Publications by authors named "Ahmed Abdullah"

53 Publications

Genome Sequencing Identified a SARS-CoV-2 Lineage B.1.1.7 Strain with a High Number of Mutations from Dhaka, Bangladesh.

Microbiol Resour Announc 2021 May 27;10(21):e0034521. Epub 2021 May 27.

Genomics Center, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

We report a coding-complete genome sequence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain SARS-CoV-2/BGD/GC001, isolated from a Bangladeshi patient with respiratory symptoms. Phylogenetic analysis assigned this strain to lineage B.1.1.7, which presented a total of 36 mutations in the spike and other genomic regions compared to strain Wuhan Hu-1 (GenBank accession number NC_045512.2).
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http://dx.doi.org/10.1128/MRA.00345-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8201627PMC
May 2021

The relationship between tendency to attend to detail, sensory sensitivity, and affective response to food cues - A registered report.

Int J Psychophysiol 2021 Aug 7;166:50-60. Epub 2021 May 7.

Abertay University, Dundee, Scotland, United Kingdom of Great Britain and Northern Ireland.

Understanding the underlying drivers of food choice remains a challenge and has highlighted the need for measures that capture data over and above that offered by self-reporting tools. Consequently, a growing body of research has set out to interpret facial responses to food cues to offer a greater insight into the emotional responses that may drive food acceptance. However, interpreting facial responses is challenging, as there are numerous factors that may influence affective response to foods, including expectation, context, and individual differences. Existing findings suggest there is a link between autistic traits and sensory sensitivities; research highlights further links between sensory sensitivities and eating behaviour, and autistic traits and eating behaviour, with a body of research focusing on the autistic trait attention to detail (ATD). As such, the current study aimed to examine rapid facial activity in response to foods cues while capturing these individual differences present in the general population. This study found no evidence to suggest facial responses to food pictures were linked with attention to detail or hyper-sensitivity. The findings did support a general link between self-reported pleasantness ratings of viewed foods and activity of facial muscles. Post-hoc analyses suggested scoring on the social skills sub-scale of the Autism Quotient (AQ) was associated with levator activity while viewing pictures low in pleasantness. This study offers a greater understanding of variations, at the individual level, which are associated with affective response to foods, and may help to inform the development of tools that set out to predict food acceptance.
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http://dx.doi.org/10.1016/j.ijpsycho.2021.05.003DOI Listing
August 2021

A Case Series Describing the Recurrence of COVID-19 in Patients Who Recovered from Initial Illness in Bangladesh.

Trop Med Infect Dis 2021 Mar 31;6(2). Epub 2021 Mar 31.

International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh.

To date, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected over 80 million people globally. We report a case series of five clinically and laboratory confirmed COVID-19 patients from Bangladesh who suffered a second episode of COVID-19 illness after 70 symptom-free days. The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), is a leading public health research institution in South Asia. icddr, b staff were actively tested, treated and followed-up for COVID-19 by an experienced team of clinicians, epidemiologists, and virologists. From 21 March to 30 September 2020, 1370 icddr,b employees working at either the Dhaka (urban) or Matlab (rural) clinical sites were tested for COVID-19. In total, 522 (38%) were positive; 38% from urban Dhaka (483/1261) and 36% from the rural clinical site Matlab (39/109). Five patients (60% male with a mean age of 41 years) had real-time reverse transcription-polymerase chain reaction (rRT-PCR) diagnosed recurrence (reinfection) of SARS-CoV-2. All had mild symptoms except for one who was hospitalized. Though all cases reported fair risk perceptions towards COVID-19, all had potential exposure sources for reinfection. After a second course of treatment and home isolation, all patients fully recovered. Our findings suggest the need for COVID-19 vaccination and continuing other preventive measures to further mitigate the pandemic. An optimal post-recovery follow-up strategy to allow the safe return of COVID-19 patients to the workforce may be considered.
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http://dx.doi.org/10.3390/tropicalmed6020041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103235PMC
March 2021

Gingival depigmentation with diode and Er,Cr:YSGG laser: evaluating re-pigmentation rate and patient perceptions.

Clin Oral Investig 2021 Feb 23. Epub 2021 Feb 23.

Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.

Objective: To evaluate the efficiency of depigmentation, patient perceptions, and the recurrence rates of physiological gingival pigments during a 2-year follow-up after ablative depigmentation using two laser wavelengths: diode 940 nm and Er,Cr:YSGG 2780 nm.

Materials And Methods: Sixty patients exhibiting physiological melanin hyperpigmentation in the buccal maxillary gingiva were randomly divided into two equal groups treated with an Er,Cr:YSGG laser at 2780 nm, and a 940 nm diode laser, respectively. The depigmentation procedure essentially involves the ablation of epithelial tissue exhibiting melanin pigmentation. The intensity and extensity indices of gingival pigments were evaluated at baseline, 1 month, 1 year, and 2 years.

Results: At all time points following depigmentation treatment, oral pigmentation index (OPI) and melanin pigmentation index (MPI) scores were less significantly (p <0.05) compared to the baseline in both groups. Treatment was significantly faster with Er,Cr:YSGG laser and required no anesthesia, with faster healing and less postoperative discomfort after 1-week of treatment, compared to the diode laser treatment (p <0.001). The re-pigmentation intensity and extensity were higher significantly in the Er,Cr:YSGG group than in the diode group at 1 year and 2 years (p <0.05).

Conclusion: Both lasers efficiently removed gingival pigments with comparable clinical outcomes and overall positive patient experience. Diode laser treatment exhibited better long-term stability of gingival color, with a lower incidence of re-pigmentation.

Clinical Relevance: The color of the gingiva plays an important role in the esthetics of oral soft tissues and the overall ideal smile. Laser-assisted gingival depigmentation is an effective, comfortable, and reliable technique with good esthetical outcomes. The rate of re-pigmentation was affected by the laser wavelength and the technique used.
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http://dx.doi.org/10.1007/s00784-021-03843-6DOI Listing
February 2021

Ameliorative effects of 9-diaminoacridine derivative against Ehrlich ascites carcinoma-induced hepatorenal injury in mice.

