Predicting the Effectiveness of a Mindfulness Virtual Community Intervention for University Students: Machine Learning Model

BACKGROUND

Students' mental health crisis was recognized before the COVID-19 pandemic. Mindfulness virtual community (MVC), an 8-week web-based mindfulness and cognitive behavioral therapy program, has proven to be an effective web-based program to reduce symptoms of depression, anxiety, and stress. Predicting the success of MVC before a student enrolls in the program is essential to advise students accordingly.

OBJECTIVE

The objectives of this study were to investigate (1) whether we can predict MVC's effectiveness using sociodemographic and self-reported features and (2) whether exposure to mindfulness videos is highly predictive of the intervention's success.

METHODS

Machine learning models were developed to predict MVC's effectiveness, defined as success in reducing symptoms of depression, anxiety, and stress as measured using the Patient Health Questionnaire-9 (PHQ-9), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS), to at least the minimal clinically important difference. A data set representing a sample of undergraduate students (N=209) who took the MVC intervention between fall 2017 and fall 2018 was used for this secondary analysis. Random forest was used to measure the features' importance.

RESULTS

Gradient boosting achieved the best performance both in terms of area under the curve (AUC) and accuracy for predicting PHQ-9 (AUC=0.85 and accuracy=0.83) and PSS (AUC=1 and accuracy=1), and random forest had the best performance for predicting BAI (AUC=0.93 and accuracy=0.93). Exposure to online mindfulness videos was the most important predictor for the intervention's effectiveness for PHQ-9, BAI, and PSS, followed by the number of working hours per week.

CONCLUSIONS

The performance of the models to predict MVC intervention effectiveness for depression, anxiety, and stress is high. These models might be helpful for professionals to advise students early enough on taking the intervention or choosing other alternatives. The students' exposure to online mindfulness videos is the most important predictor for the effectiveness of the MVC intervention.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN12249616; https://www.isrctn.com/ISRCTN12249616.

The human-wildlife conflict in Musk Deer National Park, Neelum Gureze Valley, Azad Jammu & Kashmir, Pakistan

Abstract Growing human population is a solemn risk to biodiversity at a global level. Massive anthropogenic pressure and invasion in the natural habitats initiated the human-wildlife conflict in rural areas. Present study aimed to assess human-wildlife conflict in Musk Deer National Park (MDNP) from 2013 to 2018. Results revealed an estimated 241784 nomadic and 5589 residential livestock heads grazed in different areas of MDNP during the summer season. A total of 126 heads were depredated by carnivores during the study period. Majority (n=39) of livestock heads were killed in May (n=29). Livestock depredation resulted in economic losses worth 3.115 million PKRs (25744 US$) to the herder community while farmers received 1.629 million PKRs (13466 US$) losses due to crop raiding. Most (64%) of the respondents believed human-wildlife conflict heightened due to scarcity of food or prey in the natural habitats of carnivores. Majority (92%) of the respondents did not like the presence of predators in MDNP. Loss compensation schemes could turn this negative attitude into the positive one and increase tolerance about the presence of carnivores in their vicinity. This study provides an insight into the human-wildlife conflict in MDNP and paves a way for understanding the conflict and conservation of carnivore species in the study area.

Access to Virtual Mental Healthcare and Support for Refugee and Immigrant Groups: A Scoping Review

Immigrant and refugee populations face multiple barriers to accessing mental health services. This scoping review applies the (Levesque et al. in Int J Equity Health 12:18, 2013) Patient-Centred Access to Healthcare model in exploring the potential of increased access through virtual mental healthcare services VMHS for these populations by examining the affordability, availability/accommodation, and appropriateness and acceptability of virtual mental health interventions and assessments. A search in CINAHL, MEDLINE, PSYCINFO, EMBASE, SOCINDEX and SCOPUS following (Arksey and O'Malley in Int J Soc Res Methodol 8:19-32, 2005) guidelines found 44 papers and 41 unique interventions/assessment tools. Accessibility depended on individual (e.g., literacy), program (e.g., computer required) and contextual/social factors (e.g., housing characteristics, internet bandwidth). Participation often required financial and technical support, raising important questions about the generalizability and sustainability of VMHS' accessibility for immigrant and refugee populations. Given limitations in current research (i.e., frequent exclusion of patients with severe mental health issues; limited examination of cultural dimensions; de facto exclusion of those without access to technology), further research appears warranted.

Modulation of Altered Immune Parameters IL-2 and TNF-α in Diabetic Animal Models: A Therapeutic Insinuation of Metformin Beyond Diabetes

BACKGROUND

Immunomodulatory drugs target the overall immune system, hence producing numerous toxic effects on the other organs with serious health manifestations. Due to these safety concerns, there is a need to introduce or repurpose a new drug with immunomodulatory effects with good safety, efficacy, and better tolerance. Metformin, a standard antidiabetic drug, was evaluated for its immunomodulatory effects in diabetic models in the current study.

METHODOLOGY

The diabetic model was developed by intraperitoneal (IP) administration of streptozotocin (60 mg/kg). The experimental rats were divided into six groups (three diabetic and three non-diabetic) with six rats in each group. Metformin (50 mg/kg and 80 mg/kg) was given orally to both diabetic and non-diabetic groups, once a day, for 42 days. Immunomodulatory cytokines interleukin (IL)-2, IL-4, IL-5, tumor necrosis factor (TNF)-α, and interferon gamma (INF-ɣ) were analyzed from blood samples by BD FCAP flow cytometer.

RESULTS

The results revealed a significant (p=0.002) decrease in IL-2 and TNF-α in diabetic groups in comparison to control rats. However, no significant changes were observed in IL-4, IL-5, and INF-ɣ levels. Importantly, the treatment of metformin at both doses, i.e., 50 and 80 mg/kg, significantly reduced the elevated levels of IL-2 and TNF-α when compared to untreated diabetic groups.

CONCLUSION

Metformin may be considered as an optimum drug candidate to reduce pro-inflammatory cytokines, IL-2 and TNF-α, that can lead to the reduction of long-term diabetic complications.

Effectiveness of neck stabilization and Contrology training in comparison to conventional therapy amongst individuals with text neck syndrome

OBJECTIVE

Cell phones are carried by 79% of people between 18 and 44 years of age for nearly the entire day. Smartphone users spend an average of three hours/per day on their devices, whereas heavy smartphone users spend 8-10 hours/per day on their devices. Text neck is a dangerous disorder that can accelerate the degeneration of the spine. This study aimed to investigate the efficacy of neck stabilization training vs. Contrology or Pilates training in individuals with Text Neck Syndrome.

PATIENTS AND METHODS

Participants (n=75) with a history of recurrent neck pain in the previous four months, having moderate pain (at least 4/10 on the numeric pain rating scale, NPRS), and constantly using mobile phones (>4 hours/day) were randomly allocated to one of three groups: a control group (neck isometric training) and two intervention groups (neck stabilization training and Contrology). They were assessed for craniovertebral angle (CVA), NPRS, and neck disability index (NDI) at baseline and at 4 weeks post-intervention.

RESULTS

There was a significant difference in the CVA, NPRS, and NDI among individuals with Text Neck Syndrome following intervention as compared to the control. Both the neck stabilization and Contrology training increased CVA and reduced neck pain and neck disability in individuals with Text Neck Syndrome. The two intervention groups showed similar effects in all the clinical outcome measures, suggesting almost equivalent effectiveness in the individuals with Text Neck Syndrome.

CONCLUSIONS

Neck stabilization seems to work better than Contrology training when it comes to increasing the craniovertebral angle, reducing pain intensity, and making it easier for individuals with Text Neck Syndrome to move their necks.

Validation of the Malay-Version of Recovery Knowledge Inventory among mental health providers in Malaysia

Background

The Recovery Knowledge Inventory (RKI) is a widely used self-report instrument that assesses recovery-oriented knowledge among mental health professionals. The purpose of this study is to translate the RKI into the Malay language (RKI-M) and to examine its psychometric properties among Malaysian health care workers.

Methods

A cross-sectional study involving 143 participants was conducted at an urban teaching hospital, an urban government hospital, and a rural government hospital. Following the translation of the RKI, its internal reliability was determined using Cronbach's alpha. Construct validity was also determined using confirmatory factor analysis.

