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The aim of this paper was to customize user requirements and quality creation for design improvement of furniture. The major purpose has been achieved with the use of Quality Function Deployment technique and Kano Model. The study involved 564 students from 3 engineering colleges. Extensive user requirements were identified with the help of Questionnaires. The use of House of Quality, Kano Model and Pareto Diagram helped in prioritizing all important features which are needed in customizing user requirements. The prioritized requirements include ergonomic design, desk adjustability, comfortability, product corners (sharp corners) and latest material. All these factors both got high relative and absolute weight. Therefore, more engineering efforts need to be directed towards these requirements for achieving user customization for design improvement. The developed House of Quality with the help of Kano Model results has proved to be a good tool in customizing user requirements.

This paper presents anthropometric measurements regarding engineering students in India. Health survey (ergonomic assessment) was carried out to know the health status of all students who have been using poorly designed furniture. The data were measured with the help of various tools. After data collection and analysis, authors came up with exhaustive dimensions for designing adjustable classrooms furniture. Dimensions recommended include; bench surface height, bench depth and width, back rest width and height, backrest angle, desk height, desk depth, width, and desk angle. Therefore, an implementation of these data will help to create comfortability, safety, well-being, suitability, reduce Musculoskeletal disorders, and improve performance of students in terms of attentiveness. Also, it is highly recommended to consider requirements from students in designing classrooms furniture and conduct seminar or workshop to educate students regarding the negative impact towards adapting poor posture in the long usage of classrooms furniture.

Engineering Students in India like elsewhere worldwide need well designed classrooms furniture which can enable them to attend lectures without negative impact in the long run. Engineering students from India have not yet been involved in suggesting their requirements for improving the mostly out-dated furniture at their colleges. Among the available improvement techniques, Kano Model is one of the most effective improvement approaches. The main objective of the study was to identify and categorise all the main attributes regarding the classrooms furniture for the purpose of increasing student satisfaction in the long run. Kano Model has been well applied to make an exhaustive list of requirements for redesigning classroom furniture. Cronbach Alpha was computed with the help of SPSS 16.0 for validation purpose and it ranged between 0.8 and 0.9 which is a good internal consistency. Further research can be done by integrating Kano Model with Quality Function Deployment.

Sleep disorders present significant challenges to public health, necessitating effective and sustainable solutions beyond conventional pharmacological interventions. This study aims to investigate the potential of honey and its compositions as a functional food for addressing sleep disorders. A comprehensive review of existing literature explores honey's intrinsic properties and impact on sleep quality. The findings suggest that honey, with its unique composition and soothing effects, offers a promising avenue for enhancing sleep patterns without relying on pharmaceutical drugs. This study also discusses the possible mechanism of action and the challenges of using honey in this field. While further research is needed to elucidate specific mechanisms and optimal utilisation, integrating honey into holistic sleep management strategies holds promise for improving overall well-being and quality of life.

Background: Sepsis is an infection-related systemic inflammatory response that often leads to elevated lactate levels. Monitoring lactate levels during severe sepsis is vital for influencing clinical outcomes. The aim of this study was to assess the association between plasma lactate levels and mortality in children with severe sepsis or septic shock., Methods: The current prospective study was conducted in the PICU of University Children's Hospital. The International Paediatric Sepsis Consensus Conference criteria for Definitions of Sepsis and Organ Failure in 2005 were used to diagnose patients with sepsis. We measured plasma lactate levels upon admission (Lac H0) and 6 h later (Lac H6). The static indices included the absolute lactate values (Lac H0 and Lac H6), while the dynamic indices included the delta-lactate level (ΔLac) and the 6-hour lactate clearance. The 6-hour lactate clearance was calculated using the following formula: [(Lac H0-Lac H6)100/Lac H0]. ΔLac was calculated as the difference between the Lac H0 and Lac H6 levels. Patient survival or death after a PICU stay was the primary outcome., Results: A total of 46 patients were included in this study: 25 had septic shock, and 21 had severe sepsis. The mortality rate was 54.3%. The Lac H0 did not significantly differ between survivors and nonsurvivors. In contrast, the survivors had significantly lower Lac H6 levels, higher ΔLac levels, and higher 6-hour lactate clearance rates than nonsurvivors. Lactate clearance rates below 10%, 20%, and 30% were significantly associated with mortality. The best cut-off values for the lactate clearance rate and Lac H6 for the prediction of mortality in the PICU were < 10% and ≥ 4 mmol/L, respectively. Patients with higher Lac H6 levels and lower lactate clearance rates had significantly higher PICU mortality based on Kaplan-Meier survival curve analysis., Conclusions: This study highlights the significance of lactate level trends over time for the prediction of mortality in the PICU in patients with severe sepsis or septic shock. Elevated lactate levels and decreased lactate clearance six hours after hospitalisation are associated with a higher mortality rate., (© 2024. The Author(s).)

