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One of the most fundamental and obvious human rights in all countries is the right to an education. However, poverty has continued to be a stumbling block for the majority of people in achieving this fundamental right. Objective: To investigate how poverty affects academic performance of girls in secondary school. Methods: A cross-sectional study was conducted among 100 students of schools in District Faisalabad, Pakistan. The questionnaire designed for this study is self-designed, multi-section survey i-e. Demographic information including age, sex, educational level, family financial status. The (SPSS) version 22.0 was used to examine the data that had been gathered. Results: According to the current study, there were 100 total respondents, and all of them were women. About 39% of respondents' fathers were illiterate or had just a middle level of education, 28% had graduated, 21% had a middle to metric level of education, and only 12% had a high level of education. About 54% of respondents' moms were illiterate or had just a middle level of education, 21% had graduated, 17% had a middle to metric level of education, and only 8% had a high level of education. Conclusion: The study comes to the conclusion that poverty is a growing problem today and that the number of individuals living in poverty is always rising. The research also showed a strong correlation between children's academic success and their parents' socioeconomic level.

In this multi-center longitudinal cohort study conducted in Australia and New Zealand, we assessed the trajectories of health-related quality of life (HRQoL) in children with chronic kidney disease (CKD) over time. A total of 377 children (aged 6-18 years) with CKD stages 1-5 (pre-dialysis), dialysis, or transplant, were followed biennially for four years. Multi Attribute Utility (MAU) scores of HRQoL were measured at baseline and at two and four years using the McMaster Health Utilities Index Mark 3 tool, a generic multi-attribute, preference-based system. A multivariable linear mixed model was used to assess the trajectories of HRQoL over time in 199 children with CKD stage 1-5, 43 children receiving dialysis and 135 kidney transplant recipients. An interaction between CKD stage at baseline and follow-up time indicated that the slopes of the HRQoL scores differed between children by CKD stage at inception. Over half of the cohort on dialysis at baseline had received a kidney transplant by the end of year four and the MAU scores of these children increased by a meaningful amount averaging 0.05 (95% confidence interval 0.01 to 0.09) per year in comparison to those who were transplant recipients at baseline. The mean difference between baseline and year two MAU scores was 0.09 (95% confidence interval -0.05, 0.23), (Cohen's d effect size 0.31). Thus, improvement in HRQoL over time of children on dialysis at baseline was likely to have been driven by their transition from dialysis to transplantation. Additionally, children with CKD stage 1-5 and transplant recipients at baseline had no changes in their disease stage or treatment modality and experienced stable HRQoL over time.

Background: PECS, or Picture Exchange Communication System, addressed in writing. The answers for such schemes to influence word retrieval in autism spectrum disorders in children (ASD). Objective: The objective of the current study finding out the effects of Development of the picture exchange communication system in autistic children's speech and communicative requesting was the main goal of the current study. Materials & Methods: The study design was Qusai experimental. The research was carried out at Riphah International University Lahore campus. Data was collected from Lahore. The study time was six months after the approval of synopsis. Data was collected from the Autistic children and purposive sampling technique was used in this research. The sample size calculated was ten. The picture-exchange technique for communication (PECS) was used for data collection. Data was examined using SPSS software and Endnotes were used for references. Results: Results from the Childhood Autism Rating Scale (CARS) assessment scoring form indicated that there is a significant relationship between the Effects of Communicative PECS speech and request development in autistic children, overall analysis of the pre and post scores of CARS assessment. In which mean of pre score is 36.15 and mean of post score is 29.5. The standard deviation of pre score is 8.47 and the post score standard deviation is 5.39. The mean difference showed the improvement between CARS pre and post assessment. Used was the paired sample t test for finding the mean difference between the pre and post scores. The results indicate that every participant showed improvement in different skills such as verbal and nonverbal communication, visual response. Some participants got higher in verbal communication Practical implication: This will give us a better understanding of how speech develops in children with autism and how children’s vocabulary develops and awareness develops in children. Conclusion: The pre-post assessment of The Childhood Autism Rating scale (CARS) with intervention of PECS concluded that there is significant influence of intervention using a photo exchange communication technology for autistic kids. Keywords: Autism, Chemical Imbalance, PECS, CARS, Autism Rating Scale, Autism spectrum condition