Results

The Malay-Version RKI (RKI-M) has good internal reliability with a Cronbach's alpha of 0.83. However, the Malay-version RKI failed to replicate the original four-factor structure. The final model only achieved the best model fit after the removal of 9 items with two-factor loadings: (GFI = 0.92; AGFI = 0 0.87; CFI = 0.91; RMSEA = 0.074).

Conclusion

The 20-item RKI-M is reliable but has poor construct validity. However, the modified 11-item Malay-version RKI is a more reliable measure as it has good construct validity, with room for future studies to examine the psychometric properties of the modified 11-item RKI among mental health care workers. More training on recovery knowledge should be done, and a simple worded questionnaire should be developed in keeping with local practitioners.

Mental Health of Adolescents and Its Association with Their Educational Systems: A Cross-Sectional Study on High School Students

We assessed the Association of Mental Health and different education systems among high school students. A total of 174 students (107 females and 67 males) from age 16-19 years studying in 11th and 12th grades or equivalent to A levels in Karachi, Pakistan were surveyed in this cross-sectional study. Data collection involved using a specially designed structured questionnaire through literature review as well as the patient Health Questionnaire, a validated tool for assessing depression.  Our study found that majority of students suffered from mild depression (29.3%). This was followed by 27.5% of students with severe depression, 23.0% with moderate depression and 20.1 with no depression. It was also found that more females suffered from depression as compared to males. However, no significant correlation was found between the association of different education system on the mental health of adolescents.

Estimands for atopic dermatitis clinical trials: Expert opinion on the importance of intercurrent events

Despite the emergence of novel targeted treatments for atopic dermatitis (AD), there is a lack of guidelines on standardizing analysis of clinical trial data. To define and estimate meaningful treatment comparisons, several factors, including intercurrent events, must be taken into account. Intercurrent events are defined as events occurring after treatment initiation that affect either the interpretation or existence of the measurements associated with clinical questions of interest. Due to the relapsing, unpredictable nature of AD, intercurrent events frequently occur in AD trials, such as use of rescue therapy for intense itch and sleep deprivation. Despite the impact of intercurrent events in AD, they are often handled in an inconsistent manner across trials, which limits results interpretation. The estimand framework is increasingly used to estimate treatment effects while accounting for intercurrent events. This review explores how guidance from the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) on the use of estimands can be applied to support AD clinical trial design and analysis. We propose that estimands are used in AD trials and defined early during trial design. The use of estimands can provide clinicians with interventional trial results that are more reflective of clinical practice, help facilitate comparisons across clinical trials, and are more informative to enable improved treatment selection for patients.

Author Correction: Association of monomeric C-Reactive Protein (m-CRP) with hypothalamic neurons after CRP hippo-campal administration in a model of dementia

Correction to: European Review for Medical and Pharmacological Sciences 2022; 26 (22): 8713-8718. DOI: 10.26355/eurrev_202212_30543- PMID: 36524490-published online on December 15, 2022. After publication, the authors applied a correction to the funding statement: The authors extend their appreciation to the deputyship for Research & Innovation, Ministry of Education in Saudi Arabia for funding this research work through the project number (lFP-2020-36). There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/30543.

Effects of cooking methods on physicochemical properties, antioxidant properties and sensory acceptability of purple sweet potato (Ipomoea batatas)

Purple sweet potato is commonly cooked by boiling, steaming, baking and microwaving. However, information on the effects of cooking methods on the physicochemical properties, antioxidants properties and sensory acceptability is limited. In this study, the effect of cooking methods (boiling, steaming, baking and microwaving) on the physicochemical properties, antioxidant properties and sensory acceptability of purple sweet potato were investigated. The results showed that the boiled sample was the softest (hardness of 933.39 g) and also had the highest total colour difference (18.56), while the steamed sample was the most adhesive (-92.35 g.s) and least cohesive (0.41). An increased moisture content caused a decrease in other proximate compositions in the samples. The baked sample had the highest antioxidant properties, with 232.20 mg GAE/100 g of total phenolic content, 2.05 mg cyaniding-3-glucoside/L of total anthocyanins, 61.95% of DPPH and 79.20% of ABTS radical-scavenging activity. The steamed sample was rated most acceptable by the panellists.

Fused Deposition Modelling of Polymer Composite: A Progress

Additive manufacturing (AM) highlights developing complex and efficient parts for various uses. Fused deposition modelling (FDM) is the most frequent fabrication procedure used to make polymer products. Although it is widely used, due to its low characteristics, such as weak mechanical properties and poor surface, the types of polymer material that may be produced are limited, affecting the structural applications of FDM. Therefore, the FDM process utilises the polymer composition to produce a better physical product. The review's objective is to systematically document all critical information on FDMed-polymer composite processing, specifically for part fabrication. The review covers the published works on the FDMed-polymer composite from 2011 to 2021 based on our systematic literature review of more than 150 high-impact related research articles. The base and filler material used, and the process parameters including layer height, nozzle temperature, bed temperature, and screw type are also discussed in this review. FDM is utilised in various biomedical, automotive, and other manufacturing industries. This study is expected to be one of the essential pit-stops for future related works in the FDMed-polymeric composite study.

Association of monomeric C-Reactive Protein (m-CRP) with hypothalamic neurons after CRP hippo-campal administration in a model of dementia

OBJECTIVE

The ensuing ischemia due to the disruption of blood supply to the brain is one of the most common causes of stroke. Evidence suggests a clear association of the ischemic injury with vascular dementia and Alzheimer's disease (AD). In response to the brain ischemia, a cascade reaction starts leading to neuronal damage due to oxidative stress and other inflammatory mediators. A pilot study was done, which showed that following stroke, monomeric-C-reactive protein (mCRP) is expressed in large quantities around the infarcted zone and this CRP is able to induce neurodegeneration and inflammation potentially perpetuating dementia.

MATERIALS AND METHODS

We examined both patient brain samples and excised mouse brain tissue, previously injected with 1.75 mg/mL mCRP into the CA1 area of the hippocampus through the stereotactic surgical procedures and followed them over a period of over 6 months. The distribution of mCRP was examined through immunohistochemistry (mouse anti-human mCRP-specific antibodies 8C10).

RESULTS

We observed a novel finding: those micro vessels close to the injection location were strongly stained with mCRP only in the mice that had been injected with mCRP, indicating that this small blood vessel can spread it throughout the brain.

CONCLUSIONS

mCRP found in the brain after a hemorrhagic stroke promotes damage over a large area via the induction of inflammation and degeneration of perivascular compartments.

Antiulcerative potential of sweet potato (Ipomoea batatas) against aspirin-induced gastric ulcers in a rabbit model

OBJECTIVES

Sweet potato (Ipomoea batatas) is accredited as a functional food because of its nutraceutical compounds. These dietary components may help heal lesions and ulcer scars in the stomach. This research was designed to examine the antioxidant and antiulcerative potential of sweet potato (red skin, white flesh) against aspirin-induced gastric ulcers in a rabbit model.

METHODS

Sweet potato samples were analyzed for in vitro analysis, such as 2,2-diphenyl-1-picrylhydrazyl assay, total phenolic content, and total flavonoid content. In a bioefficacy study, rabbits were divided into five groups (n = 6) in which G0 received the standard diet only, G1 150 mg/kg aspirin, G2 20 mg/kg omeprazole, G3 1000 mg/kg aqueous extract of sweet potato, and G4 1000 mg/kg ethanolic extract of sweet potato. After completion of the trial, the animals were decapitated and examined for antiulcer parameters, serum analysis, and hematologic parameters.

RESULTS

The mean values for 2,2-diphenyl-1-picrylhydrazyl, total phenolic content, and total flavonoid content were 57%, 927 mg gallic acid equivalent/100 g, and 1901 µg quercetin equivalent/g, respectively. The values for gastric volume, acid output, ulcer scores and index, total oxidant status, white blood cell count, and lymphocyte count were increased significantly (P < 0.05) for the positive control group compared with G2, G3, and G4. Gastric pH and body weight at the end of the experiment were significantly reduced for the positive control group (P < 0.05) compared with G2, G3, and G4. Histology test results of gastric tissues in G1 depicted severe epithelial damage compared with G2, G3, and G4.

