Physical Examination Of Arteriovenous Fistula: A Basic Approach In AV Fistula Stenosis Detection

Objectives: To determine the accuracy and equivalence of physical examination, MDCTA and Doppler ultrasound in detection of arteriovenous fistula (AVF) stenosis. Materials and Methods: We conducted a pilot study in hemodialysis department of PNS Shifa withprospective diagnostic cohort design on 15 patients, referred for evaluation of arteriovenous fistuladysfunction. Physical examination of arteriovenous fistula was done followed by Doppler ultrasound and MDCTangiography.The results of each patient was recorded and sealed. Data analyzed byCohen's Kappa, which determined the level of agreement between the diagnosis made by Physical examination, MDCTangiography and Doppler ultrasound . Results: There was significant agreement in AVF stenosis detection made by physical examination and MDCTangiography (K: 0.865 for inflow stenosis and K: 0.602 for outflow stenosis).Whereas moderate level of agreement was observed between physical examination and Doppler ultrasound (K: 0.471 for inflow stenosis, K: 0.444 for outflow stenosis). Fair agreement existed between MDCTA and Doppler ultrasound in outflow stenosis detection. Conclusion: Physical examination is accurate and equivalent in AVF stenosis detection when compared with MDCTangiography and superior in stenosis detection when compared with Doppler ultrasound in our hospital. Doppler Ultrasound is inferior to MDCTA in diagnosis of outflow stenosi

Overcoming Vaccine Skepticism in Pakistan: A Cross-Sectional Study of Public Knowledge, Attitudes, and Behaviors towards COVID-19 Vaccination

This study examines the knowledge, attitudes, and perspectives of the public towards COVID-19 immunization in Pakistan. A cross-sectional survey was conducted using a well-structured questionnaire and distributed through internet means. The results showed that socio-economic variables such as age, gender, education level, and wealth are essential predictors of vaccination uptake. Highly educated, wealthy, and urban residents have a positive attitude towards vaccination. The media plays a critical role in distributing information and shaping attitudes. Effective communication and availability of information also significantly contribute to illness susceptibility and prevention behavior. The study suggests that the government and healthcare system can improve public awareness and adopt preventive behavior to combat the COVID-19 pandemic

Production of pyrazine flavours by mycelial fungi

An overview of the flavour and fragrance industry has indicated that there is a great demand for flavours to have the natural, halaal and kosher status. This has opened the door for the increase in production of flavours by microbial means. Particularly with regards to pyrazine production, bacterial species such as Bacillus are commonly used. Although previous literature indicated that fungi are not as prominent pyrazine producers compared to bacteria, this study has indicated that mycelial fungi can be considered for the production of natural pyrazine flavours. Out of the 280 fungi screened, 45% showed pyrazine flavour production as indicated in chapter 2. This chapter also showed that the content of growth media can have a substantial influence on flavour production. For example, fungi grown in Cz-medium produced more of the caramel and chocolate flavours, compared to fungi that were grown in TSB, which produced more of the nutty, meaty and potato flavours. The green flavour was, however, prominent in both media, of which mostly members of the Aspergillus and Penicillium groups produced this flavour. Selected Penicillium species, including Penicillium rubrum and P. purpurogenum produced a green pepper odour that is indicative of the presence of methoxypyrazine. Chemical analytical methods as described in chapter 3 confirmed that Penicillium purpurogenum produced 2-methoxy-3-isobutylpyrazine (MIBP) and Penicillium rubrum produced both 2-methoxy-3-isobutylpyrazine (MIBP) and 2-methoxy-3,5/6-isopropylpyrazine (MIPP). Methoxypyrazines are high impact aroma chemicals that have a typical green pepper odour and a high market value. Due to the favourable characteristics of the Penicillium species in industrial fermentation processes (such as mass spore production and rapid colonization of substrates) and their ability to produce high value compounds, these fungi were selected for further studies. In order to explore the potential use of these fungi in an industrial application, the methoxypyrazines produced were quantified. Prior to quantitation, a solvent extraction method, using dichloromethane, was developed. Amongst the different pH parameters analysed acidified conditions showed the best results, where 69% MIPP and 97% MIBP were recovered from the liquid-liquid extraction and 76% MIPP and 99% MIBP were recovered from the solid-liquid extraction. Pyrazines quantified from the liquid-liquid extractions indicated that Penicillium rubrum produced 0.38 μg MIPP.L-1 and 0.88 μg MIBP.L-1, and Penicillium purpurogenum produced 0.88 μg MIPP.L-1 and 2.15 μg MIBP.L-1 (Chapter 4). Yields obtained from this study were not seen as feasible for the production of methoxypyrazines by the fungi on an industrial scale and, therefore, solid state fermentation was investigated as an option to improve the yields. Due to the availability of soy press cake as a by-product, as well as the variety of the amino acids present, it was selected as a possible substrate for pyrazine production. The results from this study, however, indicated that the nature of the substrate, such as the lipid content, fungal content and particle size of the soy press cake does not support fungal growth and makes pyrazine analyses problematic. Alternate methods of improving methoxypyrazine yields thus need to be found. A limiting factor is the lack of understanding of the metabolic pathway involved in pyrazine production by Penicillium species. By having this knowledge the fermentation process can be adapted accordingly for the optimal production of methoxypyrazines by these microorganisms. Additionally, substrates that contain the necessary precursors that are cost effective would contribute significantly in the development of an economically viable fermentation process for the production of methoxypyrazines by Penicillium species.Dissertation (MSc)--University of Pretoria, 2010.Microbiology and Plant Pathologyunrestricte

