Search

المخلص: أهداف البحث: ضائقة داء السكري هي حالة من الضائقة العاطفية التي تنشأ من العيش مع مرض مزمن وعبء التعديلات اليومية للأدوية ونمط الحياة. تدرس هذه الدراسة انتشار ضائقة داء السكري في مرضى السكري من النوع 2 في الأردن والعوامل الاجتماعية والديموغرافية والطبية. طرق البحث: استخدمنا دراسة مستعرضة مع حجم عينة يبلغ 608 مرضى سكري من النوع 2 في الأردن، بين سن 15-80 عاما. قام المشاركون بتعبئة استبيان حيث طلب منهم تقييم مقياس ضائقة داء السكري الخاص بهم. تم استبعاد 32 مشاركا وفقا لمعايير الاستبعاد، مما يؤدي إلى إدراج 576 شخصا في هذه الدراسة. النتائج: إن انتشار ضائقة داء السكري الإجمالي هو 53٪ (25٪ كمرض معتدل و 28٪ كمرض عالي)، والضائقة العاطفية هي الأعلى انتشاراً بين المقاييس الفرعية لضائقة السكري بانتشار إجمالي يبلغ 58.8٪. تظهر البيانات وجود علاقة كبيرة بين ضائقة السكري وعوامل مختلفة بما في ذلك العمر، وجود مضاعفات السكري، نوع الدواء المستخدم، والالتزام بالدواء. الاستنتاجات: أظهرت هذه الدراسة انتشارا عاليا لضائقة داء السكري (53٪) ويجب أن يساعد ذلك مقدمي الرعاية الصحية على معرفة أهمية فحص ضائقة السكري كجزء من إرشادات العلاج، خاصة في المرضى الذين يتناولون عدة أنواع من الأدوية للسكري، والمرضى الذين لديهم مضاعفات طبية سابقة متعلقة بالسكري والمرضى الذين يظهرون انخفاضا في الالتزام بالأدوية؛ وجد أنهم معرضون لخطر الإصابة بمرض السكري في هذه الدراسة. Abstract: Objectives: Diabetes distress (DD) is a state of emotional distress that evolves from living with chronic disease and the burden of daily adjustments of medications and lifestyle. This study investigated the prevalence of DD in patients with type 2 diabetes mellitus (T2DM) in Jordan and the related sociodemographic and medical factors. Methods: We conducted a cross-sectional study in 608 patients with T2DM in Jordan, ranging from ages 15 to 80 years. The participants filled out a questionnaire where they were asked to self-assess their DD using the Diabetes Distress Scale. In all, 32 participants were excluded according to the exclusion criteria, which resulted in 576 people being included in this study. Results: The overall prevalence of DD was 53% (25% had moderate distress and 28% had high distress). Emotional distress had the highest prevalence among the DD subscales, with a total prevalence of 58.8%. The data showed a significant association of DD with different factors including age, the presence of diabetic complications, the type of medication used, and medication adherence. Conclusion: This study showed a high prevalence of DD (53%). This finding should raise awareness to healthcare providers about the importance of screening for DD as part of the treatment guidelines, especially in patients who are on multiple medication regimens for DM; patients who have previous medical complications related to DM; and those who exhibit poor adherence to medications, which was found to be a risk factor of DD in this study.

الملخص: أهداف البحث: سبق وأن تم الإبلاغ عن مضاعفات رئوية مثل الانخماص، والوذمة الرئوية، والانصباب الجنبي، والتشنج القصبي والالتهاب الرئوي خلال الفترة التي تتلو عمليات جراحة القلب. يُعتبر التنفس الضحل المؤدي إلى ضعف وظائف الرئة السبب الرئيس لمضاعفات الجهاز التنفسي. ويمكن قياس انخفاض قوة العضلات التنفسية عن طريق الضغط الشهيقي الأقصى والضغط الزفيري الأقصى الناتج في تجويف الفم. هدفت هذه الدراسة إلى تحديد انخفاض قوة العضلات التنفسية بعد ثمانية أسابيع من جراحة القلب. علاوة على ذلك، تمت دراسة العلاقة بين وظيفة الرئة وقوة العضلات التنفسية. طرق البحث: في هذه الدراسة المبنية على الملاحظة، تمت دراسة ٤٢ مريضا من مرضى جراحة القلب البالغين (أعمارهم ٦٥ ± ٧ سنوات). كان هناك ١٠ نساء و٣٢ رجلا. تم قياس وظيفة الرئة وقوة العضلات التنفسية قبل العملية وشهرين بعد العملية. النتائج: كانت قوة عضلات الجهاز التنفسي قبل وبعد العملية الجراحية وفقا للقيم المتوقعة؛ حيث كان الضغط الشهيقي الأقصى قبل العملية ٨١.٧٥+/- ٢٢.٠٤سم ماء، وبعد العملية بشهرين ٧٤.٥٦+/- ١٨.٨٦سم ماء. وكان الضغط الزفيري الأقصى قبل العملية ٩٨.٥٥+/- ٢٢.٢٤ سم ماء، وبعد العملية بشهرين ٨٨.٨٦+/- ١٨.١٤سم ماء. وكانت وظيفة الرئة قبل العملية وفقا للقيم المتوقعة، إلا أنه انخفضت بشكل ملحوظ بعد العملية. في زيارة المتابعة بعد العملية بشهرين، وكانت هناك علاقة معتدلة بين الضغط الشهيقي الأقصى وحجم الزفير القسري. الاستنتاجات: أظهرت هذه الدراسة أن قوة عضلات الجهاز التنفسي لم تعرقل، لا سابقا ولا شهرين بعد جراحة القلب. ولكن الآلية المحددة لهذا التعديل في وظائف الرئة ليست مفهومة بشكل واضح. يجب أن تركز التدابير الرامية إلى إعادة تحديد القدرة المثالية للرئة بعد العملية الجراحية على تمارين رئوية مختلفة قبل وبعد العملية. Abstract: Objectives: Pulmonary complications, such as atelectasis, pulmonary oedema, pleural effusion, bronchospasm, and pneumonia, have been reported following cardiac surgery. Shallow breathing leading to impaired lung function is the major cause of respiratory complications. Decreases in respiratory muscle strength can be measured using the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) produced in the oral cavity. This study aimed to determine the decrease in respiratory muscle strength 8 weeks following cardiac surgery. Moreover, the relationship between lung function and respiratory muscle strength was studied. Methods: In this observational study, 42 adult cardiac surgery patients (10 women, 32 men; mean age 65 ± 7 years) were investigated. Lung function and respiratory muscle strength were measured preoperatively and at 2 months postoperatively. Results: The pre- and postoperative respiratory muscle strengths were in accordance with the predicted values. The MIP was 81.75 ± 22.04 cmH2O preoperatively and 74.56 ± 18.86 cmH2O at the 2-month follow-up (p = 0.146). The MEP was 98.55 ± 22.24 cmH2O preoperatively and 88.86 ± 18.14 cmH2O at the 2-month follow-up (p = 0.19). The preoperative lung function was in accordance with the predicted values; however, lung function significantly decreased postoperatively. At the 2-month follow-up, there was a moderate correlation between the MIP and forced expiratory volume (r = 0.59, p = 0 .0078). Conclusions: The respiratory muscle strength was not impeded either before or 2 months after cardiac surgery. However, the exact mechanism for the alteration in lung function remains unclear. Measures to re-establish the ideal postoperative lung capacity should concentrate on different perioperative pulmonary exercises. الكلمات المفتاحية: جراحة القلب, وظيفة الرئة, قوة العضلات التنفسية, الضغط الشهيقي الأقصى, الضغط الزفيري الأقصى, Keywords: Cardiac surgery, Lung function, Maximal expiratory pressure (MEP), Maximal inspiratory pressure (MIP), Respiratory muscle strength

