Trends in Cerebrovascular Disease-related mortality among Older Adults in the United States from 1999 to 2020: an analysis of gender, race/ethnicity, and geographical disparities.

BACKGROUND: One of the most prevalent causes of morbidity and death is cerebrovascular disease in the US. The manifestations and pathophysiology of cerebrovascular disease are significantly impacted by aging and determine the quality of one's late life. However, contemporary mortality trends in cerebrovascular disease and comparison to older adults of different gender, race, and geographic disparities have not been fully examined. A thorough comprehension of these correlations and current cerebrovascular disease death patterns can impact medical treatment and strategies. OBJECTIVE: We examined the mortality trends according to gender, race, and geographical disparities in cerebrovascular disease among older adults, using mortality data (1999 - 2020) from the Centers for Disease Control and Prevention WONDER database METHODS: This research study aims to analyze disparities in cerebrovascular disease among senior citizens in the United States. The analysis has considered factors such as gender, race, and geographical variations over 21 years from 1999 to 2020. Mortality data obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database has been utilized for this retrospective cohort analysis, focusing on individuals aged 75 and above. RESULTS: From 1999 to 2020, there were 3,813,729 deaths related to Cerebrovascular disease in older adults, demonstrating a declining trend (AAPC=). Males (880.6) had slightly higher AAMRs than females (866.7). Non-Hispanic (NH) Black (1050) had higher AAMRs than NH whites (880.8) followed by NH American Indians (699.7), Hispanic (673.2), and NH Asians (669.3). AAMRs also varied by region with the Midwest (922) having the highest AAMRs followed by the South (918.2), West (884.3), and Northeast (744). Among states, Tennessee had the highest AAMRs (1076.3), whereas New York had the lowest (609.7). CONCLUSION: These results indicate a significant decline in cerebrovascular disease-related mortality among older adults from 1999 to 2020, highlighting improvements in healthcare and preventive measures over the two decades. Despite the overall decrease, elderly females had more deaths, elderly males had a higher AAMR, non-Hispanic blacks had the highest AAMR, and the Midwest and non-metropolitan areas had higher mortality burdens. The recent uptick in mortality rates from 2018 to 2020 underscores the need for ongoing public health efforts to address cerebrovascular diseases, particularly targeting vulnerable populations and high-risk regions.

Teachers' teleworking job satisfaction during the COVID-19 pandemic in Europe.

This research takes insights from the job demand resource model to examine the teleworking job satisfaction of teachers for the period of COVID-19 pandemic. This study evidenced that teachers' satisfaction with teleworking has been reduced as a consequence of the job demand increase. In contrast, access to adequate resources has allowed them to confront the challenges of teleworking, thus increasing their job satisfaction. The adverse effect of job demands on teleworking job satisfaction is buffered by job resources as teachers' required extra means to confront unexpected and increased job demands. The technological gap between younger and older teachers was uncovered.

A rare case report of short bowel anastomosis after acute mesenteric ischaemia in Covid-19 postive patient.

Acute mesenteric ischaemia is one of the serious abdominal surgical emergency, which has got very high morbidity and mortality. During the pandemic of COVID-19, besides respiratory complications, the virus was causing venous and arterial thromboembolism that can lead to acute mesenteric ischaemia in otherwise healthy individuals. Early diagnosis and suitable surgical procedures are the key to the better outcome of this disease. Surgical resection of gangrenous gut, leaving healthy gut is an important step of this operation. Leaving less than 200 cm of small intestine leads to short bowel syndrome which has got its own complication. This case report is on a healthy COVID-19 positive patient who presented with acute mesenteric ischaemia. After surgical resection only 1.5 feet small bowel (60 cm) was left behind and anastomosis was done with healthy transverse colon. He was later managed for complications of small bowel syndrome and was discharged successfully with dietary modifications.

Synthesis and evaluation of solid lipid nanoparticles loaded with bovine serum albumin prepared by different methods.