Gold nanoparticles (AuNPs) have emerged as a promising application in aquaculture. Their nano-sized dimensions, comparable to pathogens offer potential solutions for combating antibiotic resistance. In this study, AuNPs were synthesized by using polychaetes, Marphysa moribidii as the bio-reducing agent. Modifications were made to reduce agglomeration in green-synthesized AuNPs through ultrasonication. The antibacterial activities of AuNPs against V. parahaemolyticus were evaluated. The physicochemical characteristics of the green synthesized AuNPs were comprehensively investigated. The successful formation of AuNPs was confirmed by the appearance of a red ruby colour and the presence of surface Plasmon resonance (SPR) absorption peaks at 530 nm as observed from UV-vis spectroscopy. Scanning electron microscopy (SEM) revealed spherical-shaped AuNPs with some agglomerations. Transmission electron microscopy (TEM) showed particle size of AuNPs ranging from 10 nm to 60 nm, meanwhile dynamic light scattering (DLS) analysis indicated an average particle size of 24.36 nm. X-ray diffraction (XRD) analysis confirmed the high crystallinity of AuNPs, and no AuNPs were detected in the polychaetes extracts prior to synthesis. A brief ultrasonication significantly reduced the tendencies for AuNPs to coalesce. The green-synthesized AuNPs demonstrated a remarkable antibacterial efficacy against V. parahaemolyticus . The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) tests revealed that a concentration of 0.3 g/ml of AuNPs effectively inhibited V. parahaemolyticus . These findings highlighted the potential of green-synthesized AuNPs as antibacterial agents for the prevention and management of AHPND in aquaculture., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

There is a scarcity of studies focusing on irritable bowel syndrome (IBS) and anxiety in Egypt. Accordingly, our study aimed to assess the association between anxiety and IBS symptomatology among Egyptian females. Three hundred eighty-three females (145 IBS and 238 controls) were included in the study, and data were obtained using structured predesigned questionnaires. IBS and anxiety symptoms were assessed according to the Rome IV criteria and the Arabic version of the beck anxiety inventory, respectively. Both IBS and non-IBS groups showed increased anxiety during the pandemic, without a significant difference between both groups (P value = .657). Higher levels of education were significantly associated with severe anxiety (P value = .031). Multivariate analysis of IBS patients showed that intermediate education was significantly associated with 75% lower odds for increased IBS symptoms compared with illiterate or read-and-write IBS patients [odds ratio (OR): 0.25, 95% confidence interval (CI) 0.06-0.95, P value = .042]. Urban residence was significantly associated with 13.5 times greater odds of increased IBS symptoms, compared with rural residence (OR: 13.48, 95% CI 3.55-51.25, P value < .001). Moreover, patients who lost their job during the pandemic were 12.9 times more likely to have increased symptoms (OR: 12.89, 95% CI 1.84-90.15, P value = 0.01). A unit increase in patients age and beck anxiety inventory score was associated with 68% and 75% greater odds for increased IBS symptoms, respectively (OR: 1.68, 95% CI 1.12-2.53, P value = .012; OR: 1.75, 95% CI 1.08-2.84, P value = .024). Increasing anxiety is associated with increased IBS symptoms. Therefore, IBS patients should be screened for anxiety, and the role of psychiatric management of anxiety in the amelioration of IBS symptoms must be explored., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Brucellosis is a global public health issue. Brucellosis of the spine presents as a wide spectrum. The aim was to present the outcome analysis of patients treated for Spinal Brucellosis in the endemic region. Secondly to assess the accuracy of IgG and IgM Elisa in the diagnosis., Results: A retrospective study of all patients who were treated for Brucellosis of the spine from 2010 to 2020 was conducted. Confirmed cases of Brucellosis of spine and who had adequate follow up after completion of treatment were included. The outcome analysis was based on clinical, laboratory and radiological parameters. There were 37 patients enrolled with a mean age of 45 and an average follow up of 24 months. All of them presented with pain and 30% had neurological deficits. Surgical intervention was done in 24%(9/37patients). All the patients were treated with triple drug regimen for an average duration of 6 months. Those patients with relapse had a 14month period of triple drug regimen. The sensitivity and specificity of IgM was 50% and 85.71%. The sensitivity and specificity of IgG was 81.82% and 7.69%.76% of them had good functional outcome and 82% of them had near normal neurological recovery and 97.3%(36 patients) were healed of the disease with relapse in one patient(2.7%)., Conclusions: Majority (76%) of the patients with Brucellosis of the spine were treated conservatively. Average duration of treatment of triple drug regimen was 6 months. The sensitivity of IgM & IgG was 50% and 81.82% The specificity of IgM and IgG was 85.71% and 7.69% respectively., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Delhi Orthopedic Association. All rights reserved.)

