditional analysis methods. For optimum analysis results, mobile phase composition, flow rate, and sample diluent were optimized. Water-soluble vitamins, fat-soluble vitamins, and amino acids, as well as 22 vitamin metabolites and 11 vitamin metabolic pathway-related metabolites, were found in urine samples. All water-soluble vitamins except vitamin B12 and vitamin B9 were detected in urine samples. However, no fat-soluble vitamin was detected, and only one metabolite of Vitamin A was found. The comparison with a blank urine sample showed a considerable difference in metabolite content. For example, vitamin metabolites and three related metabolites were not detected in blank urine. The complete single-run screening was carried out in 5.5 minutes with the minimum consumption of toxic organic solvent (0.5 ml). The analytical method was evaluated in terms of greenness, with an analytical greenness (AGREE) score of 0.72. The method’s practicality has been investigated using the Blue Applicability Grade Index (BAGI) tool, obtaining a score of 77. The findings in this work illustrated that the 2DµCFs-TOF-MS approach could emerge as a fast, sustainable, practical, high-throughput, and promising analytical tool for screening and accurate detection of various metabolites, pharmaceuticals, and ingredients in dietary supplements as well as biological fluids.

Keywords: metabolite analysis, sustainability, carbon fibers, urine.

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Authors: Balasooriya B. M. C. M., Sujeeva N., Thowfeek Z., Siddiqa Omo, Liyanagunawardana J. E., Jayawardana Saiu, Manathunga S. S., Katulanda G. W.

Abstract:

Introduction and objectives: Adrenal venous sampling (AVS) is the gold standard to discriminate unilateral primary aldosteronism (UPA) from bilateral disease (BPA). AVS is technically demanding and only performed in a limited number of centers worldwide. To the best of our knowledge, Except for one study conducted in India, no other research studies on this area have been conducted in South Asia. This study aimed to evaluate the effectiveness of AVS in the management of primary aldosteronism. Methods: A total of 32 patients who underwent AVS at the National Hospital of Sri Lanka from April 2021 to April 2023 were enrolled. Demographic, clinical and laboratory data were obtained retrospectively. A procedure was considered successful when adequate cannulation of both adrenal veins was demonstrated. Cortisol gradient across the adrenal vein (AV) and the peripheral vein was used to establish the success of venous cannulation. Lateralization was determined by the aldosterone gradient between the two sides. Continuous and categorical variables were summarized with mean, SD, and proportions, respectively. The mean and standard deviation of the contralateral suppression index (CSI) were estimated with an intercept-only Bayesian inference model. Results: Of the 32 patients, the average age was 52.47 +26.14 and 19 (59.4%) were males. Both AVs were successfully cannulated in 12 (37.5%). Among them, lateralization was demonstrated in 11(91.7%), and one was diagnosed as a bilateral disease. There were no total failures. Right AV cannulation was unsuccessful in 18 (56.25%), of which lateralization was demonstrated in 9 (50%), and others were inconclusive. Left AV cannulation was unsuccessful only in 2 (6.25%); one was lateralized, and the other remained inconclusive. The estimated mean of the CSI was 0.33 (89% credible interval 0.11-0.86). Seven patients underwent unilateral adrenalectomy and demonstrated significant improvement in blood pressure during follow-up. Two patients await surgery. Others were treated medically. Conclusions: Despite failure due to procedural difficulties, AVS remained useful in the management of patients with PA. Moreover, the success of the procedure needs experienced hands and advanced equipment to achieve optimal outcomes in PA.

Keywords: adrenal venous sampling, lateralization, contralateral suppression index, primary aldosteronism

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Authors: Farahnaz Motamedi Sedeh, Homayoon Mahravani, Parvin Shawrang, Mehdi Behgar

Abstract:

