Why we need to pursue both universal and targeted prevention to reduce the incidence of affective and psychotic disorders: Systematic review and meta-analysis.

The effectiveness of universal preventive approaches in reducing the incidence of affective/psychotic disorders is unclear. We therefore aimed to synthesise the available evidence from randomised controlled trials. For studies reporting change in prevalence, we simulated all possible scenarios for the proportion of individuals with the disorder at baseline and at follow-up to exclude them. We then combined these data with studies directly measuring incidence and conducted random effects meta-analysis with relative risk (RR) to estimate the incidence in the intervention group compared to the control group. Eighteen studies (k=21 samples) were included investigating the universal prevention of depression in 66,625 individuals. No studies were available investigating universal prevention on the incidence of bipolar/psychotic disorders. 63 % of simulated scenarios showed a significant preventive effect on reducing the incidence of depression (k=9 - 19, RR=0.75-0.94, 95 %CIs=0.55-0.87,0.93-1.15, p=0.007-0.246) but did not survive sensitivity analyses. There is some limited evidence for the effectiveness of universal interventions for reducing the incidence of depression but not for bipolar/psychotic disorders.

Treatment of periorbital veins with vascular laser: A systematic review and retrospective case series.

INTRODUCTION: Vascular lasers may represent a promising treatment option for periorbital veins. This article aims to: (1) systematically review the literature on the safety and effectiveness of vascular laser treatment for periorbital veins and (2) assess safety and effectiveness through a retrospective case series. METHODS: Systematic review: Articles that assessed the safety and effectiveness of vascular laser treatment for periorbital veins were included and quality assessed using the Downs and Black checklist. CASE SERIES: Patient records were retrospectively reviewed from January 2020 to November 2023 to identify all patients who underwent laser treatment for periorbital veins. Outcomes assessment included percentage improvement, patient overall satisfaction and adverse effects. RESULTS: Systematic review: Three articles were included, discussing treatment of blue, periorbital veins using a 1064 nm Nd:YAG laser. Patient Fitzpatrick skin Types I-IV were treated with high patient satisfaction rates and complete clearance of treated veins. Adverse effects included pain, erythema, mild oedema, urticaria and blister formation. Quality of included studies ranged from 7 to 14 out of 21 points. CASE SERIES: Thirty-four patients with skin Types I-V were included. Blue and red periorbital veins were treated using 1064 and 532 nm wavelengths respectively. Mean percentage improvement was 4.8 (complete resolution) and patients' overall satisfaction was ranked 3 (completely satisfied). Adverse effects included erythema, oedema, and bruising. CONCLUSION: Treatment of red and blue periorbital veins using 532 and 1064 nm vascular lasers appears a safe treatment option. The procedure has a short recovery time, with patients able to resume normal activities within 1 day of treatment.

Aluminium phosphide (Al12P12) nanocage as a potential sensor for volatile organic compounds: A DFT study.

The efficacy of aluminium phosphide (Al12P12) nanocage toward sensing methanol (MeOH) and ethanol (EtOH) volatile organic compounds (VOCs) was herein thoroughly elucidated utilizing various density functional theory (DFT) computations. In this perspective, MeOH⋯ and EtOH⋯Al12P12 complexes were investigated within all plausible configurations. According to the energetic features, the EtOH⋯Al12P12 complexes exhibited larger negative values of adsorption and interaction energies with values up to -27.23 and -32.84 kcal mol-1, respectively, in comparison to the MeOH⋯Al12P12 complexes. Based on the symmetry-adapted perturbation theory (SAPT) results, the electrostatic forces were pinpointed as the predominant component beyond the adsorption process within the preferable MeOH⋯ and EtOH⋯Al12P12 complexes. The findings of the noncovalent interaction (NCI) index and quantum theory of atoms in molecules (QTAIM) outlined the closed-shell nature of the interactions within the studied complexes. Substantial variations were found in the molecular orbitals distribution patterns of MeOH/EtOH molecules and Al12P12 nanocage, outlining the occurrence of the adsorption process within the complexes under investigation. Thermodynamic parameters were denoted with negative values, demonstrating the spontaneous exothermic nature of the most favorable complexes. New energy states were observed within the extracted density of states plots, confirming the impact of adsorbing MeOH and EtOH molecules on the electronic properties of the Al12P12 nanocage. The appearance of additional peaks in Infrared Radiation (IR) and Raman spectra revealed the apparent effect of the adsorption process on the features of the utilized sensor. The emerging results declared the potential uses of Al12P12 nanocage as a promising candidate for sensing VOCs, particularly MeOH and EtOH.

