Facile Synthesis and DFT Analysis of Novel Thiazole-Based Hydrazones: An Experimental and Theoretical Perspective.

Hydrazone compounds with remarkable nonlinear optical (NLO) properties were found with vast applications due to their cost-effective synthesis and greater stability. Therefore, we synthesized hydrazone scaffolds (TCAH1-TCAH8) by condensation reaction, and their structural confirmation was accomplished with spectroscopic methods (1H-, 13C-NMR, and HRMS). Quantum chemical calculations were also performed at B3PW91/6-311G(d,p) functional of DFT to explore electronic, structural, and chemical properties. To understand the NLO responses of afore-said chromophores, various kinds of analyses such as natural bonding orbitals (NBOs), frontier molecular orbitals (FMOs), UV-vis analysis, and density of states (DOS) were performed. Findings showed that the HOMO-LUMO energy gap in TCAH8 (3.595 eV) was found to be lower than the TCAH1-TCAH7 (4.123-3.932 eV) with a large red shift which leads to a substantial NLO response. Furthermore, strong intramolecular interactions showed the highest stabilization energy (24.1 kcal mol-1) for TCAH8 in the NBO transitions, combined with the least binding energy. The significant NLO response of TCAH4 was explored with ⟨α⟩, ßtot, and ⟨γ⟩ values as 5.157 × 10-23, and 2.185 × 10-29, and 2.753 × 10-34 esu, respectively, among the entitled compounds. The recent findings may inspire scientists to develop extremely effective NLO materials for forthcoming hi-tech applications.

Quantum Chemical Exploration of A-π1-D1-π2-D2-Type Compounds for the Exploration of Chemical Reactivity, Optoelectronic, and Third-order Nonlinear Optical Properties.

Organic compounds exhibit significant nonlinear optical (NLO) properties and can be utilized in various areas like optical parameters, fiber optics, and optical communication. Herein, a series of chromophores (DBTD1-DBTD6) with an A-π1-D1-π2-D2 framework was derived from a prepared compound (DBTR) by varying the structure of π-spacer and terminal acceptor. The DBTR and its investigated compounds were optimized at the M06/6-311G(d,p) level of theory. Frontier molecular orbitals (FMOs), nonlinear optical (NLO) properties, global reactivity parameters (GRPs), natural bonding orbital (NBO), transition density matrix (TDM), molecular electrostatic potential (MEP), and natural population analysis (NPA) were accomplished at the abovementioned level to describe the NLO findings. DBTD6 has the lowermost band gap (2.131 eV) among all of the derived compounds. The decreasing order of highest occupied molecular orbital-lowest unoccupied molecular orbital (HOMO-LUMO) energy gap values was DBTR > DBTD1 > DBTD2 > DBTD3 > DBTD4 > DBTD5 > DBTD6. The NBO analysis was carried out to describe noncovalent interactions such as conjugative interactions and electron delocalization. From all of the examined substances, DBTD5 showed the highest λmax value at 593.425 nm (in the gaseous phase) and 630.578 nm (in chloroform solvent). Moreover, the ßtot and ⟨γ⟩ amplitudes of DBTD5 were noticed to be relatively greater at 1.140 × 10-27 and 1.331 × 10-32 esu, respectively. So, these outcomes disclosed that DBTD5 depicted the highest linear and nonlinear properties in comparison to the other designed compounds, which underlines that it could make a significant contribution to hi-tech NLO devices.

Is Tocilizumab An Effective Therapy For Severe Covid-19: A Single Center Study.

