Adherence to Iron Chelation Therapy Among Children with Beta Thalassemia Major: A Multicenter Cross-Sectional Study.

BACKGROUND: Adherence to iron chelation therapy (ICT) remains an issue among thalassemia patients. This study aimed to determine the prevalence of non-adherence to ICT among children with beta thalassemia major in Malaysia and the factors associated with it. METHODS: This was a cross-sectional study conducted between November 2019 and November 2021 at seven tertiary hospitals in Malaysia. Participants registered with Malaysian Thalassemia Registry were recruited by convenience sampling. Adherence was measured via pill count and self-reported adherence. Knowledge about thalassemia and ICT was measured using a questionnaire from Modul Thalassemia by Ministry of Health of Malaysia. A decision tree was used to identify predictors of non-adherence. RESULTS: A total of 135 patients were recruited. The prevalence of non-adherence to ICT in those who took subcutaneous ± oral medications was 47.5% (95% CI: 31.5%, 63.9%) and the prevalence of non-adherence to ICT in those who took oral medications only was 21.1% (95% CI: 13.4%, 30.6%). The median knowledge score was 67.5% (IQR 15%). A decision tree has identified two factors associated with non-adherence. They were ICT's route of administration and knowledge score. Out of 100 patients who were on oral medications only, 79 were expected to adhere. Out of 100 patients who were on subcutaneous ± oral medications and scored less than 56.25% in knowledge questionnaire, 86 were expected to non-adhere. Based on the logistic regression, the odds of non-adherence in patients who took oral medications only was 71% lower than the odds of non-adherence in patients who took subcutaneous ± oral medications (OR = 0.29; 95% CI = 0.13, 0.65; p = .002). CONCLUSION: The prevalence of non-adherence to ICT among children with beta thalassemia major in Malaysia was 20/95 (21.1%) in those who took oral medications only and the prevalence of non-adherence was 19/40 (47.5%) in those who took subcutaneous ± oral medications. The factors associated with non-adherence were ICT's route of administration and knowledge score.

FATIGUE IN PATIENTS WITH LONG COVID.

Purpose of the study - to characterize the metabolomic profile in patients with fatigue developing within the Long COVID, during dynamic observation. 24 patients diagnosed with U09.9 "Condition after COVID-19 unspecified" were included in a prospective study. Patients were recommended to engage in physical activity, which included moderate aerobic activity such as walking for 45 minutes a day, three days a week. Clinical assessment by scales (Modified Medical Research Council dyspnea scale; 6-minute walk test; Multidimensional fatigue inventory scale; Barthel index), and determination of metabolomic parameters were performed on days 1 and 14-18 of the study. During the observation period, lactate, fumaric acid, symmetrical dimethylarginine, asymmetric dimethylarginine remained above the reference values. The level of adipic acid returns to normal values. As a result of performing physical activity, such as walking, results on the Modified Medical Research Council scale dyspnea scale, Multidimensional fatigue inventory scale, 6 Minutes Walking Test and Barthel Index improve (p<0,001). Metabolic profile of patients with Long COVID demonstrates the complex of abnormalities at 60 days after the onset of the disease. These metabolic changes are point to possible therapeutic targets for specific pathogenetic pharmacotherapy.

Electrolyte imbalances as poor prognostic markers in COVID-19: a systemic review and meta-analysis.

PURPOSE: Serum electrolyte imbalances are highly prevalent in COVID-19 patients. However, their associations with COVID-19 outcomes are inconsistent, and of unknown prognostic value. We aim to systematically clarify the associations and prognostic accuracy of electrolyte imbalances (sodium, calcium, potassium, magnesium, chloride and phosphate) in predicting poor COVID-19 clinical outcome. METHODS: PubMed, Embase and Cochrane Library were searched. Odds of poor clinical outcome (a composite of mortality, intensive-care unit (ICU) admission, need for respiratory support and acute respiratory distress syndrome) were pooled using mixed-effects models. The associated prognostic sensitivity, positive and negative likelihood ratios (LR + , LR-) and predictive values (PPV, NPV; assuming 25% pre-test probability), and area under the curve (AUC) were computed. RESULTS: We included 28 observational studies from 953 records with low to moderate risk-of-bias. Hyponatremia (OR = 2.08, 95% CI = 1.48-2.94, I2 = 93%, N = 8), hypernatremia (OR = 4.32, 95% CI = 3.17-5.88, I2 = 45%, N = 7) and hypocalcemia (OR = 3.31, 95% CI = 2.24-4.88, I2 = 25%, N = 6) were associated with poor COVID-19 outcome. These associations remained significant on adjustment for covariates such as demographics and comorbidities. Hypernatremia was 97% specific in predicting poor outcome (LR + 4.0, PPV = 55%, AUC = 0.80) despite no differences in CRP and IL-6 levels between hypernatremic and normonatremic patients. Hypocalcemia was 76% sensitive in predicting poor outcome (LR- 0.44, NPV = 87%, AUC = 0.71). Overall quality of evidence ranged from very low to moderate. CONCLUSION: Hyponatremia, hypernatremia and hypocalcemia are associated with poor COVID-19 clinical outcome. Hypernatremia is 97% specific for a poor outcome, and the association is independent of inflammatory marker levels. Further studies should evaluate if correcting these imbalances help improve clinical outcome.

