Stereoselective Asymmetric Syntheses of Molecules with a 4,5-Dihydro-1H-[1,2,4]-Triazoline Core Possessing an Acetylated Carbohydrate Appendage: Crystal Structure, Spectroscopy, and Pharmacology.

A new series of chiral 4,5-dihydro-1H-[1,2,4]-triazoline molecules, featuring a ß-ᴅ-glucopyranoside appendage, were synthesized via a 1,3-dipolar cycloaddition reaction between various hydrazonyl chlorides and carbohydrate Schiff bases. The isolated enantiopure triazolines (8a-j) were identified through high-resolution mass spectrometry (HRMS) and vibrational spectroscopy. Subsequently, their solution structures were elucidated through NMR spectroscopic techniques. Single-crystal X-ray analysis of derivative 8b provided definitive evidence for the 3-D structure of this compound and revealed important intermolecular forces in the crystal lattice. Moreover, it confirmed the (S)-configuration at the newly generated stereo-center. Selected target compounds were investigated for anti-tumor activity in 60 cancer cell lines, with derivative 8c showing the highest potency, particularly against leukemia. Additionally, substituent-dependent anti-fungal and anti-bacterial behavior was observed.

Biochemical, morphological and molecular assessments of n butanol fraction of Phoenix dactylifera L. following exposure to inorganic mercury on the liver of Wistar rats.

BACKGROUND: Mercury chloride (HgCl2) damages tissues it comes in contact with in sufficient concentration. This study evaluated the protective effects of n-butanol fraction of Phoenix dactylifera (BFPD) on mercury-triggered liver toxicity in Wistar rats. 25 male rats were divided into 5 groups of 5 rats each. Group I was administered 2 ml/kg of distilled water; group II was administered 5 mg/kg of HgCl2; group III was administered 500 mg/kg of BFPD + 5 mg/kg of HgCl2; group IV was administered 1000 mg/kg of BFPD + 5 mg/kg of HgCl2, while group V was administered 100 mg/kg of silymarin + 5 mg/kg of HgCl2. orally for 2 weeks. The rats were euthanized and liver tissue blood samples were collected for histological, histochemical, stereological, immunohistochemical, molecular, and biochemical studies. RESULTS: The results revealed that HgCl2 induced oxidative stress in the rats evident by histoarchitectural distortions and altered levels of liver enzymes, proteins, and oxidative stress biomarkers when compared to the control. However, BFPD treatment restored these changes. Glutathione peroxidase levels decreased (p < 0.05) in the HgCl2-treated group when compared to the control and BFPD-treated groups. HgCl2 group revealed reduced reactivity with histochemical and immunohistochemical stains (Masson's Trichrome and B cell Lymphoma 2) when compared to the control, with a significant decrease in quantified liver Bcl-2 stain intensity when compared to the silymarin-treated group. BFPD administration revealed normal staining intensity comparable to the control. HgCl2 administration revealed a remarked decrease in the number of hepatocytes when compared to the control, BFPD, and silymarin groups. BFPD preserved (p < 0.05) the stereological features when compared to the HgCl2-treated group. GPx activity in the liver decreased (p < 0.05) with HgCl2 administration when compared to the control and silymarin-treated groups. BFPD attenuated GPx gene activity to levels similar to the control indicating some level of amelioration against HgCl2-induced toxicity. CONCLUSIONS: The ability of BFPD to mitigate HgCl2 triggered liver alterations could be attributed to the antioxidant property of its flavonoid content. Therefore, BFPD may be a potential candidate for treating and managing liver-induced mercury intoxication.

Investigation of solute-solvent interactions of 4'-alkyl-4-cyanobiphenyl liquid crystals using Raman spectroscopy.

Liquid crystal materials possess hybrid liquid and solid-like properties with high response to stimuli. The 4'-alkyl-4-cyanobiphenyls (nCB) are an important class of liquid crystals that are widely used for various applications. In this study, six alkylcyanobiphenyl liquid crystal samples (5CB to 10CB) were examined using Raman spectroscopy in a total of twelve solvents of various polarities. The distinctive bands contributed by the LC sample are from C≡N stretch, C-C aromatic ring breathing, C-C biphenyl linking stretch, and C-H in-plane deformation. These modes are found to be responsive to different solvent environments by shifting positions. For instance, the cyano stretching mode of 5CB is blue-shifted from 2229 cm-1 for the pure sample to 2233 cm-1 when measured in hexane due to the repulsive interaction between the mode and the solvent bath. On the other hand, this mode undergoes a red-shift to 2220 cm-1 in methanol due to hydrogen bond interaction between the mode and solvent molecules. Overall, the shift in the position of the vibrational modes of nCB molecules was correlated with solvent properties such as acceptor number, donor number, and Kamlet-Taft dipolarity constants, which are a measure of solvent polarity. In samples with longer alkyl chains (8CB, 9CB, and 10CB), the wavenumber of the stretching modes was generally shifted to around the same position in all the solvents. Such observations are related to the folding back effect and enhanced dimerization constant with an increase in the chain length.