Background: The quest for effective therapies in Covid-19 continues. We compared the outcome of severe COVID-19 patients treated with and without Tocilizumab, an IL-6 inhibitor. Methods: This is a prospective cohort study on the clinical characteristics and outcomes of patients with Covid-19 patients admitted at The Indus Hospital and Health Network, Karachi between 24th March and 19th June 2020. Adult patients who received TCZ were compared with respect to mortality and days of hospitalization with those who did not. Results: A total of 88 patients including 41 patients in the TCZ group and 47 in non-TCZ group were recruited. Baseline demographic characteristics were comparable. TCZ group patients presented with worse clinical features including median SpO2 82% vs 88%, p<0.05 and CRP 193 vs 133.9 mg/L, p<0.05. Approximately, 85.4% were admitted in ICU compared to 69.8% in non-TCZ group, p>0.05. Mortality was not different among the groups (46% in TCZ group vs 51.1% in non-TCZ group, p>0.05). Median length of hospital stays, days of intubation, use of inotropic agents, and use of invasive ventilation or in-hospital complications were similar between the groups. Sub-group analysis revealed that mortality within TCZ group was associated with high IL-6 levels (173 vs 69.66 pg/ml, p<0.05), ICU admission (100% vs 72%, p<0.05), need for mechanical ventilation (100% vs 13.6%, p<0.05) and higher incidence of in-hospital complications, p<0.05. Conclusion: TCZ failed to demonstrate any mortality benefit in our patients. Non-survivors within the TCZ group were more critical compared to survivors and developed more in hospital complications.

WHO Point Prevalence Survey to Describe the Use of Antimicrobials at a Tertiary Care Center in Pakistan: A Situation Analysis for Establishing an Antimicrobial Stewardship Program.

Antimicrobial stewardship is a systematic approach for promoting and monitoring responsible antimicrobial use globally. We conducted a prospective point prevalence survey of antimicrobial utilization among hospitalized adult patients during September 2021. The survey instrument was adapted from the WHO methodology for point prevalence surveys, and it was conducted at The Indus Hospital and Health Network, Karachi. Among the 300 admitted patients, 55% were males and the mean age was 44 (±18) years. At least 67% of the patients received one antimicrobial agent and the most common indication was surgical prophylaxis (40%). The most frequently used were antibacterial agents (97%) among all antimicrobials. Amoxicillin/Clavulanic acid and Ceftriaxone were the most frequently used antibacterial agents, i.e., 14% each. At least 56% of the antibacterial agents were amenable to antimicrobial stewardship when reviewed by infectious disease (ID) experts. Reasons for stewardship were: antibacterial not indicated (n = 39, 17.0%), unjustified prolonged duration of antibacterial (n = 32, 13.9%), extended surgical prophylaxis (n = 60, 26.2%), non-compliance to surgical prophylaxis guidelines (n = 30, 13.1%), and antibacterial not needed on discharge (n = 27, 11.7%). Median days of therapy (DOT) per agent was 3 days (IQR 2-4), while median DOT per patient was 2 days (IQR 1-4). These data have described the pattern of antimicrobial utilization in our institute. We found a higher prevalence of antimicrobial use overall as compared to the global figures, but similar to other low- and middle-income countries. Two important areas identified were the use of antimicrobials on discharge and extended surgical prophylaxis. As a result of these data, our institutional guidelines were updated, and surgical teams were educated. A post-intervention survey will help us to further determine the impact. We strongly recommend PPS at all major tertiary care hospitals in Pakistan for estimating antimicrobial utilization and identifying areas for stewardship interventions.

Development of the Arabic Health Measures database: a bibliometric analysis of Arabic health-related measures.

BACKGROUND: To develop an open-access database of Arabic health measures intended for use by researchers and healthcare providers, along with a bibliometric analysis of the measures included in the database. METHODS: A search was conducted up to 31 December 2021 in PubMed, Embase, CINAHL, SAGE, Springer and Elsevier for published articles or abstracts with keywords "Arabic" AND "translation", "adaptation" OR "validation". Information on the measure and the methodology used in the study was then entered into a database. An open-access platform was developed to allow users to search for measures according to their needs. A bibliometric analysis of the articles and measures was then conducted. RESULTS: A total of 894 publications met the inclusion criteria. The articles discussed 716 measures that were developed using participants from at least 38 countries. The number of measures for adults was five times that for children. Mental health was the most frequent construct assessed (11.5%), followed by "function/disability" measures (10.6%). The majority of measures (54%) required 5 minutes or less to complete. Approximately 17% of the tools were available directly from the article. Saudi Arabia and Lebanon had the greatest number of publications, with 217 (23%) and 114 (12%), respectively. The majority of the publications included reporting of the validation and reliability of the instruments (64% and 56%, respectively). CONCLUSIONS: There is a paucity of research on the quantity and quality of Arabic health measures. Similar to previous reviews, we found the number of publications on Arabic measures to be limited in comparison to those in English; however, it is encouraging that the number of publications appears to have increased steadily over the past decade. While we found the majority of publications reported on psychometric testing, we are unable to comment on the quality of the methodology used, and further investigation into this area is recommended. As the Arabic Health Measures database will facilitate the search for health instruments that have published data on their development, this will increase their visibility and use in research and clinical settings.