Most countries use inactivated binary ethylenimine (BEI) vaccines to control and prevent Foot-and-Mouth Disease (FMD). However, this vaccine induces a short-term humoral immune response in animals. This study investigated the cellular and humoral immune responses in homologous and prime-boost (PB) groups in the BALB/c mouse model. FMDV strain O/IRN/1/2007 was propagated in the BHK-21 cell line and inactivated by three methods, including a chemical with BEI to produce a conventional vaccine (CV), a gamma irradiation vaccine (GIV), and an electron irradiated vaccine (EIV). Three vaccines were formulated with the adjuvant aluminum hydroxide gel. In addition, a DNA vaccine was prepared by amplifying the virus VP1 gene pcDNA3.1 plasmid. In addition, the plasmid encoding the granulocyte-macrophage colony-stimulating factor gene (GM-CSF) was used as a molecular adjuvant. Eleven groups of five mice each were selected, and the vaccines were administered as homologous and heterologous strategy prime-boost (PB) in three doses two weeks apart. After the evaluation of neutralizing antibodies, interleukin (IL)-2, IL-4, IL-10, interferon-gamma (INF-γ), and MTT assays were compared in the different groups. The pcDNA3.1+VP1 cassette was prepared and confirmed as a DNA vaccine. The virus was inactivated by gamma rays and electron beams at 50 and 55 kGy as GIV and EIV, respectively. Splenic lymphocyte proliferation in the inactivated vaccinated homologous groups was significantly lower (P≤0.05) compared with the heterologous prime-boosts (PB1, PB2, PB3) and DNA + GM-CSF groups (P≤0.05). The highest SNT titer was observed in the inactivated vaccine groups. IFN-γ and IL-2 were higher in the vaccinated groups. It was found that although there was a protective humoral immune response in the groups with inactivated vaccine, there was adequate cellular immunity in the group with the DNA vaccine. However, the strongest cellular and humoral immunity was observed in the PB groups. The primary injection was accompanied by DNA vaccine + GM-CSF and boosted injection with GIV or CV.

Keywords: foot and mouth disease, irradiated vaccine, immune responses, DNA vaccine, prime boost strategy

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Authors: Rajiv Jash, Himangshusekhar Maji

Abstract:

Phytomolecules have long been associated with the effective treatment of various disorders since ages. This study focuses on identifying the immunomodulatory pure molecules isolated from plants, which can be studied for their effect in alleviating IgAN. All the phytomolecules mentioned here have inflammation-reducing properties, and IgAN, being an autoimmune disease, can be a good target of these phytomolecules. Various pathological pathways of IgA nephropathy can be targeted with these phytomolecules, and this study is an effort to find out the rationale behind the choice of the molecules based on their ability to target the effector molecules of those pathological pathways.

Keywords: IgAN, fibrosis, inflammation, ESRD, TGFβ

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Authors: Muhammad Mansoor Majeed, Imtiaz Ahmed

Abstract:

For centuries, honey has been used for the management and cure of different diseases for the treatment of wound, ulcers, burns, cough, and sore throat, etc. It has also been proved to decrease inflammation, edema, and exudates in different body tissues. This study is performed to find out the effectiveness of honey in the treatment and prevention of gingivitis, gingival bleeding, and accumulation of plaque. Randomized control trial was performed on two subject groups. Honey provided to one subject group to apply on their gums and tooth and then gargle with water and drink. Frequency of the procedure is thrice a day for a month. Another group was given a placebo. Before and after, readings were taken according to Loe and Silness Plaque and Gingival Index. Initially, the mean plaque index, Gingival index and the percentage of sites which were bleeding in the honey group was 0.910, 0.800 and 58.71% respectively which has reduced to 0.313, 0.296 and 27.6% in 30 ± 3 days whereas the control group did not show signs of improvement. Visible changed has observed in the honey group from 0.910 to 0.313 in mean plaque index, 0.800 to 0.296 in Gingival Index, and the percentage of bleeding sited decreased from 58.71% to 27.6%. No significant changes observed in another group. We can conclude that honey reduces the formation/accumulation of plaque and decreases gingival bleeding as well as it has therapeutic effects.

