Textile Wastewater Ecotoxicity Abatement after Aerobic Granular Sludge Treatment and Advanced Oxidation Process
Textile effluents are usually heavily loaded with organic carbon and color compounds, the latter being azo dyes in an estimated 70% of the case effluent posing a major challenge in environmental protection. In this study, the ecotoxicity of simulated textile effluent after biological treatment with anaerobic and aerobic phase (aerobic granular sludge, AGS) and after advanced oxidation processes (AOP) namely ozonation and UV irradiation as post-treatment, were tested to evaluate the fitness of this treatments for ecotoxicity abatement. AGS treatment achieved an 80% removal in both COD and color. AOP was applied with the intention to mineralize the metabolites resulting from biodecolorization of the azo dye Acid Red 14, especially the stable aromatic amine (4-amino-1-naphthalenesulfonic acid, 4A1NS). The ecotoxicity evaluation was based on growth inhibition of the algae Pseudokirchneriella subcapitata following OECD TG 201 except regarding the medium, MBL medium was used instead. Five replicate control cultures and samples were performed with an average STD of 2.7% regarding specific algae growth rate determination. It was found that untreated textile effluent holds an inhibition of specific growth rate of 82%. AGS treatment by itself is able to lower ecotoxicity to 53%. This is probably due to the high color removal of the treatment. AOP post-treatment with Ozone and UV irradiation improves the ecotoxicity abatment to 49 and 43% inhibition respectively, less significantly than previously thought. Since over 85% of 4A1NS was removed by either of the AOP (followed by HPLC), an individual ecotoxicity test of 4A1NS was performed showing that 4A1NS does not inhibit algae growth (0% inhibition). It was concluded that AGS treatment is able by itself to achieve a significant ecotoxicity abatement of textile effluent. The cost-benefit of AOP as a post-treatment have to be better accessed since their application resulted in an improvement of only 10% regarding ecotoxicity effluent removal. It was also found that the 4A1NS amine had no apparent effect on ecotoxicity. Further studies will be conducted to study where ecotoxicity is coming from after AGS biological treatment and how to eliminate it.
Role of Interleukin 6 on Cell Differentiations in Stem Cells Isolated from Human Exfoliated Deciduous Teeth
Interleukin 6 (IL-6) is a multifunctional cytokine, regulating various biological responses in several tissues. A Recent study shows that IL-6 plays a role in stemness maintenance in stem cells isolated from human exfoliated deciduous teeth (SHEDs). However, the role of IL-6 on cell differentiation in SHEDs remains unknown. The present study investigated the effect of IL-6 on SHEDs differentiation. Cells were isolated from dental pulp tissues of human deciduous teeth. Flow cytometry was used to determined mesenchymal stem cell marker expression, and the multipotential differentiation (osteogenic, adipogenic and neurogenic lineage ) was also determined. The mRNA was determined using real-time quantitative polymerase chain reaction, and the phenotypes were confirmed by chemical and immunofluorescence staining. Results demonstrated that SHEDs expressed CD44, CD73, CD90, CD105 but not CD45. Further, the up-regulation of osteogenic, adipogenic and neurogenic marker genes was observed upon maintaining cells in osteogenic, adipogenic and neurogenic induction medium, respectively. The addition of IL-6 induced osteogenic by up-regulated osteogenic marker gene also increased in vitro mineralization. Under neurogenic medium supplement with IL-6, up-regulated neurogenic marker. Whereas, an addition of IL-6 attenuated adipogenic differentiation by SHEDs. In conclusion, this evidence implies that IL-6 may participate in cells differentiation ability of SHEDs.
Impact of Kinesio Taping on Masseter Muscle: An Electromyographic Study
The incidence of temporomandibular disorders is 50% up to 80%. Kinesio taping (KT) is treatment method for musculoskeletal disorders. The aim of our study was to assess the impact of KT on masseter muscles’ tone evaluated by electromyography. 30 adults (aged 22±2.1) were examined. The tone of masseters before and after 4 days KT application on sternocleidomastoideus muscle was measured during resting mandibular position and clenching. Noraxon DTS device was used. Masseter muscles’ tone during clenching after KT application was relevently lower in comparison to its tone before the KT.
Exploring Transdisciplinary Process as Collaborative Occupation for Assistive Technology Selection
Purpose: Occupational therapy and occupational science have emphasized their interdisciplinary origins and intentions. Today, the importance of transdisciplinary teamwork has been increasingly emphasized in a wide range of areas. However, the transdisciplinary process, how members collaborate, communicate, and transcend the borders of their disciplines, is still unclear. In this study, the transdisciplinary process of assistive technology selection was considered as collaborative occupation and explored the perspective of forms and meanings. Method: The study employed qualitative descriptive study methods. The decision-making process of selecting assistive technology (AT) transdisciplinary professionals, a collaborative occupation, was studied with two purposefully selected teams belonging to public rehabilitation counseling centers. First, the two teams were observed during the selection process for optimal AT for a simulated client with spinal cord injury. Then, the team members were interviewed about how their regular practices differed from the simulation, and meanings and reasons for their performance in the transdisciplinary team. The observation data was background for and supplement to the interviews. Interview data was analyzed based on a modified grounded theory method, conceptualized, defined, and categorized. Trustworthiness was established through triangulation of data collection, peer debriefing, and presentations to a range of audience. Results: The meaning, 'finding a vital tool for the client', was shared by the members. To purse this meaning, they also shared the questions of 'Who is the client?', 'What is necessary to improve the client’s quality of life and future?' and 'How would AT affect the client?' A collaborative occupation, transdisciplinary decision-making process, comprised various form of subordinate occupations, such as intake, home visit and physical exam. No member participated in all subordinate occupations, and there was no meeting in which all members participated. Each subordinate occupation had a particular purpose and one to three members, whose disciplines were closely related to the purpose, participated in these subordinate occupations. Transboundary knowledge was gradually widened through the process of subordinate occupations. The members communicated not only verbally, but also tacitly through questions asked of the client by other discipline members. Their knowledge became transboundary, since the gained knowledge contained that of multiple members. The shared meaning, basic questions and transdisciplinary interchanges contributed widened knowledge to converge into shared assumptions of optimal AT. Through the series of sub-occupations, the decision for selection of optimal AT became gradually concrete. Conclusion: These findings, viewing the transdisciplinary process as collaborative occupation, add to our understanding of teamwork and revealed the usefulness of an occupational lens for exploring the selection of optimal assistive technology with transdisciplinary practice. The findings can also serve to facilitate structuring transdisciplinary practice and research in collaborative occupations in other areas of occupational therapy and occupational science.
