An exploratory study of mobility-related outcome measures and an exercise intervention in people with Huntington's Disease (HD)

Objective: There is emerging evidence that exercise may modify disease progression and improve function in a number of neurodegenerative diseases, but this has not been systematically studied in Huntington.s disease (HD). The purpose of this study was to evaluate feasibility, acceptability and benefits of an exercise programme in people with HD. Methods: Using a randomised controlled trial design, 25 participants with manifest HD were allocated to either intervention (home-based exercise; n=13) or control (usual care;n=12) groups. Participants were assessed at baseline and eight weeks later. Eleven participants from the exercise and 10 from the control group completed the intervention study. The primary outcome was gait variability (stride time coefficient of variation (CV)). Secondary outcomes included other measures of gait, disease-specific motor scale and measures of balance, muscle strength, mobility and community walking, functional performance in ADL and quality of life. These measures were included to reflect a range of physical impairments and activity limitations seen in people with HD. Analysis of covariance was used to compare follow-up scores across groups after adjustment for differences at baseline. Effect sizes were calculated for outcome measures based on differences in change scores between groups. Process interviews were conducted at the end of the study to determine acceptability of the intervention to participants. Cross sectional investigation of outcome measures was undertaken initially to investigate discriminant and concurrent validity as well as test re-test reliability and minimal detectable change (MDC95) along the broad spectrum of the disease. Baseline data from 25 participants with manifest HD (who went on to participate in the intervention), in addition to data from 17 individuals with pre-manifest HD and 25 healthy controls were analysed. This data was of use in interpreting the results from the interventional study. In particular, the MDC95 data helped in determining of whether any statistical significant changes due to the intervention are clinically meaningful. Results: Measures of gait variability, some measures of balance, community walking and measures of functional performance in ADL were able to distinguish between people with manifest HD and pre-manifest HD as well as between people with pre-manifest HD and healthy controls suggesting good discriminant validity. All these outcomes had also good concurrent validity with a disease specific motor score. The test re-tests reliability scores for the majority of the outcomes were high and the MDC95 scores were low, suggesting that the individual variability on these outcomes were low. Adherence rates to the exercise programme were high (78.8% of participants reported completion of at least 78% of the prescribed sessions). Participants in the intervention group demonstrated significant improvement in stride time CV (95% CI (-11.5, -0.6))based on complete case analysis. Significant differences between groups were also observed in the disease-specific motor scale and in measures of balance, mobility,community walking and functional performance in ADL, but not muscle strength and health-related quality of life. Effect sizes were large (>0.8) for the majority of the outcomes. The magnitude of the change as a result of the exercise intervention exceeded the calculated MDC95 values for some of the outcomes, which suggest that most of the observed changes are clinically meaningful. Qualitative feedback from the participants who completed the exercise programme suggested high levels of acceptability with positive impact on general health and mobility. Participants identified barriers and facilitators that affected performing the exercises at home and described management strategies that helped adherence to the exercise programme. Conclusions: This study was the first systematic trial to demonstrate that a short-term structured exercise programme is acceptable and can be safely delivered in a home environment; achieve good adherence; and positively affect body function and activity in people with HD. The sensitivity of the outcomes as determined in the cross-sectional study, to mobility deficits the in pre-manifest HD group is important. These outcomes has the potential to be used in future studies of exercise interventions in the premanifest stage which aim to target such deficits early in the disease life cycle, before they begin to impact on a person.s ability to participate in the community. Overall the data presented from this study provides a platform for further investigations to extend these findings about the role of exercise and physical activity in people with HD. Larger and more detailed studies are needed to replicate findings from this study in othercontexts and variations in dose

أثر الشمول المالي على النمو الاقتصادي في سورية

 يهدف هذا البحث إلى اختبار أثر الشمول المالي على النمو الاقتصادي في سورية خلال الفترة الممتدة من عام 2003 حتى عام 2017. تم قياس الشمول المالي بنمو عدد فروع البنوك التجاريَّة العامة والخاصة وعدد شركات التأمين العامة والخاصة كمؤشرات لوصول الأفراد إلى الخدمات الماليَّة، ونمو حجم القروض لدى البنوك التجاريَّة وحجم الودائع لدى البنوك التجاريَّة كمؤشرات لاستخدام الأفراد للخدمات الماليَّة. كما تمَّ قياس النمو الاقتصادي بنمو الناتج المحلي الإجمالي الحقيقي. ولتحقيق هدف الدراسة تمَّ بدايةً اختبار استقرارية السلاسل الزمنية للمتغيرات المختارة، ومن ثم اختبار وجود علاقة طويلة الأجل بين المتغيرات التفسيرية والمتغير التابع وذلك باستخدام نموذج الانحدار الذاتي للفترات الزمنية الموزعة ((ARDL. وقد أظهرت النتائج أن كل من حجم القروض والودائع لدى البنوك التجارية تؤثر إيجاباً على النمو الاقتصادي في سورية خلال فترة الدراسة. أمَّا عدد شركات التأمين فتؤثر بشكل إيجابي ولكن غير معنوي على النمو الاقتصادي، كما تبين وجود أثر سلبي ولكن غير معنوي  لعدد فروع البنوك التجاريَّة على النمو الاقتصادي في سورية

