Knowledge interface co-design of a diabetes and metabolic syndrome initiative with and for Aboriginal people living on Ngarrindjeri country

Objectives

This research program involves two phases to identify enablers and barriers to diabetes care for Aboriginal people on Ngarrindjeri country; and co-design a strength-based metabolic syndrome and Type 2 Diabetes (T2D) remission program with the Ngarrindjeri community.

Study design

A study protocol on qualitative research.

Methods

The study will recruit Aboriginal people living on Ngarrindjeri country above 18 years of age with a diagnosis of metabolic syndrome or T2D. Recruitment for phases one and two will occur through the Aboriginal Health Team at the Riverland Mallee Coorong Local Health Network. The lived experiences of T2D will be explored with 10-15 Aboriginal participants, through an Aboriginal conversational technique called 'yarning' (60-90 min) in phase 1. Elders and senior community representatives (n = 20-30) will participate in four co-design workshops (2-4 h) in phase 2. Qualitative data will be transcribed and thematically analysed (NVivo version 12). The analysis will focus on protective factors for the Cultural Determinants of Health. Ethics approval was obtained from Aboriginal Health Research Ethics Committee in South Australia (04-22-1009), and Flinders University Human Research Ethics Committee (5847).

Results

This work will be used to pilot the co-designed diabetes remission trial. Outcomes will be published in peer-reviewed journals, presented at conferences, focusing on following best practice guidelines from the Australian Institute of Aboriginal and Torres Strait Islander Studies and National Health and Medical Research Council. Research translation will occur through digital posters, manuals, and infographics.

Conclusions

The findings will be summarised to all Aboriginal organisations involved in this study, along with peak bodies, stakeholders, Aboriginal Services, and interested participants.

Exogenous Ca/Mg quotient reduces the inhibitory effects of PEG induced osmotic stress on Avena sativa L

Abstract Drought is one of the most damaging abiotic stress that hinder plant growth and development. The present study aimed to determine the effects of various Ca/Mg quotients under polyethylene glycol (PEG)–induced osmotic stress on growth, uptake and translocation of Ca and Mg in Avena sativa (L). Plants were grown in nutrient solution supplemented with three different Ca/Mg molar quotients (0.18, 2, and 4). After 30 days plants were exposed to two different PEG (Polyethylene glycol) concentrations (0.6 MPa & 0.2 MPa) for 8 days, and solutions were renewed after 4 days. A solution containing Ca and Mg nutrients has mitigated the negative impact caused via osmotic stress on relative growth rate (RGR), absolute growth rate (AGR), crop growth rate (CGR), leaf area ratio (LAR), Leaf index ratio (LAI), root-shoot ratio (RSR), water use efficiency (WUE) and net assimilation rate (NAR). In addition, it adversely affected germination parameters, including final emergence percentage (FEP), mean germination time (MGT), Timson germination Index (TGI), germination rate index (GRI) and percent field capacity (%FC), of oat (Avena sativa L.). Mg and Ca in shoot and root and Ca translocation factor decreased with increasing Ca in solution, while Mg translocation factor increased with increasing Ca in nutrient solution. In this work, the combined effects of various Ca/Mg quotients and osmotic stress produced by polyethylene glycol (PEG) in different concentrations (0.6 MPa, 0.2 MPa) on the growth and element uptake of Avena sativa L. are examined. As a result, the Ca/Mg Quotient may naturally combat the moderate drought stress experienced by field crops.

GelMA-catechol coated FeHAp nanorods functionalized nanofibrous reinforced bio-instructive and mechanically robust composite hydrogel scaffold for bone tissue engineering

Critical bone defects complicate tissue graft-based surgeries, raising healthcare expenditures and underscoring scaffold-based tissue-engineering strategies to support bone reconstruction. Our study highlighted that the phase-compatible combination of inorganic nanorods, nanofibers, and hydrogels is promising for developing biomimetic and cell-instructive scaffolds since the bone matrix is a porous organic/inorganic composite. In brief, methacrylated gelatin (GelMA) was reacted with dopamine to form catechol-modified GeLMA (GelMA-C). The GelMA-C was nanocoated onto an iron-doped hydroxyapatite (FeHAp) nanorod via metal-catechol network coordination. The modified nanorod (FeHAp@GelMA-C) was loaded onto GelMA-based nanofibers. The nanorods loaded pre-fibers were electrospun onto GelMA solution and photochemically crosslinked to fabricate a fiber-reinforced hydrogel. The structural, mechanical, physicochemical, biocompatibility, swelling properties, osteogenic potential, and bone remodelling potential (using rat femoral defect model) of modified nanorods, simple hydrogel, and nanorod-loaded fiber-reinforced hydrogel were studied. The results supported that the interface interaction between GelMA-C/nanorods, nanorods/nanofibers, nanorods/hydrogels, and nanofiber/hydrogels significantly improved the microstructural and mechanical properties of the scaffold. Compared to pristine hydrogel, the nanorod-loaded fiber-reinforced scaffold better supported cellular responses, osteogenic differentiation, matrix mineralization, and accelerated bone regeneration. The nanorod-loaded fiber-reinforced hydrogel proved more biomimetic and cell-instructive for guided bone reconstruction.

Mussel bioinspired, silver-coated and insulin-loaded mesoporous polydopamine nanoparticles reinforced hyaluronate-based fibrous hydrogel for potential diabetic wound healing

Diabetes wounds take longer to heal due to extended inflammation, decreased angiogenesis, bacterial infection, and oxidative stress. These factors underscore the need for biocompatible and multifunctional dressings with appropriate physicochemical and swelling properties to accelerate wound healing. Herein, insulin (Ins)-loaded, and silver (Ag) coated mesoporous polydopamine (mPD) nanoparticles were synthesized (Ag@Ins-mPD). The nanoparticles were dispersed into polycaprolactone/methacrylated hyaluronate aldehyde dispersion, electrospun to form nanofibers, and then photochemically crosslinked to form a fibrous hydrogel. The nanoparticle, fibrous hydrogel, and nanoparticle-reinforced fibrous hydrogel were characterized for their morphological, mechanical, physicochemical, swelling, drug-release, antibacterial, antioxidant, and cytocompatibility properties. The diabetic wound reconstruction potential of nanoparticle-reinforced fibrous hydrogel was studied using BALB/c mice. The results indicated that Ins-mPD acted as a reductant to synthesize Ag nanoparticles on their surface, held antibacterial and antioxidant potential, and their mesoporous properties are crucial for insulin loading and sustained release. The nanoparticle-reinforced scaffolds were uniform in architecture, porous, mechanically stable, showed good swelling, and possessed superior antibacterial, and cell-responsive properties. Furthermore, the designed fibrous hydrogel scaffold demonstrated good angiogenic, anti-inflammatory, increased collagen deposition, and faster wound repair capabilities, therefore, it could be used as a potential candidate for diabetic wound treatment.

Morphometric analysis and roosting ecology of bat species Pteropus Medius in Mansehra, Khyber Pakhtunkhwa, Pakistan

Morphometric measurement and roosting ecology of Pteropus medius were aimed to find out in Mansehra district of KP, Pakistan. Total 3149 numbers of bats were found in eight biological spots visited; Baffa Doraha, Darband, Dadar, Jallu, Hazara University, Garhi Habibullah Chattar Plain and Jabori, in total 299 numbers of different species of trees including; Morus alba, Pinus raxburghi, Eucalyptus camaldulensis, Morus nigra, Grevillea robusta, Brousonetia papyrifera, Platanus orientalis, Ailanthus altissima, Hevea brasiliensis and Populus nigra. Morphometric features were measured and found vary according to sex of the bats. The average wing span, wing`s length from tip of wing to neck, from thumb to tip of wing and the body`s length from head and claws were recorded to be 102.98 cm, 49.07cm, 28.7 cm and 22.78 cm respectively in males while 93.67 cm, 44.83cm, 24.78cm and 22.78 cm respectively in female bats. Mean circumference of the body including wings and without wing were measured as 22.78 cm and 17.29 cm in males and that of female were 20.07 cm and 16.9 cm. Average length of thumb 3.64 cm, ear`s length 3.1 cm, snout 5.62cm, eye length were 1.07 cm for both sexes and length between the feet in extended position were16.3 cm. Generally different measurement of males bodies were found to be greater than female such as mean body surface area, mass, volume and pressure were found to be 2691.79 cm2, 855.7gm,1236.4 ml and 295.77 dyne/ c m 3 for male and 2576.46 cm2, 852.71gm,1207 ml and 290.2 dyne/ c m 3 respectively for female. While weight and density for both males and females bats were same with mean of 8.59 newton and 0.701 g/m3. Findings of current reports can add valued information in literature about bats, which can be used for species identification and conservation.

