Search results for “Association”

A New Model of Body Composition Detects Association Between Severe Obesity and Increase in Skeletal Muscle Mass

Obesity is associated with functional limitations in muscle performance. The true effect of obesity on skeletal muscle mass, including any interactions with aging effects, remains to be elucidated. The present study investigated the impact of obesity on the stimulation of muscle growth, based on a new model of body composition. A dataset of 44 men and 64 women was analysed. Body weight (Wt), body height (Ht), hand circumference (HdC) and waist circumference (WC) were measured. Processed by the Dahlmann-Body-Analysis (DBA) system, a new model of body composition, the increase of skeletal muscle mass (ΔSMM) compared to the individual reference weight was calculated. Muscle mass data derived by the DBA model are compared with DXA-derived predictive equations of studies representing different countries and ethnicities estimating the appendicular skeletal muscle mass. Means of these groups are tested by ANOVA. Age ranged from 18 to 72 years. All subjects had a BMI ≥ 29.7 (kg/m²). The mean values of ΔSMM as an estimate of muscle mass gain calculated by the DBA-system were 11.8 ±3.6 kg for men and 8.9 ±2.6 kg for women, respectively, demonstrating a linear, significantly rising relationship with BMI (ß > 0, p<0.001). The study population did not show a decrease in muscle mass with age in either men or women up to an age of 65 years. The results suggest that the present model has satisfactory prediction qualities to detect an increase in skeletal muscle mass associated with a growing burden of body fat.

RETRACTED: Association of Body Mass Index (BMI) and Severity of COVID- 19: A Multicentric Study from Maharashtra, India

This article has been retracted on 30 August 2025. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2379-7835.ijn-25-5842) Objective The COVID-19 pandemic has led to the global research efforts to identify the risk factors which would lead to severe COVID-19 disease. This study aimed to investigate the relationship between body mass index (BMI) and severity of coronavirus disease 2019 (COVID-19). Methods A total of 2820 patients hospitalized with COVID-19 disease in nine Government Medical Colleges, COVID hospitals or COVID care centers of Maharashtra were included in the study. Interviews were conducted on the telephone and counselling was done. Results Among 2820, 2442 (86.60%) were asymptomatic or had a mild or moderate illness. More than half of the total COVID- 19 positive cases, 1591 (56.41%), were in the normal BMI range, and of these only 183 (11.50%) had severe COVID-19 disease. On the other hand, 647 (22.94%) patients were overweight and 106 (16.38%) had Severe COVID- 19 disease. Similarly, the patients who were obese, 363 (84.03%) were asymptomatic and 69 (15.97%) had severe COVID- 19 disease. Odds ratio for this association was found as 1.5, which indicates that patients who were obese (BMI ≥ 27.5) had one and half times increased odds of progression to severity as compared to patients having normal BMI. This association was found to be statistically significant (p- value < 0.05). Conclusion Our findings highlight the significant role of BMI in clinical progression of COVID-19 disease. Patients with underweight and obesity experienced more severe outcomes than those of normal weight when being hospitalized with COVID-19 disease.

Retraction Note: Association of Body Mass Index (BMI) and Severity of COVID- 19: A Multicentric Study from Maharashtra, India

Association of Serum Calcium Level with other Risk Factors of Ischaemic Stroke

Introduction Calcium (Ca2+) plays an important role in the pathogenesis of ischemic cell damage. Intracellular Ca2+ accumulation leads to neuronal damage by triggering the cycle of cytotoxic events, however the relationship of serum Ca levels and the pathways involved in ischemic injury is unclear. Aim of Study To investigate the relationship of serum Ca2+ levels with severity of acute ischaemic stroke, serum calcium (Ca2+) levels were measured within the first 48 hours and were compared with the clinical severity of acute ischaemic stroke. Material and Methods A hospital based cross sectional study was performed among 100 patients of acute ischaemic stroke who fulfilled the inclusion criteria. The Study was done from July 2020 to August 2021 in SPRC & Neurology Hospital Dhaka, Bangladesh And BSMMU Hospital Dhaka, Bangladesh. After hospitalization presenting complaints, physical findings of the patients were recorded. Severity of stroke was measured by NIHSS scale. Serum calcium level of every patient was measured. Calcium level was divided into 3 groups by weighted average. Statistical analysis was carried out by a non-parametric Ruska Wallis test. Results Among the 100 patients 59% were male. Among all patients 57% of patients were found to be smokers (98% male, 2% female). Among all patients 63% patients were found hypertensive and 21% of all patients (24% male, 17% female) were diabetic. Mean cholesterol level was 257.98mg/dl with standard deviation 55.49 which is above the reference range suggesting hypercholesterolemia, Triglyceride was borderline and LDL cholesterol was slightly higher and HDL cholesterol was slightly lower. Calcium level was divided into 3 groups and NIHSS score was calculated for every patient in each group. The median NIHSS score for group1 (calcium level ≤8.8 mg/dl) was 9(2-20), for group 2 (calcium level 8.9-9.6 mg/dl) was 6 (1-17) and for group 3 (calcium level ≥9.7mg/dl) was 4 (1-16). Conclusion Commonest risk factor of ischaemic stroke is hypertension. Other risk factors are smoking, diabetes mellitus and hyperlipidemia, cardiac disease. Higher serum calcium level is associated with less severity of ischaemic stroke.

Osteoarthritis and Frailty: Associations, Relevance, and Counter Solutions

Background Many older adults, including those who have acquired painful disabling osteoarthritis of one or more joints may be frail rather than obese as is often reported. Those older adults who are frail may acquire osteoarthritis in turn if they encounter excess joint stresses and injury. Aims This report sought to examine what has been published to date on both of these debilitating health states, namely osteoarthritis and frailty. Methods Reviewed were relevant articles published in ACADEMIC SEARCH COMPLETE, PUBMED, WEB OF SCIENCE, SCOPUS and GOOGLE SCHOLAR regardless of time period but that focused on osteoarthritis and frailty related topics. The focus was on ascertaining how these two conditions might interact among community-dwelling older adults and whether more should be done specifically to mitigate any potentially preventable ‘frailty’ induced negative health impact among this group. Results Older adults with osteoarthritis living in the community may suffer from both osteoarthritis and frailty. Those that do are at high risk for disability and injury and should be targeted more effectively. Conclusion Timely and concerted efforts are needed to offset frailty correlates as well as excess osteoarthritis disability among community dwelling older adults.

An Investigation of Emotional Intelligence and its Association with Self-Efficacy at Higher Education Level in Pakistan

The present study examined the effects emotional intelligence on self-Efficacy of tertiary education students. Two scales Schutte Self-Report Emotional Intelligence Scale 44 and Schwarzer & Jerusalem Self Efficacy Scale 47 were used. The pilot study was conducted to assess the reliability of the instrument and main study was conducted to assess the results on sample of the study. A sample of 50 students (25 males, 25 females) were taken from universities of Islamabad and Rawalpindi. Both questionnaire were administered to the sample. The psychometric properties of pilot study were found satisfactory. In second phase main study was conducted which considered of sample of 200 university students (100 males and 100 females). The psychometric properties of main study were also satisfactory. Scores were analysed using SPSS software. Results of demographic variables such as age, birth order, mother education, father education and number of siblings are positively correlated with both scales and sub scales. The results were significant at (p<0.05) of mean differences with gender, education and family system. This survey consists of three hypotheses, which were accepted.

Rare Association Between Neuroimmunological Diseases: A Possible Autoimmune Polyglandular Syndrome Type IV

Autoimmune polyglandular syndromes (APS) are a diverse group of clinical conditions characterized by loss of immune tolerance in various tissues. This condition can be diagnosed in childhood or adulthood, with changes in the components of the disease throughout life. Here, an unusual case of association between immune-mediated diseases will be addressed: Myasthenia Gravis, Systemic Lupus Erythematosus, and Celiac Disease. In this patient, each disease was expressed over time. Finally, we assume that this is a clinical form of APS type IV, due to the lack of thyroid involvement to date. 

Association of BsmI and ApaI Polymorphisms of the Vitamin D Receptor Gene with Dyslipidemia in Patients with Coronary Artery Disease.

Purpose The goals of the present study were to assess the genotypic and allelic distribution of Bsm-I (rs1544410) and Apa-I (rs7975232) polymorphisms of the vitamin D receptor (VDR) gene in coronary artery disease (CAD) patients in comparison to control patients of the same age without CAD and to determine whether these gene variants are associated with dyslipidemia. Materials and Methods Based on a case-control design, 302 hospitalized patients  with CAD and 194 people of comparable age without CAD were enrolled in the study. The BsmI and ApaI polymorphisms of VDR gene were studied using polymerase chain reaction followed by restriction analysis. The allele digested by the restriction enzyme was denoted by a lower letter, whereas that not digested was indicated by a capital letter. Determination of the level of vitamin D and immunoreactive insulin in the blood serum was carried out using the immuno-enzyme method. Results The bb genotype of Bsm-I VDR gene polymorphism was detected more often in patients with CAD than in the comparison group with an increased risk of CAD by 1.52 times (p=0.006, OR=1.52(1.05÷2.2). The level of HDL cholesterol was higher in CAD patients − carriers of BB genotype compared to its level in Bb genotype carriers and bb genotype carriers (1,13±0,05 mmol/l, 1,01±0,03 mmol/l, 1,02±0,03 mmol/l respectively, p<0,05). The level of vitamin D was higher in patients with BB genotype compared to its level in bb genotype carriers (45.12±3.73 nmol / l and 34.16±1.95 nmol/l respectively, p=0.008). The occurrence of a allele of Apa-I VDR gene polymorphism was higher in patients with CAD than in the control group (p=0.02, OR=1.21(0.93÷1.57). HDL cholesterol level was higher in CAD patients - AA genotype carriers compared with carriers of Aa and aa genotypes (1.18±0.08 mmol / l, 1,02±0.02 mmol / l and 1.01±0.03 mmol/l respectively, p<0,05). Immunoreactive insulin level was significantly higher in CAD patients – aa genotype carriers. No differences in LDL cholesterol and triglycerides were found. Vitamin D level was lower in CAD patients - Aa and aa genotype carriers (33,8±33,9 nmol/l ,p=0,02 and 24,7±4,9 nmol/l, p=0,05 respectively in comparison to vitamin D level = 43,3 ±4,2 nmol/l in AA genotype carriers). Conclusion The bb genotype of Bsm-I VDR gene polymorphism is associated with an increased risk of CAD. A carriage of b allele in CAD patients is associated with lower level of vitamin D and HDL cholesterol. A carriage of a allele of Apa-I VDR gene polymorphism in CAD patients is associated with lower level of vitamin D and HDL cholesterol.  

Molecular and Metabolic Pathogenesis of Familial Combined Hyperlipidemia and Association with Metabolic Syndrome

Background The objective of this review is to unify the various genetic defects along with elaborating metabolic pathways in Familial Combined Hyperlipidemia(FCHL) and also to differentiate the phenotype of FCHL from metabolic syndrome. Methods PubMed and Cochrane’s library was searched for keyword “Familial combined hyperlipidemia” and latter with “Familial combined hyperlipidemia genes” to finally shortlist 23 articles. Further search with key words “molecular pathogenesis of familial combined hyperlipidemia” and “metabolic syndrome and familial combined hyperlipidemia” was carried out for finding molecular defects in FCHL, non-molecular findings distinguishing FCHL from metabolic syndrome and overlapping features between FCHL and metabolic syndrome. Results Major culprit regions identified included Chromosome-1q21-q24(USF1 and FOXA2) , Ch-11q (APOA5), Ch-16q24, Ch-20q12-q13.1, Ch.4q32.3 (rs6829588), and Ch-19q13.32 containing PVRL-2 gene (Also known as Nectin-2). The genetic and metabolic pathways linked to FCHL may involve: 1-Defective clearance of Apo-B containing lipoproteins, 2-Overproduction of Apo-B containing lipoprotein i.e., VLDL and 3-Adipose tissue dysfunction. FCHL phenotype showed close resemblance with metabolic syndrome clinical and biochemical features with slight differences. Conclusion The reviewed data suggested that FCHL phenotype is the resultant end outcome from multiple molecular defects and thus underlying genetic defect identification in the index case is important for personalized medicine and incoming gene therapy. Further research is warranted to explore specific genetic defects.

Association between Sclerosing Cholangitis and Paget Disease: Diagnostic Difficulties

A rare case of association between primary sclerosing cholangitis and Paget's disease emphasizing the diagnostic difficulties in front of increased alkaline phosphatase is reported. The association between sclerosing cholangitis and Paget's disease wasn’t yet described and could thus be coincidental. However, our observation underlines the benefit of dosing ALP isoenzyme to characterize the bone or hepatic origin of ALP and therefore, help to guide the diagnosis.

Association of Non Epileptic Seizures and Epilepsy:2 Cases Reports of Masturbation Seizures

Introduction: Non epileptic seizures (NES) are little reported in our country. Case report: We report 2 observations of 4 years old girls, with normal psychomotor development, and frequent paroxystic seizures, characterized by stereotyped movements of the members, occurring during sleep onset or deep sleep. Electroencephalogram Sleep records showed brief discharges of spikes and spikes-waves. Magnetic Resonance Imaging was normal. Suspicion of NES associated with epilepsy was based on the following arguments: mild regression of the seizures frequency after using antiepileptic drug video records of the seizures strongly suggestive of masturbation seizures, masturbation seizures are triggered by the girls and stopped on order, best regression of the seizures frequency after adjunction of trihexiphenidyl. Moreover, the authors make a review of literature on the NES. Conclusion: The early diagnosis of the NES allows to avoid the inadequate treatments and an improvement of the prognosis.

Association of Gestational Diabetes and Proinflammatory Cytokines (IL-6, TNF-α and IL-1β)

Changes to proinflammatory cytokines as a result of gestational diabetes mellitus (GDM), and the pregnancy complications that these changes can cause, are of vital importance to the effective prevention and optimal management. Interleukin-6 (IL-6), interleukin-1 beta (IL-1β), and tumor necrosis factor alpha (TNF-α) are cytokines that are associated with gestational diabetes. Therefore, the aim of this review is to draw attention to the relationship between gestational diabetes and these diseases

Multivariate Analysis of Noise, Socioeconomic and Sociodemographic Factors and Their Association with Depression on Borough Level in the City State of Hamburg, Germany

The objective of this first part of our study was to investigate associations of road traffic noise, socioeconomic and -demographic risk factors, and health access on depression on borough level. We investigated in a large metropolis associations between prevalence rates of depression per borough (n = 67 boroughs) in all age groups (excluding the age group of 0–17 years) using health claims data (year 2011) and the variables “social deprivation” and “number of family members”, which were obtained from a previously conducted principal component analysis, and by using multivariate regression model. Additionally, the proportion of borough area affected by noise > 65 db(A) and physician density used as a surrogate parameter for health access were considered as potentially associated factors for depression. The results demonstrated that depression might be associated with increasing social borough deprivation. Additionally, the number of family members used as a proxy measure for positive family support showed decreasing prevalence rates the more family members were present. Furthermore, proportions of borough areas affected by noise > 65 db(A) was positively associated with depression. Our ecological study design has the advantage that a large number of large-scale, population-based aggregated data could easily be obtained and analysed and first potential associations could be found and discussed. To improve our findings, future studies will use data from a survey and data from the Hamburg City Health Study, a local follow-up health study, to better elucidate the individual risk factors together with environmental living and working conditions.

Association of Epstein-Barr Virus with Gastric Carcinoma among Sudanese Patients

Background: Gastric cancer (GC) ranks as the fourth most common cancer and the second leading cause of cancer deaths worldwide. Epstein-Barr virus is a well-known oncogenic virus, it is responsible for 10% of gastric carcinomas across the world. The aim of study was to determine the prevalence of EBV associated with GC in Sudanese patients. Method: Fifty Paraffin embedded blocks of gastric biopsy specimens diagnosed as gastric carcinoma were collected from Soba university hospital and Ribat teaching hospital, Khartoum, Sudan. DNA was extracted from the paraffin-embedded tissue, and then Epstein-Barr virus gene was detected by polymerase chain reaction (PCR). Result: Among the gastric biopsy specimens 27 (54.0%) were of male and 23(46.0%) were of female. Eleven EBV positive samples were found in gastric carcinomas (22.0%), 8 (72.7%) were of male and 3(27.2%) were of female. The mean age of the patients was 56 years, the most positive cases were between 50-59 years old, and (10%) of them are alive in Khartoum. Conclusions: There exists an association between EBV and gastric carcinoma in some Sudanese patients.

A study on the association of ACE i/D gene polymorphism, Obesity, Blood pressure and susceptibility of type 2 diabetes mellitus among the Kurmis of West Bengal, India.

Earlier studies reported significant association of obesity, hypertension and Type2 Diabetes Mellitus (T2DM). Genetic and many disease-associated alleles have been identified through GWAS and applied to T2DM and indicated roles of renin-angiotensin system (RAS) in insulin signaling pathway and insulin resistance has been well documented. Angiotensin converting enzyme (ACE) gene catalyzes the conversion of angiotensin I to angiotensin II and also inactive the vasodilatation and hence renin-angiotensin system (RAS) in insulin signaling pathway and insulin resistance has been reported. To best of the knowledge we are reporting for the first time regarding association of ACE gene polymorphism with body composition, physiological and metabolic variables among any endogamous ethnic group (Kurmis) from of West Bengal, Eastern India. To achieve the purpose, total 197 (male 99 and female 98) randomly selected apparently healthy unrelated adult individuals of Kurmi population of Purulia District, West Bengal, India were incorporated in the present study. Anthropometric variables, physiological variables (blood pressure) and metabolic variables (PP blood sugar) have been collected using standard techniques. Extracted genomic DNA was PCR amplified and genotyped to understand ACE gene I/D polymorphism. The result demonstrated significant (p<0.05) sexual dimorphism in PBF. MAP and PP blood sugar found to be in normal range among the Kurmis. ACE gene polymorphism showed no deletion of the Kurmis and hence, only the prevalence of ACE II (insertion-Insertion) genotype has been noticed. The present study vindicated on the basis of body composition in terms of fat patterning, physiological and metabolic variables and ACE gene polymorphism that there is very low or no risk of T2DM among the Kurmis of West Bengal, India.

