Foot Muscle Exercise: A Novel Approach to Improve Motor Functions in Children with Down Syndrome Having Pes Planus - A Randomized Controlled Trial.

OBJECTIVE: The study aimed to determine the efficacy of foot muscle exercises in children with DS having pes planus. METHODS: Forty-seven subjects randomly assigned to foot muscle exercises (study group) or an arch support insole with one-leg balance exercises (control group), thrice weekly intervention for 12-weeks followed by a home program with residual effect assessed after 24-weeks from baseline. RESULTS: The motor functions were significantly improved in both groups (p = 0.00). A positive residual effect was found in the study group for both parameters. Whilst in the control group it failed to give a positive residual effect for GMFM-88, while PBS yielded positive outcomes. The study group showed significantly better results than the control group in comparison. CONCLUSION: The novel finding suggests that the foot muscle exercise has the potential to improve motor functions in children with Down syndrome and it can be used as an alternative therapeutic approach to the conventional method.

Does socioeconomic and environmental burden affect vulnerability to extreme air pollution and heat? A case-crossover study of mortality in California.

BACKGROUND: Extreme heat and air pollution is associated with increased mortality. Recent evidence suggests the combined effects of both is greater than the effects of each individual exposure. Low neighborhood socioeconomic status ("socioeconomic burden") has also been associated with increased exposure and vulnerability to both heat and air pollution. We investigated if neighborhood socioeconomic burden or the combination of socioeconomic and environmental exposures ("socioenvironmental burden") modified the effect of combined exposure to extreme heat and particulate air pollution on mortality in California. METHODS: We used a time-stratified case-crossover design to assess the impact of daily exposure to extreme particulate matter <2.5 µm (PM2.5) and heat on cardiovascular, respiratory, and all-cause mortality in California 2014-2019. Daily average PM2.5 and maximum temperatures based on decedent's residential census tract were dichotomized as extreme or not. Census tract-level socioenvironmental and socioeconomic burden was assessed with the CalEnviroScreen (CES) score and a social deprivation index (SDI), and individual educational attainment was derived from death certificates. Conditional logistic regression was used to estimate associations of heat and PM2.5 with mortality with a product term used to evaluate effect measure modification. RESULTS: During the study period 1,514,292 all-cause deaths could be assigned residential exposures. Extreme heat and air pollution alone and combined were associated with increased mortality, matching prior reports. Decedents in census tracts with higher socioenvironmental and socioeconomic burden experienced more days with extreme PM2.5 exposure. However, we found no consistent effect measure modification by CES or SDI on combined or separate extreme heat and PM2.5 exposure on odds of total, cardiovascular or respiratory mortality. No effect measure modification was observed for individual education attainment. CONCLUSION: We did not find evidence that neighborhood socioenvironmental- or socioeconomic burden significantly influenced the individual or combined impact of extreme exposures to heat and PM2.5 on mortality in California. IMPACT: We investigated the effect measure modification by socioeconomic and socioenvironmental of the co-occurrence of heat and PM2.5, which adds support to the limited previous literature on effect measure modification by socioeconomic and socioenvironmental burden of heat alone and PM2.5 alone. We found no consistent effect measure modification by neighborhood socioenvironmental and socioeconomic burden or individual level SES of the mortality association with extreme heat and PM2.5 co-exposure. However, we did find increased number of days with extreme PM2.5 exposure in neighborhoods with high socioenvironmental and socioeconomic burden. We evaluated multiple area-level and an individual-level SES and socioenvironmental burden metrics, each estimating socioenvironmental factors differently, making our conclusion more robust.

Leaf Extracts of Moringa oleifera Cultivated in Baghdad: Characterization and Antimicrobial Potential against Endodontic Pathogens.

