Perception, views, and barriers of primary care doctors regarding screening of depression among elderly patients attending public healthcare clinics in Kuching district: a qualitative study.

INTRODUCTION: Depression in the elderly constitutes 7.3% of the total Malaysian national prevalence of depression. However, depression is commonly underdiagnosed by primary care physicians, which may impact coexisting comorbid conditions and general well-being. As depression in the elderly increases with age, its prevalence is expected to become even more significant due to the increased life expectancy and isolation during the pandemic. This study aims to determine the perceptions, views and barriers encountered among primary care physicians on screening for depression among the elderly. MATERIALS AND METHODS: This qualitative study involved five public healthcare clinics in the Kuching district with indepth interviews (IDI) conducted on 14 primary care doctors (PCDs). Semi-structured interviews and in-depth discussions were conducted via videoconferencing. One representative was selected from each clinic at initiation, followed by snowball method for subsequent subject selection until saturation of themes. Interviews were transcribed verbatim, and analysis based on framework analysis principles via NVivo software. Themes were analysed deductively according to study objectives and evidence from literature. RESULTS: Three main themes emerged from the IDI: (1) The perception of depression in elderly patients, (2) The perceived barriers to screening, and (3) The screening processes. Majority of the PCDs perceived depression as part of ageing process. Time constraints, lack of privacy in consultation rooms, dominant caregivers and failure to recognise recurrent somatic symptoms as part of depression influenced PCDs decision to screen. Screening was technically challenging for PCDs to use the DASS-21, which was not socio-culturally validated for local native population. Only 21.4% of respondents (3/14) reported screening at least three out 10 elderly patients seen over 1- month period. During the covid pandemic, due to the same human resource support and practices, most participants thought their screening for depression in elderlies had not changed. CONCLUSION: Awareness of depression among PCDs needs to be re-enforced via continuous medical education programs to use appropriate screening tools, address infrastructure related barriers to optimise screening practices. The use of appropriate locally validated and socio-culturally adapted tool is vital to correctly interpret the screening test for patients.

Dementia detection practice among primary care practitioners: A cross-sectional study in Hulu Langat District, Selangor.

INTRODUCTION: Dementia is a global challenge for healthcare systems, including Malaysia. Despite evidence-based Clinical Practice Guidelines (CPG) for dementia management in primary care, detection is poor. Improving detection rates requires understanding current practice and influencing factors. This study aims to assess the practice of cognitive evaluation among primary care practitioners (PCPs) and its associated factors, as well as its correlation with their knowledge and attitudes towards early dementia diagnosis. MATERIALS AND METHODS: A cross-sectional study conducted online, using Google FormTM recruited 207 Medical Officers from 14 public primary health centres, with a response rate of 74%. The Knowledge, Attitude and Practice Questionnaire for Family Physicians (KAPQFP) was used to assess PCPs' knowledge, attitude and practice in dementia care. Items in each domain were scored on a 4-point Likert scale, with scores ranging from 1 to 4. Each domain's mean score was divided by 4 and converted to a scale of 100, with higher scores indicating better knowledge, attitude and practice. Bivariate analyses were conducted to determine the factors associated with cognitive evaluation practice. RESULTS: The overall mean practice score was 3.53±0.52 (88.3%), which is substantially higher than the mean score for perceived competency and knowledge of 2.46±0.51 (61.5%). The mean score for attitude towards dementia and collaboration with nurses and other healthcare professionals was 3.36±0.49 (84.0%) and 3.43±0.71 (85.8%), respectively. PCPs with prior dementia training showed better practice (p=0.006), as did PCPs with longer primary care work experience (p=0.038). A significant positive association was found between knowledge-practice ((rs=0.207, p=0.003), attitude towards dementia practice ((rs=0.478, p<0.001), and attitude towards collaboration with other healthcare professionals-practice (rs= 0.427, p<0.001). Limited time and inadequate knowledge regarding dementia diagnosis and cognitive evaluation tools were among the reasons cognitive evaluations were not performed. CONCLUSION: PCPs demonstrated better practice of cognitive evaluation, as compared to their knowledge and attitude. Given that their perceived competency and knowledge on dementia diagnosis is low and is positively associated with their practice, it is crucial to implement a comprehensive dementia training to enhance their knowledge and confidence on early detection of cognitive decline and cognitive evaluation in order to achieve better dementia detection in primary care.

Towards next generation digital twin in robotics: Trends, scopes, challenges, and future.

