Silver decorated 2D nanosheets of GO and MoS2serve as nanocatalyst for water treatment and antimicrobial applications as ascertained with molecular docking evaluation.

In this work, synthesis of graphene oxide (GO) and reduced graphene oxide (rGO) was realized through a modified Hummers route. Different concentrations (5 and 10 wt%) of Ag were doped in MoS2and rGO using a hydrothermal technique. Synthesized Ag-MoS2and Ag-rGO were evaluated through XRD that confirmed the hexagonal structure of MoS2along with the transformation of GO to Ag-rGO as indicated by a shift in XRD peaks while Mo-O bonding and S=O functional groups were confirmed with FTIR. Morphological information of GO and formation of MoS2nanopetals as well as interlayer spacing were verified through FESEM and HRTEM respectively. Raman analysis was employed to probe any evidence regarding defect densities of GO. Optical properties of GO, MoS2, Ag-rGO, and Ag-MoS2were visualized through UV-vis and PL spectroscopy. Prepared products were employed as nanocatalysts to purify industrial wastewater. Experimental results revealed that Ag-rGO and Ag-MoS2showed 99% and 80% response in photocatalytic activity. Besides, the nanocatalyst (Ag-MoS2and Ag-rGO) exhibited 6.05 mm inhibition zones againstS. aureusgram positive (G+) and 3.05 mm forE. coligram negative (G-) in antibacterial activity. To rationalize biocidal mechanism of Ag-doped MoS2NPs and Ag-rGO,in silicomolecular docking study was employed for two enzymes i.e.ß-lactamase and D-alanine-D-alanine ligase B (ddlB) from cell wall biosynthetic pathway and enoyl-[acylcarrier-protein] reductase (FabI) from fatty acid biosynthetic pathway belonging toS. aureus. The present study provides evidence for the development of cost-effective, environment friendly and viable candidate for photocatalytic and antimicrobial applications.

Increased Expression of Cardiotrophin-1 in Cardiomyopathy Patients.

Cardiomyopathy (CM) is a condition of cardiac dysfunction. It is one of the leading causes of mortality in which both genetic and environmental factors are involved. Cardiotrophin-1 (CT-1) level in plasma is associated with CM. It affects the cardiomyocyte differentiation. To evaluate the expression of CT-1 in cardiomyopathy, this study was done on CM subjects attending the Fatima Memorial Hospital, Lahore, Pakistan, between January and June, 2016. A total of 40 subjects were enrolled who were divided into two groups; CM group (n = 20) and a control group (n = 20). A self-designed questionnaire was filled in by each subject to collect data regarding age, body mass index (BMI) and CM history. RNA was isolated from blood after its quantification, cDNA was prepared and reverse-transcriptase-polymerase chain reaction (RT-PCR) was performed for expression of CT-1. The mean age in CM subjects was 40.1±6.03 years, while it was 35.0±3.7 years in the control group. The mean expression of CT-1 in the CM subjects was 5.2±0.66, while it was 1.00±0.001 in the control group. A highly significant difference was observed in CT-1 expression in the CM group, and expression was significantly correlated with age and BMI in CM subjects.

Bimetallic Ag/Cu incorporated into chemically exfoliated MoS2 nanosheets to enhance its antibacterial potential: in silico molecular docking studies.

Bimetallic Ag and Cu (1:1 wt%) nanoparticles (NPs) were synthesized and annealed at temperatures of 400 °C, 600 °C, and 800 °C using chemical reduction techniques. High temperature annealed (at 800 °C) Ag:Cu sample ratios (5 and 10 wt%) were used to dope MoS2. A wide variety of techniques including X-ray diffraction, Fourier transform infrared spectroscopy, field emission scanning, high resolution transmission electron microscopy, differential scanning calorimetry, thermogravimetric analysis, Raman, photoluminescence, and ultraviolet visible spectrophotometry were used to study the morphology, structure, functional groups, excitons recombination, and thermal and optical properties of both annealed and doped samples. The antimicrobial activity of the prepared products was tested on the MRSA-superbug with ciprofloxacin antibiotic as the reference drug. Statistically significant (P < 0.05) inhibition zones (mm) were recorded for the as-synthesized Ag-Cu, heat-treated samples at 400 °C, 600 °C, and 800 °C, doped Ag-Cu/MoS2 5% and Ag-Cu/MoS2 10% which ranged from 6.35-9.85 mm and 8.60-11.75 mm at (0.5, 1.0 mg 50 µl-1) concentrations compared with ciprofloxacin 12.55 mm and DIW 0 mm inhibition zones, respectively. Overall Ag-Cu NPs alone and with different temperature treatments showed less antibacterial efficacy compared with Ag-Cu/MoS2 5% and 10%. Furthermore, molecular docking studies were employed to unveil the binding interaction pattern of NPs in the active pocket of ß-lactamase enzyme suggested that it could be a potential inhibitor that could be further evaluated for its enzyme inhibition characteristics.

