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Abstract Background Ultrasonography is an emerging non-invasive bedside tool for muscle quantity/quality assessment; Bioelectrical Impedance Analysis (BIA) is an alternative non-invasive bedside measure of body composition, recommended for evaluation of sarcopenia in clinical practice. We set out to assess impact of position and exercise upon measures towards protocol standardisation. Methods Healthy volunteers aged 18–35 were recruited. Bilateral Anterior Thigh Thickness (BATT; rectus femoris and vastus intermedius), BATT: Subcutaneous Ratio (BATT:SCR), and rectus femoris echogenicity were measured using ultrasound and BIA was performed; 1) lying with upper body at 45° (Reclined), 2) lying fully supine at 180o (Supine), 3) sat in a chair with upper body at 90o (Sitting), and 4) after exercise Reclined. Variability of Skeletal Muscle Mass (SMM) by two different equations from BIA (SMM-Janssen, SMM-Sergi), phase angle, fat percentage, and total body (TBW), extracellular (ECW), and intracellular water (ICW) were assessed. Results Forty-four participants (52% female; mean 25.7 years-old (SD 5.0)) were recruited. BATT increased from Reclined to Sitting (+ 1.45 cm, 1.27–1.63), and after exercise (+ 0.51, 0.29–0.73). Echogenicity reduced from Reclined to Sitting (− 2.1, − 3.9 – -0.26). SMM-Sergi declined from Reclined to Supine (− 0.65 kg, − 1.08 – − 0.23) and after exercise (− 0.70 kg, − 1.27 – -0.14). ECW increased from Reclined to Sitting (+ 1.19 L, 0.04–2.35). There were no other statistically significant changes. Conclusion Standardisation of protocols is especially important for assessment of muscle quantity by ultrasonography; BIA measurements may also vary dependent on the equations used. Where possible, participants should be rested prior to muscle ultrasonography and BIA, and flexion of the knees should be avoided.

En el campo de los derechos humanos, es cada vez más común utilizar el enfoque transdisciplinario en contraste con un análisis puramente legal. Por tanto, es necesario realizar investigaciones sobre la descolonización de derechos humanos. El propósito de este artículo es discutir los retos políticos, económicos y filosóficos en la manera en que los derechos humanos y el feminismo son teorizados, todo desde la perspectiva del Sur Global. La primera parte de este artículo es un diálogo entre la teoría crítica de derechos humanos y el pensamiento decolonial, enlazándolo con los debates contemporáneos que se llevan a cabo en el ámbito legal de los derechos humanos. Posteriormente, una sección sobre el feminismo decolonial entre América Latina y Oriente Medio propone una manera en la que los hombres pueden participar en las luchas de género.

Background: Mitral valve repair is preferred in patients undergoing surgical treatment for infective endocarditis (IE) of the native mitral valve, however, radical resection of infected tissue and patch-plasty might potentially lead to low or non-durable repair. We aimed to compare a limited-resection and non-patch technique with the classic radical-resection technique. Methods: Eligible candidates were patients with definitive IE of the native mitral valve undergoing surgery between January 2013 and December 2018. Patients were classified according to the surgical strategy into two groups: limited- versus radical-resection strategy. Propensity score matching was used. Endpoints were repair rate, all-cause mortality (30-day and 2-year), re-endocarditis and reoperation at q-year follow-up. Results: After propensity score matching, 90 patients were included. Follow-up was 100% complete. Mitral valve repair rate was 84% in the limited-resection versus 18% in the radical-resection strategy, p < 0.001. The 30-day and 2-year mortality were 20% versus 13% (p = 0.396) and 33% versus 27% (p = 0.490) in the limited-resection versus radical-resection strategy, respectively. The incidence of re-endocarditis during the 2-year follow-up was 4% in the limited-resection strategy versus 9% in the radical-resection strategy, p = 0.677. Three patients in the limited-resection strategy underwent reoperation of the mitral valve, while there were none in the radical-resection strategy (p = 0.242). Conclusions: Although mortality in patients with IE of the native mitral valve remains high, the limited-resection and non-patch surgical strategy is associated with a significantly higher repair rates with comparable 30-day and mid-term mortality, risk of re-endocarditis and re-operation compared to the radical-resection strategy.