With the advent of Industry 4.0, several cutting-edge technologies such as cyber-physical systems, digital twins, IoT, robots, big data, cloud computation have emerged. However, how these technologies are interconnected or fused for collaborative and increased functionality is what elevates 4.0 to a grand scale. Among these fusions, the digital twin (DT) in robotics is relatively new but has unrivaled possibilities. In order to move forward with DT-integrated robotics research, a complete evaluation of the literature and the creation of a framework are now required. Given the importance of this research, the paper seeks to explore the trends of DT incorporated robotics in both high and low research saturated robotic domains in order to discover the gap, rising and dying trends, potential scopes, challenges, and viable solutions. Finally, considering the findings, the study proposes a framework based on a hypothesis for the future paradigm of DT incorporated robotics.

Effect of Long-Term Treatment with Dexamethasone on the Liver and Kidney Histopathology, as well as Blood Biochemistry in Male Rabbits (Lepus Cuniculus).

Glucocorticoids have a wide range of pharmacological activities. Generally speaking, the steroid drugs, such as dexamethasone (DEX) can have severe side effects on the histology of different organs. In fact, glucocorticoids have been known as powerful medicines which can cure inflammation and work with the immune system to treat a wide range of health problems. Therefore, this study aimed to investigate the effects of DEX on the histological changes of the liver and kidney, as well as blood biochemical parameters. In total, 13 specific pathogen-free male Lepus Cuniculus rabbits aged 8-10 months old, with a mean weight of 1.12±0.13 kg were randomly divided into three groups. Group I (n=3) did not receive DEX, and they only received saline solution as a placebo (control). In Group II (n=5), the animals received 0.25 mg DEX/kg body weight/day for a period of 56 days, and the animals in Group III (n=5) received 0.5 mg DEX/kg body weight/day for 56 days. Blood was aspirated from the rabbit's marginal ear vein. All blood samples were centrifuged at 3000×g for 10 min to separate serum samples. Blood lipids and trace elements (zinc, copper, calcium, and iron) were measured. The microscopical analyses of the liver and kidney tissues were performed through the observation of the histological changes in the tissues. The results showed a significant (P≤0.05) decrease in the body and organ weight, as well as serum concentrations for the trace elements. On the other hand, lipid profile showed a significant increase (P≤0.05) in cholesterol, triglycerides, and low-density lipoprotein. However, a significant decrease was recorded in high-density lipoprotein in both treated groups with DEX, compared to the control group. The results of the histological evaluation showed some degrees of degeneration, necrosis, cell vacuolation, and lymphocyte infiltration in the kidney and liver tissues in the treatment groups.

Flavin Binding Allosteric Aptamer with Noncovalent Labeling for miR Sensing.

Modular allosteric aptamers with discrete recognition and signaling regions provide a facile method of carrying out label-free detection by forgoing complex target labeling requirements. Herein, we describe the design and function of an aptamer scaffold capable of forming a hairpin loop in the presence of FAD (the signaling trigger). The aptamer includes a recognition region for the microRNA (miR) Let-7i. Upon selective miR hybridization, the aptamer undergoes a conformational shift to release FAD and thus produce a measurable response. As a result, the described method can sensitively and selectively detect miR Let-7i with a wide linear range of 0.1 pM to 1 µM and a detection limit of 150 fM. Additionally, this strategy was able to selectively discriminate between sequences with 1- and 2-nucleotide (nt) differences.

Usage of Traditional and Complementary Medicine (T & CM): Prevalence, Practice and Perception among Post Stroke Patients Attending Conventional Stroke Rehabilitation in A Teaching Hospital in Malaysia.

INTRODUCTION: The lack of evidence that proves the benefit of traditional and complementary medicines (T & CM) in treating chronic medical conditions does not deter its usage among patients worldwide. Prevalence of usage among post-stroke patients in Malaysia especially is unknown. This study aims to determine the prevalence, practice and perception of T & CM use among stroke survivors attending an outpatient rehabilitation program in a teaching hospital. METHODS: A cross-sectional study was conducted among 104 post stroke patients attending an outpatient rehabilitation program. A structured self-administered questionnaire was used to collect data on sociodemographic and clinical profile of patients, as well as types of therapy used and perception on T & CM usage. Descriptive analysis was done, and bivariate analysis was used to determine associations between categorical data. RESULTS: Mean age of patients was 62 years (SD 12.2), 54% were Chinese and 75% of the patients had ischaemic stroke. Mean age of T & CM users was younger compared to non- T & CM users (61 years vs. 66 years, p=0.04). Two-thirds (66%) of patients admitted to concurrent T & CM usage while attending conventional post stroke rehabilitation. Acupuncture (40.4%), massage (40.4%) and traditional Chinese medicine (11.5%) were the most common T & CM used. Positive perception was recorded in terms of ability of T & CM usage to relieve post stroke symptoms (68%), and it was safe to use because it was made from 'natural sources'. Negative perception recorded: T & CM caused significant adverse effects (57.6%) and was not safe to be used in combination with other conventional medicines (62.5%). CONCLUSIONS: Concurrent T & CM usage among post-stroke patients attending structured outpatient rehabilitation program is widely practised especially acupuncture, massage and traditional Chinese medicines. Overall the perception towards its use is favourable.