Expression Profiling and Immunohistochemical Analysis of Squamous Cell Carcinoma of Head and Neck (Tumor, Transition Zone, Normal) by Whole Genome Scale Sequencing
The possibility to determine genome-wide expression profiles of cells and tissues opens a new level of analysis in the quest to define dysregulation in malignancy and thus identify new tumor markers. Toward this long-term aim, we here address two issues on this level for head and neck cancer specimen: i) defining profiles in different regions, i.e. the tumor, the transition zone and normal control and ii) comparing complete data sets for seven individual patients. Special focus in the flanking immunohistochemical part is given to adhesion/growth-regulatory galectins that upregulate chemo- and cytokine expression in an NF-κB-dependent manner, to these regulators and to markers of differentiation, i.e. keratins. The detailed listing of up- and down-regulations, also available in printed form (1), not only served to unveil new candidates for testing as marker but also let the impact of the tumor in the transition zone become apparent. The extent of interindividual variation raises a strong cautionary note on assuming uniformity of regulatory events, to be noted when considering therapeutic implications. Thus, a combination of test targets (and a network analysis for galectins and their downstream effectors) is (are) advised prior to reaching conclusions on further perspectives.
Changes in Systolic and Diastolic Blood Pressures and Cardiovascular Events
Background: Blood pressure (BP) tends to change between visits in both normotensive and hypertensive people. We hypothesized that given baseline BP values, the subsequent changes in BP components may add predictive information for cardiovascular events. Methodology: To address this question, we used data from an ongoing prospective cohort study on non-communicable diseases, named 'Tehran Lipid and Glucose Study', from a region with a high burden of cardiovascular disease. We investigated 3569 middle-aged subjects (1521 men), who had no history of cardiovascular events, and for whom systolic and diastolic BPs had been measured and recorded in two consecutive visits, three years apart from each other. After the second visit, subjects were followed on an annual basis for cardiovascular events. Multivariate sex-adjusted Cox Proportional Hazards models were built for systolic and diastolic changes, and were further adjusted for baseline BP values and other common cardiovascular risk factors (including age, family history of premature cardiovascular events, diabetes mellitus, taking antihypertensive medication, smoking, hypercholesterolemia, level of education, estimated glomerular filtration rate, body mass index, and waist circumference). In a separate model, further adjustment was performed for changes in the other BP component to see if the associations for systolic and diastolic BP changes are independent from each other. Results: During a median 6.09-year follow-up, 303 cardiovascular events occurred (257 coronary heart diseases, 46 strokes). After adjustment for baseline BP values and traditional risk factors, each 13.8 mmHg increase in systolic and 9.14 mmHg increase in diastolic BPs were associated with 21% [hazard ratio 1.21 (95% confidence interval: 1.01-1.24) and 22% [hazard ratio 1.22(95% confidence interval: 1.09-1.37) increased risk of cardiovascular diseases, respectively. However, after further adjustment for changes in the other BP component, the significant association of systolic BP disappeared (p-value 0.8), and only diastolic BP change showed an independent predictive role [hazard ratio 1.21 (95% confidence interval: 1.05-1.39). Conclusion: In this middle-aged general population, both systolic and diastolic BP changes added predictive information to the baseline BP values for cardiovascular diseases. However, the association of systolic BP change was not independent from diastolic BP change. Hence, in practice, clinicians may need to consider changes in diastolic BP in addition to baseline BP values for assessing future cardiovascular risk.
Current versus Cumulative Adiposity and Chronic Kidney Disease
Background: In this study, we aimed to compare the impact of current values of general and abdominal adiposity versus their duration on incident chronic kidney disease (CKD). Methodology: We used data of an ongoing prospective cohort on non-communicable diseases named 'Tehran Lipid and Glucose Study', from a region with a high prevalence of CKD. Overall, 4432 subjects (1915 men) aged over 20 years old, without history of CKD at baseline, who were followed in five consecutive triennial visits, were included in the analyses. To evaluate the role of current adiposity, we used time-varying body mass index (BMI) and time-varying waist circumference (WC) as exposure variables. To assess the role of cumulative adiposity, we defined the cumulative excess weight (CEW) and cumulative excess WC (CEWC) scores as representatives of both duration and degree of general and abdominal adiposity, respectively. CEW (kg/m²×years)/CEWC (cm×years) scores were calculated by multiplying the average of the deviations of BMI/WC from normal values (i.e. BMI of 25 kg/m² and WC of 90 cm) for each two consecutive visits, by the time interval between those visits (years). Time-varying sex-stratified multivariable Cox proportional hazard models were applied to explore the association of each exposure variable with incident CKD, after further adjustment for common risk factors including age, smoking, hypertension, diabetes, total cholesterol, high-density lipoprotein cholesterol, low physical activity, and the level of education. Hazard ratios were determined for 1-SD change of each exposure variable. Results: During a median 8.93-year follow-up, 1297 subjects developed CKD. Our results did not reveal any significant associations between the current levels of BMI/WC with CKD (all p-values > 0.05). Regarding cumulative adiposity, although CEW was associated with increased CKD risk, this association was only significant among men (HR 1.11 for each 26.36 kg/m²×years increase in CEW, 95% CI 1.0-1.22). CEWC showed no association with CKD in both genders. Conclusion: Our findings introduce cumulative general adiposity, measured by CEW score, as an independent risk factor for CKD among men. It may be important to consider the duration of excess weight besides its degree when determining CKD risk in men; since, given enough time, being overweight may cause equal risk for CKD as obesity.
Homing of B Cells via Afferent Lymphatics
While the entry mechanism of lymphocytes into the lymph node via the blood are well described, it is still largely unknown how cells enter lymph nodes that arrive via afferent lymphatics. In order to address this, our group has established a micro-injection technique in mice through which cells are delivered directly into the lymphatic vessel immediately afferent to the popliteal lymph node. Injected cells can then be tracked via multi-colour fluorescence or 2-photon microscopy, and their localization can be analysed within the popliteal or downstream lymph nodes by immunohistology. Since naïve B cells express the chemokine receptor CXCR5 we intra-lymphatically co-injected B cells derived from wildtype and Cxcr5-deficient mice. While CXCR5 does not play a role in guiding B cells out of the subcapsular sinus, it affects their positioning within the lymph node parenchyma, since CXCR5-deficient B cells are impaired in migrating into the B cell follicle. The knowledge obtained by studying B-cell migration may prove beneficial in clinical settings regarding tumor metastasis or autoimmune diseases.
