Ethical Consent Research Articles

Effectiveness of an Eight-Week Fundamental Skills Intervention Programme on the Motor Skills of Children with Visual Impairment, Nairobi City County, Kenya

Physical activity has been included in early intervention programmes involving fundamental motor skills among children with differing disabilities. Though research has documented improved motor skills performance generally, few have focused on intervention programmes as a means towards improving motor skill performance in children with visual impairment (VI). This study aimed to determine the effectiveness of an eight-week fundamental motor skills intervention programme on motor skills of children with visual impairment in Nairobi City County, Kenya. The study targeted children with VI aged between six to eleven years. Out of the two public integrated primary school with special unit for VI, the school with the highest number of children with VI was purposively selected. Twelve out of the 20 targeted children with VI in grade one and two met the inclusion criteria. Ethical clearance and consent were acquired before the study. One group pre and post-test quasi experimental design was used. The study utilised Test of Gross Motor development which include two subsets: locomotor and object manipulation skills. The motor skills were assessed before and after the intervention programme. The results showed significant improvement of both the locomotor and object control skills. The study therefore recommends implementation of motor skill intervention programmes for children with VI at an early age

Short time (10 min) Catheter Traction Following TURP: IS it helpful with less morbidity?

Transurethral Resection of Prostate (TURP) is the most common treatment for Benign Prostatic Hyperplasia (BPH). Blood loss during and after transurethral resection of the prostate (TURP) is a potential cause of morbidity and clot retention. Usual practise is to apply traction in every case of TURP to reduce early postoperative hematuria and clot retention. There are very few studies in the literature and they have mainly concentrated on the effect of traction on reducing blood loss but there is scanty data regarding the morbidity associated with the use of traction. Various authors have described their method of traction application. So, in this study, we will compare the result of short term (10 min) traction with standard (4-6 h) traction. It is a prospective comparative study with 50 participants, conducted at the department of Urology of a tertiary care hospital in eastern India after taking ethical clearance and consent from the patient. The patients attending urology O.P.D. with LUTS and diagnosed as BPH and planned for elective TURP and who had prolonged traction after TURP were excluded. Study period was one and the half year. Post operatively 25 patients were managed with catheter traction while 25 patients were managed with short term traction of 10 min. Pain which is assessed by visual analog scale (VAS) at 2 and 4 h post operatively is statistically significant with p value of <0.05 and cut off of 65 g prostate volume is drawn below which the successful outcome of short term traction is feasible without any complications. If hemostatsis is done properly then short term traction is preferable, safe and had fewer complications for prostate volume <65 g in comparison to standard traction TURP comparing the overall factors. Although, VAS score at 2 and 4 h post operatively shows patient experienced less pain even in prostate volume >65 g.

Clinical evaluation of post-surgical scar hyperaesthesia: a longitudinal observational pilot study.

The mechanisms underlying persistent scar pain are not fully elucidated and evidence for the clinical evaluation of scar pain is limited. This pilot observational study investigated participation data and sought to identify objective clinical scar evaluation measures for future trials. With ethical approval and consent, adults undergoing planned hand surgery were enrolled from one NHS hospital. At 1- and 4-months post-surgery scar thermal and mechanical pain thresholds were evaluated with quantitative sensory testing; peri-scar inflammation with infrared thermometry and pliability with durometry. Participation data were analysed with descriptive statistics; the association of clinical measures with patient reported scar pain was analysed. Twenty-one participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No adverse events or dropouts resulted from clinical scar evaluation. Seventy percent of participants reported undertaking topical, nonprescription scar treatment independently. Neuropathic Pain Symptom Inventory (NPSI) scores were dispersed across the score range, capturing variability in participant-reported scar symptoms. Scar morphology, pliability and inflammation were not associated with scar pain. Differences between scar and contralateral skin in thermal and mechanical pain sensitivity were identified. People with acute hand scars participate in clinical research and independently initiate scar treatment. Clinical testing of acute post-surgical hand scars is well tolerated. The NPSI demonstrates utility for exploring scar pain symptoms and may support the elucidation of mechanisms of persistent scar pain. Clinical tests of thermal and mechanical and sensitivity are promising candidate clinical measures of scar pain for future trials. Background: it is unknown why some scars remain painful long-term. We do not know if scar flexibility, inflammation or sensitivity to temperature or pressure relate to scar pain. We investigated if patients would enrol in scar research, if scar testing was tolerated and if clinical tests are useful for future scar studies. Study conduct: with ethical approval and consent, adult hand surgery patients were enrolled from one NHS hospital. Scar pain, inflammation and response to thermal, sharp and pressure tests were assessed at 1- and 4-months after surgery. Statistically, we analysed study participation, tolerance for clinical scar tests and if the scar tests related to scar pain. Findings: 21 participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No participants were injured due to scar testing. 70% of participants reported treating their scar independently. Neuropathic Pain Symptom Inventory (NPSI) allows participants to give a broad range of answers about their scar symptoms. Scores for clinical tests of scar flexibility and inflammation did not relate to participant-reported scar pain. Scars were more sensitive to tests of pin prick and cold than unaffected skin. What we learned: people with new hand scars participate in research and independently initiate scar treatment. Clinical testing of post-surgical hand scars is well tolerated. The NPSI is useful for exploring scar pain symptoms and may help us to learn about persistent scar pain. Pinprick and cold clinical tests may be useful objective pain tests for future scar research.