The use of medicinal plant preparations to clean and disinfect root canal infection is gaining popularity. The aim of this study was to evaluate the bioactive composition of leaf extracts of Moringa oleifera plants cultivated in Iraq (specifically Baghdad) and their antimicrobial activity against selected root canal pathogens for potential application in endodontic treatment. Materials and Methods. Moringa leaf extracts were prepared either through cold maceration or warm digestion techniques to perform an ethanolic or aqueous extraction, respectively. Phytochemical detection was performed before thin layer chromatography (TLC) and high-performance liquid chromatography (HPLC) to measure flavonoids and phenolic compounds within both extracts. Then, their antimicrobial activities were investigated against Streptococcus mutans, Enterococcus faecalis, and Candida albicans through minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC), and agar well diffusion assay in comparison to NaOCl and Ca(OH)2. Results. Phytochemical screening showed several active ingredients but with higher expression of flavonoids and phenolic compounds. Also, different types of these compounds were detected through TLC and quantified by HPLC. MIC values for ethanolic extract against Streptococcus mutans, Enterococcus faecalis, and Candida albicans were 60, 65, and 55, respectively, while for aqueous extract, MIC values were 70, 80, and 50, respectively. Aqueous extract showed a higher inhibition zone than ethanolic extract for both Streptococcus mutans and Enterococcus faecalis with a statistically significant difference (p ≤ 0.001) for all tested materials except with NaOCl and Ca(OH)2 in Streptococcus mutans and Enterococcus faecalis, respectively. The ethanolic extract showed a higher inhibition zone against Candida albicans, with a statistically significant difference (p ≤ 0.001) for all tested materials. Conclusion. Ethanolic and aqueous extracts of Moringa oleifera leaves cultivated in Baghdad contain considerable quantities of phytochemicals, especially flavonoid and phenolic compounds, and demonstrated antimicrobial activities against selected endodontic pathogens. Therefore, Moringa leaf extracts could be suggested as an alternative antimicrobial material in endodontic treatment.

Assessment of Type 2 Diabetes Awareness and Knowledge in the Non-medical Bahraini Population.

Background With type 2 diabetes (T2D) posing an escalating health challenge to the Kingdom of Bahrain, enhancing public awareness becomes instrumental in mitigating disease outcomes. This study aimed to appraise the level of T2D awareness among the non-medical Bahraini population by evaluating their understanding of the disease, its risk factors, symptoms, complications, monitoring, and prevention methods. Methods We conducted a cross-sectional study from March 2022 to June 2022. The study employed an electronic survey using Google® Forms (Google LLC, Mountain View, California, USA) targeting non-healthcare workers aged 15 and above. The survey consisted of multiple yes-and-no questions designed to evaluate different aspects of respondents' T2D knowledge. Results Out of 835 participants, a total of 613 participants were included. The overall awareness of T2D was found to be average (70.6% CI±6.214, SD ±8.80%). The mean scores of correct answers in the different sections such as general knowledge, risk factors, symptoms, complications, treatment, monitoring, and prevention of T2D were 54.5% CI ±14.8, 75.5% CI±12.5, 77.6% CI±5.3, 61.8% CI±8.5, and 73.4% CI±5.4 respectively. Furthermore, the diabetic population scored an average of 76.7% in awareness in comparison to the non-diabetic population which scored 72.5% in overall awareness. Conclusions These findings underscore the pressing need to enhance T2D awareness among the Bahraini population. Implementing early education programs and strategically utilizing social media platforms may aid in bolstering public understanding of T2D, aiming ultimately to reduce its prevalence and associated economic burden.

Ambient temperature and air pollution associations with suicide and homicide mortality in California: A statewide case-crossover study.