An osteogenic, antibacterial, and anti-inflammatory nanocomposite hydrogel platform to accelerate bone reconstruction

Fabricating an organic-inorganic nanocomposite hydrogel platform with antibacterial, anti-inflammatory, and osteoinductive properties that mimic bone extracellular matrix composition is decisive for guiding bone development in orthopedic practice. Despite significant progress in developing hydrogels for tissue repair, little attention has been paid to replicating the natural bone ECM microenvironments and addressing the importance of anti-inflammatory agents during osteogenesis. Herein, we developed ciprofloxacin and dexamethasone loaded strontium (Sr) and/or iron (Fe) substituted hydroxyapatite (HAp) nanomaterials precipitated in collagen (Col) to construct a multifunctional bioactive nanocomposite hydrogel platform to prevent inflammation and bacterial adhesion, leading to augmenting bone development in the defect site. The fabricated nanocomposite hydrogels (Sr:HAp-Col, Fe:HAp-Col, and Sr/Fe:HAp-Col) were physicochemically characterized and demonstrated high loading and prolonged drug release, and excellent antibacterial activity against Gram-positive and Gram-negative bacteria. In in vitro experiments, the Sr/Fe:HAp-Col sample exhibited enhanced bioactivity against the preosteoblast MC3T3-E1 cell line, with high alkaline phosphatase and bone-like inorganic calcium deposition, as well as increased gene expression of osteogenesis-related differentiation markers, including OPN, OCN, and RUNX2. Furthermore, in vivo experiments revealed that the Sr/Fe:HAp-Col matrix degraded over time by controlling the release of ions into the body, without causing acute inflammation at the implanted site or in the blood serum, or in the internal organs, including the heart, lungs, liver, and kidney of the Sprague-Dawley rat model. The micro-CT scan and histological examination showed high bone mineral density and more mature bone formation at the nanocomposite hydrogel implanted site associated with the ColMA hydrogel in the femur defect of the rat model. The strategy of applying collagen hydrogel supplemented with HAp to bone regeneration is promising due to its ability to mimic the natural bone ECM. Overall, the developed bioactive nanocomposite hydrogel may have great potential not only in bone regeneration but also in repairing nonunion-infected defects of other tissues.

Effects of microplastics in freshwater fishes health and the implications for human health

The presence of microplastics in aquatic environments has raised concerns about their abundance and potential hazards to aquatic organisms. This review provides insight into the problem that may be of alarm for freshwater fish. Plastic pollution is not confined to marine ecosystems; freshwater also comprises plastic bits, as the most of plastic fragments enter oceans via rivers. Microplastics (MPs) can be consumed by fish and accumulated due to their size and poor biodegradability. Furthermore, it has the potential to enter the food chain and cause health problems. Evidence of MPs s ingestion has been reported in >150 fish species from both freshwater and marine systems. However, microplastic quantification and toxicity in freshwater ecosystems have been underestimated, ignored, and not reported as much as compared to the marine ecosystem. However, their abundance, influence, and toxicity in freshwater biota are not less than in marine ecosystems. The interaction of MPs with freshwater fish, as well as the risk of human consumption, remains a mystery. Nevertheless, our knowledge of the impacts of MPs on freshwater fish is still very limited. This study detailed the status of the toxicity of MPs in freshwater fish. This review will add to our understanding of the ecotoxicology of microplastics on freshwater fish and give subsequent research directions.

Факторы, способствующие увеличению частоты кесарева сечения: обзор литературы

Актуальность: Во всем мире наблюдается растущая тенденция применения кесарева сечения. По данным ВОЗ, темп роста составляет около 15%.Цель исследования – поиск возможных решений для снижения частоты кесарева сечения не требуемых медицинскими показаниями.Методы: Поиск литературы включал исследовательские и обзорные статьи по кесареву сечению (кесарево сечение), доступные в Google Scholar, PubMed, Sci-Hub и Biomedical Corner.Результаты: Обзор литературы выявил ежедневное увеличение частоты кесарева сечения. Если ранее кесарево сечение считалось экстренной процедурой, спасающей жизнь, сегодня некоторые воспринимают его как метод выбора и комфорта, что приводит к превышающим рекомендованным ВОЗ нормам проведения операции. В этом обзоре обсуждаются факторы, которые приводят к увеличению частоты кесарева сечения по материнской просьбе. Для снижения частоты кесарева сечения необходимо информировать людей о факторах риска, заболеваемости, смертности, рекомендациях ВОЗ и мнениях врачей.Заключение: Общий уровень кесарева сечения можно снизить, если устранить факторы, приводящие к выбору кесарева сечения по желанию матери, и оказывать психологическую поддержку женщинам, которые обращаются за кесаревым сечением без медицинских показаний. 

Efficacy of pentamidine-loaded chitosan nanoparticles as a novel drug delivery system for Leishmania tropica

The present study compares the in vitro effects of nanoparticles loaded pentamidine drug and conventional pentamidine on Leishmania tropica. Herein, pentamidine-loaded chitosan nanoparticles (PTN-CNPs) have been synthesized through an ionic gelation method with sodium tripolyphosphate (TPP). Next, the physical characteristics of PTN-CNPs were determined through the surface texture, zeta potential, in vitro drug release, drug loading content (DLC), and encapsulation efficacy (EE) and compared its efficacy with free pentamidine (PTN) drug against promastigotes and axenic amastigotes forms of L. tropica in vitro. The PTN-CNPs displayed a spherical shape having a size of 88 nm, an almost negative surface charge (-3.09 mV), EE for PTN entrapment of 86%, and in vitro drug release of 92% after 36 h. In vitro antileishmanial activity of PTN-CNPs and free PTN was performed against Leishmania tropica KWH23 promastigote and axenic amastigote using 3-(4, 5- dimethylthiazol-2-yl)-2, 5-diphenyletetrazolium bromide (MTT) assay. It was observed that the effect of PTN-CNPs and free PTN on both forms of the parasite was dose and time dependent. Free PTN presented low efficacy even at higher dose (40 µg/ml) with 25.6 ± 1.3 and 26.5 ±1.4 mean viability rate of the promastigotes and axenic amastigotes, respectively after 72 hrs incubation. While PTN-CNPs showed strong antileishmanial effects on both forms of parasite with 16 ± 0.4 and 19 ± 0.7 mean viability rate at the same higher concentration (40 µg/ml) after 72 hrs incubation. Half maximal inhibitory concentration (IC50) values of PTN-CNPs toward promastigotes and amastigotes were obtained as 0.1375 µg/ml and 0.1910 µg/ml, respectively. In conclusion, PTN-CNPs effectively inhibited both forms of the L. tropica; however, its effect was more salient on promastigotes. This data indicates that the PTN-CNPs act as a target drug delivery system. However, further research is needed to support its efficacy in animal and human CL.

Electrospun tannin-rich nanofibrous solid-state membrane for wastewater environmental monitoring and remediation

Heavy metal, organic dyes, and bacterial contamination in water endanger human/animals' health, and therefore, the detection, adsorption, and capturing of contaminants are essential for environmental safety. Ligand-rich membranes are promising for sensors, adsorption, and bacterial decontamination. Herein, tannin (TA)-reinforced 3-aminopropyltriethoxysilane (APTES) crosslinked polycaprolactone (PCL) based nanofibrous membrane (PCL-TA-APTES) was fabricated via electrospinning. PCL-TA-APTES nanofibers possess superior thermal, mechanical, structural, chemical, and aqueous stability properties than the un-crosslinked membrane. It changed its color from yellowish to black in response to Fe^2+/3+ ions due to supramolecular iron-tannin network (FeTA) interaction. Such selective sensing has been noticed after adsorption-desorption cycles. Fe³⁺ concentration, solution pH, contact time, and ligand concentration influence FeTA coordination. Under optimized conditions followed by image processing, the introduced membrane showed a colorimetric linear relationship against Fe³⁺ ions (16.58 μM-650 μM) with a limit of detection of 5.47 μM. The PCL-FeTA-APTES membrane could restrain phenolic group oxidation and result in a partial water-insoluble network. The adsorption filtration results showed that the PCL-FeTA-APTES membrane can be reused and had a higher methylene blue adsorption (32.04 mg/g) than the PCL-TA-APTES membrane (14.96 mg/g). The high capture efficiency of nanocomposite against Fe³⁺-based S. aureus suspension than Fe³⁺-free suspension demonstrated that Fe³⁺-bounded bacterium adhered to the nanocomposite through Fe³⁺/TA-dependent biointerface interactions. Overall, high surface area, rich phenolic ligand, porous microstructure, and super-wetting properties expedite FeTA coordination in the nanocomposite, crucial for Fe^2+/3+ ions sensing, methylene blue adsorption-filtration, and capturing of Fe³⁺-bounded bacterium. These multifunctional properties could promise nanocomposite membrane practicability in wastewater and environmental protection.

Characterization of laser-induced shock waves generated during infrared laser ablation of copper by the optical beam deflection method

The shock waves generated during laser ablation of a copper target are investigated using the optical beam deflection method. The fluence of nanosecond pulsed infrared laser beam was in the range of 15-700J/cm². The density jumps related with the influx of the shock wave at two interaction points were detected with the help of He-Ne laser probes. In general, a supersonic shock wave is produced, which propagates through air and gradually decays into an acoustic wave. Experiments were carried out to study the impact of laser fluence and propagation distance on the shock wave velocity and pressure. The shock wave velocity varies with laser fluence as v∝Fl0.3 and with propagation distance as v∝d^-1.5. These results are compared with the predictions of the theoretical models. In the investigated fluence range, shock wave pressure rises by an order of magnitude (∼1-10MPa). We demonstrated that shock wave pressure and ablated mass can be related, yielding mass-specific shock wave pressure that increases linearly with laser fluence. We have also noticed the shock-wave-induced probe beam focusing under certain conditions, which indicates that the shock wave modifies the refractive index of the compressed layer of air. The reported results are useful for the fundamental understanding and pave the way for new applications of laser-induced shock waves.

Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft with Fixation Using Endobutton at Femoral End and Bioabsorbable Screw at Tibial End

Anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. It can be repaired and reconstructed by open and endoscopic method, the gold standard is, however, endoscopic reconstruction. It is usually reconstructed using bone patellar tendon bone (BPTB) or Hamstring autograft. The graft is supported using endobutton at the femoral end while bioabsorbable interference screw at the tibial end. This study aimed to determine how a certain fixation procedure for quadrupled hamstring autografts worked out. This prospective observational study duration period was 1 year in which 40 patients with ACL injury were treated with arthroscopic reconstruction using hamstring autograft from January 2020 to December 2020 with 6 months follow up after surgery. On the femoral side, an endobutton was used to secure the graft, while the tibial end was secured using a bioabsorbable screw. The International Knee Documentation Committee (IKDC) scoring system was used for prospective evaluation. According to subjective IKDC scoring, 20(50.0%) results were very good, 14(35.0%) were good, 4(10.0%) were satisfactory and 2(5.0%) were bad. In 95.0% patients the state of knee joint is very good compared to preoperative state. Of all the 40 patients underwent ACL reconstruction, 38(95.0%) patients are satisfied with the results of the operation.

Heavy Metal Ions Detection Using Nanomaterials-Based Aptasensors

Heavy metals ions as metallic pollutants are a growing global issue due to their adverse effects on the aquatic ecosystem, and human health. Unfortunately, conventional detection methods such as atomic absorption spectrometry exhibit a relatively low limit of detection and hold numerous disadvantages, and therefore, the development of an efficient method for in-situ and real-time detection of heavy metal residues is of great importance. The aptamer-based sensors offer distinct advantages over antibodies and emerged as a robust sensing platform against various heavy metals due to their high sensitivity, ease of production, simple operations, excellent specificity, better stability, low immunogenicity, and cost-effectiveness. The nucleic acid aptamers in conjugation with nanomaterials can bind to the metal ions with good specificity/selectivity and can be used for on-site monitoring of metal ion residues. This review aimed to provide background information about nanomaterials-based aptasensor, recent advancements in aptamer conjunction on nanomaterials surface, the role of nanomaterials in improving signal transduction, recent progress of nanomaterials-based aptasening procedures (from 2010 to 2022), and future perspectives toward the practical applications of nanomaterials-based aptasensors against hazardous metal ions for food safety and environmental monitoring.

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.

Spreading Terrorism, Militancy, and Radicalization in Malakand Division Khyber Pakhtunkhwa Pakistan: An Analysis of the Economic Factors

The current study is to analyze the causes of militancy, terrorism, and radicalization where multifarious factors are contributing towards spreading such behavior. However, the study is delimited to focus on the economic factors, including poverty, unemployment and other such factors that lead towards militancy, terrorism, and radical behavior in society. The field information was collected from 200 respondents using purposive sampling technique with stratified approach from 3 strata of the society including businessmen, teachers and clergy or religious class of age 20 and above. The data was collected through a structured interview schedule, and the analysis was made in the form of tables, discussion and the findings have been verified through chi-square test. The findings show that militancy, terrorism, and radicalization have their roots in deep rooted poverty, unemployment, and lack of other life facilities in the area. The study suggests proper planning for provision of jobs, equal distribution of resources among people and provision of life facilities to the masses.

Recent advances and challenges in 2D/2D heterojunction photocatalysts for solar fuels applications

Although photocatalytic technology has emerged as an effective means of alleviating the projected future fuel crisis by converting sunlight directly into chemical energy, no visible-light-driven, low-cost, and highly stable photocatalyst has been developed to date. Due to considerably higher interfacial contact with numerous reactive sites, effective charge transmission and separation ability, and strong redox potentials, the focus has now shifted to 2D/2D heterojunction systems, which have exhibited effective photocatalytic performance. The fundamentals of 2D/2D photocatalysis for different applications and the classification of 2D/2D materials are first explained in this paper, followed by strategies to improve the photocatalytic performance of various 2D/2D heterojunction systems. Following that, current breakthroughs in 2D/2D metal-based and metal-free heterojunction photocatalysts, as well as their applications for H₂ evolution via water splitting, CO₂ reduction, and N₂ fixation, are discussed. Finally, a brief overview of current constraints and predicted results for 2D/2D heterojunction systems is also presented. This paper lays out a strategy for developing efficient 2D/2D heterojunction photocatalysts and sophisticated technology for solar fuel applications in order to address the energy issue.

POS0208 STRESS AT HOME IS COMMON AND HAS SIGNIFICANT ASSOCIATION WITH MARITAL STATUS, HIGHER DISEASE ACTIVITY, COMORBIDITIES, AND WORSE QUALITY OF LIFE AMONG PATIENTS WITH RHEUMATOID ARTHRITIS: SINGLE CENTRE RESULTS FROM THE PRIME REGISTRY COHORT

Background

In chronic inflammatory diseases like rheumatoid arthritis (RA), psychological stress is widely recognised as an important risk factor to negatively affect the disease course. Perceived stress can potentially induce the disease exacerbation, but on the other hand, the disease itself might produce significant stress to patients thus the vicious circle is formed and maintained.

Objectives

We aimed to examine the prevalence of mental/emotional stress at home and its associations among patients with Rheumatoid arthritis. We addressed this question using real-world data from the PRIME registry.

Methods

This was a cross-sectional study conducted using data collected at the time of patient enrolment in the PRIME registry. The PRIME Registry is a large, independent, prospective, observational cohort initiated in October 2019 that comprises patients diagnosed with RA, SLE, PsA or AS by a rheumatologist, and is being actively followed up. IRB approval and informed consent was obtained. We assessed the data for RA patients. The clinical variables studied were gender, age, smoking habits, body mass index, education status, marital status, disease duration, comorbidities (using Charlson Comorbidity Index). Education status was stratified by whether participants completed secondary (high) school education. The SF-12 Physical Component Score (PCS-12) and Mental Component Score (MCS-12) was also measured. Evaluation of disease activity and severity was made as per internationally agreed definitions, such as: swollen joint counts, tender joint counts, deformed joint counts, and DAS-28. All participants were directly inquired at the interview during the time of patient enrolment about the presence or otherwise of mental/emotional stress at home, and to rate it from 1-3 (mild, moderate, severe). For better understanding and ease of statistical analysis, dichotomous variable was made with moderate-to-severe stress patients were categorised into one group and none-to-mild stress patients into second group.

Results

The data from consecutive 1016 RA patients (mean age 40.8±13 years, 78.6% female, disease duration of 65±67 months) was reviewed. Forty-nine percent of patients accepted to have moderate-severe stress at home. Female gender (p=0.003), low education status (p=0.050), being unmarried (p=0.051), and MCS, PCS, CCI (p<0.001) were associated with moderate-severe stress. However, no statistical association of age and disease duration was noted. On univariate analysis, significant association of moderate-severe stress at home was noted with deformed joint counts (p=0.003), higher DAS-28 scores (p<0.001), low education status (p=0.02) and being married (p<0.001). Weak statistical association of age (p=0.30), disease duration (p=0.12), low education status (p=0.14), female gender (p=0.24) was noted. On multiple logistic regression analysis, a significant association of moderate-severe stress at home was observed with higher DAS-28 scores (OR 2.38, CI 2.00-2.84, p<0.001), MCS-12 (OR 0.65, CI 0.61-0.69, p<0.001), comorbidities-CCI (OR 1.41, CI 1.15-1.74, p=0.001) and being unmarried (OR 0.55, CI 0.36-0.83, p=0.005). The final regression model resulted in a statistically significant improved association/prediction of worse moderate-severe stress at home (R square=71%). Following variables were included in multiple stepwise regression analysis: age, disease duration, gender, education status, marital status, comorbidities index, major trauma/stress in last one year, DAS-28, MCS-12 and PCS-12 scores.

Conclusion

Nearly half of the cohort was noted to have moderate-severe level of stress at home, and is associated with important adverse clinical outcomes. These findings demonstrate an important need for integration of rheumatologic, social workers and mental health services

Disclosure of Interests

Muhammad Haroon Speakers bureau: Novartis, Abbvie, Pfizer, Roche, Grant/research support from: Abbvie, Sadia Asif: None declared, Saadat Ullah: None declared, Farzana Hashmi: None declared, Saba Javed: None declared

POS0574 FEMALE GENDER AND STRESS ARE MAIN DETERMINANTS OF NON-ADHERENCE AND NEGATIVE ILLNESS PERCEPTION AMONG PATIENTS WITH RHEUMATOID ARTHRITIS: SINGLE CENTRE RESULTS FROM THE PRIME REGISTRY COHORT

Background

Adherence to medications among patients with RA is traditionally considered to be low. Little is known about the indicators and the outcomes of patients having good adherence to medications among Pakistani RA patients.