Comparison of angiographic results and clinical outcomes of no-reflow after stenting in left anterior descending (LAD) versus non-LAD culprit STEMI.

Objectives: No-reflow is a complication that frequently occurs after stenting during primary percutaneous coronary intervention. In this study, we focused on angiographic results and clinical outcomes after no-reflow in the left anterior descending (LAD) artery versus non-left anterior descending artery ST-elevation myocardial infarction (STEMI). Methods: In this prospective study, a total of 201 patients who had developed no-reflow during primary percutaneous coronary intervention were enrolled. The patients were divided into left anterior descending artery culprit and non-left anterior descending artery culprit groups. The primary endpoints were final thrombolysis in myocardial infarction flow, corrected thrombolysis in myocardial infarction frame count and final myocardial blush grade. Secondary endpoints were major adverse cardiovascular events in-hospital and at 1 month. Results: Out of the 201 patients, 60.19% had culprit left anterior descending artery. Pulse rate, baseline systolic and diastolic blood pressure, single-vessel disease, left ventricular ejection fraction <30%, baseline thrombolysis in myocardial infarction I flow and final thrombolysis in myocardial infarction II flow (24.8% vs 11.3%, p = .017), and thrombolysis in myocardial infarction frame count (28.17 ± 11.86 vs 24.38 ± 9.05, p = .016) were significantly higher in the left anterior descending artery group. In contrast, baseline Killip Class I, three-vessel disease, baseline thrombolysis in myocardial infarction II flow, final thrombolysis in myocardial infarction III flow (74.4% vs 87.5%, p = .024) and left ventricular ejection fraction >40% were significantly greater in the non-left anterior descending artery group. However, for both in-hospital and at 30 days, overall major adverse cardiovascular event was similar in the two groups. The demographics, clinical and medication profiles and the routes used to treat no-reflow were all comparable in both groups. Conclusions: No-reflow in left anterior descending artery ST-elevation myocardial infarction is associated with lower final thrombolysis in myocardial infarction III flow, higher thrombolysis in myocardial infarction frame count and relatively lower Grade III myocardial blush than non-left anterior descending artery ST-elevation myocardial infarction with subsequent lower left ventricular ejection fraction and a higher frequency of in-hospital heart failure and hospitalisation due to heart failure.

Effect of Remdesivir on mortality and length of stay in hospitalized COVID-19 patients: A single center study.

Objectives: To see the difference in mortality among hospitalized COVID-19 patients given Remdesivir (RDV) with those who were not given RDV. Methods: A prospective cohort study was conducted on patients who were admitted to the COVID-19 isolation unit at The Indus Hospital, Korangi Campus Karachi between March and June 2020. Results: Groups were similar in age and gender distribution. RDV group was more hypoxic, had severe ARDS and needed higher Oxygen support compared to non-RDV group (p=0.000). Median SOFA score was 2 in RDV vs 5 in non-RDV (p=0.000). More than moderate COVID pneumonia was found in 92% of the RDV group while 89% of non-RDV group (p value=0.001). Median day of illness to administer Remdesivir was 10. There was no difference in mortality (45.5% in RDV vs 40.4% in non-RDV; p=0.4) between the two groups. Median length of hospital stay was 12 days (IQR=7.5-14.5) in RDV group compared to 10 days (IQR=6-14) in non-RDV group (p=0.009). Conclusion: RDV did not show any difference in in-hospital mortality in our patients. More patients had severe ARDS in the RDV group while patients in the non-RDV group had higher SOFA score and multi-organ failure. Length of stay was longer in patients receiving Remdesivir.

Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan.