Keywords: honey, gingivitis, Pakistan, bleeding gums

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Authors: Kadhim Alabady

Abstract:

Purpose: Mental health problems affect women and men equally, but some are more common among women. To Provide a baseline of the current picture of major mental health challenges among women in Dubai. which can then be used to measure the impact of interventions or service development. Method: We have used mixed methods evaluation approaches. This was used to increase the validity of findings by using a variety of data collection techniques. We have integrated qualitative and quantitative methods in this piece of work. Conducting the two approaches is to explore issues that might not be highlighted enough through one method. Results: The key findings are: The prevalence of people who suffer from different types of mental disorders remains largely unknown, many women are unwilling to seek professional help because of lack of awareness or the stigma attached to it. -It is estimated there were around 2,928–4,392 mothers in Dubai (2014) suffering from postnatal depression of which 858–1,287, early intervention can be effective. -The system for managing health care for women with mental illness is fragmented and contains gaps and duplications. -It is estimated 1,029 girl aged 13–19 years affected with anorexia nervosa and there would be an estimated 1,029 girl aged 13–19 years affected with anorexia nervosa. Recommendations: -Work is required with primary health care in order to identify women with undiagnosed mental illnesses. Further work is undertaken within primary health care to assess disease registries with the aim of helping GP practices to improve their disease registers. -It is important to conduct local psychiatric morbidity surveys in Dubai to obtain data and assess the prevalence of essential mental health symptoms and conditions that are not routinely collected to get a clear sense of what is needed and to assist decision and policy making in getting a complete picture on what services are required. -Emergency Mental Health Care – there is a need for a crisis response team to respond to emergencies in the community. -Continuum of care – a significant gap in the services for women once they diagnosed with mental disorder.

Keywords: mental health, depression, schizophrenia, women

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Authors: Dativa Maria Aliddeki, Fred Monje, Godfrey Nsereko, Benon Kwesiga, Daniel Kadobera, Alex Riolexus Ario

Abstract:

Background: Cholera is a severe gastrointestinal disease caused by Vibrio cholera. It has caused several pandemics. On 26 February 2018, a suspected cholera outbreak, with one death, occurred in School X in Hoima Municipality, western Uganda. We investigated to identify the scope and mode of transmission of the outbreak, and recommend evidence-based control measures. Methods: We defined a suspected case as onset of diarrhea, vomiting, or abdominal pain in a student or staff of School X or their family members during 14 February–10 March. A confirmed case was a suspected case with V. cholerae cultured from stool. We reviewed medical records at Hoima Hospital and searched for cases at School X. We conducted descriptive epidemiologic analysis and hypothesis-generating interviews of 15 case-patients. In a retrospective cohort study, we compared attack rates between exposed and unexposed persons. Results: We identified 15 cases among 75 students and staff of School X and their family members (attack rate=20%), with onset from 25-28 February. One patient died (case-fatality rate=6.6%). The epidemic curve indicated a point-source exposure. On 24 February, a student brought fried fish from her home in a fishing village, where a cholera outbreak was ongoing. Of the 21 persons who ate the fish, 57% developed cholera, compared with 5.6% of 54 persons who did not eat (RR=10; 95% CI=3.2-33). None of 4 persons who recooked the fish before eating, compared with 71% of 17 who did not recook it, developed cholera (RR=0.0, 95%CIFisher exact=0.0-0.95). Of 12 stool specimens cultured, 6 yielded V. cholerae. Conclusion: This cholera outbreak was caused by eating fried fish, which might have been contaminated with V. cholerae in a village with an ongoing outbreak. Lack of thorough cooking of the fish might have facilitated the outbreak. We recommended thoroughly cooking fish before consumption.

Keywords: cholera, disease outbreak, foodborne, global health security, Uganda

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Authors: Benjamin Osei-Tutu, Henrietta Awewole Kolson

Abstract:

Background: Acute gastroenteritis is one of the frequently reported Out-Patient Department (OPD) cases. However, the causative pathogens of these cases are rarely identified at the OPD due to delay in laboratory results or failure to obtain specimens before antibiotics is administered. Method: A retrospective review of surveillance data from the Adentan Municipality, Accra, Ghana that were recorded in the National foodborne disease surveillance system of Ghana, was conducted with the main aim of describing the epidemiology and food practice of cases reported from the Adentan Municipality. The study involved a retrospective review of surveillance data kept on patients who visited health facilities that are involved in foodborne disease surveillance in Ghana, from January 2015 to December 2016. Results: A total of 375 cases were reviewed and these were classified as viral hepatitis (hepatitis A and E), cholera (Vibrio cholerae), dysentery (Shigella sp.), typhoid fever (Salmonella sp.) or gastroenteritis. Cases recorded were all suspected case and the average cases recorded per week was 3. Typhoid fever and dysentery were the two main clinically diagnosed foodborne illnesses. The highest number of cases were observed during the late dry season (Feb to April), which marks the end of the dry season and the beginning of the rainy season. Relatively high number of cases was also observed during the late wet seasons (Jul to Oct) when the rainfall is the heaviest. Home-made food and street vended food were the major sources of suspected etiological food, recording 49.01% and 34.87% of the cases respectively. Conclusion: Majority of cases recorded were classified as gastroenteritis due to the absence of laboratory confirmation. Few cases were classified as typhoid fever and dysentery based on clinical symptoms presented. Patients reporting with foodborne diseases were found to consume home meal and street vended foods as their predominant source of food.

