Sex-specific differences in presenting symptoms of obstructive sleep apnea

OBJECTIVES

Scant data from India are available on the gender differences in presenting features of Obstructive Sleep Apnea (OSA) in India. This study aims to compare male and female patients with OSA for general characteristics and presenting symptoms.

METHODOLOGY

Retrospective study was done in OSA patients diagnosed in our sleep lab. History, biochemical reports, and polysomnography variables were retrieved from the sleep registry and were compared between males and females.

RESULTS

Out of 514 patients of OSA (367 males; 147 females). Females were older (55.97 ± 9.73 v/s 50.2 + 12.70 years, P<0.001) and more obese (BMI 35.26 ± 7.17 v/s 29.58 ± 5.49 Kg/m2; P<0.001). Waist and hip circumference were significantly higher in the female patients (P = 0.009 and <0.001 respectively). Morning headache, nocturia, fatigability (P < 0.001), and depression (P = 0.005) was more common in females (P = 0.036). Hypersomnia was more commonly seen in males (P < 0.001). Mean diastolic blood pressure was significantly higher in males, although no difference was seen in Systolic BP. Females had higher mean Fasting Blood glucose (FBS) (P = 0.02). Apnea hypopnea index was significantly higher in females {P = 0.01}.

CONCLUSION

Women with OSA are more obese, elderly, and with higher fasting blood glucose than males at the time of diagnosis. Females have a higher prevalence of symptoms like fatigability, depression, nocturia and early morning headache and had more severe AHI than males.

Flexor Hallucis Longus Transfer And V-Y Plasty: An Effective Treatment Modality for Chronic Achilles Rupture - A Case Series

Introduction

To assess outcomes of FHL transfer and V-Y plasty for chronic Achilles rupture due to insertional Achilles tendinopathy.

Materials and methods

A case series of 12 patients was conducted between 1st January 2017 and 31st December 2018. The patients had short flexor hallucis longus tendon transfer with gastrocnemius lengthening by V-Y plasty for Achilles tendon rupture. Patients were allowed full weight bearing at six weeks post-operatively, and were followed up at three months and six months post-operatively, when the range of motion of the ankle was examined, and the outcome was assessed using the EFAS score.

Results

Of the 12 patients in the study, the majority were males; the mean age was 50.6±8.96 years. A significant improvement in dorsiflexion and plantarflexion was noted at the six-month follow-up compared to the three-month follow-up (P=<0.001 for both). When compared to the normal side, dorsiflexion and plantarflexion of the affected ankle were significantly less at three months but were comparable at six months post-operatively. A significant improvement was noted in the mean EFAS score at the six-month follow-up (25.5±5.71) compared to three months (18.6±0.90) post-surgery (P=0.001). Males were also noted to have significantly higher EFAS scores at their six-month follow-up than females (P=0.022). In contrast, a negative correlation was noted between the European Foot and Ankle Society (EFAS) score at the final follow-up and age (P=0.011).

Conclusion

FHL tendon transfer with V-Y plasty in chronic Achilles rupture due to insertional Achilles tendinopathy is an effective procedure resulting in the restoration of the ankle range of motion and improvement in functional scores.

The clinical impacts of the controlling nutritional status score on patients with Hodgkin lymphoma

OBJECTIVE

The aim of the study was to evaluate the clinical importance and potential mechanisms of controlling nutritional status (CONUT) score as a prognostic tool for Hodgkin lymphoma (HL).

PATIENTS AND METHODS

Diagnosed with HL, 307 patients were included in the study. Patients' demographic data, stages, B symptoms, extranodal involvement, presence of bulky disease, laboratory findings, treatments, treatment responses, nutritional status, and overall survival (OS) rates were evaluated from the hospital records. The primary endpoint of our study was to evaluate and classify newly diagnosed HL patients under the CONUT score. The secondary endpoint was to indicate any relationship between nutritional status, CONUT score, and other prognostic factors and OS.

RESULTS

Of 307 patients (173 males, 134 females), the mean age was 41.58±16.26 (ranging between 18-82 years). The most common type of malignancy was nodular sclerosis (72.53%). To the receiver operating characteristic (ROC) curve analysis, the best cut-off point was 2.5 to predict mortality. Eigthy-five (27.7%) and 222 (72.3%) patients had ≥3 and ≤2 CONUT scores, respectively. Twenty-four (10.80%) and 23 (27.10%) cases were also mortal in the patients with ≤2 and ≥3 CONUT scores, respectively (p<0.001). Survival times were significantly lower in those with higher (≥3) CONUT scores (p<0.001) than among the other patients.

CONCLUSIONS

Evaluation of nutritional status plays an important role in the response and survival of those with hematological malignancies. Malnutrition can reduce patients' tolerance to chemotherapy and increase the risk of secondary infections. In this study, undernutrition evaluated with the CONUT score was demonstrated to be a potential independent prognostic factor for OS in patients with HL.

Efficient Blind Signal Separation Algorithms for Wireless Multimedia Communication Systems.. [DOI: 10.21203/rs.3.rs-2869492/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

This paper studies the problem of multi-user blind signal separation (BSS) in wireless communications. The existing separation algorithms work on quadrature phase shift keying (QPSK). Through this work two proposed algorithms were presented to enhance the BSS performance. The first proposed algorithm uses wavelet denoising to remove noise from the received signals in time domain. It adopts different modulation techniques such as minimum shift keying (MSK), quadrature phase shift keying (QPSK), and Gaussian minimum shift keying (GMSK) then uses several BSS algorithms such as independent component analysis (ICA), principle component analysis (PCA), and multi user kurtosis (MUK) algorithms. The second proposed algorithm transfers the problem of BSS to transform domain and uses wavelet denoising to reduce noise effect on received mixture. BSS with Discrete Sine Transform (DST) and Discrete Cosine Transform (DCT) were investigated and compared to time domain performance. Minimum square error (MSE) and signal to noise ratio (SNR) were used as the evaluating metrics. Simulation results proved that in time domain, MUK with QPSK gives best performance and wavelet denoising was found to enhance the performance of BSS under all conditions. Signal separation in transform domain was found to give better performance than that in time domain due to the energy compaction process of these transforms and noise reduction due to their averaging effect.

Systems genetics identifies miRNA-mediated regulation of host response in COVID-19

BACKGROUND

Individuals infected with SARS-CoV-2 vary greatly in their disease severity, ranging from asymptomatic infection to severe disease. The regulation of gene expression is an important mechanism in the host immune response and can modulate the outcome of the disease. miRNAs play important roles in post-transcriptional regulation with consequences on downstream molecular and cellular host immune response processes. The nature and magnitude of miRNA perturbations associated with blood phenotypes and intensive care unit (ICU) admission in COVID-19 are poorly understood.

RESULTS

We combined multi-omics profiling-genotyping, miRNA and RNA expression, measured at the time of hospital admission soon after the onset of COVID-19 symptoms-with phenotypes from electronic health records to understand how miRNA expression contributes to variation in disease severity in a diverse cohort of 259 unvaccinated patients in Abu Dhabi, United Arab Emirates. We analyzed 62 clinical variables and expression levels of 632 miRNAs measured at admission and identified 97 miRNAs associated with 8 blood phenotypes significantly associated with later ICU admission. Integrative miRNA-mRNA cross-correlation analysis identified multiple miRNA-mRNA-blood endophenotype associations and revealed the effect of miR-143-3p on neutrophil count mediated by the expression of its target gene BCL2. We report 168 significant cis-miRNA expression quantitative trait loci, 57 of which implicate miRNAs associated with either ICU admission or a blood endophenotype.

CONCLUSIONS

This systems genetics study has given rise to a genomic picture of the architecture of whole blood miRNAs in unvaccinated COVID-19 patients and pinpoints post-transcriptional regulation as a potential mechanism that impacts blood traits underlying COVID-19 severity. The results also highlight the impact of host genetic regulatory control of miRNA expression in early stages of COVID-19 disease.

