Search

Bipolar affective disorder includes Bipolar Disease (BD) and Bipolar Spectrum Disorder (BSD). The prevalence of BSD, BD-I, BD-II, and subthreshold BD globally is estimated to be about 3.1%, 1.5%,0.03%, and 1.6%, respectively. BD is a multidimensional disease that exhibits a range of moods of mania, hypomania, and depression. The disease is chronic, complex, and fatal, with a high possibility of reappearance, infirmity, social incompetence, and felo-de-se. Managing emotional disruption, negative neuropsychology, physiology, and immunology is a challenge. This review focuses on therapeutic benefits, adverse drug reactions, and pharmacological intervention for BD and BSD, in particular lithium. Long-term management of BD with a single medication is ineffective and therefore, not recommended. It is advised to use multiple agents for treatment instead. Medications include mood stabilizers (lithium and anticonvulsants), atypical antipsychotics, and antidepressants. Along with medication provision, psychotherapy is of great significance for BD patients. The review was conducted on recent available scientific literature through the electronic database like Embase, ScienceDirect, Google Scholar, and PubMed using keywords like 'Bipolar Disease,' 'Bipolar Disease Therapeutics,' 'Bipolar Disease and Psychotherapy' to highlight the possible effective means of management of this disease of mood instability., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kamal et al.)

All humans and animals need access to clean water in their daily lives. Unfortunately, we are facing water scarcity in several places around the world, and, intentionally or unintentionally, we are contaminating the water in a number of ways. The rise in population, globalization, and industrialization has simultaneously given rise to the generation of wastewater. The pollutants in wastewater, such as organic contaminants, heavy metals, agrochemicals, radioactive pollutants, etc., can cause various ailments as well as environmental damage. In addition to the existing pollutants, a number of new pollutants are now being produced by developing industries. To address this issue, we require some emerging tools and materials to remove effluents from wastewater. Zeolites are the porous aluminosilicates that have been used for the effective pollutant removal for a long time owing to their extraordinary adsorption and ion-exchange properties, which make them available for the removal of a variety of contaminants. However, zeolite alone shows much less photocatalytic efficiency, therefore, different photoactive materials are being doped with zeolites to enhance their photocatalytic efficiency. The fabrication of zeolite-based composites is emerging due to their powerful results as adsorbents, ion-exchangers, and additional benefits as good photocatalysts. This review highlights the types, synthesis and removal mechanisms of zeolite-based materials for wastewater treatment with the basic knowledge about zeolites and wastewater along with the research gaps, which gives a quality background of worldwide research on this topic for future developments.

Aim The study aimed to clinically and radiographically evaluate the effect of biphasic calcium phosphate (BCP) versus demineralized freeze-dried bone allograft (DFDBA) in treating periodontal disease. Method The study consisted of 44 patients. The sites were randomly assigned to receive one of two treatment modalities (BCP at site 1 and demineralized freeze-dried bone at site 2) by a computerized method. All the clinical data were measured with the help of a University of North Carolina-15 (UNC-15) probe at the baseline, three months, and six months postoperatively. Radiovisiographs were taken using a Rinn XCP® (Dentsply/Rinn Corp, Elgin, IL) system and an oral grid using the paralleling technique. A manual calculation of the defect area was undertaken at the end of six months and was compared with the other groups. Result The linear bone growth recorded for site 1 at the end of six months was 3.8 ± 1.14 mm, and site 2 was 4.6 ± 1.07 mm. The intergroup comparison showed more remarkable linear bone growth in site 2, which was statistically insignificant, with a mean difference of 0.8 ± 1.23 mm and a p -value of 0.07. Conclusion Improvements were observed on all the documented parameters. However, the sites treated with DFDBA showed better periodontal regeneration., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kumar et al.)

Chlorobenzenes (CBs) are persistent and potentially have a carcinogenic effect on mammals. Thus, the determination of CBs is essential for human health. Hence, in this study, novel polyurethane−polysulfone/calix[4]arene (PU-PSU/calix[4]arene) nanofibers were synthesized using an electrospinning approach over in-situ coating on a stainless-steel wire. The nanosorbent was comprehensively characterized using scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FT-IR) techniques. The SEM analysis depicted the nanofiber’s unique morphology and size distribution in the range of 50−200 nm. To determine the levels of 1,2,4-trichlorobenzene, 1,2,3-trichlorobenzene, and 1,2,3,4-tetrachlorobenzene in water samples, freshly prepared nanosorbent was employed using headspace-solid phase microextraction (HS-SPME) in combination with gas chromatography micro electron capture detector (GC-µECD). Other calixarenes, such as sulfonated calix[4]arene, p-tert-calixarene, and calix[6]arene were also examined, and among the fabricated sorbents, the PU−PSU/calix[4]arene showed the highest efficiency. The key variables of the procedure, including ionic strength, extraction temperature, extraction duration, and desorption conditions were examined. Under optimal conditions, the LOD (0.1−1.0 pg mL−1), the LDR (0.4−1000 pg mL−1), and the R2 > 0.990 were determined. Additionally, the repeatability from fiber to fiber and the intra-day and inter-day reproducibility were determined to be 1.4−6.0, 4.7−10.1, and 0.9−9.7%, respectively. The nanofiber adsorption capacity was found to be 670−720 pg/g for CBs at an initial concentration of 400 pg mL−1. A satisfactory recovery of 80−106% was attained when the suggested method’s application for detecting chlorobenzenes (CBs) in tap water, river water, sewage water, and industrial water was assessed., Competing Interests: The authors declare no conflict of interest.

Insulin resistance (IR) is stated as diminished insulin action regardless of hyperinsulinemia. The usual target organs for insulin activities are the liver, skeletal muscle, and adipose tissue. Hence, the vasculature and kidneys are nonconventional target organs as the impacts of insulin on these are comparatively separate from other conventional target organs. Vasodilation is achieved by raising endothelial nitric oxide (NO) generation by initiating the phosphoinositide 3-kinase (PI3K) pathway. In insulin-nonresponsive conditions, this process is defective, and there is increased production of endothelin-1 through the mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK) pathway, which predominates the NO effects, causing vasoconstriction. Renal tubular cells and podocytes have insulin receptors, and their purposeful importance has been studied, which discloses critical acts of insulin signaling in podocyte survivability and tubular action. Diabetic nephropathy (DN) is a prevalent problem in individuals with hypertension, poor glycemic management, hereditary susceptibility, or glomerular hyperfiltration. DN could be a significant contributing factor to end-stage renal disease (ESRD) that results from chronic kidney disease (CKD). IR and diabetes mellitus (DM) are the constituents of syndrome X and are accompanied by CKD progression. IR performs a key part in syndrome X leading to CKD. However, it is indistinct whether IR individually participates in enhancing the threat to CKD advancement rather than CKD complexity. CKD is an extensive public health problem affecting millions of individuals worldwide. The tremendous spread of kidney disease intensifies people's health impacts related to communicable and noncommunicable diseases. Chronic disease regulator policies do not include CKD at global, local, and/or general levels. Improved knowledge of the character of CKD-associated problems might aid in reforming diagnosis, prevention, and management., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Sinha et al.)

A new solid phase micro extraction (SPME) fiber coating composed of electrospun polyethylene terephthalate (PET) nanofibrous mat doped with superhydrophobic nanosilica (SiO2) was coated on a stainless-steel wire without the need of a binder. The coating was characterized by scanning electron microscopy (SEM) and Fourier transform infrared spectrometer (FTIR) techniques and it was used in headspace-SPME of 16 organochlorine pesticides in water samples prior to gass chromatography micro electron capture detector (GC-µECD) analysis. The effects of main factors such as adsorption composition, electrospinning flow rate, salt concentration, extraction temperature, extraction time, and desorption conditions were investigated. Under the optimum conditions, the linear dynamic range (8−1000 ng L−1, R2 > 0.9907), limits of detection (3−80 ng L−1), limits of quantification (8−200 ng L−1), intra-day and inter-day precisions (at 400 and 1000 ng L−1, 1.7−13.8%), and fiber-to-fiber reproducibility (2.4−13.4%) were evaluated. The analysis of spiked tap, sewage, industrial, and mineral water samples for the determination of the analytes resulted in satisfactory relative recoveries (78−120%).

