THE CHOICE OF BIOPREPARATION FOR THE CORRECTION OF INTESTINAL DYSBACTERIOSIS IN CHILDREN WITH CHRONIC HBV INFECTION AND GIARDIASIS

Research objective: to assess efficiency of application of bio preparations in the correction of intestinal dysbacteriosis taking into account the results of “Load” test in vitro in children with chronic hepatitis B together with giardiasis. Material and methods. We examined one hundred and fifty children with chronic hepatitis B (CHB) with concomitant giardiasis in the age from 3 to 18 years old. The diagnosis was based on data from history, results of clinical tests, biochemical and instrumental tests. Laboratory diagnostics of giardiasis was performed using the following methods: immune fluorescent method (G. Lamblia antigen in feces), polymerase chain reaction (G. Lamblia DNA in blood and feces), and triple microscopic test for precipitation components of feces. For the definition of lymphocyte sensitivity to bio preparations to choose the agent we applied loading test in vitro. For the correction of dysbacteriosis using the basic therapy we used very sensitive polycomponent probiotics in capsules such as “Bifilax-immuno”, “Lacto-G”, and “Narimax-plus”.Lamblia eradication was performed using Macmirror (Nifuratel) 15mg/kg two times a day for 10 days. Assessment of the efficiency of the prescribed therapy was done according to the clinical, biochemical, and bacteriological data. Results. We determined a direct proportional decrease of lymphocyte ability for E-rosette formation dependent on the expression of intestinal dysbacteriosis. The most sensitive biopreparation in in vitro test was Bifilax-immuno (62.7%), which differed by its quantitative and qualitative composition compared to Lacto-G (48.0%) and Narimax-plus (38.7%), р\u3c0.05. Prescription of anti-giardiasis therapy with individually chosen very sensitive biopreparation for the correction of intestinal dysbacteriosis in children with CHB provided achievement of stabilization (60.0%) and regression of pathological process in liver, prevention of unfavorable outcomes such as hepatic cirrhosis and hepatocellular carcinoma. Conclusion. Differential approach to the choice of probiotic for the correction of intestinal dysbacteriosis provides the increase of the efficiency of therapy in children with CHB with concomitant giardiasis by 40.1%. Development of clinical, biochemical, and microbiological remission was achieved using Bifilax-immuno in 76.5% cases, Lacto-G in 64.4%, and Narimax-plus in 62.0% of the cases respectively (p \u3c 0.01). In relation to that, children with CHB and concomitant giardiasis together with the test for intestinal dysbacteriosis have to undergo loading test in vitro for the prescription of efficient and targeted correction taking into account individual sensitivity of an organism to biopreparations

Folic acid, vitamin B12 and homocysteine levels following olanzapine administration in schizophrenia patients

The purpose of this study was to assess the levels of folic acid, vitamin B12 and homocysteine in the serum of schizophrenia patients (n=20) and to evaluate the effect of olanzapine on these biomarkers. The blood was also collected from the 10 healthy volunteers as control. Compared to control, the serum folic acid (p=0.005) and vitamin B12 levels (p=0.211) were higher in the schizophrenia patients, whereas no difference was evident in the serum homocysteine level. But significantly higher levels of serum folic acid (p=0.005), vitamin B12 (p=0.047) and significantly lower level of serum homocysteine (p=0.000) were observed after 10 weeks of olanzapine administration. BPRS score was reduced significantly after intervention. The Pearson correlation coefficient test showed a statistically not significant negative relationship between the serum folate, vitamin B12 and homocysteine levels. In conclusion, olanzapine can significantly elevate the  serum folic acid and vitamin B12 levels whereas it can lower the serum homocysteine level which may contribute to the improvement of symptoms of schizophrenia

Semen amyloids participate in spermatozoa selection and clearance

Unlike other human biological fluids, semen contains multiple types of amyloid fibrils in the absence of disease. These fibrils enhance HIV infection by promoting viral fusion to cellular targets, but their natural function remained unknown. The similarities shared between HIV fusion to host cell and sperm fusion to oocyte led us to examine whether these fibrils promote fertilization. Surprisingly, the fibrils inhibited fertilization by immobilizing sperm. Interestingly, however, this immobilization facilitated uptake and clearance of sperm by macrophages, which are known to infiltrate the female reproductive tract (FRT) following semen exposure. In the presence of semen fibrils, damaged and apoptotic sperm were more rapidly phagocytosed than healthy ones, suggesting that deposition of semen fibrils in the lower FRT facilitates clearance of poor-quality sperm. Our findings suggest that amyloid fibrils in semen may play a role in reproduction by participating in sperm selection and facilitating the rapid removal of sperm antigens

Gender roles and their influence on life prospects for women in urban Karachi, Pakistan: a qualitative study

Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women's and men's life prospects.The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men's and women's life circumstances.Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied. Two major themes emerged during analysis: ‘Reiteration of gender roles’ and ‘Agents of change’. The first theme included perceptions of traditional gender roles and how these preserve women's subordination. The power gradient, with men holding a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation.This study reveals serious gender inequalities and human rights violations against women in the Pakistani society. The unequal gender roles were perceived as static and enforced by structures imbedded in society. Women routinely faced serious restrictions and limitations of autonomy. However, attainment of higher levels of education especially not only for women but also for men was viewed as an agent towards change. Furthermore, mass media was perceived as having a positive role to play in supporting women's empowerment

Nurse delivered Sleep Restriction Therapy for adults with Insomnia Disorder: process evaluation

Background: Sleep Restriction Therapy (SRT) is a behavioural therapy for insomnia. Aim: To conduct a process evaluation of a randomised controlled trial comparing SRT delivered by primary care nurses plus sleep hygiene booklet with sleep hygiene booklet only for adults with Insomnia Disorder. Design and setting: Mixed methods process evaluation. Methods: We used semi-structured interviews of a purposive sample of patients receiving SRT, practice nurses delivering it, and general practitioners (GPs) or practice managers. Qualitative data were explored using Framework Analysis, and integrated with nurse comments and quantitative data, including baseline Insomnia Severity Index score and serial sleep efficiency outcomes to investigate relationships between these. Results: We interviewed 16 patients, 13 nurses, 6 practice managers and 1 GP. Patients had no previous experience of behavioural therapy, needed flexible appointment times, and preferred face-to-face consultations; nurses felt prepared to deliver SRT, accommodating patient concerns, tailoring therapy, and negotiating sleep timings, despite treatment complexity and delays between training and intervention delivery. We explored how the intervention produced change, including patient and nurse interactions and patient responses to SRT. Difficulties maintaining SRT, negative attitudes towards treatment, and low self-efficacy were highlighted. Contextual factors, including freeing GP time, time constraints and conflicting priorities for nurses, with suggestions for alternative delivery options. Participants who found SRT a positive process showed improvements in sleep efficiency, whilst those that struggled did not. Conclusion: SRT was successfully delivered by practice nurses and was generally well received by patients, despite some difficulties delivering and applying the intervention in practice

Bioactivity of miltefosine against aquatic stages of Schistosoma mansoni, Schistosoma haematobium and their snail hosts, supported by scanning electron microscopy

<p>Abstract</p> <p>Background</p> <p>Miltefosine, which is the first oral drug licensed for the treatment of leishmaniasis, was recently reported to be a promising lead compound for the synthesis of novel antischistosomal derivatives with potent activity <it>in vivo </it>against different developmental stages of <it>Schistosoma mansoni</it>. In this paper an <it>in vitro </it>study was carried out to investigate whether it has a biocidal activity against the aquatic stages of <it>Schistosoma mansoni </it>and its snail intermediate host, <it>Biomphalaria alexandrina </it>, thus being also a molluscicide. Additionally, to see whether miltefosine can have a broad spectrum antischistosomal activity, a similar <it>in vitro </it>study was carried out on the adult stage of <it>Schistosoma haematobium</it>, the second major human species, its larval stages and snail intermediate host, <it>Bulinus truncutes</it>. This was checked by scanning electron microscopy.</p> <p>Results</p> <p>Miltefosine proved to have <it>in vitro </it>ovicidal, schistolarvicidal and lethal activity on adult worms of both <it>Schistosoma </it>species and has considerable molluscicidal activity on their snail hosts. Scanning electron microscopy revealed several morphological changes on the different stages of the parasite and on the soft body of the snail, which further strengthens the current evidence of miltefosine's activity. This is the first report of mollusicidal activity of miltefosine and its <it>in vitro </it>schistosomicidal activity against <it>S.haematobium</it>.</p> <p>Conclusions</p> <p>This study highlights miltefosine not only as a potential promising lead compound for the synthesis of novel broad spectrum schistosomicidal derivatives, but also for molluscicidals.</p

Clinical and cost-effectiveness of nurse-delivered sleep restriction therapy for insomnia in primary care (HABIT): a pragmatic, superiority, open-label, randomised controlled trial.