A prospective cohort study was conducted at the Indus Hospital Karachi, Pakistan between March and June 2020 to estimate the in-hospital mortality among hospitalized COVID-19 patients and its determinants. A total of 170 adult patients were enrolled and all-cause mortality was found to be 39% (67/170). Most non-survivors were above 60 years of age (64%) while gender distribution was quite similar in both groups (males: 77% vs 78%). Most (80.6%) non-survivors came with peripheral oxygen saturation less than 93% while 95% of them had critical disease on arrival. Use of non-invasive ventilation in emergency room was higher among non-survivors (56.7%) versus survivors (26.2%). Median Interleukin-6 levels were higher among non-survivors (78.6: IQR = 33.8-49.0) compared to survivors (21.8: IQR = 12.6-36.3). Most patients in the non-survivor group (86.6%) required invasive ventilator support during hospital stay compared to 7.8% in the survivors. The median duration of ICU stay was longer for non-survivors (9: IQR = 6-12) compared to survivors (5: IQR = 3-7) days. Univariable binary logistic regression showed that age above 60 years, oxygen saturation below 93%, Neutrophil to lymphocyte ratio above 5, procalcitonin above 2ng/ml, unit increase in SOFA score and arterial lactate levels were associated with mortality. We also found that a unit decrease in Pao2/FiO2 ratio and serum albumin were associated with mortality in our patients. Multivariable regression showed that age above 60 years (aOR = 3.4: 95% CI = 1.6-6.9), peripheral oxygen saturation below 93% (aOR = 3.5:95% CI = 1.6-7.7) and serum pro-calcitonin above 2ng/ml (aOR = 4.8; 95% CI = 1.9-12.2) were associated with higher odds of mortality when adjusted by month of admission. Most common cause of death was multisystem organ failure in 35 (56.6%) non-survivors while 22 (35.5%) died due to respiratory failure. Larger prospective studies are needed to further strengthen these findings.

Angiographic profile and outcomes of Pakistani women with ST elevation myocardial infarction.

OBJECTIVE: To evaluate the angiographic profile and outcome of primary percutaneous coronary intervention in female patients with acute myocardial infarction. METHODS: The cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from July 1, 2017, to March 31, 2018, and comprised of female patients presenting with acute myocardial infarction who underwent primary percutaneous coronary intervention and got enrolled in the National Cardiovascular Data Registry. Follow-up calls were made 1 year post-intervention and outcomes were noted. Data were analysed using SPSS 21. RESULTS: Of the 522 female patients with a mean age of 57.41±11.14 years, 334(64%) were hypertensive, 202(38.7%) diabetic, 16(3.1%) had a family history of coronary artery disease, and 9(1.7%) were smokers. Single-vessel disease was observed in 183(35.1%) patients, and three-vessel disease in 144(27.6%). Post-procedure thrombolysis in myocardial infarction flow (0-II) was observed in 29(5.6%) patients, bleeding in 2(0.4%), and in-hospital mortality was in 22(4.2%). Telephonic follow-up was successfully conducted in 436(87.5%) of the discharged patients, and, of them 15(3.4%) had expired and recurrence was reported by 10(2.3%) patients and 8(80%) of them underwent re-intervention. CONCLUSIONS: More than half the female patients had multi-vessel disease and bifurcation lesion was observed in more than three-fourth of the sample.

Parenting behaviors, marital discord and the mental health of young females: a cross-sectional study from Saudi Arabia.