Environ Sci Pollut Res Int 2021 May 7;28(17):21835-21850. Epub 2021 Jan 7.

Chemistry Department, Faculty of Science, Menoufia University, Sheben Elkom, 32511, Egypt.

Ehrlich ascites carcinoma induces hepatorenal injuries while acridine derivatives have antioxidant, anticancer, and anti-inflammatory. Thus, this study evaluated the protective potential of a newly synthesized the 9-diaminoacridine derivative (9-DAAD), N1-(acridin-9-yl) propane-1, 3-diamine hydrochloride, against Ehrlich ascites carcinoma (EAC) induced hepatorenal injury in female mice. Forty female mice were allocated into 4 groups. Group I was injected with 0.1% DMSO subcutaneously and kept a control. Group II received 9-DAAD (30 mg/kg bw/2 days) subcutaneously for 2 weeks. Group III was injected interaperitonealy with 2.5 × 10 cells of EAC/20 g bw. Group IV was injected with EAC as the third group and administered with 9-DAAD as the second group for 2 weeks after induction of EAC. EAC significantly elevated total leukocytes and platelets counts; activities of serum AST, ALT, and ALP; serum levels of alpha-fetoprotein; carcinoembryonic antigen; urea and creatinine; and expression of vascular endothelial growth factor protein in hepatic and renal tissues. Meanwhile it decreased red blood cells count, hemoglobin concentration and hematocrit value. At the same time, it significantly reduced serum levels of total protein and albumin and altered hepatic and renal tissues structures. Also, EAC decreased apoptosis and DNA synthesis in hepatic and renal cells. However, treatment of EAC-bearing mice with 9-DAAD improved liver and kidney structures, functions and modulated EAC altered parameters, as well as it reduced hepatic and renal cells proliferation and DNA synthesis. This study indicated that 9-DAAD had a potential ameliorative effect against EAC-induced hepatorenal injury.
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http://dx.doi.org/10.1007/s11356-020-11857-yDOI Listing
May 2021

Awareness of the Risk Factors for Heart Attack Among the General Public in Pahang, Malaysia: A Cross-Sectional Study.

Risk Manag Healthc Policy 2020 23;13:3089-3102. Epub 2020 Dec 23.

Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.

Background: Cardiovascular disease is a leading nationwide cause of morbidity and mortality. Public awareness of risk factors for heart attacks is thought to impact the burden of disease, prevention, and timely management. The objective of this study was to assess the awareness of risk factors for heart attack and to identify the factors associated with the awareness of all modifiable risk factors for heart attack in the general population.

Methods: This is a cross-sectional study conducted among 393 adult individuals in Kuantan, Pahang, Malaysia. Data collection was conducted through face-to-face interviews among the lay public members who were 18-64 years old, excluding healthcare professionals in clinical settings and academic settings. Statistical analysis was performed using chi-square test and logistic regression analysis.

Results: The majority of the individuals identified smoking as a risk factor for heart attack, followed by atrial fibrillation (57.7%), heart disease (54.1%), and obesity (53.8%). However, diabetes (26%) was the risk factor that was least recognized by the participants. A total of 90.6% of participants identified at least one risk factor for heart attack, while 9.8% of the participants did not identify any risk factors for heart attack, whereas 5.6% identified all modifiable heart attack risk factors. Furthermore, participants aged 46-64 years old, married respondents, and Chinese participants, those with higher educational levels, and received prior information demonstrated great awareness of eight modifiable risk factors for heart attack. Multivariable logistic regression presented that participants with aged 55-64, those with family history of heart attack and individuals with dyslipidemia were factors independently related to excellent awareness (p=0.04, OR=6.21, 95% CL= 1.081-35.641), (p=0.049, OR=2.11, 95% CL=0.721-6.230) and (p=0.009, OR= 4.08, 95% CL= 1.427-11.685), respectively.

Conclusion: Awareness of risk factors for heart attack appears to be poor, where most of the respondents recognized only one modifiable risk factor. According to these findings, programs and strategies to raise awareness of modifiable risk factors for HA are urgently needed to protect the lay public from HA.
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http://dx.doi.org/10.2147/RMHP.S281285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767710PMC
December 2020

Multicolor FRET-FLIM Microscopy to Analyze Multiprotein Interactions in Live Cells.

Methods Mol Biol 2021 ;2247:287-301

Central Laser Facility, Science and Technology Facilities Council (STFC) Rutherford Appleton Laboratory, Research Complex at Harwell, Oxford, UK.

The need to describe and understand signaling pathways in live cell is seen as a primary route to identifying and developing targeted medicines. Signaling cascade is also seen as a complex communication and involves interactions between multiple interconnecting proteins. Where subcellularly and how different proteins interact need to be preserved during investigation. Furthermore, these complex events occurring simultaneously may lead to a single or multiple end point or cell function such as protein synthesis, cell cytoskeleton formation, DNA damage repair, or autophagy. There is therefore a need of real-time noninvasive methods for protein assays to enable direct visualization of the interactions in their natural environment and hence overcome the limitations of methods that rely on invasive cell disruption techniques. Förster resonance energy transfer (FRET) coupled with fluorescence lifetime imaging microscopy (FLIM) is an advanced imaging method to observe protein-protein interactions at nanometer scale inside single living cells in real-time. Here we describe the development and use of two-channel pulsed interleave excitation (PIE) for multiple protein interactions in the mTORC1 pathway. The proteins were first tagged with multiple color fluorescent protein derivatives. The FRET-FLIM combination means that the information gained from using standard steady-state FRET between interacting proteins is considerably improved by monitoring changes in the excited-state lifetime of the donor fluorophore where its quenching in the presence of the acceptor is evidence for a direct physical interaction.
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http://dx.doi.org/10.1007/978-1-0716-1126-5_16DOI Listing
March 2021

High Prevalence of Gene among Extended-Spectrum β-Lactamase-Producing Isolates Causing Extraintestinal Infections in Bangladesh.

Antibiotics (Basel) 2020 Nov 11;9(11). Epub 2020 Nov 11.

Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka-1212, Bangladesh.