All the social, economic and industrial development depends on the availability of energy. Since energy demand is increasing exponentially throughout the world, more and more CO2 is being emitted out into the atmosphere, giving rise to global warming. Therefore, establishing a sustainable environment is becoming increasingly important. It has been found through research that domestic sector contributes a great deal to the rising energy consumption. Due to prevailing energy crisis, efforts are being made to reduce the increasing energy consumption and make efficient use of energy by making the buildings energy efficient. For this, realistic assessment of energy use patterns in existing houses and buildings is necessary to assure dataset accuracy. Living lab concept integrated with sensor technologies can be used for assessment of such patterns. This paper presents living lab concept for sensor-based energy performance assessment of Houses. First, detailed literature review to benchmark concepts of energy efficiency of buildings, living labs concept, sensor based assessment, energy audit, and application of living lab concept has been discussed. Thereafter, sensors based living lab assessment and living lab approach has been introduced as being utilized by the author in a research project for development of guidelines for energy efficient housing. The paper also highlights important parameters to be monitored that effect energy performance. The concept reflects usefulness of living lab concept for sensor-based energy performance assessment of houses that help in substantial reduction in the energy consumption. As such data can be utilized for both realistic energy simulations by improving level of development of models as well as better usage comparisons with modeled analysis, hence helping in identifying true and effective improvement measures

Introduction: Community acquired pneumonia (CAP) and diabetes mellitus (DM) are common medical conditions which lead to increased morbidity, mortality and high hospitalization rates. Objective: To determine the outcome and predictors of community acquired pneumonia in patients with diabetes mellitus. Methodology: This study was hospital based descriptive case series carried out at the department of Medicine Hayatabad Medical Complex, Peshawar for duration of six months from December 2020 to June 2021. 150 patients were included in this study. All the information’s including name, age, sex, co-morbidity were recorded in pre-designed questionnaire. Data entry and analysis were done through Statistical package for social sciences (SPSS) verion20.0. Results: Based on distribution of predictors, total leukocytes count greater than 12000 or less than 4000 was observed in 37(24.7%) patients, FBS equal to or greater than 126mg/d1 and RBS equal to or greater than 200mg/d1 was observed in 20(13.3%) patients, HbAl c greater than 6.5% was observed in 32(21.3%) patients, blood urea greater than 40mg/d1 in 15(10.0%) patients, serum creatinine greater than 1.2mg,/d1 in 20(13.3%) patients while serum sodium less than 130mEq/L was observed in 26(17.3%) patients. Based on outcomes, expired, survived and prolonged stay in hospital was observed in 67(44.7%), 48(32.0%) and 35(23.3%) patients respectively. Conclusion: Our study concludes that diabetic patients with community acquired pneumonia have unique clinical features. The major predictors of diabetic patients with community acquired pneumonia were total leukocytes count, FBS, RBS, HbAl c, blood urea, serum creatinine and serum sodium. High mortality rate was observed in our study. Keywords: Community acquired pneumonia; Diabetes mellitus, Mortlity

Gastrointestinal symptoms are most commonly observed in patients with diabetic ketoacidosis (DKA), which usually resolves completely with therapy. However, gastrointestinal symptoms may persist after DKA is resolved.A 22-year-old female was admitted to hospital for epigastric pain and persistent vomiting. The results of laboratory examination showed fungal esophagitis complicated by DKA.The patient was diagnosed with DKA associated with ascariasis and fungal esophagitis.The patient was discharged after treatment.In this case, despite the correction of metabolic acidosis, persistent nausea, vomiting and dysphagia can be a sign of esophagitis in patients with type 1 diabetes. Therefore, physicians should be aware of fungal infections associated with type 1 diabetes.

