Higher Decrease Research Articles

The Effectiveness and Safety of the Duodenal-Jejunal Bypass Liner (DJBL) for the Management of Obesity and Glycaemic Control: a Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The duodenal-jejunal bypass liner (DJBL) is a less-invasive treatment of obesity and type 2 diabetes mellitus (T2DM). This is a systematic review and meta-analysis including randomized clinical trials (RCTs) comparing DJBL versus sham or pharmacotherapies aiming to evaluate the effectiveness and safety of DJBL. Ten RCTs (681 patients) were included. The DJBL group showed superior excess weight loss (+ 11.4% [+ 7.75 to + 15.03%], p < 0.00001) and higher decrease in HbA1c compared to the control group (- 2.73 ± 0.5 vs. - 1.73 ± 0.4, p = 0.0001). Severe adverse events (SAEs) occurred in 19.7%. The DJBL did not reach the ASGE/ASMBS thresholds for the treatment of obesity. However, it is important to state that many SAEs were not really severe. Therefore, we believe this therapy plays an important role in the management obesity and T2DM.

Degradation of Chemical Components of Thermally Modified Robinia pseudoacacia L. Wood and Its Effect on the Change in Mechanical Properties

Currently, emphasis is placed on using environmentally friendly materials both from a structural point of view and the application of protective means. For this reason, it is advisable to deal with the thermal modification of wood, which does not require the application of protective substances, to increase its service life. The main reason for the thermal modification of black locust is that although black locust grows abundantly in our country, it has no industrial use. It is mainly used outdoors, where thermal modification could increase its resistance. This article deals with the thermal modification of black locust wood (Robinia pseudoacacia L.) and the impact of this modification on the chemical components of the wood with an overlap in the change in mechanical properties compared to untreated wood. Static (LOP, MOR, and MOE) and dynamic (IBS) bending properties were evaluated as representative mechanical properties. At the same time, the impact of thermal modification on the representation of chemical components of wood (cellulose, lignin, hemicellulose) was also tested. As a result of the heat treatment, the mechanical properties gradually decreased as the temperature increased. The highest decrease in mechanical values found at 210 °C was 43.7% for LOP and 45.1% for MOR. Thermal modification caused a decrease in the content of wood polysaccharides (the decrease in hemicelluloses content was 33.2% and the drop in cellulose was about 29.9% in samples treated at 210 °C), but the relative amount of lignin in the wood subjected to increased temperature was higher due to autocondensation, and mainly because of polysaccharide loss. Based on the correlations between chemical and mechanical changes caused by thermal modification, it is possible to observe the effects of reducing the proportions of chemical components and changes in their characteristic properties (DP, TCI) on the reduction in mechanical properties. The results of this research serve to better understand the behavior of black locust wood during thermal modification, which can primarily be used to increase its application use.

Individual and Combined Effects of High-Temperature Stress at Booting and Flowering Stages on Rice Grain Yield

Extreme temperature events as a consequence of global climate change result in a significant decline in rice yield. A two year phytotron experiment was conducted using three temperature levels and two heating durations to compare the effects of heat stress at booting (BT), flowering (FL), and combined (BT + FL) stages on rice yield and yield components. Compared with T1 (Tmean of 27 °C), heat stress at BT + FL and BT stages produced more regenerated tillers and compensated more for yield loss than heat stress at FL. Heat stress at BT + FL stages alleviated spikelet sterility and yield loss of original tillers compared to heat stress at FL. The greater variation of yield per plant (YPP) under heat stress at flowering as compared to BT and BT + FL stages was accompanied by a higher decrease in spikelet fertility, while, at BT and BT + FL stages, spikelet number per plant and 1000-grain weight also contributed well to variation in yield. Furthermore, heat stress during BT and BT + FL stages caused a significant decline in spikelet fertility of the upper part of panicles, followed by middle and lower parts, while heat stress at the FL stage responded inversely. For every 1 °C day increase in heat degree days at BT, FL, and BT + FL stages, YPPO (only original tillers) declined by 2.9%, 2.5%, and 6.0%, and YPPT (including original + regenerated tillers) decreased by 5.8%, 2.7%, and 2.2%, respectively. The projected alleviation effects under BT + FL stages of heat stress in contrast to single-stage heat stress would help to accurately estimate rice yield under extreme temperature events, as well as to develop a heat-tolerant rice cultivar.

