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Abstract Background Therapeutic ceiling of care is the maximum level of care deemed appropiate to offer to a patient based on their clinical profile and therefore their potential to derive benefit, within the context of the availability of resources. To our knowledge, there are no models to predict ceiling of care decisions in COVID-19 patients or other acute illnesses. We aimed to develop and validate a clinical prediction model to predict ceiling of care decisions using information readily available at the point of hospital admission. Methods We studied a cohort of adult COVID-19 patients who were hospitalized in 5 centres of Catalonia between 2020 and 2021. All patients had microbiologically proven SARS-CoV-2 infection at the time of hospitalization. Their therapeutic ceiling of care was assessed at hospital admission. Comorbidities collected at hospital admission, age and sex were considered as potential factors for predicting ceiling of care. A logistic regression model was used to predict the ceiling of care. The final model was validated internally and externally using a cohort obtained from the Leeds Teaching Hospitals NHS Trust. The TRIPOD Checklist for Prediction Model Development and Validation from the EQUATOR Network has been followed to report the model. Results A total of 5813 patients were included in the development cohort, of whom 31.5% were assigned a ceiling of care at the point of hospital admission. A model including age, COVID-19 wave, chronic kidney disease, dementia, dyslipidaemia, heart failure, metastasis, peripheral vascular disease, chronic obstructive pulmonary disease, and stroke or transient ischaemic attack had excellent discrimination and calibration. Subgroup analysis by sex, age group, and relevant comorbidities showed excellent figures for calibration and discrimination. External validation on the Leeds Teaching Hospitals cohort also showed good performance. Conclusions Ceiling of care can be predicted with great accuracy from a patient’s clinical information available at the point of hospital admission. Cohorts without information on ceiling of care could use our model to estimate the probability of ceiling of care. In future pandemics, during emergency situations or when dealing with frail patients, where time-sensitive decisions about the use of life-prolonging treatments are required, this model, combined with clinical expertise, could be valuable. However, future work is needed to evaluate the use of this prediction tool outside COVID-19.

Objetivo: Descrever as tendências no diagnóstico de síndrome mielodisplásica no Brasil entre o período de 2014 e 2023 e sua associação com variáveis demográficas, sexo e faixa etária. Metodologia: Refere-se a um estudo documental quantitativo, retrospectivo e descritivo, realizado com base em informações referentes aos casos de síndrome mielodisplásica diagnosticados no período de 2019 a 2023, disponíveis no banco de dados do Sistema de Informações Ambulatoriais (SIA), no banco de informações em saúde TABNET (DATASUS). Nesta pesquisa, foram utilizadas as seguintes variáveis: sexo e faixa etária, fazendo uma comparação entre regiões do país e casos por ano. Resultados: Houve um aumento de 117,8% nos diagnósticos de Síndrome Mielodisplásica (SMD) no Brasil, de 450 casos em 2014 para 980 casos em 2023. Em se tratando da distribuição por sexo, em 2023, 54,1% dos casos diagnosticados eram homens (530 casos) e 45,9% eram mulheres (450 casos). Já na análise da faixa etária, nota-se que a maioria dos casos ocorreu em indivíduos acima de 60 anos, que representaram 65% dos diagnósticos em 2023. A faixa etária de 40 a 59 anos teve 25% dos casos, enquanto os indivíduos com menos de 40 anos representaram 10% dos diagnósticos. A região Sudeste apresentou o maior número de casos em relação ao total (40%), enquanto a menor taxa é da região Norte (5%). Discussão: Este estudo epidemiológico apresentou relevancia por fortalecer o direcionamento assertivo aos cuidados de saúde em pessoas com Síndrome Mielodisplásica (SMD), sobretudo a partir da identificação da maior incidência em pessoas do sexo masculino e acima de 60 anos. Aproximadamente 65% dos pacientes com SMD têm mais de 60 anos de idade no momento do diagnóstico e a taxa de incidência dobra a cada década acima dos 40 anos de idade. Apresentando um curso clínico extremamente variável, ela se enquadra em um espectro que varia desde um curso estável da doença ao longo de 10 ou mais anos, até evolução para morte, com evolução acelerada entre alguns meses subsequente à complicações de citopenia ou transformação leucêmica. Além disso, o fato de ter um aumento no número de casos entre 2014 e 2023, sendo a maior quantidade de pacientes no Sudeste, demonstra que a SMD é uma doença que necessita de estratégias de prevenção e diagnóstico precoce. Conclusão: Diferenças étnicas e influências regionais desempenham um papel significativo na patogênese e estabelecimento da Síndrome Mielodisplásica. Sendo assim, fatores genéticos, fatores étnicos, ocupacionais, de estilo de vida e ambientais contribuem para a história natural e desenvolvimento da síndrome em questão. A compreensão desses aspectos é crucial para o desenvolvimento de estratégias eficazes de prevenção, diagnóstico precoce e manejo da SMD, visando melhorar a qualidade de vida dos pacientes e otimizar os recursos de saúde.

Introdução: A anemia grave leva a hipóxia tecidual e ativação de mecanismos compensatórios, com aumento da frequência cardíaca (FC) e frequência respiratória (FR). Como em humanos, a transfusão sanguínea com concentrado de hemácias em cães é uma terapia suporte enquanto se busca o diagnóstico ou o tratamento se torne efetivo. Objetivo: O objetivo do presente estudo foi analisar os parâmetros: frequência cardíaca (FC), frequência respiratória (FR), temperatura retal (T°C) e coloração de mucosas (CM) pré e pós-transfusionais em cães com anemia de causas diversas. Material e métodos: Foi realizada análise retrospectiva das fichas de acompanhamento de transfusões de concentrado de hemácias em um Hospital Veterinário no período de julho de 2023 a junho de 2024. As transfusões foram realizadas em cães de várias raças, idades e peso corpóreo. A hemoglobina destes pacientes variou de 1,5 a 5g/dL. Foram analisados os registros de FC, FR, T°C e CM pré-transfusionais (T1) e pós-transfusionais (T2) de 149 transfusões, sendo que foram retirados do estudo quatro transfusões devido a reação transfusional (três reações febril não hemolítica e uma sobrecarga de volume (TACO)), totalizando 145 transfusões avaliadas. Os dados foram submetidos ao teste t pareado ou de Mann Whitney na dependência da avaliação da normalidade dos dados, considerando p < 0,05 como significativo. Resultados: Houve redução significativa na frequência cardíaca e frequência respiratória após as transfusões: FC T1: 134,9 ± 29,6 bpm; FC T2: 104,3 ± 26,1bpm; FR T1: 28 (mín: 8, max: 80) mpm; FR T2: 24 (mín: 8, max: 80) mpm. Não houve diferença na temperatura retal, T1: 37,7ºC (min: 33,4; max: 40,0) e T2: 37,9ºC (min: 33,0; max:39,7). Das 145 transfusões, houve melhora na CM em 97 transfusões (67%); não houve alterações na CM em 41 transfusões (28%); em 7 transfusões (5%) não foi possível avaliar a mucosa por fatores como agressividade dos animais. Discussão: A redução na FC e FR após as transfusões confirma a eficácia do procedimento na diminuição da hipóxia tecidual e redução na ativação de mecanismos compensatórios. A T°C ao longo das transfusões não apresentou alterações significativas, mostrando que a utilização de sangue refrigerado (à 4°C) em cães não ocasiona diminuição da temperatura corporal. A melhora da coloração das mucosas pode sinalizar o aumento do número de hemácias e/ou diminuição da vasoconstrição periférica. Conclusão: Pode-se concluir com os presentes dados que o acompanhamento da transfusão sanguínea com FC, FR, CM e temperatura é importante para detecção precoce de reação transfusional, mas também para avaliação da melhora dos parâmetros clínicos dos pacientes. Portanto, a transfusão de concentrado de hemácias em cães é eficaz para diminuição da hipóxia tecidual demonstrada pelo acompanhamento de parâmetros facilmente obtidos no exame físico.

Introdução: Diversas doenças em cães causam anemias que requer transfusão sanguínea, podendo causar reações transfusionais. Objetivo: O presente estudo avaliou o número e classificou as reações transfusionais ocorridas em cães que receberam concentrado de hemácias durante o período de janeiro/2022 a junho/2024 em um Hospital Veterinário Universitário. Material e métodos: Foram analisadas de forma retrospectiva 260 fichas de acompanhamento de transfusões de concentrado de hemácias em cães. Dois pacientes foram retirados do estudo pois vieram a óbito no início da transfusão por complicações da doença de base, sendo descartada a possibilidade de reação transfusional. Os pacientes incluídos no estudo receberam bolsas de concentrado de hemácias em taxas que correspondem ao seu quadro clínico, idade e doença e foram acompanhados durante todo o procedimento. As transfusões só ocorreram após verificar a compatibilidade do sangue do doador e receptor, para assim evitar ao máximo reações hemolíticas agudas. Parâmetros clínicos como frequência cardíaca e respiratória, ausculta cárdio-respiratória, temperatura, coloração de mucosa, tempo de preenchimento capilar e outras avaliações clínicas, quando necessárias, eram aferidas/avaliadas antes do início, a cada 15 minutos na primeira hora e a cada 30 minutos até o término da transfusão e após a sua finalização. Após coleta dos dados foi realizado análise descritiva utilizando médias para quantificar a porcentagem de reações transfusionais. Resultados: Neste período o Projeto Vida – Medicina Transfusional, realizou 260 transfusões de concentrado de hemácias em cães, sem distinção de idade, raça, sexo e peso corpóreo. Das 258 transfusões incluídas no estudo, 13 cães (5,03%) apresentaram alterações clínicas compatíveis com reação transfusional e o procedimento foi interrompido e o paciente tratado. Nenhum dos animais veio à óbito. As reações transfusionais diagnosticadas foram: 2,32% (6/258) sobrecarga circulatória (TACO), 2,32% (6/258) reação febril não hemolítica por exclusão de outras causas como contaminação bacteriana e reação imunomediada hemolítica aguda e 0,38% (1/258) hipotensão. Discussão: Transfusão sanguínea salva vidas, mas tem riscos. Como acontece em humanos, em animais as reações transfusionais também têm sido diagnosticadas, porém pouco são os estudos sobre sua incidência e não há um sistema próprio para registro destas reações. Um levantamento realizado em 2009 no mesmo Hospital Veterinário Universitário com o uso ainda de sangue total registrou 15% de reações transfusionais em sua maioria reação imunomediada não hemolítica (alérgica), o que após 2009 com a separação dos componentes sanguíneos estas taxas diminuíram e neste presente estudo apenas 5,03% das transfusões apresentaram intercorrência. Outros estudos mostram resultados variáveis dependendo da reação transfusional como: sobrecarga circulatória de 4,7%, reação febril não hemolítica 1,3 a 24,2% e hipotensão 0,9%. Os resultados deste presente estudo demonstram que a incidência de reações transfusionais está com índices melhores do que os apresentados na literatura. Conclusão: O uso e controle de hemocomponentes, testes de compatibilidade pré-transfusionais, o acompanhamento do paciente durante o procedimento e o reconhecimento das reações transfusionais são condutas que diminuem o risco transfusional e aumentam a segurança da transfusão sanguínea em cães.

