Quantitative ethnomedicinal study and conservation status of medicinal flora used by the indigenous peoples of Sultan Khail valley, Dir Upper, Pakistan

The present study was conducted to explore the ethnomedicinal uses, quantitative analysis and conservation status of medicinal flora of Sultan Khail valley, Dir Upper, Pakistan. The data was collected during 2017-2019 using a semi-structured questionnaire. Ethnomedicinal uses of plant species were determined and the plant species were classified based on habits, parts used, and method of preparation of remedies. Frequency of citation (FC), relative frequency of citation (RFC) and family importance values (FIV) were calculated. The plant species were assessed for their conservation status as per IUCN standard criteria. The inhabitants of the Sultan Khail valley use 88 plant species belonging to 57 families for the treatment of different human diseases. Lamiaceae was the dominant family represented with 8 medicinal species (9%) followed by Rosaceae (5 species, 6%). The most commonly used plant parts were leaves (33.1%) followed by fruits (16.1%), while the main method of remedy preparation was decoctions (33.3%). The highest RFC value was recorded for Geranium wallichianum (0.47), followed by Berberis lycium (0.44). Lamiaceae was the most cited family (FIV, 231), followed by Polygonaceae (73). Five plant species were found to be endangered, 39 species were vulnerable, 32 species were rare, and 12 species were found to be infrequent. The medicinal flora of the area is under severe biotic pressure and needs proper conservation; otherwise, they will be lost in the near future.

Insight into the electronic structure of the centrosymmetric skyrmion magnet GdRu2Si2

The discovery of a square magnetic-skyrmion lattice in GdRu2Si2, with the smallest so far found skyrmion size and without a geometrically frustrated lattice, has attracted significant attention. In this work, we present a comprehensive study of surface and bulk electronic structures of GdRu2Si2 by utilizing momentum-resolved photoemission (ARPES) measurements and first-principles calculations. We show how the electronic structure evolves during the antiferromagnetic transition when a peculiar helical order of 4f magnetic moments within the Gd layers sets in. A nice agreement of the ARPES-derived electronic structure with the calculated one has allowed us to characterize the features of the Fermi surface (FS), unveil the nested region along kz at the corner of the 3D FS, and reveal their orbital compositions. Our findings suggest that the Ruderman-Kittel-Kasuya-Yosida interaction plays a decisive role in stabilizing the spiral-like order of Gd 4f moments responsible for the skyrmion physics in GdRu2Si2. Our results provide a deeper understanding of electronic and magnetic properties of this material, which is crucial for predicting and developing novel skyrmion-based systems.

Influence of Sapindus mukorossi extract in comparison to 17% EDTA as final root canal irrigant on the sealer penetration and microleakage of dentinal tubules

OBJECTIVE

The study evaluated the effect of Sapindus mukorossi (SM) extract as a final root canal irrigant on sealer penetration (SP) in dentinal tubules and microleakage.

MATERIALS AND METHODS

Samples were selected based on inclusion and exclusion criteria. An access opening in all samples was performed and the working length was decided using pro taper for canal finishing along with constant irrigation. Specimens were randomly divided into 3 groups. Group 1 was irrigated with 3 ml of 17% EDTA; group 2 was irrigated with SM irrigant and group 3 samples were irrigated with 0.9% saline. After obturation, samples were vertically placed in 1% methylene blue dye cut in half longitudinally, and viewed under a stereomicroscope. Analysis of SP in the dentinal tubule was assessed using scanning electron microscopy (SEM). For microleakage assessment, mean and standard deviation were reported and One-Way ANOVA was applied. SP was compared using Kruskal-Wallis' test. For inspecting the interaction between SM/EDTA and NaOCl, Fisher's exact test was applied. No statistically significant difference between microleakage in any of the tested groups was observed. The control group showed minimum leakage as compared to EDTA and SM.

RESULTS

The results displayed that there was no significant difference, (p=0.67), between dentinal tubule SP at 2 mm. A significant difference between dentinal tubule SP among groups at 5 mm was observed (p<0.05).

CONCLUSIONS

SM ethanolic extract showed comparable outcomes of smear layer removal and sealer penetration to 17% EDTA, as a final irrigant in root canal cleaning. Therefore, SM has the potential to be used as an adjuvant final irrigant in conjunction with NaOCl.

Do e-cigarettes have a part to play in peri-implant diseases?

DESIGN

Systematic review.

DATA SOURCES

The following databases were searched for publications up to May 2022: Medline, EMBASE, Scopus, Web of Science, LILACS, Cochrane and Open Grey. Additionally, four journals were hand searched.

STUDY SELECTION

Clear inclusion and exclusion criteria were provided. A focused question was outlined using PICO format. A full search protocol was supplied, and all study designs were considered.

DATA EXTRACTION AND SYNTHESIS

Two reviewers screened 97 articles after de-duplication. Fourteen full-text articles were assessed. Data were collected using a spreadsheet.

RESULTS

Four cross-sectional studies were included in the systematic review, all reporting on male participants. Meta-analysis was performed highlighting worse outcomes in electronic cigarette (e- cigarette) user group regarding increased bone loss, probing depth, plaque index and bleeding on probing, as well as increased levels of inflammatory cytokines, when compared to never-smokers.

CONCLUSIONS

From the limited number of studies available, e-cigarettes appear to have a negative impact on dental implant outcomes in male patients.

Tuning the carrier injection barrier of hybrid metal-organic interfaces on rare earth-gold surface compounds

Magnetic hybrid metal-organic interfaces possess a great potential in areas such as organic spintronics and quantum information processing. However, tuning their carrier injection barriers on-demand is fundamental for the implementation in technological devices. We have prepared hybrid metal-organic interfaces by the adsorption of copper phthalocyanine CuPc on REAu₂ surfaces (RE = Gd, Ho and Yb) and studied their growth, electrostatics and electronic structure. CuPc exhibits a long-range commensurability and a vacuum level pinning of the molecular energy levels. We observe a significant effect of the RE valence of the substrate on the carrier injection barrier of the hybrid metal-organic interface. CuPc adsorbed on trivalent RE-based surfaces (HoAu₂ and GdAu₂) exhibits molecular level energies that may allow injection carriers significantly closer to an ambipolar injection behavior than in the divalent case (YbAu₂).