BACKGROUND: Divorce is considered a sentinel event influencing the economic, psychosocial and physical health of the family as a whole. Research shows a negative impact of parental marital discord (PMD) on the psychological health and social well-being of children. Only one study from Saudi Arabia has assessed educational and social attainment among young females, and the children were school girls aged 12-16 years. OBJECTIVES: Explore the relationship between parental marital discord and depression, anxiety, stress, social support and self-esteem of the female child. We also studied the parenting behaviors and their association with the psychosocial health of adolescents. DESIGN: Cross-sectional questionnaire. SETTINGS: Women's university in Saudi Arabia. SUBJECTS AND METHODS: REDCap was used for collecting data through email invitations sent to all students at the university. Data on family structure, parental relationship, self-esteem and psycho-social health was collected. MAIN OUTCOME MEASURES: Depression, anxiety, stress, self-esteem and social support of the adolescent. Parenting behaviors of both parents were also assessed. SAMPLE SIZE: 296. RESULTS: The mean (SD) age of participants was 20.5 (2.4) years (median 20.0, IQR 19-22). The frequency of PMD was 24.6% (73/296). Overall, 38% of the students had extra severe anxiety, 26.5% had extra severe depression and 20.5% had extra severe stress on the Depression Anxiety and Stress Scale (DASS). The mean self-esteem score was 20.8 (5.5) and social support score was 57 (19.7). Both parents demonstrated low care and high protection trait on the Parental Bonding Instrument (PBI). Among those with PMD, mean (SD) age at discord was 11.4 (6.7) years. Mean (SD) duration of parental marriage was 20.9 (10.7) years and 35% of daughters received no financial help from the father. There was a significant association between PMD and depression, anxiety, stress and poor social support. PMD was associated with low paternal care and high protection trait. CONCLUSIONS: The study showed an alarming burden of mental health problems including depression, anxiety and stress among young Saudi females. Marital discord is prevalent in Saudi Arabia and is significantly related to poor psychosocial health in the child. Parents undergoing marital discord should be educated about healthy parenting styles and their children should be provided with counselling and coping strategies to maintain their emotional and psychological well-being. LIMITATIONS: Online survey could lead to volunteer bias. Only females are included in the study. CONFLICT OF INTEREST: None.

Epidemiology and outcomes of trauma patients at The Indus Hospital, Karachi, Pakistan, 2017 - 2018.

OBJECTIVE: Structured trauma care has proven to improve patient outcomes, and this is more relevant in the low- and middle-income countries (LMICs). The objective of this study was to determine the distribution, etiology, severity and outcomes of trauma patients at the Indus Hospital. METHODS: All adult poly-trauma patients presenting to The Indus Hospital from July 2017 to June 2018 were included in this retrospective review. Data was extracted on etiology of trauma, severity of injury, investigations and final disposition of patients. RESULTS: Of 972 trauma patients presenting to TIH Emergency Department, 663 (68.2%) were males with a mean age of 36 (17.4) years. Road traffic accidents (RTAs) led to trauma in 766 patients (78.8%), followed by 121 falls (12.7%). Injury Severity score (ISS) was calculated upon arrival and 528 (54.3%) were found to be critically injured. Median length of stay was 60 (24-720) minutes while none utilized pre-hospital Emergency Medical services. CONCLUSION: Most trauma patients were males suffering from RTA. Nearly half of the patients were critically injured on arrival. EMS is not utilized by trauma patients. There were gaps identified in the diagnosis and treatment of trauma.

Maternal characteristics and outcomes affected by hypothyroidism during pregnancy (maternal hypothyroidism on pregnancy outcomes, MHPO-1).

BACKGROUND: Hypothyroidism in pregnancy is an arena of ongoing research, with international conflicts regarding screening, management, and outcomes. Various studies have described the outcomes depending on geographical and international diagnostic criteria. No study has been conducted in this regard from the region of Pakistan. Therefore, we aim to report the clinical features and maternal outcomes of hypothyroid pregnancies and compare the maternal outcomes between uncontrolled and controlled TSH levels in the preconception as well as the gestational period. METHODS: We conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital after ethical approval. We collected information on pregnant females who have diagnosed hypothyroidism before conception or during their antenatal period. We noted the maternal characteristics and maternal comorbidities. Laboratory data were recorded for thyroid stimulating hormone levels before conception and during gestation. We recorded maternal outcomes as pregnancy loss (including miscarriage, stillbirth/intrauterine death, medical termination of pregnancy and ectopic pregnancy), gestational hypertension, pre-eclampsia, postpartum hemorrhage, placental abruption, and modalities of delivery. Data analysis was performed on Statistical Package for the Social Sciences version 20.0. RESULTS: Among 708 hypothyroid women 638 had live births. Postpartum hemorrhage was the most frequent maternal outcome (38.8%). The emergency cesarean section occurred in 23.4% of cases. We determined TSH levels in 53.2, 56.7, 61.7 and 66.6% of cases in preconception, 1st, 2nd, and 3rd trimester periods. A significant association existed between cesarean section and preconception thyrotropin levels > 2.5 mIU/L, whereas postpartum hemorrhage was significantly associated with thyrotropin levels > 2.5 mIU/L in the preconception and third trimester. CONCLUSION: Successful live births in our patients were complicated by maternal postpartum hemorrhage and a frequent number of emergency cesarean section.

