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Abstract Maternal dietary quality may alter the nutrient content of breast milk. In this study, we aimed to investigate the relationship between the healthy eating index (HEI) and alternative healthy eating index (AHEI) of a breastfeeding mother’s diet with the antioxidant profile of her breast milk and her infant’s urine. This study included 300 healthy mother-infant pairs. The participants’ dietary intake was estimated using a validated semi-quantitative food frequency questionnaire. The diet quality of participants was assessed using the HEI and AHEI. The total antioxidant content of the breast milk and infant’s urine was evaluated using ferric reducing antioxidant power (FRAP), 2, 2′-diphenyl-1-picrylhydrazyl (DPPH), thiobarbituric acid reactive substances (TBARs), and Thiol quantification assays. After adjusting for confounding factors, the odds of a low malondialdehyde (MDA) content of breast milk were significantly higher in the highest quartile of HEI than in the lowest quartile. The odds of low DPPH and FRAP in infant urine decreased in the highest quartile of HEI compared to the lowest quartile. No significant relationship was found between AHEI and antioxidant levels of breast milk and the infant’s urine. Our findings demonstrate that a high quality diet of breastfeeding mothers, identified by a higher HEI, can affect the oxidant-antioxidant balance of a mother’s breast milk and her infant’s urine.

Abstract Purpose Understanding the technical efficiency of health facilities is essential for an optimal allocation of scarce resources to primary health sectors. The COVID-19 pandemic may have further undermined levels of efficiency in low-resource settings. This study takes advantage of 2019 and 2020 data on characteristics of health facilities, health services inputs and output to examine the levels and changes in efficiency of Ghanaian health facilities. The current study by using a panel dataset contributes to existing evidence, which is mostly based on pre-COVID-19 and single-period data. Methods The analysis is based on a panel dataset including 151 Ghanaian health facilities. Data Envelopement Analysis (DEA) technique was used to estimate the level and changes in efficiency of health facilities across two years.. Results The results show a net increase of 26% in inputs, influenced mostly by increases in temporary non-clinical staff (131%) and attrition of temporary clinical staff and permanent non-clinical staff, 40% and 54% respectively. There was also a net reduction in output of 34%, driven by a reduction in in-patient days (37%), immunization (11%), outpatients visits and laboratory test of 9%. Nowithstanding the COVID-19 pandemic, the results indicate that 59 (39%) of sampled health facilities in 2020 were efficient, compared to 48 (32%) in 2019. The results also indicate that smaller-sized health facilities were less likely to be efficient compared to relatively bigger health facilities. Conclusion Based on the findings, it will be essential to examine factors that accounted for efficiency improvements in some health facilities, to enable health facilities lagging behind to learn from those on the efficiency frontier. In addition, the findings emphasise the need for CHAG to work with health facility managers to optimise inputs allocation through a redistribution of staff. Most importantly, the findings are suggestive of the resilience of CHAG health facilities in responding to a health shock such as the COVID-19 pandemic.

Abstract CAFs (cancer-associated fibroblasts) are highly flexible cells of the cancer microenvironment. They produce the extracellular matrix (ECM) constituents that form the structure of the tumor stroma but are also a source of metabolites, growth factors, chemokines, and exosomes that impact every aspect of the tumor, including its response to treatment. It is believed that exosomal miRNAs facilitate intercellular signaling, which is essential for the development of cancer. The role of miRNAs and CAFs in the tumor microenvironment (TME) and carcinogenesis is reviewed in this paper. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines were used to perform a systematic review. Several databases, including Web of Science, Medline, Embase, Cochrane Library, and Scopus, were searched using the following keywords: CAFs, CAF, cancer-associated fibroblasts, stromal fibroblasts, miRNA, exosomal miRNAs, exosome and similar terms. We identified studies investigating exosomal miRNAs and CAFs in the TME and their role in carcinogenesis. A total of 12,572 papers were identified. After removing duplicates (n = 3803), 8774 articles were screened by title and abstract. Of these, 421 were excluded from further analysis. It has been reported that if exosomal miRNAs in CAFs are not functioning correctly, this may influence the secretory phenotype of tip cells and contribute to increased tumor invasiveness, tumor spread, decreased treatment efficacy, and a poorer prognosis. Under their influence, normal fibroblasts (NFs) are transformed into CAFs. Furthermore, they participate in metabolic reprogramming, which allows for fast proliferation of the cancer cell population, adaptation to growing energy demands, and the capacity to avoid immune system identification.

Abstract We aimed to investigate the association between an empirical dietary index for hyperinsulinemia (EDIH), empirical dietary index for insulin resistance (EDIR), and MetS and its components in an adult Iranian population. In this cross‐sectional study, a total of 6482 participants aged 35–65 years were recruited as part of the MASHAD cohort study. Dietary intakes were assessed using a validated food frequency questionnaire (FFQ). The International Diabetes Federation (IDF) criteria were used to define MetS. Multivariable logistic regression models were applied to determine the association between EDIH, EDIR, and MetS and its components. The mean age and BMI of participants were 48.44±8.20 years, and 27.98±4.73 kg/m2, respectively. Around 59% of the population was female. Of the total population, 35.4% had MetS. According to the full‐adjusted model, there was no significant association between higher quartiles of EDIH and EDIR and odds of MetS (Q4 EDIH; OR (95%CI):0.93 (0.74‐1.18), Q4 EDIR; OR (95%CI):1.14 (0.92‐1.40). Regarding MetS components, EDIR was associated with increased odds of hypertension and diabetes (Q4 EDIR; OR (95%CI):1.22 (1.04‐1.44) and 1.22 (1.01‐1.47), respectively). EDIH was also associated with decreased odds of hypertriglyceridemia (Q4 EDIH; OR (95%CI): 0.72 (0.60‐0.87)). This study showed no significant association between hyperinsulinemia and insulin resistance potential of diet and odds of MetS among Iranian adults. However, EDIR was significantly associated with increased odds of hypertension and diabetes as MetS components.

Abstract Engineering is critical for socio-economic development, however only a few women participate in engineering education and careers. This study aimed to identify the types of negative information propagated by the social networks of engineering students that could create barriers to students, and particularly women’s retention in engineering education and careers, and assess whether they influence men and women differently. The study was exploratory hence six focus group discussions were conducted with undergraduate engineering students in their second, third, and fourth years of study in a Ghanaian university. An interview guide was used to, among others, examine the perceptions and misconceptions of students’ social networks about engineering and the negative information that circulates within the networks. Demotivating information from students’ social networks were mainly misconceptions such as (1) engineering is too difficult and strenuous for women, and only meant for strong and well-built people, (2) engineering negatively affects women’s beauty and body image, (3) engineering makes women unfashionable and unattractive, and (4) engineering is a threat to marital and family lives. Both female and male students were negatively affected by misinformation about engineering being difficult and having limited job prospects as well as societal preferences for other programmes such as medicine. The misinformation could serve as a barrier, especially for students lacking ‘faith and the spirit of perseverance’ to pursue and graduate from engineering programmes. While efforts are being made to bridge the gender gap in engineering education and careers, there are misconceptions and misinformation that can hinder progress toward achieving the desired gender parity. Educational policies must integrate gender-responsive strategies including addressing the socio-cultural and stereotypical factors and public misconceptions. There is a need to provide strategic counselling services to engineering students to be able to cope with the effects of negative information from their social networks especially during the early years of their studies in the universities.

Green peppers are massively produced all over the world; however, substantial quantities of peppers are wasted. Functional polysaccharides can be produced from pepper waste. A conventional acid extraction method was used to obtain pectin-like materials from green bell pepper (GBP). A 23 experimental design (two-level factorials with three factors: temperature, pH, and time) was used to study the relationship between the extraction conditions and the measured physicochemical properties. The extracted polysaccharides were further analysed regarding their physicochemical and functional properties. The yields were in the range of (11.6–20.7%) and the highest yield value was extracted at pH 1. The polysaccharides were classified as “pectin-like”, as the galacturonic acid content was lower than 65%. Glucose and galactose were the major neutral sugars, and their relative amounts were dependent on the extraction conditions. The degree of esterification (DE) of the pectin-like extracts was greater than 50% and they were therefore classified as high methoxyl regardless of the extraction conditions. Also, important levels of phenolic materials (32.3–52.9 mg GAE/g) and proteins (1.5–5.4%) were present in the extract and their amounts varied depending on the extraction conditions. The green bell pepper polysaccharides demonstrated antioxidant and emulsifying activities and could also be used adequately to stabilise oil/water emulsion systems. This finding shows that green bell pepper could be used as an alternative source of antioxidants and an emulsifier/stabilising agent, and furthermore, the extraction conditions could be fine-tunned to produce polysaccharides with the desired quality depending on their application.