CONCLUSIONS

The results for the antiulcer parameters ascertained the antiulcer activity of sweet potato in aspirin-induced gastric ulcer models.

Comparison of Growth of School Children in Mymensingh City Area, Bangladesh Using the 2000 CDC Standards and 2007 WHO Standards

Growth assessment is an essential component of child health surveillance. The most influential tool in the growth assessment is the growth chart. Growth parameters of children are usually interpreted in relation to international standards like the NCHS/1977, CDC/2000 and WHO/2007 growth charts. This comparative study was carried out in the Department of Paediatrics, Mymensingh Medical College, Mymensingh, Bangladesh from November 2014 to October 2015 to compare the growth parameters of children using 2000 CDC standards and 2007 WHO standards. A total of five hundred healthy school children, aged 6 to 10 years were randomly selected proportionately from each class of five government primary schools from Mymensingh city area. Children with physical deformities and acutely ill and those with chronic debilitating diseases were excluded from the study. The mean and median weight, height and BMI were calculated for each age and sex. The median weight, height and BMI were then standardized by converting them to Z-scores (SD) for comparing against known reference values of 2000 CDC and 2007 WHO charts. Among 500 children, 252(50.4%) were boys and 248(49.6%) were girls. The mean age was found 8.0±1.42 years in boys and 8.04±1.42 years in girls. The mean weight was found 24.4±6.36kg in boys and 24.08±6.35kg in girls. The mean height was 125.90±10.16cm in boys and 125.38±10.74cm in girls. The mean weight, height and BMI of boys and girls were found to be lower in all age groups with compared to 2000 CDC standard and 2007 WHO standard but were closer to the WHO standards compared to the CDC standards. According to CDC and WHO in the study it was observed that underweight was found 16.3% and 14.7%, stunting 7.1% and 6.7%, overweight 6.7% and 8.7%, and obese 2.8% and 4.0% respectively in male subjects. On the other hand, in female subjects it was observed that according to CDC chart and WHO chart underweight was found 19.4% and 13.3%, stunting 6.0% and 4.8%, overweight 7.3% and 8.1% and obese 2.0% and 2.0% respectively. The findings in this study imply that growth pattern of Bangladeshi school children is closer with WHO standards and wider from CDC standards.

Nemolizumab efficacy in prurigo nodularis: onset of action on itch and sleep disturbances

BACKGROUND

Patients with prurigo nodularis (PN) have multiple itchy nodules, impaired quality of life and sleep deprivation. Prurigo nodularis patients have a high burden of disease, primarily due to the intensity of the itch. It is reasonable to expect that rapid relief of itch - and associated improvement of sleep - are highly valued clinical outcomes for patients. Nemolizumab is an IL-31A-receptor inhibitor that modulates the neuroimmune response with reported positive efficacy and safety data in a phase 2 study of PN.

OBJECTIVES

To evaluate the onset of action of nemolizumab on itch and sleep disturbances.

METHODS

Post hoc analysis of a phase 2 trial of nemolizumab 0.5 mg/kg SC vs. placebo in patients (n = 70) with moderate-to-severe PN (≥20 nodules) and severe pruritus (NRS ≥ 7). Time to significant reduction was assessed for peak pruritus (PP) and sleep disturbance (SD) using numerical rating scales (NRS), also assessed was scratching time during sleep.

RESULTS

Nemolizumab significantly reduced itch vs. placebo within 48 h (PP NRS -19.5% vs. -5.8%, respectively, P = 0.014). Significant difference between nemolizumab and placebo in reducing itch by ≥4 on PP NRS was achieved at Day 3 (23.5% vs. 0%, P < 0.001). A significant difference in SD NRS was reported by Day 4 (-24.0% vs. -4.3% placebo, P = 0.012). In addition, there was a separation between groups in SD responders (decrease of ≥4 points) in favour of nemolizumab by Day 2 (8.8% vs. 0%, P = 0.037). Sleep continued improving through Week 4, when there was a -56.0% reduction in SD NRS vs. -22.9% placebo (P < 0.001). Actigraphy data showed improvement in scratch/sleep duration for nemolizumab vs. placebo, respectively, by Week 1 (-32.15 vs. +28.15 min/h, P = 0.001).

CONCLUSION

Nemolizumab has a rapid and robust onset of action in PN with itch reduction and improvement of sleep within 48 h.

Probing nutritional and functional properties of salted noodles supplemented with ripen Banana peel powder

Banana peel is appreciated for higher dietary fiber, phenolics, flavonoid contents, and minerals (particularly iron, calcium, and potassium), despite being a waste product. After drying, it can be processed into powder/flour to be combined with wheat flour (WF) for development of value-added products. In this study, we substituted WF with banana peel powder (BPP) at supplementation rates of 5, 10, and 15%, and evaluated their suitability to develop salted noodles. The results showed that the composite flour with 15% BPP had significantly higher protein, ash, and crude fiber content as compared to control. Higher antioxidant capacity was observed in composite flour noodles: total phenolics content (TPC), total flavonoid content (TFC), ferric reducing power (FRAP) and DPPH reducing power were increased up to 278, 260, 143 and 13 percent respectively in the noodles containing 15% BPP as compared to control (100% WF). On the other hand, values for viscosity decreased up to 22% with addition of BPP in WF. Furthermore, water absorption capacity and cooking losses were increased up to 15 and 13 percent respectively with 15% BPP incorporation in WF. Results for sensory evaluation demonstrated that noodles with 10% BPP scored highest for sensory profile.

Graphical abstract

A review on fish sauce processing, free amino acids and peptides with sensory properties

Fish sauce is a well-known condiment for its delicious flavour developed through a fermentation process. It is generally used as an additive for flavour enhancement in cooking. The fish sauce comes in several appearances, ranging from a clear liquid with light colour and texture to a dark and cloudy liquid. This product is produced by a longduration of fermentation process by the combination of fish and salt. This high salt fermentation began with the action of enzymes from fish muscle and its digestive tracts, then continued with halophilic bacteria activity to further break down fish proteins in producing a liquid product with a mixture of soluble proteins, peptides and amino acids. This review is comprised of two sections, the first section covers various processing methods of fish sauces, mainly in the Asia region, namely Nam-pla, Nuoc-mam, Yu-lu, Ishiru, Shottsuru, Bakasang and Budu. These fish sauces roughly involve applying salt for fermentation, with different fish species, salt concentration, fermentation duration and processing techniques. The later section covers taste-contributing components of fish sauces in the scope of amino acids and peptides. Five of the major amino acids found to taste in the fish sauce, glutamic acid, threonine, alanine, methionine and histidine, are also reviewed in this paper. Sensory peptides in fish sauces shown in this paper are peptides with salt taste enhancement properties and peptides exhibiting sweet, sour, bitter, umami and kokumi tastes.

Scoping Review of Existing Evaluations of Smokeless Tobacco Control Policies: What Is Known About Countries Covered, Level of Jurisdictions, Target Groups Studied, and Instruments Evaluated?

OBJECTIVE

The implementation of smokeless tobacco control policies lags behind those for smoking. This scoping review summarizes the studies that evaluated public policies on smokeless tobacco regulation (SLT) and provides an overview of the jurisdictional level, target groups, and policy instruments.

METHODS

Seven databases were systematically searched for studies reporting on public policies regulating SLT. Two reviewers independently screened all studies. Data extraction was performed using a predefined extraction form. Extraction was replicated for 10% of the identified studies for quality assurance. A narrative synthesis of the included studies was used to analyze and interpret the data. The protocol was published beforehand with the Open Science Foundation (OSF).

RESULTS

Fourty articles comprising 41 studies were included. Most of the studies reported in the articles were conducted in the United States (n = 17) or India (n = 14). Most studies reported outcomes for students (n = 8), retailers/sellers (n = 8), and users/former users (n = 5). The impact of public policies on smokeless tobacco use, in general, was most frequently assessed (n = 9), followed by the impact of taxes (n = 7), product bans (n = 6), sales/advertising bans near educational institutions (n = 4), and health warnings (n = 3) on consumer behavior.