Objectives

We aimed to assess the level of non-adherence and its associations with clinical indicators and outcomes using validated measures in a large consecutive Pakistani RA population. Moreover, we measured illness perception using additional validated tools to help us better understand this concept.

Methods

This was a cross-sectional study conducted using data collected at the time of patient enrolment in the PRIME registry. IRB approval and informed consent was obtained. The clinical variables studied were gender, age, smoking habits, body mass index, education status, marital status, disease duration, Charlson Comorbidity Index. Education status was stratified by whether participants completed secondary (high) school education. Evaluation of disease activity and severity was made as per internationally agreed definitions. To measure adherence, the instrument used in the study was the Urdu version of the General Medication Adherence Scale (GMAS), which has been validated for RA patients. Brief Illness Perception Questionnaire (BIPQ) is the simplified version of the Illness Perception Questionnaire (IPQ). BIPQ is a nine-item scale designed to rapidly assess the cognitive and emotional representations of illness. To facilitate interpretation of results in daily clinical practice and to identify patients with the most negative illness perception, we dichotomized the BIPQ scores using the 75th interquartile range score as cutoff, as previously done.

Results

The data of consecutive 320 RA patients enrolled in PRIME registry (mean age 37.4±13.4 years, 74% female, disease duration of 73±68 months, 30% rural residents, 32.5% had low education status of ≤primary school, and 35% of the cohort was employed) was reviewed. Thirty six percent of the cohort (n=116) was noted to have non adherence. On multiple logistic regression analysis, a significant association of moderate-severe stress (OR 1.85, CI 1.04-3.2, p=0.03), DAS-28 scores (OR 1.83, CI 1.52-2.21, p<0.001), HAQ scores (OR 1.77, CI 1.07-2.92, p=0.02), deformed joint counts (OR 1.30, CI 1.15-1.46, p<0.001). We further examined the concept of non-adherence among our cohort across three domains or components of GMAS questionnaire individually. Firstly, on multivariate regression analysis showed that non-adherence due to patient behavior had significant association with male gender (OR 0.48, p=0.01), unemployment (OR 1.82, p=0.02), stress (OR 2.17, p=0.001), DAS-28 (OR 1.15, p=0.050), worse HAQ scores (OR 1.83, p=0.005). Secondly, multivariate regression analysis showed that non-adherence due to comorbidity and pill burden was associated with age of onset of arthritis (OR 1.02, p=0.006), DAS-28 (OR 1.18, p=0.03), and HAQ (OR 1.81, p=0.008). Thirdly, multivariate regression analysis showed that cost-related non-adherence had no significant association with patient related demographics and traits, but was noted to have significant association with worse DAS-28 and HAQ scores. The mean total BIPQ score of the cohort was 62±8.8. Twenty six percent of the cohort (n=86) was noted to have the most negative illness perception (BIPQ score of >68). On multiple logistic regression analysis, a significant protective association of male gender (OR 0.24, CI 0.11-0.53, p<0.001) and age of onset of arthritis (OR 0.96, CI 0.94-0.99, p=0.01), along with significant association of worse HAQ scores (OR 3.7, CI 2.2-6.1, p<0.001) was noted with the most negative illness perception.

Conclusion

Non-adherence is common and its main determinants were female gender and stress, along with associated adverse clinical outcomes. Gender-based discrimination in low socioeconomic states along with associated stress is a plausible explanation.

Disclosure of Interests

Farzana Hashmi: None declared, Muhammad Haroon Speakers bureau: Novartis, Roche, Abbvie, Pfizer, Grant/research support from: Abbvie, Pfizer, Sadia Asif: None declared, Saadat Ullah: None declared, Saba Javed: None declared.

AppAxO : Designing App lication-specific A ppro x imate O perators for FPGA-based Embedded Systems

Approximate arithmetic operators, such as adders and multipliers, are increasingly used to satisfy the energy and performance requirements of resource-constrained embedded systems. However, most of the available approximate operators have an application-agnostic design methodology, and the efficacy of these operators can only be evaluated by employing them in the applications. Furthermore, the various available libraries of approximate operators do not share any standard approximation-induction policy to design new operators according to an application’s accuracy and performance constraints. These limitations also hinder the utilization of machine learning models to explore and determine approximate operators according to an application’s requirements. In this work, we present a generic design methodology for implementing FPGA-based application-specific approximate arithmetic operators. Our proposed technique utilizes lookup tables and carry-chains of FPGAs to implement approximate operators according to the input configurations. For instance, for an \( \text{M}\times \text{N} \) accurate multiplier utilizing K lookup tables, our methodology utilizes K -bit configurations to design \( 2^K \) approximate multipliers. We then utilize various machine learning models to evaluate and select configurations satisfying application accuracy and performance constraints. We have evaluated our proposed methodology for three benchmark applications, i.e., biomedical signal processing, image processing, and ANNs. We report more non-dominated approximate multipliers with better hypervolume contribution than state-of-the-art designs for these benchmark applications with the proposed design methodology.

GC-MS analysis of organic fractions of Chrozophora tinctoria (L.) A.Juss. and their prokinetic propensity in animal models

Chrozophora tinctoria (L.) A.Juss. is herbaceous, monecious annual plant used traditionally to cure gastrointestinal disorders. The present study was carried out to find the bioactive compounds by Gas Chromatography-Mass Spectrometry, the acetylcholinesterase inhibitory potential acute toxicity, and emetic activity present in the ethyl acetate fraction of Chrozophora tinctoria (EAFCT) and dichloromethane fraction of Chrozophora tinctoria (DCMFCT). The compounds detected in both fractions were mostly fatty acids, with about seven compounds in EAFCT and 10 in DCMFCT. These included pharmacologically active compounds such as imipramine, used to treat depression, or hexadecanoic acid methyl ester, an antioxidant, nematicide, pesticide, hypocholesterolemic, 9,12,15-Octadecatrienoic acid, ethyl ester, (Z,Z,Z)- is used as a cancer preventive, antiarthritic, antihistaminic, hepatoprotective, insectifuge, nematicide, Pentadecanoic acid, 14-methyl-, methyl ester have antifungal, antimicrobial and antioxidant activities, 10-Octadecanoic acid, methyl ester have the property to decrease blood cholesterol, Antioxidant and antimicrobial, 1-Eicosanol is used as an antibacterial, 1-Hexadecene has antibacterial, antioxidant, and antifungal activities. Both DCMFCT and EAFCT fractions inhibited acetylcholinesterase (AChE) activity with IC50 values of 10 µg and 130 µg, respectively. Both the fractions were found to be toxic in a dose-dependent manner, inducing emesis at 0.5g onward and lethargy and mortality from 3-5 g upwards. Both the fractions combined with distilled water showed highly emetic activity. The significant increase in the number of vomits was shown by EAFCT plus distilled water which are 7.50±1.29, 7.25±3.10, and 11.75±2.22 number of vomits at 1g, 2g, and 3g/kg concentration respectively, while DCMFCT plus distilled water showed 5.25±2.22, 7.50±2.52 and 10.25±2.22 number of vomits at 1g, 2, and 3g/kg correspondingly. The antiemetic standard drug metoclopramide has a higher impact against the emesis induced by both the fractions than dimenhydrinate. Metoclopramide decreases the number of vomits caused by EAFCT to 1.00±0.00, 2.00±0.00, 4.00±1.00 at 1g, 2, and 3g/kg sequentially, while dimenhydrinate decreases the number of vomits to 1.33±0.58, 2.33±1.15, 4.33±0.58 at 1g, 2, and 3g respectively. In the same way, Metochloprimide decreases the number of emesis caused by DcmCt from 5.25±2.22, 7.50±2.52, 10.25±2.22 to 1.33±0.58, 2.33±1.1, 4.33±0.58 at 1g, 2, and 3g/kg concentrations. The present study is the first documented report that scientifically validates the folkloric use of Chrozophora tinctoria as an emetic agent.

Multifaceted tannin crosslinked bioinspired dECM decorated nanofibers modulating cell-scaffold biointerface for tympanic membrane perforation bioengineering

Tympanic membrane (TM) perforation leads to persistent otitis media, conductive deafness, and affects life quality. Ointment medication may not be sufficient to treat TM perforation due to the lack of an underlying tissue matrix and thus requiring a scaffold-based application. The engineering of scaffold biointerface close to the matrix via tissue-specific decellularized extracellular matrix (dECM) is crucial in instructing cell behaviour and regulating cell-material interaction in the bioengineering domain. Herein, polycaprolactone (PCL) and TM-dECM (from SD rats) were combined in a different ratio in nanofibrous form using an electrospinning process and crosslinked via tannic acid. The histological and biochemical assays demonstrated that chemical and enzymatic decellularization steps removed cellular/immunogenic contents while retaining collagen and glycosaminoglycan. The morphological, physicochemical, thermomechanical, contact angle, and surface chemical studies demonstrated that the tannin crosslinked PCL/dECM nanofibers fine-tune biophysical and biochemical properties. The multifaceted crosslinked nanofibers hold the tunable distribution of dECM moieties, assembled into a spool-shaped membrane, and could easily insert into perforated sites. The dECM decorated fibers provide a preferable biomimetic matrix for L929 fibroblast adhesion, proliferation, matrix adsorption, and f-actin saturation, which could be crucial for bioengineering. Overall, dECM patterning, surface hydrophilicity, interconnected microporosities, and multifaceted nanofibrous biosystem modulate cell-scaffold performance and could open opportunities to reconstruct TM perforation in a biomimetic fashion.