Ethical Aspects of Psychedelic-Assisted Treatments: An Overview.

In this chapter, we provide an overview of ethical aspects of psychedelic-assisted treatments in the areas of clinical ethics, research ethics, and at the intersection of psychedelic medicine and society. In contrast to earlier psychedelic research, nowadays medical ethics have been firmly established as a discipline regulating patient-physician relationships which highlight the importance of autonomy, shared decision-making and informed consent in clinical ethics. During and after altered states of consciousness, autonomy is particularly important as participants are in a vulnerable state. In this vulnerable state, both touch and suggestibility are central ethical concerns. In turn, the debate surrounding hallucinogenic and nonhallucinogenic psychedelic substances discusses the importance of altered states of consciousness in general. Of further concern are exceptional training requirements and competencies of psychedelic therapists, as well as the particular context of end-of-life care. Lastly, this section discusses how ethical integrity in clinical treatments can be supported through institutions. In research ethics, inclusivity, research equipoise, and expectation management are key issues in the participation and trials, while open question for the posttrial access to care after psychedelic trials remain. Finally, the chapter addresses the question of equitable access to psychedelic medicine. Furthermore, justice for indigenous communities using psychedelics and the impact of legalization and medicalization of psychedelic substances are pressing ethical concerns amidst the "psychedelic renaissance."

Efficacy of ketamine and thiopentone sodium with modified electroconvulsive therapy in depressive disorder: An observational study

Background: The first-line treatment for people with acute mania, mood disorders, severe depression, and catatonia is electroconvulsive therapy (ECT). The goal of anesthesia during ECT is to cause unconsciousness, and the drugs administered should not have any effect on seizures. Because all anesthetics have some ability to change seizures, the kind of anesthetic used in modified ECT becomes crucial. This study aimed to assess the hemodynamic profile during modified ECT and the effects of ketamine and thiopentone sodium on seizure duration. Aims and Objectives: The aim of the study was to compare the outcome of ECT, such as hemodynamics, improvement in depression, and duration of seizure, with ketamine versus thiopentone sodium in depressive disorder. Materials and Methods: A prospective observational study was conducted with 50 randomly selected depression patients after obtaining permission from the Institutional Ethics Committee and consent from the patients and attendants from June 2021 to November 2022. All 50 cases were equally divided into group K and group T. To obtain the data, a predesigned, semi-structured questionnaire was used along with the Hamilton rating scale for depression and ECT. The Chi-square test was used to measure the association between two categorical variables. A P &lt; 0.05 was considered statistically significant. Results: The mean heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and saturation of peripheral oxygen are higher in group K than in group T, and the mean difference was significant between group K and group T. Groups had a statistically significant association with increased secretions, nausea and vomiting, and headache, but not with gender, ASA grade, and number of ECT sessions. Conclusion: Compared to ketamine, thiopentone sodium was found to have minimal hemodynamic derangements, a decrease in seizure duration, and side effects.