Abstract Background Coronary artery disease (CAD) is known as the leading cause of disability and death globally. Anxiety disorders are also recognized as common types of mental disorders that substantially impact global health. Iran ranks among the countries with a high incidence of CAD and anxiety disorders. Therefore, the present study aims to determine the potential association and epidemiological aspects of anxiety and CAD within the population of Mashhad, the second most popoulos city in Iran. Methods The present study is based on extracted data from the Mashhad stroke and heart atherosclerotic disorder (MASHAD) study which is a 10-year prospective cohort study intended to assess the effects of various CAD risk factors among Mashhad city residents. Anxiety scores were assessed at the baseline using Beck Anxiety Inventory and individuals were classified based on the BAI 4-factor structure model which included autonomic, cognitive, panic, and neuromotor components. Accordingly, the association between baseline anxiety scores and the BAI four-factor model with the risk of CAD events was analyzed using SPSS software version 21. Results Based on the results, 60.4% of the sample were female, and 5.6% were classified as having severe forms of anxiety. Moreover, severe anxiety was more prevalent in females. Results showed a 1.7% risk of CAD (p-value

Introduction Breast cancer is a major public health concern worldwide and the most prevalent form of cancer in Morocco. This study aimed to describe the histological and immunohistochemical profiles of breast cancer in women admitted to Cheikh Khalifa Hospital in Casablanca, Morocco. Methods This is a retrospective cross-sectional study. All histologically confirmed female breast cancer cases diagnosed between January 2017 and May 2021 at the Cheikh Khalifa University Hospital were included in the study. Data were collected from patient electronic medical records. Using an electronic sheet, information was collected about the socio-demographic characteristics of the patients, clinical features, histopathology, molecular characteristics, treatment received, and progression. Results Invasive carcinoma of no special type was the most common type of cancer accounting for 90.7% of all cases. The majority of the tumors (56.1%) were grade II tumors. About 42.1% of tumors were lymph node-positive and only 13.4% developed distant metastasis. Immunohistochemical data revealed that 57.9% of the tumors in this study were hormone receptor-positive (ER+ and PR+), 74.4% were estrogen receptor-positive (ER+), 58.5% were progesterone receptor positive (PR+), and 18.9% were HER2 positive (HER2+). The most common molecular subtype was Luminal A-like (43.9%). A statistically significant difference was found in histological grades across the four molecular subtypes ( P < 0.001). Conclusions Our findings should be used to guide breast cancer management policies in Morocco. Larger cohort studies are needed to determine the specificity of the breast cancer profile in Morocco as well as the epidemiological risk factors specific to every subtype.

This participatory session concerned consideration of the ‘critical turn in LD’ (Syska and Buckley, 2023: 107), manifest through an emerging critical LD movement – as centring an academic literacies approach (Hilsdon, 2018; Asher, 2022, 2023a; Dhillon, 2023; Rooney, 2023) – as a response to ‘the crisis of the university’ (Bacevic, 2017). The focus is on the positionality of LD/LDers within the increasingly neoliberal university, and to this critical learning development movement. Time and space are provided for sharing experiences, worries and hopes for LD/HE and to collectively explore the contemporary realities/trajectory of LD/HE – and alternative futures. The central cause of the crisis of UK HE, exacerbated by government and senior management responses to COVID-19, is intensifying and accelerating processes of the ‘deep neoliberalisation’ of the public university – reflected in industrial action concerning ‘pay devaluation; pay inequality, based on gender and race; excessive workloads; and casualisation’ (Hall, 2020a). The session explores where LD/LDers are positioned within the HE crisis, before considering how critically oriented LD/LDers who believe HE should be a social and public good can best respond to the crisis, while connecting such to wider contemporary societal and global crises. Specifically: • How might LD/LDers respond to different contexts of crisis in ways that encompass LD’s developmental/pedagogical ethos, emancipatory values and empowering academic literacies approach (Syska and Buckley, 2023; Webster, 2019)? • How do we link with wider critical educational theories, practices, communities and struggles? • What might be the role of critical Learning Development and academic literacies? The objective is critical reflection on contemporary LD/HE contexts – with take-aways, as thus grounded in actual lived experiences of the crisis, including: • Developing understandings as to self, team and LD contemporary positionality. • Considerations of possible actions and next steps, including the potential for an ALDinHE CoP focused on critical LD and academic literacies.

BackgroundCOVID-19 disruptions including lockdowns and prioritization of COVID-19 control programs in Africa in 2020–2022 contributed to reductions in malaria control activities including malaria diagnosis, treatment and resistance monitoring. This study investigated the malaria burden and distribution on the background of active transmission of SARS-CoV-2 in Southern Ghana; utilizing community health education and medical screening (CHEMS) approach to determine epidemiological overlaps in COVID-19 and malaria.MethodsBetween October–December 2022, prospective cross-sectional surveys, with CHEMS were conducted in Greater Accra and Central regions, where 994 participants enrolled either at a hospital or community setting provided demographic and clinical data including history of clinical malaria infection and antimalarial treatment in the past 2 weeks. Of this study population, 953 provided nasal/throat swabs for COVID-19 RT-PCR testing, with a subset of 136 participants also providing finger-prick blood for malaria RDT testing.ResultsThe study population comprised of 73.6% adults, with 54.6% COVID-19 vaccination rate. Overall, 18.1% of participants had a history of clinical malaria, which was associated (adjusted odds ratio > 1.50, p-value ≤0.022) with COVID-19 symptoms and positivity, study area and hospital setting, suggestive of overlaps in the epidemiological risk for malaria. On a background of widespread SARS-CoV-2 infections (12–37%), malaria parasitaemia was detected in 6%, with 2% being co-infections with SARS-CoV-2. Among the malaria positives, 9.5% had a history of antimalarial treatment, which suggested that their infections were recrudescent parasitaemia.ConclusionThe epidemiological and clinical overlap between malaria and COVID-19 within the hospital and community settings underscores the need for accurate case diagnosis to inform effective clinical treatments. Innovative surveillance programs, with community engagement are needed to maximize control interventions including treatment of asymptomatic malaria infections.

Background: The Ghanaian elderly population is increasing at the fastest rate and this has become a burden as the rate is not proportional to the investment in health to meet their deteriorating health needs. This creates discrepancies and inequalities in healthcare access and coupled with poor healthcare provider services, the inequalities widen. Poor care services are related to poor knowledge and bad attitudes of care providers hence this study seeks to explore the health practitioners’ level of knowledge, attitude, and practice (KAP) toward geriatric care. Methods: The study used a cross-sectional survey design with a simple stratified random technique to select study participants. Out of 257 participants who were sampled for the study, 215 responses were received, representing 83.6% response rate. However, 200 questionnaires were complete (93%) and valid for analysis, which consisted of 166 nurses, representing 83% valid responses, and 34 medical officers, physician assistants, and other allied health care providers, representing 17% valid responses from these professionals. A structured questionnaire was used to assess KAP using the knowledge about Older Patients Quiz (KOP-Q) and Kogan’s Attitudes toward Old People Scale (KAOP). Using a mean score of 80%, knowledge, attitude, and practice were dichotomized into good or bad. The Kruskal-Wallis H test was used to compare mean rank across health professionals’ knowledge, attitude, and practice of geriatric care. Results: It shows that the majority (94%) of participants have low levels of knowledge in geriatric care. The majority (84%) of participants do not practice good geriatric care. Differences in knowledge exist among health providers and were statistically significant ( P = .045). Doctors had the lowest mean knowledge score (78.61). Nurses (100.27) and physician assistants (106.15) had moderate mean knowledge score ranks. Although not statistically significant, the rank order for practice scores from highest to lowest was: physician assistants (112.95), nurses (99.19), and doctors (79.21). There were however no statistically significant differences between professions in practice scores ( P = .067), or attitude scores ( P = .097). Conclusion: Health care providers have low knowledge and, bad attitude toward aged care and this may be related to their service delivery which may affect the aged patronage of healthcare services. This is a wake-up call for authorities to organize continuous professional development to enable care providers to improve their service delivery.

Abstract Although previous research has explored the link between plant-based diets and mental health outcomes, there has been limited study on the quality levels of plant foods in this context. This study was conducted on 733 adolescent girls from cities in northeastern Iran. The validated Iranian version of the Insomnia Severity Index, SF-12v2 questionnaire and Persian version of the Beck Depression Inventory used to assess insomnia and poor quality of life (QoL) and depression, respectively. Dietary intakes assessed using a valid and reliable food frequency questionnaire. The association of scores of plant based dietary index (PDI) and poor QoL, depression and insomnia explored by binary logistic regression. The unadjusted model showed subjects in the highest quartile of healthy PDI had lower chances of insomnia than those in the lowest quartile (OR: 0.50; 95% CI 0.27–0.91, P = 0.024). The association persisted across various adjusted models. Subjects in the highest quartile of unhealthy PDI (uPDI) had higher chances of depression than those in the lowest quartile (OR: 1.83; 95% CI 1.09–3.08, P = 0.022). The significance of the association was maintained after adjusting for other confounders. A healthy plant-based dietary index is associated with a lower odds of insomnia. An unhealthy plant-based dietary index was associated to an increased chance of depression. Findings need to be confirmed by future studies.

Abstract Cardiovascular disease (CVD) can be determined and quantified using the electrocardiogram (ECG) analysis. Identification of the risk factors associated with ECG abnormalities may advise prevention approaches to decrease CVD burden. In this study we aimed to investigate the association between CVD risk factors and minor and major ECG abnormalities in a general Iranian adult population. This study was conducted in 2010 and covered a population of 9035 males and females aged 35 to 65 years recruiting from the phase I of Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) cohort study. The participants were drawn by a stratified cluster random sampling technique. The Bivariate and multinomial logistic regression analysis were conducted considering gender stratification to explore the association of ECG abnormalities with traditional cardiovascular risk factors. There was a significant association between minor and major ECG abnormalities and hypertension (HTN), type 2 diabetes (T2DM), smoking, and physical activity (p 60 years were more likely to have major [ARRR = 2.01, 95% CI 1.49, 2.74] and minor [ARRR = 1.59, 95% CI 1.20, 2.10] abnormalities compared to women aged

Muscle atrophy due to limb immobilization and inactivity is a common consequence of many diseases and treatment processes. One of the systems activated in inflammatory conditions is the renin-angiotensin system (RAS). The present study was conducted with the aim of investigating the effects of one of the angiotensin-converting enzyme (ACE) inhibitors, enalapril, on improving muscle atrophy caused by immobility. The study was conducted in three groups: a control, an atrophy, and an atrophy group treated with enalapril on Balb/c mice. After tying a splint to cause atrophy in one of the legs, daily treatment with enalapril intraperitoneally (dissolved in DMSO) at a dose of 10 mg/kg/day was done for 7 days. On the eighth day, the splint was opened and half of the mice were evaluated. Then, in the recovery phase, treatment with enalapril was continued in the remaining mice for 10 days without a splint. At the end of each phase, the mice were examined for the muscle strength of the lower limb muscles, and histological and biochemical analyses were subsequently carried out. The tissue level of the oxidative stress index MDA was evaluated, which showed a significantly lower level in the enalapril group compared to the atrophy group (*P

Abstract Background Low-grade inflammation and stress oxidative condition play a role in the pathogenesis of obesity, and the serum levels of these markers, such as pro-oxidant-antioxidant balance (PAB), high-sensitivity C-reactive protein (hs-CRP), and uric acid may indicate obesity progression. In this study, we aimed to investigate the relationship between obesity with PAB, hs-CRP, and uric acid in the Iranian population. Methods This study was derived from the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study. A total of 7985 subjects aged 35 to 65 years were divided into three groups according to body mass index (BMI) as: normal, overweight and obese groups. Anthropometric indices and biochemical parameters such as PAB, superoxide dismutase type 1 (SOD1), hs-CRP, and uric acid were measured in all the participants. We evaluated the association of obesity with inflammatory factors by using multivariate regression analysis. Also, those participants with hypertension, an endocrine disorder, history of cardiovascular diseases and diabetes mellitus were excluded from the study. Results There was a positive significant correlation between BMI and serum PAB, hs-CRP and uric acid (p

Background: Premature menopause (PM) is the cessation of ovarian function before age 40. PM women are more likelyto have cardiovascular diseases (CVDs), diabetes, and mental disorders. This is the first study that assessed the associationof single nucleotide polymorphisms (SNPs) with anti-heat shock protein 27 (Hsp27), High-sensitivity C-reactive protein(hs-CRP), and PM and serum pro-oxidant-antioxidant balance (PAB), as putative risk factors for CVDs. We aimed toexplore the association of oxidative stress markers with eight different SNPs shown to be related to premature menopause.Materials and Methods: In this cross-sectional research, we included 183 healthy women and 117 premature menopausalwomen. We determined baseline characteristics for all participants and measured serum hs-CRP, anti-HSP-27 antibody titer, and PAB levels using the established methods. Genotyping for eight SNPs was done usingthe tetra amplification refractory mutation system polymerase chain reaction (Tetra-ARMS PCR) and allele-specificoligonucleotide PCR (ASO-PCR) methods.Results: We found a significant difference between mean serum PAB levels and the genetic variant of rs16991615(P=0.03). ANCOVA showed a significant effect of the genotypes rs4806660 and rs10183486 on hs-CRP serum levelsin the case and control groups, respectively (P=0.04 and P=0.007). ANCOVA also showed an association betweenrs244715 genotypes and anti-hsp27 serum levels in the case group (P=0.02). There was a significant effect of thegenotypes of rs451417 on the serum hs-CRP level in the control group (P=0.03).Conclusion: There was a significant association of the genetic variants related to PM with oxidative stress and inflammatorymarkers (serum PAB, anti-hsp27 antibody, and hs-CRP). Accordingly, this seems to be an effective approach topredicting susceptible subjects for cardiovascular and mental disorders as well as various cancers.

Abstract Objectives Artificial intelligence (AI) has tremendous potential to help radiologists in daily clinical routine. However, a seamless, standardized, and time-efficient way of integrating AI into the radiology workflow is often lacking. This constrains the full potential of this technology. To address this, we developed a new reporting pipeline that enables automated pre-population of structured reports with results provided by AI tools. Methods Findings from a commercially available AI tool for chest X-ray pathology detection were sent to an IHE-MRRT-compliant structured reporting (SR) platform as DICOM SR elements and used to automatically pre-populate a chest X-ray SR template. Pre-populated AI results could be validated, altered, or deleted by radiologists accessing the SR template. We assessed the performance of this newly developed AI to SR pipeline by comparing reporting times and subjective report quality to reports created as free-text and conventional structured reports. Results Chest X-ray reports with the new pipeline could be created in significantly less time than free-text reports and conventional structured reports (mean reporting times: 66.8 s vs. 85.6 s and 85.8 s, respectively; both p

Abstract Background The aim of this study was to determine the association between dietary mineral intake and Coronavirus-disease 2019 (COVID-19) infection and its associated hospitalization. Methods This cohort study utilized the MASHAD study population, which comprised individuals aged 35–65. Upon recruitment in 2007, dietary intake was documented using a validated 65-item food frequency questionnaire (FFQ). Data on COVID-19 PCR test results was collected from all relevant medical centers in Mashhad between February 2020 and June 2022. The regression model included dietary minerals and employed the backward variable selection method, along with advanced data analysis techniques. Results The final analysis involved 1957 participants, including 193 COVID-19-positive patients. The mean age was 49.71 and 50.28 years in the COVID-19-positive and negative groups, respectively (p = 0.12). Dietary intakes of magnesium, iron, and potassium were notably lower in COVID-19-positive patients (P

Introduction: After the influenza pandemic since 1918, the world is experiencing another viral challenge by a coronavirus (SARS-CoV-2). One of the most important strategies is to enhance the immune system.Results: Having an optimal nutritional behavior, following a balanced dietary pattern is essential for immune enhancement and reduce the risk of infectivity. Cytokine release syndrome (CRS) is hypothesized as one of the main causes of inflammation and consequently, lung damage in this viral infection. Undernutrition or overnutrition as the result of nutritional status can affect the immune system. Multivitamin and Minerals (MVM) intake can be beneficial in vulnerable populations such as the elderly, having a regular diet with the priority of healthy food portions can supply all daily requirements.Conclusion: According to the WHO recommendations for consumption of fresh fruits and vegetables and also diets which have been hypothesized as an immune enhancer, the Mediterranean diet may involve all nutrients needed for improvement of the immune system.

IntroductionThe oropharyngeal microbiome plays an important role in protection against infectious agents when in balance. Despite use of vaccines and antibiotic therapy to prevent respiratory tract infections, they remain one of the major causes of mortality and morbidity in Low- and middle-income countries. Hence the need to explore other approaches to prevention by identifying microbial biomarkers that could be leveraged to modify the microbiota in order to enhance protection against pathogenic bacteria. The aim of this study was to analyze the oropharyngeal microbiome (OPM) of schoolchildren in Côte d’Ivoire presenting symptoms of upper respiratory tract infections (URTI) for better prevention strategy.MethodsPrimary schools’ children in Korhogo (n = 37) and Abidjan (n = 39) were followed for six months with monthly oropharyngeal sampling. Clinical diagnostic of URT infection was performed and nucleic acid extracted from oropharyngeal swabs were used for 16S rRNA metagenomic analysis and RT-PCR.ResultsThe clinical examination of children’s throat in Abidjan and Korhogo identified respectively 17 (43.59%) and 15 (40.54%) participants with visible symptoms of URTIs, with 26 episodes of infection in Abidjan and 24 in Korhogo. Carriage of Haemophilus influenzae (12%), Streptococcus pneumoniae (6%) and SARS-CoV-2 (6%) was confirmed by PCR. A significant difference in alpha diversity was found between children colonized by S. pneumoniae and those that were not (p = 0.022). There was also a significant difference in alpha diversity between children colonised with H. influenzae and those who were not (p = 0.017). No significant difference was found for SARS-CoV-2. Sphingomonas, Ralstonia and Rothia were significantly enriched in non-carriers of S. pneumoniae; Actinobacillus was significantly enriched in non-carriers of H. influenzae; Actinobacillus and Porphyromonas were significantly enriched in non-carriers of SARS-CoV-2 (p < 0.001).DiscussionNearly 40% of children showed clinical symptoms of infection not related to geographical location. The OPM showed an imbalance during H. influenzae and S. pneumoniae carriage. This study provides a baseline understanding of microbiome markers in URTIs in children for future research, to develop targeted interventions aimed at restoring the microbial balance and reducing the symptoms associated with RTIs.