Country-wide, multi-location trials of Green Super Rice lines for yield performance and stability analysis using genetic and stability parameters.

Rice (Oryza sativa L.) is an important member of the family Poaceae and more than half of world population depend for their dietary nutrition on rice. Rice cultivars with higher yield, resilience to stress and wider adaptability are essential to ensure production stability and food security. The fundamental objective of this study was to identify higher-yielding rice genotypes with stable performance and wider adaptability in a rice growing areas of Pakistan. A triplicate RCBD design experiment with 20 Green Super Rice (GSR) advanced lines was conducted at 12 rice growing ecologies in four Provinces of Pakistan. Grain yield stability performance was assessed by using different univariate and multivariate statistics. Analysis of variance revealed significant differences among genotypes, locations, and G x E interaction for mean squares (p < 0.05) of major yield contributing traits. All the studied traits except for number of tillers per plant revealed higher genotypic variance than environmental variance. Broad sense heritability was estimated in the range of 44.36% to 98.60%. Based on ASV, ASI, bi, Wi2, σ2i and WAAS statistics, the genotypes G1, G4, G5, G8, G11 and G12 revealed lowest values for parametric statistics and considered more stable genotypes based on  paddy yield. The additive main effects and multiplicative interaction (AMMI) model revealed significant variation (p < 0.05) for genotypes, non-signification for environment and highly significant for G × E interaction. The variation proportion of PC1 and PC2 from interaction revealed 67.2% variability for paddy yield. Based on 'mean verses stability analysis of GGE biplot', 'Which-won-where' GGE Biplot, 'discriminativeness vs. representativeness' pattern of stability, 'IPCA and WAASB/GY' ratio-based stability Heat-map, and ranking of genotypes, the genotypes G1, G2, G3, G5, G8, G10, G11 and G13 were observed ideal genotypes with yield potential more than 8 tons ha-1. Discriminativeness vs. representativeness' pattern of stability identifies two environments, E5 (D.I Khan, KPK) and E6 (Usta Muhammad, Baluchistan) were best suited for evaluating genotypic yield performance. Based on these findings we have concluded that the genotypes G1, G2, G3, G5, G8, G10, G11 and G13 could be included in the commercial varietal development process and future breeding program.

Decoding the DSCC1 gene as a pan-cancer biomarker in human cancers via comprehensive multi-omics analyses.

OBJECTIVES: While dysregulation of DSCC1 (DNA Replication And Sister Chromatid Cohesion 1) has been established in breast cancer and colorectal cancer, its associations with other tumors remain unclear. Therefore, this study was launched to explore the role of DSCC1 in pan-cancer. METHODOLOGY: In this study, we investigate the biological functions of DSCC1 across 33 solid tumors, elucidating its role in promoting oncogenesis and progression in various cancers through comprehensive analysis of multi-omics data. RESULTS: We conducted a comprehensive analysis of DSCC1 expression using RNA-seq data from TCGA and GTEx databases across 30 cancer types. Striking variations were observed, with significant overexpression of DSCC1 identified in numerous cancers. Elevated DSCC1 level was strongly associated with poorer prognosis, shorter survival, and advanced tumor stages in kidney renal papillary cell carcinoma (KIRP), liver hepatocellular carcinoma (LIHC), lung adenocarcinoma (LUAD), as indicated by Kaplan-Meier curves and GEPIA2 analysis. Further investigation into the molecular mechanisms revealed reduced DNA methylation in the DSCC1 promoter region in KIRP, LIHC, and LUAD, supporting enhanced RNA transcription. Protein expression analysis via the Human Protein Atlas (HPA) corroborated mRNA expression findings, showcasing elevated DSCC1 protein in KIRP, LIHC, and LUAD tissues. Mutational analysis using cBioPortal revealed alterations in 0.4% of KIRP, 17% of LIHC, and 5% of LUAD samples, predominantly characterized by amplification. Immune cell infiltration analysis demonstrated robust positive correlations between DSCC1 expression and CD8+ T cells, CD4+ T cells, and B cells, influencing the tumor microenvironment. STRING and gene enrichment analyses unveiled DSCC1's involvement in critical pathways, emphasizing its multifaceted impact. Notably, drug sensitivity analysis highlighted a significant correlation between DSCC1 mRNA expression and responses to 78 anticancer treatments, suggesting its potential as a predictive biomarker and therapeutic target for KIRP, LIHC, and LUAD. Finally, immunohistochemistry staining of clinical samples validated computational results, confirming elevated DSCC1 protein expression. CONCLUSION: Overall, this study provides comprehensive insights into the pivotal role of DSCC1 in KIRP, LIHC, and LUAD initiation, progression, and therapeutic responsiveness, laying the foundation for further investigations and personalized treatment strategies.

