Supervised exercise training improves cardiorespiratory fitness and reduces perioperative risk in peripheral artery disease patients with intermittent claudication

INTRODUCTION

This study examined to what extent supervised aerobic and resistance exercise combined with continued unsupervised exercise training improves cardiorespiratory fitness and corresponding perioperative risk in peripheral artery disease (PAD) patients with intermittent claudication.

METHODS

A total of 106 patients (77% male) were enrolled into the study, alongside 155 healthy non-PAD control participants. Patients completed supervised exercise therapy (aerobic and resistance exercises of the upper and lower limbs) twice a week for 10 weeks. Thereafter, 52 patients completed 12 weeks of an unsupervised tailored home-based exercise. Pain-free walking distance (PWD), maximum walking distance (MWD), peak oxygen uptake ([Formula: see text]) and perioperative risk were assessed before and after both exercise interventions.

RESULTS

Patients were highly unconditioned relative to healthy controls ([Formula: see text]=11.9 vs 24.2ml/kg/min, p=<0.001) with 91% classified as high perioperative risk (peak oxygen uptake <15ml/kg/min). Supervised exercise increased PWD (+44±81m, p=<0.001), MWD (+44±71m, p=<0.001) and [Formula: see text] (+1.01±1.63ml/kg/min, p=<0.001) and lowered perioperative risk (91% to 85%, p=<0.001). When compared with supervised exercise, the improvements in PWD were maintained following unsupervised exercise (+11±91m vs supervised exercise, p=0.572); however, MWD and [Formula: see text] decreased (-15±48m, p=0.030 and -0.34±1.11ml/kg/min, p=0.030, respectively) and perioperative risk increased (+3%, p=<0.001) although still below baseline (p=<0.001).

CONCLUSIONS

Supervised aerobic and resistance exercise training and, to a lesser extent, unsupervised tailored exercise improves walking capacity and cardiorespiratory fitness and reduces perioperative risk in PAD patients with intermittent claudication.

Management of menopause: a survey of physicians from the Middle East and Africa

OBJECTIVE

This study evaluated physicians' perceptions, practices, confidence, comfort level and prior training in managing menopause.

METHODS

A survey was conducted of a convenience sample of physicians from the Middle East and Africa (MEA) in 2019. We covered knowledge of symptoms, menopausal hormone therapy (MHT), other menopause management strategies and prior training in menopause medicine.

RESULTS

Of the 254 participants, 64.2% were seniors in family medicine (36.4%), endocrinology (36.0%), gynecology (15.8%) and internal medicine (13.8%). Fewer than one-third (28.8%) correctly identified the diagnostic criteria of menopause. Almost all recognized vasomotor symptoms (99.5%), vaginal dryness (96.2%) and mood disturbance (94.3%), but to a lesser extent other symptoms. Inconsistency and critical gaps were identified in responses to competence questions on six case studies. They recalled having occasional (43.2%) or no training (19.4%) in menopause medicine and rated their preparedness to treat menopause widely. A total of 66.2% agreed that training is very important. Variation between specialties was identified.

CONCLUSION

Many physicians recognize the importance of education in menopause management, but their responses revealed critical knowledge gaps that underscored the need for comprehensive, evidence-based menopause management.

Prevalence of chronic diseases among United Arab Emirates University students: cross-sectional study

Background

Chronic disease burden is increasing globally. In Arab Gulf Countries, the burden has increased exponentially over the past five decades due to rapid economic growth and urbanization. In the United Arab Emirates (UAE), chronic diseases are the leading cause of mortality and economic burden, hence, there is need to explore their patterns for targeted interventions. Studies among university students in Europe and the United States show chronic diseases prevalence ranging from 16.5% to 30.0%, respectively. To our knowledge, this is the first study in the Gulf region to assess multiple chronic diseases among university students. Our study describes the prevalence and patterns of multiple chronic diseases among UAE University (UAEU) students.

Methods

We conducted a descriptive cross-sectional study among UAEU students ≥18years from July to October 2021. Online questionnaire was used to collect data. Self-reported chronic diseases were described and compared between male and female students using chi-square and t tests. Other students’ characteristics were also explored. All analyses were conducted using STATA statistical software.