The emergence of multidrug-resistant (MDR) () clonal lineages with high virulence potential is alarming. Lack of sufficient data on molecular epidemiology of such pathogens from countries with high infection burden, such as Bangladesh, hinders management and infection control measures. In this study, we assessed the population structure, virulence potential and antimicrobial susceptibility of clinical isolates from Dhaka, Bangladesh. A high prevalence of MDR (69%) and extended-spectrum β-lactamase production (ESBL) (51%) was found. Most isolates were susceptible to amikacin (95%), meropenem (94%) and nitrofurantoin (89%) antibiotics. A high prevalence of ST131 (22%) and ST95 (9%) followed by ST69 (4%) and ST73 (3%) was observed. Phylogroups B2 (46%), B1 (16%), D (10%) and F (9%) were prominent. (52%) and (5%) were the most prevalent ESBL and carbapenem resistance genes, respectively. Moreover, the predominant pathotype identified was extraintestinal pathogenic (ExPEC) (41%) followed by enteric pathogens (11%). In conclusion, our results suggest the transmission of clonal groups amidst diverse population that are associated with high virulence potential and MDR phenotype. This is of high concern and mandates more efforts towards molecular surveillance of antimicrobial resistance (AMR) in clinically significant pathogens.
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http://dx.doi.org/10.3390/antibiotics9110796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7696227PMC
November 2020

Directly imaging the localisation and photosensitization properties of the pan-mTOR inhibitor, AZD2014, in living cancer cells.

J Photochem Photobiol B 2020 Dec 15;213:112055. Epub 2020 Oct 15.

Central Laser Facility, Science & Technology Facilities Council, Rutherford Appleton Laboratory, Harwell Campus, Didcot, Oxfordshire OX11 0QX, UK. Electronic address:

The range of cellular functions the mechanistic target of rapamycin (mTOR) protein performs makes it an attractive drug target for cancer therapy. However, the cellular localisation and mode of action of second generation inhibitors of mTOR is poorly understood despite the level of attention there is in targeting the mTOR protein. We have therefore studied the properties of the pan-mTOR inhibitor AZD2014, an ideal candidate to study because it is naturally fluorescent, characterising its photochemical properties in solution phase (DMSO, PBS and BSA) and within living cells, where it localises within both the nucleus and the cytoplasm but with different excited state lifetimes of 4.8 (+/- 0.5) and 3.9 (+/- 0.4) ns respectively. We measure the uptake of the inhibitor AZD2014 (7 μM) in monolayer HEK293 cells occurring with a half-life of 1 min but observe complex behaviour for 3D spheroids with the core of the spheroid showing a slower uptake and a slow biphasic behaviour at longer times. From a cellular perspective using fluorescence lifetime imaging microscopy AZD2014 was found to interact directly with GFP-tagged mTORC1 proteins including the downstream target, S6K1. We observe light sensitive behaviour of the cells containing AZD2014 which leads to cell death, in both monolayer and spheroids cells, demonstrating the potential of AZD2014 to act as a possible photodynamic drug under both single photon and multiphoton excitation and discuss its use as a photosensitizer. We also briefly characterise another pan-mTOR inhibitor, INK128.
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http://dx.doi.org/10.1016/j.jphotobiol.2020.112055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762844PMC
December 2020

Draft Genome Sequence of Chromobacterium violaceum RDN09, Isolated from a Patient with a Wound Infection in Bangladesh.

Microbiol Resour Announc 2020 Oct 15;9(42). Epub 2020 Oct 15.

Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh

is an emerging environmental opportunistic pathogen that causes life-threatening infections in humans. Here, we describe the draft genome sequence of RDN09, isolated from the infected wound of an adult male patient in Bangladesh. The genome assembly consists of 4,736,739 bp spread across 84 contigs.
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http://dx.doi.org/10.1128/MRA.00957-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7561691PMC
October 2020

Exploring the influence of socio-cultural factors and environmental resources on the health related quality of life of children and adolescents after congenital heart disease surgery: parental perspectives from a low middle income country.

J Patient Rep Outcomes 2020 Aug 28;4(1):72. Epub 2020 Aug 28.

Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, The University of Sydney, Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia.

Background: Health related quality of life (HRQOL) is an important indicator of long-term well-being, influenced by environmental factors such as family, culture, societal norms and available resources. This study aimed to explore parental perspectives on the influence of socio-cultural factors and environmental resources on the HRQOL of children and adolescents after congenital heart disease (CHD) surgery.

Methods: Using a descriptive, qualitative design, semi-structured interviews of children/adolescents who had CHD surgery in this low-middle income country (LMIC) were collected between July to December 2017. There were 20 families enrolled, which included 18 parent dyads (mother and father) and two single mothers, making a total of 38 participants. Initial inductive analysis was further refined using the Social Ecological Model as an analytic lens.

Results: At the intrapersonal level, unrealistic expectations of surgery, residual CHD symptoms and difficulty maintaining educational progress were of great concern. There were low levels of health literacy and understanding about CHD among family and friends, however, strong kinship ties were an important resource at the interpersonal level. These families lived in poverty and mothers often carried the sole burden of care for their sick children. At the institutional level, there were unclear expectations of the child's needs at school, and parents had poor access to psychological, family-planning and genetic counselling, and poor access to CHD education resources. At a sociocultural level, religion and trust in God were important coping factors, however, CHD was a gendered experience with particular concerns around scarring and the marriageability of girls. Parents noted the deficit of antenatal and specialist CHD services and felt the consequence of a lack of a universal health care system at the public policy level.

Conclusion: Socio-ecological factors have the potential to explain the issues and challenges that children living in LMIC experience with CHD after surgery. The study findings will help to inform future interventions to be implemented in countries like Pakistan.
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http://dx.doi.org/10.1186/s41687-020-00239-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455647PMC
August 2020

Health-related quality of life in adult CHD surgical patients in a low middle-income country: a mixed-methods study.

Cardiol Young 2020 Aug 23;30(8):1126-1137. Epub 2020 Jun 23.

Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, The University of Sydney, Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia.

Background And Objectives: This mixed-methods study aimed to assess health-related quality of life in young adults with CHD following surgery in a low middle-income country, Pakistan. Despite the knowledge that geographic, cultural and socio-economic factors may shape the way health and illness is experienced and managed and consequently determine a person's health-related quality of life, few health-related quality of life studies are conducted in low middle-income countries. This deficit is pronounced in CHD, so there is little guidance for patient care.

Methods: The study utilised concurrent, mixed methods. Adults with CHD (n = 59) completed health-related quality of life surveys (PedsQLTM 4.0 Generic Core Scale, PedsQLTM Cognitive Functioning Scale and PedsQLTM 3.0 Cardiac Module). Semi-structured interview data were collected from a nested sub-sample of 17 participants and analysed using qualitative content analysis, guided by the revised Wilson-Cleary model of health-related quality of life.

Results: The lowest health-related quality of life domain was emotional with the mean score (71.61 ± 20.6), followed by physical (78.81 ± 21.18) and heart problem (79.41 ± 18.05). There was no statistical difference in general or cardiac-specific health-related quality of life between mild, moderate or complex CHD. Qualitative findings suggested low health-related quality of life arose from a reduced capacity to contribute to family life including family income and gender. A sense of reduced marriageability and fear of dependency were important socio-cultural considerations.

Conclusions: CHD surgical patients in this low-income country experience poor health-related quality of life, and contributing factors differ to those reported for high-income countries. Socio-cultural understandings should underpin assessment, management and care-partnering with young adults with CHD following surgical correction.
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http://dx.doi.org/10.1017/S1047951120001663DOI Listing
August 2020

Genome Dynamics of Vibrio cholerae Isolates Linked to Seasonal Outbreaks of Cholera in Dhaka, Bangladesh.

mBio 2020 02 11;11(1). Epub 2020 Feb 11.

International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh

The temporal switching of serotypes from serotype Ogawa to Inaba and back to Ogawa was identified in O1, which was responsible for seasonal outbreaks of cholera in Dhaka during the period 2015 to 2018. In order to delineate the factors responsible for this serotype transition, we performed whole-genome sequencing (WGS) of O1 multidrug-resistant strains belonging to both the serotypes that were isolated during this interval where the emergence and subsequent reduction of the Inaba serotype occurred. The whole-genome-based phylogenetic analysis revealed clonal expansion of the Inaba isolates mainly responsible for the peaks of infection during 2016 to 2017 and that they might have evolved from the prevailing Ogawa strains in 2015 which coclustered with them. Furthermore, the gene in these Inaba serotype isolates was inactivated due to insertion of a transposable element at the same position signifying the clonal expansion. Also, isolates in the Inaba serotype dominant clade mainly contained classical allele and revealed differences in the genetic composition of eventh andemic sland II (VSP-II) and the SXT integrative and conjugative element (SXT-ICE) compared to those of Ogawa serotype strains which remerged in 2018. The variable presence of phage-inducible chromosomal island-like element 1 (PLE1) was also noted in the isolates of the Inaba serotype dominant clade. The detailed genomic characterization of the sequenced isolates has shed light on the forces which could be responsible for the periodic changes in serotypes of and has also highlighted the need to analyze the mobilome in greater detail to obtain insights into the mechanisms behind serotype switching. The switching of serotype from Ogawa to Inaba and back to Ogawa has been observed temporally in O1, which is responsible for endemic cholera in Bangladesh. The serospecificity is key for effective intervention and for preventing cholera, a deadly disease that continues to cause significant morbidity and mortality worldwide. In the present study, WGS of allowed us to better understand the factors associated with the serotype switching events observed during 2015 to 2018. Genomic data analysis of strains isolated during this interval highlighted variations in the genes , , and and also identified significant differences in the genetic content of the mobilome, which included key elements such as SXT ICE, VSP-II, and PLE. Our results indicate that selective forces such as antibiotic resistance and phage resistance might contribute to the clonal expansion and predominance of a particular serotype responsible for an outbreak.
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http://dx.doi.org/10.1128/mBio.03339-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018647PMC
February 2020

Evaluation of prokinetic and laxative effects of Hippophae rhamnoides in rodents.

Pak J Pharm Sci 2019 Sep;32(5(Special)):2527-2533

Natural Product Research Division, Department of Biological and Biomedical Sciences, The Aga Khan University Medical College, Karachi, Sindh, Pakistan.

Hippophae rhamnoides (Family; Elaeagnaceae) fruit extract was investigated for prokinetic and gut excitatory effects to rationalize its therapeutic utility in gastrointestinal complaints like delayed gastric emptying and constipation. The fruit extract of Hippophae rhamnoides (Hr.Cr) prepared in hydro-methanol (30:70) was verified for flavonoids, tannins, coumarins and terpenes as plant constituents. In mice, Hr.Cr administration caused an increased in faecal production and charcoal meal transport (50-300mg/kg, per-oral.), similar to activity pattern of carbamylcholine (1 mg/kg). Laxative and prokinetic effects of Hr.Cr were found partially atropine-sensitive. On challenge with isolated intestinal tissues, Hr.Cr charged a dose-dependent spasmogenic effect on jejunum (0.01-1mg/mL) preparations of rabbit and in ileal tissues (guinea-pig) at the dose range of 0.03 to 3mg/mL, following predominant relaxing impact at increased concentrations. Unlike carbamylcholine, stimulant effect of Hr.Cr was partly antagonized in atropine incubated tissues. These data attest the laxative, prokinetic and gut excitatory activities of Hippophae rhamnoides probably mediated through partial activation of muscarinic receptors. Further in agreement of the current findings with earlier reports on gastric emptying effects of Hippophae rhamnoides seed oil, this is the first study of its kind providing insight into mechanism to the laxative potential of Hippophae rhamnoides fruit, thus rationalizing its medicinal use in constipation.
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September 2019

The relationship between study skills and depressive symptoms among medical residents.

BMC Med Educ 2019 Nov 21;19(1):435. Epub 2019 Nov 21.

Department of Educational Development and Research Maastricht University, Maastricht, the Netherlands.

Background: The cost of depression among residents is staggering as it extends into the quality and safety of patient care. Finding an explanation to resident depression by investigating the associated factors is therefore important. Study skills can be a possible factor, and a clear gap in the literature exists in this regard. We sought to investigate the relationship between depressive symptoms among residents and their study skills.