Racial and regional disparities of triple negative breast cancer incidence rates in the United States: An analysis of 2011-2019 NPCR and SEER incidence data.

Triple negative breast cancer (TNBC) is a more aggressive subtype resistant to conventional treatments with a poorer prognosis. This study was to update the status of TNBC and the temporal changes of its incidence rate in the US. Women diagnosed with breast cancer during 2011-2019 were obtained from the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology and End Results (SEER) Program SEER*Stat Database which covers the entire population of the US. The TNBC incidence and its temporal trends by race, age, region (state) and disease stage were determined during the period. A total of 238,848 (or 8.8%) TNBC women were diagnosed during the study period. TNBC occurred disproportionally higher in women of Non-Hispanic Black, younger ages, with cancer at a distant stage or poorly/undifferentiated. The age adjusted incidence rate (AAIR) for TNBC in all races decreased from 14.8 per 100,000 in 2011 to 14.0 in 2019 (annual percentage change (APC) = -0.6, P = 0.024). Incidence rates of TNBC significantly decreased with APCs of -0.8 in Non-Hispanic White women, -1.3 in West and -0.7 in Northeastern regions. Women with TNBC at the age of 35-49, 50-59, and 60-69 years, and the disease at the regional stage displayed significantly decreased trends. Among state levels, Mississippi (20.6) and Louisiana (18.9) had the highest, while Utah (9.1) and Montana (9.6) had the lowest AAIRs in 2019. New Hampshire and Indiana had significant and highest decreases, while Louisiana and Arkansas had significant and largest increases in AAIR. In individual races, TNBC displayed disparities in temporal trends among age groups, regions and disease stages. Surprisingly, Non-Hispanic White and Hispanic TNBC women (0-34 years), and Non-Hispanic Black women (≥70 years) during the entire period, as well as Asian or Pacific Islander women in the South region had increased trends between 2011 and 2017. Our study demonstrates an overall decreased trend of TNBC incidence in the past decade. Its incidence displayed disparities among races, age groups, regions and disease stages. Special attention is needed for a heavy burden in Non-Hispanic Black and increased trends in certain groups.

Bone mineral density changes in osteoporotic and osteopenic patients after COVID-19 infection

BackgroundCoronavirus disease 2019 (COVID-19) infection is linked to high levels of inflammatory cytokines and prolonged immobilization; furthermore, corticosteroid treatment leads to increased bone loss and resorption. We aimed to study the change in bone mineral density (BMD) after COVID-19 infection in osteoporotic and osteopenic patients. One hundred osteoporotic or osteopenic patients were selected in this single-center retrospective study; the patients were divided into two groups. Group 1 included 56 patients who got COVID-19 infection. Group 2 included 44 patients who did not get COVID-19 infection. BMD was assessed at baseline, after 9 months of COVID infection, and then after 1 year follow-up using dual energy x-ray absorptiometry (DXA) scan.ResultsThere was no significant difference between two groups regarding demographic data (p > 0.05); there was a significant decrease in BMD of the lumbar region and femur at 9 months as compared to baseline in group1 (p < 0.001), while there was a significant increase in the lumbar BMD of osteoporotic patients who did not get COVID infection after 21 months. Concerning activity of COVID infection, there was a significant difference between the three subgroups of COVID patients regarding percentage of change in BMD after 9 months, the severe group having the highest decrease in BMD (p < 0.001).ConclusionsCOVID-19 may have deleterious effect on BMD in osteoporotic patients. It is recommended to assess BMD in osteoporotic/osteopenic patients who got COVID infection to detect if there is an increased risk of fracture which may necessitate post-COVID change in the therapeutic intervention plan.

Lands Cover Dynamics of Siais Lake Catchment Area, Tapanuli Selatan District, Indonesia

The Siais Lake Catchment Area (SLCA) is a water resource that includes various types of land cover and land use in Rianiate village, Angkola Sangkunur sub-district, and Tapanuli Selatan district. The SLCA lake catchment area has altered the land cover and increased the surface area of Siais Lake. The purpose of this study was to determine the type of land cover that changed in the Siais lake catchment area between 1990 and 2018. The land cover classification was obtained using Landsat 5 and Landsat 8 OLI images. Make use of supervised classification. Forest, plantation, bare land, paddy field, settlement, waterbody, shrub, and swamp were the land covers identified in the Lake Siais catchment area. Plantations had the highest percentage of land cover increase from 1990 to 2018, with an increase of 3,995.87%, while paddy fields had the highest decrease, with a decrease of 93.77%. .