Purple Wheat: Food Development, Anthocyanin Stability, and Potential Health Benefits

Colored wheats such as black, blue, or purple wheat are receiving a great interest as healthy food ingredients due to their potential health-enhancing attributes. Purple wheat is an anthocyanin-pigmented grain that holds huge potential in food applications since wheat is the preferred source of energy and protein in human diet. Purple wheat is currently processed into a variety of foods with potent antioxidant properties, which have been demonstrated by in vitro studies. However, the health impacts of purple wheat foods in humans still require further investigations. Meanwhile, anthocyanins are vulnerable molecules that require special stabilization treatments during food preparation and processing. A number of stabilization methods such as co-pigmentation, self-association, encapsulation, metal binding, and adjusting processing conditions have been suggested as a means to diminish the loss of anthocyanins in processed foods and dietary supplements. The present review was intended to provide insights about purple wheat food product development and its roles in human health. In addition, methods for stabilizing anthocyanins during processing were briefly discussed.

Cerebrospinal fluid neurofilament light chain differentiates primary psychiatric disorders from rapidly progressive, Alzheimer's disease and frontotemporal disorders in clinical settings

INTRODUCTION

Many patients with cognitive and neuropsychiatric symptoms face diagnostic delay and misdiagnosis. We investigated whether cerebrospinal fluid (CSF) neurofilament light (NfL) and total-tau (t-tau) could assist in the clinical scenario of differentiating neurodegenerative (ND) from psychiatric disorders (PSY), and rapidly progressive disorders.

METHODS

Biomarkers were examined in patients from specialist services (ND and PSY) and a national Creutzfeldt-Jakob registry (Creutzfeldt-Jakob disease [CJD] and rapidly progressive dementias/atypically rapid variants of common ND, RapidND).

RESULTS

A total of 498 participants were included: 197 ND, 67 PSY, 161 CJD, 48 RapidND, and 20 controls. NfL was elevated in ND compared to PSY and controls, with highest levels in CJD and RapidND. NfL distinguished ND from PSY with 95%/78% positive/negative predictive value, 92%/87% sensitivity/specificity, 91% accuracy. NfL outperformed t-tau in most real-life clinical diagnostic dilemma scenarios, except distinguishing CJD from RapidND.

DISCUSSION

We demonstrated strong generalizable evidence for the diagnostic utility of CSF NfL in differentiating ND from psychiatric disorders, with high accuracy.

The association between body fat percentage and self-reported depression in the United Arab Emirates

Background

The United Arab Emirates Healthy Future Study (UAEHFS) is one of the first large prospective cohort studies in the region which examines causes and risk factors for chronic diseases among adult UAE nationals. The aim of this study was to explore the relationship between body fat percentage (BF%) and the eight-item Patient Health Questionnaire (PHQ-8) as a screening instrument for depression among the UAEHFS pilot study participants.

Methods

We analyzed the UAEHFS pilot data to investigate the association between BF% and PHQ-8 adjusted for age and gender. We used multivariate logistic ordinal regression model. To impute missing values, 100 multiple imputations (MI) were performed using multivariate imputation of classification and regression tree. The statistical analysis was performed using R Statistical Software (version 4.2.0)

Results

Out of 517 participants, data from 487 (94.2%) were analyzed after excluding participants who didn't fill out the questionnaires. The median age was 30 years (Interquartile Range: 23 - 38). There were more males (67.8%) than females in the UAEHF pilot data. Approximately, 64 (13.1%) of the participant reported depression. The prevalence of obesity was 35.2% in this study population. The estimated odds ratio of BF% from the fitted multivariate logistic ordinal regression model was OR = 1.046 (95% CI: 1.012-1.08), and OR = 1.03 (95% CI: 1.003-1.057) for the omitted data, and MI (sensitivity analysis) respectively.

Conclusions

High body fat percentage was statistically significantly associated with high risk of reporting depression. Additional research is needed, using the main UAEHFS data (after recruitment is complete), to further investigate the association between body fat percentage and depression.

Key messages

• Our results can help contribute to the knowledge based on current and potential population mental health in the UAE and Gulf Region.

• The main finding of this study that excess body fat is associated with an increased risk of developing depression and vice versa; thus, this could add to the future direction of mental health research.

Plasma neurofilament light chain protein is not increased in treatment-resistant schizophrenia and first-degree relatives

OBJECTIVE

Schizophrenia, a complex psychiatric disorder, is often associated with cognitive, neurological and neuroimaging abnormalities. The processes underlying these abnormalities, and whether a subset of people with schizophrenia have a neuroprogressive or neurodegenerative component to schizophrenia, remain largely unknown. Examining fluid biomarkers of diverse types of neuronal damage could increase our understanding of these processes, as well as potentially provide clinically useful biomarkers, for example with assisting with differentiation from progressive neurodegenerative disorders such as Alzheimer and frontotemporal dementias.

METHODS

This study measured plasma neurofilament light chain protein (NfL) using ultrasensitive Simoa technology, to investigate the degree of neuronal injury in a well-characterised cohort of people with treatment-resistant schizophrenia on clozapine (n = 82), compared to first-degree relatives (an at-risk group, n = 37), people with schizophrenia not treated with clozapine (n = 13), and age- and sex-matched controls (n = 59).

RESULTS

We found no differences in NfL levels between treatment-resistant schizophrenia (mean NfL, M = 6.3 pg/mL, 95% confidence interval: [5.5, 7.2]), first-degree relatives (siblings, M = 6.7 pg/mL, 95% confidence interval: [5.2, 8.2]; parents, M after adjusting for age = 6.7 pg/mL, 95% confidence interval: [4.7, 8.8]), controls (M = 5.8 pg/mL, 95% confidence interval: [5.3, 6.3]) and not treated with clozapine (M = 4.9 pg/mL, 95% confidence interval: [4.0, 5.8]). Exploratory, hypothesis-generating analyses found weak correlations in treatment-resistant schizophrenia, between NfL and clozapine levels (Spearman's r = 0.258, 95% confidence interval: [0.034, 0.457]), dyslipidaemia (r = 0.280, 95% confidence interval: [0.064, 0.470]) and a negative correlation with weight (r = -0.305, 95% confidence interval: [-0.504, -0.076]).

CONCLUSION

Treatment-resistant schizophrenia does not appear to be associated with neuronal, particularly axonal degeneration. Further studies are warranted to investigate the utility of NfL to differentiate treatment-resistant schizophrenia from neurodegenerative disorders such as behavioural variant frontotemporal dementia, and to explore NfL in other stages of schizophrenia such as the prodome and first episode.

Multidimensional psychopathological profile differences between patients with psychogenic nonepileptic seizures and epileptic seizure disorders

OBJECTIVE

Early differential diagnosis of psychogenic nonepileptic seizures (PNES) and epileptic seizures (ES) remains difficult. Self-reported psychopathology is often elevated in patients with PNES, although relatively few studies have examined multiple measures of psychopathology simultaneously. This study aimed to identify differences in multidimensional psychopathology profiles between PNES and ES patient groups.

METHOD

This was a retrospective case-control study involving patients admitted for video-EEG monitoring (VEM) over a two-year period. Clinicodemographic variables and psychometric measures of depression, anxiety, dissociation, childhood trauma, maladaptive personality traits, and cognition were recorded. Diagnosis of PNES or ES was determined by multidisciplinary assessment and consensus opinion. General linear mixed models (GLMMs) were used to investigate profile differences between diagnostic groups across psychometric measures. A general psychopathology factor was then computed using principal components analysis (PCA) and differences between groups in this 'p' factor were investigated.

RESULTS

261 patients (77 % with ES and 23 % with PNES) were included in the study. The PNES group endorsed greater symptomatology with GLMM demonstrating a significant main effect of group (η²_p = 0.05) and group by measure interaction (η²_p = 0.03). Simple effects analysis indicated that the PNES group had particularly elevated scores for childhood trauma (β = 0.78), dissociation (β = 0.70), and depression (β = 0.60). There was a high correlation between psychopathology measures, with a single p factor generated to explain 60 % variance in the psychometric scores. The p factor was elevated in the PNES group (β = 0.61). ROC curve analysis indicated that these psychometric measures had limited usefulness when considered individually (AUC range = 0.63-0.69).

CONCLUSION

Multidimensional psychopathological profile differences exist between patients with PNES and ES. Patients with PNES report more psychopathology overall, with particular elevations in childhood trauma, dissociation, and depression. Although not suitable to be used as a standalone screening tool to differentiate PNES and ES, understanding of these profiles at a construct level might help triage patients and guide further psychiatric examination and enquiry.

12 Trends in Neck of Femur Fracture Incidence in EU15+ Countries From 1990–2017

Background

Neck of femur fractures (NOFF) pose significant socio-economic costs to society with a high degree of morbidity and mortality. Its incidence rate has been collated within the Global Burden of Disease (GBD) database; however, to date, no comparison across countries has been reported.

Method

NOFF age-standardised incidence rates (ASIR) per 100,000 population were extracted from the GBD database for European Union (EU) 15+ countries over the period 1990 to 2017. Joinpoint regression analysis of the data identified trends in ASIR and associated estimated annual percentage changes (EAPC). These were analysed by specified timeframe, country, and gender.

Results

Of the 19 EU15+ countries, 11 (58%) had overall increases in NOFF ASIRs in 2017 compared to 1990. The median ASIRs were 240/100,000 and 322/100,000 for males and females, respectively, in 1990. By 2017, this had increased to 259/100,000 and 325/100,000, respectively. Females consistently had relatively higher NOFF ASIRs with a median gender fracture gap of 62/100,000 in 2017. Males had a higher percentage change in increasing ASIRs, with a smaller percentage change in decreasing ASIRs for all included countries. The highest national ASIRs was observed in Australia, followed by Finland and Belgium. Conversely the Mediterranean countries demonstrated the lowest ASIRs, closely followed by the USA.

Conclusions

Despite significant advances in primary and secondary hip fracture prevention strategies over the 28-year study period, significant increases in NOFF ASIRs among most EU15+ countries were observed, especially with respect to gender.

The Impact of Innovative Plant Sources (Cordia myxa L. Fruit (Assyrian Plum) and Phoenix dactylifera L. Biowaste (Date Pit)) on the Physicochemical, Microstructural, Nutritional, and Sensorial Properties of Gluten-Free Biscuits

The gluten-free products available on the markets are deficient in bioactive compounds and high in cost. The present study is designed to develop gluten-free biscuits with enhanced nutritional properties. The gluten-free biscuits are formulated with rice flour (RF) incorporated with Assyrian plum fruit flour (APF) and bio-waste date-pit flour (DPF) according to the following ratios; RF:DPF:APF (100:0:0)/T0, (90:5:5)/T1, (80:10:10)/T2, and (70:15:15)/T3. The results demonstrate that flour blends with different concentrations of APF and DPF incorporated in RF have high contents of protein, damaged starch, crude fiber, ash, phytochemicals, and antioxidants in contrast to 100% RF, which shows the lowest values for all these parameters. The pasting properties of the flour blends reveals that the values of peak, final, breakdown, and setback viscosities reduce from T1 to T3. Similarly, a differential scanning calorimeter reveals that the phase transition temperature of the flour blends decreases with the increasing amylose content. Moreover, the scanning electron microscopy of the biscuit samples shows a positive contribution of APF and DPF for the development of the desired compactness of the structure due to the leaching of amylose content from the starch. The total phenol content (TPC) and total flavonoid content (TFC) increase from 38.43 to 132.20 mg GAE/100 g DW and 18.67 to 87.27 mg CE/100 g DW, respectively. Similarly, the antioxidant activities of biscuits improved. The protein and fiber contents of the biscuits increased from 10.20 to 14.73% and 0.69 to 12.25%, respectively. The biscuits prepared from T3 resulted in a firmer texture with a reduced spread ratio. However, the formulation of T1 and T2 biscuit samples contributed to desirable physical and sensory properties. Therefore, the addition of DPF and APF to RF is a sustainable way to make gluten-free biscuits as they provide adequate amylose, damaged starch, and fiber content to overcome the essential role of gluten in the baked product with nutraceutical properties.

Determinants of agricultural competitiveness: the case of pineapple production among smallholders in Johor, Malaysia

Pineapple is a tropical fruit that contains great nutritional values and fine flavour with high export potential and provides income generation for many smallholders in Malaysia. In 2019, Malaysia exported pineapple-based products worth RM419 million. Therefore, this paper aimed to analyse the competitiveness of pineapple in Malaysia, which was relatively understudied in the literature, especially in Asia. In this study, the level of competitiveness of fresh pineapple production among smallholders at the farm level was evaluated using an extension to the Policy Analysis Matrix (PAM). The extension provides a disaggregate analysis that has allowed the development of the distribution of competitiveness scores for each pineapple production at individual farms, taking into consideration the drawbacks of the use of aggregated data. In the second stage of the analysis, the multiple regression method was used to examine the key determinants that affected the competitiveness of pineapple production. A sample of 191 smallholders was randomly selected in Johor. The results demonstrated that Malaysian smallholders particularly in Johor had strong comparative advantages in the production of pineapple. The findings showed the Social Cost Benefit (SCB) value was less than 1, which means at a social price, the average smallholders were socially profitable and internationally competitive. However, by using disaggregated data, the results proved that some smallholders were not producing social profits where 29% of them remained uncompetitive internationally. Apart from that, the results of regression analysis revealed that the competitiveness of pineapple production was significantly influenced by age, working experience, farm size and the variety of pineapple. To conclude, the study presented recommendations for the potential enhancement of viability and competitiveness of pineapple smallholders.

P-691 Assessment of ovarian vascularity by three-dimensional vaginal power Doppler on day seven of menstrual cycle to predict the number of eggs collected in antagonist cycle

Study question

Could ovarian vascularity indices on day 2 and 7 of stimulation, measured by 3-dimensional (3D) vaginal power Doppler, predict after controlled ovarian stimulation?

Summary answer

Ovarian vascularity index (VI) on day 7 may be an indicator of poor (&lt;three mature eggs collected) ovarian responses to gonadotropins.

What is known already

Poor and/or hyper ovarian responses to gonadotropins may be related to cycle cancellation during controlled ovarian stimulation (COS). In this context, gonadotropin dose is often individualized using patient features that predict ovarian response (such as age, antral follicular count (AFC) and anti-Müllerian hormone (AMH)). In parallel, ovarian vascularity color doppler is a valuable evaluation method to predict the ovarian hyperstimulation syndrome and the growth/maturity of Graafian follicles. The aim of the present study is to estimate the utility of 3-dimensional vaginal power Doppler and ovarian vascular flow indices in the prediction of the number of mature occytes collected after COS.

Study design, size, duration

A prospective study was conducted on 296 couples undergoing intracytoplasmic sperm injection cycle at Al Hadi Laboratory and Medical center, Beirut, Lebanon. It was performed between January 2020 and dec 2021. Couples were categorized into poor responders group (3 or less metaphase II (MII) eggs collected) (36.1%), high responders group (16 or more MII eggs collected) group ( 6.7%), and normal responders group (more than 3 and less than 16 MII eggs collected) (57,2%).

Participants/materials, setting, methods

On the second and seventh day of the menstrual cycle, ovarian volume and vascularity parameters (vascularity index (VI), flow index (FI), and vascularity flow index (VFI)) were measured using the 3D power Doppler and the Virtual Organ Computer-Aided Analysis. On day 2 , the antral follicle count was evaluated and a blood sample for AMH testing was collected. Women included in the study have undergone COS using GnRH antagonist protocol.

Main results and the role of chance

Mean age was 35,88+/- 6 year , day2 VI and day2 VFI correlates with the number of egg collected (p = 0.014 and 0.045 respectively).

9 parameters were used to predict poor and high ovarian responses (Age, AMH, AFC, day2 VI, day2 FI , day2 VFI , day7 VI, day7 FI and day7 VFI) in a Receiver operator characteristics (ROC) curve model .