Regular intake of ready-to-eat meals is related to obesity and several noninfectious illnesses, such as cardiovascular diseases, hypertension, diabetes mellitus (DM), and tumors. Processed foods contain high calories and are often enhanced with excess refined sugar, saturated and trans fat, Na + andphosphate-containing taste enhancers, and preservatives. Studies showed that monosodium glutamate (MSG) induces raised echelons of oxidative stress, and excessive hepatic lipogenesis is concomitant to obesity and type 2 diabetes mellitus (T2DM). Likewise, more than standard salt intake adversely affects the cardiovascular system, renal system, and central nervous system (CNS), especially the brain. Globally, excessive utilization of phosphate-containing preservatives and additives contributes unswervingly to excessive phosphate intake through food. In addition, communities and even health experts, including medical doctors, are not well-informed about the adverse effects of phosphate preservatives on human health. Dietary phosphate excess often leads to phosphate toxicity, ultimately potentiating kidney disease development. The mechanisms involved in phosphate-related adverse effects are not explainable. Study reports suggested that high blood level of phosphate causes vascular ossification through the deposition of Ca 2+ and substantially alters fibroblast growth factor-23 (FGF23) and calcitriol., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Sinha et al.)

Medical education is changing at a fast pace. Students attend medical school with a high degree of technological literacy and a desire for a diverse educational experience. As a result, a growing number of medical schools are incorporating technology-enhanced active learning and multimedia education tools into their curriculum. Gamified training platforms include educational games, mobile medical apps, and virtual patient scenarios. We provide a systematic review of what is meant by gamification in this era. Specific educational games, mobile apps, and virtual simulations that may be used for preclinical and clinical training have been discovered and classified. The available data were presented in terms of the recognized platforms for medical education's possible benefits. Virtual patient simulations have been shown to enhance learning results in general. Gamification could improve learning, engagement, and cooperation by allowing for real-world application. They may also help with promoting risk-free healthcare decision-making, remote learning, learning analytics, and quick feedback. We account for Preclinical training which included 5 electronic games and 4 mobile apps, while clinical training included 5 electronic games, 10 mobile applications, and 12 virtual patient simulation tools. There were additionally nine more gamified virtual environment training products that were not commercially accessible. Many of these studies have shown that utilizing gamified media in medical education may confer advantages. This collection of hyperlinked resources may be utilized by medical students, practitioners, and instructors at all levels., (© 2022 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

Objectives: Listening to or memorizing the Quran has been suggested to affect the psychosocial health and well-being of Muslims. Muslims who memorized Quran have a higher quality of life (QoL) and lower anxiety and stress. Hence, this systematic review was conducted to evaluate the studies that assessed the effect of listening to, reciting, or memorizing the Quran on physical and mental health. Methods: This review was performed on articles published from the inception and April 2021. Databases including ProQuest, PubMed and Web of Science were searched on 19 April 2021. Keywords such as "Quran", "al- Quran," "al- Kareem," "Holy Quran," "memori," "Tahfiz," "Huffaz," "listening" and "reciting" were used for databases searching. The risk of bias was assessed using Cochrane risk of bias tool and Joanna Briggs Institute (JBI). Only 20 articles were included in data synthesis out of a total of 230. Results: The findings revealed that listening to, reciting or memorizing the Quran had a favorable effect on depression, anxiety, physiologic parameters, quality of life, quality of sleep and intelligence quotient. Conclusion: The current evidence suggests that, listening to, reciting or memorizing the Quran may be useful as an intervention to improve physical and mental health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Che Wan Mohd Rozali, Ishak, Mat Ludin, Ibrahim, Abd Warif and Che Roos.)

In this study, we propose a new method to detect outlying observations in spherical data. The method is based on the k-nearest neighbours distance theory. The proposed method is a good alternative to the existing tests of discordancy for detecting outliers in spherical data. In addition, the new method can be generalized to identify a patch of outliers in the data. We obtain the cut-off points and investigate the performance of the test statistic via simulation. The proposed test performs well in detecting a single and a patch of outliers in spherical data. As an illustration, we apply the method on an eye data set., Competing Interests: The authors have declared that no competing interests exist.

Lubrication has become essential in enhancing engine efficiency in the era of rapid globalising. The tribological, oxidation and thermal conductivity properties of an engine oil play a vital role in improving the quality of a vehicle's engine life. In this research, molybdenum disulfide (MoS 2 ) nanoparticle was synthesised via a microwave hydrothermal reactor. Later, the nanoparticles were dispersed in SAE 20W50 diesel engine oil to formulate the nanolubricant. The results show that nanolubricant with 0.01 wt% MoS 2 concentration showed the coefficient of friction, average wear scar diameter decreased by 19.24% and 19.52%, respectively, compared to the base oil. Furthermore, the nanolubricant with 0.01 wt% concentration of MoS 2 nanoparticle showed an enhancement of 61.15% in oxidation induction time in comparison to the base oil. Furthermore, MoS 2 addition within the base oil demonstrates a ~ 10% improvement in thermal conductivity compared to the base oil., (© 2022. The Author(s).)

Atopic dermatitis (AD) is a long-lasting inflammatory dermatological condition characterized by itchy, eczematous, sparsely tiny blisters that hold a clear watery substance. Additionally, the diseased skin can suppurate, occasionally with weeping with thickening of the affected skin. This is considered one of the top skin disorders involving both children and adult populations globally. The principal therapeutic intervention for AD is long-standing topical glucocorticoids, which have been used for several decades. Corticosteroid therapy brings several adverse drug effects (ADRs), including irreversible skin atrophy. Tacrolimus belongs to the class of calcineurin inhibitors, which is a type of immunomodulator possessing promising efficacy in treating AD. Topical tacrolimus is an effective and safe non-corticosteroid substitute treatment for AD. We reviewed the available literature to compare and institute the safety, efficacy, and effectiveness of tacrolimus when equated to corticosteroid therapy in managing AD., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Umar et al.)

Background: Patients with β-thalassemia major (β-TM), a genetic issue due to hemoglobin (Hb) synthesis disorder, require life-long erythrocyte transfusion. The purpose of this study is to evaluate and compare gingival pigmentation and skin color with serum ferritin levels of patients with β-TM, using the Dummett's oral pigmentation index (DOPI) and Fitzpatrick skin scale, respectively., Methods: A total of 100 patients were monitored at a thalassemia care center. Each patient's gingival pigmentation and skin color were matched with DOPI and the skin scale under natural light. Serum ferritin levels, the interval of blood transfusions, and iron chelation medications were studied. A gingival pigmentation score and skin color type were compared with the serum ferritin., Results: A significant correlation was found between age, serum ferritin, pigmentation score, and skin color, which means as serum ferritin level increases, gingival pigmentation score increases, and skin color darkens., Conclusion: This study evaluated the correlation between gingival pigmentation and skin color with serum ferritin levels and established gingival pigmentation as a sign of iron deposition in β-TM patients. This is the simplest and least invasive method for evaluating serum ferritin level parameters in β-TM patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Gajjar et al.)

Background: In the sacrococcygeal region, anatomical variation is due to the sacralization of the coccygeal vertebra, which is the due union of/fusion of the fifth sacral with the first coccygeal vertebra of five couples of sacral foramina under-detected or asymptomatic beyond radiological assessment. That is why it is challenging to know the cause of coccydynia, caudal block failure, the difficult second stage of labor, and perineal tears. The present study aims to improve knowledge about the anatomical variation of sacralization of the coccygeal vertebra. Additionally, to find the prevalence of sacralization of coccygeal vertebra in Sylhet, Bangladesh., Methods: This study was performed on 60 parched, totally calcified, typical sacra of mature-age individuals of undetermined sexes, fulfilling the inclusion criteria from the bone bank of the osteology museum of the Department of Anatomy, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh, from July 2017 to June 2018. Sex determination of the collected unknown sacra was conducted using discriminant function analysis. It was found that 50% (30) were male and 50% (30%) were female. The unpaired t -tests and chi-square were utilized to determine the statistical significance., Results: Out of 60 sacra, eight (13.33%) samples presented with sacralization. This study found that males had significantly higher straight (p=0.05) and curved (p=0.05) lengths of sacrococcygeal vertebrae. The sacrococcygeal curvature index (SCI) showed statistically significant (p=0.05) differences between the sexes., Conclusion: Sacralization may exert an impact on the caudal block. It could extend the second stage of the labor process with perineal tears. Therefore, knowledge about the anatomical variation of the coccygeal vertebra is essential., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Naznin et al.)