Hábitos e costumes da comunidade muçulmana de Lisboa quanto à saúde e ao tratamento de doenças

Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2020, Universidade de Lisboa, Faculdade de Farmácia.Objetivo: Este estudo tem como objetivo contribuir para caracterizar os comportamentos e atitudes na saúde e na doença da população muçulmana que vive em Portugal, em função dos costumes ensinados pelo Islão. Pretende-se estudar em particular a adoção das opções terapêuticas propostas pela religião islâmica e a interação com os cuidados de saúde prescritos pela medicina ocidental para que haja uma melhor interação entre os utentes e farmacêuticos. Métodos: Este estudo segue um desenho transversal e descritivo. Foi elaborado um inquérito dirigido aos professantes da fé muçulmana, para caracterizar alguns dos hábitos e costumes da comunidade muçulmana quanto à saúde e ao tratamento das doenças. Cerca de 100 muçulmanos receberam o convite para participar entre 1 de março de 2019 e 30 de setembro de 2019, após aprovação ética do estudo pelo líder espiritual e responsável legal da comunidade (Sheik Munir) que informou a comunidade e convidou à participação. O estudo seguiu todas as regras de boa prática da investigação que envolve dados pessoais, sendo totalmente anónimo e voluntário. O inquérito foi primeiramente testado pela equipa de investigação e colaboradores e seguidamente foi sujeito a um ensaio piloto constituído por 10 indivíduos da população interesse. Resultados: Em termos de prática religiosa, a amostra observou os princípios fundamentais de seguir os ditames, Alcorão e jejuns. 60,3% dos entrevistados revelaram associar a recitação de versículos ao tratamento médico, enquanto 49,3% associam os versículos a opções de medicina alternativa. De entre as limitações do Alcorão quanto à ingestão de determinadas substâncias, 61,9% dos entrevistados referiram não tomar cápsulas de gelatina e 82,9% medicamentos com álcool na sua composição. O mandamento de não jejuar em caso de doença crônica foi seguido por 67,2%. O produto usado com mais frequência foi o mel, principalmente para dor de garganta, seguido por água de Zam-Zam e azeite, ambos contribuindo para uma boa saúde geral. Conclusão: Os muçulmanos têm por norma utilizar a medicina profética associada à medicina ocidental: acreditam que a sinergia destas duas poderá trazer melhores resultados para a saúde. Os versículos mais recitados foram o 1:1 e o 2:255, indicados para a proteção da saúde em geral. Os medicamentos contendo álcool e gelatina de origem animal são evitados. Os jejuns do mês do Ramadão não são cumpridos na maior parte dos portadores de doenças crónicas. Os produtos mais consumidos pelos respondentes, como produtos que trazem benefícios para a saúde foram o mel, a água de Zam-Zam (sendo esta mais consumida por representantes do sexo feminino), o azeite de oliveira e o cardo mariano.Objectives: This study aims to contribute to characterize the health and illness behaviors and attitudes of the Muslim population living in Portugal, according to the customs taught by Islam. It is intended to study in particular the adoption of the therapeutic options proposed by the Islamic religion and the interaction with healthcare prescribed by Western medicine so that there is a better interaction between users and pharmacists. Methods: This study follows a cross-sectional and descriptive design. A survey was carried out aimed at adherents of the Muslim faith, to characterize some of the habits and customs of the Muslim community regarding health and treatment of diseases. About 100 Muslims were invited to participate between March 1, 2019 and September 30, 2019, after ethical approval of the study by the spiritual leader and legal guardian of the community (Sheik Munir) who informed the community and invited them to participate. The study followed all the rules of good practice in the investigation involving personal data, being completely anonymous and voluntary. The survey was first tested by the research team and collaborators and then subjected to a pilot trial consisting of 10 individuals from the population of interest. Results: In terms of religious practice, the sample observed the fundamental principles of following the dictates, Qur'an and fasts. 60.3% of the interviewees revealed that they associated the recitation of verses with medical treatment, while 49.3% associated the verses with alternative medicine options. Among the limitations of the Qur'an regarding the ingestion of certain substances, 61.9% of the interviewees reported not taking gelatin capsules and 82.9% medicines with alcohol in their composition. The commandment not to fast in case of chronic illness was followed by 67.2%. The most frequently used product was honey, mainly for sore throat, followed by Zam-Zam water and olive oil, both of which contribute to overall good health. Conclusion: Muslims usually use prophetic medicine associated with Western medicine: they believe that the synergy of these two could bring better health results. The most recited verses were 1: 1 and 2: 255, indicated for the protection of health in general. Medicines containing alcohol and gelatin of animal origin are avoided. Ramadan fasts are not fulfilled in most people with chronic diseases. The products most consumed by the respondents, as products that bring health benefits were honey, water from Zam-Zam (this being most consumed by female representatives), olive oil and marian thistle