BACKGROUND: Higher ambient temperature and air pollution may contribute to increased risk of behaviors harmful to oneself or to others; however, quantitative evidence is limited. We examined the relationship of deaths due to suicide and homicide with temperature and air pollution in California-a state prone to high levels of both exposures. METHOD: California death certificates from 2014 to 2019 were used to identify deaths due to suicide and homicide. Residential data for decedents were used to assign exposure to daily temperature (maximum[Tmax], minimum[Tmin]) and daily average air pollution concentrations (particulate matter <10 µm[PM10] and < 2.5 µm[PM2.5], nitrogen dioxide[NO2], ozone[O3]). Tmin served as a surrogate for nighttime temperature. A time-stratified case-crossover study design using conditional logistic regression was used to assess the effects of daily exposure to temperature and air pollutants on suicide and homicide mortality, adjusting for relative humidity. Effect modification by sex and age was assessed. RESULTS: We observed 24,387 deaths due to suicide and 10,767 deaths due to homicide. We found a monotonic temperature association for both outcomes. A 5 °C increase in Tmax at lag-2 and Tmin at lag-0 was associated with 3.1 % (95 % confidence interval [CI]: 1.1 %-5.2 %) and 3.8 % (95%CI: 0.9 %-6.8 %) increased odds of death due to suicide, respectively. The increased odds of homicide mortality per 5 °C increase in Tmax at lag-0 and Tmin at lag-1 were 4.9 % (95%CI: 1.6 %-8.1 %) and 6.2 % (95%CI: 1.6 %-11.0 %), respectively. No air pollutant associations were statistically significant. Temperature associations were robust after adjustment for PM2.5. Some temperature effects were larger among women for suicide and men for homicide mortality, and among those over age 65 years for both outcomes. CONCLUSION: Risk of suicide and homicide mortality increases with increasing daily ambient temperatures. Findings have public health relevance given anticipated increases in temperatures due to global climate change.

In vitro study of the effect of resveratrol purified from the skin of Iraqi black grape (Vitis vinifera) on lymphocyte cultures isolated from the blood of patients with lymphoma.

The natural stilbene compound resveratrol (RSV) was extracted and purified locally from the black grape skin (Vitis vinifera) cultivated in Iraq. Cultures of human peripheral lymphocytes were obtained from the blood samples of patients with and without lymphoma to be treated with RSV at different concentrations. Three RSV concentration levels were subjected to isolated lymphocytes from blood samples of Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), and without lymphoma to estimate the change in TNF-α and IL-10. Resveratrol seemed to differently affect cytokines level in normal and lymphoma lymphocytes in relation to its concentration. The lowest resveratrol concentration (50 µg/ml) decreased TNF-α levels for patients without lymphoma and all NHL patients in contrast to the HL sample. Treating normal lymphocytes with a higher dose (1000 µg/ml) might elevate the levels of TNF-α in almost all samples. There was an inverse relationship between both cytokines in most treatments; with the increase in TNF-α level, there was a decrease in IL-10 level except in HL and normal lymphocytes treatment. The locally purified resveratrol could serve as a multi-target drug that modulates the immune system to improve body defense in patients suffering from lymphoma and in patients without lymphoma by altering cytokine levels in response to different resveratrol concentrations in a different manner.

Levels of perceived stress according to professional standings among dental surgeons of Karachi: a descriptive study.

BACKGROUND: Globally, occupational stress is a common finding among dentists. The present study aimed to assess prevalence of perceived stress among practicing dentists of Karachi, Pakistan, and assess the perceived stress levels according to the professional standing among dental surgeons. METHODS: A cross-sectional survey was conducted using a convenience sampling technique in which 200 dentists from Karachi were recruited. A self-constructed questionnaire was used to collect data, including demographic and professional backgrounds. Stress level assessment was performed using the perceived stress scale (PSS). RESULTS: The response rate was 78.5%. In general, a moderate stress level (mean PSS = 18.35 ± 5.417) appeared in the sample size of 157 dentists, and the prevalence of perceived stress was 86%. The level of perceived stress was significantly lower in groups including 40 years old and above (mean diff; p = - 0.197), Rupees 1 lac (100,000) and more of monthly income (mean diff; p = 0.029), 11 and more years of experience (mean diff; p = 0.001) and Assistant Professor/Associate Professor/Professor (mean diff; p = 0.035). CONCLUSION: All groups representing the senior status of dentists have appeared with lower stress than groups representing the junior status of dentists. Exploratory studies are required to discover an effective coping strategy to deal with occupational stress among the junior dentists of Karachi.