Smile aesthetics in Pakistani population: dentist preferences and perceptions of anterior teeth proportion and harmony.

BACKGROUND: This study aimed to evaluate dentist perceptions of attractive smiles in the Pakistani population, considering different dental proportions. METHODS: Maxillary casts and digital images were used to create symmetrical representations of anterior teeth. dentists' preferences for good and bad teeth proportions, width/height ratios, and various dental proportions (golden, recurring esthetic dental (RED), golden percentage, Preston, and local/observed) were assessed using one sample and paired t-test. The Chi-square test was used to determine the gender disparities and factors affecting smile attractiveness. A p-value of ≤ 0.05 was taken as significant. RESULTS: The RED proportion emerged as the preferred choice for normal-sized teeth, with specialists and general dentists favoring it over the golden proportion. For tall teeth, the golden proportion was predominantly preferred. The golden percentage received limited preference for aesthetic smile construction. CONCLUSIONS: The smiles created using the principles of RED proportion were opted as the most attractive by local dentists. Factors such as tooth arrangement, color, and midline were highlighted as essential considerations in aesthetic smile construction.

In-tube solid phase extraction with graphitic-based polyurethane sponge as a superhydrophobic sorbent and determination of drug residues in foodstuffs using high-performance liquid chromatography.

Veterinary drugs used in animal husbandry raise public health concerns due to their residues in the bodies of animals. This study employs a simple and quick sample preparation technique, in-tube solid phase extraction, to extract drug residues from foodstuffs, including eggs, honey, and water. This technique utilizes the synergy of graphitic-based materials and polyurethane sponges (PU) combined through dip coating method to make reusable sorbents for extracting drugs, including amoxicillin, paracetamol, ciprofloxacin, and cefixime. These prepared sorbents were characterized using FTIR, SEM, and XRD. HPLC analysis assessed the extraction efficiency, considering various parameters such as analyte concentration, sample solution pH, extraction time, type of eluting solvent, and graphitic-based polyurethane sponge reusability and stability. The proposed method exhibited a linear response for all three sorbents in the range of 0.03-1000 µg mL-1, with LOD 0.03-1.60 µg mL-1 and LOQ 0.18-4.84 µg mL-1. The % RSD ranged from 1.3 to 9.3 %, with recoveries of up to 98.42 %.

The significance of chemical reaction, thermal buoyancy, and external heat source to optimization of heat transfer across the dynamics of Maxwell nanofluid via stretched surface.