.We evaluated the effect of different synthesis methods of solid lipid nanoparticles (SLNs) loaded with bovine serum albumin (BSA) on parameters including particle size, polydispersity index, loading capacity and % entrapment efficiency including release study. We investigated the binary fatty acids mixtures for test protein BSA. Different techniques were used as micro emulsion, ultrasound homogenization and double emulsification-evaporation for the BSA loading of SLNs. With the increase in BSA content from 0-10%, indicated an increase in the size and decrease in polydispersity index. The stability of SLNs loaded with BSA was examined by measuring the zeta potential and all formulations were found to be quite stable. Release study and kinetic models were applied to assess BSA release profile from different formulations of SLNs. The particle size of BSA loaded SLNs was reduced to 89.67 ± 4.88 nm when PEG 6000 and Brij were used as 0.25% and 1.5% of total formulation (F5). Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and Fourier-transform infrared spectroscopy (FTIR) indicated the chemical stability of BSA which was used to load SLNs in different formulations. SLNs from the combinations of solid and liquid lipids had enhanced the physicochemical properties and permitted controlled release of BSA for up to 10 days. The study also evaluated the addition of polyethylene glycol which reduced the particles size and enhanced % entrapment efficiency. The release of BSA from SLNs was followed zero order rate kinetics and diffusion-controlled. Different mathematical models, i.e., zero order, first order, Higuchi and Korsmeyer-Peppas models were found best fit to BSA release profile of all formulations of SLNs.

The Mental Well-Being of Health Care Professionals During the COVID-19 Pandemic.

OBJECTIVES: Adopting the protection motivation theory and self-determination theory as frameworks, the present study examined whether the mental well-being of health care workers is determined by a combination of COVID-19-related factors (exposure and resources), organizational factors, and individual and attitudinal factors. METHODS: The present study is based on Eurofound's Living, Working, and COVID-19 survey, and the fieldwork for this survey was performed via uncontrolled convenience sampling throughout June and July 2020 in the 27 European Union countries. This research utilized a subsample of 1824 health sector employees and 11,750 workers in the other service industries. Further, to meet the objectives of this study, different linear regression models are estimated. RESULTS: Despite the close contact of health care workers with COVID-19, we found that the risk of contracting the coronavirus does not explain their poor or high well-being. However, the availability of personal protection equipment and mistrust in the national health system contribute to well-being, along with other organizational (eg, job insecurity) and individual-attitudinal factors (eg, health and life satisfaction). CONCLUSIONS: The present study offers various valuable insights for health institutes, organizations, practitioners, and employers to combat COVID-19 and identify the determinants of the mental well-being of health care professionals.

Inculcation of Green Behavior in Employees: A Multilevel Moderated Mediation Approach.

In this era of globalization, preventing organizations from undermining and degrading the environment has become a great challenge, especially when considering that organizations are among the major contributors to environmental deterioration. As a result, scholars have recently begun to focus on understanding the key determinants of employee green behavior (EGB), a nascent field within the area of sustainable development and organizational behavior. This study extends the emerging discussion over EGB by investigating how green behavior can be inculcated into employees' mindsets and under what conditions this can best be accomplished. The present research examines the relationship between ethical leadership and EGB by the mediating mechanisms of green psychological climate, employees' harmonious environmental passion, and employees' environmental commitment, through the underpinnings of social learning theory. Further, the study examines the contingency effects of leaders' pro-environmental attitudes to determine how leaders with ethical attributes and pro-environmental attitudes can create a green psychological climate that ultimately leads to EGB through employees' harmonious environmental passion and employees' environmental commitment. The approach to implementing theory development is deductive as the research employed a quantitative research design and survey administration with a time-lagged approach. Multi-level data were collected from 400 respondents working in public and private sector hospitals and universities in Pakistan. The analysis was conducted in MPlus. The results show positive and statistically significant effects of ethical leadership on EGB through the serial mediations of a green psychological climate and employees' harmonious environmental passion, and a green psychological climate and employees' environmental commitment. Moreover, the leaders' pro-environmental attitude contingency strengthens the indirect impact of ethical leadership on EGB. This research provides several managerial implications through which organizations can strategically concentrate on EGB, including saving energy by turning off unused lights, reducing waste, and recycling.

Intensive upper extremity training improved whole body movement control for children with unilateral spastic cerebral palsy.