Association of Risk Factors in Gestational Diabetes Mellitus among Pregnant Mothers Attending at a Tertiary Care Hospital in Bangladesh

Objective: To observe association of risk factors with gestational diabetes mellitus (GDM) in a tertiary care hospital of Bangladesh. Materials and Methods: Risk factors of GDM were evaluated in pregnant subjects (n=385; age: 26.4±4.9 yrs; body mass index, BMI: 25.3±4.3 kg/m2; mean ± SD) screened by 75 gram oral glucose tolerance test (OGTT) following WHO 1999 criterion irrespective of gestational age in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU). BMI, maternal age, parity, trimester and family history of diabetes were considered as risk factors. Plasma glucose was measured by glucose-oxidase method on the same day. Results: GDM and normal glucose tolerance (NGT) showed significant difference for age (28.2±4.9 vs. 25.3±4.6 yrs, p<0.001), BMI (26.7±4.4 vs. 24.4±3.9 kg/m2, p˂0.001), family history of DM (55.5% vs. 43.0%, p=0.017) and number of gravida (p=0.048). There was no significant difference of frequencies of GDM among various trimesters (39.4% vs. 42.5% vs. 38.2%; χ2=0.653, p=0.721). OGTT performed before 24 weeks revealed GDM in about 44% (88/202). Multiple regression revealed age (p<0.001), BMI (p=0.007) and family history of DM (p=0.048) as independent predictors for GDM. Conclusion: It is concluded that age of mother, increased BMI, family history of diabetes as well as multigravidae are important predictors for GDM.

The Risk Factors, Complications, Management Strategies and Predictors of Morbidity & Mortality Among Pediatric Patients Presenting with Severe Diarrhea at Muhimbili National Hospital’s Emergency Medicine Department

Background Acute diarrhea is the major cause of health public problem among paediatric patients in Tanzania. And in Low income countries (LICs), studies have shown, Acute watery Diarrhea (AWD) is the cause of morbidity and mortality which can be prevented by immediate identification and treatment of complications. Methods A prospective cohort study was done between December 2021 and April 2022 to determine the risks, complications, management strategies and predictors of mortality among paediatric patients ≤12 years of age with severe diarrhea. We excluded those who arrived in cardiac arrest at the Emergency Medicine Department (EMD) of Muhimbili National Hospital (MNH). Proportion was used to summarize the counts and frequency of participants who were at risk of complications and management strategies given and for predictors of outcomes. A Modified Poisson log linear model with a robust estimation test was used to test for significant associations between predictors and outcomes. Multivariate logistic regression was used to adjust for confounders. Results A total 6,570 paediatric patients presented to EMD during study period, and we recruited 144 (2.2%). The median age was 1 (IQR 0.7-2.0) years and most were male 86 (59.7%). Among the study participants with diarrhea, 120 (83.3%) had dehydration, acidosis 60 (42.3%), hypoglycemia 8 (5.6%), hypokalemia 76 (53.1%), and Acute renal failure 11 (7.6%). Those patients with complications received appropriate management, including IV crystalloid solution given to 131 (90.97%), and correction of acidosis 60 (42.3%), hypoglycemia correction with IV dextrose 10% 6 (4.2%), and hypokalemia and infections were corrected with IV potassium chloride 52 (36.1%) and IV antibiotic treatment 84 (58.3%) respectively. Conclusion Pediatric patients under 2 years of age are at high risk of severe diarrhea with dehydration as compared to other ages. Early referral and availability of point care tests are essential in early recognition of accompanied complications.

Outcomes of Differentiated Thyroid Cancer Patients Treated with Surgery and Radioactive Iodine at SQCCCRC

Objective To evaluate the treatment outcomes of patients with Differentiated thyroid cancer (DTC) who underwent total thyroidectomy followed by RAI therapy at the Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC) in Oman. Methods This is a retrospective observational clinical study conducted at SQCCCRC. The study included all patients diagnosed with DTC who were admitted to SQCCCRC between June 2021 and November 2023. A total of 255 patients were identified and met the inclusion criteria for this study. Results The mean age at diagnosis was 39.9 ± 12.4 years (range: 14–79), with 78% of patients being female. The mean BMI was 30.3 ± 6.4 kg/m², with nearly half of the cohort (48.2%) classified as obese (BMI ≥ 30). Most patients had papillary thyroid carcinoma (92.9%), while follicular and Hürthle cell carcinoma accounted for 5.9% and 0.8% of cases, respectively. Based on the American Joint Committee on Cancer (AJCC) staging, 86.3% of the patients were classified as stage I and 3.9% as stage II. Six patients (2.4%) had stage IVB disease. According to American Thyroid Association (ATA) risk stratification the majority were low-risk. Patient age was strongly associated with disease stage. The distribution of metastatic cases varied by region, with the highest proportion observed in Dhofar. Most patients (87.1%) received a single dose of radioactive iodine (RAI), with a median cumulative dose of 3.7 mCi). At six months post-treatment, 70.2% of patients had a TG level < 0.2 ng/mL. Conclusion The outcome of therapy in majority of our patients is favorable with 72% having excellent biochemical response at last follow up. None of the patients with distant metastasis achieved excellent response and a high proportion of them came from the Dhofar governorate, a targeted intervention would be of benefit. Low risk patients require special attention and may need radioactive iodine during follow up, unlike other regions and hence warrant very close follow up and further review to establish the best practice guidelines in our region.

Interactions Between Natural Nuclear Reactors and Microbial Evolutionary Processes

The impact of ionizing radiation on genetic change is well established, yet the extent to which naturally occurring radiation fields have influenced evolutionary trajectories remains incompletely understood. This study examined correlations between microbial evolution and the radiation and geochemical environments associated with natural fission reactors, with emphasis on the Oklo–Bangombé system in present-day Gabon, Africa. The current paper compares plausible doserate regimes adjacent to reactor zones with published observations of radiationinduced phenotypes, geneexpression changes, and repair strategies in model organisms and complex biotas. This study further considers indirect mechanisms (e.g., water radiolysis, redox restructuring, tracemetal mobilization) by which natural reactors could have modulated ecological selection pressures over long timescales. The synthesis supports the plausibility of three interacting pathways: (i) increased mutation supply under low, chronic dose rates; (ii) selection in oxidantrich, redoxstratified niches; and (iii) metabolic subsidies (e.g., H₂) from radiolysis that support chemotrophic guilds. Although temporal–spatial associations exist between reactor activity and biological innovations preserved in Paleoproterozoic strata of Gabon, current evidence remains correlational rather than demonstrably causal. The study further outlines testable predictions and experimental designs capable of discriminating among these mechanisms.

The Effectiveness of Cognitive-Analytic Therapy in Women Diagnosed with Breast Cancer and Post-Traumatic Stress Disorder

The present study examines the effectiveness of Cognitive-Analytic Therapy (CAT) in women diagnosed with breast cancer and Post-Traumatic Stress Disorder (PTSD) on reducing PTSD symptomatology and improving their mental health state (depression, self-esteem, post- traumatic growth, quality of life, therapeutic alliance). Additionally, the investigation includes the determination of the demographic, socio-economic and medical factors’ impact on mental health indicators in women with breast cancer and PTSD. The sample was 188 women with breast cancer and PTSD at the Chemotherapy Unit of ‘Agios Andreas’ General Hospital in Patras. The questionnaire data were analyzed using descriptive and inferential statistical analysis in order to determine any statistically significant correlations between the experimental and the control group and between psychological scales and the demographic and socio-economic factors. The findings confirm the effectiveness of CAT in women with breast cancer and PTSD in reducing PTSD and depressive symptoms, improving self-esteem and quality of life, achieving greater post-traumatic growth, and fostering a better therapeutic relationship with the therapist. The demographic, socio-economic and medical factors examined affected dissimilarly each psychological scale, as statistically significant associations were found with some scales but not with others.

Correlation of Fast Food Consumption and Overweight/Obesity among Undergraduate Students at the University of Hargeisa in Hargeisa, Somaliland

Background Fast food consumption is the major cause of obesity and overweight in worldwide affecting more than 2 billion people, especially developing countries and low income countries. It can lead to hyperinsulinemia and development of insulin resistance, high energy density, high glycemic index, and fatty acid composition of fast foods may increase the prevalence of obesity and cardiovascular risk factors Objectives The main aim of this study was, to assess fast food consumption and its association with overweight /obesity among undergraduate students of University Hargeisa, Somaliland, 2023. Methods The study was carried out from May 01 to July 20, 2023 at University of Hargeisa using an institutional based cross-sectional study design to among 260 students. The study participants were selected using a simple random sampling technique. A structured questionnaire was prepared based on review literatures and dig out from related studies. The anthropometric data was taken by data collectors to measure weight and height using a stadiometer. Data was entered and checked for errors using EPI-info version 7.1.5.0 and then, data were exported to statistical package for social sciences (SPSS) software version 21 and STATA software version 14 for data processing and analysis. Descriptive statistics such as; frequencies, means and proportion was used for present the findings. A variable with P-values of less than 0.25 in the binary logistic regression analysis was entered into a multivariable logistic regression analysis to identify the independent predictors of stunting. Finally, variable at P-value less than 0.05 in multivariable logistic regression analysis was considered as a statistically significant variable. Results In this study, the majority 235 (90.4%, CI: 86.5- 93.8) of the study participants were fast food consumers. The study revealed that, from the total study participants 46(17.7%),127(48.8%),84(32.3%), 3(1.2%) were underweight, normal, overweight and obese respectively. A chi-square test revealed that there was a significant (p-value=0.058) associations between BMI and fast food consumption among students of University of Hargeisa. On multi-variable logistic regression model educational level of the students (AOR = 12.45 (95% CI: 1.7, 14.6)) and frequency of fruit (AOR = 0.76, 95% CI (0.7, 0.8)) and vegetable consumptions (AOR = 0.51, 95% CI (0.47, 0.575)) were found to be significantly associated with fast food consumptions (p < 0.05). Conclusion In this study, of the total 90.4% number of fast food consumers. A chi-square test revealed that there was a significant (p-value=0.058) associations between BMI and fast food consumption among students of University of Hargeisa. Educational level of the students and frequency of fruit and vegetable consumptions were found to be significantly associated with fast food consumptions. Effort should be made to increase access to fast food-related information and counseling.

Prevalence and Risk Factors of Intestinal Parasitic Helminths among Primary School Children in Oru West Lga, Imo State, Nigeria

Intestinal parasitic helminths pose a significant public health burden, particularly among children. This cross-sectional study investigated the prevalence and risk factors of intestinal parasitic helminths among 550 school children aged 4-12 years in Oru-West L.G.A, Imo State, Nigeria. Stool samples were examined using parasitological techniques, and questionnaires were administered to collect data on risk factors. The overall prevalence of intestinal parasitic helminths was 49.1% (270/550), with Ascaris lumbricoides being the most prevalent (30.37%). Multivariate analysis revealed significant associations between intestinal parasitic helminths and lack of hand-washing, insufficient toilet facilities, consumption of unwashed vegetables, and poor environmental sanitation. Males had a significantly higher infection rate than females (P < 0.05). Age-related prevalence was highest among children aged 4-6 (51.85%). Occupational status and educational level of parents were also significant predictors of infection. These findings highlight the need for public health education, provision of basic sanitation facilities, and regular de-worming as preventive measures.

Factors Impacting Nutritional Status in Infants with Single Ventricle Physiology

Infants with single ventricle (SV) physiology are at increased risk of undernutrition, which can contribute to adverse outcomes. This is a retrospective case series examining factors associated with undernutrition in patients with SV physiology at one year of age. It includes 56 infants from a single institution who underwent SV palliation between 2003 and 2023. Undernutrition was defined as a weight-for-length z-score (WLZ) below -1, based on World Health Organization (WHO) normative data. Independent variables included surgical interventions, cardiorespiratory factors, and nutritional interventions. Associations between these variables and nutritional status were assessed using Fisher’s exact test. At one year, a total of nine infants (16%) were undernourished. Undernutrition rates significantly declined after 2013 (p=0.02), demonstrating improvements in nutritional outcomes over our study period. Those who used supplemental oxygen or pulmonary medications were undernourished at lower rates. While this difference was not statistically significant, the number of undernourished patients in the cohort may have limited the study’s power. Our findings suggest that early respiratory interventions may provide nutritional benefits in infants with SV physiology.

HIV-Associated Peripheral Neuropathy and Antiretroviral Therapy: A Prospective Study from a Tertiary Care Centre in South India

Background Peripheral neuropathy (PN) is a common and debilitating complication in people living with HIV (PLHIV). While HIV itself contributes to neuropathy, certain antiretroviral therapy (ART) drugs, particularly nucleoside reverse transcriptase inhibitors (NRTIs) such as stavudine (d4T) and zidovudine (AZT), are known for their neurotoxic effects. Objectives To evaluate the impact of ART on HIV-associated peripheral neuropathy (HIV-PN) and to determine whether certain ART regimens increase the risk or severity of neuropathy. Materials and Methods A cross-sectional study was conducted among 158 HIV-positive patients. Neuropathy was diagnosed using clinical criteria, Total Neuropathy Score (TNS), and nerve conduction studies (NCS). Patients were grouped based on their ART regimen, and statistical analysis was performed to assess the association between ART type and peripheral neuropathy severity. Results It was noted that patients on older NRTIs (stavudine, zidovudine) had significantly higher rates of peripheral neuropathy (p=0.002) and tenofovir-based regimens were associated with lower peripheral neuropathy prevalence (p=0.01). There was a significant correlation between the duration of ART exposure and peripheral neuropathy severity (p<0.001), suggesting a cumulative neurotoxic effect. Conclusion Older ART regimens, particularly stavudine and zidovudine, significantly contribute to HIV-PN. The study supports the WHO recommendation to phase out neurotoxic ART and highlights the importance of early ART regimen optimisation to prevent long-term neurological complications.

Perceived Physical Progress and Mental Improvement Among Midlife Women Practicing the 3D Movement Method: A Brief Report from a Cross-Sectional Survey

Background Mind–body exercises are frequently used to support well-being during the menopausal transition, but perceived physical and psychological outcomes associated with practices such as the 3D Movement Method have not been quantitatively assessed. Objective To examine associations between characteristics of the 3D Movement Method and women’s self-reported physical and mental improvement during the menopausal transition. Methods Cross-sectional survey data from 330 women aged ≥ 35 years were analyzed using general linear models. Perceived physical progress and mental improvement were each assessed using single-item, 15-point scales. Independent variables included practice frequency, duration of experience, explanation clarity, satisfaction, baseline health status (SF-36 Physical and Mental Component Summary scores), age, and menopausal status. Results The model for physical progress was significant, F(16, 144) = 6.26, p < .001, R² = .41. Greater practice frequency, longer experience, clearer instructional explanations, and higher satisfaction were each independently associated with higher perceived physical progress. The mental improvement model was also significant, F(16, 96) = 2.25, p = .008, R² = .27, identifying satisfaction as the sole significant predictor. Baseline health, age, and menopausal status did not predict outcomes in either model. Conclusions Perceived physical progress was shaped by structured engagement parameters consistent with deliberate-practice principles, whereas perceived mental improvement was primarily linked to subjective satisfaction, a pattern compatible with motivational accounts of engagement. The 3D Movement Method may support women’s health across the menopausal transition when designed to optimize clarity, engagement, and experiential quality.

Addressing an Overlooked Population: The Role of Discrimination and Violence in Depression Among South Asian Female College Students

South Asian female college students in the United States face mental health challenges shaped by intersecting experiences of discrimination and violence. This study examined how discrimination and violence contribute to depression in this population. An anonymous, cross-sectional, web-based survey (N=673) was distributed nationally through South Asian organizations, listservs, and social media. Validated measures assessed day-to-day discrimination, college-based discrimination, experiences of violence during college, and depression (PHQ-9). Bivariate analyses and multivariate linear regression examined associations, adjusting for sociodemographic factors. Over half of participants (51.1%) reported college-based discrimination, 66.1% reported experiencing violence during college, and 25.7% met the criteria for depression. In adjusted models, day-to-day discrimination (β=0.261, p<0.001) and college violence (β=0.207, p<0.001) were significant predictors of depression. Bisexual and questioning/unsure students also reported higher depression scores than heterosexual peers. Discrimination and violence are key social determinants of mental health among this population. Findings underscore the need for culturally responsive mental health services, intersectional campus policies, and evidence-based interventions to promote health equity among minority women in higher education.

Systematic Review of Spinal Cord Injuries in Equestrian Athletes: Incidence, Risk Factors, and Outcomes

Objective The goal of this systematic review is to identify common themes amongst acute spinal cord injuries (SCI) in equestrian athletes. Design A systematic review was performed using PubMed, CINAHL Plus with Full Text (EBSCO), Cochrane Library, and Scopus with pre-determined MESH terms. The initial search returned 354 studies. Following PRISMA guidelines, 13 articles were included. Exclusion criteria included injuries to the horse only, non-English language, cauda equina, and case reports. Data extraction was completed, and common findings were evaluated narratively due to heterogeneity of data. Results Seven manuscripts listed specific horse-related activities that caused SCI, with fall from horse as the highest percentage of injury. Nine articles identified the injury region, with large variations and no clear dominant area of injury. Five articles identified the length of hospital stay with ranges from 1 to 82 days. Four articles looked at the association of professional vs non-professional riders. Only two articles evaluated helmet use at time of injury, with one article showing 81% of those with SCI used helmets, and the other showing only 35.6% utilized this safety measure. Conclusion SCI in equestrian athletes can have a wide presentation, with large variation on location of injury, length of stay, and other factors. However, non-professional riders are at greater risk of SCI and individuals are more likely to sustain injury from a fall from a horse rather than a kick or another modality of injury. Future study can elicit presenting symptoms, types of surgical intervention used, and long-term outcomes and recovery.