Background: Patients' satisfaction is defined as a subjective evaluation of the service received against the individual’s expectations. Patients' satisfaction should be measured frequently as it is the important indicator of quality in health care and also because there is still room for improvement in quality of health care. Objective: The aim of this research is to determine patients’ satisfaction in reference to doctor’s behavior and environment of the out-patient department at the tertiary care teaching hospital. Materials and Methods: Study was carried out in OPD of Sheikh Zayed Hospital using a pretested questionnaire with 320 samples from January 2022 to March 2022, selected by systemic random sampling technique. The data was analyzed using SPSS version 21.00. Data was presented using figure and tables and described using frequencies and percentages. Result: Patients expressing satisfaction were 68.4% while remaining 31.5% were dissatisfied with their OPD experience. Overall behavior of doctor towards patients was satisfying while the environmental structure of OPD showed some flaws. Mean consultation time given by doctor was found to be 5.78±4.28 minutes. And 53.1% of the patients waited for more than 45 minutes. Conclusion: The findings of this survey must be used to bring improvement. Loopholes found in environmental structure should be addressed timely. Satisfaction level can further be improved and brought to the level of developed countries.

Background: Introduction of Pre-lacteal feeding soon after the baby is born is a common practice, and different predictors of PLFs have been reported worldwide. Mainly, people practice Pre-lacteal feeding to follow the religious beliefs or cultural traditions of their area. Objective: To describe the frequency, nature, reasons, and factors associated with Pre-lacteal feeding. Methods: 320 mothers and their neonates were studied from January 2022 to March 2022. Family and infant socioeconomic status, PLF classification, and PLF triggers were all recorded. Results: Nearly two-thirds of the infants were given prelacteal meals. Honey accounted for 59.3% of all PLFs. Conventional/historical reasons accounted for 80.2% of all PLF distributions in 2017. The independent predictors of PLF are urban residence, maternal education, age of mother and trend running in the family. Conclusion: Advantages of Pre-lacteal feeding along with breastfeeding should be studied more comprehensively to define a clear-cut relationship between the two.

Background: Hepatitis C virus infection is a worldwide health issue. The rise in the prevalence of steatosis may be attributed to alterations in eating patterns, changes in the nutritional content of food, and changes in lifestyle, such as decreased physical activity and high sedentary lifestyle, as well as etio-pathogenic variables that influence individuals from infancy. Objective: To determine prevalence and severity of steatosis in chronic hepatitis C patients Methodology: The current study was cross sectional study piloted at the Gastroenterology Department, Hayatabad Medical Complex, Peshawar. The duration of study was six months after synopsis approval from August 2021 to January 2022. Totally 200 patients fulfilling the inclusion criteria were included in our study. Under aseptic conditions, a liver biopsy was done using an 18G lumbar puncture needle. All the Data analysis was done by using IBM SPSS version 24. Results: The overall frequency of steatosis was 80 (40%). On the basis of degree of steatosis, mild steatosis was observed in 53 (58.89%) subjects, moderate steatosis in 31 (34.44%) patients while severe steatosis was observed in 6 (6.67%) subjects. Conclusion: Our study concludes that steatosis is a common histological characteristic in patients with chronic hepatitis C virus infection. Steatosis is more prevalent in female patients than males. Study based on large sample size is recommended to get better findings. Keywords: Prevalence; Severity; Steatosis; Hepatitis C

Introduction: Portal hypertensive gastropathy is a term applied to the typical appearance of the mucosa of stomach consisting of a mosaic-like diffuse and reticular cobblestone pattern of gastric mucosal layer secondary to increased blood pressure in the portal vein. Objective: To determine the occurrence and characteristic of portal hypertensive gastropathy in patients with liver cirrhosis Methodology: This study was descriptive cross-sectional piloted at the department of Medicine, Hayatabad medical complex Peshawar for duration of six months from November 2020 to May 2021. A total of 158 patients were observed in our study. All the data was entered and analyzed in SPSS version 21. Results: In our study portal Hypertensive Gastropathy was observed in 34(21.5%) cirrhosis patients while it was not observed in 124(78.5%) patients. Based on the class of portal hypertensive gastropathy, severe and mild types were observed in 43(27.2%) and 115(72.8%) patients respectively. Conclusion: In our study portal hypertensive gastropathy was observed in 34(21.5%) cirrhotic patients, amongst these 27.2% were severe and 72.8% were mild types. In cirrhotic and portal hypertensive gastropathy patients, these findings might have major therapeutic implications. Keywords: Frequency; Portal Hypertensive Gastropathy, Liver cirrhosis