Background: Helicobacter pylori (H. pylori) is affecting half of the globe. It is considered a main causative organism of chronic gastritis, peptic ulcer disease, and different gastric maliganacies. It has been also correlated to extraintestinal diseases, including refractory iron deficiency anaemia, vitamin B12 deficiency, and immune thrombocytopenic purpura. The misuse of antibiotics during the coronavirus diseases 2019 (COVID-19) pandemic time can affect H. pylori eradication rates. Our aim was to compare the efficacy of clarithromycin versus levofloxacin-based regimens for H. pylori treatment in naïve patients after the COVID-19 pandemic misuse of antibiotics., Methods: A total of 270 naïve H. pylori infected patients with previous treatment for COVID-19 more than 3 months before enrolment were recruited. Patients were randomized to receive either clarithromycin, esomeprazole, and amoxicillin, or levofloxacin, esomeprazole, and amoxicillin., Results: A total of 270 naïve H. pylori infected patients with previous treatment for COVID-19 more than 3 months before enrolment were included, 135 in each arm. In total, 19 patients in the clarithromycin group and 18 patients in the levofloxacin group stopped treatment after 2-4 days because of side effects or were lost for follow-up. Finally, 116 subjects in the clarithromycin group and 117 in the levofloxacin group were assessed. The eradication rates in intention to treat (ITT) and per protocol (PP) analyses were: group I, 55.56% and 64.66%; and Group II, 64.44% and 74.36% respectively (p = 0.11)., Conclusion: As COVID-19 pandemic has moved forward fast, high resistance rates of H. pylori to both clarithromycin and levofloxacin were developed after less than two years from the start of the pandemic. Molecular & genetic testing is highly recommended to identify antimicrobial resistance patterns. Strategies to prevent antibiotic misuse in the treatment of COVID-19 are needed to prevent more antibiotic resistance., Trial Registration: The trial was registered on Clinicaltrials.gov NCT05035186. Date of registration is 2-09-2021., (© 2023. The Author(s).)

Background: In certain settings, the prevalence and severity of schistosoma infection do not lessen despite repeated rounds of preventative chemotherapy; these areas are known as hotspots. This study aimed to investigate the role of human practices, besides environmental and malacological factors, in the maintenance of the Schistosoma mansoni infection transmission chain in hotspot areas in Egypt., Methods: This cross-sectional study was conducted between July and November 2019 in Kafr El-Sheikh Governorate, Egypt. A pre-designed structured interviewing questionnaire was used to collect humanitarian data. Stool samples were collected from children aged 6-15 years on three successive days and examined using the Kato-Katz technique. Simultaneously, water and snail samples were taken from watercourses surrounding houses. Snails were identified based on their shell morphology and structure and tested for cercaria shedding. Water samples were analyzed for their physicochemical and biological characteristics., Results: A total of 2259 fecal samples (1113 in summer and 1146 in fall) were collected from 861 children. About 46.9% of the participants were males, and 31.8% were aged 6-10 years. The prevalence of S. mansoni infection was higher during the summer than during the fall (19.1% vs 7.2%, respectively, P < 0.01). The intensity of infection (light, moderate, and heavy) during summer versus fall was (93.55 vs 89.38%, 6.45 vs 8.85%, and 0.00% vs 1.77%), respectively (P < 0.05). A higher prevalence of human infection was observed among males than females [OR = 1.63, 95% confidence interval (CI):1.10-2.40, P = 0.015], children aged 11-15 years than among their counterparts aged 6-10 years (OR = 2.96, 95% CI: 1.72-5.06, P < 0.001), and mothers with a low level of education (OR = 3.33, 95% CI: 1.70-6.52, P < 0.001). The main identified risk factors were contacting the main body of water-canal for washing clothes (OR = 1.81, 95% CI: 1.12-2.49, P = 0.015), land irrigation (OR = 2.56, 95% CI: 1.32-4.96, P = 0.004), water collection (OR = 2.94, 95% CI: 1.82-4.73, P < 0.001), bathing (OR = 2.34, 95% CI: 1.21-4.31, P = 0.009), and garbage disposal (OR = 2.38, 95% CI:1.38-4.12, P < 0.001). The count of Biomphalaria alexandrina was distinct between seasons (P < 0.01) in consistent with statistically significant differences in water temperature, salinity, turbidity, the total concentration of coliforms, depth, velocity, and water level (P < 0.01). The presence of grasses and duckweeds was significantly associated with snail infection (P = 0.00 l). Significant effects of water depth, pH, temperature, and total dissolved solids on snail count were also observed (P < 0.05)., Conclusions: The persistence of the infection is due to adoption of risky behaviors and environmental factors that enhance snail survival and infection. Schistosomiasis elimination in hotspots requires an integrated control approach that combines preventive chemotherapy with other complementary measures., (© 2022. The Author(s).)

The COVID-19 pandemic globally impacted physical, spiritual, and mental health (MH). The consequences significantly affected students' quality of life (QoL) too. This cross-sectional study assessed MH status and its relationship to the QoL of college students in Indonesia. This study collected data (September 2021-April 2022) online using the depression, anxiety, and stress scale-21 (DASS-21) to measure MH and the world health organization quality-of-life scale (WHOQoL-BREF) to measure the QoL. The data were analysed using SPSS with a bivariate and multivariate linear regression test. A total of 606 respondents participated in this study, with the majority being women (81.0%), aged 21-27 years (44.3%), and unmarried (98.5%) respondents. We observed 24.4% (n = 148) moderate depression, 18.3% (n = 111) very severe anxiety, and 21.1% (n = 128) moderate stress status. The QoL measurement determined that a moderate QoL in the physical and environmental health domains (>70%) and poor QoL in the psychological health domain (58.3%) were found. Gender, age, family support, history of COVID-19 diagnosis, family with COVID-19 diagnosis, vaccination status, and physical symptoms are significantly associated with MH status and QoL ( p -value < 0.05). This study demonstrated that COVID-19 was negatively related to college students' MH and QoL. Targeted interventions may be needed to ameliorate both MH and QoL.