Background Previous studies using animal models and cultured cells suggest that vascular smooth muscle cells (SMCs) and inflammatory cytokines are important players in atherogenesis. Validating these findings in human disease is critical to designing therapeutics that target these components. Multiplex imaging is a powerful tool for characterizing cell phenotypes and microenvironments using biobanked human tissue sections. However, this technology has not been applied to human atherosclerotic lesions and needs to first be customized and validated. Methods and Results For validation, we created an 8‐plex imaging panel to distinguish foam cells from SMC and leukocyte origins on tissue sections of early human atherosclerotic lesions (n=9). The spatial distribution and characteristics of these foam cells were further analyzed to test the association between SMC phenotypes and inflammation. Consistent with previous reports using human lesions, multiplex imaging showed that foam cells of SMC origin outnumbered those of leukocyte origin and were enriched in the deep intima, where the lipids accumulate in early atherogenesis. This new technology also found that apoptosis or the expression of pro‐inflammatory cytokines were not more associated with foam cells than with nonfoam cells in early human lesions. More CD68+ SMCs were present among SMCs that highly expressed interleukin‐1β. Highly inflamed SMCs showed a trend of increased apoptosis, whereas leukocytes expressing similar levels of cytokines were enriched in regions of extracellular matrix remodeling. Conclusions The multiplex imaging method can be applied to biobanked human tissue sections to enable proof‐of‐concept studies and validate theories based on animal models and cultured cells.

Abstract Background It has been proposed that a greater degree of adherence to a healthy dietary pattern is associated with a lower risk of depression and a poor quality of life (QoL). The Lifelines diet score (LLDS) is a new, evidence-base scoring system to define the quality of diet. We designed a cross-sectional study to investigate the association between LLDS with depression and QoL in Iranian adolescent girls. Methods A total of 733 female adolescents were recruited from Mashhad and Sabzevar cities, Iran. Depression and QoL were assessed utilizing the Beck Depression Inventory (BDI) and SF-12v2 questionnaires, respectively. The LLDS was defined by dividing intakes of 12 food groups with negative or positive health effects into quintiles ranging 12 to 60 points. To explore the association between LLDS with QoL and depression, logistic regression was used in crude and adjusted models. Results The prevalence of depression and poor QoL was 24% and 49%, respectively. After adjusting for confounding factors, adolescent girls in the highest quartile of LLDS compared with the participants in the lowest quartile had a 42% lower probability of reporting depressive symptoms (OR: 0.58; 95% CI: 0.35–0.97, P = 0.03). In addition, the participants in the highest quartile of LLDS had lower odds of poor QoL compared with the subjects in the lowest quartile (OR: 0.65; 95% CI: 0.42–0.92, P = 0.04). Conclusions There is an inverse relationship between LLDS with risk of depression and poor QoL. Prospective and interventional investigations are needed to reach a clear vision.

Abstract Background and aim premature ovarian insufficiency (POI) is defined as the menopause before 40 years of age, and its prevalence is reported to be two-fold higher in Iranian women than the average for woman globally. POI is associated with several cardio/cerebrovascular complications as well as an increased overall mortality. Genetic factors, and serum levels of minerals and vitamin D, have been reported to be related to the prevalence of POI. We have investigated the association between some POI -related genotypes with the serum levels of some important micronutrients. Methods One hundred and seventeen women with POI and 183 controls without any renal, hepatic, and thyroid abnormalities were recruited as part of the MASHAD study. Demographic and anthropometric features were recorded and blood samples were collected and processed. DNA was extracted from the buffy coat of blood samples from all participants and 8 POI-related single nucleotide polymorphisms (SNPs) were determined using ASO-PCR or Tetra ARMS-PCR. Serum minerals and vitamin D concentrations were measured using routine methods. Results In women with POI, serum copper, phosphate, and calcium were significantly different for those with rs244715, rs16991615, and rs4806660 genotypes, respectively. In our control population, significant differences were also found in serum copper concentrations between different genotypes of rs4806660, rs7246479, rs1046089, and rs2303369. After adjusting for all confounding factors, the women with POI carrying TC genotype (rs4806660) had a lower risk to have serum copper levels 155 than those carrying AA genotype. Conclusion The C and G alleles of the rs4806660 and rs244715 polymorphisms respectively are independently associated with serum copper in women with POI. Further studies are necessary to investigate the association of serum copper and other micronutrients in women and other POI -related polymorphisms.

Abstract Background Previous studies have reported insulin resistance (IR) to be associated with hyperuricemia. In this study, we aimed to assess the possible associations between the empirical dietary index for IR (EDIR), the empirical lifestyle index for IR (ELIR), and non-insulin-based surrogates (triglyceride–glucose (TyG) index, triglyceride-to-high-density-lipoprotein-cholesterol (TG/HDL-C) ratio, metabolic score for insulin resistance (METS-IR) and TyG with body mass index (TyG-BMI)) and hyperuricemia in an Iranian population. Methods In this cross-sectional study, 6457 participants aged 35–65 years were recruited as part of the MASHAD cohort study. EDIR and ELIR were calculated using dietary intakes, body mass index, and physical activity information. Insulin resistance surrogates including TyG, TyG-BMI, TG/HDL-C, and METS-IR were calculated for all participants. Hyperuricemia was defined as serum uric acid ≥ 7 mg/dl in men or ≥ 6 mg/dl in women. Multivariable logistic regression models were applied to determine the association between indexes of IR and hyperuricemia. Results The mean ELIR and IR surrogates (TyG, TyG-BMI, TG/ HDL, and METS-IR) were significantly higher in subjects with hyperuricemia compared to non-hyperuricemic subjects (p

Abstract Studying the effects of the microbiome on the development of different types of cancer has recently received increasing research attention. In this context, the microbial content of organs of the gastrointestinal tract has been proposed to play a potential role in the development of pancreatic cancer (PC). Proposed mechanisms for the pathogenesis of PC include persistent inflammation caused by microbiota leading to an impairment of antitumor immune surveillance and altered cellular processes in the tumor microenvironment. The limited available diagnostic markers that can currently be used for screening suggest the importance of microbial composition as a non-invasive biomarker that can be used in clinical settings. Samples including saliva, stool, and blood can be analyzed by 16 s rRNA sequencing to determine the relative abundance of specific bacteria. Studies have shown the potentially beneficial effects of prebiotics, probiotics, antibiotics, fecal microbial transplantation, and bacteriophage therapy in altering microbial diversity, and subsequently improving treatment outcomes. In this review, we summarize the potential impact of the microbiome in the pathogenesis of PC, and the role these microorganisms might play as biomarkers in the diagnosis and determining the prognosis of patients. We also discuss novel treatment methods being used to minimize or prevent the progression of dysbiosis by modulating the microbial composition. Emerging evidence is supportive of applying these findings to improve current therapeutic strategies employed in the treatment of PC.

Abstract Background Systems of across the world have developed and implemented patient rights policies to protect and improve the provider-patient relationship. The Patient Charter of Ghana was developed in 2002 to improve service quality and protect patients’ rights. However, it is not yet known whether those at the frontline of healthcare delivery can read and understand the contents of the charter. While studies have explored the socioeconomic and institutional level factors related to awareness and knowledge of the Patient Rights Charter, there is a lack of literature on its readability and comprehensibility among nurses. This study assesses nurses’ knowledge of the Patient Rights Charter and associated literacy-related factors. Method An exploratory cross-sectional design and quantitative methods were used to collect data on knowledge, comprehension, and readability of the Patient Rights Charter. 205 nurses from four district hospitals in the Central Region were recruited using proportional and total enumeration sampling. Data were collected using structured questionnaires and were processed using SPSS (version 26) and an online text readability consensus calculator (version 2.0). Descriptive and inferential statistical analyses were performed, and data were presented using simple frequencies, readability statistics, and regression output. Results The results show the charter is written at a higher reading grade level; Flesch-Kincaid Grade Level (13.36), Simple Measure of Gobbledygook (11.57), and Coleman-Liau Readability Index (14.2). The average reading grade level score was 14. The Gunning Fox Index (15.40) and the Flesch Reading Ease Score (34%) show the patient charter is difficult to read and will require at least 14 years of education to be able to read. 87.3% of nurses were able to read and comprehend the charter. Very few (8.3%) read at frustration level. Nurses’ actual comprehension of the charter was the only significant predictor of knowledge of the charter. Conclusion Comprehension of the patient charter is an important predictor of its knowledge. The results emphasize the need to enhance the readability and comprehensibility of the charter for providers. Hospitals can stimulate nurses’ knowledge of the charter by simplifying the charter’s language and deliberately educating nurses on its content.

Abstract Background The aim was to establish a 10-year dyslipidemia incidence model, investigating novel anthropometric indices using exploratory regression and data mining. Methods This data mining study was conducted on people who were diagnosed with dyslipidemia in phase 2 (n = 1097) of the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study, who were compared with healthy people in this phase (n = 679). The association of dyslipidemia with several novel anthropometric indices including Conicity Index (C-Index), Body Roundness Index (BRI), Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), Abdominal Volume Index (AVI), Weight-Adjusted-Waist Index (WWI), A Body Shape Index (ABSI), Body Mass Index (BMI), Body Adiposity Index (BAI) and Body Surface Area (BSA) was evaluated. Logistic Regression (LR) and Decision Tree (DT) analysis were utilized to evaluate the association. The accuracy, sensitivity, and specificity of DT were assessed through the performance of a Receiver Operating Characteristic (ROC) curve using R software. Results A total of 1776 subjects without dyslipidemia during phase 1 were followed up in phase 2 and enrolled into the current study. The AUC of models A and B were 0.69 and 0.63 among subjects with dyslipidemia, respectively. VAI has been identified as a significant predictor of dyslipidemias (OR: 2.81, (95% CI: 2.07, 3.81)) in all models. Moreover, the DT showed that VAI followed by BMI and LAP were the most critical variables in predicting dyslipidemia incidence. Conclusions Based on the results, model A had an acceptable performance for predicting 10 years of dyslipidemia incidence. Furthermore, the VAI, BMI, and LAP were the principal anthropometric factors for predicting dyslipidemia incidence by LR and DT models.

Background: Today, the use of social media for health care advice has become more popular. The present study aimed to evaluate the opinions of Iranian dietitians on virtual nutritional counseling on the Instagram platform.Methods: The present descriptive, cross-sectional study enrolled Iranian dietitians working in the field of nutrition counseling using Instagram. The link to an online questionnaire including questions on their activity in virtual counseling on Instagram and the challenges of virtual counseling was sent to the 131 participants. Descriptive statistics were used to analyze and interpret the data.Results: Out of 163 dietitians, 131 participated in the study. 47.3% started virtual counseling during COVID-19, and 35.2% had more virtual clients. 58.8% preferred face-to-face counseling for concept transfer, and 43.5% found it more effective. Text and voice messaging were the most practical methods for virtual counseling, with weight loss being the most common topic.Conclusion: During the COVID-19 pandemic, virtual nutritional counseling became more widespread. However, it is believed that face-to-face counseling is more effective in conveying concepts. For virtual platforms, text messaging is the most practical method for nutrition counseling, followed by voice messaging. It has been observed that the elderly have been the least likely people to seek virtual nutrition counseling, while weight loss counseling has been the most frequently requested topic.

Abstract Background Type 2 Diabetes Mellitus (T2DM) has become a major health concern with an increasing prevalence and is now one of the leading attributable causes of death globally. T2DM and cardiovascular disease are strongly associated and T2DM is an important independent risk factor for ischemic heart disease. T-wave abnormalities (TWA) on electrocardiogram (ECG) can indicate several pathologies including ischemia. In this study, we aimed to investigate the association between T2DM and T-wave changes using the Minnesota coding system. Methods A cross-sectional study was conducted on the MASHAD cohort study population. All participants of the cohort population were enrolled in the study. 12-lead ECG and Minnesota coding system (codes 5–1 to 5–4) were utilized for T-wave observation and interpretation. Regression models were used for the final evaluation with a level of significance being considered at p 0.05). Hypertension, age, and body mass index were significantly associated with T2DM (p

Abstract Background and aim Coronavirus disease (COVID-19) is an infectious disease that can spread very rapidly with important public health impacts. The prediction of the important factors related to the patient's infectious diseases is helpful to health care workers. The aim of this research was to select the critical feature of the relationship between demographic, biochemical, and hematological characteristics, in patients with and without COVID-19 infection. Method A total of 13,170 participants in the age range of 35–65 years were recruited. Decision Tree (DT), Logistic Regression (LR), and Bootstrap Forest (BF) techniques were fitted into data. Three models were considered in this study, in model I, the biochemical features, in model II, the hematological features, and in model II, both biochemical and homological features were studied. Results In Model I, the BF, DT, and LR algorithms identified creatine phosphokinase (CPK), blood urea nitrogen (BUN), fasting blood glucose (FBG), total bilirubin, body mass index (BMI), sex, and age, as important predictors for COVID-19. In Model II, our BF, DT, and LR algorithms identified BMI, sex, mean platelet volume (MPV), and age as important predictors. In Model III, our BF, DT, and LR algorithms identified CPK, BMI, MPV, BUN, FBG, sex, creatinine (Cr), age, and total bilirubin as important predictors. Conclusion The proposed BF, DT, and LR models appear to be able to predict and classify infected and non-infected people based on CPK, BUN, BMI, MPV, FBG, Sex, Cr, and Age which had a high association with COVID-19.

Introduction: Cardiovascular disease (CVD) is the leading cause of mortality and one of the main challenges for health systems worldwide. In this study, we aimed to evaluate the association of socio-demographic, lifestyle, psychological and anthropometric factors and underlying diseases such as hypertension (HTN), diabetes mellitus (DM) and metabolic syndrome (MS) with CVD risk among a subpopulation of Iranian adults.Methods: In this prospective study, a total of 235 CVD patients along with 8405 healthy and non-symptomatic individuals who participated in MASHAD cohort study were enrolled. CVD diagnosis was performed by taking electrocardiogram (ECG) and medical history and performing physical examination for each participant. Health and lifestyle questionnaires, the Beck’s anxiety inventory (BAI), Beck’s depression inventory (BDI) and the James and Schofield human energy requirements equations were completed for all participants. Anthropometric measurements were also recorded for all subjects. All statistical analyses including chi-square and student independent T-test were performed using SPSS 16.0 software (SPSS Inc., Chicago, IL, USA) at a significant level of 0.05.Results: We found that there were significant associations between CVD risk and age, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), diabetes mellitus (DM) and family history (FH) of CVD in both genders; though, there was a significant negative correlation between physical activity level (PAL) and risk of CVD among men and women. Also hypertension (HTN), metabolic syndrome (MS), depression and anxiety were positively and higher education level was negatively associated with CVD events only in females. While, waist-to-hip ratio (WHR) was an independent predictor of CVD among males (P-value< 0.05).Conclusion: There are several modifiable and non-modifiable risk factors that are independently considered as CVD predictors among the MASHAD study population. It is recommended to prioritize the lifestyle modification, development of local risk calculators and gender-related stratified strategies in order to prevent and manage CVD among the Iranian population.

Abstract There have been inconsistent reports regarding the association between dietary acid load and Metabolic Syndrome (MetS). We aimed to investigate the association between dietary acid load and MetS in an Iranian adult population. In this cross-sectional study, 1945 participants aged 35–65 years were recruited from MASHAD cohort study. Dietary intakes were assessed using a 24-h dietary recall. Diet-based acidity was assessed as the net endogenous acid production (NEAP), potential renal acid load (PRAL), and dietary acid load (DAL). To define MetS, the International Diabetes Federation (IDF) criteria were used. Multivariable logistic regression models were applied to determine the association between diet-based acid load scores and MetS. Participants' mean age and BMI were 47.13 ± 7.78 years and 27.57 ± 4.48 kg/m2, respectively. Around 57% of the population was female. Overall, 31.9% had MetS. According to the full-adjusted model, there was a significant association between higher quartiles of PRAL, NEAP, and DAL and MetS (Q4 PRAL; OR (95%CI) 1.42(1.05–1.91), Q4 NEAP; OR (95%CI) 1.48(1.11–1.98), Q4 DAL; OR (95%CI) 1.44(1.05–1.91)). This study showed a significant positive association between different dietary acid load indicators (PRAL, NEAP, and DAL) and odds of MetS among Iranian adults.

