Background: Limited data are available about evaluation of the effects of sleeve gastrectomy on the glycaemic control on diabetes mellitus. The objective of this study is to evaluate the effectiveness of sleeve gastrectomy in improving the control of glycemic status in obese diabetic patients

Patients and methods: This is retrospective cross sectional study to review the maintained data base collected between May 2018 to April 2021 in department of laparoscopic surgery in Farwaniyah hospital-Kuwait. A total 120 patients with diabetes mellitus who had undergone laparoscopic sleeve gastrectomy were studied.at 3 months and 6 months of follow up visits, collected data about variation in Body Mass Index (BMI). And glycosylated hemoglobin (HbA1c),and fasting blood glucose were analyzed.

Results: Of the 120 diabetic patients with≥ 6 months post-operative follow up 48 diabetic patients (40%) are still taking medications for diabetes mellitus and 72 diabetic patients (60%) are resolved at 3 months and 6 months of follow up. HbA1c has decreased from 9.22±1.36 (n=18) preoperatively to 6.02±0.22 after 3 months of surgery and 30 diabetic patients ,HbA1c become 5.88±0.22 after 6 months Body Mass Index (BMI) has decreased from 47.43±11.33 in the sample of the study(120 diabetic patients )preoperatively to 37.82±6.80 at 3 months and to 33.25±3.12 Kg/m after 6 months of surgery Patients with short duration of diabetes less than 5 years have had better weight loss after surgery and achieved greater resolution rates (euglycemic state).

Conclusion: Sleeve gastrectomy has improved the glycemic control in obese diabetic patients in the for of improvement and resolution and also succeeded in reduction of the body weight in the sample of the study

There are many conflicting statements in the literature regarding camel milk (CM)'s influence on the anesthesia duration. It is clear that there must be something common connecting these contradictory statements, and some reason for the disagreement on this issue: some data show that CM prolongs anesthesia, while other scientists state the exact opposite: that CM shortens the effect of the anesthetic. We decided to shed light on these studies by analyzing the effect of CM consumption on the efficacy of local anesthesia in different patients, dividing them into groups depending on their habit of drinking CM. Twenty patients were given local anesthesia. The first, control group consisted of medically healthy patients who did not use CM during their lifetime, while the second group had the habit of taking CM regularly. In both groups, local anesthesia was first performed without prior drinking of CM. For the second time, participants in the control and experimental groups were asked to drink CM before the anesthesia procedure. Both in the control and experimental groups, patients drank CM one hour before local anesthesia. A significant correlation was found between the use of CM and the duration of anesthesia in both groups. Consumption of CM had a different impact on the duration of local anesthesia in the experimental and control groups. When drinking milk before using analgesics in different groups, it changed exactly the opposite: it was shortened in those who usually drink milk, and lengthened in those who do not drink it daily. Thus, we found that the differences in the statements of scientists regarding the influence of CM on anesthesia is based on the fact of the different effects of CM with its one time and prolonged use. We attribute this to the suppression of the activity of the cytochrome system neutralizing both foreign compounds and nutrients entering the body with the prolonged use of CM

Introduction: FOCUS PDCA instrument created to particularly address the complex challenges the healthcare industry faces from expanding quality requests The methodology gives a structure to direct problem solving and prepare enhancement exercises by setting up a comprehensive investigation, reaction, activity arrange, FOCUS PDCA is comprised of two components – one utilized to distinguish and the other to implement.

FOCUS an acronym whose steps offer assistance to streamline the method of distinguishing the region of a healthcare organization that requires change, bringing together a group competent of accomplishing that improvement, and selecting conceivable arrangement to execute the improvement.
Broken down by its parts, here is how FOCUS works:
Find: a process to improve – Identify the process improvement opportunity.
Organize the effort to work on improvement – Identify who the key stakeholders in the workflow and the process are and who should be involved of the improvement team
Clarify: current knowledge of the process –stakeholders’ input to ensure that all information has been gathered and the workflow it is clear and there is a consistent on both the process improvement opportunity and the direction of the proposed solution Understand: Process variation and capability – Identify potential process variations, small or large, and their possible effects on change implementation.by using Fish bone Methodology
Select a strategy for continued improvement – Select an implementation strategy and solutions outline the expected results, and identify success criteria using the information gathered from the above steps as input.
PDCA – Implementing the Solution Once the FOCUS process has identified the area for improvement, brought together a team, and found the best possible solution, it is time to implement that solution. The PDCA portion of the tool identifies the process to successfully implement the changes and verify that the desired result has been achieved. •Plan – Create an action plan for implementation, including a list of required steps, the implementation schedule, ownership, and responsibilities, and desired outcomes and period •Do – this part of Start implementing the plan, following the Plan steps, and adhering to the schedule to stay on track. •Check – Take measurements against the success criteria set when selecting the strategy to ensure the implementation is progressing, as it should be. Using key performance indicator •Act – Based on Check results, determine the process was successfully changed; or return to the beginning of the cycle if it did not meet goals. And sustained the success A Practical Application Although developed specifically for healthcare, the FOCUS PDCA tool covers all the basic components needed for improvement in any business process, and over the past 12 years, Consulting has successfully applied lean process management concepts in healthcare, energy, and financial services.

One of the main factors determining children’s health is nutrition. During their education in secondary schools, students perform not only mental but also physical activities. During this period, students feel the need for foods with high energy value due to high energy spending. Improper organization of children’s nutrition in secondary schools reduces their educability and increases the body's susceptibility to various diseases.

Currently, there are no commercially available phosphate tablets or intravenous preparations for correction of hypophosphatemia in the Philippines. Hence, a non-inferiority, open-label, randomized controlled pilot trial was performed at Makati Medical Center, a tertiary hospital in the Philippines. The study aimed to compare skimmed milk with the institutionally accepted formulary phosphate buffer solutions in raising serum phosphorus levels in patients with mild and moderate hypophosphatemia.
A total of 41 participants were randomized. Participants randomized to skimmed milk (n = 20) were given a total of 150mL/day divided into three doses while those randomized to phosphate solution (n = 21) were given 60mL in 3-6 divided doses. Treatment difference was determined using the mean percent change between skimmed milk and phosphate solution, with the non-inferiority limit that we set at 15%. The frequency of adverse events was noted, and intention to treat was done.
Results of the study showed that skimmed milk was able to raise serum phosphorus levels post-treatment but was not significantly different from phosphate solution (2.62 ± 0.76 mg/dl vs 3.02 ± 0.94, p = 0.14). The mean percent change was higher in the phosphate solution group (50.32% ± 44.4) than skimmed milk (30.93% ± 32.3) but was not statistically significant (p = 0.12). The mean percent change difference between the two treatments is -19.39% (95% CI: -44.5, 5.47). There were no adverse events noted with skimmed milk, but there was an isolated episode of abdominal pain and vomiting with phosphate solution. Intention to treat analysis was done.
The key finding of our trial is that giving skimmed milk was not different from phosphate solutions in raising serum phosphorus levels in mild or moderate hypophosphatemia. Although, statistically significant non-inferiority was not met. Nevertheless, skimmed milk is still a safe, readily available, and inexpensive alternative for phosphorus correction in resource-limited areas.