1207 EXPLORING AUDIO-RECORDING IN TERMINAL ILLNESS - THE HOSPICE BIOGRAPHERS MODEL

Introduction

The therapeutic benefits of narrative in terminally ill patients is widely studied and evidenced in the research literature. The Hospice Biographers are a charity offering a professional free service for end-of-life patients the opportunity to audio-record their life story in a memory stick and to keep copies for themselves and for their families. The objective of this qualitative study is to explore the experience of a group of people either recording or listening to an audio-biography.

Methods

Five semi-structured in-depth interviews with terminally ill adults who recorded an audio-biography and another interview with a family member were conducted virtually. Transcripts of the zoom interviews were coded using thematic analysis.

Results

Our findings showed that patients found talking to a trained audio-biographer provided a neutral, non-judgemental interlocutor. The biographer helped them reminisce in a guided conversation navigating their life stories in chronological order. The experience of planning for the recording varied from preparing a mind-map, to writing down some guide notes or no preparation at all. Patients reported a feeling of catharsis while telling their stories as well as being able to reflect on and analyse significant life events. However, it was challenging to convey difficult emotions whilst being mindful of how patients’ life stories might be perceived by families. Although there was a degree of uncertainty about impact of the recording upon listeners, it was felt that leaving a voice-recorded account would still be informative and beneficial. A personal narrative could also provide a wider historical account of the relevant time period. Some individuals fed back that they would have valued the opportunity to edit their recording after listening and include a visual element.

Conclusions

Recording an audio-biography in terminal illness allows patients a space for reflection and provides a valued connection with immediate family members and future generations.

1285 IMPLEMENTATION OF A MEDICINE MANAGEMENT PLAN TO REDUCE MEDICATION-RELATED HARM IN OLDER PEOPLE POST-HOSPITAL DISCHARGE - AN RCT

Introduction

Medication-related harm (MRH) events are increasing among older adults especially in the 8-weeks after hospital discharge. The Discharge Medical Service (DMS), a UK initiative, aims to reduce post-discharge MRH. In this study, we will compare the clinical, economic, and service outcomes of the DMS.

Method

Using a randomised control trial design, 682 older adults ≥ 65years due for hospital-discharge will be recruited. Participants will be randomized to either intervention arm (medicine management plan (MMP) and DMS), or control arm (DMS only) using a 1:1 stratification. The MMP includes patient and carer education about MRH, copy of discharge medications, and MRH risk score calculated using a validated prediction tool (1). Data collection includes patient clinical and social demographics, and admission and discharge medications. At 8-weeks post discharge, study pharmacist will verify MRH through patient telephone interview, and review of patients’ GP records.

Data Analysis

Univariate analysis will be done for baseline variables comparing the intervention and control arms. Variables known to be associated with MRH will be described by the randomisation groups. Further multivariate logistic regression will be done incorporating these variables. Economic evaluation will compare the cost-of-service use among the two arms and modelled to provide national estimates. Qualitative data from focus group interviews at participating hospital sites will explore practitioners’ understanding and acceptance of the DMS and MMP.

Conclusion

This study will inform the use of a validated MRH risk prediction tool, and provide a clinical, and economic evaluation of the DMS and MMP in the NHS. The study has ethics approval and is adopted in the national ageing research portfolio. We are seeking additional sites.

Reference

1. Parekh N, Ali K, Davies JG et al. Medication-related harm in older adults following hospital discharge: development and validation of a prediction tool. BMJ Quality and Safety 2020; 29: 142–53.

1283 MEDICATION-RELATED HARM (MRH) IN OLDER PEOPLE AFTER LEAVING HOSPITAL - AN UNDER-REPORTED EGYPTIAN CHALLENGE

Introduction

Ageing is associated with multimorbidity, polypharmacy and medication-related harm (MRH). A 2013 systematic review reported only one study of medication errors (MEs) in older Egyptian patients. Our study investigated MRH (adverse drug reactions (ADR), drug errors, and non-adherence) in older Egyptian adults after hospital-discharge.

Methods

Between 2018 and 2020, we recruited 400 Egyptian patients, aged ≥60 years on discharge from Geriatrics and Internal Medicine wards from 3 hospitals, and followed them up for 8 weeks. Study procedures adopted a modified PRIME trial methodology (1).

Results

The average age of study participants was 71 (range 60 to 93, SD +/- 6.29) years with 53% females. In the cohort of 325 patients completing follow up, MRH occurred in 99 patients (incidence of 30.5%), with 5 patients (5.1%) experiencing a fatal MRH. Almost two thirds (65.7%) of MRH events were secondary to ADRs, 2 % related to non-adherence, 18.2 % due to both ADR and non-adherence, and 14% related to MEs. Multivariate logistic regression analysis showed that non-adherence (p-value 0.000, OR- 95% CI: 36.029), inappropriate prescription using Beer’s criteria (p 0.000, OR- 95% CI: 6.589), length of stay &gt;7days (p 0.001, OR- 95% CI: 6.176), presence of Ischaemic Heart Disease (IHD) (p 0.000,OR- 95% CI: 5.695), Platelets count ≤ 245X 109/L (p 0.021, OR- 95% CI: 2.640), and dementia medications (p 0.017, OR- 95% CI: 4.616) were all significantly associated with MRH.

Conclusions

Medication-related harm in older Egyptian adults is common after hospital discharge. An integrated care pathway is required targeting high-risk older patients.

Reference

1. Stevenson J, Parekh N, Ali K et al. Protocol for a Prospective (P) study to develop a model to stratify the risk (RI) of medication (M) related harm in hospitalized elderly (E) patients in the UK (The PRIME study). BMC Geriatrics 2016; 16: 22. https://doi.org/10.1186/s12877-016-0191-8.