Results

902 students participated in the study with mean age of 21.9±5.2yrs. 79.8% were females. 80.7% were undergraduates. The prevalence of self-reported chronic diseases was 23.0%. Obesity, Diabetes and Asthma/Allergies were the commonest (12.5%, 4.2% & 3.2%, respectively). 34.8% of the students were either overweight or obese. Overall chronic disease prevalence was similar between males and females [27.5% vs 21.8%, 0.104] though it was significantly higher among postgraduates, students who are older, married and have family history of diabetes. 4.7% of the students reported 2 or more chronic diseases.

Conclusions

Our study showed that more than 1 in 5 of the students reported at least one chronic disease. This shows the need for proactive chronic disease screening and prevention programs to meet the health needs of the students.

Key messages

• Prevalence of chronic diseases (Diabetes, Prediabetes, Obesity, Hypertension, Asthma/Allergies, Lipid disorders, Thyroid disorders, GI disorders, and CVDs) was high among the university students.

• Universities should commit to researching students’ health and creating targeted health policies and interventions, as chronic diseases have direct and indirect negative impact on students’ education.

Naushad's Modification of Griggs Percutaneous Tracheostomy: Retrospective Case Series Study on 200 Patients at Subharti Medical College, Meerut, India

Introduction:Percutaneous dilational tracheostomy (PDT) is a frequently performed procedure in critically ill patients in hospital emergency department, intensive care unit (ICU) and operating theater (OT). The purpose of this study is to describe a technical modification of Griggs percutaneous tracheostomy by using two 7G and 12G dilators after undergoing sterilization by ethylene oxide. Two hundred patients underwent the procedure. There were no major complications related to the procedure. There were two minor bleedings managed conservatively. The technical modification described in this study is safe and simple to execute and is most cost effective. Materials and methods: Patients admitted to ICUs on prolonged mechanical ventilation who are difficult to wean and ventilate, those with facial trauma, oropharyngeal cancer patients, burn patients, a child with diphtheria, patients with chronic obstructive pulmonary disease requiring tracheostomy were included in our retrospective study. The study group underwent PDT using the Naushad's modified Griggs technique. The time taken to perform the procedure, its ease of insertion, number of attempts and its early and late procedural complications were recorded. Results:The time taken by tracheostomy was 3-10 minutes. Our method is most cost effective, as it costs only around 1000 INR/15$, while the whole set of Griggs technique costs around 15000 INR/150 US $. There was only one post procedural infection, no long-term morbidity and a single case got converted to surgical tracheostomy. Conclusion:The technique seems reliable for carrying out percutaneous PDT at bedside in all patients admitted to different hospital departments, including ICUs, triage, emergency and routine OT, as a measure to secure the airway by mainly involving the oral and neck area.

Antisickling effect of chrysin is associated with modulation of oxygenated and deoxygenated haemoglobin via alteration of functional chemistry and metabolic pathways of human sickle erythrocytes

Sickle cell disease (SCD) treatment and management remain a challenging puzzle especially among developing Nations. Chrysin's sickling-suppressive properties in human sickle (SS) erythrocytes in addition to its effect on AA-genotype erythrocytes were evaluated. Sickling was induced (76%) with 2% sodium metabisulphite at 3 h. Chrysin prevented (81.19%) the sickling and reversed same (84.63%) with strong IC₅₀s (0.0257 µM and 0.00275 µM, respectively). The levels of oxygenated haemoglobin in the two groups (before and after induction approaches) were similar but significantly (P < 0.05) higher than that of SS erythrocytes (the 'induced' control), with chrysin-treated AA-genotype showing no effects relative to the untreated. The level of deoxygenated haemoglobin in the 'induced' control group was significantly (P < 0.05) higher than those of the chrysin-treated SS erythrocytes. Normal and chrysin-untreated erythrocytes (AA-untreated) were significantly more resistant to osmotic fragility than the SS-untreated. However, treatment with chrysin significantly reduced the osmotic fragility of the cells relative to the untreated cells. Furthermore, chrysin treatment significantly lowers the high level of 2,3-diphosphoglycerate (2,3-DPG) observed in the sickle erythrocytes, with no effects on AA-genotype erythrocytes. Based on functional chemistry, chrysin treatment alters the functional groups in favour of its antisickling effects judging from the observed bends and shifts. From metabolomics analysis, it was observed that chrysin treatment favors fatty acid alkyl monoesters (FAMEs) production with concomitant shutting down-effects on selenocompound metabolism. Thus, sickling-suppressive effects of chrysin could potentially be associated with modulation of oxygenated and deoxygenated haemoglobin via alteration of human sickle erythrocyte's functional chemistry and metabolic pathways implicated in SCD crisis.

13 Medical Students’ Mood Adversely Affected By COVID-19 Pandemic: An Interim Analysis from the SPICE-19 Prospective Cohort Study Of 2075 Medical Students and Interim Foundation Doctors

Introduction

In order to appropriately support medical students and foundation year doctors, it is imperative that we understand the impact the COVID-19 pandemic has had upon them. This study assessed the effects of the COVID-19 pandemic on medical students and interim foundation year doctors across the United Kingdom (UK), and the support that they received and sought.

Method

A prospective, observational, multicentre study was conducted. All medical students and interim foundation year doctors were eligible to participate.

Results

A total of 2075 individuals participated. There was a decrease in participants’ mood when comparing their mood before the pandemic to during the pandemic (p < 0.0001). Social distancing negatively impacted the mood of the greatest number of participants. All areas of life included in the study were found to have been significantly more negatively impacted than positively impacted (p < 0.0001). 931 participants wanted more support from their university.

Conclusions

When medical students return to their universities, there is likely to be a need for enhanced wellbeing support, adaptations in the short-term and long-term strategies for medical education, and provision of financial guidance. If no action is taken, there may be a knock-on effect on workforce planning and the health of our future workforce.

Design, construction and characterisation of a portable gamma-ray spectrometer for low-level natural occurring radioactive material ex-situ measurement

The activity concentrations in naturally occurring radioactive material (NORM) samples are conventionally measured using a gamma-ray spectrometer with a single detector (mostly HPGe or NaI:Tl) enclosed in a lead shield. In this work, a passive water shield to reduce background radiation reaching the detectors was designed using GEANT4-toolkit Monte Carlo simulations and then constructed. This measurement system is portable and cost-effective for ex-situ measurements. IAEA-375 soil and beach sand each placed in Marinelli beakers were measured using two LaBr₃:Ce detectors in singles and coin-cidence modes. A novel method of background reduction by using photon time-of-flight was employed together with the measurement of the two photons energies. These samples were also measured in singles mode using a NaI:Tl detector inside the constructed water shield and HPGe detector shielded with lead to compare and validate the results of LaBr₃:Ce detectors measurement. Both the simulated and measured results show that the water shield (500 mm thick) attenuates 2614.5 keV gamma rays by 90 %. The minimum detectable activity (MDA) measured for 24 h using the NaI:Tl detector without shield and inside the water shield are; 546 Bq kg^-1 and 146 Bq kg^-1 at 1460.8 keV (⁴⁰K), 194 Bq kg^-1 and 15 Bq kg^-1 at 1764.5 keV (²³⁸U series), and 131 Bq kg^-1 and 15 Bq kg^-1 at 911.2 keV (²³²Th series), respectively. The measured activity concentrations of ²³⁸U and ²³²Th series and ⁴⁰K radionuclides inside IAEA-375 soil agree with certified values to within measurement uncertainties. The measured activity of ¹³⁸La in the LaBr₃:Ce detector crystal is 263.8 ± 26.8 Bq kg^-1. The internal activity of the LaBr₃:Ce detector increases the MDA at 1460.8 keV and 2614.5 keV, which limits the measurement of primordial radionuclides with low activity concentration in singles mode. The activity concentrations of ²³⁸U and ²³²Th series radionuclides in beach sand were measured using NaI:Tl and LaBr₃:Ce detectors. The results are consistent with those from HPGe measurement to within uncertainties.