General wellbeing and work impacts among community pharmacists during crisis management

Background: Community pharmacists are highly accessible for advice, as most pharmacies are open long hours and no appointment is needed. Community pharmacists, as essential community health workers, play a critical role in the fight against coronavirus disease 2019 (COVID-19). This study aimed to determine the general wellbeing and work impacts of pharmacists and the factors important for adaptability and resilience during the COVID-19 pandemic. Methods: This study adopted a cross-sectional design. Community pharmacists from various professional networks in Australia were invited through emails and social media posts to complete an anonymous online survey during the second wave of the COVID-19 pandemic in Victoria, Australia. Results: Sixty-five community pharmacists completed the online survey. The respondents reported fair levels of general wellbeing during the COVID-19 pandemic, with a mean self-related health score of 33.57 (s.d. = 13.19) out of a maximal of 96, despite relatively high levels of job stress and emotional labour. Lower levels of general wellbeing were correlated with higher levels of job stress (r = 0.645, P < 0.01) and emotional labour (r = 0.513, P < 0.01), and lower levels of occupational self-efficacy (r = −0.566, P < 0.01). Leader member exchange was negatively correlated with job stress (r = −0.419, P < 0.01) and positively correlated with psychological safety (r = 0.693, P < 0.01). The linear regression models showed that female pharmacists had lower occupational self-efficacy (β = −0.286, P = 0.024), but higher psychological safety (β = 0.234, P = 0.042). Higher work ability was associated with lower job stress (β = −0.529, P < 0.001), higher occupational self-efficacy (β = 0.511, P = 0.001), and poorer self-related health (β = −0.659, P < 0.001). Conclusions: The findings highlight the importance of a supportive work environment in helping community pharmacists to feel psychologically safe and reduce stress during a crisis

A pilot study of a minimally supervised home exercise and walking program for people with Parkinson’s disease in Jordan

Aim: This study aimed to evaluate the feasibility and cultural considerations of a minimally supervised, home-based exercise program in Jordan. Methods: Quantitative and qualitative approaches were used. Thirty participants were randomly allocated to either an 8-week intervention group (n = 16), or a standard care group (n = 14). The intervention incorporated the home use of an exercise DVD, walking program and initial instructional sessions and weekly phone calls provided by a physiotherapist. Interviews were used to explore feasibility. Unified Parkinson’s disease rating scale (UPDRS-III); balance and walking speed were assessed. Results: The retention rate was 86.7% and mean adherence rate was 77%. Personal and sociocultural barriers of adherence to the exercise program were identified. UPDRS-III at follow-up was lower in the intervention group. Conclusion: A home exercise program was feasible. Sociocultural barriers specific to Arabic culture may affect the uptake of such an intervention in Parkinson’s disease in these countries

BERRY EXTRACTS IMPROVED INFLAMMATORY CYTOKINES, ANTIOXIDANT ENZYME AND SUPPRESSED THE GENE EXPRESSION ALTERATIONS IN DIABETIC RATS

Objective: The present work was conducted to evaluate the ameliorative effect of red berry (Morus rubra) and white berry (Morus alba) extracts in diabetic rats.Methods: Inflammatory biomarkers; tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), transforming growth factor-β (TGF-β), paraoxanase1 (PON1), gene expression of apoptosis and inflammatory related genes were carried out.Results: Treatment of male rats with streptozotocin (STZ) to induce diabetes increased the levels of TNF-α, IL-1β, TGF-β, the apoptosis rates and the alterations of the pro-apoptosis (eotaxin, caspase-1, and caspase-2) and inflammation; nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB1) and allograft inflammatory factor 1 (AIF-1) related genes. While marked reduction in PON1 level was detected in STZ-induced diabetic rats. However, treatment of STZ-exposed rats with red and white berry extracts exhibited noticeable ameliorations in TNF-α, IL-1β, TGF-β levels and PON1 activity as well as low apoptosis rates and decreased the alteration of the pro-apoptosis and inflammatory related genes.Conclusion: Red and white berry extracts exhibited attenuation in antioxidant status, suppressed inflammatory cytokines, apoptosis and the alterations in the apoptosis and inflammatory related genes induced by STZ in male rats

Assessment of level of serum cardiac troponin T in neonates with respiratory distress syndrome