Ovarian day7 FI significantly predicted poor ovarian response to gonadotropins (p = 0.038) with an area under the curve of 0.679. AFC predicted also poor ovarian response to gonadotropins (p = 0.006) . In parallel, AFC significantly predicted high ovarian response to gonadotropins (p = 0.002) and AUC (0.778) while all other 3D doppler parameters couldn’t predict high responders.

Limitations, reasons for caution

It will be necessary to perform a prospective analysis on a broad sample size to validate these findings. In addition, it will be interesting to assess the impact of ovarian vascularity on pregnancy outcomes.

Wider implications of the findings

Assessing ovarian vascularity during ovarian stimulation can help reduce the rate of cycle cancellation. In addition, more studies are welcomed in the field to unravel the mechanisms behind altered ovarian vascularity and to test the possibility of restoring normal ovarian physiology.

Trial registration number

Not Applicable

Colchicine anti-inflammatory therapy for non-intensive care unit hospitalized COVID-19 patients: results from a pilot open-label, randomized controlled clinical trial

Systemic inflammation is a hallmark of severe coronavirus disease-19 (COVID-19). Anti-inflammatory therapy is considered crucial to modulate the hyperinflammatory response (cytokine storm) in hospitalized COVID-19 patients. There is currently no specific, conclusively proven, cost-efficient, and worldwide available anti-inflammatory therapy available to treat COVID-19 patients with cytokine storm. The present study aimed to investigate the treatment benefit of oral colchicine for hospitalized COVID-19 patients with suspected cytokine storm. Colchicine is an approved drug and possesses multiple anti-inflammatory mechanisms. This was a pilot, open-label randomized controlled clinical trial comparing standard of care (SOC) plus oral colchicine (colchicine arm) vs. SOC alone (control arm) in non-ICU hospitalized COVID-19 patients with suspected cytokine storm. Colchicine treatment was initiated within first 48 hours of admission delivered at 1.5 mg loading dose, followed by 0.5 mg b.i.d. for next 6 days and 0.5 mg q.d. for the second week. A total of 96 patients were randomly allocated to the colchicine (n=48) and control groups (n=48). Both colchicine and control group patients experienced similar clinical outcomes by day 14 of hospitalization. Treatment outcome by day 14 in colchicine vs control arm: recovered and discharged alive: 36 (75.0%) vs. 37 (77.1%), remain admitted after 14-days: 4 (8.3%) vs. 5 (10.4%), ICU transferred: 4 (8.3%) vs. 3 (6.3%), and mortality: 4 (8.3%) vs. 3 (6.3%). The speed of improvement of COVID-19 acute symptoms including shortness of breath, fever, cough, the need of supplementary oxygen, and oxygen saturation level, was almost identical in the two groups. Length of hospitalization was on average 1.5 day shorter in the colchicine group. There was no evidence for a difference between the two groups in the follow-up serum levels of inflammatory biomarkers including C-reactive protein (CRP), D-dimer, lactate dehydrogenase (LDH), ferritin, interleukin-6 (IL-6), high-sensitivity troponin T (hs-TnT) and N-terminal pro b-type natriuretic peptide (NT pro-BNP). According to the results of our study, oral colchicine does not appear to show clinical benefits in non-ICU hospitalized COVID-19 patients with suspected cytokine storm. It is possible that the anti-inflammatory pathways of colchicine are not crucially involved in the pathogenesis of COVID-19.

AB0908 Treating to target of psoriasis: An evidence-based consensus on clinical practice recommendations

Background

The Tight Control of psoriatic arthritis (TICOPA) trial revealed a treat to target (T2T) strategy has led to improved clinical outcomes in psoriatic arthritis (PsA). The heterogeneity of the disease, the feasibility of therapy and the associated comorbidities made the implementation of such strategy in routine care a real challenge. There is a high need for establish real world recommendations for the T2T approach in PsA tailored to the disease activity status, the Psoriasis manifestations as well as the individual patient’s requirements.

Objectives

to provide up-to-date, evidence-based and consensus-based recommendations for Treat-to-Target management of psoriatic arthritis (PsA) and its associated clinical manifestations.

Methods

14 key clinical questions were identified by scientific committee according to the Patient/ Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. Literature Review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 3-round Delphi process was conducted with 19 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations.

Results

An online questionnaire were sent to expert panel who participated in the three rounds (response rate 100%). At the end of round 3, a total of fifty-one recommendation items, categorized into 6 sections to address the main 6 PsA categories, were obtained. Agreement with the recommendations (rank 7-9) ranged from 89.5-100%. Consensus was reached (i.e.≥75%of respondents strongly agreed or agreed) on the wording of all the 51 clinical standards identified by the scientific committee. Algorithms for the management of PsA have been suggested.

Conclusion

These recommendations provide an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal treat to target outcomes in in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation.

Disclosure of Interests

None declared

POS1168 TREAT TO TARGET OF GOUT: AN EVIDENCE-BASED CONSENSUS ON CLINICAL PRACTICE GUIDELINES

Background

New therapies, management approaches and evidence regarding the management of gout have become available over the past years. This triggered the need for updated recommendations for the management of gout.

Objectives

to develop an up-to-date consensus evidence-based clinical practice guideline for the management of gout including recommendations for management of acute gout flares, optimum usage of urate lowering therapy for chronic gout as well as patient education and lifestyle guidance.

Methods

An extensive systematic literature review was performed, and evidence-based recommendations were extrapolated, based on 16-key questions identified according to population, intervention, comparator, and outcomes (PICO) approach. For each item, the level of evidence was determined using the Oxford Centre for Evidence-based Medicine (CEBM) system. These were evaluated by a panel of 17-experts via online surveys over a 2-round Delphi process.

Results

At the end of round 2, a total of 30-recommendation items, categorized into 10 domains to were obtained. Agreement with the recommendations (rank 7-9) ranged from 90-100%. Consensus was reached (i.e.≥75%of respondents strongly agreed or agreed) on the wording, the grade of recommendation and level of evidence of all the 30 clinical standards identified by the scientific committee. The guideline emphasized that all gouty patients should be screened for comorbidities. Based on this, an algorithm for treat to target management approach tailored to the individual patient’s needs and associated comorbidities has been outlined.

Conclusion

This work provides updated evidence-based recommendations for the prevention and treatment of acute as well as chronic gouty arthritis. It provides an approach for physicians and patients making decisions on the management of gout. It will also facilitate improvement and uniformity of care.

Disclosure of Interests

None declared

Third-order neutral differential equations of the mixed type: Oscillatory and asymptotic behavior

In this work, by using both the comparison technique with first-order differential inequalities and the Riccati transformation, we extend this development to a class of third-order neutral differential equations of the mixed type. We present new criteria for oscillation of all solutions, which improve and extend some existing ones in the literature. In addition, we provide an example to illustrate our results.

Sleep EEG Signatures in COVID-19 Survivors

Study Objectives

Effect of COVID-19 on sleep architecture is not known. This study was done to find out EEG changes seen during sleep in COVID-19 survivors.

Methodology

In this prospective single centre study, consecutive patients diagnosed with RTPCR confirmed COVID 19 were included after 4–6 weeks of discharge from hospital. All patients underwent level I PSG. EEG was analysed for presence of abnormal EEG pattern.

Results

Total 189 patients were contacted telephonically for participation in this study. Finally 81 patients (55 males, 26 females) underwent Level I PSG. Total sleep time was 345.1 ± 85.1 min. Sleep efficiency was 76.0 ± 14.2%. Mean time (%) during N1, N2, N3 and Rapid Eye movement (REM) was 16.4%, 59.2%, 7.9% and 18.4% percentage, respectively. Mean AHI was 28.7 ± 22.8 per hour and arousal index was 23.9 ± 13.3. Alpha intrusion was the most common EEG finding (78%), followed by cyclical alternating pattern (59%). REM density was significantly increased in 38% of patients. REM alpha bursts and increased spindles were also seen in 27% and 16%.