Changes in air pollution due to COVID-19 lockdowns in 2020: Limited effect on NO2, PM2.5, and PM10 annual means compared to the new WHO Air Quality Guidelines.

Lockdowns have been fundamental to decreasing disease transmission during the COVID-19 pandemic even after vaccines were available. We aimed to evaluate and compare changes in air quality during the first year of the pandemic in different cities around the world, investigate how these changes correlate with changes in mobility, and analyse how lockdowns affected air pollutants' annual means. We compared the concentrations of NO2, PM2.5, and PM10 in 42 cities around the world in the first months of the pandemic in 2020 to data from 2016-2019 and correlated them with changes in mobility using Human Development Indexes (HDIs). Cities with the highest decreases in air pollutants during this period were evaluated for the whole year 2020. We calculated the annual means for these cities and compared them to the new World Health Organization (WHO) Air Quality Guidelines. A Student's t-test (95% confidence interval) was used to evaluate significant changes. Highest decreases in NO2, PM2.5, and PM10 were between -50 and -70%. Cities evaluated for the whole year 2020 generally showed a recovery in air pollution levels after the initial months of the pandemic, except for London. These changes positively correlated with year-long mobility indexes for NO2 and PM2.5 for some cities. The highest reductions in air pollutants' annual means were from -20 to -35%. In general, decreases were higher for NO2, compared to PM2.5 and PM10. All analysed cities showed annual means incompliant with the new WHO Air Quality Guidelines for NO2 of 10 μg/m3, with values 1.7 and 4.3 times higher. For PM2.5, all cities showed values 1.3 to 7.6 times higher than the WHO Guidelines of 5 μg/m3, except for New Delhi, with a value 18 times higher. For PM10, only New York complied with the new guidelines of 15 μg/m3 and all the other cities were 1.1 to 4.2 times higher, except for New Delhi, which was 11 times higher. These data show that even during a pandemic that highly affected mobility and economic activities and decreased air pollution around the world, complying with the new WHO Guidelines will demand a global strategical effort in the way we generate energy, move in and around the cities, and manufacture products.

The use of Kepok Banana Stem (Musa paradisiaca) in diabetes rats does not reduce Malondialdehyde (MDA) levels

Introduction: The prevalence of diabetes mellitus (DM) is still high and is expected to continue to increase. An increase follows this increase in the number of side events, so innovation is needed in DM therapy. DM induces oxidative stress so antioxidants can be an alternative therapy for DM. One source of antioxidants whose use is still limited is the banana plant, especially the banana stem. This study aimed to determine the effectiveness of kepok banana stem extract (Musa paradisiaca Var. Balbisiana colla) on MDA levels in diabetic rats. Methodology/Approach: The study used a post-test-only control group design on 24 male rats (Rattus novergicus) Sprague Dawley strain with a bodyweight of 150-250 grams and ± eight weeks old. Rats were divided into four groups, namely the metformin treatment for positive control, distilled water for the negative control, and stem banana extract dose of 200 mg/kg BW and 250 mg/kg BW as treatment group of mice induced diabetes using STZ-NA and given treatment according to the group for 14 days. MDA level measurement using the TBARS method on rat liver. Data were analyzed using the One Way ANOVA comparison test. Results: MDA levels in the positive control group, negative control, treatment 1 (200 mg), and treatment 2 (250 mg) were 0.9790 + 0.52 mg/dl, 0.7533 + 0.58 mg/dl, 1.2510 + 0.52 mg/dl, 1.5175 + 0.53 mg /dl. There was no statistically significant difference in MDA levels between groups (p=0.182), but there was a decrease in blood glucose levels in the group treatment. The highest decrease in blood glucose levels was in the dose treatment group, 250 mg/kg BW. Conclusion:The treatment of kepok banana stem extract (Musa paradisiaca Var. Balbisinia colla) for 14 days at 200mg/kg BW and 250mg/kg BW increased malondialdehyde (MDA) levels, although not statistically significant.

Interactive salinity and water stress severely reduced the growth, stress tolerance, and physiological responses of guava (Psidium Guajava L.)

