Does walking protect against decline in cognitive functioning among breast cancer patients undergoing chemotherapy? Results from a small randomised controlled trial

Background Cancer related cognitive impairments have been subjectively reported and objectively detected in breast cancer patients treated with chemotherapy and are known to have a profound negative impact on productivity, psychosocial well-being and overall quality of life. Moderate levels of walking are known to be of benefit to the psychosocial well-being of those affected by breast cancer and for managing cognitive impairment in healthy adults, children, and the elderly. The purpose of this study is to investigate the effects of a home based, self-managed, moderate intensity walking intervention on subjective and objective cognitive functioning in breast cancer patients undergoing chemotherapy. Methods A home-based, self-managed intervention that consisted of moderate levels of walking was compared to usual care among breast cancer patients treated with chemotherapy in a randomised controlled trial. Outcome measures included changes in subjective (CFQ) and objectively detected cognitive functioning (Stroop, SART and two subscales from the WAISDigit Span and Block Design). Fifty participants were randomised to either the intervention group (n = 25), who completed 12 weeks of moderate intensity walking, or to the control group (n = 25) mid-way through chemotherapy. Results Compared with the control group, the self-managed walking intervention had positive effects on perceived cognitive function but not on sustained attention, executive function, memory or visual spatial skills when assessed objectively using neuropsychological measures. Conclusion This home-based, self-managed intervention is beneficial for protecting against perceived cognitive decline in breast cancer patients treated with chemotherapy. There is a need for further research to objectively assess cognitive decline within this population with larger sample sizes of patients. Trial registration Current Controlled Trials ISRCTN5070929

Comparison between Mesh Hernioplasty and Simple Suture Repair in the treatment of Paraumbilical Hernias at Bahawalpur Hospitals

To compare the rate of recurrence between mesh hernioplasty and simple suture repair in the management of paraumbilical hernias. Total 215 patients were selected in medical ward of Bahawal Victoria Hospital Bahawalpur. They were subdivided into three groups. Group A 112 patients were repaired in traditional way and group B 88 patients underwent mesh repair and the in third group C 15 patients undergone other ways of repair which we did not covered in our study. And the patients who showed the recurrence of hernia were selected and those were subject of interest. A comparison was made between two groups in terms of, complications and rate of recurrence. In Group A, 12(10.71%) patients had recurrence which was quite high compared to the group B which had only 2(2.27%) patients. Rate of infection was higher in group B (12%). There were incidences of postoperative hematomas and seromas formation in group A but none in group B. Mesh hernioplasty significantly reduced the recurrence rate as compared to the traditional suture repair. Unlike results of the other studies, infection rate was not high in mesh group. Keywords: Paraumbilical hernia, Mesh repair, Simple suture repair

Can physical activity help to maintain cognitive functioning and psychosocial well-being among breast cancer patients treated with chemotherapy? A randomised controlled trial: study protocol

Background: Evidence suggests chemotherapy treatment for breast cancer is associated with side effects such as cognitive impairment in domains of memory, attention, concentration and executive function. Cognitive impairments reported by patients have been associated with higher levels of emotional distress. To date, intervention studies to alleviate cognitive impairment associated with chemotherapy have focused on psycho-educational techniques or cognitive training. Studies have not yet considered physical activity as a potential for alleviating cognitive problems. Physical activity interventions are reported to be effective in alleviating emotional distress and fatigue in those with breast cancer. They have also been reported to improve cognitive functioning in the elderly, in those suffering with dementia and in children. We propose that physical activity could also help to alleviate cognitive impairments in women diagnosed with breast cancer. The study has been designed using a recently developed taxonomy of behaviour change techniques to reliably report the content of the intervention to allow future replication. Method: This study will deliver a home-based moderate intensity walking intervention to women diagnosed with breast cancer mid-way through their chemotherapy treatment and will compare them to patients receiving usual care alone. The primary outcome measure for this intervention is changes in an objective measure of memory assessed using the Digit Span. Secondary outcome measures include: objective measures of executive function; attention; visual spatial skills; self report cognitive function; self-report fatigue; anxiety; depression; mood and self-esteem. As emotional distress has been associated with self-reporting of cognitive problems, this intervention will further test whether emotional distress mediates between the amount of walking undertaken during the intervention period and levels of self-reported cognitive functioning. Discussion: The development of an effective intervention for preventing difficulties in emotional and cognitive functioning of cancer patients’ post-treatment will help to guide health care professionals to improve patients’ overall quality of life. It will also provide direction for future research, ultimately to improve the day to day functioning of breast cancer survivors. Trial Registration: Current Controlled Trials ISRCTN50709297