Background: Among persons over sixty, stroke is the 2nd major cause of death, and the sixth greatest cause of death among those aged 15 to 59 years. It is also one of the most common causes of disability and death. Respiratory complications are very common in stroke patients. Pneumonia affects up to a third of those who have had a stroke. Objective: To find out frequency of aspiration pneumonia in stroke patients Methodology: This study design was Descriptive cross-sectional conducted at the Medicine department, Khyber Teaching Hospital, Peshawar from 15Th October 2019 to 15th April 2020. All patients admitted in medical D unit meeting the inclusion criteria were included in the study. Necessary investigations such as sputum examination, chest x-ray, total leukocyte count and physical examination was done to confirm aspiration pneumonia. Data analysis was done by using IBM SPSS version 23. Results: Ischemic stroke amongst 100 patients was observed in 68(68%) patients while hemorrhagic stroke was observed in 32(32%) patients. Amongst 100 stroke patients aspiration pneumonia was observed in 17(17%) patients whereas it was not observed in 83(83%) patients. Conclusion: Our study concludes that frequency of aspiration pneumonia in patients with stroke is high in our population. Aspiration pneumonia should be early diagnosed and it should be properly managed to decrease the mortality and morbidity. Keywords: Aspiration pneumonia; Stroke; Mortality

Introduction: Dengue fever is a mosquito-borne viral disease caused by dengue virus (DENV) - a single stranded RNA virus, belongs to the genus Flavivirus. Objective: To determine the frequency of bleeding diathesis amongst patients presenting with dengue fever in tertiary care hospital Methodology: This study was descriptive cross-sectional piloted at the Medicine Department, Hayatabad Medical Complex, Peshawar for duration of six months from June 2021 to December 2021. Totally 135 patients were included in our study. All the information like gender, age, sign and symptoms and bleeding diathesis were recorded on predesigned Performa. All the data was analyzed by using SPSS version 24. Results: In this study, a total of 135 patients were included. Amongst 135, 90(66.7%) were males and female were 45(33.3%). Bleeding Diathesis among 135 patients was observed in 47(34.8%) patients. Conclusion: Our study concludes that bleeding diathesis commonly occur in dengue patients. As a result, screening for coagulation abnormalities and treating them early may assist to prevent additional consequences in dengue patients. Keywords: Bleeding; Diathesis, Dengue fever

(1) Background: weight-management interventions vary in their delivery features and intervention strategies. We aimed to establish a protocol to identify these intervention components. (2) Methods: a framework was developed through literature searches and stakeholder consultation. Six studies were independently coded by two reviewers. Consensus included recording conflict resolutions and framework changes. (3) Results: more conflicts occurred for intervention strategies compared to delivery features; both required the updating of definitions. The average coding times were 78 min (SD: 48) for delivery features and 54 min (SD: 29) for intervention strategies. (4) Conclusions: this study developed a detailed framework and highlights the complexities in objectively mapping weight-management trials.

There are two types of languages one is receptive and the other one is expressive. The lack in sufficient social interaction of parents with their children although normal in all developmental milestones causes a delay in their expressive language.Objective: The objective of the present study was to determine the different patterns of soial interaction used by families that are responsible for the development of Expressive Language Delay in children. Methods: Comparitive Cross sectional survey was used for this study. The parents of 100 children from Lahore, of which 50 were parents of normally speaking children and 50 were parents of children with expressive language delay was taken as sample. These parents were asked to fill the questionairre accordingly that consists of different statements regarding their social patterns used by them to interact with their children. Results: Results indicated that there were significant differences with a p-value of 0.01 between the patterns used by parents of normally speaking children than those of expressive language delayed children. The mean values of excessive screen time of children with expressive language delay and normally speaking were 1.9600 and 4.0200 with standard deviations of 1.22824 and 0.84491 respectively. There were also insignificant differences with the p-value

