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Authors: Nadia E. Christiana, Azzahra A. N. Ginting, Ardhito Nurcahya, Havisa P. Novira

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One of the quickest ways to do a short trip in urban areas is by walking, either individually, in couple or groups. Walkability nowadays becomes one of the parameters to measure the quality of an urban neighborhood. As a Central Business District and public transport transit hub, Dukuh Atas area becomes one of the highest numbers of commuters that pass by the area and interchange between transportation modes daily. Thus, as a public transport hub, a lot of investment should be focused to speed up the development of the area that would support urban transit activity between transportation modes, one of them is revitalizing pedestrian walkways. The purpose of this research is to formulate the visual design concept of 'Walkable City' based on the results of the observation and a series of rankings. To achieve this objective, it is necessary to accomplish several stages of the research that consists of (1) Identifying the system of pedestrian paths in Dukuh Atas area using descriptive qualitative method (2) Analyzing the sidewalk walkability rate according to the perception and the walkability satisfaction rate using the characteristics of pedestrians and non-pedestrians in Dukuh Atas area by using Global Walkability Index analysis and Multicriteria Satisfaction Analysis (3) Analyzing the factors that determine the integration of pedestrian walkways in Dukuh Atas area using descriptive qualitative method. The results achieved in this study is that the walkability level of Dukuh Atas corridor area is 44.45 where the value is included in the classification of 25-49, which is a bit of facility that can be reached by foot. Furthermore, based on the questionnaire, satisfaction rate of pedestrian walkway in Dukuh Atas area reached a number of 64%. It is concluded that commuters have not been fully satisfied with the condition of the sidewalk. Besides, the factors that influence the integration in Dukuh Atas area have been reasonable as it is supported by the utilization of land and modes such as KRL, Busway, and MRT. From the results of all analyzes conducted, the visual design and the application of the concept of walkable city along the pathway pedestrian corridor of Dukuh Atas area are formulated. Achievement of the results of this study amounted to 80% which needs to be done further review of the results of the analysis. The work of this research is expected to be a recommendation or input for the government in the development of pedestrian paths in maximizing the use of public transportation modes.

Keywords: design, global walkability index, mass rapid transit, walkable city

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Authors: Rebecca-Lee Kuhnert, Ron Rapee

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Up to 15% of Australian youth will experience an emotional disorder, yet relatively few get the help they need. Schools provide an ideal environment through which we can identify young people who are struggling and provide them with appropriate help. Universal mental health screening is a method by which all young people in school can be quickly assessed for emotional disorders, after which identified youth can be linked to appropriate health services. Despite the obvious logic of this process, universal mental health screening has received little scientific evaluation and even less application in Australian schools. This study will develop methods for Australian education systems to help identify young people (aged 9-17 years old) who are struggling with existing and emerging emotional disorders. Prior to testing, a series of focus groups will be run to get feedback and input from young people, parents, teachers, and mental health professionals. They will be asked about their thoughts on school-based screening methods and and how to best help students at risk of emotional distress. Schools (n=91) across New South Wales, Australia will be randomised to do either immediate screening (in May 2021) or delayed screening (in February 2022). Students in immediate screening schools will complete a long online mental health screener consisting of standard emotional health questionnaires. Ultimately, this large set of items will be reduced to a small number of items to form the final brief screener. Students who score in the “at-risk” range on any measure of emotional health problems will be identified to schools and offered pathways to relevant help according to the most accepted and approved processes identified by the focus groups. Nine months later, the same process will occur among delayed screening schools. At this same time, students in the immediate screening schools will complete screening for a second time. This will allow a direct comparison of the emotional health and help-seeking between youth whose schools had engaged in the screening and pathways to care process (immediate) and those whose schools had not engaged in the process (delayed). It is hypothesised that there will be a significant increase in students who receive help from mental health support services after screening, compared with baseline. It is also predicted that all students will show significantly less emotional distress after screening and access to pathways of care. This study will be an important contribution to Australian youth mental health prevention and early intervention by determining whether school screening leads to a greater number of young people with emotional disorders getting the help that they need and improving their mental health outcomes.

Keywords: children and young people, early intervention, mental health, mental health screening, prevention, school-based mental health

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Authors: Cynthia Briggs, Kimberly Gerardi

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Over the past six years, the authors have been working together on World Language Collaborations in the Middle School French Program at St. Luke's School in New Canaan, Connecticut, USA. Author 2 brings design expertise to the projects, and both teachers have utilized the fabrication lab, emerging technologies, and collaboration with students. Each year, author 1 proposes a project scope, and her students are challenged to design and engineer a signature project. Both partners have improved the iterative process to ensure deeper learning and sustained student inquiry. The projects range from a 1:32 scale model of the Eiffel Tower that was CNC routed to a fully functional jukebox that plays francophone music, lights up, and can hold up to one thousand songs powered by Raspberry Pi. The most recent project is a Fragrance Marketplace, culminating with a pop-up store for the entire community to discover. Each student will learn the history of fragrance and the chemistry behind making essential oils. Students then create a unique brand, marketing strategy, and concept for their signature fragrance. They are further tasked to use the industrial design process (bottling, packaging, and creating a brand name) to finalize their product for the public Marketplace. Sometimes, these dynamic projects require maintenance and updates. For example, our wall-mounted, three-foot francophone clock is constantly changing. The most recent iteration uses Chat GPT to program the Arduino to reconcile the real-time clock shield and keep perfect time as each hour passes. The lights, motors, and sounds from the clock are authentic to each region, represented with laser-cut embellishments. Inspired by Michel Parmigiani, the history of Swiss watch-making, and the precision of time instruments, we aim for perfection with each passing minute. The authors aim to share exemplary work that is possible with students of all ages. We implemented the reverse engineering process to focus on student outcomes to refine our collaborative process. The products that our students create are prime examples of how the design engineering process is applicable across disciplines. The authors firmly believe that the past and present of World cultures inspire innovation.

Keywords: collaboration, design thinking, emerging technologies, world language

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Authors: Michael Adebayo, Saheed Lawal

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The Comprehensive Geriatric Assessment (CGA) is the multidimensional tool used to assess elderly, frail patients either on admission to hospital care or at a community level in primary care. It is a tool designed with the aim of using a holistic approach to managing patients. A Cochrane review of CGA use in 2011 found that the likelihood of being alive and living in their own home rises by 30% post-discharge. RCTs have also discovered 10–15% reductions in readmission rates and reductions in institutionalization, and resource use and costs. Past audit cycles at King’s College Hospital, Denmark Hill had shown inconsistent evidence of CGA completion inpatient discharge summaries (less than 50%). Junior Doctors in the Health and Ageing (HAU) wards have struggled to sustain the efforts of past audit cycles due to the quick turnover in staff (four-month placements for trainees). This 7th cycle created a multi-faceted approach to solving this problem amongst staff and creating lasting change. Methods: 1. We adopted multidisciplinary team involvement to support Doctors. MDT staff e.g. Nurses, Physiotherapists, Occupational Therapists and Dieticians, were actively encouraged to fill in the CGA document. 2. We added a CGA Document Pro-forma to “Sunrise EPR” (Trust computer system). These CGAs were to automatically be included the discharge summary. 3. Prior to assessing uptake, we used a spot audit questionnaire to assess staff awareness/knowledge of what a CGA was. 4. We designed and placed posters highlighting domains of CGA and MDT roles suited to each domain on geriatric “Health and Ageing Wards” (HAU) in the hospital. 5. We performed an audit of % discharge summaries which include CGA and MDT role input. 6. We nominated ward champions on each ward from each multidisciplinary specialty to monitor and encourage colleagues to actively complete CGAs. 7. We initiated further education of ward staff on CGA's importance by discussion at board rounds and weekly multidisciplinary meetings. Outcomes: 1. The majority of respondents to our spot audit were aware of what a CGA was, but fewer had used the EPR document to complete one. 2. We found that CGAs were not being commenced for nearly 50% of patients discharged on HAU wards and the Frailty Assessment Unit.

Keywords: comprehensive geriatric assessment, CGA, multidisciplinary team, quality of life, mortality

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Authors: Aena Iqbal

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The lack of access to maternal and reproductive health in Pakistan poses a great threat to global public health. Obstetric issues, including vesicovaginal fistulas (VVF), are the most common in South Asian countries, leaving women in a more vulnerable state. Koohi Goth Women’s Hospital offers free VVF operations, which draws in women from all over Pakistan. Although reproductive health is being handled, mental health is often neglected in these scenarios. Using a series of questions inspired by the Warwick Edinburgh Model, this paper builds on the results from interviewing women who have received vesicovaginal fistula repair surgery on their mental health, a taboo topic in Pakistan.

Keywords: obstetrics, VVF, Pakistan, reproductive health

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Authors: Danielle G. Saique

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Introduction: Promoting Gender Equality, Equity and Empowerment of Women (GEE&EW) can be attained by practicing thereby exercising Sexual and Reproductive Health and Rights (SRHR). Gender Inequality is manifested thru Violence Against Women (VAW). Objectives: This study presents causes, prevalence, effects of Gender Inequality for not practicing and violating SRHR. This proposes Action Plan by promoting, integrating SRHR in the “holistic approach” of Social Work education, practice and service-delivery in any work-set-ups. Limitations: VAW cases showed victim and violator are known, related and living together. Cases transpired at home, reported, investigated in the police and filed in the legal court of law for the year 2013. Methods: Data from blotters, reports, filed cases, case studies gathered by the Social Worker (SWr). Qualitative analysis identified cause, prevalence of VAW related in violating SRHR. SWr serves innovative interventions in any work settings by applying SRHR background, skills in educating, counseling client-victims. Results: 65 VAW cases on non-negotiation or refusal of practicing SRHR. Non-acceptance of Family Planning yielded unwanted, unplanned pregnancies, abandoned children, battered women. Neglected pre-post natal maternal care caused complications or death. Rape, incest led trauma or death. Unsafe, unprotected sex transmitted STDs. Conclusions: Non-availing SRHR from health facilities, from Medical Health SWr concluded to non-practicing or violating rights to life, health care, protection, rights to information, education, rights to plan family, rights from torture, ill-treatment. VAW brings undesirable effects to the well-being, wellness and humaneness of the victim. Recommendations: The innovative intervention services on SRHR of a SWr and the findings, results in violating SRHR are recommendations in Action Planning by adding “The SRHR Concepts” in Social Work thereby preventing VAW; empowering women’s rights to development, gender equality, equity liberty, security, freedom; resilience and involvement in promoting, practicing, exercising SRHR at home. Recommended therefore to duplicate this innovative practice and experience on SRHR as implemented by the SWr in any work setting.

Keywords: women development, promoting gender equality, equity, empowerment of women

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Authors: P. Prasannakumar, L. Myoung Young, G. Seung Kye, P. Sang Hun, S. Chul Gyu

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In this paper, we discussed the coupling medium in the optoacoustic imaging. The coupling medium is placed between the scanned object and the ultrasound transducers. Water with varying temperature was used as the coupling medium. The water temperature is gradually varied between 25 to 40 degrees. This heating process is taken with care in order to avoid the bubble formation. Rise in the photoacoustic signal is noted through an unfocused transducer with frequency of 2.25 MHz as the temperature increases. The temperature rise is monitored using a NTC thermistor and the values in degrees are calculated using an embedded evaluation kit. Also the temperature is transmitted to PC through a serial communication. All these processes are synchronized using a trigger signal from the laser source.

Keywords: embedded, optoacoustic, ultrasound , unfocused transducer

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Authors: Recep Keşli, Gülşah Aşık, Cengiz Demir, Onur Türkyılmaz

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Objective: Serratia species are identified as aerobic, motile Gram negative rods. The species Serratia marcescens (S. marcescens) causes both opportunistic and nosocomial infections. The genus Providencia is Gram-negative bacilli and includes urease-producing that is responsible for a wide range of human infections. Although most Providencia infections involve the urinary tract, they are also associated with gastroenteritis, wound infections, and bacteremia. The aim of this study was evaluate the antimicrobial resistance rates of S. marcescens and Providencia spp. strains which had been isolated from various clinical materials obtained from different patients who belongs to intensive care units (ICU) and inpatient clinics. Methods: A total of 35 S. marcescens and Providencia spp. strains isolated from various clinical samples admitted to Medical Microbiology Laboratory, ANS Research and Practice Hospital, Afyon Kocatepe University between October 2013 and September 2015 were included in the study. Identification of the bacteria was determined by conventional methods and VITEK 2 system (bio-Merieux, Marcy l’etoile, France) was used additionally. Antibacterial resistance tests were performed by using Kirby Bauer disc (Oxoid, Hampshire, England) diffusion method following the recommendations of CLSI. Results: The distribution of clinical samples were as follows: upper and lower respiratory tract samples 26, 74.2 % wound specimen 6, 17.1 % blood cultures 3, 8.5%. Of the 35 S. marcescens and Providencia spp. strains; 28, 80% were isolated from clinical samples sent from ICU. The resistance rates of S. marcescens strains against trimethoprim-sulfamethoxazole, piperacillin-tazobactam, imipenem, gentamicin, ciprofloxacin, ceftazidime, cefepime and amikacin were found to be 8.5 %, 22.8 %, 11.4 %, 2.8 %, 17.1 %, 40 %, 28.5 % and 5.7 % respectively. Resistance rates of Providencia spp. strains against trimethoprim-sulfamethoxazole, piperacillin-tazobactam, imipenem, gentamicin, ciprofloxacin, ceftazidime, cefepime and amikacin were found to be 10.2 %, 33,3 %, 18.7 %, 8.7 %, 13.2 %, 38.6 %, 26.7%, and 11.8 % respectively. Conclusion: S. marcescens is usually resistant to ampicillin, amoxicillin, amoxicillin/clavulanate, ampicillin/sulbactam, cefuroxime, cephamycins, nitrofurantoin, and colistin. The most effective antibiotic on the total of S. marcescens strains was found to be gentamicin 2.8 %, of the totally tested strains the highest resistance rate found against to ceftazidime 40 %. The lowest and highest resistance rates were found against gentamiycin and ceftazidime with the rates of 8.7 % and 38.6 % for Providencia spp.