Ternary Phenolate-Based Thiosemicarbazone Complexes of Copper(II): Magnetostructural Properties, Spectroscopic Features and Marked Selective Antiproliferative Activity against Cancer Cells.

The new diprotic ligand 3,5-di-tert-butylsalicylaldehyde 4-ethyl-3-thiosemicarbazone, abbreviated H2(3,5-t-Bu2)-sal4eT, exists as the thio-keto tautomer and adopts the E-configuration with respect to the imine double bond, as evidenced by single-crystal X-ray analysis and corroborated by spectroscopic characterisation. Upon treatment with Cu(OAc)2·H2O in the presence of either 2,9-dimethyl-1,10-phenanthroline (2,9-Me2-phen) or 1,10-phenanthroline (phen) as a co-ligand in MeOH, this thiosemicarbazone undergoes conformational transformation (relative donor-atom orientations: syn,anti → syn,syn) concomitantly with tautomerisation and double deprotonation to afford the ternary copper(II) complexes [Cu{(3,5-t-Bu2)-sal4eT}(2,9-Me2-phen)] (1) and [Cu2{3,5-t-Bu2)-sal4eT}2(phen)] (2). Crystallographic elucidation has revealed that complex 1 is a centrosymmetric dimer of mononuclear copper(II) complex molecules brought about by intermolecular H-bonding. The coordination geometry at the copper(II) centre is best described as distorted square pyramidal in accordance with the trigonality index (τ = 0.14). The co-ligand adopts an axial-equatorial coordination mode; hence, there is a disparity between its two Cu-N coordinate bonds arising from weakening of the apical one as a consequence of the tetragonal distortion. The axial X-band ESR spectrum of complex 1 is consistent with retention of this structure in solution. Complex 2 is a centrosymmetric dimer of dinuclear copper(II) complex molecules exhibiting intermolecular H-bonding and π-π-stacking interactions. The two copper(II) centres, which are 4.8067(18) Å apart and bridged by the thio-enolate nitrogen of the quadridentate thiosemicarbazonate ligand, display two different coordination geometries, one distorted square planar (τ4 = 0.082) and the other distorted square pyramidal (τ5 = 0.33). Such dinuclear copper(II) thiosemicarbazone complexes, which are crystallographically characterised, are extremely rare. In vitro, complexes 1 and 2 outperform cisplatin as antiproliferative agents in terms of potency and selectivity towards HeLa and MCF-7 cancer cell lines.

Prognostic accuracy of qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients presenting with suspected infection to the emergency department (PASSEM) Multicenter prospective external validation cohort study protocol.

BACKGROUND: Early identification of a patient with infection who may develop sepsis is of utmost importance. Unfortunately, this remains elusive because no single clinical measure or test can reflect complex pathophysiological changes in patients with sepsis. However, multiple clinical and laboratory parameters indicate impending sepsis and organ dysfunction. Screening tools using these parameters can help identify the condition, such as SIRS, quick SOFA (qSOFA), National Early Warning Score (NEWS), or Modified Early Warning Score (MEWS). We aim to externally validate qSOFA, SIRS, and NEWS/NEWS2/MEWS for in-hospital mortality among adult patients with suspected infection who presenting to the emergency department. METHODS AND ANALYSIS: PASSEM study is an international prospective external validation cohort study. For 9 months, each participating center will recruit consecutive adult patients who visited the emergency departments with suspected infection and are planned for hospitalization. We will collect patients' demographics, vital signs measured in the triage, initial white blood cell count, and variables required to calculate Charlson Comorbidities Index; and follow patients for 90 days since their inclusion in the study. The primary outcome will be 30-days in-hospital mortality. The secondary outcome will be intensive care unit (ICU) admission, prolonged stay in the ICU (i.e., ≥72 hours), and 30- as well as 90-days all-cause mortality. The study started in December 2021 and planned to enroll 2851 patients to reach 200 in-hospital death. The sample size is adaptive and will be adjusted based on prespecified consecutive interim analyses. DISCUSSION: PASSEM study will be the first international multicenter prospective cohort study that designated to externally validate qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients with suspected infection presenting to the ED in the Middle East region. STUDY REGISTRATION: The study is registered at ClinicalTrials.gov (NCT05172479).

Knowledge, awareness and use of current practice of palliative care amongst physiotherapists.