Cryoprotectant effect of trehalose in extender on post-thaw quality and in vivo fertility of water buffalo (Bubalus bubalis) bull spermatozoa.

This study was designed to ascertain the cryoprotectant effects of different concentrations of trehalose [0 (T0), 25 (T25), 35 (T35), 45 (T45) mm], egg yolk [20% (E20), 15% (E15) v/v] and glycerol [7% (G7), 5% (G5) v/v] in Tris-citric acid-based extender on post-thaw quality and in vivo fertility of buffalo bull spermatozoa. Twenty-five ejaculates were collected from five bulls and split into four parts. After that, the split ejaculates from each of the bull were diluted either in T0E20G7 (control) or T25E20G5 or T35E15G5 or T45E15G5 extender. Finally, the sperm suspension was frozen in 0.54-ml French straws. Post-thaw sperm total motility (%), progressive motility (%), rapid velocity (%), average path velocity (µm/s), straightline velocity (µm/s), curvilinear velocity (µm/s), linearity (%), plasma membrane and acrosome integrities (%) were higher (p < .05) in T45E15G5 extender as compared to other treatment groups and control. The fertility rate (56.8% versus 41.3%) was higher (p < .05) in buffaloes inseminated with semen doses cryopreserved in extender containing T45E15G5 combination of cryoprotectants than the control. In conclusion, addition of 45 mm trehalose along with 15% egg yolk and 5% glycerol in extender improves the post-thaw quality and in vivo fertility of buffalo bull spermatozoa.

Chloride Depletion Alkalosis as a Predictor of Inhospital Mortality in Patients with Decompensated Heart Failure.

OBJECTIVES: Chloride depletion alkalosis (CDA) is often seen as a consequence of diuresis in heart failure (HF) but its prognostic significance remains unknown. The purpose of this study was to evaluate the prognostic role of CDA in decompensated HF (DHF). METHODS: A retrospective cohort analysis was performed on 674 patients who were admitted with DHF. Patients were assigned to 2 groups based on the change in serum bicarbonate (median = 3 mmol/l) after diuresis, which was calculated by computing the difference in the admission and discharge serum bicarbonate: the CDA group (a change in serum bicarbonate ≥3 mmol/l) and the non-CDA group (change in serum bicarbonate <3 mmol/l). The primary end points were inhospital mortality and the composite end point of all-cause 30-day mortality and hospital readmission for HF. RESULTS: In a multivariable logistic regression model, the CDA group, i.e. 374 patients, had a lower inhospital mortality than the non-CDA group, i.e. 300 patients (OR 0.11, 95% CI 0.03-0.38; p = 0.0005) after adjusting for other covariates. There was no statistically significant difference in the combined end point of all-cause 30-day mortality and readmission between the 2 groups (OR 1.26, 95% CI 0.74-2.12; p = 0.39). CONCLUSION: The presence of CDA during hospitalization for DHF was independently associated with a better inhospital survival rate.

Experiences of stigma among hepatitis B and C patients in Rawalpindi and Islamabad, Pakistan.

Hepatitis B and C are chronic diseases with mental and social impacts which can result in poor quality of life. The aim of this study was to determine the experiences of stigma in a sample of hepatitis B- and C-positive patients in Pakistan. In a cross-sectional study, 140 inpatients and outpatients from 3 tertiary-care hospitals in Islamabad and Rawalpindi answered a semi-structured questionnaire about stigma experienced from relatives, friends, spouse and health-care providers, and about work/financial problems. The majority of patients (75%) said they had had to change their lifestyle, and significantly more were males than females. Stigma was marked in terms of disease transmission, with 66% of patients fearing that they could transmit the infection to others; 19% said that family members avoided sharing towels, soap and eating and drinking utensils. Marital relationships were affected for 51% of married patients who had told their spouse. Patients' comments showed a sense of family and societal discrimination resulting in feelings of disappointment and isolation.

Novel lip pit phenotypes and mutations of IRF6 in Van der Woude syndrome patients from Pakistan.

