Assessing Dietary Salt Intake and Pilot-Testing a Home-Based Intervention to Lower Salt Intake Among Filipino College Students.

PURPOSE: To assess the knowledge, attitude, and behaviors related to dietary salt intake and develop a home-based intervention that helps lower salt intake among Filipino college students. DESIGN: Two-phase program development study utilizing descriptive and quasi-experimental design. METHODS: Phase 1 determined the knowledge, attitude, and behaviors alongside the frequency of dietary salt intake of a consecutive sample (n = 118). Phase 2 involved the development and pilot-testing of a home-based intervention wherein a random sample (n = 35) selected from Phase 1 joined for pilot-testing. The study was conducted from October - November 2021 and utilized valid and reliable measures to test the knowledge, attitude, and behavior of the participants. FINDINGS: Initial assessment showed knowledge regarding health risks of high salt intake and positive attitude toward health-promoting behaviors. Post-intervention showed improvement in attitude (p = 0.0004) and behavior (p = 0.001) related to dietary salt intake alongside health literacy (p = 0.036). There was no significant change in knowledge (p = 0.054). CONCLUSION: The home-based intervention involving the use of health education materials is successful in improving dietary salt intake patterns. CLINICAL EVIDENCE: Community health nurses may utilize home-based interventions to help develop health-promoting behaviors among young adults.

Thermal site energy fluctuations in photosystem I: new insights from MD/QM/MM calculations.

Cyanobacterial photosystem I (PSI) is one of the most efficient photosynthetic machineries found in nature. Due to the large scale and complexity of the system, the energy transfer mechanism from the antenna complex to the reaction center is still not fully understood. A central element is the accurate evaluation of the individual chlorophyll excitation energies (site energies). Such an evaluation must include a detailed treatment of site specific environmental influences on structural and electrostatic properties, but also their evolution in the temporal domain, because of the dynamic nature of the energy transfer process. In this work, we calculate the site energies of all 96 chlorophylls in a membrane-embedded model of PSI. The employed hybrid QM/MM approach using the multireference DFT/MRCI method in the QM region allows to obtain accurate site energies under explicit consideration of the natural environment. We identify energy traps and barriers in the antenna complex and discuss their implications for energy transfer to the reaction center. Going beyond previous studies, our model also accounts for the molecular dynamics of the full trimeric PSI complex. Via statistical analysis we show that the thermal fluctuations of single chlorophylls prevent the formation of a single prominent energy funnel within the antenna complex. These findings are also supported by a dipole exciton model. We conclude that energy transfer pathways may form only transiently at physiological temperatures, as thermal fluctuations overcome energy barriers. The set of site energies provided in this work sets the stage for theoretical and experimental studies on the highly efficient energy transfer mechanisms in PSI.

Phenylimino Indolinone: A Green-Light-Responsive T-Type Photoswitch Exhibiting Negative Photochromism.

Imines are photoaddressable motifs useful in the development of new generations of molecular switches, but their operation with low-energy photons and control over isomer stability remain challenging. Based on a computational design, we developed phenylimino indolinone (PIO), a green-light-addressable T-type photoswitch showing negative photochromism. The isomerization behavior of this photoactuator of the iminothioindoxyl (ITI) class was studied using time-resolved spectroscopies on time scales from femtoseconds to the steady state and by quantum-chemical analyses. The understanding of the isomerization properties and substituent effects governing these photoswitches opens new avenues for the development of novel T-type visible-light-addressable photoactuators based on C=N bonds.

Predicting the substituent effects in the optical and electrochemical properties of N,N'-substituted isoindigos.