Salinity and water stress are serious environmental issues that reduced crop production worldwide. The current research was initiated (2012) in the wirehouse of the Institute of Soil and Environmental Sciences, University of Agriculture, Faisalabad, Pakistan to investigate the growth, stress tolerance, and physiological responses of guava to salinity and water shortage. Guava was grown for one year in pots containing soil with Eight treatments (control, 10 dS m−1, 20 dS m−1, 40 dS m−1, control + water stress (WS), 10 dS m−1 + WS, 20 dS m−1 + WS, 40 dS m−1 + WS) in a completely randomized design. The results indicated that plant growth, stress tolerance, and physiological parameters declined at higher salinity and water stress and could not survive at 40 dS m−1. The 20 dS m−1 + WS caused a > 70% decline in dry weights of shoot and root regarding control. Similarly, the highest decrease in stress tolerance was noticed in 20 dS m−1 + WS followed by the 20 dS m−1 treatment than control. Our findings validated that guava can be cultivated on soils having salinity ≤ 10 dS m−1 but it could not be cultivated on soils having salinity ≥ 20 dS m−1 with limited water supply.

Temporal Trends in Acute Coronary Syndrome Mortality in Serbia in 2005-2019: An Age-Period-Cohort Analysis Using Data from the Serbian Acute Coronary Syndrome Registry (RAACS).

Cardiovascular diseases ranked first in terms of the number of deaths in Serbia in 2019, with 52,663 deaths. One fifth of those were from ischemic heart disease (IHD), and half of IHD deaths were from acute coronary syndrome (ACS). We present the ACS mortality time trend in Serbia during a 15-year period using the latest available data, excluding the COVID-19 pandemic. The data on patients who died of ACS in the period from 2005 to 2019 were obtained from the National Statistics Office and processed at the Department of Prevention and Control of Non-communicable Diseases of the Institute of Public Health of Serbia. Number of deaths, crude mortality rates (CR) and age-standardized mortality rates (ASR-E) for the European population were analyzed. Using joinpoint analysis, the time trend in terms of annual percentage change (APC) was analyzed for the female and male population aged 0 to 85+. Age-period-cohort modeling was used to estimate age, cohort and period effects in ACS mortality between 2005 and 2019 for age groups in the range 20 to 90. From 2005 to 2019 there were 90,572 deaths from ACS: 54,202 in men (59.8%), 36,370 in women (40.2%). Over the last 15 years, the number of deaths significantly declined: 46.7% in men, 49.5% in women. The annual percentage change was significant: -4.4% in men, -5.8% in women. Expressed in terms of APC, for the full period, the highest significant decrease in deaths was seen in women aged 65-69, -8.5%, followed by -7.6% for women aged 50-54 and 70-74. In men, the highest decreases were recorded in the age group 50-54, -6.7%, and the age group 55-59, -5.7%. In all districts there was significant decline in deaths in terms of APC for the full period in both genders, except in Zlatibor, Kolubara and Morava, where increases were recorded. In addition, in Bor and Toplica almost no change was observed over the full period for both genders. In the last 15 years, mortality from ACS in Serbia declined in both genders. The reasons are found in better diagnostic and treatment through an organized network for management of ACS patients. However, there are districts where this decline was small and insignificant or was offset in recent years by an increase in deaths. In addition, there is space for improvement in the still-high mortality rates through primary prevention, which at the moment is not organized.

Correlation between Neutrophil-to-lymphocyte ratio and Euthyroid Sick Syndrome in elderly patients with proximal femur fractures.

Proximal femur fractures are among the most common type of trauma in elderly patients, and Euthyroid sick syndrome has already been related to fractures and trauma. The evidence of a consistent inflammatory state occurring during hip fracture, made us consider as a potential marker also the neutrophil-to-lymphocyte ratio (NLR), which is already in use to measure the prognosis and guide the therapeutic management in various conditions. A retrospective observational analysis on patients affected by proximal femur fractures was conducted. Patients were divided between affected and non-affected by Euthyroid Sick Syndrome (ESS). Standard follow up was conducted at 1, 3, 6 and 12 months. 79 patients were enrolled in this study. There were 19 males and 60 females, the mean age was 83.8 ± 6.5 y.o., and 44 patients were affected by ESS. Affected patients showed higher NLR values (10.2 ± 9.4 vs. 6.9 ± 3.9; p= 0.001) and higher decrease in fT3 values in the 1st post-operative day (1.8 ± 0.4 vs. 2.2 ± 0.3; p= 0.001), higher values of PTH (97.9 ± 46.2 vs. 70.1 ± 36.2; p=0.004) and lower levels of Vitamin D (18.8 ± 7.8 vs. 23.5 ± 12.9; p= 0.04). As regards complications, we found them in 27% of patients in group A, while only in 8% in Group B, with a statistically significant difference (p= 0.03). ESS and NLR are promising prognostic markers in PFF in the elderly patients. If used together, they could help in the pre- and post-operative management of the patients.