Detection of Curvilinear Structure via Recursive Anisotropic Diffusion
The detection of curvilinear structures often plays an important role in the analysis of images. In particular, it is considered as a crucial step for the diagnosis of chronic respiratory diseases to localize the fissures in chest CT imagery where the lung is divided into five lobes by the fissures that are characterized by linear features in appearance. However, the characteristic linear features for the fissures are often shown to be subtle due to the high-intensity variability, pathological deformation or image noise involved in the imaging procedure, which leads to the uncertainty in the quantification of anatomical or functional properties of the lung. Thus, it is desired to enhance the linear features present in the chest CT images so that the distinctiveness in the delineation of the lobe is improved. We propose a recursive diffusion process that prefers coherent features based on the analysis of structure tensor in an anisotropic manner. The local image features associated with certain scales and directions can be characterized by the eigenanalysis of the structure tensor that is often regularized via isotropic diffusion filters. However, the isotropic diffusion filters involved in the computation of the structure tensor generally blur geometrically significant structure of the features leading to the degradation of the characteristic power in the feature space. Thus, it is required to take into consideration of local structure of the feature in scale and direction when computing the structure tensor. We apply an anisotropic diffusion in consideration of scale and direction of the features in the computation of the structure tensor that subsequently provides the geometrical structure of the features by its eigenanalysis that determines the shape of the anisotropic diffusion kernel. The recursive application of the anisotropic diffusion with the kernel, the shape of which is derived from the structure tensor leading to the anisotropic scale-space where the geometrical features are preserved via the eigenanalysis of the structure tensor computed from the diffused image. The recursive interaction between the anisotropic diffusion based on the geometry-driven kernels and the computation of the structure tensor that determines the shape of the diffusion kernels yields a scale-space where geometrical properties of the image structure are effectively characterized. We apply our recursive anisotropic diffusion algorithm to the detection of curvilinear structure in the chest CT imagery where the fissures present curvilinear features and define the boundary of lobes. It is shown that our algorithm yields precise detection of the fissures while overcoming the subtlety in defining the characteristic linear features. The quantitative evaluation demonstrates the robustness and effectiveness of the proposed algorithm for the detection of fissures in the chest CT in terms of the false positive and the true positive measures. The receiver operating characteristic curves indicate the potential of our algorithm as a segmentation tool in the clinical environment.
Comparison between High Resolution Ultrasonography and Magnetic Resonance Imaging in Assessment of Musculoskeletal Disorders Causing Ankle Pain
There are various causes of ankle pain including traumatic and non-traumatic causes. Various imaging techniques are available for assessment of AP. MRI is considered to be the imaging modality of choice for ankle joint evaluation with advantage of its high spatial resolution, multiplanar capability, hence its ability to visualize small complex anatomical structures around the ankle. However, the high costs and the relative limited availability of MRI systems, as well as the relatively long duration of the examination all are considered disadvantages of MRI examination. Therefore there is a need for a more rapid and less expensive examination modality with good diagnostic accuracy to fulfill this gap. HRU has become increasingly important in the assessment of ankle disorders, with advantages of being fast, reliable, of low coast and readily available. US can visualize detailed anatomical structures and assess tendinous and ligamentous integrity. The aim of this study was to compare the diagnostic accuracy of HRU with MRI in the assessment of patients with AP. We included forty patients complaining of AP. All patients were subjected to real time HRU and MRI of the affected ankle. Results of both techniques were compared to surgical and arthroscopic findings. All patients were examined according to a define protocol that include imaging the tendon tears or tendinitis, muscle tears, masses, or fluid collection, ligament sprain or tears, inflammation or fluid effusion within the joint or bursa, bone and cartilage lesions, erosions and osteophytes. Analysis of the results showed that the mean age of patients was 38 years. The study comprised of 24 women (60%) and 16 men (40%). The accuracy of HRU in detecting causes of AP was 85%, while the accuracy of MRI in detection of causes of AP was 87.5%. In conclusions: HRU and MRI are two complementary tools of investigation with the former will be used as primary tool of investigation and the latter will be used to confirm the diagnosis and the extent of the lesion especially when surgical interference is planned.
Efficacy of Preimplantation Genetic Screening in Women with a Spontaneous Abortion History with Eukaryotic or Aneuploidy Abortus
Most spontaneous miscarriage is believed to be a consequence of embryo aneuploidies. Transferring eukaryotic embryos selected by PGS is expected to decrease the miscarriage rate. Current PGS indications include advanced maternal age, recurrent pregnancy loss, repeated implantation failure. Recently, use of PGS for healthy women without above indications for the purpose of improving in vitro fertilization (IVF) outcomes is on the rise. However, it is still controversy about the beneficial effect of PGS in this population, especially, in women with a history of no more than 2 miscarriages or miscarriage of eukaryotic abortus. This study aimed to investigate if karyotyping result of abortus is a good indicator of preimplantation genetic screening (PGS) in subsequent IVF cycle in women with a history of spontaneous abortion. A single-center retrospective cohort study was performed. Women who had spontaneous abortion(s) (less than 3) and dilatation and evacuation, and subsequent IVF from January 2016 to November 2016 were included. Their medical information was extracted from the charts. Clinical pregnancy was defined as presence of a gestational sac with fetal heart beat detected on ultrasound in week 7. Statistical analysis was performed using SPSS software. Total 234 women were included. 121 out of 234 (51.7%) underwent karyotyping of the abortus, and 113 did not have the abortus karyotyped. Embryo biopsy was performed on 3 or 5 days after oocyte retrieval, followed by embryo transfer (ET) on a fresh or frozen cycle. The biopsied materials were subjected to microarray comparative genomic hybridization. Clinical pregnancy rate per ET was compared between PGS and non-PGS group in each study group. Patients were grouped by two criteria: karyotype of the abortus from previous miscarriage (unknown fetal karyotype (n=89, Group 1), eukaryotic abortus (n=36, Group 2) or aneuploidy abortus (n=67, Group 3)), and pursuing PGS in subsequent IVF cycle (pursuing PGS (PGS group, n=105) or not pursuing PGS (non-PGS group, n=87)). The PGS group was significantly older and had higher number of retrieved oocytes and prior miscarriages compared to non-PGS group. There were no differences in BMI and AMH level between those two groups. In PGS group, the mean number of transferable embryos (eukaryotic embryo) was 1.3 ± 0.7, 1.5 ± 0.5 and 1.4 ± 0.5, respectively (p = 0.049). In 42 cases, ET was cancelled because all embryos biopsied turned out to be abnormal. In all three groups (group 1, 2, and 3), clinical pregnancy rates were not statistically different between PGS and non-PGS group (Group 1: 48.8% vs. 52.2% (p=0.858), Group 2: 70% vs. 73.1% (p=0.730), Group 3: 42.3% vs. 46.7% (p=0.640), in PGS and non-PGS group, respectively). In both groups who had miscarriage with eukaryotic and aneuploidy abortus, the clinical pregnancy rate between IVF cycles with and without PGS was not different. When we compare miscarriage and ongoing pregnancy rate, there were no significant differences between PGS and non-PGS group in all three groups. Our results show that the routine application of PGS in women who had less than 3 miscarriages would not be beneficial, even in cases that previous miscarriage had been caused by fetal aneuploidy.
