Paediatric Post Burn Flexion Contracture Release: Early Outcomes Using Two Bloodless Techniques.

Post burn flexion contracture of the hand in children constitutes a significant proportion of post burn complications. We compared the early clinical outcomes of reconstruction of pediatric post burn flexion contracture of the digits of the hand using tourniquet or tumescent technique. A prospective randomised study of pediatric patients requiring contracture release and wound resurfacing with full thickness skin graft between September 2020 and August 2021. Patients were randomised into groups of either tourniquet or tumescent technique for contracture release. The surface area of graft take and total active motion across joints were the outcome measures. Student t-test, and Chi-squared test were performed. Twenty-two (22) patients were randomised into either group. The mean age of the participants was 6.09 ± 2.41 years, mostly males 31 (72.1%). A grade three (3) flexion contracture was the most common (72.1%). Ninety four (94) digits and one hundred and seventy eight (178) joints were operated on with the proximal interphalangeal joint (PIPJ) being the most common (48.9%). The mean surface area of graft take on post operative day ten (10) was significantly higher for the tumescent group than the tourniquet group, p =0.001. The total active motion across the joints at six (6) and nine (9) weeks post operative showed a strong correlation between the total active motion across joints and the technique of release, p=0.004 and 0,001 respectively. Tumescent technique is a feasible alternative to the tourniquet method for post burn flexion contracture release of the digits in the pediatric burned hand.

An empirical study of software ecosystem related tweets by npm maintainers.

The npm ecosystem is crucial for the JavaScript community and its development is significantly influenced by the opinions and feedback of npm maintainers. Many software ecosystem maintainers have utilized social media, such as Twitter, to share community-related information and their views. However, the communication between npm maintainers via Twitter in terms of topics, nature, and sentiment have not been analyzed. This study conducts an empirical analysis of tweets by npm maintainers related to the software ecosystem to understand their perceptions and opinions better. A dataset of tweets was collected and analyzed using qualitative analysis techniques to identify the topic of tweets, nature, and their sentiments. Our study demonstrates that most tweets belong to the package management category, followed by notifications and community-related information. The most frequently discussed topics among npm maintainers in the package management category are usage scenarios. It appears that the nature of tweets mostly shared by npm maintainers is information, followed by question and answer, respectively. Additionally, the sentiment analysis reveals that npm maintainers express more positive sentiments towards notification and community-related discussion while expressing more neutral opinions towards the package management related discussion. This case study provides valuable insights into the perceptions and opinions of the npm maintainers regarding the software ecosystem and can inform future development and decision making.

In Vivo, In Vitro and In Silico Study of Cucurbita moschata Flower Extract: A Promising Source of Natural Analgesic, Anti-Inflammatory, and Antibacterial Agents.

For thousands of years, medicinal plants have played a pivotal role in maintaining human health and improving the quality of human life. This study was designed to analyze the analgesic, anti-inflammatory, and antibacterial potentials of a hydro-methanolic extract of Cucurbita moschata flowers, along with qualitative and quantitative phytochemical screening. The anti-inflammatory effect was tested using the in vitro membrane stabilizing method for human red blood cells (HRBC), the analgesic effect was tested using the in vivo acetic acid-induced writing method, and the antibacterial effect was tested using the disc diffusion method. In silico ADME/T and molecular docking studies were performed to assess the potential of the stated phytochemicals against Cyclooxygenase-II enzyme. Phytochemical screening confirmed the presence of flavonoids, alkaloids, glycosides, tannins, and carbohydrates. The flower extract demonstrated the maximum protection of human red blood cells at 1000 µg/mL, with a 65.73% reduction in hemolysis in a hypotonic solution. The extract also showed significant (p < 0.05) and dose-dependent analgesic effects at oral doses of 200 and 400 mg/kg on the tested animals. Furthermore, the flower extract exhibited potent antibacterial activity due to the disc diffusion method, which was compared with standard ciprofloxacin. In silico testing revealed that 42 phytochemicals exhibited notable pharmacokinetic properties and passed drug likeness screening tests. Among the six best-selected compounds, 3,4-dihydro-2H-pyran-2-yl)methanamine showed the highest binding affinity (-10.1) with significant non-bonding interactions with the target enzyme. In conclusion, the hydro-methanolic extract of Cucurbita moschata was found to be rich in various phytochemicals that may be associated with therapeutic potential, and this study supports the traditional use of Cucurbita moschata flowers in the management of inflammation and painful conditions.

