Spontaneous bilateral pneumothorax in a previously healthy COVID-19 patient: A case report

Coronavirus disease 2019 (COVID-19) is commonly linked with mild cough, fever, and shortness of breath symptoms. However, there have been reports of pneumothorax, which particularly occurred at least 1 week following symptom onset in elderly COVID-19 patients. Spontaneous pneumothorax (SP) is an uncommon but possibly fatal complication of COVID-19 pneumonia and is rarely reported in non-intubated patients. We report a case of a healthy, non-smoker 35-year-old young woman who presented with a 7-day cough, fever, and sudden shortness of breath. She was diagnosed with severe COVID-19 pneumonia, experienced a right SP, and developed a second pneumothorax on the contralateral side. She improved gradually following chest tube insertion in the right lung and conservative management for the left pneumothorax.

Psychosocial experiences of selected pediatric occupational therapists in the Philippines on the shift to Telehealth Practice during the COVID-19 pandemic

BACKGROUND@#At the beginning of the COVID-19 pandemic, healthcare professionals including pediatric occupational therapists (OTs) mandatorily had to shift to the practice of telehealth in the absence of a safe in- person setup caused by the outbreak.@*OBJECTIVE@#This study aims to determine the psychosocial experiences encountered by selected pediatric OTs in the Philippines brought by the shift to telehealth practice during the COVID-19 pandemic@*METHODOLOGY@#Purposive sampling was used in the study to gather six (6) licensed pediatric OTs who provide occupational therapy (OT) services via telehealth in the Philippines, and the respondents were not personally connected to any of the researchers. A semi-structured one-on-one interview with the participants through a Zoom call was conducted to obtain their psychosocial experiences. A thematic analysis was used and four (4) themes emerged by the end of the study: consequences of the shift to telehealth practice, changes during telehealth provision, increased resilience, and increased psychological strain.@*CONCLUSION@#In conclusion, the transition to provision of telehealth services to pediatric clients has challenged the practices of the selected pediatric OTs in terms of preparing for the session, where one of the main prevalent concerns was toward collaboration and communication with the caregivers; conducting of telehealth sessions, where communication interruption was one of the main concerns; and in ethical considerations, where OTs made it a point that they rectified ethical dilemmas amidst telehealth provision. These experienced challenges also included increased workload and psychological distress, while improved occupational balance and adaptability were most commonly experienced by OTs

Association of acute hyperglycemia and diabetes mellitus with Platelet-derived Microparticle (PDMP) levels during acute myocardial infarction / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#This research aims to investigate whether there is an association between acute hyperglycemia and diabetes mellitus and the amount of circulating platelet-derived microparticles (PDMPs) during acute myocardial infarction (AMI) initial episode.@*Methodology@#This was a cross-sectional study. Subjects were AMI patients underwent hospitalization. Demography and clinical data were obtained from hospital records. Diabetes mellitus was defined from history of disease, antidiabetic use and/or level of HbA1C ≥6.5%. Levels of HbA1c, admission random and fasting blood glucose levels were measured in hospital laboratory. The PDMPs was measured by flow-cytometry method, by tagging with CD-41 FITC and CD-62 PE markers and threshold size of <1 µm, from venous blood. The circulating PDMPs amount was compared according to glucometabolic state, namely acute hyperglycemia (admission random glucose ≥200 mg/dL and fasting glucose ≥140 mg/dL) and diabetes mellitus. The comparative analysis between group was conducted with Student T tests or Mann-Whitney tests, where applicable.@*Results@#A total of 108 subjects were included and their data analyzed. Circulating PDMPs amount was significantly lower in subjects with admission random glucose ≥200 mg/dL as compared to those with below level (median (interquartile range (IQR)): 2,710.0 (718.0-8,167.0) count/mL vs. 4,452.0 (2,128.5-14,499.8) count/mL, p=0.05) and in subjects with fasting glucose ≥140 mg/dL as compared to those with below level (median (IQR): 2,382.0 (779.0-6,619.0) count/mL vs. 5,972.0 (2,345.7-14,781.3) count/mL, p=0.006). Circulating PDMPs amount was also significantly lower in diabetes mellitus as compared to non diabetic (median (IQR): 2,655.0 (840.0-5,821.0) count/mL vs. 4,562.0 (2,128.5-15,055.8) count/mL; p=0.007).@*Conclusion@#Acute hyperglycemia and diabetes mellitus significantly associated with lower amount of circulating PDMPs during the initial episode of AMI.