The Effect of Melatonin on Thrombosis, Sepsis and Mortality Rate in COVID-19 Patients.

OBJECTIVES: This study aimed to determine the effect of melatonin on thrombosis, sepsis, and mortality rate in adult patients with severe coronavirus infection (COVID-19). METHODS: This single-center, prospective, randomized clinical trial was conducted from 1 December 2020 to 1 June 2021 at Al-Shifaa hospital in Mosul, Iraq. There were 158 patients with severe COVID-19 included in the study: 82 in the melatonin group (who received 10 mg melatonin in addition to standard therapeutic care) and 76 in the control group (given standard therapeutic care only). Patients were chosen by a blocked randomization design. The physician then evaluated and recorded the incidence of thrombosis, sepsis, and mortality rate on days 5, 11, and 17 of symptoms. RESULTS: The intervention group consisted of 82 patients, while the control group consisted of 76 patients. In comparison to the control group, thrombosis and sepsis developed significantly less frequently (P < 0.05) in the melatonin group during the second week of infection, while mortality was significantly higher in the control group (P < 0.05). CONCLUSIONS: Adjuvant use of melatonin may help to reduce thrombosis, sepsis, and mortality in COVID-19 patients.

Delays In Breast Cancer Diagnosis At A Tertiary Care Facility In Karachi, Pakistan.

BACKGROUND: Diagnostic delay of breast cancer is linked to poor prognosis and survival. It can be caused by patients or healthcare providers. Since there is no quantification of provider delay and total delay in Pakistan, the general picture of breast cancer diagnostic delay is poorly understood. This study was conducted to quantify total delay, provider delay, and patient delay, along with the factors contributing to each type of delay in breast cancer management. METHODS: This was a descriptive study conducted over 3 years at a hospital in Karachi. Convenience sampling was used. Breast cancer patients undergoing treatment were interviewed. Values for diagnostic delays extracted from literature were >12 weeks in seeking care as patient delay and >4 weeks in treatment initiation as provider delay. RESULTS: A total of 334 patients were included in the analysis. Mean total delay was 56±52 weeks, the median (IQR) patient delay was 4 (0-22) weeks, and the median provider delay was 17 (9-52) weeks. Patient delay was found in 149 (44.6%), and provider delay was found in 269 (80.5%) patients. Believing symptoms to resolve on their own was the most common reason (24.9%) for patient delay. Seeking multiple opinions (43.7%) and misdiagnosis (43.4%) were the most common reasons for provider delay. CONCLUSIONS: Patients and providers both caused diagnostic delay in breast cancer treatment. There is a need to increase awareness in the general population and enhance the training of providers regarding timely recognition in all patients presenting with breast-related symptoms.

The examination of sleep quality for frontline healthcare workers during the outbreak of COVID-19.

PURPOSE: Few studies have addressed the sleep disturbances of healthcare workers during crisis events of public health. This study aimed to examine the sleep quality of frontline healthcare workers (FLHCW) in Bahrain during the COVID-19 pandemic, and compare it with the sleep quality of non-frontline healthcare workers (NFLHCW). METHODS: Healthcare workers (n = 280) from multiple facilities belonging to the Ministry of Health, Bahrain, were invited to participate in this cross-sectional study. An online questionnaire, including socio-demographics, the Pittsburgh Sleep Quality Index (PSQI), and the Perceived Stress Scale (PSS), was used to evaluate sleep disturbances and stress levels of healthcare workers. Poor sleep quality was defined as PSQI ≥ 5 and moderate-severe stress as PSS ≥ 14. Descriptive statistics were used to compare the scores of FLHCW and NFLHCW. Univariate and multivariate binary logistic regressions were used to identify predictors of poor sleep quality, moderate-severe stress, and the combined problem of poor sleep quality and moderate-severe stress. RESULTS: A total of 257 participants (129 FLHCW and 128 NFLHCW) provided usable responses. The overall PSQI and PSS scores were 7.0 ± 3.3 and 20.2 ± 7.1, respectively. The FLHCW scored higher in the PSQI and PSS compared with the NFLHCW; however, the differences in the PSQI and PSS scores were not statistically significant. For the FLHCW, 75% were poor sleepers, 85% had moderate-severe stress, and 61% had both poor sleep quality and moderate-severe stress. For the NFLHCW, 76% were poor sleepers, 84% had moderate-severe stress, and 62% had both poor sleep quality and moderate-severe stress. Female sex and professional background were the predictors of poor sleep quality and stress. CONCLUSIONS: Poor sleep quality and stress are common during the COVID-19 crisis. Approximately, 60% of both FLHCW and NFLHCW have poor sleep quality combined with moderate-severe stress.