Methods: This was a correlational study and a non-probability sample of 240 residents completed the Beck Depression Inventory II (BDI-II) and the Study Skills Inventory (SSI). Chi-square test was used to compare different categorical variables, while student t-test and ANOVA for continuous data. Pearson's correlation coefficient was performed to find the relationship between depressive symptoms and study skills and the association that these measures have with the demographic variables.

Results: Overall, 186 residents (76%) filled out the questionnaire. The SSI total score was found to have a significant negative association with the BDI-II depression score (Pearson correlation = - 0.447and p < 0.000). No significant association was found between the total SSI score and the residents' sex, age, marital status, smoking status, training years or specialties.

Conclusion: Poor study skills were found to be correlated with higher depressive symptoms. Future studies are required to develop a deeper understanding of this relationship and reconfigure the approach to study skills for the well-being of the future physicians.
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http://dx.doi.org/10.1186/s12909-019-1870-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873798PMC
November 2019

Development of questionnaire on awareness and action towards symptoms and risk factors of heart attack and stroke among a Malaysian population.

BMC Public Health 2019 Oct 16;19(1):1300. Epub 2019 Oct 16.

Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang, Malaysia.

Background: The awareness of symptoms and action towards heart attack and stroke is important to reduce the morbidity and mortality in both developed and developing countries. The aim of this study was to develop a questionnaire on awareness and action towards symptoms and risk factors of heart attack and stroke among lay public in Malaysia. The questionnaire was developed in both English and Bahasa Melayu.

Methods: Primarily the questions were generated in English. Face and content validity were performed by five experts in Pharmacy Practice and Medicine. A translation as per guidelines into Malay language was performed; followed by face-to-face interview of 96 lay public in Kuantan, Pahang, Malaysia. For internal consistency, reliability was assessed utilizing Cronbach's alpha.

Results: The mean ± SD of the awareness and action towards heart attack symptoms and risk factors was 65.52 ± 6.3, with a good internal consistency (Cronbach's alpha = 0.75), whereas the mean of the awareness and action towards stroke symptoms and risk factors was 61.93 ± 7.11, with an accepted internal consistency (Cronbach's alpha = 0.86).

Conclusion: The current validation research showed that the developed questionnaire is valid and reliable for assessing the awareness and action towards symptoms and risk factors of heart attack and stroke among lay public in Malaysia.
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http://dx.doi.org/10.1186/s12889-019-7596-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796340PMC
October 2019

Use and abuse of fecal occult blood tests: a community hospital experience.

BMC Gastroenterol 2019 Sep 3;19(1):161. Epub 2019 Sep 3.

Department of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, TN, USA.

Background: The Fecal Occult Blood Test (FOBT) is one of the diagnostic modalities indicated for screening patients for Colorectal Cancer (CRC). Despite being approved only for screening for CRC, numerous studies in the past have illustrated misuse of the FOBT. We examined utilization of the FOBT for patients admitted to a community teaching hospital.

Methods: The study was conducted at Saint Joseph Hospital, Chicago USA. A retrospective review of Electronic Medical Records (EMRs) of patients admitted from January 2016 to December 2017 was performed.

Results: We reviewed the EMRs of 729 patients who received the stool testing for occult blood (FOBT). All tests (100%) were carried out for purposes other than CRC screening. Anemia (38%) was the most common reason documented for carrying out the FOBT. Further, 88% of the tests were ordered on patients who either did not fulfill CRC screening criteria or had other contraindications for testing. Usage of contraindicated medication was the most important factor (58% of patients) that made the candidates ineligible for testing. A total 73 Colonoscopies were ordered for patients who received the test inappropriately with a resulting low yield (0.47%) of CRC diagnosis.

Conclusion: The stool occult blood test continues to be utilized for reasons other than CRC screening. Majority of patients who underwent the test were not suitable candidates due to the presence of contraindications for testing. Unsuitable FOBT testing led to further unnecessary investigations.
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http://dx.doi.org/10.1186/s12876-019-1079-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6724234PMC
September 2019

The learning environment of four undergraduate health professional schools: Lessons learned.

Pak J Med Sci 2019 ;35(3):598-604

Abdullah MA Ahmed, BSc., College of Medicine, Department of Family and Community Medicine, King Saud University Chair for Medical Education Research and Development, King Saud University, Riyadh, Saudi Arabia.

Background And Objectives: Learning is an interplay between cognition and environmental factors. Any learning environment, that fulfills the intrinsic and extrinsic needs of the students will probably lead to better and more promising learning outcomes. This study aimed to investigate the student perceptions of Learning Environment (LE) in four health schools of a large university and compare between schools, years of study, and gender.

Methods: Dundee Ready Education Environment Measure (DREEM) questionnaire and a socio-demographic questionnaire were completed by 1185 undergraduate students enrolled in the school of Medicine, Dentistry, Nursing and Applied Medical Sciences (AMS) of a large university during the academic year 2012-2013. Chi-square test was used to compare categorical variables. Independent student t-test or ANOVA (with Tukey post-hoc test) was used for continuous variables at a significance level of p≤0.05.

Results: The mean total DREEM score was 89.23±33.3. The total DREEM mean scores for Dentistry (120.54±23.45) and Medicine (110.72±19.33) were higher compared with AMS (63.48±21.36) and Nursing (57.48±22.80) (p=0.000) (Post hoc Tukey p=0.000). First year students gave significantly higher positive perceptions ratings than the rest of the years (p=0.000). Total scores were significantly higher for male (92.78±33.86) than female students (84.70±32.25) p=0.000.

Conclusion: The LE significantly differed by year and gender. The students from non-integrated curricula (nursing and AMS) perceived the LE less positively than their integrated curriculum counterparts (medicine and dentistry). A qualitative study is needed to investigate the variation in the perception of LE among these groups.
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http://dx.doi.org/10.12669/pjms.35.3.712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6572965PMC
January 2019

Mean centering-triple divisor and ratio derivative-zero crossing for simultaneous determination of some diabetes drugs in their quaternary mixture with severely overlapping spectra.