Effects of a self-managed home-based walking intervention on psychosocial health outcomes for breast cancer patients receiving chemotherapy: a randomised controlled trial

Purpose: This study evaluated the effectiveness of a self-managed home-based moderate intensity walking intervention on psychosocial health outcomes among breast cancer patients undergoing chemotherapy. Methods: The randomised controlled trial compared a self-managed, home-based walking intervention to usual care alone among breast cancer patients receiving chemotherapy. Outcome measures included changes in self-report measures of anxiety, depression, fatigue, self-esteem, mood and physical activity. Fifty participants were randomised to either the intervention group (n = 25), who received 12 weeks of moderate intensity walking, or the control group (n = 25) mid-way through chemotherapy. Participants in the intervention group were provided with a pedometer and were asked to set goals and keep weekly diaries outlining the duration, intensity and exertion of their walking. Levels of psychosocial functioning and physical activity were assessed pre- and post-intervention in both groups. Results: The intervention had positive effects on fatigue (F = 5.77, p = 0.02), self-esteem (F = 8.93, p ≤ 0.001), mood (F = 4.73, p = 0.03) and levels of physical activity (x2 = 17.15, p = 0.0011) but not anxiety (F = 0.90, p = 0.35) and depression (F = 0.26, p = 0.60) as assessed using the HADS. We found an 80 % adherence rate to completing the 12-week intervention and recording weekly logs. Conclusion: This self-managed, home-based intervention was beneficial for improving psychosocial well-being and levels of physical activity among breast cancer patients treated with chemotherapy. Trial registration: Current Controlled Trials ISRCTN50709297

Histological changes in the liver of diabetic rats: A review of pathogenesis of nonalcoholic fatty liver disease in type 1 diabetes mellitus

Abstract: Abundant knowledge is present over nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus but no attention has been given to the same aspect with type 1 diabetes mellitus (T1DM) in humans. However, various animal modeled studies are documented having induced T1DM using chemical induction by alloxan (ALX) or streptozotocin (SZ) to investigate and comprehend the nature and pathophysiology of NAFLD in T1DM. The objectives of this review were to assess whether T1DM induced by ALX or SZ could cause histological (morphological and ultrastructural) changes in rat liver to illustrate the effects of these drugs and diabetes, and pathophysiology of NAFLD in T1DM. To achieve these objectives, we systematically searched the studies from EconLit, Embase, Google Scholar, Medline, PubMed, ProQuest, Scopus, Springer Link, and Science Direct databases. Initially, 150 studies were retrieved. Out of these, 107 studies were removed as these failed to provide relevant details. Finally, 43 articles were selected for this review. This review concluded that diabetes induced by ALX or SZ, cause biochemical alterations in blood and pathophysiological variations in the liver of rats. These changes can vary from steatosis to steatohepatitis and liver fibrosis, and are similar to the modifications observed in human liver

Maternal anaemia and the risk of postpartum haemorrhage: a cohort analysis of data from the WOMAN-2 trial