Background: One of the most prevalent reasons for admission to neonatal intensive care units (NICUs) is respiratory distress syndrome (RDs). When myocardial cells are damaged, cardiac troponin I (cTnT) is released as a biomarker of myocardial damage, which is very specific and sensitive.Objective: To determine the level of cTnT in preterm infants who have respiratory distress syndrome as a marker of cardiac dysfunction.Patients and Methods: This study was carried as a case-control trial on forty preterm infants, 20 patients of respiratory distress syndrome at neonatal intensive care unit as a group I, 20 apparently healthy newborns as a control group. Serum cardiac troponin T level sample was taken on the 3rd day of delivery.Results: A statistically significant difference in blood troponin was found between the groups tested, with a negative connection between serum troponin and gestational age, length, and APGAR scores at the first and fifth minutes of life. Respiratory rate and serum troponin were found to have a statistically significant connection. Any one of the echocardiographic measures had a statistically significant positive connection with serum troponin. Serum troponin was able to diagnose respiratory distress syndrome with cutoff ≥ 93.5 ng/mL with the area under the curve, Positive predictive value: 83.33% Positive predictive value: 83.33% Negative predictive value: 100 percent Accuracy: 90%.Conclusion: Cardiac troponin T can be used to detect cardiac dysfunction in ill newborns, especially in centers that do not have in-house echocardiography

HAEMATOCOCCUS PLUVIALIS EXTRACT PROMOTING THE RECOVERY OF MEMORY IMPAIRMENT IN ALZHEIMER'S RATS: ANTI-INFLAMMATORY AND ANTIAPOPTOTIC EFFECTS

ABSTRACTObjective: The present study was conducted to investigate the role of Haematococcus pluvialis extract against oxidative damage, the inflammatory,and apoptotic impacts characterizing the neurodegenerative disorders.Methods: Oxidative stress, B-cell lymphoma 2, brain-derived neurotrophic factor, the inflammation, apoptotic and antiapoptotic impacts in Alzheimer'sdisease (AD) rats were determined through assessment of glutathione reduced (GSH), GSH peroxidase (GPx), lipid peroxide (malondialdehyde), thecytokines level such as tumor necrosis factor-alpha (TNF-α), interleukins (IL-6 and IL-1β), and macrophage inflammation protein (MIP1α) in AD rats.Moreover, the expression of phosphoinositide 3-kinase (PI3K) and serine-threonine protein kinase (Akt) genes regulating the apoptosis in AD ratswas measured.Results: The results revealed that levels of TNF-α, IL-6, IL-1β, and MIP1α were significantly increased in AD rats. Moreover, the expression of PI3Kand Akt genes was downregulated which it was coincided with the increase of apoptosis in AD rats. On the other hand, treatment of AD rats withH. pluvialis extract decreased the oxidative stress of AD in the form of prevention the inflammatory and apoptotic impacts.Conclusion: H. pluvialis could be used for ameliorating AD due to its role in decreases the oxidative stress of AD in the form of prevention theinflammatory and apoptotic impacts. H. pluvialis is a very attractive candidate for uses against neurodegenerative disorders that are caused byincreases oxidative stress inducing neuroinflammation and apoptosis.Keywords: Haematococcus pluvialis, Oxidative stress, Inflammation biomarkers, Apoptotic and antiapoptotic impacts

ANTINEURODEGENERATIVE ACTIVITY OF MICROALGAE DUNALIELLA SALINA IN RATS WITH ALZHEIMER'S DISEASE

Objective: The present study is aimed to investigate the promising action of Dunaliella salina extract as a natural protector against Alzheimer's disease (AD) and reported to possess a variety of activities, including antioxidant effects due to its ability to create large amount of carotenoids.Methods: D. salina is a type of halophile green microalgae was used in the present study. 50 male rats were used in this study, where aluminum chloride was orally administered to induce AD in a dose of 100 mg/kg, daily for 6 weeks. Al-intoxicated rats treated orally daily with D. salina ethanolic extract for 6 weeks in a dose of 150 mg/kg b.wt., whereas standard anti-Alzheimer drug donepezil tartrate was administered at the dose of 10 mg/kg b.wt./day for 6 consecutive weeks. The anti-Alzheimer properties of D. salina extract were achieved through measuring the calmodulin (CaM) level, paraoxonase 1 (PON1) activity, the antiapoptotic marker (Bcl2), brain-derived neurotrophic factor (BDNF), the generation of the DNA adducts (8-hydroxy-2-deoxyguanosine [8-OHdG]/2-deoxy guanosine [2-dG]), and alteration in the expression of amyloid precursor protein, β-site APP-cleaving enzyme 1 (BACE1), and β-site APP-cleaving enzyme 2 (BACE2) in AD rats.Results: The current results demonstrated that supplementation of AD rats with D. salina extract-enhanced CaM level, and increased PON1 activity, upregulated Bcl2 and BDNF, decreased the levels of DNA adducts (8-OHdG/2-dG), and suppressed the alterations of the expression levels of APP, BACE1, and BACE2-m RNAs as compared with those in AD rats.Conclusion: It could be concluded that the biological activity of D. salina extract might be regulated by 9-cis b-carotene protecting the brain cells from the oxidative stress in AD rats.Keywords: Dunaliella salina, Calmodulin, Paraoxonase 1, Bcl2, Brain-derived neurotrophic factor, Alzheimer's disease, DNA adduct, Amyloid precursor protein