Change in orthopedics and traumatology admissions during the COVID-19 pandemic at a university hospital in Turkey

Objective: The rapidly increasing cases of coronavirus disease 2019 (COVID-19) in Turkey required the reorganization of the health system. The first response to the pandemic in our university hospital was to stop elective surgery on March 30, 2020, minimize outpatient consultations and reduce the number of patients in the wards. To determine the change in the number of patients admitted to our hospital, we examined the data during the pandemic process and compared them with the data of the previous year. Methods: The number of patients admitted to Pamukkale University Orthopedics and Traumatology Outpatient Clinic and Emergency Service for orthopedic and trauma injuries between March 1, 2020 and October 31, 2020 was documented and compared with the data of the same period in 2019. Results: During the pandemic period, the number of emergency and outpatient orthopedics and traumatology admissions decreased significantly by 15% and 42.93% respectively (p&amp;lt;0.001). The highest decrease in outpatient admissions was in April 2020 with 79.29%, and the highest decrease in emergency admissions was in March 2020 with 31.35%. Conclusion: In conclusion, due to fear of getting infected, curfews, and decreased human mobility, there was a dramatic decrease in the number of hospital admissions between March 1, 2020, and October 31, 2020. The COVID-19 pandemic has impacted healthcare in many ways, putting some healthcare systems under great pressure and pushing others beyond their capacity. New strategies can be determined to ensure the continuity of health services and to maximize resources.

Estimating the burden of diseases attributable to lead exposure in the North Africa and Middle East region, 1990–2019: a systematic analysis for the Global Burden of Disease study 2019

BackgroundLead exposure (LE) and its attributable deaths and disability-adjusted life years (DALYs) have declined in the recent decade; however, it remains one of the leading public health concerns, particularly in regions with low socio-demographic index (SDI) such as the North Africa and Middle East (NAME) region. Hence, we aimed to describe the attributable burden of the LE in this region.MethodsData on deaths, DALYs, years of life lost (YLLs), and years lived with disability (YLDs) attributable to LE in the NAME region and its 21 countries from 1990 to 2019 were extracted from the Global Burden of Disease (GBD) 2019 study.ResultsIn 2019, the age-standardized death and DALY rates attributable to LE were 23.4 (95% uncertainty interval: 15.1 to 33.3) and 489.3 (320.5 to 669.6) per 100,000 in the region, respectively, both of which were higher among men than women. The overall age-standardized death and DALY rates showed 27.7% and 36.8% decreases, respectively, between 1990 and 2019. In this period, Bahrain, the United Arab Emirates, and Turkey had the highest decreases in the age-standardized death and DALY rates, while Afghanistan, Egypt, and Yemen had the lowest ones. Countries within high SDI quintile had lower attributable burden to LE compared with the low SDI quintile. Cardiovascular diseases and chronic kidney diseases accounted for the 414.2 (258.6 to 580.6) and 28.7 (17.7 to 41.7) LE attributable DALYs per 100,000 in 2019, respectively. The attributable YLDs was 46.4 (20.7 to 82.1) per 100,000 in 2019, which shows a 25.7% reduction (-30.8 to -22.5%) over 1990–2019.ConclusionsThe overall LE and its attributed burden by cause have decreased in the region from 1990–2019. Nevertheless, the application of cost-effective and long-term programs for decreasing LE and its consequences in NAME is needed.

Covalent Organic Framework (C6N6) as a Drug Delivery Platform for Fluorouracil to Treat Cancerous Cells: A DFT Study.