Conclusion

Abnormal EEG waves are very commonly seen in COVID-19 survivors. Presence of these abnormal PSG-EEG waves hints that COVID-19 might have similar effects as depression, insomnia on these subjects, at least in short run. Whether these changes are temporary or permanent needs to be evaluated by performing serial polysomnographies in patients with COVID-19 ARDS.

932 Delivering Excellence in Orthopaedic Training - A Five Year Qualitative Study of Characteristics Valued by Trainees Voting for Trainer of The Year

Background

Previous studies have described attributes of successful trainers. Dean et al’s (2017) systematic analysis found 12 commonly cited positive characteristics in medical literature. This paper and Nisar et al’s (2011) study which had a more exhaustive list of desirable qualities in surgical trainers formed the basis of our thematic analysis to identify trainer characteristics/behaviours valued by trainees on an orthopaedic training programme.

Method

We evaluated qualitative data from votes on the North West Thames rotation for Trainer of the Year over a 5-year period (2016-2020). We applied thematic analysis to identify 15 characteristics commonly cited by trainees in their nominations and logged how frequently each characteristic was raised.

Results

The five most popular qualities possessed by nominees are 1) prioritisation of training needs and endeavouring to create more training opportunities for trainees 2) being a source of support 3) willingness to allow trainees to operate 4) setting and facilitating the achievement of educational goals/targets 5) providing appropriate levels of supervision. All 15 valued characteristics and their frequency of mention are listed in the table presented.

Conclusions

To the best of our knowledge this is the only study which focuses exclusively on desirable qualities orthopaedic specialist trainees’ value in their trainers. ‘Advocating for trainees’ is a valued quality, also highlighted in ASIT’s 2018 analysis of the Silver Scalpel Award nominations, which is not otherwise well described in the literature. We hope our work will allow aspiring orthopaedic trainers insight into what trainee’s value most in a surgical mentor.

1266 Digital Rectal Examination: Do You Still Put Your Foot in It If You Don’t Put Your Finger in It?

Introduction

Most surgical trainees are familiar with the aphorism ‘if you don’t put your finger in it, you put your foot in it’, with regards to digital rectal examination (DRE). This commonly taught maxim, attributed to Bailey and Love in their Short Practice of Surgery, was coined to highlight the folly of neglecting DRE in patients with histories suggestive of malignant anorectal pathology. However, data are lacking on the diagnostic yield of DRE for detecting anorectal cancer in patients with lower gastrointestinal bleeding (LGIB), whilst advances in biomarker and imaging technology beg the question: is there still a role for DRE in the assessment of patients with LGIB?

Method

We designed a clinical coding search strategy to identify all adult patients with acute LGIB referred to general surgery at a UK university hospital from January to July 2020. Electronic patient records were interrogated to identify history and examination findings, diagnoses and clinical outcomes.

Results

169 patients (median age 63 (16-94) years, 54.4% male) were identified, 74.6% (126/169) with bright red bleeding, 23.7% (40/169) with altered blood and 1.8% (3/169) with melaena. DRE was performed in 91.1% (154/169) of patients, identifying blood in 42.9% (66/154) of cases and suspicious lesions, which were subsequently confirmed as anorectal malignancy, in 1.3% (2/154).

Conclusions

DRE represents a possibly stigmatising and uncomfortable examination for patients and clinicians alike. These data support the utility of DRE in patients with LGIB and may inform the discussion at the bedside to facilitate the timely diagnosis of anorectal malignancy.

1439 A Change in The Use of Post-Operative Drains in Total Knee Arthroplasty (TKA)

Aim

Closed suction drains (CSD) are routinely used to reduce the risk of haematoma formation and wound infections in TKA. Our study aims to determine if the use of drains has any impact on estimated blood loss, transfusion rates and length of stay in hospital.

Method

Elective TKA cases performed under a single consultant between February 2018-March 2020 were identified. Electronic medical records were reviewed, and data collected on relevant variables. Estimated blood loss was calculated using Ward’s formula. Mann-Whitney U test was applied to assess for statistical significance.

Results

A total of 86 elective TKA cases were included in the study. In 41 cases patients had a CSD insitu post-operatively (group 1), in the other 45 cases a drain was not used (group 2). Both groups had similar distributions of age, BMI, and sex. We found no statistically significant differences in mean change (+/-SD) in haemoglobin post-operatively between group 1 (21.3 (+/- 9.4)) and group 2 (19 (+/- 10)), (p = 0.34). Mean estimated blood loss was 915mls (+/-365) for group 1 and 871mls (+/-455) for group 2, (p = 0.45). Group 1 had a higher rate of transfusion (4.8% vs 2.2%); however, this was not statistically significant (p = 0.51). After accounting for unrelated medical complications or social barriers to discharge, the length of hospital stay was 4.7 (+/- 2.27) and 4.9 (+/- 3.14) for group 1 and 2 respectively, (p = 0.84). There were no reported cases of wound infection in both groups.

Conclusions

We found the use of drains in TKA confers no benefits in the outcomes evaluated.

1134 Incidence of Bile Acid Diarrhoea Post-Cholecystectomy - A Single Centre Cohort

Aim

Bile acid diarrhoea (BAD) can occur as a result of enterohepatic circulation interruption following cholecystectomy. Although up to 57.2% of patients are reported to develop post-cholecystectomy diarrhoea, this is not always because of BAD. The aim of this study was to determine the incidence of post-cholecystectomy BAD diagnosis and evaluate the current practices.

Method

This study was conducted as part of BADCAP study. The electronic records of patients underwent cholecystectomy operation at Oxford University Hospitals between January 2013 and December 2017 were retrospectively analysed. Records were matched with patients who underwent 75SeHCAT testing during the same time period. A positive 75SeHCAT testing was defined as a seven-day retention time of &lt; 15%.

Results

A total of 4327 patients underwent cholecystectomy operation. 2.05% (N = 89) investigated for diarrhoea by 75SeHCAT. Alongside 75SeHCAT, 69.7% (N = 62) had colonoscopy, 37.1% (N = 33) had CT abdomen and pelvis and 3.4% (N = 3) had MRCP/MRE. Gender wise statistics revealed females were 74.5% (N = 73) and males were 19.1% (N = 17). Median time from cholecystectomy to 75SeHCAT test was 780 days (SD +/-510 days). 70.8% (N = 63) had a positive 75SeHCAT test for BAD. IBD was confirmed in 2.2% (N = 2).

Conclusions

A small number of patients were investigated and only 1.5% were diagnosed with post-cholecystectomy diarrhoea. There was a significant time delay from operation to diagnosis. The true prevalence of BAD after cholecystectomy may be much higher and clinicians need to have an increased awareness of this condition. 75SeHCAT is a useful tool for diagnosis of bile acid diarrhoea.

Glycogen synthase kinase-3 (GSK-3) a magic enzyme: it's role in diabetes mellitus and glucose homeostasis, interactions with fluroquionlones. A mini-review

Diabetes mellitus (DM) is a non-communicable disease throughout the world in which there is persistently high blood glucose level from the normal range. The diabetes and insulin resistance are mainly responsible for the morbidities and mortalities of humans in the world. This disease is mainly regulated by various enzymes and hormones among which Glycogen synthase kinase-3 (GSK-3) is a principle enzyme and insulin is the key hormone regulating it. The GSK-3, that is the key enzyme is normally showing its actions by various mechanisms that include its phosphorylation, formation of protein complexes, and other cellular distribution and thus it control and directly affects cellular morphology, its growth, mobility and apoptosis of the cell. Disturbances in the action of GSK-3 enzyme may leads to various disease conditions that include insulin resistance leading to diabetes, neurological disease like Alzheimer's disease and cancer. Fluoroquinolones are the most common class of drugs that shows dysglycemic effects via interacting with GSK-3 enzyme. Therefore, it is the need of the day to properly understand functions and mechanisms of GSK-3, especially its role in glucose homeostasis via effects on glycogen synthase.