Reducing the risks of nuclear war - the role of health professionals

@#In January, 2023, the Science and Security Board of the Bulletin of the Atomic Scientists moved the hands of the Doomsday Clock forward to 90’s before midnight, reflecting the growing risk of nuclear war.1 In August, 2022, the UN Secretary-General António Guterres warned that the world is now in “a time of nuclear danger not seen since the height of the Cold War.2 The danger has been underlined by growing tensions between many nuclear armed states.1,3 As editors of health and medical journals worldwide, we call on health professionals to alert the public and our leaders to this major danger to public health and the essential life support systems of the planet—and urge action to prevent it.

Effectiveness of Education Using Comic Media on Knowledge About Covid-19 Among Elementary School Students

@#Introduction: Children typically have a diminished capacity to comprehend the COVID-19 epidemic. To convey information about COVID-19 to elementary school students (ESS), it takes educational comic media that children like because it is “fun,” “ informative, “ and well-understood. However, the effectiveness of this intervention has yet to be thoroughly investigated. This study aimed to measure the knowledge of ESS after studying COVID-19 with comics. Methods: A pre-post quasi-experimental design with a control group was used in this study. There were 66 ESS recruited on purpose. Intervention (n = 33) and control (n = 33) groups were formed. The intervention group received COVID-19 education using comic book media. Who Will Win the Fight Between Kids, Vaayu, and Corona?, a COVID-19 Awareness Comic, was translated into Indonesian. The education was given twice every two weeks, while the standard school intervention was given to the control group. To collect data, researchers designed a questionnaire based on a literature study. The questionnaire was valid and reliable, with a Cronbach alpha of 0.71, and the results were analysed using the independent sample t-test. Results: There was a substantial difference in Knowledge towards COVID-19 ratings between the control and intervention groups (p = 0.001). The mean Knowledge towards COVID-19 score of the intervention group was higher than that of the control group (M=4.33 vs M=1.63). Knowledge about COVID-19 differed significantly between the intervention and control groups (p = 0.001). Conclusion: Comic books are effective in increasing knowledge about COVID-19 in ESS.

Development of “Moroca” as a Learning Media for Reproductive Health Services in Disaster Situations

@#Introduction: Due to its geographical, geological, and demographic conditions, Indonesia is facing the risks of natural disasters such as floods, landslides, earthquakes, and volcanic eruptions. Midwives as health workers have a strategic role as providers of reproductive health services, including in disaster situations. This study aims to develop learning media for reproductive health services in a disaster situation based on the monopoly game. Methods: The research employed research and development (R&D) design. The development of learning media for reproductive health services in disaster situations is based on the monopoly game, which consists of the following steps: seeing the potential and problems, data collection, product design, validation by experts, product trials, and product revisions. Results: The learning media is named “Moroca” (Monopoli Kesehatan Reproduksi pada Situasi Bencana / Monopoly of Reproductive Health Services in Disaster Situations). Validation was carried out by two experts and the media was declared feasible and valid for use. The product trial was conducted on 22 students of Midwifery Program. The statistical test used the Wilcoxon test. The results of the analysis showed that there was a significant increase in the level of knowledge about reproductive health services in disaster situations among students after using “Moroca”. Conclusion: Learning media is needed to increase the knowledge and skill of the students. Moroca is can be used as one of the alternative media in education for midwifery students.

Accuracy of Xpert® MTB/RIF in diagnosing extrapulmonary tuberculosis in Indian children

BACKGROUND Diagnosing extrapulmonary tuberculosis (EPTB) can be challenging because of a variety of presentations. We assessed the accuracy of the Xpert MTB/RIF assay in diagnosing EPTB in children. METHODS Of the 255 children diagnosed to have tuberculosis (TB) who underwent testing by the Xpert MTB/ RIF assay at the TB clinic from December 2014 to April 2017, 182 had EPTB and were included in the study. The diagnostic accuracy, specificity and sensitivity of the Xpert assay were calculated with Mycobacterium growth indicator tube (MGIT) as a reference standard. RESULTS Lymph node TB was present in 58 (32%) children, 37 (20%) had neurological TB, 36 (20%) had bone TB, 31 (17%) had pleural TB, 15 (8%) had abdominal TB, 2 (1%) had abscess, 2 (1%) had congenital TB and disseminated TB was seen in 1 (0.4%) child. Xpert MTB/RIF assay was positive in 84 (46.2%) patients. The sensitivity and specificity of the Xpert MTB/RIF assay were 72% and 72.04%, respectively. Compared to MGIT, a kappa coefficient of 0.44 shows moderate agreement between the Xpert assay and MGIT. The sensitivity of Xpert MTB/RIF assay in abdominal TB, bone TB, lymph node TB, neurological TB and pleural TB was 50% (15%–85%), 72.7% (15.9%– 86.9%), 80.8% (62.1%–91.5%), 75% (50.5%–90%) and 25% (4.6%–70%), respectively. The specificity of abdominal TB, bone TB, lymph node TB, neurological TB and pleural TB was 83.3% (43.7%–97%), 69.2% (42.4%– 87.3%), 55.2% (37.6%–71.6%), 85% (64%–94.8%) and 82.6% (62.9%–93%), respectively. Forty-seven (26%) patients had drug-resistant TB (DR-TB), of which 15 (8%) were rifampicin-resistant (RR), 2 (1%) were polyresistant, 14 (8%) had multi-DR (MDR), 15 (8%) had pre-extremely DR (XDR) and 1 (1%) had XDR-TB. Of the 15 patients with MDR-TB, Xpert MTB/RIF assay detected only 10 (71%) as RR (p=0.06). Of the 15 pre-XDR cases, Xpert MTB/RIF detected only 8 (53%) as RR (p=0.02). CONCLUSION Xpert MTB/RIF assay is useful in the diagnosis of EPTB. It shows good concordance with MGIT. However, it may be negative in patients with DR-TB.

Caries experience scores revisited for caries risk assessment using cariogram model – A cross-sectional study

Context: The widely accepted caries risk assessment tools such as the Cariogram model needs modifications in the scoring of different factors for reliable results. Aims: The study was aimed to report the caries experience in 3?60 years of the Rajasthan population and to apply the newly derived average decayed exfoliated filled teeth/Decayed Missing Filled Teeth (deft/DMFT) scores in the Cariogram model to assess the caries risk. Settings and Design: The cross?sectional study was planned in the Department of Dentistry and a total of 500 participants were equally divided into five groups (3?6, 7?12, 13?30, 31?44, and 45?60 years) were included. Methods and Material: All participants were examined for caries detection using deft/DMFT, ICDAS, and CAST indices according to the predefined protocol. A single examiner evaluated the participants in a dental operatory and data was recorded. Statistical Analysis Used: One?Way ANOVA and Tukey’s Post?Hoc tests were used to evaluate the significant difference between the groups of each caries index. Results: A statistically significant difference was observed between the mean deft/ DMFT and CAST scores of 3?6, 7?12, and 13?30 age groups with the 45?60 years age group. Caries prevalence was highest (83%) in 31?44 and 45?60 year age groups and lowest (51%) in the 3?6 year age group. Conclusions: Caries experience scores increase as the age increases and the highest scores were observed in 31?44 and 45?60 year age groups and the lowest were observed in the 3?6 year age group. The average ICDAS and CAST scores were higher when compared to the deft/DMFT index