Background Few data exist on the cognitive and academic functioning of children with chronic kidney disease (CKD) over the trajectory of their illness. We aimed to determine the association between CKD stages and cognitive and academic performance in children over time. Methods We included 53 participants (aged 6–18 years) with CKD stages 1–5 (n = 37), on dialysis (n = 3), or with functioning kidney transplant (n = 22) from three units in Australia from 2015 to 2019. Participants undertook a series of psychometric tests and were invited for repeated assessments annually. We used linear regression and linear mixed models to investigate the effect of CKD stage, adjusted for socioeconomic status. Results At baseline, full-scale intelligence quotient (FSIQ) (95%CI) of children on kidney replacement therapy (KRT) was in the low average range (87: 78, 96) and average (101: 95, 108) for children with CKD 1–5. Mean (95%CI) FSIQ, word reading, numerical operations, and spelling scores for children on KRT were 14.3 (− 25.3, − 3.3), 11 (− 18.5, − 3.6), 8.5 (− 17.6, 0.76), and 10 (− 18.6, − 1.3) points lower than children with CKD Stages 1–5. Spelling and numerical operations scores declined by 0.7 (− 1.4, − 0.1) and 1.0 (− 2.0, 0.2) units per year increase in age, regardless of CKD stage. Conclusions Children treated with KRT have low average cognitive abilities and lower academic performance for numeracy and literacy compared to both children with CKD 1–5 and to the general population. However, the rate of decline in academic performance over time is similar for children across the full spectrum of CKD. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.

Background: Fetal growth assessment is necessary for prediction of fetal health during pregnancy. Aim: To determine the diagnostic accuracy of transcerebellar diameter / abdominal circumference ratio in predicting intrauterine growth retardation after 20 weeks gestation taking birth weight as gold standard. Study design: Cross sectional study. Methodology: Present study was conducted at Department of Obstetrics & Gynecology, Combined Military Hospital Kharian. Patients (n=80) with an age range of 18-40 years with singleton pregnancies at 20 weeks gestation were enrolled. All patients were assessed by ultrasound and TCD/AC ratio was calculated. All patients followed till birth and actual birth weight was obtained. All this information was recorded on Performa. Statistical analysis: Data was analyzed using SPSS version 26. Results were presented as frequency and percentage. Age was presented as mean± SD. Results: The mean age of patients was 28.61±5.72 years. The mean gestational age was 21.96±1.50 weeks. For prediction of IUGR, TCD/AC had sensitivity, specificity, PPV, NPV & diagnostic accuracy of 85.29%, 91.3%, 87.88%, 89.36% & 88.75%, respectively. Conclusion: It was concluded that TCD/AC ratio is an accurate diagnostic tool accuracy for prediction of IUGR during pregnancy. Keywords: Transcerebellar Diameter, Abdominal Circumference, Intrauterine Growth Retardation and Birth Weight.

Fall from height (FFH) at the construction sites has the major portion of the total accidents; it may be due to traditional methods of monitoring at the site. For the site manager, manual monitoring is difficult, as some workers avoid wearing PPE at the risk area. To overcome this issue and eliminate the FFH accidents, a Smart Safety Hook (SSH) system is proposed. A preliminary experiment is carried out to record the kinematics and tilt angle of the safety hook from an IMU sensor in real-time through User Datagram Protocol (UDP) Communication. Machine learning algorithms (SVM, Naive Bayes, KNN, etc.) are trained to detect the status of a safety hook as attached and unattached in 3 testing scenarios. The result of this research demonstrates the opportunity of utilizing SSHs at the construction site to eliminate the FFH incidents in real-time with high accuracy and precision. Furthermore, the proposed SSH device may help facilitate the construction workers at the elevation and assure safety in real-time.

The use of information and communication technologies (ICT) in commerce improves the commercial structure and economic capacity of a country. This study empirically assesses the impact of ICTs on international trade in 36 countries in Asia and the Pacific, at the sectoral level, between 2007 and 2018. The study evaluates whether ICTs improve international trade by hiring the gravity model of international trade and increasing it with the ICT variable. An ICT development indicator (IDI) is formed by joining seven different ICT variables that show ICT infrastructure, use, and skills. Using the Poisson pseudo-maximum likelihood (PPML) estimation technique, this study shows that ICTs improve trade by reducing transaction costs. The findings reveal that information and communication technology positively and significantly influence international trade in all sectors of the Asia-Pacific region, and that trade intensifies when both trading partners have a high endowment of information and communications technology. The study recommends that governments in developing countries upgrade their ICT infrastructure levels.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of patient navigator programmes in children and adolescents with chronic diseases.

As the world struggles to deal with the consequences of the COVID-19 pandemic, dengue fever endemic regions are facing the threat of a double pandemic that might totally overwhelm administrations of health care service. In Latin America and Asia, simultaneous epidemics of dengue and COVID-19, as well as possible instances of co-infections, have already begun. Because the healthcare system is already stretched enough, a fatal combination like this may devastate hospital emergency departments and the economy as a whole. Frontline clinicians must use precise epidemiological and contact history-taking techniques, as well as pay close attention to false-positive dengue serology and the possibility of co-infections, to tackle this apparently overwhelming obstacle. Key words: Covid-19; Dengue fever; Co-infection; health system

Organic waste can be converted to compost for sustaining soil health by microbial activities to improve its physiochemical properties. Compost is called as Gardener’s Gold and a vital partner in enhancing crop productivity on a sustainable basis. Composting is helpful to reduce the volume of wastes and in managing landfills through recycling and reusing of organic waste. Vermicompost is also a type of compost utilizing worms for organic wastes disintegration. Composting can be categorized as an aerobic and anaerobic process either carried out in the existence of air or done in controlled air condition. In the aerobic process, it can be grouped into heap, aerated window, and in-vessel, whereas in anaerobic conditions, it is classified into stacks or pile, bokashi, and submerged composting. Nowadays, mechanical composter is available, which is cost effective in terms of time and labor-saving. Compost benefits soil in various ways, such as reducing soil’s bulk density and improve water holding capacity, in addition to having an antagonistic effect on pests. The addition of compost in soil enhances microbial activities that consequently trigger mineralization and recycling of organic substances, thereby increases crop productivity. The biochemical changes that occur during decomposition are described on the basis of different phases like the latent phase (microbes are acclimatized and colonized in the compost heap), growth phase, thermophilic phase, and maturation phase. Compost can be enriched through suitable strains of beneficial microbes, inorganic fertilizers, or other suitable additives. Keeping in view the importance of biochemical reactions involved in the process of composting, the aim of this chapter is to highlight the basic understanding of composting biochemistry, its phases, and, finally, its role in sustainable agriculture.

The phenotypic and genotypic characterization of eight rhizobial isolates obtained from Arachis hypogaea nodules grown under stress environment was performed. Isolates were screened for their ability to tolerate different abiotic stresses (high temperature (60&deg, C), salinity (1&ndash, 5% (w/v) NaCl), and pH (1&ndash, 12). The genomic analysis of 16S rRNA and housekeeping genes (atpD, recA, and glnII) demonstrated that native groundnut rhizobia from these stress soils are representatives of fast growers and phylogenetically related to Rhizobium sp. The phenotypic characterization (generation time, carbon source utilization) also revealed the isolates as fast-growing rhizobia. All the isolates can tolerate NaCl up to 3% and were able to grow between 20 and 37 &deg, C with a pH between 5 to 10, indicating that the isolates were alkali and salt-tolerant. The tested isolates effectively utilize mono and disaccharides as carbon source. Out of eight, three rhizobial isolates (BN-20, BN-23, and BN-50) were able to nodulate their host plant, exhibiting their potential to be used as native groundnut rhizobial inoculum. The plant growth promoting characterization of all isolates revealed their effectiveness to solubilize inorganic phosphate (56&ndash, 290 &micro, g mL&minus, 1), synthesize indole acetic acid (IAA) (24&ndash, 71 &micro, 1), and amplification of nitrogen fixing nifH gene, exploring their ability to be used as groundnut biofertilizer to enhance yield and N2-fixation for the resource poor farmers of rainfed Pothwar region. `