Continuous studies are being carried out to explore new methods and carrier surfaces for target drug delivery. Herein, we report the covalent triazine framework C6N6 as a drug delivery carrier for fluorouracil (FU) and nitrosourea (NU) anti-cancer drugs. FU and NU are physiosorbed on C6N6 with adsorption energies of -28.14 kcal/mol and -27.54 kcal/mol, respectively. The outcomes of the non-covalent index (NCI) and quantum theory of atoms in molecules (QTAIM) analyses reveal that the FU@C6N6 and NU@C6N6 complexes were stabilized through van der Waals interactions. Natural bond order (NBO) and electron density difference (EDD) analyses show an appreciable charge transfer from the drug and carrier. The FU@C6N6 complex had a higher charge transfer (-0.16 e-) compared to the NU@C6N6 complex (-0.02 e-). Frontier molecular orbital (FMO) analysis reveals that the adsorption of FU on C6N6 caused a more pronounced decrease in the HOMO-LUMO gap (EH-L) compared to that of NU. The results of the FMO analysis are consistent with the NBO and EDD analyses. The drug release mechanism was studied through dipole moments and pH effects. The highest decrease in adsorption energy was observed for the FU@C6N6 complex in an acidic medium, which indicates that FU can easily be off-loaded from the carrier (C6N6) to a target site because the cancerous cells have a low pH compared to a normal cell. Thus, it may be concluded that C6N6 possesses the therapeutic potential to act as a nanocarrier for FU to treat cancer. Furthermore, the current study will also provide motivation to the scientific community to explore new surfaces for drug delivery applications.

Resilience and life quality of health professionals in capital of Turkey during COVID-19 pandemic

Abstract Background COVID-19 pandemic has had significant effects on physical and mental health of health professionals. It is thought that resilience protects individuals against mental illness and helps individuals cope with difficulties and stress more effectively. In this study, it was aimed to evaluate resilience, life quality and related factors of health professionals during COVID-19 pandemic. Methods A cross-sectional study was performed among health professionals working at a tertiary hospital in Turkey’s capital Ankara. An occupation based stratified sampling was done with taking alpha 0.05 and 1-beta 0.80. A questionnaire that consists of sociodemographic information, COVID-19 Impact on Quality of Life Scale and Connor Davidson Resilience Scale was used to collect data. The results of scales were divided into two parts by taking the median values as cut off points. Descriptive/inferential statistics and logistic regression were performed on IBM’s SPSS 27.0 program. Results A total of 987 participants were surveyed. 66% of them were female, and the average age was 36. Multivariate logistic regression analysis results that physicians (OR:1.48, 95% CI:1.05-2.07, p = 0.024) and nurses (OR:1.46, 95% CI:1.08-1.97, p = 0.013) have lower resilience. The impact of COVID-19 on quality of life was higher for the following groups; physicians (OR:2.07, 95% CI:1.43-3, p &amp;lt; 0.001), nurses (OR:1.61, 95% CI:1.10-2.36, p = 0.013), who have bachelor/higher degrees (OR: 1.54,95% CI: 1.02-2.31,p=0.038), infected with COVID-19 (OR:1.33, 95% CI:1.02-1.74, p = 0.034), have COVID-19 related relative lost (OR:1.42, 95% CI:1.06-1.89, p = 0.016), and live with risk groups (OR:1.31, 95% CI:1.01-1.71, p = 0.042). Conclusions Physicians and nurses who take care of patients one-on-one have lower resilience and higher decrease in life quality due to COVID-19 impacts. This result indicates a significant quality drop in health services is inevitable during pandemics and should be considered by the policy makers. Key messages • Policies should be developed to increase the resilience of healthcare professionals so that they can effectively combat public health emergencies such as COVID-19 and not affect their quality of life. • It is necessary to determine risk groups among health workers and plan training programs to increase resilience.

The impact of SARS-CoV-2 on emergency health care in a referral acute-care center in northern Italy