β -Glucan Improves Protective Qi Status in Adults with Protective Qi Deficiency-A Randomized, Placebo-Controlled, and Double-Blinded Trial / 中国结合医学杂志

OBJECTIVE@#To test the hypothesis that β -glucan enhances protective qi (PQi), an important Chinese medicine (CM) concept which stipulates that a protective force circulates throughout the body surface and works as the first line of defense against "external pernicious influences".@*METHODS@#A total of 138 participants with PQi deficiency (PQD) were randomized to receive β -glucan (200 mg daily) or placebo for 12 weeks. Participants' PQi status was assessed every 2 weeks via conventional diagnosis and a standardized protocol from which a PQD severity and risk score was derived. Indices of participants' immune and general health status were also monitored, including upper respiratory tract infection (URTI), saliva secretory IgA (sIgA), and self-reported measures of physical and mental health (PROMIS).@*RESULTS@#PQi status was not significantly different between the β -glucan and placebo treatment groups at baseline but improved significantly in the β -glucan (vs. placebo) group in a time-dependent manner. The intergroup differences [95% confidence interval (CI)] in severity score (scale: 1-5), risk score (scale: 0-1), and proportion of PQD participants (%) at finish line was 0.49 (0.35-0.62), 0.48 (0.35-0.61), and 0.36 (0.25-0.47), respectively. Additionally, β -glucan improved URTI symptom (scale: 1-9) and PROMIS physical (scale: 16.2-67.7) and mental (scale: 21.2-67.6) scores by a magnitude (95% CI) of 1.0 (0.21-1.86), 5.7 (2.33-9.07), and 3.0 (20.37-6.37), respectively, over placebo.@*CONCLUSIONS@#β -glucan ameliorates PQi in PQD individuals. By using stringent evidence-based methodologies, our study demonstrated that Western medicine-derived remedies, such as β -glucan, can be employed to advance CM therapeutics. (ClinicalTrial.Gov registry: NCT03782974).

Risk factors of PTSD, depression and anxiety in patients with previous COVID-19 infection: A systematic review and meta-analysis / The Health Sciences Journal

INTRODUCTION@#Studies showed that those who tested positive for COVID-19 have a 65% risk for a psychiatric disorder, while those undergoing isolation or quarantine are put at risk for anxiety and depression. The objective of this study was to appraise studies that determine the risk factors for psychiatric disorder post-COVID-19 infection.@*METHODS@#All cross-sectional and cohort studies from 2019 onwards that had COVID-19 survivors that developed anxiety, depression and/or post-traumatic stress disorder (PTSD), were included. Medline, Cochrane Library and ClinicalKey were searched using MeSH terms including “COVID-19”, “depression”, “anxiety”, “post-traumatic stress disorder”, and “risk factor”. The risk of bias was assessed using the Newcastle-Ottawa scale. The data extracted from the studies were characteristics of the participants, risk factors, outcome measures and outcomes.@*RESULTS@#Four cohort and four cross-sectional studies involving 1438 COVID-19 survivors who developed depression, anxiety and/or depression were included. The risk factors that were statistically significant were 1) female sex (RR = 1.86; 95% CI 1.06, 2.04; Z = 2.32; p = 0.02) for depression, 2) having family members infected with COVID-19 (RR = 1.56; 95% CI 1.32, 1.85; Z= 5.17; p = <0.01) for depression, 3) steroid administration during hospital admission (RR = 1.62; 95% CI 1.07, 2.47; Z = 2.26; p = 0.02) for anxiety and 4) female sex (RR = 2.13; 95% CI 1.16, 3.91; Z = 2.45, p = 0.01) for PTSD.@*CONCLUSION@#Female sex increases the risk of depression and PTSD. A family history of COVID-19 increases the risk of depression. Steroid administration is a risk factor for anxiety.