The role of interferon regulatory factor 6 (IRF6) gene mutations in causing Van der Woude syndrome (VWS) and poplyteal pterygium syndrome has been described in different populations worldwide. The former is one of the major syndromes of cleft lip and/or cleft palate (CL/P) with the distinct phenotype of presence of pits with or without sinuses on the lower lip. We identified seven probands with VWS from Punjab province of Pakistan and recognized two previously unreported lip pit phenotypes. The mutational analysis of IRF6 in this cohort revealed four novel and two previously reported mutations. The newly identified mutations include three frameshifts (c.635delG; c.21_33del13; c.627delC) and one transition mutation (c.2T>C) affecting the first codon of IRF6. Together with a past epidemiological study on VWS in Pakistan, the frequency of this syndrome among CL/P individuals from Punjab was calculated to be 1.17%.

Dominant modifier DFNM1 suppresses recessive deafness DFNB26.

More than 50% of severe childhood deafness is genetically determined, approximately 70% of which occurs without other abnormalities and is thus termed nonsyndromic. So far, 30 nonsyndromic recessive deafness loci have been mapped and the defective genes at 6 loci, DFNB1, DFNB2, DFNB3, DFNB4, DFNB9 and DNFB21, have been identified, encoding connexin-26 (ref. 3), myosin VIIA (ref. 4), myosin XV (ref. 5), pendrin, otoferlin and alpha-tectorin, respectively. Here we map a new recessive nonsyndromic deafness locus, DFNB26, to a 1.5-cM interval of chromosome 4q31 in a consanguineous Pakistani family. A maximum lod score of 8.10 at theta=0 was obtained with D4S1610 when only the 8 affected individuals in this family were included in the calculation. There are seven unaffected family members who are also homozygous for the DFNB26-linked haplotype and thus are non-penetrant. A dominant modifier, DFNM1, that suppresses deafness in the 7 nonpenetrant individuals was mapped to a 5.6-cM region on chromosome 1q24 with a lod score of 4.31 at theta=0 for D1S2815.

Effect of natural and synthetic androgen hormone on sex reversal of Nile Tilapia (Oreochromis niloticus).

The present study aimed to produce a monosex population of all male Nile tilapia (Oreochromis spp.) using 17α-methyl testosterone and common carp testes (as a source of natural androgen). Trial was conducted into two consecutive phases, the first was fry (4-5 days old)administration with negative control (without hormone) and positive control (with hormone) feed viz., MT1:60mg/kg, MT2:70mg/kg (17α-MT), carp testis CT1:70% and CT2:80% for 30 days to reverse the sex of male fish and the second phase was nursing the fingerlings for two months on control diet (32% Crude protein).Results revealed a significant growth rate (P<0.05) in the control group where final weight (4.8±0.34ab) and weight gained was recorded as 0.66±0.03ac. In proximate chemical composition of body meat, CT2 treatment showed maximum retention of crude protein, crude fat, and ash whereas dry matter showed maximum retention in MT2 and CT1 treatments. Morphological and histological examination revealed significant difference (p<0.05) in phenotypic males of Nile tilapia fed with the highest percent in MT-treated diet (MT2) of 95±0.58a while MT1, CT2 and CT1 had males of 85±6.0b, 70±5.0b and 65±6.5b, respectively. It was concluded that synthetic androgen (17αMT) was more effective for masculinization but natural androgen scan be an alternative method to produce male tilapia population in an environment-friendly manner as they are inexpensive, eco-friendly, and radially available. These results suggested that synthetic and natural androgen supplementation in the diet plays a significant role in improving growth performance and body composition.

Determining the 3-substituted Coumarins inhibitory potential against the HslV protease of E. coli.

OBJECTIVE: The growing bacterial resistance towards classical antibiotics demands the development of novel approaches for the effective treatment of potentially fatal bacterial infections in humans. Proteostasis is crucial for the survival of every living cell, as several important physiological functions depend on well-regulated proteostasis. Within bacteria, the regulation of proteostasis relies on AAA+ (Adenosine 5'-triphosphatases associated with diverse cellular activities), ATPases, such as the HslVU complex (heat shock locus gene products U and V), along with other proteases. The HslVU protease/chaperon complex is thought to be the progenitor of the eukaryotic proteasome that regulates proteostasis mostly in prokaryotes. This study aimed to determine the inhibitory potential of 3-substituted coumarin derivatives against Escherichia coli heat shock locus V (HslV) protease. MATERIALS AND METHODS: In this study, twenty-three derivatives of 3-substituted coumarin were assessed for their inhibitory potential against E. coli HslV protease using both in-vitro and in-silico techniques. RESULTS: Among all the tested compounds, US-I-64, US-I-66, US-I-67, and US-I-68 displayed notable inhibitory potential against the HslV protease, showing IC50 (half maximal inhibitory concentration) values ranging from 0.2 to 0.73 µM. Additionally, the inhibitory potential of these compounds against the eukaryotic proteasome was also evaluated using a separate in-silico study. It was found that these compounds did not bind with the proteasomal active site, suggesting no apparent side effects of these lead molecules. CONCLUSIONS: These identified HslV protease inhibitors can be used for the development of novel and safer anti-bacterial drugs.

Cloning and periplasmic soluble expression of hepatitis B surface antigen gene in Escherichia coli.

OBJECTIVE: The objective of this study was to clone and express the hepatitis B surface antigen gene (HBsAg) in Escherichia coli (E. coli), thereby aiming to develop potential local therapeutics for combating Hepatitis B virus (HBV) infection in the Pakistani community by producing HBsAg in E. coli. MATERIALS AND METHODS: Blood serum samples were collected from hepatitis B-infected patients, and their genomic DNA was extracted. Real-time and nested polymerase chain reaction (PCR) was performed to amplify the HBsAg gene. The gene of interest was cloned into the pET20b expression vector and transformed into E. coli BL21 (DE3) using Isopropyl ß-D-1-thiogalactopyranoside (IPTG) induction. The gene's precise size was confirmed with gene-specific external and internal primers (681 bp and 400 bp, respectively). RESULTS: The HBsAg gene was successfully sequenced and submitted to GenBank, exhibiting 98% homology with targeted HBV sequences worldwide. The expression of HBsAg protein was confirmed through silver staining, Coomassie staining, western blot, and dot blot analysis. CONCLUSIONS: The expressed protein clones are now available for further development as a local recombinant DNA vaccine to prevent hepatitis B viral infection in the local community.

Effects of selenium supplementation on the growth performance, slaughter characteristics, and blood biochemistry of naked neck chicken.

This study examined how selenium-supplemented diets affected the performance of naked neck chickens. The birds were fed both organic and inorganic selenium at 0.30 ppm, while the control diet did not include any additional selenium. A total of 225 one-day-old naked neck chicks were randomly divided into 3 experimental groups, each of which was replicated 5 times (replicates) and contained 15 birds. This was done using a completely randomized design. The data was collected after growth, meat quality, and blood profile parameters were assessed. The findings showed that the birds fed inorganic selenium in the diet displayed increased (P < 0.05) feed intake followed by those administered organic selenium and the control diet. On the other hand, birds fed organic selenium in the diet showed enhanced body weight gain and better feed conversion ratio (P < 0.05). Similarly, organic selenium supplementation increased (P < 0.05) breast and thigh weight compared to inorganic selenium, but no other metrics, such as dressing percentage, drumstick weight, liver weight, gizzard weight, heart weight, or wing weight, significantly differed between treatments (P > 0.05). When compared to birds fed inorganic Se and control diet, the birds fed organic Se had greater (P < 0.05) blood levels of total protein and globulin. Additionally, it was discovered that organic Se-fed birds had greater (P < 0.05) blood Se concentrations than control and inorganic Se-fed birds. However, no differences between treatments were found in albumin, glucose, cholesterol, triglycerides, or uric acid (P > 0.05). In conclusion, adding Se-enriched yeast, as an organic selenium source, to diets may enhance the poor growth and slaughter characteristics of naked neck chicks without negatively affecting blood chemistry.

Entamoeba species associated with chronic diarrhoea in Pakistan.

We determined the prevalence of Entamoeba (E.) histolytica, E. dispar and E. moshkovskii in patients with chronic diarrhoea associated with abdominal pain or discomfort mimicking irritable bowel syndrome. Stool samples were collected from 161 patients with chronic diarrhoea and from 157 healthy controls. Stool microscopy with modified trichrome stain, culture and polymerase chain reaction (PCR) for Entamoeba spp. differentiation was performed. Microscopy demonstrated Entamoeba cysts in 44% (57/129) of patients with diarrhoea compared to 29% (44/151) of controls (P=0·009). In patients with diarrhoea, PCR for E. histolytica was positive in 9% (11/129) (P=0·008), E. dispar in 19% (24/129) (P=0·117) and E. moshkovskii in 19% (24/129) (P<0·001). E. histolytica and E. moshkovskii were significantly associated with diarrhoea while E. dispar was found equally in both groups.

Microsporidial infections due to Encephalitozoon intestinalis in non-HIV-infected patients with chronic diarrhoea.

We determined the prevalence of microsporidia Enterocytozoon (Ent.) bieneusi and Encephalitozoon (E.) intestinalis infection in patients with chronic diarrhoea and hepatocellular carcinoma (HCC). A total of 330 stool samples were examined from 171 (52%) patients with chronic diarrhoea, 18 (5%) with HCC while 141 (43%) were controls. Stool microscopy, polymerase chain reaction (PCR) with species-specific primers for Ent. bieneusi and E. intestinalis and sequencing were carried out. Microsporidia were found by trichrome staining in 11/330 (3%) and E. intestinalis by PCR in 13/330 (4%) while Ent. bieneusi was not detected. PCR for E. intestinalis was positive in 8/171 (5%) stool samples from patients with chronic diarrhoea, 2/141 (1·4%) samples from healthy controls and in 3/18 (17%) samples from patients with HCC. In the chronic diarrhoea group, E. intestinalis was positive in 4/171 (2·3%) (P=0·69) stool samples compared to 2/18 (11%) (P=0·06) in the HCC group and 2/141 (1·4%) from healthy controls. E. intestinalis infection was significantly associated with chronic diarrhoea and HCC in these patients who were negative for HIV. Stool examination with trichrome or species-specific PCR for microsporidia may help establish the cause of chronic diarrhoea.

Virulence markers of Helicobacter pylori in patients with diarrhoea-dominant irritable bowel syndrome.

Recent studies suggest that irritable bowel syndrome (IBS) is associated with low-grade inflammation. This study aims to determine the distribution of Helicobacter pylori cytotoxin-associated gene A (cagA) and vacuolating cytotoxin A (vacA) alleles (e.g., s1 and s2) in patients with diarrhoea-dominant IBS (IBS-D) as the latter causes vacuolation in colonic epithelial cells in vitro. One hundred and seventy patients meeting Rome III criteria for IBS-D (mean age: 40 +/- 15 years) were enrolled. Gastric biopsy was assessed histologically and DNA extraction was performed by polymerase chain reaction (PCR) for H. pylori genus 16S ribosomal DNA (16S rDNA), cagA and vacA allele s1 and s2. There was no age- or gender-related difference in H. pylori positivity in IBS-D compared to the control group. H. pylori was positive in 116 (68%) with IBS-D compared to 88 (55%) in the control group (P=0.01). cagA was positive in 73 (63%) with IBS-D compared to 42 (48%) in the control group (P=0.03). vacA s1 was positive in 61 (53%) with IBS-D compared to 32 (36%) in the control group (P=0.02). cagA s1 was positive in 39 (34%) with IBS-D compared to 13 (15%) in the control group (P=0.002).

Bioaccumulation of lead in different organs of Ctenopharyngodon Idella (grass fish) and Tor putitora (Mahseer) fish.

Bioaccumulation of toxic heavy metals in the human body can give rise to adverse health effects, the severity of which depends upon their dosage and duration of exposure. In this study, yearlings of two different species of edible fish, i.e., Tor putitora (Mahseer) and Ctenopharyngodon Idella (grass carp), were exposed to different concentrations of lead nitrate in a controlled environment of aquarium for three different lengths of duration (14, 28, and 60 days). The bioaccumulation of lead in different organs, including gills, skin, muscles, liver, intestine, and swim bladder of the fish, was assessed using atomic absorption spectrometry. Generally, the highest lead concentration was observed in the gills and lowest in the muscles for both species at each experimental dosage and duration. In 14-days exposure, the relative pattern of bioaccumulation in different organs was observed as gill > liver > skin > intestine > swim bladder > muscle for both fish species. Similarly, the pattern of bioaccumulation observed in 28-days exposure was as: gill > liver > intestine > skin > swim bladder > muscle in both species. Whereas, pattern in 60-days exposure was observed as gill > liver > intestine > swim bladder > muscle > skin. The data shows that grass carp had stored higher concentrations of lead than Mahseer, which may be attributed to the fact that they are omnivorous. Furthermore, the lowest bioaccumulation was recorded in the muscles until the 56th day of the exposure, after which the concentration steadily increased in the muscles. The observed pattern highlights the importance of exposure's duration to lead; chronic exposure could result in its bioaccumulation at toxic concentrations in the muscles, which is particularly of concern because the fish muscles are heavily consumed as food worldwide.

