End Of The Study Research Articles

Safety and possible anti-inflammatory effect of paclitaxel associated with LDL-like nanoparticles (LDE) in patients with chronic coronary artery disease: a double-blind, placebo-controlled pilot study.

Studies in cholesterol-fed rabbits showed that anti-proliferative chemotherapeutic agents such as paclitaxel associated with solid lipid nanoparticles (LDE) have marked anti-atherosclerotic effects. In addition, association with LDE nearly abolishes paclitaxel toxicity. We investigated whether treatment with LDE-paclitaxel changes plaque progression by coronary CT angiography and is safe in patients with chronic coronary artery disease. We conducted a prospective, randomized, double-blind, placebo-controlled pilot study in patients with multi-vessel chronic coronary artery disease. Patients were randomized to receive IV infusions of LDE-paclitaxel (paclitaxel dose: 175 mg/m2 body surface) or LDE alone (placebo group), administered every 3 weeks for 18 weeks. All participants received guideline-directed medical therapy. Clinical and laboratory safety evaluations were made at baseline and every 3 weeks until the end of the study. Analysis of inflammatory biomarkers and coronary CTA was also performed at baseline and 4 weeks after treatment. Forty patients aged 65.6 ± 8 years, 20 in LDE-paclitaxel and 20 in placebo group were enrolled. Among those, 58% had diabetes, 50% had myocardial infarction, and 91% were in use of statin and aspirin. Baseline demographics, risk factors, and laboratory results were not different between groups. In all patients, no clinical or laboratory toxicities were observed. From the baseline to the end of follow-up, there was a non-significant trend toward a decrease in IL-6 levels and hsCRP in the LDE-paclitaxel group (-16% and -28%, respectively), not observed in placebo. Regarding plaque progression analysis, variation in plaque parameter values was wide, and no difference between groups was observed. In patients with multivessel chronic coronary artery disease and optimized medical therapy, LDE-paclitaxel was safe and showed clues of potential benefits in reducing inflammatory biomarkers. https://clinicaltrials.gov/study/NCT04148833, identifier (NCT04148833).

Is cryoablation still suitable for advanced non-small cell lung cancer after failure of first-line chemotherapy? A multicenter, prospective, randomized-controlled trial of eighty-seven patients

The aim of this study was to investigate the therapeutic effect of cryoablation treatment in advanced NSCLC patients who had failed first-line chemotherapy. Eighty-seven patients from ten hospitals in China were enrolled into the study, forty-four patients received cryoablation treatment plus basic treatment (experimental group), and forty-three patients had basic treatment alone (control group). Follow-up was performed once every three months until the end of the study or the death of the patient. The primary endpoints were overall and post-intervention survival; secondary endpoints included tumor markers, solid tumor efficacy, and symptom changes before and after treatment. There was no significant difference in median OS between the two groups of patients (9.0 months vs 11.2 months, P = 0.583). The disease control rate (DCR) and living quality of the experimental group was higher than that of the control group. In terms of OS, indiscriminate use of cryoablation for such patients was not beneficial, though it could improve symptoms of patients. Cryoablation had a significant effect on selected advanced NSCLC patients after the failure of first-line chemotherapy.

Effect of Maternal and Newborn Care Service Package on Perinatal and Newborn Mortality

