MicroRNAs in Endometriosis: Insights into Inflammation and Progesterone Resistance.

Endometriosis, a non-malignant gynecological disorder influenced by estrogen, involves the growth of endometrial tissue outside the uterus. Its development includes processes such as inflammation, progesterone resistance, angiogenesis, and cell proliferation. Epigenetic factors, particularly the dysregulation of microRNAs (miRNAs), have emerged as key factors in these mechanisms in endometriosis. This review aims to unveil the intricate molecular processes that control inflammation, progesterone resistance, and miRNA functions in endometriosis. In addition, it provides a comprehensive overview of the current understanding regarding the involvement of miRNAs in the inflammatory aspects of this condition. This synthesis encompasses research investigating the molecular underpinnings of inflammation, along with the biogenesis and roles of miRNAs in endometriosis. Furthermore, it examines human studies and functional analyses to establish the intricate connection between miRNAs, inflammation, and progesterone resistance in the context of endometriosis. The results highlight the significant impact of dysregulated miRNAs on the inflammatory pathways and hormonal imbalances characteristic of endometriosis. Consequently, miRNAs hold promise as potential non-invasive biomarkers and targeted therapeutic agents aimed at addressing inflammation and enhancing the response to progesterone treatment in individuals with endometriosis.

Berberine Ameliorate Haloperidol and 3-Nitropropionic Acid-Induced Neurotoxicity in Rats.

Berberine due to its antioxidant properties, has been used around the globe significantly to treat several brain disorders. Also, oxidative stress is a pathological hallmark in neurodegenerative diseases like Huntington's disease (HD) and Tardive dyskinesia (TD). Berberine an alkaloid from plants has been reported to have neuroprotective potential in several animal models of neurodegenerative diseases. Hence, this study aims to evaluate the neuroprotective effect of berberine in the animal model of 3-nitropropionic acid (3-NP) induced HD and haloperidol induced tardive dyskinesia with special emphasis on its antioxidant property. The study protocol was divided into 2 phases, first phase involved the administration of 3-NP and berberine at the dose of (25, 50, and 100 mg/kg) intraperitoneally (i.p) and orally (p.o.) respectively for 21 days, and the following parameters (rotarod, narrow beam walk and photoactometer) as a measure of motor activity and striatal and cortical levels of (LPO, GSH, SOD, catalase, and nitrate) evaluated as a measure of oxidative stress were assessed for HD. Similarly in the second phase, TD was induced by using haloperidol, for 21 days and berberine at the dose of (25, 50, and 100 mg/kg) was administered, and both physical and biochemical parameters were assessed as mentioned for the HD study. The resultant data indicated that berberine attenuate 3-NP and haloperidol-induced behavioral changes and improved the antioxidant capcity in rodents. Hence berberine might be a novel therapeutic candidate to manage TD & HD.

Environmental sustainability assessment due to stone quarrying and crushing activities in Jaflong, Sylhet.

Quarrying and crushing activities constitute a major threat to the environment and occupational health of the workers in Jaflong, Sylhet. This study aims to determine the environmental sustainability of stone quarrying and crushing activities considering four dominant environmental components, viz. physicochemical parameters of water, PM2.5 and PM10, sound, and land use land cover (LULC). Water quality was measured in a seasonal variation, and air and sound data were collected in an 8-h period of every weekday of 2 months while LULC data were also collected from 1999 to 2019 with 5 years of interval. Water quality index (WQI) and cluster analysis were applied to classify the pollution sources while inverse distance weighting (IDW) and weighted overlay were used to show the vulnerable zone. All the parameters were considered with the established limit of WHO. WQI detects that the sampling stations located near the quarrying site were responsible for the deterioration of the water quality. Cluster analysis identified that the S8 and S10 sites were heavily susceptible to air and sound pollution. IDW and WO ranked the south-western lower stream and tribal village located at the north-western side as moderately to highly polluted. Correlation analysis illustrated that the values of air and sound parameters were concentrated above the permissible limit. Besides, LULC change revealed the significant lowering trend of vegetation and water bodies whereas it shows the upward trend of barren land and settlement. Finally, the extensive quarrying and crushing activities without any safety measure lead to breaking the environmental sustainability as well as workers and nearby dwellers were exposed to several respiratory diseases.

