Two Weeks of Ischemic Conditioning Improves Walking Speed and Reduces Neuromuscular Fatigability in Chronic Stroke Survivors

This pilot study examined whether ischemic conditioning (IC), a noninvasive, cost-effective, and easy-to-administer intervention, could improve gait speed and paretic leg muscle function in stroke survivors. We hypothesized that 2 wk of IC training would increase self-selected walking speed, increase paretic muscle strength, and reduce neuromuscular fatigability in chronic stroke survivors. Twenty-two chronic stroke survivors received either IC or IC Sham on their paretic leg every other day for 2 wk (7 total sessions). IC involved 5-min bouts of ischemia, repeated five times, using a cuff inflated to 225 mmHg on the paretic thigh. For IC Sham, the cuff inflation pressure was 10 mmHg. Self-selected walking speed was assessed using the 10-m walk test, and paretic leg knee extensor strength and fatigability were assessed using a Biodex dynamometer. Self-selected walking speed increased in the IC group (0.86 ± 0.21 m/s pretest vs. 1.04 ± 0.22 m/s posttest, means ± SD; P\u3c 0.001) but not in the IC Sham group (0.92 ± 0.47 m/s pretest vs. 0.96 ± 0.46 m/s posttest; P= 0.25). Paretic leg maximum voluntary contractions were unchanged in both groups (103 ± 57 N·m pre-IC vs. 109 ± 65 N·m post-IC; 103 ± 59 N·m pre-IC Sham vs. 108 ± 67 N·m post-IC Sham; P = 0.81); however, participants in the IC group maintained a submaximal isometric contraction longer than participants in the IC Sham group (278 ± 163 s pre-IC vs. 496 ± 313 s post-IC, P = 0.004; 397 ± 203 s pre-IC Sham vs. 355 ± 195 s post-IC Sham; P = 0.46). The results from this pilot study thus indicate that IC training has the potential to improve walking speed and paretic muscle fatigue resistance poststroke

Mashallah…; may Allah bless you: the sociopragmatics of giving and responding to compliments in the Hijazi Saudi dialect

This thesis investigates the influence which sociocultural values and norms can have on performing compliment exchanges in the Hijazi Saudi dialect and show whether aspects of compliment exchanges can be correlated with social variables such as gender, age and relationship. Using the field observation method and a note-taking tool, data based on real-life interactions were gathered from various social settings in Jeddah city in the Kingdom of Saudi Arabia. A database of 390 compliments and 482 compliment responses was compiled and classified in terms of gender, age and relationship. Compliments were investigated in terms of compliment topics, syntactic patterns, directness and indirectness, and the sociocultural phraseologies used in giving compliments. Responses were categorized in terms of response strategies and their correlations with gender, age and relationship. The examination of 390 compliments showed that compliments occurred far more frequently in same-gender exchanges than in cross-gender exchanges. Appearance was the most frequent topic over all on which Hijazi people gave compliments. Appearance was the most frequent topic used by females, whereas performance/skill was the most frequent topic for the males. The young group also tended to focus on the appearance topic, while performance/skill was the most frequent topic for the middle-aged and elder groups. (Mashallah) (ADV) (INT) NP (INT) ADJ (mashallah) was the most common syntactic pattern used among Hijazi people in giving compliments. Ijnan ‘stunning’, raw’ah/rai’a ‘wonderful’, ti’aim ‘tasty’, lazeez ‘delicious’, wala ghaltah ‘flawless’, and fakhmah ‘fancy’ were the most common adjectives used in the dataset. Intensifiers such as merrah ‘very’, haqiqi ‘really’ and harfyean ‘literally’ were top words used most frequently in giving compliments. Moreover, the findings showed that Hijazi people used explicit (direct) compliments more frequently than implicit (indirect) compliments. Mashallah, ‘may Allah’s grace be upon you’, allahuma salli ala a-nabi ‘Allah’s prayers be upon the prophet’, and tabarak allah ‘bless Allah’ tended to be unique markers for Hijazi speakers as the most frequent religious expressions used in giving compliments. Hijazi speakers believe that using such ritualistic phrases will drive the evil eye away and prevent any potential threats to the complimentee’s negative face. The examination of 482 compliment responses showed that appreciation token ranked first as the most frequent response strategy, followed by invocation and blessing. The findings showed that there were other responses which occurred in the Hijazi dialect such as evil-eye (envy) protection and request interpretation. Furthermore, the results revealed that Hijazi speakers used single responses more frequently than complex responses. The Appreciation token + return compliment complex response was on the top preferences, followed by the invocation and blessing + return compliment complex response