Abstract To assess how SARS-CoV-2 has changed the demand for in-person health care, we retrospectively analyzed data on access to the emergency department (ED) of San Martino Hospital, the referral acute-care center in the Liguria region (Northwest Italy). 181,699 records of patients diagnosed with an ICD-9 code between 2019 and 2021 were considered. In comparison to pre-pandemic levels, following the introduction of social distancing measures, the median number of ED visits declined by 41.4% in 2020 and by 28.1% in 2021. The period of maximum drop in access (-58.6%) corresponded to the 2020 11-12th calendar weeks and coincided with the highest rates of COVID-like illness - defined as either ILI or LRTI cases - identified through an operator-dependent syndromic surveillance system (+340%; 19.5% of total ED attendances). In terms of relative impact, in 2020 and 2021 non-urgent ED codes decreased (by 6.7% and 7.3%) and both urgent and emergency ED codes increased (by 4.8% and 3.8% the former; 5.5% and 8.8% the latter), even so, the absolute number of ED access fell drastically for all codes. Urgent codes, in particular, experienced the most severe decrease, shifting from a pre-pandemic value of 25,009 to 18,826 in 2020 and 19,528 in 2021. With regards to diagnosis, in 2020, respiratory infections saw the highest increase (+3.3%) while traumas and eye diseases saw the highest decrease (-1.1% and -3.8%, respectively). This trend reversed in 2021 during which respiratory infections decreased (-2.2%) and traumas increased (+2.2%). Despite the admissions of males and the elderly being routinely lower, these categories experienced the greatest increase in access for respiratory infections: +3.9% and +10.1% in 2020; +2.8% and +7.4% in 2021. While reduction of non-urgent ED visits indicates that the high pre-pandemic access levels may have been avoidable, the significant decline in non-COVID-19 urgent accesses potentially points to an increase in delayed and missed care. Key messages • During the COVID-19 pandemic – possibly due to fear and underestimation of symptoms – there was an overall reduction in ED accesses that potentially points to an increase in delayed or missed care. • The reduction in non-urgent attendances indicates that high pre-pandemic accesses may have been avoidable and that a reduction in unnecessary ED visits is an attainable goal for healthcare systems.

Influence of hyaluronic acid on intra-articular friction – a biomechanical study in whole animal joints

BackgroundCartilage is a mechanically highly stressed tissue in the human body and an important part of synovial joints. The joint cartilage is lubricated by synovial fluid with hyaluronic acid (HA) as main component. However, in joints with osteoarthritis HA has a lower concentration and molecular weight compared to healthy joints. In recent years, the intra-articular injection of therapeutic HA lubricant, has become a popular therapy. The effect of HA application on the friction of a complete joint with physiological movement needs to be further determined.MethodsThe aim of the present study was to evaluate the lubrication effect of the joint by three lubricants (NaCl, fetal calf serum (FCS) and HA) and their effect on the friction in nine complete ovine carpo-metacarpal joints. The joints were mounted on a material testing machine and a physiological movement with 10° rotation was simulated with ascending axial load (100 – 400 N). Specimens were tested native, with cartilage damage caused by drying out and relubricated. Dissipated energy (DE) as a measure of friction was recorded and compared.ResultsInvestigating the effect of axial load, we found significant differences in DE between all axial load steps (p < .001), however, only for the defect cartilage. Furthermore, we could document an increase in DE from native (Mean: 15.0 mJ/cycle, SD: 8.98) to cartilage damage (M: 74.4 mJ/cycle, SD: 79.02) and a decrease after relubrication to 23.6 mJ/cycle (SD: 18.47). Finally, we compared the DE values for NaCl, FCS and HA. The highest values were detected for NaCl (MNorm = 16.4 mJ/cycle, SD: 19.14). HA achieved the lowest value (MNorm = 4.3 mJ/cycle, SD: 4.31), although the gap to FCS (MNorm = 5.1 mJ/cycle, SD: 7.07) was small.ConclusionsWe were able to elucidate three effects in joints with cartilage damage. First, the friction in damaged joints increases significantly compared to native joints. Second, especially in damaged joints, the friction increases significantly more with increased axial load compared to native or relubricated joints. Third, lubricants can achieve an enormous decrease in friction. Comparing different lubricants, our results indicate the highest decrease in friction for HA.