Attenuation of cisplatin-induced acute kidney injury by N-(2-Hydroxyphenyl) acetamide and its gold conjugated nano-formulations in mice.

The attenuation of cisplatin-induced acute kidney injury (AKI) in mice by N-(2-hydroxyphenyl) acetamide (NA-2) and NA-2-conjugated gold nanoparticles (NA2-AuNPs) was investigated. Male BALB/c mice (n = 54) were divided into nine groups having six animals in each group. Animals in groups 3-9 were pre-treated for 5 days with test compounds, whereas, animals in group 1 and 2 received normal saline. On day 4, animals in groups 2, 3, 4, 5, 6 and 9 were given single intra-peritoneal injection of CP at the dose of 5 mg/kg. After 72 hours of CP injection, all animals were sacrificed. Blood was collected for serum urea and creatinine estimation, and kidneys were harvested for histo-pathological examinations and qPCR studies for nuclear factor-κB p50, (NFκB) ; inducible nitric oxide synthase (iNOS); hemeoxygenase-1 (HO-1); and interleukin-6 (IL-6).NA-2 and NA2-AuNPs was observed to decrease the serum urea and creatinine levels. Both the test compounds reduced kidney injury damage score and improved histological architecture in the treated animals in dose dependent manner. Furthermore, the mRNA expressions of NFkB p50, iNOS and IL-6 genes were down-regulated, and HO-1 gene was up-regulated in the animals treated with the test compounds. It is concluded that NA-2 and NA2-AuNPs attenuates CP-induced AKI in mice models through anti-inflammatory and anti-oxidant mechanisms.

Exploring the Role of MicroRNAs in Progesterone and Estrogen Receptor Expression in Endometriosis.

Background/Objectives: Patients with endometriosis still respond poorly to progestins due to progesterone resistance associated with microRNAs (miRNAs). The aim of this study was to investigate the expression of selected miRNAs, estrogen receptor (ER)α, ERß, progesterone receptor (PR)-A and PR-B and to determine the target genes of upregulated miRNAs in endometriosis. Methods: In this study, 18 controls, 18 eutopic and 18 ectopic samples were analysed. Profiling and validation of miRNAs associated with functions of endometriosis were performed using next-generation sequencing (NGS) and qRT-PCR. At the same time, the expression of ERα, ERß, PR-A and PR-B was also determined using qRT-PCR. Target prediction was also performed for miR-199a-3p, miR-1-3p and miR-125b-5p using StarBase. Results: In this study, NGS identified seven significantly differentially expressed miRNAs, of which six miRNAs related to the role of endometriosis were selected for validation by qRT-PCR. The expression of miR-199a-3p, miR-1-3p, miR-146a-5p and miR-125b-5p was upregulated in the ectopic group compared to the eutopic group. Meanwhile, ERα and ERß were significantly differentially expressed in endometriosis compared to the control group. However, the expressions of PR-A and PR-B showed no significant differences between the groups. The predicted target genes for miR-199a-3p, miR-1-3p and miR-125b-5p are SCD, TAOK1, DDIT4, LASP1, CDK6, TAGLN2, G6PD and ELOVL6. Conclusions: Our findings demonstrated that the expressions of ERα and ERß might be regulated by miRNAs contributing to progesterone resistance, whereas the binding of miRNAs to target genes could also contribute to the pathogenesis of endometriosis. Therefore, miRNAs could be used as potential biomarkers and for targeted therapy in patients with endometriosis.

Unravelling the role of HAS2, GREM1, and PTGS2 gene expression in cumulus cells: implications for human oocyte development competency - a systematic review and integrated bioinformatic analysis.