Knowledge and attitude of antenatal mothers on the preconception and prenatal diagnostic techniques act attending Government Maternity Hospital in Andhra Pradesh: A cross-sectional study

Background: Girl children are vulnerable to gender biases throughout the economic and social strata. From the moment of conception, a girl’s existence is an ongoing struggle for survival, development, and growth. Gender equality has gained recognition in the past 10 years as essential to a country’s social and economic progress and overall health. Aims and Objectives: The aim of the study was to know the awareness and attitude of antenatal mothers regarding the preconception and prenatal diagnostic techniques (PCPNDT) act, gender preference, and their awareness regarding related social issues. Materials and Methods: A hospital-based cross-sectional study was conducted after obtaining ethics committee approval and consent from 200 antenatal mothers attending a maternity hospital from September to December 2022. Data were collected using a predesigned, pre-tested, semi-structured questionnaire. The analysis was done with Statistical Package for the Social Sciences software version 26.0. Results: Out of 200 study subjects, 80% were in the age group of 19–25 years, 60.5% were aware of the PCPNDT act, and 43.8% of mothers had knowledge about the PCPNDT act from hospital sources. Of the 56% of mothers who preferred a male child, 35.7% said it was first being a girl child. In this study, awareness of the PCPNDT act was significantly associated with age, area of living, religion, education, occupation, and socio-economic status, but not with type of family. Conclusion: Despite better knowledge regarding the PCPNDT act, the attitude toward sex determination, female foeticide, and son preference has to be changed. For this reason, strict implementation of the PCPNCDT act is essential.

Impact of mobile usage among Phase 1 medical undergraduates: A cross-sectional study

Background: Mobile phone usage has dramatically expanded over the past 10 years, especially among students. Because smart mobile phones have nearly all the additional capabilities of personal digital aid, including desktop synchronization, access to email, internet surfing, and third-party applications, they have become an alternative to portable computers. At the same time, excessive use of mobile phones has negatively impacted their perceived health, resulting in symptoms such as fatigue, stress, headaches, difficulty focusing, and a negative impact on their academic performance. The present study was conducted in this context to observe the effects of mobile usage among Phase 1 medical undergraduates. Aims and Objectives: The aims and objectives are to study the impacts of mobile usage among Phase 1 medical undergraduates and to explore the change in attitudes, evaluate the addiction, and assess the effects of mobile usage among medical undergraduates. Materials and Methods: A cross-sectional study was conducted after obtaining ethics committee approval and consent from 250 phase 1 medical undergraduates from February 2024 to March 2024. Data were collected using a predesigned, pre-tested, semi-structured questionnaire. The analysis was done using the Statistical Package for the Social Sciences software, version 26.0. Results: Of the 250 undergraduates, the majority (68.4%) were females, and 73.2% were hostlers. Daily time spent on mobile usage was &gt;4 h among 42.4% of undergraduates. Among the undergraduates, 81.2% used mobiles for calling family members, 80.4% for WhatsApp, and 75.6% for study purposes. Self-perception of mobile addiction was reported by 36.5% of undergraduates. Headaches and dry eyes were the most commonly experienced effects due to excessive usage of their mobile devices. Conclusion: Mobile phone addiction is increasing among medical undergraduates, which has to be addressed with proper counseling to prevent further addiction and curtail the adverse effects of mobile addiction.

Long-Term Results in the Treatment of Avascular Necrosis of Femoral Head with Free Vascularized Fibular Graft

Objective: to evaluate outcomes of vascularized fibula flap used for Avascular necrosis of femoral head. Outcomes were recorded by post-operative Harris hip and radiological improvement of the femoral head. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad Pakistan, from Jan 2019 to Jan 2020. Methodology: Cases were recruited from 2005-2018 (SIH) performed by the same Orthopaedic and Plastic Surgeon. Data from 30 patients was reviewed. Ethical approval and consent of the patient were taken before the utilization of their data. Results: A total of 30 patients were included, comprising 27(90%) males and 3(10%) females. The mean age was 28.3± years. Pre-operative Harris Hip scores were fair in 17(56.7%) and poor in 13(43.3%) patients. Post operatively these scores improvedv and were noted to be excellent in 10(33.3%), good in 18(60%) and fair in 2(6,7%) patients. Radiological improvement was seen in 20(80%) patients, 8(23.3%) showed no change and 2(6.7%) went into progression. The radiological improvement was significantly associated with aetiology (p=0.004) and Avascular necrosis of HIP (p=0.007). Conclusion: A vascularized fibular graft is an effective treatment option for avascular necrosis of the femoral head in terms of improved radiological outcomes and post-operative Harris Hip scores.