In resource-constrained settings where the neonatal mortality rate (NMR) is high due to preventable causes and health systems are underused, community-based interventions can increase newborn survival by improving health care practices. To develop and evaluate the effectiveness of a community-based maternal and newborn care services package to reduce perinatal and neonatal mortality in rural Pakistan. This cluster randomized clinical trial was conducted between November 1, 2012, and December 31, 2013, in district Rahim Yar Khan in the province of Punjab. A cluster was defined as an administrative union council. Any consenting pregnant resident of the study area, regardless of gestational age, was enrolled. An ongoing pregnancy surveillance system identified 12 529 and 12 333 pregnancies in the intervention and control clusters, respectively; 9410 pregnancies were excluded from analysis due to continuation of pregnancy at the end of the study, loss to follow-up, or miscarriage. Participants were followed up until the 40th postpartum day. Statistical analysis was performed from January to May 2014. A maternal and newborn health pack, training for community- and facility-based health care professionals, and community mobilization through counseling and education sessions. The primary outcome was perinatal mortality, defined as stillbirths per 1000 births and neonatal death within 7 days per 1000 live births. The secondary outcome was neonatal mortality, defined as death within 28 days of life per 1000 live births. Systematic random sampling was used to allocate 10 clusters each to intervention and control groups. Analysis was conducted on a modified intention-to-treat basis. For the control group vs the intervention group, the total number of households was 33 188 vs 34 315, the median number of households per cluster was 3092 (IQR, 3018-3467) vs 3469 (IQR, 3019-4075), the total population was 229 155 vs 234 674, the mean (SD) number of residents per household was 6.9 (9.5) vs 6.8 (9.6), the number of males per 100 females (ie, the sex ratio) was 104.2 vs 103.7, and the mean (SD) number of children younger than 5 years per household was 1.0 (4.2) vs 1.0 (4.3). Altogether, 7598 births from conrol clusters and 8017 births from intervention clusters were analyzed. There was no significant difference in perinatal mortality between the intervention and control clusters (rate ratio, 0.86; 95% CI, 0.69-1.08; P = .19). The NMR was lower among the intervention than the control clusters (39.2/1000 live births vs 52.2/1000 live births; rate ratio, 0.75; 95% CI, 0.58-0.95; P = .02). The frequencies of antenatal visits and facility births were similar between the 2 groups. However, clean delivery practices were higher among intervention clusters than control clusters (63.2% [2284 of 3616] vs 13.2% [455 of 3458]; P < .001). Chlorhexidine use was also more common among intervention clusters than control clusters (55.9% [4271 of 7642] vs 0.3% [19 of 7203]; P < .001). This pragmatic cluster randomized clinical trial demonstrated a reduction in NMR that occurred in the background of improved household intrapartum and newborn care practices. However, the effect of the intervention on antenatal visits, facility births, and perinatal mortality rates was inconclusive, highlighting areas requiring further research. Nevertheless, the improvement in NMR underscores the effectiveness of community-based programs in low-resource settings. ClinicalTrials.gov Identifier: NCT01751945.

Comparative effects of incretin-based therapy on doxorubicin-induced nephrotoxicity in rats: the role of SIRT1/Nrf2/NF-κB/TNF-α signaling pathways.

Introduction: Nephrotoxicity represents a major complication of using doxorubicin (DOX) in the management of several types of cancers. Increased oxidative stress and the activation of inflammatory mediators play outstanding roles in the development of DOX-induced kidney damage. This study aimed to investigate whether the two pathways of incretin-based therapy, glucagon-like peptide-1 receptor agonist (presented as semaglutide, SEM) and dipeptidyl peptidase-4 inhibitor (presented as alogliptin, ALO), differentially protect against DOX-induced nephrotoxicity in rats and to clarify the underlying molecular mechanisms. Methods: Adult male rats were divided into six groups: control (received the vehicle), DOX (20mg/kg, single I.P. on day 8), DOX + ALO (20mg/kg/day, P.O. for 10days), DOX + SEM (12μg/kg/day, S.C. for 10days), ALO-alone, and SEM-alone groups. At the end of the study, the animals were sacrificed and their kidney functions, oxidative stress, and inflammatory markers were assessed. Kidney sections were also subjected to histopathological examinations. Results: The co-treatment with either ALO or SEM manifested an improvement in the kidney functions, as evidenced by lower serum concentrations of creatinine, urea, and cystatin C compared to the DOX group. Lower levels of MDA, higher levels of GSH, and increased SOD activity were observed in either ALO- or SEM-treated groups than those observed in the DOX group. DOX administration resulted in decreased renal expressions of sirtuin 1 (SIRT1) and Nrf2 with increased NF-κB and TNF-α expressions, and these effects were ameliorated by treatment with either ALO or SEM. Discussion: Co-treatment with either ALO or SEM showed a renoprotective effect that was mediated by their antioxidant and anti-inflammatory effects via the SIRT1/Nrf2/NF-κB/TNF-α pathway. The fact that both pathways of the incretin-based therapy demonstrate an equally positive effect in alleviating DOX-induced renal damage is equally noteworthy.

COVID-19 in Patients with Different Hematological Malignancies: Treatment Strategy and Outcome: An Iraqi Experience

Background: Patients with hematological malignancies may have higher rates of morbidity and mortality due to SARS-COVID-19 than those in the general population. Objectives: To evaluate the outcome of SARS-COVID-19 in patients with different hematological malignancies undergoing active or modified therapy. Settings: This was a retrospective cohort, multicenter study conducted on 167 patients diagnosed with SARS-COVID-19. The selected patients had been diagnosed with different hematological malignancies and had received treatment (chemotherapy or immunosuppressive). The study was carried out in different centers across Iraq between 1 December 2020 and 1 December 2021. Patients and Methods: This study was conducted in seven hematology centers across Iraq with 167 patients; of these, this study showed that 88 (52.7%) were males and 79 (47.3%) were females (mean age 51.9 ± 18.3 years). All patients had had a COVID-19 infection confirmed through RNA-specific fragments by real-time reverse transcriptase polymerase chain reaction (RT-PCR) of the nasopharyngeal swab specimens, and by computed tomography (CT) of the chest. Demographic data were obtained from patient files, which included the type of hematological malignancy, treatment (chemotherapy, immunotherapy, supportive), severity of COVID-19, modification of treatment and disease outcome for patients, whether alive or not. Patients identified as having benign or non-hematological malignancies were excluded. Results: The treatment protocol was modified in 124 patients (74.3%), while 43 patients (25.7%) continued on the same protocol. Regarding treatment outcomes, 77.2% of patients were alive at the end of the study and 22.8% had died. The survival of COVID-19 patients did not change significantly when the treatment protocol was modified compared to those who continued on treatment as per protocol. The death rate was significantly higher among patients with severe disease compared to those with mild and moderate disease (61.4% v. 0% and 5.0%, respectively) (p&lt;0.001). Conclusions: The management of patients with hematological malignancies during the COVID-19 pandemic may be challenging, with higher mortality in patients with concurrent hematological malignancies and COVID-19. The survival of COVID-19 patients did not change significantly when treatment was modified. Age groups, sex, type of hematological malignancy, and disease status did not affect the survival of these patients. The death rate was significantly higher among patients with hematological malignancies and severe COVID-19 compared with mild or moderate disease.

Do reflection prompts promote children's conflict monitoring and revision of misconceptions?

We tested whether reflection prompts enhance conflict monitoring and facilitate the revision of misconceptions. German children (N = 97, Mage = 7.20, 56% female) were assigned to a prediction or a prediction with reflection condition that included reflection prompts. Children in the prediction with reflection condition (1) showed greater error-related response times and pupil dilation responses, indicating better conflict monitoring, and(2) performed closer to an optimal Bayesian learner, indicating better monitoring-based control. However, by the end of the study, all children had similar levels of misconception revision. Thus, reflection prompts can enhance learning from anomalous evidence by improving conflict monitoring, but they may need to be repeated often to sustain their beneficial effects.

The relationship between morphological awareness and reading comprehension among early grade Chinese children with reading difficulties: A path analysis

Substantial evidence revealed that morphological awareness could contribute to reading achievement in different alphabetic languages among children with and without reading difficulties. However, as the most spoken non-alphabetic language, there is a paucity of available research on Chinese reading development and impairment. This research focused on evaluating two potential intervening variables through the relationship between morphological awareness and reading comprehension. Compounding awareness, homophone awareness, homograph awareness, in addition to reading ability including character recognition, vocabulary knowledge, and reading comprehension were assessed in this research. Controls of phonological awareness and rapid automatized naming (RAN) were also included in the model. Participants were 200 second-grade students with reading difficulties in Chinese mainland . Path analysis revealed that morphological awareness made a direct contribution to reading comprehension beyond all other variables and this relationship was mediated by character recognition and vocabulary knowledge. Furthermore, two indirect pathways showed a significant difference in this study. The distinctive role of morphological awareness in reading comprehension for Chinese children with reading difficulties and the potential reasons for the significant effect difference between the two indirect pathways were discussed at the end of the study.

Or sexism from Veblen's institutionalist theory

Sexism is a deeply rooted social issue that manifests itself in many forms, including unequal treatment, limited opportunities, and biased expectations placed on individuals based on their gender. Understanding the intricate relationship between sexism and economic development is crucial for designing effective policies and interventions to combat gender inequalities. The main objective is, then, to examine the cultural dimension of sexism, aiming to provide an understanding of the mechanisms through which sexism operates within institutions. A case study was then carried out, with a qualitative approach and observation technique to perceive cultural evidence of sexism in the participants' attitudes. At the end of the study, it was possible to understand that the main objective can only be achieved with systematic, longer-term research that can use different research instruments for in-depth analysis.

Improving Tenebrio molitor Growth and Nutritional Value through Vegetable Waste Supplementation.