Economic Masculinity Support and Well-Being of Married Women in Luwero District, Uganda: A Cross-sectional Study

Economic masculinity support is paramount in promoting women’s well-being through numerous ways, including enhancing access to healthcare, education, and financial freedom, hence fostering equitable distribution of household responsibilities. However, studies examining the relationship between economic masculinity support and women’s well-being have not been well established in existing research. This study evaluated the relationship between economic masculinity support and the well-being of married women in Luwero district, Uganda. This Cross-Sectional study was conducted among 382 married women aged 18 to 50 years of age, from selected villages in Luwero district. The outcome variable, well-being, was assessed using the Gender Empowerment Measure (GEM). Data were analyzed using the Pearson correlation coefficient and linear regression to ascertain the relationship between economic masculinity support and the well-being of women. The findings show a moderate positive association between economic masculinity support and women's well-being (r = 0.55, p < 0.0001). Regression analysis indicated that economic masculinity support had a significant predictive influence (β = 0.42, p < 0.01) on women’s well-being, accounting for approximately 30% of the variance in well-being outcomes (Adjusted R² = 0.30). Linking economic masculinity supports improved access to essential resources. These results highlight the crucial role of economic support in enhancing women’s welfare, while also emphasizing the need to address socio-cultural barriers to achieve lasting empowerment. The study underscores the significant role of economic masculinity in promoting married women’s well-being. Transforming economic masculinity into a framework of mutual support is essential for advancing gender equity and safeguarding women’s well-being globally

Soil Fertility Dynamics and Xanthomonas Wilt Incidence in Enset (Ensete Ventricosem) Based Farming at Chencha, Southern Ethiopia

Enset (Ensete ventricosum) is a vital food security crop cultivated in South and South-western parts of Ethiopia. However, enset production and the farming families have been threatened by Xanthomonas wilt and its spread in the farming system. Thus, this study was conducted to investigate the soil fertility and plant management practices association on the incidence of Enset Xanthomonas wilt. Data on soils fertility and diseases from enset based farming clustered into inner, outer and outfield farm zone were sampled and surveyed. The result indicated that soil chemical properties significantly (p≤0.05) varied from inner to outfield farm zone. Significantly maximum nutrients store revealed in inner enset farm zones. Disease incidence reduced from inner to the outfield enset farm zone. Disease prevalence and disease incidence scored 28.5% and 11.6%, respectively depending on altitude and genotypes. Soil fertility levels in the enset inner and outfield plots were varied purposely to cultivate enset products as kocho, bulla or amicho (cooking type). The variations in soil fertility and Xanthomonas wilt incidence was associated with management practices applied for desired enset products. Therefore, management practices in enset based farming, soil fertility and location of enset planting zones found to be major indicators for disease incidence addressing to device control interventions.

Intersecting Epidemics: Intimate Partner Violence, Stress, and Diabetes Among South Asian Women in the United States

South Asian women in the United States face disproportionate health challenges, including higher rates of intimate partner violence as well as higher rates of Type 2 diabetes and gestational diabetes compared to other racial and ethnic groups. This cross-sectional study examines the association between intimate partner violence (psychological, physical, and sexual) and the diagnosis of gestational diabetes and type 2 diabetes. A web-based survey recruited 2,634 South Asian women in the U.S., collecting data on socio-demographics, intimate partner violence experiences, stress levels, and diabetes diagnosis. Logistic regression models adjusted for significant sociodemographic factors revealed that women with a history of intimate partner violence were 5.82 significantly more likely to report a type 2 diabetes diagnosis and 3.91 more likely to report a gestational diabetes diagnosis. Furthermore, stress as measured by the perceived stress scale, was also higher among women with intimate partner violence, potentially moderating the relationship between intimate partner violence and adverse health outcomes through cortisol dysregulation. Despite high levels of educational attainment and employment, the prevalence of intimate partner violence was alarmingly high (66.7%), highlighting its pervasive impact on socioeconomic strata. These findings underscore the urgent need for culturally tailored interventions addressing intimate partner violence and its health consequences within South Asian communities. Further research is warranted to elucidate causal pathways and inform integrated public health strategies to mitigate disparities in chronic disease and intimate partner violence-related health outcomes.

Plasma TREM2 Levels, Alcohol Consumption, and Liver Enzymes in Patients with Alcohol use Disorder: A Sex-Dependent Relationship Involving MS4A6A Genetic Polymorphism

Alcohol use disorder (AUD) is the most prevalent substance use disorder. Excessive alcohol consumption leads to a range of health issues. We set out to identify inflammatory markers linked to alcohol consumption, which might ultimately offer novel insight into genetic underpinnings and have implications for alcohol-associated disease. Alcohol consumption and blood-based multi-omics data were collected by The Mayo Clinic Center for Individualized Treatment of Alcohol Dependence study. Plasma samples from patients with AUD were used for proteomics analysis using the OLINK “Explore Inflammation” panel (n=410). Liver enzymes were also measured. A genome-wide association study (GWAS) was performed to explore the relationship between genetic variants and plasma TREM2 levels. Our findings show thatplasma triggering receptor expressed on myeloid cells 2 (TREM2), a key gene associated with neurodegenerative disease, was the most significant signal correlated with alcohol consumption, and has also been associated with liver enzyme levels in patients with AUD. We identified the rs7232 single nucleotide polymorphism (SNP) in MS4A6A as a key genetic variant associated with plasma TREM2 levels, with the minor allele (A) linked to higher TREM2 levels and increased alcohol consumption, particularly in men. Furthermore, MA4A6A is an ethanol-responsive gene in a SNP-dependent manner, and the variant genotype of the rs7232 SNP was associated with lower expression for MA4A6A due to proteasome-mediated protein degradation. In summary, this study provides insight into the relationship between plasma TREM2 levels, alcohol consumption, and liver function in AUD patients, shedding light on genetic factors underlying alcohol-related diseases.

Burden of Unintentional Childhood Injuries in Pre-School Children (2-6yrs) and Knowledge of Primary Caregivers on Early Management: A Descriptive Observational Study in Urban Slums of Bhubaneswar, Odisha

Background Injuries, particularly unintentional ones, are a neglected public health concern and are preventable or avoidable. Children in urban slums are especially vulnerable due to hazardous living conditions, inadequate supervision, and lack of safe sojourns or play areas. Since these injuries result in seeming spontaneous recovery, appropriate care being initiated by the primary care giver is questionable. Objective To assess the burden of unintentional injuries of unintentional injuries in pre-school going children aged 2-6 years in urban slums of Bhubaneswar, Odisha. To compare the knowledge of the 1st level care post-injury among the primary care givers against standardized prescribed care. Methods A cross-sectional descriptive observational study was conducted for over 2 years in urban slums under the Bhubaneswar Municipal Corporation (BMC), the capital city of Odisha. A total of 285 children aged 2-6 years, whose mothers consented to participate, were included in the study. Data regarding the type of injury and its management, as well as, associated socio-demographic factors, were collected using a pre-designed, pre-tested questionnaire. Descriptive statistics was used to derive the burden of unintentional injuries in children. The knowledge of the 1st level of care to be given after the common injuries was assessed among all the primary caregivers to detect the treatment and care gap. Results The majority of primary respondents were mothers aged 21-30 years (82.1%), The frequency of an episode of unintentional injury (occurrence in last 3 months) in the study population was found to be 58%. The most common type of injury reported was skin lacerations or tears, common site being in the upper and lower limbs. Males were more affected as compared to females (54.64 %) The reporting of unintentional injuries among the children was found to have significant association with the occupation of the father. Fathers who were unemployed or working as unskilled labor, their child’s probability of reporting an unintentional injury was found to be high, with p value coming to be statistically significant. Conclusion The study highlights the complex interplay of sociodemographic factors influencing unintentional injuries among children in urban slums and the need to create awareness among the primary caregivers, about the immediate management, so that chronic complications may be averted. It is difficult to avert injury as this age group is agile and nowadays supervision is challenging. Still, the knowledge of management would not just empower the caregiver, but also the growing child, who can attend to their younger siblings or themselves, whenever they get injured next. Further research with larger sample sizes is warranted to validate these findings and develop effective prevention strategies.

Assessing the risk of Obstructive Sleep Apnea in Type 2 Diabetes Mellitus patients in India

Background/Aim Obstructive Sleep Apnea (OSA) is a prevalent disorder characterized by recurrent respiratory disturbances during sleep. Patients with Type 2 Diabetes Mellitus (T2DM) and obesity exhibit a substantial susceptibility to OSA (23%–86%). People with OSA have a high risk of several comorbidities like insulin resistance, cardiovascular disease, depressed mood and hypertension. Thus, the objective was to comprehensively evaluate the risk of OSA among T2DM patients in India. Materials and Methods A cross-sectional survey was conducted across four cities in India involving 2,000 T2DM patients. The survey gathered data on patient demographics, clinical endpoints, and estimated the risk of OSA using an app which included the STOP BANG questionnaire. Multivariate logistic regression analysis was used to evaluate the association between OSA risk and key variables such as age, gender, BMI, and HbA1c. Result Overall, 63.9% of T2DM patients were identified as high risk and 27.3% were at intermediate risk for OSA development. Results of the multivariate logistic regression demonstrated that patients with high BMI ≥35 had significantly greater odds (OR: 5.70; p<0.00) of developing OSA; males had 2.75 times higher odds (p<0.00) and patients with HbA1c value >8% had higher odds (OR: 1.22; p<0.00) of developing OSA. Conclusion OSA risk and prevalence are significantly higher in T2DM patients than in the general population with a notable escalation in patients who are overweight/obese, older, and have prolonged diabetes duration. Early screening using digitalization with a highly sensitive, cost-efficient, and valid tool like STOP-BANG followed by appropriate intervention for OSA can not only reduce the eventual economic burden but can improve patient outcomes.

Primary Membranous Nephropathy Flare After COVID-19 Vaccination

Primary membranous nephropathy (MN) is due to autoantibodies to phospholipase A2 receptor (PLA2R Ab). It is unclear whether COVID-19 vaccines can trigger flares of glomerular diseases such as primary MN. There have been increasing reports of glomerular diseases presenting or flaring after receipt of COVID-19 vaccines. We present a patient with primary MN who developed nephrotic syndrome after receiving her second mRNA-1273 COVID-19 vaccine with positive PLA2R Ab. Renal biopsy confirmed primary MN. She was treated for her primary MN flare with rituximab in a manner similar to non-vaccine-associated MN, which led to significant reduction in both PLA2R Ab level and proteinuria. This case adds to the growing literature on MN flares after receipt of mRNA COVID-19 vaccines. Close follow-up of patients with primary MN and other glomerular diseases after COVID-19 vaccination is warranted. Further research is needed to determine the pathophysiology behind vaccine-induced MN flares and whether there is a potential association between exposure to SARS-CoV-2 antigens and loss of tolerance to the PLA2R antigen.

Relationship between Systolic and Diastolic Blood Pressure Loads on ABPM and BMI Percentiles in Children

Ambulatory blood pressure monitoring is widely used in pediatric patients to identify hypertension and its complications. Previous studies correlating obesity and hypertension using ABPMs showed increasing blood pressure loads with increasing BMI. However, BMI percentiles are more reliable indicators of obesity in children. Our study aimed to describe the association between BMI percentiles and systolic and diastolic blood pressure load using ABPM in children and adolescents. Retrospective analysis of ABPMs (Welch Allyn) was performed on a total of 115 patients between 7 and 18 years of age who were referred for elevated BP without a diagnosis of hypertension at our institution from Jan 2011 to Oct 2013. Patients were divided into 4 groups based on BMI percentile: <94th percentile, 94–98th percentile, 98–99th percentile, and >99th percentile. Analysis between blood pressure loads and BMI percentiles revealed greater mean systolic and diastolic loads with increasing BMI percentiles, but the P value was not statistically significant. Analysis of the systolic loads between children from different racial backgrounds revealed higher values in African American children than in Hispanic and Caucasian children, but the P value was not statistically significant.

A Cross Sectional Analysis of Frailty and Markers of Frailty in Young People Living with HIV/AIDS

Background Frailty is an ageing-associated state linked to poor prognostic outcomes. Chronic inflammation due to HIV-infection, AIDS-related infections. and the adverse effects of antiretroviral therapy (ART) all contribute to frailty in people living with HIV/AIDS (PLHA). Frailty has been comprehensively studied in populations comprising predominantly of Caucasian PLHA. However, there remains a dearth of such data in Indian populations, especially in younger PLHA. Methodology This cross-sectional study aimed to estimate the prevalence of frailty in PLHA (18 - 50 years) who had been on ART for 24-60 months and identify markers linked to frailty. Frailty was assessed in 152 subjects using the Fried frailty-index. Parameters measured included the mid-upper arm and calf circumferences, pain-severity (using the Brief Pain Inventory), highly-sensitivity C-reactive protein, d-dimer, and interleukin-6. Results The prevalence of frailty and pre-frailty were 6.58% and 23.02%, respectively. Reduced grip strength and self-reported exhaustion were associated with frailty (15.79% and 13.16%, respectively). Low calf-circumference and mid-upper arm circumference were not significantly associated with frailty/pre-frailty. The prevalence of pain was 21.7% and both pain severity and pain interference were significantly associated with frailty/pre-frailty. CD-4 counts at the time of assessment showed an inverse association with frailty. Elevated C-reactive protein (CRP of 0.04 associated with 0.49 probability of frailty (95% CI 0.40 – 0.59), CRP of 0.12 associated with 0.63 probability of frailty (95% CI 0.47 – 0.76)). D-dimer levels were not significantly associated with frailty /pre-frailty. Conclusion In this first-of-its-kind study on frailty in young PLHA (mean age 37 years) from the Indian sub-continent, the prevalence of frailty and pre-frailty was 6.58% and 23.02%, respectively. Multivariate analysis showed a strong association of frailty with pain severity, CD4 count at time of assessment, hs-CRP levels and duration of ART.

Rbm45 Phylogenetics, Protein Domain Conservation, and Gene Architecture in Clade Metazoa

Mammalian Rbm45 is predominately expressed in neuronal tissue and is integral in brain development and neuronal differentiation under physiological conditions. Dysregulation of Rbm45 has been strongly associated with neurodegenerative disorders in humans and can drive hepatocellular carcinoma through reprogramming lipid metabolism. Intriguingly, Rbm45 is an ancient protein, evolutionarily conserved throughout metazoans, including in sponges which lack a nervous system. Curiously, the evolution of Rbm45 gene structure and protein domain conservation across kingdom Animalia is largely unknown. We performed phylogenetic analysis of Rbm45 nucleotide and amino acid sequences from 36 species representing 9 phyla: Porifera, Cnidaria, Priapulida, Mollusca, Brachiopoda, Arthropoda, Echinodermata, Hemichordata, and Chordata. While the tree from Rbm45 nucleotide sequence data resulted in clades Protostomia and Deuterostomia showing paraphyly, the phylogeny derived from Rbm45 amino acid sequence largely recapitulated known monophyletic relationships among metazoans. Human RBM45 protein structure includes three RNA-binding domains (RBD), a homo-oligomerization association (HOA) domain, a nuclear localization sequence (NLS), and a nuclear export sequence (NES). Multiple sequence alignment across the same 36 taxa used for phylogenetic analysis revealed conservation of all three RBDs, the HOA, and NLS; in contrast the NES was only detected in clade Craniata and not in clades Ambulacraria and Protostomia. Rbm45 gene structure analysis revealed increasing gene complexity concomitant with increasing evolutionary complexity. Rbm45 from non-bilaterian taxa had from 2 to 4 large exons, while bilaterian taxa had between 6 to17 small exons. These findings demonstrate that Rbm45 is an ancient, highly conserved gene among metazoans suggesting a function in a breadth of neural/sensory systems.

A Study on Nutraceuticals

Hippocrates trusted foodstuff, maybe medicine, and healthcare management, administration, and costing are important. Nutraceuticals, derived from "nutrition" and "pharmaceutical," cover differing healing areas like “antagonistic-hard, cold and cough, sleep difficulties, digestion, cancer prevention, osteoporosis, blood pressure, cholesterol management, pain relievers, depression, and diabetes”. “Stephen De Felice”, “founder of the Foundation for Innovation in Medicine, created the term in 1989”.Functional foods, like milk and orange juice, supply health benefits that surpass food, in the way that a better lifestyle and a lower risk of ailment. Nutraceuticals, in another way, involve fortified dairy products like milk that help avoid or cure illnesses and disorders apart from anaemia.Conventional arrangements like Solvents extraction , Soxhlet distillation ,maceration and “Non conventional designs” like ‘Microwave assisted origin’, Ultrasound Assisted Extraction are used to restore the bioactive material from plants for nutraceuticals.”The Indian Health and Dietary Supplement Association” supports drug, nutraceutical, herbaceous, and direct selling energies by categorising them based on chemical arrangement, food type, and conventional arrangement.This paper gives a brief review on nutraceuticals ,its history , its market trend , extraction techniques , benefits and its applications .

The Impact of Nutrients on Diabetes

Over the past 20 years, the number of persons with diabetes has more than doubled globally. The purpose of this review article is to investigate the connection between certain vitamins and diabetes. Diabetes patients have been found to have decreased amounts of certain antioxidant vitamins including A, C, and E, presumably as a result of the requirement to control oxidative stress brought on by problems with glucose metabolism. Retinol-binding protein has regulatory and adipocytokine function. Thiamine, pyridoxine, and biotin levels are also decreased in diabetics. Studies have shown that it restricts the absorption of several nutrients, such as vitamins B9 and B12, thus diabetics must frequently replenish these vitamins. Low vitamin D levels increase the risk of developing diabetes and associated complications, such as cardiovascular disease. Although some studies indicate that vitamin K supplementation can enhance glucose metabolism, it is not known if vitamin K supplementation can prevent or repair oxidative damage. Numerous studies have demonstrated the detrimental consequences of excessive vitamin supplementation. The association between a few nutrients—specifically, vitamins A, D, C, B3, B6, B9, Zn, B12, E, B1/K, and irons—and the already mentioned pathways implicated in diabetes—as well as their potential regulatory activity—will be analyzed in the review that follows.

