Assessment of depression and anxiety in adult cancer outpatients: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The prevalence of anxiety and depressive disorders in cancer patients and its associated factors in Pakistan is not known. There is a need to develop an evidence base to help introduce interventions as untreated depression and anxiety can lead to significant morbidity. We assessed the prevalence of depression and anxiety among adult outpatients with and without cancer as well as the effect of various demographic, clinical and behavioral factors on levels of depression and anxiety in cancer patients.</p> <p>Methods</p> <p>This cross-sectional study was carried out in outpatient departments of Multan Institute of Nuclear Medicine and Radiotherapy and Nishtar Medical College Hospital, Multan. Aga Khan University Anxiety and Depression Scale (AKUADS) was used to define the presence of depression and anxiety in study participants. The sample consisted of 150 diagnosed cancer patients and 268 participants without cancer (control group).</p> <p>Results</p> <p>The mean age of cancer patients was 40.85 years (SD = 16.46) and median illness duration was 5.5 months, while the mean age of the control group was 39.58 years (SD = 11.74). Overall, 66.0% of the cancer patients were found to have depression and anxiety using a cutoff score of 20 on AKUADS. Among the control group, 109 subjects (40.7%) had depression and anxiety. Cancer patients were significantly more likely to suffer from distress compared to the control group (OR = 2.83, 95% CI = 1.89-4.25, P = 0.0001). Performing logistic regression analysis showed that age up to 40 years significantly influenced the prevalence of depression and anxiety in cancer patients. There was no statistically significant difference between gender, marital status, locality, education, income, occupation, physical activity, smoking, cancer site, illness duration and mode of treatment, surgery related to cancer and presence of depression and anxiety. Cancers highly associated with depression and anxiety were gastrointestinal malignancies, chest tumors and breast cancer.</p> <p>Conclusions</p> <p>This study highlights high prevalence rates of depression and anxiety in cancer patients. Younger age was associated with a higher likelihood of meeting criteria for psychological morbidity. The findings support screening patients for symptoms of depression and anxiety as part of standard cancer care and referring those at a higher risk of developing psychological morbidity for appropriate care.</p

Modeling Wastewater Evolution and Management Options under Variable Land Use Scenarios

The development of a reliable decision support system and predictions for water quantity and quality often require a reasonable level of environmental and hydrological simulations at various geographic scales. The Soil and Water Assessment Tool (SWAT) model offers distributed parameter and continuous time simulation, and flexible watershed configuration and with the adoption of geographic information system (GIS) technology, a user-friendly and interactive decision support system can be developed for wastewater management. In this chapter, we evaluated the spatio-temporal evolution of wastewater contaminants in an environmentally degraded watershed through integrated field-based investigations and modeling approach. Later, management options were identified to improve the watershed health and agro-environment. The results of the modeling study exhibited variable responses of surface runoff and water quality to different scenarios of land use change. Temporal wastewater analysis indicated a significant impact of seasonality on the contaminants’ population levels. The adopted approach would prove effective in evaluating better management options to reduce negative impacts of wastewater and contaminants for sustainable agro-environment in future

Prevalence and Purpose of Medical App Usage In Pakistan: A Cross-Sectional Study

Objective: To determine the prevalence and purpose of medical app usage in Pakistan. Methodology: A cross-sectional study was conducted using a pretested form, distributed via Google Forms. Convenience sampling was used to select a sample of 357 MBBS, BDS, Allied Health, and Nursing students of CMH Lahore Medical College. Data was analyzed using “SPSS version 23.0”. Descriptive statistics were calculated as frequencies. A “p-value” of less than 0.05 was deemed statistically significant. Results: Out of all the participants (357), 40.3% were males, and 59.7% were females, with an average age of20.89 ± 1.61. 95.5% of the participants used intelligent devices, and 86.6% were aware of the medical apps available for use on mobiles. A majority (64.1%) of the students had various medical apps installed on their phones. Almost half of these students (45.1%) were advised by medical educators to use different medical apps for their studies. Most of the students made use of medical apps to search for medical information (49.7%), followed by exam preparations (37.6%), Revision (34.6%), and preparation of presentations (26.4.%). The use of general clinical textbooks and clinical skills guide apps were 22.2% and 23.9%, respectively. 20.5% of the participants did not use Medical Apps for any purpose. A Likert scale showed that students think that Medical Apps are easy to obtain, and many of them frequently use them too. They believe that these apps save time during clinical practice. Medscape was the most common app being used (29.3%), followed by Gray’s Anatomy (25%) and Pharmapedia (23.9%). Conclusion: The common usage of medical apps was recurrent amongst medical student