Harnessing Large Language Models in Medical Research and Scientific Writing: A Closer Look to The Future

Large Language Models (LLMs), a form of artificial intelligence generating natural language responses based on user input, have demonstrated potential across various applications such as entertainment, education, and customer service. This review comprehensively highlights their current research status and potential applications within the medical domain, addressing the challenges and opportunities for future development and implementation. Key aspects covered include diverse data sources for training and testing, such as electronic health records and clinical trials; ethical considerations, including privacy and consent; evaluation techniques focusing on accuracy and coherence; and clinical applications ranging from diagnosis to patient education. The review concludes that LLMs hold significant promise for enhancing the quality and efficiency of medical research and scientific writing but also emphasize the need for careful design and regulation to ensure safety and reliability.

An observational study to evaluate the awareness of drug treatment, prescription pattern, adverse drug reactions, and adherence in patients of major depressive disorder.

Due to the paucity of studies in and out of India that dealt with treatment awareness of major depressive disorder (MDD), we decided to assess the awareness of MDD patients, and since adherence and awareness are linked to each other, we assessed adherence too. Prescription pattern studies identify changes in prescriptions due to poor initial response or adverse drug reactions (ADRs), which may result in dose reduction or switching medications and delay remission. Therefore, the study assessed the ADR pattern. A cross-sectional questionnaire-based study was carried out on 200 MDD patients with treatment records for at least 3 months after getting approval from the Institutional Ethics Committee and consent from the patients. The data obtained were entered in Microsoft Excel and analyzed using descriptive statistics. The mean age was 44.65 ± 12.02 years, and females were 70%. Maximum patients (98%) were aware of the consequence of stopping the drugs suddenly, and only 12.5% were aware of the onset of response to treatment. Escitalopram was the most common antidepressant prescribed (43.77%), and 67 ADRs out of 136 were attributable to it. Weakness and fatigue were the most common ADRs. The majority (97) of the ADRs were possibly related to antidepressants, and 65% of patients showed optimal adherence to medications. This study sheds light on the treatment awareness and adherence of MDD patients in India and highlights the need for educating patients about treatment response. It also emphasizes the importance of monitoring ADRs and adjusting prescription patterns accordingly to improve treatment outcomes.

ABNORMAL CHONDROCYTE MORPHOLOGY, CLUSTERING, AND CELL SWELLING IN A SCRAPED HUMAN CARTILAGE MODEL OF OSTEOARTHRITIS

AbstractObjectivesOsteoarthritis (OA) is a complex joint disorder characterised by the loss of extracellular matrix (ECM) leading to cartilage degeneration. Changes to cartilage cell (chondrocyte) behaviour occur including cell swelling, the development of fine cytoplasmic processes and cell clustering leading to changes in cell phenotype and development of focal areas of mechanically-weak fibrocartilaginous matrix[1]. To study the sequence of events in more detail, we have investigated the changes to in situ chondrocytes within human cartilage which has been lightly scraped and then cultured with serum.MethodsHuman femoral heads were obtained with Ethical permission and consent from four female patients (mean age 74 yrs) undergoing hip arthroplasty following femoral neck fracture. Osteochondral explants of macroscopically-normal cartilage were cultured as a non-scraped control, or scraped gently six times with a scalpel blade and both maintained in culture for up to 2wks in Dulbecco's Modified Eagle's Medium (DMEM) with 25% human serum (HS). Explants were then labelled with CMFDA (5-chloromethylfluorescein-diacetate) and PI (propidium iodide) (10μM each) to identify the morphology of living or dead chondrocytes respectively. Explants were imaged using confocal microscopy and in situ chondrocyte morphology, volume and clustering assessed quantitatively within standardised regions of interest (ROI) using Imaris® imaging software.ResultsWithin 2wks of culture with HS, chondrocyte volume increased significantly from 412±9.3µm3 (unscraped) at day 0 to 724±16.6 µm3 (scraped) [N(n) = 4(380)] (P=0.0002). Chondrocyte clustering was a prominent feature of HS culture as the percentage of clusters in the cell population increased with scraping from 4.8±1.4% to 14.9±3.9% [N(n) = 4(999)] at week 2 (P=0.0116). In addition, the % of the chondrocyte population within clusters increased from approximately 38% to 60%, and the number of cells per cluster increased significantly from 3.2±0.08 to 4±0.22 (P=0.031). The development of abnormal ‘fibroblastic-like’ chondrocyte morphology demonstrating long (&gt;5µm) cytoplasmic processes also occurred, however the time course of this was more variable. For some samples, clustering occurred before abnormal morphology, but for others the opposite occurred. Typically, by the second week, 17±2.64% of the cell population had processes and this increased to 22±4.02% [N(n) = 4(759)] with scraping.ConclusionsScraping the cartilage will remove surface constituents including lubricants (e.g. lubricin, hyaluronic acid, phospholipids), extracellular matrix constituents (collagen, proteoglycans – potentially the ‘lamina splendens’) and cells (chondrocytes and mesenchymal stromal cells (MSCs)). Although we do not know which of these component(s) is important, the effect is to dramatically increase the permeation of serum factors into the cartilage matrix and signal the development of cytoplasmic processes, cell clustering and swelling. It is notable that these cellular changes are similar to those occurring in early OA[1]. This raises the interesting possibility that scraped cartilage cultured with human serum recapitulates some of the changes to in situ chondrocytes during early stages of cartilage degeneration and as such, could be a useful model for following the deleterious changes to matrix metabolism.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