Background: Recently, there has been a marked increase in the incidence of cancer, HIV, and other noncommunicable diseases globally. Thus, the demand for palliative care (PC), including end-of-life care, continues to grow worldwide. Physiotherapy has an important role in PC as it aims to alleviate symptoms and improve quality of life by optimising independent levels of function. Objective: To assess the level of knowledge, awareness and current practice of PC amongst Nigerian physiotherapists in clinical practice. Method: Our study used a cross-sectional descriptive census-based method and recruited practising physiotherapists in Nigeria. An electronic questionnaire was used to collect data over 12 weeks, comprising 36 semistructured questions in four domains: personal information, knowledge, awareness and current practices regarding PC. Data were analysed using a pragmatist paradigm. Results: Of the 426 physiotherapists who participated, 50% (n = 213) had a postgraduate degree, 49.5% (n = 211) had a bachelor's degree and 0.5% (n = 2) had a Doctor of Physical Therapy degree. The results also indicate that 73.9% (n = 315) of the participants had sufficient knowledge about PC, 80.5% (n = 343) had a sufficient level of awareness about PC and 66.7% (n = 284) were using current clinical practices in the rehabilitation of critically ill patients or those with chronic conditions. Conclusion: It was concluded that most Nigerian physiotherapists had sufficient knowledge and awareness about PC and were involved in the management of patients requiring PC physiotherapy. Clinical implication: It can be understood that a large proportion of Nigerian physiotherapists have clinical experience managing patients requiring PC, despite inadequate formal training in this field.

The pharmacokinetics of 38% silver diamine fluoride in healthy children with dental caries: a quasi-experimental study.

PURPOSE: Silver diamine fluoride (SDF) is a medication used for the arrestment of dental caries. This study aims to determine the pharmacokinetics (PK) of silver and fluoride following SDF application in healthy children with dental caries. METHODS: A total of 15 subjects, aged 4 to 10 years, with at least one cavity on a primary tooth, were recruited for this study. Urine samples were collected at baseline, first 24 h (F1) and second 24 h (F2) after SDF treatment for analysis of silver and fluoride content. Hair samples were also collected at baseline and at 7, 14, 30, 60, 75, and 90 days after SDF treatment to analyze silver content. RESULTS: Participants with under or over-collection of urine, or failure to provide urine collection were excluded for fluoride analysis. As a result, eight subjects' urine samples were eligible for fluoride analysis. Significant correlations were observed between baseline urinary fluoride levels and F1/F2 levels. Pairwise comparisons from Friedman's test showed significant differences between baseline and F1 fluoride levels. For silver analysis, 15 subjects were studied. F1 urinary silver levels were higher than baseline and F2 levels. Subsequent to SDF treatment, hair silver levels displayed fluctuations around the baseline. None of the participants reported adverse effects, and all caries teeth ceased progression within 30 days. CONCLUSIONS: The urinary fluoride levels after SDF treatment, although higher, were not clinically significant. Urinary and hair silver levels were negligible. Therefore, SDF appears safe to be used among children.

Effect of transcutaneous spinal direct current stimulation on spasticity in upper motor neuron conditions: a systematic review and meta-analysis.

STUDY DESIGN: A systematic review and meta-analysis of clinical trials. OBJECTIVES: To determine the effect of non-invasive transcutaneous spinal direct current stimulation (tsDCS) on spasticity, activity limitations and participation restrictions in various upper motor neuron diseases. METHODS: Six databases including CINAHL plus, Cochrane CENTRAL, Embase, MEDLINE, SCOPUS and Web of Science were searched for the relevant records from January 2008 to December 2022. Two reviewers independently selected and extracted data on spasticity, activity limitations and participation restrictions. The risk of bias was evaluated using the PEDro scale while the GRADE approach established the certainty of the evidence. RESULTS: Eleven studies were identified of which 5 (45.5%) were rated as having a low risk of bias and 8 (72.7%) were meta-analyzed. The meta-analyses did not show any significant differences between cathodal (SMD = -0.67, 95% CI = -1.50 to 0.15, P = 0.11, I2 = 75%, 6 RCTs) or anodal (SMD = 0.11, 95% CI = -0.43 to -0.64, p = 0.69, I2 = 0%, 2 RCTs) and sham tsDCS for spasticity. There was also no significant difference between active and sham tsDCS for activity limitations (SMD = -0.42, 95% CI = -0.04 to 0.21, p = 0.2, I2 = 0%, 2 RCTs) and participation restrictions (MD = -8.10, 95% CI = -18.02 to 1.82, p = 0.11, 1 RCT). CONCLUSIONS: The meta-analysis of the available evidence provides an uncertain estimate of the effect of cathodal tsDCS on spasticity, activity limitation and participation restriction. It might be very helpful, or it may make no difference at all. However, considering the level of the evidence and the limitation in the quality of the majority of the included studies, further well-designed research may likely change the estimate of effect. TRIAL REGISTRATION: PROSPERO CRD42021245601.

Prevalence of psychological symptoms and their correlates among physiotherapy clinical students: A cross-sectional study.

