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1.
Braz. j. biol ; 82: e238891, 2022. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1249229

RESUMO

Abstract Food handlers plays a primary role in the transmission of pathogenically important protozoans and helminth parasites. This study was aimed to evaluate the prevalence of intestinal pathogenic protozoans and helminth parasites among food handlers in and around University of Malakand, Lower Dir, Pakistan. Stool samples were collected from 642 food handlers (all of male) in a cross-sectional study from January to November, 2017. Wet Mount Techniques and concentration methods by using salt and formol-ether solutions. Three hundred and eighty four cases (59.8%) were found infected with one more parasites. Most of the individuals were found infected with helminth (47.6%) as compared to intestinal protozoans (0.93%). Seventy two cases (11.2%) of the cases presented mixed infection with both intestinal protozoan and helminth parasites. The order of prevalence for intestinal helminth was Ancylostoma duodenale (n = 258, 40.1%), followed by Taeniasa ginata (n=96, 14.9%) Ascaris lumbricoides (n = 54, 8.40%) and Trichuris trichura (n=30, 4.60%). For intestinal protozoa, Entamoeba histolytica/dispar (n = 36, 5.64%) was the only protozoan detected. Mono-parasitism was higher than poly-parasitism. Family size income and education level were the factors significantly (P<0.05) associated in the parasites prevalence. Current research showed that IPIs are primarily the foodborne pathogens still an important public health problem in Pakistan. Effective control programs on parasitic diseases transfer and their associated factors are recommended.


Resumo Os manipuladores de alimentos desempenham um papel fundamental na transmissão de protozoários e helmintos parasitas patogenicamente importantes. Este estudo teve como objetivo avaliar a prevalência de protozoários patogênicos intestinais e helmintos parasitas entre manipuladores de alimentos na Universidade de Malakand, Lower Dir, Paquistão. Amostras de fezes foram coletadas de 642 manipuladores de alimentos (todos do sexo masculino) em um estudo transversal de janeiro a novembro de 2017. Técnicas de montagem úmida e métodos de concentração usando soluções de sal e formol-éter. Trezentos e oitenta e quatro casos (59,8%) foram encontrados infectados com mais um parasita. A maioria dos indivíduos foi encontrada infectada por helmintos (47,6%) em comparação com protozoários intestinais (0,93%). Setenta e dois casos (11,2%) dos casos apresentavam infecção mista com protozoários intestinais e helmintos parasitas. A ordem de prevalência de helmintos intestinais foi Ancylostoma duodenale (n = 258, 40,1%), seguido por Taeniasa ginata (n = 96, 14,9%) Ascaris lumbricoides (n = 54, 8,40%) e Trichuris trichura (n = 30, 4,60 %). Para protozoários intestinais, Entamoeba histolytica / dispar (n = 36, 5,64%) foi o único protozoário detectado. Monoparasitismo foi maior do que poliparasitismo. A renda familiar e o nível de escolaridade foram os fatores significativamente (P <0,05) associados na prevalência de parasitos. A pesquisa atual mostrou que os IPIs são principalmente os patógenos de origem alimentar, ainda um importante problema de saúde pública no Paquistão. Programas eficazes de controle da transferência de doenças parasitárias e seus fatores associados são recomendados.

2.
Braz. j. biol ; 82: e238874, 2022. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1249231

RESUMO

ABSTRACT This research was aimed to explore the helminth parasitic diseases in Schizothorax plagiostomus (the snow trout) from river Swat and river Panjkora, Pakistan. Collection of 360 fish specimens have done from the lower, middle and upper reaches of both the rivers through gill nets, cast nets, dragon nets and hooks. All the samples were examined in the University of Malakand, Zoology Department for helminth parasites during the months from January 2015 to December 2016. Of the total examined fish samples 21.9% (n=79) were infected with Rhabdochona spp including 17.7% (n=32/180) in river Swat and 26.6% (n=47/180) in river Panjkora. Highest month-wise prevalence (p=0.09878,p<0.05) was reported in May (30%), then by February and October each (26.6%) while the lowest during August (13.3%). Highest prevalence (p=0.9723, p<0.05) was reported in summer season (26.6%), while lowest in the winter season (20%). Adults were highly infected (p=< 0.0001) in prevalence (63.7%) followed by sub-adults (13.2%) while no infection was found in juvenile specimens. Females fish samples had higher (p=0.0277, p>0.05) prevalence (28.8%) than males (16.6%). Fishes of the lower reaches had highest (p=0.0029, P>0.05) prevalence (31.7%) followed by middle reaches (16.5%) while the lowest prevalence was observed in samples of fish collected from upper reaches (9.87%). Present study address that Rhabdochona spp in the intestine of snow trout has a long term relationship and call as a natural infection in cyprinids and zoonotic risk to human.