Introduction: There is a growing focus on researching the management of children with COVID-19 admitted to hospital, especially among developing countries with new variants alongside concerns with the overuse of antibiotics. Patient care can be improved with guidelines, but concerns with the continued imprudent prescribing of antimicrobials, including antibiotics, antivirals, and antimalarials., Objective: Consequently, a need to document the current management of children with COVID-19 across India. Key outcome measures included the percentage of prescribed antimicrobials, adherence to current guidelines, and mortality., Methodology: A point prevalence study using specially developed report forms among 30 hospitals in India., Results: The majority of admitted children were aged between 11 and 18 years (70%) and boys (65.8%). Reasons for admission included respiratory distress, breathing difficulties, and prolonged fever. 75.3% were prescribed antibiotics typically empirically (68.3% overall), with most on the Watch list (76.7%). There were no differences in antibiotic prescribing whether hospitals followed guidelines or not. There was also appreciable prescribing of antimalarials (21.4% of children), antivirals (15.2%), and antiparasitic medicines (27.2%) despite limited evidence. The majority of children (92.2%) made a full recovery., Conclusion: It was encouraging to see low hospitalization rates. However, concerns about high empiric use of antibiotics and high use of antimalarials, antivirals, and antiparasitic medicines exist. These can be addressed by instigating appropriate stewardship programs., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kumar et al.)

Introduction Gastrointestinal parasitic infections are one of the global health concerns in developing countries like Bangladesh. Among them, Cryptosporidium spp. plays an essential role in causing diarrhea, malnutrition, and poor cognitive function, especially in children. This study was conducted to identify the frequency of Cryptosporidium cases and other parasitic agents.  Methods A cross-sectional observational study was conducted among 219 hospitalized children with diarrhea. The conventional microscopic technique was applied for parasitic detection. Particular staining (modified Ziehl-Neelsen) procedure was performed to identify oocysts of Cryptosporidium spp . A polymerase chain reaction (PCR) was performed to determine the SSU rRNA and gp60 gene of Cryptosporidium.  Results Cysts of Giardia duodenalis (2.3%), ova of Ascaris lumbricoides (1.4%,), Trichuris trichiura (0.5%), and both A. lumbricoides and T. trichiura (0.9%) were identified in samples through wet mount preparation. The distribution of Cryptosporidium spp. as detected by the staining method and nested PCR was 1.4% and 4.1%, respectively.  Conclusion Factors independently associated with Cryptosporidium infection are unsafe water, lack of regular hand washing, and insufficiency of exclusive breastfeeding. This study reports, presumably for the first time, the detection of Cryptosporidium oocysts in Chattogram metropolitan city of Bangladesh., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Nipa et al.)

Acanthamoeba spp. are free living amoebae which can give rise to Acanthamoeba keratitis and granulomatous amoebic encephalitis. The surface of Acanthamoeba contains ergosterol which is an important target for drug development against eukaryotic microorganisms. A library of ten functionally diverse quinazolinone derivatives (Q1-Q10) were synthesised to assess their activity against Acanthamoeba castellanii T4. The in-vitro effectiveness of these quinazolinones were investigated against Acanthamoeba castellanii by amoebicidal, excystation, host cell cytopathogenicity, and NADPH-cytochrome c reductase assays. Furthermore, wound healing capability was assessed at different time durations. Maximum inhibition at 50 μg/mL was recorded for compounds Q5, Q6 and Q8, while the compound Q3 did not exhibit amoebicidal effects at tested concentrations. Moreover, LDH assay was conducted to assess the cytotoxicity of quinazolinones against HaCaT cell line. The results of wound healing assay revealed that all compounds are not cytotoxic and are likely to promote wound healing at 10 μg/mL. The excystation assays revealed that these compounds significantly inhibit the morphological transformation of A. castellanii. Compound Q3, Q7 and Q8 elevated the level of NADPH-cytochrome c reductase up to five folds. Sterol 14alpha-demethylase (CYP51) a reference enzyme in ergosterol pathway was used as a potential target for anti-amoebic drugs. In this study using i-Tasser, the protein structure of Acanthamoeba castellanii (AcCYP51) was developed in comparison with Naegleria fowleri protein (NfCYP51) structure. The sequence alignment of both proteins has shown 42.72% identity. Compounds Q1-Q10 were then molecularly docked with the predicted AcCYP51. Out of ten quinazolinones, three compounds (Q3, Q7 and Q8) showed good binding activity within 3 Å of TYR 114. The in-silico study confirmed that these compounds are the inhibitor of CYP51 target site. This report presents several potential lead compounds belonging to quinazolinone derivatives for drug discovery against Acanthamoeba infections., (Copyright © 2022. Published by Elsevier B.V.)

2D-WS 2 incorporated polyaniline nanocomposites (WS 2 -PANI) with varying WS 2 loadings were synthesized by a facile in situ oxidative polymerization technique which effectively promoted photocatalytic waste-water remediation using methylene blue (MB) as the probe molecules. The physicochemical properties of WS 2 -PANI (1-5) nanocomposites were investigated using multifarious techniques such as FT-IR, XRD, BET surface area, TGA, FESEM, and HRTEM. An electron microscopy analysis that was performed using HRTEM analysis confirm the layered structure of WS 2 with periodic planes (100) separated by 0.27 nm. The photocatalytic performance of the WS 2 -PANI (1-5) for MB degradation performed under UV photo irradiation clearly showed that 2 wt.% WS 2 -PANI outperformed other variants with 93% degradation MB within 90 min. Furthermore, the catalytic material was reusable for five cycles without a significant loss of the catalytic performance.

The unique structures and multifunctionalities of two-dimensional (2D) nanomaterials, such as graphene, have aroused increasing interest in the construction of novel scaffolds for biomedical applications due to their biocompatible and antimicrobial abilities. These two-dimensional materials possess certain common features, such as high surface areas, low cytotoxicities, and higher antimicrobial activities. Designing suitable nanocomposites could reasonably improve therapeutics and reduce their adverse effects, both medically and environmentally. In this study, we synthesized a biocompatible nanocomposite polyhydroxyalkanoate, chitosan, and tungsten disulfide (PHA/Ch-WS 2 ). The nanocomposite PHA/Ch-WS 2 was characterized by FESEM, elemental mapping, FTIR, and TGA. The objective of this work was to investigate the antimicrobial activity of PHA/Ch-WS 2 nanocomposites through the time-kill method against the multi-drug-resistant model organisms Escherichia coli ( E. coli ) K1 and methicillin-resistant Staphylococcus aureus (MRSA). Further, we aimed to evaluate the cytotoxicity of the PHA/Ch-WS 2 nanocomposite using HaCaT cell lines by using a lactate dehydrogenase (LDH) assay. The results demonstrated very significant bactericidal effects of the PHA/Ch-WS 2 nanocomposite, and thus, we hypothesize that the nanocomposite would feasibly suit biomedical and sanitizing applications without causing any adverse hazard to the environment.

Background: Health policy is a set of comprehensive principles and legislations that guide how healthcare should be effectively delivered in the community. Medical schools should prepare students to undertake managerial responsibilities by incorporating health policy into the curriculum to deal with the intricacies of healthcare systems and their clinical roles in their future professional careers., Objective: To examine medical students' perception at a Public University in Malaysia regarding teaching health policy and their participation in health policy roles., Material and Methods: A cross-sectional study using universal sampling was carried out among the medical students using a paper-based questionnaire to collect the data., Results: Most respondents opined their willingness to learn health policy (80.9%) and that teaching health policy (83.6%) should be compulsory for medical students. The respondents thought health policy should be introduced earlier in Year 1 or 2. The student scores on their knowledge regarding health policy and year of study were significantly associated with their involvement in the health policy roles in both the simple and multiple logistic regression. Both statistical tests reported higher participation in health policy roles with the higher year of study, though only Year 4 and 5 were significant in the simple logistic regression and only Year 5 in the multiple logistic regression compared to Year 1. On the other hand, age and type of admission show significant results only in the simple logistic regression, while the race was only significant at the multivariate level., Conclusions: This study demonstrated that most respondents showed their willingness to learn health policy, participate in the health policy programs, and recommend that health policy be considered an essential topic in the medical curriculum, which should be taught right from the first year of medical school. We recommend encouraging students' participation in health policy activities.

Water is a vital resource that is required for social and economic development. A rapid increase in industrialization and numerous anthropogenic activities have resulted in severe water contamination. In particular, the contamination caused by heavy metal discharge has a negative impact on human health and the aquatic environment due to the non-biodegradability, toxicity, and carcinogenic effects of heavy metals. Thus, there is an immediate need to recycle wastewater before releasing heavy metals into water bodies. Hydrogels, as potent adsorbent materials, are a good contenders for treating toxic heavy metals in wastewater. Hydrogels are a soft matter formed via the cross-linking of natural or synthetic polymers to develop a three-dimensional mesh structure. The inherent properties of hydrogels, such as biodegradability, swell-ability, and functionalization, have made them superior applications for heavy metal removal. In this review, we have emphasized the recent development in the synthesis of hydrogel-based adsorbent materials. The review starts with a discussion on the methods used for recycling wastewater. The discussion then shifts to properties, classification based on various criteria, and surface functionality. In addition, the synthesis and adsorption mechanisms are explained in detail with the understanding of the regeneration, recovery, and reuse of hydrogel-based adsorbent materials. Therefore, the cost-effective, facile, easy to modify and biodegradable hydrogel may provide a long-term solution for heavy metal removal.