Huge amounts of vegetable wastes are generated by the food industry. Their bioconversion into valuable products (e.g., insect flours or biofertilizer) through insect farming is a promising solution to reduce their negative environmental and economic impacts. This study evaluates the growth of Tenebrio molitor larvae and their nutritional profile after supplementing their diets with vegetable wastes. Over a 6-week period, 45-day larvae were fed a diet comprising wheat bran supplemented (1:1) with cucumber or tomato wastes from both conventional and ecological crops. The control diet consisted of wheat bran and an equivalent amount of water to compensate for the waste moisture. Larval weight was measured weekly, and length measures were taken fortnightly. Nutritional composition and fatty acid profile were analyzed at the end of the study in 90-day larvae. Regardless of using vegetable waste from conventional or ecological harvesting, the weight of 6-week supplemented larvae almost doubled that of larvae fed with just wheat bran, and their length was 15% higher. Supplementation also increased larval polyunsaturated fatty acid percentage by 22-37%, with linoleic acid being the most abundant. Likewise, larval protein content reached 50% after supplementation. This study demonstrates that both cucumber and tomato wastes from conventional or ecological crops are excellent supplements for T. molitor's diet, improving their nutritional value and reducing the time necessary for larvae growth.

Prognostic role of mesangial IgM deposition in IgA nephropathy: a long-term cohort study

Background The clinical significance of mesangial immunoglobulin (Ig) M deposition in IgA nephropathy (IgAN) has been less explored and remains a topic of debate. Therefore, our study aimed to investigate the prognostic value of mesangial IgM deposition in a long-term follow-up cohort of IgAN patients. Methods A unicentric retrospective study was conducted on 93 consecutive IgAN patients (median age 41 years, 68% male, eGFR 48.7 mL/min, proteinuria 1.1 g/g) from 2010 to 2015. They were followed until end-stage kidney disease (ESKD), death, or until the end of the study in January 2021, with a median follow-up of 7 years. An independent pathologist evaluated the IgM immunofluorescence pattern, Oxford MEST-C score, and transmission electron microscopy (TEM) lesions following a comprehensive protocol. Results In our cohort, 70% had mesangial IgM-positive deposits, while 30% were IgM-negative. Both groups were similar in age, sex, prevalence of arterial hypertension, Charlson comorbidity scores, kidney function (eGFR and proteinuria), pathology findings (Oxford MEST-C score, IgG and C3 immune deposition), and TEM analysis. Treatment with RASI and immunosuppression, and death rates were also comparable. However, 37% of IgM-positive patients progressed to ESKD, significantly higher than the 11% in the IgM-negative group. Univariate and multivariate Cox proportional hazards regression analyses identified lower eGFR, higher Oxford MEST-C score, and mesangial IgM deposits as independent factors associated with shorter kidney survival. Conclusions Our study highlights mesangial IgM deposition as a potential risk factor for ESKD in patients with advanced IgAN, laying a foundation for further research in this area.

تصنيف الجرائم الإلكترونية وفقاً لطبيعة الحق المعتدى عليه دراسة مقارنة بين التشريع الفلسطيني والإماراتي

This research investigates the issue of the different classifications of electronic crimes, and the importance of classifying them in the criminal law, with a focus on the specificity and the importance of the right assaulted in classifying them, as well as the importance of classifying them according to this criterion at all stages of the legal process to Combatting phenomenon of electronic crime. In this study we also investigates, the approach of Palestinian and Emirati legislators in classifying and regulating the provisions electronic crimes and Communications Crimes &amp; information technology, pursuant to Decree-Law No. 10 of 2018, and Federal Law Decree-Law No. 34 of 2021 on combating phenomenon of electronic crime. At the end of the study, the researcher reached a set of conclusions and recommendations, One of the most important of conclusions is that The classification of electronic crimes based on the criterion of the right assaulted constitutes a vital issue in confronting these crimes, just as the Palestinian legislator did not follow a specific approach in his classification of electronic crimes and their substantive and procedural provisions, as the UAE legislator did in organizing and classifying crimes according to a clear approach. One of the most important recommendations is the necessity of the legislator the need for the Palestinian legislator to make amendments to the electronic crimes Law, classify these crimes, and separate the substantive and procedural provisions within this law, as well as amend the texts of Articles (21, 28, 48) of this law.

A multicentre, randomized, double blind, placebo controlled pilot study to evaluate the efficacy and safety of colloidal Nano silver gel (SilverSol) in the treatment of bacterial vaginosis, vulvovaginal candidiasis and trichomoniasis

The study evaluated the efficacy and safety of colloidal nano silver gel (SilverSol Vagigel) (A patented technology from American Biotech Labs, USA) in combination with 0.2% lactic acid in the female subjects for the treatment of vaginal infections.This study was a multicenter, randomized, double-blind, placebo-controlled pilot study in which post-menarchal female subjects between 18 and 65 years of age clinically diagnosed with bacterial vaginosis and vulvovaginal candidiasis were enrolled. The participants were randomized to receive treatment with SilverSol Vagigel or placebo (vehicle) gel (both treatments as one 4 gm application inserted into the vagina with an applicator device, once daily at bedtime for internal use and 2 gm gel for local application to the vulva and vagina for external use twice daily for a period of 14 days). The primary endpoint evaluated was the proportion of subjects achieving clinical cure. The secondary endpoint was the proportion of subjects achieving microbiological cure at the end of the study visit. A total of 57 subjects were randomized in the study out of which 38 subjects were randomized in SilverSol Vagigel arm and 19 subjects were randomized in placebo arm. SilverSol Vagigel significantly improved cure rates of vaginal infections compared to placebo. The proportion of subjects achieving clinical cure of vaginal infections was higher i.e., 33 (86.84%) subjects in SilverSol Vagigel arm compared to 07 (41.18%) subjects in Placebo gel arm (p-value: 0.0009). The clinical cure rate with SilverSol Vagigel was 81.82% (P=0.1758) for bacterial vaginosis and 92.59% (P=0.0010) for vulvovaginal candidiasis patients at the end of the study. Overall SilverSol Vagigel treatment resulted in a significantly higher microbial cure of vaginal infections (P=0.0028) compared to placebo, with a microbial cure rate of 100% for bacterial vaginosis (P=0.0330) and 85.19% for vulvovaginal candidiasis (P=0.0097). No adverse events were reported in subjects treated with SilverSol Vagigel.Colloidal Nano Silver Gel (SilverSol Vagigel) was effective and safe in treating bacterial vaginosis and vulvovaginal candidiasis.

Dietary contribution of iron from limestone and dicalcium phosphate for broiler chickens

Iron is routinely supplemented in broiler feeds aiming to prevent dietary deficiencies. Limestone and phosphates are very rich in Fe; however, its contribution from these sources have not been thoroughly investigated with chickens. The present research was conducted to evaluate live performance and blood parameters of broilers when using limestone and dicalcium phosphate as sources of Fe. A total of 576 one-day-old male Cobb x Cobb 500 were allocated into a total of 72 battery cages, 6 treatments with 12 replication cages of 8 chicks at placement. Chicks were fed diets formulated with corn, soybean meal (SBM) with laboratory grade calcium carbonate and phosphoric acid (having traces of Fe). All chicks were fed a common prestarter without Fe supplementation (analyzed total 58.2 ± 2.4 mg/kg Fe) from placement to 7 d. Allocation of birds to dietary treatments was completely randomized on day 8. Treatments had increasing Fe derived from commercial limestone and dicalcium phosphate (analyzed Fe 7,218 and 4,783 mg/kg, respectively) progressively replacing calcium carbonate and phosphoric acid to provide graded increases in total Fe (analyzed Fe in the feeds were 57.6 ± 2.1, 92.0 ± 2.3, 124.1 ± 2.7, 159.3 ± 3.1, 187.2 ± 3.2, 223.7 ± 3.6 mg/kg, respectively). There were no effects of dietary Fe on live performance, hematocrit, and hemoglobin the end of the study on day 28 (P > 0.05). Increasing dietary Fe from commercial limestone and dicalcium phosphate led to a linear reduction in the percent ileal digestible Fe. However, linear increments in Fe retention, serum ferritin and liver Fe occurred when compared to feeds without Fe derived from limestone and phosphate dicalcium. It is concluded that Fe from limestone and dicalcium phosphate can be partially utilized by broiler chickens. It was estimated that the Fe retained from limestone and dicalcium phosphate is of 1.9%. Broilers fed corn-soy feeds (58.2 mg/kg Fe) do not require supplemental Fe.