Recurrence of prolapse following vaginal hysterectomy with and without vaginal vault fixation: A retrospective review

Background@#The rate of prolapse recurrence after vaginal hysterectomy ranges from 6% to 12%. Vaginal vault fixation procedures like the iliococcygeus fixation and the cul-de-sac obliteration (McCall culdoplasty) have been used to address the loss of apical support in patients with advanced-stage prolapse to prevent this recurrence. @*Objectives@#This study aims to assess the rate of prolapse recurrence and risk factors for recurrence as well as urinary, bowel, and sexual symptoms in women who have undergone vaginal hysterectomy with and without vaginal vault fixation for pelvic organ prolapse stage 2 or higher. @*Methods@#This study is a retrospective study that included patients with pelvic organ prolapse stage 2 or greater who underwent vaginal hysterectomy with and without vaginal vault fixation from 2009 to 2014 seen at the urogynecology clinic of a Philippine tertiary referral center. The cohorts were divided into those with iliococcygeal fixation (n=171) and those without (n=83). The Z test of mean difference was used in comparing average values between the two groups. Chi-square test of independence was used in comparing the proportion of patients as stratified by various variables and their corresponding groups, while some variables were adjusted for 2x2 Fischer Exact test. Any associated p-value less than 0.05 alpha were considered statistically significant. @*Results@#Of the 876 patients operated on for prolapse between 2009 to 2014, 254 were included in the study. They were divided into those with iliococcygeal fixation (n=171) and those without (n=83). Recurrence was significantly lower in the group who underwent iliococcygeal fixation (23.39% vs 36.14%, p=0.037) after a median follow-up of 28.98 months for those with fixation and 31.08 for those without. The posterior compartment prolapse recurrence rate is higher in those without fixation (16.87% vs 6.43%, p=0.013). Longer duration of menopause (16.96 ± 7.16 vs 13.37 ± 7.1, p=0.001), unemployment (52.85% vs 36.41%, p=0.22) and longer time from surgery (37.84 ± 15.69 vs 26.55 ± 12.59, p=0.000) were significantly associated with recurrence. Moreover, higher pre- (6.24 ± 1.41 vs 5.78 ± 0.95, p=0.003) and post-operative genital hiatus (4.53 ± 0.97 vs 4.23 ± 0.54, p=0.002) and shorter pre-operative perineal body (1.86 ± 0.35 vs 1.97 ± 0.35, p=0.025) measurements were also significantly associated with recurrence. Both groups have no significant difference in urinary, sexual or bowel symptoms. @*Conclusion@#Iliococcygeus fixation is an effective method of preventing prolapse recurrence. Increased duration of menopause, longer time from surgery, longer genital hiatus, and shorter perineal body all contribute to recurrence. Moreover, urinary, sexual and bowel symptoms do not differ significantly between those with and without iliococcygeus fixation. Thus performing prophylactic vaginal vault fixation should be contemplated in patients undergoing prolapse surgery, with careful consideration of patient factors and potential morbidities.

Dental anxiety among the adult residents of Barangay Cambaog, Bustos, Bulacan, Philippines

Background@#Dental anxiety (DA) creates a vicious cycle of dentist avoidance, oral health neglect, increased unmet treatment needs, compromised well-being and quality of life (QoL), which then generates added anxiety. The prevalence of DA among adult Filipinos has not been investigated. @*Objectives@#This study aimed to establish baseline data on dental anxiety among the adult residents of Barangay (Brgy.) Cambaog, Bustos, Bulacan, Philippines. @*Methodology@#Three hundred thirty-six (336) randomly selected adult residents completed a questionnaire that included demographics, frequency of dental visits, self-assessment of their oral health status, the Corah's Dental Anxiety Scale (DAS), and reasons for their DA. @*Results@#The study showed that 11% of the 336 participants had DA, were young adults, affecting twice as many women than men, had lower levels of education, and with a lessening of anxiety with age. Participants with DA were also found to have infrequent dental visits, were symptom-driven, had poorer self-assessed oral health status, and only 13% of the respondents with DA viewed their oral health as healthy. Needles, tooth extraction, pain, previous negative experience, and sound of the drill were some of the triggers that elicited anxiety. @*Conclusion@#DA affects a proportion of the adult residents of Brgy. Cambaog and can be considered a dental public health problem. The use of screening tools like DAS should be considered for the early recognition of patients with DA so that management measures may be taken to enhance the delivery of oral health services.

Oxigenación de músculos respiratorios y locomotores durante el test cardiopulmonar en pacientes con circulación de fontan: serie de casos / Patients with fontan: oxygen consumption in respiratory and Locomotor muscles during excersie testing

Resumen: Antecedentes: Los pacientes con circulación de Fontan (PCF) presentan limitación cardíaca durante el esfuerzo máximo lo que repercute en menor capacidad de ejercicio (VO2-peak). La rehabilitación cardiovascular (RC) revierte este desacondicionamiento, al aumentar el gasto cardíaco y diferencia arteriovenosa de oxígeno, aspectos evaluados con monitorización invasiva y gases exhalados. La valoración no invasiva de la saturación muscular de oxígeno (SmO2) es un método de reciente aplicación para evaluar la limitación muscular al ejercicio. En PCF esta limitación puede atribuirse a la mayor acción de músculos respiratorios (cambios ventilatorios) y/o locomotores (carga periférica). Objetivo: Evaluar el trabajo de músculos respiratorios y locomotores durante el ejercicio físico máximo e incremental mediante los cambios en la SmO2. Métodos: A seis PCF (5 hombres; 13.8±2.9 años; 158±9cm; 49.8±13.3 kg) se les valoró el VO2-peak (23.0±4.5mL·kg-1·min-1) mediante ciclo-ergoespirometría sincrónicamente con SmO2 en músculos respiratorios (SmO2-m.Intercostales) y locomotores (SmO2-m.Vastus-Laterallis) mediante espectroscopía cercana al rango infrarrojo durante el test cardiopulmonar. Resultados: SmO2-m.Intercostales disminuyó desde el 60% del VO2-peak (p<0.05), mientras que SmO2-m.Vastus-Laterallis no cambió. La ventilación pulmonar (VE) aumentó progresivamente, siendo significativo a partir del 60% VO2-peak (p<0.05). La mayor desoxigenación de SmO2-m.Intercostales (∆SmO2) se asoció con los máximos cambios en ventilación pulmonar (∆VE) en ejercicio (rho=0.80; p=0.05). Conclusiones: Durante un protocolo de esfuerzo, los pacientes con circulación de Fontan presentan mayor trabajo muscular respiratorio que locomotor. Los cambios en la ventilación pulmonar se asocian a mayor extracción de oxígeno en la musculatura respiratoria, reforzando la necesidad de incorporar el entrenamiento respiratorio en la rehabilitación cardiovascular.

Abstract: Background: During a maximum incremental exercise patients with Fontan circulation (PFC) show cardiac limitation reducing aerobic exercise capacity (VO2-peak). Cardiovascular rehabilitation (CR) reverses this deconditioning by increasing cardiac output and arteriovenous oxygen difference, aspects that can be evaluated by invasive methods and analyzing the exhaled gases. Non-invasive assessment of muscle oxygen saturation (SmO2) is a novel method for recording local oxygen levels. By this technology, it is possible to evaluate the muscle limitation to exercise. In PFC, that limitation could be attributed to higher contractions of respiratory (ventilatory changes) and/ or locomotor muscles (peripheral load). Objective: To evaluate in PFC the changes at SmO2 of respiratory and locomotor muscles during a maximum and incremental exercise protocol (cardiopulmonary test, VO2-peak). Methods: Six PFC (5 men; 13.8±2.9 years; 158±9 cm; 49.8±13.3 kg) were assessed during the VO2peak test (23.0±4.5mL·kg-1·min-1) by cyclo-ergospirometry synchronously with SmO2 at respiratory (SmO2-m.Intercostales) and locomotor (SmO2-m. Vastus-Laterallis) muscles by Near-Infrared Spectroscopy (NIRS). Results: SmO2-m.Intercostales decreased from 60% of VO2-peak (p<0.05), while SmO2-m.Vastus-Laterallis did not change. Minute ventilation (VE) increased progressively, showing changes to rest at 60% of VO2-peak (p<0.05). The higher deoxygenation of SmO2-m.Intercostales (∆SmO2) correlated to maximum changes of lung ventilation (∆VE) (rho=0.80; p=0.05). Conclusions: During an incremental and maximum exercise protocol, patients with Fontan circulation have more work at respiratory than locomotor muscles. Changes in VE are direct associated with greater extraction of oxygen at respiratory muscles, reinforcing the incorporation of respiratory muscle training in cardiovascular rehabilitation.

