A comparative study to evaluate the effects of antibiotics, plant extracts and fluoride-based toothpaste on the oral pathogens isolated from patients with gum diseases in Pakistan

Oral diseases caused by various microorganisms are common around the world. Scientific research has now been focusing on novel medicines to overcome bacterial resistance and antibiotics side effects; therefore, the current study was designed to assess the efficacy of certain antibiotics, toothpaste, and medicinal plant extracts (Ajuga bracteosa and Curcuma longa) versus the bacterial pathogens isolated from the human oral cavity. A total of 130 samples were collected from Khyber Teaching Hospital Peshawar, Pakistan, among those 27 species isolated, and eight bacterial species were identified from the samples. Among all the bacterial species, Staphylococcus aureus (29.62%) and Proteus mirabilis (22.2%) were found to be more prevalent oral pathogens. In comparison, the least pervasive microbes were Proteus vulgaris, Shigella sonnei, Escherichia coli and Aeromonas hydrophila. The study also suggested that dental problems were more prevalent in males (41-50 years of age) than females. Among the eight antibiotics used in the study, the most promising results were shown by Foxicillin against A. hydrophila. The survey of TP1 revealed that it showed more potent antagonist activity against Proteus vulgaris as compared TP2 and TP3 that might be due to the high content of fluoride. The Curcuma longa showed more significant activity than Ajuga bracteosa (Stem, leaves and root) extracts. The data obtained through this study revealed that antibiotics were more effective for oral bacterial pathogens than toothpaste and plant extracts which showed moderate and low activity, respectively. Therefore, it is suggested that the active compounds in individual medicinal plants like Curcuma longa and Ajuga bracteosa could replace the antibiotics when used in daily routine as tooth cleansers or mouth rinses.

Mindfulness-based practices, psychological capital, burnout and performance anxiety

Purpose The study examined the role of classroom-based mindfulness-based interventions (MBI) on psychological capital, burnout, and performance anxiety among business executives. Design/Methodology/Approach 52 mid-level and senior leaders filled up a structured questionnaire on mindfulness, psychological capital, and performance anxiety before and after the intervention. They also participated in 2 week-long classroom-based mindfulness intervention programs for 1 hour daily. Findings The finding suggests that mindfulness-based intervention significantly improved PsyCap and reduced burnout and performance anxiety among the executives. Research limitations/implications Self-report measures, sample size, and programmed duration could be a limitation. We can plan long-term (4 weeks) intervention on cross-section data for better outcomes and generalizations. Research implications Mindfulness-based interventions can help save healthcare costs by reducing anxiety and burnout. Leaders can also quantify the value of such intervention for developing PsyCap. Practical implications Management should conduct mindfulness-based training programs, and leaders can practice it in their daily routine to improve psychological resources to reduce stress and better face workplace challenges. Originality/value The study's contribution was using the classroom-based mindfulness-based intervention to improve psychological capital and reduce dysfunctional outcomes in leaders.

The Psychological Impact of the COVID-19 Lockdown: A Comparison between Caregivers of Autistic and Non-Autistic Individuals in Italy

The COVID-19 outbreak has disrupted the daily routine of the population worldwide, including autistic people and their caregivers, with severe consequences on mental health. On one hand, the reduced social contacts and the interruption of outpatient and daycare services during the lockdown have represented a real challenge for autistic people and their caregivers. On the other hand, confinement has allowed individuals to spend more time pursuing their interests and stay home with their family members without feeling the pressure of social expectations. The present study aimed to compare the levels of personal wellbeing, family distress, insomnia, and resilience between caregivers of autistic people and caregivers of people with other neurodevelopmental, psychiatric, or relational disabilities. A web survey was completed by 383 participants, of which 141 were primary caregivers of autistic people. We did not find any significant difference between caregivers of autistic and non-autistic people in any of the considered psychological variables. Lower age of the autistic family member and lower resilience levels were significantly associated with higher individual distress in the group of caregivers of autistic people. Our findings do not corroborate the hypothesis that caregivers of autistic individuals have had more severe consequences than other caregivers during the lockdown. However, they confirm the importance of promoting resilient coping strategies in autistic people and their caregivers.