Background: Mental health in medical students is well researched, with physiotherapy students receiving less attention even though psychiatry is a recognised specialty within physiotherapy. Objectives: To assess the prevalence and correlates of depression, anxiety and stress among physiotherapy clinical students. Methods: A descriptive cross-sectional study design was employed on 402 physiotherapy clinical students aged 17-40 years using a convenience sampling method. The data were collected using the self-administered 42-items Depression, Anxiety and Stress scale (DASS) and the data were analysed using a Chi-square test and binary logistic regression analysis. Results: The prevalence of depression, anxiety and stress among these students was 79.9%, 85.6% and 81.6%, respectively. The results indicate that financial status and social life influenced depression by 20.6% (odds ratio [OR] [95%] = 1.206 [1.110, 1.311]) and 36% (OR [95%] = 1.360 [1.050, 1.764]), respectively. Fear of repeating a class influenced anxiety by eight times (OR [95%] = 8.330 [6.643, 10.422]). Fear of repeating a class, financial status and academic performance influenced stress by eight times (OR [95%] = 8.360 [6.677, 10.470]), 17.5% (OR [95%] = 1.175 [1.083, 1.275]) and 18.1% (OR [95%] = 1.181 [1.083, 1.276]), respectively. Conclusion: Our study concluded that there was a high prevalence of depression, anxiety and stress among physiotherapy clinical students. These outcomes suggest that more attention needs to be given to improving physiotherapy clinical students' mental health, which will ultimately improve learning outcomes. Clinical implications: The long-term effects of psychological distress could potentially impact students' academic performance. It may also have long-lasting effects after graduation. Therefore, students who are at risk of developing psychological symptoms are needed to be thoroughly examined and then receive early required interventions.

Evaluation of in vitro antifungal effects of synthetic and herbal mouth rinses on oral Candida albicans and Candida glabrata.

Mouth rinses which function as breath fresheners, medicaments, and antiseptics can also deliver oral therapeutic agents. This study evaluated and compared the antifungal effects of synthetic and herbal mouth rinses on oral C. albicans and C. glabrata via disk diffusion, minimal inhibition concentration (MIC), minimum fungicidal concentration (MFC), time-kill assay, and growth profile tests. The four chemical mouth rinses, namely Brand O (A), Brand M (B), Brand H (C), and Brand B (D) used in the study showed positive antifungal activity in these two species. The average diameter of the inhibition zones obtained from the disk diffusion test was higher in mouth rinse B (C. albicans = 12.0 ± 0.9 mm, C. glabrata = 13.5 ± 0.8 mm) compared to those in C, A and D. Both Candida species exhibited similar MIC and MFC values, ranging from 1.63 ± 0.5 to 18.75 ± 0.0 µg/mL and 6.51 ± 2.01 to 50.00 ± 9.36 µg/mL, respectively. These synthetic mouth rinses had efficient killing activity eliminating 50% of the growing population of both Candida spp. following 15 seconds exposure time. Analyses of the growth profile curves showed that mouth rinses B and A resulted in rapid growth depletion of both Candida spp. Meanwhile, three herbal mouth rinses, namely Brand S (E), Brand C (F), and Brand P (G), were less effective against C. albicans and C. glabrata. Mouth rinses B and A contained cetylpyridinium chloride and chlorhexidine, respectively, and could be an effective alternative for controlling and preventing oral candidiasis.

Clinical, Radiological, and Outcome Characteristics of Acute Pulmonary Embolism: A 5-year Experience from an Academic Tertiary Center.

BACKGROUND: Acute pulmonary embolism (PE) is a common and potentially life-threatening condition. This comprehensive study from a Gulf Cooperation Council (GCC) country aimed to evaluate the clinical, radiological, and outcome characteristics associated with acute PE. METHODS: This retrospective observational study analyzed data of patients with confirmed acute PE who were admitted to the largest academic tertiary center in the State of Qatar from January 1, 2014, to December 31, 2018. Data on the clinical presentation, radiologic, and echocardiographic findings, as well as outcomes were collected. RESULTS: A total of 436 patients were diagnosed with acute PE during the study period (male, 53%). Approximately 56% of the patients were < 50 years old at presentation, with a median age of 47 years. In approximately 69% of cases, the PE occurred outside the hospital. The main associated comorbidities were obesity (34.6%), hypertension (29.4%), and diabetes (25%). Immobilization (25.9%) and recent surgery (20.6%) were the most common risk factors. The most frequent presenting symptom was dyspnea (39.5%), and the most frequent signs were tachycardia (49.8%) and tachypnea (45%). Cardiac arrest was the initial presentation in 2.2% of cases. Chest X-ray findings were normal in 41%. On computed tomography pulmonary angiography (CTPA), 41.3% of the patients had segmental PE, 37.1% had central PE, and 64.1% had bilateral PE. The main electrocardiographic (ECG) abnormality was sinus tachycardia (98%). In patients who underwent echocardiography, right ventricular (RV) enlargement was the main echocardiographic finding (36.4%). Low-, intermediate-, and high-risk PE constituted 49.8%, 31.4%, and 18.8% of the cases, respectively. Thrombolysis was prescribed in 8.3% of the total and 24.4% of the high-risk PE cases. Complications of PE and its treatment (from admission up to 6 months post-discharge) included minor bleeding (14%), major bleeding (5%), PE recurrence (4.8%), and chronic thromboembolic pulmonary hypertension (CTEPH) (5%). A total of 15 (3.4%) patients died from PE. CONCLUSIONS: Acute PE can manifest with complex and variable clinical and radiological syndromes. Striking findings in this study are the younger age of acute PE occurrence and the low PE-related mortality rate.