Abstract Background Effective stakeholder engagement in health research is increasingly being recognised and promoted as an important pathway to closing the gap between knowledge production and its use in health systems. However, little is known about its process and impacts, particularly in low-and middle-income countries. This opinion piece draws on the stakeholder engagement experiences from a global health research programme on Chronic Obstructive Pulmonary Disease (COPD) led by clinician researchers in Brazil, China, Georgia and North Macedonia, and presents the process, outcomes and lessons learned. Main body Each country team was supported with an overarching engagement protocol and mentored to develop a tailored plan. Patient involvement in research was previously limited in all countries, requiring intensive efforts through personal communication, meetings, advisory groups and social media. Accredited training programmes were effective incentives for participation from healthcare providers; and aligning research findings with competing policy priorities enabled interest and dialogue with decision-makers. The COVID-19 pandemic severely limited possibilities for planned engagement, although remote methods were used where possible. Planned and persistent engagement contributed to shared knowledge and commitment to change, including raised patient and public awareness about COPD, improved skills and practice of healthcare providers, increased interest and support from clinical leaders, and dialogue for integrating COPD services into national policy and practice. Conclusion Stakeholder engagement enabled relevant local actors to produce and utilise knowledge for small wins such as improving day-to-day practice and for long-term goals of equitable access to COPD care. For it to be successful and sustained, stakeholder engagement needs to be valued and integrated throughout the research and knowledge generation process, complete with dedicated resources, contextualised and flexible planning, and commitment.

Introduction: Diabetic Macular Oedema (ME) is the main cause of poor visual acuity due to the breakdown of the inner and/or outer Blood Retinal Barrier (BRB). This can occur at any stage of Diabetic Retinopathy (DR) due to increased vascular permeability from retinal capillaries, as well as from microaneurysms and Intraretinal Microvascular Abnormalities (IRMAs). A high level of Glycosylated Haemoglobin (HbA1c) is a well known risk factor for diabetic ME. Aim: To evaluate the relationship between glycosylated Haemoglobin (Hb) and macular thickness on Optical Coherence Tomography (OCT) in patients with Type 2 Diabetes Mellitus (T2DM). Materials and Methods: A cross-sectional study was in the Department of Ophthalmology at RL Jalappa Hospital, Kolar, Karnataka, India. The study duration was one year and eight months, conducted from January 2021 to September 2022. A total of 162 eyes of 81 patients with Diabetes Mellitus (DM) were included. Patients were assessed for age, gender, duration of diabetes, subfield macular thickness, total macular volume as measured by Optical Coherence Tomography (OCT), and HbA1c levels. Pearson’s correlation and paired t-test were used to identify the mean difference between paired data. A p-value 8% compared to those with HbA1c values 8% and a longer duration of diabetes exhibited increased macular thickness and total macular volume as measured by OCT, which was also observed in patients with severe non proliferative DR and proliferative DR.

Introduction The empty pelvis syndrome is a significant source of morbidity following pelvic exenteration surgery. It remains poorly defined with research in this field being heterogeneous and of low quality. Furthermore, there has been minimal engagement with patient representatives following pelvic exenteration with respect to the empty pelvic syndrome. ‘PelvEx—Beating the empty pelvis syndrome’ aims to engage both patient representatives and healthcare professionals to achieve an international consensus on a core outcome set, pathophysiology and mitigation of the empty pelvis syndrome.Methods and analysis A modified-Delphi approach will be followed with a three-stage study design. First, statements will be longlisted using a recent systematic review, healthcare professional event, patient and public engagement, and Delphi piloting. Second, statements will be shortlisted using up to three rounds of online modified Delphi. Third, statements will be confirmed and instruments for measurable statements selected using a virtual patient-representative consensus meeting, and finally a face-to-face healthcare professional consensus meeting.Ethics and dissemination The University of Southampton Faculty of Medicine ethics committee has approved this protocol, which is registered as a study with the Core Outcome Measures in Effectiveness Trials Initiative. Publication of this study will increase the potential for comparative research to further understanding and prevent the empty pelvis syndrome.Trial registration number NCT05683795.

The presence of distinct social groups within an animal population can result in heterogeneity in many aspects of its life history and ecology. The ability to accurately assess social group membership increases with the number of times individuals are identified, but obtaining sufficient sightings of rarely encountered species can be difficult. Three social clusters were previously identified for the endangered population of false killer whales Pseudorca crassidens around the main Hawaiian Islands, using modularity among associations within a 12 yr photographic dataset with no restrictions on the number of times seen. In this study, we used photo-identification data over a 23 yr period to reassess the number and membership of social clusters, restricted to individuals seen on at least 5 different days. We compared the robustness of clustering assignments from 6 community detection algorithms using modularity and found that the 3 highest-ranking algorithms all identified the same number (4) and membership of social clusters. Spatial use of clusters varied among the islands, with 3 of the 4 clusters encountered regularly only off 1 or 2 of the 3 main island study areas. Comparison of genetic differentiation among social clusters revealed significant differentiation in nuclear DNA. Furthermore, all individuals in 2 of the clusters possess the same mitochondrial DNA haplotype, while in the other 2 clusters, approximately 40% of animals possess a second haplotype. This level of clustering and associated heterogeneity within the population may have implications for mark-recapture abundance estimation, as well as for mitigating exposure to anthropogenic activities, including interactions with fisheries.HŌ‘ULU‘ULU MANA‘O: Pili nā ‘ano like ‘ole o ka nohona a me ke kālaikaiaola o nā pū‘uo holoholona i ka loa‘a ‘ana o nā pū‘ulu kiko‘ī. Pi‘i a‘e ka hiki ke helu kūpono‘ia ka māhuahua ‘ana o nā heluna o ia mau pū‘ulu i ka helu ‘ana i nā wā e ‘ike ‘ia ai kēlā me kēia holoholona, ‘o ka lawa ‘ana na‘e o ka ‘ike ‘ana i nā lāhulu ‘ane halapohe kekahi ālaina. Hō‘ia ‘ia ‘ekolu pū‘ulu o ke koholā ‘ane halapohe, ‘o ka Pseudorca crassidens, a puni nā mokupuni nui ‘ewalu o Hawai‘i, ma ka ho‘owae‘anona ‘ana i ka pilina i loko o kekahi ‘ikepili ki‘a he ‘umikūmālua makahiki me ke kāohi ‘ole i ka nui o ka ‘ike ‘ia ‘ana. Ma kēia kilo ‘ana, ua ho‘ohana mākou i ka ‘ikepili ma o nā makahiki he iwakāluakūmākolu i mea e hō‘oia hou ai i ka heluna a me nā lālā o nā pū‘ulu launa i loko o kekahi pū‘uo holoholona, a pāpā ‘ia nā kālailaina i nā mea i ‘ike ‘ia ma ‘elima mau lā ‘oko‘a ma ka li‘ili‘i loa. Ho‘ohālikelike mākou i ke ‘ano me ka ikaika o kēia mau pū‘ulu launa ma ka ho‘ohana ‘ana i ka ho‘owae‘anona ‘ana ma ‘eono pū‘ulu ha‘ilula a ‘o ka mea i loa‘a, ‘o ia ho‘i ka ‘ike ‘ana, ma o nā ha‘ilula nui ‘ekolu, i ka heluna a me ka lālā ho‘okahi o nā pū‘ulu launa. Loli ka ho‘ohana ‘ana i ke koana o nā pū‘ulu ma waena o nā mokupuni, ‘ike ‘ia ‘ekolu pū‘ulu ma ho‘okahi a ‘elua paha mokupuni mai loko mai o nā mokupuni nui ‘ekolu e kālailai ‘ia ana. Ma ka ho‘ohālikelike ‘ana aku i nā hi‘ohi‘ona ōewe ‘oko‘a o nā pū‘ulu launa, ‘ike ‘ia ka ‘oko‘a ‘ano nui ma ka piko ōewe o nā pū‘ulu. A no laila, loa‘a i nā mea a pau o ia mau pū‘ulu ‘elua ke ōewe ho‘oilina ho‘okahi, a ma nā pū‘ulu ‘ē a‘e ‘elua, loa‘a he hi‘ohi‘ona ōewe ‘elua i nā holoholona he 40 pākēneka. Hiki nō paha i kēia ‘ano ho‘opū‘ulu ‘ana me kēia ‘ano wae‘anona ōewe ho‘opili ma kekahi pū‘uo ke pili i ke kuhi ‘ana i ka nui ma ka hopu kaha ‘ana, a i ke kāohi a ho‘ēmi ‘ana mai i nā hopena o nā hana kanaka, e la‘a ho‘i me ka hana ma ke kai lawai‘a.