Abstract The metastasis of melanoma cells to regional lymph nodes and distant sites is an important contributor to cancer-related morbidity and mortality among patients with melanoma. This intricate process entails dynamic interactions involving tumor cells, cellular constituents, and non-cellular elements within the microenvironment. Moreover, both microenvironmental and systemic factors regulate the metastatic progression. Central to immunosurveillance for tumor cells are natural killer (NK) cells, prominent effectors of the innate immune system with potent antitumor and antimetastatic capabilities. Recognizing their pivotal role, contemporary immunotherapeutic strategies are actively integrating NK cells to combat metastatic tumors. Thus, a meticulous exploration of the interplay between metastatic melanoma and NK cells along the metastatic cascade is important. Given the critical involvement of NK cells within the melanoma tumor microenvironment, this comprehensive review illuminates the intricate relationship between components of the melanoma tumor microenvironment and NK cells, delineating their multifaceted roles. By shedding light on these critical aspects, this review advocates for a deeper understanding of NK cell dynamics within the melanoma context, driving forward transformative strategies to combat this cancer.

A patient-oriented approach to addressing high levels of polysubstance use among sexual and gender minority men (SGM) who use crystal methamphetamine (CM) requires an understanding of which drugs they would like to change their use of. We examined readiness to change for 24 separate substances. Participants were SGM, aged 18+, living with Canada, who used CM in the past six months that were recruited through advertisements on socio-sexual networking applications. Frequency of use and readiness to change were descriptively analyzed and associations between frequency of use and readiness to change were assessed. Only slightly more than half (53.1%) of CM-using SGM were ready now, soon, or in the future to change substance use. Participants were most ready to change their tobacco, methamphetamine, and barbiturate use. Greater frequency of use was associated with greater readiness to change for all drugs in which daily or almost daily use was common. SGM participants reported high levels of comfort being asked about their substance use from primary care, mental health, and queer-identified health professionals. Interventions addressing multiple and specific substances are needed in health care settings serving SGM who use CM. Screening, brief interventions, and referral to treatment (SBIRT) in these settings may help identify those ready to address their substance use. Harm reduction interventions should offer supports for those not wanting to change their substance use—which includes most SGM for most of the drugs they use.

Background: The highly infectious nature of SARS-CoV-2 necessitates using bio-containment facilities to study viral pathogenesis and identify potent antivirals. However, the lack of high-level bio-containment laboratories across the world has limited research efforts into SARS-CoV-2 pathogenesis and the discovery of drug candidates. Previous research has reported that non-replicating SARS-CoV-2 Spike-pseudotyped viral particles are effective tools to screen for and identify entry inhibitors and neutralizing antibodies. Methods: To generate SARS-CoV-2 pseudovirus, a lentiviral packaging plasmid p8.91, a luciferase expression plasmid pCSFLW, and SARS-CoV-2 Spike expression plasmids (Wild-type (D614G) or Delta strain) were co-transfected into HEK293 cells to produce a luciferase-expressing non-replicating pseudovirus which expresses SARS-CoV-2 spike protein on the surface. For relative quantitation, HEK293 cells expressing ACE2 (ACE2-HEK293) were infected with the pseudovirus, after which luciferase activity in the cells was measured as a relative luminescence unit. The ACE2-HEK293/Pseudovirus infection system was used to assess the antiviral effects of some compounds and plasma from COVID-19 patients to demonstrate the utility of this assay for drug discovery and neutralizing antibody screening. Results: We successfully produced lentiviral-based SARS-CoV2 pseudoviruses and ACE2-expressing HEK293 cells. The system was used to screen compounds for SARS-CoV-2 entry inhibitors and identified two compounds with potent activity against SARS-CoV-2 pseudovirus entry into cells. The assay was also employed to screen patient plasma for neutralizing antibodies against SARS-CoV-2, as a precursor to live virus screening, using successful hits. Significance: This assay is scalable and can perform medium-to high-throughput screening of antiviral compounds with neither severe biohazard risks nor the need for higher-level containment facilities. Now fully deployed in our resource-limited laboratory, this system can be applied to other highly infectious viruses by swapping out the envelope proteins in the plasmids used in pseudovirus production.

Abstract Background Loss‐of‐function (LOF) variants of the angiopoietin‐like 3 (ANGPTL3) gene are reported to be associated with serum triglyceride (TG) and high‐density lipoprotein cholesterol (HDL‐C) concentrations and thereby affect the risk of cardiovascular disease (CVD). Objective In the present study, we examined the association of rs10789117 in the ANGPTL 3 gene locus and the risk of CVD in the group of people who were part of the Mashhad‐Stroke and Heart‐Atherosclerotic‐Disorders (MASHAD) cohort. Methods One thousand and two healthy individuals enrolled in this study of whom 849 subjects were healthy and 153 subjects developed CVD outcomes after 6 years of follow‐up. After a 12‐h overnight fasting, 20 mL of blood samples were collected for the measurement of fasting blood glucose and lipid profile. DNA was extracted, and the Tetra‐ARMS PCR (amplification refractory mutation system) was used for genotyping of rs10789117 in the ANGPTL3 gene. The genotype frequencies of the variant of rs10789117 in the ANGPTL3 gene were estimated using χ2 tests. Eventually, the statistical analysis was done by SPSS version 20. Results Individuals with AC/CC genotypes (rs10789117) were found to have to greater risk of CVD events compared to AA genotype (OR = 1.43, 95%CI = 1.01–2.02, p = 0.041). There was a 1.3‐fold increase in cardiovascular events in individuals carrying the C allele of rs10789117 variant compared to non‐carriers (OR = 1.32, 95%CI = 1.06–1.72, p value = 0.038). There were significant differences between different genotypes for serum triglyceride levels within the control group, but this difference was not significant in the group with CVD. Moreover, there was a significant association between CC genotype and CVD risk in the individuals with a normal serum HDL‐C. Conclusion We have found that a rs10789117 C>A in ANGPTL3 gene polymorphism was associated with incident CVD events, and this may be of value as a risk stratification biomarker in CVD in the Iranian population.

Ghana has recently renewed its commitment to build a strong Science, Technology, and Innovation (STI) base for improved socio-economic development. This commitment hinges on recognizing that the strength of the nation’s STI policy depends on the quality of pre-tertiary education and training in science and mathematics to produce a critical mass of young people well-prepared for Science, Technology, Engineering, and Mathematics (STEM) courses at the tertiary level. However, despite numerous interventions to improve upon STI, Ghana still performs poorly, along with other Sub-Sahara Africa (SSA) countries with common STI indicators in the Global Innovation Index. Using Ghana as a lens, this article highlights the challenges in STEM teaching and learning throughout the sub-region. The qualitative research approach was adopted to allow an in-depth exploration of participants’ perspectives. Six pre-tertiary schools (three Junior High Schools and three Senior High Schools) and the University of Ghana, Legon, were selected due to the availability of their students and teachers to participate in the interviews in Accra, the capital city. This article argues that, to develop the critical mass of human capital needed for sustainable development, there is a need to improve the performance of students in STEM subjects at the pre-tertiary level. In addition, performance improvement, which is linked to student interest in the study of STEM subjects, should increase the quality of students entering tertiary education institutions. These students will then be trained to meet the quality of human resources needed to run the STI system—a step toward achieving sustainable development this article recommends the redesign of STEM curriculum at the pre-tertiary level to align with tertiary STEM education as that in turn aligns with Ghana’s STI system.

IntroductionThe life expectancy of people living with HIV receiving effective combination antiretroviral therapy is approaching that of the general population and non AIDS-defining age-related comorbidities are becoming of greater concern. In order to support healthy aging of this population, we set out to explore the association between multimorbidity (defined as presence of 2 or more non AIDS-defining comorbidities) and quality of life (QoL).MethodsWe performed a cross-sectional analysis using data from the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study, a Canadian cohort of people living with HIV age 65 years and older. Study participants completed two QoL modules, the general QoL and health related QoL (HR-QoL).Results433 participants were included in the analysis with a median age of 69 years (interquartile range, IQR 67–72). The median number of comorbidities among study participants was 3 (IQR 2–4), with 78% meeting the definition of multimorbidity. General QoL scores (median 66, IQR 58–76) were lower than HR-QoL scores (median 71, IQR 61–83) and were not associated with multimorbidity after adjusting for age, sex, relationship status, household income, exercise, tobacco smoking history, malnutrition, time since HIV diagnosis, and HIV-related stigma. In contrast, multimorbidity was associated with lower HR-QoL (adjusted β = −4.57, 95% CI −8.86, −0.28) after accounting for the same variables. Several social vulnerabilities (not having a partner, low household income), health behaviours (lower engagement in exercise, smoking), and HIV-related factors (HIV stigma, longer time since HIV diagnosis) were also associated with lower QoL.DiscussionOverall, our study demonstrated a high burden of multimorbidity among older adults living with HIV in Canada, which has a negative impact on HR-QoL. Interventions aimed at preventing and managing non-AIDS-defining comorbidities should be assessed in people living with HIV to determine whether this can improve their HR-QoL.