BACKGROUND: Children with unilateral spastic cerebral palsy (USCP) exhibit impaired bimanual coordination, gait control, and whole body movement control. Intensive upper extremity training has been found to be effective for improving upper extremity function. However, the effectiveness of the intensive upper extremity training on whole body movement control is not known. RESEARCH QUESTION: The present study aimed to evaluate the effects of Constraint Induced Movement Therapy (CIMT) and Hand Arm Bimanual Intensive Therapy (HABIT) on bimanual coordination and gait control during a complex whole body task. METHODS: Sixteen children with congenital hemiplegia (age 6-12 years; GMFCS: I-II, MACS: I-II) were randomly assigned to either CIMT or HABIT for 6 h per day training for 15 days. Children were asked to perform two whole body tasks (walking with and without a tray carrying) while 3-D kinematic analysis was performed before and after training. RESULTS: After training, the HABIT group increased the symmetry in height of their hands during tray carrying (more leveled tray). Both CIMT and HABIT groups decreased the lateral motion of the tray. The CIMT group increased speed and stride length after training in both the walking and tray carrying tasks. Both groups also increased their minimum toe clearance (all p < 0.05). SIGNIFICANCE: Two types of intensive upper extremity training have provided significant improvements to whole body movement control for children with USCP. Adhering to the specificity of practice concept, HABIT improved bimanual coordination after training during the whole body tray carrying tasks. Given extensive interactions between the upper and lower extremities in real-world activities, future studies should focus on the effects of such combined training.

"Is our choice of empirical antibiotics appropriate for patients with methicillin resistant Staphylococcus aureus in breast abscess?"

BACKGROUND AND OBJECTIVES: Breast abscesses remain as one of the most common reasons for females to come for a surgical consult. This retrospective cohort study includes both lactating and non-lactating females with breast abscesses. Due to changing trends in bacteriology of organisms, we need to reconsider our empirical choices of antibiotics. In our study, the main causative organism in breast abscess was Staphylococcus aureus with predominant species being MRSA. MATERIALS AND METHODS: This is an analytical review of all breast abscesses treated in a single center from 2012 to 2015. This study included bacterial cultures, antibiotic sensitivities and resistance pattern in breast abscesses. RESULTS: 268 patients were included in the study. 143 (53.4%) were Lactational abscesses and 125 (46.6%) were non-Lactational abscesses. 169 (63.0%) harbored S. aureus in which 86 (50.8%) were MRSA. MRSA was the predominant organism in the Lactational group while non-Lactational group had no growth or other organisms in culture in this study. Other growing organisms were Klebsiella pneumoniae, Bacteroides, Pseudomonas, Streptococcus species and Mycobacterium tuberculosis. On comparative analysis, MRSA showed statistically a significant difference with p<0.0001, when it comes to predominant growth in lactating mothers. First line prescribed empirical antibiotics received by the patient, which is amoxicillin clavulanate, is mostly resistant. It is recommended that the institutional antibiogram targeted treatment be offered to patients with breast abscess. We also recommend ciprofloxacin with clindamycin as initial empirical therapy. CONCLUSION: MRSA was the most common organism seen in breast abscesses. Our first line treatment of antibiotics was resistant. Clindamycin and ciprofloxacin should be the preferred 1st choice for treatment.

Enhancing the dissolution of phenylbutazone using Syloid® based mesoporous silicas for oral equine applications.

Three mesoporous silica excipients (Syloid® silicas AL-1 FP, XDP 3050 and XDP 3150) were formulated with a model drug known for its poor aqueous solubility, namely phenylbutazone, in an attempt to enhance the extent and rate of drug dissolution. Although other forms of mesoporous silica have been investigated in previous studies, the effect of inclusion with these specific Syloid® silica based excipients and more interestingly, with phenylbutazone, is unknown. This work reports a significant enhancement for both the extent and rate of drug release for all three forms of Syloid® silica at a 1:1 drug:silica ratio over a period of 30 min. An explanation for this increase was determined to be conversion to the amorphous form and an enhanced drug loading ability within the pores. Differences between the release profiles of the three silicas were concluded to be a consequence of the physicochemical differences between the three forms. Overall, this study confirms that Syloid® silica based excipients can be used to enhance dissolution, and potentially therefore bioavailability, for compounds with poor aqueous solubility such as phenylbutazone. In addition, it has been confirmed that drug release can be carefully tailored based on the choice of Syloid® silica and desired release profile.

Bcr-Abl tyrosine kinase inhibitors- current status.

Bcr-Abl plays a central role in the development of chromosome positive leukaemia. Chronic Myeloid leukaemia occurs due to increase proliferation and resistance to apoptosis by Bcr-Abl positive cells. Imatinib (STI571) is the first drug in the family of Bcr-Abl tyrosine kinase inhibitors while Nilotinib (AMN107) and Dasatinib (BMS-345825) are second generation drugs that are intended to have less resistance and intolerance than imatinib. Ponatinib (AP24534) an orally active Bcr-Abl Tyrosine Kinase Inhibitor and Bafetinib (INNO-406) have efficacy against various point mutations in the Bcr-Abl kinase. 1, 3, 4 thiadiazole derivatives has also displayed moderate inhibitory action on both Abl and Src kinase family. However there are varieties of Bcr-Abl inhibitors but Nilotinib is still the frontline tyrosine kinase inhibitors.