The versatile precursor 2-acetyl-4-allyl-1-hydroxy naphthalene was synthesized efficiently via Claisen rearrangement 2-acetyl-1-allyloxynaphthalene. The Claisen-Schmidt condensation of latter precursor afforded the corresponding chalcones which were exploited to synthesize a series of potential heterocycles such as pyrazoline, isoxazoline, benzocoumarin and benzoflavone. The synthesized products showed potent antioxidant and antimicrobial activities. Chalcone 3c, naphthyl pyrazoline 6b and hydroxycoumarin 13 exhibited the highest activity as antioxidants. Their binding mode showed specialized recognition of hydroxycoumarin 13 with the triad key amino acids at the active site of the oxidoreductase enzyme (PDB code 1DXO). 1-Hydroxynaphth-2-yl pyrazoline (6b) revealed the highest efficacy against both Gram positive and negative bacterial species. In silico molecular docking of pyrazoline 6b endorsed its proper binding at the active site of the 2EX6 enzyme which explains its potent antibacterial activity in comparison with standard ampicillin. Keywords: Hydroxyacetyl, heterocycle, Naphthyl, Biological, Docking, 1DXO active site

Objective: This current study was designed to compare and correlate between smear layer eradication and reduction in microhardness by natural 0.2%chitosan nanoparticles and novel chemical irrigants with surfactant at the apical root third., Materials and Method: One hundred and twenty straight single-rooted extracted lower premolars were decoronated and working length obtained with #10 K-file. Pro-taper rotary files were used till apical size F3. The canals were simultaneously flushed with assigned irrigant containing surfactant [(ChX-Ultra, NaOCl-Extra, Pro-EDTA, 0.2%chitosan nanoparticles, Biopure MTAD]. The samples were randomly divided into two equal groups (n = 60). InGroup S (n = 60), the residual smear layer was examined by scanning electron microscope and in Group M(n = 60) microhardness was determined by Vickers Microhardness Tester. Further both groups were divided into six equal groups (n = 10 each) according to assigned irrigating solutions.For smear layer removal; Kruskal-Wallis tests followed by pair wise comparison using Mann Whitney U test was done. For change in microhardness ANOVA and post hoc Tukey tests was done., Results: Maximum smear layer removal was recorded in Biopure MTAD (1.8 ± 0.63), followed by pro-EDTA (2.2 0 ± 0.63) then 0.2%chitosan (2.6 ± 0.51), then NaOCL Extra (3.5 ± 0.53)and least in CHX-Ultra (4.4 ± 0.52) and saline (5.0 ± 0.00). Pro-EDTA group (12.8 ± 2.47) revealed significant highest reduction in microhardness followed by Biopure MTAD (8.01 ± 3.06), 0.2%chitosan nanoparticles (5.48 ± 2.87), NaOCl-Extra (5.44 ± 1.62) and least recorded in CHX-Ultra (4.94 ± 1.43) and saline (3.04 ± 0.63)., Conclusion: The elimination of the smear layer is always accompanied by a reduction in microhardness. Moreover, irrigant with surfactant and chelators enhanced smear layer removal, with best perceived in Biopure MTAD., (© 2024 Published by Elsevier B.V. on behalf of Craniofacial Research Foundation.)

Disparities in endometrial cancer has increased during the past decade with Black women more likely to be diagnosed at a later stage and have higher mortality. The majority of research has been focused on cultural barriers, socioeconomic status, lack of access to care, comorbidities, and tumor histology to explain these disparities. Limited studies have been conducted on the disparity in the treatment of endometrial intraepithelial neoplasia(EIN). We sought to analyze the differences in treatment used in the management of postmenopausal women with EIN to evaluate whether race/ethnicity is a contributing factor. An IRB approved retrospective study was conducted amongst women at a single institution diagnosed with EIN. Ethnicity/race was defined as non-Hispanic White, non-Hispanic Black, Hispanic, and Asian. Demographic and clinical data was extracted. Multivariable logistic regression was used to examine the association between ethnicity/race and treatment, adjusted for age, BMI, and underlying medical conditions such as cardiovascular disease and diabetes. In total, 254 patients were analyzed. A significant association between ethnicity/race and treatment with non-Hispanic Black women less likely to be treated with surgical management compared to non-Hispanic White women (OR = 0.326, 95 %CI 0.129-0.827, p = 0.026). Importantly, after adjusting for clinical risk factors(age, BMI, CVD, diabetes), non-Hispanic Black women remained at an increased risk of not undergoing surgical intervention (OR = 0.333, 95 % CI 0.125-0.882, p = 0.027). Future research is imperative to evaluate the root cause of this disparity in the healthcare system., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Background: Cancer patients with preexisting autoimmune diseases (AID) have been traditionally excluded from clinical trials of immune checkpoint inhibitors (ICI) due to concerns for toxicity. As indications for ICI expand, more data are needed on the safety and efficacy of ICI treatment in cancer patients with AID., Methods: We systematically searched for studies consisting of NSCLC, AID, ICI, treatment response, and adverse events. Outcomes of interest include incidence of autoimmune flare, irAE, response rate, and ICI discontinuation. Study data were pooled using random-effects meta-analysis., Results: Data were extracted from 24 cohort studies, consisting of 11,567 cancer patients (3774 NSCLC patients and 1157 with AID). Pooled analysis revealed an AID flare incidence of 36% (95% CI, 27%-46%) in all cancers and 23% (95% CI, 9%-40%) in NSCLC. Preexisting AID was associated with an increased risk of de novo irAE in all cancer patients (RR 1.38, 95% CI, 1.16-1.65) and NSCLC patients (RR 1.51, 95% CI, 1.12-2.03). There was no difference in de novo grade 3 to 4 irAE and tumor response between cancer patients with and without AID. However, in NSCLC patients, preexisting AID was associated with a 2-fold increased risk of de novo grade 3 to 4 irAE (RR 1.95, 95% CI, 1.01-3.75) but also better tumor response in achieving a complete or partial response (RR 1.56, 95% CI, 1.19-2.04)., Conclusions: NSCLC patients with AID are at a higher risk of grade 3 to 4 irAE but are more likely to achieve treatment response. Prospective studies focused on optimizing immunotherapeutic strategies are needed to improve outcomes for NSCLC patients with AID., Competing Interests: Disclosure The authors have no conflict of interests to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