Isoindigo, the structural isomer of the well-known dye indigo, has seen a major revival recently because of the increasing interest of its use as a potential drug core structure and for the development of organic photovoltaic materials. Highly beneficial for diverse applications are its facile synthesis, straightforward functionalisation and the broad absorption band in the visible range. Moreover, its intrinsic electron deficiency renders isoindigo a promising acceptor structure in bulk heterojunction architectures. Here we present new insights into the substituent effects of N-functionalised isoindigos, developing a reliable and fast in silico screening approach of a library of compounds. Using experimental UV-Vis and electrochemical data increased the accuracy of the TD-DFT method employed. This procedure allowed us to accurately predict the optical and electrochemical properties of N-functionalised isoindigos and the elucidation of the relationship between substituent effects and electronic properties.

Point Spread Function Reconstruction for Integrated 18F-FET PET/MRI in Patients With Glioma: Does It Affect SUVs and Respective Tumor-to-Background Ratios?

PURPOSE: Semiquantitative F-FET PET assessment using the tumor's SUV or tumor-to-background ratios (TBRs) can separate gliomas from peritumoral tissue or progression from pseudoprogression. This study investigated if point spread function (PSF) reconstruction of F-FET PET data affects SUV-based dignity assessment. MATERIALS AND METHODS: This study is a retrospective analysis of 87 glioma patients (female, 36; male, 51; age, 48 [13-81] years) undergoing F-FET PET/MRI for staging (n = 17) or restaging (n = 70). PET was reconstructed using ordered-subset expectation maximization with and without PSF. Lesions were delineated with semiautomated background-adapted thresholding relative to SUVmax; background was delineated contralaterally. Comparative measurements with a National Electrical Manufacturers Association International Electrotechnical Commission PET body phantom (sphere-to-background ratios, 8:1 and 4:1) were performed. RESULTS: PSF showed significantly higher tumor SUVmax (median difference, +0.1; interquartile range, 0.04-0.18), SUVmean (+0.05; 0.03-0.08), TBRmax|mean (+0.1; 0.04-0.2), and TBRmean|mean (+0.06; 0.03-0.09) than non-PSF (P < 0.001). Background SUVmean was unaffected. In patients and phantom, differences between PSF and non-PSF increased with TBR and decreased with lesion's PET volume. Differences only exceeded 0.2 SUV for SUVmax or 0.1 SUV for SUVmean if TBR was greater than 3 and lesion's PET volume was less than 10 mL (d = 27 mm). Dignity assessment by PSF and non-PSF was concordant in all patients examined for staging (cutoff, TBRmean|mean > 1.6; positive, 14; negative, 3) and restaging (cutoff, TBRmax|mean > 2.0; positive, 67; negative, 3). CONCLUSIONS: PSF increased tumor SUVmax and SUVmean compared with non-PSF F-FET PET/MRI data, especially in small lesions with high TBR (>3). However, dignity assessment using established TBR cutoffs was not affected.

Standardized visual reading of F18-FDG-PET in patients with non-small cell lung cancer scheduled for preoperative thoracic lymph node staging.

OBJECTIVES: Routine visual assessment of positron emission tomography (PET) for thoracic lymph node (LN) staging in patients with non-small cell lung cancer (NSCLC) is limited by a lack of reliable assessment criteria. This study evaluates the accuracy and inter-rater agreement of a standardized approach with unified windowing and a PET-based visual score. MATERIALS AND METHODS: This retrospective analysis included pretherapeutic FDG-PET data of 86 patients with NSCLC. After standardized windowing (threshold: 2×liver SUVmean) the LN uptake was assessed visually by three independent readers with varying levels of experience using a 4-step score (1, LN uptake≤mediastinal blood pool structures (MBPS); 2, MBPS3). The inexperienced (n=1), advanced (n=1), and expert readers (n=1) achieved similar accuracies of 93.5%, 91.4% and 92.1%, respectively (P>0.05 each). Cohen's κ ranged from 0.92 to 0.96 and Fleiss' κ was 0.93. ROC-analyses showed no significant differences between attendant readers within any subgroup (AUC, 0.92-0.96). CONCLUSION: Applying unified windowing, the introduced PET-score achieved highly accurate and robust LN assessment. This approach may shorten learning curves of inexperienced readers, facilitate multicenter trials, and improve comparability of future studies.