Spectrochim Acta A Mol Biomol Spectrosc 2019 Nov 14;222:117261. Epub 2019 Jun 14.

Department of Chemistry, College of Education, Salahaddin University-Erbil, Iraq.

Two ratio derivative spectrophotometric methods were performed for the simultaneous analysis of metformin hydrochloride, empagliflozine, linagliptin, and pioglitazone hydrochloride in their synthetic mixtures without prior chemical separation. The drugs are approved for the treatment of type 2 diabetes. Despite the various advances in the management of diabetes, it remains to be the major cause of disability and morbidity, including blindness, amputation, heart disease, peripheral neuropathy, and kidney disease. These techniques consisted of several steps using ratio and derivative spectra. The absorption spectra of the mentioned drugs were recorded in the range of 200-350 nm, which have the concentration ranges of 1.0-10, 2.5-30, 5.0-40, and 2.5-30 μg mL for metformin hydrochloride, empagliflozine, linagliptin, and pioglitazone hydrochloride, respectively, using zero-order spectra. The mean centring of ratio spectra combined with triple divisor were measured at the amplitude values 242, 256, 272 and 296 nm for metformin hydrochloride, empagliflozine, linagliptin and pioglitazone hydrochloride, respectively; the derivative ratio spectra-zero crossing quantifies the amplitude value of the analytical signal at 234, 244, 260 and 280 nm for metformin hydrochloride, empagliflozine, linagliptin and pioglitazone hydrochloride, respectively. The method was validated according to the ICH guidelines, accuracy, precision and repeatability were found to be within the acceptable limits. Finally, statistical comparisons between the proposed methods and with the reported methods with respect to accuracy and precision show that no significant difference was found by using Student's t-test, the F-test and one-way ANOVA.
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http://dx.doi.org/10.1016/j.saa.2019.117261DOI Listing
November 2019

Direct imaging of the recruitment and phosphorylation of S6K1 in the mTORC1 pathway in living cells.

Sci Rep 2019 03 4;9(1):3408. Epub 2019 Mar 4.

Central Laser Facility, Research Complex at Harwell, STFC Rutherford Appleton Laboratory, Harwell Campus, Didcot, OX11 0FA, UK.

Knowledge of protein signalling pathways in the working cell is seen as a primary route to identifying and developing targeted medicines. In recent years there has been a growing awareness of the importance of the mTOR pathway, making it an attractive target for therapeutic intervention in several diseases. Within this pathway we have focused on S6 kinase 1 (S6K1), the downstream phosphorylation substrate of mTORC1, and specifically identify its juxtaposition with mTORC1. When S6K1 is co-expressed with raptor we show that S6K1 is translocated from the nucleus to the cytoplasm. By developing a novel biosensor we demonstrate in real-time, that phosphorylation and de-phosphorylation of S6K1 occurs mainly in the cytoplasm of living cells. Furthermore, we show that the scaffold protein raptor, that typically recruits mTOR substrates, is not always involved in S6K1 phosphorylation. Overall, we demonstrate how FRET-FLIM imaging technology can be used to show localisation of S6K1 phosphorylation in living cells and hence a key site of action of inhibitors targeting mTOR phosphorylation.
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http://dx.doi.org/10.1038/s41598-019-39410-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399282PMC
March 2019

Systematic review and meta-analysis of randomized controlled trials of atosiban versus nifedipine for inhibition of preterm labor.

Int J Gynaecol Obstet 2019 May 13;145(2):139-148. Epub 2019 Mar 13.

Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt.

Background: Two tocolytic drugs-atosiban and nifedipine-are currently used for first-line treatment of preterm labor (PTL).

Objective: To compare the efficacy and safety of atosiban with nifedipine for PTL treatment.

Search Strategy: In May 2017, we searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Clinical Trials with search terms including "nifedipine", "atosiban", and "preterm labor".

Selection Criteria: Randomized controlled trials of women with PTL.

Data Collection And Analysis: Data were extracted for study design, patient characteristics, risk of bias domains, and study outcomes. A random-effects model was used to generate pooled risk ratios (RRs) and 95% confidence intervals (CIs).

Results: We included seven studies that enrolled 992 patients. There was no significant difference between atosiban and nifedipine for pregnancy prolongation of 48 hours or more regarding efficacy (RR 1.06, 95% CI 0.92-1.22; P=0.440) or effectiveness (0.93, 0.84-1.03; P=0.177). Pregnancy prolongation for 7 days or more also did not differ between groups for efficacy (RR 1.04, 95% CI 0.89-1.21; P=0.656) or effectiveness (0.91, 0.79-1.05; P=0.177). Atosiban-however-was associated with fewer maternal side-effects than nifedipine.

Conclusion: Atosiban resulted in fewer maternal side-effects than nifedipine, with no difference in pregnancy prolongation. PROSPERO registration: CRD42018090223.
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http://dx.doi.org/10.1002/ijgo.12793DOI Listing
May 2019

Family physicians' utility of social media: a survey comparison among family medicine residents and physicians.

Afr Health Sci 2018 Sep;18(3):817-827

Deparmtent of Educational Development & Research Maastricht University, Netherland.

Introduction: Social media has become ubiquitous and has brought a dramatic change in health services. Little is known about its use by family physicians and residents for personal or professional purpose. The aim of the current study was to evaluate the utility of social media among family medicine residents and consultants.

Methods: The collection of data was through the use of a five part questionnaire developed by researchers. The questionnaire was delivered to 70 physicians and 100 residents, out of which 132questionnaires were completed, representing a 78 percent response rate.

Results: Our findings demonstrate that there was an overall high use of social media. Females used social media more for general education and professional purposes. Men, by contrast, used it more frequently for personal purposes. The participants in this study appeared to consider social media as having several useful dimensions, such as: enabling them to accomplish job tasks, improve job performance, productivity and more effective patient care when using social media.

Conclusions: To date, limited studies have compared social media use among family physicians and residents. This study may serve as an initial step for future studies explaining the pattern of use among physicians.
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http://dx.doi.org/10.4314/ahs.v18i3.41DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307000PMC
September 2018

Health-related quality of life in surgical children and adolescents with congenital heart disease compared with their age-matched healthy sibling: a cross-sectional study from a lower middle-income country, Pakistan.

Arch Dis Child 2019 05 15;104(5):419-425. Epub 2018 Dec 15.

Charles Perkins Centre and Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, University of Sydney, Camperdown, New South Wales, Australia.

Objective: Inconsistencies have been reported in health-related quality of life (HRQOL) in postoperative congenital heart disease (CHD). Despite the need for lifelong care due for residual symptoms, only a few studies have explored cardiac-related HRQOL but none in lower middle-income countries (LMIC). This study therefore addresses the gap by exploring HRQOL and its associated predictors in postoperative CHD in Pakistan.

Outcome Measures: General and cardiac-related HRQOL, associated predictors.

Methods: This cross-sectional study recruited patients with CHD and age-matched healthy siblings as controls (n=129 each) at a single centre in Pakistan. Patients and their siblings completed HQROL surveys (PedsQL 4.0 Generic Core, PedsQL Cognitive Functioning). Patients only completed PedsQL 3.0 Cardiac module. Generalised linear models identified predictors.

Results: The sample mean age was 8.84±3.87 years and 70% were below the poverty line for an LMIC. The majority (68%) had their first surgery after 1 year of age and were interviewed at a mean 4.08±1.91 years postoperatively.Patients with CHD had lower HRQOL in all domains compared with their age-matched siblings, with the biggest differences for total HRQOL (effect size, d=-1.35). Patients with complex CHD had lower HRQOL compared with simple to moderate CHDs in cardiac-related HRQOL. The lowest scores were for treatment problems (effect size, d=-0.91). HRQOL was worse for patients who were on cardiac medications, had complex CHD, longer cardiopulmonary bypass time, re-operations and were female.

Conclusions: HRQOL issues persist in postoperative patients with CHD in LMIC, Pakistan. Solutions are needed to address poor HRQOL and lifelong concerns of patients and their parents.
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http://dx.doi.org/10.1136/archdischild-2018-315594DOI Listing
May 2019

Incidence of and Causes for Ventriculoperitoneal Shunt Failure in Children Younger Than 2 Years: A Systematic Review.

J Neurol Surg A Cent Eur Neurosurg 2019 Jan 3;80(1):26-33. Epub 2018 Dec 3.

Department of Neurosurgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt.

Objectives:  Ventriculoperitoneal (VP) shunting is commonly used to treat pediatric hydrocephalus, but failure rates are high. VP shunt failure in children is mostly caused by infection and/or proximal/distal shunt obstruction. However, to our knowledge, no previous reviews have discussed this topic using only clinical studies when age-related data could be obtained. This systematic review aimed at reevaluating what is already known as the most common causes of shunt failure and to determine the incidence and causes of VP shunt failure during the first 2 years of life as a step to establish solid evidence-based guidelines to avoid VP shunt failure in infants.

Methods:  We performed a search using the search terms "Cerebrospinal Fluid Shunts" (Medical Subject Headings [MeSH]) AND failure [All Fields] AND ("humans" [MeSH] AND English [lang] AND "infant" [MeSH]). Only articles that specifically discussed VP shunt complications in children < 2 years were included.

Results:  We found that the most common causes of VP shunt failure in children < 2 years were shunt obstruction and infection, both observed in a range.

Conclusion:  VP shunt failure is very common in infants, mostly resulting from obstruction and infection. Future studies should focus on methods designed to avoid these complications or on alternative treatments for hydrocephalus.
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http://dx.doi.org/10.1055/s-0038-1669464DOI Listing
January 2019

Enamel resistance to demineralisation around orthodontic brackets after CO laser irradiation: a randomised clinical trial.

J Orthod 2018 12 2;45(4):234-242. Epub 2018 Aug 2.

c Faculty of Dental Medicine , Damascus , Syria.

Objective: To evaluate the clinical effect of 10.6 µm CO laser irradiation on the formation of demineralised lesions (DLs) around orthodontic brackets.

Design: A two-arm, split-mouth, randomised clinical trial (RCT).

Setting: The Orthodontic Department, Faculty of Dentistry, Damascus University, Syria.

Participants: Twenty-six patients with a total of 520 teeth were recruited into the trial.

Method: Two reversed quadrants of the dental arches in each patient were randomly allocated to CO laser application around the orthodontic brackets. The other two quadrants received a control non-therapeutic light. There was blinding of both patients and assessors in the study. The primary outcome was the presence or absence of at least one new DL observed by clinical and photographic examinations. Secondary outcomes included the degree and area of DLs measured on digital images and DIAGNOdent assessment. Teeth were examined before bonding (T0), after bonding and laser irradiation (T1), after 1 month (T2), 2 months (T3) and 6 months (T4).

Results: The presence of at least new DL was significantly lower in the laser group when observed at 2 and 6 months (P < .0001), the DLs degree and area were also significantly lower in the laser group at 2 and 6 months (P ≤ .005), and DIAGNOdent values were significantly lower in the laser group (P < .0001) at all observation times.

Conclusions: Enamel irradiation with a CO laser (at the wavelength of 10.6 µm) has an inhibitory effect on DL formation during orthodontic treatments. Registration: The trial was registered at ClinicalTrials.gov, number NCT03114475.
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http://dx.doi.org/10.1080/14653125.2018.1504410DOI Listing
December 2018

Migration of the Distal Catheter of Ventriculoperitoneal Shunts in Pediatric Age Group: Case Series.

World Neurosurg 2018 Nov 19;119:e131-e137. Epub 2018 Jul 19.

Department of Neurosurgery, Cairo University, Cairo, Egypt; Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany.

Background: Ventriculoperitoneal (VP) shunting is the most commonly performed procedure in the treatment of hydrocephalus. VP shunt migration can occur at different sites. The aim of the study was to present different sites of abnormal distal shunt location, pathophysiology, and the management in each situation.

Methods: Between 2014 and 2017, all patients with hydrocephalus in the Department of Neurosurgery, Cairo University, were gathered prospectively. All pediatric patients below the age of 12 years with shunt migration of the distal end of the VP shunt were identified.