Women’s Awareness and Attitude toward Epidural Analgesia

Introduction: Women’s awareness and attitudes toward Epidural Analgesia (EA) are not clearly identified.  The benefits of EA in relieving labor pain are well recognized.  However, women’s preferences in using EA to relieve labor pain differ between cultures. The objective of this study was to assess women’s awareness and attitudes toward EA. Methods: A descriptive correlational cross-sectional design was used to collect data from a convenience sample of 550 women in childbearing age.   Women were interviewed face-to-face after they agreed to participate in the study.  Data were collected from shopping malls, women’s cafeterias, beauty salons and outpatient clinics in Riyadh, KSA. Demographic profiles, knowledge and attitudes of EA questionnaires were used to collect data for the study. Results:  The majority of women were young, married, multigravids, lived in Riyadh, were well educated, unemployed, and had a significant monthly income.  Women reported a good level of knowledge regarding most of the items on the EA questionnaire.  42% reported that they know about EA from family members/relatives and friends, 18% from the media or readings, 13% from previous delivery experience and 8% from brochures at antenatal clinics.  Women’s attitudes toward using EA in future labor were varied since similar percentages agreed, did not agree and weren’t sure about using EA in their future labor.  The reasons for the unclear attitudes were advice from relatives not to use EA, and a desire to experience natural labor pain.  There was a significance moderate correlation between knowledge and parity (r = .40**, p = .000), income (r = .39**, p = .001), education (r = .31**, p = .000), and attitude (r = .31**, .000). Conclusion and recommendations: Although women’s awareness regarding EA was relatively high, their attitude toward using EA in future labor was not clear.  Culturally sensitive educational programs are needed to improve women’s perception and attitude toward using EA in their future labor and to have a satisfactory labor. Keywords: Awareness, attitude, epidural, labor pain, wome

Are semi-automated software program designed for adults accurate for the identification of vertebral fractures in children?

Objectives To assess whether diagnostic accuracy of morphometric vertebral fracture (VF) diagnosis in children can be improved using AVERT™ (a 33-point semi-automated program developed for VF diagnosis in adults) compared with SpineAnalyzer™ (a 6-point program), which has previously been shown to be of insufficient accuracy. Materials and methods Lateral spine radiographs (XR) and dual-energy X-ray absorptiometry (DXA) scans of 50 children and young people were analysed by two observers using two different programs (AVERT™ and SpineAnalyzer™). Diagnostic accuracy (sensitivity, specificity, false-negative (FN) and false-positive rates (FP)) was calculated by comparing with a previously established consensus arrived at by three experienced paediatric musculoskeletal radiologists, using a simplified algorithm-based qualitative scoring system. Observer agreement was calculated using Cohen’s kappa. Results For XR, overall sensitivity, specificity, FP and FN rates using AVERT™ were 36%, 95%, 5% and 64% respectively and 26%, 98%, 2% and 75% respectively, using SpineAnalyzer™. For DXA, overall sensitivity, specificity, FP and FN rates using AVERT™ were 41%, 91%, 9% and 59% respectively and 31%, 96%, 4% and 69% respectively, using SpineAnalyzer. Reliability (kappa) ranged from 0.34 to 0.37 (95%CI, 0.26–0.46) for AVERT™ and from 0.26 to 0.31 (95%CI, 0.16–0.44) for SpineAnalyzer™. Inter- and intra-observer agreement ranged from 0.41 to 0.47 for AVERT™ and from 0.50 to 0.79 for SpineAnalyzer™. Conclusion AVERT™ has slightly higher accuracy but lower observer reliability for the representation of vertebral morphometry in children when compared with SpineAnalyzer™. However, neither software program is satisfactorily reliable for VF diagnosis in children

Are semi-automated software program designed for adults accurate for the identification of vertebral fractures in children?