Acceptability of atraumatic restorative treatment and Hall Technique among children, parents, and general dental practitioners: a systematic review and meta-analysis.

OBJECTIVE: This systematic review aimed to evaluate the acceptance level of atraumatic restorative treatment (ART) and Hall Technique (HT) among children, parents, and general dental practitioners. METHOD AND MATERIALS: The study was registered in the PROSPERO database. Articles published between January 1960 and January 2021 were searched in 11 online databases and six textbooks according to PRISMA guidelines. Fifteen studies were chosen for qualitative and quantitative analyses. Among them, five studies focused on ART, seven studies on HT, and the remaining three studies compared both ART and HT. The children, parents, and general dental practitioners' acceptance were estimated using the DerSimonian-Laird random--effects method based on both single-arm and two-arm approaches. The risks of bias were evaluated using Cochrane RoB 2, ROBINS-1, NOS, and JBI assessment tools, while evidence levels were determined using OCEBM. Subgroup analysis and meta-regression were conducted to assess the effect of different evaluation methods on the acceptance rates of ART and HT among children and parents. RESULTS: The acceptance rates of ART among children, parents and general dental practitioners were 90.1%, 95.7%, and 67.7%, respectively, whilst the acceptance rates of HT were 88.3%, 85.7%, and 81.8%, respectively. Two-arm meta-analysis revealed no significant difference (P > .05) between the acceptance of HT and ART among children and parents, respectively. Subgroup analysis showed that using questionnaire-based evaluation had a higher (P < .05) acceptance value than using face scale-based evaluation. CONCLUSION: Both ART and HT are considered well--accepted among children, parents, and general dental practitioners, although general dental practitioners showed a slightly lower level of acceptance. A standardized evaluation tool for assessing acceptance level should be established for better comparison among published articles. Future well-designed studies are warranted to verify the validity of the present review.

Investing in scholarship for health professions education: Learning from the past to move into the future.

There have been recent discourses of what scholarship means for health professions education (HPE) and how it may need a rethink during the pandemic. One key take home message from these discourses is the role of institutions in nurturing and investing in scholarship. Given the current challenges faced by both higher education and healthcare, there is a risk that activities and resources for scholarship in HPE may be neglected. How do institutions make a case for continuous investment in HPE scholarship? Despite being a relatively new and small private university with no public funding, IMU has made fairly significant progress in delivering a unique model of HPE programmes with HPE scholarly output. This commentary discusses the importance of investing in scholarship for HPE with the International Medical University (IMU) in Kuala Lumpur, Malaysia as a case study. Examples of institutional initiatives that support and enhance scholarship are presented based on the recent AMEE guide (142) on redefining scholarship.

Transfer of knowledge, skills and confidence from a faculty development programme for health professions educators into practice.

BACKGROUND: Faculty development programmes should incorporate the transfer of knowledge, skills, and confidence from the training to educational practice. However, there is a risk that transfer may fail due to inadequate integration of knowledge, skills, and confidence. The study evaluated transfer levels, guided by learned principles from a faculty development programme. METHOD: The submitted self-reports on a pedagogical intervention of 92 out of 190 health professions educators who participated in a mandatory teaching and learning training programme, were analysed by a mixed-method approach guided by a structured conceptual framework. RESULTS: Overall 93.4% reported the successful transfer of learning. Participants incorporated sustainable changed practice (level A, 57.6%), showed reflection on the impact of changed practice (level B, 21.7%), and performed effect analysis (level C, 14.1%). The rest planned application of learning (level D, 4.4%) and identified gaps in current practice or developed an idea for educational intervention but did not implement (level E, 2.2%). CONCLUSION: The majority of participants transferred their learning. Faculty development programmes must ensure successful transfer of knowledge, skills, and confidence from the training to educational practice to ensure sustainable development of teaching and learning practices.

[Change in the expression of gene transcription negative regulator SOCS1 in the patients with bronchial asthma and metabolic disorders].