Influential Health Care System Rankings Can Conceal Maximal Inequities: A Simulation Study
Background: Comparative rankings are increasingly used to evaluate health care systems. These rankings combine discrete attribute rankings into a composite overall ranking. Health care equity is a component of overall rankings, but excelling in other categories can counterbalance low inequity grades. Highly ranked inequitable health care would commend systems that disregard human rights. We simulated the ranking of a maximally inequitable health care system using a published, influential ranking methodology. Methods: We used The Commonwealth Fund’s ranking of eleven health care systems to simulate the rank of a maximally inequitable system. Eighty performance indicators were simulated, assuming maximal ineptitude in equity benchmarks. Maximal rankings in all non-equity subcategories were assumed. Subsequent stepwise simulations lowered all non-equity rank positions by one. Results: The maximally non-equitable health care system ranked first overall. Three subsequent stepwise simulations, lowering non-equity rankings by one, each resulted in an overall ranking within the top three. Discussion: Our results demonstrate that grossly inequitable health care systems can rank highly in comparative health care system rankings. These findings challenge the validity of ranking methodologies that subsume equity under broader benchmarks. We advocate limiting maximum overall rankings of health care systems to their individual equity rankings. Such limits are logical given the insignificance of health care system improvements to those lacking adequate health care.
Host Responses in Peri-Implant Tissue in Comparison to Periodontal Tissue
Objective: To investigate the baseline expression of host inflammatory cytokines in peri-implant tissue in comparison to periodontal tissue. Materials and Methods: A total of 19 patients with healthy implant and periodontium were included in the study with written consent form. Gingival crevicular fluid (GCF) and Peri-implant crevicular fluid (PICF) were collected from periodontal and peri-implant sulci respectively, by using sterile paper points. Pro-inflammatory cytokines were assessed using the enzyme-linked immunosorbent assay (ELISA). The concentration of IL-1α, IL-1β, IL-6, IL-8, TNF-α, and IFN-γ was compared between samples from implant and teeth. Results: The concentration of total protein in PICF from healthy implants was higher than in GCF from teeth. While the expression of IL-6, IL-8, TNF-α, and IFN-γ were not statistically different between implant and teeth, the concentration of IL-1α and IL-1β were significantly higher in PICF from implants. Conclusion: Within the limitations of this study design, it can be concluded that the host response of peri-implant and periodontal tissues, as assessed by cytokine levels in PICF and GCF, is different.
Coping Strategies among Caregivers of Children with Autism Spectrum Disorders: A Cluster Analysis
Background/Significance: Caregivers of children with Autism Spectrum Disorders (ASD) develop coping mechanisms to overcome daily challenges to successfully parent their child. There is variability in coping strategies used among caregivers of children with ASD. Capturing homogeneity among such variable groups may help elucidate targeted intervention approaches for caregivers of children with ASD. Study Purpose: This study aimed to identify groups of caregivers of children with ASD based on coping mechanisms, and to examine whether there are differences among these groups in terms of strain level. Methods: This study utilized a secondary data analysis, and included survey responses of 273 caregivers of children with ASD. Measures consisted of the COPE Inventory and the Caregiver Strain Questionnaire. Data analyses consisted of cluster analysis to group caregiver coping strategies, and analysis of variance to compare the caregiver coping groups on strain level. Results: Cluster analysis results showed four distinct groups with different combinations of coping strategies: Social-Supported/Planning (group one), Spontaneous/Reactive (group two), Self-Supporting/Reappraisal (group three), and Religious/Expressive (group four). Caregivers in group one (Social-Supported/Planning) demonstrated significantly higher levels than the remaining three groups in the use of the following coping strategies: planning, use of instrumental social support, and use of emotional social support, relative to the other three groups. Caregivers in group two (Spontaneous/Reactive) used less restraint relative to the other three groups, and less suppression of competing activities relative to the other three groups as coping strategies. Also, group two showed significantly lower levels of religious coping as compared to the other three groups. In contrast to group one, caregivers in group three (Self-Supporting/Reappraisal) demonstrated significantly lower levels of the use of instrumental social support and the use of emotional social support relative to the other three groups. Additionally, caregivers in group three showed more acceptance, positive reinterpretation and growth coping strategies. Caregivers in group four (Religious/Expressive) demonstrated significantly higher levels of religious coping relative to the other three groups and utilized more venting of emotions strategies. Analysis of Variance results showed no significant differences between the four groups on the strain scores. Conclusions: There are four distinct groups with different combinations of coping strategies: Social-Supported/Planning, Spontaneous/Reactive, Self-Supporting/Reappraisal, and Religious/Expressive. Each caregiver group engaged in a combination of coping strategies to overcome the strain of caregiving.
Intentional Poisoning in Paediatric Patients: Examining the Risk Factors
Background: Poisonings in children are a significant cause of presentation to the emergency department and can potentially have serious complications. Intentional self-poisoning poses a significant clinical and psychosocial burden, which is often underestimated. We aim to evaluate the characteristics, risk factors and outcomes of patients who present with intentional poisoning, which will provide valuable information for the design of preventive measures. Methodology: A retrospective medical record review of all intentional paediatric poisoning cases presenting to the Children’s Emergency at National University Hospital (NUH), Singapore between January 2014 and December 2015 was carried out. Demographic information and data on risk factors and outcomes were collected. Results: Of the 186 poisoning cases identified, 88 cases were intentional poisonings, of which 31 (36.5%) were with suicidal intent. The mean age was 16.2 (range 13.4 to 18.5 years). Majority of cases were female (85.1%) and adolescents 16 years and older (93.1%). A known psychiatric history was present in 57.5%, with majority comprising mood disorders (76.0%), and/or personality disorders/traits (34.0%). Sixty-two (71.3%) had a history of deliberate self-harm. Twenty-seven (31.0%) of the cases had a history of intentional poisoning, while 15 (17.2%) went on to have subsequent presentations for poisoning. A history of intentional poisoning was independently associated with a known psychiatric history (p=0.007, OR 5.91, 95% CI 1.62-21.58) and history of deliberate self-harm (p=0.020, OR 7.49, 95% CI 1.38-40.66). Deliberate overdosing on personal long-term medication was seen in 15/42 (35.7%), of which 12/15 (80%) were psychiatric indications. However in general, paracetamol was the most common substance implicated (60.9%). In terms of outcomes, seventy (83.3%) patients presented within 12 hours to the emergency department. Presentation within 12 hours was associated with known psychiatric diagnosis (p=0.013, OR=6.169, 95% CI 1.47-25.83) and suicidal intent (p= 0.009, OR=6.96, CI 1.62-29.9). Sixty-three (72.4%) cases required admission. However, only 1(1.1%) and 3 (3.4%) cases required admission to the High Dependency Unit and Intensive Care Unit respectively. Among those admitted, 35(59%) required medical admission for ≥3 days. Suicidal intent was significantly associated with admission for ≥3 days for medical indications (p=0.020, OR 5.33, 95% CI 1.30-21.86). Most episodes of poisoning were mild, with 80(92.0%) children having a Poisoning Severity Score (PSS) severity grade of 1(None or minor). Among patients with no known psychiatric history, 21/37 (56.8%) received a new diagnosis during the episode. Receiving a new psychiatric diagnosis was associated with a history of self-harm (p=0.045, OR 6.74, 95% CI 1.04-43.62). Conclusion: Female adolescents, a known psychiatric history or a history of deliberate self-harm are risk factors for intentional poisoning. Although paracetamol was the most common substance taken, psychiatric drugs made up a significant proportion of drugs ingested. Appropriate risk stratification and pre-emptive interventions involving closer surveillance or cognitive behavioural programs are possible measures to prevent intentional self-poisoning, especially in these at-risk groups of patients.
Evaluating the Characteristics of Paediatric Accidental Poisonings
Background: While accidental poisonings in children may seem unavoidable, knowledge of circumstances surrounding such incidents and identification of risk factors is important in the development of secondary prevention strategies. Some risk factors include age of the child, lack of adequate supervision and improper storage of substances. The aim of this study is to assess risk factors and circumstances influencing outcomes in these children. Methodology: A retrospective medical record review of all accidental poisoning cases presenting to the Children’s Emergency at National University Hospital (NUH), Singapore between January 2014 and December 2015 was conducted. Information on demographics, poisoning circumstances and clinical outcomes were collected. Results: Ninety-nine of a total of 186 poisoning cases were accidental ingestions, with a mean age of 4.7 (range 0.4 to 18.3 years). The gender distribution is rather equal with 52(52.5%) females and 47(47.5%) males. Seventy-nine (79.8%) were self-administered by the child and in 20 cases (20.2%), the substance was administered erroneously by caregivers 12/20 (60.0%) of whom were given the wrong drug dose while 8/20 (40.0%) were given the wrong substance. Self-administration was associated with presentation to the ED within 12 hours (p=0.027, OR 6.65, 95% CI 1.24-35.72). Notably, 94.9% of the cases involved substances kept within reach of the child. Sixty-nine (82.1%) had the substance kept in the original container, 3(3.6%) in food containers, 8(9.5%) in other containers and 4(4.8%) without a container. Of the 50 cases with information on labelling, 40/50(80.0%) were accurately labelled, 2/50 (4.0%) wrongly labelled, and 8/50 (16.0%) were unlabelled. Implicated substances included personal care products (11.1%), household cleaning products (3.0%), and different classes of drugs such as paracetamol (22.2%), antihistamines (17.2%) and sympathomimetics (8.1%). Children < 3 years of age were 4.8 times more likely to be poisoned by household substances than children >3 years of age (p=0.009, 95% CI 1.48-15.77). Prehospital interventions were more likely to have been done in poisoning with household substances (p=0.005, OR 6.12 95% CI 1.73-21.68). Fifty-nine (59.6%) were asymptomatic, 34 (34.3%) had a Poisoning Severity Score (PSS) grade of 1 (minor) and 6 (6.1%) grade 2 (moderate). Older children were 9.3 times more likely to be symptomatic (p< 0.001, 95% CI 3.15-27.25). Thirty (32%) required admission. Conclusion: A significant proportion of accidental poisoning cases were due to medication administration errors by caregivers, which should be preventable. Risk factors for accidental poisoning included lack of adequate caregiver supervision, improper labelling and young age of the child. There is an urgent need to improve caregiver counselling during medication dispensing as well as to educate caregivers on basic child safety measures in the home to prevent future accidental poisonings.
Alleviation of Endoplasmic Reticulum Stress in Mosquito Cells to Survive Dengue 2 Virus Infection
Dengue viruses (DENVs) are naturally transmitted between humans by mosquito vectors. Mosquito cells usually survive DENV infection, allowing infected mosquitoes to retain an active status for virus transmission. In this study, we found that DENV2 virus infection in mosquito cells causes the unfolded protein response (UPR) that activates the protein kinase RNA-like endoplasmic reticulum kinase (PERK) signal pathway, leading to shutdown of global protein translation in infected cells which was apparently regulated by the PERK signal pathway. According to observation in this study, the PERK signal pathway in DENV2-infected C6/36 cells alleviates ER stress, and reduces initiator and effector caspases, as well as the apoptosis rate via shutdown of cellular proteins. In fact, phosphorylation of eukaryotic initiation factor 2ɑ (eIF2ɑ) by the PERK signal pathway may impair recruitment of ribosomes that bind to the mRNA 5’-cap structure, resulting in an inhibitory effect on canonical cap-dependent cellular protein translation. The resultant pro-survival “byproduct” of infected mosquito cells is undoubtedly advantageous for viral replication. This finding provides insights into elucidating the PERK-mediated modulating web that is actively involved in dynamic protein synthesis, cell survival, and viral replication in mosquito cells.
A Comparison between the McGrath Video Laryngoscope and the Macintosh Laryngoscopy in Children with Expected Normal Airway
Background: This prospective, randomized, controlled study was performed to evaluate the usefulness of the McGrath VL compared to Macintosh laryngoscopy in children with expected normal airway during endotracheal intubation, by comparing the time to intubation and ease of intubation.