Modulating the production of xylanase by Bacillus pumilus BS131 through optimization using waste fiber sludge

In recent days, cheapest alternative carbon source for fermentation purpose is desirable to minimize production cost. Xylanases have become attractive enzymes as their potential in bio-bleaching of pulp and paper industry. The objective of the present study was to identify the potential ability on the xylanase production by locally isolated Bacillus pumilus BS131 by using waste fiber sludge and wheat bran media under submerged fermentation. Culture growth conditions were optimized to obtain significant amount of xylanase. Maximum xylanase production was recorded after 72 hours of incubation at 30 °C and 7 pH with 4.0% substrate concentration. In the nutshell, the production of xylanase using inexpensive waste fiber sludge and wheat-bran as an alternative in place of expensive xylan substrate was more cost effective and environment friendly.

P–688 Assessment of ovarian vascularity by three-dimensional vaginal power Doppler on day two of menstrual cycle to predict the number of mature eggs collected

Study question

Could ovarian vascularity indices, measured by 3-dimensional (3D) vaginal power Doppler, predict the number of mature oocytes collected after controlled ovarian stimulation?

Summary answer

Ovarian vascularity index (VI) may be an indicator of poor (&lt;three mature eggs collected) and high (&gt;ten mature eggs collected) ovarian responses to gonadotropins.

What is known already

Poor and/or hyper ovarian responses to gonadotropins may be related to cycle cancellation during controlled ovarian stimulation (COS). In this context, gonadotropin dose is often individualized using patient features that predict ovarian response (such as age, antral follicular count (AFC) and anti-Müllerian hormone (AMH)). In parallel, ovarian vascularity color doppler is a valuable evaluation method to predict the ovarian hyperstimulation syndrome and the growth/maturity of Graafian follicles. The aim of the present study is to estimate the utility of 3-dimensional vaginal power Doppler and ovarian vascular flow indices in the prediction of the number of mature occytes collected after COS.

Study design, size, duration

A prospective study was conducted on 200 couples undergoing intracytoplasmic sperm injection cycle at Al Hadi Laboratory and Medical center, Beirut, Lebanon. It was performed between January 2020 and July 2020. Couples were categorized into poor responders group (3 or less metaphase II (MII) eggs collected) (n = 43), high responders group (10 or more MII eggs collected) group (n = 66), and normal responders group (more than 3 and less than 10 MII eggs collected) (n = 66).

Participants/materials, setting, methods

On the second day of the menstrual cycle, ovarian volume and vascularity parameters (vascularity index (VI), flow index (FI), and vascularity flow index (VFI)) were measured using the 3D power Doppler and the Virtual Organ Computer-Aided Analysis. On the same day, the antral follicle count was evaluated and a blood sample for AMH testing was collected. Women included in the study have undergone COS using GnRH antagonist protocol.

Main results and the role of chance

Receiver operator characteristics (ROC) curve model was used to predict the number of mature eggs collected. 7 parameters were used to predict poor and high ovarian responses (Age, AMH, AFC, ovarian volume, VI, FI and VFI). Ovarian VI significantly predicted poor ovarian response to gonadotropins (p = 0.033 and area under the curve (AUC)=0.668). Subsequently, the cut off value was 0.0025 with 84% sensitivity and 83.3% specificity. In parallel, ovarian VI significantly predicted high ovarian response to gonadotropins (p = 0.036 and AUC (0.778)) with a cut off value 0.0375 and with 77.8% sensitivity and 78.3% specificity. Furthermore, VFI significantly predicted high ovarian response to gonadotropins (p = 0.045; AUC=0.677).

Limitations, reasons for caution

It will be necessary to perform a prospective analysis on a broad sample size to validate these findings. In addition, it will be interesting to assess the impact of ovarian vascularity on pregnancy outcomes.

Wider implications of the findings: Assessing ovarian vascularity prior to ovarian stimulation can help reduce the rate of cycle cancellation. In addition, more studies are welcomed in the field to unravel the mechanisms behind altered ovarian vascularity and to test the possibility of restoring normal ovarian physiology.

Trial registration number

Not applicable

Antibacterial and antioxidant potential of the phenolic extract and its fractions isolated from Allium ascalonicum (onion) peel

Aqueous methanolic (20:80) crude extract of the outer peel of Allium ascalonicum (onions) was fractionated into anthocyanin (II), acidic (i.e., phenolic acids, Ia), neutral A (i.e., flavanols, Ib) and neutral B (i.e., flavonols, Ic) phenols using C-18 and hydrophilic-lipophilic balanced (HLB) Co-polymer cartridges. The fractions were analysed for total phenolic, total flavonoids, antibacterial activity, antioxidant potential and lipoxygenase (LOX) inhibition. The recovery of total phenols and bio functional activity in all fractions were found to be more in HLB. All fractions showed antimicrobial activity against tested strains with phenolic acids (Ia) being most active and flavanol (Ib) least active, while the highest free radical scavenging, reducing power and LOX inhibition was exhibited by flavonol (Ic) and least by flavanols (Ib). HPLC analysis revealed the presence of vanillic acid and quercetin in non-anthocyanin I and cyanidin in anthocyanin II.

Psychiatric and cognitive characteristics of older adults admitted to a Video-EEG monitoring (VEM) unit

OBJECTIVE

To compare the clinical, psychiatric, and cognitive characteristics of older with younger patients presenting to a video-EEG monitoring (VEM) unit.

METHOD

This was a retrospective case-control study involving patients admitted for VEM over a two-year period (from April 2018 to April 2020) at two comprehensive epilepsy units. Patients were categorized into an older (≥60 years) and a younger (<60 years) group. Younger patients were individually matched to older adults to form a matched younger group. Diagnosis was determined by a consensus opinion of epileptologists, neurologists, and neuropsychiatrists. The main diagnostic categories were epilepsy, psychogenic nonepileptic seizures (PNES), and 'other' diagnosis (non-diagnostic and other nonepileptic diagnoses). Clinical psychiatric diagnoses were obtained from neuropsychiatric reports. Objective cognitive function was measured with the Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG). Subjective cognitive function was assessed using the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) cognitive subscales.

RESULTS

Five-hundred and thirty three patients (71 older, 462 younger) aged 16-91 years were admitted to the VEM unit during the study period. There was a diagnosis of focal epilepsy in 55% of the older group and 48% of the younger group, generalized epilepsy in 3% of the older group and 10% of the younger group, and 'other' in 32% of the older group and 19% of the younger group. Ten percent (2 males and 5 females) of the older group were diagnosed with PNES compared to 22% of the younger group (p = 0.016). A depressive disorder was diagnosed in 34% of the older group and 24% of the younger group (p = 0.20). An anxiety disorder was diagnosed in 15% of the older group and 25% of the younger group (p = 0.15). Mild neurocognitive disorder was more common in the older group (34%) compared to the matched younger group (34% vs 3%, p < 0.001). The older group had lower mean NUCOG scores compared to the matched younger group (79.49 vs 87.73, p = <0.001). There was no evidence for a relationship between mean NUCOG score and overall subjective cognitive difficulties for the older group (r = 0.03, p = 0.83). Among older adults, those diagnosed with PNES had more experiences of childhood trauma. Measures of dissociation, depression, or general anxiety did not differ between PNES and non-PNES diagnoses in the older group.

CONCLUSION

Psychiatric comorbidities are common among older adults admitted for VEM. The psychological impact of epilepsy and risk factors for PNES seen in younger patients are also applicable in the older group. The older group demonstrated more cognitive impairments than the younger group, although these were usually unrecognized by individuals. Older adults admitted to VEM will benefit from psychiatric and neuropsychological input to ensure a comprehensive care approach to evaluation and management.