Bovine lead exposure from informal battery recycling in India.

We provide an estimate of annual bovine lead exposure and attributable mortality at informal lead acid battery recycling sites in India. We use Pure Earth's Toxic Sites Identification Program database, the FAO's Gridded Livestock dataset, and a Poisson plume model of lead particle air dispersion to estimate site-level mortality. We calculate that India suffers 2370 excess bovine fatalities each year, resulting in more than USD $2.1 million of economic damage. The distribution of damages by location is highly skewed. While we find most sites (86.3%) induce no mortalities, 6.2% of sites induce minor damage (1 to 5 fatalities), 4.1% induce moderate damage (6 to 20 fatalities), and 3.4% induce severe damage (21 + fatalities). These findings highlight the importance of geospatial data to prioritize mitigation efforts and identify a previously unquantified burden on the rural poor.

Keloid masking a parotid tumor: A rare case presentation.

A 37-year-old Nigerian woman presented with an itchy and occasionally painful scar that appeared after the healing of an acne lesion over the left parotid region, 13 years ago. She noticed a progressive increase; however, there was no history of facial weakness. Examination revealed a keloid lesion overlying a firm nontender mass. Ultrasound scan and fine-needle aspiration cytology indicated a benign tumor of the left parotid. Superficial parotidectomy was performed, and the histology revealed a keloid overlying a pleomorphic adenoma. This is an unusual presentation of keloid which developed over a pleomorphic adenoma. Hence, we report the above case for its rarity.

Résumé Une femme Nigériane de 37 ans s'est présentée avec une cicatrice qui démangeait et parfois était douloureuse, apparue après la cicatrisation d'une lésion acnéique sur le région parotide gauche, il y a 13 ans. Elle a remarqué une augmentation progressive; cependant, il n'y avait aucun antécédent de faiblesse faciale. Examen révélé une lésion chéloïde recouvrant une masse ferme non sensible. L'échographie et la cytoponction à l'aiguille fine ont révélé une tumeur bénigne du côté gauche parotide. Une parotidectomie superficielle a été réalisée et l'histologie a révélé une chéloïde recouvrant un adénome pléomorphe. C'est un peu inhabituel présentation d'une chéloïde qui s'est développée sur un adénome pléomorphe. Par conséquent, nous signalons le cas ci-dessus pour sa rareté. Mots-clés: Cicatrice chéloïde, adénome pléomorphe, rare.

Fixation disparity and refractive error among first-year optometry students.

PURPOSE: To determine the fixation disparity and refractive error of first-year optometry students to ascertain any relationship between them and also identify any association between fixation disparity and visual symptoms at near. METHOD: It was an analytical cross-sectional study involving 85 participants aged 17 to 27 years (18.60 ± 1.37), 41% of whom were males. Subjective refraction was done at 3 m and fixation disparity was measured with and without spectacle correction using the Wesson Fixation Disparity Card. All analysis was set within a 95% confidence interval with a p-value ≤ 0.05 considered statistically significant. RESULTS: Refractive error ranged from 0.25 SEQ (spherical equivalent) to 5.50 SEQ. Mean fixation disparity ranged from 2.9 ± 2.6 to 3.9 ± 2.8 min arc. There was no statistically significant correlation between refractive error and fixation disparity without correction (r = -0.180, p = 0.098) and with correction (r = 0.155, p = 0.157). For fixation disparity in the ortho and exo direction, mean fixation disparity with correction of participants who experienced headaches during or after reading (5.1 ± 2.6 min arc) was significantly higher (p = 0.032) than participants who did not (2.0 ± 2.6 min arc). CONCLUSION: Myopia is common among first-year optometry students. Refractive error has no significant effect on fixation disparity. Headache is significantly associated with exo fixation disparity at near.

Segmenting 3D geometry of left coronary artery from coronary CT angiography using deep learning for hemodynamic evaluation.

While coronary CT angiography (CCTA) is crucial for detecting several coronary artery diseases, it fails to provide essential hemodynamic parameters for early detection and treatment. These parameters can be easily obtained by performing computational fluid dynamic (CFD) analysis on the 3D artery geometry generated by CCTA image segmentation. As the coronary artery is small in size, manually segmenting the left coronary artery from CCTA scans is a laborious, time-intensive, error-prone, and complicated task which also requires a high level of expertise. Academics recently proposed various automated segmentation techniques for combatting these issues. To further aid in this process, we present CoronarySegNet, a deep learning-based framework, for autonomous and accurate segmentation as well as generation of 3D geometry of the left coronary artery. The design is based on the original U-net topology and includes channel-aware attention blocks as well as deep residual blocks with spatial dropout that contribute to feature map independence by eliminating 2D feature maps rather than individual components. We trained, tested, and statistically evaluated our model using CCTA images acquired from various medical centers across Bangladesh and the Rotterdam Coronary Artery Algorithm Evaluation challenge dataset to improve generality. In empirical assessment, CoronarySegNet outperforms several other cutting-edge segmentation algorithms, attaining dice similarity coefficient of 0.78 on an average while being highly significant (p < 0.05). Additionally, both the 3D geometries generated by machine learning and semi-automatic method were statistically similar. Moreover, hemodynamic evaluation performed on these 3D geometries showed comparable results.

Prevalence of keratoconus in Ghana: A hospital-based study of tertiary eye care facilities.

PURPOSE: To estimate the prevalence of keratoconus in tertiary eye care facilities in Ghana. METHODS AND ANALYSIS: In this hospital-based retrospective cohort study, medical records of patients from tertiary/referral eye care facilities in Ghana were reviewed. Included in the study were records of individuals who visited the eye care facilities and were diagnosed of keratoconus within the period of January 2016 to December 2019 inclusive. Data on patients' demographics, severity of keratoconus, mode of diagnosis, treatment, and visual acuity outcomes were analysed. RESULTS: Out of the total of 142,209 records reviewed, 75 patients were diagnosed of keratoconus in at least one eye (127 eyes; 86.8% bilateral cases), representing a prevalence estimate of 53 per 100000 (95% confidence interval (CI): 41 to 65 per 100000). The mean ± SD age of patients at the time of diagnosis was 21.1 ± 9.5 years (66.2% males). The mean ± SD keratometry in keratoconus patients was 52.1 ± 7.0: majority (76.5%) of the cases were moderate to severe keratoconus. The main primary treatment regimen was corneal transplant (58.8%) followed by spectacles (25.0%), crosslinking (8.8%) and rigid contact lens (7.3%). There was a significant association between post-treatment visual acuity outcomes and treatment type (p < 0.001). CONCLUSION: Our study represents the first prevalence estimate of keratoconus in Ghana. The prevalence of keratoconus estimated in our study is lower than that reported in countries with tropical climates. This could be due to lower uptake of referrals, underdiagnosis and/or misdiagnosis of the condition in lower-level health facilities.

Chemico-Pharmacological Screening of the Methanol Extract of Gynura nepalensis D.C. Deciphered Promising Antioxidant and Hepatoprotective Potentials: Evidenced from in vitro, in vivo, and Computer-Aided Studies.