The leading indicator for successful outcomes in in-vitro fertilization (IVF) is the quality of gametes in oocytes and sperm. Thus, advanced research aims to highlight the parameter in assessing these qualities - DNA fragmentation in sperm and oocyte development capacity (ODC) via evaluation of microenvironments involving its maturation process. Regarding oocytes, most evidence reveals the role of cumulus cells as non-invasive methods in assessing their development competency, mainly via gene expression evaluation. Our review aims to consolidate the evidence of GDF-9 derivatives, the HAS2, GREM1, and PTGS2 gene expression in cumulus cells used as ODC markers in relevant publications and tailored to current IVF outcomes. In addition to that, we also added the bioinformatic analysis in our review to strengthen the evidence aiming for a better understanding of the pathways and cluster of the genes of interest - HAS2, GREM1, and PTGS2 in cumulus cell level. Otherwise, the current non-invasive method can be used in exploring various causes of infertility that may affect these gene expressions at the cumulus cell level. Nevertheless, this method can also be used in assessing the ODC in various cohorts of women or as an improvement of markers following targeted tools or procedures by evaluating the advancement of these gene expressions following the targeted intervention.

Hospital preparedness for COVID-19 in Indonesia.

Introduction: As a disaster-prone country, hospital preparedness in dealing with disasters in Indonesia is essential. This research, therefore, focuses specifically on hospital preparedness for COVID-19 in Indonesia, which is important given the indication that the pandemic will last for the foreseeable future. Methods: During March to September 2022, a cross-sectional approach and a quantitative study was conducted in accordance with the research objective to assess hospital preparedness for the COVID-19 pandemic. This research shows the level of readiness based on the 12 components of the rapid hospital readiness checklist for COVID-19 published by the World Health Organization (WHO). Evaluators from 11 hospitals in four provinces in Indonesia (Capital Special Region of Jakarta, West Java, Special Region of Yogyakarta, and North Sumatra) filled out the form in the COVID-19 Hospital Preparedness Information system, which was developed to assess the level of hospital readiness. Results: The results show that hospitals in Capital Special Region of Jakarta and Special Region of Yogyakarta have adequate level (≥ 80%). Meanwhile, the readiness level of hospitals in West Java and North Sumatra varies from adequate level (≥ 80%), moderate level (50% - 79%), to not ready level (≤ 50%). Conclusion: The findings and the methods adopted in this research are valuable for policymakers and health professionals to have a holistic view of hospital preparedness for COVID-19 in Indonesia so that resources can be allocated more effectively to improve readiness.

COVID-19 infection prevention and control for hospital workers in Indonesia.

Introduction: The outbreak of SARS-CoV-2 in 2019 led to a global pandemic, posing unprecedented challenges to healthcare systems, particularly in hospitals. Purpose: This study explores the intricacies of strategies employed for preventing and controlling COVID-19 in Indonesian hospitals, with a particular focus on the protocols, challenges, and solutions faced by healthcare professionals. Methods: Using a cross-sectional analysis, we examined 27 hospitals and uncovered disparities in their preparedness levels. During our investigation, we observed the robust implementation of infection prevention measures, which encompassed stringent protocols, adequate ventilation, and proper use of personal protective equipment. However, shortcomings were identified in areas such as surveillance, mental health support, and patient management. Discussion: This study underscores the importance of addressing these gaps, suggesting tailored interventions, and continuous training for healthcare staff. Effective leadership, positive team dynamics, and adherence to comprehensive policies emerge as pivotal factors. Hospitals should strengthen weak areas, ensure the ethical execution of emergency protocols, and integrate technology for tracking and improving standard operating procedures. By enhancing the knowledge and skills of healthcare workers and maintaining strong management practices, hospitals can optimize their efforts in COVID-19 prevention and control, thereby safeguarding the wellbeing of professionals, patients, and communities.

Factors Associated with Psychosocial Symptoms Experienced by Students in Response to COVID-19 Pandemic: A Multivariate Analysis.

