Potential barriers amongst health care professionals of Pakistan in managing COVID-19 patients

Objectives: To evaluate basic knowledge of Health Care Professionals (HCPs) of Pakistan in managing COVID 19 patients. It includes information regarding infection control measures, administrative and professional support. This was followed by evaluation of psychological factor that can act as a barrier in effective management of these patients.Methods: The survey was conducted on line using Google Form. After approval from hospital ethical committee survey link was disseminated to HCPs using social media.Results: Four hundred fifteen HCPs were participated. Most of them were younger than 30 years and majority of them were postgraduate trainees. Results showed gaps in the knowledge about basic infection control measure like donning/doffing and understanding about high-risk procedures. On job training, professional and administrative support is compromising. Many of HCPs are anxious nowadays, having symptoms related to burn out with logical reasons behind. Even with all those hurdles they are committed and ready to volunteer themselves.Conclusion: The HCPs of Pakistan needs urgent attention for providing them Formal training regarding infection control measure. Administrative and professional support is required from institutions and scientific societies. Online teaching modules and webinar is a suitable option. The symptoms of burn out are significant and would increase with passage of time. This needs to be supported by occupational health committees

Skin permeation mechanism and bioavailability enhancement of celecoxib from transdermally applied nanoemulsion

<p>Abstract</p> <p>Background</p> <p>Celecoxib, a selective cyclo-oxygenase-2 inhibitor has been recommended orally for the treatment of arthritis and osteoarthritis. Long term oral administration of celecoxib produces serious gastrointestinal side effects. It is a highly lipophilic, poorly soluble drug with oral bioavailability of around 40% (Capsule). Therefore the aim of the present investigation was to assess the skin permeation mechanism and bioavailability of celecoxib by transdermally applied nanoemulsion formulation. Optimized oil-in-water nanoemulsion of celecoxib was prepared by the aqueous phase titration method. Skin permeation mechanism of celecoxib from nanoemulsion was evaluated by FTIR spectral analysis, DSC thermogram, activation energy measurement and histopathological examination. The optimized nanoemulsion was subjected to pharmacokinetic (bioavailability) studies on Wistar male rats.</p> <p>Results</p> <p>FTIR spectra and DSC thermogram of skin treated with nanoemulsion indicated that permeation occurred due to the disruption of lipid bilayers by nanoemulsion. The significant decrease in activation energy (2.373 kcal/mol) for celecoxib permeation across rat skin indicated that the stratum corneum lipid bilayers were significantly disrupted (p < 0.05). Photomicrograph of skin sample showed the disruption of lipid bilayers as distinct voids and empty spaces were visible in the epidermal region. The absorption of celecoxib through transdermally applied nanoemulsion and nanoemulsion gel resulted in 3.30 and 2.97 fold increase in bioavailability as compared to oral capsule formulation.</p> <p>Conclusion</p> <p>Results of skin permeation mechanism and pharmacokinetic studies indicated that the nanoemulsions can be successfully used as potential vehicles for enhancement of skin permeation and bioavailability of poorly soluble drugs.</p

Interaction between Melatonin, Sleepiness-Alertness and Body Temperature

Circadian rhythms confer a biological clock of all living beings, comprising oscillations in a range of physiological variables, including body temperature and melatonin, that regulate the sleep/wake cycle rhythmically. Both variables have been marked to influence the sleep/wake cycle; even so, the interrelationship among the triad (body temperature, melatonin & sleepiness/alertness) is still unknown. The current literature review is envisioned to examine the contemporary details regarding the interaction between melatonin, body temperature, and sleepiness/alertness. All the included information is procured from the latest review articles, systematic & meta-analytical literature reviews, and original research reports. Findings revealed that melatonin and body temperature collectively contribute to the formation of sleep. An increase in melatonin induces fluctuations in body temperature. Both physiologic variables serve as close indicators of sleepiness/alertness. However, modulating factors such as light, environmental temperature, and timing of melatonin administration (with the circadian clock) may impact the overall outcomes. A significant number of studies are required to infer the underlying processes by which these factors influence the circadian clock

Association of Wilms Tumor with Crossed Fused Renal Ectopia in Children: A Case Report

Introduction: Wilms tumor is the most common renal malignancy in children. The occurrence of Wilms tumor with various congenital genitourinary anomalies has been reported, particularly in horseshoe kidneys, hypospadias, disorder of sexual development, and double collecting system. However, Wilms tumor with crossed renal ectopia is a rare finding. Case Description: We are reporting a case report of Wilms tumor in a 3-year-old girl who presented with a huge left flank mass with cross-fused renal ectopia. After the initial workup and triphasic computed tomography (CT) scan of the chest, abdomen, and pelvis for confirmation of diagnosis and metastasis, the patient underwent image-guided tissue biopsy followed by neo-adjuvant chemotherapy, left radical nephrectomy with separation of fused right ectopic renal moiety and adjuvant chemoradiation. Practical Implication: This report shows an association of Wilms tumor with cross-fused renal ectopia, a rare combination. Unusual findings on imaging with unilateral flank mass should be considered as part of the differential diagnosis for this rare finding. Adjuvant chemotherapy and modern imaging helped delineate the anatomy and ease the surgery for safe resection, improving the overall outcome