Resumo Esta pesquisa teve como objetivo explorar as doenças parasitárias por helmintos em Schizothorax plagiostomus (a truta das neves) do rio Swat e do rio Panjkora, Paquistão. A coleta de 360 ​​espécimes de peixes foi feita nos trechos inferior, médio e superior de ambos os rios por meio de redes de emalhar, de lançamento, de dragão e anzóis. Todas as amostras foram examinadas na Universidade de Malakand, Departamento de Zoologia, para helmintos parasitas durante os meses de janeiro de 2015 a dezembro de 2016. Do total de amostras de peixes examinadas, 21,9% (n = 79) estavam infectados com Rhabdochona spp, incluindo 17,7% (n = 32/180) no rio Swat e 26,6% (n = 47/180) no rio Panjkora. A maior prevalência no mês (p = 0,09878, p <0,05) foi relatada em maio (30%), depois em fevereiro e outubro cada (26,6%), enquanto a menor em agosto (13,3%). A maior prevalência (p = 0,9723, p <0,05) foi relatada no verão (26,6%), enquanto a menor no inverno (20%). Os adultos foram altamente infectados (p = <0,0001) na prevalência (63,7%), seguidos por subadultos (13,2%), enquanto nenhuma infecção foi encontrada em espécimes juvenis. As amostras de peixes do sexo feminino tiveram maior (p = 0,0277, p> 0,05) prevalência (28,8%) do que o masculino (16,6%). Os peixes do curso inferior tiveram maior (p = 0,0029, P> 0,05) prevalência (31,7%) seguida do curso médio (16,5%), enquanto a menor prevalência foi observada em amostras de peixes coletados do curso superior (9,87%). O presente estudo aborda que Rhabdochona spp no ​​intestino da truta das neves tem uma relação de longo prazo e pode ser considerada uma infecção natural em ciprinídeos e risco zoonótico para humanos.

3.
Braz. j. biol ; 82: e243774, 2022. tab, graf
Artigo em Inglês | LILACS-Express | MEDLINE, LILACSEXPRESS | ID: biblio-1278468

RESUMO

Abstract The present study was conducted for the taxonomic, morphometric and limnological assessment of the commercially important ichthyofauna of Sakhakot Stream, Malakand, Pakistan. The study area was divided into three sites along the water course namely Dargai Stream, Sakhakot Stream and Shergarh Stream. Fish samples were collected randomly during January to August 2017 with the help of fish gears. A taxonomic key was designed for the collected fish specimens. Ten fish species were identified belonging to 3 orders and 4 families. Family Cyprinidae was the dominant family with seven representative species while families Siluridae, Nemacheilidae and Mastacembelidae were represented by one species each. Lower mean total length and standard length was recorded in Puntius conchonius (Hamilton, 1822) as 9.2 ± 0.6 cm and 7.3 ± 0.6 cm respectively, while highest mean total length and standard length was recorded in Mastacembelus armatus (Lacepede, 1800) as 28.1 ± 1.7 cm and 15.9 ± 2.4 cm respectively. Mean pH of the water ranged from 6.1 at Shergarh Stream in August to 8.7 at Sakhakot Stream in January. Average temperature range was recorded from 10.9 °C in January at Dargai Stream to 18.7 °C in August at Shergarh Stream. No statistically significant difference was found for temperature (p = 0.96) and pH (p = 0.14) in the three water streams. The present study will provide a baseline for the rearing and enhancement of wild stock of the commercially important ichthyofauna in the field of aquaculture and fisheries.


Resumo O presente estudo foi realizado para a avaliação taxonômica, morfométrica e limnológica da ictiofauna comercialmente importante do Riacho Sakhakot, Malakand, Paquistão. A área de estudo foi dividida em três locais ao longo do curso de água, nomeadamente Riacho Dargai, Riacho Sakhakot e Riacho Shergarh. As amostras de peixes foram coletadas aleatoriamente durante janeiro e agosto de 2017, com a ajuda de artes de peixes. Uma chave taxonômica foi projetada para os espécimes de peixes coletados. Foram identificadas dez espécies de peixes pertencentes a 3 ordens e 4 famílias. A família Cyprinidae foi a família dominante, com sete espécies representativas, enquanto as famílias Siluridae, Nemacheilidae e Mastacembelidae foram representadas por uma espécie cada. O comprimento total médio mais baixo e o comprimento padrão foram registrados em Puntius conchonius (Hamilton, 1822) como 9.2 ± 0.6 cm e 7.3 ± 0.6 cm, respectivamente, enquanto o comprimento total médio e o comprimento padrão mais altos foram registrados em Mastacembelus armatus (Lacepede, 1800) como 28.1 ± 1.7 cm e 15.9 ± 2.4 cm, respectivamente. O pH médio da água variou de 6.1 no Riacho Shergarh em agosto a 8.7 no Riacho Sakhakot em janeiro. A faixa de temperatura média foi registrada de 10.9 °C em janeiro no Riacho Dargai a 18.7 °C em agosto no Riacho Shergarh. Não foi encontrada diferença estatisticamente significativa para temperatura (p = 0,96) e pH (p = 0,14) nos três cursos de água. O presente estudo fornecerá uma linha de base para a criação e aprimoramento do estoque selvagem da ictiofauna comercialmente importante no campo da aquicultura e pesca.

