Backgrounds
Although metered‐dose inhalers (pMDI) therapy is convenient and widely prescribed, its use usually results in repetitive inhalation technique errors.
One of the most repetitive errors is ...inhaling too fast through the pMDI. The present study aimed to evaluate the effect of Clip‐tone® along with smartphone visual feedback application on the subject's inhalation time.
Methods
Two hundred subjects were included in the study. They were randomised into four groups. Group 1 received only verbal counselling; group 2 received verbal counselling with resistance (a modified Clip‐tone® that does not produce whistle attached to their pMDI); group 3 received verbal counselling plus whistle (as audio feedback) from ordinary Clip‐tone® and group 4 received verbal counselling plus audio feedback (whistle) from Clip‐tone® and visual feedback (smartphone application). Inhalation time through the pMDI for each subject was recorded three times and inter and intra‐subjects variations were calculated.
Results
Verbal counselling plus audio feedback and verbal counselling plus audio and visual feedbacks groups had 45/50 (90%) and 37/50 (74%) subjects respectively, having correct inhalation flow (inhaling at between 3 to 7 seconds). Verbal counselling plus audio feedback and verbal counselling plus audio and visual feedbacks groups' inter and intra‐subjects variations were lower than that of verbal counselling and verbal counselling with resistance groups which had 28/50 (52%) and 20/50 (40%) subjects respectively, with inhalation time between 3 and 7 seconds.
Conclusions
Providing audio feedback by the Clip‐tone® along with smartphone visual feedback application maintained the deep and slow inhalation through pMDI much better compared to verbal counselling only. We recommend the patients to take all their inhaled doses using pMDI attached to a training device like Clip‐tone® along with a smartphone visual feedback application for optimisation of the aerosol delivery from the pMDI.
Introduction
Aerosol delivery from DPIs could be affected by different factors. This study aimed to evaluate and predict the effects of different factors on drug delivery from DPIs.
Methods
Modelling ...and optimisation for both in vitro and in vivo data of different DPIs (Diskus, Turbohaler and Aerolizer) were carried out using neural networks associated with genetic algorithms and the results are confirmed using a decision tree (DT) and random forest regressor (RFR). All variables (the type of DPI, inhalation flow, inhalation volume, number of inhalations and type of subject) were coded as numbers before using them in the modelling study.
Results
The analysis of the in vitro model showed that Turbohaler had the highest emitted dose compared with the Diskus and the Aerolizer. Increasing flow resulted in a gradual increase in the emitted dose. Little differences between the inhalation volumes 2 and 4 litres were shown at fast inhalation flow, and interestingly two inhalations showed somewhat higher emitted doses than one‐inhalation mode with Turbohaler and Diskus at slow inhalation flow. Regarding the in vivo model, the percent of drug delivered to the lung was highly increased with Turbohaler and Diskus in healthy subjects where continuous contour lines were observed. The Turbohaler showed increased lung bioavailability with the two‐inhalation modes, the Diskus showed a nearly constant level at both one and two inhalations at slow inhalation. The Turbohaler and Aerolizer showed little increasing effect moving from one to two inhalations at slow inhalation.
Conclusions
Modelling of the input data showed a good differentiating and prediction power for both in vitro and in vivo models. The results of the modelling refer to the high efficacy of Diskus followed by Turbohaler for delivering aerosol. With two inhalations, the three DPIs showed an increase in the percent of drug excreted at slow inhalations.
Objective: In many type 2 diabetes mellitus (T2DM) patients, metformin is prescribed concomitantly with hypolipidemic agents, particularly statins. Meanwhile, variability in response to metformin is ...one of the most important problems in the efficacy of this combination. The present study aims to evaluate the effect of adding atorvastatin with metformin on the glycemic control, adiposity indices, and lipid profile of overweight patients newly diagnosed with type T2DM.Methods: A total of 50 overweight patients with T2DM were allocated into two groups, the first one received 850 mg/day of sustained release metformin and the second group received 10 mg/day atorvastatin in addition to the metformin. The patients were followed for 90 days through evaluating fasting serum glucose (FSG), glycated hemoglobin (HbA1c), body mass index (BMI), visceral adiposity index (VAI), and the lipid profile at baseline and after 90 days. In addition, the safety of the protocol was monitored through the evaluation of the renal and liver functions.Results: HbA1c, FSG, BMI, and VAI values were significantly decreased in both treatment groups compared with baseline. Meanwhile, the combination improves all the lipid profile components with respect to the baseline. No significant differences reported between the two groups regarding all the measured parameters. The addition of atorvastatin produced a slight but significant negative impact on the renal and liver functions.Conclusion: Addition of 10 mg/day atorvastatin with metformin in the treatment of newly diagnosed T2DM overweight patients did not produce significant improvement in glycemic control, adiposity index, and lipid profile compared with the use of metformin alone.
The aim of this study was to evaluate the possibility of using visceral adiposity index (VAI), serum leptin, and lipid profile as indicators of impaired glucose tolerance in Iraqi obese patients.
A ...cross-sectional study was performed in Iraqi obese patients of both sexes. Body mass index (BMI), waist circumference, hip circumference, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), VAI, waist-to-hip ratio (WHR), serum leptin, and 2-h glucose tolerance test (2-h GT) were determined and compared with those of healthy non-obese control group. A correlation analysis was performed to determine the strength of association between the studied markers. Data were adjusted to determine gender differences in this regard.
Kolmogorov-Smirnov, Shapiro-Wilk analyses, Mann-Whitney
test, and unpaired
test were used for the two-group comparisons once applicable. Pearson's and Spearman's correlation analyses were used to measure the relationship levels between the studied variables.
A total of 144 obese patients were included; the mean age was 37.11 ± 8.2 years and 92 (63.9%) were females. Compared with non-obese subjects, the participants had significantly higher levels of BMI, WC, WHR, VAI, TG, leptin, and 2-h GTObese male subjects had significantly higher values of body weight, WC, HC, VAI, and TG compared with obese females. Elevated 2-h GT was significantly associated with VAI (
= 0.291,
= 0.0004), TG (
= 0.319,
= 0.0001), and LDL-C/HDL-C ratio (
= 0.435,
< 0.0001) in the obese patients only.
The results provide evidence that VAI, TG, and LDL-C/HDL-C ratio can be suggested as potential markers for the risk assessment of impaired glucose tolerance in Iraqi obese patients.
Natural language processing (NLP) is a branch of artificial intelligence (AI) that enables computers to comprehend, generate, and manipulate human language. Natural language processing can ...interrogate the data with natural language text or voice. Abstractive Text Summarization is based on the Natural Language Processing technique that tries to provide new and more concise textual summaries for huge texts. Artificial intelligence and deep learning techniques are used in abstractive summarization to examine the text's essential information and create a new summary that conveys the content more concisely and accurately. This type of summary differs from normal extractive summarizing in that it can generate new summaries beyond simply extracting key lines from the source text. This study presents an abstractive Arabic summarization based on the Multilingual T5 (MT5) model AASMT5 to address these concerns. This technique is based on deep neural networks and models like transformers, which have changed the ability to summarize text. This research has explored the various types of summarizations and highlighted the significance of two prominent techniques: abstractive and extractive summarization. This research describes a complete process for developing an Arabic abstractive summarization model using the MT5 architecture. Experiments on different datasets show that this model achieves state-of-the-art results across MT5.
Lycopene is a hydrocarbon phytochemical that is present in red vegetables and fruits, several studies reviewed the pharmacological properties of Lycopene across years ago and in different aspects ...including inflammation, cardiovascular disease, prostatic cancer and different dermatological complaints. Objective: we investigated the potential impact of two different doses of topical Lycopene and as add on therapy to Clobetasol on Psoriasis model that induced by Imiquimod in mice. Methods: This was accomplished by dividing 48 mice into six groups (8 mice per each group). All groups received Imiquimod for induction of Psoriasis (except Group I which is healthy group) across the experiment days. Group II (Induction group) received Petrolatum gel (Vaseline) for six days after 6 days induction period with Imiquimod. The rest groups III, IV,V,VI received Clobetasol propionate 0.05%, 0.125 mg/ml Lycopene, 0.25 mg/ml Lycopene and combination of 0.25 mg/ml Lycopene and 0.05% Clobetasol propionate ointments respectively once daily for six days after 6 days of induction period with Imiquimod.
This study aimed to evaluate the prevalence, multidrug-resistance traits, PCR-detection of virulence, and antibiotic-resistance genes of E. coli isolated from secondary infections following ...FMD-outbreak in cattle. A total of 160 random samples were gathered from private dairy farms in Damietta Province, Egypt. The specimens were subjected to bacteriological examination, serotyping, congo-red binding assay, antibiogram-testing, and PCR-monitoring of virulence-determinant genes (tsh, phoA, hly, eaeA, sta, and lt) as well as the antibiotic-resistance genes (bla
, bla
, and bla
). The prevalence of E. coli was 30% (n = 48) distributed in 8 serogroups (40/48, 83.3%), while 8 isolates (8/48, 16.6%) were untypable. Besides, 83.3% of the examined isolates were positive for CR-binding. The tested strains harbored the virulence genes phoA, hly, tsh, eaeA, sta, and lt with a prevalence of 100% and 50%, 45.8%, 25%, 8.4%, and 6.2%, respectively. Furthermore, 50% of the recovered strains were multidrug-resistant (MDR) to penicillins, cephalosporins, and carbapenems, and are harboring the bla
, bla
, and bla
genes. Moreover, 25% of the examined strains are resistant to penicillins, and cephalosporins, and are harboring the bla
and bla
genes. To the best of our knowledge, this is the first report concerning the E. coli secondary bacterial infections following the FMD-outbreak. The emergence of MDR strains is considered a public health threat and indicates complicated treatment and bad prognosis of infections caused by such strains. Colistin sulfate and levofloxacin have a promising in vitro activity against MDR-E. coli.
Control fabrication of metal-oxide nanocatalysts for electrochemical reactions has received considerable research attention. Here, manganese oxide (Mn
3
O
4
) nanorods modified indium tin oxide (ITO) ...electrodes were prepared based on the in-situ one-step hydrothermal methods. The nanorods were well characterized using field emission scanning electron microscopy, Fourier transform infrared, and X-ray diffraction spectroscopy. The results showed the formation of pure crystalline Mn
3
O
4
nanorods with a length of approximately 1.4 μm and a thickness of approximately 100 ± 30 nm. The Mn
3
O
4
nanorod-modified ITO electrodes were used for accelerating urea electrochemical oxidation at room temperature using cyclic and square wave voltammetry techniques. The results indicated that the modified electrode demonstrated excellent electrocatalytic performance toward urea electrooxidation in an alkaline medium over concentrations ranging from 0.2 to 4 mol/L. The modified electrode showed high durability, attaining more than 88% of its baseline performance after 150 cycles; furthermore, the chronoamperometry technique demonstrated high stability. Thus, the Mn
3
O
4
nanorod-modified ITO electrode is a promising anode for direct urea fuel cell applications.
Global population ageing is creating immense pressures on hospitals and other healthcare services, compromising their abilities to meet the growing demand from elderly patients. Current demand–supply ...gaps result in prolonged waiting times in emergency departments (EDs), and several studies have focused on improving ED performance. However, the overcrowding in EDs generally stems from delayed patient flows to inpatient wards – which are congested with inpatients waiting for beds in post-acute facilities. This problem of bed blocking in acute hospitals causes substantial cost burdens on hospitals. This study presents a system dynamics methodology to model the dynamic flow of elderly patients in the Irish healthcare system aimed at gaining a better understanding of the dynamic complexity caused by the system's various parameters. The model evaluates the stock and flow interventions that Irish healthcare executives have proposed to address the problem of delayed discharges, and ultimately reduce costs. The anticipated growth in the nation's demography is also incorporated in the model. Policy makers can also use the model to identify the potential strategic risks that might arise from the unintended consequences of new policies designed to overcome the problem of the delayed discharge of elderly patients.
•An application of system dynamics in examining bed blockage at Irish hospitals.•Implications of future demands including changes in demography are considered.•Interventions using stock (post-acute beds) and flow (elderly patients) policies.•Increasing capacity in post-acute beds is a counter-intuitive policy.•Integrated solution is required to mitigate the bed blockage problem at large.
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