In the present work, the anti-inflammatory effect of 30 compounds containing 3-fluorophenyl pyrimidinylimidazo[2,1-b]thiazole was investigated. All final target compounds showed significant Inhibitory effect on p38α. P38α is considered one of the key kinases in the inflammatory process due to its regulatory effect on pro-inflammatory mediators. The final target compounds divided into four group based on the type of terminal moiety (amide and sulfonamide) and the linker between pyrimidine ring and terminal moiety (ethyl and propyl). Most compounds with terminal sulfonamide moiety and propyl linker between the sulfonamide and pyrimidine ring were the most potent among all synthesized final target compounds with sub-micromolar IC 50s . Compound 24g (with p-Cl benzene sulfonamide and propyl linker) exhibited the highest activity over P38α with IC 50 0.68 µM. All final target compounds were tested for their ability to inhibit nitric oxide release and prostaglandin E2 production. Compounds having amide terminal moiety with ethyl linker showed higher inhibitory activity for nitric oxide release and compound 21d exhibited the highest activity for nitric oxide release with IC 50 1.21 µM. Compounds with terminal sulfonamide moiety and propyl linker showed the highest activity for inhibiting PGE2 production and compounds 24i and 24g had the lowest IC 50s with value 0.87 and 0.89 µM, respectively. Compounds 21d, 22d and 24g were tested for their ability to inhibit over expression of iNOS, COX1, and COX2. In addition the ability of compounds 21d, 22d and 24g to inhibit inflammatory cytokines were determined. Finally molecular docking of the three compounds were performed on P38α crystal structure to expect their mode of binding., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The anti-inflammatory and chemopreventive activities of aspirin (ASA) may be mediated through its cyclooxygenase inhibitor function. We have previously shown that ASA can protect against UVR-induced skin inflammation and DNA damage; however, the role of inflammation in UV-induced DNA damage and the mechanism underlying ASA protection are poorly characterized. Using immunodeficient NOD scid gamma mice and immunocompetent C57BL/6 mice treated with immune cell‒depleting antibodies, we found that inflammation was not required for UVB-induced 8-oxoguanine and cyclobutane pyrimidine dimers in vivo. Unlike ASA, neither its immediate metabolite salicylate nor the cyclooxygenase inhibitor indomethacin reduced UVB-induced 8-oxoguanine or cyclobutane pyrimidine dimers in melanocyte Melan-a or keratinocyte HaCat cells in vitro. Moreover, addition of prostaglandin E 2 did not reverse the protective effect of ASA on UVB-treated cells. Phosphorylation of the 5' AMP protein kinase, observed in ASA-treated cells, could be blocked by the 5' AMP protein kinase inhibitor compound C. Compound C or 5' AMP protein kinase knockdown partially reduced ASA-mediated protection against UVB-induced DNA damage. Finally, injection of compound C partially reversed the protective effect of ASA on UVB-treated mouse skin in vivo. These studies suggest that ASA confers protection against UVB-induced DNA damage through the activation of 5' AMP protein kinase rather than through cyclooxygenase inhibition., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to assess if using computer simulations as a supplemental tool for teaching social determinants of health (SDoH) would impact first-year pharmacy students' knowledge and perceptions of SDoH., Methods: A brief lecture and online poverty game were followed by completion of two, in-class, computer-simulated SDoH clinical scenarios and corresponding case discussion. Students completed a pre- and post-quiz and perception survey with two open-ended questions. Qualitative analysis of the open-ended questions and quantitative analyses of the poverty game choices, quiz, and perception survey were conducted., Results: In total, 132 students were enrolled in this study. Thematic analysis of the open-ended question asking students what they learned included empathy (42%), general SDoH knowledge (30%), culture/religion (18%), and economic impact (15%). Student perceptions for all teaching modalities had a mean score of 4. Mean quiz scores on the pre- and post-class quizzes were 2.31 (SD 0.93) and 2.51 (SD 0.89), respectively., Conclusions: Computer simulations can be utilized as a supplemental tool to teach and apply clinical patient cases focused on SDoH. Strategically threading SDoH throughout the pharmacy curriculum is recommended to further develop SDoH knowledge and clinical skills., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to compare Doppler flow velocity and thermodilution-derived indexes and to determine the optimal thermodilution-based diagnostic thresholds for coronary flow reserve (CFR)., Background: The majority of clinical data and diagnostic thresholds for flow-based indexes are derived from Doppler measurements, and correspondence with thermodilution-derived indices remain unclear., Methods: An international multicenter registry was conducted among patients who had coronary flow measurements using both Doppler and thermodilution techniques in the same vessel and during the same procedure., Results: Physiological data from 250 vessels (in 149 patients) were included in the study. A modest correlation was found between thermodilution-derived CFR (CFR thermo ) and Doppler-derived CFR (CFR Doppler ) (r 2  = 0.36; P < 0.0001). CFR thermo overestimated CFR Doppler (mean 2.59 ± 1.46 vs 2.05 ± 0.89; P < 0.0001; mean bias 0.59 ± 1.24 by Bland-Altman analysis), the relationship being described by the equation CFR thermo  = 1.04 × CFR Doppler  + 0.50. The commonly used dichotomous CFR thermo threshold of 2.0 had poor sensitivity at predicting a CFR Doppler value <2.5. The optimal CFR thermo threshold was 2.5 (sensitivity 75.54%, specificity 81.25%). There was only a weak correlation between hyperemic microvascular resistance and index of microvascular resistance (r 2  = 0.19; P < 0.0001), due largely to variation in the measurement of flow by each modality. Forty-four percent of patients were discordantly classified as having abnormal microvascular resistance by hyperemic microvascular resistance (≥2.5 mm Hg · cm -1 · s) and index of microvascular resistance (≥25)., Conclusions: CFR calculated by thermodilution overestimates Doppler-derived CFR, while both parameters show modest correlation. The commonly used CFR thermo threshold of 2.0 has poor sensitivity for identifying vessels with diminished CFR, but using the same binary diagnostic threshold as for Doppler (<2.5) yields reasonable diagnostic accuracy. There was only a weak correlation between microvascular resistance indexes assessed by the 2 modalities., Competing Interests: Funding Support and Author Disclosures This work was supported by the British Heart Foundation (PG/19/9/34228), the National Institute for Health Research via the Biomedical Research Centre award to Guy’s and St Thomas’ Hospital and King’s College London, and the National Institute for Health Research Oxford Biomedical Research Centre. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Supervised exercise therapy (SET) is a first-line treatment for patients with peripheral artery disease (PAD). The efficacy of SET is most commonly expressed by significant statistical improvement of parameters that do not clarify how each individual patient will benefit from SET. This study examined the minimal clinically important difference (MCID) in walking speed in claudicating patients with PAD after SET., Methods: A total of 63 patients with PAD-related claudication (Fontaine stage II PAD) participated in a 6-month SET program. Self-selected walking speed was measured before and after SET. Distribution and anchor-based approaches were used to estimate the MCID for small and substantial improvement. The ability to walk one block and the ability to climb one flight of stairs questions were chosen as anchor questions from the Medical Outcomes Study 36-item Short Form questionnaire. Receiver operating characteristics curve analyses were performed to detect the threshold for MCID in walking speed after treatment., Results: The distribution-based method estimated 0.03 m/s as a small improvement and 0.08 m/s as a substantial improvement after SET. Small and substantial improvements according to the anchor question walking one block were 0.05 m/s and 0.15 m/s, respectively. For the climbing one flight of stairs anchor question, 0.10 m/s was a small improvement. Receiver operating characteristics curve analyses identified an increase of 0.04 m/s and 0.03 m/s for improvement based on walking one block and climbing one flight of stairs, respectively., Conclusions: We report our findings for the MCID for walking speed among claudicating patients receiving SET. Claudicating patients who increase walking speed of 0.03 m/s or greater are more likely to experience a meaningful improvement in walking impairment than those who do not. The MCID reported in this study can serve as a benchmark for clinicians to develop goals and interpret clinically meaningful progress in the care of claudicating patients with PAD., (Copyright © 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Aims: The aim of this study was to compare outcomes following hip fracture for patients who sustained their fracture whilst in hospital (inpatients) with those who sustained their fracture in the community (outpatients)., Patients and Methods: Data on all hip fracture admissions aged 65 years or over between 1 st May 2007 and 31 st March 2018 was analysed from a prospectively collected hip fracture database. Patient demographics, co-morbidities, and discharge information were analysed. Outcome measures included mortality (inpatient, 30-day and one year), surgical site infection (SSI) rate and mean length of stay (LOS). Baseline characteristics were used to generate propensity-match scores for each patient, with inpatients matched to outpatients in a 1:1 ratio. Outcomes were compared after matching., Results: 7,592 patients were included in the study. 338 were identified as having an inpatient hip fracture. There was a significantly greater level of comorbidity in the inpatient group at baseline. After propensity-score matching, there were 229 patients in the inpatient group and 222 in the outpatient group, with no significant difference in baseline co-morbidities. In this propensity score matched cohort, 30-day mortality was significantly higher in the inpatient group (16%) compared to the outpatient group (10%), P = 0.049. 1-year mortality was also significantly higher in the inpatient group (44%) compared to the outpatient group (34%), P = 0.03. There was no significant difference in inpatient mortality, mean LOS and SSI rates between the two groups., Conclusion: Patients who suffer a hip fracture whilst in hospital have significantly poorer outcomes than those who suffer a hip fracture whilst an outpatient, even after adjusting for co-morbidities. Dedicated guidelines are needed for this particularly vulnerable group., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: This study assessed the ability to identify coronary microvascular dysfunction (CMD) in patients with angina and nonobstructive coronary artery disease (NOCAD) using high-resolution cardiac magnetic resonance (CMR) and hypothesized that quantitative perfusion techniques would have greater accuracy than visual analysis., Background: Half of all patients with angina are found to have NOCAD, while the presence of CMD portends greater morbidity and mortality, it now represents a modifiable therapeutic target. Diagnosis currently requires invasive assessment of coronary blood flow during angiography. With greater reliance on computed tomography coronary angiography as a first-line tool to investigate angina, noninvasive tests for diagnosing CMD warrant validation., Methods: Consecutive patients with angina and NOCAD were enrolled. Intracoronary pressure and flow measurements were acquired during rest and vasodilator-mediated hyperemia. CMR (3-T) was performed and analyzed by visual and quantitative techniques, including calculation of myocardial blood flow (MBF) during hyperemia (stress MBF), transmural myocardial perfusion reserve (MPR: MBF HYPEREMIA / MBF REST ), and subendocardial MPR (MPR ENDO ). CMD was defined dichotomously as an invasive coronary flow reserve <2.5, with CMR readers blinded to this classification., Results: A total of 75 patients were enrolled (57 ± 10 years of age, 81% women). Among the quantitative perfusion indices, MPR ENDO and MPR had the highest accuracy (area under the curve [AUC]: 0.90 and 0.88) with high sensitivity and specificity, respectively, both superior to visual assessment (both p < 0.001). Visual assessment identified CMD with 58% accuracy (41% sensitivity and 83% specificity). Quantitative stress MBF performed similarly to visual analysis (AUC: 0.64 vs. 0.60; p = 0.69)., Conclusions: High-resolution CMR has good accuracy at detecting CMD but only when analyzed quantitatively. Although omission of rest imaging and stress-only protocols make for quicker scans, this is at the cost of accuracy compared with integrating rest and stress perfusion. Quantitative perfusion CMR has an increasingly important role in the management of patients frequently encountered with angina and NOCAD., Competing Interests: Funding Support and Author Disclosures This work was supported by the British Heart Foundation (FS/16/49/32320), the National Institute for Health Research via the Biomedical Research Centre award to Guy’s and St Thomas’ Hospital and King’s College London and via the Cardiovascular MedTech Co-operative, the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z), and the EPSRC Centre for Doctoral Training in Medical Imaging (EP/L015226/1). The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Despite international revascularisation guidelines strongly recommending functional assessment of coronary artery stenosis using pressure-wire derived indices, the adoption rate of coronary physiology remains low., Methods: An online questionnaire was designed to evaluate behavioural determinants impacting the adoption rate of coronary physiology. Factor analysis was performed to combine multiple items of a common behavioural domain into one explanatory factor. Regression analysis was performed to evaluate the influence of resulting factors on the variance of the coronary physiology adoption rate. Additionally, the influence of experience, demographics and provider structures was assessed., Results: 104 interventional cardiologists, from 21 countries, completed the questionnaire. Mean adoption rate of coronary physiology was 26.9%. Regression analysis revealed that factors ease-of-use (Coefficient = 0.58, p = 0.01), financial and/or time constraints (Coefficient = -0.22, p = 0.01) and knowledge about guideline recommendations (Coefficient = 0.21, p = 0.06) had the greatest influence on coronary physiology adoption rate variance (R 2  = 0.3, p < 0.001), with ease-of-use and guideline recommendations positively influencing greater uptake and constraints influencing lesser uptake of adoption of coronary physiology., Conclusion: Ease-of-use, financial and/or time constraints, and knowledge about guideline recommendations were the most relevant behavioural factors impacting the adoption rate of coronary physiology. Ease-of-use was identified as the most influential factor, highlighting the importance of cardiac catheterisation laboratory teams being adequately trained to perform coronary physiology assessment seamlessly., Competing Interests: Declaration of Competing Interest Miss Schrieken is currently an employee of Abbott Vascular. None of the other authors have any conflict of interest or relationships with industry that could have influenced this manuscript., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objectives: The present study aimed to assess antioxidant activity of herbal antioxidants namely 6% cranberry extract, 10% green tea, 50% aloe vera and 10% sodium ascorbate and their effect on reversal of bond strength in bleached enamel., Materials and Method: From one hundred and twenty extracted maxillary central incisors enamel blocks of 5 ​× ​5 ​mm were prepared and arbitrarily divided into six experimental groups (n ​= ​20): Group A: no bleaching, Group B: only bleaching protocol, Group C - bleaching ​+ ​6% cranberry extract solution, Group D - bleaching +10% Green Tea extract, Group E - bleaching ​+ ​50% aloe vera extract, Group F - bleaching ​+ ​10% Sodium Ascorbate. After bleaching antioxidants were applied for 10 ​min and were subjected to bonding procedures. The specimens were sectioned into 120 small strips of size (1 ​× ​1 ​× ​8 ​mm). Sixty sticks were analyzed to micro tensile bond strength using Universal testing machine and fractured segment were observed for failure modes (Adhesive, Cohesive and Mixed) under stereomicroscope. Remaining 60 sticks were observed for interface gap between tooth and composite resin under SEM. The %AA (antioxidant activity) was assessed with spectrophotometric analysis., Results: Data was statistically analyzed using ANOVA and Post Hoc Tukey's test. Group A (91.68 ​± ​2.24 Mpa) showed higher mean micro tensile bond strength versus group D (82.14 ​± ​1.45 Mpa), followed by group E (75.26 ​± ​1.92Mpa), group F (63.89 ​± ​1.95Mpa), group C (57.58 ​± ​1.96 Mpa) and least in group B (31.5 ​± ​1.27 Mpa). The %failure mode inferred maximum adhesive mode of failure (86.25%)., Conclusion: All the four antioxidants were able to reverse the compromised bond strength comparatively after bleaching maximum being green tea followed by aloe vera, sodium ascorbate, and minimum in cranberry., Clinically Significance: Easily available, biocompatible, cost effectual, and potent herbal antioxidants could be used considerably for immediate esthetic cases where time is a restricting factor., Competing Interests: We do not have any conflict of interest to declare., (© 2021 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