Keywords: Serratia marcescens, Providencia spp., antibiotic resistance, intensive care unit

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Authors: Joana PaScoa Pinheiro, David Goncalves Ferreira, Filipe Ramos, Joaquim Soares Do Brito, Samuel Martins, Marco Sarmento

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Introduction: The SARS-CoV-2 (COVID-19) pandemic was identified in January 2020 in China, in the city of Wuhan. The increase in the number of cases over the following months was responsible for the restructuring of hospitals and departments in order to accommodate admissions related to COVID-19. Essential services, such as trauma, had to readapt to maintain their functionality and thus guarantee quick and safe access in case of an emergency. Objectives: This study describes the impact of COVID-19 on a Level III Trauma Center and particularly on the clinical management of hospitalized patients with spine injuries. Study Design & Methods: This is a retrospective cohort study whose results were obtained through the medical records of patients with spine injuries who underwent surgical intervention in the years 2019 and 2020 (period from March 1st to December 31st). A comparison between the two groups was made. In the study patients with injuries in the context of trauma were included who underwent surgery in the periods previously described. Patients hospitalized with a spine injury in a non-traumatic context and/or were not surgically treated were excluded. Results: In total, 137 patients underwent trauma spine surgery of which 71 in 2019 (51.8%) were without significant differences in intergroup comparisons. The most frequent injury mechanism in 2019 was motor vehicle crash (47.9%) compared to 2020 which was of a person falling from a height between 2-4 meters (37.9%). Cervical trauma was reported to be the most frequent spine injury in both years. There was a significant decrease in the need for intensive care in 2020, 51.4% vs 30.3%, p = .015 and the number of complications was also lower in 2020 (1.35% vs 0.98%), including the number of deaths, being the difference marginally significant. There were no significant differences regarding time for presentation to surgery or in the total days of hospitalization. Conclusions: The restructuring made in the trauma unit at a Level III Trauma Center in the context of the current COVID-19 pandemic was effective, with no significant differences between the years of 2019 vs 2020 when compared with the time for presentation to surgery or the number of days of hospitalization. It was also found that lockdown rules in 2020 were probably responsible for the decrease in the number of road traffic accidents, which justifies a significant decrease in the need for intensive care as well as in the number of complications in patients hospitalized in the context of spine trauma.

Keywords: trauma, spine, impact, covid-19

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Authors: Theresa N. Uzor

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The word cardiovascular fitness is a topic of much interest to people of Nigeria, especially during this time, some heart diseases run in families. Cardiovascular fitness is the ability of the heart and lungs to supply-rich blood to the working muscle tissues. This type of fitness is a health-related component of physical fitness that is brought about by sustained physical activity such as plyometric training. Plyometric is a form of advanced fitness training that uses fast muscular contractions to improve power and speed in the sports performance by coaches and athletes. Plyometric training involves a rapid stretching of muscle (eccentric phase) immediately followed by a concentric or shortening action of the same muscle and connective tissue. However, the most basic example of true plyometric training is running and can be safe for a wide variety of populations. This paper focused on building cardiovascular health through Plyometric Training. The centre focus of the article is cardiovascular fitness and plyometric training with factors of cardiovascular fitness. Plyometric training at any age provides multiple benefits even beyond weight control and weight loss, decrease the risk of cardiovascular diseases, stroke, high blood pressure, diabetes, and other diseases, among other benefits of plyometric training to cardiovascular fitness. Participation in plyometric training will increase metabolism of an individual, thereby burning more calories even when at rest and reduces weight is also among the benefits of plyometric training. Some guidelines were recommended for planning plyometric training programme to minimise the chance of injury. With plyometric training in Nigeria, fortune can change for good, especially now that there has been an increase in cardiovascular diseases within the society for great savings would be saved.

Keywords: aerobic, cardiovascular, concentric, stretch-shortening cycle, plyometric

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Authors: A. Tamimi, S. Greatrex-White, A. Narayanasamy

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Background: Spirituality has been increasingly acknowledged in the nursing literature as an important element of holistic patient care. To date there have been numerous studies investigating the meaning of spirituality in Western cultures. Spirituality in Middle Eastern countries however remains under-researched. We will present a study which aimed to address this gap. Aim: The study aimed to explore how spirituality manifests in the lives of Jordanian End Stage Renal Failure (ESRF) patients. Methodology and Method: A hermeneutic phenomenological approach was adopted informed by the philosophy of Martin Heidegger. Participants (n=27) were recruited from four different dialysis units: in a public hospital, a private hospital, an educational hospital and a refugee’s hospital in Jordan. Data was collected through in-depth unstructured interviews. Data Analysis: Analysis was guided by the tenets of hermeneutic phenomenology namely: gaining immediate sense of what was said both during and after each interview, transcribing data verbatim, translating interviews into the English language, intensive reading and re-reading, seeking meaning units by line to line coding, developing situated structures (how spirituality was manifest in each text), developing a general structure from the individual situated structures (how the phenomenon ‘spirituality’ comes into being). Findings: Three major themes emerged from analysis: Religion, Relationships and Desperation. We will argue that a ‘secular’ concept of spirituality had no meaning for the participants in the study. Spirituality is fundamentally part of religion and vice versa. Discussion: The findings may have consequences for the use of spirituality in multi-cultural settings in Western countries. Additionally, findings highlighted an important emphasis on the practice of spirituality, often underestimated in previous literature for Arab-Muslim Jordanian patients. Conclusion: The study findings contribute to the existing gap in knowledge regarding how Arab-Muslim Jordanian ESRF patients experience spirituality during their illness. It provides valuable insights into the importance of spirituality for this patient group and suggests how nurses, educators and policy makers might help address ESRF patients’ spiritual needs and provide appropriate spiritual care. We suggest the findings may have relevance beyond the Jordanian context in educating nurses’ on the importance of appreciating the religious dimension of spirituality.