4.
Artigo em Inglês | VETINDEXEXPRESS | ID: vti-762575

RESUMO

Abstract Food handlers plays a primary role in the transmission of pathogenically important protozoans and helminth parasites. This study was aimed to evaluate the prevalence of intestinal pathogenic protozoans and helminth parasites among food handlers in and around University of Malakand, Lower Dir, Pakistan. Stool samples were collected from 642 food handlers (all of male) in a cross-sectional study from January to November, 2017. Wet Mount Techniques and concentration methods by using salt and formolether solutions. Three hundred and eighty four cases (59.8%) were found infected with one more parasites. Most of the individuals were found infected with helminth (47.6%) as compared to intestinal protozoans (0.93%). Seventy two cases (11.2%) of the cases presented mixed infection with both intestinal protozoan and helminth parasites. The order of prevalence for intestinal helminth was Ancylostoma duodenale (n = 258, 40.1%), followed by Taeniasa ginata (n=96, 14.9%) Ascaris lumbricoides (n = 54, 8.40%) and Trichuris trichura (n=30, 4.60%). For intestinal protozoa, Entamoeba histolytica/dispar (n = 36, 5.64%) was the only protozoan detected. Mono-parasitism was higher than poly-parasitism. Family size income and education level were the factors significantly (P 0.05) associated in the parasites prevalence. Current research showed that IPIs are primarily the foodborne pathogens still an important public health problem in Pakistan. Effective control programs on parasitic diseases transfer and their associated factors are recommended.


Resumo Os manipuladores de alimentos desempenham um papel fundamental na transmissão de protozoários e helmintos parasitas patogenicamente importantes. Este estudo teve como objetivo avaliar a prevalência de protozoários patogênicos intestinais e helmintos parasitas entre manipuladores de alimentos na Universidade de Malakand, Lower Dir, Paquistão. Amostras de fezes foram coletadas de 642 manipuladores de alimentos (todos do sexo masculino) em um estudo transversal de janeiro a novembro de 2017. Técnicas de montagem úmida e métodos de concentração usando soluções de sal e formol-éter. Trezentos e oitenta e quatro casos (59,8%) foram encontrados infectados com mais um parasita. A maioria dos indivíduos foi encontrada infectada por helmintos (47,6%) em comparação com protozoários intestinais (0,93%). Setenta e dois casos (11,2%) dos casos apresentavam infecção mista com protozoários intestinais e helmintos parasitas. A ordem de prevalência de helmintos intestinais foi Ancylostoma duodenale (n = 258, 40,1%), seguido por Taeniasa ginata (n = 96, 14,9%) Ascaris lumbricoides (n = 54, 8,40%) e Trichuris trichura (n = 30, 4,60 %). Para protozoários intestinais, Entamoeba histolytica / dispar (n = 36, 5,64%) foi o único protozoário detectado. Monoparasitismo foi maior do que poliparasitismo. A renda familiar e o nível de escolaridade foram os fatores significativamente (P 0,05) associados na prevalência de parasitos. A pesquisa atual mostrou que os IPIs são principalmente os patógenos de origem alimentar, ainda um importante problema de saúde pública no Paquistão. Programas eficazes de controle da transferência de doenças parasitárias e seus fatores associados são recomendados.

5.
Artigo em Inglês | VETINDEXEXPRESS | ID: vti-762574

RESUMO

ABSTRACT This research was aimed to explore the helminth parasitic diseases in Schizothorax plagiostomus (the snow trout) from river Swat and river Panjkora, Pakistan. Collection of 360 fish specimens have done from the lower, middle and upper reaches of both the rivers through gill nets, cast nets, dragon nets and hooks. All the samples were examined in the University of Malakand, Zoology Department for helminth parasites during the months from January 2015 to December 2016. Of the total examined fish samples 21.9% (n=79) were infected with Rhabdochona spp including 17.7% (n=32/180) in river Swat and 26.6% (n=47/180) in river Panjkora. Highest month-wise prevalence (p=0.09878,p 0.05) was reported in May (30%), then by February and October each (26.6%) while the lowest during August (13.3%). Highest prevalence (p=0.9723, p 0.05) was reported in summer season (26.6%), while lowest in the winter season (20%). Adults were highly infected (p= 0.0001) in prevalence (63.7%) followed by sub-adults (13.2%) while no infection was found in juvenile specimens. Females fish samples had higher (p=0.0277, p>0.05) prevalence (28.8%) than males (16.6%). Fishes of the lower reaches had highest (p=0.0029, P>0.05) prevalence (31.7%) followed by middle reaches (16.5%) while the lowest prevalence was observed in samples of fish collected from upper reaches (9.87%). Present study address that Rhabdochona spp in the intestine of snow trout has a long term relationship and call as a natural infection in cyprinids and zoonotic risk to human.