Background: Worldwide, more than half a billion women of reproductive age are anaemic. Each year, about 70 000 women who give birth die from postpartum haemorrhage. Almost all deaths are in low-income or middle-income countries. We examined the association between anaemia and the risk of postpartum haemorrhage. Methods: We did a prospective cohort analysis of data from the World Maternal Antifibrinolytic-2 (WOMAN-2) trial. This trial enrols women with moderate or severe anaemia giving birth vaginally in hospitals in Pakistan, Nigeria, Tanzania, and Zambia. Hospitals in each country where anaemia in pregnancy is common were identified from a network established during previous obstetric trials. Women who were younger than 18 years without permission provided by a guardian, had a known tranexamic acid allergy, or developed postpartum haemorrhage before the umbilical cord was cut or clamped were excluded from the study. Prebirth haemoglobin, the exposure, was measured after hospital arrival and just before giving birth. Postpartum haemorrhage, the outcome, was defined in three ways: (1) clinical postpartum haemorrhage (estimated blood loss ≥500 mL or any blood loss sufficient to compromise haemodynamic stability); (2) WHO-defined postpartum haemorrhage (estimated blood loss of at least 500 mL); and (3) calculated postpartum haemorrhage (calculated estimated blood loss of ≥1000 mL). Calculated postpartum haemorrhage was estimated from the peripartum change in haemoglobin concentration and bodyweight. We used multivariable logistic regression to examine the association between haemoglobin and postpartum haemorrhage, adjusting for confounding factors. Findings: Of the 10 620 women recruited to the WOMAN-2 trial between Aug 24, 2019, and Nov 1, 2022, 10 561 (99·4%) had complete outcome data. 8751 (82·9%) of 10 561 women were recruited from hospitals in Pakistan, 837 (7·9%) from hospitals in Nigeria, 525 (5·0%) from hospitals in Tanzania, and 448 (4·2%) from hospitals in Zambia. The mean age was 27·1 years (SD 5·5) and mean prebirth haemoglobin was 80·7 g/L (11·8). Mean estimated blood loss was 301 mL (SD 183) for the 8791 (83·2%) women with moderate anaemia and 340 mL (288) for the 1770 (16·8%) women with severe anaemia. 742 (7·0%) women had clinical postpartum haemorrhage. The risk of clinical postpartum haemorrhage was 6·2% in women with moderate anaemia and 11·2% in women with severe anaemia. A 10 g/L reduction in prebirth haemoglobin increased the odds of clinical postpartum haemorrhage (adjusted odds ratio [aOR] 1·29 [95% CI 1·21–1·38]), WHO-defined postpartum haemorrhage (aOR 1·25 [1·16–1·36]), and calculated postpartum haemorrhage (aOR 1·23 [1·14–1·32]). 14 women died and 68 either died or had a near miss. Severe anaemia was associated with seven times higher odds of death or near miss (OR 7·25 [95% CI 4·45–11·80]) than was moderate anaemia. Interpretation: Anaemia is strongly associated with postpartum haemorrhage and the risk of death or near miss. Attention should be given to the prevention and treatment of anaemia in women of reproductive age. Funding: The WOMAN-2 trial is funded by Wellcome and the Bill & Melinda Gates Foundation

Can physical activity help to maintain cognitive functioning and psychosocial well-being among breast cancer patients treated with chemotherapy? A randomised controlled trial: study protocol

Background: Evidence suggests chemotherapy treatment for breast cancer is associated with side effects such as cognitive impairment in domains of memory, attention, concentration and executive function. Cognitive impairments reported by patients have been associated with higher levels of emotional distress. To date, intervention studies to alleviate cognitive impairment associated with chemotherapy have focused on psycho-educational techniques or cognitive training. Studies have not yet considered physical activity as a potential for alleviating cognitive problems. Physical activity interventions are reported to be effective in alleviating emotional distress and fatigue in those with breast cancer. They have also been reported to improve cognitive functioning in the elderly, in those suffering with dementia and in children. We propose that physical activity could also help to alleviate cognitive impairments in women diagnosed with breast cancer. The study has been designed using a recently developed taxonomy of behaviour change techniques to reliably report the content of the intervention to allow future replication. Method: This study will deliver a home-based moderate intensity walking intervention to women diagnosed with breast cancer mid-way through their chemotherapy treatment and will compare them to patients receiving usual care alone. The primary outcome measure for this intervention is changes in an objective measure of memory assessed using the Digit Span. Secondary outcome measures include: objective measures of executive function; attention; visual spatial skills; self report cognitive function; self-report fatigue; anxiety; depression; mood and self-esteem. As emotional distress has been associated with self-reporting of cognitive problems, this intervention will further test whether emotional distress mediates between the amount of walking undertaken during the intervention period and levels of self-reported cognitive functioning. Discussion: The development of an effective intervention for preventing difficulties in emotional and cognitive functioning of cancer patients’ post-treatment will help to guide health care professionals to improve patients’ overall quality of life. It will also provide direction for future research, ultimately to improve the day to day functioning of breast cancer survivors. Trial Registration: Current Controlled Trials ISRCTN50709297. Keywords: Intervention, Breast cancer, Chemotherapy, Physical activity, Exercise, Walking, Cognitive function, Emotional distress, Psychosocial well-bein