Evaluation and modelling of the performance of an automated SARS-CoV-2 antigen assay according to sample type, target population and epidemic trends

The Lumipulse® G SARS-CoV-2 Ag assay performance was evaluated on prospectively collected saliva and nasopharyngeal swabs (NPS) of recently ill in- and outpatients and according to the estimated viral load. Performances were calculated using RT-PCR positive NPS from patients with symptoms ≤ 7 days and RT-PCR negative NPS as gold standard. In addition, non-selected positive NPS were analyzed to assess the performances on various viral loads. This assay yielded a sensitivity of 93.1% on NPS and 71.4% on saliva for recently ill patients. For NPS with a viral load > 103 RNA copies/mL, sensitivity was 96.4%. A model established on our daily routine showed fluctuations of the performances depending on the epidemic trends but an overall good negative predictive value. Lumipulse® G SARS-CoV-2 assay yielded good performance for an automated antigen detection assay on NPS. Using it for the detection of recently ill patient or to screen high-risk patients could be an interesting alternative to the more expensive RT-PCR.

WAR POETICS IN TS - ZH. ZHIMBIEV'S NOVEL "THE YEAR OF THE FIERY SNAKE"

В статье рассматриваются этнопоэтические истоки сюжетостроения в прозе Бурятии 2 - й половины 20 века. В основу обзора положен анализ романа «Год огненной змеи» Ц. - Ж. Жимбиева. Выявляются особенности использования символов и понятий этнопоэтики в названии произведения, сюжетной структуре романа и художественный опыт самого писателя в осмыслении начала Великой Отечественной войны, совпавшей по восточному календарю - литэ с годом огненной змеи. Автором статьи смысловое наполнение образа змеи, в мифологии монголоязычных народов выступающей символом врага, опасности, рассматривается в связи и противопоставлении с понятиями «война» как пожирающий огонь (пожар) и «враг» как змея, от которого страдает «народ». На основе анализа сюжетно - композиционной структуры романа доказывается, что чередованием глав «День» и «Ночь» Ц. - Ж. Жимбиев актуализирует смысловую логику понятия «война» как противоестественное состояние жизни, когда всё меняется местами: день становится мрачным и беспросветным проявлением темного, а ночь позволяет уйти от дневного мрака будней в сказочно - загадочное со звездами и небом. Обоснован вывод о том, что соединение реального и мифологического придает сюжету романа особую художественную полноту и национальный колорит, способствует усилению трагического смысла событий года «змеи», раскрывает характеры, моральные качества литературных героев. The article deals with the ethnopoetic origins of plot - building in prose of Buryatia of the second half of the twentieth century. The review is based on the analysis of Ts-Zh. Zhimbiev's novel "The Year of the Fiery Snake". It identifies the features of the use of symbols and concepts of ethnopoetics in the title, the plot structure of the novel and artistic experience of the writer in understanding the beginning of the Great Patriotic war, which, according to the Chinese calendar, coincided with the year of the fiery snake. The meaning of the snake's image, which in the mythology of Mongolian - speaking peoples serving as a symbol of an enemy, danger, is considered by the author of the article in connection and opposition with concepts "war" like a consuming flame (fire) and "enemy" like a snake that oppresses "the people" Based on the analysis of the plot - compositional structure of the novel, it is proved that alternating chapters "Day" and "Night" Ts-Zh. Zhimbiev actualizes the semantic logic of the concept "war" as an unnatural state of life, when everything swaps over: the day becomes a dark and gloomy expression of darkness, and the night allows you to escape from dark daily routine into a fabulous mystery with the stars in the sky. The conclusion is proved that the conjunction of real and mythological essence gives the plot of the novel special artistic completeness and national character, enhances sense of tragic events of the year of the "snake', and reveals literary heroes' tempers and moral qualities.