BackgroundPostoperative sepsis is an important cause of morbidity and mortality in patients with infective endocarditis undergoing surgical therapy. Blood purification using hemoadsorption therapy shows promising results in the treatment of sepsis. In this study, the clinical effects of intraoperative hemoadsorption in high-risk patients with infective endocarditis were evaluated.MethodsEligible candidates were high-risk patients with infective endocarditis undergoing cardiac surgery between January 2014 and December 2019. Patients with intraoperative hemoadsorption (hemoadsorption) were compared to patients without hemoadsorption (control). The endpoints were the incidence of postoperative sepsis, sepsis-associated death and in-hospital mortality. Additionally, postoperative vasopressor need, systemic vascular resistance indices and Sequential Organ Failure Assessment (SOFA) scores were compared.ResultsAfter propensity score matching, 70 high-risk patients were included. Postoperative sepsis occurred in 14 patients in the hemoadsorption group and in 16 patients in the control group, p = 0.629. Four patients died due to postoperative sepsis in the hemoadsorption group, while 11 postoperative septic patients died in the control group, p = 0.041. In-hospital mortality was 34% in the hemoadsorption group versus 43% in the control group, p = 0.461. On ICU-admission and the first postoperative day, the cumulative vasopressor need was 0.17 versus 0.25 μg/kgBW/min, p = 0.123 and 0.06 versus 0.11 μg/kgBW/min, p = 0.037, and the systemic vascular resistance index was 1448 versus 941 dyn·s·cm-5, p = 0.013 and 1156 versus 858 dyn·s·cm-5, p = 0.110 in the hemoadsorption versus control group, respectively. Postoperative course of SOFA score normalized significantly (p = 0.01) faster in the hemoadsorption group.ConclusionsIn high-risk cardiac surgical patients with infective endocarditis, intraoperative hemoadsorption significantly reduced sepsis-associated mortality. Furthermore, intraoperative hemoadsorption resulted in significant faster recovery of hemodynamics and organ function. Intraoperative hemoadsorption seems to attenuate the severity of postoperative sepsis.

Abstract Introduction To assess if in adults with COVID‐19, whether those with diabetes and complications (DM+C) present with a more severe clinical profile and if that relates to increased mortality, compared to those with diabetes with no complications (DM‐NC) and those without diabetes. Methods Service‐level data was used from 996 adults with laboratory confirmed COVID‐19 who presented to the Queen Elizabeth Hospital Birmingham, UK, from March to June 2020. All individuals were categorized into DM+C, DM‐NC, and non‐diabetes groups. Physiological and laboratory measurements in the first 5 days after admission were collated and compared among groups. Cox proportional hazards regression models were used to evaluate associations between diabetes status and the risk of mortality. Results Among the 996 individuals, 104 (10.4%) were DM+C, 295 (29.6%) DM‐NC and 597 (59.9%) non‐diabetes. There were 309 (31.0%) in‐hospital deaths documented, 40 (4.0% of total cohort) were DM+C, 99 (9.9%) DM‐NC and 170 (17.0%) non‐diabetes. Individuals with DM+C were more likely to present with high anion gap/metabolic acidosis, features of renal impairment, and low albumin/lymphocyte count than those with DM‐NC or those without diabetes. There was no significant difference in mortality rates among the groups: compared to individuals without diabetes, the adjusted HRs were 1.39 (95% CI 0.95–2.03, p = 0.093) and 1.18 (95% CI 0.90–1.54, p = 0.226) in DM+C and DM‐C, respectively. Conclusions Those with COVID‐19 and DM+C presented with a more severe clinical and biochemical profile, but this did not associate with increased mortality in this study.

Calcium-silicate cement mainly based on dicalcium-silicate (C2S) was synthesized by the mean of solid state reaction. Beta-C3P was added to C2S to obtain C2S-C3P. Zinc oxide and bismuth oxide was incorporated to prepare radioc cement. In this work, the bioactivity and the mechanical strength of the synthesized cement were investigated. The in vitro test was carried out by immersion of cement pastilles in the artificial saliva in different periods from 4 hours to 30 days. Whereas the mechanical strength of some samples was operated at 28 and 72 days. The specimens are characterized by X-ray diffraction , Infrared spectroscopy and scanning electron microscopy. The results indicated that hydroxyapatite may appear after 24 hours of soaking; it was also shown that the presence of C3P with a small amount of the cement can enhance the bioactivity and develop more resistance strength of cement. Moreover, the addition of zinc oxide and bismuth oxide increase the radiopacity of the cement. However, the mechanical strength enhances with the incorporation of the zinc oxide while decrease with bismuth oxide. It was concluded then that there is possibility of combining addition of C3P (10%) and an agent radiopacifiers ZnO/Bi2O3 (15%) with small amounts on C2S to obtain a cement with excellent bioactivity, good mechanical strength and significante radiopacity that makes this material a great candidate as a biomaterial for biomedical use. [ABSTRACT FROM AUTHOR]