Gynura nepalensis D.C. (family: Asteraceae) has abundant uses in the alternative medicinal practice, and this species is commonly used in the treatment of diabetes, rheumatism, cuts or wounds, asthma, kidney stones, cough, urinary tract bleeding, gall bladder stones, hepatitis, diarrhea, hemorrhoids, constipation, vomiting, fertility problems, blood poisoning, septicemia, skin allergy, indigestion, high cholesterol levels, and so on. This study aims to investigate the hepatoprotective and antioxidant potential of the methanol extract of the Gynura nepalensis D.C. (GNME) along with chemical profiling with phytochemical screening. Moreover, prospective phytocompounds have been screened virtually to present the binding affinity of the bioactive components to the hepatic and oxidative receptors. In the hepatoprotective study, alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total protein (TP), and lipid peroxidation (LP) and total bilirubin (TB) have been assessed, and in the antioxidant study, the DPPH free radical scavenging, total antioxidant flavonoid, and phenolic contents were determined. Moreover, the molecular binding affinity of the bioactive component of the plant has been analyzed using PyRx AutoDock Vina, Chimera, and Discovery Studio software. The plant extract showed dose-dependent hepatoprotective potential (p < 0.05, 0.01, 0.001) as well as strong antioxidant properties. Moreover, hepatoprotective and antioxidant molecular docking studies revealed a result varying from −2.90 kcal/mol to −10.1 kcal/mol. 4,5-dicaffeoylquinic acid and chlorogenic acid revealed the highest binding affinity among the selected molecules. However, the plant showed portent antioxidant and hepatoprotective properties in the in vitro, in vivo, and in silico models, and it is presumed that the hepatoprotective properties of the plant extract have occurred due to the presence of the vast bioactive chemical compounds as well as their antioxidant properties. Therefore, advanced studies are recommended to elucidate the pharmacological properties of the plant extracts.

Prevalence and predictors of diabetes distress among adults with type 2 diabetes mellitus: a facility-based cross-sectional study of Bangladesh.

INTRODUCTION: Diabetes distress (DD) is common and has considerable impacts on diabetes management. Unfortunately, DD is less discussed and frequently underestimated. This study evaluated the prevalence and predictors of DD in adults with type 2 diabetes mellitus (T2DM). METHODS: A cross-sectional study was conducted at several specialized endocrinology outpatient clinics in Bangladesh from July 2019 to June 2020; 259 adults with T2DM participated. Participants' DD and depression were measured using the 17-item Diabetes Distress Scale (DDS-17) and 9-item Patient Health Questionnaire (PHQ-9), respectively. DDS-17 scores ≥2 and PHQ-9 scores ≥10 were the cutoffs for DD and significant depression, respectively. RESULTS: The mean (±SD) age of the participants was 50.36 (±12.7) years, with the majority (54.8%) being male; their median (IQR) duration of diabetes was 6 (3-11) years. Among the study participants, 52.5% had DD (29.7% moderate and 22.8% high DD). The prevalence of emotional burden, physician-related distress, regimen-related distress, and interpersonal distress was 68.7, 28.6, 66, and 37.7%, respectively. Depression was present in 40.5%; 28.6% of the participants had DD and depression. The total DDS-17 score was positively correlated with the PHQ-9 score (r = 0.325, p < 0.001). Rural residence (OR 1.94), presence of any diabetic complication (OR 3.125), insulin use (OR 2.687), and presence of major depression (OR 4.753) were positive predictors of DD. In contrast, age ≥ 40 years at diabetes diagnosis (OR 0.047) and diabetes duration of > 10 years (OR 0.240) were negative predictors of DD (p < 0.05 in all instances). CONCLUSIONS: The prevalence of DD in our setting is notably high; DD and depression frequently overlap. Screening for diabetes distress may be considered, especially in high-risk patients.

Age- and sex-related differences in the measures of anterior segment parameters in a myopic clinical sample using Pentacam Scheimpflug tomography.