Methods: Eighty-four patients, aged 1-10 years undergoing endotracheal intubation for elective surgery were randomly assigned to McGrath group (n = 42) or Macintosh group (n = 42). Anesthesia was induced with propofol 2.5-3.0 mg/kg and sevoflurane 5-8 vol%. Orotracheal intubation was performed 2 minutes after injection of rocuronium 0.6 mg/kg with McGrath VL or Macintosh laryngoscope. The primary outcome was time to intubation. The Cormack and Lehane glottic grade, intubation difficulty score (IDS), and success rate of intubation were assessed. Hemodynamic changes also were recorded.
Results: Median time to intubation [interquartile range] was not different between the McGrath group and the Macintosh group (25.0 [22.8-28.3] s vs. 26.0 [24.0-29.0] s, p = 0.301). The incidence of grade I glottic view was significantly higher in theMcGrath group than in the Macintosh group (95% vs. 74%, p = 0.013). Median IDS was lower in the McGrath group than in the Macintosh group (0 [0-0] vs. 0 [0-1], p = 0.018). There were no significant differences in success rate on intubation or hemodynamics between the two groups.
Conclusions: McGrath VL provides better laryngeal views and lower IDS, but similar intubation times and success rates compared to the Macintosh laryngoscope in children with the normal airway.
The Emotional Life of Patients with Chronic Diseases: A Framework for Health Promotion Strategies
Being a patient with a chronic disease is both a physical and emotional experience. The ability to recognize a patient’s emotional health is an important part of a health care provider’s skills. For purposes of this paper, emotional health is viewed as the way that we feel, and the way that our feelings affect us. Understanding the patient’s emotional health leads to improved provider-patient relationships and health outcomes. For example, when a patient first hears his or her diagnosis from a provider, they might find it difficult to cope with their emotions. Struggling to cope with emotions interferes with the patient’s ability to read, understand, and act on health information and services. As a result, the patient becomes more frustrated and confused, creating barriers to accessing healthcare services. These barriers are challenging for both the patient and their healthcare providers. There are five basic emotions that are part of who we are and are always with us: fear, anger, sadness, joy, and compassion. Living with a chronic disease however can cause a patient to experience and express these emotions in new and unique ways. Within the provider-patient relationship, there needs to be an understanding that each patient experiences these five emotions and, experiences them at different times. In response to this need, the proposed presentation highlights a health promotion framework for patients with chronic disease. This framework emphasizes the emotional health of patients.
Effects of Narghile Smoking in Tongue, Trachea and Lung
The effects that may be related to narghile smoking in the tissues of the oral cavity, trachea and lung and associated inflammation has been the question raised lately. The objective of this study was to identify histopathological changes and the presence of inflammation through the exposure of mice to narghile smoking through a whole-body study. The animals were divided in 4 groups with 5 animals in each group, being: one control group, one with 7 days of exposure, 15 days and the last one with 30 days. The animals were exposed to the conventional hookah smoke from Mizo brand with 0.5% percentage of unwashed tobacco and the EcOco brand coconut fiber having a dimension of 2cm × 2cm. The duration of the session was 30 minutes / day per 7, 15 and 30 days. The tobacco smoke concentration at which test animals were exposed was 35 ml every two seconds while the remaining 58 seconds were pure air. Afterward, the mice were sacrificed and submitted to histological evaluation through slices. It was found in the tongue of the 7-day group the presence in epithelium areas with acanthosis, hyperkeratosis and epithelial projections. In-depth, more intense inflammation was observed. All alteration processes increased significantly as the days of exposure increased. In trachea, with the 7-day group, there was a decrease in thickening of the pseudostratified epithelium and a slight decrease in lashes, giving rise to the metaplasia process, a process that was established in the 31-day sampling when the epithelium became stratified. In the conjunctive tissue, it was observed the presence of defense cells and formation of new vessels, evidencing the chronic inflammatory process, which decreased in the course of the samples due to the deposition of collagen fibers as seen in the 15 and 31 days groups. Among the structures of the lung, the study focused on the bronchioles and alveoli. From the 7-day group, intra-alveolar septum thickness increased, alveolar space decreased, inflammatory infiltrate with mononuclear and defense cells and new vessels formation were observed, increasing the number of red blood cells in the region. The results showed that with the passing of the days a progressive increase of the signs of changes in the region was observed, a factor that shows that narghile smoking stimulates alterations mainly in the alveoli (place where gas exchanges occur that should not present alterations) calling attention to the harmful and aggressive effect of narghile smoking. These data also highlighted the harmful effect of smoking, since the presence of acanthosis, hyperkeratosis, epithelial projections and inflammation evidences the cellular alteration process for the tongue tissue protection. Also, the narghile smoking stimulates both epithelial and inflammatory changes in the trachea, in addition to a process of metaplasia, a factor that reinforces the harmful effect and the carcinogenic potential of the narghile smoking.
Deceased Donors with Terminal Acute Kidney Injury as a Valuable Source of Organs
Piotr Jan Domagala
, Michal Wszola
, Lukasz Gorski
, Piotr Diuwe
, Piotr Goralski
, Jakub Drozdowski
, Agata Ostaszewska
, Magdalena Durlik
, Janusz Trzebicki
, Leszek Paczek
, Andrzej Chmura
, Artur Kwiatkowski
Background: Organ transplantation is currently the standard management of patients with end-stage failure of renal, liver or heart. The criteria for organ acceptance became more flexible due to the big discrepancy between organ supply and increasing requirements. However, kidneys from deceased donors with acute kidney injury (AKI) are not widely accepted for transplantation. Aim: The aim of this study was to report the results of kidney transplantation when organs were procured from deceased donors with AKI. Material and Methods: Four hundred sixty-five patients received cadaveric renal transplants in the analyzed period. Data regarding donors, organ storage, recipients, and results of kidney transplantation were collected. Terminal AKI was identified when the terminal serum creatinine concentration was greater than 1.99 mg/dL (110 cases). Results: There were more episodes of delayed graft function (DGF) observed in the AKI group compared to the non-AKI group (50% vs. 29%, P < 0.05). There were no differences in the serum creatinine concentrations in the first, third, or fourth year post-transplantation between groups. There were no differences in patient and graft survival between the groups. Conclusion: Donors with AKI are valuable source of kidneys and may expand the organ pool.