A Treatable Cause of Progressive Visual Loss

Sphenoethmoidal encephalocoele is a rare clinical entity with varying clinical presentation. It can be seen in association with corpus callosal agnesis and midline facial defects. We are reporting a case of 44 year old female presented with progressive vision loss of right eye, and surgical correction of meningoencephalocoele and the defect prevent further visual detiortion.

Helminth parasites prevalence and distribution among Sheep in Gudaya Bila District, East Wallaga, Ethiopia

Helminth parasite infections in sheep are of major veterinary importance in many agro-ecological zones and are a primary factor in the productivity of sheep. The main objective of this study was to determine helminth parasites prevalence and their economic loss caused on sheep with its control approach at the study area. A cross-sectional study using a simple random sampling procedure was used to study helminth parasite identification at Gudaya Bila district during 2022 in two seasons of the year: winter (January - March) and summer (June - August). Out of 384 sheep chosen at random sampling from five Kebeles in the Gudaya Bila district (Welenelemu, Harogodisa, Chalejima, Hagelogidami, and Bila) that underwent flotation and sedimentation procedures, about 149 were infected by ay helminth parasites, with an overall prevalence 38.8%. Regarding the distribution of helimenth parasites at the class level, the prevalence was 13.9%, 11.7%, and 3.9% in trematoda, nematode, and cestoda, respectively. The helminth species that had highest prevalence were Fasciola species (19.5%), Haemonchus species (14.76%), Strongyloides species (10.74%), and Schistosoma species (9.4%), and those that had the least prevalence were Moniezia species (6.04%), Paramphistomum species (5.4%), Taenia species (4.02%), Nematodirus species (3.3%) and Trichostrongylus species (1.34 %). The summer season was favorable for helminths parasite transmission. The prevalence of helminths in the summer season was 98 (25.5%), and in the winter season it was 51 (13.3%). The study shows that the gastrointestinal helminth parasite was a major health problem and had an impact on the production of sheep in the study area. Therefore, a detailed study should be conducted to identify the parasite at the species level, and further investigation will be needed to study the association of the prevalence of helminth parasites within age, sex and the agroecology of sheep in the area. Then educating the people about the impacts of helminths is needed to control them.

Gastric Pneumatosis: the tale of two late preterm infants with Necrotizing Enterocolitis

Gastric pneumatosis though rare, when seen is cause for concern. It has been associated with fulminant necrotizing enterocolitis (NEC) and gastric outlet obstruction, although other associations have been identified. It is not to be confused with pneumoperitoneum and can be managed conservatively as it is not always a harbinger of intestinal perforation. This case report highlights gastric pneumatosis which occurred in association with necrotizing enterocolitis in two late preterm infants. NEC accounts for 5.4% of our Neonatal Intensive Care Unit admissions, however these are the first two cases of gastric pneumatosis seen in the history of our unit. It is crucial for clinical staff to be cognizant of this pathognomonic sign so that cases are not missed, and for the feeding policy that governs the management of late preterm infants to be revisited. That which specifically predisposes a baby with NEC to developing gastric pneumatosis remains unknown and warrants further research.

Preconception Immunoglobulins and Complements as Potential Biomarkers in Unexplained Female Infertility in Saudi Arabia

Background Immunological abnormalities are currently under scrutiny to potentially unravel the etiology of frustrating cases of unexplained female infertility (UFI). Objectives To explore the prevalence of immunological abnormalities in the levels of total immunoglobulins and complements in the cases of UFI. Methods Females with a history of UFI were included in this cross sectional study. They were consulted at the clinical immunology clinic at the King Abdulaziz University Hospital (KAUH). Their demographics, clinical features, total immunoglobulins and complements tests results were collected and analyzed for any relationship. Results One hundred and twenty-one cases of UFI with an average age of 34 ± 5.6 (range from 23 to 49 years old) were studied. Secondary infertility was predominant in 99 cases (81.8%). An overall prevalence of at least one abnormal level of total immunoglobulins or complements was found in 65 cases (55.1%). The predominant immunological abnormalities were elevated levels of immunoglobulins (hypergammaglobulinemia) in 51 cases (43.2%), high IgG in 26 cases (22%), high IgA in 14 cases (11.9%), and high IgM in 11 cases (9.3%). This was followed by elevated levels of complements (hypercomplementemia) in C4 in nine cases (8.5%). A significant association was found between high C4 group and some parameters of infertility, including primary infertility (p = 0.005), no pregnancy (p = 0.001), no abortion (p = 0.047), in comparison to normal C4 group. Moreover, a statistically significant association was found between high IgA group and abortion in comparison to normal IgA group (p = 0.054). Conclusion At least one abnormal level of total immunoglobulins or complements was detected in more than half of the UFI cases. The commonest abnormalities were hypergammaglobulinemia (IgG, IgM, IgA) and hypercomplementenemia (C4), which showed a potential association with some infertility parameters. These findings may encourage the screening of general immunological tests to explore promising new immunopathology in UFI.

Osteoarthritis and Depression Update: 2023-Can the Stress and Coping Model Help?

Background Osteoarthritis and depression are both key barriers to healthy aging and greatly heighten the risk for many negative health issues that seriously impact life quality. When combined what are the implications? Aim This mini review examines 2023 data pertaining to osteoarthritis and depression and older adults and a possible theoretical framework of stress that may direct our approaches in the future. Methods and Procedures Articles published between January 1 and August 15 2023 that addressed the current topic of interest and that were extracted from PUBMED, PubMed Central, Science Direct, and Google Scholar were carefully read and their key points arepresented in narrative form. Results As in the past, very few tangible theory-based prospective analyses that employ valid measures of depression and examine any association of any form of osteoarthritis longitudinally and in a consistent manner prevail. Several reports use the same or similar large cohort to draw upon, and find various degrees of clinical implications, but this may not embrace the need for more inclusivity, sampling strategies, control and diversity issues, as well as embracing the role of cognitions positive and negative. Conclusion Without efforts to develop sound research designs of diverse and carefully differentiated osteoarthritis substantive samples it is impossible to delineate the origin or implications of the osteoarthritis-depression linkage reported currently or arrive at a deep understanding of its relevance, to life quality and public health costs. What is needed to protect against or minimize either or both these clinically related disabling correlates in the aged population warrants timely study.

Attitude of Nursing Students towards LGBTIQ Individual and its Associated Factors in Kathmandu Metropolitan City

Background People may have both negative and positive attitudes about other people, their way of living and those attitudes can be influenced by various factors. LGBTIQ individuals are facing various difficulties and barriers to run their daily life due to different attitudes of people. Attitudes may be different from person to person influenced by their knowledge, acceptance behaviour and understanding. By finding out the associated factors that influences the attitude of people we can change people’s view towards LGBTIQ individuals. Each and every person deserves to be treated equally regardless of their gender, sexual orientation, and preferences. Methods This was a cross-sectional study in which the sample size was 423 and the study population was nursing students. A simple random sampling method was used to select sample for the study. Self-administered questionnaire was used to collect data. The collected data was entered in EPI 3.1 and analyzed using SPSS 25. A descriptive statistic was used to find out the frequency and percentage and analysis (chi-square) was used to find out the association between the dependent and independent variables. A p-value of <0.05 was considered statistically significant. Results Results showed that 87.2% have positive attitudes towards LGBTIQ individuals, and the majority (56.6%) have knowledge about homosexuality. Similarly, more than two-thirds (82.7%) of respondents were not homophobic, and 50.4% showed positive stereotypes about LGBTIQ individuals. Religion (p=0.030), caste (p=0.001) and Family type (p=0.016) were statistically significant with regard to the attitudes of students towards LGBTIQ. Conclusion The majority of students had positive attitudes towards LGBTIQ individuals and few had negative attitudes. Almost half of the respondents had adequate knowledge about homosexuality. The majority of students were not homophobic and few were homophobic. Half had positive stereotypes and about other half had negative stereotypes.

Can Vitamin D Positively Impact Sarcopenia Severity Among Older Adults with Hand Osteoarthritis: A Review of the Evidence

Aim This review examines the research base concerning hand osteoarthritis and changes in muscle mass and quality known as sarcopenia and the possible use of vitamin-D supplementation for reducing this potentially adverse functionally disabling state. Methods Publications detailing a possible link between hand osteoarthritis manifestations and sarcopenia, plus those discussing vitamin D as a possible intervention strategy for minimizing sarcopenia in the older adult were systematically sought and reviewed. Results Collectively, data reveal hand osteoarthritis in the older population is common, and is possibly affected by age as well as disease associated muscle mass declines. Vitamin D, a powerful steroid required by the body to foster many life affirming physiological functions may help reduce the degree of any prevailing sarcopenia and thereby some degree of hand osteoarthritis disability. Conclusions Older individuals with hand osteoarthritis, as well as healthy older adults at risk for sarcopenia are likely to benefit physically from efforts to clarify the extent of this association and if indicated, to examine and intervene thoughtfully to maximize muscle composition as well as safe vitamin D levels where subnormal. Researchers can make highly notable impacts in multiple spheres in this regard and are encouraged to do so.

Assessment of Oral Health-Related Quality of Life Among a Sample of Yemeni Population

The study aimed to assess the oral health condition and its impact on the quality of life (QoL) among a sample of Yemeni population. The study including 256 individuals who responded to the Oral Health Impacts Profile (OHIP) through completing a face-to-face survey of the OHIP-14 Arabic version. The data were collected by one dentist trained in the terms of oral health-related quality of life (OHRQoL). The study revealed that the impact of OHRQoL among the study sample was found with a weighted OHIP-14 score of 1.1 (±0.9). Physical pain (3.7±2.3), followed by physical disability (2.4±2.2), and psychological disability (2.1±2.3) were the highest scoring. A significantly higher effect (p < 0.05) was found for the adults (18-44 years old) compared to those elderly individuals (> 64 years). The OHRQoL was better in male than in female and in employees than in both pensioners and un-employees. Females had a significantly higher effect when compared to males in the OHRQoL (p < 0.05). The unemployed subjects were significantly higher than those pensioners and employees in the OHRQoL (p < 0.05). The OHRQoL was also better in subjects with higher income and education than those participants with low. However, there were no significant differences for OHRQoL with respect to the educational level and monthly income of participants (p > 0.05). Conclusion, the quality of life is greatly affected by the oral health conditions of the elderly. This impact of oral health on quality of life has an association with individual and contextual variables.

Long COVID-19 Syndrome and Frailty: Cause or Consequence or Both?

Background Many older adults remain vulnerable to COVID-19 infections. They are also often at risk for frailty and poor health outcomes.  Aim This exploratory review examines the correlates of long COVID and frailty and their association insofar as the older adult’s wellbeing may be jeopardized.  Methods and procedures Articles that emerged between January 1 2022 and 2023 in major electronic data bases that addressed the current topic of interest were sought using the key words: Long COVID and Frailty. Those deemed relevant were duly downloaded, analyzed and summarized in narrative form.  Results A high proportion of older adults can be expected to remain vulnerable to COVID-19 long term impacts, plus new variants of infection, along with frailty as both an outcome and mediator. Many too are at risk for persistent long COVID-19 complications and a low life quality if more concerted preventive and rehabilitation efforts to avert frailty early on are not forthcoming in a timely manner.  Conclusion Prompt and continuing frailty assessments of older adults at risk for COVID-19 or recovering from this disease, especially those with long COVID manifestations who are frail or may become frail are strongly indicated.

Abdominal Aortic Aneurysms: Epidemiological, Clinical and Echographic Aspects in The Health Structures of Lomé and At The Kara University Hospital (TOGO)

Objective To describe the epidemiological, clinical and arterial Doppler ultrasound aspects of abdominal aortic aneurysm (AAA). Material and Methods This is a prospective study with descriptive and analytical aims carried out from January 2019 to March 2022 (3 years) at the cardiovascular exploration center (CEC) "Saint-Esprit" of the association of the people's doctors for the research on cardiovascular diseases (AMP-MCV), at the clinic "Le Printemps" and at the University Hospital of Kara. All patients who underwent arterial Doppler ultrasound of the lower limbs for any reason in these centers during the study period were included. Ultrasound scans were performed or confirmed by a physician with a diploma specializing in vascular Doppler ultrasound. Results We retained 32 Doppler ultrasound scans out of 739 performed for AAA with a frequency of 4.38%. The mean age was 73.5± 9.07 years. The sex ratio M/F was 1.4. The cardiovascular medical history (84.38%) found was: hypertension (33.33%), diabetes (18.52%), dyslipidemia (33.33%) and a combination of diabetes and hypertension (14.81%). The circumstances of discovery were: downstream MI ischemia (72%), incidental finding on abdominal ultrasound (15.63%) and De bakey sign (6.25%). The location of the aneurysms was subrenal (84.4%), suprarenal (9.4%) and both (6.2%). AAAs were fusiform (71.9%) and saccular (28.1%). The size of the aneurysms was greater than 5 cm in 78.17% of patients. High blood pressure increases the probability of the occurrence of subrenal AAA while dyslipidemia increases the occurrence of fusiform AAA. Diabetes increases the probability of occurrence of AAA larger than 7cm. AAAs were thrombosed in 75% of patients. There were extensions of the aneurysms to the iliac arteries in 70.59%. Downstream embolic complications represented 46.88%, in the form of occlusions and tight stenoses. Spontaneous mortality was 81.24%. Conclusion Arterial Doppler ultrasonography is a very important tool in the screening, positive and lesion diagnosis of AAA. The risk factors for AAA are: age over 60 years, male gender, hypertension, diabetes and dyslipidemia. Early detection remains essential, because the spontaneous prognosis is poor.

Adolescent-Parent Communication on Sexual and Reproductive Health and its Associated Factors among Higher Secondary School Students of Tokha Municipality, Kathmandu, Nepal

Introduction Physical, psychological, and emotional growth are among the changes that define the adolescent stage. As compared to other age groups, adolescents are more vulnerable to sexual and reproductive health issues. Parents can become protective and influencing factors for their children to prevent risky sexual behavior. This study aims to assess adolescent-parent communication on sexual and reproductive health and its associated factors.   Methods A descriptive cross-sectional study was conducted among 212 adolescents aged 15–19 in higher secondary schools of Tokha Municipality. A self-administered structured modified questionnaire to assess the communication used the Weighted Topics Measure of Family Sexual Communication (WTM) tool with a simple random sampling technique of data collection. We performed descriptive statistical analysis and chi-square tests to analyze data and assess the association between variables. Data quality was assured through careful questionnaire design, pretesting, and training.  Results The study found that about 75.9% of adolescents had communicated on SRH topics with their parents. Only 56.1%, 50.1%, 55.2%, and 50.5% of adolescents communicated about choosing a life partner, menstruation, physical and psychological changes during adolescence, and the physical growth and development of reproductive organs, respectively, while topics like using birth controls, when to start having sex, pregnancy, how to handle sexual pressure from a partner, STI and HIV/AIDs, about condoms, and abortion had never communicated by 61.3%, 86.6%, 69.3%, 85.8%, 72.2%, 78.8%, and 82.5% of adolescents, respectively. Adolescent-parent communication on sexual and reproductive health was significantly associated with the level of knowledge regarding sexual and reproductive health (X2 = 5.809, p = 0.01, df = 1). Similarly, there was a significant association with the perceived parenting style (X2 =3.932, p =0.04, df =1), living arrangements (X2 =6.376, p=0.01, df =1), and adolescent-parent communication. Conclusion  It concluded that adolescent-parent communication on SRH issues is not satisfactory. Creating an adolescent-friendly environment at home and conducting awareness programs with the help of the local government of the respective schools would help to increase adolescent-parent communication. 

Improved Latrine Coverage and Associated Factors Among Rural Community in Gicumbi Gistrict, Rwanda

This study aimed at determining improved latrine coverage and associated factors among rural community in Gicumbi district. A cross-sectional study was employed using mixed methods with quantitative and qualitative data collection approaches. The quantitative approach of data collection method was conducted and then qualitative approach followed. A structured questionnaire was used to collect quantitative data and Focus Group Discussions (FGDs) was conducted to collect the qualitative data. The study population consists of household heads or their representatives and key informants from the study area of Gicumbi district. For quantitative the total sample size was 236 households while for qualitative data, a total of three FGDs with eight (8) participants was conducted among twenty four (24) rural community members of Gicumbi district. Raw data from the questionnaire were entered into EPI data and transported into SPSS version 22 for analysis. Descriptive statistics was used to tabulate and describe the data. The strengths of the associations were determined with multiple logistic regressions. The results shows that 69.1% of respondents were male, 30.1% were farmers, 16.9% had formal employment while 57.2% completed secondary education. The prevalence of improved latrine in Gicumbi District was 65.3%. Tertiary education was also 4.3 times more likely to have improved compared to those who did not have formal education (AOR=4.3CI: 95%: 1.027-7.032. P=0.005). Respondents with average monthly income Between 50,000 and 100,000 Rwfs are 2.7 times more likely to have improved latrine (AOR=2.7 CI at 95%:1.009-4.120, P=0.022).