CONCLUSIONS

There are significant gaps in the evaluation of smokeless tobacco regulation studies that need to be filled by further research to understand the observed outcomes. WHO reporting on Framework Convention on Tobacco Control (FCTC) implementation should be linked to studies evaluating smokeless tobacco control measures at all levels of jurisdictions and in countries not members of the WHO FCTC or do not provide data.

IMPLICATION

Large gaps in the evaluation of SLT control policies exist. For some countries, WHO FCTC evaluations are available for different levels of jurisdictions. In countries with a strong federal structure, there is a lack of data beyond the national level to provide a more detailed look at compliance, indirect effects, or implementation gaps. More research is needed at all levels of jurisdictions, which add to the work of the WHO to understand what works for which target group, how the different levels of jurisdiction interact, how the real-world context can be incorporated, and what indirect effects may occur.

Proximate composition, amino acid composition and food product application of anchovy: a review

Anchovies are the small pelagic fish that belongs to the family of Engraulidae dominant all over the Indo-Pacific region, which account for human consumption and as feed for other larger fish. Anchovies are rich in macronutrients and micronutrients such as protein, carbohydrate, fat and amino acids. In addition, anchovy is composed of well-balanced amino acid compositions containing eight essential amino acids and eight non-essential amino acids. The nutritive value of anchovies has become the reason for numerous food applications. Proximate analysis is vital in the food industry for the development and quality controls of food products. Knowledge and information regarding the proximate composition of fish are essential in the food processing technology of fish products at commercial and industrial scales. Additionally, this review highlights both conventional and innovative anchovy-based food items. The review demonstrated that anchovies have several possible breakthroughs in the food industry, as shown by their proximate composition and the amino acid profiles used in various food items.

Perspectives of older Tamil immigrants on social inclusion: A concept mapping study in Canada

Evidence shows that immigrants face several challenges post migration, impacting their social inclusion. Yet, limited scholarly knowledge exists on older immigrants including Tamils from Sri Lanka. Thus, an exploratory concept mapping (CM) study was conducted in 2017 with 27 Tamil immigrant women and men aged ≥55 years and settled in Toronto, Canada. The aim was to gather their perspectives on factors that help them to feel socially included (focal question). The CM methodology first engaged participants in brainstorming sessions to generate ideas in response to the focal question. Participants then joined sorting and rating sessions and sorted 72 generated items and rated them on a scale of 1-5 for importance and feasibility to initiate a change. Finally, in the interpretation session, participants provided feedback on the visual cluster maps generated through quantitative analysis of the collected data. Participants labelled the seven identified clusters: (a) Services for Employment and Settlement; (b) Financial Independence; (c) Medical System and Senior Care; (d) Adaptation and Integration; (e) Family Harmony; (f) Cultural Interaction and Feeling of Security; and (g) Social Interaction. The clusters one to three were at the top for importance (mean 4.33, 4.22, 4.17) and participants interpreted these as needing policy-level attention (e.g. credential evaluation, hiring practices) and identified the roles of advocacy and community-engagement for community-based programmes (CBPs). The Family Harmony was interpreted as needing 'work within families', while CBPs' culturally sensitive outreach was viewed as valuable. Participant interpretation of other clusters highlighted the role of social networking, trust, belonging, civic engagement and social cohesion through joint working of the community members and CBPs. The findings call for an inter-sectoral and community-engaged approach to strengthen the social inclusion of the community. Future research with a larger sample is needed, especially on early settlement experiences and social inclusion of older immigrants.

Rationale and Design of the TARGET-EFT Trial: Multicomponent Intervention for Frail and Pre-frail Patients Hospitalized with Acute Cardiac Conditions

BACKGROUND

With the aging population and rising rates of cardiovascular disease (CVD), cardiologists and cardiac surgeons are encountering a growing number of frail older patients that have complex cardiac and non-cardiac issues. Measuring frailty provides valuable prognostic information to help personalize treatment decisions. However, there is minimal evidence on multicomponent frailty interventions in this setting. The TARGET-EFT (The MulTicomponent Acute Intervention in FRail GEriatric PaTients with cardiovascular disease using the Essential Frailty Toolset) trial aims to target physical and non-physical frailty deficits to improve health-related quality of life and hospital-acquired disability in frail patients hospitalized with CVD.

METHODS

The TARGET-EFT trial is a single-center parallel-group randomized clinical trial in frail and pre-frail older adults ≥65 years admitted to the cardiovascular unit (CVU) at the Jewish General Hospital, Montreal, Quebec. The trial will compare usual inpatient care to a multicomponent intervention targeting physical weakness, cognitive impairment, malnutrition, and anemia. Outcomes of interest in both groups will be assessed at three time points: (1) study enrollment, (2) discharge from the CVU, and (3) 30 days after hospital discharge.

CONCLUSIONS

The overarching goal is to treat patients' frailty in parallel with their CVD, and in doing so, optimize patient functional losses while in-hospital and shortly thereafter. The results of this trial will inform best practices for patient-centered care in this vulnerable patient group.

Assessing Virtual Mental Health Access for Refugees during the COVID-19 Pandemic Using the Levesque Client-Centered Framework: What Have We Learned and How Will We Plan for the Future?

During the COVID-19 pandemic, mental health services rapidly transitioned to virtual care. Although such services can improve access for underserved populations, they may also present unique challenges, especially for refugee newcomers. This study examined the multidimensional nature of access to virtual mental health (VMH) care for refugee newcomers during the COVID-19 pandemic, using Levesque et al.'s Client-Centered Framework for Assessing Access to Health Care. One hundred and eight structured and semi structured interviews were conducted in four Canadian provinces (8 community leaders, 37 newcomer clients, 63 mental health or service providers or managers). Deductive qualitative analysis, based on the Client-Centered Framework, identified several overarching themes: challenges due to the cost and complexity of using technology; comfort for VMH outside clinical settings; sustainability post-COVID-19; and communication and the therapeutic alliance. Mental health organizations, community organizations, and service providers can improve access to (virtual) mental health care for refugee newcomers by addressing cultural and structural barriers, tailoring services, and offering choice and flexibility to newcomers.

Efficacy of Nebulized Hypertonic Saline (3%) Versus Normal Saline and Salbutamol in Treating Acute Bronchiolitis in A Tertiary Hospital: A Randomized Controlled Trial

Acute bronchiolitis is a viral respiratory illness of infants and young children that occurs in the first two years of life. It is a major cause of hospital admissions in Bangladesh. Management of bronchiolitis is a great challenge for the pediatrician both in the outpatient and inpatient department. Because mainstay of treatment options are usually supportive like cool humidified oxygen, fluids, bronchodilators, epinephrine and corticosteroids. A number of agents have been proposed as adjunctive therapies, but their effects are controversial. Nebulized hypertonic saline (3%) has been reported to have some benefit in recent studies. So the objective of this study was to compare the efficacy of nebulized 3% hypertonic saline (HS) with salbutamol and normal saline (0.9%) nebulization in children with acute bronchiolitis. A double-blind randomized controlled trial was conducted in the Department of Paediatrics, Mymensingh Medical College Hospital, Bangladesh from November 2015 to October 2016. A total of 100 children aged one month to two years with acute bronchiolitis admitted in the Pediatric wards of MMCH were included in the study and were randomly assigned to either 3% nebulized hypertonic saline (n=50) or to 0.9% nebulized isotonic saline with salbutamol solution (n=50). The main outcome variables were clinical severity score, length of hospital stay, duration of oxygen therapy and oxygen saturation (SpO2). The therapy was repeated three times on every hospitalization day and the outcome was evaluated two times daily (12 hourly) for 60 hours. Mean duration of oxygen therapy in study group was 33.6±21.7 hours and in control group was 36.8±22.5 hours. But their difference was not statistically significant (p>0.05). The mean clinical severity score and mean oxygen saturation of the entire study patients in both groups decreased and increased respectively during hospital stay. There was significant difference of mean clinical severity score and oxygen saturation between admission and follow up-5 in each group (p<0.001). But their difference between two groups was not statistically significant (p>0.05). Mean duration of hospital stay was 2.91±1.54 days in study group and 3.09±1.85 days in control group. But their difference between two groups was not statistically significant (p>0.05). So in acute bronchiolitis nebulized hypertonic saline (3%) is as effective as normal saline (0.9%) and salbutamol nebulization.