Episode of Hepatitis C viral infection in the people of Swat, Pakistan

Infectious agents cause serious diseases in humans worldwide and are responsible for the high rate of morbidity and mortality. The prevalence and epidemiology of infectious disease (HCV) in the hospital visited patients referred by the physicians through the initial findings and their associated risk factors were studied in Swat. The data of 174 infected patients were collected during the period of 2015 to 2017 from two clinical laboratories of Tehsil Matta Swat. Inform consent form was taken before blood collection. After taking informed consent blood samples were collected and ICT test was performed and then ICT positive cases were conform through PCR. A total of 174 ICT positive samples [106 male and 68 females] were included in this study. Age was considered from 10 to 72 years. Of the 174 ICT strip positive, 99 [63 males, 36 females] were confirmed through PCR. The prevalence rate was recorded 56.89%. I.V/I.M injection was recorded in 100% of the individuals. Visits to the barber shop was reported in (58%) of the individuals, married individuals were (81.0), surgical operation was reported in (44.8%), sharing toothbrush was observed in (29.9%), piercing was reported in (39.7%), family history was reported in (26.4%), dental treatment was observed in (21.8%), jaundice were (13.2%) and tattooing was (1.7%). Blood transfusion, surgical operations, Jaundice, family history and dental treatment were found significant risk factors for acquiring HCV infection. It was concluded that proper implementation of precautionary measures should be needed to control the spread of HCV in far near future.

Computed tomography-guided transfacial buccal space core biopsy of deep head and neck space lesions: our experience

Deep head and neck space lesions can present a number of diagnostic challenges due to their deep anatomical position and difficult access for diagnostic tissue sampling. We describe a series of percutaneous 'transfacial' buccal space computed tomography (CT)-guided core biopsies of these lesions and subsequent histological findings. Six patients underwent CT-guided core biopsy of deep parotid, parapharyngeal, or masticator space lesions over a 30-month period. We describe our biopsy technique and correlate our histological findings with subsequent surgical resection where performed. Five of six of CT-guided biopsies obtained sufficient tissue for histological interpretation with varying findings, including salivary gland tumours and squamous cell carcinoma confirmed on subsequent resection. One patient was treated palliatively following core biopsy. No biopsy-related complications were observed. In our small series, percutaneous CT-guided transfacial biopsy via the buccal space has proved an excellent option for the minimally invasive tissue acquisition of deep head and neck space lesions.

Clinical predictors of discordance between screening tests and psychiatric assessment for depressive and anxiety disorders among patients being evaluated for seizure disorders

OBJECTIVE

This study was undertaken to identify factors that predict discordance between the screening instruments Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Generalized Anxiety Disorder scale (GAD-7), and diagnoses made by qualified psychiatrists among patients with seizure disorders. Importantly, this is not a validation study; rather, it investigates clinicodemographic predictors of discordance between screening tests and psychiatric assessment.

METHODS

Adult patients admitted for inpatient video-electroencephalographic monitoring completed eight psychometric instruments, including the NDDI-E and GAD-7, and psychiatric assessment. Patients were grouped according to agreement between the screening instrument and psychiatrists' diagnoses. Screening was "discordant" if the outcome differed from the psychiatrist's diagnosis, including both false positive and false negative results. Bayesian statistical analyses were used to identify factors associated with discordance.

RESULTS

A total of 411 patients met inclusion criteria; mean age was 39.6 years, and 55.5% (n = 228) were female. Depression screening was discordant in 33% of cases (n = 136/411), driven by false positives (n = 76/136, 56%) rather than false negatives (n = 60/136, 44%). Likewise, anxiety screening was discordant in one third of cases (n = 121/411, 29%) due to false positives (n = 60/121, 50%) and false negatives (n = 61/121, 50%). Seven clinical factors were predictive of discordant screening for both depression and anxiety: greater dissociative symptoms, greater patient-reported adverse events, subjective cognitive impairment, negative affect, detachment, disinhibition, and psychoticism. When the analyses were restricted to only patients with psychogenic nonepileptic seizures (PNES) or epilepsy, the rate of discordant depression screening was higher in the PNES group (n = 29, 47%) compared to the epilepsy group (n = 70, 30%, Bayes factor for the alternative hypothesis = 4.65).

SIGNIFICANCE

Patients with seizure disorders who self-report a variety of psychiatric and other symptoms should be evaluated more thoroughly for depression and anxiety, regardless of screening test results, especially if they have PNES and not epilepsy. Clinical assessment by a qualified psychiatrist remains essential in diagnosing depressive and anxiety disorders among such patients.

Correction to: Exploring the potential of black gram (Vigna mungo) flour as a fat replacer in biscuits with improved physicochemical, microstructure, phytochemicals, nutritional and sensory attributes

The version of Fig. 5 in the initial online publication was incorrect. The original article has been corrected.

Adverse events related to antiepileptic drugs

OBJECTIVE

Adverse events (AEs) related to antiepileptic drugs (AEDs) may interfere with adequate dosing and patient adherence, leading to suboptimal seizure control, and relatedly, increased injuries, hospitalizations, and mortality. This study investigated the clinicodemographic factors associated with AEs related to AEDs as reported by the Liverpool Adverse Events Profile (LAEP), and explored the ability of LAEP to discriminate between epilepsy and psychogenic nonepileptic seizures (PNES). We hypothesized that female sex, mood disorders, AED-polytherapy, duration, and severity of epilepsy are associated with increased endorsement of AEs related to AEDs, and that endorsement of AEs related to AEDs would significantly differ between epilepsy and PNES patients.

METHODS

We prospectively enrolled adult patients admitted to two inpatient video-electroencephalogram monitoring units. Clinicodemographic variables and psychometric measures of depression, anxiety, and cognitive function were recorded. Patient-reported AE endorsement was obtained using the LAEP, which was reduced to four latent domains using exploratory structural equation modeling. General linear models identified variables associated with each domain. Logistic regression determined the ability of LAEP scores to differentiate between epilepsy and PNES.

RESULTS

311 patients met inclusion criteria. Mean age was 38 years and 56% of patients were female. Network analysis demonstrated strong relationships between depression and anxiety with physical, sleep, psychiatric, and dermatological AE endorsement. Depression, female sex, and AED polytherapy were associated with greater AE endorsement. Epilepsy, compared to PNES, was associated with lower AE endorsement. Fewer prescribed AEDs and greater reported physical AE endorsement were associated with PNES diagnosis.

SIGNIFICANCE

There is a strong relationship between patient-reported AEs and psychiatric symptomatology. Those with PNES paradoxically endorse greater physical AEs despite receiving fewer AEDs. Patients who endorse AEs in clinical practice should be screened for comorbid depression or anxiety and treated accordingly.

The Epidemiology and Burden of Cardiometabolic Risk factors in a Young Emirati Population

Introduction

The United Arab Emirates (UAE) has experienced a rapid growth in economy. This growth was paralleled with a drastic rise in non-communicable diseases (NCDs); primarily cardiovascular disease, which accounts for 40% of mortality in UAE. These NCDs are caused by the accumulation of cardiometabolic risk factors (CRFs) such as obesity, dysglycemia, dyslipidemia, hypertension and central obesity. The CRFs are associated with other factors including sociodemography, physical inactivity, tobacco use, and heredity.

Objective

The objective is to investigate the burden of CRFs and their interrelationship, and to estimate the association with other determinants like sociodemographic status, lifestyle and family history.

Methods

Data was drawn from the UAE Healthy Future Study participants aged 18 to 40. Demographic and health data was collected by questionnaires. Measurements, blood pressure, and blood samples were collected. CRFs were analyzed by age and gender.

Results

A total of 5,126 eligible participants were included in the analysis. The age-adjusted prevalence rates were 26.5% for obesity, 11.7% for dysglycemia, 62.7% for dyslipidemia, 22.4% for hypertension and 22.5% for central obesity. Obesity had the strongest relationship with other metabolic factors. Education, employment, smoking and family history had associations with some metabolic markers. Forty percent had ≥2 risk factors. The burden of ≥ 2 CRFs was affected by age (OR 1.1), having lower education (OR 1.37) and having a family history (OR 1.44).