Development and Validation of a Simple Risk Model for Predicting Metabolic Syndrome (MetS) in Midlife: A Cohort Study.

Purpose: To develop and validate a simple risk model for predicting metabolic syndrome in midlife using a prospective cohort data. Design: Prospective cohort study. Participants: A total of 7626 members of the 1958 British birth cohort (individuals born in the first week of March 1958) participated in the biomedical survey at age 45 and have completed information on metabolic syndrome. Methods: Variables utilised were obtained prospectively at birth, 7, 16, 23 and 45 years. Multivariable logistic regression was used to develop a total of ten (10) MetS risk prediction models taking the life course approach. Measures of discrimination and calibration were used to evaluate the performance of the models. A pragmatic criteria developed was used to select one model with the most potential to be useful. The internal validity (overfitting) of the selected model was assessed using bootstrap technique of Stata. Main Outcome Measure: Metabolic syndrome was defined based on the NCEP-ATP III clinical criteria. Results: There is high prevalence of MetS among the cohort members (19.6%), with males having higher risk as compared to females (22.8% vs 16.4%, P < 0.001). Individuals with MetS are more likely to have higher levels of HbA1c and low HDL-cholesterol. Similarly, regarding the individual components of MetS, male cohort members are more likely to have higher levels of glycaemia (HbA1c), BP and serum triglycerides. In contrast, female cohort members have lower levels of HDL-cholesterol and higher levels of waist circumference. Furthermore, a total of ten (10) MetS risk prediction models were developed taking the life course approach. Of these, one model with the most potential to be applied in practical setting was selected. The model has good accuracy (AUROC 0.91 (0.90, 0.92)), is well calibrated (Hosmer-Lemeshow 6.47 (0.595)) and has good internal validity. Conclusion: Early life factors could be included in a risk model to predict MetS in midlife. The developed model has been shown to be accurate and has good internal validity. Therefore, interventions targeting socioeconomic inequality could help in the wider prevention of MetS. However, the validity of the developed model needs to be further established in an external population.

Life-Course Influence of Adolescent Behaviour Problems on Type 2 Diabetes in Midlife: Results from 1958 British Birth Cohort Study.

Purpose: To assess whether there is a long-term relationship between childhood behaviour problems and type 2 diabetes in midlife. The study will also investigate whether any of such relationship is independent of other factors which may be associated with type 2 diabetes. Design: Cohort study. Participants: A total of 9377 members of the 1958 British birth cohort participated in the biomedical survey at age 45 years. The cohort has been followed up at regular intervals in childhood (age 7, 11 and 16 years) and adulthood (23, 33, 42 and 45 years). Predictor Variables: Information regarding childhood behaviour collected during follow-ups at ages 7, 11 and 16 years. Main Outcome Variables: Type 2 diabetes assessed using HbA1c at age 45 years. Results: Unadjusted estimates show that teachers reported adolescent behaviour problems at age of 16 are associated with increased risk of type 2 diabetes in midlife. After adjustment for potential confounders and mediators in childhood and adulthood, a relationship was observed between the severity of adolescent behaviour problems and type 2 diabetes risk in midlife (mild behaviour problems: OR 2.17, 95% CI 1.11-4.23; severe behaviour problems: OR 4.40, 95% CI 1.14-16.99). However, no such relationship was observed between behaviour problems at 7 and 11 years and type 2 diabetes in midlife. Conclusion: There is an association between adolescent behaviour problems and an increased risk of type 2 diabetes in midlife. Further molecular/genetic studies are required to understand the biological basis for this observed association.

Comparison of the Ivermectin and Lopinavir/Ritonavir Treatment Outcomes among COVID-19 Mild to Moderate Cases in Kaduna State.