Serum Electrolyte, Serum Calcium and Blood Sugar Status in Severe Acute Malnutrition and Their Relationship with Edema, Vomiting and Diarrhea

Severe acute malnutrition (SAM) is the most severe form of protein energy malnutrition (PEM). Few studies found serum electrolyte, serum calcium level changes as important factors of poor outcome. Hypoglycemia is already established as a risk factor for death in severe acute malnutrition. Edema, diarrhea and vomiting are commonly present in severe acute malnutrition which has impact on electrolyte balance and blood sugar level in healthy children. Their impact in severe acute malnutrition is not clearly established. This cross sectional descriptive study was conducted in Department of Pediatrics, MMCH from March 2018 to October 2019 to estimate serum electrolyte, serum calcium and random blood sugar level in severe acute malnutrition and their relationship with edema, vomiting and diarrhea. Forty-one (41) cases of SAM were enrolled in this study. Test samples were collected before starting the treatment. Case record form was used to collect information. Cases were divided into Group A and Group B based on the presence or absence of vomiting or diarrhea, respectively. Again, all cases were divided into Group C and Group D based on presence or absence of edema, respectively. Data were analyzed using IBM SPSS statistics version 23. Mean age was 9.71±10.4 months with 85.36% having age less than 1 year. Twenty-four (58.5%) were male and 17(41.5%) were female. Parents had low level of education with 48.8% mother and 51.2% father having primary education or no education. Higher number of serum electrolyte, serum calcium and blood sugar were found with hyperglycemia present in 29.3%, hypocalcemia in 22%, hypokalemia in 22% and hyponatremia in 19.5% cases. Hypokalemia was present more in SAM with vomiting or diarrhea (p=0.008). Other disturbances do not vary on presence or absence of edema and vomiting or diarrhea. Result of the present study shows hypokalemia is associated with SAM with vomiting/diarrhea. Hypocalcemia, hyperglycemia, hyponatremia and hypernatremia were also present in high number. These changes should be detected early and treated accordingly.

Interactive mental health assessments for Chinese Canadians: A pilot randomized controlled trial in nurse practitioner-led primary care clinic

INTRODUCTION

Mental health conditions like depression and anxiety are on the rise, but access to care remains a challenge. Immigrants and racialized communities including Chinese Canadians experience high level of access barriers including communication with clinicians. With the aim to facilitate mental health communications, we tested an Interactive Computer-assisted Client Assessment Survey (iCCAS) in Cantonese/Mandarin and English at a nurse practitioner-led primary care clinic in Toronto. The iCCAS offers a touch-screen, pre-consultation survey with questions on depression, anxiety, post-traumatic stress, alcohol abuse, and social context. The program generates point-of-care reports for the clinician and patient.

METHODS

A pilot randomized controlled trial examined the intervention impact on mental health discussion and symptom detection, compared with the usual care, followed by clinicians' qualitative interviews.

RESULTS

Fifty self-identified Chinese adult patients participated (iCCAS = 26, Usual Care = 24), response rate 79.4%. Participant mean age was 44.8 years and 92% were immigrants. There was an increase of 19% and 15% in the mental health discussion and detection of symptoms in the iCCAS group compared with the usual care. More participants in the iCCAS group were referred to a social worker or psychiatrist. Patients found the use of iCCAS easy and clinicians identified its benefits for themselves (eg, early identification and comfort) and patients (eg, self-awareness and anonymity) and proposed practice-integration.

DISCUSSION

The studied tool holds promise for enhancing clinician-patient mental health communications in primary care settings for overseas Chinese. Implications are discussed for in-person and virtual healthcare which could also inform responses to mental health crisis related to COVID-19.

Socio-demographic and Clinico-epidemiological Study of Scrub Typhus in A Tertiary Care Hospital of Mymensingh, Bangladesh

Scrub typhus is one of the leading causes of undifferentiated treatable febrile illness in Asia pacific region. It is grossly under diagnosed in many tropical countries of South Asia including Bangladesh, due to wide range of non-specific clinical presentations, low index of suspicion among clinicians, limited awareness and lack of accurate diagnostic facilities. This cross sectional observational study was conducted at department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh from March 2019 to February 2020 enrolling 113 diagnosed cases of scrub typhus by Immunochromatographic test (ICT) and / or Nested PCR to characterize the socio-demographic and clinico-epidemiological features of scrub typhus in Mymensingh area. Majority of the scrub typhus cases came from rural areas (63.83%) and there was a slight female predominance (52.21%). The young (32.74%) and the young-adult age group (28.31%) were mostly affected. Most of the scrub typhus cases were housewives (30.98%), followed by farmers (23.89%) and students (21.23%). All the enrolled cases presented with fever. Other findings were myalgia (76.10%), headache (56.63%), cough (30.97%), vomiting (12.38%) and Respiratory distress (9.73%). Typical eschar of scrub typhus was present only in 9(7.96%) cases and 4(3.53%) patients had rashes on their skin. Few cases (3.53%) had jaundice and 15.96% cases were anaemic. Oliguria (7.96%) and neck rigidity (1.76%) were also documented. Most of the Nested PCR positive scrub typhus cases were documented during late rainy season and beginning of winter months. Findings of the study may offer increased awareness about high burden of scrub typhus as well as heightened suspicion among clinicians for early diagnosis, timely treatment and prevention of complications.

C87. Serial Cases of Cardiovascular Manifestation on Leptospirosis: A Tales of Unfortunate Events

Background

Leptospirosis is a zoonosis disease caused by Leptospira species. It's endemic and has become a major public health issue, especially in tropical regions. Clinical manifestation varies from mild or asymptomatic to severe multiple organ failure. We report cases of severe leptospirosis which complicates supraventricular tachycardia and myoperdicarditis from Universitas Sebelas Maret Academic Hospital.

Case Summary

The first case was a 44-year-old man referred from Internal Medicine Department with Leptospira infection with Weil’s disease. On 5th daycare, the patient was reporting had an episode of tachyarrhythmia, the ECG show SVT-AVNRT, there was no history of arrhythmic events before admitted to the hospital, the echocardiography was normal. The second case was a 67-year-old man who was referred from emergency department with shortness of breath, the ECG reveals diffuse ST-segment elevation in all limb and precordial leads with reciprocal ST-depression at aVR and V1, there was also downsloping of the PR and TP segment on precordial leads (Spodick’s sign), with normal ejection fraction on echocardiographic examination with pericardial thickening. Both patients have hsTroponin levels rose above the normal limit and serological testing found positive leptospira IgM.

Discussion

Severe leptospirosis can cause multi-organ dysfunction including cardiac involvement. The patients, in this case, suffered from leptospirosis with SVT-AVNRT and myopericarditis. The exact pathophysiology is still unclear, but there are several hypotheses, such as cytokine storms and direct damage from leptospira endotoxins. Arrhythmias and cardiac disturbance in leptospirosis patients are associated with poor outcomes and higher mortality rates. 

C31. Closure of patent ductus arteriosus using intravenous paracetamol : a case series

Background

Although patency of ductal arteriosus is essential for fetal circulation, postnatal ductal closure is critical for postnatal circulation adaptation in order to avoid pulmonary overcirculation with diminished circulation blood flow. Standard medical treatment for patent ductal arteriosus (PDA) consists of pharmacotheraphy and or surgical intervention.

Case Summary

We present 17 cases of PDA confirmed by echocardiography and was observed for ductal closure after 3 days of intravenous paracetamol intervention (10-15 mg/kg) given every 8 hours. The echocardiography evaluation of PDA status was conducted after those pharmacological intervention and divided based on the gestational age group. In the preterm groups (&lt;36 weeks), 3 cases remained open, 3 cases were closed, and 1 case with reduced flow. In the aterm groups (36-42 weeks), 5 out of 8 cases were closed, while the other 3 showed reduced flow. In the postterm groups (&gt;42 weeks), 1 case was closed and 1 case with reduced flow. Successful rate for PDA closure of each groups were 43%, 62,5% and 50%.

Discussion

Indomethacin and ibuprofen are standard treaments for PDA closure. However, they have some side effects such as acute renal failure and gastrointestinal complications. From this case series, paracetamol has a promising effect similar to indomethacin and ibuprofen in conducting PDA closure with less side effects. Paracetamol inhibits prostaglandin synthetase activity eventhough its precise mechanism of action remains controversial.