Abstract Background Orthodontic braces have become symbols of wealth and fashion accessories in some parts of the world. However, there is a scarcity of information about the effects of fashion braces on various aspects of quality of life. Therefore, our aim was to investigate the effects of fashion braces on oral health related quality of life (OHRQoL). Methods A cross-sectional study was carried out with data collection from a Google form questionnaire distributed in Saudi Arabia via various forms of social media over a period of 4 months. OHRQoL was assessed using the validated Arabic version of the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The fashion braces group included respondents who had braces installed for fashion purposes only. Therapeutic braces group included subjects who were wearing braces to treat any malocclusion problems. Control group included subjects who did not have any kind of braces. People who had previously completed orthodontic treatments were excluded from the study. The negative impacts were divided into seven domains and a total OHIP score was calculated. Statistical analyses and data illustration were performed with SPSS v25 (IBM, NY). Results A total of 1141 people voluntarily participated in the study. More than 60% of the participants were in the control group while 33.7% had conventional braces for therapeutic reasons and 3.4% had fashion braces. Sociodemographic distributions varied among the groups, with the majority of the fashion braces group having education below the university level and family incomes less than average. There were significant group differences in OHIP domains. Physical pain was the most frequently reported complaint by all subjects and was the highest in the therapeutic braces group. People with therapeutic braces reported significantly higher functional limitation and physical disability than the controls. Fashion braces group reported significantly lower psychological discomfort and disability, social disability and handicap compared to control groups. Conclusions The illustrated effects of fashion braces on OHRQoL suggest the need to study the role of social media and educate the public on the use of braces to minimize the negative effects experienced by individuals.

Abstract Background Pharmacy service is an essential part of a healthcare system. The profession of pharmacy is well recognized and is practiced to its full potential in developed countries however, it is underutilized in developing countries such as Pakistan. The recognition of pharmacist’s role as healthcare professional is limited. This study aimed to document pharmacists’ attitude towards their role in Pakistan’s healthcare system, their experience with doctors and their perceptions towards involvement in medicines management. Methods A 4-month cross-sectional survey (Jan – Apr 18) was conducted targeting pharmacists practising in 26 tertiary care hospitals across Pakistan using a developed and validated questionnaire in both Urdu/English languages. Chi square (χ2) test was used to report any associations between independent variables, i.e., education, type of hospital and work experience and, dependent variables, i.e., pharmacists’ attitudes, experience, and perception. A p-value of ≤0.01 with value of Cramer’s V ≥ 0.3 was considered cut-off for establishing statistical significance. The study was approved by ethical committee and local hospital committees. Results Three hundred ninety-six questionnaires were returned out of 500, i.e., response rate = 87.9%. Most participants (92.2%) interacted with doctors at least once daily. Most interactions were related to drug availability inquiry (72.5%). Most pharmacists (91.4%) mentioned that pharmacy duties are mostly clinical in nature. 93.4% of the respondents indicated that pharmacists are reliable source of information regarding general medicines. Furthermore, 87.4% reasoned inadequate training for not being able to discuss issues of clinical nature with doctors. Conclusion Pharmacists were willing to perform their duties and provide healthcare benefits to patients however, they seemed sceptical of advanced clinical pharmacy roles such as intervening in prescriptions and medication therapy, consultations and prescribing. There is a need to increase awareness regarding pharmacist’s role. Therefore, it would be helpful if trainings and seminars are conducted on the importance of clinical pharmacy to improve the pharmacy services in Pakistan’s healthcare system.

Generating intuitions from data using data mining and machine learning algorithms to predict outcomes is useful area of computing. The application area of data mining techniques and machine learning is wide ranging including industries, healthcare, organizations, academics etc. A continuous improvement is witnessed due to an ongoing research, as seen particularly in healthcare. Several researchers have applied machine learning to develop decision support systems, perform analysis of dominant clinical factors, extraction of useful information from hideous patterns in historical data, making predictions and disease classification. Successful researches created opportunities for physicians to take appropriate decision at right time. In current study, we intend to utilize the learning capability of machine learning methods towards the classification of birth data using bagging and boosting classification algorithms. It is obvious that differences in living styles, medical assistances, religious implications and the region you live in collectively affect the residents of that society. This motive has encouraged the researchers to conduct studies at regional levels to comprehensively explore the associated medical factors that contribute towards complications among women during pregnancy. The current study is a comprehensive comparison of bagging and boosting classification algorithms performed on birth data collected from the government hospitals of city Muzaffarabad, Kashmir. The experimental tasks are carried out using caret package in R which is considered an inclusive framework for building machine learning models. Accuracy based results with different evaluation measures are presented. Bagging functions including Adabag and BagFda performed marginally better in terms of accuracy, precision and recall. Improvements are observed in comparison to previous study performed on same dataset.

The COVID-19 pandemic caused by SARS-CoV-2 has started in December 2019 in Wuhan, China, and become a global health problem. The SARS-COV-2 main protease (Mpro) play a crucial role in the multiplication and control of virus activity. Therefore, we assume that the inhibition of these enzymes inhibits viral replication. To determine potential inhibitors of this protease among existing chemical libraries, we have carried out a virtual screening of 300 antiviral molecules obtained by the ASINEX database. Nine molecules were chosen based on their stability with the target (Mpro), and the molecular docking study was carried out against the same target. These molecules showed higher binding affinities than the positive control to the active site of the same target (Mpro) and exhibit interactions with the amino acids responsible for the inhibitory activity of this enzyme (Cys145 and His 41). Then, these molecules were selected and chosen as potential inhibitors of SARS-Cov-2. Highlights Three hundred antiviral compounds obtained from the ASINEX database were subjected to a virtual screening against SARS-COV-2 main protease Mpro. Nine molecules were selected and were subjected to molecular docking against the same target to evaluate their stability and the mode of binding inside the active site. The nine molecules show favourable interactions with the two amino acids Cys145 and His41, which suggests that these molecules could have competitive inhibitory activity. against the Mpro target main protease The graphical abstract was created using BioRender.com

Amel B Ibrahim,1 Hala F Zaki,2 Walaa Wadie,2 Mervat M Omran,3 Samia A Shouman3 1Department of Pharmacology, Faculty of Medicine, Zawia University, Zawiya, Libya; 2Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt; 3Department of Cancer Biology, Pharmacology Unit, National Cancer Institute, Cairo University, Cairo 11796, EgyptCorrespondence: Samia A ShoumanDepartment of Cancer Biology, National Cancer Institute, Cairo University, Kasr Al Eini Street, Fom El Khalig, Cairo 11796, EgyptFax +202-23644720Email samia.shouman@nci.cu.edu.egPurpose: Tamoxifen (TAM) is a non-steroidal antiestrogen drug, used in the prevention and treatment of all stages of hormone-responsive breast cancer. Simvastatin (SIM) is a lipid-lowering agent and has been shown to inhibit cancer cell growth. The study aimed to investigate the effect of the combination of TAM and SIM in the treatment of estrogen receptor positive (ER+) breast cancer cell line, MCF-7, and in mice-bearing Ehrlich solid tumors.Methods: MCF-7 cells were treated with different concentrations of TAM or/and SIM for 72 hours and the effects of the combination treatment on cytotoxicity, oxidative stress markers, apoptosis, angiogenesis, and metastasis were investigated using different techniques. In addition, tumor volume, oxidative markers, and inflammatory markers of the combined therapy were explored in mice bearing solid EAC tumors.Results: The results showed that treatment of MCF-7 cells with the combination of 10 μM TAM, and 2 μM SIM significantly inhibited the increase in oxidative stress markers, LDH, and NF-kB induced by TAM. In addition, there was a significant decrease in the total apoptotic ratio, caspase-3 activity, and glucose uptake, while there was a non-significant change in Bax/bcl-2 ratio compared to the TAM-treated group. Using the isobologram equation, the drug interaction was antagonistic with combination index, CI=1.18. On the other hand, the combination regimen decreased VEGF, and matrix metalloproteinases, MMP 2&9 compared to TAM-treated cells. Additionally, in vivo, the combination regimen resulted in a non-significant decrease in the tumor volume, decreased oxidative markers, and the protein expression of TNF-α, and NF-κB compared to the TAM treated group.Conclusion: Although the combination regimen of TAM and SIM showed an antagonistic drug interaction in MCF-7 breast cancer, it displayed favorable antiangiogenic, anti-metastatic, and anti-inflammatory effects.Keywords: combined therapy, antitumor effect, apoptosis, oxidative markers, VEGF