Abstract Ovarian cancer is one of the most prevalent malignancies in women. Harmaline is reported to have powerful anticancer properties. We aimed to investigate the apoptotic and antimetastatic properties of harmaline in A2780 ovarian cancer cells. Cell viability, apoptosis, migration, and invasion were investigated in cells treated with harmaline. Reactive oxygen species (ROS) production, mRNA expression of apoptosis‐associated genes, MMP‐2, and MMP‐9 were measured. Harmaline attenuated the viability of A2780 ovarian cancer cells in a dose‐ and time‐dependent way. Furthermore, compared to NIH/3T3 mouse normal cell line (IC50 = 417 μM), the malignant A2080 cells were more sensitive to harmaline (IC50 = 300 μM after 24 h). Harmaline increased the production of ROS, raised the mRNA expression of p53 and the Bax/Bcl2 ratio. Harmaline also increased the proportion of cells in the late apoptotic and necrotic phases. MMP‐2 and MMP‐9's mRNA expression, gelatinase activity, and migration of A2780 cells also decreased by harmaline. These findings suggest that harmaline may have the potential to be a therapeutic drug for ovarian cancer by triggering apoptosis and suppressing invasion and migration.

Background: Two years after the WHO declared a state of emergency as a result of the rapid spread of the COVID-19 virus from Wuhan, China, the rate of new infections experienced intermittent flare-ups globally, with vaccinations still ongoing in countries such as Ghana. One year after the implementation of Ghana’s COVID-19 vaccine deployment program, Ghanaians have had the opportunity to reflect on their vaccination decisions, albeit the initial vaccine hesitancy. Objectives: The current paper examined the knowledge and lived experiences of Ghanaians during the COVID-19 pandemic, and the factors influencing their vaccination decisions, one year after COVID-19 vaccinations commenced in Ghana, with special focus on the social and geographical histories which influenced their vaccination decisions. Methodology: A qualitative approach using a case study design was used to conduct in-depth interviews among 25 respondents who were 18 years and above, not pregnant, and willing to participate in the study, between 5th and 23rd September 2022. Data was collected in 5 hotspot areas in Ghana with the highest cumulative case counts. A semi-structured interview guide was used to collect data which was analyzed using a thematic approach. Findings: Respondents demonstrated a good level of knowledge on COVID-19 and related vaccines. Fear, panic, and anxiety were some of the experiences lived by respondents during the pandemic. The factors influencing vaccination decisions included conspiracy theories about COVID-19 and related vaccines, subjective notions about the COVID-19 disease, and subjective notions about the vaccine. The type of community one lived in, taboos, and previous successful vaccination programs in the community were geographic factors that informed respondents’ decision to vaccinate or not. Social circles, religion, opinion leaders, and media-based campaigns were the social factors that influenced respondents’ decision to vaccinate or not.

Objectives: Curcumin has antioxidant properties and has been proposed as a potential treatment for NAFLD. The aim of current systematic review and meta-analysis was to evaluate previous findings for the effect of curcumin supplementation on glycaemic indices, lipid profile, blood pressure, inflammatory markers, and anthropometric measurements of NAFLD patients. Methods: Relevant studies published up to January 2024 were searched systematically using the following databases: PubMed, SCOPUS, WOS, Science Direct, Ovid and Cochrane. The systematic review and meta-analysis were conducted according to the 2020 PRISMA guidelines. The quality of the papers was assessed the using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Pooled effect sizes were calculated using a random-effects model and reported as the WMD and 95% CI. Also, subgroup analyses were done to find probable sources of heterogeneity among studies. Results: Out of 21010 records initially identified, 21 eligible RCTs were selected for inclusion in a meta-analysis. Overall, 1191 participants of both genders, 600 in the intervention and 591 in the control group with NAFLD were included. There are several limitations in the studies that were included, for instance, the results are weakened substantially by potential bias or failure to account for potential adulteration (with pharmaceuticals) or contamination (with other herbs) of the curcumin supplements that were tested. However, previous studies have reported curcumin to be a safe complementary therapy for several conditions. Our study indicated that curcumin supplementation in doses of 50−3000 mg/day was associated with significant change in FBG [WMD: −2.83; 95% CI: −4.61, −1.06), I2 = 51.3%], HOMA-IR [WMD: −0.52; 95% CI: −0.84, −0.20), I2= 82.8%], TG [WMD: −10.31; 95% CI: −20.00, −0.61), I2 = 84.5%], TC [WMD: −11.81; 95% CI: −19.65, −3.96), I2 = 94.6%], LDL [WMD: −8.01; 95% CI: −15.79, −0.24), I2 = 96.1%], weight [WMD: −0.81; 95% CI: −1.28, −0.35), I2= 0.0%] and BMI [WMD: −0.35; 95% CI: −0.57, −0.13), I2= 0.0%] in adults with NAFLD. There was no significant change in HbA1C, plasma insulin, QUICKI, HDL, SBP, DBP, CRP, TNF-α and WC after curcumin therapy. Subgroup analysis suggested a significant changes in serum FBG, TG, SBP, WC in RCTs for intervention durations of ≥ 8 weeks, and SBP, TG, LDL, HDL, BMI, WC in RCTs with sample size > 55 participants. Conclusion: Curcumin supplementation in doses of 50−3000 mg/day over 8–12 weeks was associated with significant reductions in levels of FBG, HOMA-IR, TG, TC, LDL, weight and BMI in patients with NAFLD. Previous studies have reported curcumin as a safe complementary therapy for several diseases. We would suggest that should curcumin supplements be used clinically in specific conditions, it should be used with caution. Also, difference in grades of NAFLD may effect the evaluated outcomes, so it is suggested that future studies be conducted with an analyses on subgroups according to their NAFLD grade. Furthermore, because of the failure to conduct independent biochemical assessment of the turmeric/curcumin product used in most studies as well as potential sources of bias, results should be interpreted with caution.

Provitamin D3 is the biological precursor to naturally formed vitamin D3 in humans, and its conversion is initiated via photoexcitation by near ultraviolet light. Following an initial photolysis, the primary intermediate, known as previtamin D3, is prone to light-induced isomerization or recyclization, which creates byproducts that limit the desired final thermal conversion to vitamin D3. The branching of the photochemical reaction is highly wavelength-dependent, whereby excitation toward the blue edge of the provitamin D3 absorption spectrum tends to terminate the reaction with the most undesired tachysterol byproduct and the lowest previtamin D3 concentration. In this work, the influence of introducing the natural amino acid phenyalanine as an excitation energy donor to the photochemical reaction is investigated. We find that the incorporation of phenylalanine into provitamin D3 solution results in greater intermediate concentrations and prolonged lifetimes of the desired previtamin D3 while simultaneously reducing the final concentration of tachysterol when exposing the solution to wavelengths at the blue edge of the provitamin D3 spectrum. The results, coupled with quantum chemical analysis, suggest that phenylalanine indeed helps to funnel energy from shorter wavelengths more effectively into the provitamin D3 precursor, while simultaneously screening those wavelengths from direct excitation, which otherwise leads to enhanced concentrations of tachysterol byproduct at the expense of previtamin D3.

Abstract Non-alcoholic fatty liver disease (NAFLD) comprises a range of chronic liver diseases that result from the accumulation of excess triglycerides in the liver, and which, in its early phases, is categorized NAFLD, or hepato-steatosis with pure fatty liver. The mortality rate of non-alcoholic steatohepatitis (NASH) is more than NAFLD; therefore, diagnosing the disease in its early stages may decrease liver damage and increase the survival rate. In the current study, we screened the gene expression data of NAFLD patients and control samples from the public dataset GEO to detect DEGs. Then, the correlation betweenbetween the top selected DEGs and clinical data was evaluated. In the present study, two GEO datasets (GSE48452, GSE126848) were downloaded. The dysregulated expressed genes (DEGs) were identified by machine learning methods (Penalize regression models). Then, the shared DEGs between the two training datasets were validated using validation datasets. ROC-curve analysis was used to identify diagnostic markers. R software analyzed the interactions between DEGs, clinical data, and fatty liver. Ten novel genes, including ABCF1, SART3, APC5, NONO, KAT7, ZPR1, RABGAP1, SLC7A8, SPAG9, and KAT6A were found to have a differential expression between NAFLD and healthy individuals. Based on validation results and ROC analysis, NR4A2 and IGFBP1b were identified as diagnostic markers. These key genes may be predictive markers for the development of fatty liver. It is recommended that these key genes are assessed further as possible predictive markers during the development of fatty liver.

