Exercise-based gaming in patients with multiple sclerosis: A systematic review and meta-analysis.

Background: Multiple sclerosis presents a significant burden, with balance disturbances impacting patients' daily living. Conventional therapies have been supplemented with technological advancements like virtual reality (VR) and exergaming, providing engaging, multisensory rehabilitation options. Objective: This study aimed to synthesize evidence on exergaming's role in multiple sclerosis treatment, particularly to evaluate the impact of exergaming on cognitive, motor, and psychological outcomes in patients with multiple sclerosis. Methods: A systematic review and subsequent meta-analysis design were employed. An extensive search was conducted up to June 2023 across five electronic databases - Web of Science, Scopus, PubMed, Cochrane, and EMBASE. The data extraction process from the selected studies was conducted independently. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool 1 (ROB1) and the National Institutes of Health (NIH) assessment tool. Continuous outcomes were consolidated as mean differences (MD) with 95% confidence intervals (CIs). Meta-analyses were performed using RevMan ver. 5.4. Results: Out of 1,029 studies, 27 were included for meta-analysis. There were no significant differences in cognitive outcomes between the exergaming and the no-intervention group or the Conventional Physiotherapy and Rehabilitation interventions (CPRh) subgroups. However, the Symbol Digit Modalities Test (SDMT) showed a statistically significant difference in favor of exergaming in the no-intervention subgroup (MD = 5.40, 95% CI [0.08, 10.72], p = 0.05). In motor outcomes, exergaming only demonstrated better results in the 6-minute walking test compared to the no-intervention group (MD = 25.53, 95% CI [6.87, 44.19], p = 0.007). The Berg Balance Scale score in both studied subgroups and the Timed Up and Go (TUG) test in the no-intervention group favored exergaming. In terms of psychological outcomes, the Beck Depression Inventory did not reveal any significant differences, while the Modified Fatigue Impact Scale (MFIS) score favored exergaming in the CPRh subgroup. Conclusion: Exergaming shows promise for enhancing cognitive and motor functions, motivation, adherence, and quality of life in MS patients, which is beneficial for nurses. It can be tailored to individual preferences and easily conducted at home, potentially serving as a viable alternative to traditional rehab programs, especially during relapses. However, further research is necessary to fully understand its optimal and lasting benefits.

Association between oral diseases and impact on daily performance among male Saudi schoolchildren.

Objective: Little is known about exploring the oral health related quality of life (OHRQoL) of school children in Saudi Arabia. The importance of examining this topic has centred on its ability to measure associations between the oral symptoms, impacts and clinical measures. This study aims to explore associations between the (OHRQoL) based on the children's Oral Impacts on Daily Performance (Child-OIDP) index and oral diseases of Saudi school children living in Albaha region. Materials and methods: A cross-sectional study was conducted between November 2017 to January 2018 using two-stage randomised sampling technique. The oral diseases and impacts were examined using the World Health Organization's (1997) guidelines and the Child-OIDP index, respectively. Data analysis was conducted using the SPSS software version 20.0. Chi-squared, bivariate and multivariate logistic regression tests were used, as appropriate. Results: In total 349 Saudi male school children, 12 to 15 years old, were recruited. The Child-OIDPrate was significantly high (75.1%). The participants reported minor, moderate and major (severe) oral impacts (29.4%, 50%, and 20.6% respectively). The overall mean of the Child-OIDP score was 2.15±1.40. Conclusions: The high overall Child-OIDP score was in accordance with the participants' dental status. Further research should focus on improving knowledge and implementing education programmes to advance the community's oral diseases and practices.

'Hearing hooves, finding zebras': the differential diagnosis of cardiac arrest precipitated by chest pain in the postpartum woman.

We describe the case of a 3-week postpartum 27-year-old woman who presented with chest pain to the emergency department shortly before developing cardiac arrest with refractory ventricular fibrillation. She was initially misdiagnosed and treated for presumed pulmonary embolism (PE) with thrombolysis. A total of 14 direct current cardioversion shocks were given and return of spontaneous circulation (ROSC) was achieved post thrombolysis. Subsequent CT pulmonary angiography excluded PE. A post-ROSC ECG demonstrated anterolateral ST elevation and she was transferred to the local cardiac unit for angiography. This revealed extensive dissection of the left anterior descending artery (LAD) with proximal occlusion. The diagnosis therefore was pregnancy-associated spontaneous artery dissection, a type of acute coronary syndrome. She received percutaneous intervention to her LAD with five drug-eluting stents. The patient survived and was discharged 5 days later. Her ventricular function is now grossly impaired, and had the correct diagnosis been arrived at sooner, this loss of function would have been less severe.

Prevalence of anaemia among Quranic school (Khalawi) students (Heiran)in Wad El Magboul village, rural Rufaa, Gezira State, Central Sudan: a cross sectional study.

INTRODUCTION: This is a cross sectional descriptive community-based study. The aim was to assess the prevalence of anaemia among quranic schoolchildren in khalawi Wad EL Magboul village, rural Rufaa, Gezira State, central Sudan. METHODS: A sample of 180 male participants were included in the study. Informed consent was obtained. Venous blood samples were obtained to measure the hematological parameters and blood films for malaria parasites. Urine and stool analyses were also done. Data were analyzed using SPSS. RESULTS: The mean age of participants was 12.31 years (SD +/- 2.26). The mean Hb value was 11.75g/dl and it was statistically significant correlation when compared with the mean Hb reference value (13.5g/dl) P value 0,000 (95% CI). Regarding period of stay in the khalwa up to the time of the study, 88 (49.28%) for one year, 54 (30.24%) for 2 years, 22 (12.32%) for 3 years and 16 (8.96%) for more than 3 years. About 77 students (42.78%) were pale on clinical examination. The Mean Cell Hemoglobin (MCH) mean value was 25.58 pg ( 3.55). Many conditions known to be associated with anemia were found; 49 students (27.2%) had a positive blood films for falciparum malaria, 14 students (7.8%) were found to have haematuria and ova of S. haematobium, In169 students (93.4%) stool examination was negative , while 11 students (6.6%) had intestinal worms (Enterobius vermicularis). CONCLUSION: Majority of the study participants had iron deficiency anaemia, followed by haemolytic, macrocytic and sickle cell anaemia. This might have negative health and educational implications.

Green synthesis, antimicrobial and cytotoxic effects of silver nanoparticles mediated by Eucalyptus camaldulensis leaf extract

OBJECTIVE: To investigate the environmental-friendly extracellular biosynthetic technique for the production of the silver nanoparticles (AgNPs) by using leaf extract of Eucalyptus camaldulensis (E. camaldulensis). METHODS: The NP were characterized by colour changes and the UV-visible spectroscopy. The cytotoxic effects of prepared AgNPs was detected against four types of pathogenic bacteria, including two Gram-negative bacteria (Pseudomonas aeruginosa and Escherichia coli) and two Gram-positive bacteria (Staphylococcus aureus and Bacillus subtilis) by using agar well diffusion method. RESULTS: A peak absorption value between 400-450 nm for the extract and the colour change to dark brown were corresponding to the plasmon absorbance of AgNPs. On the other hand, aqueous extract of E. camaldulensis leaves could be effective against tested microorganisms which showed inhibition zones of 9.0-14.0 mm. Furthermore, biologically synthesized AgNPs had higher ability to suppress the growth of the tested microorganisms (12.0-19.0 mm). CONCLUSIONS: Our findings indicated that extracellular synthesis of AgNPs mediated by E. camaldulensis leaf extract had an efficient bactericidal activity against the bacterial species tested. The exact mechanism of the extracellular biosynthesis of metal NP was not well understood. Further studies are needed to highlight the biosynthesis process of AgNPs and also to characterize the toxicity effect of these particles.

Efficacy of VBHOM to predict outcome following major lower limb amputation.

PURPOSE: This study tests an existing Vascular Biochemistry and Haematology Outcome Model (VBHOM) on independent data and presents further refinements to the model. METHODS: Data from 306 patients who underwent lower limb amputation over a 4-year period were collated. Urea, creatinine, sodium, potassium, hemoglobin, white cell count, albumin, age, gender, mode-of-admission, and short-term mortality events were extracted from the database. This study tests an existing model and trains a new model for predicting mortality using forward stepwise logistic regression. RESULTS: The existing model suggests a significant lack of fit (c-index = 0.665, P = .04). For the exception of gender and mode-of-admission, all predictor variables had significant univariate associations with short-term mortality (P < .05). The refined model included age, sodium, potassium, creatinine, and albumin and had good discriminatory power (c-index = 0.8, no evidence of lack of fit, P = .616). CONCLUSIONS: Our simplified model had good predictive ability and suggests redundancy in input variables used by the existing models.

Study on some trace element contents in serum and nail samples obtained from Sudanese subjects.

This study was performed to investigate trace elements and arsenic contents among Sudanese inhabitants living in the north, east, and west of Sudan. Inductively coupled plasma atomic emission spectrometry was used to determine the contents of Zn and Cu. Graphite furnace atomic absorption spectrometry was used to determine Se in serum samples. It was found that Se and Cu are in the normal range. Zinc showed discrepancies among all studied groups. Acute Zn deficiency was detected in the northern and eastern regions of Sudan. Inductively coupled plasma mass spectroscopy was operated in the dynamic reaction cell mode to determine the arsenic content in the nail samples of the northern inhabitants of Sudan. High values of arsenic were found in the northern people compared with the control group. This elevation could be linked to the misuse of insecticides and herbicides which might be associated with the high rate of cancer incidence in this region.