Examinati̇on the Relationship between Chronic Back and Neck Pain and Sleep Problems in Dentists and Students of Dentistry
The study was conducted to examine the relationship between chronic back and neck pain and sleep problems in dentists and students of dentistry. Dentists are at high risk for neck and back pain. They often assume static positions that are uncomfortable and asymmetric. Chronic back and neck pain affect person’s daily routine such as social relationships, nutrition, emotional and psychological states, sleep quality, etc. The most important of these is sleep quality. Insufficient sleep could well be related to the increased prevalence of musculoskeletal pains. This study performed in Yeditepe University Faculty of Dentistry with 40 dentists and students of dentistry. The inclusion criteria are working actively, looking at least minimum five patient every day, in standing position long time. Neck Disability Index (NDI) was used to examine neck pain of participants, Oswestry Low Back Pain Index was used for back pain of participants, Pittsburgh Sleep Quality Index was used to evaluate sleep quality of participants. Results showed that there was a difference in NDI, ODI, PSQI and VAS values between dentists and students of dentistry (3rd, 4th, 5th classes). However, that differences were not systematic.
Establishing a Genetic Link between Fat Mass and Obesity Associated and Vitamin D Receptor Gene Polymorphisms and Obesity in the Emirati Population
Obesity is a non-communicable disease that is widely prevalent with approximately 600 million people classified as obese worldwide. Its etiology is multifactorial and involves a complex interplay between genes and the environment. Over the past few decades, obesity rates among the Emirati population have been increasing. The aim of this study was to investigate the association of candidate gene single nucleotide polymorphisms (SNPs), namely the fat mass and obesity associated (FTO) gene SNP rs9939609 and Vitamin D Receptor (VDR) gene SNP rs1544410, with obesity in the UAE population. Methods: This is a case-control study in which 414 individuals were enrolled during their routine visit to endocrinology clinics in Abu Dhabi, United Arab Emirates between the period of June 2012 and December 2013. Several biochemical tests and clinical assessments along with a lifestyle questionnaire for each participant were completed at the clinic. Genomic DNA was extracted from saliva samples of 201 obese, 114 overweight and 99 normal subjects. Genotyping for the variants was performed using TaqMan assay. Results: The mean Body Mass Index (BMI) ± SD for the obese, overweight, and normal subjects was 35.76 ± 4.54, 27.53 ± 1.45 and 22.69 ± 1.84 kg/m2, respectively. Increasing BMI values were associated with an increase in values for systolic blood pressure, diastolic blood pressure, HbA1c, and triglycerides. The SNP rs9939609 in the FTO gene was found to be significantly associated with the BMI (p=0.028), with the minor allele A having a clear additive effect on BMI values. No significant association was detected between BMI and rs1544410 of the VDR gene. Conclusions: Our study findings indicate that the minor allele A of the rs9939609 has a significant association with increasing BMI values. In addition, our findings support the fact that increasing BMI is associated with increasing risks of other comorbidities such as higher blood pressure, poorer glycemic control and higher triglycerides.
Identification of Nursing Students’ Attitudes toward Older People in Turkey
Objective: The present study aims to identify nursing students’ attitudes toward older people. Methods: This descriptive study was conducted with 166 nursing department students enrolled in a four-year undergraduate program in a university located in Eastern Turkey. The participants were chosen using convenience sampling method, and the data were collected through the Descriptive Characteristics Form and Turkish version of Kogan's Attitudes toward Old People Scale (KAOP). Results: It was found that the students participating in the study had positive attitudes toward old people, and the mean scores of those who wanted to work with old people after graduation were significantly high (p< 0.05). Scale mean scores according to receiving Gerontology Nursing course showed that the score difference between the two groups was not statistically significant. Conclusion: This study found that nursing students’ attitudes toward older people were positive. Cultural features of the region where the study was conducted are considered to contribute to this result.
Sexual Behaviors and Its Predictors among Iranian Women in Iran: A Cross-Sectional Study
Background: Women's sexual well-being is center of focus in the field of sexology. Study of sexual behavior and investigating its predictors is important in women's health promotion. Objectives: This study aimed to explore the components of sexual behaviors and their possible associations with the women's demographic. Methods: A National Sexual Behavior Assessment Questionnaire was administered to 500 women ages 15 to 45 who referred to the public health centers seeking for health care services. The associations with demographic were examined. Results: From all participant, 31.8% of women obtain high score in the sexual capacity 21.2% in sexual motivation and 0.2% in sexual function. In sexual script component, 86.2% of women were holding traditional beliefs toward sexual behaviors; the majority (91.5%) of women believed in mutual and relational sexuality, 83.4% believed in androcentricity (male-dominated sexuality). Pearson correlation test showed significant positive correlations between sexual capacity, motivation, function and sexual script (p < 0.05). Regression model showed that sexual capacity is associated with women's education, age of her spouse. Sexual function and sexual motivation were significantly associated with the age of subjects' spouses. Conclusion: In this study, lower score was found in sexual performance while women were scored higher in the sexual capacity and motivation. We argue that these lower score in sexual performance more likely is due to the level of participants' religiosity and formation of their sexuality through an androcentric culture. Women's level of education and the spouse age appear to be predicting factors in the scores the subjects gained. We suggest that gender-specific and culturally sensitive sexuality education should be focus of women's health programs in Iran.
Time Fetching Water and Maternal Childcare Practices: Comparative Study of Women with Children Living in Ethiopia and Malawi
The burden of collecting water tends to disproportionately fall on women and girls in low-income countries. Specifically, women spend between one to eight hours per day fetching water for domestic use in Sub-Saharan Africa. While there has been research done on the global time burden for collecting water, it has been mainly focused on water quality parameters; leaving the relationship between water fetching and health outcomes understudied. There is little available evidence regarding the relationship between water fetching and maternal child care practices. The main objective of this study was to help fill the aforementioned gap in the literature. Data from two surveys in Ethiopia and Malawi conducted by CARE Canada in 2016-2017 were used. Descriptive statistics indicate that women were predominantly responsible for collecting water in both Ethiopia (87%) and Malawi (99%) respectively, with the majority spending more than 30 minutes per day on water collection. With regards to child care practices, in both countries, breastfeeding was relatively high (77% and 82%, respectively); and treatment for malnutrition was low (15% and 8%, respectively). However, the same consistency was not found for weighing; in Ethiopia only 16% took their children for weighting in contrast to 94% in Malawi. These three practices were summed to create one variable for regressions analyses. Unadjusted logistic regression findings showed that only in Ethiopia was time fetching water significantly associated with child care practices. Once adjusted for covariates, this relationship was no longer found to be significant. Adjusted logistic regressions also showed that the factors that did influence child care practices differed slightly between the two countries. In Ethiopia, a lack of access to community water supply (OR= 0.668; P=0.010), poor attitudes towards gender equality (OR= 0.608; P=0.001), no access to land and (OR=0.603; P=0.000), significantly decreased a women’s odd of using positive childcare practices. Notably, being young women between 15-24 years (OR=2.308; P=0.017), and 25-29 (OR=2.065; P=0.028) increased probability of using positive childcare practices. Whereas in Malawi, higher maternal age, low decision-making power, significantly decreased a women’s odd of using positive childcare practices. In conclusion, this study found that even though amount of time spent by women fetching water makes a difference for childcare practices, it is not significantly related to women’s child care practices when controlling the covariates. Importantly, women’s age contributes to child care practices in Ethiopia and Malawi.
A Review of the Literature on Nutritional Supplements for the Treatment of Obesity
The problem of obesity is one that continues to be faced in the United States health care system and across the developing world. Prescription medications are available, but are often very expensive with minimal insurance coverage. The over-the-counter diet aid industry is a robust one, selling billions of dollars in products every year. It is important for clinicians to understand the myriad of different nutritional supplements marketed for obesity, and to weigh the evidence behind these products. This manuscript outlines the most commonly used nutritional supplements currently marketed for weight loss, reviewing the evidence with a focus on efficacy and safety of these products.
Association of Alcohol Consumption with Active Tuberculosis in Taiwanese Adults: A Nationwide Population-Based Cohort Study
Background: Animal studies have shown that alcohol exposure may cause immunosuppression and increase the susceptibility to tuberculosis (TB) infection. However, the temporality of alcohol consumption with subsequent TB development remains unclear. This nationwide population-based cohort study aimed to investigate the impact of alcohol exposure on TB development in Taiwanese adults. Methods: We included 46 196 adult participants from three rounds (2001, 2005, 2009) of the Taiwan National Health Interview Survey. Alcohol consumption was classified into heavy, regular, social, or never alcohol use. Heavy alcohol consumption was defined as intoxication at least once/week. Alcohol consumption and other covariates were collected by in-person interviews at baseline. Incident cases of active TB were identified from the National Health Insurance database. Multivariate logistic regression was used to estimate the association between alcohol consumption and active TB, with adjustment for age, sex, smoking, socioeconomic status, and other covariates. Results: A total of 279 new cases of active TB occurred during the study follow-up period. Heavy (adjusted odds ratio [AOR], 5.21; 95% confident interval [CI], 2.41-11.26) and regular alcohol use (AOR, 1.73; 95% CI, 1.26-2.38) were associated with higher risks of incident TB after adjusting for the subject demographics and comorbidities. Moreover, a strong dose-response effect was observed between increasing alcohol consumption and incident TB (AOR, 2.26; 95% CI, 1.59-3.21; P
Association of Human Immunodeficiency Virus with Incident Autoimmune Hemolytic Anemia: A Population-Based Cohort Study in Taiwan
The molecular mimicry between human immunodeficiency virus (HIV) protein and red blood cell (RBC) antigens could induce the production of anti-RBC autoantibodies. However, the association between HIV infection and subsequent development of autoimmune hemolytic anemia (AIHA) remains unclear. This nationwide population-based cohort study aimed to determine the association between incident AIHA and HIV in Taiwan. From 2000–2012, we identified adult people living with HIV/AIDS (PLWHA) from the Taiwan centers for disease control HIV Surveillance System. HIV-infected individuals were defined by positive HIV-1 western blot. Age- and sex-matched controls without HIV infection were selected from the Taiwan National Health Insurance Research Database for comparison. All patients were followed until Dec. 31, 2012, and observed for occurrence of AIHA. Of 171,468 subjects (19,052 PLWHA, 152,416 controls), 30 (0.02%) had incident AIHA during a mean follow-up of 5.45 years, including 23 (0.12%) PLWHA and 7 (0.01%) controls. After adjusting for potential confounders, HIV infection was found to be an independent risk factor of incident AIHA (adjusted hazard ratio [AHR], 20.9; 95% confidence interval [CI], 8.34-52.3). Moreover, PLWHA receiving HAART were more likely to develop AIHA than those not receiving HAART (AHR, 10.8; 95% CI, 2.90-40.1). Additionally, the risk of AIHA was significantly increased in those taking efavirenz (AHR, 3.15; 95% CI, 1.18-8.43) or atazanavir (AHR, 6.58; 95% CI, 1.88-22.9) component of the HAART. In conclusion, HIV infection is an independent risk factor for incident AIHA. Clinicians need to be aware of the higher risk of AIHA in PLWHA.
Detailed Autonomic Nervous System Analysis of Microcurrent Point Stimulation Applied to Battlefield Acupuncture Protocol
Introduction: A detailed comparative analysis of the effects of DC Microcurrent Point Stimulation on the autonomic nervous system functioning, when applied to Battlefield acupuncture protocol to 8 patients with a history of chronic pain. Methods: Evaluations entailed a standard baseline VAS pain scale, saliva cortisol, and a baseline status of 27 autonomic nervous system functions, all repeated prior to and following electro-therapy on this cohort of patients. Results: The autonomic nervous system response to Microcurrent Point electrical nerve stimulation reflected a statistically significant pre-post improvement in seven of the 29 markers collected: pain on the VAS scale was reduced by 63% [2.0625 points; 95% CI (1.2745, 2.8505; p=0.0001], heart rate variability improved by 42% [662.375 points; 95% CI (-1273.675, -51.075); p=0.037). High Frequency-Vagal tone improved by 56% [231.25 points; 95% CI (-430.42, -31.58); p=0.029]. exercise tolerance increased by 22% [9.500 points; 95% CI (-16.747, -2.253); p=0.017], parasympathetic activity improved by 38% [14.000 points; 95% CI (-23.202, -4.798); p=0.009], stress reduced by 27% (39.125 points; 95% CI (1.945, 76,305); p=0.042], PTGi cardiac marker of Autonomic Nervous System regulation, endothelial function and arterial blood flow improved by 48% [21.5125 points; 95% CI (-35.441754, -7.5832461); p=0.008). Another Cardiac marker PTGVLFi - an Autonomic Nervous System regulation marker of endothelial function and an indicator of Beta Cell activity had a statistically significant reduction of 36% [9.250 points; 95% CI (1.062, 17.438; p=0.032]. Salivary cortisol decreased by 14% [0.08286 points; 95% CI (-0.1182, 0.28384); p=0.352). Conclusion: The positive and impressive results in this study show significant improvement in several parameters of autonomic nervous system function and reduction in pain and cortisol levels. If replicated, this study paves the way for use of DC Microcurrent Point Stimulation applied to Battlefield acupuncture protocol for other pathologies that are known to be impacted by sympathetic nervous system activation.