Resumo Esta pesquisa teve como objetivo explorar as doenças parasitárias por helmintos em Schizothorax plagiostomus (a truta das neves) do rio Swat e do rio Panjkora, Paquistão. A coleta de 360 espécimes de peixes foi feita nos trechos inferior, médio e superior de ambos os rios por meio de redes de emalhar, de lançamento, de dragão e anzóis. Todas as amostras foram examinadas na Universidade de Malakand, Departamento de Zoologia, para helmintos parasitas durante os meses de janeiro de 2015 a dezembro de 2016. Do total de amostras de peixes examinadas, 21,9% (n = 79) estavam infectados com Rhabdochona spp, incluindo 17,7% (n = 32/180) no rio Swat e 26,6% (n = 47/180) no rio Panjkora. A maior prevalência no mês (p = 0,09878, p 0,05) foi relatada em maio (30%), depois em fevereiro e outubro cada (26,6%), enquanto a menor em agosto (13,3%). A maior prevalência (p = 0,9723, p 0,05) foi relatada no verão (26,6%), enquanto a menor no inverno (20%). Os adultos foram altamente infectados (p = 0,0001) na prevalência (63,7%), seguidos por subadultos (13,2%), enquanto nenhuma infecção foi encontrada em espécimes juvenis. As amostras de peixes do sexo feminino tiveram maior (p = 0,0277, p> 0,05) prevalência (28,8%) do que o masculino (16,6%). Os peixes do curso inferior tiveram maior (p = 0,0029, P> 0,05) prevalência (31,7%) seguida do curso médio (16,5%), enquanto a menor prevalência foi observada em amostras de peixes coletados do curso superior (9,87%). O presente estudo aborda que Rhabdochona spp no intestino da truta das neves tem uma relação de longo prazo e pode ser considerada uma infecção natural em ciprinídeos e risco zoonótico para humanos.

6.
Obes Surg ; 2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34791618

RESUMO

BACKGROUND: Obesity is a risk factor for gallstone formation, which can be exacerbated by bariatric surgery-induced rapid weight loss. Current guidelines do not recommend concomitant cholecystectomy (CC) for asymptomatic gallstones during the bariatric surgery procedure. However, long-term follow-up studies have shown that the incidence of post-bariatric surgery symptomatic gallstones necessitating therapeutic cholecystectomy increases to 40%. Therefore, some surgeons advocate simultaneous cholecystectomy during the bariatric surgery for asymptomatic individuals. This study aims to evaluate the safety of performing cholecystectomy for asymptomatic gallstones during the bariatric procedure. METHODS: Data from a consecutive series of patients that underwent primary laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB) or conversion of LSG to a LRYGB with or without concomitant cholecystectomy for asymptomatic gallstones between Jan 2010 and Dec 2017 were retrieved from the database. The primary endpoint was the complication rate. Secondary endpoints were the surgical operating room time (ORT) and the length of hospital stay (LOS). RESULTS: Out of the 2828 patients who were included, 120 patients underwent a concomitant cholecystectomy during their bariatric procedure (LSG or LRYGB) for asymptomatic gallbladder stones and were compared to the 2708 remaining patients who only had bariatric surgery. None of the concomitant cholecystectomy patients developed a gallbladder-related complication. There was no significant increase in the rate of minor or major complications between the CC groups and the non-CC groups (LSG: 6.7% vs. 3.2%, p=0.132; LRYGB: 0% vs. 2.3%, p =0.55; and conversion of LSG to LRYGB: 20% vs. 7.1%, p = 0.125, respectively). In addition, there was no significant increase in the length of hospital stay (1.85 ±4.19 days vs. 2.24 ±1.82, p=0.404) for LSG group and (1.75 ±2.0 vs. 2.3 ±2.1, p=0.179) for LRYGB group. Adding the cholecystectomy to the bariatric procedure only added an average of 23 min (min) (27 min when added to LSG and 18 min when added to LRYGB). CONCLUSION: As one of the largest series reviewing concomitant cholecystectomy in bariatric surgery, this study showed that in skilled laparoscopic bariatric surgical hands, concomitant cholecystectomy during bariatric surgery is safe and prevents potential future gallstone-related complications. Long-term large prospective randomized trials are needed to further clarify the recommendation of prophylactic concomitant cholecystectomy during bariatric surgery.

7.
Math Biosci Eng ; 18(6): 8415-8443, 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34814306

RESUMO

The aim of this research work is to put forward fuzzy models of granular computing based on fuzzy relation and fuzzy indiscernibility relation. Thanks to fuzzy information granulation to provide multi-level visualization of problems that include uncertain information. In such a granulation, fuzzy sets and fuzzy graphs help us to represent relationships among granules, groups or clusters. We consider the fuzzy indiscernibility relation of a fuzzy knowledge representation system (I). We describe the granular structures of I, including discernibility, core, reduct and essentiality of I. Then we examine the contribution of these structures to granular computing. Moreover, we introduce certain granular structures using fuzzy graph models and discuss degree based model of fuzzy granular structures. Granulation of network models based on fuzzy information effectively handles real life data which possesses uncertainty and vagueness. Finally, certain algorithms of proposed models are developed and implemented to solve real life problems involving uncertain granularities. We also present a concise comparison of the models developed in our work with other existing methodologies.