The prevalence of chronic pain and its associated factors among Saudi Al-Kharj population; a cross sectional study.

BACKGROUND: Chronic pain (CP) can be a symptom of many underlying health issues. The consequences of CP may vary from slight discomfort to disruption of quality of life and normal functioning. In this study, we aim to investigate the prevalence of CP and its associated factors in Al Kharj, Saudi Arabia. METHODS: This was a cross-sectional study conducted in Al Kharj, Saudi Arabia. We recruited 1031 participants for our study. Data was collected on socio-demographic, health predictors and anthropometric measurements (such as weight, height and waist circumference). The data analysis was performed on JMP®, Version 12. SAS Institute Inc., Cary, NC, 1989-2007. RESULTS: The prevalence of self-reported chronic pain in Al Kharj population was 19% with a mean age of 26.4 (SD = 8.6) years. The most common locations of pain included; back pain (30%), abdominal pain (26%), headache (13%), and any musculoskeletal pain (56%). Multiple logistic regression revealed that presence of a chronic disease (OR = 3.8; 95% CI = 2.3-6.2), psychological disease (OR = 2.3; 95% CI = 1.2-4.3), high General Health Questionnaire (GHQ)-12 score (OR = 1.06; 95% CI = 1.03-1.1), and pack-years of smoking (OR = 1.05; 95% CI = 1.01-1.08) were significantly related to chronic pain in Al Kharj population. CONCLUSIONS: Our study results found a high burden of chronic pain in this selected Saudi population. The most prevalent pain was low back pain. The presence of chronic and psychological diseases were strongly related to chronic pain. Future prospective studies are needed to establish the temporal relationship of chronic pain with these factors.

Adherence to American Academy of Pediatrics' Oral Health Guidelines by Pediatricians and Pediatrics Residents in Riyadh, Saudi Arabia.

Purpose: The purpose of this study was to assess: (1) oral health knowledge and practices of pediatricians and pediatrics residents in Riyadh, Saudi Arabia; (2) their adherence to American Academy of Pediatrics (AAP) guidelines for caries-risk assess- ment and anticipatory guidance; and (3) the barriers that prevent their adherence to these guidelines.
Methods: Participants completed a questionnaire comprised of three sections: (1) demographic and professional characteristics; (2) oral health knowledge and practices; and (3) adherence to AAP oral health guidelines and barriers against adherence. The association between knowledge and practices scores and demographic and profes- sional characteristics was assessed using Mann Whitney and Kruskal Wallis tests.
Results: One-third of 1,261 pediatricians and pediatrics residents returned complete questionnaires. The mean±(standard deviation [SD]) knowledge score was 5.0±2.4 (out of 12), and the mean±(SD) practice score was 13.4±5.4 (out of 26). Only 8.3 percent reported following the AAP oral health guidelines, and the barriers against this included lack of awareness (60.9 percent), inadequate training on oral health (28.1 percent), and lack of time (21.6 percent).
Conclusion: Most pediatricians and pediatrics residents in Riyadh had inadequate oral health knowledge and practices as well as poor adherence to the AAP guidelines. Unfamiliarity with the guidelines was reported to be the main barrier against following them. (J Dent Child 2019;86(1):10-6)
Received November 1, 2018; Last Revision November 23, 2018; Accepted November 27, 2018.

Interprofessional learning experiences: Exploring the perception and attitudes of Saudi Arabian medical and dental students.