BACKGROUND: Ivermectin has been a popular anti-parasitic drug since the late 1970s. The promising result of in-vitro studies on the antiviral activity of the drug has led clinicians in many countries to use this drug to treat COVID-19 patients. This study determined and compared the mean number of days at clinical recovery for mild to moderate cases of COVID -19 treated with Lopinavir/Ritonavir (Alluvia) and Ivermectin at the Kaduna State Infectious Disease Control Centres. METHODS: This was a comparative cross-sectional study conducted among 300 mild to moderate COVID- 19 cases enrolled for the study. The outcome variables were the time required for the resolution of symptoms from the onset and at commencement of the treatment regimens. Data were collected from patient folders using a questionnaire. Data were analysed with the IBM SPSS Version 25.0 and STATA/SE 13. Statistical significance was set at p<0.05. RESULTS: The mean recovery time (MRT) from symptom onset was significantly lower for Covid-19 patients treated with ivermectin (7.15±4.18 days) compared to lopinavir/ritonavir (9.7±5.3 days), 95%CI=7.37-9.62. Multivariate logistic regression showed that there was no significant relationship between the patients age (AOR=0.36, 95%CI=0.09-1.49), sex (AOR=0.34,95%CI=0.54-5.93), educational status (AOR=1.04, 95%CI=0.3-3.57), marital status (AOR=0.55,95%CI=0.14-2.11) place of treatment (AOR=1.66, 95%CI=0.54-5.11) and MRT. There was also no significant relationship between patients' comorbid chronic illness (AOR=0.83, 95%CI=0.27-2.61) and MRT. CONCLUSION: The mean recovery time for COVID-19 patients managed with ivermectin was slightly lower than for the lopinavir/ ritonavir regimen. RECOMMENDATION: Clinical trials to further prove the efficacy of Ivermectin as a supportive therapy in clinical management of mild to moderate cases of COVID-19 in this setting should be carried out.

CONTEXTE: L'ivermectine a été un médicament antiparasitaire populaire depuis la fin des années 1970. Le résultat prometteur d'études in vitro sur l'activité antivirale du médicament a conduit les cliniciens de nombreux pays à utiliser ce médicament pour traiter les patients atteints de COVID-19. Cette étude a déterminé et comparé le nombre moyen de jours de récupération clinique pour les jours légers à cas modérés de COVID-19 traités par Lopinavir/Ritonavir (Alluvions) et ivermectine à la maladie infectieuse de l'État de Kaduna Centres de contrôle. MÉTHODES: Il s'agissait d'une étude comparative transversale menée auprès de 300 cas légers à modérés de COVID-19 inscrits pour l'étude. Les variables de résultat étaient le temps requis pour la résolution des symptômes dès le début et au début de la schémas thérapeutiques. Les données ont été recueillies à partir des dossiers des patients à l'aide d'un questionnaire. Les données ont été analysées avec version 25.0 du IBM SPSS et STATA/SE 13. La signification statistique a été fixée à p<0.05. RÉSULTATS: Le temps moyen de récupération (TRM) à partir de l'apparition des symptômes était significativement plus faible chez les patients Covid-19 traités par l'ivermectine(7.15±4.18 jours) par rapport au lopinavir/ritonavir (9.7±5.3 jours), IC à 95 % = 7.37 à 9.62. La régression logistique multivariée a montré qu'iln'avait pas de relation significative entre l'âge des patients (AOR = 0.36, IC à 95 % = 0.09 à 1.49), sexe (AOR = 0.34, 95 % IC = 0.54 à 5.93), education statut (AOR =1.04, IC à 95 % = 0.3­3.57), état matrimonial(AOR = 0.55, 95% IC = 0.14­2.11) lieu de traitement (AOR = 1.66, IC à 95 % = 0.54 à 5.11) et TRM. Il n'y avait pas non plus de relation entre la maladie chronique comorbide des patients (AOR = 0.83, IC à 95 % = 0.27 à 2.61) et TRM. CONCLUSION: Le temps de récupération moyen pour les patients atteints de COVID-19 gérés avec de l'ivermectine était légèrement inférieur à celui du lopinavir/régime de ritonavir. RECOMMANDATION: Essais cliniques pour prouver l'efficacité de l'ivermectine comme traitement de soutien dans la prise en charge clinique des cas lègers à modérés de COVID-19 dans ce contexte devraient être effectués. Mot-clés: Ivermectine, Alluvie, Traitement, MRT, Essai clinique, COVID-19.

Saddle versus non-saddle pulmonary embolism: differences in the clinical, echocardiographic, and outcome characteristics.