1299 CO-CREATING A VIDEO FOR TRAINING HEALTHCARE PROFESSIONALS IN DEMENTIA

Introduction

There are 400 thousand people living with dementia (PLWD) in Egypt. Most of the care for PLWD is delivered by family members. Healthcare Professionals (HCP) supporting these families need adequate training. Involving HCP in designing and producing training material ensures sustainability of these educational resources as their content will be socially and culturally relevant.

Methods

The first part of the project involved the lead author (OM) meeting with two geriatricians to identify common challenging situations in dementia. A short video for training HCP in dementia using these situations was produced, based on OM lived experience, and then shared with two old-age psychiatrists for comments. Feedback on the video was subsequently obtained via semi-structured interviews with 16 HCP (2 doctors, 1 nurse, 1 dietitian, 1 communication therapist, 2 social workers, and 9 clinical psychologists) either in person (3), over the phone (1), or virtually (12) approached in two institutions for ageing in Cairo and Alexandria in 2021. The video was finally checked by an adult psychiatrist for consistency with non-violent communication approaches. All interviews were analysed using a thematic framework. Comments and feedback were used to co-produce a final version of the video.

Results

From the initial co-design phase, six frequently-encountered situations were identified: anger, low mood, wandering, repetitive behaviour, refusing support with activities of daily living, and sleep disturbance. Five key qualities for appropriate response in these situations were agreed on: kindness, sensitivity, compassion, avoiding confrontation, and shared-decision making in activities of daily living. The subsequent co-production phase with 19 HCP resulted in an 18-minute: 43-seconds simulation video of six challenging interactions between PLWD and their carers. The video is now freely available on YouTube, https://m.youtube.com/watch?v=ylINBXZwH8M&feature=youtu.be

Conclusions

Involving healthcare professionals in dementia in co-creating a video for training their peers led to a freely available online educational resource.

Genetic variation between hybrid (Labeo rohita ♂, Cirrhinus mrigala ♀ and Labeo rohita) by RAPD marker

The present work was to study the genetic variability between the major carps Labeo rohita and Cirrhinus mrigala and their hybrids of L. rohita (male♂) and C. mrigala (female♀). Genetic variability was studied by employing RAPD molecular markers. 25 samples of each target species having different sizes with the same age group for the determination of interspecific variation were collected. The morphometric parameters such as body weight, total length, tail length, and lengths of dorsal and anal fins of each individual were recorded and results showed that wet body weight, total length, dorsal fin, anal fin, and tail fin length are positively correlated and then the DNA was extracted using the inorganic salt-based method and conformed by Gel electrophoresis. Twenty-four arbitrary decamer primers were used to get species-specific RAPD analysis Distinct and highly reproducible RAPD profiles with significant genetic variability was detected among species. Only five primers showed amplification. The RAPAD primer OPB-05 produced a total of seven bands out of these 5 monomorphic and 2 polymorphic, so in this case, the percentage polymorphism was 28.57%. The Hybrid show more than a 50% difference from the Labeo rohita. This shows that the Hybrid more resembles C.mrigala. Phylogenetic analysis demonstrated that hybrid (L. rohita ♂ X Cirrhinus mrigala ♀) is the closest to C. mrigala and the farthest from L. rohita. Overall data are presented concerning the applications of RAPD markers for hybrid identification, genetic diversity assessment, and studying taxonomic relationships at a molecular level.

Implant abutment disinfection using plasma of argon and 0.2% and chlorhexidine gel applications immediately before prosthesis delivery: clinical and radiographic status at 5-years of follow-up

OBJECTIVE

The purpose of this five-year follow-up study was to investigate the clinical and radiologic status of implants that had undergone abutment disinfection immediately prior to prosthetic loading (PL) using plasma of argon (PA) or 0.2% chlorhexidine (CHX) gel.

PATIENTS AND METHODS

Sixty patients who had had an implant-supported prosthesis fitted at least five years previously were recruited for this study. In groups 1, 2, and 3, implant abutment disinfection was performed using PA, 0.2% CHX, and a vapor protocol, respectively. Modified plaque index (mPI), modified bleeding index (mBI), probing depth (PD), and mesial and distal crestal bone loss (CBL) were measured. A questionnaire on routine oral hygiene, smoking habits, and systemic health status was also administered. Sample size estimation was performed, and group comparisons were made. Probability values less than 0.05 were considered statistically significant.

RESULTS

Group 1, 2, and 3 included 20 (20 implants) patients each. At five-year's follow-up, there was no difference in mBI, mPI, and PD in all groups. There was no significant difference in peri-implant CBL in all patients. None of the patients were immunosuppressed or had periodontal disease, and or had used nicotinic products within the past five years. Toothbrushing twice daily was reported by at least 90% of individuals in all groups. Flossing of interproximal spaces once daily was reported by at minimum 60% of individuals in all groups.

CONCLUSIONS

Disinfection of implant abutments directly before PL can be performed using AP, or 0.2% CHX gel.

Effect of Post Dilatation on TIMI Flow in Patients Undergoing Primary Percutaneous Coronary Intervention

Objective: To evaluate the impact of post dilatation performed with Non- Compliant Balloon on Angiographical outcome (that is TIMI flow grade) in patients who underwent the primary percutaneous coronary intervention. Study Design: Retrospective cross-sectional study. Place and Duration of Study: At Tertiary Cardiac Care Center, Rawalpindi Pakistan from Nov 2020 to Apr 2021. Methodology: The retrospective data of the all the patients with STEMI was assessed via non-probability consecutive sampling technique and analyzed statistically. The study participants were classified into two categories based on whether they underwent post-dilatation or not, i.e., Category-I: patients who underwent post-dilatation with NC balloon and Category-II: patients who did not undergo post-dilatation. The primary study end-point was post-dilatation TIMI flow grade. Continuous study variables were expressed as Mean±S.D and categorical variables as frequencies and percentages. Chi square test was applied to find the association between study variables by keeping 95% CI and 5 % margin of error. p-value <0.05 was considered statistically significant. Results: The study included (n=410) eligible patients in total. Majority were males (n=303; 73.9%), 217 (52.9 %) patients underwent PD procedure. TIMI flow grade did not differ significantly between the two study categories (p-value > 0.05). Postprocedural success rate was 81.3% for patients with PD. Conclusion: The current study illustrates that PD does not adversely affect the final angiographic outcomes when performed after primary angioplasty. 