Dual time point imaging for F18-FDG-PET/CT does not improve the accuracy of nodal staging in non-small cell lung cancer patients.

OBJECTIVES: To analyze the diagnostic performance of dual time point imaging (DTPI) for pre-therapeutic lymph node (LN) staging in non-small cell lung cancer (NSCLC). METHODS: This was a retrospective analysis of 47 patients with NSCLC who had undergone DTPI by PET (early + delayed) using F18-fluorodeoxyglucose (FDG). PET raw data were reconstructed iteratively (point spread function + time-of-flight). LN uptake in PET was assessed visually (four-step score) and semi-quantitatively (SUVmax, SUVmean, ratios LN/primary, LN/liver, and LN/mediastinal blood pool). DTPI analyses included retention indices (RIs), Δ-ratios and changes in visual score. Histology or cytology served as standards of reference. Accuracy was determined based on ROC analyses. RESULTS: Thirty-six of 155 LNs were malignant. DTPI accuracy was low for all measures (visual assessment, 24.5%; RI SUVmax, 68.4%; RI SUVmean, 65.8%; Δ-ratios, 63.9-76.1%) and significantly inferior to early PET. Accuracies of early (range, 86.5-92.9%) and delayed PET (range, 85.2-92.9%) were comparable. At early PET, accuracy of the visual score (92.9%) was similar or superior to semi-quantitative analyses (range, 86.5-92.3%). CONCLUSIONS: Using a modern PET/CT device and novel image reconstruction, neither additional delayed PET nor DTPI analyses improved the accuracy of PET-based LN staging. Dedicated visual assessment criteria performed very well. KEY POINTS: • DTPI did not improve accuracy of PET-based LN staging in NSCLC. • Analyzed SUV ratios were not superior to LN SUVmax or SUVmean. • A four-step visual score may allow highly accurate, standardized LN assessment.

Complications of ultrasound-guided percutaneous renal biopsy at the National Kidney and Transplant Institute: A radiologic perspective

OBJECTIVES: This  study  aims  to  determine  the  incidence of  complications  associated  with  ultrasound-guided percutaneous native renal biopsies.It also aims to determine  the  association  between  the  occurrence of  complications  and  the  following  factors,  if  present:age,  sex,  serum  creatinine,  platelet  count,  hemoglobin,hematocrit, prothrombin time, partial thromboplastin time, international normalized ratio (INR), history of hypertension or diabetes, pre-biopsy blood pressure, renal length, biopsy laterality, and number of needle passes.METHODS: This  was  a  retrospective  multivariate  analysis research  done  in  a  tertiary  medical  specialty  center involving  all  patients  aged  19  years  and  older  who underwent ultrasound-guided percutaneous native kidney biopsy from July 2012 to June 2015. Data were gathered through a review of charts and electronic radiology and laboratory databases. RESULTS: A  total  of  984  patients  were  included.Overall incidence of complications detected by routine post-biopsy ultrasound  was  51.7%,  with  only  1.0%  classified  as  major.Factors  shown  to  have  statistically  significant  association with the development of complications were female sex,higher systolic and diastolic blood pressure, longer partial thromboplastin time, and shorter renal length by ultrasound. CONCLUSION: Although there are no absolute contraindications to performing the procedure, and the decision to perform it rests on the clinician's judgment of whether the risks outweigh the benefits and on the patient's consent,following a nationwide protocol would help the clinician comprehensively assess whether the patient is a good candidate for the procedure, educate him or her on the potential complications, and address modifiable risk factors.

Guidelines for the preventive health practices for the adult patient in family practice

At the end of this module you should be able to: 1. Extract a medical history that is useful for preventive health care. 2. Perform additional recommended physical examination procedures. 3. Perform only the recommended screening procedures. 4. Provide the recommended medical counselling. 5. Give the recommended vaccines. 6. Formulate a health maintenance plan for the patient.

