Association of SMAD7 genetic markers and haplotypes with colorectal cancer risk

Purpose Colorectal cancer (CRC) is one of the common cancers with a high mortality rate worldwide. In Iran, there has been a trend of increased incidence of colorectal cancer in the last three decades that necessitates the early diagnosis. Genetic factors have an influential role in its etiology along with the conventional risk factors such as age, diet, and lifestyle. Results from GWAS have shown significant associations between SMAD7 gene variants and risk of CRC. This study aimed to assess the association of certain polymorphisms as well as haplotypes of this gene and risk of colorectal cancer. Methods and materials This study was designed as a case–control association study. After obtaining ethical approval and informed consent, blood samples from 209 patients with colorectal cancer were collected and DNA was extracted. Four variants: rs4939827, rs34007497, rs8085824 and rs8088297 were genotyped using ARMS-PCR method. Results SMAD7 rs4939827 in the recessive and co-dominant models was associated with colorectal cancer risk [TT/CT + CC: OR = 2.90, 95%CI (1.38–6.09), p = 0.005; CC + TT/CT: OR = 1.66, 95%CI (1.00–2.75), p = 0.01]. Haplotype analysis indicated that some SNP combinations including two for-SNPs haplotypes of T-T-C-C and T-C-C-A were significantly associated with CRC risk. Conclusion Based on the identified association of SMAD7 gene variations and haplotypes with colorectal cancer risk in our population, genetic variations in this gene region may have a role in CRC development. This data may shed light on the genetic predisposition of CRC which involves different pathways including TGF-β.

A Co-creation Centre for Accessible Rehabilitation Technology

Background: The prevalence of disabling conditions is increasing globally. Rehabilitation improves function and quality of life across many conditions, particularly when applied intensively. The limited workforce, however, cannot deliver evidence-based intensive rehabilitation. By providing individuals with the tools for self- rehabilitation, technology helps bridge the gap between evidence and practise. Few people, however, can access rehabilitation technology. Barriers such as cost, training, education, portability and poor design stand in the way of equitable access. Our group of engineers and researchers have established a centre dedicated to developing accessible technology through close, frequent engagement with users and industry.Methods: The centre employs a co-creation model, coupling engineering and science with user experience and industrial partnerships to develop accessible technology and associated processes. Due to the complexity and size of the challenge the initial focus is stroke. Recruited through a medical charity, participants, with a wide range of disabilities, use prototype and commercial technology during an 8-week rehabilitation programme with supervision from health professionals. The centre includes de-weighting systems, neurostimulation, virtual reality, treadmills, bespoke rehab games, communication apps, powered exercise equipment and gamified resistance equipment. Standard outcome measures (International Classification of Functioning, Disability and Health) are recorded before, during, immediately after, and 3 months after the intervention and used in combination with an interview to design the initial rehabilitation programme, which is reviewed fortnightly. Qualitative methods (surveys and interviews) are used to capture personal experiences of the programme and individual technology and an advisory group of stroke survivors help interpret outcomes to feed into the technology design process. Ethical approval has been granted for a pilot cohort study with stroke survivors, which is currently underway (01/09/2021–31/12/2021) investigating acceptability and feasibility, due to report findings in 2022.Discussion: Through partnerships, research collaborations and a co-creation model a new centre dedicated to the development of accessible rehabilitation technology has been launched and currently undergoing acceptability and feasibility testing with stroke survivors. The centre, through its close engagement with users and industry, has the potential to transform the way rehabilitation technology is developed and help revolutionise the way rehabilitation is delivered.

Multidimensional impacts of coronavirus pandemic in adolescents in Pakistan: A cross sectional research

Background COVID-19 has posed unique challenges for adolescents in different dimensions of their life including education, home and social life, mental and physical health. Whether the impact is positive or negative, its significance on the overall shaping of adolescents’ lives cannot be overlooked. The aim of the present study was to explore impacts of the pandemic on the adolescents’ everyday lives in Pakistan. Methods Following ethical approval, this cross-sectional study was conducted through September to December, 2020 via an online survey on 842 adolescents with the mean age of 17.14 ± SD 1.48. Socio-demographic data and Epidemic Pandemic Impact Inventory-Adolescent Adaptation (EPII-A) was used to assess the multi-dimensional effects of the pandemic. Results Among the 842 participants, 84% were girls. Education emerged as the most negatively affected Pandemic domain (41.6–64.3%). Most of the adolescents (62.0–65.8%) had reported changes in responsibilities at home including increased time spent in helping family members. Besides, increase in workload of participants and their parents was prominent (41.8% & 47.6%). Social activities were mostly halted for approximately half (41–51%) of the participants. Increased screen time, decreased physical activity and sedentary lifestyle were reported by 52.7%, 46.3% and 40.7% respectively. 22.2–62.4% of the adolescents had a direct experience with quarantine, while 15.7% experienced death of a close friend or relative. Positive changes in their lives were endorsed by 30.5–62.4% respondents. Being male and older adolescents had significant association with negative impact across most domains (p<0.05). Conclusions Results have shown that COVID-19 exert significant multidimensional impacts on the physical, psycho-social, and home related domains of adolescents that are certainly more than what the previous researches has suggested.

A clinical and epidemiological study of non-venereal genital dermatoses: A cross-sectional, hospital-based study from Nepal

Background: Non-venereal genital dermatoses are the conditions of the genitalia that are not transmitted sexually. They may be confused with venereal diseases and be responsible for concerns among patients as well as diagnostic dilemmas for physicians. This study was conducted to determine the prevalence and describe the patterns of non-venereal genital conditions. Methods: This was a hospital-based, cross-sectional, prospective study conducted in a tertiary center in Kathmandu, Nepal, over a period of one year. Non-probability purposive sampling was employed to select the samples. Two hundred patients were enrolled in the study. Ethical approval was taken prior to the study. Detailed history taking along with a complete cutaneous examination were conducted for all patients and recorded in a preformed proforma. Results: Among 21366 patients, two hundred patients had non-venereal genital dermatoses. The prevalence of non-venereal dermatoses was 0.93 %. The mean age of the patient was 29.5 ± 15 years, ranging from 2 months to 81 years. The male-to-female ratio was 2.7:1. Itching was the most common presentation (46%). Fifty-four different types of non-venereal diseases were encountered and classified into inflammatory lesions (n = 84; 42%), infections and infestations (n = 43; 21.5%), normal variants and benign abnormalities (n = 41; 20.5%), and miscellaneous (n = 21; 10.5%). The most common were, among inflammatory dermatoses, drug reactions (11.5%) and eczema (6.5%) and, among infections and infestations, scabies (9.5%) and fungal infections (7.5%). Conclusion: Non-venereal genital dermatoses are important yet less common dermatological conditions. A number of patients have misconceptions about them as venereal. A comprehensive study of non-venereal dermatological genital conditions is required for careful management to minimize morbidity.

Exploring hepatitis C virus testing and treatment engagement over time in Melbourne, Australia: a study protocol for a longitudinal cohort study (EC-Experience Cohort study)

IntroductionThe advent of direct acting antiviral therapy for hepatitis C virus (HCV) means the elimination of HCV is possible but requires sustained effort to achieve. Between 2016 and 2019, 44% of those living with HCV were treated in Australia. However, treatment uptake has declined significantly. In Australia, people who inject drugs (PWID) are the population most at risk of HCV acquisition. Eliminating HCV in Australia will require nuanced understanding of the barriers to HCV treatment experienced by PWID and tailored interventions to address these barriers. The EC-Experience Cohort study aims to explore the barriers and enablers reported by PWID to engagement in HCV care.Methods and analysisThe EC-Experience Cohort study is a prospective cohort of PWID, established in Melbourne, Australia in 2018. Participants are assigned into three study groups: (1) those not currently engaged in HCV testing; (2) those diagnosed with HCV but not currently engaged in treatment and (3) those completed treatment. Participants complete a total of four interviews every 6 months across an 18-month study period. Predictors of experience of key outcome events along the HCV care cascade will be explored over time.Ethics and disseminationEthical approval for the EC-Experience Cohort study was obtained by the Alfred Hospital Ethics Committee in Melbourne, Australia (Project Number: HREC/16/Alfred/164). All eligible participants are assessed for capacity to consent and partake in a thorough informed consent process. Results from the EC-Experience Cohort study will be disseminated via national and international scientific and public health conferences and peer-reviewed journal publications. Data from the EC-Experience Cohort study will improve the current understanding of the barriers to HCV care for PWID and guide the tailoring of service provision for specific subgroups. Understanding the barriers and how to increase engagement in care of PWID is critical to achieve HCV elimination goals.