The Third Survey on the Activity of Human Milk Banks in Italy and the Impact of the COVID-19 Pandemic

Background Growing scientific evidence points to the benefits of human milk for the growth and development of a newborn. Compelling evidence has confirmed the benefits not only for full-term babies but also for preterm infants. Objective This survey was planned by the Italian Ministry of Health together with the Italian Association of Donor Human Milk Banks (AIBLUD) and aimed to evaluate the activity of human milk banks (HMBs) in Italy in the period 2018-2020, analyzing several items and the impact of the COVID-19 pandemic. Methods Following the two surveys performed in 2012 and 2016, a third survey was planned in the year 2021 to evaluate possible changes in the activity of the Human Milk Banks (HMBs) operating in Italy. A questionnaire was sent to all the 41 HMBs officially operating in Italy in the year 2021 with the purpose to obtain national data concerning milk banks activity, number of donors, volume of human milk collected, and other information related to the years 2018, 2019 and 2020. Additional questions related to the impact of the COVID-19 on the activity of HMBs in the year 2020 were included. Therefore the questionnaire proposed in this third survey collected fundamental data on the donation of human milk with the implications related to the COVID-19 pandemic. Results 90% of the banks (37/41) responded to this survey. The collected data confirm the results of the second survey (2016), with a high level of adherence to the Ministerial Guidelines and the AIBLUD recommendations. The application of the principles of the HACCP system continues to improve (89%), while in the last three years there has been a sharp decline in the home collection service for donor human milk (68%). This decline is mainly linked to the interruption of this service due to the limitations imposed by the pandemic. In 2020 (the year of the COVID-19 pandemic) there was a clear reduction in the number of donors with a return to the values ​​of 2016. The volumes of milk collected, and the average duration of donation, however, remained high. The reasons linked to the reduction in the number of donors are described. Conclusion This survey underlines the high quality standard of Italian HMBs and the usefulness of this service for the national health policy. Despite the difficulties due to the COVID-19 pandemic, the Italian HMBs have maintained an efficient and safe service and have guaranteed the collection of satisfactory volumes of donor milk. Lack of information represents the most important barrier to the donation of human milk.

Users Perception and Factors Affecting Data Quality in Nyarugenge Public Health Facility, Rwanda

The study evaluated the users' opinions on data quality and related characteristics in ten public-health institutions of Nyarugenge district. A study used a cross-sectional design, data was collected through quantitative (n=150) methodology while qualitative data was obtained using interviews (n=20) and focus group talks (n=3). A checklist was utilized to examine the completeness, accuracy, and timeliness of data quality aspects. Collected quantitative data was analyzed through logistic regression by SPSS to examine the association of variables, while qualitative data was analyzed using the summative content analysis (SCA) to summarize the key themes. A 95 percent confidence level, Odds Ratio (AOR) were used to establish the strength of correlation among study variables, while a p-value of less than (p<0.05) was utilized to identify the variables which were statistically significant associated to HMIS data quality. The study finding showed that the majority (53.0%) was female while, 33 years was an average age, the majority of health practitioner (52.7%) had an A1 diploma. Approximately 90.6% of respondents have a positive perceptions on the system usage. Limited ability and a lack of relevant technology equipment such as computers and the internet have been cited as the challenges while using the system. Factors such as training AOR:2.62(95% CI:1.45, supervision AOR:1.81(95% CI:1.02, AOR:2.50(95% CI:0.85 for education background, works-experience AOR:1.60(95% CI:090 are factors associated with data quality. Maintaining, supportive supervision, regular training and refresher courses should be regularly offered to public health professionals to improve their knowledge in order to maximize the use of health information.

Microalbuminuria and the Presence of Hypoxemia in Patients with Chronic Obstructive Pulmonary Disease

Introduction Worldwide, the Chronic Obstructive Pulmonary Disease (COPD) is a major public health concern; On the basis of epidemiologic data, by 2020, COPD will be the third leading cause of death worldwide. Objective To assess the frequency of Microalbuminuria and the presence of Hypoxemia in patients with COPD. Materials and Methods Study Design Cross-sectional observational study. Place of Study Department of Medicine & Respiratory Medicine in Dhaka Medical College Hospital (DMCH). Study Period Six months after approval of the protocol Study Population Patient suffering from COPD and admitted in Department of Medicine & Respiratory medicine, DMCH, Dhaka, Bangladesh. Total 100 samples were included in this study. COPD usually presents with a history of chronic cough with sputum production or exertional breathlessness which may be associated with relevant clinical findings and a post-bronchodilator FEV1/FVC less than 0.7. In most cases it is associated with smoking Results Total 100 patients of COPD were included in the study. Mean age was 58.16±5.4 years ranging from 50 to 74 years. Out of 100 patients, majority (42%) were from age group 55 to 60 years. Among all, 82% patients were male and 18% were female, of 100 patients, majority (30%) were day laborer. Only 2% were unemployed. The percentage of housewives was 18%. Other 34% were businessman and service holders. COPD severity was assessed using GOLD guideline. Out of 100 COPD patients, 38% had severe COPD (GOLD stage III). 16 % patients were in mild (Stage I) and 32% patients were in moderate stage (Stage II). The condition was very severe for 14% patients (Stage IV). Of 100 COPD patients, 30% had microalbuminuria. Among 100 COPD patients, chance of microalbuminuria increases among COPD patients with the increase of age significantly. There is smoking history of 36 pack year for COPD patients with microalbuminuria. Of 100 patients 26% were hypoxemic. The average forced expiratory volume (FEV1%) was 37.40 with standard deviation 14.48 for patients with microalbuminuria. The PaO2 and PaCO2 is 63.06 with standard deviation 7.09 and 46.09 with standard deviation 2.43 for COPD patients with microalbuminuria respectively. All of these characteristics are significant with p-value 0.00. However, the body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were not found significant. The patients who had PaO2 less than 70 mmHg were considered hypoxemic. The patients who had microalbuminuria among them 87% were hypoxemic. Only 13% patients were free from hypoxemia who had microalbuminuria. Patients without microalbuminuria had no history of hypoxemia. There is significant relation exists between hypoxemia and the presence of microalbuminuria (p<0.5). Conclusion In this study, about one-fourth of the patients have hypoxemia and more than one fourth of the patients have microalbuminuria. Stage III was more frequent among the study population but there was no association between severity grading and presence of microalbuminuria. However, significant relation is found between co-existence of both microalbuminuria and hypoxemia in COPD patients.

Reproductive Health Knowledge and Services Utilization among Rural Adolescents in Rwamagana District, Rwanda

This study aims to assess reproductive health knowledge and services utilization among adolescents from Rwamagana District. A community based cross-sectional study was carried out in Rwamagana district. A sample of 392 adolescent aged 15-19 participated in the study. Simple random sampling was used to select respondents. Data was collected by using a questionnaire adopted from previous studies. Data was checked for completeness, cleaned, coded and entered into excel sheet, and then exported to SPSS version 22.0 for further analysis. Frequencies and percentage was used to summarize descriptive statistics. To determine the association between different factors associated with reproductive health knowledge and services utilization, a logistic regression model was employed. Ethical clearance was obtained from the Ethical committee of Mount Kenya University. It was observed that the majority of adolescents in Rwamagana District knew the sign of maturity. Overall the majority of adolescents 91.8% in Rwamagana District had good knowledge about reproductive health services. The majority of adolescents in Rwamagana District (66.8%) had ever utilized reproductive health services at health facility. It was observed that adolescents who live with their parents were more likely to use reproductive health services compared to those who do not live with parents (aOR=2.161, 95%CI: 1.162-4.021, p=0.015). Moderate reproductive health services utilization was observed among adolescents. There is a need to increase adolescent’s awareness on the available services at health facilities.

Challenges and Factors Associated with Adherence to Non-Pharmaceutical Interventions to Prevent the Spread of COVID-19 in a Slum Setting

Objectives This study aims to evaluate the challenges of implementing non-pharmaceutical interventions, assess adherence, accessibility to prevention materials and identify requirements for the control of the spread of COVID-19 among individuals living in a slum-setting in Lagos, Nigeria. Methods This is a five-month cross-sectional study conducted in Makoko, Lagos an urban-slum community. Data on sociodemographic characteristics, living conditions and adherence to COVID-19 prevention strategies were obtained with a semi-structured questionnaire. Logistics-regression model was used to determine factors associated with adherence to COVID-19 preventive measures. Results There was a total of 357 participants who had a mean age of 45.8 ± 12.9 years. Majority were males (62.2%), married (83.8%), self-employed (66.4%), and had secondary education (31.4%). Most participants (93.8%) had no space for self-isolation as majority lived in a one-room apartment (72.8%), shared toilets/kitchen space (64.4 %), had no constant source of water supply (61.9%) and buy water (62.5%). About 98.8% are aware of the COVID-19 pandemic but only 33.9% adhered. Most of the participants disclosed inability to purchase face masks/ hand sanitizers (68.9%). After adjusting for covariates, the ability to afford facemasks/hand sanitizers (P < 0.0001, aOR 6.646; 95% CI: 3.805-11.609), living alone (P < 0.0001, aOR 3.658; 95% CI: 1.267-10.558), and ability to buy water (aOR: 0.27; 95% CI: 0.14-0.50), had greater odds of association with adherence to the non-pharmaceutical COVID-19 preventive measures. Conclusion The lack of isolation space among majority of the respondents calls for concern. Inability to purchase prevention materials is a major factor influencing poor compliance to COVID-19 prevention strategies.

A Patient with Monoclonal Gammopathy of Undetermined Significance and Detected Philadelphia Chromosome

Background Monoclonal gammopathy of undetermined significance (MGUS) and chronic myeloid leukemia (CML) are diseases of different lineages. The diagnosis of both MGUS and CML in the same patient is a rare occurrence and has not been reported in much literature. Case Presentation We describe a 56-year-old man with a history of rheumatoid arthritis incidentally found to have an increase in IgA paraprotein. With less than 10% monoclonal plasma cells on the bone marrow biopsy and absence of hypercalcemia, renal failure, anemia and bone lesions, MGUS was diagnosed. The conventional cytogenetics at the time showed the presence of the Philadelphia chromosome in 30% of metaphases. However, there was no morphologic evidence of CML in the peripheral blood or bone marrow. Patient received no treatment and lost follow-up until 3 years later when a routine CBC showed leukocytosis and thrombocytosis. CML, chronic phase was diagnosed following a bone marrow aspiration and biopsy with Philadelphia chromosome observed in 100% of metaphases. Patient was treated with imatinib and later switched to dasatinib and complete molecular remission was continued to be achieved. Discussion and Conclusion Here we report a case of pre-leukemic CML as an incidental finding during the diagnosis of MGUS. The possible underlying mechanisms of the association are discussed although the exact cause of the coexistence is unclear.

Targeting Mutational Landscape of TP53 in patients diagnosed with Oral Cancer living in Senegal

Introduction Genomic mutations in TP53 gene in association with etiological risk factors have been associated with oral carcinogenesis. Herein, we screened for genomic variants of TP53 predisposing to oral cancers in Senegalese patients. Methodology 88 patients with confirmed diagnostic were recruited after informed consent. Blood samples were collected from each patient to perform DNA extraction, PCR amplification of all coding exons of TP53 followed by Sanger Sequencing of PCR products. Nucleotide sequences were analysed with Genalys software. 94 blood donors with no cancer diagnosis were also recruited as controls for association study between the most common variants identified in patients and predisposition to oral cancers. Results Sequence analysis showed that 52.27% of patients carry at least one mutation in TP53. Eleven genomic variants were identified, 7 variants already reported in databases and 4 new variants. The most recurrent variants in this study already reported as cancer-related variants were Pro72Arg (rs1042522; Arginine frequency estimated at 31.26%) and a 16 bp insertion in intron 3 (rs59758982; allelic frequency estimated at 26.25%). Haplotype analysis between these variants showed a strong linkage disequilibrium (D’ = 0.999, r2 = 0.153 and p-value < 0.05). However, association study did not find any significant association with susceptibility to oral cancer (p-value > 0.05). Conclusion Our study highlighted that despite the absence of association between the two most common cancer-related variants in Senegalese patients diagnosed with oral cancer, their strong LD suggested that they could be transmitted together in a common haplotype which may be implicated in oral carcinogenesis.

Perspectives of Workplace Incivility and Nurses Intent to Quit: Investigations Examined

The connection between the nurse employee’s apparent degree of work environment incivility and their expectation to stop their individual associations has been upheld by research for far over 10 years. Placed contentions have additionally analyzed a distinction in nurses' view of work environment incivility considering the kind of working environment (i.e., regardless of whether a public or private healthcare practice), considering the impression of existing working environment incivility and aim to stop employment, separately. The reason for such survey of writings is not just to decide the degree to which work environment incivility influences a nurses' plan to stop employment, yet more so to make for all viewpoints being additionally featured. Additional exploration on working environment incivility, remains continuous, with its related contributory elements, and the impacts on the examined relationships. New research on working environment incivility has critical ramifications for nurses, patients, healthcare services and associations were generally investigated 14569151718232427282943445868697172. Work environment incivility displays lack of respect, negligence or discourteousness that has formed into a combined issue, proved by irritating unfavorable consequences for human resources, and the adverse consequence on the association 78.

Fear of Falls and Frailty: Cause or Consequence or Both?

Background Many older adults are vulnerable to becoming frail. They are also often at risk for falling and serious injuries and poor health outcomes. Aim This exploratory review examines the correlates of frailty, and fear of falling and their association insofar as older adults wellbeing may be jeopardized.   Methods and Procedures Articles extracted from major electronic data bases that addressed the current topic of interest were used. Key findings regarding the syndromes of frailty and fear of falling were duly downloaded, analyzed and summarized in narrative form. Results A high proportion of older adults can be expected to exhibit frailty or become frail as they age. Many too are at risk for falls and fear of future falls, regardless of frailty status. A persistent fear of falls may however, heighten frailty risk or manifestations if not duly addressed in a timely manner. Conclusion Prompt comprehensive assessment of at risk older adults, as well as the frail and pre frail older adult, plus those who have fallen may avert serious injury and long term disability plus excess frailty and its deleterious impacts this syndrome has on aging older adults as well as societies.

One Out of Five Women Practiced Cervical Cancer Screening in Felege Hiwot Referral Hospital, Amhara, North West Ethiopia

Background Eighty five percent of cervical cancer occurrence in resource-poor countries. Contributing factors for these are inadequate knowledge about the disease, early initiation of sexual intercourse and multiple sexual partners. Early screening is an intervention in reduction of maternal deaths due to cervical cancer. Consequently this study was conducted aiming to find out about the practice of cervical cancer screening and its associated factors. Methods A facility based cross sectional study was conducted using a pretested structured questionnaire among women attended Maternal and Child Health (MCH) department of Felege Hiwot Referral Hospital (FHRH) from March15 to April 15, 2019. The study participants were selected systematically. The collected data were entered and analyzed using SPSS version 20. Logistic regression analysis was employed to examine factors association with cervical cancer screening that was confirmed using AOR with its 95% CI. Results A total of 400 study participants were included with a response rate of 99.5%. Of the total study participants only 78 (19.5%; 95% CI: 15.6, 23.4) practiced screening for cervical cancer. The cervical cancer screening practice was affected by age (AOR=2.025; 95% CI: 1.118, 3.668). Of those women who had ever heard of about cervical cancer were seven fold more likely to practice cervical screening (AOR=6.924; 95% CI: 1.602, 29.928) compared to those who did not have any information before. Moreover, knowing genital tract discharge as a problem of female organ implement fourfold more likely compared to that of knowing nothing about problem of genital tract (AOR=3.766; 95% CI: 1.761,8.055). Conclusion and Recommendation The study depicted there was low utilization of cervical cancer screening. Awareness creation about cervical cancer and knowledge of genital tract problems had positive influence for screening practice.

A Cross Section Survey Assessment Study on the Knowledge and Practice of Periodic Medical Check up among the Saudi population

In Saudi Arabia most of the individuals give very little attention to issues like health or no priority to medical checkup. This investigation was carried out to measure knowledge, practice of periodic medical checkup in Kingdom of Saudi Arabia people. A cross-sectional investigation was conducted among 1015 participants. A structured interviewer administered an online questionnaire were distribute by social media and whatsApp. We collected data and analyzed using SPSS version 21. Association between categorical variables were explored using bar chart and tables, Level of significance was set at 5%. The main age of the respondents was 21-30 years, 78.4% were females and 64.2% were married. About 42.1% have ever heard of periodic medical check-up , 57% of those who haven’t ever heard of periodic medical checkup and only 21.9% among those who had ever done it had frequent medical check-up and 78.1% didn’t do it. Attempt is required in ensuring that periodic medical check-up is urged. There is a need to study the factors associated with the uptake of medical check-up among the study population and effort should be made by health agencies to educate traders on the various types of medical check-up, their indications and benefits as well as its practice encouraged

The Sweet and Sour of the Sugar-Sweetened Beverage Tax

Obesity is a common and preventable Non-Communicable Disease that is of great importance. Population-based interventions are recognised to have a profound effect on improving health outcomes. One of these approaches includes the adoption of the Sugar-Sweetened Beverage (SSB) Tax. Objectives There were three objectives, 1) explore the associations between gender, age, nationality, and change in SSB consumption, 2) explore SSB consumption during Covid-19 lockdown, and 3) inform policy decision making. Methods A cross-sectional survey in the United Arab Emirates. We performed descriptive analysis and chi-square for independence to test the difference between the expected and the observed frequencies in one or more categories. Results Since the introduction of SSB tax, change in SSB consumption by gender, age or nationality was not statistically significant. Further analysis of the proportion of sugar intake per day was statistically significant (P-value <0.001) by nationality. There was no statistically significant change in SSB consumption by age, gender, or nationality during the Covid-19 lockdown. Further analysis within the group that reported change in SSB consumption suggests a majority (80.5%) reported a reduction in SSB consumption. Conclusions Change in SSB consumption by gender, age or nationality was not statistically significant since the introduction of SSB tax, or during Covid-19 lock-down; thus, we accept the Null Hypothesis. Imposing a levy on frequently consumed SSB or revisiting levy by the gram, volume, or type of added sugar (or in combination) may prove to be more effective in reducing SSB consumption. Further research is needed to determine the extent other demographic factors influence SSB consumption as well as the enablers and barriers associated with SSB consumption. 

Anatomical Structure of the Umbilical Cord in Sudanese and Correlation with Neonatal Outcome 

Background The neonatal morbidity and mortality is very high in the Sudan, the umbilical cord association and contribution to this is planned to be answered. Therefore the present study was designed to provide some information on the morphological variations of human umbilical cord via gross anatomical assessment and their correlation with foetal factors such as foetal weight and length. Methods A prospective hospital - based study conducted in Wad Madani Maternity Teaching Hospital Department of Obstetrics and Gynecology between July 2014 and March 2018 Results The mean diameter of the 371 umbilical cords was 2.1±0.24cm. Length was 53.8±3.8 cm length ranging from 48 – 62 cm and 10 (2.7%) of 371 umbilical cords were uncoiled. of which, 1 (0.3%) cords were with absent Wharton’s Jelly. The mean neonatal indices were 2.95 kg, 33.19 cm and 44.42 cm for weight, head circumference and length respectively. There was just significant strong positive correlation between umbilical cord length and length of neonates. Also Umbilical cord diameter had a positive correlation with length of neonates and negative correlation with weight of neonates and APGAR Score. Conclusion The present study suggests that ‘normal’ cord length should be between 40 cm and 70 cm in length. Umbilical cord diameter had a positive correlation with fetal length and negative correlation with fetal weight and APGAR score. The diameter range of 1-2 cm suggests that a normal cord must not exceed 2 cm in diameter. However the umbilical cord index had negative correlation with length of neonates.

Some Regulation Mechanisms of Candidate Genes for Human Cardiovascular Diseases

Cardiovascular disease is actually a major cause of mortality, illness and hospitalization worldwide. Several risk factors have been identified that are strongly associated with the development of cardiovascular disease. Public prevention strategies have relied predominately on managing environmental factors that contribute to cardiovascular disease, such as obesity, smoking and lack of exercise. The understanding of the role of genetics in cardiovascular disease development has become much more important to link genetics with the onset of disease and response to therapy. This seeks to examine how genes can predispose individuals to cardiovascular disease and how this knowledge might be applied to more comprehensive preventive strategies in the future. In addition, the review explores possibilities for genetics in cardiovascular disease treatment, particularly through the use of identified driver genes and gene therapy. To fully understand the biological implications of these associations, there is a need to relate them to the exquisite, multilayered regulation of protein expression and regulatory elements, mutation, microRNAs and epigenetics. Understanding how the information contained in the DNA relates to the operation of these regulatory layers will allow us not only to better predict the development of cardiovascular disease but also to develop more effective therapies.

Vitamin D, Falls and Balance Capacity Impacts in Older Adults: Update

Background Falls injuries continue to contribute to numerous premature deaths as well as high disability levels, and excess morbidity rates among older adults, worldwide. But can vitamin D account for excess falls injuries among older adults? This review specifically focuses on what is known about vitamin D in the context of postural stability or balance control, both fairly consistent independent predictors of falls among older adults. Methods and Procedures Drawn largely from a review of current relevant English language peer reviewed research publications published over the last 10 years detailing the relationship between vitamin D levels and balance control among the elderly, as this relates to falls injuries, evidence for any emerging consensus on this controversial topic was sought. Used to conduct the search were various key word combinations including: falls injuries and older adults, vitamin D or vitamin D deficiency and balance or postural control. The database used predominantly to provide input into this largely descriptive assessment and narrative overview was PUBMED. Results The prevailing data show falls injuries currently constitute a widespread costly major impediment to successful aging and longevity for many older adults, despite numerous efforts to prevent this disabling set of events over the past two to three decades. However, no consistent association appears to exist between the variables of vitamin D, falls, and balance attributes in the older population-despite years of research, regardless of study approach, and a strong rationale for hypothesizing a clinically meaningful relationahip. Conclusion It is not possible to arrive at any universal recommendation concerning the value of vitamin D supplementation as regards its possible influence on balance capacity among older adults in the realm of falls prevention efforts, as has been frequently proposed. However, until more definitive research is conducted, there still appears sufficient justification for considering the screening of vulnerable aging adults for serum vitamin D levels, along with balance impairments, and intervening as required in the case of deficits in either or both of these possible falls determinants.

Correlation of Modified Computed Tomography Severity Index with Biochemical Markers in Acute Pancreatitis

Introduction Multislice computed tomography examinations performed 3 to 4 days after the onset of symptoms is the imaging procedure of choice in acute pancreatitis, which is mainly done for evaluating the complications. Due to radiation exposure and cost, alternative scoring systems like Ranson’s score and Glasgow’s score were devised but were cumbersome. The serum amylase and lipase were found to increase with progression of disease. The objective of this study was to evaluate the association of acute pancreatitis by modified CT scoring system with the serum levels of amylase and lipase. Material and Methods In hundred patients presenting with acute pancreatitis, the severity of pancreatitis was recorded using the modified CT severity index. The serum amylase and lipase levels were recorded and correlated with modified CT severity index score. Results Among 100 patients studied, 46%, 40% and 14% had mild, moderate and severe grades of pancreatitis respectively by modified CTSI score. No significant correlation was found between the levels of serum amylase (r = -0.104, p = 0.301) and lipase (r = -0.177, p = 0.079) with the modified CT severity index in patients with acute pancreatitis. Conclusion The serum level of amylase and lipase had non-significant correlation with the modified CT severity index score and thus did not indicate severity of pancreatitis.

Can Vitamin D Mitigate Osteoarthritic Hip Joint Arthroplasty Infections Among Older Adults? A Narrative Overview of the Literature Amidst COVID-19 Lockdowns and Beyond

Background Older adults with hip joint osteoarthritis, a major cause of chronic progressively disabling highly painful functional experiences, may require a surgical joint replacement procedure known as total joint arthroplasty surgery. Objective This review aimed to address the question of whether there an association between hip joint arthroplasty infection rates and prevailing pre or preoperative vitamin D levels that warrants consideration in efforts to prevent or minimize infection related hip arthroplasty complications among older adults particularly during the current ongoing COVID-19 pandemic. Methods PUBMED, SCOPUS, and WEB OF SCIENCE articles related to the topic and published between January 2016-2021 were searched, examined, and summarized. Results Older adults with hip joint osteoarthritis and low vitamin D serum levels who undergo total hip joint arthroplasty surgery may be at higher risk for post-operative infections than those with adequate vitamin D serum levels. Conclusion More research to verify whether efforts to screen for, and maximize vitamin D levels, before and after surgery, as indicated, may be helpful in the context of minimizing total hip joint arthroplasty surgery infection susceptibility and severity among older vitamin D deficient severely disabled hip osteoarthritis cases.

Effect of Hydroxychloroquine on Clinical Improvement and Mortality Among Patients with COVID-19 Admitted to Four General Hospitals in Saudi Arabia

Background The use of hydroxychloroquine in coronavirus disease (COVID-19) pandemic raised significant concerns as regards safety and efficacy in hospitalized patients. The objective was to examine the effect of hydroxychloroquine on clinical improvement and mortality among hospitalized patients with COVID-19. Methods A prospective cohort study was conducted at four general hospitals in the Western region, Saudi Arabia. Patients who had absolute or relative contraindication for using hydroxychloroquine were excluded. Patients concomitantly receiving other medications including azithromycin, antivirals, and supportive treatment were not excluded. Results A total 267 patients were included in the current analysis; 185 (69.3%) on hydroxychloroquine and 82 (30.7%) on non-hydroxychloroquine treatments. The average age was 46.0±13.3 years and 78.3% of the patients were males. Approximately 95.9% of the patients were symptomatic with mild (50.6%), moderate (32.6%), severe (8.2%), or ARDS symptoms (4.5%). Compared with no hydroxychloroquine, those on hydroxychloroquine had significantly longer length of stay (11.5±7.1 versus 7.8±4.3 days, p<0.001), more ICU admission (22.7% versus 9.8%, p=0.012), and more intubation (12.4% versus 3.7%, p=0.026). Improvement of symptoms (84.3% versus 81.7%, p=0.595) and hospitalization death (7.0% versus 1.2%, p=0.071) were not significantly different between groups. With exception of length of stay, the association of hydroxychloroquine with the above negative outcomes disappeared after adjustment for several factors including disease severity and concomitant use of azithromycin. Conclusions Hydroxychloroquine is not associated with better improvement of symptoms compared with other treatments. Moreover, it is associated with longer length of stay but not mortality or ICU admission in adjusted analysis.

COVID-19, and Vitamin D, and Air Pollution Global Epidemics Impact on Older Adults

Background Most current Corona virus or COVID-19 pandemic deaths have been found to occur among populations older than 65 years of age, who often suffer from the presence of an array of chronic diseases that may be related to a co-occurring vitamin D deficiency. Another factor affecting older adults’ immune response mechanisms is air quality. In turn, air quality can impact the absorption of vitamin D from sunlight sources, a factor which could explain why older people, who are often vitamin D deficient, may be more likely than younger adults or healthy adults to be at risk for COVID-19 and poor outcomes. Aim This work was designed to examine the recent literature on COVID-19, vitamin D and air pollution and what it might imply for public health workers, policy makers, and others. Methods Available data accessed largely from the PUBMED data base for the year 2020 using the key words COVID-19, air pollution, and vitamin D deficiency were sought and selected items were carefully examined and documented in narrative and tabular formats. Results Many publications on COVID-19 prevail, but far fewer focus specifically on vitamin D deficiency and its possible role in explaining COVID-19 global health risk among older adults. A similar, albeit small number of publications, discuss the global pandemics of air pollution and its possible COVID-19 association, as well as its impact on vitamin D production. However, while most related articles support a possible independent as well as a dual role for both factors in COVID-19 the realm of this highly infectious widespread disease, very few actual studies have been conducted to date on any of these topical issues Conclusion More research to examine if vitamin D-based nutrients or supplements may provide some degree of community wide protection against COVID-19 in the older vitamin D populations, especially among those living in highly polluted areas may prove highly valuable. Controlling air pollution emissions globally and locally may also prove to be a highly impactful public health approach to reducing overall COVID-19 risk, and extent, and warrants study.

Coprological Examination of Ovine Fasciolosis in Horro District Community Based Sheep Breeding Program, Horro Guduru Wollega Zone, Western Ethiopia

A cross-sectional study was conducted from November 2017 to March 2018 to determine the prevalence of ovine fasciolosis in the Community Based Horro Sheep Breeding site at Horro district, Horro Guduru Wollega zone, Ethiopia. Coprological examination was performed on a total of 390 sheep at the study area. Age, sex, body condition score and peasant association were taken into consideration as rik factors. An overall prevalence of fasciolosis 45.4% 95% CI (40.41 50.36 was found on the basis of coprological examinations. The prevalence of fasciolosis findings according to PAs were (41.5%) in Laku Ingu and (48.2%) in Gitilo Dole. Statistical analysis of the prevalence among study site (PAs) showed insignificant difference P=0.102 (P>0.05), but significant difference (P<0.05) was observed between animal age groups (P=0.032, with a prevalence of 37.2% in young and 49.8% in adult) and body condition scores (P=0.001, with a prevalence of 57.9%, 43.5% and 29.9% in sheep with poor, medium and good body condition score, respectively. There was insignificance difference (P>0.05) in sex group of study animals in which the prevalence was 47.6% in female and 38.8% in male. Therefore further studies on the epidemiology, seasonal dynamic of the disease, the snail intermediate host and impacts of the infection in animal production with implementations of strategic intervention is necessary.

Impact of Environmental Sanitation and Hygienic Practices on Nutritional Status of Lodha Women and Children of West Bengal, India

Aim To assess the sanitation and hygienic practices of women and its effects on the nutritional status of the mother and preschool children of the Lodha tribal community in two districts of West Bengal. Methods A cross-sectional study was conducted during November, 2014 - December, 2018 of 941 Lodha mothers and 1043 of their preschool children in Paschim Medinipur and Jhargram districts. All information was collected by using KAP questionnaire following interview and group discussion. Mother nutritional status was assessed based on body mass index (BMI) and mid upper arm circumference (MUAC). A child was classified as underweight, stunting and wasting as weight-for-age, height-for-age and weight-of -height Z-score below -2 standard deviation of WHO standard. Results This study found 35% of the households used safe drinking water. Almost 97.2% of the mother had the low hand wash score and about 67.1% of them had an average WaSH score. Overall, 41.6% and 1.6% mothers were suffered from undernutrition (BMI <18.5 kg/m2) and overweight/obesity (BMI≥25kg/m2). Whereas, 48.9% women were undernourished based on MUAC<22.0cm. Moreover, the overall prevalence of wasting, stunting and underweight of preschool children was 31.9%, 62.1% and 61.3%, respectively. The WaSH score of family was significantly associated with child stunted and underweight. Conclusion There is a good association between poor household WaSH practices with child undernutrition and morbidity. Hence, there is an urgent need to develop the comprehensive knowledge, attitude and practice (KAP) guidelines in their language to educate them about appropriate water storage, retrieval methods, sanitation and hand washing practices.

Social Network Analysis of Integrated Medical Services for Hypertension – Using District Hospitals of Shanghai as a Model

Objective To examine the current linkage between different medical services for hypertension patients for enhanced integration among medical service systems. Methods A total of 18 hospitals and community medical centers from a district of Shanghai were enrolled for social network analysis which covered emergency visits and hospitalization records of 171,177 outpatients with hypertension. Stata software was used for data preprocessing and UCINET software was used for network analysis of medical service providers to quantify and visualize the network tightness and the "main role" of information delivery of the medical institution network in the area. Results The service network of hypertension consultation institutions in the region is closely connected as a whole, but the level of diagnosis and treatment of medical services in various communities varies widely, and the degree of association with higher-level medical institutions is not uniform. Conclusion Based on the limited tightness of various medical service providers, it is necessary to implement the responsibilities of individual medical institutions at different levels and pay more attention to improving the service capabilities of primary medical institutions for enhanced integrating medical services in future.

Factors Associated with Persistent malaria transmission in urban Peripheral Areas Dar es Salaam Region, Tanzania

Africa Region has the highest burden of malaria with an estimated of 3.5 million more malaria cases in 2017 compared 212 million cases in reported in 2016. Data collected from 2015 to 2017, shown no global progress in reducing malaria cases. In Mainland Tanzania, malaria control interventions have significantly led to the reduction in malaria prevalence from 18.1% in 2008 to 7.3% in 2017. Despite of these achievements, malaria burden is still highly heterogonous with some regions including urban peripheral areas of Dar es Salaam, presenting persistent malaria transmission ranging from 2 to 57%. Material and Methods A cross- sectional population based survey was carried out in Ilala Municipality in Dar es Salaam; data was collected from 2nd to 31 April, 2019. Multistage cluster sampling was used to select the households where individual member were conveniently selected to participate in the study. Structured questionnaire were administered by the trained researcher assistants to assess individual risk factors for malaria. Rapid Malaria diagnostic test (mRDT) was used to identify individual exposed to malaria infection. Measure of association used was prevalence odds ratio (POR). Multivariate regression model used to determine prevalence odds ratio, variable with p- value < 0.05 were considered as independent risk factor for persistent malaria transmission. Results A total of 830 participants were recruited in the study, mean age was 24yrs ±20.4SD. Majority 489 (58.9%) were female, 459 (55.3%) were >18 yrs old, primary or no education were 687 (82.8%), farmer or unemployed were 639 (77%). Msongola ward contributed 406 (48.9%). Overall malaria prevalence in the study areas was (4.5%). Nets ownership was 141 (16.9%), usage was 121 (85.8%).Low proportion of net ownerships (POR: 7.67, 95% CI: 4.23, 24.6), residing in the households surrounded by mosquito breeding sites POR: 20.07, 95% CI: 7.03, 57.29) and residing in houses with unscreened windows (POR: 1.21, 95% CI: 1.26, 3.40) were independently associated with malaria infection. Conclusion Low nets ownership, residing in the households surrounded by mosquito breeding sites and in households with unscreened windows was independent factors associated with risk of malaria in the areas. Promotion of ITNs coverage, application of biolarvicides through community engagement and house screening was recommended to reduce the risk of malaria infection in the areas.

Investigation of Emerging Risk Factors and Isolation of Potential Pathogenic Bacteria from Domestic Dog Stool in Port Harcourt Metropolis, Niger Delta

This study investigated the potential pathogenic bacteria that are associated with domestic dog stool in Port Harcourt Metropolis. Convenience sampling techniques were used for sample collection outcome. A total of fifty dog stool samples were collected aseptically into a sterile stool container from different locations (Agip Estate, Rumuokoro Community, Government Residential Area, Sand-fill Borokiri, Port Harcourt Township, and Rivers State University lecturers’ quarters) all within Port Harcourt City. Bacteriological analysis was determined using standard microbiological analytical and identification techniques. Statistical analysis was performed using Statistical Package for Social Science version 21 for frequency, percentage, prevalence rate and correlation at 0.01 and 0.05 level of significance. Potential pathogens with associated percentages that were isolated are E coli (20.0%), Klebsiella species (16.0%), Pseudomonas species (4.0%), Proteus species (28.0%), Bacillus species (4.0%), Staphylococcus aureus (14.0%), and unidentified [other Staphylococcus species] (4.0%). However, the research further revealed that Proteus species (28.0%), was the most prevalent pathogen, while Bacillus species (4.0%), Pseudomonas species (4.0%), and Streptococcus species (4.0%), were the least prevalent among pet dogs studied. The correlation analysis showed no significant relationship between isolates with socio-demographic data of pet owner and Pet biodata respectively. From the analysis, correlation coefficient values of .269 and .124 were obtained for Age of Pet Owner and Gender of Owner respectively. It also show a direct correlation but by implication, a very weak, non-significant (p<0.05) relationship existed between the organisms isolated and the variables (Age of Pet Owner and Gender of Pet Owner). However, no relationship exists between isolates and visit to vet Doctor (r-0.038; p>0.05). Furthermore, negative non-significant correlation (p>0.05) was observed for marital status of Pet Owner (r=-.158) and Age of Pet (r=-.023) and isolate. Also, correlation association between isolates and some risk factors using the correlation analysis matrix revealed an indication of an indirect but moderate association between isolates and Caressing (r=-.347, p=0.01). However, other risk factors like vaccination (r=.042), Feeding Pattern(r=.125), Pet Bathing (r=.220) and Eating with pet in same plate (r=.146), did not prove statistical significance at p>0.05. The results from the study strongly suggest that pet dogs carry potential pathogenic organisms in their faecal matter that can serve as a source of infection to the pet owners. It is, therefore, very critical that these pets should be treated and possibly vaccinated frequently, even as their faecal matters should be well disposed to prevent possible zoonotic infectious epidemic outbreak in our global communities.