Permasalahan Kuomintang dalam politik China, 1911-1949: satu tinjauan umum

China pada awal dan pertengahan abad ke-20 mengalami pelbagai masalah yang mengancam kedaulatannya. Dinasti Qing gagal memerintah China dengan baik telah disingkirkan oleh pihak nasionalis yang kemudiannya menubuhkan Kuomintang (KMT). KMT juga menghadapi masalah besar untuk memulihkan masalah di China. Yuan Shih Kai yang diharap memimpin China dengan baik gagal berbuat demikian dan telah mengkhianati perjuangan KMT. Kematian Yuan Shih Kai membawa masalah besar apabila China berpecah berdasarkan penguasaan panglima perang. Dengan pertolongan Soviet Union, KMT telah berjaya menyatukan China pada tahun 1928. Walaupun berjaya berkuasa di China tetapi KMT masih mempunyai masalah besar. Panglima Perang masih lagi tidak menunjukkan taat setia yang kuat kepada KMT. Manakala hubungan KMT dan komunis mula rengang pada pertengahan tahun 1920an. Hal ini mewujudkan masalah antara mereka sehingga KMT berusaha melenyapkan komunis di China. Pencerobohan tentera Jepun pada tahun 1930an membawa masalah KMT semakin rumit. Walaupun mendapat sokongan Soviet Union dan Amerika Syarikat dalam melawan Jepun tetapi KMT gagal menangani kemaraan Jepun. Tamatnya perang tidak menamatkan masalah KMT. KMT terpaksa pula berhadapan dengan masalah lama iaitu komunis. Masalah antara kedua-dua pihak ini berterusan sehingga tamatnya Perang Dunia Kedua. Akhirnya KMT gagal menpertahankan China apabila ditewaskan oleh pihak komunis pada tahun 1949

Exploration of Mental Health and Well-Being of Healthcare Professionals During the COVID-19 Pandemic

Introduction In response to curbing the spread of SARS-CoV-2, healthcare professionals (HCPs) encounter a multitude of mental stresses. The primary intent was to explore the mental health and well-being experienced by HCPs in Ekiti State, Nigeria, amid the COVID-19 pandemic. Methods Data were analyzed using inductive qualitative methodology. The study was undertaken among HCPs in two teaching hospitals in Ekiti State during the SARS-CoV-2 outbreak. Convenience sampling techniques were employed to select participants for this study. A comprehensive interview ranging from 30 to 50 minutes per participant was administered to a sample of 14 HCPs (doctors and nurses) representing various departments within the hospital. The interviews were conducted between March 2020 and May 2020. COVID-19 stressful situations, the physiological consequences of stress, personality, disposition, stress management techniques, and coping mechanisms were evaluated. Results The study outcomes indicate that a significant proportion of HCPs currently face mental well-being. The primary sources of stress identified in this study included heavy workloads and pressure from social media platforms and government agencies. The outbreak crisis significantly influenced on their lives and work, with the fear of catching diseases and their anxiety about spreading infections to their loved ones. Conclusions HCPs require a secure working environment during the current circumstances, along with an enhanced support system to alleviate stressors. This study contributes to a significant proportion of HCPs currently facing stress

Population Reference Ranges of Urinary Endogenous Sulfate Steroids Concentrations and Ratios as Complement to the Steroid Profile in Sports Antidoping

The population based Steroid Profile (SP) ratio of testosterone (T) and epitestosterone (E) has been considered as a biomarker approach to detect testosterone abuse in '80s. The contemporary Antidoping Laboratories apply the World Antidoping Agency (WADA) Technical Document (TD) for Endogenous Androgenic Anabolic Steroids (EAAS) in the analysis of SP during their screening. The SP Athlete Biological Passport (ABP) adaptive model uses the concentrations of the total of free and glucuronide conjugated forms of six EAASs concentrations and ratios measured by GC/MS. In the Antidoping Lab Qatar (ADLQ), the routine LC/MS screening method was used to quantitatively estimate the sulfate conjugated EAAS in the same analytical run as for the rest qualitative analytes. Seven sulfate EAAS were quantified for a number of routine antidoping male and female urine samples during screening. Concentrations, statistical parameters and selected ratios for the 6 EAAS, the 6 sulfate EAAS and 29 proposed ratios of concentrations from both EAAS and sulfate EAAS, which potentially used as SP ABP biomarkers, population reference limits and distributions have been estimated after the GC/MSMS analysis for EAAS and LC/Orbitrap/MS analysis for sulfate EAAS

A comprehensive perspective of traditional Arabic or Islamic medicinal plants as an adjuvant therapy against COVID-19

COVID-19 is a pulmonary disease caused by SARS-CoV-2. More than 200 million individuals are infected by this globally. Pyrexia, coughing, shortness of breath, headaches, diarrhoea, sore throats, and body aches are among the typical symptoms of COVID-19. The virus enters into the host body by interacting with the ACE2 receptor. Despite many SARS-CoV-2 vaccines manufactured by distinct strategies but any evidence-based particular medication to combat COVID-19 is not available yet. However, further research is required to determine the safety and effectiveness profile of the present therapeutic approaches. In this study, we provide a summary of Traditional Arabic or Islamic medicinal (TAIM) plants’ historical use and their present role as adjuvant therapy for COVID-19. Herein, six medicinal plants Aloe barbadensis Miller, Olea europaea, Trigonella foenum-graecum, Nigella sativa, Cassia angustifolia, and Ficus carica have been studied based upon their pharmacological activities against viral infections. These plants include phytochemicals that have antiviral, immunomodulatory, antiasthmatic, antipyretic, and antitussive properties. These bioactive substances could be employed to control symptoms and enhance the development of a possible COVID-19 medicinal synthesis. To determine whether or if these TAIMs may be used as adjuvant therapy and are appropriate, a detailed evaluation is advised

Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18 : a modelling study

Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2 ·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676· 5 (513· 6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81· 1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas