Agromorphological traits dataset of butterfly pea accessions from Thailand, Indonesia, and Brazil

Butterfly pea (Clitoria ternatea L.) is a horticultural crop also known as underutilized crop. All parts of the butterfly pea can be used into various products including flowers that can be used as natural dyes and traditional medicines. Besides that, the plant parts can be used as fodder and cover crop. The development of butterfly pea in Indonesia is still very low both in cultivation and utilization. Therefore, a breeding program is required to increase usefulness of butterfly pea can be done for the development. To assemble superior varieties of butterfly pea, it is necessary to determine the genetic diversity of both in agronomy and morphology. Genetic diversity and relationships are needed to evaluate plant germplasm. Raw data analysis was conducted after standardization using Principal Componet Analysis (PCA) and Hierarchical Clustering Analysis (HCA) to determine phenotypic diversity and relationship among the newly collected genetic resources. The data in this article showed broad phenotypic diversity with weight of fresh flower per plant, seed color, weight of total seed, pod width, calix length, flower color, petal number, number of total pods, plant height, number of seed per pod, weight total fresh flower, seed width, weight of fresh flower per plant, and seed length as distinguishing traits among the accessions. PCA based on agromorphogical traits showed eigenvalue ranged from 1.13 to 9.47 with a cumulative contribution of 93.02%. HCA showed butterfly pea accessions divided into two cluster with euclidean distance 0.27-4.65.

Effects of flavanols and procyanidins-rich cocoa consumption on metabolic syndrome: an update review (2013-2023)

Studies indicated that cocoa-based products effectively mitigate the risks associated with metabolic syndrome (MetS), however, the effect varies based on cocoa types, dosages, and study durations. This review aimed to determine the flavanol-rich cocoa consumption on MetS outcomes within the last decade (2013-2023), adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seven randomized-controlled trials (RCTs) used cocoa-based products containing 0.3-1680 mg flavanol monomers and 3.5-1270 mg procyanidins. Cocoa-based products beneficially reduced glycemic response, blood pressure and lipid profiles. However, this review highlights little evidence pinpointing the best cocoa products type and required dosage for the observed effects. Further intervention aiming to improve MetS should justify the selection and concentration of flavanols (monomers and procyanidins). A robust study design should consider registering the trials before study commencement, consider multicenter RCT trials, and adjust for potential covariates that might "masked" the outcomes.

Amylase-assisted extraction alters nutritional and physicochemical properties of polysaccharides and saponins isolated from Ganoderma spp

This study aimed to evaluate the efficacy of amylase in hydrolyzing complex carbohydrates of different parts of Ganoderma spp. The aqueous extracts of the Ganoderma samples were analyzed for their selected nutritional composition and physicochemical properties. The purified extracts were also structurally characterized. The aqueous canopy extracts of red-purple Ganoderma had a notably higher total sugar and saponin content than their stalks, but not for the black-type Ganoderma. The enzymatic extraction effectively improved the extraction yields, whereas the amounts of sugars and saponins in some extracts were increased after the enzymatic treatment. The results also showed that only those enzyme-treated cultivated black Ganoderma canopy had increased total sugar and total saponin content. The antioxidant activities of all stalk extracts were higher than the canopy extracts. Their emulsifying properties were comparable with lecithin due to their high saponin content. Therefore, these extracts are new natural emulsifiers.

Knowledge of computed tomography dose optimisation and justification among CT users and referring physicians: A single hospital study

INTRODUCTION

Radiation dose associated with computed tomography (CT) remains a concern, and radiation risk does not receive the needed attention, especially in low and middle-income countries. This because the frequency of this high-dose examination is rapidly growing and systems for protocol optimisation and dose justification are yet to be provided in CT imaging.

OBJECTIVE

To determine radiographers' and radiologists' awareness and knowledge of CT dose optimisation. We also determined knowledge of dose justification and use of the referral guidelines amongst the referring physicians.

METHODS

Radiographers and radiologists were invited to complete a web-based questionnaire whilst the referring physicians completed a self-administered questionnaire. The returned questionnaires were analysed and a significant difference was determined using Yates corrected Chi-square, and a p-value of 0.05 was considered at the 95% confidence interval.

RESULTS

The response rates were 50% (17 out 34) and 35% (16 out 46) for radiographers and radiologists respectively while referring physicians had a response rate of 84% (92 out of 110). Overall, more radiographers (47.1%) than radiologists (18.8%) had good knowledge of CT doses and image quality, however, the difference in knowledge was not found to be significant (p = 0.167). In addition, knowledge of diagnostic reference levels (DRLs) was significantly (p = 0.033) higher amongst radiographers (52.9%) as compared to radiologists (12.5%). Meanwhile, physicians understood the principles of dose justification. However, their knowledge of referral guidelines was limited.

CONCLUSION

The study revealed that radiographers were more knowledgeable on matters relating to radiation dose and image quality as well as DRLs when compared to radiologists. Meanwhile, the concept of dose justification was understood among physicians, however, they had limited awareness and knowledge of referral guidelines.

RELATIONSHIP BETWEEN SICKLE CELL NEPHROPATHY AND SOME BIOCHEMICAL MARKERS OF HAEMOLYSIS AMONGST PATIENTS WITH SICKLE CELL ANAEMIA IN KANO, NORTHWESTERN NIGERIA

Introduction

Advancements in the care of patients with sickle cell anaemia have led to significant improvement in survival with many patients reaching adulthood. As they age, long-term complications of the disease manifest in them, notable amongst which is nephropathy which is one of the leading causes of morbidity and mortality in them. There is limited information about sickle cell nephropathy and some biochemical markers of haemolysis that can detect it early in our setting. This study aimed to determine the relationship between some indirect markers of haemolysis and sickle cell nephropathy.

Methodology

The study was a descriptive cross-sectional one where 204 adolescent and adult patients with sickle cell anaemia attending the clinic of AKTH Kano were recruited. An interviewer-administered questionnaire was utilized. Blood samples were taken for determination of serum bilirubin, LDH, and reticulocyte count. Spot urine was used to quantitatively determine albumin to creatinine ratio. Data collated was analyzed using SPSS version 22.0. P-value <0.05 was considered significant.

Result

Two hundred and four (204) participants were enrolled in to the study. Their mean age was 19.6±5years. Females were the majority 131/204 (64.2%). The median (IQR) serum lactate dehydrogenase, bilirubin, direct bilirubin, and reticulocyte count were 607.0(487.3-758.5) U/L, 54.5(37.0-119.0) umol/L, 16.0(11.3-29.0) umol/L and 4.0(3.0-8.4%) respectively. Sickle cell nephropathy was found in 29/204 (14.2%). There were positive significant associations between sickle cell nephropathy with raised serum bilirubin and serum lactate dehydrogenase (p-value = 0.02 and 0.032 respectively).

Conclusion

Sickle cell nephropathy is common amongst patients with sickle cell anaemia and raised serum bilirubin and lactate dehydrogenase are predictors of sickle cell nephropathy.

Burden, Severity and Characteristic Pattern of Coronary Artery Disease using 160-Slice Computed Tomographic Angiography: Earliest Report from Northern Nigeria

BACKGROUND

Coronary computed tomography angiography (CCTA) allows for non-invasive visualization of the coronary arteries which is promising in diagnosing coronary artery disease.

OBJECTIVES

To determine the prevalence, morphology, anatomic distribution pattern and correlates of CAD in our environment.

METHODS

This cross-sectional study was conducted on the first cohort of patients referred for CCTA in our hospital. The patients were examined with 160-slice Toshiba® CT scanner. Their demographic data, relevant clinical information as well as the findings on CCTA were extracted and documented. The data were analysed using the R programming software version 4.0.4.

RESULTS

Out of a total of 153 patients who presented for CCTA within the study period, 133 (84.7%) were eligible for analysis. Their age ranged from 22-78 years with a mean ± SD of 55.8 ± 11.7 years. A total of 33 (24.8%) had normal CCTA, while 100 (75.2%) had either stenosis or total occlusion. There was a significantly higher (p-value of 0.00001) calcium score among those with stenosis compared to those with normal CCTA. The severity of the stenotic lesion was associated with the calcium score. The logistic regression analyses showed a statistically significant (P = 0.0415, OR = 1.0569, 97.5% CI =1.078152-1.123240) association between age and the presence of coronary stenosis. In addition, most of the stenotic lesions were in the left anterior descending artery (LAD).

CONCLUSION

Majority of the patients had coronary artery disease of variable severity and the LAD was the most involved artery. There was no significant association between sex and severity of the disease; however, old age and higher number of lesions were associated with severe disease.

Clinicians' interpretation of ventilation/perfusion lung scan reports: Where are we today?

Background

Clinicians' interpretation of lung scan reports will determine which further management decisions are taken when potentially fatal pulmonary embolism (PE) is suspected.

Objectives

To assess current referring clinicians' interpretation of the terminology used in ventilation/perfusion (V/Q) scan reports, whether this interpretation is affected by experience level, and how it affects clinical management decisions.