Human presence impacts fungal diversity of inflated lunar/Mars analog habitat

BACKGROUND

An inflatable lunar/Mars analog habitat (ILMAH), simulated closed system isolated by HEPA filtration, mimics International Space Station (ISS) conditions and future human habitation on other planets except for the exchange of air between outdoor and indoor environments. The ILMAH was primarily commissioned to measure physiological, psychological, and immunological characteristics of human inhabiting in isolation, but it was also available for other studies such as examining its microbiological aspects. Characterizing and understanding possible changes and succession of fungal species is of high importance since fungi are not only hazardous to inhabitants but also deteriorate the habitats. Observing the mycobiome changes in the presence of human will enable developing appropriate countermeasures with reference to crew health in a future closed habitat.

RESULTS

Succession of fungi was characterized utilizing both traditional and state-of-the-art molecular techniques during the 30-day human occupation of the ILMAH. Surface samples were collected at various time points and locations to observe both the total and viable fungal populations of common environmental and opportunistic pathogenic species. To estimate the cultivable fungal population, potato dextrose agar plate counts method was utilized. The internal transcribed spacer region-based iTag Illumina sequencing was employed to measure the community structure and fluctuation of the mycobiome over time in various locations. Treatment of samples with propidium monoazide (PMA; a DNA intercalating dye for selective detection of viable microbial populations) had a significant effect on the microbial diversity compared to non-PMA-treated samples. Statistical analysis confirmed that viable fungal community structure changed (increase in diversity and decrease in fungal burden) over the occupation time. Samples collected at day 20 showed distinct fungal profiles from samples collected at any other time point (before or after). Viable fungal families like Davidiellaceae, Teratosphaeriaceae, Pleosporales, and Pleosporaceae were shown to increase during the occupation time.

CONCLUSIONS

The results of this study revealed that the overall fungal diversity in the closed habitat changed during human presence; therefore, it is crucial to properly maintain a closed habitat to preserve it from deteriorating and keep it safe for its inhabitants. Differences in community profiles were observed when statistically treated, especially of the mycobiome of samples collected at day 20. On a genus level Epiccocum, Alternaria, Pleosporales, Davidiella, and Cryptococcus showed increased abundance over the occupation time.

An apical left ventricular aneurysm rupture presenting as left breast mass 11 years after surgical repair

Left ventricular (LV) pseudoaneurysm is a rare entity and, consequently, there is limited knowledge of the condition's natural history. The most frequent mode of presentation for LV pseudoaneurysm is heart failure with chest pain. However, the variable presentation of this condition requires a high index of suspicion for diagnosis. We report the case of a 75-year-old woman who had suffered an acute myocardial infarction 23 years previously, which resulted in a calcified LV apical aneurysm. Three weeks prior to being referred to our hospital, she was noted by her general practitioner to have a left-sided breast mass although mammography was negative. One week later, she attended the accident and emergency department; she was haemodynamically unstable but was resuscitated successfully. Contrast enhanced computed tomography showed a large haematoma located in the left chest wall communicating with the left ventricle. She underwent emergency cardiac surgical repair. On arrival at the intensive care unit following surgery, her haemodynamic status was unstable, and she deteriorated rapidly and died. With this report, we aim to raise the level of awareness for an apical LV pulsatile mass that could anatomically expand and present as a breast mass or tumour. An early diagnosis and timely surgical intervention is essential in order to achieve better outcomes and avoid detrimental complications.

Delayed aorto-right atrial fistula following percutaneous closure of atrial septal defect

We present the case of a 27-year-old man who underwent percutaneous atrial septal defect (ASD) repair using the Amplatzer(®) (St Jude Medical, St Paul, MN, US) septal occluder (ASO). Six weeks later, he presented with heart failure and was found to have an aorto-right atrial fistulation. He required urgent surgical device explantation and repair of the existing ASD using a pericardial patch repair technique. This is the first case to be reported from the UK describing a delayed aorto-right atrial fistula following percutaneous closure using ASO.

Notizen: Isolation and Structure of Rosamine a New Pseudoindoxyl Alkaloid from Catharanthus roseus

The isolation and structure of a new pseudoindoxyl alkaloid from Catharanthus roseus leaves is described.

Isolation, Structure and Oxidative Fragmentation of 16-epi-19-S-Vindolinine – an Alkaloid from the Leaves of Catharanthus roseus

A new alkaloid has been isolated from the leaves of Catharanthus roseus. Spectroscopic and degradative studies have established its structure to be 16-epi-19-S-vindolinine

Senna occidentalis leaf extract possesses antitrypanosomal activity and ameliorates the trypanosome-induced anemia and organ damage

The in vitro and in vivo antitrypanosomal effects of the ethanol extract of Senna occidentalis leaf were investigated. The crude extract exhibited an in vitro activity against Trypanosoma brucei brucei as it completely eliminated parasites’ motility within 10 minutes postincubation with 6.66 mg/ml of effective extract concentration. The extract was further used to treat experimentally T. brucei brucei infected rats at concentrations of 100 and 200 mg/kg body weight, beginning on day 5 post infections (p.i.). At the termination of the experiment on Day 11 p.i., the extract significantly (P < 0.05) kept the parasitemia lower than was recorded in the infected untreated rats. All the infected animals developed anemia, the severity of which was significantly (P < 0.05) ameliorated by the extract treatment. The infection caused significant (P < 0.05) increases in serum alanine and aspartate aminotransferases as well as serum urea and creatinine levels. However, treatment of infected animals with the extract significantly (P < 0.05) prevented the trypanosome-induced increase in these biochemical indices. Furthermore, the T. brucei infection caused hepatomegaly and splenomegaly that were significantly (P < 0.05) ameliorated by the extract administration. It was concluded that orally administered ethanol extract of S. occidentalis leaf possessed anti-T. brucei brucei activity and could ameliorate the disease-induced anemia and organ damage.

Inhibition of Naja nigricolis (Reinhardt) venom protease activity by Luffa egyptiaca (Mill) and Nicotiana rustica (Linn) extracts

Luffa egyptiaca and Nicotiana rustica are used in traditional medicine to treat snakebites and were evaluated for inhibitory activities on Naja nigricolis venom protease. The aqueous and ethanolic extracts of L. egyptiaca significantly reduced the maximum velocity (Vmax) and the computed index of physiological efficiency (Kcat) of the enzyme in a dose dependent fashion. The protease activity was non-competitively inhibited by the aqueous extract of N. rustica with the Vmax significantly decreased and the K(M) remained unchanged. However, the N. rustica ethanol extract completely inhibited the protease activity. Ethyl acetate fractions partitioned from ethanol extracts of both plants were also found to completely inhibit the N. nigricolis venom protease activity at 0.1 and 0.05%. The use of these plants could be important in the treatment of snakebites.

Urinary collagen IV and πGST: potential biomarkers for detecting localized kidney injury in diabetes--a pilot study

BACKGROUND/AIMS

Urinary biomarkers can identify damage to specific parts of the nephron. We performed a cross-sectional study to characterise the pattern of diabetic nephropathy using urinary biomarkers of glomerular fibrosis (collagen IV), proximal tubular damage (α-glutathione-S-transferase, GST) and distal tubular damage (πGST).

METHODS

Clinical data from 457 unselected patients attending a hospital diabetes clinic were collected. Spot urine samples were analysed for albumin and creatinine. Biomarkers were measured by enzyme-linked immunosorbent assay, and corrected to urinary creatinine.

RESULTS

All 3 biomarkers correlated weakly with albumin/creatinine ratios (Pearson correlation <0.2, p values <0.001). The most common abnormality was elevated urinary collagen IV (glomerular, 35%) compared to αGST (proximal tubule, 18%) or πGST (distal tubule, 15%). The proportion of patients with abnormal biomarker results increased across the normo-, micro- and macroalbuminuria groups, with collagen IV (26, 58, 65%) and πGST (11, 25, 35%) but not αGST.

CONCLUSION

In patients with diabetes, these urinary biomarkers appear to identify renal damage that is related to, but distinct from, urine albumin/creatinine ratios. The markers of glomerular fibrosis and distal tubular damage related most closely to the degree of albuminuria. Longitudinal studies are now required to assess whether these biomarkers can detect early renal disease with greater specificity and sensitivity than the albumin/creatinine ratio.