Frequency of Subacute Stent Thrombosis (SAT) in Patients Presenting with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention (PCI)

Objective: To assess the rate of occurrence of sub-acute Stent Thrombosis (SAT) after primary PCI in the patients presented with the acute coronary syndrome. Study Design: Retrospective cross-sectional study. Place and Duration of Study: At Tertiary Cardiac Care Center of Lahore Pakistan, from Jul 2019 to Jun 2021. Methodology: The retrospective demographical and angiographic data of the admitted patients who underwent PCI for ACS,was gathered from the Hospital Registry of a tertiary cardiac care center of Lahore. The sampling technique was nonprobability consecutive sampling, and all the data was analyzed using SPSS 20.0 and continuous data was presented as Mean±SD and frequencies & percentages for categorical variables. Chi square test (CI=95%, α=5%) was used to find the association of SAT with predisposing factors. p-value < 0.05 was taken as statistically significant. Results: Out of (n=551) patient underwent PPCI, the stent thrombosis was observed to occur in 29(5.2 %), among which 4.9 % were subacute stent thrombosis. The predisposing factors of sub-acute stent thrombosis were Diabetes Mellitus, ACS, smaller vessel size, presence of bifurcation lesion, under sizing of the stent and edge dissection and were in significant association with SAT (p < 0.05). Conclusion: Our study reveals that subacute stent thrombosis is an event with a comparatively higher frequency in patients who go through primary PCI for acute coronary syndrome, demonstrating a frequency of 4.9% and a mortality rate of 74% within 30 days of the procedure.

Association between plasma desmosine, a marker of elastin degradation, and total atherosclerotic burden measured by whole body magnetic resonance angiography

Background

Elastin degradation has been implicated in the pathophysiology of vulnerable atherosclerotic plaque. Desmosine is the cross-link component in the elastin molecule and is exclusively released from mature elastin breakdown, thus has the potential to be a physiologically relevant biomarker of atherosclerosis.

Objectives

The aim of the present study was: 1. To investigate whether patients with known cardiovascular disease (CVD) have higher elastin degradation as indicated by plasma desmosine (pDES); 2. to determine the relationship between pDES and total atherosclerotic burden.

Methods

We measured pDES by a validated stable isotope dilution LC-MS/MS method1 in a total of 146 subjects from the SUMMIT (SUrrogate markers for Micro- and Macro-vascular hard endpoints for Innovative diabetes Tools) study2. (62% male, mean age 64±8 (SD) years). This included 62 patients with prior clinical diagnosis of CVD (including coronary artery disease (CAD), cerebrovascular disease and/or lower extremity arterial disease (LEAD)), and 84 patients without a clinical diagnosis of CVD. Total atherosclerotic burden was measured by whole body magnetic resonance angiography (WB-MRA). The WB-MRA data was divided into 31 anatomical arterial segments with each segment scored according to degree of luminal narrowing: 0 = no stenosis, 1 = &lt;50% stenosis, 2 = 51–70% stenosis, 3 = 71–99% stenosis, 4 = vessel occlusion. The segment scores were summed and from this, a standardized atheroma score (SAS) was calculated by summing each individual segment's stenosis score, and divided by the number of diagnostic segments before dividing by 4 which is the maximum potential score. Relationship between SAS and pDES levels was investigated using multiple linear regression models

Results

pDES levels were significantly greater in patients with established clinical CVD compared to patients with no CVD (CVD patients, 0.56 (0.45–0.67) ng/mL; patients with no CVD, 0.47 (0.41–0.54)ng/mL; p=0.001). Median SAS for the study population was 4 (2–10). Overall pDES levels showed a strong correlation with SAS (r=0.44, p≤0.001). Univariable analysis suggested a significant association between pDES and whole-body atheroma score as measured by SAS. (β 29.31, p&lt;0.001). This association persisted in the multivariable regression model adjusting for traditional cardiovascular risk factors including age, gender, BMI, systolic blood pressure, diabetes, smoking status and LDL. (adjusted β 18.75, p=0.004)

Conclusion

pDES levels are elevated in patients with clinical CVD when compared to those with no clinical history of CVD. pDES is also strongly associated with global atheroma burden. Overall, these findings support the role of pDES as a potential biomarker for atherosclerosis.

Funding Acknowledgement

Type of funding sources: None.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

What is the value of simulated patient assessment in structured clinical examinations of undergraduate students, and how should it be used?

INTRODUCTION

The aim of this study was to explore correlations between clinical assessor and simulated patient (SP) scores drawn from summative Integrated Structured Clinical Examination (ISCE) and inform the best use of SP scores in future assessments.

MATERIALS AND METHODS

This retrospective study explores summative clinical assessor and formative SP numeric scores drawn from summative ISCE assessments spanning three academic years (2017-18 to 2019-20). Analyses were carried out using R 3.5.1 (R Core Team, 2018), with the stats package.

RESULTS

The sample consisted of 169 final-year BDS students across the three cohorts and included 95 females (56.2%) and 74 males (43.8%). Data from eight substations where SPs were included, were explored. Kendall's Tau, a non-parametric correlation, was used to investigate the relationships between the assessor and SP scores. Clinical assessor scores were out of a total of 20 points across various assessed domains within each substation. The formative SP assessment was out of 10 points with the same five affective domains related to communication included in each substation. Overall, the assessor and patient substation scores were not correlated (τ = 0.04, p = .272) indicating that communication skills alone, as assessed by patients, do not correlate with more holistic performance across other domains. There was significant positive correlation for two of the eight substations with the other substations showing very little correlation.

CONCLUSION

This study shows that assessment of student performance by SPs does not show a correlation with examiner scores and may provide additional information relating to affective skills of students. Notwithstanding the limitations of this study, the findings underscore the need to investigate further the value of involvement of SPs in clinical assessments to explore if scores by SPs can be used to enhance the validity of assessments if used summatively.

Artificial intelligence - can it be used to outsmart oral cancer?

Data Sources Electronic search on PubMed, Cochrane, Scopus, Embase, Google Scholar, Saudi Digital Library and Web of Science, and hand searching carried out for studies published January 2000-March 2021. Language was restricted to English.Study selection Original research studies involving artificial intelligence technology for oral cancer diagnosis and prognosis prediction were considered. The studies had to provide quantitative data of their evaluation analysis. The exclusion criteria were reported. No limit was set on study design.Data extraction and synthesis The initial search yielded 628 articles. Following deduplication, 340 full-text articles were screened. QUADAS-2 tool was used to assess the quality of the included studies regarding diagnostic accuracy.Results A total of 16 studies were included with various study designs: 14 cross-sectional, one cohort and one retrospective study. Six studies reviewed the diagnosis aspect. All studies indicate an overall positive trend of artificial intelligence technology.Conclusions Artificial intelligence appears to have good accuracy in oral cancer diagnosis and its prediction.

Multiple lump and rogue wave for time fractional resonant nonlinear Schrödinger equation under parabolic law with weak nonlocal nonlinearity

This article retrieve lump, lump with one kink and rogue wave soliton for the time fractional resonant nonlinear Schrödinger equation with parabolic law having weak nonlocal nonlinearity. According to theory of dynamical systems, Schrödinger equation may be converted into plane systems. We use Hirota bilinear method to obtained these solutions. At the end, we present graphical representation of our results in various dimensions.

705 CHARACTERISING OLDER ADULTS’ RISK OF HARM FROM BLOOD-PRESSURE LOWERING MEDICATIONS: A SUB-ANALYSIS FROM THE PRIME STUDY

Introduction

Hypertension is a major risk factor for cardiovascular disease and death. Randomised trials in older adults with relatively few co-morbidities recommend treatment of their hypertension [1]. However, blood-pressure lowering medications increase the risk of medication-related harm (MRH) from adverse drug reactions (ADRs), non-adherence, medication errors and drug–drug interactions. We aimed to identify characteristics associated with MRH in older people on blood-pressure lowering medications.

Method

The PRIME (prospective study to develop a model to stratify the risk of MRH in hospitalized elderly patients in the UK) study investigating the incidence and cost of MRH in 1280 older people in Southern England [2]. Adults ≥65 years were recruited from five teaching hospitals at hospital discharge and followed up for 8-weeks. Telephone interviews with study participants, review of primary care records and hospital readmissions were undertaken to identify MRH. PRIME study participants taking blood-pressure lowering medications, as defined by National Institute for Health and Care Excellence hypertension guidelines [3], were included in this analysis.

Results

Sixty-six percent of the PRIME cohort (n = 841) were taking blood-pressure lowering medications. Patients on four blood-pressure lowering medications were five times more likely to experience MRH compared to those taking just one medication (OR 4.96; 95%CI 1.63-15.13;p = 0.01). Most harm events were serious (80%,n = 123), requiring dose change or treatment cessation. Most MRH cases were potentially preventable (49%,n = 75).

Conclusion

MRH from blood-pressure lowering medication in older people is common, serious, and potentially preventable. Decisions around maximising cardiovascular risk reduction must be carefully considered in the context of MRH from blood-pressure lowering medications.

References

1. Sheppard JP, Lown M, Burt J et al. Generalizability of blood pressure lowering trials to older patients: cross-sectional analysis. J Am Geriatr Soc 2020; 68: 2508–15.

2. Parekh N, Ali K, Stevenson JM et al. Incidence and cost of medication harm in older adults following hospital discharge: a multicentre prospective study in the UK. Br J Clin Pharmacol 2018; 84: 1789–97.

3. National Institute for Health and Care Excellence (2019). Available at https://www.nice.org.uk/guidance/ng136. Accessed 27/11/2020.

736 REAL-TIME MOBILITY DATA FROM WEARABLE DEVICES PREDICTING FALLS RISK IN OLDER ADULTS

Introduction

Falls are a common cause of injuries in people over 65 years, usually resulting in life-threatening or life-altering sequalae for affected individuals. Falls risk assessment typically requires a face-to-face evaluation delivered by a trained professional in a clinical setting, thus limiting their application for many older people with falls. Therefore, there is a need for a remote monitoring system (RMS) that captures mobility data to assess comprehensively an older individual’s true falls risk undertaking their everyday activities in their usual environment.

Methods

A pilot study was conducted with 16 participants over 65 years classified as high (n = 9) or low falls risk (n = 7) based on their fall’s history. A RMS was developed, which combines inertial measurement unit (IMU) data from a wearable device and online real-time Machine Learning (ML) to generate a two-stage fall risk assessment. In stage one, a ML activity motion classifier identified raw IMU data from participants as either, walking, resting or transitional movements (turning or sitting to standing). In stage two, previously classified motion segments were analysed by a ML fall-risk classifier, providing an objective risk assessment based on gait characteristics during everyday motion. Falls incidence was recorded prospectively at one year follow-up.

Results

The motion classifier achieved an 94.8% accuracy in differentiating between resting, walking and transitional movements. The fall risk classifier initially trained with retrospective fall history data achieved an 87.5% accuracy with 88.9% sensitivity and specificity, which is comparable to other accurate classifiers in published literature. The fall risk classifier retrained with prospective one year follow-up data achieved a 73% accuracy which was superior to the 67% accuracy of the Timed Up and Go test for falls prediction.

Conclusion

Our study shows the potential of a machine-learning remote monitoring system using information from mobility data to classify an older person’s falls’ risk.

Multiple lump and interaction solutions for fifth-order variable coefficient nonlinear-Schrödinger dynamical equation

Lump and their interactions with kink, periodic and rogue waves, and periodic cross lump waves will be studied for fifth-order variable coefficient nonlinear-Schrödinger equation in this paper. With the combinations of bilinear, exponent, and trigonometric functions, we'll study different lump soliton solutions. With interaction phenomenon we'll set up some new analytical solutions and also represents them in graphical ways.