The COVID-19 pandemic has significantly impacted many sectors, including the education sector. After in-person school activities were suspended due to the pandemic, a number of educational institutions in Indonesia reported concerns in implementing online learning due to the institutions' unpreparedness. This issue may potentially induce mental health disorders among students and triggers long-term stress. This study aimed to examine factors linked to the psychosocial symptoms of anxiety, stress, and depression in response to the early stage of the COVID-19 pandemic. An online cross-sectional study in Indonesia was conducted with 433 undergraduate and senior high school students aged 15 to 26 years old, both female and male. The self-reported symptoms were analyzed using both bivariate and multivariate linear regression methods. It was found that the percentage of participants with depression symptoms was 66%, while 61% and 43% participants experienced stress and anxiety respectively. The bivariate analysis presented strong correlations between anxiety and gender, learning duration and use of gadgets, internet expenses, and highly-interrupted learning. Furthermore, the multivariate regression revealed that only anxiety was significantly linked to internet expenses. This study indicates that many students are affected by COVID-19, the impacts of which manifest in psychosocial issues in the form of anxiety. We suggest that creating a supportive and positive family environment would help to alleviate some of these issues.

Identification of Depression Among Elderly During COVID-19.

Elderly population is increasing, while the world has been facing the novel coronavirus (COVID-19), which causes a greater adverse impact among older population in various aspects of their lives, such as depression, daily routine disruption, illness, and social and emotional issues. The purpose of this study was to assess the elderly's depression during the COVID-19 pandemic, and the risk factors including socio-demographic, physical and psychosocial conditions, as well as family support. The method used was cross-sectional design, with a total sampling of 457 participants. The measuring instruments used were ADL (Activities of Daily Living Scale) and IADL (Lowton and Brody Instrumental Activities of Daily Living Scale) for physical activities assessment, APGAR (Adaptability, Participation, Growth, Affection, Resolution) for family support function assessment, and Geriatric Depression Scale (GDS) for depression level measurement, with additional questions for psychosocial assessment. 212 elderlies (46.4%) were found with no depression tendency, 183 elderlies (40%) had a tendency of depression, and 62 elderlies (13.6%) had depression. These depression issues were significantly linked to retirement and income among elderly, dependency, fitness and health status, family and social support, and sources of funds. In the presence of depression, control measures for social, health, and psychosocial support must be implemented in order to minimize its impact among the elderly.

A Systematic Review and Integrated Bioinformatic Analysis of Candidate Genes and Pathways in the Endometrium of Patients With Polycystic Ovary Syndrome During the Implantation Window.

Polycystic ovary syndrome (PCOS) is a common disorder with wide-ranging clinical heterogeneity that causes infertility. However, the comprehensive molecular mechanisms of PCOS in causing infertility is remaining unclear. Hence, a comprehensive literature search was conducted using PubMed, Scopus, EBSCOhost, and Science Direct. Medical Subject Heading (MeSH) terms like PCOS, gene expression, implantation window and endometrium were used as the keywords. From 138 studies retrieved, original articles with RNA profiling on human endometrial tissues in PCOS women during the implantation window were included. Study design, sample size, sample type, method, and differentially expressed genes (DEGs) were identified from all publications. The DEGs were analyzed using the software packages DAVID, STRING, and Cytoscape. Three studies that met inclusion criteria were included, and 368 DEGs were identified. Twelve significant clusters from the protein-protein interaction network (PPI) complex were found, and cluster 1 showed very high intermolecular interactions. Five candidate genes (AURKA, CDC25C, KIF23, KIF2C, and NDC80) were identified from the systematic review and integrated bioinformatics analysis. It is concluded that cell cycle is the fundamental biological processes that were dysregulated in the endometrium of PCOS women, affecting decidualization progression in the endometrium during the implantation window.

Case report of ruptured non-communicating right rudimentary horn pregnancy: an acute emergency.