This study aims to investigate CAM use among CD patients from Qassim, Saudi Arabia and to compare CAM practice with different demographic and disease characteristics of the participants. A cross-sectional study was conducted among CD patients. During the three-months of data collection period, a total of 377 patients were approached and 208 patients participated in the study, giving a response rate of 55.17%. A p value of <0.05 was considered as significant. Among the study population, 94 (45.2%) patients were CAM users. Diabetes mellitus patients were the majority (48 (51.06%)) followed by hypertensive patients (34 (36.17%)). Spiritual therapies were the most common CAM followed by herbal products. Among CAM users, 41 (19.7%) patients reported disclosing CAM use to their health care providers. Among all the sociodemographic variables, gender (p = 0.029), marital status (p = 0.034) and education level (p = 0.047) were significantly associated with CAM use. In conclusion, the use of CAM among CD patients was relatively high in Qassim. Patients reported using CAM without disclosing to their health care providers which is a major health risk. It is critical to counsel CD patients regarding rational and informed CAM use in order to prevent harmful and unwanted effects.

Moringa concanensis Nimmo (Moringaceae) belongs to the same family of M. oleifera (miracle tree) and is a medicinal plant traditionally used by Indians to treat various ailments related to diabetes, tumours, inflammation, and blood pressure. Despite its versatility, the photoprotective properties of the plant remain unclear. This study revealed the UV-protective properties of its methanol bark extract and respective subfractions, chloroform, hexane, and ethyl acetate through total phenolic and flavonoid content (TPC & TFC), antioxidant (DPPH), sun protecting factor (SPF) value, and UV absorption spectra analysis. This study also investigated on the inhibitory effect of the tested samples on collagenases and elastase, which are well-known for their role in the skin. The cytotoxic and H 2 O 2 scavenging properties of M. concanensis in 3T3-L1 cells were explored. Finally, the phytochemical profiling of the active fraction was conducted through UPLC-QTOF/MS analysis. Among the tested fractions, the chloroform fraction of M. concanensis showed the highest TPC (30.92 ± 0.71 mg GAE/DW), TFC (29.05 ± 0.09 mg QE/DW), and antioxidant properties (IC 50 -6.616 ± 1.90  μ gml -1 ). Additionally, chloroform fraction demonstrated the highest SPF value, 10.46 at 200  μ gml -1 , compared to the other tested fractions. All the fractions showed a broad absorption spectrum covering both UVA and UVB ranges. The chloroform fraction of M. concanensis also showed collagenase (50%) and elastase (IC 50 -2.95 ± 1.23  μ gml -1 ) inhibition properties similar to the positive control. Cytotoxic results revealed that the chloroform fraction of M. concanensis prevented the H 2 O 2 -induced oxidative damage in 3T3-L1 cells even at lower concentrations (1.56  μ gml -1 ). UPLC-QTOF/MS analysis tentatively identified the presence of bioactive flavonoids and phenolics such as astragalin, quercetin, isoquercetin, and caffeic acid in the active fraction of M. concanensis bark. Overall, it is suggested that the chloroform fraction of M. concanensis bark has the potency to be used as an active ingredient in sunscreen products., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2022 Rameshkumar Santhanam et al.)

Introduction: Extra-pulmonary manifestations of the Coronavirus disease of 2019 (COVID-19) have been increasingly reported, especially gastrointestinal and hepatic system dysfunction. The concern of faecal-oral transmission for COVID-19 was raised., Aim: To study the trend of faecal calprotectin in COVID-19 patients with intestinal symptoms., Material and Methods: Forty confirmed cases of COVID-19 infection presenting with diarrhoea were subjected to a thorough history taking, clinical examination, and routine laboratory investigations. They were treated according to the Egyptian MOH guidelines. Faecal calprotectin (FC) concentration was measured at initial presentation and after 3 months. Those who had persistently elevated levels ≥ 200 µg/g were subjected to colonoscopic examination and histopathological examination. Forty confirmed cases of COVID-19 without diarrhoea were recruited as a control group in the initial FC evaluation., Results: Faecal calprotectin was found to be significantly elevated in the studied COVID-19 patients who presented with diarrhoea, with a mean value 260 ±80 µg/g compared to the those without diarrhoea, with a mean value of 31.6 ±12.9 µg/g ( p < 0.001). Moreover, 20% (8 patients) had an elevated level exceeding 200 µg/g 3 months after recovery; among them, 5 patients showed mild colonoscopic changes whereas 3 patients showed severe ileocolitis. Out of the 3 patients with marked ileocolitis, 2 showed histopathological changes raising the diagnosis of Crohn's disease., Conclusions: Faecal calprotectin was found to be elevated in COVID-19 patients with intestinal symptoms, especially diarrhoea, with or without colonoscopic and histopathological changes., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Termedia.)