Background Insomnia is prevalent and distressing but access to the first-line treatment, cognitive behavioural therapy (CBT), is extremely limited. We aimed to assess the clinical and cost-effectiveness of sleep restriction therapy, a key component of CBT, which has the potential to be widely implemented. Methods We did a pragmatic, superiority, open-label, randomised controlled trial of sleep restriction therapy versus sleep hygiene. Adults with insomnia disorder were recruited from 35 general practices across England and randomly assigned (1:1) using a web-based randomisation programme to either four sessions of nurse-delivered sleep restriction therapy plus a sleep hygiene booklet or a sleep hygiene booklet only. There was no restriction on usual care for either group. Outcomes were assessed at 3 months, 6 months, and 12 months. The primary endpoint was self-reported insomnia severity at 6 months measured with the insomnia severity index (ISI). The primary analysis included participants according to their allocated group and who contributed at least one outcome measurement. Cost-effectiveness was evaluated from the UK National Health Service and personal social services perspective and expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. The trial was prospectively registered (ISRCTN42499563). Findings Between Aug 29, 2018, and March 23, 2020 we randomly assigned 642 participants to sleep restriction therapy (n=321) or sleep hygiene (n=321). Mean age was 55·4 years (range 19–88), with 489 (76·2%) participants being female and 153 (23·8%) being male. 580 (90·3%) participants provided data for at least one outcome measurement. At 6 months, mean ISI score was 10·9 (SD 5·5) for sleep restriction therapy and 13·9 (5·2) for sleep hygiene (adjusted mean difference –3·05, 95% CI –3·83 to –2·28; p<0·0001; Cohen's d –0·74), indicating that participants in the sleep restriction therapy group reported lower insomnia severity than the sleep hygiene group. The incremental cost per QALY gained was £2076, giving a 95·3% probability that treatment was cost-effective at a cost-effectiveness threshold of £20 000. Eight participants in each group had serious adverse events, none of which were judged to be related to intervention. Interpretation Brief nurse-delivered sleep restriction therapy in primary care reduces insomnia symptoms, is likely to be cost-effective, and has the potential to be widely implemented as a first-line treatment for insomnia disorder

Level of agreement between frequently used cardiovascular risk calculators in people living with HIV

Objectives The aim of the study was to describe agreement between the QRISK2, Framingham and Data Collection on Adverse Events of Anti‐HIV Drugs (D:A:D) cardiovascular disease (CVD) risk calculators in a large UK study of people living with HIV (PLWH). Methods PLWH enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study without a prior CVD event were included in this study. QRISK2, Framingham CVD and the full and reduced D:A:D CVD scores were calculated; participants were stratified into ‘low’ ( 20%) categories for each. Agreement between scores was assessed using weighted kappas and Bland–Altman plots. Results The 730 included participants were predominantly male (636; 87.1%) and of white ethnicity (645; 88.5%), with a median age of 53 [interquartile range (IQR) 49–59] years. The median calculated 10‐year CVD risk was 11.9% (IQR 6.8–18.4%), 8.9% (IQR 4.6–15.0%), 8.5% (IQR 4.8–14.6%) and 6.9% (IQR 4.1–11.1%) when using the Framingham, QRISK2, and full and reduced D:A:D scores, respectively. Agreement between the different scores was generally moderate, with the highest level of agreement being between the Framingham and QRISK2 scores (weighted kappa = 0.65) but with most other kappa coefficients in the 0.50–0.60 range. Conclusions Estimates of predicted 10‐year CVD risk obtained with commonly used CVD risk prediction tools demonstrate, in general, only moderate agreement among PLWH in the UK. While further validation with clinical endpoints is required, our findings suggest that care should be taken when interpreting any score alone