Conclusions

CRFs are highly prevalent in young adults in the UAE. These risk factors are accumulating and are affected by multiple determinants. Obesity is highly associated with having other CRFs simultaneously. This should be taken into account in the design of target-group-specific prevention of NCD development. Further research is needed to investigate how the clustering manifests in young adults to prevent the early rise of NCDs in the UAE.

Key messages

Cardiovascular disease and associated risk factors are highly prevalent in the young population (18-40) of the UAE. The clustering of cardiometabolic risk factors occurs early in young people in UAE.

Job satisfaction, work environment and intent to stay of Jordanian midwives

AIM

The aims of this study were to (1) assess the levels of Jordanian midwives' job satisfaction, intention to stay and work environment; (2) examine the relationship between work environment and intention to stay, and the level of job satisfaction among midwives working in Jordanian hospitals and maternal and child health centres and (3) to investigate the associations between job satisfaction and selected demographic variables among Jordanian midwives.

BACKGROUND

The shortage, turnover and retention of midwives are global problems and Jordan is one of the countries thathas a shortage of midwifery workforce. Job satisfaction is well studied among nurses worldwide; however, there are inadequate studies that have assessed the job satisfaction among midwives including Jordan.

METHODS

A descriptive, correlational design survey was used and a sample of 413 midwives were recruited from 14 different hospital settings (12 governmental and 2 teaching hospitals) and 8 health centres.

RESULTS

The levels of job satisfaction of Jordanian midwives were neither satisfied nor unsatisfied. The overall mean intent to stay at work was between neutral to agree in general. A positive significant correlation was found between job satisfaction, work environment and intent to stay. The work environment was neither a favourable nor an unfavourable. CONCLUSION AND IMPLICATIONS FOR NURSING, HEALTH AND EDUCATION POLICY: Jordanian midwives have neutral job satisfaction and work environment. Managerial plans and interventions are needed to improve midwives' job satisfaction and to create a favourable work environment which might reflect positively on their work and performance and improve their retention. Policymakers and mangers should enhance midwives' job satisfaction through external reward via salary, vacation and benefits packages. Engaging in research activities, publication and more collaboration with academic staff may improve midwives' professional development. Midwives should take more active roles in hospital affairs and receive more support by their management in Jordan.

Elemental analysis of sage (herb) using calibration-free laser-induced breakdown spectroscopy

In this work, laser-induced breakdown spectroscopy (LIBS) has been used for the quantitative and qualitative analysis of the sage sample using the calibration-free LIBS (CF-LIBS) technique. The sage plasma is generated by focusing the second harmonics (532 nm) of a Q-switched Nd:YAG laser with a repetition rate of 10 Hz and pulse duration of 5 ns. The emission spectra are recorded using a LIBS 2000 detection system spectrometer consisting of five high-resolution spectrometers covering a wavelength range from 200 to 720 nm. The optical emission spectra of the sage sample reveal the spectral lines of Fe, Ca, Ti, Co, Mn, Ni, and Cr. The plasma temperature and electron number density of the neutral spectral lines of the pertinent elements have been deduced using the Boltzmann plot and Stark-broadening line profile method, with average values 8855±885K and 3.89×10¹⁶cm^-3, respectively. The average values of the plasma parameters were used for the quantification of the detected elements in the sample. Based on the calibration-free method, the measured results demonstrate that Fe is the major constituent in the sample, having a percentage concentration of 48.1%, while the remaining elements are Ca, Ti, Co, Mn, Ni, and Cr, with percentage concentrations 0.7%, 5.3%, 8%, 11%, 12.3%, and 14.6%, respectively. This study demonstrates the feasibility of LIBS for the compositional analysis of major and trace elements present in the plant samples and its further applications in medicine.

Exploring the structure of Xe isotopes in A ~ 130 region: Single particle and collective excitations

High and medium spin structures of 130,131Xe have been studied using α-induced fusion-evaporation reaction and the Indian National Gamma Array (INGA) coupled with a digital data acquisition system. Various new band structures and near yrast levels of 131Xe have been established. The multipolarities of the observed transitions have been assigned on the basis of the DCO ratios and the polarization asymmetry measurements. Band structures based on 1-quasi-particle (qp), 3-qp configurations have been observed. A new Magnetic Rotational (MR) band based on 5-qp configuration has also been established in 131Xe. The MR band has been interpreted in terms of shears mechanism with principal axis cranking (SPAC) calculations. Shell Model calculations are carried out to describe the non yrast states of 131Xe above the 11/2− isomer. New excited states have also been identified in 130Xe, produced in the same reaction.

Transdermal Microneedles-A Materials Perspective

Transdermal drug delivery is an emerging field in the pharmaceutical remit compared with conventional methods (oral and parenteral). Microneedle (MN)-based devices have gained significant interest as a strategy to overcome the skin's formidable barrier: the stratum corneum. This approach provides a less invasive, more efficient, patient friendly method of drug delivery with the ability to incorporate various therapeutic agents including macromolecules (proteins and peptides), anti-cancer agents and other hydrophilic and hydrophobic compounds. This short review attempts to assess the various materials involved in the fabrication of MNs as well as incorporation of other excipients to improve drug delivery for novel medical devices. The focus will be on polymers, metals and other inorganic materials utilised for MN drug delivery, as well as their application, limitations and future work to be carried out.

Potential nutraceutical benefits of basmati rice bran oil as analgesic, anti-inflammatory and anti-arthritis

Numerous nutraceutical applications have been explored during the last decades. The present study is based on extraction of oil from super kernel basmati rice which has shown effective analgesic, anti- inflammatory, and anti-arthiritic activities. The feeding experiments on male Wister rats and female Sprague-dawley (SD) rats have elaborated the therapeutic value of variety of bioactive components including γ-oryzanol present in the oil.

Serum RANKL, osteoprotegerin (OPG) and RANKL/OPG ratio in children with systemic lupus erythematosus

Background

Systemic lupus erythematosus (SLE) patients have lower bone mineral density (BMD) compared with healthy individuals because of general, genetic, disease and medication-related factors. The disturbance of the receptor activator of nuclear factor-κB ligand (RANKL)/osteoprotegerin (OPG) ratio has been reported to be associated with low BMD in many disorders in adults and children alike.

Objectives

The objectives of this study were (i) to assess serum OPG, RANKL and RANKL/OPG ratio levels in SLE children and controls, (ii) to determine whether the cumulative glucocorticoid (CGCS) dose had any effect on the concentration of serum RANKL, OPG and RANKL/OPG ratio, and (iii) to determine the relation of these parameters to BMD.

Methods

We evaluated 50 SLE children and 50 age- and sex-matched healthy controls. RANKL and OPG were assessed in serum and compared between patients and controls. For SLE patients, a univariate followed by multivariable analysis were carried out to detect the possible predictors of the changes in RANKL, OPG and RANKL/OPG ratio levels. Lumbar BMD for all patients was assessed by dual-energy X-ray absorptiometry (DXA) scan and then correlated to different probable correlated factors.

Results

RANKL, OPG and RANKL/OPG ratio were significantly higher in SLE patients ( p ≤ 0.001). Univariate analysis showed significant correlations of RANKL with CGCS ( p ≤ 0.001) and with DXA scan z-score ( p = 0.007): OPG was significantly correlated to Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score ( p = 0.001) and anti-double-stranded DNA ( p = 0.001), whereas RANKL/OPG was significantly correlated to duration of illness and DXA z-score ( p = 0.002). The multivariable analysis showed that DXA z-score was an independent predictor of RANKL and RANKL/OPG ratio ( p = 0.019 and 0.008, respectively), whereas SLEDAI score was an independent predictor of OPG levels. BMD was negatively correlated to disease duration ( p = 0.008) and CGCS dose ( p = 0.015), but no significant correlation has been found between BMD and cumulative SLEDAI score ( p = 0.29).

Conclusions

Serum RANKL/OPG ratio is elevated in Egyptian children with SLE and is considered a risk factor for reduced bone mass in these children. Other risk factors for low BMD include high CGCS dose and disease duration, supporting that osteoporosis in SLE is multifactorial.