8.
Genome Med ; 13(1): 184, 2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34814937

RESUMO

We discuss the current state of genomic medicine in Arab countries of the Middle East, a region with outsized contribution to Mendelian genetics due to inbreeding yet has poor representation in global variome datasets. We focus on genomic testing, clinical genetics, and genetic counseling services along with associated training and research programs. Finally, we highlight opportunities for improvement in genomic medicine services in this region.

9.
Trop Biomed ; 38(3): 462-468, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34608120

RESUMO

COVID-19 has spread rapidly worldwide. The role of fomites in facilitating onward transmission is plausible. This study aimed to determine the presence of viable virus and its persistence on the surfaces of fomites in wards treating COVID-19 patients in Malaysia. This study was conducted in two stages. First, environmental sampling was performed on random days in the intensive care unit (ICU) and general wards. Then, in the second stage, samples were collected serially on alternate days for 7 days in two selected general wards. In Stage 1, a total of 104 samples were collected from the surfaces of highly touched and used areas by patients and healthcare workers. Only three samples were tested positive for SARS-COV-2. In Stage 2, three surface samples were detected positive, but no persistence of the virus was observed. However, none of the SARS-CoV-2 RNA was viable through tissue culture. Overall, the environmental contamination of SARS-CoV-2 was low in this hospital setting. Hospitals' strict infection control and the compliance of patients with wearing masks may have played a role in these findings, suggesting adherence to those measures to reduce occupational exposure of COVID-19 in hospital settings.


Assuntos
COVID-19/transmissão , Exposição Ambiental/estatística & dados numéricos , Fômites/virologia , Controle de Infecções/métodos , Contaminação de Equipamentos , Hospitais/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Malásia , Quartos de Pacientes/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação
10.
Circulation ; 144(16): 1272-1279, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34662161

RESUMO

BACKGROUND: Substantial differences exist between United States counties with regards to premature (<65 years of age) cardiovascular disease (CVD) mortality. Whether underlying social vulnerabilities of counties influence premature CVD mortality is uncertain. METHODS: In this cross-sectional study (2014-2018), we linked county-level CDC/ATSDR SVI (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index) data with county-level CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research) mortality data. We calculated scores for overall SVI and its 4 subcomponents (ie, socioeconomic status; household composition and disability; minority status and language; and housing type and transportation) using 15 social attributes. Scores were presented as percentile rankings by county, further classified as quartiles on the basis of their distribution among all US counties (1st [least vulnerable] = 0 to 0.25; 4th [most vulnerable = 0.75 to 1.00]). We grouped age-adjusted mortality rates per 100 000 person-years for overall CVD and its subtypes (ischemic heart disease, stroke, hypertension, and heart failure) for nonelderly (<65 years of age) adults across SVI quartiles. RESULTS: Overall, the age-adjusted CVD mortality rate per 100 000 person-years was 47.0 (ischemic heart disease, 28.3; stroke, 7.9; hypertension, 8.4; and heart failure, 2.4). The largest concentration of counties with more social vulnerabilities and CVD mortality were clustered across the southwestern and southeastern parts of the United States. The age-adjusted CVD mortality rates increased in a stepwise manner from 1st to 4th SVI quartiles. Counties in the 4th SVI quartile had significantly higher mortality for CVD (rate ratio, 1.84 [95% CI, 1.43-2.36]), ischemic heart disease (1.52 [1.09-2.13]), stroke (2.03 [1.12-3.70]), hypertension (2.71 [1.54-4.75]), and heart failure (3.38 [1.32-8.61]) than those in the 1st SVI quartile. The relative risks varied considerably by demographic characteristics. For example, among all ethnicities/races, non-Hispanic Black adults in the 4th SVI quartile versus the 1st SVI quartile exclusively had significantly higher relative risks of stroke (1.65 [1.07-2.54]) and heart failure (2.42 [1.29-4.55]) mortality. Rural counties with more social vulnerabilities had 2- to 5-fold higher mortality attributable to CVD and subtypes. CONCLUSIONS: In this analysis, US counties with more social vulnerabilities had higher premature CVD mortality, varied by demographic characteristics and rurality. Focused public health interventions should address the socioeconomic disparities faced by underserved communities to curb the growing burden of premature CVD.

11.
Int J Radiat Oncol Biol Phys ; 111(3S): e498-e499, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34701595

RESUMO

PURPOSE/OBJECTIVE(S): With increasing interest in stereotactic body radiotherapy (SBRT) for unresectable pancreatic cancer, quality improvement (QI) initiatives to develop integrated clinical workflows are crucial to ensure quality assurance (QA) when introducing this high risk technique into radiation practices. MATERIALS/METHODS: In 2017, we used the Plan, Do, Study, Act (PDSA) QI methodology to implement a new pancreas SBRT program in an integrated community radiation oncology satellite. A unified integrated information technology infrastructure was used to virtually integrate the planned workflow into the community satellite network (P - Plan/D - Do). This workflow included multiple prospective quality assurance (QA) measures including multidisciplinary evaluation, prospective radiation target delineation scrutiny, radiation plan evaluation, and real-time monitoring of patient outcomes. Institutional review board approval was obtained to retrospectively study and report outcomes of patients treated in this program (S - Study). RESULTS: There were 12 consecutive patients identified who were treated in this program from 2017-2020 with a median follow-up of 27 months. The median survival was 13 months, median local failure free survival was 12 months and median progression free survival was 6 months from SBRT. There were no acute or late Common Terminology Criteria for Adverse Effects (CTCAE) version 5 toxicities ≥ Grade 3. CONCLUSION: We report the successful implementation of a community pancreas SBRT program involving multiple prospective QA measures, providing the groundwork to safely expand community access to pancreas SBRT in our community satellite network (A - Act).