Ruptured pregnancy in the rudimentary horn of women who have had a vaginal delivery is rare and unpredictable. However, when undiagnosed, this condition could lead to maternal morbidity and mortality. We report a pregnancy at 19 weeks gestation presented with acute abdomen and hypovolemic shock. She was initially thought to have an intrauterine pregnancy with the provisional diagnosis of a ruptured uterus. Intraoperatively, a ruptured non-communicating right rudimentary horn with ex utero pregnancy was discovered.

Identification of Workplace Bullying: Reliability and Validity of Indonesian Version of the Negative Acts Questionnaire-Revised (NAQ-R).

Bullying can pose a risk to health and safety, including the risk for damage to the emotional, psychosocial, mental, or physical health of employees in the workplace. Since bullying has a detrimental impact on victims and organizations, several studies on this issue had been conducted using the Negative Acts Questionnaire-Revised (NAQ-R), which is one of the most widely used tools to assess and minimize the occurrence of workplace bullying. However, this tool has not been validated for the Indonesian contexts. In this study, the author tested the reliability and constructed validity of the Indonesian version of NAQ-R. A total of 3140 participants were recruited in this study from various companies from different industries. NAQ-R, Psychosocial Distress (K10), and Satisfaction with Life Scale (SWLS) were administrated through an online survey. The results showed that 22 items yielded three model factors, i.e., person-related bullying, work-related bullying, and intimidation towards a person. Cronbach's alpha coefficients for the total and sub-scales of the Indonesian NAQ-R was acceptable, ranging from 0.721 to 0.897. This study confirmed that the Indonesian version of NAQ-R has an internal consistency reliability, and the concurrent and construct validity are at acceptable levels. Thus, this tool can be used as the screening instrument in assessing workplace bullying.

Analysis of Bio-Risk Management System Implementation in Indonesian Higher Education Laboratory.

Developing countries face various challenges in implementing bio-risk management systems in the laboratory. In addition, educational settings are considered as workplaces with biohazard risks. Every activity in a laboratory facility carries many potential hazards that can impact human health and the environment and may cause laboratory incidents, including Laboratory Acquired Infections (LAIs). In an effort to minimize the impact and occurrence of these incidents, it is necessary to evaluate the implementation of a bio-risk management system in every activity that involves handling biological agents. This study was conducted in an Indonesian higher-education institution, herein coded as University Y. This is a descriptive, semi-quantitative study aimed at analysing and evaluating the implementation of the bio-risk management systems used in laboratories by analysing the achievements obtained by each laboratory. The study used primary data that were collected using a checklist which referred to ISO 35001:2019 on Laboratory Bio-risk Management. The checklist consisted of 202 items forming seven main elements. In addition, secondary data obtained from literature and document review were also used. The results show that out of 11 laboratories examined, only 2 laboratories met 50% of the requirements, which were Laboratory A and B, achieving good performance. Regarding the clauses of standards, a gap analysis identified leadership, performance evaluation, and support as elements with the lowest achievement. Therefore, corrective action should be developed by enhancing the commitment from management as well as improving documentation, policy, education and training.

Implementation of Bio-Risk Management System in a National Clinical and Medical Referral Centre Laboratories.

The increasing threats from biological agents have become a concern in laboratories, and emerging infectious diseases have demanded increased awareness and preparedness of laboratory facilities. Bio-risk assessment is needed to provide a framework for organisations to establish a comprehensive bio-risk management system. The assessment criteria should include both biosafety and biosecurity measures. Laboratories in Indonesia play a significant role in public health interventions in term of disease screening, diagnosis and medical decision making. The National Clinical and Medical Referral Centre Laboratories have the potential of daily exposures to dangerous biological materials. This study aims to identify the gap between bio-risk management system implementation and International Standard Organisation (ISO) 35001:2019 requirements. The 202 items in ISO 35001:2019 are categorized into seven main elements. The findings show that more than half of the elements on ISO 35001:2019 have been implemented in these centres. Good performance was identified at lab 4 and 5 which obtained the highest scores, particularly in the context of organisation, planning, operation and improvement elements. However, the widest gap was found in leadership, support and performance evaluation. One way to address this would be to create written rules and regulations at the laboratory top management level to require all laboratory facilities to comply to the bio-risk policies, rules, and regulations.