AIM: Comprehensive study of the negative regulation components of cell signaling in the bronchial asthma (BA) patients with metabolic disorders. MATERIALS AND METHODS: 113 people were examined: 63 patients with allergic BA (ABA), 50 patients with a non-allergic variant of the disease (NABA). SOCS1 mRNA expression was evaluated by reverse transcription PCR (RT-PCR). SOCS1 protein expression was investigated by immunoblotting. The determination of cytokine levels was carried out according to the standard protocol on a Bio-Plex flow fluorimeter. RESULTS: A significant and multidirectional change in the expression of SOCS1 mRNA was found at a body mass index 25 (greater than normal) in ABA and NABA. The positive correlations between SOCS1 mRNA expression and body mass index indicate the regulatory role of SOCS1 in leptin signaling. The spectra of correlations in ABA and NABA are different, it indicates the probable existence of specificity in the pathogenesis of these variants of the diseases. CONCLUSION: The obtained data allow us to consider the complexity of regulation disorders occurring at different levels of cell signaling. The multifunctionality of the SOCS1 regulator provides complex control of cytokine signaling simultaneously in different signaling pathways in the BA with metabolic disorders.

[Complex rehabilitation of a patient with marked motor and cognitive impairments after a brain injury]. / Kompleksnaya reabilitatsiya patsienta posle tyazheloi zakrytoi cherepno-mozgovoi travmy s vyrazhennymi dvigatel'nymi i kognitivnymi narusheniyami.

In the presented case report, the complex approach of rehabilitation in the remote period of traumatic brain injury (TBI) allowed the achievement of the significant clinical effect. The authors analyzed the experience of reflex therapy in the treatment of TBI. The effectiveness and potential of acupuncture, objectification of the results are topical issues that require further research.

Evaluation of a magnetic activated charcoal modified with non-ionic silicone surfactant as a new magnetic solid phase extraction sorbent with triazine herbicides as model compounds in selected milk and rice samples.

The non-ionic silicone surfactant (OFX 0309) has been applied in cloud point extraction for the extraction of triazine herbicides in food samples. Evidence has shown that the non-ionic silicone surfactant demonstrated a good performance as an extractor toward triazine herbicides. In this present study, OFX 0309 surfactant was combined with activated charcoal (AC) due to their valuable properties. Activated charcoal modified with non-ionic silicone surfactant coated with magnetic nanoparticles (AC-OFX MNPs) was synthesized and characterized by FT-IR, VSM, SEM, TEM and BET. This novel material was applied as a magnetic adsorbent for the pre-concentration and separation of triazine herbicides due to hydrophobic interaction between polysiloxane polyether of OFX 0309 surfactant and triazine herbicides. Under optimal conditions, the proposed magnetic solid phase extraction method using AC-OFX MNPs adsorbent was applied to extract triazine herbicides from selected milk and rice samples using high performance liquid chromatography coupled with diode array detector. The validation method revealed a good linearity (1 - 500 µg L-1) with the coefficient of determination (R2) in the range of 0.992-0.998 for the samples. The limits of detection (LOD) of the developed method were 0.04 - 0.05 µg L-1 (milk sample) and 0.02 - 0.05 µg L-1 (rice sample). The limits of quantification (LOQ) were 0.134 - 0.176 µg L-1 (milk sample) and 0.075 - 0.159 µg L-1 (rice sample). The recoveries of the triazine compounds ranged from 81% to 109% in spiked milk samples and from 81% to 111% in spiked rice samples, with relative standard deviations (RSD) values lower than 13.5% and 12.1% for milk and rice samples, respectively. To the best of our knowledge, this is the first study that have investigated the use of magnetic nanoparticles coated activated charcoal modified with OFX 0309 surfactant for pretreatment of triazine herbicides in food samples analysis for simultaneous separation of organic pollutants.

ß-Cyclodextrin conjugated bifunctional isocyanate linker polymer for enhanced removal of 2,4-dinitrophenol from environmental waters.