Methods

This was a questionnaire-based cross-sectional study. Between September 2020 and May 2021, 300 questionnaires were distributed among clinicians who refer patients for V/Q scans.

Results

Of the 162 clinicians who responded, 94% thought that there is >85% likelihood of PE or definitely PE present when a scan is reported as 'high probability of PE'; 87% interpreted 'low probability of PE' as <10% likelihood of PE or definitely no PE present. Overall, >70% of clinicians across all experience levels correctly interpreted the intended meaning of probability categories according to the Modified Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II criteria. Of the respondents, 77% agreed that clinically significant PE is ruled out by a normal scan. Further investigation for inconclusive findings, features of parenchymal lung disease and cardiomegaly were selected by 72%, 93% and 98% of clinicians, respectively.

Conclusion

The findings of this study regarding high-probability scan results were in line with existing literature on lung scan report interpretation. However, our findings regarding low-probability scan results and negative V/Q scan specificity contrasted with the findings in these articles, suggesting that clinicians are now more familiar with lung scan interpretation guidelines. Experience level did not significantly affect interpretation of reports. Although most clinicians agreed that a negative scan excludes clinically significant PE, two-thirds of them would still subject the patient to further unnecessary investigations to exclude PE.

Study synopsis

What the study adds. Our findings regarding a low-probability ventilation/perfusion (V/Q) scan and the specificity of a negative V/Q scan contrasted with previous articles on lung scan interpretation, suggesting that clinicians are now more familiar with lung scan interpretation guidelines.Implications of the findings. Although most clinicians understood the negative predictive value of a V/Q scan, 20% would still investigate further with computed tomography pulmonary angiography or treat as confirmed pulmonary embolism. Education of clinicians about the negative predictive value of V/Q scans is important to avoid unnecessary radiation or anticoagulation.

The role of lutein-rich purple sweet potato leaf extract on the amelioration of diabetic retinopathy in streptozotocin-induced Sprague-Dawley rats

The objective of this study is to access the effect of purple sweet potato leaf (PSPL) extract on diabetic retinopathy (DR) of streptozotocin (STZ)-induced male Sprague-Dawley (SD) rats. In this study, rats were injected intraperitoneally with a single dose of 60 mg/kg STZ, and diabetes was confirmed on day 7. Rats were further divided into a few groups, which were then orally administered with one of the following treatments: 25 mg/kg of gliclazide (D25G), 200 mg/kg of PSPL extract (DT 200), and 400 mg/kg of PSPL extract (DT 400). However, the normal control (NS) and control group for diabetic (DNS) were given normal saline (NS) for 12 weeks. The results show that the treated group demonstrated a reduction in serum oral glucose tolerance test (OGTT) levels of DT 200 and DT 400, and an increase in the serum and retinal insulin levels, and restored oxidative stress markers in serum and retina on week 12. The PSPL extract exhibited protective effects in maintaining the kidney, liver, retina, and pancreas architecture in 400 mg/kg compared to the 200 mg/kg treated group and D25G, thereby restoring fully transparent lenses in diabetes-induced rats. In conclusion, 400 mg/kg PSPL is the most effective dose for the amelioration of STZ-induced DR pathology in male SD rats.

Effect of Different Ratios of Mentha spicata Aqueous Solution Based on a Biosolvent on the Synthesis of AgNPs for Inhibiting Bacteria

Our work was devoted to studying the effect of different concentrations of Mentha spicata aqueous extract on the green synthesis of silver nanoparticles (AgNPs) in order to obtain the most effective of these concentrations for bacteria inhibitory activity. Different concentrations of the aqueous M. spicata extract (0.25, 0.50, 0.75, and 1.00 mM) were used as biological solvent to synthesize AgNPs by means of the reduction method. The crystal structure and morphology of the NPs were characterized UV–vis spectra, X-ray diffraction (XRD), and scanning electron microscopy (SEM). The inhibition effect of AgNPs on Escherichia coli was studied to determine the minimum inhibitory concentration (MIC). The dark yellow color of the M. spicata extract aqueous solution indicates the successful synthesis of the AgNPs. UV spectra of the NPs show a gradual increase in absorption with increasing concentration of aqueous M. spicata extract solution from 0.25 to 1.00 mM, accompanied by a shift in the wavelength from 455 to 479 nm along with a change in the nanoparticle size from 31 to 9 nm. The tests also showed a high activity of the particles against bacteria (E. coli) ranging between 15.6 and 62.5 µg/ml. From the AgNPs, it was confirmed that aqueous M. spicata extract is an effective biosolvent for the synthesis of different sizes of AgNPs according to the solvent concentration. The AgNPs also proved effectual for the killing of bacteria.

The effect of different aqueous solutions ratios of Ocimum basilicum utilized in AgNPs synthesis on the inhibition of bacterial growth

This study examined the effect of varying concentrations of Ocimum basilicum aqueous extract, which was done via the green synthesis of Silver nanoparticles (AgNPs), on the identification of the most effective concentration for bacteria inhibitory activity. Different concentrations of the aqueous Ocimum basilicum extract (0.25, 0.50, 0.75 and 1.00 mM) were used as reducing and stabilizing agent to synthesize AgNPs by means of the reduction method. The crystal structure and morphology of the NPs were characterized UV-Vis spectra, X-ray diffraction (XRD) and scanning electron microscopy (SEM). The antibacterial efficacy of AgNPs was studied against E. coli ATCC 35218 using well diffusion, MIC, MBC, and time-kill curve. The dark yellow color of the Ocimum basilicum aqueous solution indicates the successful synthesis process of the AgNPs. UV-spectra of the AgNPs display a gradual increase of absorption in sequence with concentration increase of aqueous Ocimum basilicum extract solution from 0.25 to 1.00 mM. This, in turn, led to a shift in the wavelength from 488 to 497 nm, along with a change in the nanoparticle size from 52 to 8 nm. The tests also showed a high activity of the particles against bacteria (E. coli), ranging between 15.6 and 62.5 µg/ml. Based on AgNPs, it was confirmed that an aqueous Ocimum basilicum extract can be used as an effective, reducing and stabilizing agent for the synthesis of different sizes of AgNPs based on the solvent concentration. The AgNPs also proved to be effective in inhibiting and killing bacteria.

Short-chain fatty acids: possible regulators of insulin secretion

The benefits of gut microbiota-derived short-chain fatty acids (SCFAs) towards health and metabolism have been emerging since the past decade. Extensive studies have been carried out to understand the mechanisms responsible in initiating the functionalities of these SCFAs towards body tissues, which greatly involves the SCFA-specific receptors free fatty acid receptor 2 (FFAR2) and free fatty acid receptor 3 (FFAR3). This review intends to discuss the potential of SCFAs particularly in regulating insulin secretion in pancreatic β-cells, by explaining the production of SCFAs in the gut, the fate of each SCFAs after their production, involvement of FFAR2 and FFAR3 signalling mechanisms and their impacts on insulin secretion. Increased secretion of insulin after SCFAs treatments were reported in many studies, but contradicting evidence also exist in several other studies. Hence, no clear consensus was achieved in determining the true potential of SCFA in regulating insulin secretion. In this review, we explore how such differences were possible and hopefully be able to shed some perspectives in understanding SCFAs-signalling behaviour and preferences.

Real-world outcomes of Selexipag for treatment of pulmonary hypertension in an Asian population

Funding Acknowledgements

Type of funding sources: None.

Introduction

Selexipag is an oral selective prostacyclin IP receptor agonist indicated for treatment of pulmonary arterial hypertension (PAH). Data on its real-world safety and efficacy in Asians is lacking.

Purpose

We sought to evaluate the clinical characteristics, treatment regimens and outcomes of patients initiated on selexipag in a tertiary cardiac centre in Asia.

Methods

This was a retrospective study on all patients initiated on selexipag from January 2017 to December 2020. Baseline and follow up characteristics including demographics, functional status and clinical data were collected. Clinical outcomes evaluated included hospitalisation for PH related complications and all-cause mortality. Patients were risk stratified using the COMPERA 2.0 risk scores.

Results

A total of 36 PAH patients were treated with selexipag. At baseline, most patients were WHO functional class II or III (36.4% and 51.5% respectively), with a NT-proBNP of 1335 pg/ml (557 – 2918) and 6 minute walk test (6MWT) duration of 327.5 ±126.4 meters. Selexipag was initiated at 200mcg twice daily dosage for all except one patient (started at 200mcg once daily) and the maximum tolerated dose ranged from 200mcg twice daily to 1400mcg twice daily, with majority tolerating up to a dose of 600mcg twice daily (58.3%). Side effects were reported in 23 patients (63.9%), of which headache (27.8%), diarrhea (30.6%) or musculoskeletal symptoms (27.8%) were predominant. After a median follow up duration of 25.9 ± 23.1 months, selexipag was stopped in 20 patients (55.6%), of which eight patients were due to PAH progression requiring alternative therapy, and 12 patients due to side effects from selexipag. At baseline, patients were classified into low (8.3%), intermediate-low (30.6%), intermediate-high (33.3%) and high risk (27.8%) respectively. Patients who continued on selexipag at follow up showed no change (46.2%), improvement (15.4%) and deterioration (38.5%) in risk score. In the overall cohort of 36 patients, majority (75%) had at least one hospitalisation for PAH related complications and 15 patients (41.7%) demised.