Keywords: spirituality, nursing, muslim, Jordan

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Authors: Gikunda Aloise, Mjema Saida, Barasa Herbert, Wanyungu John, Kimani Maureen

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Background: Community Health Workforce (CHW) is health care providers at the community level (Level 1) and serves as a bridge between the community and the formal healthcare system. This human resource has enormous potential to extend healthcare services and ensures that the vulnerable, marginalized, and hard-to-reach populations have access to quality healthcare services at the community and primary health facility levels. However, these cadres are neither recognized, remunerated, nor in most instances, registered in a master list. Management and supervision of CHWs is not easy if their individual demographics, training capacity and incentives is not well documented through a centralized registry. Description: In February 2022, Amref supported the Kenya Ministry of Health in developing a community health workforce database called Community Health Workers Master List Registry (CHWML), which is hosted in Kenya Health Information System (KHIS) tracker. CHW registration exercise was through a sensitization meeting conducted by the County Community Health Focal Person for the Sub-County Community Health Focal Person and Community Health Assistants who uploaded information on individual demographics, training undertaken and incentives received by CHVs. Care was taken to ensure compliance with Kenyan laws on the availability and use of personal data as prescribed by the Data Protection Act, 2019 (DPA). Results and lessons learnt: By June 2022, 80,825 CHWs had been registered in the system; 78,174 (96%) CHVs and 2,636 (4%) CHAs. 25,235 (31%) are male, 55,505 (68%) are female & 85 (1%) are transgender. 39,979. (49%) had secondary education and 2500 (3%) had no formal education. Only 27 641 (34%) received a monthly stipend. 68,436 CHVs (85%) had undergone basic training. However, there is a need to validate the data to align with the current situation in the counties. Conclusions/Next steps: The use of CHWML will unlock opportunities for building more resilient and sustainable health systems and inform financial planning, resource allocation, capacity development, and quality service delivery. The MOH will update the CHWML guidelines in adherence to the data protection act which will inform standard procedures for maintaining, updating the registry and integrate Community Health Workforce registry with the HRH system.

Keywords: community health registry, community health volunteers (CHVs), community health workers masters list (CHWML), data protection act

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Authors: Kirsty Biggs, Peter Larsen-Disney

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Background: The UK cervical screening programme significantly reduces cancer mortality through the early detection of abnormal cells. Despite this, over a quarter of eligible women choose not to attend their appointment. Objective: To qualitatively explore patients’ barriers to attending cervical smear appointments and identify key trends of cervical screening behaviour, knowledge, and attitudes in primary and secondary care. Methods: A cross-sectional study was conducted to evaluate smear services in Brighton and Hove using questionnaires in general practice and colposcopy. 226 patients participated in the voluntary questionnaire between 10/11/2017 and 02/02/2018. 118 patients were recruited from general practice surgeries and 108 from the colposcopy department. Women were asked about their smear knowledge, self-perceived risks factors, prior experiences and reasons for non-attendance. Demographic data was also collected. Results: Approximately a third of women did not engage in smear testing services. This was consistent across primary and secondary care groups. Over 90% were aware of the role of the screening process in relation to cervical cancer; however, over two thirds believed the smear was also a tool to screen for other pathologies. The most commonly cited reasons for non-attendance were negative emotions or previous experiences. Inconvenient appointment times were also commonly described. In a comparison of attenders versus non-attenders previous negative experiences (p < 0.01) and number of identified risk factors (p = 0.02) were statistically significant with non-attenders describing more prior negative smears and identifying more risk factors. Smear knowledge, risk perception and perceived importance of screening were not significant. Negative previous experiences were described in relation to poor bedside manner, pain, embarrassment and staff competency. Conclusions: In contrary to the literature, our white Caucasian cohort experienced significant barriers to accessing smear services. Women’s prior negative experiences are overriding their perceived importance to attend the screening programme; therefore, efforts need to focus on improving clinical experiences through auditing tools, training and providing a supportive appointment setting. Positive changes can also be expected by improving appointment availabilities with extended hours and self-booking systems.

Keywords: barriers, cervical, Papanicolaou, screening, smear

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Authors: Ladislas Havugimana, Véronique Zinnen, Mary Hadley, Jean Claude Mwumvaneza, Francois Régis Habarugira, Silas Rudasingwa, Victor Ndaruhutse, Evelyne Bocquet

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Rwanda's health systems face various challenges, including low health infrastructure coverage (the objective is to have at least one health center per administrative sector) and insufficient qualified human resources for infrastructure maintenance and financing. Moreover, there is no policy for the preventive maintenance of infrastructures for the health sector. This paper presents action research conducted in seven districts, focusing on the impact of health infrastructure's quality on maternal and neonatal care, with the support of the Belgian cooperation agency through Enable Barame project.

Keywords: health infrastructure, maintenance, maternity, neonatology

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Authors: Nabil Ghedadba, Abdessemed Samira, Leila Hambaba, Sidi Mohamed Ould Mokhtar, Nassima Fercha, Houas Bousselsela

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The overall objective of this study was to evaluate in vitro the hemostatic activity of secondary metabolites (polyphenols, flavonoids, and tannins) of Marrubium vulgare leaves, aromatic plant widely used in traditional medicine for the treatment of asthma, cough, diabetes (by its effect on the pancreas to secrete insulin), heart disease, fever has a high efficiency as against inflammation. Qualitative analysis of the aqueous extract (AQE) by thin layer chromatography revealed the presence of quercetin, kaempferol and rutin. Quantification of total phenols by Folin Ciocalteu method and flavonoids by AlCl3 method gave high values with AQE: 175±0.80 mg GAE per 100g of the dry matter, 23.86±0.36 mg QE per 100g of dry matter. Moreover, the assay of condensed tannins by the vanillin method showed that AQE contains the highest value: 16.55±0.03 mg e-catechin per 100 g of dry matter. Assessment of hemostatic activity by the plasma recalcification method (time of Howell) has allowed us to discover the surprising dose dependent anticoagulant effect of AQE lyophilized from leaves of M. vulgare. A positive linear correlation between the two parameters studied: the content of condensed tannins and hemostatic activity (r=0.96) were used to highlight a possible role of these compounds that are potent vasoconstrictor activity in hemostatic. From these results we can see that Marrubium vulgre could be used for the treatment of health.

Keywords: Marrubium vulgare L., aqueous extract, phenolic compounds dosing, hemostatic activity, condensed tannins

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Authors: Kinneret Segal

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Background: The work of a midwife is emotionally challenging, both positively and negatively. Midwives share moments of joy when a baby is welcomed into the world and also attend difficult events of loss and trauma. The relationship that develops with the maternity is the essence of the midwife's care, and it is a fundamental source of motivation and professional satisfaction. This close relationship with the maternity may be used as a double-edged sword in cases of exposure to traumatic events at birth. Birth problems, exposure to emergencies and traumatic events, and loss can affect the professional quality of life and the Compassion satisfaction of the midwife. It seems that the issue of traumatic experiences in the work of midwives has not been sufficiently explored. Aim: The present study examined the associations between exposure to traumatic events, personal resilience and post-traumatic symptoms, professional quality of life, and organizational commitment among midwifery nurses in Israeli hospitals. Methods: 131 midwives from three hospitals in the country's center in Israel participated in this study. The data were collected during 2021 using a self-report questionnaire that examined sociodemographic characteristics, the degree of exposure to traumatic events in the delivery room, personal resilience, post-traumatic symptoms, professional quality of life, and organizational commitment. Results: The three most difficult traumatic events for the midwives were death or fear of death of a newborn, death or fear of the death of a mother, and a quiet birth. The higher the frequency of exposure to traumatic events, the more numerous and intense the onset of post-trauma symptoms. The more numerous and powerful the post-trauma symptoms, the higher the level of professional burnout and/or compassion fatigue, and the lower the level of compassion satisfaction. High levels of compassion satisfaction and/or low professional burnout were expressed in a heightened sense of organizational commitment. Personal resilience, country of birth, traumatic symptoms, and organizational commitment predicted satisfaction from compassion. Conclusions: Midwives are exposed to traumatic events associated with dissatisfaction and impairment of the professional quality of life that accompanies burnout and compassion fatigue. Exposure to traumatic events leads to the appearance of traumatic symptoms, a decrease in organizational commitment, and psychological and mental well-being. The issue needs to be addressed by implementing training programs, organizational support, and policies to improving well-being and quality of care among midwives.

Keywords: organizational commitment, traumatic experiences, personal resilience, quality of life

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Authors: Marcio Freire Cruz, Naoaki Ono, Shigehiko Kanaya, Carlos Arthur Mattos Teixeira Cavalcante

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The systems that record patient care information, known as Electronic Medical Record (EMR) and those that monitor vital signs of patients, such as heart rate, body temperature, and blood pressure have been extremely valuable for the effectiveness of the patient’s treatment. Several kinds of research have been using data from EMRs and vital signs of patients to predict illnesses. Among them, we highlight those that intend to predict, classify, or, at least identify patterns, of sepsis illness in patients under vital signs monitoring. Sepsis is an organic dysfunction caused by a dysregulated patient's response to an infection that affects millions of people worldwide. Early detection of sepsis is expected to provide a significant improvement in its treatment. Preceding works usually combined medical, statistical, mathematical and computational models to develop detection methods for early prediction, getting higher accuracies, and using the smallest number of variables. Among other techniques, we could find researches using survival analysis, specialist systems, machine learning and deep learning that reached great results. In our research, patients are modeled as points moving each hour in an n-dimensional space where n is the number of vital signs (variables). These points can reach a sepsis target point after some time. For now, the sepsis target point was calculated using the median of all patients’ variables on the sepsis onset. From these points, we calculate for each hour the position vector, the first derivative (velocity vector) and the second derivative (acceleration vector) of the variables to evaluate their behavior. And we construct a prediction model based on a Long Short-Term Memory (LSTM) Network, including these derivatives as explanatory variables. The accuracy of the prediction 6 hours before the time of sepsis, considering only the vital signs reached 83.24% and by including the vectors position, speed, and acceleration, we obtained 94.96%. The data are being collected from Medical Information Mart for Intensive Care (MIMIC) Database, a public database that contains vital signs, laboratory test results, observations, notes, and so on, from more than 60.000 patients.

Keywords: dynamic analysis, long short-term memory, prediction, sepsis

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Authors: Oluwaseun Adeleke, Samuel O. Ikani, Fidelis Edet, Anthony Nwala, Mopelola Raji, Simeon Christian Chukwu

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Background: The Delivering Innovations in Selfcare (DISC) project aims to increase access to self-care options for women of reproductive age, starting with self-inject subcutaneous depot medroxyprogesterone acetate (DMPA-SC) contraception services. However, the project has faced challenges in ensuring the continuous availability of the commodity in health facilities. Although most states in the country rely on the federal ministry of Health for supplies, some are gradually funding the procurement of Family Planning (FP) commodities. This attempt is, however, often accompanied by procurement delays and purchases inadequate to meet demand. This dilemma was further exacerbated by the commencement of demand generation activities by the project in supported states which geometrically increased commodity utilization rates and resulted in receding stock and occasional service disruptions. Strategies: The project deployed various strategies were implemented to ensure the continuous availability of commodities. These include facilitating inter-facility transfer, monthly tracking of commodity utilization, and alerting relevant authorities when stock levels reach a minimum. And supporting state-level procurement of DMPA-SC commodities through catalytic interventions. Results: Effective monitoring of commodity inventory at the facility level and strategic engagement with federal and state-level logistics units have proven successful in mitigating stock-out of commodities. It has helped secure up to 13,000 units of DMPA-SC commodities from federal logistics units and enabled state units to prioritize supported sites. This has ensured the continuity of DMPA-SC services and an increasing trend in the practice of self-injection. Conclusion: A functional supply chain is crucial to achieving commodity security, and without it, health programs cannot succeed. Stakeholder engagement, stock management and catalytic interventions have provided both short- and long-term measures to mitigate stock-outs and ensured a consistent supply of commodities to clients.

Keywords: family planning, contraception, DMPA-SC, self-care, self-injection, commodities, stock-out

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Authors: Lu Yang, Keng Po Lai

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Metformin, a well-known clinical drug against diabetes, is found with potential anti-diabetic and anti-obese benefits, as reported in increasing evidences. However, the current clinical and experimental investigations are not to reveal the detailed mechanisms of metformin-anti-obesity/hypertension. We have used the bioinformatics strategy, including network pharmacology and molecular docking methodology, to uncover the key targets and pathways of bioactive compounds against clinical disorders, such as cancers, coronavirus disease. Thus, in this report, the in-silico approach was utilized to identify the hug targets, pharmacological function, and mechanism of metformin against obesity and hypertension. The networking analysis identified 154 differentially expressed genes of obesity and hypertension, 21 interaction genes, and 6 hug genes of metformin treating hypertensive obesity. As a result, the molecular docking findings indicated the potent binding capability of metformin with the key proteins, including interleukin 6 (IL-6) and chemokine (C-C motif) Ligand 2 (CCL2), in hypertensive obesity. The metformin-exerted anti-hypertensive obesity action involved in metabolic regulation, inflammatory reaction. And the anti-hypertensive obesity mechanisms of metformin were revealed, including regulation of inflammatory and immunological signaling pathways for metabolic homeostasis in tissue and microenvironmental melioration in blood pressure. In conclusion, our identified findings with bioinformatics analysis have demonstrated the detailed hug and pharmacological targets, biological functions, and signaling pathways of metformin treating hypertensive obesity.