In this work, we reported the synthesis, characterization and adsorption study of two ß-cyclodextrin (ßCD) cross-linked polymers using aromatic linker 2,4-toluene diisocyanate (2,4-TDI) and aliphatic linker 1,6-hexamethylene diisocyanate (1,6-HDI) to form insoluble ßCD-TDI and ßCD-HDI. The adsorption of 2,4-dinitrophenol (DNP) on both polymers as an adsorbent was studied in batch adsorption experiments. Both polymers were well characterized using various tools that include Fourier transform infrared spectroscopy, thermogravimetric analysis, Brunauer-Emmett-Teller analysis and scanning electron microscopy, and the results obtained were compared with the native ßCD. The adsorption isotherm of 2,4-DNP onto polymers was studied. It showed that the Freundlich isotherm is a better fit for ßCD-TDI, while the Langmuir isotherm is a better fit for ßCD-HMDI. The pseudo-second-order kinetic model represented the adsorption process for both of the polymers. The thermodynamic study showed that ßCD-TDI polymer was more favourable towards 2,4-DNP when compared with ßCD-HDI polymer. Under optimized conditions, both ßCD polymers were successfully applied on various environmental water samples for the removal of 2,4-DNP. ßCD-TDI polymer showed enhanced sorption capacity and higher removal efficiency (greater than 80%) than ßCD-HDI (greater than 70%) towards 2,4-DNP. The mechanism involved was discussed, and the effects of cross-linkers on ßCD open up new perspectives for the removal of toxic contaminants from a body of water.

[Role of negative regulators of SOCS1, SOCS3, and SOCS5 gene transcription in the negative cell signaling regulation system in asthma]. / Rol' negativnykh regulyatorov transkriptsii genov SOCS1, SOCS3 i SOCS5 v sisteme negativnoi regulyatsii kletochnoi signalizatsii pri bronkhial'noi astme.

AIM: To conduct a comprehensive study of the components of negative cell signaling regulation in different types of asthma. SUBJECTS AND METHODS: A total of 171 people, including 80 patients with allergic asthma (AA), 60 patients with non-allergic asthma (NAA), and 31 apparently healthy individuals, were examined. SOCS5 mRNA expression was assessed by reverse-transcription polymerase chain reaction. The expression of SOCS1 and SOCS3 proteins was investigated by immunoblotting. The concentration of total serum IgE was determined by enzyme immunoassay; the level of cytokines was measured according to the standard protocol using a Bio-Plex fluorometer. RESULTS: The findings show that the patients with AA generally display more marked changes in the expression of all three investigated SOCSes (SOCS1, SOCS3, and SOCS5) at baseline and when interleukin 4 (IL-4) acts. In NAA, there are pronounced changes in the expression of SOCS3 only and, to a lesser extent, SOCS5. The results of investigating the concentrations of IL-4 in the examined groups demonstrate its significant decrease in the AA group, whereas in the NAA group, it is similar to those in healthy individuals. On the contrary, IL-10 concentrations in AA tend towards those in the control group, but much exceed in NAA. CONCLUSION: The findings allow one to consider the complexity of regulatory disorders arising at various levels of cell signaling in the context of the multifunctional nature of the molecules from the family of negative regulators of transcription of the SOCS1, SOCS3, and SOCS5 genes, which provide the comprehensive control of cytokine signaling simultaneously in different signal pathways.

Laser and light therapy for facial warts: a systematic review.

Facial verruca plana, or flat warts, are benign skin papillomas caused by human papillomavirus infections. A large portion of cases are refractory to treatment and can cause psychosocial distress in patients. Laser and light modalities offer an alternative therapeutic approach that has not been extensively explored. We systematically reviewed PubMed for studies describing treatment of facial verruca plana using lasers, photodynamic therapy and infrared coagulation. Final inclusion and review of eighteen studies suggests laser and light therapies to have considerable potential in the treatment of this recalcitrant condition. In particular, yttrium aluminium garnet lasers, infrared coagulation and photodynamic therapies have been reported to demonstrate efficacy. Further studies with larger power are required to determine which method should be established as the alternative treatment of choice for recalcitrant facial verrucae.

Measures of acute physiology, comorbidity and functional status to differentiate illness severity and length of stay among acute general medical admissions: a prospective cohort study.

BACKGROUND: Simple measures of acute physiologic compromise, functional status and comorbidity may help clinicians to make decisions relating to clinical care and resource utilisation. AIMS: To explore the usefulness of common assessment tools in predicting outcomes of (i) death or intensive care unit (ICU) admission and (ii) length of hospital stay at a busy tertiary hospital in Singapore. METHODS: Three hundred and ninety-eight consecutive admissions to two general medicine teams were prospectively assessed during 2 months in 2011. Patients were followed until discharge or transfer to ICU/high dependency unit (HDU). Data collected included routine demographic data, final diagnosis, comorbid conditions including a weighted prognostic comorbidity index (the updated Charlson index) and the modified Early Warning Score (MEWS) at presentation to the emergency department. The admission modified Barthel Index was recorded for patients aged 65 and over. Death and total length of hospital stay were recorded in all cases. RESULTS: Of 398 patients, 16 (4 %) died or were transferred to ICU and 99 (25%) stayed for more than 7 days. Medical early warning (MEW) scores of ≥5 were significantly associated with death or ICU admission (hazard ratio 5.50, 95% confidence interval 1.77-17.07, P = 0.003). There was no independent association between this outcome and the Charlson score or admission Barthel Index. Excess length of stay was associated with a modified Barthel Index ≤17 and altered mental status at presentation. CONCLUSION: Among unselected general medical patients, MEW scores of ≥5 were significantly associated with death or ICU admissions and only functional status and altered mental status were independent predictors of excess length of stay.