Proof-of-Concept and Feasibility Study to Evaluate the Effect of β-Glucan on Protective Qi Deficiency in Adults / 中国结合医学杂志

OBJECTIVE@#To preliminarily explore the potential effect of β-glucan on Chinese medicine (CM) concept protective qi deficiency (PQD), and the methodology for future definitive studies.@*METHODS@#To have a standardized assessment of PQD, a list of 13 potentially PQD-relevant parameters were firstly created, each with defined quantitative or categorial scales. Using the data from 37 participants with (21 cases) or without (16 cases) PQD, multivariate logistic modeling was conducted to create a preliminary diagnostic PQD risk score. Subsequently, 21 participants diagnosed with PQD were treated with β-glucan in a dose of 200 mg/day for 8 weeks. Data were collected for trial acceptability measures (rate of recruitment, withdrawal, and compliance), and the participants were assessed for PQD status at baseline and every 2 weeks thereafter.@*RESULTS@#The preliminary logistic model consisted of 3 parameters (low voice and apathy, aversion to wind and cold, and Cun pulse). The resulting risk score demonstrated a degree of PQD-predicting accuracy that, as evaluated by statistical (discrimination and classification) methods, was higher than those obtained from any of the individual candidate parameters. The 21 PQD participants treated with β-glucan demonstrated good receptibility and a time-dependent improvement in PQD status as evidenced by the decrease of PQD participant to 9.5% at the end of study.@*CONCLUSIONS@#This study demonstrated the effect of proof-of-concept of β-glucan on improving PQD and the proof-of-concept of a multivariate-model-derived diagnostic PQD risk score. It also indicated feasibility for future definitive studies. Studies like this embody an innovative approach that uses therapies derived from the mainstream biomedicine to enrich therapeutics guided by CM principle. (Trial registration No. NCT03829228).

Awareness of nursing students towards cancer and their comparison with medical students

Background: Cancer is the 2nd leading cause of mortality worldwide. The three leading cancers in India are cervical cancer, breast cancer and upper aerodigestive tract carcinoma. Cervical carcinoma is the 2nd most common cancer in women next to breast carcinoma. This study has been done to assess the knowledge, causation and preventive methods about the common cancers in India amongst Medical and Nursing students in a tertiary care center in rural Kerala. Preventive measures and early diagnosis of cancer can lead to decrease in mortality and morbidity. This can be achieved by creating awareness. A special emphasis has been made regarding cervical cancer and HPV vaccination in this study.Methods: A total of 337 medical and 148 nursing students from 1st year to final year were included in this study and the results were analysed by descriptive statistics.Results: Out of 337 medical and 148 nursing students, there was significant difference in knowledge between pretest/posttest and amongst the medical/nursing students. Medical students were found be more aware about the cancer, their causation and preventive methods as compared to the nursing students. 76.4% of nursing students were aware about the role of HPV (Human Papilloma Virus) in the causation of cervical cancer pretest. 98.6% of nursing students were aware about the role of HPV in causation of cervical cancer posttest following a short lecture. Following a short lecture both medical and nursing students were found to have more awareness.Conclusions: Creating awareness to the medical and nursing students who are intouch with the community and the patients is essential. Targeted health education in very important in creating a great impact about the knowledge of cancer in the community, thereby leading to decrease in mortality and morbidity.