Occupational Exposures to Organic Dust in Irish Bakeries and a Pizzeria Restaurant.

For decades, occupational exposure to flour dust has been linked to a range of respiratory diseases, including occupational asthma, thought to result from exposure to fungi present in the flour. Antifungal resistance is of increasing prevalence in clinical settings, and the role of occupational and environmental exposures, particularly for specific fungal species, is of concern. Occupational exposure to flour dust can occur in a range of occupational settings, however, few studies have focused on restaurant workers. The objective of this study was to measure occupational exposure to flour and microbial contamination, including azole resistance screening, in two small commercial bakeries and in a pizzeria. Personal full shift inhalable dust measurements were collected from workers, and were analyzed for inhalable dust and fungi, bacteria, azole resistance, and mycotoxins. Samples of settled dust were collected, and electrostatic dust cloths (EDC) were deployed and analyzed for microbial contamination, including azole resistance screening, and mycotoxins. Geometric mean exposures of 6.5 mg m-³ were calculated for inhalable dust, however, exposures of up to 18.30 mg m-³ were measured-70% of personal exposure measurements exceeded the occupational exposure limit for flour dust of 1.0 mg m-³. The air and EDC fungal counts were similar to those reported in previous studies for similar occupational environments. The fungi were dominated by Penicillium genera, however Aspergillus genera, including Fumigati and Flavi sections, were observed using culture-based methods, and the Fumigati section was also observed by molecular tools. Both Aspergillus sections were identified on the azole resistance screening. Mycotoxins were also detected in the settled dust samples, dominated by deoxynivalenol (DON). The role of environmental exposure in both the development of antimicrobial resistance and the total mycotoxin body burden is a growing concern; therefore, the presence of azole-resistant fungi and mycotoxin contamination, although low in magnitude, is of concern and warrants further investigation.

Fine needle aspiration cytology of neuroendocrine carcinoma of the breast--a case report and review of literature.

Neuroendocrine carcinomas of the breast are uncommon tumors known to occur in the elderly. While focal neuroendocrine differentiation may be noted in many ductal and lobular carcinomas, the term neuroendocrine carcinoma is to be applied when more than 50% of the tumor shows such differentiation. This case report details the cytological features of a neuroendocrine carcinoma that was encountered in our hospital. The fine needle aspiration (FNA) smears showed discohesive polygonal cells with abundant cytoplasm, many of which contained eosinophilic granules located at one pole. Histology of the mastectomy and axillary lymph nodes specimen from this patient showed features of neuroendocrine carcinoma--solid type, with metastasis, confirmed with immunohistochemistry. The patient is disease free seven months after surgery. This case highlights the need to closely observe cytological details to identify this rare tumor that may otherwise appear to be invasive duct carcinoma--not otherwise specified on FNA. The implications of diagnosing neuroendocrine differentiation for prognosis and management are also discussed.

Deoxyelephantopin induces ROS-mediated autophagy and apoptosis in human colorectal cancer in vitro and in vivo