Conclusion

In this real-world study, while selexipag was associated with a stable or improved PAH risk scores in majority of patients, there was a subset of patients with disease progression or intolerance to the medication. Further studies are warranted to identify patients who will benefit most from this therapy.

Long-term memory and synapse-like dynamics in two-dimensional nanofluidic channels

Fine-tuned ion transport across nanoscale pores is key to many biological processes, including neurotransmission. Recent advances have enabled the confinement of water and ions to two dimensions, unveiling transport properties inaccessible at larger scales and triggering hopes of reproducing the ionic machinery of biological systems. Here we report experiments demonstrating the emergence of memory in the transport of aqueous electrolytes across (sub)nanoscale channels. We unveil two types of nanofluidic memristors depending on channel material and confinement, with memory ranging from minutes to hours. We explain how large time scales could emerge from interfacial processes such as ionic self-assembly or surface adsorption. Such behavior allowed us to implement Hebbian learning with nanofluidic systems. This result lays the foundation for biomimetic computations on aqueous electrolytic chips.

Evaluation of nutritional quality of complementary foods formulated from blends of Nigerian yellow maize (Zea mays), soybean (Glycine max) and crayfish (Procambarus clarkii)

BACKGROUND

Plant-based complementary foods (CFs) supply insufficient amount of nutrients to meet recommended nutrient intakes for 6-23-month-old children. The present study determined the nutritional quality of CFs formulated from blends of Nigerian yellow maize (Zea mays), soybean (Glycine max) and crayfish (Procambarus clarkii). Three CFs were formulated; namely, maize flour (MF, 100:0% w/w), blends of maize and soybean flour (MSF, 72:28% w/w), and maize, soybean and crayfish flour (MSCF, 80:10:10% w/w). Nutritional quality was evaluated using analyses of chemical composition of CFs and of protein quality of complementary food diets. Data were compared by multivariate analysis of variance and significantly differentiated. Nine selected nutritional criteria were used to decide the CF that had best nutritional characteristics compared to MF and fortified wheat flour (FWMF).

RESULTS

Total scores obtained from the selected nutritional criteria ranked MSCF, with total score of 15, as the lowest and thus it was considered to have the most desirable nutritional characteristics compared to MF, MSF and FWMF, which had respective total scores of 31, 22 and 20.

CONCLUSION

Conclusively, MSCF may serve as a better alternative CF for MF, MSC and FWMF. The present study has produced a potential alternative cost-effective and adequate CF, formulated from crayfish (P. clarkii) supplementation of locally available blend of yellow maize (Z. mays) and soybean (G. max), for the poor human population, aiming to encourage the consumption of animal-sourced CF for alleviating the prevalence of childhood undernutrition. © 2022 Society of Chemical Industry.

Influence of lysozyme utilization with lactic acid bacteria in yoghurt on some foodborne pathogens

Despite the existence of many different food preservation methods, foodborne pathogens are still the most common related problems to dairy products. Developing naturally alternative techniques to control such problems is necessary. This research was planned to assess the bacteriological quality of yoghurt samples commercially available in Kafr El-Sheikh city, Egypt. Also to study the impact of natural antibacterial agents on the inhibition of selected foodborne pathogens artificially inoculated in yoghurt samples. The obtained results revealed poor bacteriological quality of the examined yoghurt samples, as total staphylococci and coliforms were detected in 80% and 90% yoghurt samples, with mean values of 2.4 ×103±0.13× 103cfu/gm and 3.6×105± 2.4×105 MPN/gm, respectively. S. aureus was noticed in 4% of examined samples, polymerase chain reaction (PCR) confirmed the pres­ence of virulence adhesion gene (clfA) in one isolate. E. coli was detected in 14% of yoghurt samples, then serologically identified as O146:H5 (2), O111:H2 (2), O125:H11 (1), O26:H10 (1) and O158:H7 (1). Artificially inoculated yoghurt with S. aureus (7.39 log cfu/gm) and E. coli (8.3 log cfu/gm), were used to investigate the ability of hen egg-white lysozyme either with LAB classic or with ABT-5 (L. acidophilus LA5+ S. thermophiles + Bifidobacterium Bb12) starter cultures to inhibit the growth of these pathogens. During refrigerated storage, all yoghurt batches showed a reduction in pH value. It was observed that both pathogens couldn't be detected in the yoghurt batch containing LAB classic starter + heated lysozyme. Furthermore, S. aureus was completely inhibited in that containing ABT-5 cultures alone, while E. coli decreased by 6.23 log. Conversely, there was not complete inhibition in other batches containing (LAB classic starter, LAB classic starter+ native lysozyme, ABT-5 culture+ native lysozyme and ABT-5 culture+ heated lysozyme) as the reduction rate during all storage periods for S. aureus count was 1.66, 2.63, 4.47  and 4.19 log, While for E. coli count was  3.3, 3.81, 5.53 and 4.89 log,  respectively. This study highlighted the importance of adding natural antibacterial agents like lysozyme with LAB culture to yoghurt as a bio-control strategy to overcome foodborne pathogens that cause a public health hazard.

Postprandial Metabolome Following a Low Glycaemic Index Meal-Challenge Test: A Narrative Review

The Identifying the dynamic metabolome of the individual in response to a particular stimulus using a metabolomic approach is an emerging research area. Measuring the postprandial metabolite response utilising a meal-challenge test (MCT) provides information beyond the fasting state, which is especially important since human beings spend most of their time in the postprandial state. This is pertinent as an excessive rise in postprandial glycaemia is common in individuals with type 2 diabetes mellitus (T2DM), which puts them at a high risk of developing cardiovascular disease (CVD). While a low glycaemic index (GI) meal improves postprandial glycaemia and insulin levels in MCT studies among individuals with T2DM, its effect on metabolite changes in the postprandial state is unclear. This review summarises the perturbation in postprandial metabolites following a low GI meal in comparison to that following a usual or high GI meal and maps the metabolites in their metabolic pathways. We undertook a literature review using electronic databases, with the Medical Subject Headings (MeSH) terms, to retrieve relevant studies based on specific criteria. A total of seven related studies were documented. For the majority of metabolites studied, it was identified that metabolic regulation following an MCT extends beyond the glucose pathway. Altered metabolic pathways after the consumption of a low GI meal include: i) essential amino acid metabolism by altering the levels of plasma phenylalanine, tyrosine, lysine, leucine, isoleucine and valine; ii) glycolysis and tricarboxylic acid (TCA) metabolism by altering citrate and alanine, and iii) gut microbiota metabolism by altering betaine and acetate. The altered metabolites regulated the pancreatic insulin secretion and related to other dietary factors beyond GI modifications. These metabolomics data need to be interpreted cautiously because the metabolic changes analysed might not be due to the beneficial effects of a low GI meal. Validation of the putative metabolomic biomarkers following a dietary intervention MCT is suggested because researchers need to fully understand the kinetics and metabolism of individuals metabolite before reaching a solid conclusion. Further research characterising the metabotype based on habitual dietary patterns is warranted.

National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK

A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.

Zero-fluoroscopy ablation of the cavotricuspid isthmus guided by intracardiac echocardiography in patients with typical atrial flutter

Introduction

In previous studies we have demonstrated the advantages of electrophysiology catheter navigation by intracardiac echocardiography (ICE). In this prospective study we investigated ICE-guided zero-fluoroscopy ablation of the cavotricuspid isthmus (CTI) involving a decapolar diagnostic and an irrigated radiofrequency (RF) ablation catheter in patients with typical atrial flutter (AFL).

Methods and results

Twenty-seven consecutive patients (mean age 73.4±11.6 years, 18 male) with ECG-recordings suggesting ongoing (n=19) or recent CTI-dependent AFL underwent an electrophysiological study (EPS) utilizing solely ICE for catheter navigation. All EPS could be successfully accomplished without the need for fluoroscopy. CTI-dependent AFL was confirmed by entrainment manoeuvre in all patients with ongoing AFL. Mean EPS duration was 44.0±20.3 minutes and mean ablation procedure duration was 22.3±16.4 minutes. RF ablation was applied for 6.3±3.1 minutes (50 Watts, irrigated RF-ablation in all patients). After the last RF application, bidirectional CTI-Block was confirmed by differential pacing in all patients. Echocardiographic parameters such as CTI-length, prominence of the eustachian ridge (ER), and depth of the CTI-pouch on the ablation plane (Figure 1) were assessed to analyse their correlation with EPS- or ablation procedure duration. CTI-pouch was shallower in patients with ablation procedure duration above median (4,9±1.09mm vs. 6.3±0.9mm, p=0.048), suggesting a more laterally ablation plane in these patients, where the CTI musculature is stronger. CTI-length or ER-prominence above the respective median did not correlated with longer EPS duration. However, in some cases with prominent ER inversion of the ablation catheter was needed to achieve contact of catheter-tip to the tissue. An asymptomatic intramural hematoma was diagnosed by ICE after successful ablation in one patient, no other major or minor complications were documented in this study.