PURPOSE: To assess age-and sex-related differences of anterior segment parameters in a myopic clinical sample. METHODS: This clinic-based retrospective study involved eligible subjects grouped into myopia (i.e., low-to-moderate) and high myopia. Demographics and anterior segment parameters measures were recorded and analyzed. RESULTS: Some 153 eligible eyes were analyzed-98 myopia and 55 high myopia-comprising 87 males and 66 females. The mean ages and ranges were 28.47 years (SD = 9.59 years), 8-50 years, and 27.82 years (SD = 9.69 years), 10-51 years, for the myopia and the high myopia groups, respectively. The means of the spherical equivalents were - 3.02 D (SD = 1.46 D, range: - 0.50 to - 5.85 D), for the myopia group and - 10.42 D (SD = 5.50 D, range: - 6.00 to - 21.86 D) for the high myopia group. No significant difference was found between degree of myopia and anterior segment measures. Males had larger anterior chamber volume (mean 175.71 ± 26.27, range: 124-225 mm3); (P = 0.007) and deeper anterior chamber depth (3.73 ± 0.27, range: 3.06-4.41 mm) (P = 0.017) than females in the myopia group. Females also had significantly steeper anterior corneal curvature, Km (ant.) but flatter posterior corneal curvature, Km (post.), (- 6.31 ± 0.25, range - 7.00 to - 5.90 D) in both the myopia group [Km (ant.): 44.06 D ± 1.33 D, range: 41.30-47.10; Km (post.): - 6.31 D ± 0.25 D, range: - 7.00 to - 5.90; P = 0.008, P = 0.002, respectively] and the high myopia group [Km (ant.): 43.79 D ± 0.33 D, range: 41.00-47.10; Km (post.): - 6.22 D ± 0.30 D, range: - 6.80 to - 5.60; P = 0.034, P = 0.049, respectively]. Age was not correlated with the anterior segment parameters in both degrees of myopia. CONCLUSION: Sex has significant influence on the corneal curvature, anterior chamber volume and anterior chamber depth regardless of the degree of myopia.

Relationship between peripheral refraction, axial lengths and parental myopia of young adult myopes.

PURPOSE: To determine the relationship between peripheral refraction at the horizontal retina, axial length and parental history of myopia between myopic adults who have positive parental myopia and those with negative parental myopia. METHODS: 69 males and 44 females in the age range of 18-25 years were assigned either a negative parental myopia (NPM) or positive parental myopia (PPM) group. In the corrected and uncorrected states, peripheral refractive error was measured up to 30° horizontally in 10° steps using an open field autorefractor. Axial length was measured using an Opto US1000 Fine A-Scan Ultrasonography (model US1000). RESULTS: Relative peripheral refractive error showed more hyperopic defocus that was statistically significantly more increased in the positive parental myopia group than in the negative parental myopia group (P ≥ 0.02). The overall mean ± SD axial length of all subjects was 23.38 ± 0.32 mm (range 23.01-25.01 mm). The study showed a statistically significant difference (P = 0.005) in axial lengths of young adult myopes (23.45 ± 0.36 mm) with parental myopia compared to those with similar spherical equivalent refraction who have non-myopic parents (23.28 ± 0.19 mm). CONCLUSION: There was significantly more hyperopic defocus at 30° N and 30° T retina in the corrected states of young adult myopes who had myopic parents compared to their counterparts with non-myopic parents.

Psychological distress, fear and coping among Malaysians during the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic has enormously affected the psychological well-being, social and working life of millions of people across the world. This study aimed to investigate the psychological distress, fear and coping strategies as a result of the COVID-19 pandemic and its associated factors among Malaysian residents. METHODS: Participants were invited to an online cross-sectional survey from Aug-Sep 2020. The study assessed psychological distress using the Kessler Psychological Distress Scale, level of fear using the Fear of COVID-19 Scale, and coping strategies using the Brief Resilient Coping Scale. Univariate and multivariate logistic regression analyses were conducted to adjust for potential confounders. RESULTS: The mean age (±SD) of the participants (N = 720) was 31.7 (±11.5) years, and most of them were females (67.1%). Half of the participants had an income source, while 216 (30%) identified themselves as frontline health or essential service workers. People whose financial situation was impacted due to COVID-19 (AOR 2.16, 95% CIs 1.54-3.03), people who drank alcohol in the last four weeks (3.43, 1.45-8.10), people who were a patient (2.02, 1.39-2.93), and had higher levels of fear of COVID-19 (2.55, 1.70-3.80) were more likely to have higher levels of psychological distress. Participants who self-isolated due to exposure to COVID-19 (3.12, 1.04-9.32) and who had moderate to very high levels of psychological distress (2.56, 1.71-3.83) had higher levels of fear. Participants who provided care to a family member/patient with a suspected case of COVID-19 were more likely to be moderately to highly resilient compared to those who did not. CONCLUSION: Vulnerable groups of individuals such as patients and those impacted financially during COVID-19 should be supported for their mental wellbeing. Behavioural interventions should be targeted to reduce the impact of alcohol drinking during such crisis period.