Light-driven heterogeneous photocatalysis has gained great significance for generating solar fuel; the challenging charge separation process and sluggish surface catalytic reactions significantly restrict the progress of solar energy conversion using a semiconductor photocatalyst. Herein, we propose a novel and feasible strategy to incorporate dihydroxy benzene (DHB) as a conjugated monomer within the framework of urea containing CN (CNU-DHBx) to tune the electronic conductivity and charge separation due to the aromaticity of the benzene ring, which acts as an electron-donating species. Systematic characterizations such as SPV, PL, XPS, DRS, and TRPL demonstrated that the incorporation of the DHB monomer greatly enhanced the photocatalytic CO 2 reduction of CN due to the enhanced charge separation and modulation of the ionic mobility. The significantly enhanced photocatalytic activity of CNU-DHB 15.0 in comparison with parental CN was 85 µmol/h for CO and 19.92 µmol/h of the H 2 source. It can be attributed to the electron-hole pair separation and enhance the optical adsorption due to the presence of DHB. Furthermore, this remarkable modification affected the chemical composition, bandgap, and surface area, encouraging the controlled detachment of light-produced photons and making it the ideal choice for CO 2 photoreduction. Our research findings potentially offer a solution for tuning complex charge separation and catalytic reactions in photocatalysis that could practically lead to the generation of artificial photocatalysts for efficient solar energy into chemical energy conversion.

The demand for wound care products, especially advanced and active wound care products is huge. In this study, gellan gum (GG) and virgin coconut oil (VCO) were utilized to develop microemulsion-based hydrogel for wound dressing materials. A ternary phase diagram was constructed to obtain an optimized ratio of VCO, water, and surfactant to produce VCO microemulsion. The VCO microemulsion was incorporated into gellan gum (GG) hydrogel (GVCO) and their chemical interaction, mechanical performance, physical properties, and thermal behavior were examined. The stress-at-break (σ) and Young's modulus (YM) of GVCO hydrogel films were increased along with thermal behavior with the inclusion of VCO microemulsion. The swelling degree of GVCO hydrogel decreased as the VCO microemulsion increased and the water vapor transmission rate of GVCO hydrogels was comparable to commercial dressing in the range of 332-391 g m -2 d -1 . The qualitative antibacterial activities do not show any inhibition against Gram-negative ( Escherichia coli and Klebsiella pneumoniae ) and Gram-positive ( Staphylococcus aureus and Bacillus subtilis ) bacteria. In vivo studies on Sprague-Dawley rats show the wound contraction of GVCO hydrogel is best (95 ± 2%) after the 14th day compared to a commercial dressing of Smith and Nephew Opsite post-op waterproof dressing, and this result is supported by the ultrasound images of wound skin and histological evaluation of the wound. The findings suggest that GVCO hydrogel has the potential to be developed as a biomedical material.

Direct-acting antivirals (DAAs) are associated with remarkable efficiency and safety profiles; however, their effect on erectile function remains insufficiently studied. This study included 200 male patients with chronic hepatitis C virus (HCV) infection divided into groups A and B and 100 healthy controls. Group A received sofosbuvir (SOF) 400 mg/ledipasvir 90 mg (Harvoni), whereas group B received SOF 400 mg/ daclatasvir 60 mg for 3 months. The Arabic version of the five-item International Index of Erectile Function-5 (IIEF-5) questionnaire was used to assess erectile function before and after completion of therapy and 3 months after. Erectile dysfunction (ED) was present in 74.5% of the patients and 14% of the controls. Immediately after treatment, group B (22.5±2.6) had a significantly higher mean IIEF-5 score than did group A (17.3±3.3) (p<0.001). Three months after treatment, all groups had no significant differences in mean IIEF-5 scores (group A: 23.1±1.9, group B: 23.3±1.9, controls: 23.7±2.3); however, free testosterone (FT) levels were significantly higher compared with pre-treatment. Both treatment regimens were associated with the improvement of erectile function and sex hormonal milieu. SOF/daclatasvir was associated with earlier improvement of erectile function compared with SOF/ledipasvir., Competing Interests: Conflict of interests None., (Copyright © 2016 - 2021 InfezMed.)

Misuse and overuse of antibiotics are potential causes of the increasing prevalence of antibiotic resistance (ABR). Having information about the knowledge, attitude, and practices concerning antibiotics use by the public might help control ABR growth. Therefore, this cross-sectional study aimed to investigate the levels and associated factors of knowledge, attitude, and practice (KAP) of antibiotics use among the public. A questionnaire was designed and validated, which consisted of a total of 51 questions with four sections: demographics (6), knowledge (20), attitude (12), and practice (13) to measure KAP. Univariate analysis (using Mann-Whitney U and Kruskal-Wallis analysis) was applied to assess the differences in the mean scores of KAP. Linear regression analysis was performed to identify factors associated with KAP. Finally, using Spearman analysis we have examined the correlation between responses to the KAP. The sample size of this study was 575, with a 99.96% response rate. Regarding knowledge, 73.12% of respondents stated that antibiotics could be used to treat viral infections, and 63.35% of respondents answered that antibiotics could reduce fever. Concerning attitude, 50% of respondents had considered stopping taking antibiotics as soon as symptoms had disappeared. In analyzing practice, we found 40% of respondents obtained antibiotics from a pharmacy without a prescription from a physician, a nurse, or a midwife. Statistical analysis revealed that KAP about antibiotic use was significantly associated with gender, area of residence, level of education, and monthly income ( p < 0.05). Our findings concluded that men, respondents with low income, those with low-level education, and those living in rural areas are more prone to excessive use of antibiotics without knowing the adverse effects of improper use and how it can contribute to high ABR. So it is urgently necessary to strengthen policies on antibiotics use, including drug provision, distribution, and sales. In addition, people with low KAP should be a priority consideration in education outreach initiatives., Competing Interests: The authors declare no conflict of interest.