Keywords: metformin, obesity, hypertension, bioinformatics findings

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Authors: Ana Claudia de Souza Costa, Beatriz de Cássia Pinheiro Goulart, Karine de Cássia Cavalari, Henrique Ceretta Oliveira, Edineis de Brito Guirardello

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Background: During the COVID-19 pandemic, nursing represents the largest category of health professionals who were on the front line. Thus, investigating the practice environment and the job satisfaction of nursing professionals during the pandemic becomes fundamental since it reflects on the quality of care and the safety climate. The aim of this study was to evaluate and compare the nursing professionals' perception of the work environment, job satisfaction, and safety climate of the different hospitals and work shifts during the COVID-19 pandemic. Method: This is a cross-sectional survey with 130 nursing professionals from public, private and mixed hospitals in Brazil. For data collection, was used an electronic form containing the personal and occupational variables, work environment, job satisfaction, and safety climate. The data were analyzed using descriptive statistics and ANOVA or Kruskal-Wallis tests according to the data distribution. The distribution was evaluated by means of the Shapiro-Wilk test. The analysis was done in the SPSS 23 software, and it was considered a significance level of 5%. Results: The mean age of the participants was 35 years (±9.8), with a mean time of 6.4 years (±6.7) of working experience in the institution. Overall, the nursing professionals evaluated the work environment as favorable; they were dissatisfied with their job in terms of pay, promotion, benefits, contingent rewards, operating procedures and satisfied with coworkers, nature of work, supervision, and communication, and had a negative perception of the safety climate. When comparing the hospitals, it was found that they did not differ in their perception of the work environment and safety climate. However, they differed with regard to job satisfaction, demonstrating that nursing professionals from public hospitals were more dissatisfied with their work with regard to promotion when compared to professionals from private (p=0.02) and mixed hospitals (p< 0.01) and nursing professionals from mixed hospitals were more satisfied than those from private hospitals (p= 0.04) with regard to supervision. Participants working in night shifts had the worst perception of the work environment related to nurse participation in hospital affairs (p= 0.02), nursing foundations for quality care (p= 0.01), nurse manager ability, leadership and support (p= 0.02), safety climate (p< 0.01), job satisfaction related to contingent rewards (p= 0.04), nature of work (p= 0.03) and supervision (p< 0.01). Conclusion: The nursing professionals had a favorable perception of the environment and safety climate but differed among hospitals regarding job satisfaction for the promotion and supervision domains. There was also a difference between the participants regarding the work shifts, being the night shifts, those with the lowest scores, except for satisfaction with operational conditions.

Keywords: health facility environment, job satisfaction, patient safety, nursing

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Authors: Indhumathi Gopal

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Undergraduate research is well documented in Science, Technology, Engineering, and Mathematics (STEM), neurosciences, and microbiology disciplines, though it is hardly part of a physical fitness & wellness discipline. However, students need experiential learning opportunities, like internships and research assistantships, to get ahead with graduate schools and be gainfully employed. The first step towards this goal is to have students do a simple research project in a semester-long course. The value of research experiences and how to integrate research activity in a physical fitness & wellness course are discussed. The investigator looks into a mini research project, “Awareness of Obesity among College Students” and explains how to guide students through the research process, including journal search, data collection, and basic statistics. Besides, students will be introduced to the statistical package program SPSS 22.0 to assist with data evaluation. The lab component of the combined lecture-physical activity course could include the measurement of student’s weight with respect to their height to obtain body mass index (BMI). Students could categorize themselves in accordance with the World Health Organization’s guidelines. Results obtained after completing the data analysis help students be aware of their own potential health risks associated with overweight and obesity. Overweight and obesity are risk factors for hypertension, hypercholesterolemia, heart disease, stroke, diabetes, and certain types of cancer. It is hoped that this experience will get students interested in scientific studies, gain confidence, think critically, and develop problem-solving and good communication skills.

Keywords: physical fitness, undergraduate research experience, obesity, BMI

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Authors: Enock E. Goler, Emmanuel H. Kwon-Ndung, Gbenga F. Akomolafe, Terna T. Paul, Markus Musa, Joshua I. Waya, James H. Okogbaa

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An ethno-medicinal survey of plants used in treating various diseases and ailments was carried out in the study area of Nasarawa State, North Central Nigeria to obtain information on their uses and potentials. The ethno-medicinal survey was administered through structured questionnaires among local inhabitants from areas with high plant density and diversity within the various Local Government Areas of the State. A total of 84 (Eighty four) plant species belonging to 45 (Forty five) families were found to be useful in treatment of various ailments such as diabetes, measles, fever, asthma, jaundice, pneumonia, sexually transmitted diseases (STDs), aches, diarrhea, cough, arthritis, yellow fever, typhoid, erectile dysfunction and excessive bleeding. Different parts of the plant such as the roots, leaves and stems are used in preparing herbal remedies which could be from dry or freshly collected plants. The main methods of preparation are decoction or infusion, while in some cases the plant parts used are consumed directly. Residents in the study areas find the herbal remedy cheaper and more accessible and claimed that there are no side effects compared to orthodox medicine. This study has confirmed the need towards the conscious conservation of plant genetic resources in order to ensure sustained access to these ethno-medicinal plant materials.

Keywords: ethno-medicinal, Nasarawa, plants, survey

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Authors: T. Suleiman, C. Mchugh, H. Ranu

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Background; Asthma continues to be associated with poor patient outcomes, including mortality. An audit of the management of acute asthma admissions in our hospital in 2020 found poor compliance with National Asthma and COPD Audit Project (NACAP) standards which set out to improve inpatient asthma care. Clinical nurse specialists have been shown to improve patient care across a range of specialties. In September 2021, an asthma Nurse Specialist (ANS) was employed in our hospital. Aim; To re-audit management of acute asthma admissions using NACAP standards and assess for quality improvement post-employment of an ANS. Methodology; NACAP standards are wide-reaching; therefore, we focused on ‘specific elements of good practice’ in addition to the provision of inhaled corticosteroids (ICS) on discharge. Medical notes were retrospectively requested from the hospital coding department and selected as per NACAP inclusion criteria. Data collection and entry into the NACAP database were carried out. As this was a clinical audit, ethics approval was not required. Results; Cycle 1 (pre-ANS) and 2 (post-ANS) of the audit included 20 and 32 patients, respectively, with comparable baseline demographics. No patients had a discharge bundle completed on discharge in cycle 1 vs. 84% of cases in cycle 2. Regarding specific components of the bundle, 25% of patients in cycle 1 had their inhaler technique checked vs. 91% in cycle 2. Furthermore, 80% of patients had maintenance medications reviewed in cycle 1 vs. 97% in cycle 2. Medication adherence was addressed in 20% of cases in cycle 1 vs. 88% of cases in cycle 2. Personalized asthma action plans were not issued or reviewed in any cases in cycle 1 as compared with 84% of cases in cycle 2. Triggers were discussed in 30% of cases in cycle 1 vs. 88% of cases in cycle 2. Tobacco dependence was addressed in 44% of cases in cycle 1 vs. 100% of cases in cycle 2. No patients in cycle 1 had community follow-up requested within 2 days vs. 81% of the patients in cycle 2. Similarly, 20% of the patients in cycle 1 vs. 88% of the patients in cycle 2 had a 4-week asthma clinic follow-up requested. 75% of patients in cycle 1 were the recipient of ICS on discharge compared with 94% of patients in cycle 2. Conclusion; Our quality improvement project demonstrates the utility of an ANS in improving performance in the management of acute asthma admissions, evidenced here through concordance with NACAP standards. Asthma is a complex condition with biological, psychological, and sociological components; therefore, ANS is a suitable intervention to improve concordance with guidelines. ANS likely impacted performance directly, for example, by checking inhaler technique, and indirectly as a safety net ensuring doctors included ICS on discharge.