Evaluation of Chitinase 3-like 1 (CHI3L1) as a noninvasive biomarker of hepatic fibrosis in patients with Hepatitis B virus-related compensated chronic liver disease.

BACKGROUND: Liver biopsy is the gold-standard method for diagnosing and staging liver fibrosis, but the procedure is invasive, not available in the primary health care facilities, and not free from complications. Noninvasive serum biomarkers of hepatic fibrosis are the current research focus. OBJECTIVES: To assess the correlation between serum Chitinase 3-like 1 (CHI3L1) levels and histological severity in patients with Hepatitis B Virus (HBV)-related compensated chronic liver disease (CLD). MATERIAL AND METHODS: This cross-sectional study evaluated 50 treatment-naïve patients with chronic hepatitis B with compensated CLD. Liver biopsy was done, and hepatic fibrosis was categorized using the METAVIR scoring system; we divided the study subjects into three groups; group 1 included subjects with F0 and F1, group 2 having F2 group 3 having F3 and F4. Serum CHI3L1 was measured in all by immunoassay. RESULT: Among 50 patients, only one had METAVIR score F0, seven had F1, 33 had F2, nine had F3, and none had METAVIR score F4. The median value of CHI3L1 was 460.8 (IQR 340.1-570.3) in all study subjects; 359.5 (IQR 272.8-526.9) in group 1, 450.0 (IQR 307.75-5332.0) in group 2, and 1355.5 (IQR 530.75-1580.5) in the group 3. The difference in median CHI3L1 across the groups was statistically significant. Serum aspartate aminotransferase (AST) and the AST to Platelet Ratio Index (APRI) score had significant positive correlations with CHI3L1 levels. CHI3L1 also had significant positive correlations with METAVIR scores. CONCLUSION: This study found a positive correlation between serum CHI3L1 level and hepatic histological severity in patients with HBV-related compensated CLD. Further larger-scale research is needed to establish the fact.

Obstetrics violence among parturient women in Kano State, north-west Nigeria.

OBJECTIVES: Women endure physical and psychological abuse from carers during delivery. This form of human-right violation has not been well investigated, especially, in low-income countries. This study determined the prevalence and predictors of obstetric violence among women who gave birth in urban Kano, Nigeria. STUDY DESIGN: Descriptive cross sectional study. MAIN OUTCOME MEASURES: Three hundred and sixty (360) postnatal attendees were interviewed using validated structured questionnaires. Forms of obstetric violence were ascertained and predictors generated using a logistic regression model in SPSS. RESULTS: The overall prevalence of obstetric violence was 32.3% (n = 115). The proportion among women who gave birth at home and in the hospital were 15.8% (n = 28) and 48.6% (n = 87), respectively (p < 0.05). Of the respondents that have experienced at least one form of OV, the most reported form was due to failure to meet professional standards of care (61.7%), of which neglect and abandonment (38.3%) was the commonest form. The least reported form was physical abuse (22.6%). Obstetric violence was predicted by place of delivery (hospital versus home) (Adjusted Odds ratio (AOR) = 3.52, 95% Confidence Interval (CI) = (2.07-5.99), parity (0 versus ≥ 1) (AOR = 2.94, 95%CI (1.62-5.35), and labour/delivery complication (present versus absent) (AOR = 2.22, 95%CI (1.17-4.24). CONCLUSIONS: Obstetric violence was prevalent, especially, among hospital births. Health workers require training on respectful maternity care.