11.G. Skills building seminar: Navigating the ocean of data: unpacking ethical values in Health Technology Assessment

Abstract Health technology assessment (HTA) is multidisciplinary process that uses explicit methods to determine the value of a health technology at different points in its lifecycle. The purpose is to implement an informed decision-making process in order to promote an equitable, efficient, and high-quality health system. Ethics has been identified as a key element in HTA because health care is a moral endeavour and potential technology presents complex moral dilemmas, especially with the rise of novel technologies. In evaluating health technologies, ethical aspects must be taken into account such as patients’ privacy and informed consent in terms of (re-)use of their personal sensitive data, alongside with the possibility of unintended consequences (e.g., doing more harm than good: Thalidomide case) and the effects on society in terms of justice and equity, with implications for financial sustainability. Without taking account of the ethical dimension in the process, choices may be made without considering the overall context of implementation, thus, compromising the relevance of decisions and policies, with potentially unintended consequences and/or harmful effects to the health and wellbeing of individuals/patients, to public health, to the environment, and to the society at large. Decision-makers should guarantee that adopted health technologies are meaningful and relevant for the society, with due consideration to their development too, to the extent possible, by also taking ethical aspects into consideration when evaluating health technology. Despite many years of recognising ethics as a foundational part of HTA, studies have shown that the ethical dimension is still not systematically and sufficiently addressed by means of ethical analysis. Furthermore, novel technologies, new types of data, and a paradigm shift in terms of how we generate and synthesize evidence, whilst providing us with unique opportunities in terms of HTA, pose concrete challenges and new (and revisited) dilemmas. EUPHA-HTA, EUPHA-ETH and EUPHAnxt sections and HTAi are committed to build capacity amongst healthcare professionals about evidence-based decision-making with due consideration to ethical aspects. The aim of this workshop is two-fold. First, we will discuss the role of ethics in healthcare decision-making and tools to ensure the integration of ethics in the HTA process. We will then explore case studies and present a simple model with the contribution of EUPHA-HTA, EUPHA-ETH, and HTAi to illustrate ethical dilemmas that can arise during HTA processes. In the second half of workshop, attendees will be divided into groups to discuss ethical challenges in HTA and means to overcome them. We will capture the needs and input of young researchers/audience and move towards developing a EUPHA-HTAi priority map for competency mapping as output. Key messages • Systematic real-world data collection and context-specific analysis of the ethical principles coupled with legal and social analysis contributes to good decision making and policies. • Ethical analysis is an integral part of HTA, ensuring that the value=laden use of a health technology is made transparent, identifying ethical consent and dispute. Speakers/Panelists Elena Petelos EUPHA-HTA, EUPHA-GH Pietro Refolo Università Cattolica del Sacro Cuore, Rome, Italy Els Maeckelberghe University Medical Center Groningen, Groningen, Netherlands Wija Oortwijn HTAi

Self-Reported Side Effects of Different COVID-19 Vaccines in Bangladesh- A Vaccine Recipient Survey