Background: Worldwide, microbes are becoming more challenging by acquiring virulent skills to adapt and develop antimicrobial resistance (AMR). This is a concern as AMR increases morbidity, mortality, and costs. Consequently, physicians need to be trained on appropriate antimicrobial prescribing, starting as medical students., Objective: To evaluate medical students' confidence in antimicrobial prescribing and AMR., Methods: Cross-sectional study assessing medical students' knowledge, perception, and confidence in prescribing antimicrobials and AMR in a Malaysian University. A universal sampling method was used., Results: Most responding students believed that educational input regarding overall prescribing was sufficient. Regarding the principle of appropriate and accurate prescriptions, female medical students had less knowledge (odds ratio (OR) = 0.51; 95% confidence interval (CI) 0.25-0.99; p = 0.050). Year-IV and Year-V medical students had more excellent knowledge than Year-III students regarding confidence in potential antibiotic prescribing once qualified. Year-V students also showed an appreciably higher confidence in the broad principles of prescribing, including antibiotics for infectious diseases, compared to those in other years., Conclusion: Overall, medical students gain more knowledge and confidence regarding the potential prescribing of antimicrobials as their academic careers progress. This is important given concerns with the current excessive use of antimicrobials in Malaysia.

The purpose of this research was to establish the optimal recovery duration following a pre-load stimulus on performance measures related to handball players. Seventeen senior male University handball players (mean ± SD: age 23.6 ± 2.3 yrs., height 1.79 ± 0.06 m and body mass 72.5 ± 10.7 kg) performed three experimental sessions. All sessions consisted of a standardised warm-up followed by a pre-load stimulus (HSR) back squats followed by a passive rest for either 4-min (PAP4), 8-min (PAP8), or 12-min (PAP12). Following the completion of the passive recovery, players then performed a countermovement jump (CMJ), a 20-m linear sprint and a modified agility t-test. The significance level was set at P < 0.05. There was a significant main effect of passive rest duration after the pre-load stimulus. The PAP12 condition improved CMJ scores (2.3-2.6%; effect size = small), 20-m linear sprint times (3.3-3.7%; effect size = small to moderate) and agility times (1.6-1.9%; effect size = trivial) compared to PAP4 and PAP8 conditions (P < 0.0005). Values of heart rate and rating of perceived exertion were also significantly lower during the PAP12 condition compared to the PAP4 and PAP8 conditions (P < 0.0005). A positive Pearson correlation was established between agility and CMJ for all conditions (P < 0.001). The findings provide novel data observing that a pre-load stimulus, followed by 12-min of recovery, results in greater maximal jump, sprint and agility measures when compared with a 4-min or 8-min recovery in male handball players., Competing Interests: The authors have declared that no competing interests exist.

Background: Injury prevalence data, muscle strength, and fatiguability differ between males and females. In addition, arm spatial orientation affects muscle activation and strength of the shoulder muscles. Nevertheless, little research has been conducted in relation to the shoulder rotator muscles comparing men and women. Therefore, the main aim of of this study was to perform a comparative investigation between two arm spatial orientations (45° and 90° of abduction in the frontal plane) during a fatigue assessment of the internal rotator (IR) and external rotator (ER) shoulder muscles. Secondly, the interaction between sex and dominance with muscular performance was assessed., Methods: Forty healthy sedentary participants, 20 males and 20 females took part in this study. Participants performed a fatigue resistance protocol consisting of 30 consecutive maximal concentric contractions of the IR and ER shoulder muscles in a supine position at a speed of 180°/s. The upper limb was abducted to an angle of 45° or 90° in the frontal plane and each participant was tested on the dominant and nom-dominant side, counterbalanced in order of administration. Performance measures of Induced Fatigue (IF; %), Cumulated Performance (C.Perf; J) and Best Repetition (BR; J) were calculated and used for analysis. IF represents the % difference between the amount of work done over the last 3 and first 3 repetitions, BR represents the largest amount of work done during a single contraction, and C.Perf represents the total amount of work done during all repetitions., Results: Muscle group was the only factor to display significant variation when not considering other factors, with higher values for C.Perf (mean difference = 353.59 J, P < 0.0005), BR (mean difference = 14.21 J, P < 0.0005) and IF (mean difference = 3.65%, P = 0.0046). There was a significant difference between both angles, with higher values observed at 90° compared to 45° of abduction for C.Perf by ~ 7.5% (mean difference = 75 to 152 J) and ~ 10.8% (mean difference = 5.1 to 9.4 J) for BR in the ER, in males and females respectively (P < 0.0005). The dominant arm was significantly stronger than the non-dominant arm for C.Perf by 11.7% (mean difference = 111.58 J) for males and by 18% (mean difference = 82.77 J) for females in the ER at 45° abduction. At 90° abduction, only females were stronger in the dominant arm by 18.8% (mean difference = 88.17 J). Values for BR ranged from 9.2 to 21.8% depending on the abduction angle and sex of the athlete (mean difference = 2.44 - 4.85 J). Males were significantly stronger than females by 48.8 to 50.7% for values of C.Perf and BR in both the IR and ER (P < 0.0005). There was a significant difference between the ER and IR muscles, with significantly higher values observed for the IR in C.Perf (mean difference = 331.74 J) by 30.0% and in BR (mean difference = 13.31 J) by 26.64%., Discussion: Differences in shoulder performance fatiguability between sexes are affected by arm position, arm dominance and muscle groups. In agreement with the literature, performance values in males were approximately 50% higher than in females. However, the amount of IF was no different between both sexes. Based on findings in literature, it could be suggested that this is due to differences between males and females in motor control and/or coordination strategies during repetitive tasks. In addition, we also observed the IR muscles to be significantly stronger than the ER muscles. It has long been established in literature that these observations are due to the muscle-size differences between both muscle groups, where the IR muscles can produce a larger amount of force due to the larger cross-sectional area. Results of our study found similar ER:IR ratios compared to previous reports., Conclusion: Therefore, these findings are useful for clinicians when monitoring rehabilitation programs in sedentary individuals following shoulder injuries., (© 2022. The Author(s).)

Increased COVID-19 vaccine hesitancy presents a major hurdle in global efforts to contain the COVID-19 pandemic. This study was designed to estimate the prevalence of adverse events after the first dose of the Covishield (AstraZeneca) vaccine among physicians in Bangladesh. A cross-sectional study was conducted using an online questionnaire for physicians ( n  = 916) in Bangladesh. Physicians who received at least one dose of the COVID-19 vaccine were included. The study was carried out from April 12 to May 31, 2021. More than 58% of respondents ( n  = 533) reported one or more adverse events. Soreness of the injected arm (71.9%), tiredness (56.1%), fever (54.4%), soreness of muscles (48.4%), headache (41.5%) and sleeping more than usual (26.8%) were the most commonly reported adverse events. Most vaccine-related reactogenicities were reported by the younger cohorts (<45 years). The majority of respondents reported severity of reactogenicity as "mild," experienced on the day of vaccination, and lasting for 1-3 days. The most common reactogenicity was pain at the injection site; the second most common was tiredness. Almost half (49.2%) of the physicians took acetaminophen (paracetamol) to minimize the effects of vaccine reactogenicity. Multivariate logistic regression analyses showed that physicians with diabetes and hypertension (OR = 2.729 95% CI: 1.282-5.089) and asthma with other comorbidities (OR = 1.885 95% CI: 1.001-3.551) had a significantly higher risk of vaccine-related reactogenicities than physicians without comorbidities. Further safety studies with larger cohorts are required to monitor vaccine safety and provide assurance to potential vaccine recipients., Competing Interests: The authors have no conflict of interest to declare., (© 2022 The Authors. FASEB BioAdvances published by the Federation of American Societies for Experimental Biology.)

Background: Rapid increase in COVID-19 suspected cases has rendered disease diagnosis challenging, mainly depending upon RT-qPCR. Reliable, rapid, and cost-effective diagnostic assays that complement RT-qPCR should be introduced after thoroughly evaluating their performance upon various disease phases, viral load, and sample storage conditions., Objective: We investigated the correlation of cycle threshold (Ct) value, which implies the viral load and infection phase, and the storage condition of the clinical specimen with the diagnosis of SARS-CoV-2 through our newly developed in-house rapid enzyme-linked immunosorbent assay (ELISA) system., Method: Naso-oropharyngeal samples of 339 COVID-19 suspected cases were collected and evaluated through RT-qPCR that were stored up to 30 days in different conditions (i.e. -80°C, -20°C and initially at 4°C followed by -80°C). The clinical specimens were evaluated with our in-house ELISA system after finalizing the assay method through checkerboard assay and minimizing the signal/noise ratio., Result: The ELISA system showed the highest sensitivity (92.9%) for samples with Ct ≤30 and preserving at -80°C temperature. The sensitivity reduced proportionally with increasing Ct value and preserving temperature. However, the specificity ranged between 98.3% and 100%., Conclusion: The results indicate the necessity of early infection phase diagnosis and lower temperature preservation of samples to perform rapid antigen ELISA tests.

Objective: The aim of this study is to determine the characteristics of eye injuries, medical costs and return-to-work status among industrial workers to provide better vision rehabilitative services., Setting: Nationwide data from the Social Security Organisation (SOCSO) of Malaysia., Participants: A stratified random sample of workers registered with the SOCSO of Malaysia with documentation of eye injury., Primary and Secondary Outcome Measures: Characteristics of eye injuries and medical costs related to eye injury (primary) and return-to-work status (secondary)., Results: A total of 884 from 8861 case files workplace accidents involving eye injury registered with Social Security Services (SOCSO) were identified. The mean age was 35±10 years and the highest incidence of work-related eye injury occurred in the age group 30-39 years and among Malay ethnics. Males are affected more than females' workers. The highest cause of eye injury was the impact from a moving object excluding falling objects (89.2%) and anterior segment injuries occurred more than posterior segment injuries. The total direct and Indirect medical cost was RM1 108 098.00 (US$316 599.40) and RM4 150 140.00 (US$1 185 754.20) for 884 cases., Conclusion: The majority of workers suffered from the low level of eye injury. A significant relationship was found between the severity of eye injury and employee work status. The indirect cost of medical and vision rehabilitation was higher than the direct cost. Awareness and vision rehabilitation programmes at the workplace need to be addressed for better prevention and rehabilitative service., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Sports nutrition and food knowledge can influence athletes' dietary intake, potentially affecting athletic performance. Limited studies have been conducted to identify sports nutrition and food knowledge among Malaysian university athletes. This study aimed to determine Malaysian university athletes' knowledge of sports nutrition and food, and their reference sources and preferred sports nutrition education programme. Seventy athletes (52.9% females, mean weight = 61.8 kg; height = 1.66 m) aged 18.5-22.4 years responded to an online survey administered using a Google Form. A score of ≥60% was considered as adequate knowledge. The average overall knowledge score was 58.6%. The highest knowledge score was for sports nutrition, specifically food intake periodicity (84.8%), while the lowest was for general food knowledge on fat (44.6%). An analysis of specific questions revealed a lack of understanding about the recommended daily intake of fruits and vegetables (only 14.3% answered correctly), the roles of vitamins and minerals in energy production (21.4%), and good sources of unsaturated fat (37.2%). The academician was the primary reference source (81%), while magazines were the least referred to sources (36%). The university athletes preferred sports camps (33%) over the other nutrition education programme options. More initiatives are needed to improve Malaysian university athletes' understanding and knowledge of sports nutrition and general food.

Purpose: This study aimed to determine the prevalence and status of refractive error among Chinese primary school children in a rural area in Pahang., Methods: This investigation entailed a cross-sectional retrospective study design involving case file analyses. The study site was a Chinese medium primary school in a rural locality within Bentong district. A total of 82 school children met the B40 classification and selection criteria; therefore, universal sampling was done. Analyses were done according to age group: Level 1 included ages 7 to 9 years, while Level 2 comprised 10- to 12-year-olds., Results: The mean age of the 82 Chinese school children was 9.72±1.5 years; the percentage of refractive errors found was 80.48%. A total of 53 (64.63%) children had myopia. Two-way ANOVA showed a significant difference ( P =0.038) in the refractive error between age groups Level 1 and 2, but no significant difference ( P =0.947) was observed in refractive error between genders. The chi-square test and Fishers exact test showed no significant association between the type of refractive error with gender ( P >0.05) and age group ( P =0.319)., Conclusion: Myopia was the most common type of refractive error among Chinese school children in a rural area in Pahang. Refractive error severity was influenced by age group but not by gender. Types of refractive error were not associated with age group and gender. Hence, it is recommended that Chinese school children in rural areas seek an annual vision screening or eye test., (© Academy of Family Physicians of Malaysia.)

Background: Fifteen COVID-19 vaccines have been granted emergency approval before the completion of conventional phases of clinical trials. The present study aimed to analyze the neurological adverse events (AEs) post-COVID-19 vaccination and focuses on determining the association of AEs with the vaccine., Methodology: The neurological AEs reported for COVID-19 vaccines in the WHO pharmacovigilance database (VigiBase) were extracted from the System Organ Classes - neurological disorders and investigations. Descriptive statistics are reported as percentage and frequency and the disproportionality analysis was also conducted., Results:  For the neurological system, 19,529 AEs were reported. Of these, 15,638 events were reported from BNT162b2 vaccine, 2,751 from AZD1222 vaccine, 1,075 from mRNA-1273 vaccine, eight from Vero vaccine, two from Covaxin, and for 55 AEs, vaccine name was not mentioned. The reason for more AEs reported with BNT162b2 can be maximum vaccination with BNT162b2 vaccine in the study period. According to the disproportionality analysis based on IC 025 value, ageusia, anosmia, burning sensation, dizziness, facial paralysis, headache, hypoaesthesia, lethargy, migraine, neuralgia, paresis, parosmia, poor sleep quality, seizure, transient ischemic attack, and tremor are some of the AEs that can be associated with the administration of the vaccine., Conclusion: The vaccines should be monitored for these AEs till the causality of these AEs with COVID-19 vaccines is established through further long-term follow-up studies. These neurological AEs reported in VigiBase should not be taken as conclusive and mass vaccination should be carried out to control the pandemic until a definite link of these adverse effects is established., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Dutta et al.)

Drug-drug interactions (DDIs) and adverse drug reactions (ADRs) occur during the pharmacotherapy of multiple comorbidities and in susceptible individuals. DDIs and ADRs limit the therapeutic outcomes in pharmacotherapy. DDIs and ADRs have significant impact on patients' life and health care cost. Hence, knowledge of DDI and ADRs is required for providing better clinical outcomes to patients. Various approaches are developed by the scientific community to document and report the occurrences of DDIs and ADRs through scientific publications. Due to the enormously increasing number of publications and the requirement of updated information on DDIs and ADRs, manual retrieval of data is time consuming and laborious. Various automated techniques are developed to get information on DDIs and ADRs. One such technique is text mining of DDIs and ADRs from published biomedical literature in PubMed. Here, we present a recently developed text mining protocol for predicting DDIs and ADRs from PubMed abstracts., (© 2022. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Acanthamoeba castellanii is a pathogenic free-living amoeba responsible for blinding keratitis and fatal granulomatous amoebic encephalitis. However, treatments are not standardized but can involve the use of amidines, biguanides, and azoles., Objectives: The aim of this study was to synthesize a variety of synthetic tetrazole derivatives and test their activities against A. castellanii., Methods: A series of novel tetrazole compounds were synthesized by one-pot method and characterized by NMR and mass spectroscopy. These compounds were subjected to amoebicidal and cytotoxicity assays against A. castellanii belonging to the T4 genotype and human keratinocyte skin cells, respectively. Additionally, reactive oxygen species determination and electron microscopy studies were carried out. Furthermore, two of the seven compounds were conjugated with silver nanoparticles to study their anti-amoebic potential., Results: A series of seven tetrazole derivatives were synthesized successfully. The selected tetrazoles showed anti-amoebic activities at 10 μM concentration against A. castellanii in vitro. The compounds tested caused increased reactive oxygen species generation in A. castellanii and morphological damage to amoebal membranes. Moreover, conjugation of silver nanoparticles enhanced anti-amoebic effects of two tetrazoles., Conclusions: The results showed that azole compounds hold promise in the development of new formulations of anti-Acanthamoebic agents., (© 2021 S. Karger AG, Basel.)

Oral cancers (OCs), being one of the frequent malignancies in the head and neck region, need prompt diagnosis and treatment. Apart from basic therapeutic modalities, immunotherapy has now been utilized as a novel approach to combat the disease. With the comprehension of the strategies adopted by cancer cells to evade the immune elimination by the body's immune system, targeted immunotherapies have now become the core area of research. The immune expression of epidermal growth factor receptor (EGFR), programmed cell death protein ligand-1 (PDL-1), etc., are enhanced in OC and have been associated with evasion of the immune system. Targeted immunotherapies now include monoclonal antibodies targeting EGFR like cetuximab and panitumumab, programmed cell death-1 (PD-1) inhibitors like pembrolizumab, cemiplimab, and nivolumab, and PD-L1 inhibitors like atezolizumab, avelumab, and durvalumab. Targeted immunotherapies like chimeric antigen receptor T-cell treatment and small molecule inhibitors are in several clinical trials tried as monotherapy and adjuvant immunotherapy and have shown promising results. Other immunothera-peutic approaches such as cytokines like interferons or interleukins, vaccines, and gene therapy have also been an area of research for the management of OC. However, the cautious selection of appropriate patients with specific immune characteristics as a candidate for immunotherapeutic agents is a crucial component of targeted immunotherapy. This article elaborates on the immune contexture of oral cancer cells, the mechanism of immune evasion by cancer cells, targets for immunotherapies, existent immunotherapeutic agents, and prospects in the field of immunotherapy.

Drug-drug interactions (DDIs) and adverse drug reactions (ADR) are experienced by many patients, especially by elderly population due to their multiple comorbidities and polypharmacy. Databases such as PubMed contain hundreds of abstracts with DDI and ADR information. PubMed is being updated every day with thousands of abstracts. Therefore, manually retrieving the data and extracting the relevant information is tedious task. Hence, automated text mining approaches are required to retrieve DDI and ADR information from PubMed. Recently we developed a hybrid approach for predicting DDI and ADR information from PubMed. There are many other existing approaches for retrieving DDI and ADR information from PubMed. However, none of the approaches are meant for retrieving DDI and ADR specific to patient population, gender, pharmacokinetics, and pharmacodynamics. Here, we present a text mining protocol which is based on our recent work for retrieving DDI and ADR information specific to patient population, gender, pharmacokinetics, and pharmacodynamics from PubMed., (© 2022. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.)

Background Caesarian sections (CS) are life-saving management for a pregnant mother and fetus subject to obstetric complications. The World Health Organization (WHO) expected CS rates not to exceed 10 to 15 per 100 live births in any country. This study aimed to assess the prevalence of CS and its associated factors from the 2016 Nepal Demographic and Health Survey (NDHS), building on previous studies mentioned in detail in the latter part of the paper. Methods This study analyzed the secondary data from the 2016 Nepal Demographic and Health Survey (NDHS), conducted from June 19, 2016, to January 31, 2017. The survey is undertaken every five years; consequently, the data capture the information in the previous five years from the data collection period. We used the 2016 NDHS, which is implemented by the new Enumeration Area (EA) under the support of the Ministry of Health (MOH) and funded by the U.S. Agency for International Development (USAID). In the rural areas, the sample is stratified and selected in two stages. In the first stage, wards are selected as the primary sampling units (PSU), with households subsequently chosen from the PSUs. In the urban areas, the sample is nominated in three stages. In the first stage, wards are selected as PSUs; in the second stage, one EA is chosen from each PSU, and finally, households are selected from the EAs. Then data were collected from the women in the reproductive age group within the selected households. Results The prevalence of CS in Nepal conforms to the WHO standard with 7.8, 7.5, and 8.1 per 100 deliveries, or 9.8, 8.9, and 9.1 per women's last births in the previous one, three, and five years, respectively. Older mothers of 30 years old or more, having high incomes, being overweight and obese, using the internet, ante-natal care (ANC) visits of more than four times, ANC by doctors, twin delivery, and having babies of 4 kg or more, had higher odds for a CS while having two or more children seemed to be protective towards CS. Conclusion These findings can be used to update health policies surrounding CS delivery to limit unnecessary CS and ensure better health as CS is not without complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Das et al.)

The catastrophic pandemic engendered due to the Novel coronavirus (COVID-19) outbreak which causes severe clinical afflictions on the respiratory system has severely high morbidity and mortality rates. The requirement of novel compounds is at utmost importance due to lack of targeted drug molecule to treat the afflictions and restrict the viral infection and for the usage of prophylactic treatment to avoid the spread of the infection is of utmost importance. Vitamin D is one such naturally available multifunctional molecule, which plays an eminent role in the immune system and instigation of numerous cellular pathways further promoting health benefits and enhancing the human quality of life. This article reviews the current standpoint scenario and future prevalence of vitamin D supplementation in the management of covid-19 patients. Novel findings of Vitamin D suggest that along with regulation of cell growth, neuroprotective and mood-stabilizing effects, it regulates the immune response also modulate cytokine Interleukin-6 (IL-6) by inducing progesterone-induced blocking factor (PIBF), given the IL-6 levels are considerably high in COVID-19 patients which increases the further complications. Vitamin D also have its effect on angiotensin converting enzyme (ACEII) inhibitor through which the COVID-19 virus makes cell entry. Numerous research data elucidate the play of Vitamin D, in complications of COVID-19 including the most common comorbid conditions, neurological manifestations and immunological aspects makes it an ideal molecule for adjuvant therapy. Including Vitamin D as add-on therapy in the management of COVID-19 might aid the arrest of infection and helps fight this arduous epidemic., Competing Interests: Declaration of competing interest No conflict of interest., (Copyright © 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background Sterilization failure is one of the main reasons for surgical site infections (SSIs). The biological indicator (BI) test is the most reliable test to check sterilization efficiencies. But 48 hours BI test result makes the monitoring process time-consuming. Rapid BI testing can be time demanding in this regard. Therefore, the objective is to determine the importance of rapid BI monitoring for the quality assurance of sterile surgical instruments. Methods This study was conducted in the Labaid Cardiac Hospital, Bangladesh from April 1, 2021, to July 8, 2021. A total of 100 steam and 100 ethylene oxide (EO) rapid BIs and an auto reader incubator were used to conduct this research. Quick BI of steam and EO were used once per day and tested by the auto reader. Later, all the tested BIs were incubated for 48 hours by a conventional incubator to confirm the auto reader's rapid BI test results. Result All the EO BI results were found negative, but the BI was found positive twice in steam sterilization. Surgical items of those two loads were re-sterilized. Again, after checking the BI result, the items were released. All BIs except positive steam rapid BIs were found with no growth after 48 hours of incubation for cross-checking of auto reader results. In positive rapid BI of steam, growth was found after 48 hours of incubation. Conclusion When sterilization failure occurred, process recall could not be possible at that time if rapid BI tests were not performed. So, integration of a rapid BI test with an auto reader can save the patient from critical SSI., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Zaman et al.)

Cognitive impairment is not only common but may also act as a precursor for dementia. Moreover, diabetes mellitus has been shown to promote the progression of dementia. This study aims to determine the prevalence of cognitive impairment and its associated risk factors among the elderly patients having type 2 diabetes mellitus (T2DM) in Hospital Kuala Lumpur, Malaysia. This is a cross-sectional study involving 113 participants who were attending the physician clinic. The participants were selected using the universal sampling method. The tools included a sociodemographic questionnaire, the Montreal Cognitive Assessment, the Depression Anxiety Stress Scale, and the Mini-International Neuropsychiatry Interview. Descriptive analysis was performed and followed by multiple logistic regression. The prevalence of cognitive impairment, depressive disorder, and anxiety disorder was 46.9, 10.6, and 2.7%, respectively. Indians (aOR = 4.90, 95% CI = 1.57-15.27) as well as participants who had completed their secondary (aOR = 0.34; 95% CI = 0.12-0.96) and tertiary (aOR = 0.05; 95% CI = 0.01-0.26) levels of education were significantly associated with cognitive impairment. The prevalence of cognitive impairment was high as well as significantly associated with the ethnicity and education levels of the elderly participants. Indeed both secondary and tertiary education decreased the odds ratio of developing cognitive impairment when compared with no formal and primary education. To determine and reduce the potential risk factors which contribute to cognitive impairment, an early diagnosis of T2DM is crucial. The early detection and treatment of T2DM as well as its associated risk factors are key factors in protecting against cognitive impairment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Suain Bon, Ariaratnam, Mat Saher, Mohamad and Lee.)

Background: Cervical cancer is the second-most common female cancer in Malaysia after breast cancer. This study intended to investigate the knowledge and attitude regarding cervical cancer and its prevention and its associated factors among young female adults in Kuantan, Malaysia, to gauge the community's understanding and idea about this issue., Materials and Methods: The study was conducted in attractive places in Kuantan, Malaysia, such as shopping malls and Urban Transformation Centre, using a cross-sectional study design and convenience sampling method. Data on the respondents' knowledge and attitude regarding cervical cancer and its prevention were collected using a questionnaire. Kruskal-Wallis, Independent t-, and Pearson correlation tests were used to investigate the study variables' association using SPSS software., Results: From the total of 142 respondents, almost half of them aged between 20 and 24 years old with the majority were Malays (85.9%) and single (74.6%). The internet (78.1%) was identified as the main medium to gain information regarding cervical cancer. The results show that levels of education, races, and occupation types were statistically significantly associated with the respondents' knowledge and attitude scores in this study. Age was found to be associated with knowledge scores only, while marital status was only significantly associated with the attitude scores regarding cervical cancer and its prevention. Knowledge scores were also found to be positively associated with attitude scores., Conclusion: Several socio-demographic factors were significantly associated with the knowledge and attitude regarding cervical cancer and its prevention. In view of the positive association between knowledge and attitude scores, suitable health promotion activities can be designed and planned to increase young female adults' knowledge and attitudes toward cervical cancer and its prevention., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)

Introduction: Prevalence rates for diabetes mellitus continue to rise, which, coupled with increasing costs of complications, has appreciably increased expenditure in recent years. Poor glycaemic control including hypoglycaemia enhances complication rates and associated morbidity, mortality and costs. Consequently, this needs to be addressed. Whilst the majority of patients with diabetes have type-2 diabetes, a considerable number of patients with diabetes require insulin to help control their diabetes. Long-acting insulin analogues were developed to reduce hypoglycaemia associated with insulin and help improve adherence, which can be a concern. However, their considerably higher costs have impacted on their funding and use, especially in countries with affordability issues. Biosimilars can help reduce the costs of long-acting insulin analogues thereby increasing available choices. However, the availability and use of long-acting insulin analogues can be affected by limited price reductions versus originators and limited demand-side initiatives to encourage their use. Consequently, we wanted to assess current utilisation rates for long-acting insulin analogues, especially biosimilars, and the rationale for patterns seen, across multiple Asian countries ranging from Japan (high-income) to Pakistan (lower-income) to inform future strategies., Methodology: Multiple approaches including assessing utilization and prices of insulins including biosimilars among six Asian countries and comparing the findings especially with other middle-income countries., Results: Typically, there was increasing use of long-acting insulin analogues among the selected Asian countries. This was especially the case enhanced by biosimilars in Bangladesh, India, and Malaysia reflecting their perceived benefits. However, there was limited use in Pakistan due to issues of affordability similar to a number of African countries. The high use of biosimilars in Bangladesh, India and Malaysia was helped by issues of affordability and local production. The limited use of biosimilars in Japan and Korea reflects limited price reductions and demand-side initiatives similar to a number of European countries., Conclusions: Increasing use of long-acting insulin analogues across countries is welcomed, adding to the range of insulins available, which increasingly includes biosimilars. A number of activities are needed to enhance the use of long-acting insulin analogue biosimilars in Japan, Korea and Pakistan.

Background: Acceptance of the COVID-19 vaccine by the target groups would play a crucial role in stemming the pandemic. Healthcare professionals (HCPs) are the priority group for vaccination due to them having the highest risk of exposure to infection. This survey aimed to assess their acceptance of COVID-19 vaccines in Bangladesh., Research Design and Methods: A cross-sectional survey using an online questionnaire was conducted between January 3 to 25, 2021, among HCPs (n = 834) in Bangladesh., Results: Less than 50% of HCPs would receive the vaccine against COVID-19 if available and 54% were willing to take the vaccine at some stage in the future. Female participants (OR:1.64;95%CI:1.172-2.297), respondents between 18-34 years old (OR:2.42; 95% CI:1.314-4.463), HCPs in the public sector (OR:2.09; 95% CI:1.521-2.878), and those who did not receive a flu vaccine in the previous year (OR:3.1; 95% CI:1.552-6.001) were more likely to delay vaccination., Conclusions: The study revealed that, if available, less than half of the HCPs would accept a COVID-19 vaccine in Bangladesh. To ensure the broader success of the vaccination drive, tailored strategies and vaccine promotion campaigns targeting HCPs and the general population are needed.

The MXenes are a novel family of 2-D materials with promising biomedical activity, however, their anticancer potential is still largely unexplored. In this study, a comparative cytotoxicity investigation of Ti 3 C 2 MXenes with polypropylene glycol (PPG), and polyethylene glycol (PEG) surface-modified 2-D Ti 3 C 2 MXene flakes has been conducted towards normal and cancerous human cell lines. The wet chemical etching method was used to synthesize MXene followed by a simple chemical mixing method for surface modification of Ti 3 C 2 MXene with PPG and PEG molecules. SEM and XRD analyses were performed to examine surface morphology and elemental composition, respectively. FTIR and UV-vis spectroscopy were used to confirm surface modification and light absorption, respectively. The cell lines used to study the cytotoxicity of MXene and surface-modified MXenes in this study were normal (HaCaT and MCF-10A) and cancerous (MCF-7 and A375) cells. These cell lines were also used as controls (without exposure to study material and irradiation) to measure their baseline cell viability under the same lab environment. The surface-modified MXenes exhibited a sharp reduction in cell viability towards both normal (HaCaT and MCF-10A) and cancerous (MCF-7 and A375) cells but cytotoxicity was more pronounced towards cancerous cell lines. This may be due to the difference in cell metabolism and the occurrence of high pre-existing levels of reactive oxygen species (ROS) within cancerous cells. The highest toxicity towards both normal and cancerous cell lines was observed with PEGylated MXenes followed by PPGylated and bare MXenes. The normal cell's viability was barely above 70% threshold with 250 mg/L PEGylated MXene concentration whereas PPGylated and bare MXene were less toxic towards normal cells, even at 500 mg/L concentration. Moreover, the toxicity was found to be directly related to the type of cell lines. In general, the HaCaT cell line exhibited the lowest toxicity while toxicity was highest in the case of the A375 cell line. The photothermal studies revealed high photo response for PEGylated MXene followed by PPGylated and bare MXenes. However, the PPGylated MXene's lower cytotoxicity towards normal cells while comparable toxicity towards malignant cells as compared to PEGylated MXenes makes the former a relatively safe and effective anticancer agent.

Andrographolide (AG) has been shown to have several medicinal and pharmaceutical effects, such as antimicrobial, anti-inflammatory, antioxidant, anti-diabetic, and anti-malarial activities. Moreover, studies to assess the pharmacological effect of AG on the metabolic changes of uninfected red blood cells (uRBCs) have not yet been investigated. This study aims to evaluate the pharmacological effects of AG compared to chloroquine (CQ) on the metabolic variations of uRBCs in vitro using a proton nuclear magnetic resonance ( 1 H-NMR)-based metabolomics approach coupled with multivariate data analysis (MVDA). Forty-one metabolites were successfully identified by 1 H-NMR. The results of the unsupervised data analysis principal component analysis (PCA) showed ideal differentiation between AG and CQ. PC1 and PC2 accounted for 71.4% and 17.7% of the explained variation, respectively, with a total variance of 89.10%. Based on S-plot and VIP values, a total of 28 and 32 metabolites were identified as biomarkers in uRBCs-AG and uRBCs-CQ, respectively. In uRBCs treated with AG, ten metabolic pathways were determined to be disturbed, including riboflavin metabolism, d-glutamate and d-glutamine metabolism, phenylalanine metabolism, glutathione metabolism, proline and arginine metabolism, arginine biosynthesis, citrate cycle, glycolysis/gluconeogenesis, and pyruvate metabolism as well as alanine, aspartate, and glutamate metabolism. In contrast, in CQ-treated uRBCs, nine affected metabolic pathways were determined, which involved the same metabolic pathways for uRBCs-AG, except for glutathione metabolism. These findings suggest an evident relationship between AG and CQ associated with metabolic changes in intact RBCs after being exposed to the treatment. The metabolomics results could allow useful comprehensive insights into the underlying mechanism of the action of AG and CQ on red blood cells. Consequently, the 1 H-NMR-based metabolomics approach was successfully utilized to identify the pharmacological effects of AG and CQ on the metabolic variations of uRBCs.

Background: Serological tests detecting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are widely used in seroprevalence studies and evaluating the efficacy of the vaccination program. Some of the widely used serological testing techniques are enzyme-linked immune-sorbent assay (ELISA), chemiluminescence immunoassay (CLIA), and lateral flow immunoassay (LFIA). However, these tests are plagued with low sensitivity or specificity, time-consuming, labor-intensive, and expensive. We developed a serological test implementing flow-through dot-blot assay (FT-DBA) for SARS-CoV-2 specific IgG detection, which provides enhanced sensitivity and specificity while being quick to perform and easy to use., Methods: SARS-CoV-2 antigens were immobilized on nitrocellulose membrane to capture human IgG, which was then detected with anti-human IgG conjugated gold nanoparticle (hIgG-AuNP). A total of 181 samples were analyzed in-house. Within which 35 were further evaluated in US FDA-approved CLIA Elecsys SARS-CoV-2 assay. The positive panel consisted of RT-qPCR positive samples from patients with both <14 days and >14 days from the onset of clinical symptoms. The negative panel contained samples collected from the pre-pandemic era dengue patients and healthy donors during the pandemic. Moreover, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FT-DBA were evaluated against RT-qPCR positive sera. However, the overall efficacies were assessed with sera that seroconverted against either nucleocapsid (NCP) or receptor-binding domain (RBD)., Results: In-house ELISA selected a total of 81 true seropositive and 100 seronegative samples. The sensitivity of samples with <14 days using FT-DBA was 94.7%, increasing to 100% for samples >14 days. The overall detection sensitivity and specificity were 98.8% and 98%, respectively, whereas the overall PPV and NPV were 99.6% and 99%. Moreover, comparative analysis between in-house ELISA assays and FT-DBA revealed clinical agreement of Cohen's Kappa value of 0.944. The FT-DBA showed sensitivity and specificity of 100% when compared with commercial CLIA kits., Conclusion: The assay can confirm past SARS-CoV-2 infection with high accuracy within 2 minutes compared to commercial CLIA or in-house ELISA. It can help track SARS-CoV-2 disease progression, population screening, and vaccination response. The ease of use of the assay without requiring any instruments while being semi-quantitative provides the avenue of its implementation in remote areas around the globe, where conventional serodiagnosis is not feasible., Competing Interests: Mr Md. Ahsanul Haq reports a patent 10202006327W pending; Prof Dr Bijon Kumar Sil reports a patent 10202006327W pending; Dr Mohd Raeed Jamiruddin reports a patent 10202006327W pending to Intellectual Property Office of Singapore; Dr Nihad Adnan reports a patent 10202006327W pending; the authors report no other conflicts interest in this work. This research has the potential possibility for applying for patent rights. Mainul Haque declines not to be part of the patent., (© 2021 Sil et al.)

This article aims to narrate the various oral complications in individuals suffering from diabetes mellitus. Google search for "diabetes mellitus and oral complications" was done. The search was also carried out for "diabetes mellitus" and its oral complications individually. Diabetes mellitus is a chronic metabolic disorder that is a global epidemic and a common cause of morbidity and mortality in the world today. Currently, there are about 422 million cases of diabetes mellitus worldwide. Diabetic patients can develop different complications in the body such as retinopathy, neuropathy, nephropathy, cardiovascular disease. Complications in the oral cavity have been observed in individuals suffering from diabetes mellitus. A study noted that more than 90% of diabetic patients suffered from oral complications. Another research has shown a greater prevalence of oral mucosal disorders in patients with diabetes mellitus than non-diabetic population: 45-88% in patients with type 2 diabetes compared to 38.3-45% in non-diabetic subjects and 44.7% in type 1 diabetic individuals compared to 25% in the non-diabetic population. Oral complications in people with diabetes are periodontal disease, dental caries, oral infections, salivary dysfunction, taste dysfunction, delayed wound healing, tongue abnormalities, halitosis, and lichen planus. The high glucose level in saliva, poor neutrophil function, neuropathy, and small vessel damage contribute to oral complications in individuals with uncontrolled diabetes. Good oral health is imperative for healthy living. Oral complications cause deterioration to the quality of life in diabetic patients. Complications like periodontal disease having a bidirectional relationship with diabetes mellitus even contribute to increased blood glucose levels in people with diabetes. This article intends to promote awareness regarding the oral health of diabetics and to stress the importance of maintaining proper oral hygiene, taking preventive measures, early detection, and appropriate management of oral complications of these patients through a multidisciplinary approach., Competing Interests: The authors declare that they do not have any financial involvement or affiliations with any organization, association, or entity directly or indirectly with the subject matter or materials presented in this article. This also includes honoraria, expert testimony, employment, ownership of stocks or options, patents or grants received or pending, or royalties., (© 2021 Ahmad and Haque.)

Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers. Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders. Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries. Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production. Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities., Competing Interests: MW and JR work for HTA Consulting and MH works for Square Toiletries Limited. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Godman, Haque, Leong, Allocati, Kumar, Islam, Charan, Akter, Kurdi, Vassalo, Bakar, Rahim, Sultana, Deeba, Khan, Alam, Jahan, Kamal, Hasin, Munzur-E-Murshid, Nahar, Haque, Dutta, Abhayanand, Kaur, Rwegerera, Nascimento, Dias Godói, Irfan, Amu, Matowa, Acolatse, Incoom, Sefah, Acharya, Opanga, Njeri, Kimonge, Kwon, Bae, Khuan, Abubakar, Sani, Khan, Hussain, Saleem, Malande, Piloya-Were, Gambogi, Hernandez Ortiz, Alutuli, Kalungia, Hoxha, Marković-Peković, Tubic, Petrova, Tachkov, Laius, Harsanyi, Inotai, Jakupi, Henkuzens, Garuoliene, Gulbinovič, Wladysiuk, Rutkowski, Mardare, Fürst, McTaggart, MacBride-Stewart, Pontes, Zara, Tagoe, Banzi, Wale and Jakovljevic.)

Background: Dynamics and persistence of neutralizing and non-neutralizing antibodies can give us the knowledge required for serodiagnosis, disease management, and successful vaccine design and development. The disappearance of antibodies, absence of humoral immunity activation, and sporadic reinfection cases emphasize the importance of longitudinal antibody dynamics against variable structural antigens., Methods: In this study, twenty-five healthy subjects working in a SARS-COV-2 serodiagnostic assay development project were enrolled, and their sign and symptoms were followed up to six months. Three subjects showed COVID-19-like symptoms, and three subjects' antibody dynamics were followed over 120 days by analyzing 516 samples. We have developed 12 different types of in-house ELISAs to observe the kinetics of IgG, IgM, and IgA against four SARS-CoV-2 proteins, namely nucleocapsid, RBD, S1, and whole spike (S1+S2). For the development of these assays, 30-104 pre-pandemic samples were taken as negative controls and 83 RT-qPCR positive samples as positive ones., Results: All three subjects presented COVID-19-like symptoms twice, with mild symptoms in the first episode were severe in the second, and RT-qPCR confirmed the latter. The initial episode did not culminate with any significant antibody development, while a multifold increase in IgG antibodies characterized the second episode. Interestingly, IgG antibody development concurrent with IgM and IgA and persisted, whereas the latter two weans off rather quickly if appeared., Conclusion: Antibody kinetics observed in this study can provide a pathway to the successful development of sero-diagnostics and epidemiologists to predict the fate of vaccination currently in place., Competing Interests: Dr. Mohd Raeed Jamiruddin, Mr. Md. Ahsanul Haq, Prof. Dr. Mohib Ullah Khondoker, Prof. Dr. Bijon Kumar Sil, and Dr. Nihad Adnan report a patent 10202006327W pending/licensed to Intellectual Property Office of Singapore. The authors report no other conflicts interest in this work., (© 2021 Jamiruddin et al.)

The outbreak of pneumonia caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), later named COVID-19 by the World Health Organization (WHO), was initiated at Wuhan, Hubei, China, and there was a rapid spread of novel SARS-CoV-2 and the disease COVID-19 in late 2019. The entire world is now experiencing the challenge of COVID-19 infection. However, still very few evidence-based treatment options are available for the prevention and treatment of COVID-19 disease. The present review aims to summarize the publicly available information to give a comprehensive yet balanced scientific overview of all the fat-soluble vitamins concerning their role in SARS-CoV-2 virus infection. The roles of different fat-soluble vitamins and micronutrients in combating SARS-CoV-2 infection have been recently explored in several studies. There are various hypotheses to suggest their use to minimize the severity of COVID-19 infection. These vitamins are pivotal in the maintenance and modulation of innate and cell-mediated, and antibody-mediated immune responses. The data reported in recent literature demonstrate that deficiency in one or more of these vitamins compromises the patients' immune response and makes them more vulnerable to viral infections and perhaps worse disease prognosis. Vitamins A, D, E, and K boost the body's defense mechanism against COVID-19 infection and specifically prevent its complications such as cytokine storm and other inflammatory processes, leading to increased morbidity and mortality overemphasis. However, more detailed randomized double-blind clinical pieces of evidence are required to define the use of these supplements in preventing or reducing the severity of the COVID-19 infection., Competing Interests: The authors declare no conflicts of interest in this work., (© 2021 Samad et al.)