A75 PEDIATRIC ABDOMINAL PAIN PRESENTING TO A HOSPITAL-BASED GI CLINIC: EVOLUTION AND DISPOSITION

Abstract Background Abdominal pain accounts for 50% of pediatric gastroenterology consultations. While data exists on the possible etiologies of abdominal pain, there is a paucity of data on the natural evolution of abdominal pain while under the care of a Pediatric Gastroenterologist. Given limited access to Pediatric Gastroenterologists and long waiting times for initial consultation for abdominal pain, understanding what interventions ameliorate pain may help Gastroenterologists advise referring physicians while the patient awaits a consultation. Aims Primary outcome measure was the percentage of patients who reported at least a 75% subjective improvement of pain over baseline consultation. Methods A retrospective chart review between April 2014 and Dec 31, 2022 was taken in a hospital based GI clinic. Subjects referred for assessment of abdominal pain were identified, along with subjects referred for reflux and dysphagia as a comparator group. Subsequent visits were abstracted to identify diagnosis disposition and assess which interventions were tried and to what extent they succeeded. Patient loss to follow up were also measured. Results were summarized using descriptive statistics, and regression modeling will be attempted to identify predictors of response. Results 393 subjects were referred for abdominal pain and 286 for GERD and dysphagia. 439 (64.7%) reported at least 75% improvement in symptoms. 242 (35.6%) underwent endoscopy, 263 (38.7%) used Proton Pump Inhibitors, and 38 (8.54%) used Polyethylene Glycol-3350. Carbohydrate eliminations of various types were used in 13.5 - 27% of subjects with pain. 193 subjects (28.5%) were ultimately lost to follow up though some did report improvement in symptoms. Only 45 (6.6%) remained in active care by the end of the study while only 13 (1.93%) were transitioned to an Adult Gastroenterologist at 18 years old. Conclusions Pediatric Abdominal Pain is primarily a transitory population in the Pediatric GI clinic, with a large number responding to successive interventions. There is also a sizable minority who are lost to follow up. Future studies should attempt to identify the reasons for loss to follow up and ultimate disposition. Funding Agencies William Osler Health System Summer Student Research Program

Autologous transplantation of P63+ lung progenitor cells for chronic obstructive pulmonary disease therapy.

Adult lung resident stem/progenitor cells, including P63+ progenitor cells, have demonstrated the capacity for regeneration of lung epithelium in preclinical models. Here, we report a clinical trial of intrapulmonary P63+ progenitor cell transplantation in 28 participants with stage II to IV chronic obstructive pulmonary disease (COPD). Autologous P63+ progenitor cells were isolated from the airway basal layer of participants in the intervention group via bronchoscopic brushing, cultured for 3 to 5 weeks, and then transplanted back into the lungs via bronchoscopy at 0.7 × 106 to 5.2 × 106 cells per kilogram of body weight. Twenty patients were evaluable at the end of the study (intervention group, n = 17; control group, n = 3). No grade 3 to 5 adverse events (AEs) or serious AEs occurred. Although bronchoscopy-associated AEs were recorded in participants in the intervention group, other AEs were not substantial different between groups. Twenty-four weeks after transplantation, participants in the intervention group displayed improvement in gas transfer capacity [diffusing capacity of the lung for carbon monoxide (DLCO) change from baseline: +18.2%], whereas the control group experienced a decrease (DLCO change from baseline: -17.4%; P = 0.008). Furthermore, participants in the intervention group showed >30-meter increase in walking distance within 6 minutes. Transcriptomic analysis of progenitor cells isolated from responding and nonresponding individuals in the intervention group showed that higher expression of P63 was associated with treatment efficacy. In conclusion, transplantation of cultured P63+ lung progenitor cells was safe and might represent a potential therapeutic strategy for COPD.

A308 AN UNUSUAL CASE OF MACE DYSFUNCTION: THE BENEFIT OF USING ANTEGRADE CONTRAST FOLLOW THROUGH MIMICKING HOME SETTINGS

Abstract Background Malone Antegrade Continence Enema (MACE) is indicated in cases where medical management for constipation or faecal incontinence with laxatives or enemas has failed. MACE allows the administration of flushes with and without laxatives in an antegrade manner to mechanically empty the colon. Aims The aim of this case report is to illustrate an unusual case of MACE dysfunction and how it was troubleshooted. Methods Case report and review of the literature Results 11-year-old female with neurogenic constipation and faecal incontinence for which MACE was being used. She was referred to clinic for evaluation of new-onset vomiting, abdominal distention, and abdominal pain with MACE flushes. Her flushes consisted of crushed Bisacodyl, glycerin, PEG 3350 and 300 ml of saline solution. Cone enemas were also being used to completely empty her rectum, otherwise evacuation with regular flushes was not occurring, but was causing significant abdominal pain, distention and vomiting. A contrast study was done by flushing water-soluble contrast through the MACE in an antegrade manner, while simultaneously performing a contrast enema, demonstrating good passage of contrast with no findings suggestive of obstruction. She was admitted to hospital to complete imaging studies, bowel clean out and to better understand her MACE dysfunction. Following bowel clean out in hospital, MACE flushes were resumed, causing the same symptoms. Flushes without Bisacodyl were tried in the attempt to avoid possible colonic spasms; however symptoms re-occurred. A second contrast study was performed (figure 1), mimicking home flushes in volume and time of administration, as well as patient’s position (sitting), completed in an antegrade fashion only. The patient developed symptoms 20 minutes after administering the contrast requiring cone enema. By the end of the study, there was poor passage of contrast through the proximal descending colon, suggesting a kink at the juncture between the sigmoid and descending colon. There was no reflux on contrast into the terminal ileum. An x-ray was done around 5 hours after, and contrast was still not seen in the rectum. The patient underwent diagnostic laparoscopy, finding adhesions in the left upper quadrant of the descending and sigmoid colon, causing a Z-configuration hairpin obstruction, and colostomy creation. The patient has been doing well since colostomy creation with no pain. Conclusions MACE dysfunction can be caused by colonic adhesions distal to the MACE site Simultaneous antegrade contrast through MACE and contrast enema may miss bowel obstruction Antegrade contrast study mimicking home settings may be more helpful in situations where bowel obstruction is suspected Funding Agencies None