Background: COVID-19 (Corona Virus disease 2019) is a newly discovered disease that originated in China and quickly spread throughout the world, killing millions of people and infecting many more. People have a new hope due to newly discovered vaccines for this fatal disease. However, the vaccines showed a number of side effects on the people receiving them. Nonetheless, it has proven to be helpful in providing protection against the fatal infection. Purpose: To analyze the probable side effects of the vaccines experienced by vaccine recipient and their belief regarding vaccine. Method: An online survey was conducted through different social media platforms and Email from 11 July’2021 to 16 July’2021. Ethical permission and consent was taken prior to the survey and data collections. Occurance and the extent of vaccine side effects were analyzed using descriptive and logistic regression analysis. Result: Among 175 vaccine recipients, 92 (52.58%) received one dose and 83 (47.42%) received two doses, with 93 (53.1) receiving SinoPharm vaccine, 78 (44.6) receiving AstraZeneca vaccine, and 4 (2.3%) receiving Pfizer vaccine. More than half of the respondents experienced side effects among which headaches (50.3%) and drowsiness (45.71%) were common followed by fever (36%) and muscle ache (32%). Female (P=0.000) and vaccine concerned group (P=0.033) experienced more side effects. Headache (68.8%), fever (40.9%) and drowsiness (50.5%) were more common among Sinopharm recipients. Fever (50%) and muscle ache (50%) were more common among Pfizer recipients while muscle ache (43.5%) and drowsiness (42.3%) were common among AstraZaneca recipients group. Conclusion: Headache, fever, muscular discomfort, soreness at the injection site, drowsiness, nausea, and other adverse effects are common with the COVID vaccination. Females are more susceptible to side effects than males, and the probability of experiencing them increases with the second dose. AstraZeneca vaccine recipient experiencing more side effects than other types of vaccine recipients. Update Dent. Coll. j: 2023; 13(2):3-8

Displaced Women and Sexual and Reproductive Health Services: Exploring Challenges Women With Sexual and Reproductive Health Face in Displaced Camps of Nigeria

Background: Displaced women are affected by sexual and reproductive health (SRH) challenges, often exacerbated by poor living conditions, limited access to healthcare, and cultural norms. The aim of this study was to explore SRH issues, the effects of displacement into camps on women’s SRH, and challenges with accessing and utilizing SRH services among women in camps for the displaced in Benue State, Nigeria. Methods: A qualitative phenomenological approach was employed to gain an in-depth understanding of the women’s SRH challenges, based on 12 focus group discussions between women of different age groups and eight in-depth interviews. The data were collected using tape recorders and notes. Data analysis followed a thematic approach. Ethical approval and appropriate consent were obtained for the study. Results: The majority of research participants stated that sexually transmitted disease/human immunodeficiency virus was the most serious SRH issue in the camp. Their stay in camp enhanced the women’s vulnerability and exposed them to sex in exchange for basic needs/palliatives, increasing their SRH challenges. Access to and use of SRH services were impacted by their migratory lifestyle, cultural and religious views, lack of SRH knowledge, and other difficulties. Short-term approaches to intervention, health providers’ poor communication, and attitudes were reported to affect SRH service use. Conclusion: There is an urgent need for comprehensive interventions to address SRH challenges among women in displaced settings, including proper coordination of humanitarian services, education on transactional sex, encouragement of men to participate in SRH initiatives, and expansion of access to services, as well as the training and hiring of culturally competent healthcare providers.

Association of viral load and autophagy-related genes polymorphisms with hepatitis B virus pre-core/core mutations in chronic hepatitis B virus Iraqi patients

Introduction: Chronic hepatitis B (CHB) is a global concern due to its association with cirrhosis and hepatocellular carcinoma (HCC) development. The interplay between viral load, the immune system, and host factors is critical in tumorigenesis. Autophagy is a significant contributor to immune system function, since vitamin D plays an important role in this context. Objectives: The objective of this study was to assess the association between ATG5 (rs506027 and rs510432) and ATG16L1 (rs2241880 and ATG16 rs2241879) polymorphisms, viral load, and vitamin D with HBV pre-C/C mutations in Iraqi patients with CHB. Patients and Methods: In this cross-sectional study, a total of 134 CHB patients were evaluated for ATG polymorphisms, viral load, and vitamin D levels. Blood samples were collected after obtaining ethical consent, and the mutations were analyzed using polymerase chain reaction (PCR) followed by Sanger sequencing. Serum samples from CHB patients were used for viral load and vitamin D assessment. Results: The evaluation of patients revealed that 67 (44.6%) were male and 83 (55.4%) were female, with a mean age of 36±12.7 years and a mean duration of infection of 5.2±4.8 years. Mutations in pre-C/C were observed in 20% (27/134) of the patients. There was a significant association between all evaluated ATG polymorphisms and pre-C/C mutants (P&lt;0.05). Furthermore, there was an association between viral load and mutations in pre-C/C (P=0.03), while no statistically significant difference was found between vitamin D levels and pre-core/core mutants or viral load. Conclusion: Our study demonstrates a higher frequency of ATG5 (rs506027 and rs510432) and ATG16L1 (rs2241880 and ATG16 rs2241879) polymorphisms, as well as a higher viral load in Iraqi CHB patients with HBV pre-C/C mutations.