Chlorpyrifos (CPF) is a broad-spectrum chlorinated organophosphate (OP) pesticide used for the control of a variety of insects and pathogens in crops, fruits, vegetables, as well as households, and various other locations. The toxicity of CPF has been associated with neurological dysfunctions, endocrine disruption, and cardiovascular diseases (CVDs). It can also induce developmental and behavioral anomalies, hematological malignancies, genotoxicity, histopathological aberrations, immunotoxicity, and oxidative stress as evidenced by animal modeling. Moreover, eye irritation and dermatological defects are also reported due to CPF toxicity. The mechanism of action of CPF involves blocking the active sites of the enzyme, acetylcholinesterase (AChE), thereby producing adverse nervous system effects. Although CPF has low persistence in the body, its active metabolites, 3,5,6-trichloro-2-pyridinol (TCP), and chlorpyrifos-oxon (CPO) are comparatively more persistent, albeit equally toxic, and thus produce serious health complications. The present review has been compiled taking into account the work related to CPF toxicity and provides a brief compilation of CPF-induced defects in animals and humans, emphasizing the abnormalities leading to endocrine disruption, neurotoxicity, reproductive carcinogenesis, and disruptive mammary gland functionality. Moreover, the clinical signs and symptoms associated with the CPF exposure along with the possible pharmacological treatment are reported in this treatise. Additionally, the effect of food processing methods in reducing CPF residues from different agricultural commodities and dietary interventions to curtail the toxicity of CPF has also been discussed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