Parvovirus B19 (B19V) is the predominant cardiotropic virus found in endomyocardial biopsies (EMBs). Nevertheless, direct evidence showing a causal relationship between B19V cardiac presence and disease progression of B19V‐associated dilated inflammatory cardiomyopathy (DCMi) were still missing. Parvovirus B19 NS1 and VP1/2 mRNA expression indicates viral activity. Aim of this study was - To established qRT-PCR to detect B19V viral RNA of capsid (VP1) and non-structural (NS1) sequences - to analyse the influence of actively replicating B19V and inflammation upon long-term mortality in a large cohort of adult patients with inflammatory cardiomyopathy. The study group comprised 871 consecutive B19V-positive patients (mean ejection fraction (LVEF) =48.6±20.0%) who underwent EMB after exclusion of ischemic or valvular heart disease. EMB analysis confirmed inflammation in 436 (50.1%) B19V-positive patients. The patients were followed for 60 months. Information on vital status was obtained from official resident data files. Patients with inflammation and replicative active B19V infection revealed the poorest prognosis compared to patients without/with inflammation without B19V replicative intermediates (p=0.0002/p=0.045). Viral load had no significant influence on the patient’s outcome (p=0.079), contrary to inflammation (p=0.028) and replicative status (0.034).

Conclusion: This is the first study investigating the pathogenic clinical importance of B19V in a large cohort of patients. Transcriptional active cardiotropic B19V infection with positive replication intermediates and inflammation are unfavourable prognostic triggers of adverse long term-mortality, whereas B19 virus genomes without transcriptional activity has no effect on mortality. Our findings are of high clinical relevance, as they indicate for the first time that a selection of specific characterized B19V positive patients may profit from innovative tailored anti-viral immunomodulatory treatment strategies.

Statement of the Problem: In 2020 non-COVID UK research was substantially reduced. The number of trials dropped 26% in Q1/Q2 of 2020 vs 2019 and there were approx. 480,000 participants in non-covid research in 2020 vs 732,716 in 2019. The pandemic in the UK had one of the highest infections per capita in Europe in three discrete ‘waves’ (March-May 2020, Nov 2020-Feb 2020, July 2021).

Methodology and Theoretical Orientation: We present the experience of a clinical research organization in London at the epicenter of the first wave. Richmond Pharmacology (RPL) conducts clinical research in both healthy and patient volunteers, including COVID vulnerable conditions such as cardiac amyloidosis, type II diabetes and Wilsons’ disease. Early on a bespoke infection control guideline was established and adapted throughout the pandemic as required. This guideline has included on-site 30-minute turnaround PCR capability, strict entry protocol, HEPA filtration, mandatory N95 masks, social distancing, electronic contact tracing, vaccination and antibody testing. We also instituted an internal trial methodology collecting all data to constantly inform management decisions.

Findings: RPL consistently reported positivity rates well below the national estimate (ONS data). Between March 2020 and Sept 2021 there were 69 community-acquired infections amongst volunteers and visitors, 90 PCR-positive infections amongst approx. 300 staff, significantly with zero documented cases of internal transmission.

Conclusion & Significance: As a result, after the first wave we were able to continue normal clinical trial activity performing 29 early and late phase clinical trials enrolling 1225 volunteers (319 patients, 906 healthy volunteers) dosed between June 2020 and Oct 2021, with bed occupancy in the second wave comparable to pre-pandemic levels. We present a gold-standard model of pandemic interventions to mitigate risk in an environment of high virus prevalence and a benchmark for continuing drug development in healthy and patient populations in anticipated future crises.

Late prenatal growth, early postnatal growth, and layering of the neocortical neurons (NC-Ns) play determining roles in the development of the cerebral cortex (CC). Here, we systematically explore the interactive role of neuronal surface receptors (NSRs) on cytoskeleton activation (CA) and the piconewton (pN) force generation (P-FG) and their influence on the proper development, growth, and functioning of neurons using a designed DNA nanomechanical device (DNA-NMD). This DNA-NMD, functioning as a molecular tension probe (MTP), can be used to selectively bind the different NSRs (β-NGFR, Reelin, and Integrin) to mono-, bi-, and trispecifically activate the receptors on the NC-Ns surface for imaging and calculating the P-FG involved in various processes. Measurements in vivo on the brain of newly born Institute of Cancer Research mice (early postnatal) or in vitro after extracting neurons from the fetal brain of pregnant Institute of Cancer Research mice (late prenatal) reveal that there are augmented interactive roles of the β-NGFR with Integrin and Reelin receptors (RR) on the CA and P-FG, resulting in enhanced directional migration of the neuronal endings (M-NEs), layering, and the somal terminal translocation (S-TT) followed by early postnatal growth.

Keywords: Neocortical neurons (NC-Ns), Neuronal surface receptors (NSRs), Migration of the neuronal endings, Somal terminal translocation, DNA nanomechanical device, Trispecific activation/deactivation.

Lumbar artery pseudoaneurysm (LAPA) is a pathology infrequently described in the literature. The most frequent complications are the expansion and rupture of the pseudoaneurysm. Pulmonary Embolism (PE) is the third most common cause of death in hospitalized patients. It has an incidence of 39 to 112 per 100,000 habitants. Reports of association between PE with LAPA have not yet been described. We present a 53-year-old male patient with the antecedent of hypertension, blunt abdominal trauma, and chronic lumbar pain for 3 years. Incidental CT - scan showed a retroperitoneal hematoma Subsequently, he underwent resection of the retroperitoneal mass and was discharged. 10 days after, he was admitted to our emergency department presenting acute right back pain with irradiation to ipsilateral limb and right abdominal inner quadrant. Abdominal enhanced CT – scan showed right lumbar artery pseudoaneurysm with a size of 5.5×5cm associated with inferior vena cava compression. On the fourth day of hospitalization, the patient presented acute dyspnea, chest pain, and clouding of consciousness. Pulmonary CT angiography was done showing bilateral pulmonary thromboembolism. Arteriography was performed and corroborated a right lumbar artery pseudoaneurysm. He underwent mechanical thrombectomy and inferior cava vein filter placement associated with embolization of the LAPA. Left partial and total right pulmonary artery mechanical thrombectomy and inferior vein cava filter placement was performed. Selective embolization of the right lumbar artery was performed with two coils and cyanoacrylate. Final arteriography showed the successful exclusion of the pseudoaneurysm. After the embolization, our patient presented no more episodes of additional bleeding. Despite the severe clinical profile, the patient was discharged with a favorable postoperative course without complications.

Background: Venous thromboembolism (VTE) prophylaxis is an important management plan for every patient admitted to the Acute Medical Unit in a hospital. Pulmonary embolism remains as the leading cause of preventable in-hospital death. Bleeding risk and possible contraindication to antithrombotic agents must be assessed before instituting VTE thromboprophylaxis. Based on national and international thromboprophylaxis guidelines, only 40-50% of medical patients received VTE prophylaxis while 60-75% of surgical patients received VTE prophylaxis. The 2018 National Institute of Clinical Excellence (NICE) guidelines recommend to prescribe VTE prophylaxis to all admitted patients who need it within 14hours of admission. When the assessment of risk favours the use of thromboprophylaxis, low molecular weight heparin or fondaparinux should be administered.

Method: Collecting preliminary data, intervention, data collection, reviews of data, meetings with medical staff and ongoing improvement made.

Duration: August 2018 to July 2019, across a year span. 5 patients data are randomly collected every week and Microsoft excel software is used to generate the percentage.

Problem: Venous thromboembolism prophylaxis was very poorly prescribed in the acute medical unit. The preliminary data shows that less than 35% of patients were prescribed dalteparin sodium within 14hours of admission to the acute medical unit in the hospital.

Result: The data has improved from less than 35% to more than 60% and plateauing at more than 80%. In order to generate this final VTE flow chart, we have made some changes accordingly after having discussion with our junior and senior doctors including all nursing staff and quality improvement managers several times over the past months. That means all medical team have to be involved in any kind of quality improvement project for the safety of patients ultimately.

Intervention: Design a VTE flow chart based on the local hospital guideline, regional Scottish guideline and national United Kingdom, NICE guideline. This is to guide prescribers mainly the junior doctors whether to prescribe dalteparin sodium or not. A period of intervention was assigned for two months. Then, data was collected again and saw a great improvement to more than 80%. We would like to see a consistency in the practice, hence we figured out the causes in the inconsistency of the data. We intervened again by presenting this project to all medical staff. reciving feedbacks from the meeting, and made a few changes accordingly.

Conclusion: This project can be reproduced in the future to ensure a good medical practice amongst the doctors in the hospital. The same method can be easily followed. This is an ongoing QI project which will be stopped once a consistency of more than 80% of the data is achieved across a few data points. No ethics approval is required and this was checked with the QI manager before commencement.

Key message: Timing of commencement of VTE prophylaxis in line with the NICE guidelines is of great importance because this is the kind of medical problem we can prevent provided patients receive appropriate VTE prophylaxis dose within the targeted time frame.

Problem Statement: The pandemic of COVID-19 has been a global public health emergency, with not a single antiviral drug being approved for treatment so far, except for Remdesivir. We sought to evaluate the efficacy of repurposed use of Favipiravir in the clinical outcomes of mild and moderate COVID-19 cases in Nepal.

Methods: We conducted a multicenter, randomized (1:1), open labeled, phase III clinical trial among adults diagnosed with mild to moderate COVID-19 infections, as an inpatient or outpatient basis. Patients with mild symptoms were randomly assigned to receive Favipiravir (study regimen: oral form, 1800 mg twice on Day1 and then 800mg twice daily for 5 days) or matching placebo. Those with moderate symptoms were randomly allocated to receive either Favipiravir (study regimen for 10 days) or intravenous Remdesivir (200mg on Day 1, followed by 100mg once daily for 5days). The primary outcome was to evaluate for clinical improvement among both the cohorts based on treatment received. Here, we report an interim safety and efficacy analysis of the study.

Results: Between January 2021 to March 2021, a total of 90 cases (Mild: 70, Moderate: 20) with 61% being male, were enrolled from 8 different centers. The result of analysis on clinical efficacy has been as reported in the table submitted herewith. There was one minor event of increment in uric acid level and two events of elevated liver enzymes observed, however none of the adverse events required any hospital admissions or special intervention.

Conclusion: We conclude that Favipiravir has an excellent safety profile but we need to achieve a bigger sample size in order to evaluate for any possible efficacy in treatment of mild & moderate COVID-19 cases.

CYP3A4*1B is a single nucleotide polymorphism of CYP3A4 and is associated with prostate cancer which exhibits higher nifedipine oxidase activity in liver. This research provides details of the effects of structural variation and medium effects for the recently reported split-oligonucleotide (tandem) probe system for excimers-based fluorescence detection of DNA. In this approach the detection system is split at a molecular level into signal-silent components, which must be assembled correctly into a specific 3-dimensional structure to ensure close proximity of the excimer partners and the consequent excimer fluorescence emission on excitation. The model system consists of two 11-mer oligonucleotides, complementary to adjacent sites of a 22-mer DNA target. Each oligonucleotide probeis equipped with functions able to form an excimer on correct, contiguous hybridization. The extremely rigorous structural demands for excimer formation and emission required careful structural design of partners for excimer formation, which are here described. This study demonstrates that the excimer formed emitted at ~480 nm with alarge Stokes shift (~130 - 140 nm).

Cow’s milk protein allergy (CMPA) is caused by a reproducible immune-mediated response to milk proteins and tends to present during the first few months of life. This response can vary significantly from an immediate reaction within 2 hours of ingestion to a more delayed reaction, which can occur anywhere between 2 and 72 hours later. A delay in diagnosis can cause significant child and parental distress, while overdiagnosis can lead to an unnecessary elimination diet. CMPA can be confused with lactose intolerance which is a non-immune mediated response as a result of lactase enzyme deficiency. We review the diagnosis and management of CMPA in this article along with future directions.