C31. Closure of patent ductus arteriosus using intravenous paracetamol : a case series

Background

Although patency of ductal arteriosus is essential for fetal circulation, postnatal ductal closure is critical for postnatal circulation adaptation in order to avoid pulmonary overcirculation with diminished circulation blood flow. Standard medical treatment for patent ductal arteriosus (PDA) consists of pharmacotheraphy and or surgical intervention.

Case Summary

We present 17 cases of PDA confirmed by echocardiography and was observed for ductal closure after 3 days of intravenous paracetamol intervention (10-15 mg/kg) given every 8 hours. The echocardiography evaluation of PDA status was conducted after those pharmacological intervention and divided based on the gestational age group. In the preterm groups (&lt;36 weeks), 3 cases remained open, 3 cases were closed, and 1 case with reduced flow. In the aterm groups (36-42 weeks), 5 out of 8 cases were closed, while the other 3 showed reduced flow. In the postterm groups (&gt;42 weeks), 1 case was closed and 1 case with reduced flow. Successful rate for PDA closure of each groups were 43%, 62,5% and 50%.

Discussion

Indomethacin and ibuprofen are standard treaments for PDA closure. However, they have some side effects such as acute renal failure and gastrointestinal complications. From this case series, paracetamol has a promising effect similar to indomethacin and ibuprofen in conducting PDA closure with less side effects. Paracetamol inhibits prostaglandin synthetase activity eventhough its precise mechanism of action remains controversial.

C87. Serial Cases of Cardiovascular Manifestation on Leptospirosis: A Tales of Unfortunate Events

Background

Leptospirosis is a zoonosis disease caused by Leptospira species. It's endemic and has become a major public health issue, especially in tropical regions. Clinical manifestation varies from mild or asymptomatic to severe multiple organ failure. We report cases of severe leptospirosis which complicates supraventricular tachycardia and myoperdicarditis from Universitas Sebelas Maret Academic Hospital.

Case Summary

The first case was a 44-year-old man referred from Internal Medicine Department with Leptospira infection with Weil’s disease. On 5th daycare, the patient was reporting had an episode of tachyarrhythmia, the ECG show SVT-AVNRT, there was no history of arrhythmic events before admitted to the hospital, the echocardiography was normal. The second case was a 67-year-old man who was referred from emergency department with shortness of breath, the ECG reveals diffuse ST-segment elevation in all limb and precordial leads with reciprocal ST-depression at aVR and V1, there was also downsloping of the PR and TP segment on precordial leads (Spodick’s sign), with normal ejection fraction on echocardiographic examination with pericardial thickening. Both patients have hsTroponin levels rose above the normal limit and serological testing found positive leptospira IgM.

Discussion

Severe leptospirosis can cause multi-organ dysfunction including cardiac involvement. The patients, in this case, suffered from leptospirosis with SVT-AVNRT and myopericarditis. The exact pathophysiology is still unclear, but there are several hypotheses, such as cytokine storms and direct damage from leptospira endotoxins. Arrhythmias and cardiac disturbance in leptospirosis patients are associated with poor outcomes and higher mortality rates. 

Bacterial strains integrated with surfactin molecules of Bacillus subtilis MTCC441 enrich nematocidal activity against Meloidogyne incognita

Bacteria secrete lipopeptide (surfactin) molecules, which are known to act as natural antibiotics. Recently, research on lipopeptide molecules has grown because of their role in increasing resistance to plant pathogens. Isolated surfactin molecules at several concentrations, viz. 35, 25, 15 and 5 ppm, were used in an in vitro study for analysis of egg hatching inhibition and second-stage juvenile (J2) mortality of the nematode Meloidogyne incognita. Cell suspensions (1.2 × 10⁸  cfu·ml^-1 ) of both Bacillus subtilis (MTCC-441) and Pseudomonas putida (MTCC-102) were used in J2 inoculated tomato plants. Root-dip treatment of tomato seedlings with the crude lipopeptide (35 ppm) was also performed to analyse biocontrol potential. MALDI-TOF MS analysis was conducted to determine specific lipopeptide molecules. Data showed nematode egg mortality of 85% in the 35 ppm surfactin concentration 96 h after exposure. The maximum ovicidal activity was 83.97% after incubation with 35 ppm surfactin for the same exposure period. Plant growth attributes and biochemical parameters were significantly improved when bacterial cultures were applied before J2 inoculation of tomato seedlings. We also recorded a reduction in egg masses, nematode population and root galling. The J2 penetration into tomato roots was effective in the root-dip experiments. Surfactin mass peak was determined at m/z 1058 [M+Na]⁺ using MALDI-TOF MS. These results indicate that bacterial cell suspensions can be used as a potent and versatile source to deal with nematode infection and provide a rich source of bioactive compounds with antinematode activity.

Bacillus cereus Bacteremia: An Unusual Case Following Food Poisoning

Introduction/Objective

Bacillus cereus is a spore-forming, gram-positive rod, well known for causing food poisoning. In addition, this bacterium often presents as a contaminant of blood cultures. Differentiating true bacteremia from contamination of blood samples is important as it has treatment implications. Early recognition is necessary, as it can cause septic shock if untreated. We present a challenging case of food poisoning with concomitant bacteremia in a young patient with a history of diabetes mellitus (DM), celiac disease, and new-onset chronic kidney disease (CKD).

Methods/Case Report

A 23-year-old adult male with a history of DM, new-onset CKD, and celiac disease presented with nausea, intermittent vomiting, and lower abdominal pain for 2 weeks. On initial evaluation, he had normal blood pressure but tachypnea and tachycardia. Physical examination was significant for left lower quadrant and flank tenderness. The symptoms were persistent and progressed to point that he could not tolerate meals due to vomiting. Two weeks earlier, he presented with similar complaints along with dysuria and was treated for suspected urinary tract infection with Co-trimoxazole. This time, further workup revealed normal white blood cell count (11.8 k/µL) with 81% neutrophils, elevated creatinine (3.56 mg/dL), blood urea nitrogen (49 mg/dL), and procalcitonin (0.39 ng/mL), with abnormal urinalysis showing increased turbidity, pyuria, and nitrituria. He was started on ceftriaxone, fluids, antiemetics and was admitted to the hospital for further management. The urine culture had no bacterial growth. Two sets of peripheral blood cultures (different sites at different times) had gram-positive rods which eventually turned out to be B. cereus, identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Levofloxacin was started, and he reported improvement in nausea and vomiting by the next day of admission and was discharged.

Results (if a Case Study enter NA)

NA

Conclusion

Differentiating true B. cereus bacteremia from blood sample contamination is important. Additionally, no symptoms are specific for B. cereus-associated food poisoning, and the presence of risk factors doesn’t always favor this entity over other entities, hence adding difficulty to the diagnosis. A high index of suspicion is needed, as early intervention can prevent the development of life-threatening complications.

The impact of COVID-19 on the mental health and wellbeing of caregivers of autistic children and youth: A scoping review

Caregivers and families of autistic people have experienced stress and increase in demands due to the COVID‐19 pandemic that may have long‐term negative consequences for both their own and their children's mental health. A scoping review was conducted to identify pandemic related demands experienced by caregivers and families of autistic children and youth. The review also consolidated information on coping strategies and parenting‐related guidelines that have emerged to help parents meet these demands. Search strategies were approved by a research librarian and were conducted in peer‐reviewed and gray literature databases between May 2020 and February 2021. Additional resources were solicited through author networks and social media. All articles were published between December 2019 and February 2021. Article summaries were charted, and a thematic analysis was conducted with confirmation of findings with our knowledge users. Twenty‐three published articles and 14 pieces of gray literature were included in the review. The majority of articles characterized and highlighted the increase in demands on caregivers of autistic children and youth during the pandemic globally. Both quantitative and qualitative studies suggest that parents have experienced an increase in stress and mental health‐related symptoms during lockdown measures. Findings suggest that families are employing coping strategies, but there no evidence‐based supports were identified. The review highlighted the potential long‐term impact of prolonged exposure to increasing demands on the mental health and wellbeing of caregivers and families of autistic people, and pointed to a need for the rapid development and evaluation of flexible and timely support programs.

Effects Of Metformin On The Weight Of Healthy And Streptozotocin-Induced Diabetic Animal Model

BACKGROUND

Metformin was approved by FDA in 1994 for the treatment of type II diabetes mellitus. Due to its interaction with the AMP kinases enzyme system, it showed multiple effects on other organ systems of the body. Despite being the drug of the first choice for type II diabetes it became a popular drug for PCOS and currently, various trials are proving its anticancer effects. Though not approved by FDA it is also responsible for weight loss. The study aims to investigate the effect of metformin on the weight of healthy and streptozotocin-induced diabetic animal models. The study was performed at Animal House, Faculty of Pharmacy Ziauddin University Karachi.

METHODS

It was a pre-clinical experimental study conducted at Ziauddin University Karachi from August 2019 to December 2019. 36 male Albino rats were divided into 6 groups such with 6 rats in each group. Out of six three were healthy models (i.e., groups 1, 2, and 3) and the remaining three were diabetic models (i.e., Group 4, 5, and 6). Diabetes was induced in groups 4,5 and 6 by using the diabetogenic drug Streptozotocin. In Group 1 and 4, 0.5 ml normal saline was administered, 50 mg/kg (5 mg/100g) metformin diluted in 0.5 ml distilled water was administered in Group 2 and 5 followed by administration of 80 mg/kg (8 mg/100g) metformin diluted in 0.5ml distilled water in Group 3 and 6. the protocol was followed twice a day for 42 days. The weight of all the groups was calculated before and after drug intervention.

RESULTS

Metformin-induced weight loss was observed in healthy treated groups at both doses, however, there was no significant difference in weight loss in diabetic treated and untreated groups.

CONCLUSIONS

Metformin showed weight lowering properties in healthy treated subjects, after induction of diabetes we found weight loss in diabetic untreated and treated groups which suggests that hyperglycaemia may cause weight loss but when metformin corrects the hyperglycaemic profile it does not lead to an increase in weight.

Prevalence of Hepatitis B Virus Infection among Children with Liver Disease Admitted In Mymensingh Medical College Hospital

Hepatitis B virus infection is an important cause of liver disease. Hepatitis B Virus may present with varying degree of severity. In older children, 5-10% cases leading to chronic liver disease, cirrhosis and hepatocellular carcinoma. This descriptive cross sectional study was done to assess the prevalence of Hepatitis B Virus infection among hospitalized children with liver disease in pediatric department of Mymensingh Medical College Hospital, Bangladesh from December 2015 to October 2016. All the children of both sexes having age between six months to twelve years admitted in the pediatric ward with acute or chronic liver disease were included in this study by purposive sampling. A written consent was obtained from legal guardian of children before inclusion. Ethical clearance was obtained from competent authority. A detailed history was taken from parents in each case according to pre-designed questionnaire about demography of the patients and the risk factors of the liver disease. A thorough clinical examination and available relevant investigations like serological testing for HBV infection was done in all patients. We had figure out the seropositivity of HBV among patients having liver disease by doing HBsAg and Anti-HBc IgM. Progress of the patient was monitored by daily clinical examinations and by investigating HBsAg and Anti-HBc IgM. Finally data analysis was done by SPSS version 21.0. Among total 100 patients most (44%) patients were in 7-10 years old and most (62%) of the participants were male. Acute liver disease was 58% cases and chronic liver disease was 42% cases. HBsAg was positive in 1 case among acute liver disease and 5 cases among chronic cases. Total 6 (six) patients were found positive for HBsAg. Anti HBc IgM was positive in 4 patients among acute liver disease. Among these Anti HBc IgM positive (4) patients only one had both HBsAg and Anti HBc IgM positive. So, four patients were confirming suffered from acute viral hepatitis because they had anti HBc IgM positive. On the contrary 5 patients suffered from chronic hepatitis by hepatitis B because they were only HBsAg positive. So, in this study 9 patients (9%) were confirming suffered from HBV infection. Possible transmission factors of hepatitis B were history of (H/O) blood transfusion/trauma/parenteral injection, H/O umbilical sepsis, H/O maternal illness/infection during pregnancy. HBV still is a major cause of morbidity. All the children with liver disease should be routinely tested for HBV.

Feasibility of the TARGET-EFT trial in frail and pre-frail cardiovascular inpatients

Funding Acknowledgements

Type of funding sources: None.

Background

Older adults are at risk for hospital-acquired disability and deconditioning, often leading to the "post-hospitalization syndrome" of accelerated functional decline. We hypothesized that this syndrome could be prevented by a pragmatic multi-faceted intervention, and now report the initial experience and feasibility of our ongoing randomized clinical trial.

Methods

Patients admitted to the cardiovascular ward at a single academic center are screened with the Essential Frailty Toolset (EFT). Those ≥65 years with frailty (EFT: 3-5) or pre-frailty (EFT: 1-2) are eligible for the TARGET-EFT trial, in which they are randomly allocated to usual care or intervention. The intervention is targeted such that patients with physical weakness receive supervised exercise sessions (in addition to clinically-indicated physiotherapy), those with cognitive impairment receive stimulation activities, those with iron deficiency anemia receive intravenous iron sucrose, and those with malnutrition-related hypoalbuminemia receive protein supplements. The outcome is a composite score representing mobility, disability, activity, discomfort, and mood (EQ-5D-5L) ascertained by a blinded observer on the day of discharge and at 30 days post-hospitalization.

Results

To date, 77 out of a planned 144 patients have been randomized. The most common reasons for exclusion are age &lt;65 years, expected discharge within &lt;3 days and patient refusal. The median age is 80 years and length of stay is 8 days. In each group, 1 patient withdrew and 1 died. There were no intervention-related adverse events. Of the 39 intervention patients, 36 qualified for exercise and received an average of 6 sessions (46% of sessions were deferred because patients were away for tests, were bedrest post-procedures, or refused), 18 received cognitive stimulation, 15 received intravenous iron sucrose, and 16 received protein supplements.

Conclusion

The TARGET-EFT intervention is feasible and appears safe for frail and pre-frail patients hospitalized with acute cardiovascular disease. Given that nursing staff, physiotherapists, nutritionists and clinicians already address basic cognitive orientation, mobilization and nutritional/iron supplementation needs, it appears that adding targeted interventions for patients’ specific frailty deficits is feasible when shared amongst allied health professionals.

Mental health Apps to address inequitable access to care in specific regions of the global North and South: A scoping review

Introduction: There is a recent growth in the development of mental health applications (MHAPPs) to reduce stigma, improve knowledge and facilitate access to care especially in the area of common mood disorders. Yet, it remains unclear whether such interventions can address the access to care gap equitably in the global North and South. Such understanding could provide insights for mental health innovations during the COVID-19 pandemic as well. Methods: Using Arksey and O’Malley’s methodical framework, a scoping review was conducted on academic and grey literature published during 2015 and 2019. The countries of India and China were selected as exemplar for the global South and Canada and US for the global North. The reviewed literature was synthesized through thematic analysis and employed the social determinants of health lens.  Results: 20 articles were selected for full-text review. The results reveal that MHAPPs for depression and anxiety are efficacious in improving symptoms across the examined regions. Outcome scores (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, flourishing scale, social interaction anxiety scale) improved in 13 studies. Yet, public awareness in the global North and logistical barriers (mental health stigma/discrimination, financial and social challenges, usability of apps, and cultural barriers to self-care) in the global South inhibit uptake. Conclusion: Awareness of MHAPPs and logistical barriers must be addressed to make MHAPPs more accessible. Policy makers should be cautious in implementing MHAPPs in disadvantaged communities given several challenges. A broader policy level emphasis is needed to address the logistical capabilities and cultural sensitivity of MHAPPs. The findings are also discussed in relation to the digital innovations for mental health in the pandemic. Given the focus of the presented review on specific regions, the transferability of findings warrant caution.