UVR promotes skin cancer through multiple mechanisms, including induction of inflammation, oxidative stress, and DNA damage such as 8-oxoguanine and cyclobutane pyrimidine dimers. We investigated whether the anti-inflammatory activities of aspirin (acetylsalicylic acid [ASA]) could protect against UVB-induced DNA damage and skin carcinogenesis. ASA reduced UVB-induced 8-oxoguanine and cyclobutane pyrimidine dimers in Melan-A melanocytes and HaCaT keratinocytes. Skin from UVB-irradiated C57BL/6 mice receiving 0.4 mg ASA daily by gavage exhibited less inflammation, fewer sunburn cells, and reduced 8-oxoguanine lesions than skin from irradiated control animals. ASA similarly reduced UVB-induced sunburn cells, 8-oxoguanine, and cyclobutane pyrimidine dimer lesions in skin of melanoma-prone TN 61R mice, and this was associated with decreased prostaglandin E 2 in plasma and skin. These effects of ASA, however, did not delay melanoma onset in TN 61R mice exposed to a single neonatal dose of UVB. In SKH1-E mice prone to squamous cell carcinoma, ASA reduced plasma and skin prostaglandin E 2 levels and indices of UVB-induced DNA damage and delayed squamous cell carcinoma onset induced by chronic UVB. These results indicate that ASA can protect against UVB-induced inflammation in skin and reduce UVB-induced DNA damage in both melanocytes and keratinocytes. These effects translated into greater chemopreventive efficacy for UVB-induced squamous cell carcinoma than melanoma mouse models., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

In this review article, we have presented a detailed analysis of the recent advancement of quantum mechanical calculations in the applications of the low-dimensional nanomaterials (LDNs) into biomedical fields like biosensors and drug delivery systems development. Biosensors play an essential role for many communities, e.g. law enforcing agencies to sense illicit drugs, medical communities to remove overdosed medications from the human and animal body etc. Besides, drug delivery systems are theoretically being proposed for many years and experimentally found to deliver the drug to the targeted sites by reducing the harmful side effects significantly. In current COVID-19 pandemic, biosensors can play significant roles, e.g. to remove experimental drugs during the human trials if they show any unwanted adverse effect etc. where the drug delivery systems can be potentially applied to reduce the side effects. But before proceeding to these noble and expensive translational research works, advanced theoretical calculations can provide the possible outcomes with considerable accuracy. Hence in this review article, we have analyzed how theoretical calculations can be used to investigate LDNs as potential biosensor devices or drug delivery systems. We have also made a very brief discussion on the properties of biosensors or drug delivery systems which should be investigated for the biomedical applications and how to calculate them theoretically. Finally, we have made a detailed analysis of a large number of recently published research works where theoretical calculations were used to propose different LDNs for bio-sensing and drug delivery applications., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 Elsevier B.V. All rights reserved.)

Background: Outpatient total knee arthroplasty (TKA) is becoming more commonplace in the United States. Alternatively, the current practice in the Middle East involves an inpatient stay of 7-10 days in the hospital after TKA. This study reports the early results of the first reported series of outpatient TKA performed on patients in the Middle East and compares the clinical and functional outcomes with those of patients who underwent inpatient TKA., Methods: Eighty-eight patients underwent TKA (inpatient: 44 and outpatient: 44) using the modified intervastus approach in 2 hospitals in the Middle East from 2017 to 2019. Clinical and functional outcomes were assessed by recording the Knee Injury and Osteoarthritis Outcome Score, visual analog scale (VAS) for pain, and knee range of motion (ROM) preoperatively, on the day of surgery, and postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months., Results: Two patients undergoing outpatient TKA had complications: one patient suffered a periprosthetic fracture on postoperative day 10 after a fall, and the other patient had drainage on postoperative day 5. No complications occurred in the inpatient TKA cohort. There were no significant differences observed in the VAS scores or knee ROM numbers recorded for inpatient and outpatient TKA groups at any of the follow-up periods. Overall, the Knee Injury and Osteoarthritis Outcome Score, VAS, and ROM significantly improved 6 months after surgery compared with preoperative values for both inpatient and outpatient TKA groups., Conclusions: Outpatient TKA was safely implemented when compared with inpatient TKA, with satisfactory results. A total of 2 complications were seen in this study, which we believe are unrelated to the patient's discharge status. The concept of outpatient TKA using the modified intervastus approach was very well accepted by the patients in this study and can potentially be applied safely elsewhere in the region., (© 2020 The Authors.)

Despite the rarity of necrotizing fasciitis (NF), it is a relatively common cause of death in many lawsuits. Families seek financial compensation or legal charges against those they believe to be involved in the death, usually physicians who did not identify the infection soon enough. This paper explores six cases in forensic pathology practice where NF posed a unique medico-legal dilemma., (Copyright © 2020 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Background: Antenatal education is an essential component of antenatal care that prepares and facilitates the acquisition of women's skills and confidence required for positive experiences throughout pregnancy, birth and the postnatal period., Aim: To evaluate pregnant women's experiences of education during the antenatal period in Brunei Darussalam., Methods: A descriptive cross-sectional study was conducted using a pre-designed instrument to examine the provision of antenatal education among 110 pregnant women attending two major Maternal and Child Health Clinics in Brunei Darussalam. The quantitative data was analysed descriptively whereby the scores of each scale was calculated and reported accordingly., Findings: A majority of participants possess good health knowledge and live a healthy lifestyle. They have a positive perception about baby and postnatal care. However, participants only possess average knowledge about practical health techniques., Discussion: Overall, the majority of women were satisfied with the antenatal education provided in the Maternal and Child Health Clinics in Brunei Darussalam. Good rapport and interactive learning were the two most quoted important characteristics in antenatal education classes. Breastfeeding, which required both practical knowledge and the acquisition of skills was found to be the most interesting antenatal education topic. Antenatal education provided through verbal information was identified as the least interesting to the women., Conclusion: This first study, which aimed to evaluate antenatal education in Brunei Darussalam could provide baseline data and guide strategies to engage pregnant women and relevant agencies in antenatal education. Future studies involving a more in-depth exploration of the women's experiences are recommended., (Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: There is inconsistency in the literature regarding the clinical effects of proton pump inhibitors (PPI) when added to dual antiplatelet therapy (DAPT) in subjects with coronary artery disease (CAD). We performed meta-analysis stratified by study design to explore these differences., Methods and Results: 39 studies [4 randomized controlled trials (RCTs) and 35 observational studies) were selected using MEDLINE, EMBASE and CENTRAL (Inception-January 2018). In 221,204 patients (PPI = 77,731 patients, no PPI =143,473 patients), RCTs restricted analysis showed that PPI did not increase the risk of all-cause mortality (Risk Ratio (RR): 1.35, 95% Confidence Interval (CI), 0.56-3.23, P = 0.50, I 2  = 0), cardiovascular mortality (RR: 0.94, 95% CI, 0.25-3.54, P = 0.92, I 2  = 56), myocardial infarction (MI) (RR: 0.97, 95% CI, 0.62-1.51, P = 0.88, I 2  = 0) or stroke (RR: 1.11, 95% CI, 0.25-5.04, P = 0.89, I 2  = 26). However, PPI significantly reduced the risk of gastrointestinal (GI) bleeding (RR: 0.32, 95% CI, 0.20-0.52, P < 0.001, I 2  = 0). Conversely, analysis of observational studies showed that PPI significantly increased the risk of all-cause mortality (RR: 1.25, 95% CI, 1.11-1.41, P < 0.001, I 2  = 82), cardiovascular mortality (RR: 1.25, 95% CI, 1.03-1.52, P = 0.02, I 2  = 71), MI (RR: 1.30, 95% CI, 1.16-1.47, P < 0.001, I 2  = 82) and stroke (RR: 1.60, 95% CI, 1.43-1.78, P < 0.001, I 2  = 0), without reducing GI bleeding (RR: 0.74, 95% CI, 0.45-1.22, P = 0.24, I 2  = 79)., Conclusion: Meta-analysis of RCTs endorsed the use of PPI with DAPT for reducing GI bleeding without worsening cardiovascular outcomes. These findings oppose the negative observational data regarding effects of PPI with DAPT., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Mental Health problems are one of the leading disabilities worldwide. Individuals seeking help for their mental illness expect nurses to be cognisant of their needs without prejudice and discrimination. Existing evidences suggest a growing number of patient referral from primary healthcare to psychiatric consultations. This study aimed to explore primary healthcare nurses' knowledge and attitude towards mental illness and people with mentally illness., Methods: A cross-sectional study using the Mental Health Problem Perception and the Community Attitudes to Mental Illness questionnaires. Descriptive and multivariate regression using maximum likelihood procedures were applied., Results: Regression analysis showed significantly high correlation between knowledge and authotarianism (β = 0.775, p = 0.007) and moderate inverse correlation with social restrictiveness (β = -0.517, p < 0.001). However, no significant correlation with benevolence (β = -0.057, p = 0.181) was detected. Nurses with higher educational level were significantly associated with authotarianism attitude., Conclusions: This is the first study examining knowledge and attitude of primary healthcare nurses in Brunei. The relationship between the study variables as well as demographic factors, in comparison to other countries, were discussed. Overall, negative attitude among nurses is still a challenging issue; therefore, developing re-education initiatives and increase contact time, especially for healthcare front liners with negative attitudes regardless of education level, to favour change of attitude, is important to foster holistic care to people with mental illness and promote mental health in the population., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Growing evidence supports physiology-guided revascularization, with Fractional Flow Reserve (FFR) the most commonly used invasive measure of coronary blood flow impairment at the time of diagnostic angiography. Recently, there has been growing interest in stenosis severity indices measured at rest, such as Instantaneous Wave Free Ratio (iFR) and the ratio of distal coronary to aortic pressure at rest (resting Pd/Pa). Their reliability may, theoretically, be more susceptible to changes in microvascular tone and coronary flow. This study aimed to assess variability of resting coronary flow with normal catheter laboratory stimuli., Methods: Simultaneous intracoronary pressure (Pd) and Doppler Average Peak Flow Velocity (APV) recordings were made at rest and following the verbal warning preceding an intravenous adenosine infusion., Results: 72 patients undergoing elective angiography were recruited (mean age 62 years, 52.7% male) with a wide range of coronary artery disease severity (FFR 0.86 ± 0.09). Average peak flow velocity varied significantly between measurements at rest and just prior to commencement of adenosine, with a mean variation of 10.2% (17.82 ± 9.41 cm/s vs. 19.63 ± 10.44 cm/s, p < 0.001) with an accompanying significant drop in microvascular resistance (6.27 ± 2.73 mm Hg·cm -1 ·s -1 vs. 5.8 ± 2.92 mm Hg·cm -1 ·s -1 , p < 0.001). These changes occurred without significant change in systemic hemodynamic measures. Whilst there was a trend for an associated change in the resting indices, Pd/Pa and iFR, this was statistically and clinically not significant (0.92 ± 0.08 vs. 0.92 ± 0.08, p = 0.110; and 0.90 ± 0.11 vs. 0.89 ± 0.12, p = 0.073)., Conclusion: Resting coronary flow and microvascular resistance vary significantly with normal catheter laboratory stimuli, such as simple warnings. The clinical impact of these observed changes on indices of stenosis severity, particularly those measured at rest, needs further assessment within larger cohorts., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: For two decades, bright-blood late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been considered the reference standard for the non-invasive assessment of myocardial viability. While bright-blood LGE can clearly distinguish areas of myocardial infarction from viable myocardium, it often suffers from poor scar-to-blood contrast, making subendocardial scar difficult to detect. Recently, we proposed a novel dark-blood LGE approach that increases scar-to-blood contrast and thereby improves subendocardial scar conspicuity. In the present study we sought to assess the clinical value of this novel approach in a large patient cohort with various non-congenital ischemic and non-ischemic cardiomyopathies on both 1.5 T and 3 T CMR scanners of different vendors., Methods: Three hundred consecutive patients referred for clinical CMR were randomly assigned to a 1.5 T or 3 T scanner. An entire short-axis stack and multiple long-axis views were acquired using conventional phase sensitive inversion recovery (PSIR) LGE with TI set to null myocardium (bright-blood) and proposed PSIR LGE with TI set to null blood (dark-blood), in a randomized order. The bright-blood LGE and dark-blood LGE images were separated, anonymized, and interpreted in a random order at different time points by one of five independent observers. Each case was analyzed for the type of scar, per-segment transmurality, papillary muscle enhancement, overall image quality, observer confidence, and presence of right ventricular scar and intraventricular thrombus., Results: Dark-blood LGE detected significantly more cases with ischemic scar compared to conventional bright-blood LGE (97 vs 89, p = 0.008), on both 1.5 T and 3 T, and led to a significantly increased total scar burden (3.3 ± 2.4 vs 3.0 ± 2.3 standard AHA segments, p = 0.015). Overall image quality significantly improved using dark-blood LGE compared to bright-blood LGE (81.3% vs 74.0% of all segments were of highest diagnostic quality, p = 0.006). Furthermore, dark-blood LGE led to significantly higher observer confidence (confident in 84.2% vs 78.4%, p = 0.033)., Conclusions: The improved detection of ischemic scar makes the proposed dark-blood LGE method a valuable diagnostic tool in the non-invasive assessment of myocardial scar. The applicability in routine clinical practice is further strengthened, as the present approach, in contrast to other recently proposed dark- and black-blood LGE techniques, is readily available without the need for scanner adjustments, extensive optimizations, or additional training.