‘When we meet, we play football, it reminds me of home': emotions, institutional work, and sport-for-development and peace

ABSTRACT Research question While there is a growing body of scholarship on institutional work in sport, less is known about the role of emotions by which institutions are affected. This study aims to explore the role of emotions in sport-for-development and peace (SDP)-related institutional work to challenge conditions of social inequality for refugees in Kampala, Uganda. Two core research questions are: (1) How do emotions related to forced displacement inform the institutional work of an SDP organization? (2) What emotions are mobilized by refugees and an SDP organization to challenge the institution of social inequality? Research methods Guided by a participatory action research approach, fieldwork was undertaken with a refugee-led organization in Kampala. Data collection included semi-structured interviews, photovoice, and photocollaging. Ethical consent was obtained from all individuals participating in the research and for the display of images. Results and Findings The findings demonstrate that a variety of emotions experienced as positive (e.g. love of sport) or negative (e.g. stress) stimulate SDP-related work to change relations between host communities and refugees. The findings also illustrate that emotions experienced positively (e.g. nostalgia, happiness) were generated via SDP activities, including creation of sport groups related to homelands and conflict resolution among refugees and host communities. Three mechanisms – diverting, bonding, peacemaking – are identified that enabled SDP-related practices to transform refugees’ emotions. The resulting positive emotional state helped to undermine the institution of social inequality between the host community and refugees. Implications This study advances theoretical development of institutional theory in sport management by accounting for the lived experience and emotions that play a role in SDP-related institutional work.

E69 Localised intraarticular pigmented villonodular synovitis in an adolescent patient: a case-based review of the literature

Abstract Introduction Pigmented villonodular synovitis (PVNS) is a rare, locally aggressive subtype of tenosynovial giant cell tumours that affect the synovium of the joints and tendons, occurring either focally or diffusely associated with the deposition of hemosiderin into the involved joint(s) and soft tissues. Although PVNS is historically considered an inflammatory process, recent evidence suggests the possibility of a neoplastic transformation. In addition, despite being typically found as a monoarticular knee disorder, other large and small joints can also be affected. The disease is rarely reported in African children, with most reported cases not histologically confirmed. We, therefore, present the first histologically proven case of localised intraarticular PVNS in an African teenager who presented with unilateral left knee swelling and pain. Method/Setting We report the case of a 16-year-old male teenager who presented to the rheumatology clinic with a nine-month history of non-traumatic anterior left knee swelling and pain that increased over time with associated difficulty walking and standing without aid. After clinical examination and relevant investigations, Magnetic Resonant Imaging (MRI) was done to confirm our suspicion of PVNS. Findings/Treatment Examination revealed a tender, swollen knee with a fluctuant palpable infrapatellar mass. Knee arthrocentesis yielded about 200mls of non-clotted hemorrhagic effusions. The patient had an open synovectomy following MRI, which was highly suggestive of pigmented villonodular synovitis with extensive suprapatellar bursitis. Specific histological findings (below) further confirmed the diagnosis. He commenced early physiotherapy, and symptoms resolved without recurrence of swelling eleven months after surgery. Conclusion This case highlights the visual presentation of an uncommon joint disorder and suggests it is considered a differential diagnosis of non-traumatic monoarticular pain and swelling in our rheumatology clinic set-up and among teenagers in whom juvenile rheumatoid arthritis would have been the first differential. Key words: Pigmented villonodular synovitis, Synovectomy, Multinucleated giant cells Contribution statement: AA conceived the idea to write the case report, draft the first manuscript, and manage the patient. YA, HO and AF edited the manuscript, while AIL interpreted the histological findings. All the authors approved the final version of the manuscript. Disclosure statement: None declared. Ethics and patient consent: This case report adheres to the Helsinki declaration, and the patient’s parents gave written consent to publish the details of the information. Additional information: Any institution did not fund this publication. Acknowledgements: We thank Dr Isaac Akanbi and Dr Bukar for interpreting the MRI and performing the surgery.