Objective: Premenstrual syndrome and primary dysmenorrhea are common gynecological complaints that are associated with psychological disorders. There is increasing evidence for the neuroprotective properties of curcumin, a polyphenolic natural product. This study aimed to assess the effects of curcumin on sleep complications in women with premenstrual syndrome and dysmenorrhea.Materials and Methods: This triple-masked, placebo-controlled clinical trial comprised 124 patients with both premenstrual syndrome and dysmenorrhea. Participants were randomly assigned to curcumin (n=57) or control (n=60) groups. Each participant received one capsule containing either 500 mg of curcumin plus piperine or placebo, daily, from 7 days before until 3 days after menstruation for three consecutive menstrual cycles. Insomnia and sleepiness were assessed using standard questionnaires.Results: Scores for insomnia and daytime sleepiness were directly correlated with the Premenstrual Syndrome Screening Tool (PSST) score (p0.05). There was a non-significant reduction in insomnia and sleepiness scores in both curcumin and placebo groups after the study intervention. Whilst, improvement rate of insomnia status, daytime sleepiness severity, short sleep duration and difficult sleep initiation was not statistically significant between the curcumin and placebo groups.Conclusion: Curcumin does not significantly affect sleep disorders in young women with premenstrual syndrome and dysmenorrhea.

Abstract Aims The possible role of lifestyle including diet on immunity led us to investigate the association between dietary macronutrient intake and COVID-19 in an Iranian population. Methods Dietary intakes were recorded in the first phase of the MASHAD cohort study (started in 2007), using a 24-h dietary recall. To determine the COVID-19 incidence, data from all PCR-positive patients in Mashhad were recorded between February 2020 and June 2022. Dietary macronutrients were included in the regression model, adjusting for age and sex. System dynamical models were also applied. Results The analysis included 1957 participants, including 193 COVID-19-positive patients. Dietary intakes of non-starch polysaccharides (NSP) and fiber were significantly lower in COVID-19 patients (P

Abstract Pancreatic ductal adenocarcinoma (PDAC) is associated with a very poor prognosis. Therefore, there has been a focus on identifying new biomarkers for its early diagnosis and the prediction of patient survival. Genome-wide RNA and microRNA sequencing, bioinformatics and Machine Learning approaches to identify differentially expressed genes (DEGs), followed by validation in an additional cohort of PDAC patients has been undertaken. To identify DEGs, genome RNA sequencing and clinical data from pancreatic cancer patients were extracted from The Cancer Genome Atlas Database (TCGA). We used Kaplan–Meier analysis of survival curves was used to assess prognostic biomarkers. Ensemble learning, Random Forest (RF), Max Voting, Adaboost, Gradient boosting machines (GBM), and Extreme Gradient Boosting (XGB) techniques were used, and Gradient boosting machines (GBM) were selected with 100% accuracy for analysis. Moreover, protein–protein interaction (PPI), molecular pathways, concomitant expression of DEGs, and correlations between DEGs and clinical data were analyzed. We have evaluated candidate genes, miRNAs, and a combination of these obtained from machine learning algorithms and survival analysis. The results of Machine learning identified 23 genes with negative regulation, five genes with positive regulation, seven microRNAs with negative regulation, and 20 microRNAs with positive regulation in PDAC. Key genes BMF, FRMD4A, ADAP2, PPP1R17, and CACNG3 had the highest coefficient in the advanced stages of the disease. In addition, the survival analysis showed decreased expression of hsa.miR.642a, hsa.mir.363, CD22, BTNL9, and CTSW and overexpression of hsa.miR.153.1, hsa.miR.539, hsa.miR.412 reduced survival rate. CTSW was identified as a novel genetic marker and this was validated using RT-PCR. Machine learning algorithms may be used to Identify key dysregulated genes/miRNAs involved in the disease pathogenesis can be used to detect patients in earlier stages. Our data also demonstrated the prognostic and diagnostic value of CTSW in PDAC.

There has been increasing interest in studying the effects of dietary factors on telomere length. The telomere is a noncoding DNA sequence including "TTAGGG" at the ends of chromosomes of vertebrates. The stability of telomere length is an important factor as a survival signal for cells and cancer prevention. Telomerase is a multi-subunit DNA polymerase that plays a crucial role in maintaining the telomere length, which is critical for the age-related pathogenesis of breast neoplasm. Some regulatory factors interfere with telomerase activity and therefore promote breast tumorigenesis. High telomerase activity and restoring telomere lengths are determined as key factors in progressing tumors to advanced stages of malignancies, which are highly estrogen-dependent in breast carcinogenesis. Melatonin is a hormone-like substance secreted by the pineal gland and has been reported to downregulate telomerase. It may therefore control telomere length in cancer cells. Certain malignancy-related biological pathways have recently been linked to telomere length, and this review provides new insights regarding the effects of melatonin on telomere length by reviewing the anticarcinogenic mechanisms underlying melatonin in relation to telomerase activity in breast carcinogenesis. Experimental insights presenting the effects of melatonin alone or in combination with drugs on enhancing therapeutic protocols were also reviewed, which could assist our understanding of this hormone-like substance and telomeres as prognostic and therapeutic biomarkers in breast cancer.

Introduction: Serum vitamin D levels are related to a wide spectrum of factors including low sunlight exposure, high oxidative stress, low physical activity and sleep disorders. In this paper we are going to investigate the most crucial parameters associated with serum vitamin D levels in survey of ultraviolet intake by nutritional approach (SUVINA) study with a data mining approach.Material and Methods: Data including demographic, anthropometric, clinical and laboratory information were extracted from the SUVINA dataset comprising 289 subjects who were enrolled into our study. The XGBoost algorithm was used to define the most important features related to vitamin D level in our population.Results: Applying XGBoost modeling for vitamin D level showed that the presented scheme can determine the most important determinants of serum vitamin D level with an accuracy of 91%. Pro-oxidant anti-oxidant balance (PAB), body fat percentage, physical activity level (PAL), age, restless leg syndrome (RLS), and dietary inflammatory index (DII) density were the most important variables correlated with vitamin D deficiency.Conclusion: Using XGBoost and with an accuracy of more than 90%, we showed that the six most important risk factors for vitamin D deficiency are PAB, PAL, age, body fat percentage, RLS and DII density, respectively.

Introduction: The pandemic of COVID-19 created a psychological response. So, the psychological function of COVID-19 patients is an important subject that forces us to follow up with them.Aim: Assess the correlation between vitamin D serum concentrations and psychological functions such as insomnia, stress, and depression through the COVID-19 pandemicMethods: In this cross-sectional study, blood samples from 120 COVID-19 patients (61 males and 59 females) who had more than 30 years, were taken. Also, 25(OH)D Serum level of COVID-19 patients was analyzed. The Insomnia Severity Index (ISI), Depression anxiety stress scales (DASS), and the Short Form Health Survey (SF-36) were used to analyze insomnia, anxiety, stress, quality of life, and depression.Results: The relationship between temperature (p=0.039), PCO2 (p=0.022), and serum vitamin D level was significant. Additionally, there was a significant correlation between stress (p=-0.023, OR=0.389, 95% CI for OR=0.047, 0.843), depression (p=0.012, OR=0.659, 95% CI for OR=0.476, 0.913), and the concentration of serum vitamin D.Conclusion:This study recommends that vitamin D supplementation improve psychological state in COVID-19 patients.

Abstract Background RNA editing at the Q/R site of GluA2 occurs with ~99% efficiency in the healthy brain, so that the majority of AMPARs contain GluA2(R) instead of the exonically encoded GluA2(Q). Reduced Q/R site editing increases AMPA receptor calcium permeability and leads to dendritic spine loss, neurodegeneration, seizures and learning impairments. Furthermore, GluA2 Q/R site editing is impaired in Alzheimer’s disease (AD), raising the possibility that unedited GluA2(Q)-containing AMPARs contribute to synapse loss and neurodegeneration in AD. If true, then inhibiting expression of unedited GluA2(Q), while maintaining expression of GluA2(R), may be a novel strategy of preventing synapse loss and neurodegeneration in AD. Methods We engineered mice with the ‘edited’ arginine codon (CGG) in place of the unedited glutamine codon (CAG) at position 607 of the Gria2 gene. We crossbred this line with the J20 mouse model of AD and conducted anatomical, electrophysiological and behavioural assays to determine the impact of eliminating unedited GluA2(Q) expression on AD-related phenotypes. Results Eliminating unedited GluA2(Q) expression in AD mice prevented dendritic spine loss and hippocampal CA1 neurodegeneration as well as improved working and reference memory in the radial arm maze. These phenotypes were improved independently of Aβ pathology and ongoing seizure susceptibility. Surprisingly, our data also revealed increased spine density in non-AD mice with exonically encoded GluA2(R) as compared to their wild-type littermates, suggesting an unexpected and previously unknown role for unedited GluA2(Q) in regulating dendritic spines. Conclusion The Q/R editing site of the AMPA receptor subunit GluA2 may act as an epigenetic switch that regulates dendritic spines, neurodegeneration and memory deficits in AD.