Tree species composition, growing stock and biomass carbon dynamics of the major timber species in Hindu Kush regions of Pakistan

Using inventory data, this study evaluates the species composition, growing stock volume (GSV), and biomass carbon (BMC) of the five major timber species in the sub-tropical, and temperate/sub-alpine regions of Pakistan. It was found that the stem density varies between 50 and 221 trees ha -1, with a mean of 142 trees ha-1 (13.68 million trees for entire forest area). Among the species, Pinus wallichiana showed a high species composition (27.80%) followed by Picea smithiana (24.64%). The GSV was found in the range of 67.81 to 425.94 m3 ha-1, with a total GSV value of 20.68 million m3 for the entire region. Similarly, The BMC ranged from 27.04 to 169.86 Mg ha-1, with a mean BMC value of 86.80 Mg ha-1. The total amount of stored carbon was found at 8.69 million tons for a total of 95842 ha of commercially managed forest. Furthermore, the correlation analysis between the basal area (BA) and GSV and BMC showed that BA is the best predictor of GSV and BMC. The findings provide insights to the policy makers and forest managers regarding the sustainable commercial forest management as well as forest carbon management in the recent global carbon management for climate change mitigation.

Graphene Based Nanohybrid Aptasensors in Environmental Monitoring: Concepts, Design and Future Outlook

In view of ever-increasing environmental pollution, there is an immediate requirement to promote cheap, multiplexed, sensitive and fast biosensing systems to monitor these pollutants or contaminants. Aptamers have shown numerous advantages in being used as molecular recognition elements in various biosensing devices. Graphene and graphene-based materials/nanohybrids combined with several detection methods exhibit great potential owing to their exceptional optical, electronic and physicochemical properties which can be employed extensively to monitor environmental contaminants. For environmental monitoring applications, aptamers have been successfully combined with graphene-based nanohybrids to produce a wide range of innovative methodologies. Aptamers are immobilized at the surface of graphene based nanohybrids via covalent and non-covalent strategies. This review highlights the design, working principle, recent developmental advances and applications of graphene based nanohybrid aptasensors (GNH-Apts) (since January 2014 to September 2021) with a special emphasis on two major signal-transduction methods, i.e., optical and electrochemical for the monitoring of pesticides, heavy metals, bacteria, antibiotics, and organic compounds from different environmental samples (e.g., water, soil and related). Lastly, the challenges confronted by scientists and the possible future outlook have also been addressed. It is expected that high-performance graphene-based nanohybrid aptasensors would find broad applications in the field of environmental monitoring.

Varying isoleucine level to determine effects on performance, egg quality, serum biochemistry, and ileal protein digestibility in diets of young laying hens

To ascertain an appropriate level of isoleucine for LSL-LITE layers (23- to 30-week-old), diets containing total isoleucine concentrations (levels) of 0.66 (Control), 0.69, 0.72, 0.75, 0.78, 0.81, and 0.84% were fed as 7 treatments (2730 kcal/kg metabolizable energy) x 7 replicates x 10 birds per replicate. Significance for performance, egg quality, serum biochemistry, and ileal digestibility of protein was determined at P ≤ 0.05. Level, week, and level*week (L*W) were significant for production, egg mass, and feed intake. Level and week were significant for FCR. Week was significant for weight gain. Level was significant for egg weight, specific gravity, and shell thickness; week was also significant for these external egg parameters as well as shape index and proportional shell thickness. L*W was significant for all except shape index. For internal egg measurements, level was significant for proportional yolk, proportional albumen, yolk index, and yolk:albumen. Week was significant for internal egg parameters while L*W significantly affected Haugh unit, proportional albumen weight, yolk index, albumen index, and yolk color. Level was significant for globulin and glucose in serum. Isoleucine at 0.72%, 0.81%, and 0.84% produced the lowest FCR, an important standard in the poultry industry. Considering the low FCR of 1.45 and cost for inclusion as a dietary ingredient, 0.72% isoleucine was chosen for further studies with varying quantities of other branched chain amino acids in diets for young laying hens.

Molecular docking, dynamics, and quantum chemical study of vanillylacetone and beta-hydroxy ketone derivatives against Mpro of SARS-CoV-2

This study is carried out to find novel active drug candidates which can effectively bind to key residues of main protease (Mpro) of SARS-CoV-2. We performed molecular docking of fifty-seven (57) ligands from two classes: vanillylacetone and its derivatives and beta-hydroxy ketone derivatives against Mpro of SARS-CoV-2. We also docked three antiviral drugs as reference/benchmark drugs including remdesivir (RDV), chloroquine (CQ), and hydroxychloroquine (HCQ) against Mpro for comparison of inhibition tendencies of selected ligands. Binding energies of our reference drugs are as: CQ = -5.1 kcal mol-1 (with predicted inhibition constant (Ki pred) = 177 μmol), HCQ = -5.7 kcal mol-1 (Ki pred = 64.07 μmol) and RDV -6.3 kcal mol-1 (Ki pred = 13.95 μmol). We got remarkable results for our docked ligands as 79% of total ligands indicated binding energies better than CQ, 39 % better than both HCQ and CQ, and 19 % better than all reference drugs. More interestingly interaction analysis of eight best-docked ligands showed that they interacted with desired key residues of Mpro. We further selected the four best-docked ligands L1 = -6.6 kcal mol-1 (Ki pred =13.95 μmol), L6 = -7.0 kcal mol-1 (Ki pred = 7.08 μmol), L34 = -6.0 kcal mol-1 (Ki pred = 38.54 μmol), and L50 = -6.6 kcal mol-1 (Ki pred =13.95 umol) for further analysis by quantum chemical study, molecular dynamic (MD) simulations and ADMET analysis. We have also carried out MD-simulations of six more docked ligand L2, L14, L20, L36, L46 and L48 some of which were showing weak binding affinities and some average binding affinities to check their simulation behavior. Their RMSD, RMSF and binding free energy results were also quite satisfying. We believe the current investigation will evoke the scientific community and highlights the potential of selected compounds for potential use as antiviral compounds against Mpro of SARS-CoV-2.

Efficacy of Citrullus colocynthis seed extract on Earias vittella, Fabricius, (Lepidoptera: Noctuidae): environment sustainable approach

Abstract Earias vittellaFabricius, 1794 (Noctuidae: Lepidoptera) is deliberated to be one of the most destructive pests of cotton and okra vegetation in the world including Asia. The pest has established resistance to various synthetic insecticides. The use of bio-pesticide is one of the unconventional approaches to develop a vigorous ecosystem without harming non- target pests and beneficial natural insect fauna. In the present study, the toxicity levels of Citrullus colocynthis seed extract have been evaluated against the populations of E. vittellaunder standardized laboratory conditions. The toxic effects of C. colocynthis on development periods, protein contents and esterase activity of the life stages of E. vittella were also evaluated. The toxicity levels of methanol, ethanol, hexane, water and profenofos were evaluated on the 1st instar larvae of E. vittella. LC30 and LC80 concentrations exhibited the effectiveness of methanol-based C. colocynthis seed extract against 1st instar larvae of E. vitella. The enhanced larval and pupal periods were revealed in treated samples during the comparison with untreated samples. The intrinsic rate of increase, net reproductive rate in the LC30 and LC80 concentrations exposed larvae remained less than the control treatment. Fecundity, the esterase activity and protein contents were declined in LC30 and LC80 treated samples as compared to the control. The present findings suggest that C. colosynthis extracts based botanical insecticides are beneficial, ecosystem sustainable and can be integrated with insect management programs from environment safety perspective.

Diagnostic accuracy of ultrasound in the paediatric population with acute right iliac fossa pain, our District General Hospital experience

AIM

This project aimed to evaluate the role of ultrasound scan (USS) in children presenting with acute onset right iliac fossa (RIF) pain and suspected appendicitis.

METHODS

We retrospectively studied 100 consecutive children undergoing USS for RIF pain. Children with low to moderate clinical probability of appendicitis were seen by the surgical team and subsequently underwent USS by a radiologist or a sonographer with a special interest in paediatric USS. The clinical findings, blood tests, and radiological diagnosis led to a decision to operate, observe or discharge. USS findings were subsequently verified with the final histology. The six-month follow-up data of these patients were also analysed.

RESULTS

35 males, median age of 11 years (range 4-17), and 65 females, median age of 14 years (range 6-18) were included. A total of 23 appendicectomies were performed. On histology appendicitis was confirmed in 20, including 16 pre-operatively diagnosed on USS. 6 of these appendicectomies were performed on clinical suspicion with normal USS. 1 patient was diagnosed with neuroendocrine tumour of the appendix. Only 2 negative appendicectomies were performed. 62 patients were discharged without intervention. USS sensitivity was 74%, and specificity was 92% for appendicitis. An additional 16 patients were identified with alternate pathology including 5 ovarian cysts.