Evolution towards Smart and Software-Defined Internet of Things

The Internet of Things (IoT) is a mesh network of interconnected objects with unique identifiers that can transmit data and communicate with one another without the need for human intervention. The IoT has brought the future closer to us. It has opened up new and vast domains for connecting not only people, but also all kinds of simple objects and phenomena all around us. With billions of heterogeneous devices connected to the Internet, the network architecture must evolve to accommodate the expected increase in data generation while also improving the security and efficiency of connectivity. Traditional IoT architectures are primitive and incapable of extending functionality and productivity to the IoT infrastructure’s desired levels. Software-Defined Networking (SDN) and virtualization are two promising technologies for cost-effectively handling the scale and versatility required for IoT. In this paper, we discussed traditional IoT networks and the need for SDN and Network Function Virtualization (NFV), followed by an analysis of SDN and NFV solutions for implementing IoT in various ways

Directed evolution of an orthogonal nucleoside analog kinase via fluorescence-activated cell sorting

Nucleoside analogs (NAs) represent an important category of prodrugs for the treatment of viral infections and cancer, yet the biological potency of many analogs is compromised by their inefficient activation through cellular 2′-deoxyribonucleoside kinases (dNKs). We herein report the directed evolution and characterization of an orthogonal NA kinase for 3′-deoxythymidine (ddT), using a new FACS-based screening protocol in combination with a fluorescent analog of ddT. Four rounds of random mutagenesis and DNA shuffling of Drosophila melanogaster 2′-deoxynucleoside kinase, followed by FACS analysis, yielded an orthogonal ddT kinase with a 6-fold higher activity for the NA and a 20-fold kcat/KM preference for ddT over thymidine, an overall 10 000-fold change in substrate specificity. The contributions of individual amino acid substitutions in the ddT kinase were evaluated by reverse engineering, enabling a detailed structure–function analysis to rationalize the observed changes in performance. Based on our results, kinase engineering with fluorescent NAs and FACS should prove a highly versatile method for evolving selective kinase:NA pairs and for studying fundamental aspects of the structure–function relationship in dNKs

Effect of palm-sesame biodiesel fuels with alcoholic and nanoparticle additives on tribological characteristics of lubricating oil by four ball tribo-tester

Dilution of engine oil with unburned fuels alters its lubricity and tribological properties. In this research paper, SAE-40 lubricating oil samples were contaminated with known percentages (5%) of fuels (diesel, palm-sesame biodiesel blend (B30), B30 + ethanol, B30 + dimethyl carbonate, B30 + carbon nanotubes and, B30 + titanium oxide). The effect of all these fuels on wear and frictional characteristics of lubricating oil was determined by using a 4-ball tribo tester and wear types on worn surfaces were analyzed by using SEM. Lubricating oil diluted with B10 (commercial diesel) showed highest COF (42.95%) with severe abrasive and adhesive wear than mineral lubricant among other fuels. Lubricating oil diluted with palm-sesame biodiesel (B30 blend) with alcoholic additives showed comparatively less COF, less wear scar diameter and polishing wear due to presence of ester molecules. Lub + B30 + Eth exhibited increment in COF value (35.81%) compared to SAE-40 mineral lubricant. While lubricating oil contaminated with B30 with nanoparticles showed least frictional characteristics with abrasive wear. Lub + B30 + TiO2 showed least increment in COF value (13.78%) among all other contaminated fuels compared to SAE-40 mineral lubricant. It is concluded that nanoparticles in biodiesel blends (B30) helps in reducing degradation of lubricants than alcoholic fuel additives and commercial diesel. (C) 2021 THE AUTHORS. Published by Elsevier BV on behalf of Faculty of Engineering, Alexandria University