Characterization of bone aluminum, a potential biomarker of cumulative exposure, within an occupational population from Zunyi, China.

OBJECTIVES: Aluminum (Al) is a neurotoxicant; however, efforts to understand Al toxicity are limited by the lack of a quantitative biomarker of cumulative exposure. Bone Al measurements may address this need. Here, we describe and compare non-invasive bone Al measurements with fingernail Al and Al cumulative exposure indices (CEIs). METHODS: We completed a cross-sectional study of 43 factory workers in Zunyi, China. Bone Al measurements were taken with a compact in-vivo neutron activation analysis system (IVNAA). Fingernail samples were analyzed using inductively coupled plasma mass spectrometry. CEIs, based on self-reported work history and prior literature, were calculated for the prior 5, 10, 15, 20 years and lifetime work history. Linear regressions adjusted for age and education compared fingernail Al and Al CEIs with bone Al. RESULTS: Median (interquartile range (IQR)) Al measurements were: 15 µg/g dry bone (IQR = 28) for bone Al; 34.9 µg/g (43.3) for fingernail; and 24 (20) for lifetime CEI. In adjusted regression models, an increase in 15-year CEI was significantly associated with increased bone Al (ß = 0.91, 95% confidence interval (CI): 0.16, 1.66). Associations of bone Al with 10- and 20-year CEI were approaching statistical significance (ß = 0.98, 95% CI: -0.14, 2.1; ß = 0.59, 95% CI: -0.01, 1.18, respectively). Other models were not statistically significant. CONCLUSIONS: Bone Al was significantly associated with 15-year Al CEI, but not other Al CEIs or fingernail Al. Bone Al may be a useful measure of cumulative, rather than short-term, Al exposure. Additional refinement of this method is ongoing.

Cardiorespiratory fitness and its association with adiposity indices in young adults.

OBJECTIVE: This study investigated the relationship between cardiorespiratory fitness (CRF) and adiposity in young adults. METHODS: Data was collected from 133 students of a medical college of Pakistan. The study was conducted on young adults, aged 17-24 years, recruited from Jinnah Medical & Dental College, Karachi, between Aug-Dec, 2015. Queen's College Step Test was conducted to measure CRF and maximal oxygen uptake (VO2max) evaluated. Anthropometric measurements (body mass index, body fat, visceral fat, waist circumference) were taken to assess adiposity. Associations of VO2max and adiposity were analyzed. RESULTS: The prevalence of overweight/obesity was 44% overall. The VO2max (ml/kg/min) of males and females was 55.41±9.45 and 39.91±3.14, respectively, the gender difference being highly significant (p<0.001). Quartiles of VO2max showed strong inverse relationship between adiposity and VO2max, obese individuals having low VO2max (1st quartile) and normal weight individuals having high VO2max (4th quartile). VO2max correlated greatest with body fat in males (r = -0.600; p<0.001), and waist circumference in females (r = -0.319; p=0.004). CONCLUSION: The results indicate low CRF in young females and a strong inverse relationship between fitness levels and adiposity in young adults of both genders. Improving these parameters in our young population may prevent development of chronic non-communicable disease in later life.