12.
Med J Malaysia ; 76(5): 672-679, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34508373

RESUMO

OBJECTIVE: The aims of this study are to measure the psychometric properties of the newly developed preliminary version of hearing impairment inventory for religious duties for Muslim adults, i.e., the Inventori Persepsi Bagi Muslim Yang Memiliki Masalah Pendengaran (IPM3P), and to produce a final version of IPM3P. METHODS: The preliminary version of IPM3P that is used to investigate the perception of Muslim adults with hearing impairment towards Islamic understanding and practice has been tested in this study. The preliminary version of IPM3P consists of three domains (obligation, practice, and difficulty) with 59 items in total. Four phases of validity and reliability testing involved were: i) Content validation, ii) Pretesting, face validity and proofreading, iii) Pilot study, and iv) Psychometric evaluation. RESULTS: The final version of IPM3P consists of 36 items. The findings from the present study suggest that the final version of IPM3P has excellent psychometric properties manifested by: i) good content validity, ii) excellently pretested, iii) good face validity, iv) good construct validity shown by principal component analysis and convergent validity, and v) good discriminant validity showed by divergent validity. CONCLUSION: IPM3P shows good potential to be used as a tool in investigating perception of Muslim adults towards Islamic understanding and practice.


Assuntos
Perda Auditiva , Islamismo , Adulto , Humanos , Malásia , Percepção , Projetos Piloto , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
13.
EClinicalMedicine ; 38: 100997, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34505026

RESUMO

Background: The effects of omega-3 fatty acids (FAs), such as eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, on cardiovascular outcomes are uncertain. We aimed to determine the effectiveness of omega-3 FAs on fatal and non-fatal cardiovascular outcomes and examine the potential variability in EPA vs. EPA+DHA treatment effects. Methods: We searched EMBASE, PubMed, ClinicalTrials.gov, and Cochrane library databases through June 7, 2021. We performed a meta-analysis of 38 randomized controlled trials of omega-3 FAs, stratified by EPA monotherapy and EPA+DHA therapy. We estimated random-effects rate ratios (RRs) with (95% confidence intervals) and rated the certainty of evidence using GRADE. The key outcomes of interest were cardiovascular mortality, non-fatal cardiovascular outcomes, bleeding, and atrial fibrillation (AF). The protocol was registered in PROSPERO (CRD42021227580). Findings: In 149,051 participants, omega-3 FA was associated with reducing cardiovascular mortality (RR, 0.93 [0.88-0.98]; p = 0.01), non-fatal myocardial infarction (MI) (RR, 0.87 [0.81-0.93]; p = 0.0001), coronary heart disease events (CHD) (RR, 0.91 [0.87-0.96]; p = 0.0002), major adverse cardiovascular events (MACE) (RR, 0.95 [0.92-0.98]; p = 0.002), and revascularization (RR, 0.91 [0.87-0.95]; p = 0.0001). The meta-analysis showed higher RR reductions with EPA monotherapy (0.82 [0.68-0.99]) than with EPA + DHA (0.94 [0.89-0.99]) for cardiovascular mortality, non-fatal MI (EPA: 0.72 [0.62-0.84]; EPA+DHA: 0.92 [0.85-1.00]), CHD events (EPA: 0.73 [0.62-0.85]; EPA+DHA: 0.94 [0.89-0.99]), as well for MACE and revascularization. Omega-3 FA increased incident AF (RR, 1.26 [1.08-1.48]). EPA monotherapy vs. control was associated with a higher risk of total bleeding (RR: 1.49 [1.20-1.84]) and AF (RR, 1.35 [1.10-1.66]). Interpretation: Omega-3 FAs reduced cardiovascular mortality and improved cardiovascular outcomes. The cardiovascular risk reduction was more prominent with EPA monotherapy than with EPA+DHA. Funding: None.