The central location, the size, and instability of saddle pulmonary embolism (PE) have raised considerable concerns regarding its hemodynamic consequences and the optimal management approach. Sparse and conflicting reports have addressed these concerns in the past. We aimed to evaluate the clinical presentation, hemodynamic and echocardiographic effects, as well as the outcomes of saddle PE, and compare the results with those of non-saddle type. This was a retrospective study of 432 adult patients with saddle and non-saddle PE. Overall, 432 patients were diagnosed with PE by computed tomography pulmonary angiography (CTPA). Seventy-three (16.9%) had saddle PE, and 359 had non-saddle PE. Compared to those with non-saddle PE, patients with saddle PE presented more frequently with tachycardia (68.5% vs. 46.2%, P= .001), and tachypnea (58.9% vs. 42.1%, P= .009) on admission, required more frequent intensive care unit (ICU) admissions (45.8% vs. 26.6%, P= .001) and thrombolysis/thrombectomy use (19.1% vs. 6.7%, P= .001), and were at more risk of developing decompensation and cardiac arrest after their initial admission (15.3% vs. 5.9%, P= .006). On echocardiography, right ventricular (RV) enlargement (60% vs. 31.1%, P= .000), RV dysfunction (45.8% vs. 22%, P= .000), and RV systolic pressure (RVSP) of greater than 40 mmHg (61.5% vs. 39.2%, P= .003) were significantly more observed with saddle PE. The two groups did not differ concerning the rates of hypotension (17.8% vs. 18.7%, P= .864) and hypoxemia (41.1% vs. 34.3%, P= .336) on admission and mortality rates. A logistic regression model indicated that the use of oral contraceptive pills (OCP), RVSP > 40 mmHg, and development of hypotension and decompensation following admission were associated with an increased likelihood of having saddle embolus. Saddle PE accounts for a higher proportion among all PE cases than previously reported. Patients with saddle PE tend to present more frequently with adverse hemodynamic and echocardiographic changes and decompensate after their initial presentation. OCP use, development of hypotension, and decompensation following admission and RVSP > 40 mmHg are significant predictors of saddle PE. These characteristics should not be overlooked when managing patients with saddle PE.

Tracing Some Salivary Immune Elements in Iraqi SARS-2 Patients.

Saliva is one of the most significant components in maintaining oral homeostasis and symbiosis. It contains antimicrobial proteins and peptides, such as mucins, lactoferrin, lysozyme, lactoperoxidase, Catherine, statins, and antibodies (secretory immunoglobin A [sIgA]). Early defenses against respiratory infections rely heavily on mucosal immunity, especially secretory sIgA, which has several features and functions that make it suitable for mucosal defense. Salivary testing has been utilized to define mucosal immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Lysozyme has muramidase, with antimicrobial activity, and high concentrations in body fluids, such as saliva and tear. This research aimed to offer an update on how saliva components suppress viral infection and sustain health. A total of 50 individuals, including 30 SARS-2 patients and 20 non-infected subjects, in the age range of 32-54 years were enrolled in this study. Saliva specimens were obtained from polymerase chain reaction (PCR)-confirmed coronavirus disease 2019 (COVID-19) patients and non-infected participants. To collect saliva, the subjects were advised to swirl water over their lips three times, and 5.0 ml of saliva was collected. Samples were centrifuged at 800 x g for 10 min. Saliva was diluted at 1:2,000 with 1 × Diluent N. The immunoglobulin A (IgA) titer in saliva was detected. A spectrophotometer was used to measure the solution's change in absorbance at 550 nm. Measurements (salivary IgA and lysozyme) were made after 7, 30, and 60 days of confirmatory PCR COVID-19 test. The mean scores of salivary IgA levels were obtained at 17.85, 15.26, and 10.73 mg/dl in patients and 9.53, 10.33, and 9.21 mg/dl in healthy individuals after 7, 30, and 60 days, respectively. The salivary lysozyme activity levels in SARS-2 patients compared to controls were 9.7, 7.3, and 4.2 mg/dl versus 2.9, 3.4, and 3.77 mg/dl, respectively. The salivary IgA level was significantly higher in patients of a confirmatory test for COVID-19 compared to healthy individuals.

Predictors of COVID-19 vaccine acceptance among Nigerian medical doctors

Background: Since its discovery in late 2019, COVID-19 has claimed approximately three million lives worldwide, causing a significant economic burden and strain on health care delivery and services. Therefore, the COVID-19 vaccine may offer the potential to promote global recovery. Objective: To determine the acceptability of the COVID-19 vaccine among Nigerian doctors and the factors influencing the acceptance. Methods: Using a cross-sectional design, an anonymous online survey was administered to medical doctors across the six geopolitical zones in Nigeria between 13 January and 31 January 2021, using the health belief model (HBM). Results: Out of 830 respondents, 38.8% were willing to take the COVID-19 vaccine, 36.0% were unsure, while the remaining 26.5% refused to take the vaccine. Following adjustments, males were more likely to take the vaccine (OR = 3.357; 95% CI 2.009-5.610; p = 0.0001), whereas increasing age, higher perceived viral virulence and perceived viral infectivity were observed to be significantly associated with less likelihood of accepting the vaccine. Respondents who believed in the efficacy of ivermectin were much less likely to receive the vaccine (OR = 0.217; 95% CI 0.108-0.436; p=0.001). Concerns on vaccination safety were the main barriers to vaccine acceptability. Hypothetically addressing these concerns increased vaccine acceptance rates by approximately a third (34.6%) (p < 0.001). Conclusion: The proposed nationwide distribution of the COVID-19 vaccine may be met with poor vaccine acceptability among Nigerian medical practitioners. Measures specifically addressing vaccine safety concerns should be provided to allay fears and enhance the acceptability of the vaccine.