Generalized Twisted (α, β)-ψ-Contractive Mappings of Integral Type on Spaces with Two Metrics

Abstract In this paper, we extend and generalize the notion of twisted (α, β)-ψ-contractive maps on spaces with two metrics. Our results provide a compact form for both type of results related to twisted (α, β)-ψ-contractive mappings and generalized contractions on spaces with two metrics. We establish new fixed point theorems which generalize the Banach contraction principle and so many other results in the literature. An example is constructed to support our results

Histological changes in the liver of diabetic rats: A review of pathogenesis of nonalcoholic fatty liver disease in type 1 diabetes mellitus

Abundant knowledge is present over nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus but no attention has been given to the same aspect with type 1 diabetes mellitus (T1DM) in humans. However, various animal modeled studies are documented having induced T1DM using chemical induction by alloxan (ALX) or streptozotocin (SZ) to investigate and comprehend the nature and pathophysiology of NAFLD in T1DM. The objectives of this review were to assess whether T1DM induced by ALX or SZ could cause histological (morphological and ultrastructural) changes in rat liver to illustrate the effects of these drugs and diabetes, and pathophysiology of NAFLD in T1DM. To achieve these objectives, we systematically searched the studies from EconLit, Embase, Google Scholar, Medline, PubMed, ProQuest, Scopus, Springer Link, and Science Direct databases. Initially, 150 studies were retrieved. Out of these, 107 studies were removed as these failed to provide relevant details. Finally, 43 articles were selected for this review. This review concluded that diabetes induced by ALX or SZ, cause biochemical alterations in blood and pathophysiological variations in the liver of rats. These changes can vary from steatosis to steatohepatitis and liver fibrosis, and are similar to the modifications observed in human liver

Evaluation of Phenolic Compounds and Antioxidant and Antimicrobial Activities of Some Common Herbs

The study was designed to evaluate the phenolic, flavonoid contents and antioxidant and antimicrobial activities of onion (Allium cepa), garlic (Allium sativum), mint (Mentha spicata), thyme (Thymus vulgaris), oak (Quercus), aloe vera (Aloe barbadensis Miller), and ginger (Zingiber officinale). All extracts showed a wide range of total phenolic contents, that is, 4.96 to 98.37 mg/100 g gallic acid equivalents, and total flavonoid contents, that is, 0.41 to 17.64 mg/100 g catechin equivalents. Antioxidant activity (AA) was determined by measuring reducing power, inhibition of peroxidation using linoleic acid system, and 2,2-diphenyl-1-picrylhydrazyl radical (DPPH) scavenging activity. Different extracts inhibited oxidation of linoleic acid by 16.6–84.2% while DPPH radical scavenging activity (IC50 values) ranged from 17.8% to 79.1 μg/mL. Reducing power at 10 mg/mL extract concentration ranged from 0.11 to 0.84 nm. Furthermore the extracts of these medicinal herbs in 80% methanol, 80% ethanol, 80% acetone, and 100% water were screened for antimicrobial activity by disc diffusion method against selected bacterial strains, Staphylococcus aureus, Escherichia coli, Bacillus subtilis, and Pasteurella multocida, and fungal strains, Aspergillus niger, Aspergillus flavus, Rhizopus solani, and Alternaria alternata. The extracts show better antimicrobial activity against bacterial strains as compared to fungal strains. Results of various assays were analyzed statistically by applying appropriate statistical methods