WAR POETICS IN TS - ZH. ZHIMBIEV'S NOVEL "THE YEAR OF THE FIERY SNAKE"

В статье рассматриваются этнопоэтические истоки сюжетостроения в прозе Бурятии 2 - й половины 20 века. В основу обзора положен анализ романа «Год огненной змеи» Ц. - Ж. Жимбиева. Выявляются особенности использования символов и понятий этнопоэтики в названии произведения, сюжетной структуре романа и художественный опыт самого писателя в осмыслении начала Великой Отечественной войны, совпавшей по восточному календарю - литэ с годом огненной змеи. Автором статьи смысловое наполнение образа змеи, в мифологии монголоязычных народов выступающей символом врага, опасности, рассматривается в связи и противопоставлении с понятиями «война» как пожирающий огонь (пожар) и «враг» как змея, от которого страдает «народ». На основе анализа сюжетно - композиционной структуры романа доказывается, что чередованием глав «День» и «Ночь» Ц. - Ж. Жимбиев актуализирует смысловую логику понятия «война» как противоестественное состояние жизни, когда всё меняется местами: день становится мрачным и беспросветным проявлением темного, а ночь позволяет уйти от дневного мрака будней в сказочно - загадочное со звездами и небом. Обоснован вывод о том, что соединение реального и мифологического придает сюжету романа особую художественную полноту и национальный колорит, способствует усилению трагического смысла событий года «змеи», раскрывает характеры, моральные качества литературных героев. The article deals with the ethnopoetic origins of plot - building in prose of Buryatia of the second half of the twentieth century. The review is based on the analysis of Ts-Zh. Zhimbiev's novel "The Year of the Fiery Snake". It identifies the features of the use of symbols and concepts of ethnopoetics in the title, the plot structure of the novel and artistic experience of the writer in understanding the beginning of the Great Patriotic war, which, according to the Chinese calendar, coincided with the year of the fiery snake. The meaning of the snake's image, which in the mythology of Mongolian - speaking peoples serving as a symbol of an enemy, danger, is considered by the author of the article in connection and opposition with concepts "war" like a consuming flame (fire) and "enemy" like a snake that oppresses "the people" Based on the analysis of the plot - compositional structure of the novel, it is proved that alternating chapters "Day" and "Night" Ts-Zh. Zhimbiev actualizes the semantic logic of the concept "war" as an unnatural state of life, when everything swaps over: the day becomes a dark and gloomy expression of darkness, and the night allows you to escape from dark daily routine into a fabulous mystery with the stars in the sky. The conclusion is proved that the conjunction of real and mythological essence gives the plot of the novel special artistic completeness and national character, enhances sense of tragic events of the year of the "snake', and reveals literary heroes' tempers and moral qualities.

Acceptability of a nurse-led non-pharmacological complex intervention for knee pain: Nurse and patient views and experiences

Objectives The overall purpose of this research programme is to develop and test the feasibility of a complex intervention for knee pain delivered by a nurse, and comprising both non-pharmacological and pharmacological interventions. In this first phase, we examined the acceptability of the non-pharmacological component of the intervention; issues faced in delivery, and resolved possible challenges to delivery. Methods Eighteen adults with chronic knee pain were recruited from the community. The intervention comprised holistic assessment, education, exercise, weight-loss advice (where appropriate) and advice on adjunctive treatments such as hot/cold treatments, footwear modification and walking aids. After nurse training, the intervention was delivered in four sessions spread over five weeks. Participants had one to one semi-structured interview at the end of the intervention. The nurse was interviewed after the last visit of the last participant. These were audio recorded and transcribed verbatim. Themes were identified by one author through framework analysis of the transcripts, and cross-checked by another. Results Most participants found the advice from the nurse easy to follow and were satisfied with the package, though some felt that too much information was provided too soon. The intervention changed their perception of managing knee pain, learning that it can be improved with self-management. However, participants thought that the most challenging part of the intervention was fitting the exercise regime into their daily routine. The nurse found discussion of goal setting to be challenging. Conclusion The nurse-led package of care is acceptable within a research setting. The results are promising and will be applied in a feasibility randomised-controlled trial.