Introduction: Intravenous opioids have been frequently used to provide analgesia and supplemental sedation during general anaesthesia or monitored anaesthesia care. Opioid Free Anaesthesia (OFA) is a multimodal approach which combines different drugs likes lignocaine, dexamethasone, paracetamol and dexmedetomidine with different techniquessuch as hypnosis, sedation, analgesia and sympatholysis. Thus, reducing and avoiding opioids perioperatively will lead to decrease in opioid related adverse effects with better postoperative outcomes. Aim: To compare OFA and Opioid-based Anaesthesia (OBA) in terms of haemodynamic stability, speed and quality of recovery, postoperative pain score and analgesic requirement. Material and Methods: The present study was a randomised study conducted over a period from June 2021 to September 2022, in which 90 patients of American Society of Anaesthesiologists (ASA) Grade I,II, 20-60 years of age undergoing elective Laparoscopic Cholecystectomy (LC) were divided into OBA fentanyl and OFA-lignocaine and dexmedetomidine. A standard general anaesthesia protocol of the institute was followed. OBA group received fentanyl (2 μg/kg) over 10 minutes before induction of anaesthesia and OFA group received lignocaine (2 mg/kg) and dexmedetomidine (0.5 μg/kg) both intravenously over 10 minutes before induction of anaesthesia. In OFA group analgesia was maintained by infusion of lignocaine 2 mg/kg/hr and dexmedetomidine 0.5 μg/kg/hr whereas in OBA group fentanyl 0.5 μg/kg was given whenever required till the gallbladder was resected. Postoperative intraperitoneal instillation of gallbaldder fossa was done with 20 mL 0.5% bupivacaine. Intraoperative mean Heart Rate (HR) and Mean Arterial Pressure (MAP) were recorded. Postoperative speed and quality of recovery, pain score, analgesic requirements and incidence of Postoperative Nausea and Vomiting (PONV) were noted. Paracetamol 15 mg/kg was given intravenously whenever Numerical Rating Scale (NRS) score was ≥6. Comparison of means between the two groups was done using unpaired t-test, association between two non parametric variables was done using Pearson Chi-square (χ2 test) test. Results: The mean age, sex, weight, ASA and duration of surgery were comparable in both the groups. The mean HR and mean MAP were significantly lower in OFA group compared to the OBA group at all the time points (p-value=0.001). Although postoperative speed of recovery was slower in OFA group, the overall quality of recovery was better (p-value=0.001). The postoperative pain score, analgesic requirement and incidence of nausea and vomiting were all significantly less in OFA group as compared to OBA group with p-values of 0.02, 0.001 and 0.02, respectively. Conclusion: OFA is new anaesthetic approach that provides better perioperative haemodynamic stability, postoperative pain control with less PONV and thus can be used safely and successfully.

Introdução: Blinatumomabe é um anticorpo monoclonal bi-específico para o tratamento da leucemia linfoblástica aguda (LLA), que tem como alvo o CD19+ do linfócito B e o CD3+ no linfócito T. Esse medicamento tem demonstrado eficácia significativa na indução da remissão completa em pacientes refratários ou em recaída. Contudo, a literatura destaca a ocorrência de reações adversas, incluindo eventos neurológicos, que podem comprometer a qualidade de vida e o sucesso terapêutico. Objetivo: Relato de caso de neurotoxicidade (NT) associada ao uso de Blinatumomabe em um indivíduo diagnosticado com LLA. Método: as informações foram obtidas por meio de revisão do prontuário, diagnósticos aos quais o paciente foi submetido e revisão da literatura. Dados demográficos, histórico médico, evolução do tratamento e reações neurológicas foram registrados ao longo do período de observação. Resultados: Paciente do sexo masculino, 50 anos, diagnosticado prévio de hipertensão, diabetes mellitus tipo II, dislipidemia, hiperplasia de próstata, obesidade, ototocixidade com LLA B comum, Philadelphia negativo, cariótipo in situs complexo, CD19 positivo. Realizou tratamento com protocolo HiperCvad, e recaída após. Foi indicado DaunoFlag, onde demonstrou refratariedade. Como terapia alternativa foi instituído reindução com St. Judes, onde apresentou remissão no início do tratamento e posterior recaída precoce. Após discussão, foi proposto tratamento com 3 ciclos de Blinatumomabe. Durante o tratamento, o paciente apresentou sintomas psíquicos e somáticos, incluindo cefaleia persistente, perturbações da consciência, confusão, desorientação e tremores. A investigação clínica e os exames complementares revelaram alterações no sistema nervoso central. Essas reações neurológicas foram relacionadas a NT do Blinatumomabe, uma reação adversa já descrita, sendo optado por manter a infusão com o monitoramento contínuo do enfermeiro para novos sinais e sintomas neurotóxicos. Discussão: A NT é uma preocupação emergente no tratamento com Blinatumomabe, provavelmente decorrente da ativação imune e da liberação de citocinas. Essas reações podem variar desde sintomas leves até graves complicações que ameacem a vida, necessitando de intervenção imediata. O presente caso reforça a importância do monitoramento rigoroso de pacientes sob tratamento com Blinatumomabe, visando a detecção precoce e o gerenciamento eficaz de reações adversas neurológicas. Conclusão: A NT relacionada ao uso de Blinatumomabe representa um desafio clínico na terapia da LLA. Este relato de caso destaca a importância da vigilância clínica cuidadosa realizada pelo enfermeiro para identificação precoce de reações neurológicas adversas graves. O entendimento aprofundado dessas complicações é fundamental para a otimização do tratamento, garantindo uma abordagem terapêutica eficaz e minimizando os riscos associados ao uso de Blinatumomabe em pacientes com LLA.

Introdução: O linfoma Burkitt (LB) é o tumor que surge a partir de uma célula do centro germinativo, que perde o controle da proliferação devido à ativação do gene c-myc. A resistência à apoptose é uma causa importante da falha à quimioterapia. O risco de infiltração secundária em Sistema Nervoso Central (SNC) é de 25% a 30%, podendo indicar recidiva mais agressiva, com prognóstico complexo, mas passível de ser tratada. Objetivo: Descrever um caso de progressão de LB em SNC e tratamento paliativo com pemetrexede. Método: Estudo descritivo tipo relato de caso com diagnóstico de Linfoma Não Hodgkin (LNH) de alto grau. Resultados: Paciente do sexo masculino, 35 anos, diagnóstico de LNH alto grau, Ki67 95%, com comprometimento de SNC ao diagnóstico, sorologia positiva para hepatite B e sífilis, ansiedade generalizada, condiloma face e perianal. A primeira linha de tratamento foi R-DA-EPOCH (C1-C4), com últimas duas imunofenotipagens do líquor negativas. Reinterna para o C5 com quadro de confusão mental e, diagnóstico de recaída em SNC, tratado com 1 ciclo de MAD. Retorna com piora do sensório, e progressão das lesões em SNC. Como alternativa paliativa, optou-se o uso do Pemetrexede, devido sua permeabilidade na barreira hematoencefálica, com plano de 3 infusões de 900 mg/m2 a cada 3 semanas, com possibilidade de terapia adjuvante com radioterapia em SNC. Realizou um ciclo de Pemetrexede associado a dexametasona, folato e vitamina B12 para profilaxia da toxicidade do fármaco. Respondeu com regressão rápida dos sintomas neurológicos e apresentou condições de alta hospitalar. Em poucas semanas retornou com sintomas neurológicos graves, crises convulsivas, edema cerebral, evoluindo a óbito. Em um estudo prospectivo de 2017, realizado na China, com 17 pacientes tratados com Pemetrexede na mesma dose proposta, 5 casos apresentaram remissão completa, 5 com remissão parcial, 4 casos com doença estável e 3 com doença progressiva. A taxa de resposta geral foi de 58,8% e a taxa de controle da doença foi de 82,4%. Outro estudo de 2011 em Chicago, avaliou 11 pacientes com linfomas primários do SNC recidivante/refratário, onde o tratamento com Pemetrexede obteve resposta geral associada de 55% e taxa de controle da doença de 91%. Conclusão: O estudo realizado na China foi o primeiro ensaio clínico aplicando Pemetrexede para tratar pacientes PCNSL recorrentes e os resultados indicaram que o Pemetrexede pode ser eficaz para recorrência de PCNSL, com toxicidade moderada. Neste relato, o paciente com doença agressiva, c-Myc negativo, expressando PAX-5 (DAK-Pax5), CD20, CD3 e CD10 positivos, Ki67 de 95% e classificação Burkitt Lymphoma International Prognostic Index (BL-IPI) 2, alto grau, evoluiu para óbito, com progressão dos sintomas neurológicos após a primeira aplicação do Pemetrexede. O uso da medicação pode ser uma opção em casos complexos e com restrições terapêuticas, porém são necessários mais estudos complementares.