Socio-demographic Profile of COVID-19 Patients and Difficulties Faced by Them while Testing RT-PCR: A Multi-center Cross-sectional Study

This study was aimed to find out the socio-demographic profiles as well as difficulties of Reverse transcription polymerase chain reaction (RT-PCR) testing faced by Coronavirus Disease 2019 (COVID-19) patients. This cross-sectional study was conducted from 10th August to 7th September 2020. Data were collected by telephone interview using a pre-designed questionnaire after taking verbal consent from the participants. Out of 281 COVID-19 patients, 279 were diagnosed by RT-PCR; 10.3% were asymptomatic. Off them 67.6%were males, 24% were hospital staffs. Majority (66.2%) were from the non-city corporation area. History of recent contact with known COVID-19 patients was present in 56.9% cases. Fever (78.3%) and cough (58%) were the most common symptoms. One third of the patients faced difficulty to test RT-PCR for COVID-19. Sixteen percent patients complained of difficulty of getting serial for testing, the maximum waiting time was one week before giving samples. Thirty patients (10.8%) had to wait longer than usual time after reaching the center before giving sample. Hospital staffs were unable to co-operate in 2.5% of the patients while difficulty of managing transport to the hospital for suspected COVID-19 patient was an issue in 2.2% of the patients. Though testing was more difficult in city corporation areas (p=0.028), delay of getting test result was less (p<0.001). Maximum delay of getting test result was 10 days. Finding out the difficulties of COVID-19 testing will help to point out the issues behind these and will help to take necessary steps to tackle this matter. Testing rate can be increased to contain this highly contagious virus in this densely populated country.

Risk Factors of Neonatal Sepsis in Neonatal Intensive Care Unit (NICU) of Mymensingh Medical College Hospital

Neonatal sepsis is associated with increased mortality and morbidity including prolonged hospital stay. Management of such cases is difficult, costly and need expert centers in many cases. Therefore, continued surveillance is mandatory to identify risk factors of neonatal sepsis which help optimizing its management. With the above idea, this cross-sectional descriptive study was conducted at the neonatal intensive care unit (NICU) in the department of Neonatology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2017 to December 2017 to observe the effects of maternal and neonatal risk factors in the development of neonatal sepsis and to determine risk factors of neonatal sepsis. Ninety four neonates (0-28 days) who were admitted in NICU with suspected sepsis were included in this study by purposive sampling technique. After admission written informed consent from parents or guardians obtained and histories were obtained including perinatal history and full physical examination of the infants were done and septic screening were sent. All the relevant information was recorded in a pre-designed questionnaire and all data were compiled, tabulated and then analyzed by SPSS version 21.0. Among 94 cases, 72.3% were preterm and 27.6% were term. There was male predominance and male/ female ratio was 1.9:1. Most (76.6%) of the patient admitted within 72 hours of birth. Most (83%) had low birth weight (<2500gm). Most came from rural area 61(64.9%) and also from low income family 59(62.8%). Premature onset of labour 40(42.6%), PROM >18 hours 36(38.3%), vaginal route of delivery 52(55.3%), instrumental resuscitation 15(16%), prelacteal feeding 11(11.7%), bottle feeding 15(16%) were the antenatal, natal and postnatal risk factors in this study. Also the neonatal factors, like prematurity, resuscitation at birth and low APGAR score carried the significant risk of developing sepsis. Poor feeding, lethargy, respiratory distress, jaundice were more common presenting symptoms. Tachycardia, tachypnea, chest indrawing, cyanosis hypothermia, hyperthermia and apnoea were found as more common presenting sign of sepsis in this study. Based on result it is concluded that prolonged rupture of membrane>18 hours, vaginal route of delivery, preterm birth, instrumental resuscitation, prelacteal feeding, bottle feeding were the major perinatal risk factors in this study.

Multiple Optical Features In Binary-Transition-Metal Borate Glasses.. [DOI: 10.21203/rs.3.rs-583999/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Glasses doped with transition metal (TM) ions exhibit rich optical transitions spanning the entire ultraviolet, visible, and infrared spectral regimes. Here we utilize the melt-quenching techniques to synthesis binary-TM-doped borate glasses of composition xCuO-(75-x)B2O3-24.7Li2O-0.3Cr2O3, with x = 0, 0.2, 1.0 and 2.0 mol %. We identify several optical transitions from Cr3+, Cr6+, and Cu2+ ions, the latter manifests at longer wavelengths and gains higher intensity with Cu additives. Despite Cr concentration being fixed, the Cr6+ peaks are quenched and Cr3+ signals are barely attenuated. This behavior rules out possible phase separation and suggests non-trivial interplay between the two TM ions and ligand, as supported by probing their oxidation states from electron spin resonance. The crystal field and Racah parameters followed an opposite behavior, while the optical band gap is reduced upon doping. These changes are correlated with structural modifications introduced by Cu additives, where we anticipate homogenous and preferential proximity of Cu-Cr ions within the network.

Cereal processing waste, an environmental impact and value addition perspectives: A comprehensive treatise

This review is to describe various methods used for the treatment of cereal processing wastes and their efficiency to reduce environmental issues. Physico-chemical and biological methods have great potential for the treatment of cereal industrial waste. These methods can be used alone or in combination with effective treatment. Physico-chemical treatments are mostly employed for the pretreatment of cereal processing wastes that helps in reduced sludge formation during biological treatments. Biological treatments are mostly used owing to their high efficiency in removing pollutants, and less expensive than physico-chemical treatments. However, these treatments consume more time as compared to physico-chemical treatments. These treatments also proved to be efficient for a high rate of cereal waste conversion into value-added products. Thus, cereal industrial waste can result in value-added products such as biohydrogen, bioethanol, butanol, biogas and biocoal as biofuels, industrial valued enzymes, biomass, biofertilizer, proteins, organic acids, polysaccharides and few others.

Elucidation of morphological characteristics, crystallinity, and molecular structures of native and enzyme modified cereal brans

Bran is a nutritious outermost layer of the cereal grain that is removed during milling to curtail the technical problems in end-products. Modification techniques such as enzyme treatments might be an effective way to alter bran morphology and end-use quality. In this study, bran from six cereals (wheat, barley, oat, maize, millet, and sorghum) were enzymatically modified (cellulase and xylanase), and evaluated for morphological properties through scanning electron microscopy, crystallinity through x-ray diffraction and molecular structures through FTIR spectroscopy. Scanning electron microscopy revealed that enzyme modifications caused breakage in bran fibers by hydrolyzing non-starch polysaccharides. X-ray diffraction exhibited that crystallinity of the structures was increased after modifications as enzymes hydrolyzed amorphous regions of cellulose and hemicellulose in bran matrix. Molecular structures studied by FTIR spectroscopy demonstrated absorption in wavelength ranges of 900-3400cm^-1 associated to carbohydrates, oligosaccharides, proteins, and non-starch polysaccharides. PRACTICAL APPLICATIONS: Cereal bran creates technical problems for food processors and bakers in terms of grittiness leading to the unacceptability of the product. The bran can be modified using different approaches, such as enzyme modifications. This research will be helpful for the food scientists & researchers and bakers for making choices for preferred method of bran modification. This will also be helpful for cereal scientists for the understanding of structural properties of bran layers.

Green synthesis of silver nanoclusters via Melia azedarach plant and their potential towards catalytic reduction of 4-nitrophenol

Biomolecules present in the plant extracts have potential to reduce metal ions to nanoclusters by a single-step green synthesis approach. In the current study, we have synthesized the silver nanoclusters (AgNCs) from a medicinal plant, Melia azedarach and studied their catalytic activity toward the reduction of 4-nitophenol to 4-aminophenol and organic dyes. Morover, the phytochemical analysis of the plant extract was carried out in order to determine the bioactive compounds present in it. Metallic nature of the synthesized AgNCs was verified by X-ray diffraction study, while their morphology and size of was confirmed by transmission electron microscopy and Zetasizer, respectively. The study revealed that they were 56±2 nm in size and formed clusters. Fourier transformed infrared spectroscopy gives information about the different functional groups present in synthesized these NCs. Furthermore, the important catalytic applications, such as catalytic reduction of 4-nitrophenol in the presence of mild reducing agent NaBH4 and the catalytic degradation of organic dyes was monitored by FTIR. Therefore, these results indicate that the obtained nanomaterials have important applications in industrial areas.                     KEY WORDS: Green synthesis, Silver nanoclusters, Catalytic reduction, Characterization   Bull. Chem. Soc. Ethiop. 2021, 35(1), 197-206. DOI: https://dx.doi.org/10.4314/bcse.v35i1.17