The INTEND 1 randomized controlled trial of duct endoscopy as an indicator of margin excision in breast conservation surgery.

PURPOSE: With early detection, breast conservation surgery with adequate surgical margins is the standard of care. The aim of this study was to evaluate the use of pre-operative duct endoscopy (DE) to target surgical resection, improve adequate margins and reduce re-excision operations. METHODS: Women with DCIS, stage I and II breast cancer suitable for breast conservation were randomized to DE-assisted wide local excision versus standard wide local excision (without DE). The primary endpoint was margin re-excision rates between the two groups. Secondary end points were: (i) volume differences of the surgical specimen; (ii) whether an extensive in situ component (EIC) influenced successful DE-guided resection. RESULTS: 78 women were randomized: 44 patients to no-DE and 34 patients to the DE group. The median age was 59 (49-65) and 56 (48-64) years in the two groups respectively with mean follow-up of 9.1 (4.2-11.1) years. There were 23 positive findings in 17 women in 30 successful DE procedures (17/30 = 56.7%). The surgical specimen volume, no-DE (17 [IQR 10-29] cm3) and DE 20 [IQR 12-28] cm3), did not differ, p = 0.377. The overall re-excision rate was 20/78 (26%), 9 (20%) and 11 (32% in the no-DE and DE groups, respectively, p = 0.233. CONCLUSIONS: This randomized clinical trial was limited by incomplete accrual. DE did not contribute to improved margin excision rates whether a target lesion was visualized or not. The presence of EIC did not improve efficacy of DE.

Oral symptoms in patients with advanced cancer: an observational study using a novel oral symptom assessment scale.

PURPOSE: The aim of this study was to utilise a novel oral assessment tool (the Oral Symptom Assessment Scale/OSAS) to investigate oral symptoms in a cohort of advanced cancer patients receiving specialist palliative care. METHODS: Participants were asked to complete the OSAS, which asks about the presence of 20 oral symptoms in the previous week (and, if present, about the frequency, the severity, and the amount of distress caused by the symptoms). Patients were also asked to complete the Memorial Symptom Assessment Scale - Short Form, and to rate their performance status. RESULTS: Two hundred fifty participants completed the study, and 244 (97.5%) participants reported at least one oral symptom on the OSAS. The median number of oral symptoms reported was five (range, 1 to 18), with dry mouth being the most common symptom (83.5% participants). The total number of oral symptoms was higher in younger participants (p = 0.012), female participants (p = 0.048), and those with a worse performance status (p < 0.001). No other oral symptoms were reported by more than two participants. Statistical analysis identified a number of potential oral symptom clusters. CONCLUSIONS: Oral symptoms (and related oral problems) are common in patients with advanced cancer, and are associated with significant morbidity in this group of patients. TRIAL REGISTRATION: CancerTrials.gov registry reference number: NCT04404920.

Assessment of availability, awareness and perception of stakeholders regarding preschool vision screening in Kumasi, Ghana: An exploratory study.

BACKGROUND: Regardless of the importance of preschool vision screening (PSVS), there is limited data on the current state of these programs in Africa (particularly Ghana). This study sought to investigate the level of awareness and perception of stakeholders regarding PSVS, its availability and related policies/programmes in the Kumasi Metropolis, Ghana. METHODS: This descriptive cross-sectional study included 100 systematically sampled preschools in the metropolis (using probability proportional-to-size method); 72 private schools and 28 public schools. Convenience sampling was used to recruit stakeholders of preschools (teachers, head teachers, proprietors, administrators, directors, and educationists), and were interviewed using a well-structured questionnaire. Questionnaires were administered to all eligible respondents who were present at the time of data collection. RESULTS: A total of 344 respondents participated in the study; 123 (35.8%) males and 221 (64.2%) females. The overall mean age of respondents was 37.63 ±12.20 years (18-71 years). Of the respondents, 215 (62.5%), 94 (27.3%), and 35 (10.2%) were enrolled from private schools, public schools, and Metropolitan Education Directorate, respectively. 73.8% of respondents reported the absence of routine PSVS in schools whereas 90.1% reported no written policies for PSVS in schools. Only 63.6% of respondents were aware of PSVS whereas more than half (59.6%) of all respondents perceived PSVS to be very important for preschoolers. Private school ownership was significantly associated with availability of PSVS whereas age, teachers, private school ownership, and preschool experience > 10 years were significantly associated with awareness of PSVS (P < 0.05). However, there was no significant association between sociodemographic factors and perception of PSVS. CONCLUSION: PSVS is largely unavailable in most Ghanaian schools. Majority of stakeholders were aware of PSVS and agreed to its implementation and incorporation into schools' health programmes. There is the need to implement a national programme/policy on preschool vision screening in Ghana.

A proposed tailored investigational algorithm for women treated for gynaecological cancer with long-term gastrointestinal consequences.

BACKGROUND AND AIM: Long-term changes in gastrointestinal function impacting quality of life after treatment for cancer are common. Peer reviewed guidance to investigate and manage GI dysfunction following cancer treatment has been published. This study reviewed gastrointestinal symptoms of women previously treated for gynaecological cancer and considered whether suggested algorithms could be amended to optimise management for this cohort. METHODS: Demographic and clinical data recorded for patients attending a specialist consequences of cancer treatment gastroenterology service prospectively are reported using median and range. The Wilcoxon signed rank test analysed changes in symptoms between initial assessment to discharge from the service. RESULTS: Between April 2013 and March 2016, 220 women, with a median age of 57 years (range 24-83 years), treated for gynaecological cancer (cervical (50%)), endometrial (28%), ovarian (15%), vaginal or vulval (7%) attended. Twelve gastrointestinal symptoms were statistically significantly reduced by time of discharge from the specialist gastroenterology clinic including bowel frequency ≥ 4/day (88%), type 6 or 7 stool consistency (36%), urgency (31%) and incontinence (21%). General quality of life improved from a median score of 4 at first assessment to a median of 6 at discharge (p < 0.001). A median of four (range, 1-9) diagnoses were made. CONCLUSION: Women with gastrointestinal symptoms after cancer treatment benefit from a systematic management approach. After excluding disease recurrence, a proposed investigational algorithm and the oncology team includes FBC, U&Es, LFTs, thyroid function test, vitamin B12, vitamin D, a hydrogen methane breath test and a SeHCAT scan. If rectal bleeding is present, iron studies, flexible sigmoidoscopy or colonoscopy should be performed. Patients with normal investigations or symptoms not responding to treatment require gastroenterology input.

The efficacy of a low-fat diet to manage the symptoms of bile acid malabsorption - outcomes in patients previously treated for cancer.

Dietary fat ingestion triggers bile secretion into the gastrointestinal tract. Bile acid malabsorption affects >1% of the population, causing loose stool and other gastrointestinal symptoms. The diagnosis is frequently missed. Treatments are often considered ineffective. We evaluated low-fat diets for managing gastrointestinal symptoms in these patients. All patients reporting type 6 or 7 stool were offered a selenium-75 homocholic acid taurine (SeHCAT) scan. Prospective data in patients with 7-day scan retention <20% were analysed. -Patients requiring a bile acid sequestrant were given this before receiving dietary advice. Patients completed a 7-day food diary before dietetic consultations. Personalised dietary interventions, providing 20% of daily energy from fat, were prescribed. Symptoms were assessed using a modified gastrointestinal symptom rating scale questionnaire before and 4-12 weeks after dietary intervention. A total of 114 patients (49 male, median age 64 years, median body mass index 27 kg/m2) were evaluated. 44% of these patients were taking colesevelam. After dietary intervention, there was statistically significant improvement in abdominal pain and nocturnal defecation (0.2% alpha, p=0.001). Improvement in bowel frequency, urgency, flatulence, belching, borborygmi and stool consistency were seen, but did not reach statistical significance (p≤0.004-0.031). Dietary intervention is an effective treatment option for patients with symptomatic bile acid malabsorption and should be routinely considered.