Energy loss during the transportation of energy is the main concern of researchers and industrialists. The primary cause of heat exchange gadget inefficiency during transportation was applied to traditional fluids with weak heat transfer characteristics. Instead, thermal devices worked much better when the fluids were changed to nanofluids that had good thermal transfer properties. A diverse range of nanoparticles were implemented on account of their elevated thermal conductivity. This research addresses the significance of MHD Maxwell nanofluid for heat transfer flow. The flow model comprised continuity, momentum, energy transport, and concentration equations in the form of PDEs. The developed model was converted into ODEs by using workable similarities. Numerical simulations in the MATLAB environment were employed to find the outcomes of velocity, thermal transportation, and concentration profiles. The effects of many parameters, such as Hartman, Deborah, buoyancy, the intensity of an external heat source, chemical reactions, and many others, were also evaluated. The presence of nanoparticles enhances temperature conduction. Also, the findings are compared with previously published research. In addition, the Nusselt number and skin friction increase as the variables associated with the Hartman number and buoyancy parameter grow. The respective transfer rates of heat are 28.26 % and 38.19 % respectively. As a result, the rate of heat transmission increased by 14.23 % . The velocity profiles enhanced while temperature profiles declined for higher values of the Maxwell fluid parameter. As the external heat source increases, the temperature profile rises. Conversely, buoyancy parameters increase as it descends. This type of problem is applicable in many fields such as heat exchangers, cooling of electronic devices, and automotive cooling systems.

Combined Preoperative Endovascular Embolization and Surgical Excision for Scalp Arteriovenous Malformations: A Systematic Review and Case Illustration.

OBJECTIVE: To evaluate the efficacy of the combined approach of preoperative endovascular embolization (EE) and surgical excision (SE) for scalp arteriovenous malformation (AVM) and present an illustrative case report. METHODS: A systematic review was conducted using online databases (PubMed/Medline, Cochrane, and Embase) on February 15, 2023. The inclusion criteria were any type of study of patients with scalp AVMs who were diagnosed and confirmed through angiography and treated with combined preoperative EE and SE. All the articles that met the inclusion criteria were included in this study. RESULTS: A total of 49 articles (91 patients) were included. The patients' age ranged from 10 days to 70 years at the time of presentation. The most common symptoms were a pulsatile mass in 51 patients (56.04%), progressively growing mass in 31 patients (34.06%), and bruits and/or thrills in 22 patients (24.17%). Complications of preoperative EE and SE were observed in only 5 patients; 3 patients (3.29%) had harvested skin graft marginal necrosis, 1 patient (1.09%) had skin necrosis, and 1 patient (1.09%) had a wound infection. Only 2 patients (2.19%) reported a recurrent or residual mass during a median follow-up period of 12 months. CONCLUSIONS: The management of scalp AVMs can be challenging; therefore, focused, and accurate identification of the complexity of the vascular anatomy is required. The combined method of preoperative EE and SE showed satisfactory outcomes with low rates of complications and recurrence; thus, we recommend this approach for the management of scalp AVMs.

Assessment of parental satisfaction with paediatric health services in public sector tertiary hospitals within a low-income setting using Patient Satisfaction Questionnaire (PSQ-18).

INTRODUCTION: Patient satisfaction is an integral part of healthcare quality, impacting treatment adherence, patient loyalty and healthcare utilisation. Parental satisfaction is particularly crucial as parents influence decision-making for their child's healthcare. OBJECTIVE: The objective was to assess parental satisfaction levels (as measured by Patient Satisfaction Questionnaire-18 (PSQ-18)) related to paediatric healthcare services and identify specific factors significantly influencing parental satisfaction with paediatric healthcare services. METHODOLOGY: This is a descriptive cross-sectional study that used a structured questionnaire based on the PSQ-18. The study was conducted in Faisalabad, Islamabad, Peshawar and Swat. Seven subscales measured satisfaction across various dimensions. RESULTS: We found 882 suitable responses indicating a diverse participant demographic, with the largest group in the 6-12 years age category. The overall mean parental satisfaction score was 2.0±0.5 (40.0%). Notably, financial aspects scored highest at 2.8 (55%), followed by accessibility and convenience at 2.0 (40.5%). However, lower satisfaction scores in the interpersonal relationship (1.8±0.5) and technical quality (1.8±0.5) domains were recorded. Sociodemographic analysis indicated age, education and occupation significantly influenced satisfaction. Conversely, factors such as gender, residence and the presence of chronic disease did not significantly impact satisfaction levels. CONCLUSION: The study offers valuable insights into paediatric patient satisfaction in Pakistan, emphasising the need for targeted interventions and improvements in specific domains to enhance overall healthcare quality.

Identification of provenance of Basmati rice grown in different regions of Punjab through multivariate analysis.

High-priced Basmati rice is vulnerable to deliberate mislabeling to increase profits. This type of fraud may lower consumers' confidence as inferior products can affect brand reputation. To address this problem, there is a need to devise a method that can efficiently distinguish Basmati rice grown in regions that are famous versus the regions that are not suitable for their production. Therefore, in this investigation, thirty-six samples of Basmati rice were collected from two zones of Punjab province (one known for Basmati rice) of Pakistan which is the major producer of Basmati rice. The elemental composition of rice samples was assessed using inductively coupled plasma-optical emission spectrometry and an organic elemental analyzer, whereas data on δ13C was acquired using isotopic ratio-mass spectrometry. Regional clustering of samples based on their respective cultivation zones was observed using multivariate data analysis techniques. Partial least squares-discriminant analysis was found to be effective in grouping rice samples from the different locations and identifying unknown samples belonging to these two regions. Further recommendations are presented to develop a better model for tracing the origin of unidentified rice samples.

Analysis of shade-matching ability in dental students: a comparative study under clinical and correcting light conditions.

BACKGROUND: Selecting the ideal tooth shade is essential to the success of aesthetic dental restorations. Students' cognitive abilities are involved in the multifaceted and intricate process of shade matching. Hence, the present study aimed to assess and compare the shade-matching ability of undergraduate dental students in various years of dental education under clinical and correcting light. METHODS: This comparative cross-sectional study was instigated amongst male 4th, 5th, and 6th-year students of the dental complex of King Faisal University, Kingdom of Saudi Arabia. A total of 72 male dental students assessed the shade under clinical (fluorescent light) and correcting light (handheld Dental Base Light) by using VITA Classical shade guides. Statistical analysis was done using SPSS version 23 (Armonk, NY, USA). The Chi-square test was used to evaluate the association between correct and incorrect shade matching under correcting and clinical light. RESULTS: Out of 72 male students, 22(30.6%) were from the 4th year, 26(36.1%) were from the 5th year, and 24(33.3%) were from the 6th year, with a mean age of 22.92 ± 1.01 years. The majority of the 6th-year students selected shade of anterior tooth # 11 correctly under clinical and correcting light, and 3(12.5%) students selected incorrectly under clinical and correcting light, with a statistically significant association among them (p = 0.004). As far as the shade selection of the posterior tooth is concerned, a statistically significant difference was observed under clinical light among all clinical students (p = 0.008). CONCLUSION: The clinical performance of dental students in shade matching improved with advancing years of dental education. Additionally, the shade matching ability of all groups of dental students was superior under correcting light compared to conditions under clinical light.

Rocephin-graphene oxide-silver nanocomposites: A versatile platform for biomedical applications.

For many years, the synthesis of graphene oxide (GO) had involved exfoliating graphite flakes, and the methods applied were expensive and time-consuming. Thus, an attempt had been made to create an inventive, less expensive method for the synthesis of GO using unrefined, raw carbon-containing material. Modified Hummer's method was used to prepare GO from banana peel. In addition, the metallic silver nanocomposite was also synthesized along with laoding of drug Rocephin where they interact with each other through electrostatic hydrogen bond interaction. The degree of crystallinity and the crystallite size were through x-ray diffraction (XRD) analysis and the crystallite size of AgNPs was found to be 40.40 nm. The scanning electron microscopy (SEM) analysis shows that the morphology of the GO gradually changes with the addition of AgNPs and Rocephin. A blue shift was seen in the absorbance maxima of the raw carbon upon the conjugation of Rocephin in UV analysis. The Fourier-transform infrared spectroscopy, and energy dispersive X-ray (EDX) spectroscopy were used to determine the chemical composition of the samples. Furthermore, a broad biological screening of the synthesized samples had been carried out following the total reducing power (TRP), total antioxidant capacity (TAC), antibacterial, antifungal, MTT (Cytotoxicity of biologically synthesized silver nanoparticles in MDA-MB-231 human breast cancer cells) cell viability, brine shrimp lethality, and hemolytic protocols. Significant results were obtained, and the Rocephin-GO-AgNPs had depicted promising activity as compared with their counterparts. RESEARCH HIGHLIGHTS: The GO was prepared from the raw carbon extracted from banana peels and was used as a substrate for the synthesis Graphene oxide silver nanoparticles (GO-AgNPs) and Rocephin-loaded graphene oxide silver nanoparticles (Rocephin-GO-AgNPs) The structural and compositional analysis of the nanomaterial was carried out, and they were screened for several biomedical applications. The Rocephin-GO-AgNPs exhibit the highest activity as compared with their counterparts.

Safety and efficacy revisited: a systematic review and meta-analysis of glue versus tack mesh fixation in laparoscopic inguinal herniorrhaphy.

Background: This analysis addresses the uncertainty surrounding the efficacy of glue mesh fixation (GMF) compared with tack mesh fixation (TMF) in laparoscopic herniorrhaphy. Our meta-analysis incorporates recently conducted randomized controlled trials (RCTs) to enhance the reference for assessing the efficacy and safety of GMF. Methods: PubMed Central, Google Scholar, Science Direct, and Cochrane Library were extensively reviewed for articles in the English language performed from inception to May 2023 using the keywords "Glue mesh repair," "Tack mesh repair," "Inguinal Hernia," "Herniorrhaphy," "Laparoscopic," "Mesh Fixation," and "Randomized controlled trials." Results: In this meta-analysis, we incorporated a total of 20 randomized controlled trials, evaluating each article individually using quality ratings. Compared with TMF, GMF demonstrated a significant reduction in the incidence of chronic pain [RR: 0.40, (0.23, 0.68)] and pain scores on postoperative day 1 [MD: -1.07, (-1.90, -0.25)]. We also used funnel plots and Egger's regression to test for publication bias. Conclusion: In summary, this meta-analysis establishes the significance of GMF in reducing chronic pain and postoperative day 1 pain compared with TMF. However, no statistically significant difference was noted between the GMF and TMF groups concerning hematoma, seroma, operation time, recurrence rate, and total complications. Nonetheless, given the small number of cases in this study, the findings must be validated in the future by multicenter, large-sample, high-quality RCTs.

Seroprevalence of Hepatitis B virus and human immunodeficiency virus co-infection in pregnant women from Osun State, Nigeria.

INTRODUCTION: Hepatitis B virus and human immunodeficiency virus (HBV/HIV) co-infection is a global health concern due to its significant impact on morbidity and mortality. Reports of HBV/HIV co-infections are increasing in Nigeria, but information on the disease burden in pregnant women and its implications on the fetus is scarce. This study aimed to determine the prevalence of HBV/HIV co-infection in pregnant women. In addition, the study identified the risk factors for the disease in pregnant women attending antenatal clinics in Osun State, Nigeria. METHODOLOGY: We collected plasma samples from 303 consenting pregnant women and used enzyme-linked immunosorbent assay (ELISA) to test for HBV (HBsAg) and HIV I/II antigens. We obtained demographic and risk factor data on HBV and HIV transmission using a structured questionnaire. RESULTS: Our analysis revealed a prevalence of 3.96% for HBV/HIV co-infection in pregnant women. Bivariate analysis indicated a history of blood transfusion, oral or anal sex, and multiple sexual partners may be associated with an increased likelihood of HBV/HIV co-infection in pregnant women. After adjusting for other variables in multivariate analysis, none of these risk factors were significant at the 5% level. In contrast, formal education was a potential preventive factor in this population. CONCLUSIONS: Our study provides valuable information on the disease burden of HBV/HIV co-infection in pregnant women in Osun State, Nigeria, highlighting the importance of routine screening for HBV and HIV during antenatal care and emphasizing the importance of implementing preventive measures to reduce the morbidity and mortality associated with HBV/HIV co-infection.

Smoke Signals: Unraveling the Paradoxical Impact of Smoking on Stroke Prognosis and Treatment Efficacy.