Conclusions

Zero-fluoroscopy CTI ablation guided solely by intracardiac echocardiography in patients with CTI-dependent AFL is feasible and safe. ICE visualisation may help to localize the optimal ablation plane, to detect and correct poor tissue contact of the catheter tip and recognise early potential complications during the ablation procedure.

Funding Acknowledgement

Type of funding sources: None.

From freshwaters to bivalves: Microplastic distribution along the Saint-Lawrence river-to-sea continuum

Despite the close connection of freshwaters to human health, the occurrence and fate of microplastics in marine estuaries remain poorly documented. To study these particles in the Saint-Lawrence River (Quebec, Canada), surface water and marine bivalve samples were collected along the river-to-sea continuum. The water samples were subdivided to characterize the large microplastics (LMPs; 300-3200 µm) and the small microplastics (SMPs; 20-300 µm). Particles were identified by microscopy and infrared spectroscopy techniques. The concentration of LMPs was higher in the surface water in the downstream stations (0.0319 ± 0.0147 items.L^-1) compared to the upstream stations (0.0007 ± 0.0006 items.L^-1). No clear trend was observed for the SMPs. After digestion of the biological tissues, the microplastics ingested by the bivalves were recovered and characterized by microscopy coupled with infrared spectroscopy. Up to 3 items were found per bivalve suggesting that these particles are also present in the water column of the marine estuary and the gulf. The physico-chemical gradients along the continuum were monitored since they could be directly involved in the vertical and horizontal transport of microplastics. This study provides scarce field data collected along the world's largest estuary and gives new insights concerning the fate of microplastics along a river-to-sea continuum.

Safety assessment of natural products in Malaysia: current practices, challenges, and new strategies

The belief that natural products are inherently safe is a primary reason for consumers to choose traditional medicines and herbal supplements for health maintenance and disease prevention. Unfortunately, some natural products on the market have been found to contain toxic compounds, such as heavy metals and microbes, as well as banned ingredients such as aristolochic acids. It shows that the existing regulatory system is inadequate and highlights the importance of thorough safety evaluations. In Malaysia, the National Pharmaceutical Regulatory Agency is responsible for the regulatory control of medicinal products and cosmetics, including natural products. For registration purpose, the safety of natural products is primarily determined through the review of documents, including monographs, research articles and scientific reports. One of the main factors hampering safety evaluations of natural products is the lack of toxicological data from animal studies. However, international regulatory agencies such as the European Food Safety Authority and the United States Food and Drug Administration are beginning to accept data obtained using alternative strategies such as non-animal predictive toxicological tools. Our paper discusses the use of state-of-the-art techniques, including chemometrics, in silico modelling and omics technologies and their applications to the safety assessments of natural products.

FIRST CARDIAC COMPUTED TOMOGRAPHY TYPICAL RADIATION DOSE VALUES FROM A SINGLE CENTRE IN NIGERIA: A PILOT STUDY

Concern regarding radiation dose associated with cardiac computed tomography (CT) still exists and requires the use of diagnostic reference levels for dose optimisation. Typical median doses were established for 58 consented adult patients from a single centre for coronary artery calcium score (CACS) as volume computed tomography dose index (CTDIvol): 5.9 mGy; dose length product (DLP): 86.6 mGy*cm and cardiac CT angiography (CCTA) as CTDIvol: 11.1 mGy; DLP: 190.8 mGy*cm. Wide radiation dose variability in terms of CTDIvol was noted for CACS: 2.7-15.9 mGy, a 6-fold, whereas for CCTA it ranges from 3.8 to 52.8 mGy, a 14-fold. The DLP values for CACS range from 33.2 to 344.2 mGy*cm, which is 10-fold, whereas for CCTA it ranges from 32.8 to 834.9 mGy*cm, a 25-fold. The typical values compared lower than the radiation dose from other countries; however, the wide variability in dose remains a call for concern.

POS1521-HPR UNDERSTANDING AND IDENTIFYING KEY CONTEXTUAL FACTORS THAT INFLUENCE THE PRACTITIONER-PATIENT ENCOUNTER IN THE MANAGEMENT OF OSTEOARTHRITIS: A QUALITATIVE SYSTEMATIC REVIEW

Background

Contextual factors (CFs) related to the patient, healthcare practitioners, and their therapeutic relationship are integral to the overall treatment effect of any given intervention (1). In osteoarthritis (OA), around 75% of the treatment effect is directly attributable to CFs (2). Identifying and understanding the role of CFs may encourage healthcare practitioners to develop and enhance the contextual aspects of care.

Objectives

To explore and understand the experience and perspectives of patients and health practitioners regarding CFs in consultations for OA.

Methods

A systematic search was conducted between March 15 and May 18, 2020, on the following databases: MEDLINE via Ovid, EMBASE, AMED, PsycINFO and CINAHL. The search for unpublished studies included ProQuest Dissertations and Google Scholar. The search was not limited to any language or publication year. The Joanna Briggs Institute (JBI) methodology for quality assessment, study selection, data extraction and synthesis were used. Findings were assessed for credibility, categorised based on similarity in meaning and subjected to a meta-aggregation. The ConQual approach was used to assess the confidence of the synthesised findings (3).

Results

Of 1808 records generated from the systematic search of databases and grey literature, eight studies were included in the meta-aggregation (Figure 1). All included papers were moderate to high quality based on the JBI qualitative critical appraisal tool. Meta-aggregation generated three synthesised findings. According to the ConQual criteria, all the synthesised findings’ level of evidence was rated as moderate (Table 1). The key, potentially modifiable, factors identified were positive communication; clear and relevant information provided by the health practitioner; patient expectation concerning their outcome and the consultation experience; sufficient consultation time; and easy access to consultations.

Table 1.

ConQual summary of findings

Synthesized findingType of researchDependabilityCredibilityConQual scoreI. People with OA will likely experience comprehensive and satisfactory management of their condition if the key contextual enhancers are implemented.QualitativeUnchanged*Downgrade 1 level**ModerateII. Health providers acknowledged that information provision and efficient communication skills are likely to enhance management during consultations for OA.QualitativeUnchanged*Downgrade 1 level**ModerateIII. Effective consultations are affected by an intersection of organizational challenges and patient and provider characteristics. Limited experience with OA of some practitioners, unrealistic patients’ expectations, and short consultation duration are barriers that need to be adjusted for better management.QualitativeUnchanged*Downgrade 1 level**Moderate

* The average score was (4/5) for dependability.

** Downgraded one level due to a mix of unequivocal and credible findings.

Figure 1.

PRISMA flowchart of the study selection and inclusion process

Conclusion

This qualitative systematic review has defined three synthesized findings. Identification of modifiable CFs that are deemed important by both patients and health practitioners can inform the development of a training package for healthcare professional.

References

[1]Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. The Lancet. 2001;357(9258):757-762.

[2]Zou K, Wong J, Abdullah N, Chen X, Smith T, Doherty M et al. Examination of overall treatment effect and the proportion attributable to contextual effect in osteoarthritis: meta-analysis of randomised controlled trials. Annals of the Rheumatic Diseases. 2016;75(11):1964-1970.

[3]Munn, Z., Porritt, K., Lockwood, C., Aromataris, E. & Pearson, A. 2014. Establishing confidence in the output of qualitative research synthesis: the ConQual approach. BMC medical research methodology, 14, 1-7.

Disclosure of Interests

None declared

Predictive value of doppler cerebroplacental ratio for adverse perinatal outcomes in postdate pregnancies in Northwestern Nigeria

Background

Postdate pregnancy is a very common obstetric condition, increasing the risk of perinatal morbidity and mortality from uteroplacental insufficiency.

Aim

To determine the predictive values of Doppler cerebroplacental ratio (CPR), that is, the ratio between middle cerebral artery (MCA) and UA pulsatility indices (UA PI), and other potential velocimetric predictors of adverse perinatal outcomes in women with postdated pregnancies.

Patients and Methods

A prospective cohort study was conducted on consenting 212 low-risk pregnant women beyond 40 weeks' gestational age. The pulsatility indices of MCA, UA, and CPR as well as non-stress tests (NST) and amniotic fluid index (AFI) were measured and recorded. The women were divided into two groups based on the presence or absence of adverse perinatal outcome defined as: meconium stained liquor, meconium aspiration syndrome, perinatal asphyxia, cesarean section for suspected fetal distress, and perinatal death.

Results

: Of the 200 women whose data were available for analysis, 40 (20%) of them had adverse perinatal outcome and 160 (80%) had normal perinatal outcome. The CPR showed statistically significant difference in predicting adverse perinatal outcome (P < 0.001). CPR had a better predictive value than UA-PI and outperformed MCA-PI and NST for adverse perinatal outcomes. The sensitivity, specificity, negative predictive value (NPV), and accuracy of prediction of adverse perinatal outcomes by CPR were 90%, 81.25%, 97.01%, and 83%, respectively.

Conclusion

The Doppler CPR shows the highest diagnostic accuracy in prediction of adverse perinatal outcome in pregnant women after 40 weeks' gestation than UA PI and velocimetric indices when used as stand-alone test.

ESTIMATION OF SCATTERED NEUTRONS CONTRIBUTION IN A NEUTRON CALIBRATION BUNKER USING A MONTE CARLO SIMULATION

The contribution of scattered neutrons is inevitable in neutron calibration facilities. This contribution complicates the measurements of neutron radiation, therefore, it should be estimated to correct the response of neutron probe instruments. In the present work, Monte Carlo simulation was performed for a neutron calibration bunker using the MCNP-4C code. This simulation aimed to calculate the contribution ratio of scattered neutrons to the neutron field. To simulate the neutron field, 241Am-Be neutron source defined in the ISO 8529-1 was used. The results of the simulation reported in this work were found to be consistent with those found experimentally in previous work. Additionally, the distribution of both the ambient dose equivalent rate and the contribution ratio of scattered neutrons in the bunker were mapped using this simulation.

Clozapine-induced gastrointestinal hypomotility: presenting features and outcomes, UK pharmacovigilance reports, 1992-2017

BACKGROUND

Clozapine-induced gastrointestinal hypomotility (CIGH) affects some 75% of patients treated with clozapine.

AIMS

To document the incidence of potentially harmful CIGH in the UK.

METHOD

We studied spontaneous UK pharmacovigilance reports recorded as clozapine-related gastrointestinal adverse drug reactions, 1992-2017.

RESULTS

There were 527 patients reported with potentially harmful CIGH; 33% (n = 172) died. Deaths averaged 1 per year 1992-1999, 5 per year 2000-2009 and 15 per year 2010-2017. Those who died were older (median 52 years v. 49 years) and had been prescribed clozapine for longer than those who recovered (median 11.3 years v. 4.8 years), but there was no difference in prescribed dose. Within the first 4 years of clozapine treatment, there were 169 reports of CIGH, of which 3% (n = 5) were fatal. At 10-14 years there were 63 reports of CIGH, of which 25% (n = 16) were fatal. Among the deaths, males were younger (median 51, range 22-89 v. median 57, range 24-89 years) with higher clozapine doses (median 450, range 100-900 v. median 300, range 12.5-800 mg/d) than females. In non-fatal CIGH, surgery was the most frequent outcome (n = 92). The procedures included appendectomy, ileostomy, total/partial colectomy, colostomy/stoma and proctosigmoidectomy. Clozapine dosage was reduced in 6 patients, stopped and restarted in 23, 'continued' in 6 and discontinued permanently in at least 76 patients.

CONCLUSIONS

The risk of serious morbidity/mortality from CIGH is substantial. The need to actively monitor bowel function and give laxatives to patients treated with clozapine is clear.

Ergogenic property of Morinda citrifolia L. leaf extract affects energy metabolism in obese Sprague Dawley rats

Ergogenic property is the ability to enhance capacity for physical activities through efficient production of energy and is potentially beneficial in weight management for the obese. In this study, ergogenic property of Morinda citrifolia leaf's extract (MCL) was evaluated using AMP-activated protein kinase (AMPK) activity and high fat diet-induced obese rats. Findings from the study showed that MCL demonstrated ergogenic activity via enhancement of AMPK activity using L6 skeletal muscle cell line. Interestingly, the result also revealed that rats treated with the intermediate dosage of MCL experienced the lowest % weight gain. The rats fed the highest dose of 200 mg/kg BW MCL demonstrated the longest swimming time of approximately three times that of green tea and caffeine-fed rats. The highest dose fed rats were also found to have lower glucose and lactate levels, suggesting that energy metabolism was more effective in these rats. In addition, lactate dehydrogenase and creatinine kinase activities, the muscle injury indicators, were found to be the lowest in rats fed the highest MCL dose. The same effect was not seen in rats fed either caffeine or green tea, indicating that MCL treatment is may be protective of the rats' muscles. It was also shown that MCL consisted of various flavonoids with epicatechin, catechin, and quercetin that may be responsible for the effects measured. In conclusion, improvements were seen in rats fed MCL in terms of weight management, endurance capacity, energy metabolism, and muscle injury parameters. PRACTICAL APPLICATIONS: Results of the study revealed that Morinda citrifolia leaf has great potential to be used as functional ingredient in the development of designer food/drink as ergogenic aid for both obese and non-obese individuals. Morinda citrifolia leaf could help in the weight management of obese people and enhance endurance capacity and energy metabolism in active individuals.

α-Amylase and dipeptidyl peptidase-4 (DPP-4) inhibitory effects of Melicope latifolia bark extracts and identification of bioactive constituents using in vitro and in silico approaches

CONTEXT

Melicope latifolia (DC.) T. G. Hartley (Rutaceae) was reported to contain various phytochemicals including coumarins, flavonoids, and acetophenones.

OBJECTIVE

This study investigates the antidiabetic and antioxidant effects of M. latifolia bark extracts, fractions, and isolated constituents.

MATERIALS AND METHODS

Melicope latifolia extracts (hexane, chloroform, and methanol), fractions, and isolated constituents with varying concentrations (0.078-10 mg/mL) were subjected to in vitro α-amylase and dipeptidyl peptidase-4 (DPP-4) inhibitory assay. Molecular docking was performed to study the binding mechanism of active compounds towards α-amylase and DPP-4 enzymes. The antioxidant activity of M. latifolia fractions and compounds were determined by 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging and β-carotene bleaching assays.

RESULTS

Melicope latifolia chloroform extract showed the highest antidiabetic activity (α-amylase IC₅₀: 1464.32 μg/mL; DPP-4 IC₅₀: 221.58 μg/mL). Fractionation of chloroform extract yielded four major fractions (CF₁-CF₄) whereby CF₃ showed the highest antidiabetic activity (α-amylase IC₅₀: 397.68 μg/mL; DPP-4 IC₅₀: 37.16 μg/mL) and resulted in β-sitosterol (1), halfordin (2), methyl p-coumarate (3), and protocatechuic acid (4). Isolation of compounds 2-4 from the species and their DPP-4 inhibitory were reported for the first time. Compound 2 showed the highest α-amylase (IC₅₀: 197.53 μM) and β-carotene (88.48%) inhibition, and formed the highest number of molecular interactions with critical amino acid residues of α-amylase. The highest DPP-4 inhibition was exhibited by compound 3 (IC₅₀: 911.44 μM).

DISCUSSION AND CONCLUSIONS

The in vitro and in silico analyses indicated the potential of M. latifolia as an alternative source of α-amylase and DPP-4 inhibitors. Further pharmacological studies on the compounds are recommended.

Lung microbiome of stable and exacerbated COPD patients in Tshwane, South Africa

Chronic obstructive pulmonary disease (COPD) is characterised by the occurrence of exacerbations triggered by infections. The aim of this study was to determine the composition of the lung microbiome and lung virome in patients with COPD in an African setting and to compare their composition between the stable and exacerbated states. Twenty-four adult COPD patients were recruited from three hospitals. Sputum was collected and bacterial DNA was extracted. Targeted metagenomics was performed to determine the microbiome composition. Viral DNA and RNA were extracted from selected samples followed by cDNA conversion. Shotgun metagenomics sequencing was performed on pooled DNA and RNA. The most abundant phyla across all samples were Firmicutes and Proteobacteria. The following genera were most prevalent: Haemophilus and Streptococcus. There were no considerable differences for alpha and beta diversity measures between the disease states. However, a difference in the abundances between disease states was observed for: (i) Serratia (3% lower abundance in exacerbated state), (ii) Granulicatella (2.2% higher abundance in exacerbated state), (iii) Haemophilus (5.7% higher abundance in exacerbated state) and (iv) Veillonella (2.5% higher abundance in exacerbated state). Virome analysis showed a high abundance of the BeAn 58058 virus, a member of the Poxviridae family, in all six samples (90% to 94%). This study is among the first to report lung microbiome composition in COPD patients from Africa. In this small sample set, no differences in alpha or beta diversity between stable and exacerbated disease state was observed, but an unexpectedly high frequency of BeAn 58058 virus was observed. These observations highlight the need for further research of the lung microbiome of COPD patients in African settings.

Drone technology in maternal healthcare in Malaysia: A narrative review

INTRODUCTION

The vast advancement of technology and breakthrough in high-tech disciplines created multiple areas of research activities, including the emergence of the medical drone. Malaysia, a rapidly developing country in Southeast Asia is on track to achieving high-income status. However, the stagnant growth of Malaysian maternal healthcare does not run parallel with the aspiration. This review paper assessed and reported narratively the current condition of maternal healthcare in Malaysia, the possible application of drones in improving the sector, exploring in detail several challenges, and providing recommendations for experts in studying the rising technological phenomena.

MATERIALS AND METHODS

A literature search was done from June 2019 to November 2019 with restrictions to the English language. The search was performed in ScienceDirect, PubMed, and EMBASE databases, using a combination of search terms related to drones, Unmanned Aerial Vehicles (UAV), Unmanned Aerial Systems (UAS), maternal, obstetric, healthcare, medical products transportation and Malaysia. A discourse analysis followed and a narrative review was provided on this subject.

RESULTS AND DISCUSSION

The validated ability of drones in the delivery of blood products is highlighted as a possible application in improving maternal healthcare in Malaysia, particularly in the state of Sabah. Five key challenges are identified: infrastructure, technicalities, regulations, expertise, and social acceptance. Future predictions of drone technology in healthcare were outlined with the suggestion of three principle arms of application.

CONCLUSION

The usage of the medical drone in medical products transportation supports the objectives of WHO MDG 5 for Malaysian maternal health. A study on the impact of drones in reducing the maternal mortality ratio is recommended for further exploration.

Manipulation of Gut Microbiota Using Acacia Gum Polysaccharide

Acacia gum (AG) is a branched-polysaccharide gummy exudate that consists of arabinose and galactose. The traditional practice in African-Middle Eastern countries uses this gum as medicine. Traditional use of AG is to treat stomach disease, which can be a potential functional food. In this research, commercially available AG from Acacia senegal and Acacia seyal was investigated as the prebiotic. The experiment employed a pH-controlled in vitro colon model inoculated with human fecal microbiota to mimic the human colon. Fermentation samples at 0, 6, 12, and 24 h were brought for short-chain fatty acid (SCFA) analysis using high-performance liquid chromatography and bacterial enumeration via fluorescent in situ hybridization. Results showed that AG significantly promotes Bifidobacteria proliferation similar to fructo-oligosaccharides (FOS) while inhibiting the Clostridium histolyticum group, commonly associated with gut dysbiosis. Acetate, propionate, and butyrate showed a similar trend to FOS (p > 0.05). The AG shows potential against gut dysbiosis, as it promotes gut-probiotics, through modulation of microbial population and SCFA production, especially butyrate.

Antibiotic Resistance in Diarrheagenic Escherichia coli Isolated from Broiler Chickens in Pakistan

Background: Diarrheagenic Escherichia coli (DEC) strains are predominant cause of gastrointestinal tract illnesses. The main objective of the study was to determine antibiotic resistance in various types of DEC isolated from chicken broilers farmed in Pakistan. Methods: A total of 200 feces and 200 meat samples from broiler chickens were collected from the slaughtering shops in Southern Punjab, Pakistan. The confirmed fecal (n=150) and meat (n=150) E. coli isolates were investigated against 16 antibiotics. Fourteen virulence genes specific for Enteropathogenic (EPEC), Shiga Toxin-producing (STEC), Enteroinvasive (EIEC), Enteroaggregative (EAEC), and Enterotoxigenic (ETEC) E. coli were identified using Polymerase Chain Reaction. Results: EPEC was the most detected pathotype in both feces (76%) and meat (90%) samples, followed by STEC, EIEC, and ETEC. The highest resistance (40-90%) was observed against penicillin, oxytetracycline, and nalidixic acid in fecal isolates. More than 50% EPEC and EAEC fecal isolates, and 60% EAEC meat isolates were simultaneously resistant to 6 or more antibiotics. Conclusion: Conclusively, the broiler meat sold in open markets of Pakistan was considerably contaminated with multi-drug resistant DEC. To mitigate the issue, the gov- ernment should regulate the use of antibiotics at poultry farms and monitor slaughtering practices in slaughterer houses.

Currents Nutritional Practices of Nutritionists in the Management of Type 2 Diabetes Patients at Public Health Centres in Padang, Indonesia

(1) Background: The interest in nutrition practices and education is slowly gaining traction among Indonesian nutritionists. However, there is a lack of local studies that evaluate nutritional practices, especially in the management of type 2 diabetes (T2DM). This cross-sectional study aimed to determine the nutritional practices among nutritionists and the adequacy of the current practices in the management of Type 2 Diabetes Mellitus (T2DM) patients at the Public Health Clinic in Padang (PHC), Indonesia. (2) Methods: An online survey form was distributed to all the nutritionists (n = 50) involved in the management of T2DM patients in their daily practices at the PHC. Socio-demographic characteristics, the current practice of T2DM, the need for DM nutrition education, and an evaluation questionnaire on the Indonesian Non-Communicable Diseases guideline and the Public Health Centre guideline were captured in the survey. (3) Result: A total of 48 completed survey forms were received, providing a response rate of 96% from the recruited nutritionists. One-third (37.5%) of the respondents counselled between one and ten patients per day. Nearly half (41.7%) conducted a monthly follow-up session for the patients at their respective PHC in the previous three months. Each nutritionist educated five to ten T2DM patients. The most common nutrition education topics delivered included appropriate menus (89.6%) as well as the etiology and symptoms of T2DM (85.5%). Almost all the nutritionists (93.8%) used leaflets and about 35.4% used poster education. Around 70.8% of counseling sessions lasted 30 min and two-thirds (66.7%) of the sessions included nutrition education. Based on the results, about half (52.1%) of them claimed that T2DM patients were reluctant to attend individual nutrition education. One-fifth of them (20.8%) claimed that it was because the T2DM patients were not interested in the tool kits and materials used. (4) Conclusions: T2DM patients are reluctant to attend individual nutrition education due to uninteresting tool kits and materials.

OP0302-HPR IDENTIFYING THE CONTEXTUAL FACTORS IN THE PATIENT-PRACTITIONER ENCOUNTER THAT HAVE THERAPEUTIC EFFECT: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background:

Placebo or contextual effect is an integral part of the treatment effect (1). The factors related to this effect are “contextual factors” (CFs) (2). CFs may be categorised into five groups as factors related to practitioner, patient, practitioner-patient interaction, treatment and therapeutic environment (3). Several CFs have demonstrated their therapeutic effect, whereas others not (4). The majority of musculoskeletal pain relief result from CFs (5). Identifying the key CFs may encourage health practitioners to optimize the contextual aspects of care.

Objectives:

To identify the modifiable CFs that can improve clinical outcomes in published randomised controlled trials (RCTs).

Methods:

A systematic search was carried out, up until April 18th 2019, on the following databases: MEDLINE via Ovid, EMBASE, AMED, PsycINFO and Cochrane library. RCTs comparing contextual enhanced interventions versus non-enhanced control in adults for any health conditions were searched. The outcomes included both self-reported outcomes and objectively measured outcomes. The effect size and 95%confidence interval were calculated using the standard mean difference. Risk of bias was evaluated using the modified Cochrane tool. The random effects model was used to pool the results.

Results:

Of 3900 records generated from the systematic search, 15 trials (4615 participants) met the inclusion criteria, and 13 were included in this meta-analysis (Figure 1). Conditions studied included musculoskeletal [4], cardiovascular [2], irritable bowel syndrome [1], diabetes [1], asthma [1], GP or hospital patients [6]. Three CFs have been identified from these trials, including empathy, patient involvement and positive communication. All were found to be effective for patient experience i.e. satisfaction. Positive communication was also effective for symptoms but not objective outcomes (Table 1).

Table 1.

Summary of results.

OutcomeInterventionNumber of studies (Number of participants) SMD (95% CI)I2Patient experience outcomes,e.g. satisfactionEmpathy2 (137)0.45 (0.11, 0.79)42.2 %Patient involvement4 (1596)0.31 (0.21, 0.41)93.0 %Positive communication3 (793)0.38 (0.24, 0.52)93.9 %Symptomatic outcomes,e.g. painEmpathy1 (221)-0.18 (-0.45, 0.08)0.0 %Patient involvement1 (314)-0.05 (-0.27, 0.17)0.0 %Positive communication3 (658)0.20 (0.05, 0.35)64.8 %Objective outcomes,e.g. peak expiratory flowPositive communication2 (266)0.10 (-0.14, 0.34)66.6 %

Positive SMD favours intervention group. SMD= Standard mean difference, CI= Confidence interval, I2= heterogeneity.

Figure 1.

Summary of screening process.

Conclusion:

This systematic review has identified three CFs (empathy, patient involvement and positive communication) that have therapeutic effects for different conditions in trials, especially for self-reported outcomes. More research is needed to examine the clinical outcomes of CFs and to understand the influence of health practitioners on disease processes.

References:

[1]Zou K, Wong J, Abdullah N, Chen X, Smith T, Doherty M et al. Examination of overall treatment effect and the proportion attributable to contextual effect in osteoarthritis: meta-analysis of randomised controlled trials. Annals of the Rheumatic Diseases. 2016;75(11):1964-1970.

[2]Miller F, Kaptchuk T. The power of context: reconceptualizing the placebo effect. Journal of the Royal Society of Medicine. 2008;101(5):222-225.

[3]Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. The Lancet. 2001;357(9258):757-762.

[4]Howick J, Moscrop A, Mebius A, R Fanshawe T, Lewith G, L Bishop F et al. Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. Journal of the Royal Society of Medicine. 2018;111(7):240–252.

[5]Rossettini G, Carlino E, Testa M. Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain. BMC Musculoskeletal Disorders. 2018;19(1).

Disclosure of Interests:

None declared.

Effect of Food Colorants Supplementation on Reactive Oxygen Species, Antioxidant Vitamins Level and DNA Damage

There are various undesirable products generated from endogenous aerobic metabolism such as reactive oxygen species (ROS). Physiological and biochemical lesions are caused by ROS and which give rise to oxidative damages towards DNA, proteins and lipids which ultimately lead to cell death. This study was aimed to examine the effect of oral administration of food colorants (tartrazine and curcumin) on the oxidants and antioxidants level in blood and fecal of rats after 15, 30, and 45 days. Two doses were used based on the admissible daily intake (ADI) of 9.6 and 96 (high) mg/kg/body weight for tartrazine, 3.85 and 38.5 6 mg/kg/body weight for curcumin. The results showed that oral administration of tartrazine had significantly increased the total oxidant level, arylesterase, glutathione reductase, and MDA whereas there was significantly decreased the total antioxidants level, catalase, glutathione peroxidase in plasma and fecal after 30 and 45 days. Vitamin E and C were decreased in plasma. Fecal showed high level of vitamin A. High dose of tartrazine caused alteration in the aldehyde reactive probe (ARP) sites of DNA showing the DNA damage. After 45 day, significant increment was observed in the level of AST in low and high curcumin treated group. Whereas, elevations of arylestrase were seen in high curcumin group after 45 day. High dose of curcumin significantly (P≤ 0.05) decreased the concentration of vitamin C after 45 days of treatment and increased the level of vitamin E in plasma of treated groups after 30 and 45 days of treatment. The present study showed that the ADI and doses up to 10 times higher than ADI showed negative effects on antioxidant level and demonstrated the importance of using appropriate doses of food colorants such as tartrazine and curcumin in different processed food products.

Synergistic of antimicrobial activities of lactic acid bacteria in fermented Tilapia nicoliticus incorporated with selected spices

Fermented tilapia (Tilapia nicoliticus) is one of the famous fermented food in Malaysia. Lactic acid bacteria (LAB) which well known as GRAS (Generally Regarded as Safe) are present in most fermented foods and they are well-known non-pathogenic bacteria that play an important role in everyday life. Apart from LAB, spices have also been used for centuries across different regions of the world to improve aroma, flavour and food preservative. This research was aimed to explore a potential natural food preservative using LAB isolated from fermented Tilapia nicoliticus incorporated with various spices (9% turmeric, 6% chilli and 9% black pepper) against foodborne pathogens. The isolation of LAB in different media (MRS, MRS+CaCO3, M17 and Tomato Juice Agar) showed the highest LAB count on day-9 and day-15 during the fermentation period in fermented Tilapia incorporated with black pepper, turmeric and chilli. The highest antimicrobial activity by LAB against Bacillus cereus was observed in fermented tilapia incorporated with black pepper. On the other hand, fermented fish incorporated with chilli showed the highest antimicrobial activity against Staphylococcus aureus, Escherichia coli and Salmonella enterica serovar Typhimurium. Higher antimicrobial activity was detected in fermented Tilapia in the presence of LAB together with the spices, in comparison to the presence of LAB alone, suggesting synergistic effects between LAB in fermented fish with spices could enhance stronger antimicrobial activities against food pathogens and therefore, served as a natural food preservative.

Recovery of Gelatin from Bovine Skin with the Aid of Pepsin and Its Effects on the Characteristics of the Extracted Gelatin

Pepsin enzyme was used to pretreat the bovine skin at the rate of 5, 15, and 25 units of enzyme/g of skin to recover gelatin, and the recovered gelatins were referred to as Pe5, Pe15, and Pe25, respectively. The gelatin yield increased significantly (p < 0.05) from 18.17% for Pe5 to 24.67% for Pe25 as the level of pepsin increased, but the corresponding gel strength and viscosity decreased significantly (p < 0.05) from 215.49 to 56.06 g and 9.17 to 8.17 mPa·s for Pe5 and Pe25, respectively. β- and α1- and α2-chains were degraded entirely in all the gelatins samples as observed in protein pattern elaborated by gel electrophoresis. ¹H nuclear magnetic resonance (¹H NMR) analysis indicated the coiled structure of gelatin protein chains. The lowest amide III amplitude of Pe25 as found by Fourier transform infrared (FTIR) spectroscopy indicated that α-helix structure of protein chains were lost to more irregular coiled structure. Thus, it could be summarized that pepsin might be used at the lower level (5 units/g of wet skin) to extract gelatin from bovine skin with good functional properties and at higher level (15/25 units/g of wet skin) to obtain gelatin of industrial grade with high yield.

Oxygen radical antioxidant capacity (ORAC) and antibacterial properties of Melicope glabra bark extracts and isolated compounds

Melicope glabra (Blume) T. G. Hartley from the Rutaceae family is one of the richest sources of plant secondary metabolites, including coumarins and flavanoids. This study investigates the free radical scavenging and antibacterial activities of M. glabra and its isolated compounds. M. glabra ethyl acetate and methanol extracts were prepared using the cold maceration technique. The isolation of compounds was performed with column chromatography. The free radical scavenging activity of the extracts and isolated compounds were evaluated based on their oxygen radical absorbance capacity (ORAC) activities. The extracts and compounds were also subjected to antibacterial evaluation using bio-autographic and minimal inhibitory concentration (MIC) techniques against two oral pathogens, Enterococcus faecalis and Streptococcus mutans. Isolation of phytoconstituents from ethyl acetate extract successfully yielded quercetin 3, 5, 3’-trimethyl ether (1) and kumatakenin (2), while the isolation of the methanol extract resulted in scoparone (3), 6, 7, 8-trimethoxycoumarin (4), marmesin (5), glabranin (6), umbelliferone (7), scopoletin (8), and sesamin (9). The study is the first to isolate compound (1) from Rutaceae plants, and also the first to report the isolation of compounds (2–5) from M. glabra. The ORAC evaluation showed that the methanol extract is stronger than the ethyl acetate extract, while umbelliferone (7) exhibited the highest ORAC value of 24 965 μmolTE/g followed by glabranin (6), sesamin (9) and scopoletin (8). Ethyl acetate extract showed stronger antibacterial activity towards E. faecalis and S. mutans than the methanol extract with MIC values of 4166.7 ± 1443.4 μg/ml and 8303.3 ± 360.8 μg/ml respectively. Ethyl acetate extract inhibited E. faecalis growth, as shown by the lowest optical density value of 0.046 at a concentration of 5.0 mg/mL with a percentage inhibition of 95%. Among the isolated compounds tested, umbelliferone (7) and sesamin (9) exhibited promising antibacterial activity against S. mutans with both exhibiting MIC values of 208.3 ± 90.6 μg/ml. Findings from this study suggests M. glabra as a natural source of potent antioxidant and antibacterial agents.

The Missing Uterus, the Missed Diagnosis, and the Missing Care. Mayer-Rokitansky-Küster-Hauser Syndrome in the Lives of Women in Malaysia

STUDY OBJECTIVE

To explore the effect of the diagnosis of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome on affected Malaysian women.

DESIGN

Qualitative study with a quantitative component.

SETTING

Pediatric and adolescent gynecology unit at Universiti Kebangsaan Malaysia Medical Centre, Malaysia.

PARTICIPANTS

Twelve women with MRKH.

INTERVENTIONS

Face-to-face interview and short questionnaire.

MAIN OUTCOME MEASURES

Thematic analysis was used to understand participants' experiences.

RESULTS

There were 7 themes identified: (1) delayed diagnoses; (2) doctors' roles and attitudes; (3) gender identity; (4) family and society's response; (5) reaction toward infertility; (6) managing sexual intimacy; and (7) coping mechanisms. Several participants consulted their physicians regarding their primary amenorrhea at an opportunistic setting. When they were referred to the gynecologists, they were dismayed at the lack of information given. The term, "MRKH" plays an important role to ease information-seeking. Participants felt that the doctors were insensitive toward them. Mental illness is a significant complication of MRKH. All participants acknowledged that infertility was the hardest part of the condition. The importance of blood lineage affects their outlook on childbearing options. Some were afraid of sexual intimacy and worried that they would not be able to satisfy their partners. Participants gained support and bonded with their counterparts in the MRKH support group.

CONCLUSION

A multidisciplinary approach including medical, psychological, and social support is essential for the management of MRKH. Adequate information and sexual education plays the utmost importance in preventing social-related complications of MRKH.

Cytotoxic constituent of Melicope latifolia (DC.) T. G. Hartley

An undescribed conjugated sesquiterpene, amelicarin (1), together with nine known compounds (2-10) were isolated for the first time from Melicope latifolia. Their structures were elucidated by extensive NMR spectroscopic and mass spectrometric methods. The conjugated sesquiterpene possesses a unique 6/6/9/4-ring fused tetracyclic skeleton. The proposed biosynthesis pathway of 1 consist of three reactions steps: (1) polyketide formation, (2) cyclisation and (3) addition to form the conjugated sesquiterpenoid as final metabolite. Out of the ten isolated metabolites, amelicarin (1) showed activity against 4 cancerous cell lines namely SK-MEL skin cancer, KB oral cancer, BT-549 breast cancer, and SK-OV-3 ovarian cancer with IC₅₀ values between 15 and 25 µg/mL.

A Comparison of Nutritional Status, Knowledge and Type 2 Diabetes Risk Among Malaysian Young Adults With and Without Family History of Diabetes

BACKGROUND

Genetic factors increase the risk of type 2 diabetes mellitus (T2DM). Thus, family history status may be a useful public health tool for disease prevention. This study compared the nutritional status, knowledge level, and T2DM risk among young adults with and without a family history of diabetes in Malaysia.

METHODS

A total of 288 university students aged 18 to 29 years participated in this comparative cross-sectional study. We assessed dietary intake, level of physical activity, knowledge of diabetes and T2DM risk.

RESULTS

Respondents with a family history of diabetes had significantly higher weight (P = 0.003), body mass index (P < 0.001), waist circumference (P < 0.001), diabetes knowledge level (P < 0.005) and T2DM risk (P < 0.001). Ethnicity, fibre intake, T2DM risk score and knowledge about diabetes were significant contributors toward family history of diabetes (P = 0.025, 0.034, < 0.001 and 0.004, respectively).

CONCLUSION

Young adults with a family history of diabetes had suboptimal nutritional status. Despite being more knowledgeable about diabetes, they did not practice a healthy lifestyle. Family history status can be used to screen young adults at the risk of developing T2DM for primary disease prevention.

Food forensics on gelatine source via ultra-high-performance liquid chromatography diode-array detector and principal component analysis

This study provided a step-by-step procedure to investigate the distribution of 17 amino acids (AAs) in 50 fish, 50 bovine and 54 porcine gelatines using Ultra-High-Performance Liquid Chromatography Diode-Array Detector (UHPLC–DAD) with the incorporation of principal component analysis (PCA). Dataset pre-processing step, including outlier removal, analysis of variance (ANOVA), dataset adequacy test, dataset transformation and correlation test was performed before the PCA. The method rendered linearity range of 37.5–1000 pmol/µL and accuracy of 85–111% recovery. The bovine and porcine gelatines showed a similar ranking while the l-Alanine (Ala), l-Arginine (Arg) and l-Glutamic acid (Glu) concentrations had differed the fish gelatine from the bovine and porcine gelatines. The PCA, which explained 77.013% cumulative variability at eigenvalue of 5.436, showed AAs with strong FL in PC1 had polar and nonpolar side chains while AAs with strong FL in PC2 had polar side chain. The AAs with moderate and weak FL in PC1 had a nonpolar side chain. The AAs with strong FL of in PC1 were also the same AAs with 7, 6 and 5 strong CMs as determined in the correlation test. The second PCA showed that the l-Serine (Ser), Arg, Glycine (Gly), l-Threonine (Thr), l-Methionine (Met), l-Histidine (His) and L-Hydroxyproline (Hyp) were significant in fish gelatine; Hyp, Met, Thr, Ser, His, Gly, and Arg in bovine gelatine; and l-Proline (Pro), l-Tyrosine (Tyr), l-Valine (Val), l-Leucine (Leu), and l-Phenylalanine (Phe) in porcine gelatine. The 100% fish, bovine and porcine gelatines accommodated grouping 1, 2 and 3, respectively, which proved that AAs with strong FL (Hyp, His, Ser, Arg, Gly, Thr, Pro, Tyr, Met, Val, Leu and Phe) were the significant AAs and becomes the biomarkers to identify the gelatine source. From this study, the PCA was a useful tool to analyse a multivariate dataset that could provide an in-depth understanding of AA distributions as compared to ANOVA and correlation test.

Effects of Cocoa Polyphenols and Dark Chocolate on Obese Adults: A Scoping Review

Obesity remains a major public health problem due to its increasing prevalence. Natural products have become common as adjunct therapeutic agents for treating obesity and preventing metabolic diseases. Cocoa and its products are commonly consumed worldwide. Dark chocolate, a rich source of polyphenols, has received attention lately for its beneficial role in the management of obesity; however, conflicting results are still being reported. This scoping review aims to provide a comprehensive understanding of the existing literature on the relationship and effects of cocoa and dark chocolate intake among obese adults. We searched multiple databases for research investigating the consumption of cocoa and/or dark chocolate in managing obesity among adults. This review includes epidemiological and human studies that were published in English over the last 10 years. Our review of the current literature indicates that epidemiological and human trials with obese adults have shown inconsistent results, which may be due to the different populations of subjects, and different types of cocoa products and doses used for intervention. Studies among obese adults are mainly focusing on obese individuals with comorbidities, as such more studies are needed to elucidate the role of cocoa polyphenols in weight control and preventing the risk of chronic diseases among obese individuals without comorbidities as well as healthy individuals. Careful adjustment of confounding factors would be required. The effects of cocoa and dark chocolate intake on obese adults were discussed, and further research is warranted to identify the gaps.

Global longitudinal strain predicts survival and response in patients with systemic AL amyloidosis. analysis of 915 patients from the ALchemy prospective trial

Background

Cardiac involvement determines prognosis in systemic AL amyloidosis. The extent is assessed by biomarker-based staging systems. This a prospective report of a large cohort of patients assessing the utility of changes in longitudinal function by 2D strain (GLS%), impairment - a hallmark of amyloidosis.

Purpose

To evaluate the prognostic role of GLS% and other echocardiographic parameters in systemic AL amyloidosis.

Methods

915 newly diagnosed patients seen at the UK National Amyloidosis Centre (February 2010–August 2017) were included. All patients underwent 6-monthly comprehensive assessments inclusive of echocardiogram. The European modification of the Mayo 2004 staging was used with Mayo stage III patients stratified into IIIa (NT-proBNP &lt;8500ng/L) and IIIb (NT-proBNP ≥8500ng/L).

Results

653/915 (71.4%) patients had cardiac involvement. Mayo stage 1, 2, 3a and 3b in 144 (15.7%), 302 (33.0%) 344 (37.6%) and 125 (13.7%) respectively. The median NT-proBNP was 2228ng/L and TNT was 0.54ng/ml. The GLS% significantly worsened with increasing Mayo stage (p&lt;0.0001 between GLS% for each Mayo stage). Poorer baseline GLS% associated with significantly worse OS and stratified patients into three groups: GLS% &lt;−12.8%: OS 69.1 months; GLS% −12.8% to −9%: OS 54.5 months; GLS% &gt;−9%: OS 45.3 months (p&lt;0.0001). On univariate analysis, 11/14 parameters predicted survival (LV wall thickness, LV ejection fraction, systolic velocities of the septal (s'sep) and lateral mitral annulus (s' lat), mitral annulus movement at the lateral corner (e' lat), transmitral early peak flow velocity (E) divided by tissue Doppler mitral annular motion velocity (e') – E/e' and mitral annular plane systolic excursion (MAPSE)). Baseline GLS% &gt;−17% was independent of Mayo stage in predicting survival [Mayo II: Hazard ratio (HR) 2.10 (95% CI: 1.12–3.92) p=0.02, Mayo III: HR 3.94 (95% CI: 2.13–7.32) p&lt;0.0001, Mayo IV: HR 7.49 (95% CI: 3.94–14.21) p&lt;0.0001, GLS &lt;17%: HR 2.14 (95% CI: 1.59–2.88) p&lt;0.0001]. At 12 months, only patients in a haematological complete response (CR) had significant improvement in overall GLS% (p=0.02) as well as baso-lateral (p=0.0004) and baso-septal (p=0.0001) GLS% and MAPSE (p=0.002). The OS was significantly better in patients who achieved a minimum absolute improvement in GLS% of 1.5% improvement (not reached in those with improved GLS% vs. 72 mo in those without) (p=0.034)).

Conclusion

These data show that baseline GLS% is an independent predictor of survival in AL amyloidosis. GLS% is the first functional marker that is independent of the Mayo staging in predicting outcomes and should be incorporated in prognostic staging for patients with AL amyloidosis. GLS% shows improvement in patients who achieve a complete haematologic response to treatment and improvement in GLS% of 1.5% is associated with improved outcomes. An absolute improvement in GLS% should be considered as a criterion for cardiac response in AL amyloidosis.

Funding Acknowledgement

Type of funding source: None