Evaluation of in vitro antifungal effects of synthetic and herbal mouth rinses on oral Candida albicans and Candida glabrata

@#Mouth rinses which function as breath fresheners, medicaments, and antiseptics can also deliver oral therapeutic agents. This study evaluated and compared the antifungal effects of synthetic and herbal mouth rinses on oral C. albicans and C. glabrata via disk diffusion, minimal inhibition concentration (MIC), minimum fungicidal concentration (MFC), time-kill assay, and growth profile tests. The four chemical mouth rinses, namely Brand O (A), Brand M (B), Brand H (C), and Brand B (D) used in the study showed positive antifungal activity in these two species. The average diameter of the inhibition zones obtained from the disk diffusion test was higher in mouth rinse B (C. albicans = 12.0 ± 0.9 mm, C. glabrata = 13.5 ± 0.8 mm) compared to those in C, A and D. Both Candida species exhibited similar MIC and MFC values, ranging from 1.63 ± 0.5 to 18.75 ± 0.0 µg/mL and 6.51 ± 2.01 to 50.00 ± 9.36 µg/mL, respectively. These synthetic mouth rinses had efficient killing activity eliminating 50% of the growing population of both Candida spp. following 15 seconds exposure time. Analyses of the growth profile curves showed that mouth rinses B and A resulted in rapid growth depletion of both Candida spp. Meanwhile, three herbal mouth rinses, namely Brand S (E), Brand C (F), and Brand P (G), were less effective against C. albicans and C. glabrata. Mouth rinses B and A contained cetylpyridinium chloride and chlorhexidine, respectively, and could be an effective alternative for controlling and preventing oral candidiasis.

Strength exercise for balance and gait in HIV-associated distal symmetrical polyneuropathy: A randomised controlled trial.

BACKGROUND: HIV-associated peripheral neuropathy (PN) is a common neurological complication associated with HIV infection. Distal symmetrical polyneuropathy (DSPN) is the most commonly occurring type, which is associated with symptoms such as numbness, unsteady gait and, in some cases, muscle atrophy and weakness when myelinated nerve fibres are affected. If unmyelinated nerve fibres are affected, a painful neuropathy and autonomic symptoms may occur. OBJECTIVES: This research study assessed the effects of a strength exercise intervention on balance impairment and gait disturbance amongst individuals living with HIV-associated DSPN. METHOD: The study was a single-blinded, randomised controlled trial (RCT) with participants sourced from four HIV centres in Kano metropolis, Nigeria. The intervention was supervised and included progressive resistance exercise (PRE) (three 40-min sessions per week for 12 weeks) using a quadriceps bench (n = 44). The control group (CG) included the non-exercise group (n = 47). The two groups continued to receive routine care. Data were summarised and analysed using inferential statistics (SPSS version 20 program) with the alpha level set at < 0.05. RESULTS: At 12 weeks, the results revealed significant improvement with regard to balance performance (p = 0.001) and walking ability (p = 0.001) in the training group. In contrast, no significant differences in balance (P = 0.677) or gait (P = 0.578) were observed in the CG. CONCLUSION: The findings suggest that PRE is beneficial for balance impairment and gait disturbance caused by neuropathy in persons living with HIV and receiving antiretroviral drugs.

Oral bacteria detection among children with cancer in a tertiary teaching hospital in Kuala Lumpur, Malaysia.

This study sought to determine the prevalence of pathogenic and non-pathogenic bacteria in the oral cavities of children with cancer. There were 68 paediatric patients with cancer who were included in this study. Oral swab samples from the dorsum of tongues and mouth floors of these patients were subjected to culture, staining, and molecular methods to detect the bacteria. The overall prevalence of gram-positive and gram-negative bacteria was 79.4% (54/68; 95% CI = 68.4 - 87.3) and 25% (17/68; 95% CI = 16.2 - 36.4), respectively. Streptococcus salivarius and Streptococcus parasanguinis were the predominant pathogenic grampositive bacteria, while Neisseria subflava and Neisseria perflava were the most common pathogenic gram-negative bacteria. The results revealed that the number of bacteria isolates recovered in patients receiving cancer treatment was higher (55.9%) than those who had not received treatment (16.2%). Therefore, more isolated pathogenic bacteria were observed post-therapy (54.4%). Pathogenic organisms can have significant implications on patient health. Awareness of the types of bacteria inhabiting the oral cavity is essential to predict and prevent dental problems, and their associated systemic complications. Findings on the diversity of oral microflora can also provide a better understanding of the aetiology of oral diseases in paediatric patients receiving cancer treatment.