How children perceive COVID-19? Kids drawings and perceptions of parents

COVID-19 affected many lives, number of children become stressful and socially isolated. School closure also has great impact on children’s social-emotional development and overall wellbeing. The aim of current study was to identify children’s reactions to COVID-19 and its impact on academic and social life. Qualitative participatory research design was used to assess children perception about COVID-19. Data were collected from parent’s interview and Children drawing. Three major themes include: Fear of the drastic changes, increased sense of responsibility, and gratitude for being at home with family was reported by the parents however children drawings revealed that most of the children felt unhappy and sad because of lock down they were missing things they were missing enjoyed earlier such as school, fiends and outdoor activities and games. This is astonished that most of the children drawn the COVID-19 virus and represented as giant and ugly. Few children also draw mask and other protective measures. Public awareness program on COVID-19 protection and mental health promotion of will be window of opportunity for children psychosocial wellbeing

Dizajn, razvoj i vrednovanje novih nanoemulzija za transdermalnu primjenu celekoksiba

The aim of the present study was to investigate the potential of nanoemulsion formulations for transdermal delivery of celecoxib (CXB). The in vitro skin permeation profile of optimized formulations was compared with CXB gel and nanoemulsion gel. Significant increase in the steady state flux (Jss), permeability coefficient (Kp) and enhancement ratio (Er) was observed in nanoemulsion formulations T1 and T2 (p < 0.05). The highest value of these permeability parameters was obtained in formulation T2, which consisted of 2% m/m of CXB, 10% m/m of oil phase (Sefsol 218 and Triacetin), 50% m/m of surfactant mixture (Tween-80 and Transcutol-P) and 40% m/m of water. The anti-inflammatory effects of formulation T2 showed a significant increase (p < 0.05) in inhibition after 24 h compared to CXB gel and nanoemulsion gel on carrageenean-induced paw edema in rats. These results suggested that nanoemulsions are potential vehicles for improved transdermal delivery of CXB.U radu su opisana ispitivanja nanoemulzija za transdermalnu primjenu celekoksiba (CXB). Profil permeacije kroz kožu ispitivan je in vitro i uspoređivan sa CXB gelom i nanoemulzijskim gelom. U formulacijama T1 i T2 postignuto je značajno povećanje ustaljenog fluksa (Jss), koeficijenta permeabilnosti (Kp) i povećanje omjera (Er) (p < 0.05). Najveće vrijednosti parametara permeabilnosti dobivene su u formulaciji T2 koja je sadržala 2% m/m CXB, 10% m/m uljne faze (Sefsol 218 i Triacetin), 50% m/m površinski-aktivnih tvari (Tween-80 i Transcutol-P) i 40% m/m vode. Protuupalno djelovanje formulacije T2 na edem šape štakora uzrokovan karageninom značajno je povećano (p < 0.05) poslije 24 h u usporedbi sa CXB gelom i nanoemulzijskim gelom. Rezultati ukazuju na poboljšanu isporuku celekoksiba putem nanoemulzija

Influence of personality traits on open access mode of publishing

Abstract Purpose – The purpose of this paper is to assess the influence of personality traits on perception and acceptance of open access (OA) mode of publishing by the author community of University of Kashmir, India. The study is an attempt to highlight the relationship between personality traits of authors and OA mode of publishing. Design/methodology/approach – The study is based on the responses of 48 faculty members affiliated with different Departments of Science Discipline of University of Kashmir. Big Five personality traits (extraversion, agreeableness, conscientiousness, emotional stability and openness to experience) were tapped through ten-item personality inventory, and information regarding OA was gauged through six self-devised statements. Findings – Pearson correlation test confirms statistically significant relation between personality traits and different dimensions of OA mode of publishing. Personality traits are found to have an influence on author’s perception of OA mode of publishing. However, the study could not ascertain any relation between the notions of an author about the quality of OA content with any of the personality traits. Emotionally stable authors are found to explicitly submit their work in OA journals without any anxiety or negativity. Agreeable and conscientious authors also prefer to keep their work open to make it helpful to the broader audience and get maximum recognition from peers and citations to their work respectively. However, some authors (agreeable) hesitate in submitting their work in open platforms due to the fear of getting their works easily copie

Cytoskeleton-associated risk modifiers involved in early and rapid progression of sporadic Creutzfeldt-Jakob disease

A high priority in the prion field is to identify pre-symptomatic events and associated profile of molecular changes. Inthisstudy,wedemonstratethepre-symptomatic dysregulation of cytoskeleton assembly and its associated cofilin-1 pathway in strain and brain region-specific manners in MM1 and VV2 subtype-specific Creutzfeldt-Jakob disease at clinical and pre-clinical stage. At physiological level, PrPC interaction with cofilin-1 and phosphorylated form of cofilin (p-cofilin(Ser3)) was investigated in primary cultures of mouse cortex neurons (PCNs) of PrPC wildtype and knockout mice (PrP−/−). Short-interfering RNA downregulation of active form of cofilin-1 resulted in the redistribution/downregulation of PrPC, increase of activated form of microglia, accumulation of dense form of Factin, and upregulation of p-cofilin(Ser3). This upregulated p-cofilin(Ser3) showed redistribution of expression predominantly in the activated form of microglia in PCNs. At pathological level, cofilin-1 expression was significantly altered in cortex and cerebellum in both humans and mice at pre-clinical stage and at early symptomatic clinical stage of the disease. Further, to better understand the possible mechanism of dysregulation of cofilin-1, we also demonstrated alterations in upstream regulators; LIM kinase isoform 1 (LIMK1), slingshot phosphatase isoform 1 (SSH1), RhoA-associated kinase (Rock2), and amyloid precursor protein (APP) in sporadic Creutzfeldt-Jakob disease MM1 mice and in human MM1 and VV2 frontal cortex and cerebellum samples. In conclusion, our findings demonstrated for the first time a key pre-clinical response of cofilin-1 and the associated pathway in prion disease

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P &lt; 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P &lt; 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk