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Jun 2026 DOI 10.14302/issn.2766-8681.jcsr-26-6296
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.
Dec 2025 DOI 10.14302/issn.2690-6759.jpar-25-5496
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.
Dec 2025 DOI 10.14302/issn.2690-6759.jpar-25-5576
Background Tick infestations severely impair cattle health and productivity in Nigeria through blood loss, hide damage, and transmission of tick-borne pathogens. Objective This study assessed key risk factors influencing tick infestation and evaluated control methods among Fulani pastoral herds in Plateau State. Methods A cross-sectional survey involving 250 cattle from ten herds was conducted across five Local Government Areas. Tick burden was analyzed against acaricide application methods (pour-on vs. hand-spray), hand-picking frequency, and herd mobility (sedentary vs. migratory). Data were collected via owner interviews and manual tick counts. Statistical analyses were performed using generalized linear models in R software. Results Cattle treated with pour-on acaricides had significantly lower tick burdens compared to those treated via hand-spray (P<0.05). Herds that practiced hand-picking five times weekly had fewer ticks than those hand-picking thrice weekly (P<0.01). Migratory herds recorded significantly lower infestations than sedentary herds (P<0.05). Conclusion Effective tick control requires the integration of optimized acaricide application, frequent manual removaland consideration of herd mobility patterns. Education, capacity building, and policy support are necessary to enhance adoption of effective tick control measures among pastoralists.
Nov 2025 DOI 10.14302/issn.2694-2283.jsem-25-5730
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.
Mar 2022 DOI 10.14302/issn.2692-1537.ijcv-21-3757
Background The pandemic has disrupted the lives of many globally including persons with disabilities. These disruptions are universal. However, the vulnerable communities are more affected. Purpose The study examines impacts on persons with disabilities to share knowledge and inform interventions that ensure persons with disabilities are supported. Methodology The study is a systematic literature review using different search engines to search for scholarly articles all over the globe. Results Persons with disabilities have been negatively impacted in numerous ways: lack of access to healthcare services, inadequate rehabilitation services, increased human rights violation, stigmatization and discrimination, increased risk of dying, being subjected to violence, losing financial income, lack of access to education and treatment, increased in neglect and traumatization, poverty, lack of access to food, decreased in community support; and worse of all, in comparison with the overall population, the death of persons with disabilities during the Covid-19 is higher. These impacts were precipitated by inaccessible built environment and sense of touching, lack of disability sensitive policies, increased prevalence of risk factors, difficulties in adhering to WHO recommendations, pervasiveness of underlying health conditions, lack of disability-friendly information and inclusive intervention, national budget cuts; and poorly funded institutions. Conclusion Persons with disabilities have been negatively impacted due to many risk factors peculiar to them.
Feb 2022
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.
May 2021 DOI 10.14302/issn.2641-4538.jphi-21-3820
In Rwanda the prevalence of mother-to-child HIV transmission is 1.5%, the prevalence was found to be higher in rural area. The purpose of this study was to determine the Prevalence and Risk Factors of HIV Infection among Children born from HIV Positive Women in Musanze District. The study findings help to decrease the rate of HIV infection among children born from mother HIV positive to zero. This study was conducted in Musanze District, Northern Province in Rwanda. The study targeted 420 HIV positive mothers who delivery in different health facilities located in Musanze district form January 2019 to December 2020 and their children. SPSS version 22 was used for analysis. Of 420 children born from HIV positive mothers 91.7% were aged between 18-24 months, 55.2% were female. The majority of HIV positive mothers 80.2% who participated in the study were married. The prevalence of HIV infection among children born from HIV positive women was 2.9%. Children whose mother had poor adherence to ART were 1.5 times more likely to get HIV at birth compared to those whose mother had good adherence (AOR = 1.5; 95% CI: (1.12-2.21)). Children born from mothers in WHO stage II were more likely to get HIV from their mother (AOR = 1.24; 95% CI: (1.32-2.207)). Children born from HIV positive mother with one ANC visit were 2.5 times more likely to get HIV from their mothers (AOR = 1.56; 95% CI: (2.31-5.17)).
Dec 2020 DOI 10.14302/issn.2474-3585.jpmc-20-3672
Background Prevalence of Metabolic syndrome is high among Asians including Indians, and is high among those having sedentary occupations. Teaching is one of the important occupations, which demands no strenuous physical activity. However, there is little information available about the prevalence of metabolic syndrome among teaching staff of engineering college. Hence, the present study was conducted to study its prevalence, certain risk factors and co-morbidities among teaching staff of engineering institutes. Methods Teachers from engineering colleges of Nagpur city were the study subjects. Data was collected by interview technique. Clinical examination and laboratory investigations like Fasting blood glucose, High Density Lipoproteins and Serum Triglycerides were done. National Cholesterol Evaluation Programme (NCEP) Adult Treatment Panel Three (ATPIII) criteria were used to study Metabolic syndrome. Blood pressure and anthropometric measurements like height, weight and waist circumference were obtained by standard methods. Results The prevalence of metabolic syndrome was found to be 20.5%. It was 25.32% in females and 19.31% in males. It was more common in subjects of higher age group, muslim religion, and among widows and separated. Alcohol consumption, smoking and sedentary life style was found to be significantly associated with presence of metabolic syndrome. Frozen shoulder, fungal infection and stroke were common co morbidities found among subjects having metabolic syndrome.
Sep 2020 DOI 10.14302/issn.2372-6601.jhor-20-3544
In Mexico, breast cancer is the second most common site of cancer in women and in most developed and emerging countries. Incidence rates have increased in many countries, although in some, mortality has remained stable with a slight reduction. There are geographical differences with high rates of breast cancer in North America, Northern Europe and Oceania, and lower rates in Central and South America, South and East Europe; in addition to emerging countries in Africa and Asia. Genetic and hereditary factors constitute less than 5% of breast cancer cases and other risk factors for breast cancer are related to the reproductive life of the woman. This work was carried out in order to determine if the risk factors considered classic are really associated with breast cancer in our sample of Mexican women studied.
Sep 2020 DOI 10.14302/issn.2694-2275.jzr-20-3537
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.
Mar 2020 DOI 10.14302/issn.2471-2140.jaa-20-3236
Objective Search of pathogenetic mechanisms and risk factors of atherosclerosis in the employees of the cleaning service in Tbilisi. Materials and Methods As a result of a preliminary survey and examination of 200 employes of Tbilisi cleaning service aged 25-45 years (2014-2016), 22 patients with angina, hypercholesterolemia, intimae-media thickness > 0.65 mm, were selected into I group, and 23 individuals without these disorders into II group. In the blood plasma of the selected patients the intensity of oxidative metabolism parameters, TAA and MDA were determined. The variance and correlation analysis (АNOVA) was used for conducting the comparative analysis of the levels of studied parameters. Results In the combined group (I+II) there are several reliable correlations between the Age -TCol, Age-MDA, BMI-Tg, BMI-MDA, LDLChol-HDLChol, LDLChol–TChol, HDLChol-TChol, LDLChol-MDA, LDLChol-TAA. no correlation between these parameters in individual groups (I and II) was found. That indicates that we have an imaginary correlation related to the large intergroup difference between the average values of the group indicators, that is the values of various indicators change during the development of the pathological process, but there is no causal relationship between these alterations. The reliable TAA-MDA correlation in the combined group (I+II) is related to the high anticorrelation between these parameters and the significantly higher average value of TAA in the low-risk group (II) in comparison to the high-risk group (I). Conclusion The results analysis indicates both the diagnostic value of redox status indicators and their leading role in the atherogenesis processes. In populations with a high risk of atherosclerosis, monitoring of serum TAA is recommended.
Mar 2020 DOI 10.14302/issn.2575-1212.jvhc-20-3225
Objective To evaluate/ determine the risk factors for dogs presented with Gastric Dilation- Volvulus (GDV) to a referral veterinary centre and to compare the results with those currently reported in veterinary literature. Materials and Methods The observational case-control study comprised a population of 215 dogs that attended the referral centre between 2000 and 2018. Medical records were searched for GDV and those matching the criteria were manually reviewed. A questionnaire was completed by the owners of the dogs involved in the study (both case and control populations) in order to gain further information that could be considered relevant to GDVs. In particular, information included the dogs’ behaviour and the dogs daily activities. Results The study included 115 cases of GDV and 115 controls. Out of the GDV dogs 13% (15/115) were small breed dogs and the remaining 87% (100/115) either large or giant breeds. The following risk factors for developing a GDV have been identified: Purebred dogs over 3 years old and either large of giant breeds, weighing > 30 kg. Foreign body ingestion, diarrhoea, and grass consumption were also associated to increase the likelihood in developing GDV. Behavioural temperament was not associated with developing GDV. Clinical Significance The findings support previously identified risk factors in the development of GDV, but characteristics related to the dogs temperament warrant further investigation. Knowledge of these results will further allow clinicians to make evidence‐based recommendations to owners in attempting to prevent GDV in dogs. Furthermore this paper confirms that the risk of GDV in certain breeds and in certain conditions is always high and that GDV is still an extremely current disease.
Oct 2019 DOI 10.14302/issn.2691-5014.jphn-19-3038
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
Feb 2019 DOI 10.14302/issn.2324-7339.jcrhap-18-2533
This study was conducted in two (VCTs) at Elgenina town, the capital of West Darfur State in Sudan in period from November 2010 to February 2011, the study included all people attending VCTs in Elgeniena town for voluntary checking one hundred and fifty clients who visited the (VCT) centers and volunteered were included in this study, nonprobability sample, 150 volunteers was taken and covered all ages, One ml of blood was taken from each of the study sample and tested by rapid Immune Chromatographic (ICT) for HIV, a structured questionnaire was designed and the interviewed after a written consent to participate in the study was signed, data was analyzed using the SPSS statistical programmer and for possible association between study variables, the Chi square test was used, the study showed that 35 volunteers (23.33%) were positives, of whom 54.3% 19 were males. People having more than one sex partner were high 63.6% with statistically significant factor of getting infection (P.value = 0.00). Also, practicing unsafe sex were 5.2% another major risky (P.value = 0.00). Among the HIV positive cases 34.3% were drug users, compared to 20.9% from the HIV negatives (p. value = 0.10). There is no relation between education level and infection with HIV (p .value = 0.154). Forty two percent of the participants were single, 30% married, 10% divorced, 7.3% widows and 10.7% were separate
Jul 2018 DOI 10.14302/issn.2690-4837.ijip-18-2238
Background Colonization with methicillin-resistant Staphylococcus aureus (MRSA) is recognized as an association towards development of infections that may cause of morbidity among people living with Human Immunodeficiency Virus (PLWHIV). We report on the prevalence, antibiotic susceptibility pattern and risk factors associated with MRSA carriage among PLWHIV at Nyenga hospital, Buikwe district in central Uganda. Materials and Methods We conducted a cross-sectional study among PLWHIV attending Nyenga hospital anti-retroviral therapy (ART) clinic. Nasopharyngeal swab was collected from each participant, cultured to isolate Staphylococcus aureus, and drug susceptibility testing (DST) performed. Sociodemographic data and medical history was recorded. Results We enrolled 219 PLWHIV; of these, 58.4% (N=128) were females. The majority of participants (95.0%) were on ART. Ninety-eight (44.75%) of the nasopharyngeal swabs had growth, of which 41 (41.84%) were S. aureus. Of these, 11 (5.02%, 95% confidence interval: 3.67-7.02) were MRSA. Of 41 isolated S. aureus strains, only 8 (19.51%) were susceptible to all antibiotics tested. A total of three (7.32%) were multi-drug resistant (MDR), while one1 (2.43%) was a possible extensively drug resistant (XDR) strain. Deteriorating immunologic state as indicated by a low CD4 count showed a significant association with the MRSA colonization. Conclusion These results are reassuring that MRSA colonization is high among PLWHIV. As most of the antibiotics in use were resistant, it raises concerns of intricate clinical management in a low resource set up.
Feb 2018 DOI 10.14302/issn.2641-5518.jcci-17-1880
Objective: Presentation of rare case report of primary non-Hodgkin Lymphoma of temporal bone secondary to immunodeficiency after prolonged steroid administration in a diabetic patient. Then review the literature of similar case reports. Method: 49 years old female presented with hearing loss, facial paralysis and otalgia. Biopsy revealed high grade non Hodgkin’s B-lymphoma. She underwent chemotherapy and had remarkable response. Result: Rapidly progressive deafness, facial paralysis and otalgia are common presentations of external canal Non-Hodgkin lymphoma. The disease is common in middle age, females and has a fair response to chemotherapy, good to radiotherapy. Surgery is an alternative method in isolated lesions or recurrent cases. Conclusion: High dose steroid and type II diabetes are potential risks for acquired immunodeficiency. External Auditory canal lymphoma is uncommon sequel. Chemotherapy is very effective in treatment of isolated cases without B symptoms
Jan 2018 DOI 10.14302/issn.2576-6694.jbbs-17-1850
Obesity has become a serious health issue worldwide. There is much evidence that obesity among adolescents contributed to worsening blood biochemical profile that leads to development of many non-communicable diseases. Therefore, the aim of this study was to evaluate the predictive value of some central obesity anthropometric indicators to metabolic risk factors in the Syrian male adolescents. A cross-sectional study of a randomly selected sample of 2064 apparently healthy Syrian males’ adolescents from Damascus city, Syria, aged 18 to 19 years was performed. Waist circumference (WC) and hip circumference (HC) were measured, and waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR) were calculated. Blood pressure (BP) was also measured. Serum fasting blood sugar (FBS), triglyceride (TG), low-density lipoprotein cholesterol(LDL-C), total cholesterol (Chol) were determined. The metabolic risk factors components were defined according to the national criterion. A receiver operating characteristics (ROC) curves were drawn to determine appropriate cut-off points of the WC, HC, WHpR and WHtR for defining the performance of these measurements as predictors of metabolic risk factors. The obtained data showed that BP and overall concentrations of TG, Chol and TG/HDL were significantly (p<0.05) increased with increasing WC, HC, WHpR and WHtR values. Based on ROC calculation for the measured anthropometric indicators and some metabolic syndrome (MetS) risk factors, the best WC HC, WHpR, WHtR cut-offs values were ranged between 73.15 - 79.90 cm, 93.75 - 101.10 cm, 0.80 - 0.81, and 0.43 and 0.47, respectively. These cut-off values were lower than the values recommended by the WHO. In conclusion: A significant association between the studied anthropometric indicators and the MetS components has been demonstrated. The best cut-offs of these indicators were defined. These cut-off values were lower than the values recommended by the WHO. Our results indicating that WC, WHpR and WHtR could be better predictors of MetS risk factors in Syrian adolescents.
Nov 2017 DOI 10.14302/issn.2641-5518.jcci-17-1806
Background Hypertension is one of the most prevalent risk factors for myocardial infarction, strokes, congestive cardiac failure and chronic kidney disease (CKD)and its prevalence is significantly higher inthe elderly population. Objectives To assess the demography, various presentations and the prevalence of risk factors among elderly hypertensive patients followed up in a tertiary care hospital in Sri Lanka. Materials and Methods This was a cross sectional descriptive study involving 250 patients whoseage was 60 years or above onantihypertensives for at least 6 months. Results Approximately 65.2% of the study population was female. The mean age was 70.17.Dizziness and chest pain were the most prevalent symptoms.The mean age at first detection was 58.17 years.Mean SBP and DBP were 128.5mmHg and 81.14mmHg respectively. The prevalence of alcohol consumption and smoking among men were 70.1% and 72.4% respectively. Approximately 54.7% were either overweight or obese.Approximately 81.6% females and 41.4% males had a waist circumference ofmore than therisk level with p-value<0.05. Approximately 36% had diabetes mellitus and 27.6% of the patients had at least one parent and 36.8% had at least one sibling diagnosed with hypertension. Approximately 61.3% of the patients hadadequate levels of physical activity while 31.8% had IHD,11.5% had stroke and 3.8% had CKD. Conclusion Dizziness and chest pain were the most disturbing symptoms while abdominal obesity among females,and alcohol consumption and smoking among males were the major risk factors in elderly hypertensive patients
Aug 2017 DOI 10.14302/issn.2470-5020.jnrt-17-1487
The global popularity of soccer has led to widespread tendency towards this sport. Because of the convenience of using artificial surfaces, the rapid growth of using these surfaces led to concerns about the declining performance of the players. The aim of this comprehensive review is to study the difference between the performance of players on different playing surfaces and the risk factors for use of artificial turf compared to natural grass. A literature search of valid scientific databases such as Science Direct, PubMed and Jstor by searching keywords was performed. In total, more than 6,000 articles were retrieved. After the preliminary selection process, the final analysis was performed on a total of 76 articles. Results: Mechanical properties of artificial grass have a significant effect on the average time of sprinting, the best time of sprinting and maximum speed. The numbers of sliding tackles on artificial turf were lower compared to natural grass. Artificial turfs exposed hardness, elasticity and high friction. The characteristics of artificial grass have changed over time and increased the probability of injuries. There was no significant difference between the overall risks of acute injuries in soccer players performing on artificial turf compared to natural grass. The amateur, young and female soccer players had rated lower injuries on artificial grass. But the rate of injuries in elite soccer players were higher on artificial grass and hence they are not found of playing on such playing surfaces.
Jun 2017 DOI 10.14302/issn.2329-9487.jhc-17-1493
Objective: Studies suggest that cardiovascular risk of patients with congenital heart disease (CHD) is increased. This study aims on the predictive value of a single daily activity and exercise capacity assessments on the change of body-mass-index (BMI) and blood pressure in the future. Patients and Methods: We retrospectively analyzed all patients with CHD who underwent a daily activity assessment by triaxial accelerometry and accompanied cardiopulmonary exercise testing. From 276 patients 16 years or older (120 female, 28.6 ± 8.5 years) current BMI and blood pressure could be abstracted from their last outpatient visit. Results: After a mean follow-up of 5.5 ± 1.5 years, the BMI of the patients has increased from 23.0 ± 3.4 to 23.7 ± 3.5 kg/m2 (p<.001) corresponding to an annual increase of 0.14 ± 0.40 kg/m2 respectively. The systolic blood pressure decreased by -0.37 ± 3.14 mmHg (p=.049). The multivariable regression analysis corrected for confounders showed no association to annual BMI change according to baseline daily activity levels (p=.891) or peak oxygen uptake (p=.596). Only in patients with higher BMI at baseline (Beta= -.275; p<.001) and females (Beta= -.177; p=.009) increase in BMI was less. Also the blood pressure change was not associated with daily activity levels (p=.420) and peak oxygen uptake (p=.732) at baseline. Conclusions: Single daily activity or exercise capacity measures do not predict future BMI or blood pressure changes. Regular evaluation of functional status including exercise testing, activity assessment and tailored counseling are therefore recommended in patients with CHD.
Jan 2017 DOI 10.14302/issn.2379-7835.ijn-16-1408
Despite the agreed global and national stunting reduction targets, Uganda has made very little progress. Understanding context-specific risk factors for stunted growth is therefore pertinent to designing programs to address the problem. A cross-sectional study was conducted in 32 randomly selected villages in Buhweju district, Southwest Uganda. Data entry, cleaning and analysis were carried out using Statistical Package for Social Sciences (SPSS) version 21. A regression analysis was conducted to examine the associations between potential risk factors and stunted growth. The survey covered 256 households and anthropometric measurements were taken for 221 children aged 6–59 months. The majority of the households (66%) in the district were food insecure and had a low socioeconomic status (84%). The prevalence of stunting in Buhweju district was 51%, which is significantly higher than the regional and national averages. Only 28% of the children were exclusively breastfed in the first 6 months of life, and only 10% of them received the minimum acceptable diet (MAD). The findings of this study demonstrate that reductions in stunted growth at national or regional levels has not necessarily translated into similar trends in rural areas of Uganda. The notable contributors to stunting in these areas include morbidity, sub-optimal infant and young child feeding (IYCF) practices, low consumption of animal-source foods, food insecurity, lack of access to high-quality drinking water, sanitation and hygiene (WASH) facilities and poverty. Increased investment in both nutrition specific and sensitive interventions is therefore crucial to address these risk factors.
Oct 2016 DOI 10.14302/issn.2329-9487.jhc-16-1301
Purpose: The purpose of this study was to examine the mediation of depressive symptoms in the relationship between cardiovascular risk and the health conservation of community-dwelling vulnerable diabetic elderly in order to provide a basis for planning nursing interventions to improve the health conservation of vulnerable diabetic elderly. Methods: The participants were 99 vulnerable diabetic elderly who registered at the community health centers in D city. Data were collected using self-report questionnaires and analyzed with the SPSS-WIN 19.0 program. The instruments were Sung’s Health Conservation Scale, the Arizona Heart Institute Cardiovascular Risk Factor Questionnaire, and the Geriatric Depression Scale Short Form-Korea version (GDSSF-K). Results: The mean score for health conservation was 100.52. Overall depressive symptoms were 11.84, cardiovascular risk was 20.35. There were significant correlations among the three variables: health conservation, depressive symptoms, and cardiovascular risk. Also, depressive symptoms had a proportional mediating effect in the relationship between cardiovascular risk and health conservation. Conclusion: Based on the findings of this study, health management programs focusing on cardiovascular risk management and depressive symptom improvement are highly recommended to promote health conservation in the vulnerable diabetic elderly
Jul 2016 DOI 10.14302/issn.2473-1005.jdoi-16-999
Purpose: The aim of the study was to analyze the spatial relationship between the sinus floor and the alveolar bone of maxillary premolars and molars in order to assess the amount of basal bone available for immediate extraction placement of endosseous implants. Materials and Methods: All the cone-beam computerized tomographic (CBCT) scans taken over a three-year period at four centers were identified. The subsinus bone height (SBH) was evaluated by measuring the distance between the sinus floor and the first and second premolar root apexes. The interradicular septum bone height (ISBH) of all the first and second molars was also measured, and the presence or absence of sinus-floor invagination between the molar roots was recorded. Results: Five hundred twenty-six (526) CBCT scans of fully or partially dentate maxillary arches were examined. The root apex was inside the sinus of 1.8% of all the first premolars. It approximated the sinus floor of 5.3% of them, and the distance between the two points was between 1 and 3mm of 20%, between 3 and 7mm for 34.1%, and more than 7mm for 34.1%. For the second premolars, the findings were 13.5% (inside the sinus), 10.5% (touching the sinus), 32.8% (1-3mm of distance) 28% (3-7 mm), and 15.2% (more than 7mm). Root invagination was noted in 50.2% of the first molars and 43.1% of the second molars, with the ISBHs ranging from 13.4% to 56.9%. Conclusion: Radiological evaluation is essential to determining whether implants should be placed immediately after extraction of maxillary premolars and molars.
Mar 2016 DOI 10.14302/issn.2374-9431.jbd-16-939
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.
Feb 2016 DOI 10.14302/issn.2324-7339.jcrhap-13-255
People living with HIV (PLWH) are at risk of developing chronic lifestyle diseases such as ischaemic heart disease (IHD). Physical inactivity is a modifiable risk factor for IHD. The level of ambulation physical activity in individuals living with HIV in a South African context is unknown. The aim of this study was to assess the physical activity levels and other risk factors for IHD in PLWH on antiretroviral therapy (ARV). An observational study was conducted from October 2010 to June 2012 at an outpatient clinic in Johannesburg, South Africa. Two hundred and five individuals who were on ARV for 6-12 months were screened. Physical activity was measured with the Yamax SW200 pedometer over a seven day period. Physical activity of the sample was reduced at 7673.2 (±4017.7) steps/ day with women walking less than men 6993.3 (±3462.6) and 10076.3 (±4885.6)respectively. Body mass index was increased to 25.6 (±5.4) kg/m2 with women noted to be overweight [26.6 (±5.5) kg/m2]. Independent predictors of being overweight were systolic blood pressure, waist and hip circumference, CD4 count and daily fruit and vegetable intake. Smoking was less common in the study population with 16.1% of the sample being current smokers and 25.9% former smokers. Individuals’ mean perceived stress levels were 19.9 (±7.8) on the Cohen’s Perceived Stress Scale. The ambulation physical activity level of individuals living with HIV requires modification to assist with reducing risk factors of IHD.
Jan 2016 DOI 10.14302/issn.2379-7835.ijn-15-770
The objective of this study was to confirm the nutritional risk factors for asthma and obesity in adolescents using a cross-sectional survey. We included male and female adolescents aged 10 to 19 years of age in this study. The indicators of nutritional status used in this study were body mass index, the height-for-age index, and arm and waist circumferences. We used a food frequency questionnaire to estimate the average consumption of sodium. Physical activity was assessed using the International Physical Activity Questionnaire, and asthma characteristics were evaluated using the International Study of Asthma and Allergies in Childhood (ISAAC). Factors associated with asthma in bivariate and multivariate analyses were assessed using the Poisson regression analysis. The significance level was set at 5%, and the analyses were performed using the SPSS statistical package. We evaluated 1362 students with an average age of 15.65 ± 1.24 years. There was a positive risk for asthma between females (PR = 1.41) and asthma severity in adolescents with a high sodium intake (PR = 2.30). Within overweight adolescents, the prevalence for asthma risk washigher among females (PR = 1.66) and the high sodium intake group (PR = 1.98). An increased risk for asthma severity correlated with high sodium intake (PR = 3.07). There was a higher risk for asthma and its severity in females with high sodium intake. The same pattern was observed for adolescents with excessive weight.
Feb 2015 DOI 10.14302/issn.2379-7835.ijn-14-461
Objective: To investigate the association of meat consumption with self-reported chronic diseases (heart disease, hypertension, diabetes (type I or type II) and dyslipidemia), according to demographic, social and anthropometric variables. Methods: This was a cross sectional study, conducted at the Heart Institute, University of São Paulo, with 549 adults (≥ 18 years) who answered a questionnaire to select people for The CARVOS Study (Carotid Atherosclerosis, Aortic Stiffness and Risk Factors in Vegetarians and Omnivorous Subjects). The variables analyzed were: age, gender, education level, meat consumption, self-reported coronary heart disease, hypertension, diabetes (type I or type II) and dyslipidemia, smoking and body mass index (BMI) (kg/m2). Study subjects were classified as omnivorous (OMN=consumption of meat or fish four or more times/week) (n=228, 41.5 %), semi-vegetarians (SV=consumption of meat or fish 1-3 times/week) (n=97, 17.7%) and vegetarians (VEG=no consumption of meat or fish) (n=224, 40.8%). The differences between mean values was calculated by T-ANOVA test. To test the association between the variables, chi-square test and multiple logistic regression were used (p<0.05; CI = 95%). Results: There was a greater prevalence of smokers among OM than SV and VEG respectively 56.5%, 14% and 29.4 %, p=0.009, and a higher prevalence of overweight (41.7%) in OMN in comparison with SV (29.2%) and VEG (29.0%), p=0.008. Being OM significantly increased the risk of referring hypertension, regardless of sex and age (OR 2.19; CI 95% 1.08-4.46), and was also associated with dyslipidemia, regardless of body mass index, smoking, sex and age (OR 1.78; CI 95% 1.03-3.08). Conclusion: Higher meat consumption was associated with a greater prevalence of risk factors for hypertension and dyslipidemiachronic diseases.
Feb 2015 DOI 10.14302/issn.2381-862X.jwrh-14-532
Objective: To identify risk factors for ≥4500 g macrosomic babies given that maternal and neonatal complications of macrosomia increase with birth weight. Design: Cross sectional analytical study. Setting: The Yaoundé University Teaching Hospital and Central Maternity, Cameroon from October 1st, 2012 to June 30th, 2013. Population: 42 women who delivered ≥4500 g babies and 126 women who delivered babies of 4000 to <4500 g were recruited. Methods: Data were analysed using SPSS 18.0. Analyses included the student t-test and the Fisher exact test. The level of significance was P<0.05. Main outcome measures: Fetal sex and birth weight, gestational age at delivery, maternal age at delivery, parity, mother's pre-gestational body mass index (BMI), weight gain during pregnancy, father's BMI and past history of ≥4000 g macrosomia. Results: Main risk factors for ≥4500 g macrosomic babies were maternal weight gain of ≥16 kg (OR 4.2, 95%CI 2.0-8.9), maternal age ≥30 (OR 3.8, 95%CI 1.8-8.2), post term (OR 2.3, 95%CI 0.9-5.6), past history of ≥4000 g macrosomia (OR 1.9, 95%CI 0.9-4.1) and male sex (OR 1.3, 95%CI 0.6-2.8). Conclusion: To reduce the risk of ≥4500 g macrosomic babies, women at risk should make efforts to gain less than 16 kg bodyweight during pregnancies. Moreover, post term pregnancies should be avoided.
Jan 2015 DOI 10.14302/issn.2379-7835.ijn-14-536
The risk levels of chronic diseases are increasing among Asian migrants in Western countries compared to their origin-country counterparts. This study evaluates the impact of an 8-week nutrition and lifestyle intervention on cardio-metabolic risk factors in Korean migrants living in Melbourne, Australia. Thirty participants aged 32-62 years completed the program. Self-reported food intake and physical activity, anthropometric and blood pressure measurements, and biomarkers of cardio-metabolic risk were assessed. An initial training session and four consequent nutrition advice sessions were provided for all participants. There was a significant reduction in the waist and hip circumferences. Positive changes were also observed in plasma lipid profiles, calcium intake and frequency of physical activities. These findings demonstrate that a culturally appropriate nutrition and lifestyle intervention can be successfully delivered to reduce the cardio-metabolic risk factors and improve the health and wellbeing of Korean adult migrants.
Feb 2014 DOI 10.14302/issn.2324-7339.jcrhap-12-157
Background: Human Immunodeficiency Virus (HIV) and antiretroviral therapy (ART) are found to be strongly associated with cardiovascular diseases. Data are sparse on the prevalence and distribution of cardiovascular risk factors among people being treated for HIV in South Asia region. Methods: A cross-sectional study of 103 HIV patients (51 women and 52 men) attending routine follow-up consultations at the largest ART centre in Nepal was conducted. Data on several cardiovascular risk factors were collected through interview questionnaires, biophysical measurements and consulting medical records. Results: The most common cardiovascular risk factors observed were central obesity 34.6% 95% Confidence Interval (CI): 25.3% to 43.9%, chronic kidney disease {20.7% (95% CI: 11.6% to 29.7%)} and tachycardia {20.6% (95% CI: 12.7% to 28.5%)}. Females were significantly more likely to have central obesity (male 9.8% vs. female 60%, p=0.016) and chronic kidney disease (male 15.4% vs. female 26.3%, p=0.003) as compared to the males. Participants were fairly active but a large proportion, especially men, had smoked {65% (95% CI: 57%-72.3%)}, used tobacco products {66% (95% CI: 56.4%-74.4%)} or drugs (53.8% of the men) and consumed alcohol {60.2% (95% CI: 50.5%-69.1%)}. Conclusion: A high prevalence of several cardiovascular risk factors was observed among patients being treated for HIV in Nepal. Further larger studies are warranted to better understand the relevance and public health impact of cardiovascular risk factors in this region.
May 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-140
Analyzing SNPs linked to fatty liver disease, this study finds no association with HAART‑related hepatic steatosis in HIV patients. The work underscores the multifactorial nature of antiretroviral toxicity and points to metabolic and pharmacologic contributors beyond common variants.
Jan 2026 DOI 10.14302/issn.2474-7785.jarh-25-5940
Lower limb osteoarthritis, a widespread age related chronic condition is often accompanied by an increased tendency to fall and thereby various degrees of intrinsic and extrinsic injury. Falls, in turn may provoke the disease alone and in turn a high falls risk and cycle of recurrent falls and heightened disability. This report which updates what is known about falls in the context of disabling osteoarthritis argues for a possible future ecological orientation rather than a focal uni dimensional approach to addressing this costly health problem. It examines osteoarthritis falls risk factors, falls injury prevention attempts, and recommendations to advance research and practice using an ecological analytic approach in this regard. Using the PUBMED data base and others, lower limb osteoarthritis linkages and falls interaction studies were sought and examined. The data revealed osteoarthritis can lead to the chances of incurring one or more falls and further health and disability challenges, while falling can provoke the onset of osteoarthritis in its own right. Although many factors appear to be involved, these are rarely viewed through a broad multi dimensional ecological perspective, thus are confusing or overwhelming to apply to the active community dwelling elderly subject.
Dec 2025 DOI 10.14302/issn.2641-4538.jphi-25-5613
Background Domestic violence among HIV discordant couples poses significant public health challenges, affecting treatment adherence and HIV transmission risks. This study examined factors contributing to domestic violence among HIV discordant couples in Kicukiro District, Rwanda. Methods A cross-sectional study was conducted among 384 HIV discordant couples from eleven health centers using stratified systematic sampling. Data were collected through structured face-to-face interviews and analyzed using descriptive statistics and bivariate analysis. Results Domestic violence prevalence was 41.1% physical violence, 34.2% sexual coercion, and 52.3% emotional abuse. Key socio-demographic risk factors included female gender (56% vs. 29% males, p<0.001), older age (61% in ≥55 years vs. 32% in 18-24 years, p=0.004), unemployment (55% vs. 34% formal employment, p=0.014), and financial hardship (63% vs. 25% comfortable situations, p=0.002). Behavioral factors included alcohol use (58% vs. 38%, p=0.021), substance abuse (62% vs. 35%, p<0.001), and poor conflict resolution (72% vs. 25%, p<0.001). Contextual factors like hostile HIV disclosure reactions (68% vs. 34%, p<0.001) and HIV-related stigma (60% vs. 35%, p<0.001) significantly increased violence risk. Conclusions Domestic violence among HIV discordant couples is multifactorial, driven by socio-economic, behavioral, and HIV-related factors. Integrated interventions addressing economic empowerment, conflict resolution skills, stigma reduction, and couple-centered counseling are urgently needed.
Dec 2025 DOI 10.14302/issn.2769-2264.jw-24-4937
Access to potable and quality water in most rural communities is low such that over 2.2 billion people worldwide are negatively affected. The increasing population in Fiapre and the inconsistent water supply by the Ghana Water Company Limited (GWCL) have forced most residents to resort to alternative groundwater sources such as boreholes, wells, etc. Yet, many residents use these sources of water unaware of the quality of the water and its potential health implications. This study assessed drinking water quality in Fiapre by calculating its Weight Average Water Quality Index (WAWQI) and investigating potential risk factors associated with contamination through a cross-sectional study and laboratory analysis of various physicochemical and microbiological water quality parameters. WAWQI was used to compute parameters using 10 factors including pH, electrical conductivity, temperature, TDS, phosphate, chloride, total hardness, nitrate, alkalinity, and faecal coliform. The findings revealed that the pH level of water, phosphate concentration, and fecal coliform count surpassed the recommended thresholds set by the World Health Organization (WHO) for safe drinking water. Although levels of electrical conductivity, TDS, nitrate, total hardness, and chlorine kept changing from one water source to another, the difference was not significant apart from phosphate and fecal coliform which shows a significant difference between the sachet water sources and other water sources (P<0.05). The study outcomes demonstrated that the overall water quality is predominantly categorized as good to fairly good, with the highest Water Quality Index (WQI) value reaching 87.84% and the lowest recorded at 54.81%. Therefore, to improve the water quality in the municipality, local management agencies should pay attention to the microbiological quality of the water sources. The study recommends regular handwashing practices, hygienic surroundings of the water source, and drinking water treatment to reduce the possible risk factors associated with the contamination of the water sources.
Nov 2025 DOI 10.14302/issn.2379-7835.ijn-24-5360
Background Malnutrition is a significant public health issue in Bangladesh, particularly impacting women and children. Rajshahi, marked by socio-economic disparities, offers a distinctive context to explore the nutritional status and health outcomes of these vulnerable groups. Objectives This study aims to assess the nutritional status of women and children in Rajshahi and investigate associated health outcomes. Additionally, it seeks to identify socio-economic and cultural factors that influence nutrition. Methods A mixed-methods approach was utilized, incorporating a cross-sectional survey of 460 households and in-depth interviews with mothers and caregivers. Anthropometric measurements were taken to evaluate the nutritional status of women and children, while dietary assessments measured nutrient intake and diversity. Logistic regression analysis was performed to determine the likelihood of malnutrition based on socio-economic characteristics, thereby identifying key risk factors. Results The findings indicate a troubling prevalence of malnutrition, with 36% of children under five classified as stunted and 25% as underweight. The analysis highlights critical factors contributing to chronic undernutrition, including maternal education, employment, and dietary diversity. Notably, mothers aged 27-37 exhibit a lower risk of undernutrition, and urban households with secure food access demonstrate better nutritional outcomes. Discussion Maternal education and employment were positively associated with better nutritional outcomes, as educated and employed mothers had higher chances of maintaining a normal BMI. Regular ANC visits (≥4 visits) were crucial for improved maternal nutrition. Household food security emerged as a significant determinant, with food-secure households showing better maternal nutritional status. Safe water access and adequate dietary diversity were also linked to improved maternal BMI. Additionally, factors such as child birth weight, exclusive breastfeeding, and childhood diarrhea significantly influenced maternal nutrition. Moreover, frequent antenatal care visits and a diverse diet are vital in mitigating undernutrition risks among children. Conclusion This study emphasizes the urgent need for targeted interventions to combat malnutrition in Rajshahi. Recommendations include implementing community-based nutrition education programs and improving access to healthcare services. By addressing the socio-economic and cultural determinants of nutrition, stakeholders can enhance health outcomes for women and children in the region, ultimately contributing to broader public health objectives in Bangladesh.
May 2025 DOI 10.14302/issn.2379-8572.joa-25-5504
Introduction Angiosarcoma is a rare malignant tumour from fast-evolving and aggressive vascular endothelial cells that accounts for 1% of all sarcomas. The sinus location of angiosarcoma is exceptional. The clinical polymorphism of this tumour may cause a delay in diagnosis. Risk factors are not always understood. However, a history of radiation therapy for locoregional cancer and/or lymphedema is most commonly found. The prognosis remains bleak with an overall five-year survival of 35 to 40%. Objectives The authors discuss the diagnostic, therapeutic and prognostic modalities and difficulties of this tumour. Observation: The authors report a case of maxillary sinus angiosarcoma confirmed by radio-induced secondary CD34 immunohistological staining in a 40-year-old man having a history of hemangioendothelioma treated with conservative endoscopic surgery and adjuvant radiotherapy 15 months earlier. Discussion This lesion is rare in the ENT sphere and may be confused with a benign tumor in its early stages. Only histological examination with immunohistochemistry can confirm the diagnosis (factor VIII, CD34 and CD31 antigens). Treatment consists of a wide resection followed by radiotherapy, hence the need for early diagnosis in the metastatic phase, first-line treatments include doxorubicin or paclitaxel weekly. Conclusion Radio-induced angiosarcoma is a rare malignant tumour, it occurs in patients who have received conservative treatment and radiation therapy for nasosinusitis cancers. Angiosarcomas of the nasal passages remain a diagnostic and therapeutic challenge due to their local and general aggressiveness.
Feb 2025 DOI 10.14302/issn.2379-7835.ijn-24-5283
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.
Dec 2024 DOI 10.14302/issn.2470-0436.jos-24-5322
Studies show that individuals with limited health literacy skills experience worse health outcomes in a multitude of chronic diseases including glaucoma. These patients have poorer compliance, worse disease understanding and greater disease progression. The main purpose of our study was to evaluate the knowledge about glaucoma basic concepts in patients with this disease. A 24 question survey was given to patients followed by the glaucoma department, by phone or in person. Epidemiological data and personal therapeutic regimens were collected as well as data concerning the pathophysiology, treatment and prognosis of the disease. Survey responses were obtained from 79 patients with a mean age of 72 years old. Most of the patients had a low education level. The majority of patients could not enumerate glaucoma risk factors (74.5%), their glaucoma type (94.9%) or the best glaucoma definition (57%). However, they were able to relate the disease to a high IOP (75.9%) and the possibility of it leading to blindness (96.2%). We believe that patients, when observed in their glaucoma appointments, tend to retain information related to the prognosis and consequences of the disease and not focus on the understanding of its pathophysiology, causes and mechanisms, which may reflect their concern about their own future. However, this may lead to some misconceptions about the definition of glaucoma and specially about what can cause this disease. Some investment should be done to improve health literacy in the glaucoma population, with appropriate language and handed material.
Feb 2024 DOI 10.14302/issn.2693-1176.ijgh-23-4879
Background Cancer and diabetes are risk factors for COVID-19 mortality rates. Remdesivir, dexamethasone, and vaccines are used to improve clinical outcomes. We aimed to evaluate the factors associated with COVID-19 mortality rates. Methods This retrospective study enrolled moderate to critical COVID-19 patients. The index day was the day of the COVID-19 diagnosis. Patients were followed up until either death or discharge. A two-way analysis of variance examined the interaction between independent mortality risk factors. Results A total of 205 patients were analyzed, and the mortality rate was 29.5% (n=60/205). The cumulative survival rate was significantly lower in patients with a CCI score ≥ 6, cancer, and diabetes. In multivariate analysis, critical illness, cancer, diabetes, chronic liver disease, a CCI score ≥ 6, unvaccinated, and early use of remdesivir/dexamethasone were independent risk factors for mortality. The onset of remdesivir/dexamethasone ≥ 2 days and < 3 doses of vaccinations were higher mortality rate, with its impact being more significant amongst patients with cancer/diabetes, compared to those without cancer/diabetes (p for interaction = 0.046/0.049, 0.060/0.042, and 0.038/0.048 respectively). Conclusions COVID-19 vaccination ≥ 3 doses and early administration of remdesivir and dexamethasone can significantly reduce mortality rates, particularly in patients with cancer or diabetes.
Oct 2023 DOI 10.14302/issn.2575-1212.jvhc-23-4532
Camels are a significant source of income for nomadic populations in many developing countries, including Ethiopia. Camels are well adapted to dry and semi-dry regions, providing income, food security, and transportation. However, camel production and productivity are constrained by infectious diseases, such as brucellosis, which is a highly infectious bacterial disease that affects camels and humans worldwide. Brucellosis causes significant economic losses due to abortion, low herd fertility, and decreased milk production. In Ethiopia, the prevalence of camel brucellosis varies depending on factors related to the host, agent, climate, and management system, with a reported prevalence ranging from 0.5% to 11.9%. Accurate diagnosis of camel Brucellosis is essential for herd-based screening of animals. Although culturing the pathogen is the preferred method for diagnosis, serological tests such as Rose-Bengal plate test (RBPT), Enzyme-linked immunosorbent assay (ELISA), and Complement fixation test (CFT) and polymerase chain reaction (PCR) assays have been developed. Implementing effective diagnosis and surveillance systems to control the spread of brucellosis in animals and humans is very important, on top of awareness campaigns, vaccination programs, and suitable laboratory establishment recommended. Continued research is essential to maintain the health and productivity of camel populations, particularly in pastoral areas where camels play a significant role in the livelihood of communities. Therefore, the present paper views the seropositive prevalence and potential risk factors associated with camel brucellosis in Ethiopia.
Jul 2023 DOI 10.14302/issn.2470-5020.jnrt-23-4576
Background The evolution of multiple sclerosis (MS) is highly variable. Predicting this evolution at the beginning of the disease will help in the therapeutic management. The objective of this study was to describe the clinical characteristics and to identify early predictors of long-term disability among MS patients in Algeria. Methods We performed a descriptive and retrospective study of 400 MS patients followed over a 4-years period from July 2012 to July 2016 in the neurology department of Mustapha Bacha hospital in Algiers. The following parameters were systematically assessed for each patient: Age at onset, gender, relapses, initial demyelinating event, interval between first and second attack, residual deficit after first attack, onset of the progressive course, time of assignment of the successive scores of irreversible disability and type of disease modifying therapies. Univariate and multivariate Cox models were used to determine factors influencing time to Expanded Disability Status Scale (EDSS) 4 and 6. Results During the follow-up of this cohort of MS patients, a total of 144 (36%) and 83 (20%) patients reached EDSS scores 4 and 6 respectively. The median times from the onset of MS to assignment of a score 4 and 6 was 10 years and 19 years, respectively. Using the MSSS severity score, and after univariate analysis we identified several risk factors predictive of disease severity. These included male sex (P= 0.002), age of onset ≥ 40 years (P= 0.001), pyramidal (P= 0.0001), cerebellar (P= 0.002), and poly-symptomatic (P=0.0001) onset of the disease, incomplete recovery after the first attack (P= 0.0001), a high number of attacks during the first 2 years (P= 0.04) and the progressive form (P=0.001), and all these factors were correlated with a high MSSS score. However, prognostic factors in the multivariate binomial logistic regression analysis were limited to pyramidal onset, incomplete recovery after the first attack, short interval between the first and second attack, and progressive onset. Conclusion On the whole, the early predictive factors of disability in MS among Algerian patients were age of onset over 40 years, pyramidal onset, incomplete recovery after the first attack, short interval between the first and second attack and progressive form at onset. To increase the generalizability of findings, a national MS registry is strongly recommended, as well as long-term follow-up epidemiological studies.
Apr 2023 DOI 10.14302/issn.2576-9383.jhhr-22-4259
Asthma is a chronic disease of airways; that is widely characterized by an increased responsiveness to a large variety of stimuli, airway inflammation and obstruction. It is the most common respiratory disorder disease in developed and developing countries. The study was aimed to assess the factors that contribute for the cause of asthma disease in Ambo town and cross-sectional survey was conducted to gather information from March to April 2022. 30 respondents were selected using purposive sampling technique for interview and data collections. According to the study the more affected age group were 22-32(53%) and the major risk factor for the disease was air pollution (53%). The pollution is due to domestic wastes that are discharged to the environment. Therefore, the government and extension health workers should aware the community about the risk factors of asthma and proper waste disposal mechanisms.
Mar 2023 DOI 10.14302/issn.2474-3585.jpmc-23-4442
Objective Women have continued to bear a heavy burden of cardiovascular disease morbidity and mortality with hypertension as the flagship. This is partly because as the modifiable cardiovascular disease risk factors are falling in rate, gender specific risk factors have persisted. One of them is age at first pregnancy and delivery. Methods In order to contribute to this discourse, we secondarily analysed data generated in a previous field study on risk factors for cardiovascular diseases in free living adults in Plateau State, Nigeria. The women were divided into four groups and we looked at blood pressure at the time of study from the perspective of age at first pregnancy. Reults It was found that those who had their first pregnancy in the late teenage years had the lowest mean arterial blood pressure many years down the line; better than those who started child bearing earlier and those who started later. There was also significant within and between group differences in the blood pressures (p = 0.000). Conclusion To stem the tide of female hypertension later in life, child bearing should not start in the early teenage years nor be unnecessarily delayed. Sociocultural conditions that promote early teenage marriage and pregnancy should be discouraged.
Jan 2023 DOI 10.14302/issn.2329-9487.jhc-22-4362
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.
Sep 2022 DOI 10.14302/issn.2329-9487.jhc-22-4252
Background Prevalence of coronary artery disease is between 7-13 percent in urban and 2-7 % in rural India1. The alarm in rise in the prevalence of coronary risk factors like diabetes, hypertension, dyslipidemia, smoking, central obesity and physical inactivity2. The correlation between these risk factors and the severity of coronary atherosclerosis, assessed by angiography which may be either single or multivessel is less consistent with studies reporting conflicting results 3,4. Therefore our study aims to understand the proper correlation between risk factors and severity of coronary artery disease in an Indian population Methods This study was conducted in the department of cardiology, NIMS hospital Hyderabad which receives patients from the urban as well as rural areas of Telangana. the patients admitted in the department of cardiology, NIMS hospital Hyderabad that presented with acute coronary syndromes and diagnosed to have coronary artery disease (single vessel/multivessel disease) on coronary angiography taken for study. Sample Size is 150 Results Among the 150 subjects, males were 111(74%) and females were 39(26%). Mean age of the study population is 55.2 ± 11.4. Among SVD group 73.65% were males &26.3% were females. Among MVD group 76.2% were males & 23.7% were females. Mean age for SVD was 53±14.4 years, while mean age foe MVD was 58.6±14.5 years. For ACS mean age of presentation for females is 60.7±11.4 and for males mean age of presentation is 55.1±12.6. MVD (57.2%) were more common among smokers than SVD. In <45 years age group SVD (69.2%) were more common than MVD (30.8%). In 45- 70 years age group and >70 years age group MVD were more common than SVD with 69.6% and 66.6% respectively, which is statistically significant. MVD (60%) were more common among hypertensives than SVD. Among non-hypertensives MVD (41.8%) was less common than SVD (58.2%) MVD was common among all age groups, which is statistically signicant. Among STEMI group SVD (58.3%) was more common than MVD (41.7%). Among NSTEMI group MVD (62%) was more common than SVD (38%).Correlation between groups was statistically significant. Among SVD study group, LVEF was commonly between 30-45% & very few with LVEF <30% MVD was associated with more severe LV dysfunction as compared to SVD in acute MI. The difference in ejection fraction between the two groups was statistically significant P value=0.0002. In hospital MACE Among SVD there was 1 MI (due to stent thrombosis) who had to TVR (primary PCI) & rest were asymptomatic and discharged in normal state MVD there were in hospital deaths (due to refractory cardiogenic shock) rest were asymptomatic and were discharged in normal state. This difference between the two groups was statistically insignificant. Conclusion Multivessel disease in ACS were seen more commonly among elderly as compared to young subjects where single vessel disease were more common. Females especially elderly more commonly have multivessel disease. Mean age for multivessel disease was higher than single vessel disease. Among <45 years age group, SVD was more prevalent among smokers, obese and physically active. Multi vessel disease is more prevalent among patients with risk factors like diabetes, hypertension, dyslipidemia and physically inactive. Subjects with family history of premature CAD presented early and correlated well with prevalence of SVD.NSTEMI presented more with multi vessel disease. In echocardiographic wall motion analysis, a depressed regional segment of infarcted area with remote hyperkinesis predicted SVD where as remote area hypokinesis predicts more multivessel disease. In hospital outcomes were seen among multi vessel disease as compared to single vessel disease although not statistically significant.
Aug 2022 DOI 10.14302/issn.2641-4538.jphi-22-4245
This study investigated the healthcare provider’s knowledge and attitudes towards induced abortion in Rwanda. A total of 152 healthcare providers from six public hospitals in Kigali city participated in this study. Questionnaires were used to record data on demographics, level of knowledge and attitudes towards abortion law then be cleaned, coded and entered into Excel sheet. Then all data were exported into SPSS version 22 for final cleaning and analysis. The study findings revealed that 54.6% were female, 56.0% were single, and 73% participants said that they attended formal training on abortion care. The study findings revealed that 23.70% healthcare providers had poor knowledge towards legal abortion law, and 57.20% had positive attitude with regards to induced abortion law. The findings revealed that religion and formal training on abortion care were among the factors which were strongly influencing attitudes of health care providers towards induced abortion where protestants were unlikely to have positive attitude with regards to induced abortion (AOR=0.277; 95% CI=0.027-0.377; P=<0.001) compared to participants belonged to catholic religion and participants who were not trained were unlikely to have positive attitude with regards to induced abortion (AOR=0.696; 95% CI=0.056-0.721; P=0.048) compared to trained respondents. It concludes that marital status, category of caregiver, religion, formal training on abortion and level of knowledge were the main risk factors of level of attitude towards induced abortion. More training about induced abortion are highly needed among health care providers to increase related knowledge as well as to eliminate negative attitude towards induced abortion.
Mar 2022 DOI 10.14302/issn.2572-3030.jcgb-22-4121
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.
Feb 2022 DOI 10.14302/issn.2329-9487.jhc-22-4067
Introduction Congenital Heart Defects (CHDs) are structural abnormalities of the heart and intra-thoracic great vessels that are present at birth and may be of functional significance. They are the most frequently occurring congenital anomalies and babies born with severe forms of these defects are likely to die in the neonatal period. Objectives The aim of this study was to determine the prevalence of CHDs among neonates delivered in Port Harcourt, Rivers State, Nigeria Methods Using a stratified sampling technique, 530 neonates were selected from three hospitals in Port Harcourt. The biodata of the parents and socio-demographic information were obtained through an interviewer-administered questionnaire to the mothers. Physical examination and echocardiograghy were performed on all the neonates. Results Five hundred and thirty (530) neonates aged 0-7days (5.2±1.8) participated in this study and the male to female ratio was 1.1:1. Forty-three neonates were found to have CHD giving a prevalence of 8.1% 95%CI: 6.0. Thirty-nine were acyanotic and four cyanotic. Congenital Heart Defects were found in 21 (48.8%) males and 22 (51.2%) females. The more common heart defects were isolated Atrial Septal Defect in 16(37.2%), isolated Patent Ductus Arteriosus in 11(25.6%) and isolated Ventricular Septal Defect in 6 (13.9%). The most common cyanotic CHD was Transposition of the Great Arteries in 2 neonates (4.7%). The clinical features identified in neonates with CHD were tachypnoea, dysmorphia, cyanosis, hypoxia and murmur Conclusion The prevalence of CHD is considerably high in Port Harcourt and further studies need to be carried out to ascertain the risk factors.
Mar 2021 DOI 10.14302/issn.2329-9487.jhc-21-3742
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.
Mar 2021 DOI 10.14302/issn.2474-3585.jpmc-20-3557
Background Breast cancer is one of the most common types of cancer affecting women globally. It has shown increasing morbidity and mortality rates over the past years. Several screening methods ranging from simple breast self-examination to a highly sensitive test procedures for early detection and treatment are available, but uptake is a challenge. Lack of a national screening programme in the country makes available regional screening programme unsuccessful. This study aims to assess the factors affecting the uptake of breast cancer screening programme among female staff in a tertiary hospital, Southwest Nigeria. Method This descriptive cross-sectional study involves 375 participants selected by a stratified random sampling technique, with proportional allocation to population size and the use of a semi-structured questionnaire. Respondents were questioned on their basic knowledge of breast cancer symptoms, risk factors and treatment, over a score of 50 and above, were set as the cut-off mark to determine good knowledge of breast cancer. Patients attitudes towards breast cancer screening as well as factors affecting uptake were also measured. Descriptive statistical analysis was done using SPSS-20 while the predictors of the uptake of screening were determined using logistic regression at p ≤ 0.05. Results There were 360 respondents, comprising of 13.3% clinical and 86.7% non-clinical female staff within the age bracket of 20 to 58 years (38.2±0.42 years). Out of the respondents, 97.8% have heard about breast cancer but only 52.3% had been screened while 65.5% had “Good knowledge” of breast cancer. Positive attitude to breast cancer screening was displayed in 52.5% while over 90% claimed to be practicing breast self-examination. Only 36.1% of respondents above 40 years old have had mammography done. Most frequent barriers to screening uptake include cost, poor accessibility to screening facilities, shyness (unfamiliar screener), unavailability of female doctors, careless attitude, fear of cancer and other more pressing family problems. Using logistic Regression at p ≤ 0.05, females with a negative attitude, young unmarried (less than 30years) and lack of easy accessibility to screening facilities were significant factors affecting uptake of breast cancer screening services. Conclusion Due to knowledge-uptake gap of breast cancer screening revealed in this study. It is therefore obvious from these findings that a concerted effort is needed to actively remove these barriers by repeated education, training and re-training strategies among health workers and to improve their uptake and level of advocacy and campaign for breast cancer screening among their patients and clients.
Feb 2021
Introduction Risk reduction intervention is meant to provide enhanced and desirable interventions for HIV prevention among adolescents especially the in-school. Adolescents have been identified as the most vulnerable groups that can easily acquire human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). Therefore, adolescents are the appropriate target for HIV prevention efforts. Most interventions for adolescents focus on providing AIDS-related education with the assumption that improving knowledge would enable adolescents to protect themselves from sexually transmitted infections. Numerous studies have shown that using class-room education alone is insufficient in reducing adolescents’ risky sexual behaviours. Therefore, this study used role-plays and peer facilitation for the study. Materials and Method The study used role-play and peer facilitation for the intervention strategy. The theme of the role-play was ‘My Future is My Choice’ (MFMC) intervention which was aimed to reduce HIV risk behaviours among sexually inexperienced adolescents. The role-play was carried out by 4 peer leaders who were trained in the theoretical framework of role-plays and peer facilitation by a consultant. With mastery and experience they carried out the role play in a regular classroom section for over 3 class periods, co-facilitated with the assistance of a volunteer teacher. A unique feature of this intervention was the dual focus on strategies that influenced both individual risk factors (i.e., attitudes, behavioural skills) and social environments (e.g., peer resources). A school was chosen by simple random sampling for the intervention. In the school chosen, a total sample of 65 students in senior secondary classes 2&3 ( SS2&3) were included in the study. These were the students considered to be sexually active who can respond to the questions in the questionnaire. Self-administered pre-and post-questionnaire were completed by the students. The results were analysed using frequency tables, descriptive and inferential statistics. Results The students studied were between the ages of 13-18 years. There was evidence that the role play ‘My Future is My Choice’ (MFMC) intervention created positive effects on reduction of HIV risk behaviours among the sexually inexperienced participants aged 13–18. Perceptions on methods of preventing risk reduction behaviours were also positively impacted by the intervention as 12(18.5%) and 34(52.3 %) of the respondents realized after post- intervention that having sex with someone outside marriage and being transfused with infected blood respectively Will constitute risk to HIV infection. Conclusion The role play which used the theme ‘My Future is My Choice’ (MFMC) intervention provided safer choices for reducing one or more measures of sexual risk behaviours among the sexual inexperienced respondents. It created the opportunity for the students to recognize that engaging in unprotected sex constitutes high risk for HIV, other sexually transmitted infections and pregnancy.
Dec 2020 DOI 10.14302/issn.2578-2371.jslr-20-3362
Background and Aim Gallbladder (GB) cancer is a highly fatal malignancy and approx. 10% new cases are diagnosed every year in India. The GB cancer has poor prognosis due to progressive nature. Understanding of risk factors that lead to GB development is urgently required for better management of the disease. Presence of stones in gall bladder generates varied mucosal reactions, which leads to different types of histopathological changes in mucosa. Here, our aim is to study the correlation between various types of mucosal responses e. g. inflammation, hyperplasia, metaplasia and carcinoma with different characteristics e. g. number and morphology of gallstones both in males and females. Materials and Methods A retrospective study of gallstones was performed on 438 cases of cholecystectomies operated laparoscopically based on the histological changes. Out of 438 cases, 394 (89.95%) were associated with gallstones and the rest 44 (10.05%) belonged to acalculous cholecystitis. The mucosal changes in calculous gall bladder were studied in 394 cases and its correlation with number and types of observed gallstones were evaluated. Tissue sections were taken from the fundus, body, neck and abnormal area of gallbladder for histopathological studies. Results Our study has revealed the higher incidence of inflammatory changes in males, while gall bladder hyperplasia, intestinal metaplasia and cancer cases were found mostly in females. Conclusion Our study showed that changes in the number and morphology of gallstones are directly associated with the mucosal changes in gallbladder e.g. inflammation, hyperplasia, metaplasia and gall bladder carcinoma.
Oct 2020 DOI 10.14302/issn.2641-4538.jphi-19-3115
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.
Aug 2020 DOI 10.14302/issn.2474-7785.jarh-20-3495
Hip fractures, which remain highly prevalent among the elderly and produce enormous social and economic costs, have not truly abated in prevalence despite years of research that outlines a multitude of preventable risk factors and intervention programs. This review aimed to examine if sleep disturbances have a bearing on the risk of incurring a hip fracture directly or indirectly, among older adults. The specific aim was to explore and summarize what we know, and how this might inform future research and practice. To this end, PUBMED, Web of Science, Scopus, and Google Scholar data bases were searched to uncover available data representing the topic of sleep in relation to hip fractures among the elderly. Articles of note were scrutinized and summarized in narrative form. Results showed very few studies on the topic prevail, even with no restriction on years examined, and of these, discordant, rather than any solid uniform conclusions prevail. It is concluded there is a need to explore this topic carefully, including both the direct, as well as the indirect impact of sleep that may place an older adult at heightened risk for a fall and hip fracture injury as well as subsequent fractures.
Apr 2020 DOI 10.14302/issn.2691-5014.jphn-20-3295
This review catalogs clinical landmarks of COVID‑19 across newborns, children, and adolescents, including MIS‑C, risk factors, and considerations for vaccination and school policies.
Jan 2020
A brief educational piece clarifies open‑angle versus angle‑closure glaucoma mechanisms, risk factors, and screening considerations. It provides practical pointers for early detection and referral.