14.
Mol Genet Metab ; 134(1-2): 29-36, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34535384

RESUMO

INTRODUCTION: Clinical standard of care for newborn screening (NBS) is acylcarnitine metabolites quantitation by tandem mass spectrometry (MS/MS) from dried blood spots. Follow up sequencing often results in identification of one or more variants of uncertain significance (VUS). Isovaleric acidemia (IVA) is an autosomal recessive inborn error of metabolism caused by deficiency of isovaleryl-CoA dehydrogenase (IVDH) in the Leu catabolism pathway. Many IVD mutations are characterized as VUS complicating IVA clinical diagnoses and treatment. We present a testing platform approach to confirm the functional implication of VUS identified in newborns with IVA applicable to multiple inborn errors of metabolism identified by NBS. METHODS: An IVD null HEK293T cell culture model was generated by using a dual sgRNA CRISPR/Cas9 genome-editing strategy targeting IVD exons 2-3. Clonal cell lines were confirmed by a combination of genomic breakpoint sequencing and droplet digital PCR. The IVD null model had no IVDH antigen signal and 96% reduction in IVDH enzyme activity. The IVD null model was transfected with vectors containing control or variant IVD and functional assays were performed to determine variant pathogenicity. RESULTS: c.149G > C (p.Arg50Pro; precursor numbering), c.986T > C (p.Met329Thr), and c.1010G > A (p.Arg337Gln), c.1179del394 f. mutant proteins had reduced IVDH protein and activity. c.932C > T (p.Ala311Val), c.707C > T (p.Thr236Ile), and c.1232G > A (p.Arg411Gln) had stable IVDH protein, but no enzyme activity. c.521T > G (p.Val174Gly) had normal IVDH protein and activity. IVD variant transfection results confirmed results from IVA fibroblasts containing the same variants. CONCLUSIONS: We have developed an IVD null HEK293T cell line to rapidly allow determination of VUS pathogenicity following identification of novel alleles by clinical sequencing following positive NBS results for suspected IVA. We suggest similar models can be generated via genome-editing for high throughput assessment of VUS function for a multitude of inborn errors of metabolism and can ideally supplement NBS programs.

15.
J Am Coll Health ; : 1-9, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34437818

RESUMO

INTRODUCTION: New Coronavirus (COVID-19) pandemic has multiple effects. We aimed in this study to assess anxiety, depression, and stress levels among university students in Saudi Arabia and associated factors. METHOD: We collected 5,140 participations from universities for our cross-sectional study, responders completed the demographic questions, patient health questionnaire 9 (PHQ9) for depression, generalized anxiety disorder 7 (GAD7) for anxiety, and perceived stress scale (PSS) between 24th and 30th of April 2020. RESULT: 80.99% were females and mean age was 21.85 years. 40.8% had significant symptoms of anxiety, 48.8% had significant symptoms of depression, and 86.7% had moderate to high perceived stress. Being Female, younger age, living in eastern region, had a relative or acquaintances with COVID-19, and had chronic medical or mental illness are associated factors with high levels of depression, anxiety, and stress. DISCUSSION: COVID-19 pandemic negatively affected the mental health of university students. Quick and effective interventions are mandatory.

16.
BMC Psychiatry ; 21(1): 382, 2021 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-34320930

RESUMO

BACKGROUND: The COVID-19 pandemic has had a major impact on people's lives globally. The outbreak in Saudi Arabia worsened when the number of cases and deaths rose in March and April of 2020, leading to a national lockdown. This study aimed to assess the factors associated with mental health symptoms in a sample of people residing in Saudi Arabia during the COVID-19 pandemic. METHODS: We conducted an observational cross-sectional study using an online survey distributed via social media, completed by 3032 respondents from all Saudi regions. We collected demographic data, illness history, and scores of validated self-report scales to assess mental health symptoms, intolerance of uncertainty, and coping strategies. RESULTS: In total, respondents indicated moderate to very severe symptoms during the pandemic as follows: 20.9% for depression, 17.5% for anxiety, and 12.6% for stress. Younger age, female gender, and history of mental illness were associated with higher levels of depression, anxiety, stress, and insomnia. Intolerance of uncertainty and certain coping strategies (such as denial or self-blame) were associated with more severe symptoms. CONCLUSIONS: Mental health is a key concern during the COVID-19 pandemic, especially for the identified vulnerable groups. Agencies concerned with mental health during crises may use the studied associated factors of mental health symptoms to generate targeted policies or interventions.


Assuntos
COVID-19 , Pandemias , Adaptação Psicológica , Ansiedade/epidemiologia , Controle de Doenças Transmissíveis , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Saúde Mental , SARS-CoV-2 , Arábia Saudita/epidemiologia , Inquéritos e Questionários , Incerteza
17.
Cureus ; 13(5): e15334, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34235013

RESUMO

Sickle cell disease (SCD) is a qualitative hemoglobinopathy that can cause widespread sickling and vaso-occlusive events in all organ systems. Sickle cell hepatopathy is an umbrella term for various acute and chronic pathologies of the liver as a result of sickling in SCD patients. We present below the case of a 49-year-old woman who had an acute liver failure in the setting of a hepatic crisis with recovery after exchange transfusion. Hepatic involvement in SCD may be life-threatening. Understanding the etiology and severity of hepatic involvement by sickling is necessary for appropriate treatment.

18.
J Family Community Med ; 28(2): 77-84, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34194271

RESUMO

BACKGROUND: General practitioners (GPs) and family medicine physicians (FMPs) have a vital role to play in co-ordinating the care for mental disorders. The objective of this study was to determine the perception of GPs and FMPs on the use of cognitive-behavioral therapy (CBT) for depression in Saudi Arabia, and the barriers against the implementation of CBT in such settings. MATERIALS AND METHODS: All physicians working in Primary Healthcare Centers and Family Medicine Clinics in Saudi Arabia were targeted and invited to participate in this cross-sectional study. A self-administered online questionnaire was sent via E-mail through the Saudi Commission for Health Specialties and the Saudi Society of Family and Community Medicine. Data was collected using an existing validated questionnaire and was modified to fit the objectives of current study. RESULTS: A total of 469 FMPs and GPs completed the survey; the mean age of respondents was 38 years. More than half of the FMPs' and GPs' (53%) showed a positive perception of the use of CBT in primary healthcare settings. Most participants (91.9%) were willing to use CBT if they had adequate education and training. More than half of the participants (59.5%) thought it was time-consuming, while 39% thought that CBT training was a very time-intensive process. CONCLUSION: We conclude that more than half of the physicians clearly had a good perception of the effectiveness of CBT administration in primary healthcare settings. Younger physicians were more perceptive. The most agreed-on barrier to CBT implementation was the lack of training and education.

19.
Med J Malaysia ; 76(4): 480-487, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34305108

RESUMO

BACKGROUND: Previous research has documented the benefits of physical activity (PA) for cancer survivors which include improved quality of life, physical, physiological, emotional and social functioning, reduced relapse of cancer and the mitigation of cancer mortality. This study aims to evaluate the effects of an independent PA programme based on PA level, quality of life, self-efficacy, outcome expectations, reinforcement, behavioural capability and observational learning amongst registered National Cancer Society Malaysia's (NCSM) cancer survivors. METHODS: A two-armed, parallel, double-blinded, randomized, controlled trial, intervention and wait-list control groups will be conducted amongst 106 NCSM's cancer survivors. The programme is developed based on a Social Cognitive Theory that combines both psychoeducation and social media approaches to behavioural intervention. The duration of intervention will be 2 months, in which data will be collected at baseline, 2- month (immediately post-intervention) and 4-month. The primary outcome of the study is to determine the PA level of the participant which will be measured as METminutes/ week of PA using the International Physical Activity Questionnaire (IPAQ). There are four measurements of PA that are measured which are moderate and vigorous PA (MVPA) MET-minutes/week, light PA MET-minutes/week, moderate PA MET-minutes/week and vigorous PA METminutes/ week. A Generalised Estimating Equation (GEE) analysis will be used to evaluate the effectiveness of the intervention, adjusted for baseline covariates on both continuous and categorical outcomes. This study will utilize a significance level of 0.05 with a confidence interval of 95% for means estimation in rejecting null hypothesis. The trial registered to the Australian New Zealand Clinical Trials (ANZCTR) with the Registration Number, ACTRN12620000039987. CONCLUSION: The programme will be useful as a supplementary prescription to assist policy makers to strengthen non-pharmacological cancer management options and to empower cancer survivors to be self-reliant and self-sufficient to include PA as part of their recovery process.


Assuntos
Sobreviventes de Câncer , Neoplasias Colorretais , Terapia por Exercício , Austrália , Neoplasias Colorretais/terapia , Exercício Físico , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Sobreviventes
20.
Genet Med ; 23(11): 2208-2212, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34230634

RESUMO

PURPOSE: The ClinGen Variant Curation Expert Panels (VCEPs) provide disease-specific rules for accurate variant interpretation. Using the hearing loss-specific American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) guidelines, the Hearing Loss VCEP (HL VCEP) illustrates the utility of expert specifications in variant interpretation. METHODS: A total of 157 variants across nine HL genes, previously submitted to ClinVar, were curated by the HL VCEP. The curation process involved collecting published and unpublished data for each variant by biocurators, followed by bimonthly meetings of an expert curation subgroup that reviewed all evidence and applied the HL-specific ACMG/AMP guidelines to reach a final classification. RESULTS: Before expert curation, 75% (117/157) of variants had single or multiple variants of uncertain significance (VUS) submissions (17/157) or had conflicting interpretations in ClinVar (100/157). After applying the HL-specific ACMG/AMP guidelines, 24% (4/17) of VUS and 69% (69/100) of discordant variants were resolved into benign (B), likely benign (LB), likely pathogenic (LP), or pathogenic (P). Overall, 70% (109/157) variants had unambiguous classifications (B, LB, LP, P). We quantify the contribution of the HL-specified ACMG/AMP codes to variant classification. CONCLUSION: Expert specification and application of the HL-specific ACMG/AMP guidelines effectively resolved discordant interpretations in ClinVar. This study highlights the utility of ClinGen VCEPs in supporting more consistent clinical variant interpretation.


Assuntos
Genoma Humano , Perda Auditiva , Monofosfato de Adenosina , Testes Genéticos , Variação Genética/genética , Perda Auditiva/diagnóstico , Perda Auditiva/genética , Humanos
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