Background: Brucellosis of the spine is quite common among adults in endemic regions. The incidence of brucellosis of the spine affecting children is very rare. This article describes the clinical characteristics, diagnosis, management and outcome of children with brucellosis of the spine. It also aims to create awareness among all health care professionals, especially spine surgeons, regarding this rare entity., Methods: This was a retrospective study of children aged less than 15 years who were diagnosed and treated for brucellosis of the spine. Confirmed cases of brucellosis in children who had completed a full course of a triple-drug regimen as per Centers for Disease Control and Prevention (CDC) guidelines were included. Outcome analysis included both clinical and radiological measures. Clinical measures included pain, neurological status, and return to school. Resolution of the abscess and sclerosis of the involved vertebra were taken as the radiological measure., Results: A total of 5 children (4 boys and 1 girl) with an average age of 10 years, ranging from 6 to 14 years, fulfilled the inclusion criteria. The mean follow-up period was 32 months. All children presented with fever, back pain, and constitutional symptoms. Two of them had neurological deficits, and posttreatment, they improved to near normal neurological status. Only 1 child with an epidural abscess compressing the lumbar canal required surgical intervention. All the children were treated with a triple-drug regimen. Longer duration of treatment (14 months) was given for 2 children with history of relapse. All children were healed of the disease without any sequalae or relapse., Conclusions: Blood culture and standard agglutination tests are mandatory for the diagnosis of brucellosis. Children tolerated the triple-drug regimen well. Prolonged duration of treatment was required for children with relapse. Health education to all treating health care professionals and parents is of paramount importance for treatment and control of this endemic disease., (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2021 ISASS.)

Background: Hypertension is one of the major world health problems. Ultrasonography plays a useful role in the assessment of morphologicalchanges at the kidneys in hypertensive patients., Aim: To assess sonographic findings of the kidneys in hypertensive patients' co-morbidities with type 2 diabetes mellitus and ischemic heart disease (IDH)., Materials and Methods: This was a prospective cross-sectional study involved 100 participants with primary hypertension selected by a method of simple convenient sampling. The patients were examined using ultrasonography to assess the sonographic findings of the kidneys. The renal length, corticomedullary differentiation (CMD), and renal artery diameters were assessed. Statistical Package for the Social Sciences (SPSS version 23.0) was used in data analysis., Results: The length of the right kidney was 8.9850 ± 1.01 cm and 9.48 ± 0.98 cm for the left kidney. Among the hypertensive patients, the incidence of hypertension was highest in housewives (27%) and students (23%) as compared with the other groups. The sonographic findings were 18% affected with simple renal cysts, 7% poor CMD, and the majority had normal kidneys. Significant correlation was found between age and sonographic findings of kidneys ( r = 0.21, P value = 0.033)., Conclusion: Simple renal cysts, poor CMD, and stenosis of renal arteries were most common sonographic findings in hypertension. Simple renal cystshad a significant association with hypertension., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Family Medicine and Primary Care.)

Implants are widely used in the human body for the replacement of affected bones. Fatigue failure is one of the serious concerns for implants. Therefore, understanding of the underlying mechanism leading to fatigue failure is important for the longevity of biomaterial implants. In this paper, the fracture toughness and fatigue crack growth of titanium alloy biomaterial Ti-27Nb has been experimentally investigated. The Ti-27Nb material is tested for fatigue crack growth in different environmental conditions representing the ambient and in vitro environments for 504 hours and 816 hours, respectively. Fractography of the tested specimen is conducted using Scanning Electron Microscope (SEM). The results of the fatigue crack growth propagation of the ambient and in vitro samples are similar in the Paris crack growth region. However, in the threshold region, the crack growth rate is higher for the Simulated Body Fluid (SBF) treated specimen. The fracture surface morphology of in vitro samples shows brittle fracture as compared to ambient specimens with significant plasticity and striations marks. It is proposed that a similar investigation may be conducted with specimens treated in SBF for prolonged periods to further ascertain the findings of this study.

Purpose: To assess the efficacy of Thiele massage (TM) as monotherapy for nonulcerative interstitial cystitis/bladder pain syndrome (IC/BPS)., Methods: A prospective evaluation of 40 women with IC/BPS who underwent TM was conducted. TM was initially administrated by a physiotherapist and then self-administrated at home twice weekly for 16 weeks. Patients were assessed every 4 weeks on an outpatient basis. Assessment tools included 3-day voiding diaries, the Likert visual analog scale (VAS) for pain, and the Interstitial Cystitis Symptom Index (ICSI) and the Interstitial Cystitis Problem Index (ICPI) of the O'Leary-Sant questionnaire. Sexual function was assessed using the Female Sexual Function Index (FSFI)., Results: Thirty-six patients completed the study with a mean age ± SD 41.31 ± 9.93 (range 21-60 years). The mean duration of illness ± SD was 81.29 ± 34.55 (range 12-300 months). Perception of pain was higher than at basal level according to Likert VAS (9.2 ± 1.5 vs 9.8 ± 0.5, P = .018). The ICSI and ICPI questionnaires were deteriorated (16.83 ± 2.57 vs 12.89 ± 3.50, P = .015 and 15.75 ± 0.94 vs 14.31 ± 2.55, P < .001, respectively). TM had no significant impact on the total score of FSFI (P = .119); however, there was a negative impact on the lubrication domain with more dryness (0.045)., Conclusions: TM is not an effective option as monotreatment modality for nonulcerative IC/BPS. An attempt of physiotherapy should be integrated in a multidisciplinary treatment., (© 2019 John Wiley & Sons Australia, Ltd.)

Combination of natural products with chemodrugs is becoming a trend in discovering new therapeutics approach for enhancing the cancer treatment process. In the present study, we aimed to investigate the cytotoxic and apoptosis induction of Gelam honey (GH) combined with or without 5-Fluorouracil (5-FU) on HT-29 cells. The cell viability was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay to assess cytotoxicity. Morphological changes and apoptosis were determined by the inverted microscope, Annexin V-FITC, and DNA fragmentation via flow cytometric analysis, respectively. Our results demonstrate that combined treatment revealed a remarkable and concentration-dependent cytotoxic effect on HT-29 cells in comparison with GH and 5-FU alone. Flow cytometry analysis showed that early apoptosis event was more pronounced in combined treatment. In addition, compared to 5-FU alone, apoptosis of HT-29 cells treated with combinations of GH and 5-FU demonstrated increasing percentages of fragmented DNA. Our results suggest that GH has a synergistic cytotoxic effect with 5-FU in HT-29 cell lines in vitro . Although the actions of the molecular mechanisms are not yet clear, the results reveal that the combination of GH and 5-FU could have the potential as a therapeutic agent.

Background and Purpose: This study investigated the disclosure of complementary and alternative medicine (CAM) use to health care providers by Malaysian thalassemia patients., Methods: The semi-structured interviews were audio taped, transcribed verbatim, and translated into English., Results: Thematic analysis identified four themes: 1) reason for CAM disclosure, 2) attempt to disclose CAM, 3) withdrawal from CAM disclosure, and 4) non-disclosure of CAM use. The reason for patients' disclosure of CAM use to healthcare providers is because they wanted to find information about CAM and were afraid of the interaction between the conventional medicine and CAM. Patients also disclosed the use of CAM because they were not satisfied with the conventional medicine that had caused them harm., Conclusion: Effective communication between patients and health care providers is important, especially for patients who are undergoing conventional thalassemia treatment, for fear that there is an interaction between conventional treatment and CAM use., (Copyright © 2018. Published by Elsevier Ltd.)

Introduction: Cirrhosis as a pathological term has some criteria known to be common in all cases of liver cirrhosis. Esophageal varices are portosystemic collaterals arising in the submucosa of the lower esophagus because of portal hypertension. Portal hypertension is defined as hepatic venous pressure gradient greater than 5 mmHg that arises often as a sequelae of mesenchymal dysfunction in a cirrhotic liver. This study was carried out on 120 personnel divided into three groups: group A included 50 cases of liver cirrhosis with esophageal varices, group B consisted of 50 cases of cirrhosis without esophageal varices, and group C had 20 healthy volunteers a control group., Patients and Methods: DNA was extracted from the peripheral blood of the study participants. Genotyping of the HO1 413A>T promoter SNP (rs2071746) was performed using TaqMan SNP genotyping assay according to the manufacturer's protocol by RQ-PCR., Results: Patients carrying T allele of HO1 promoter were found to have 5.46-fold increased risk of esophageal varices development than patients with cirrhosis carrying A allele. T allele was significantly higher in cirrhotics with esophageal varices compared with those without esophageal varices (P<0.001). Rates of esophageal varices development in patients with cirrhotic liver were 52, 40, and 8% for genotypes TT, AT, and AA, respectively., Conclusion: The T allele of heme oxygenase 1 gene SNP polymorphism (rs2071746) is a risk factor for esophageal varices development in cirrhotics.

Aim: Osteosarcoma is a highly malignant primary bone tumor. The study aim to evaluate the prognostic factors influencing the survival rate in our center., Methods: This was a retrospective cohort study of all patients treated between January 2005 and December 2010., Results: We included 163 patients with an age range of 6-59 years (median = 19). The median follow-up was 47 months (range 36-84). The overall survival in patients who completed chemotherapy and surgery (n = 117) was 72% at 2 years and 44% at 5 years. Histologically, 99 (85%) had osteoblastic, 6 (5%) had chondroblastic and 3 (2.5%) had telangiectatic osteosarcoma. Limb salvage surgery was performed in 80 (49%) and 41 (25%) underwent amputation. However, 46 patients (28%) underwent no surgical intervention and incomplete chemotherapy. In total, 38/79 patients had a good chemotherapy response. There was a significantly better survival rate for limb salvage versus amputation. Independent prognostic factors for survival are compliance to treatment and presence of lung metastasis., Conclusion: The overall survival of osteosarcoma patients was influenced by the presence of pulmonary metastases and compliance to treatment. Histological subtype, different chemotherapy regimens and histological necrosis after chemotherapy did not significantly influence survival. The patients who did not complete treatment had significantly poorer survival., (© 2015 Wiley Publishing Asia Pty Ltd.)