Immediate acupuncture with GB34 for biliary colic: protocol for a randomised controlled neuroimaging trial

IntroductionAs the main manifestation of gallstone disease, biliary colic (BC) is an episodic attack that brings patients severe pain in the right upper abdominal quadrant. Although acupuncture has been documented with significance to lead to pain relief, the immediate analgesia of acupuncture for BC still needs to be verified, and the underlying mechanism has yet to be covered. Therefore, this trial aims first to verify the immediate pain-alleviation characteristic of acupuncture for BC, then to explore its influence on the peripheral sensitised acupoint and central brain activity.Methods and analysisThis is a randomised controlled, paralleled clinical trial, with patients and outcome assessors blinded. Seventy-two patients with gallbladder stone disease presenting with BC will be randomised into a verum acupuncture group and the sham acupuncture group. Both groups will receive one session of immediate acupuncture treatment. Improvements in patients’ BC will be evaluated by the Numeric Rating Scale, and the pain threshold of acupoints will also be detected before and after treatment. During treatment, brain neural activity will be monitored with functional near-infrared spectroscopy (fNIRS), and the needle sensation will be rated. Clinical and fNIRS data will be analysed, respectively, to validate the acupuncture effect, and correlation analysis will be conducted to investigate the relationship between pain relief and peripheral–cerebral functional changes.Ethics and disseminationThis trial has been approved by the institutional review boards and ethics committees of the First Teaching Hospital of Chengdu University of Traditional Chinese Medicine, with the ethical approval identifier 2019 KL-029, and the institutional review boards and ethics committees of the First People’s Hospital of Longquanyi District, with the ethical approval identifier AF-KY-2020071. The results of this trial will be disseminated through peer-reviewed publications and conference abstracts or posters.Trial registration numberCTR2000034432.

Barriers to and facilitators of the implementation of pharmacist services in primary care clinics: a scoping review protocol

IntroductionInappropriate medication use is a leading cause of avoidable harm in health systems and is particularly severe in primary care settings. Evidence has shown that the integration of pharmacists into primary care clinics has favourable satisfaction and effectiveness in health outcomes. However, barriers to and facilitators of pharmacist services in these settings have not been comprehensively reviewed. Therefore, this scoping review aims to map and examine the literature available on the barriers to and facilitators of the implementation of pharmacist services in primary care clinics to guide future implementation research.Methods and analysisThis scoping review will be undertaken following the six-stage framework developed by Arksey and O’Malley and be guided by recommendations by Levac et al. Eight electronic databases (PubMed, Embase, Scopus, Web of Science, CINAHL, PsycINFO, CNKI and Wanfang) will be searched. Reference lists and related citations, and grey literature from websites will be searched manually. Available information that has been reported in Chinese or English up to 31 August 2021 will be included. Studies will be selected and screened by two reviewers independently. Findings from the included studies will be extracted by two independent reviewers and supervised by a third reviewer. A content analysis of the findings will be performed using MAXQDA 2020.Ethics and disseminationEthical approval will not be required for this scoping review, as all data and information will be obtained from publicly available literature. The findings of this scoping review will be shared with healthcare managers in primary care institutions and health authorities as well as disseminated via publication in a peer-reviewed journal.