Introdução: A cardiotoxicidade pode ser um evento adverso preocupante no contexto da assistência do paciente submetido ao Transplante de Células-Tronco Hematopoéticas (TCTH). O efeito cumulativo ocasionado pelo tratamento quimioterápico prévio com antraciclinas e agentes alquilantes em altas doses e outras drogas que podem causar danos aos cardiomiócitos ou ao sistema de condução elétrica. As cardiotoxicidades apresentadas pelos pacientes incluem: pericardite, miocardite, Insuficiência Cardíaca Congestiva (ICC), angina, infarto do miocárdio, choque cardiogênico e até mesmo parada cardiorespiratória. Objetivo: Descrever os cuidados de enfermagem, diante do uso em pacientes submetidos ao TCTH. Método: Revisão bibliográfica a partir de publicações nacionais e internacionais. Foram identificados 20 artigos dos últimos 8 anos, disponíveis na íntegra, indexadas na Biblioteca Virtual em Saúde (BVS): SCIELO, com os seguintes descritores: “Cardiotoxicidade”; “Oncologia”; “Quimioterápicos”; “Trasplante de células- tronco hematopoéticas”. Discussão: De acordo com estudos, constata-se o elevado risco de cardiotoxicidade em pacientes tratados com antraciclinas, diante de um diagnóstico prévio de cardiopatia. Foram constatados 220 genes envolvidos em absorção, distribuição, metabolismo e eliminação de antraciclina, identificando em crianças o polimorfismo de nucleotídeo único no gene SLC28A3 como possível biomarcador preditivo de ICC induzida por antraciclinas. A avaliação dos riscos cardíacos antes do TCTH, bem como a monitoração contínua dos exames de função cardíaca durante o condicionamento e pós-TCTH, são estratégias encontradas na literatura para reduzir o impacto de complicações cardíacas causadas durante o tratamento. A avaliação pré-TCTH inclui exames como eletrocardiograma, ecocardiograma, tomografia torácica, teste de caminhada, espirometria e exames laboratoriais. Monitorização dos biomarcadores como troponina e Peptídeo Natriurético tipo-B (BNP) durante o tratamento pode detectar precocemente pacientes com alto risco de desenvolver uma insuficiência cardíaca. O enfermeiro onco-hematológico deve ter conhecimento necessário para monitorar este paciente por meio do exame físico diário, acompanhamento dos exames clínicos e laboratoriais, avaliando de forma global durante todo o processo do TCTH. Deve elaborar e revisar diariamente o plano de cuidado e orientar a equipe de enfermagem sob sua supervisão. Conclusão: O estudo enfatiza a importância da atuação do enfermeiro, como integrante da equipe multidisciplinar do TCTH, cabendo a esse profissional implementar os cuidados de enfermagem frente às possíveis alterações cardiológicas na prática assistencial.

Introdução: O Transplante de Células Tronco-Hematopoéticas (TCTH) é um procedimento complexo, com diversas etapas, ainda na internação os pacientes enfrentam momentos de ansiedade, incertezas, sendo a alta hospitalar uma etapa aguardada com expectativa e muitos anseios, uma vez que as mudanças nas rotinas são necessárias e tais cuidados estão diretamente relacionados ao sucesso do tratamento. A relação enfermagem ‒ paciente é muito estreita, considerando ser os profissionais que estão continuamente ao lado destes, acolhendo suas angústias, peculiaridades, planejando e implementando o cuidado durante a internação hospitalar e os preparando para alta. As informações de educação ao paciente e seus cuidadores são densas, e a compreensão adequada pode repercutir nos resultados do TCTH. Tal pressuposto requer do profissional a construção de conhecimentos e a habilidade de transmitir a informação em uma linguagem clara para o paciente, já que essas orientações caracterizam-se como uma ferramenta essencial para auxiliar em uma evolução favorável no pós-TCTH imediato. Objetivo: Descrever o processo de orientações de enfermagem na alta do paciente após TCTH alogênico e a transferência do cuidado. Método: Trata-se de um relato de experiência das enfermeiras que atuam em uma unidade de TCTH de um Hospital Universitário no sul do país. Resultados: O processo de orientações para alta ocorre de forma sistemática e inicia precocemente, partindo do pressuposto que as orientações são contundentes e com envolvimento de mais de diferentes especialidades. Semanalmente a equipe interdisciplinar se reúne para discutir em round o caso de cada paciente internado e sua previsão de alta. Uma vez identificada a previsão de alta breve, a enfermagem inicia o processo de orientações formais, entregando um folder impresso com todos os cuidados a serem seguidos pelo paciente em seu domicílio. É estipulado um período para que o paciente possa ler esse material e elaborar as dúvidas. Em outro momento, a enfermeira responsável pelo paciente retoma as informações através da leitura completa do material junto ao paciente e seu cuidador, caso o mesmo esteja presente durante a internação. Nas orientações são ressaltados sinais/sintomas de alterações e sua gravidade que possam ocorrer no domicílio e quais as providências a serem tomadas. Adaptações a este processo são realizadas de acordo com as características do paciente, fazendo com que as orientações sejam elaboradas individualmente e de acordo com a necessidade do paciente. Após a realização das orientações, é feito contato telefônico com o enfermeiro do Hospital-Dia para transferência do plano de cuidado, informando-o sobre o caso e as principais complicações, assim como os aspectos importantes para a continuidade do tratamento. Conclusões: O TCTH alogênico é um procedimento que inicia previamente à internação do paciente, com as orientações pré TCTH, e se estende após a alta, visando o controle dos riscos de infecções ou outras complicações, como a Doença do Enxerto Contra o Hospedeiro (DECH). A educação em saúde, proporciona conhecimentos desde o esclarecimento de dúvidas relacionadas à clínica da doença até os cuidados com a nutrição, higiene e importância da continuidade do tratamento sendo uma ferramenta fundamental na prevenção de complicações pós TCTH, e que o início precoce deste processo contribui para melhor adesão do paciente às orientações fornecidas e às adaptações sugeridas.

The bioactive secondary metabolites produced by sea cucumbers are very diverse with differences in composition, linkages, molecular weight, and various functional properties. Due to their physicochemical properties, these bioactive molecules in sea cucumbers have found applications in various market segments such as functional foods and cosmetics. Sea cucumber side dishes are a prominent food item in traditional cuisine in East Asian countries such as South Korea, China, and Japan. In addition, many studies have reported that the consumption of sea cucumbers can reduce the risk of cardiovascular disease, the pathogenesis of cancer cells, chronic inflammatory diseases, etc. In particular, many studies have recently reported the potential of sea cucumbers to develop functional products to reduce inflammation, oxidative stress, diabetes, and cancer. Additionally, these bioactive properties associated with sea cucumbers make them ideal compounds for use as functional ingredients in functional food products. However, no report has yet reviewed the properties of sea cucumbers related to functional foods. Therefore, in this review, the primary focus is given to collecting published scientific data (from 2019 to 2023) on the bioactive properties of sea cucumbers relevant to the functional food industry.

The precise knowledge of the seasonal influence on phenology, timing and duration of different growth stages (phenophases) exhibited in a life cycle of a plant is crucial for undertaking several crop management decisions. The reproductive growth stages hold a particular relevance in this regard that conveys a ‘seasonal shift’ and also a ‘shift’ in the timing, duration and intensity of vegetative and reproductive growth stages due to subnormal micro-climate induced by climate change. The present study investigates the phenological growth stages of Tecoma stans - a drought tolerant, yellow flowering shrub with a versatile use for urban greening and beautification. Till date, the phenological characteristics in T. stans have never been codified or described so far. The study was undertaken with an objective to codify the seasonal change in the phenological growth stages of T. stans using bi-numeric BBCH (Biologische Bun-desantalt, Bundessortenamt und Chemische Industrie) scale under subtropical climatic conditions of North West India. The experiment was planned on T. stans planted as a shrubbery block in a randomized block design layout. The distinct phenological growth stages of this shrub were represented through photographs. The year-round phenological calendar was also evolved exhibiting the time lapse of different phenophases along with their frequency and intensity of occurrence. Seasonal variation in mean temperature and precipitation markedly affected the phenological behavior of T. stans that exhibited seven major phenological growth stages namely, seed germination, leaf development, elongation of lateral shoots, inflorescence emergence, flower development, pod development and maturity of seed. The investigations undertaken are of vital interest to the urban landscape managers for the selection of species not only based on their aesthetic attributes but also to consider their functionality associated with the site-specific conditions. In addition, the salient findings will help deepen the understanding of weather-induced ‘eventful’ interactions of pollinators and flowers of T. stans that greatly benefit in a symbiotic manner, ensuring the survival and perpetuation of the species. The newly developed scale provides a unified standard for describing and identifying the phenological growth of T. stans that can potentially be utilized as a reference scale for undertaking future phenological studies.

Introduction: Stillbirth is defined as a baby born with no signs of life after a given threshold. It is a sensitive indicator of quality of care received by the mother during antepartum and intrapartum period. There has been a renewed focus on stillbirth in the backdrop of COVID-19 pandemic, as pregnant women are at an increased risk for severe form of COVID-19 and are associated with adverse perinatal outcomes. Aim: To estimate the prevalence of stillbirths and its characteristics during the pandemic and also, to classify the causes of stillbirths according to the International Classification of Diseases for use in Perinatal Mortality (ICD-PM) classification. Materials and Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Government Medical College, Thrissur, Kerala, India, during the COVID-19 pandemic from 1st August 2021 to 30th July 2022. A total of 106 mothers, who gave birth to stillbirths after 28 weeks of gestation were included in the study. When gestational age was not sure, stillbirth weighing more than 500 grams was considered as the inclusion criteria. Foetus, placenta, cord and membranes were examined after the delivery. The parameters studied were age, domicile, income, gestational age, order of pregnancy, mode of delivery, timing of foetal death, baby weight, gender, presence of anomalies and maternal medical complications. The causes were classified according to International Classification of Diseases-10-to Perinatal Mortality (ICD-PM) classification system. Categorical variables were assessed by Chi-square test and continuous variables were assessed by unpaired Student’s t-test. Results: There were 106 stillbirths with a Stillbirth Rate (SBR) of 38.78 per 1000 births. Major proportions of stillbirths were antepartum. Mean maternal age was 28.7±4.7 years. There were 73 (68.86) rural women and 33 (31.1%) urban women with stillbirths. A total of 90 (84.9%) cases were referral, while 16 (15.1%) were registered in the Institute for antenatal care. A total of 67 (63.2%) stillborns were male babies, but there was no significant difference in SBR, according to the order of pregnancy. Causes were classified according to the ICD-PM classification system. Hypertensive disorders in pregnancy (36.79%) and the foetal growth restriction (39.62%) were the common maternal and foetal condition identified among the cases. There were 22 COVID-19 positive cases, but they were also having hypertension as co-morbidity. Conclusion: In present study, antepartum stillbirth was the commonest type and occurred mostly in referral cases from periphery. Hypertensive diseases in pregnancy and foetal growth restriction were the leading causes. Early detection of high-risk conditions and timely referral, may reduce the rate of stillbirth.

Background. SARS-CoV-2 continues to be a major issue in resource-limited settings, particularly owing to the limited supply of vaccinescaused by inequitable distribution.Objective. To monitor diagnostic gene targets to identify potential test failures caused by mutations, which is important for public health.Methods. Here we analysed the genome sequence of SARS-CoV-2 from the second wave in Zimbabwe. A total of 377 samples weresequenced at Quadram Institute Bioscience. After quality control, 192 sequences passed and were analysed.Results. The Beta variant was dominant during this period, contributing 77.6% (149) of the genomes sequenced and having a total of 2994mutations in diagnostic polymerase chain reaction target genes. Many single nucleotide polymorphism mutations resulted in amino acidsubstitution that had the potential to impact viral fitness by increasing the rate of transmission or evading the immune response to previousinfection or vaccination.Conclusion. There were nine lineages circulating in Zimbabwe during the second wave. The B.1.351 was dominant, accounting for >75%.There were over 3 000 mutations on the diagnostic genes and lineage B.1.351, contributing almost two-thirds of the mutations. The S-genehad the most mutations and the E-gene was the least mutated.

Our previous study reported that chronic exposure to sublethal levels of estrogen induces DNA damage and endocrine dysfunction in sea bass. In this study, we extended our hypothesis to test changes in genotoxicity and biotransformation induced by Benzo[a]pyrene (BaP) that may regulate endocrine disorders in the estuarine fish. Therapon jarbua an euryhaline fish was exposed to BaP at two different ambient concentrations for 21 days. Biomarkers such as ethoxyresorufin-O-deethlylase (EROD) and DNA damages were assessed in the gill and liver, while neuroendocrine markers such as serotonin (5-HT) and acetyl cholinesterase (AChE) were studied in the brain. The findings showed that longer the exposure, higher the levels of biotransformation enzymes and DNA damage were produced. In both gill and the liver, BaP exposure generated dose-dependent EROD induction and DNA damages, with such a response being more linear in the case of liver than gill. BaP toxicity exacerbated the neurotoxicity by inhibiting acetylcholinesterase (AChE) activity and serotonin levels in the brain and this response was dose-dependent. Neuroendocrine system and biotransformation enzyme have a negative correlation. Results of the correlation and regression data suggest the reduction of endocrine marker might be attributed to the activation of biotransformation enzymes. These findings showed that BaP exposure can harm the gills and liver by inducing the biotransfomation enzyme and causing DNA damage, and so inhibiting neurotransmitters in the brain. These findings are predicted to give fresh insight on the research of the ecotoxicology effect of PAHs on estuarine fish.

Introduction: Pregnant women worry about their physical changes, child delivery and impending parenthood. Wide range of psychological, biological and social factors influence emotional wellbeing during pregnancy which can be described by the extent of birth anxiety, self-efficacy and psychosocial adaptations. The factors like coping and self-efficacy help to overcome the stress and provide better birth satisfaction resulting in good mother and infant bonding. Aim: To know stress levels among low-risk pregnant women and to assess the influence of coping and self-efficacy of these women on birth satisfaction after delivery. Materials and Methods: A prospective, cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College, Thrissur, Kerala, India, from January 2019 to June 2019. Total 188 pregnant women who reached term and without any known risk factors in the current pregnancy were enrolled. Data was collected using proforma and questionnaires by conducting semi-structured interview to measure pregnancy specific stress, coping, self-efficacy and birth satisfaction. Data was analysed using Statistical Package for the Social Sciences (SPSS) software version 16.0. Multiple regression analysis was used for analysing the influence of stress, coping and self-efficacy on birth satisfaction. Results: Study showed that 14.36% of women had high levels of stress. Antenatal women residing at rural areas had high levels of stress than their urban counterparts (p-value=0.004). Employed women had high levels of self-efficacy (p-value=0.038). significant negative correlation was seen between the stress and self-efficacy (r-value=-0.479, p-value

The effects of climate change on at-risk species will depend on how life history processes respond to climate and whether the seasonal timing of local climate changes overlaps with species-specific windows of climate sensitivity. For long-lived, iteroparous species like gopher tortoises Gopherus polyphemus, climate likely has a greater influence on reproduction than on adult survival. Our objective was to estimate the timing, magnitude, and direction of climate-driven effects on gopher tortoise reproductive output using a 25 yr dataset collected in southeastern Georgia, USA, near the northern edge of the species’ range. We assessed the timing of climate effects on reproductive output (both probability of reproduction and clutch size) by fitting models with climate covariates (maximum temperature, precipitation, and temperature range) summarized at all possible time intervals (in 1 mo increments) within the 24 mo period prior to the summer census date. We then fit a final model of reproductive output as a function of the identified climate variables and time windows using a Bayesian mixture model. Probability of reproduction was positively correlated with the prior year’s April-May maximum temperature, and clutch size was positively correlated with the prior year’s June maximum temperature. April-May and June maximum temperatures have increased over the past 3 decades at the study site, which likely led to an increase in clutch size of approximately 1 egg (15% increase over a mean of 6.5 eggs). However, the net effect of climate change on gopher tortoise population dynamics will depend on whether there are opposing or reinforcing climate responses for other demographic rates.

Annona cultivar ‘Arka Sahan’, an inter-specific hybrid of Annona atemoya × A. squamosacomes to harvest during August-September under mild tropical climate, which coincides with monsoon rains resulting in poor fruit quality and high susceptibility to anthracnose and fruit fly. An attempt was made to advance the fruiting in this hybrid through pruning during 2016- 17 and 2017-18. The effect of three pruning levels (25, 50 and 75% of previous season’s growth) at five different times (60, 75, 90, 105 and 120 days after final harvest of previous crop) on flowering and fruiting were compared. Early sprouting, flowering and fruit harvest were recorded in trees pruned to 75% of the past season’s growth in both the years. Earliest fruits were harvested 271 (3rd week of June) and 268 (2nd week of June) days after pruning in trees pruned during first week of October in 2016-17 and 2017-18 respectively (P

Introduction: Subarachnoid block remains the anaesthesia modality of choice for surgical fixation of femur. Extreme fracture pain makes ideal positioning for spinal anaesthesia difficult. Preoperative continuous femoral block can provide analgesia for such patients. Aim: To evaluate the effect of continuous femoral nerve block in ease of administration of spinal anaesthesia for fracture neck of femur stabilisation. Materials and Methods: This was a prospective case-control study conducted at the Government Medical College, Kozhikode, Kerala, India, from September 2020 to September 2021. Total of 86 adult patients posted for fracture femur neck stabilisation were selected and divided into two groups- group 1 and group 2. Patients in group 1, were administered ultrasound guided continuous femoral nerve block with 0.2% ropivacaine (15 mL) followed by subarachnoid block and group 2 patients were administered subarachnoid block without prior femoral nerve block. Parameters observed included were Visual Analogue Score (VAS) score while positioning for spinal anaesthesia, ease of palpating interspinous space, time required to perform spinal anaesthesia, number of attempts required to achieve dural puncture, patient satisfaction score as well as haemodynamic and respiratory changes while positioning for subarachnoid block. Statistical analysis was done using IBM SPSS (Statistical Package for the Social Sciences) Statistics for Windows, version 20.0. Results: Group 1 patients had significantly lower VAS scores while positioning for spinal anaesthesia (4.2±1.8 in group 1 as compared to 6.3±1.2 in group 2, p-value=0.001). There was a significant difference in the number of attempts required for dural puncture (1.3±0.4 in group 1 as compared to 1.8±0.6 in group 2, p-value=0.04) and total performance time for spinal anaesthesia (2.2±0.4 min in group 1 as compared to 3.3±0.9 minutes in group 2, p-value=0.02) between two groups. Patient satisfaction scores were significantly higher in group 1 compared to group 2 (9.3±0.6 in group 1 as compared to 6.5±0.5, p-value

Introduction: Hidradenitis Suppurativa (HS) is a chronic socially debilitating disorder of unknown aetiology. Surgical treatments include simple incision and drainage; excision followed by healing by secondary intention or split-skin grafting and the more recent method of excision followed by local flap reconstructions. In this study, the use of a lateral thoracic fasciocutaneous island flap based on vessels arising from the thoracodorsal or thoracic lateral vessels is described. Aim: To describe the benefit and outcomes of lateral thoracic flap reconstruction technique in treatment of axillary HS. Materials and Methods: This prospective interventional study was conducted at the Plastic Surgery Department at Amala Institute of Medical Sciences, Thrissur, Kerala, India (tertiary care center), from January 2017 to June 2018. The study included 36 patients with chronic axillary hidradenitis, who underwent lateral thoracic flap surgery on one or both axillae. These patients were studied closely preoperatively during surgery and during postoperative follow-up period. The basic demographic details, clinical parameters and Hurley stage; along with postoperative outcomes were recorded. Data was summarised using descriptive statistics. Results: The study sample consisted of 36 patients with a mean age of 38.33±13.11 years. There were 20 females and 16 males. Total 11 patients were having co-morbidities in the form of type 2 diabetes mellitus or hypertension. The mean duration of illness was 3.17±1.44 years. Six patients had bilateral axilla involvement and underwent bilateral axillary reconstructions. Out of these 36 patients; 30 patients only had antibiotic treatment previously and five patients underwent excision of affected axillary skin previously without flaps; one patient was treatment naïve. Total 24 patients were Hurley stage 2 and 12 were stage 3. These patients were taken up for repair with a lateral thoracic flap. The mean postoperative hospitalisation was six days. There was no impairment of shoulder movement in the early or late postoperative period. There were no surgical complications in terms of vessel damage or flap viability. All flaps healed without complications and there was no recurrence of disease or scar contracture during the follow-up period. Conclusion: Lateral thoracic flap reconstruction for axillary HS is without doubt the strategy for treating axillary HS due to its lower recurrence rates.

Objectives To assess the feasibility of delivering a culturally tailored pulmonary rehabilitation (PR) programme and conducting a definitive randomised controlled trial (RCT).Design A two-arm, randomised feasibility trial with a mixed-methods process evaluation.Setting Secondary care setting in Georgia, Europe.Participants People with symptomatic spirometry-confirmed chronic obstructive pulmonary disease recruited from primary and secondary care.Interventions Participants were randomised in a 1:1 ratio to a control group or intervention comprising 16 twice-weekly group PR sessions tailored to the Georgian setting.Primary and secondary outcome measures Feasibility of the intervention and RCT were assessed according to: study recruitment, consent and follow-up, intervention fidelity, adherence and acceptability, using questionnaires and measurements at baseline, programme end and 6 months, and through qualitative interviews.Results The study recruited 60 participants (as planned): 54 (90%) were male, 10 (17%) had a forced expiratory volume in 1 second of ≤50% predicted. The mean MRC Dyspnoea Score was 3.3 (SD 0.5), and mean St George’s Respiratory Questionnaire (SGRQ) 50.9 (SD 17.6). The rehabilitation specialists delivered the PR with fidelity. Thirteen (43.0%) participants attended at least 75% of the 16 planned sessions. Participants and rehabilitation specialists in the qualitative interviews reported that the programme was acceptable, but dropout rates were high in participants who lived outside Tbilisi and had to travel large distances. Outcome data were collected on 63.3% participants at 8 weeks and 88.0% participants at 6 months. Mean change in SGRQ total was −24.9 (95% CI −40.3 to –9.6) at programme end and −4.4 (95% CI −12.3 to 3.4) at 6 months follow-up for the intervention group and −0.5 (95% CI −8.1 to 7.0) and −8.1 (95% CI −16.5 to 0.3) for the usual care group at programme end and 6 months, respectively.Conclusions It was feasible to deliver the tailored PR intervention. Approaches to improve uptake and adherence warrant further research.Trial registration number ISRCTN16184185.

The aim of this study was to evaluate the cytotoxicity of the prepared Gold Nanoparticles from Triphala Plant extract and of the indigenous mouthwash prepared from these Triphala based gold nanoparticles (AuNP’s) using Artemia salina test. Its objective was to assess whether the prepared mouthwash was safe and biocompatible to use as an alternative to commercial mouthwashes in orthodontic patients to reduce the plaque load around brackets and bands as an adjuvant to tooth brushing. 15 g of brine shrimps was hatched in salt solution after incubating them for 24 – h. Prepared AuNP’s at concentrations 0µL (microliter), 5µL, 10µL, 20µL, 30µL, 50µL were added using a micropipette in one of the microtiter plates and mouthwash prepared from these AuNP’s were added at concentrations 0µL, 10µL, 20µL, 30µL, 40µL, 50µL in another microtiter plate. 10 Hatched nauplii (brine shrimps) were added in each of these microtiter plates and incubated for 24 – h. All nauplii were alive at the end of 24 – h in the microtiter plate containing AuNP’s. At concentrations 0µL, 10µL, 20µL, 30µL nauplii were alive and at 40µL, 50µL concentrations no nauplii were alive at the end of 24 – h in the microtiter plate containing mouthwash. Triphala mediated AuNP’s showed no toxic effect on the brine shrimps. AuNP’s based mouthwash showed excellent compatibility at lower concentrations. Mild toxic effects were elicited at higher concentrations. Hence, AuNP’s could be used to prepare mouthwashes at 20- 30 µL concentrations.

Basmati rice is known for its extra-long slender grains, exceptional kernel dimensions after cooking, high volume expansion, and strong aroma. Developing high yielding Basmati rice varieties with good cooking quality is a gigantic task. Therefore, identifying the genomic regions governing the grain and cooked kernel dimension traits is of utmost importance for its use in marker-assisted breeding. Although several QTLs governing grain dimension traits have been reported, limited attempts have been made to map QTLs for grain and cooked kernel dimension traits of Basmati rice. In the current study, a population of recombinant inbred lines (RIL) was generated from a cross of Sonasal and Pusa Basmati 1121 (PB1121). In the RIL population, there was a significant positive correlation among the length (RRL: rough rice length, MRL: milled rice length, CKL: cooked kernel length) and breadth (RRB: rough rice breadth, MRB: milled rice breadth and CKB: cooked kernel breadth) of the related traits, while there was significant negative correlation between them. QTL mapping has led to the identification of four major genomic regions governing MRL and CKL. Two QTLs co-localize with the earlier reported major gene GS3 and a QTL qGRL7.1, while the remaining two QTLs viz., qCKL3.2 (qMRL3.2) and qCKL4.1 (qMRL4.1) were novel. The QTL qCKL3.2 has been bracketed to a genomic region of 0.78 Mb between the markers RM15247 and RM15281. Annotation of this region identified 18 gene models, of which the genes predicted to encode pentatricopeptides and brassinosteroid insensitive 1-associated receptor kinase 1 precursor may be the putative candidate genes. Furthermore, we identified a novel QTL qKER2.1 governing kernel elongation ratio (KER) in Basmati rice.

Introduction: Tymanoplasty, a middle ear surgery, is done either under Local Anaesthesia (LA), General Anaesthesia (GA) or sedation with local anaesthesia. It is usually performed under Monitored Anesthesia Care (MAC) providing advantages of rapid onset, allowing hearing test intraoperatively and early mobilisation of the patient. Aim: To study the effect of nalbuphine/dexmedetomidine with nalbuphine/propofol on sedation and analgesia in tympanoplasties performed under MAC. Materials and Methods: This randomised, double-blind, clinical study was conducted from June 2020 to June 2021 in the Department of Anaesthesiology at Mahatma Gandhi Memorial Medical College and MY Hospital, Indore, Madhya Pradesh, India. Total 60 adult patients, of American Society of Anesthesiologists (ASA) grade I and II undergoing tympanoplasty under MAC, were randomly allocated into two groups. All patients received injection nalbuphine 50 μg/kg intravenously (i.v.). Group D received a bolus dose of injection dexmedetomidine 1 μg/kg i.v. over 10 min followed by an infusion at 0.3 μg/kg/h i.v. Group P received a bolus dose of injection propofol 0.75 mg/kg followed by an infusion at 0.025 mg/kg/min i.v. Sedation and analgesia were titrated to Ramsay Sedation Score (RSS) and Visual Analog Scale (VAS) of 3 each. The vital parameters and need for intraoperative rescue sedation/analgesia were recorded and compared. Results: Mean RSS was significantly more in group D (3.11±0.055) than group P (2.80±0.350). Overall, VAS score was significantly less in group D (1.60±0.670) than group P (2.70±0.691). In group D, 2 (6%) patients and in group P, 4 (12%) patients required inj. midazolam. Similarly, the requirement of inj. paracetamol in group D was in 3 (10%) patients, and in group P, it was 10 (33%) patients. Bradycardia (23.3% in group D and 13.3% in group P) and hypotension (20% in group D and 13.3% in group P) were the major side effects seen in the study. Conclusion: The present study concludes that, Nalbuphine/dexmedetomidine is superior to nalbuphine/propofol in producing sedation and decreasing VAS in patients undergoing tympanoplasty under MAC.

Background: Effective communication is a key feature of optimal doctor-patient relationship. As the postgraduate curriculum lacks standardized teaching and assessment, this study aimed to assess effectiveness of training program on communication skills of postgraduate medical students. Materials and methods: A prospective interventional study was conducted among first year postgraduate medical students from different clinical specialty. Training program included introduction to principles of communication with basics of doctor-patient relationship, administering informed consent, breaking bad news and counselling patients with HIV/cancer. Pre-test and post-test skill assessment by Faculty and postgraduate (PG) self-rating was carried out using KEECC-A Assessment tool for seven core communication competencies. Perception of students on training program was collected via feedback questionnaire. Results: Forty-three postgraduate medical students participated. Statistically significant increase in communication skills scores post training was observed with mean post-test assessment scores of 24.26±2.94, p

Introduction: Tobacco smoking is a worldwide accepted health hazard and its effect on cardiopulmonary system is a well known fact. In a long run, it results in to gross derangements in haemodynamics and Arterial Blood Gases (ABG) which can lead to further complications during general anaesthesia. Aim: To evaluate the effect of smoking on cardiopulmonary system and also to compare its effects on haemodynamics and ABG during general anaesthesia for abdominal surgeries in smokers and non smokers. Materials and Methods: This prospective observational analytical study was conducted in the Department of Anaesthesiology, Mahatma Gandhi Memorial Medical Colledge, Indore, Madhya Pradesh, India, from May 2020 to April 2021. The study included 74 male patients of American Society of Anaesthesiologist (ASA) grade I and II, aged 20-70 years, undergoing elective abdominal surgeries. The patients were divided into two groups, smokers and non smokers, depending on their smoking status. Haemodynamic monitoring was done from preinduction time till 48 hours after extubation and ABG analysis was also done before induction and two hours after extubation in both the groups. T-test and Mann-whitney test were applied according to the requirement. A p-value

Tungsten is incorporated in many industrial goods, military applications and medical devices due to its ability to impart flexibility, strength and conductance to materials. Emerging evidence has questioned the safety of tungsten exposure as studies have demonstrated it can promote tumour formation, induce pulmonary disease and alter immune function. Although tungsten is excreted from the body it can accumulate in certain organs such as the brain, colon, liver, kidneys, spleen and bones, where most of the bioaccumulation occurs. Whether prolonged tungsten exposure leads to accumulation in other tissues is unknown. The present study demonstrated that mice exposed to 15 ppm sodium tungstate for 4 weeks in their drinking water showed comparable accumulation in both the bony vertebrae and intervertebral discs (IVDs). Lumbar IVD height was significantly reduced in tungsten-exposed mice and accompanied by decreased proteoglycan content and increased fibrosis. In addition to catabolic enzymes, tungsten also increased the expression of the inflammatory cytokines IL-1β and tumour necrosis factor (TNF)-α as well as the neurotrophic factors nerve growth factor (NGF) and brain-derived nerve factor (BDNF) in IVD cells. Tungsten significantly increased the presence of nociceptive neurons at the endplates of IVDs as observed by the expression of calcitonin gene-related peptide (CGRP) and anti-protein gene product 9.5 (PGP9.5) in endplate vessels. The present study provided evidence that tungsten may enhance disc degeneration and fibrosis as well as increase the expression of markers for pain. Therefore, tungsten toxicity may play a role in disc degeneration disease.

Bioactive glasses (BAG) are used as bone-graft substitutes in orthopaedic surgery. A specific BAG scaffold was developed by sintering BAG-S53P4 granules. It is hypothesised that this scaffold can be used as a bone substitute to fill bone defects and induce a bioactive membrane (IM) around the defect site. Beyond providing the scaffold increased mechanical strength, that the initial inflammatory reaction and subsequent IM formation can be enhanced by coating the scaffolds with poly(DL-lactide-co-glycolide) (PLGA) is also hypothesised. To study the immunomodulatory effects, BAG-S53P4 (± PLGA) scaffolds were placed on monolayers of primary human macrophage cultures and the production of various pro- and anti-inflammatory cytokines was assessed using reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) and ELISA. To study the osteogenic effects, BAG-S53P4 (± PLGA) scaffolds were cultured with rabbit mesenchymal stem cells and osteogenic differentiation was evaluated by RT-qPCR and matrix mineralisation assays. The scaffold ion release was quantified and the BAG surface reactivity visualised. Furthermore, the pH of culture media was measured. BAG-S53P4 scaffolds had both anti-inflammatory and osteogenic properties that were likely attributable to alkalinisation of the media and ion release from the scaffold. pH change, ion release, and immunomodulatory properties of the scaffold could be modulated by the PLGA coating. Contrary to the hypothesis, the coating functioned by attenuating the BAG surface reactions and subsequent anti-inflammatory properties, rather than inducing an elevated inflammatory response compared to BAG-S53P4 alone. These results further validated the use of BAG-S53P4 (± PLGA) scaffolds as bone substitutes and indicate that scaffold properties can be tailored to a specific clinical need.

Introduction: The Supraglottic Airway Devices (SAD) are bridges between a face mask and Endotracheal Tubes (ETT). Various induction agents like sevoflurane and propofol were used till date for smooth insertion. Propofol causes dose-dependent cardiorespiratory depression while opioids may increase the haemodynamic instability. Aim: To investigate the role of dexmedetomidine and fentanyl as co-induction agents to propofol for Proseal Laryngeal Mask Airway (PLMA) insertion conditions. Materials and Methods: The present study was a randomised clinical study in which 60 patients of American Society of Anaesthesiologists (ASA) grade I-II, 20-60 years of age were divided into two groups. Group P+D received 2.5 mg/kg propofol+1 μg/kg dexmedetomidine while Group P+F received 2.5 mg/kg propofol+1 μg/kg fentanyl. A Bispectral Index (BIS) value of 50-45 was taken as desired end point for insertion of PLMA. Induction time, insertion time, ease of insertion, number of attempts, total propofol requirement and various haemodynamic changes were taken into consideration. Results: Mean induction time with dexmedetomidine (8.28±0.81 min) was lower as compared to that with fentanyl (9.28±0.83 min) (p

PurposePrevious studies have demonstrated that radiologists and other providers perceive maging to be higher than they actually are. Thus, pregnant patients were less likely to receive ionizing radiation procedures. While it is imperative to minimize fetal radiation exposure, clinicians must remember that diagnostic studies should not be avoided due to fear of radiation, particularly if the imaging study can significantly impact patient care. Although guidelines do exist regarding how best to image pregnant patients, many providers are unaware of these guidelines and thus lack confidence when making imaging decisions for pregnant patients. This study aimed to gather information about current education, confidence in, and knowledge about emergency imaging of pregnant women among radiology, emergency medicine, and OB/GYN providers.MethodsWe created and distributed an anonymous survey to radiology, emergency medicine, and OB/GYN providers to evaluate their knowledge and confidence in imaging pregnant patients in the emergent setting. This study included a questionnaire with the intent of knowing the correct answers among physicians primarily across the United States (along with some international participation). We conducted subgroup analyses, comparing variables by specialty, radiology subspecialty, and training levels. Based on the survey results, we subsequently developed educational training videos.Results108 radiologists, of which 32 self-identified as emergency radiologists, ten emergency medicine providers and six OB/GYN clinicians completed the survey. The overall correct response rate was 68.5%, though performance across questions was highly variable. Within our 18-question survey, four questions had a correct response rate under 50%, while five questions had correct response rates over 90%. Most responding physicians identified themselves as either "fairly" (58/124, 47%) or "very" (51/124, 41%) confident. Amongst specialties, there were differences in performance concerning the knowledge assessment (p = 0.049), with the strongest performance from radiologists. There were no differences in knowledge by training level (p = 0.4), though confidence levels differed significantly between attending physicians and trainees (p

Background: Chronic obstructive pulmonary disease is a major contributor to morbidity, mortality and health service costs but is vastly underdiagnosed. Evidence on screening and how best to approach this is not clear. There are also uncertainties around the natural history (prognosis) of chronic obstructive pulmonary disease and how it impacts on work performance. Objectives: Work package 1: to evaluate alternative methods of screening for undiagnosed chronic obstructive pulmonary disease in primary care, with clinical effectiveness and cost-effectiveness analyses and an economic model of a routine screening programme. Work package 2: to recruit a primary care chronic obstructive pulmonary disease cohort, develop a prognostic model [Birmingham Lung Improvement StudieS (BLISS)] to predict risk of respiratory hospital admissions, validate an existing model to predict mortality risk, address some uncertainties about natural history and explore the potential for a home exercise intervention. Work package 3: to identify which factors are associated with employment, absenteeism, presenteeism (working while unwell) and evaluate the feasibility of offering formal occupational health assessment to improve work performance. Design: Work package 1: a cluster randomised controlled trial with household-level randomised comparison of two alternative case-finding approaches in the intervention arm. Work package 2: cohort study – focus groups. Work package 3: subcohort – feasibility study. Setting: Primary care settings in West Midlands, UK. Participants: Work package 1: 74,818 people who have smoked aged 40–79 years without a previous chronic obstructive pulmonary disease diagnosis from 54 general practices. Work package 2: 741 patients with previously diagnosed chronic obstructive pulmonary disease from 71 practices and participants from the work package 1 randomised controlled trial. Twenty-six patients took part in focus groups. Work package 3: occupational subcohort with 248 patients in paid employment at baseline. Thirty-five patients took part in an occupational health intervention feasibility study. Interventions: Work package 1: targeted case-finding – symptom screening questionnaire, administered opportunistically or additionally by post, followed by diagnostic post-bronchodilator spirometry. The comparator was routine care. Work package 2: twenty-three candidate variables selected from literature and expert reviews. Work package 3: sociodemographic, clinical and occupational characteristics; occupational health assessment and recommendations. Main outcome measures: Work package 1: yield (screen-detected chronic obstructive pulmonary disease) and cost-effectiveness of case-finding; effectiveness of screening on respiratory hospitalisation and mortality after approximately 4 years. Work package 2: respiratory hospitalisation within 2 years, and barriers to and facilitators of physical activity. Work package 3: work performance – feasibility and acceptability of the occupational health intervention and study processes. Results: Work package 1: targeted case-finding resulted in greater yield of previously undiagnosed chronic obstructive pulmonary disease than routine care at 1 year [n = 1278 (4%) vs. n = 337 (1%), respectively; adjusted odds ratio 7.45, 95% confidence interval 4.80 to 11.55], and a model-based estimate of a regular screening programme suggested an incremental cost-effectiveness ratio of £16,596 per additional quality-adjusted life-year gained. However, long-term follow-up of the trial showed that at ≈4 years there was no clear evidence that case-finding, compared with routine practice, was effective in reducing respiratory admissions (adjusted hazard ratio 1.04, 95% confidence interval 0.73 to1.47) or mortality (hazard ratio 1.15, 95% confidence interval 0.82 to 1.61). Work package 2: 2305 patients, comprising 1564 with previously diagnosed chronic obstructive pulmonary disease and 741 work package 1 participants (330 with and 411 without obstruction), were recruited. The BLISS prognostic model among cohort participants with confirmed airflow obstruction (n = 1894) included 6 of 23 candidate variables (i.e. age, Chronic Obstructive Pulmonary Disease Assessment Test score, 12-month respiratory admissions, body mass index, diabetes and forced expiratory volume in 1 second percentage predicted). After internal validation and adjustment (uniform shrinkage factor 0.87, 95% confidence interval 0.72 to 1.02), the model discriminated well in predicting 2-year respiratory hospital admissions (c-statistic 0.75, 95% confidence interval 0.72 to 0.79). In focus groups, physical activity engagement was related to self-efficacy and symptom severity. Work package 3: in the occupational subcohort, increasing dyspnoea and exposure to inhaled irritants were associated with lower work productivity at baseline. Longitudinally, increasing exacerbations and worsening symptoms, but not a decline in airflow obstruction, were associated with absenteeism and presenteeism. The acceptability of the occupational health intervention was low, leading to low uptake and low implementation of recommendations and making a full trial unfeasible. Limitations: Work package 1: even with the most intensive approach, only 38% of patients responded to the case-finding invitation. Management of case-found patients with chronic obstructive pulmonary disease in primary care was generally poor, limiting interpretation of the long-term effectiveness of case-finding on clinical outcomes. Work package 2: the components of the BLISS model may not always be routinely available and calculation of the score requires a computerised system. Work package 3: relatively few cohort participants were in paid employment at baseline, limiting the interpretation of predictors of lower work productivity. Conclusions: This programme has addressed some of the major uncertainties around screening for undiagnosed chronic obstructive pulmonary disease and has resulted in the development of a novel, accurate model for predicting respiratory hospitalisation in people with chronic obstructive pulmonary disease and the inception of a primary care chronic obstructive pulmonary disease cohort for longer-term follow-up. We have also identified factors that may affect work productivity in people with chronic obstructive pulmonary disease as potential targets for future intervention. Future work: We plan to obtain data for longer-term follow-up of trial participants at 10 years. The BLISS model needs to be externally validated. Our primary care chronic obstructive pulmonary disease cohort is a unique resource for addressing further questions to better understand the prognosis of chronic obstructive pulmonary disease. Trial registration: Current Controlled Trials ISRCTN14930255. Funding: This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 13. See the NIHR Journals Library website for further project information.