Effectiveness of pharmaceutical care for improving medication‐related quality of life and adherence to treatment among people living with schizophrenia: a randomised controlled trial

AbstractBackgroundPeople living with schizophrenia frequently exhibit poor medication adherence because of adverse drug reactions (ADRs) or lack of disease awareness. This prospective randomised controlled trial investigated the benefits of pharmaceutical care delivered by hospital pharmacists for improving pharmacotherapy‐related quality of life and medication adherence among this patient group.AimThe purpose of this study was to evaluate the effectiveness of pharmaceutical care interventions in enhancing medication adherence and improving the quality of life of people living with schizophrenia.MethodData were collected during inpatient and subsequent outpatient treatment from 6 January–8 June 2021. Participants were divided into two groups via block randomisation: a control group receiving standard treatment; and an intervention group receiving pharmaceutical care combined with standard treatment. The pharmaceutical care comprised medication review, monitoring of drug‐related problems (including ADRs), adjustment of the dose of antipsychotic medicines in collaboration with psychiatrists, and counselling of participants and caregivers about disease management before discharge. Pharmacotherapy‐related quality of life was assessed using the short version of the Patient‐Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT‐QoL), whereas medication adherence was evaluated using the Medication Taking Behaviour in Thai Patients (MTB‐Thai). The primary outcomes were the average change in the PROMPT‐QoL score from inpatient to outpatient care and the average outpatient MTB‐Thai score. Ethical approval was granted by the Srithanya Hospital Office of the Ethics Commission for Human Research (Reference no: STY.COA008/2564) and the study conforms to the Declaration of Helsinki. Informed consent was obtained from all patient and caregiver participants via a project information sheet and the completion of a written consent form.ResultsAt the end of the study, compared with the control group, the intervention group exhibited a significantly lower ADR prevalence (57.90% vs 79.70%, p &lt; 0.05) and a greater change in the mean PROMPT‐QoL scores pertaining to ‘obtaining information of medicines and diseases’, ‘impact of medicine side effects’, ‘ease of use of medicines’, and ‘therapeutic relationship’. In addition, the intervention group achieved a significantly higher mean of medicine adherence score than the control group (22.81 ± 1.61 vs 16.85 ± 3.00, p &lt; 0.001).ConclusionPharmaceutical care may improve the outcomes of people living with schizophrenia by improving their quality of life, decreasing ADRs, and enhancing medication adherence.

Anatomical knowledge enhancement through echocardiography and videos, with a spotlight on cognitive load, self-efficacy, and motivation.