Background and Aims Nutritional management is an important, but complex, component of treatment for people on haemodialysis. Dietary recommendations are poorly adhered to, and novel strategies to improve self-management are needed. The aim of this study was to determine the feasibility and effectiveness of a mobile phone text message intervention to improve dietary behaviours in people on haemodialysis. Method We conducted a six-month, multi-centre randomised controlled trial (2:1) in patients on maintenance haemodialysis. Participants who were randomised to receive the KIDNEYTEXT intervention received three semi-tailored text messages per week for six months plus usual care. The control group received usual care. The primary outcome was a composite outcome to determine feasibility, using: recruitment rate, retention rate, adherence to dietary recommendations and acceptability. Adherence to dietary recommendations was defined as meeting 3 of 4 nutrition guidelines (potassium, phosphorus, sodium and protein). Acceptability was evaluated by semi-structured interviews to elicit perspectives regarding satisfaction, acceptability and change in behaviours. Secondary outcomes included serum electrolytes, interdialytic weight gain (IDWG) and dietary intake. Trial registration - ACTRN12617001084370. Results In total, 130 participants were recruited (87 intervention, 43 control) from six haemodialysis units in Sydney, Australia. 48% of eligible patients consented to participate and 114 participants (88%) completed the trial. Whilst there was no significant difference in adherence to dietary recommendations at 6 months (p=0.14), there were significant reductions in dietary intake of potassium (p=0.01), phosphorus (p=0.003), sodium (p=0.031) and protein (p=0.024) in intervention participants compared to control. Compared to control participants, intervention arm had a significant increase in the number of participants meeting IDWG guidelines (p=0.005) and significant reduction in average IDWG (p=0.024). There was a significant reduction in the number of phosphate binders prescribed in the intervention arm compared to control at 6 months (p=0.03). There was no significant difference in serum electrolytes between the 2 arms at 6 months. Semi-structured interviews explored acceptability, with 5 themes emerging: clear and comprehensive, engaging with consistent and relevant content, maintaining attention with timely reminders, sustaining interest through ongoing care and generic messages inadequate to prompt dietary change. Conclusion A mobile phone text message intervention targeting dietary behaviours in people on haemodialysis is feasible and has the potential to change dietary behaviours and improve clinical parameters, such as fluid management and pill burden. Future trials evaluating the effect of a mobile phone text message intervention on patient-centred and clinical outcomes in the haemodialysis population is warranted.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: This review aims to look at the benefits and harms of synbiotics, prebiotics, and probiotics for people with CKD.

Rationale & Objective An important component of hemodialysis management involves delivery of complex dietary recommendations. The aim of this study was to determine the feasibility of a mobile phone text-message intervention to improve dietary behavior in people undergoing hemodialysis. Study Design Six-month randomized feasibility study. Setting & Participants Patients receiving maintenance hemodialysis across 2 health districts in Sydney, Australia. Interventions Participants randomized to the intervention received 3 text messages per week in addition to standard dietary care for 6 months. The usual care group received standard dietary care. Outcomes The primary outcomes were feasibility measured using recruitment and retention rates, acceptability of the intervention, and adherence to dietary recommendations. Secondary exploratory outcomes included information on certain clinical parameters related to dietary management of patients receiving maintenance hemodialysis. Results 130 people were recruited; 48% of eligible patients (130 of 272) consented to participate, and 88% (115 of 130) completed the study. Semistructured interviews evaluating acceptability identified 5 themes: clear and comprehensive, engaging with consistent and relevant content, maintaining attention with timely reminders, sustaining interest through ongoing care, and generic messages inadequate to prompt dietary change. There was no difference in adherence to dietary recommendations across treatment groups (odds ratio, 1.21 [95% CI, 0.55-2.72]; P = 0.6). Secondary exploratory analyses suggested reductions in dietary intake of single nutrients (potassium, phosphorus, sodium, protein), interdialytic weight gain, and phosphate binder use among intervention participants compared with participants assigned to standard care. Limitations Our feasibility study was of short duration. Adherence was based on self-reported data. Generalizability to populations receiving maintenance hemodialysis outside of an urban, Australian setting is unknown. Conclusions A simple mobile phone text-messaging intervention was feasible and acceptable to patients. Further investigation of the impact on patient-reported and clinical outcomes is warranted. Funding Funding for the study was provided by a Sydney Medical School Foundation Grant and the Centre for Transplant and Renal Research at Westmead Hospital. Trial Registration Registered at Australian New Zealand Clinical Trials Registry with study number ACTRN12617001084370.