Soaking Maize Seeds in Zeatin-Type Cytokinin Biostimulators Improves Salt Tolerance by Enhancing the Antioxidant System and Photosynthetic Efficiency.

There is an urgent need for innovative strategies to raise the performance of environmentally stressed plants. The seeds of single-cross yellow Zea mays (L.) hybrid Giza-168 were soaked in Cis-(c-Z-Ck) or trans-zeatin-type cytokinin (t-Z-Ck) solutions at a concentration of 50 or 40 µM, respectively. Salinity stress was imposed at 0, 75 or 150 mM NaCl in the Hoagland nutrient solution (full strength) used for irrigation. The total carotenoids content was negatively affected by only 150 mM NaCl, while both 75 and 150 mM NaCl negatively affected the growth and yield components, relative water content, membrane stability index, photochemical activity, gas exchange, K+ and chlorophyll contents, K+/Na+ ratio, and photosynthetic efficiency. However, all of these traits were significantly improved by c-Z-Ck pretreatment and further enhanced by t-Z-Ck pretreatment compared with the corresponding controls. Furthermore, the contents of proline, soluble sugars, ascorbate, and glutathione, as well as enzymatic antioxidant activities, were significantly elevated by both salt stress concentrations and increased more by both biostimulators compared to the control. Compared to c-Z-Ck, t-Z-Ck was superior in mitigating the harmful effects of the high H2O2 levels caused by salt stress on the levels of malondialdehyde and ion leakage compared to the control. Under normal or stress conditions, t-Z-Ck pretreatment was better than c-Z-Ck pretreatment, while both positively affected maize hormonal contents. As a result, t-Z-Ck is recommended to enhance the growth and productivity of maize plants by suppressing the effects of oxidative stress caused by saline water irrigation.

Structured, Timely, and Individualized Patient Feedback to Residents and its Effect on HCAHPS Scores.

Physician communication is integral for improving patients' experience and clinical outcomes. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores are used by the Centers for Medicare & Medicaid Services to assess the quality of care provided to the patients. We conducted a prospective pre-post-intervention study from March 2018 to March 2020 and included patients and residents of the community-based university-affiliated Internal Medicine Residency Program. Residents' communication was evaluated through resident surveys and results were shared with them and attending physicians within 48 h. To correlate with the effect over a 4-year period, 839 HCAHPS surveys were obtained for attending physicians as an outcome measure. The mean overall HCAHPS score and doctor's communication scores increased by 8.52 and 6.06 points post-intervention. The doctor's performance score for respect increased by 6.18 points, listening increased by 3.12 points, and explanation increased by 8.23 points. This study demonstrates that timely, structured, and individualized resident feedback in an academic medicine service can result in a sustainable increase in the attendings' overall HCAHPS and doctor's communication scores.

Impact of patient and family engagement in improving continuous positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial.

STUDY OBJECTIVES: The aim of the Improving CPAP Adherence Program was to assess the impact of a multidimensional treatment framework based on shared decision-making, patient activation, and caregiver engagement on improving long-term positive airway pressure (PAP) adherence in patients newly diagnosed with obstructive sleep apnea. METHODS: In this pilot study, patients aged ≥ 18 years with a new obstructive sleep apnea diagnosis who qualified for PAP treatment and lived with a caregiver were randomly assigned to receive either the multidimensional treatment (intervention, n = 28) or unrelated education (control group, n = 32). All patients and their caregiver participated in a group visit. The intervention group attended 4 structured sessions: interactive education, peer coaching, hands-on experience, and a semistructured motivational interview. The control group was educated on physical activity and lifestyle only. Objective PAP adherence data were obtained at baseline (day that they received PAP machine to group visit), group visit to 3 months, and 3-6 months. RESULTS: In an age-adjusted model, the mean daily use of PAP increased significantly over the 3 time periods (P = .03). Intervention-arm participants gained a mean 1.23 hours (95% confidence interval, 0.33-2.13) in PAP mean daily use between 3 and 6 months vs those in the control arm (P = .008). We saw no difference in the percentage of PAP adherence across time between the 2 arms. CONCLUSIONS: A multifaceted patient-centered intervention with caregiver engagement improved PAP adherence vs control levels, a beneficial effect sustained for the 6 months. Our findings suggest that caregivers, with the appropriate training, can improve patients' PAP adherence by providing a socially supportive environment. CITATION: Khan NNS, Todem D, Bottu S, Badr MS, Olomu A. Impact of patient and family engagement in improving continuous positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med. 2022;18(1):181-191.