Factors Affecting Traumatic Brain Injury Outcome Among Patients Treated for Head Injury at Surgical Side, in Nekemte Referral Hospital, Oromia, Ethiopia.

Background Traumatic brain injury is an expanding major public health problem and the leading cause of death of the young and productive part of the world’s population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. Only few studies have examined prognostic factors of traumatic brain injury outcome in developing countries including Ethiopia. This study was aimed at defining the peculiar demographic and other associated factors of traumatic brain injury (TBI) outcome among patients treated for head injury at Nekemte Referral Hospital. Objective The main purpose of this study was to describe the magnitude of TBI outcome and assess factors associated with unfavourable outcome of TBI among patients treated for head injury at the surgical side in Nekemte Referral Hospital from July 8, 2016 to July 7, 2018. Methods A retrospective cross-sectional document review was conducted among TBI patients treated for head injury from July 8, 2016 to July 7, 2018 at Nekemte Referral Hospital. Data were collected using a pre-tested data collection format. Data analysis was done using SPSS version 20. Descriptive statistics were computed and association between the dependent and independent variables were assessed by using logistic regression. Odds ratios with 95% confidence interval were computed. Significant association was declared when the p value was <0.05. Results In this study, out of 378 cases 95 (25.1%) were discharged with unfavourable outcome of which 37(9.8%) were neurologic deficits and 58 were deaths giving overall mortality rate of 15.3%. Patient age>60years (AOR: 15.13; 95%CI: 3.575-64.028), time interval from injury to treatment (AOR: 16.054; 95%CI: 5.832-44.194), low GCS (AOR: 18.224; 95%CI: 4.167, 79.695), conservative management (AOR: 20.774; 95%CI: 6.106-70.681), pupils abnormality (AOR: 9.078; 95%CI: AOR: 2.996-27.509) were associated with unfavourable outcome. Conclusions A quarter of patients treated for TBI at Nekemte Referral Hospital are discharged with unfavourable outcomes. Old age, delayed presentation to the hospital, low GCS, conservative management, and pupillary abnormality increase the odds of unfavourable outcome. Timely management of TBI before patients develop secondary brain injury and use of surgical intervention based on CT scan diagnosis will reduce the occurrence of unfavourable outcome.

Level of Antenatal Care Services Utilization and Associated Factors Among Mothers who have Given Birth in the Past Twelve Months in Gelemso Town, West Hararghe Zone, Oromia National Regional State, East Ethiopia

Background In Ethiopia, the levels of maternal and infant morbidity and mortality are among the highest in the world. This is attributed to, among other factors, none use of modern health care services by women. According to the 2011 Ethiopian Demographic Health Survey, more than seven in ten mothers did not receive antenatal care at all. Objectives The objective of this study was to determine level and identify factors influencing maternal antenatal care services utilization among mothers who gave birth in the last twelve months in Gelemso town west Hararghe Oromia, Ethiopia. Methods A community-based cross sectional study design was conducted on 347 study participants in Gelemso town west Hararghe Oromia Ethiopia from July 15, 2017 to August 15, 2017 G.C.A probability to proportional to size sampling technique was used to select the study population in two urban Kebeles. Data were collected using a pre tested structured questionairs. Descriptive results were presented using frequencies, and numerical summary measures. Bivariate analysis was carried out to assess the association between outcome variable and each in dependent variables. Odds ratio with 95% confidence level was estimated to identify factors associated with Antenatal Care (ANC) utilization using multivariable logistic regression. The statistical significance was declared at p- value < 0.05. Result The response rate this study was 98%. The prevalence of antenatal care service utilization was 64.6%. About 146 (42.1%) of the pregnant mother started antenatal care visit during the second trimester of pregnancy and a significant proportion 289(83.3%) had less than the recommended four visits. Educational status (AOR;15.19:CI 95%,6.006,38.417), husband attitude (AOR;1.995:CI 95%,1.016,3.916), marital status(AOR:4.587:CI 95%,1.888,11.146), planned pregnancy (AOR:4.938:CI 95%,2.514,9.702) were major factors associated with antenatal care service utilization. Conclusion Though more than half mother used antenatal care service in the study setting, two in ten of the mothers did not have the minimum number of visits recommended by World Health Organization. Promotion of information, education and communication in the community should be strengthened is to sustain antenatal care service utilization in the community.

Osteoarthritis and Falls: Is there a Link?

Osteoarthritis, a widespread joint disease, commonly results in considerable pain and functional disability, especially among older adults. At the same time, falls and fall injuries, also common among the older population, may not only contribute to the onset of osteoarthritis, but once established, to falls that lead to fractures and disability in their own right. But what does the research show specifically? Objective This report aimed to examine what is known about the interrelationship between falls and osteoarthritis and the implications that can be drawn from this information. Methods Using the PUBMED data base, studies describing an association between osteoarthritis and falls were sought. Those fulfilling the eligibility criteria were reviewed and summarized in narrative form. Results Consistent support for an osteoarthritis-falls associated linkage is limited and not as robust as one would predict. Whether the observed associations between these health determinants are a cause of osteoarthritis, a consequence or both, or simply spurious findings is hard to decipher. Conclusion More numerous and carefully designed research to examine this issue is warranted and may be extremely helpful in preventing, as well as ameliorating a high degree of excess disability and associated fiscal costs due to both falls as well as osteoarthritis among the elderly.

Knowledge, Attitudes and Practices of Prescribers towards Antimicrobial Stewardship at Hospitals in Khartoum State - Sudan

Introduction Antimicrobial stewardship (ASP) is of the utmost importance as a way to optimize the use of antimicrobials to prevent the development of resistance and improve patient outcomes. So, it is worthwhile to assess the knowledge, attitude and awareness regarding antimicrobial stewardship in hospitals. Objective The aim of this study is to assess knowledge, attitudes and practices (KAP) of prescribers towards antimicrobial stewardship at hospitals in Khartoum state and to identify the associations between prescriber’s demographic information and their knowledge. Methodology This descriptive cross-sectional study multi-centered study conducted in 10 hospitals at Khartoum state -Sudan, during period from November to December 2018. Study population included all prescribers who is available at study’s hospitals during study period and willing to participate in the study. A self-administered questionnaire addressing participants’ knowledge, attitudes, and practice (KAP) regarding antibiotic resistance and ASP distributed in the selected hospitals among attending house-officers, registrars and consultants completed then analyzed. Results Of the 294 medical staff targeted, 287 responded to the survey (response rate 97.6%). Only (26.4%) were familiar with the term ASP and (31.5%) claimed that it is effective in reducing resistance. (43.0%) of respondents believe that ASP play vital role on antibiotic prescribing. Only (9.5%) had ASP in their hospital and (13.5%) having policy and team. (45.3%) of participants had good level of knowledge about antimicrobial stewardship, but majority show negative attitude (63.1%), and poor practices (92.0%) regarding ASP. There was no observed correlation between knowledge and attitude, knowledge with practice (p-value ≥ 0.05). Only attitude with practice shows significance correlation (P=0.0001), which means that prescribers with positive attitude had the better practices towards antimicrobial stewardship. Age, occupation and experience are the only significant predictors of prescriber's knowledge and attitude towards antibiotic stewardship, while no association between these factors and practice. Conclusion The present study concludes that the knowledge of prescribers regarding ASP is moderate and their attitude is negative. Unfortunately, practices regarding ASP were poor, despite, the good knowledge regarding the effects of ASP on antimicrobial resistance.

Reactive Stepping Responses Mediated by Predictable Manual Waist-Pull Perturbations are Associated with Fall History in Older Adults

Background and Purpose The ability to respond effectively to perturbations is a key element of reactive postural control and is a crucial mediator of falls. Several studies exist in the literature that determine older adults’ responses to perturbations, however those studies typically involve procedures that lack objectivity or applicability outside a laboratory. A study involving waist-pull perturbations with a spring-scale (SS) is an exception. In that study, fall history was most accurately differentiated by a reactive stepping response to a perturbing force of 10% total body weight. Using data from that study, we retrospectively examined the association between fall history and the number of steps accompanying a SS perturbing force of 10% total body weight in older adults. For perspective, the association of fall history with Timed-Up-and-Go (TUG) and single limb stance (SLS) times was also determined. Methods Fifty-eight healthy older adults (mean age = 80.7 years) participated in the study. Their 2-year fall history (yes, no) was recorded. All participants underwent SS testing with one-pound incremental, horizontal sagittal plane manual waist-pull perturbations. The number of steps in response to perturbation with 10% total body weight was recorded; TUG and SLS tests were performed. Associations between variables were examined using Spearman (rank-biserial) correlations. Results The median number of steps for fallers was 5 in both anterior and posterior directions. For non-fallers, the median number of steps was 1 and 2 in the anterior and posterior directions, respectively. The significant correlations between fall status and number of steps were 0.772 and 0.813 for the anterior and posterior directions, respectively. Similarly, the significant correlations between fall status and balance tests were 0.722 and -0.456 for the TUG and the SLS, respectively. Conclusions The number of steps accompanying waist-pull perturbations with forces of 10% of body weight were highly explanatory of experiencing a fall during the preceding 2 years.

Closed Frequent Itemsets Mining Based on It-Tree

In the last decade, the amount of collected data, in various computer science applications, has grown considerably. These large volumes of data need to be analysed in order to extract useful hidden knowledge. This work focuses on association rule extraction. This technique is one of the most popular in data mining. Nevertheless, the number of extracted association rules is often very high, and many of them are redundant. In this paper, we propose an algorithm, for mining closed itemsets, with the construction of an it-tree. This algorithm is compared with the DCI (direct counting & intersect) algorithm based on min support and computing time. CHARM is not memery-efficient. It needs to store all closed itemsets in the memory. The lower min-sup is, the more frequent closed itemsets there are so that the amounts of memory used by CHARM are increasing.

Impact of Low Birth Weight on Early Vascular Aging and Cardiometabolic Phenotypes in Later Life Among Cameroonian Adults

Background Evidence suggests that low birth weight (LBW) is associated with increased cardiovascular and metabolic risk in adulthood, including increased arterial stiffness, a marker of early vascular aging (EVA) assessable by pulse wave velocity (PWV), obesity and glucose homeostasis abnormalities. The present study aimed to explore the late impact of LBW on PWV and cardiometabolic phenotypes among young adult Cameroonians. Methods The study evaluated 120 subjects (mean age: 26 ± 5 years; 54% male sex) at the Cameroon Heart Institute, Douala, Cameroon, between January and June 2018. Birth weight (BW) and gestational age, sociodemographic, anthropometrics and fasting capillary blood glucose were recorded in all participants. Blood pressure (BP) and PWV were measured using an automatic oscillometric device (Mobil-O-Graph®). Multiple-adjusted linear regression was used to determine predictive factors for PWV. For assessment of potential impact of BW on EVA, PWV was adjusted for age, sex, body mass index (BMI) and mean arterial pressure (MAP). Results 28 participants (23.3%) of the study sample had LBW (<3000g). There was no gender difference between LBW or normal birth weight patients (NBW; controls). Age- and MAP-adjusted PWV (aPWV) were higher in women with LBW compared to NBW (5.6 m/s and 5.3 m/s respectively, P = 0.038). In men, aPWV was similar in LBW and NBW. In this study population, aPWV was higher (on average +15 cm/s) in LBW than in controls, although the difference was not statistically significant (P=0.083). Multivariate regression analysis showed age, male sex, BMI and MAP were independent determinants of PWV, but not LBW. Compared to NBW controls, the prevalence of overweight/obesity, impaired glucose homeostasis and diabetes was higher in LBW: 42.9% vs 37%; 10.7% vs 3.3%, and 3.6 % vs 1.1%, respectively. Moreover, compared with controls, LBW individuals who were overweight/obese in adulthood had a much higher mean fasting capillary glucose (1.54 ±0.17 g/l vs 0.87 ±0.11 g/l in NBW, p=0.003). Conclusion This study suggests that although LBW is associated with increased aortic stiffness in young adulthood, mainly in women, the association was predominantly driven by aging, MAP, BMI and male sex. In adulthood, LBW subjects exhibited higher obesity indices and altered glucose homeostasis.

Pain between Psyche and Soma in Uro-Andrology

How to define pain? One of the most accredited definition is certainly “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" (IASP (International Association for the Study of Pain - 1986) and World Health Organization (WHO) 1. However, what are the essential components of pain experience? Certainly many factors are involved such as, among others: Perceptual ability / suitability / subjective threshold; The "subjective" experience; Multidimensionality; Occasionally or chronicity. All these components have to be taken into consideration in the treatment of these disorders which, very often, require a multidisciplinary approach. From a clinical psychological point of view, much can also be offered at a diagnostic level, from the reception to listening to the patient's suffering, to the evaluation with standardized tests and psychophysiological analysis procedures in order to arrive at an effective personalization of treatments

Molecular Study of Hepcidin HAMP (-582A/G) Gene Polymorphisms and Measurement of Serum Hepcidin Level among Sudanese Patients with Anemia of Chronic Kidney Disease

Background Anemia of chronic disease is anemia found in certain chronic disease states, is typically marked by the disturbance of iron homeostasis or hypoferremia. Chronic renal failure is currently known as Chronic Kidney Disease (CKD) or Chronic Renal Insufficiency (CRI) implies long-standing, progressive and irreversible renal parenchyma disease resulting in diminished renal function up to 40 to 60%. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. This disease may also be identified when it leads to one of its recognized complications such as cardiovascular disease, anemia, or pericarditis.                             Methods Sysmex kx21 used to CBC and the Cobase411 used to iron profile. Enzyme-Linked immunoassay (ELISA) was used to determine the level of serum hepcidin.  Sample preparation and PCR detection of HAMP DNA Polymorphisms: Restriction digestion of PCR products was done using Fast Digest. (Figure 1).                                                                                         Results Serum hepcidin levels higher in patients with anemia of chronic kidney disease compared with healthy controls mean. The polymorphisms of the hepcidin gene promoter in Sudanese patients with ACKD showed that the hepcidin HAMP AA genotype 70, AG 23, and GG 7 in 100 patients dialysis-dependent and AA 83, AG 17 and GG 0, and the allele A are more frequent in patients affected by ACKD. Significant statistical association observed between the hepcidin level and end-stage kidney disease. Conclusion This study evaluates for the first time the association between anemia of chronic kidney disease and hepcidin genes promoter polymorphisms and show that the hepcidin HAMP AA genotype and the allele A are more frequent in patients affected by ACKD, further investigation is needed, our data support the hypothesis and hepcidin HAMP are important in the pathophysiology of ACKD.

Mental Health in The Context of The COVID 19 Pandemic

We explore the global evidence of major health crisis potential impacts and the factors influencing the mental health outcomes among the population during the outbreak of COVID-19. Preparation measures for a COVID-19 focus on rapid quarantine of social isolation and economic concerns have risen metal health considerations that become an integrated part of the pandemic outbreak. This outbreak of novel Coronavirus disease (COVID-19) pandemic is swayed an overall 213 countries, areas or territories, with over 2,921,439 confirmed cases and 203,289 confirmed deaths reported till 26 April 2020. This created a lot of strain and fear; fear of falling ill and dying of being infected leading to heightened levels of insurmountable psychological pressure. This scrutiny attempt to assess the widespread outbreaks of COVID-19 on mental health professionals, healthcare workers and general population in association with adverse mental health sequelae like generalized anxiety disorder (GAD), depressive symptoms, insomnia, panic attacks, post-traumatic stress disorder, OCD, suicidal behavior, delirium, psychosis, harmful alcohol consumption, and drug use. There is a need for more evocative exploration to intensify awareness to address the potential psychological and behavioral risks that will remain elevated as long as the COVID-19 pandemic continues in the community. In conclusion, incessant surveillance of the subsyndromal mental health problems for outbreaks should be part of galvanized global action during the quarantine.  

Assessment of Target Volume Definition for Radiosurgery of Atypical Meningiomas with Multimodality Imaging

Objective Meningiomas are most common intracranial benign tumors comprising around one third of all intracranial neoplasms, and typically have benign and indolent nature with slow-growing behaviour. Benign meningiomas are slow growing tumors typically following an indolent disease course. Nevertheless, atypical or anaplastic meningiomas may follow a more aggressive disease course with invasion of critical structures and recurrences. In the current study, we evaluate the incorporation of magnetic resonance imaging (MRI) for radiosurgery treatment planning of atypical meningiomas. Materials and Methods Atypical meningioma radiosurgery target volume determination with and without incorporation of MRI has been evaluated. Ground truth target volume used as the reference has been outlined by the board-certified group of radiation oncologists after comprehensive assessment, thorough collaboration and consensus. Results Target volume definition by use of Computed Tomography (CT)-only imaging and by CT-MR fusion based imaging has been comparatively evaluated in this study for linear accelerator (LINAC)-based radiosurgical management of atypical meningioma. Ground truth target volume defined by the board-certified radiation oncologists after detailed evaluation, collaboration, colleague peer review and consensus has been found to be identical to target determination by use of CT-MR fusion based imaging. Conclusion Despite significant progress in neurosurgical techniques over the years, complete surgical resection may not be feasible in the presence of meningiomas located at eloquent brain areas in close association with important neurovascular structures. RT may have a role in multidisciplinary management of meningiomas. Incorporation of MRI into treatment planning for radiosurgery of atypical meningiomas may improve target definition despite the need for further supporting evidence.