CONCLUSION

Appendicitis was more common in male patients; however, there was no difference in overall disease prevalence in male or female paediatric patients. Thus, USS is a valuable tool to exclude appendicitis in children with low to moderate probability.

Synergistic impact of α-linolenic acid and α-tocopherol on in vitro maturation and culture of buffalo oocytes

The objective of the current study was to investigate the synergistic impact of α-Tocopherol and α-Linolenic acid (100 µM) on IVM and IVC of Nili Ravi buffalo oocytes. Oocytes were obtained from the ovaries of slaughtered buffaloes within two hours after slaughter and brought to laboratory. Buffalo cumulus oocyte complexes were placed randomly in the five experimental groups included; GROUP 1: Maturation media (MM) + 100 µM ALA (control), GROUP 2: MM + 100 µM ALA + 50μM α-Tocopherol, GROUP 3: MM + 100 µM ALA + 100μM α-Tocopherol, GROUP 4: MM + 100 µM ALA + 200 μM α-Tocopherol and GROUP 5: MM + 100 µM ALA + 300 μM α-Tocopherol under an atmosphere of 5% CO2 in air at 38.5 °C for 22-24 h. Cumulus expansion and nuclear maturation status was determined (Experiment 1). In experiment 2, oocytes were matured as in experiment 1. The matured oocytes were then fertilized in Tyrode's Albumin Lactate Pyruvate (TALP) medium for about 20 h and cultured in synthetic oviductal fluid (SOF) medium to determine effect of α-Linolenic acid (100 µM) and α-Tocopherol in IVM medium on IVC of presumptive zygotes. To study the effect of α-Linolenic acid (100 µM) in IVM media and increasing concentration of α-tocopherol in the culture media on early embryo development (Experiment 3), the presumptive zygotes were randomly distributed into the five experimental groups with increasing concentration of α-tocopherol in culture media. Higher percentage of MII stage oocytes in experiment 1(65.2±2.0), embryos at morula stage in experiment 2 (30.4±1.5) and experiment 3 (22.2±2.0) were obtained. However, overall results for cumulus cell expansion, maturation of oocyte to MII stage and subsequent embryo development among treatments remain statistically similar (P > 0.05). Supplementation of α-tocopherol in maturation media having α-Linolenic acid and/or in embryo culture media did not further enhance in vitro maturation of oocyte or embryo production.

Prediction of soil seed bank of piedmont and alluvial environments of Dera Ghazi Khan, Punjab, Pakistan

The current focus is on the overall pattern of seed storage present in the fragments of the soil of piedmont and alluvial landscapes of the environment. The present study predicted the seed banks of both soils of alluvial and piedmont zones in different ecological conditions and evaluate the potential of seeds in the restoration of both environments. The composition of the seed bank of soil is mainly affected by the alluvial environment and the structure of cleared area shows that more species of germinating annual grasses and growable seeds with the higher total number. Extant vegetation structures have an important role in the diversity of soil seed reservoirs, whose composition corresponded with the openness of the site. When in situ soil seed bank is recruited, it helps to restore only some components of the plant community in an alluvial environment. In our current research, it was confirmed that seed richness was higher in number at lower elevation (alluvial) than that at high elevation (piedmont). Seed richness showed a significant negative correlation with anions, cations, while significantly positive with altitude that suggests the richness pattern of the overall seed bank of the area is influenced by various environmental factors.

Poverty, Migration and the Transmission of HIV/AIDS in District Dir Lower, Khyber Pakhtunkhwa, Pakistan

Poverty, a multifaceted concept has been defined as: hunger; lack of shelter; being sick and not being able to see a doctor; having no access to a job; lack of freedom: fear for the future. Historically, people have migrated from one place to another to increase their livelihood and improve the living standards of their left behind families, while the process of globalization has intensified the movement of people across the world. Although, migration has been an important source of remittance and help in socioeconomic uplift of migrant families, however; it has also negatively impacted migrants and their families. Migrants are exposed to different risks and vulnerabilities at their destinations, which exposes them to many other health problems including their exposure of contracting HIV/AIDS. This study was conducted in the District Lower Dir of Khyber Pakhtunkhwa province of Pakistan with the objectives to know the relationship between poverty, migration and transmission of HIV/AIDS. The study was qualitative in nature while the selection of the sample has been made under the purposive sampling technique. Primary data was collected from 12 respondents through in-depth interview using interview guide. The collected information was analyzed thematically in order to clarify the issue under study. The study concluded that migrants: face unsafe environments; lesser access to information and health services; precarious working and living condition; exposure to risky behaviors which put them at risk of contracting the disease.

Honey as a bioindicator of environmental organochlorine insecticides contamination

Honey is a suitable matrix for the evaluation of environmental contaminants including organochlorine insecticides. The present study was conducted to evaluate residues of fifteen organochlorine insecticides in honey samples of unifloral and multifloral origins from Dir, Pakistan. Honey samples (5 g each) were extracted with GC grade organic solvents and then subjected to Rotary Evaporator till dryness. The extracts were then mixed with n-Hexane (5 ml) and purified through Column Chromatography. Purified extracts (1μl each) were processed through Gas Chromatograph coupled with Electron Capture Detector (GC-ECD) for identification and quantification of the insecticides. Of the 15 insecticides tested, 46.7% were detected while 53.3% were not detected in the honey samples. Heptachlor was the most prevalent insecticide with a mean level of 0.0018 mg/kg detected in 80% of the samples followed by β-HCH with a mean level of 0.0016 mg/kg detected in 71.4% of the honey samples. Honey samples from Acacia modesta Wall. were 100% positive for Heptachlor with a mean level of 0.0048 mg/kg followed by β-HCH with a mean level of 0.003 mg/kg and frequency of 83.3%. Minimum levels of the tested insecticides were detected in the unifloral honey from Ziziphus jujuba Mill. Methoxychlor, Endosulfan, Endrin and metabolites of DDT were not detected in the studied honey samples. Some of the tested insecticides are banned in Pakistan but are still detected in honey samples indicating their use in the study area. The detected levels of all insecticides were below the Maximum Residue Levels (MRLs) and safe for consumers. However, the levels detected can cause mortality in insect fauna. The use of banned insecticides is one of the main factors responsible for the declining populations of important insect pollinators including honeybees.

Mosquitocidal activities of Chenopodium botrys whole plant n-hexane extract against Culex quinquefasciatus

This research aimed to investigate various mosquitocidal activities of Chenopodium botrys whole- plant n-hexane extract against Culex quinquefasciatus. The extract showed remarkable larvicidal, pupicidal, adulticidal, oviposition deterrent and adult emergence inhibitory activities against Cx. quinquefasciatus. During the larvicidal and pupicidal activities, the 24-hour lethal concentration (LC50) of extract against 2nd instar larvae, 4th instar larvae and pupae were 324.6, 495.6 and 950.8 ppm, respectively. During the CDC (Centers for Disease Control and Prevention) bottle bioassay for adulticidal activity, the median knockdown times (KDT50) at 1.25% concentration was 123.4 minutes. During the filter paper impregnation bioassay for adulticidal activity, the KDT50 value at 0.138 mg/cm2 concentration was 48.6 minutes. The extract was fractionated into 14 fractions through silica gel column chromatography which were then combined into six fractions on the basis of similar retention factor (Rf) value. These fractions were screened for adulticidal activity by applying CDC bottle bioassay. The fraction obtained through 60:40 to 50:50% n-hexanes-chloroform mobile phase with 0.5 Rf value showed 100% adulticidal activity at 0.2% concentration. During oviposition deterrent activity, the highest concentration (1000 ppm) showed 71.3 ± 4.4% effective repellence and 0.6 ± 0.1 oviposition activity index. During adult emergence inhibition activity, the median emergence inhibition (EI50) value was 312.3 ppm. From the outcome of the present investigation, it is concluded that the n-hexane extract of C. botrys whole- plant possesses strong larvicidal, pupicidal, adulticidal, oviposition deterrent and adult emergence inhibitory activities against Cx. quinquefasciatus.

Why Older People Seek Health Information Online: A Qualitative Study

Despite the increasing number of older adults’ growing need for health information, little is known about their motivation to seek online health information. This exploratory qualitative study was conducted to examine why older adults seek required health information through online sources. In this qualitative content analysis, we purposefully approached 19 older adults with age in the range between 60–75 (63.78 ± 3.8 years) in Tabriz, Iran. Data were collected via individual, semi-structured face-to-face interviews at a place and time convenient to the study participants from October 2018 to September 2019. We evaluated the content of recorded data until saturation was reached, using MAXQDA 10 software. Subsequently, four central motivational themes were emerged including being self-reliant, achieving a healthier life, seeking reliable sources of health information, and accumulating health information. Older adults seek health information based on their needs and expectations to achieve optimal health status. Our findings provide valuable information for nurses and other health care providers to facilitate older adults’ access to trusting and valid online health information. It further suggests that, with the consideration of COVID-19 pandemic, fact-checking skills of elderly in identifying and accessing credible information sources should be addressed in future health literacy interventions.

A threefold approach including quantum chemical, molecular docking and molecular dynamic studies to explore the natural compounds from Centaurea jacea as the potential inhibitors for COVID-19

In the current report, we studied the possible inhibitors of COVID-19 from bioactive constituents of Centaurea jacea using a threefold approach consisting of quantum chemical, molecular docking and molecular dynamic techniques. Centaurea jacea is a perennial herb often used in folk medicines of dermatological complaints and fever. Moreover, anticancer, antioxidant, antibacterial and antiviral properties of its bioactive compounds are also reported. The Mpro (Main proteases) was docked with different compounds of Centaurea jacea through molecular docking. All the studied compounds including apigenin, axillarin, Centaureidin, Cirsiliol, Eupatorin and Isokaempferide, show suitable binding affinities to the binding site of SARS-CoV-2 main protease with their binding energies -6.7 kcal/mol, -7.4 kcal/mol, -7.0 kcal/mol, -5.8 kcal/mol, -6.2 kcal/mol and -6.8 kcal/mol, respectively. Among all studied compounds, axillarin was found to have maximum inhibitor efficiency followed by Centaureidin, Isokaempferide, Apigenin, Eupatorin and Cirsiliol. Our results suggested that axillarin binds with the most crucial catalytic residues CYS145 and HIS41 of the Mpro, moreover axillarin shows 5 hydrogen bond interactions and 5 hydrophobic interactions with various residues of Mpro. Furthermore, the molecular dynamic calculations over 60 ns (6×106 femtosecond) time scale also shown significant insights into the binding effects of axillarin with Mpro of SARS-CoV-2 by imitating protein like aqueous environment. From molecular dynamic calculations, the RMSD and RMSF computations indicate the stability and dynamics of the best docked complex in aqueous environment. The ADME properties and toxicity prediction analysis of axillarin also recommended it as safe drug candidate. Further, in vivo and in vitro investigations are essential to ensure the anti SARS-CoV-2 activity of all bioactive compounds particularly axillarin to encourage preventive use of Centaurea jacea against COVID-19 infections.

The Siberian pine growth dynamics in Altai Mountains, China

Climatic factors play an essential role in the growth of tree ring width. In this study, we aimed to evaluate the correlation between climatic variables and tree-ring growth characteristics of Pinus sibirica in Altai mountains, northwestern China. This study being is first of its kind on climate growth analysis of Pinus sibirica in northwestern China. The study showed great potential to understand the species growing under the specific climatic conditions. Total of 70 tree cores collected from three sites in the sampling area, out of which 63 tree cores considered for this study. The effect of climatic variables which was studied include precipitation, temperature and PDSI. Our results showed that Tree Ring Width chronology has a significantly positive correlation with the late winter (March) temperature and significant negative correlation with the July temperatures. A significant correlation was observed with the late summer precipitation whereas no significant relation found with the Palmer Drought Severity Index. These significant correlations with temperature and precipitation suggested that this tree species had the potential for the reconstruction of the past climate in the area.

Enterotoxigenic methicillin resistant Staphylococcus aureus contamination in salted fish from Gwadar Balochistan

Staphylococcus aureus is an important foodborne pathogen associated to food intoxication and other multiple infections in human being. Its presence in salted food is a serious issue due to its salt tolerance potential. A study was conducted to analyze the presence of enterotoxins producing drug resistance S. aureus in salted sea fish from Gwadar. Freshly persevered samples (n=50) of salted fish were subjected to analyze the presence of S. aureus using 16S rRNA and Nuc genes primers. The isolates were then evaluated for drug resistance and enterotoxins producing potential using specific primers for MecA (methicillin resistance gene), (SEA) staphylococcal enterotoxin A and (SEB) staphylococcal enterotoxin B genes. Total 13/50 (26%) of the samples were found positive for the presence of S. aureus, preliminary confirmed with biochemical profiling and finally with the help of target genes presence. The isolates were found showing 100% resistant to methicillin, which were molecularly confirmed by the presence of MecA gene present in genome. The isolates 5/13 (38%) were positive for SEA and 3/13 (23%) for SEB genes, whereas 2/13 (15%) were confirmed having both SEA and SEB genes in its genome. It was also confirmed that all the isolates were capable to form biofilm over the glass surfaces. It was concluded that the study confirmed the presence of enterotoxigenic methicillin resistance Staphylococcus aurous (MRSA) in salted fish product, that poses gross food safety concern. Preventive and control measures are necessary to handle this serious food safety concern.

Socio-cultural Factors and the Transmission of HIV/AIDS in Malakand Division: A Qualitative Analysis

The epidemic of HIV/AIDS has devastating impacts on many societal features of both urban and rural communities. Cultural factors have been played a significant role in human decision making and behavior around health. In simple terms, culture basically refers to the traditions and customs upheld by societies and communities because of their belief systems and values, which guide their decisions and shape their thinking, actions, attitudes and behaviors. The role of culture has been of particular significance both in the transmission of HIV/AIDS. Certain cultural practices such as: gender inequalities; unequal access to health care services; injectable drug users; unequal access to economic resources and opportunities; and male dominancy contribute to the spread of HIV/AIDS. The current study aims to investigate how various cultural factors contribute in the transmission of HIV/AIDS. The study was conducted in Malakand Division of Khyber Pakhtunkhwa province, while using a qualitative approach. Further, primary data was collected from 15 respondents through in-depth interview (using interview guide) while the selection of the sample was made through non-probability sampling using purposive sampling techniques. The collected information was qualitatively analyzed and a thematic discussion has been made for better understanding of the issue. The researchers also suggests some remedies.

Biodegradation of petroleum by bacteria isolated from fishes of Indian Ocean

In this study, oil degrading bacteria discovered from fish living near the oil ports at Karachi in Pakistan were characterized. The bacteria isolated from skin, gills, and gut in fish could consume crude oil as a source of carbon and energy. Total 36 isolates were tested using Nutrient Agar (NA) and MSA media with different crude oil concentrations (0.2%, 0.5%, 0.7%, 1%, 2%, and 5%) and 4 out of 36 isolates (two Gram positive and two Gram negative bacteria) were selected for further identification. 16S rRNA gene sequencing revealed that the isolates are related to Bacillus velezensis, Bacillus flexus, Pseudomonas brenneri and Pseudomonas azotoforman. Oil degrading potential of these bacteria was characterized by GC-MS analysis of degradation of oil components in crude oil as well as engine oil. We found that one (2, 6, 10, 14-Tetramethylpentadecane) out of 42 components in the crude oil was fully eliminated and the other oil components were reduced. In addition, 26 out of 42 oil components in the engine oil, were fully eliminated and the rest were amended. Taken together, these studies identify that B. velezensis, B. flexus, P. brenneri and P. azotoforman have high oil degrading potential, which may be useful for degradation of oil pollutants and other commercial applications.

Biodiversity of orb-web spiders (family: araneidae) of buner valley, Pakistan

The present research was carried out to explore the spider fauna of Buner valley with taxonomic study from February 2018 to January 2019. For this purpose samples were collected, four times at each month from 4 tehsils: Daggar, Gagra, Mandan and Totalai. Two methods were used, hand picking and sweep net for collection of samples. During day and night, three habitats, arid area, agriculture land and building area were search for collection. A total of 534 samples of spider were collected from four sampling sites, in which 379 were belonging to family Araniedae. After confirmation, the identified species were belonging to 8 genera (Neoscona, Argiope, Cyclosa, Araneus, Cyrtophora, Larinia, Erivoxia and Poltys) and 19 species. 18 of them were identified to specie level while a single specie to its generic level. The genus Neoscona was the dominant genus 26.31% having 5 species while the genus Argiope 21.05% is the second dominant having 4 species followed by Cyclosa 15.78% having 3 species followed by Cyrtophora and Araneus 10.52% having two species both. The Poltys and Larinia 5.26% are the rarest genera represent single-single specie both. Statistical analysis show that specie richness (D) = 5.77, Simpson index (1-D) = 0.87, Shannon index (H) = 2.33. Diversity of spiders was evenly distributed and calculated Evenness value was H/InS = 0.5408. There is also few atypical species and Fisher alpha estimate high value (Fisher α) = 4.42. Chao-1 estimated we have reported 22 species.

POS0310 EXPOSURE TO MAJOR PSYCHOLOGICAL TRAUMA OR STRESS IN THE PRECEDING ONE YEAR SIGNIFICANTLY CONTRIBUTES TO POOR DISEASE CONTROL IN PATIENTS WITH RHEUMATOID ARTHRITIS: SINGLE CENTRE RESULTS FROM THE PRIME REGISTRY COHORT

Background:

Stress response is considered to involve the activation of both the hypothalamus-pituitary-adrenal axis and the autonomic nervous system, along with its communication with the immune system. Because many rheumatic diseases are characterized by immune-mediated joint inflammation, stressful events might contribute to the aetiology, maintenance and exacerbation of rheumatic diseases.

Objectives:

We aimed to examine whether real-life major stressful events lead to poor disease control among patients with Rheumatoid arthritis (RA). We addressed this question using real-world data from the PRIME registry.

Methods:

This was a cross-sectional study conducted using data collected at the time of patient enrolment in the PRIME registry. The PRIME Registry is a large, independent, prospective, observational cohort initiated in October 2019 that comprises patients diagnosed with RA, SLE, PsA or AS by a rheumatologist, and is being actively followed up. IRB approval and informed consent was obtained. We assessed the registry data for RA patients. The clinical variables studied were gender, age, smoking habits, body mass index, education status, marital status, disease duration, comorbidities (using Charlson Comorbidity Index). Education status was stratified by whether participants completed secondary (high) school education. Evaluation of disease activity and severity was made as per internationally agreed definitions, such as: swollen joint counts (SJC), tender joint counts (TJC), deformed joint counts, and DAS-28. Major psychological trauma or stress was defined if the patient has experienced any of the following in the past year: a) major personal injury or illness; b) death/major illness of a close relative; c) marital separation/divorce; d) loss of job; e) major financial loss; f) mass casualty incident loss.

Results:

The data of consecutive 507 RA patients (mean age 42.3±12.6 years, 73.6% female, disease duration of 80±22 months) was reviewed. Thirty-six percent of the cohort reported to have major psychological stress and trauma in the preceding one year. No statistical association of age, gender, and marital status was noted, but statistical association of low education status (p=0.042), longer disease duration (p=0.044), higher DAS-28 values (p<0.001) and other markers of RA disease activity (SJC, TJC, ESR, patient global health) was found. On multiple logistic regression analysis, a significant association of major psychological stress and trauma in the preceding one year was noted with active disease (DAS-28; OR 1.67, CI 1.17-2.4, p=0.005). Following variables were included in the full regression model, disease duration, gender, age, marital status, education status, and DAS-28 value (also used models with SJC, TJC, deformed joint counts, ESR, patient global health, but the results remained unchanged).

Conclusion:

Major psychological stress and trauma in the preceding one year is associated with high disease activity among patients with RA. Therapies that focus on stress management may be important adjuncts to traditional pharmacotherapy in the treatment of inflammatory rheumatic diseases.

Disclosure of Interests:

Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, Sadia Asif: None declared, Shabnam Batool: None declared, Farzana Hashmi: None declared, Saadat Ullah: None declared, Arfa Ashraf: None declared, Hafiza Javeria Shaheen: None declared

POS0663 SAFETY AND EFFICACY OF COMBINING METHOTREXATE AND LEFLUNOMIDE AMONG PATIENTS WITH INFLAMMATORY ARTHROPATHIES: FINDINGS FROM THE PRIME REGISTRY

Background:

Currently, conventional synthetic DMARDs (csDMARDs) are the most commonly prescribed drugs as first-line treatment for peripheral arthritis. In resource-constrained settings where biologic agents are not widely available, there are limited therapeutic options for patients with rheumatoid arthritis (RA) and seronegative inflammatory arthropathies refractory to other csDMARD therapies. Hence, in our practice, we are inclined to use combination of potent DMARDs after MTX failure, prior to considering biologic therapies. We believe that combination of DMARDs, especially combining MTX and Leflunomide (LEF) provides a potent and valuable low-cost treatment option. Efficacy of MTX and LEF is very well established, but there have been lot of concern as regards their combination use due to potential risk of hepatotoxicity.

Objectives:

We aimed to review our inflammatory arthropathies cohort data especially examining the safety, efficacy and drug retention of the combination usage of MTX and Leflunomide. We addressed this question using real-world data from the PRIME registry.

Methods:

This was a cross-sectional study conducted using data collected at the time of patient enrolment in the PRIME registry. The PRIME Registry is a large, independent, prospective, observational cohort initiated in October 2019 that comprises patients diagnosed with RA, SLE, PsA or AS by a rheumatologist, and is being actively followed up. IRB approval and informed consent was obtained. A number of clinical variables were recorded. Detailed history was gathered from every patient regarding their present and past medications usage. Questions were asked directly about the usage or otherwise of all available DMARDs and biologics. The duration of usage, any adverse events, or the reasons for discontinuation were recorded. Evaluation of disease activity and severity was made as per internationally agreed definitions.

Results:

The data of 766 inflammatory arthritis patients (RA=663, PsA=103) was reviewed. Among them, 241 patients (RA=196, PsA=45) were using combination therapy of MTX and LEF (combo MTX+LEF) with mean age 42.3±6 years; 42% male]. These patients had failed MTX or LEF monotherapy. Among these 241 patients, 49 patients were also on concomitant hydroxychloroquine therapy. It was noted that median drug retention of combo MTX+LEF therapy has been 9.5 months (IQR 6-16). Regarding any adverse events of combo MTX+LEF therapy, hepatotoxicity (ALT ≤3 times the upper limit of normal) was noted among 15 (6.2%) patients, hepatotoxicity (ALT ≥3 times the upper limit of normal) was noted among 8 (3.3%) patients, and troublesome gastrointestinal upset (nausea, or vomiting, or diarrhoea) in 3 (1.2%). Overall, only 13 (5.4%) patients had to discontinue this combo MTX+LEF therapy due to adverse events. Disease activity among combo MTX+LEF users was as follows: 64% (n=29) of PsA patients had achieved MDA; 42% (n=83) of RA cohort were in DAS28 remission, 46% (n=91) of RA patients were having DAS low disease activity.

Conclusion:

Combination of MTX and LEF was well tolerated and had good drug retention time, with 94.6% of patients having ongoing treatment to date. In low-income countries, where bDMARD availability is limited, financial arguments significantly influence decision making process, and our data provides initial evidence that MTX and LEF combination therapy could be an effective treatment option.

Disclosure of Interests:

Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, Arfa Ashraf: None declared, Hafiza Javeria Shaheen: None declared, Sadia Asif: None declared, Shabnam Batool: None declared, Farzana Hashmi: None declared, Saadat Ullah: None declared

POS0589 PREVALENCE AND SEVERITY OF STRESS AT HOME AMONG PATIENTS WITH RHEUMATOID ARTHRITIS: SINGLE CENTRE RESULTS FROM THE PRIME REGISTRY COHORT

Background:

In chronic inflammatory diseases like rheumatoid arthritis (RA), psychological stress is widely recognised as an important risk factor to negatively affect the disease course. Stress activates the hypothalamic-pituitary adrenal axis and the autonomic nervous system, which associate with the release of neurotransmitters (i.e. norepinephrine), hormones (i.e. cortisol) and activation of immune cells. Perceived stress can potentially induce the disease exacerbation, but on the other hand, the disease itself might produce significant stress to patients thus the vicious circle is formed and maintained.

Objectives:

We aimed to examine the prevalence of mental/emotional stress at home and its associations among patients with Rheumatoid arthritis. We addressed this question using real-world data from the PRIME registry.

Methods:

This was a cross-sectional study conducted using data collected at the time of patient enrolment in the PRIME registry. The PRIME Registry is a large, independent, prospective, observational cohort initiated in October 2019 that comprises patients diagnosed with RA, SLE, PsA or AS by a rheumatologist, and is being actively followed up. IRB approval and informed consent was obtained. We assessed the data for RA patients. The clinical variables studied were gender, age, smoking habits, body mass index, education status, marital status, disease duration, comorbidities (using Charlson Comorbidity Index). Education status was stratified by whether participants completed secondary (high) school education. Evaluation of disease activity and severity was made as per internationally agreed definitions, such as: swollen joint counts, tender joint counts, deformed joint counts, and DAS-28. All participants were directly inquired at the interview during the time of patient enrolment about the presence or otherwise of mental/emotional stress at home, and to rate it from 1-3 (mild, moderate, severe). For better understanding and ease of statistical analysis, dichotomous variable was made with moderate-to-severe stress patients were categorised into one group and none-to-mild stress patients into second group.

Results:

The data of consecutive 507 RA patients (mean age 42.3±12.6 years, 73.6% female, disease duration of 80±22 months) was reviewed. Forty-eight percent of patients accepted to have moderate-severe stress at home (moderate stress=29.9%, severe stress=18.3%). On univariate analysis, significant association of moderate-severe stress at home was noted with deformed joint counts (p=0.036), higher DAS-28 scores (p<0.001), and being married (p=0.001). Weak statistical association of age (p=0.11), disease duration (p=0.13), low education status (p=0.14), female gender (p=0.24) was noted. On multiple logistic regression analysis, a significant association of moderate-severe stress at home was observed with higher DAS-28 scores (OR 1.76, CI 1.29-2.41, p<0.001) and deformed joint counts (OR 1.15, CI 1.00-1.31, p=0.040). Following variables were included in multiple stepwise regression analysis: age, disease duration, low education status, married, Das-28 scores, and deformed joint counts. However, when gender was included in the regression analysis, a significant association of moderate-severe stress at home was observed with female gender (OR 3.99, CI 1.47-10.83, p=0.007), higher DAS-28 scores (OR 1.8, CI 1.31-2.51, p<0.001), with marginal association with deformed joint counts (OR 1.13, CI 0.99-1.30, p=0.061).

Conclusion:

Stress at home is common among patients with RA, and nearly half of the cohort was noted to have moderate-severe level of stress at home. Ongoing stress at home has significant association with higher RA disease activity and deformities suggesting a bidirectional relationship. These findings demonstrate an important need for integration of rheumatologic, social workers and mental health services

Disclosure of Interests:

Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, Farzana Hashmi: None declared, Saadat Ullah: None declared, Arfa Ashraf: None declared, Hafiza Javeria Shaheen: None declared, Sadia Asif: None declared, Shabnam Batool: None declared