OBJECTIVE: The objective of this study is to evaluate the awareness and attitudes of medical and dental students regarding interprofessional learning (IPL). METHODS: A cross-sectional study was conducted with 278 female undergraduate Medical and Dental students from Princess Nourah bint Abdulrahman University, Riyadh. These students undertook IPL in the Foundation block, in basic science teaching, clinical skills' laboratories and in professionalism and learning skills' modules. A modified, validated RIPLS questionnaire with four subscales and 29 items was used to collect data regarding their perception and attitudes towards shared learning. A five-point Likert scale was used with a value ranging from 1 (strongly disagree) to 5 (strongly agree) for each item. Factor analysis was done using Varimox rotation. Student's t test was applied to detect difference between mean scores of medical and dental student's responses Results: The mean age of respondents was 19.8 ± 1.7 years with the majority in the second year of each program. There was no difference in mean responses of the medical and dental students. The respondents favored shared learning in the areas of professional skills and patient care. They agreed that IPL helps to develop respect, trust and appreciation for other professions; however, both groups preferred to learn uni-professionally with regard to developing discrete professional identities and roles. CONCLUSIONS: There is an overall positive response towards IPL and the value of team work; however, more attention needs to be paid to enabling students to learn about the specific roles of each profession in the healthcare team.

Incidence of Venous Thromboembolism in cancer patients treated with Cisplatin based chemotherapy - a cohort study.

BACKGROUND: Cancer related thrombosis not only increases morbidity and mortality but also poses a significant financial burden on health care system. Risk of venous thromboembolism (VTE) in these patients substantially increases with the addition of chemotherapy. Lately, cisplatin has been implicated as an independent factor. There is little data estimating the risk of venous thromboembolism in patients receiving cisplatin based chemotherapy when compared to other chemotherapeutic agents. METHODS: Patients who had received chemotherapy between November 2010 and October 2012 were retrospectively identified from a single institute cancer registry. 200 patients who had received cisplatin based chemotherapy were identified as the exposed group while 200 patients who had received non-Cisplatin based regimens were identified as the non-exposed group. Patients were followed for development of VTE throughout the entire duration of therapy and one month thereafter. Cox proportional hazard model was used to compute relative risks with 95% confidence intervals. RESULTS: The baseline characteristics were similar in the two groups. Mean age for the entire cohort was 55.4 ± 10.7 years and male to female ratio was almost 1:1. On univariate analysis, cisplatin based chemotherapy, presence of central venous catheter, female gender, poor performance status, high risk stratification according to the Khorana model and use of granulocyte colony stimulating factor were all significantly associated with the development of VTE. The crude relative risk for the incidence of VTE in cisplatin group was 2.8 (95% CI, 1.4 - 4.2) times compared to the non-Cisplatin group. When the relative risk was adjusted for the above variables in multivariable analysis, it increased to 3.3 (95% CI, 1.6 - 6.8) compared to the control group. CONCLUSION: A high incidence of VTE in patients receiving cisplatin based chemotherapy was demonstrated in this study. Prospective studies are warranted to establish this observation with certainty and to explore the possible use of thromboprophylaxis in patients receiving cisplatin based chemotherapeutic regimens.

Lesion Topography and Microscopic White Matter Tract Damage Contribute to Cognitive Impairment in Symptomatic Carotid Artery Disease.

Purpose To investigate associations between neuroimaging markers of cerebrovascular disease, including lesion topography and extent and severity of strategic and global cerebral tissue injury, and cognition in carotid artery disease (CAD). Materials and Methods All participants gave written informed consent to undergo brain magnetic resonance imaging and the Addenbrooke's Cognitive Examination-Revised. One hundred eight patients with symptomatic CAD but no dementia were included, and a score less than 82 represented cognitive impairment. Group comparison and interrelations between global cognitive and fluency performance, lesion topography, and ultrastructural damage were assessed with voxel-based statistics. Associations between cognition, medial temporal lobe atrophy (MTA), lesion volumes, and global white matter ultrastructural damage indexed as increased mean diffusivity were tested with regression analysis by controlling for age. Diagnostic accuracy of imaging markers selected from a multivariate prediction model was tested with receiver operating characteristic analysis. Results Cognitively impaired patients (n = 53 [49.1%], classified as having probable vascular cognitive disorder) were older than nonimpaired patients (P = .027) and had more frequent MTA (P < .001), more cortical infarctions (P = .016), and larger volumes of acute (P = .028) and chronic (P = .009) subcortical ischemic lesions. Lesion volumes did not correlate with global cognitive performance (lacunar infarctions, P = .060; acute lesions, P = .088; chronic subcortical ischemic lesions, P = .085). In contrast, cognitive performance correlated with presence of chronic ischemic lesions within the interhemispheric tracts and thalamic radiation (P < .05, false discovery rate corrected). Skeleton mean diffusivity showed the closest correlation with cognition (R2 = 0.311, P < .001) and promising diagnostic accuracy for vascular cognitive disorder (area under the curve, 0.82 [95% confidence interval: 0.75, 0.90]). Findings were confirmed in subjects with a low risk of preclinical Alzheimer disease indexed by the absence of MTA (n = 85). Conclusion Subcortical white matter ischemic lesion locations and severity of ultrastructural tract damage contribute to cognitive impairment in symptomatic CAD, which suggests that subcortical disconnection within large-scale cognitive neural networks is a key mechanism of vascular cognitive disorder. Online supplemental material is available for this article.

1,2,3,4,6-Pentakis[-O-(3,4,5-trihydroxybenzoyl)]-α,ß-D-glucopyranose (PGG) analogs: design, synthesis, anti-tumor and anti-oxidant activities.

1,2,3,4,6-Pentakis[-O-(3,4,5-trihydroxybenzoyl)]-α,ß-D-glucopyranose (PGG) 12 has been reported for its antioxidant activities, where the free OH groups in PGG seem to be critical for activities. To explore PGG-based compounds as chemotherapeutic agents and to analyze the contribution of specific OH groups in PGG for anti-cancer activities, we designed and synthesized a series of 27 benzoic and cinnamic acid analogs of PGG. These analogs were tested for cytotoxicities against two human lung (A549 and H1299) and two human colon (HCT116 and HT29) cancer cell lines. Compound 12 (PGG) had highest cytotoxicities against HCT116 and A549 cells with IC50 of 1.61 µM and 3.02 µM, respectively. In contrast, the compound 16 (1,2,3,4,6-pentakis[-O-(4-hydroxy-3-methoxybenzoyl)]-α,ß-D-glucopyranose, PVG) was most effective at killing HT29 and H1299 cells with IC50 of 1.76 µM and 3.65 µM, respectively, indicating the mutual contribution of m-methoxy and p-hydroxy groups to the observed cytotoxicities. Moreover, cinnamic acid analogs were less active than the benzoic acid analogs evidenced by higher IC50 values. Furthermore, in cinnamic acid analogs the hydrogenation of double bond to saturated 2-C side chain enhance the cytotoxicities in all four cell lines. Compounds also possess good anti-oxidant and reducing activities. Compound 12 and 26 show the highest antioxidant and reducing activities.

Measurement of the vascular pedicle width predicts fluid repletion: a cross-sectional comparison with inferior vena cava ultrasound and lung comets.

BACKGROUND: Determination of a patient's volume status remains challenging. Ultrasound assessments of the inferior vena cava and lung parenchyma have been shown to reflect fluid status when compared to the more traditional static and dynamic methods. Yet, resource-limited intensive care units (ICUs) may still not have access to bedside ultrasound. The vascular pedicle width (VPW) measured on chest radiographs remains underutilized for fluid assessment. In this study, we aimed to determine the correlation between ultrasound assessment and vascular pedicle width and to identify a discriminant value that predicted a fluid replete state. METHODS: Eighty-four data points of simultaneous VPW and inferior vena cava measurements were collected on mechanically ventilated patients. VPW measurements were compared with lung comet scores, fluid balance, and a composite variable of inferior vena cava diameter greater than or equal to 2 cm and variability less than 15 %. RESULTS: A VPW of 64 mm accurately predicted fluid repletion with a positive predictive value equal to 88.5 % and an area under the curve (AUC) of 0.843, 95 % CI 0.75-0.93, p < 0.001. VPW closely correlated with inferior vena cava diameter (Pearson's r = 0.64, p = <0.001). Poor correlations were observed between VPW and lung comet score, Pearson's r = 0.12, p = 0.26, fluid balance, Pearson's r = 0.3, p = 0.058, and beta natriuretic peptide, Pearson's r = 0.12, p = 0.26. CONCLUSIONS: This study shows a high predictive ability of the VPW for fluid repletion, as compared to an accepted method of volume assessment. Given the relationship of fluid overload and mortality, these results may assist fluid resuscitation in resource-limited intensive care units.