Aug 2019 DOI 10.14302/issn.2574-450X.jom-19-2987
Introduction It has been demonstrated that vitamin D deficiency is associated with type 2 diabetes mellitus (T2DM). We conducted a cross sectional study to investigate the prevalence severe vitamin D deficiency in patients with T2DM. Method A cross-sectional single centre study was conducted in 4053 patients with T2DM. Patients with T2DM attended the Diabetes Centre at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia between January 2018 and December 2018 were recruited. Results There were 4053 patients with T2DM, 1145 male and 2908 female (28 % vs.72% respectively). The mean age was 53.9 ±16.5 years. The mean and median 25-OHD concentrations were 57.8±30.5 and 51.9 respectively. Severe vitamin D deficiency (25-OHD<25 nmol/l) was found in 1916 (9.5%). Moreover, severe vitamin D deficiency was not statistically significant more prevalent among females than males with male to female ratio 1:2.3 (70% vs. 30% respectively, p=0.6). In addition, severe vitamin D deficient patients were statistically significant younger than non-vitamin D deficient (48.0±16.7 vs. 54.6±16.3 respectively, p<0.0001). Severe vitamin D deficient patients have statistically significant higher HbA1c than non-vitamin D deficient (8.3 ±2.3 vs. 7.6±1.9 respectively, p<0.0001). The mean 25-OHD was upward as age advanced with highest frequency of vitamin D deficiency was found in the age group ≥60 years (27%) with males statistically significant most frequent than females in the age group ≥60 years (39 s, 22 respectively, p=0.003). Regression analysis of odd ratio of risk factors for patients with severe vitamin D deficiency showed that age and HbA1c were statistically significant associated with vitamin D deficiency. Conclusions The prevalence of severe vitamin D deficiency in patients with T2DM is low and that more females with T2DM are affected with vitamin D deficiency than males.
Aug 2019
Objective Antisocial behavior (ASB) in children and youth is public health problem in Georgia. Nevertheless, there has been no systematic study the risk factors for ASB that could counteract on ASB development. To prevent ASB development and acceleration the understanding of biological (assessment of Brain morphology using MRI) and psychological (assessment using Freiburg Personality Inventory) risk factors is critical. This was the aim of this study. Method The children/youth with ASB tendency (AST) were identified by the Freiburg Personality Inventory (FBI). The biological and psychosocial factors contributing to AST were evaluated using a semi-structured clinical interview. Brain anatomy and morphology was studied using magnetic resonance imaging (MRI). Results Children/youth with AST had significant abnormalities in most axial elements of the DSM multi-axial system but not in brain anatomy measured by MRI. Conclusion Early identification of ASB tendencies and a provide correlationship between specific psychiatric, medical and family stress factors will likely reduce the number of children/youth with ASB and will promote their integration into society.
Jul 2019 DOI 10.14302/issn.2694-2283.jsem-19-2938
An anterior cruciate ligament (ACL) injury is an important cause of rest in athletes. In most cases, ACL injuries do not require external contact and they are associated with biomechanical risk factors that increase ACL tension. The increase of the hip flexion angle (HF) is included within these. The ACL requires cooperation of the periarticular musculature of the knee, muscle groups, hip stabilizers and CORE muscles; consequently, fatigue caused by exercise would alter the balance and put this ligament at risk. The objective of the study is to determine the angular behavior for HF before and after a physical load (a standardized training) in children between 11 and 12 years old. A non-randomized clinical study was carried out. The sample consisted of 50 soccer school students born between 11 and 12 years old. The angular behavior of HF was compared before and after performing a training session. The angular behavior was measured through the Drop Jump test (DJ), with data obtained by inertial sensors. After the exercise, there was a significant increase in HF. It was concluded that the angular behavior of HF increases significantly in both extremities after training and that preventive measures must be applied for neuromuscular control of the hip.
Jul 2019 DOI 10.14302/issn.2694-2283.jsem-19-2949
Background The Anterior Cruciate Ligament (ACL) injury is uncommon, but constitutes an important percentage of the lesions requiring more than 8 weeks of recovery in sports. Most ACL injuries do not require external contact and are associated with biomechanical risk factors that stress this ligament ACL: like an increase in knee valgus angle (KV) and hip flexion (HF) and a decreased in knee flexion (KF). The ACL requires muscle cooperation to resist the load; however, when there is fatigue, the protective capacity of the musculature would decrease. The objective of the study is to analyze the angular behavior before and after a physical load for HF in children of 14-15 years old. Hypothesis The physical load applied in a single training session is enough to change some biomechanical risk factors of ACL injury. Study Design Experimental study Level of Evidence 2b Methods The sample consisted of 50 students from different soccer schools between 14-15 years old. We analyzed the hip angular behavior of hip flexion before and after a training session. The angles where obtained from inertioal sensor while the students performed a Drop Jump test from a 30 centimeters drawer. Results Statistically significant differences were found in the differences between pre physical load HF / post-load HF (p = 0.00053), right pre physical load HF / right post- load HF (p = 0.0086) and left post- load (p = 0.0248206). Conclusions It was concluded that the angular behavior of HF increases significantly in both post-training limbs, after performing a physical load. Clinical Relevance This study analyzed the importance of using prevention injury programs since early stages, and give importance to the eccentric role of hamstring, gluteus and core exercises.
Apr 2019 DOI 10.14302/issn.2329-9487.jhc-19-2714
Progressive increase of cardiovascular disease (CVD), with a rising costs for the society, is driving to focus on risk’s factors reduction. The importance to prevent acute events and to reduce mortality and morbility have risen the sound of the correct life style indications as the primary approach for hypertension. The new classification of hypertension has amplified an high-value of the role of the physical activity especially in the initial phase of the disease when the potential positive impact of the regular physical activity can permit to avoid the use of the pharmacological treatment. The numbers of the hypertensive subjects is increasing everywhere; however the awareness of the presence of the disease is not so frequent. Although some risk factors, such as age and hereditary factors cannot be changed, on the contrary lifestyle’s modification can prevent the CVD and hypertension. Sports Medicine physicians agree that healthcare providers need to focus on preventive and lifestyle aspects of cardiovascular care to promote individual and population health. A dedicated approach to prescribe the amount of weekly physical activity at moderate intensity can allow to control the blood pressure values avoiding the assumption of antihypertensive drugs. Aerobic and resistance exercises need to be individually established by dedicated models tailored on the basis of the specific characteristics of the people involved. Sports and Exercise Medicine can contributes to manage and to tailor the amount of programmed physical activity starting from the ”exercise prescription” guidelines.
Apr 2019 DOI 10.14302/issn.2379-7835.ijn-19-2579
Objective Postmenopausal women are at an increased risk of Cardiovascular Disease. We aimed to investigate whether this risk differed between individuals with a naturally occurring and other reasons for menopause within a large population-based Iranian sample. Study Design A total number of 1763 postmenopausal women (defined by amenorrhea for more than a year, or FSH > 30-40 mIU/ml), 900 of them with a natural menopause and 863 of them with other reasons for menopause caused by (hysterectomy without oophorectomy or one side oophorectomy, hysterectomy with oophorectomy or two side oophorectomy without hysterectomy) were recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study. Biochemical and hematological risk factors were measured in all the subjects and the data were analyzed by SPSS software version 20 Results There was a significant difference in the presence of cardiovascular disease in the natural menopause group compared with other reasons for menopause group (p<0.05). There was also a meaningful difference between the prevalence of depression and anxiety in the natural menopause individuals compared with other reasons for menopause group (p<0.05). Discussion High prevalence of CVD, depression and anxiety in other reasons in menopause women were observed among Mashhad urban females. It should be considered as a noticeable message. Furthermore, studies are necessary to determine different parameters between evaluating CVD, depression and anxiety among menopauses women.
Feb 2019
Objectives This study was designed to assess the demographic characteristics, prevalence of metabolic syndrome (MetSy) among patients with schizophrenia in Saudi Arabia. Methods This is a disease-oriented and observational study. Schizophrenia was defined by DSM-IV criteria. MetSy were assessed based on the international criteria (NCEP-ATP III and AHA/NHLB). Results 90% of the participants are without a university degree and 56.4% are single. Chronic and acute cases of schizophrenia were 95% and 5%, respectively. The treatment of schizophrenia was combination therapy and monotherapy with percentages of 56% and 44%, respectively. Systolic and diastolic blood pressures were 121.92±11.07 mmHg and 77.29±0.45 mmHg, respectively. Surprisingly, all patients have abnormal HDL. A mean waist circumference of 90.23±14.88 cm for men, and 93.38±15.28 cm for women. The analysis of 101 patients showed a prevalence of the MetSy is 15.8%. Chi-square test of independence showed lack of independency of MetSy on type of therapy. Modeling of MetSy and risk factors was also conducted. Conclusion The metabolic syndrome is greatly established among schizophrenic patients. It signifies a vital hazard for metabolic and cardiovascular ailments. Evaluation of the incidence and examining of the related threats of the metabolic syndrome should be an element of the clinical managing of patients cured with antipsychotics.
Jan 2019 DOI 10.14302/issn.2691-5014.jphn-18-2456
Vitamin D, the sunshine vitamin, is now recognized not only for its importance in promoting bone health in children and adults, but also for its other health benefits, including reducing the risk of chronic diseases such as autoimmune diseases, common cancer, and cardiovascular diseases. Ultraviolet radiation of the sun with wavelengths of 290-310 nm penetrates into the skin and converts 7-dehydrocholesterol to previtamin D3, which quickly transforms to vitamin D3. Vitamin D (D represents either D2 or D3) made in the skin or ingested through diet is biologically inert and requires two successive hydroxylations first in the liver on carbon 25 to form 25-hydroxyvitamin D 25(OH)D and then in the kidney for a hydroxylation on carbon 1 to form the biologically active form of vitamin D, 1,25-dihydroxyvitamin D (1,25(OH)2D) 121419. The concentration of the produced 25-hydroxy vitamin D in blood circulation is 1,000 times more than 1,25-dihydroxy vitamin D 4, and it is regarded as a standard indicator of vitamin D status in humans 3. 25-hydroxy vitamin D half-life is about 2-3 weeks and it is regulated by calcium (Ca), phosphorus (P), and serum parathyroid hormone (PTH) to some extent. 25-hydroxy vitamin D content also reflects the amount of vitamin D produced in the skin after exposure to sunlight or received through food intake 56. Guidelines for vitamin D insufficiency/deficiency defined by serum 25(OH)D concentrations have been published from many countries and regions all over the world 7891011. Vitamin D deficiency is a pandemic problem. According to global estimations, more than one billion people around the world suffer from vitamin D deficiency. Among Iranian population, the incidence of vitamin D deficiency varies from 2.5 to 98.5% based on geographic area 1213. Various factors may give rise to vitamin D deficiency, including skin pigments, low levels of vitamin D in diet (insufficient fish oil and egg yolk intake), malnutrition, genetic factors, exclusive breast feeding, vitamin D deficiency of mother during pregnancy, prematurity, chronic use of drugs (e.g., anticonvulsants, aluminum-containing anti-acids, rifampcin, isoniazid, antifungal drugs, antiviral drugs, and glucocorticoids), winter and obesity 113. Cultural habits, the need for full body coverage during outdoor activities and the lack of sunlight programs are the risk factors for low vitamin D levels in women 151617. Children enter foster care due to early childhood adverse experiences such as poor prenatal and infant health care, food insecurity, chronic stress, and the effects of abuse and neglect. As a result, they are at higher risk for poor physical, psychological, neuroendocrine and neurocognitive outcomes compared to others. Foster children are at risk for growth and nutritional deficiencies due to their poor nutritional environment prior to placement in foster care. Insufficient caloric intake results in growth deficiencies. Evidence showed that the risk of stunting and underweight is high in this population 18. The risk of developing hypovitaminosis D was significantly higher in children living in foster homes. One reason is that they are at higher risk of child abuse, emotional deprivation and physical neglect than children living with their families. Moreover, these children most likely do not spend much time outdoors and they lack adequate sun exposure. Another reason is that as children grow up in institutional care, they shift from a diet of vitamin D–fortified formula milk to cooked food, which may not be fortified with vitamin D 1. Iranian government has made some efforts to apply efficient interventions to reduce the prevalence of vitamin D deficiency, and the country’s healthcare system should be managed through accurate planning. Yet, in this country, studies on vitamin D deficiency in children living in foster homes are very limited, and given that timely diagnosis and treatment of this deficiency is vital, this research is conducted in Ali Asghar foster home in Mashhad, Iran.
Sep 2018
Epilepsy comprises a series of chronic neurological disorders characterized by recurrent seizures. Over 50 million people are affected by epilepsy worldwide. In addition, genetic components capable of predicting epilepsy predisposition and antiepileptic drugs response would lead to the development of promising treatment and a better prognosis of the disease. Several genes and their variants have been investigated whether they could affect the onset of epilepsy. The brain-derived neurotrophic factor gene, the ATP-binding cassette subfamily B member and the cytochrome P450 are the most common polymorphic genes related to epilepsy. Early identification of risk factors for epilepsy should optimize treatment and prognosis. The characterization of genetic polymorphism contribute to the selection of the most promising antiepileptic therapy and avoidance of drug resistance. The development of biomarkers to estimate the risk of epilepsy and drug resistance would have a clinical impact on the treatment of the disease and on anti-epileptic drug therapy.
Aug 2018
The present study was designed to examine differences among cancer patients who died by medical/natural causes or by suicide. This study aims to identify protective and risk factors for suicide in individuals who have been diagnosed with cancer. Unlike previous studies that examined suicidality in cancer patients, our study did not find significant differences between patients with a cancer diagnosis at TOD who died by suicide and those who died by natural or medical causes.
Aug 2018
Background: Co-morbidities are associated with increasing risk of mortality, hospitalizations and costs of treatment in Chronic Obstructive Pulmonary Disease patients. Identification of Co- morbidities related to COPD phenotypes may guide individualized therapies and achieve better prognosis. Methods: A prospective study of one hundred ten patients of confirmed COPD diagnosis were carried out and divided into five different phenotypes with related co-morbidities. History taking, clinical examination, Chest X-ray, Computed chest Tomography, laboratory investigations, arterial blood gas, Echocardiography and Electrocardiography were done for all patients. St. George’s Respiratory Questionnaire, COPD assessment test (CAT score) and BODEx (BMI, FEV1, dyspnea and exacerbations) were used for assessment of disease impact on quality of life, severity, and exacerbation respectively. Results: Emphysema group were 31% among all cases with mean age 61.8±9.1, frequent exacerbator group and Chronic bronchitis phenotype were 18% with mean age 64.4±11.3, and 48.8±9 respectively. COPD with bronchiectasis group were 19% with mean age 60.3±6 and Asthma COPD Overlap Syndrome (ACOS) were 12% with mean age 62.8±15.8. There was significant difference as regards age between different group of phenotypes P- value <0.001. There was significance difference in BODEx index and in (CAT) score among different COPD phenotypes P-value 0.020, 0.001 respectively. There was significant difference in all items of SGRQ among different COPD phenotypes P–value 0.001. Diabetes was commonly presented in 50 % ACOS cases, Ischemic heart disease was present more in Emphysema 22.9%, Osteoporosis was more in COPD with bronchiectasis 28.6%, Cor-pulmonale was more present in frequent excerbator 65%, and Anemia more common in COPD with bronchiectasis 23.8%. Depression was more common in frequent excerbator phenotype (45.0 %). Gastro-esophageal reflux was the most common co-morbidities (58 %) then cor-pulmonale 41.8%, systemic hypertension 40 % and pulmonary hypertension 28%. Conclusion: The presence of significant co-morbidities is important modifying risk factors for severity in COPD. They contribute to the overall severity in individual patients, have a major impact on quality of life, and major causes of hospitalization. Co-morbidities can be associated with any clinical phenotype.
Aug 2018 DOI 10.14302/issn-2470-0436.jos-18-2222
Objective: The aim of the present study is to determine the efficiency of third year ophthalmology residents from a tertiary hospital in performing preliminary retinal examination to identify eyes at risk retinopathy of prematurity on the basis of retinal fundus findings up to International Classification of Retinopathy of Prematurity (ICROP) Zone II. Methods: This is a single-center, cross-sectional, prospective comparative research conducted from June to October 2015 at a tertiary training hospital in the Philippines. All infants referred for retinopathy of prematurity screening within the study period where included. The presence of retinal vessel dilatation and tortuosity were identified by third year ophthalmology residents using indirect funduscopy. The residents’ fundus findings were then compared to that of a retina consultant who is proficient in the diagnosis and management of retinopathy of prematurity (ROP). The Kappa index was used to rate inter-observer agreement. The correlation between ROP risk factors and the presence of abnormal retinal vessels were assessed using odd ratio computations. Fisher’s exact test was used to determine the correlation between retinopathy of prematurity and the presence of retinal dilatation and tortuosity. The McNemar’s test was also applied to determine significant differences in the retinal findings of the consultant and ophthalmology residents. Results: A total of 82 eyes of 41 premature infants were evaluated to determine if retinal findings observed by ophthalmology residents were comparable to that of a retina consultant. Odds ratios show that age of gestation, birth weight, and history of blood transfusion are significantly associated with the presence of retinopathy of prematurity. Retinal vessel tortuosity and dilatation are also more common among infants diagnosed with retinopathy of prematurity. There was no significant difference between the retinal vascular findings of the retina consultant and the third year ophthalmology resident in terms of identifying retinal vessel dilatation and tortuosity (P < 0.05). Conclusion: After sufficient and in-depth ophthalmology training, third year ophthalmologists, who will be general ophthalmologists in the future, can reliably identify eyes at risk for severe retinopathy of prematurity on the basis of retinal vascular dilatation and/or tortuosity.
Jun 2018 DOI 10.14302/issn.2372-6601.jhor-18-2139
Pulmonary hypertension (PH) has become an increasingly recognized complication in sickle cell anaemia (SCA) and is a major cause of morbidity and mortality. Though the burden of SCA in sub-Saharan Africa is high, there is paucity of data on SCA-associated PH with little or no attention given to it in routine patient care. The current study therefore sought to determine the prevalence of PH and its associated risk factors among adult patients with SCA. This was a cross-sectional study involving 76 clinically stable, hydroxyurea-naive participants. We obtained socio-demographic and clinical history. Measurement of Tricuspid Regurgitant jet Velocity (TRV) was obtained via transthoracic echocardiography and lung function was assessed using spirometry and pulse oximetry. Other investigations were complete blood counts, free plasma haemoglobin, serum urea and creatinine. Twenty-five (32.9%) of study participants had elevated TRV (≥ 2.5m/s) on Doppler echocardiography, which was suggestive of raised pulmonary artery systolic pressure. There were significant associations between elevated TRV and steady-state haemoglobin (p < 0.001), blood urea level (p = 0.030), presence of chronic leg ulcers (p = 0.043) and oxygen saturation (p < 0.001) and these may be identifiable and modifiable risk factors for selective screening with echocardiography in a resource poor setting.
May 2018 DOI 10.14302/issn.2474-3585.jpmc-18-2059
Extant epidemiological and social diagnosis information shows an alarming upsurge in the prevalence of overweight and obesity over the last decade in developing countries including Ghana. Despite literature on the dangers and associated risk factors of these two health related constructs is well-written and documented, there seems to be a distinct knowledge gap on cultural influences that may trigger the onset of overweight and obesity, and related comorbidities. This review paper provides a general overview on overweight and obesity, and presents a supportive evidence of their rising prevalence as well as associated overall implications on public health in Ghana. Additionally, the paper explores how indigenous cultural perceptions, beliefs and norms impact on dietary and physical activity behaviours of the people. Based on available evidence, the complementary role of behaviour modification towards the management of overweight and obesity is suggested. The PEN-3 model as an appropriate cultural framework is proposed for future empirical investigations. This would afford programme planners to assess how to design culturally underpinned appropriate intervention programmes that would positively influence long term behavioural practices of the local people.
May 2018 DOI 10.14302/issn.2381-862X.jwrh-18-2074
Objective: To determine the prevalence and risk factors of non-fistulous urinary incontinence (UI) among non-parturient women at University College Hospital, Ibadan, Nigeria. Methods: A hospital based cross sectional study of 500 non-parturient women presenting with non- fistulous gynaecological symptoms at the University College Hospital, Ibadan. An interviewer administered questionnaire was used to obtain information. Data were analyzed using SPSS version 20. Data analysis involved descriptive statistics, bivariate and multivariate analysis to determine the risk factors of urinary incontinence. Results: Mean age was 36.61 (SD=10.1) years and almost all (83.2%) were married. Prevalence of urinary incontinence is 21.4%. Majority (40.6%) had symptoms of stress urinary incontinence and 8.0% had urge urinary incontinence. Only 19.6% of those who leaked urine in the last one month sought medical attention despite visiting the hospital for other ailment(s), while of those that had ever leaked urine, 13.1% of them ever sought medical attention. Risk factors for UI were age at first delivery (OR=21.21, 95%CI=2.179-206.478), marital status (OR=0.142, 95%CI=0.044-0.454), chronic illness (OR=3.987, 95%CI=2.147-7.405) and history of prolonged labour (OR=3.111, 95%CI=1.584-6.110). Conclusion: UI is not uncommon in Nigeria. The identified predisposing factors were low age at first delivery, history of prolonged labour and chronic illness. There is need to sensitize women of the symptoms and complications associated with urinary incontinence as well as its prevention and need to seek medical care if they have the symptoms.
Mar 2018
School is a competitive place where people have many duties and responsibilities. This requires coping abilities to manage academic stress efficiently. Objectives a) Determine the general level of stress among high school students; b) identify the students’ main sources of stress; c) identify the students’ main responses to stress; d) determine if students have protections against or risk factors for stress. Materials & Method The stress levels and the main responses to stress of 335 high school students, aged 15–19 years, were surveyed using Nowack’s Stress Profile. Results and Discussion Most of the students reported normal (54%) or lower (39%) stress levels, but women reported significantly higher stress levels than men (p < 0.05). The main sources of stress were examinations, choosing a career path, and family troubles. The students’ main responses to stress were listening to music, talking with someone about the problem, and exercise.
Jan 2018 DOI 10.14302/issn.2474-3585.jpmc-17-1836
Objective: Demographic analysis of intrauterine deaths in North-Eastern Hungary with national and international comparison. Materials and Methods: The authors collected data from the National Bureau of Statistics’ 1996-2014 database to assess frequency, gestational age, maternal age and education for six counties of the region. 722 individual cases were analyzed. A regional survey was initiated to collect more detailed data on living environment in the region between 2010 and 2014 through community midwifery services records. Results: Data over 20 years showed most intrauterine deaths (Perinatal mortality, Late fetal death, Stillbirth] occurred between 24th and 36th weeks of which 35% occurred in the North-Eastern region of Hungary. The causes of intrauterine deaths were placental abruption, cord accident, placental insufficiency, malformations and intrauterine infection. Detailed analysis regarding attendance at either the Obstetricians or the community midwifery services, the patient’s medical history and the patients’ compliance were reported, compliance in 1% completely lacked. Gravidity and multiparity were associated risk factors. A significant proportion was associated with teenage pregnancy, low maternal education, smoking risks, unemployment, dependence on social support, unhygienic environment and smaller accommodations. Lack of cooperation during antenatal care was significant. Conclusion: Frequency and distribution of intrauterine deaths in North-Eastern Hungary show a similar picture as those of socio-economic indices. The unfavorable trend came to an end in 2015, however the national statistics did not show any improvement. The solution to the problem seems to be independent of the service provision, therefore, socio-economic development of affected counties is warranted, and financial incentives and/or government aid provided during pregnancy may improve future perinatal outcomes.
Oct 2017 DOI 10.14302/issn.2381-862X.jwrh-17-1758
Background: The nature of placenta previa can be unpredictable and harsh on the mother and baby. These complications are often unpredictable, unpreventable and often leave the labour ward team in a dilemma. This Obstetricians' nightmare is fortunately a rare complication. The frequency of placenta previa at the time of delivery average 1/200 births i.e. 0.5%. Placenta previa is still an important cause of maternal and fetal death in our country. The risk factors are Advanced Maternal age, Multi parity, Previous Cesarean Section, Multiple gestation, Previous Abortions, Previous intrauterine surgery, placenta previa in previous pregnancy, Smoking. Objective: Identification of risk factors, the feto-maternal outcome and complications of patients having placenta previa with previous caesarean section. Methodology: This cross sectional study was conducted from July 2012 to June 2015 in Obstetrics and Gynaecology department, Dhaka Medical College hospital. 100 patients of placenta previa were included in this study. Non-probability purposive sampling method was used for selection of patients. Results: In this study, Socio-demographic profiles, Identification of risk factors, the feto-maternal outcome and complications of patients having placenta previa were assessed. The frequency of placenta previa associated with previous cesarean section was 61%. In demographic profiles of the patients in this study - with a history of previous caesarean section, 78.7% patients were in the age group 26-35. Multiparity was predominant on scarred uterus group (63.9%). Here, demonstrated that > 2 previous history of caesarean section was associated with 80.3% of placenta previa. Regarding maternal outcome, complications like massive haemorrhage, ureteral injury, bladder injury, wound infection, DIC, maternal and perinatal mortality were more in the scarred patients than in the unscarred patients. In our study, 29.5% of morbid adhesion of placenta observed in scarred uterus. Conclusions: There is significant association of placenta previa with previous cesarean delivery. So, Careful monitoring of high risk pregnancies is of utmost importance. Avoidance of unnecessary caesarean sections and early week’s pregnancy terminations can minimize the Obstetricians' nightmare.
Aug 2017 DOI 10.14302/issn.2644-1101.jhp-17-1665
Objective: To describe the presence of mental distress in a representative sample of the Surinamese ethnic groups in the population, across urban and rural areas. Design and Methods: The Kessler Psychological Distress Scale was applied to data from the Suriname Health Study (n=5,434 (15 to 65 years)) designed according to WHO Steps guidelines,to determine prevalences for mental distress in all living areas. Calculations were made in subgroups of sex, age, ethnicity, education, income, marital and employment status. The Odds Ratio (OR) for Sex and Ethnicity was estimated for mild-moderate and severe mental distress. Results: An overall prevalence of 3.8% (95%CI, 3.3-4.4) was observed for severe mental distress, 4.9% (95%CI, 4.4-5.5) for moderate mental distress and 10.8% (95%CI,10.0-11.6) for mild mental distress. The OR for mild-moderate and severe mental distress was 0.7 and 0.5 for men compared to women and higher prevalence of all categories of mental distress were found in women compared to men. Respondents with lower education and lower income showed higher prevalence of all categories of mental distress. Prevalence was also higher among respondents living in urban versus rural coastal areas, among singles versus people living with a partner and in unemployed versus employed. Maroons had higher Odds for mild-moderate and severe mental distress compared to Hindustani. Amerindian and Javanese had lower Odds for mild-moderate mental distress and Creole had lower Odds for Severe mental distress compared to Hindustani. Conclusions: Overall 19.5% of respondents reported mental distress. The main risk factors were female gender, Maroon ethnicity, low level of education and income, living in urban areas, unemployment and being single.
Jul 2017 DOI 10.14302/issn.2574-4372.jesr-17-1705
Drug-induced cardiotoxicity is one of the predominant reasons for drug attrition and withdrawals. This is of critical concern when potentially cardiotoxic drugs are administered to individuals with inherited arrhythmogenic cardiac diseases or with metabolic diseases such as obesity and diabetes, which are key risk factors for cardiovascular diseases. Pathophysiological alteration prevalent under such conditions can alter or exacerbate cardiotoxic responses. The growing incidence of obesity, diabetes and metabolic syndrome subject a significant percentage of the population to drug treatments, thereby augmenting their risk for drug-induced cardiovascular toxicity. Hence, screening for drug-induced cardiotoxicity early in the preclinical stages of drug development, by using appropriate human disease models, can be effective in ensuring safety in clinical trials and preventing late stage and post-marketing drug withdrawals owing to cardiotoxicity. The advent of human pluripotent stem cells (hPSC) and induced pluripotent stem cell (iPSC)-derived cardiomyocytes are revolutionizing safety/toxicity screening in human cells by providing relevant human-specific, renewable model systems to explore human drug toxicity. The ability to generate patient-specific iPSCs that can model cardiac diseases, now offers a valuable option that can further improve drug safety assessments and enable a more accurate prediction of toxicity that occurs in the representative population that are prescribed the drugs. Use of appropriate disease models will not only provide cost savings by decreasing potential drug attrition and withdrawals, seen with many drugs, but will also be a promising option to advance precision medicine
Jul 2017 DOI 10.14302/issn.2474-7785.jarh-16-1067
Aim Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in hospital with orthopaedic surgery already an established risk factor. This study aims to establish the length of time that a patient is at risk of sustaining a VTE post orthopaedic surgery. Method A retrospective case series of all patients who underwent orthopaedic surgery between 2010 and 2014 whom re-presented with a VTE within one year of their initial operation. Demographic, operative and clinical information was obtained in order to identify potential risk factors. Results 53 patients were identified as having a VTE within one year of discharge. The majority (63.4%) underwent lower limb arthroplasty. 29% of the cohort had either a family or personal history of VTE, 79% had ischaemic heart disease (IHD), hypertension or both. The average body mass index (BMI) of the cohort was 31.4; above the UK national average. 56.6% of the cohort developed a pulmonary embolism (PE) and 49% developed a deep vein thrombosis (DVT). Co-occurring DVT and PE was diagnosed in 5.6% of patients. The average length of time for readmission for patients to re-present at hospital with a PE was 122 days (range 4-361) and 107 days (range 7 – 360) with a DVT. Conclusion This study confirms the existence of pre-established risk factors for developing VTE including obesity, personal and family history of DVT, cardiovascular disease and lower limb arthroplasty. These risk factors are recognised despite patients receiving post-operative thromboprophylaxis. The findings of this study extend the current research by suggesting that patients presenting with known risk factors of developing VTE may be at risk for longer than the current guidelines cover for the administration of thromboprophylaxis. We propose further studies are needed to identify any potential requirements for more extensive VTE prophylaxis in this population.
Jul 2017 DOI 10.14302/issn.2476-1710.jdt-17-1564
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.
Jul 2017 DOI 10.14302/issn.2471-2140.jaa-17-1630
Introduction: Aflatoxins are cytotoxic andserve as one of the key risk factors of hepatocellular carcinoma. Currently, plants and extract are widely used as potential scavenging substances for the detoxification of mycotoxins. Thus, this study aims to investigate the activity of the crude ethanolic leaves extract from Alchorneacordifolia in aflatoxicosis prevention. Material and Methods: The phytochemical screening was performed through qualitative analysis based on coloring and/or precipitation reactions. Groups of rats were treated daily with a mixture dose of aflatoxin B1 (AFB1) at 150 µg/kg and the crude extract of Alchorneacordifolia at doses of 50, 100, and 300 mg/kg for 21 days. The body weight, biochemical, and histological assessments were determined. Results: The phytochemical screening revealed the presence of polyphenols, flavonoids, sterols and terpenoids, quinoid compounds, tannins catechic and alkaloids. AFB1 treatmentcaused a significant increase of transaminases, urea, and creatinine abundances but reduced the rates of albumin and total proteins. Alchorneacordifolia administration alleviated biochemical parameters and body weight gain compared with the AFB1 group (p<0.05). The histological lesions of organs (liver and kidney) caused by AFB1 were significantly improved after administration of the extract at a dose of 300 mg/kg. Conclusion: This plant plays a beneficial role in AFB1-induced injury and may be used in the treatment of aflatoxicosis.
Jun 2017 DOI 10.14302/issn.2379-7835.ijn-17-1548
A new approach to weight loss and weight loss maintenance is urgently needed, with the global epidemic of obesity leading to ever higher levels of chronic disease. This new approach should be cheap and simple, it should maintain essential nutrients and not deplete lean mass, should have minimal adverse effects and be carried out safely at home without support from the healthcare profession. This review looked at the forms of caloric restriction (CR) investigated in randomised controlled trials (RCTs) and found that supervised continuous and intermittent CR was more effective than other forms of weight loss over periods from 12 weeks to 2 years and could improve cardiovascular and diabetes risk factors. CR was equally as effective as bariatric surgery, suggesting that it is the post-surgery caloric restriction that has the impact on weight, rather than the surgery itself. Intermittent CR, including alternate day fasting (ADF), was as effective as continuous CR but may show improved compliance and higher lean mass. Unsupervised weight loss maintenance presents a greater problem, since in most weight loss regimens all the weight lost is ultimately regained. Although both continuous and intermittent CR can be effective, it has been found that ADF and a higher protein intake is more likely to maintain the weight loss. These results hold for all age groups and ethnicities and both genders. These findings suggest that intermittent CR, and particularly ADF, may be a viable form of weight loss and maintenance which fulfils all the criteria above. It is therefore recommended that larger RCTs investigate intermittent CR and ADF as a viable and cost effective form of weight loss and weight loss maintenance.
Apr 2017 DOI 10.14302/issn.2474-3585.jpmc-16-1213
As people age, environments supporting changing needs can potentially impact their quality of life. The purpose of this exploratory study was to develop and assess the validity of a checklist instrument used to evaluate senior-supportive environmental risk factors within assisted living facilities (ALFs). Aging often leads to a decrease in the ability of a person to interpret sensory cues within his or her environment. This checklist instrument examined the relationship between sensory cue frequency and the influence on fall incidence within ALFs to maximize safety and quality of life. Observers visited 140 ALFs, utilizing the checklist instrument to document the presence or non-presence of 110 sensory cues. Contrary to the original hypothesis, a positive correlation was found between sensory cues and reported falls in each space. As the number of cues increased, the number of falls also increased. Additionally, the frequency of sensory cues within each room increased as facility size increased. Lastly, data revealed that more sensory cues were present in ALFs designed or renovated by design professionals. Although the results were contrary to expectations, the checklist instrument demonstrated face and predictive validity as a future research tool.
Feb 2017 DOI 10.14302/issn.2381-862X.jwrh-15-848
Postpartum depression is a common mood disorder following childbirth. Depression occurring at this crucial stage in a child’s life is known to have far reaching and potentially damaging consequences for the mother, the baby and her family. Whilst a number of risk factors have been identified in the literature as contributing to the development of postpartum depression, including a past psychiatric history and lack of social support, some of these are not easily modifiable through psychological interventions. The aim of this longitudinal study was to examine the contribution of specific psychological factors, including maternal beliefs about motherhood and perfectionism and perceived social support, in the development of postpartum depression. Seventy-three pregnant women consented to take part and returned questionnaires during the third trimester of their pregnancy. Of those women, 61 also completed questionnaires 4-6 weeks following the birth of their baby. Significant associations were identified for postpartum depression and the psychological variables of perfectionistic beliefs and social support, whereas many demographic factors were not significantly implicated in the development of depression. Using a multiple hierarchical regression analysis, the study examined whether maternal beliefs about motherhood and beliefs about perfectionism predicted more of the variance in postpartum depression scores than other demographic variables, including a past history of emotional difficulties. As predicted, beliefs about motherhood and perceptions of poor social support from friends and family were significant predictors of postpartum depression, when the influence of antenatal depression scores were accounted for. A past history of emotional difficulties was also retained in the final model, whereas beliefs about perfectionism were not. These findings have implications for clinical services, highlighting the need for refined assessments of expectant mothers’ beliefs about motherhood and their perceptions of their social support during pregnancy and the need for more refined psychological interventions that address these beliefs.
Jan 2017 DOI 10.14302/issn.2379-7835.ijn-16-1411
Background: Isoflavones are phytoestrogens present in natural sources, and they resemble estradiol in structure and manner of action. The aim of the study was to assess the effects of soy-milk on serum tHcy levels and to assess the glycemic and lipidemic status of Bangladeshi postmenopausal women. Methods: Thirty-six women (aged 50 ±5.16 years, M ±SD) participated in a randomized, un-blinded, open-ended, crossover study design for 52 days. The soy-milk group consumed 350 mL of milk twice a day for 21- day; the milk contained ~30 mg of isoflavones. FBG, PPG, HbA1c, TC, TG, HDL-C, NEFA, and tHcy were measured on day 0, day 21, day 31, and day 52 with a 10- day washout period. Results: After the consumption of soy-milk, the level of HDL-C significantly (p=0.005) increased on day 21 in the subjects. No significant changes were observed between the groups. After crossover, significant changes in FBG (p=0.005) and TG (p=0.049) were observed on day 52 in the soy-milk group. Significant improvement in TG (p=0.001) and HDL-C (p=0.032) was also seen at the end-point. Conclusions: Soy isoflavones is to some extent favorable to reduce CVD risk factors among Bangladeshi postmenopausal women.
Jan 2017 DOI 10.14302/issn.2577-137X.ji-16-1139
We describe seasonal influenza-like illness (ILI) outbreaks in long-term care facilities in the Health Service Executive (HSE) East area of Ireland in the 2013/2014 influenza season, risk factors associated with outbreak duration and attack rates, and management challenges. Separate questionnaires were distributed to 28 facilities who reported an outbreak and to public health specialists leading outbreak management, with a 79% response rate. Mean outbreak duration (21 vs 17 days; p=0.046) was longer in facilities with staff vaccination rates of <40%. Facilities with a high attack rate (≥50%) were less likely to have an outbreak plan (p=0.03). Smaller facilities (under 50 residents) had a higher attack rate (50% vs 23%, p=0.003) even when controlled for staff vaccination rate (p=0.01). Prior to the outbreak, resident vaccination rates were high (82%, above the World Health Organization target of 75%) but staff vaccination rates were low (39%). Reported challenges to ILI outbreak management in long term care facilities included visitor restrictions, staff education issues, outbreak notification delays and lack of outbreak lead in facilities. Targeted public health-assisted planning, training and response, comprising of staff vaccination, education, written policies, with early notification and prompt response would facilitate a more co-ordinated approach to the management of outbreaks, and reduction in infection rates and consequent morbidity.
Nov 2016 DOI 10.14302/issn.2324-7339.jcrhap-16-1271
Introduction The cardiovascular complications have became the 3rd cause of death and the 4th reason for hospitalization of the patients infected by the HIV. The objective of this work was to determine the frequency of asymptomatic myocardial ischemia among patients infected by the HIV receiving antiretroviral therapy. Patients and Methods It was a descriptive cross-sectional study which was conducted in November 2015. The patients infected by HIV1 receiving antiretroviral treatment, with asymptomatic myocardial ischemia were included in the study and they were followed up in the HIV clinic of the in Infectious diseases service of the University Hospital Souro Sanou of Bobo-Dioulasso(CHUSS).. The includes patients benefited from a collection of cardiovascular risk factors, and of two measurements of the blood pressure in a sitting position after 10 minutes of rest and an electrocardiogram 12 derivations after rest. Results A total sample of 123 patients infected by HIV1 was selected, with a median age of 42 years (IQR: 36-50). It was composed of 79% of female. The cardiovascular risk factors found were distributed as follows: HTA (31.7%), obesity (33%), dyslipidemia (10.57%), active smoking (0.8%), diabetes (0.8%). All the known hypertensive cases (5.7%) were insufficiently treated. The median duration of exposure to the antiretroviral therapy was 5.3 years (IIQ: 3-7.7). The disorders of the repolarization were observed in 26 cases (21.13%). They were divided into under epicardic ischemia in 20 cases (16.26%), under endocardic lesion in 2 cases (1.63%) and after-effect of necrosis in 4 cases (3.25%). The Left ventricular hypertrophywas observed in 12 cases (9.76%) and all of them were hypertensive patients. QTc was lengthened among 7 patients (5.69%) independently of the class of antiretroviral therapy administrated. Conclusion In this study about patients infected by HIV1, it emerges that asymptomatic myocardial ischemia is frequent. It would be advisable to reinforce its tracking by using more powerful tests of ischemia, in order to better specify its gravity in this population with an increased cardiovascular risk.
Nov 2016 DOI 10.14302/issn.2474-3585.jpmc-16-1198
Spain is one of the countries with the highest incidence of HIV within the European Union. Multiple and complex factors influence HIV infection in young people. This study aims to determine the influence of sexual sensation seeking, sexual compulsivity and perceived sexual pleasure variables in condom use. A total of 424 heterosexual youth were evaluated (M age = 20.62; SD = 2.62) distributed into a risk group (60.7%) and a no-risk group (39.3%). Sexual Sensation Seeking Scale, AIDS Prevention Questionnaire, Sexual Compulsivity Scale, and Sexual Pleasure Perceived Scale were administered. Results indicate statistically significant differences in sexual sensation seeking (p=.001), failure to control sexual impulses (p=.030), perceived sexual pleasure with a condom (p=.027) and without a condom (p=.001). The regression analysis revealed that three factors explained about 14% of the variance in condom use: sexual sensation seeking and sexual pleasure perceived without a condom (risk factors), and sexual pleasure perceived with a condom (protective factor). It is necessary to incorporate these variables into HIV prevention programs to reduce the number of infections in young people.
Oct 2016 DOI 10.14302/issn.2471-2175.jdrt-16-1296
Case Report This report describes a case of diffuse pyoderma in a 10-year-old female dog with hypothyroidism. A previous treatment, without an early diagnosis, including cephalosporin associated with prednisolon resulted to be unsuccessfully. After clinical and microbiological examination in our laboratories, a diagnosis of methicillinresistant Staphylococcus aureus (MRSA)-associated pyoderma was made. The antimicrobial susceptibility testing evidenced many resistances and susceptibility of the strain only to vancomycin and linezolid. A new therapy against hypothyroidism and associated with an appropriate antimicrobial (vancomycin) treatment, improved and resolved the infection. Clinical Significance To our knowledge, this is the first case of canine pyoderma caused by a strain of MRSA with a such severe multiresistant profile. MRSA infections present a serious challenge because of the emergence of resistance to numerous conventional antibiotics and the risk factors associated with the transfer of the bacteria to humans, who have a contact with infected pets.
Oct 2016 DOI 10.14302/issn.2470-5020.jnrt-16-1240
Background: Impulse Control Disorders (ICDs) are characterized as pathologicalbehavioral patterns of excess impulsivity which may result as part of the non-motor complications of Parkinson’s disease (PD). These significantly affect the patient’s overall quality of life and have impact on their care givers, as well. Currently, the prevalence of ICDs among adult Filipino patients with Parkinson’s disease is unknown and less reported. Objectives: The study is intended to determine the prevalence of ICDs and its severityamong adult Filipino patients with idiopathic Parkinson’s disease seen at Jose R. Reyes Memorial Medical Center. Specifically, this study will identify risk factors and the clinical correlates to these patients. Methods: Adult Filipino patients diagnosed withidiopathic Parkinson’s diseasewhowere seen at the outpatient department from March 2015 – September 2015 are screened for the study. The Modified Hoehn and Yahr staging was utilized to determine the stage of PD. With approval from the author, the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease-Rating Scale (QUIP-RS) was used for detecting the presence of ICDs and corresponding severity. Results: We were able to examine 66 patients (31 males and 35 females) withidiopathic Parkinson disease. Majority of the patients manifested with Tremor Dominant (50%) subtype, followed by Early Disease Onset (34.8%), and Non-Tremor Dominant (15.2%). Sixteen (16) out of 66 patients (24.2%) have ICD symptoms with the following incidence rates: hobbyism/ punding 56.25%, compulsive eating 50%, hypersexuality 18.75%, compulsive shopping 18.75, Dopamine dysregulation syndrome 18.75%, and gambling 12.5%. Overall average QUIP-RS score is 5.42. There is significant association of PD duration with occurrence of ICD symptoms; the longer the PD duration, the higher risk of having ICD symptoms (x2 20.41; p = 0.026). Patients with higher mean modified Hoehn and Yahr stage (2.66±0.94), t 2.735, df 64, p 0.008, have much higher incidence of ICD symptoms. Conclusion: Filipino patients with idiopathic Parkinson disease who are majority onlevodopa + carbidopa therapy may develop impluse control disorders (ICDs). Other contributory factors in development of ICDs include longer duration of PD and higher mean Modified Hoehn and Yahr stage.
Jul 2016 DOI 10.14302/issn.2329-9487.jhc-16-1020
Background: Hypertension is a public health problem with high mortality and morbidity globally. A rapid assessment of hypertensive patients at Harare Central Hospital Outpatients Department (OPD) in June 2013 revealed that 41% of patients had uncontrolled hypertension. We, therefore, explored the factors associated with uncontrolled hypertension among hypertensive patients at Harare Hospital. Methods: A one-on-one unmatched case-control study was conducted among 118 cases and 118 controls. A case was a person aged 18years and above on hypertensive treatment for ≥6months with mean Blood Pressure (BP) ≥ 140/90mmHg while a control was 18years and above on hypertensive treatment ≥6 months with mean BP<140/90mmHg. Interviews were used to collect information on socio-demographic, treatment, health system, condition, and patient-related factors. Written informed consent was obtained from all study participants. Medication adherence was measured with Morisky medication adherence scale-8. Results: The median ages for cases were 49 years (IQR: 41-63) and 48 years (IQR: 42-62) for controls. Almost 57% were women with 23% living in rural areas. Most cases (94%) and controls (78%) added salt to meals. Rural women were less likely to have uncontrolled BP compared to urban women (OR=0.7; 95%CI: 0.35, 1.37). Lack of exercise, adding salt to meals and eating fruits/vegetables less than three times/week were associated with uncontrolled BP. Independent factors associated with uncontrolled BP were low adherence to medication, aOR 22.03 (95%CI: 9.10,53.5), receiving health education, aOR 0.24 (95%CI: 0.11 , 0.53), exercises aOR 0.33 (95%CI: 0.15,0.73) and on medical insurance aOR 2.69 (955CI: 1.12,6.44). Conclusions: Common risk factors for hypertension were associated with uncontrolled BP. Since these are modifiable factors there is a need to implement interventions that will encourage healthy living in this population to improve treatment outcomes.
Jun 2016 DOI 10.14302/issn.2574-4518.jsdr-16-1002
Obstructive sleep apnea (OSA) syndrome is a common disease characterized by partial or complete collapse of the upper airway during sleep secondary to functional or anatomical factors. The gold standard method for OSA diagnosis is an overnight polysomnogram demonstrating repetitive obstructive apneas and hypopneas during sleep. OSA syndrome is associated with cardiovascular diseases, stroke and rarely with sudden death. OSA and cervical spine osteophytes share some common risk factors, and their coexistence may cause mechanic respiratory obstruction with a severe sleep apnea. We present a brief overview on this syndrome, its links to the cervical spine pathology and their combined effect on a patient presenting with neurological signs who suddenly died before an effective treatment was possible to perform. This case highlights how a rapid deterioration of the functional balance may be possible even when a clinical condition has been present, known and unchanged for a long period of time and the need to treat adequately a not-so-innocuous pathology without an excessive delay.
Jun 2016 DOI 10.14302/issn.2329-9487.jhc-15-905
Backgroud: Metabolic acidosis, a common condition particularly in end stage renal disease patients, results in malnutrition and inflammation. In this study, we focused on the importance of metabolic acidosis on manifestations of cardiovascular disease in patients on peritoneal dialysis. Methods: We studied 20 patients on continuous ambulatory peritoneal dialysis (CAPD), 15 males and 5 females, on mean age 61.6 ±11.3 years old. Metabolic acidosis was determined by serum bicarbonate concentrations less than 22mmol/L, which were measured in gas machine. Dialysis adequacy was defined by total Kt/V/week for urea including peritoneal Kt/V for urea and residual GFR (ml/min/1.73m2). High sensitivity C-reactive protein (hsCRP) was measured using enzyme linked immunoabsorbed assay (ΕLISA). The concentrations of intact-parathormone (i-PTH) and beta2-microglobulin (beta2M) were measured by radioimmunoassays. Arterial stiffness was measured as carotid-femoral pulse wave velocity (c-f PWV) and augmentation index (AIx). We built a Cox regression analysis to predict coronary artery disease (CAD), congestive heart failure (CHF) and peripheral vascular disease (PVD). Results: Serum bicarbonate levels were inversely associated to beta2M, i-PTH and AIx (r=-0.451, p=0.04, r=-0.477, p=0.03 and r=-0.569, p=0.009 respectively). Cox- regression analysis revealed significant association of serum bicarbonate levels and PVD having as confounders traditional and specific for these patients risk factors. Conclusion: Metabolic acidosis may be an independent risk factor for arterial stiffening and peripheral vascular disease manifestation in patients on peritoneal dialysis.
May 2016 DOI 10.14302/issn.2574-450X.jom-16-1039
Over the last three decades, an epidemic of obesity has markedly affected patients suffering from mental illnesses such as schizophrenia. Antipsychotic medications used to treat schizophrenia are considered as major culprits. The aim of this review is to first consider risk factors, to then outline negative sequelae of obesity for this population, and finally to address timing and content of recommended clinical interventions. Medical databases were searched with the terms “”weight,” “obesity,” and “schizophrenia.” Selection of articles was guided by date of publication; recent papers are preferentially cited. The main findings were that, in addition to antipsychotic medications, socio-economics, lifestyle, immune factors, and circadian rhythms also contribute to obesity risk. A barrier to effective health promotion within psychiatry has been the concern that fears about gaining weight might stop individuals with schizophrenia from taking needed antipsychotic medication. Recommendations, therefore, are to keep the dose of antipsychotic medication as low as possible, avoid polypharmacy, encourage healthy eating and physical activity, address sleep problems and substance use, monitor weight, blood pressure, and metabolic parameters regularly, utilize motivational interviewing techniques and peer support, pay special attention to special needs such as those of women during pregnancy, and include bariatric surgery as a potential intervention. Conclusion: Besides careful attention to medication regimens, the literature supports the active encouragement and support of patient self-management strategies to both prevent and manage obesity in schizophrenia.
Oct 2015 DOI 10.14302/issn.2470-5020.jnrt-15-726
Background: A higher incidence of symptomatic lacunar infarction (LI) was confirmed in metropolitan areas. The aim of this study was to determinethe prevalence characteristics and early predictors of LI in a population of elderly outpatients in northern China. Methods: From February 2011 to March 2012, a retrospective cohort of new patients was selected for study, all registered neurologic outpatients of the tertiary teaching hospital in northern China. A total of 453 outpatients, clinically only having had an initial visit and a magnetic resonance imaging study of the brain, were enrolled. The prevalence characteristics and vascular risk factors of LI were assessed. Results: Of 453 symptomatic outpatients, 258(57.0%) patients had symptomatic LI. We found that the main types of symptomatic LI were nonfocal symptoms, such as dizziness and headache, dizziness/vertigo, and migraine/headache. Age, BMI, smoking, history of hypertension, duration of hypertension, existing hypertension, headache and dizziness, pure motor hemiparesis, blood glucose, hypercholesterolemia, systolic blood pressure, and ABCD2 score, were significantly higher in patients with LI than in those without LI (P<0.05). Multivariate logistic regression confirmed that hypertension ≥3years in duration (odds ratio=1.092; 95% CI, 1.019 -1.170) and a median mABCD2 score ≥4 (odds ratio=3.912; 95% CI, 2.955- 5.180) were independent, early predictors of symptomatic LI. Conclusions: The incidence of LI in Northern China was located at the higher end of range in northern China, and common type of symptomatic LI was nonfocal symptoms. Hypertension of long duration and high-risk ABCD2 scores are early predictors of symptomatic LI.
Jun 2015 DOI 10.14302/issn.2474-3585.jpmc-14-540
Objective Measuring coronary artery calcification (CAC) enables to optimize cardiovascular risk-stratification also in patients with type 2 diabetes mellitus (T2D), however the prevalence of CAC in randomly selected patients with T2D is uncertain. For this purpose we set out to examine and compare the occurrence of CAC in unselected T2D patients. Design A randomly selected cohort of 1825 individuals, men and women, either 50 or 60 years old, were invited to the screening study. Traditional risk factors were obtained and a non-contrast CT-scan was performed to assess the CAC score. Results A total of 1211 individuals participated, of whom 54 (4%) had T2D while 1157 (96%) were without diabetes. CAC was present in 62% of the patients with T2D versus 44% in those without (p=0.013). Also the prevalence of traditionally risk factors was high in patients with T2D as compared to subjects without T2D. When adjusting for age, gender, smoking, hypertension and hypercholesterolemia in multivariate logistic regression, T2D was not associated with presence of CAC (OR=1.0; 95% confidence interval 0.5 - 2.0, p=0.94). Conclusions One-third of patients with T2D did not have any CAC, and T2D per se was not associated to CAC.
May 2015 DOI 10.14302/issn.2372-6601.jhor-14-382
Background/Aims: Thyroid disorders are a common, worldwide clinical problem in general practice.It presents predominantly as a thyroid nodule. Each thyroid nodule has a risk of cancer. The incidence of thyroid cancer is much more common in Saudi Arabia in comparison to the West. There is a worldwide increase in the incidence of thyroid cancer. The objective of this study is to highlight in details the wide spectrum of histopathologic diagnosis encountered in patient undergoing thyroid surgery in the population of Riyadh region of Saudi Arabia. Patients and Methods: Retrospective review of all thyroid samples for 256 patients whom underwent thyroid surgery at King Khalid University Hospital, King Saud University, Riyadh, during the period between 2000 and 2009. Of those, 171 cases were non neoplastic and 85 neoplastic lesions. Females constitute 80% of non neoplastic lesions and 79% of all thyroid malignancies. The peak incidence of thyroid cancer was in the third decade. Papillary thyroid carcinoma was the most common cancer (71%). Conclusion: Thyroid cancer is a common cancer in Saudi Arabia; it is the second most common cancer in females. The increasing rates of thyroid cancer occur predominantly in women. Papillary thyroid carcinoma accounted for the bulk of this increase. Additional studies are needed to explain the rise in papillary thyroid carcinoma incidence in Saudi Arab as well as throughout the world and to search potential risk factors that are currently unrecognized.
May 2015 DOI 10.14302/issn.2470-5020.jnrt-14-558
Background. Endothelial function is characterized by the vasodilator capacity of blood vessel smooth muscle cells mediated by nitric oxide. Some studies have shown an inverse association between the endothelial function and the carotid intima-media thickness (IMT). The relationship between endothelial dysfunction and stroke based on several studies has shown that is altered in all stroke subtypes especially lacunar strokes. Methods. We aimed to investigate endothelial function by EndoPAT device in relation to stroke subtypes. We investigate too the correlations between endothelial function and IMT and we study possible interactions with age, sex, traditional risk factors and severity of stroke. Subsequent patients with acute ischemic stroke were enrolled. They were divided according with the etiological mechanism of stroke (TOAST classification). Endothelial function was assessed with finger plethysmography by the EndoPAT device that gave Reactive Hyperemia Index (RHI) and Augmentation Index (AI). Results. Patients with a cardioembolic stroke had a RHI higher than atherotrombotic or lacunar stroke. There was a negative correlation between RHI and IMT and positive between AI and age. Conclusions. The endothelial function is different between stroke subtypes with higher values of RHI in the cardioembolic respect to lacunar or atherotrombotic. The RHI is correlated with the atherosclerosis by the negative relationship with the IMT. The AI that shows the rigidity in the arteries increased with the age.
Nov 2014 DOI 10.14302/issn.2379-7835.ijn-14-475
Osteoporosis prevention among women requires obtaining proper knowledge early in life about the disease, risk factors and treatments. This study compares specific education sources to osteoporosis knowledge and calcium intake. Online survey usinga convenience sampling was performed with women between ages 18 and 40. The survey measured osteoporosis knowledge, calcium consumption, and specific education source within categories of age, school classes, television, radio, newspaper, magazine, Internet, and in-person. Multiple regression analysis determined influential education sources for osteoporosis knowledge and calcium intakes. Osteoporosis knowledge was suboptimal (13.8 ± 3.3, as a score higher than 16 defined as “adequate”) and average daily calcium intake was 1315.1 ± 609.9 mg. Age and newspaper had greatest contribution towards osteoporosis knowledge, while Internet, school classes and radio were most influential resources on calcium intakes. Creating an osteoporosis education initiative utilizing these sources is imperative for increasing disease knowledge and preventive behavior among young women.
Nov 2014 DOI 10.14302/issn.2379-8572.joa-14-429
Background: We reviewed the 2005-2011 ACS-NSQIP database to evaluate factors associated with adverse events (AE) after total laryngectomy (TL). Methods: All total laryngectomies performed from 2006 to 2011 were identified for analysis. The cohort was characterized with respect to preoperative and demographic characteristics, complications, reoperation, and mortality. Results: 493 cases were identified. Complications of any category occurred in 189 cases (38.3%). Factors that were found to confer significant risk for medical complications were increased age (dds Ratio (OR) 1.03), prior PCI (OR 2.84), disseminated cancer (OR 2.47), chronic steroid/immunosuppresion use (OR 2.87), unintended weight loss > 10% over 6 months prior to surgery (OR 2.02), increasing work RVU total (OR 1.02), and increased anesthesia Z-score (OR 1.31). Only increased anesthesia Z-score (OR 1.27) was found to be a statistically significant risk factor for surgical complications. Chronic steroid/immunosuppression use (OR 3.16) and increased anesthesia Z-score (OR 1.29) were both found to be statistically significant risk factors of reoperation within 30 days. Conclusions: NSQIP is the only dataset that correctly discerns between minimally invasive and wide excision in laryngectomy. The use of the NSQIP dataset may be imperfect, as pertinent details of chemotherapy and radiation, and procedure-specific complications, including fistula formation, are not tracked. In spite of this, our findings suggest avenues for improvement in the care of TL patients, and suggest directions for a laryngectomy-specific outcomes database.
Jun 2014 DOI 10.14302/issn.2372-6601.jhor-13-379
Sarcomas are neoplastic malignancies that typically arise in tissues of mesenchymal origin. The identification of novel molecular mechanisms leading to sarcoma formation and the establishment of new therapies has been hampered by several critical factors. Human uterine leiomyosarcoma (Ut-LMS) develops more frequently in the muscle tissue layer of the uterine body than in the uterine cervix. Although the development of gynecologic tumors is often correlated with the secretion of female hormones; that of human Ut-LMS does not and its risk factors remain unknown. Importantly, a diagnostic biomarker that can distinguish malignant Ut-LMS from benign tumor uterine leiomyoma (LMA) has yet to be established. Therefore the risk factor(s) associated with human Ut-LMS to establish a diagnosis and novel therapeutic method. Proteasome b-ring subunit LMP2/b1i-deficient mice spontaneously develop Ut-LMS, with a disease prevalence of ~40% by 14 months of age. We shown that LMP2/b1i expression was absent in human Ut-LMS, but present in other human uterine mesenchymal tumors including uterine LMA. Therefore, defective-LMP2/b1i expression may be one of the risk factors for human Ut-LMS. LMP2/b1i is a potential diagnostic biomarker for human Ut-LMS, and may be a targeted-molecule for a new therapeutic approach.
Nov 2013 DOI 10.14302/issn.2329-9487.jhc-12-154
Objective: To determine whether age at menarche is an independent predictor of common carotid artery intima-media thickness in overweight and obese adult women. Methods: 403 overweight and obese women, aged 18–72 years, were evaluated. We examined the associations among common carotid artery intima-media thickness (CCA-IMT), age at menarche, body mass index, central fat accumulation (indirectly measured by waist circumference), and other well-known cardiovascular risk factors (blood pressure; fasting serum insulin, glucose and lipids concentrations; insulin resistance (estimated by homeostasis model assessment for insulin resistance)). Results: CCA-IMT was significantly and positively correlated with age (r=0.632, p<0.001), age of menarche (r=0.156, p<0.01), waist circumference (r=0.110, p<0.05), systolic (r=0.292, p<0.001) and diastolic (r=0.183, p<0.001) blood pressure, fasting blood glucose (r=0.265, p<0.001), triglycerides (r=0.204, p<0.001) and total cholesterol (r=0.396, p<0.001) levels. Conversely, CCA-IMT was negatively associated with high-density lipoprotein cholesterol (r=-0.111, p<0.05). Age at menarche was associated with CCA-IMT (r=0.156, p<0.01), age (r=0.110, p<0.05) and waist circumference (r=0.121, p<0.05). Multiple linear analysis showed that only age and age at menarche maintained an independent positive relationship with the CCA-IMT. Conclusions: Age at menarche is positively associated with CCA-IMT, independently of common cardiovascular risk factors (adverse glucose and lipid levels, higher blood pressure,insulin resistance, body fatness and central body fat). Late age at menarche can be considered as an independent cardiovascular risk factor in obese subjects.