Results: Of 1092 patients operated on by the VP shunt between 2014 and 2017, 15 presented with shunt dysfunction because of distal shunt migration (6 anal, 3 scrotal, 1 colon, 1 peroral, 1 upper lumbar extrusion, 1 paraspinal, 1 penile, and 1 umbilical). Especially upper lumbar extrusion and paraspinal shunt location are extremely rare. All the 15 patients were treated successfully with VP shunts and prospectively followed until they presented with complications on different occasions.

Conclusions: Peritoneal complications are among the most common causes of VP failure. We present a rare complication where the shunt migrates outside the peritoneal cavity elsewhere with ambiguous pathogenesis. Special considerations have to be appointed during the shunt revision surgeries of these cases.
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http://dx.doi.org/10.1016/j.wneu.2018.07.073DOI Listing
November 2018

Validation of a new study skills scale to provide an explanation for depressive symptoms among medical students.

PLoS One 2018 25;13(6):e0199037. Epub 2018 Jun 25.

Department of Educational Development and Research Maastricht University, Maastricht, the Netherlands.

Background: Medical students are faced with enormous academic demands that may influence their emotional wellbeing. The high rate of depression among medical students and its negative impact is an impetus to find explanation for the factors associated with it. Study skills that students possess might be such a factor. The current tools for the assessment of the study skills may have certain limitations, particularly for different cultural settings.

Objectives: This study aimed to develop and validate a Study Skills Inventory (SSI), and to investigate the relationship between the students' study skills and the extent (severity) of depressive symptoms, measured using the validated tool.

Method: The first version of the SSI was developed through expert consensus. The inventory was then administered to a randomly selected group of medical students. Confirmatory factor analysis was conducted for the internal validity. External validation was conducted by comparing the results of the SSI with the "Approaches and Study Skills Inventory for Students" (ASSIST). After validation, the correlation between the SSI total score with the Beck Depression Inventory II (BDI-II) total score was investigated using the Pearson correlation coefficient. The means of the total study skills scores for each severity category of depression were compared using ANOVA.

Results: A total of 23 items, representing five sub-scales, were included in the inventory. Based on 372 student responses (response rate of 93%), the five-factor solution explained a cumulative variance of 52% and Cronach alpha was 0.84. The SSI total score had a significant negative association with the BDI-II depression score (Pearson correlation of -.348** and P<0.0001).

Conclusion: This study showed evidence for acceptable reliability and validity of the newly developed SSI. Poor study skills were found to correlate with higher depressive symptoms. This association needs confirmation in future research and could open a new door for better understanding of student depression.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199037PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016898PMC
January 2019

The pattern of social media use and its association with academic performance among medical students.

Med Teach 2018 09 6;40(sup1):S77-S82. Epub 2018 May 6.

a KSU Chair for Medical Education Research and Development, Department of Family and Community Medicine, College of Medicine , King Saud University , Riyadh , Saudi Arabia.

Background: There are concerns that the use of social media (SM) among medical students could affect academic performance. The objectives of the study were to investigate the pattern and reasons for SM use and their association with academic performance.

Methods: A stratified random sample, frequency distribution and comparison of categorical variables with Chi-square and Fisher exact tests were used.

Results: Of the 97% who responded, 98% used SM. The most popular were Whatsapp (87.8%), You tube (60.8%) and Twitter (51.8%) for general use; while You tube (83.5%), Whatsapp (35.5%) and Twitter (35.3%) for learning. For general use, there was a significant higher number of visits to You tube and Facebook among male students, while the reverse was true for Instagram and Path. Around 71% visited SM >4 times/day and 55% spent 1-4 hours/day. The main reasons for SM use were entertainment (95.8%), staying up-to-date with news (88.3%), and socializing (85.5%); for academic studies (40%). There was no significant association between Grade Point Average and the frequency of daily SM use or use during lectures.

Conclusions: While almost all the students used SM, only a minority used them for academic purposes. SM use was not associated with academic performance.
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http://dx.doi.org/10.1080/0142159X.2018.1465536DOI Listing
September 2018

Health-related quality of life in congenital heart disease surgery patients in Pakistan: protocol for a mixed-methods study.

BMJ Open 2017 Oct 30;7(10):e018046. Epub 2017 Oct 30.

Charles Perkins Centre, Faculty of Nursing, The University of Sydney, Camperdown, New South Wales, Australia.

Introduction: Reduced health-related quality of life (HRQOL) has been reported in postoperative patients with congenital heart disease (CHD). However, there is a paucity of data from low-income and middle-income countries (LMIC). Differences in sociodemographics and sociocultural contexts may influence HRQOL. This protocol paper describes a study exploring HRQOL in surgical patients with CHD from a tertiary hospital in Pakistan. The study findings will assist development of strategies to improve HRQOL in a resource-constrained context.

Methods And Analysis: This prospective, concurrent triangulation, mixed-methods study aims to compare HRQOL of postsurgery patients with CHD with age-matched healthy siblings and to identify HRQOL predictors. A qualitative component aims to further understand HRQOL data by exploring the experiences related to CHD surgery for patients and parents. Participants include patients with CHD (a minimum of n~95) with at least 1-year postsurgery follow-up and no chromosomal abnormality, their parents and age-matched, healthy siblings. PedsQL 4.0 Generic Core Scales, PedsQL Cognitive Functioning Scale and PedsQL 3.0 Cardiac Module will measure HRQOL. Clinical/surgical data will be retrieved from patients' medical files. Student's t-test will be used to compare the difference in the means of HRQOL between CHD and siblings. Multiple regression will identify HRQOL predictors. A subsample of enrolled patients (n~20) and parents (n~20) from the quantitative arm will be engaged in semistructured qualitative interviews, which will be analysed using directed content analysis. Anticipated challenges include patient recruitment due to irregular follow-up compliance. Translation of data collection tools to the Urdu language and back-translation of interviews increases the study complexity.

Ethics And Dissemination: Ethics approval has been obtained from The Aga Khan University, Pakistan (3737-Ped-ERC-15). Study findings will be published in peer-reviewed journals and presented at national and international conferences.
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http://dx.doi.org/10.1136/bmjopen-2017-018046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5665301PMC
October 2017
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