Objective: To systematically map the stepwise events leading to deoxyelephantopin-induced cell death of HCT116 human colorectal cancer cells and evaluate the effectiveness of deoxyelephantopin in vivo. Methods: HCT116 cells were treated with deoxyelephantopin at various concentrations and time points. Autophagy was confirmed by the detection of autophagosomes and autophagosomal proteins by electron microscopy and Western blotting assays, respectively, and then validated by siRNA knockdown. In addition, apoptosis was confirmed by the detection of apoptosis-related proteins. The intracellular reactive oxygen species (ROS) level was measured using flow cytometry. The growth inhibitory effect of deoxyelephantopin was further evaluated in vivo using a mouse xenograft model. Results: Deoxyelephantopin firstly elevated ROS production, which then triggered autophagic flux with the accumulation of autophagosomal proteins including LC3A/B, ATG5, and ATG7, followed by the induction of apoptosis via the intrinsic and extrinsic pathways. Pre-treatment with N-acetyl-L-cysteine, a ROS inhibitor, reversed both apoptosis and autophagy. The knockdown of LC3 prevented apoptosis induction which confirmed that deoxyelephantopin induced autophagy-dependent apoptosis in HCT116 cells. Accumulation of ROS also activated apoptosis via the mitogen-activated protein kinases signaling pathway. Furthermore, deoxyelephantopin also inhibited the PI3K/AKT/mTOR pathway, which then released the inhibition of autophagy. In vivo study further showed that deoxyelephantopin significantly suppressed the growth of HCT116 subcutaneous xenograft in nude mice. Conclusions: Our findings revealed that deoxyelephantopin elevates oxidative stress and induces ROS-dependent autophagy followed by apoptosis in HCT116 cells via the concerted modulation of multiple signaling pathways. These findings further support the development of deoxyelephantopin as a therapeutic agent for colorectal cancer.

Knowledge, perception and attitude towards human papillomavirus among pre-university students in Malaysia.

BACKGROUND: To evaluate the knowledge, perception and attitudes towards human papilloma virus (HPV) among pre-university students in Malaysia. STUDY DESIGN: In this cross sectional study, between November 2013 to March 2014, in a public university, a convenient sampling method was used. A total of 716 respondents were recruited and interviewed with a set of standard questionnaires for assessment of knowledge, perception and attitudes towards HPV and predictor variables associated with level of knowledge. RESULTS: Almost half (48.9%) of the respondents scored less than 5 and were categorised as having poor knowledge. Three hundred and twelve (43.6%) respondents had moderate knowledge and only 54 (7.5%) respondents exhibited good knowledge with the score of 11 and above. Only 142 (20%) students perceived themselves to be vulnerable to HPV infection though 560 (78.2%) students thought that HPV infection is a serious disease. Perceived benefits and desire to be vaccinated were significantly associated with gender (p=0.000) and knowledge of HPV vaccine and cervical cancer (p=0.000). CONCLUSIONS: The level of knowledge regarding HPV among the pre-university students was low. However, student intention for vaccination increased with increasing level of knowledge. Thus, efforts to improve knowledge and awareness should be prioritised to increase uptake of the HPV vaccination programme and hence reduce morbidity and mortality from consequences of HPV infection, including cervical carcinoma.

Modified Phalen's test as an aid in diagnosing carpal tunnel syndrome.

OBJECTIVE: We developed a modified Phalen's test (MPT), which uses sensory testing in Phalen's position, as a diagnostic screening tool for carpal tunnel syndrome (CTS). This study was designed to determine the sensitivity, specificity, and receiver operating characteristic (ROC) curve of the MPT for diagnosis of CTS. METHODS: Electrodiagnostic nerve conduction studies (EDS) were used as the gold standard. MPT was performed by a blinded examiner on patients prior to EDS. MPT was recorded as either positive or negative based on the presence or absence of a median nerve sensory deficit while the hand was in Phalen's position. RESULTS: Sixty-six hands were included in this study. Chi-square for the MPT compared to EDS as the gold standard was 41.449 (P < 0.001), and the validity coefficient (phi) was 0.792 (P < 0.01). The traditional Phalen's test (TPT) compared to the EDS demonstrated a chi-square of 15.349 (P < 0.001) and a phi coefficient of 0.482 (P < 0.01). ROC curve estimates for the MPT revealed a sensitivity of 84.4% compared to 50% for the TPT. The standard error of the estimate for sensitivity was 3.3% for the MPT and 5.8% for the TPT. CONCLUSION: The MPT is a highly useful screening diagnostic tool for CTS. The MPT demonstrates greater accuracy than the TPT for predicting CTS. The MPT also demonstrates greater sensitivity than the TPT in predicting a positive electrodiagnostic test for CTS.