Resumo: A estratégia de prevenção e de identificação precoce das reações transfusionais no cuidado direto da equipe de enfermagem deve garantir segurança transfusional durante e após o processo de transfusão.1,2 A equipe de enfermagem deve estar capacitada para atuar no processo transfusional de forma a reconhecer sinais e sintomas de uma possível reação transfusional, evitando desfechos desfavoráveis.3 Objetivo: Descrever o processo de elaboração de um vídeo como tecnologia educativa (TE) com as melhores evidências científicas nas reações transfusionais imediatas (RTI) para uso em Educação Permanente na Enfermagem. Método: Trata-se de um estudo metodológico. A construção do vídeo foi realizada em quatro etapas: 1) Revisão integrativa de literatura para busca de evidências científicas por meio da questão de pesquisa: Quais as recomendações para a elaboração de uma tecnologia educativa na assistência de enfermagem nas RTI? 2) Identificou-se:conceito,sinais e sintomas, eventos adversos, fatores de risco, estratégias de prevenção, tratamento padrão e assistência de enfermagem; 3) Produção do roteiro do conteúdo do vídeo, seleção das imagens e sons; 4) Desenvolvimento do vídeo com as recomendações sobre RT e Validação por 6 profissionais com expertise em hemoterapia que utilizaram o Instrumento de Validação de Conteúdo Educativo em Saúde (IVCES). Resultados: A busca resultou em 48 artigos, sendo incluídos 11, conforme percurso metodológico. Evidenciou-se nos estudos os principais sinais e sintomas nas RTI são: febre, tremores, calafrios, náuseas, dispneia, dor lombar, prurido, tosse, placas eritematos ase alterações de sinais vitais. Quanto ao manejo assistencial de enfermagem, destaca-se: verificar a prescrição médica, o paciente certo, o tipo de sangue, Rh, os sinais vitais,orientar o paciente sobre sinais e sintomas de reação á transfusão, regular o gotejamento e registrar o tempo de infusão Discussão: O conhecimento cientifico baseado em evidências e a habilidade profissional da equipe de enfermagem, em especial aspectos da prática clínica como: observar tempo de infusão e avaliação clínica do receptor, garantem a qualidade do processo e minimizam os riscos para o receptor. Conclusão: O vídeo apresenta o desenvolvimento do processo transfusional, destacando as RT como uma produção que agrega conhecimento científico, pois foi elaborado na perspectiva da enfermagem baseada em evidências. Seu uso pode corroborar e potencializar os serviços de educação permanente das organizações de saúde que atuam diretamente em hemoterapia, promovendo a prática assistencial de enfermagem qualificada. Palavras-chave: Reações transfusionais; Prática assistencial de enfermagem; Tecnologia educativa.

The phenological studies of tree species is a potential tool to develop a keen observation for monitoring the gradual impact of climate change on biology of trees, manifested through variation in timing and duration of different phenological events in their life cycle. The documentation of these phenological growth stages reflect upon the implications for their responsiveness to seasonal variation in climate and potential utilization for the benefit of mankind. Pertaining to the immense significance of phenology, a study was conducted to document different growth and developmental stages in Moringa oleifera Lam. referencing to the BBCH scale (Biologische Bundesantalt, Bundessortenamt und Chemische Industrie), supplementing with significant Landmark stages (developed by the authors) under the subtropical conditions of Punjab state, India. The observation and the analysis of the growth stages in M. oleifera depicted asynchronous growth patterns exhibiting juvenile, vegetative and reproductive developmental stages within an individual tree canopy. These phenophases appeared simultaneously and were designated numerical values corresponding to principle growth stages (0–9) and secondary sub-stages (0–9) reflecting their relative intensity of occurrence. The novel landmark scale proposed for M. oleifera, defines the optimum stage(s) for its utilization such as tender leaves for culinary purpose; mature leaves for processing for manufacturing of fortified food products and herbal medicines; and immature pods for utilization in culinary preparations. The landmark stages proposed in M. oleifera reflect its immense significance for introducing as an edible tree species in Urban Food Forests as a source of nutrition besides offering other multi-functionalities of ecological, landscaping, esthetic and spiritual aspects.

Most mammals exhibit natal dispersal of one or both sexes, a behavior that likely evolved in part to reduce the chances of breeding with close relatives. When natal social group fidelity of both sexes has been documented, the risk of inbreeding is reduced by breeding among rather than within social groups. We investigated mating patterns in an endangered population of false killer whales Pseudorca crassidens from the main Hawaiian Islands (USA) using both genetic and photo-identification data. We tested the presence of the 2 most commonly observed inbreeding avoidance behaviors, i.e. natal dispersal and exogamy (mating occurring primarily among individuals from different social groups). Because not all mother-offspring pairs or individual ages were known prior to this study, we used re-sighting histories to determine plausible ranges of birth year for individuals, thereby limiting the pool of candidate parents and increasing analytical power. We identified 32 parent-offspring pairs, revealing strong natal social group fidelity for both sexes. Our results indicate that between 36 and 64% of matings involved individuals from the same social group. Because the population declined from over 400 to around 150 individuals between the 1980s and early 2000s, the intra-group matings may be the result of reduced opportunities for inter-group mating since the decline. Prior to the decline, social groups may have been sufficiently large that selective pressure to develop inbreeding avoidance mechanisms was low, or the population may have evolved alternate inbreeding avoidance mechanisms such as kin recognition.

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The use of illicit drugs in recent times in modern sport has become an issue of growing concern. This study assessed the factors responsible for the use of illicit drugs by medical students in sports in Delta State University Abraka The target population included five departments in the Faculty of Basic Medical Sciences of Delta State University Abraka. A cross-sectional survey design was conducted among 1,436 medical student athletes of the College of Health Sciences of Delta State University Abraka and random sampling technique was used to select a sample size of 143 respondents. A researcher-made confidential questionnaire was the instrument used for the collection of data. A coefficient index score (r) of 0.78 was obtained which ascertained the internal consistency of the instrument was reliable. A total of 120 questionnaires were successfully retrieved and used for data analysis. Mean score and Pearson Product Moment Correlation were adopted as statistical tools for analyzing the obtained data. There was significant (p0.05) relationship between the gender of the students and their knowledge of illicit drugs used in sports. Similarly, there was no significant (p>0.05) relationship between type of school of medical students and knowledge of illicit drugs used in sports. Findings from the study further equally revealed that there was no significant (p>0.05) relationship between parental background and medical students’ knowledge of use of illicit drugs in sports. Based on the findings of this study, it is obvious age was supported to determine the use of illicit drugs in sports by medical in sports, hence, the need for stringent policies to be censored especially towards the age requirement for medical student participation while adopting adequate measures to curtail the use of illicit drug among medical students. Keywords: Illicit drugs, Sports, Gender, Age, Medical students

Vibriosis is regarded as an important disease of penaeid shrimps affecting larvae in hatcheries. Among the Vibrio species, Vibrio parahaemolyticus, Vibrio vulnificus, Vibrio furnissii, Vibrio campbellii, Vibrio harveyi, Vibrio alginolyticus , and Vibrio anguillarum are often associated with diseases in finfish and shellfish of brackishwater ecosystem. Accurate species differentiating methods for the organisms present in an ecosystem are required for precise classification of the species and to take steps for their management. Conventional methods like 16s rRNA phylogeny and multilocus sequence typing (MLST) have often failed to correctly identify Vibrio species. This has necessitated a comprehensive investigation on methodologies available to distinguish Vibrio species associated with brackishwater aquaculture system. To achieve this, 35 whole genomes belonging to 7 Vibrio species were subjected to phylogenetic analysis based on 16s rRNA gene, MLST genes, single-copy orthologous genes, and single-nucleotide polymorphisms. In addition, genome-based similarity indices like average nucleotide identity (ANI) and in silico DNA-DNA hybridization (DDH) were computed as confirmatory tests to verify the phylogenetic relations. There were some misclassifications occurred regarding phylogenetic relations based on 16s rRNA genes and MLST genes, while phylogeny with single-copy orthologous genes produced accurate species-level clustering. Study reveals that the species identification based on whole genome-based estimates or genome-wide variants are more precise than the ones done with single or subset of genes.

Introduction: The growing impact of fragility hip fracture (FHF) on the healthcare system and the society has become a major concern worldwide. A unified multidisciplinary FHF pathway from admission to rehabilitation and back to community was established in 2015. The acute phase of the pathway was put into pilot in our hospital to evaluate the outcome. Method: A designated FHF team was established in our centre since January 2015. The FHF pathway was piloted since June 2015. Patients admitted with a hip fracture resulting from fall on standing height were included. Major outcome parameters were compared in three phases: (1) before FHF team and FHF pathway (January to December 2014), (2) after FHF team but before FHF pathway (January to May 2015) and (3) after FHF team and FHF pathway (June 2015 to May 2016). Result: In phases 1, 2 and 3, 631, 263 and 634 patients were included, respectively. From phases 1 to 3, the average key performance indicator (KPI) has improved from 49.2% to 65.8% to 70.0% significantly; average acute length of stay (days) has improved from 13.7 to 13.4 to 11.3 significantly; total surgical complication rates have improved from 6.2% to 7.6% to 5.8%. The 30-day mortality rate and the unplanned readmission rate (within 28 days) have remained below 2.7% and 2.2%, respectively. Conclusions: Implementation of an FHF pathway can form a multidisciplinary platform that can improve the standard of care and outcome for our FHF patients in terms of KPI and also length of stay. New knowledge added by this study: A newly designed and implemented fragility hip fracture pathway in our centre as a pilot with the results evaluated. Implications for clinical practice or policy: With the increasing elderly population in Hong Kong and globally, there is a need to design and implement a fragility hip fracture (FHF) pathway to improve the care and effectiveness for FHF patients.