Characterization of Streptomyces isolates causing colour changes of mural paintings in ancient Egyptian tombs.

Paintings in ancient Egyptian tombs often suffer colour changes due to microbial growth and colonization. Streptomyces strains were isolated from mural paintings of Tell Basta and Tanis tombs (East of Nile Delta, Egypt) and were identified using biochemical and molecular methods. The16S rDNA sequences data indicated that isolated strains were closely related to S. coelicolor, S. albidofuscus, S. ambofaciens, S. canarius, S. parvullus, S. corchorusii, S. albidofuscus and S. nigrifaciens. It could be shown that Streptomyces strains are involved on a large scale in the colour changes of paintings and stone support by producing a wide range of metabolites such as acids (oxalic, citric and sulphuric acids), biopigments of melanin, carotenoids, and hydrogen sulphide.

Sodium valproate induced necrotising pancreatitis: A case report.

Sodium valproate is one of the most common first-line antiepileptics prescribed for primary and secondary generalised seizures. However, serious complications associated with sodium valproate, such as acute pancreatitis, need to be considered when choosing this medication for treating epilepsy in certain populations such as children and persons with intellectual disability. We report a case of a 21-year-old man with intellectual disability who presented to the emergency department with an acute abdomen, vomiting and diarrhoea. He had to undergo an emergency exploratory laparotomy during which acute necrotising pancreatitis was diagnosed intra-operatively. We believe that the recent increase in sodium valproate dosage for his epilepsy was the cause of the pancreatitis. Carers of such persons should be adequately informed regarding possible life-threatening complications of medications prescribed to avoid delay in diagnosis and unwanted incidents.

Osteosynthesis for a T-shaped fracture of the femoral neck and trochanter: a case report.

Ipsilateral fractures of the femoral neck and trochanter are uncommon. We report a 30-year-old man with a T-shaped fracture separating the trochanter and neck from the head. He underwent osteosynthesis using a dynamic compression plate, screws, and pins. Bone union occurred 4 months postoperatively. At the one-year follow-up, the patient was free of pain and had no evidence of avascular necrosis. It is important to preserve the femoral head in young patients by preventing further compromise of the tenuous blood supply.

Acute invaginating docking for infected non-unions of the humerus.

PURPOSE: To assess the efficacy of acute invaginating docking for infected non-unions of the humerus. METHODS: Eight men and 3 women aged 17 to 59 years with infected non-unions of the humerus underwent acute invaginating docking with shortening and Ilizarov fixation. RESULTS: The mean shortening was 2.9 cm owing to additional debridement. The mean time to external fixator removal was 14.9 (range, 8-28) weeks. The final bone result was excellent in 1, good in 8, and fair in 2. The functional result was excellent in 7 and good in 4. CONCLUSION: This modality enables simultaneous treatment of infected non-unions, axial alignment, vascularity, stability, and function.

Long-term survival of patients with resistant lymphoma treated with tandem stem cell transplant.

Dose-intensive chemotherapy with autologous stem cell support is commonly used in resistant/refractory cases of Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). The purpose of this study was to evaluate the role of tandem transplantation in these patients. We used non cross-resistant conditioning regimens with thiotepa, mitoxantrone and carboplatin (TMJ) followed by ifosphamide, carboplatin and etoposide (ICE) with autologous stem cell rescue in an attempt to maximize dose intensity and achieve long-term remission. Seventy-six patients were included in this study. Twenty-nine patients with HD and 47 with NHL underwent autologous stem cell transplant using TMJ as the conditioning regimen for the first transplant. Of these, 49 patients proceeded to the second transplant using ICE as the conditioning regimen. In 57 patients, only peripheral blood cells were used and in 11 patients both bone marrow and peripheral stem cells were used. Twelve patients died due to treatment-related toxicity. On an intent to treat basis, 32.14% of patients with HD refractory to initial or subsequent therapy survived long term as opposed to 12.76% of patients with NHL. With a median follow-up of 83 months (range 25 - 110 months), the median disease-free survival of patients with HD was 7 months, as opposed to 2 months for patients with NHL. Multivariate analysis identified that patients with HD had a superior outcome if they were less than 35 years of age and did not have B symptoms. Dose-intensive chemotherapy with tandem transplantation is an option in patients with resistant/refractory lymphoma who have very limited treatment options and poor prognosis.

Antimicrobial peptides isolated from skin secretions of the diploid frog, Xenopus tropicalis (Pipidae).