Keywords: accra, etiologic food, food poisoning, gastroenteritis, illness, surveillance

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Authors: H. Shola Adeosun, D. Adeoye Odedeji, F. Ajoke Adebiyi

Abstract:

This study examines the impact of media on the electoral process in Nigeria and the roles played by the media in the reform process. Survey research method was adopted as research methodology, and this enables the researcher to use questionnaire, and oral interview to elicit primary data from the respondents was interpreted, analysed and interpreted with statistical tools such as tables, figures, and percentages. The hypothesis formulated were tested with chi-square. The findings revealed that there is significant relationship between the media and electoral reform process in the 2011 and 2015 general elections in Nigeria. The study recommends that electoral committee should implement virile electoral system with the peaceful voting environment. The media should intensify efforts to expose violation of electoral laws; media should play an advocacy role for dialogue and debate on the reform recommendations. The study recommends that media should unite the nation through their reports on peace, national security, national integration and ethnoreligious tolerance and that adequate training should be given to media practitioners on how to report issues relating to elections.

Keywords: evaluation, impact, media, electoral reform process

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Authors: Katarzyna Palus, Jarosław Całka

Abstract:

Gastrointestinal disorders, especially acid-related diseases, including peptic and duodenal ulcers, gastroesophageal reflux disease, upper GI bleeding or stress-related mucosal disease, are currently serious health issues encountered very frequently in patients worldwide. However, to date, the response of sympathetic neurons to gastric mucosal injury and local inflammation following hyperacidity is unknown. Thus, the present study was designed to determine possible changes in expression of galanin (GAL) in the CSMG neurons supplying the prepyloric area of the porcine stomach in a physiological state and following experimentally-induced hyperacidity by using combined retrograde tracing and double-labelling immunohistochemistry. The choice of the domestic pig as an experimental model in the present study is not accidental and is justified by the high degree of physiological and anatomical similarity to human digestive system functions. In this experiment ten juvenile female pigs of the Large White Polish breed were used. The animals were divided into two groups: control and animals with hydrochloric acid infusion (HCl). The neuronal retrograde marker Fast Blue (FB) was injected into the anterior prepyloric wall of the stomach of all animals. After 23 days, animals of the HCl-group were reintroduced into a state of general anesthesia and intragastrically given 5 ml/kg of body weight of 0.25 M aqueous solution of hydrochloric acid. On the 28th day, all animals were euthanized. The CSMG complexes were then collected and the CSMG cryostat sections were stained immunocytochemically for GAL and TH (tyrosine hydroxylase). Immunohistochemistry revealed that in the control group 8.40 ± 0.53 % out of 200 FB-positive CSMG neurons contained GAL. In HCl group upregulation of the GAL-IR neurons to 22.52 ± 1.18 % were observed. All GAL-IR neurons in both groups showed the simultaneously TH immunoreactivity. Increase in the expression of GAL in FB-positive neurons of the HCL group may suggest its participation in the protective mechanisms of neurons in different pathological processes, such as gastric hyperacidity.