Osseous Metaplasia in Leiomyoma: Case Report with Literature Review

Introduction: Leiomyoma is being one of the commonesttumors of the female genital tract during the reproductiveyears. It is a benign neoplasm of smooth muscle.Case report: We present one such case in a 60 year oldpostmenopausal female patient presented with uterovaginalprolapse.Conclusion: The leiomyoma demonstrate a wide spectrum ofhistological variation, but osseous metaplasia is a rare clinicalentity

Cytotoxicity of Calcium Hydroxide on Human Umbilical Cord Mesenchymal Stem Cells

Abstract Objective: To examine the cytotoxicity of calcium hydroxide on human umbilical cord mesenchymal stem cells (HUCMSC) to understand the characteristics for use in regenerative dentistry procedures especially regenerative endodontics. Material and Methods: HUCMSC was isolated, cultured, and confirmed by flow cytometry. The biological characteristics, such as cell morphology, proliferation, and protein expression, were screened. To check the cytotoxicity, HUCMSC was cultured and divided into two groups, the control group (cultured in minimum essential medium (MEM) alpha) and calcium hydroxide group (cultured in MEM alpha and calcium hydroxide). Methyl-thiazole-tetrazolium (MTT) assay was done on different concentrations of calcium hydroxide (0.39 to 25 µg/mL) and the cells were observed and counted. One-way ANOVA test was used with a significance level set at 5%. Results: Flow cytometric analysis confirmed positive of CD73, CD90, CD105, negative of CD45 and CD34. A significant difference was found between the concentration of 6.25 and 3.125 µg/mL (p=0.004). There was no significant difference among 6.25, 12.5 and 25 µg/mL concentrations. There was also no significant difference among 0.39, 0.78, 1.56, and 3.125 µg/mL concentrations. Conclusion: Even though calcium hydroxide is a medicament of choice in clinical endodontics, it decreases the viability of HUCMSC. The lower the concentration of calcium hydroxide, the higher the viability of HUCMSC.

Evaluation of anticancer effects of a pharmaceutically viable extract of a traditional polyherbal mixture against non-small-cell lung cancer cells / 中西医结合学报

OBJECTIVE@#The present work tested organic solvents to prepare an extract with anticancer properties from a polyherbal mixture containing Nigella sativa (seeds), Hemidesmus indicus (roots) and Smilax glabra (rhizomes). We evaluate anticancer effects in non-small-cell lung cancer cells (NCI-H292), and discuss optimization for pharmaceutical use in the context of efficacy, yield and toxicity.@*METHODS@#Using different organic solvents, six extracts were prepared from the polyherbal mixture. Based on the cytotoxic effects of these extracts on NCI-H292 cells and normal lung cells (MRC-5), as evaluated by the sulphorhodamine B assay, the total ethyl acetate (T-EA) extract was selected for further analysis. The possible anticancer mechanisms were assessed by evaluating the extract's effects on apoptosis (through fluorescent microscopic analysis, DNA fragmentation analysis, caspase 3/7 assay and analysis of expression levels of apoptosis-related genes p53, Bax, survivin, Hsp70 and Hsp90), colony formation and antioxidant activity.@*RESULTS@#The extract had cytotoxic effects against NCI-H292 cells in a time- and dose-dependent manner. Significant antioxidant activity and inhibition of colony formation were also observed. The expression level of caspase 3/7 significantly (P < 0.001) increased in NCI-H292 cells treated with 50 μg/mL of the extract. The same dosage led to a significant increase in expression levels of Bax and p53 (P < 0.05 and P < 0.01 respectively), accompanied by a significant decrease (P < 0.0001) in survivin, Hsp70 and Hsp90.@*CONCLUSION@#T-EA extract of the above polyherbal mixture has cytotoxicity against NCI-H292 cells via induction of apoptosis, antioxidant effects and inhibition of colony formation.