Smoking is a well-established risk factor for stroke, yet its impact on stroke prognosis remains complex and multifaceted. This systematic review aims to elucidate the relationship between smoking and various stroke outcomes, including response to treatment and long-term recovery. We conducted a comprehensive analysis of four fundamental studies that examined the prognosis of stroke in smokers, focusing on clinical outcomes post-endovascular treatment, response to antiplatelet therapy, incidence of post-stroke delirium, and the effectiveness of thrombolysis treatment. The studies varied in design, including observational, retrospective, and post hoc trial analyses. The review reveals that smoking may paradoxically predict better clinical outcomes in specific treatment scenarios, such as post-endovascular treatment and when using clopidogrel. However, smokers also demonstrated higher rates of ischemic stroke and post-stroke delirium. Notably, the smoker's paradox in thrombolysis treatment was not supported. These findings highlight the need for personalized treatment approaches based on smoking status. Smoking has a complex and significant impact on stroke prognosis. While some benefits in specific treatment contexts were observed, the overall evidence strongly advises against smoking due to its adverse health consequences. This review underscores the importance of personalized stroke management in smokers and the integration of smoking cessation programs in post-stroke care. Future research should focus on larger, longitudinal studies to explore these associations further.

A systematic review of patient reported outcome measures in patients with anti-neutrophil cytoplasmic antibody associated vasculitis.

OBJECTIVES: ANCA associated vasculitis (AAV) is associated with significant morbidity, fatigue, pain and poor health-related quality of life (HRQoL). This review aims to assess the comprehensiveness of existing patient reported outcome measures (PROMs) used in AAV and identify associations with poorer HRQoL outcomes. METHODS: A literature review of studies using PROMs, including those labelled HRQoL in people with AAV as a primary or secondary study outcome were screened and reviewed up to July 2023. Quality was assessed using the Critical Appraisal Skills Programme. RESULTS: A total of 30 articles were included which utilised 22 different PROM tools. 76.7% (n = 23) used the SF-36 or a variation as a generic measure of health status and or HRQoL. Two studies developed a disease specific PROM. The AAV-PRO showed good psychometric properties but potential limitations in capturing all relevant aspects of the disease experience for AAV patients. Factors associated with poorer HRQoL included: neurological and sinonasal involvement, women and younger patients. 86.6% of studies showed no meaningful relationships between the SF-36 and BVAS, VDI or disease duration. Depression and anxiety were common and socioeconomic factors such as unemployment were significantly associated with poorer mental health outcomes. Glucocorticoids were found to be independently associated with worse SF-36 scores. CONCLUSION: Generic PROMs are useful in measuring significant changes but lack sensitivity to specific symptoms and unique AAV-related issues, while existing disease specific PROMs have limitations and may not fully capture AAV patient's perspective on disease and treatment burden.

Voices of Change: Stakeholders' Roles in the Fight Against Substance Abuse in Mogadishu, Somalia.

Aim: This study explores the roles, challenges, and collaborative efforts of key stakeholders engaged in addressing substance abuse. Methods: Using a qualitative narrative approach, the study examined stakeholder roles in tackling substance abuse in Mogadishu, Somalia. Purposive sampling was utilised to select all available community stakeholders actively addressing substance abuse. Semi-structured interviews were conducted to collect data, allowing participants the freedom to share their experiences openly. Thematic analysis was employed to identify patterns, commonalities, and diversities in the stakeholders' roles. The study focused on a population of five key stakeholders, including the Somali police force, a National Medicines Regulatory Authority officer, two social workers, and a representative from the Ministry of Endowments & Religious Affairs. Results: The research reveals a significant prevalence of psychoactive substances in Mogadishu, with emerging trends like the misuse of pregabalin driven by accessibility and affordability. Emphasising collaborative efforts, the study highlights the importance of effective communication and coordination among stakeholders to provide comprehensive support for individuals with substance abuse issues. Despite these challenges, such as limited resources, evolving drug trends, and addiction complexity, ongoing efforts and adaptation are crucial. Additionally, the research elucidates the established link between substance abuse and criminal behaviour, emphasising the potential consequences of drug addiction on financial desperation, violent acts, drug trafficking, and other criminal behaviours. Conclusion: The study reveals widespread substance abuse, necessitating adaptable authorities. Collaborative stakeholder efforts are vital for supporting individuals affected. Challenges demand sustained efforts. The study links substance abuse to crime. Effective resolution requires stakeholder unity, prevention programs, expanded treatment access, and adaptation to the evolving drug landscape while supporting those affected.