Self-perceived quality of sleep among COPD patients in Greece: the SLEPICO study

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide accompanied by a substantial social and economic burden for the patient and the society. Poor sleep quality among COPD patients is frequently unnoticed and unaddressed by physicians and patients themselves, although it is a major source of further deterioration of these patients’ quality of life. The aim of the present study was to record the quality of sleep in COPD patients among the Greek population and correlate these findings with various features of these patients, using the COPD and Asthma Sleep Impact Scale (CASIS). This was a cross-sectional observational study. Forty different variables (demographics, vital sign measurements, COPD-related medical history parameters, comorbidities, CASIS questionnaire results, COPD assessment test, COPD severity based on spirometry measurements, COPD stage based on the ABCD assessment approach, inhaled COPD treatment report) were collected from 3454 nation-wide COPD patients (Greece). The study sample consisted of COPD patients, mainly male (73%) with a median age of 69 years and a median BMI of 27.2. More than half of COPD patients (60.6%) suffered from moderate disease severity and 23.8% from severe disease, while less than half (42.1%) suffered from at least one exacerbation of the disease over the last year prior study enrollment. About 14% reported frequent to very frequent issues affecting their sleep quality, between a fourth and a third of them reported occasional night sleep disturbances, and at least half of them reported no or very infrequent problems in their night sleep. Our study indicates that the COPD assessment test (CAT) and the spirometry-based disease severity can predict the poorness in the quality of sleep (F2,3451 = 1397.5, p < 0.001, adj. R2 = 0.45) as assessed by CASIS score, and that the latter also correlates with age (ρ = 0.122, p < 0.001) and disease duration (ρ = 0.104, p < 0.001). On the contrary, there appears to be no correlation between sleep quality and number of exacerbations. Finally, untreated patients with COPD suffer from poorer quality of sleep compared to treated subjects, independently of the use of inhaled corticosteroids (F2,3451 = 21.65, p < 0.001). The results of the SLEPICO study show that increased age, prolonged disease duration, and especially CAT score ≥ 10, and severe COPD stage, might act as important indicators for deterioration in the quality of sleep, with potential consequences in the daily routine of those patients, thus urging potentially for further pharmacological interventions or modifications.