Introduction: Pregnancy, a period from conception till birth, causes changes in the functioning of the human body as a whole and specifically in the oral cavity that may favour the emergence of dental caries. Many studies have shown pregnant women at increased risk for dental caries, however, specific salivary caries risk factors and the particular period of pregnancy at heightened risk for dental caries are yet to be explored and give a scope of further research in this area., Aim: The aim of the present study was to assess the severity of dental caries in pregnant women compared to non-pregnant women by evaluating parameters like Decayed, Missing, Filled Teeth (DMFT) index, salivary Streptococcus mutans count, flow rate, pH and total calcium content., Materials and Methods: A total of 50 first time pregnant women in the first trimester were followed during their second trimester, third trimester and postpartum period for the evaluation of DMFT by World Health Organization (WHO) scoring criteria, salivary flow rate by drooling method, salivary pH by pH meter, salivary total calcium content by bioassay test kit and salivary Streptococcus mutans count by semiautomatic counting of colonies grown on Mitis Salivarius (MS) agar supplemented by 0.2U/ml of bacitracin and 10% sucrose. The observations of pregnant women were then compared with same parameters evaluated in the 50 non-pregnant women. Paired t-test and Wilcoxon sign rank test were performed to assess the association between the study parameters., Results: Evaluation of different caries risk factors between pregnant and non-pregnant women clearly showed that pregnant women were at a higher risk for dental caries. Comparison of caries risk parameters during the three trimesters and postpartum period showed that the salivary Streptococcus mutans count had significantly increased in the second trimester , third trimester and postpartum period while the mean pH and mean salivary total calcium content decreased in the third trimester and postpartum period. These changes reflected on the DMFT score which increased in the third trimester and postpartum period., Conclusion: The results of this study suggest that there is a definite correlation between pregnancy and dental caries. We conclude that the third trimester and postpartum period of pregnancy are the periods during which the pregnant women are at a higher risk for development of dental caries.

Many studies revealed the potential of honey consumption in controlling obesity. However, no study has been conducted using Malaysian honey. In this study, we investigated the efficacy of two local Malaysian honey types: Gelam and Acacia honey in reducing excess weight gain and other parameters related to obesity. The quality of both honey types was determined through physicochemical analysis and contents of phenolic and flavonoid. Male Sprague-Dawley rats were induced to become obese using high fat diet (HFD) prior to introduction with/without honey or orlistat for four weeks. Significant reductions in excess weight gain and adiposity index were observed in rats fed with Gelam honey compared to HFD rats. Moreover, levels of plasma glucose, triglycerides, and cholesterol, plasma leptin and resistin, liver enzymes, renal function test, and relative organ weight in Gelam and Acacia honey treated groups were reduced significantly when compared to rats fed with HFD only. Similar results were also displayed in rats treated with orlistat, but with hepatotoxicity effects. In conclusion, consumption of honey can be used to control obesity by regulating lipid metabolism and appears to be more effective than orlistat., Competing Interests: The authors declare that there is no conflict of interests regarding the publication of this paper.

Objective: To assess, using transperineal ultrasonography (TPUS), the numerical value of the rotation of the bladder neck [represented by the difference in the anterior (α angle) and posterior urethral angles (β angle)] at rest and straining, in continent women and women with stress urinary incontinence (SUI), to ascertain if there are significant differences in the angles of rotation (Rα and Rβ) between the groups., Patients Subjects and Methods: In all, 30 women with SUI (SUI group) and 30 continent women (control group) were included. TPUS was performed at rest and straining (Valsalva manoeuver), and the threshold value for the urethral angles (α and β angles) for each group were estimated. The degree of rotation for each angle was calculated and was considered as the angle of rotation., Results: Both the α and β angles were significantly different between the groups at rest and straining, and there was a significant difference in the mean increment in the value of each angle. Higher values of increment (higher rotation angles) were reported in the SUI group for both the α and β angles compared with those of the control group [mean (SD) Rα SUI group 19.43 (12.76) vs controls 10.53 (2.98) °; Rβ SUI group 28.30 (12.96) vs controls 16.33 (10.8) °; P < 0.001]., Conclusion: Urethral rotation angles may assist in the assessment and diagnosis of patients with SUI, which may in turn reduce the need for more sophisticated urodynamic studies.

To report a rare case of axis brown tumor and to review literature of cervical spine brown tumor. Brown tumor is a rare bone lesion, incidence less than 5% in primary hyperparathyroidism. It is more common in secondary hyperparathyroidism with up to 13% of cases. Brown tumor reactive lesion forms as a result of disturbed bone remodeling due to long standing increase in parathyroid hormones. Cervical spine involvement is extremely rare, can be confused with serous spine lesions. To date, only four cases of cervical spine involvement have been reported. Three were due to secondary hyperparathyroidism. Only one was reported to involve the axis and was due to secondary hyperparathyroidism. This is the first reported case of axis brown tumor due to primary hyperparathyroidism. A case report of brown tumor is presented. A literature review was conducted by a Medline search of reported cases of brown tumor, key words: brown tumor, osteoclastoma and cervical lesions. The resulting papers were reviewed and cervical spine cases were listed then classified according to the level, cause, and management. Only four previous cases involved the cervical spine. Three were caused by secondary hyperparathyroidism and one was by primary hyperparathyroidism which involved the C6. Our case was the first case of C2 involvement of primary hyperparathyroidism and it was managed conservatively. Brown tumor, a rare spinal tumor that presents with high PTH and giant cells, requires a high level of suspicion.