Ventillation-perfusion scan findings of pulmonary artery sarcoma

Pulmonary artery sarcoma is a rare tumor of the cardiovascular system with only a few hundred cases reported in the literature. Because of its rarity and the similarity of its presentation to that of pulmonary thromboembolic disease, the diagnosis of pulmonary artery sarcoma is often not considered early in patients presenting with recurrent or chronic pulmonary emboli. In the last decade, heightened clinical suspicion and improved diagnostic modalities have allowed the diagnosis to be made prior to surgery. We present a case of a 29-year-old female with syncope in whom pulmonary artery sarcoma was diagnosed with highlights on the importance of performing a pre- and post-operative VQ scan in such cases.

Comparison Tests of BioRID II and RID 2 with Regard to Repeatability, Reproducibility and Sensitivity for Assessment of Car Seat Protection Potential in Rear-End Impacts.

The objective of our study was to investigate the properties of the BioRID II and RID2 dummies regarding repeatability and reproducibility as well as their suitability to identify the protection potential of different car seats. For repeatability and reproducibility tests, three BioRID II and three RID 2 dummies at current build levels were seated on a rigid bench seat equipped with a head restraint, and mounted on a HyGe-type sled. The test velocity was prescribed by the proposed ISO-Pulse. For testing the interaction of the dummies with varying car seat geometries and mechanical properties and their ability to assess the protection potential of the seats, three seat types with passive and one seat with an active head restraint system from different car manufacturers were used. The seats were chosen due to their injury protection potential, indicated by accident field data and results of seat evaluation tests. One BioRID II equipped with a T1-load cell and one RID2 were positioned side-by-side on identical seats for each test. The tests were performed at velocities prescribed by the ISO-Pulse (deltav 16km/h / 8 g max.)and a more severe pulse (deltav 24km/h / 13 g max.). The dummy responses were interpreted by applying all currently proposed whiplash injury criteria (e.g. NIC, N(km), NDC, LNL). A comparison of these criteria shows their sensitivity for identification of the respective seat protection potential. This study examines the repeatability, reproducibility, kinematics and sensitivity of these two dummies in sled tests as well as their suitability with regard to the different injury criteria. The RID2 exhibited better repeatability and reproducibility than the BioRID II, because of its simpler mechanical design. The dummies did not give a consistent ranking of the low-speed, rear-end impact protection potentials of the four seat evaluated. More experience is needed to decide which dummy, injury criteria and limits should be used to assess the whiplash protection potential of seat designs.

Analysis of immunoreactivity to a Streptococcus equi subsp. zooepidemicus M-like protein To confirm an outbreak of poststreptococcal glomerulonephritis, and sequences of M-like proteins from isolates obtained from different host species.

The etiologic agent of a large 1998 outbreak of poststreptococcal acute glomerulonephritis (PSGN) in Nova Serrana, Brazil, was found likely to be a specific strain of Streptococcus equi subsp. zooepidemicus from contaminated cheese (S. Balter et al., Lancet 355:1776-1780, 2000). In the present study, we used a serologic screen for a known surface-exposed virulence factor to confirm the epidemiologic findings. Using primers flanking a previously characterized M-like protein gene (J. F. Timoney et al., Infect. Immun. 63:1440-1445, 1995), we amplified and sequenced the M-like protein (designated Szp5058) gene and found it to be identical among four independent acute-phase PSGN patient isolates. Convalescent-phase sera from 33 of 44 patients in the PSGN outbreak were found to contain antibodies highly reactive to a purified Szp5058 fusion protein, compared with 1 of 17 control sera (P < 0. 0001), suggesting that Szp5058 was expressed during infection and further implicating this strain as the cause of the PSGN outbreak. The predicted signal sequence and cell wall association motif of Szp5058 were highly conserved with the corresponding sequence from S. equi subsp. zooepidemicus SzpW60, while the predicted surface-exposed portions differed markedly between these two proteins. The 5' end of the szp5058 gene, including its variable region, was identical to the szp gene from another strain associated with a previous PSGN outbreak in England (M. Barham et al., Lancet i:945-948, 1983), and the corresponding szp sequence found from the Lancefield group C type strain isolated from a guinea pig. In addition, the hypervariable (HV) portion of szp5058 was identical to a previously published HV sequence from a horse isolate (J. A. Walker and J. F. Timoney, Am. J. Vet. Res. 59:1129-1133, 1998). Three other strains of S. equi subsp. zooepidemicus, including another strain previously associated with a PSGN outbreak, were each found to contain a distinct szp gene. Two of these szp genes had HV regions identical to szp regions from isolates recovered from different host species.