Keywords: asthma, nurse specialist, clinical audit, quality improvement

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Authors: Fagner O. Serrano, Danielle R. Bouchard, Todd A. Duhame

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Walking cadence (steps/min) is an effective way to prescribe exercise so an individual can reach a moderate intensity, which is recommended to optimize health benefits. To our knowledge, there is no study on the required walking cadence to reach a moderate intensity for people that present chronic conditions or risk factors for chronic conditions such as Cardiovascular Diseases (CVD). The objectives of this study were: 1- to identify the walking cadence needed for people at risk of CVD to a reach moderate intensity, and 2- to develop and test an equation using clinical variables to help professionals working with individuals at risk of CVD to estimate the walking cadence needed to reach moderate intensity. Ninety-one people presenting a minimum of two risk factors for CVD completed a medically supervised graded exercise test to assess maximum oxygen consumption at the first visit. The last visit consisted of recording walking cadence using a foot pod Garmin FR-60 and a Polar heart rate monitor, aiming to get participants to reach 40% of their maximal oxygen consumption using a portable metabolic cart on an indoor flat surface. The equation to predict the walking cadence needed to reach moderate intensity in this sample was developed as follows: The sample was randomly split in half and the equation was developed with one half of the participants, and validated using the other half. Body mass index, height, stride length, leg height, body weight, fitness level (VO2max), and self-selected cadence (over 200 meters) were measured using objective measured. Mean walking cadence to reach moderate intensity for people age 64.3 ± 10.3 years old at risk of CVD was 115.8  10.3 steps per minute. Body mass index, height, body weight, fitness level, and self-selected cadence were associated with walking cadence at moderate intensity when evaluated in bivariate analyses (r ranging from 0.22 to 0.52; all P values ≤0.05). Using linear regression analysis including all clinical variables associated in the bivariate analyses, body weight was the significant predictor of walking cadence for reaching a moderate intensity (ß=0.24; P=.018) explaining 13% of walking cadence to reach moderate intensity. The regression model created was Y = 134.4-0.24 X body weight (kg).Our findings suggest that people presenting two or more risk factors for CVD are reaching moderate intensity while walking at a cadence above the one officially recommended (116 steps per minute vs. 100 steps per minute) for healthy adults.

Keywords: cardiovascular disease, moderate intensity, older adults, walking cadence

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Authors: Ivory A. Rulona, Jarungchai Anton S. Vatanagul

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Background: Depression is common after stroke with quoted rates ranging from 18% to 61%. 8 Mood disturbance is common after stroke and may present as depression or anxiety. Psychological mood disturbance is associated with higher rates of mortality, long term disability, and hospital readmission. Objectives: To investigate the incidence of post-stroke depression in a tertiary hospital in Cebu City, Philippines and to determine its associated factors. The study is designed to be prospective, descriptive, cross-sectional survey. Participants: Adult patients seen and diagnosed to have stroke either infarct or hemorrhage within the period of January 1 to July 31, 2014. Results: A total of 100 patients with stroke were interviewed using the 17-item Hamilton Depression Rating Scale (HDRS) questionnaire. The average age of the respondents was 60.50 years old ±1.18, majority were males (55%), 83% were married, and 81% were employed. The most common co-morbidity was hypertension 78% followed by diabetes mellitus at 50%. Moreover, 39% of these patients had stroke in months, 26% in years, and 18% in weeks. The average functional capacity based on Modified Rankin Scale was 2.14+/-0.14. Among 100 patients, a total of 30 patients (30%) had depression: 2 (2%) very severe, 5 (5%) moderate and 23 (23%) had mild depression while 70 patients (70%) had no depression. Stroke located at the dominant hemisphere was not associated with severe depression (p=0.102). A similar trend was also noted among those with stroke at the right side (p=0.183), pons (p=0.634), bilateral (p=0.776), and midbrain (p=0.336). Conclusion: This study showed that majority of stroke patients were males with average age of 60.50 years. Hypertension was the most common co-morbidity. There was no association between stroke location and depression. The incidence of PSD was 30%.

Keywords: post-stroke depression, co-morbidity, disturbance, bilateral

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Authors: Andrea Knezevic, Padmini Pai, Julaine Allan, Katarzyna Olcoń, Louisa Smith

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Healthcare staff are on the frontline during times of disaster and are required to support the health and wellbeing of communities despite any personal adversity and trauma they are experiencing as a result of the disaster. This study explored the experiences of healthcare staff trained as ‘Wellness Warriors’ following the 2019-2020 Australian bushfires. The findings indicated that healthcare staff developed interpersonal skills around deep listening and connecting with others which allowed them to feel differently about work and restored their faith in healthcare leadership.

Keywords: Australian bushfires, burnout, health care providers, mental health, occupational trauma, post-disaster, wellbeing, workplace wellness

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Authors: Matthew Sedgwick

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Introduction: Social media continues to grow in popularity and Instagram is one of the largest platforms available. It provides an invaluable method of communication between health care professionals and patients. Both patients and dentists can benefit from seeing clinical cases posted by other members of the profession. It can prompt discussion about how the outcome was achieved and showcases what is possible with the right techniques and planning. This study aimed to identify what people were posting about the topic ‘veneers’ and inform health care professionals as to what content had the most engagement and make recommendations as to how to improve the quality of social media posts. Design: 150 consecutive posts for the search term ‘veneers’ were analyzed retrospectively between 21st October 2021 to 31st October 2021. Non-English language posts duplicated posts, and posts not about dental veneers were excluded. After exclusions were applied, 80 posts were included in the study for analysis. The content of the posts was analyzed and coded and the main themes were identified. The number of comments, likes and views were also recorded for each post. Results: The themes were: before and after treatment, cost, dental training courses, treatment process and trial smiles. Dentists were the most common posters of content (82.5%) and it was interesting to note that there were no patients who posted about treatment in this sample. The main type of media was photographs (93.75%) compared to video (6.25%). Videos had an average of 45,541 views and more comments and likes than the average for photographs. The average number of comments and likes per post were 20.88 and 761.58, respectively. Conclusion: Before and after photographs were the most common finding as this is how dentists showcase their work. The study showed that videos showing the treatment process had more engagement than photographs. Dentists should consider making video posts showing the patient journey, including before and after veneer treatment, as this can result in more potential patients and colleagues viewing the content. Video content could help dentists distinguish their posts from others as it can also be used across other platforms such as TikTok or Facebook reaching a wider audience. More informative posts about how the result has shown are achieved required, including potential costs. This will help increase transparency regarding this treatment method, including the financial and potential biological cost to teeth. As a result, this will improve patient understanding and become an invaluable adjunct in informed consent.

Keywords: content analysis, dental veneers, Instagram, social media

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Authors: K. Rajarajeswaran, Krishna Prasad

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Introduction: Refractory shock is a typical consequence of sepsis that does not improve with standard vasopressor therapy. A possible adjuvant therapeutic option for treating refractory shock in sepsis is methylene blue. This study looked at the effects of intravenous methylene blue plus norepinephrine given as a single bolus infusion on mortality and hemodynamic improvement in patients suffering from refractory shock. Methodology: This six-month observational prospective study was carried out at an intensive care unit, teaching hospital, and medical college. It involved 112 patients who had been diagnosed with refractory septic shock and needed vasopressor medication. Group B received injection norepinephrine 0.01 µg/kg/min infusion alone, while Group A received injection methylene blue 2 mg/kg iv single bolus (fixed dose) in addition to injection norepinephrine 0.01 µg/kg/min infusion. Both groups' noradrenaline doses were titrated to reach the desired MAP of 60–75 mm Hg. The amount of norepinephrine needed to sustain a MAP of more than 60 mm Hg was the data gathered. Serum lactate, procalcitonin level, C-reactive protein, length of stay in the intensive care unit (ICU), sequential organ failure assessment (SOFA) score, and duration of mechanical ventilation, incidence of acute kidney injury (AKI), and mortality were compared. Results: A total of 112 patients with refractory shock were included in the study. With the use of IV methylene blue, 36 (59.3%) patients showed significant improvement in MAP within 2 hours (77.12 ± 8.90 vs 74.28 ± 21.84, p = 0.005). Responders were 4.009 times more likely to have vasopressor-free time within 24 hours (19.5% vs 6.1%, p = 0.022, odds ratio 5.017, 95% confidence interval, 1.110–14.283). The serum lactate was lower, and urine output was higher in group I than in group II (p <0.05). Group I had a significantly greater reduction in SOFA score in 12 hours than group II. However, there was no significant difference in terms of mortality, length of ICU stay, ventilator free days, and incidence of AKI. In the responder group, there was a significant increase in the MAP and decrease in vasopressor requirement pre- and post-infusion of methylene blue (p < 0.05). Responder had shorter vasopressor-free days as compared with non-responder (5.44 vs 6.99, p = 0.007). Conclusion: When administered as adjuvant therapy, a single-dose bolus infusion of Methylene Blue plus Norepinephrine may aid in meeting early resuscitation goals for the management of patients with septic shock. But the patients' death rate, ICU stay duration, ventilator-free days, or incidence of AKI were unchanged.

Keywords: norepinephrine, methylene blue, shock, vasopressor

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Authors: Marzieh Sayyad, Mohsen Salesi

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Metabolic syndrome (MetS), a collection of cardiometabolic risk factors, is linked to the development of cardiovascular disease (CVD) and diabetes. The prevalence of MetS is on the rise with more women affected than men. The goal of this study was to compare the effects of resistance and aerobic exercise training on metabolic syndrome components in non-athlete, middle-aged woman. 51 non-athlete overweight female participated voluntarily in this study. Participants were divided randomly into three groups including resistance, aerobic and control group (number of each group 17). 24 hours before the beginning of training program, the blood sample was taken in fasting state. The two training groups participated in sport activities for eight weeks, three times a week duration 60-90 minutes. Two days following the end of the 8th week, all the measurements were performed similar to the pretest phase. The data was analyzed using one-way analysis of variance. The results showed that aerobic exercise training significantly decreased weight (p=.05), triglyceride (p<0.01) and systolic blood pressure (p<0.02) and HDL-c (p<0.01) was significantly increased. Also in resistance exercise training group TG decreased significantly (p<0.01) and HDL-c (p<0.05) was significantly increased. This study demonstrated that a regular physical activity program improved several metabolic and physiological parameters in healthy, previously sedentary subjects with the metabolic syndrome. In conclusion, it seems that this type of training can be efficient, safe and inexpensive way in order to reduce and prevent metabolic syndrome.

Keywords: aerobic exercise, metabolic syndrome, overweight sedentary female, resistance exercise

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Authors: Moizza Tahir, Uzma Bashir, Aisha Akhtar, Zainab Ansari, Sameen Ansari, Muhammad Ali Tahir

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Cancer burden has globally increased. Among cutaneous cancers basal cell carcinoma constitute vast majority of skin cancer. There is need for appropriate diagnostic, therapeutic and prognostic significance evaluation for skin cancers Present study report intraoperative frozen section (FS) histopathological clearance for excision of BCC in a tertiary care center and find the frequency of involvement of surgical margin with reference to anatomical site, with size and surgical technique. It was prospective open label interventional study conducted at Dermatology department of tertiary care hospital Rawalpindi Pakistan in lais on with histopathology department from January 2023 to April 2024. Total of thirty-six (n = 36) patients between age 45-80 years with basal cell carcinoma of 10-20mm on face were included following inclusion exclusion criteria by purposive sampling technique. Informed consent was taken. Surgical excision was performed and intraoperative frozen section histopathology clearance of tumor margin was taken from histopathologist on telephone. Surgical reconstruction was done. Final Histopathology report was reexamined on day 10th for margin and depth clearance. Descriptive statistics were calculated for age, gender, sun exposure, reconstructive technique, anatomical site, and tumor free margin report on frozen section analysis. Chi square test was employed for statistical significance of involvement of surgical margin with reference to anatomical site, size and decision on reconstructive surgical technique, p value of <0.05 was considered significant. Total of 36 patients of BCC were enrolled, males 12 (33.3%) and females were 24 (66.6%). Age ranged from 45 year to 80 year mean of 58.36 ±SD7.8. Size of BCC ranged from 10mm to 35mm mean of 25mm ±SD 0.63. Morphology was nodular 18 (50%), superficial spreading 11(30.6%), morphoeic 1 (2.8%) and ulcerative in 6(16.7%) cases. Intraoperative frozen section for histopathological margin clearance with 2-3 mm safety margin and surgical technique has p-value0.51, for anatomical site p value 0.24 and size p-0.84. Intraoperative frozen section (FS) histopathological clearance for BCC face with 2-3mm safety margin with reference to reconstructive technique, anatomical site and size of BCC were insignificant.

Keywords: basal cell carcinoma, tumor free amrgin, basal cell carcinoma and frozen section, safety margin

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