Infection Dynamics of Clostridium perfringens Fingerprinting in Buffalo and Cattle of Punjab Province, Pakistan

Clostridium perfringens produces core virulence factors that are responsible for causing hemorrhagic abomasitis and enterotoxemia making food, animals, and humans susceptible to its infection. In this study, C. perfringens was isolated from necropsied intestinal content of buffalo and cattle belonging to four major bovine-producing regions in the Punjab Province of Pakistan for the purpose offind out the genetic variation. Out of total 160 bovine samples (n: 160), thirty-three (n: 33) isolates of C. perfringens were obtained from buffalo (Bubales bubalis) and cattle (Bos indicus) that were further subjected to biochemical tests; 16S rRNA based identification and toxinotyping was done using PCR (Polymerase Chain Reaction) and PFGE (Pulse Field Gel Electrophoresis) pulsotypesfor genetic diversity. Occurrence of C. perfringens was found to be maximum in zone-IV (Bhakkar and Dera Ghazi Khan) according to the heatmap. Correlation was found to be significant and positive among the toxinotypes (α-toxin, and ε-toxin). Response surface methodology (RSM) via central composite design (CCD) and Box-Behnken design (BBD) demonstrated substantial frequency of C. perfringens based toxinotypes in all sampling zones. PFGE distinguished all isolates into 26 different pulsotypes using SmaI subtyping. Co-clustering analysis based on PFGE further decoded a diversegenetic relationship among the collected isolates. This study could help us to advance toward disease array of C. perfringens and its probable transmission and control. This study demonstrates PFGE patterns from Pakistan, and typing of C. perfringens by PFGE helps illustrate and mitigate the incidence of running pulsotypes

Evaluation of anakinra in the management of patients with COVID-19 infection: A randomized clinical trial

Background: The global COVID-19 pandemic led to substantial clinical and economic outcomes with catastrophic consequences. While the majority of cases has mild to moderate disease, minority of patients progress into severe disease secondary to the stimulation of the immune response. The hyperinflammatory state contributes towards progression into multi-organ failure which necessitates suppressive therapy with variable outcomes. This study aims to explore the safety and efficacy of anakinra in COVID-19 patients with severe disease leading to cytokine release syndromes. Methods: In this open-label, multi-center, randomized clinical trial, patients with confirmed COVID-19 infection with evidence of respiratory distress and signs of cytokine release syndrome were randomized in 1:1 ratio to receive either standard of care (SOC) or anakinra (100 mg subcutaneously every 12 h for 3 days then 100 mg subcutaneously once daily for 4 days) in addition to SOC. The primary outcome was treatment success at day 14 as defined by the WHO clinical progression score of ≤3. Primary analysis was based upon intention-to-treat population, with value of p of <0.05. Results: Out 327 patients screened for eligibility, 80 patients were recruited for the study. The mean age was 49.9 years (SD = 11.7), with male predominance at 82.5% (n = 66). The primary outcome was not statistically different (87.5% (n = 35) in anakinra group vs. 92.5% (n = 37) in SOC group, p = 0.712; OR = 1.762 (95%CI: 0.39–7.93). The majority of reported adverse events were mild in severity and not related to the study treatment. Elevated aspartate aminotransferase was the only significant adverse event which was not associated with discontinuation of therapy. Conclusion: In patients with severe COVID-19 infection, the addition of anakinra to SOC treatment was safe but was not associated with significant improvement according to the WHO clinical progression scale. Further studies are warranted to explore patients’ subgroups characteristics that might benefit from administered therapy. Clinical Trial Registration: Trial registration at ClinicalTrials.gov, identifier: NCT04643678.This study was funded by the Medical Research Center at Hamad Medical Corporation, Qatar (MRC-01-20-1095)

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020