In recent years, there has been a growing recognition of the importance of integrating ultrasound into undergraduate medical curricula. However, empirical evidence is lacking as to its effect on anatomy learning and related student cognition. Therefore, the present study compared the impact of echocardiography-based instruction with narrated videos on students' understanding of anatomical relationships, as well as the interaction with students' autonomous motivation, self-efficacy beliefs, mental load, and attitudes. Second-year medical students were given the opportunity to enroll in a supplementary booster course about cardiac anatomy. On the base of a randomized controlled trial with a cross-over design, we studied the effect of taking this course on spatial anatomical knowledge. After completing a pre-test (T0), students were allocated randomly to either the echocardiography-based teaching condition (cohort A) or the narrated anatomy video condition (cohort B). Next, participants were crossed over to the alternative intervention. Immediately after each phase in the intervention, students were asked to rate their mental load. Additionally, a spatial anatomical knowledge test, an autonomous motivation scale, and a self-efficacy scale were administered before (T0) and after the first intervention (T1) and at the end of the study (T2). Finally, each student completed a perception-based survey. The study design allowed a comparative evaluation of both interventions at T1, while the cross-over design facilitated the assessment of the most optimal sequencing in the interventions at T2. A total of 206 students participated (cohort A: n = 99, cohort B: n = 107). At T1, no significant differences in the knowledge test and the autonomous motivation scale were observed between cohorts A and B. However, cohort A showed higher self-efficacy beliefs compared to cohort B (p = 0.043). Moreover, cohort A reported higher levels of perceived mental load (p < 0.001). At T2, the results showed that neither sequence of interventions resulted in significant differences in anatomy scores, autonomous motivation, or self-efficacy. However, a significant difference in mental load was found again, with students in cohort B reporting a higher level of mental load (p < 0.001). Finally, based on the perception-based survey, students reported favorably on the echocardiography experience. In conclusion, the hands-on echocardiography sessions were highly appreciated by the medical students. After participating in the ultrasound sessions, they reported higher levels of self-efficacy beliefs compared to the video-based condition. However, despite embodied cognition principles, students in the echocardiography condition did not outperform students in the narrated anatomy video condition. The reported levels of mental load in the ultrasound condition could explain these findings.

Seasonal bleaching and partial mortality of Pocillopora verrucosa corals of the coast of central Vietnam

IntroductionCoral reefs are one of the most productive yet vulnerable ecosystems on Earth. An important step in understanding the functioning of coral communities is studying the environmental impact on the state of reefs. The present study aimed to assess the impacts of the water temperature, precipitation, wave action, and population density on the seasonal bleaching, partial and complete mortality of shallow-water branching corals of Pocillopora verrucosa species complex. Materials and methodsThe present study was conducted at the Dam Bay research station (Nha Trang Bay) from 26 April 2020 to 2 April 2021. The environmental data was collected from the Dam Bay weather station and using a temperature logger planted on the nursery, coral bleaching and mortality were assessed visually using photos taken underwater. ResultsThroughout the study, the percentage of bleached coral colonies varied from 1 to 41.5% with two peaks, in autumn (October) and spring (April). Rates of the development of partial mortality varied from 0 to 10%, with a pronounced peak in December. At the end of the experiment, the percentage of coral colonies suffering from partial mortality reached 47%. Only 4,5% of experimental colonies died to the end of the study. Analysis revealed that water temperature and partial mortality are the drivers of bleaching, while wave action, temperature and bleaching are the factors with a significant impact on partial mortality.DiscussionThus, both bleaching and patrial mortality are interlinked and the effect of partial mortality on bleaching is stronger than the opposite. Both phenomena have pronounced seasonal variation, but their maximum manifestation does not coincide in time allowing corals to avoid their synergetic effect. Moreover, it was found that the impact of individual stress on mortality prevailed over the impact of seasonal bleaching and partial mortality events. The main cause of coral death was the development of algal fouling at the sites of colony lesions, which gradually spread over the entire surface of the colony.

Just-in-Time: A Caregiver-Mediated Intervention for Toddlers With Autism.

We investigated effects of an adaptive telehealth coaching model on caregiver implementation of enhanced milieu teaching (EMT) with newly diagnosed toddlers with autism. Three caregiver-child dyads participated in a multiple-baseline-across-behaviors, single-case design. Caregivers were taught EMT via telehealth using the teach-model-coach-review approach. EMT strategies were taught sequentially in four components corresponding to design tiers. Caregivers reported their needs for support and adaptation via weekly surveys. Primary outcomes were measures of caregiver's implementation, including (a) a fidelity checklist for wholistic use of EMT and (b) a percentage of correct use of a subset of key EMT strategies (e.g., matched turns, target talk, expansions, play actions, milieu episodes). Generalization and maintenance of caregiver strategy use in uncoached home activities were measured. The number of different words used by children was measured as a secondary, descriptive outcome. Social validity data were collected through ratings and interviews at the end of the study. There was a functional relation between the intervention and caregiver's implementation of EMT for all dyads. Caregiver's use of EMT strategies often generalized and maintained post-intervention. Child response to intervention was variable. Social validity data indicated that the model was beneficial to caregivers and children. An adaptive telehealth coaching model is effective for teaching caregivers of toddlers with autism to implement EMT and potentially helps to bridge the gap between diagnosis and comprehensive intervention. Further exploration of the relation between caregiver fidelity and dosage of active ingredients and child spoken language outcomes is needed. https://doi.org/10.23641/asha.25156223.