Gliomas are tumors of the central nervous system, which usually start within the glial cells of the brain or the spinal cord. These are extremely migratory and diffusive tumors, which quickly expand to the surrounding regions in the brain. There are different grades of gliomas, hinting about their growth patterns and aggressiveness and potential response to the treatment. As part of routine clinical procedure for gliomas, both radiology images (rad), such as multiparametric MR images, and digital pathology images (path) from tissue samples are acquired. Each of these data streams are used separately for prediction of the survival outcome of gliomas, however, these images provide complimentary information, which can be used in an integrated way for better prediction. There is a need to develop an image-based method that can utilise the information extracted from these imaging sequences in a synergistic way to predict patients’ outcome and to potentially assist in building comprehensive and patient-centric treatment plans. The objective of this study is to improve survival prediction outcomes of gliomas by integrating radiology and pathology imaging. Multiparametric magnetic resonance imaging (MRI), rad images, and path images of glioma patients were acquired from The Cancer Imaging Archive. Quantitative imaging features were extracted from tumor regions in rad and path images. The features were given as input to an ensemble regression machine learning pipeline, including support vector regression, AdaBoost, gradient boost, and random forest. The performance of the model was evaluated in several configurations, including leave-one-out, five-fold cross-validation, and split-train-test. Moreover, the quantitative performance evaluations were conducted separately in the complete cohort (n = 171), high-grade gliomas (HGGs), n = 75, and low-grade gliomas (LGGs), n = 96. The combined rad and path features outperformed individual feature types in all the configurations and datasets. In leave-one-out configuration, the model comprising both rad and path features was successfully validated on the complete dataset comprising HGFs and LGGs (R=0.84 p=2.2×10−16). The Kaplan–Meier curves generated on the predictions of the proposed model yielded a hazard ratio of 3.314 [95%CI:1.718−6.394], log−rank(P)=2×10−4 on combined rad and path features. Conclusion: The proposed approach emphasizes radiology experts and pathology experts’ clinical workflows by creating prognosticators upon ‘rad’ radiology images and digital pathology ‘path’ images independently, as well as combining the power of both, also through delivering integrated analysis, that can contribute to a collaborative attempt between different departments for administration of patients with gliomas.

Background: Patients on direct oral anticoagulants are at high risk of perioperative bleeding complications. We analyzed the results of intraoperative hemoadsorption (HA) in patients undergoing cardiac surgery who were also on concurrent therapy with apixaban. Methods: we included 25 consecutive patients on apixaban who underwent cardiac surgery with the use of cardio-pulmonary bypass (CPB) at three sites. The first 12 patients underwent surgery without hemoadsorption (controls), while the next 13 consecutive patients were operated with the Cytosorb® (Princeton, NJ, USA) device integrated into the CPB circuit (HA group). The primary outcome was perioperative bleeding assessed by the Bleeding Academic Research Consortium (BARC) definition and secondary outcomes included 24 h chest-tube-drainage (CTD) and need for 1-deamino-8-d-arginine-vasopressin (desmopressin (DDAVP)) administration to achieve hemostasis. Results: Preoperative mean daily dose of apixaban was higher in the HA group (8.5 ± 2.4 vs. 5.6 ± 2.2 mg, p = 0.005), while time since last apixaban dose was longer in the controls (1.3 ± 0.9 vs. 0.6 ± 1.2 days, p < 0.001). No BARC-4 bleeding events and no repeat-thoracotomies occurred in the HA group compared with 3 and 1, respectively, in the controls. Postoperative 24 h CTD volume was significantly lower in the HA group (510 ± 152 vs. 893 ± 579 mL, p = 0.03) and there was no need for DDAVP compared to controls, who received an average of 10 ± 13.6 mg (p = 0.01). Conclusions: In patients on apixaban undergoing emergent cardiac surgery, the intraoperative use of hemoadsorption was feasible and safe. Compared to patients operated on without hemoadsorption, BARC-4 bleeding complications did not occur and the need for 24 h CTD and DDAVP was significantly lower.