All about red tide and paralytic shellfish poisoning

In summary, we are presented with a patient who ingested mussel that are suspected to contain toxins that cause paralytic shellfish poisoning or PSP. Upon reaching the stomach, the digestive process accelerates the release of PSP toxins. The toxins are rapidly absorbed in the stomachs acidic medium and starts to work on the cellular Na channels, blocking the movement of Naions thus preventing the progression of the action potential with the absence of the action potential, there is a continued state of depolarization. This explains the feeling of numbness of the lips and fingertips, as seen in our patient, since these are the areas where nerve endings abound, and thus, are the areas most sensitive to these chemical changes. Our patient experienced this whole gamut of neurologic manifestations. He also started experiencing gastrointestinal symptoms such as epigastric pain and vomiting which are initially erroneously diagnosed as a separate problem Hearing hearsay reports on coconut milk being used as antidote for cases like these, the patient tried it too. The coconut milk, being an alkaline substance, must have stabilized some of the toxins, thus explaining the mild relief experienced by the patient prior to hospitalization. Upon reaching the hospitals, NGT was inserted and NaHCO3 lavage was done which further stabilized the toxins that were not yet absorbed, while those that were absorbed were excreted through the kidneys with the help of mannitol. After all these measures, the patient experienced considerable relief of the neurologic symptoms, though still with the intermitent epigastric pain erroneously diagnosed as Acid Peptic Disease and treated with antacids. Improvement of the neurologic complaints eventually lead to the discharge of the patient Our patient is just one of the lucky ones who benefited from immediate medical intervention to save his life. Many others arent so lucky - - - most of them never even know what hit them and thus could only look heavenwards hoping for divine intervention. Others are left to languish in understaffed overcrowded hospitals in far-flung places. Worse, a lot of those who have died of PSP never even get to a hospital Grim scenarios such as these are bound to occur yearly as long as pollution, deforestation, ignorance, and poverty prevail. We physician may not be able to curb these ills of society but we can certainly help, first and foremost by initiating the more crucial preventive measures, then by administering immediate and knowledgeable modes of treatment, and finally, by never losing the family physicians most important therapeutic tool: genuine concern for the patient. Hopefully, in doing so, we family physicians can join the family of man down to the sunset of our lives, enjoying Manila Bay for its red beautiful scape, and not for its red deadly tide.

The detection of renal malignancy extension into the renal vein and inferior vena cava: a comparison of venacavography and doppler ultrasound

Accurate preoperative evaluation of the inferior vena cava and renal vein for uroflourecent in patients with renal malignancy is important in planning a successful surgical approach. The presence of venous extension may alter anesthetic and transfusion requirements as well as the addition of a vascular surgeon to the operative team. Traditionally, venacavography has been considered as the most reliable method of identifying tumor thrombus; although doppler ultrasound has been proposed as a non-invasive alternative. We have compared these two procedures in a limited study of five (5) subjects with renal malignancy who subsequently underwent nephrectomy. Venacavography was able to correctly identify thrombus extension in all cases (2 true positives and 3 true negatives). Sensitivity, specificity, accuracy, and positive and negative predictive values were 100%. Doppler ultrasound on the other hand had a false positive and no false negative. Sensitivity 66%, specificity 66%, accuracy 80%, positive predictive value 66%, and negative predictive value 100%.