Objectives To assess whether diagnostic accuracy of morphometric vertebral fracture (VF) diagnosis in children can be improved using AVERT™ (a 33-point semi-automated program developed for VF diagnosis in adults) compared with SpineAnalyzer™ (a 6-point program), which has previously been shown to be of insufficient accuracy. Materials and methods Lateral spine radiographs (XR) and dual-energy X-ray absorptiometry (DXA) scans of 50 children and young people were analysed by two observers using two different programs (AVERT™ and SpineAnalyzer™). Diagnostic accuracy (sensitivity, specificity, false-negative (FN) and false-positive rates (FP)) was calculated by comparing with a previously established consensus arrived at by three experienced paediatric musculoskeletal radiologists, using a simplified algorithm-based qualitative scoring system. Observer agreement was calculated using Cohen’s kappa. Results For XR, overall sensitivity, specificity, FP and FN rates using AVERT™ were 36%, 95%, 5% and 64% respectively and 26%, 98%, 2% and 75% respectively, using SpineAnalyzer™. For DXA, overall sensitivity, specificity, FP and FN rates using AVERT™ were 41%, 91%, 9% and 59% respectively and 31%, 96%, 4% and 69% respectively, using SpineAnalyzer. Reliability (kappa) ranged from 0.34 to 0.37 (95%CI, 0.26–0.46) for AVERT™ and from 0.26 to 0.31 (95%CI, 0.16–0.44) for SpineAnalyzer™. Inter- and intra-observer agreement ranged from 0.41 to 0.47 for AVERT™ and from 0.50 to 0.79 for SpineAnalyzer™. Conclusion AVERT™ has slightly higher accuracy but lower observer reliability for the representation of vertebral morphometry in children when compared with SpineAnalyzer™. However, neither software program is satisfactorily reliable for VF diagnosis in children

Alpha-amylase and alpha-glucosidase enzyme inhibition and antioxidant potential of 3-oxolupenal and katononic acid isolated from Nuxia oppositifolia

Nuxia oppositifolia is traditionally used in diabetes treatment in many Arabian countries; however, scientific evidence is lacking. Hence, the present study explored the antidiabetic and antioxidant activities of the plant extracts and their purified compounds. The methanolic crude extract of N. oppositifolia was partitioned using a two-solvent system. The n-hexane fraction was purified by silica gel column chromatography to yield several compounds including katononic acid and 3-oxolupenal. Antidiabetic activities were assessed by α-amylase and α-glucosidase enzyme inhibition. Antioxidant capacities were examined by 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2′-azino-bis(3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) scavenging assays. Further, the interaction between enzymes (α-amylase and α-glucosidase) and ligands (3-oxolupenal and katononic acid) was followed by fluorescence quenching and molecular docking studies. 3-oxolupenal and katononic acid showed IC50 values of 46.2 µg/mL (101.6 µM) and 52.4 µg/mL (119.3 µM), respectively against the amylase inhibition. 3-oxolupenal (62.3 µg/mL or 141.9 µM) exhibited more potent inhibition against α-glucosidases compared to katononic acid (88.6 µg/mL or 194.8 µM). In terms of antioxidant activity, the relatively polar crude extract and n-butanol fraction showed the greatest DPPH and ABTS scavenging activity. However, the antioxidant activities of the purified compounds were in the low to moderate range. Molecular docking studies confirmed that 3-oxolupenal and katononic acid interacted strongly with the active site residues of both α-amylase and α-glucosidase. Fluorescence quenching results also suggest that 3-oxolupenal and katononic acid have a good affinity towards both α-amylase and α-glucosidase enzymes. This study provides preliminary data for the plant’s use in the treatment of type 2 diabetes mellitus

The co-existence of NAFLD and CHB is associated with suboptimal viral and biochemical response to CHB antiviral therapy: a systematic review and meta-analysis

Background and aimsChronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD) are leading causes of liver-related morbidity and mortality. The interaction between these two disease processes is poorly defined and the impact of NAFLD on HBV-related cirrhosis and HCC remains unclear. The aim of this study was to evaluate the impact of NAFLD on response to antiviral CHB therapy to inform the debate on changing CHB treatment thresholds for these comorbid patients.MethodsStudies with a minimum of 50 adult CHB patients on nucleoside analogue therapy with or without concurrent NAFLD were identified from PubMed/Medline and EMBASE to February 21, 2023. Data extraction from each study included HBeAg and treatment status, diagnostic method of NAFLD, frequency of monitoring intervals, patient age, gender, grade of hepatic steatosis, BMI and metabolic comorbidities. The outcomes of interest, complete virological response (CVR), biochemical response (BR) and HBeAg loss/seroconversion, were recorded at each available monitoring interval. Comparing CHB-NAFLD and CHB-only groups, pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using random- or fixed-effects models depending on heterogeneity.ResultsFrom a search of 470 citations, we identified 32 potentially relevant papers. Overall, 11 studies, comprising 2580 unique patients, met the inclusion criteria of the meta-analysis. CHB-NAFLD patients exhibited significantly lower rates of CVR compared to CHB-only patients. This was demonstrated by an OR of 0.59 (0.38-0.93, p=0.001, I2 = 72%) at 12 months, which tapered off to an OR of 0.67 (0.48-0.95, p=0.02) at 60 months. CHB-NAFLD patients also exhibited significantly lower rates of BR compared to CHB-only patients, as demonstrated by ORs of 0.39 (0.24-0.62, p<0.0001, I2 = 53%) at 12 months and 0.33 (0.17-0.63, p=0.0008) at 24 months.ConclusionPatients with concurrent CHB and NAFLD experience delayed CVR to antiviral therapy and more persistent biochemical abnormalities in comparison to patients with CHB only. This supports the argument for earlier antiviral therapy in order to avert CHB complications in these multi-morbid patients, as the global disease burden of NAFLD continues to increase

Exploring barriers to and facilitators of preventive measures against infectious diseases among Australian Hajj pilgrims: cross-sectional studies before and after Hajj

Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Objective For reasons that have yet to be elucidated, the uptake of preventive measures against infectious diseases by Hajj pilgrims is variable. The aim of this study was to identify the preventive advice and interventions received by Australian pilgrims before Hajj, and the barriers to and facilitators of their use during Hajj. Methods Two cross-sectional surveys of Australians pilgrims aged ≥18 years were undertaken, one before and one after the Hajj 2014. Results Of 356 pilgrims who completed the survey (response rate 94%), 80% had the influenza vaccine, 30% the pneumococcal vaccine, and 30% the pertussis vaccine. Concern about contracting disease at Hajj was the most cited reason for vaccination (73.4%), and not being aware of vaccine availability was the main reason for non-receipt (56%). Those who obtained pre-travel advice were twice as likely to be vaccinated as those who did not seek advice. Of 150 pilgrims surveyed upon return, 94% reported practicing hand hygiene during Hajj, citing ease of use (67%) and belief in its effectiveness (62.4%) as the main reasons for compliance; university education was a significant predictor of hand hygiene adherence. Fifty-three percent used facemasks, with breathing discomfort (76%) and a feeling of suffocation (40%) being the main obstacles to compliance. Conclusion This study indicates that there are significant opportunities to improve awareness among Australian Hajj pilgrims about the importance of using preventive health measures

Social and Economic Factors that Influence Health Outcomes in Family Medicine

Over the last twenty years, the social determinants of health (SDOH) have gained more and more attention in the public health community. SDOH are non-medical elements that may be significantly impacted by social policies and have an impact on health. The increasing variety that exists within our societies makes it absolutely necessary for us to incorporate into undergraduate medical education social determinants of health such as racial factors, financial instability, partner violence, insufficient accessibility to transportation, and inadequate social supports, as well as the crucial role of health education.  Nonetheless, a growing body of research indicates that a variety of health outcomes are fundamentally caused by socioeconomic variables including wealth, income, and education together. In this review we highlight the influence of socio-economic factors on health outcomes, approaches to incorporate social determinants of health in family medicine practice, and we also talk about challenges and solutions in addressing social determinants in family medicine. The objective of this research was to assess the impact of social determinants of health on family medicine practice in which socioeconomic determinants of health might have an effect on health outcomes and healthcare delivery within the context of a family medicine clinical environment

Early Childhood Mathematics Curriculum in the light of the standards of the National Council of Mathematics Teachers

This study aims at exploring the preschool mathematics curriculum in light of the National Council of Teachers of Mathematics Standards. The study researched a sample of (140) preschool educators. An analysis of the mathematical content of preschool Self-Learning curriculum was conducted, and Saudi preschool educators were surveyed, in terms of their educational practices, and the processes used in teaching mathematics in their classes In accordance with the U.S. national standards for mathematicians, it means the methods in which children interact with sports content or content, namely (problem solving- communication- logical thinking - representation - Connection), where the study showed that the reality of the components of the mathematics curriculum applied in kindergartens within Saudi Arabia achieved these standards at these levels was The application of representation, communication and connectivity are the most achieved in the self-learning curriculum units with ratios of (86.4%, 83%, 82%), respectively, while problem-solving and logical thinking have reached the minimum use in the classroom, indicating that these processes are the least interested in application from the sample point of view, with 80%, respectively, using them (80%, 67.80%), despite the critical importance of these two processes specifically in building mathematical concepts as they focus on the ability of the child to be focused on the ability of the child. To use his accumulated sports skills to meet challenges such as predicting and examining hypotheses in order to find a scientific solution to the sports situation