Correction: Influence of 4f filling on electronic and magnetic properties of rare earth-Au surface compounds

Correction for 'Influence of 4f filling on electronic and magnetic properties of rare earth-Au surface compounds' by L. Fernandez et al., Nanoscale, 2020, 12, 22258-22267, DOI: 10.1039/D0NR04964F.

Prevalence of parasites in selected captive bird species

Blood and fecal samples of chukar partridge (Alectoris chukar), albino pheasant (Phasianus colchicus), silver pheasant (Lophura nycthemera), rose-ringed parakeet (Psittacula krameri) and turkeys (Meleagris gallopavo) were analyzed to check parasitic prevalence. To record parasites these five avian species were placed kept in separate cages at Avian Conservation and Research Center, Department of Wildlife an Ecology, University of Veterinary and Animal Sciences, Lahore, Pakistan. 100 fecal and 100 blood samples for each bird species were inspected to analyze internal parasites. During present study, 17 species of endoparasites 14 from fecal samples and three from blood were examined. Two species of ectoparasites i.e. mite Dermanyssus gallinae 42% and fowl ticks Args persicus 41%were studied. Blood parasites included Plasmodium juxtanucleare 50%, Leucoctoyzoon simond having parasitic prevalence 40%, and Aegyptinella pullorum having parasitic prevalence of 40%. Parasitic species recorded from fecal samples included 6 species of nematodes viz. Allodpa suctoria 2%. Syngamus trachea with parasitic prevalence of 60%, Capillaria annulata 37.5%, Ascardia galli 24%, Capillaria anatis 40% and Heterakis gallinarum 28.3%. Similarly, two species of trematodes viz. Prosthogonimus ovatus having parasitic prevalence of 50% and Prosthogonimus macrorchis 21% were also documented from fecal avian samples . Single cestode species Raillietina echinobothrida having parasitic prevalence of 72% and 3 protozoan species i.e. Eimeria maxima having parasitic prevalence of 21%, Giardia lamblia 41% and Histomonas meleagridis 18% were documented during corpological analysis. In our recommendation, proper sanitation, medication and vaccination of bird's enclousres are suggested to avoid parasites.

Development of chitosan based microencapsulated spray dried powder of tuna fish oil: oil load impact and oxidative stability

The impact of fish oil concentration on the oxidative stability of microcapsules through the spray drying process using chitosan and maltodextrin as wall material was studied. Emulsions were prepared with different Tuna fish oil (TFO) content (TFO-10%, TFO20%, TF030% TF0-40%) while wall material concentration was kept constant. Microencapsulated powder resulting from emulsion prepared with high fish oil load have high moisture content, wettability, total oil and low encapsulation efficiency, hygroscopicity and bulk tapped density. Oxidative stability was evaluated periodically by placing microcapsules at room temperature. Microcapsules prepared with TFO-10% presented high oxidative stability in terms of peroxide value (2.94±0.04) and anisidine value (1.54±0.02) after 30 days of storage. It was concluded that optimal amounts of fish oil for microencapsulation are 10% and 20% using chitosan and maltodextrin that extended its shelf life during study period.

Amelioration potential of Moringa oleifera extracts against sodium arsenate induced embryotoxicity and genotoxicity in mouse (Mus musculus)

Previous studies have suggested that arsenic crosses the placenta and affects the fetus development. The study under consideration aims to show comparative ameliorative effect of Moringa oleifera leaf and flower extracts against sodium arsenate induced fetus toxicity of mice. Pregnant mice (N=44) were kept in lab and divided into eleven group from (A to K) and were orally administered the doses 6 mg/kg, 12 mg/kg for sodium arsenate, 150 mg/kg and 300 mg/kg for Moringa oleifera leaf extracts (MOLE) and 150 mg/kg and 300 mg/kg for Moringa oleifera flower extracts (MOFE) comparing with control. The investigation revealed evident reduction in the fetuses weight, hind limb, fore limb, tail and snout length, crown rump and head circumferences well as malformations in tail, feet, arms, legs, skin and eyes in the negative control group (only administered with sodium arsenate). Co-administration of sodium arsenate with MOLE and MOFE ameliorate the reversed effect of sodium arsenate on the shape, length, body weight and DNA damage of fetus significantly at 95% confidence interval. However, Moringa oleifera leaf extract showed more significant results in comparison to Moringa oleifera flower extract. Hence concluded that Moringa oleifera leaf extract ameliorated the embryo toxic effects of sodium arsenate and can be used against environmental teratogens.

Influence of 4f filling on electronic and magnetic properties of rare earth-Au surface compounds

One-atom-thick rare-earth/noble metal (RE-NM) compounds are attractive materials to investigate two-dimensional magnetism, since they are easy to synthesize into a common RE-NM2 structure with high crystal perfection. Here we perform a comparative study of the GdAu2, HoAu2, and YbAu2 monolayer compounds grown on Au(111). We find the same atomic lattice quality and moiré superlattice periodicity in the three cases, but different electronic properties and magnetism. The YbAu2 monolayer reveals the characteristic electronic signatures of a mixed-valence configuration in the Yb atom. In contrast, GdAu2 and HoAu2 show the trivalent character of the rare-earth and ferromagnetic transitions below 22 K. Yet, the GdAu2 monolayer has an in-plane magnetic easy-axis, versus the out-of-plane one in HoAu2. The electronic bands of the two trivalent compounds are very similar, while the divalent YbAu2 monolayer exhibits different band features. In the latter, a strong 4f-5d hybridization is manifested in neatly resolved avoided crossings near the Fermi level. First principles theory points to a residual presence of empty 4f states, explaining the fluctuating valence of Yb in the YbAu2 monolayer.

Assessment of Tumor Angiogenesis by Expression of CD 105 in Ameloblastoma, Odontogenic Keratocyst and Central Giant Cell Lesion

Background:

Angiogenesis is critical for tumor growth and reflects the aggressive behavior of invasive odontogenic lesions [like amelogenesis (AM) (AM), Odontogenic Keratocyst (OKC) and Central giant cell lesion (CGCL)]. Mean vascular density (MVD) shows the angiogenic potential and CD105 is an ideal endothelial biomarker due to its specificity to new blood vessels for MVD detection. The aim of the study was to compare the MVD (angiogenic potential) among AM, OKC and CGCL in comparison to Pyogenic Granuloma (PG) using CD105 biomarker.

Methods:

Sixty-four primary cases of odontogenic invasive tumors (AM, OKC and CGCL) and PG, diagnosed clinically and histologically were included in the study, with 16 samples in each group. Tissue samples of peripheral AM, Peripheral GCL of jaws, malignant AM, and specimen with insufficient tissue were excluded. Tissue sections were embedded, processed and stained using Hematoxylin and Eosin (H and E). Immunohistochemistry was performed using antibodies against CD105, with positive brown cytoplasmic staining in the endothelial cells of neo-vasculature. Distinct countable, positively stained endothelial cell or clusters were evaluated under light microscope for identification of MVD. ANOVA and t-test were applied for statistical analysis of data.

Results:

Highest MVD was displayed in CGCL (32.99±0.77) and the minimum was observed in OKC (7.21± 0.75) respectively. CGCL showed significantly higher MVD to AM, OKC and PG lesions (p<0.05). AM (8.07± 0.36) and Odontogenic Keratocyst (7.21± 0.75) showed comparable MVD, which was lower than PG (14.7± 0.96) and CGCL vascular density (p < 0.01) respectively.

Conclusion:

CGCL was most aggressive, with highest MVD among the investigated odontogenic lesions (OKC, AM and PG). The proliferative aggressive behavior of Odontogenic Keratocyst is comparable to AM due to comparable mean vascular density.

Evidence-based strategies to reduce contamination from aerosolised microbes in dental practice environment

Cohort selection The aim was to evaluate interventions to minimise microbial contamination from aerosol generating procedures in the dental office. Seven electronic databases were searched using key words such as 'aerosols', 'droplets', 'spatter', 'microbial loads' etc to identify relevant randomised controlled trials and prospective non-randomised clinical trials until 6 April 2020.Data sources PubMed; Scopus; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Open Grey; ClinicalTrials.gov; National Research Register; and hand searches.Data analysis Eligible studies were analysed for effectiveness of various interventions on the microbial counts in the aerosols generated in the dental office using predefined criteria. Data were analysed for assessment of quality of evidence and confidence in the estimated effect, risk of bias and other analyses using Stata 15.1 software. PRISMA guidelines extension for network meta-analysis were followed for reporting.Results Initial search identified 266 studies, of which 35 were evaluated for full text. Finally, 29 studies fulfilled the eligibility criteria for qualitative synthesis. The majority of the included studies were published in the last decade, and 21 out of the 29 studies were randomised controlled trials. However, based on comparable procedural settings (study design, study populations, interventions and outcome measures), only 11 were eligible for contribution to the network meta-analysis. The setting of all interventions was ultrasonic scaling of adult patients in a clinical dental practice environment, and involved 16 direct and 29 indirect comparisons. A multivariate meta-analysis showed pre-procedural mouth rinse with tempered chlorhexidine 0.2% at 47°C was most effective in reducing post-procedural bacterial load compared to the control. A mean difference of -0.92 (95% CI -15.4 to -0.29) in log10 colony-forming units was observed in air samples within 90 cm of the dental unit.Conclusions Notwithstanding the limitations of this network meta-analysis, pre-procedural mouth rinse with tempered chlorhexidine appears to be most effective in reducing bacterial counts in aerosols generated during dental operative procedures. Further randomised controlled clinical trials based on robust designs are required to establish the effectiveness of antimicrobial agents in reducing aerosol-related microbial loads (bacteria and viruses) in clinical environments.

Preparedness of undergraduate dental students in the United Kingdom: a national study

Aims To evaluate the self-perceived preparedness of final year dental undergraduate students in the United Kingdom.Methods Dental undergraduate students in their final year were invited by email through the Dental Schools Council (DSC) to provide their responses to an online preparedness assessment scale. The data analysis was carried out using the RUMM2030 software which is specifically designed for Rasch analysis, a measurement model based on item response theory.Results Students felt adequately prepared to carry out simple clinical procedures and communication skills. However, low scores were reported on ability to assess orthodontic treatment needs, treatment planning, crowns, endodontics, research skills, referral for suspected oral cancer and raising concerns regarding inappropriate behaviour of colleagues.Conclusions The scale used in this study explored the self-perceived preparedness on a range of cognitive, clinical and behavioural attributes. The data show that the students felt prepared for the majority of the attributes expected from dentists. However, a number of areas were identified where students may benefit from further training and consolidation.

Smoking Cessation After Counselling In Patients Presenting With Acute Coronary Syndrome

BACKGROUND

The long-term cardiovascular health risks associated with cigarette smoking are well established. It is a major risk factor for all manifestations of coronary artery disease, stroke, and peripheral vascular disease. Patients with acute coronary syndrome, who quit smoking, reduce their risk of cardiovascular events immediately and significantly when compared to those who continue smoking. The study was conducted to determine the frequency of smoking cessation after counselling in patients presenting with acute coronary syndrome (ACS).

METHODS

Patients of age 35-80 years of either gender presenting with Acute coronary syndrome presented in emergency within 12 hours of symptoms having history of smoking (>1pack year for >5 years) were included in the study. A total 225 patients were enrolled in the study from emergency of Punjab institute of cardiology, Lahore for the duration of six months. Informed consent was obtained from all patients. Their demographic information was also noted. Then patients under went counselling session with researcher himself in presence of psychiatrist from Department of Psychiatry, Services hospital, Lahore. After admitting patients in ward, patients received standard in-hospital treatment for smoking cessation which consisted of an assessment of their smoking behaviour and a personalized brief quit advice. Then patients were followed-up for 12 weeks. On weekly visit, patients were counselled for smoking cessation. After 12 weeks, patients were assessed for cessation of smoking.

RESULTS

Smoking cessation was seen in only 37 (16.4%) in ACS patients. Highest frequency of smoking cessation was seen in patients >65 years of age, i.e., 35.1%. Highest frequency for smoking cessation was seen in patients whose BMI was <30 (70.3%), patients with low socioeconomic status (45.9%) and patients with educational status as under matric (40.5%). None of these factors were significantly associated with smoking cessation in patients who presented with ACS.

CONCLUSIONS

Results of this study demonstrate low frequency of smoking cessation among patients presenting with ACS. However, there is a strong need to identify those factors that were associated with failure to reduce smoking.

A computational study of high pressure polymorphic transformations in monazite-type LaPO4

Polymorphic transformations in LaPO₄ are investigated as a function of pressure using density functional theory (DFT) based calculations under the generalized gradient approximation. The monazite-type (P2₁/n) → barite-type (Pbnm) structural transformation is identified at 16.2 GPa and experimentally, no transformation is observed near this pressure. A discontinuity in the pressure-volume relation (of 4.16% volume discontinuity compared to the monazite structure at the same pressure) and unit-cell dimensions is observed around 28 GPa, which matches well with the previous experimental results. The pressure of discontinuity matches the DFT calculated monazite-type (P2₁/n) → post barite-type (P2₁2₁2₁) structural transformation pressure. The equation of state, single crystal elastic constants and phonon dispersion curves of the different polymorphs as a function of pressure are determined. Both the barite-type (Pbnm) and post barite-type (P2₁2₁2₁) structures are mechanically and dynamically stable at 27 GPa indicating that the monazite-type (P2₁/n) → barite-type (Pbnm) phase transformation may be hindered by a kinetic barrier. The phase transformation in monazite-type LaPO₄ is driven by a softening of the C₂₅ single crystal elastic constant. Moreover, a small displacement and tilting of PO₄ tetrahedra as a function of pressure leads to a change in the La chemical environment and creates space for the construction of LaO₁₂ polyhedra from LaO₉ due to a phase transformation.

Ethno-botanical and geo-referenced profiling of medicinal plants of Nawagai Valley, District Buner (Pakistan)

The prime objective of the research was to list the important ethnomedicinal plants of Nawagai village, District Buner. During the survey, 44 plant species from 27 families were observed and collected from the targeted area of Khyber Pakhtunkhwa, Pakistan. Lamiaceae members were the most dominant (54%) followed by members of Asteraceae (30%), Poaceae (18%) and Solanaceae (12%). Relevant information such as field data, GPS coordinates family names, local names, therapeutic uses and plant habits were recorded for each species. For preservation purposes, specimens were mounted on herbarium sheets, and identified with the help of flora of Pakistan, flora of Australia and other relevant floristic records. During this research work all the collected specimens were preserved in the (BG&H, UOM) Botanical Garden and Herbarium, the data were also provided to the Department of Botany, University of Malakand Dir (Lower), Khyber Pakhtunkhwa, Pakistan.

Effects of concurrent training on physical health and performance

The primary objective of this narrative review was to evaluate the current literature and to provide further insight into the role of concurrent training on various components of physical health or performance. Literature was obtained by electronic searches of databases using specific keywords. Combined effect of training sessions proved to be as beneficial as drug interactions. Results from cross-sectional, longitudinal, and intervention studies are reviewed and discussed with main focus on physical parameters, such as body composition, physiological parameters, molecular adaptation, athlete’s perspective, order of execution, interference phenomena and recovery. In conclusion, concurrent resistance and endurance training is an effective method for enhancing overall fitness as well as improving quality of life.

Impact of early clinical exposure on the learning experience of undergraduate dental students

AIMS

The aim of this research was to evaluate the impact of early clinical exposure on the learning experiences of undergraduate dental students.

METHODS

This study was based on mixed methods. The first phase involved administering a purposely designed questionnaire consisting of 16 items, grouped into three subscales. The second phase of the research was conducted using qualitative semi-structured interviews to explore the perceptions and experiences of stakeholders regarding early clinical exposure.

RESULTS

In total, 134 undergraduate dental students and eight clinical supervisors responded to the questionnaire and reported positive perceptions regarding the learning experiences, professional relationship and learning environment. Qualitative interviews were conducted with 12 participants, and early clinical exposure was perceived to be useful in providing a context to theoretical learning and development of interpersonal skills. Curriculum overload and further need for consolidation were highlighted as the main challenges.

CONCLUSIONS

This study provided insights into the clinical training model in an undergraduate dental programme and highlights the benefits and challenges of early clinical exposure in the study population. The study served as a vehicle for engagement with a range of stakeholders using a mixed methods approach to inform further development of the training model.

Ethnobotanical and ecological study of Punica granatum in Dir district, Khyber Pakhtunkhwa, Pakistan

Punica granatum L. (wild) belongs to family Punicaceae, a woody plant, predominantly found on calcareous and alkaline soils. The species is extensively utilized as food and firewood and for the extraction of various chemicals due to its therapeutic properties. To understand the ethno-botanical and ecological status of the species on a regional scale, a questionnaire survey was conducted in the Dir (L) area using close and open-ended questionnaires. Data collected from 124 respondents were analysed quantitatively using statistical analysis to calculate indices like Relative Frequency of Citation (RFC), Use value (UV) and multivariate analysis. GPS data used for the presence data of the plants were used to develop GIS thematic maps. Geo-referenced data on P. granatum was collected from the study area, using GPS. Results suggest that the plant is mostly used as a remedy for dry cough, as an astringent, people used powder form of fruit peelings. It was documented in the present investigation that P. granatum is mainly eradicated due to its extensive use as firewood. The study also evaluated on the major aspect of how the P. granatum can be conserved naturally. It was found out that the plant is conserved in areas inaccessible to humans. The status of the vegetation community around this plant was also explored, it is found out that specific shrub and tree communities were major flora growing in proximity to P. granatum. The finding of this survey has concluded that wild P. granatum is an endangered species due to its extensive and uncontrollable use for firewood, curing diseases and its economic potential. These findings could be exploited to take necessary steps for the conservation of this species.