Background: The objective of this study was to investigate whether baseline low-density lipoprotein cholesterol (LDL-C) levels influence total and cardiovascular mortality reduction associated with proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor therapy., Methods: In this meta-analysis, 9 randomized controlled trials were selected using Medline, Embase, and CENTRAL until November 2018. Analyses were stratified by mean baseline LDL-C (<100 mg/dL and ≥ 100 mg/dL). Stepwise prespecified sensitivity analyses were performed after excluding the SPIRE trials and by regrouping ODYSSEY OUTCOME mortality data according to the baseline LDL-C (< and ≥100 mg/dL)., Results: In 83,321 patients, PCSK9 inhibitor therapy was not associated with a reduction in the risk of all-cause mortality (relative risk [RR], 0.94, 95% confidence interval [CI], 0.81-1.09, P = .41). These results remained consistent after excluding the SPIRE trials (RR, 0.89, 95% CI, 0.75-1.05, P = .18). However, the RR varied by baseline LDL-C, with significant RR reduction only in patients with LDL-C ≥ 100 mg/dL (RR, 0.39, 95% CI, 0.20-0.76) (P-interaction = .01). Meta-regression showed RR of 0.97 for all-cause mortality per 1 mg/dL higher baseline LDL-C (95% CI, 0.94-0.99). PCSK9 inhibitor therapy showed no significant effect on cardiovascular mortality, with no effect when excluding the SPIRE trials. However, after regrouping ODYSSEY OUTCOME estimates, there was a significant reduction in cardiovascular mortality restricted to patients with LDL-C ≥ 100 mg/dL (RR, 0.67, 95% CI, 0.51-0.87) (P-interaction = .006)., Conclusion: PCSK9 inhibitor therapy on a background statin treatment may reduce the risk of total and cardiovascular mortality in patients with baseline LDL-C ≥ 100 mg/dL. These results support current guidelines reserving PCSK9 inhibitors for high-risk patients with residually high LDL-C., (Copyright © 2019 National Lipid Association. Published by Elsevier Inc. All rights reserved.)

Background: Swine brucellosis is a zoonotic disease caused by Brucella suis. The study describes the occurrence of brucellosis in two organized piggeries in Southern India., Methods: A total of 585 serum samples comprising 575 from pigs and 10 from animal handlers were collected and tested by serological tests and PCR. Tissue samples were collected for isolation of the pathogen., Results: Out of 575 serum samples screened, 236 (41.04%) were positive for brucellosis by both Rose Bengal plate test (RBPT) and indirect ELISA (iELISA) and 47 (8.17) samples showed Brucella DNA amplification by genus specific PCR. The sows those aborted and 19 boars with orchitis were seropositive for brucellosis indicating association of clinical symptoms with brucellosis seropositivity. Two of 10 pig handlers were positive by RBPT and showed significant serum agglutination test (SAT) titres of >1:160 and 1:320. B. suis bvI was isolated and identified by biochemical tests and confirmed by amplification Brucella genus and Bruce ladder PCRs from vaginal and testicular samples., Conclusions: The introduction of untested breeding boars in the farms might have resulted in the disease transmission and spread. The present study highlighted the diagnosis of B. suis bvI as a cause of abortions in the pigs and occupational exposure to farm personnel., (Copyright © 2018. Published by Elsevier Ltd.)

The physico-chemical properties of lipids influencing the solubilisation of imatinib mesylate (IM) in lipid matrix were evaluated and a statistical model to predict the same has been derived in the present study. After experimental quantification of IM solubility in various lipids, Hansen Hildebrand's total solubility parameters were calculated in order to study the role of various forces connected to lipid-drug interaction. To develop a relationship between the various descriptors of the lipids and experimental solubility of IM in lipids (% w/w), quantitative structure-solubility relationship (QSSR) was used. To generate equations that can predict the solubility of IM in lipids (%w/w), multiple linear regression was used. Amongst the various lipids tested, glyceryl monostearate and behenic acid solubilised the highest (6.19 ± 0.22%) and lowest (0.01 ± 0.01%) amounts of IM respectively. Our results suggested that alkyl chain length, polarity of the lipids, index of cohesive interaction in solids, estimated number of hydrogen bonds that would be accepted by the solute from water molecules in an aqueous solution, estimated number of hydrogen bonds that would be donated by the solute to water molecules in an aqueous solution and solvent accessible surface area collectively play a significant role in solubilising IM in the lipids. The equation developed could predict the solubility of IM in lipids with good accuracy (R 2 pred  = 0.912)., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: The ideal oral anticoagulant agent during catheter ablation (CA) for atrial fibrillation (AF) remained unclear., Hypothesis: Novel oral anticoagulants (NOACs) are safer and effective compared to uninterrupted vitamin K antagonists (U-VKA) among patients requiring CA for AF., Methods: Four randomized controlled trials (RCTs) and 9 observational studies (OS) were selected using PubMed/Medline, EMBASE and the CENTRAL data bases (Inception-December-2017). Estimates were reported as random effects risk ratio (RR) with 95% confidence interval (CI). The primary safety outcome was major bleeding and main efficacy endpoint was thromboembolism., Results: In RCTs restricted analysis, NOACs significantly reduced the relative risk of major bleeding by 72% compared to U-VKA (RR, 0.28, 95% CI, 0.14-0.58, P < 0.001). This significant effect was not achieved in OS based analysis (RR, 0.86, 95% CI, 0.42-1.78, P = 0.68). In terms of thromboembolism, both anticoagulation strategies were equally effective in analysis of RCTs (RR, 0.28, 95% CI, 0.05-1.70, P = 0.17) or OS (RR, 1.43, 95% CI, 0.46-4.39, P = 0.54). In sensitivity analysis, there was no difference among uninterrupted NOACs (U-NOACs) and U-VKA in terms of major bleeding [(RCTs: RR, 0.33, 95% CI, 0.10-1.06, P = 0.06); (OS: RR, 0.70, 95% CI, 0.28-1.78, P = 0.46)] or thromboembolism [(RCTs: RR, 0.25, 95% CI, 0.03-2.29, P = 0.22); (OS: RR, 0.68, 95% CI, 0.08-5.53, P = 0.72)]., Conclusion: NOACs, either interrupted or un-interrupted, are safer and equally effective drugs compared to U-VKA in AF patients requiring CA., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Trypanosoma evansi, a haemo-flagellated protozoan parasite causes chronic wasting disease in a wide range of animals. For its diagnosis, blood smear examination is useful in clinical cases for direct identification of the parasite but in latent infection the carrier animals are difficult to screen out by conventional blood smear test. Harboring low level of parasites and showing no symptom, the carrier animals for surra can act as a source of infection. The level of parasitaemia fluctuates, especially during latent infection; moreover the antibodies which are not found early in the infection may persist even after recovery or chemotherapy. In the present study a double antibody sandwich ELISA exploring, monoclonal antibodies and hyperimmune serum, raised against recombinant variable surface glycoprotein has been developed to detect circulating trypanosome antigens. The developed antigen detection ELISA (Ag-ELISA) was evaluated using 652 blood samples collected from cattle, buffalo, equine and camel. The statistical analysis of the data showed diagnostic sensitivity and specificity at 97.4% and 96.4% respectively, with a positive-negative cut-off OD value >0.28. Furthermore, the detection limit of the assay was found to 7.15 trypanosomes per mL. The present finding revealed that the developed assay can be exploited as a potential diagnostic test in the detection of circulating trypanosome antigens and also can be used as a population screening test for multiple animal species for detection of active infection for further treatment and control of the disease., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: The optimal preventive strategy for contrast induced acute kidney injury (CIAKI) in patients undergoing cardiac catheterization remains uncertain., Objective: We conducted Bayesian network meta-analysis (NMA) to compare different preventive strategies for CIAKI in these cohorts., Methods: Forty-nine randomized controlled trials were extracted using MEDLINE, EMBASE and CENTRAL data bases (inception-1st December 2017). We calculated median of the odds ratio (OR) with the corresponding 95% credible interval (CrI). The ranking probability of each treatment was based on SUCRA (surface under the cumulative ranking curve)., Results: In NMA of 28,063 patients [normal saline (NS: 9716 patients), sodium bicarbonate (NaHCO3: 4484 patients), statin (2542 patients), N-acetylcysteine (NAC: 3006 patients), NAC + NaHCO3 (774 patients), NS + NAC (3807 patients), NS + NaHCO3 (135 patients) and placebo (3599 patients)], statins reduced the relative risk of CIAKI compared with NS (OR: 0.50; 95% CrI, 0.25-0.99), and placebo (OR: 0.44; 95% CrI, 0.24-0.83). Subgroup analyses showed that in patients receiving low osmolar contrast, statins reduced the relative risk of CIAKI by 58% versus NS, and 51% versus placebo. There were no significant differences across all the treatments in terms of risk of hemodialysis or all-cause mortality. Statins had the highest probability for reducing the risk of CIAKI (SUCRA, 0.86), risk of hemodialysis (SUCRA, 0.88) and all-cause mortality (SUCRA, 0.81)., Conclusion: Statins were the superior preventive strategy for reducing the risk of CIAKI compared with NS alone and placebo., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Bromide (Br - ) is a bromine atom with a negative charge which is released mainly in the production of pesticides and flame retardants. It is also found naturally in seawater. Br¯ has been associated with many detrimental effects such as respiratory problems, gastric hemorrhages, and dermal burns. The aim of the study was to monitor serum bromide in humans and to correlate its level with genotoxicity and apoptosis in human. The study utilized comet assay, to measure DNA damage in peripheral leukocytes (i.e. T%DNA), enzyme-linked immunosorbent assay were used to determine fortilin level as an apoptosis marker, and spectrophotometry to measure serum Br¯ in two populations at the Dead Sea area, which are located close to and far from a local bromine factory: Ghor As-safi and Deir Alla, respectively. The biomarkers were compared with the correlating serum Br¯. A total of 397 individuals were involved in the study. The serum Br - and the genotoxicity biomarker were significantly higher (p <  0.001) in Ghor As-safi than in Deir Alla. In contrast, serum fortilin did not differ significantly between the two regions (p >  0.05). T%DNA was significantly correlated (r = 0.867, p <  0.01) to serum Br¯. In conclusion, residing near a bromide source site is increasing the bromide body burden, and enhancing genotoxicity with no detectible apoptosis. Furthermore, the selected biomarkers could serve as tools to assess the toxicity of bromide as a consequence of environmental exposure., (Copyright © 2018. Published by Elsevier B.V.)

Trypanosomosis, an endemic disease in Asia, America (central and south) and Africa causes havoc economical loss in livestock industry. The carrier animals which are symptomless and harbours low level of parasites can act as a source of infection. The level of parasitaemia fluctuates, especially during the latent infection; moreover the antibodies which are not found early in the infection may persit even after recovery or chemotherapy. The parasitological and/or serological tests always can not detect current infection or carrier animals. Hence, in the present study double antibody sandwitch antigen detection ELISA (Ag-ELISA) is developed to detect circulating trypanosomes. The new assay has been evaluated using 554 field samples comprising bovine and camel. The diagnostic sensitivity and specificity of the new assay was found to be 97.4% and 99.0% respectively, with a Cohen's kappa value of 0.96. The developed assay could detect 11.5 Trypanosoma evansi per mL from the experimentally infected blood, buffy coat and purified T. evansi samples. The findings revealed that the developed assay can be exploited as a potential diagnostic tool in the detection of active trypanosomal infection., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Trypanosoma evansi, a haemoflagellated protozoan parasite, is responsible for chronic as well as the acute debilitating disease called surra in a wide range of herbivores and carnivores including domestic and wild animals. Since the parasite is having wide host range, there is a need for diagnostic test which can detect the T. evansi specific antibody in different species of animals for generating sero-surveillance data. In the present study we developed and evaluated competitive enzyme immunoassay using monoclonal antibodies (MAbs) raised against recombinant variable surface glycoprotein (rVSG) of T. evansi. The immunoreactivity of the developed MAbs (IgG3-subtype) was evaluated by immunoblot as well as ELISA and subsequently used in the development and standardization of competitive ELISA (C-ELISA). Further, the serological data generated from the C-ELISA using reference samples constituting true positive or surely infected (35), true negative (45), sero-positive (225) and sero-negative (215) samples and was analyzed statistically. The true positivity/negativity was determined by thin blood smear examination and diagnostic PCR assay, While, seropositivity/seronegativity of the reference samples was determined through standard reference tests. The data showed the diagnostic sensitivity of 92.6% and specificity of 96.4% with Cohen's kappa value of 0.88. In order to determine the utility of C-ELISA in detecting T. evansi antibodies in different species of animals, the assay was further evaluated with 1361 field sera sample comprising bovine, horse, donkey and camel. Since the C-ELISA described herein has showed high sensitivity and specificity, this single test can be explored in the sero-surveillance of T. evansi in a wide range of animals., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: We estimate the effectiveness of Japanese encephalitis (JE) SA 14-14-2 live-attenuated vaccination single dose campaign among children aged 1-15 years in India during 2006-07., Methods: Acute encephalitis syndrome (AES) cases hospitalized following vaccination campaigns during the years 2006-08 were investigated retrospectively. The laboratory-confirmed JE cases were detected from the surveillance laboratories based on anti-JE IgM antibody by ELISA or viral RNA detection by RT-PCR in sera or cerebrospinal fluid. Consent was sought from parents or guardians. Four community controls were chosen randomly per case during house-to-house survey employing individual matching on age, gender and residence during the risk period. Vaccination history was enquired from the child's guardian and verified from vaccination card at home or records at health centre. Conditional logistic regression was conducted on matched case-control sets., Results: We studied 149 cases and matched 596 controls. Vaccination effectiveness was 43.8% (95% CI, 1.9-67.8) based on vaccination card or record. However, effectiveness was 72.2% (95% CI, 56.2-82.4) based on parental history or card/record. Vaccination effectiveness in Assam state was higher than in Uttar Pradesh state., Conclusions: We concluded that the single subcutaneous dose of SA 14-14-2 JE vaccine provided moderate effectiveness in Indian children., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The optimal revascularization strategy in patients with multi-vessel disease (MVD) presenting with acute myocardial infarction (AMI) and cardiogenic shock (CS) remains unclear., Objective: To investigate the comparative differences between culprit-only revascularization (COR) versus instant multi-vessel revascularization (IMVR) in AMI and CS., Methods: 13 studies were selected using MEDLINE, EMBASE and the CENTRAL (Inception - 31 November2017). Outcomes were assessed at short-term (in-hospital or ≤30 days duration) and long-term duration (≥6 months). Estimates were reported as random effects relative risk (RR) with 95% confidence interval (CI)., Results: In analysis of 7311 patients, COR significantly reduced the relative risk of short-term all-cause mortality (RR: 0.87; 95% CI, 0.77-0.97; p = 0.01, I 2  = 50%) and renal failure (RR: 0.75; 95% CI, 0.61-0.94; p = 0.01, I 2  = 7%) compared with IMVR. There were no significant differences between both the strategies in terms of reinfarction (RR: 1.25; 95% CI, 0.59-2.63; p = 0.56, I 2  = 0%), major bleeding (RR: 0.88; 95% CI, 0.75-1.04; p = 0.14, I 2  = 0%) and stroke (RR: 0.77; 95% CI, 0.50-1.17; p = 0.22, I 2  = 0%) at short term duration. Similarly, no significant differences were observed between both groups regarding all-cause mortality (RR; 1.01; 95% CI, 0.85-1.20; p = 0.93, I 2  = 61%) and reinfarction (RR: 0.71; 95% CI, 0.34-1.47; p = 0.35, I 2  = 26%) at long term duration., Conclusion: In MVD patients presenting with AMI and CS, IMVR was comparable to COR in terms of all-cause mortality at long term follow up duration. These results are predominantly derived from observational data and more randomized controlled trials are required to validate this impression., (Copyright © 2018 Elsevier Inc. All rights reserved.)