Incidence of breast cancer among women in Al-Madinah Al-Munawwara

Background: Breast cancer (BC) is the second most common cancer in the world, and most frequent cancer among women. BC is a public health issue because of the highest rate of morbidity and mortality, so our study about the incidence of breast cancer among women in Al-Madinah Al-Munawara to answer many questions such as lifestyle, risk factor age, and the roles of the patients in awareness of the community. Methods: It was a retrospective study that analyzed questionnaires collected from King Fahad Hospital and early diagnostic Taiba Cancer Screening centers from women patients with breast cancer after ethical consent in a specific time interval from January 2022 to March 2023 in Al-Madinah, Kingdom of Saudi Arabia. Results: Among 111 women with breast cancer, 51.4% were diagnosed at the age 19 to 30 years, 16.2% were diagnosed at the age 31 to 40 years, 6.3% were diagnosed at the age 41 to 50 years, 20.7% were diagnosed at the age 51 to 60 years old, and 5.4% were diagnosed at an age over 60 years. 39.6% of women diagnosed with breast cancer have (1-3) children, 22.5% have (4-7) children, and 3.6% have more than (7) children. 56.2% of patients breastfeed their children, while 43.8% do not. Conclusions: The incidence of breast cancer according to our study shows a high-risk factor in younger women, we suggest starting breast cancer screening from earlier age 19 years old and above. An increase in childbirth and lactation reduces the progress of breast cancer and prevents the disease, encouraging women with or without breast cancer for breastfeeding and childbirth. The experience and knowledge of patients with breast cancer about the disease make them active members in community awareness and urged other women to early screening, also the success story of recovering patients can be inspired for newly diagnose or relapse cases to complete their treatment by conducting educational meetings.

Intraoperative plethysmography variability index directed fluid management versus standard care during intraabdominal surgery in cancer patients

Background: During the past 20 years, numerous publications have described the usefulness of systolic pressure variation, pulse pressure variation, stroke volume variation, etc., to guide intraoperative fluid administration. However, we still lack robust noninvasive physiological variables to successfully predict the response to fluid loading. Aims and Objectives: The present study was designed to evaluate the utility of plethysmography variability index (PVI) to optimize fluid management during intra-abdominal surgery in cancer patients. Materials and Methods: After the Institutional Ethics Committee approval and consent, 60 patients scheduled for elective lower abdominal cancer surgeries were randomized to receive fluid by either PVI-directed management (2 mL/kg/h) or using central venous pressure (8 mL/kg/h) after standardized technique of general and lumbar epidural anesthesia. The PVI was calculated by measuring changes in the PI during the respiratory cycle (PVI = [(PImax - PImin)/PImax] × 100). Arterial blood samples were taken at the time of incision and after 6 h postoperatively. Instances of intraoperative hypotension and oliguria were recorded. Results: Among the 60 patients enrolled in the study, demographic data, ASA status, duration of surgery, and hemodynamics were found to be comparable. The amount of crystalloid given was significantly lesser in Group P (984.70±51.16) as compared to Group C (2395.27±209.68) (P&lt;0.001). Four patients in Group P and three patients in Group C required vasopressors. Conclusion: The use of PVI-guided fluid management was associated with lower lactate levels and crystalloid requirement. Reduced lactate levels in PVI-guided patients suggest that PVI-guided fluid management may be tailored to everyone’s needs.

“What is the Community Going to Get from It?” Abolitionist Ethics and the Praxis of Responding to Reciprocal Community Requests

In this article, we highlight an underdiscussed element of field work: reciprocal community requests—requests from community to engage beyond conducting ethical research and to support a community’s own work. We draw from our own fieldwork in New Orleans, LA, Camden, NJ, and Philadelphia, PA, to make these requests visible and discuss their importance. We find that these reciprocal requests extend far beyond consideration of rigorous research or an ethics of consent. We discuss our framework of how to answer these requests, drawing from abolition principles of (1) Participatory Partnership, (2) Finding Shared Values, (3) Sharing Risk.