Seven peptides (XT-1-XT-7) with antimicrobial activity were isolated from norepinephrine-stimulated skin secretions of the diploid clawed frog, Xenopus tropicalis. Structural characterization of the peptides demonstrated that amino acid sequence similarity to antimicrobial peptides previously isolated from Xenopus laevis was low, suggesting that the species are not closely related phylogenetically. Peptides XT-5 and XT-3 are probably the orthologs of X. laevis peptide glycine-leucine amide (PGL(a)) and the N-terminal spacer region of prolevitide, respectively. XT-1, XT-6 and XT-7 show limited structural similarity to the spacer region of X. laevis procaeruleins and the paralogs XT-2 and XT-4 are similar to corresponding regions of proxenopsin. Orthologs of the magainins were not identified. The C-terminally alpha-amidated peptide XT-7 (GLLGPLLKIAAKVGSNLL.NH2) showed the lowest minimum inhibitory concentrations against reference microorganisms (Staphylococcus aureus 5 microM, Escherichia coli 5 microM, and Candida albicans 40 microM) and was also active against clinical isolates of methicillin-resistant S. aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus, Streptococcus group C, Shigella sonnei, Pseudomonas aeruginosa and Enterobacter cloacae. The peptide was, however, hemolytic against human erythrocytes (50% lysis at 70 microM). Circular dichroism studies showed that XT-7 has a random structure in aqueous solution, pH 7.0 but adopts an alpha-helical conformation in the presence of 50% trifluoroethanol. Decreasing the cationicity of XT-7 either by replacement of the C-terminal CONH2 group by COOH or by deletion of the Lys(8) residue produced analogs with greatly (>10-fold) decreased antimicrobial potencies.

High-dose chemotherapy and stem cell transplantation for patients with stage IV breast cancer without clinically evident disease: correlation of CD34+ selection to clinical outcome.

Forty-five patients with metastatic breast cancer without clinically evident disease were treated with thiotepa 750 mg/m2, mitoxantrone 40 mg/m2 and carboplatin 1000 mg/m2 followed by stem cell transplantation to determine the safety and efficacy of CD34+ selection of peripheral blood stem cells. Of these, 15 patients' (group I) stem cells were processed through Baxter Isolex 300 device for CD34+ selection, whereas 30 patients (group II) received unmanipulated stem cells. Toxicity, progression-free survival and survival were compared between these two groups. There was no difference in transfusion requirements, white cell count and platelet recovery and non-hematologic toxicity between the two groups. The survival of patients in group I was 27 months compared to 38 months in group II (P = 0.8). The progression-free survival was 12 months and 13.5 months for group I and group II patients, respectively (P = 0.6). Our results indicate that while there is no adverse effect, there is also no significant advantage of CD34+ selection in terms of progression-free survival and survival in patients with metastatic breast cancer without clinically evident disease. Bone Marrow Transplantation (2000).

Decortication for empyema thoracis.

Full text is available as a scanned copy of the original print version.

[Response of prolactin to thyrotrophin-RH(TRH) and chlorpromazine stimulation in the syndrome of hypogonadism and anosmia (author's transl)]. / Respuesta de la prolactina a los estímulos de torotrofina-RH(TRH) y clorpromacina en el síndrome hipogonadismo-anosmia.

Basal and stimulatory tests of FSH, LH and PRL are reported in three cases of hypogonadism-anosmia syndrome (Maestre-Kallmann-De Morsier syndrome), two of whom were brothers. Basal FSH levels were low (mean = 1.7 mU/ml) and did not respond to the first acute stimulation with intravenous LRH (x = 2.3 mU/ml), but after intramuscular LRH, 500 microgram/day for 10 days, a clear-cut response was noted in two patients (from a mean of 7.8 mU/ml to 16.8 mU/ml), while the other patient continued without response. Low basal LH levels (mean 1.8 mU/ml) responded poorly to the first LRH stimulation (mean 4.6 mU/ml), while after intramuscular LRH for 10 days there was a marked increase in all three cases (mean 29.7 mU/ml). In no case was there a response to clomiphene. With regard to PRL, all cases had a clear response to TRH, although it was subnormal in two of them. Opposite results were obtained in one case of Klinefelter's syndrome, namely, elevated basal PRL levels (44 ng/ml) with an exaggerated response to TRH. Chlorpromazine administration caused an elevation of PRL to 43 and 30 ng/ml, respectively, in the two patients with a subnormal response to TRH, while the third case responded less than to TRH. In conclusion, the response to TRH of FSH and LH with lack of response to clomiphene supports the hypothalamic nature of the hypogonadism, while the response of PRL to both TRH and chlorpromazine, along with the normal levels of the remaining pituitary hormones (ACTH, TSH and STH) demonstrate the selectivity of the hypothalamic lesion whereby only gonadotrophin control is impaired.