The Knowledge and Perception of Hand Hygiene Among Health Care Workers in Clinical Settings in Khartoum State - Sudan

Objective This study conducted to assess health care practitioners’ knowledge and perceptions of hand hygiene among health professional working in clinical settings in Khartoum State - Sudan. with the specific objective of determining the association between their stance on hand hygiene and the general demographic characteristics of these health-care professionals.   Methodology This is a cross-sectional study conducted between July and November 2017 using a modified form of WHO questionnaire for knowledge and perception that was included 22 items was sent online to health care workers via social media. The data obtained entered and analyzed by SPSS version 24. Chi-square and test of independence were used as a test of significance. A p-value of < 0.05 was considered statistically significant for all purposes.  Result 437 hospital staff were responded to the questionnaire. (99.3%) was found to have good knowledge. 197(45.2%) had good perception and 239(54.8%) had fair perception. Formal hand hygiene training was found to have no association with knowledge levels of hand hygiene, but the fair perception was higher in the respondents who didn’t receive formal training.  Conclusion The present study highlights the hand hygiene knowledge and perception. Most health care workers were found to have good knowledge, and the majority was found to have a fair perception. Formal hand hygiene training courses were found to have no association with knowledge but it may be reflected in practice. The importance of training sessions regarding hand hygiene was noticed in the perception level.

Implementation of an Elemental Diet in Five Children Diagnosed with Autism Spectrum Disorder Presenting with Gastrointestinal Disease: A Brief Report

Autism Spectrum Disorder (ASD) is a developmental disorder characterized by impaired communication and social interaction. Children with ASD are frequently diagnosed with gastrointestinal (GI) issues, including inflammatory bowel disease (IBD), gastroesophageal reflux, abdominal pain, diarrhea, and constipation, although the association between ASD and GI conditions is unclear. Underlying nutritional deficiencies are more common in children with ASD, and increase the risk of them developing medical conditions secondary to the behavioral diagnosis. This objective of this study was to examine the use of an elemental diet (ED) in the treatment of gastrointestinal disease in 5 children with ASD ages 2-21 years of age. In the study participants, the ED was well-tolerated with improvements in anthropometric measures, nutritional markers, and/or GI functioning reported after 12 weeks of intervention. Further research to advance the development of specific evidence-based guidelines in the management and treatment of gastrointestinal concerns in the ASD population is warranted.

Prevalence of Overconsumption of Salt and its Determinants – The Case of Southwestern Rural China

Aim Overconsumption of salt contributes to hypertension and increases the risks of cardiovascular diseases. Most studies that investigated salt intake by applying the Health belief model (HBM) have focused on urban settings. This study aims to identify the prevalence of salt overconsumption (>6 g per day) in a rural village in Southwestern China and to determine the association between knowledge regarding salt consumption/HBM constructs and salt overconsumption behavior among village residents. Methods Inthis cross-sectional study, 79 adults aged 18 years and above were interviewed using household-based and face-to-face questionnaires. Salt intake was measured using an electronic balance in accordance with a previous protocol. Results Our finding showed that the average daily salt intake is 11.19±11.14 (mean±SD) g. Moreover, 64.6% of the participants overconsumed salt. None of the participants was aware of the national recommendation for salt intake. Univariate logistic regression showed that i) knowledge about hypertension causing cardiovascular diseases (odds ratio [ORu]=3.02), ii) perceived severity of hypertension as a serious disease (ORu=4.92), and iii) perceived benefit of reducing salt intake to prevent hypertension (ORu=3.52) were unexpectedly positively associated with salt overconsumption behavior. All the studied sociodemographic factors were not associated with salt overconsumption behavior. Conclusions A high prevalence of salt overconsumption was found among residents of rural villages in Southwestern China. HBM was unable to explain the causal relationship between its constructs and salt overconsumption behavior. The extremely low awareness of the national salt recommendation highlighted the urgent need to provide relevant health education in rural China.

D Allele and DD Genotype of I /D Polymorphism in The ACE Gene in Patients with Hypertension, Stroke And Cancer Prostate In Libreville: A Concern Given The High Frequencies of these Signatures in Gabonese Population

Background During the last two decades, the polymorphism of Angiotensin-Converting Enzyme (ACE) gene has been extensively studied among different human populations. In humans, several studies have shown the relationship between this polymorphism and the risk of many serious diseases with a heavy burden of health in developing countries. After analyzing the polymorphism in the population, the present study was also concerned with the investigation of an eventual association between hypertension, stroke, cancer prostate and I/D polymorphism of the ACE gene. Materials and Methods Our study population included 163 Baka (pygmy) and 158 Fang (Bantu) from Gabon to evaluate the polymorphism in the country. Concerning the diseases, we included 105 patients and 120 controls for hypertension, 37 patients stroke matched with 50 controls and 97 patients with prostate cancer were recruited. All participants in the study were genotyped for the ACE I/D polymorphism obtained by polymerase chain reaction amplification on genomic DNA. Results Our analysis showed that the ACE D allele DD genotype frequencies were highest of all the data so far in human populations. We obtained a frequency of 0.138 for I allele and 0.862 for D allele among pygmy and the frequencies of 0.313 and 0.687 respectively for the I and D alleles. This difference was significant (p<0.05). In patients, we revealed the predominance of D allele and DD genotype for hypertension (0.27 for I allele and 0.73 for D allele), for stroke (0.15 for I allele and 0.85 for D allele) and 83% of individuals with cancer prostate carry the D allele. D allele and DD genotype are associated with risk to hypertension whereas allele I seem protective at the occurrence of stroke (p<0.05 between healthy and controls). Conclusion We show that the D allele and DD genotype were higher in this population. Also theses two signatures may be associated at genetic risk of hypertension, stroke and prostate cancer in this country deprived of human resources for quality care of many patients.

Risk Factors of Persistent Diarrhoea in Children below Five Years of Age

Background Persistent diarrhoea is a commonly observed phenomenon both in Bangladesh and all over the developing countries. It is the single most important cause of diarrhoea related deaths in the community, accounting for over half of them. If associated factors are properly identified & treated, it is possible to prevent most cases of persistent diarrhoea. Objective This study was undertaken to find out the possible risk factors associated with persistent diarrhoea in children below 5 years of age. Methods This was a prospective analytical case control study carried out in a tertiary care hospital, Dhaka. A total of 30 consecutive cases of persistent diarrhoea and 60 consecutive acute diarrhoea controls (matched for age and sex) under 5 comprised the study subjects in this study. Children beyond the age and whose parents didn’t give written consent were excluded from the study. Data were collected using a structured questionnaire and a standered case definition of acute & persistent diarrhoeawere adopted. Data were later processed and analyzed using SPSS (Statistical Package for Social Science version 12) in the year 2012. Results were considered statistically significant when p value was <0.05. Results According to the study, 56.6% of cases and 63.3% of controls were in the ‘6 to 12 months’ age group and about two-third of the participants in both cases 20 (66.7%) and controls 39 (65.0%) were males.Strong association was found with ‘bottle feeding’ RR=2.2556; 95% CI: 1.259, ‘presence of blood/mucus’ RR=2.5038; 95% CI: 1.4129, ‘WAZ≤ 2)’ RR=2.8867; 95% CI: 1.7202 and ‘early complementary feeding [RR=4.67; 95% CI: 2.5017-8.7175 and OR=7.8858; 95% CI: 3.6791-16.9 Conclusion In the present studyfour factors showed some association with persistent diarrhoea, namely: ‘use of animal milk’; ‘antibiotic use during acute diarrhoea’; ‘history of diarrhoea in previous 3 months’ and ‘pre-lacteal feed’. Strong association was found with ‘bottle feeding practices’ ‘presence of blood &/or mucus in stool’, WAZ <-2 and ‘early complementary feeding

Resting-State Functional Connectivity Predicts Emotional Conflict Control

Emotional conflict control refers to the ability to select task-relevant emotional information and ignore task-irrelevant emotional distractors. Previous fMRI studies provide some evidence about brain structure and function related to emotional conflict control. Yet, the underlying resting-state functional connectivity was largely unknown. Here, this is the first study to explore the resting-state functional connectivity related to emotional conflict. According to the literature which used the whole-brain analysis to investigate the key brain area associated with emotional conflict, we select the amygdala (AMY) as the seed region. We then investigated the association between emotional conflict and functional connectivity between amygdala (AMY) and another brain region in a large sample. We found the emotional conflict effect was positively correlated with functional connectivity strength between AMY (the seed ROI) and right supplementary motor area (SMA). This finding implied that the functional connectivity between AMY and SMA was linked to emotional conflict and that AMY was the key region which plays a crucial role in emotional conflict.

Branching Pattern of the Medial Calcaneal Neurovascular Bundle in Porta Pedis of the Human Foot

The medial calcaneal nerve (MCN) is the first branch of the posterior tibial nerve (PTN) in the porta pedis, enervates the skin of the heel and medial side of the foot. Heel pain is a common condition encountered by physicians, and this may have a significant clinical association with the MCN’s branching pattern. This study was to identify branching pattern variations in the medial calcaneal neurovascular bundle. This study was carried out using 60lower limbs of formalin-embalmed cadavers, using the tarsal tunnel dissection method for 30right and 30 left lower limbs. The medial calcaneal neurovascular bundle course was identified by exposing the PTN and its branches from the distal end of the leg toward the plantar surface beyond its bifurcation and resecting the skin and flexor retinaculum. Many MCN branching pattern variations (specifically concerning origins, numbers, and levels of branching) were observed. In the right foot a single branch was present in 21 specimens (70%), while two branches were observed in nine specimens (30%). In the left foot, a single branch was present in 22 specimens (73.3%) and two branches were present in 8 specimens (26.7%). In this study, two branches originate from lateral planter artery is the most common observation. This study concludes that a single MCN originating from the TN is the most common variant. Two medial calcaneal arteries (MCAs) originating from the LPA is also common.

Severe Infantile Blount’s Disease in Kumasi, Ghana: A Case Report

Blount’s disease, also known as tibia vara, is a developmental disorder involving the posteromedial proximal tibial physis resulting in progressive varus, procurvatum and internal torsion of the affected tibia 1. The condition was first published by Blount in 1973 2. The aetiology of this disease is unkown. However, associations exist between blount’s disease and the Afro-Caribbean race, early age of walking and obesity 34. Furthermore, genetic predisposition has been postulated as well as mechanical loading of the physis 456. Affected children are usually overweight and start walking early. It is bilateral in 80% of cases 7.

Knowledge and Practice for Bio-Medical Waste Management among Healthcare Personnel at Kabgayi District Hospital, Rwanda

Background Globally, about 10 to 25% of the volume of bio-medical waste from hospitals and healthcare institutions presents a serious health risks to patients, healthcare personnel, and anybody who comes in contact with it. The waste management practices in Rwanda healthcare facilities are poor and need improvement. Objectives To assess the knowledge and practices regarding bio-medical waste management among healthcare personnel at Kabgayi district hospital in Southern Province of Rwanda. Materials and Methods A cross-sectional study design was conducted. A total of 200 healthcare personnel were selected randomly out of 400 target population including doctors, nurses, social workers, and cleaners. Structured questionnaire was used to collect data. Descriptive analysis using frequency and proportions were used. Chi-Square test was used to determine the association between the variables and level of significance was set at p ≤ 0.05. Results The study found that about half (49.0%) of healthcare personnel had good knowledge about waste management. We found that the majority of healthcare personel 133(66.5%) had poor practices towards bio-medical waste management. The factors associated with good practice were better knowledge on bio-medical waste management (p=0.013) and older age group (p=0.001). Conclusion/Recommendations The level of in both knowledge and practice towards bio-medical waste management among healthcare personnel was low. Continuing education and training programmes and short courses on bio-medical waste management should be carried out to improve the knowledge and practices towards bio-medical waste management among healthcare personnel.

A Meningeal Syndrome Revealing A Tetanus in A Togolese: Case Report and Review of the Literature

Although it is a vaccine-preventable disease, tetanus is frequently found in sub-Saharan Africa. Because of its rarity, this disease poses two problems for doctors of the 21st century: to make early diagnosis in order to refer patients to appropriate care structures, and to continue to ensure correct prevention of an affection that few current doctors have met. In it generalized form, the diagnosis of tetanus is easy, but when the beginning is localized, tetanus can be change with other diseases leading to a diagnostic wandering and a delay of adequate management. We report a case of tetanus in an 18-year-old male, who was received for neck pain and stiffness of the neck with a positive Kernig sign associated to fever since 48 hours. Initially treated for meningitis, the patient will develop at day 3 of hospitalization, the signs of generalized tetanus which led to evoked the diagnosis of tetanus. This diagnosis was reinforced by the notion of a rusty nail injury to the soles of the right foot 3 weeks before hospitalization and the absence of anti-tetanus vaccination. After using tetanus serum and vaccination with antibiotics (Metronidazole and Penicillin) and Diazepam in association with stripping of the wound under the foot, the patient was improved. This case illustrates that any neurological sign with the first trismus must evoke until proof of the contrary, a tetanus especially in case of association with a wound even if the immunization schedule is up to date.

Splanchnic Aneurysms & Possible Etiology

Four cases are reported with splanchnic aneurysms of the branches of the main arteries. Three of the cases presented as emergencies. Possible rupture was present in Case 2 and true rupture in Case 4. The etiology of Cases 1 and 2 may have been a floxacin antibiotics, Table 1. This report is the first clinical chronological association of the antibiotics and arterial and aortic pathology. This association was supported by nationwide research by Pasternak, 11. Detailed experimental work done on mice showed connective tissue fragmentation and arterial cell injury. Apparently, the above antibiotic induced mitochondrial DNA damage and dysfunction, 9.

L162v Polymorphism of Par-Α Gene, A603g Polymorphism of Tissue Factor Gene and Risk of Coronary Heart Disease in Russian Population

Purpose The goal of this study is to determine the association of L162V polymorphism of PPAR-alpha gene, A603G polymorphism of tissue factor gene and the risk of coronary heart disease development in Russian population.   Materials and Methods A clinical and genetic study of 414 patients with CHD and 220 people of comparable age without CHD which amounted to a control group was performed. L162L and L162V genotypes of L162V polymorphism of PPAR-α gene, A603A, A603G and G603G genotypes of A603G polymorphism of tissue factor gene were determined by polymerase chain reaction followed by restriction analysis. Results A carriage of L162V genotype and V allele of PPAR-α gene was associated with an increase risk of CHD in 2,13 times (L162V genotype) and in 2,21 times (V allele), with an increase in risk of CHD before the age of 45 years in 4,68 times (L162V genotype) and in 3,88 times (V allele). Significantly higher in patients with CHD compared with the general population and in patients with a carriage of G603G genotype and G allele of tissue factor gene was associated with the increase of CHD risk in 2,68 times (G603G genotype) and in 4,37 times (G allele), occurred more frequently in patients with debut of disease at age of 45 years and younger. The level of tissue factor was significantly higher in patients with CHD – carriers G603G genotype compared with carriers A603A genotype (217,9±15,2 pg/ml and 152,6±30,4 pg/ml, respectively, p=0,04). A carriage of the combination of L162V and G603G genotypes was associated with an increased risk of CHD in 3,04 times. Conclusion A carriage of V allele of L162V polymorphism of PPAR-α gene and G allele of A603G polymorphism of tissue factor gene, as well as their pair combination are associated with an increased CHD risk, especially at age 45 years or less.

Outcome Assessment of Open Foot Injuries in A Teaching Hospital in Ghana

Purpose Foot injuries are common in low- and middle-income countries and continue to increase in incidence due to the surge in the use of motorcycles as means of transport.Yet, there is scanty data on the incidence and outcomes of treatment of open injuries to the foot in the developing world.We aimed to determine the incidence and functional outcomes of open foot injuries that are treated in a teaching hospital in Ghana. Methods We used a structured questionnaire to record the type of open foot injury, the mechanism of injury, any concomitant injuries, the time interval between injury and arrival at the hospital for treatment as well as the type of treatment instituted. Recruited patients were followed up for six months, complications resulting from the injury or its treatment were recorded for each patient. The function of the foot after healing of the injury was measured using a questionnaire-based visual analogue outcome scale of the American Foot and Ankle Society. Regression and chi-square analysis were used to evaluate potential associations. Results Over a four-month period, a total of 81 cases of open injuries to the foot were recorded. Out of this figure, 55 patients (67.9%) were males and 26 (32.1%) were females. It was found, that 66.7% aged between 19 and 49 years, 76.5% of the injuries occurred on the road and 29.7% was motor cycle related. Pedestrians are the most afflicted (61.7%). The treatment outcomes of traumatic amputations, open phalangeal fractures, dorsal skin degloving and lacerations were good. Gustillo-Anderson grade IIIB open fractures with associated plantar skin degloving had the worst outcomes with residual pain on weight bearing, bigger foot, inability to wear previous shoes and inability to tiptoe on the affected foot. Conclusions Open injuries to the foot are common in Ghana and exert a significant health burden, particularly on active young males. Long term disability may occur, even after adequate treatment of open fractures involving the foot.

On the Role of Cholecystokinin (CCK) in Fear and Anxiety: A Review and Research Proposal

Cholecystokinin (CCK) is found in high concentrations in cortical and limbic structures including the amygdala of rodents, and evidence has been gathered supporting a role for CCK in the neurobiology of anxiety. A variety of animal models have been used to study a central state of fear or anxiety, state that appears to produce a complex pattern of behaviors highly correlated with each other. It is now well established that the amygdala in particular is a critical link in the pathway through which sensory stimuli come to acquire fear evoking properties. The purpose of the proposed experiments is to study the role of the putative neurotransmitter CCK in fear and anxiety in vivo by means of a methodology coupling electrochemical and electrophysiological measurements in various brain areas. Indeed, the association of in vivo differential pulse voltammetry (DPV) with in vivo extracellular single unit recording could be able to provide concomitant physiological and neurochemical indications and to relate them to behavioral events. To further study and support the initial observations pharmacological experiments will also be performed by means of CCK receptor agonists and antagonists. This may eventually lead to development of more effective pharmacological strategies for treating clinical anxiety disorders.