Keywords: coeliac-superior mesenteric ganglion complex, gastric innervation, hyperacidity, immunohistochemistry

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Authors: Vineet Gairola

Abstract:

In many cultures, ethnographers have tried to set up a tight link between music and possession. However, they rarely informed us about the psychology of interactions between music and the possessed. Ancient myths and the archetypal find expression through the rituals practiced in Uttarakhand. In Uttarakhand (a part of the Central Himalayan region), an intriguing archetypal healing mechanism takes place. Some people get 'possessed' by a deity and shower blessings onto people gathered for a puja in a temple, where invocation of deity takes place through two archetypal drumming instruments played together named dhol-damaun. There is devi-doli (palanquin of the goddess) worship, which is carried on the shoulders of two people and is said to be tilting and shaking on its own. Archetypal in the modern mind survives effortlessly. The 'oceanic' of religious feelings are explored through an oral text of Dholsagar. The method of ethnography along with case-studies has been used. A substantial part of fieldwork was carried out in Rudraprayag, Uttarakhand. The research suggests that the collective unconscious is also sonic in nature, which is characterized by sounds and rhythms—not only symbols and images, as Dr. Jung suggested.

Keywords: archetypal, music, myth, mysticism, possession, sonic collective unconscious

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Authors: Abdou Elhendy

Abstract:

Numerous study have shown the efficacy of the percutaneous intervention (PCI) and coronary stenting in improving left ventricular function and relieving exertional angina. Furthermore, PCI remains the main line of therapy in acute myocardial infarction. Improvement of procedural techniques and new devices have resulted in an increased number of PCI in those with difficult and extensive lesions, multivessel disease as well as total occlusion. Immediate and late outcome may be compromised by acute thrombosis or the development of fibro-intimal hyperplasia. In addition, progression of coronary artery disease proximal or distal to the stent as well as in non-stented arteries is not uncommon. As a result, complications can occur, such as acute myocardial infarction, worsened heart failure or recurrence of angina. In a stent, restenosis can occur without symptoms or with atypical complaints rendering the clinical diagnosis difficult. Routine invasive angiography is not appropriate as a follow up tool due to associated risk and cost and the limited functional assessment. Exercise and pharmacologic stress testing are increasingly used to evaluate the myocardial function, perfusion and adequacy of revascularization. Information obtained by these techniques provide important clues regarding presence and severity of compromise in myocardial blood flow. Stress echocardiography can be performed in conjunction with exercise or dobutamine infusion. The diagnostic accuracy has been moderate, but the results provide excellent prognostic stratification. Adding myocardial contrast agents can improve imaging quality and allows assessment of both function and perfusion. Stress radionuclide myocardial perfusion imaging is an alternative to evaluate these patients. The extent and severity of wall motion and perfusion abnormalities observed during exercise or pharmacologic stress are predictors of survival and risk of cardiac events. According to current guidelines, stress echocardiography and radionuclide imaging are considered to have appropriate indication among patients after PCI who have cardiac symptoms and those who underwent incomplete revascularization. Stress testing is not recommended in asymptomatic patients, particularly early after revascularization, Coronary CT angiography is increasingly used and provides high sensitive for the diagnosis of coronary artery stenosis. Average sensitivity and specificity for the diagnosis of in stent stenosis in pooled data are 79% and 81%, respectively. Limitations include blooming artifacts and low feasibility in patients with small stents or thick struts. Anatomical and functional cardiac imaging modalities are corner stone for the assessment of patients after PCI and provide salient diagnostic and prognostic information. Current imaging techniques cans serve as gate keeper for coronary angiography, thus limiting the risk of invasive procedures to those who are likely to benefit from subsequent revascularization. The determination of which modality to apply requires careful identification of merits and limitation of each technique as well as the unique characteristic of each individual patient.

Keywords: coronary artery disease, stress testing, cardiac imaging, restenosis

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Authors: Issam M Hajjaji, Adel Tajoury, Salah R Benhamid

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The MENA region has the highest prevalence of diabetes in the world. Various risk scores were developed, not all appropriate locally. The objective of this study is to apply the FINDRISC Score to adult Libyan males to determine its significance, sensitivity, specificity and Positive Predictive Values as an initial screening tool for type 2 diabetes, and suggest a cut-off point. Methods: 600 subjects answered the questionnaire at their place of work, and their waist, weight, height & BP were measured. Thereafter, after excluding those with known diabetes, an Oral Glucose Tolerance Test was done. Results: 414 subjects aged 19-78 completed the questionnaire and tests. 35 (8.4%) had impaired glucose tolerance (IGT) and 13 (3.1%) had diabetes (DM). The AUC-ROC for IGT was 0.614 (95% CI: 0.527-0.701), for DM 0.810 (95% CI: 0.709-0.911) and for both 0.689 (95% CI: 0.609-0.769). The Positive Predictive Value for a cut-off score of 5 were 15.5%, 11.7% & 5.7% for both conditions combined, prediabetes & diabetes respectively. The equivalent values for a cut-off score of 8 were 16.1%, 9.0% & 7.7%. The Negative Predictive Values were uniformly above 90%. Conclusions & Recommendations: The FINDRISC Score had a low predictive value for dysglycaemia in this sample and performed at a level of significance for IGT that is similar to other MENA countries, but did better for DM. A larger sample that included women is suggested, with a view of adjusting the Score to suit the local population.

Keywords: diabetes, FINDRISK, Libya, prediabetes

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Authors: Anna Höfer, Johannes Herrmann, Patrick Meybohm, Christopher Lotz

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Mitochondria are pivotal for energy supply and regulation of cellular functions. Deficiencies of mitochondrial metabolism have been implicated in diverse stressful conditions including infections. Platelets are key mediators for thrombo-inflammation during development and resolution of acute respiratory distress syndrome (ARDS). Previous data point to an exhausted platelet phenotype in critically-ill patients with coronavirus 19 disease (COVID-19) impacting the course of disease. The objective of this work was to characterize platelet mitochondrial metabolism in patients suffering from COVID-19 ARDSA longitudinal analysis of platelet mitochondrial metabolism in 24 patients with COVID-19 induced ARDS compared to 35 healthy controls (ctrl) was performed. Blood samples were analyzed at two time points (t1=day 1; t2=day 5-7 after study inclusion). The activity of mitochondrial citrate synthase was photometrically measured. The impact of oxidative stress on mitochondrial permeability was assessed by a photometric calcium-induced swelling assay and the activity of superoxide dismutase (SOD) by a SOD assay kit. The amount of protein carbonylation and the activity of mitochondria complexes I-IV were photometrically determined. Levels of interleukins (IL)-1α, IL-1β and tumor necrosis factor (TNF-) α were measured by a Multiplex assay kit. Median age was 54 years, 63 % were male and BMI was 29.8 kg/m2. SOFA (12; IQR: 10-15) and APACHE II (27; IQR: 24-30) indicated critical illness. Median Murray Score was 3.4 (IQR: 2.8-3.4), 21/24 (88%) required mechanical ventilation and V-V ECMO support in 14/24 (58%). Platelet counts in ARDS did not change during ICU stay (t1: 212 vs. t2: 209 x109/L). However, mean platelet volume (MPV) significantly increased (t1: 10.6 vs. t2: 11.9 fL; p<0.0001). Citrate synthase activity showed no significant differences between ctrl and ARDS patients. Calcium induced swelling was more pronounced in patients at t1 compared to t2 and to ctrl (50µM; t1: 0.006 vs. ctrl: 0.016 ΔOD; p=0.001). The amount of protein carbonylation as marker for irreversible proteomic modification constantly increased during ICU stay and compared to ctrl., without reaching significance. In parallel, superoxid dismutase activity gradually declined during ICU treatment vs. ctrl (t2: - 29 vs. ctrl.: - 17 %; p=0.0464). Complex I analysis revealed significantly stronger activity in ARDS vs. ctrl. (t1: 0.633 vs. ctrl.: 0.415 ΔOD; p=0.0086). There were no significant differences in complex II, III or IV activity in platelets from ARDS patients compared to ctrl. IL-18 constantly increased during the observation period without reaching significance. IL-1α and TNF-α did not differ from ctrl. However, IL-1β levels were significantly elevated in ARDS (t1: 16.8; t2: 16.6 vs. ctrl.: 12.4 pg/mL; p1=0.0335, p2=0.0032). This study reveals new insights in platelet mitochondrial metabolism during COVID-19 caused ARDS. it data point towards enhanced platelet activity with a pronounced turnover rate. We found increased activity of mitochondria complex I and evidence for enhanced oxidative stress. In parallel, protective mechanisms against oxidative stress were narrowed with elevated levels of IL-1β likely causing a pro-apoptotic environment. These mechanisms may contribute to platelet exhaustion in ARDS.

Keywords: acute respiratory distress syndrome (ARDS), coronavirus 19 disease (COVID-19), oxidative stress, platelet mitochondrial metabolism

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