LONG-TERM AMBULATORY ECG MONITORING AN ESSENTIAL DIAGNOSTIC TOOL FOR CURRENT TIMES

Ambulatory ECG (AECG) monitoring with diary correlation of symptoms has been proven to provide significant diagnostic, therapeutic and prognostic benefit with an arrhythmic cause of symptoms. Arrhythmias can range from premature atrial and ventricular complexes (APCs/ PVCs usually benign), to Atrial and Ventricular Fibrillation which causes significant morbidity and mortality. Symptoms such as palpitations, shortness of breath, chest pain and syncope are common during arrhythmias and their frequency determines the choice of investigation needed to diagnose the arrythmia. Arrhythmias can be a manifestation of many cardiac and non-cardiac diseases. These also include congenital diseases and are often missed due to inadequate monitoring. Since most arrhythmias are intermittent they are more likely to be detected during extended ECG monitoring. Other uses of ambulatory ECG devices include ST segment analysis, heart rate variability, signal averaged ECGs, diurnal QT and QTc analysis (including patients with long QT) (1) obstructive sleep apnea and vectorcardiography (2). These factors have been shown to have relation to significant cardiovascular diseases aiding the diagnosis of various arrhythmias. Syncope although mostly benign, could potentially be a consequence of a life-threatening arrhythmia in up to 20% patients(3). Nonetheless syncope poses a significant cause of disturbance in a patients’ life and definitive diagnosis is necessary to ensure patients well-being. ESC Guidelines on Syncope (2018) recommend further testing with AECG via Holter monitoring, wearable patch recorder, external and internal loop recorders etc. depending on the frequency after initial examination is negative for a definite cause. Atrial Fibrillation (AF) increases risk of stroke more than five times. Atrial Fibrillation diagnosed after stroke is an important hallmark of recurrent stroke risk. (7) Many studies have demonstrated post stroke AECG increases the chances of detecting AF (15% vs 5%) when compared to standard monitoring. An increase incidence in atrial arrythmias (atrial high rate episodes AHRE) has been seen in patients with Permanent Pacemakers which should be documented by AECG to be treated accordingly.(4). Uses can be prognostic if rate was to be monitored in AF to assess efficacy of rate control treatment and offer adequate anticoagulation according to the 2020 ESC atrial fibrillation guidelines. (8) Some limitations of twenty-four hours Holter monitoring have recently been overcome by improvements in hardware and software technology including adhesive patches and wireless telemetry. Newer adhesive patches are softer, waterproof and electrode free monitors which offer unprecedented mobility and ease of carrying out daily routine by the patient. They operate as either recorders or wireless streaming devices (5). These devices were safe and effective during the pandemic even when delivered home through mail to critically ill patients.(6) The advent of smart phones has added endless potential for recording through wireless Bluetooth transmission. Smart devices like the OMSHIRTtm have the added advantage of being comfortable to wear. Newer devices for example Cardiostat has been shown to offer equal quality tracings when compared to standard Holter monitoring, often up to the 99% sensitivity and specificity through better designed R wave (QRS) detection algorithms(7) (8)Studies have shown these newer devices to be easily operable and can even be mailed to patients homes for self-attachment with an equal efficacy to hospital applied machine (6). Many studies have shown a preference over intra cardiac monitors (ICM) due to these above mentioned advantages (9). The effectiveness of even longer recordings through Implantable Loop Recorder has also been satisfactory when following patients after Ablation therapy leading to practice updating guideline changes in rhythm management(10). A recent review article summarized that although physicians in the US had knowledge of how and when to offer monitoring devices based on the frequency of symptoms, they were often seen prescribing Holter monitoring due to familiarity. Data also showed that in case the initial investigation was inconclusive, the physician would still repeat the same investigation(3). In a country like Pakistan where there are limited resources, diagnosis and management of arrythmias still has a long way to go. This article sheds light on the need of utilizing the recommended available devices.

Electronic gadgets use and sleep quality among medical students during COVID-19 Lockdown

BACKGROUND: The Nepal Government imposed two national-level lockdowns to curtail the spread of coronavirus. Schools, colleges, and universities were briefly shut leading students to stay indoors. Change in daily routine, online education and plenty of free time has ultimately led to an increase in use of electronic gadgets like smartphones, laptops, etc. There have not been enough studies to evaluate the usage pattern of electronic gadgets and sleep quality among undergraduate medical students of Nepal before and during the COVID-19 lockdown. Our study aims to evaluate the usage pattern of electronic gadgets and sleep quality among undergraduate medical students before and during the COVID-19 lockdown in Nepal.METHODOLOGY: This cross-sectional study was conducted among 208 undergraduate medical students of Lumbini Medical College, Tansen, Palpa. Participants were requested to fill up an online questionnaire circulated via Viber and Facebook messenger. Gadget usage pattern and sleep quality before and during COVID-19 lockdown were evaluated using Smartphone addiction score-short version (SAS-SV) and Pittsburgh Sleep Quality Index (PSQI) respectively.RESULTS: Of 208 responses which met the inclusion criteria, smartphone addiction was seen 94 (46.30%) respondents with higher number of male addicts (27.59%). Mean time spent in electronic gadgets raised significantly during lockdown compared to pre-COVID phase. 99 (48.77%) respondents had impaired sleep according to PSQI global sleep score. Significant relation was present between most of the components of PSQI with addicts and non-addicts.CONCLUSION: This study is merely a partial snapshot of the present scenario and provides preliminary understanding on smartphone use pattern and sleep quality among medical students from Nepal. It is critical to decrease total screen time and promote sleep quality for the betterment of physical and mental health of the future health care professionals.