A rapid assessment of the impact of the 2020 “ENDSARS” protests and political unrest on weekly TB notification in Southwest Nigeria

Background: The “ENDSARS” protest was a 3-week national protest staged by angry Nigerian youths to demand an end to brutality of the Special Anti-robbery Squad (SARS) unit of the Nigeria Police Force in October 2020. It is well reported that crises and armed conflicts have a negative impact on tuberculosis (TB) surveillance and case notifications. We aimed to analyze the impact of the political unrest caused by “ENDSARS” conflict on weekly TB notification and overall TB cascade performance. Methods: A retrospective review of weekly notification data across over 300 health facilities and 103 local government areas participating in active TB case findings in Lagos, Oyo, Ogun, and Osun States, all in Southwest Nigeria. TB cascade data (outpatient department (OPD) attendance, screening, presumptive TB, evaluation, and notification) were aggregated from relevant TB registers, entered into Microsoft Excel, and descriptively analyzed. Percentage increase or decrease in cascade and notification data were compared 3 weeks before and after the onset of the conflict. Results: OPD visits declined from 140,886 to 130,788. TB screening declined from a total of 146,955 to 136,348 while the number of TB diagnostic evaluation declined from 6567 to 5624 from the 3 weeks before to the 3 weeks following the ENDSARS protest. TB notification declined across states (with the exception of Oyo state) and intervention types from 3 weeks before the “ENDSARS” protests to 3 weeks following the onset of the protests. Highest decreases, −27% from 174 to 137, were observed in community interventions, bacteriologically diagnosed declined by −20% from 599 to 481, and in Osun state by −26% from 65 to 48. There was a significant increase in clinical diagnosis, + 58% from 99 in the 3 weeks before to 156 during the 3 weeks of the protest. Conclusion: There is an urgent need for national capacity building on TB program preparedness in crises, with emphasis on how national and sub-national governments, hospitals, and communities could anticipate and respond effectively, thus maintaining the minimum package of TB care in conflict.

4-Arylthiosemicarbazide derivatives – Pharmacokinetics, toxicity and anti-Toxoplasma gondii activity in vivo

The increasing resistance of Toxoplasma gondii to drugs and side effects of therapy indicate that specific treatment for these parasites is still needed. The 4-arylthiosemicarbazide derivatives seem to be a solution to this challenge because they have low cytotoxicity against host cells and high anti-T. gondii activity. The molecular mechanism for these compounds is related to the inhibition of tyrosine amino acids involved in the proliferation and parasitophorous vacuole formation. The pharmacokinetic analysis shows that 1-(4-Methylimidazol-5-oyl)-4-(4-nitrophenyl)thiosemicarbazide and 4-(3-Iodophenyl)-1-(4-methylimidazol-5-oyl)thiosemicarbazide administered intragastrically pass into the bloodstream and cross the blood–brain barrier, and the absorption of both compounds is first-order absorption. Toxicity analysis shows that our derivatives possess lower toxicity than the routinely used drugs trimethoprim, sulfadiazine and pyrimethamine, as was observed in the level of liver enzymes and creatinine. Both derivatives are highly potent antiparasitic agents against T. gondii, prolonged survival and cure parasite-infected mice. Additionally, significant reductions in cyst formation in the brain and heart were observed, but the highest decreases were noted in muscle and the level of bradyzoites was similar to these observed in mice treated with commercially used drugs. Collectively, the obtained results support the conclusion that both compounds are highly efficacious in a mouse model of acute and chronic toxoplasmosis.

Land cover change detection in the Turkish coastal zone based on 28-year (1990-2018) Corine data.

In this research, land cover changes in the coastal region of Turkey were analyzed using the Corine dataset between 1990 and 2018. Changes in each period were analyzed by using the rate of change and the annual rate of change, the transition matrix of net changes, and the transition probability matrix. In order to predict land cover change trends and to determine future land cover change probabilities, a combination of Markov and cellular automata models was used. It was determined that the highest increase in each study period was in artificial surfaces and the highest decrease was in the forest and the semi-natural area. The total forest areas were converted to the other land cover type in the first study period amounting to 2479.32 km2. Also, it was decreased and transformed by about 62.47 km2, 118.82 km2, and 203.09 km2 of the forest area that existed in the second, third, and fourth periods respectively. The results indicate that the probabilities of the increasing area will be covered by artificial surfaces and agricultural areas. It is estimated that the rate of 57% in 1990, the initial year of the forest areas, will decrease to 53.4% in 2034 and to 53% in 2050. Also, the rate of 2.1% in 1990, the initial year of the artificial surfaces, will increase to 4.5% in 2034 and to 5.0% in 2050. It is seen that more artificial surfaces will be needed in the Turkish coastal region due to the increasing population and number of tourists. It is important to evaluate and investigate the coastal areas where more artificial areas are expected to be needed within the scope of the coastal area management plans to be prepared at the national scale.