MDRO Beijing Consensus Meeting Report: Global burden of multidrug-resistant organisms' current antimicrobial resistance problems in Asia-Pacific.

The International Society of Chemotherapy's Working Groups on Antibiotic Resistance and Antibiotic Stewardship convened a half-day workshop on the burden of multidrug-resistant organisms in the Asia-Pacific. This short review is a summary of their discussion and conclusions.

20-year-old injury: an unusual cause of stroke.

A 62-year-old man presented with a 2-day history of headache, nausea and dizziness on a background of recently diagnosed stage 2c prostate carcinoma and controlled hypertension. Imaging confirmed bilateral cerebellar strokes; on further investigations, he was found to have undiagnosed subclavian steal syndrome following severe injury to his left arm more than 20 years earlier.

Role of nicotinic and muscarinic cholinoreceptors in the realization of the cholinergic anti-inflammatory pathway during the early phase of sepsis.

Stimulation of nicotinic and muscarinic cholinoreceptors (nAChR, mAChR) in outbred albino mice with nicotine and aceclidine, respectively, in single equilethal doses 0.5 DL(50)6 h before sepsis induction significantly reduced animal mortality due to a decrease in blood concentrations of proinflammatory cytokines IL-1ß, IL-6, and MIP-2. Stimulation of mAChR (injection of aceclidine) stimulated the neutrophilic phagocytic and metabolic activity. Realization of the cholinergic anti-inflammatory pathway (stimulation of the peripheral nicotinic cholinoreceptors (α7nAChR) and central muscarinic cholinoreceptors (mAChR) was modulated by stimulation of the muscarinic cholinoreceptors of the phagocytic monocytic system cells.

Effects of reversible inhibition of cholinesterase and nicotine on mouse mortality and blood levels of proinflammatory cytokines during the early phase of sepsis.

Experiments on outbred albino mice have shown that proserine (reversible cholinesterase inhibitor) and nicotine (nicotinic receptor agonist) in a equivalent dose of 0.2 DL(50)injected 2 h before sepsis induction significantly reduced animal mortality from experimental infection due to reduction of blood concentrations of proinflammatory cytokines TNF-α, IL-1ß, and IL-6.

[Disturbances of immune status and cytokine profile caused by chronic intoxication with organophosphorus compounds and their correction by administration of imunofan].

Experiments on noninbred rats showed that the chronic intoxication with organophosphorus compounds sarin and methylparathion (30 days; total dose, 0.9 LD50; single daily dose, 0.03 mg/kg,) significantly decreases the immune responses and reduces the concentrations of blood cytokines IFN-gamma, IL-2, IL-4, IL-6, and IL-10. The damage is more pronounced in Th1 cells than in Th2 lymphocytes. The administration of imunofan (single daily dose, 20 microg/kg) for 5 days partly recovers the immune status and the content of cytokines in the blood.

Application of bivariate statistics to full wine bottle diamagnetic screening data.

A bivariate correlated Student distribution is applied to full wine bottle diamagnetic screening measurements. Previous work involving a limited number of rare wines indicated that like wines cluster in a plot of the first two principal component scores derived from a covariance matrix of the diamagnetic screening measurements. This study extends the approach to a much larger, statistically meaningful sixty bottle wine library where bivariate statistics are used to comment on the measured data. The full bottle diamagnetic screening of thirty-six identically labeled, sealed bottles of wine obtained from four different sources combined with principal component analysis data reduction followed by treatment with a bivariate distribution permit the effect of wine transport and storage to be observed. The usefulness and future success of the method towards the identification of counterfeit wines is mentioned.

The time dependent Dirac-Frenkel-McLachlan variation of parameters: an NMR application.

The time dependent variation of parameters solution to the time dependent Schrödinger equation pioneered by Dirac, Frenkel, and McLachlan is described in terms useful for immediate application to complex time dependent problems in magnetic resonance. A benchmark comparison of the theory to one dimensional images and spin echo envelope signals in simple spatially varying magnetic fields with molecular diffusion is provided.