Novel urinary markers: taurine, dopamine and L-fucose levels in predicting neonatal seizures

Introduction and Aim: Neonatal seizure is an age specific neurological emergency. Their unique pathophysiological mechanism has become subject of interest for many research studies. The recurrence risk for seizures is high during neonatal period and currently used treatment strategies have limited efficacy in preventing it. From past decades although the treatment has not changed, there is a gradual progress in various mechanisms that are involved in generation of seizures and their response to anti-epileptics. With the emergence of new biochemical parameters for risk assessment in patients with seizures, there is a strong need for their comparative evaluation in order to evaluate their potential clinical application. So, this study was carried out to compare the urine levels of taurine, dopamine and fucose in assessing their role in mechanism of seizure. Materials and Methods: After obtaining ethical approval and consent from parents total 43 neonates, urine taurine, dopamine and fucose were measured in 24 cases of seizures and 19 apparently healthy normal controls. Dopamine and Taurine were measured using ELISA and L-fucose by Dische and Shettles method. Results: The median level of urine fucose was significantly higher in male neonates, taurine was significantly decreased in cases compared to that of controls. Males had higher preponderance to develop seizures. The median levels of urine dopamine were high in cases compared to controls but has not showed any significance. Conclusion: Amino acid like taurine, carbohydrate moiety like fucose and a neuromodulator like dopamine may have a mechanistic role in development of seizures in neonatal period.

Morphological Variations of the Lungs: A Cadaveric Study

The lungs are the organs of respiration which are situated on either side of the heart and other mediastinal contents in its pleural cavity. A fresh lung is spongy, can float in water and crepitates when handled. Lungs are important with respect to its blood circulation. The lungs are divided by fissures into lobes which facilitate movements of lobes in relation to one another. The hilum of each lung is its gateway. In the present study, we aim to assess the morphological variations of human cadaveric lungs at Chitwan Medical College (CMC). An observational study was conducted at dissection hall of anatomy department at Chitwan Medical College from September 2019 to October 2020 after taking ethical approval form Institutional Review Committee of CMC. All the intact 70 lungs present in the department were studied. Photographs of the intact lungs were taken from different surface. The lungs were porus, highly elastic and spongy in texture. On keeping lungs to water tank it got floated. We found 34(80.96%) of the studied specimen of right side had horizontal fissure present in it. The remaining 8 (19.04%) specimens did not have horizontal fissures, while 3 (5.88%) specimens had incomplete fissures. The oblique fissure was not present in 2 (2.38%) of the study specimens. The left side of the study specimen has a variance of 1(4.16%). When the hilum right lung was examined, 40 (95.23%) of the structure had the usual organization pattern. In the left lung, the usual pattern of organization was 21(75%). The differences are thought to be present in the lung’s fissure and hilum. The current study’s findings are therapeutically important. The findings could prove beneficial to cardiovascular and thoracic surgeons.

Psychological distress and its associated factors in health workers during COVID-19 pandemic in Nepal: An online survey

Introduction: Psychological distress among healthcare workers amidst COVID-19 pandemic has emerged as a serious health problem. Understanding its magnitude is crucial to guide policies and interventions to improve their psychological wellbeing. This study assessed the psychological distress and its associated factors among health care workers in Nepal during the COVID-19 pandemic. Methods: A cross-sectional online survey was carried out among 427 health workers currently working in Nepal from April 25 to June 10, 2020. Psychological distress was measured using “The Kessler Psychological Distress Scale” (K10). Descriptive statistics and inferential statistics were computed at a 5% level of significance. Ethical approval was taken from Nepal Health Research Council. Results: A total of 427 healthcare workers participated in the study. Out of the total participants, 50.4% were males. Nearly half of the participants were medical doctors (48%) followed by nurses (22.2%), health assistants (12.2%) and 61% were non-government employees. The healthcare workers who experienced symptoms of psychological distress were 28.9%. Out of 123 respondents who had symptoms of psychological distress, 19% had mild, 7.3% had moderate and 2.6% had severe psychological distress. Female healthcare workers were more likely to have psychological distress than males [AOR: 1.75, CI: 1.05-2.92]. Conclusions: Psychological distress in healthcare workers during the COVID-19 pandemic is a matter of serious health concern. This issue demands urgent comprehensive intervention embracing the provision of a supportive environment and protective equipment, screening psychological outcomes and psychological counseling especially targeting female healthcare workers.