Fahr's syndrome: literature review of current evidence.

Fahr's disease or Fahr's syndrome is a rare, neurological disorder characterized by abnormal calcified deposits in basal ganglia and cerebral cortex. Calcified deposits are made up of calcium carbonate and calcium phosphate, and are commonly located in the Basal Ganglia, Thalamus, Hippocampus, Cerebral cortex, Cerebellar Subcortical white matter and Dentate Nucleus. Molecular genetics of this disease haven't been studied extensively; hence evidence at the molecular and genetic level is limited. Fahr's disease commonly affects young to middle aged adults. Etiology of this syndrome does not identify a specific agent but associations with a number of conditions have been noted; most common of which are endocrine disorders, mitochondrial myopathies, dermatological abnormalities and infectious diseases. Clinical manifestations of this disease incorporate a wide variety of symptoms, ranging from neurological symptoms of extrapyramidal system to neuropsychiatric abnormalities of memory and concentration to movement disorders including Parkinsonism, chorea and tremors amongst others. Diagnostic criteria for this disease has been formulated after modifications from previous evidence and can be stated briefly, it consist of bilateral calcification of basal ganglia, progressive neurologic dysfunction, absence of biochemical abnormalities, absence of an infectious, traumatic or toxic cause and a significant family history. Imaging modalities for the diagnosis include CT, MRI, and plain radiography of skull. Other investigations include blood and urine testing for hematologic and biochemical indices. Disease is as yet incurable but management and treatment strategies mainly focus on symptomatic relief and eradication of causative factors; however certain evidence is present to suggest that early diagnosis and treatment can reverse the calcification process leading to complete recovery of mental functions. Families with a known history of Fahr's disease should be counseled prior to conception so that the birth of affected babies can be prevented. This review was written with the aim to remark on the current substantial evidence surrounding this disease.

Assessment of gallstone predictor: comparative analysis of ultrasonographic and biochemical parameters.

BACKGROUND: Gallstones represent a significant burden for health care systems worldwide and are one of the most common disorders presenting to emergency room. Ultrasonography, complete blood picture test and liver function tests are procedures of choice in suspected gallstones or biliary diseases. They are the most sensitive, specific, non-invasive and inexpensive tests for the detection of gallstones. Our main objective was to evaluate the relationship of ultrasonographic findings, hemolytic indices and liver function tests with gallstones. METHODOLOGY: It was a prospective study carried out in Civil Hospital Karachi (DUHS) and Liaquat National Hospital, two largest tertiary care hospitals of Karachi, Pakistan. Duration of the study was from July 2011 to October 2012. The study was carried out on diagnosed, pre-operative and symptomatic patients of cholelithiases. Exclusion criteria were patients of gallbladder and pancreatic carcinoma, emergency operations, patients having age <12 years and non-cooperative patients, who refused to give written consent for participation in the study. Total two tests were performed on each patient after diagnosis by ultrasonography. These were complete blood count and liver function tests. All the demographic data, laboratory findings and ultrasonographic features were noted in a pre-structured Performa. Sample size was calculated by using open-epidemiological sample size calculator prevalence (p) = 35%, d = 5%, and confidence interval (CI) 95% = 350. All the data was entered and analyzed through SPSS 19. RESULT: There were 454 diagnosed and pre-operative cases of gallstones present in the study. There were 120(26.4%) males and 334(73.6%) females, with a mean age of 42.80 ± 12.26 years. Most of the suspects had multiple stones 384 (84.5%) while few had single stones 70(15.4%). Fatty liver was found to be present in 144(31.7%) patients and 92(20.2%) had hepatomegaly. Splenomegaly was present in 16(3.5%) patients. Alkaline phosphatase was elevated in 186(41.0%) patients while SGPT was found to be raised in 160(35.2%). Blood urea nitrogen was found to be elevated in 186(41%) patients and serum creatinine was elevated in 46(10.1%) patients. CONCLUSION: In the light of findings it is recommend that all patients should go through the process of ultrasonography and all the biochemical parameters should be analyzed before surgery.